bluuebunny/crossref_metadata_2025_split huggingface dataset:
Judgements and processes in care decisions in acute medical and surgical wards
Authors: Lamond Dawn , Crow Rosemary A. , Chase Jonathan 
Published: December 2007

AbstractThe decisions which health care professionals make are the basis of treatment and care given. In order to evaluate effective care it seems logical to suggest that an awareness of the decisions which health care professionals make and how they make them is needed. This study examines the processes nurses use when making decisions about the health care needs of acutely ill patients. In stage one, 104 qualified nurses were interviewed to identify how they decide health care needs. In stage two, a ‘think aloud’ technique was used with patient simulations to obtain verbal protocols from a further 55 qualified nurses to identify the information strategies they used when making these decisions. The results suggest that nurses base their health care decisions mainly on their assessment of qualitative patient states or conditions. Initial indications are that the processes used differ from those characterized in the diagnostic reasoning model, with the context in which decisions are made being an important influence together with nurses' experience. It is suggested that, in order to develop effective predictive models and clinical guidelines which aid decision making, more research into the nature of health care professionals' decision making is carried out.
Comparison between the Health Belief Model and Subjective Expected Utility Theory: predicting incontinence prevention behaviour in postpartum women
Authors: Dolman Mary , Chase Jonathan 
Published: December 2007

AbstractA small‐scale study was undertaken to test the relative predictive power of the Health Belief Model and Subjective Expected Utility Theory for the uptake of a behaviour (pelvic floor exercises) to reduce post‐partum urinary incontinence in primigravida females. A structured questionnaire was used to gather data relevant to both models from a sample of antenatal and postnatal primigravida women. Questions examined the perceived probability of becoming incontinent, the perceived (dis)utility of incontinence, the perceived probability of pelvic floor exercises preventing future urinary incontinence, the costs and benefits of performing pelvic floor exercises and sources of information and knowledge about incontinence. Multiple regression analysis focused on whether or not respondents intended to perform pelvic floor exercises and the factors influencing their decisions. Aggregated data were analysed to compare the Health Belief Model and Subjective Expected Utility Theory directly.
Assessing quality of care: what are the implications of the potential lack of sensitivity of outcome measures to differences in quality?
Authors: Mant Jonathan , Hicks Nicholas R. 
Published: December 2007

AbstractMeasuring outcome can be an insensitive way to detect differences in the quality of health care. This paper captures the implications of this poor sensitivity for the interpretation of studies of outcome that compare provider performance, and considers in what circumstances monitoring outcome might be useful. When interpreting studies, it is important to consider the size of the effect that a difference in the quality of care might be expected to have on outcome and whether it is likely that important differences in quality might not have been detected. It is argued that outcome measures may be of value when how you do something is as important as what you do, when process measures are invalid or impractical, and when the overall effectiveness of an intervention is critically dependent upon its complication rate.
Accuracy and reliability of assessment of severity of illness before and after an educational intervention
Authors: Shlels Christopher , Hutchlnson Allen , Eccles Martin , Gardiner Eric , Smoljanovlc Lada 
Published: December 2007

AbstractSeverity‐of‐illness measurement is considered to be an important factor in the risk adjustment of medical outcomes. However, for those measures that involve a high level of clinical judgment, strategies have to be developed to maximize the consistency of rating severity that can be implemented, especially when rating is based upon medical record review. A group of 25 clinicians were sent the same set of 14 patient records, and requested to use the Duke University Severity of Illness (DUSOI) checklist to rate the severity of patients' illness. Written instructions for the use of this instrument were provided. A short educational intervention was then made by the research team, and the clinicians were sent the same set of records to be rated again. Any improvement in the accuracy and reliability of severity assessment over the two ratings was then studied. The educational intervention resulted in identification of fewer irrelevant health problems. However, it had little impact upon the reliability of severity scoring itself, as measured by the intraclass correlation coefficient. Measuring severity of illness is a conceptually complex procedure. However, given its role in outcome interpretation, it may be worth pursuing strategies aimed at maximizing consistency of clinician rating. There are a number of options, including improved written instructions and more intensive training, that could be implemented.
A method of estimating tooth life expectancy
Authors: Kay Elizabeth , Locker David , Bllnkhorn Anthony 
Published: December 2007

AbstractOne of the most important outcome measures for dental services is the increase in tooth life expectancy which is brought about by the interventions provided. Thus, a convenient and accurate index of tooth survival is critical both to clinical decision making and to more general assessments of public dental health policies.This paper describes a simple method of approximating tooth life expectancy (TLE). The method is based on the assumption that tooth survival follows a simple declining exponential function. Assuming a constant mortality rate, TLE is the integral of the survival function, expressed as S(t) = e‐μt, where t is time, and μ the constant mortality rate.Using 3‐year tooth‐specific mortality rates for 491 subjects aged 50 years or more, tooth‐specific life expectancies for the population as a whole were found to range from 27 years for upper canines to 71 years for lower incisors. Individuals with a mean periodontal attachment loss greater than 4 mm and people on low incomes had significantly lower tooth life expectancies than their periodontally fit and more wealthy counterparts.This technique can be used to obtain disease‐specific or intervention‐specific tooth life expectancies. Thus, gains in TLE for individuals with different oral, social and behavioural characteristics can be calculated. The declining exponential approximation of tooth life expectancy has the potential to become a powerful tool in the evaluation of dental services and treatments.
Medical technology assessment and the role of economic evaluation in health care
Authors: Adang E.M.M. , Ament A. , Dirksen C.D. 
Published: December 2007

AbstractThe growth in health care expenditure over the last few decades has necessitated the introduction of priority setting and decision making based on the results of critical evaluation. Medical technology assessment (MTA) is a valuable tool to assist policy makers in controlling existing and new medical technologies. Medical technology assessment and the role of economic evaluation as part of MTA are described, and various techniques of economic evaluation are discussed.
Using clinical audit to promote evidence‐based medicine and clinical effectiveness — an overview of one health authority's experience
Authors: Auplish Saroj 
Published: December 2007

AbstractHealth care purchasers are facing increasing pressure to make the best use of their limited resources and to purchase only those services known to be clinically effective. This paper describes one health authority's experience of promoting clinical effectiveness through clinical audit and clinical guidelines. It highlights the central role of public health physicians in working closely with clinicians on the one hand and managers on the other, to promote evidence‐based medicine. The recent changes in the funding arrangements for audit have allowed purchasers to have more say in what should be audited, and link audit and clinical effectiveness with contracts.
Reviewing and selecting outcome measures for use in routine practice
Authors: MPH Joanne Greenhalgh BSc , MPhil Andrew F. Long BA MSc , MSc Alison J. Brettle BA , BA Maria J. Grant 
Published: December 2007

AbstractFor the successful achievement of evidence‐based practice, clinicians, managers and purchasers need evidence on whether a particular intervention works and ways to judge the appropriateness of the outcome criteria and measures used. Guidance is needed on what outcome measure to use, especially within routine clinical care settings. Beginning with a re‐clarification of the difference between a health status and an outcome measure, the paper presents an evaluative checklist for use by clinical audit and research staff to review outcome measures for use in routine care settings. Central features include the user‐centredness of the measure, its psychometric properties, feasibility of use and utility. The applicability of the checklist is illustrated for outcome measurement in diabetes and stroke care. A modified form of the checklist is proposed for use by the busy clinician as an aid to the critical review of research papers within the context of evidence‐based practice and to aid health care practitioners' choice of which outcome measure(s) to use within routine clinical care.
Vulnerability to criminal exploitation: influence of interpersonal competence differences among people with mental retardation
Authors: Wilson C. , Seaman L , Nettelbeck T. 
Published: December 2007

AbstractA study by Wilson & Brewer (1992) has indicated that people with mental retardation are at greater risk of having a crime committed against them than age‐matched cohorts from the general population. The present study was designed to test the hypothesis that this heightened vulnerability is partially explained in terms of behavioural shortcomings reflecting interpersonal competence. Twenty victims of crime and 20 nonvictims, all with mental retardation, were recruited so that means for age, adaptive behaviour and IQ were similar. Groups were compared on the Test of Interpersonal Competence and Personal Vulnerability (TICPV) developed for the present study. Results showed poorer interpersonal competence among the victims, indicating that victims had difficulty in deciding on the appropriate behaviour in some interactions. Performance on the test was shown to be internally consistent, stable over time and a valid measure of vulnerability. The study concluded with recommendations for more detailed investigation of the precise behaviours which influence risk as a first step in an attempt at remediation.
Autism in immigrants: a population‐based study from Swedish rural and urban areas
Authors: Gillberg I. C. , Gillberg C. 
Published: December 2007

AbstractIn a population study, 55 children aged 13 years and under were diagnosed as suffering from autistic disorder according to DSM‐III‐R criteria. Fifteen of these children (27%) were born to parents, at least one of whom had migrated to Sweden. These 15 cases were analysed in some detail with a view to finding possible background factors that could account for the relatively high prevalence of autism among some immigrant populations. In a few cases, autism or Asperger syndrome had been diagnosed in a native Swedish parent who went abroad in order to find a spouse. In several other cases, the child was the first child born in Sweden after the mother had moved there. The contribution of genetic and other prenatal factors to autism in immigrant populations is discussed.
Short‐term prognosis of depression in adults with Down's syndrome: association with thyroid status and effects on adaptive behaviour
Authors: Prasher V. P. , Hall W. 
Published: December 2007

AbstractFindings for Down's syndrome adults with depression were compared to those for non–depressed Down's syndrome controls. Mean age of onset of depression was 30.1 years, the majority of subjects were female and biological more so than psychotic symptoms were presenting features. No statistically significant association between depression and thyroid dysfunction was found. For the depressed group, scores for level of adaptive functioning were significantly lower and those for maladaptive behaviour significantly higher. At one–year follow–up, although some improvement was found, the majority of depressed subjects were still symptomatic. The short‐term prognosis for depression in adults with Down's syndrome appears to be poor but possibly better the earlier the age of onset.
Ocular defects in children and adolescents with severe mental deficiency
Authors: Kwok S. K. , Ho P. C. P. , Chan A. K. H. , Gandhi S. R. , Urn D. S. C. 
Published: December 2007

AbstractTo assess the need for eye care in children and adolescents with severe mental deficiency, a cross‐sectional study of the prevalence and causes of ocular defects amongst these individuals was conducted. Two hundred and sixty residents in a mental handicap unit were examined from January 1992 to June 1993. It was found that there was an unusually high prevalence of severe visual impairment (25%), refractive errors (24%), squint (8%) and a number of organic ocular diseases (8%). All the patients studied were non‐verbal and 18% of them were deaf. Only 23 patients could walk. The results emphasize the need for establishing an efficient system to provide regular ophthalmic care for children with severe mental deficiency.
Comorbidity in people with Down's syndrome: a criteria‐based analysis
Authors: van Schrojenstein Lantman‐de Valk H. M. J. , Haveman M. J. , Crebolder H. F. J. M. 
Published: December 2007

AbstractThe aims of this study were to review what is currently known about comorbidity in people with Down's syndrome and to determine if their relative risk for certain disorders was increased. Analysis was carried out on the published literature from 1982 through 1994. In order to be included in this study, articles had to meet predetermined criteria. The strengths and weaknesses of the selected articles were considered in this review. The estimation of relative risks was done by calculating the odds ratio (OR). Odds ratios of >2 or <0.5 were found in more than one article for congenital heart defects, hypothyroidism, hearing Impairment and hepatitis B. Only one article indicated an OR within this range for all of the following disorders: obesity, epilepsy, degenerative spine disorders and a wide atlanto‐axial distance. The results were unclear in the areas of hyperthyroidism, visual disorders, dementia and psychiatric disorders. The concept of comorbidity, i.e. establishing the relationships between the various conditions in one person and understanding the implications for medical care, seems promising, especially for people with intellectual disability. Further work in this area may well improve the quality of care offered to these people.
Predictors of sustained response, relapse and no response in patients with chronic hepatitis C treated with interferon‐α
Authors: Chemello L. , Cavalletto L. , Noventa F. , Bonetti P. , Casarin C. , Bernardinello E. , Pontisso P. , Donada C. , Casarin P. , Belussi E , Frezza M. , Alberti A. 
Published: December 2007

Summary. Three main patterns of response are seen when interferon‐α (IFN‐α) is used for the treatment of chronic hepatitis C:1 sustained response with alanine‐aminotransferase (ALT) normalization that is maintained after cessation of therapy, with or without clearance of serum hepatitis C virus (HCV) RNA;2 transient response with ALT normalization during therapy followed by relapse after its withdrawal, and3 no response with no or only partial reduction in ALT levels.In order to define variables that could predict each of these three types of response we studied 321 cases of chronic hepatitis C treated with IFN‐α in two consecutive trials conducted in our Unit. By univariate analysis, age < 45 years (P < 0.01), known disease duration < 60 months (P < 0.01), normal gamma‐glutamyltranspeptidase (γGT) levels (P < 0.01) and infection by HCV genotype 2 or HCV genotype 3 (P < 0.01) were found to be statistically associated with sustained response while age > 45 years (P < 0.01), body weight (P= 0.05), cirrhosis (P < 0.01) and elevated γGT levels (P < 0.01) were associated with no response. By multivariate analysis sustained response was predicted by HCV genotype 2 (P < 0.01) and HCV genotype 3 (P < 0.01), known disease duration (P < 0.01), patient's age (P < 0.05) and associated with the use of a more aggressive treatment schedule (P < 0.05). Transient response with relapse was predicted by known duration of disease (P < 0.05), HCV genotype 1 (P < 0.05) and female sex (P < 0.05). No response was statistically associated with elevated γGT levels (P < 0.01), higher body weight (P < 0.05) and with the less aggressive regimen of 3 MU of natural IFN‐α given three times weekly for 6 months (P < 0.05).These results indicate that the HCV genotype as well as the schedule of treatment greatly affect the pattern of response to IFN in chronic hepatitis C and allow us to define criteria to predict which type of response is more likely in individual patients.
Sorbitol inhibition of glucose metabolism by Streptococcus sanguis 160
Authors: Hamilton I. R. , Svensater G. 
Published: December 2007

Hamilton IR, Svensater G. Sorbitol inhibition of glucose metabolism by Streptococcus sanguis 160.Clinical studies in Sweden have shown that the proportion of sorbitol‐utilizing strains of Streptococcus sanguis increases in dental plaque from individuals using sorbitol‐containing products for prolonged periods. We have undertaken to study the metabolism of glucose and sorbitol by S. sanguis 160, isolated from a subject consuming sorbitol‐containing chewing‐gum 4 times a day for 4 years. Growth on glucose was inhibited by the presence of sorbitol in the growth medium and sorbitol was utilized in the presence of glucose, albeit, at a slower rate than glucose. In addition, pulses of glucose added to cultures growing on sorbitol resulted in the expulsion of sorbitol from the cell. In order to examine further the relationship of sorbitol and glucose, uptake assays were carried out with S. sanguis 160 grown in continuous culture (pH 7.0, dilution rate = 0.1 h−1) with glucose, sorbitol or nitrogen (sorbitol excess) limitations. The uptake of [14C]‐glucose by sorbitol‐limited cells, but not by glucose‐limited cells, was inhibited by sorbitol, as was glycolysis. Kinetic experiments with glucose‐limited cells showed 2 transport systems for glucose with Ks values of 5.2 and 40 μM, and glucose phosphorylation activity by decryptified cells indicated transport by the P‐enolpyruvate (PEP) phosphotransferase system (PTS) with lesser activity for an ATP‐dependent transport process. Transition from glucose‐limited growth to sorbitol‐limited growth revealed repression of total [14C]‐glucose uptake by intact cells and activity for Enzyme II for glucose (Ellglc) of the PTS measured in membrane preparations in the presence of an excess of the soluble PTS proteins in crude cell‐free supernatant fractions. In a ‘crossover’ experiment, Ellglc activity in membranes of glucose‐limited cells was repressed when the glucose‐limited soluble fraction was replaced by the soluble supernatant derived from sorbitol‐limited and sorbitol‐excess cells. This suggests that the transition from a glucose limitation to a sorbitol limitation resulted in the repression of a soluble PTS component, possibly Enzyme III for glucose (IIIglc), necessary for glucose transport. In addition, the 8‐fold lower Ellglc activity in sorbitol‐limited membranes when combined with the glucose‐limited soluble components revealed repression of Ellglc by sorbitol. Higher repression (103‐fold) of Ellglc activity was observed with sorbitol‐excess membranes. This evidence indicates that sorbitol is an effective catabolite repressor of the glucose‐PTS, exhibiting negative regulation over synthesis of both Ellglc and a soluble component, presumably IIIglc.
Vitamin E
Authors: COTTRELL R. C. 
Published: December 2007

SUMMARyRecent interest in the physiological role of vitamin E has been stimulated by a wide range of evidence from animal experiments linking this biological antioxidant with a range of defensive mechanisms. The absence of clear evidence for diseases in human adults attributable to deficiency in this vitamin, except as a result of surgery, has not prevented intense speculation of possible roles in various disease states. This paper should provide the reader with a general view of the background to current research activity and speculates a little as to some possible outcomes. Lest the unwary should become over‐enthusiastic it may be well to remember that no clear basis exists on which to recommend a daily allowance for this vitamin. Indeed it is conceivable that regeneration of the vitamin occurs within the body so minimal dietary intake is required in the adult.
SOME EPIDEMIOLOGIC FEATURES OF DISASTERS IN GUATEMALA
Authors: Arturo Romero B. , Cobra Rodrigo , Western Karl A. , Lopez Sergio Mayorga 
Published: December 2007

Epidemiological procedures can be organised under disaster conditions by means of a simple surveillance system and with few personnel.In the aftermath of the 4 February 1976 earthquake in Guatemala, an information system was organized by which the requisite information for decision‐making was obtained with adequate speed and promptness.The initial epidemiologic informution was based on reports collected during the early days on symptoms observed at hospitals and health centers and in localities and villages in the stricken area.At a second, post‐emergency stage a more elaborate surveillance system was instituted to provide guidance in the investigntwn of outbreaks, evaluate the health activities and establish basic criteria for preventive and control measures.
THE RECONSTRUCTION OF DARWIN AFTER CYCLONE TRACY
Authors: Walters K.J. 
Published: December 2007

Learning from any process or past experience is one of the wing graces of mankind. In this context, the rebuilding of Darwin had been to ensure that the catastrophic events, wrought by nature, will not be repeated by bringing total devistation of a city and a way of life.The total engineered city is a unique product of the “rethink” process brought about by the rebuilding of Darwin.The future economic viability of this cyclone resistant city is of paramount importance, but the lessons to be learnt also include a social and psychological value that the people of any city have for their existing infrastructure, and life style. The economic well being of any population development goes hand in hand with the happiness and contentment that the settled population work towards.The following is an assessment of the background, problems and achievements in which the Commonwealth Department of Construction played a major role.The Author, during the whole of the rebuilding programme in Darwin, occupied the position of Associate Director in charge of a multidiscipline cell within the Departpent of Construction, whose sole purpose was to handle the majority of the reconsiruction work for the Darwin Reconstruction Commission.