bluuebunny/crossref_metadata_2025_split huggingface dataset:
Creation and validation of the evidence‐based practice confidence scale for health care professionals
Authors: Salbach Nancy M. , Jaglal Susan B. 
Published: July 2010

AbstractRationale  Self‐efficacy beliefs may provide a means to influence health care professionals' (HCPs) engagement in evidence‐based practice (EBP) but no standardized measure of this construct exists.Objectives  To create and evaluate the validity and comprehensibility of a scale measuring belief in ability to implement EBP, known as EBP self‐efficacy, among HCPs.Methods  Items describing the steps of EBP outlined in the literature were generated. Fourteen content experts reviewed the scale for face and content validity. A purposive sample of 10 HCPs from medicine, nursing, physical and occupational therapy and speech language pathology provided feedback on the clarity and meaning of scale wording in telephone interviews.Results  Progressive refinement yielded an 11‐item self‐report scale. Each item describes an activity that is part of the process of implementing EBP, such as formulating a question to guide a literature search and asking your patient or client about his/her needs, values and treatment preferences. To complete the scale, HCPs rate their level of confidence on an 11‐point scale ranging from 0% (no confidence) to 100% (completely confident) in their ability to perform each activity. Item‐level responses are averaged to obtain a summary score that can range from 0% to 100%.Conclusion  The newly created scale, named the EPIC (evidence‐based practice confidence) scale, provides an opportunity to evaluate HCPs' beliefs in their ability to implement EBP and the effects of interventions on these beliefs. Psychometric evaluation of the test‐retest reliability and construct validity of the scale is necessary prior to its widespread use.
The validation of a clinical algorithm for the prevention and management of pulmonary dysfunction in intubated adults – a synthesis of evidence and expert opinion
Authors: Hanekom Susan , Berney Sue , Morrow Brenda , Ntoumenopoulos George , Paratz Jennifer , Patman Shane , Louw Quinette 
Published: July 2010

AbstractBackground  Pulmonary dysfunction (PDF) in intubated patients remains a serious and costly complication of intensive care unit care. Optimal cardiopulmonary therapy strategies to prevent and manage PDF need clarification to reduce practice variability. The purpose of this paper is to report on the content validation of an evidence‐based clinical management algorithm (EBCMA) aimed at the prevention, identification and management of PDF in critically ill patients.Methods  Forty‐four draft algorithm statements extracted from the extant literature by the primary research team were verified and rated by research clinicians (n = 7) in an electronic three‐round Delphi process. Statements which reached a priori defined consensus [semi‐interquartile range (SIQR) <0.5] were collated into the EBCMA.Results  One hundred per cent response rate. Forty‐four statements were added after round one. Consensus was reached on rating of 83% (73/88) statements. Differences in interpretation of the existing evidence base, and variations in accepted clinical practice were identified. Four themes were identified where panel failed to reach consensus.Conclusion  The internationally agreed hierarchical framework of current available evidence and clinical expertise developed through this Delphi process provides clinicians with a tool to inform clinical practice. This tool has the potential to reduce practice variability thereby maximizing safety and treatment outcome. The clinical utility of the EBCMA requires further evaluation.
Changing doctors' behaviours: an educational program to disseminate a new clinical pathway for the hospital management of hip fractures in elderly patients in the Lazio Region, Italy
Authors: Ciaschi Alma , Caprara Andrea , Gillespie Francesca , Furnari Giacomo , Mamede Sílvia 
Published: July 2010

AbstractRationale and aims Concerns with patient safety have increased interest in approaches to improving doctors' performance, yet dissemination of clinical guidelines and conventional continuing medical education have often failed. This study investigated the effects of an educational program based on reflection upon experience on the quality of care for patients with hip fracture in Lazio, Italy.Methods Five hospitals participated. The study consisted of the development of a clinical pathway, a preparatory phase and the educational intervention itself, which comprised a course followed by monthly audits with reflection on practice, guided by analysis of patients' charts. Data on the quality of care for patients with hip fracture were collected from the routine information system for the period before and after the intervention.Results There was a significant increase in the proportion of patients who underwent surgery within 48 hours of admission (from 7% in 2006 to 26.4% in 2007) and a significant reduction in the average length of hospital stay (from 18.8 to 16.4 days). Some process indicators of quality of care were high after the intervention, though non‐recommended practices were still routinely used (e.g. urinary catheterization in 72.2% of patients). There were differences in the changes when comparing hospitals.Conclusion An educational intervention that combined the dissemination of a clinical pathway with external auditing geared to reflection upon practice was effective in promoting changes in doctors' behaviours. The persistence of non‐recommended practices and the variation among hospitals indicate that multiple factors influence performance and affect the effectiveness of interventions.
Using complexity to promote group learning in health care
Authors: Arrow Holly , Henry Kelly B. 
Published: July 2010

AbstractRationale  Multidisciplinary groups are common in the health care arena, from operating teams to mental health treatment groups to guideline development groups. Differences among group members in information, background, training and skills can potentially help groups reach good decisions and complete complex tasks in variable circumstances. Too often, however, differences in values, status and preferences prevent these groups from achieving the potential benefits of diversity, marooning them instead in an unproductive fixed state.Aim  Drawing on the literature on diversity and complex adaptive systems, we discuss how to improve the functioning of multidisciplinary groups by increasing the spontaneous flow of information and energy to shift groups into the complex state.Conclusion  Differentiation needs to be balanced by integration. Differences that pose obstacles need to be transformed into gradients to achieve complex self‐organization and effective group coordination.
Borderline competence – from a complexity perspective: conceptualization and implementation for certifying examinations
Authors: Sturmberg Joachim P. , Hinchy John 
Published: July 2010

AbstractBackground  Passing or failing a candidate is a complex decision with one essential aspect being the definition of the required minimal level of competence. Commonly used methods, such as the Angoff method, are based on the ‘borderline competence’ concept; however, the method describes a ‘borderline candidate’– a fictitious person, rather than describing a set of clearly defined criteria that describe a real person whose competencies fall between the clearly incompetent and clearly competent – the borderline zone.Approach and findings  We argue that competence arises from the combination of discrete abilities across the entire subject domain including the interaction of some of those abilities, where strengths in some interacting abilities could partly compensate for weaknesses in others. We further argue that scores in the borderline zone may include combinations of abilities in which deficiencies are sufficiently compensated for by areas of strength, thus ensuring competency, while other, similarly scoring combinations do not include required compensations to ensure competency. We offer evidence that standard setting judges systematically and consistently assess the level of required ability on each individual task, taking into account the characteristics of those tasks based on the significance – being a function of the severity and incidence of that condition, and the ability to help – and the difficulty of executing that task.Implications  Consequently, a borderline zone of competence implies an overlap of competence and incompetence with respect to the level of performance on tasks of varying clinical significance. We further suggest that this overlap can be conceptualized as a folding of the ‘competence plane’ (consistent with a cusp catastrophe model) that cuts the space defined by performance levels on clinical conditions of varying significance, with their associated skills requirements. That folding defines the borderline zone in which competent candidates will perform most of the tasks in the borderline zone correctly whereas incompetent candidates will fail most tasks.
Dynamics of bovine spleen cell populations during the acute response to Babesia bovis infection: an immunohistological study
Authors: SCHNEIDER D. A. , YAN H. , BASTOS R. G. , JOHNSON W. C. , GAVIN P. R. , ALLEN A. J. , BARRINGTON G. M. , HERRMANN‐HOESING L. M. , KNOWLES D. P. , GOFF W. L. 
Published: July 2010

SummaryThe spleen is a critical organ in defence against haemoparasitic diseases like babesiosis. Many in vitro and ex vivo studies have identified splenic cells working in concert to activate mechanisms required for successful resolution of infection. The techniques used in those studies, however, remove cells from the anatomical context in which cell interaction and trafficking take place. In this study, an immunohistological approach was used to monitor the splenic distribution of defined cells during the acute response of naïve calves to Babesia bovis infection. Splenomegaly was characterized by disproportionate hyperplasia of large versus small leucocytes and altered distribution of several cell types thought to be important in mounting an effective immune response. In particular, the results suggest that the initial crosstalk between NK cells and immature dendritic cells occurs within the marginal zone and that immature dendritic cells are first redirected to encounter pathogens as they enter the spleen and then mature as they process antigen and migrate to T‐cell‐rich areas. The results of this study are remarkably similar to those observed in a mouse model of malarial infection, suggesting these dynamic events may be central to the acute response of naïve animals to haemoparasitic infection.
Phytochelatin synthesis plays a similar role in shoots of the cadmium hyperaccumulator Sedum alfredii as in non‐resistant plants
Authors: ZHANG ZHONG‐CHUN , CHEN BO‐XIA , QIU BAO‐SHENG 
Published: July 2010

ABSTRACTPhytochelatin (PC) synthesis is considered necessary for Cd tolerance in non‐resistant plants, but roles for PCs in hyper‐accumulating species are currently unknown. In the present study, the relationship between PC synthesis and Cd accumulation was investigated in the Cd hyperaccumulator Sedum alfredii Hance. PCs were most abundant in leaves followed by stems, but hardly detected by the reversed‐phase high‐performance liquid chromatography (HPLC) in roots. Both PC synthesis and Cd accumulation were time‐dependent and a linear correlation between the two was established with about 1:15 PCs : Cd stoichiometry in leaves. PCs were found in the elution fractions, which were responsible for Cd peaks in the anion exchange chromatograph assay. About 5% of the total Cd was detected in these elution fractions as PCs were found. Most Cd was observed in the cell wall and intercellular space of leaf vascular cells. These results suggest that PCs do not detoxify Cd in roots of S. alfredii. However, like in non‐resistant plants, PCs might act as the major intracellular Cd detoxification mechanism in shoots of S. alfredii.
Aragonite loss in a cold‐water coral mound: mechanisms and implications
Authors: FRANK TRACY D , TITSCHACK JÜRGEN , THIERENS MIEKE 
Published: July 2010

AbstractSelective dissolution of aragonitic grains is emerging as a volumetrically significant process that affects a broad range of modern carbonate settings. This study explores mechanisms and implications of aragonite loss in Challenger Mound, a giant cold‐water coral (Lophelia pertusa) mound of Pleistocene age, which lies on the continental slope off south‐west Ireland. A comprehensive sampling scheme allowed the integration of petrographic data with geochemical analyses of sediment and pore water. The mound remains virtually unlithified and consists of stacked, fining‐upward cycles of silty coral floatstone–rudstone and bafflestone grading into wackestone. Whereas calcitic grains appear unaltered, aragonitic grains are corroded and fragmented. Aragonite dissolution is attributed to organic matter oxidation at/near the sediment–water interface and, at greater depths, to the initial stages of bacterially mediated sulphate reduction, when alkalinity production is outpaced by the generation of H+. Pore water profiles indicate that undersaturated waters are diffusing towards the mound interior from two centres of sulphate reduction: one located in the upper 10 m of the sediment column and a second that lies below an erosional unconformity which marks the base of the mound. Continued aragonite dissolution is expected to gradually lower the diagenetic potential of the Challenger Mound and delay lithification until deep burial, when solution‐compaction processes come into play. Despite a fundamental role in predestining the final taphonomic and textural characteristics of Challenger Mound, the processes described here are expected to leave little trace in the geological record due to a lack of cementation and calcitization. Assuming that similar processes have been active throughout the Phanerozoic, results imply that the understanding of diagenetic processes in carbonate systems may be incomplete.
Prevalence of the Child Behavior Checklist‐pediatric bipolar disorder phenotype in a German general population sample
Authors: Holtmann Martin , Bölte Sven , Goth Kirstin , Döpfner Manfred , Plück Julia , Huss Michael , Fegert Jörg M , Lehmkuhl Gerd , Schmeck Klaus , Poustka Fritz 
Published: July 2010

Background:  In children with pediatric bipolar disorder (PBD), a consistent pattern of elevations in inattention/hyperactivity, depression/anxiety, and aggression has been identified on the Child Behavior Checklist (CBCL‐PBD profile). In Germany, no epidemiological study has included PBD to date.Objectives:  To estimate the six‐month prevalence of the CBCL‐PBD profile in Germany in a large normative general population sample, and to examine subjects with CBCL‐PBD profile with regard to symptoms assumed to coexist with PBD (e.g., suicidality, decreased need for sleep, and hypersexuality).Methods:  We studied a nationwide representative general population sample of 2,856 children and adolescents aged 4–18 years.Results:  A total of 21 subjects [0.7% of the sample; 95% confidence interval (CI) = 0.5–1.1] met the criteria for the CBCL‐PBD phenotype. CBCL‐PBD subjects were more pervasively disturbed than clinical controls (n = 118; 4.1% of total sample; 95% CI = 3.4–4.9), demonstrated in significantly more social problems and delinquent behavior, and showed significantly higher rates of suicidality, decreased need for sleep and hypersexual behavior.Conclusions:  The prevalence of CBCL‐PBD subjects in the general German population compares to rates of PBD in US and Dutch epidemiological samples. Regardless of whether these subjects are affected by ‘real’ PBD or ‘severe, pervasive ADHD’ with pronounced emotional dysregulation, they constitute a group of seriously disturbed children and adolescents. The high rate of suicidality among CBCL‐PBD subjects emphasizes the need for the identification and adequate treatment of children meeting this profile.
Developing seamount fishery produces localized reductions in abundance and changes in species composition of bycatch
Authors: Niklitschek Edwin J. , Cornejo‐Donoso Jorge , Oyarzún Ciro , Hernández Eduardo , Toledo Pamela 
Published: July 2010

AbstractEvidence of localized and cumulative impacts of bottom‐trawling upon bycatch abundance and diversity was found during the 8‐year period the Chilean orange roughy (Hoplostethus atlanticus) fishery was open. We analyzed acoustic, orange roughy catch and fish bycatch data available from a voluntary monitoring program implemented by the fishing‐rights holders. Acoustic data, recorded from the third year of the fishery (2002) until its closure in 2006, permitted us to extract detailed bathymetry and precise information about trawl tows. From these data we reconstructed the yearly and cumulative extent of the bottom trawling footprint and compared biodiversity indices, bycatch abundance and assemblage structure between nominally pristine areas and others that exhibited different levels of previous trawling impacts (as measured by within‐ and across‐years impact indices). Although the footprint area expanded as the cumulated number of tows increased, degrees of overlapping between tows were found in all seamounts. The trawled footprint was 22 km2 for the 2002–2006 period, equivalent to 2.7% of the study area. An extrapolation to include unassigned tows and years without data (1999–2001) increased this estimate to 81 km2 (9.8% of the study area) for the entire duration of the fishery. The relative abundance of bycatch species decreased at more heavily impacted areas, suggesting a local depletion response. Evidence of bycatch species richness decline and significant changes in diversity and species assemblage composition were also found at these areas. Seamount management and conservation efforts must consider the cumulative and localized nature of bottom trawling effects we found to occur upon seamount fish communities.
Environmental predictors and turnover of biota along a seamount chain
Authors: O’Hara Timothy D. , Consalvey Mireille , Lavrado Helena P. , Stocks Karen I. 
Published: July 2010

AbstractBiological communities on seamounts are widely regarded as being distinct from those in other offshore habitats, but it is unclear what factors drive any differences. We used invertebrate and algal data from the extensive REVIZEE benthic surveys from the continental margin and seamounts in the Southwest Atlantic Ocean off Eastern Brazil to investigate environmental predictors of seamount assemblage composition. We found that seamount summit samples were significantly different from those of the continental shelf for both invertebrates and algae. Invertebrate samples from the shelf showed more spatial variability than those from seamounts, congruent with the increased variability in both sampled sea‐floor habitats and oceanographic conditions recorded along the continental margin. The most important environmental predictors of assemblage composition across all habitats were distance from shore, temperature, dissolved oxygen and particulate organic carbon for invertebrates, and distance from shore, nitrate and phosphate concentrations for algae. Only distance from shore for invertebrates, and distance from shore, nitrate and phosphate concentrations for algae were consistently emphasised in analyses restricted to seamount and island samples. We found no support for the hypothesis that seamount assemblages in this region become less species rich with distance from the continental margin. However, algal samples did form a serial gradient of compositional turnover with distance from shore. In summary, the seamounts shared the same species pool as nearby continental margins but samples contained a different, equally rich, assemblage of species.
Conflicting estimates of connectivity among deep‐sea coral populations
Authors: Miller Karen , Williams Alan , Rowden Ashley A. , Knowles Claire , Dunshea Glenn 
Published: July 2010

AbstractGenetic data were used as an indirect means of assessing connectivity among deep‐sea coral populations on seamounts and slopes in the Australian and New Zealand region. We sequenced three DNA regions (16S, ITS and Control Region) in nine deep‐sea coral species from sites spanning thousands of kilometers. Based on haplotype distributions and AMOVA, we found evidence of genetic subdivision across ocean expanses for three species: the scleractinian Desmophyllum dianthus, and the antipatharians Antipathes robillardi and Stichopathes variabilis. Levels of genetic variation were low for the remaining species, including the reef‐forming Solenosmila variablis and Madrepora oculata, and more sensitive molecular markers may be needed to resolve their spatial structure properly. For two species (the scleractinian Stephanocyathus spiniger and the antipatharian Stichopathes filiformis), we found no evidence of genetic subdivision among sites within regions, suggesting sufficient gene flow occurs to maintain genetic homogeneity at scales of tens to hundreds of kilometers. Recognising that some seamount regions and coral populations are, or are not, effectively isolated will be a key component of successful management planning based on marine protected area networks – both within and beyond national jurisdictions.
Treatment of neurogenic male urinary incontinence related to intrinsic sphincter insufficiency with an artificial urinary sphincter: a French retrospective multicentre study
Authors: Kastler Emmanuel Chartier , Genevois Sandra , Gamé Xavier , Denys Pierre , Richard Francois , Leriche Albert , Saramon Jean Pierre , Ruffion Alain 
Published: July 2010

Study Type – Therapy (retrospective cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Intermittent catheterism is, in 2011, the gold standard of care for neurogenic bladder. Artificial urinary sphincter is also a gold standard for sphincteric insufficiency. If a patient with a neurogenic bladder needs needs an artificial urinary sphincter, the risk of urethral erosion is increased.This article describes the position of the device around the bladder neck to decrease this complication.OBJECTIVETo assess results and morbidity of the periprostatic insertion of an artificial urinary sphincter (AUS) in adult male patients with a neurogenic bladder.PATIENTS AND METHODSA retrospective study was carried out on 51 adult male patients operated on in four urologic academic wards from April 1988 to January 2008. Among these patients, 31% (16/51) had spina bifida and 69% (35/51) had spinal cord injury. All patients suffered urinary incontinence secondary to sphincteric deficiency, and this was associated with detrusor overactivity in 39% of them (leading in these cases to an added bladder augmentation). Perfect continence was defined as a period of dryness of at least 4 h between two self‐intermittent catheterizations (SIC) or spontaneous micturitions, moderate incontinence as nocturnal leakage or need to wear protection once during the day or for stress leakage, while severe incontinence was defined as uncontrollable leakage causing patient discomfort.RESULTSMean age at the procedure was 35 years (18–58). Mean follow‐up was 83 months (CI 95%, 65–101). At the end of the study, 15 patients (29.4%) were lost to follow‐up. One patient (2%) died shortly after the procedure from a pulmonary infection. Post‐operative morbidity was observed in 19% (10/50) of the patients (8 urinary tract infection, 1 failure to perform SIC, 1intracranial hypertension). Of the patients in our study 74% had perfect or moderate continence with a working AUS after a 10‐year follow‐upCONCLUSIONSWe present a specific study on adult patients with a neurological lesion leading to bladder dysfunction treated by a periprostatic AUS. This procedure was effective in restoring urinary incontinence in the vast majority of our patients with an acceptable morbidity.