H & C Management 2

151: Issues Ment Health Nurs. 2007 Dec;28(12):1309-22.
Related Articles, Links
Dual diagnosis: an exploratory qualitative study of staff perceptions

of substance misuse among the mentally ill in Northern India.
Phillips PA.
City University London, Department of Mental Health And Learning Disability,

Philpot Street, London E1 2EA, England. p.phillips@city.ac.uk
Dual diagnosis is well recognized as a significant clinical problem. It is associated

with poor outcomes, staff difficulties, and management problems. This
exploratory study investigated the extent and clinical correlates of dual diagnosis
and traditional substance use among the mentally ill by interviewing staff from
several substance misuse and mental health services in Northern India, using a
semi-structured interview schedule and focus groups. Dual diagnosis was seen as
a common problem according to staff interviewed from substance misuse and
mental health services, although types of substance use reported were different
than in western studies. Traditional substance use (the use of substances in
distinct cultural, religious, and social settings that is not prohibited, such as khat
or betel nut) also was reported as common among those with dual diagnosis.
Substance misuse among the mentally ill is common in Northern India.
Opportunities exist for informing mental health nursing practice about
"traditional" substance use.
PMID: 18058336 [PubMed - indexed for MEDLINE]
152: Burns. 2008 Feb;34(1):67-70. Epub 2007 Nov 28.

First aid and initial management for childhood burns in Vietnam--

an appeal for public and continuing medical education.
Lam NN, Dung NT.
Burn Intensive Care Unit, National Institute of Burns, Hanoi, Vietnam.

lamnguyenau@yahoo.com
A prospective study to investigate first aid and initial management for 247
paediatric burn patients from 1 June, 2004 to 31 June, 2006 at the Burn Intensive
Care Unit, National Institute of Burns (NIB), Hanoi. Data were collected from
documents from referring hospitals and direct interview of patients, relative and
transport team as guided by the International Society for Burn Injury (ISBI) and
the World Health Organization (WHO). Results showed that cooling the burn
surface by cold water was applied in 27.17%. Among 132 patients transferred
from other hospitals, fluid resuscitation was given in 102 patients (77.28%) before
transferring and over a half of these patients were not given intravenous fluid
during the time of transfer, especially for children under 1 year of age (p<0.05).
Dressings were applied in 36.36% of transferred patients. Burn surface area was
accurately diagnosed in only 21.90% of total cases. In conclusion, first aid and
initial management in Vietnam are still far from ideal. Further public education
and continuing medical education should be applied in Vietnam.
153: Ann Trop Paediatr. 2007 Dec;27(4):253-9.

Clinical profile of sickle cell disease in Yemeni children.
Al-Saqladi AW, Delpisheh A, Bin-Gadeem H, Brabin BJ.
Faculty of Medicine & Health Sciences, Aden University, Yemen.
The clinical spectrum of sickle cell disease (SCD) in the Arabian Peninsula varies
widely. This is the first report in Yemeni children. METHODS: A hospital-based,
cross-sectional study was undertaken in Al-Wahada Teaching Hospital in Aden of
children under 16 years with homozygous (SS) SCD. RESULTS: Fifty-six (55%)
were males. There were clinical manifestations in 20% by the age of 6 months
and in 67%, 88% and 92% by 1, 2 and 3 years, respectively. Dactylitis (hand-foot
syndrome) was the most common presenting symptom and occurred in 54% of
cases, followed by acute respiratory infections and other acute febrile illnesses.
The main causes of hospitalisation were painful crisis (36%), anaemic crisis
(16%) and acute chest syndrome (11%). Hepatomegaly was detected in 72% and
splenomegaly in 40%. Cerebrovascular accident, cholelithiasis, hepatic crisis and
leg ulcers each occurred in about 5% of patients. There was first- and second-
degree consanguinity in 31% and 16%, respectively, of patients' families.
CONCLUSION: SCD is a serious problem, affecting children in Yemen from an
early age. Disease course and severity were similar to that in Africans and
American blacks and some reports from western Saudi Arabia. A screening
programme linked to comprehensive medical care and genetic counselling is
required to improve management and quality of life.
154: J Clin Psychiatry. 2007 Nov;68(11):1793-8.

Effect of olanzapine, risperidone, and haloperidol treatment on
weight and body mass index in first-episode schizophrenia patients
in India: a randomized, double-blind, controlled, prospective study.
Saddichha S, Manjunatha N, Ameen S, Akhtar S.
Central Institute of Psychiatry, Ranchi, India. saddichha@gmail.com
OBJECTIVE: The presence of obesity and increases in body mass are important
risk factors for cardiovascular disease and diabetes. This study examined the
effects of olanzapine, risperidone, and haloperidol on weight, body mass index
(BMI), and development of obesity in a drug-naive population compared with a
matched healthy control group. METHOD: Consecutive patients during the period
from June through October 2006 with DSM-IV schizophrenia at our referral
psychiatric hospital were recruited for an extensive prospective study that
included anthropometric measures of weight, waist circumference, waist-hip ratio,
and BMI. Subjects were randomly assigned to receive haloperidol, olanzapine, or
risperidone and compared with a matched healthy control group. The prevalence
of obesity, which was the main outcome measure, was assessed on the basis of 2
criteria: revised World Health Organization (WHO) definition for Asians and
criteria of the International Diabetes Federation (IDF). Inclusions started in June
2006, and patients were followed for a period of 6 weeks. RESULTS: The
analysis of 66 patients showed a prevalence of overweight (WHO criteria) at
22.7% and obesity at 31.8% (IDF criteria). The prevalence of obesity (IDF
criteria) in our patients is over 30 times as high as that of the matched healthy
control group (p < .001). Subjects in the olanzapine group had the greatest weight
gain at 5.1 kg, followed by risperidone at 4.1 kg and haloperidol at 2.8 kg.
CONCLUSIONS: Obesity is highly prevalent among patients treated with
atypical antipsychotics for schizophrenia. Assessment and monitoring of obesity
along with preventive and curative measures should be part of the clinical
management of patients treated with antipsychotics. TRIAL REGISTRATION:
ClinicalTrials.gov, NCT00534183, www.clinicaltrials.gov.
Publication Types:
• Randomized Controlled Trial
155: J Clin Nurs. 2007 Nov;16(11C):350-7.

A cross-cultural comparison of the developmental evolution of
expertise in diabetes self-management.
Shimizu Y, Paterson BL.
Area of Nursing Science, Division of Health Sciences, Osaka University,

Graduate School of Medicine, Osaka, Japan.
AIMS: The authors compare the findings of two research studies, one conducted
in Japan and the other in Canada, about the developmental evolution of self-
management of diabetes. In this article, the authors identify the similarities and
differences that exist in the research data, proposing that the differences are
situated in the different cultural perspectives of self-management that exist in both
countries. BACKGROUND: Researchers have acknowledged that self-
management has cultural dimensions. Despite this, however, there are few studies
that have provided a cross-cultural comparison of the experience of self-
management among different cultural groups. DESIGN: The authors conducted a
critical comparative analysis of two models of developing expertise in diabetes
self-management. The review included an analysis of the cultural meanings of the
various terms and the underlying assumptions of both models. CONCLUSIONS:
The models shared many similarities; however, their differences were identified,
such as the meaning and interpretation of various words or experiences, and
shaped by the culturally bound perspectives of self and health. RELEVANCE TO
CLINICAL PRACTICE: The findings serve as a caution to imposing ethnocentric
views and interpretations in diabetes care. In addition, they remind us about the
importance of asking people with diabetes about what they understand, desire and
understand. The findings challenge nurses to reflect on how the development of
self-management of diabetes in various national contexts is influenced by health
care practices that focus on control or harmony.
Publication Types:
• Comparative Study
• Research Support, Non-U.S. Gov't
• Review
156: J Clin Nurs. 2007 Nov;16(11C):250-7.

Self-efficacy, outcome expectations and self-care behaviour in people

with type 2 diabetes in Taiwan.
Wu SF, Courtney M, Edwards H, McDowell J, Shortridge-Baggett LM,

Chang PJ.
Nursing Faculty, National Taipei College of Nursing, Taipei, Taiwan.

shufang@ntcn.edu.tw
AIMS: To explore differences in self-care behaviour according to demographic

and illness characteristics; and relationships among self-care behaviour and
demographic and illness characteristics, efficacy expectations and outcome
expectations of people with type 2 diabetes in Taiwan. BACKGROUND: Most
people with diabetes do not control their disease appropriately in Taiwan.
Enhanced self-efficacy towards managing diseases can be an effective way of
improving disease control as proposed by the self-efficacy model which provides
a useful framework for understanding adherence to self-care behaviours. DESIGN
AND METHODS: The sample comprised 145 patients with type 2 diabetes aged
30 years or more from diabetes outpatient clinics in Taipei. Data were collected
using a self-administered questionnaire for this study. One-way anova, t-tests,
Pearson product moment correlation and hierarchical regression were analysed for
the study. RESULTS: Significant differences were found: between self-care
behaviour and complications (t = -2.52, p < 0.01) and patient education (t = -1.96,
p < 0.05). Self-care behaviour was significantly and positively correlated with
duration of diabetes (r = 0.36, p < 0.01), efficacy expectations (r = 0.54, p < 0.01)
and outcome expectations (r = 0.44, p < 0.01). A total of 39.1% of variance in
self-care behaviour can be explained by duration of diabetes, efficacy
expectations and outcome expectations. CONCLUSIONS: Findings support the
use of the self-efficacy model as a framework for understanding adherence to self-
care behaviour. RELEVANCE TO CLINICAL PRACTICE: Using self-efficacy
theory when designing patient education interventions for people with type 2
diabetes will enhance self-management routines and assist in reducing major
complications in the future.
Publication Types:
• Clinical Trial
• Multicenter Study
157: Nippon Ronen Igakkai Zasshi. 2007 Sep;44(5):611-8.

[An overview and prospect of demented outpatient care in a

department of geriatric medicine: report based on statistical review
of the memory clinic at the geriatric outpatient unit of the Nagoya
University Hospital]
[Article in Japanese]
Kawano N, Umegaki H, Mogi N, Yamamoto S, Suzuki Y, Iguchi A.
Department of Geriatrics, Medicine in Growth and Aging, Program in Health and

Community Medicine, Nagoya University Graduate School of Medicine.
AIM: Although there are many reports regarding the status of memory clinics in
Japan, most are from the clinical departments of psychiatry or neurology, and
there are few from the geriatric outpatient clinics. This study aimed to review the
status of the memory clinic at the geriatric outpatient unit of a university hospital
and also to compare the results with other reports. METHODS: Patient records of
the memory clinic at the geriatric outpatient unit of the Nagoya University
Hospital between January 2000 and June 2006, which included clinical
information and neuropsychological profiles were extensively reviewed for
statistical analyses. Of the patients who first visited the memory clinic between
January 2004 and June 2006, prior written consent are obtained from 232
outpatients, among which 223 individuals who had intact sets of data were
subjected to detailed analyses. RESULTS: During the period investigated, we had
a total of 778 visits by 577 patients. The characteristics of patients were: age:
74.5+/-8.3 years; MMSE: 23.8+/-4.7; education year: 10.7+/-2.9. Clinical profiles
of the patients who visited during the most recent 2.5 years were as follow:
cognitively normal, 8.1%; dementia of Alzheimer's type, 45.3%; vascular type,
5.4%; mixed type, 2.2%; frontotemporal dementia, 3.1%; mild cognitive
impairment, 15.7%, and others. CONCLUSION: Compared with previous reports
from other institutions, we observed that the visitors to our geriatric memory
clinic had a relatively higher educational background with earlier stages of
dementing disorders, which also included pre-clinical cognitive impairment.
Publication Types:
• English Abstract
158: Psychol Med. 2008 Feb;38(2):221-8. Epub 2007 Nov 30.

Detecting common mental disorders in primary care in India: a

comparison of five screening questionnaires.
Patel V, Araya R, Chowdhary N, King M, Kirkwood B, Nayak S, Simon G,
Weiss HA.
London School of Hygiene and Tropical Medicine, London, UK.

Vikram.patel@lshtm.ac.uk
BACKGROUND: Screening of patients for common mental disorders (CMDs) is

needed in primary-care management programmes. This study aimed to compare
the screening properties of five widely used questionnaires. METHOD: Adult
attenders in five primary-care settings in India were recruited through systematic
sampling. Four questionnaires were administered, in pairs, in random order to
participants: the General Health Questionnaire (GHQ, 12 items); the Primary
Health Questionnaire (PHQ, nine items); the Kessler Psychological Distress Scale
(K10, 10 items), and from which we could extract the score of the shorter 6-item
K6; and the Self-Reporting Questionnaire (SRQ, 20 items). All participants were
interviewed with a structured lay diagnostic interview, the Revised Clinical
Interview Schedule (CIS-R). RESULTS: Complete data were available for 598
participants (participation rate 99.3%). All five questionnaires showed moderate
to high discriminating ability; the GHQ and SRQ showed the best results. All five
showed moderate to high degrees of correlation with one another, the poorest
being between the two shortest questionnaires, K6 and PHQ. All five had
relatively good internal consistency. However, the positive predictive value (PPV)
of the questionnaires compared with the diagnostic interview ranged from 51% to
77% at the optimal cut-off scores. CONCLUSIONS: There is little difference in
the ability of these questionnaires to identify cases accurately, but none showed
high PPVs without a considerable compromise on sensitivity. Hence, the choice
of an optimum cut-off score that yields the best balance between sensitivity and
PPV may need to be tailored to individual settings, with a higher cut-off being
recommended in resource-limited primary-care settings.
Publication Types:
• Validation Studies
159: J Clin Nurs. 2008 Feb;17(3):412-20. Epub 2007 Nov 30.

Discharge training and counselling increase self-care ability and

reduce postdischarge problems in CABG patients.
Cebeci F, Celik SS.
Antalya School of Health, Akdeniz University, Campus/Antalya, Turkey.
AIMS AND OBJECTIVES: The aim of this study was to determine how
discharge training and counselling provided to patients, who had undergone
coronary artery bypass graft (CABG) surgery, had effects on patients' self-care
ability and on the problems encountered after discharge. The objectives were to
help patients develop self-care behaviour to deal more comfortably with the
problems caused by the disease and, hopefully, to reduce the number of problems
they may encounter. BACKGROUND: CABG surgery patients needing to
manage various aspects of their self-care at home often find these tasks very
difficult to carry out effectively. Discharge training and counselling services help
patients undergoing CABG to develop self-care behaviours. DESIGN: The study
was prospective and quasi-experimental. METHODS: The intervention and
control groups consisted of 57 patients who were given discharge training and
counselling by a researcher and 52 patients who were given routines by a nurse,
respectively. The intervention group began receiving discharge training and
counselling on the day of hospitalization. These were provided according to their
individual knowledge needs and patients were given a booklet developed for
training purposes. Data were collected by researcher using the Personal
Information Form, the Self-Care Agency Scale. RESULTS: It was found that the
intervention group had a higher mean self-care score than the control group and
experienced fewer problems following discharge compared with patients in the
control group. CONCLUSION: The discharge training and counselling services
given to patients in the intervention group had a positive impact on the self-care
ability of these patients and on alleviating the problems they encountered.
RELEVANCE TO CLINICAL PRACTICE: As discharge training and
counselling services had a positive impact on the self-care and alleviation of the
problems that patients encounter after being discharged, we recommend
application of these services and the usage of the training booklet for CABG
patients.
Publication Types:
• Controlled Clinical Trial

160: J Gen Intern Med. 2008 Mar;23(3):304-9. Epub 2007 Nov 28.
Does physicians' case volume impact inpatient care costs for
pneumonia cases?
Lin HC, Xirasagar S, Lin HC, Hwang YT.
Department of Pediatric Infection, Taipei Medical University and Hospital,

Taipei, Taiwan.
BACKGROUND: Increasing physician case volumes are documented to reduce

costs and improve outcomes for many surgical procedures but not for medical
conditions such as pneumonia that consume significant health care resources.
OBJECTIVE: This study explored the association between physicians' inpatient
pneumonia case volume and cost per discharge. DESIGN: The design was a
retrospective, population-based, cross-sectional study, using National Health
Insurance administrative claims data. SETTING: The setting was Taiwan.
PARTICIPANTS: The participants were a universal sample of 270,002 adult,
acute pneumonia hospitalizations, during 2002-2004, excluding transferred cases
and readmissions. MEASUREMENTS: Hierarchical linear regression modeling
was used to examine the association of physician's volume (three volume groups,
designed to classify patients into approximately equal sized groups) with cost,
adjusting for hospital random effects, case severity, physician demographics and
specialty, hospital characteristics, and geographic location. RESULTS: Mean cost
was NT$2,255 (US$1 = NT$33 in 2004) for low-volume physicians (< or =100
cases) and NT$1,707 for high-volume physicians (> or =316 cases). The adjusted
patient costs for low-volume physicians were higher (US$264 and US$235 than
high- and medium-volume physicians, respectively; both P < .001), with no
difference between high- and medium-volume physicians. High-volume
physicians had lower in-hospital mortality and 14-day readmission rates than low-
volume physicians. CONCLUSIONS: Data support an inverse volume-cost
relationship for pneumonia care. Decision processes and clinical care of high-
volume physicians versus low-volume physicians should be studied to develop
effective care algorithms to improve pneumonia outcomes and reduce costs.
Publication Types:
PMCID: PMC2359464 [Available on 03/01/09]
161: Singapore Med J. 2007 Dec;48(12):1069-73.

Physician leadership.
Woo KT.
Department of Renal Medicine, Singapore General Hospital, Outram Road,

Singapore 169608. woo.keng.thye@sgh.com.sg
Doctors, because of the nature of their training and their profession, have to be
leaders. Subsequently, when they specialise, leadership qualities are even more
important if they are to be effective in leading the specialty team. It is common
knowledge that doctors have become leaders in various sectors of society. One of
the fundamental advantages a doctor has over others in leadership positions is his
basic training in studying and understanding human nature. With years of practice
and experience, the doctor, a student of human nature, has a good grasp of human
behaviour which enables him to become a better leader. The six universal and
timeless characteristics of great leaders are: ability to share a vision, surrounding
oneself with great people, ability to coach other team members, ability to focus on
perfection, developing emotional intelligence and ability to train effective leaders.
I would like to see three essential qualities in a strong leader: ability to secure an
"envisioned future", ability to sacrifice in order to cultivate loyalty, and courage
to do the right thing and protect his people. An effective leader positions himself
in a situation to ensure survival. Having secured the leadership position, one must
take certain steps to strengthen one's leadership so that it will survive. Six
strategies from the Art of War by Sun Tzu which are of great practical value are:
walk the ground, have trusted lieutenants, information gathering, confuse the
enemy, win most while doing nothing, and that which is too good will not last
forever. Sometimes we have to change in order to survive. We need to get rid of
outmoded practices and shed old burdens to take advantage of the present. The
task of exiting from leadership is facilitated if one has groomed a successor. The
longer one is in a leadership position, the more difficult it is for one to step down.
Some organisations retain old leaders as advisors or mentors. They should be just
seen and not heard and go about their work quietly, contributing to the
department. A retired leader should be able to command respect from his peers
and preserve his dignity.
162: Phys Ther. 2008 Feb;88(2):270-85. Epub 2007 Nov 27.

Implementing an integrated electronic outcomes and electronic

health record process to create a foundation for clinical practice
improvement.
Deutscher D, Hart DL, Dickstein R, Horn SD, Gutvirtz M.
Physical Therapy Service, Maccabi Healthcare Services, Tel Aviv, Israel.

Deutsch_d@mac.org.il
BACKGROUND AND PURPOSE: Improving clinical outcomes requires

continuous measurement and interpretation in conjunction with treatment process
and patient characteristics. The purposes of this study were: (1) to describe
implementation and integration of electronic functional status outcomes into an
electronic health record (EHR) for the promotion of clinical practice improvement
processes and (2) to examine the effect of ongoing outcomes data collection in a
large physical therapy service in relation to patient and clinic burden. SUBJECTS:
Data were examined from 21,523 adult patients (mean age=50.6 years, SD=16.3,
range=18-99; 58.9% women, 41.1% men) referred for physical therapist
management of neuromusculoskeletal disorders. METHODS: Process and patient
characteristic data were entered into the EHR. OUTCOMES: data collected using
computerized adaptive testing technology in 11 outpatient clinics were integrated
into the EHR. The effect of data collection was assessed by measuring the
participation rate, completion rate, and data entry time. Qualitative assessment of
the implementation process was conducted. RESULTS: After 1 year, the average
participation rate per clinic was 79.8% (range=52.7%-100%), the average
completion rate per clinic was 45.1% (range=19.3%-64.7%), and the average data
entry time per patient (minutes:seconds) was 03:37 (SD=02:19). Maximum
estimate of average administrative time per patient was 9.6% of overall episode
time. Barriers to and facilitators of the implementation process were identified.
DISCUSSION AND CONCLUSION: The results indicate that routine collection
of outcome data is realistic in a large public physical therapy service and can be
successfully integrated with EHR data to produce a valuable clinical practice
improvement platform for service evaluation and outcomes research. Participation
and completion rate goals of 90% and 65%, respectively, appear to be feasible.
Publication Types:
163: Clin Ther. 2007 Oct;29(10):2256-67.

Cost-effectiveness analysis of bevacizumab combined with

chemotherapy for the treatment of metastatic colorectal cancer in
Japan.
Shiroiwa T, Fukuda T, Tsutani K.
Department of Drug Policy and Management, Graduate School of Pharmaceutical

Sciences, University of Tokyo, Tokyo, Japan. t.shiroiwa@gmail.com
BACKGROUND: Rapid progress has been made in the treatment of metastatic

colorectal cancer (mCRC). New treatment regimens for mCRC include not only
cytotoxic chemotherapy but also targeted monoclonal antibodies, including
bevacizumab. However, bevacizumab is an expensive medication, which costs
from 300,000 yen to 400,000 yen (US $2500-$3300) per month. OBJECTIVE:
The purpose of this cost-effectiveness analysis was to examine the economic
efficiency of treating mCRC with bevacizumab plus chemotherapy versus
chemotherapy alone in Japan. METHODS: We searched an electronic database
(MEDLINE, UpToDate, and American Society of Clinical Oncology [ASCO]
Virtual Meeting; key terms: bevacizumab limited to randomized controlled trial;
years: 2000 to present [June 29, 2007]) to detect randomized controlled trials
(RCTs) that compared chemotherapy alone with chemotherapy plus bevacizumab.
To analyze the cost-effectiveness of bevacizumab, we used the Weibull regression
model and determined an expected treatment duration at each state using reported
survival curves of RCTs. We included only the direct medical costs (2006) of
these medications to estimate the expected values of incremental costs; thus, the
analysis was conducted from the perspective of the health care payer. The
incremental cost-effectiveness ratios (ICERs) were calculated from these expected
values of incremental life-years and incremental costs. RESULTS: We identified
5 articles using MEDLINE and 1 trial found on UpToDate and ASCO Virtual
Meeting; these data composed the final analysis group. First-line chemotherapy
regimens included in this analysis were bevacizumab + 5-fluorouracil/leucovorin
(FU/LV), irinotecan/FU/LV (IFL), infusional FU/LV/ oxaliplatin (FOLFOX6),
bolus FU/LV/oxaliplatin (bFOL), and capecitabine/oxaliplatin (CAPOX). The
only second-line chemotherapy regimen included was FOLFOX4. The ICERs of
additional bevacizumab when combined with FU/LV,IFL,FOLFOX6, bFOL, and
CAPOX were 17.4 million yen (US $145,000), 11.9 million yen ($99,000), 13.5
million yen ($113,000), 16.9 million yen ($141,000), and 8.5 million yen
($71,000), respectively, per life-year gained; the ICER was 14.1 million yen
($118,000) with second-line FOLFOX4. CONCLUSIONS: In this cost-
effectiveness analysis in Japan, the ICERs of bevacizumab + FU/LV combination
treatment, IFL, and second-line FOLFOX4 were high compared with other
chemotherapies for mCRC. It remains difficult to assess first-line therapies
comprising bevacizumab with oxaliplatin-based regimens, especially CAPOX.
Further information is needed to assess cost-effectiveness.
Publication Types:
164: Med Educ. 2008 Jan;42(1):18-26. Epub 2007 Nov 28.

What does patient-centred communication mean in Nepal?
Moore M.
BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal.

malnepal@hotmail.com
OBJECTIVES: To ascertain the expectations of Nepalese patients regarding

aspects of doctor-patient communication and to review a model of patient-centred
care for its appropriateness to Nepalese medical communication training.
METHODS: A cross-sectional survey, using an adapted version of the Patient-
Practitioner Orientation Scale (PPOS), was undertaken with a random sample of
patients attending a general outpatients department in rural Nepal. An alternative
survey instrument, derived from the PPOS, was also used. RESULTS: The
following issues were most important to patients: being treated in a friendly and
respectful manner; being fully informed, and being given adequate consultation
time. Patients were happy for the doctor to be in charge and did not want to seek
information outside the doctor's advice. They expressed a strong preference for
receiving advice about preventative care. Patient responses were significantly
more 'doctor-centred' than those found in comparable studies in the USA.
DISCUSSION: Patients expressed strong preferences for some aspects of patient-
centred communication (PCC), but were not very concerned with sharing power
and control. Models of PCC in Nepal require modification to reflect these local
preferences. The importance of good communication techniques requires
emphasis in clinical training and practice. Methods of disseminating information
need to be enhanced in this low-literacy setting.
165: J Med Assoc Thai. 2007 Oct;90(10):2192-7.

Disability assessment in elderly orthopedic patients.
Kuptniratsaikul V, Smathajitt A, Danputipong P, Ratanachoti P, Graisorn

N, Marktuam S, Phainuphong P.
Department of Rehabilitaion Medicine, Faculty of Medicine, Siriraj Hospital,

Mahidol University, Bangkok, Thailand.
OBJECTIVE: To assess the disability level in elderly patients with orthopedic

conditions. MATERIAL AND METHOD: All possible patients aged more than
60 years, who attended the Out-patient Clinic of Orthopedic Department, Siriraj
Hospital, between October and December 2005, were recruited. They were
assessed for the disability level by using a Brief Disability Questionnaire (BDQ),
Thai version. It is a simple and practical tool for assessing disability levels. It is
an eight-item scale with the total score ranging from 0 to 16. A higher score
indicates a greater disability. RESULTS: Two hundred and thirteen patients
participated in the study. The mean age was 69.4 years and 64% had degenerative
joint diseases. The affected parts were the lower extremity and back (56.8% and
26.8% respectively). The three most common limited activities were vigorous
activities, long distance walking, and stair climbing or walking uphill (55.9%,
51.6%, and 42.7% respectively). The mean BDQ score of the subjects was 7.9 +/-
3.8. Patients with lower extremity problems including back problems had the
highest BDQ score (8.2 +/- 3.7). According to the BDQ, the number of patients
with a moderate-to-severe degree of disability was 79%. CONCLUSION: The
majority of elderly patients with orthopedic problems had moderate-to-severe
disability as assessed by the BDQ. Physicians and other health care personnel
should consider the management of the principal diseases, and the assessment of
the disability level to improve the patients' quality of life, which is the ultimate
goal of the treatment in clinical practice.
166: J Med Assoc Thai. 2007 Oct;90(10):2016-23.

Combined clinical risk indices with quantitative ultrasound

calcaneus measurement for identifying osteoporosis in Thai
postmenopausal women.
Pongchaiyakul C, Panichkul S, Songpatanasilp T.
Division of Endocrinology and Metabolism, Department of Medicine, Faculty of

Medicine, Khon Kaen University, Khon Kaen, Thailand. pchatl@kku.ac.th
OBJECTIVE: To examine the diagnostic performance of clinical risk indices

combined with quantitative ultrasound calcaneus measurement (QUS) for
identifying osteoporosis in Thai postmenopausal women. MATERIAL AND
METHOD: The present study was designed as a cross-sectional investigation in
300 Thai women, aged between 38 and 85 years (mean age: 58). Femoral neck
bone mineral density (BMD) was measured by DXA (Hologic QDR-4500;
Hologic, Bedford, MA, USA). A BMD T-scores < or = -2.5 was defined as
"osteoporosis"; otherwise, "non-osteoporosis". QUS was measured by Achilles+
(GE Lunar, Madison, WI, USA) and converted to T-score. The OSTA and KKOS
score was calculated for each woman using her age and weight Women with
OSTA/KKOS scores < or = -1 and > -1 were classified as "high risk" and "low
risk", respectively. RESULTS: Using DXA as the gold standard, the sensitivity of
QUS to identify osteoporosis was lower than the sensitivity of OSTA/KKOS (60
vs. 71/74%) but the specificity and PPV of QUS were higher than OSTA/KKOS.
The sensitivity increased when using OSTA/KKOS combined with QUS to
identify osteoporosis (approximately 87-89%) while the specificity, PPV and
NPV were comparable with using clinical risk indices alone. The risk (odds ratio;
OR) of osteoporosis when QUS T-score < or = -2.5 alone was 9.94 (95%CI: 4.74-
20.87), which was higher than high risk by OSTA/KKOS alone (OR: 6.35,
95%CI: 2.99-13.47 for OSTA and 8.15, 95%CI: 3.76-17.66 for KKOS).
Furthermore, individuals were classified "high risk" from OSTA/KKOS with
QUS T-score < or = -2.5SD, the risk of osteoporosis was increased (OR: 43.68,
95%CI: 13.89-137.36 and OR: 60.92, 95%CI: 17.69-209.76 for OSTA and
KKOS, respectively). CONCLUSION: Using the clinical risk indices combined
with QUS could improve the accuracy of osteoporosis identification. This
approach could be used in a primary care setting or community-based hospital
where a DXA machine is not available.
167: J Med Syst. 2007 Dec;31(6):497-503.

An evaluation of patients' opinions of primary care physicians: the

use of EUROPEP in Gaza Strip-Palestine.
Abu Mourad T, Shashaa S, Markaki A, Alegakis A, Lionis C, Philalithis A.
Department of Social Medicine, Faculty of Medicine, University of Crete, PO

Box 2208, 71003 Heraklion, Crete, Greece.
The objective of this paper is to identify the level of patients' satisfaction with
primary care physicians. Data were gathered from an exit interview using a
standardized questionnaire (EUROPEP) and background variables. A total of 956
patients in fifteen primary health care clinics in Gaza Strip participated. Outcome
measures is positive patient satisfaction (good and excellent ratings in the
EUROPEP Index). As a results, the mean percentage of positive satisfaction with
medical services was poor (41.8%). The poorest performance was recorded for:
getting through to the clinic on the phone, being able to speak to physician on the
telephone, time spent in waiting rooms and helping the patient deal with
emotional problems. The comparison between clinical behaviour dimension and
organization of care showed that clinical behaviour was evaluated higher. In
conclusion, Palestinian patients expressed overall dissatisfaction with services
provided by primary care physicians. These findings present a real challenge for
Palestinian authority policy makers and administrators in terms of designing
appropriate quality improvement strategies.
Publication Types:
• Evaluation Studies
168: J Adv Nurs. 2007 Dec;60(6):654-62.

Characteristics of patient and healthcare service utilization

associated with inappropriate hospitalization days.
Hwang JI.
Department of Nursing and Healthcare Management, College of Nursing Science,

Kyung Hee University, Seoul, Korea. jihwang@khu.ac.kr
AIM: This paper is a report of a study to examine the number of inappropriate

days of hospitalization and to identify the characteristics of patient and healthcare
service utilization associated with inappropriate hospital stays. BACKGROUND:
Inappropriate hospitalization stays are recognized as an important indication of
the misuse of healthcare services, but the published literature shows inconsistent
findings on factors influencing this. METHOD: A descriptive, correlational study
was carried out in September 2005, with a patient survey and a review of patient
records. Data were collected for 383 patients discharged from eight general
nursing care units in a tertiary teaching hospital in Korea. Inappropriate
hospitalization days were defined as inpatient days not requiring continuous and
active medical, nursing or paramedical treatment provided by hospital services,
and were judged using the Korean version of the Appropriate Evaluation Protocol.
Univariate and multiple regression analyses were performed to determine factors
associated with inappropriate hospitalization days. FINDINGS: A total of 3076
hospitalization days were reviewed. The average proportion that were
inappropriate was 5.1% (+/-16.0) per patient, and 14.1% of patients were
determined to have had at least one inappropriate hospitalization day. The most
common reason judged as appropriate was need for nursing/life support services.
Statistically significant factors associated with inappropriate stay included gender,
age, primary disease, length of stay and ward bed occupancy level during the
patient's hospitalization. CONCLUSION: Managers should take into account
patient and clinical characteristics to promote better utilization of hospital
resources.
Publication Types:
169: Aust Crit Care. 2004 Nov;17(4):142-4, 146, 148-50.

Research priorities for Australian critical care nurses: do we need

them?
Marshall A.
Critical Care Nursing Professorial Unit, Royal North Shore Hospital and The
University of Technology, Sydney, NSW.
The development of research priorities for critical care nurses has been previously
examined from the perspective of both Australian and international critical care
nursing experts. A variety of techniques have been used to determine research
priorities for critical care nursing, however, a clear articulation of research
priorities for Australian critical care nurses, which are both timely and encompass
all aspects of critical care nursing practice, is lacking. Research priorities
previously determined in Australia and elsewhere identify similar clinical
research priorities such as nutritional support, infection control, supporting
respiratory and cardiac function, and follow-up of critically ill patients. However,
differences between the few available studies exist, possibly because of the
changing nature of critical care nursing practice. Despite the identification of
research priorities for critical care nursing in the past, there is little evidence to
demonstrate a direct effect on research output in these areas. Future development
of research priorities for Australian critical care nurses needs to be carefully
considered. It is essential that identification of such research priorities be done
within the context of their intended use.
Publication Types:
• Review
170: Bull World Health Organ. 2007 Oct;85(10):768-73.

Contraceptive injections by community health workers in Uganda: a
nonrandomized community trial.
Stanback J, Mbonye AK, Bekiita M.
Family Health International, Research Triangle Park, NC 27709, USA.

jstanback@fhi.org
OBJECTIVE: To compare the safety and quality of contraceptive injections by

community-based health workers with those of clinic-based nurses in a rural
African setting. METHODS: A nonrandomized community trial tested provision
of injectable Depo Provera (DMPA) by community reproductive health workers
and compared it with routine DPMA provision at health units in Nakasongola
District, Uganda. The primary outcome measures were safety, acceptability and
continuation rates. FINDINGS: A total of 945 new DMPA users were recruited
by community workers, clinic-based nurses and midwives. Researchers
successfully followed 777 (82% follow-up): 449 community worker clients and
328 clinic-based clients. Ninety-five percent of community-worker clients were
"satisfied" or "highly satisfied" with services, and 85% reported receiving
information on side-effects. There were no serious injection site problems in
either group. Similarly, there was no significant difference between continuation
to second injection (88% among clients of community-based workers, 85%
among clinic-going clients), nor were there significant differences in other
measures of safety, acceptability and quality. CONCLUSION: Community-based
distribution (CBD) of injectable contraceptives is now routine in some countries
in Asia and Latin America, but is practically unknown in Africa, where arguably
the need for this practice is greatest. This research reinforces experience from
other regions suggesting that well-trained community health workers can safely
provide contraceptive injections.
Publication Types:
• Clinical Trial
• Research Support, U.S. Gov't, Non-P.H.S.
171: Hypertens Res. 2007 Sep;30(9):807-14.

Design and baseline characteristics of an observational study in

Japanese patients with hypertension: Japan Hypertension
Evaluation with Angiotensin II Antagonist Losartan Therapy (J-
HEALTH).
Naritomi H, Fujita T, Ito S, Ogihara T, Shimada K, Shimamoto K, Tanaka

H, Yoshiike N.
National Cardiovascular Center, Suita, Japan. hnaritom@hsp.ncvc.go.jp
The Japan Hypertension Evaluation with Angiotensin II Antagonist Losartan

Therapy (J-HEALTH) study is a nationwide, prospective, multicenter
observational study that was designed to enroll hypertensive Japanese patients
(>30,000 subjects). The patients in this study received treatment with open-label
losartan, an angiotensin II receptor antagonist, for a maximum of 5 years. This
report summarizes the study protocol and the baseline characteristics of the
patients. Between June 2000 and May 2002, patients were screened in all 47
prefectures around Japan. Among the 31,515 patients screened, 31,048 patients
were enrolled in this study and treated with losartan at a daily dose of 25-50 mg.
These patients were 62.4 +/- 12.1 years old (mean +/- SD) and the mean clinic
systolic/diastolic blood pressure (BP) values were 165.3 +/- 17.3/94.3 +/- 11.7
mmHg (mean +/- SD). The complications of hyperlipidemia, diabetes mellitus,
cardiovascular disease, and cerebrovascular disease were also present in 38.5%,
13.1%, 8.0%, and 4.4% of patients, respectively. Regarding the World Health
Organization classification, grade 2 hypertension was most frequent in this patient
cohort. Nearly 10,000 patients agreed to perform home BP monitoring and report
details regarding their lifestyles at baseline. Among the patients, 4.2% had white
coat hypertension at the baseline. The J-HEALTH study is expected to provide
valuable information about the significance of clinic and home BP control and
home BP monitoring for the management of hypertension in Japanese patients.
Publication Types:
• Clinical Trial
172: J Clin Nurs. 2007 Dec;16(12):2357-64.

The experiences of Chinese family members of terminally ill patients

- a qualitative study.
Wong MS, Chan SW.

Haven of Hope Hospital, Kowloon, Hong Kong, China.
AIM: To describe and understand the experiences of Chinese family members of

terminally ill patients during the end of life process in a palliative care unit.
BACKGROUND: Palliative care aims to provide care to dying patients and their
family members. Skillful interventions are necessary to help family members
cope with the impending death of the patient and maintain their emotional
equilibrium. Hence, it is important to understand the experiences of family
members of palliative care. DESIGN: A phenomenological study was conducted.
Data were collected by semi-structured interviews. We interviewed a purposive
sample of 20 family members of terminally ill patients in a palliative care unit in
Hong Kong. The data were analysed following Colaizzi's phenomenological
methodology. RESULTS: Family members experienced anticipatory grief, with
reactions that included anger, unease, sadness and helplessness. This was
particularly acute when the patient was first admitted to the palliative care unit.
However, the family members quickly accepted the reality and committed
themselves to the care of the patient, seeking informational and emotional support
from the nurses. The families wanted to be assured that the patient had been
offered good care and suffered no pain. It was considered important to be with the
patient during the dying process. CONCLUSION: This study demonstrated that
Chinese family members were committed to the care of the patients in the
palliative care unit. Cultural beliefs played a part in influencing family emotions
and concerns. RELEVANCE TO CLINICAL PRACTICE: This study offers a
direction for family interventions that acknowledge the reactions of family
members to the admission of a patient to a palliative care unit. It highlights that
families need active informational and emotional support from nurses.
173: J Clin Nurs. 2007 Dec;16(12):2323-30.

Maternal experiences making a decision about heart surgery for

their young children with congenital heart disease.
Lan SF, Mu PF, Hsieh KS.
TzuHui Institute of Technology, Shan-Ming District, Kaohsiung City, Taiwan.
AIM: The aim of this study was to investigate the essence of the experience of
mothers during the decision-making process when facing their less than three-
year-old child undergoing heart surgery due to congenital heart disease (CHD).
METHODS: In this phenomenological study in Taiwan nine mothers were
interviewed in their homes. They were invited to share their experience of family
interactions and relationships while facing a decision about their child's heart
surgery. The interviews were recorded and transcribed for further analysis
according to Colaizzi's phenomenological methodology. RESULTS: The essence
of the maternal experience themes during the decision-making process included
(i) understanding the surgery step by step, (ii) role pressure, (iii) constructing
care-taking ability, (iv) endeavouring to maintain family functioning while
preparing for surgery and (v) deliberate consideration to make the correct
decision. CONCLUSIONS: When parents face their child having CHD and plan
heart surgery, the whole family is living through a stressful decision-making
process. According to the results of this study, it is obvious that the caregivers and
their whole families experience psychological distress, role reorganization and
remodelling of family functioning. RELEVANCE TO CLINICAL PRACTICE:
The results of this study provide evidence-based essential knowledge that will
assist the management of such decision-making processes and help to prepare the
child and the family to have confidence in the heart surgery.
174: J Clin Nurs. 2007 Dec;16(12):2229-36.

Overseas nurses in the National Health Service: a process of

deskilling.
O'Brien T.
International Observatory on End of Life Care, Institute for Health Research,

Lancaster University, Lancaster, UK. t.obrien@lancaster.co.uk
AIMS AND OBJECTIVES: This paper shows that overseas nurses (OSN)
recruited to UK hospital trusts become deskilled in technical aspects of clinical
practice. BACKGROUND: Existing research reports that many newly recruited
OSN are prevented from using technical skills acquired in training abroad, to the
detriment of the National Health Service (NHS) and the concern of the nurses
themselves. DESIGN: The author conducted case study work in three NHS
hospital trusts in the northwest of England. The findings reported are part of a
wider investigation into the assimilation(1) of OSN from the Philippines, India
and Spain into NHS hospitals. Semi-structured interviews were undertaken with
members of four groups of actors: managers, OSN, home nurses (HN) and
mentors, which were analysed thematically. Results. The research confirms the
finding that many OSN are prevented from using technical skills in the UK, but
also suggests reasons why this is so. The finding of deskilling emerged strongly in
all three cases and is singled out for discussion in this paper. CONCLUSIONS:
The experience of OSN highlights ambiguity surrounding the role of the nurse in
British hospitals. This arises partly because OSN tend to be recruited to the
bottom grades of nursing in the NHS, where their technical skills are underused.
RELEVANCE TO CLINICAL PRACTICE: Segmentation within the nursing
hierarchy contributes to the conflicting messages and mismatch of expectations
experienced by nurses at the ward level, regarding the role of the nurse.
Publication Types:
175: J Clin Nurs. 2007 Dec;16(12):2221-8.

Engaging with a new reality: experiences of overseas minority ethnic

nurses in the NHS.
Alexis O, Vydelingum V, Robbins I.
School of Health and Social Care, Oxford Brookes University, Oxford, UK.
oalexis@brookes.ac.uk
AIM AND OBJECTIVE: The purpose of this study was to explore, describe and
develop a greater understanding of the experiences of overseas black and minority
ethnic nurses in the National Health Service (NHS) in the south of England.
BACKGROUND: For the past five decades, the NHS has been recruiting
overseas black and minority ethnic nurses from several former British colonies to
alleviate the manpower shortages. More recently there has been a shortage of
nurses in the labour force and as a result the NHS has once again recruited
overseas nurses. Despite this recruitment drive there are limited studies outlining
how overseas black and minority nurses have fared in the NHS. METHODS: This
qualitative phenomenological study used four purposeful focus groups and all
participants involved were interviewed at a place convenient for them. These all
non-white participants originated from Asia, Africa and the Caribbean. Each
focus group contained six participants with an overall total of 24 participants
involved in the study. RESULTS: Following thematic analysis, the findings
revealed six themes such as, the devaluation process, concept of self-blame,
discrimination/lack of equal opportunity, concept of invisibility, experiencing fear
and benefits of being here. Several overseas nurses felt devalued and indicated
that white UK nurses appeared to have placed little trust in them. They stated that
both discrimination and lack of equal opportunity were present in the workplace
and they also revealed that some white UK nurses were sometimes abusive. As a
result they tolerated such behaviour for fear of being thrown out with their
families. Despite such negative experiences participants indicated that the
experiences gained whilst working in the NHS were useful. CONCLUSIONS:
There is a need for overseas nurses to be treated fairly and with respect
particularly in the light of an acute labour shortage of nurses in the NHS. The
findings suggest that overseas minority ethnic nurses' experiences have been
mixed, with some positive as well as negative experiences, within a process that
devalues them as workers. RELEVANCE TO CLINICAL PRACTICE: This
paper highlights a need for a re-evaluation of equal opportunity policies and
proposes more diversity training so as to prepare nurses to cope with an
increasingly complex and diverse workforce.
176: Eur J Contracept Reprod Health Care. 2007 Dec;12(4):326-34.

Quality of family planning services at primary care facilities in an

urban area of East Azerbaijan, Iran.
Mohammad-Alizadeh S, Marions L, Vahidi R, Nikniaz A, Johansson A,

Wahlström R.
Division of International Health (IHCAR), Department of Public Health Sciences,

Child Health, Karolinska Institutet, Stockholm, Sweden.
sakineh.mohammad.alizadeh@ki.se
OBJECTIVE: To determine the quality of family planning (FP) services at

primary care facilities in Tabriz, Iran, and to identify areas for improvement.
METHODS: Structured observations of 469 client-provider interactions and some
clinical procedures at 34 facilities. Exit interviews with 416 of the observed
clients. RESULTS: The providers treated the clients respectfully in more than
80% of the consultations and discussed a return visit in 89%. Privacy was not
assured in one-third of the cases. Over two-thirds of the clients were not
encouraged to ask questions or raise concerns, and 54% were not satisfied with
the amount of information given. The use of educational audio-visual and printed
materials was very infrequent. Reported waiting time was less than 30 minutes in
89%. Most new clients received their preferred contraceptive method, but were
informed about neither other available methods, nor common side effects and
warning symptoms due to the chosen method. Provider performance in some
clinical procedures, such as the implementation of hand hygiene, was insufficient.
CONCLUSIONS: All elements of the FP services need improvement. Special
attention should be paid to interactive communication, information given to
clients, privacy and confidentiality, as well as to infection prevention procedures.
Multifaceted interventions seem necessary to improve the quality.
Publication Types:
177: Int J Health Care Qual Assur. 2007;20(6):516-31.

An e-health trend plan for the Jordanian health care system: a

review.
Rawabdeh AA.
Department of Hospital Management, Faculty of Administrative and Financial

Sciences, Philadelphia University, Amman, Jordan. alirawabdeh12@yahoo.com
PURPOSE: The purpose of this research is to examine the potential of e-health by

focusing explicitly on the delivery of health care products and services. The
examination of e-health activity is guided by one broad research question, "What
is the potential for constructing e-health strategy as an innovative health
technology?". A great amount of attention has been given to e-health activity in
the present day. However important this form of e-health is, this type of service
simply does not face the same constraints that must be addressed by those actually
delivering health care services. DESIGN/METHODOLOGY/APPROACH: The
researchers employed a qualitative data collection technique to formulate more
examples and cases to derive lessons for Jordan. Phone interviews in a random
sample were conducted with corporate officers in Jordan in order to reveal the
internal organizational structure and business trends, interface issues, marketing
strategies, as well as comparing and contrasting the online health world to the
traditional health care realm. FINDINGS: Internet-related projects is a top priority
for health care information technology executives in the present day, with a
cautious approach toward "e-health", as many products have yet to mature, and
that the "click and mortar" model may perhaps be the optimal strategy for e-health
in Jordan. RESEARCH LIMITATIONS/IMPLICATIONS: This paper reviews
the e-health trends to demonstrate the tremendous potential for health-related
commercial activity on the internet. However, the researcher examining the
barriers facing e-health to the Jordanian health system also pointed out almost
insurmountable challenges. PRACTICAL IMPLICATIONS: Despite the apparent
promise of e-health, its instability is measured by its failure so far to
systematically penetrate the organization of health care. Beyond the pragmatic
negotiation of e-health in the immediate context of clinical practice, there are
wider issues about how the development/implementation of e-health is funded,
about its organization and management at the policy level; and about its potential
medico-legal risks. ORIGINALITY/VALUE: It is hoped that the handful of
ventures into cyber medicine appears to be coming from a few enterprising
physicians who have set up medical practices on the Web.
Publication Types:
• Review
178: Pharmacopsychiatry. 2007 Nov;40(6):269-74.

Clinical and social determinants of long-term use of benzodiazepines

and its impact on quality of life of Chinese schizophrenia patients.
Xiang YT, Weng YZ, Leung CM, Tang WK, Ungvari GS.
Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR,

PR China. xyutly@cuhk.edu.hk
AIMS: To date there have been no studies investigating prescription patterns of

benzodiazepine agents (BZDs) in Chinese outpatients with schizophrenia. This
study examined the frequency and socio-demographic and clinical correlates of
BZD prescription in Hong Kong (HK) and Beijing (BJ), China. METHODS: Five
hundred and five clinically stable outpatients with schizophrenia were randomly
selected and interviewed in HK and BJ using standardized assessment
instruments. Basic socio-demographic and clinical data and psychotropic drug
prescriptions were collected at the time of a diagnostic interview. RESULTS:
One-hundred and fifty one (29.9%) patients were prescribed BZDs in the whole
sample; 25.1% and 34.8% of the HK and BJ samples, respectively. Use of BZDs
was associated with sex, employment status, history of suicide, less use of
clozapine, more frequent use of typical antipsychotics (APs), higher doses of APs,
severity of positive symptoms, extrapyramidal side effects (EPS) and insomnia. In
multiple logistic regression analysis, severity of depressive symptoms, study site,
sex, employment status, less use of clozapine and history of suicide remained
significantly associated with BZDs. CONCLUSION: Although the ethnic and
clinical characteristics of the two samples were nearly identical, there was a wide
variation in the frequency of BZD prescriptions between HK and BJ suggesting
that socio-cultural and economic factors as well as traditions of psychiatric
training and practice all played a role in determining the use of BZDs.
Prescription of BZDs in either site was not in line with current recommendation.
Publication Types:

179: Perit Dial Int. 2007 Jun;27 Suppl 2:S59-61.

Increased utilization of peritoneal dialysis to cope with mounting

demand for renal replacement therapy--perspectives from Asian
countries.
Li PK, Lui SL, Leung CB, Yu AW, Lee E, Just PM, Abraham G, Almazan-
Gomez L, Huang CC, Hooi LS, Kawaguchi Y, Kuok UI, Tungsanga K, Wang
T, Wong AK, Yu XQ, Lo WK; Participants of the Roundtable Discussion on
Dialysis Economics in Asia.
Division of Nephrology, Department of Medicine and Therapeutics, Prince of

Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, PR
China. philipli@cuhk.edu.hk
With the number of end-stage renal disease (ESRD) patients growing, one of the
crucial questions facing health care professionals and funding agencies in Asia is
whether funding for dialysis will be sufficient to keep up with demand. During the
ISPD's 2006 Congress, academic nephrologists and government officials from
China, Hong Kong, India, Indonesia, Japan, Macau, Malaysia, Philippines,
Singapore, Taiwan, Thailand, and Vietnam participated in a roundtable discussion
on dialysis economics in Asia. The focus was policy and health care financing.
The roundtable addressed ESRD growth in Asia and how to obtain enough
funding to keep up with the growth in patient numbers. Various models were
presented: the "peritoneal dialysis (PD) first" policy model, incentive programs,
nongovernmental organizations providing PD, and PD reimbursement in a
developing economy. This article summarizes the views of the participant
nephrologists on how to increase the utilization of PD to improve on clinical and
financial management of patients with ESRD.
Publication Types:
• Clinical Conference
180: Bull World Health Organ. 2007 Sep;85(9):653-4.

Chinese research register joins WHO network, raising hopes for
improved clinical trials.
Adams M.
Publication Types:
• News
181: J Hosp Infect. 2007 Dec;67(4):323-8. Epub 2007 Nov 19.

Experience applying the UK meticillin-resistant Staphylococcus

aureus (MRSA) guidelines in a tertiary referral hospital in the
United Arab Emirates 1999-2002: same guidelines, different
cultures.
Jumaa PA, Hateley PM, Bacon S, Salabsalo FL, Neringer R.
Department of Medical Microbiology, Faculty of Medicine and Health Sciences,

UAE University, PO Box 17666, Al Ain, UAE. pauline.jumaa@uhb.nhs.uk
Meticillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial

pathogen worldwide. There are few reports concerning MRSA in the United Arab
Emirates (UAE). We report our experience with MRSA in a 400-bed tertiary
referral hospital in the UAE, which followed the UK MRSA guidelines. MRSA
data were reviewed to include demographic and clinical data on all new MRSA
cases; a review of the ward environment including number of single rooms, sinks,
toilets and bathrooms, frequency of cleaning; cultural observations; and number
of infection control personnel per beds. MRSA was an uncommon pathogen.
There were 90 new MRSA cases from 1999 to 2002 including two clusters of
MRSA. While the procedures followed were the same as those in the UK, there
were differences in the hospital environment compared with the UK and in
cultural aspects of the patients' behaviour. At least 70% of inpatients were in
single rooms with ensuite bathrooms. It was rare for more than two patients to
share a toilet or bathroom. There were fewer than recommended infection control
personnel and no antibiotic restriction policy in the hospital. Cleaners were on the
wards for >100 h per week and were available 24 h per day for rapid response.
We conclude that there are many factors that influence the management and
control of MRSA, including cultural and social behaviour.
182: J Assoc Physicians India. 2007 Aug;55:551-5.

Clinical profile of diseases causing chronic airflow limitation in a

tertiary care centre in India.
Gothi D, Shah DV, Joshi JM.
Department of Respiratory Medicine, T. N. Medical College, BYL Nair Hospital,

Mumbai, India.
SETTING: Pulmonary department of a tertiary health care centre in India.

OBJECTIVES: To study the clinical profile of diseases causing chronic airflow
limitation (CAL). DESIGN: Standard criteria were used for the diagnosis for
various diseases causing CAL. Severity of CAL was graded using forced
expiratory volume in one second (FEV1)% predicted. Pulmonary hypertension
(PH) was confirmed by 2-dimensional echocardiography with colour Doppler.
RESULTS: Two hundred sixty eight consecutive patients of CAL, age range 12-
75 years, 172 men and 96 women were included in the study. Sixty three percent
had asthma, 17% had chronic obstructive pulmonary disease (COPD), 6% had
bronchiectasis, 13% had obliterative bronchiolitis (OB) and 1% had occupational
airway disease. 98% of COPD was caused by tobacco smoking, of which 84%
were bidi smokers. Ninety-two percent cases of OB were post infectious, 78%
being post tuberculosis. 37% of COPD, 33% of bronchiectasis, 53% of OB and
22% of asthma had severe airflow limitation. PH was observed in 15%, 19% and
13% cases of COPD, OB and bronchiectasis, while none with asthma had PH.
CONCLUSION: Although, asthma was the leading cause of CAL, it caused least
functional impairment. CAL due to OB was as common as COPD. Bidi smoke
was an important cause of COPD, while respiratory infection was common cause
for OB.
183: Psychiatr Rehabil J. 2007 Fall;31(2):139-48.

Community rehabilitation for persons with psychiatric disabilities:

comparison of the effectiveness of segregated and integrated
programs in Israel.
Dor IA, Savaya R.

Amitim Program, The Israeli Association of Community Centers, Israel.
This study compares the effectiveness of a segregative and an integrative

psychosocial recreational program for persons with psychiatric disabilities in
Israel. Comparison of changes in 97 members of a segregated social club with
those of 89 participants in an integrative program in their local community center
shows that both reported significantly greater satisfaction with their social life,
having more friends than previously, increased support from friends, less
loneliness, greater social support, and engaging in more leisure activities. The
only significant differences were that the participants in the segregative program
reported making more new friends, while those in the integrative program
reported a greater increase in the number of leisure activities in which they
engaged. With this, the findings also show that the participants in the integrative
program were generally stronger and in better clinical condition than those in the
segregative program. These findings point to the need for different types of
recreational programs to meet the needs of persons with different levels of
disability.
Publication Types:
184: Am J Cardiol. 2007 Oct 22;100(8B):77M-83M.

Real-world safety and efficacy of the endeavor zotarolimus-eluting

stent: early data from the E-Five Registry.
Jain AK, Meredith IT, Lotan C, Rothman MT, Pateraki S; E-Five

Investigators.
Barts and The London National Health Service Trust, London, United Kingdom.
The E-Five is a prospective, nonrandomized, multicenter global registry of

patients receiving the Endeavor zotarolimus-eluting stent (ZES; Medtronic
Vascular, Santa Rosa, CA) for the treatment of coronary artery stenosis. All
consecutive procedures were included in the registry, without any specific
anatomic or clinical exclusion criteria. Since October 2005, 8,318 patients have
been enrolled in the E-Five Registry at 188 hospitals in Europe, South America,
Australia, New Zealand, and Asia, and 10,343 lesions have been treated. The
primary end point is the rate of major adverse cardiac events (MACE) at 1 year.
Of the lesions treated, 60.3% were American College of Cardiology (ACC) and
American Heart Association (AHA) type B2 or C lesions, and 16.5% were
bifurcation stenoses. The average lesion length was 18.50 +/- 10.60 mm, and
50.6% of the lesions were > or =16 mm long. Clinical data have been analyzed for
1,989 of the patients (23.9%) receiving the Endeavor ZES in this registry, with
30-day clinical outcomes available for 1,985 of these 1,989 patients (99.8%). The
acute procedure success rate in these patients was 98.6%, comparable with
procedure success rates observed in previous Endeavor ZES clinical trials. The
30-day rate of MACE in these patients was just 1.7%, comparable with 30-day
rates of MACE observed in previous ENDEAVOR clinical trials. In an early
analysis of a subgroup of patients enrolled in the E-Five Registry, the Endeavor
ZES demonstrated encouraging acute and 30-day outcomes in a real-world
population of patients who underwent single-vessel or multivessel percutaneous
coronary intervention.
Publication Types:
• Clinical Trial
185: Acta Otolaryngol Suppl. 2007 Oct;(558):54-60.

A standardized database management of middle ear surgery in

Korea.
Kim HJ.
Department of Otolaryngology, Hallym University College of Medicine,

Chuncheon, Korea. hjk1000@hallym.ac.kr
CONCLUSION: The classification and hearing result reporting system of middle

ear surgery provide a set of standard that otologic surgeons should comply with
when they investigate the efficacy of procedures or report the post-operative
results of middle ear surgery. Keeping up with this system will, in turn, facilitate
and activate the evidence-based clinical research they would ask for.
OBJECTIVES: The aims of the project were to establish the standardized
classification nomenclature, to propose a guideline for the post-operative result
reporting system, and to develop a database management program for middle ear
surgery. METHODS: Nine otologic surgeons from seven university hospitals in
Korea carried out a field survey on the nation-wide status of middle ear surgery
and its records, and also collected the information regarding international
classification and result reporting system from 2001 through 2004. To make a
consensus, it also underwent a process of public audit and, a questionnaire
investigation, as well. RESULTS: The classification of surgery consisted of four
kinds of procedures of mastoidectomy, tympanoplasty, extraneous procedures,
and concurrent procedures. Post-operative hearing result reporting consisted of
basic requirement and reporting guidelines of hearing success. The basic
requirements stated minimum follow up duration, and computing formulae of
pure tone average (PTA) and post-operative air bone gap (ABG). The reporting
guidelines included criteria of hearing success (Post-operative ABG <or= 20 dB,
hearing gain >or=15 dB, or hearing level <or=30 dB), post-operative ABG
grading of excellent, good, no or poor improvement, and comparisons of hearing
improvement among the groups. Next, a database management program was
developed using the standardized classification and result reporting system.
Structure of database is composed of 144 fields including patient
information/preoperative findings (45 fields), operative findings (36 fields),
operative procedures (29 fields), and post-operative follow up (23 fields).
Publication Types:
186: J Clin Immunol. 2008 Mar;28(2):186-93. Epub 2007 Nov 16.

Primary immunodeficiency disorders in Kuwait: first report from

Kuwait National Primary Immunodeficiency Registry (2004--2006).
Al-Herz W.
Allergy & Clinical Immunology Unit, Pediatrics Department, Al-Sabah Hospital,

Kuwait city, Kuwait. wemh@hotmail.com
Primary immunodeficiency disorders are heterogeneous group of illnesses that

predispose patients to serious complications. Registries for these disorders have
provided important epidemiological data and shown both racial and geographical
variations. The clinical features of 76 patients with primary immunodeficiency
disorders registered in Kuwait National Primary Immunodeficiency Registry from
2004 to 2006 were recorded. Ninety-eight percent of the patients presented in
childhood. The prevalence of these disorders in children was 11.98 in 100,000
children with an incidence of 10.06 in 100,000 children. The distribution of these
patients according to each primary immunodeficiency category is: combined T
and B cell immunodeficiencies (21%), predominantly antibody immunodeficiency
(30%), other well defined immunodeficiencies (30%), diseases of immune
dysregulation (7%), congenital defects of phagocyte number, function or both
(8%), and complement deficiencies (4%). The consanguinity rate within the
registered patients was 77%. The patients had a wide range of clinical features
affecting different body systems. Primary immunodeficiency disorders are
prevalent in Kuwait and have a significant impact into the health system.
Publication Types:
187: Vaccine. 2007 Dec 12;25(51):8508-11. Epub 2007 Oct 26.

Low seroprevalence of hepatitis B surface antibody among nursing

students in Taiwan: an implication for boosting.
Lin CC, Chang CK, Huang YL, Tseng HF.
Department of Laboratory Medicine, Fooyin University Hospital, Pingtong,

Taiwan.
The national hepatitis B vaccination program in Taiwan began in July 1984. The
purpose of this repeated survey was to investigate the levels of anti-HBs (hepatitis
B surface antibody) in the first-year students of a 5-year nursing program in
Taiwan. Each year during 2000-2006, the entering students of the 5-year nursing
program at Fooyin University, a vocational university located in southern Taiwan,
were examined for their HBsAg and anti-HBs status using commercially available
microparticle enzyme immunoassay. The seroprevalence of HBsAg (+) showed a
significant trend of decrease, dropping 57% from 4.9% in 2000 to 2.1% in 2006.
The seroprevalence of anti-HBs (+) also showed a significant trend of decrease,
dropping 49% from 77.1% in 2000 to only 39.7% in 2006. With the relatively low
seroprevalence of anti-HBs (+) of the future healthcare workers and high HBV
endemicity in Taiwan, recommendation of serology test before boosting to
nursing students before they proceed their clinical practice is prudent.
188: Telemed J E Health. 2007 Oct;13(5):565-71.

A multispecialist teleconsultation system using multiple unicasting.

Yoo SK, Kim SH, Jung SM, Park IC, Chun HJ, Seo KJ.
Medical Engineering, Yonsei University College of Medicine, Seoul, South

Korea. sunkyoo@yuhs.ac
Multispecialist teleconsultation systems can be particularly useful in obtaining a

second opinion from remote medical specialists. In this paper, a multispecialist
teleconsultation (MST) system was designed by using multiple unicasting to
enable operability over the existing Internet infrastructure and the support of
reliable data transmission. The MST was tested over Asynchronous Digital
Subscriber Line (ADSL), Very high speed Digital Subscriber Line (VDSL),
Wireless Local Area Network (WLAN), and the hospital Local Area Network
(LAN) to demonstrate the operability of the designed system over popularly
deployed networks that together make up the current Internet. Also, subjective
evaluation using induced delay and low quality video coding of sample brain
surgery testing videos and two cases of clinical experimentations demonstrated
the limiting factors of the MST in terms of quality and delay differences as well
as the feasibility of the MST in a real clinical setting.
Publication Types:
189: Indian Pediatr. 2007 Oct;44(10):751-9.

Comment in:
• Indian Pediatr. 2008 Mar;45(3):243-4; author reply 244-5.
Clinico-epidemiological profile and validation of symptoms and

signs of severe illness in young infants (< 60 days) reporting to a
district hospital.
Narang A, Kumar P, Narang R, Ray P, Carlin JB, Greenwood P, Muley P,

Misra S, Weber M.
Department of Pediatrics, Advanced Pediatrics Center, Post Graduate Institute of

Medical Education and Research, Chandigarh, India. anilnarang2004@yahoo.com
OBJECTIVES: To describe the clinical and epidemiological profile of infants less
than 2 months of age reporting to a district hospital and to assess the ability of
simple clinical symptoms and signs used by health workers to detect severe illness
warranting hospital admission. METHODS: It was an observational study done at
a general district hospital at Chandigarh, North India. Infants less than 2 months
of age presenting to this hospital were enrolled. All infants were first evaluated by
an auxiliary nurse midwife (ANM) to record a pre-determined set of symptoms
and signs. A pediatrician who was blinded to the findings of the ANM did an
independent assessment for severe illness needing urgent hospitalization.
RESULTS: A total of 1268 infants were enrolled. Of these, 356 (28%) were
below 7 days of age. Overall, regurgitation, vomiting and stool problems (25%)
were the most common presenting complaints in the first 2 months of life,
followed by jaundice (22%) and respiratory symptoms (15%). 112 (8.8%) infants
were classified as having "severe illness requiring urgent hospital management"
by the pediatrician. Nearly half (46%) of the admissions were because of jaundice
while 17% each were due to sepsis and pneumonia / lower respiratory tract
infection (LRTI). A history of not feeding well (OR 14.7, 8.0 and 11.3 in 0-6, 7-
27 and 28-59 days age groups, respectively) and a respiratory rate >60/min (OR
21.5, 6.2 and 10.5 in 0-6, 7-27 and 28-59 days age groups, respectively) had
significant positive predictive value to predict severe illness (except jaundice) in
all the 3 age groups studied. In the second month of life, severe chest in-drawing
(OR 4.6) was also a significant predictor. CONCLUSIONS: Simple clinical signs
are useful in hands of health worker for identifying neonates with serious illness
warranting hospital admission. These will be of use in the further development of
clinical algorithms for the national integrated management of childhood illnesses.
Publication Types:
190: Indian Pediatr. 2007 Oct;44(10):739-48.

Comment in:
• Indian Pediatr. 2008 Mar;45(3):243-4; author reply 244-5.
Clinicoepidemiological profile and predictors of severe illness in

young infants (< 60 days) reporting to a hospital in North India.
Deorari AK, Chellani H, Carlin JB, Greenwood P, Prasad MS, Satyavani A,
Singh J, John R, Taneja DK, Paul P, Meenakshi M, Kapil A, Paul VK,
Weber M.
Department of Pediatrics and Microbiology, All India Institute of Medical

Sciences, Safdarjung Hospital, Ansari Nagar, New Delhi, India.
ashokdeorari_56@hotmail.com
OBJECTIVES: To describe the clinical and epidemiological profile of young

infants reporting to a hospital and assess previously proposed simple clinical signs
for their value in enabling health workers to detect young infants with severe
illness warranting hospital admission. METHODS: Observational study of infants
less than 2 months of age presenting consecutively to a large public hospital in
South Delhi who were evaluated by a health worker (nurse), on a standardized list
of signs and symptoms, and the ability of these were evaluated against the need
for hospital admission which was assessed by an independent pediatrician.
RESULTS: Of the 1624 young infants triaged, 878 were enrolled into the study.
Of these 100 (11%) were below 7 days of age, for whom the common reasons for
seeking care were jaundice (52%), not feeding well (6%) and fever (5%). The
remaining 778 (89%) were 7-59 days of age with respiratory symptoms as the
main presenting complaints (29.1%). The primary clinical diagnoses in infants
with serious illness needing admission to hospital in the age group <7 days (n =
66) were hyperbilirubinemia (56%) and sepsis (21%). In those between 7-27 days
of age (n = 60), primary diagnoses were sepsis (27%), pneumonia (13%),
diarrhea, dysentery or dehydration (10%), while in the age group 28-59 days of
age (n = 47) pneumonia (40%), sepsis (19%) and diarrhea or dehydration (13%)
were the common primary diagnoses. Signs that had at least a prevalence of 5%
and were strong predictors for all the age categories studied were history of
difficult feeding (OR 6.8 for 0-6 days, 15.1 for 2-27 days and 6.2 for 28-59 days
age groups), not feeding well on observation (OR 13.7, 27.6 and 20.9 respectively
for the 3 age groups), temperature > 37.5C (OR 21.8, 14.6 and 30.0 respectively
for the 3 age groups) and respiratory rate > 60 per minute (OR 6.8, 15.1 and 21.0
respectively for the 3 age groups). Additional strong predictors with > 5%
prevalence were history of convulsions (OR 7.9, only in 0-6 day age group),
lethargy (OR 26.1, only in 7-27 day age group), and history of diarrhea (OR 3.0
for 2-27 days and 2.2 for 28-59 days age groups). CONCLUSIONS: Simple
clinical signs are useful in hands of health worker for identifying neonates with
serious illness warranting hospital admission. These will be of use in the further
development of clinical algorithms for the national integrated management of
childhood illnesses.
Publication Types:

191: J Affect Disord. 2008 May;108(1-2):121-7. Epub 2007 Nov 13.

The predictive effect of insight on adverse clinical outcomes in

bipolar I disorder: a two-year prospective study.
Yen CF, Chen CS, Yen JY, Ko CH.
Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung

Medical University, Kaohsiung, Taiwan.
Research has revealed that a lack of insight is associated with poorer clinical
outcomes in schizophrenia; however, the predictive value of insight on adverse
clinical outcomes among bipolar patients is quite understudied. The aim of this
prospective study was to examine the impact of insight on adverse clinical
outcomes among the patients with bipolar I disorder over a 2-year period. Sixty-
five remitted bipolar I disorder patients received follow-up assessments at 3, 6, 9,
12, 18, and 24 months to detect the adverse clinical outcomes defined by the
incidence of bipolar-related psychiatric hospitalization, emergency room visits,
violent or suicidal behavior. The Schedule of Assessment of Insight was used to
provide a baseline insight score. Cox regression analysis was used to examine the
predictive value of insight on the adverse clinical outcomes. Impaired insight into
treatment and a greater number of previous hospitalizations significantly
increased the risk of adverse clinical outcomes with bipolar disorder in the 2-year
period. However, insight into recognition of the illness and re-labeling of
psychotic phenomena did not have any significant effect on adverse clinical
outcomes. Bipolar patients' insight into treatment is an independent predictor of
adverse clinical outcomes. Improving insight into treatment might be a promising
target for a better outcome.
Publication Types:
192: Int J Ment Health Nurs. 2007 Dec;16(6):441-6.

Computerized mental health assessment in integrative health clinics:

a cross-sectional study using structured interview.
Leung SF, French P, Chui C, Arthur D.
School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong

Kong. hsfong@inet.polyu.edu.hk
Computerized mental health assessment is gaining popularity. It enables the

standardization of assessment of clinical problems, increases the capacity to
collect sensitive or confidential information, facilitates personal assessment at
one's own pace, and offers rapid screening of mental health status. The use of
computer technology to conduct mental health assessment was an initiative
proposed for two nurse-led integrative health clinics affiliated to a University in
Hong Kong. It was intended to provide an efficient screening for depression,
anxiety, alcohol abuse, and problem gambling common in the primary health-care
settings to facilitate early intervention. This study was conducted to assess the
effectiveness of using a computerized health assessment kiosk to perform mental
health assessment. The assessment items were derived from an abbreviated World
Health Organization Mental Disorders Checklist and the Diagnostic and
Statistical Manual of Mental Disorders, Fourth Edition Criteria for Pathological
Gambling. The study involved an opportunity sample of 31 subjects who
volunteered to complete the computerized mental health assessment during their
waiting time in the clinics. The results showed that most subjects had positive
feelings about using a computer to perform a mental health assessment and had
increased understanding of their mental health. Suggestions made to improve
computerized mental health assessments included touch screen, voice instructions,
and enlarged print font size.
Publication Types:
193: J Trauma. 2007 Nov;63(5):1014-20; discussion 1020.

Traumatic carotid cavernous fistula accompanying basilar skull

fracture: a study on the incidence of traumatic carotid cavernous
fistula in the patients with basilar skull fracture and the prognostic
analysis about traumatic carotid cavernous fistula.
Liang W, Xiaofeng Y, Weiguo L, Wusi Q, Gang S, Xuesheng Z.

Department of Neurosurgery, First Affiliated Hospital, College of Medicine,
Zhejiang University, Hangzhou City, Zhejiang Province, 31003, PR China.
BACKGROUND: Traumatic carotid cavernous fistula (TCCF) is a rare vascular

complication of traumatic brain and facial injury. The purpose of this study was to
analyze the incidence of this disorder in different types of basilar skull fracture,
determine whether particular clinical factors impacted outcomes, and discuss
ways of improving prognosis. METHOD: We performed a retrospective analysis
of cases with basilar skull fracture or angiography-confirmed TCCF in inpatients
between 1999 and 2005, as well as an analysis of the incidence rate of TCCF in
each type of basilar skull fracture. For patients diagnosed with TCCF, cases were
divided into "disability" and "no disability" groups, and related clinical factors
with potential impact on prognosis were analyzed. RESULTS: In 312 inpatients
with basilar skull fractures, an overall incidence of 3.8% for TCCF was observed,
and the incidence of this disorder with anterior fossa fracture, middle fossa
fracture, and posterior fossa fracture was 2.4%, 8.3%, and 1.7%, respectively. In
this retrospective analysis, factors such as patients' age, gender, number of
embolization procedures performed, and time from injury to first symptom onset
did not significantly affect outcome (p > 0.05). However, the time from first
symptom onset to endovascular embolization differed significantly between the
disability and no disability groups (p < 0.05). CONCLUSIONS: A relatively high
incidence of TCCF occurred in patients with middle fossa fractures, especially
those with transverse or oblique fractures. Prompt diagnosis and intervention
should be emphasized in the management of patients with TCCF, and noninvasive
techniques for early detection of TCCF should be considered in cases of middle
fossa fractures under certain conditions after brain or facial trauma to ensure
positive outcomes.
194: BMJ. 2007 Nov 17;335(7628):1030. Epub 2007 Nov 8.

Comment in:
• BMJ. 2007 Nov 17;335(7628):1002-3.
Effect of general practitioner education on adherence to

antihypertensive drugs: cluster randomised controlled trial.
Qureshi NN, Hatcher J, Chaturvedi N, Jafar TH; Hypertension Research

Group.
Clinical Epidemiology Unit, Department of Community Health Sciences, Aga
Khan University, P O Box 3500, Stadium Road, Karachi, 74800, Pakistan.
OBJECTIVE: To determine the impact of a simple educational package for

general practitioners on adherence to antihypertensive drugs. DESIGN: Cluster
randomised controlled trial. SETTING: Six randomly selected communities in
Karachi, Pakistan. PARTICIPANTS: 200 patients with hypertension taking
antihypertensive drugs; 78 general practitioners. INTERVENTION: Care by
general practitioners specially trained in management of hypertension compared
with usual care. MAIN OUTCOME MEASURE: Correct dosing, defined as
percentage of prescribed doses taken, measured with electronic medication event
monitoring system (MEMS) bottle. RESULTS: 200 patients were enrolled, and
178 (89%) successfully completed six weeks of follow-up. Adherence was
significantly greater in the special care group than in the usual care group
(unadjusted mean percentage days with correct dose 48.1%, 95% confidence
interval 35.8% to 60.4%, versus 32.4%, 22.6% to 42.3%; P=0.048). Adherence
was also higher among patients who had higher levels of education (P<0.001),
were encouraged by family members (P<0.001), believed in the effect of drugs
(P<0.001), and had the purpose of the drugs explained to them (P<0.001).
CONCLUSIONS: Special training of general practitioners in management of
hypertension, emphasising good communication between doctors and patients, is
more effective than usual care provided in the communities in Karachi. Such
simple interventions should be adopted by other developing countries that are
now facing an increasing burden of hypertension. TRIAL REGISTRATION:
Clinical trials NCT00330408 [ClinicalTrials.gov].
Publication Types:
PMCID: PMC2078673
195: J Assoc Nurses AIDS Care. 2007 Nov-Dec;18(6):32-43.

Nurses' health education program in India increases HIV knowledge

and reduces fear.
Pisal H, Sutar S, Sastry J, Kapadia-Kundu N, Joshi A, Joshi M, Leslie J,

Scotti L, Bharucha K, Suryavanshi N, Phadke M, Bollinger R, Shankar AV.
BJ Medical College/Johns Hopins MIT Study Group, Pune, India.
Few health care facilities are adequately prepared to manage and care for
HIV/AIDS patients in India. Nurses play a critical role in patient care but are
often ill-equipped to deal with their own fears of occupational risk and handle the
clinical aspects of HIV/AIDS care, leading to stigma and discrimination toward
HIV-positive patients. The authors examine the impact of a 4-day HIV/AIDS
health education program on knowledge and attitudes of nurses in a government
hospital. This education program was developed using a training of trainers model
and qualitative research. A total of 21 master trainers underwent 6 days of training
and began training of 552 hospital nurses (in 2004-2005). Using a pretest-posttest
design, the authors assessed changes in knowledge and attitudes of 371 trained
nurses. Significant improvements were seen in nurses' HIV/AIDS knowledge in
all areas including care, treatment, and issues of confidentiality and consent. Fear
of interaction with people living with HIV/AIDS was reduced significantly. The
short course was successful in increasing nurses' knowledge in all aspects. There
is great potential to expand this stigma-reduction intervention to other public and
private hospitals.
Publication Types:
• Research Support, N.I.H., Extramural
196: Curr Gastroenterol Rep. 2007 Oct;9(5):429-33.

Amebic colitis: new insights into pathogenesis and treatment.
Bercu TE, Petri WA, Behm JW.
Division of Infectious Diseases and International Health, University of Virginia

Health System, P.O. Box 801340, Charlottesville, VA 22908, USA.
Wap3g@virginia.edu
Amebiasis, caused by the protozoan parasite Entamoeba histolytica, affects more

than 50 million people worldwide, with over 100,000 deaths annually. The
majority of cases are asymptomatic; however, significant morbidity and mortality
are associated with illness in the remaining 10% of cases. Recent advances in the
understanding of the mechanism of infection by E. histolytica, the role of the
innate immune system, and the role of genetic disposition to infection will allow
the development of novel detection and treatment methods. The disease
mechanisms, clinical findings, therapeutic strategies, and important developments
regarding amebiasis are discussed here.
Publication Types:
• Review
197: J Health Popul Nutr. 2007 Jun;25(2):127-33.

Introduction of routine zinc therapy for children with diarrhoea:

evaluation of safety.
Khan AM, Larson CP, Faruque AS, Saha UR, Hoque AB, Alam NU, Salam
MA.
Clinical Sciences Division, ICDDR,B, GPO Box 128, Dhaka 1000, Bangladesh.
miraj@icddrb.org
On 8 May 2004, the World Health Organization (WHO) and the United Nations
Children's Fund (UNICEF) recommended routine administration of zinc in the
management of children, aged less than five years, with acute diarrhoea. In
making the recommendation, WHO and UNICEF also suggested careful
monitoring for adverse events associated with routine administration of zinc,
particularly unusual or excess vomiting. The study assessed, in a phase IV trial,
i.e. post-marketing surveillance of zinc, the occurrence of adverse events during
the first hour after the administration of the first dose of zinc in children with
acute or persistent diarrhoea. The study was conducted at the Dhaka Hospital of
ICDDR,B and at an outpatient clinic operated by a local health NGO-Progoti
Samaj Kallyan Protisthan (PSKP), Dhaka, Bangladesh. Eligible children, aged 3-
59 months, were treated with 20 mg of zinc sulphate provided in a dispersible
tablet formulation. The children were observed for 60 minutes following the
initial treatment with zinc for adverse events, with particular attention given to
vomiting or regurgitation. During the one-year observation period, 42,440
children (male 57% and female 43%) received zinc, and 20,246 (47.8%) of them
were observed. Regurgitation and/or vomiting occurred in 4,392 (21.8%) of the
children; 90.8% of these children had vomiting only once, 8.7% twice, and 0.5%
more than twice. No children revisited the hospital for recurrent vomiting
following their discharge. A significant proportion of infants and children may
experience vomiting or regurgitation, usually once, following the administration
of the first dose of zinc. This is a transient phenomenon that did not impact on
continuation of treatment with zinc.
Publication Types:
• Clinical Trial, Phase IV

198: Yakugaku Zasshi. 2007 Nov;127(11):1789-95.

[Need for pharmacists to contribute to infection control and building

patient safety]
Katayama T.
Department of Pharmacy, Yokkaichi Social Insurance Hospital, Yokkaichi City,

Japan. yokkab32@comet.ocn.ne.jp
With the revisions to the Japanese medical institutions law of April 2006, an
improved medical care security system in a medical institution is indispensable.
More and more medical institutions are now assigning full-time pharmacists to
the task of medical safety. Hospital pharmacy sections are utilizing a valid
evaluation system developed by the Japan Council for Quality Health Care.
Pharmaceutical specialists who contribute to medical security, such as certified
oncology pharmacists and certified infection control pharmacists (CICPha) are
much awaited. In addition, the DPC (Diagnosis Procedure Combination) system
has now become widespread in Japan, and the call is for pharmaceutical care that
can decrease medical costs. It is imperative for health care systems to assure the
appropriate use of drugs to decrease medical costs without reducing medical
services. CICPha can contribute to the antimicrobial management program, and
has also focused on medical care security. Several antimicrobial management
programs of broad-spectrum agents, i.e., formulary restriction and prior approval,
are gradually being enforced in Japan. The CICPha role is far-reaching, and it
should make a concerted effort to prevent the injudicious use of antimicrobial
agents resulting in the emergence of drug resistance; this must be handled by
infection control doctors and nurses along with microbiological technicians. The
CICPha must regulate the appropriate use of these agents, and perform
surveillance of antimicrobial use and resistance (AUR). We describe the necessity
and evaluation of AUR, and also underscore the necessity of training clinical
pharmacists who will contribute to patient safety in days to come.
Publication Types:
• Review
199: Singapore Med J. 2007 Nov;48(11):990-5.

Patients' complaints in a hospital emergency department in

Singapore.
Wong LL, Ooi SB, Goh LG.
Department of Clinical Services, Alexandra Hospital, Level 3 Admin Block, 378

Alexandra Road, Singapore 159964. lilian_wong@alexhosp.com.sg.
INTRODUCTION: This study analysed the complaint rates, profile and trend, and
complainant profile of patients' complaints received by the National University
Hospital Emergency Medicine Department. An earlier ten-year study (1986-1995)
was done on the complaint profile. METHODS: Records of all patients'
complaints, solicited and unsolicited, from January 2002 to December 2003, were
retrieved from the Medical Affairs and Quality Improvement Unit files.
Complaint profile analysed was reason, validity, and outcome of complaint and
staff category involved. Complainant profile analysed was relationship of
complainant to patient, ethnic group, gender and residence type of the
complainant; and age group and triage category of the patient. RESULTS:
Complaint case rate was 1.17 per 1,000 visits, with 1.27 complaints per complaint
case. The complaints were organisation/logistics (49.0 percent), communication
(26.0 percent), standard of care (22.9 percent) and other issues (1.3 percent). Most
standard of care (76.0 percent) and half of organisation/logistics complaints (46.8
percent) were not valid. Most communication complaints were valid (73.7
percent) and involved all staff categories equally. Most complaints (82.8 percent)
were resolved with an explanation/apology. Age group specific and triage-specific
complaint rates were highest among adult patients and among priority 3 patients,
respectively; ethnic group and gender-specific complaint rates were highest
among Chinese patients and among female patients, respectively.
CONCLUSION: Staff-patient communication and organisation/logistics must be
continually improved to reduce complaints, while upholding a good standard of
care. These would translate into cost savings for all parties. There must also be
appropriate checks and balances particularly where complaints are not valid, so
that doctors can practice cost-effective medicine.
200: Public Health Nurs. 2007 Nov-Dec;24(6):529-37.

Health promotion health center project.
Lee TW, Lee CY, Kim HS, Ham OK.
College of Nursing, Nursing Policy Research Institute, Yonsei University, Seoul,

Korea. twlee5@yumc.yonsei.ac.kr
OBJECTIVES: As part of a major government support for health promotion, a

health promotion health center (HPHC) project was launched at the national level
in Korea. The purpose of the study was to describe this 2-year HPHC project
within the framework of the Ottawa Charter for Health Promotion and to evaluate
the preliminary outcomes of the community residents. DESIGN: A cross-sectional
design was used. SAMPLE: A total of 2,261 community residents participated in
the survey, with 792 in HPHC sites and 1,469 in non-HPHC sites.
MEASUREMENT: The instrument included questions on participants'
demographic characteristics, awareness, participation, health behavior (smoking,
exercise, meat consumption, and blood pressure checkup), and satisfaction with
the health promotion programs. RESULTS: The 5 main health promotion
strategies of the Ottawa Charter were evident in the HPHCs. HPHCs were
successful in enhancing awareness, participation, and satisfaction through their
health promotion programs, although health behaviors were not significantly
different between the 2 groups, except exercise. CONCLUSION: Ottawa Charter
strategies embedded within the practice of the community health promotion
activities were effective in increasing the short-term outcomes (awareness,
participation, and satisfaction with health promotion programs), which is a
promising finding for the development of health promotion behaviors in the
future.
Publication Types:

PMID: 17973730
201: N Z Med J. 2007 Oct 26;120(1264):U2773.

A New Zealand outbreak of norovirus gastroenteritis linked to the

consumption of imported raw Korean oysters.
Simmons G, Garbutt C, Hewitt J, Greening G.
Population Protection Group, Auckland Regional Public Health Service,

Auckland. gregs@adhb.govt.nz
AIM: To investigate an outbreak of gastroenteritis that occurred following an

international rugby test at Eden Park (Auckland, New Zealand) on 17 June 2006.
METHOD: 387 patrons were interviewed. Cases were defined as those from one
of four hospitality areas who consumed food or beverage at Eden Park on the
evening of 17 June 2006 and subsequently suffered from diarrhoea or vomiting;
or, stomach cramps and nausea. A case-control study was conducted and food and
beverage items associated with illness were identified. Clinical specimens were
requested from patrons and food handlers, and leftover foods were analysed for
pathogens. A food safety assessment was conducted at the implicated catering
premises. RESULTS: A total of 115 cases were identified. Attack rates varied
between the four hospitality areas from 8% to 47%. Predominant symptoms
among cases included nausea, vomiting, diarrhoea, stomach cramps, fever, and
chills. The consumption of several foods was associated with an increased risk of
illness but the strongest was for raw oysters consumed in Hospitality Area 1 (Risk
Ratio 11.9; 95%CI 3.9-36.1; p<0.00001), attack rate 65%. Norovirus (genogroups
I and II) was detected in samples provided by four of the cases and three
unopened packets of implicated batches of imported Korean Pacific oysters
(Crassostrea gigas) linked to the outbreak. CONCLUSION: This outbreak
resulted from consumption of raw imported Korean oysters contaminated by
norovirus. Labelling recommending cooking prior to consumption failed to
prevent the outbreak.
202: Health Policy Plan. 2008 Jan;23(1):67-75. Epub 2007 Oct 30.
Midwifery provision in two districts in Indonesia: how well are rural

areas served?
Makowiecka K, Achadi E, Izati Y, Ronsmans C.
Department of Epidemiology and Population Health, London School of Hygiene

and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
krystyna.makowiecka@lshtm.ac.uk
Attention has focused recently on the importance of adequate and equitable
provision of health personnel to raise levels of skilled attendance at delivery and
thereby reduce maternal mortality. Indonesia has a village-based midwife
programme that was intended to increase the rate of professional delivery care and
redress the urban/rural imbalance in service provision by posting a trained
midwife in every village in the country. We present findings on the distribution of
midwifery provision in our study area: 10% of villages do not have a midwife but
a nurse as a midwifery provider; there is a deficit in midwife density in remote
villages compared with urban areas; those assigned to remote areas are less
experienced; midwives manage few births and this may compromise their
capacity to maintain professional skills; over 90% of non-hospital deliveries take
place in the woman's (64%) or the midwife's (28%) home; three-quarters of
midwives did not make regular use of the fee exemption scheme; midwives who
live in their assigned village spend more days per month on clinical work there.
We conclude that adequate provider density is an important factor in effective
health care and that efforts should be made to redress the imbalance in provision,
but that this can only contribute to reducing maternal mortality in the context of a
supportive professional environment and timely access to emergency obstetric
care.
Publication Types:

203: Eur J Emerg Med. 2007 Dec;14(6):332-6.

Cardiopulmonary resuscitation surprise drills for assessing,

improving and maintaining cardiopulmonary resuscitation skills of
hospital personnel.
Farah R, Stiner E, Zohar Z, Zveibil F, Eisenman A.
Department of Internal Medicine F, Western Galilee Hospital, Nahariya, Israel.

Raymond.Farah@naharia.health.gov.il
BACKGROUND: Cardiopulmonary resuscitation (CPR) is a sudden emergency

procedure that requires a rapid and efficient response, and personnel trained in
lifesaving procedures. Regular practice and training are necessary to improve
resuscitation skills and reduce anxiety among the staff. Western Galilee Hospital
has developed simulator programs for surprise CPR training exercises in all
hospital departments and units. This study assessed the efficacy of surprise drills.
METHODS: Advanced cardiac life-support instructors performed 131 surprise
drills between 2003 and 2005, using a computerized simulation mannequin (SIM
4000). Nine criteria were measured and scored in the drill: reaction time, CPR
according to ABC principles, calling for doctor, CPR knowledge, CPR skills,
resuscitation management, staff work, resuscitation chart, and defibrillator
management. Drills were evaluated, discussed, and compared with previous drills
from the same department and from other departments. RESULTS: A gradual
improvement was observed in the results of the drills held through 2003-2005,
more significantly in the medical departments than in the surgical departments
and outpatient clinics. The average score in 2005 was 77.2% (P=0.001), compared
with 74% (P=0.012) in 2004 and 59% (P<0.001) in 2003. Major improved criteria
were calling for doctor, staff work, CPR knowledge, and defibrillator (P<0.05).
CONCLUSION: It is our belief that surprise resuscitation drills constitute an
effective tool to improve performance in case of a real emergency resuscitation,
both on a departmental and a general hospital level.
Publication Types:
204: Health Policy Plan. 2008 Jan;23(1):76-82. Epub 2007 Oct 27.
Implementation of a new birth record in three hospitals in Jordan: a

study of health system improvement.
Khresheh R, Barclay L.
Faculty of Nursing, Muttah University, PO Box 7, Karak, Jordan.
This study tested the introduction of a new integrated clinical record in Jordan
where currently no clinical report links antenatal, birth and postnatal care for
women. As a result, no continuity of information is provided to clinicians nor are
there national statistics on trends, or performance of hospitals around birth. Our
study was conducted in the Jordanian Ministry of Health, the maternity wards and
registration departments of three hospitals in Jordan and in the Maternal and Child
Health Centres located near these hospitals. We used an exploratory, descriptive
design and practice-research engagement to investigate and report on the process
of change to improve and implement the new birth record. Through engaging
practitioners in research, care improved, the quality of reporting changed,
managers developed more effective measures of hospital performance and policy
makers were provided with information that could form the basis of a national
maternity data monitoring system. Quantitative and qualitative audit data
demonstrated improved clinical reporting, organizational development and
sustained commitment to the new record from clinicians, managers and policy
leaders.
205: Nephrol Dial Transplant. 2008 Jan;23(1):288-93. Epub 2007 Oct 27.
Assessment of management and treatment responses in

haemodialysis patients from Tehran province, Iran.
Mahdavi-Mazdeh M, Zamyadi M, Nafar M.
Department of Nephrology, Medical Sciences, Tehran University, Tehran, Iran.

mmahdavi@tums.ac.ir
BACKGROUND: Chronic kidney disease (CKD) and end-stage renal disease

(ESRD) are emerging as globally important public health problems, and will
necessitate improvements in health-care policy. ESRD incidence/prevalence data
are not available from large parts of the developing world. The main objective of
this study is to describe and assess the current clinical practices for patients on
maintenance haemodialysis (HD) living in the province of Tehran. METHODS:
In December 2005, an observational study was performed with 2630 patients
(1505 males and 1125 females) from 56 different centres in the province of
Tehran (the entire HD population), which has a population of 13.5 million
inhabitants. RESULTS: The prevalence/incidence of HD was 194.8/77.3 p.m.p.
The leading causes of ESRD were diabetes and hypertension. Population of 90.3
and 9% received three and two sessions per week, respectively, with a KT/V
mean value of 0.97+/-0.25. All centres used synthetic membranes, and 68% of the
sessions were performed using bicarbonate as a buffer. The type of vascular
access was autogenous arteriovenous fistula in 91% of patients. Our findings
indicated that compliance with the K/DOQI recommendations for calcium-
phosphorus management is difficult to achieve. Only 1.8% of patients achieved
all four target laboratory tests. For the management of anaemia, ferritin was the
most commonly performed measure of iron status (76.7%). Iron deficiency was
seen in <20% of patients (ferritin <or=200) and the mean value of haemoglobin
(Hb) was 10.14+/-2.00 g/dl. CONCLUSION: The achieved standard of renal
replacement therapy (RRT) in Tehran province, Iran is acceptable and in some
aspects is comparable with European countries, but the number of ESRD patients
is increasing in Tehran and worldwide. Increases in the number of HD centres,
machines, shifts and kidney transplantations are taking place but cannot keep pace
with the increasing number of patients. It is highly recommended that we try to
increase peritoneal dialysis (PD) coverage and cadaveric transplantation, while
keeping in mind that the prevalent population of individuals with CKD is
estimated to be at least 20 times the number with ESRD. It is not too ambitious to
consider CKD prevention, and we should place initial focus on strategies and
treatments that slow disease progression, in order to postpone RRT.
206: Taiwan J Obstet Gynecol. 2007 Sep;46(3):248-54.

The interns' learning assessment in obstetrics and gynecology

department of Zahedan University of Medical Sciences.
Roudbari M, Yaghmaei M.
Department of Public Health, School of Health, Zahedan University of Medical

Sciences and Health Services, Zahedan, Iran. mroudbari@yahoo.co.uk
OBJECTIVE: One of the aims of management priorities in medical universities is

the evaluation of learning in educational departments in order to prevent
educational retardation and to improve the quality of education. The aim of this
study was to evaluate the interns' learning in the obstetrics and gynecology
(O&G) department at Zahedan University of Medical Sciences (ZUMS).
MATERIALS AND METHODS: The study was performed in ZUMS, Iran, in
2002-2003 on all interns at the O&G department, including 30 men and 40
women. For data collection, a questionnaire was used and included some
questions regarding the common emergencies and diseases in O&G, together with
different learning indicators such as reading, observation, hearing, management,
and the capability of management. The data were analyzed using descriptive
statistics, tables, t test, and chi-square test using the SPSS software. RESULTS:
The mean percentages of learning indicators of observation, bedside teaching,
supervised management, and personal management in the common emergencies
and diseases of O&G in male interns were significantly lower than those in
female interns. Also, the mean percentages of managing capabilities were 12%
and 70.5% in common emergencies and 14.2% and 59.3% in common diseases
for male and female interns, respectively. The chi-square test showed a significant
difference between the mean percentages of the managing capabilities in male and
female interns for the majority of the common emergencies and diseases. Also,
the chi-square test revealed a significant relationship between the learning
indicators and the interns' managing capabilities for common emergencies and
diseases. CONCLUSION: Some learning indicators in the male interns were very
low. This needs urgent improvement of the learning quality in the O&G
department, especially for the male interns, particularly those who are supposed to
work in the deprived areas of the country after graduation in the public service.
207: Nurs Health Sci. 2007 Dec;9(4):263-9.

Delivery life support: a preliminary report on the chain of survival

for complicated deliveries in rural Cambodia.
Chandy H, Steinholt M, Husum H.
Delivery Life Support Program, Trauma Care Foundation, Battambang,

Cambodia.
Most programs to reduce maternity deaths focus on hospital performance and

general obstetric protocols. In communities where most mothers deliver at home,
such strategies will not reduce avoidable deaths. The key concept in the actual
intervention is to regard deliveries in poor rural communities as a trauma and to
merge midwives and traditional birth attendants (TBAs) with an already existing
and successful rural trauma rescue system. A total of 256 Cambodian
careproviders, 41 health center midwives and paramedics, plus surgical teams at
local hospitals were trained over a 2 year period. After completing the training
program, the participants themselves rated their skills, confidence, and quality of
team work by Visual Analog Scale measurement. The results demonstrate
significant improvement, both for the TBAs and the certified midwives. The
intervention results so far indicate that delivery life support training to rural
careproviders increases their capacity to cope with emergency obstetric cases.
Publication Types:
208: Int Nurs Rev. 2007 Dec;54(4):367-74.

The use of physical restraints on children: practices and attitudes of

paediatric nurses in Turkey.
Demir A.
Ankara University Cebeci School of Health, Cebeci-Ankara, Turkey.
aytendemir2000@yahoo.com
AIMS: This study aimed to determine paediatric nurses' ideas and attitudes
towards physical restraint in Turkey, the consent obtained, physical restraint types
used in paediatric units and complications developing in children subjected to
physical restraint. BACKGROUND: Physical restraint, although controversial, is
still common in paediatric units in Turkey and creates complications, which were
observed or investigated by researchers. DESIGN AND METHOD: The research
used descriptive, analytical and cross-sectional methods with 121 paediatric
nurses working in paediatric surgical-internal medicine services and paediatric
intensive care units of four hospitals. The questionnaire consisted of open-ended
questions and was applied via face-to-face interviews. RESULTS: 66.9% of
nurses reported that nurse shortages were the main reason for increased physical
restraint applications, 58.7% tried alternative methods, and 71.1% indicated no
need of written orders for physical restraint use. Physical restraint decreased while
the mother accompanied her child (P = 0.0001) and increased while inexperienced
clinic nurses were in charge (P = 0.003). Wrist (96.7%), ankle (81.0%), and whole
body (17.4%) restraints were all used. No nurse had received any verbal or
written consent from children or surrogates and 96.7% used physical restraint
without any verbal or written physician order. Thirty (24.8%) respondents
reported that children under physical restraint had developed various
complications, for example, oedema and cyanosis by arm and wrist restraint, food
rejection and agitation. Physical restraint could be reduced by a wiser
combination of education and expert consultation in paediatric units in Turkey,
although further detailed research is needed.
209: Trop Med Int Health. 2007 Oct;12(10):1218-24.

Private practitioners and tuberculosis case detection in Jogjakarta,

Indonesia: actual role and potential.
Mahendradhata Y, Utarini A, Lazuardi U, Boelaert M, Stuyft PV.
Epidemiology and Disease Control Unit, Public Health Department, Institute of

Tropical Medicine, Antwerp, Belgium. yodi_mahendradhata@yahoo.co.uk
BACKGROUND: Indonesia has a high tuberculosis (TB) prevalence and a large

private health sector. OBJECTIVES: To explore the potential of private
practitioners (PP) in TB control in Jogjakarta by assessing their load of TB
suspects and case-management practices. METHODS: We conducted a cross-
sectional telephone survey of a random sample of 164 PP, weighted to the local
proportions of specialists, general practitioners (GP), nurses and midwives. We
investigated their knowledge of directly observed treatment, short-course
(DOTS), whether they see TB suspects, whether they refer such patients and how
they possibly diagnose and treat TB. RESULTS: We sampled 174 PP, of which
164 (94.3%) completed the interview. Most PP (63.4%) reported to have seen TB
suspects in their private practice, and 62.8% were also employed in a DOTS
facility. Specialists saw on average 18 suspects, GP 11 suspects, and nurses-
midwives three suspects in a year. Many PP (45.2%) always relied on National
Tuberculosis Control Programme (NTP) services for diagnosis. Fewer PP (41.5%)
used, by themselves, diagnostic procedures complying with the NTP guidelines.
The majority (63.6%) always referred confirmed cases for treatment, mainly
(71.4%) to NTP services. Most PP (72.7%) who treated TB patients themselves
did not prescribe the NTP standard regimen. CONCLUSION: The study shows
that the TB case load per PP is low in Jogjakarta, where the NTP already involves
public and private hospitals besides public health centres. Initiatives to engage all
PP might only marginally contribute in increasing the TB case detection.
Publication Types:
210: J Am Board Fam Med. 2007 Nov-Dec;20(6):565-71.

How should complementary practitioners and physicians

communicate? A cross-sectional study from Israel.
Ben-Arye E, Scharf M, Frenkel M.
The Complementary and Traditional Medicine Unit, Department of Family

Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa,
Clalit Health Services, Haifa and Western Galilee District.
eranben@netvison.net.il
OBJECTIVES: The extensive use of complementary and alternative medicine for

patients can complicate dialogue between physicians and complementary and
alternative medicine practitioners, but not much data have been collected on the
expectations and attitudes of physicians and complementary and alternative
medicine practitioners concerning their communication and collaboration. In this
study, we compared the results of a cross-sectional survey of both groups to
elucidate the attitudes and expectations regarding communication and
collaboration. METHODS: Questionnaires were mailed electronically or through
the mail to 2532 primary care physicians and 450 complementary and alternative
medicine practitioners employed by Clalit Health Services, the largest health
maintenance organization in Israel. RESULTS: Questionnaires were returned by
333 physicians (response rate of 13%) and 241 practitioners (response rate of
54%). According to our results, the majority of both groups expressed an interest
in clinical practice collaboration (69% and 77% of physicians and practitioners,
respectively; P = .043); preferred using a medical letter to communicate with each
other; and expected to consult with each other about mutual patients to formulate
treatment plans. However, the practitioners were more interested than the
physicians in collaborative scientific research (15% vs 42%, respectively; P <
.0001) and collaborative medical education (2% vs 27%, respectively; P < .0001).
The physicians also supported a physician-guided model of teamwork in clinical
practice, whereas the practitioners supported a more collaborative model.
CONCLUSIONS: Educational programs for primary care physicians and
complementary and alternative medicine practitioners should focus on aspects of
communication between the groups and practical methods for writing referral or
medical letters.
211: Int J Psychiatry Med. 2007;37(2):163-72.

Pattern of psychiatry morbidity during Hajj period at Al-Noor

Specialist Hospital.
Masood K, Gazzaz ZJ, Ismail K, Dhafar KO, Kamal A.
Al-Noor Specialist Hospital, Holy Makkah, KSA.
OBJECTIVE: To study the pattern and extent of psychiatric morbidity in the Hajj
period (pilgrimage to Mecca by a Muslim). METHOD: Study was conducted by
psychiatry department and Health Research Centre, Al-Noor Specialist Hospital.
We recorded demographic and clinical characteristics of all patients presenting
during first two weeks of Zulhajjah, 1425H (11th to 24th of January 2005).
Detailed clinical interviews were conducted by qualified psychiatrists and
findings were recorded in semi-structured form. Diagnoses were made following
the guidelines in clinical version of chapter V (Mental and Behavioral Disorders)
of International Classification of Diseases (ICD-10). In difficult cases diagnosis
was assigned by consensus between three psychiatrists. RESULTS: During study
period 92 patients presented. Males were dominant (54%). Mean age was 43 +/-
17. Highest proportion (52%) belonged to young adults followed by middle-aged
(20%). Majority (48%) belonged to Saudi Arabia. Self-referrals were 66% and
52% presented as first episodes. Behavior, mood, and sleep were affected more
commonly (65%, 63%, and 59% respectively). Physical symptoms were reported
by 28% of patients. Highest number (34%) belonged to "Neurotic, stress-related
and somatoform disorders" followed by "Mood disorders" (22%). Medical
disorder was reported by 33% of patients. Medications were advised to 79% and
psychiatric admission to 6.5% of patients. CONCLUSIONS: In our study,
important findings are outlined and discussed. Replication of study with increased
sample size and planning of psychiatric services according to established need of
population served particularly during hajj period is needed.
Publication Types:
212: Hu Li Yan Jiu. 2001 Jun;9(3):300-10.

[Continuing education needs & knowledge of gerontological nursing

among nurses in nursing homes]
[Article in Chinese]
Yeh SH, Lin LW, Wang SY, Ho TH.
Chang Gung Institute of Nursing.
The purpose of this study was to explore continuing education needs and
knowledge of gerontological nursing among nurses in nursing homes, and analyze
the relationship of demographic characteristics, knowledge and continuing
education needs. Twenty nursing homes were randomly selected and 130 nurses
were interviewed by structured questionnaires to ascertain their demographic
characteristics, knowledge of gerontological nursing, and continuing education
needs. Results showed that more than half of the nurses had not attended any
courses in gerontological nursing in school, or in post-graduate continuing
education. The rate of correct answers for knowledge of gerontological nursing
was 70.8%. The worst knowledge was of gerontological statistics, followed by
physical and psychological aspects of aging. Knowledge levels in gerontological
nursing were positively correlated with age (r = .22, p < .05) having taken
gerontological nursing courses (r =.22, p < .05) and having taken continuing
education in gerontological nursing (r = .18, p < .05). Knowledge levels were
negatively correlated with having lived with the elders in their own family (r = -
.30, p < .05). Nurses who graduated from junior college or nursing high school
had lower scores for knowledge than college graduates (F = 25.31, p < .001). The
intensity level of continuing education needs ranged from needed to strongly
needed, especially for knowledge regarding clinical care, followed by general
information on aging, and administration and management. The level of
continuing education needs was not different among the various demographic
characteristics and knowledge levels in gerontological nursing. Results from this
study suggest that gerontological nursing courses should be increased in nursing
schools. Furthermore, a well-formulated continuing education model for
gerontological nurses in nursing homes is also essential to promote the quality of
care of the elderly.
Publication Types:
213: J Occup Health. 2007 Sep;49(5):424-9.

The effectiveness of a training program on reducing needlestick

injuries/sharp object injuries among soon graduate vocational
nursing school students in southern Taiwan.
Yang YH, Liou SH, Chen CJ, Yang CY, Wang CL, Chen CY, Wu TN.
Institute of Occupational Safety and Health, Kaohsiung Medical University,

Taiwan.
Needlestick/sharp injuries (NSIs/SIs) are a serious threat to medical/nursing

students in hospital internships. Education for preventing NSIs/SIs is important
for healthcare workers but is rarely conducted and evaluated among vocational
school nursing students. We conducted an educational intervention for such
students after their internship rotations before graduation. This program consisted
of a lecture to the students after the internship training and a self-study brochure
for them to study before their graduation. This study used the pre-test
questionnaires completed by all students and the post-test questionnaires
completed by 107 graduates after work experience as licensed nurses to assess the
effectiveness of the intervention. After educational intervention, the incidence of
NSIs/SIs decreased significantly from 50.5% pre-test to 25.2% post-test, and the
report rate increased from 37.0% to 55.6%, respectively. In conclusion, this
intervention significantly reduced the incidence of NSIs/SIs and increased the
report rate of such events.

214: Int J Infect Dis. 2008 Jan;12(1):43-6. Epub 2007 Oct 18.
Efficacy of measles and rubella vaccination one year after the

nationwide campaign in Shiraz, Iran.
Pourabbas B, Ziyaeyan M, Alborzi A, Mardaneh J.
Professor Alborzi Clinical Microbiology Research Center, Shiraz University of

Medical Sciences, Shiraz, Iran. bpourabbas@yahoo.com
BACKGROUND: The World Health Organization target for measles elimination

in the Eastern Mediterranean Region was established in 2010. In Iran, the national
measles-rubella campaign, targeting individuals aged 5-25 years, was initiated in
December 2003. METHODS: To evaluate the impact of the campaign after one
year, 909 serum samples were collected in Shiraz, southern Iran, from a
population aged 6-26 years, divided into five groups according to age. IgG
antibodies were tested using ELISA for the measles and rubella antibodies, and
the plaque reduction neutralization test (PRNT; measles) was used for samples
with equivocal results. RESULTS: Measles protective immunity reached 80.6%,
72.7%, 84.9%, and 87.5% and rubella immunity reached 91.0%, 99.6%, 99.6%,
and 97.0% for the age groups 6-10, 11-15, 16-20, and 20-26 years, respectively.
Seropositivity to the rubella virus in this population was high, especially in
women of childbearing age (98.9%), thereby preventing congenital rubella
infections. However for measles, it was significantly lower than the rate required
to achieve >or=95% coverage for elimination. CONCLUSIONS: These data
indicate that an increase in immunization coverage by supplementary
administration of a second dose of measles vaccine is needed to interrupt the
endemic transmission of the measles virus.
215: Conf Proc IEEE Eng Med Biol Soc. 2006;1:6312-5.

Distributed personal health information management system for

dermatology at the homes for senior citizens.
Lavanya J, Goh KW, Leow YH, Chio MT, Prabaharan K, Kim E, Kim Y,
Soh CB.
Biomed. Eng. Res. Centre, Nanyang Technol. Univ.,Singapore.
A distributed personal health information management system (D-PHIMS) has

been tested at a nursing home for the senior citizens (NHSC) in Singapore. The
personal health information management system (PHIMS) from the University of
Washington was customized to Singapore's context for teledermatology. A
clinical trial commenced in October 2005 is ongoing and the survey results
obtained indicate that the participants are satisfied with the D-PHIMS system. The
diagnosis and treatment recommendations made by the dermatologists using the
D-PHIMS diagnosis module were effective in most cases based on feedback from
the nursing staff at the elderly nursing home. The results suggest that a
teledermatology system could become a useful tool for the nursing homes and to
control increasing healthcare costs for elderly care.
216: Aliment Pharmacol Ther. 2007 Nov 1;26(9):1277-83.

Clinical trial: evaluation of a clinical decision-support model for

upper abdominal complaints in primary-care practice.
Horowitz N, Moshkowitz M, Leshno M, Ribak J, Birkenfeld S, Kenet G,

Halpern Z.
Department of Gastroenterology, Tel-Aviv Sourasky Medical Center, Tel-Aviv,

Israel. noyah@tasmc.health.gov.il
Background: Gastro-oesophageal reflux disease (GERD) and dyspepsia affect 25-

40% of the general population. In the absence of alarm symptoms, the current
recommended policy in young dyspeptic patients is a 'test and treat' strategy for
Helicobacter pylori; in GERD patients, a therapeutic trial with proton pump
inhibitors is the treatment of choice. AIM: To create a short and simple clinical
algorithm, for the diagnosis and treatment of patients with upper gastrointestinal
complaints. METHODS: The clinical usefulness and cost-effectiveness of the new
algorithm were evaluated in a controlled clinical trial, held in primary-care clinics
in Israel. Clinical and economical treatment outcomes were evaluated after 1, 3
and 6 months comparing doctors who used the algorithm (cases) vs. those who
did not (controls). RESULTS: 78 cases and 54 controls completed the 6 months of
follow up. The improvement in symptom severity and quality of life was greater
in the cases than in the controls (P < 0.05). General practitioner clinics visits (P =
0.04), gastroenterology clinics visits (P = 0.02) and medication costs (P = 0.004)
were all significantly reduced among cases. Controls underwent also more
imaging tests (computerized tomography, ultrasound and X-ray) and endoscopies.
The average cost for 6 months' treatment and follow-up was $US 199 for cases
compared with an average of $US 336 in the control group. CONCLUSION: The
use of a clinical decision-support tool can facilitate and promote the
implementation of management guidelines by general practitioners. The short
algorithm presented in the study was found to be useful and easy to apply in
clinical practice. Its effectiveness can be further increased by implementing it in
computerized medical systems.
Publication Types:
• Clinical Trial
217: J Nurs Manag. 2007 Nov;15(8):801-10.

Career needs, career development programmes, organizational

commitment and turnover intention of nurses in Taiwan.
Chang PL, Chou YC, Cheng FC.
Department of Business Administration, Feng Chia University, Taichung,

Taiwan. plchang@fcu.edu.tw
AIM: This study divided nursing careers into four stages: exploration,
establishment, maintenance and disengagement. Besides exploring whether nurses
have different career needs at different career stages, this study also examines the
gap between career needs and career development programmes, and its
relationship with organizational commitment and turnover intention of nurses in
Taiwan. BACKGROUND: Although previous studies have recognized that
nurses' careers have different stages, a few studies have identified nurses' career
needs or offered programmes to respond to nurses' needs. METHOD: Through a
literature review and in-depth interviews, this study developed a scale to measure
career needs of nurses at different stages and identify the appropriate career
development programmes. Additionally, regression analyses were implemented to
explore the relationships objectively. RESULTS: Nurses were found to have
different career needs at different career stages, and the gap between career needs
and career development programmes influenced turnover intention caused by the
decline in nurses' commitment towards the hospital. CONCLUSIONS: If
hospitals' administrators can provide career development programmes to satisfy
career needs of nurses at different career stages, then nurses' commitment to the
hospital may increase and nurses' turnover intention may decrease, which may
lead to reciprocity between the hospital and the nurses.

218: Isr Med Assoc J. 2007 Sep;9(9):659-62.
Burns in Israel: demographic, etiologic and clinical trends, 1997-

2003.
Haik J, Liran A, Tessone A, Givon A, Orenstein A, Peleg K; Israeli Trauma

Group.
Burn Unit, Department of Plastic Surgery & Reconstructive Surgery, Gertner

Institute for Epidemiology and Health Policy Research, Sheba Medical Center,
Tel Hashomer.
BACKGROUND: Burns are a major public health problem, with long

hospitalization stay in both intensive care units and general wards. In Israel about
5% of all hospitalized injuries are burn injuries. There are no long-term
epidemiological studies on burn injuries in adults in Israel. OBJECTIVES: To
identify risk factors for burn injuries and provide a starting point for the
establishment of an effective prevention plan. METHODS: We analyzed the
demographic, etiologic and clinical data of 5000 burn patients admitted to the five
major hospitals with burn units in Israel during a 7 year period (1997-2003). Data
were obtained from the records of the Israeli National Trauma Registry. The
differences between various groups were evaluated using the chi-square test.
RESULTS: Male gender was twice as frequent as female gender in burn patients
(68.0% vs. 31.9%), and non-Jewish ethnicity was more common when
considering their proportion in the total population (62.3% vs. 36.8%). Second
and third-degree burns with body surface areas less than 10% constituted the
largest group (around 50%). The largest age group was 0-1 years, constituting
22.2% of the cases. Inhalation injury was uncommon (1.9%). The most common
etiologies were hot liquids (45.8%) and open fire (27.5%). Children less than 10
years old were burnt mainly by hot liquids while the main cause of burns for
adults > 20 years old was an open flame. The majority of burns occurred at home
(58%); around 15% were work related. The mean duration of hospitalization was
13.7 days (SD 17.7); 15.5% were in an intensive care unit with a mean duration of
12.1 days (SD 17.1). Surgical procedures became more common during the period
of the study (from 13.4% in 1998 to 26.59% in 2002, average 19.8%). The
mortality rate was 4.4%. We found a strong correlation between burn degree and
total body surface area and mortality (0.25% mortality for 2nd to 3rd-degree
burns with less than 10% TBSA, 5.4% for 2nd to 3rd-degree burns with 20-39%
TBSA, and 96.6% for burns > 90% TBSA). The worst prognosis was for those
over the age of 70 (mortality rate 35.3%) and the best prognosis was for the 0-1
year group (survival rate 99.6%). CONCLUSIONS: The groups at highest risk
were children 0-1 years old, males and non-Jews (the incidence rate among non-
Jews was 1.5 times higher than their share in the general population). Those with
the highest mortality rate were victims of burns > 90% TBSA and patients older
than 70. Most burns occurred at home.
Publication Types:
219: Reprod Health Matters. 2007 Nov;15(30):214-5.

Making pregnancy safer in Myanmar: introducing misoprostol to

prevent post-partum haemorrhage as part of active management of
the third stage of labour.
Htay TT.
Department of Health, Ministry of Health, Nay Pyi Taw, Myanmar.

thtay@mptmail.net.mm
Publication Types:
• Clinical Conference
220: Fam Med. 2007 Oct;39(9):627-33.

The emergence of family medicine in Kyrgyzstan.
Hardison C, Fonken P, Chew T, Smith B.
Scientific Technology Language Institute, Bishkek, Kyrgyzstan.

cphardison@bigfoot.com
BACKGROUND AND OBJECTIVES: In post-Soviet Central Asia, Kyrgyzstan

has emerged as the leader in family medicine reform. This paper examines the
factors that have allowed family medicine to become the foundation of primary
care and the rationale for retraining specialists in primary care. METHODS:
Critical elements of successful family medicine reform have included national
policy, international cooperation, training programs, support structures, and
quality measures. The national policy has contributed to an environment that has
allowed many international organizations to participate in the process of
reforming the health care system. The 9-year training process was a momentous
nationwide development task that was supported by various structures,
organizations, and events and included the implementation of quality measures.
Analysis: Various reports, studies, and evaluations support the positive impact
family medicine has had on patient satisfaction, physician attitude, and scope of
practice. Further, one study indicates improved health outcomes in terms of
decreased years of potential life lost. RESULTS: The national policy of reform
that is in favor of family medicine, and international donor agencies-supported
training, produced the following results: a group of family medicine teachers,
98% (2,691) of the country's primary care doctors retrained in family medicine,
and there were 372 family medicine resident graduates. To ensure quality,
objective structured clinical exams were implemented in all levels of training.
CONCLUSIONS: It will take many more years to fully establish family medicine
in the medical culture of Kyrgyzstan and reap its full benefits, but already it is
contributing toward improvements in the quality of patient care.
Publication Types:

221: Heart. 2008 May;94(5):554-60. Epub 2007 Oct 11.

Prospective observational study of acute coronary syndromes in

China: practice patterns and outcomes.
Gao R, Patel A, Gao W, Hu D, Huang D, Kong L, Qi W, Wu Y, Yang Y,

Harris P, Algert C, Groenestein P, Turnbull F; CPACS
Investigators.Collaborators (51)
Cao S, Chen Y, Cui J, Gai L, Gao W, Gao Y, Guo D, Han L, He Y, Huang L,

Huang Z, Jia Z, Jin Z, Jiang H, Jiang S, Jing M, Li T, Li Y, Liao Y, Liu J, Lu
D, Lu F, Luo K, Meng Q, Qian J, Ren J, Shi W, Shou X, Sun X, Sun Y, Tian
G, Wang D, Wang F, Wang J, Wang L, Wang L, Wang S, Wang X, Wu Q,
Wu Y, Xiao R, Xie Q, Xu Y, Yang M, Yang Q, Yang X, Zhao M, Zhao R,
Zhao S, Zhong M, Zhu G.
FuWai Heart Hospital, Beijing, China.

OBJECTIVE: To describe the investigation and management of patients admitted
to hospitals in China with suspected acute coronary syndromes (ACS) and to
identify potential areas for improvement in practice. DESIGN: A multicentre
prospective survey of sociodemographic characteristics, medical history, clinical
features, in-hospital investigations, treatment practices and major events among
patients with suspected ACS. SETTING: Large urban public hospitals.
PATIENTS: Consecutive patients admitted to in-patient facilities with a diagnosis
of suspected acute myocardial infarction (MI) or unstable angina pectoris. MAIN
OUTCOME MEASURES: Myocardial infarction/re-infarction, heart failure,
death. RESULTS: Between September 2004 and May 2005, data were collected
prospectively from 2973 patients admitted to 51 hospitals in 18 provinces of
China. An initial diagnosis of ST elevation MI, non-ST elevation MI and unstable
angina was made in 43%, 11% and 46% of patients, respectively. Diagnosis was
inconsistent with objective measures in up to 20% of cases. At both tertiary and
non-tertiary centres, there was little evidence that clinical risk stratification was
used to determine the intensity of investigation and management. The mortality
rate during hospitalisation was 5% overall and similar in tertiary and non-tertiary
centres, but reported in-hospital re-infarction rates (8%) and heart failure rates
(16%) were substantially higher at non-tertiary centres. CONCLUSION: This
study has identified a number of areas in the management of ACS patients,
including diagnosis and risk stratification, which deviate from current guidelines.
These findings will help inform the introduction of widely used quality
improvement initiatives such as clinical pathways.
Publication Types:
222: JSLS. 2007 Jul-Sep;11(3):358-62.

Three-port versus standard four-port laparoscopic cholecystectomy:

a randomized controlled clinical trial in a community-based
teaching hospital in eastern Nepal.
Kumar M, Agrawal CS, Gupta RK.
Department of Surgery, B P Koirala Institute of Health Sciences, Dharan, Nepal.

docmk_2002@yahoo.co.in
OBJECTIVES: With increasing surgeon experience, laparoscopic

cholecystectomy has undergone many refinements including reduction in port
number and size. Three-port laparoscopic cholecystectomy has been reported to
be safe and feasible in various clinical trials. However, whether it offers any
additional advantages remains controversial. This study reports a randomized trial
that compared the clinical outcomes of 3-port laparoscopic cholecystectomy
versus conventional 4-port laparoscopic cholecystectomy. METHODS: Seventy-
five consecutive patients who underwent elective laparoscopic cholecystectomy
were randomized to undergo either the 3-port or the 4-port technique. Four
surgical tapes were applied to standard 4-port sites in both groups at the end of the
operation. All dressings were kept intact until the first follow-up 1 week after
surgery. Postoperative pain at the 4 sites was assessed on the first day after
surgery by using a 10-cm unscaled visual analog scale (VAS). Other outcome
measures included analgesia requirements, length of the operation, postoperative
stay, and patient satisfaction score on surgery and scars. RESULTS: Demographic
data were comparable for both groups. Patients in the 3-port group had shorter
mean operative time (47.3+/-29.8 min vs 60.8+/-32.3 min) for the 4-port group
(P=0.04) and less pain at port sites (mean score using 10-cm unscaled VAS:
2.19+/-1.06 vs 2.91+/-1.20 (P=0.02). Overall pain score, analgesia requirements,
hospital stay, and patient satisfaction score (mean score using 10-cm unscaled
VAS: 8.2+/-1.7 vs 7.8+/-1.7, P=0.24) on surgery and scars were similar between
the 2 groups. CONCLUSION: Three-port laparoscopic cholecystectomy resulted
in less individual port-site pain and similar clinical outcomes with fewer surgical
scars and without any increased risk of bile duct injury compared with 4-port
laparoscopic cholecystectomy. Thus, it can be recommended as a safe alternative
procedure in elective laparoscopic cholecystectomy.
Publication Types:

223: J Clin Nurs. 2008 Feb;17(3):296-303. Epub 2007 Oct 11.

Effectiveness of a prenatal education programme on breastfeeding

outcomes in Taiwan.
Lin SS, Chien LY, Tai CJ, Lee CF.
Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan.
AIMS: The objectives of this study were to design a structured prenatal education
programme on breastfeeding and to evaluate the effectiveness of the programme.
Indicators of effectiveness were selected based on Kirkpatrick's Training
Evaluation Model, including satisfaction with the programme, breastfeeding
knowledge, breastfeeding attitude, breastfeeding satisfaction, breastfeeding
problems and rate of exclusive breastfeeding. METHODS: This study applied a
quasi-experimental design. The experimental group included 46 women who
received a 90-minute group educational programme on breastfeeding during their
20th-36th week of pregnancy. Each experimental subject was matched by a
control subject according to age, educational level, work status and pregnancy
gestational age. Control subjects did not receive any intervention. Data were
collected through self-administered questionnaires at preintervention,
postintervention, three days postpartum and one month postpartum. RESULTS:
Satisfaction with the programme was high. The experimental group had higher
scores in breastfeeding knowledge and breastfeeding attitude at three days
postpartum. The experimental group showed higher breastfeeding satisfaction at
three days and one month postpartum. There were no significant differences in
experiencing breastfeeding problems. The rate of exclusive breastfeeding was
higher for the experimental group at three days and one month postpartum, but the
differences were not statistically significant. CONCLUSION: This study
demonstrated the effectiveness of a prenatal education programme on maternal
knowledge, attitude and satisfaction toward breastfeeding. RELEVANCE TO
CLINICAL PRACTICE: Other hospitals could apply this model to plan and
evaluate their prenatal education programme on breastfeeding.
Publication Types:
224: J Clin Virol. 2007 Nov;40(3):202-6.

Clinicians' diagnostic practice of dengue infections.
Ng CF, Lum LC, Ismail NA, Tan LH, Tan CP.
Department of Applied Statistics, Faculty of Economics and Administration,

University of Malaya, Malaysia. chrisng@um.edu.my
BACKGROUND: Difficulties in the classification of dengue infection have been

documented. Such difficulties could be due to the low awareness of the World
Health Organization diagnostic guidelines among clinicians. OBJECTIVE: To
study the diagnostic practices of clinicians in classifying patients as dengue fever
(DF) or dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) at the
time of discharge during an outbreak. METHODS: A prospective descriptive
study of clinical features and disease classification in adult and pediatric dengue
patients in the University of Malaya Medical Centre. RESULTS: Five hundred
and twenty adult and 191 pediatric patients were enrolled. Thrombocytopenia and
evidence of plasma leakage were present in 8% of adult and 19% of pediatric
patients. Of these, 93% and 49%, respectively, were given the discharge
diagnoses of DF instead of DHF/DSS. Hemoconcentration, serous effusion and
thrombocytopenia were not recognized in clinicians' discharge diagnosis of
DHF/DSS for adult patients. The receiver operating characteristic (ROC) curve
suggested a lack of consistency in the use of WHO guidelines in establishing
DHF/DSS in adult patients, while implying otherwise for pediatric patients.
CONCLUSION: DHF/DSS is an under-recognized condition by clinicians
managing these patients. This can affect the case fatality rate of DHF/DSS and the
economic burden of the disease. The lack of awareness in disease manifestations
especially plasma leakage, can lead to delayed recognition of DHF/DSS.
225: Pharmacoepidemiol Drug Saf. 2008 Jan;17(1):62-9.

Trends in the use of lipid-lowering drugs by outpatients with

diabetes in Taiwan, 1997-2003.
Chiang CW, Chiu HF, Chen CY, Wu HL, Yang CY.
Graduate Institute of Pharmaceutical Science, Kaohsiung Medical University,

Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan.
PURPOSE: To analyze recent trends in LLD use by outpatients with diabetes in

Taiwan over a 7-year period and to see whether the trends are consistent with
clinical trial outcomes and published guidelines. METHODS: A cross-sectional
survey was implemented using the National Health Insurance Research Database
between January 1997 and December 2003. Adult outpatients who had diagnoses
of diabetes and dyslipidemia and who had concurrent antidiabetic drug and LLD
claim were identified. The prescribing trends were described in terms of the
prescribing rates and patterns of LLDs in each study year. RESULTS: Between
1997 and 2000, fibrates were the most widely prescribed major class of LLDs,
while the rates showed a significant decline over time. The proportions of statin
use increased 3.3-fold from 20.8% of all LLDs in 1997 to 69.0% in 2003. With
the continuous increase in the use of statins, by 2001, they replaced fibrates as the
most heavily used LLDs. Monotherapy was the most prominent prescribing
pattern comprising 98.1% and 98.3% of all LLD prescriptions in 1997 and 2003,
respectively. Among patients with diabetic dyslipidemia plus CHD, the use of
statins increased almost threefold instead of a large reduction in the percentage
with non-statin class. CONCLUSIONS: The prescribing rates of LLDs shifted
from the fibrates to statins, especially in newer statin. The majority of patients
were maintained on monotherapy. These findings may imply that management of
hyperlipidemia in patients with diabetes had a positive trend towards recent
clinical trial outcomes and guideline's recommendation.
226: J Community Health. 2007 Oct;32(5):324-42.

Knowledge, beliefs, and behaviors about hypertension control

among middle-aged Korean Americans with hypertension.
Han HR, Kim KB, Kang J, Jeong S, Kim EY, Kim MT.
Johns Hopkins University School of Nursing, 525 N. Wolfe Street, Baltimore,

MD 21205-2110, USA. hhan@son.jhmi.edu
This report describes the management and control of high blood pressure (HBP)
in a sample of middle-aged (40 to 64 years) Korean Americans (KAs) with HBP.
Participants in the Self-Help Intervention Program for HBP care (SHIP-HBP), a
culturally tailored clinical trial for HBP management in KAs through lifestyle
approaches, underwent baseline assessments to determine HBP control status and
knowledge, beliefs, and practices related to HPB control. Data were stratified by
sex. In all, 445 Korean patients are described. About 55% of the sample were
receiving antihypertensive therapy, and less than one-third had controlled BP (<
140/90 mm Hg). Sex differences were observed in terms of clinical characteristics
and anti-hypertensive medication use: women were more likely than men to have
controlled BP and lower diastolic BP and to have been on HBP medication.
Lower rates of smoking, drinking, and overweight or obesity were also observed
more frequently in women. Most participants agreed that taking anti-hypertensive
medication lowered BP. When asked what the most important behavioral factor
was for controlling BP, about a quarter reported cutting down on salt, followed by
exercise and medication taking. While poor HBP control remains a common
problem that contributes to significant cardiovascular morbidity and mortality,
particularly among ethnic minorities, our findings underscore the need to test the
beneficial effects of primary and secondary prevention programs, suitably
modified to meet the language, cultural, and individual needs of this high-risk
population of hypertensive patients.
Publication Types:
• Research Support, U.S. Gov't, P.H.S.

227: Stud Health Technol Inform. 2007;130:257-68.

Differences in public and private sector adoption of telemedicine:

Indian case study for sectoral adoption.
Sood SP, Negash S, Mbarika VW, Kifle M, Prakash N.
C-DAC School of Advanced Computing, Quatre Bornes, Mauritius.

sood@spsood.com
Telemedicine is the use of communication networks to exchange medical

information for providing healthcare services and medical education from one site
to another. The application of telemedicine is more promising in economically
developing countries with agrarian societies. The American Telemedicine
Association (ATA) identifies three healthcare services: clinical medical services,
health and medical education, and consumer health information. However, it is
not clear how these services can be adopted by different sectors: public and
private. This paper looks at four Indian case studies, two each in public and
private sectors to understand two research questions: Are there differences in
telemedicine adoption between public and private hospitals. If there are
differences: What are the differences in telemedicine adoption between public and
private sectors? Authors have used the extant literature in telemedicine and
healthcare to frame theoretical background, describe the research setting, present
the case studies, and provide discussion and conclusions about their findings.
Authors believe that as India continues to develop its telemedicine infrastructures,
especially with continued government support through subsidies to private
telemedicine initiatives, its upward trend in healthcare will continue. This is
expected to put India on the path to increase its life expectancy rates, especially
for it rural community which constitute over 70% of its populace.
228: Stud Health Technol Inform. 2007;129(Pt 1):307-10.

Principles-based medical informatics for success--how Hong Kong

built one of the world's largest integrated longitudinal electronic
patient records.
Cheung NT, Fung V, Wong WN, Tong A, Sek A, Greyling A, Tse N, Fung H.
Health Informatics Section, Hospital Authority, Kowloon, Hong Kong SAR.
cheungnt@ha.org.hk
Since 1994, the Hospital Authority has been developing and deploying clinical
applications at its constituent 41 hospitals and 121 clinics. The Clinical
Management System (CMS) is now used by over 4000 doctors and 20000 other
clinicians on a daily basis to order, document and review care. The territory-wide
Electronic Patient Record (ePR) has given clinicians an integrated, longitudinal,
lifelong view of a patient's record. Today the CMS and ePR form an essential
clinical and management tool to the Hospital Authority. The CMS handles two
million clinical transactions per day, and the ePR has over 6TB of data covering
57 million episodes for 7.9 million patients. This paper describes how the HA has
taken a principles-based approach to Medical Informatics to achieve its success in
the enterprise-wide deployment and deep utilization of a comprehensive clinical
information system.
229: Singapore Med J. 2007 Oct;48(10):906-10.

Body composition, nutrient intake and physical activity patterns in

young women during Ramadan.
Al-Hourani HM, Atoum MF.
Department of Clinical Nutrition and Dietetics, Faculty of Allied Health Sciences,

The Hashemite University, PO Box 150459, Zarqa 13115, Jordan.
hhourani@hu.edu.jo
INTRODUCTION: Muslims abstain from food and fluid between the hours of
sunrise to sunset, and usually eat a large meal after sunset and a lighter meal
before sunrise. The purpose of this study was to assess body composition, nutrient
intake and physical activity patterns during Ramadan fasting. METHODS: This
study was carried out during Ramadan in October 2004. A total of 57 female
subjects were recruited from The Hashemite University in Jordan. Body weight,
fat percentage, muscle mass, and percentage body water content were measured,
and body mass index (BMI) was calculated. Estimated food records over a
duration of three days were used to assess the intake of energy, carbohydrates,
protein, fat, and sugars before and during Ramadan fasting. Physical activity
patterns were determined from a three-day activity diary before and during
Ramadan fasting; the amount of physical activity was expressed as the physical
activity level. RESULTS: Body weight and BMI decreased significantly during
Ramadan fasting. The mean energy and nutrients intake before Ramadan (energy;
percent carbohydrates:protein:fat was 1,252; 56:12:33) and during Ramadan
(1,171; 56:13:34) were not significantly different. The mean physical activity
level was 1.54 before Ramadan and 1.51 during Ramadan, and this was also not
significantly different. CONCLUSION: This study revealed that there was a
significant weight loss during Ramadan. Estimates of energy, carbohydrates,
protein, fat and sugar did not change, despite the reduction in the number of meals
taken. The overall activity patterns remained similar.
Publication Types:
230: Nurs Ethics. 2007 Nov;14(6):810-24.

Chinese nurses' ethical concerns in a neurological ward.
Tang PF, Johansson C, Wadensten B, Wenneberg S, Ahlström G.
Kunming Medical College, Kunming, Province of Yunnan, China.
Our aim was to describe Chinese nurses' experiences of workplace distress and
ethical dilemmas on a neurological ward. Qualitative interviews were performed
with 20 nurses. On using latent content analysis, themes emerged in four content
areas: ethical dilemmas, workplace distress, quality of nursing and managing
distress. The ethical dilemmas were: (1) conflicting views on optimal treatment
and nursing; (2) treatment choice meeting with financial constraints; and (3)
misalignment of nursing responsibilities, competence and available resources. The
patients' relatives lacked respect for the nurses' skills. Other dilemmas could be
traced to the transition from a planned to a market economy, resulting in an
excessive workload and treatment withdrawal for financial reasons. Lack of
resources was perceived as an obstacle to proper patient care in addition to
hospital organization, decreasing the quality of nursing, and increasing moral and
workplace distress. The nurses managed mainly by striving for competence,
which gave them hope for the future.
Publication Types:

231: Nurs Ethics. 2007 Nov;14(6):741-52.

Ethics in Turkish nursing education programs.
Görgülü RS, Dinç L.
Hacettepe University, Ankara, Turkey. sgorgulu@hacettepe.edu.tr
This descriptive study investigated the current status of ethics instruction in

Turkish nursing education programs. The sample for this study comprised 39
nursing schools, which represented 51% of all nursing schools in Turkey. Data
were collected through a postal questionnaire. The results revealed that 18 of
these nursing schools incorporated an ethics course into undergraduate and three
into graduate level programs. Most of the educators focused on the basic concepts
of ethics, deontological theory, ethical principles, ethical problems in health care,
patient rights and codes of ethics for nurses. More than half of the educators
believed that students' theoretical knowledge of ethics is applied to their clinical
experiences. The teaching methods used included discussion in class, lectures,
case studies, small group discussion, dramatization and demonstration.
Assessment was carried out by means of written essays and written examinations.
232: J Int Med Res. 2007 Sep-Oct;35(5):590-6.

Evaluation of acute myocardial infarction in-hospital mortality

using a risk-adjustment model based on Japanese administrative
data.
Hayashida K, Imanaka Y, Sekimoto M, Kobuse H, Fukuda H.
Department of Healthcare Economics and Quality Management, School of Public

Health, Kyoto University Graduate School of Medicine, Kyoto, Japan.
This study aimed to develop a new risk-adjustment method to assess acute

myocardial infarction (AMI) in-hospital mortality. Risk-adjustment was based on
variables obtained from administrative data from Japanese hospitals, and included
factors such as age, gender, primary diagnosis and co-morbidity. The infarct
location was determined using the criteria of the International Classification of
Diseases (10th version). Potential comorbidity risk factors for mortality were
selected based on previous studies and their critical influence analysed to identify
major co-morbidities. The remaining minor co-morbidities were then divided into
two groups based on their medical implications. The major co-morbidities
included shock, pneumonia, cancer and chronic renal failure. The two minor co-
morbidity groups also demonstrated a substantial impact on mortality. The model
was then used to assess clinical performance in the participating hospitals. Our
model reliably employed the available data for the risk-adjustment of AMI
mortality and provides a new approach to evaluating clinical performance.
Publication Types:

233: Clin Rheumatol. 2008 Apr;27(4):429-36. Epub 2007 Sep 26.

The efficacy of cevimeline hydrochloride in the treatment of

xerostomia in Sjögren's syndrome in southern Chinese patients: a
randomised double-blind, placebo-controlled crossover study.
Leung KC, McMillan AS, Wong MC, Leung WK, Mok MY, Lau CS.
Oral Rehabilitation, Faculty of Dentistry, The University of Hong Kong, Hong

Kong, China.
Cevimeline hydrochloride, a specific agonist of the M3 muscarinic receptor, is

beneficial in the treatment of symptoms of xerostomia and xerophthalmia
associated with Sjögren's syndrome (SS). Cevimeline has not been evaluated in
southern Chinese patients. Furthermore, the effects of cevimeline on health-
related quality of life and oral health status are not known. In this randomised,
double-blind, placebo-controlled crossover study, patients received cevimeline 30
mg or matched placebo three times per day over 10 weeks followed by a 4-week
washout period before treatment crossover. Participants self-completed the
following questionnaires: Xerostomia Inventory (XI), the General Oral Health
Assessment Index (GOHAI), the Ocular Surface Disease Index (OSDI) and the
Medical Outcomes Short Form (SF-36). Clinical assessments included sialometry,
examination of the oral cavity for the degree of xerostomia and dental
complications of xerostomia. Fifty patients (22 primary SS and 28 secondary SS)
were enrolled in the trial. Forty-four patients completed the study. There was a
significant improvement in the XI and GOHAI scores as well as the objective
rating of xerostomic signs of the oral cavity after treatment with cevimeline.
However, there was no improvement in salivary flow rates and dry eye symptoms.
SS patients had lower SF-36 scores, but these did not improve after treatment with
cevimeline.
Publication Types:
234: Nurse Educ Today. 2008 May;28(4):409-18. Epub 2007 Sep 25.
Fostering maturity for senior nursing students: a pre-graduation

clinical placement.
Chung LY, Wong FK, Cheung SC.
School of Nursing, The Hong Kong Polytechnic University, Hung Hom,

Kowloon, Hong Kong. hslchung@inet.polyu.edu.hk
BACKGROUND: There is considerable literature on graduates' role transition to

registered nurse from the employer's perspective. Few studies have discussed
issues and strategies related to nursing students' preparedness. In response to the
Bachelor of Nursing (Honours) senior nursing students' needs in terms of role
transition, a pre-graduation clinical placement (PGCP) was implemented. AIM:
The aim of this paper is to report the learning experiences and outcomes of the
PGCP. METHODS: Both quantitative and qualitative approaches were used. All
students (n=37) and preceptors (n=33) involved in the PGCP consented to
participate in summer 2002. The data included: students' and preceptors' appraisal
of pre- and post-Inventory for Nursing Competencies (INC), students' formative
and summative reflective journals, and post-PGCP focus group interviews. Paired
t-tests were done to compare students' and preceptors' pre- and post-INC scores,
and thematic analyses were carried out for qualitative data. RESULTS: There
were statistically significant improvements in students' INC. Three themes -
learning to work with ward nurses and preceptors, learning total aspects of care,
and acting as RNs - were revealed. CONCLUSION: The success of the PGCP
demonstrates the promising outcome of a long consolidating clinical block prior
to graduation in fostering maturity for role transition.
Publication Types:
235: BMC Med Res Methodol. 2007 Sep 24;7:43.

Optimising reproductive and child health outcomes by building

evidence-based research and practice in South East Asia (SEA-
ORCHID): study protocol.
Henderson-Smart DJ, Lumbiganon P, Festin MR, Ho JJ, Mohammad H,

McDonald SJ, Green S, Crowther CA; SEA-ORCHID Study Group.
NSW Centre for Perinatal Health Services Research, Queen Elizabeth ll Research
Institute, University of Sydney, NSW 2006, Australia. dhs@mail.usyd.edu.au
BACKGROUND: Disorders related to pregnancy and childbirth are a major

health issue in South East Asia. They represent one of the biggest health risk
differentials between the developed and developing world. Our broad research
question is: Can the health of mothers and babies in Thailand, Indonesia, the
Philippines and Malaysia be improved by increasing the local capacity for the
synthesis of research, implementation of effective interventions, and identification
of gaps in knowledge needing further research? METHODS/DESIGN: The
project is a before-after study which planned to benefit from and extend existing
regional and international networks. Over five years the project was designed to
comprise five phases; pre-study, pre-intervention, intervention, outcome
assessment and reporting/dissemination. The study was proposed to be conducted
across seven project nodes: four in South East Asia and three in Australia. Each
South East Asian study node was planned to be established within an existing
department of obstetrics and gynaecology or neonatology and was intended to
form the project coordinating centre and focus for evidence-based practice
activities within that region. Nine hospitals in South East Asia planned to
participate, representing a range of clinical settings. The three project nodes in
Australia were intended to provide project support.The intervention was planned
to consist of capacity-strengthening activities targeted at three groups: generators
of evidence, users of evidence and teachers of evidence. The primary outcome
was established as changes in adherence to recommended clinical practices from
baseline to completion of the project and impact on health outcomes.
DISCUSSION: The SEA-ORCHID project was intended to improve care during
pregnancy and the perinatal period of mothers and their babies in South East Asia.
The possible benefits extend beyond this however, as at the end of this project
there is hoped to be an existing network of South East Asian researchers and
health care providers with the capacity to generalise this model to other health
priority areas. It is anticipated that this project facilitate ongoing development of
evidence-based practice and policy in South East Asia through attracting long-
term funding, expansion into other hospitals and community-based care and the
establishment of nodes in other countries.
Publication Types:
PMCID: PMC2194765
236: Int J Gynaecol Obstet. 2008 Jan;100(1):13-7. Epub 2007 Sep 24.
Dysmenorrhea among Japanese women.
Ohde S, Tokuda Y, Takahashi O, Yanai H, Hinohara S, Fukui T.
Clinical Practice Evaluation and Research Center, St Luke's Life Science

Institute, St Luke's International Hospital, Tokyo, Japan. saohde@luke.or.jp
OBJECTIVE: To investigate the epidemiology of dysmenorrhea in Japanese

women of menstrual age. METHODS: A prospective cohort study was conducted
using a health diary in a sample representative of Japanese women. Information
on health care use was also collected. RESULTS: Among 823 enrolled
participants (age range, 18-51 years), dysmenorrhea (mean duration 1.75 days;
range 1-5 days) was reported in 15.8% (95% CI, 13.3-18.3) during the 1-month
study period. Common associated symptoms included headache (10.77%), back
pain (6.92%), and fatigue (5.38%). No participant with dysmenorrhea visited a
physician, while 51.5% of the women used self-medication, and 7.7% used
complementary/alternative medicine. CONCLUSION: Dysmenorrhea is common
in Japanese women. In our study, about half used self-medication, while some
preferred complementary/alternative medicine. Dysmenorrhea is significantly
associated with younger age and employment status.
Publication Types:

237: Value Health. 2008 May-Jun;11(3):354-64. Epub 2007 Sep 21.

An Asian regional analysis of cost-effectiveness of early irbesartan

treatment versus conventional antihypertensive, late amlodipine,
and late irbesartan treatments in patients with type 2 diabetes,
hypertension, and nephropathy.
Annemans L, Demarteau N, Hu S, Lee TJ, Morad Z, Supaporn T, Yang WC,

Palmer AJ.
Ghent University and IMS Health, Bruxelles, Belgium, and IMS Health,
Bruxelles, Belgium.
OBJECTIVE: The prevalence of type 2 diabetes, often leading to diabetic

nephropathy, has increased globally, especially in Asia. Irbesartan treatment
delays the progression of kidney disease at the early (microalbuminuria) and late
(proteinuria) stages of nephropathy in hypertensive type 2 diabetics. This
treatment has proven to be cost-effective in Western countries. This study
assessed the cost-effectiveness of early irbesartan treatment in Asian settings.
METHODS: An existing lifetime model was reprogrammed in Microsoft Excel to
compare irbesartan started at an early stage to irbesartan or amlodipine started at a
late stage, and standard treatments from a health-care perspective in China,
Malaysia, Thailand, South Korea, and Taiwan. The main effectiveness parameters
were incidences of end-stage renal disease, time in dialysis, and life expectancy.
All costs were converted to 2004 US$ using official purchasing power parity.
Local data were obtained for costs, transplantation,dialysis, and mortality rates.
Probabilities regarding disease progression after treatment with the investigated
drugs were extracted from two published clinical trials. A probabilistic sensitivity
analysis was performed. RESULTS: Early use of irbesartan yielded the largest
clinical and economic benefits reducing need for dialysis by 61% to 63% versus
the standard treatment, total costs by 9% (Thailand) to 42% (Taiwan), and
increasing life expectancy by 0.31 to 0.48 years. Early irbesartan had a 66%
(Thailand) to 95% (Taiwan) probability of being dominant over late irbesartan.
CONCLUSION: Although the absolute results varied in different settings,
reflecting differences in epidemiology, management, and costs, early irbesartan
treatment was a cost-effective alternative in the Asian settings.
Publication Types:
238: Indian J Tuberc. 2007 Jul;54(3):117-24.

Management of multi drug resistance tuberculosis in the field:

Tuberculosis Research Centre experience.
Thomas A, Ramachandran R, Rehaman F, Jaggarajamma K, Santha T,

Selvakumar N, Krishnan N, Mohan NS, Sundaram V, Wares F, Narayanan
PR.
Tuberculosis Research Centre, Channai.
SETTING: Multi-drug TB resistant (resistant to isoniazid and rifampicin) patients

identified from a rural and urban area. OBJECTIVE: To study the feasibility of
managing MDR TB patients under field conditions where DOTS programme has
been implemented. METHODS: MDR TB Patients identified among patients
treated under DOTS in the rural area and from cases referred by the NGO when
MDR TB was suspected form the study population. Culture and drug
susceptibility testing were done at Tuberculosis Research Centre (TRC).
Treatment regimen was decided on individual basis. After a period of initial
hospitalization, treatment was continued in the respective peripheral health
facility or with the NGO after identifying a DOT provider in the field. Patients
attended TRC at monthly intervals for clinical, sociological and bacteriological
evaluations. Drugs for the month were pre-packed and handed over to the
respective center. RESULTS: A total of 66 MDR TB patients (46 from the rural
and 20 from the NGO) started on treatment form the study population and among
them 20 (30%) were resistant to one or more second line drugs (Eto, Ofx, Km)
including a case of "XDR TB". Less than half the patients stayed in the hospital
for more than 10 days. The treatment was provided partially under supervision.
Providing injection was identified to be a major problem. Response to treatment
could be correctly predicted based on the 6-month smear results in 40 of 42
regular patients. Successful treatment outcome was observed only in 37% of cases
with a high default of 24%. Adverse reactions necessitating modification of
treatment was required only for three patients. IMPLICATIONS: Despite having
reliable DST and drug logistics, the main challenge was to maintain patients on
such prolonged treatment by identifying a provider closer to the patient who can
also give injection, have social skills and manage of minor adverse reactions.
Publication Types:

239: Med Teach. 2007 Jun;29(5):e133-8.

Domestic violence: a national simulation-based educational program

to improve physicians' knowledge, skills and detection rates.
Shefet D, Dascal-Weichhendler H, Rubin O, Pessach N, Itzik D, Benita S, Ziv

A.
Israel Center for Medical Simulation, Tel Hashamer, Israel. dshefet@yahoo.com
BACKGROUND: Although physicians are in a unique position to identify and

report domestic violence (DV), detection rates are poor. AIM: To develop a
national DV experiential training program, based on standardized patients (SPs),
to improve knowledge, skills and detection rates among physicians. METHODS:
The program was initiated by the Israeli Ministry of Health and took place at the
Israel Center of Medical Simulation (MSR). Three one-day workshops for
physicians were developed, each focusing on intimate partner violence, elder
abuse or child abuse. Outcome measures were perceived capabilities, reported
case management, and perceived intervention barriers, as obtained by self-
assessment questionnaires at baseline and within a follow-up period of six
months. RESULTS: A total of 150 participants took part in 15 workshops.
Perception of knowledge and skills, routine screening frequency and reported case
management all demonstrated significant improvement. A clear trend to elevation
in detection, evaluation and referral rates was found. Ranking of intervention
barriers was compared with baseline values and lack of knowledge, lack of skills
and psychological difficulties diminished significantly. CONCLUSIONS: An SP-
based experiential DV training program for physicians improved perceived
capabilities and overall management of DV cases and reduced intervention
barriers in a follow-up period of six months.
Publication Types:
240: Hum Exp Toxicol. 2007 Jul;26(7):579-82.

Poisoning from wild mushrooms in Eastern Anatolia region:
analyses of 5 years.
Durukan P, Yildiz M, Cevik Y, Ikizceli I, Kavalci C, Celebi S.
Erciyes University Faculty of Medicine Department of Emergency Medicine,

Kayseri, and Atatürk State Hospital, Turkey. polatdurukan@gmail.com
The objective of this study was to describe the demographic and clinical features
of patients who were admitted to the emergency department (ED) due to wild
mushroom poisoning and to point the importance of mushroom poisonings in our
area. This study was performed by examining the files of wild mushroom
poisoning patients who were admitted to the ED of Firat University, Faculty of
Medicine, between January 2000 and June 2004, retrospectively. Patients>or=16
years of age were included in the study. The frequency of wild mushroom
poisoning, age and sex of the patients, season, place of the residence, laboratory
findings, treatment and outcome of the patients were investigated. During the
study period, 64 patients with wild mushroom poisoning were admitted to the ED.
From 64 overall patients, 25 (39.1%) were males. The most common complaints
during the admission were nausea, vomiting and abdominal discomfort. The
duration of hospitalization was two (range 1-4 days) days. No death was
observed. Severity of mushroom poisoning depends on the type of mushroom
eaten, the time lag between the poisoning and admission to the hospital, and the
rapid and correct treatment given to the patient either in the ambulance or at
health centre.
241: Int J Qual Health Care. 2007 Dec;19(6):377-81. Epub 2007 Sep 20.
Metastatic spinal cord compression as an oncology emergency:

getting our act together.
Lee K, Tsou I, Wong S, Yu C, Ming Z, Loh Y, Shakespeare T, Mukherjee R,

Back M.
Department of Radiation Oncology, The Cancer Institute, Tan Tock Seng

Hospital, 11 Jalan Tan Tock Seng, Singapore, Republic of Singapore.
khai_mun_lee@ttsh.com.sg
BACKGROUND: Metastatic spinal cord compression is a dreaded complication

of cancer affecting 5-10% of patients requiring urgent treatment. A clinical
practice improvement project was carried out to review and fine tune the clinical
pathway for the acute management of patients with metastatic spinal cord
compression. OBJECTIVE: To improve the quality of care for metastatic spinal
cord compression over 6 months by ensuring that >90% of patients receive
definitive treatment within 24 h of radiological diagnosis. METHOD: Using
clinical practice improvement project methodology, the clinical pathway of 17
patients treated with radiotherapy for metastatic spinal cord compression within
the last 6 months were reviewed to identify gaps and delays in the system.
Interventions to form a multidisciplinary acute spinal cord crisis team, fine tune
clinical referral processes and formulate a standardized treatment protocol were
then implemented. Post-intervention of 22 subsequent patients were monitored for
time to start steroids and radiation therapy, length of stay and hospitalization bill.
RESULTS: With the interventions implemented, the mean response time to start
steroidal therapy was reduced from 8.4 to 2.6 days and radiotherapy from 9.9 to
3.9 days. These translated into shorter mean length of stay from 23.8 to 14.7 days
and smaller hospitalization bill size from 13,723 to 8,808 Singapore dollars.
CONCLUSION: A clinical practice improvement project, to improve the quality
of care for patients with metastatic spinal cord compression, can shorten response
time to start steroidal therapy and definitive radiotherapy resulting in shorter
length of stay and smaller hospitalization bill.
Publication Types:
242: J Emerg Nurs. 2007 Oct;33(5):463-7.

Pakistan medical missions: an extension of our skills as emergency

room nurses.
Bowman A, Gately B.
Liberty Hospital, Smithville, MO, USA. Abowman58@cheerful.com
243: Southeast Asian J Trop Med Public Health. 2007 Jul;38(4):737-48.

Syndromic management training for non-formal care providers in

Pakistan improves quality of care for sexually transmitted diseases
STD care: a randomized clinical trial.
Shah SA, Kristensen S, Memon MA, White HL, Vermund SH.
Dow Medical College, Karachi, Pakistan.
We conducted a randomized, controlled, three-armed trial to assess whether

training in syndromic management, with provision of packets, could improve the
quality of STD services provided among non-formal care providers. The quality
of STD case management service, observed by "incognito patients" in both
intervention groups, improved substantially compared to the control group (p <
0.05). The training-and-packets group performed better in service delivery, HIV-
testing referral, and condom provision when compared to the training-only group
(all p < 0.05). The training-and-packets group also retained more knowledge and
practiced more skillfully at six months post-intervention when compared to the
training-only group (p < 0.05). Exit interviews of clients suggested that 81% of
providers in the intervention groups offered advice on condom use when
compared to none of those in the control group (p < 0.001). Syndromic
management training and free syndrome packets for non-formal providers had a
positive impact on the quality of STD care among the trained providers.
Publication Types:

• Research Support, N.I.H., Extramural
244: Rinsho Byori. 2007 Aug;55(8):764-72.

[Trends of utilization of information technologies in clinical

laboratory and pathology domain]
Tofukuji I.
Department of Healthcare Informatics, Faculty of Health and Welfare, Takasaki

University of Health and Welfare, Takasaki.
The life expectancy of the Japanese population is one of longest in the world.
Society is aging, with fewer children, increasing the total national medical
payment in Japan. This situation has forced the Government to reduce the
payment and to increase the efficiency of the medical system, so information
technologies are expected to contribute to these policies. Electronic patient record
systems (EPR) were expected to be used widely, but only 23% of clinical training
hospitals have implemented them. This is mainly due to the lack of incentives and
large costs to install EPR. Standardization is a good method to reduce system
construction cost and increase its quality. New global IHE activities are expected
to solve these problems with methodologies of workflow analyses, standard
applications, tests and demonstrations. Laboratory information systems (LIS)
have a long history and tradition of standard interfaces for connecting computers
with analyzers. IHE activities for LIS are providing easy and secure connections
with hospital information systems (HIS). Pathology departments also have their
own information systems. IHE activities for pathology were launched in 2005,
and we are now developing in collaboration with the international IHE pathology
working group, HL7 SIG pathology and DICOM WG-26. Pathologists and
technical experts in Japanese laboratories are encouraged to join IHE activities to
ensure good results.
Publication Types:
245: Int J Gynaecol Obstet. 2007 Nov;99 Suppl 1:S143-50. Epub 2007 Sep 18.
The Campaign to End Fistula: what have we learned? Findings of

facility and community needs assessments.
Velez A, Ramsey K, Tell K.
UNFPA, New York, NY 10017, USA.
OBJECTIVE: To present a summary of the findings of the fistula needs

assessments that have been conducted through the Campaign to End Fistula in 25
countries in Africa and Asia to expand knowledge on the issue related to causes
and impact, country capacity to manage the problem and clinical and
programmatic gaps. METHOD: The methodology of the assessments was
qualitative and quantitative, and included focus group discussions; in-depth
interviews/narratives; key informant interviews; and review of medical records,
with slight variations by country. RESULTS: Analysis of 20 of these assessments
provides insight into the capacities, gaps, and perspectives specific to each
country regarding fistula prevention and treatment and the social reintegration of
treated women. CONCLUSION: Needs assessment findings have been key tools
to spark action and guide the implementation of national programs to eliminate
obstetric fistulas throughout Africa and Asia.
Publication Types:
246: Int J Gynaecol Obstet. 2007 Nov;99 Suppl 1:S117-21. Epub 2007 Sep 18.
Obstetric fistula: guiding principles for clinical management and

programme development, a new WHO guideline.
de Bernis L.
Making Pregnancy Safer Department, World Health Organization (Seconded to

UNFPA), Geneva, Switzerland. debernis@unfpa.org
It is estimated that more than 2 million women are living with obstetric fistulas
(OFs) worldwide, particularly in Africa and Asia, and yet this severe morbidity
remains hidden. As a contribution to the global Campaign to End Fistula, the
World Health Organization (WHO) published Obstetric fistula: Guiding
principles for clinical management and programme development, a manual
intended as a practical working document. Its 3 main objectives are to draw
attention to the urgency of the OF issue and serve as an advocacy document for
prompt action; provide policy makers and health professionals with brief, factual
information and principles that will guide them at the national and regional levels
as they develop strategies and programs to prevent and treat OFs; and assist health
care professionals as they acquire better skills and develop more effective services
to care for women treated for fistula repair.
Publication Types:
• Guideline
247: J Clin Nurs. 2007 Oct;16(10):1927-35.

Psychometric evaluation of Self-Assessed Support Needs of women
with breast cancer Scale.
Erci B.
Department of Public Health Nursing, School of Nursing, Atatürk University,

Erzurum, Turkey. behiceerci@hotmail.com
AIMS: The issue of self-assessed support needs of women with breast cancer has
not been studied enough although it is an important subject for women's health in
Turkey. Most of the studies concerning breast cancer patients are about quality of
life and life satisfaction. This study aimed to adapt an English version of the Self-
Assessed Support Needs of women with breast cancer Scale for Turkish women
with breast cancer and to evaluate its psychometric properties. DESIGN: A
descriptive study. METHODS: The sample consisted of 143 women with breast
cancer who attended the outpatient and inpatient oncology clinics. Data were
collected by a structured questionnaire including demographic characteristics and
the Self-Assessed Support Needs of women with breast cancer Scale. Item
analysis, principal components analysis, internal consistency reliability and
Cronbach's alpha were used to measure the psychometric properties of the 54-
item scale. RESULTS: In the assessment of construct validity, the principal
components method of factor analysis was performed. Seven factors were
identified with eigenvalues >1 explained 52.1% of the total variance (diagnosis,
treatment, support, femininity and body image, family and friends, information
and after care). Internal reliability coefficients of these seven factor-based scales
were found to be substantial, ranging from 0.71 to 0.84. CONCLUSION: The
present study provides evidence of the Self-Assessed Support Needs of women
with breast cancer Scale's validity, reliability and acceptability. This scale should
be further evaluated; with a large enough sample size, in different regions in
Turkey and diverse populations of world. RELEVANCE TO CLINICAL
PRACTICE: The scale has potential applications. It can be used both as a research
or a regular screening tool with clinical settings. The use of the scale in clinics
will enable identification of self-management activities in patients with breast
cancer. Assessment of the self-assessed support needs of women with breast
cancer should be an essential part of nursing practice.
Publication Types:
248: J Clin Nurs. 2007 Oct;16(10):1886-97.

A nurse-led cardiac rehabilitation programme improves health

behaviours and cardiac physiological risk parameters: evidence
from Chengdu, China.
Jiang X, Sit JW, Wong TK.
West China School of Nursing, Sichuan University, Chengdu, Sichuan Province,

China. jiang_xiaolian@126.com
AIM: The aim of this study was to examine the effect of a cardiac rehabilitation
programme on health behaviours and physiological risk parameters in patients
with coronary heart disease in Chengdu, China. BACKGROUND:
Epidemiological studies indicate a dose-, level- and duration-dependent
relationship exists between cardiac behavioural and physiological risks and
coronary heart disease incidence as well as subsequent cardiac morbidity and
mortality. Cardiac risk factor modification has become the very primary goal of
modern cardiac rehabilitation programmes. DESIGN METHODS: A randomized
controlled trial was conducted. Coronary heart disease patients (n = 167) who met
the sampling criteria in two tertiary medical centres in Chengdu, south-west
China, were randomly assigned to either an intervention group (the cardiac
rehabilitation programme) or control group (the routine care). The change of
health behaviours (walking performance, step II diet adherence, medication
adherence, smoking cessation) and physiological risk parameters (serum lipids,
blood pressure, body weight) were assessed to evaluate the programme effect.
RESULTS: Patients in the intervention group demonstrated a significantly better
performance in walking, step II diet adherence, medication adherence; a
significantly greater reduction in serum lipids including triglyceride, total
cholesterol, low-density lipoprotein; and significantly better control of systolic
and diastolic blood pressure at three months. The majority of these positive
impacts were maintained at six months. The effect of the programme on smoking
cessation, body weight, serum high-density lipoprotein, was not confirmed.
CONCLUSIONS: A cardiac rehabilitation programme led by a nurse can
significantly improve the health behaviours and cardiac physiological risk
parameters in coronary heart disease patients. Nurses can fill significant treatment
gaps in the risk factor management of patients with coronary heart disease.
RELEVANCE TO CLINICAL PRACTICE: This study raises attention regarding
the important roles nurses can play in cardiac rehabilitation and the unique way
for nurses to meet the rehabilitative care needs of coronary heart disease patients.
Furthermore, the hospital-home bridging nature of the programme also created a
model for interfacing the acute care and community rehabilitative care.
Publication Types:
249: Southeast Asian J Trop Med Public Health. 2007 May;38(3):586-93.

Increased risk of preterm birth among non- smoking, non- alcohol

drinking women with maternal periodontitis.
Le HT, Jareinpituk S, Kaewkungwal J, Pitiphat W.
Department of Epidemiology, Faculty of Public Health, Mahidol University,

Bangkok, Thailand. hanghung98@gmail.com
The aim of this case-control study was to examine the association between
periodontitis and preterm birth among non-smoking, non-alcohol drinking
women. The cases were 130 women who delivered a live singleton newborn
before 37 weeks gestation. A random sample of 260 women who delivered a
normal child on the same day as the cases were selected as controls. Periodontal
examinations were performed during 24-hour period postpartum at bedside. Other
related information was collected by structured questionnaire and medical
records. Multiple logistic regression analysis was performed controlling for age,
ethnicity, place of residence, education, occupation, income, pre-pregnancy body
mass index (BMI), weight gain, antenatal care (ANC), parity, systematic
infections, genitourinary infections, antibiotics used, and history of periodontal
treatment. Periodontitis (defined as presence of at least 4 teeth having > or = 1 site
with a probing depth (PD) > or = 4 mm, clinical attachment loss (CAL) > or = 3
mm and bleeding on probing (BOP) after 10 seconds at the same site) was
diagnosed in 33.9% of cases and 10.4% of controls. Periodontitis was
significantly associated with preterm birth (adjusted OR = 4.47, 95%Cl= 2.43,
8.20). These findings suggest that periodontitis may increase the risk of preterm
delivery even among women who do not smoke or drink.
Publication Types:
250: Southeast Asian J Trop Med Public Health. 2007 May;38(3):519-27.

Comparative study of LDL-cholesterol levels in Thai patients by the
direct method and using the Friedewald formula.
Teerakanchana T, Puavilai W, Suriyaprom K, Tungtrongchitr R.
Clinical Chemistry Laboratory, Department of Clinical Pathology, Rajavithi

Hospital, Ministry of Public Health, Bangkok, Thailand.
In this study, low-density lipoprotein cholesterol (LDL-C) levels by direct

measurement and estimation using the Friedewald formula, were compared
among 1,016 Thai patients. The study assessed blood samples from out-patients
sent to the Clinical Chemistry Laboratory, Department of Clinical Pathology,
Rajvithi Hospital, Ministry of Public Health, for measurement of total cholesterol
(TC), LDL-C, high-density lipoprotein cholesterol (HDL-C) and triglyceride (TG)
levels, January 2004-December 2005. Patients' ages ranged 8-89 years, 573
(56.4%) were females. Linear regression analysis showed the two methods had
highly significant correlation coefficients (p<0.001). Upon comparing the two
methods, at TG levels of 151-200 mg/dl, bias was 18.3 mg/dl; and for TG levels
of 201-300 mg/dl, bias was lower at 11.4 mg/dl; for TG levels of 301-400 mg/dl,
bias increased to 20.9 mg/dl. The direct assay meets currently established
analytical performance targets and may be useful for the diagnosis and
management of hyperlipidemic patients. The Friedewald formula did not give a
homogeneous performance when estimating LDL-C levels in samples with
different TG levels.
Publication Types:
PMID: 17877229

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151: Issues Ment Health Nurs. 2007 Dec;28(12):1309-22.

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H & C Management 2