bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pressure ulcer prevention in intensive care – a randomised control trial of two pressure‐relieving devices
Authors: Theaker C. , Kuper M. , Soni N. 
Published: March 2005

SummaryPressure sores are a potential complication of intensive care. Modern methods of pressure sore prevention centre around the use of pressure‐relieving devices. Few studies exist that confirm the effectiveness of these devices. This study evaluates the effectiveness of two devices, the Hill‐Rom Duo® mattress and the KCI TheraPulse®. High‐risk patients were randomly assigned to receive one of two devices. We excluded those patients who had pressure sores upon admission. Those patients that did develop a pressure sore had their wound digitally photographed and graded by two independent tissue viability nurses. Sixty‐two patients were included (30 TheraPulse® , 32 Duo®). Nine developed a pressure sore (6 Duo®, 3 TheraPulse®). No statistical differences between the two devices could be found. The longer a patient was nursed on a device, the greater the risk of pressure sore development. Despite the use of these devices, pressure sores can still develop in the Intensive Care patient population.
Quality of life before and after intensive care
Authors: Cuthbertson B. H. , Scott J. , Strachan M. , Kilonzo M. , Vale L. 
Published: March 2005

SummaryQuality of life is often thought to be poor before and after intensive care unit admission. The aim of this study was to investigate changes in quality of life before and after intensive care. A prospective cohort study of 300 consecutive patients admitted to intensive care was performed in a Scottish Teaching Hospital. Quality of life was assessed premorbidly and 3, 6 and 12 months after intensive care admission for surviving patients using SF‐36 as well as EQ‐5D scores at 12 months. The median value for age was 60.5 years and for APACHE II score, 18. The mean length of stay was 6.7 days. SF‐36 physical component scores decreased from premorbid values at 3 months (p = 0.05) and then returned to premorbid values at 12 months (p < 0.001). The mean physical scores were below the population norm at all time points but the mean mental scores were similar or higher than these population norms. Patients who died after intensive care discharge had lower quality of life scores than did survivors (all p < 0.01). Poor premorbid quality of life was demonstrated and appears to reduce after ICU discharge. For survivors there was a slow increase in physical quality of life to premorbid levels by the end of the first year but these remained lower than in the general population. ICU patients experience a considerable longer‐term burden of ill health.
Effects of a height and weight adjusted dose of local anaesthetic for spinal anaesthesia for elective Caesarean section*
Authors: Harten J. M. , Boyne I. , Hannah P. , Varveris D. , Brown A. 
Published: March 2005

SummaryIn this prospective, randomised, double‐blind study, we compared the effects of two dosage regimens. Pregnant patients at term were randomly assigned to two groups to be given diamorphine 0.4 mg in hyperbaric bupivacaine 0.5% 2.4 ml or diamorphine 0.4 mg in a volume of hyperbaric bupivacaine 0.5% adjusted according to the patient's height and weight. Adequate anaesthesia was provided in all patients in both groups. The onset of the sensory block for cold and pinprick was faster with the fixed dose regimen (p = 0.01). There were more spinal blocks to above the first thoracic dermatome in the fixed dose group (17.1% vs. 2.2%, p = 0.022). Hypotension occurred in 71.7% vs. 50.0% of patients in the fixed dose and adjusted dose groups respectively (p = 0.035). In the fixed dose group, more patients required ephedrine to treat hypotension (79.5% vs. 56.8%, p = 0.022) and a larger median dose was administered (9 mg vs. 6 mg, p = 0.042). The decrease in mean (SD) arterial pressure was less in the adjusted group (35.0 (16.4) mmHg vs. 28.0 (13.5) mmHg, p = 0.036).
Assessing the applicability of scoring systems for predicting postoperative nausea and vomiting
Authors: Van Den Bosch J. E. , Kalkman C. J. , Vergouwe Y. , Van Klei W. A. , Bonsel G. J. , Grobbee D. E. , Moons K. G. M. 
Published: March 2005

SummaryWe have validated two scoring systems for predicting postoperative nausea and vomiting, derived by Apfel et al. and Koivuranta et al. from 1388 adult inpatients undergoing a wide range of surgical procedures. The predictive accuracy of the scoring systems was evaluated in terms of the ability to discriminate between patients with and without postoperative nausea and vomiting (discrimination) and agreement between observed and predicted outcomes (calibration). Discrimination and calibration were less than expected based on previous reports, with both scoring systems providing risk predictions that were too extreme. The area under the ROC curve was 0.63 for Apfel et al.'s scoring system and 0.66 for Koivuranta et al.'s scoring system. Neither of the scoring systems provided a risk threshold for administering anti‐emetic prophylaxis that yielded satisfying results in terms of predictive values, sensitivity and specificity. Hence, in their original forms, the scoring systems do not guarantee accurate prediction of the risk of postoperative nausea and vomiting in other patient populations. Koivuranta et al.'s scoring system appears to be more robust across different populations.
Evaluating a family‐centred intervention for infant sleep problems
Authors: Thome Marga , Skuladottir Arna 
Published: March 2005

Aim.  This paper reports a study to describe changes in parents’ distress after a family‐centred intervention for sleep problems of infants.Background.  Infant sleep problems are common and are related to depressive symptoms in mothers, but their impact on fathers has rarely been studied. Because childhood sleep problems and parental distress are associated, their interdependence should be recognized in research and in paediatric sleep practice.Methods.  All children hospitalized for sleep problems in a hospital in Iceland in 1997–1998 and their parents were studied using a pre‐ and post‐test quasi‐experimental design. The sample consisted of 33 infants (6–23 months of age), 33 mothers and 30 fathers. Parents’ distress was assessed before and after treatment with regard to: (1) fatigue and resulting symptom distress; (2) parenting stress; (3) state‐anxiety; and (4) depressive symptoms. Infants were treated for a variety of sleep problems by a paediatric nurse. The parents were simultaneously treated for distress by either the paediatric nurse or a specialist, depending on the nature of their problems.Results.  Mothers and fathers experienced a high degree of distress before the intervention, with no significant difference between them. Two months after the intervention both parents’ distress had significantly improved. Parents’ degree of distress was at a psychopathological level before the intervention but was reduced to population norms 2 months after the intervention. The paediatric nurse intervention was sufficient to reduce distress for 83% of parents.Conclusions.  Health care professionals who care for infants with sleep problems should pay attention to the distressed responses of parents and support their recovery. An intervention such as that described here could be used by nurses for this purpose.
Beliefs about health and diabetes in men of different ethnic origin
Authors: Hjelm Katarina G. , Bard Karin , Nyberg Per , Apelqvist Jan 
Published: March 2005

Aim.  This paper reports the findings of a study exploring the health and illness beliefs of men with diabetes, who were from different cultural backgrounds and living in Sweden.Background.  No studies have been reported that have focused on the beliefs about health and illness in men with diabetes mellitus of different ethnic origin. Beliefs may affect self‐care and care‐seeking behaviour.Method.  An explorative study design and purposive sampling procedure was used. Focus‐group interviews were held with 35 men with diabetes and aged between 39 and 78 years. Fourteen participants were born in Arabic countries, 10 in former Yugoslavia and 11 in Sweden.Findings.  Important factors for health were the ability to be occupied/employed and economically independent and, especially among Arabs and former Yugoslavians, sexual functioning. Swedes focused on heredity, lifestyle and management of diabetes, while non‐Swedes claimed the influence of supernatural factors and emotional stress related to the role of being an immigrant and migratory experiences as factors related to development of diabetes and having a negative influence on health. Swedes and Arabs described health as ‘freedom from disease’ in contrast to many former Yugoslavians who described health as ‘wealth and the most important thing in life’. Knowledge about diabetes was limited among the men studied, but Arabs showed an active information‐seeking behaviour compared with Swedes and former Yugoslavians. Non‐Swedish respondents, particularly Arabs, had sought help from health care professionals to a greater extent than Swedes, who were more likely to use self‐care measures.Conclusion.  Being occupied/employed and having knowledge about the body and management of diabetes are important for positive health development. There are dissimilarities in beliefs about health and diabetes that influence self‐care behaviour and health care seeking. Men's cultural backgrounds and spiritual beliefs need to be considered in diabetes care.
Maternal–fetal attachment: an integrative review
Authors: Cannella Barbara L. 
Published: March 2005

Aims.  This paper presents an integrative review of the literature that aimed to (a) review, categorize and critique the published research on maternal–fetal attachment (MFA), (b) analyse and interpret the MFA findings and (c) evaluate the state of knowledge on MFA and provide directions for future research.Background.  Previous researchers have examined MFA in independent studies using a variety of research designs. There was a need to synthesize the findings across studies in order to evaluate the knowledge developed about MFA since the construct was created.Methods.  Five stages for conducting an integrative review were carried out. The research problem was identified; data were collected; data were evaluated; findings were analysed and interpreted. Forty‐one studies of MFA were located using the online databases of Medline, International Nursing Index, Cumulative Index of Nursing and Allied Health Literature, and Psychological Information. The keywords for the search were MFA, parental–fetal attachment, and prenatal attachment.Findings.  Of the 41 studies reviewed, there were 152 findings relevant to the analysis. Of the 152 findings, 70 were statistically significant, while 82 were not.Conclusions.  Research focusing on MFA has begun to create a body of scientific knowledge. This needs to be expanded through continued research using a variety of designs.
Programme‐related stressors among part‐time undergraduate nursing students
Authors: Nicholl Honor , Timmins Fiona 
Published: March 2005

Aim.  The aim of this paper is to report a study exploring the perceived stressors identified by a group of 70 students who undertook a part‐time degree at one Irish university.Background.  In the literature on stress, part‐time nursing students who are undertaking continuing education programmes appear to have received little attention. Stress amongst nurses is evident within the nursing literature but little information is available on the specific stressors that affect Registered Nurses who undertake further academic study. Anecdotally, students attending part‐time programmes while working full‐time report high levels of stress.Method.  Quantitative methods were used. While many instruments exist to measure overall stress, this study aimed to explore student's perceptions of specific stressors associated with academic study. We used a questionnaire developed from the literature on the topic.Results.  Factors related to writing assignments at degree level, fulfilling personal needs and academic demands, were perceived as major stressors by these students. Factors of little concern were financial issues and attendance on the programme. Individual items receiving highest mean scores were: trying to balance work commitments and the required study (mean 3·89, sd = 1) and the prospect of the final examination (mean 3·86, sd = 1). This study was limited by the use of convenience sampling and self‐report methods. Larger studies are required to support the findings. In addition, student stress was not observed or measured.Conclusion.  Those involved in the delivery of nurse education programmes to part‐time students need to consider the impact of the workload on student welfare, and to prepare students for demands of the programme.
Factors influencing the decision of older people living in independent units to enter the acute care system
Authors: Cheek Julianne , Ballantyne Alison , Roder‐Allen Gerda 
Published: March 2005

Aims and objectives.  This South Australian‐based study explored and described the factors influencing the decision of older people living in the community in independent living units to enter the acute care system.Background.  Community‐based older Australians, an increasing population segment, make choices about support needed to optimize health and well‐being. This includes when to enter the acute care system. Entering this system has potential risks as well as benefits. The current South Australian Department of Human Services policies of ‘keeping older people out’ of the acute care system has implications for prevention and early intervention measures and requires an understanding of how and why older people enter the acute care system.Method.  In‐depth interviews were conducted with older people (N = 31) and their families (N = 10), drawn from three South Australian aged care organizations providing independent living unit accommodation, and focus groups (N = 14) were conducted with stakeholders to identify factors influencing the decision of older people living in independent living units to enter the acute care system.Findings.  Analysis of the data revealed eight facets influencing this group of older people's decision‐making with respect to entering the acute care system; they were: expectations of support in the independent living unit not being met; the presence/absence of safety nets; lack of after‐hours support; the desire to remain independent; the general practitioner as pivotal; the influence of others; perceptions of the emergency department; and having access to information.Relevance to practice.  These facets provide insights into entry processes, links and relationships that form an interface between primary care, community care, the aged care industry and the acute system. Analysis of these insights highlight prevention and early intervention responses that can promote the health and well‐being of older people, potential ways to streamline services, as well as gaps in current services.
Nutritional status and clinical outcomes of older patients in rehabilitation
Authors: Neumann S. A. , Miller M. D. , Daniels L. , Crotty M. 
Published: March 2005

AbstractBackground  Malnutrition is associated with poor outcomes in older adults and those admitted to rehabilitation may be particularly at risk.Objective  To assess the nutritional status and outcomes of older adults in rehabilitation.Subjectsandmethods  We recruited 133 adults ≥65 years from consecutive rehabilitation admissions. Nutritional status was assessed using the mini nutritional assessment, body mass index (BMI) and corrected arm muscle area (CAMA). Outcomes measured included length of stay, admission to higher level care, function and quality of life (QOL).Results  Sixty‐two (47%) subjects were well nourished, 63 (47%) at risk of malnutrition and eight (6%) malnourished. Twenty‐two (17%) and 27 (20%) were below the desirable reference values for BMI and CAMA respectively. Subjects at risk of malnutrition/malnourished had longer length of stay (P = 0.023) and were more likely to be admitted to higher level care (P < 0.05). These subjects also had poorer function on admission (P < 0.001) and 90 days (P = 0.002) and QOL on admission (P < 0.008) and 90 days (P = 0.001). Those with low CAMA were twice as likely to be admitted to higher level care (P < 0.05) and had poorer function at 90 days (P = 0.017).Conclusions  Over half our sample was identified as at risk of malnutrition or malnourished and this was associated with poorer clinical outcomes.
Policy Networks, Elections, and State Subsidies1
Authors: Zahariadis Nikolaos 
Published: March 2005

AbstractWhat are the effects of electoral competition on the disbursement of state subsidies in industrialized democracies? I argue that the scope of subsidies, which ranges from economy‐wide to regional and industry‐specific subsidies, is determined by the extent of political (electoral) monopoly conditioned by economic threats from foreign competition. The mechanism through which electoral competition is linked to subsidies is the policy network. I assess this argument by examining thirteen Organization for Economic Cooperation and Development (OECD) countries in the period 1990–1993. The findings offer amendments to models of policy networks and speak to the importance of domestic institutions on factor mobility and trade policy.
Border Security Technologies: Local and Regional Implications
Authors: Ackleson Jason 
Published: March 2005

AbstractThe Bush administration's “Smart Border” accords with Mexico and Canada present a number of important implications for North America's border communities and regions. As part of the plans, new security technologies have emerged as the preferred policy solution to the difficult problem of screening for weapons and terrorist incursions into the United States through its international boundaries while maintaining flows of goods and individuals, key drivers of globalization and hallmarks of the North American Free Trade Agreement (NAFTA) era. These new technological systems have various capabilities, ranging from prescreening cargo to identifying problematic travelers to detecting nuclear material in trucks. Deploying these systems in border communities, however, invokes a range of important economic, social, and political challenges, all of which are under examination in this work. Using a risk‐centered approach to United States border security, this article explores several technologically oriented border control systems: screening, biometrics, and information technology. The research is based on regional field research and a public policy analysis method that uses Birkland's “focusing event” framework, a model that provides insights into the postcrisis policy formation process. The article concludes by offering an initial appraisal of these policies within the context of risk, interdependent border communities, and an open democratic society.
A Prospect Theory Analysis of California's Initiatives in Implementation of its Zero Emission Vehicles (ZEV) Mandate1
Authors: Majumdar Sarmistha R. 
Published: March 2005

AbstractIn 1990, the state of California passed the pioneering mandate on zero emission vehicles (ZEV). This technology‐forcing regulation is aimed at improvement of air quality and protection of public health from the adverse effects of air pollutants from automobiles. Facing severe opposition from the auto industry, the mandate has been revised a number of times, most recently in 2003, whereby the requirement for ZEVs have been made to align with the pace of technology development. Review of strategies used in implementation of the mandate has revealed greater emphasis on the economic incentives for rather than on environmental merits of ZEVs. Using prospect theory as the framework for analysis, the reasons have been explored. The findings of the study help us to understand how decisions are made with respect with to deviations from a mental anchor point and through the process of evaluation of losses and gains.
Utilization‐Focused Evaluation
Authors: Briedenhann Jenny , Butts Steve 
Published: March 2005

AbstractGovernments, in both developed and less‐developed nations, promote rural tourism as an instrument of socioeconomic development. Tourism scholars highlight the use of evaluation as a tool in managing the development of tourism. Despite this, few evaluation studies appear to form an integral part of tourism development practice. Nevertheless, systematic evaluation is becoming a more common constituent of tourism policy and planning. However, the importance of evaluation lies not only in its technical correctness, but also in how the evaluation results are used. The emphasis on the use of evaluation findings in the utilization‐focused evaluation approach suggested by this article is congruent with this contention.
Systematic, Political, and Socioeconomic Influences on Educational Spending in the American States1
Authors: Saeki Manabu 
Published: March 2005

AbstractFor decades, scholars have debated the relative explanatory power of economic and political factors in determining policy outputs. In addition, I introduce a new concept, “systematic determinants,” which includes incrementalism and proportionalism. Policy spending is likely to change only marginally, or incrementally, from previous spending levels. Also, the relative sizes of policy programs in a government are likely to remain similar, or proportional.In my study of the elementary and secondary educational spending by the state governments of the United States in 2000, I found that the systematic determinants, such as incrementalism and proportionalism, have a greater influence on the educational spending. Also, my finding shows that Democratic‐majority legislative chambers are likely to increase educational spending.
A Turn in the Epistemology and Hermeneutics of Twentieth Century U⋅ūl al-Fiqh
Authors: Johnston David 
Published: March 2005

AbstractI argue here that an epistemological shift has taken place in twentieth century u⋅ūl al-fiqh: away from the classical/orthodox Ash'arī position in which the human mind simply discovers the divine law and extends it to new cases on the basis of consensus (ijmā') and analogical reasoning (qiyās); and toward a position in which reason is empowered to uncover the ratio legis behind the divine injunctions — a distinctly Mu'tazilī a pproach. This shift has been accompanied by a privileging of universal ethical principles (kulliyyāt), now identified as the aims of the Law (maqā⋅id al-sharī'a), over the specific injunctions of the texts (juz'iyyāt) — a hermeneutic strategy that has often favored public interest (ma⋅laha) as the chief criterion for developing fresh legal rulings in the light of new sociopolitical conditions. The main theoreticians discussed h ere are Muhammad'Abduh, Muhammad Rashīd Ridā,'Abd al-Razzāq Sanhūrī, 'Abd al-Wahhāb Khallāf, Muhammad Abū Zahra, and Muhammad Hashim Kamali.