bluuebunny/crossref_metadata_2025 huggingface dataset:
Possible causes of spatial variability inDiatraea saccharalisFabr. (Lep., Crambidae) and its parasitoid populations in sugarcane fields in Brazil
Authors: Rossi M. N.
Published: December 2004

Based on the large data set stored in some sugarcane mills regarding the biological control programme ofDiatraea saccharalisusing the parasitoidsCotesia flavipesand tachinid flies, the aim of the present study was to determine whether sugarcane varieties, number of cuts and plant ages are major determinants in promoting spatial variability inD. saccharalis,C. flavipesand tachinid fly populations in sugarcane fields in the state of São Paulo (Brazil). The data set used to support this study was provided by the São João and Barra sugarcane mills. Coefficient of variation was adopted as a measure of the spatial variability of population density. Spatial variability was estimated for the total density ofD. saccharalis(parasitized + unparasitized larvae), and also forD. saccharalislarvae parasitized by tachinids and byC. flavipes. Statistical analysis revealed that the spatial variation inD. saccharalispopulations was influenced by the number of cuts and by plant ages in the Barra and São João Mills, respectively. Similar results were obtained forD. saccharalislarvae parasitized by tachinids; however, in the São João Mill, the spatial variability of these populations was also influenced by the different number of varieties. Finally, consideringD. saccharalislarvae parasitized byC. flavipes, no significant regressions with any of the three categories were observed for both sugarcane mills. The multitrophic implications for this agricultural system are also discussed.
Consumer expectations of residential aged care: reflections on the literature
Authors: Edwards Helen , Courtney Mary , Spencer Lyndall
Published: December 2004

The decision‐making process that accompanies aged‐care home placement is complex and there is a paucity of literature documenting the experiences of those who undertake the activity. The deficiency extends to an understanding of consumer expectations about the quality of the services they encounter once admission has been obtained. Although fewer than 7% of Australian women and 3% of Australian men aged 65 years occupied residential aged care places in 1999–2000, the probability that they will do so at some point in their lives is 0.42 and 0.24, respectively. This study examined 20 papers on this subject found through an extensive search of the literature. Themes identified include the search and selection process of residential aged‐care facilities, consumer expectations and satisfaction of placement outcomes, and global and community expectations of quality of care.
Increased expression of the natural killer cell inhibitory receptor CD85j/ILT2 on antigen‐specific effector CD8 T cells and its impact on CD8 T‐cell function
Authors: Ince M. Nedim , Harnisch Brooke , Xu Zhan , Lee Sang‐Kyung , Lange Christoph , Moretta Lorenzo , Lederman Michael , Lieberman Judy
Published: December 2004

We investigated whether inhibitory natural killer cell receptor (iNKR) expression contributes to impaired antigen‐specific cytotoxicity and interferon‐γ (IFN‐γ) production by CD8 T cells during chronic infection. iNKR immunoglobulin‐like transcript‐2 (ILT2/CD85j) is expressed on 40–55% of cytomegalovirus (CMV)‐, Epstein–Barr virus (EBV)‐ and human immunodeficiency virus (HIV)‐specific CD8 T cells in both healthy and HIV‐infected donors. Other iNKRs (CD158a, b1, e1/e2, k, CD94/NKG2A) are expressed on only a small minority of CD8 T cells and are not preferentially expressed on tetramer‐staining virus‐specific cells. In normal donors, ILT2 is expressed largely on perforin+ CD27– effector cells. However, in HIV‐infected donors, only a third of ILT2+ cells are also perforin+. In both normal and HIV‐infected donors, ILT2+ cells are prone to spontaneous apoptosis. Therefore, ILT2 is normally expressed during effector cytotoxic T‐lymphocyte (CTL) differentiation, but can also be expressed when effector maturation is incomplete, as in HIV infection. The effect of ILT2 on CD8 cell function was assessed by preincubating effector cells with ILT2 antibody. While blocking ILT2 engagement has no appreciable effect on cytotoxicity, it increases antiviral IFN‐γ production by approximately threefold in both normal and HIV‐infected donors. Thus, ILT2 expression, increased on antiviral CD8 cells in chronic infection, may interfere with protective CD8 T‐cell function by suppressing IFN‐γ production.
Trust, control and the role of interorganizational systems in electronic partnerships
Authors: Gallivan Michael J. , Depledge Gordon
Published: December 2004

Abstract.To survive and thrive in today's competitive marketplace, organizations are increasingly migrating to new organizational structures in which partnerships and interorganizational systems (IOSs) are becoming more important. The success of these partnerships depends on both trust and control – complex constructs that act on and shape each other over time. Many organizations assume that high levels of trust are necessary for net‐enabled electronic partnerships. We examine this assumption from two perspectives: the initial decision to enter into a partnership or alliance, and its ongoing operation. Our findings suggest that researchers have treated trust simplistically, failing to distinguish the need for trust (which is inversely related to the organization's ability to control its partners) and the level of trust (which is an actual quantity that may change during the lifetime of the partnership). In many organizations, there is a gap between these two trust dimensions, which management attempts to close by changing the level of control. In this process, the IOS is key. To understand the relationship of IOS use to trust and control, we applied structured content analysis and analytic induction to 16 published case studies and used the results to create a framework for relating trust and control. At the heart of the framework is the recognition that trust and control are not simple substitutes for each other. Rather, they form a dialectic, where it makes sense to consider each construct only in relationship to the other. Using the framework, we identify areas for follow‐up research and suggestions for practitioners.
Development of an orally infectious Sindbis virus transducing system that efficiently disseminates and expresses green fluorescent protein in Aedes aegypti
Authors: Pierro D. J. , Myles K. M. , Foy B. D. , Beaty B. J. , Olson K. E.
Published: December 2004

We have constructed an orally infectious Sindbis virus, ME2/5′2J/GFP, that expresses green fluorescent protein (GFP) in the midgut of Aedes aegypti and in other tissues as the virus disseminates. This virus has two unique features that are improvements over the SIN‐based expression systems currently used in mosquitoes. First, a subgenomic RNA promoter and GFP coding sequence is located 5′‐ to the second subgenomic promoter and structural genes of the virus. Second, the E2 glycoprotein gene of TE/5′2J/GFP is replaced with the E2 gene of MRE16 SIN virus. The first feature enhances virus genome stability during virus dissemination from the midgut to other tissues and the second allows efficient virus entry into the midgut epithelial cells and then spread of the virus throughout the mosquito.
Oral lesions and dental caries status in perinatally HIV‐infected children in Northern Thailand
Authors: Pongsiriwet S. , Iamaroon A. , Kanjanavanit S. , Pattanaporn K. , Krisanaprakornkit S.
Published: December 2004

Summary. Objective. To describe the prevalence of oral lesions and dental caries status in perinatally HIV‐infected children.

Design. A cross‐sectional study.

Setting. Paediatric HIV outpatient department at the Nakornping Provincial Hospital, Chiang Mai, Thailand.

Patients and methods. Forty children with perinatal HIV infection, from early infancy to 12 years of age, were included in the study. These children were examined for oral lesions and dental caries. A number of children receiving antifungal and antiretroviral (ART) therapy were recorded.

Results. The mean DMFT and DMFS scores were both 2·1 (SD = 2·3). The dft and dfs scores were 4·1 (SD = 5·0) and 10·9 (SD = 14·8), respectively. A total of 57·5% of the children had one or more oral lesions. Oral candidiasis and hairy leukoplakia were the most common oral lesions. Only 12·5% of children had received ART. A total of 22·5% of the children had a history of receiving antifungal therapy.

Conclusions. Oral lesions and dental caries were relatively high in this study. Consequently, treatment and prevention for oral lesions and dental caries are inevitably required for children with HIV infection in Northern Thailand. Furthermore, ART should be made available for all HIV‐infected children to decrease the prevalence of HIV‐associated oral lesions.
Pulp therapy in a maxillary fused primary central incisor – report of a case
Authors: Santos L. M. , Forte F. D. S. , Rocha M. J. C.
Published: December 2004

Summary. This paper describes a case in which pulp therapy was provided in a fused maxillary primary central incisor in a 4‐year‐old patient with a history of fistula on the gingival mucosa. The tooth involved was larger than expected, suggesting fusion. The diagnosis of fusion was confirmed on radiographical examination. The clinical management of the case is described and the diagnosis and treatment discussed.
Integration of therapeutic approaches: a new direction for mental health nurses?
Authors: Wilshaw G.
Published: December 2004

In this paper, the author reviews the value of the taking up of a specific therapeutic school or base for practice in mental health nursing, such as cognitive behavioural therapy or client‐centred therapy. This is examined against a background of increased interest in non‐‘purist’ forms of therapeutic approach in the fields of psychotherapy and counselling. The common factors present in effective helping relationships are highlighted, along with a way of understanding the fundamental form of a given helping relationship which is perhaps independent of theoretical orientation. Thinking in this mode cuts across traditional ‘models of nursing/therapy’ speak. This may allow the mental health nurse to adopt appropriate client‐need‐driven interventions, which are not hamstrung by theoretical dogma. Given this, the paper suggests an ‘honourable position’ of eclecticism for mental health nurse education and practice.
Finnish public health nurses' experiences of primary health care based on the population responsibility principle
Authors: Koponen Päivikki , Heliö Sirkka‐Liisa , Aro Seppo
Published: December 2004

Implementation of a ‘population responsibility’ principle in Finnish health centres began in the late 1980s. The aim of this study was to describe public health nurses’(PHNs') experiences of primary health care based on this principle and to identify contextual and personal factors related to their experiences. The sample consisted of PHNs in 10 health centres. A questionnaire was developed based on a qualitative study. The survey was conducted in 1990 and repeated in 1992. The response rate was 84% for the 1990 sample (n=102) and 91% for the 1992 sample (n=131). In the multivariate analysis of variance type of community (urban/rural), size of the target population, task division model and existence of regular teamwork between social and health care personnel were chosen as contextual factors studied. Age, length of professional experience and having specialist education in midwifery were chosen as personal factors. Dependent variables were subscales on: experiences of planning and implementation, perceived influence of population responsibility on nurse–client relationships, comparison with previous experiences, views and experiences on comprehensiveness of care and job satisfaction. The majority of the PHNs experienced only minor changes in their work after the implementation of population responsibility. They were most critical about the way these changes were planned and implemented. Changes were mainly perceived as positive. There were some differences in the two samples, reflecting a shift from both positive and negative responses towards more neutral or more positive responses. Several contextual factors were multi‐dimensionally related to the PHNs' experiences.
Intuition: a critical review of the research and rhetoric
Authors: King Lindy , Appleton Jane V.
Published: December 2004

This paper will explore the concept of intuition in nursing from an acute care and community nursing perspective. It will consider definitions of intuition and examine the research which can inform our understanding of this important component of decision making. In the current health service climate, which demands measurable research‐based evidence, the involvement of intuition as an element of judgement is often denigrated. The result is that many nurses are being forced to be covert in their use of this crucial aspect of judgement and focus solely on the conscious elements of decision‐making. However, research evidence would suggest that intuition occurs in response to knowledge, is a trigger for action and/or reflection and thus has a direct bearing on analytical processes in patient/client care. The authors therefore argue that the essential nature of intuition cannot be ignored in the practice, management, education and research of nursing.
Postnatal quality of life: a pilot study using the Mother‐Generated Index
Authors: Symon Andrew , MacKay Anna , Ruta Danny
Published: December 2004

Background. Although postnatal morbidity has been well documented in recent years, postnatal quality of life has not been addressed. A newly derived subjective measurement of postnatal quality of life (the Mother‐Generated Index) combines a quantitative and qualitative evaluation.

Aims. This part of our pilot study aimed to compare the aspects of their lives nominated by women with low and high quality of life (Primary Index) scores, and to examine the respective importance of these areas.

Methods. The Mother‐Generated Index was tested using the Edinburgh Postnatal Depression Scale, Short Form 12, and an established maternal and neonatal physical morbidity index as validators. Four health visitors administered these at 6–8 weeks and 8 months postpartum to 103 women by structured face‐to‐face interviews between June 2000 and March 2001. Data were entered into Epi‐Info, and exported to Microsoft Excel and SPSS for analysis.

Results. A wide variety of quality of life aspects were reported, including emotional, social and financial concerns. Tiredness was prevalent in all groups, but other physical problems were rare at 8 months. Mothers with low quality of life (Primary Index) scores at 6–8 weeks and 8 months commonly reported having less personal time. Low scoring areas, which health professionals might consider in greatest need of attention, were often not the ones mothers deemed most important.

Limitations. The study involved only 103 participants, and did not assess the degree of support experienced by the mothers.

Conclusions. The Mother‐Generated Index helps mothers to identify the areas of their lives which are of most concern to them. This pilot suggests that mothers with high and low quality of life scores have markedly divergent experiences.
Improving the knowledge and skills of psychiatric nurses: efficacy of a staff training programme
Authors: Willetts Lucy , Leff Julian
Published: December 2004

Background. Working with people with mental illness is very challenging and mental health workers can have a significant impact on the mental status of their patients. Few studies have been published that describe training programmes for this staff group.

Aim. This paper aims to describe and evaluate a training programme for generic mental health workers used in the context of a residential unit for ‘difficult to place’ mentally ill patients.

Method. The staff training programme was adapted from a previous programme showing good efficacy. It was conducted over 10 sessions and addressed a wide range of issues relating to the management of mentally ill patients, with the use of a variety of teaching methods. Twenty‐nine generic mental health workers participated in the programme. The impact of the programme was examined using a knowledge questionnaire and a semi‐structured questionnaire exploring the range and use of management strategies by staff members.

Results. Comparison of pre‐ and post‐training measures indicated that the training programme increased staff knowledge of schizophrenia and the use of certain management skills, in particular, systematic strategies to effect change. This included increased use of structured programmes with patients.

Conclusion. The training programme was effective in increasing knowledge and skills of staff and could be used with a variety of psychiatric staff. There are numerous limitations to this study, in particular the poor attendance rates which are likely to have decreased the impact of the programme.
A survey of postnatal debriefing
Authors: Steele Anne‐Marie , Beadle Mary
Published: December 2004

Background. The evidence for postnatal debriefing generally lacks clarification of what postnatal debriefing constitutes. This is true of the recommendation in the United Kingdom for midwives to undertake ‘active postnatal debriefing’ (Department of Health 1999).

Aim. The study aimed to explore current practice and describe the provision of postnatal debriefing in two health regions of England.

Methods. A descriptive survey using cohort sampling was undertaken using a self‐report questionnaire which was sent to each maternity unit in the two regions (n = 46). A response rate of 93% (n = 43) was obtained. The questionnaire collected information about the maternity units and their provision of ‘postnatal debriefing’. A list of debriefing descriptors formed the basis of the questionnaire, and comprised activities that various authors had included in their definitions of debriefing.

Results. Responses indicated that 38 (88%) of maternity units offered women an opportunity to ‘debrief’ by discussing their experiences of maternity care. The provision of this service fell into three distinct sub‐groups: firstly, those who provided a service which is in keeping with debriefing, however not all the maternity units actually called their service debriefing; secondly, those who provided a service which is fundamental postnatal care, usually called routine postnatal care; thirdly, those who provided a service which was inconsistent and neither debriefing nor postnatal care. This inconsistency was also reflected in the names chosen for the service.

Conclusions. The findings of this study support previous claims that confusion about postnatal debriefing continues. Recommendations for practice are made with the intention of promoting a consistent approach; this would also enable further research and evaluation to be conducted.
Using student nurses as teachers in inquiry‐based learning
Authors: Morris David , Turnbull Patricia
Published: December 2004

Background.  Traditionally, teaching in nurse education colleges and universities in the United Kingdom (UK) has relied substantially on didactic, large group, teacher‐led approaches. Emerging literature identifies a shift towards student‐centred learning in a variety of formats, such as problem‐ and enquiry‐based learning. These approaches require students to take greater responsibility for both their own learning and that of others. Internationally, and in a number of academic educational disciplines, use of peer‐assisted learning, supplemental instruction and peer tutoring as curriculum initiatives has aided improvement in student retention and academic performance. There is, however, a paucity of literature exploring the use of undergraduate student nurses as peer teachers.

Aim.  To explore the viability of using student nurses as teachers in an inquiry‐based nursing curriculum and to ascertain the value students place on this teaching and learning method.

Method.  The first phase of the study involved observation of ‘parallel resource sessions’: teacher‐led sessions that addressed a theoretical component of the curriculum. In the second phase, student feedback of these sessions to their peers was observed. This was followed by focus group interviews (with a total of 240 participants), which were analysed using thematic analysis.

Findings.  The findings suggest that student nurses were uncomfortable with being used as teachers, often questioned the intrinsic worth of this approach as a developmental tool, and considered the responsibility for teaching the content of parallel resource sessions to lie with nurse educators.

Conclusion.  Nurse educators must continue to explore innovative approaches to improve both student nurses’ experience and their fitness for practice. The strategy of using student nurses as teachers may be appropriate in some circumstances but requires further research, considerable support and continual evaluation.
Infant feeding attitudes of expectant parents: breastfeeding and formula feeding
Authors: Shaker Iolanda , Scott Jane A. , Reid Margaret
Published: December 2004

Background.  Research has indicated that parental attitudes are strong predictors of choice of infant feeding. Identification and understanding of the infant feeding attitudes of mothers and their social networks should be an early step in the design and implementation of breastfeeding interventions.

Aim.  To compare the infant feeding attitudes of parents of breastfed infants with those of parents of formula fed infants.

Methods.  A survey was carried out with a convenience sample of pregnant women (gestational age 8–12 weeks) attending three maternity clinics in Scotland in 2000. Expectant mothers and their partners (n = 108 couples) completed the 17 item Iowa Infant Feeding Attitude Scale. Demographic information was collected by face‐to‐face interview and the method of feeding at discharge from hospital was obtained from medical records.

Results.  Parents of breastfed infants had more positive attitudes towards breastfeeding than parents of formula fed infants, and were more knowledgeable about the health benefits and nutritional superiority of breastfeeding. Fathers of both breastfed and formula fed infants were more likely than their partners to disapprove of women breastfeeding in public. Parents considered their chosen method of feeding to be the more convenient alternative. Mothers of formula fed infants were more likely to think that women who occasionally drink alcohol should not breastfeed.

Conclusion.  Parents of formula fed infants had several misconceptions about breastfeeding. Use of the Iowa Infant Feeding Attitude Scale could help health professionals identify and address these in infant feeding discussions in the early antenatal period. Efforts should be made to include fathers in these infant‐feeding discussions.
Mature women's experiences of preregistration nurse education
Authors: Kevern Jennifer , Webb Christine
Published: December 2004

Background.  The government of the United Kingdom is encouraging more flexible recruitment strategies to overcome the shortage of qualified nurses. Mature women returning to education, often after completing their families, are a major target, but there has been little evaluation of their experiences as higher education students of nursing.

Aim.  The aim of the study was to follow‐up a previous quantitative study of mature women students’ outcomes on preregistration diploma courses in order to gain a deeper understanding of their experiences, and consider ways in which their needs might be addressed.

Methods.  Five focus groups were conducted in one higher education institution, and data were analysed using thematic analysis, assisted by the ‘spike’ feature of Word for Windows.

Findings.  Three major themes were identified: ‘Didn't know what to expect’, ‘Reality shock’ and ‘Learning the game’. Subthemes of ‘Learning the game’ were ‘Academic study’, ‘Practice placements and shift work’, ‘Managing the effect of course workload on domestic roles’, ‘Personal growth and changing relationships’, and ‘Support systems and friendships’.

Conclusions.  The findings are discussed in relation to reports of women's experiences in higher education in general. We conclude that the situation and needs of mature women preregistration nursing students are such that fundamental curriculum redesign is needed so that they can participate in higher education in ways that allow integration of their family and student lives, and permit them to benefit from the higher education experience in the same ways as younger students. The study is limited by its local nature, but the findings mirror those of other work, giving reassurance of its wider applicability. Recommendations are made for changes in the philosophy and organization of future programmes to improve their appropriateness and acceptability to mature women nursing students.
The idea of nursing science
Authors: Winters Janice , Ballou Kathryn A.
Published: December 2004

Background.  In response to the question of the idea of nursing as a legitimate science, Edwards (1999) claims that it does not qualify as a legitimate science. He bases his claim on the assumption that legitimate science must be empirical. Edwards defends his claim based on the lack of consensus and development in nursing philosophy during the past 40 years and, as he describes it, the lack of ends (or truth) of nursing science.

Aim.  The aim of this response is to refute Edwards’ conclusion. The basis for this refutation is twofold. First, legitimate science includes both empirical and non‐empirical scientific methods. Second, evidence of development of a nursing school of philosophical thought is found in the nursing literature.

Discussion.  Empirical science is only one mode of inquiry in nursing. Philosophical and non‐empirical methodologies are gaining increasing importance as modes of scientific inquiry. I therefore contend that nursing would be better served to continue applying an offensive effort into integrating all applicable modes of scientific inquiry into the discipline.
Salutogenesis as a framework for child protection: literature review
Authors: Taylor Julie S.
Published: December 2004

Aim. The aim of this paper is to demonstrate the usefulness of salutogenesis in work relating to child protection.

Methods. A systematic review to explore the links between parenting, social factors and failure to thrive was carried out using 17 CD ROM and online databases using keywords in appropriate medical subject headings (MeSH terms) and Boolean operators refined for the studies. The salutogenic framework was then used as a way of clarifying what benefit particular research findings may have in identifying and using factors which can be associated with protection, safety and well being of children. Cross‐referencing the evidence from the systematic review against Antonovsky's generalized resistance resources created a salutogenic matrix.

Findings. Four factors in the systematic review were found crucially important: parent factors; parenting factors; child factors; and social factors. However, it is probable that these are useful within all child protection research and the evidence gathered in particular cases (here failure to thrive) could be plotted against each factor. Application of a salutogenic framework to the results was further illuminating and has utility for both systematic review methodology and other child protection explorations. The matrix created a warp and weft effect that identified gaps in current evidence and practice and was able to disentangle some of the complexities inherent within failure to thrive situations. By beginning to shed understanding on such processes, the concept of salutogenesis added further depth and rigour to the analysis.

Conclusions. The concept of salutogenesis is widely used in some areas of nursing practice and research, and can also be regarded as a theoretical tool that has potential in child care and protection research, development and practice. The paper also illustrates the importance of a sound theoretical framework in ensuring depth and rigour in analyses of literature review findings.
Unique effect of tetrapentylammonium ions on sympathetic transmission in rat vas deferens
Authors: Huang Y. , Lau C. W.
Published: December 2004

Effects of tetrapentylammonium ions (TPA+) on contractile responses induced by electric field stimulation and by exogenous agonist such as noradrenaline, ATP and high K+ were examined in the isolated epididymal half of the rat vas deferens.

The electrically evoked monophasic contractions (0.5 Hz, 1 ms pulse duration, 40 V) were potentiated by TPA+ at low concentrations (1–3 μM) and inhibited by TPA+ at a concentration greater than 10 μM.

TPA+ (0.3‐3 μM) potentiated the contractile responses induced by noradrenaline and ATP, whilst, TPA+ (10 μM) concentration‐dependently reduced the agonist‐induced contractions.

TPA+ (0.3 μM) potentiated 30 mM K+ ‐Induced phasic contraction which was inhibited by pretreatment with α,β‐methylene ATP (3 μM) and prazosin (3 μM).

TPA+ (10‐300 μM) reduced the contractions induced by 100 mM extracellular K+ while TBA+ and TEA+ had no effect.

The present results show that TPA+ at low concentrations may act at prejunctional nerve membranes to enhance release of contractile transmitters and act as a putative K+ channel blocker at postjunctional membranes to increase muscle contractility in rat vas deferens; whilst at high concentrations TPA+ mainly acts on smooth muscle probably as a non‐selective relaxant against the agonist‐induced contraction probably through inhibition of Ca2+ influx; this inhibitory effect appears unique for TPA+ since TEA+ and TBA+ did not induce muscle relaxation.
Health‐related quality of life in persons with long‐term pain after a stroke
Authors: Widar Marita , Ahlström Gerd , Ek Anna‐Christina
Published: December 2004

Background.  No study has, to our knowledge, previously been published on health‐related quality of life (HRQoL) in a group suffering from long‐term pain after a stroke.

Aim.  The aim of the present study was to describe HRQoL in persons with long‐term pain after a stroke, and to compare this with different types of pain conditions, age, gender and household status.

Design.  This study has a design combining qualitative and quantitative methods.

Methods.  Forty three participants suffering from long‐term pain after a stroke were included. A qualitative interview was performed and then analysed by means of latent content analysis. In addition, two self‐report questionnaires, SF‐36 and the Hospital Anxiety and Depression Scale (HAD Scale), were used.

Results.  The qualitative data revealed that physical and cognitive functioning, economic security and good relationships, support and having the ability to be together with family and friends were important factors with regard to experienced HRQoL. No significant differences were found in SF‐36 and the HAD Scale with regard to the different types of pain. The older age group had decreased physical functioning in SF‐36. The men had more decreased vitality than the women.

Conclusion.  The results show, that the participants in this study have a lower HRQoL due to their long‐term pain than those in previous studies on stroke survivors. It is evident that further research is needed with longitudinal studies and larger populations to gain more knowledge and thereby provide better supportive care.

Relevance to clinical practice.  Awareness and understanding of the patients’ perceptions and transitions with regard to their life situation and suffering from long‐term pain after a stroke is important in order to support a maintained or increased HRQoL. This is also important after the acute stage and rehabilitation, including quality of life of the relatives, especially to older and dependent persons.
Chronic illness self‐management: taking action to create order
Authors: Kralik Debbie , Koch Tina , Price Kay , Howard Natalie
Published: December 2004

Background.  This paper presents research that was framed by our early understandings about the ways that people incorporate the consequences of illness into their lives. The word ‘transition’ has been used to describe this process. We believed self‐management to be central to the transition process but this assertion required further research, hence this paper.

Aim.  The research aimed at understanding the way in which people who lived with chronic illness constructed the notion of self‐management. While the participants of this study were living with arthritis, the focus was on understanding the meaning of self‐management rather than the experience of living with the symptoms of arthritis.

Approach.  Data were generated when nine people living with arthritis were invited to write an autobiography about their life and experiences of living with illness. Two telephone interviews were recorded with each participant and then the research group (researchers and participants) convened for a discussion meeting.

Findings.  In contrast to health professionals who identify self‐management as structured education, participants identified self‐management as a process initiated to bring about order in their lives. Creating a sense of order, or self‐management, had four key themes (i) Recognizing and monitoring the boundaries, (ii) Mobilizing the resources, (iii) Managing the shift in self‐identity, (iv) Balancing, pacing, planning and prioritizing

Conclusions.  People learned about their responses to illness through daily life experiences and as a result of trial and error. They reconfigured their daily lives and reconstructed their self‐identity by exploring their personal limitations or boundaries. Self‐management of chronic illness has been considered as both structure and process, however it is the process of self‐management that we contend is central to the experience of transition.

Relevance to clinical practice.  Clinical nursing intervention for people with a long term illness may be enhanced when self‐management is approached from a broad, contextual perspective and self‐management processes are integrated into clinical practice. The challenge is for nurses to embrace processes in nursing practice that will facilitate interactions with clients without obstructing the diversity of perspectives, create an environment conducive to learning and engage individuals in identifying self‐management strategies that have meaning in their lives.
The challenge of spiritual care in a multi‐faith society experienced as a Christian nurse
Authors: Fawcett Tonks N. , Noble Amy
Published: December 2004

Background.  Understanding the spiritual dimension of holistic nursing care is arguably regaining its centrality in the assessment of patient well being in whatever area of care. However it is argued that we are still far from having a universal agreement as to what is meant by the concept of spirituality.

Aims and objectives.  This paper aims to explore some of the definitions and models of spirituality and determine what is meant by spiritual needs. Taking the perspective of a Christian nurse, the potential tension between the nature of spiritual care and evidence‐based professionalism is explored.

Conclusion.  The exploration reveals the challenges faced by a nurse who wishes to administer this spiritual care and holds a personal commitment to the Christian faith.

Relevance to clinical practice.  Acknowledging and debating the challenge of spiritual care is arguably the first step towards meeting optimally this need in our patients. The dilemma that may need to be further explored within the context of nursing care is how a nurse, holding and operating within one particular belief (e.g. Christianity) can offer the ideal of spiritual care to patients who hold other, quite different beliefs.
Professionalism in medicine
Authors: Miettinen MD MPH MSc PhD MD‐PhD(hc) D(hc) FAHA FACE FIEA Olli S. , Flegel MD MSc FRCP(C) FACP Kenneth M.
Published: December 2004

A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the profession's definition of good practices and the payer's confinement of insurance coverage to these.
Improving ACE inhibitor use in patients hospitalized with systolic heart failure: a cluster randomized controlled trial of clinical practice guideline development and use
Authors: Thilly Nathalie , Briançon Serge , Juillière Yves , Dufay Edith , Zannad Faiez
Published: December 2004

Rationale, aims and objectives   The efficacy of angiotensin‐converting enzyme (ACE) inhibitors in treating heart failure is well established, but there is concern that these agents are underutilized. This study aimed to evaluate the effect of developing and implementing Clinical Practice Guidelines (CPGs) on the quality of care given to patients receiving ACE inhibitors for systolic heart failure.

Methods  Twenty cardiology units in Lorraine (France) were randomized to an experimental (n = 10) or a control group (n = 10). In each experimental unit, doctors were involved in drafting and implementing CPGs; those at control units were not. Practice surveys were conducted in all units before and after the intervention; 723 patients with heart failure and less than 75 years old were included. The main outcome was compliance with the CPGs.

Results  Before intervention, clinicians in both groups were already compliant with CPGs relating to indications and contra‐indications, adverse effects management, concomitant therapy and monitoring of biologic factors. After intervention, adherence to others CPGs was generally better in the experimental group. Compliance with the CPG relating to ACE inhibitor dose on discharge was higher in the experimental group (P = 0.003). Compliance with CPGs relating to increasing ACE inhibitors doses (P < 0.0001) and the contents of the discharge letter (P = 0.02) improved in all units between the two periods.

Conclusions  These results suggest that doctors involved in drafting and implementing CPGs are more likely to comply with them.
Case reports and a review of the literature on ulcers mimicking pyoderma gangrenosum
Authors: Nguyen Kari H. , Miller Jeffrey J. , Helm Klaus F.
Published: December 2004

Pyoderma gangrenosum (PG) is a rare, ulcerative skin disease. Diseases with cutaneous manifestations resembling PG may lead to the misdiagnosis of PG. We discuss two patients presenting with cutaneous ulcers originally thought to be PG, and review the literature on the clinical and pathologic characteristics of PG ulcers compared to PG‐like ulcers in order to determine possible distinguishing features.
Polymerase chain reaction based detection ofMycobacterium tuberculosisin tissues showing granulomatous inflammation without demonstrable acid‐fast bacilli
Authors: Hsiao Pa‐Fan , Tzen Chin‐Yuan , Chen Hsiu‐Chin , Su Hsin‐Yi
Published: December 2004

BackgroundCutaneous tuberculosis is especially difficult to distinguish from other granulomatous dermatoses. We used polymerase chain reaction (PCR) to evaluate the incidence of cutaneous tuberculosis and atypical mycobacterial infection in formalin‐fixed, paraffin‐embedded tissues with unspecified granulomatous inflammation and negative results for acid‐fast bacilli (AFB), and analyzed the pattern of cutaneous tuberculosis in this group of patients.

MethodsA total of 38 specimens which had been collected from 36 patients and fulfillled the criteria for tissues described above were used in this study. Two different primer pairs targeting the gene encoding for 16S ribosomal RNA (common to all mycobacteria) and the insertion sequence IS6110 (specific forM. tuberculosiscomplex) were used in the PCR assays. The clinical characteristics, histopathologic findings, and culture results of the patients were also analyzed.

ResultsFour specimens were excluded from the analysis due to the lack of internal control testing. Of the remaining 34 specimens, 22 were PCR positive for the 16S rRNA gene. Among them, 18 specimens were PCR positive for both the 16S rRNA gene and IS6110. Cutaneous tuberculosis could be diagnosed in these 18 cases (56.2%). Out of the 18 cases, there were 8 women and 10 men. The age range was 15–77 years (mean: 44.2 years). After reviewing their clinical presentation, 11 cases were considered as tuberculosis verrucosa cutis, 6 cases as lupus vulgaris, and 1 case as erythema induratum. The remaining 4 cases (12.5%) positive only for 16S rRNA gene were considered as possible atypical mycobacteria infection.

ConclusionsThese results show that in paucibacillary form of cutaneous tuberculosis with unclassical clinical and histological presentation, this PCR system provides rapid and sensitive detection ofM. tuberculosisDNA in formalin‐fixed, paraffin‐embedded specimens. Cutaneous tuberculosis represents a significant proportion in specimens showing granulomatous inflammation. In areas like Taiwan, where prevalence of pulmonary tuberculosis is still high, tuberculosis verrucosa cutis and lupus vulgaris are common forms of cutaneous tuberculosis and are seen more frequently than atypical mycobacterial infection.
IgG class antibodies to heat shock‐induced streptococcal antigens in psoriatic patients
Authors: Pérez‐Lorenzo Rolando , Zambrano‐Zaragoza José Francisco , Moo‐Castillo Karina , Luna‐Vázquez Dora L. , Ruiz‐Guillermo Leopoldo , García‐Latorre Ethel
Published: December 2004

Background Psoriasis is a chronic inflammatory skin disease. Probably autoimmune in nature, and associated with streptococcal throat infections as a triggering factor. Although many groups have associated the disease with other pathogens, Streptococcus pyogenes seems to be the most important microorganism related to this disease. Therefore, it is necessary to identify the streptococcal antigens involved in the process.

Methods In this work IgG class antibodies to soluble antigens obtained from Staphylococcus aureus, Candica albicans or S. pyogenes before and after heat shock induction, were analyzed by ELISA in 28 psoriatic patients and 30 healthy donors.

Results In all cases, the patients and the controls had IgG class antibodies to the four antigens. Nevertheless, the IgG levels to the heat shock‐induced S. pyogenes were statistically different between the patients and the controls (P < 0.001). There was no difference between the groups when the IgG antibodies to the other antigens, including the noninduced streptococcal extract, were analyzed. Additionally, anti‐streptolysin O titers and throat cultures were carried out in all patients and controls. No differences between ASO titers were found but the patients were more frequently colonized by S. pyogenes.

Conclusion Results obtained in this study suggest that heat shock‐induced proteins from S. pyogenes are associated with psoriasis.
Incidence of cutaneous tuberculosis in patients with organ tuberculosis
Authors: Kivanç‐Altunay Ilknur , Baysal Zerrin , Ekmekçi Tugba Rezan , Köslü Adem
Published: December 2004

Background Tuberculosis continues to be a health problem in some countries. The development of resistance to antituberculitic drugs and the increase in diseases and conditions associated with immunodeficiency such as AIDS and chemotherapy have caused tuberculosis to increase recently. As a result, the incidence of cutaneous tuberculosis has been increasing as well.

Aim To detect cutaneous tuberculosis in patients with organ tuberculosis and to establish some characteristics of the relation between organ and cutaneous TB.

Material and methods A total of 370 patients (145 females and 225 males), aged 2–76 years (mean age 27.5), enrolled for this screening study. These patients were hospitalized patients who already had pulmonary or extrapulmonary tuberculosis diagnosed before admission. All patients underwent a general skin examination, and, if needed, cutaneous biopsies were taken from involved skin areas.

Results Three hundred and forty‐seven (93.78%) out of 370 patients had pulmonary tuberculosis only or in association with one of other organ tuberculoses. Twenty‐three patients had extrapulmonary TB: nine were TB adenitis, six were TB peritonitis, three were bone tuberculosis, and five were TB meningitides. Of 370 patients, only 13 (3.51%) had cutaneous TB: seven scrofuloderma (SCD; 2.16%), four lupus vulgaris (LV; 1.35%), one LV and SCD, and one Bacille Calmette‐Guerin (BCG) adenitis (0.027%). Cutaneous tuberculosis was observed in seven out of 260 patients with parenchymal tuberculosis (2.96%). Four out of nine patients with TB adenitis (44.4%), one out of 12 pulmopleuretic (8.3%), and one out of 67 pleuresic patients (1.40%) had cutaneous TB as well. Mean age of the 13 patients was 32.46 years: mean age of SCD and LV was 24.8 and 48 years, respectively. The one patient with BCG adenitis was 7 months old. Five (62.5%) out of eight patients with SCD, and only one (20%) out of five patients with LV were new cases. Four patients with SCD had a positive family history, while LV patients did not.

Conclusions Organ tuberculosis is rarely associated with cutaneous tuberculosis. Scrofuloderma and LV are the most frequent forms of skin TB associated with organ TB in this population. Tuberculosis adenitis is the organ TB that causes cutaneous TB most often among other organ tuberculoses. More than one form of cutaneous TB affected only one patient with pulmonary TB; therefore, it is very rare. Tuberculids were not observed in any of the patients.
Familial atrophia maculosa varioliformis cutis
Authors: Kalayciyan Aylin , Kotogyan Agop , Demirkesen Cuyan , Tüzün Yalçin
Published: December 2004

Atrophia maculosa varioliformis cutis (AVMC) was first described by Heidingsfeld in 1918, as a rarely reported form of idiopathic macular atrophy on the cheek.1 It is characterized, clinically, by shallow, sharply demarcated depressions in various shapes. Extrahepatic biliary atresia2 and pachydermodactyly3 have been the only conditions associated with AMVC reported in the past 80 years. Although keratosis pilaris is a common skin disorder, it is related to other idiopathic atrophic conditions considered in the differential diagnosis of AMVC, namely keratosis pilaris atrophicans.4 However, the two associations may be coincidental. We observed a patient with keratosis pilaris, and her brother and an unrelated young man, whose findings led to a diagnosis of AMVC.