bluuebunny/crossref_metadata_2025 huggingface dataset:
Peripheral parameters of oxidative stress in Graves’ disease: the effects of methimazole and 131 iodine treatments
Authors: Abalovich M. , Llesuy S. , Gutierrez S. , Repetto M.
Published: August 2003

background Increased oxidative stress, with elevated levels of free radicals, together with diminished antioxidation have been described previously in models of hyperthyroidism and in patients with Graves’ disease. However, controversial results have been found about the antioxidant status and its response to treatment.

aim To evaluate the antioxidant/oxidant balance in active Graves’ disease and the effects of treatment with methimazole (MMI) and 131 iodine (131I).

patients and methods We studied 69 hyperthyroid (H) patients, 58 female and 11 male, 16–50 years old; total T3: 8 ± 2 nmol/l, total T4: 264 ± 65 nmol/l (all mean ± SD), TSH: 0·1 ± 0·1 mIU/l, TSH receptor antibody 41 ± 21%, highest 131Iodine uptake: 67 ± 16%. As a control group (C), 19 normal adults were studied.

design Parameters evaluated were: tert‐butyl hydroperoxide initiated chemiluminiscence (CL), superoxide dismutase (SOD), catalase (CAT), glutathione (GSH), glutathione peroxidase (GPx) and total reactive antioxidant potential (TRAP).

results In patients vs. controls there was an increase in CL levels (6207 ± 1434 vs. 3000 ± 851 cpm/mg of haemoglobin, P < 0·001), decrease in SOD (0·4 ± 0·1 vs. 0·7 ± 0·2 U/mg prot, P < 0·05; corresponding to 0·15 µg/ml), CAT (2·8 ± 0·6 vs. 3·8 ± 0·7 pmol/mg prot, P < 0·001) and GSH (1·2 ± 0·4 vs. 2 ± 0·7 mmol/l erythrocytes, P < 0·05). The decrease in GPx and TRAP did not show significant differences. The parameters were also recorded in 30 patients who became euthyroid after treatment: 20 of them under MMI therapy (2–12 months) and the rest 3–6 months after 131Iodine administration. All the parameters evaluated were normalized after MMI; however, CL levels stayed high after 131I and only CAT and GSH levels returned to normal values.

conclusion Our results confirm the imbalance of the antioxidant/oxidant status in hyperthyroid patients. MMI treatment was more effective than 131I therapy to improve that balance. We speculate on the benefits of antioxidant therapy administrated together with the habitual treatment of hyperthyroidism, especially in patients after 131I therapy.
Reduced expression of the growth hormone and type 1 insulin‐like growth factor receptors in human somatotroph tumours and an analysis of possible mutations of the growth hormone receptor
Authors: Kola Blerina , Korbonits Márta , Diaz‐Cano Salvador , Kaltsas Gregory , Morris Damian G. , Jordan Suzanne , Metherell Lou , Powell Michael , Czirják Sándor , Arnaldi Giorgio , Bustin Stephen , Boscaro Marco , Mantero Franco , Grossman Ashley B.
Published: August 2003

objective Clinical acromegaly is characterized by elevated GH secretion in the presence of high circulating IGF‐I levels. We hypothesized that the physiological IGF‐I/GH negative feedback loop may be reset in somatotroph adenomas, specifically in terms of the level of expression of these receptors or mutations of the GH receptor (GH‐R) in such tumours.

methods We therefore investigated the full coding sequence of the GH‐R in a series of somatotroph and other pituitary adenomas. We also investigated the mRNA expression of these putative feedback receptors in a series of pituitary adenomas and normal pituitary tissue, and their protein expression by immunostaining. Real‐time RT–PCR assay was used for the quantification of the type 1 IGF receptor (IGF‐R) and GH receptor (GH‐R) mRNA, and sequence analysis was performed on the coding region of the GH‐R gene.

results No somatic mutations of the GH‐R mRNA were detected in 18 GH‐secreting tumours or two nonfunctioning pituitary adenomas (NFPAs). However, the levels of GH‐R mRNA were significantly lower in both somatotroph tumours and NFPAs compared to the normal pituitary (P < 0·05 for both). Immunostaining for GH‐R also showed significantly less GH‐R expression in somatotroph adenomas compared to normal pituitary tissue (P < 0·0001). IGF‐R mRNA levels were significantly lower in somatotroph tumours compared to normal pituitary (P = 0·005), and trended lower in corticotroph tumours (P = 0·07), while the other tumour types showed no significant difference from normal pituitary. Immunostaining for IGF‐R also showed less IGF‐R protein in the somatotroph adenomas compared to the normal pituitary tissue (P < 0·01).

conclusions Our findings suggest that decreased feedback inhibition of GH because of somatic mutations of the coding region of the GH‐R are unlikely to be a common factor in the pathogenesis of these tumours. Nevertheless, decreased expression of the GH‐R and of IGF‐R in somatotroph tumours (both at the mRNA and protein level) may, at least in part, help explain the continuous secretion of GH from the tumour despite the high circulating levels of IGF‐I and GH.
Clinical and radiological features of patients with macroprolactinaemia
Authors: Strachan Mark W. J. , Teoh Wei Leng , Don‐Wauchope Andrew C. , Seth John , Stoddart Mary , Beckett Geoffrey J.
Published: August 2003

objectives Macroprolactin is a complex of prolactin (PRL) and IgG and may account for a significant proportion of cases of ‘idiopathic hyperprolactinaemia’. In this study, we sought to determine the prevalence and clinical features of macroprolactinaemia in patients diagnosed with hyperprolactinaemia in our region, with a view to determining how patients with macroprolactinaemia should be investigated and managed.

patients and methods An Immuno‐1 automated immunoassay system with polyethylene glycol (PEG) precipitation was used to identify macroprolactin, with a recovery of ≤ 50% taken as indicating significant macroprolactinaemia. Macroprolactin was found in 58 (21%) of 273 patients with a total PRL > 700 mU/l. The clinical records of 51 (44 female) were available for retrospective review.

results The mean (range) age of patients was 39·5 (18–82) years. The median (range) concentrations for the various forms of PRL were: total PRL 1130 mU/l (728–5116), monomeric PRL 240 mU/l (50–656) and macroprolactin 895 mU/l (381–4854). Classical symptoms of hyperprolactinaemia were present in 39% of patients, although in many there were other possible explanations for their symptomatology. Pituitary adenomas were identified in six out of 36 people who underwent neuroimaging. Five of these patients had a microadenoma and one had a 10‐mm macroadenoma (although, in this patient macroprolactin was identified after the discovery of the tumour). There was no relationship between macroprolactin concentrations and the presence of hyperprolactinaemic symptoms or neuroimaging abnormalities.

conclusions Macroprolactinaemia is a common occurrence in patients with hyperprolactinaemia, but associated symptomatology may not necessarily be linked. The neuroimaging abnormalities were also probably incidental findings and it is questionable whether neuroimaging is necessary when significant macroprolactinaemia is identified and the concentration of monomeric PRL is not elevated (using the Immuno‐1 assay system, following PEG precipitation).
Changes in both size and cytological features of thyroid nodule after levothyroxine treatment
Authors: Vermiglio Francesco , Lo Presti Vincenzo Pio , Violi Maria Antonia , Moleti Mariacarla , Castagna Maria Grazia , Finocchiaro Maria Daniela , Mattina Filiberto , Mandolfino Mattia , Zimbaro Giovanni , Trimarchi Francesco
Published: August 2003

objective We prospectively evaluated the effects of 12 months thyrotropin suppressive levo‐thyroxine (L‐T4) therapy in terms of changes in both thyroid nodule size and cytological features and considered whether thyroid nodule size changes actually resulted in (or were the result of) cytological changes.

design and patients We studied 142 consecutive patients with benign ‘cold’ solitary thyroid nodules. For the purposes of the study, we divided our patients into three groups according to their initial cytological nodule classification as follows: group 1, including 88 colloid nodules (CN); group 2, including 30 hyperplastic nodules (HN); and group 3, including 24 adenomatous nodules (AN).

measurements The effects of TSH suppressive L‐T4 treatment on both nodule volume and cytological characteristics were evaluated by ultrasonography and fine‐needle aspiration (FNA) before and 12 months after the onset of therapy.

results Twelve months of TSH suppressive L‐T4 treatment were effective in shrinking about one‐third to one‐quarter (31·8% CN, 26·7% HN and 25% AN) of thyroid nodules, irrespective of their initial cytological characteristics. Similarly, there was no difference in the prevalence of ‘non‐responders’ (increasing nodules) to L‐T4, which accounted for about one‐fifth or less (20·5% CN, 13·3% HN and 20·8% AN) of all nodules. We found also that cytological features changed in 33·8% nodules after 12 months of L‐T4 treatment. These changes were most commonly observed in HN and AN and consisted largely (∼80%) of cytological characteristics resembling colloid features, not only in shrinking but also in stable nodules, thus indicating that cytology changes might be the very first indicator of nodule sensitivity to L‐T4 therapy even in the continued absence of nodule shrinkage. When nodules were divided into three subgroups according to variations in size (shrinking, stable and increasing nodules), we observed that the distribution of the three cytological types showed a trend towards colloid lesions in shrinking nodules (χ2 3·8, P < 0·005) and towards an augmentation of hypercellular, adenomatous and suspicious characteristics in increasing nodules (χ2 3·6, P < 0·005).

conclusion The frequency of shrinking nodules was not different between colloid, hyperplastic and adenomatous nodules. Repeat FNA should be advisable for thyroid nodules which increase in volume despite L‐T4 therapy and might also provide useful information about nodule sensitivity to L‐T4 treatment for both HN and AN, even where nodule size remains stable.
Increased expression of endothelin‐1 and its mitogenic receptor ETA in human papillary thyroid carcinoma
Authors: Donckier Julian E. , Michel Luc , Van Beneden Ronald , Delos Monique , Havaux Xavier
Published: August 2003

objective Since the isolation of endothelin‐1 (ET‐1) in 1988, there has been tremendous interest in the pathophysiological roles of ET‐1 as a vasoconstrictive and mitogenic peptide. Whereas ET‐1 is mainly released by vascular endothelial cells, it also proved to be produced by various tissues including the thyroid. Because of its mitogenic properties in malignancy and its role as an inflammatory modulator, ET‐1 could be involved in thyroid carcinogenesis and thyroiditis.

design and patients Studies were performed in human thyroid samples obtained at the time of surgery from 39 men and women aged 15–72 years. Thyroid samples were classified in four groups according to conventional histology: normal thyroid (n = 7) papillary thyroid carcinoma (n = 12), Hashimoto's thyroiditis (n = 9) and benign nontoxic nodular goitres (n = 11). Immunohistochemistry and real‐time quantitative polymerase chain reaction were used to determine the expression of ET‐1 and its receptors (ETAR and ETBR).

results ET‐1 and ETAR mRNA levels were, respectively, 3·8 ± 1·3 and 4·1 ± 1·5 times greater (P < 0·001) in papillary thyroid carcinoma than in normal thyroid. Expression of ETBR was unaltered. In Hashimoto's thyroiditis, ET‐1 and ETAR were also overexpressed (P < 0·005). Furthermore, immunohistochemistry demonstrated a greater percentage of ET‐1‐positive follicular cells in these conditions (P < 0·001). In nodular goitres, the expression was increased by 1·7 ± 0·7 times (P < 0·05) but expression of receptors remained unchanged.

conclusions ET‐1 and ETAR overexpression observed in thyroid carcinoma suggest a mitogenic role of ET‐1 that theoretically could be countered by ETAR antagonists. ET‐1 and ETAR overexpression in thyroiditis supports a role of ET‐1 in the inflammatory process.
Accuracy of ultrasonography to establish the diagnosis and aetiology of permanent primary congenital hypothyroidism
Authors: Kreisner E. , Camargo‐Neto E. , Maia C. R. , Gross J. L.
Published: August 2003

objective To compare ultrasonography and 99mTc thyroid scintigraphy for the aetiologic diagnosis of permanent congenital hypothyroidism (CH).

study design Eighty‐eight consecutive patients with CH were recruited at an endocrinology outpatient clinic and submitted to high‐frequency ultrasonography and to 99mTc scintigraphy.

results Seventy‐six patients were diagnosed with permanent CH and 12 with transitory CH. The agreement between ultrasound and scintigraphy was very high (kappa coefficient = 0·866; P < 0·001) for the entire group. In permanent CH patients, ultrasonography identified 67 cases of dysgenesis (absence of thyroid gland in the usual anatomical location in 66 and hemiagenesis in one), and this diagnosis was confirmed by scintigraphy (absence of functional thyroid tissue in 43 and ectopia in 24). In the other nine permanent CH patients, the thyroid was in the usual anatomical location on ultrasonography but scintigraphy did not identify functional tissue in one patient. In the 12 transitory CH patients, a normally shaped thyroid was detected by ultrasound in the usual location, whereas scintigraphy showed absence of functional tissue in two identical twins and scarce concentration of isotope in a third patient.

conclusion Ultrasonography is an accurate method to establish the presence of dysgenesis and might be used as the first imaging tool in patients with CH, whereas scintigraphy should be used mainly to distinguish agenesis from ectopia. Further examination is required to differentiate permanent CH with a normally located and shaped gland from transitory hypothyroidism.
An investigation of fetal, postnatal and childhood growth with insulin‐like growth factor I and binding protein 3 in adulthood
Authors: Ben‐Shlomo Y. , Holly J. , McCarthy A. , Savage P. , Davies D. , Gunnell D. , Davey Smith G.
Published: August 2003

objective Weight at birth and adult height are positively associated with cancer risk. These patterns may be mediated by the insulin‐like growth factor (IGF) axis. We have examined whether pre‐ and postnatal growth patterns have a long‐term influence on adult IGF‐I and IGFBP‐3 levels.

design A follow‐up study of a randomized controlled trial of milk supplementation in pregnancy and childhood.

subjects A total of 951 individuals took part in a study of diet and growth in South Wales between 1972 and 1974 followed up from birth until their mid‐20s.

measurements Anthopometric measures at birth, postnatally up to 5 years of age and in adulthood, and serum measures of IGF‐I and IGF‐I to IGFBP‐3 ratio at mean age of 25 years.

results A total of 63 subjects (70%) provided blood for analysis. We found no association between birth dimensions and adult IGF‐I. Subjects who exhibited ‘catch‐down growth’ had lower IGF‐I levels (P‐value for trend 0·02). Adult height was positively related to IGF‐I, for every one standard deviation increase in adult height, IGF‐I increased by 3·75 ng/dl (95% CI 0·46–7·08, P = 0·03). Adiposity was inversely associated with the IGF‐I and IGF‐I to IGFBP‐3 ratio and positively associated with IGFBP‐3. The strength of the associations increased with age. Downward centile crossing at any time in childhood was associated with lower IGF‐I whilst the highest levels were observed in subjects who were tall throughout their early life course. Adult height remained a significant predictor of IGF‐I even after adjustment for earlier growth.

conclusions Our results indicate that IGF‐I levels in early adulthood are associated with patterns of childhood growth as well as adult stature and adiposity. These associations suggest the IGFs may contribute to anthropometric associations with cancer risk.
Obstructive sleep apnoea syndrome impairs insulin sensitivity independently of anthropometric variables
Authors: Tassone Francesco , Lanfranco Fabio , Gianotti Laura , Pivetti Sonia , Navone Fabrizia , Rossetto Ruth , Grottoli Silvia , Gai Valerio , Ghigo Ezio , Maccario Mauro
Published: August 2003

objectives Obstructive sleep apnoea syndrome (OSAS) is strongly associated with obesity and characterized by endocrine and metabolic changes including impairment of insulin sensitivity. The aim of this study was to further clarify the insulin dynamics and glucose metabolism in this condition.

design, patients and measurements We studied 30 obese patients with OSAS [OSA, 21 males, 9 females; age, mean ± SEM: 53·1 ± 1·7 years; body mass index (BMI): 38·6 ± 1·1 kg/m2; waist‐to‐hip ratio (WHR): 0·99 ± 0·07; Apnoea/Hypopnoea Index (AHI): 40·5 ± 5·8 events/h of sleep] by means of overnight polysomnography and oral glucose tolerance testing. Mathematical models were used to assess: (i) whole‐body insulin sensitivity index (ISI composite); (ii) hepatic ISI; (iii) the first phase of insulin secretion (ΔI30′−0′/ΔG30′−0′). Results were compared with those in 27 weight‐matched patients with simple obesity (OB, 12 males, 15 females; age: 48·1 ± 2·8 years, BMI: 38·5 ± 1·4 kg/m2, WHR: 0·94 ± 0·09; AHI: 2·15 ± 0·5 events/h of sleep) and with 20 normal subjects (NS, 15 females; 5 males, age: 40·4 ± 2·9 years; BMI: 22·2 ± 0·6 kg/m2).

results ISI composite value was significantly lower in OSAS (1·71 ± 1·41) than in OB (3·08 ± 0·27) and in NS (6·1 ± 0·4) even after age‐, BMI‐ and WHR‐adjustment. Similarly, hepatic ISI was significantly different among the three groups (OB = 0·25 ± 0·02, OSAS = 0·16 ± 0·014 and NS = 0·55 ± 0·04). Sex did not affect ISI indices. Insulin secretion estimates were not significantly different among the three groups.

discussion Obese patients with obstructive sleep apnoea syndrome are more insulin resistant than patients with simple obesity independently of the degree and distribution of adiposity. The worsening in insulin sensitivity in obstructive sleep apnoea syndrome patients could reflect the hypoxic state and would account for the increased vascular risk in this condition.
Relationship between longitudinal behaviour of some markers of eye autoimmunity and changes in ocular findings in patients with Graves’ ophthalmopathy receiving corticosteroid therapy
Authors: De Bellis Annamaria , Bizzarro Antonio , Conte Marisa , Coronella Concetta , Solimeno Stefano , Perrino Silvia , Sansone Daniela , Guaglione Mariangela , Wall Jack R. , Bellastella Antonio
Published: August 2003

objective To investigate whether variations over time of TSH‐receptor antibodies (TRAb) and antibodies against G2s (G2sAb) and extraocular muscles (EMAb) can predict worsening of ophthalmopathy in Graves’ patients treated with intravenous glucocorticoid (IVGC) therapy.

patients Of 65 consecutive patients with treated Graves’ disease and severe and active ophthalmopathy (GO) chosen to undergo IVGC treatment, only 57 patients, persistently euthyroid under methimazole therapy, were studied longitudinally for ocular parameters, TRAb, G2sAb and EMAb before therapy, at the end of therapy and, subsequently, every month for 21 months.

measurements TRAb was detected by radioimmunoassay (RIA), G2sAb by enzyme‐linked immunosorbent assay (ELISA) and EMAb by indirect immunofluorescence.

results Forty‐three out of 57 patients (75·4%, group 1) responded positively to therapy [improvement in diplopia and decrease in proptosis and clinical activity score (CAS)] but 14 (24·6%) did not (group 2). During follow‐up after IVGC therapy, 12 out of 43 patients in group 1 (28%) showed a worsening in GO (group 1a), while 31 (72%) had stable ocular conditions or further improvement (group 1b). At the start of the study, TRAb, G2sAb and EMAb were not significantly different among the three groups. At the end of IVGC therapy TRAb levels decreased significantly with respect to starting values in all three groups of patients, whereas G2sAb and EMAb decreased significantly in groups 1a and 1b but not in group 2. During the subsequent follow‐up, 10 patients in group 1a one/two months before and all 12 patients at the time of GO worsening showed an increase in G2sAb and EMAb but not in TRAb, which were consistently absent or present at low titre in all patients in this group. In group 1b TRAb, G2sAb and EMAb further decreased or became negative during the follow‐up period. In all patients, TRAb were positively correlated with both CAS and proptosis only at the start of the study; by contrast, a significant correlation between both G2sAb and EMAb and diplopia was observed in groups 1a and 1b at all the times during the study, except one/two months before the worsening of GO in group 1a.

conclusions Our results indicate that TRAb, G2sAb and EMAb can be considered sensitive markers of Graves’ ophthalmopathy during the initial stages of ophthalmopathy, but that only G2sAb and EMAb seem to be good predictive markers of the outcome in patients after corticosteroid therapy. Thus, taking into account the cost/benefit ratio, a longitudinal evaluation of either EMAb or G2sAb could be useful in monitoring the intravenous glucocorticoid therapy in patients with severe and active ophthalmopathy to predict a possible worsening of Graves’ ophthalmopathy.
Risk factors for and prevalence of thyroid disorders in a cross‐sectional study among healthy female relatives of patients with autoimmune thyroid disease
Authors: Strieder Thea G. A. , Prummel Mark F. , Tijssen Jan G. P. , Endert Eric , Wiersinga Wilmar M.
Published: August 2003

objective Autoimmune thyroid disease (AITD) is a common disorder especially in women, and both genetic and environmental factors are involved in its pathogenesis. We wanted to gain more insight into the contribution of various environmental factors. Therefore, we started a large prospective cohort study in subjects at risk of developing AITD, for example healthy female relatives of AITD patients. Here we report on their baseline characteristics.

subjects Only first‐ or second‐degree female relatives of patients with documented AITD were included.

measurements Smoking habits, oestrogen use, pregnancy history and iodine exposure were assessed by questionnaires, and correlated to the thyroid function and antibody status.

results Of 803 subjects, 440 came from families with more than one patient with documented AITD. Of these families, 33% had documented cases of both Graves’ disease and Hashimoto's thyroiditis. Although the subjects were in self‐proclaimed good health, 3·6% were found to have hypothyroidism (overt disease in 1·3%) and 1·9% had hyperthyroidism (overt disease in 0·4%). These patients were older than the euthyroid subjects and were mostly positive for thyroid peroxidase (TPO) antibodies. Oestrogen use was associated with a lower rate of hyperthyroidism [relative risk (RR) 0·169; 95% confidence interval (CI) 0·06–0·52], whereas having been pregnant was associated with a higher relative risk for hyperthyroidism (RR 6·88; 95% CI 1·50–30·96). Of the 759 euthyroid subjects, 24% had TPO antibodies. Smoking and oestrogen use were negatively correlated with the presence of TPO antibodies. In the euthyroid subjects, TPO antibody titre correlated positively with TSH levels (r = 0·386; P < 0·001).

conclusions The high prevalence of evidence for autoimmune thyroiditis at baseline supports the importance of genetic factors in its pathogenesis. The co‐occurrence of Hashimoto's thyroiditis and Graves’ disease within one family suggests a common genetic basis for these diseases. Oestrogen use is associated with a lower risk, and pregnancy with a higher risk for developing hyperthyroidism. The positive correlation between TPO antibody titres and TSH levels in euthyroid subjects suggests that TPO antibodies are indeed a marker of future thyroid failure.
Time management strategies in nursing practice
Authors: Waterworth Susan
Published: August 2003

Background. With the increasing emphasis on efficiency and effectiveness in health care, how a nurse manages her time is an important consideration. Whilst time management is recognized as an important component of work performance and professional nursing practice, the reality of this process in nursing practice has been subject to scant empirical investigation.

Aim. To explore how nurses organize and manage their time.

Methods. A qualitative study was carried out, incorporating narratives (22 nurses), focus groups (24 nurses) and semi‐structured interviews (22 nurses). In my role as practitioner researcher I undertook observation and had informal conversations, which provided further data. Study sites were five health care organizations in the United Kingdom during 1995–1999.

Findings. Time management is complex, with nurses using a range of time management strategies and a repertoire of actions. Two of these strategies, namely routinization and prioritizing, are discussed, including their implications for understanding time management by nurses in clinical practice.

Conclusions. Ignoring the influence of ‘others’, the team and the organization perpetuates a rather individualistic and self‐critical perspective of time management. This may lead to a failure to address problems in the organizing of work, and the co‐ordinating of care involving other health care workers.
The ideal attributes of Chief Nurses in Europe: a Delphi study
Authors: Hennessy Deborah , Hicks Carolyn
Published: August 2003

Background. Policy decisions to advance the role of Chief Nurse in member countries of the World Health Organization European Region will necessitate the systematic selection and recruitment of suitable postholders who can develop the role and status of nursing within a wide range of political frameworks and structures. Such posts are clearly of great importance for providing appropriate care through strategic and policy decisions, both nationally and internationally. The appointment and development of suitable personnel are, therefore, essential elements in the success of these roles. To date, no information exists about the qualities and attributes required for effective delivery of the Chief Nurse role.

Aim. To identify the characteristics considered to be most relevant in a Chief Nurse, in order to inform and systematize recruitment.

Method. A Delphi study was undertaken of 22 European member states. Consensus was reached by the second round, in which 12 countries participated.

Results. Sixteen relevant qualities were identified and listed in order of importance.

Of the eight countries for which statistical analysis was possible, seven demonstrated a significant level of accord [Belgium, Denmark, the Netherlands, the United Kingdom (UK), Iceland, Sweden, Hungary and Switzerland], with only Finland showing no intra‐country agreement.

Conclusions. To the extent that there is a high level of inter and intra‐country consensus on the desirable qualities of Chief Nurses, these could be used to inform the future systematic selection and operational development of this role in European member states.
Critical realism and psychiatric nursing: a philosophical inquiry
Authors: Littlejohn Christopher
Published: August 2003

Background. There is a tension within contemporary psychiatric nursing between those who would embrace the knowledge and methods of psychiatry and psychology, and those who instead argue for the development of an autonomous nursing profession. This tension cannot be resolved by way of the underpinning philosophies of these positions, namely empiricism and idealism. Instead, critical realism, positioned between these philosophies offers a methodology through which to seek a new paradigm.

Aim. This paper aims to determine whether psychiatric nursing has the potential to exist as an independent and autonomous profession, concerned with providing a helping response to those in mental distress.

Method. The paper asks critical realism's transcendental question in order to identify the a priori requirements of an autonomous psychiatric nursing, independent of both psychiatry and psychology. Consideration of these a priori requirements includes selected information from contemporary texts in order to identify potentially helpful nursing responses to mental distress, as opposed to the theorising that surrounds these helping responses.

Findings. The theories of psychiatry and psychology are neither necessary nor sufficient in providing a foundation for an autonomous psychiatric nursing. While medications have an intrinsic helpfulness for some people, for some of their problems, for some of the time, this does not illuminate the causes of mental distress. There is an intrinsic helping response in human interpersonal communication, yet this is not specific to ‘psychotherapy’ and does not ‘belong’ solely to psychotherapists.

Conclusion. Support is found for an autonomous and independent profession of psychiatric nursing, able to provide a helping response to those in mental distress independent of psychiatry and psychology.
Spirituality and sexual orientation: relationship to mental well‐being and functional health status
Authors: Coleman Christopher L.
Published: August 2003

Background. Research has shown that spirituality has a positive effect on physical and mental health; however, few studies have explored the influence of spirituality and sexuality on mental well‐being and functional health status in people with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS).

Aim. This descriptive cross‐sectional study was designed to examine the relationships among spirituality, sexual orientation, mental well‐being and aspects of functional health status (physical, role, social and cognitive functioning) in a sample of 117 African‐American men and women living with HIV/AIDS.

Methods. Spirituality was measured using the Spiritual Well‐Being Scale. A demographic questionnaire gathered data on sexual orientation, age and gender. The Medical Outcomes Study Questionnaire‐30 assessed aspects of functional health status and mental well‐being. The HIV Symptom Checklist for Persons With HIV disease was used to collect data on HIV symptoms. The data were collected in 1996.

Findings. The findings indicate that spirituality had a direct relationship with cognitive and social functioning and was inversely related to HIV symptoms. Sexual orientation had direct relationships with mental well‐being, cognitive, physical, social and role functioning. t‐Tests showed that heterosexual participants reported poorer mental well‐being and functional health status compared with homosexual participants. Regression analysis showed that spirituality, sexual orientation, age and HIV symptoms contributed significantly to mental well‐being and functional health status.

Conclusions. The regression analysis showed that spirituality, sexual orientation, age and HIV symptoms contributed significantly to mental well‐being and functional health status. Further research is needed to explore the various ways that sexual orientation influences health status findings in those with HIV disease in certain segments of the population. The findings support the inclusion of spirituality as a variable when examining mental well‐being and physical health. Finally, given the limitations of the design, more rigorous methods should be employed to understand further the contribution of spirituality to the health status of African‐Americans living with HIV, because of its social importance to this particular community.
Effects of multi‐sensory stimulation for people with dementia
Authors: Baker Roger , Holloway Jane , Holtkamp Chantal C.M. , Larsson Anita , Hartman Lindy C. , Pearce Rebecca , Scherman Birgitta , Johansson Seija , Thomas Peter W. , Wareing Lesley Ann , Owens Matthew
Published: August 2003

Background. Over recent years multi‐sensory stimulation (MSS) has become an increasingly popular approach to care and is used in several centres throughout Europe. This popularity could be explained by the limited alternatives available to staff and a widely held belief that MSS is a friendly and highly humane approach. A randomized controlled trial was therefore essential to evaluate the effectiveness and extent of the benefits of MSS.

Aim. To assess whether MSS is more effective in changing the behaviour, mood and cognition of older adults with dementia than a control of activity (playing card games, looking at photographs, doing quizzes, etc.).

Methods. A total of 136 patients from three countries [United Kingdom (UK), the Netherlands and Sweden] were randomized to MSS or activity groups. Patients participated in eight 30‐minute sessions over 4 weeks. Ratings of behaviour and mood were taken before, during and after sessions to investigate immediate effects. Pre‐, mid‐, post‐trial and follow‐up assessments were taken to investigate any generalization of effects to cognition and behaviour and mood at home/on the ward or at the day hospital.

Results. There were limited short‐term improvements for both the MSS and activity groups immediately after sessions, and limited short‐term improvements between the groups during sessions. There were no significant differences between the groups when assessing change in behaviour, mood or cognition at home/on the ward or at the day hospital. In the UK, however, behaviour at the day hospital for both groups remained stable during the trial but deteriorated once the sessions had stopped, and active/disturbed behaviour at home improved but likewise deteriorated once sessions had stopped.

Conclusions. Overall, MSS was found to be no more effective than an activity in changing the behaviour, mood or cognition of patients with dementia in the short‐ or long‐term.
Living with the Ilizarov frame: adolescent perceptions
Authors: Martin Linda , Farrell Michael , Lambrenos Karina , Nayagam Duria
Published: August 2003

Introduction. The Ilizarov technique has become an established method in the treatment of children with serious skeletal disorders. Whilst the technique is acknowledged for solving difficult conditions, the application of the external fixator marks the beginning of an arduous treatment programme. Research has suggested that undergoing such treatment can negatively impact upon the physical and psychological well‐being of the young person. Yet limitations in research design reduce the usefulness of the findings, given in that most of the previous studies have used retrospective, quantitative data collection approaches, often with a heterogeneous sample population. We wished to gain a richer insight into the experiences of adolescents living with the frame by drawing on both qualitative and quantitative approaches.

Aims. To explore adolescents’ perceptions of the anticipated and actual impact of the Ilizarov frame on aspects of daily activity.

Design. A mixed‐method approach, using a prospective and longitudinal study design.

Method. Fifteen adolescents undergoing the Ilizarov treatment were contacted at several predetermined time‐points during the course of their treatment to share their perceptions of living with the frame. At several of these points semi‐structured interviews were used to ascertain their perceptions, whilst quantitative data were gained at all time‐points by adolescents completing a range of psychometric measures.

Findings. Adolescents found that life with the frame was not as bad as anticipated, and they adopted a pragmatic approach, appreciating that this was something they ‘just had to get through’. Peers had a substantial role in supporting their friend to adjust and cope with the frame. Psychometric scores were largely within normal limits.

Conclusion. This study suggests that, while the Ilizarov treatment is demanding for adolescents, it is one that they can tolerate without sustained adverse psychological impact.
Baby walkers – health visitors’ current practice, attitudes and knowledge
Authors: Kendrick Denise , Illingworth Rachel , Hapgood Rhydian , Woods Amanda J. , Collier Jacqueline
Published: August 2003

Background. Baby walkers are a commonly used item of nursery equipment. Between 12% and 50% of parents whose infant uses a walker report that their child has suffered a walker‐related injury. Health visitors’ knowledge, attitudes and practice with regard to walkers and related health education has not been explored so far.

Aim. The aim of the study was to describe health visitors’ knowledge of walkers and walker‐related injuries, their attitudes towards walkers and current practice with regard to walker health education, and to examine the relationship between knowledge and attitudes and knowledge and practice.

Method. A survey was carried out with 64 health visitors prior to participation in a randomized controlled trial assessing the effectiveness of an educational package in reducing baby walker use.

Results. The response rate was 95%. Half of the health visitors always discussed walkers postnatally, most frequently at the 6–9 month check. Most did not usually discuss the frequency of walker‐related injuries. Most had negative attitudes towards walkers, but believed that parents hold positive attitudes to them and that it is hard to persuade parents not to use them. Health visitors had a limited knowledge of walker use and walker‐related injuries. Those giving advice on walkers most often had higher knowledge scores than those giving advice less often (P = 0·03). Those with higher knowledge scores held more negative attitudes towards walkers (rs = 0·29, P = 0·023) and believed parents to have more positive attitudes towards walkers (rs = −0·49, P < 0·001). Few health visitors had resources to discuss walkers.

Conclusions. Health visitor advice regarding walkers needs to be given earlier in the postnatal period than is currently common practice, and they need more knowledge about walker use and related injuries. Education about baby walkers needs to be incorporated into undergraduate and in‐service education, which may need to include the development of skills in exploring reasons why parents use walkers and in negotiating alternatives to their use. The provision of audio‐visual aids for discussing walkers might also be helpful.
Approaches to learning: psychometric testing of a study process questionnaire
Authors: Snelgrove Sherrill , Slater Julie
Published: August 2003

Background. One method of evaluating students’ learning is to measure surface, deep and achieving approaches to learning using a questionnaire. In comparison with research on student nurses’ learning styles, there has been little examination of their ‘approaches to learning’. Much of the ‘approaches to learning’ research has been conducted with higher education students in Australia and Hong Kong and this kind of measurement is viewed as a valid and reliable way to assess learning.

Aim. The aim of study reported here was to establish the validity of an ‘approaches to learning’ questionnaire, the study process questionnaire, for use with student nurses by undertaking psychometrical testing, including exploratory factor analysis.

Method. The study process questionnaire is a 42‐item questionnaire measuring surface, deep and achieving approaches to learning. It was distributed to 300 student nurses attending a common foundation programme in a higher education establishment in the United Kingdom (UK) in July 2000. Principal components analysis was conducted to determine the validity of the deep, surface and achievement scales in the questionnaire.

Results. A new factor structure was identified comprising three main scales which were similar in content but not identical to the original questionnaire. The deep factor correlated positively and significantly with grade performance average and sociology examination results.

Conclusion. The study process questionnaire is a valid and useful tool for nurse teachers to gain knowledge about student nurses’ approaches to learning. Deep learning appears to influence academic performance. More work is required to elucidate the complex nature of deep learning.
Individual determinants of research utilization: a systematic review
Authors: Estabrooks Carole A. , Floyd Judith A. , Scott‐Findlay Shannon , O'Leary Katherine A. , Gushta Matthew
Published: August 2003

Context. In order to design interventions that increase research use in nursing, it is necessary to have an understanding of what influences research use.

Objective. To report findings on a systematic review of studies that examine individual characteristics of nurses and how they influence the utilization of research.

Search strategy. A survey of published articles in English that examine the influence of individual factors on the research utilization behaviour of nurses, without restriction of the study design, from selected computerized databases and hand searches.

Inclusion criteria. Articles had to measure one or more individual determinants of research utilization, measure the dependent variable (research utilization), and evaluate the relationship between the dependent and independent variables. The studies also had to indicate the direction of the relationship between the independent and dependent variables, report a P‐value and the statistic used, and indicate the magnitude of the relationship.

Results. Six categories of potential individual determinants were identified: beliefs and attitudes, involvement in research activities, information seeking, professional characteristics, education and other socio‐economic factors. Research design, sampling, measurement, and statistical analysis were examined to evaluate methodological quality. Methodological problems surfaced in all of the studies and, apart from attitude to research, there was little to suggest that any potential individual determinant influences research use.

Conclusion. Important conceptual and measurement issues with regard to research utilization could be better addressed if research in the area were undertaken longitudinally by multi‐disciplinary teams of researchers.
Emotional support and the role of Clinical Nurse Specialists in palliative care
Authors: Skilbeck Julie , Payne Sheila
Published: August 2003

Background. Clinical Nurse Specialists (CNS) play a major role in the delivery of specialist palliative care services to patients with advanced cancer, in hospital, hospice and community settings across the United Kingdom. A major component of their work focuses on the delivery of emotional care and support to patients and their families.

Aim. This paper critically examines the literature on emotional care and support for patients with advanced cancer requiring palliative care. The aim is to increase understanding of how CNSs and patients interact and work together to produce emotionally supportive relationships.

Methods. A literature search was performed using the CINAHL, MEDLINE and ASSIA CD‐ROM databases and combinations of the key words: ‘emotional support’, ‘emotional care’, ‘end of life’, ‘palliative’, ‘terminal illness’, ‘advanced cancer’, ‘Clinical Nurse Specialist’, ‘emotional labour’. Additional relevant articles were identified from the reference lists of papers identified by the literature search.

Findings. The literature revealed a lack of clarity about the terms used to describe emotional care and support. However, at the same time, there is a taken for granted assumption that a shared understanding of these terms exists. Developing supportive nurse–patient relationships involves a complex process, one that consists of getting to ‘know the patient’ through the effective use of communication skills, in a variety of health care contexts. The costs of engaging in ‘emotion work’ are highlighted.

Conclusions. Existing research fails to recognize that emotional care and support as a concept is not a fixed, stable entity learnt through experience and socialization, but is moulded by the process of social interaction and by specific contexts and theoretical perspectives. Further methodologically sound research is needed to explore what happens when emotional care and support are delivered in different care settings, obtaining the views of both parties involved. Implications for the practice of CNSs are discussed.
The structural differences between bovine lens αA‐ and αB‐crystallin
Authors: Abgar Saïd , Backmann Jan , Aerts Tony , Vanhoudt Jos , Clauwaert Julius
Published: August 2003

Lens αA‐ and αB‐crystallin have been reported to act differently in their protection against nonthermal destabilization of proteins. The nature of this difference, however, is not completely understood. Therefore we used a combination of thermally and solvent‐induced structural changes to investigate the difference in the secondary, tertiary and quaternary structures of αA‐ and αB‐crystallin. We demonstrate the relationship between the changes in the tertiary and quaternary structures for both polypeptides. Far‐ultraviolet circular dichroism revealed that the secondary structure of αB‐crystallin is more stable than that of αA‐crystallin, and the temperature‐induced secondary structure changes of both polypeptides are partially reversible. Tryptophan fluorescence revealed two distinct transitions for both αA‐ and αB‐crystallin. Compared to αB‐crystallin, both transitions of αA‐crystallin occurred at higher temperature. The changes in the hydrophobicity are accompanied by changes in the quaternary structure and are biphasic, as shown by bis‐1‐anilino‐8‐naphthalenesulfonate fluorescence and sedimentation velocity. These phenomena explain the difference in the chaperone capacity of αA‐ and αB‐crystallin carried out at different temperatures. The quaternary structure of α‐crystallin is more stable than that of αA‐ and αB‐crystallin. The latter has a strong tendency to dissociate under thermal or solvent destabilization. This phenomenon is related to the difference in subunit organization of αA‐ and αB‐crystallin where both hydrophobic and ionic interactions are involved. We find that an important subunit rearrangement of αA‐crystallin takes place once the molecule is destabilized. This subunit rearrangement is a requisite phenomenon for maintaining α‐crystallin in its globular form and as a stable complex. On the base of our results, we suggest a four‐state model describing the folding and dissociation of αA‐ and αB‐crystallin better than a three‐state model [Sun et al. (1999) J. Biol. Chem. 274, 34067–34071].