bluuebunny/crossref_metadata_2025 huggingface dataset:
Persistent viral infection in humans can drive high frequency low‐affinity T‐cell expansions
Authors: Khan Naeem , Cobbold Mark , Cummerson Joanne , Moss Paul A. H.
Published: August 2010

CD8 T cells that recognize cytomegalovirus (CMV) ‐encoded peptides can be readily detected by staining with human leucocyte antigen (HLA) –peptide tetramers. These cells are invariably highly differentiated effector memory cells with high avidity T‐cell receptors (TCR). In this report we demonstrate an HLA‐A*0201 restricted CMV‐specific CD8 T‐cell response (designated YVL) that represents several percent of the CD8 T‐cell subset, yet fails to bind tetrameric major histocompatibility complex (MHC) ligands. However, these tetramer‐negative cells are both phenotypically and functionally similar to other CMV‐specific CD8 T cells. YVL peptide‐specific CD8 T‐cell clones were generated and found to be of high avidity in both cytotoxicity and interferon‐γ (IFN‐γ) assays, and comparable with other CMV peptide‐specific CD8 T‐cell clones. However, under conditions of CD8 blockade, the response was almost nullified even at very high ligand concentrations. This was also the case in IFN‐γ experiments using peripheral blood mononuclear cells stimulated with peptide ex vivo. In contrast, all other CMV specificities (tetramer‐positive) displayed minimal or only partial CD8 dependence. This suggests that YVL‐specific responses depict a low‐affinity TCR–MHC–peptide interaction, that is compensated by substantial CD8 involvement for functional purposes, yet cannot engage multivalent soluble ligands for ex vivo analysis. It is interesting that such a phenomenon is apparent in the face of a persistent virus infection such as CMV, where the responding cells represent an immunodominant response in that individual and may present a highly differentiated effector phenotype.
The roles of antigen‐specificity, responsiveness to transforming growth factor‐β and antigen‐presenting cell subsets in tumour‐induced expansion of regulatory T cells
Authors: Coe David , Addey Caroline , White Matthew , Simpson Elizabeth , Dyson Julian , Chai Jian‐Guo
Published: August 2010

In this study we investigated the impact of several factors on the expansion of natural regulatory T (nTreg) cells by tumours, including antigen specificity, transforming growth factor‐β (TGF‐β) signalling and the antigen‐presenting cell subsets responsible for expansion. We found that antigen non‐specific expansion of nTreg cells is tumour cell line‐dependent. Although both antigen‐specific and non‐specific pathways can contribute to expansion, the migration of activated nTreg cells to tumour tissues is strictly antigen‐dependent. Intact TGF‐β signalling on nTreg cells is also essential for tumour‐induced expansion. Finally, for stimulation of resting antigen‐specific CD4 T cells, CD11c+ cells purified from tumour‐draining lymph nodes were more potent than CD11b+ cells, suggesting that dendritic cells are the key antigen‐presenting cell subset involved in cross‐presentation of tumour antigens. This study not only provides an in vivo system in which cross‐talk between nTreg cells and tumours can be explored but also reveals novel aspects of tumour immune evasion.
Immunoinformatics: an integrated scenario
Authors: Tomar Namrata , De Rajat K.
Published: August 2010

Genome sequencing of humans and other organisms has led to the accumulation of huge amounts of data, which include immunologically relevant data. A large volume of clinical data has been deposited in several immunological databases and as a result immunoinformatics has emerged as an important field which acts as an intersection between experimental immunology and computational approaches. It not only helps in dealing with the huge amount of data but also plays a role in defining new hypotheses related to immune responses. This article reviews classical immunology, different databases and prediction tools. It also describes applications of immunoinformatics in designingin silicovaccination and immune system modelling. All these efforts save time and reduce cost.
Histological evaluation of the effectiveness of increased apical enlargement for cleaning the apical third of curved canals
Authors: Fornari V. J. , Silva‐Sousa Y. T. C. , Vanni J. R. , Pécora J. D. , Versiani M. A. , Sousa‐Neto M. D.
Published: August 2010

Fornari VJ, Silva‐Sousa YTC, Vanni JR, Pécora JD, Versiani MA, Sousa‐Neto MD. Histological evaluation of the effectiveness of increased apical enlargement for cleaning the apical third of curved canals. International Endodontic Journal, 43, 988–994, 2010.

Objective  To evaluate the influence of apical size on cleaning of the apical third of curved canals prepared with rotary instruments.

Methodology  Forty‐four mesiobuccal canals of maxillary molars teeth were instrumented to different apical sizes (30, 0.02; 35, 0.02; 40, 0.02; 45, 0.02) using a crown‐down technique. After canal preparation, the apical thirds of the roots were submitted to histological processing and examination. The specimens were analysed at 40× magnification and the images were submitted to morphometric analysis with an integration grid to evaluate the percentage of debris and uninstrumented root canal walls. The action of the instruments on the root canal walls was assessed based on the surface regularity, abrupt change on the continuity of root canal walls, and partial or total pre‐dentine removal. The results were statistically compared using one‐way anova with post hoc Tukey test. Pearson’s correlation was performed to identify potential correlations between values.

Results  The percentage of uninstrumented root canal dentine was higher when apical enlargement was performed with instruments 30, 0.02 taper (55.64 ± 4.62%) and 35, 0.02 taper (49.03 ± 5.70%) than with instruments 40, 0.02 taper (38.08 ± 10.44%) and 45, 0.02 taper (32.65 ± 8.51%) (P < 0.05). More debris were observed when apical enlargement was performed with instruments 30, 0.02 taper (34.62 ± 9.49%) and 35, 0.02 taper (25.33 ± 7.37%) (P < 0.05). There was a significant correlation between the amount of remaining debris and the perimeter of uninstrumented root canal dentine (r = 0.9130, P < 0.001).

Conclusion  No apical enlargement size allowed the root canal walls to be prepared completely. Apical third cleanliness could be predicted by instrument diameter.
Ex vivo assessment of genotoxicity and cytotoxicity in murine fibroblasts exposed to white MTA or white Portland cement with 15% bismuth oxide
Authors: Zeferino E. G. , Bueno C. E. S , Oyama L. M. , Ribeiro D. A.
Published: August 2010

Zeferino EG, Bueno CES, Oyama LM, Ribeiro DA.
Ex vivo assessment of genotoxicity and cytotoxicity in murine fibroblasts exposed to white MTA or white Portland cement with 15% bismuth oxide. International Endodontic Journal, 43, 843–848, 2010.

Aims  To evaluate whether white mineral trioxide aggregate (MTA) or white Portland cement with 15% bismuth oxide were able to induce genetic damage and cellular death ex vivo.

Methodology  Aliquots of 1 × 104 murine fibroblasts were incubated at 37 °C for 3 h with MTA (white) or white Portland cement with 15% bismuth oxide, at final concentrations ranging from 10 to 1000 μg mL−1 individually. Data of three independent repeats from the comet assay and the trypan blue exclusion test were assessed by the one‐way anova followed by Tukey’s test.

Results  Mineral trioxide aggregate or Portland cement containing bismuth oxide did not produce genotoxic effects with respect to the single‐cell gel (comet) assay data for all concentrations evaluated. Furthermore, no cytotoxicity was observed for MTA or Portland cement.

Conclusion  White MTA or white Portland cement containing 15% bismuth oxide were not genotoxic and cytotoxic.
Patients with colorectal cancer: relationship between demographic and disease characteristics and acceptance of disability
Authors: Chao Hui‐Lin , Tsai Tzung‐Yi , Livneh Hanoch , Lee Hsin‐Chung , Hsieh Pi‐Ching
Published: August 2010

chao h.‐l., tsai t.‐y., livneh h., lee h.‐c. & hsieh p.‐c. (2010) Patients with colorectal cancer: relationship between demographic and disease characteristics and acceptance of disability. Journal of Advanced Nursing 66(10), 2278–2286.

Aim.  This article is a report of a study conducted to examine acceptance of disability among patients with colorectal cancer and its relationships to other disease‐related factors.

Background.  Colorectal cancer had become the third leading cause of cancer death worldwide. Recently, the topic of acceptance of disability in patients with chronic disease, especially cancer, has attracted enormous attention because the higher acceptance, the better coping with disease and the better quality of life after therapy.

Method.  A cross‐sectional study was carried out with 110 patients with colorectal cancer recruited from a medical centre in northern Taiwan in 2008. Data were collected using the Acceptance of Disability Scale. Descriptive statistics, Pearson correlations and multiple linear regression analysis were used for analysis.

Findings.  Participants reported moderate levels of acceptance of disability. The regression model showed that those with shorter disease duration, stoma, lower educational level (below 9th grade), or in Duke C1 stage or above reported lower levels of acceptance, and these variables accounted for 25% of the total variance.

Conclusion.  The results suggest that acceptance of disability (i) is a useful construct to examine in future studies on psychosocial adaptation to cancer, and (ii) can be integrated into a clinical intervention programme of providing holistic care to patients with colorectal cancer.
Terms used for isolation practices by nurses at an academic medical center
Authors: Landers Timothy , McWalters Jessica , Behta Maryam , Bufe Gina , Ross Barbara , Vawdrey David K. , Larson Elaine
Published: August 2010

landers t., mcwalters j., behta m., bufe g., ross b., vawdrey d.k. & larson e. (2010) Terms used for isolation practices by nurses at an academic medical center. Journal of Advanced Nursing 66(10), 2309–2319.

Aim.  This paper is a report of a study to determine if the terms used by nurses to describe isolation precautions are associated with correct identification of required personal protective equipment.

Background.  Isolation measures are important in the prevention of healthcare‐associated infections. The terms used to describe categories of isolation have changed in response to new pathogens and with advances in infection prevention.

Methods.  For 3 months in 2009, nurses from an academic medical center on the East Coast of the United States of America completed a survey consisting of ten clinical scenarios which asked about recommended personal protective equipment and for the name of the recommended isolation type. Correct identification of required personal protective equipment was compared to use of an approved isolation category term, controlling for infection knowledge and demographic variables.

Results.  Three hundred and seventeen nurses gave responses to 2215 clinical scenarios. Use of non‐approved category terms was associated with statistically significantly lower rates of correct personal protective equipment identification compared to use of an approved term (62·2% vs. 77·8%; P < 0·001). Specific PPE was also selected for use when not indicated – including gowns (42%), N‐95 respirators (13%), fluid shield masks (13%) and sterile gloves (6%).

Conclusion.  Inconsistent terminology for isolation precautions may contribute to variations in practice. Adoption of internationally accepted and standardized category terms may improve adherence to these precautions.
Chinese version of the Pain Assessment in Advanced Dementia Scale: initial psychometric evaluation
Authors: Lin Pei Chao , Lin Li Chan , Lotus Shyu Yea Ing , Hua Mau Sun
Published: August 2010

lin p.c., lin l.c., shyu y.i.l. & hua m.s. (2010) Chinese version of the Pain Assessment in Advanced Dementia Scale: initial psychometric evaluation. Journal of Advanced Nursing 66(10), 2360–2368.

Aim.  This paper is a report of the validity and reliability testing of the Chinese version of the Pain Assessment in Advanced Dementia Scale (PAINAD‐C).

Background.  Pain is under‐reported and under‐treated for people with dementia, largely due to impairment of communication. An adequate instrument for assessment of pain in this population is essential to improving their quality of life and decreasing disability and behavioural disturbances, but none were found that were appropriate for these purposes.

Method.  The PAINAD‐C was developed in three phases in 2006. First, back‐translation was used to create the Chinese version, where five medical and nursing experts assessed content validity. Inter‐rater reliability, internal consistency reliability and test–retest reliability were then examined. Finally, principal component analysis and known‐group comparisons were used to test construct validity. Participants with dementia were selected from five licensed long‐term care facilities in Taiwan. Direct observation was used to collect data.

Results.  Inter‐rater reliability showed an intra‐class correlation coefficient of 0·80–0·86, and a test–retest reliability intra‐class correlation coefficient of 0·71. The internal consistency reliability was 0·55–0·66. Factor analysis of the PAINAD‐C showed two factors that explained 62·48% of variance. The PAINAD‐C scores showed statistically significant differences between the non‐dementia group and the advanced dementia group as well as significant differences between activities and rest groups.

Conclusion.  The PAINAD‐C is useful in a clinical setting for people with advanced dementia for both research and practice. It is easy to use and is a comprehensive instrument.
Phylogeographical analyses of domestic and wild yaks based on mitochondrial DNA: new data and reappraisal
Authors: Wang Zhaofeng , Shen Xin , Liu Bin , Su Jianping , Yonezawa Takahiro , Yu Yun , Guo Songchang , Ho Simon Y. W. , Vilà Carles , Hasegawa Masami , Liu Jianquan
Published: August 2010

Aim  We aimed to examine the phylogeographical structure and demographic history of domestic and wild yaks (Bos grunniens) based on a wide range of samples and complete mitochondrial genomic sequences.

Location  The Qinghai‐Tibetan Plateau (QTP) of western China.

Methods  All available D‐loop sequences for 405 domesticated yaks and 47 wild yaks were examined, including new sequences from 96 domestic and 34 wild yaks. We further sequenced the complete mitochondrial genomes of 48 domesticated and 21 wild yaks. Phylogeographical analyses were performed using the mitochondrial D‐loop and the total genome datasets.

Results  We recovered a total of 123 haplotypes based on the D‐loop sequences in wild and domestic yaks. Phylogenetic analyses of this dataset and the mitochondrial genome data suggested three well‐supported and divergent lineages. Two lineages with six D‐loop haplogroups were recovered for all morphological breeds of domestic yaks across their distributions in the QTP, while one more lineage and more endemic haplogroups or haplotypes were found for wild yaks. Based on the mitochondrial genome data, the divergences of the three lineages were estimated to have occurred around 420,000 and 580,000 years ago, consistent with the geological records of two large glaciation events experienced in the QTP.

Main conclusions  There are distinct phylogeographical differences between wild and domestic yaks. However, there is no apparent geographical correlation between identified haplogroups and distributions of domestic yaks. Three differentiated lineages of yaks probably evolved allopatrically in different regions during the Pleistocene glaciation events, then reunited into a single gene pool during post‐glacial population expansion and migrations before the start of the domestication of yaks in the Holocene.
Species pools along contemporary environmental gradients represent different levels of diversification
Authors: Bartish Igor V. , Hennekens Stephan , Aidoud Ahmed , Hennion Françoise , Prinzing Andreas
Published: August 2010

Aim  Within a region, different habitat types are characterized by different species and some habitat types have higher species diversities than others. Different habitat types are also characterized by different phylogenetic clades. However, it is not known whether – within a given region – some habitat types have species pools that are more phylogenetically diversified than others. We investigated whether species pools in contemporary habitat types represent different levels of diversification of angiosperms and, if so, whether these differences correlate with particular environmental factors. We tested these relationships in a region of recent geological origin possessing a comparatively young flora, and compared the result with standard analyses of species diversity.

Location  The Netherlands.

Methods  We studied angiosperms across the full range of habitat types present in the Netherlands. We characterized levels of diversification represented in species pools within each of these habitat types with respect to (1) taxonomic diversification, i.e. the rate of increase of richness across taxonomic ranks (relative to a null expectation for a given species richness), and (2) cladogenic diversification, i.e. the average cladogenic distance of species from the root of a phylogenetic tree of the species pool within a given region.

Results  Species pools of different habitat types represented different levels of taxonomic and cladogenic diversification. These differences were strongly correlated with the environmental characteristics of the habitat type. Greater levels of taxonomic diversification were represented in the species pools of relatively dry and open habitat types. Greater levels of cladogenic diversification were represented in habitats with both dry and weakly acidic soils. The relationship between environmental factors and taxonomic and cladogenic diversification (r2 = 0.88 and 0.76, respectively) was stronger than that between environmental factors and species richness (r2 = 0.34).

Main conclusions  Within a region, species resulting from particularly high rates of diversification accumulated in particular habitat types. These habitat types represent specific contemporary abiotic environments and have a tighter relationship with levels of diversification than with species richness.
Between being and doing – the nature of leadership of first‐line nurse managers and registered nurses
Authors: Johansson Gunilla , Andersson Lars , Gustafsson Barbro , Sandahl Christer
Published: August 2010

Aims and objectives.  The aim of this study was to describe first‐line nurse managers’ (F‐LNMs) and subordinate registered nurses’ (RNs) conceptions and experiences of their routine work and how leadership was exercised.

Background.  Extensive changes in health care organisations have had a powerful impact on leadership in nursing management. Nursing leadership, in turn, has an affect on both the quality of care and the subordinates’ work environment. Therefore, it is important to enhance our understanding of current leadership in nursing management.

Design.  This is a descriptive qualitative study carried out in three units at three Swedish hospitals.

Methods.  Three F‐LNMs and 14 RNs participated. Interviews were used to collect data. The interviews were analysed using qualitative content analysis.

Results.  The result of this study was illustrated in one main theme referred to in this study as between being and doing. The RNs and F‐LNMs described what it was to be a good professional (being), how they were engaged in creating a good work climate (doing) and personal outcomes of this project (gaining).

Conclusion.  The reciprocal relation between being and doing, which can be described as the development of virtues, was a central point in the professional work of the F‐LNMs and RNs. The development of virtues is also a strategy to attain the goals of nursing and establish a work climate that motivates staff and improves performance.

Relevance to clinical practices.  The implication for nursing management is to create ample space to develop strategies and knowledge about how leadership in nursing management can stimulate the development of a common perspective of good care and professional virtues appropriate for health care praxis.
Questioning family‐centred care
Authors: Shields Linda
Published: August 2010

Aims.  This article poses topics for discussion around family‐centred care as a model of care delivery to children and families in health services.

Background.  Family‐centred care developed over three decades following awakening awareness that excluding parents during a child’s hospital admission was detrimental to the child’s mental health. Using resources from both past and current literature and existing research, I argue that it is time for a revision of practices and policies that espouse family‐centred care as the optimum model of care in paediatrics. Once the historical development of family‐centred care is discussed, current research shows a dearth of evidence about family‐centred care, its use, implementation and applicability across cultures and nations.

Design.  Discursive.

Methods.  Five questions are discussed: is family‐centred care relevant now? is it relevant only in Western countries?, what does it mean to implement family‐centred care?, is family‐centred care implemented effectively?, does it make a difference? Exemplars of good family‐centred care practice are provided.

Results.  At this stage, it is difficult to know whether using family‐centred care makes a difference to a child’s and family’s health outcomes, as there is no rigorous evidence to answer the question ‘does it work?’

Conclusions.  Nurses must undertake studies so we can either support the successful implementation of family‐centred care, or abandon it in the best interests of children, families and health services.

Relevance to clinical practice.  Practitioners must be aware that family‐centred care is a wonderful ideal that is almost impossible to implement and so new ways of delivering care to children may be needed.
Life values and self‐regulation behaviours among adults with type 2 diabetes
Authors: Oftedal Bjørg , Karlsen Bjørg , Bru Edvin
Published: August 2010

Aim.  The aim of this study was to identify life values in adults with type 2 diabetes and to describe their experiences of how these values may influence self‐regulation behaviours.

Background.  Daily self‐regulation behaviours have been described as challenging, because the individuals try to find a balance between them and life values. However, little is known about how life values may influence the motivation for necessary self‐regulation behaviours.

Design and methods.  A descriptive/explorative qualitative design that included focus groups was used to collect data. The sample consisted of 19 adults with type 2 diabetes. Data were analysed using qualitative content analysis.

Results.  The findings revealed six themes: maintaining health and longevity, a feeling of bodily well‐being, preserving a positive body image, self‐determination, maintaining the ability to work and belonging. The results reflect the fact that many life values have a major influence on self‐regulation behaviours.

Conclusions.  The findings indicate that several of the life values can conflict with self‐regulation behaviours, which in turn may influence the motivation for self‐regulation of type 2 diabetes. Some of these values could be considered to be related to self‐worth, which is regarded as an important motivational component for engaging in a task. Moreover, this study highlights the fact that goals related to self‐regulation behaviours were formulated in more general than in specific terms.

Relevance to clinical practice.  This study may help health professionals to understand how adults’ life values influence their motivation for adequate self‐regulation. The findings indicate that the existing support structures should make an effort to learn about people’s life values and take them into account when giving advice about self‐regulation behaviours. Moreover, people with type 2 diabetes should be supported by health professionals to set more specific self‐regulation goals that are consistent with their life values.
Reasons why women choose a medical practice or a women’s health centre for routine health screening: worker and client perspectives
Authors: Peters Kathleen
Published: August 2010

Aims and objectives.  This article aims to explore the stories and perceptions of consumers and health care workers in an area with a low uptake rate of women’s health screening. Further, this article explores what factors influence women’s choices for women’s health screening in relation to the type of services they access.

Background.  Routine women’s health screening, using mammography and Papanicolaou (Pap) testing, is known to assist in the early detection of cancer and thereby has the potential to increase positive health outcomes for women. However, traditionally, compliance rates to women’s health screening are lower than desired because of multiple barriers. Previous studies have largely been quantitative and few have been conducted in areas of low compliance to women’s health screening. Furthermore, previous research has not identified the type of service offered, or gender of the professional providing this service, as potential barriers to women’s health screening.

Design.  Qualitative, storytelling design.

Method.  Participants from a socioeconomically disadvantaged area were recruited into the study via media releases. Data were collected during conversational, face to face interviews which were between 30 and 90 minutes in duration, digitally recorded and transcribed verbatim. During the process of analysis, dominant stories became obvious through the repetition or emphasis of women's accounts, and it is these stories that are presented in the findings.

Results.  Findings suggest that women’s decisions about care for routine health screening are guided by three major concerns. Women are seeking a woman friendly and woman‐centred service, a safe environment and continuity of care. All these factors informed women’s decision‐making around where to seek care for routine health screening.

Conclusions.  Additional specialised women’s health services are required to meet the needs of women. The provision of accessible women‐centred environments has the potential to enhance compliance with women’s health screening.

Relevance to clinical practice.  It is possible that generalist medical practises as well as specialised women’s health centres can provide woman‐centred care. This as well as further access to education and training that supports nurses to become specialised competent and confident women’s health practitioners may enhance screening rates.
A literature review of the potential of telephone follow‐up in colorectal cancer
Authors: Cusack Martina , Taylor Claire
Published: August 2010

Aims.  The aim of this review is to examine the potential of telephone follow‐up for patients with colorectal cancer.

Background.  More people are surviving cancer and entering into follow‐up care. It is recognised that improvements in cancer follow‐up care are needed in the UK. Telephone use has proved a very successful medium for conducting health care in other specialties and may offer an acceptable alternative to face‐to‐face follow‐up appointments. Nurse specialists could assume responsibility for patients’ follow‐up by offering telephone consultations.

Design.  A literature review was conducted via a systematic electronic and hand search of relevant literature.

Method.  Thematic content analysis was used to achieve the objectives of the review.

Results.  The findings demonstrate that telephone follow‐up conducted by an experienced nurse specialist is cost‐effective and accepted by the majority of patients. Aspects of care such as symptom management and reassurance are possible over the phone.

Conclusion.  Telephone follow‐up meets patients’ satisfaction, support and information needs and has potential to deliver high standards of aftercare when conducted by a nurse specialist. It is at least equivalent to traditional follow‐up in meeting the needs of patients with cancer. Because of the disparity of the studies examined, further research in the area of nurse‐led telephone follow‐up vs. nurse‐led traditional follow‐up would be constructive in the development of this new initiative.

Relevance to clinical practice.  Nurses are now increasingly involved in patient follow‐up care and telephone dialogue after hospital discharge. However, the ideal structure, method and timing of telephone follow‐up as well as the skills required to carry out such care over the phone are often not considered and have not been articulated. The option of telephone follow‐up could, for some patients, dramatically improve their care experience.
Cannabis use in palliative care – an examination of the evidence and the implications for nurses
Authors: Green Anita J , De‐Vries Kay
Published: August 2010

Aim and objective.  Examine the pharmaceutical qualities of cannabis including a historical overview of cannabis use. Discuss the use of cannabis as a clinical intervention for people experiencing palliative care, including those with life‐threatening chronic illness such as multiple sclerosis and motor neurone disease [amyotrophic lateral sclerosis] in the UK.

Background.  The non‐medicinal use of cannabis has been well documented in the media. There is a growing scientific literature on the benefits of cannabis in symptom management in cancer care. Service users, nurses and carers need to be aware of the implications for care and treatment if cannabis is being used medicinally.

Design.  A comprehensive literature review.

Method.  Literature searches were made of databases from 1996 using the term cannabis and the combination terms of cannabis and palliative care; symptom management; cancer; oncology; chronic illness; motor neurone disease/amyotrophic lateral sclerosis; and multiple sclerosis. Internet material provided for service users searching for information about the medicinal use of cannabis was also examined.

Results.  The literature on the use of cannabis in health care repeatedly refers to changes for users that may be equated with improvement in quality of life as an outcome of its use. This has led to increased use of cannabis by these service users. However, the cannabis used is usually obtained illegally and can have consequences for those who choose to use it for its therapeutic value and for nurses who are providing care.

Relevance to clinical practice.  Questions and dilemmas are raised concerning the role of the nurse when caring and supporting a person making therapeutic use of cannabis.
Evaluation of the feasibility of a school‐based asthma management programme in Taiwan
Authors: Maa Suh‐Hwa , Chang Yue‐Cune , Chou Chun‐Liang , Ho Shu‐Chuan , Sheng Te‐Fang , MacDonald Karen , Wang Yanping , Shen Yu‐Ming , Abraham Ivo
Published: August 2010

Aims and objectives.  To investigate the feasibility of a school‐based asthma management programme for middle school children.

Background.  Asthma rates are increasing among school‐aged children. Successful asthma treatment in children depends in part on clear communication and effective education.

Design.  This feasibility study employed a one‐group only longitudinal design with four time points over 18 months.

Methods.  Nineteen female and twelve male (n = 31) seventh‐grade children with asthma (13 SD 0·71 years) were identified using a six‐stage asthma case‐finding approach. Teachers and school staff were trained in the principles and methods of the proposed school‐based asthma management programme. An individualised guided asthma self‐management programme was developed for each child by a clinical team at a major academic medical centre. We assisted teachers in implementing the school programme; building a support network and monitoring children’s activities. Outcome measures included lung function tests (at 0, six, 12 and 18 months), disease‐related symptoms, psychosocial status and impact of asthma on learning (at 0 and 18 months). School provided data on academic achievement and school absences at 0, six, 12 and 18 months.

Results.  Significant improvements were noted at six, 12 and 18 months on forced vital capacity (FVC)% of predicted (p = 0·001, 0·015, 0·015, respectively), forced expiratory volume in one second (FEV1)% of predicted (p = 0·001, 0·006, 0·088, respectively) and FEV1/FVC% of predicted (p = 0·001, 0·015, 0·099, respectively). There was a trend towards improved asthma symptoms (p = 0·050) and a significant decrease in positive perception of curriculum (p = 0·017) at 18 months after adjustment for covariates.

Conclusions.  This programme was associated with respiratory benefits on physiological asthma markers commonly, with a trend for symptom control. Academic and psychosocial outcomes are subject of further inquiry.

Relevance to clinical practice.  School‐based asthma management holds promise as a feasible clinical option for middle school children with asthma in the Taiwanese school system.
Effectiveness of resource‐enhancing family‐oriented intervention
Authors: Häggman‐Laitila Arja , Tanninen Hanna‐Mari , Pietilä Anna‐Maija
Published: August 2010

Aim.  The purpose of the study was to assess the effectiveness of a resource‐enhancing family‐oriented intervention.

Background.  There is very little empirical knowledge of how nurses working in a home context develop relationships with families, what methods they use to enhance families’ resources and how such relationships affect the families’ health outcomes.

Design.  The study was designed as a descriptive service evaluation.

Methods.  A total of 129 family members from 30 families with small children participated in the study. Data were collected with family care plans and client reports in 2004–2005. Data were analysed by qualitative content analysis and by descriptive statistical methods. Resource‐enhancing discussions were carried out in all family meetings. Other methods were video guidance, creation of a family tree and parents’ role map, network collaboration, observation and parent‐child group activity.

Results.  The families needed support mostly in parents’ health and well‐being, coping with parenthood, upbringing and child care, parents’ relationships, social relations and children’s health and growth. The families had an average of five support needs at the beginning of the intervention and 1·8 needs at the completion. The families set on average 3·6 and achieved 4·5 goals during the family nursing process.

Conclusion.  The resource‐enhancing family nursing can be used for supporting parenthood, the raising of and caring for the children, strengthening of social support networks, decreasing the need for support from the authorities and enhancing the parents’ resources to manage the duties related to their work and studies.

Relevance to clinical practice.  The study resulted in empirically based concepts that can be used in the future to construct instruments to evaluate the effectiveness of resource‐enhancing family nursing from the perspective of families and family health. The findings add to our professional understanding of resource‐enhancing family nursing.
A structured observation of the interaction between nurses and patients during the administration of medication in an acute mental health unit
Authors: Duxbury Joy A , Wright Karen Margaret , Hart Anna , Bradley Diane , Roach Pamela , Harris Neil , Carter Bernie
Published: August 2010

Aims.  This aims of this study are to describe current practice in the administration of medication in an acute psychiatric unit and explore factors that influence nurses’ decisions regarding the administration of medication during ‘rounds’.

Background.  Medication ‘rounds’ form part of the ward routine in many inpatient mental health settings. Nurses make several clinical decisions about administrating medication; yet, concerns have been raised about the poor assessment of patients’ needs and the quality of the information exchanged.

Design.  A structured non‐participant observational design was used for this research.

Method.  This study involved the observation of 20 medication ‘rounds’ over three months. The Ward Administration of Medication Schedule was used to report on the interactions between nurses and patients and aspects of their communication during each round.

Results.  From the rounds observed nurses appeared adept at communicating a positive interpersonal style but less so in demonstrating skills portraying collaboration and information giving. For example whilst nurses communicated warmth in 97% of cases, using non‐verbal behaviours such as good eye contact, the provision of information was only initiated in 46% of cases. Enquiries regarding the patient’s general health and medication taking (35% and 17% respectively) were less commonly observed. Verbal consent was sought in only 25% of cases. Procedural matters were adhered to overall.

Conclusions.  Findings suggest limited collaboration between nurses and patients and the poor monitoring of health status and medication effects. Information exchange could be improved; however, this may be related to medication procedures that make it difficult to explore sensitive information with patients, rather than nursing skills and behaviour.

Relevance to clinical practice.  The Ward Administration of Medication Schedule can be used as a clinical or educational tool in the administration of medication. In both instances, it may be self‐administered and used to reflect on personal skills or employed as an observational tool during peer review and audit.
Post‐discharge health care needs of patients after lung cancer resection
Authors: Wang Kwua‐Yun , Chang Nai‐Wen , Wu Tzu‐Hsin , Hsu Chu‐Chun , Lee Ya‐Hsin , Lee Shih‐Chun
Published: August 2010

Aims and objective.  To determine the health care needs of patients after surgical resection of lung cancer at discharge and evaluate the significance of factors associated with such needs.

Background.  Other studies have found that symptom distress level, social supports and health beliefs are associated with health care needs.

Design.  Sixty‐two participants were recruited from a thoracic surgery clinic at a medical centre in Taipei from July–December 2005. Data related to demographic variables, disease characteristics, functional status, symptom distress and social support were collected.

Methods.  The patients were administered the Karnofsky Performance Scale, the Symptom Distress Scale–Chinese Modified Form, the Social Support Scale (adapted from the Interpersonal Support Evaluation List), the Health Needs Scale and self‐reported rating scales for pain. Data were analysed using Pearson’s correlation coefficients and linear regression models.

Results.  Pulmonary function was found to be correlated with the level of need for health care information and physiological care. Self‐perceived symptom distress and degree of distress were also correlated with levels of need for information, physiological care and psychosocial care. The level of pain was found to be correlated with the level of need for health care information and physiological care. After controlling for pain level, multivariate analysis revealed that self‐perceived symptom severity (p = 0·032) and degree of distress (p = 0·043) were modestly correlated with the need for health care.

Conclusions.  Pulmonary function, self‐perceived symptom distress, degree of distress and level of pain were correlated with the level of need for health care information and physiological care. Self‐perceived symptom severity and degree of distress were independent predictors of health care needs.

Relevance to clinical practice.  Administration of relevant questionnaires to assess postoperative symptom distress may be necessary for optimal disease management.
Evaluation of email alerts in practice: part 1 – review of the literature on clinical emailing channels
Authors: Pluye Pierre , Grad Roland M. , Granikov Vera , Jagosh Justin , Leung Kit
Published: August 2010

Rationale  Methods to systematically assess electronic knowledge resources by health professionals may enhance evaluation of these resources, knowledge exchange between information users and providers, and continuing professional development. We developed the Information Assessment Method (IAM) to document health professional perspectives on the relevance, cognitive impact, potential use and expected health outcomes of information delivered by (push) or retrieved from (pull) electronic knowledge resources. However, little is known about push communication in health sciences, and what we propose to call clinical emailing channels (CECs). CECs can be understood as a communication infrastructure that channels clinically relevant research knowledge, email alerts, from information providers to the inboxes of individual practitioners.

Aims  In two companion papers, our objectives are to (part 1) explore CEC evaluation in routine practice, and (part 2) examine the content validity of the cognitive component of IAM.

Methods  The present paper (part 1) critically reviews the literature in health sciences and four disciplines: communication, information studies, education and knowledge translation. Our review addresses the following questions. What are CECs? How are they assessed?

Results  The review contributes to better define CECs, and proposes a ‘push‐pull‐acquisition‐cognition‐application’ evaluation framework, which is operationalized by IAM.

Conclusion  Compared with existing evaluation tools, our review suggests IAM is comprehensive, generic and systematic.
Predictors of doctor‐rated and patient‐rated gout severity: gout impact scales improve assessment
Authors: Sarkin Andrew J. , Levack Ashley E. , Shieh Marian M. , Kavanaugh Arthur F. , Khanna Dinesh , Singh Jasvinder A. , Terkeltaub Robert A. , Lee Susan J. , Hirsch Jan D.
Published: August 2010

Rationale, aims and objectives  Our objective was to describe the factors associated with doctor‐rated and patient‐rated gout severity to explain how doctor assessment involving patient‐reported outcomes can improve the clinical management of gout.

Methods  Patients completed a newly validated gout‐specific health‐related quality of life instrument, the Gout Impact Scale (GIS) and other questions regarding their gout. Both patients and their doctors gave an overall gout severity assessment. We conducted correlation analyses between each predictor of interest and the two different severity ratings (doctor‐rated severity and patient‐rated severity). Stepwise multiple regressions were performed to determine the best predictors for doctor‐rated and patient‐rated severity, respectively.

Results  Doctor‐rated severity more closely correlated with objective clinical and laboratory findings, particularly the presence of tophi, which was not a leading factor in patient‐rated severity assessments. Patient‐rated severity more closely correlated with the domains of the GIS, which expressed the impact of gout on health‐related quality of life.

Conclusion  Doctors might have a better understanding of their patients' level of disease impact if they incorporate an instrument such as the GIS in their evaluation of gout severity and their decisions regarding aggressiveness of treatment. The increased use of patient‐reported outcomes measures has the potential to improve quality of care and patient satisfaction, as well as reduce costs of health care utilization.
The identification of risk factors for infectious patients with acute fever and formulation of activation criteria to alert outpatient clinic doctors
Authors: Xiao Hongli , Qi Haiyu , Li Xingwang , Wang Jing , Li Xiaoli , Ma Suxia , Diao Zongli , Wang Yan , Sun Fangfang , Yin Chenghong
Published: August 2010

Rationale, aims and objectives  Acute fever is the most common clinical symptom for infectious diseases. It is necessary to identify risk factors for infectious patients with acute fever and formulate activation criteria of early warning infectiosity score system (EWIS) to alert outpatient clinic doctors.

Methods  Logistic regression analysis was used to determine risk factors for infectious diseases from the clinical data of 758 patients with acute fever. Risk factors were weighted and an EWIS was formulated. A receiver operator characteristic (ROC) analysis of weighted cumulative scores was performed to evaluate the diagnostic accuracy of EWIS, and the Kappa test used to confirm diagnostic reliability. A χ2‐test for trend was applied to determine the relevance between EWIS and incidence of infectious diseases.

Results  Risk factors for infections included conjunctival hyperaemia, rash, diarrhoea, increased alanine aminotransferase, splenomegaly and abnormal percentage of peripheral neutrophils (NE%). Risk factors were weighted and tabulated. The areas under the ROC curves of the EWIS was 0.929 and ≥4 points predicted infectious diseases, and the Kappa values were 0.750. As the score increased, the incidence of infectious diseases increased. The areas under the ROC curves of the EWIS predicting on single viral and bacterial infectious diseases were 0.961 and 0.896, and the Kappa values were 0.807 and 0.701, respectively.

Conclusions  Risk factors for infections have been identified, quantified and formulated into a table of EWIS that have high diagnostic accuracy and reliability for the early identification of contagious diseases.
Evaluation of a health service delivery intervention to promote falls prevention in older people across the care continuum
Authors: Peel Nancye M. , Travers Catherine , Bell Rebecca A. R. , Smith Kate
Published: August 2010

Rationale, aims and objectives  The incidence of falls and fall‐related injuries in older age is predicted to increase concomitantly with global population ageing, representing a serious challenge to health care systems. In spite of the availability of policy and practice guidelines for the prevention of falls and fall‐related injuries, a considerable gap remains between best practice and current health service delivery. This paper describes the method and results of the implementation and evaluation of a state‐wide workforce enhancement strategy to promote the uptake of evidence‐based falls prevention activities for older people.

Methods  The project was undertaken in Queensland, Australia in 2008 across the community, acute and residential aged care sectors. Six Falls Safety Officers (FSOs) were appointed to implement a 1‐year pilot of strategies aimed at enhancing workforce capacity to deliver a coordinated approach to falls prevention across the care continuum. The project was independently evaluated for process, impact and outcome. Both quantitative and qualitative data were extracted from records maintained by the FSOs for the evaluation and additional data were obtained from interviews with key stakeholders.

Results  Considerable progress was achieved towards the project's objectives, including the wide dissemination of information and resources, as well as the establishment of working groups to continue falls prevention planning and implementation. Barriers and facilitators to the project's implementation were identified.

Conclusion  The formal evaluation provides evidence for the development of a cross‐continuum service delivery model for implementing coordinated state‐wide falls prevention strategies for the prevention of falls in older people.