bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a self-management and exercise model for people with multiple sclerosis
Authors: Hartley S
Published: May 2014

Aims

The recognition of lack of support for people with multiple sclerosis (MS) with minimal to moderate disability, and growing evidence to support the benefits of exercise, initiated the development of an interdisciplinary self-management model. This article describes the development and components of the model, and the evaluation of the programme to date.

Methods

The service model was developed to include four programmes over a 2-year time frame. The study group comprised 33 people with MS. The group programme consisted of 6 weeks of information and exercise in the hospital setting, followed by 8 weeks of supervised exercise sessions in a leisure centre setting. Measures of gait, quality of life, fatigue levels and mood were obtained at baseline and following programme completion and the perceived benefits were recorded using a patient satisfaction questionnaire.

Findings

The evaluation demonstrated significant improvements in walking speed and quality of life and the participants reported a range of perceived physical and psychological benefits. It was identified that tighter selection criteria is required, with consideration of the time since diagnosis and how participants have adapted to their condition. The need for guidelines for other therapists setting up similar programmes was also identified.

Conclusions

This model provides evidence of the potential benefits of earlier intervention for people with MS and encouraging exercise through self-management programmes. It can therefore, with further refinement, meet a perceived shortfall in service provision both now and in the future.
Head posture assessment for patients with neck pain: Is it useful?
Authors: Silva Anabela Gonalves , Punt T David , Sharples Paul , Vilas-Boas João Paulo , Johnson Mark I
Published: May 2014

Aims

Neck pain is a common complaint and accounts for a significant proportion of individuals seeking physiotherapy. Assessment for patients with neck pain normally involves a judgment of head posture. Head posture is considered important as deviations from ‘normal’ may have detrimental biomechanical and physiological implications and provide clues as to optimal interventions. However, studies comparing head posture between patients with neck pain and asymptomatic individuals have shown conflicting results. This article critically appraises the role of head posture assessment for patients with neck pain.

Methods

The rationale for a relationship between head posture and neck pain is discussed; clinical assessment of head posture—including issues around surrogate measures, validity and reliability—is explored, and studies comparing patients with neck pain and asymptomatic individuals are examined. Finally, studies investigating techniques to correct head posture are appraised.

Findings and conclusions

It is unclear whether the assessment of head posture through observation is valid and/or reliable and whether therapeutic interventions to improve head posture result in gains for the patient. There is a need for further research exploring the links between these factors, and practitioners should be encouraged to re-appraise the value of assessing head posture for patients with neck pain.
Exploring the impact of rheumatoid arthritis on patients' lives
Authors: Hughes John G
Published: May 2014

Aims

A limited number of published studies have explored the perceptions and experiences of people living with rheumatoid arthritis (RA). Qualitative research of this kind is essential for the design and development of patient-centred outcome indices. This study aimed to explore the experiences of those patients with RA, to improve understanding of the impact of the condition on a person's life.

Methods

A grounded theory qualitative study was conducted with a convenience sample of 13 persons from the North West of England. The issues to be discussed during interviews were dictated by emerging categories and themes.

Findings

Those persons who participated in the study identified a range of symptoms and consequences of RA, including intractable pain, reduced mobility, systemic fatigue, sleeplessness, eating difficulties, and emotional disturbances. RA also negatively impacted on participants' ability to perform everyday tasks, reduced freedom and independence, and resulted in persons becoming more sedentary and socially reclusive.

Conclusions

The study showed that RA has a huge impact on every aspect of a sufferer's life. Most outcome tools do not adequately reflect this. This highlights the need for the development of new patient-centred outcome indices capable of incorporating the symptoms and consequences identified here.
Long-term stroke survivors' needs and perceptions of an exercise maintenance model of care
Authors: Patterson Sarah , Ross-Edwards Benjamin
Published: May 2014

Aims

Stroke is a leading cause of disability in Australia, having an associated decline in functional activities and socialization over time. This article discusses an exploration of stroke survivors' views on a stroke maintenance exercise group, and aims to provide insight into the long-term needs of this clinical group.

Methods

A qualitative study using open-ended, in-depth interviews was completed with a purposive sample of 10 long-term stroke survivors from two stroke maintenance exercise groups.

Findings

Thematic analysis of survivor's responses identified three common themes: further insight into difficulties post-stroke; group provision of exercise opportunity, information and social support; and outcomes of increased confidence, motivation and participation.

Conclusions

This study highlights the challenges faced by long-term stroke survivors and the value of programmes, such as this stroke maintenance exercise group, in facilitating community participation.
Hip precautions following hemiarthroplasty: A UK study of occupational therapists
Authors: McQueen Jean , Nivison Catherine , Clyde Deborah , Ballance Fiona , Fairbairn Pamela , Murray Elaine
Published: May 2014

Aims

One intervention that occupational therapists may undertake with patients following hip fracture is the promotion of hip precautions. These hip precautions focus on advising patients to avoid certain movements and/or the provision of aids to independence, for up to 12 weeks post surgery. A systematic search of published literature identified limited evidence on which to base practice in this field. A national survey was therefore undertaken to establish whether hip precautions are used uniformly throughout the United Kingdom.

Methods

This study aimed to capture occupational therapy current practice in hip precautions following hemiarthroplasty surgery. Questionnaires were sent to members of the College of Occupational Therapists Specialist Section - Trauma and Orthopaedics, and to therapists who responded to an article in Occupational Therapy News. A total of 198 questionnaires were distributed.

Findings

100 questionnaires were returned. The majority of occupational therapists who responded encouraged their patients to adhere to hip precautions post surgery, however, there was concern at the lack of robust evidence to support practice. A small number of therapists who did not encourage their patients to adhere to hip precautions reported no detrimental consequences.

Conclusions

This study discusses concern that focusing on hip precautions following hemiarthroplasty surgery may unnecessarily impair function, and highlights the need for further research to investigate whether post surgery hip precautions are necessary.
An analysis of the ‘Six disabled lives’ report in the UK: Important or impotent?
Authors: Scullion Philip
Published: May 2014

Background

Rights of disabled people are enshrined in an international convention mediated by the United Nations (UN). However, a recent Ombudsman's Report in the UK: ‘Six lives: the provision of public services to people with learning disabilities’, adds to a long line of similar reports showing evidence that such citizens are denied equitable treatment from health and social care organizations.

Content

This article offers an analysis of the Ombudsman's Report in the context of current disability legislation and the work of other bodies which have an obligation to ensure equitable treatment in UK health and social care settings. The report found that many vulnerable groups have suffered extreme injustices in their encounters with health and social care professionals, which have resulted in avoidable deaths and unnecessary distress and suffering. These findings, and how these injustices may be avoided and overcome in the future, are discussed.

Conclusions

Despite a plethora of official commitments to good practice to ensure that the rights of disabled people are upheld, these vulnerable citizens are still not being protected. Mencap, a UK disability-related charity has labelled this ‘institutional discrimination’. It is suggested here that individual professionals, in practice, education and research, must take on the responsibility to challenge and change underlying attitudes and behaviours in relation to disabled people.
Qigong as a mindful exercise intervention for people living with mental ill health
Authors: Lloyd Chris , Tsang Hector , Deane Frank
Published: May 2014

Background

Individuals with schizophrenia are more likely to be overweight or obese than the general population, and the associated health problems put them at a higher risk of death. Exercise is therefore an important non-pharmacological intervention that mental health workers can assist clients to engage in, and mindful exercise approaches may be particularly well-suited to this population.

Content

This article describes the concept of qigong as a mindful exercise and looks at preliminary evidence suggesting that mindful exercise is of physical and emotional benefit to people with mental ill health. The authors propose an easy, standardized exercise protocol which clinicians can use and teach patient, and call for further research to explore its efficacy.

Conclusions

It is suggested that mindful exercise may be used as an intervention to assist people living with mental ill health to improve their community functioning and hence their recovery.
Concept analysis in healthcare research
Authors: Cronin Patricia , Ryan F , Coughlan M
Published: May 2014

Background

In recent years there has been an increasing interest in concept analysis as a means of establishing conceptual clarity about phenomena of interest within healthcare disciplines. This emergence is associated primarily with the recognition that a set of well developed key concepts pertaining to a discipline's domain of interest is an essential pre-requisite to building its scientific research base. Concept analysis focuses on concepts that are abstract and about which there is some ambiguity of meaning. Within healthcare disciplines these are mainly behavioural concepts that are concerned with understanding health and illness experiences.

Content

There are a number of approaches to concept analysis that appear to have some similarities but which possess essential philosophical differences. This article examines the ontological and epistemological underpinnings of concepts and concept analysis. Methods of concept analysis that represent the various philosophical positions are presented and a critique of their limitations is offered.

Conclusions

Concept analysis, using a structured framework, is means of identifying characteristics and attributes of abstract or ill-defined concepts with the purpose of achieving clarity. However, it can be a difficult and time consuming process that requires rigorous attention at all stages if the outcome is to be meaningful for knowledge and theory development and ultimately, practice.
Long-term follow-up of persons with spinal cord injury integrated in the community
Authors: Martin Priya , Cherian Binu , John Judy , Tharion George , Bhattacharjee Suranjan
Published: May 2014

Aims

The main aim of this study was to identify the changes over time on the functional status of people with spinal cord injury in a sample of the South Indian population, integrated in the community, following rehabilitation. It also aimed at evaluating the adaptations that occurred in that time period, in order to facilitate planning of services based on patient requirements

Methods

Data was gathered from medical records and through structured interviews from 85 individuals with traumatic paraplegia who were rehabilitated from the Christian Medical College, Vellore. The Functional Independence Measure was used to assess activities of daily living. Thirteen variables were analysed using Chi-square and Pearson's Correlation Coefficient tests.

Findings

The mean age of the patients at the time of study was 38.95±10.19. Out of the 85 patients, 89.4% were male, 43.5% were between 19 to 50 years of age and 61.2% were married. The most common site of spinal lesion (84.7%) was between T10 and T12. The majority, 64.7%, of the patients were ambulant with orthoses and appliances such as walker, crutches and canes. Most of the patients were independent in activies of daily living with some assistive devices (90.6%). The majority of the patients (76.5%) were over 5 years post injury.

Conclusions

Adjustments and adaptations occurred in a time period within 5 years post injury, after which the gains were stabilized. Rehabilitation and intervention measures should focus on the initial time frame after SCI.The results may provide better understanding to plan and co-ordinate rehabilitation measures for people with SCI.
Rehabilitation nursing: invisible and underappreciated therapy
Authors: M Kearney Penelope , Lever Sandra
Published: May 2014

A nursing colleague recently spoke of the dismay she felt at a multi-disciplinary meeting where preliminary findings of a study related to time use in neurological rehabilitation were discussed. One researcher reported that ‘too much time was spent in the bathroom’. This time was perceived as inactive, and encroaching on patients' therapy time. The nurse challenged the classification and interpretation as ‘time wasted’, pointing to the likely therapeutic nature of time spent in the bathroom – time spent coaching patients in specific tasks to develop self-care and independence. This is what rehabilitation nurses do; where possible, we don't ‘do for’ (which does speed up bathroom time), but use all opportunities to ‘do with’ or to explain, demonstrate and stand by while our patients slowly ‘do’. Rehabilitation nurses do not see bathroom time as getting patients ready for their group therapy sessions, but rather as one-to-one sessions of therapy in vivo, therapy that is focused and tailored to the achievement of meaningful tasks for individuals.
Occupational therapy in the modern adult acute mental health setting: a review of current practice
Authors: Lloyd Chris , Lee Williams Philip
Published: May 2014

Background

Health care systems are changing and with them, the role and scope of occupational therapy. The inpatient mental health setting is one area where change has been rapid and expansive, directly impacting on the role of occupational therapy. Literature pertaining to the current practice of occupational therapy in this setting is currently overshadowed by a focus on community-based care. This article aims to describe and summarize the recently published literature regarding current practices of occupational therapy in this important setting.

Methods

Current practices were identified with reference to policy documents, text books and journal articles dating from 1990 to the present day.

Findings

There was found to be a paucity of current literature relating to occupational therapy practice in acute mental health. From the literature that was available, four core elements of occupational therapy practice in acute mental health were identified: individual assessment, individual treatment, therapeutic groups, and discharge planning.

Conclusions

It is suggested that the development and communication of the occupational therapy role focusing on the four core elements of practice will provide a sound base for the development of the clinical role of occupational therapy in acute mental health. Occupational therapists working in the acute mental health setting are encouraged to be aware of the available literature pertaining to this area and establish a renewed focus on clinical research to evaluate current practice and to guide debate on emerging occupational therapy roles.
Issues experienced by service users with an eating disorder: a qualitative investigation
Authors: Walker Sarah , Lloyd Chris
Published: May 2014

Aims: This study examined the perceptions of treatment by service users who had been diagnosed with an eating disorder

Methods: A qualitative research design using Consensual Qualitative Research (CQR) was used. A focus group was held where the discussion was guided by a semi-structured interview schedule. Three key domains were identified using the CQR procedure: therapeutic relationship, response of others, and treatment experiences.

Conclusions: The pervasive theme that appeared to emerge throughout the session was the lack of understanding by others including family, friends and health professionals.
A smarter future: technology to enhance an independent lifestyle for our future selves
Authors: Evans Nina , Harris Nigel , Kuppuswamy Annapoorna
Published: May 2014

Background: Technology plays an increasing role in our everyday lives, but we have yet to explore its full potential for supporting independent living.

Content: This article gives an overview of the range of new telecare technology that is available and looks at some of the current challenges and future opportunities this presents. The evidence base for the effectiveness still needs to be established and more work is needed to quantify the benefits for carers. There are opportunities around the application of the technology to support independent living for people with dementia. We discuss our experiences and the potential for assistive technology.

Conclusion: Although technology has great potential for supporting independent living, we are currently utilizing a fraction of this capacity. To fully realize its benefits, a systematic and cohesive approach across various sectors needs to be adopted.
The Longer Term Functional Impact of a Traumatic Hand Injury on People Living in a Regional Metropolitan Australian Location
Authors: Bell Joanna , Gray Marion , Kingston Gail
Published: May 2014

Aims:

This article describes a study exploring the longer term functional impact of a traumatic hand injury on people residing in a regional metropolitan Australian location.

Methods:

A descriptive cross sectional retrospective survey was sent to adult patients who received treatment for a traumatic hand injury from the occupational therapy clinic at a regional Australian hospital, 1-4 years post injury (n=498). The Upper Extremity Functional Index was included in the survey.

Findings:

Over 90% of respondents reported having ongoing residual difficulties. Participants indicated that the most affected areas were work and leisure. Almost half the respondents agreed or strongly agreed that the exercises ‘hurt too much to do’ (46%) and that they ‘did not have enough time’ to do exercises (34.5%).

Conclusions:

This study emphasized notable longer term impact of a traumatic hand injury on people residing in a metropolitan Australian location; especially in the areas of work and leisure. Findings indicate the need for some change in the delivery of rehabilitation programmes in an Australian regional metropolitan context. Holistic consideration of factors which may influence outcomes will improve rehabilitation programmes and, in turn, overall quality of life for individuals who sustain a traumatic hand injury.
The value of an inter-agency pathway for Attention Deficit Hyperactivity Disorder (ADHD)
Authors: Russell Lucy , Forbes Fiona , Forsyth Kirsty , Maciver Donald , Mulvanny Amanda , Whitehead Jacqueline
Published: May 2014

Introduction:

This article, co-authored by experts in research, child and adolescent mental health, occupational therapy and education services, considers service provision in Attention Deficit Hyperactivity Disorder (ADHD).

Contents:

This article outlines the roles of those who are involved in service provision for children and young people with ADHD, and identifies the challenges faced by ADHD services. Care pathways are then described, with details of factors that need to be considered in the mapping of potential local pathways.

Conclusions:

The development of local care pathways for the diagnosis and management of ADHD is suggested as a method of meeting the challenges identified.
Perceptions of physiotherapy students of a person-centred approach in rehabilitation
Authors: Schmitt Janet , Akroyd Karen , Akroyd Linda
Published: May 2014

Aims: A person-centred approach is a core component of health care policy and professional standards in the UK. The aims of this study were to explore perceptions of final year physiotherapy students of a person-centred approach in rehabilitation and compare students' views of person-centred to service users' views as found in the literature.

Methodology: A qualitative cross-sectional study was undertaken using elements of grounded theory. Data were collected from semi-structured focus group interviews and then analyzed using iterative content analysis.

Results: The principles of a person-centred approach raised by participants included: patient empowerment and choice; information and education for patients; holistic approach; individualization of interventions; and family/carers'/providers' roles. Results indicate that there are key distinctions between the principles of a person-centred approach in rehabilitation considered important by service users in the literature and those perceived as important by final year physiotherapy students.

Conclusions: Evidence suggests that the perceptions of the physiotherapy students are more closely aligned to the principles of a person-centred approach as defined by health care professionals, as compared to those defined by service users. Further research is required to ascertain the nature and prevalence of the power dynamic within the therapeutic relationship and its potential impact upon a person-centred approach to rehabilitation.
Occupational therapists' involvement views, and training needs of evidence-based practice: a rural perspective
Authors: Hu Dai
Published: May 2014

Aim: To date, a number of studies on occupational therapists’ views and perceptions of evidence-based practice (EBP) have been published; however there has been little research with the same purposes focusing on therapists who work in rural areas in the UK. This study aims at exploring the perception, involvement and participation of EBP of occupational therapists in rural areas, and the indication of future improvements.

Methods: A questionnaire reflecting practitioner's attitudes, involvement in EBP activities and training needs was mailed to 73 therapists who practice in one rural area in England. All of the 64 (response rate 87.7%) respondents were from one NHS trust, and the majority work in mental health/learning disability settings.

Results: The results showed no significant difference between the sample and those who work in urban areas. Most participants were positive to EBP, but generally had a low involvement in EBP related activities due to various barriers. Postgraduate education demonstrated significant positive influence on perception and skills of EBP in the sample.

Conclusion: How to integrate research findings into practice is the priority in future training, and a focus on multifaceted and innovative approaches, including their effectiveness, is important in promoting EBP.
Effect of The Back Book on fear-avoidance beliefs, disability, and pain levels in subjects with low back pain
Authors: Sparkes Valerie , Chidwick Nathan , Coales Philippa
Published: May 2014

Background/Aim: The Back Book was designed as an evidenced-based booklet to change patients’ beliefs and behaviours regarding back pain. This information focused on encouragement of normal activity, avoiding too much rest and maintaining a positive attitude. Previous studies have shown that The Back Book, when combined with other management strategies, appears to have a positive effect on patients’ beliefs about back pain and clinical outcomes. This study aimed to determine the effect of The Back Book on attitudes towards back pain, function, and pain when given to patients on a waiting list to see a physiotherapist in a spinal pain clinic (SPC).

Method: Subjects were recruited from a SPC waiting list and randomized into experimental and control groups. All subjects completed the Back Beliefs, Fear Avoidance Beliefs, and Roland Morris Disability questionnaires, and Visual Analogue Scale for pain before and after reading The Back Book or no intervention.

Results: No statistical or clinical differences were seen in any of the outcome measures.

Conclusion: This preliminary data suggests that The Back Book may not be suitable to be used in isolation. Further research should establish the most appropriate point and mode of delivery of this information.
The realist approach to evaluation research: an introduction
Authors: Hewitt Gillian , Sims Sarah , Harris Ruth
Published: May 2014

Background:

The realist approach is a form of theory-driven evaluation developed to strengthen the explanatory power of evaluation studies and contribute to evidence-based policy and practice. It is a generic approach that can be applied to many fields of research, including health and social care.

Content:

This article introduces the reader to the realist approach and outlines its application in empirical evaluation studies and literature syntheses. It describes how the realist researcher evaluates complex social interventions not by asking whether a particular programme or intervention ‘works’, but, recognising that all interventions only ever work for certain people in certain circumstances, by asking instead ‘what works for whom in what circumstances’? Realist researchers then try to articulate the theories (termed ‘mechanisms’) that underpin the programme and explore how contexts influence the mechanisms to produce different programme outcomes.

Conclusions:

Realist evaluation and realist synthesis are an advanced approach to evaluation research, but they offer an innovative and insightful means by which to further our understanding of complex social interventions.
Qualitative researching with vulnerable groups
Authors: Pyer Michelle , Campbell Jackie
Published: May 2014

The importance of enabling a wide range of people to participate in research and evaluation reflects continuing calls for service users to be a part of the decision-making which goes on around them. Involving service users in project work is not without its challenges, raising pertinent ethical and practical issues which need to be considered and reflexively responded to. In this paper we will provide a summary of the key ethical and governance issues to consider when undertaking (primarily) qualitative research with those deemed ‘vulnerable’, before offering an outline of some of the best practice approaches to applying these issues in the field.
Speech and language therapists’ understanding and adoption of evidence-based practice
Authors: Stephens Danielle , Upton Dominic
Published: May 2014

Aim:

This review aimed to explore the knowledge, understanding and attitudes held by speech and language therapists (SLTs) to evidence-based practice (EBP). Furthermore, it addresses the adoption of such a framework and how it could be increased within SLTs professional practice.

Method:

The review included research conducted between 1998 and 2011. Academic Search Complete, CINAHL Plus, Psyc Articles, Medline, Ingenta, Science Direct, JSTOR and Google Scholar, were searched using the terms ‘Evidence-Based Practice’, ‘Speech and Language Therapists’ and ‘Clinical Practice'0.

Results:

Research predominantly reports limited engagement with EBP. Findings continuously demonstrate how SLTs lack the skills required in order to conduct literature searches and assess relevant research evidence. Furthermore, the research base available to SLTs is of low level quality due to focusing principally on efficacy rather than effectiveness. Additionally, many barriers are evident, including lack of time, resources, skills and understanding, which prevent both conducting research and the implementation of EBP.

Conclusion:

Although SLTs tend to display high positive regard for EBP, these attitudes are rarely translated into practice. Due to the inadequacy of the current research base available to SLTs it is essential for SLT researchers and practitioners to combine efforts in order to ensure the reliability of future research. This will enable the expansion of relevant research whilst continually promoting EBP and SLT as a discipline.
Developing patient-centred care in health professionals: reflections on introducing service-learning into the curriculum
Authors: Roskell Carolyn , White Deborah , Bonner Cathy
Published: May 2014

Background:

This paper examines how professionalism is fostered to promote ‘patient-centred care’ in UK healthcare education and identifies challenges reported by educators. It reports a pilot study which introduced ‘service-learning’ into the dental and physiotherapy curricula as a strategy for promoting pertinent professional values and skills.

Content:

Undergraduate dental, and pre-registration postgraduate physiotherapy, students experienced service-learning via attendance at non-professional community placements, such as organising social events with homeless people, as part of their programme of study. Pre-placement preparation and post-placement debrief were offered. Evaluation data were obtained through focus groups, questionnaires, and interviews from students, placement providers and academic staff. Although the intervention was generally well received, important limitations emerged revealing new insights into difficulties with this type of learning for students, placement providers and institutions.

Conclusion:

Service-learning shows potential for enhancing capability to deliver patient-centre care. Lessons learnt from this project may usefully inform curriculum development in healthcare education and open up further avenues for research.
Are we missing any patients with serious spinal pathology?
Authors: Keillar Eden
Published: May 2014

Background:

Due to its rarity, serious spinal pathology (SSP) is often missed or misdiagnosed. The consequence of missing the vital signs and symptoms can be devastating for patients, their families and clinicians. At present, there appear to be no available NHS statistics on the prevalence rates of missed or misdiagnosed conditions in the UK.

Aim:

To identify whether a specialist physiotherapy-led back pain service misdiagnosed any patients with SSP between 2004–2008.

Methods:

Subject data was extracted from a back pain service database and International Classification of Disease (ICD) codes were used to identify patients diagnosed with SSP. The two data sources were cross matched to identify patients assessed by the specialist service and later diagnosed with SSP.

Results:

The database search identified 25 patients (0.2% of the total number of patient records) who had been diagnosed with SSP. Four patients had been misdiagnosed. Clinicians should be aware that there appears to be a small cohort of patients in which it is almost impossible to differentiate between simple mechanical lower back pain (LBP) and SSP early in its evolution.

Conclusion:

SSP continues to be rare; however, the risk of misdiagnosis remains. The emergence of new red flags and a growing body of evidence emphasising the importance of combinations of red flags raises the question over whether an up-to-date review of the red flag recommendation list is warranted.
Arm Activity measure (ArmA) application for recording functional gain following focal spasticity treatment
Authors: Ashford Stephen , Slade Mike , Nair Ajoy , Turner-Stokes Lynne
Published: May 2014

Background and Aims:

The Arm Activity measure (ArmA) is a new measure for recording the pattern of change in passive function after focal spasticity intervention. This study aimed to demonstrate the application of the ArmA for measuring passive and active functional movement.

Methods

An open-label prospective cohort study was conducted within a two-centre specialist spasticity management program. Outcome measures used were the ArmA, the Modified Ashworth Scale (MAS) and the Leeds Adult Spasticity Impact Scale (LASIS). Measurement was undertaken at baseline, at 8 weeks and at 16 weeks. Participants (n=58) presenting for treatment of upper limb spasticity were included and comprised of 32 men and 26 women, with a mean age of 47 years (SD=17.5). Participants received a single administration of BoNT (Dysport®, Ipsen, Slough, UK; or BOTOX®, Allergan, Irvine, CA, USA) following baseline assessment as part of routine clinical practice.

Results

Significant changes were demonstrated over the 16-week period in both the MAS (Xr2=66.6; P<0.005) and the ArmA passive function subscale (Xr2=11.9; P<0.005) (e.g. improved ease of dressing and hygiene). No change was identified in the ArmA active function subscale. Comparison of change at individual time-points showed the gain in passive function to be maintained at 16 weeks (Z=-2.6; P<0.01).

Conclusion

Significant gains in passive function were recorded by ArmA at 8 weeks, and maintained at 16 weeks post-injection in the context of on-going physical intervention.
A pilot study to investigate the muscle strength of children infected with HIV
Authors: Humphries Carolyn , Potterton Joanne , Mudzi Witness
Published: May 2014

Background/aims

Paediatric HIV remains a significant challenge to children and caregivers in South Africa. Little is known about the effect of HIV infection on muscle strength in children, however potential decrease in muscle strength has been inferred to affect functional ability in these children. The aim of this pilot study was to compare the muscle strength of children infected with HIV who had been receiving highly active antiretroviral therapy (HAART) to that of children infected with HIV not receiving HAART.

Methods

The study population included a group of 16 children receiving HAART and 16 children not receiving HAART. A one-off test of muscle strength was undertaken using a hand-held dynamometer for the child, and a demographic questionnaire and social status index to their primary caregiver. Two-sample student t tests, Pearson correlation analyses, and backward regression analyses were used to analyse data.

Results

The cluster of differentiation (CD4) count of the group on HAART was significantly higher than the group not receiving HAART. The group not receiving HAART was stronger than the HAART group. No significant correlation was shown between length of time having received HAART and muscle strength, or between CD4 count and muscle strength in the group receiving HAART. A significant negative correlation was shown between CD4 count and muscle strength in the group not receiving HAART.

Conclusion

Further research is needed to establish the impact of earlier administration of HAART on muscle strength in children infected with HIV.
Evaluation and conservative treatment for Osgood-Schlatter disease: A critical review of the literature
Authors: Kabiri Laura , Tapley Howell , Tapley Stasia
Published: May 2014

Background

Osgood-Schlatter disease (OSD) is a tibial tubercle traction apophysitis resulting from repetitive strain on the patellar tendon insertion. OSD can lead to significant functional limitations and disability that can persist into adulthood.

Methods

The authors of this review systematically searched PubMed, CINAHL, TWUniversal, and The Cochrane Library for articles dated from January 1980 to December 2013 that related to the evaluation and conservative treatment of Osgood-Schlatter disease. Search phrases included ‘Osgood-Schlatter disease AND diagnosis’ and ‘Osgood-Schlatter disease AND treatment’. Articles were assessed for evidence strength based upon modified criteria from the evidence-based medicine pyramid and the diagnosis and treatment sections of the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Table.

Findings

There is a wealth of evidence to support a clinical diagnosis of Osgood-Schlatter disease. There is also fair evidence to employ functional outcome measures during evaluation. Evidence concerning conservative treatments for Osgood-Schlatter disease ranges from poor to strong based upon the intervention.

Conclusion

While strong evidence for clinical diagnosis is supported by the literature, further research is required to establish definitive functional outcome measures and effective interventions in the management of Osgood-Schlatter disease.
How we can learn from mistakes
Authors: Panting Gerard
Published: May 2014

No matter how careful nurses are, clinical errors are inevitable.
Raising awareness of testicular cancer
Authors: DeVille Almond Jane
Published: May 2014

June is Everyman Male Cancer Month. Jane DeVille Almond explains testicular cancer and how to broach the topic with young men
Ear pain in children
Authors: Gupta Rajeev , Gupta Pawan
Published: May 2014

A four part article covering the assessment of ear pain in children, injury to the ear, infections and other painful conditions, and foreign bodies and wax.
Cognitive behavioural therapy explained
Authors: Short Nigel
Published: May 2014

CBT can break the patterns of thinking and behaviour that frequently reinforce depression
Update on occupational asthma
Authors: McArthur Ruth JD
Published: May 2014

Inhalant exposure to a substance at work can lead to occupational asthma.
Diagnosing herpes viruses
Authors: Healy Rachel , Sahota Anshoo
Published: May 2014

Identification of this common infection can be problematic, write Dr Rachel Healy and Dr Anshoo Sahota.
Learning from analysis of significant events
Authors: McIntosh Iain
Published: May 2014

Significant event analysis is an important tool for continuing professional development
Changes to nurses' pensions
Authors: Quinn Kevin
Published: May 2014

April brings important changes to NHS pensions. Kevin Quin outlines the pros and cons for nurses.
Diagnosing adult eczema
Authors: Lawton Sandra
Published: May 2014

Eczema is a common skin disorder that can present in a variety of ways in adults. Sandra Lawton explains.
Clinical focus - Appendicitis
Authors: Dawson Joe
Published: May 2014

Epidemiology, the importance of early diagnosis, and management. Contributed by Mr Joe Dawson, specialist registrar in general surgery, Southend University Hospital NHS Trust.
Erectile dysfunction
Authors: Rees Rowland
Published: May 2014

Contributed by Mr Rowland Rees, consultant urological surgeon, Royal Hampshire County Hospital, Winchester
Boosting health through football
Authors: Andrews Crispin
Published: May 2014

A project in South Africa is using the World Cup to engage young patients.
Summary Care Records for all
Authors: Barr Fiona
Published: May 2014

Minsters intend all patients to be offered an SCR by the end of 2013.
Adjuvant analgesics in pain management
Authors: Hall Sandra
Published: May 2014

Adjuvant analgesia is becoming part of pain management, although many drugs used as adjuvant analgesics are not licensed for this indication.
Use of simulation for pre-hospital healthcare education
Authors: Smart Jonathan , Newton Andy
Published: May 2014

Simulation is increasingly being utilised for pre-hospital professional education in Europe. To ensure this growth continues, it is important that experience is shared throughout Europe to help ‘spread the word’ and share examples of ‘best practice’. The Society in Europe for Simulation Applied to Medicine (SESAM) is an organisation which was set up to help facilitate and exchange knowledge about the use of simulation in medical (and paramedical) education throughout Europe. Previous SESAM annual meetings have not attracted significant numbers of delegates from the pre-hospital professions. This could be because previous programmes have not had much direct relevance for this audience. Working with the SESAM executive committee for the 2012 annual meeting in Stavanger, the authors helped co-ordinate a group of European pre-hospital simulation educationalists to create a programme of presentations and workshops designed to be directly relevant to a pre-hospital professional audience. Attendance overall for the 2012 annual meeting in Stavanger was significantly higher than in 2011 and it appears that more pre-hospital professionals attended in 2012 (but this cannot be supported in this paper). The increased emphasis placed on pre-hospital simulation in Stavanger helped create a specific SESAM supported network (Pre-Hospital Special Interest Group or PH-SIG) and this network will help share simulation ‘best practice’ amongst European pre-hospital professionals in the future.
A review of nasogastric tube management in children 1: Enteral feeding
Authors: Clarke Sonya , Richardson Olga
Published: May 2014

This first article of two identifies the primary themes in the literature regarding nasogastric tube management in children. The principal focus is a critical evaluation of the methods, effects, experiences and outcomes of the primary theme, nasogastric tube feeding in children. This article concludes with the implications and recommendations for future nursing practice.

The in-depth critical review encompassed a systematic and rigorous search of appropriate healthcare databases using appropriate search terms in conjunction with preset inclusion and exclusion criteria. The review divided the harvested primary papers into three key themes: enteral feeding via the nasogastric tube (considered here); confirmation of tube position and associated incidence of tube placement error; hydration via the nasogastric tube for acute gastroenteritis in children. Valid and reliable methods were used to grade and appraise the culled papers so that conclusions could be drawn and recommendations made.

Three primary literary themes are identified from this investigation. The primary theme, enteral feeding using the nasogastric tube is contraindicated for a selection of children. In spite of these findings empirical evidence suggests the nasogastric tube as a safe and effective method for short term feeding in children with a variety of chronic conditions that can be regularly used at home and in hospital.

Health professionals need to review their practice in relation to nasogastric tube management in children, and ensure their practice reflects the best available evidence.
The impact of having a child with complex and continuing health needs on employment
Authors: Hewitt-Taylor Jaquelina
Published: May 2014

This paper discusses the experiences of parents whose children have complex and continuing health needs in relation to their ability to engage in paid employment. The findings are taken from a qualitative study of parents’ experiences of having a child who has complex and continuing health needs.

The principal findings of the study are that having such a child often alters their parents’ ability to engage in paid employment and the type of employment they can consider. The nature of their children’s needs means that they usually need more opportunities for flexible and part-time working than other parents. In addition, the availability of suitable out-of-school childcare for children with complex needs means that parents are often very limited in the hours they can work. Changes in their employment status can mean a significant reduction in the family’s income, and changes in the ways in which parents perceive themselves and in how others perceive them.

Service providers should consider the effect that the support offered may have on parents’ ability to return to work and, where parents cannot return to work, the loss of earnings that this occasions means families may need support to enable them to appropriately access the benefits to which they are entitled. In addition, where parents’ roles are significantly changed by being their child’s carer, nursing staff should be aware of the effect of society devaluing such roles on parents’ sense of self.

While this is a small study, it contributes to an increasing body of evidence that should inform the delivery of support for children and their families.
Preparing children for hospital: what does the evidence say?
Authors: O’Neill Colleen
Published: May 2014

Children like adults fear hospitals and health-care professionals must acknowledge the potential adverse effects that hospitalization can have on a child. The benefits of preparing children for hospitalization and medical procedures have been well documented in the healthcare literature. Various methods of preparation are advocated, all claiming to reduce children’s anxiety and stress as well as eradicating some of the reported adverse effects of hospitalization. Interventions include books, videos, play sessions and hospital pre-admission visits. Nurses must be cognisant of the various methods of preparing children for hospital in order to select the most appropriate method for each individual child. Although there appears to be a disagreement with regard to the best type of preoperative preparation, there is a consensus that some type of preparation should be offered to children. This paper reviews the current methods of preparation techniques and the role of the children’s nurse in relation to preparation.
Do caregiving models after cesarean birth influence the infants’ breathing adaptation and crying? A pilot study
Authors: Erlandsson Kerstin , Christensson Kyllike , Dsilna Ann , Jnsson Baldvin
Published: May 2014

Cesarean birth is a mode of delivery that often minimizes the mothers’ possibility to handle her term baby skin-to-skin while the father takes care of the baby for part, or all, of the first hours. No attention has, as far as we know, been given to different caregiving models and their eventual effects on the adaptation of breathing for the term infant born by elective cesarean. Previous publications on breathing patterns in newborn infants have mostly been conducted on premature infants in kangaroo care. The aim of this pilot study was to compare the effects of two caregiving models on the adaptation of breathing and infant crying after elective cesarean section, in term infants during the first hours after birth. Term infants born by elective cesarean were held skin-to-skin on their father’s chest or cared for in a cot during the mother’s post-operative observation stay. Thirteen father-infant pairs participated in a pilot sub-study with a randomized control trial design. Data were collected both by respiratory inductance plethysmography (RIP) and by tape-recorded crying time. The data raises important questions about the effects on breathing adaptation in relation to caregiving models. The infants in the skin-to-skin group showed significantly higher inspiratory and expiratory air flows, larger breath volume (all p<0.001) and minute ventilation, compared with the cot group. The infants in the skin-to-skin group cried less than the infants in the cot group (p<0.001). A caregiving model where fathers hold their infants skin-to-skin in an upright position on their chest has a positive impact on the infants’ respiratory adaptation and reduced infant crying. Larger studies of caregiving models after elective cesarean birth on the adaptation of breathing need to be conducted.