bluuebunny/crossref_metadata_2025_split huggingface dataset:
Oral magnesium and vitamin C supplements in asthma: a parallel group randomized placebo‐controlled trial
Authors: Fogarty A. , Lewis S. A. , Scrivener S. L. , Antoniak M. , Pacey S. , Pringle M. , Britton J. 
Published: October 2003

SummaryBackground
Epidemiological studies suggest that higher intakes of dietary vitamin C and magnesium may be associated with a reduced risk of asthma.Objective
To determine whether vitamin C or magnesium supplements improve the clinical control of asthma in primary care patients.Methods
A randomized, placebo‐controlled, double‐blind parallel group trial of 16 weeks supplementation with 1 g/day vitamin C, 450 mg/day magnesium chelate or matched placebo. Three hundred patients aged 18–60 years with physician‐diagnosed asthma, controlled with at least one dose of an inhaled corticosteroid daily, were recruited from 24 primary care practices in Nottingham, UK. The main outcome measures were change in forced expiratory volume in 1 s, forced vital capacity, airway responsiveness to methacholine, mean morning and evening peak flow, symptom scores and bronchodilator use, both individually and as a combined summary statistic.Results
There was no evidence of any beneficial effect of either supplement on any outcome measure of asthma control in the primary intention‐to‐treat analysis, or in an analysis restricted to participants who completed the study.Conclusions
Regular dietary supplementation with vitamin C or magnesium adds no clinical benefit to current standard therapy of asthma in primary care patients.
Nursing interventions for patients with chronic conditions
Authors: Frich Liv Merete Holm 
Published: October 2003

Background. Maintaining independence in older people or restoring and encouraging self‐management in those with chronic conditions are ways of increasing health‐related quality of life and at the same time may achieve cost savings. Nurses often carry out these types of interventions in follow‐up home visits.Aims. To describe nursing interventions during home visits and their effects on people suffering from a range of chronic conditions.Method. A structured descriptive review was carried out using the Medline, Embase, PsycINFO, CINAHL and Cochrane databases and the terms chronic or diabetic or arthrit* or pain and randomi* and [(nurs* and care) or (nurs* and interventions)].Findings. In older people the best outcomes are reached if the target population is ‘the younger‐old’, or if intervention is tailored to elders who have stated health problems. The effect depends on the duration of the follow‐up period, number of follow‐up visits and personality of the nurse. Follow‐up nursing interventions for patients with diabetes can improve psychosocial and health outcomes.Education of health providers and amount of time spent with patients seem to be important for positive outcome. A rheumatology nurse specialist seems to provide equally good clinical results as a rheumatologist and produces better patient‐related outcomes. Compared with a multidisciplinary team treating patients in day care or inpatient settings, a rheumatology nurse specialist provides less patient satisfaction, but equally good clinical outcomes.Conclusions. Patients with chronic conditions often benefited from follow‐up visits by nurses. Visits should be multiple, extended over a long‐term, and interventions should be individualized. The outcomes may be described as patient satisfaction, good clinical outcomes and cost savings. Future randomized controlled trials should describe nurses’ interventions and educational background to enable replication. Randomized controlled trials using the Health Technology Assessment method would permit comparison between studies and be a good foundation for future decision‐making.
Wandering behaviour in people with dementia
Authors: Lai Claudia K.Y. , Arthur David G. 
Published: October 2003

Background. Wandering has been described as one of the most challenging behaviours to manage and yet a search of the literature in the last two decades yields only a limited number of papers that specifically studied wandering.Aim. This paper reviews the current literature on wandering in relation to the nature of the phenomenon, attempts to classify the behaviour, the extent of the problem, the profile of those who wander, postulations about its aetiology, and intervention strategies being employed.Method. Eight literature databases were searched for the last 40 years up to February 2003 using ‘wandering’ and ‘dementia’ as combined keywords. A total of 133 articles was included in the review.Findings. The prevalence of wandering behaviour was difficult to assess and no conclusions could be reached. The typical wanderer depicted in the literature was relatively young in the older population, more cognitively impaired, more likely to be a man, might have experienced sleep problems, had a more active premorbid lifestyle, and used more psychotropic medications. While studies agreed that wanderers are more cognitively impaired, their findings did not necessarily agree on other attributes. Three major approaches, namely the biomedical, psychosocial and person–environment interaction perspectives, in conceptualizing wandering behaviour can be identified from the literature. Medications, activity programmes, behavioural modification and environmental manipulation have been used as interventions but none has so far demonstrated unequivocal effectiveness.Conclusion. Knowledge generated through research remains insufficient to explain fully why and when wandering occurs. Variability in how the phenomenon was defined and studied, and the small size of the samples made generalizability of findings difficult. Future research should incorporate a clearer definition of wandering; a specific targeted population with representative sample size; appropriate subject identification strategies; focussed interventions, and better control conditions.
Early recognition of dementia by nurses
Authors: Manthorpe Jill , Iliffe Steve , Eden Alison 
Published: October 2003

Background. Early recognition of dementia is a key policy objective designed to maximize the efficacy of treatment and to provide timely and appropriate support before crisis occurs. The impact of early recognition of dementia is under‐researched in primary care nursing.Aim. To explore whether community mental health nurses (CMHNs), community nurses (CNs) and practice nurses (PNs) have different perspectives on early diagnosis of dementia and to consider the possible effects of any variation.Method. Data are drawn from questionnaires completed by CMHNs (79), CNs (153) and PNs (36) who attended workshops offered on 24 occasions in 21 settings across the United Kingdom. The workshops attracted a range of primary care practitioners and were part of a training programme on early diagnosis of dementia.Results. Analysis of the data shows some differences in knowledge, experience and confidence between the three nurse groups. CMHNs were more confident in their abilities to recognize dementia and found providing support less difficult than CNs and PNs. CMHNs considered that they were best placed to co‐ordinate services for people with newly recognized dementia. CNs and PNs, however, reported experience of working with people with dementia and many appeared able to respond to early signs and to identify potential sources of support.Conclusions. While CMHNs may have a key role in responding effectively to the newly identified needs of people with early dementia, other nurses working in the community are likely to encounter people with early dementia. In the context of a policy objective to identify people with dementia earlier, all community‐based nurses should be able to recognize the possibility of dementia and support those undergoing referral or assessment. Their confidence in doing so should be enhanced by continued professional development. Training in dementia recognition, involvement in and membership of primary care teams supporting people with dementia should not be confined to CMHNs. Nurses who regularly encounter the general population of older people may be well placed to provide continuity of support for those who may, or may not, have cause to suspect that they or their relatives have early dementia.
Nursing and health care in Indonesia
Authors: Shields Linda , Hartati Lucia Endang 
Published: October 2003

Aim. Indonesia, with its population of over 220 million, has health problems similar to those of other developing countries. In an attempt to provide nurses throughout the world with knowledge about Indonesia, we describe the country, its health system, and problems encountered by nurses and other health professionals.Method. We explain the way the health system works within Indonesian culture, discuss the effects of the international nursing shortage and outline the role of aid agencies. The ethical dilemmas faced by health professionals who care for patients within a poorly resourced system are examined. While the information pertains to the whole country, we focus on the main island of Java, as that is where we have worked and resided.Findings. Nursing education is primarily conducted at senior high school, while medical education is similar to the university education offered in many countries, and allied health professionals are educated to varying standards. Indonesian health officials recognize that the low standard of nursing education contributes to poor health statistics, and they are working hard to improve this. There has been strong support from the government for the implementation of university education for nurses, and for courses within academies that bridge the gap between current standards and the levels of education required for the delivery of optimum health care.Discussion. We both are nurses. One of us is an Indonesian and the other has worked for many years in Indonesia and coordinated a programme that organized exchanges of health professionals working in large tertiary referral hospitals and health departments in Indonesia and Australia. The information presented here is the result of many collaborative projects and gives information not available in published works.
Nutrient intakes of an adult Pakistani, European and African‐Caribbean community in inner city Britain
Authors: Vyas Avni , Greenhalgh Alyson , Cade Janet , Sanghera Baljit , Riste Lisa , Sharma Sangita , Cruickshank Kennedy 
Published: October 2003

AbstractObjectives  To report nutrient intakes for three different ethnic groups living in inner city Manchester and explore under‐reporting in each group.Design  Cross‐sectional survey. All participants completed one of three food frequency questionnaires, specifically developed for each ethnic group, and took part in a larger international survey of risk factors for diabetes and hypertension.Setting  Participants were drawn randomly from seven GP registers in inner city Manchester, UK.Participants  Men and women aged 25–79 years, 86 European, 246 African‐Caribbean origin and 84 Pakistani origin participants were included in the analysis.Results  Body mass index was highest in the Pakistani women, 30.2 kg m−2. European participants had the highest reported energy intakes (EIs) for men and women (10.9 and 9.6 MJ, respectively). Pakistani men and women had the highest percentage of energy from fat (36.7 and 36.6%, respectively). Iron intakes were low in the African‐Caribbean group and calcium intakes were low in the Pakistani group. Under‐reporting [assessed as EI : basal metabolic rate (BMR) ratio <1.2] appeared to be high and occurred across all ethnic groups, with those apparently under‐reporting having higher BMIs in all groups.Conclusion  The data provide nutrient intake estimates in three different ethnic groups using a similar method. Limitations include under‐reporting across all ethnic groups in a similar pattern with under‐reporters having higher BMIs in all groups, as found elsewhere.
Knowledge and use of evidence‐based nutrition: a survey of paediatric dietitians
Authors: Thomas D. E. , Kukuruzovic R. , Martino B. , Chauhan S. S. , Elliott E. J. 
Published: October 2003

AbstractObjective  To survey paediatric dietitians’ knowledge and use of evidence‐based nutrition (EBN).Design  Cross‐sectional survey using reply‐paid questionnaires.Subjects  Paediatric dietitians in Australian teaching hospitals.Main outcome measures  Age, sex, appointment, clinical practice, research activities; attitudes to, training in and use of EBN; and perceived barriers to use of EBN.Statistical analysis  Data were analysed using descriptive statistics (SPSS).Results  Fifty‐nine (86%) of 69 questionnaires were returned. Most (97%) dietitians were women working full‐time (63%), mean age 37 years (±9 SD). Most (75%) dietitians encountered knowledge gaps less than five times per week and most (87%) questions related to therapy. The majority (95%) performed their own literature searches, less than five times per month. All had access to ≥1 electronic literature databases including Medline (n = 58, 98%), Cochrane Library (n = 44, 75%) and CINAHL (n = 35, 59%). Information sources used most often were Medline and consultation with colleagues. Reported barriers to using EBN were lack of time (n = 53, 90%) or lack of skills for critical appraisal of published articles (n = 51, 86%) or literature searching (n = 48, 81%). While 53 (90%) believed in an evidence‐based approach, 43 (73%) either did not practise EBN or rated themselves as beginners.Conclusion  Most dietitians favoured evidence‐based practice, but reported lack of time, skills or rapid access to electronic databases as barriers to its practice.
The prevalence of malnutrition in patients with human immunodeficiency virus on admission to hospital
Authors: Martin S.A. , Phillpot M. , Baldwin C. , Madden A.M. 
Published: October 2003

Introduction: The prevalence of malnutrition in new hospital admissions is between 9 and 60% but it is widely acknowledged that malnutrition is often unrecognized (Lennard‐Jones, 1992; McWhirter & Pennington, 1994; Karlsson & Nordstrom, 2001). In patients with human immunodeficiency virus (HIV), weight loss and wasting are common features, which have been extensively studied and shown to have significant clinical implications. Loss of 5–10% of body weight has been demonstrated to be highly predictive of the development of opportunistic infections and death (Wheeler et al., 1998). However, few studies have examined the frequency of undernutrition in these patients. The aim of the study was to determine the prevalence of malnutrition in HIV patients admitted to a dedicated ward at the Chelsea and Westminster Hospital.Method: Data on height, weight and weight change were collected from patients admitted consecutively between January and April 2002. Body mass index (BMI) and, where a reliable weight history was available, percentage weight loss was calculated. Patients at high risk of malnutrition were identified using the screening tool for adults at risk of malnutrition (BAPEN, 2000), which uses a combination of BMI and percentage body weight loss to determine overall risk. Patients with BMI <18.5 kg m−2 and with weight loss >10% were considered to be at high risk of malnutrition.Results: Data were collected on 120 admissions, of which 100 were eligible for inclusion. Thirty seven patients were found to be at high risk of malnutrition, 19 of whom had a BMI <18.5 kg m−2 and 18 of whom had reported a body weight loss greater than 10% (Table 1). Only six patients of 32 patients in the high‐risk group were identified in both the BMI and weight loss categories.

Classification of patients by BMI and weight loss category

Weight loss category

<5%
5–10%
>10%
Unavailable

BMI category (kg m−2)

>20
30
18
9
12

18.5–20
1
6
3
2

<18.5
4
6
6
3

Values in bold indicate patients at high risk of malnutrition.

Discussion: The results show that a substantial proportion of HIV patients admitted to hospital are malnourished. Using a single measure of identifying patients at greatest risk of malnutrition (either BMI <18.5 kg m−2 or weight loss >10%) can underestimate the number of patients who may be at nutritional risk and require further nutritional assessment and possibly nutritional support.
Direct attachment of cell suspensions to high‐pressure freezing specimen planchettes
Authors: Sawaguchi A. , Yao X. , Forte J. G. , Mcdonald K. L. 
Published: October 2003

SummaryWe describe a procedure for high‐pressure freezing (HPF) of cultured cells using the HPF aluminium planchettes as a substrate. Cells are either grown directly on planchettes covered with Matrigel or allowed to attach to poly‐l‐lysine‐coated planchettes. This method allows for rapid transfer of the cells into the HPF and minimizes physical and physiological trauma to the cells. Furthermore, the yield of well‐frozen cells approaches 100% for every cell type we have tried so far. In this report, we show well‐preserved ultrastructure in mitotic and interphase HeLa cells, isolated gastric parietal cells and isolated gastric glands. Immunogold labelling of H+/K+‐ATPase is shown in parietal cells of isolated gastric glands embedded in LR White resin. The aluminium planchettes appear to have little effect on cell physiology, as demonstrated by the fact that parietal cells cultured for 24–28 h on the planchettes retain their responsiveness to stimulation with histamine.
Freeze‐substitution protocols for improved visualization of membranes in high‐pressure frozen samples
Authors: Giddings T. H. 
Published: October 2003

SummarySpecimen preparation methods based on high‐pressure freezing and freeze‐substitution have enabled significant advances in the quality of morphological preservation of biological samples for electron microscopy. However, visualization of a subset of cellular membranes, particularly the endoplasmic reticulum and cis Golgi, is often impaired by a lack of contrast. By contrast, some efforts to increase membrane staining may lead to excessively granular staining. No one freeze‐substitution method has emerged that both overcomes these limitations and is suitable for all types of analysis. However, one or more of the following protocols, perhaps with minor modifica‐tions, should yield satisfactory results in most cases. Freeze‐substitution in glutaraldehyde and uranyl acetate in acetone, followed by embedding in Lowicryl HM20, generates samples suitable for both immunolocalization and high‐resolution structural studies. Membranes are typically lightly stained but very well defined. Initial freeze‐substitution in tannic acid and glutaraldehyde in acetone prior to exposure to osmium tetroxide significantly enhanced contrast on mammalian cellular membranes. Finally, initial trials indicate that freeze‐substitution in potassium permanganate in acetone can provide strong contrast on endoplasmic reticulum and Golgi as well as other membranes. The tendency of permanganate to degrade cytoskeletal elements and other proteins when employed in aqueous solutions at room temperature is apparently curtailed when it is used as a freeze‐substitution reagent.
The use of filter membranes for high‐pressure freezing of cell monolayers
Authors: Morphew M. K. , Mcintosh J. R. 
Published: October 2003

SummaryRapid freezing of cells and tissues, followed by freeze‐substitution fixation and plastic embedding, has become a highly reliable method for preparing samples for imaging in the electron microscope. High‐pressure freezing is an efficient means of immobilizing suspensions of yeasts, thick pellets of mammalian cells, or small (< 0.5 mm) pieces of plant or animal tissue. Monolayers of cultured mammalian cells that are too thick for efficient immobilization by other modes of rapid freezing have also been successfully preserved by this method. Monolayer cultures are often important because they can be imaged by light microscopy (LM) both before and after their preparation for electron microscopy (EM). Additionally, some monolayer cultures serve as model systems for physiological processes, so it is important that cells under study can grow on a substrate that is both physiologically appropriate and convenient for EM processing. Here we describe a reliable method for preparing mammalian cell monolayers (PtK1 and polarized MDCK) for EM. Our protocol results in good preservation of cellular ultrastructure, it is a useful companion to studies of cell physioloy and, with some limitation, is suitable for correlative LM and EM.
Recent progress in freeze‐fracturing of high‐pressure frozen samples
Authors: Walther P. 
Published: October 2003

SummaryPancreatic tissue, bacteria and lipid vesicles were high‐pressure frozen and freeze‐fractured. In addition to the normal holder, a new type of high‐pressure freezing holder was used that is particularly suitable for suspensions. This holder can take up an EM grid that has been dipped in the suspension and clamped in between two low‐mass copper platelets, as used for propane‐jet freezing. Both the standard and the new suspension holder allowed us to make cryo‐fractures without visible ice crystal damage. High‐pressure frozen rat pancreas tissue samples were cryo‐fractured and cryo‐sectioned with a new type diamond knife in the microtome of a freeze‐etching device. The bulk fracture faces and blockfaces were investigated in the frozen‐hydrated state by use of a cryo‐stage in an in‐lens SEM. Additional structures can be made visible by controlled sublimation of ice (‘etching’), leading to a better understanding of the three‐dimensional organization of organelles, such as the endoplasmic reticulum. With this approach, relevant biological structures can be investigated with a few nanometre resolution in a near life‐like state, preventing the artefacts associated with conventional fixation techniques.
Influence of aldehyde fixation on the morphology of endosomes and lysosomes: quantitative analysis and electron tomography
Authors: Murk J. L. A. N. , Posthuma G. , Koster A. J. , Geuze H. J. , Verkleij A. J. , Kleijmeer M. J. , Humbel B. M. 
Published: October 2003

SummaryCryoimmobilization is regarded as the most reliable method to preserve cellular ultrastructure for electron microscopic analysis, because it is both fast (milliseconds) and avoids the use of harmful chemicals on living cells. For immunolabelling studies samples have to be dehydrated by freeze‐substitution and embedded in a resin. Strangely, although most of the lipids are maintained, intracellular membranes such as endoplasmic reticulum, Golgi and mitochondrial membranes are often poorly contrasted and hardly visible. By contrast, Tokuyasu cryosectioning, based on chemical fixation with aldehydes is the best established and generally most efficient method for localization of proteins by immunogold labelling. Despite the invasive character of the aldehyde fixation, the Tokuyasu method yields a reasonably good ultrastructural preservation in combination with excellent membrane contrast. In some cases, however, dramatic differences in cellular ultrastructure, especially of membranous structures, could be revealed by comparison of the chemical with the cryofixation method. To make use of the advantages of the two different approaches a more general and quantitative knowledge of the influence of aldehyde fixation on ultrastructure is needed. Therefore, we have measured the size and shape of endosomes and lysosomes in high‐pressure frozen and aldehyde‐fixed cells and found that aldehyde fixation causes a significant deformation and reduction of endosomal volume without affecting the membrane length. There was no considerable influence on the lysosomes. Ultrastructural changes caused by aldehyde fixation are most dramatic for endosomes with tubular extensions, as could be visualized with electron tomography. The implications for the interpretation of immunogold localization studies on chemically fixed cells are discussed.