bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prescribing trends by nurse practitioners and physician assistants in the United States
Authors: Cipher Daisha J. , Hooker Roderick S. , Guerra Patricia 
Published: May 2006

AbstractPurpose: As an important step in analyzing the role of nurse practitioners (NPs) and physician assistants (PAs), we examined their prescribing behavior. The intent is to study the characteristics of providers and patients, and the type of prescriptions written by NPs and PAs in primary care and to compare these activities to physicians.Data sources: The National Ambulatory Medical Care Survey (NAMCS) database was examined for prescriptions written by primary care clinicians (family and general medicine, internal medicine, and general pediatrics). A representative sample of 88,346 primary care visits over a 6‐year period (1997–2002) was analyzed in which a prescription was written by an NP, a PA, or a physician in an urban or rural setting.Conclusions: The characteristics of all the patients seen were similar for geographical region of visit, age, and gender, but differed by ethnicity and race. An NP or a PA was the provider of record for 5% of the primary care visits in the NAMCS database. The three clinician types were likely to write at least one prescription for 70% of all visits, and the mean number of prescriptions was 1.3–1.5 per visit (range 0–5) depending on the provider. PAs were more likely to prescribe a controlled substance for a visit than a physician or an NP (19.5%, 12.4%, 10.9%, respectively). Only in nonmetropolitan settings did differences emerge. In rural areas, NPs wrote significantly more prescriptions than physicians and PAs.Implications for practice: We suggest that NPs and PAs may provide a role that is similar to that of physicians in primary care based on prescribing behavior. The prescribing behavior of PAs and NPs parallels that of physicians by the number of medications per visit, the types of therapeutic classes, and the type of patient. However, in nonmetropolitan areas, prescribing differences emerge between the three types of providers that bear further exploration.
Nutritional aspects of non‐alcoholic steatohepatitis treatment
Authors: YUNIANINGTIAS Diah , VOLKER Dianne 
Published: May 2006

AbstractObjective and design: The aim of the present study is to review literature associated with the nutritional aspect of the treatment of non‐alcoholic steatohepatitis (NASH).Subjects and setting: The studies reviewed used small numbers of subjects and the majority of the studies were retrospective reviews and case series, not randomised controlled trials. The duration of the studies ranged from seven weeks to two years.Main outcome measures: Almost all of the studies demonstrate improvement in liver function tests, with weight loss combined with exercise beneficially reversing fatty liver. Omega‐3 fatty acid supplementation suggests positive effects in triglycerides level reduction by its role in suppression of sterol regulatory element binding protein‐1, whereas vitamin E supplementation reduces serum transaminase. Nutritional treatment in NASH is directed at its risk factors. Some studies give useful information regarding the importance of the nutritional aspects of treatment of the NASH patient, and almost all of the studies provide positive results although in some regimens the results are inconsistent.Conclusion: Well‐designed trials (in terms of numbers of subjects, with valid outcome measures) are needed to determine the efficacy of each strategy.
Post‐migration food habits of sub‐Saharan African migrants in Victoria: A cross‐sectional study
Authors: RENZAHO André M.N. , BURNS Cate 
Published: May 2006

AbstractObjective:  (i) To describe sub‐Saharan African (SSA) post‐migration food habits and eating patterns; and (ii) to examine how the food habits of SSA households in Victoria reflect post‐migration acculturation.Design:  A cross‐sectional survey using a snowball sampling technique. Data on food habits and eating patterns were obtained using semi‐structured, face‐to‐face interviews from November 2001 to April 2002.Subjects:  A total of 139 households of demographically diverse recent migrants from across sub‐Saharan Africa.Setting:  Melbourne metropolitan and Melbourne fringes.Analysis:  Data were summarised using descriptive statistics.Results:  SSA migrants and refugees indicated dietary acculturation characterised by three processes: substitution, supplementation and modification of recipes. They experienced difficulty locating their traditional foods, in particular, African vegetables (34.2%), unprocessed maize meal (29.1%), camel milk (23.1%) and maize grain (13.7%). The new foods adopted since arrival were pizza, breakfast cereals and fast foods, but also included new fruits and vegetables. Takeaway food such as Pizza Hut or McDonalds featured prominently in the SSA post‐migration diet. Reasons for eating out were favourite food (48.3%), routine family outing (38.3%), special occasion (33.3%) and no time to cook (25%). A significant change in meal pattern was the inclusion of breakfast, although 21% reported skipping breakfast.Conclusion:  Many of the observed dietary changes were not consistent with good health and may predispose this population to rapid weight gain and chronic disease. Rapid modernisation and the Anglo‐Australian culture interact in a complex way with traditional eating and socialisation practices of SSA migrants. Understanding these forces can allow effective health promotion and community development strategies to be developed for the future health of SSA migrants and their communities.
Accessibility for parents of weight management information on the Internet
Authors: OWAIMRIN Amal , STEINBECK Katharine 
Published: May 2006

AbstractObjective:  The aim of the present study was to describe the accessibility, quality and readability of web base content on the Internet for childhood obesity management from a parental viewpoint. As more than 25% of Australian children are overweight or obese, it is likely that parents access the Internet for advice on obesity management for their child.Design:  Links to websites were generated using three search engines and three phrases. The first 10 website links were selected from each of nine searches. Ten aspects of obesity management were identified for the analysis of childhood obesity and related websites. The Fry readability graph was used to assess content readability.Data analysis:  The data were analysed using spss Version 10, Minitab and Microsoft Excel 2000. anova was used to compare clinical criteria between website type.Results:  A total of 90 links were generated with 60 relevant for analysis. In total, 30 were specific to childhood obesity and 47 websites were either obesity‐specific or weight‐related. Childhood obesity websites were community‐based or commercial. Most websites relevant to childhood obesity management came at no cost, in comparison with general weight‐related sites. Childhood obesity websites scored generally high on accuracy of content. Overall, website readability was at an undergraduate level.Conclusions:  There appears to be a paucity of accessible information on the Internet related to childhood weight management, which parents could access. Childhood obesity management websites should ideally include clinically approved management guidelines and follow e‐health codes of ethical practice.
Promoting breast health: older women's perceptions of an innovative intervention to enhance screening
Authors: Wood Robin Y. , Della‐Monica Nola R. 
Published: May 2006

Aims and objectives.  This study is a continuation of prior funded research in which we tested the use of age and ethnically sensitive video breast health kits to increase knowledge about breast cancer and enhance the screening practices of breast self‐examination and mammography among older Caucasian and African‐American women.Background.  Breast cancer is the most frequent cancer in women worldwide and accounts for 23% of all cancers. Mammography is currently the best procedure available for mass screening of breast cancer. However, underutilization of mammography is a problem among older women in the United States. Elders are at the greatest risk for developing and dying from breast cancer but they are the least likely group to be screened routinely with mammograms or to practice breast self‐examination, particularly if they are African‐American.Design.  Participatory qualitative evaluation focus groups were used to assess the overall impact of the video kit intervention programme and to elucidate the quantitative findings of the original study.Methods.  Four focus groups were conducted in two diverse settings with a purposive sample of 23 participants (N = 23). The overall sample was predominantly African‐American (87%) with mean age of 71 ± 7.9 years and mean education completed of 12 ± 3.4 years.Results.  Five major themes emerged from group discussions: usability and appeal of the intervention, fear and empowerment, personal relevance and intergenerational sharing, impact on screening behaviours, and story telling.Conclusions.  Analyses suggest that customized media materials constructed especially for older African‐American women empowered participants in this sample to action regarding their own breast health.Relevance to clinical practice.  These findings may translate to global populations where risk is increasing but screening programmes are not widely available. Given that older women are historically difficult to access and impact, further design and evaluation of innovative and sensitive educational programmes such as the one described here are recommended.
Moving forward together: evaluation of an action group involving staff and relatives within a nursing home for older people with dementia
Authors: Barry Aveyard , Davies Sue 
Published: May 2006

Background.  This paper describes the implementation and evaluation of an action group within a nursing home for older people with dementia. Over a two‐year period, researchers worked with staff, residents and relatives on a series of initiatives aimed at improving experiences of living and working within the home. The action group, involving staff, residents and their relatives was the vehicle through which a number of important changes were achieved. The project was underpinned by ideas about relationship‐centred care and the Senses Framework.Methods.  A constructivist methodology informed both the initial development and the evaluation of the project. This paper reports findings from interviews with staff and relatives and process recordings of group discussions.Findings.  Data from the evaluation provide evidence of ways in which the project has contributed to creating the senses (security, significance, belonging, purpose, continuity and achievement) for each of the key stakeholder groups. Factors supporting and hindering the project were also identified.Conclusions.  The development approach using the Senses Framework adopted within the project is a useful model for partnership working in settings providing continuing care for older people.Relevance to clinical practice.  Findings from this small‐scale but intensive project suggest that staff within care homes should seek to engage with a range of stakeholders in order to improve experiences for all involved in long‐term care. Academic staff within schools of nursing should consider innovative, action‐oriented approaches to supporting developments within care homes.
Students’ ideals for nursing older people in practice
Authors: Alabaster Erica S. 
Published: May 2006

Aim.  Drawing on research exploring nursing students’ experiences of working with older people, this paper aims to demonstrate how context and culture can impact on the realization of their ideals.Background.  The principles underpinning individualized and person‐centred approaches to care resonate with those focal to gerontologic nursing. Restrictive contexts of care and pervasive workplace cultures render nurses unable to deliver care in accord with these.Design and method.  This interpretive study was informed by phenomenological–hermeneutic theory. A purposive sample (n = 10) was recruited from a single educational institution. Data were generated in two phases using loosely structured interviews and supplementary activity. Themes explicating their experiences were identified via systematized detailed analysis and issues pertaining to nursing students’ orientation towards older people cut across these.Findings and discussion.  Students perceived that older people were prone to depersonalization and marginalization, so sought to show respect by coming to know individuals, form human connections with them and personalize care accordingly. Giving respect, promoting personhood, asserting reciprocal identity and maintaining dignity were prominent features of this but were often frustrated by practices and cultures encountered in mainstream settings.Conclusions.  Nursing students’ approaches to older people are contextual and reflect elements of person‐centred ideology. Their attempts upholding their ideals are liable to be subverted by workplace norms. Preparatory education should address these, assist students to learn how to attend to personhood in restrictive environments and offer targeted placements in age‐specific and non‐acute services.Relevance to clinical practice.  Demographic trends mean that working with older people has increased significance for nurses in most settings. Person‐centredness is seen as beneficial for older people but contemporary service imperatives and enduring practices are inhibitory, preventing entrants to nursing from developing related skills.
How we do it: Frequency of skin necrosis after BAHA surgery
Authors: Tjellström A. , Granström G. 
Published: May 2006

Keypoints• To establish a lasting reaction free skin penetration the skin at the penetration site must not move in relation to the coupling.• The skin should also be free of hair follicles in order to facilitate everyday cleaning.• A specially designed dermatome will ensure a 0.6‐mm thick hairless skin flap.• By applying a very gentle pressure on the flap the risk of skin necrosis during the healing phase is reduced.
How we do it: Implementing change – a multi‐centre audit of an evidence‐based protocol on post‐thyroidectomy calcium maintenance
Authors: Gillett D. , Fahmy F. , Liew L. , Massey S. , Shotton J.C. 
Published: May 2006

Keypoints• Our previous retrospective audit (Clinical Otolaryngology, December 2004) identified considerable variation in post‐thyroidectomy calcium assessment. This led to a well‐structured protocol.• The protocol was introduced into two trusts. The results were prospectively collated for 64 thyroid procedures over a period of 6 months.• All patients that warranted it were tested on day 1, and 71% were tested on day 2 – highlighting a more structured approach, and avoiding unnecessary vene‐ puncture in all thyroid lobectomy patients.• Such protocols have been proven to be an important tool in the effort to improve the quality and lower the cost of care.• Resistance to change, established practise and lack of data collection resources prevented this protocol from becoming established in more regional trusts.
Head & neck cancer incidence in Wales 1992‐‐2001
Authors: Khan A.M. , Tomkinson A. 
Published: May 2006

Introduction. There are 12 cancer registries. The process of cancer registration within the United Kingdom is similar. The Welsh Cancer Intelligence & Surveillance Unit (WCISU) has published a report ‘Cancer Incidence in Wales 1992‐‐2001’. Objective. The aim of the study was to validate head and neck section of the report. Material and method. Data of cancer patients travels from the clinical notes through clinical coding to Patient Administration System (PAS) at each Trust, then to the Patient Episode Database for Wales (PEDW), and finally to WCISU. The processed data used for the publication of this report was retrieved from WCISU and was compared to that received from the clinical notes, PAS and PEDW. Results. 12% of the notes examined were inappropriately coded in terms of gross anatomical tumour site. If non‐melanoma skin cancers are included in the definition of Head and Neck Cancer 80% (17\,101) of the patients appear to not be included in the WCISU report. If skin cancer is excluded from the definition 57% (5750) of head and neck cancer patients appear to not be included. Conclusion. The definition of Head & Neck Cancer appears to differ between clinicians and that used in the WCISU report. This difference will create an apparent gross underestimate in the true incidence of Head and Neck cancer in Wales when viewed from a clinical or workload perspective. It appears that this report could not be used for the present and future planning of Head & Neck services in Wales.
Tissue engineering strategies for reinnervation of the larynx
Authors: Kingham P.J. , Terenghi G. , Birchall M.A. 
Published: May 2006

Objectives. Injury to the recurrent laryngeal nerve (RLN) results in synkinesis and a dysfunctional larynx. Novel nerve repair techniques might enhance the speed of RLN regeneration and encourage accurate muscle reinnervation. Our first approach has been to apply neurotrophins (NT) to the site of repair using artificial nerve conduits. Currently we are investigating whether adult stem cells can be differentiated to provide a source of Schwann cells for future cell‐based therapies. Method. In a pig model, the phrenic nerve was anastomosed with the RLN abductor branch1 and repaired using poly‐hydroxybutyrate wrap‐around conduits either untreated or impregnated with NT‐3 (500 ng/mL). Markers of nerve regeneration (neurofilament) and muscle denervation/reinnervation (NCAM) were assessed to determine the efficiency of repair. Stem cells were isolated from adipose tissue and treated with glial growth factors for 2 weeks before phenotypic characterisation. Results. Compared with controls, NT‐3 treated animals showed significantly elevated levels of neurofilament protein in the distal nerve segment at 2 months (n = 5, P < 0.01). Injury increased the number of denervated, NCAM positive abductor muscle fibres from 1.3 ± 0.68% to 33.9 ± 5.8% at 2 months and 3.7 ± 2.3% at 4 months. NT‐3 did not significantly reduce these numbers. Differentiated adipose derived stem cells adopted a bi‐polar morphology similar to Schwann cells and expressed S100 and GFAP glial proteins. Conclusions. NT‐3 treatment promotes early nerve regeneration but is insufficient to enhance long‐term muscle reinnervation. Differentiated adipose derived stem cells may represent a novel source of Schwann cells for future RLN repair studies. Reference 1 Kingham P.J., Birchall M.A., Burt R., et al. (2005) Reinnervation of laryngeal muscles: a study of changes in myosin heavy chain expression. Muscle Nerve. 32(6), 761‐‐766
NPTA: an audit of an audit and some worrying conclusions
Authors: Pothier D.D. , Nankivell P.C. , Hunasaghatta S. 
Published: May 2006

Objectives. Data sent to the National Prospective Tonsillectomy Audit (NPTA) may be flawed by systematic bias. The NPTA was set up to record data concerning all tonsillectomies performed in England and Northern Ireland over a 15 month period.1 A potential weakness of the NPTA system is that a great deal of reliance is placed on accurate recording of complication data. We set out to determine how results from a case note review would compare to data sent by us to the NPTA. Method. Case notes of tonsillectomy patients, who had NPTA documentation completed, were retrieved (Gloucestershire Royal 267 and Bath 294). The notes of patients who had consented to inclusion in the NPTA (Gloucestershire Royal 227 and Bath 246) were reviewed, independently of the NPTA form, for data that was required by NPTA. Results. The review of the case notes showed a far higher rate of complications than the data sent to the NPTA. Rates of delayed discharge were higher by a factor of 1.67 and 7 times, the readmission rate was 1.54 and 2.43 times higher and the return to theatre rate and secondary bleed rate from the case note review was over double that of the data we sent to the NPTA. Conclusions. The construct of the NPTA makes the data regarding the initial tonsillectomy easier to record than any complications thereafter. If the other participants in the NPTA have standards of data submission similar to ours, the conclusions drawn upon those data should be regarded with great caution. Reference 1 RCSEng, BAOHNS. National Prospective Tonsillectomy Audit Informtion Leaflet. http://www.tonsil‐audit.org/documents/information_leaflet.pdf . 2005. Last accessed 6/9/2005
Immunohistochemical expression of p53 and MDM2 within head and neck squamous cell carcinoma
Authors: Tandon S. , Beer H. , Jones T.M. , Birchall M. , Boyd M. , Helliwell T.R. 
Published: May 2006

Objectives. To determine the presence, location and degree of expression of p53 and MDM2, by use of immunohistochemistry, in squamous cell carcinoma of the head and neck (HNSCC). Design. Laboratory based observational study. Setting. University Hospital Aintree, Liverpool and The University of Liverpool. Participants. Twenty‐three consecutive patients with HNSCC were studied. Ethics approval and informed patient consent were gained. Paraffin sections of carcinoma were stained for p53 and MDM2. Sections were assessed by stratified random sampling of the periphery and centre of the tumour for nuclear staining. Main outcomes measures. (i) Number of positive cases for p53 and MDM2; (ii) percentage of cells positive for p53 and MDM2; (iii) variation of positive cells within the tumour. Results. The range of p53 positivity was 0–100%; 10 cases were negative for p53, five cases were intermediate for p53, seven cases were highly positive for p53. The range of MDM2 positivity was 0–16%; 10 cases were negative for MDM2, four cases were intermediate for MDM2, nine cases were highly positive for MDM2. 10 cases were predominantly p53 positive, eight cases were predominantly MDM2 positive and five cases were negative for both p53 and MDM2. There was no consistent difference between the edge and the centre for either antibody, however for MDM2, there is increased expression in peri‐necrotic areas. Conclusions. (i) HNSCC shows different patterns of p53 and MDM2 co‐expression, which has potential biological and clinical significance; (ii) peri‐necrotic expression of MDM2 may be explained by a response to hypoxia.
Biosynthetic Gene Cluster for the Polyenoyltetramic Acid α-Lipomycin
Authors: Bihlmaier C. , Welle E. , Hofmann C. , Welzel K. , Vente A. , Breitling E. , Müller M. , Glaser S. , Bechthold A. 
Published: May 2006

ABSTRACT

The gram-positive bacterium
Streptomyces aureofaciens
Tü117 produces the acyclic polyene antibiotic α-lipomycin. The entire biosynthetic gene cluster (
lip
gene cluster) was cloned and characterized. DNA sequence analysis of a 74-kb region revealed the presence of 28 complete open reading frames (ORFs), 22 of them belonging to the biosynthetic gene cluster. Central to the cluster is a polyketide synthase locus that encodes an eight-module system comprised of four multifunctional proteins. In addition, one ORF shows homology to those for nonribosomal peptide synthetases, indicating that α-lipomycin belongs to the classification of hybrid peptide-polyketide natural products. Furthermore, the
lip
cluster includes genes responsible for the formation and attachment of
d
-digitoxose as well as ORFs that resemble those for putative regulatory and export functions. We generated biosynthetic mutants by insertional gene inactivation. By analysis of culture extracts of these mutants, we could prove that, indeed, the genes involved in the biosynthesis of lipomycin had been cloned, and additionally we gained insight into an unusual biosynthesis pathway.