bluuebunny/crossref_metadata_2025 huggingface dataset:
Senile onset Tourette's syndrome
Authors: Sikdar S , Paranthaman R
Published: May 2014

Gilles de la Tourette's syndrome (named after a French neurologist) is a relatively rare neuropsychiatric disorder of childhood that presents with fluctuating vocal and motor tics.
How is health-care education to be organized in the new NHS?
Authors: Gilliland Elaine A
Published: May 2014

The programme of modernization in the NHS strives to introduce a comprehensive framework for quality, including mechanisms to set standards and to assess and inspect performance.
Active hypothermia in the management of head injuries
Authors: Martin Daniel , Smith Martin
Published: May 2014

For over half a century scientists and clinicians have been attempting to discover if moderate therapeutic hypothermia (32–34°C) is beneficial in the treatment of severe brain injury. Deep hypothermia (15–22°C) has long been recognized as one method of achieving neuroprotection, but is not without serious implications and risks to the patient. However, hyperthermia among headinjured patients is known to be associated with a worse outcome as compared to a normothermic cohort. Early work suggested that hypothermia could protect the brain after traumatic head injury.
The future health-care worker: health-care practitioner
Authors: Yoong Kevin KY , Clarke Sian , Heymann Tim
Published: May 2014

Changes in working patterns, advances in technology and changing patients' expectations are increasing the difficulties with recruitment and retention of appropriately skilled health-care staff (Hutchinson et al, 2001). This has resulted in increasing difficulty in meeting the population's health-care needs. Newer ways of working that may attract additional staff into the service and better ways of deploying the resources of new and existing staff may help ease the problem. This editorial considers one such initiative: the health-care practitioner (HCP) model that is being piloted in general (internal) medicine at Kingston Hospital, a district general hospital to the south west of London.
The role of infection in preterm labour and birth
Authors: Lamont Ronald F
Published: May 2014

Preterm birth is the major cause of neonatal mortality and morbidity. Infection is a major cause of preterm labour. Abnormal genital tract flora in early pregnancy is predictive of preterm labour. Antibiotics may be of help in preventing preterm birth.
The impact of multiple preterm births on the family
Authors: Bryan Elizabeth
Published: May 2014

As the number of multiple births has steadily risen over the past 20 years, twins and triplets form an increasingly large proportion of the preterm population. This causes a number of stresses to their families. Addressing the cause of the epidemic of iatrogenic multiple births is the most effective way to reduce the number of preterm infants and the long-term problems to which they are prone.
Memantine (Ebixa®) in the later stages of dementia
Authors: Findlay David J , Connelly Peter J
Published: May 2014

Memantine is the first agent licensed for the treatment of moderate to severe Alzheimer's disease. It is an N-methyl D-aspartate (NMDA) receptor antagonist which reduces glutamatergic excitotoxicity. Benefits are seen in cognitive, functional and global measures in both outpatients and nursing home residents. Prospective health economic benefits have been reported.
Relapsed non-Hodgkin's lymphoma with high CA-125 mimicking ovarian tumour
Authors: Leong CF , Cheong SK , Ng P , Amran AR
Published: May 2014

A25-year-old woman was initially diagnosed to have stage IIB non-Hodgkin's lymphoma in April 1999 when she presented with shortness of breath and features of superior vena cava obstruction. She was treated with eight courses of CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) and showed complete response with disappearance of all the enlarged lymph nodes. She remained well for about 18 months until July 2001, when she presented again with shortness of breath, loss of appetite and loss of weight. Physical examination and investigations confirmed relapsed non-Hodgkin's lymphoma (huge mediastinal mass with right pleural effusion). She was then treated with salvage therapy with ICE (ifosfamide, carboplatin, etoposide). She was given six courses of ICE followed by irradiation to the mediastinum in view of the bulky disease. At the end of the radiotherapy, computed tomography of the thorax and abdomen showed no residual mediastinal mass or mediastinal lymph nodes, but bilateral ovarian tumours (Figure 1a) (the right ovarian mass measured 27 × 20 cm, left ovarian tumour measured 15 × 20 cm), and bilateral hydronephrosis (Figure 1b) were visible. Investigations showed markedly raised CA-125 (1216 U/ml) and lactate dehydrogenase (3147 umol/litre), and normal CEA and alpha-fetoprotein.

During open biopsies of the ovaries, multiple nodules were noted in the omentum. The histopathological examination of both ovarian (Figure 2) and omentum biopsies indicated non-Hodgkin's lymphoma, diffuse, large cell and B cell type. After the operation, the patient deteriorated rapidly with malignant ascites and massive pleural effusion, and died.
The eye in lung disease
Authors: Kok Howe Sen
Published: May 2014

This article reviews disorders in which both pulmonary and ocular disease can occur. These may occur at the same time or the disease process can start in one and involve the other later. Different treatments may be needed as the severity of lung and eye involvement may vary. The lung may be affected by treatment for an unrelated eye problem and treatment for lung disease may affect the eye.
Herpes zoster misdiagnosed as testicular torsion
Authors: Kumar T Sathesh , Saklani AP , Hockey T
Published: May 2014

An 11-year-old boy presented with acute onset left scrotal pain of 3 hours' duration. There was no history of trauma, urinary symptoms, fever or vomiting. On examination, the child was in agony. The left testis was exquisitely tender and there was hyperaesthesia over the scrotal skin. An exploration performed on the clinical suspicion of torsion revealed a testis lying normally. The following day, the boy developed classical herpes zoster rash involving the perineum and the left scrotum (Figure 1). This was confirmed by serological tests. Treatment with acyclovir was successful.
Orthopaedic care in haemophilia
Authors: Ribbans WJ
Published: May 2014

Haemophilia, affecting 1 in 10 000 males, is the most common congenital coagulation disorder affecting about 6000 patients in the UK. Although most patients inherit the disorder as an X-linked inheritance, one third arise as spontaneous mutations.
Treating severe sepsis with drotrecogin alfa (activated)
Authors: Wyncoll Duncan
Published: May 2014

Severe sepsis is a complex condition with mortality rates ranging from 30 to 50% in spite of advances in critical care. Xigris (drotrecogin alfa (activated)) is associated with an absolute reduction in the risk of death of 6.1% and was granted European Union marketing authorization in August 2002.
The second stage of labour
Authors: Ferguson Evelyn , Owen Philip
Published: May 2014

Obstetric intervention in the second stage of labour is frequently indicated. An appreciation of the physiology of the second stage and an awareness of the range of interventions with their appropriate selection and application will contribute towards ensuring a safe delivery.
Evidence-based practice in urogynaecology
Authors: Smith ARB , Higgs PJ
Published: May 2014

Urogynaecology practice is rapidly progressing, with a trend towards minimally invasive techniques. This article attempts to cover the evidence behind the assessment and treatment of urinary and anal incontinence, and vaginal prolapse.
The broadening use of leflunomide in clinical practice
Authors: Kiely Patrick DW
Published: May 2014

Autoimmune diseases make up a large proportion of chronic disease care. Inducing remission by immunosuppression remains the cornerstone of long-term management. This article reviews the place of leflunomide in clinical practice and outlines its potential applications beyond its licenced indication, rheumatoid arthritis.
Levetiracetam in the management of epilepsy
Authors: Leach John Paul
Published: May 2014

Epilepsy is one of the commonest neurological conditions. For historical reasons, this condition is often managed in the UK by non-specialists. Treatment options have increased markedly in the last 15 years, with a resultant increase in the potential for better seizure control and an enhanced quality of life for patients with epilepsy.
Systemic therapy for acne vulgaris
Authors: Layton Alison
Published: May 2014

There are three main groups of systemic therapies available for the treatment of acne vulgaris: systemic antibiotics, hormonal therapy (for females) and oral isotretinoin. This article outlines when these treatments should be prescribed for the treatment of acne, considers the impact of therapy on aetiology, and advises on dosage regimens, potential adverse effects and expected efficacy.
Diagnosing and treating depression in general hospitals
Authors: Hawley Chris
Published: May 2014

Depressive conditions are common in general hospital patients but if recognized can be treated by both pharmacotherapeutic and psychotherapeutic means. Although hospital doctors cannot be expected to be masters of the intricacies of treating depression, they can make the diagnosis and prescribe first-line antidepressants to the benefit of most cases.
Acute dissection of the thoracic aorta
Authors: Aziz Shahid , Ramsdale David R
Published: May 2014

Aortic dissection is an acute medical emergency with a high mortality. Crucial to improving survival is early recognition and appropriate treatment. This review describes the presenting clinical features and imaging techniques used in the diagnosis of aortic dissection and outlines the treatment modalities.
Antenatal detection of congenital heart disease
Authors: Simpson John
Published: May 2014

Most congenital heart defects are potentially detectable during fetal life. Detailed fetal echocardiography is indicated for high-risk pregnancies, and can now be offered at an earlier stage in gestation than was previously possible.
Thyrotoxic periodic paralysis in a Caucasian male
Authors: Chatterjee Apurba K , Dhakam Zahid , Morrish Nicholas J , Manford Mark R
Published: May 2014

A 35-year-old Caucasian system analyst presented to his GP with a 6-month history of intermittent weakness of both upper and lower limbs lasting 30–40 minutes and resolving spontaneously. He gave no history of any precipitating factors. There was no history of headaches, dizziness, loss of consciousness or sphincter disturbances. His vision, speech and swallowing were not affected during the episodes of limb weakness.

All of the episodes occurred on getting out of bed, most on waking in the morning, except for one which occurred on waking in the middle of the night when he got out of bed to go to the toilet. His legs gave way but he did not lose consciousness. There were no symptoms and signs of thyrotoxicosis. He was referred for further assessment. Neurological and systemic examination did not reveal any abnormal findings.

Investigations including magnetic resonance imaging scan of the spine, vitamin B12, red cell folate, urea and electrolytes, full blood count and erythrocyte sedimentation rate were within normal limits.

However, his thyroid function revealed free thyroxine >50 μmol/litre and thyroid-stimulating hormone <0.02 pmol/litre suggesting thyrotoxicosis. He was positive for anti-microsomal thyroid antibodies. A technetium scan showed symmetric enlargement of both lobes of the thyroid gland with an avid uptake.

On treatment with carbimazole the attacks became less frequent and over a period of 3 months regressed completely. He remains asymptomatic after treatment with carbimazole.
Evidence-based management of schizophrenia
Authors: Camprubi Marcelo , Dratcu Luiz
Published: May 2014

Antipsychotic medication is the foundation of care for patients who suffer from schizophrenia and other psychotic conditions. Newly diagnosed patients should be treated with atypical antipsychotics, of which the National Institute for Clinical Excellence guidelines recommend five. The quality of clinical evidence will ultimately establish the differences between available treatments.
Bilateral concurrent rupture of the Achilles tendon in the absence of risk factors
Authors: Kelly M , Dodds M , Huntley JS , Robinson CM
Published: May 2014

A 36-year-old woman presented with right calf pain that had begun when she rose suddenly in celebration of a dramatic sporting victory on television. She had felt a snap and was unable to weight-bear. On examination a ruptured Achilles tendon was diagnosed. She subsequently complained of pain in the left calf and, on examination, was also found to have ruptured that Achilles tendon. There was no history of recent or chronic tendon problems, steroid use, fluoroquinolone antibiotic therapy or renal impairment.

Ultrasound (Figure 1) confirmed bilateral ruptures, just below the myotendinous junctions, 10 cm from the calcaneal insertion on the right and 7 cm on the left. She was treated with serial casting for 10 weeks, after which she made a complete recovery with physiotherapy.
Medicolegal consequences of adhesions
Authors: Ellis Harold
Published: May 2014

Postoperative intra-abdominal adhesions are an almost invariable consequence of abdominal and pelvic surgery. Most patients are unaware of their presence, but they may result in morbidity such as acute intestinal obstruction, female infertility and dyspareunia. Claims made against surgeons and gynaecologists in the UK are reviewed, and lessons are highlighted.
Increasing the use of orphan drugs in clinical practice
Authors: Hulton Sally-Anne , Greener Mark
Published: May 2014

Orphan drugs allow people with rare disease to access well-tolerated, safely formulated and effective drugs. Over the next few years, orphan drugs will probably be increasingly adopted into everyday clinical practice, partly because of genomic stratification.
Medical students' views about Modernising Medical Careers: a questionnaire survey of London students
Authors: Malawana Johann , Aitken Maryanne , Heard Shelley
Published: May 2014

A survey of London medical students asked for their views of the changes to postgraduate medical education starting in August 2005. The majority had clear ideas about their career plans and did not want their career held back by the introduction of an extra year. They overwhelmingly preferred to start their early training in or reasonably near to where they had undertaken their medical studies.
Supporting science
Authors: Baker Yvonne
Published: May 2014

The National STEM Centre offers a wealth of CPD support and free resources for primary science teachers and co-ordinators. Yvonne Baker explains
What will be the sport premium's legacy?
Authors: O'Connell Suzanne
Published: May 2014

Primary schools are diligently making use of their primary sport premium, but will this pump-priming see any long-term benefit, or is it another flash in the political pan?
Improving your pupils' mental health – two case studies
Authors: Stoneman Barbara , Barnard Katharine
Published: May 2014

Supporting children's emotional wellbeing in primary school is vital to ensuring pupils can grow into happy and healthy adults. Two winning schools from the Resilience and Results Awards explain how they prioritise their pupils' mental health
Pupil Premium: What strategies work best?
Authors: Woolfrey Christopher
Published: May 2014

Since the Pupil Premium was introduced, debate has raged over how schools can use the funding effectively and efficiently. Christopher Woolfrey looks at some specific interventions and how three schools are spending their Pupil Premium allocations
Case study: Supporting social and emotional difficulties via the Pupil Premium
Authors: Gallagher Kevin
Published: May 2014

Colley Lane Primary School has worked with psychologists to develop interventions for Pupil Premium children, including a Nurture Suite, and to offer training for teachers. Ahead of presenting its work at a free CPD event, Kevin Gallagher explains more
Recruiting from abroad
Authors: Hannigan Lynne
Published: May 2014

While teachers trained overseas can contribute a great deal to your school team, the process of recruiting them can seem daunting. Lynne Hannigan offers her advice.
How prepared are you for the new primary curriculum?
Authors: Pope Elizabeth
Published: May 2014

What areas of the new primary core curriculum are schools most prepared for and where do they feel least confident? Elizabeth Pope looks at the findings from NFER's latest Teacher Voice survey.
FGM: How can you protect your pupils?
Authors: Thandi Kamaljit
Published: May 2014

Teachers are crucial in the fight to protect girls aged as young as five from the horrors of female genital mutilation. The NSPCC's Kamaljit Thandi offers her advice on what schools can do.
Case study: Mathematics Mastery
Authors: Mintz Alexandra
Published: May 2014

How do you demonstrate pupil progress when the best moments of learning often aren't on paper? Alexandra Mintz speaks to Caroline Farrant, a teacher at Sir Thomas Abney, which is involved in the Mathematics Mastery project..
Introducing tablets to the primary school
Authors: Minor Tom
Published: May 2014

Many primary schools are introducing tablet devices as part of their ICT strategies. Teacher and app developer Tom Minor offers some advice to get the most out of this technology in the classroom.
Whole-school projects: Take One Picture
Authors: Frostick Helen
Published: May 2014

The annual Take One Picture project allows schools to explore all corners of the curriculum using one of the National Gallery's famous paintings. Helen Frostick explains how her school has been inspired.
Ophthalmic advanced practice: ‘the lived experience’
Authors: Evans Patricia
Published: May 2014

Aim:

The aim of this study was to explore and describe the transitional experience of developing within these roles using a phenomenological approach.

Methods:

Purposive sampling of five advanced practitioners/nurse consultants was used. Data were generated from in depth unstructured face-to-face interviews of practitioners. Data were analyzed by thematic analysis.

Results:

The study is significant because it focused on the experience of role transition to consultant level in ophthalmic nursing. Key themes arising from the findings are nurse consultant/advanced practitioner role issues; the person behind the role; preparation for the role; role enjoyment; issues within the care team.

Conclusions:

This study helps to identify factors that support and hinder role development in this context and may inform planning for managers as well as clinical staff when considering the implementation of these roles in practice.
Triage assessment in the ophthalmic unit
Authors: Marsden Janet
Published: May 2014

Triage is a method of ‘sorting’ patients based on the severity of their presenting problem. It is important to know who and what is sitting in your waiting room and to make sure that the patients with urgent problems are treated quickly and that avoidable sight loss is prevented. This article describes a widely-used method whose effectiveness is international, recognized and evidenced and is highly appropriate for use in ophthalmic emergency settings.
The National Intravitreal Injection Survey: a look at current practice
Authors: Turnbull AMJ , Trikha S , Khandhadia S , Rennie C , Lotery AJ
Published: May 2014

Aims:

As our understanding of many ocular conditions increases, the use of intravitreal injections is likely to expand significantly. Therefore, it is important to establish the most cost-effective and safe method of delivery. This survey aimed to compare current UK practice with the latest guidelines from the Royal College of Ophthalmologists regarding intravitreal injections, highlighting areas in which service provision can be streamlined.

Methods:

An online survey of 36 questions was distributed to all NHS ophthalmology units in the UK. Questions were designed to address each aspect of the latest guidelines. Responses were uploaded anonymously during a 6-week time frame in late 2009.

Results:

127 responses were received from 110 ophthalmology units, 63.8% of which were from those with a special interest in medical or surgical retina. Interesting variations in technique were found, especially with respect to the level of asepsis and the method of service provision.

Conclusion:

Despite recently published guidelines, there remains considerable variation in current practice. Although there is consensus on several aspects of the technique, there is little evidence to address specific areas of debate. Further investigation into this area is warranted in order to optimize the delivery of this valuable treatment option.
Sports injuries affecting the eye: an overview
Authors: Martin Lene
Published: May 2014

This article provides an overview of eye injuries caused by different sporting activities, the incidence and the type of injuries, and also presents a typical case report of a closed globe contusion. Sports trauma remains a significant cause of ocular morbidity, however, the incidence numbers vary due to differences in classification, year of publication, and geographic location. Most sport-related injuries to the eye can be prevented by modifying and enforcing game rules and the use of appropriate sports eye protection.
Never events in ophthalmic practice
Authors: Cox Carol , Luckett Tracy
Published: May 2014

Frequently in ophthalmic practice there are procedures performed on the eyes that can lead to serious consequences for patients. This generally happens when the healthcare organization has not put in place the correct systems and processes to prevent incidents from happening, procedures have not been followed or when an individual disregards protocol. These incidences are termed ‘never events’. Never events are very serious, largely preventable patient safety incidents that should not occur when the relevant preventative measures are in place in the healthcare organization. There are specific incidents that the Department of Health has identified as never events. Each of these should be regarded as unacceptable in the health service. Nurses and allied health professionals should understand the concept of risk assessment, the monitoring of risks and the impact of incidents including those associated with never events. They should be encouraged to participate in the investigation of and any subsequent recommendations from serious incidents so that learning is maximized and change can occur.
Adherence: compliance, persistence and concordance in the management of glaucoma. Part 1
Authors: Amro Raed , Cox Carol L
Published: May 2014

Adherence is laden with difficulties in relation to the management of glaucoma. Perhaps a significant issue associated with a lack of the aforementioned is associated with the patient's failure to recognize there is a need to administer their eye drops as prescribed. Undoubtedly the greatest issue is that patients experience no pain with their debilitating eye disease. It is not until there is considerable loss of vision that awareness of the need to administer eye drops becomes a reality. Understanding the complexities of adherence and its association with compliance, persistence and concordance as discussed in this article can assist the healthcare practitioner in developing models of care that help the patient in self management of their glaucoma. This article is published in two parts. Part I addresses the background to issues associated with adherence in glaucoma management including definition of terms, assessing adherence and barriers and interventions to improve adherence. Part 2 addresses the theory of adherence and self management of chronic open angle glaucoma (COAG). It provides perspectives, theories and models that can be employed to improve adherence in the self-management of glaucoma.
Adherence: compliance, persistence and concordance in the management of glaucoma. Part 2
Authors: Amro Raed , Cox Carol L , Hill Marie
Published: May 2014

Adherence was noted in Part I of this series as a concept laden with difficulties in relation to the management of glaucoma. A significant issue associated with a lack of adherence is the patient's failure to recognize there is a need to administer their eye drops as prescribed. Part I identified that the greatest issue is that patients experience no pain with their debilitating eye disease. It is not until there is considerable loss of vision that awareness of the need to administer eye drops becomes a reality. It was further noted that understanding the complexities of adherence and its association with persistence, compliance and concordance can assist the healthcare practitioner in developing models of care that help the patient in self management of their glaucoma. This article addresses the theory of adherence and self management of chronic open angle glaucoma and discusses perspectives, theories and models that help the patient in self management of their glaucoma.
Measuring structure and function — where do we stand today?
Authors: Martin Lene
Published: May 2014

This paper is a condensed version of a speech presented at the allied personnel session ‘Chronic disease management — a story without end?’ at the Joint Congress SOE/AAO, Geneva 2011 and presents an overview of where we stand today regarding measurements of structural changes of the optic nerve head and the retinal nerve fibre layer and function measurement, i.e. the visual field, in glaucoma management.
Better value eye care for the 21st century: the population approach
Authors: Malik Aeesha NJ , Gray JA Muir
Published: May 2014

Health services globally and in the UK face challenges from increasing need and rising expectations to inequalities and financial constraints. The UK government has recently published a Public Health Framework for the first time. This has included preventable sight loss as an outcome measure for the nation's public health refecting increasing recognition of eye health issues in the broader public health agenda. This presents a real opportunity to improve eye care services at a population level. However the chief executive of the National Health Service (NHS) has set his own challenge to the NHS to find £20 billion in efficiency savings in the next 3 years in order to maintain services within the available healthcare budget. We have reviewed national routine healthcare data in order to understand the current financial expenditure, activity and outcomes in ophthalmology. Our results have found a wide variation in expenditure in health care and activity across the country. We discuss a population-based value orientated approach to dealing with healthcare issues which will provide a sustainable framework for the future.
A multilevel refraction protocol based on visual acuity
Authors: Orr Peggy R. , Guyton David L.
Published: May 2014

Objective:

To describe the historical development and methodology of a standard subjective refraction protocol to obtain best-corrected visual acuities in multicentre ophthalmic clinical trials.

Methods:

A revised, multilevel, subjective refraction protocol was developed for the Macular Photocoagulation Study (MPS) to accommodate poorer levels of vision than had previously been encountered.

Results:

Since its development in 1983, the multilevel refraction protocol has been adopted by several major clinical trials, is a reliable method to obtain best-corrected visual acuity among patients with a wide range of visual acuities and eye disorders, and has been shown to be more reliable than autorefraction. Among 82 participants in the MPS, 89% of repeated refractions obtained using the multilevel refraction protocol differed from each other by less than +/– 0.50 dioptre (D) and 97.5% by less than +/–1.00 D. Among 29 participants in the Submacular Surgery Trials (SST), the multilevel refraction protocol gave a spherical equivalent that averaged 1.04 D more positive than autorefraction (95% limits of agreement: 0.74, 1.34), and the visual acuity score, using the refraction protocol, was 1.5 letters better compared with autorefraction (95% limits of agreement: 0.0, 3.0).

Conclusions:

The multilevel refraction protocol is a reliable method of obtaining best-corrected visual acuity among patients across a wide range of visual acuities and many different eye disorders in ophthalmic clinical trials.
Ophthalmia neonatorum: a modern problem
Authors: Smith Liz
Published: May 2014

Ophthalmia neonatorum is conjunctivitis that occurs in the first 28 days of life and is strongly associated with sexually transmitted disease particularly gonorrhoea and chlamydia. The incidence of sexually transmitted disease globally remains high and in the industrialized countries is increasing despite public health interventions. Ophthalmia neonatorum can cause permanent damage to the eye and can lead to associated serious disease and it is therefore important that healthcare professionals observe for and diagnose the condition promptly. Preventative measures have some value particularly in developing countries.
Dry eye disease: simple to diagnose but complex to manage
Authors: Törnquist Alba Lucia
Published: May 2014

Dry eye disease is a multifactorial condition affecting the tears and ocular surface usually presenting with ocular discomfort and/or visual complaints. Dry eye disease is a condition that increases in prevalence with increasing age. Ocular structures involve not only the cornea but also the eyelids. The diagnosis is based on a positive questionnaire regarding symptoms and the results of a thorough ocular investigation. There are different treatment options including modification of the environment, eyelid hygiene, tear substitutes, anti-inflammatory agents, punctual occlusions, and dietary modifications. Successful treatment can dramatically improve the patient's quality of life.

The main objective of this article is to present the most common clinical manifestations of dry eye disease, different investigation methods, treatment modalities and suggestions of environmental modifications.
Birdshot uveitis: clinical features and treatment
Authors: Wilson-Barrett Claudia , Gibbons Helen
Published: May 2014

Uveitis, is the term used to describe inflammation of the uveal tract, i.e. iris, ciliary body, choroid. Birdshot uveitis is a chronic posterior uveitis which is an inflammatory, autoimmune disease. It tends to affect both eyes which may not happen initially but over a few years it normally does. It is sight threatening if left untreated. It involves choroid and retinal vessels and optic disc. This article will provide an overview of birdshot uveitis, its clinical features and treatment.
Evaluation of reading performance in clinical settings using the Tobii 1750 Eye Tracker
Authors: Källmark Fredrik , Brautaset Rune
Published: May 2014

Aim:

To evaluate the Tobii 1750 Eye Tracker system's usefulness in evaluating reading performance.

Material:

Twenty healthy subjects, aged 21–33 years, were measured with the Tobii 1750 Eye Tracker while reading two texts with equal readability rating. Reading speed was measured in words read per minute (wpm) from the onset of the first page to the conclusion of the last. Comprehension was enumerated as the ratio of correct answers (%). Eye movements were recorded as time-stamped coordinates of how the eyes moved over the screen.

Results:

There was a significant difference in reading speed and all eye movements except the saccade/regression ratio. Furthermore there was no significant difference in comprehension between the texts.

Conclusion:

The results show that texts used for studying reading performance most be chosen carefully as texts of the same linguistic difficulty, fonts, size and spacing can yield differences in reading performance, i.e. readability indexes are most likely not able to differentiate texts in a sophisticated enough manner. Furthermore, the results show that the Tobii system, despite its relative low resolution and sampling frequency, is suitable for evaluation of reading eye movements.
Sight threatening pets? The tarantula tale
Authors: Tillotson Julie , Giddens Graham
Published: May 2014

The objective of this article is to highlight potential injury to the eye from handling or keeping tarantulas and stress the importance of taking a good history and thorough eye examination. Recently two cases of ocular problems caused by tarantula hairs being lodged in the eye were seen at the Royal Bournemouth Hospital. Most tarantulas of the New World species are able to flick a mist of microscopic barbed urticating hairs from their abdomen into the face of potential predators to ward them off. These hairs can lodge in the cornea and migrate into the eye causing intraocular inflammation. This study examines the effects on the eye, highlights key information about tarantulas and looks at other published cases of injury to the eye from tarantula hairs.

Injury from tarantula hairs in the eye can range from mild to fairly extensive inflammation resulting in vitreo-retinal surgery. Health professionals dealing with eye injuries need to be aware of the potential damage so that a careful history is taken and a full slit lamp examination performed. Tarantulas are becoming popular as pets kept in captivity. Customers should be warned about the risks of handling tarantulas and advised to wear eye protection if handling is essential.
A review on the use of corneal inlays for the treatment of presbyopia
Authors: McCutcheon Karen
Published: May 2014

This article explores current treatments for presbyopia and the recent advances in technology, which have renewed interest in the use of corneal implants. Currently, the safest method to correct presbyopia is the use of spectacles or prescription contact lenses, but for some people there is a need for an alternative.
Anticoagulation management in patients requiring small-gauge vitreoretinal surgery: a review of the literature
Authors: Donaldson Lisa M , Donaldson Mark J
Published: May 2014

The management of the patient taking oral anticoagulants is a common clinical scenario in vitreoretinal surgery, where patients are often elderly and have multiple comorbidities. Performing surgery on anticoagulated patients has been associated in past studies with elevated risk of haemorrhagic complications, such as choroidal and vitreous haemorrhage.

Over the past decade, the use of small-gauge sutureless vitrectomy technology has dramatically changed vitreoretinal surgery. In this article, the literature is reviewed for articles evaluating the risks of performing small-gauge sutureless vitrectomy surgery on anticoagulated patients, and the evidence-base regarding the best practice peri-operative management of these patients is reviewed.

Overall, the risk of haemorrhagic complications is low in anticoagulated patients undergoing vitreoretinal surgery. There are, however, only a small number of studies that have evaluated the safety of performing this surgery while patients are on warfarin or other antiplatelet agents, and the number of patients in these studies is low. Until larger studies are performed, the clinical management of anticoagulated patients requiring vitreoretinal surgery must be individualised, taking into account the reason for anticoagulation and the risks of the particular indications for the surgery.
Pain in patients who have undergone retinal surgery: a review of a research project
Authors: Wheatley Sarah , Gibbons Helen
Published: May 2014

Aims: This research project was used to ascertain: whether patients suffer from pain after retinal detachment surgery at Moorfields Eye Hospital, London, UK; if the care being delivered in relation to patients’ pain levels is satisfactory; if enough is being done in relation to education postoperatively regarding pain levels.

Methods: A total of 40 patients were sampled and randomly selected into two groups of 20 patients. The first 20 patients (control group) were given a visual pain scoring chart and a form to fill in at certain times postoperatively to monitor their pain levels, how they controlled their pain and whether these methods were effective in pain control. Verbal information was given to them as it is at present, but they did not receive any written information. The second group of 20 patients (advice group) also received a visual pain scoring chart and a form to fill in at certain times postoperatively to monitor their pain levels, how they controlled their pain and whether these methods were effective in pain control. These patients had the same verbal information given to them as the first group, but in addition they also received detailed written information on what to do if they had any pain, with contact telephone numbers to phone for advice.

Results: There was little difference in the results between the two groups, with the majority of patients reporting the surgical procedure to be less painful than they had expected. However, both groups wanted to recieve the information regarding pain prior to their admission so they could be prepared at home with the recommended pain relief.

Conclusion: This research project has alerted the staff involved into preparing patients for retinal detachment surgery to ensure they have the correct knowledge regarding pain relief prior to their admission for surgery.
Ocular involvement in sickle cell disease: the ophthalmic nurse role
Authors: Gregg Emma M , Jaiyesimi Stella O , Barket Cynthia
Published: May 2014

Sickle cell disease is a genetic disorder that can affect any system in the body. When the eye is involved, the disease can threaten vision, affecting any anatomical part of an eye. When the retinal blood vessels are damaged sight loss can occur. Ocular screening of all sickle cell patients will help in the early identification of symptoms and immediate treatment or management. The chronic nature of the disease can have a serious impact on the patient's quality of life, and the ophthalmic nurse has an important role to play in promoting health education and patient support.
The palliative care needs of people with learning disabilities
Authors: Read Sue
Published: May 2014

This article examines many of the issues and difficulties associated with caring for people with learning disabilities who require palliative intervention. Providing palliative care for this client group is both complex and challenging for all those involved in the patient’s care. The Composite Model of palliative care is outlined and the needs of the person with a learning disability, those of the carer and the family are discussed. Finally, recommendations are made to help health professionals address the challenges posed by this client group and to assist them in providing more effective care for people with a learning disability who require palliative care.
Barriers to the effective management of pain
Authors: Redmond Kathy
Published: May 2014

Pain is one of the most common symptoms experienced by cancer patients and for many it is the most feared. A vast amount of time, money and effort has been expended on developing effective ways of managing cancer pain and as a result pain can be relieved in the vast majority of cancer patients using relatively simple measures. However, it has been estimated that adequate control of pain is achieved in only 50% of patients in Western societies and in only 10% of those living in developing countries (Hanks, 1995). A number of factors contribute to this undesirable situation including: poor clinical decision making on the part of health professionals; myths and misconceptions about pain and the use of opioids; patients’ non-compliance with treatment and their reluctance to report pain; and problems within the healthcare system which include lack of opioid availability and breakdowns in the continuity of care. This article aims to explore the barriers to effective pain relief and identifies ways in which they may be overcome.
Patients’ views on nurses’ communication skills: a pilot study
Authors: Bailey Koren , Wilkinson Susie
Published: May 2014

This article explores how patients view the communication skills of nurses involved in their care and highlights the personal and professional qualities or skills that may encourage rapport and understanding. Thirty-six patients with advanced cancer were involved in this pilot study and took part in an audiotaped assessment undertaken by a nurse with specialist communication training. Following the assessment interview the patients completed a self-report questionnaire which was anonymously returned. Themes were generated and analysed from the 29 questionnaires returned. Each patient was asked to highlight their main concerns and to detail whether these concerns had been discussed during the interview with the nurse. Regrettably as a result of an administrative error it was not possible to compare individual taped assessments with corresponding questionnaires. The pilot study enabled communication to be viewed from the patient’s perspective and demonstrates that for some patients their main concerns remain hidden.
The management of nausea and vomiting in advanced cancer
Authors: Campbell Tanya , Hately Juliet
Published: May 2014

Nausea and vomiting represent a significant problem in patients with advanced cancer which not only affects their quality of life but also the lives of informal carers. The application of nursing assessment tools, underpinned by a thorough knowledge regarding the physiology and aetiology of nausea and vomiting in this group of patients enables nurses to plan and provide effective interventions, in collaboration with other members of the multidisciplinary team. This article describes the physiological basis of nausea and vomiting. Epidemiological data informs the subsequent discussion, which focuses on assessment in terms of identifying the problem and its cause(s), setting goals with the patient and his/her carers, planning appropriate nursing interventions to support medical interventions and evaluating clinical outcomes. Pharmacological and non-pharmacological interventions for nausea and vomiting are discussed.
District nurses perception of palliative of palliative care services: part 2
Authors: Mcilfatrick S , Curran CI
Published: May 2014

The overall aim of this study was to examine district nurses' (ONs') perceptions of palliative care services within the community setting. A questionnaire which focused on the key areas of defining palliative care, perception of roles, communication, service provision and the educational and training needs of ONs was used. This was designed following a review of the literature and combined with data from phase one of the study (Vol 5(5): 215-222), which involved focus group interviews with ONs. The questionnaire was distributed to district nursing sisters (n = 66) within two community trusts in Northem Ireland. Findings suggest that the physical ‘doing’ aspects of care continue to dominate ONs' perceptions of palliative care and their educational needs. However, the supportive element of the ON's role was also identified alongside the potential role as coordinator. Palliative care service provision was considered adequate and the main services that nurses identified as useful related to the provision of 24-hour care. The main factors identified by nurses as influencing service provision related to organizational issues such as inadequate staffing levels, limited resources and a lack of time.
Implications of the Stephen Lawrence Inquiry for palliative care
Authors: Gunaratnam Yasmin
Published: May 2014

Last month marked the first anniversary of the Stephen Lawrence Inquiry report (MacPherson, 1999), which put ‘institutional racism’ firmly on the agenda of British public services. Brief details relating to the Inquiry are highlighted in Box 1 and a definition of institutional racism is provided in Box 2. During the past year the UK Government has announced plans to extend the 1976 Race Relations Act to cover both ‘direct’ and ‘indirect’ racism in public bodies, including the National Health Service (NHS).
Primary care services received during terminal illness
Authors: Beaver Kinta , Luker Karen A , Woods Simon
Published: May 2014

The World Health Organization (1990) provides guidelines on what constitutes effective palliative care. However, it remains unclear whether people with a terminal illness living in their own homes have access to the services they need. This article reports on a study carried out in the United Kingdom on the views of people with a terminal illness (n=15), their lay carers (n=10) and bereaved carers (n=19). Participants were asked about the primary care services they had received and their views on both helpful and unhelpful aspects of service provision. All terminally ill people in the study (except one) had cancer, which raises questions about access to palliative care services for non-cancer populations. Participants had contact primarily with district nurses, general practitioners and Macmillan nurses (specialist nurses). Few other services were received. A number of important issues arose from the data, indicating that lay carers in particular were not always receiving the information and support they needed in order to be effective care-givers.
A collaborative nursing model for advanced non-malignant disease
Authors: Loftus Linda A
Published: May 2014

This article reviews the arguments for and against specialist palliative care for patients with advanced non-malignant disease. It argues the case for a collaborative model of education to develop the skills of specialist nurses so that they can better care for such patients. A clinically-based collaborative nursing model of palliative care, which has not been derived from current cancer models, has also been developed. In addition, a brief overview of the current provision of care for cancer patients is given, since it is against this background that care for patients with advanced non-malignant disease will be developed.
Enhancing creativity to improve palliative care: the role of an experiential self-care workshop
Authors: de Vries Kay
Published: May 2014

Creativity plays an important part in all aspects of life. Although the nature of creativity is hypothesized in a variety of ways, there is no common agreement as to how or why it manifests. In the USA and UK, creative ability is often restricted by education, and nursing education programmes appear to be no exception. This article discusses the development of a weekend workshop programme for health professionals working with older people and in palliative care, using Alligood’s (1991) hypotheses, that there are positive correlations between creativity, self-actualization and empathy. Actualization and creativity are closely related to self-care and there is evidence that ‘selfishness’ is an essential ingredient in the actualizing process. There is also evidence that an empathic relationship between health workers and their patients has a significant positive impact on interpersonal care processes. If the creative potential of nurses and carers can be enhanced through self-care, their ability to empathize may be increased. The focus of the workshops is on creative methods of self-care, using experiential exercises in relaxation, music, touch, massage and silence. Evaluation of the workshops revealed that the potential of using this method to develop care practices is worthy of investigation and development.