bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hospital care pathways for patients with schizophrenia
Authors: Jones Adrian 
Published: March 2003

•  Greater emphasis is being placed on reducing clinical variation in managing patient groups in the reformed National Health Service (NHS) in the United Kingdom (UK).•  The use of a care pathway to enable greater control over the process and quality of care will be explored for patients suffering from schizophrenia.•  The paper addresses three main factors for the development of care pathways for people suffering from schizophrenia: predictability of the illness; nature of standardized care; and role autonomy.•  It is argued that the diagnosis of schizophrenia does not lend itself easily to predicting care and treatment within a care pathway framework. However, a care pathway may bring other benefits, such as standardized care and a greater control over the delivery of care.•  Development and implementation of hospital care pathways require extensive research. Qualitative research directions are advocated due to the possible difficulties of conducting an experimental study.
Functionalism and holism: community nurses’ perceptions of health
Authors: Long Ann , Baxter Rosario 
Published: March 2003

• This paper reports the results of a study that was designed to explore and examine the perceptions of two groups of newly qualified community nurses about the factors they considered to be embedded within the concepts of health, health‐enhancing behaviours at individual, family and community levels and their ‘innermost self ’.• The research was exploratory in nature, and included two sample groups: group 1 comprised 16 newly qualified health visitors; group 2 comprised 16 newly qualified community mental health nurses. Purposive sampling was used and data were collected using semi‐structured interviews.• The group of health visitors perceived health in terms of physical fitness and functional states. At a global level they perceived the need to provide education on health matters. They gave generously to ‘charities’ and perceived the ‘inner self’ as ‘that part that matters’.• The group of community mental health nurses perceived health in terms of holism and being states. Their concept of health was related to listening to each individual’s perception of what is ‘right’ and ‘health‐enhancing’ for them. At a global level they considered the protection of the ozone layer and the promotion of a just and equitable society which focused on the reduction of poverty, to be key health‐enhancing activities. They perceived their ‘innermost self’ to be ‘that part of me that makes life worth living’, and the soul.• The findings have implications for developing new and creative approaches for teaching the holistic concept of health and healing. Educational activities could be designed which strive to ensure that nurses themselves have safe and health embracing opportunities for exploring all the elements that are embedded within the topic of health. Their role in facilitating holistic health promoting activities for all clients also needs to be addressed.
Studying complex caring interfaces: key issues arising from a study of multi‐agency rehabilitative care for people who have suffered a stroke
Authors: ALLEN DAVINA , LYNE PATRICIA , GRIFFITHS LESLEY 
Published: March 2003

• Ensuring `seamless' health and social services provision has been a concern of policy makers for many years but our understanding of this complex system of work remains underdeveloped.• This article reports selected findings from a series of ethnographic case studies of health and social services provision to adults recovering from a first acute stroke.• Flexible working, the need for a lead professional and the transition from hospital to home are themes considered.• The need for high quality data in order to develop our existing understanding of complex caring interfaces is underlined.
Role boundaries – research nurse or clinical nurse specialist? A literature review
Authors: RAJA‐JONES HANSA 
Published: March 2003

• This paper focuses on issues relating to the role components of clinical nurse specialists and clinical research nurses working in breast cancer care.• Identified issues relate to the lack of agreement as to the role and definition of clinical nurse specialists. At the same time there has been an increase and emergence of clinical research nurses, both within the NHS and university departments.• The review fails to reveal the relationship between these two specialist groups in terms of role overlap and role boundaries.• The lack of knowledge in this area substantiates the need for further research to be carried out.
An empowerment approach to needs assessment in health visiting practice
Authors: HOUSTON ANNA M. , COWLEY SARAH 
Published: March 2003

• This paper examines the usefulness of an integrated approach to needs assessment using an empowerment framework, within a health visitor/client interaction, in the home setting.• It is intended to demonstrate the existence of a flexible approach to assessing need that is based on research about necessary processes for carrying out health visiting.• The design of the tool described in this paper allows the use of professional judgement as well as fulfilling commissioning requirements to address health outcomes.• Health promotion and empowerment are central to health visiting practice and should be reflected in the way needs are assessed.• Many NHS trusts have introduced a system of targeting and prioritizing health visiting through a system of questioning to assess needs. This may reveal the work that health visitors do, but may also inhibit the open, listening approach required for client empowerment.• Different methods of assessing need can be used that do not compromise the commissioning requirements, the health visitor's duty of care or professional accountability.• The empowerment approach is key to the philosophy of health visiting.• There are ways of approaching needs assessment that do not compromise the ethos of partnership‐working in a health promoting way.
Nursing documentation of postoperative pain management
Authors: Idvall Ewa , Ehrenberg Anna 
Published: March 2003

Summary? Previous studies have shown that nursing documentation is often deficient in its recording of pain assessment and treatment. In Sweden, documentation of the care process, including assessment, is a legal obligation.? The aim of this study was to describe nursing documentation of postoperative pain management and nurses' perceptions of the records in relation to current regulations and guidelines.? The sample included nursing records of postoperative care on the second postoperative day from 172 patients and 63 Registered Nurses from surgical wards in a central county hospital in Sweden.? The records were reviewed for content and comprehensiveness based on regulations and guidelines for postoperative pain management. Three different auditing instruments were used. The nurses were asked if the documentation concurred with current regulations and guidelines.? The result showed that pain assessment was based mainly on patients' self‐report, but less than 10% of the records contained notes on systematic assessment with a pain assessment instrument. Pain location was documented in 50% of the records and pain character in 12%. About 73% of the nurses reported that the documentation concurred with current regulations and guidelines.? The findings indicate that significant flaws existed in nurses' recording of postoperative pain management, of which the nurses were not aware.
Developing palliative care practice in nursing and residential care homes: the role of the clinical nurse specialist
Authors: Froggatt Katherine A. , Hoult Lizzy 
Published: March 2003

Summary? The development of practice is but one aspect of Clinical Nurse Specialists' (CNSs) work, and a number of factors act to shape the extent to which CNSs are able to work with and develop practice with nursing and residential care homes.? A postal survey of 730 community CNSs in palliative care working in the UK was undertaken to explore the involvement of these nurses with nursing and residential care homes.? Much of the focus of the involvement was reactive work meeting the direct clinical needs of residents, primarily with cancer.? Although the CNSs perceived that there were some educational and care deficits in these care settings, the amount of proactive work undertaken to improve practice was limited.? The development work undertaken was focused on educational initiatives and establishing link nurse systems.? There is potential to develop palliative care practice in nursing and residential care homes through practice development initiatives.
Adolescent access to emergency contraception in A and E departments: reviewing the literature from a feminist perspective
Authors: Fallon Debbie 
Published: March 2003

Summary• Recent moves in parts of UK to provide opportunities for ‘over the counter’ purchasing at pharmacies, has meant that access to emergency oral hormonal contraception for adolescents is undergoing something of a revolution.• The provision of emergency contraception (EC) to adolescents in Accident and Emergency (A and E) departments, however, is nothing new and is now an established component of the current government objective to reduce teenage pregnancy rates in this country.• The tensions apparent in A and E departments related to the provision of EC, particularly to adolescents, have recently been recognized, but little attention has been paid to analysing the reasons why such tensions might exist.• This article is based on a literature review carried out as part of a study of nurses' encounters with adolescents accessing EC in A and E departments in the North‐west of England.• It is a reappraisal of the salient issues in this arena from a feminist perspective, aiming to provide an alternative with which to view the encounter between adolescents and service providers in A and E.
Drug monitoring during the treatment of AIDS‐associated Pneumocystis carinii pneumonia with trimethoprim‐sulfamethoxazole
Authors: Klinker Hartwig , Langmann Peter , Zilly Michael , Richter Ernst 
Published: March 2003

Objective: To monitor trimethoprim and sulfamethoxazole plasma levels in patients with AIDS‐associated
Pneumocystis carinii pneumonia
Method: Trimethoprim–sulfamethoxazole steady‐state plasma concentrations were measured by high‐pressure liquid chromatography during 37 episodes of
Pneumocystis carinii pneumonia in patients with AIDS. Initially, 15–23 mg/kg/day trimethoprim and 75–115 mg/kg/day sulfamethoxazole were given i.v. Assuming a therapeutic range for trimethoprim from 4 to 10 μg/ml, the doses were adjusted if trimethoprim levels were found to be outside this range
Results:
Mean concentrations were 6·7±3·3 μg/ml for trimethoprim and 187±56 μg/ml for sulfamethoxazole. A widespread inter‐patient range was found and could be decreased after dose adjustment. Enzyme inducing co‐medication did not influence plasma concentrations. In patients with coexisting chronic liver disease, significantly increased sulfamethoxazole plasma levels were observed. A correlation could be demonstrated between serum creatinine and trimethoprim plasma levels. Adverse reactions associated with co‐trimoxazole occurred during 65% of treatment periods and increased with increasing trimethoprim‐sulfamethoxazole levels, as well as increasing length of treatment. Therapy only had to be prematurely discontinued in one patient. Overall mortality was 2·7%Conclusion: Monitoring of co‐trimoxazole levels during the treatment of
P. carinii pneumonia in AIDS may help in reducing the high variability of plasma‐concentrations and in avoiding severe side‐effects especially associated in patients with chronic liver disease or renal failure
Seed bank dynamics in abandoned meadows during a 20‐year period in the Białowieża National Park
Authors: Falińska Krystyna 
Published: March 2003

1 The relationship between size and floristic composition of the seed bank and vegetation dynamics was studied between 1976 and 1996 in 0.75 ha of an abandoned Cirsietum rivularis meadow. The plot was divided into 100‐m2 (10 × 10 m) quadrats and sampled 5‐yearly to map the vegetation and determine the soil seed bank. 2 Densities of seeds in the soil fluctuated as succession proceeded. The initially small seed bank trebled by 15 years after abandonment, before falling, after 20 years, to approximately the same as in the initial stage. 3 The floristic richness of the seed bank decreased during succession, with the number of species falling from 38 to 25. The diversity of life forms, however, increased in later periods, with tall herbs, shrubs and trees appearing after 10 years. 4 Seed bank floristic composition is apparently both a product of the species composition of the current vegetation and a record of the long‐term substitution of species. Other factors, including the structure of the vegetation, also influence the accumulation of seeds in the soil. 5 Although changes in number of species show a directional pattern, the seed bank size fluctuated in the course of succession on these fertile wet meadows.
Variation in floral sex allocation and reproductive success within inflorescences of Corydalis ambigua (Fumariaceae): pollination efficiency or resource limitation?
Authors: Kudo Gaku , Maeda Toshihiko , Narita Kenji 
Published: March 2003

Summary

The variation of floral sex allocation with flower position within inflorescences was investigated in the spring ephemeral, Corydalis ambigua. Investment in female function (pistil), attraction (corolla) and nectar production decreased from bottom to top flowers, whereas male investment (stamen) did not differ.
This self‐incompatible species appears to set seeds as a result of visitation by nectar robbing bumblebee queens. The tendency of bees to visit lower flowers first and then move upwards within an inflorescence should result in directional pollen flow from bottom to top flowers.
Naturally pollinated upper flowers set fewer seeds than intermediate and lower flowers due to pollen limitation. The lack of differences in seed set and seed mass per pod following artificial outcrossing indicated that resource limitation did not explain the variation in seed production of flowers in different positions. Pollen viability also did not differ significantly between flower positions.
A model of pollination was developed that incorporated the visitation pattern of bumblebees and observed variations in nectar distribution between flower positions. This predicted that receipt of outcross pollen would decrease from bottom to top flowers, but that pollen export to other plants would not differ between flower positions provided that the pollen exchange rate of pollinators was either small or positively correlated with nectar content of each flower position. The observed pattern of floral sex allocation would then be parallel to relative success of pollen export and import between flower positions within inflorescences.
Selecting a mental health needs assessment scale: guidance on the critical appraisal of standardized measures
Authors: Evans S. , Greenhalgh J. , Connelly J. 
Published: March 2003

AbstractThe assessment of need has become a central element of the NHS policy on mental health care. Despite the importance placed on a needs‐led mental health service, little guidance has been provided as to the most appropriate means of assessing need. The use of standardized instruments can facilitate a systematic approach to the needs assessment process. However, available mental health needs assessment scales (MHNAS) vary considerably. Care is required to ensure that the scale selected is appropriate to the proposed purpose. This paper presents practical guidance on instrument selection for potential users of MHNAS including: (1) a review of the key issues to be considered when selecting an assessment scale, (2) a critical appraisal checklist for use in the review of needs assessment scales, and (3) a comparative analysis of three of the most commonly cited needs assessment scales. In addition, recommendations are made of ways to improve both the accessibility of MNHAS and to facilitate their appraisal prior to application in a clinical or research setting.
Palliative radiotherapy of bone metastases: an evaluation of outcome measures
Authors: Barton M.B. , Dawson R. , Wk B Soc , Jacob S. , B D. Currow , Stevens G. , Morgan G. 
Published: March 2003

AbstractThe objective of this study was to identify and evaluate important patient‐based outcomes that are specific to the palliative radiotherapy of bone metastases. We first conducted a literature review to identify and evaluate outcomes that are currently in use. To identify outcomes that are important to patients, in‐depth patient interviews were conducted. Finally, issues identified through the interviews were quantified through a prospective survey, in which patients completed a questionnaire prior to commencing radiotherapy and again after 6 weeks. In our literature review, we found that there was no standardized definition of either response to radiotherapy or assessment of pain relief. Pain measurement in many studies was undertaken using very simple measures, which could possibly yield inaccurate results. The vast majority of studies did not include quality of life as an endpoint. The patient interviews and survey showed that chronic pain and associated limitation of movement were the disease symptoms causing the most concern. Having a clear, alert mind and being able in self‐care were the aspects of daily living given the highest priority. Sustained pain relief and minimizing the risk of future complications were the main priorities relating to radiotherapy treatment. The practical aspects of treatment (travelling distance, remaining at home and brevity of treatment) were of least importance. This study indicates the complexity of evaluating the outcomes of palliative interventions, and confirms the deficiencies of pain relief as the primary end‐point. The patient's quality of life is affected by many factors other than pain (such as limited mobility, reduced performance, side effects and impaired role functioning); hence a wider range of end‐points is required. Greater sensitivity is required than in currently used end‐points. Concurrent diseases as well as concurrent therapies can make it difficult to attribute effects with precision. Unless such factors are considered in research design, the results may prove unreliable.
Rationality in medical decision making: a review of the literature on doctors’ decision‐making biases
Authors: Bornstein Brian H. , Emler A. Christine 
Published: March 2003

AbstractThe objectives of this study were to describe ways in which doctors make suboptimal diagnostic and treatment decisions, and to discuss possible means of alleviating those biases, using a review of past studies from the psychological and medical decision‐making literatures. A number of biases can affect the ways in which doctors gather and use evidence in making diagnoses. Biases also exist in how doctors make treatment decisions once a definitive diagnosis has been made. These biases are not peculiar to the medical domain but, rather, are manifestations of suboptimal reasoning to which people are susceptible in general. None the less, they can have potentially grave consequences in medical settings, such as erroneous diagnosis or patient mismanagement. No surefire methods exist for eliminating biases in medical decision making, but there is some evidence that the adoption of an evidence‐based medicine approach or the incorporation of formal decision analytic tools can improve the quality of doctors’ reasoning. Doctors’ reasoning is vulnerable to a number of biases that can lead to errors in diagnosis and treatment, but there are positive signs that means for alleviating some of these biases are available.
The effectiveness of adenoviral vectors to deliver and express genes in rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Overturf K , LaPatra S , Reynolds P N 
Published: March 2003

AbstractThe efficacy of adenoviral vectors for gene delivery into fish cells, both in vitro and in vivo, was evaluated. Vectors utilized were of human adenovirus serotype 5 (Ad), which are commonly used in human clinical trials, but have not been assessed for gene delivery to fish. Because nothing is known about Ad receptors in fish, both an Ad (Ad5Luc1) with natural tropism for the coxsackie and adenovirus receptor (CAR), as well as an infectivity enhanced Ad (Ad5LucRGD) were included within this study. Gene expression was detected in cell lines using either vector. The levels seen with Ad5LucRGD were much higher than for Ad5Luc1 in most lines except CHSE‐214. Transduction of CHSE‐214 cells with Ad5Luc1 could be blocked with an excess of a competitive inhibitor, suggesting that these cells possess a CAR homologue that mediates attachment of Ad, similar to that seen in mammalian cells. In vivo gene delivery was attempted by several methods, with significant expression seen only via intramuscular injection, although infection efficiency was low. Thus it was observed that several teleost cell lines are capable of being infected and one cell line expressed a human serotype adenoviral receptor homologue that aids in Ad infection. Additionally, in vivo studies indicated that muscle tissue of rainbow trout could be infected with Ad vectors, suggesting an alternative gene delivery strategy for this animal.
Crohn's disease affects diet and growth in children
Authors: Laiho  , Nuutinen  , Malin  , Isolauri  
Published: March 2003

Background: Thirteen (eight girls, five boys) patients, aged 9.8–15.4 years, and 13 controls matched for age and sex were studied to identify foods that might aggravate the symptoms of children with Crohn's disease, to examine the adequacy of nutrient intake and to assess nutritional status.Methods: The link between symptoms and food intake was determined by 48‐h dietary recall on two separate occasions and by a dietary questionnaire. Nutritional status was assessed using growth charts and biochemical values.Results: Patients with Crohn's disease identified several foods that aggravate symptoms. The intakes of bread, cereals and fat were greater in patients than in controls. The mean relative (% energy) intake of protein was lower, but the mean absolute intake of carbohydrates was higher in patients than in controls. The intakes of vitamin D, calcium, iron and zinc by the patients were below the respective recommended dietary allowances (RDAs). Nutritional status was good in the majority of the patients. However, the mean height‐for‐age was lower in the patients than in the controls, and 38% of the patients had serum albumin concentrations below the reference value.Conclusions: Symptoms and foods that aggravate symptoms may restrict diet and thus decrease nutrient intake. The diet of children with Crohn's disease may contain insufficient amounts of nutrients. In some children, Crohn's disease markedly retards growth. These results substantiate the need for coordinated dietetic follow‐up.