bluuebunny/crossref_metadata_2025 huggingface dataset:
Drug therapies for Alzheimer's disease
Authors: Cunningham Emma , Passmore Anthony
Published: May 2014

Dementia is a progressive, irreversible decline in cognition that has impacted on the patient's pre-existing level of functioning. Alzheimer's disease (AD) is the most common cause of dementia. Therapeutic efforts thus far have concentrated on prevention, disease modification and symptom management. Currently only drugs for symptom control are available. The acetylcholinesterase inhibitors (AChEs) donepezil, galantamine and rivastigmine and the N-methyl-d-aspartate (NMDA) receptor antagonist memantine are licensed for the management of AD. Consistent evidence from clinical trials in AD shows modest clinical benefit from AChEIs, and, in more severe disease, from memantine therapy. All four drugs are available in oral preparations, rivastigmine is also available as a daily transdermal patch. Contraindications to and adverse effects of AChEI treatment are in keeping with the physiological effects of acetylcholine. Non-cognitive symptoms can be markers of comorbid pathology or symptomatic of worsening AD. AChEIs and memantine have been shown to be of discernible clinical benefit in these cases. Antipsychotic drugs reduce agitation, aggression and psychosis but also confer a higher risk of serious adverse effects. Drug therapies are a single facet of the comprehensive assessment and treatment of patients with AD.
A cognitive therapy conceptual framework for clinical supervision
Authors: Travers Isabel , Sloan Graham
Published: May 2014

Clinical supervision has been recognised as an effective strategy to facilitate and support practitioners to develop expertise, knowledge and clinical reasoning skills, with the selection of an appropriate framework deemed crucial to professional practice. However, there is an acknowledged paucity of evidence in relation to the efficacy of individual conceptual frameworks. The efficacy, suitability and applicability of a cognitive therapy clinical supervision framework for associated health professionals is considered, along with the implementation of this specific conceptual framework to an area of occupational therapy practice. Findings confirmed adopting such a highly structured and clinically focused framework was of benefit to supervisees, supervisors and healthcare delivery within a specific clinical setting.
Development of a valid and reliable tool for assessment of urinary incontinence in people with neurological problems
Authors: Woodward Sue
Published: May 2014

The aim of this study was to evaluate a tool for use by non-specialist nurses to assess continence problems in neuroscience patients.

Methods:

An evaluation study was conducted, to facilitate assessment of validity and reliability of a newly developed tool. A cohort of 84 student nurses was selected to participate and was asked to complete a previously validated knowledge questionnaire on the subject of incontinence, before and after attending a study day on continence promotion. The cohort was also split into two groups and each group was asked to identify types of incontinence in a series of previously validated vignettes. One group performed this task using the Woodward Key to Continence, and the other group without. The validity and reliability of the tool was assessed using multivariate analysis of variance.

Results:

Both groups of students significantly improved their knowledge of incontinence following teaching (P<0.001) and their ability to identify correctly the type of incontinence represented by the vignettes (P<0.001). There was also a difference between the groups' abilities to correctly assess the vignettes, with the group using the Woodward Key to Continence performing significantly better than those working without the tool (P<0.001).

Limitations:

The study used vignettes rather than real patients. It is not possible to identify if knowledge gained and the effects produced would be applied in practice.

Conclusions:

The teaching given was effective in improving students' knowledge of incontinence and ability to correctly identify types of incontinence from vignettes. It was found that the Woodward Key to Continence is a valid and reliable tool.
Surgical procedures for children with epilepsy
Authors: May Lindy
Published: May 2014

Epilepsy is a serious lifelong disorder characterized by seizures which often appears during childhood. Partial or even complete recovery from seizures is possible as a result of medical or surgical treatment. The following article discusses some of the important differences between children and adults, including different pathology, surgical techniques and outcomes. In addition, the effect on the family is considered. It is important to consider these differences when assessing a child's suitability for surgery and when giving advice and care to children and parents before and after surgery.
Palliative care for all: Slowly but surely
Authors: Thomas Sue
Published: May 2014

Sue Thomas discusses the importance of palliative care for those with neurological conditions, as well as those with malignant disease.
Do you know someone who deserves a special day?
Authors: Rounds Laura
Published: May 2014

Laura Rounds explains how the Willow Foundation can brighten the lives of young people with life-threatening illnesses
Care for the person with dementia, 1: The meaning of symptoms and memory loss
Authors: Beart Kirsty
Published: May 2014

The aim of this series of articles is to provide a resource for helping individuals live with dementia. The traditional view is that the devastation of dementia is all that is left of the person we care for and love. It is often assumed that when a person is diagnosed with dementia their life is one long problem and their personality, intellect and relationships will diminish unrecognizably. This negative idea does little to help us live with dementia, never mind die with it. A social disability model allows us to consider the plight in a different way. A person's individuality can be maintained by accepting that everyone needs emotional attachment, even those who cannot clearly communicate that need, and carers can learn how to interpret what seemingly unrecognizable comments or behaviours mean.
Filling the void: How real life health information builds better services
Authors: Ingram Charlotte , Knowles Vicky , Beety Dan
Published: May 2014

Sue Ryder Care established a health informatics team in 2006 to carry out needs assessments to establish current and future requirements for specialist palliative and neurological services throughout the UK. This team undertook a comprehensive literature search of publications in neurological, palliative and end-of-life care, followed by research involving a triangulation of methods. Three main forms of secondary data were collated in each geographical area; demographic statistics, strategic documents and structured information from key stakeholders. A detailed report has been produced about each strategic health authority in England, each health board in Scotland, in addition to a summary report for Wales and Northern Ireland. This work has demonstrated that commissioners are unable, or unwilling, to plan neurological services using standardized data. This will impact on the ability of providers to guarantee equity of access to services, and will therefore compromise compliance with the quality requirements set out in the National Service Framework for Long-Term Conditions.
The use of intermittent self-catheterization in managing neurogenic bladder problems
Authors: Rew Maggie
Published: May 2014

Patients with neurogenic bladder problems face many difficulties when managing continence problems. These problems can have a substantial impact on a patient's quality of life. They create practical barriers to activities of daily living and socializing, and severely compromise a person's self-image and self-esteem. Intermittent self-catheterization can help address many of the problems encountered by patients who use indwelling catheters, and therefore has the potential to improve quality of life. The use of one particular intermittent self-catheter, Actreen, is discussed to show how it may benefit patients.
Understanding narcolepsy, part 1: Epidemiology and neurophysiology
Authors: Cook Neal F
Published: May 2014

Narcolepsy is a chronic neurological disorder with significant impact on health-related quality of life. The disorder is often misunderstood, and considerably under-diagnosed. Research over the last ten years has made significant progress in identifying the causes and devising management solutions for this condition. Narcolepsy′s complexity can make the disorder challenging for the individual to manage, requiring neuroscience nurses to be knowledgeable about the condition and its optimal management. This article is the first part of two, focusing on narcolepsy, offering a definition of the disorder, the pathophysiological process of the condition, and how this is manifested in the individual. The second part will focus on diagnosis and management of the condition
Understanding narcolepsy, part 2: Accurate diagnosis and effective management
Authors: Cook Neal F
Published: May 2014

The complexity of narcolepsy is a challenge to patients and health professionals who wish to achieve optimal management of this condition. This complexity is often associated with the reduced health-related quality of life experienced by those with narcolepsy. The first article in this two-part series considered the definition of narcolepsy and discussed its neuro-pathophysiology (Cook, 2008). This second article focuses on the diagnosis and management of narcolepsy, essential components of care requiring a multiprofessional approach to maximize patient outcomes, coping and health-related quality of life.
A review of the psychosocial consequences of stroke and their impact on spousal relationships
Authors: Thompson Hilary S , Ryan Assumpta
Published: May 2014

The experience of stroke has far-reaching consequences for the physical, social and emotional dynamics of spousal relationships. However, there remains a dearth of research on the impact of stroke on spousal relationships. The first purpose of this review was to analyse and synthesize the literature pertaining to the experience of stroke recovery, in particular the associated psychosocial consequences of this experience. Second, the review aimed to examine how identified stroke consequences change the dynamics of spousal relationships. The review was conducted by systematically searching online literature databases from a variety of health-related disciplines using keywords and bibliographical searches. The issues identified in the literature were categorized into four broad domains: coping, adapting and adjusting; role, identity and work; emotional issues and post-stroke fatigue; and sexual function and sexuality. The review highlights the need for health and social care practitioners to have a have a comprehensive understanding of, and sensitivity towards, the psychosocial issues which survivors may encounter in the longer term trajectory of stroke recovery.
Movement therapies for children with learning difficulties
Authors: Burn Robin
Published: May 2014

Robin Burn asks why more is not done to provide access to movement therapies for children with learning difficulties given the available evidence and interventions
Has the development of new anticonvulsants inproved quality of life in people with epilepsy?
Authors: Louden Walter
Published: May 2014

Antiepileptic drugs are known to cause a number of side effects. When developing new antiepileptic drugs, it is necessary for researchers to prove that the new drugs are as efficacious as the older ones available. To gain a place for use it is also necessary to show that the new drugs have a better side effect profile than other drugs available. From the perpective of the nursing care, quality of life is one of the most important considerations in discussions with patients about the choice of drug regimen. This article questions the extent to which the evidence available from drug trials can inform assessments about a drug's effect on a patient's quality of life. The implications for nursing care in epilepsy are discussed.
Research Round-Up
Authors: Woodward Sue
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Management of spasticity: A brief overview of educational and pharmacological therapies
Authors: Birns Jonathan , Fitzpatrick Maria
Published: May 2014

Spasticity is a common symptom of neurological diseases including cerebral palsy, multiple sclerosis, traumatic brain injury, stroke and spinal cord injury. Spasticity has many components including increased muscle tone, exaggerated reflexes, weakness and contractures. It is a symptom that is not isolated, and can cause pain, stiffness and spasm resulting in a massive impact on a person's physical and emotional lifestyle. The management of spasticity requires a multidisciplinary approach including nurses, physicians, physiotherapists and occupational therapists working together to provide a variety of treatments tailored to the needs of the individual.
Medication benchmark for Parkinson's disease
Authors: Braine Mary
Published: May 2014

Mary Braine reports on the discussions of the recent business meeting of the Neuroscience Nursing Benchmarking Group held in June
The angry ape's archaic cortex
Authors: Winter George
Published: May 2014

George Winter reflects on the neural origins of violence in the age of the mobile phone
Age-related consequences of diagnosis with MS
Authors: Alexiou Gus
Published: May 2014

Gus Alexiou describes the experience of being diagnosed with multiple sclerosis (MS) at the age of 26. He argues that support groups specifically for younger people with MS could help with adjustment
Nontraumatic spinal cord injury part 5: Vascular causes and syringomyelia
Authors: Pellatt Glynis Collis
Published: May 2014

Nontraumatic spinal cord injury can be caused by vascular compromise, where the blood supply to the spinal cord is disrupted by haemorrhage, embolism or surgical procedures. Cavitation of the spinal cord (syringomyelia) from a range of causes can also compromise its neurological functioning. In either case the result is often pain and disability with an uncertain prognosis. Rapid diagnosis and treatment may reverse the neurological deficits but for some patients disability is likely to be permanent. Nurses therefore have an important role to play both in the acute care and rehabilitation management of these patients within a specialist health team.
Treating neuroinflammation: Exploring its potential in Parkinson's disease
Authors: Ahmed-Landeryou Musharrat J
Published: May 2014

Parkinson's disease (PD) is the second most common disease of the ageing brain, Alzheimer's being the first, about 1% of the world's population over the age of 60. PD is a complex disease with many external factors that may influence its pathogenesis. The current focus of PD research is on prevention and retardation of the disease. This article will inform the reader of one aspect of such research, that is neuroinflammation and the part it plays in PD. The most informative results about the relationship between neuroinflammation and accelerated dopaminergic cell death have come from experimental, usually animal, models of PD. The results from experiments using non-steroidal anti-inflammatory drugs (NSAIDs) are very encouraging for neuroprotective qualities against onset of PD. An over-the-counter NSAID that could protect against Parkinson's has the potential to be not only ground-breaking but practical and cost-effective.
CORRESPONDENCE
Authors: Hassall Mandy
Published: May 2014

November diary: New look website and award-winning resources
Infusion line preferences of patients prescribed apomorphine for complex Parkinson's disease
Authors: Parsons Jan
Published: May 2014

There are over 1000 patients with complex Parkinson's disease in the UK undergoing waking-hours apomorphine (APO-go) infusion therapy. Correct line placement in the subcutaneous fat is critical for optimal drug absorption and helps prevent adverse events at the injection site, such as nodule formation. The majority of patients on apomophine therapy manage their treatment without any nursing involvement, according to the NICE guidelines for Parkinson's disease.

Aim: To explore the experiences and preferences of patients with Parkinson's disease using two types of infusion line for apomorphine infusion therapy: the Graseby and Contact/Thalaset lines.

Method: A brief five-point questionnaire was sent to 104 patients of two specialist nurses receiving apomorphine infusion therapy for treatment of Parkinson's disease. A total of 69 patients returned completed questionnaires, of whom 51 had used both lines and were able to express a preference.

Conclusions: It was demonstrated that the patients preferred an infusion line for apomorphine infusion therapy that had a fine needle design with a 90° insertion technique (the Contact/Thalaset type) beause this was found to be easier to insert than a butterfly line and is associated with fewer adverse effects such as pain, nodules and occasional abscess, at the injection site, which leads to better compliance with the drug regimen.
The role of the hypothalamus, part 1: The regulation of temperature and hunger
Authors: Braine Mary E
Published: May 2014

The hypothalamus is a tiny structure in the centre of the brain but its size is no indication of its importance, because it is essential for survival and homeostasis. The hypothalamus is one of the most evolutionarily conservative regions of the mammalian brain, and contains clusters of cells identified as discrete nuclei. Situated at the base of the brain near the pituitary gland the hypothalamus is a critical integrator in many homeostatic functions these include temperature regulation and the regulation of feeding. In this paper the discrete nuclei within the hypothalamus are identified and their functions highlighted. The integrative role the hypothalamus plays in thermoregulation and the regulation of feeding will also be explored, providing an insight into the complexity of these mechanisms that are a part of our everyday life, and can play a critical role in neurological injury and recovery.
Identifying and managing ring chromosome 20 syndrome
Authors: Pountney David
Published: May 2014

Ring chromosome 20 syndrome is a rare genetic condition. David Pountney considers the causes and clinical characteristics of this syndrome and discusses effective clinical management
The struggle against Parkinson's disease
Authors: Woodward Sue
Published: May 2014

I am sure you will all have heard of Michael J Fox and also be aware that 10 years ago he was diagnosed with young-onset Parkinson's disease. Many people still think of Parkinson's as a disease that affects older people, but one in twenty of those diagnosed will be under the age of 40 years. This week his book, Always Looking Up, is published and this coincides with Parkinson's Awareness Week. The book chronicles the last decade of his life and struggle against the challenges posed by Parkinson's disease and shows how he has come to see these challenges as opportunities.
Advice and information on tuberous sclerosis complex
Authors: Cox Jane
Published: May 2014

Tuberous sclerosis complex (TSC) is an inheritable condition, caused by a fault in one of two genes involved in the regulation of cell growth. As a result the chemical ‘brakes’ are taken off in a key molecular pathway, resulting in extra growth of normal tissue, in the form of benign tumours. These typically occur in the brain, kidneys, skin, lungs and other organs, to varying and sometimes devastating and unpredictable effect. In the brain they may be a focus for epilepsy. Other significant symptoms include autism, learning disability and behavioural difficulties.
Live surgery: Education or entertainment?
Authors: Woodward Sue
Published: May 2014

May 2009 saw neurosurgery being broadcast live on television for the first time—breaking new ground, but raising a number of questions. It is possible to accept that the patients undergoing the surgical procedures being aired had given informed consent and there must have been ethical debates that occurred before the programmes were scheduled, but what are the potential issues raised by this type of broadcast?
Preventing medication overuse headache: The nurse's role in educating patients
Authors: Gillies Catherine
Published: May 2014

Medication overuse headache is one of the most common complications of primary headaches, i.e. migraines. Analgesia such as paracetamol which is available over the counter, and others prescribed by general practitioners, can cause this secondary headache. This condition makes diagnosis and treatment of a primary headache more difficult and reduces the efficacy of prophylaxis. It is difficult for the patient to grasp the concept that painkillers can cause pain. If repeatedly prescribed by a GP it puts a shadow of doubt over the GP's knowledge and can upset the patient's trust in his/her doctor. This article is an overview of the condition and considers the response to care of a small sample of patients from the acute service headache clinic at Southern General Hospital. The patients' concerns as to the cause of their headaches and methods of obtaining medication were documented. They were given the correct information regarding medication overuse headache. Responses to this information is considered.
Identifying and managing Guillain-Barré syndrome
Authors: Pountney David
Published: May 2014

Guillain-Barré syndrome (GBS) is the most common form of acute neuromuscular paralysis in developed countries, where the nerves become inflamed resulting in weakness and loss of sensation (Vucic et al, 2009). The condition is named after two French physicians, Guillain and Barré, who in 1916 described the condition in two soldiers affected by paralysis but who later recovered (van Doorn et al, 2008). Several variants of the condition are now recognized (Gregory et al, 2005).
Assisted suicide: Will policy change?
Authors: Thomas Sue
Published: May 2014

Policy on assisted suicide may slowly be changing; new developments will help discussions about patients' preferences become more open
A double celebration of progression and renewal
Authors: McDonald Sheena
Published: May 2014

As the acute brain injury unit at the National Hospital for Neurology and Neurosurgery celebrates its 10th anniversary, Sheena McDonald also marks the date that her life changed, and that new friendships began.
The assessment and management of pain in neurological disease
Authors: Oliver David
Published: May 2014

Patients with progressive neurological disease may experience pain in different ways–physical, psychosocial and spiritual. The careful multidisciplinary assessment of the pain is essential, particularly as patients may minimise their pain or find it difficult to express and describe their symptoms. The careful use of analgesics, including opioids, such as morphine, can be very helpful. Patients, their families and professionals all may fear using analgesics, but there is good evidence that pain can be relived effectively and safely if analgesics are used correctly, with improvement in quality of life.
Identifying and understanding dermatomyositis
Authors: Pountney David
Published: May 2014

Dermatomyositis is characterized by chronic muscle inflammation and weakness, affecting movement and coordination. David Pountney considers its clinical characteristics and the implications for nursing care
Understanding a meningioma diagnosis using Mishel's theory of uncertainty in illness
Authors: Guadalupe Kristen
Published: May 2014

Uncertainty is probably the most certain thing a patient will experience when diagnosed with a potentially life-threatening illness. The diagnosis of a meningioma is no exception. The frequently benign, subtle, insidious growth of this tumor before diagnosis contributes to its uncertainty. The purpose of this article is to explore Mishel's theory of uncertainty in illness as it applies to a meningioma diagnosis. The implications of this theory for nursing practice will be considered. It is argued that an understanding of patients' response to the uncertainty surrounding a diagnosis of meningioma can help nurses offer women support to make more informed decisions about treatment options and subsequent interventions.
Identifying and managing hereditary spastic paraplegia
Authors: Pountney David
Published: May 2014

Hereditary spastic paraplegia is a group of inherited neurological disorders characterized by weakness of the lower limbs. The causes and clinical characteristics are considered and effective management discussed.
Investing in quality, innovation, prevention and productivity
Authors: Thomas Sue
Published: May 2014

The national QIPP programmes aim to improve the delivery of high quality care to patients, and specialist nurses need to be at the forefront of developments
Beyond the pledge: Front Line Care and neuroscience nursing
Authors: Eberhardie Christine
Published: May 2014

The recent Front Line Care report recognizes the complexity of modern nursing yet does not deal adequately with specialist and advanced practice.
Making decisions on treatment withdrawal
Authors: Woodward Sue
Published: May 2014

In July the BBC screened a documentary, Between Life and Death, following the life and death decisions being made for some of the patients in the neuro-intensive care unit at Addenbrooke's Hospital, Cambridge. This compelling programme highlighted in particular the case of one patient whose family was convinced that he would not want to live in a quadriplegic or vegetative state. He had expressed this opinion previously, having seen a friend in this state. The decision to withdraw treatment was being considered until the patient's consultant noticed that the patient appeared to have intermittent voluntary control over his eye movements in response to direct questioning. It became apparent that the patient was in a locked-in state, rather than in a coma or vegetative state, and many months passed before he was able to communicate consistently by moving his eyes to indicate ‘yes’ and ‘no’. Once this point was reached, the medical staff were able to involve the patient in the decision making, respecting his autonomy, and he chose to live, knowing that he would never recover any further. For him, that was enough.
Campaigning in Parliament for Huntington's disease
Authors: Stanley Cath
Published: May 2014

Huntington's disease is a rare neuropsychiatric disorder that affects, at a minimum, around 12.4 in every 100 000 people in the UK (Rawlins, 2010). The illness is hereditary, and every child born to an affected parent has a 50% chance of inheriting the gene that causes Huntington's disease, and if a child does so, he/she will go on and develop the illness. There is a genetic test that can tell people whether or not they carry the gene that causes the illness.
Spinal surgery for acute traumatic spinal cord injury: Implications for nursing
Authors: Collis Pellatt Glynis
Published: May 2014

Spinal fixation surgery has become a key option in the management of acute traumatic spinal cord injury. There is, however, considerable debate about the role of spinal surgery in spinal cord injury management and research evidence is conflicting. Nurses have a vital role in the pre- and postoperative care of patients undergoing spinal surgery. Although the principles of pre- and postoperative care are the same as in other surgical procedures, the care of patients with spinal cord injury requires specialist and specific nursing care. There is a need for good quality nursing research that will provide evidence to inform nursing care and enable patients to make informed decisions about their early spinal cord injury management.
Adherence to secondary prevention strategies after stroke: A review of the literature
Authors: Slark Julia
Published: May 2014

Of the 110000 annual new stroke occurrences in the UK, one third will go on to have a further stroke. Recurrent stroke is more likely to be fatal than first stroke and survivors are more likely to be left with major disability (Rothwell, 2007). Stroke recurs in up to 20% of patients, most commonly within the first year, and within the first 90 days following a transient ischaemic attack (Feasby and Barnett, 2007; Talelli and Greenwood, 2008). However, modification of reversible risk factors can reduce morbidity and mortality and improve survival (Chaudhry and McDermott, 2008). Despite this, studies have shown that secondary risk factor management is not optimal (Qureshi et al, 2001; Tsui et al, 2004; Chaudhry and McDermott, 2008). Patient non-adherence may be one of the reasons for this and therefore a greater understanding of why the patient may not adhere to secondary prevention advice is needed. The literature surrounding adherence and strategies to improve adherence to both medication and lifestyle advice in stroke survivors will be reviewed, as well as for other important risk factors for stroke prevention.
Encouraging greater partnership working
Authors: Sam Emily
Published: May 2014

Formal links between teams are needed to improve understanding of the interface between palliative care, neurology and rehabilitation.
Updating knowledge at the BANN 2010 conference
Authors: Cook Neal F , McNamara Shanne
Published: May 2014

The annual conference of the British Association of Neuroscience Nurses (BANN) encouraged delegates from across the UK to participate and discuss clinical practice and policy developments.
Obtaining quality of life for Huntington’s disease patients and their families
Authors: Aubeeluck Aimee , Wilson Eleanor , JN Stupple Edward
Published: May 2014

Huntington’s disease (HD) is an inherited progressive dementia that causes movement abnormalities alongside cognitive and behavioural disturbances ( Bates et al. 2002 ). There is no cure for HD, with the treatments available being purely palliative or purely experimental and death occurring on average 15-17 years after onset ( Harper, 1996 ). Existing research suggests that family caregivers of persons with HD face a unique series of problems linked to the complex nature of the disease and highlights the continuing need for specialist knowledge and education for nurses working in this field ( Baker et al. 2009 ). This specialist knowledge is particularly pertinent to HD symptomology, social impact and familial environment within the context of a multidisciplinary approach. This paper offers suggestions for the application of current literature, incorporating practical approaches that health professionals can implement to maintain and enhance quality of life (QoL) for HD patients and their families.
Goal setting in stroke rehabilitation: part 1
Authors: Hartigan Irene
Published: May 2014

Stroke is a sudden neurological event. The effects of stroke vary and stroke survivors' inevitably encounter psychosocial challenges during the adjustment process. Rehabilitation requires a structured programme that considers the patient's personal goals and empowers them during this process. It has been suggested that goal setting approaches to rehabilitation achieve increased patient satisfaction and shorter inpatient stays. However, the concept of goal setting can be interpreted in many ways, and there are a varied number of methods for undertaking goal setting. The purpose of this paper is to present the evidence related to goal setting in stroke rehabilitation. Part-one of this two-part paper identifies frequently used goal setting tools and discusses the importance of patients' devised goals during stroke rehabilitation. Part two will uncover anomalies that health professionals are challenged by during the process of goal setting and will examine opportunities the nurse can create to enhance the goal setting process.
Dementia: diagnosis and early interventions
Authors: Harrison-Dening Karen
Published: May 2014

Nurses are often central to care in the early stages of dementia and as such have the potential to have a positive long-term effect on the lives of all those affected by the condition. This paper examines several issues of importance to the early stages of the disease: the definition of dementia, its diagnosis, and early interventions for people with dementia and their families. Through this early pathway the article goes on to consider a ‘toolbox’ of various approaches and interventions that are available to ameliorate the impact of the condition on those affected.
The health and wellbeing of people with epilepsy and non-epileptic attack disorder
Authors: Gurr Marcus
Published: May 2014

Epilepsy is a chronic condition characterised by recurrent, unpredictable and usually unprovoked seizures that result from transient disequilibrium of cerebral excitatory and inhibitory influences, causing an ‘electrical storm’ of excessive neuronal discharge. Non-epileptic attack disorder (NEAD) is a condition of change in behaviour or movement that is not caused by electrical activity of the brain. This article describes detailed clinical assessments that allowed a comparison of three patients with epilepsy and three patients with NEAD and that provided insights for a health management group which aimed to help the patients engage in personal health management and develop robust stress-reduction skills. Reflection on the differences and similarities between the two conditions may be helpful in developing holistic understanding, suggesting methods of treatment and pointing to areas that need further research.
Adherence to medication and self-management in stroke patients
Authors: Chapman Beatrice , Bogle Vanessa
Published: May 2014

Stroke is the third most common cause of mortality and one of the leading causes of adult physical disability in England. Medical treatment is imperative for the management of stroke and reducing the risk of recurrent stroke. The success of a medical treatment is determined largely by adherence. However, research has shown that adherence to medication in stroke patients is often suboptimal. Self-management interventions have been shown to improve adherence in long-term conditions, but their impact specifically on adherence to stroke medication is unknown. This paper systematically reviews the impact of self-management interventions on adherence to stroke medication. Six studies met the inclusion criteria. Self-management interventions were effective in improving adherence to stroke medication in the short term. However, in the longer term these benefits were not maintained. Thus, applying self-management interventions to improve medication adherence in stroke patients across integrated clinical settings shows promise. However, further development of such interventions and research is recommended, with more stringent methodologies and longer follow-up periods.
Policy developments: a Scottish perspective
Authors: Reid Lindsay , Hillan Edith , McGuire Margaret
Published: May 2014

This article, the first of two considering woman-centred Care In Scotland, describes the action for change In the maternity services In Scotland before the publication of The Provision of Maternity Services in Scotland — A Policy Review (Scottish Home and Health Department, 1993). This article examines the Policy Review and concludes by asking how midwives see themselves In the centre of the changes. This question, the subject of current Scottish research soon to be published, is central to the effecting of Improved maternity care.
Baseline audit of an antenatal day assessment unit
Authors: Knowles Helena , Wilson Linda
Published: May 2014

This article reports the findings of an audit that was carried out following the introduction of an antenatal day assessment unit (DAU). Three main areas were examimed; clinical effectiveness, women's satisfaction with the service provided, and cost-effectivenes. The majority of women treated in the DAU during the audit period delivered at full term gestation. Sixty per cent had spontaneous vaginal delivery. Eight infants (14%) required some treatment in Special Care Baby Unit (SCBU). Women reported high satisfaction with the service, which was found to be cost-effective. We conclude that many women with various complications of pregnancy can be managed in the DAU, and prefer this to inpatient treatment.
Late pregnancy loss: issues in hospital care
Authors: Moulder Christine
Published: May 2014

Drawing on the findings of a larger study, this article addresses the issues in providing high quality hospital care for women whose pregnancies end in the second or third trimester without a live baby. A good relationship with an understanding midwife who appreciated the diversity of women's needs was the basis of these women's experiences of good care. The midwives who provided this care formed a partnership with the women based on mutual respect and acceptance. They did not assume they knew best but negotiated care with the women. These midwives were open to their own feelings. They were confident and at ease with the experiences of loss, abnormality and death. They worked in a supportive unit.
The silent enemy: domestic violence in pregnancy
Authors: Scobie Josephine , McGuire Margaret
Published: May 2014

This article discusses the concept of domestic violence in pregnancy and describes the main findings of a pilot study which explored midwives' knowledge and experience of domestic violence in pregnancy. The findings of the study highlights the fact that midwives did not not feel adequately prepared to deal with victims of domestic violence. Midwives did not routinely screen for domestic violence and admitted to being reluctant to do so. Respondents were aware of a gap in their knowledge and practice and agreed that they needed more education and support on the topic.
Breast-feeding policies: are they used in practice?
Authors: West Jane , Topping Annie
Published: May 2014

Achieving successful breast-feeding remains a priority as hospitals worldwide strive to become ‘Baby Friendly’. The ‘Baby Friendly Initiative was launched in 1991 in an attempt to promote the ‘10 Steps to Successful Breast-feeding’ defined by the World Health Organization (WHO) and UNICEF in 1989. The first step states the need for a written breast-feeding policy. This article describes a small qualitative study designed to examine midwives’ adherence to a locally developed research based policy in practice. Two groups of midwives, one community based and one hospital based participated in focus group interviews. These were audiotaped, transcribed and analysed using Kreuger's (1995) ‘Taped Based Analysis’ approach. Two main themes emerged from the findings. Firstly, at times midwives draw upon their own experience in addition to the policy and secondly, hospital priorities appear on occasions to restrict its implementation.
Part 16: Data protection acts
Authors: Dimond Bridgit
Published: May 2014

As a result of our membership of the European Community, this country has had to accept stringent regulations relating to the control of and access to automated data from which persons can be identified. The Data Protection Act 1984 applied only to information held in automated form but set down basic principles of data protection. Tougher European rules (European Directive 95/46/EC) have led to the passing of the Data Protection Act 1998 which is being brought in over the next few years. The Data Protection Act 1998 applies not only to information held in automated form but also to personal information held in a file. The new provisions are designed to ensure greater harmony across the EC when data is transferred across member states.
Part 1. Integrating into teams: The midwife's experience
Authors: Shallow Helen
Published: May 2014

The proposed changes recommended by the report Changing Childbirth (Department of Health, 1993) heralded a new era for midwifery as it moved towards using midwifery skills in a more holistic and less fragmented way in order to promote continuity of care. Seven years on from the report, midwives are unhappy. The proposed changes have seen midwives overworked, overstressed, undermined, and devalued. In the main, women are still cared for at the birth by an unknown midwife and care continues to be fragmented. This paper is drawn from a qualitative study which involved interviewing a group of midwives, in a small district general hospital in the north east of England, who had experienced major changes in the way care was organized in their maternity unit. A modified grounded theory approach was used to analyse the data incorporating feminist principles of reflection, collaboration, and women's ways of knowing to guide and interpret meaning.
Epidural analgesia: Historical summary and present practice
Authors: Morris PJ
Published: May 2014

This is a brief historical summary of the use of epidurals in labour and of how developments and shortcomings have led to our present practice in the UK. After coming into widespread use in the 1960s and gaining a reputation for giving excellent pain relief, epidural blocks were then criticised as impediments, causing delays, more operative births and of being unnatural. The accent now is on fine adjustment — keeping the advantages while minimizing the handicaps. This subtlety requires the midwife — who gauges the effectiveness of the block and usually gives some of the epidural solution — to have an understanding of what is a very simple mechanism and its main complications.
Phenomenological approach to research in first-time fathers
Authors: Somers-Smith Mary Jane
Published: May 2014

Being and identifying as a first-time expectant father and new father is a fundamental issue for most men. Despite a burgeoning research literature on fatherhood, the question ‘What does it mean to be and identify as a first-time expectant and then new father?’ can still embarrass midwives and researchers alike. Within this paper the author explores why a specific phenomenological approach has been adopted to guide the data gathering and analysis. This paper develops the argument by examining the differences between Husserlian transcendental phenomenology and Heideggerian hermeneutic or interpretive phenomenology, as their distinctions have implications for the methodology employed. Although the importance of intersubjectivity and language influenced the choice of phenomenological approach, the main recommendation in this paper is that researchers have a thorough understanding of the philosophical underpinnings of the methodologies they pursue.
Expanding the midwifes role in examining the newborn
Authors: Lomax Anne
Published: May 2014

In 1993, Changing Childbirth, the report of the Expert Maternity Group made recommendations to provide continuity of carer, which would improve autonomy of the midwife. It suggested that some midwives would need to carry out some of the duties undertaken by senior house officers and recommend that professional training should be reviewed accordingly. More recently the government has made proposals in its document The National Plan for the New NHS (Department of Health, 2000) to empower appropriately qualified midwives to undertake a wider range of clinical tasks. Acceptance of this role by midwives can only serve to enhance and improve the quality and level of care given to women and their families.
But its not what I wanted: When a baby is the wrong sex
Authors: Robinson Jean
Published: May 2014

I once knew a woman who was one of thirteen children. The first twelve were girls. ‘It was like Coronation Day in our street when my brother arrived’ she said. Another acquaintance — charming, attractive and intelligent — an only child — told me she had always known that her parents had wanted a boy instead. She had been christened Leslie and treated like a son, but spoke with understanding and compassion of her parents. However, another woman, Billie, never came to terms with the rejection of her true self and her treatment as the mythical son she should have been. Her friends believed her early death from alcoholism was the result.
The meaning of problem solving in critical situations
Authors: Danerek Margaret , Dykes Anna-Karin
Published: May 2014

The objective was to explore the meaning of the phenomenon of problem solving in midwifery when the midwife is faced with a critical situation in the absence of an obstetrician or any other physician. A qualitative method was used and critical incidents from delivery wards and/or antenatal clinics in the south of Sweden were narrated by midwives and transcribed verbatim. The interviews were then analysed using a phenomenological method. Seven midwives, all with at least five years working experience of both antenatal and delivery ward work participated. Problem solving in midwifery showed itself to be a multifaceted phenomenon. Some of the facets were to listen, to assess, to make fast decisions, to possess knowledge and experience, to use intuition, to be able to identify a problem and find a solution, cooperation, engagement, purposefulness, concentration, euphoria, consideration and control. Knowledge about the meaning of problem solving in midwifery can influence the working team to support the midwife to solve problems in critical situations. The knowledge is also useful in midwifery education.
Failing women: The impact of sexual abuse on childbirth
Authors: Gutteridge Kathryn EA
Published: May 2014

Women who have been sexually abused as children are often unaware of the impact that childbirth will have upon their lives. Midwives and obstetricians are not sufficiently prepared in their academic and clinical practice to preserve the integrity of such women. The subject of child sexual abuse is one that shocks and offends society. However, it is this response that serves to perpetuate and harm women. Acceptance of its existence and recognition of responsibility can be the only hope to change attitudes and practice.
Do we care enough about perineal wounds?
Authors: Steen Mary
Published: May 2014

The risk of perineal injury during childbirth continues to affect the majority of women. About 40% of primiparous women and 20% of multiparous women will sustain some degree of perineal injury (James et al, 1999).
Post-traumatic stress disorder: myth or reality?
Authors: Laing Katharine G
Published: May 2014

The commonly held view that the pain and distress of labour are quickly forgotten once the mother holds her baby in her arms is not always true. The focus of this article is on the psychological aspect of childbirth and post-traumatic stress disorder (PTSD). Midwives have a professional responsibility to educate themselves in all aspects of their practice. This article aims to increase understanding of the impact of trauma by describing the symptoms of PTSD with particular emphasis on the implications for midwifery practice in relation to control, power, sensitivity and communication.
The National Patient Safety Agency
Authors: Dimond Bridgit
Published: May 2014

Following its report on An Organisation with a Memory the Department of Health has now published plans to set up a National Patient Safety Agency. These are considered and their implications for midwives discussed.
Breast-feeding and the diabetic mother
Authors: Whittaker Karen Mary
Published: May 2014

This article aims to provide succinct information for midwives regarding the additional benefits afforded to diabetic women and their baby when breast-feeding. It can be acknowledged that such information is not currently readily available to the midwifery profession. Indeed, in 1995, a consultant psychiatrist, DF O'Sullivan, reported in the British Medical Journal that the British Diabetic Association was unable to provide sufficient information for his diabetic wife who was eager to breast-feed. This article will endeavour to depict the increased physiological and psychological benefits of breast-feeding for diabetic mothers and their babies.