bluuebunny/crossref_metadata_2025_split huggingface dataset:
A study of nurses' views about the prevention of nosocomial urinary tract infections
Authors: BRIDGER JANE C. 
Published: December 2007

Summary

This study sought to discover the contribution of nursing practice to the prevention of hospital‐acquired or nosocomial urinary tract infections (NUTIs), the most commonly occurring nosocomial infection.
Seventy‐five per cent of such infections are associated with urethral catheters.
The practices of nurses who are caring for patients on a 24 h basis would appear to be fundamental to achieving any reduction in the incidence of NUTIs.
This qualitative study utilized unstructured interviews to explore the views of 12 registered nurses about three key issues: first, what care do nurses give with the aim of preventing catheter‐associated NUTIs; secondly, what improvements in practice would further prevent catheter‐associated NUTIs; thirdly, what do nurses see as constraints to the prevention of catheter‐associated NUTIs?
The nurses identified many of the measures that were cited in the literature as effective for preventing NUTIs; however, in reality, they stated that their practice differed because of a lack of time to give care and to update themselves.
The consequences of under‐staffing were that junior and temporary staff (whose competence in preventing NUTIs was questioned) worked unsupervised.
Those interviewed identified feelings of powerlessness in effecting preventative measures, and identified not only the role of medical staff in influencing NUTIs but also their inconsistent approach to care.
All these forces effectively limited the nurses' ability to prevent NUTIs.
The study is concluded with recommendations for changes in practice and further research.
An attempt to give nursing home residents a voice in the quality improvement process: the challenge of frailty
Authors: MITCHELL PATRICIA , KOCH TINA 
Published: December 2007

Summary

Advanced frailty and confusion of many nursing home residents present a particular conundrum to researchers committed to resident participation. While the research is set in Australia, the challenge of frailty is common to researchers working with compromised older persons.
This study was conducted in an Australian 32 bed nursing home. As researchers we took on the roles of facilitators and negotiators within a quality improvement process using the approach of fourth generation evaluation.
The overall aim of the project was to provide all stakeholders, including residents and their significant others, with a voice in the negotiations and decisions that impact on their lives.
The focus of this paper is our attempt to gain the perspective of residents and significant others.
Evaluation of a new night nursing service for elderly people suffering from dementia
Authors: WATKINS MARY , REDFERN SALLY J. 
Published: December 2007

Summary

A new night hospital nursing service was developed for older people with dementia.
A case study approach to evaluation was adopted using a structure‐process‐outcome quality assurance cycle.
The effects and attendance of patients are reported and discussed.
Discussion relating to care provision for the future is presented.
The effects on carers of patients' attendance are briefly discussed.
Integrated Care Pathways: effective tools for continuous evaluation of clinical practice
Authors: Kitchiner Denise , Davidson Campbell , Bundred Peter 
Published: December 2007

AbstractThe critical examination of clinical practice should be an integral part of patient care. It includes the development and implementation of guidelines, together with continuous evaluation of clinical process and outcomes to improve the quality of care provided. Clinical audit has not been successful in achieving this. The use of Integrated Care Pathways facilitates the introduction of guidelines and the continuous evaluation of clinical practice. Improvements are achieved by frequently revising the pathways to reflect current, local best practice.Integrated Care Pathways define the expected course of events in the care of a patient with a particular condition, within a set time‐scale. A pathway is divided into time intervals during which specific goals and expected progress are defined, together with appropriate investigations and treatment. A pathway reflects the activities of a multidisciplinary team and can incorporate established guidelines and evidence‐based medicine. It is usually unique to the institution in which it was developed. The pathway forms part of the clinical record of every patient. All variations from the pathway are documented, and the reasons for the variations analysed. Solutions are developed to address the causes of potentially avoidable variation, and the pathway is revised to incorporate these improvements. Integrated Care Pathways provide a powerful audit tool, as all aspects of the process and outcome of clinical practice can be constantly monitored. Variations from set standards are minimized, and improvements are rapidly incorporated into routine practice and subsequently re‐evaluated.
Qualitative research in health care: II. A structured review and evaluation of studies
Authors: Boulton Mary , Fitzpatrick Ray , Swinburn Clare 
Published: December 2007

AbstractA hand search of the original papers in seven medical journals over 5 years was conducted in order to identify those reporting qualitative research. A total of 210 papers were initially identified, of which 70 used qualitative methods of both data collection and analysis. These papers were evaluated by the researchers using a checklist which specified the criteria of good practice. Overall, 2% of the original papers published in the journals reported qualitative studies. Papers were more frequently positively assessed in terms of having clear aims, reporting research for which a qualitative approach was appropriate and describing their methods of data collection. Papers were less frequently positively assessed in relation to issues of data analysis such as validity, reliability and providing representative supporting evidence. It is concluded that the full potential of qualitative research has yet to be realized in the field of health care.
Decision making in HIV testing among a group with low HIV risk
Authors: Coyle Adrian , Knapp Maria , O'Dea Edmond 
Published: December 2007

AbstractRelatively little is known about how individuals (apart from gay and bisexual men) decide to have an HIV test and how, once they have presented for testing, they make decisions about proceeding through the testing trajectory. This paper reports on a qualitative study in which 55 mainly heterosexual respondents with low HIV risk were interviewed about their experiences of decision making around HIV testing. Reasons for deciding to be tested centred on a desire for reassurance and the circumstances of the respondents' current relationship. The most common relationship reason focused on a desire to confirm HIV status before beginning sexual relations or engaging in unprotected sex with a partner. Although some respondents recognized that other individuals had influenced their decision to be tested, few said that pretest counselling had been influential in this respect. Instead, it was said to have promoted feelings of ‘ownership’ of a decision which had already been taken prior to counselling. The potential effects of HIV testing on HIV risk behaviour were also examined and a non‐significant increase in unprotected sex was reported between the month before the test and the month after. The implications of these findings for the provision of HIV testing services are explored.
Is the patient's right to die evolving into a duty to die?: Medical decision making and ethical evaluations in health care
Authors: Sprung Charles L. , Eidelman Leonid A. , Steinberg Avraham 
Published: December 2007

AbstractWhen patient or family requests for continued life‐sustaining treatments conflict with doctor recommendations, different conclusions as to what is beneficial for the patient may arise. Past practices usually accepted patient or family requests based on the principle of autonomy or that the doctor's primary responsibility is to the individual patient. Many patients die in intensive care units after doctors forego life‐prolonging interventions. Health care changes and cost containment have led to a change in the classical ethical model of the patient‐doctor relationship such that concerns for societal requirements increasingly overrule those for individual patient needs. The ability to keep patients alive with little likelihood of recovery and the recognition of escalating health costs have led to calls for the needs of society and distributive justice to be taken into account. A tendency to justify a duty to die for these patients has arisen. Recent legal decisions in cases with conflicts between families and health care providers and institutions over foregoing life‐sustaining therapies have decided for the families against doctors and hospitals, compelling institutions and their staff to act contrary to their ethical views. Value judgments of doctors are sometimes confused with medical indications for therapy. Doctors have defined therapies as futile or non‐beneficial based on their own values and even withdrawn life‐sustaining treatments without patient or family input. In some cases, the right to die is leading to the duty to die even against patient or surrogate wishes. Such observations indicate the need for rigorous analyses of medical decision making in this context and for ethical evaluations in health care in general.
Evidence‐based medicine: a Kuhnian perspective of a transvestite non‐theory
Authors: MD Joaquim S. Couto 
Published: December 2007

AbstractEvidence‐based medicine (EBM) has been presented by its protagonists as a new paradigm for medical practice. In this article that claim is analysed through the theory of scientific development proposed by Thomas S. Kuhn in 1962. Traditional medical paradigms are discussed, as well as the assumptions of the supposedly ‘new’ paradigm of EBM. The value of the results of randomized clinical trials (RCTs) for the elaboration of clinical guidelines is analysed within the context of the assumptions of EBM and the paradigm concept of Thomas S. Kuhn. It is argued that the results of RCTs, whenever contradicted by fundamental medical theory, constitute inadmissible evidence for the development of clinical guidelines. The supremacy of results of clinical trials over traditional medical paradigms, advocated by the protagonists of EBM, is rejected. Fundamental contradictions of EBM are also exposed: the fact that there is no evidence to support the utility of EBM and its call for a new type of authoritarianism in medicine. Finally, it is suggested that ‘epidemiology‐based medical practice’ is a better, rhetoric‐free designation for what is currently termed evidence‐based medicine*. It is concluded that EBM is not what it claims to be and that its assumptions are simply irrational.
A false dichotomy. Commentary on ‘Clinical guidelines: ways ahead’ (C. W. R. Onion and T. Walley, Journal of Evaluation in Clinical Practice 4, 287–293, this issue)
Authors: MRCGP Jeremy M. Grimshaw MBChB PhD , MRCGP M. Stuart Watson MBChB MSc , MFPHM Martin Eccles MBBS MD FRCP FRCGP 
Published: December 2007

SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence‐based implementation strategy (Grimshaw & Eccles 1998).
Performance management using health outcomes: in search of instrumentality
Authors: MFPHM H.T.O. Davies PhD Hon 
Published: December 2007

AbstractThe past decade has seen the growing use of performance data in the hope of bringing about quality improvements in health care. Most recently, an emphasis on health outcomes (and especially mortality rates) has led to much activity around collecting and publishing such data. Two major problems intervene. What meanings can be ascribed to reported health outcomes? And what impacts are they likely to have on clinical performance? Much empirical work supports the assertion that reported outcomes may be poor indicators of service quality. In addition, the impact of these data may be small or even detrimental unless great care is made to connect the reporting with explicit quality‐improving actions.
Trainee teachers’ attitudes to inclusive education for children with Down's syndrome
Authors: Wishart J. G. , Manning G. 
Published: December 2007

AbstractThe attitudes of 231 trainee teachers towards inclusive education for children with Down's syndrome were surveyed in two UK colleges of education, one in Scotland and one in Northern Ireland. While the right to educational integration for children with special educational needs was widely endorsed, considerable reservations were expressed about its implementation in practice. Only 13% of respondents indicated that they would welcome the opportunity to teach in an integrated setting and 96% felt that their professional training did not prepare them to meet this challenge. Many underestimated potential levels of achievement in children with Down's syndrome and over half wrongly associated the condition with very short life expectancy.
Recessive (true) microcephaly: a case report with neuropathological observations
Authors: McCreary B. D. , Rossiter J. P. , Robertson D. M. 
Published: December 2007

AbstractThe clinical and pathological features of a severely retarded 77‐year‐old man with recessive (true) microcephaly are reported. This case demonstrates that this major developmental error can be consistent with normal longevity.
Ring chromosome 22 and mood disorders
Authors: Sovner R. , Stone A. , Fox C. 
Published: December 2007

AbstractThe case of a 21 ‐year‐old man with severe developmental disabilities, ring chromosome 22 and rapid‐cycling bipolar illness is presented. This is the first reported occurrence of mood disorder in a person with ring chromosome 22. Previously published case reports describing behavioural problems associated with this chromosome disorder suggest that severe hyperactivity is typical and that affected individuals may have an excited mood state. These symptoms are consistent with atypical bipolar disorder and raise the possibility that ring chromosome 22 increases the risk for atypical bipolar disorder.
Attrition and housing improvements: A study of post‐disaster housing after three years
Authors: Snarr D. Neil , Brown E. Leonard 
Published: December 2007

This research is part of an effort to monitor houses built for victims of hurricane Fifi in 1975. After 3 years (1978) we interviewed the residents to determine the rate of continued occupancy and the amount of housing improvement and the correlates of both. We found that a significant number of small families, Protestants, and families that had not participated in the construction of the housing had moved. From what we could determine, moving was primarily related to seeking work and improving one's financial position.Nearly 90% of the permanent occupants had improved their houses with either indigenous or manufactured materials. Non‐improvement of houses was concentrated among families with few members. The largest number of unimproved houses was located in the project that sewed the poorest victims and contained the cheapest housing.
A microcomputer‐based emergency response system*
Authors: Belardo S. , Howell A. , Ryan R. , Wallace W A. 
Published: December 2007

A microcomputer‐based system was developed to provide local officials responsible for disaster management with assistance during the crucial period immediately following a disaster, a period when incorrect decisions could have an adverse impact on the surrounding community.While the paper focuses on a potential disaster resulting from an accident at a commercial nuclear power generating facility, the system can be applied to other disastrous situations. Decisions involving evacuation, shelter and the deployment of resources must be made in response to floods, earthquakes, accidents in the transportation of hazardous materials, and hurricanes to name a few examples.As a decision aid, the system was designed to enhance data display by presenting the data in the form of representations (i.e. road maps, evacuation routes, etc.) as well as in list or tabular form. The potential impact of the event (i.e. the release of radioactive material) was displayed in the form of a cloud, representing the dispersion of the radioactive material. In addition, an algorithm was developed to assist the manager in assigning response resources to demands.The capability for modelling the impact of a disaster is discussed briefly, with reference to a system installed in the communities surrounding the Indian Point nuclear power plant in New York State.Results demonstrate both the technical feasibility of incorporating microcomputers indecision support systems for radiological emergency response, and the acceptance of such systems by those public officials responsible for implementing the response plans.
Damage to structures due to liquefaction in the Japan Sea earthquake of 1983
Authors: Yanagisawa Eiji 
Published: December 2007

A strong earthquake of magnitude of 7.7 hit the northeast part of Japan on 26th May 1983. Because 100 persons were killed by tsunami, the disaster created a sensation throughout Japan, but there was also a large amount of damage to structures due to the earthquake. Highways, railways, bridges, harbours, levees and private houses were damaged severely in Aomori and Akita prefectures. A great portion of the damage was caused by liquefaction of sand.This is a prompt report of earthquake damage to structures due to liquefaction. The paper describes general aspects of the damage to structures, with some typical examples are mentioned in more detail. Preliminary results of investigation after the earthquake are also presented to describe the liquefaction phenomena in the earthquake.
Training refugees as primary health care workers: Past imperfect, future conditional
Authors: Simmonds Stephanie , Cuttst Felicity , Dick Bruce 
Published: December 2007

Many problems have been encountered in the planning and implementation of health care in refugee camps, and more specifically in the training of refugees as primary health care workers. A review of the published literature and a “survey” of the opinions and experiences of refugee, national and international health personnel regarding training has therefore been undertaken to provide an overview of what has been done and to make recommendations for future work.The review highlights the need to reallocate resources away from high visibility emergency aid to development activities, such as training, that will create an infrastructure for primary health care and promote self‐reliance.
Supplementary feeding for refugees and other displaced communities – questioning current orthodoxy
Authors: Dick Bruce 
Published: December 2007

Supplementary feeding programmes of one sort or another are an almost universal response to refugee displacements, particularly in Africa. The aim of this paper is to question some of the assumptions which underlie current approaches to providing this additional food.First, there is a brief description of recent general policy developments relating to refugee health care and an outline of the two main factors that are likely to affect the objectives of supplementary feeding programmes: the adoption of either the medical or the epidemiological model of malnutrition, and the identification of the major differences between refugees and stable communities in developing countries.The characteristics of vulnerable groups are then discussed, as is the need to place food supplements within a much broader context of appropriate interventions directed towards improving and maintaining the health and nutritional status of these vulnerable groups. At the same time, emphasis is placed on the non‐nutritional value of food and the importance of allowing refugees to determine their own priorities and to use the available resources accordingly.Several unresolved questions about nutrition programmes are identified, in particular whether the focus of supplementary food should be high risk individuals or families, and whether supplements should be provided on a supervised or take home basis – or if they should merely be included as part of a basic ration determined by “need.”Eight axioms of supplementary feeding programmes for refugees are stated and the implications of these for planning, training and research are discussed.
Fiji, land of tropical cyclones and hurricanes: A case study of agricultural rehabilitation
Authors: Chung Joseph 
Published: December 2007

Tropical cyclones and hurricanes have a severe impact on the social and economic activities of affected communities. For small island nations in the Pacific region, the effects can be devastating because of their smallness. FQi and several other countries in the region are vulnerable to such disasters as they are situated in the zone where cyclones occur frequently.During the last decade, the frequency of natural disasters and their adverse impact on die economic and social development of small nations like Fiji, has aroused awareness mat relief efforts must go beyond immediate “mopping up” operations to those which contribute to attaining longer term benefits through reconstruction and rehabilitation.The paper outlines the 1985 agricultural rehabilitation program and discusses related issues and problems.
Opportunities for British Involvement in the International Decade for Natural Disaster Reduction
Authors: DAVIS IAN 
Published: December 2007

The UK Science, Technology and Engineering Committee for the International Decade for Natural Disaster Reduction (IDNDR) was jointly established by The Fellowship of Engineering and The Royal Society, in 1990. Its purpose is to promote the aims of the IDNDR with particular reference to disaster risk reduction within developing countries.In order to provide a forum for people with a wide range of experience in this field to meet and exchange views, the Committee convened a one‐day Workshop, held at The Royal Society in London on 27 March 1992. The following is a shortened version of a position paper (originally drafted by Ian Davis and subsequently approved by the Committee), setting out seven ‘priorities’ for the IDNDR, which formed the basis of discussion at the Workshop.
From Relief to Development: The Long‐term Effects of ‘Temporary’ Accommodation on Refugees and Displaced Persons in the Republic of Croatia
Authors: ELLIS SUE , BARAKAT SULTAN 
Published: December 2007

The increasing scale of international intervention in conflict is generating new pressures on the humanitarian community. Increased expenditure on emergency relief, static levels of overseas development aid and subsequent lack of funds for development are dictating that agencies design relief projects that positively effect developmental reconstruction.This paper examines the provision of shelter for refugees and displaced persons in the Republic of Croatia and identifies ways in which it has encouraged and discouraged sustainable reconstruction. It argues that to promote lasting reconstruction, programmes must focus on saving livelihoods as well as lives, thus minimising the long‐term psychological and physical impacts of aid on refugees, displaced persons and host communities.