bluuebunny/crossref_metadata_2025_split huggingface dataset:
Readmissions: a primary care examination of reasons for readmission of older people and possible readmission risk factors
Authors: Dobrzanska Linda , Newell Robert 
Published: April 2006

Aim.  To identify the reasons that may have contributed to the emergency readmission of older people to a medical unit, within 28 days of hospital discharge.Background.  The current UK Government has initiatives in place to monitor quality and service delivery of NHS organizations. This is achieved by setting, delivering and monitoring standards, one of which is ‘emergency readmission to hospital within 28 days of discharge (all ages), as a percentage of live discharges’.Design/method.  A year‐long study examined reasons for unplanned readmission of patients (aged 77 and over) within 28 days of hospital discharge. The population was patients, registered with North Bradford PCT General Practitioners, readmitted to one of five care of older people wards in two local acute trust NHS hospitals. Patient records were scrutinized and data related to demography, diagnosis and readmission were collected using a structured extraction tool. Data analysis was undertaken using descriptive statistics and identification of differences and correlations within the data.Results.  A pilot study indicated patients readmitted from home vs. other sources and patients discharged to home vs. other sources had a significantly shorter stay on readmission. The main study showed other significant findings. Patients who lived in care were readmitted sooner than those who lived at home: those discharged home vs. other sources and agreeing to increased social service provision had longer stays on readmission. Shorter length of stay on index admission (up to 72 hours) was associated with increased likelihood of earlier readmission.Conclusions.  A framework of factors was identified and could be used to target resources to meet patients’ needs more flexibly.Relevance to clinical practice.  It is possible that the process of targeting resources to ‘at‐risk’ patients might enable services to be delivered in a more cost‐efficient and cost‐effective way.
Nurse education – the role of the nurse teacher
Authors: Gillespie Mark , McFetridge Brian 
Published: April 2006

Aim.  To explore and analyse the role of the nurse teacher.Background.  This paper examines the issue of clinical credibility among nurse teachers which has been ongoing for over a decade. The move of nurse education from colleges of nursing to the Higher Education Institutes was seen in 1992. Since then, nurse teachers have been faced with the need to juggle the roles of teaching, administration, research and clinical support for students. Nursing students within these Higher Education Institutes require more than the traditional theoretical classroom teaching. Nurse teachers have a role beyond this in encouraging students to link theory with practice, and practice with theory. Therein lies a challenge for nurse teachers to ensure they remain credible within the clinical setting and continue to provide education and support, which is firmly grounded in both practice and theory.Method.  The authors have critically reviewed the evidence related to the role of the nurse teacher in an attempt to identify key concepts and ideas, assumptions, supporting examples and the implications for their role.Conclusion.  The role of the nurse teacher, it would appear, is a dynamic one that needs to engage actively the needs of the student. Nurses therefore need to be dynamic in their approach in order to respond to both local and global demands and ensure that students become competent, professional, knowledgeable and caring in their approach.Relevance to clinical practice.  This paper demonstrates the complex and ever changing role of the nurse teacher. This paper attempts to help nurse teachers understand the complex nature of their role.
An evaluation of nursing practice models in the context of the severe acute respiratory syndrome epidemic in Hong Kong: a preliminary study
Authors: Chan Engle Angela , Chung Joanne WY , Wong Thomas KS , Yang Joseph CS 
Published: April 2006

Aim and objective.  Like other health‐care workers, Hong Kong nurses had their professional knowledge and skills seriously challenged during the SARS outbreak. Could current nursing practices support the care of SARS or SARS‐like patients in the future? If not, alternative practices would be needed. Providing a preliminary understanding, this paper compares the conventional with different nursing delivery models in a simulated SARS ward and focuses on nurses’ efficiency, infection control practices and views of the two models.Design and methods.  This study was conducted in three phases. First, a baseline understanding of nursing practices was achieved through four workflow observations. In an eight‐hour day, four research assistants observed nursing activities in the medical and fever wards. These data were used in the second phase to construct two sets of clinical vignettes, pertaining to SARS patient care in both conventional and alternative practice models. These scripts were discussed with nine nurses of various ranks from the hospital under study for their expert validation and input. In the third phase, nurse participants and patient actors enacted the vignettes in a simulated setting. Video‐taped observations and four nurse participant interviews were employed. Observational data were analysed through descriptive statistics and independent t‐tests. Textual data were coded and categorized for common meanings.Results.  Conventional practice from the findings consisted of cubicle and named nurse nursing. While the former reflected modified team and functional nursing, it did not confine patient care within a cubicle as suggested by its name. The latter depicted a modified primary nursing approach in a team, with delegation of care. Preliminary findings concerning infection control and nurse satisfaction revealed that the alternative model had an advantage over the conventional.Relevance to clinical practice.  This study findings lay the foundation for clinical trials, which would evaluate the significance of patient‐care quality, cost‐effectiveness and better human resource management by restructuring current nursing practices.
Model testing on the crisis interventions and actions to prevent medical disputes: a Taiwanese nursing perspective
Authors: Tzeng Huey‐Ming 
Published: April 2006

Aims and objectives.  This study investigated the contributions of comprehensiveness and necessity scales on crisis interventions and actions toward nursing practice‐related medical disputes in Taiwanese hospitals and institutions’ demographic characteristics, to overall satisfaction toward nursing‐related crisis management policies and interventions and overall satisfaction toward their institution's crisis management system.Background.  In a health‐care environment that is focused on cost containment, for overworked nurses and understaffed medical wards, patients still expect nurses to provide high quality, compassionate care. Patients usually regard nurses as the principal link between the technical and interpersonal aspects of their care. However, current hospital systems tend to require patients to be self‐reliant in managing their own care. Patient mistrust of medical care providers might have contributed to the current medical error/dispute crisis.Methods.  In this cross‐sectional study, the subjects were nursing directors of Taiwanese hospitals (197 valid subjects). The author developed the questionnaire used in this study.Results.  The ordinal logistic regression analyses demonstrated that being a public hospital managed by the government, being a hospital operated by a corporate body, the more comprehensive the technical/structural aspect and the assessment aspect and the more needed the psychological aspect, contribute to higher general satisfaction levels toward nursing‐related crisis management. The more comprehensive the strategic aspect and having more acute beds, contributes to higher satisfaction levels with their institution's overall crisis management activities.Conclusions.  These findings inferred a possible change in a hospital's resource allocation or power structure when dealing with issues of patient care quality, including nursing practice‐related crisis management policies, interventions and actions.Relevant to clinical practice.  A good crisis management system may help to keep a crisis from worsening, which might lead to a serious situation that includes malpractice litigation. It is believed that the questionnaire used in this study may be used as a diagnostic tool for assessing a crisis management system within a hospital's nursing environment.
Evaluation of a model of nursing care for older patients using participatory action research in an acute medical ward
Authors: Glasson Janet , Chang Esther , Chenoweth Lynn , Hancock Karen , Hall Tracy , Hill‐Murray Frances , Collier Lesley 
Published: April 2006

Aims and objectives.  The main aim of this study was to improve the quality of nursing care for older acutely ill hospitalized medical patients through developing, implementing and evaluating a new model of care using a participatory action research process.Background.  One of the challenges of nursing today is to meet the health‐care needs of the growing older population. It is important to consider what quality of nursing care means to older patients if nurses are to address gaps between their own perceptions and those of older patients themselves and to consider conceptual models of care appropriate for older patients care in order to improve the quality of care provided.Design.  This study is a mixed method triangulated study, involving the use of both quantitative and qualitative methods through participatory action research methodology to establish an evidence‐base for an evolving model of care.Methods.  The model was tested on 60 acutely ill patients aged at least 65 years. The medical ward nurses selected a key reference group including the researcher to facilitate the participatory action research process to develop, implement and evaluate a new model of care based on Orem's self‐care model incorporating the Nurses Improving Care to Health System Elders Faculty (Am J Nurs 1994; 94:21) medication protocol to improve the nursing care provided for acutely ill older patients.Results.  The participatory action research process resulted in improved heath‐care outcomes for the patients, such as significant improvements in activities of daily living capabilities between admission to discharge, significant improvements in knowledge levels regarding their medication regimes, as well as increased satisfaction with nursing care activities as perceived by older patients and nursing staff. The implementation of educational sessions during the model of care improved the older patient's functional activities and knowledge levels of their medication regime prior to discharge. In addition, by repeatedly explaining procedures, nurses became more involved with their individual patient's care, developing a patient‐centred care relationship based on Orem's self‐care model.Conclusions.  This study demonstrates the efficacy of a new model of nursing care in improving the quality of nursing care for older patients in the acute medical ward setting.Relevance to clinical practice.  This study is significant because of its evidence‐base and demonstrates how the participatory action research process empowered nurses to make sustainable changes to their practice. The nurses in the study wanted to affect change. The planned change was not dictated by management, but was driven by the clinical nursing staff at the ‘grass roots’ level. Therefore, being involved in the decision‐making process provided an incentive to actively implement change.
A legacy for the children – attitudes of older adults in the United Kingdom to genetic testing
Authors: Skirton Heather , Frazier Lorraine Q , Calvin Amy O , Cohen Marlene Z 
Published: April 2006

Aim.  The aim of this study was to assess understanding of genetics and attitudes towards genetic testing for clinical and research purposes in a group of older adults in the UK.Background.  Increasingly, genomics will have an impact on the diagnosis, prevention and treatment of common diseases and the prescription of drugs. The chance of being affected by a medical condition increases with age and therefore the use of genetic testing as part of general health‐care practice has an impact on the older population.Methods.  Older adults were recruited to two focus groups (n = 7 and n = 10 respectively). Focus group discussions were guided by a series of questions and were audiotaped. The transcribed data were coded for significant statements, which were organized under thematic headings.Results.  The mean age of participants was 76 years. The main themes to emerge were: understanding, approach to genetic testing and conditions for testing. In this cohort, the older adults were largely unsure about the underlying scientific basis of genetics but were keen to learn more. While enhanced medical knowledge could enable preventive measures to be taken and so reduce suffering, it was acknowledged that for some people knowing the future could potentially cause anxiety and harm. Participants were wary about research being used to benefit private companies and voiced ethical concerns about potential coercion to be tested and the misuse of science. However, all participants had an altruistic approach that influenced their willingness to be tested to benefit others in their family or the wider community. Conditions for testing included provision of information about the purpose of testing and feedback on the results.Conclusions.  Older adults are positive about the opportunities presented by genetic testing for clinical reasons and research, but need accurate information about the reasons for and implications of such testing.Relevance to clinical practice.  The results of this study confirm the need for nurses to be proactive in developing the genetic competencies required to detect potential familial disease, make appropriate referrals to genetic services and ensure informed consent is obtained for genetic testing.
Life satisfaction among older people (65+) with reduced self‐care capacity: the relationship to social, health and financial aspects
Authors: Borg Christel , Hallberg Ingalill R , Blomqvist Kerstin 
Published: April 2006

Aims and objectives.  This study aimed at investigating life satisfaction and its relation to living conditions, overall health, self‐care capacity, feeling lonely, physical activities and financial resources among people (65+) with reduced self‐care capacity.Background.  Knowledge about factors related to low life satisfaction among older people with reduced self‐care capacity is sparse, although this is important in health care and nursing so that the care is adapted to their needs and perspective. Previous research has mainly focused on isolated aspects such as pain in relation to life satisfaction among older people in general and less among so those with reduced self‐care capacity in general.Design and method.  A subsample of 522 persons was selected from a randomly selected cross‐sectional survey using a modified form of the Older Americans’ Resources Schedule and Life Satisfaction Index Z.Results.  The mean age in the total sample was 77·9; women (79·5) were significantly older than men (77·0). Low life satisfaction was found among women, as well as those living in special accommodations. Life Satisfaction Index Z was 15·3 (SD 5·6) in the total sample. Gender and living conditions did not explain life satisfaction whilst poor overall self‐reported health and poor financial resources in relation to needs had the strongest explanatory value. Also of significant importance were loneliness, the degree of reduced self‐care capacity and feeling worried.Conclusion.  Life satisfaction in older people with reduced self‐care capacity is determined by several factors, with social, physical, mental and financial aspects probably interacting with each other; especially feeling lonely, degree of self‐care capacity, poor overall health, feeling worried and poor financial resources in relation to needs. These factors need to be considered in the care of these people to preserve or improve their life satisfaction.Relevance to clinical practice.  Nursing interventions in terms of preventive home visits, rehabilitation, health education directed towards physical, psychological, social and economic aspects of importance may help to preserve or improve life satisfaction for those with reduced self‐care capacity.
Nursing documentation audit – the effect of a VIPS implementation programme in Denmark
Authors: Darmer Mette Rosendal , Ankersen Lena , Nielsen Bettina Geissler , Landberger Gitte , Lippert Elisabeth , Egerod Ingrid 
Published: April 2006

Aim and objectives.  The aim of this paper is to present a study describing nurses’ adherence to the VIPS model by evaluating the quality of nursing assessment, and the quantity of completed nursing care plans.Background.  Numerous efforts have been made over the years to improve nursing documentation in Denmark. Hospitals have traditionally based nurses’ charting on a rudimentary version of the nursing process and on Virginia Henderson's theory of human needs. In 2002–2004 the Copenhagen University Hospital, Rigshospitalet, introduced the Swedish VIPS model for nursing documentation. VIPS is an acronym for well being, integrity, prevention and safety, all of which are seen as major goals for nursing care. The model organizes nursing data according to a system of keywords, which facilitates storage and retrieval of data.Design and methods.  The design in this part of the study was retrospective, wherein 50 journals from each of the departments of cardiology, neurology, oncology and urology were audited annually for three years using the Cat‐ch‐Ing instrument (n = 600). All nursing journals were randomly selected by including the first 50 journals at each site given a specific date.Results.  The nursing documentation significantly improved during the course of the study. After the second year the participants used the keywords appropriately and correctly according to the VIPS model. Application of primary nursing increased during the study. Initial, ongoing and discharge patient status improved. The nurses’ familiarity with nursing diagnoses, goals and interventions increased.Conclusions.  The structured implementation programme significantly improved nursing documentation, and the simultaneous training of the entire nursing staff shows promise. The VIPS model has prepared the nurses for more complex computerized taxonomies and classification systems in the future by improving the nurses’ analytical skills.Relevance to clinical practice.  New strategies for improving nursing documentation have been demonstrated.
Do Corticosteroids Damage the Brain?
Authors: Herbert J. , Goodyer I. M. , Grossman A. B. , Hastings M. H. , De Kloet E. R. , Lightman S. L. , Lupien S. J. , Roozendaal B. , Seckl J. R. 
Published: April 2006

AbstractCorticosteroids are an essential component of the body's homeostatic system. In common with other such systems, this implies that corticosteroid levels in blood and, more importantly, in the tissues remain within an optimal range. It also implies that this range may vary according to circumstance. Lack of corticosteroids, such as untreated Addison's disease, can be fatal in humans. In this review, we are principally concerned with excess or disturbed patterns of circulating corticosteroids in the longer or shorter term, and the effects they have on the brain.
Regulation of Salmon Gonadotrophin‐Releasing Hormone Gene Expression by Sex Steroids in Rainbow Trout Brain
Authors: Vetillard A. , Ferriere F. , Jego P. , Bailhache T. 
Published: April 2006

AbstractSalmon gonadotrophin‐releasing hormone (sGnRH) is the major form of gonadotrophin‐releasing hormone in the brain of Salmonids and is encoded by two different genes: sGnRH1 and sGnRH2. In the present study, we examined the expression patterns of these two genes during development and throughout the reproductive cycle of the female rainbow trout (Oncorhynchus mykiss), and also investigated the feedback action of sex steroids on brain mRNA levels. Both genes are expressed as early as 14 days postfertilisation and show a similar expression pattern during early life stages. In the adult female, sGnRH1 and sGnRH2 mRNAs are both present in neurones located in the ventral forebrain. This gene expression in the brain appears to be low during early vitellogenesis, and increases during oocyte maturation to reach a maximum after ovulation. The expression of sGnRH1 was not modified by in vivo steroid treatments in any experiment; however, testosterone and 5α‐dihydrotestosterone down‐regulate brain sGnRH2 gene in immature and adult ovariectomised females. Oestradiol treatment decreases sGnRH2 mRNA levels in the brain of adult ovariectomised females only. In the triploid fish brain, none of the steroids affect brain sGnRH mRNA levels. Our results suggest that, unlike sGnRH1, the sGnRH2 gene is under a strongly androgenic inhibitory control in the immature and adult female rainbow trout.
Brain‐Derived Neurotrophic Factor in the Brain of Xenopus laevis May Act as a Pituitary Neurohormone Together with Mesotocin
Authors: Calle M. , Wang L. , Kuijpers F. J. , Cruijsen P. M. J. M. , Arckens L. , Roubos E. W. 
Published: April 2006

AbstractBrain‐derived neurotrophic factor (BDNF), a member of the neurotrophin family, occurs abundantly in the brain, where it exerts a variety of neural functions. We previously demonstrated that BDNF also exists in the endocrine melanotroph cells in the intermediate lobe of the pituitary gland of the amphibian Xenopus laevis, suggesting that BDNF, in addition to its neural actions within the brain, can act as a hormone. In the present study, we tested whether BDNF, in addition to its neural and hormonal roles, can be released as a neurohormone from the neural pituitary lobe of X. laevis. By light immunocytochemistry, we show that BDNF is present in perikarya, in ventrolaterally projecting axons of the hypothalamic magnocellular nucleus and in the neural lobe of the pituitary gland, and that it coexists in these structures with the amphibian neurohormone, mesotocin. The neural lobe was studied in detail at the ultrastructural level. Two types of neurohaemal axon terminals were observed, occurring intermingled and in similar numbers. Type A is filled with round, moderately electron‐dense secretory granules with a mean diameter of approximately 145 nm. Type B terminals contain electron‐dense and smaller, ellipsoid granules (long and short diameter approximately 140 and 100 nm, respectively). BDNF is exclusively present in secretory granules of type A axon terminals. Double gold‐immunolabelling revealed that BDNF coexists in these granules with mesotocin. Furthermore, we demonstrate in an superfusion study performed in vitro that mesotocin stimulates peptide release from the endocrine melanotroph cells. On the basis of these data, we propose that BDNF can act on these cells as a neurohormone.