bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence‐based medicine and the real world: understanding the controversy
Authors: Ghali William A. , Saitz Richard , Sargious Peter M. ,   ., Hershman Warren Y.
Published: March 2003

Controversy has surrounded the ‘paradigm’ of evidence‐based medicine since its introduction in 1992 as a new approach to the teaching and practice of medicine. Here, we address two questions: (1) is evidence‐based medicine a good thing?; and (2) why has so much controversy arisen? In addressing these questions, we propose that the discussion surrounding evidence‐based medicine should no longer be about whether the application of evidence in clinical practice is a good thing, because it obviously is. Instead, the debate ought to focus on the more difficult question of how to enhance its acceptability among busy clinicians practising in the ‘real world’. For the future, we optimistically anticipate an enhanced adoption of evidence‐based medicine, as clinicians will become increasingly capable of efficiently accessing existing and forthcoming evidence resources.
Ideas and ideals in medicine: fruits of reason or props of power?
Authors: Miettinen Olli S.
Published: March 2003

Editors of medical journals play a central role in the promotion – or suppression – of ideas and ideals in medicine. Recently eminent among these have been the advocacies of the Evidence‐based Medicine (EBM) movement and colleagues concerned with evidence and guidelines for health care. With regard to these topics, it still remains for editors of journals either to advance or to retard even the consolidation of the associated core concepts, most notably those of evidence in medicine, scientific medicine, and rational medicine. I present, first, a case study on the conduct of the editors of three medical journals, specifically their assumption of the role of authority on the scholarly fundamentals of evidence in medicine and their responding to propositions on the topic with commentaries well below the intellectual standards that should prevail in the journals of a learned profession. Then, following a brief review of the Flexnerian and EBM ideas and ideals on the practice of medicine, supplemented by observations drawn from medical sociology and the precepts of the philosophy of science, I posit a way of understanding such behaviour by editors of medical journals. They can have a temptation, and apparently some propensity, to play a regressive role in the development of the fundamentals of medicine. This is prone to occur whenever reason constitutes a threat to power, whether solely to the editors’ own or to that of the profession at large. A full realization of the dream of reason in medicine requires an immense integrity of its journal editors and of its other intellectual leaders.
What is action research and can it promote change in primary care?
Authors: Hampshire A. J.
Published: March 2003

Improving the quality of health care is an international priority. However, research has shown that methods of altering clinician's behaviour or implementing organizational change are often ineffective. Action research has been used successfully to facilitate change and improve service provision in industry, education and more recently in health care. In this paper, action research methodology and why it should be successful in promoting change are outlined. Recently published studies using action research in the primary health care team setting in the UK are discussed. They demonstrate that action research improves clinical care, teamwork, communication and administration. It also encourages practice teams to audit their work and identify their educational needs. The main problems encountered were the amount of time and effort required to maintain collaboration with participants, staff turnover and completing the research process in a short time scale. Action research should be a useful means of improving quality in health care and could be used more widely. In the UK, government strategy has called for individual‐ and team‐based development plans based on individual learning needs. Action research could be a useful method of transforming these from theory to practice.
An evidence‐based approach to drainage of the pleural cavity: evaluation of best practice
Authors: Tang Augustine T. M. , Velissaris Theodore J. , Weeden David F.
Published: March 2003

Recent surveys have uncovered major variations in key aspects of intercostal drain management, suggesting that decisions are being made on individual preferences without resorting to sound evidence. We provide an up‐to‐date review of the best practice with evidence‐based recommendations and expert consensus views. The following aspects of chest drain management have been addressed: indications for drainage, insertion technique, complications, management of an indwelling chest drain, indications and technique for removal. The emphasis in this review is that safe intercostal drain practice relies upon adherence to a few important principles. Furthermore, when in doubt, particularly with a complex thoracic problem, one should seek prompt specialist advice.
Calman–Hine reassessed: a survey of cancer network development in England, 1999–2000
Authors: PhD Beth Kewell BA ,   Chris Hawkins MA BA Grad Dip Phys MCSP SRP, PhD Ewan Ferlie BA
Published: March 2003

Rationale, aims and objectives The paper assesses preliminary national data on the development of cancer care networks in England. Methods In January 2000, a national postal survey was sent to lead clinicians at 36 cancer centres and associate centres. Respondents were asked to provide basic numerical data on the design of the network (i.e. its configuration), detailing how many units it encompassed, and whether the centre was a multiple or a single entity. Results The survey highlighted national variations in the size and configuration of networks. The survey also highlighted tentative signs of shifts in clinical practice. The results showed that consultants at cancer centres and units were engaging in two forms of collaboration across centre–unit boundaries. Type 1 involved routine multidisciplinary team (MDT) outreach from centres to units, incorporating joint planning between clinicians at cancer centres and cancer units. Type 2 collaboration involved joint planning but also promoted joint centre and unit training and continuing professional development (CPD) programmes. Conclusions In our estimation, both forms of collaboration represented early evidence of qualitative changes in medical working practices. Organizational changes within cancer services have moved swiftly since initial soundings were taken in 2000 and we update our initial commentary in the light of recent empirical data. The findings may be of wider significance to managers and health practitioners who are working towards the implementation of delivery network elsewhere in the UK National Health Service.
Influence of combined vitamins C and E on non‐specific immunity and disease resistance of rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Wahli  , Verlhac  , Gabaudan  , Schüep  , Meier
Published: March 2003

The effect of various combinations of vitamins C and E on immune response and disease resistance was investigated in rainbow trout, Oncorhynchus mykiss (Walbaum). The following combinations of vitamins were included in the diet (C/E): 0/0, 0/800, 2000/0, 30/30, 30/800, 2000/30, 2000/800. Liver ascorbic acid and alpha‐tocopherol contents reflected the dietary treatments well. Complement levels showed no significant differences. The combination of the high dietary doses of vitamins C and E significantly stimulated lymphoproliferation induced by Concanavalin A when compared with fish fed a low level of both vitamins, but also when compared with fish fed a low level of vitamin C and a high level of vitamin E. The highest macrophage oxidative burst activity, measured by chemiluminescence, was found in fish receiving both vitamins at high levels. In the disease resistance experiments, the best survival rates in trout infected with viral haemorrhagic septicaemia virus were achieved with diets containing both vitamins at a high level, or at least one at a high and the other at a low level. Highest mortalities in fish infected with Yersinia ruckeri occurred in trout fed double‐deficient or double low diets. The best survival of fish exposed to Ichthyophthirius multifiliis was achieved with diets high in one and low in the other, or high in both vitamins. However, differences were not statistically significant in the parasite experiment.
The effects of hydrogen peroxide treatment on different life‐cycle stages of the salmon louse, Lepeophtheirus salmonis (Krøyer 1837)
Authors: McAndrew K J , Sommerville C , Wootten R , Bron J E
Published: March 2003

The effects of hydrogen peroxide administered at a concentration of 1500 ppm for 20 min at 7.5 °C on different life‐cycle stages of Lepeophtheirus salmonis were examined experimentally. The mobile adult and pre‐adult stages of L. salmonis readily reattached to Atlantic salmon after hydrogen peroxide treatment. Adult female lice, but not adult males or pre‐adults, reattached in significantly lower numbers than untreated controls. Survival of early chalimus stages (I and II) was not affected by hydrogen peroxide treatment, but their subsequent development to chalimus III and IV was delayed compared with untreated controls. Nauplii and copepodid larvae of L. salmonis were almost all dead by 1 hour post‐treatment. A very few copepodids survived 24 h post‐treatment. Egg strings of L. salmonis at an early stage of development failed to hatch after hydrogen peroxide treatment, but those with pigmented eggs did hatch, although in significantly reduced numbers. Treated egg strings did produce viable copepodids, although in significantly reduced numbers compared with controls.
Effects of hydrogen peroxide on clearance of formalin‐killed Flavobacterium branchiophilum from the gills of rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Derksen J. A. , Ostland V. E. , Ferguson H. W.
Published: March 2003

The effect of hydrogen peroxide (H2O2) treatment on the clearance of formalin‐killed Flavobacterium branchiophilum from the gills of rainbow trout was examined. In untreated control fish, clearance was characterized by a rapid initial phase, with 50% reduction in bacterial antigen in the first 12 h after exposure. The bacteria then cleared more gradually, with total clearance being achieved by 40 h. Treatment of fish with 100 p.p.m. H2O2 did not influence bacterial clearance compared to untreated controls. Exposure for 1 h to H2O2 concentrations ≤ 100 p.p.m. caused no detectable clinical signs or evidence of ultrastructural damage to the respiratory epithelium. However, levels in excess of this caused significant gill damage.
Nocardiosis in tank‐reared Atlantic salmon, Salmo salar L.
Authors: Bransden M P. , Carson J. , Munday B L. , Handlinger J H. , Carter C G. , Nowak B F.
Published: March 2003

Nocardiosis is an infection caused by aerobic Gram‐positive, branching, filamentous rods of the genus Nocardia. The organism is resident in both soil and plants (
Austin & Austin 1993;
Frerichs 1993), and is closely related to Mycobacterium spp. Nocardiosis caused by Nocardia asteroides and N. seriolae (previously N. kampachi) has been reported in several finfish species, both freshwater and marine. The first reported incidence was recorded by
Valdez & Conroy (1963) in neon tetras, Hyphessobrycon innesi (Myers), and subsequently in other fish species, some of commercial significance including rainbow trout, Oncorhynchus mykiss (Walbaum) (
Snieszko, Bullock, Dunbar & Pettijohn 1964), brook trout, Salvelinus fontinalis (Mitchill), (
Campbell & MacKelvie 1968) and yellowtail, Seriola quinqueradiata (Temminck & Schlegel;
Kubota, Kariya, Nakamura & Kira 1968). Despite two of these incidences occurring in salmonids, infection by Nocardia spp. in Atlantic salmon, Salmo salar L., has not previously been reported.
Pathogenicity of Vibrio harveyi to salmonids
Authors: Zhang X‐H , Austin B
Published: March 2003

Out of 19 Vibrio harveyi isolates obtained from a diversity of hosts and geographical locations, 14 were pathogenic to rainbow trout, Oncorhynchus mykiss (Walbaum), and Atlantic salmon, Salmo salar L., with mortalities of up to 100% following intraperitoneal injections of 106 cells fish−1. The extracellular products (ECPs) of only five pathogenic isolates were harmful to fish. Both pathogenic and non‐pathogenic cultures produced ECPs containing caseinase, gelatinase, phospholipase, lipase and haemolysins. Vibrio harveyi VIB 645, which was the most pathogenic isolate, produced ECPs with a maximal effect on salmonids from preparations obtained by using cellophane overlays on tryptone soya agar supplemented with 1% (w/v) sodium chloride with incubation at 28 °C for 24 h. This preparation contained the highest titre of haemolytic activity to Atlantic salmon (1:256) and rainbow trout (1:32) erythrocytes.
Characterization and application of monoclonal antibodies against white spot syndrome virus
Authors: Shih  , Wang  , Tan  , Chen
Published: March 2003

Three hybridoma clones secreting monoclonal antibodies (MAbs) were produced from mouse myeloma and spleen cells immunized with white spot syndrome virus (WSSV) isolated and purified from Penaeus monodon (Fabricius), collected from north‐eastern Taiwan. By sodium dodecyl sulphate–polyacrylamide gel electrophoresis (SDS–PAGE), the protein profile of this isolate contained four major proteins with sizes of approximately 35 (VP35), 28 (VP28), 24 (VP24), and 19 kDa (VP19). Western blot analysis revealed that two MAbs (1D7 and 6E1) recognized epitopes on VP28 and one MAb (3E8) recognized an epitope on VP19. The MAb 6E1 isotyped to the IgG1 class was used in both an indirect immunofluorescence assay (IFA) and in an immunochemical staining protocol for successful identification and localization of WSSV in infected shrimp tissues. Antigenic similarity of isolates from Indonesia and Malaysia to the Taiwan isolate was illustrated by IFA with MAb 6E1. A MAb (2F6) which bound specifically to two shrimp proteins, 75 and 72 kDa, and reacted to the healthy and non‐target tissues of WSSV in infected shrimp, such as hepatopancreas, is also described here and shows the necessity for specific identification of antibodies.
Cytotoxic activity against prelabelled RTG‐2 cells in the turbot, Scophthalmus maximus (L.)
Authors: Tafalla  , Figueras  , Novoa
Published: March 2003

Leucocytes derived from head kidney, blood and spleen of turbot, Scophthalmus maximus (L.), exhibited cytotoxic activities against an established cell line (RTG‐2) derived from rainbow trout, Oncorhynchus mykiss (Walbaum). The optimal effector:target ratio, temperature and incubation period for the activity was determined. Cytotoxicity was not caused by released factors, as effector:target contact was needed. Visualization of the cultures under the transmission electron microscope corroborated the contact between leucocytes and target cells and suggested the implication of monocyte‐like cells in this cell‐mediated cytotoxicity.
Use of microencapsulated fish oil as a means of increasing n‐3 polyunsaturated fatty acid intake
Authors: Higgins S. , Carroll Y. L. , O'Brien N. M. , Morrissey P. A.
Published: March 2003

Background: The successful incorporation of fish oil into foods may provide a means of increasing intakes of n‐3 polyunsaturated fatty acids (n‐3 PUFA). The aim of the present study was to evaluate the bioavailability of n‐3 PUFA in microencapsulatd fish oil compared with a fish oil capsule.

Methods: Twenty‐eight healthy volunteers were recruited to take part in this randomized controlled trial. Volunteers were supplemented with 0.9 g n‐3 PUFA daily for 4 weeks, delivered either as microencapsulated fish oil in a milkshake or as a fish oil capsule. Plasma fatty acid composition and plasma total cholesterol levels were measured at baseline and after supplementation. In addition, volunteers completed a questionnaire on fish consumption, use of supplements and exercise.

Results: Responses to the questionnaire indicated that the males who took part in this study took more physical exercise, consumed less fish and were less likely than the females to take supplements. Plasma n‐3 PUFA concentrations were raised significantly and by a similar level by both fish oil supplements. Furthermore, no significant difference was observed in plasma n‐3 PUFA concentrations following supplementation with either form of fish oil. Plasma total cholesterol levels were not significantly altered by n‐3 PUFA supplementation in either group. The results of this study indicated that there was no difference in the bioavailability of n‐3 PUFA given as microencapsulated fish oil compared with n‐3 PUFA delivered as a fish oil capsule. Fortification of foodstuffs with microencapsulated fish oil therefore offers the potential to increase intakes of n‐3 PUFA in line with current recommendations.
Dietitians and supervision: should we be doing more?
Authors: Kirk S. F. L. , Eaton J. , Auty L.
Published: March 2003

As the role of the dietitian has expanded over recent years, many are becoming increasingly involved in the care and management of vulnerable individuals, both alone and as part of multidisciplinary teams. This raises an important question – how are we as a profession managing our changing role in the health care setting? The advent of Clinical Governance means there is a need for dietitians to join the debate on the issue of supervision, which has been raging in the nursing and other health professions over recent years. This article attempts to define the terms supervision and clinical supervision both globally and in the context of dietetics, to describe models of clinical supervision being used in other professional groups and to put forward a framework for addressing whether there is a need for clinical supervision in all areas of dietetic practice.
Consumption of soup and nutritional intake in French adults: consequences for nutritional status
Authors: Bertrais S. , Galan P. , Renault N. , Zarebska M. , Preziosi P. , Hercberg S.
Published: March 2003

Aim

The impact of soup consumption on nutrient intake and nutritional indicators was assessed in adults who consumed soup compared to those who did not or who were occasional eaters.

Methods

Data were obtained for 2188 men and 2849 women living in France and participating in the SU.VI.MAX cohort, who reported twelve 24‐h dietary records during a 2‐year follow‐up period (60 444 records). Subjects were divided into three groups: (1) those who ate soup 0–2 days or less out of 6 days were classified as occasional or non‐consumers; (2) those who consumed soup 3–4 days out of 6 were defined as regular consumers; (3) those who consumed soup 5–6 days out of 6 were defined as heavy consumers.

Results

Seven per cent of women and 9% of men were heavy consumers of soup. Respectively, 46 and 42% were regular, and 47 and 49% were occasional or non‐consumers. Mean energy intake was lower in heavy consumers than in occasional or non‐consumers, but the difference was statistically significant only in women. In men and women, heavy consumers of soup had significantly higher intakes of carbohydrates than occasional and non‐consumers (245 g J−1 vs. 227 g J−1 in men; 186 g J−1 vs. 176 g J−1 in women) and lower lipid intakes (97 g J−1 vs. 102 g J−1 in men; 80 g J−1 vs. 75 g J−1 in women). Soup consumers presented lower energy intake at dinner than light or non‐consumers. In soup consumers, breakfast and lunch contained greater amounts of carbohydrates, lipids and proteins, but dinner contained significantly smaller amounts of lipids and proteins.

A higher frequency of BMI > 27 kg m−2 was found in occasional and non‐soup consumers; conversely a higher frequency of BMI between 23 and 27 kg m−2 was found in regular consumers of soup and a higher frequency of BMI < 23 kg m−2 in heavy consumers. For women, an association was found between occasional or non‐ consumers and BMI > 25 kg m−2 and between heavy consumers and BMI < 22 kg m−2. Likewise an association was found in men only between heavy consumption of soup and lower value of serum cholesterol.

Conclusion

The present data suggest that the consumption of soups contributes to a balanced diet. Consumption of soup may be beneficial for a healthy nutritional status in the overall population.
Dietetic guidelines: diet in secondary prevention of cardiovascular disease
Authors: Hooper L.
Published: March 2003

Aim

To produce dietetic guidelines summarizing the systematic review evidence on dietary advice for secondary prevention of cardiovascular disease.

Methods

The Cochrane Library,MEDLINEandEMBASEwere comprehensively searched for systematic reviews on aspects of diet and heart health. Reviews were included if they searched systematically for randomised controlled trials relating to diet and secondary prevention of cardiovascular disease. Two members of the UK Heart Health and Thoracic Dietitians Group critically appraised each review. The quality and results of each review were discussed and summarized in a whole group meeting. The guidelines were trialled in seven dietetic departments and modified where necessary.

Results

Providing evidence‐based dietary information (including increasing omega‐3 fat plus fruit and vegetable intake) to all people after myocardial infarction will save more lives than concentrating dietary advice on those in need of weight loss or lipid lowering. The practice of prioritizing dietetic time to those with raised lipids is out of date since the advent of statin therapy.

Conclusion

There is good systematic review evidence that dietary advice to those with cardiovascular disease can reduce mortality and morbidity as well as modify risk factors. Dietary advice that does this most effectively should be prioritized.
Information sessions for outpatients referred to a hospital Nutrition and Dietetic Service for cholesterol lowering advice
Authors: Reid V. , Barnes E. , Daly L.
Published: March 2003

Aim  To assess the feasibility of recruiting outpatients referred for cholesterol lowering advice to attend a 1‐h evening information session provided by a hospital dietitian and to evaluate the service.

Method  A Cholesterol Information Session was held on one evening each month between April and September 2000. Patients referred to the Nutrition and Dietetic Service for cholesterol lowering advice were sent appointments for these sessions by post instead of a one‐to‐one daytime appointment with the dietitian. At the session, the dietitian explained what cholesterol is and gave advice about the healthy eating and lifestyle changes needed to control it. Video material and literature were used to support verbal information. Questions were encouraged throughout the session.

Results  Thirty‐four patients were sent appointments. Twenty‐seven (79%) attended, 10 of whom were accompanied by a spouse/partner/carer/family member. All patients who attended completed evaluation forms. There was a high level of satisfaction with the sessions. Twenty‐six patients (96%) said they liked the way the session was runand found the advice and videos helpful. Twenty‐five patients (93%) preferred the evening appointment to a day time one. Patients who attended with a spouse/partner/carer/family member indicated it was helpful to them and the accompanying person. Feedback through patient comments was positive. The seven patients (21%) who did not attend the sessions made contact with the dietetic service.

Conclusion  As a result of the positive outcome of the evaluation, the Cholesterol Information Session is continuing as a service to patients. It provides a facility outside the usual hours of outpatient services and can readily accommodate accompanying people. The information session uses the group format, which may be applicable to other specialist areas of the Nutrition and Dietetic service in the future, such as diabetes management.
Velo‐cardio‐facial syndrome, schizophrenia and deletion at chromosome 22q11
Authors: Chow L. Y. , Waye M. M. Y. , Garcia‐Barcelo M. , Chiu H. F. K. , Fung K. P. , Lee C. Y.
Published: March 2003

A man with intellectual disability presented with schizophrenia, hypocalcaemia, facial dysmorphism and cleft soft palate. Velo‐cardio‐facial syndrome was diagnosed and deletion at 22q11 was confirmed by fluorescent in situ hybridization.
A questionnaire survey of sleep and night‐time behaviour in a community‐based sample of adults with intellectual disability
Authors: Brylewski J. E. , Wiggs L.
Published: March 2003

Two hundred and five people with intellectual disability, aged 18 years or over, and living in health‐ or social‐services‐managed community housing, completed sleep and behaviour questionnaires. An 85.7% return rate was achieved. Settling problems were present in 26.8% and night waking in 55.6% of the subjects. Parasomnias were present in 14% of subjects and 15% of the sample showed some features associated with sleep‐related breathing problems. Factors associated with sleep‐related problems included gender, aetiology of intellectual disability, epilepsy, treatment with antiepileptic medication, evening caffeine consumption, nocturnal urinary incontinence and ability to communicate. Significant sleep‐related problems were demonstrated in this population; some of these problems might be avoided by simple measures.
The Rorschach Egocentricity Index in subjects with intellectual disability: a study on the incidence of different psychological pathologies
Authors: Colucci G. , Pellicciotta A. , Buono S. , Di Nuovo S. F.
Published: March 2003

The aims of the present research were to assess the level of self‐concern in people with intellectual disability using the Rorschach Egocentricity Index, to correlate the Index with other Rorschach and IQ variables, and to study the effect of associated psychological pathology. The Rorschach Inkblot Test and the Wechsler Intelligence Scale were administered to a group of 75 subjects with intellectual disability, aged between 18 and 38 years, who were divided into subgroups according to their additional diagnosis (i.e. personality disorders, psychosis and depression). A fourth subgroup was composed of people with intellectual disability but without other pathologies. The Egocentricity Index was very low in the subjects with intellectual disability and differences were a result of the effects of additional psychological pathologies. The meaning of the measurement of egocentricity in people with intellectual disability is discussed.
Osteoporosis and intellectual disability: is there any relation?
Authors: Wagemans A. M. A. , Fiolet J. F. B. M. , Van Der Linden E. S. , Menheere P. P. C. A.
Published: March 2003

One of the causes of osteoporosis is immobility. The present study examined osteoporosis in 23 bedridden adults with intellectual disability. It was found that the bone mineral density of the subjects was low, even though their calcium intake was more than adequate. Vertebral and other fractures were concentrated mainly in the elderly subjects (> 50 years). Very low vitamin D levels were also found in the subjects despite good nutritional levels. It is concluded that people with intellectual disability and mobility disorders are at risk of metabolic bone disease.
Diverse diagnostic and behavioural patterns amongst people with a dual diagnosis
Authors: Dudley J. R. , Ahlgrim‐Delzell L. , Calhoun M. L.
Published: March 2003

People who have both an intellectual disability and a mental illness diagnosis are gaining more attention in the mental health and developmental disabilities service systems. This interest is partly because of the challenging behaviours and the complexities of the problems in this population. The present study analyses the diagnoses, behaviour problems and demographic characteristics of a group of people with a dual diagnosis to determine if specific patterns are evident which distinguish this set of subjects. A group of 940 people who were part of a class action lawsuit in North Carolina, USA, were investigated. A factor analysis was conducted to determine whether or not distinct patterns or factors were evident. This analysis revealed six distinct patterns primarily based on the behaviour problems of this group and secondarily based on their diagnoses. These six factors are referred to as: (1) aggressive/disturbing behaviour; (2) withdrawal/asocial behaviour; (3) inappropriate behaviours; (4) sociopathic characteristics; (5) suicidal or runaway crises; and (6) pica disorder. The findings suggest that mental illness is a prominent characteristic of some of the six factors but not of others. Furthermore, an intellectual disability diagnosis and the particular level of intellectual disability are reflected very differently amongst all of these factors.
Organizational culture and staff outcomes in services for people with intellectual disabilities
Authors: Hatton C. , Rivers M. , Mason H. , Mason L. , Emerson E. , Kiernan C. , Reeves D. , Alborz A.
Published: March 2003

Organizational culture has been shown by organizational psychology to influence important aspects of staff behaviour. In particular, mismatches between staff perceptions of real and ideal organizational cultures have been shown to be associated with a range of negative outcomes for staff, such as stress, sickness and staff turnover. The present study investigates organizational culture in services for people with intellectual disabilities. The aim was to discover the prevalent organizational cultures in these services, and associations between organizational culture and staff outcomes. As part of a large‐scale survey of staff in services for people with intellectual disabilities, information concerning organizational culture and staff outcomes was collected from 450 staff. A self‐report measure of real and ideal organizational culture produced nine dimensions of organizational culture: (1) tolerant/staff‐oriented; (2) achievement‐oriented; (3) innovative; (4) analytical; (5) social relationships; (6) rewarding staff; (7) stable work environment; (8) demanding; and (9) conflict management. These nine dimensions of organizational culture showed generally adequate psychometric properties. While there was some variation in organizational culture across services, there is little variation across staff with different job titles. Overall, the staff rated real organizational cultures to be relatively high in achievement orientation and fostering social relationships, and relatively low in managing conflict and providing rewards for staff. Staff rated ideal organizational cultures to be high in rewarding staff, being tolerant/staff‐oriented and fostering social relationships, and low in demands on staff. Except for the dimension of making demands on staff, where staff rated organizations as considerably higher than ideal, staff generally rated organizations as being less than ideal on all dimensions of organizational culture. Organizational psychology theory predicts that poor ‘person–organization fit’ (i.e. a greater mismatch between real and ideal organizational culture) will be associated with a range of negative staff outcomes. This theory was largely supported by findings of the present study. The implications for practice and for future research are discussed.
Utility of modified DCR‐10 criteria in the diagnosis of depression associated with intellectual disability
Authors: Clarke D. J. , Gomez G. A.
Published: March 2003

A retrospective study of 11 inpatients with intellectual disability who received antidepressant treatment over a 12‐month period indicated the utility of minor modifications to DCR‐10 criteria in the diagnosis of depressive illness. The modifications were made by adding items found in previous research to be behavioural equivalents of depression in people with severe intellectual disability to DCR‐10 criteria. The time course of symptom response to antidepressant treatment was documented. All 11 patients had a remission of depressive symptoms, as described by the modified criteria, within 5 weeks of starting antidepressant treatment.
Developing a model for quality evaluation in residential care for people with intellectual disability
Authors: Maes B. , Geeraert L. , Bruel B. Van den
Published: March 2003

The present article describes the development of a general model for the evaluation, enhancement and assurance of quality of care processes in residential facilities for children and adults with intellectual disability. The framework is based on current theories regarding quality of life and quality evaluation, on a consensus between several participants in Delphi discussion‐rounds, and on a questionnaire for care providers and clients in all Flemish residential facilities. The model describes 13 quality standards and a list of indicators concerning organization and support interventions. Facilities may use this set of criteria and indicators in several ways within a continuous and dynamic system of internal quality assurance. Finally, the prospects of and conditions for the implementation of this model are discussed.
Challenging behaviour in community services
Authors: Joyce T. , Ditchfield H. , Harris P.
Published: March 2003

The implementation of community care in the UK has led to the requirement that services should be able to meet the needs of adults with intellectual disability (ID) and additional needs in terms of challenging behaviour. However, the extent to which people with challenging behaviour are present in the community and the extent to which community services can support them effectively still requires significant research. The present study examines the prevalence of challenging behaviour amongst adults with ID residing in three London boroughs and the issues which arise from service delivery to this client group. All service providers and general practitioners in the area were contacted and asked to identify any individuals with ID and challenging behaviour. All responses were screened, and then key staff were interviewed for information on a range of demographic factors and on the Checklist of Challenging Behaviour. The reliability of the instrument was also assessed. Four hundred and forty‐eight individuals were identified from a total borough population of 670 000. There was consistency in the types of behaviour which were frequently identified across the three boroughs. There were significant levels of self‐injury as well as a range of behaviours of the ‘hard to engage’ type. Most individuals had more then one challenging behaviour and some individuals with seriously aggressive behaviour used local community services. Twenty‐five per cent of the sample lived at home with their families and 50% were in community residential services. The boroughs differed in their ability to manage those with challenging behaviour in that one borough had many more people placed out‐of‐borough. Significant numbers of individuals with challenging behaviour were living in the community. The range and number of behaviours suggest that staff need to be very skilled in supporting such individuals, and that effective planning and support are essential if people with challenging behaviour are to be maintained in community settings.
Transfer and interference of motor skills in people with intellectual disability
Authors: Mohan A. , Singh A. P. , Mandal M. K.
Published: March 2003

Atypical laterality (i.e. the lack of a clear pattern of lateralization) has been found to be a characteristic feature of individuals with intellectual disability (ID). The evidence for this has been based on ‘handedness’ studies which have contained little information about the ability of people with ID to carry out interhemispheric tasks reflecting bilateral transfer or interference. The present study examined this capacity in individuals with ID by utilizing bilateral transfer and interference paradigms. Right‐handed subjects with ID (IQ = 55–76) and controls matched for age and sex were tested for bilateral transfer of motor skill in contralateral hands with a mirror‐drawing task. The subjects were also tested for their ability to perform a finger‐tapping task while processing verbal and non‐verbal stimuli. The findings indicated that people with ID are significantly deficient relative to matched controls in bilateral transfer of motor skills from their non‐preferred (left) hand to their preferred (right) one. The effect of interference during performance of the dual task was significantly greater in individuals with ID. Subjects with ID were found to perform better with their non‐preferred than with their preferred hand. A within‐group comparison revealed that right‐handed performance was more affected by interference than left in these subjects.
Prader–Willi syndrome: new insights in the behavioural and psychiatric spectrum
Authors: Descheemaeker M. J , Vogels A , Govers V , Borghgraef M , Willekens D , Swillen A , Verhoeven W , Fryns J. P
Published: March 2003

Prader–Willi syndrome (PWS) is a genetic disorder caused by the loss of the paternal contribution of the proximal part (15q11–q13) of the long arm of chromosome 15 (i.e. deletion, disomy and imprinting mutation). The syndrome is associated with distinct physical dysmorphism, as well as with specific behavioural and psychopathological characteristics. Psychiatric symptoms in adolescence and adulthood have been described, including acute cycloid psychosis, and obsessive compulsive, bipolar and pervasive developmental disorders. At the Centre for Human Genetics in Leuven, Belgium, 53 individuals (31 children and adolescents, and 22 adults) have been followed up for 15 years by a special multidisciplinary team. Attention was given to their medical, cognitive, behavioural and emotional development, and the evolution of psychiatric disorders in adolescence and adulthood. This study describes the psychiatric problems in four patients diagnosed with acute cycloid psychosis and traces their development from infancy to adolescence. Four other individuals needed psychiatric evaluation and treatment, and could be diagnosed as having unspecified bipolar disorder, also termed unstable mood disorder. Both groups were compared, and significant differences in early development and later evolution into adulthood were noted. The individuals with PWS who later developed psychotic episodes were described as active and extrovert toddlers, and showed autistic behaviour during their primary school education. Their intellectual functioning was in the moderate to severely retarded range. The individuals with PWS who later developed an unstable mood disorder were described as rather passive and introvert toddlers, and they presented less disturbed behaviour during their primary school education. The intellectual functioning of these subjects was in the normal to borderline range.
Getting personal: an exploratory study of intimate and personal care provision for people with profound and multiple intellectual disabilities
Authors: Carnaby S. , Cambridge P.
Published: March 2003

Background Intimate and personal care is a major area of support and provision for people with intellectual disability (ID), particularly those with profound and multiple ID. However, its management and practice has largely been neglected outside the use of individual guidelines and same‐gender intimate care policies, with little research evidence or theoretical literature to inform the planning, conduct and organization of associated care tasks.

Results The present paper reports on the methodology and findings of an exploratory study designed to map the key management and practice issues, and suggest ways forward for the providers of services for people with ID in relation to the quality and outcomes of intimate and personal care.
Involvement with peers: comparisons between young children with and without Down’s syndrome
Authors: Guralnick M. J.
Published: March 2003

Background

It has been well established that heterogeneous groups of young children with mild intellectual disability are at considerable risk of becoming socially isolated from their peers in school, home and community settings.

Method

Matched groups of young children with and without Down’s syndrome (DS) were compared in terms of the children’s involvement with peers, maternal arranging and monitoring of peer play, and maternal beliefs about inclusion.

Results

Despite aetiology‐specific expectations for children with DS, no differences were found for a variety of measures of peer involvement focusing on the frequency of contacts and the characteristics of children’s peer social networks. Maternal arranging of activities with peers was similarly related to peer involvement for both groups of children. Higher ratings of the benefits of inclusion were obtained from mothers of children with DS, but these maternal beliefs were unrelated to maternal arranging or peer involvement.

Conclusions

Parental adaptations to the aetiology‐specific behavioural patterns of children and the general influence of children’s experiences within a developmental framework are discussed in the context of interpreting aetiology‐specific findings.
Self‐concept and adaptive behaviour of people with intellectual disability in integrated and segregated recreation activities
Authors: Duvdevany I.
Published: March 2003

Background

Leisure and recreation are areas in which the inclusion of people with intellectual disability (ID) in the community is required. In Israel, leisure activities have been developed over the past decade as part of the services provided to individuals with ID in the regular programmes of the community. However, even within those frameworks, people with ID are typically segregated from the whole population.

Methods

The purpose of the present study was to examine whether individuals with ID who participate in recreation activities with normal people as equals are different in their self‐concept and adaptive behaviour from their counterparts who participate in segregated recreation programmes. Two hypotheses were examined: (1) whether people with ID who participate in integrated recreation programmes have a higher self‐concept than those who participate in segregate programmes; and (2) whether individuals with ID who have better adaptive behaviour have a higher self‐concept than people with ID who have lower adaptive behaviour.

Results

The hypotheses were partially confirmed. Differences were found in two subscales of self‐concept. First, the physical self‐concept of individuals with ID who participated in integrated programmes was found to be higher than that of their counterparts who participated in segregated programmes. Secondly, satisfaction with the whole self‐concept of people with ID who participated in integrated programmes was found to be higher than of those who participated in segregated programmes.

Conclusions

The implications of the research findings are discussed and future planning is recommended.
Perceived health modifies the effect of biomedical risk factors in the prediction of acute myocardial infarction. An incident case–control study from northern Sweden
Authors: Weinehall  , Johnson  , Jansson  , Boman  , Huhtasaari  , Hallmans  , Dahlen  , Wall
Published: March 2003

Objectives

To assess the importance of biomedical risk factors, social factors and self‐reported health in the prediction of the first event of acute myocardial infarction (AMI) in an apparently healthy middle‐aged population.

Design

An incident case–control study.

Setting

The study was nested within the Västerbotten Intervention Program and the Northern Sweden MONICA cohorts.

Subjects

The study consists of 78 AMI cases with two randomly selected controls per case from the same study cohorts.

Results

Significant odds ratios were found for history of diabetes, daily smoking, cholesterol, body–mass index, hypertension, lower education and perceived ill health. In multivariate logistic regression smoking, hypertension and cholesterol of ≥7.8 mmol L−1 remained significant. An interaction was observed between number of biomedical risk factors and perceived health.

Conclusions

Smoking, hypertension and hypercholesterolaemia explain a major share of incident AMI events in a Swedish middle‐aged population. The study further illustrates that perceived ill health negatively modifies the impact of these risk factors.
Intravenous nitroglycerin reduces ischaemia in unstable angina pectoris: a double‐blind placebo‐controlled study
Authors: Karlberg  , Saldeen  , Wallin  , Henriksson  , Nyquist
Published: March 2003

Karlberg K‐E, Saldeen T, Wallin R, Henriksson P, Nyquist O, Sylvén C (Huddinge Hospital, Huddinge; University of Uppsala, Uppsala; and Södertälje; Sweden). Intravenous nitroglycerin reduces ischaemia in unstable angina pectoris: a double‐blind placebo‐controlled study. J Intern Med 1998; 243: 25–31

Objectives

To study whether intravenous nitroglycerin (NTG) reduces the incidence of ischaemic events and leucocyte activation, as well as inhibiting platelet aggregation in patients with unstable angina pectoris.

Design

Randomized double‐blind placebo‐controlled study.

Subjects

One hundred and sixty‐two patients with a history and electrocardiographic changes suggesting unstable angina pectoris.

Interventions

A 48‐hour titrated intravenous infusion of NTG or placebo.

Results

Of the 162 randomized patients, 19 were excluded because of an acute myocardial infarction on randomization (11 patients) or proven presence of a non‐ischaemic cause of the pain (6 patients). Other causes (2 patients). No differences in the clinical findings were detected between the groups on randomization. In the comparison of NTG and placebo, fewer patients in the former group had more than two new attacks of chest pain lasting for <20 min or one new attack of chest pain lasting >20 min, despite sublingual NTG (13/25, P < 0.03). In addition, the attacks of pain lasting >20 min in the NTG group were delayed compared to those in the placebo group (P < 0.05), suggesting a beneficial effect on these more servere episodes. Fewer patients in the NTG group required more than two sublingual NTG tablets (P < 0.005). NTG also reduced the rate‐pressure product (P < 0.05), compared to placebo after 2 h but not after 24 h. Compared to baseline, platelet aggregation was inhibited in the patients who had received an NTG infusion for 2 h (P < 0.05). In both groups, leucocytes were activated at baseline, but remained unchanged thereafter.

Conclusions

Intravenous NTG seems to reduce myocardial ischaemia in patients with unstable angina pectoris more than the placebo.
Pharmacological treatment of diabetic patients with cardiovascular complications
Authors: Sawicki  , Berger
Published: March 2003

Sawicki PT, Berger M (Heinrich‐Heine University of Düsseldorf, Germany). Pharmacological treatment of diabetic patients with cardiovascular complications (Review). J Intern Med 1998; 243: 181–89.

Cardiovascular complications are frequently present in insulin‐dependent (IDDM) and non‐insulin dependent diabetes mellitus (NIDDM) patients and confer a very poor prognosis. In this overview we critically analyse the current literature with regard to the benefits and also the possible harms of the available pharmacological treatment strategies in these patients. To date, insulin is the only hypoglycaemic agent which has been proven both effective and safe in NIDDM patients with cardiovascular complications. Also, several trials indicate that treatment with oral hypoglycaemic agents may confer a substantial risk in such patients. Conventional antihypertensive treatment, including betablockers and diuretics, has been convincingly shown to reduce mortality and morbidity in diabetic nephropathy and in NIDDM patients. However, this may not be the case with newer antihypertensive agents, such as angiotensin‐converting enzyme (ACE) inhibitors and calcium channel blockers. Likewise, convincing evidence is lacking that these newer antihypertensive agents provide meaningful clinical benefit when compared to the conventional treatment regarding slower progression of diabetic nephropathy or their impact on lipid and glucose metabolism. Cholesterol lowering therapy with statins and aspirin treatment have also been repeatedly shown to improve the prognosis of diabetic patients with coronary heart disease.