bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative split‐face study of 5‐aminolevulinic acid photodynamic therapy with intense pulsed light for photorejuvenation of Asian skin
Authors: KOSAKA Sachiko , YASUMOTO Minako , AKILOV Oleg E. , HASAN Tayyaba , KAWANA Seiji
Published: August 2010

Photodynamic therapy (PDT) with 5‐aminolevulinic acid (ALA) (ALA‐PDT) using intense pulsed light (IPL) as a light source (IPL‐ALA‐PDT) has been used for photorejuvenation, but it is unclear if this protocol can be applied to darker skin types. We performed this study to assess our IPL‐ALA‐PDT protocol for photorejuvenation in Asian skin. To determine an appropriate dose, ALA ointment (0–20%) was applied to the upper arm of five healthy volunteers and the fluorescence intensity (FI) was measured using a spectrofluorometer. Non‐linear regression analysis of FI 2 h after ALA application with global fitting gave a typical sigmoid dose–response curve with R2 = 0.9705 and saturation after 5% ALA. The entire faces of 16 Japanese women with photodamage were then treated with IPL (500–670 and 870–1400 nm, 23–30 J/cm2) 2 h after application of 5% ALA to one side of the face. Three treatments were delivered at 4‐week intervals with follow‐up visits. Comparative analysis of photorejuvenation showed noticeable improvements on both sides of the face, although the reduction in the photoaging score from baseline did not differ significantly between the two sides in all subjects. Despite this finding, 75% of the patients felt that the IPL‐ALA‐PDT‐treated side of the face showed greater improvement than the IPL‐treated side. However, all IPL‐ALA‐PDT‐treated sides showed adverse effects such as erythema and pain. Therefore, we conclude that the IPL‐ALA‐PDT protocol requires optimization for photorejuvenation in Asians.
Safety of meloxicam in patients with aspirin/non‐steroidal anti‐inflammatory drug‐induced urticaria and angioedema
Authors: GÖKSEL Özlem , AYDIN Ömür , MISIRLIGIL Zeynep , DEMIREL Yavuz S. , BAVBEK Sevim
Published: August 2010

It has been proposed that aspirin (ASA) and other non‐steroidal anti‐inflammatory drug (NSAID)‐induced urticaria (UR)/angioedema (AE) are mediated through inhibition of cyclooxygenase‐1 (COX‐1) enzymes. Therefore, drugs with COX‐2 selectivity may be well tolerated in such patients. We investigated the safety of preferential COX‐2 inhibitor meloxicam in subjects with UR or AE type intolerance reaction to classical ASA/NSAIDs. Subjects with reliable or documented history of UR/AE due to classical ASA/NSAIDs underwent a single‐blinded, placebo‐controlled oral challenge with a cumulative dose of 7.5 mg meloxicam on 2 separate days. One‐quarter and three‐quarter divided doses of placebo and the active drug were given at 1‐h intervals. A total of 116 patients (86 women and 30 men, mean age 39.6 ± 12.7 years) were enrolled to the study. The rate of atopy was 25.9%. Mean duration of drug reaction was 87.4 ± 110.8 (1–720) months. Almost half of the patients were multi‐reactors. The most comorbid disease was asthma and the two most frequent NSAIDs inducing UR/AE were paracetamol (19. 6%) and ASA (19%). No reaction to placebo was observed. Ten out of 116 patients (8.6%) developed mild UR/AE, or only erythema and pruritus at a one‐quarter or cumulative dose of 7.5 mg of meloxicam. The remaining subjects (91.4%) tolerated perfectly meloxicam challenge. This study indicates that 7.5 mg meloxicam is a safe alternative for ASA/NSAID‐intolerant UR/AE patients. Intolerance reactions to meloxicam are much milder forms of the patients’ historical ASA/NSAID‐induced cutaneous reactions.
Objective evaluation of photoepilation by phototrichogram
Authors: KIM Beom‐Joon , KIM Mi‐Hyang , OH Jun‐Kyu , RHO Yong‐Kwan , KIM Dong‐Hyun , CHOI Jee‐Woong , YOUN Sang‐Woong , PARK Kyoung‐Chan , HUH Chang‐Hun
Published: August 2010

Photoepilation is one of the most popular cosmetic procedures. However, there has been no objective method to evaluate the efficacy of hair removal. The goal of this study is to evaluate the effect of photoepilation more objectively using a phototrichogram method. Thirteen young, healthy, female volunteers were enrolled in this study. At initial work‐up, semi‐permanent tattoos were marked in both axillae of all the volunteers and hair variables were evaluated by phototrichogram and digital camera. Intense pulsed light‐assisted photoepilations were performed in both axillae of the volunteers twice at 4‐week intervals. At each visit, dermatologists checked changes of hair parameters. Clinically, 8 weeks after two treatments, hair reduction of all patients was achieved. Total hair counts, changes of anagen ratio, non‐vellus hair counts, hair density, anagen growth rate and hair diameter were decreased sequentially and the reduction was statistically significant. No correlations were found between power, pain, patient and doctor evaluations at 4 weeks. Doctor evaluations correlated with anagen hair counts, anagen/total hair ratio, anagen/telogen ratio and total growth rate. Using phototrichograms could be an objective evaluation technique for hair removal. Anagen parameters and total growth rate of hairs in phototrichograms may be able to be predictable values for evaluating epilation.
Mechanisms of dNTP supply that play an essential role in maintaining genome integrity in eukaryotic cells
Authors: Niida Hiroyuki , Shimada Midori , Murakami Hiroshi , Nakanishi Makoto
Published: August 2010

Optimization of intracellular concentrations of dNTPs is critical for the fidelity of DNA synthesis during DNA replication and repair because levels that are too high or too low can easily lead to increased rates of mutagenesis. Recent advances in the analysis of intracellular concentrations of dNTPs have suggested that eukaryotes use diverse mechanisms in supplying dNTPs for DNA synthesis during DNA replication and repair. The enzyme ribonucleotide reductase (RNR) is a key enzyme involved in the synthesis of dNTPs. We found that Tip60‐dependent recruitment of RNR at sites of DNA damage is essential for supplying a sufficient amount of dNTPs for mammalian DNA repair. In this review, we focus on recent findings related to RNR regulation in eukaryotes of the dNTPs supplied for DNA synthesis. We also discuss the effect of this regulation on mutagenesis and tumorigenesis. (Cancer Sci 2010; 101: 2505–2509)
Functional mapping of harpin HrpZ ofPseudomonas syringaereveals the sites responsible for protein oligomerization, lipid interactions and plant defence induction
Authors: HAAPALAINEN MINNA , ENGELHARDT STEFAN , KÜFNER ISABELL , LI CHUN‐MEI , NÜRNBERGER THORSTEN , LEE JUSTIN , ROMANTSCHUK MARTIN , TAIRA SUVI
Published: August 2010

Harpin HrpZ is one of the most abundant proteins secreted through the pathogenesis‐associated type III secretion system of the plant pathogenPseudomonas syringae. HrpZ shows membrane‐binding and pore‐forming activitiesin vitro, suggesting that it could be targeted to the host cell plasma membrane. We studied the native molecular forms of HrpZ and found that it forms dimers and higher order oligomers. Lipid binding by HrpZ was tested with 15 different membrane lipids, with HrpZ interacting only with phosphatidic acid. Pore formation by HrpZ in artificial lipid vesicles was found to be dependent on the presence of phosphatidic acid. In addition, HrpZ was able to form pores in vesicles prepared fromArabidopsis thalianaplasma membrane, providing evidence for the suggested target of HrpZ in the host. To map the functions associated with HrpZ, we constructed a comprehensive series of deletions in thehrpZgene derived fromP. syringaepv.phaseolicola, and studied the mutant proteins. We found that oligomerization is mainly mediated by a region near the C‐terminus of the protein, and that the same region is also essential for membrane pore formation. Phosphatidic acid binding seems to be mediated by two regions separate in the primary structure. Tobacco, a nonhost plant, recognizes, as a defence elicitor, a 24‐amino‐acid HrpZ fragment which resides in the region indispensable for the oligomerization and pore formation functions of HrpZ.
Local factors control the community composition of cyanobacteria in lakes while heterotrophic bacteria follow a neutral model
Authors: DRAKARE STINA , LIESS ANTONIA
Published: August 2010

1. Neutral community models are derived from the proposition that basic probabilities of species loss (extinction, emigration) and gain (immigration, speciation) explain biological community structure, such that species with many individuals are very likely to be widespread. Niche models on the other hand assume that interactions between species and differential resource use mediate species coexistence, thus invoking environmental factors to explain community patterns.

2. In this study, we compared neutral and niche models to test how much of the spatial variability of assemblages of heterotrophic bacteria and phytoplankton in 13 lakes they could explain. Analysis of phytoplankton was restricted to cyanobacteria, so that they could be studied with the same molecular fingerprinting method, automated ribosomal intergenic spaces analysis (ARISA), as heterotrophic bacteria. We determined local biotic and abiotic lake variables as well as lake age, glacial history and distance between sites.

3. The neutral community model had a good fit to the community composition of heterotrophic bacteria (R2 = 0.69), whereas it could not produce a significant model for the community composition of cyanobacteria.

4. The community composition of cyanobacteria was instead correlated to environmental variables. The best model, a combination of total organic carbon, biomass of eukaryotic phytoplankton, pH and conductivity, could explain 8% of the variation. In contrast, variation in the community composition of heterotrophic bacteria was not predicted by any of the environmental variables. Historical and spatial variables were not correlated to the community composition of either group.

5. The pattern found for heterotrophic bacteria suggests that stochastic processes are important. The correlation of cyanobacteria with local environmental variables alone is consistent with the niche model. We suggest that cyanobacteria, a group of organisms containing bloom‐forming species, may be less likely to fit a neutral community model, since these blooms are usually triggered by a particular combination of environmental conditions.
The extant Chaoborus assemblage can be assessed using subfossil mandibles
Authors: QUINLAN ROBERTO , SMOL JOHN P.
Published: August 2010

1. Assemblages of Chaoborus were examined in 80 thermally stratified southern central Canadian Shield lakes to explore whether subfossil mandibles could be useful in assemblage‐level studies of Chaoborus.

2. Chaoborus (Sayomyia) (probably Chaoborus punctipennis in this study region) and Chaoborus flavicans were the most common taxa recorded, while Chaoborus trivittatus was rarer. Chaoborus americanus was not recorded in subfossil assemblages, because no fishless lakes were included in this study. Chaoborus flavicans had higher relative abundances (%) in lakes with higher dissolved organic carbon (DOC), probably because of reduced fish predation in less transparent water.

3. Results from logistic regression indicate that patterns of presence/absence for Chaoborus mandibles in the study lakes were influenced primarily by hypolimnetic oxygen concentration, probably because of the presence or extent of a hypolimnetic refugium from fish predation.

4. Chaoborus species richness in lakes, derived from subfossil assemblages, did not differ significantly from species richness estimates derived from plankton sampling with a net. Patterns of dominance and coexistence [e.g. the widespread co‐occurrence of C. flavicans and C. (Sayomyia)] determined from subfossil assemblages agreed with previous studies of the contemporary living assemblage.

5. These results suggest that subfossil assemblages may be used as an alternative to nocturnal plankton sampling to carry out research on the community ecology of Chaoborus.

6. We propose a hierarchical conceptual model of assemblage‐level patterns of Chaoborus in temperate lakes. Chaoborus americanus dominates in fishless lakes, whereas in lakes with fish Chaoborus is typically absent where there is no anoxic hyplimnion. In lakes with anoxic strata, C. trivittatus tends to dominate in lakes with few fish; in the remaining lakes, C. flavicans and C. (Sayomyia) dominate, although C. flavicans is more relatively abundant in lakes with lower water clarity (higher DOC).
Chromatin dynamics mediated by histone modifiers and histone chaperones in postreplicative recombination
Authors: Endo Hirohito , Kawashima Satoshi , Sato Lui , Lai Mong Sing , Enomoto Takemi , Seki Masayuki , Horikoshi Masami
Published: August 2010

Eukaryotic chromatin is regulated by chromatin factors such as histone modification enzymes, chromatin remodeling complexes and histone chaperones in a variety of DNA‐dependent reactions. Among these reactions, transcription in the chromatin context is well studied. On the other hand, how other DNA‐dependent reactions, including postreplicative homologous recombination, are regulated in the chromatin context remains elusive. Here, histone H3 Lys56 acetylation, mediated by the histone acetyltransferase Rtt109 and the histone chaperone Cia1/Asf1, is shown to be required for postreplicative sister chromatid recombination. This recombination did not occur in the cia1/asf1‐V94R mutant, which lacks histone binding and histone chaperone activities and which cannot promote the histone acetyltransferase activity of Rtt109. A defect in another histone chaperone, CAF‐1, led to an increase in acetylated H3‐K56 (H3‐K56‐Ac)‐dependent postreplicative recombination. Some DNA lesions recognized by the putative ubiquitin ligase complex Rtt101‐Mms1‐Mms22, which is reported to act downstream of the H3‐K56‐Ac signaling pathway, seem to be increased in CAF‐1 defective cells. Taken together, these data provide the framework for a postreplicative recombination mechanism controlled by histone modifiers and histone chaperones in multiple ways.
Haemophilia care in Europe: a survey of 19 countries
Authors: O’MAHONY B. , NOONE D. , GIANGRANDE P. L. F. , PRIHODOVA L.
Published: August 2010

Summary.  In 2009, a questionnaire was circulated to 19 national haemophilia patient organizations in Europe affiliated to the European Haemophilia Consortium (EHC) and the World Federation of Hemophilia (WFH) to seek information about the organization of haemophilia care and treatment available at a national level. The responses received highlighted differences in the level of care despite the recent promulgation of consensus guidelines designed to standardize the care of haemophilia throughout the continent of Europe. There was a wide range in factor VIII consumption with usage ranging from 0.38 IU per capita in Romania to 8.7 IU per capita in Sweden (median: 3.6 IU per capita). Despite the specific inclusion of coagulation factor concentrate in the WHO list of essential medications, cryoprecipitate is still used in some eastern European countries.
The tortoise and the hare: slowly evolving T‐cell responses take hastily evolving KIR
Authors: Van Bergen Jeroen , Koning Frits
Published: August 2010

The killer cell immunoglobulin‐like receptor (KIR) locus comprises a variable and rapidly evolving set of genes encoding multiple inhibitory and activating receptors. The activating receptors recently evolved from the inhibitory receptors and both bind HLA class I and probably also class I‐like structures induced by viral infection. Although generally considered natural killer (NK) cell receptors, KIR are also expressed by a large fraction of effector memory T cells, which slowly accumulate during human life. These effector memory cells are functionally similar to NK cells, as they are immediate effector cells that are cytotoxic and produce IFN‐γ. However, different rules apply to NK and T cells with respect to KIR expression and function. For example, KIR tend to modulate signals driven by the T‐cell receptor (TCR) rather than to act independently, and use different signal transduction pathways to modulate only a subset of effector functions. The most important difference may lie in the rules governing tolerance: while NK cells with activating KIR binding self‐HLA are hyporesponsive, the same is unlikely to apply to T cells. We argue that the expression of activating KIR on virus‐specific T cells carrying TCR that weakly cross‐react with autoantigens can unleash the autoreactive potential of these cells. This may be the case in rheumatoid arthritis, where cytomegalovirus‐specific KIR2DS2+ T cells might cause vasculitis. Thus, the rapid evolution of activating KIR may have allowed for efficient NK‐cell control of viruses, but may also have increased the risk that slowly evolving T‐cell responses to persistent pathogens derail into autoimmunity.
Review of pulp sensibility tests. Part ΙΙ: electric pulp tests and test cavities
Authors: Jafarzadeh H. , Abbott P. V.
Published: August 2010

Jafarzadeh H, Abbott PV. Review of pulp sensibility tests. Part II: electric pulp tests and test cavities. International Endodontic Journal, 43, 945–958, 2010.

The electric pulp test (EPT) is one type of pulp sensibility test that can be used as an aid in the diagnosis of the status of the dental pulp. However, like thermal pulp sensibility tests, it does not provide any direct information about the vitality (blood supply) of the pulp or whether the pulp is necrotic. The relevant literature on pulp sensibility tests in the context of endodontics up to January 2009 was reviewed using PubMed and MEDLINE database searches. This search identified articles published between November 1964 and January 2009 in all languages.

The EPT is technique sensitive, and false responses may occur. Various factors can affect the test results, and therefore it is important that dental practitioners understand the nature of these tests and how to interpret them. Test cavities have been suggested as another method for assessing the pulp status; however, the use of this technique needs careful consideration because of its invasive and irreversible nature. In addition, it is unlikely to be useful in apprehensive patients and should not be required because it provides no further information beyond what thermal and electric pulp sensibility tests provide – that is, whether the pulp is able to respond to a stimulus. A review of the literature and a discussion of the important points regarding these two tests are presented.
Development of a fortified peanut‐based infant formula for recovery of severely malnourished children
Authors: Kane Nimsate , Ahmedna Mohamed , Yu Jianmei
Published: August 2010

A peanut milk‐based infant formula was developed from peanuts. The effects of extraction pH and temperature on the yield and protein content of spray‐dried peanut milk were evaluated. Peanut‐based infant formulas (PBIF‐75) was developed using spray‐dried peanut milk and a premix of vitamins and minerals. Physical properties, approximate composition, minerals, vitamins and amino acid composition, and caloric value of PBIF‐75 were evaluated and compared to those of soya‐based infant formula (SBIF) and World Health Organization (WHO) F‐75. Spray‐dried peanut milk yield was 15–18% with a protein content of 30–45%, depending on the extraction pH and temperature. PBIF‐75 was nearly identical to WHO F‐75 in terms of amino acid profile, most vitamins and minerals, proximate composition, caloric value, and physicochemical characteristics such as water activity and colour. However, few of the vitamins and minerals in PBIF‐75 will require further adjustment to fully meet WHO’s requirements of a recovery formula for undernourished infants.
Characterisation of Sierra Morena citrus blossom honey (Citrus sp)
Authors: Rodriguez Inmaculada , Salud Serrano , Hortensia Galán , Luis Ubera José , Jodral Manuela
Published: August 2010

The citrus blossom honey of Sierra Morena (a mountain chain located in the south of Spain) has been characterised by melissopalinological, physicochemical and sensorial analyses with the aim of establishing criteria for a future Protected Designation of Origin, which includes citrus blossom honey as one of the monofloral types produced in that region. Thus, a content in pollen of Citrus sp. ≥5%, Maurizio classes I and II was established, the accompanying pollen spectrum characteristic being that composed by the Myrtus, Echium, Lavandula, Reseda, Quercus, Olea, Crataegus and Cistus pollen types. The physicochemical parameters set were electrical conductivity ≤0.27 mS cm−1; diastase activity≥ 6 diastase number; colour ≤20 mm Pfund and coordinate CIE‐Lab L = 89.72–95.18, a = −1.28 to 1.05, b = 16.99–21.79, C = 17–21.82, H = 87.23°–92.01°; hydroximethylfurfural ≤10 mg kg−1; free acidity ≤28 milliequivalents/litre and moisture ≤18.5%. From the sensorial study, the following profile, based on the evaluation of attributes on a five‐point scale, was obtained: colour white–pale yellow, fluidity (4.22), odour intensity (3.55), citrus blossom aroma/odour intensity (3.6/3.8), sweetness (3.14), acidity (2.36), freshness (61.5%) and persistence (2.9).
Pain management interventions with parents in the emergency department: a randomized trial
Authors: LeMay Sylvie , Johnston Celeste , Choinière Manon , Fortin Christophe , Hubert Isabelle , Fréchette Gabrielle , Kudirka Denise , Murray Louise
Published: August 2010

lemay s., johnston c., choinière m., fortin c., hubert i., fréchette g., kudirka d. & murray l. (2010) Pain management interventions with parents in the emergency department: a randomized trial. Journal of Advanced Nursing 66(11), 2442–2449.

Aim.  This paper is a report of the efficacy of a parental educational intervention on children’s pain intensity and experience of pain‐related unpleasantness at 24 hours post‐discharge from the emergency department, and on parents’ beliefs about pain.

Background.  Parents’ misbeliefs about pain management may inhibit them from managing their child’s pain appropriately. Educating parents about pain management may increase their knowledge, dispel myths and help decrease children’s pain intensity and unpleasantness related to pain following a visit to an emergency department.

Method.  A randomized design was adopted with samples of parent/child dyads. The experimental group received a bookmark, booklet on pain management and pain scale. The control group only received a pain scale. Pain intensity and unpleasantness were measured at triage and 24 hours after discharge from the emergency department. Parents’ beliefs were measured with the Pain Belief Questionnaire. Data were collected from November 2005 to May 2006.

Results.  Samples of 98 (experimental) and 97 (control) children/parents were recruited. No statistically significant differences were found between both groups regarding pain intensity and unpleasantness, at triage and 24 hours post‐discharge. Results for the Pain Belief Questionnaire were similar between the groups (t = 1·751, P = 0·082).

Conclusion.  The interventions were not effective to reduce pain and unpleasantness related to pain, as well as to improve pain beliefs of parents. Other interventions, such as having parents participate actively in their child’s pain management, might be more effective than a passive educational intervention.
Health index, sense of coherence scale, brief religious coping scale and spiritual perspective scale: psychometric properties
Authors: Rohani Camelia , Khanjari Sedigheh , Abedi Heidar‐Ali , Oskouie Fatemeh , Langius‐Eklöf Ann
Published: August 2010

rohani c., khanjari s., abedi h‐a., oskouie f. & langius‐eklöf a. (2010) Health index, sense of coherence scale, brief religious coping scale and spiritual perspective scale: psychometric properties. Journal of Advanced Nursing 66(12), 2796–2806.

Aim.  This paper is a report of a study to translate one Swedish and three English instruments into the Persian language, and to estimate their validity and reliability.

Background.  The Sense of Coherence Scale, Health Index, Brief Religious Coping Scale and Spiritual Perspective Scale are all well tested instruments for use in nursing research. Since there was no Persian translation of these instruments, they had to be translated and cross‐culturally adapted for nursing research in the Iranian culture.

Method.  After the translation process, sampling for psychometric tests was done. A sample of healthy Iranian people (n = 375) was selected to response to the instruments in 2006, at baseline and 1 month later.

Findings.  Cronbach’s alpha values and intra‐class correlations were high (>0·70). Tests of criterion‐related validity showed that six of the ten hypotheses were confirmed, and the four rejected hypotheses did not imply a threat to validity. Hierarchical multiple regression analysis showed that sense of coherence was the strongest predictor of well‐being (Health Index scores) both at baseline ( = 0·52, P < 0·001) and 1 month later (= 0·58, P < 0·001).

Conclusion.  There is a sound psychometric basis for using the Iranian versions of these instruments in nursing research with the Iranian population. The Sense of Coherence Scale proved to be as valid and reliable as in Western countries, which supports its cross‐cultural applicability.
New graduate nurses’ experiences of bullying and burnout in hospital settings
Authors: Laschinger Heather K. Spence , Grau Ashley L. , Finegan Joan , Wilk Piotr
Published: August 2010

laschinger h.k.s., grau a.l., finegan j. & wilk p. (2010) New graduate nurses’ experiences of bullying and burnout in hospital settings. Journal of Advanced Nursing. 66(12), 2732–2742.

Aim.  This paper is a report of a study conducted to test a model linking new graduate nurses’ perceptions of structural empowerment to their experiences of workplace bullying and burnout in Canadian hospital work settings using Kanter’s work empowerment theory.

Background.  There are numerous anecdotal reports of bullying of new graduates in healthcare settings, which is linked to serious health effects and negative organizational effects.

Methods.  We tested the model using data from the first wave of a 2009 longitudinal study of 415 newly graduated nurses (<3 years of experience) in acute care hospitals across Ontario, Canada. Variables were measured using the Conditions of Work Effectiveness Questionnaire, Negative Acts Questionnaire‐Revised and Maslach Burnout Inventory‐General Survey.

Results.  The final model fit statistics revealed a reasonably adequate fit (χ² = 14·9, d.f. = 37, IFI = 0·98, CFI = 0·98, RMSEA = 0·09). Structural empowerment was statistically significantly and negatively related to workplace bullying exposure (β = −0·37), which in turn, was statistically significantly related to all three components of burnout (Emotional exhaustion: β = 0·41, Cynicism: β = 0·28, Efficacy: β = −0·17). Emotional exhaustion had a direct effect on cynicism (β = 0·51), which in turn, had a direct effect on efficacy (β = −0·34).

Conclusion.  The results suggest that new graduate nurses’ exposure to bullying may be less when their work environments provide access to empowering work structures, and that these conditions promote nurses’ health and wellbeing.
Using research to implement change: the introduction of group activities on a psychiatric unit
Authors: PARAHOO K. , McGURN A. , McDONNELL R.
Published: August 2010

Staff in a psychiatric unit of a general hospital proposed the introduction of a programme of structured group activities, based on their casual observation that patients were sometimes unoccupied and bored. It was decided to collect data systematically in order to inform the implementation of activities.

An activities record sheet was developed to list all activities taking place over a 1‐week period. Questionnaires were administered to patients (n= 23) and staff (n= 20) on the unit to seek their views on the value, type, timing, frequency and location of activities as well as on other related aspects.

Overall, staff made practical and realistic suggestions regarding the implementation of structured group activities. The data collected, although useful in planning change, raised questions about the poor quality of patients' responses and the low response rate (50%) from staff. Implications of these and other issues are discussed.
Incidence and prevalence of lymphoedema: a literature review
Authors: LOGAN VINNY
Published: August 2010

Lymphoedema is a significant health problem for some groups of patients and few health authorities have carried out a systematic health needs assessment for this client group. When planning and developing services, there is a need to demonstrate a knowledge of the literature relating to the incidence and prevalence of this condition. To facilitate interpretation of the literature, clarification of the difference between incidence and prevalence rates is included in this review. It is important that the differences between these rates is clearly understood when considering the nature of a chronic, progressive condition.

The problems inherent in comparing results from studies which use different definitions of what constitutes ‘lymphoedema’, as well as different methods of measurement are acknowledged. A number of studies are examined and using information from this review, it is suggested that the prevalence rate of lymphoedema in women treated for breast cancer is in the region of 25–28%.

Factors which influence the development of lymphoedema, and the controversy concerning axillary node sampling and dissection are discussed. The need to consider patients with lymphoedema due to very advanced cancer, and those with lower limb problems is also highlighted.
Administration of blood transfusions to adults in general hospital settings: a review of the literature
Authors: Wilkinson John , Wilkinson Chris
Published: August 2010

• The Serious Hazards of Transfusion (SHOT) haemovigilance scheme for the United Kingdom and Republic of Ireland has clearly indicated that there are avoidable risks to which recipients of blood transfusion are exposed.

• Sometimes errors in practice have led to serious and even fatal consequences, particularly when a haemolytic response occurs due to an incompatible transfusion.

• Despite the risks, blood transfusion is an important and frequently life‐saving therapy and its use in clinical practice is common.

• This paper discusses recently published national guidelines for the care of recipients of blood transfusion in the light of a review of the literature relevant to the administration of blood transfusions to adults in general hospital settings.

• Recommendations for practitioners, managers and teachers are offered in relation to preventing errors and to patient care associated with blood transfusion in the context of contemporary emphasis upon evidence based care.
The cycle of homelessness in the lives of young mothers: the diagnostic phase of an action research project
Authors: Walters Susan , East Linda
Published: August 2010

• This paper presents the findings of the first stage of an action research project designed to explore the experience of repeated homelessness in the lives of young women. An action research strategy was selected because it offered a framework within which to work with and for rather than on this vulnerable group of service users.

• The women participating in the research developed a conceptual model that captured the essence of their experience, which they named ‘Our Cycle’. They also proposed a system for service delivery, ‘From trauma to recovery: a non‐professional model’.

• The diagnostic phase of the action research has thus resulted in a sound theoretical and practical framework to guide the implementation and evaluation stages of the project, currently being funded through the United Kingdom Department of Health's Health Action Zone initiative.
A discussion of the strengths and weaknesses of ‘reflection’ in nursing practice and education
Authors: Hannigan Ben
Published: August 2010

• This paper begins by exploring the principles underpinning ‘reflective practice’.

• The impact of reflection on the nursing profession is discussed, with particular attention being paid to nursing education.

• The value of reflective practice in nursing has been subject to considerable debate. This paper reviews both the claimed strengths and shortcomings of ‘reflection’, particularly in relation to the use of reflective material in the assessment of students.
Nursing staff perceptions of the behaviour of older nursing home residents and decision making on restraint use: a qualitative and interpretative study
Authors: Hantikainen V.
Published: August 2010

• This study examined staff perceptions of the behaviour of older nursing home residents and how these perceptions govern their decision making on restraint use.

• Data were collected in unstructured interviews with 20 trained and untrained nursing staff from two Swiss nursing homes.

• Data analysis was based on Colaizzi's phenomenological method.

• Two main themes were extracted from the data: (i) situations in which behaviour is perceived in terms of a problem that needs to be controlled and consequently leads to restraint use; and (ii) situations in which behaviour is perceived in terms of something one has to learn to live with and consequently leads to avoidance of restraint.

• Staff members’ choices to perceive resident's behaviour from the angle they did were clearly associated with the rights and responsibilities of both nursing staff and older people.

• It is concluded that the primary source of change towards the avoidance of restraint use does not necessarily lie in external factors, but in staff members themselves.
Eating difficulties, need for assisted eating, nutritional status and pressure ulcers in patients admitted for stroke rehabilitation
Authors: Westergren Albert , Karlsson Siv , Andersson Pia , Ohlsson Ola , Hallberg Ingalill R.
Published: August 2010

• The aim of this study was to describe the types and extent of eating difficulties, the need for assistance when eating, the nutritional status and pressure ulcers in consecutive patients (n=162) admitted for stroke rehabilitation over a period of 1 year.

• Structured observations and assessments of eating, nutritional status (subjective global assessment of nutritional status), pressure ulcers and activities in daily living (Katz ADL‐index) were performed by a nurse who also trained the staff to perform these assessments.

• Difficulties in eating were found in 80%, and 52.5% were unable to eat without assistance. Eating difficulties were: ‘eats three‐quarters or less of served food’ (60%), difficulties in ‘manipulating food on the plate’ (56%), ‘transportation of food to the mouth’ (46%), ‘sitting position’ (29%), ‘aberrant eating speed’ (slow or forced) (26%), ‘manipulating food in the mouth’ (leakage, hoarding, chewing difficulties) (24%), ‘swallowing difficulties’ (18%), ‘opening and/or closing the mouth’ (16%), and ‘alertness’ (9%).

• Thirty‐two percent were undernourished (49% of patients needing assisted eating and 13% of those not needing assistance, P < 0.0005). Among patients who were dependent in one or more functions according to the Katz ADL‐index, 15% had pressure ulcers.

• The strongest eating variables for predicting nutritional status were ‘alertness’, ‘swallowing difficulties’, ‘eats three‐quarters or less of served food’, and ‘aberrant eating speed’. Nutritional status could in turn significantly predict pressure ulcers.

• Eating difficulties among patients with stroke are complex and the patient's situation before stroke adds to this complexity, especially among those dependent on assisted eating.

• As difficulties occur both among patients needing and not needing assisted eating, all patients with stroke admitted for rehabilitation need to be systematically assessed for eating difficulties and action needs to be taken to facilitate eating, especially as patients with eating difficulties risk becoming undernourished and in turn developing pressure ulcers.
Relevance of the diagnosis ‘stage 1 pressure ulcer’: an empirical study of the clinical course of stage 1 ulcers in acute care and long‐term care hospital populations
Authors: Halfens R. J. G. , Bours G. J. J. W. , Van Ast W.
Published: August 2010

• Stage 1 pressure ulcers are difficult to diagnose. Several prevalence studies have shown that almost half of the pressure ulcers identified are stage 1. The present study investigated the importance of stage 1. The following research questions were formulated: Is there a difference between the prevalence of stage 1 pressure ulcers identified in the institutions participating in the present study and that found in the other institutions participating in the Dutch National Prevalence Survey? What percentage of stage 1 pressure ulcers are reversible within a few hours? What is the clinical course of stage 1 pressure ulcers? Which patient characteristics and preventive interventions are related to the clinical course of stage 1?

• The study used a prospective, descriptive and comparative design.

• All patients of six long‐term care hospitals and six acute care hospitals in whom stage 1 pressure ulcers were identified during the 1999 National Prevalence Survey in the Netherlands were followed for 1 week (acute care hospitals; n=68 patients) or 2 weeks (long‐term care hospitals; n=115 patients).

• The patients were reassessed using the questionnaire developed for the National Prevalence Survey (patient characteristics, assessment of risk of pressure ulcers, characteristics of the pressure ulcers and use of preventive methods) on the same day as the national survey itself, and again after 3 days, after 7 days and after 14 days (only long‐term care hospitals).

• The results showed fewer stage 1 pressure ulcers in the institutions participating in the present study than in the National Prevalence Survey, the difference being almost 50%. The first reassessment found the prevalence of stage 1 to be further reduced by an average of almost 50%, a reduction which was greater for the long‐term care hospitals than for the acute care hospitals. However, some of the ulcers that had disappeared reappeared in subsequent reassessments.

• In the long‐term care hospitals, 8.7% of the stage 1 pressure ulcers deteriorated to a higher stage, vs. 22.1% in acute care hospitals.

• No significant patient characteristics were found to affect the course of stage 1, except that women in acute care hospitals more often had a stage 1 pressure ulcer at the first reassessment than men.

• In general, patients whose stage 1 ulcer deteriorated were undergoing more preventive interventions; not all differences were significant.

• We conclude that, although stage 1 is reversible in most cases, it can be interpreted as an important warning sign for nurses and patients to act. If no adequate interventions are applied, the pressure ulcer may deteriorate.
Early recognition of delirium: review of the literature
Authors: Schuurmans Marieke J. , Duursma Sijmen A. , Shortridge‐Baggett Lillie M.
Published: August 2010

• This review focuses on delirium and early recognition of symptoms by nurses.

• Delirium is a transient organic mental syndrome characterized by disturbances in consciousness, thinking and memory. The incidence in older hospitalized patients is about 25%.

• The causes of delirium are multi‐factorial; risk factors include high age, cognitive impairment and severity of illness.

• The consequences of delirium include high morbidity and mortality, lengthened hospital stay and nursing home placement.

• Delirium develops in a short period and symptoms fluctuate, therefore nurses are in a key position to recognize symptoms.

• Delirium is often overlooked or misdiagnosed due to lack of knowledge and awareness in nurses and doctors. To improve early recognition of delirium, emphasis should be given to terminology, vision and knowledge regarding health in ageing and delirium as a potential medical emergency, and to instruments for systematic screening of symptoms.
A study of a training scheme for Macmillan nurses in Northern Ireland
Authors: Gail Johnston
Published: August 2010

Aim.  To evaluate a one year training scheme for Macmillan Nurses.

Background.  The role of the clinical nurse specialist has evolved and expanded greatly over the past few years so that it now encompasses components far beyond the traditional nursing remit of direct clinical practice. While several studies have looked at the barriers and facilitators to this process for clinical nurse specialists in particular, none has looked at the benefits of a structured training scheme which involves both a theoretical and clinical component.

Methods.  Tape recorded, semi‐structured interviews were undertaken with a purposive sample of trainees who undertook the scheme, their practice‐based facilitators and another person(s) involved in the trainee's support

Analysis.  Tapes were transcribed verbatim and each transcript anonymized to prevent identification of participants. Data were analysed thematically using the main headings of expectations, experience and impact and the structured prompts from the aide‐memoir within these headings.

Results.  Results showed that the majority of respondents felt the scheme had been successful with one of the main achievements being that trainees were perceived to be adequately prepared to take on the role of a CNS on completion of the scheme. While the Role Development Programme was thought to provide a good academic structure for the scheme some participants thought that more theory on symptom control and communication skills and a placement in a specialist palliative care centre should also be included.

Conclusion.  The Macmillan Trainee Scheme has succeeded in its objectives to facilitate the transition from generalist to specialist nursing. It should be extended to include an induction and consolidation period and more theoretical input on communication skills and symptom control.

Relevance to clinical practice.  With these improvements, the scheme could be used as a standard model for training specialist practitioners and a means to address the current issues of workforce planning.
Chinese female nurses’ perceptions of male genitalia‐related care – Part 1
Authors: Zang Yu‐Li , Chung Loretta YF , Wong Thomas KS
Published: August 2010

Aims. To explore Chinese female nurses’ experiences of male genitalia‐related care.

Background. Male patients who require male genitalia‐related care may have psychosocial and sexual concerns and needs. Nurses’ attitudes and conduct in the provision of male genitalia‐related care, if negative, may obviate meeting these needs. Previous research indicates that limited studies have been conducted focusing on nurses’ perceptions, responses and attitudes towards male genitalia‐related care. There is a dearth of knowledge about the practice of Chinese female nurses delivering male genitalia‐related care, particularly given that physical contact between Chinese adults of different genders outside marriage is traditionally prohibited.

Design. This study is an exploratory qualitative study.

Methods. Through purposive sampling, eight subjects were approached and semi‐structured interviews were conducted. Digitally recorded interviews were transcribed verbatim and thematic analysis was conducted. The strategies of long engagement, member checking, peer debriefing and journal writing were used to establish trustworthiness.

Results. Two themes emerged from interviews: ‘association with sexuality’ and ‘consequences’. The theme ‘association with sexuality’ comprised the sub‐themes of ‘being sexual’, ‘impact on intimate relationship’ and ‘emotional responses’. The theme ‘consequences’ was constituted by the sub‐themes of ‘care with preconditions’, ‘unavoidable responsibilities’ and ‘limited involvement with implicit approval’.

Conclusions. This study suggests that Chinese female nurses’ perceptions, responses and attitudes towards male genitalia‐related care may be negative, with the consequence that the quality of male genitalia‐related care might be compromised. The Chinese culture of sexual conservativeness may play a critical role.

Relevance to clinical practice. Risks may be embedded in the practice of male genitalia‐related care by Chinese female nurses. Particular attention, therefore, should be drawn to the possibility of adverse effects of Chinese female nurses delivering male genitalia‐related care on them and their patients.
Managing infant feeding practices: the competing needs of bulimic mothers and their children
Authors: Stapleton Helen , Fielder Anna , Kirkham Mavis
Published: August 2010

Aim.  This paper seeks to explain how bulimic mothers accommodated infant feeding demands in conjunction with managing their disordered eating practices.

Background.  Eating disorders are chronic and disabling illnesses primarily affecting women. There are few qualitative studies describing bulimia in the context of motherhood.

Design.  The study employed an inductive qualitative approach.

Methods.  A purposive sample of childbearing women (n = 16), who self‐defined as living with an eating disorder, were recruited. Data were generated from one‐to‐one interviews; a thematic analysis identified key issues.

Results.  Participants were primarily responsible for ensuring child/ren’s socialisation processes, including modelling appropriate dietary behaviours and these demands often conflicted with their personal needs for food restraint. Pressures to participate in social activities with children were widely experienced as stressful especially when these events focused on food. Participants viewed early and repeated exposure to ‘healthy’ eating as protective against their children acquiring an eating disorder and in this respect commercial child‐care facilities provided alternative environments for children to explore food‐related activities.

Conclusions.  Participants employed a variety of strategies to ensure children’s exposure to normalising influences and socialising processes. Concerns about personal competencies with respect to food preparation and storage were articulated by all participants.

Relevance to clinical practice.  Professionals involved with providing care to mothers and their infants are well placed to support bulimic clients and to foster confidence in their mothering skills. Early and appropriate intervention is key to effecting positive changes in bulimic patterns, with potential benefits to women’s future health and well‐being and that of their children.