bluuebunny/crossref_metadata_2025 huggingface dataset:
An evaluation of educational outreach to improve evidence‐based prescribing in Medicaid: a cautionary tale
Authors: Zillich Alan J. , Ackermann Ronald T. , Stump Timothy E. , Ambuehl Roberta J. , Downs Steven M. , Holmes Ann M. , Katz Barry , Inui Thomas S.
Published: September 2010

Rationale, aims and objectives  Evidence suggests that educational outreach (‘academic detailing’) improves evidence‐based prescribing. We evaluated the impact of an academic detailing programme intended to increase new statin prescriptions.

Methods  In a 2 × 2 factorial design we evaluated the effect of an academic detailing programme with/without telephonic care management for patients. Eligible patients were continuously enrolled Medicaid members at high risk for cardiovascular disease utilization who were not receiving statin medication in the 18 months prior to the intervention. All primary care prescribers assigned to these patients were randomized by clinic to academic detailing. Two trained nurses provided the detailing to prescribers, including specific discussion about the use of statins in this high‐risk patient population. Nurses left the prescribers with a summary of clinical practice guidelines, a one‐page detailing sheet and a list of patients under the care of the prescriber who were candidates for statins. The primary outcome was the incidence of a new statin prescription claim during the 6‐month intervention period and the subsequent 6 months. Logistic regression models were used to estimate main effects of the interventions and to adjust for potential confounding variables in the study.

Results  Forty‐eight clinics were randomized, effectively randomizing a total of 284 patients and 128 prescribers. Among the 284 patients, 46 (16%) received a new statin claim during the evaluation period. Controlling for significant bivariate associations, the academic detailing intervention had no significant effect on new statin prescriptions compared with the control group (odds ratio = 0.8, 95% confidence interval: 0.4–1.6, P = 0.5).

Conclusion  Among this Medicaid population at high risk for cardiovascular events, an academic detailing programme to increase statin prescriptions was not effective. To assist others to learn from our failed effort, we identify and discuss critical elements in the design and implementation of the programme that could account for these results.
Do urea breath test (UBT) referrals for Helicobacter pylori testing match the clinical guidelines in primary care practice? A prospective observational study
Authors: Noya Horowitz , Anat Beit‐Or , Moshe Leshno , Gennady Polishchouk , Zamir Halpern , Menachem Moshkowitz
Published: September 2010

Background  Various international guidelines recommend the use of non‐endoscopic tests [such as urea breath test (UBT)] for the evaluation of dyspeptic patients, unless endoscopy is clinically indicated.

Aim  To assess adherence with guidelines for UBT referrals among primary care doctors in Israel.

Methods  Patients referred by primary care doctors to an open‐access UBT service were included in the study. Prior to the test, all patients were administered with a short questionnaire regarding their symptoms, previous and concomitant medications including previous Helicobacter pylori eradication.

Results  The study sample consisted of 209 patients, aged 18–94 years, M/F = 74/135. The UBT was judged to be appropriate in 94 (45%) subjects, inappropriate in 93 (44.5%) subjects and appropriate but avoidable in 22 (10.5%) subjects, most of them asymptomatic patients following anti H. pylori treatment. The inappropriate indications include 38 (18%) patients with suspected gastro‐oesophageal reflux disease symptoms and 21 (10%) dyspeptic patients aged 45 years or more.

Conclusion  Nearly 45% percent of UBT referrals in primary care practice were inappropriate, and a significant number of dyspeptic patients should have been referred to endoscopy. These findings show a substantial non‐compliance with guidelines for H. pylori testing among primary care doctors.
Integrated audit as a means to implement unit protocols: a randomized and controlled study
Authors: Charrier Lorena , Allochis Maria Cristina , Cavallo Maria Rita , Gregori Dario , Cavallo Franco , Zotti Carla Maria
Published: September 2010

Rationale  Great emphasis is placed on the need to base assistance activities on efficacy evidence. Nevertheless, it is demonstrated that the mere knowledge of scientific recommendations is not sufficient to determine changes in practice. Many elements can influence the operators' behaviour, so that comprehensive strategies are needed to change wrong or not evidence‐based practices.

Objectives  The aim was to compare the efficacy of two protocol implementation strategies: clinical–organizational integrated audits with feedback and presence of facilitators in the departments versus standard observation.

Methods  Cluster‐randomized, controlled and open trial methods were used. Implementation was investigated for protocols regarding the prevention of pressure lesions and the management of peripheral and central venous catheters. For both protocols, a checklist with the indicators needed for the evaluation was created. The study was divided into five time points. For the initial and final investigation, evaluators filled‐in the checklists for both study groups; for the three intermediate investigations, the checklists were self‐filled by the operators of the control group, while the operators of the experimental group received the intervention.

Results  For almost all indicators, the data show an increment in the adoption of correct practices. Nevertheless, the last investigation shows a significant (P < 0.05) difference between the two groups in favour of the experimental group: 12 process indicators versus one for catheter management protocol and seven versus one for protocol on pressure lesions.

Conclusions  The main strong point of the study lies in carrying out an intervention aimed at improving the operators' adoption of two protocols as a whole, rather than of single procedures. The audit intervention allowed to highlight some more subjective criticalities important in determining the success or failure of the implementation of effective practices.
EBM: evidence to practice and practice to evidence
Authors: Isaac Carol A. , Franceschi Amy
Published: September 2010

Rationale  The purpose of this paper is to explore new perspectives about difficulties academicians may have communicating with clinicians, obtaining subjects, and gaining compliance for their research.

Aims and Objectives  Evidence‐based medicine (EBM) has been defined as an integration of best research evidence, clinical expertise, and patient values; however, clinical observation and experience are placed last in the evidence hierarchy with the randomized controlled trial held as the standard for clinical intervention. This paper describes how the hierarchical model of power in the research community obstructs new areas of knowledge, and how clinicians create resistance.

Methods  Foucault gave new perspectives describing how power circulates through individuals within organizational discourse. Drawing on literature and experience, and using a framework based on postmodern theoretical concepts, this paper examines patterns of discourse, subjectivity, resistance, and power/knowledge within the physical therapy profession.

Results  The hierarchical discourse of medical knowledge produces opposition rather than collaboration between researcher, clinician, and patient. Alleviating perceptions of dominance and creating connections produces cohesion within medical communities.

Conclusions  Evidence to practice and practice to evidence redefines EBM as a circular integration of best research evidence, clinical expertise, and patient values.
How to run an effective journal club: a systematic review
Authors: Deenadayalan Y. , Grimmer‐Somers K. , Prior M. , Kumar S.
Published: September 2010

Background  Health‐based journal clubs have been in place for over 100 years. Participants meet regularly to critique research articles, to improve their understanding of research design, statistics and critical appraisal. However, there is no standard process of conducting an effective journal club. We conducted a systematic literature review to identify core processes of a successful health journal club.

Method  We searched a range of library databases using established keywords. All research designs were initially considered to establish the body of evidence. Experimental or comparative papers were then critically appraised for methodological quality and information was extracted on effective journal club processes.

Results  We identified 101 articles, of which 21 comprised the body of evidence. Of these, 12 described journal club effectiveness. Methodological quality was moderate. The papers described many processes of effective journal clubs. Over 80% papers reported that journal club intervention was effective in improving knowledge and critical appraisal skills. Few papers reported on the psychometric properties of their outcome instruments. No paper reported on the translation of evidence from journal club into clinical practice.

Conclusion  Characteristics of successful journal clubs included regular and anticipated meetings, mandatory attendance, clear long‐ and short‐term purpose, appropriate meeting timing and incentives, a trained journal club leader to choose papers and lead discussion, circulating papers prior to the meeting, using the internet for wider dissemination and data storage, using established critical appraisal processes and summarizing journal club findings.
Knowledge and attitudes of trainee physicians regarding evidence‐based medicine: a questionnaire survey in Tehran, Iran
Authors: Ahmadi‐Abhari Sara , Soltani Akbar , Hosseinpanah Farhad
Published: September 2010

Rationale, aims and objectives  Knowledge in evidence‐based medicine (EBM) is increasingly becoming a core competence in medical education. We evaluated the trainee doctors’ attitudes and knowledge of EBM to obtain the basis required for developing appropriate teaching and learning opportunities.

Methods  Trainee physicians at a Tehran University hospital were surveyed. The questionnaire included six questions evaluating knowledge of EBM, the number of correct answers yielding the knowledge score, and eight questions evaluating attitudes towards EBM. Participants were also asked to mark on a 10‐cm Visual Analogue Scale their use of various information sources and tendency to participate in EBM training courses.

Results  The response rate was 80% (104/130). The mean knowledge score was 3 ± 1.3 (SD) on a range of 0–6 for all respondents and was not significantly different between interns (2.9 ± 1.4) and postgraduates (3.3 ± 1.0). Forty one per cent of interns and 66% of postgraduates had a positive attitude towards EBM; the remaining respondents were neutral. Textbooks and consulting experts were the most, and Cochrane Library was the least, used sources of information among both interns and postgraduates. The knowledge score was not associated with attitude, but was higher in those with previous research experience, prior EBM training, or the postgraduates that read more articles. The postgraduates and those with prior EBM training showed a significantly more positive attitude towards EBM.

Conclusion  The present study demonstrates that the majority of trainee physicians at a Tehran University hospital lack adequate knowledge about basic concepts of EBM. Furthermore, most of them continue to use traditional sources of knowledge rather than evidence‐based sources. On the positive side, there was an overall positive attitude towards EBM and the majority had a positive tendency to take part in EBM training courses.
The epidemic of chronic kidney disease: looking at ageing and cardiovascular disease through kidney‐shaped lenses
Authors: Mangione F. , Canton A. Dal
Published: September 2010

Abstract.  Mangione F, Dal Canton A (Section of Nephrology, Department of Internal Medicine and Medical Therapeutics, University of Pavia; and Unit of Nephrology, Dialysis and Renal Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy) The epidemic of chronic kidney disease: looking at ageing and cardiovascular disease through kidney‐shaped lenses (Foresight) J Intern Med 2010; 268: 449–455.

In recent years, a ‘silent’ chronic kidney disease (CKD) epidemic has been proposed by many authors. The ‘outbreak’ is because of the inclusion of a large proportion of the elderly population within stage 3 CKD according to the Kidney Disease Outcomes Quality Initiative staging system. Unfortunately, this does not take into account the fact that renal function normally declines with age; in addition, the Modification of Diet in Renal Disease formula used to calculate glomerular filtration rate underestimates renal function in the elderly. Because population preventive strategies need a precise definition of the target for screening, a more accurate tool to detect CKD in the general population is required. Considerable interest in CKD has been generated by the evidence that predialysis CKD is associated with increased risk of cardiovascular disease (CVD). Such an association per se does not imply that CKD is a causal determinant of CVD. As CKD has been detected particularly in elderly individuals, it is tempting to speculate that an association may exist between age and cardiovascular outcomes in patients with CKD. Furthermore, the definition of CKD is a nosographic simplification that includes diseases with different causes and pathogenetic mechanisms. The aetiologies of renal diseases can affect cardiovascular outcomes, and the two major causes of end‐stage renal disease, diabetes mellitus and hypertension, indeed do so. These findings point to a need for a better definition of CKD to optimize the allocation of healthcare resources and to clarify the nature of the association between CKD and CVD.
Something special: forensic psychiatric nursing
Authors: Martin T.
Published: September 2010

In this paper the claims that forensic psychiatric nursing has achieved the status of a specialist area of nursing are refuted. An examination of the literature demonstrates that specialist knowledge and skills have not been documented. It is suggested that three requirements are necessary if forensic psychiatric nurses wish to achieve specialty status. Forensic nurses have to consolidate their role in the containment and care of patients, they have to return to the nurse–patient relationship as the foundation of psychiatric nursing practice, then, within that relationship, nurses must expand their practice to include dealing with offence issues.
Self‐esteem and self‐acceptance: an examination into their relationship and their effect on psychological health
Authors: MACINNES D. L.
Published: September 2010

Nurses are increasingly using cognitive behaviour therapy as an intervention for psychological problems attached to a variety of clinical conditions. Developing both self‐acceptance and self‐esteem have been identified as ways to enhance cognitive interventions. However, there are disagreements about the relationship between self‐esteem and self‐acceptance and their influence on psychological health. The study examined the relationship between these concepts and also the association between the concepts and psychological health. Fifty‐eight participants with a diagnosis of severe and enduring mental health problems were assessed recording levels of self‐esteem, self‐acceptance, depression, anxiety and psychological well‐being. The results revealed that, in comparison with the general population, the sample were more likely to have lower self‐acceptance and self‐esteem, and higher levels of anxiety, depression and psychological ill health. The concepts of self‐esteem and self‐acceptance were found to be similar but not synonymous. Self‐esteem was more closely associated with affect, with higher levels of self‐esteem being indicative of lower levels of depression. Self‐acceptance appeared to be more closely associated with general psychological well‐being and to be more helpful when undertaking clinical work for general psychological problems.
The patient’s view of need and caregiving consequences: a cross‐sectional study of inpatients with severe mental illness
Authors: CLEARY M. , HUNT G. E. , WALTER G. , FREEMAN A.
Published: September 2010

This cross‐sectional study was conducted across inpatient facilities of a metropolitan mental health service in Sydney, Australia. Given shorter lengths of stay in acute inpatient facilities, it is important to ascertain differences between patients’ and carers’ perceptions of need and support in order to guide delivery of care in the community. The objectives were to: (1) assess the needs of patients recently admitted to hospital and ascertain the level of carer involvement while in hospital; (2) compare the degree of agreement between patients’ and carers’ perceptions of need and caregiver burden; and (3) determine the relationship between levels of need and carer burden prior to hospitalization. Over a 2‐month period, consecutive patients (n = 200) were interviewed using the Camberwell Assessment of Need Short Appraisal Schedule and a modified version of the Involvement Evaluation Questionnaire to assess basic needs and patient perceptions of caregiver burden, respectively. Of the 200 patients interviewed, 68% (n = 135) identified a carer. Patients with schizophrenia had most met needs, those with affective disorders had most unmet needs and patients with other diagnoses recorded the lowest number of needs overall. The level of agreement between patient and carer perceptions of need was low, possibly because of confusion about the definition of need or different views about the support required to fulfil a need. Patients underestimated the consequences of caregiving, especially the impact of strained atmosphere, global burden, worrying about their future and encouragement to undertake an activity, indicating that carers were more burdened than patients perceived them to be.
Patients’ feelings about ward nursing regimes and involvement in rule construction
Authors: ALEXANDER J.
Published: September 2010

This study compared two acute psychiatric ward nursing regimes, focusing on ward rules as a means of investigating the relationship between the flexibility/inflexibility of the regimes and patient outcomes. Previous studies identified an association between ward rules and patient aggression. A link between absconding and nurses’ attitudes towards rule enforcement has also been explored. However, an in‐depth exploration of ward rules from the perspective of nurses and patients had not been undertaken previously. The study aimed to discover the content of rules within acute psychiatric wards; to explore patients’ responses to the rules; to evaluate the impact of rules and rule enforcement on nurse–patient relationships and on ward events; and to investigate the relationship between ward rules, ward atmosphere and ward design. The relevance of sociological theory emerged from the data analysis. During this process, the results were moved up to another conceptual level to represent the meaning of lived experience at the level of theory. For example, nurses’ descriptions of their feelings in relation to rule enforcement were merged as role ambivalence. This concept was supported by examples from the transcripts. Other possible explanations for the data and the connections between them were checked by returning to each text unit in the cluster and ensuring that it fitted with the emergent theory. The design centred on a comparative interview study of 30 patients and 30 nurses within two acute psychiatric wards in different hospitals. Non‐participant observations provided a context for the interview data. Measures of the Ward Atmosphere Scale, the Hospital‐Hostel Practices Profile, ward incidents and levels of as required (PRN) medication were obtained. The analysis of the quantitative data was assisted by spss, and the qualitative analysis by QSR *NUDIST. Thematic and interpretative phenomenological methods were used in the analysis of the qualitative data. A series of 11 interrelated concepts emerged from an analysis of the data, and a synthesis of the main themes. This paper focuses on the results and recommendations that emerged from the quantitative and qualitative patient data. A further paper will focus on nurses’ perceptions of the same topics.
Introduction of routine outcome measures: staff reactions and issues for consideration
Authors: MEEHAN T. , MCCOMBES S. , HATZIPETROU L. , CATCHPOOLE R.
Published: September 2010

The aim of this study was to explore clinician reactions to (i) the introduction of routine outcome measures and (ii) the utility of outcomes data in clinical practice. Focus group discussions (n = 34) were conducted with mental health staff (n = 324) at approximately 8 months post implementation of routine outcome measures. A semi‐structured interview schedule was used to collect data on two key issues; reactions to the introduction of outcome measures and factors influencing the utility of outcomes data in clinical practice. Data from the discussion groups were analysed using content analysis to isolate emerging themes. While the majority of participants endorsed the collection and utilization of outcomes data, many raised questions about the merits of the initiative. Ambivalence, competing work demands, lack of support from senior medical staff, questionable evidence to support the use of outcome measures, and fear of how outcomes data might be used emerged as key issues. At 8 months post implementation a significant number of clinical staff remained ambivalent about the benefits of outcome measurement and had not engaged in the process. The shift to a service model driven by outcomes and case‐mix data will take time and resources to achieve. Implications for nursing staff are discussed.
Developing a framework for admission and discharge: a nurse‐led initiative within a mental health setting
Authors: FIDDLER M. , BORGLIN G. , GALLOWAY A. , JACKSON C. , LOVELL K.
Published: September 2010

Admission to a mental health inpatient setting is one important aspect of care which requires collaborative working between Community Mental Health Teams (CMHTs) and ward staff. However, links are not always formalized. The failure of effective gatekeeping coupled with inconsistent admission and discharge practices further complicates the situation for all those involved. A number of local changes, for example, adoption of a centralized bed bureau, together with policy changes, initiated a nurse‐led practice development project. It was predicted that by creating a framework for more formalized communication between the different disciplines admission and discharge processes would be improved, thus enhancing service users' satisfaction and empowering all staff participating in the process. During the project, 132 service users were notified as potentially requiring admission. Admissions were avoided and diverted for 22 of them. The quality of the communication and information shared between the CMHTs and ward staff was significantly improved. Accessing inpatient beds, at times still remained problematic, as beds could only remain ring‐fenced on 65% of occasions. This initiative, conducted within a ‘real world setting’, showed that it is possible to improve admission and discharge practices by creating a framework for a formalized communication process between disciplines.
Psychiatric nurses' knowledge, experience and attitudes towards clients with borderline personality disorder
Authors: JAMES P. D. , COWMAN S.
Published: September 2010

There is evidence in the literature to suggest that mental health care staffs' attitudes towards clients with borderline personality disorder (BPD) are less than favourable. This study reports on a survey of psychiatric nurses' knowledge, experience and attitudes towards care received by clients with a diagnosis of BPD. The questionnaire was sent to all clinical nurses (n = 157) working in a psychiatric service in Dublin, Ireland and received a response rate of 41.4% (n = 65). The results indicate that the majority of nurses have regular contact with clients with BPD and nurses on inpatient units reported more frequent contact than nurses in the community. Eighty per cent of nurses view clients with BPD as more difficult to care for than other clients and 81% believe that the care they receive is inadequate. Lack of services was cited as the most important factor contributing to the inadequate care and the development of a specialist service is reported as the most important resource to improve care.
Obsessive–compulsive disorder in children and adolescents
Authors: CAMERON C. L.
Published: September 2010

Obsessive–compulsive disorder (OCD) is an extremely common form of child and adolescent psychopathology. Obsessive–compulsive disorder in children and adolescents has garnered a significant amount of attention from mental health practitioners and mental health researchers over the past decades. In order to provide a comprehensive account of this attention, the phenomenology, theoretical perspectives, empirical literature and interventions used to treat OCD in children and adolescents are reviewed in this paper. While by no means an exhaustive review, the information presented in this paper provides health and mental health professionals interested in OCD in children and adolescents with the knowledge required to enhance their understanding of this complicated form of child and adolescent psychopathology.
Mental health professionals' attitudes towards consumer participation in inpatient units
Authors: MCCANN T. V. , BAIRD J. , CLARK E. , LU S.
Published: September 2010

Consumer participation has been a major focus in mental health services in recent years, but the attitudes of mental health professionals towards this initiative remain variable. The purpose of this study was to describe mental health professionals' attitudes towards mental health consumer participation in inpatient psychiatric units. The Consumer Participation and Consultant Questionnaire was used with a non‐probability sample of 47 mental health professionals from two adult inpatient psychiatric units situated in a large Australian public general hospital. Ethics approval was obtained from a university and a hospital ethics committee. Data were analysed using spss, Version 12. Overall, respondents had favourable attitudes towards consumer participation in management, care and treatment, and mental health planning. They were less supportive about matters that directly or indirectly related to their spheres of responsibility. The type of unit that the respondents worked in was not a factor in their beliefs about consumer participation. Recommendations are made about the development of guidelines for consumer participation in inpatient units, the educational preparation of mental health clinicians, and the need for mental health professionals to reflect on, and discuss their own beliefs and practices about, consumer participation.
Bibliotherapy and information prescriptions: a summary of the published evidence‐base and recommendations from past and ongoing Books on Prescription projects
Authors: CHAMBERLAIN D. , HEAPS D. , ROBERT I.
Published: September 2010

This paper summarizes the published evidence and reports from ongoing and completed projects that used Bibliotherapy and Information Prescription to deliver patient care. A literature search was conducted and relevant papers were summarized into: type of study, type of Bibliotherapy, client group and recommendations. In total, 65 papers were considered with 57 reviewed. A survey was also sent to Library Authorities subscribing to national survey standards asking for details about delivery of Information Prescription projects. There were 21 returned surveys. The experiences and recommendations were then summarized. The aim of the paper is to collate the evidence‐base of written research and the experience and recommendations of projects into an easy format so that practitioners interested in using Bibliotherapy/Information Prescription/Books on Prescription have an understanding what they are, the extent of the evidence‐base to inform practice, and highlight gaps in the research.
An evaluation of education and implementation of psychosocial interventions within one UK mental healthcare trust
Authors: SIN J. , SCULLY E.
Published: September 2010

Psychosocial interventions (PSI), though recommended in the NICE guidelines for schizophrenia and bipolar affective disorder, are not routinely available to people with a serious mental illness in the UK. Education and training initiatives to equip mental health professionals with skills in PSI have grown over the last decade; yet the literature indicates serious problems in implementation of PSI in routine service provision. This paper examines on a local level the factors which support and limit the education and practice of PSI in one UK mental healthcare trust. It reports on a survey of trainees and their managers which aims to evaluate the impact of a PSI training programme and practice development strategy on staff, managers and service provision. The key findings are: a high rate of implementation of PSI by PSI‐trained staff in the Trust; a strong association between PSI training and career progression for staff; and the support mechanisms which are most effective in the education and implementation of PSI. The paper concludes that certain measures and support mechanisms have facilitated the successful implementation of PSI with positive outcomes for staff and service provision. Further recommendations are made identifying measures which facilitate the implementation of PSI through an integrated education and practice development strategy owned by all stakeholders.
Comorbidity of mental health and substance misuse problems: a review of workers' reported attitudes and perceptions
Authors: ADAMS M. W.
Published: September 2010

A comorbidity of mental health and substance misuse problems has been associated with deleterious outcomes. In the United Kingdom it has been acknowledged that people with comorbidity have often received poor care, with gaps in service provision suggesting ambivalence towards this issue. Previous reviewing authors have concluded that health professionals hold stereotypical views towards people that misuse substances, but these findings may not be directly comparable to those who work within mental health services. There is however a growing body of evidence concerning this context. The author has reviewed the literature from 1996 to 2006 to ascertain mental health professionals and allied workers attitudes and perceptions towards comorbidity, perceptions on the effectiveness of service systems, and perceptions of personal knowledge and skill in providing effective interventions. The evidence presented mainly pertains to mental health nurses, which reflects their status as the largest discipline within the mental health workforce. Overall attitudes towards comorbidity are mixed, possibly being related to contextual issues of practice and are not necessarily negative. However, there is an almost universal negative perception of deficiencies in service provision and the adequacy of training. Implications for research, development and practice are explored.
Exploring independent nurse prescribing for mental health settings
Authors: JONES A.
Published: September 2010

The purpose of this study was to explore issues relating to the implementation of independent nurse prescribing (IP) in mental health settings. Nurse prescribing in mental health has been promoted through various policy documents and has been subject to extensive research enquiry. Independent nurse prescribing is the latest form of prescriptive authority although little is known about how it can be used in mental health settings. Focus groups were used to collect qualitative data. In total, 22 nurses and three psychiatrists joined one of five focus groups. A form of grounded theory was used to analyse the data. Three major findings will be discussed. The first theme related to how IP could support system redesign and new ways of working. The second theme revolved around the form of future training and competency requirements to support an IP role, and the third theme was about the types of setting and diagnostic restrictions that need to be considered for IP. Findings suggest an overall cautious view on IP for a range of clinical settings. Implications for practice include the impact on new roles for nurses and psychiatrists and how nurses can best be trained and supported to carry out IP safely.
Positive relationships between genetic diversity and abundance in fishes
Authors: MCCUSKER MEGAN R. , BENTZEN PAUL
Published: September 2010

Molecular markers, such as mitochondrial DNA and microsatellite loci, are widely studied to assess population genetics and phylogeography; however, the selective neutrality of these markers is increasingly being questioned. Given the importance of molecular markers in fisheries science and conservation, we evaluated the neutrality of both mtDNA and microsatellite loci through their associations with population size. We surveyed mtDNA and microsatellite data from the primary literature and determined whether genetic diversity increased with abundance across a total of 105 marine and freshwater fishes, with both global fisheries catch data and body size as proxies for abundance (with an additional 57 species for which only body size data were assessed). We found that microsatellite data generally yielded higher associations with abundance than mtDNA data, and within mtDNA analyses, number of haplotypes and haplotype diversity were more strongly associated with abundance than nucleotide diversity, particularly for freshwater fishes. We compared genetic diversity between freshwater and marine fishes and found that marine fishes had higher values of all measures of genetic diversity than freshwater fishes. Results for both mtDNA and microsatellites generally conformed to neutral expectations, although weaker relationships were often found between mtDNA nucleotide diversity and ‘abundance’ compared to any other genetic statistic. We speculate that this is because of historical events unrelated to natural selection, although a role for selection cannot be ruled out.
The Chandra Small Magellanic Cloud Wing Survey – the search for X-ray binaries
Authors: McGowan K. E. , Coe M. J. , Schurch M. P. E. , McBride V. A. , Galache J. L. , Edge W. R. T. , Corbet R. H. D. , Laycock S. , Buckley D. A. H.
Published: September 2010

We have detected 523 sources in a survey of the Small Magellanic Cloud (SMC) Wing with Chandra. By cross-correlating the X-ray data with optical and near-infrared catalogues, we have found 300 matches. Using a technique that combines X-ray colours and X-ray to optical flux ratios, we have been able to assign preliminary classifications to 265 of the objects. Our identifications include four pulsars, one high-mass X-ray binary (HMXB) candidate, 34 stars and 185 active galactic nuclei (AGN). In addition, we have classified 32 sources as ‘hard’ AGN which are likely absorbed by local gas and dust, and nine ‘soft’ AGN whose nature is still unclear. Considering the abundance of HMXBs discovered so far in the Bar of the SMC the number that we have detected in the Wing is low.
A 610-MHz survey of the ELAIS-N1 field with the Giant Metrewave Radio Telescope – observations, data analysis and source catalogue
Authors: Garn Timothy , Green David A. , Riley Julia M. , Alexander Paul
Published: September 2010

Observations of the European Large-Area ISO Survey-North 1 (ELAIS-N1) field taken at 610 MHz with the Giant Metrewave Radio Telescope are presented. 19 pointings were observed, covering a total area of ∼ 9 deg2 with a resolution of 6 × 5 arcsec2, position angle (PA) +45°. Four of the pointings were deep observations with an rms of ∼40 μJy before primary beam correction, with the remaining 15 pointings having an rms of ∼70 μJy. The techniques used for data reduction and production of a mosaicked image of the region are described, and the final mosaic is presented, along with a catalogue of 2500 sources detected above 6σ. This work complements the large amount of optical and infrared data already available on the region. We calculate 610-MHz source counts down to 270 μJy, and find further evidence for the turnover in differential number counts below 1 mJy, previously seen at both 610 MHz and 1.4 GHz.
Period analysis of three close binary systems: TW And, TT Her and W UMi
Authors: Kreiner J. M. , Pribulla T. , Tremko J. , Stachowski G. S. , Zakrzewski B.
Published: September 2010

Orbital period changes of three close binaries, TW And, TT Her and W UMi, were studied using the Kraków data base of minima of eclipsing binaries, and new photoelectric observations obtained by the authors. The interval of the observations spans roughly a century. The major orbital period change in TW And is explained by the presence of a third body with P3= 49.6 yr and a continuous secular period increase. A third body, with P3= 41.0 yr, was also found in the system TT Her. The (O–C) diagram of W UMi can be interpreted as either an abrupt orbital period decrease which occurred around the end of 1973 or as a secular orbital period decrease combined with cyclic change. In this case, the orbital period of the third body is 62.2 yr and the sum of squares of residuals is lower than for a broken-line fit, therefore cyclic variations should be preferred. In all three systems, the third body is a low-mass companion.
The Monitor project: rotation of low-mass stars in the open cluster NGC 2547
Authors: Irwin Jonathan , Hodgkin Simon , Aigrain Suzanne , Bouvier Jerome , Hebb Leslie , Moraux Estelle
Published: September 2010

We report on the results of an I-band time-series photometric survey of NGC 2547 using the MPG/ESO 2.2-m telescope with Wide Field Imager, achieving better than 1 per cent photometric precision per data point over 14 ≲I≲ 18. Candidate cluster members were selected from a V versus V−I colour–magnitude diagram over 12.5 < V < 24 (covering masses from 0.9 M⊙ down to below the brown dwarf limit), finding 800 candidates, of which we expect ∼330 to be real cluster members, taking into account contamination from the field (which is most severe at the extremes of our mass range). Searching for periodic variations in these gave 176 detections over the mass range 0.1 ≲M/M⊙≲ 0.9. The rotation period distributions were found to show a clear mass-dependent morphology, qualitatively intermediate between the distributions obtained from similar surveys in NGC 2362 and 2516, as would be expected from the age of this cluster. Models of the rotational evolution were investigated, finding that the evolution from NGC 2362 to 2547 was qualitatively reproduced (given the uncertainty in the age of NGC 2547) by solid body and core-envelope decoupled models from our earlier NGC 2516 study without need for significant modification.
Association of pregnancy history and birth characteristics with neuroblastoma: a report from the Children's Cancer Group and the Pediatric Oncology Group
Authors: Hamrick Shannon E. G. , Olshan Andrew F. , Neglia Joseph P. , Pollock Brad H.
Published: September 2010

Previous studies have suggested a relationship between reproductive history, pregnancy and birth factors, and the risk of neuroblastoma. We conducted a case–control telephone interview study that included a total of 504 children under the age of 19 years with newly diagnosed neuroblastoma identified by two national collaborative clinical trials groups, the Children's Cancer Group and the Pediatric Oncology Group. A total of 504 controls, matched to cases on age, were identified by random digit dialling. Conditional logistic regression was used to estimate the matched odds ratio (OR) and 95% confidence interval (CI) with adjustment for household income, and maternal race and education. In addition, case subgroups defined by age at diagnosis, tumour MYCN oncogene amplification status, and stage were evaluated. A suggestive pattern of increased risk was seen for a greater number of prior pregnancies, history of previous miscarriages and induced abortions, with nearly a twofold increase in risk for two or more prior induced abortions (OR = 1.9, 95% CI [1.0,3.7]). No association was found for the following diseases or conditions during pregnancy: hepatitis, rubella, measles, mumps, chickenpox, mononucleosis, vaccinations, morning sickness, pre‐eclampsia, bleeding, proteinuria, anaemia, urinary tract infections, heart disease, kidney disease, liver disease and diabetes. A weak association was found for hypertension during pregnancy. Several labour and delivery factors were related to an increased risk, including threatened miscarriage, anaesthetic during labour (specifically epidural) and caesarean delivery. We found associations between premature delivery (<33 weeks: OR = 1.9, 95% CI [0.7,4.8]), very low birthweight (<1500 g: OR = 2.6, 95% CI [0.7,10.3]) and risk of neuroblastoma. There was no consistent pattern of increased risk found for most factors within subgroups defined by age at diagnosis, stage or MYCN status.
Stillbirth and neonatal mortality due to congenital anomalies: temporal trends and variation by small area deprivation scores in England and Wales, 1986–96
Authors: Neasham David , Dolk Helen , Vrijheid Martine , Jensen Tina , Best Nicky
Published: September 2010

We investigated the variation of stillbirth and neonatal mortality due to congenital anomalies in relation to small‐area measures of deprivation in a population‐based study in England and Wales, 1986–96. We found 10 954 stillbirths and neonatal deaths from all non‐chromosomal and chromosomal anomalies during the study period out of a total of 7 487 007 live and stillbirths. The extended perinatal mortality rate (EPM rate) (defined as babies who were stillborn or died within 28 completed days after birth per 10 000 total live and stillbirths) for all chromosomal and all non‐chromosomal anomalies was 1.5/10 000 and 13.2/10 000, respectively, over the whole period. The rate for non‐chromosomal anomalies halved over the decade while the rate for chromosomal anomalies remained unchanged. The relative risks of EPM for chromosomal and non‐chromosomal anomalies were 0.71 [0.80, 0.95] and 1.17 [95%CI 1.06, 1.30], respectively, in the group of wards with highest deprivation compared with the least deprived group. Increasing gradients of EPM with increasing deprivation were observed for (1) grouped non‐chromosomal anomalies including neural tube defects, all renal and urinary anomalies, all musculoskeletal anomalies, and multiple anomalies, and (2) several specific non‐chromosomal anomalies including anencephaly, limb reduction defects, diaphragm and abdominal wall defects. This study provides strong evidence that increased deprivation is associated with increased EPM due to most non‐chromosomal anomalies; the finding of decreased relative risk for chromosomal anomalies is probably related to differences in maternal age distribution between deprivation groups.
Folic acid supplements in pregnancy and birth outcome: re‐analysis of a large randomised controlled trial and update of Cochrane review
Authors: Charles Deborah H. M. , Ness Andy R. , Campbell Doris , Smith George Davey , Whitley Elise , Hall Marion H.
Published: September 2010

Periconceptual folic acid prevents neural tube defects. The effect of folic acid taken throughout pregnancy is unclear, however. We re‐analysed data from a large randomised controlled trial performed between 1966 and 1967 and combined the results with those from trials included in a Cochrane review. A total of 2928 women were randomised: 1977 were allocated to placebo, 466 to folic acid 200 µg/day and 485 to folic acid 5 mg/day.

Folic acid supplementation was not associated with any difference in mean birthweight, placental weight or gestational age. When combined with trials in the Cochrane review folic acid at high doses was associated with reduced risk of low birthweight (pooled relative risk 0.73 [95% CI 0.53, 0.99]). We found no conclusive evidence of benefit for folic acid supplementation in pregnant women given from time of booking onwards.
Allergy and infectious disease histories and the risk of childhood acute lymphoblastic leukaemia
Authors: Rosenbaum Paula F. , Buck Germaine M. , Brecher Martin L.
Published: September 2010

Infectious disease histories were evaluated in a population‐based case‐control study of childhood acute lymphoblastic leukaemia (ALL) as it has been hypothesised that delays in early infections are associated with an increased risk of disease. Allergy histories were also assessed as part of a broader evaluation of the role of immune factors in ALL. Cases (n = 255) were diagnosed between 1980 and 1991 at one of four referral centres in a 31‐county area of New York State; controls (n = 760) were a random sample of live births from the same region, frequency matched to cases by sex, race and birth year. Data were collected by mailed questionnaire, completed by case and control parents in 1995. Allergy and infectious histories before the age at leukaemia diagnosis for cases and an equivalent age for controls were evaluated. The adjusted odds ratio and 95% confidence interval [CI] associated with a positive history of any allergy was 0.58 [95% CI 0.38, 0.88] compared with a negative allergy history. The occurrence of several common childhood illnesses before 25 months of age and ALL were assessed, with both weak positive and weak inverse associations observed.

Overall, these analyses provide little support for the hypothesis that infection delay in early life is associated with an increased risk of ALL. Children with positive allergy histories reported significantly more infections than those with negative histories; however, effect modification of the infection‐ALL associations by child allergy history was not observed. Nonetheless, these observations suggest the importance of assessing both allergy and infectious histories and their possible interactions when evaluating the association between these immune factors and childhood ALL.
Infant mortality in Israel during 1950–2000: rates, causes, demographic characteristics and trends
Authors: Amitai Yona , Haklai Ziona , Tarabeia Jalal , Green Manfred S. , Rotem Naama , Fleisher Eve , Leventhal Alex
Published: September 2010

We evaluated the trends and risk factors in infant mortality in Israel over five decades (1950–2000), based on data obtained from the official notifications of live births, and death certificates. Until the 1960s the main cause of infant mortality was infectious disease; this was replaced by congenital anomalies in Moslems and Druzes, and preterm birth in Jews and Christians. In 2000, there were 746 infant deaths, and the national infant mortality rate (IMR) was 5.4 per 1000 live births (Jews 3.9; [95% CI 3.5, 4.3]; Moslems 9.2 [8.3, 10.3]; Christians 3.6 [1.4, 5.8]; Druzes 6.3 [3.6, 9.0]). Between 1955 and 2000 the overall IMR declined sevenfold (absolute declines of 56.8, 56.3, 45.0 and 28.3 per 1000 live births, in Moslems, Druzes, Christians and Jews, respectively). The reduction in IMRs between 1990 and 2000 in all religious groups (>45%) exceeded the goal set by the World Summit for Children in 1990 of 33%. In 2000, the main risk factors were birthweight < 1500 g [relative risk (RR) = 69], major congenital malformations (RR = 22.0 [18.8, 25.7], and multiple births (RR of 9.3 and 4.2 in triplets and twins respectively). We conclude that the marked decline in IMRs in Israel over five decades reflects a major improvement in population health. Today, infant mortality in Israel represents a unique combination of high rate of congenital malformations among Moslems, where consanguineous marriages are common, and medical termination of pregnancy of malformed fetuses are infrequent; and relatively high IMRs from preterm birth in Jews, associated with high rates of assisted reproduction.