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2.  Effect of clinical guidelines in nursing, midwifery, and the therapies: a systematic review of evaluations 
Quality in Health Care : QHC  1998;7(4):183-191.
BACKGROUND: Although nursing, midwifery, and professions allied to medicine are increasingly using clinical guidelines to reduce inappropriate variations in practice and ensure higher quality care, there have been no rigorous overviews of their effectiveness, 18 evaluations of guidelines were identified that meet Cochrane criteria for scientific rigor. METHODS: Guideline evaluations conducted since 1975 which used a randomised controlled trial, controlled before and after, or interrupted time series design were identified through a combination of database and hand searching. RESULTS: 18 studies met the inclusion criteria. Three studies evaluated guideline dissemination or implementation strategies, nine compared use of a guideline with a no guideline state; six studies examined skill substitution: performance of nurses operating according to a guideline were compared with standard care, generally provided by a physician. Significant changes in the process of care were found in six out of eight studies measuring process and in which guidelines were expected to have a positive impact on performance. In seven of the nine studies measuring outcomes of care, significant differences in favour of the intervention group were found. Skill substitution studies generally supported the hypothesis of no difference between protocol driven by nurses and care by a physician. Only one study included a formal economic evaluation, with equivocal findings. CONCLUSIONS: Findings from the review provide some evidence that care driven by a guideline can be effective in changing the process and outcome of care. However, many studies fell short of the criteria of the Cochrane Effective Practice and Organisation of Care Group (EPOC) for methodological quality.
PMCID: PMC2483618  PMID: 10339020
4.  Newcastle satisfaction with nursing scales: an instrument for quality assessments of nursing care. 
Quality in Health Care  1996;5(2):67-72.
OBJECTIVES--To test the validity and reliability of scales for measuring patients' experiences of and satisfaction with nursing care; to test the ability of the scales to detect differences between hospitals and wards; and to investigate whether place of completion, hospital, or home influences response. DESIGN--Sample survey. SETTING--20 wards in five hospitals in the north east of England. PATIENTS--2078 patients in general medical and surgical wards. MAIN MEASURES-- Experiences of and satisfaction with nursing care. RESULTS--75% of patients approached to complete the questionnaires did so. Construct validity and internal consistency were both satisfactory. Both the experience and satisfaction scales were found to detect differences between randomly selected wards and hospitals. A sample of patients (102) were sent a further questionnaire to complete at home. 73% returned this; no significant differences were found in either experience or satisfaction scores between questionnaires given in hospital or at home. CONCLUSION--Scales to measure patients' experiences of and satisfaction with nursing in acute care have been developed and found to be valid, reliable, and able to detect differences between hospitals and wards. Questionnaires can be given before patients leave hospital or at home without affecting scores, but those given at home have a lower response rate.
PMCID: PMC1055368  PMID: 10158594
5.  Role of T-lymphocyte subsets in recovery from respiratory syncytial virus infection in calves. 
Journal of Virology  1995;69(11):6658-6664.
The role of T-cell subsets in respiratory syncytial virus (RSV) infection was investigated by using monoclonal antibodies (MAbs) to selectively deplete gnotobiotic calves of CD4+, CD8+, or WC1+ gamma delta T-cell receptor+ lymphocytes. Injection of these MAbs produced specific reductions of the target cell populations in the circulation and tissues. Ten days after RSV infection, immunoglobulin M (IgM), IgG1, and IgA antibodies were detected in sera and lung washings from control calves. Depletion of CD8+ T cells had no effect on either the serum or local antibody responses to RSV, whereas depletion of CD4+ T cells suppressed the antibody responses in two of three calves. The IgM and IgA responses were significantly increased in the lung washings of calves from which WC1+ T cells were depleted. Depletion of CD4+ or WC1+ T cells caused no significant delay in virus clearance, although an increase in the extent of pneumonic consolidation was observed in anti-CD4-treated calves. Nasopharyngeal excretion of RSV was prolonged in calves depleted of CD8+ T cells, and virus was isolated in high titers from lung washings of these animals 10 days after infection, whereas virus had been cleared from lung washings of all other animals. The delayed virus clearance was associated with an increase in the severity of pneumonic consolidation in three of four of the calves from which CD8+ T cells were depleted. This study shows that CD8+ T cells play a dominant role in the recovery of calves from RSV infection.
PMCID: PMC189575  PMID: 7474075
6.  Ischaemic heart disease and consumption of hydrogenated marine oils in England and Wales. 
STUDY OBJECTIVE--The aim was to examine the hypothesis that hydrogenated fats, particularly those obtained from marine oils, may present a health hazard. DESIGN--Storage fat specimens obtained at necropsy were collected from several areas in England and Wales during 1975-1978. Cases (n = 136 samples) consisted of males dying of ischaemic heart disease, male deaths from unrelated causes acting as controls (n = 95 samples). The fatty acid compositions of the specimens were determined, and analysis included those acids--16:1 trans and "higher" C-20 plus C-22 (H)--highly characteristic of partially hydrogenated marine oils. MEASUREMENTS AND MAIN RESULTS--The case samples, which had been shown to be the richer in 16:1 trans (p less than 0.005), were now found to have a significantly higher value of the ratio 16:1 trans to H (p less than 0.002), arising from consumption of differing hydrogenated marine oil types. CONCLUSIONS--It is concluded that the cases had consumed a greater amount (p less than 0.001) of hydrogenated marine oils of a certain type, ie, that manufactured from certain highly unsaturated raw oils. The process of partial hydrogenation results in conversion to a product containing large amounts of polyunsaturated acids (PUFA) which are no longer in the natural all-cis methylene interrupted configuration. Such isomeric PUFA may obstruct or compete with utilisation of natural PUFA. It is further concluded that the case excess did not rise from medical advice favouring margarine or from any difference in social class status, but rather from fortuitous selection of margarine brand.
PMCID: PMC1059499  PMID: 1573366
7.  A comparison of three vaccines against respiratory syncytial virus in calves. 
The Journal of Hygiene  1984;93(2):251-261.
An inactivated vaccine against respiratory syncytial virus (RSV) was compared with two live vaccines. The inactivated (GC) vaccine consisted of glutaraldehyde-fixed bovine nasal mucosa cells persistently infected with RSV and emulsified with oil adjuvant. The live vaccines were a modified virus (MV) derived from a bovine strain of RSV and a temperature-sensitive mutant (ts-1) derived from a human strain. The GC vaccine was inoculated subcutaneously into 12 calves and the live vaccines intramuscularly into eight calves each. Nine unvaccinated calves acted as controls. The vaccines were administered in two doses 3 weeks apart and all calves were challenged intranasally with 2 X 10(7) p.f.u. of bovine RSV 3 weeks after the second dose. At the time of challenge calves given GC, MV and ts-1 vaccines had mean serum neutralizing antibody titres of 25, 19 and 2 respectively; mean titres of IgG1 antibody by radioimmunoassay were log10 4.5, 1.3 and 2.6 respectively and mean zone areas by single radial haemolysis (SRH) were 107, 27 and 36 mm2 respectively. Eleven of 12 calves given GC vaccine were completely protected against challenge but all control animals and those given the two live vaccines were infected. The mean peak titre of virus in nasal swabs of control calves was 3.0 log10 p.f.u./ml and the mean duration of virus shedding was 6.8 days. Both these parameters were significantly reduced in animals given MV and ts-1 vaccines: mean peak titres were 2.1 and 2.4 log10 p.f.u./ml and mean duration of shedding was 3.4 and 3.3 days respectively. Thus, protection correlated better with RSV antibody detected by radioimmunoassay and SRH than with neutralizing antibody. These results are discussed in relation to the possible mechanism by which protection was mediated.
PMCID: PMC2129425  PMID: 6501875
8.  Concentration of transunsaturated fatty acids in the adipose body tissue of decedents dying of ischaemic heart disease compared with controls. 
The constituents of the fat of 136 decedents who had died of ischaemic heart disease are compared with the constituents of the fat from 95 controls who had died from other causes. The cases had a lower concentration of fatty acids (L) characteristic of ruminant animal fat and a higher concentration of total transunsaturated acids (T), but the concentrations of certain higher (C20 and C22 mostly monoenoic) acids (H) were similar. The ratio T/L was higher in the cases, which suggests that the cases may have consumed more hydrogenated fats in life than had the controls. The ratio T/L increased linearly with H within both the case and control specimens, which suggests in view of the similarity in the mean levels of H that the difference in trans contents may be concentrated in the lower (18:1 and 16:1) trans acids.
PMCID: PMC1052249  PMID: 6875439
9.  A survey of virus infections of the respiratory tract of cattle and their association with disease. 
The Journal of Hygiene  1980;85(2):257-270.
A total of 1590 caves were investigated between May 1972 and December 1975. Twenty-two per cent were treated for respiratory disease and 2 . 5% died of pneumonia. Almost 80% of the respiratory illness occurred in six sharp outbreaks. Samples of virology were collected routinely from 127 healthy calves and from 354 calves treated for respiratory signs and comprised 1143 nasopharyngeal swabs and 1069 sera. Virus infections were detected on 540 occasions including 135 by parainfluenzavirus type 3 (Pi-3), 78 by respiratory syncytial virus (RSV), 103 by rhinovirus, 49 by bovine virus diarrhoea virus (BVDV), 29 by adenoviruses, 53 by reoviruses and 88 by enteroviruses. The seasonal and age distribution of infections differed between viruses. Only infections by RSV, Pi-3 and BVDV were significantly associated with disease.
PMCID: PMC2133932  PMID: 6256435
10.  Interactions between calf alveolar macrophages and parainfluenza-3 virus. 
Infection and Immunity  1977;15(2):576-585.
Cells washed from the lungs of freshly killed calves (lung wash cells; LWC) were cytotoxic for calf kidney (CK) target cells infected with parainfluenzavirus type 3 (Pi-3) when assayed by chromium release. LWC collected from 25 calves, including two gnotobiotic animals that had not previously been infected with Pi-3, were all cytotoxic, giving a specific chromium release between 11 and 50%. Cytotoxicity was detected at ratios of LWC to target cell as low as 5:1. The cytotoxic reaction required viable LWC, was inhibited by Pi-3 antiserum, and was not the result of virus-induced damage to the target cells. The cytotoxic cells in the LWC population were identified as alveolar macrophages from observations on glass adherence, phagocytic activity, killing by silica and fine-structural appearance. When LWC were added to CK cells or organ cultures of bovine trachea infected with Pi-3, the yield of virus was reduced for the first 2 to 3 days. However, subsequently, Pi-3 virus replicated in the LWC. Infection of LWC with Pi-3 virus reduced their cytotoxic activity. The significance of these interactions between alveolar macrophages and Pi-3 virus is discussed.
PMCID: PMC421406  PMID: 191403
11.  Mortality from arteriosclerotic disease and consumption of hydrogenated oils and fats. 
Consumptions of chemically modified hydrogenated fat are estimated for the United Kingdom standard regions, conurbations, and urban/rural aggregates as well as for the social classes. Consumptions are shown to correlate satisfactorily with mortality from arteriosclerotic disease and account reasonably well for certain peculiarities in the ratio of female to male death rates and for secular changes in mortality patterns.
PMCID: PMC478895  PMID: 1182357
12.  Inhibition by Mycoplasma dispar of Ciliary Activity in Tracheal Organ Cultures 
Infection and Immunity  1974;10(2):405-408.
The inhibition by Mycoplasma dispar of ciliary activity of organ cultures of bovine fetal trachea was found to be dependent on the presence of serum in the maintenance medium. Inhibitory activity was unaffected by catalase and no toxic substance was demonstrated in organ culture supernatant fluid.
PMCID: PMC415014  PMID: 4604610
13.  Concentration of 18:1 and 16:1 transunsaturated fatty acids in the adipose body tissue of decedents dying of ischaemic heart disease compared with controls: analysis by gas liquid chromatography. 
Proportions of "lower" 16:1 and 18:1 trans acids (TL) and "higher" C20 and C22 trans acids (TH) in samples of depot fat taken at postmortem examination from 136 people who had died of ischaemic heart disease (cases) and from those who had died of unrelated causes (controls) have been determined. Whereas mean percentages of TH are virtually identical for cases and controls, the mean value of TL was significantly higher for the case specimens. Although these lower trans acids are present in small amounts in ruminant-animal fat, they are more characteristic of commercially hydrogenated fats. We conclude, therefore, that the cases consumed on average a higher proportion of those hydrogenated fats rich in 16:1 trans and 18:1 trans acids and a lower proportion of ruminant fat than did the controls.
PMCID: PMC1052248  PMID: 6875438
14.  Ischaemic heart disease and the proportions of hydrogenated fat and ruminant-animal fat in adipose tissue at post-mortem examination: a case-control study. 
Fatty acids characteristic of ruminant-animal fat have been found to be present in significantly lower proportions in samples from the depot fat of persons dying of ischaemic heart disease (cases) than in specimens from persons dying of unrelated causes (controls). Although such acids are also present, in lesser amounts, in hydrogenated marine oils, this case-versus-control difference is difficult to explain other than on the basis that controls consumed a higher proportion of ruminant-animal fat in their total dietary fat than did the cases. The proportions of polyunsaturated acids and of certain higher (C20 and C22 mostly mono-enoic) acids in the depot fat of cases and controls are virtually identical. There is also no indication of any difference in degrees of saturation of fats between the case and control specimens.
PMCID: PMC1052172  PMID: 7338699

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