bluuebunny/crossref_metadata_2025_split huggingface dataset:
Psycho‐educational interventions for children with chronic disease, parents and siblings: an overview of the research evidence base
Authors: Barlow J. H. , Ellard D. R. 
Published: November 2004

AbstractBackground  The role of psycho‐educational interventions in facilitating adaptation to chronic disease has received growing recognition and is in keeping with policy developments advocating greater involvement of patients in their own care. The purpose of this paper is to provide an overview of the current literature regarding the effectiveness of psycho‐educational interventions for children and adolescents with chronic disease, their parents and siblings.Methods  Electronic searches were conducted using AMED, CINAHL, Cochrane Database, DARE, HTA, MEDLINE, NHS EED, PsycLIT, PsycINFO, and PubMED. Inclusion criteria were systematic reviews, meta‐analyses and overviews based on traditional reviews of published literature. The titles of papers were reviewed, abstracts were obtained and reviewed, and full copies of selected papers were obtained.Results  No reviews of psycho‐educational interventions were found for either parents or siblings. Twelve reviews of interventions for children and adolescents were identified: chronic disease in general (three); chronic pain (one); asthma (three); chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) (one); diabetes (two); juvenile idiopathic arthritis (JIA) (one) and one informational intervention for paediatric cancer patients. The main focus was on disease management (particularly in asthma and diabetes) with less attention being paid to psychosocial aspects of life with a chronic condition. Overall, there is evidence of effectiveness for interventions incorporating cognitive‐behavioural techniques on variables such as self‐efficacy, self‐management of disease, family functioning, psychosocial well‐being, reduced isolation, social competence, knowledge, hope, pain (for chronic headache), lung function (asthma), days absent from school (asthma), visits to A & E (asthma), fatigue (CFS), and metabolic control (diabetes). A number of gaps and limitations were identified across all disease categories, such as inadequate description of interventions, small sample sizes, and lack of evidence regarding cost‐effectiveness.Conclusion  This overview has highlighted the need to extend the evidence base for psycho‐educational interventions, particularly in a UK context. It is essential that effective interventions are implemented and embedded in service provision in order to maximize empowerment through self‐care for children, adolescents and their parents.
A literature review to identify interventions to improve the use of medicines in children
Authors: Costello I. , Wong I. C. K. , Nunn A. J. 
Published: November 2004

AbstractBackground  It is estimated that 200 million prescriptions for children and adolescents were issued in the UK during 2002. Therefore, it is important for the National Service Framework for Children (NSFC) to include advice on managing medicines effectively for children. This literature review was performed at the request of the NSFC Medicines External Working Group in order to provide underpinning evidence in the development of advice on managing medicines.Methods  Detabases, websites and conference abstracts were searched systematically to identify information on managing medicines in children in 2003. This article reported the results on medication review, concordance, enhanced medicines access through community pharmacy services and the use of medicines in schools.Results and conclusions  Although there is little evidence specific to paediatrics, the objectives and rationale of medication review could be expected to apply to chronic diseases in children. Issues such as polypharmacy, wastage, repeat prescriptions and medication problems could be similar. The benefits seen in adults may also occur in children, and medication review may possibly have a role in the management of medicines in children. There is an obvious role for pharmacists in ensuring the safety of over‐the‐counter medications and provision of information and education to parents, carers and adolescents. Evaluation and provision of necessary education and training to community pharmacists is needed, even in the most basic paediatric issues such as sugar‐free medications. The evidence suggests that treatment compliance and adherence are generally lower in children than in adults, particularly in adolescents as they approach independence. Those with learning disabilities and infants are likely to be at risk of non‐compliance, although little work has been done in these populations. Children and adolescents need appropriate parental and professional support in taking control of their medication and treatment. The management of medicines in school would appear to be far from ideal. Further research into school‐based medicines education and outreach clinics would also be beneficial.
The impact of day care on socially disadvantaged families: an example of the use of process evaluation within a randomized controlled trial
Authors: Toroyan T. , Oakley A. , Laing G. , Roberts I. , Mugford M. , Turner J. 
Published: November 2004

AbstractAim  This paper describes a process evaluation that was conducted alongside a randomized controlled trial of out‐of‐home pre‐school day care. The evaluation aimed to: (1) describe the intervention; (2) document the day care received by participating families; (3) describe the social context of the trial; and (4) provide data to assist in the interpretation of trial outcomes.Methods  The setting for the trial was an out‐of‐home day care Centre in Hackney, East London. Process data were collected through the use of questionnaires, interviews, and researcher field‐notes. Data from questionnaires were collected from 120 mothers and included data on 143 children. Interviews were undertaken with 21 participating mothers. Staff also completed questionnaires and the Head of the Centre was interviewed. The quality of care provided was assessed using the Early Childhood Environment Rating Scale.Results  Process data collected during the trial suggest that the day care provided was education‐led, flexible in catering to families’ needs, and was of a very high quality. The social context of the trial resulted in financial pressures, which may well have influenced the intervention provided. Data collected through in‐depth interviews suggested that it may be the flexibility of day care that is particularly important in allowing women to return to paid employment, but that the loss of benefits when starting work may have meant no increase in household income.Conclusion  The paper illustrates the value of conducting a process evaluation alongside a randomized trial, particularly where complex interventions are involved. In this case, where the intervention was not provided by the research team, the evaluation allowed an insight into the content of a multifaceted intervention, which is useful in interpreting the trial's results, and in explaining the possible effects of the social context on the intervention.
The effect of income inequality and macro‐level social policy on infant mortality and low birthweight in developed countries – a preliminary systematic review
Authors: Spencer N. 
Published: November 2004

AbstractObjective  To carry out a preliminary systematic review of literature to address the question – among rich nations (or states within nations) what is the evidence that income inequality and differences in macro‐level social policy affect rates of infant mortality and low birthweight (LBW)?Study design A systematic literature review.Search strategy  Medline database (1968–August 2003) was searched for empirical studies of the relationship between macro‐level economic and social policies in rich nations and rates of infant mortality (IMR) and LBW. Cross‐national comparison of infant mortality and LBW that did not compare the effects of macro‐level economic and social policies was excluded from the review as were studies including less developed countries. Keywords representing IMR and LBW were entered into Medline along with exposures related to international comparison and macro‐level policy. Abstracts obtained from the initial search were reviewed for relevant studies. Full papers of potentially relevant studies were obtained and reviewed for inclusion. Secondary search of papers cited in included papers was undertaken. For this review, papers were not excluded on the basis of quality although methodological limitations were commented on and taken into account in interpreting the results. Summary statistics were not estimated.Results  Twelve studies, fulfilling the inclusion criteria, were identified. Ten studies examined the association of IMR with income inequality, eight of which reported a statistically significant positive association with higher levels of inequality after adjustment for a range of variables. Six studies reported significant positive associations of IMR with other indicators of less re‐distributive social and economic policy. Associations with LBW were reported in four studies; three showed significant positive associations with higher levels of income inequality and one showed no association with low levels of parental leave entitlement. Methodological differences, particularly the wide range of variables used to adjust for confounding, make interpretation of the findings difficult.Conclusions  The results of this review represent a preliminary attempt to summarize the literature linking macro‐level economic and social policies in rich nations with IMR and LBW. The findings, taking account of the methodological limitations of the review and of the included studies, suggest a statistically significant association between IMR and higher income inequality and other indicators of less re‐distributive social policy. Only three studies examined the association of income inequality with LBW and, although they suggest a significant association, further studies will be needed to confirm this finding.
The social and economic consequences of childhood asthma across the lifecourse: a systematic review
Authors: Milton B. , Whitehead M. , Holland P. , Hamilton V. 
Published: November 2004

AbstractBackground  Asthma prevalence rates are high, and may be increasing in the Western world, particularly among children. The aim of this study was to evaluate the longer‐term social and economic consequences of having asthma as a child and to determine whether adverse consequences are more severe for poorer children.Methods Results from published and unpublished, quantitative and qualitative studies were synthesized narratively to examine the impact of childhood‐onset asthma on school attendance, academic achievement and employment in adulthood. The question of whether the impact differed for different social groups was also examined.Findings  Twenty‐nine good quality studies were identified, including in total 12 183 children with asthma or wheeze. Compared with asymptomatic children, those with asthma missed more days of school (additional absence as a result of asthma ranged from 2.1 to 14.8 days). Studies of academic achievement found that children with asthma performed as well as their healthy peers. The existing evidence on labour market performance is sparse, but there is an indication that people with asthma during childhood experience disadvantage in later employment. In an examination of consequences by social position, children with asthma from deprived areas were more likely to miss school than their more affluent peers, and minority ethnic children were also more likely to have poor school attendance. The only qualitative study suggested that children with asthma strove to participate fully in every aspect of their daily lives.Interpretation  Although asthma limits children's daily activities and affects their social activities, this research synthesis found little evidence of major, adverse long‐term social and economic consequences in studies reviewed. Further longitudinal research using comparison groups is needed to fill key gaps in the existing evidence base.
Spatial and temporal trends in abundance of Atlantic salmon, Salmo salar, in Newfoundland with emphasis on impacts of the 1992 closure of the commercial fishery
Authors: Dempson J. B. , O'Connell M. F. , Schwarz C. J. 
Published: November 2004

AbstractClosure of the Newfoundland commercial Atlantic salmon, Salmo salar L., fishery in 1992 was the most restrictive measure introduced to help rebuild depressed local stocks of salmon. Here, the effects of the closure are evaluated by analysing trends in abundance since 1984, and estimates of survival in both freshwater and marine environments derived from enumeration of salmon at fish counting facilities. While freshwater production of smolts generally has been maintained, marine survival rates remain low (2–10%), and highly variable. Overall, total stock size differs little from that prior to the closure of the commercial salmon fishery. Spawning escapements have increased by a factor of 2 or 3 in some rivers, but in other areas total returns are lower on average than those prior to the fishery closure. Factors other than exploitation are contributing to lack of stock recovery, resulting in continued conservation concerns.
Nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention
Authors: Moore Zena , Price Patricia 
Published: November 2004

Background.  Pressure ulcers are not a plague of modern man; they have been known to exist since ancient Egyptian times. However, despite the increasing expenditure on pressure ulcer prevention, pressure ulcers remain a major health care problem. Although nurses do not have the sole responsibility for pressure ulcer prevention, nurses have a unique opportunity to have a significant impact on this problem.Aims and objectives.  The specific aims of the study were to identify:• Staff nurses’ attitudes towards pressure ulcer prevention.• The behaviour of staff nurses’ in relation to pressure ulcer prevention.• Staff nurses’ perceived barriers towards pressure ulcer prevention.Design.  A cross‐sectional survey method was used.Methods.  A randomly selected sample of staff nurses (n = 300) working in an acute care setting in an urban location was invited to participate. Data were collected using a prepiloted questionnaire. Data analysis was carried out using SPSS version 10 and SPSS Text Smart version 1.1.Results.  The nurses surveyed demonstrated a positive attitude towards pressure ulcer prevention. However, prevention practices were demonstrated to be haphazard and erratic and were negatively affected by lack of time and staff. These barriers prevented the nurses’ positive attitude from being reflected into effective clinical practice. Education, although poorly accessed, or made available, was rarely cited as impeding practice in this area.Conclusion.  This study suggests that positive attitudes are not enough to ensure that practice change takes place, reinforcing the complex nature of behavioural change. Implementation strategies should introduce ways in which key staff can be empowered to overcome barriers to change.Relevance to clinical practice.  This study provides a unique exploration of Irish nurses’ attitudes, behaviours and perceived barriers towards pressure ulcer prevention, thereby contributing to the body of knowledge on this subject. As tissue viability is a new and emerging speciality, this information will contribute to evidence based practice in this area of patient care and will form the basis for the development of an educational strategy for pressure ulcer prevention and management.
Inter‐rater reliability of the EPUAP pressure ulcer classification system using photographs
Authors: Defloor Tom , Schoonhoven Lisette 
Published: November 2004

Background.  Many classification systems for grading pressure ulcers are discussed in the literature. Correct identification and classification of a pressure ulcer is important for accurate reporting of the magnitude of the problem, and for timely prevention. The reliability of pressure ulcer classification systems has rarely been tested.Aims and objectives.  The purpose of this paper is to examine the inter‐rater reliability of classifying pressure ulcers according to the European Pressure Ulcer Advisory Panel classification system when using pressure ulcer photographs.Design.  Survey was among pressure ulcer experts.Methods.  Fifty‐six photographs were presented to 44 pressure ulcer experts. The experts classified the lesions as normal skin, blanchable erythema, pressure ulcer (four grades) or incontinence lesion. Inter‐rater reliability was calculated.Results.  The multirater‐Kappa for the entire group of experts was 0.80 (P < 0.001). Various groups of experts obtained comparable results. Differences in classifications are mainly limited to 1 degree of difference. Incontinence lesions are most often confused with grade 2 (blisters) and grade 3 pressure ulcers (superficial pressure ulcers).Conclusions.  The inter‐rater reliability of the European Pressure Ulcer Advisory Panel classification appears to be good for the assessment of photographs by experts. The difference between an incontinence lesion and a blister or a superficial pressure ulcer does not always seem clear.Relevance to clinical practice.  The ability to determine correctly whether a lesion is a pressure ulcer lesion is important to assess the effectiveness of preventive measures. In addition, the ability to make a correct distinction between pressure ulcers and incontinence lesions is important as they require different preventive measures. A faulty classification leads to mistaken measures and negative results. Photographs can be used as a practice instrument to learn to discern pressure ulcers from incontinence lesions and to get to know the different grades of pressure ulcers. The Pressure Ulcer Classification software package has been developed to facilitate learning.
A randomized controlled trial to measure the effectiveness of a sacral wedge in preventing postoperative back pain following trans‐urethral resection of the prostate (TURP) in lithotomy position
Authors: Pietrocola Peter , Riley Robin G , Beanland Christine J , Kelly Catherine , Radnell Jenny 
Published: November 2004

Background.  Postoperative back pain is a common, yet under reported, complication of surgery. Previous studies, although small in number, have indicated that the use of a sacral wedge is effective in reducing the incidence of postoperative back pain.Aim.  The aim of the study was to test the hypothesis that the intra‐operative use of a sacral wedge would decrease the incidence of postoperative back pain in patients undergoing trans‐urethral resection of the prostate in lithotomy position.Methods.  The design of the study was a randomized controlled trial involving the use of a sacral wedge intra‐operatively in a male population undergoing trans‐urethral resection of the prostate. A total of 236 participants was recruited to the study and allocated to the control or intervention group by block randomization. All patients selected one of three different sized sacral wedges for use during surgery. Data were collected preoperatively, intra‐operatively and at postoperative days 2 and 4 and the tools included a structured questionnaire, Oswestry Disability Questionnaire, a visual analogue scale to measure pain intensity and a body map to record its location.Results.  Fifty‐two per cent of participants reported having a history of back pain and point prevalence on admission to hospital was 27%. Twenty‐eight per cent of participants experienced back pain on day 2 postoperatively and this decreased to 14% on day 4. There was no significant difference between the control and intervention groups. The severity of back pain increased after surgery. Postoperatively there were reports of back pain from participants who had not reported a history of back pain before their admission for surgery.Conclusions.  In contrast to other studies we found no evidence to support the use of a sacral wedge intra‐operatively to reduce the incidence of postoperative back pain.Relevance to clinical practice.  Despite the non‐significant results, the high level of postoperative back pain stills draws attention to the need to develop strategies to reduce its incidence.
Liver transplant patients: their experience in the intensive care unit. A phenomenological study
Authors: Del Barrio Miriam , Lacunza Mª Mar , Armendariz Ana Carmen , Margall Mª Angeles , Asiain Mª Carmen 
Published: November 2004

Background.  The nurses’ knowledge of patients’ experiences contributes to gaining a deeper understanding of their health process, which will help to provide a better foundation for nursing care. The patients’ experiences in the intensive care unit are singular; liver transplant patients constitute a specific group, because generally their admission to the intensive care unit marks the first step towards recovery of their health after a process in which they have lived in fear because their illness was reaching a more or less terminal stage.Aim.  To describe the liver transplant patient's experience in the intensive care unit.Design.  Phenomenological descriptive qualitative study.Method.  In‐depth interviews were carried out with a sample of 10 patients. The interviews were audiotaped and transcribed verbatim. The transcripts were analyzed using the method devised by Giorgi and modified by Baker.Results.  After the data were analyzed, a general description emerged, which includes five themes reflecting the essence of what this group of patients experienced: preconceived ideas marked the way they approached transplant; captured impressions of the intensive care unit's environment and experienced sensations; their perception of the caring behaviour of the nursing staff; support from the social environment (family) and religious beliefs; and their preconceived idea of the intensive care unit contrasted with their lived experience.Conclusion.  This research enabled us to gain in‐depth knowledge of the liver transplant patient's lived experience of the intensive care unit. Nurses can optimize the nursing care plan for this group of patients based on these results.Relevance to clinical practice.  Awareness of the importance that these participants gave to discomfort caused in their basic needs should lead nurses to pay special attention to the nursing interventions to help with these needs. As a result of this research, nurses and other professionals in the intensive care unit know that patients have an immediate sense of positive change. This enables us to reinforce this perception, reminding them frequently that they have already had their transplant and they are progressing well, thereby aiding their recovery. With regard to the social support of liver transplant patients, nurses must facilitate the presence of family members at the patient's bedside, as participants stated that the only support they needed was that of their family.