bluuebunny/crossref_metadata_2025 huggingface dataset:
End of life services: public and patient involvement
Authors: Gandy Rob , Wilford Sara
Published: May 2014

This article describes the outcomes from a national pilot project undertaken by the NHS National Centre for Involvement and Liverpool Primary Care Trust to establish how best to undertake patient and public involvement (PPI) in respect of end of life (EOL) services, given the intrinsic emotional and cultural difficulties. The project targeted service improvement distinguishing between patients with cancer, dementia and long term conditions. Methods included mapping exercises, systematic documentation reviews, surveys, targeted workshops, follow-up interviews and emails, and an organisational learning event. The project highlighted important lessons, distinguishing where commonality applies and where allowance should be made for patients' different diseases. The main difference in handling PPI for EOL care across the three disease groups concerns timing. It is better to engage with people about EOL care during the early stages of their condition, on a primarily prospective basis, rather than leave engagement until a time when it would be intrusive or inappropriate. PPI in EOL care is of critical importance to everyone in society. Improved engagement enables improved EOL services and better patient experiences, through greater choice and involvement in care, thereby facilitating a dignified experience of death.
It's the people in the boardroom
Authors: Deffenbaugh John
Published: May 2014

The current economic and geopolitical environment means that board effectiveness must be increased. This will not be tackled by further structural and process improvement in board operations, but rather by addressing the key relationship issues that underpin decision making. These relationships are analysed from two related perspectives, based on both experience as a board member, and through coaching board members and facilitating their workshops. First, there is the range of ‘hats’ that board members wear. There are three of these: the individual; the expert; the corporate player. The article explores these hats, explaining each, showing the relationship among them, and what can be done to make them fit properly. Building on this analysis, the second dimension explores the relationship among the ‘groups’ within the board. Again, much has been written about the roles of the chair, chief executive, non-executives and executive directors. The article analyses the relationship between these individuals and groups as it contributes to debate and decision making. It then explores how these relationships compare and contrast in boards of different types of organisation—NHS trust, foundation trust, clinical commissioning group and health and wellbeing board. With insight to the groups, board members will better understand why things work right, why they do not, and what to do about it.
The benefits of mobile apps for patients and providers
Authors: Moore John
Published: May 2014

Apps and mobile technology has major benefits for healthcare providers and consumers, including: Improved patient care through greater communication between professionals, and from professionals to patients; Reducing the cost of healthcare provision; Giving patients greater involvement in their own conditions, through better education and understanding, therefore reducing the need for visits to hospital and doctors’ surgeries; greater patient access to medical records; and Making education and refresher training more accessible for healthcare professionals, providing the option of working from home or on the move, when most convenient. The increasing proliferation of iPhones, iPads and other similar devices will make this even more apparent. New applications will also come to the fore. This view has been endorsed by numerous health organisations, both in the UK and North America, including the current Government.
Guidelines on glaucoma and the demand for services
Authors: Chalk Daniel , Smith Michael
Published: May 2014

The authors produced a seasonalised forecast using a linear regression trendline to predict the level of demand for ophthalmology services at Royal Devon and Exeter hospital between 2013 and 2017. The model predicts an average annual increase in demand of 9.92%, but a significant proportion of this predicted increased demand is for glaucoma services. Given the historical patterns of demand observed in the data, it is possible that the increases in demand for glaucoma services have arisen because of dramatically increased referral rates from community optometrists, following the publication by the National Institute for Clinical Excellence (NICE) of clinical guidelines on the diagnosis and management of glaucoma and ocular hypertension ( NICE, 2009 ). As this patient cohort may be best served by assessment outside of secondary care, we would encourage other hospital managers and analysts to produce similar forecasts and consider alternative pathways of care for this patient group
The role of ‘care bundles’ in healthcare
Authors: Clarkson D McG
Published: May 2014

The aim of the review is to clarify the concept of the ‘care bundle’ which has emerged in modern clinical practice as a means of providing consistent clinical care of the highest quality. The ‘care bundle’ is essentially a process within which identified components of care are diligently applied and where the separate elements have been validated by extensive clinical practice. Specific examples of care bundles include ‘care bundle to prevent surgical site infection’, ‘care bundle for ventilated patients’ and ‘urinary catheter care bundle’. The adoption of ‘care bundles’ can be seen as a fundamental shift in thinking from the acceptance of some adverse outcomes as an inevitable result of delivered care to the concept of significant reduction or even elimination of such adverse outcomes. The philosophy of ‘care bundles’ is linked to well-established processes of ‘Plan, Do, Check, Act’ where there is monitoring of compliance of carrying out of ‘bundle’ components and also patient outcomes.
Social media: raising the profile of AHPs
Authors: Holdsworth Lesley K , Douglas Lynne , Hunter Elaine , McDonald Carolyn
Published: May 2014

Social media is reshaping healthcare and the way healthcare professionals and patients interact. In Scotland, few allied health professionals (AHPs) use these media to connect with policy makers, service users, the public, or colleagues. We aimed to establish whether social media, could be used to raise the profile of AHPs—three members of the AHP Directors Scotland Group (ADSG) and one AHP national lead. Training in the use of social media tools was supplemented by support by a subject matter expert throughout the 12-week project. Each AHP used social media in support of their own area of expertise. Over 1348 tweets and 8 blogs were posted, 753 followers attracted. Various audiences were reached; including UK and international AHPs; other healthcare professionals, professional bodies, the public, third sector and patient representative organisations. Working within an ethical framework, AHPs can use social media to promote greater awareness of their role and impact. It can also be used to forge new relationships and connect with individuals and organisations not routinely experienced.
Learning between managers and doctors
Authors: Poddar Rini
Published: May 2014

This research investigated the relationship between two vital groups in the NHS—managers and clinicians. It explores the possibilities of them learning from each other to engage cohesively for the development of the healthcare system. The data was collected over a year using semi-structured interviews with managers and doctors, observations in their workplaces and the author's reflective diary. Prior to this study, a pilot project was undertaken to help inform the questions posed to the participants in this insider research. Data showed that there were dominant themes around understanding each other's roles that led to ineffective communication. This was within the context of the major organisational changes of the last decade that have focused managers on financial constraints while pressurising clinicians to improve the quality of patient care. Analysis suggests that clinical leadership can be the mediator in bridging the divide, an aspect of the role of which consultants are often unaware. This research raises many questions; however, the author's findings suggest that the future lies with both groups developing a collaborative style of working to build mutual respect and to create the interdependence that managers and clinicians say they want.
Is current NHS leadership sufficient or defficient?
Authors: McComb Jacqueline
Published: May 2014

Organisations as large and complex as the NHS cannot function effectively without sufficient high-quality interprofessional leadership and development. This will only happen if managers and staff are supported with the necessary skills and have the commitment from the organisation to invest resources in creating leaders if the future vision of the NHS is to be realised. The King's Fund—among other commentators and authorities on the NHS and the Department of Health—share the view that the era of heroic leadership styles are well and truly over. The NHS needs to shift into a model of shared/distributed leadership where staff can work interprofessionally, sharing their skills and knowledge, collectively leading to provide a better service to the patient. This requires engaging with others both internally and externally to the organisation to facilitate this, and also, for the skill of influencing change in the decision-making process. Thus, enabling a better outcome in relation to the future of the NHS.
Research Round-Up
Authors: Cook Neal F
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Improving follow-up for head injury patients in a nurse-led post-concussion clinic
Authors: Powell Jacky
Published: May 2014

A proportion of the large number of people who attend accident and emergency departments with mild head injury will develop post-concussion symptoms. These can be debilitating enough to prevent the person leading a normal life or being able to work to his/her premorbid ability. It has been documented in a variety of reports that there should be a follow-up system in place for these individuals. A nurse-led post-concussion clinic was developed to meet this need. This clinic offers a therapeutic service giving information and advice with suggested coping strategies to help the patient manage his/her symptoms. It is believed that this is a cost-effective way of achieving the recommendations in the reports and meeting the needs of this marginalized group. Emphasis needs to be placed on the sequalae of a mild head injury because this client group experiences a lack of understanding from some health professionals. Further research is needed into the incidence, risk factors and management of post-concussion symptoms.
Time to sit down and network
Authors: Woodward Sue
Published: May 2014

Within this issue we are delighted to announce the details of the inaugural BJNN neuroscience nursing conference, to be held at Regent′s College in London on 6 March 2006.
Exploring interventions in secondary stroke prevention: A case study
Authors: Thompson Hilary S , Mitchell Elizabeth A
Published: May 2014

Stroke remains the third leading cause of death in the UK after coronary heart disease and cancer, and the main cause of adult disability in the western world (Bonita, 1992). Unfortunately, for those people who suffer a recurrent stroke, outcomes are poorer than for those after a first stroke (Lee et al, 2004). The Royal College of Physicians (2004: 40) recommend: ‘An individual strategy for stroke prevention should be implemented within a maximum of seven days of acute stroke or transcient ischaemic attack.’ This paper explores the evidence base for interventions in secondary stroke prevention. Risk factors for stroke are outlined, the role of anti-platelet therapy is discussed, and pharmacological strategies in the management of hyperglycaemia, hyperlipidaemia and hypertension are examined. The risk factor of cigarette smoking is also addressed. Collaborative goal setting and care planning is a central tenet of this case study, with the patient enabled to make informed life-style changes.
RESEARCH ROUND-UP
Authors: Hibbins Stuart
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
BOOK REVIEWS
Authors: Eberhardie Christine
Published: May 2014

Good Practice in Brain Injury Case Management is edited by Jackie Parker, an experienced social worker working in the field of private brain injury case management. The book is the eleventh in a series entitled ‘Good Practice in Health, Social Care and Criminal Justice’, edited by Jacki Pritchard, and aimed at professionals working insocial care, health care and the probation service.
When is a stroke not a stroke?
Authors: Woodward Sue
Published: May 2014

There has been significant focus on stroke in the mass media since December 2005, following the stroke suffered by Ariel Sharon, the Israeli Prime Minister, and the death in January of Tony Banks as a result of a similar catastrophic vascular event. It has been interesting to notice the way in which these cases have been described in news broadcasts. Initially the term ‘stroke’ was used, but subsequent bulletins seemed to avoid using this word, preferring instead to use the term ‘brain haemorrhage’.
Discussing innovations in neuroscience
Authors: Benison Liam
Published: May 2014

The British Journal of Neuroscience Nursing's first national conference was held at Regent's College, London on 6 March. Liam Benison reports.
BOOK REVIEW
Authors: Woodward Sue
Published: May 2014

This book is aimed at all health professionals who have an interest in caring for patients following a stroke. It has been put together from a collection of papers that have been published in the The International Journal of Therapy and Rehabilitation, the British Journal of Hospital Medicine and Practice Nursing in recent years. Many of these evidence-based papers contributed to the development of the National Clinical Guidelines for Stroke that were published by the Royal College of Physicians in 2004. This book aims to pull together much of the published work demonstrating a clear pathway to stroke rehabilitation.
Has the NHS had its best year ever?
Authors: Woodward Sue
Published: May 2014

Has the NHS had its best year ever? Most practitioners I have spoken to recently believe that it is ludicrous even to suggest this, as they struggle to get to grips with the changes affecting workloads and practice. Neuroscience nurses in some units are practicing with staffing levels of one qualified nurse to ten patients. Policy is being issued from the Department of Health on a regular basis and services are being restructured locally, leaving many practitioners feeling the effects of excessive change. This situation can lead to ‘BOHICA’ moments (Bend Over Here It Comes Again).
A model for rehabilitation in the community: A client-needs approach
Authors: Abelson-Mitchell Nadine
Published: May 2014

It is clear from the literature that a community-based approach to rehabilitation following traumatic brain injury is both essential and cost-effective. A model is presented for community-based rehabilitation which is client needs-led and interprofessional. The model described uses a client-led needs assessment as a basis for a contract identifying immediate, short- and long-term goals, and an intervention programme to achieve these in clients' homes and supported by their families. Interprofessional records are kept and regular re-assessment leads to goal and programme modification if necessary. Case studies are presented to show how activities of living scores can be dramatically increased when the model and programme of stimulation are implemented and systematically evaluated. Community-based rehabilitation for people recovering from traumatic brain injury requires commitment and dedication by all partners, and it will be shown that high levels of functioning can be restored using this approach.
A systematic approach to weaning and decannulation of tracheostomy tubes
Authors: Braine Mary E , Sweby Catherine
Published: May 2014

The need for a tracheostomy is a common occurrence in the specialist field of the adult neurosciences. The process of weaning and decannulating patients from a tracheostomy tube is a complex process. A number of researchers highlight the lack of agreement on a definitive systematic approach to weaning from tracheostomy, or to the process of decannulation, although a number of criteria are reported in the literature. The literature on respiratory care offers many papers on weaning from mechanical ventilation, but the literature on weaning from a tracheostomy is less prevalent. This paper explains why problem solving is important and how a systematic approach to weaning from a tracheostomy tube can be designed to address the variety of problems that may arise in individual patients. Guidance is offered on the nursing care of these patients, and of the role of the nurse within the multidisciplinary team involved in the day-to-day management of patients as they progress through the weaning process. While it is recognized that this process must address individual patients' needs, this paper offers an approach that is based on the best available evidence and meets the needs of the neuroscience patient in general. It is directed, in particular, toward clinical staff who may not have access to a specialist tracheostomy team, but who are expected to participate in tracheostomy weaning of neuroscience patients alongside other members of the multidisciplinary team.
Discussing innovations in the paediatric neurosciences
Authors: May Linda
Published: May 2014

Lindy May reports from the third conference of the Paediatric Neuroscience Benchmarking Group, held in Bristol on 10 March 2006.
Good and bad news for Parkinson's
Authors: Woodward Sue
Published: May 2014

Two stories on Parkinson's disease (PD) research appeared last month. The first (BBC, 2006a) discussed two papers published in Nature which found that symptoms in the inherited form of PD may be triggered by damaged mitochondria as a result of a protein mutation. This effect may damage muscle cells, leading to movement problems, and may also trigger neuronal degeneration among dopamine-producing neurones. The second report (BBC, 2006b) discussed research that investigated whether a single genetic mutation may be linked to the age of onset of symptoms. While it has been known for sometime that inheriting two copies of the abnormal Parkin gene can reduce the age of onset, it was reported that inheriting a single copy of this gene can also reduce the age of onset of PD.
New resource for hydrocephalus
Authors: Farrall Peter
Published: May 2014

Peter Farrall highlights a new source of information for people with spina bifida and hydrocephalus.
Ageism in the neurosciences
Authors: Woodward Sue
Published: May 2014

The population of the UK is ageing. There are regular reports in the media about how this is affecting our society. We have seen changes to the retirement age, as people are living longer and staying healthier, to reduce the burden on pensions. We also need to consider the impact that this ageing population is going to have on health-care provision. One good example of where this may have an impact is on the number of people having strokes. We know that stroke is predominantly a condition of older age and that the majority of stroke patients are over the age of 65 years. As the population ages, the number of people having strokes will continue to increase, putting an added demand on already stretched resources.
Counteracting ageism in Parkinson's disease: A challenge for nurse specialists
Authors: Turner Kirsten
Published: May 2014

Age discrimination in the clinical management of elderly patients is an area of medicine that has been the subject much debate. In Parkinson's disease a patient's age at diagnosis has a direct effect on his/her treatment pathway and outcomes. The trend to increased life expectancy for people with with Parkinson's disease has provoked debate on chronological versus biological age. This article provides an examination of the prevalence and causes of age discrimination in the management of Parkinson's disease and includes suggestions for strategies that nurses working with people with Parkinson's disease could use to ensure that biases do not inadvertently influence the management of older patients.
Mechanical ventilation for raised intracranial pressure in the patient with cerebral insult
Authors: McLeod Anne
Published: May 2014

Mechanical ventilation is an important intervention in the management of the patient with a cerebral insult who is showing signs of raised intracranial pressure. Control of respiratory gases is essential for the maintenance of cerebral blood flow and, as a consequence, the prevention of cerebral ischaemia. This article explores the physiological effects of oxygen and carbon dioxide on the cerebral blood flow. Mechanical ventilation is discussed and modes are evaluated in view of patient benefit. Methods to promote oxygenation are identified and control of carbon dioxide is explored in light of recent research. Recommendations for the ventilatory management for this patient group are made for nurses working in the intensive care setting.
Improving the care of people with multiple sclerosis through implementing NICE guidance
Authors: Shaw Pauline
Published: May 2014

People with multiple sclerosis (MS) need services that are specialized and responsive to their needs. They require thorough and sensitive assessment of problems and need to be able to access services when required. This report is an evaluation of how effectively an MS nursing team working across three south London primary care trusts is implementing the priorities outlined in the NICE guidelines for the management of MS. This evaluation shows that four of the six key priorities of the NICE guidelines are being implemented. It is argued that national initiatives can be embraced by nurses in a practical way to improve services for people living with long-term conditions such as MS.
Are we becoming a eugenic society?
Authors: Woodward Sue
Published: May 2014

A disturbing report was published in The Sunday Times newspaper on 5 November identifying that there were moves to allow euthanasia of severely disabled babies (Templeton, 2006). The Royal College of Obstetricians and Gynaecologists is calling for doctors to consider killing the ‘sickest newborns’ who survive today because of technological advances. If such a proposal were established today, many thousands of people with disabling neurological problems may never have survived to live the fulfilling lives they do.
Headache: Recognizing its impact on quality of life and improving management
Authors: George Jithin , Weatherby Stuart
Published: May 2014

Headache is often inadequately treated and the impact of headache on patients' lives under-recognized. As a consequence, there is significant scope for improving the care of these patients, as patient satisfaction levels are low. There is an important role for specialist nurses in the management of headache. Guidelines from the British Association for the Study of Headache provide a framework for diagnosing and managing the common causes of headaches.
‘Recovery’ creates a tidal wave of reaction
Authors: Worthington Esme
Published: May 2014

Sunday 25 February saw the screening of a one-off BBC drama entitled ‘Recovery’, starring David Tennant (of Dr Who fame) and Sarah Parish. This was the first primetime TV drama since ‘Some Kind of Life’ in 1995 to deal directly with the issue of brain injury and the devastating impact it has on the lives of brain injury survivors and their families.
Tools to improve end-of-life care for neurological patients
Authors: Byrne Judi , Beety Dan
Published: May 2014

Sue Ryder Care is a leading provider of specialist palliative care and longterm neurological care throughout the UK. It operates homecare, residential care and community-based care services, and its vision of ‘care that liberates lives’ means that the charity adopts a holistic approach, whereby all of a person's needs are cared for, whether they are physical, emotional, psychological or spiritual. Sue Ryder Care is dedicated to helping people who are living with chronic and terminal conditions and illnesses get the best from their lives.
What do patients want to know when they are diagnosed with Parkinson's disease?
Authors: Heisters Daiga
Published: May 2014

There are about 120 000 people with Parkinson's diseasein the UK, and 10 000 people are diagnosed with Parkinson's disease each year. Being diagnosed with a long-term and progressive condition can be extremely distressing. The way in which this diagnosis is given can signifi cantly affect the person's wellbeing and his/her approach to the condition.

This article explains how the use of audio and visual aids, as well as the development of a sensitive method of communicating with patients, can greatly enhance a patient's perception of his/her diagnosis. It gives practical examples of tools available to help communication. Increasing patient understanding of Parkinson's disease should help them manage their condition more effectively and make fewer demands on limited health resources.
New hand–held assessment device may save lives
Authors: Newbold David
Published: May 2014

Early detection of intracranial bleeding is the essential fi rst step in delivering effective, often life-saving neurosurgical intervention. The ability to assess, swiftly detect and report markers of deterioration makes appropriately trained nurses and other front-line health professionals the key links in this particular ‘chain of survival’. Not only is survival at stake for the estimated 10 million annual head trauma cases worldwide (Ratanalert et al, 2003), early intervention also preserves brain function.
Neurological assessment of facial features in patients with cerebrovascular disease
Authors: Ito Keiichi , Shiraishi Kazuko , Iseki Hiroshi
Published: May 2014

Objective: In the treatment of post-acute cerebrovascular disease it may be possible to assess the consciousness levels of patients who have difficulty communicating by evaluating changes in facial features. To determine the usefulness of changes in facial features for assessment in neurological nursing, the correlation between the process of recovery from consciousness disturbance and the facial features of patients with cerebrovascular disease was investigated.

Methods: Using a tool for facial image processing, the average faces of three patients with cerebrovascular disease were produced and the nurses then instructed to describe the characteristic changes in facial features associated with the process of recovery from consciousness disturbance.

Results: As patient consciousness levels improved, facial features such as eyelid muscles, mouth muscles, and orofacial contours changed, owing to improved motor function of the mandibular bone. Changes in facial features are useful for assessment in neurological nursing.

Conclusions: These findings could form the foundation for nursing research on facial assessment involving greater numbers of subjects.
An outline of the current options for the supply and administration of medicines
Authors: Hobden Alison
Published: May 2014

Medicinal products are categorized into three groups; General Sales List medicines, pharmacy medicines and prescription-only medicines. These categories govern how a medicine can be supplied, including where it can be supplied from and who can supply it. After summarizing these categories this article will go on to explore the current options available to nurses and other health professionals wanting to supply and administer medicines to their patients. Six options will be discussed, and the legislative and regulatory requirements for each one will be outlined along with examples from practice.
How nurses can help epilepsy patients take control over managing their condition
Authors: Rollinson Lucy
Published: May 2014

Epilepsy is the most common neurological condition in the world after migraine. It is defined as the tendency to experience recurrent seizures. A seizure is caused by a sudden burst of electrical activity in the brain causing a temporary disruption to the normal messages passing through brain cells. There are about 40 different types of seizure, classified into generalized seizures and partial seizures.
Tackling the unpredictability of multiple sclerosis
Authors: Manley Sheila
Published: May 2014

Multiple sclerosis (MS) is the most common debilitating neurological condition affecting young adults in the UK. MS is an autoimmune condition in which the central nervous system comes under attack. Although the exact cause and mechanisms of MS are not fully understood, damage to the brain and spinal cord causes a large and unpredictable range of symptoms, which can vary over time.
Human prion diseases: A clinical overview of their transmission and neuropathology
Authors: Hampson Suzanne , Suvankar Pal
Published: May 2014

Prion diseases, also known as transmissible spongiform encephalopathies, are a group of rare and uniformly fatal neurodegenerative diseases. They occur as distinct diseases in animals and humans, and have been identified in spontaneous, hereditary and acquired forms (Prusiner, 1998). Examples include human Creutzfeldt-Jakob disease (CJD), sheep scrapie and bovine spongiform encephalopathy (BSE). It is the latter that has heightened awareness and public concern for these previously low profile diseases. Following the outbreak of BSE among cattle in the UK in the mid-1980s, its probable subsequent food-borne transmission to humans as a novel form of Creutzfeldt-Jakob disease, termed variant CJD (vCJD), is now widely accepted by the scientific community (Hill et al, 1997). More recently, the identification of secondary person-to-person spread of vCJD via blood products has exposed the wider public health risk potential and the need for an increased awareness of this disease among health professionals (Wroe et al, 2006). This paper presents an overview of the diverse forms and presentations of human prion disease, and explores the unique challenges faced by health professionals in terms of diagnosis, disease progression and management.
Ergot-derived dopamine agonists in Parkinson's: Implications of associated adverse events
Authors: Scott Liz , Kerr Jacqui
Published: May 2014

Clinical evidence shows that there is an increased risk of pulmonary fibrosis and cardiac valvulopathy in patients prescribed certain dopamine agonists for the treatment of Parkinson's disease. It is important for Parkinson's disease nurse specialists to understand the clinical implications of these findings, and be able to inform and support patients through the process of changing their drug regimens where required. The professional and regulatory recommendations for switching patients on ergot-derived dopamine agonists to alternative therapies are examined and the clinical implications discussed. Some practical suggestions are provided to help nurses ensure that the potential effects of ergot-derived treatments are communicated to patients and decisions are reached with their acknowledgment and full understanding.
Research Round-Up
Authors: Neal Cook
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Prevent stroke: Spread the word about FAST
Authors: Woodward Sue
Published: May 2014

The first week of December has seen much publicity about the new government campaign to raise awareness of stroke which is to be launched in February 2009. The FAST test has been promoted by The Stroke Association for some time and yet many people still do not recognize the warning signs of stroke or transient ischaemic attack (TIA), and do not treat it as a medical emergency. This can delay access to scanning and potentially life-saving thrombolysis. Stroke is the third leading cause of death in the UK and the single largest cause of disability. There is significant evidence that thrombolysis, where appropriate, can dramatically improve outcomes from stroke if administered within 3 hours, so it is vital that people seek help immediately when this is happening to them.
Addressing the lottery of palliative care
Authors: Thomas Sue
Published: May 2014

The Department of Health is seeking nurses' views on new quality markers for end-of-life care. Sue Thomas reports
Nontraumatic spinal cord injury, part 4: Degenerative disorders of the spine
Authors: Pellatt Glynis Collis
Published: May 2014

Degeneration of the spine starts at a very early age but by late middle age it may start to cause pain and limit mobility. There are a number of degenerative conditions that may lead to compression of the spinal cord and nerve roots which will require either conservative management or surgical intervention. However, there are risks as well as benefits to surgical treatment with little reliable research evidence to identify the most appropriate approach. The role of the nurse, within an interprofessional approach to the care and management of patients with neurological disturbance due to degenerative disease includes emotional support, physical support such as pain relief, co-ordination and information provision to enable patients to make informed choices regarding their treatment.
RESEARCH ROUND-UP
Authors: Woodward Sue
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Encephalitis: The broader spectrum
Authors: White Steven , Easton Ava
Published: May 2014

Steven White and Ava Easton report on recent conference discussions about developments in knowledge about the epidemiology and treatment of forms of encephalitis
Understanding the use of corticosteroids in managing cerebral oedema
Authors: Khan Ehsan
Published: May 2014

Cerebral oedema is a significant and detrimental pathological occurrence frequently associated with poor prognosis in patients. The primary cause for cerebral oedema is inflammation-mediated breakdown of the blood-brain barrier resulting in unrestricted movement of electrolytes and proteins into the brain parenchyma. This produces an osmotically derived oedema in the brain. Steroidal therapies reduce blood-brain barrier breakdown by influencing proteins at the junctions of brain capillary endothelial cells. However, use of steroids for reducing brain inflammation is associated with detrimental effects on brain function, limiting the use of this therapy to angiogenic oedema. This paper presents the clinician with an analysis of the options and discusses the current understanding of the use of steroids in limiting cerebral oedema and brain damage secondary to cerebral inflammation.
RESEARCH ROUND-UP
Authors: Eberhardie Chris
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
The aetiology, diagnosis and management of cluster headache and the nurse's role
Authors: Bhola Ria
Published: May 2014

Cluster headache is often considered to be one of the most painful forms of headache. The symptoms of cluster headache are distinct from other types of headache but sufferers often do not receive the right diagnosis and treatment when they seek help. This is particularly difficult given the degree of suffering the patient must endure from the condition and sometimes inappropriate treatments. In this article an overview of the presentation of cluster headache is provided, and the available treatment options are outlined with reference to the nurse's role.
A review of the intensive care management of severe paediatric traumatic brain injury
Authors: Tume Lyvonne , Thorburn Kent , Sinha Ajay
Published: May 2014

Severe traumatic brain injury in children continues to pose significant challenges for the intensive care team. This paper reviews the current evidence base for the treatment strategies recommended and highlights the differences between paediatric and adult traumatic brain injury. The paediatric intensive care nurse has a key role to play in paediatric traumatic brain injury, but to contribute effectively to the multidisciplinary team must have a good understanding of the medical and surgical management strategies
Longer term rehabilitation for patients following stroke: A literature review
Authors: McIntyre Melanie , Mitchell Elizabeth A
Published: May 2014

Stroke remains the main cause of severe disability in the UK with approximately one third of stroke survivors functionally dependent at 1 year after a stroke. Early access to cognitive and physical rehabilitation therapy after stroke is considered to be a hallmark of effective stroke services but evidence is also emerging to support longer term rehabilitation for these patients.

This paper explores the evidence base for cognitive and physical rehabilitation therapy for patients 6 months or later after stroke. Intensively applied interventions appear to mediate more positive and sustained outcomes. Group interventions can be an efficient way to maximize intensity. All professions have a responsibility to ensure that practice is evidence based. In light of a paucity of quality research in rehabilitation interventions, it is incumbent on health professionals, service users and researchers to work together to study longer term rehabilitation in a more rigorous manner.
Identifying and managing chronic fatigue syndrome
Authors: Pountney David
Published: May 2014

Chronic fatigue syndrome (CFS) is the most common name given to conditions characterized by persistent fatigue that is unrelated to physical exertion and not substantially relieved by rest (Evengård et al, 1999). CFS is classified by the Department of Health (DH) as a long-term neurological condition. In CFS the symptoms of fatigue are not caused by any other known medical conditions. The condition is also sometimes refered to as post-viral fatigue syndrome (PVFS) or chronic fatigue immune dysfunction syndrome (CFIDS) when it follows a flu-like infection, or as myalgic encephalomyelitis (ME). Most clinicians use the terms CFS and ME interchangeably to refer to chronic post-viral fatigue (Gallagher et al, 2004). However, certain groups have argued for ME to be recognized as a separate condition, but this is controversial (Wyller, 2007). In this aritcle ‘CFS’ will be used as an umbrella term.
Low-dose naltrexone as a treatment for multiple sclerosis
Authors: Gilhooly Tom
Published: May 2014

Published trials have supported naltrexone's potential to treat multiple sclerosis, however, it will remain unavailable until there is an extensive body of research to support its use.
Chris Eberhardie: Paving a way for neuroscience nursing
Authors: Eberhardie Christine
Published: May 2014

The development and promotion of neuroscience nurses' education has been a consistent objective of Chris Eberhardie's throughout her 40-year career
World class commissioning: What does it all mean?
Authors: Thomas Sue
Published: May 2014

The world class commissioning programme, now in its second year, is a Department of Health (DH) programme developed to help strengthen primary care trusts' (PCT) ability to commission health and social care services effectively (DH, 2007b). The NHS vision is to deliver a health and care system that is fair, personalized, effective and safe within the goal of ‘adding life to years and years to life’. World class commissioning will be one of the most important vehicles for delivering this vision. To become world class, commissioners will need to develop the knowledge and skills to plan an important number of roles, these include becoming world class local NHS leaders, community partners, strategic planners, market innovators and process managers—a tall order. This must be done by reflecting on the needs of their local communities, while also delivering on national priorities set by government.
The many costs of road traffic injury
Authors: McDonald Sheena
Published: May 2014

In the developing world a traffic accident injury can be a ‘one-way ticket to poverty’. Commitments are being made to help turn this situation around and Sheena McDonald is rooting for the Decade of Action.
Progress on CSF drainage and IVIg benchmarks
Authors: Arnott Lynn , Gray Olivia , Baird Catherine
Published: May 2014

The Royal Victoria Hospital, Belfast (now part of Belfast Health and Social Care Trust) hosted the North West Benchmarking Group's regional meeting on 28 January 2009, sponsored by Beagle Orthopaedics. Beaumont Hospital Dublin, the Walton Centre Liverpool, Greater Manchester Neuroscience Centre, and the Royal Victoria Belfast were represented. Apologies were received from The Royal Preston.
Sharing information with patients like me
Authors: Wicks Paul
Published: May 2014

Patients LikeMe.com is an online health community which creates new knowledge by charting the real-world course of disease through the shared experiences of patients with:

▪ Motor neurone disease (MND) (or amyotrophic lateral sclerosis (ALS)) ▪ Multiple sclerosis ▪ Parkinson's disease ▪ HIV ▪ Mood conditions (including depression and bipolar, anxiety, obsessive-compulsive and posttraumatic stress disorders) ▪ Fibromyalgia.
Is recovery possible after brain injury?
Authors: McDonald Sheena
Published: May 2014

People who knew me before I experienced my head-injury and haven't seen me for some years often ask, ‘Are you really alright now?’ ‘Yes,’ I say—and watch them trying to hide their scepticism. I can read their thoughts: ‘Poor dear, she's still in denial.’ And I understand why. If the families and carers of people who suddenly acquire a traumatic brain injury turn to the contemporary literature on the subject, they are given pretty uncompromising advice. For example, Kay and Lezak (1990), admired authorities in the field, claim to debunk the ten myths of recovery. ‘We avoid phrases such as “recovery after head-injury”,’ they write. ‘Almost never does a patient “recover”; the residual deficits are usually significant and permanent … we prefer to speak in terms of hope for as much improvement as possible, to build in realistic expectations from the beginning.’
Are budgets and targets compromising patient care?
Authors: Thomas Sue
Published: May 2014

Readers cannot have failed to have heard or seen some of the press relating to Mid Staffordshire NHS Foundation Trust in recent weeks. In March the Healthcare Commission (HCC) (2009a) published a report that found that this trust was responsible for significant failings across emergency health care, leadership and management. The shocking details reported are a clear indication of what can happen when trusts cut staffing numbers, fail to provide leadership and implement cost-saving measures rather than delivering quality patient care. In this trust clear barriers were in place that prevented quality care taking place and, although the nurses working in the trust had raised their concerns with management, both formally and informally, their concerns were never addressed.
Fostering tolerance toward survivors
Authors: McDonald Sheena
Published: May 2014

My friend, a radio producer, was standing outside the cafe where we had planned to meet, talking on her mobile phone. She gestured me in. Five minutes later, she came and joined me. ‘That was so frustrating,’ she said. ‘I was talking to a colleague who can't understand why her programme idea hasn't been commissioned. She's retired, so she's working on a freelance basis—she has a pension already! Eighteen months ago, she was diagnosed with a brain tumour, which turned out to be benign. She's been operated on successfully—but she's now really unreasonable! And it's difficult to know what to say…’
Autopsy trends in head injury: Understanding the benefits and potential for alternatives
Authors: Outtrim Joanne
Published: May 2014

In recent years the UK has seen a number of public scandals regarding the unauthorized removal and retention of human organs and tissue. This has contributed to an already decreasing rate of hospital autopsy. Deaths from traumatic brain injury must legally be subject to a coronial investigation to confirm cause of death. This process should be less modified by changes in public opinion, but there has been a clear reduction in the numbers of coronial autopsies as well.

This decline in the number of autopsies is likely to be detrimental to clinical practice and research. There is therefore increasing interest in finding potential alternatives or adjuncts to autopsy for patients who die as a result of traumatic brain injury. In this article, the trends in current rates of autopsy will be examined, with a brief review of the change in current laws, the types of autopsy that are practised, the English legal requirements for coronial and hospital autopsies, current research into alternative methods of autopsy and the implications for nursing practice.
The psychosocial impact of communication changes in people with Parkinson's disease
Authors: Whitehead Bridget
Published: May 2014

Aim: to explore the perspectives of individuals with Parkinson's disease and their spouses on their experiences of living with communication difficulties as a consequence of the disease.

Design: Semi-structured interviews were conducted with four individuals with Parkinson's disease and three spouses. A thematic analysis of the content was used to identify themes from the discourse.

Results: Themes identified included: (1) individuals' perceived change in self, misperception by others, and coping strategies; and (2) spouses' experiences, including communication changes in partner, the impact on the spouse, other people's reactions, and speech and language therapy.

Conclusions: Communication changes occurring as a consequence of Parkinson's disease significantly impact on both the individual's and spouse's psychological and social functioning. This study advocates provision of a broader, social model of service delivery, incorporating elements of counselling, group therapy and social support, in order to meet patients' and families' needs more effectively. Specialist nurses working with this patient group need to be aware of the psycho-social impact of communication difficulties and early referral to speech and language therapy should be considered.
CORRESPONDENCE
Authors: Easton Ava
Published: May 2014

January diary: Generating impetus for the NSF in the new year