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Selected AbstractsLong chain polyunsaturated fatty acids (LC-PUFA) and perinatal developmentACTA PAEDIATRICA, Issue 4 2001B Koletzko This paper reports on the conclusions of a workshop on the role of long chain polyunsaturated fatty acids (LC-PUFA) in maternal and child health The attending investigators involved in the majority of randomized trials examining LC-PUFA status and functional outcomes summarize the current knowledge in the field and make recommendations for dietary practice. Only studies published in full or in abstract form were used as our working knowledge base. Conclusions: For healthy infants we recommend and strongly support breastfeeding as the preferred method of feeding, which supplies preformed LC-PUFA. Infant formulas for term infants should contain at least 0.2% of total fatty acids as docosahexaenoic acid (DHA) and 0.35% as arachidonic acid (AA). Since preterm infants are born with much less total body DHA and AA, we suggest that preterm infant formulas should include at least 0.35% DHA and 0.4% AA. Higher levels might confer additional benefits and should be further investigated because optimal dietary intakes for term and preterm infants remain to be defined. For pregnant and lactating women we consider it premature to recommend specific LC-PUFA intakes. However, it seems prudent for pregnant and lactating women to include some food sources of DHA in their diet in view of their assumed increase in LC-PUFA demand and the relationship between maternal and foetal DHA status. [source] Not all roads lead to Rome,a review of quality of life measurement in adults with diabetesDIABETIC MEDICINE, Issue 4 2009J. Speight Abstract Aims Quality of life (QoL) is recognized widely as an important health outcome in diabetes, where the burden of self-management places great demands on the individual. However, the concept of QoL remains ambiguous and poorly defined. The aim of our review is to clarify the measurement of QoL in terms of conceptualization, terminology and psychometric properties, to review the instruments that have been used most frequently to assess QoL in diabetes research and make recommendations for how to select measures appropriately. Methods A systematic literature search was conducted to identify the ten measures most frequently used to assess QoL in diabetes research (including clinical trials) from 1995 to March 2008. Results Six thousand and eight-five abstracts were identified and screened for instrument names. Of the ten instruments most frequently used to assess ,QoL', only three actually do so [i.e. the generic World Health Organization Quality of Life (WHOQOL) and the diabetes-specific Diabetes Quality of Life (DQOL) and Audit of Diabetes-Dependent Quality of Life (ADDQoL)]. Seven instruments more accurately measure health status [Short-Form 36 (SF-36), EuroQoL 5-Dimension (EQ-5D)], treatment satisfaction [Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and psychological well-being [Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Well-Being Questionnaire (W-BQ), Problem Areas in Diabetes (PAID)]. Conclusions No single measure can suit every purpose or application but, when measures are selected inappropriately and data misinterpreted, any conclusions drawn are fundamentally flawed. If we value QoL as a therapeutic goal, we must ensure that the instruments we use are both valid and reliable. QoL assessment has the proven potential to identify ways in which treatments can be tailored to reduce the burden of diabetes. With careful consideration, appropriate measures can be selected and truly robust assessments undertaken successfully. [source] Paediatric lap-belt injury: A 7 year experienceEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2006Michael Shepherd Abstract Objective:, To highlight the injuries that result from lap-belt use and make recommendations for prevention, the recent experience of a regional paediatric trauma centre was reviewed. Methods:, Retrospective review of admissions to Starship Children's Hospital from 1996 to 2003, with significant injury following involvement in a motor vehicle crash, while wearing a lap-belt. Patients were identified from two prospectively collected databases and discharge coding data. Results:, In total, 19 patients were identified over the 7 year period. The morbidity sustained includes 15 patients with hollow viscus injury, 13 laparotomies, 7 spinal fractures, 2 paraplegia and 1 fatality. A total of 11 patients required laparotomy with a median delay of 24 h. Of patients in the present series, 58% were aged less than 8 years and thus were inappropriately restrained. Conclusions:, Lap-belt use can result in a range of life-threatening injuries or permanent disability in the paediatric population. The incidence of serious lap-belt injury does not appear to be decreasing. Morbidity and mortality could be reduced by the use of three-point restraints, age appropriate restraints and booster seats. [source] Polyunsaturated fatty acids and epilepsyEPILEPSIA, Issue 8 2010Ameer Y. Taha Summary Omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) are dietary fatty acids that are involved in a myriad of physiologic processes in the brain. There is some evidence suggesting that PUFAs,and particularly omega-3 PUFAs,may have anticonvulsant effects, both in humans and in animals. In the present review, we assess the evidence related to the antiseizure properties of the n-3 PUFAs, discuss their possible mechanism(s) of action, and make recommendations for future clinical trials. In general, the available data from cell cultures and whole animal studies support the idea that the n-3 PUFAs have antiseizure properties. Future clinical trials involving the n-3 PUFAs should involve higher doses and longer periods of administration in order to definitively assess their possible antiseizure effects. [source] Evaluation of decision criteria for detection of spinal cord compression based on cervical myelography in horses: 38 cases (1981,2001)EQUINE VETERINARY JOURNAL, Issue 1 2004J. Van Biervliet Summary Reasons for performing study: Different criteria have been described based on height reduction of the total myelographic contrast column and components of it as tests for compression of the spinal cord due to cervical stenotic myelopathy (CSM). Fifty percent height reduction of the dorsal myelographic column (DMC), <2 mm empiric height of the DMC and a 40% reduction of the ratio of stenosis calculated based on the height reduction of the entire dural diameter (DD) have been described as decision criteria for considering the test result positive. The reasons for selecting these decision criteria or their accuracies have rarely been reported. Objectives: To evaluate the accuracy of diagnostic criteria based on reduced height of the total myelographic column and components of it for diagnosing extradural spinal cord compression using different decision criteria, and make recommendations for consistent myelographic interpretation in horses suspected of having CSM. Methods: Four measurements were obtained by 2 readers in a retrospective sample population of 38 horses in which both cervical myelography and histopathological examination of the cervical spinal cord were performed. The prevalence of CSM in the sample was 50%. At intervertebral sites, the minimum heights of the DD and DMC were measured. At intravertebral sites, the maximum heights of the entire DD and DMC were obtained. Percent height reductions of the DMC and DD were determined as the ratio of minimum intervertebral height to maximum intravertebral height within the next cranial vertebra. Histological examination was used as the gold standard for determining the actual site of spinal cord compression. Sensitivity and specificity for the diagnostic criteria were estimated at each site in neutral and flexed neck positions using several different decision criteria. Conclusions: At C6-C7, in neutral or flexed neck position and using 20% reduction of DD, the test was highly sensitive and specific for CSM. At other sites, reduced height of the myelographic column generally was not accurate for diagnosing extradural spinal cord compression. Using 20% reduction of DD in neutral position at the mid-cervical sites, the test had only low sensitivity and high specificity. Flexion of the neck appeared to increase detection of spinal cord compression in the mid-cervical region, but also substantially increased the frequency of false-positive diagnoses. Potential relevance: By using the reported sensitivity and specificity estimates, readers may decide on a decision criterion for diagnosis of extradural spinal cord compression due to CSM. However, in planning a surgical correction, it is difficult to define a decision criterion that combines acceptable sensitivity and specificity, especially at the mid-cervical sites. [source] Medicinal plants and the treatment of diabetes in Senegal: survey with patientsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2 2008Amadou Moctar Dièye Abstract Diabetes is the most common metabolic disorder worldwide and is a major public health problem. Its frequency increases every day in all countries. However, in developing African countries, few people have access to drugs. In addition, in Africa, traditional beliefs induce people to use medicinal plants whenever they have health problems. Thus, many people in these developing countries use plants for the treatment of diabetes. Yet, few studies are focused on the knowledge and attitudes of the users on medicinal plants in Africa in general and in Senegal in particular. Hence we undertook this survey on the use of medicinal plants for the treatment of diabetes in Senegal in order to make recommendations which could contribute to the increase of the value of herbal medicines in developing countries. We did a cross-sectional survey by direct interview at a university teaching hospital, in Dakar with a representative sample of 220 patients. Forty-one plants were used by the patients and the two most frequently cited were Moringa oleifera Lam (65.90%) and Sclerocarya birrea (A. Rich) Hochst (43.20%). Patients gave several reasons for using medicinal plants (traditional treatment: 40%, efficacy: 32%, low cost: 20%). The principal suppliers of plants were tradesmen in the market (66.8%) and traditional therapists (5%). Sixty-five per cent of patients think that medicinal plants are efficient for the treatment of diabetes and 20% have reported adverse effects which could be caused by medicinal plants. In conclusion, many people in our study think that medicinal plants are efficient for the treatment of diabetes, which requires research work by scientists in developing countries in this field in order to prove their efficacy and innocuousness. [source] Absconding: A review of the literature 1996,2008INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 5 2008Eimear Muir-Cochrane ABSTRACT:, Absconding is a significant problem with potential for harm to patients or the general public. The consequences of absconding include physical harm, prolonged treatment time, and substantial economic costs. The aim of this systematic literature review is to synthesize quality literature about absconding from psychiatric facilities, identify gaps in knowledge, and make recommendations for practice. An electronic search yielded 39 journal articles that met the review criteria. Findings demonstrate that a single definition of absconding remains elusive, making the prevalence of absconding difficult to establish. Absconding events are multifactorial, with environmental, psychosocial, and organic aspects. Negative consequences exist including violence, aggression, and self-neglect and harm to self and others. Papers are clustered around the following themes: harm and risk, absconder profiles, absconding rates, and perceptions of nurses and patients. Nursing interventions designed to decrease absconding have been implemented with success, but only in a few studies and in Australia, none have been reported in the literature to date. Further research is required to identify appropriate nursing-based interventions that may prove useful in reducing the risk of absconding. [source] Lifestyle limitations of children and young people with severe cerebral palsy: a population study protocolJOURNAL OF ADVANCED NURSING, Issue 5 2008Collette Donnelly Abstract Title.,Lifestyle limitations of children and young people with severe cerebral palsy: a population study protocol Aim., This paper is a presentation of a study protocol to establish the prevalence of orthopaedic problems (hip dislocation, pelvic obliquity, spinal deformity and contractures) and their impact on pain, function, participation and health in a population of children and young people with severe cerebral palsy. Background., Cerebral palsy is the commonest cause of motor impairment in childhood and is associated with life-long disability. An estimated 30% of people with cerebral palsy have severe forms and are non-ambulant. Although the underlying neurological damage is not amenable to correction, many health services are dedicated to providing therapeutic and adaptive support to help people with the condition reach their potential. Method., A cross-sectional survey of children and young people, aged 4,25 years with severe, non-ambulant cerebral palsy as defined using the Gross Motor Function Classification System (Levels IV and V). Study participants will be identified from a pre-existing, geographically defined case register and recruited via a healthcare professional known to them. Two assessments will be undertaken: one involving parents/carers at home and using questionnaires; the other involving the child/young person ideally in one of three settings and including X-rays if clinically indicated. Discussion., This study will contribute to our knowledge of the history and epidemiology of orthopaedic problems in children and young people with cerebral palsy and how these problems accumulate and impact on participation, health and well-being. The study will also identify unmet need and make recommendations for good practice in relation to the orthopaedic care and management for people with severe cerebral palsy. [source] A systematic review of the effectiveness of cutaneous warming systems to prevent hypothermiaJOURNAL OF CLINICAL NURSING, Issue 5 2009Cristina M Galvão Aims., To retrieve and critique recent randomised trials of cutaneous warming systems used to prevent hypothermia in surgical patients during the intraoperative period and to identify gaps in current evidence and make recommendations for future trials. Background., Hypothermia affects up to 70% of anaesthetised surgical patients and is associated with several significant negative health outcomes. Design., Systematic review using integrative methods. Methods., We searched CINAHL, EMBASE, Cochrane Register of Controlled Trials and Medline databases (January 2000,April 2007) for recent reports on randomised controlled trials of cutaneous warming systems used with elective patients during the intraoperative period. Inclusion criteria., We included randomised control trials examining the effects of cutaneous warming systems used intraoperatively on patients aged 18 years or older undergoing non-emergency surgery. Studies published in English, Spanish or Portuguese with a comparison group that consisted of either usual care or active cutaneous warming systems without prewarming were reviewed. Results., Of 193 papers initially identified, 14 studies met the inclusion criteria. There was moderate evidence to indicate that carbon-fibre blankets and forced-air warming systems are equally effective and that circulating-water garments are most effective for maintaining normothermia during the intraoperative period. Few trials reported costs. Conclusions., Carbon-fibre blankets and forced-air warming systems are effective and circulating-water garments may be preferable. Future research should measure the direct and indirect costs associated with competing systems. Relevance to clinical practice., Nurses can use this review to inform their selection of warming interventions in perioperative nursing practice. They can also assess other factors such as nursing workload, staff training and equipment maintenance, which should be incorporated into future research. [source] The Returns to Education: MacroeconomicsJOURNAL OF ECONOMIC SURVEYS, Issue 2 2003Barbara Sianesi We offer an extensive summary and a critical discussion of the empirical literature on the impact of human capital on macro-economic performance, with a particular focus on UK policy. We also highlight methodological issues and make recommendations for future research priorities. Taking the studies as a whole, the evidence that human capital increases productivity is compelling, though still largely divided on whether the stock of education affects the long-run level or growth rate of GDP. A one-year increase in average education is found to raise the level of output per capita by between three and six percent according to augmented neo-classical specifications, while leading to an over one percentage point faster growth according to estimates from the new-growth theories. Still, over the short-run planning horizon (four years) the empirical estimates of the change in GDP are of similar orders of magnitude in the two approaches. The impact of increases at different levels of education appear to depend on the level of a country's development, with tertiary education being the most important for growth in OECD countries. Education is found to yield additional indirect benefits to growth. More preliminary evidence seems to indicate that type, quality and efficiency of education matter for growth too. [source] The efficacy of dietetic intervention in patients with chronic obstructive pulmonary diseaseJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2008L. Bottle Background:, Clinical trials have shown that pulmonary rehabilitation can improve the functional status and quality of life of chronic obstructive pulmonary disease (COPD) patients (Lacasse, 2006) but there is no research examining the efficacy of group dietetic intervention during standard 8 week rehabilitation courses. Current input is usually limited to a 1 h nutrition education session. This pilot study aimed to investigate whether patients receiving additional dietetic intervention during pulmonary rehabilitation significantly increased their general nutritional knowledge, thereby facilitating improvements in dietary intake and nutritional status. Methods:, Patients were recruited from two courses of pulmonary rehabilitation and randomly allocated to a control group or an intervention group. Anthropometry (height, weight, body mass index, mid arm circumference and triceps skinfold), 3 day food diaries and nutritional knowledge questionnaires covered guidelines, food groups, choosing healthy options and diet and COPD were completed at baseline and at the end of 8 weeks. In week 2 both groups received the same nutrition education session which covered healthy eating during periods of stability as well as advice on coping with loss of appetite and reduced intake during illness and exacerbations. The intervention group was followed up during weeks 4, 6 and 7 when further anthropometric measurements were taken and additional dietary advice was provided, which addressed issues raised by individual patients. Information from food diaries was converted to nutrients using Windiets dietary analysis software. Statistical analyses were carried out using SPSS (v14) and included Mann,Whitney U non parametric tests, paired t -tests and Spearman correlations used for comparisons over time and between groups. For analysis purposes patients were classified as normal weight (NW) and overweight (OW). Approval was obtained from the appropriate Ethics Committee. Results:, Changes reported were not statistically significant (P > 0.05). Complete data sets were obtained for six control (NW = 2, OW = 4) and five intervention (NW = 1, OW = 4) patients. Nutritional knowledge increased in the control group by 5% compared to 3% in the intervention group. Control NW patients increased their energy intake resulting in a mean weight gain of 0.5 kg (SD 3.3). OW control group patients increased their energy intake by 12.4% (16.9) with a mean weight gain of 0.2 kg (2.5). All control patients increased their intake of in total fat, saturated fatty acids (SFA), sugars and sodium. Conversely there was a decrease in energy intake in the intervention group of 14.4% (17.8) and a mean weight loss of 1.5 kg (1.2) (three out of four overweight patients lost weight). Improvements in diet were shown with reduced intakes of total fat, SFA, sugars and sodium. The NW patient in the intervention group regained weight that had previously been lost. These changes did not correlate with changes in nutritional knowledge. Discussion:, An increase in nutritional knowledge was expected to facilitate appropriate changes in dietary intake and nutritional status. Despite the lack of correlation between dietary knowledge and intake, beneficial outcomes were none-the-less observed in the intervention group. The trend for weight gain in OW control group patients, and weight loss in OW intervention group patients contrasted with results seen by Slinde et al. (2002) where the control OW patients lost weight, and OW intervention patients gained weight. It is possible that in the current study, patients in the intervention group were motivated to lose weight with repeated exposure to the dietitian, rather than an increase in nutritional knowledge. Significant anthropometrical changes were unlikely to be observed in 8 weeks, and further follow up may be necessary to establish sufficient evidence for the most efficacious level of dietetic intervention. The small sample sizes, especially with regard to weight sub groups, limits the conclusions which can be drawn. Further research is recommended, using a larger sample size, in order to make recommendations for dietetic best practice. Conclusion:, The results of this study did not show statistical significance and the association between nutritional knowledge and improved nutritional outcomes remains unclear. However, the findings may have clinical significance since they appear to show that additional dietetic intervention may benefit the nutritional status of patients with COPD attending pulmonary rehabilitation. References, Lacasse, Y., Goldstein, R., et al. (2006) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 4, CD003793. Slinde, F., Gronberg, A.M., et al. (2002) Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation. Respir. Med. 96, 330,336. [source] Cancer Research UK's Cancer Campaigns function: moving into the campaigning arenaJOURNAL OF PUBLIC AFFAIRS, Issue 3 2009Jon Spiers This paper explores the evolution of patient and public involvement in campaigning at Cancer Research UK. Cancer Research UK is the world's leading charity dedicated to cancer research. They support research into all aspects of cancer through the work of more than 4500 scientists, doctors and nurses in over 40 towns and cities in the UK. They produce information for audiences including cancer patients and their families, the general public and health professionals. They also work with government in Westminster, Scotland, Wales and Europe to ensure cancer is at the top of the political agenda. In 4 years, the charity grew its campaigner base from zero to well over a third of a million people. This case study covers the research exercise in 2004, the 2005 launch of the pilot and growth of the nascent campaigning function, the major campaigns up to 2008 and what lessons were learnt from them. The aim of this case study is to examine how the process occurred, share insights into the challenges and opportunities, and make recommendations for any organization considering a similar move. Copyright © 2009 John Wiley & Sons, Ltd. [source] Treatment of Hypertriglyceridemia With Omega-3 Fatty Acids: A Systematic ReviewJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 9 2004Amanda Lewis MS Purpose To (a) critically appraise available randomized controlled trials (RCTs) addressing the efficacy of long-chain omega-3 fatty acids as secondary agents for prevention of hypertriglyceridemia and (b) make recommendations for clinical practice. Data Sources Two independent reviewers examined all RCTs from 1994 to 2003 identified in several databases, extracted data from each study, and used the previously tested Boyack and Lookinland Methodological Quality Index (MQI) to determine study quality. Conclusions Ten studies reported long-chain omega-3 fatty acids to be effective in the treatment of hypertriglyceridemia. The average decrease in triglycerides was 29%, total cholesterol 11.6%, very low density lipoprotein (VLDL) 30.2%, and low-density lipoprotein (LDL) 32.5%. One study found LDLs to increase by 25%. The average increase in highdensity lipoprotein was 10%. The overall average MQI score was 36% (range = 26% to 54%). Many of the RCTs had serious shortcomings, including short duration, lack of a power analysis, no intention-to-treat analysis, no report of blind assessment of outcome, and lack of dietary control as a confounding variable. Implications for Practice Overall study methodology was weak. Although the evidence supporting use of long-chain omega-3 fatty acids in the secondary prevention of hypertriglyceridemia is reasonably strong, until there are larger RCTs of better methodological quality, it is not recommended that practitioners treat hypertriglyceridemia with omega-3 fatty acid supplementation in lieu of lipid-lowering medications. [source] The use of vasopressin for treating vasodilatory shock and cardiopulmonary arrestJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 2 2009DACVIM, Richard D. Scroggin Jr. Abstract Objective , To discuss 3 potential mechanisms for loss of peripheral vasomotor tone during vasodilatory shock; review vasopressin physiology; review the available animal experimental and human clinical studies of vasopressin in vasodilatory shock and cardiopulmonary arrest; and make recommendations based on review of the data for the use of vasopressin in vasodilatory shock and cardiopulmonary arrest. Data Sources , Human clinical studies, veterinary experimental studies, forum proceedings, book chapters, and American Heart Association guidelines. Human and Veterinary Data Synthesis , Septic shock is the most common form of vasodilatory shock. The exogenous administration of vasopressin in animal models of fluid-resuscitated septic and hemorrhagic shock significantly increases mean arterial pressure and improves survival. The effect of vasopressin on return to spontaneous circulation, initial cardiac rhythm, and survival compared with epinephrine is mixed. Improved survival in human patients with ventricular fibrillation, pulseless ventricular tachycardia, and nonspecific cardiopulmonary arrest has been observed in 4 small studies of vasopressin versus epinephrine. Three large studies, though, did not find a significant difference between vasopressin and epinephrine in patients with cardiopulmonary arrest regardless of initial cardiac rhythm. No veterinary clinical trials have been performed using vasopressin in cardiopulmonary arrest. Conclusion , Vasopressin (0.01,0.04 U/min, IV) should be considered in small animal veterinary patients with vasodilatory shock that is unresponsive to fluid resuscitation and catecholamine (dobutamine, dopamine, and norepinephrine) administration. Vasopressin (0.2,0.8 U/kg, IV once) administration during cardiopulmonary resuscitation in small animal veterinary patients with pulseless electrical activity or ventricular asystole may be beneficial for myocardial and cerebral blood flow. [source] Dysautonomia rating scales in Parkinson's disease: Sialorrhea, dysphagia, and constipation,Critique and recommendations by movement disorders task force on rating scales for Parkinson's disease,MOVEMENT DISORDERS, Issue 5 2009Marian L. Evatt MD Abstract Upper and lower gastrointestinal dysautonomia symptoms (GIDS),sialorrhea, dysphagia, and constipation are common in Parkinson's disease (PD) and often socially as well as physically disabling for patients. Available invasive quantitative measures for assessing these symptoms and their response to therapy are time-consuming, require specialized equipment, can cause patient discomfort and present patients with risk. The Movement Disorders Society commissioned a task force to assess available clinical rating scales, critique their clinimetric properties, and make recommendations regarding their clinical utility. Six clinical researchers and a biostatistician systematically searched the literature for scales of sialorrhea, dysphagia, and constipation, evaluated the scales' previous use, performance parameters, and quality of validation data (if available). A scale was designated "Recommended" if the scale was used in clinical studies beyond the group that developed it, has been specifically used in PD reports, and clinimetric studies have established that it is a valid, reliable, and sensitive. "Suggested" scales met at least part of the above criteria, but fell short of meeting all. Based on the systematic review, scales for individual symptoms of sialorrhea, dysphagia, and constipation were identified along with three global scales that include these symptoms in the context of assessing dysautonomia or nonmotor symptoms. Three sialorrhea scales met criteria for Suggested: Drooling Severity and Frequency Scale (DSFS), Drooling Rating Scale, and Sialorrhea Clinical Scale for PD (SCS-PD). Two dysphagia scales, the Swallowing Disturbance Questionnaire (SDQ) and Dysphagia-Specific Quality of Life (SWAL-QOL), met criteria for Suggested. Although Rome III constipation module is widely accepted in the gastroenterology community, and the earlier version from the Rome II criteria has been used in a single study of PD patients, neither met criteria for Suggested or Recommended. Among the global scales, the Scales for Outcomes in PD-Autonomic (SCOPA-AUT) and Nonmotor Symptoms Questionnaire for PD (NMSQuest) both met criteria for Recommended, and the Nonmotor Symptoms Scale (NMSS) met criteria for Suggested; however, none specifically focuses on the target gastrointestinal symptoms (sialorrhea, dysphagia, and constipation) of this report. A very small number of rating scales have been applied to studies of gastrointestinal-related dysautonomia in PD. Only two scales met "Recommended" criteria and neither focuses specifically on the symptoms of sialorrhea, dysphagia, and constipation. Further scale testing in PD among the scales that focus on these symptoms is warranted, and no new scales are needed until the available scales are fully tested clinimetrically. © 2009 Movement Disorder Society [source] The Suffering of the HealerNURSING FORUM, Issue 4 2003John Rowe RN TOPIC The severe distress sometimes experienced by nurses in their role as healer. PURPOSE To identify the sources that give rise to the suffering of the healer, describe the responses of healers to their suffering, and make recommendations on how to prepare nurses to cope with suffering. SOURCES The concept of the suffering of the healer is derived from the work of Erik Cassell; the framework for understanding responses to suffering from the work of Dorothy Solle. CONCLUSIONS Nurses need to be aware that practice in health care can give rise to the suffering of the healer. Nursing education and administration need to help nurses learn to cope. [source] Methadone and Buprenorphine Toxicity in ChildrenTHE AMERICAN JOURNAL ON ADDICTIONS, Issue 1 2010Edward W. Boyer MD Recent years have seen very large increases in the prescribing of methadone and buprenorphine formulations for treatment of opioid addiction as well as the increasing utilization of methadone for the treatment of chronic pain. Coincident with the rise in the prescribing of these drugs has been a substantial increase in pediatric opioid toxicities and adverse events. This review will address the current state of methadone- and buprenorphine-related adverse events in children in the United States. We will also discuss treatment of opioid toxicity in pediatric populations and make recommendations aimed at reducing these occurrences.,(Am J Addict 2009;19:89,95) [source] Investigating the efficacy of concept mapping with pupils with autistic spectrum disorderBRITISH JOURNAL OF SPECIAL EDUCATION, Issue 3 2007Veronica Roberts Pupils with autism often present significant challenges to teachers. They seem to have real strengths in visual processing but a cognitive style that encourages them to focus on detail rather than the overarching connections between concepts. Veronica Roberts, currently undertaking doctoral training at the Institute of Education, University of London, in order to become an educational psychologist, and Richard Joiner, senior lecturer in the Department of Psychology at the University of Bath, set out to explore these issues. In this article, they report the outcomes of a naturalistic experiment in which they investigated the utility of concept mapping as an educational strategy with pupils diagnosed with an autistic spectrum disorder (ASD). Theoretical arguments supporting the use of concept mapping with an autistic population are outlined in the paper. A tutor group of ten pupils with ASD, aged between 11 and 14 years, took part in the study. Concept mapping tasks were integrated within National Curriculum science lessons in collaboration with the school's science teacher. The study found that the increase in pupil performance in subject-specific questionnaires was nearly four times greater in the concept mapping condition than after a more conventional teaching intervention. Veronica Roberts and Richard Joiner tentatively draw out the implications of their work for staff who work with pupils with ASD and make recommendations for further research into the use of these learning strategies. [source] Disabled Children and Residential Schools: The Implications for Local Education ProfessionalsBRITISH JOURNAL OF SPECIAL EDUCATION, Issue 2 2003Jenny Morris Jenny Morris, freelance researcher, David Abbott, research associate at the Norah Fry Research Centre at the University of Bristol, and Linda Ward, Director of the Norah Fry Research Centre at the University of Bristol, carried out research to look at whether the current system of legislation and regulation is adequately protecting and promoting the interests of disabled children placed at residential schools. This article summarises some findings from the research which investigated the decision-making processes leading to residential special school placements and explored the involvement of education and social services authorities after placements have been made. The research found that the needs of individual children are not central to these decision-making processes; and that the local authorities who make such placements do not pay sufficient attention to protecting and promoting children's educational or care needs once they have gone away to school. Jenny Morris, David Abbott and Linda Ward indicate some of the ways in which current practice could be improved; make recommendations for future developments; and call for further research into the role of special residential schools in the context of policy on educational and social inclusion. [source] Textile dye allergic contact dermatitis prevalenceCONTACT DERMATITIS, Issue 4 2000Kathryn L. Hatch This article summarizes textile dye prevalence studies and makes recommendations for advancing knowledge about textile-dye sensitization. Prevalence data is provided by study and by dye. Dermatology teams are encouraged to conduct textile-dye prevalence studies in countries other than Italy, include dyes for which the least prevalence data has been collected, to standardize method of application and reading, and to verify purity and identity of dyes used for patch testing. Testing with pure dyes and other chemicals in dye formulations should provide insights in choosing dye systems that will decrease sensitization. [source] The Diagnosis and Prediction of Bank Failures in Zambia, 1990,98DEVELOPMENT POLICY REVIEW, Issue 3 2002Samuel Munzele Maimbo This article presents a non-econometric, yet practical approach for regulators in developing countries. With limited financial resources to determine the ,safety and soundness' of a large number of financial institutuions, regulatory authorities are appreciative of any kind of mechanism that can identify banks that are in financial difficulties. The Zambian case is interesting, in that the bank failures of 1995 and 1997/8 brought into question the ability of the central bank to diagnose the financial condition of banks. This article evaluates the Bank of Zambia's experience over the period 1990 to March 1998 and makes recommendations on how to improve diagnosis and prediction of bank failures by incorporating non-financial factors into the analysis of bank performance. [source] Standard Setters: Stand Up and Take a Stand!EDUCATIONAL MEASUREMENT: ISSUES AND PRACTICE, Issue 1 2008Barbara S. Plake This 2006 NCME Career Award Address presents observations made over a career in the field of standard setting, summarizes the status of current research, and makes recommendations for future research. [source] THE CAUSES OF GIRLS' DELINQUENCY AND THEIR PROGRAM IMPLICATIONSFAMILY COURT REVIEW, Issue 3 2007Margaret A. Zahn This article summarizes some of the literature reviewed by the Girls Study Group, which is a federally funded project aimed at assessing the causes of girls' delinquency as well as evaluating programs to address it. The literature reveals that a number of factors such as family dysfunction, involvement with antisocial peers, and living in disadvantaged neighborhoods are correlated with delinquency for both boys and girls. Some factors, however, are gender sensitive, meaning that either girls are more exposed to a given risk factor than boys or react somewhat differently to a given risk factor. Girls have higher rates of exposure to sexual assault, which is associated with delinquency and, although more research is needed, they are more affected by the impacts of early puberty, when it is coupled with harsh parenting and disadvantaged neighborhoods. This article discusses some implications of the research on correlates of delinquency for programming for girls and makes recommendations for program selection. [source] The responsibility to care for single homeless peopleHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 6 2001Maureen Crane RGN RMN MSc PhD Abstract This paper examines the reasons why in contemporary Britain many single homeless people with severe physical and mental health problems and welfare needs do not receive the treatment, care and financial support that they manifestly need, and in particular considers the interaction between their personal characteristics and the organisation and the obligations of services. Homelessness is a complex concept associated with problems of housing, health, social care and income. The greatest weaknesses of the service system are that no single agency has a statutory responsibility to ensure that vulnerable homeless people are served, and none of the generalist welfare agencies have a duty to seek out those who do not present. As a result, single homeless people fall between the housing, health and social services and amass exceptional unmet needs. The paper appraises the approaches to single homeless people's problems that have recently been introduced by the Rough Sleepers' Unit (RSU), and discusses the ways in which current reforms of the welfare services may impact on the situation of homeless people. With the possibility that the RSU's prime responsibility for commissioning single homeless people's services will transfer to local authorities in 2002, the paper concludes by specifying the implications for voluntary and statutory providers and makes recommendations about the attribution of the responsibility to care for this vulnerable group. [source] Global health partnerships in practice: taking stock of the GAVI Alliance's new investment in health systems strengtheningINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 1 2009Joseph F. Naimoli Despite a burgeoning literature on global health partnerships (GHPs), there have been few studies of how GHPs, particularly those trying to build a bridge between horizontal and vertical modes of delivering essential health services, operate at global and country levels. This paper will help address this knowledge gap by describing and analyzing the GAVI Alliance's early experience with health systems strengthening (HSS) to improve immunization coverage and other maternal-child health outcomes. To date, the strengths of HSS reside in its potential to optimize GAVI's overall investment in immunization, efforts to harmonize with other initiatives, willingness to acknowledge risk and identify mitigation strategies, engagement of diverse stakeholders, responsiveness to country needs, and effective management of an ambitious grant-making enterprise. The challenges have been forging a common vision and approach, governance, balancing pressure to move money with incremental learning, managing partner roles and relationships, managing the "value for money" risk, and capacity building. This mid-point stock-taking makes recommendations for moving GAVI forward in a thoughtful manner. The findings should be of interest to other GHPs because of their larger significance. This is a story about how a successful alliance that decided to broaden its mandate has responded to the technical, organizational, and political complexities that challenge its traditional business model. Copyright © 2009 John Wiley & Sons, Ltd. [source] Peer review in Nursing and Midwifery: a literature reviewJOURNAL OF CLINICAL NURSING, Issue 4 2008Amelia Rout MSc, BSc (Hons) Aims and objectives., The Clinical Education Project investigated clinical education in nursing and midwifery settings. The aim of this phase was to investigate and evaluate the processes and outcomes of clinical assessment of preregistration nurses and midwives, focusing on the assessment interview, and to evaluate the feasibility of introducing peer review of the clinical assessment interview in acute clinical settings. Background., Peer review is common in many professional areas. The literature describes various applications of peer review and makes recommendations for its use. However, there is a shortage of studies investigating the use of peer review in nursing and midwifery education and practice. Design., The project involved a systematic literature review and a qualitative exploratory study. This article describes the first part of the study: a systematic literature review of peer review. The second part of the study is reported elsewhere. Methods., The systematic literature review investigated international articles written since 1994 that contained information on peer review in pre/post registration nursing and midwifery within higher education or practice. Results., From the available literature, 52 specific initiatives were analysed. The majority of articles originated in America and involved nursing staff working in secondary care settings. Fifty-one articles had missing information varying from not stating the sample size to not including information about evaluations. Conclusions., The literature review found that whilst peer review is commonplace in nursing and midwifery practice, there is a lack of robust literature about its use. Relevance to clinical practice., Peer review in clinical settings such as nursing and midwifery can facilitate the sharing of good practice and personal and professional growth. It allows participants to learn from each other and gain insight into their development. [source] A "cure" for Parkinson's disease: Can neuroprotection be proven with current trial designs?MOVEMENT DISORDERS, Issue 5 2004Carl E. Clarke BSc Abstract Current medical and surgical therapies for Parkinson's disease provide symptomatic control of motor impairments rather than slowing or halting the progression of the disease. Previous clinical trials examining drugs such as dopamine agonists and selegiline for neuroprotective effects used "surrogate" outcomes, including clinical measures (rating scales, time to require levodopa), neuroimaging techniques (,-CIT single photon emission computed tomography; fluorodopa positron emission tomography), and mortality tracking. These studies failed to provide conclusive results because of design faults such as failing to control for symptomatic effects, small sample size, and not accounting for the possible effects of drugs on radionuclide tracer handling. Lessons must be learned from these failed neuroprotection trials. This review summarises the problems with previous neuroprotection studies and makes recommendations for future trial design. It is concluded that the primary outcome of explanatory trials should continue to be clinical measures such as the Unified Parkinson's Disease Rating Scale (UPDRS). It should be assumed that all agents have a symptomatic effect, which necessitates evaluation after a prolonged drug washout period. To achieve the evaluation after a prolonged drug washout period more effectively, trials must be performed in early disease and over a short period (6,12 months) so that symptomatic therapy is not required. To achieve adequate statistical power, these trials will need to include thousands of patients. Radionuclide imaging can only be used in such trials after considerable methodological work has been performed to establish its validity and reliability. To be affordable, such large explanatory trials need more streamlined designs with fewer hospital visits, fewer outcome measures, and rationalised safety monitoring. The clinical effectiveness of promising compounds from explanatory trials will need to be established in large long-term pragmatic trials using outcome measures such as quality of life, cost-effectiveness, and mortality. Such pragmatic trials could be continuations of the explanatory trials: after the primary outcome of the explanatory study (e.g., UPDRS) has been reported in an interim analysis, the trial could be continued for a further 5 to 10 years to report on quality of life and health economics outcomes. © 2004 Movement Disorder Society [source] Recommendations for the use of icodextrin in peritoneal dialysis patientsNEPHROLOGY, Issue 1 2003Review Article SUMMARY: Icodextrin is a starch-derived, high molecular weight glucose polymer, which has been shown to promote sustained ultrafiltration equivalent to that achieved with hypertonic (3.86%/4.25%) glucose exchanges during prolonged intraperitoneal dwells (up to 16 h). Patients with impaired ultrafiltration, particularly in the settings of acute peritonitis, high transporter status and diabetes mellitus, appear to derive the greatest benefit from icodextrin with respect to augmentation of dialytic fluid removal, amelioration of symptomatic fluid retention and possible prolongation of technique survival. Glycaemic control is also improved by substituting icodextrin for hypertonic glucose exchanges in diabetic patients. Preliminary in vitro and ex vivo studies suggest that icodextrin demonstrates greater peritoneal membrane biocompatibility than glucose-based dialysates, but these findings need to be confirmed by long-term clinical studies. This paper reviews the available clinical evidence pertaining to the safety and efficacy of icodextrin and makes recommendations for its use in peritonal dialysis. [source] Use of film for community conservation education in primate habitat countriesAMERICAN JOURNAL OF PRIMATOLOGY, Issue 5 2010Juliet H. Wright Abstract Wildlife films have become an integral part of broadcast schedules in developed countries. As charismatic mammals, primates are frequently the focus of the wildlife filmmaker's attention. Yet the people watching these films tend to be situated on different continents from the species concerned. Communities in primate habitat countries are unlikely to ever have the opportunity to gain such an insight into the species with which they share their environment and the threats these species face. Over recent years, an increasing number of filmmakers are realizing the importance of reaching local audiences through film for conservation purposes. Published research on the impact films can have on eliciting conservation action in developed or developing countries is minimal. The perceived power of wildlife films to change attitudes and behaviors is largely based on anecdotal evidence. This commentary highlights the on-going debate regarding the conservation impact of wildlife films, discusses the work of various NGOs that are using films for conservation purposes in habitat countries and makes recommendations with regards to the film type and situational context necessary to promote positive conservation behavior in communities. Bespoke conservation films convey a specific message to a specific audience at a particular point in time. If produced by trained local conservation educators, these films are likely to have the biggest impact. Films must be shown as a part of a conservation education program that incorporates other education materials and group discussion so that the desired conservation message can be clearly defined and reinforced. Audiences should not be made to feel disillusioned, depressed or vilified by the content of wildlife films. Rather films should increase support for conservation and empower people to act. Once enthusiasm for specific conservation actions has been created, practical assistance and follow-up support is necessary to ensure ideas are implemented. Am. J. Primatol. 72:462,466, 2010. © 2009 Wiley-Liss, Inc. [source] Patents and Access to Antiretroviral Medicines in Vietnam after World Trade Organization AccessionTHE JOURNAL OF WORLD INTELLECTUAL PROPERTY, Issue 3-4 2007Jakkrit Kuanpoth Antiretroviral (ARV) drugs, where they are accessible, have been shown to prolong the lives and increase the health and well-being of people living with human immunodeficiency virus/acquired immunodeficiency syndrome. In general terms, whether a country is able to provide affordable ARVs to people in need is determined by the pricing structure of the drugs, which is in turn based on the patent environment that regulates them. Increasing access in many developing countries, including Vietnam, requires a thorough understanding of the patent environment and of the legal options that will allow the production and/or importation of affordable treatments. This article provides an analysis of current patent law in Vietnam with regard to the production and importation of pharmaceuticals. It then reviews the current situation of supply of ARVs with regard to pharmaceutical patents and Vietnam's obligations and practices against international agreements. The study concludes by suggesting options for utilizing current law to improve access to ARVs and makes recommendations for the implementation of Vietnamese patent law. [source] | ||||||||||||||||||||||||||||||||||||||||