bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of offering silage during housing at night on the performance of grazing dairy cows and on labour requirements
Authors: Ferris C. P. , Binnie R. C. , Frost J. P. , Patterson D. C.
Published: February 2008

In the UK, dairy cows are increasingly housed at night throughout the grazing season. However, there is limited information on cow performance and the impact on labour requirements when a forage supplement is offered during housing at night throughout the entire grazing season. The effects of housing at night were studied in two experiments, in which two treatments were compared. On treatment part‐grazing (PG), dairy cows were given access to grazing by day and were offered grass silage while housed at night, and, on treatment continuous grazing (CG), dairy cows were given access to grazing both by day and by night. Experiments 1 (138‐d duration) and 2 (127‐d duration) involved sixty (primiparous) and seventy‐six (primiparous and multiparous) Holstein‐Friesian dairy cows respectively. Concentrates were offered during milking at 4·0 and 3·0 kg per cow per day in Experiments 1 and 2 respectively. In Experiment 1, total milk output was significantly higher with treatment PG than treatment CG (P < 0·01) while the reverse occurred in Experiment 2 (P < 0·001). Milk protein concentration was significantly higher with treatment CG in Experiments 1 and 2 (P < 0·001). Cows on treatment CG in Experiment 2 had significantly higher body condition scores and live weights at the end of experiment than those on treatment PG (P < 0·05). Weekly labour requirements were calculated to be proportionally 0·04 lower on treatment PG than on treatment CG. When offered silage during housing at night, the response of grazing dairy cows was largely determined by the grazing conditions encountered and the quality of the forage offered.
Manipulation of herbage production by altering the pattern of applying nitrogen fertilizer
Authors: Hennessy D. , O’Donovan M. , French P. , Laidlaw A. S.
Published: February 2008

The redistribution of herbage production during the growing season to synchronize herbage supply with feed demand by livestock by altering the application pattern of a range of nitrogen (N) fertilizer rates was studied. Application rates of N were 50, 150 and 250 kg N ha−1 per annum and patterns were with 0·60 of N fertilizer applied before June (treatment RN) and with only 0·20 of N fertilizer before June (treatment IN). Treatments were imposed in a cutting (simulated grazing) experiment (Experiment 1), which was conducted for 2 years and a grazing experiment (Experiment 2) which was conducted for 3 years. In both experiments, herbage production was reduced in April and May and increased in the June–October period on treatment IN relative to RN, but annual herbage production was not significantly affected except in the third year of Experiment 2, when treatment RN had significantly (P < 0·05) higher herbage production than treatment IN. Crude protein (CP) concentration of herbage was lower in April and May on treatment IN than treatment RN. However, CP concentration of herbage was rarely below 150 g kg−1 DM and so it is unlikely that livestock productivity would be compromised. On treatment IN, concentrations of CP in herbage were higher in the late summer than on treatment RN, which may increase livestock productivity during July and August when livestock productivity is often lower. Altering the strategy of application of N fertilizer did not affect in vitro dry matter digestibility of herbage.
Anthropogenic disturbance and the formation of oak savanna in central Kentucky, USA
Authors: McEwan Ryan W. , McCarthy Brian C.
Published: February 2008

Aim  To deepen understanding of the factors that influenced the formation of oak savanna in central Kentucky, USA. Particular attention was focused on the link between historical disturbance and the formation of savanna ecosystem structure.

Location  Central Kentucky, USA.

Methods  We used dendrochronological analysis of tree‐ring samples to understand the historical growth environment of remnant savanna stems. We used release detection and branch‐establishment dates to evaluate changes in tree growth and the establishment of savanna physiognomy. We contrasted our growth chronology with reference chronologies for regional tree growth, climate and human population dynamics.

Results  Trees growing in Kentucky Inner Bluegrass Region (IBR) savanna remnants exhibited a period of suppression, extending from the establishment date of the tree to release events that occurred c. 1800. This release resulted in a tripling of the annual radial growth rate from levels typical of oaks suppressed under a forest canopy (< 1 mm year−1) to levels typical of open‐grown stems (3 mm year−1). The growth releases in savanna trees coincided with low branch establishment. Over the release period, climatic conditions remained relatively constant and growth in regional forest trees was even; however, the growth increase in savanna stems was strongly correlated with a marked increase in Euro‐American population density in the region.

Main conclusions  Our data suggest that trees growing in savanna remnants originated in the understorey of a closed canopy forest. We hypothesize that Euro‐American land clearing to create pasturelands released these trees from light competition and resulted in the savanna physiognomy that is apparent in remnant stands in the IBR. Although our data suggest that savanna trees originated in a forest understorey, this system structure itself may have been a result of an unprecedented lack of Native American activity in the region due to population loss associated with pandemics brought to North America by Euro‐Americans. We present a hypothetical model that links human population dynamics, land‐use activities and ecosystem structure. Our model focuses on the following three land‐use eras: Native American habitation/utilization; land abandonment; and Euro‐American land clearance. Ecological understanding of historical dynamics in other ecosystems of eastern North America may be enhanced through recognition of these eras.
Quality of institutional care of older people as evaluated by nursing staff
Authors: Isola Arja , Backman Kaisa , Voutilainen Päivi , Rautsiala Tarja
Published: February 2008

Aims.  The aim of this paper was to report on the quality of institutional nursing of older people as evaluated by nursing staff in 2001 and to compare the responses with those obtained in 1998.

Background.  The healthcare division of one Finnish city authorised an outside survey of long‐term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of care of older people were issued. A re‐survey was conducted in 2001, using the same criteria of quality assessment.

Methods.  A survey research method was used. All the seven institutions providing long‐term geriatric care, including a total of 53 wards, participated. In 1998, a total of 607 questionnaires was returned. The response percentage was 78·6%. In 2001, a total of 573 questionnaires was returned. The response percentage was 76·8%.

Results.  The staff considered their possibilities to help geriatric patients best in the domain of physical care and slightly less good in the domain of psychosocial care. The differences in staff estimates between the two years were very small. More than 90% of the respondents considered their knowledge of physical care adequate. The nursing staff's evaluations were roughly similar in 1998 and 2001. More than 98% of the respondents considered the helping of older people important or moderately important in the other subdomains except sexual expression. According to the nursing staff, intentional or unintentional negligence in care was more common than physically or psychically offensive conduct. Observations concerning maltreatment had increased from 1998 to 2001. The staff reported both physical and mental fatigue. Nevertheless, the nursing staff appeared to be quite content with their current workplaces.

Relevance to clinical practice.  The findings indicated that geriatric care mostly aims to respond to the physical needs of older people. Nursing should, therefore, be developed and improved because mere satisfaction of physical needs is not enough to guarantee a good quality of life for older people in long‐term institutional care.
A systematic review of peer teaching and learning in clinical education
Authors: Secomb Jacinta
Published: February 2008

Aims and objectives.  The purpose of this review is to provide a framework for peer teaching and learning in the clinical education of undergraduate health science students in clinical practice settings and make clear the positive and negative aspects of this teaching and learning strategy.

Background.  The practice of using peers incidentally or purposefully in the clinical education of apprentice or undergraduate health science students is a well‐established tradition and commonly practiced, but lacks definition in its implementation.

Method.  The author conducted a search of health science and educational electronic databases using the terms peer, clinical education and undergraduate. The set limitations were publications after 1980 (2005 inclusive), English language and research papers. Selection of studies occurred: based on participant, intervention, research method and learning outcomes, following a rigorous critical and quality appraisal with a purposefully developed tool. The results have been both tabled and collated in a narrative summary.

Results.  Twelve articles met the inclusion criteria, representing five countries and four health science disciplines. This review reported mostly positive outcomes on the effectiveness of peer teaching and learning; it can increase student's confidence in clinical practice and improve learning in the psychomotor and cognitive domains. Negative aspects were also identified; these include poor student learning if personalities or learning styles are not compatible and students spending less individualized time with the clinical instructor.

Conclusions.  Peer teaching and learning is an effective educational intervention for health science students on clinical placements. Preclinical education of students congruent with the academic timetable increases student educational outcomes from peer teaching and learning. Strategies are required prior to clinical placement to accommodate incompatible students or poor student learning.

Relevance to clinical practice.  The findings from this systematic review, although not statistically significant, do have pragmatic implications for clinical practice. It can increase clinical placement opportunities for undergraduate health students, assist clinical staff with workload pressures and increase clinician time with clients, while further developing students’ knowledge, skills and attitudes.
Self‐care management of sleep disturbances and risk factors for poor sleep among older residents of Taiwanese nursing homes
Authors: Tsai Yun‐Fang , Wong Thomas KS , Ku Yan‐Chiou
Published: February 2008

Aims.  To explore self‐care management strategies for sleep disturbances and risk factors for poor sleep among older residents of nursing homes in Taiwan.

Background.  With the deterioration of health that accompanies ageing, sleep quality becomes poorer, making it a significant issue in geriatric care. However, little is known about self‐care strategies for management of sleep disturbances among elders worldwide.

Design.  A cross‐sectional design was used.

Methods.  Residents (n = 196) were recruited from nine nursing homes chosen by stratified sampling across Taiwan. The Pittsburgh Sleep Quality Index, a self‐care management of sleep disturbance questionnaire and a demographic form were used to collect data.

Results.  The prevalence of poor sleep in these older nursing home residents was 46·4%. Only 48·5% of participants used self‐care strategies to manage sleep disturbances. The most frequently used strategy was ‘take prescribed medicines’. Self‐learning was the main information source for self‐care strategies. Logistic regression analysis indicated that having no spouse and a low educational level significantly predicted poor sleep.

Conclusions.  This study revealed a high prevalence of poor sleep quality among older residents of nursing homes in Taiwan. Older residents’ inability to get relief from sleep disturbances may have been because of their limited use of strategies to manage sleep disturbances.

Relevance to clinical practice.  As health care providers play an important role in helping older people to manage sleep disturbances in nursing homes, it is crucial to train nursing home staff to perform sleep assessments and provide current knowledge about sleep disturbance management. It is also necessary to pay more attention to the sleep problems of elders without spouses and with little education.
Comparison of homecare costs of local wound care in surgical patients randomized between occlusive and gauze dressings
Authors: Ubbink Dirk Th , Vermeulen Hester , Van Hattem Jarne
Published: February 2008

Aims and objectives.  To study the material and nursing costs and outcome of wound care at home comparing two dressing groups (occlusive vs. gauze‐based) in surgical patients after hospital dismissal.

Background.  The large variety in dressing materials and lack of convincing evidence make the choice for optimum local wound care at home cumbersome. Occlusive wound dressings require a lower change frequency than gauze‐based dressings, which appears especially useful for homecare patients and could save costs.

Methods.  We investigated a consecutive series of 76 patients with wounds, included in a randomized trial comparing occlusive vs. gauze dressings. Daily dressing change frequency, consumption of dressing materials and need for district nursing visits were recorded until wound closure by means of diaries and at outpatient visits. Costs were expressed as means and 95% confidence intervals (CI) after calculation using non‐parametric bootstrapping.

Results.  Patient groups were similar regarding age, wound size and aetiology. Dressing change frequency in the occlusive group (median: 0·6/day) was significantly (p = 0·008) lower than in the gauze group (1·1/day). Mean daily material costs of modern dressings were €5·31 vs. €0·71 in the gauze group. Mean difference; €4·60 (95% CI, €2·68–€6·83) while daily total (material plus nursing) costs showed no difference between the groups; mean €2·86 (95% CI, €−6·50–€10·25). Wound healing in the gauze‐treated group tended to be quicker than in the occlusive dressing group (medians: 30 vs. 48 days, respectively; log‐rank p = 0·060).

Conclusions.  The use of occlusive dressings does not lead to a reduction in costs and wound healing time as compared with gauze dressings for surgical patients receiving wound care at home.

Relevance to clinical practice.  District nurses should reconsider using gauze‐based dressings, particularly in surgical patients with exudating wounds.
Can venous and arterial leg ulcers be differentiated by the characteristics of the pain they produce?
Authors: Closs S José , Nelson E Andrea , Briggs Michelle
Published: February 2008

Aim.  To explore the characteristics of venous and arterial leg ulcer pain among people cared for in the community.

Background.  There is little information available concerning the different characteristics of pain resulting from venous and arterial leg ulcers. The identification of clear differences in pain experience might aid recognition of arterial deterioration and provide a useful adjunct for existing diagnostic procedures.

Design.  This was a prospective interview‐based survey.

Method.  Structured interviews were conducted with each of the participants in their home. Ulcer history, pain (McGill pain questionnaire and verbal rating scale) and factors influencing pain were assessed.

Results.  Fifty‐two women and 27 men aged 77·7 (SD 8·9) took part. Pain scores for least, average, worst and present pain varied widely, and arterial ulcers were associated with the highest average pain scores. Pain tended to be worst at night and least in the afternoon; arterial ulcers were more painful than venous ulcers on lying down. Venous leg ulcers were frequently described as throbbing, burning and itchy, while arterial ulcer pain tended to be described as sharp and hurting.

Conclusions.  Some characteristics of pain appeared to be suggestive of the leg ulcer type. Differences were found in the words chosen to describe the pain as well as the temporal and postural aspects of arterial and venous leg ulcer pain. More research is needed to confirm these preliminary findings.

Relevance to clinical practice.  Patients’ descriptions of pain have the potential to supplement other methods of differentiating between types of leg ulcer and provide an early‐warning indicator for transition from venous to arterial ulceration.
Effects of self‐efficacy, self‐care behaviours on depressive symptom of Taiwanese kidney transplant recipients
Authors: Weng Li‐Chueh , Dai Yu‐Tzu , Wang Yi‐Wen , Huang Hsiu‐Li , Chiang Yang‐Jen
Published: February 2008

Aims.  The aim of this study was to examine the effect of self‐efficacy on depression and to consider the mediating effect of self‐care behaviour.

Background.  Depression is a problem for kidney transplant recipients and can compromise their quality of life. From other studies on chronic illnesses, self‐efficacy and self‐care behaviour have been considered to be potential determinants for depressive symptoms. However, none of these previous studies have investigated the relationships among these variables in kidney transplantation recipients.

Design.  A cross‐sectional survey employing correlation design and purposive sampling was used.

Methods.  One hundred and seventy‐seven persons who had received a kidney transplant participated. A self‐administrated questionnaire and a medical record audit were used to collect data. The data were analysed using correlation and hierarchical linear regression methods.

Results.  The average score of depressive symptoms was 8·61 SD 7·64. Among the participants in the study, 32·8% had scores of depressive symptoms higher than 11 (indicating mild to severe symptoms of depression). Self‐efficacy and self‐care behaviour had direct negative effects on depressive symptoms. Self‐care behaviour had partial mediating effect on the relationship between self‐efficacy and depression. Total variance explained was 23%.

Conclusion.  Depressive symptoms are still a problem that need to be addressed among kidney transplantation patients. Patients who have higher self‐efficacy and higher self‐care behaviour will have lower depressive symptoms. Our results support that self‐efficacy is the significant predictor of depressive symptoms.

Relevance to clinical practice.  Self‐efficacy is a powerful and modifiable determinant of depressive symptoms. We should design interventions that focus not only on the skill aspects of self‐care behaviour but also on those that have a strong connection with self‐efficacy. We could incorporate the self‐efficacy‐enhanced strategies as proposed by social cognitive theory into the kidney transplantation care programme.
Nursing information: users’ experiences of a system in Taiwan one year after its implementation
Authors: Lee Ting‐Ting
Published: February 2008

Aim and objective.  The purpose of this study was to explore nurses’ experiences during the first year of the installation of a nursing information system (NIS). The objective was to identify the major issues that emerged regarding the users’ concerns of this technology in their daily practice.

Background.  The success of the implementation of an information system depends mostly on the users’ acceptance of this technology; however, nurses’ experience of a system installation for a particular length of time, as in this study, has seldom been explored. This is a report on a qualitative study that explored nurses’ experiences of a NIS use during the first year of its installation.

Design.  Descriptive qualitative interviews with nurse participants were used to collect data at a medical centre in Taiwan.

Method.  Four focus groups were conducted with the 23 nurse participants in November 2005. The interview guide included questions about the impact of computer use on the nurses’ workflow and the electronic documentation process.

Results.  Six major themes emerged regarding the nurses’ NIS use, including their dissatisfaction with insufficient personal computers and printers, the slow system response time, workflow change, poor content design, decreased charting quality and the impact on their interpersonal relationships.

Conclusions.  Organizations may need to redesign the computer interface, to provide better hardware and to maintain a more reliable network function to meet the nurses’ needs during the adoption process, as well as to modify or devise appropriate documentation regulations.

Relevance to clinical practice.  As they continue to use electronic documentation, nurses may become accustomed to the technology and use it more easily as it becomes the required documentation method. However, understanding the barriers and difficulties they encountered could maximize their technology use and improve both the nursing efficiency and the documentation quality.
Effectiveness of psychoeducation intervention on post‐traumatic stress disorder and coping styles of earthquake survivors
Authors: Oflaz Fahriye , Hatipoğlu Sevgi , Aydin Hamdullah
Published: February 2008

Aims and objectives.  The aim of the study was to examine the effectiveness of a psychoeducation intervention based on Peplau's approach, including problem‐solving compared with intervention with medication on post‐traumatic stress disorder (PTSD) symptoms and coping of earthquake survivors.

Background.  Post‐traumatic reactions and recovery are the result of complex interactions among biological, personal, cultural and environmental factors. Both psychosocial and psychopharmacological methods have been advised to treat PTSD. The general goal of treatment is to decrease the anxiety and to support these patients in regaining normal daily functions.

Design.  The study used a pretest to posttest quasi‐experimental design with three comparison groups.

Methods.  The sample of the study included 51 survivors of the Marmara Earthquake who met diagnostic criteria for PTSD. Comparison groups were made up as psychoeducation only, medication only and psychoeducation with medication (PEM). Six semi‐structured psychoeducation sessions were conducted individually. Patients in the ‘medication only’ group did not participate in these sessions. The Clinician Administered PTSD Scale, Hamilton Depression Scale and Coping Strategies Scale were used for the measurements.

Results.  There was a significant difference between the ‘PEM’ group and the ‘medication only’ group with the first group showing greater relief of symptoms. Generally, there were no differences between the ‘medication only’ and ‘psychoeducation only’ groups. Avoidance as a coping strategy had significant positive correlations with PTSD and depression outcomes.

Conclusions.  Patients with PTSD seem to take more advantage from the combined treatment model. Nurses can help the patients with PTSD by teaching them to cope with the symptoms.

Relevance to clinical practice.  The number and variety of catastrophic events in the world are increasing. Psychiatric nurses should therefore take responsibility regarding the effects of trauma and investigate the ways of working with people who experienced trauma in more detail and develop interventions based on scientific evidence.
The influence of patient acuity on satisfaction with emergency care: perspectives of family, friends and carers
Authors: Ekwall Anna , Gerdtz Marie , Manias Elizabeth
Published: February 2008

Aims and objectives.  To investigate the factors that influence satisfaction with emergency care among individuals accompanying patients to the emergency department and explore agreement between the triage nurse and accompanying person regarding urgency.

Background.  Many patients seeking treatment in hospital are escorted by an accompanying person, who may be a friend, family member or carer. Several factors influence patient satisfaction with emergency care, including waiting time and time to treatment. It is also influenced by provision of information and interpersonal relations between staff and patients. Research on satisfaction has focused on the patient perspective; however, individuals who accompany patients are potential consumers. Knowledge about the ways accompanying persons perceive the patient's medical condition and level of urgency will identify areas for improved patient outcomes.

Design and methods.  A prospective cross‐sectional survey with a consecutive sample (n = 128 response rate 83·7%) was undertaken. Data were collected in an Australian metropolitan teaching hospital with about 32,000 visits to the emergency department each year. The Consumer Emergency Satisfaction Scale was used to measure satisfaction with nursing care.

Results.  Significant differences in perceptions of patient urgency between accompanying persons and nurses were found. Those people accompanying patients of a higher urgency were significantly more satisfied than those accompanying patients of a lower urgency. These results were independent of real waiting time or the accompanying person's knowledge of the patients’ triage status. In addition, older accompanying persons were more satisfied with emergency care than younger accompanying persons.

Discussion.  Little attention has been paid to the social interactions that occur between nurses and patients at triage and the ways in which these interactions might impact satisfaction with emergency care.

Relevance to clinical practice.  Good interpersonal relationships can positively influence satisfaction with the emergency visit. This relationship can contribute to improved patient care and health outcomes.
Depressive symptomatology and the prevalence of cardiovascular risk factors among older men and women from Cyprus; the MEDIS (Mediterranean Islands Elderly) epidemiological study
Authors: Panagiotakos Demosthenes B , Kinlaw Mallory , Papaerakleous Natasa , Papoutsou Stalo , Toutouzas Pavlos , Polychronopoulos Evangelos
Published: February 2008

Aims.  The purpose of this paper is to explore the link between symptoms of depression and the prevalence of cardiovascular risk factors in older adults.

Methods.  During 2005, 136 older men and 164 women from various parts of Cyprus agreed to participate in the study. The sampling was random and multistage (according to age–sex distribution of the referent population). All participants were living in the community and not in institutions. Among several socio‐demographic, bioclinical, lifestyle and dietary characteristics, depressive symptoms were assessed using the short version of the Geriatric Depression Scale (GDS).

Results.  Participants without signs of depression, typically, have fewer cardiovascular risk factors (i.e. hypertension, hypercholesterolemia, diabetes and obesity) than those with moderate or severe symptoms. Even when behavioural variables (e.g. diet, smoking, exercise) are statistically controlled, participants that are higher than others on depression are more likely to have hypertension and/or hypercholesterolemia than those with lower scores. Every one‐unit increase in GDS score (range 0–15) is associated with a 12% higher likelihood of having an additional cardiovascular disease risk factor.

Conclusions.  Symptoms of depression are positively associated with the number of cardiovascular risk factors in ‘healthy’ older adults, irrespective of lifestyle behaviours (e.g. smoking, dietary intake and physical activity).

Relevance to clinical practice.  Healthcare providers should consider the implications of both the presence and nature of this relationship in their continuing care of older adults.
Effect of an interactive computerized psycho‐education system on patients suffering from depression
Authors: Lin Mei‐Feng , Moyle Wendy , Chang Hsiu‐Ju , Chou Mei Hsien , Hsu Mei‐Chi
Published: February 2008

Aims.  The aim of this study was to examine the effect of an Interactive Computerized Psycho‐Education System on patients suffering from depression and to compare the use of an Interactive Computerized Psycho‐Education System vs. traditional pamphlet education approach.

Background.  Depression management depends on pharmacological treatment and psychotherapy and on appropriate and timely patient education. Whilst multimedia learning concepts have been applied in areas such as education, this approach has not been widely used in psychiatric outpatient departments.

Design and method.  A preliminary pre and post quasi‐experimental design with patients with depression was employed at an hospital. Participants in the experimental group (n = 19) received an Interactive Computerized Psycho‐Education System intervention programme (Interactive Computerized Psycho‐Education System and the educational manual). Participants in the control group (n = 13) were exposed only to the traditional pamphlet education approach (consultation from psychiatrists and information sheets). Primary outcome was depression knowledge scores. Secondary outcomes were scores on the Compliance Behaviour Assessment Scale.

Results.  In the experimental group (n = 19), the time spent working on the Interactive Computerized Psycho‐Education System was about 30–180 minutes per session, with an average of 67 minutes. Participants in the experimental group had a considerably decreased incidence of medication non‐compliance compared with participants in the control group. Knowledge scores of the experimental group ranged from 30–100, with an average score of 74.7.

Conclusion.  The Interactive Computerized Psycho‐Education System is acceptable and may be as more effective than a traditional education approach to achieve adherence to medications for depression.

Relevance to clinical practice.  Compared with a traditional approach, the combination of the Interactive Computerized Psycho‐Education System and a nursing‐consulting clinic may assist patients with depression to achieve and maintain better medication compliance in addition to improving their knowledge of depression.
The role of community mental health nurses caring for people with schizophrenia in Taiwan: a substantive grounded theory
Authors: Huang Xuan‐Yi , Yen Wen‐Jiuan , Liu Shwu‐Jiuan , Lin Chouh‐Jiuan
Published: February 2008

Aim and objectives.  The aim was to develop a practice theory that can be used to guide the direction of community nursing practice to help clients with schizophrenia and those who care for them.

Design.  Substantive grounded theory was developed through use of grounded theory method of Strauss and Corbin.

Methods.  Two groups of participants in Taiwan were selected using theoretical sampling: one group consisted of community mental health nurses and the other group was clients with schizophrenia and those who cared for them. The number of participants in each group was determined by theoretical saturation. Semi‐structured one‐to‐one in‐depth interviews and unstructured non‐participant observation were utilized for data collection. Data analysis involved three stages: open, axial and selective coding. During the process of coding and analysis, both inductive and deductive thinking were utilized and the constant comparative analysis process continued until data saturation occurred. To establish trustworthiness, the four criteria of credibility, transferability, dependability and confirmability were followed along with field trial, audit trial, member check and peer debriefing for reliability and validity.

Results.  A substantive grounded theory, the role of community mental health nurses caring for people with schizophrenia in Taiwan, was developed through utilization of grounded theory method of Strauss and Corbin.

Conclusion.  In this paper, results and discussion focus on causal conditions, context, intervening conditions, consequences and phenomenon.

Relevance to clinical practice.  The theory is the first to contribute knowledge about the field of mental health home visiting services in Taiwan to provide guidance for the delivery of quality care to assist people in the community with schizophrenia and their carers.
A comparison of mothers’ and fathers’ experiences of the attachment process in a neonatal intensive care unit
Authors: Fegran Liv , Helseth Sølvi , Fagermoen May Solveig
Published: February 2008

Aim.  To compare mothers’ and fathers’ individual views and experiences of the attachment process in a neonatal intensive care unit within the first week after a premature birth.

Background.  The attachment between parents and children is a precursor to the consolidation of parenting skills, the growth and development of the infant and the establishment of a bond between parent and child. Premature birth and the resultant hospitalization disrupt the normal attachment process between parent and child. Most of the litteraure on attachment theory focuses on the mother–child connection and is being criticised for regarding the father's role as supportive and peripheral.

Methods.  The design of this study was descriptive with a hermeneutic approach. Twelve parents (six mothers and six fathers) in a 13‐bed neonatal intensive care unit in a Norwegian regional hospital participated in a field study addressing the encounter between parents and nurses. This paper is based on the semi‐structured interviews with the parents at discharge.

Results.  The interview analysis revealed two main categories. (a) Taken by surprise: For mothers, the premature birth created a feeling of powerlessness and they experienced the immediate postnatal period as surreal and strange. The fathers experienced the birth as a shock, but were ready to be involved immediately. (b) Building a relationship: Mothers experienced a need to regain the temporarily lost relationship with their child, whereas the fathers experienced the beginning of a new relationship.

Conclusion.  Comparing parents’ experiences of the attachment process within the first days after a premature birth reveals a striking contrast between the mother's experience of surrealism and the father's ability to be involved immediately after birth.

Relevance to clinical practice.  Parents’ of premature children's different starting points should be acknowledged as professionals encourage parents to have early skin‐to‐skin contact with their premature infant.
Interrater reliability using Modified Norton Scale, Pressure Ulcer Card, Short Form‐Mini Nutritional Assessment by registered and enrolled nurses in clinical practice
Authors: Bååth Carina , Hall‐Lord Marie‐Louise , Idvall Ewa , Wiberg‐Hedman Katarina , Wilde Larsson Bodil
Published: February 2008

Aim. Examine the interrater reliability between and among registered and enrolled nurses using Modified Norton Scale, Pressure Ulcer Card and Short Form‐Mini Nutritional Assessment.

Background. In Sweden, registered nurses and enrolled nurses usually co‐operate in patient care. National guidelines emphasize that reliable and valid assessment tools should be used. Interrater reliability for regular use of assessment tools is seldom studied.

Design cross‐sectional. Registered nurses and enrolled nurses made 228 assessments of patients’ skin, risk for pressure ulcer and malnutrition, in patients with hip fracture and patients who had suffered a stroke.

Results. The interrater reliability of the Modified Norton Score total score was very good among registered nurses, good among enrolled nurses and between both groups. There was good, moderate and fair agreement on the subscales. Interrater reliability of Short Form Mini‐Nutritional Assesment screening score was very good between both groups, good among registered nurses and moderate among enrolled nurses. There was good and moderate agreement on the items. There was good, moderate and fair agreement between and among registered nurses and enrolled nurses when using the Pressure Ulcer Card.

Conclusion. The Modified Norton Scale and Short Form Mini‐Nutritional Assessment were reasonably understandable and easy to utilize in clinical care. Therefore, it seems possible for nurses to accomplish assessment using these tools. The agreement level was low for most skin sites except sacrum when nurses assessed patients’ skin with the Pressure Ulcer Card.

Relevance to clinical practice. The utilize of reliable and valid assessment tools is important in clinical practice. The tools could be used as an aid to the clinical judgement and therefore identify patients at risk for pressure ulcers and malnutrition. Pressure ulcer grading is a difficult skill that requires training and time to develop.
Single and multiple‐dose pharmacokinetics of tepoxalin and its active metabolite after oral administration to rabbits (Oryctolagus cuniculus)
Authors: POLLOCK C. G. , CARPENTER J. W. , KOCH D. E. , HUNTER R. P.
Published: February 2008

The anti‐inflammatory agent, tepoxalin, was administered to eight healthy 6‐month‐old female New Zealand white rabbits once daily at an oral dose of 10 mg/kg. Blood samples were obtained immediately before and at 0.25, 0.5, 1, 2, 3, 4, 6, 8, 12, and 24 h postadministration on days 1 and 10. Tepoxalin and its active metabolite, RWJ 20142, concentrations were determined in plasma by use of high‐performance liquid chromatography with mass spectrometry. Cmax of the parent compound was reached between 3 and 8 h of drug administration, with a harmonic mean t1/2 of 3.6 h. Peak tepoxalin plasma concentrations were 207 ± 49 ng/mL. After oral administration, the metabolite RWJ 20142 achieved Cmax in plasma 2–8 h after administration, with a t1/2 of 1.9–4.8 h (harmonic mean 2.8 h). Peak plasma concentrations of RWJ 20142 on day 1 were 2551 ± 1034 ng/mL.
Anti‐Coa implicated in severe haemolytic disease of the foetus and newborn
Authors: Michalewska B. , Wielgos M. , Zupanska B. , Bartkowiak R.
Published: February 2008

summary The Colton (Coa) antigen is of high frequency; its incidence in Caucasians is about 99.8%. Reports on haemolytic transfusion reactions and haemolytic disease of the foetus/newborn (HDFN) due to anti‐Coa are rare. We report a severe HDFN due to anti‐Coa. The first child of the mother was healthy. The second died a few hours after delivery because of hydrops fetalis, likely due to HDFN; anti‐Coa in the maternal serum, the father typed as Co(a+). The third pregnancy was followed up by the measurements of anti‐Coa titre (additional antibodies were excluded), its functional activity by the chemiluminescence test (CLT) and the Doppler flow in the middle cerebral artery of the foetus. Increased values of antibody titre up to 128, the CLT to 30% and multiplex of median of the peak systolic velocity to 1·71 indicated haemolytic disease and the necessity for an intrauterine transfusion. The foetus received the maternal red blood cells (RBCs). Delivery had to be by Caesarean section for obstetrical reasons at 34‐week gestation. The newborn (anti‐Coa on red cells and in plasma, the rise of the bilirubin concentration up to 333 μmol L−1) had four exchange transfusions: the first of maternal RBCs, the remaining of donor’s Co(a+) cells and one top‐up transfusion. The baby was discharged in good health. Anti‐Coa was responsible for severe HDFN. Proper monitoring during pregnancy and antenatal and post‐natal therapy were successful. This is the second severe published HDFN due to anti‐Coa.
Anti‐HBc screening in Egyptian blood donors reduces the risk of hepatitis B virus transmission
Authors: El‐Zayadi A.‐R. , Ibrahim E. H. , Badran H. M. , Saeid A. , Moneib N. A. , Shemis M. A. , Abdel‐Sattar R. M. , Ahmady A. M. , El‐Nakeeb A.
Published: February 2008

summary Occult hepatitis B virus (HBV) in blood donors is considered as a potential risk for transmission of HBV infection. The aim of this study was to determine the prevalence of anti‐hepatitis B core antibody (anti‐HBC) positivity in Egyptian blood donations as well as to estimate the frequency of HBV‐DNA in anti‐HBc‐positive donations. The study included 760 Egyptian healthy blood donors, representing 26 different Egyptian governorates screened according to routine practice for the presence of hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) antibodies (Abs), HIV‐1/2 Abs and Treponema Abs. The accepted blood units for donation were tested for the presence of total anti‐HBc Abs by two tests. Positive units for anti‐HBc were further tested for HBV‐DNA by polymerase chain reaction. According to routine screening, a total of 48/760 units (6·3%) were rejected [38 (5%) HCV‐Ab‐positive units, 9 (1·18%) HbsAg‐positive units and 1 (0·13%) Treponema‐Ab‐positive unit]. Among the accepted blood units for donation, prevalence of anti‐HBc was 78/712 units (10·96%). HBV‐DNA was detected in 9/78 (11·54%) of the anti‐HBc‐positive units, and thus, occult HBV infection was detected in 9/712 (1·26%) of the accepted blood donations. Implementing anti‐HBc test to the routine assay for the forthcoming two decades would certainly eliminate possible HBV‐infected units. Rejection of these units will be beneficial to decrease the risk of HBV transmission with its potential consequences particularly in immunocompromised recipients.
A randomized, single‐blind, increasing dose safety trial of an oxygen‐carrying plasma expander (Hemospan®) administered to orthopaedic surgery patients with spinal anaesthesia
Authors: Olofsson C. , Nygårds E. B. , Ponzer S. , Fagrell B. , Przybelski R. , Keipert P. E. , Winslow N. , Winslow R. M.
Published: February 2008

summary The objective of this study was to further explore the safety of Hemospan® (Sangart Inc., San Diego, CA, USA), an oxygen‐carrying plasma expander. The aim of this study was to determine if Hemospan is well tolerated in orthopaedic surgery patients with spinal anaesthesia in doses up to 1 L. Hemospan was previously found to be well tolerated in normal volunteers and orthopaedic surgery patients with spinal anaesthesia in doses up to 500 mL. Five cohorts of six orthopaedic surgery patients, American Society of Anesthesiologists (ASA) I and II, were studied. In each cohort, four patients received Hemospan in doses ranging from 200 to 1000 mL, and two received Ringer’s lactate immediately prior to induction of spinal anaesthesia. There were no serious adverse events (SAEs). Iohexol clearance measured before and 24 h after dosing was unaffected. There were 14 adverse events (AEs) in the 10 control patients (1·4 per patient) and 30 in the 20 patients receiving Hemospan (1·5 per patient). One patient in the group receiving 200 mL Hemospan had elevated mean arterial pressure after dosing, but there were no elevations in any of the other patients. The peak plasma Hemospan concentration in the 1000 mL group was 1·3 g dL−1, with a dose‐dependent clearance (T1/2) ranging from 14·1 to 23·0 h. Plasma methaemoglobin levels were independent of dose, reaching a maximum at 40 h after dosing and never exceeded 0·125 g dL−1. Troponin T was transiently elevated in two patients receiving Hemospan without symptoms or electrocardiographic abnormalities or elevation of myocardial creatinine kinase isoenzyme. Hemospan was well tolerated in this group of patients at doses up to 1000 mL.
Measles, mumps and rubella infections and atopic disorders in MMR‐unvaccinated and MMR‐vaccinated children
Authors: Bernsen Roos M. D. , Van Der Wouden Johannes C.
Published: February 2008

Vaccinations have been incriminated in the increase of atopic disorders. Especially the measles‐mumps‐rubella (MMR) vaccination is often refused by people having a notion that these infectious diseases are beneficial for a healthy development of a child’s immune system. This practice endangers herd immunity and is the cause of repeated outbreaks. As the clinical course of infections and also its possible impact on the development of atopy may be different in vaccinated and unvaccinated individuals, we explored in vaccinated and unvaccinated children associations of MMR infection with atopic disorders. Using data from a previously conducted study on the relationship between the diphtheria‐tetanus‐pertussis‐(inactivated) poliomyelitis vaccination in the first year of life and atopic disorders, the study population of 1872 8–12‐yr‐old was divided as children MMR‐unvaccinated and children MMR‐vaccinated in the first year of life. Within each group the association between MMR infections and atopic disorders (both as reported by the parents) was assessed. We found a statistically significant positive association between measles infection and ‘any atopic disorder’ [adjusted odds ratio, OR (95% confidence interval, CI): 1.77 (1.20–2.61)] in the MMR‐vaccinated group, mainly because of the relationship with eczema. For rubella there was a negative association with eczema and food allergy in the unvaccinated group: adjusted OR (95% CI): 0.57 (0.38–0.85) and 0.23 (0.07–0.76), respectively. All other associations were not statistically significant. We found a positive relationship between measles infection and any atopy in a group of MMR‐vaccinated children and a negative association between rubella infection and eczema and food allergy in unvaccinated children. However, we cannot conclude that these relationships are causal. The negative association with rubella may be an artefact. This study shows no evidence for any protective effects from MMR diseases for the development of atopy and therefore supports conclusions found elsewhere that childhood vaccinations do not cause atopy.
Level of oxidative stress and damage in erythrocytes in apprentices indirectly exposed to lead
Authors: Ergurhan‐Ilhan Inci , Cadir Bilge , Koyuncu‐Arslan Meltem , Arslan Cagatay , Gultepe F. Mustafa , Ozkan Guleren
Published: February 2008

Background: Oxidative stress (OS) may result in damage to critical macromolecules, and an association between lead (Pb) toxicity and OS is a matter of research. Therefore, the aim of the present study was to investigate the effect of Pb on the oxidative system in indirectly Pb‐exposed male apprentices.

Methods: Established parameters of Pb toxicity (aminolevulinic acid dehydratase index [ALAD index], zinc‐protoporphyrin [ZPP]) as well as Pb‐level in blood were determined in Pb‐exposed apprentices (n > 25) and controls (n > 24). Enzymatic (glutathione peroxides [GPx], superoxide dismutase [SOD], catalase [CAT]) and non‐enzymatic (α‐tocopherol, β‐carotene) indices of OS, and malondialdehyde (MDA) level were also determined.

Results: There was a statistically significant increase in Pb level, ALAD index, ZPP concentration, GPx activity and MDA concentration in Pb‐exposed apprentices when compared to controls. Although a statistically significant decrease in α‐tocopherol and β‐carotene levels was seen, SOD and CAT activities were unaltered in Pb‐exposed apprentices. Pb level and duration of Pb exposure were correlated with each other, as well as various indices of OS and MDA concentration.

Conclusions: Chronic indirect Pb exposure results in lipid peroxidation in erythrocytes of apprentices via OS, and duration of Pb exposure is a reliable marker of Pb toxicity.