bluuebunny/crossref_metadata_2025 huggingface dataset:
General practice after the introduction of the QOF
Authors: Yahya Mohammad Al , Beck Matthias
Published: May 2014

While the Quality and Outcomes Framework (QOF) is reported to improve performance, its impact on some aspects of organisations need to be explored given the increased reliance on such schemes. Organisational culture can be seen as providing a sense of common values, belief, and norms, which may act as guidelines for behaviour in organisational settings. This research employs a competing value framework depictures different types of culture based on specific focuses and processes. The study is based on interviews with 2 GP practices in the north of England involving 19 participants. Healthcare professionals were aware that there is a dominant value held and shared strongly among members of the organisations—to provide high quality patient-centred services. This study found that while clan culture is still strong in both practices, changes occured in respondents’ culture after the implementation of the QOF.
Demand for hospital beds in primary care organisations
Authors: Jones Rod
Published: May 2014

This paper demonstrates that the ratio of bed days per death reflects the contribution from factors which increase demand for hospital admission and bed use. Data covering primary care organisations was extracted from a variety of sources and the relationships affecting higher bed days per death were explored. The capitation formula used to fund primary care organisations in England shows no correlation with bed days per death and may be inadvertently creating financial pressures. Healthcare policy needs to foster greater integration in healthcare. Bed days per death is introduced as a new performance measure which can be used to track the success of a variety of admission avoidance and other schemes for care in the community and to support international comparisons of bed utilisation.
Management of infertility in primary care
Authors: Wilkes Scott
Published: May 2014

It has only been over 30 years since the birth of Louise Brown, the first in vitro fertilisation (IVF) success. Since then, there has been a rapid rise in assisted reproductive technologies and the routine use of IVF in clinical practice. However, the ‘whole patient’ journey from presentation to final outcome has largely been ignored or served by outdated commissioning arrangements. This article reviews the role of primary care in investigation, diagnosis, obesity management, ovulation induction and referral, concluding that there is an urgent need for NHS commissioners to reappraise their fertility pathways.
GP referral to dermatology: which conditions?
Authors: Jones Rod
Published: May 2014

Over the past 15 years GP referral to dermatology has increased at a rate 2.4-times higher than expected. The reasons behind this are discussed and preliminary evidence is given to show that the changes are condition specific and that a time cascade in conditions appears to occur at key points of high growth.
Legal issues facing radiographers in Nigeria
Authors: Eze CU , Abonyi LC , Njoku J , Omiyi DO , Ayanru OI
Published: May 2014

Medical litigation cases are on the rise globally. Professional negligence is the cause of most medical litigations. The knowledge and attitude of radiographers to ethical/medico-legal issues in radiographic practice in Nigeria were assessed. A cross-section of radiographers was selected using convenience sampling method. A structured questionnaire was used to obtain the needed data. Data were analysed with SPSS computer software version 17.0 while Chi square was used to test for statistical significance at p = 0.05. More than 10% of radiographers in Nigeria were not aware of the increased demands in patient rights. Moreover, more than 10% did not know or were not sure of their ethical duty to the patient while more than 10% do not understand medical negligence with its implications. These results are statistically significant (p < 0.05). The awareness and attitude of radiographers to ethical and medico-legal issues are poor. Adherence to professional ethics of radiographic practice is advised to avoid a likely avalanche of medical litigations in the country in the near future.
Knowledge transfer partnerships: a case study
Authors: Cleaver Karen , Omolade Samuel , Usher Greg , Marks-Maran Di
Published: May 2014

Knowledge transfer partnerships (KTPs) enable universities to work collaboratively with businesses and other organisations. KTPs have mutual benefits for both organisations, enabling the university to increase its commercial potential and business/service organisations to increase their capacity for growth, development and sustainability. This article presents a literature review of KTPs followed by a case study of a KTP between a university (University of Greenwich) and a charity (The Metro Centre), which provides services to people experiencing issues related to sexuality, gender and diversity and that primarily supports lesbian, gay, bisexual and transgender (LGBT) people. An evaluation of this KTP has demonstrated gains and benefits for both the university and Metro, primarily in terms of increasing the evidence-base of the work of Metro and developing its research capacity. This has resulted in the acquisition of significant national funding for a range of projects and studies related to the aims of both the University and Metro.
Is the demographic shift the real problem?
Authors: Jones Rod
Published: May 2014

Rod Jones, statistical advisor, asks whether we should be blaming increased accident and emergency attendances and admissions on an ageing population
5 Steps to Safer Surgery: managing culture change
Authors: Jones Alistair D R
Published: May 2014

To display the difficulties in introducing team briefing and debriefing (part of the World Health Organization's (WHO) 5 Steps to Safer Surgery) and to calculate the impact its use has on efficiency in theatre. Twenty-two surgeons, anaesthetists, managers, scrub nurses and operating department practitioners filled in questionnaires asking about attitudes to the pre-existing ‘sign in, time out, sign out’ surgical safety checklist, attitudes to the introduction of team briefing and debriefing and attitudes to how it was implemented. Orthopaedic theatre efficiency before and after the introduction of team briefing was calculated. There was resistance to the implementation of team briefing and debriefing among some professional groups. Surgeons and anaesthetists were more likely to resist change, citing lack of engagement from management, briefings delaying the start of theatre lists and lack of evidence base for change. The number of operations performed in the three month period after the introduction of briefing and debriefing increased from 4.47 per list to 5.19 per list (p = 0.012). Attitudes to culture change are mixed, with staff more likely to resist change when they have not been consulted beforehand. The use of briefing and debriefing correlates with an increase in efficiency in theatre
Saving time, improving information: mobile devices
Authors: Jessop Steve
Published: May 2014

Steve Jessop, Chief Nurse Information Officer of Hull and East Yorkshire NHS Trust, argues that the way forward is using mobile devices for managing clinical information
Measuring Concordance in Clinical Practice
Authors: Barron Derek T , Snowden Austyn
Published: May 2014

This article describes the construction of a tool to measure concordance in clinical practice. The second of two parts, it details the strategic background underpinning concordance and expands the rationale as this relates to the construction of individual items within the evaluation tool used and described. Cribb (2011) considers that while policy drivers extol the rhetoric of shared decision-making and person-centred care, the application of this is complex. Cribb's thesis is summarised to show that the evaluation tool is grounded in the right type of evidence to support the facilitation of concordance in clinical practice.
Influence of British army nurses on mental healthcare
Authors: Finnegan Colonel Alan , Nolant Peter
Published: May 2014

Without war and conflict, the mental health treatments that are now considered routine in the NHS and civilian practice would not exist. This article discusses how many mental healthcare initiatives have emerged as a result of the requirement to provide high-quality nursing care for soldiers. Much has been learned since the first formal deployment of army nurses during the Crimean War (1853–56). Reference will be made to how military conflicts have shaped clinical nursing practice within civilian health services in areas including group psychotherapy, assertive outreach, community based care, and crisis intervention. It focuses on the period 1853–1918, and aligns lessons learnt to recent nursing-led initiatives for the care of soldiers and their implications for occupational mental health services.
Prevention of self-harm and suicide: innovations in practice
Authors: Ashcroft Henry , Caulfield Michael , Proctor Sarah
Published: May 2014

Continuous special observation (CSO) is used in inpatient psychiatry, for patients who are at risk of suicide and self-harm. This article reviews the evidence for the practice and recent innovation in CSO. The findings highlight the lack of evidence to support the practice and discusses the recent developments that show promise for a more dynamic and patient-centred approach. These include using a standardised algorithm for assessment and use of CSO, using an observation checklist at the end of each shift, and using patient-agreement to increase autonomy and trust.
Self-managing mental health: The WRAP approach
Authors: Stokoe Nicole , Bradbury Katherine
Published: May 2014

Despite increasing popularity, the Wellness Recovery Action Plan (WRAP) has few published efficacy studies. WRAP aims to support participants to take ownership of their mental health and wellbeing through facilitated groups. Bandura's (1977) self-efficacy mechanism framework proposed that a person's belief in their ability to use coping skills is predictive of future behaviour. This project focused on evaluating the effectiveness of WRAP for improving coping self-efficacy, confidence and clinical outcomes for adults with mental health difficulties supported through NHS community mental health teams. 17 participants took part and showed significant mean differences between their pre- and post-scores for coping self-efficacy, mental health confidence, depression and overall distress. These findings suggest that WRAP improves coping self-efficacy and confidence in ability to self-manage, and reduces levels of distress and low mood. Improvements in ability to seek support and cope related to improvements in all but one of the clinical outcomes. Further research with larger samples, follow-up data, comparison and control groups is suggested to identify key variables for enhancing change.
A tool to measure progress and outcome in recovery
Authors: Ion Robin , Monger Bridey , Hardie Scott , Henderson Nigel , Cumming Jane
Published: May 2014

Recovery and the use of routine outcome measurement tools are key topics for mental health nurses. This article reports on research carried out to assess the usability of an outcome measure designed to assess recovery in clinical practice. Results indicate that the Individual Recovery Outcomes Counter (I.ROC) is both easy to use and well liked by services users.
Is CBT an appropriate intervention in reducing anger and aggression?
Authors: Carthy John , Dudley Alison , Ayres Joe
Published: May 2014

This literature review aims to identify cognitive behaviour therapy (CBT) for anger models, and examine their efficiency. This article aims to determine whether current approaches can be adapted to provide an appropriate intervention in a high-secure, mentally disordered offender (MDO) population.
Fundamentals of fluids and hydration in the nursing of the neuroscience patient
Authors: Cook Neal F
Published: May 2014

Fluid and electrolyte management is a fundamental aspect of the role of the neuroscience nurse. Hydrational and electrolyte status are crucial mediators to the extent of the neuro-hormonal response to trauma. This is of particular significance for those with neurological disorders, considering the vital role the central nervous system plays in the regulation of hydration and electrolyte status. This paper reviews the physiology related to the homeostatic maintenance of hydration and electrolyte status, while reviewing the criteria associated with an in-depth nursing assessment of hydrational and electrolyte status. Issues concerning accountability and role are acknowledged within the current context of contemporary nursing practice.
The sources of ethical deliberation in neuroscience nursing: Three case scenarios
Authors: McLeod Anne
Published: May 2014

Neuroscience nurses may encounter ethical dilemmas during their work. To promote clarity over the decision-making process, it is essential that nurses have an insight into ethical principles that are applied in the treatment of patients. Clear definitions are also required so that there is a clear distinction between legitimate treatment cessation and euthanasia, thereby ensuring adherence to legal perspectives. This article explores these principles and applies them to clinical scenarios. Through this application, neuroscience nurses will gain an appreciation of how difficult decisions are made and the guiding values that are used to make them.
National survey has important implications for MS nurse specialists
Authors: Porter Bernadette
Published: May 2014

Two years on from the arrival of the national guidelines for management of multiple sclerosis (MS) and very little has improved. That is the message from the first ‘360-degree’ national audit of NHS services for MS, jointly commissioned by the Royal College of Physicians and the MS Trust (2006).
A review of the use of cognitive stimulation therapy in dementia management
Authors: Spector Aimee , Orrell Martin
Published: May 2014

There has been increasing interest in therapeutic interventions for dementia. Although the main emphasis has been on drug therapies, there is growing recognition that psychosocial interventions have an important role to play. This has been highlighted in the draft guidelines for the care of dementia released by the National Institute for Health and Clinical Excellence. Cognitive stimulation therapy is a brief treatment for people with mild-to-moderate dementia. It is based on the theoretical concepts of reality orientation and cognitive stimulation. It involves 14 sessions of themed activities, which usually run twice a week over a 7-week period. A multi-centre, randomized controlled trial showed that cognitive stimulation therapy, when compared to no treatment, led to significant benefits in cognition and quality of life. Cognitive stimulation therapy is also cost-effective, and benefits in cognition are comparable to those gained through medication. This review discusses how cognitive stimulation therapy was developed and evaluated, the implications of its effectiveness and how it might be used in a clinical setting.
Understanding fatigue in multiple sclerosis: A case study inquiry
Authors: Warner Richard
Published: May 2014

This case study used a range of data collection methods, including actigraphy and self-report measures, to gain data that demonstrate the complexity of fatigue related to multiple sclerosis. This unique combination and use of data collection techniques have made it possible to record data as they are occurring. Analysis has demonstrated a statistically significant correlation between physical activity and perceived levels of fatigue. This is an important finding because these techniques could be useful in evaluating psychosocial interventions for fatigue in multiple sclerosis.
Emotional support after stroke, part 1: Two models from hospital practice
Authors: Bennett Bev , Barnston Sue , Smith Rachael
Published: May 2014

Admission to hospital following a stroke can be an emotionally overwhelming experience for patients. Nurses make an important contribution to stroke rehabilitation, and the ways in which they respond to a person's emotional needs can significantly affect the patient's recovery. Insights from people who have experienced a stroke suggest that patients need opportunities to talk, but nurses do not always have the time to explore with patients how they are feeling. In this first of two articles, examples from hospital-based practice are used to illustrate successful approaches to addressing patients' emotional needs. It will be explained how a ‘tell your story’ group offers patients opportunities to explore their feelings in a safe and supportive environment, while one-to-one, person-centred counselling enables patients to learn to understand that the emotions they are experiencing are normal reactions to a stroke. Both approaches highlight the need to look beyond physical recovery and address a person's emotional needs following a stroke.
Euthanasia: A caricature of care, not a cure for suffering
Authors: Robinson Vicky , Clarke Jan , George Rob
Published: May 2014

The legacy that a ‘bad death’ leaves in society is destructive and very real. Over half of complaints to the NHS relate to poor care of the dying (Healthcare Commission, 2007). Yet evidence exists that what the dying want is dignity, i.e. a sense of worth. According to the Department of Health (DH) (2006), this means ‘being treated as though I am somebody’. Skilful nursing delivers dignity (Hunt, 1992; May, 1995). Any act of killing by assisted suicide and euthanasia fails to meet any of these needs and at best is a caricature of good care. Therefore, the efforts of health professionals should be focused on raising the levels of skill among health-care teams to relieve suffering and promote dignity, not burying the problem by burying the patient. Furthermore, to change the law will change everything.
Long-term neurological illness in parents has a substantial impact on the lives of children
Authors: Jahanshahi Marjan , Sheikh Shamira
Published: May 2014

A chronic illness, such as Parkinson's disease, affects the daily life of the patient and that of the family. While the effects of Parkinson's on the psychosocial functioning and quality of life of the patients and the spouse/carer have been investigated, there is limited information about the impact of parental Parkinson's on children. No instruments were available for quantitative assessment of the impact of chronic parental illness on children. As a first step towards investigating the psychosocial effects of parental Parkinson's on children, the Parental Illness Impact (PII) Scale was developed by our group at the Institute of Neurology. Studies of its psychometric properties have established that the PII Scale is a reliable and valid measure. Using this scale, we found that the greatest effect of parental Parkinson's was in terms of family functioning, burden of daily help, communication and understanding, and impact on personal future. In contrast, for the sample as a whole, the domains of social development, independence and responsibility, and friends' reactions were less severely affected. Compared to other chronic disorders, parental Parkinson's had the least negative impact (and parental multiple sclerosis and stroke the greatest impact) on children. Medical professionals need to be aware of the implications of chronic neurological illness for the family. Medical management of long-term neurological disorders should extend to the impact of these disorders on families.
Nurse prescribing: benefits and limitations for the clinical nurse specialist in multiple sclerosis
Authors: Embrey Nikki , Lowndes Claire
Published: May 2014

The nursing and health service environment is one of constant change. In particular, changes involve the development of new and expanding roles for health professionals. The extension of prescribing power to nurses and other health professionals is a significant example with important implications for the health care of patients. Opportunities now exist for nurses to take the lead role on improving holistic care for patients. Some practices, currently provided by medical staff within specialities, can be better coordinated through nurse-led services, ultimately enhancing the patient's care pathway and enhancing the nursing skills of the clinical nurse specialist. This article discusses how the clinical nurse specialist in multiple sclerosis can use prescribing skills to provide a more holistic service for people affected by multiple sclerosis. A brief overview of multiple sclerosis is provided, followed by an outline of the history of nurse prescribing. It will assess the benefits of prescribing for patients, nurses and medical staff will be assessed and the legal aspects of nurse prescribing discussed.
Non-traumatic spinal cord injury part 2: Causes and care of transverse myelitis
Authors: Pellatt Glynis Collis
Published: May 2014

Transverse myelitis is an inflammation of the grey and white matter of the spinal cord that can be caused by a range of inflammatory diseases and infections. The damage to the spinal cord can in some cases be severe causing permanent disability. Transverse myelitis has implications for nurses in primary, acute and rehabilitation settings yet with the exception of multiple sclerosis there is very little nursing research to provide an evidence base for nursing interventions. This article discusses inflammatory and infectious causes of transverse myelitis and offers a nursing perspective. The need for nursing research in this area is highlighted.
An audit of nurses' conduct and recording of observations using the Glasgow Coma Scale
Authors: Waterhouse Catheryne
Published: May 2014

Objectives:

The Glasgow Coma Scale (GCS) is routinely used to assess patients following head injury or other acute neurological events. The aims of this project were: to assess and evaluate registered nurses' baseline knowledge of the three behavioural responses that make up the assessment tool; to review the recording of GCS in neuroscience areas compared with non-specialist units; and to ascertain when the GCS is taught during nurse training and the background experience of the lecturers who teach it.

Methods:

Sixty questionnaires were used across six clinical areas: neurosurgery, neuro-intensive care, neuromedicine, general medicine, accident and emergency, and general intensive care. Observational studies compared nurses' performance, recording and documentation of GCS observations in each of these units. The unpublished standards for making GCS observations, written by the Neuroscience Nursing Benchmarking Group, were used to identify questions for examination in the audit.

Results:

Several areas for improvement were identified; including the use and application of painful stimulus. The use of sternal rubbing and nail bed compression continues to be common practice. Data collected also suggested a lack of knowledge of the patho-physiology underpinning the three components that make up the scale. Problems were evident in the record keeping, with very few examples of documentation within nursing records of the separate components of the GCS. Finally, the questionnaires returned from the universities revealed that students were introduced to the assessment tool during the first year of training, normally by lecturers with a critical care or accident and emergency clinical background.

Conclusions:

The data demonstrated wide variation in GCS scoring across all specialties. While the benchmarking standards are applied in neuroscience wards, the guidelines are not widely available for use in other units. It is pertinent to consider whether access to a clear and comprehensive protocol would help remove some of the ambiguities and ensure a more consistent approach to assessment. Novel approaches to education are required to maintain knowledge and skills in this area of practice. Documentation needs to improve and include the results from component parts of the scale. Instruction on the performance of GCS observations, if taught in the first year of training, should be re-examined, linking theory to practice prior to qualifying. The findings from this study will provide a useful basis for future research using more precise methods.
Centres of excellence for the care of people with progressive ataxias
Authors: Greenfield Julie , Treacy Colm , Giunti Paola
Published: May 2014

The progressive ataxias are a heterogenous group of neurological disorders comprising conditions that result in disturbances of coordinated movements. Ataxia patients can face numerous difficulties in everyday life. A multidisciplinary approach to care is important, including the role of the clinical nurse specialist. Nurses can provide an important link between health and social care professionals involved in a patient's care. Their role includes assessment of daily living and making referrals to appropriate professional support. The development of specialist centres of excellence for the diagnosis and management of people with ataxia can bring important benefits to the management and quality of life of patients.
Marking 20 years of Parkinson's disease nurse specialists: Looking to the future
Authors: Osborne Lynne
Published: May 2014

This year we celebrate 20 years since the introduction of the first Parkinson's disease nurse specialist (PDNS) in Cornwall. Vast improvements in Parkinson's care have resulted from the creation of about 270 posts, throughout the UK, since 1989. With a population of 100000 people with Parkinson's disease (PD) in the UK and 10000 new cases of this long-term condition each year, this specialist role is clearly needed.

Nationally, access to a PDNS varies, and in areas of the country where there is an established PDNS service there can be problems with unmanageable caseload numbers. This has been an issue in Cornwall, so a combined approach of utilising alternative models of care along with the extension of practitioners' roles, has helped meet service demand.

However, with a possible reduction in commissioning of nurse specialists in the next few years different approaches to care will be essential to provide care effectively for the growing caseloads of such nurses.
The use of music therapy in neuro-rehabilitation of people with acquired brain injury
Authors: Magee Wendy L , Baker Mark
Published: May 2014

The purpose of this paper is to provide a practical overview for nurses of the evidence for and uses of music therapy for people following acquired brain injury, and to highlight its relevance to the nurse's role in providing care for this patient population. As a specialist clinical intervention, music therapy is able to effect changes in physical, cognitive, psychosocial and communicative functioning for people with acquired neurological disorders, indicating its role in multiprofessional teams offering maintenance or rehabilitation programmes. Although the growing body of evidence is yet to be assessed, a number of small studies offer promising results. An overview of the evidence for music therapy with people with acquired neurological conditions will be given, with a particular focus on methods of intervention which have been researched to address physical, communicative, cognitive and emotional functioning. The possibilities for collaborative practice between nursing and music therapy are highlighted.
The use of painful stimulus in relation to Glasgow Coma Scale observations
Authors: Waterhouse Catheryne
Published: May 2014

The Glasgow Coma Scale is a well established and invaluable tool that enables practitioners to make systematic and rapid evaluations of several key indicators of neurological status. The National Neuroscience Benchmarking Group has written standards and guidelines for the performance of neurological observations based on the best evidence, knowledge and skills of nurses from around the UK, which is available to members of the benchmarking group and the British Association of Neuroscience Nurses. However, discussion continues about the most effective and appropriate method of applying painful stimulus and the requirement to use a central or a peripheral pain stimulus. An understanding of the pathophysiological basis for the procedure may help guide and direct future management options.
Applying specialist nurse skills to improve epilepsy adolescent transition services
Authors: Chisanga Erica
Published: May 2014

Epilepsy is one of the most common chronic neurological disorders. A diagnosis of epilepsy during childhood and care received in a paediatric healthcare setting does not automatically prepare the young person for use of services that are tailored for adults. This article considers the epilepsy adolescent transition service that is provided at Cambridge University Hospitals NHS Foundation Trust (CUHFT) and focuses on the role that the specialist nurses play in providing this valuable service. This service was set up in 2004. It is staffed by two consultant paediatric neurologists both with a special interest in epilepsy, one community paediatrician, one adult neurologist with a special interest in epilepsy, one adult specialist nurse (nonmedical independent prescriber) and one paediatric epilepsy specialist. The clinics are run every 3 months at Addenbrooke's Hospital in the paediatric clinic.
Psychosocial outcome following subarachnoid haemorrhage: An under-researched problem
Authors: Noble Adam J , Schenk Thomas
Published: May 2014

The high mortality rate associated with spontaneous subarachnoid haemorrhage (Hop et al, 1997) has meant that for a long time research on subarachnoid haemorrhage has focused on gross morbidity and survival time. However, improving survival over the last few decades (Nieuwkamp et al, 2009) has meant that it is now important to also examine subarachnoid haemorrhage patients' psychosocial outcome. This has been measured by asking patients to report on their health-related quality of life (HRQoL). Research that has looked into the effects on HRQoL of subarachnoid haemorrhage has found significant reductions compared to both normative levels and that reported by persons after other illnesses (e.g. Deane et al, 1996; Hackett and Anderson, 2000). Despite their importance in explaining more fundamental aspects of outcome after subarachnoid haemorrhage, classical predictors–such as patient age, sex, clinical severity, bleed severity, physical and cognitive disability–have not been found to help explain the reduction in subarachnoid haemorrhage HRQoL. This article will examine why traditional predictors are of little use in explaining subarachnoid haemorrhage patients' HRQoL. The evidence on alternative explanative factors is discussed. The evidence suggests that there are indications that the secondary consequences of subarachnoid haemorrhage in the form of post-traumatic stress disorder (Noble et al, 2008) and hormonal dysfunction (Kreitschmann-Andermahr et al, 2007) may better account for the reduced HRQoL after subarachnoid haemorrhage.
Neuroscience nurses' perceptions of caring for challenging patients
Authors: Soreny Cathy
Published: May 2014

Within the neurosciences, many patients display challenging behaviours. This study set out to gain an understanding of registered nurses' experiences of caring for this patient group. One-to-one qualitative interviews were conducted with four nurses. The sample was drawn from a neuroscience department including neuromedical, neurosurgical and critical care wards. Data were analysed using Ritchie and Spencer's framework (1994). The experiences described fell into four main categories: the context of neurosciences (patient group and behaviours), understanding the causes and impact of challenging behaviour, informal and structured tactics and strategies in dealing with challenging patients, and utilization of support from colleagues and mental health professionals. Nurses felt frustrated at their lack of mental health skills. They described impact on time and feelings of resentment, but also reported enjoying the challenge of delivering care. The need for mental health skills training was highlighted.
Spasticity management, part 3: Surgery and the use of intrathecal baclofen
Authors: Keenan Elizabeth
Published: May 2014

Spasticity is a common symptom of neurological conditions such as cerebral palsy, multiple sclerosis, traumatic brain injury, stroke and spinal cord injury. It occurs when there is an imbalance between inhibitory and excitatory signals from the spinal cord and brain. Spasticity is complex and requires careful evaluation within a multidisciplinary team so that treatment options can be tailored uniquely to the individual's needs.

Many patients with spasticity try a combination of anti-spasmodic medications over a period. Unfortunately high doses of anti-spasmodic medication can be hard to tolerate as significant side effects can impair quality of life, causing fatigue and cognitive side effects. Intrathecal baclofen is often recommended if all other management strategies are failing. Other more invasive neurosurgical and orthopaedic interventions are considered occasionally; however, these are used infrequently in the adult population and are beyond the scope of this paper.
Activated thalamic glucose metabolism after combined donepezil and psychosocial intervention
Authors: Meguro Mitsue , Meguro Kenichi
Published: May 2014

Effectiveness of donepezil in slowing the rate of cognitive decline in Alzheimer's disease (AD) has been established. Psychosocial interventions, such as reminiscence therapy and art therapy, are also known to have some clinical effects. However, combined effect of donepezil and psychosocial interventions on cerebral glucose metabolism has not been investigated. A case study using (18F) fluorodeoxyglucose and positron emission tomography revealed that cerebral glucose metabolism in the thalamus and fronto-subcortical network was stimulated after the combined intervention. These areas are considered not to be severely affected by pathological changes in AD. The comprehensive approach of donepezil and psychosocial interventions was judged to be effective for AD patients.
Use of brain computer interfaces in neurological rehabilitation
Authors: Siang Ang Chee , Sakel Mohamed , Pepper Matthew , Phillips Malcolm
Published: May 2014

Brain computer interfaces (BCI) enable users to transform their thoughts into actions without involving voluntary motor movement. This relatively new user interface technology not only offers those with severe neuromotor disabilities a new means to interact with the environment, but can also provides effective and engaging rehabilitation to restore motor or cognitive functions that have been impaired due to disease or trauma. This article summarizes the use of BCI in neurorehabilitation settings based on a review of relevant literature. It also identifies the challenges of BCI and provides recommendations for practical use and future directions for research. BCI could be a promising tool to assist patients undergoing neurological rehabilitation by providing access to environmental control and communication, as well as neurofeedback rehabilitation.
Multiple sclerosis and bladder dysfunction
Authors: Moore Katie , Tawadros Cecile , Betts Christopher
Published: May 2014

Bladder dysfunction in multiple sclerosis (MS) often results in distressing urinary symptoms that can seriously limit daily activities and have an adverse effect on quality of life. Professionals managing patients with MS should have a good understanding of the bladder dysfunction and the modern treatments available to control the urinary symptoms. Fortunately, with simple investigations and the institution of appropriate treatment continence can often be achieved. In view of the progressive nature of multiple sclerosis the patients need regular review of their bladder management by a well-trained multidisciplinary team.
An overview of traumatic spinal cord injury: part 1. Aetiology and pathophysiology
Authors: Sarhan Firas , Saif Danah , Saif Ahmad
Published: May 2014

The history of spinal cord injury (SCI) dates back as far as the ancient Egyptians, who described it as an ‘ailment not to be treated’ ( Eltorai, 2003 ). For a long time, victims of SCI saw a bleak future confined to a wheelchair and a lifetime of comorbidities and poor survival rates ( McDonald and Sadowsky, 2002 ). It was not until after World War II that the outlook for such patients began to improve ( Eltorai, 2003 ). The development of an infrastructure for the emergency transportation of injured patients and advances in acute care and rehabilitation practices have dramatically reduced mortality and morbidity ( Talu et al. 2005 ). Therapies to enhance neurological function following SCI have been extensively investigated by the clinical and scientific community. Subsequently, significant insight has been generated into the pathology and pathophysiology of acute spinal cord trauma. It has been hypothesised that the primary mechanical injury to the spinal cord initiates a cascade of vascular, cellular and biochemical events that cause extension of the injury site. Current interventions for the acutely cord-injured patient attempt to minimise this secondary injury and protect the tissue that initially survived the mechanical injury ( Dumont et al, 2001 ; Kwon et al. 2004 ; Li and Yang, 2009 ).
Protecting the autonomy of patients with locked-in syndrome through conserving dignity
Authors: Sorenson Claire , Bounds Dawn , Huffine Julie , Moss Angela
Published: May 2014

Locked-in syndrome (LIS) is a unique condition characterised by complete paralysis without loss of consciousness. This limitation places affected individuals at risk of having their autonomy violated. Communication is severely limited in LIS patients, impairing their ability to express needs, wishes, and preferences regarding health-care decisions. Health-care providers might therefore take a paternalistic approach to patients’ care, infringing on patient autonomy. In addition, these limitations present challenges for including LIS patients in decision making; health-care providers have a responsibility to find ways to overcome these challenges. Literature suggests that preserving patient dignity is an effective way of protecting patient autonomy. This paper uses the Dignity Conserving Care (DCC) Model to identify potential violations of autonomy, related nursing diagnoses, and evidence-based practices to preserve dignity and protect the autonomy of patients with LIS.
An overview of traumatic spinal cord injury: part 3. Rehabilitation
Authors: Saif Danah , Saif Ahmad , Sarhan Firas
Published: May 2014

Rehabilitation for people with spinal cord injuries (SCI) is a lifelong process that starts in the critical care setting and continues into primary care, with the aim of restoring an individual's functional skills and enabling them to regain self-sufficiency and independence. While the injury in itself is life-changing, the major factors affecting morbidity and mortality in the long term are related to complications of the SCI. Previous articles in this series have discussed the occurrence of acute complications and their immediate management, including haemodynamic and respiratory issues. These may become chronic and patients will often have to be readmitted for care. Early management aims to prevent issues arising further along the rehabilitative process; nevertheless, SCI patients are prone to pressure ulcers and neuromusculoskeletal disorders as ambulatory patients. Prevention should be the mainstay of care, and nurses have a pivotal role in this.
The personal impact of disclosure of a dementia diagnosis: a thematic review of the literature
Authors: Mitchell Gary , McCollum Patricia , Monaghan Catherine
Published: May 2014

Background: Decisions around disclosure of a diagnosis of dementia are not always patient-centred; a plethora of literature supports the notion that physicians do not always clearly and directly disclose the diagnosis to the person with dementia.

Aim: To conduct a thematic review of the literature in relation to the effects of disclosing a dementia diagnosis to the person with dementia.

Method: The literature was searched between February 2013 and June 2013. To enable detailed appraisal and analysis, only studies conducted from 2006 onwards were reviewed.

Results: The perceived negative impacts of disclosure, i.e. depression and suicidal tendencies, were not as common as the background literature suggests. Disclosure had many positive outcomes, for example in terms of future planning and the ‘relief’ that a recognised disease was the cause of the symptoms as opposed to ‘old age’.

Discussion: The person with dementia has a right to disclosure in all instances, even if to decline a formal diagnosis. Through omission of a clear diagnosis, the person is disempowered. A clear diagnostic framework is absent. Diagnosis should take place over multiple sessions, not only to facilitate coping but also for practical reasons, for example to allow adequate recall.
Baby friendly initiative: a cause for concern?
Authors: Chaffer Denise
Published: May 2014

As maternity units throughout the UK strive to achieve baby friendly status, it is apparent that some have reservations about the initiative. To date only a few maternity units in the UK have achieved this award, despite overwhelming evidence relating to the benefits of increased breastfeeding. Some health professionals have suggested that the campaign is ‘wholly inappropriate in a developed country’ (Williams, 1996) while others have focused on the issue of choice for women in deciding how to feed their baby.
Can midwives respond to the needs of fathers?
Authors: Lavender Tina
Published: May 2014

An exploratory study was conducted In a regional midwifery unit in Liverpool in August 1995 to discover the knowledge and feelings of a group of first-time expectant fathers in their anticipation of labour.

The study design was a combination of specifically designed questionnaires and semistructured interviews. The data was presented following qualitative analysis. Three main themes emerged from this analysis — support, information and role conflict.

This study demonstrates that the inclusion of expectant fathers in the birth experience needs greater consideration by health professionals.
Midwife ventouse practitioners
Authors: Mulholland Louise
Published: May 2014

Some midwives have developed particular expertise in certain areas and with formal training are extending their roles. A small number in two areas of the country have become ‘midwifery ventouse practitioners’. Is this appropriate to the midwifery profession?
Restriction of oral intake for women in labour
Authors: Sharp Deborah Anne
Published: May 2014

While working in the delivery suite it has been observed that labouring women frequently request to have something to eat or drink. However, once in established labour they are mainly only permitted to have sips of water or ice cubes. The policy of prohibiting oral intake for women in established labour has been questioned. The available research and evidence at the time of writing has been reviewed to produce a literature review of the topic of restriction of oral intake for women in labour.
Pre-registration student midwives: ‘Fitting In’
Authors: Yearley Carole
Published: May 2014

This study explores some of the experiences of a small group of pre-registration (long) student midwives using an ethnographic approach of enquiry; the emphasis is on the analysis of the students' perceptions of the clinical environment. Issues are explored which relate to some of the ways they learn how to function and behave in what they see as a novel and sometimes hostile world. The paper discusses how the informants strive to initiate and develop occupational and personal relationships with midwives who act as professional ‘gatekeepers’. The findings have been places within an anthropological framework in order to demonstrate the relevance and value of medical anthropology for midwives and midwifery.
Lesbian parents talk about their birth experiences
Authors: Stewart Mary
Published: May 2014

This qualitative study set out to ask whether the maternity services are meeting the needs of lesbian parents. Women who have had babies within a lesbian relationship were interviewed using semi-structured in-depth interviews. The data was analysed using a phenomenological approach. Six common themes emerged from the material analysed, namely: communication; choice, continuity and control; support; being accepted; assumptions and stereotyping and, finally, homophobia. Some of these themes are common to previous work that has been done, examining the needs of women as users of the maternity services. Some of these themes, however, are related to the participants' sexuality. There is, at present, an assumption by the maternity services that all women are heterosexual and the language, culture and philosophy of care further reinforce that assumption. In order to provide a system of care that is truly woman-centred there is a need to challenge assumptions of heterosexuality, and to acknowledge the existence and unique needs of lesbian parents.
Power and political power positions in maternity care
Authors: Harcombe Joanne
Published: May 2014

Power is not a new concept in relation to maternity care. However, discussion regarding the use and misuse of power is becoming high profile. Throughout history it is possible to trace the development of certain ‘power positions’ for obstetricians, midwives and women. This article discusses how socio-political developments and may have shaped the above ‘power positions’. The issue of obstetric and midwifery power reflects a historical power struggle for both ‘expert’ and ‘positional’ power status. The power position of women is more complex and this article highlights that a covert ‘third dimension of power’ may have been involved in shaping women's perception of their own needs. The implementation of Changing Childbirth (Department of Health, 1993) is challenging established positions and this explores how obstetricians, midwives and women are responding. Attitudes are changing and the ideology of women's empowerment is becoming accepted and valued. The challenge is now for women, midwives and obstetricians to re-examine power positions, abandon the power struggle and to work together in creating a positive climate for change.
Home birth: the midwife effect
Authors: Hall Jennifer
Published: May 2014

This paper describes a couple's contrasting experiences of two home births in different areas of the country. An analysis follows of the actions of the midwives concerned, and suggests the need for different attitudes in the home environment compared to hospital births. It is recommended that midwives should be competent to practise in the home for the safety of the mother and baby, and that the issues raised should be addressed by all concerned with the future of home birth.
Working time regulations and the midwife
Authors: Dimond Bridgit
Published: May 2014

This paper explores the implications of the Working Time Regulations for the midwife. It discusses the fundamental provision that working time including overtime should not exceed an average of 48 hours for each seven days. Regulations relating to night work and to documentation are also considered. While doctors in training and ambulance officers are specifically excluded, midwives are exempt if their activities involve the need for continuity of service in relation to the treatment or care provided by hospitals. Individual midwives may agree to work longer than 48 hours a week, but this must be voluntary and put in writing.