bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cognitive dissonance and undergraduate nursing students’ knowledge of, and attitudes about, smoking
Authors: Clark Eileen , McCann Terence V. , Rowe Kathy , Lazenbatt Anne 
Published: May 2004

Background.  Smoking is a major cause of morbidity and mortality. Although nurses have an important role in health promotion, and are well placed to see the harmful effects of tobacco smoking, studies suggest that they smoke at much the same rate as the general population.Aim.  The aim of this paper is to report a study examining undergraduate nursing students’ knowledge about the impact of smoking on health, and their attitudes towards smokers and smoking.Methods.  The study took place in 2001, using a non‐probability sample of 366 undergraduate nursing students from an Australian university. Participants completed the Smoking and Health Promotion instrument. Festinger's theory of cognitive dissonance provided an explanatory framework for the findings.Results.  Most respondents who were still smoking began the habit while in high school. Students had greater generic than specialized knowledge about the effects of smoking on health, and there was no significant difference between second and third year students’ knowledge. Those who still smoked had less favourable attitudes towards smoking‐related health promotion than those who had never smoked or stopped smoking. Non‐smokers were more supportive of non‐smokers’ rights than those who continued to smoke, while those who had stopped smoking were undecided. There was minimal association between levels of knowledge and attitudes about being sensitive to smoking‐related health risks.Conclusion.  The findings have implications for both high school education and undergraduate nursing education, and for the recruitment of students to undergraduate nursing programmes. More attention needs to be given in undergraduate nursing programmes to smoking and smoking‐related illnesses, and to nurses’ role in smoking health promotion.
Making portfolios work in practice
Authors: Scholes Julie , Webb Christine , Gray Morag , Endacott Ruth , Miller Carolyn , Jasper Melanie , McMullan Mirjam 
Published: May 2004

Background.  A portfolio captures learning from experience, enables an assessor to measure student learning, acts as a tool for reflective thinking, illustrates critical analytical skills and evidence of self‐directed learning and provides a collection of detailed evidence of a person's competence.Aims.  This paper reports data on how assessors and nursing students match learning outcomes and/or competencies to their practice and then reconstruct those experiences into the format required by the portfolio documentation. The data were gathered as part of a larger study to evaluate the use of portfolios in the assessment of learning and competence in England.Methods.  This three phase stakeholder evaluation was designed to gain the views of those involved in designing, implementing and using portfolios in nurse education. In phase 2, 122 students and 58 nurse teachers were interviewed about their perceptions of portfolio use, and a further 32 students and 26 assessors were interviewed after they had been observed taking part in an assessment process. Thematic data analysis was used.Findings.  Assessors and students underwent a complex process of deconstructing learning outcomes/competences to fit these to their practice. These then had to be reconstructed through the written medium to fit the structure of the portfolio. Confirmation that this met teachers’ expectations was essential to allay feelings of insecurity.Conclusions.  To achieve maximum benefit from the portfolio as a learning tool to link theory and practice, there needs to be a clear fit between the model of portfolio and the professional practice that is to be assessed. Outcomes and competences, as well as the type of evidence required to demonstrate their achievement, and integration of the whole experience should match the students’ stage of professional and academic development. Over‐complex approaches to practice assessment, particularly in the early stages of students’ careers, can detract from clinical learning in favour of learning how to complete the portfolio successfully.
‘The good nurse’: visions and values in images of the nurse
Authors: Fealy Gerard M. 
Published: May 2004

Background.  The various ways in which the nurse has been publicly portrayed do not merely reflect the value of nursing in society, but also define the boundaries of nursing, and reveal the ideologies and systems of power‐brokerage at work in shaping nursing. Therefore, it is of profound interest to the profession to continue to examine the ways in which the nurse is and has been portrayed.Aim.  This paper aims to present a historical analysis of the image of the nurse in public discourses in Ireland.Methods.  Using a framework of critical discourse analysis within the method of historical research, the paper draws on documentary primary sources to present an analysis of discourse concerning the ‘good nurse’.Findings.  In exposing the diverse ways in which the nurse has been depicted in Irish public discourses, the origins of the ‘good nurse’ ideal are identified, the reasons for its continued promotion are critically examined, and the effects of the ideal on the development of nursing in Ireland are considered.Conclusions.  While the ways in which Irish nurses have been depicted in public discourses have similarities with international nursing imagery, the ‘good nurse’ ideal has a uniquely Irish expression, indicating that the image of the nurse is both culture‐specific and changes to reflect the underlying sociocultural context, and prevailing system of political power and influence.
Black house spiders are unlikely culprits in necrotic arachnidism: a prospective study
Authors: Isbister G. K. , Gray M. R. 
Published: May 2004

Abstract Twenty‐five patients with definite bites by Badumna spp. spiders were recruited prospectively. Bites occurred across Australia, 92% from October to March, and most during daylight. Pain occurred in all cases, was severe in seven cases, with a median duration of 5 min. Other effects included: puncture marks (24%), swelling (12%) and erythema (68%). Minor systemic effects occurred in 4 bites. No patient had a necrotic ulcer (0%; 97.5% confidence interval 0−14%). Black house spiders (Badumna spp.) are unlikely to cause necrosis, contrary to reports of suspected bites. Patients can be reassured and do not require any further investigation or treatment. (Intern Med J 2004; 34: 287−289)
Neurological manifestations of cardiac myxoma: a review of the literature and report of cases
Authors: Ekinci E. I. , Donnan G. A. 
Published: May 2004

Abstract Background and aims: Cardiac myxoma is a rare but important cause of stroke, which affects young people. More recently the diagnosis has been enhanced by the use of echocardiograms. We aimed to review the neurological presentations, including stroke, of cardiac myxoma in this modern era of diagnosis and management.Methods : Records of patients with neurological presentations at the Austin and Repatriation Medical Centre and The Northern Hospital were retrieved from 1985 to late 2001, using International Classification of Diseases codes for atrial myxoma. Published literature reports were obtained by using Medline search database. An iterative process of bibliography review was utilised to identify reports not found by primary search. Case demographics, neurological presentations, investigations, treatment and outcome were recorded.Results : From the Austin and Repatriation Medical Centre and The Northern Hospital, 6 cases were reported in detail and 107 cases from the published literature were analysed. The mean age of all cases was 43 (range 6−82). There was a female to male predominance (3:2). While there were overlapping neurological presentations, the most common presentation was ischaemic stroke (83% of all patients) most often in multiple sites (41%). The other presentations included syncope (28%), psychiatric presentations (23%), headache (15%) and seizures (12%). Commonest means of reaching the diagnosis was by echocardiography. The myxoma was surgically resected in 69% of cases. Of all cases, 24% were autopsy reports, almost all prior to availability of echocardiograms (in mid‐1970s).Conclusions : Patients who presented with neurological complications of cardiac myxoma were young and stroke was by far the most common single presentation. Importantly, when all clinical manifestations were considered, almost half were potentially reversible. In recent years, echocardiography has made significant contribution to establishing the diagnosis less invasively. There is uncertainty about the role of anticoagulants. The treatment of choice remains surgical excision, although the timing post stroke is debatable. There is a need for large scale collaborative studies to help refine management strat­egies. (Intern Med J 2004; 34: 243−249)
Renal‐related deaths in Australia 1997−1999
Authors: Li S. Q. , Cunningham J. , Cass A. 
Published: May 2004

Abstract Background:  Despite marked increases in cases of treated end‐stage renal disease in Australia, little is known about renal disease mortality.Aims:  To quantify the contribution of renal diseases to mortality in Australia and to explore the relationship between renal disease and other common diseases as causes of death.Methods:  Data from the Australian Bureau of Statistics on underlying and associated causes of death (based on death certificates) were examined for deaths occurring in 1997−1999 and registered by the end of 1999. Causes of death were coded according to the International Classification of Diseases, 10th Revision (ICD‐10). Several causes outside the ICD‐10 chapter on diseases of the genito‐urinary system (e.g. diabetic renal disease, hypertensive renal disease and congenital malformations of the kidney) were included as renal.Results:  Of 378 832 recorded deaths, renal disease was coded as the underlying cause for 7888 (2.1%) and as an associated cause for an additional 28 012 (7.4%). Almost all renal deaths (98.4%) had at least one other cause of death recorded on the death certificate.Conclusions:  The contribution of renal disease to Australian mortality has been underestimated because of historical reliance on a single (underlying) cause of death. Deaths involving renal disease usually occur in the context of multiple coexisting chronic and/or acute conditions. (Intern Med J 2004; 34: 259−265)
Changes in prevalence and site of care of diabetes in a health district 1991–2001
Authors: Whitford D. L. , Roberts S. H. 
Published: May 2004

AbstractAims  Alongside a rising prevalence of known diabetes, patterns of care for diabetes have been changing in the United Kingdom. The aim of this study is to describe the changes in the prevalence of known diabetes and shift in site of care of patients in a single health district over a 10‐year period.Methods  Repeat cross‐sectional study over 10 years of patients with diabetes resident in North Tyneside district.Results  The crude prevalence of known diabetes in North Tyneside rose from 1.1 to 3.0% between 1991 and 2001. The proportion of patients receiving their diabetes care wholly in primary care rose significantly from 608/2236 (27%) in 1991 to 3995/5809 (69%) in 2001 (χ2 = 968, 1 d.f., P < 0.001). The number of patients attending secondary care also rose by 14% over this period of time from 1508 to 1712 patients.Conclusions  Most of the extra workload of the rising prevalence of diabetes has been met in primary care. However, hospital care has not seen a drop in workload. This has important implications for health care planning, as an increase in resources will be required within both primary and secondary care to meet the needs of the diabetic population.
Increased levels of triglycerides, BMI and blood pressure and low physical activity increase the risk of diabetes in Swedish women. A prospective 18‐year follow‐up of the BEDA*study
Authors: Dotevall A. , Johansson S. , Wilhelmsen L. , Rosengren A. 
Published: May 2004

AbstractAim  To investigate risk factors for the development of diabetes in middle‐aged women.Methods  A random population sample of 1351 women without prior diabetes or cardiovascular disease, aged 39–65 years, took part in a screening study in 1979–1981 with questionnaires, physical examination and blood sampling. Development of diabetes up to 1998 was identified at a second examination in 1997–1998.Results  Seventy‐three women (5.4%) were diagnosed with diabetes during follow‐up. As expected, obesity resulted in a rising age‐adjusted risk with hazards ratio 3.2 [95% confidence interval (CI) 1.3, 8.1] at body mass index (BMI) 24–27 kg/m2, and 8.3 (3.5, 19.7), at BMI ≥ 27, compared with BMI < 22 kg/m2. S‐triglycerides (TG) carried a steeply increasing age‐adjusted risk with hazards ratio 4.0 (95% CI 2.1, 7.6) already at s‐TG 1.0–1.4 mmol/l, 7.1 (3.6, 14.0) at s‐TG 1.5–1.9 mmol/l and 9.3 (4.3, 20.2) at s‐TG ≥ 2.0 mmol/l compared with s‐TG < 1.0 mmol/l. Increasing systolic blood pressure (SBP) to 130–144, 145–159 and ≥ 160 mmHg escalated the hazards ratio of diabetes to 1.6 (0.8, 3.3), 3.6 (1.7, 7.4) and 5.6 (2.7, 11.4), respectively, compared with SBP < 130 mmHg. Also, low physical activity predicted diabetes, with hazards ratio 2.1 (1.3, 3.3) for sedentary compared with non‐sedentary activity. Smoking was not associated with increased risk of diabetes. After adjustment for BMI, SBP and physical activity, increasing TG level remained a strong and significant risk factor for diabetes [hazards ratio 3.0 (1.6, 5.7), 3.7 (1.8, 7.7) and 4.5 (2.0, 10.0), P < 0.001].Conclusions  Among middle‐aged Swedish women even very slightly elevated s‐TG resulted in a considerably enhanced risk of developing diabetes, which was independent of age, BMI, blood pressure and physical activity.
Schizophrenia, the metabolic syndrome and diabetes
Authors: Holt R. I. G. , Peveler R. C. , Byrne C. D. 
Published: May 2004

AbstractThe prevalence of diabetes is increased in patients with schizophrenia. Although many reasons, including hereditary and lifestyle factors, contribute to this association, recently there has been heightened interest in the subject because of the link between the use of the newer atypical anti‐psychotic drugs and the development of diabetes. These drugs cause significant weight gain and this may be one of the mechanisms by which they increase incident diabetes. The increased prevalence of diabetes among people with schizophrenia has implications for the delivery of care by psychiatrists, diabetologists and primary care.
Vascular endothelium and inflammatory process, in patients with combined Type 2 diabetes mellitus and coronary atherosclerosis: the effects of vitamin C
Authors: Antoniades C. , Tousoulis D. , Tountas C. , Tentolouris C. , Toutouza M. , Vasiliadou C. , Tsioufis C. , Toutouzas P. , Stefanadis C. 
Published: May 2004

AbstractAims  Type 2 diabetes mellitus (DM) and coronary artery disease (CAD) are both associated with endothelial dysfunction and elevated oxidative and inflammatory state. We examined the effect of vitamin C on endothelial function and levels of soluble vascular cell adhesion molecule (sVCAM‐1), interleukin‐6 (IL‐6) and tumour necrosis factor (TNF‐α), in DM patients with or without CAD and in non‐diabetic subjects.Methods  Thirty‐seven patients with DM + CAD, 17 patients with DM without CAD and 21 non‐diabetic subjects were divided into groups receiving vitamin C 2 g/day or no anti‐oxidant for 4 weeks. Forearm blood flow was determined using venous occlusion gauge‐strain plethysmography. Forearm vasodilatory response to reactive hyperemia was considered as index of endothelium‐dependent dilation.Results  Baseline levels of IL‐6 and TNF‐α were significantly higher in patients with DM + CAD compared with patients with DM (P < 0.01) or non‐diabetic subjects (P < 0.01). IL‐6 and TNF‐α levels were also higher in DM compared with non‐diabetic subjects (P < 0.05). sVCAM‐1 levels were lower in non‐diabetic controls compared with DM + CAD (P < 0.05) or DM (P < 0.05). Reactive hyperaemia was higher in non‐diabetic controls compared with DM + CAD (P < 0.001) or DM (P < 0.001). Vitamin C significantly increased reactive hyperaemia only in the DM + CAD group, while it had no effect on serum levels of sVCAM‐1, TNF‐α and IL‐6 in any of the groups.Conclusions  Type 2 diabetes mellitus is associated with impaired endothelial function and increased levels of TNF‐α, IL‐6 and sVCAM‐1, especially in patients with DM and CAD. Vitamin C significantly increased forearm vasodilatory response to reactive hyperaemia only in patients with combined DM and CAD.
The advantages and disadvantages of a ‘herbal’ medicine in a patient with diabetes mellitus: a case report
Authors: Wood D. M. , Athwal S. , Panahloo A. 
Published: May 2004

AbstractBackground  Patient‐initiated alternative treatments in the management of chronic conditions are common and increasing in the United Kingdom. To date, there have been no reports of herbal medicine use alone in the management of diabetes mellitus. We report here the case of a man who attained excellent glycaemic control using a ‘herbal’ medicine and reveal how important it was to identify the products of active constituents.Case report  A 48‐year‐old man attending our clinic in Tooting, South London with known Type 2 diabetes, with evidence of both micro‐ and macro‐vascular diabetes‐related complications, was poorly controlled despite a drug regimen consisting of oral metformin and twice daily insulin. He went to India for at least 1 year and on returning to the clinic had excellent glycaemic control off all diabetic medication. While away he had started himself on a regimen of three different ‘herbal’ balls. Samples of blood were found to contain chlorpropamide in a therapeutic concentration; chlorpropamide was also found in one of the balls. He has been counselled on the potential risks associated with chlorpropamide and his treatment reverted to a more conventional treatment regimen.Conclusions  General practitioners and hospital physicians should be alert to those patients returning from abroad on effective ‘herbal’ medications that these may in fact contain an active ingredient.
The value of the Rydel‐Seiffer tuning fork as a predictor of diabetic polyneuropathy compared with a neurothesiometer
Authors: Kästenbauer T. , Sauseng S. , Brath H. , Abrahamian H. , Irsigler K. 
Published: May 2004

AbstractAims  The aim of the study was to investigate the predictive value of the Rydel‐Seiffer tuning fork for detecting diabetic neuropathy and to compare it with an electronic neurothesiometer.Methods  In 2022 consecutive diabetic subjects, peripheral polyneuropathy was diagnosed by vibration perception threshold (VPT) at the tip of both great toes using a 128‐Hz tuning fork and a neurothesiometer, by simple bedside tests and by the presence of neuropathic symptoms. These evaluations were further combined to diagnose peripheral nerve dysfunction (abnormal bedside tests) and symptomatic neuropathy. VPT was also measured in 175 non‐diabetic control subjects to define normal values.Results  VPT was normal in 1917 subjects and abnormal in 105 (5.2%) patients when measured by the tuning fork. Patients with an abnormal vibration test were significantly (P < 0.0001) older than subjects with a normal vibration sense, while diabetes duration and HbA1c of the former were also significantly elevated. The same was true for the percentages of an abnormal 10‐g monofilament test (66.7% vs. 7.2%, P < 0.0001) and a missing Achilles’ tendon reflex (68.6% vs. 24.8%, P < 0.0001). Finally, the VPT measured by the neurothesiometer was 2.5 times higher in patients with an abnormal tuning fork test (32.0 ± 9.8 vs. 12.5 ± 6.4 V, P < 0.0001). The plot of the difference of both methods against their mean yielded a good agreement of the two VPT measurements, and the tuning fork had a high sensitivity and positive predictive value for the diagnosis of abnormal bedside tests and for symptomatic neuropathy.Conclusion  The tuning fork reliably detected peripheral neuropathy in comparison with the neurothesiometer. A tuning fork is a useful screening test for diabetic neuropathy.
Cyprus’ Accession to the European Union and Educational Change: a critique
Authors: ANGELIDES PANAYIOTIS , LEIGH JAMES 
Published: May 2004

AbstractCyprus will soon become a member of the European Union. The negotiations for its the access have ended and as from next year it will represent one of the countries that will expand the EU. The member countries of the EU have progressed in the field of education, they have high requirements from their schools and offer quality education (although there is no homogeneity amongst their educational systems). Therefore, the future accession of Cyprus to the EU raises many questions regarding the situation of its education system in comparison to the other Members. With a focus on change, this article studies the situation that prevails in Cyprus and examines the different barriers that hamper the development of its educational system. The authors then discuss a number of ways to achieve educational change.
Silver Nitrate Sclerotherapy for ‘Clinically Significant’ Chyluria: A Prospective Evaluation of Duration of Therapy
Authors: Dalela D. , Rastogi M. , Goel Apul , Gupta Vipul P. , Shankhwar S.N. 
Published: May 2004

<i>Objectives:</i> To evaluate and compare the results of regimen A (3 instillations at 8-hourly intervals in 1 day) with the control regimen B (9 instillations at 8-hourly intervals in 3 days) of using 1% silver nitrate solution for renal pelvic instillation sclerotherapy in ‘clinically significant’ filarial chyluria. <i>Materials and Methods:</i> Forty-seven patients with clinically significant chyluria attending on 2 different days our urology clinic were prospectively randomized between two groups; the study group received regimen A (n = 21) while the control group received regimen B (n = 26). The variables evaluated included visualization of pyelolymphatic fistulae on retrograde pyelography, hospital stay, outcome and morbidity of the two regimens. <i>Results:</i> Patients in both groups were comparable for age and sex. The morbidity (fever, symptomatic UTI, hematuria) following regimen A was less than that of regimen B although not statistically significant. The average hospital stay was 3 days for regimen A and 5.5 days for regimen B (p = 0.001). The initial success rate was 80.95% in group A and 92.30% in group B (p = 0.47). The mean duration of follow-up was 15 months (range 9–18). There was no significant difference in recurrence between the two groups during follow-up (group A: 21.05% and group B: 22.72%; p = 0.98). <i>Conclusions:</i> Regimen A was as effective as regimen B. Regimen A had the advantages of having less morbidity and shorter duration of hospital stay. We recommend only a 3-instillation regimen in patients with clinically significant chyluria, particularly those who demonstrate pyelolymphatic fistulae on retrograde pyelography.