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Kinds of This Paper Selected AbstractsUniversity postgraduate training in implant dentistry for the general dental practitioner,AUSTRALIAN DENTAL JOURNAL, Issue 3 2010S Ivanovski Aims of This Paper This paper aims to: (1) Describe the educational requirements of general practitioners who want to safely and effectively introduce implant dentistry procedures to their practice. (2) Define the necessary competencies and level of complexity that would need to be attained in a postgraduate implant dentistry programme for general dental practitioners. (3) Discuss the programme structures which universities can utilize in order to provide quality education in implant dentistry for general practitioners. (4) Provide guidelines for the resources, content, course format and instructional methods which could be well suited to the educational requirements of such programmes. The authors intend to produce a headline reference guide to outline the necessary educational structures for postgraduate pathways aimed at facilitating the continuous professional development of general practitioners within implant dentistry. This paper does not address issues concerning specialist training or higher research degrees. [source] Primary prevention of neural tube defects with folate in Western Australia: the value of the Western Australian Birth Defects RegistryCONGENITAL ANOMALIES, Issue 2 2006Carol Bower ABSTRACT This paper reviews the role of the Western Australian Birth Defects Registry in the primary prevention of neural tube defects. The Registry provides complete and up-to-date information on all neural tube defects (NTD), including terminations of pregnancy. These data have been used to determine a baseline rate of NTD and to monitor trends in NTD over time, when health promotion of folic acid supplement use and voluntary fortification of food with folate were introduced. The register has also been used to investigate NTD in special populations (Indigenous infants in Australia) and as a sampling frame for case control studies. The data derived from these studies have been used to assist in assessing whether mandatory food fortification in Australia is indicated to prevent NTD. [source] The humanitarians' tragedy: escapable and inescapable crueltiesDISASTERS, Issue 2010Alex De Waal Paradoxically, elements of cruelty are intrinsic to the humanitarian enterprise., This paper focuses on some of these. Escapable cruelties arise from technical failings, but the gradual professionalisation of the field and improvements in relief technologies mean that they have been significantly reduced in comparison to earlier eras. Other cruelties arise from clashes among rights, and the tensions inherent in trying to promote humanity amid the horrors of war. These are inescapable and constitute the ,humanitarians' tragedy'. Among them is the individual cruelty of failing to do good at the margin: a clash between the individual's impulses and ideals and the constraints of operating in constrained circumstances. This is a version of triage. In addition, there is the cruelty of compromising dearly-held principles when faced with other competing or overriding demands. There is also the cruelty whereby humanitarians feed victims' dreams that there is an alternative reality, which in fact cannot be attained. [source] Barrett's esophagus: current and future role of endosonography and optical coherence tomographyDISEASES OF THE ESOPHAGUS, Issue 2 2004S. A. Faruqi SUMMARY., This paper reviews the role of endosonography and optical coherence tomography (OCT) for imaging of Barrett's esophagus (BE). The routine use of endoscopic ultrasound (EUS) to screen patients with BE is neither justified nor cost effective. EUS does appear to have a role in patients who have BE and high-grade dysplasia or intramucosal carcinoma, in whom a non-operative therapy is being contemplated. For patients with a diagnosis of esophageal cancer with or without BE, EUS is superior to computed tomography or magnetic resonance imaging for assessing esophageal wall penetration and for detecting regional lymph node involvement. In its current state, OCT is not yet ready for application in clinical practice. However, given its superior resolution compared with other modalities such as EUS, OCT has great potential as a powerful adjunct to standard endoscopy in surveillance of BE and may enhance the ability of endoscopists to detect high-grade dysplasia at an early stage. With further technical refinement, this technique may become a mainstay in the surveillance of BE and other premalignant conditions of the gastrointestinal tract. [source] Gall wasps and their parasitoids in cork oak fragmented forestsECOLOGICAL ENTOMOLOGY, Issue 1 2007GUILLEM CHUST Abstract 1.,This paper explores the potential effects of host-plant fragmentation on cork oak gall wasp populations (Cynipidae, Hymenoptera) and on their predators, lethal inquilines, and parasitoids. To address this objective, galls were collected across a gradient of cork oak (Quercus suber) forest fragmentation in the East Pyrenees (Albera, Spain), and they were incubated to obtain the parasitism rates. 2.,Two hypotheses were tested: (1) Host-plant fragmentation may induce a decline in gall wasp populations because of area and isolation effects on local extinction and dispersal; as a consequence of that, parasitoids may decline even more strongly in fragmented habitats than their prey. (2) Host-plant fragmentation may cause a decline in gall wasp parasitoid populations that, in turn, can lead to an ecological release in their prey populations. 3.,Among the eight cork oak gall wasps sampled in the study area of Albera, the gall abundances of three species (Callirhytis glandium, Callirhytis rufescens, and Andricus hispanicus) were significantly related to forest fragmentation. The overall abundance of gall wasps was affected by a radius of , 890 m surrounding landscape, presenting constant abundances with forest loss until forest cover is reduced at , 40%; below that value the abundance increased rapidly. Three inquilines and 23 parasitoids species were recorded after gall incubation. In 25 cases, species of inquilines and parasitoids were newly recorded for the corresponding host in the Iberian peninsula. 4.,Although the overall parasitism rate was high (1.1), it was uncorrelated with fragmentation and with overall cynipid abundance. These results indicate that host-plant fragmentation was correlated with higher abundance of gall wasps, whereas the parasitism rate could not explain this hyper-abundance in small forest fragments. [source] Comparative Ant Faunas between Seonyudo and Seven Other Islands of West Sea in KoreaENTOMOLOGICAL RESEARCH, Issue 2 2002So-Jin HA ABSTRACT This paper is intended as an investigation of the biogeographic characteristics of ant faunas of the eight islands in West Sea of South Korea, using quantitative genetic analyses. The faunal similarity is examined using the Nomura-Simpson's Coefficient (NSC). The obtained NSC value matrix was examined by a cluster analysis using UPGMA method. The MSC-values between the seven areas investigated range from 0.500 (Deokjeokdo Hongdo) to 0.909 (Wonsando-Hongdo). In these islands including Seonyudo, the NSC -values range from 0.571 (Deokjeokdo) to 0.778 (Bigeumdo). The cluster analysis using the similarity index (NSC) showed that eight islands were divided into two groups at the level of 41%. It was shown that Wonsando and Bigeumdo were closer (Similarity = 83%) than those between others. Deokjeokdo and Bigeumdo were remote (Similarity = 41%) from each conspecific population. That is, the species composition of Bigeumdo (Similarity = 70%) was similar to that of the Seonyudo, while that of Deokjeokdo (Similarity = 41%) was different from that. [source] RESEARCH REPORT Alcoholism treatment and medical care costs from Project MATCHADDICTION, Issue 7 2000Harold D. Holder Aims. This paper examines the costs of medical care prior to and following initiation of alcoholism treatment as part of a study of patient matching to treatment modality. Design Longitudinal study with pre- and post-treatment initiation. Measurements. The total medical care costs for inpatient and outpatient treatment for patients participating over a span of 3 years post-treatment. Setting. Three treatment sites at two of the nine Project MATCH locations (Milwaukee, WI and Providence, RI). Participants. Two hundred and seventy-nine patients. Intervention. Patients were randomly assigned to one of three treatment modalities: a 12-session cognitive behavioral therapy (CBT), a four-session motivational enhancement therapy (MET) or a 12-session Twelve-Step facilitation (TSF) treatment over 12 weeks. Findings. Total medical care costs declined from pre- to post-treatment overall and for each modality. Matching effects independent of clinical prognosis showed that MET has potential for medical-care cost-savings. However, patients with poor prognostic characteristics (alcohol dependence, psychiatric severity and/or social network support for drinking) have better cost-savings potential with CBT and/or TSF., Conclusions. Matching variables have significant importance in increasing the potential for medical-care cost-reductions following alcoholism treatment. [source] Biaxial testing and analysis of bicycle-welded components for the definition of a safety standardFATIGUE & FRACTURE OF ENGINEERING MATERIALS AND STRUCTURES, Issue 6 2003N. PETRONE ABSTRACT This paper presents the experimental evaluation of the fatigue behaviour of welded components under non-proportional variable amplitude biaxial loads. The study was undertaken on welded mountain bike handlebar stems, which were different in terms of geometry and technology and tested with load histories that were reconstructed and accelerated from recorded field data. Loads measured in the field were decomposed into bending and torsional components; a synchronous Peak-Valley counting, a spectrum inflation technique, a spline interpolation and a final amplification were applied to the measured signals in order to obtain test drive signals with the correct content of biaxial non-proportional loadings. After evaluation of the bending and torsion load-life curves of components under constant amplitude fatigue, the resulting data from biaxial variable amplitude fatigue tests were analysed in order to evaluate the damage contribution as a result of the two load components and an equivalent simplified two-stage constant amplitude fatigue test was proposed to the working group ISO/SC1/TC149/WG4. [source] Nature-Society Interactions in the Pacific IslandsGEOGRAFISKA ANNALER SERIES B: HUMAN GEOGRAPHY, Issue 4 2003Patrick D. Nunn ABSTRACT This paper focuses on nature,society interactions in the Pacific Islands before European contact about 200 years ago. It argues that the character of early interactions was decided by both the nature of a particular island environment and the intentions of the human settlers. Throughout the pre-European contact human history of the Pacific Islands, environmental changes of extraneous cause have been the main control of societal and cultural change. This environmental determinist view is defended using many examples. The contrary (and more popular) cultural determinist view of societal change in the Pacific Islands is shown to be based on largely spurious data and argument. A key example discussed is the ,AD 1300 Event', a time of rapid temperature and sea-level fall which had severe, abrupt and enduring effects on Pacific Island societies. It is important to acknowledge the role of environmental change in cultural transformation in this region. [source] Quality of Life and the Migration of the College-Educated: A Life-Course ApproachGROWTH AND CHANGE, Issue 1 2008RONALD L. WHISLER ABSTRACT This paper examines how the college-educated population,segmented into selective demographic groups, from young adults to the elderly,differentially values quality-of-life (QOL) indicators of metropolitan areas in the United States. Using data from the 2000 Census and the 1997 Places Rated Almanac, out-migration patterns are shown to depend jointly upon stage in the life course, the spatial-demographic setting, and QOL characteristics. An abundance of cultural and recreational amenities lowers out-migration rates of young college-educated. For the older college-educated population, the revealed preferences shift toward concerns for safety and a strong preference for milder climates. The study also finds significantly lower out-migration rates for metropolitan areas with growing human capital. In light of shifting age distributions and rising educational attainment levels, the results have important implications for the emergence of new migration patterns and the concentration of human capital. [source] Geography and the Future of Stock Exchanges: Between Real and Virtual SpaceGROWTH AND CHANGE, Issue 2 2007DARIUSZ WÓJCIK ABSTRACT This paper aims to contribute to the debate on the future of stock exchanges and financial centres by focusing on two questions. First, whether, how, why, and which stock exchange activities are prone to concentration in financial centres? Second, are they prone to concentration in national or international financial centres? Through a detail-rich analysis of stock exchange activities, including trading system, as well as relationships with members, issuers, and investors, the paper suggests a framework for the geography of stock exchange activities based on two dimensions,proneness to concentration in a financial centre and proneness to international consolidation. With this framework, predictions are made about the future geography of stock exchange activities led by the argument that while significant geographical reconfigurations are likely to unfold, driven primarily by the development of international networks of stock market institutions, stock exchanges, and financial centres will remain crucially important for each other. [source] The Impact of Metropolitan Structure on Commute Behavior in the Netherlands: A Multilevel ApproachGROWTH AND CHANGE, Issue 3 2004Tim Schwanen ABSTRACT This paper documents the investigation of the impact of metropolitan structure on the commute behavior of urban residents in the Netherlands. Not only has the impact of monocentrism versus polycentrism been analyzed, but the influence of metropolitan density and size has also been considered, together with the ratio of employment to population and the growth of the population and employment. Furthermore, data are used at a variety of levels of analysis ranging from the individual worker to the metropolitan region rather than being drawn from aggregate level statistics alone. Multilevel regression modeling is applied to take account of the interdependencies among these levels of aggregation. With regard to mode choice, the results indicate that the probability of driving an auto to work is lower in employment-rich metropolitan regions, and rises as the number of jobs per resident has grown strongly. Furthermore, women in most polycentric regions are less likely to commute as an auto driver. All else being equal, commute distances and times for auto drivers are longer in most polycentric regions than in monocentric urban areas. In addition, commute time as an auto driver rises with metropolitan size, whereas commute distance depends on employment density and the growth of the number of jobs per resident. The investigation shows that metropolitan structure, although significantly influencing commute patterns, explains only a small part of the variation of individuals' commute behavior. [source] E-commerce, Transportation, and Economic GeographyGROWTH AND CHANGE, Issue 4 2003William P. Anderson ABSTRACT This paper explores possible ways in which growth in Internet retailing (e-retailing) may affect the spatial distribution of economic activities. After a brief overview of e-retailing, a categorization of possible spatial impacts is introduced. These include impacts on the retail industry, such as substitution of e-retail for brick-and-mortar retail, impacts on transportation, such as substitution of freight transportation for personal transportation in goods delivery, and pervasive impacts that affect the whole economy. The latter category includes uniform delivered pricing, spatial leveling of accessibility, and marketing strategies that target individuals rather than regions. The question of whether e-retailing and brick-and-mortar retailing are truly substitutes is taken up in the next section, along with potential implications of multi-channel retailing. The final section of the paper defines some critical research directions. [source] The epidemiology of inhibitors in haemophilia A: a systematic reviewHAEMOPHILIA, Issue 4 2003J. Wight Summary., This paper emphasizes the importance of distinguishing between the prevalence, incidence and cumulative incidence of inhibitors in haemophilia A. Incidence and cumulative incidence data will include patients with transient inhibitors or whose inhibitors have been eliminated by treatment. As these will not be included in prevalence data, prevalence studies will tend to give rise to lower figures than incidence studies. As a result, the most accurate estimates of the true risk of inhibitor development comes from prospective studies of newly diagnosed haemophiliacs who are tested regularly for the presence of inhibitors. This paper reports a systematic review of the best available evidence relating to the epidemiology of inhibitors in haemophilia A. Cohort studies, registry data reporting incidence or prevalence of inhibitors in patients with haemophilia A, and prospective studies of factor VIII (FVIII) in the treatment of previously untreated patients which reported the development of inhibitors as an outcome, were included in the review. The overall prevalence of inhibitors in unselected haemophiliac populations was found to be 5,7%. The cumulative risk of inhibitor development varied (0,39%). Incidence and prevalence were substantially higher in patients with severe haemophilia. Studies of patients using a single plasma-derived FVIII (pdFVIII) preparation reported lower inhibitor incidence than those using multiple pdFVIII preparations or single recombinant FVIII preparations. Incidence data should be used to estimate the likely demand for treatments aimed at eliminating inhibitors, whereas the best estimates of the overall burden to the National Health Service (NHS) of treating bleeding episodes in patients with continuing inhibitors will come from prevalence studies. [source] Conflict and identity shape shifting in an online financial communityINFORMATION SYSTEMS JOURNAL, Issue 5 2009John Campbell Abstract., This paper challenges traditional explorations of online communities that have relied upon assumptions of trust and social cohesion. In the analysis presented here, conflict becomes more than just dysfunctional communication and provides an alternative set of unifying principles and rationales for understanding social interaction and identity shape shifting within an online community. A model is advanced that describes the systematic techniques of hostility and aggression in technologically enabled communities that take the form of contemporary tribalism. It is argued that this tribe-like conflict embodies important rituals essential for maintaining and defining the contradictory social roles sometimes found in online environments. This research offers a critical interpretive perspective that focuses on the link between identity shape shifting behaviours and the power relations within an online financial community. The analysis reveals how conflict between positions of power can help to align the values and ideals of an online community. With this study we seek to motivate a re-examination of the design and governance of online communities. [source] A temporal perspective of the computer game development processINFORMATION SYSTEMS JOURNAL, Issue 5 2009Patrick Stacey Abstract., This paper offers an insight into the games software development process from a time perspective by drawing on an in-depth study in a games development organization. The wider market for computer games now exceeds the annual global revenues of cinema. We have, however, only a limited scholarly understanding of how games studios produce games. Games projects require particular attention because their context is unique. Drawing on a case study, the paper offers a theoretical conceptualization of the development process of creative software, such as games software. We found that the process, as constituted by the interactions of developers, oscillates between two modes of practice: routinized and improvised, which sediment and flux the working rhythms in the context. This paper argues that while we may predeterminately lay down the broad stages of creative software development, the activities that constitute each stage, and the transition criteria from one to the next, may be left to the actors in the moment, to the temporality of the situation as it emerges. If all development activities are predefined, as advocated in various process models, this may leave little room for opportunity and the creative fruits that flow from opportunity, such as enhanced features, aesthetics and learning. [source] Degenerative structures that inhibit the emergence of communities of practice: a case study of knowledge management in the British CouncilINFORMATION SYSTEMS JOURNAL, Issue 4 2007Will Venters Abstract., This paper presents the British Council's knowledge management strategy. It outlines how, as part of this strategy, the organization attempted to engender communities of practice among a strategically significant group spread across the 110 countries in which the organization operates. Using a case study of this group, the paper explores ,degenerative structures' that impact on the ability to engender communities of practice and, through consideration of issues of individualization and risk, highlights a series of paradoxes that inhibited this organization's attempt to move from a ,hub-and-spoke' structure to become a networked organization in which communities of practice flourish. [source] Persistent problems and practices in information systems developmentINFORMATION SYSTEMS JOURNAL, Issue 3 2007Karlheinz Kautz Abstract.,This paper identifies and discusses the persistent problems and development practices of information systems development (ISD). A critical examination and comparison of past times',traditional' and present-day ,web-based' development shows that contemporary ISD can be seen as an accentuated evolution , rather than a revolution , of well-known challenges and solutions. On this basis, (1) diversity; (2) knowledge; and (3) structure are identified as inherent and interrelated problems, while the practices for coping with these three challenges are (a) organization and specialization; (b) constant verbal communication and negotiation; and (c) pragmatic application of certain development methods and methodical concepts. We conclude that more research on the occurrence and interaction of problems and practices at, and between, different contextual levels (e.g. the business environment, company, project, team and individual levels) is needed to understand and assess (the gap between) ,observed practice' and ,good practice' across the many types of Web and non-Web ISD projects conducted today. We outline a possible research agenda to investigate these issues. [source] Prospering in a transition economy through information technology-supported organizational learningINFORMATION SYSTEMS JOURNAL, Issue 1 2007Marius Janson Abstract., This paper presents the findings of a longitudinal study of the Slovenian company Sava during its 1995,2004 transition period when it adapted to and prospered in a free market economy. The company is particularly interesting because of its successful transition from a socialist company operating in a protected market to a privatized company operating in a capitalist global market, as well as the pivotal role of information technology (IT)-supported organizational learning that brought about radical change and successful transition. Our investigation of Sava's experiences demonstrates how the company's increasing attention to organizational learning, integration of working and learning, and its constant innovation of products and processes created new needs for IT support that motivated the adoption of new IT systems (such as Lotus Notes, document management systems, SAP), which in turn increased Sava's capacity to learn. Furthermore, our study reveals how the role of IT systems in organizational learning depends on the nature of learning (single-loop, double-loop or triple-loop learning) and the organizational level at which learning takes place (individual, group/department or organization). By providing insight into the emergence of distinct types of IT-supported learning and their vital role in Sava's successful transition, the paper contributes to a deeper understanding of the relationship between IT and organizational learning that is relevant and inspiring to other companies, especially those operating in transition economies. [source] Escalation and de-escalation of commitment: a commitment transformation analysis of an e-government projectINFORMATION SYSTEMS JOURNAL, Issue 1 2006Gary Pan Abstract., This paper presents a commitment transformation framework for analysing the change in actors' commitment during the transition from escalation to de-escalation in information technology projects. De-escalation is potentially a more important issue than escalation because de-escalation provides remedies for the ills of escalation. Therefore, it is important to understand how stakeholders may bias facts in the direction of previously accepted beliefs and thus prevent an organization from de-escalating. Here, we adopt Lewin's change theory to examine the commitment transformation during the transition from escalation to de-escalation of an e-government project in a local council in the United Kingdom. By conceiving actors' commitment transformation as an ,unfreezing,changing,refreezing' process, researchers may develop a deeper understanding of how actors may give up previous failing course of action and accept an alternative course of action. Practitioners can also utilize the framework in post-mortem analyses of projects which have faced escalation to devise useful de-escalation strategies for future project development.1 [source] Client-Led Information System Creation (CLIC): navigating the gapINFORMATION SYSTEMS JOURNAL, Issue 3 2005Donna Champion Abstract., This paper offers a new framework to facilitate an interpretive approach to client-led information system development, referred to as CLIC (Client-Led Information System Creation). The challenge of moving seamlessly through a process of information systems (IS) design is still the subject of much research in the IS field. Attempts to address the difficulties of ,bridging the gap' between a client's business needs and an information system definition have hitherto not provided a coherent and practical approach. Rather than attempting to bridge the gap, this paper describes an approach to managing this gap by facilitating the clients' navigating through the information system design process (or inquiry process) in a coherent manner. The framework has been developed through practice, and the paper provides an example of navigating through the design phase taken from an Action Research field study in a major UK bank. [source] Towards a distinctive body of knowledge for Information Systems experts: coding ISD process knowledge in two IS journalsINFORMATION SYSTEMS JOURNAL, Issue 4 2004Juhani Iivari Abstract., This paper introduces the idea of coding a practically relevant body of knowledge (BoK) in Information Systems (IS) that could have major benefits for the field. In its main part, the paper focuses on the question if and how an underlying body of action-oriented knowledge for IS experts could be distilled from the IS research literature. For this purpose the paper identifies five knowledge areas as the most important parts for an IS expert's BoK. Two of these are claimed as distinct areas of competence for IS experts: IS application knowledge and IS development (ISD) process knowledge. The paper focuses particularly on ISD process knowledge because it allows the organizing of practically relevant IS knowledge in an action-oriented way. The paper presents some evidence for the claim that a considerable body of practically relevant IS process knowledge might, indeed, exist, but also notes that it is highly dispersed in the IS literature. It then argues that the IS research community should take stock of this knowledge and organize it in an action-oriented way. Based on results from prior work it proposes a four-level hierarchical coding scheme for this purpose. In order to test the idea of coding action-oriented knowledge for IS experts, the paper reports the results of a coded literature analysis of ISD research articles published from 1996 to 2000 in two leading IS journals , Information Systems Journal and MIS Quarterly. The results suggest that ISD approaches form a useful framework for organizing practically relevant IS knowledge. [source] An institutional perspective on developing and implementing intranet- and internet-based information systemsINFORMATION SYSTEMS JOURNAL, Issue 3 2003Tom Butler Abstract. ,This paper adopts a constructivist, case-based research strategy to examine the development and implementation of intranet- and internet-based information systems (IS) in a single organization. Institutional theory is used to describe, explain and understand the commitments of social actors in the development of web-based IS. The findings illustrate that: (1) social and organizational problems similar to those that beset ,traditional' IS development arise in the development and implementation of web-based IS; (2) ,top-down' development and implementation strategies give rise to more conflict and change management problems than ,bottom-up' approaches; and (3) fostering high levels of commitment to organizational imperatives is key to the successful development and implementation of web-based IS. [source] Evaluation of the Implementation of Nursing Diagnoses, Interventions, and OutcomesINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2009Maria Müller-Staub PhD PURPOSE.,This paper aims to provide insight into nursing classifications and to report the effects of nursing diagnostics implementation. This paper summarizes the results of six studies. METHODS.,Two systematic reviews, instrument development and testing, a pre,post intervention study, and a cluster-randomized trial were performed. FINDINGS.,The NANDA International classification met most of the literature-based classification criteria, and results showed the Quality of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) to be a reliable instrument to measure the documented quality of nursing diagnoses, interventions, and outcomes. Implementation of standardized nursing language significantly improved the quality of documented nursing diagnoses, related interventions, and patient outcomes. As a follow-up measure, Guided Clinical Reasoning (GCR) was effective in supporting nurses' clinical reasoning skills. CONCLUSIONS.,Carefully implementing classifications led to enhanced, accurately stated nursing diagnoses, more effective nursing interventions, and better patient outcomes. IMPLICATIONS.,Rethinking implementation methods for standardized language and using GCR is recommended. Based on the results of this study, the inclusion of NANDA International diagnoses with related interventions and outcomes in electronic health records is suggested. [source] Risk management dilemmas in dementia care: an organizational survey in three UK countriesINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2009Charlotte L. Clarke PhD Aims and objectives., The overall project aimed to understand the variability of the construction of risk in dementia care from the perspective of the person with dementia, family carers and practitioners with the intention of developing negotiated partnerships in risk management. This paper focuses on the objective of identifying the understandings of risk by practitioners. Background., Risk management can result in a ,safety first' approach to care practices, but this may be disempowering for people with dementia. Design., This paper describes the results of the first stage of the study: a survey to service managers or equivalent in health, social and voluntary sector care organizations in three countries of the UK. Methods., Data from this stage was collection by postal questionnaire (n = 46). Results., Risk was portrayed as a multidimensional concept and clustered around three themes: (1) Risk and Independence, (2) Risk and Resource, and (3) Organizational Risk Management. Conclusions., Very wide understandings of risk are identifiable, ranging from avoidance of physical harm through to managed risk taking to improve quality of life, and to an appreciation of the impact of organizational and professional patterns of behaviour resulting in harm to the person with dementia. Relevance to clinical practice., Obtaining information about the perspectives of others may help to illuminate some of the dilemmas experienced by staff in this study, and the development of risk assessment frameworks may assist staff to resolve some of these. [source] An evaluation of the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2007Assumpta Ryan PhD MEd, BSc(Hons), PGCTHE Objectives., This paper reports the results of a study that aimed to evaluate the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people. Background., With repeated exposure to very sick older people in hospitals or nursing homes, nursing students are at risk of adopting stereotypical views about this section of the population as frail and dependent. Design., A pre- and post-test design was used to conduct the study. Methods., Using Kogan's Attitudes Towards Old People Scale, the attitudes of nursing students were tested at the beginning of a degree programme in Adult Nursing (n = 130) and one year later (n = 94) following a series of visits to a well-older person in the community. Results., Nursing students reported positive attitudes towards older people and these were retained throughout the first year of their nurse training. No statistically significant differences were found associated with any of the five independent variables in either pre- or postintervention students. Conclusions., The attitudes of nursing students towards older people remained positive. While it is possible that the experiential and educational interventions utilized in this study may have contributed to the retention of positive attitudes, further research is required to test this hypothesis. Relevance to clinical practice., Nurses have a major role to play in responding to the health and social care needs of older people and their families. The cultivation of positive attitudes is a key factor in enabling practising nurses to respond to this challenge. [source] Evaluating the context within which continence care is provided in rehabilitation units for older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2007Jayne Wright Aim., This paper presents the first phase of an all Ireland 2-year study between the University of Ulster and University College Cork, to determine the contextual indicators that enable or hinder person centred continence care and management in rehabilitation settings for older people. The primary outcome of the study was the development of a tool to enable practitioners to assess the practice context within which continence care is provided. The main focus of this paper is the value of understanding practice ,context' (culture, leadership and evaluation) and its impact to the provision of person centred continence care. Background., The literature highlights the effect of continence problems on the quality of life of older people. Incontinence is often seen by health care professionals and older people as an inevitable consequence of ageing and difficult to treat. Furthermore, health care professionals do not always have the necessary skills and knowledge of best practice in continence care and treatments. The Promoting Action on Research Implementation in Health Services (PARIHS) framework utilized in the study proposes that successful implementation of evidence in practice is dependent on the inter-relationship of three key elements; the nature of the evidence, the quality of the context and expert facilitation. Kitson et al. propose that for successful implementation, evidence needs to be robust, the context receptive to change and appropriate facilitation is needed. Consequently understanding practice ,context' and its impact on the provision of person centred continence care is of value. Methods., Case study methodology with several data collection methods was utilized to measure all aspects of ,context' as identified by the PARIHS framework. Methods include: Royal College of Physicians Audit Scheme, Staff Knowledge questionnaire, semi-structured observation of practice and multidisciplinary focus groups. Findings., The data were analysed in two stages. Stage 1 using both qualitative and quantitative (SPSS 12) methods. Stage 2 analysed all the data utilizing the characteristics of context from the PARIHS framework in order to identify the strong and weak characteristics of the context within which continence care was provided. Continence care and management in this study was found to be focused on continence containment rather than proactive management. The evidence suggests that the context (leadership, culture and evaluation) was weak and not conducive to person centred continence care and management. Conclusion., An analysis of the data using the context framework provided a picture of the context within the units and the identification of the specific contextual issues hindering and enabling the delivery of person centred continence care. This process has thus, added to our understanding of the importance of context to the provision of person-centred care. [source] Probiotics and oral health effects in childrenINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 1 2008SVANTE TWETMAN Background., Probiotics are living micro-organisms added to food which beneficially affect the host by improving its intestinal microbial balance. Objective., This paper aims to present a general background on probiotics and its health effects in children, and to examine the evidence for oral colonization and the possible impact on oral health in children and young adults. Methods., For delivery and general health effects, recent systematic reviews, meta-analyses, and other relevant papers were used. Concerning oral installation and oral effects, a broad search for publications in English was conducted through February 2007 in PubMed. Studies describing an installation or intervention trial in humans with a controlled design and an oral endpoint measure were considered. Fourteen papers with dental focus were identified, of which two were narrative reviews. Results., Only one study of dental interest was conducted in children. Four papers dealt with oral installation of probiotic bacteria, and although detectable levels were found in saliva shortly after intake, the studies failed to demonstrate a long-term installation. Seven papers evaluated the effect of lactobacilli- or bifidobacteria-derived probiotics on the salivary levels of caries-associated bacteria in placebo-controlled designs. All but one reported a hampering effect on mutans streptococci and/or yeast. The single study carried out in early childhood reported a significant caries reduction in 3- to 4-year-old children after 7 months of daily consumption of probiotic milk. Conclusion., Bacteriotheraphy in the form of probiotic bacteria with an inhibitory effect on oral pathogens is a promising concept, especially in childhood, but this may not necessarily lead to improved oral health. Further placebo controlled trials that assess carefully selected and defined probiotic strains using standardized outcomes are needed before any clinical recommendations can be made. [source] A fearful child attends: a psychoanalytic explanation of children's responses to dental treatmentINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 6 2007RUTH FREEMAN Background., At the mention of dental treatment some children become overwhelmed by anxiety whereas others appear to take the news in their stride. Sometimes when anxious children attend dental treatment, they appear to cope, contain their fears, and passively submit to treatment, whereas others angrily refuse to open their mouths and a third group of children exist who seem to just ,tough it out' no matter how disagreeable or frightening dental treatment becomes. The question remains: why do children react so differently to dental treatment? Aim., This paper aims to provide a psychoanalytic explanation as to why children react and respond differently to dental treatment. Results., This paper proposes a psychoanalytic formulation based on the functionality of the family, parent,child dyads, child psychological development, and the child's emotional and actual life experiences. Conclusions., There is a need to understand the dynamic nature of child dental anxiety and to appreciate the hidden factors and underlying complexities associated with the anxious child who attends for dental treatment. [source] Family-Based Weight Management With Latino Mothers and ChildrenJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2008Kathy Shadle James PURPOSE.,This paper aims to design a culturally appropriate weight management intervention for high-risk Latino families and to examine the feasibility of recruiting program participants. DESIGN AND METHODS.,A descriptive design using qualitative and quantitative data collected during preliminary phases of an ongoing intervention study. RESULTS.,From the preliminary works, a curriculum was revised for Latino families who have overweight children. The curriculum was modified to include suggestions from the focus groups, including helping mothers set limits with their children and make the transition to lighter foods and a more active family life. PRACTICE IMPLICATIONS.,The information will aid professionals in the process of program design for Latino families who have weight concerns. [source] | ||||||||||||||||||||||||||||