bluuebunny/crossref_metadata_2025 huggingface dataset:
Interleukin (IL)-4 and IL-13 up-regulate monocyte chemoattractant protein-1 expression in human bronchial epithelial cells: involvement of p38 mitogen-activated protein kinase, extracellular signal-regulated kinase 1/2 and Janus kinase-2 but not c-Jun NH2-terminal kinase 1/2 signalling pathways
Authors: Ip W K , Wong C K , Lam C W K
Published: May 2006

The Th2 cytokines interleukin (IL)-4 and IL-13 and chemokine monocyte chemoattractant protein-1 (MCP-1) are significantly involved in bronchial hyperreactivity (BHR) and remodelling in allergic asthma. Although IL-4 and IL-13 can regulate a number of chemokines from bronchial epithelium, their regulatory effect on the expression of MCP-1 is as yet unproved. We aim to investigate the intracellular signalling mechanisms of IL-4 and IL-13 regulating the expression and secretion of MCP-1 from human bronchial epithelial cells. BEAS-2B cells, derived from a human bronchial epithelial cell line, were activated with or without IL-4 and/or IL-13 for different time intervals. MCP-1 gene expression and protein secretion were measured by reverse transcription–polymerase chain reaction and enzyme-linked immunosorbent assay, respectively. Activation of signalling molecules p38 mitogen-activated protein kinase (MAPK), extracellular signal-regulated kinase (ERK), c-Jun NH2-terminal kinase (JNK) and Janus kinase-2 (JAK-2) was accessed by Western blotting. IL-4 and IL-13 were found to up-regulate gene expression and significantly increase the release of MCP-1 from BEAS-2B cells. Both cytokines could activate p38 MAPK, ERK and JAK-2, but not JNK activity. Inhibition of p38 MAPK, ERK and JAK-2 activities by pretreating the cells with their corresponding inhibitors SB203580, PD98059 and AG490, respectively, significantly suppressed IL-4- and IL-13-induced MCP-1 production in BEAS-2B cells. Together, the above results illustrate that the activation of p38 MAPK, ERK and JAK-2 but not JNK is crucial for IL-4- and IL-13-induced MCP-1 release in human bronchial epithelial cells. Our findings may provide insight into the future development of more effective therapeutic agents for treating allergic asthma.
Immunostimulatory oligodeoxynucleotide fromBifidobacterium longumsuppresses Th2 immune responses in a murine model
Authors: Takahashi N , Kitazawa H , Iwabuchi N , Xiao J Z , Miyaji K , Iwatsuki K , Saito T
Published: May 2006

We have reported previously that novel immunostimulatory sequence (ISS) oligodeoxynucleotide (ODN) BL07S from a probiotic strain of Bifidobacterium longum inhibited immunoglobulin (Ig) E production in vitro. However, whether ISS-ODNs from probiotics regulate T helper type 2 (Th2)-polarized immune reactions in vivo remains unclear. To evaluate the inhibitory effects of ODN BL07S on type I allergic response, BALB/c mice were injected with or without ODN BL07S in the presence of ovalbumin (OVA) on days 0 and 14. Serum Ig levels (IgE, IgG1 and IgG2a) and cytokine levels (interferon (IFN)-γ, interleukin (IL)-12, IL-4, IL-5, IL-10 and IL-13) were investigated in splenocyte cultures from days 14–28. Production of OVA-specific and total IgE were significantly suppressed by administration of ODN BL07S, but not by ODN BL06S, a non-ISS-ODN. Compared to controls, ODN BL07S induced significantly lower levels of Th2 cytokines (IL-4 and IL-5) in splenocyte cultures, and significantly higher levels of serum OVA-specific IgG2a. These effects of ODN BL07S on modulation of Th2 immune response were dose-dependent. The present results demonstrate that ODN BL07S from genomic DNA of B. longum BB536 prevents antigen-induced Th2 immune responses in vivo, suggesting that ISS-ODNs from probiotics might be useful in preventing allergic disease.
Climate‐driven changes on phytoplankton–zooplankton coupling and nutrient availability in high mountain lakes of Southern Europe
Authors: MORALES‐BAQUERO RAFAEL , CARRILLO PRESENTACIÓN , BAREA‐ARCO JOSÉ , PÉREZ‐MARTÍNEZ CARMEN , VILLAR‐ARGAIZ MANUEL
Published: May 2006

1. The effect of climate variability on phytoplankton and zooplankton dynamics and nutrient availability was studied in two high mountain fishless lakes (La Caldera and Río Seco) of contrasting morphology, hydrology and dissolved inorganic nitrogen : soluble reactive phosphate (DIN : SRP) ratios during 1986 and after a 10‐year‐long drought in 1996 and 1997.

2. Thaw was delayed and water temperatures were lower in both lakes in 1996 than in 1986 and 1997. However, the lake‐specific DIN : SRP ratio was maintained in the 3 years studied, reflecting its local control.

3. On other hand, the presumptive limiting nutrient in each lake, P in La Caldera and N in Río Seco, showed higher concentrations in 1996 versus 1986 and 1997. Significant positive correlations between temperature and chlorophyll a were found in both lakes in 1996 but these relationships were negative or not significant in 1986 and 1997. Zooplankton biomass showed lower values in 1996 than in 1986 or 1997.

4. These findings can be explained by a decoupling of the phytoplankton–zooplankton interaction because of a constraint on zooplankton growth by low temperatures in the coldest year studied. This observation furnishes evidence that regional climatic control on the phytoplankton–zooplankton link can modulate the overall demand for nutrients.
The regional variation of aboveground live biomass in old‐growth Amazonian forests
Authors: MALHI YADVINDER , WOOD DANIEL , BAKER TIMOTHY R. , WRIGHT JAMES , PHILLIPS OLIVER L. , COCHRANE THOMAS , MEIR PATRICK , CHAVE JEROME , ALMEIDA SAMUEL , ARROYO LUZMILLA , HIGUCHI NIRO , KILLEEN TIMOTHY J. , LAURANCE SUSAN G. , LAURANCE WILLIAM F. , LEWIS SIMON L. , MONTEAGUDO ABEL , NEILL DAVID A. , VARGAS PERCY NÚÑEZ , PITMAN NIGEL C. A. , QUESADA CARLOS ALBERTO , SALOMÃO RAFAEL , SILVA JOSÉ NATALINO M. , LEZAMA ARMANDO TORRES , TERBORGH JOHN , MARTÍNEZ RODOLFO VÁSQUEZ , VINCETI BARBARA
Published: May 2006

The biomass of tropical forests plays an important role in the global carbon cycle, both as a dynamic reservoir of carbon, and as a source of carbon dioxide to the atmosphere in areas undergoing deforestation. However, the absolute magnitude and environmental determinants of tropical forest biomass are still poorly understood. Here, we present a new synthesis and interpolation of the basal area and aboveground live biomass of old‐growth lowland tropical forests across South America, based on data from 227 forest plots, many previously unpublished. Forest biomass was analyzed in terms of two uncorrelated factors: basal area and mean wood density. Basal area is strongly affected by local landscape factors, but is relatively invariant at regional scale in moist tropical forests, and declines significantly at the dry periphery of the forest zone. Mean wood density is inversely correlated with forest dynamics, being lower in the dynamic forests of western Amazonia and high in the slow‐growing forests of eastern Amazonia. The combination of these two factors results in biomass being highest in the moderately seasonal, slow growing forests of central Amazonia and the Guyanas (up to 350 Mg dry weight ha−1) and declining to 200–250 Mg dry weight ha−1 at the western, southern and eastern margins. Overall, we estimate the total aboveground live biomass of intact Amazonian rainforests (area 5.76 × 106 km2 in 2000) to be 93±23 Pg C, taking into account lianas and small trees. Including dead biomass and belowground biomass would increase this value by approximately 10% and 21%, respectively, but the spatial variation of these additional terms still needs to be quantified.
Retreatment efficacy of hand versus automated instrumentation in oval‐shaped root canals: an ex vivo study
Authors: Zmener O. , Pameijer C. H. , Banegas G.
Published: May 2006

Aim  To compare the efficacy of hand versus automated instrumentation when retreating oval‐shaped root canals.

Methodology  Sixty human premolars with single oval canals were instrumented and filled with gutta‐percha and sealer and divided into three groups (n = 20) – group 1: ProFile .04 taper rotary instruments; group 2: Anatomic Endodontic Technology (AET), and group 3: manual instrumentation with Hedström files. The teeth were split longitudinally and gutta‐percha/sealer remnants in the coronal, middle and apical thirds were assessed with light microscopy. The mean percentage of gutta‐percha/sealer remnants for each group was calculated and statistically analysed for significance using an anova repeated measures (P < 0.001) and Tukey's multiple comparison test. The time required for retreatment was analysed using a one‐way anova and Tukey's test (P < 0.001).

Results  Overall, 10–18% of the canal walls were covered with gutta‐percha/sealer remnants after preparation using any technique. Statistical analysis demonstrated that the mean values for remnants of filling material in the ProFile group were significantly higher than for the other groups (P < 0.001), except in the apical third where no significant difference occurred. In all groups, the mean values in the middle third were higher than the coronal and apical thirds. The retreatment time for ProFile and AET was significantly shorter compared to manual instrumentation with Hedström files (P < 0.001).

Conclusions  Under the experimental conditions, AET instruments and manual instrumentation with Hedström files resulted in cleaner canals. However, completely clean root canal walls were not produced with any of the techniques investigated.
Evaluation of canal filling after using two warm vertical gutta‐percha compaction techniques in vivo: a preliminary study
Authors: Venturi M.
Published: May 2006

Aim  To evaluate the quality of root canal filling when comparing two warm gutta‐percha filling techniques in vivo.

Methodology  Human teeth were randomly divided into two equal groups, with 30 canals each. The root canals were shaped by hand and ProFile 0.04 rotary instruments to size 20–40 at the end‐point and then filled with gutta‐percha cones and AH‐Plus. In group A, a traditional warm vertical compaction technique was performed using the Touch'n Heat, and back‐filling with the Obtura II. In group B, a modified warm vertical compaction technique was used: small amounts of gutta‐percha were removed, and the remaining most apical 3 mm were compacted with a 1 mm movement; then thermomechanical back‐filling was performed. The teeth were extracted, stored in dye, cleared, and the distance between the apex and apical limit of the filling, linear dye penetration, and voids were measured from the buccal, lingual, mesial and distal perspective.

The homogeneity of variance and means was verified using Levene's test and t‐test. anova and Dunnett post hoc test were used to establish the significance and to analyse the effects through multiple comparisons.

Results  Compared with the specimens of group A, the specimens of group B exhibited less mean linear dye penetration (P < 0.05), smaller void length (P ≤ 0.05) and maximal width (P ≤ 0.05) when examined in all four views, and a more precise filling when viewed from the buccal aspect (P < 0.05).

Conclusions  The modified warm vertical compaction technique with apical back‐filling produced a more effective and precise three‐dimensional filling.
Characterization of antigen‐presenting cells in human apical periodontitis lesions by flow cytometry and immunocytochemistry
Authors: Lukić A. , Vasilijić S. , Majstorović I. , Vučević D. , Mojsilović S. , Gazivoda D. , Danilović V. , Petrović R. , Čolić M.
Published: May 2006

Aim  To analyse phenotypic characteristics of antigen‐presenting cells (APC), isolated from human periapical lesions by flow cytometry and immunocytochemistry.

Methodology  Sixteen periapical lesions were digested for 15 min with 0.05% collagenase. Mononuclear cells, separated from other inflammatory cells by density centrifugation, were processed for flow cytometry and/or immunocytochemistry. Single and double immunostainings were performed using monoclonal antibodies specific for human CD45, CD3, CD19, CD14, HLA‐DR, CD1a, CD83 and CD123.

Results  Antigen‐presenting cells (HLA‐DR+ cells) represented 32.9 ± 17.8% of total mononuclear cells. Amongst them, B cells (HLA‐DR+ CD19+) were the predominant APC population, followed by activated macrophages (HLA‐DR+ CD14+), dendritic cells (DC) (HLA‐DR+ CD14− CD19− CD3−) and activated T cells (HLA‐DR+ CD3+). Based on the predominance of T cells (CD3+) or B cells and plasma cells (CD19+ and CD19lo, respectively) amongst mononuclear cell infiltrates, lesions were divided into T‐ and B‐types. The percentage of DC in T‐type lesions (27.1 ± 6.8% of total HLA‐DR+ cells) was higher, compared with B‐type lesions (10.3 ± 5.2%) (P < 0.01). Within the DC population, the percentages of CD1a (Langerhans cell type) and CD123 (probably plasmacytoid DC type) did not differ significantly between the groups (P > 0.05). However, the percentage of mature DC (CD83+) was significantly higher in T‐type periapical lesions (P < 0.05).

Conclusion  Flow cytometry and immunocytochemistry are suitable methods for phenotypic analysis of APC after their isolation from human periapical lesions. APC, that were phenotypically heterogeneous, constituted a significant component of infiltrating cells. Lesions with the predominance of T cells were characterized by a higher proportion of mature DC (HLA‐DR+CD83+ cells) than lesions with predominance of B cells/plasma cells.
Effect of music on power, pain, depression and disability
Authors: Siedliecki Sandra L. , Good Marion
Published: May 2006

Aim.  This paper reports a study testing the effect of music on power, pain, depression and disability, and comparing the effects of researcher‐provided music (standard music) with subject‐preferred music (patterning music).

Background.  Chronic non‐malignant pain is characterized by pain that persists in spite of traditional interventions. Previous studies have found music to be effective in decreasing pain and anxiety related to postoperative, procedural and cancer pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non‐malignant pain has not been investigated.

Method.  A randomized controlled clinical trial was carried out with a convenience sample of 60 African American and Caucasian people aged 21–65 years with chronic non‐malignant pain. They were randomly assigned to a standard music group (n = 22), patterning music group (n = 18) or control group (n = 20). Pain was measured with the McGill Pain Questionnaire short form; depression was measured with the Center for Epidemiology Studies Depression scale; disability was measured with the Pain Disability Index; and power was measured with the Power as Knowing Participation in Change Tool (version II).

Results.  The music groups had more power and less pain, depression and disability than the control group, but there were no statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported.

Conclusion.  Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of power.
Expert nurses’ use of implicit memory in the care of patients with Alzheimer's disease
Authors: Parahoo Kader , Whall Ann L. , Colling Kathleen , Nusbaum Deborah
Published: May 2006

Aim.  This paper reports a study exploring expert nurses’ use of implicit memory in the care of people with Alzheimer's disease.

Background.  Although research has shown the benefits of preserving and using implicit memory in patients with Alzheimer's disease, the literature shows little evidence of how nurses, in particular expert ones, make use of implicit memory with this client group in clinical practice.

Method.  Semi‐structured interviews were carried out with a purposive sample of eight nurses (four from Michigan, United States of America and four from Northern Ireland) in 2004. The interviews focused on specific issues, but were deliberately flexible to allow participants to tell their stories as well. A nine‐step data analysis process was developed based on a synthesis of methods used by other researchers.

Findings.  According to the expert nurses interviewed, the effective and meaningful use of the implicit memory of patients with Alzheimer's disease in achieving positive outcomes depended on ‘knowing the patient’, ‘working within the patient's worldview’ and ‘using sensitive and patient‐centred interactional skills’. They explained how their use of implicit memory (drawing from a range of knowledge sources) was underpinned by reflective practice.

Conclusion.  The findings provide a positive profile of expert nurses’ use of implicit memory of patients with Alzheimer's disease; however, their use of theoretical and research knowledge could be improved. There is also a need to test interventions based on the use of implicit memories.
Defining bioterrorism preparedness for nurses: concept analysis
Authors: Rebmann Terri
Published: May 2006

Aim.  This paper reports a concept analysis to define the concept of nursing bioterrorism preparedness.

Background.  Nursing bioterrorism preparedness is necessary, yet no theoretical or operational definition exists. The concept is often misinterpreted as being synonymous with organizational preparedness or confused with the bioterrorism preparedness needs of other professions, such as medicine. There is no standardized definition of the concept that is specific to the profession of nursing.

Methods.  A concept analysis was conducted using a systematic literature review; the Cumulative Index to Nursing and Allied Health Literature, Psych Info and Medline databases for years 1966–2005 were used. One hundred and eighteen references were identified, 41 of which were deemed relevant. Data from the 41 relevant articles were analysed and synthesized to develop a theoretical definition, defining attributes, antecedents, consequences and related concepts.

Findings.  Nursing bioterrorism preparedness is the continual process of nurses becoming better prepared to recognize and respond to a bioterrorism attack. Nurses, regardless of their level of education, areas of expertise or practice settings must participate in at least one educational session and one exercise each year to meet the minimum requirements of engaging in the bioterrorism preparedness process. The antecedents are acceptance and readiness to change. Defining attributes include gaining knowledge, planning, practising response behaviours and evaluating knowledge level and content of response plan. Consequences include recognition of an event and implementation of appropriate response actions.

Conclusion.  Nursing bioterrorism preparedness is essential. To assess nurses’ level of preparedness, a definition is needed of what bioterrorism preparedness means to the profession. The theoretical definition developed in this paper needs to be further refined and operationalized.
Dying well: nurses’ experiences of ‘good and bad’ deaths in hospital
Authors: Costello John
Published: May 2006

Aim.  This paper reports a study investigating hospital nurses’ experiences of death and dying.

Background.  Despite advances in medical science and health care, together with the push towards individualizing approaches to patient care in the developed world, significant variation in the care of dying patients still exists. The international issues relating to differing types of death reveal both its complexity and diversity, with evidence of ‘good death’ experiences largely focused on hospice experiences, and a lack of research on death in general hospitals.

Method.  In‐depth interviews were conducted in 1999 with a convenience sample of 29 Registered Nurses in the United Kingdom based on their hospital death experiences. Semiotic analysis was used to identify the ‘deep structures’ that underlie and form part of cultural communication as a way of understanding how nurses made sense of death. Data interpretation was enhanced through the use of a typology of ‘good and bad deaths’.

Findings.  The findings suggest that different experiences of death are based on the extent to which nurses were able to exert control over the dying process. The management of death in hospital is a major source of conflict for nurses. Good and bad death experiences were constructed according to their impact on the sentimental order of the ward, the intangible, but real patterns of mood that influenced nurses’ feelings. Moreover, good and bad deaths focused less on patients’ needs and the dying process and more on the death event and nurses’ abilities to manage organizational demands.

Conclusion.  There is a need to improve communication with patients and families about diagnosis and prognosis to ensure that effective communication takes place and ‘blocking behaviour’ is avoided. The findings also challenge practitioners to focus attention on death as a process, and to prioritize patients’ needs above those of the organization. Moreover, there is the need for guidelines to be developed enabling patients to have a role in shaping events at the end of their lives.
Clinical nurse specialists and the practice of community nurses
Authors: Austin Lynn , Luker Karen , Martin Roland
Published: May 2006

Aim.  This paper presents the findings of a study of the roles of Clinical Nurse Specialists and community nurses working in primary care.

Background.  Clinical Nurse Specialists are recognized internationally as expert practitioners who could facilitate the implementation of evidence‐based practice. However, others may misunderstand their role and greater support may be required if organizations are to capitalize on the skills of Clinical Nurse Specialists.

Methods.  Elements of ‘Glaserian’ grounded theory in a broadly ethnographic approach were used to gain an understanding of the perspectives of 22 Clinical Nurse Specialists working as tissue viability nurses or continence advisors and 19 district nurses in one health region in the United Kingdom. The data were collected in 2001–02.

Findings.  Clinical Nurse Specialists were keen to use their expertise to inform the practice of community nurses. However, they encountered difficulties when seeking to introduce changes in practice. Although Clinical Nurse Specialists were acknowledged as enabling rather than deskilling community nurses, receptivity to Clinical Nurse Specialists’ ideas was dependent on what community nurses viewed as their own roles. As advisors, Clinical Nurse Specialists were dependent on the use of persuasion and vicarious power to bring about desired changes. These approaches are consistent with traditional approaches to change management as opposed to contemporary approaches to practice development.

Conclusion.  If Clinical Nurse Specialists are to reach their full potential and use their expertise to inform the practice of others, organizations need to recognize these posts as central to practice development. In particular, a framework is required which enables practice developers to use more inclusive approaches when seeking to bring about changes in practice.
Methodological issues in evaluating complex healthcare interventions
Authors: Blackwood Bronagh
Published: May 2006

Aim.  This paper outlines the difficulties in defining and evaluating a complex intervention and a number of currently available models for assisting this process are discussed.

Background.  Interventions aimed at producing change in the delivery and organization of healthcare services require rigorous evaluation to demonstrate their effectiveness. Evaluation poses difficulties, however, because these interventions are usually very complex.

Methods.  A framework developed by the United Kingdom Medical Research Council to evaluate complex interventions is described. The use of this framework in designing and evaluating a nurse‐led intervention in intensive care for weaning patients from mechanical ventilation is discussed. Semi‐structured interviews, a questionnaire survey and observational work were undertaken to define the components of the intervention, which was subsequently evaluated in an exploratory trial using a quasi‐experimental design.

Conclusion.  The framework was a useful tool and can be easily applied in developing and evaluating complex nursing interventions. Three key challenges emerge from this experience: (i) relevant research evidence should be used systematically in developing the components of the intervention, (ii) the definition and measurement of complex intervention outcomes needs to be improved and (iii) appropriate research designs must be used when evaluating complex interventions.
Decision‐making about risk in people with epilepsy and intellectual disability
Authors: Vallenga Dineke , Grypdonck Mieke H.F. , Tan Francis I.Y. , Lendemeijer Bert H.G.M. , Boon Paul A.J.M.
Published: May 2006

Aim.  This paper reports a study of the process of risk‐evaluation and subsequent decision‐making in the care for people with epilepsy and intellectual disability.

Background.  People with intellectual disability and severe epilepsy are at risk of suffering accidents during seizure, and often need protection. Whether to implement protective measures or to accept risk is a complex decision, burdened with uncertainty. Taking risks can lead to dangerous, sometimes life‐threatening situations, while protective measures are restrictive and may raise ethical concerns.

Methods.  In 2003 a multiple embedded case study was conducted with 15 clients. In each case, the client, their representative, care‐manager and nurse were interviewed.

Findings.  The decision about whether to accept risks or implement protective measures was always taken in relation to specific events, and varied from medication and supervision to total restriction of the client's mobility. Decision‐making was influenced by frequency, type, predictability and consequences of seizures; the effectiveness and practicability of protective measures; additional disabilities; characteristics of the client and their representative; and characteristics of nurses and organization. The predominant factor was the attitude of the representatives. They determined the relative weight of the other factors involved.

Conclusion.  A systematic approach to risk management could considerably improve the balance between risk and quality of life. Continuous evaluation would make it possible to tune the application of protective measures to the severity of the seizures at any time, and to avoid protective measures being maintained only because care providers have become accustomed to them. A systematic assessment of clients’ capabilities to participate in this complex decision‐making process is equally indicated.
Spatial scale of observation affects α, β and γ diversity of cavity‐nesting bees and wasps across a tropical land‐use gradient
Authors: Tylianakis Jason M. , Klein Alexandra‐Maria , Lozada Tannya , Tscharntke Teja
Published: May 2006

Aim  Anthropogenic changes in land use may have major consequences for global biodiversity. However, species diversity is determined by a suite of factors that may affect species differently at different spatial scales. We tested the combined effects of land use and spatial scale on α, β and γ diversity in the tropics using experimental communities of cavity‐nesting bees and waSPS (Hymenoptera: Aculeata). We aimed to determine whether: (1) land‐use intensity negatively affects species richness of cavity‐nesting Hymenoptera, (2) β diversity, both within and between plots, is higher in more natural systems, (3) species richness of flowering herbs correlates positively with species richness of Hymenoptera within and across habitats, (4) richness of cavity‐nesting Hymenoptera in highly modified habitats declines with increasing distance from natural or semi‐natural habitats, (5) the effects of land use, herb diversity and forest distance on Hymenoptera α and β diversity vary at different spatial scales, and (6) bees and waSPS respond to land use in a similar way.

Location  Manabi, south‐west Ecuador.

Methods  We examined diversity (species richness) within 48 plots of five habitat types that comprised a gradient of decreasing agricultural intensity from rice and pasture to coffee agroforests, unmanaged abandoned agroforests and forest fragments, using standardized nesting resources for reproducing communities of cavity‐nesting bees and waSPS.

Results  (1) Land use significantly affected α diversity of trap‐nesting bees and waSPS at the subplot (per trap) scale, but not subplot β diversity or plot‐scale species richness (γ diversity). (2) Beta diversity was surprisingly higher between plots within a land‐use type than between land‐use types. (3) Species richness of bees and waSPS increased with diversity of flowering herbs at the subplot (trap) scale only. (4) Forest distance correlated positively with bee species richness at the plot scale only. (5) Land use, herb diversity and forest distance each showed significant correlations with bee and wasp diversity at only one spatial scale. (6) Despite differences in life history, bees and waSPS responded to land‐use intensity in a similar way.

Main conclusions  The effects of land use on species richness were highly dependent on spatial scale. Subplot‐scale analyses showed that rice and pasture contained the highest species diversity, whereas plot‐scale analyses showed no significant difference in the diversity of different land‐use types. We emphasize caution in the estimation of biodiversity at only one spatial scale, and highlight the surprisingly large contribution of managed land to the regional biodiversity of these species.
Integrating evidence into clinical practice: an alternative to evidence‐based approaches
Authors: Tonelli Mark R.
Published: May 2006

Evidence‐based medicine (EBM) has thus far failed to adequately account for the appropriate incorporation of other potential warrants for medical decision making into clinical practice. In particular, EBM has struggled with the value and integration of other kinds of medical knowledge, such as those derived from clinical experience or based on pathophysiologic rationale. The general priority given to empirical evidence derived from clinical research in all EBM approaches is not epistemically tenable. A casuistic alternative to EBM approaches recognizes that five distinct topics, 1) empirical evidence, 2) experiential evidence, 3) pathophysiologic rationale, 4) patient goals and values, and 5) system features are potentially relevant to any clinical decision. No single topic has a general priority over any other and the relative importance of a topic will depend upon the circumstances of the particular case. The skilled clinician must weigh these potentially conflicting evidentiary and non‐evidentiary warrants for action, employing both practical and theoretical reasoning, in order to arrive at the best choice for an individual patient.
Improving the implementation of evidence‐based practice: a knowledge management perspective
Authors: Sandars John , Heller Richard
Published: May 2006

Experience of knowledge management initiatives in non‐health care organizations can offer useful insights, and strategies, to implement evidence‐based practice in health care. Knowledge management offers a structured process for the generation, storage, distribution and application of knowledge in organizations. This includes both tacit knowledge (personal experience) and explicit knowledge (evidence). Communities of practice are a key component of knowledge management and have been recognized to be essential for the implementation of change in organizations. It is within communities of practice that tacit knowledge is actively integrated with explicit knowledge. Organizational factors that limit the development of knowledge management, including communities of practice, in non‐health care organizations need to be overcome if the potential is to be achieved within health care.
Evidence‐based treatment and quality of life in heart failure
Authors: Dobre Daniela , Van Jaarsveld Cornelia H. M. , Ranchor Adelita V. , Arnold Rosemarie , De Jongste Mike J. L. , Haaijer Ruskamp Flora M.
Published: May 2006

Objectives  To explore whether prescription of evidence‐based drug therapy is associated with better quality of life (QoL) in patients with heart failure (HF).

Methods  Patients (n = 62) were recruited in the outpatient clinic of Groningen University Hospital. Inclusion criteria were previous diagnosis of HF, age 40–80 years; ejection fraction of less than 45%, free from other serious disease (such as cancer) and psychiatric problems in the last year. QoL was assessed with the RAND 36‐item health survey questionnaire, on five scales: physical functioning, mental health, social functioning, vitality and general health perception. Medication prescribed for 1 to 6 months before the QoL assessment was classified as either evidence‐based treatment or under‐treatment, according to the 2001 European guidelines on optimal HF treatment. The study had a cross‐sectional design.

Results  QoL did not differ significantly between evidence‐based and under‐treated patients, unadjusted or after adjustment for significant patient imbalances.

Conclusions  Conventional step‐up medication approach in HF may have a positive impact on survival or morbidity, but it seems not beneficial in relation to QoL. Other interventions should be designed to improve QoL of patients with HF.
Does physiotherapy management of low back pain change as a result of an evidence‐based educational programme?
Authors: Stevenson Kay , Lewis Martyn , Hay Elaine
Published: May 2006

Rationale  The concept of evidence‐based medicine is important in providing efficient health care. The process uses research findings as the basis for clinical decision making. Evidence‐based practice helps optimize current health care and enables the practitioners to be suitably accountable for the interventions they provide. Little work has been undertaken to examine how allied health professionals change their clinical practice in light of the latest evidence. The use of opinion leaders to disseminate new evidence around the management of low back pain into practice has been proposed.

Aims  The aim of this study was to investigate if physiotherapists’ clinical management of patients with low back pain would change following an evidence‐based education package, which utilized local opinion leaders and delivered the best evidence.

Method  Thirty musculoskeletal physiotherapists from a Community Trust in North Staffordshire were cluster randomized by location of work, to two groups. The intervention group received an evidence‐based programme on the management of low back pain, including advice regarding increasing activity levels and return to normal activity and challenging patients’ fears and beliefs about their pain. The control group received a standard in‐service training package on the management of common knee pathologies. The physiotherapists’ clinical management of patients with low back pain was measured prior to training and 6 months post training. Outcome measures were based on physiotherapists completing ‘discharge summary’ questionnaires, which included information relating to the use and importance of therapies for treating their low back pain patients.

Results  There were few significant differences in treatment options between the intervention and control groups post training. Whilst there was some indication that physiotherapists were already utilizing aspects of psychosocial management for patients with low back pain, there was little change in what physiotherapists perceived to be important to patient recovery and actual clinical practice following the intervention.

Conclusions  Psychosocial factors have been identified as an important factor in the recovery of patients with low back pain. This project incorporated the latest evidence on the management of low back pain and utilized the theory of opinion leaders to disseminate this evidence into clinical practice. Whilst there were some limitations in the overall size of the study, the results help to give an insight into the challenges faced by the health care system and researchers alike to ensure quality evidence is actually utilized by practitioners for the benefits of patient care.
Evidence‐based medical education –quo vadis?
Authors: Leung Gabriel M. , Johnston Janice M.
Published: May 2006

The evidence base for most educational initiatives, at least until very recently, is largely composed of low‐level evidence. Four major barriers underlie this historical observation, namely: (1) perceived ethical and acceptability problems arising from the unequal treatment of learners in experimental designs; (2) limited choice of outcome measures and validated instruments; (3) time and resource constraints; and (4) methodological issues concerning contextual confounding and small sample sizes. We advocate the adoption of a ‘balanced scorecard’ approach in the evaluation of education interventions that brings together a comprehensive panel of outcomes under one framework. We require a diversity of rigorously applied methods to generate these outcomes, drawing from the quantitative and qualitative disciplines of epidemiology, psychology and economics. We further suggest that the research community discuss and agree on a standardized set of common metrics or benchmarks. We conclude with a case study examining whether a hand‐held computer clinical decision support tool improves clerkship learning of evidence‐based medicine. The era of Brownian motion in health education research is over. What we demand in terms of burden of proof for educational effectiveness should be no less rigorous than our call for an ever escalating threshold concerning evidence of clinical care.
Knowledge and use of evidence‐based practice of GPs and hospital doctors
Authors: Upton Dominic , Upton Penney
Published: May 2006

Rationale, aims and objectives  Clinical effectiveness and evidence‐based practice (EBP) are the cornerstone of modern day health care. Although many studies have explored attitudes and perceived knowledge of individual professions few have compared the factors between professional groups and in particular in the medical profession. We report a study comparing the views, knowledge and practice of hospital doctors with their general practitioner (GP) counterparts in terms of EBP and clinical effectiveness. In this way it was hoped to highlight not only any differences between these groups but also the needs of these groups and suggest some ways of fulfilling these.

Methods  A postal questionnaire survey was completed by a random sample of 500 GPs and 500 hospital medics.

Results  There was a significant difference between the groups with the GPs rating their skill level as lower that their medical doctor counterparts. Similarly, GPs reported using EBP steps less frequently than hospital doctors. Barriers to implementing EBP differed between the groups with GPs reporting difficulty with accessing a library and making time available.

Conclusion  A number of differences between GPs and their hospital counterparts were recorded which highlights the difference in educational and policy approach required for greater uptake of EBP.
Evidence‐based psychiatry: understanding the limitations of a method
Authors: Maier Thomas
Published: May 2006

Evidence‐based psychiatry (EBP) is an important and useful method. However, it covers only a limited range of clinical problems psychiatrists and psychotherapists encounter in daily work. This is due to some particularities of psychiatric diagnoses and therapeutic practice. (i) The validity of psychiatric diagnoses is limited. EBP is entirely depending on diagnoses, so one of its core assumptions is of doubtful applicability in the field of psychiatry and psychotherapy. (ii) Effects of complexity are more obvious in psychiatric and psychotherapeutic cases. Owing to its conceptual bases, EBP cannot sufficiently consider such effects and is therefore of limited usefulness addressing particular problems in fluctuating or symptomatically shifting diseases. (iii) EBP’s strong focusing on decision making does not reflect appropriately the clinical reality of psychiatrists and psychotherapists. Diagnostic and therapeutic procedures are in fact more iterative, and decisions are constantly re‐evaluated. EBP is not helpful to adjust this type of individual approach, which is needed to treat individual patients.
The patient experience of community hospital – the process of care as a determinant of satisfaction
Authors: Small Neil , Green John , Spink Joanna , Forster Anne , Lowson Karin , Young John
Published: May 2006

Aims and objectives  We report findings from a qualitative study to identify patient views of community hospital care. We consider how far these were in accord with the hospital staffs’ views. This constituted part of a wider randomized controlled trial (RCT). The methodological challenges in seeking to identify patient satisfaction and in linking qualitative findings with trial results are explored.

Design  A sample of 13 patients randomized to the community hospital arm of the RCT joined the qualitative study. Official documentation from the hospital were accessed and six staff interviewed to identify assumptions underlying practice.

Results  Analysis of interviews identified a complex picture concerning expectations These could be classified as ideal, realistic, normative and unformed. The hospital philosophy and staff views about service delivery were closely in harmony, they delivered rehabilitation in a home‐based atmosphere. The formal, or ‘hard’, process of rehabilitation was not well understood by patients. They were primarily concerned with ‘soft’ or process issues – where and how care was delivered.

Conclusions  We identify a model of community hospital care that incorporates technical aspects of rehabilitation within a human approach that is welcomed by patients. If patients are to be able to participate in making informed decisions about care, the rationale for the activities of staff need to be more clearly explained. Recommendations are made about the appropriate scope of qualitative findings in the context of trials and about techniques to access patient views in areas where they have difficulty in expressing critical impressions.
Preliminary development of the new individualized HDQoL questionnaire measuring quality of life in adult hypopituitarism
Authors: McMillan Carolyn V. , Bradley Clare , Gibney James , Russell‐Jones David L. , Sönksen Peter H.
Published: May 2006

Objectives  The objectives were (1) to report the preliminary development of the Hormone Deficiency‐dependent Quality of Life (HDQoL) questionnaire, a new individualized questionnaire in which respondents rate personally applicable domains for importance and impact of hormonal deficiency and its treatment; (2) to evaluate the HDQoL’s psychometric properties for adults with hypopituitarism including growth hormone deficiency (GHD).

Methods  Internal consistency reliability, aspects of validity, and sensitivity to change of the HDQoL were investigated in: (1) a cross‐sectional survey of 157 adults with treated or untreated GHD; (2) a randomized, placebo‐controlled study of 3 months’ growth hormone (GH) withdrawal from 12 of 21 GH‐treated adults.

Results  Thirteen of the original 18 HDQoL domains were relevant and important for GH‐deficient adults. The shorter 13‐item HDQoL had excellent internal reliability (Cronbach’s alpha coefficient = 0.914, n = 109), and was sensitive to sex differences (cross‐sectional study): women perceived worse present QoL than men [t(149.8) = 2.33, P = 0.021]. The HDQoL was sensitive to change (GH‐withdrawal study) with a significant between‐group difference in change in domain scores for things I can do physically[t(16) = 2.47, P = 0.025, 2‐tailed], patients withdrawn from GH reporting greater negative impact of hormone deficiency on this domain at end‐point. Qualitative work resulted in the addition of seven new HDQoL domains, including energy and bodily pain.

Conclusion  The HDQoL, although at an early stage of development, proved useful in identifying expected changes following GH withdrawal. The extended 20‐item version is recommended for further evaluation in assessing the impact of hypopituitarism on QoL.
Evaluation of a service development to implement the top three process indicators for quality stroke care
Authors: Power Maxine L. , Cross Stephen P. , Roberts Sarah , Tyrrell Pippa J.
Published: May 2006

Rationale, aim and objective  Stroke mortality remains unacceptably high with up to 30% of patients dying within 1 month. Early swallow screen and computerized tomography (CT) brain scan, facilitate delivery of aspirin, which together are recognized as the top three process indicators for quality stroke care. Evidence indicates that treatment with aspirin (300 mg) saves lives and should commence within 48 h of stroke onset. However, many hospitals find it difficult to meet this timescale. We aimed to evaluate whether reorganization of services could improve aspirin delivery following acute ischaemic stroke.

Method  A retrospective audit was carried out to determine the time to swallow screen, CT scan and aspirin administration. A service review was conducted and the findings disseminated. A decision was made to reorganize services by enhancing the role of senior nursing staff to: (1) admit patients, (2) request CT brain scans, (3) screen for swallowing abnormality, and (4) prescribe the first dose of aspirin. A second audit was conducted to evaluate the impact of the new service.

Results  Before reorganization, 30% had swallowing screened and 38% had CT scans within 24 h. Thirty‐one per cent received their first dose of aspirin within 48 h. After reorganization, 68% had their swallowing screened and 80% had a CT scan within 24 h. Ninety per cent of patients received their first dose of aspirin within 48 h.

Conclusions  Modernizing service delivery by changing traditional roles can offer quality solutions ensuring that aspirin delivery is expedited by early swallow screen and CT scan. These initiatives could be used more widely to improve patient care and implement the top three process indicators for stroke.
What do primary care nurses and radiation therapists in a Canadian cancer centre think about clinical trials?
Authors: Sale Joanna E. M.
Published: May 2006

Rationale, aims and objectives  Clinical trials are integral to progress in cancer management. While doctors’ attitudes to clinical trials have been documented, there is little or no literature on the perception of trials from the perspective of other clinicians who treat trial patients. The purpose of this phenomenological study was to explore nurses’ and radiation therapists’ (RTs) perceptions of clinical trials in their cancer centre.

Methods  This study was conducted in a Canadian cancer centre where over 50 clinical trials actively recruit patients at any one time. Nurses and RTs were interviewed to explore their perceptions of clinical trials.

Results  The following themes emerged from the analysis: (1) nurses and RTs perceived a variety of ethical concerns associated with clinical trials; (2) treating patients enrolled in clinical trials was perceived to add to the workload of RTs; (3) nurses and RTs did not perceive meaningful involvement in clinical trials as an option; and (4) the additional workload and ethical concerns associated with trials were off‐set by the view that patients’ interests outweighed those of nurses and RTs.

Discussion  Nurses and RTs should be invited to provide input regarding trial procedures and be acknowledged for their work associated with clinical trials.