bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparative metabolic effects of hydrochlorothiazide and indapamide in hypertensive diabetic patients receiving ACE inhibitor therapy
Authors: Krum H. , Skiba M. , Gilbert R. E. 
Published: August 2003

AbstractBackground ACE inhibitors, when used as monotherapy, are frequently unable to adequately control blood pressure in diabetic patients. A diuretic may be added; however, thiazide diuretics, but not indapamide, have been associated with adverse metabolic effects. Whether these effects also apply to thiazides when administered in the currently used lower doses, and whether they differ from indapamide in their metabolic effects, particularly when used in combination with an ACE inhibitor in diabetic patients, has not been previously studied.Methods We conducted a prospective, randomized, open‐label, blinded endpoint crossover study comparing the metabolic responses to the addition of either hydrochlorothiazide (HCTZ) or indapamide, in 18 diabetic hypertensive patients receiving ACE inhibitor monotherapy for hypertension. Patients stabilized on fosinopril 20 mg/day were randomized to receive either HCTZ 12.5 mg od or indapamide 2.5 mg od for 8 weeks, then crossed over to the alternate therapy for a further 8‐week period. Blood pressure, heart rate and metabolic assessments were performed at the end of each 8‐week treatment period.Results Seated and standing systolic and diastolic blood pressures were not different between HCTZ or indapamide when added to fosinopril, nor was the fasting lipid profile or urinary albumin : creatinine ratio. Plasma potassium was lower with indapamide compared with HCTZ treatment (indapamide 4.3 ± 0.1 mmol/l; HCTZ 4.5 ± 0.1 mmol/l, P < 0.01) and HbA1c was higher with indapamide than with HCTZ therapy (indapamide 7.8 ± 0.4%; HCTZ 7.2 ± 0.3%, P < 0.01).Conclusions Hydrochlorothiazide 12.5 mg/day, when added to background ACE inhibitor therapy with fosinopril in hypertensive diabetic patients, resulted in a metabolic profile that was similar, if not superior on certain parameters, in comparison with indapamide 2.5 mg/day.
An unusual cause of hyperinsulinaemic hypoglycaemia syndrome
Authors: Manning P. J. , Espiner E. A. , Yoon K. , Drury P. L. , Holdaway I. M. , Bowers A. 
Published: August 2003

AbstractEndogenous hyperinsulinism as a cause for hypoglycaemia can be attributed to a number of different causes including insulinoma, sulphonylurea drugs and the newly described disorder non‐insulinoma pancreatogenous hypoglycaemia (NIPH). The calcium stimulation test is increasingly used as a method for not only localizing insulinoma but also for distinguishing the above entities. We describe a case in which felonious sulphonylurea administration was used to mimic either an insulinoma or NIPH. Importantly, this case demonstrates that, contrary to previous reports, the insulin response to calcium stimulation in such cases may be uniformly positive and should alert the physician to possible surreptitious sulphonylurea ingestion.
Incidence of sight‐threatening retinopathy in Type 1 diabetes in a systematic screening programme
Authors: Younis N. , Broadbent D. M. , Harding S. P. , Vora J. P. 
Published: August 2003

AbstractAim To measure the cumulative incidence of any retinopathy, maculopathy and sight‐threatening diabetic retinopathy (STDR), and calculate optimal screening intervals by retinopathy grade at baseline for patients with Type 1 diabetes attending an established systematic retinal screening programme.Methods All patients with Type 1 diabetes registered with enrolled general practitioners, excluding only those attending an ophthalmologist, were studied if retinopathy data was available at baseline and at least one further screen event. Screening utilized non‐stereoscopic 3‐field mydriatic photography and modified Wisconsin grading. STDR was defined as moderate pre‐proliferative retinopathy or greater and/or significant maculopathy in any eye.Results Patients (n = 501) underwent 2742 screen events. Cumulative incidence of STDR in patients without baseline retinopathy was 0.3% (95% CI 0.0–0.9) at 1 year, rising to 3.9% (1.4–5.4) at 5 years. Rates of progression to STDR in patients with background and mild pre‐proliferative retinopathy at 1 year were 3.6% (0.5–6.6) and 13.5% (4.2–22.7), respectively. Progression to STDR was greater in patients with a higher grade of baseline retinopathy (P = 0.001) or a longer disease duration (P = 0.003). For a 95% likelihood of remaining free of STDR, mean screening intervals by baseline status were: no retinopathy 5.7 (95% CI 3.5–7.6) years, background 1.3 (0.4–2.0) years and mild pre‐proliferative 0.4 (0–0.8) years.Conclusions Screening at 2–3 year intervals, rather than annually, for patients without retinopathy in Type 1 diabetes is feasible because of the low risk of progression to STDR, and may result in significant cost savings for a screening programme. Patients with higher grades of retinopathy require screening at least annually or more frequent.
Preventing Type 2 diabetes and the dysmetabolic syndrome in the real world: a realistic view
Authors: Zimmet P. , Shaw J. , Alberti K. G. M. M. 
Published: August 2003

AbstractThe last two decades have seen an explosive increase in the number of people with diabetes globally. There is now an urgent need for strategies to prevent the emerging global epidemic. Several recent successful intervention studies, both lifestyle and pharmacological, targeting subjects with impaired glucose tolerance (IGT) have stimulated enthusiasm for prevention of Type 2 diabetes. Lifestyle interventions reduced the incidence of diabetes by over 50% in the Finnish Diabetes Prevention Study and the Diabetes Prevention Program. Can the findings of these two studies be applied globally? Underpinning the enthusiasm, there needs to be a realistic approach to interventions in both developed and developing nations, and in ethnic groups where a better understanding of the socio‐economic, cultural and demographic issues and perceptions surrounding chronic diseases such as diabetes is required. Whether the strategies used in these two studies can be translated into a ‘real world’ scenario is doubtful. In practice, it is more than likely that a number of strategies will be needed to compliment the lifestyle approach. These will include pharmacological approaches with metformin, acarbose and other agents used to treat diabetes and its complications, currently under investigation. Longer‐term follow‐up studies will also clarify whether both lifestyle and pharmacological interventions actually prevent Type 2 diabetes, or merely delay its onset.
Growth in a context of cultural marginality: North American nurse educators in Japan
Authors: Furuta B. S. , Petrini M. A. , Davis A. J. 
Published: August 2003

Abstract Background: Concepts of marginality and partnership emerged from a questionnaire completed by 12 North American nurse educators working long term in Japan. Methods: To study individual perceptions regarding current professional and personal experiences, including language competency, roles and responsibilities in a different culture, contributions made, and management of daily living. Respondents also made recommendations to others who accepted similar assignments. Results: The data revealed growth accomplished and challenges encountered as a result of marginal status in the Japanese context with varying levels of socio‐cultural adaptation.
Surviving Ebola: understanding experience through artistic expression
Authors: Locsin R. C. , Barnard A. , Matua A. G. , Bongomin B. 
Published: August 2003

Abstract Background: A dearth of knowledge and information exist about the understanding of the experience of surviving a life‐threatening illness such as Ebola Hemorrhagic Fever (Ebola). Objectives: To understand the ways in which survivors of Ebola understood the experience of surviving a life‐threatening illness. Methods: Eleven participants were asked to illustrate their understanding of the experience of surviving Ebola*. Using drawings and interviews as data, a phenomenographic approach was used to guide the research process and to analyse data. Results: Analysis revealed four ways of understanding the experience. These are described as categories of descriptions or conceptions, namely, escape in peaceful awareness, hope for a world outside of fear, persistence in defying death, and constant fear of dying. Importantly, the structure and referential aspects of the experiences are portrayed in the form of an outcome space, which is the understanding of the experience of living as survivors of Ebola, described as both ‘living in fear of the predatory spectre’, while simultaneously ‘living in constant hopefulness’. This experience is illustrated as paradoxically living in fear while concurrently hoping for life. Discussion: Understanding the experience of survivors of a life‐threatening illness is significant to nursing and its practice. Critical to this significance is its influence on the practice of compassionate and competent nursing.
Cervical cancer and Pap smear screening in Botswana: knowledge and perceptions
Authors: McFarland D. M. 
Published: August 2003

Abstract Background: Cervical cancer is the most common cancer in Botswana. Little is known about women's use of Papanicolaou (Pap) cervical smear tests. Aim: The study is to explore knowledge and beliefs of 30 women about cervical cancer and Pap smear tests using the Health Belief Model. Method: Women were recruited from all income levels using network sampling. Data were collected using a demographic questionnaire and semi‐structured interview guide. Data analysis included descriptive statistics for demographic data and content analysis for interview data. Findings: Knowledge of cervical cancer and the Pap smear test was inadequate among women with low incomes. Pap smear utilization was also limited among low‐income women. Of the 18 women who had at least one Pap smear test in their lifetime, eight (44%) had opportunistic testing as a result of having gynaecological symptoms. Twelve women (40%) had never had Pap smear tests. Major barriers to Pap smear screening included inadequate knowledge about Pap smear testing, providers’ negative attitudes, and limited access to doctors. Conclusion: The study has implications for health education and health policy and for nurses’ involvement in both.
The phenomenon of caring from the novice student nurse's perspective: a qualitative content analysis
Authors: Kapborg I. , Berterö C. 
Published: August 2003

Abstract Background: Caring has been seen as a nursing term/concept, including all the aspects that are used to deliver nursing care to patients. Sometimes caring has been conceptualized as a relational expression of human concern and as a collection of human activities that assists others. Aim: This study is to identify and describe the nature of the concept ‘caring’ from the novice student nurse's perspective. Methods: A total of 127 Swedish novice student nurses wrote comments in essay form to the question: ‘what is your image of the concept caring?’ Data were analysed using qualitative content analysis, with the use of the theoretical framework: ‘doing’ and ‘being’. Findings: Three categories of caring were identified as ‘doing’, ‘being’ and ‘professionalism’. The phenomena of caring and the caring process could be illustrated as including hand (doing), heart (being) and brain (professionalism). Conclusions: It is now time to make care more visible as a principle of practice and of moral action. This could be explicit in a clear professional framework and incorporated more fully into nursing education programmes. Caring is to take care of the entire human being physically, emotionally and intellectually. Nurses need to use hand, heart and brain in order to fulfil their commitments.
Achievements and challenges of formulating a strategic plan for nursing development at the national level in Bahrain
Authors: Al‐Gasseer N. , Al‐Darazi F. , Al‐Kuwaiti B. , Al‐Gaud K. , Al‐Muhandis B. , Murad L. 
Published: August 2003

Abstract Background: In this paper (initially presented at a symposium during the ICN Centennial Conference, 27 June−1 July 1999, London), we describe nurses’ experiences in formulating a strategic plan for nursing development at the national level in Bahrain. Aim: Specifically, we address the process undertaken to produce a comprehensive and integrated strategic plan directed at what nurses in Bahrain need to do in order to contribute to cost‐effective and high‐quality health service. Conclusions: The following strategies are addressed: regulation of nursing; reform of nursing education; development of nursing services; development of a nursing information system, and development of nursing leadership.
Broad‐scale reciprocity in an avian seed dispersal mutualism
Authors: Burns K. C. 
Published: August 2003

ABSTRACTAim Coevolved relationships between individual species of birds and plants rarely occur in seed dispersal mutualisms. This study evaluates whether reciprocal relationships may occur between assemblages of bird and plant species.Location Vancouver Island, British Columbia, Canada (48°50′‐N, 125°22′‐W).Methods The distribution and fruiting phenologies of seven shrub species were compared to seasonal changes in habitat selection and seed dispersal by six fruit‐eating bird species.Results Shrub species inhabiting forest understorey habitat had earlier fruiting phenologies than shrub species inhabiting forest edge habitat along lake and bog margins. Birds showed a parallel pattern in habitat selection, being more abundant in the forest understorey early in the fruiting season, and more abundant in the forest edge later in the season. Rates of seed deposition covaried with avian habitat selection, in such a way that birds directed seed dispersal into habitats preferred by shrubs.Conclusions These results depict a broad‐scale pattern in the abundance of birds and fruits indicative of reciprocal interactions. Seasonal changes in seed dispersal to each habitat appear to reinforce the relationship between shrub habitat affinities and fruiting phenologies. Phenological differences between habitats may also reinforce seasonal changes in avian habitat selection. Therefore, although reciprocal interactions between pairs of bird and plant species are rare, broad‐scale reciprocal relationships may occur between assemblages of bird and plant species.
Body size and area‐incidence relationships: is there a general pattern?
Authors: Biedermann Robert 
Published: August 2003

ABSTRACTAimThis paper tests firstly for the existence of a general relationship between body size of terrestrial animals and their incidence across habitat patches of increasing size, and secondly for differences in this relationship between insects and vertebrates.LocationThe analysis was based on the occupancy pattern of 50 species from 15 different landscapes in a variety of ecosystems ranging from Central European grassland to Asian tropical forest.MethodsThe area‐occupancy relationship was described by incidence functions that were calculated using logistic regression. A correlation analysis between body size of the species and the patch area referring to the two given points of the incidence function was performed. In order to test for an effect of taxon (insects vs. vertebrates), an analysis of covariance was conducted.ResultsIn all species, the incidence was found to increase with increasing patch area. The macroecological analysis showed a significant relationship between the incidence in habitat patches and the body size of terrestrial animals. The area requirement was found to increase linearly with increasing body size on a log‐log scale. This relationship did not differ significantly between insects and vertebrates.ConclusionsThe approach highlighted in this paper is to associate incidence functions with body size. The results suggest that body size is a general but rather rough predictor for the area requirements of animals. The relationship seems valid for a wide range of body sizes of terrestrial animals. However, further studies including isolation of habitats as well as additional species traits into the macroecological analysis of incidence functions are needed.
Distinguishing between signal and noise in faunal responses to environmental change
Authors: Fleishman Erica , Mac Nally Ralph 
Published: August 2003

ABSTRACTAim We tested whether variation in snapshots of butterfly species composition and species richness taken from one to six years apart could be interpreted as an ecologically meaningful trend or whether they might merely reflect stochasticity.Location Field research was conducted in the Toquima Range and Shoshone Mountains, Lander and Nye counties, Nevada, USA.Methods We obtained data for 49 sites in the Toquima Range from 1996 to 2002 and 39 sites in the Shoshone Mountains from 2000 to 2002. Sites spanned the gradient of local topographic and climatic conditions in those mountain ranges. Data on species composition and species richness were based on comprehensive field inventories. We calculated similarity of species composition using the Jaccard index. We conducted one‐factor repeated‐measures analyses of variance to test whether the distribution of similarity of species composition and the distribution of mean species richness depended on the number of years between inventories.Results In both mountain ranges, much less of the difference in species composition was attributable to turnover of species composition within sites over time than to spatial differences among sites. Annual species richness in the Toquima Range was more variable than in the Shoshone Mountains, but again far less of the variation in species richness was attributable to year than to differences among sites.Main conclusions Despite the fact that desert ecosystems are not expected to be highly resilient to global environmental change, there may be a time lag between deterministic environmental changes and a detectable faunal response, even in taxonomic groups that are known to be sensitive to changes in climate and vegetation. Although information on species richness and similarity of species composition are among the most practical data to collect in managed landscapes, these measures may not be highly sensitive to environmental changes over the short to moderate term.
Dispersal and the interspecific abundance‐occupancy relationship in British birds
Authors: Gaston Kevin J. , Blackburn Tim M. 
Published: August 2003

ABSTRACTAimTo test the prediction that deviations of species from the positive interspecific relationship between abundance and occupancy (a measure of geographical range size) are related to differences in dispersal.LocationGreat Britain.MethodsQuantitative data on the abundances, occupancy and dispersal distances of British birds are compared using phylogenetic comparative methods.ResultsMeasures of natal and adult dispersal distance, and the intraspecific variance in these parameters, explain little variation in occupancy in addition to that accounted for by population size. Individual dispersal variables failed to explain significant variance when added individually to a model with population size as a predictor. Migrants and species using wet habitats tend to disperse further than residents and dry habitat species. Analysing these four groups separately revealed effects of dispersal only on the occupancy attained by dry habitat species.ConclusionsThe only consistent predictor of occupancy in these analyses was population size.
From intent to impact: developing clinical leaders for service improvement
Authors: Hardacre Jeanne E. , Keep Jane 
Published: August 2003

AbstractThis article describes an approach to evaluating a leadership‐development programme which considers the impact of the programme on individuals, their organizations and the services they manage. Participants were clinical leaders from the health system in Eire, aiming to further develop their leadership skills, awareness and potential. The programme was used as a vehicle for linking personal development, as a leader, with leading improvements at work. Based on the principles of action learning, the programme was underpinned by the application of learning to practice, and the evaluation process was integral to the design and delivery of the development activities. Perceptions of the participants and key stakeholders were used as a baseline to identify desired changes in culture, structure, behaviour and processes in the services where participants worked. Participants used action learning and the content of programme modules to lead changes in their service areas. Perceptions of services at the beginning of the programme were compared with those at the end by using a visual analogue scale, a process that provided an indication of the extent of service improvement and change achieved in organizations by participants. The quantitative data was complemented by qualitative data which reported the personal development of participants’ leadership skills and awareness. Lessons for future evaluation of leadership‐development programmes are suggested. Sufficient time needs to be built into the design and delivery of programmes to embed ongoing evaluation within the development process. Time spent on this at early stages aids an in‐depth understanding and high level of ownership of the evaluative process by participants. To gain optimum benefit from stakeholder rating, the choice of stakeholders involved needs to take account of unavoidable stakeholder attrition. Methods for identifying organizational support for change, the relative involvement of chosen stakeholders in the change process, and external sources of data to triangulate the reported outcomes, would also enhance the overall evaluation approach.
The construction of plagiarism in a school of nursing
Authors: Paterson Barbara , Taylor Lynn , Usick Brandy 
Published: August 2003

AbstractDespite clear policies for handling reported occurrences of plagiarism, and the inclusion of antiplagiarism statements in course syllabi and university calendars, reports of both student and faculty plagiarism in universities has increased dramatically in the past decade. Critics indicate that current approaches to prevent plagiarism in universities are limited by their focus on the individual and by their failure to consider the contextual influences in university settings. Eight faculty members and 10 students in a university school of nursing were interviewed about their understanding of, and response to, plagiarism. The participants viewed plagiarism primarily as a student problem caused by moral breakdown or ignorance. Faculty indicated that they most often overlooked university policy for reporting plagiarism if the offence was deemed as unintentional or caused by personal stress. Students were aware that plagiarism was wrong, but undergraduate students frequently conceptualized it as an ‘academic quirk’. The article concludes with a discussion of the implications of the research findings to university schools of nursing.
Mature‐aged medical students: a qualitative study
Authors: Chur‐Hansen Anna 
Published: August 2003

AbstractMature‐aged entry students have been found, in previous research, to experience difficulties not always shared by their younger classmates. The majority of research has used quantitative approaches to explore these differences. The aim of this qualitative study was to explore the experiences of mature‐aged medical students in relation to their learning at university. Four students from one Australian medical school were interviewed about their experiences, and the data were analysed qualitatively. Ten themes were identified: perceived differences between mature‐aged and younger students; financial difficulties; social support; relationship problems; illness; negative emotions; discrimination; necessary personality traits; supportive relationships; and the emotions experienced on being able to study medicine. These students undergo a number of substantial stressors as a result of their studies. Given the desirable qualities that they possess, medical educators should be developing strategies to encourage such students and minimize the obstacles they face.