bluuebunny/crossref_metadata_2025 huggingface dataset:
BRIEF COMMUNICATION: Evaluating the presentation and management of upper respiratory tract infection in primary care clinics in Saudi Arabia: biomedical factors do not govern clinical decision making
Authors: Al‐Shammari Sulaiman A. , Ghani Hamza Abdul
Published: March 2003

Introduction: Upper respiratory tract infection (URTI) is a common health problem among patients attending primary health care (PHC) clinics (Kuyvenhoven et al. 1993; Khattab et al. 1997) and sore throat is one of the most common presenting symptoms in PHC clinics. It imposes a heavy burden on resources and time and results in the prescription of an oral antibiotic in 20% to 90% of cases (Kuyvenhoven et al. 1993; Carr et al. 1994). Two‐thirds of all antimicrobial drugs prescribed by Dutch PHC physicians, for example, are prescribed for URTI (Kuyvenhoven et al. 1993). PHC physicians prescribe antibiotics for sore throat for different reasons, including the prevention of complications (e.g. rheumatic fever, glomerulonephritis, sinusitis, otitis media, etc.), the relief of symptoms and for psychosocial reasons (Little & Williamson 1994). The majority of PHC physicians working in Saudi Arabia are expatriates contracted from outside the Kingdom. These colleagues come with varied backgrounds and attitudes to prescribing. A minority of patients presenting with sore throat have acute tonsillitis and only one‐third appeared to harbour Group A b‐haemolytic streptococci (GABHS), including carriers (Dangnelie et al. 1996). Thus a large number of patients may be unnecessarily exposed to risk of antibiotics and development of resistance with a concomitant drain on the health budgets. Furthermore, it is common for broad‐spectrum antibiotics, particularly amoxycillin, to be chosen, despite consistent advice that penicillin or erythromycin are still the most appropriate antibiotics for sore throat of bacterial origin (Fry 1993).Local studies that have evaluated the presentation and management pattern of such problems in PHC clinics in Saudi Arabia are rare. This study was initiated to address the following research questions:1 What is the pattern of presentation and management of sore throat in PHC clinics?2 Could clinical presentation guide us in the initiation of antimicrobial therapy?3 What is the outcome of this minor illness employing such management?
Assessing the outcomes of total knee replacement
Authors: Bardsley Martin , Cleary Robert
Published: March 2003

Abstract: The past few years have seen a growth of interest in outcome measurement in a variety of settings including audit, health care management and commissioning – besides the traditional applications in research work. This paper reports on a study of the outcomes of total knee replacement in an acute hospital where the outcomes were studied as part of an audit process. The outcome measures used included clinical and symptomatic measures as well as generic health status scales. The initial study in one hospital was expanded to include a number of others in the same region and a comparative database of outcomes developed. Examples of the results are shown. The technical measures using knee scores and general health status measure show significant improvement from pre‐operatively to 3 months later. This improvement was maintained up to the 1‐year follow‐up on both measures. Although the information systems for collecting and measuring outcomes has been successful, the ability of such measures to lead to behavioural change has been limited. The problems in using outcome measures are discussed in particular in the context of an audit within hospitals, and for purchasing agencies.
RESEARCH LETTER: Uptake of research findings into clinical practice: a controlled study of the impact of a brief external intervention on the use of corticosteroids in preterm delivery
Authors: Mant Jonathan , Hicks Nicholas R. , Dopson Sue , Hurley Pauline
Published: March 2003

To the Editor: There are a large number of studies addressing the impact of continuing medical education (Davis et al. 1995) and clinical guidelines (Grimshaw & Russell 1993) on changing clinical practice, but comparatively little on the impact of purchasers of health care. There is some evidence that financial incentives and penalties can influence practice (Greco & Eisenberg 1993). It has been suggested that purchasers can play an important role in implementing research findings (Haines & Jones 1994). Indeed, the separation of purchasers and providers has been viewed as an opportunity to use knowledge about effectiveness to improve health services (Dunning et al. 1994). We report a study the aim of which was to explore the impact that a specific brief external intervention might have on a detailed aspect of clinical practice: the use of corticosteroids in preterm labour. The intervention was initiated by public health physicians on behalf of a Health Authority. It formed a part of the Getting Research Into Practice (GRIP) initiative in the old Oxford Health Region, UK. The administration of corticosteroids to mothers expected to deliver prematurely reduces neonatal mortality and morbidity (Crowley et al. 1990). The first trial which suggested that corticosteroids were effective in this role was published in 1972, and evidence from 12 trials was assembled in a systematic review published in January 1990 (Crowley et al. 1990). Despite the accumulating evidence, in 1991 many women delivering prematurely in the UK and elsewhere were not receiving corticosteroids (Anon 1992;Donaldson 1992). The apparent failure of obstetricians to make full use of this treatment has been cited as an example of the delayed implementation of research findings that can occur in clinical practice (Haines & Jones 1994; Enkin 1996).
Bayesian statistics in medical research: an intuitive alternative to conventional data analysis
Authors: Gurrin Lyle C. , Kurinczuk Jennifer J. , Burton Paul R.
Published: March 2003

Statistical analysis of both experimental and observational data is central to medical research. Unfortunately, the process of conventional statistical analysis is poorly understood by many medical scientists. This is due, in part, to the counter‐intuitive nature of the basic tools of traditional (frequency‐based) statistical inference. For example, the proper definition of a conventional 95% confidence interval is quite confusing. It is based upon the imaginary results of a series of hypothetical repetitions of the data generation process and subsequent analysis. Not surprisingly, this formal definition is often ignored and a 95% confidence interval is widely taken to represent a range of values that is associated with a 95% probability of containing the true value of the parameter being estimated. Working within the traditional framework of frequency‐based statistics, this interpretation is fundamentally incorrect. It is perfectly valid, however, if one works within the framework of Bayesian statistics and assumes a ‘prior distribution’ that is uniform on the scale of the main outcome variable. This reflects a limited equivalence between conventional and Bayesian statistics that can be used to facilitate a simple Bayesian interpretation based on the results of a standard analysis. Such inferences provide direct and understandable answers to many important types of question in medical research. For example, they can be used to assist decision making based upon studies with unavoidably low statistical power, where non‐significant results are all too often, and wrongly, interpreted as implying ‘no effect’. They can also be used to overcome the confusion that can result when statistically significant effects are too small to be clinically relevant. This paper describes the theoretical basis of the Bayesian‐based approach and illustrates its application with a practical example that investigates the prevalence of major cardiac defects in a cohort of children born using the assisted reproduction technique known as ICSI (intracytoplasmic sperm injection).
Diaries of evidence‐based tutors: beyond ‘numbers needed to teach’...
Authors: Mrcgp Glyn Elwyn , Rosenberg William , Edwards Adrian , Mcsp Wendy Chatham , Jones Karen , Matthews Sarah , Frcr Fergus Macbeth
Published: March 2003

Interprofessional evidence‐based health care courses have been held throughout the UK over the last few years, modelled on the approach used in McMaster University of using problem‐based facilitated small‐group formats to achieve the stated goals. Both delegates and tutors have been aware of the tensions which are inherent within these courses between: (a) the variation in learning cultures which is exhibited by the delegates and the effect this has on processes (i.e. the tension between the reductionist approach of bioscience and the more qualitative leanings of the applied and ‘caring’ disciplines); and (b) the conflict which arises between the goal of ‘learning’ applied healthcare biostatistics and the ability to leave the course with the skills to teach others. This qualitative study uses tutor‐kept diaries to understand some of the tensions apparent to the teaching faculty during a week‐long course in Wales, UK.
Evidence‐based medicine and randomized double‐blind clinical trials: a study of flawed implementation
Authors: Kirk‐Smith Michael D. , Stretch David D.
Published: March 2003

The randomized double‐blind clinical trial (RDBCT) is a key source of information for evidence‐based medicine. However, anomalous and unexplainable results have prompted suggestions that ‘unknown and unidentifiable biases’ may exist. This paper identifies that a possible flaw in the implementation of RDBCTs may account for these biases. The flaw relates to the breaking of the double blind through the generation of beliefs and expectations in experimenters. These, in turn, may lead to unconscious biases in assessment and cues to patients. It is then uncertain how much of an observed effect is due to such expectations or the treatment itself. Therefore, any RDBCT in which the maintenance of blinding is not monitored throughout its course is at risk of its conclusions being compromised. It is not sufficient to assert that blinding must have been maintained through arguments based on design features. The burden of proof is on the researchers to demonstrate, through data, that blinding has been maintained. The need to address social psychological issues in implementing RDBCTs is discussed and it is recommended that to avoid this confound, methods of monitoring and accounting for experimenter beliefs and expectations should be routinely included in future RDBCTs.
An evaluation approach for a new paradigm – health care integration
Authors: De Jong Inge , Jackson Claire
Published: March 2003

This paper explores an approach to the implementation and evaluation of integrated health service delivery. It identifies the key issues involved in integration evaluation, provides a framework for assessment and identifies areas for the development of new tools and measures. A proactive role for evaluators in responding to health service reform is advocated.
Utility and treatment decisions: 15 clinical cases in Japan
Authors: Matsuura Nanshi , Kamae Isao , Nakamura Hajime , Maruo Takeshi
Published: March 2003

The purpose of this study was to investigate the applicability of utility concepts to treatment decision making in different clinical situations. In each of the 15 independent cases studied, subjective utility values were obtained directly from the patients before the treatment decisions were made. The optimal decision based on the utility values was then calculated. The actual treatment decisions were made without any input or influence by this study. The data were obtained at two large public hospitals and two privately owned multi‐service hospitals in Kobe, Japan. Active participation by patients in treatment decision making seems particularly useful when two or more treatments are approximately equivalent in terms of outcome. A careful assessment of an individual patient’s utilities can help the patient choose a treatment option meeting individual goals. Patient autonomy must be strengthened by giving the patients realistic and unbiased information of the alternatives available and the possible outcomes.
The rationale of value‐laden medicine
Authors: MD Michael H. Kottow MA(Soc)
Published: March 2003

Medicine is becoming increasingly confident that scientific advances, especially in the area of genetics, will allow a major improvement in the control and eradication of disease. This development seems to go hand in hand with health‐enhancement strategies, erasing the distinction between the states of health and disease, and blurring the specific goals of medical services. Medicine tends to become an increasingly technocentric practice that relies heavily on expert knowledge and on epidemiological evidence, neglecting the lived‐body experience of being ill, and tending to transform costly medical services into commodities only affordable by the affluent. This paper argues that disease is not merely a functional description, but rather a definitely value‐laden organismic state that is experienced by the patient, needs to be explored and treated by medical practitioners, and requires the assessment and participation of social institutions concerned with the delivery and support of medical services. Each of these perspectives introduces its own set of values, both in the clinical encounter and in public health programmes. Bioethics seems to be the appropriate discipline to discuss all these values involved, and help assign them properly in order to rescue the caring concern of medicine for the sick, as well as uphold a principle of fairness in publicly funded medical services.
Reorganizing the delivery of intensive care could improve efficiency and save lives
Authors: MSc Adrienne G. Randolph MD , PhD Peter Pronovost MD
Published: March 2003

Critically ill patients are at high risk for death and permanent disability. Their care is also very expensive. The method of delivering critical care services to these patients can have an impact on their clinical and economic outcomes. Researchers face significant challenges when attempting to identify an association between an intensive care unit (ICU) organizational characteristic and patient outcomes. In this paper we review the challenges faced when evaluating the impact of ICU organizational characteristics on patient outcomes and highlight ICU characteristics that are consistently associated with improved patient outcomes. These characteristics include: (i) the presence of specialist physicians devoted to the ICU; (ii) increased nurse : patient ratios; (iii) decreased use of tests and evaluations that will not change clinical management; (iv) development and implementation of evidence‐based protocols and guidelines; (v) use of computer‐based alerting and reminding systems; and (vi) having a pharmacist participate in daily rounds in the ICU. When implementing these in ICUs, it is important to evaluate the impact of these characteristics on patient outcomes. We provide a format for such an evaluation. Given the growing evidence supporting the association between specific ICU characteristics and improved patient outcomes, we hope the future realizes broad implementation of these beneficial characteristics.
When you hear hoofs, think horses, not zebras: an evidence‐based model of health care accountability
Authors: MPH Vahé A. Kazandjian PhD
Published: March 2003

Health care organizations are increasingly asked to show accountability about their performance. This paper proposes that accountability can best be achieved through evaluative methods that are based on evidence regarding the relationship between processes of care and expected outcomes. Root cause analysis (RCA) is used as an illustration of how a generic method of inquiring can be transformed into an ongoing monitoring, evaluation, user education and accountability strategy. The role of performance indicators, as well as patient and community expectations, is discussed.
Optimising of culture conditions and stimulation of head kidney macrophages from Atlantic cod, Gadus morhua L.
Authors: Steiro K. , Johansen A. , Gildberg A. , Bøgwald J.
Published: March 2003

The cultivation of Atlantic cod, Gadus morhua L., head kidney macrophages was optimal at 4–6 °C. The viability of cells in culture was examined by the trypan blue exclusion test 2, 5 and 7 days after seeding. Simultaneously, the number of adherent cells at the various times was checked. The morphology of the cells was also evaluated during the cultivation period. Enhanced respiratory burst activities were demonstrated in macrophages after stimulation with known immunostimulants like lipopolysaccharide, tuftsin and an acid peptide fraction previously shown to stimulate Atlantic salmon leucocytes efficiently. Generally, the Atlantic cod macrophages seemed to respond to a lesser extent compared with macrophages obtained from both mammalian and other fish species.
Infectious pancreatic necrosis virus: experimental infection of goldsinny wrasse, Ctenolabrus rupestris L. (Labridae)
Authors: Gibson D. R. , Smail D. A. , Sommerville C.
Published: March 2003

The use of wrasse as cleaner fish in farming of Atlantic salmon, Salmo salar L., is now widespread in Scotland, Ireland and Norway, but little is known about the susceptibility of these fish to the common pathogens of cage‐cultured salmon. The susceptibility of goldsinny wrasse, Ctenolabrus rupestris L., to infectious pancreatic necrosis virus (IPNV) was investigated. Captive‐bred C. rupestris were infected with IPNV‐Sp (Shetland strain) using a bath challenge method. Two infection doses were used, low (4.1 × 105 pfu mL−−1) and high (2.4 × 106 pfu mL−−1), with two replicates for each experiment. Bathing times were 1 h for the low dose and 5 h for the high dose. A maximum prevalence of infection (30%) was seen 2 weeks post‐infection in replicate 1 of the low dose experiment and was accompanied by low tissue titres. The tissue titres dropped to an undetectable level by 4 weeks post‐infection. In the high dose experiment, a high prevalence of infection was seen along with moderate titres in tissues as well as a marked pathological response. Both prevalence and intensity declined rapidly and the fish recovered. In the high dose experiment, faecal titres followed the same pattern as those in the tissues. The implications for the use of wrasse in the farming of Atlantic salmon are discussed.
Risk factors for skin lesions in Atlantic salmon, Salmo salar L.
Authors: Vågsholm I. , Djupvik H. O.
Published: March 2003

Risk factors for skin lesions observed on the slaughter line in Atlantic salmon, Salmo salar L., were examined in a cohort study in Hordaland County, Norway. The salmon were followed from seawater introduction, starting in April 1994, until the last group was slaughtered in February 1996. The findings indicated that the egg and smolt stages were important factors in the prevalence of skin lesions at slaughter. There appeared to be differences in the risk for skin lesions between salmon from different egg suppliers to the smolt farms. An increase of 3 months between vaccination and seawater introduction increased the relative risk (RR) for skin lesions (RR = 1.9). Salmon vaccinated with a vaccine with adjuvants derived from plant oil appeared to be at higher risk for skin lesions (RR = 4.6) than those vaccinated with a vaccine with adjuvants derived from mineral oil (RR = 1.4). The larger the salmon (from 3.1 to 5.7 kg), the lower the risk for skin lesions (RR = 0.4).
Isolation and characterisation of two extracellular metalloproteases from Aeromonas salmonicida ssp. salmonicida
Authors: Arnesen J. A. , Eggset G.
Published: March 2003

Two extracellular metalloproteases were purified from a culture filtrate derived from Aeromonas salmonicida ssp. salmonicida. One enzyme, leucine aminopeptidase (LAP), which had a molecular mass 37 kDa, hydrolysed aminoterminal
l‐leucine and
l‐phenylalanine. The activity was inhibited by 1,10‐o‐phenanthroline, but not by EDTA. The addition of excess Zn2+ to an o‐phenanthroline‐inhibited enzyme restored most of its activity. The peptidase was temperature stable, and had an optimum temperature and pH of 60 °C and 8, respectively. The other enzyme, metalloprotease 3 (MP3), which had a molecular mass 20 kDa, was an endoprotease, and hydrolysed azocoll and hide powder‐azure, but not gelatine. The MP3 enzyme had an optimum temperature and pH of ≈40 °C and 7.5, respectively, and a cationic isoelectrical point.
Risk factors for abdominal adhesions in Atlantic salmon, Salmo salar L.
Authors: Vågsholm I. , Djupvik H. O.
Published: March 2003

The risk factors for abdominal lesions at slaughter in Atlantic salmon, Salmo salar L., were examined in a cohort study in Hordaland County, Norway, in which 187 slaughter‐groups consisting of 5000 salmon were followed from seawater introduction in April 1994 until slaughter in February 1996. There were major differences in the risk of abdominal lesions between egg suppliers. Salmon vaccinated with a vaccine using plant oil adjuvants appeared to be at lower risk (relative risk, RR = 0.5) of abdominal lesions. The occurrence of epitheliocystis on the smolt farm was associated with an increase in the risk of abdominal lesions (RR = 3.0). An increase in smolt weight from 0.047 to 0.107 kg increased the risk of abdominal lesions and spinal deformities (RR = 1.5). If salmon were raised in a fjordic instead of an oceanic site, the risk of abdominal lesions increased (RR = 3.6). An increase in the number of days at sea decreased the risk of lesions (RR = 0.6). Hence, it appears that the observed frequency of abdominal lesions might have more determinants than the type of vaccine and vaccination procedure.
The duration of efficacy following oral treatment with emamectin benzoate against infestations of sea lice, Lepeophtheirus salmonis (Krøyer), in Atlantic salmon Salmo salar L.
Authors: Stone J , Sutherland I H , Sommerville C , Richards R H , Endris R G
Published: March 2003

The duration of efficacy of emamectin benzoate in the oral treatment of sea lice, Lepeophtheirus salmonis, infesting Atlantic salmon, Salmo salar L., was evaluated in a tank study. One group of salmon was treated at a nominal dose of 50 μg kg−1 biomass day−1 for 7 consecutive days and a second group was untreated. Fish were then redistributed to 16 tanks, each holding 17 control and 17 treated fish. On days 34, 41, 48, 55, 62, 69, 76 and 83, two tanks were challenged with L. salmonis copepodites. Eight to 14 days after each challenge, fish were anaesthetized and numbers of lice recorded. Treatment with emamectin benzoate prevented development of copepodites for up to 62 days from the start of treatment, and chalimus numbers remained low for 69 days. Treated fish, challenged from days 34 to 69, had significantly (P<0.01) fewer lice than control fish. Treated fish challenged at days 76 and 83 still had fewer lice than control groups, although differences were not statistically significant for both replicates. When chalimus appeared on treated fish challenged at days 69–83, survival of chalimus to adult stages was lower than on control fish. Louse egg production on treated fish challenged at days 62–83 was not reduced compared to control groups.
Rapid identification of Yersinia ruckeri by PCR amplification of yruI–yruR quorum sensing
Authors: Temprano A , Yugueros J , Hernanz C , Sánchez M , Berzal B , Luengo J M , Naharro G
Published: March 2003

Yersinia ruckeri possesses a quorum‐sensing system detected by cross‐streaking against the white mutant Chromobacterium voilaceum CV0blu. Quorum sensing, which occurs in a number of Gram‐negative pathogens, is known to control virulence gene expression through cell to cell communication. There are two genes required for quorum sensing which are luxR/luxI homologues and there is an N‐acylhomoserine lactone (AHL, commonly called autoinducer) synthesized by the product of luxI homologue which interacts with a response regulator (the product of luxR homologue). The Y. ruckeri quorum sensing system, termed yruR/yruI, was cloned from a gene library constructed in pUC18 plasmid vector. Nucleotide sequence analysis of Y.ruckeri yruR and yruI revealed convergent transcription with overlapped 3′ ends and two open reading frames (ORFs) of 247 and 217 amino acids, respectively. Two pairs of synthetic oligonucleotide primers of 24 bases were used in a PCR assay to amplify yruR/yruI genes with short flanking sequences as well as an internal DNA fragment within yruR/yruI genes. DNA fragments of 1900 and 1000 bp were amplified from both sources, lysed Y. ruckeri cells and isolated DNA. Amplified sequences were detected in ethidium‐bromide agarose gels or by Southern blot analysis with an internal 336‐bp fragment as a hybridization probe. Detection of Y. ruckeri by PCR amplification of yruR/yruI genes has great potential for rapid identification of this fish pathogen bacterium as it has proved to be highly specific.
The production of a lymphokine (macrophage activating factor) by rainbow trout, Oncorhynchus mykiss (Walbaum), leucocytes stimulated with the extracellular products of Mycobacterium sp.
Authors: Chen S‐C , Thompson K D , Adams A , Richards R H
Published: March 2003

The production of macrophage activation factor (MAF) by rainbow trout, Oncorhynchus mykiss (Walbaum), head kidney leucocytes was examined after culturing in vitro with extracellular products (ECP) collected from Mycobacterium sp. Cultures of leucocytes were prepared from naive fish, or fish previously vaccinated with either the ECP or with formalin killed whole cell preparations (WC) of the bacterium. The cells were then incubated with the ECP in vitro and the ability of their supernatants to activate macrophages assessed. Macrophages from control fish were incubated with the supernatants, and their ability to reduce nitroblue tetrazolium (NBT) measured as an indicator of macrophage activation. Incubation of head kidney macrophages from naive fish directly with 1, 10 or 100 μg mL–1 of ECP for 48 h significantly enhanced macrophage activation compared with control macrophages. Vaccination of fish with either ECP or WC had no significant effect on the respiratory burst of control macrophages 4 weeks post‐vaccination. By the eighth week, however, absorbance levels of respiratory burst reflecting both the primary (cells from vaccinated fish cultured in vitro with PBS) and the secondary (cells cultured in vitro with ECP) MAF responses of fish vaccinated with ECP and WC, had peaked and these were significantly different from the non‐vaccinated controls. This activity had fallen to levels similar to control fish by week 12 for fish vaccinated with WC.
Experimental susceptibility of different life‐stages of the giant freshwater prawn, Macrobrachium rosenbergii (de Man), to white spot syndrome virus (WSSV)
Authors: Kiran R B Pramod , Rajendran K V , Jung S J , Oh M J
Published: March 2003

Studies were conducted by injecting/feeding white spot syndrome virus (WSSV) derived from infected shrimp, Penaeus monodon (Fabricius), to different life‐stages, namely post‐larvae, juveniles, sub‐adults and adults of Macrobrachium rosenbergii (de Man). The disease was also induced in brood stock, and the eggs and larvae derived from these animals were subsequently tested for WSSV infection. All the stages except egg used for the experiment were found WSSV positive in histopathology, cross infection bioassay and polymerase chain reaction (PCR) analysis. Experimentally infected post‐larvae and juveniles showed a high percentage of mortality and an increased rate of cannibalism. The cumulative mortality in post‐larvae was up to 28%; with 28–40% cannibalism resulting in a maximum loss of up to 68%. In juveniles, observed mortality and cannibalism were 10–20% and 6.7–30.0%, respectively, and the maximum loss recorded was 50%. In sub‐adults, mortality ranged from 2.8 to 6.7%, cannibalism was up to 20% and the total loss was up to 26.7%. Sub‐adults and adults were found to be more tolerant to the infection as evidenced by the mortality pattern. A nested (two‐step) PCR resulted in a 570‐bp product specific to WSSV in all stages, except the eggs.
Pathology associated with retained fishing hooks in blue sharks, Prionace glauca (L.), with implications for their conservation
Authors: Borucinska J , Kohler N , Natanson L , Skomal G
Published: March 2003

Fishing hooks retained from previous capture events were found in 6 of 211 blue sharks, Prionace glauca (L.), landed in the summers of 1999 and 2000 by recreational fishermen off Long Island (New York, USA). The hooks were embedded within the distal oesophagus (n=3), or perforated the gastric wall (n=3) and lacerated the liver (n=2). The hooks were surrounded by excessive fibronecrotic tissue which ablated the normal anatomical structures and in the three sharks with oesophageal hooks caused partial luminal obstruction. Accompanying lesions included oesophagitis, gastritis, hepatitis and proliferative peritonitis. Aeromonas sp. and Vibrio sp. were isolated from the peritoneal fluid of one shark with peritonitis and intralesional bacteria were seen on histological examination in all sharks. This is the first report of the prevalence and pathology of retained fishing hooks in a large number of wild‐caught sharks.
Reliability and validity of a nutrition screening tool to be used with clients with learning difficulties
Authors: Bryan F. , Jones J. , Russell L.
Published: March 2003

Background: People with learning difficulties are nutritionally vulnerable for many reasons. There is a need for a nutrition screening tool (NST) to enable carers to identify those at nutritional risk. However, a validated NST for clients with learning difficulties does not exist.Aim: To assess the reliability and validity of a NST being used in a long‐stay hospital in North Staffordshire for people with learning difficulties. The NST investigates three areas of risk: nutritional adequacy (food groups), weight and nutrition‐related problems such as dysphagia or gastrointestinal disorders.Method: Thirty‐six subjects were randomly selected. The reliability of the NST was assessed by three nurses familiar with the participants. Each subject was independently screened using the NST. Validity was assessed by forming an expert panel of three dietitians. Each participant's nutritional status for each of the three risk areas was assessed independently by the dietitians using their own methods. A comparison of the majority opinion of the dietitians with that of the nurses gave an indication of validity.Results: Reliability was analysed using variance component models and indices of agreement. There was good agreement between nurses in the assessment of risk relating to nutrition adequacy (r=0.658), moderate agreement in the assessment of nutrition‐related problems (r=0.576), but only fair agreement in the assessment of weight‐related risk (r=0.263). Validity was assessed using Cohen's kappa statistic. There was good agreement between the majority opinions of the nurses and dietitians for the assessment of nutritional adequacy‐related risk (r=0.708) and for nutrition‐related problems (r=0.691), but only fair agreement for weight (r=0.300).Conclusion: Use of the NST in the area of nutrition adequacy gave good repeatability and validity.Similarly, there was good validity in the area of nutrition‐related problems. The NST was not satisfactory in assessing weight‐related risk and further work is needed in this risk area. There was also a suggestion from the results of the study that the dietitians differed in their approach to assessing nutritional risk.
Enteral feeding tube guidewire—another factor in the retrograde contamination of enteral feeding systems?
Authors: Beattie  , Anderton
Published: March 2003

Background:
In vitro enteral feeding systems were used to investigate the effect that withdrawal of the guidewire from the feeding tube has on bacteria ascending from a patients’ stomach or intestine via the feeding tube to the giving set and nutrient container of the feeding system.
Methods: Enteral feeding systems were assembled with the feeding tube running into nutrient broth contaminated with Klebsiella aerogenes. The enteral feeding tubes were held in different orientations (horizontal and vertical) to examine the effect in both prostrate and ambulant patients. The guidewire was removed either prior to or after the enteral feeding tube had been inserted into the K. aerogenes broth. Feed was then run through the systems for 24 h, with feed samples being collected from the distal (patient) end of the giving set at 0 and 24 h.
Results: After 24 h, 103–108 c.f.u. (colony forming units) K. aerogenes/ml were detected in feed samples taken from the distal end of the giving set in systems where the guidewire had been removed after the enteral feeding tube had been inserted into the contaminated broth (both orientations), but K. aerogenes was not detected in samples from systems in which the guidewire had been removed before the end of the tube was inserted into the broth (both orientations). However, when the latter feed samples were enriched (i.e. incubated at 37 °C for a further 24 h to detect if very low levels of bacteria were present in the original sample), 40% of samples from systems with horizontally orientated tubes, and 20% from systems with vertically orientated tubes were positive for the test organism. K. aerogenes was not detected in any samples of feed taken from the nutrient container or just below the drip chamber.
Conclusion: The results demonstrate: (i) that bacteria ascend the feeding tube over a 24‐h period (retrograde contamination) and (ii) removal of the guidewire can contribute to the colonization of the lumen of the feeding tube and distal end of the giving set with bacteria from a patients’ own flora.
Evaluation of weight management services provided by dietitians within a community trust
Authors: Keppie  , Lyon
Published: March 2003

Background: The British Dietetic Association has produced guidelines as to how dietitians should be trying to manage obesity, and locally within Leicestershire Nutrition and Dietetic Service dietitians have set up initiatives to improve obesity management Funding from the Department of Health made it possible to carry out an evaluation of the weight management services provided.

Method: A retrospective record card audit of overweight or obese patients who had completed an episode of care in a defined time period was carried out. In total 167 patient record cards were audited. The patient profile was characterized in terms of gender, age, body mass index (BMI) at start and end of treatment, source of referral and reason for referral. Information was collected on dietary targets set and achieved. A Patient Satisfaction Survey was sent to each patient at the end of the episode of care. Criteria set for successful weight loss was 5 kg or 5% starting body weight. Success in achieving dietary targets was defined as meeting > 50% of targets

Results: In total 50% (n = 83) of patients achieved weight loss or maintained their weight. 12% of patients (n = 20) were successful in losing 5 kg body weight, 38% of patients (n = 63) lost up to 5 kg or stayed the same, 13% of patients (n = 22) gained weight and 19% of patients (n = 31) failed to return after the first appointment. Most patients achieved some dietary changes suggested although there was discrepancy between reported change by patients which would have been expected to lead to weight change and actual weight change recorded at the end of treatment. The service offered by the Leicestershire Nutrition & Dietetic Department was generally well received by patients.

Conclusions: Further review of methods of managing obese patients within the time constraints of community clinics is needed, including monitoring and long‐term support, and the reliable recording of dietary change.
Are there intergenerational differences in the diets of young children born to first‐ and second‐generation Pakistani Muslims in Bradford, West Yorkshire, UK?
Authors: Parsons S. , Godson J. H. , Williams S. A. , Cade J. E.
Published: March 2003

Introduction: In previous reports, the diets of second‐ compared with first‐generation adults have shown greater signs of acculturation. This study aimed to assess whether this was also true amongst 3‐year‐old UK‐born children of first‐ (1G) (n=117) and second‐generation (2G) (n=109) Pakistani mothers in Bradford.

Materials and methods: A random sample of mothers was selected (n=320), with generation groups matched for month of birth, sex of child and district of residence. Home‐based interviews were undertaken by multilingual female interviewers. Mother's social characteristics and infant feeding practices were examined and a 24‐h dietary recall for the child was collected. Child's position in the family was not considered in this analysis.

Results: Interviews were completed for 226 mothers (117, 1G and 109, 2G). The groups varied according to educational background, linguistic ability and employment status, but analysis of dietary recall indicated more similarities between the groups than differences. For example, traditional foods were limited to midday or evening meals, snacks usually consisted of crisps and biscuits, and sweetened milk or tea was consumed at breakfast. Some differences did exist: water was more likely to be consumed by children of 1G mothers at the midday and evening meals; fish and chips were a more frequent food item among those of 2G mothers.

Conclusion: Evidence of dietary transition between groups was minimal using this methodology. This may be due to the cohesive nature of the Pakistani community resulting in it evolving in unison, or because all young children may be subject to similar dietary and cultural expectations and pressures.
Weight loss and possible reasons for dropping out of a dietary/behavioural programme in the treatment of overweight patients
Authors: Garaulet M. , Pérez‐Llamas F. , Zamora S. , Tebar F. J.
Published: March 2003

Objectives: To evaluate the weight loss of a dietary/behavioural weight reduction programme and causes for drop‐out.

Methods: 90 overweight patients with a mean weight of 79±17 kg and BMI of 28.8±5 kg m−2 who attended a clinic to lose weight were subjected to a dietary/behavioural weight reduction programme. Treatment consisted in behavioural therapy with nutritional education, diet and physical activity. To evaluate the effectiveness of the treatment the following were considered: percentage of individuals who completed the treatment, weight reduction, average rate of weight reduction and percentage of individuals who completed the follow‐up period. To determine the reasons for dropping out, an open‐ended questionnaire was administered by telephone by trained clinical personnel.

Results: 43% of patients completed the treatment, mean weight loss was 9 kg and the mean rate of weight loss was 0.8 kg week−1. Reasons for dropping out were: vacations (23%), search for faster or fad diets (23%), social pressures (11%), excessive duration of the treatment (9%); failure to understand the diet (9%); differences within the group (7%); and illness and pregnancy (7%).

Conclusions: Dietary/behavioural treatment is effective in clinical practice and especially adequate for men and young women. It is not satisfactory for individuals with very high BMI (> 35 kg m−2). Vacations, social causes and the search for ‘miracle’ diets were the principal reasons for drop‐out.
Taste preference for oral calorie supplements in children with cystic fibrosis, healthy children and healthy adults
Authors: Poustie V. J. , Watling R. M. , Ashby D. , Smyth R. L.
Published: March 2003

Background: Calorie supplements are commonly prescribed to improve the nutritional status of children with cystic fibrosis. Although the palatability of these products has been extensively researched in adults, little work has been carried out in either healthy children or children with cystic fibrosis. The aim of this study was to identify which type of supplement was preferred by children with cystic fibrosis, healthy children and healthy adults.

Methods: 23 children with cystic fibrosis, 65 healthy children and 40 healthy adults were recruited to the study. All were asked to taste four of the main types of prescribable supplements available and indicate which they preferred.

Results: The preference score for the fresh milk supplement was significantly higher than the scores for the other three supplements. There was no apparent difference between the taste preferences of the three groups studied.

Conclusions: The results of this study indicate that children with cystic fibrosis have similar taste preferences for calorie supplements to healthy children and adults. The fresh milk supplement was preferred by the majority of the subjects, which suggests that when starting a patient on calorie supplements a fresh milk product should be offered first. The preference testing method used here is quick and easy to do and may be useful for assessing patient preferences at the bedside.
Dietary assessment in the elderly: application of a two‐step semi‐quantitative food frequency questionnaire for epidemiological studies
Authors: Klipstein‐Grobusch K. , Witteman J. C. M. , den Breeijen J. H. , Goldbohm R. A. , Hofman A. , de Jong P. T. V. M. , Pols H. A. , Grobbee D. E.
Published: March 2003

Objective: Description and application of an adapted semiquantitative food frequency questionnaire (SFFQ) for dietary assessment in the elderly population of the Rotterdam Study.

Design: Dietary assessment consisting of a two‐step approach was performed in 5434 participants (2225 men, 3029 women) of the Rotterdam Study from 1990 to 1993, a population‐based prospective cohort of 7983 subjects aged 55–95 years (participation rate 78%).

Statistical analysis: Nutrient intake was calculated for men and women in four age groups (55–64 years, 65–74 years, 75–84 years, 85–95 years) and linear trend analysis for differences in mean nutrient intake across age groups (55–64 years, 65–74 years, 75–95 years) by regression analysis was conducted. The influence of baseline characteristics on energy and nutrient intakes adjusted by age and sex was investigated by one‐way‐analysis of variance.

Results: The adapted SFFQ made it possible to measure nutrient intake in the elderly within a limited time frame (2×20 min) across a wide age range (55–95 years). For nutrient intake we observed a general decline in mean intake of energy and most nutrients with age in men. In women the relation with age was not consistent: for most nutrients mean intake showed a decrease with age (e.g. water, magnesium, potassium), for some an increase (e.g. total fat, saturated fat, mono/disaccharides), and some nutrients showed no substantial change (e.g. calcium, retinol). Reported nutrient intake was influenced by body mass index, smoking status, socioeconomic status and activities of daily living. A prescribed diet was reported by 12.9% of participants and 34.6% used supplements on a regular basis.

Conclusions: The described two‐step approach for dietary assessment in the elderly facilitated collection of data on dietary habits across a wide age range and within a limited time frame making it a suitable instrument for application in large‐scale epidemiological studies in the elderly.
Nutrition audit at a community hospital
Authors: Mitchell H.
Published: March 2003

Background: The Department of Health (DoH) guidelines on hospital catering recognize the benefits of good nutrition in the reduction of medical complications and length of stay. Audit checklists are available to monitor implementation of these guidelines.

Aims: To describe current feeding practice in a community hospital; evaluate qualitative aspects of patients’ mealtimes and to audit the food provided in relation to DoH guidelines and reference nutrient intakes.

Methods: Qualitative data were collected at mealtimes by observation and recorded on a standard proforma. Nursing staff completed short questionnaires concerning food availability and support for patient feeding. Menus were compared with DoH guidelines using a standard checklist. Food intake data were collected over a 48‐h period for a group of patients (n=8) and comparison made with Reference Nutrient Intakes.

Results: Qualitative aspects of mealtimes were satisfactory, mealtimes were relaxed and pleasant. Using the DoH checklist, menus met national guidelines for vitamin C, fibre, iron and folate. However, analysis of dietary intakes showed low intakes of iron, fibre, vitamin D and folate.

Conclusion: Some aspects of food provision require attention and this would be facilitated by the setting up of a hospital food committee to set goals and monitor progress.
A nutritional screening tool for use by nurses in residential and nursing homes for elderly people: development and pilot study results
Authors: Wright L.
Published: March 2003

Background: Nutrition problems are associated with increased morbidity and mortality and poor quality of life in elderly patients. Development of a convenient and valid screening tool to identify those at risk is therefore important.

Aim: The aim was to develop a quick and simple evaluation tool for use by nurses of the elderly population within nursing and residential homes in order to facilitate nutrition intervention.

Methods: Two homes participated in this pilot study comparing the risk assessment by nurses using the tool developed with that obtained by dietitians using more detailed measures including a diet history and anthropometric measurements.

Results: The results of the pilot study showed that further modifications needed to be made to the tool. However, there was general agreement between the Dietitian and Nurses of subjects at risk was.

Conclusion: Further modifications need to be made to the tool. Staff training, especially in determination of body mass index is needed in order to implement the tool for widespread use in the nursing and residential homes.
A15. Public attitudes towards the healthiness of fruit juices
Authors: France K. I.
Published: March 2003

Background Fruit juice is a major part of children’s diets and accounts for a large proportion of their fruit and vegetable servings. People may confuse fruit juice with fruit drinks. This can cause problems as people could possibly substituting a portion of fruit for a drink, which contains little or no fruit. Studies have shown that excessive consumption of fruit juice can lead to health problems in children, including short stature, obesity, nonorganic failure to thrive and carbohydrate malabsorption. An increase in dental erosion has also been noted which appears to correlate with an increase in fruit juice and carbonated beverage consumption.

Aims The aim of this study was to find out what the general public’s attitudes are towards the healthiness of fruit juice.

Methods A mini focus group and a questionnaire were the methods used for data collection. The subjects were parents of children aged 12 or under in a local primary school.

Results Overall, the study group had a poor knowledge of the difference between fruit juice and drinks, and knowledge of sugar content was poor. The group had a good knowledge of fruit content. Fruit juice was regarded as being a health drink. They were unsure if excessive consumption could damage children’s health or not. Their main concern was regarding their children’s teeth. The factor identified as being most influential when choosing a drink was flavour, followed closely by healthiness. Nutritional knowledge was generally poor. The average daily intake of juice was 650 mL (22.8 floz), considerably more than the value recommended by several experts.

Conclusion There is a need for nutritional education regarding the consumption of fruit juice. The public should be made more aware of the potential problems associated with excessive fruit juice consumption without discouraging fruit juice intake altogether, as it is an important source of fruit in the diets of young children.