bluuebunny/crossref_metadata_2025 huggingface dataset:
Inspecting for Improvement? Emerging Patterns of Public Service Regulation in the UK
Authors: Downe James , Martin Steve
Published: May 2007

In recent years ministers in the UK have regarded external inspection as a key driver of improvement in public services and an important instrument of good governance. Detailed data analysis of the operation of Audit Commission inspection of English local authorities since April 2000 demonstrates significant variations in inspection scores in different types of authorities, in different years and in different services. These findings raise important questions about the consistency with which inspection criteria are being applied and the reliability of the evidence on which inspectors are basing their judgments about a council's capacity for improvement. This in turn casts doubt on the capacity of the current model of improvement to make service providers more accountable to the public, which central government claims to be one of its key policy objectives. The paper uses data from the shadowing of inspections in five local authorities and elite interviews to explore the practice of ‘inspecting for improvement’.
Hunting to extinction: biology and regional economy influence extinction risk and the impact of hunting in artiodactyls
Authors: Price Samantha A , Gittleman John L
Published: May 2007

Half of all artiodactyls (even-toed hoofed mammals) are threatened with extinction, around double the mammalian average. Here, using a complete species-level phylogeny, we construct a multivariate model to assess for the first time which intrinsic (biological) and extrinsic (anthropogenic and environmental) factors influence variation in extinction risk in artiodactyls. Globally artiodactyls at greatest risk live in economically less developed areas, have older weaning ages and smaller geographical ranges. Our findings suggest that identifying predictors of threat is complicated by interactions between both biological and anthropogenic factors, resulting in differential responses to threatening processes. Artiodactyl species that experience unregulated hunting live in significantly less economically developed areas than those that are not hunted; however, hunted species are more susceptible to extinction if they have slower reproductive rates (older weaning ages). In contrast, risk in non-hunted artiodactyls is unrelated to reproductive rate and more closely associated with the economic development of the region in which they live.
NUCLEAR PORE ANCHOR, theArabidopsisHomolog of Tpr/Mlp1/Mlp2/Megator, Is Involved in mRNA Export and SUMO Homeostasis and Affects Diverse Aspects of Plant Development
Authors: Xu Xianfeng Morgan , Rose Annkatrin , Muthuswamy Sivaramakrishnan , Jeong Sun Yong , Venkatakrishnan Sowmya , Zhao Qiao , Meier Iris
Published: May 2007

Vertebrate Tpr and its yeast homologs Mlp1/Mlp2, long coiled-coil proteins of nuclear pore inner basket filaments, are involved in mRNA export, telomere organization, spindle pole assembly, and unspliced RNA retention. We identified Arabidopsis thaliana NUCLEAR PORE ANCHOR (NUA) encoding a 237-kD protein with similarity to Tpr. NUA is located at the inner surface of the nuclear envelope in interphase and in the vicinity of the spindle in prometaphase. Four T-DNA insertion lines were characterized, which comprise an allelic series of increasing severity for several correlating phenotypes, such as early flowering under short days and long days, increased abundance of SUMO conjugates, altered expression of several flowering regulators, and nuclear accumulation of poly(A)+ RNA. nua mutants phenocopy mutants of EARLY IN SHORT DAYS4 (ESD4), an Arabidopsis SUMO protease concentrated at the nuclear periphery. nua esd4 double mutants resemble nua and esd4 single mutants, suggesting that the two proteins act in the same pathway or complex, supported by yeast two-hybrid interaction. Our data indicate that NUA is a component of nuclear pore-associated steps of sumoylation and mRNA export in plants and that defects in these processes affect the signaling events of flowering time regulation and additional developmental processes.
Enhancing the validity and utility of randomized clinical trials in addictions treatment research: II. Participant samples and assessment
Authors: Del Boca Frances K. , Darkes Jack
Published: May 2007

Purpose  This paper is the second in a series that describes strategies for optimizing the validity and utility of randomized clinical trials (RCTs) in addictions treatment research. Whereas the first paper focused on treatment implementation and research design, here we address issues pertaining to participant samples and assessment methods.

Scope  With respect to participant samples, sections focus on the definition of study populations; informed consent; sample size and statistical power; recruitment and enrollment; sample retention; and participant tracking systems. Assessment topics include eligibility screening and baseline assessment; treatment‐related variables; outcome measures; the frequency of follow‐up evaluation; and assessment process. A final section highlights the importance of pilot testing.

Conclusions  Sample recruitment and retention strategies are needed that safeguard both internal and external validity. Daily estimation assessment procedures are recommended because of their versatility for creating a range of outcome measures. Assessment batteries should include measures that permit the investigation of treatment processes and mechanisms of action.
Response of emergent macrophytes to experimental nutrient and salinity additions
Authors: MACEK P. , REJMÁNKOVÁ E.
Published: May 2007

Nutrient additions often result in species dominance/compositional changes in wetland ecosystems, but the impact of nutrients may be constrained by different salinity levels. Wetlands of northern Belize, distributed along a salinity gradient, are strongly phosphorus‐limited and dominated largely by three species of emergent macrophytes: Eleocharis cellulosa Torr., Cladium jamaicense Crantz and Typha domingensis Pers.

We conducted a mesocosm experiment to assess changes in growth characteristics [biomass allocation, plant height, relative growth rate (RGR), rhizome length] and nutrient uptake of these three species in response to simultaneous changes in levels of nutrients (nitrogen and phosphorus) and salinity.

The growth characteristics of Typha and Eleocharis responded positively to N and especially P addition, whereas the growth response of Cladium was largely insignificant. The RGR of Typha increased under P addition, while RGR of Eleocharis increased with N and decreased with salinity addition. Nutrient addition increased the rhizome number of both Typha and Eleocharis. However, plasticity in rhizome length was observed only in Typha, which showed increased rhizome length at medium and high P.

Salinity decreased plant height and shoot and root biomass of Cladium and Eleocharis, while in Typha it reduced only height. Rhizome number and length were decreased only in Eleocharis.

Both medium and high P additions increased tissue P content in all three species, but Eleocharis accumulated significantly more P than Cladium and Typha. Nitrogen additions increased tissue N content in Cladium and Eleocharis, but not in Typha.

 Cladium exhibited strong morphological constraint and behaved as a stress‐tolerator that was well adapted to low nutrients. Typha– characterized by its plastic, opportunistic guerrilla growth strategy, fast and efficient space occupancy, and rather wasteful nutrient management – behaved as a typical competitor. Eleocharis responded rapidly to nutrients but displayed limited rhizome plasticity, and its growth was affected at higher salinity.

According to recorded traits, we hypothesize that P input into wetlands will result in expansion of Typha, leading to competitive exclusion of both co‐occurring species. The only conditions allowing coexistence of all three species are those limiting vertical and horizontal growth of Typha: low P and higher salinity. To ensure the stability of Belizean wetlands, the maintenance of oligotrophic status is therefore crucial.
The interactive effect of temperature and humidity on the oxygen isotope composition of kangaroos
Authors: MURPHY BRETT P. , BOWMAN DAVID M.J.S. , GAGAN MICHAEL K.
Published: May 2007

A strong relationship between the oxygen isotope composition (expressed as δ18O) of body water and relative humidity has been demonstrated for a number of mammalian herbivores with low drinking water requirements, including kangaroos. Consequently, it has been suggested that the oxygen isotope composition of preserved mammal remains may be used to reconstruct past relative humidity. Other physiological, environmental and ecological factors may also influence mammalian δ18O, thereby confounding the climatic signal, yet these factors have been rigorously examined in few taxa.

We examined sources of variation in the δ18O of tooth enamel, assumed to reflect δ18O of body water, of kangaroos (Macropus spp.) collected throughout Australia.

Relative humidity explained a large proportion of the variation in enamel δ18O, a finding that is consistent with previous studies. However, we also found a previously unreported interaction between mean annual temperature and relative humidity. At lower temperatures, the relationship between enamel δ18O and relative humidity was much steeper than at higher temperatures.

This may be a consequence of the Peclét effect in plant leaves, whereby high transpiration rates diminish the 18O enrichment of bulk leaf water. It is likely that this interaction is also present in other herbivores with low drinking water requirements.

We found little evidence that δ18O varied consistently between molars, suggesting that a ‘weaning effect’ is either absent or swamped by seasonal variation in precipitation δ18O.

We suggest that the oxygen isotope composition of preserved kangaroo remains cannot be used to reconstruct relative humidity unless ambient air temperature can be reliably estimated.
Vasoactive intestinal peptide receptor expression in chronic periapical lesions
Authors: Caviedes‐Bucheli J. , Azuero‐Holguín M. M. , Moreno G. C. , González I. L. , Mateu E. , Salazar J. F. , Munoz H. R.
Published: May 2007

Aim  To use radioreceptor analysis for evaluating whether vasoactive intestinal peptide (VIP) receptors are present in chronic periapical lesions and to determine whether differences in its expression are found according to the size of the lesions.

Methodology  Twelve periapical lesions were obtained from teeth diagnosed with chronic apical periodontitis and indicated for endodontic surgery; they were classified according to the size of the lesion in two groups of six samples (lesion size greater or smaller than 5 mm), and then processed and labelled with 125I‐VIP. Binding sites were identified by 125I‐VIP and standard VIP competition assays. Mann–Whitney's test was used to establish statistically significant differences in the VIP receptor expression between groups.

Results  Vasoactive intestinal peptide receptor expression was found in all periapical lesion samples. There was a statistically significantly higher expression in periapical lesions <5 mm (P < 0.001).

Conclusion  Vasoactive intestinal peptide receptors were expressed in chronic periapical lesions with levels inversely proportional to lesion size.
Differential signalling pathways involved in cholinoceptor‐dependent stimulation of nitric oxide isoforms in dental pulp
Authors: Sterin‐Borda L. , Furlan C. , Reina S. , Orman B. , Borda E.
Published: May 2007

Aim  To investigate the role of muscarinic acetylcholine receptor (mAChR) subtype activity in the regulation of endothelial‐ (e) and neuronal‐ (n) nitric oxide synthase (NOS) expression and activity.

Methodology  Rat dental pulp tissue was used throughout the study. The e‐nos and n‐nos mRNA levels were specifically measured using reverse transcriptase polymerase chain reaction procedures that involve simultaneous co‐amplification of both target cDNA and a reference template with a single set of primers. NOS activity was measured by the production of [U‐14C]‐citrulline from [U‐14C]‐arginine.

Results  Stimulation of M1/M2 and M3/M4 mAChRs with pilocarpine caused an increase in e‐nos and n‐nos mRNA levels and NOS activity in the dental pulp. The specific mAChR subtype antagonists, l‐NMMA, l‐NIO and N2‐propyl‐l‐arginine but not aminoguanidine attenuated all these effects. Inhibitors of phospholipase C (PLC), protein kinase C (PKC) and calcium/calmodulin (CaM) prevented the pilocarpine‐dependent increase in n‐nos and e‐nos mRNA levels and NOS activity.

Conclusions  Activation of mAChR subtypes stimulated NOS activity by increasing the production of NO through e‐nos and n‐nos gene expression and NOS activity. The mechanism appears to occur secondarily to stimulation of CaM and PKC enzymatic activity.
Implementation of nurse‐delivered vestibular rehabilitation in primary care: a qualitative study of nurses’ views on involvement in an innovative service
Authors: Walsh Bronagh , Yardley Lucy , Donovan‐Hall Maggie , Smith Helen
Published: May 2007

Aim:  To explore practice nurses’ perceptions of vestibular rehabilitation and its place in relation to their general role development.

Background:  Vestibular rehabilitation has been known for a long time to be effective for chronically dizzy patients in secondary care, but its use in primary care has been limited. A recent pragmatic trial of vestibular rehabilitation delivered by practice nurses in primary care has confirmed its utility in a community setting. This type of role is increasingly common for practice nurses, but few studies explore the nurses’ perspective.

Methods:  A qualitative study was undertaken; 19 nurses took part in focus group sessions. Participants discussed their views on vestibular rehabilitation and its potential for integration with their existing role. A thematic analysis of the data was undertaken.

Findings:  Four main themes were identified: creating a unique nursing role; the therapeutic role; responsibility and role boundaries; and time. Nurses were positive about developing extended roles, but sought ways to achieve this without eroding fundamental nursing skills. Vestibular rehabilitation was seen as fulfilling both the need for a distinct nursing identity and professional development. Concerns over responsibility for patient assessment and time management constraints are potential obstacles to overcome in the wider development of this therapy in primary care.

Conclusions:  Understanding the perspective of nurses will be vital in future development of chronic disease management within primary care. Whilst nurses may be positive about such role expansion, the implementation of services of this type will require clarity about nurses’ responsibilities and flexibility in managing workload.

Relevance to clinical practice:  Vestibular rehabilitation is simple, low‐tech and appropriate for widespread development in primary care. Nurses wishing to provide vestibular rehabilitation or similar chronic disease management activities will need to work with medical colleagues to define role boundaries.
Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups
Authors: Halcomb Elizabeth J , Gholizadeh Leila , DiGiacomo Michelle , Phillips Jane , Davidson Patricia M
Published: May 2007

Aims.  This integrated literature review seeks to identify the key considerations in conducting focus groups and discusses the specific considerations for focus group research with culturally and linguistically diverse groups.

Background.  The focus group method is a technique of group interview that generates data through the opinions expressed by participants. Focus groups have become an increasingly popular method of data collection in health care research. Although focus groups have been used extensively with Western populations, they are a particularly useful tool for engaging culturally and linguistically diverse populations. The success of focus groups in this context is dependent upon the cultural competence of the research team and the research questions.

Methods.  The electronic databases Medline, CINAHL, Embase, Psychlit and the Internet using the Google Scholar search engine were explored using the search terms ‘focus group’, ‘cultural sensitivity’, ‘transcultural nursing’, ‘transcultural care’, ‘cultural diversity’ and ‘ethnic groups’. Hand searching of reference lists and relevant journals was also undertaken. English language articles were selected for the review if they discussed the following issues: (i) methodological implications of the focus group method; (ii) strengths and limitations of the focus group method; (iii) recommendations for researchers and (iv) use of the focus group in culturally and linguistically diverse groups. Conclusions were drawn from each of the articles and consensus regarding a summary of recommendations was derived from a minimum of two authors.

Results.  Findings from this review revealed several key issues involving focus group implementation including recruitment, sample size, data collection, data analysis and use within multicultural populations. Strengths and limitations of the focus group method were also identified.

Conclusions.  Focus groups are a useful tool to expand existing knowledge about service provision and identify consumer needs that will assist in the development of future intervention programmes, particularly within multicultural populations. Careful planning related to methodological and pragmatic issues are critical in deriving effective data and protecting participants.

Relevance to clinical practice.  Focus groups can facilitate increased understanding of perspectives of culturally and linguistically diverse groups and thereby shape clinical practice to better meet the needs of these groups.
Contemporary day surgery: patients’ experience of discharge and recovery
Authors: Gilmartin Jo
Published: May 2007

Aim. To explore and reveal patients’ perceptions of discharge arrangements and recovery following day surgery.

Introduction. Contemporary day surgery is increasingly being used to carry out elective surgical procedures enabling patients to be discharged on the same day. The Department of Health and government modernization programmes in the UK have encouraged this rapid growth. Preparation for discharge is important because patients require knowledge and understanding about self‐management and access to primary health care services if required.

Methods. Using a phenomenological approach, data were collected by unstructured interviews from 30 patients undergoing gynaecology, urology and general surgery procedures.

Results. Deficits in patient preparation for discharge including the timing of information giving postprocedure for all groups were highlighted. The gynaecology patients pointed to a specific lack of verbal information about resuming sexual activity following procedures. Some general surgery and urology patients alluded to finding it stressful coping with threats to body image through ‘skin discoloration’, ‘swelling’ or ‘bruising’, because they did not know what to do. A number of urology patients talked about the challenges posed by difficulty with voiding, dysuria and haematuria.

Relevance to clinical practice. The results and problems identified have applicability for the development of discharge planning services and patient education in a day surgery context. It is suggested that the use of evidenced‐based and innovative interventions among health professionals might improve patient outcomes.
Making patients better: a qualitative descriptive study of registered nurses’ reasons for working in surgical areas
Authors: Mackintosh Carolyn
Published: May 2007

Aims.  To explore the reasons and motivation identified by qualified nurses for working within the surgical area.

Background.  Little is known about the career decisions qualified nurses make, although it is clear that some areas of practice are more popular than others. This qualitative descriptive study considers one common area, surgery, and explores the motivation for decisions made by Registered Nurses (RNs) to work in this area.

Method.  A sample of 16 RNs working within surgical areas participated in semi‐structured interviews, using a thematic interview schedule. Findings were analysed using the framework suggested by Morse and Field.

Results.  Analysis of findings indicates that all participants actively chose to work within surgery and that this was because of the pace and turnover of surgical work, personal satisfaction at the recovery of patients; the close links between this type of work; and participants’ original aims when first entering nursing and participants’ preference of surgery to other areas of nursing work. Participants actively rejected working in areas where patients were likely to suffer from chronic long‐term conditions where recovery was unlikely and felt that these areas were likely to be depressing and unrewarding.

Conclusion.  These findings suggest that participants actively chose to work with ‘healthy’ patients in preference to those who may be considered ‘ill’, and this is closely linked to the identified need of participants to be able to ‘make patients better’. Participants were reluctant to work in areas where they would be unlikely to achieve this aim.

Relevance to clinical practice.  The reluctance of surgical nurses to work with patients who were considered ‘ill’, in preference to ‘healthy’ patients must be acknowledged. Findings reflect different professional perspectives on the purpose of nursing work and suggest that qualified staff choose their clinical specialism based on their own personal sense of professional purpose, with consequent implications for both the recruitment and retention of qualified staff.
Nurses’ experience with the clinical application of a research‐based nursing protocol in a long‐term care setting
Authors: Simpson Michelle R , Stevens Patricia , Kovach Christine R
Published: May 2007

Aim.  To describe nurses’ experience with the clinical application of a research‐based nursing protocol (The Serial Trial Intervention) within a long‐term care setting.

Design.  A descriptive, qualitative study was conducted with a convenience sample of eight nurses from three nursing homes, who assessed and treated residents with dementia according to the Serial Trial Intervention protocol.

Methods.  Each nurse participated in a semi‐structured interview between September 2003 and May 2004. Interviews were audiotaped and transcribed verbatim. Qualitative content analysis of the data, including thematic analysis, was used to identify patterns of experience.

Results.  Three themes emerged that offer insight into the factors contributing to implementation of research‐based practice in a clinical setting. These include determining to intervene, pertinent steps of the protocol and facilitators and barriers.

Conclusions.  The interplay between the protocol, the residents receiving care, the nurses providing care and the setting in which the care is provided, are interacting to affect the outcomes expected.

Relevance to clinical practice.  Nurses who recognize the research process, the need for continual improvement in patient care and who possess competency in comprehensive physical assessment are needed to implement this evidence‐based protocol successfully. The regulatory atmosphere, workload structure and interdisciplinary collaboration are additional factors contributing to the successful use of the Serial Trial Intervention.
The comparison of effectiveness of two modalities of mental health nurse follow‐up programmes for female outpatients with depression in Taipei, Taiwan
Authors: Hsiao Fei‐Hsiu , Yang Tsung‐Tsair , Chen Chiao‐Chicy , Tsai Shang‐Ying , Wang Kuo‐chang , Lai Yu‐Ming , Tsai Chang‐Jer , Chang Wen‐Yin
Published: May 2007

Aims and objectives.  This study compares the effectiveness of two modalities of mental health nurse three‐month follow‐up programmes: telephone counselling programme and group therapy programme for female outpatients with depression.

Background.  The lifetime prevalence of major depression is 15% and is about twice as common in women as in men. Outpatients with depression often discontinue their treatment after the initial visits to their physicians.

Methods.  This study used a quasi‐experimental, pre–post‐test comparison group design. Twenty‐six female outpatients with depression were assigned to one of follow‐up programmes: telephone counselling programme or group therapy programme. To qualify for group therapy programme, potential participants were required to come to group sessions weekly. To be accepted into telephone counselling programme, potential participants had to be able to be contacted by phone regularly. Mental health nurse three‐month follow‐up programmes included care management and structured psychotherapy. Patients in telephone counselling programme received 10 regular telephone calls of 30–60 minutes each. Patients in group therapy programme received 12 sessions of weekly group meetings of 90–120 minutes each.

Results.  Wilcoxon signed ranks tests provided evidence that the group therapy programme (S = −52·5, p < 0·001; S = 31·5, p = 0·046) and telephone counselling programme (S = −36, p = 0·002; S = 25, p = 0·050) follow‐up programmes were effective in terms of relieving depressed symptoms and improving quality of life. According to Quade's analysis of covariance, telephone counselling programme and group therapy programme appeared to have similar effects of relieving depressed symptoms (F(1,24) = 0·06, p = 0·813) and increasing quality of life (F(1,24) = 0·07, p = 0·792). While there was no significant difference in using emergency services ( = 0·89, p = 0·539) between telephone counselling programme and group therapy programme, the rate of adherence to scheduled outpatient appointments with psychiatrists was higher among patients in group therapy programme than patients in telephone counselling programme ( = 8·67, p = 0·034).

Conclusions.  Establishing two modalities of mental health nurse follow‐up programmes in Taiwan could benefit patients with different needs.

Relevance to clinical practice.  Mental health nurses specialized in management of depression could provide not only care management but also structured psychotherapy.
Nurse practitioner–client interaction as resource exchange: the nurse's view (NP–client interaction)
Authors: Koeniger‐Donohue Rebecca
Published: May 2007

Aim.  The aim of this study was to explore nurse practitioner (NP) client encounters from the nurse's perspective using a resource exchange paradigm.

Background.  In health care interactions there is a need to examine what is reinforcing from the nurse's perspective.

Design.  An exploratory descriptive design was used to address the following research questions: Prior to a clinic visit with midlife female clients what are NPs expectations of resources provided? What resources are actually provided during the visit with the NP and the client? To what extent is there congruence between the NP's expectations and the resources actually provided during a clinic visit?

Methods.  The participants included two expert NPs and eight midlife female clients. Data for the study were derived from an initial larger study which examined resource exchange from the client angle and consisted of audio‐taped pre‐ and postencounter interviews with the NPs, audiotapes of the entire clinic visit and field notes recorded by the researcher of the client visits. Content analysis was conducted using ETHNOGRPAH software.

Results.  NPs anticipated that a broad range of resources would be provided. The most prominent resources provided across visits were information, services, time and affirmation (that included affirmation itself, reassurance, reinforcement of positive health behaviours, support and feedback). In the more established relationships nurse self‐disclosure was evident.

Conclusions.  Resource exchange theoretical formulations can be applied to NP–client interactions to understand and explain the specific nature of resources NPs expect to provide and actually provide.

Relevance to clinical practice.  The nature of resources NPs provide, relationship development, types of exchange relationships in clinical practice were identified and posit a beginning typology for NPs to apply in their own clinical practice.
An evaluation of two Rapid Access Chest Pain Clinics in central Lancashire, UK
Authors: Rajpura Arif , Sethi Su , Taylor Martin
Published: May 2007

Aim  The aim of the project was to assess critically, using Maxwell’s six dimensions, the quality of the services provided by the two Rapid Access Chest Pain Clinics (RACPCs) in Central Lancashire.

Methods  Data on the actual use of the clinic was obtained from the two RACPCs. A record linkage exercise between the database of patients from the RACPC and HES/mortality data was performed. Expected use of the clinic was established from the performance of other RACPCs and from published angina incidence figures. Patient and general practitioner views were obtained by conducting questionnaire surveys.

Key recommendations  (1) Clinic is providing a valuable service and should be continued. (2) A standardized database should be created which includes ethnicity and final diagnosis. (3) Alternative methods for rapid diagnosis and management of chest pain need to be provided for patients who are not suitable for the exercise electrocardiogram. (4) Referral criteria should be redrafted in order to remove the exclusion criteria for patients with chest pain of longer duration than 3 months. (5) Further resources need to be targeted at cardiology outpatients and revascularizations, as waiting times for patients with a positive test are felt to be too long.
A survey of the practice of stroke doctors in developing transient ischaemic attack services in the UK
Authors: Beech Paula , Greenhalgh Joanne , Thornton Maria , Tyrrell Pippa
Published: May 2007

Rationale, aims and objectives  (1) To describe current practice in the establishment and running of transient ischaemic attack (TIA) clinics in the UK; (2) to identify whether TIA targets are met; (3) to inform future TIA service development.

Methods  A survey distributed to the members of the British Association of Stroke Physicians (BASP).

Results  Forty‐one per cent of full BASP members responded to the survey. TIA clinics were being run by 77% of respondents. Of the remainder 75% had plans to do so. Dedicated consultant time for stroke predominated among those involved in clinics (87% vs. 54%). The median time for clinics operation was 36 months. The median time from TIA to appointment was 2 weeks, exceeding national targets. Sixty‐four per cent of clinics were run weekly and 31% more than once a week. Forty‐six per cent stated they ran a one‐stop clinic service yet only 10% said there were no later follow‐up visits. A patient returning for completion of investigations was the most common reason for this (60%). Waits for investigations were reported – 53% indicated a wait for carotid Doppler scanning and 41% indicated this wait was in excess of 1 week.

Conclusion  Key areas of concern arising from this survey were that time from TIA to clinic appointment remained outside the national target and there were delays for key investigations. Current service models are inadequate to meet current TIA targets and exploration of alternative service models is required.
Family history of mental illness and frequent mental distress in community clinic patients
Authors: Rohrer James , Rohland Barbara , Denison Anne , Pierce J. Rush , Rasmussen Norman H.
Published: May 2007

Objective The objective of this study was to investigate the importance of family history of mental illness as a risk factor for self‐reported frequent mental distress among patients who use community‐based clinics.

Design A cross‐sectional survey was distributed to a convenience sample in three community clinics serving largely low‐income patients. Forms were completed by 793 clinic patients. Multiple logistic regression analysis was to control for the effects of demographic variables.

Results In this sample of primary care patients, 27.1% had frequent mental distress. Having a family history of mental illness or substance abuse was found to be associated with frequent mental distress in this population [adjusted odds ratio (OR) = 2.24,P = 0.000]. Also associated with increased odds of frequent mental distress were avoiding medical care owing to cost (OR = 1.86,P = 0.003) and obesity (OR = 1.73,P = 0.006).

Conclusions Having a family history of mental illness or substance abuse is independently associated with increased odds of frequent mental distress among primary care patients seen in community clinics. Three strategies are suggested for using this information to prevent frequent mental distress: health education via mass communication to the general population of primary care patients being followed in a clinic, health education to at‐risk patients, and targeted screening of clinic patients who have the risk factor.
The role of Clinical Support Workers in reducing Junior doctors’ hours and improving quality of patient care
Authors: Herbertson Rebecca , Blundell Adrian , Bowman Christine
Published: May 2007

Aim  The aim of the study was to see if the introduction of Clinical Support Workers (CSWs) at a teaching hospital could reduce the medical work intensity for junior doctors without compromising the quality of patient care.

Background  The ‘New Deal’ and ‘European Working Time Directive’ have prompted hospitals to take a close look at junior doctors’ hours and work intensity in order to make posts compliant. Following the Department of Health’s publication ‘reducing junior doctors’ hours’, it was felt that certain clinical duties could be shared with nursing staff.

Methods  Two audits were undertaken 8 months apart. The first was to determine the areas where the introduction of CSW would make the biggest impact. The second was to determine if this impact had had an effect on the intensity of work carried out by the junior doctors.

Findings  The CSW greatly reduced the number of cannulations and venepunctures performed by the doctors without any compromise to patient care.

Relevance to Clinical Practice  This study shows that other allied health professionals can be trained to carry out certain tasks that previously were only performed by doctors. This not only reduces the impact on junior doctors’ hours but can also improve patient care, with fewer delays encountered when patients are waiting for a procedure.
Multiplex ARMS analysis to detect 13 common mutations in familial hypercholesterolaemia
Authors: Taylor A , Tabrah S , Wang D , Sozen M , Duxbury N , Whittall R , Humphries SE , Norbury G
Published: May 2007

DNA analysis and mutation identification is useful for the diagnosis of familial hypercholesterolaemia (FH), particularly in the young and in other situations where clinical diagnosis may be difficult, and enables unambiguous identification of at‐risk relatives. Mutation screening of the whole of the three FH‐causing genes is costly and time consuming. We have tested the specificity and sensitivity of a recently developed multiplex amplification refractory mutation system assay of 11 low‐density lipoprotein receptor gene (LDLR) mutations, one APOB (p.R3527Q) and one PCSK9 (p.D374Y) mutation in 400 patients attending 10 UK lipid clinics. The kit detected a mutation in 54 (14%) patients, and a complete screen of the LDLR gene using single‐stranded conformation polymorphism/denaturing high performance liquid chromatography identified 59 different mutations (11 novel) in an additional 87 patients, for an overall detection rate of 35%. The kit correctly identified 38% of all detected mutations by the full screen, with no false‐positive or false‐negative results. In the patients with a clinical diagnosis of definite FH, the overall detection rate was higher (54/110 = 49%), with the kit detecting 52% of the full‐screen mutations. Results can be obtained within a week of sample receipt, and the high detection rate and good specificity make this a useful initial DNA diagnostic test for UK patients.
Gender, genotype, and phenotype differences in Smith–Magenis syndrome: a meta‐analysis of 105 cases
Authors: Edelman EA , Girirajan S , Finucane B , Patel PI , Lupski JR , Smith ACM , Elsea SH
Published: May 2007

Smith–Magenis syndrome (SMS) is a multisystem disorder characterized by developmental delay and mental retardation, a distinctive behavioral phenotype, and sleep disturbance. We undertook a comprehensive meta‐analysis to identify genotype–phenotype relationships to further understand the clinical variability and genetic factors involved in SMS. Clinical and molecular information on 105 patients with SMS was obtained through research protocols and a review of the literature and analyzed using Fisher’s exact test with two‐tailed p values. Several differences in these groups of patients were identified based on genotype and gender. Patients with RAI1 mutation were more likely to exhibit overeating, obesity, polyembolokoilamania, self‐hugging, muscle cramping, and dry skin and less likely to have short stature, hearing loss, frequent ear infections, and heart defects when compared with patients with deletion, while a subset of small deletion cases with deletions spanning from TNFRSF13B to MFAP4 was less likely to exhibit brachycephaly, dental anomalies, iris abnormalities, head‐banging, and hyperactivity. Significant differences between genders were also identified, with females more likely to have myopia, eating/appetite problems, cold hands and feet, and frustration with communication when compared with males. These results confirm previous findings and identify new genotype–phenotype associations including differences in the frequency of short stature, hearing loss, ear infections, obesity, overeating, heart defects, self‐injury, self‐hugging, dry skin, seizures, and hyperactivity among others based on genotype. Additional studies are required to further explore the relationships between genotype and phenotype and any potential discrepancies in health care and parental attitudes toward males and females with SMS.
Immunohistochemically proven cytomegalovirus end‐organ disease in solid organ transplant patients: clinical features and usefulness of conventional diagnostic tests
Authors: Fica A. , Cervera C. , Pérez N. , Marcos M.A. , Ramírez J. , Linares L. , Soto G. , Navasa M. , Cofan F. , Ricart M.J. , Pérez‐Villa F. , Pumarola T. , Moreno A.
Published: May 2007

Abstract: We studied the main clinical features, outcome, and laboratory parameters in a group of solid organ transplant (SOT) patients with immunohistochemically proven cytomegalovirus (CMV) disease. Confirmed CMV cases were obtained through databases. Demographics, clinical data, transplantation type, immunosuppressive regimens, donor and recipient CMV serostatus, therapy, outcome and laboratory results, pp65 antigenemia, and qualitative polymerase chain reaction (PCR) for CMV were analyzed. From 1995 to 2004, 31 cases with complete medical records were identified. Disease appeared between 24 and 2538 days after transplantation but most cases presented in the first 100 days. Gastrointestinal CMV disease was the most frequent form (71%), while thrombocytopenia was present in 50% of cases, and leukopenia was less common (35.5%). CMV pp65 antigenemia was positive in 58% of patients, but its sensitivity increased to 71% if performed during the first 6 months. A qualitative CMV PCR technique gave similar results during this period (71.4%). Most patients were treated with intravenous ganciclovir (n=25; 80.6%). In 4 cases (19.4%), use of foscarnet alone or a sequential regimen with ganciclovir–foscarnet was deemed necessary. Surgical procedures were necessary in 5 patients (16%). The death rate reached 13%. CMV end‐organ disease can be a life‐threatening infection in SOT patients. Gastrointestinal disease was the most frequent end‐organ disease. CMV antigen detection is best suited for the early period after transplantation.
Successful treatment of recurrent cholangitis complicating liver transplantation by Roux‐en‐Y limb lengthening
Authors: Vrochides D. , Fischer S.A. , Soares G. , Morrissey P.E.
Published: May 2007

Abstract: A 40‐year‐old male developed sepsis due to cholangitis. Five years earlier he underwent liver transplantation with hepaticojejunostomy. Over the past 18 months, he had 6 episodes of cholangitis. Radiologic studies demonstrated no biliary obstruction. Surgical intervention to eliminate bile reflux and stasis by lengthening the Roux‐en‐Y limb from 30 to 90 cm was curative. He has had no further episodes of cholangitis or hospitalization in the past 2 years. This case is the first description to our knowledge of a simple technique to treat recurrent cholangitis in patients with normal biliary anatomy, but inadequate biliary drainage following liver transplantation.
Infectious complications after kidney transplantation: a single‐center experience
Authors: Pourmand G. , Salem S. , Mehrsai A. , Taherimahmoudi M. , Ebrahimi R. , Pourmand M.R.
Published: May 2007

Abstract:Infectious complications after renal transplantation are associated with significant morbidity and mortality. The prevalence of infections in transplant recipients varies from country to country. This study sought to assess the overall incidence of post‐transplant infectious complications at our research center in Iran, compared with other centers in the world. Between 2002 and 2004, 179 renal transplantations were performed in our center. Of these, 142 were studied and followed for 1 year. Immunosuppressive regimens were cyclosporine, mycophenolate mofetil, and prednisolone. The overall incidence of infections was 54.2%. The most common sites of infections were the urinary tract (41.5%) and the respiratory tract (6.3%). The most frequent causes of infections wereKlebsiella(24%) and cytomegalovirus (CMV) (17.6%). Wound infection occurred in 4.9% of the patients. Three (2.1%) patients developed hepatitis C and 2 (1.4%) had mycobacterial infections. There was no case ofPneumocystispneumonia. Overall mortality was 7.7%. Infection‐related mortality was 3.5%. In conclusion, this study identifies infections as the cause of morbidity and mortality in the post‐transplant period. There was a low incidence of tuberculosis (<2% yearly) and a high incidence of CMV disease in our recipients.
Etiologic agents of diarrhea in solid organ recipients
Authors: Arslan H. , Inci E.K. , Azap O.K. , Karakayali H. , Torgay A. , Haberal M.
Published: May 2007

Abstract: After transplantation, diarrhea may be caused by infectious agents, drug‐specific effects, metabolic conditions, or mechanical complications of surgery. Determining the cause helps to determine whether to initiate antimicrobial therapy and the duration of treatment. In this study we aimed to determine the causes of diarrhea in kidney or liver recipients. Fifty‐two diarrhea episodes among 43 solid organ recipients were evaluated. The cause of diarrhea was detected in 43 patients (82.6%). Infectious etiologies accounted for 33 out of the 43 episodes (76.7%) in which a specific cause was determined: Giardia lamblia in 9, Cryptosporidium parvum in 7, cytomegalovirus (CMV) in 6, Clostridium difficile in 3, Campylobacter jejuni in 2, Shigella sonnei in 2, Salmonella enteritidis in 1, rotavirus in 1, Entamoeba histolytica in 1, and Blastocystis hominis in 1. Non‐infectious etiologies were found for 10 episodes (23.3%): mycophenolate mofetil‐associated diarrhea in 5, antibiotic‐associated diarrhea in 2, colchicine‐associated diarrhea in 2, and laxative drug‐associated in 1. Non‐infectious etiologies seem to be relatively common causes of diarrhea among transplant recipients. Therapy was adjusted in 5 patients because of mycophenolate mofetil‐associated diarrhea. CMV and C. parvum, which are seldom seen in the normal population, were frequent causes of diarrhea in this group. Evaluating the transplant recipients for non‐infectious causes of diarrhea is important in prompt diagnosis and treatment.
The praxis of clinical knowledge: Learning to care for paediatric patients with a congenital heart anomaly
Authors: Robertson‐Malt Suzi , Chapman Ysanne B. , Smith Victoria
Published: May 2007

In Saudi Arabia, the major tertiary care unit for the treatment of cardiovascular disease is the King Faisal Heart Institute (KFHI). Its state of the art technology and patient profile facilitates nurses to become highly knowledgeable in the diversity of treatment modalities and nursing care of a range of paediatric pathology. Like many global nursing organizations, the KFHI is experiencing nursing shortages and nurses coming to work in this highly specialized area are lacking some of the basic understanding and skills development necessary to work efficiently and effectively in the area. This paper describes the work of the cardiovascular education team in developing a praxis‐based curriculum that equips nurses to not only function at a high level in the cardiovascular area but also facilitate success in their future careers when they leave Saudi Arabia.
Psychometric testing of the Swedish version of the Philadelphia Geriatric Center Multilevel Assessment Instrument
Authors: Minhage Margareta , Larsson Bodil Wilde , Gustafsson Gunnel , Hamrin Elisabeth
Published: May 2007

We examined whether the Swedish adaptation of the Philadelphia Geriatric Center Multilevel Assessment Instrument (PGCMAI) developed by Lawton meets criteria for reliability and validity in an elderly Swedish population with locomotor disability. Data were collected, using the mid‐length version of the instrument, from 199 elderly people with locomotor disability in two Swedish counties. Reliability was determined by Cronbach's alpha and construct validity was tested by means of exploratory factor analysis. Comparison was made with the Standardized Practical Equipment (SPE) test. Factor analysis identified eight factors, which were comparable to the original eight domains. There was a logical correlation between the PGCMAI and the SPE test. Further psychometric testing is recommended on other groups of elderly people.
Reflective practice in nursing care: Embedded assumptions in qualitative studies
Authors: Gustafsson Christine , Asp Margareta , Fagerberg Ingegerd
Published: May 2007

Qualitative nursing researchers have long recognized that reflective practice (RP) seems to be a valuable tool in nursing care. The aim of the present meta‐study was to analyse current qualitative research on RP in nursing care, in order to create and synthesize the knowledge and the understanding of registered nurses' RP. Using a meta‐study synthesis approach, embedded assumptions were identified in qualitative studies that have influenced the way researchers have interpreted and made sense of RP in nursing care. Despite empirical focus in research on RP in nursing care, it was found that assumptions about RP were predominantly based on theory. The reflective movement within the practice of nursing care has mainly a constructivist epistemology, based on learning from experience. The individual nurse's RP capability is essential in providing and improving ethical and holistic nursing care.