bluuebunny/crossref_metadata_2025_split huggingface dataset:
Progression of renal disease in interleukin‐4 transgenic mice: involvement of transforming growth factor‐β
Authors: Rüger Beate M. , Hasan Qurratulain , Erb Klaus J. , Davis Paul F. 
Published: March 2003

Recent reports have suggested the involvement of interleukin‐4 (IL‐4) in glomerular pathophysiology. Using immunohistochemistry and reverse transcriptase polymerase chain reaction we investigated the renal lesions in transgenic (tg) mice with widely distributed IL‐4 expression including the kidney, and measured the serum levels of the cytokines transforming growth factor‐β (TGF‐β) and IL‐4 by ELISA.Transgenic animals exhibited glomerular hypertrophy with progressive mesangial sclerosis leading to renal failure. Renal IL‐4 transcript expression, mesangial accumulation of collagen types I, III, IV and V, and immune deposition accompanied by increased expression of TGF‐β1 protein and mRNA were observed. Seven day‐old transgenic animals showed early renal fibrotic changes in the absence of immune deposits or TGF‐β1 upregulation. The sera of transgenic mice not only showed elevated levels of circulating IL‐4 (tg: 76.6 pg/ml ± 7.1 vs wildtype (wt): < 3 pg/ml), but significantly decreased TGF‐β1 levels (tg: 18.9 ng/ml ± 4.1 vs wt: 38.7 ng/ml ± 2.9; P < 0.005). The disease severity correlated with the serum IL‐4/TGF‐β1 ratio rather than with the IL‐4 concentration.These data suggest that renal IL‐4 production results in matrix accumulation prior to any immunological insult, that increased circulating IL‐4/TGF‐β1 ratios are associated with renal immunopathological manifestations and that upregulation of renal TGF‐β1 expression following glomerular Ig deposition accelerates the sclerosis and exacerbates disease development.
Dental care in acute lymphoblastic leukaemia: experiences of children and attitudes of parents
Authors: Collard M. M. , Hunter M. L. 
Published: March 2003

Objectives. To profile the dental experiences of a group of children diagnosed as suffering from Acute Lymphoblastic Leukaemia (ALL) and to examine: 1) how parents of children diagnosed as suffering from ALL perceive the importance of dental care; 2) parental preferences with regard to the provision of dental care for children with ALL. Setting. The study was conducted in one of the 22 United Kingdom Children’s Cancer Study Group (UKCCSG) centres. Sample and methods. Data were collected by means of a structured interview, employing an administered questionnaire. Results. The majority of children had attended a dentist both prior to, and following diagnosis, though the regularity of such attendance was variable and the receipt of dental preventive advice inconsistent. Parents appeared to place a high level of importance on their children’s dental care, with more than two‐thirds expressing a preference for this to be provided within the Paediatric Oncology Unit. Conclusions. There is a need to establish means by which regular dental attendance may be encouraged and facilitated in the difficult circumstances posed following diagnosis. All healthcare professionals need to be equipped to give clear, consistent oral health advice. This, together with appropriate preventive measures, should be incorporated in oral care protocols. In accordance with the wishes of parents in this study, it is recommended that a comprehensive paediatric dental service be provided at all UKCCSG centres.
Parental anxiety as a possible predisposing factor to child dental anxiety in patients seen in a suburban dental hospital in Nigeria
Authors: Folayan M. O. , Adekoya‐Sofowora C. A. , D. Otuyemi O. , Ufomata D. 
Published: March 2003

Summary. Introduction. The aim of this study was to determine the relationship between parents’ anxiety level and that of the child patient.Methods. The Short Form of the Dental Anxiety Survey Schedule was administered to 81 children who were attending the dental clinic for the first time. The Dental Anxiety Scale was also used to collect relevant information from the parents.Results. There was no statistically significant correlation between the anxiety level of the mother (r = −0·02, P = 0·82) or the father (r = −0·59, P = 0·62) and that of their child. However, bivariate analysis showed a closer association between the anxiety levels of the mother and the child (P = 0·055) compared to that between the father and the child (P = 0·475) although this was again found not to be statistically significant.Conclusion. Assessment and management of the anxiety level of the mother may be needed in some cases, both to manage the child effectively and to break the cycle of dental care anxiety in families.
Self‐report treatment techniques used by dentists to treat dentally anxious children: a preliminary investigation
Authors: Buchanan H. , Niven N. 
Published: March 2003

Summary. Objective. To investigate the extent to which dentists report their encouragement to dentally anxious children to blunt (distract from the procedure) or monitor (give information about the procedure) during treatment.Setting. British Society of Paediatric Dentistry conference.Subjects and methods. One hundred and two of 155 delegates (66% response rate) completed a Monitor Blunter Treatment Checklist (MBTC), which was included in their conference pack. Participants were asked to tick all of the 10 statements (five monitoring and five blunting) that reflected how, in general, they would treat a dentally anxious child.Results. Dentists chose significantly more monitoring than blunting statements. Treatment strategies relating to explaining procedures were endorsed by the majority of dentists, while distraction was chosen by less than a third.Conclusion. Dentists tend to use monitoring strategies that adhere generally to the principles of the Tell‐Show‐Do technique. This may have implications if the anxious child has a ‘blunting’ coping style.
Allowing and assisting patients to die: the perspectives of oncology practitioners
Authors: Pierce Susan F. 
Published: March 2003

Allowing and assisting patients to die: the perspectives of oncology practitionersThe moral distinctions between prolonging life, allowing for a dignified death, and assisting patients to die (hastening death) are troublesome to health practitioners. On 26 June 1997 the United States Supreme Court ruled that individuals do not have a constitutional right to physician‐assisted suicide, but that individual states can legislate their preferences. Given this ruling it becomes important to ascertain the opinions of practitioners caring for persons who are at the end of their life. The data from interviews with 11 nurses and 10 physicians, who practice in the field of oncology, revealed issues associated with the care of dying persons. How health professionals integrated their perspectives of science/data with their perspectives on persons and personal goals affected the vigour with which they would institute treatment for the terminal patient. Further, ethical uncertainty dominated the decision making of all participants in this study when they were confronted with the question of assisting/hastening patients’ dying.
Experiential learning: issues for supervision
Authors: Dewar Belinda Jane , Walker Esther 
Published: March 2003

Experiential learning: issues for supervision This paper reports on an evaluation of work‐based learning within a postregistration community health nursing degree programme. Work‐based learning is primarily concerned with the process of learning and with encouraging the individual to be explicit about how and what they learn so that their experiential learning may be assessed and accredited. The methodology of Illuminative Evaluation was adopted, with case studies (n=6) used as the means of exploring in depth the different perspectives of the major stakeholders (that is, the students, their workplace supervisors and their academic supervisors). The data comprised documentation, participant and nonparticipant observation, interviews and focus groups. The initial aim was to examine the potential benefits of work‐based learning to students and to describe its impact on their practice. However, what emerged through the course of inquiry was a gap between the educational philosophy of work‐based learning and the way in which work‐based learning was delivered within the department concerned. Work‐based learning provides educators with an opportunity to debate openly fundamental issues about the nature of educational practice; in particular, about the role of the supervisor in facilitating students’ learning. As the evaluation highlights, if this debate does not occur, existing educational practice remains unchanged and the potential benefits to students of this new educational philosophy are not realized. Furthermore, it is by engaging in a reflective process in relation to their own experience that educators can begin to understand how to facilitate that process in others.
Critical thinking and nursing scripts: the case for the development of both
Authors: Greenwood Jennifer 
Published: March 2003

Critical thinking and nursing scripts: the case for the development of both It is argued that contemporary nursing education’s emphasis on the conscious development of nurses’ critical reasoning skills fails to take account of the complexity of both human cognition and clinical nursing practice. Human cognition centrally includes unconscious or tacit processes and clinical nursing practice is typified by the simultaneous presentation of clinical and non‐clinical cues and competing clinical goals. Contemporary emphases on conscious critical thinking are largely consistent with the differing theoretical frameworks which have informed the study of nurses’ clinical reasoning in the last 30 years, most of which permit the use of simulated case study. These frameworks, that is, decision theory, information processing and skills acquisition theory, are described and their limitations highlighted. In addition, an alternative theor‐ etical framework, that of schema or script theory, which does take account of the complexities of cognition and practice, is discussed. Its implications for nursing practice and education are also outlined.
School nursing: costs and potential benefits
Authors: Cotton Linda , Brazier John , Hall David M.B. , Lindsay Geoffrey , Marsh Peter , Polnay Leon , Williams T. Sim 
Published: March 2003

School nursing: costs and potential benefits Background. Previous reports that variations in school nursing resources across the UK had no relationship to deprivation; controversy about the changing role of the school nursing service. Objectives. To measure the resources allocated to school nursing, determine whether the variations can be explained by deprivation, and assess whether the allocation of school nursing time to a range of tasks is in line with current evidence and perceptions of changing needs. Study design. Quantitative economic analysis; qualitative descriptive study. Setting. Detailed study of four English districts with diverse characteristics; staffing and service questionnaire and telephone survey of 62 districts. Main measures. Staff resources and their salaries; measures of population and deprivation; activity statistics. Results. There were wide variations in the cost of the school nursing service, but in contrast to previous reports 24% of the variance was explained by deprivation. There were no clear associations with any other social or educational variables. The greatest allocation of time was in routine screening and surveillance tasks. Relatively little time was allocated to other activities such as health promotion, support of special needs or unwell children, or teenage clinics. The expenditure on school nursing is only loosely related to deprivation and the results of this study offer guidance on what districts should spend to achieve equity of provision. Conclusions. The current allocation of resources to school nursing in between districts comparisons is not equitable and the use of school nursing time is out of step with current evidence of need and effectiveness.
Disability, nursing research and the importance of reflexivity
Authors: Northway Ruth 
Published: March 2003

Disability, nursing research and the importance of reflexivity Reflexivity has been viewed as a way of promoting quality within the research process. Its importance is highlighted in both the literature concerning nursing research and that which relates to disability research. However, whilst disabled people comprise a key client group for nurses the need for nurse researchers working in this field to adopt a reflexive approach to their work has not been explored in depth. In this paper the relevance of reflexivity to nursing research is discussed and current debates concerning disability research are explored. It is argued that there are particular reasons why it is necessary for nurse researchers to adopt a reflexive approach when focusing on disability. First, there is a need to examine closely the definitions of disability which underpin our research and practice. Second, it is noted that nurse researchers may be viewed as part of a system which disables people with impairments. Finally, it is important to reflect critically upon whose interests are served by such research. Some strategies for promoting reflexivity are also explored. It is concluded that a failure to address these issues via a process of critical reflection may mean that nursing research is viewed as unhelpful by disabled people. This in turn has implications for nursing practice.
Nurses and whistleblowing: the ethical issues
Authors: Wilmot Stephen 
Published: March 2003

Nurses and whistleblowing: the ethical issues Whistleblowing – the public exposure of organizational wrongdoing – presents practical and ethical dilemma for nurses, and needs to be seen as part of a spectrum of increasingly confrontative actions against miscreant organizations by their employees. The ethics of whistleblowing can only be understood in relation to its moral purpose, whether that is to achieve a good outcome (a consequentialist view) or fulfil a duty (a deontological view). The consequentialist perspective is unable on its own to resolve problems arising from the balance of good and harm resulting from the act of whistleblowing (where considerable harm might be caused) or of responsibility for that harm. A deontological approach provides an analysis of these problems but raises its own problem of conflicting duties for nurses. However, a strong argument can be made for the precedence of the nurse’s duty to the patient over her duty to the employer. Although both duties are based on an implicit or an explicit promise, the promise to a person (the patient) must take precedence over the promise to an organization. It can even be argued that duty to the employer may in fact justify whistleblowing by nurses in some circumstances. However, the consequences of whistleblowing are forced upon nurses in a different way by the fact that the danger of reprisals acts as a deterrent to whistleblowers, however justified their actions may be. A more robust approach to the protection of whistleblowers is needed on the part of the government and the National Health Service (NHS) to remedy this situation.
Development of a theoretical framework describing relatives’ involvement in palliative care
Authors: Andershed Birgitta , Ternestedt Britt‐Marie 
Published: March 2003

Development of a theoretical framework describing relatives’ involvement in palliative care Background. The present study is based on four earlier studies in which the authors classified the relative’s involvement in palliative care into different categories and described the involvement as ‘involvement in the light’ or ‘involvement in the dark’. Aim. The aim of the study was to develop a theoretical framework concerning the involvement of relatives based on an in‐depth analysis of the results of the four earlier studies. Method. Walker & Avant’s (1995) strategies for theory construction were used for development of the framework. A number of different concepts, assumptions and statements about relatives’ involvement were penetrated in an in‐depth analysis. Results. From the concepts two theoretical ‘blocks’ of the relatives’ involvement were developed and these constitute the foundation for the framework. One is based on concrete descriptions of the concepts ‘to know’, ‘to be’ and ‘to do’. The other describes how the concepts of ‘involvement in the light’ and ‘involvement in the dark’ differ. Factors that promoted involvement in the light were professional care based on humanistic values, a stronger sense of coherence on the part of relatives, an appropriate illness trajectory, and other available resources. The opposite was the case for those who were involved in the dark. Five assumptions successively developed which together form the theoretical framework. Conclusions. An important conclusion that can be of importance in palliative care is that the manner in which the staff act toward the patient and relatives influence relatives’ possibilities for involvement, patients’ possibilities for an appropriate death, and the possibilities the staff have to give good care.
Expanding the enablement framework and testing an evaluative instrument for diabetes patient education
Authors: Stamler Lynnette Leeseberg , Cole Mary M. , Patrick Linda J. 
Published: March 2003

Expanding the enablement framework and testing an evaluative instrument for diabetes patient education Background. Strategies to delay or prevent complications from diabetes include diabetes patient education. Diabetes educators seek to provide education that meets the needs of clients and influences positive health outcomes. Aims. (1) To expand prior research exploring an enablement framework for patient education by examining perceptions of patient education by persons with diabetes and (2) to test the mastery of stress instrument (MSI) as a potential evaluative instrument for patient education. Method. Triangulated data collection with a convenience sample of adults taking diabetes education classes. Half the sample completed audio‐taped semi‐structured interviews pre, during and posteducation and all completed the MSI posteducation. Qualitative data were analysed using latent content analysis, descriptive statistics were completed. Results. Qualitative analysis revealed content categories similar to previous work with prenatal participants, supporting the enablement framework. Statistical analyses noted congruence with psychometric findings from development of MSI; secondary qualitative analyses revealed congruency between MSI scores and patient perceptions. Conclusions. Mastery is an outcome congruent with the enablement framework for patient education across content areas. Mastery of stress instrument may be a instrument for identification of patients who are coping well with diabetes self‐management, as well as those who are not and who require further nursing interventions.
Self‐reported health and glycaemic control in Tanzanian and Swedish diabetic patients
Authors: Smide Bibbi , Lukwale Jane , Msoka Agnes , Wikblad Karin 
Published: March 2003

Self‐reported health and glycaemic control in Tanzanian and Swedish diabetic patients Aims of the study. Aims of the study. To investigate self‐reported health in adult Tanzanian and Swedish diabetic patients in relation to the general population in the two countries and to investigate whether diabetic patients with poor glycaemic control also rated their self‐reported health to be impaired. Design/methods. The study design was cross‐sectional and comparative. One hundred and fifty Tanzanian patients were age‐ and gender‐matched with Swedish diabetic patients. Self‐reported health was measured using the generic SF‐36 health questionnaire, measuring eight different health domains. Glycaemic control was measured by testing glycosylated haemoglobin (HbA1c). Results. The main results were that Tanzanian diabetic patients had poorer health in comparison with general Tanzanian population living in the same geographical area. In contrast, diabetic patients in Sweden did not markedly differ from the Swedish general population. Furthermore, Tanzanian patients had poorer glycaemic control. In both countries poor glycaemic control did not associate with impaired self‐reported health, with one exception. Tanzanian patients with unsatisfactory or poor glycaemic control had significantly poorer reported health in the mental health domain. Conclusions. The results indicated that patients’ health should be assessed using a specific health measure in addition to general medical measures.
Efficacy of the Shinki bioclean room for preventing infection in neutropenic patients
Authors: Shinjo Kaori , Takeshita Akihiro , Yanagi Mitsuaki , Yokota Kazuko , Hirano Kazumi , Suzuki Mieko , Ohnishi Kazunori , Ohno Ryuzo 
Published: March 2003

Efficacy of the Shinki bioclean room for preventing infection in neutropenic patients Aim of the study. To investigate the effectiveness of a new type of bioclean room named Shinki bioclean room (SBCR) for the prevention of infection during neutropenia after intensive chemotherapy in comparison with a standard laminar air flow room (LAFR). Background. Recently, a new industrial technology, wherein a dust‐free and aseptic environment is created by circulating air containing nanometre order ultra fine water droplets with abundant negative air ions, has been developed in Japan. Methods. The air cleanliness of SBCR was examined by measuring airborne particles and microorganisms. Bacteriological samples for environment culture were taken by means of exposed settle‐plates. In addition, the frequency of pneumonia and fever higher than 38°C were examined in 34 patients with acute leukaemia who received intensive chemotherapy in SBCR or LAFR. Results. The number of airborne particles (≥0·5 μm) was 70 particles/ft3, and that of airborne microorganisms was 0·00 colony forming unit/ft3 in SBCR, and neither bacteria nor fungi were detected. The numbers of colonies of bacteria and fungi on air settle‐plates were fewer in the SBCR than in the LAFR regardless of the presence of patients or the nurse entering. The frequency of pneumonia during chemotherapy for acute leukaemia was lower in the SBCR group (0%, 0/19 cases) than in the LAFR group (27%, 4/15 cases) (P=0·0294) and the frequency of fever higher than 38°C also tended to be lower in the SBCR group (53%, 10/19 cases) than in the LAFR group (80%, 12/15 cases) (P=0·0973). Conclusion. The SBCR is equal or superior to LAFR in preventing infection during neutropenia. Other advantages for SBCR are a low level of noise (40 dB), easy control of temperature and humidity, and efficient removal of odour. In addition to the quiet and comfortable atmosphere, expected favourable effects of negative air ions may give higher quality of life for patients in SBCR than those in LAFR. Further studies will be needed to examine the safety, benefits and effects of the negative ion exposure.