bluuebunny/crossref_metadata_2025_split huggingface dataset:
Rationing scarce life‐sustaining resources on the basis of age
Authors: Clarke Clare M. 
Published: March 2003

Rationing scarce life‐sustaining resources on the basis of age Aims. The aim of this paper is to analyse critically the use of age as a criterion to ration scarce life‐sustaining resources within the intensive care environment. Background. Insufficient funding to meet the escalating costs of health care has resulted in a scarcity of life‐sustaining resources. Although an explicit policy of rationing by age within the United Kingdom (UK) has not been formulated, decisions to withhold or withdraw treatment are already being made on the basis of patients’ biological age rather than medical need. Method. Three contrasting arguments are analysed: the ‘equal worth’, ‘fair innings’ and ‘prudential lifespan’ arguments. Conclusions. In certain circumstances rationing by age is both morally permissible and justified. However, the capacity to benefit from treatment has to be considered whatever the age of the individual and any measure of benefit needs to take a broad range of medical, ethical and economic factors into account. If age is to be used, as a criterion to ration limited resources explicit, national guidelines need to be developed and applied consistently to ensure that arbitrary differences in the treatment older people receive does not occur.
Nurse endoscopists in United Kingdom health care: a survey of prevalence, skills and attitudes
Authors: Pathmakanthan Shri , Murray Iain , Smith Karen , Heeley Rebecca , Donnelly Mark 
Published: March 2003

Nurse endoscopists in United Kingdom health care: a survey of prevalence, skills and attitudes Objectives. To assess the prevalence and potential benefits of attitudes towards nurse endoscopy in the United Kingdom (UK). Design. Postal questionnaire. Subjects. All hospitals in the UK with accident and emergency, general medical and general surgical services in October 2000. Main outcome measures. Number of teaching or district general hospitals employing nurse endoscopists, range of diagnostic and therapeutic endoscopic skills and potential benefits to the endoscopy unit and patients. Results. Seventy‐six hospitals employed 102 nurse endoscopists. Forty‐four nurse endoscopists performed both oesophago‐gastroduodenoscopy (OGD) and flexible sigmoidoscopy with solitary OGD and flexible sigmoidoscopy performed by 17 and 31, respectively. Three performed full colonoscopy while seven could perform all three procedures. Nurse endoscopists were found to provide good patient care in the majority of endoscopy units with no compromise in safety. Lead clinicians were keen to restrict nurse endoscopy to diagnostic OGD and flexible sigmoidoscopy only in the majority of units. Conclusions. Nurse endoscopy is widely practised in the UK and is not limited to one procedure or solely for diagnostic purposes. Benefits include good patient acceptability, improved care and safety. Most clinicians predict an important but restricted role for nurse endoscopy in contributing to endoscopic services.
A method comparison study to assess the reliability of urine collection pads as a means of obtaining urine specimens from non‐toilet‐trained children for microbiological examination
Authors: Farrell Michael , Devine Karen , Lancaster Gillian , Judd B. 
Published: March 2003

A method comparison study to assess the reliability of urine collection pads as a means of obtaining urine specimens from non‐toilet‐trained children for microbiological examination Background. In young, non‐toilet‐trained children, the collection of a urine sample for microbiology can be challenging, with the application of a urine bag being the main method of collection. However, recent research has shown that absorbent pads can be used yielding similar results to bag specimens. However, weaknesses in study design erode confidence in research findings. Therefore, improvements in research design are required to fully evaluate the reliability of pad collection. Aims of the study. This pilot study sought to test the feasibility of a technique for the collection of concurrent bag/pad urine samples from non‐toilet‐trained children, and to assess the reliability of urine pads over bags as a collection method for urine specimens for microbiological evaluation. Design. A pilot, method comparison study. Methods. Twenty concurrent bag and pad specimens were collected from non‐toilet‐trained children, following parental consent. Urine specimens were analysed for presence or absence of white cell count (WBC), and bacterial growth, using standard laboratory methods. Data analysis. The Kappa (κ) statistics and confidence interval (CI) estimation were used to assess agreement between the two collection methods. Results. Despite concurrent samples there was a lack of agreement between bag and pad specimens on both main outcome measures. Agreement between bag and pad specimens for the presence of WBC yielded a κ=0·10 (95% CI: 0·19, 0·39), indicating poor agreement, while a κ of 0·5 (95% CI: 0·12, 0·88) was calculated for the degree of agreement in bacterial growth reflecting moderate agreement. Differences in proportions of the presence of WBC between bag and pad did not quite reach significance at the 5% level 0·2 (95% CI: 0·00, 0·42, P=0·062). For cultures the difference was calculated as 0·15 (95% CI: 0·05, 0·35, P=0·125). Conclusion. The pilot study demonstrates that concurrent urine samples can be obtained without difficulty. Despite poor to moderate agreement on outcome measures the level of agreement is greater than reported in those other studies, that use non‐current methods of urine collection, suggesting an advantage of the concurrent technique. It is recommended that larger scale studies be undertaken using the concurrent collection technique to assess reliability of these findings.
Swiss nurses' knowledge related to health care reforms: an exploratory study
Authors: Spitzer Ada , Perrenoud Béatrice , Desaulles Cécile , Camus Didier , Van Gele Patrick , Périer Jacques 
Published: March 2003

Swiss nurses' knowledge related to health care reforms: an exploratory study Background. This study examines health care reforms' implementation processes from the perspective of nurses' knowledge regarding the reforms. The research has been carried out in the Swiss (Canton Vaud) context, where health care reforms have been initiated, on the National (Federal) level, in 1996. Objectives. Three research questions were formulated: (a) What is the level of nurses' knowledge regarding the basic principles of LAMal (Loi fédérale sur l'assurance maladie, Federal Health Insurance Law)? (b) What is the level of nurses' knowledge concerning the principles of health care reforms in Canton Vaud (NOPS, Nouvelles Orientations de la Politique Sanitaire)? and (c) Are there knowledge differences relating to employment setting (hospital, community, and education), nurses' roles (managerial vs. staff nurses) and level of education? Methods. The sample consisted of a total of 74 nurses. Of these, 20 were employed in the community, 30 in hospital settings and 24 worked in schools of nursing. The research tool utilized was 40‐items nurses' knowledge questionnaire developed for the purpose of this study. Three knowledge subscales and a subscale of certainty were constructed. Results. Overall, data showed a moderate to high mean level of knowledge (around 70% correct responses) on all knowledge scales considered. Community setting, managerial position, and a nonacademic nursing degree were all positively related to higher levels of reforms' knowledge. On the contrary, employment in a hospital setting and having a university degree had both negative impacts on achieving a high score of knowledge. Levels of certainty were significantly higher for LAMal than NOPS and for correct rather than for wrong responses.
Can staff attitudes to team working in stroke care be improved?
Authors: Gibbon Bernard , Watkins Caroline , Barer David , Waters Karen , Davies Steve , Lightbody Liz , Leathley Michael 
Published: March 2003

Background.  Teamwork is regarded as the cornerstone of rehabilitation. It is recognized that the skills of a multiprofessional team are required to provide the care and interventions necessary to maximize the patient's potential to recover from his/her stroke. Literature review.  Critical evaluation of team working is lacking in the literature. Indeed, there is no consensus on a precise definition of teamwork or on the best way of implementing it, beyond a general exhortation to members to work to the same therapeutic plan in a cohesive manner. The literature has highlighted many problems in team working, including petty jealousies, ignorance and a perceived loss of autonomy and threat to professional status. Aim.  To determine if the use of team co‐ordinated approaches to stroke care and rehabilitation would improve staff attitudes to team working. Method.  A pre‐post design was adopted using ‘The Team Climate Inventory’ to explore attitudes to team working before and after introducing the interventions. Local Research Ethics Committee approval was obtained. Results.  Improvements in attitudes towards team working suggest that the introduction of team co‐ordinated approaches (integrated care pathways and team notes) did not result in greater team working. Limitations.  The introduction of an integrated care pathway and team notes is based on an assumption that they would enhance team working. Conclusions.  The results suggest that the introduction of team co‐ordinated approaches (team notes and care pathways) do not improve attitudes to team working, teams appear to take a long time to establish cohesion and develop shared values.
Evaluating the use of developmental action inquiry in constructing a problem‐based learning curriculum for pre‐registration nursing education in Hong Kong: a student perspective
Authors: Pang Samantha M.C. , Wong Thomas K.S. , Dorcas Allen , Lai Claudia K.Y. , Lee Regina L.T. , Lee Wai‐man , Mok Esther S.B. , Wong Frances K.Y. 
Published: March 2003

Background.  Developmental action inquiry (DAI) was chosen as the change strategy for introducing problem‐based learning (PBL) in a pre‐registration nursing programme. The central task was to transform the tutor and student participants to become collaborators in this curriculum reconstruction project. Aim.  This paper expounds the way in which the action inquiry was constructed and in light of students’ feedback analysis, the way in which PBL has made a difference in student learning was evaluated. Design.  Taking into consideration the change context and different group characteristics, the DAI was conducted in terms of two dynamically interlinked circles that formed partnerships between PBL core group members and tutors, and between tutors and students in coconstructing knowledge useful for PBL curriculum development. Findings.  The findings of the student evaluation questionnaire reveal that the majority of students felt PBL made a difference to their expectations of self, the student group and the teacher role in creating a facilitative environment to enhance learning. However, there was a significant difference among individual student group responses. The students’ positive and negative PBL experience in self‐learning, tutor–student interaction, and group‐learning were identified as crucial factors contributing to these group variations. Conclusion.  The evaluation findings show that a paradigm shift from teacher‐centred to student‐centred learning, from valuing self‐learning to co‐operative group‐learning, and from theory‐based to practice‐based learning occurred among the students. DAI was found to be an effective change strategy for transforming participants to become collaborators in searching for useful knowledge and coconstructing the PBL learning context.
What areas of cancer care do Norwegian nurses experience as problems?
Authors: Rustøen Tone , Schjølberg Tore K. , Wahl Astrid K. 
Published: March 2003

Background. As the number of people diagnosed with cancer increases and the treatment of cancer changes and improves, the challenges and problems nurses experience in clinical practice are also changing. Aim. To describe the problems that nurses in cancer care face in their day‐to‐day practice. Such information can be used to improve the quality of nursing care. Design. A questionnaire was distributed to half of the members of the Norwegian Society of Nurses in Cancer Care (n  = 464). Instrument. The survey questionnaire had previously been used in a Canadian study. The nurses were asked to consider 80 different areas relevant to cancer nursing and to indicate the extent to which each posed a problem for them in clinical practice. The sex, age and educational level of the nurses were also recorded, together with the work setting and number of years they had been employed in nursing. Results. The response rate was 43% (199 of 464). The area the nurses experienced as being the greatest problem in their clinical practice was patients' anxiety. Problems connected with nutrition, the development of the cancer itself and grieving, and symptoms like nausea and vomiting and fatigue were also frequently rated as problems. The results also show some significant correlations between the rating of problems and variables such as work setting, years in practice and educational level. Conclusion. The present study shows that nurses in cancer care mainly experience psychological issues as problems in their clinical practice, which confirms previous research. The impact of work setting, years in clinical practice and education was surprisingly small. As the majority of nurses today will meet cancer patients during their professional careers, further research is needed in this area.
The adaptation of written self‐management plans for children with asthma
Authors: Milnes Linda J , Callery Peter 
Published: March 2003

milnes l.j. & callery p. (2003) Journal of Advanced Nursing 41(5), 444–453

The adaptation of written self‐management plans for children with asthma Background. Self‐management plans are an important element of asthma care. Although asthma is common in children, there is limited guidance for adaptation of self‐management plans for children. Aims. A study was conducted in order to develop a set of criteria for adaptation of asthma self‐management plans for school aged children; and to use these criteria to review self‐management plans used in United Kingdom (UK) centres. Methods. Self‐management plans were obtained by telephone survey (response rate: 81%) of 47 selected UK paediatric, respiratory and community centres during the period between March and October 2001. The content of self‐management plans was analysed according to criteria developed from a review of the literature, including objectives, opportunities for individualization, and the implied roles of parent and child in asthma management. Agreement was achieved between the authors and a third independent rater. Results. The majority of centres (31 of 47) used or planned to use adapted self‐management plans while the remainder used the standard National Asthma Campaign self‐management plan. There were wide variations in self‐management plans, including variation in the person to whom plans were addressed, criteria for treatment and the objectives stated for self‐management. Few opportunities were provided for individualization of self‐management. Limitations. The study was limited to the documents used in self‐management in selected centres. Conclusion. The results suggest that many practitioners believe that self‐management education requires adaptation for children. There is little consistency in the adaptation of self‐management plans for children. Principles for devising adapted self‐management plans are proposed.
Genotype by environment interactions in winter survival in red deer
Authors: COULSON  , ALBON  , PEMBERTON  , SLATE  , GUINNESS  , CLUTTON‐BROCK  
Published: March 2003

1.  The extent to which environmental heterogeneity interacts with genetic hetero geneity to affect individual fitness within populations has the potential to affect the dynamics of natural populations and the amount of genetic variation maintained in natural populations, yet is a relatively poorly investigated topic in either ecology or evolutionary biology. 2.  Many individual‐based studies are precluded from such investigations by the practical problems of measuring heritability of traits affecting fitness and the difficulties of experimental manipulation of the study population. One way of demonstrating how commonly genotype by environmental interactions affect fitness, though not their overall importance in determining fitness, is to investigate fitness in a population subdivided by genotype at one or more marker loci. 3.  We analyse data on calf winter survival from a population of red deer from the Isle of Rum, Scotland. Data on individual survival, environmental fluctuations and genotype at 13 loci were collected from 1982 to 1994. 4.  We found associations between survival over the first winter of life and calf genotype at two out of three allozyme loci and five out of 10 microsatellite loci. All of the results remained significant under randomization tests. Other genotypes that initially appeared to have an association with survival were rejected when bootstrapped, usually due to insufficient data or anomalies in the data. 5.  Our results suggest that associations between fitness and genotype are common. Five out of the seven associations found involved interactions with environmental variables. Four of these showed density‐dependent selection with different genotypes showing high survival at high population size compared to low population size and one interacted with autumn rainfall. In a sixth case, genotype interacted with sex.
Fitness‐dependent dispersal in metapopulations and its consequences for persistence and synchrony
Authors: Ruxton Graeme D. , Rohani Pejman 
Published: March 2003

1. We present a novel metapopulation model where dispersal is fitness dependent: the strength of migration from a site is dependent on the expected reproductive fitness of individuals there. Furthermore, individuals continue to migrate until they reach a suitable habitat where their expected fitness is above a threshold value. 2. Fitness‐dependent dispersal has a very strong stabilizing effect on population dynamics, even when the intrinsic dynamics of populations in the absence of dispersal exhibit complex high‐amplitude oscillations. This stabilizing effect is much stronger than that of the density‐independent dispersal normally considered in metapopulation models. 3. Even when fitness‐dependent dispersal does not stabilize the dynamics in a formal sense, it generally leads to simplification, with complex or even chaotic fluctuations being reduced to simple cycles. 4. This form of dispersal also has a strong tendency to synchronize local population dynamics across the spatial extent of the metapopulation. 5. These conclusions are robust to the addition of strong stochasticity in the migration threshold.
Constraints on the reproductive value of vertical transmission for a microsporidian parasite and its female‐killing behaviour
Authors: Agnew Philip , Koella Jacob C. 
Published: March 2003

Summary1. Several species of microsporidian parasites use a mixture of vertical and horizontal transmission among their respective mosquito host species. These relationships vary in how hosts are exploited for either vertical or horizontal transmission. An important factor is that only females can provide vertical transmission. Two types of relationship have particularly been contrasted; those where vertically infected larvae of both sexes are killed late in their development and contribute towards the parasite's horizontal transmission, and those where only male larvae are killed while females experience benign infections, become adults, and contribute towards the parasite's vertical transmission success. The selective killing of males in these latter relationships leads to female‐biased adult sex ratios. These differences among relationships have been suggested to depend on the environmental conditions they experience and on the relative efficiency of vertical or horizontal transmission.2. The transmission behaviour of the microsporidian parasiteEdhazardia aedis(Becnel, Fukuda & Sprague) following vertical transmission was studied as a function of larval food availability to its host, the mosquitoAedes aegypti(L.). The number of vertically infected mosquitoes dying before reaching adulthood increased as larval food availability became less. However, proportionately more females died as food availability decreased and adult mosquito populations became increasingly male‐biased.3. The fate of vertically infected mosquitoes was closely related to their larval growth rate. As food availability decreased and larval growth rates slowed, the parasite's infection had more time to produce its spores and induce the host's mortality before emergence. This disproportionately affected female mosquitoes as they pupate later than males, especially as larval growth rates slow. As late ages at pupation are associated with smaller adult size (≈ lower fecundity), the potential vertical transmission offered by slowly growing female larvae is limited and more success may be gained by exploiting them for horizontal transmission.4. Our results indicate that the relative reproductive value of vertical or horizontal transmission altered with an ecological parameter (larval food availability). Constraints in the life‐history traits of each organism helped to explain why the observed sex ratio was biased towards males rather than females.
Alternative perspectives on consumer–resource dynamics: a reply to Ginzburg
Authors: Berryman Alan A. 
Published: March 2003

Summary 1.
Ginzburg (1998) proposes that models of predator–prey interactions should conform to what he calls the ‘biomass conversion principle’, that consumer reproduction should be directly linked to resource consumption. 2. I argue that consumer–resource models can be built from two different perspectives – biomass conversion or individual survival – and that, as Ginzburg's principle only applies to the first, it should not be used to judge the plausibility of individual survival models. 3. I also suggest that a failure to understand and preserve the distinction between biomass consumption and individual survival may be responsible for much of the confusion and controversy in predator–prey theory.
A method for validating stochastic models of population viability: a case study of the mountain pygmy‐possum (Burramys parvus)
Authors: McCarthy Michael A. , Broome Linda S. 
Published: March 2003

1. A method of validating stochastic models of population viability is proposed, based on assessing the mean and variance of the predicted population size. 2. The method is illustrated with a model of the population dynamics of the mountain pygmy‐possum (Burramys parvus Broom 1895), based on annual census data collected from a single population in the Snowy Mountains of New South Wales, Australia between 1986 and 1997. The model incorporates density‐dependence in survivorship and recruitment, and demographic and environmental stochasticity. 3. The model appeared to make reasonable predictions for the three populations that were used for validation, provided the equilibrium population size was estimated accurately. This may require that differences in habitat quality between populations be taken into account. 4. Following validation, the model was given new parameters using the additional data from the three populations, and the risk of population decline within the next 100 years was assessed. Although populations as small as 15 females are predicted to be relatively safe from extinction caused by stochastic processes, B. parvus appears vulnerable to loss of habitat and reductions in the population growth rate. 5. The approach used in this paper is one of few attempts to validate a model of population viability using field data, and demonstrates that some aspects of stochastic population models can be tested.