bluuebunny/crossref_metadata_2025 huggingface dataset:
Tuberculous meningitis in the developed world: a lurking menace
Authors: Booth Stuart A , Appadu Balraj , Nielsen Peder B
Published: May 2014

A 37-year-old Caucasian woman presented with headache, neck stiffness, confusion and vomiting. She had no history of respiratory symptoms, nor had there been any recent foreign travel or known contact with persons with tuberculosis. She was pyrexial (38°C) with signs of meningism. A month earlier she had developed a flu-like illness and remained generally unwell with fever, fatigue, anorexia and weight loss, before her condition acutely deteriorated. A computed tomography scan of her brain showed extensive low attenuation areas in the white matter of the parietal and occipital lobes bilaterally. CSF analysis, after a lumbar puncture, showed a raised white cell count of 144/μl, with a preponderance of lymphocytes (72% lymphocytes, 28% polymorphs). Protein levels were elevated (1.27 g/litre) and glucose levels low (0.6 mmol/litre). No bacteria were seen on Gram stain analysis. On further questioning, she had emigrated to the UK from Holland in 1991 and had never received a bacille Calmette–Guérin (BCG) vaccination. Magnetic resonance imaging (MRI) showed severe basal meningitis, extensive parenchymal abnormalities with enhancing multifocal areas consistent with tuberculomas. Further CSF analysis and polymerase chain reaction techniques confirmed the diagnosis of Mycobacterium tuberculosis meningitis with pulmonary involvement. Treatment included rifampicin, pyrazinamide, isoniazid, ethambutol and dexamethasone. Human immunodeficiency virus and cytomegalovirus tests were negative.

She developed severe cardiac and respiratory failure, but following treatment she gradually improved, such that by day 14 she was off all intensive care support. Neurological examination showed mild left leg weakness and diplopia. Investigation into this patient's contacts showed that a fellow office worker in England had contracted tuberculosis from his wife who had worked in an Aboriginal colony in Australia.

During the following 3 months her problems included a fluctuating right-sided hemiparesis, expressive dysphasia and focal motor seizures. Repeat MRI showed left middle cerebral artery stenosis as a result of surrounding basal meningeal inflammation, a left basal ganglia infarct and a left transverse sinus thrombosis. Treatment included dexamethasone, warfarin, cyclosporin and thalidomide. Ten months after her admission there had been a marked improvement in coordination, speech and right-sided strength. Warfarin had been discontinued. Unfortunately, her condition deteriorated as a result of a large intraventricular haemorrhage with hydrocephalus, followed later by encephalitis and multiple cerebral infarctions. Despite intensive management she died 4 weeks later.
Tuberculous osteomyelitis: chasing the elusive tubercle
Authors: Busteed S , Beeching NJ , Nye FJ , Thompson RN
Published: May 2014

A 61-year-old man presented to the rheumatology clinic with a 2-year history of rightsided low back pain without radiation. There were no systemic features such as weight loss, pyrexia or sweats. He had been recently admitted with epididymo-orchitis. However, a chest X-ray was normal and acid and alcohol-fast bacilli (AAFB) were not demonstrated on microscopy of pus from a scrotal sinus. Clinical examination was unremarkable.

Initial investigations revealed a mild microcytic anaemia (haemoglobin 11.1g/dl and mean cell volume 79.9 fl) and normal inflammatory parameters (C-reactive protein 6 mg/litre and erythrocyte sedimentation rate (ESR) 20 mm/hr). A white cell count was 9.8 x109/litre and rheumatoid factor was negative. Total globulin was elevated at 36 g/litre but immunoglobulins and prostate specific antigen were normal. A repeat chest X-ray was normal. Lumbar spine X-rays showed obliteration of the right sacroiliac joint with adjacent sclerosis and suspicion of erosive change. Magnetic resonance scan of the area demonstrated destructive change in the right sacroiliac joint and a possible soft tissue mass anteriorly, suggestive of either a low-grade tumour of cartilage or an infective process (Figure 1). Subsequent computed tomography-guided biopsy of the soft tissue mass was unsuccessful.

The patient continued to experience increasing pain in the right lumbar area and underwent a right sacroiliac joint biopsy under image intensification at another centre. Histology of the biopsy specimen was consistent with low-grade active chronic osteomyelitis but no organism was isolated. Empirical treatment with flucloxacillin was started. Brucella serology was subsequently negative. A repeat magnetic resonance scan showed worsening of the right sacroiliac joint destruction with bone oedema and ring-enhancing lesions post-gadolinium. An open biopsy of the right sacroiliac joint was performed and histological examination of this specimen demonstrated AAFB on microscopy. Mycobacterium tuberculosis was eventually found on culture. Histology of the de-calcified specimen showed non-caseating granulomata and a Ziehl–Nielsen stain was negative. He was treated with antituberculous treatment for a total of 12 months. Repeat investigations on discontinuing therapy showed sclerosis of the affected joint on plain films with a normal haemoglobin level (15.0 g/dl) and ESR (8 mm/hr).
Pulmonary toxicity and cancer treatment
Authors: Fennell Dean A , Rudd Robin M
Published: May 2014

Pulmonary toxicity is a serious potential complication of the use of cytotoxic drugs that can be debilitating and life threatening. Rapid recognition of this problem and its management are critical if morbidity is to be limited. This article discusses the mechanisms, common clinical features and risk factors for cytotoxic drug-induced pulmonary toxicity, and outlines general management principles.
Pleural effusions: the role of biochemical analysis
Authors: Jenkinson Fiona , Murphy Michael J
Published: May 2014

Biochemical analysis of pleural fluid may provide answers to important clinical questions. This review summarizes these questions and outlines the value and limitations of pleural fluid analysis.
Severe traumatic brain injury and spinal cord injury in children
Authors: Hoskote Aparna
Published: May 2014

Traumatic brain injury (TBI) is the single most common cause of permanent disability and death in infancy and childhood. The long-term survival and outcome is not only dependent on the nature of the primary injury but also on the effectiveness of measures to prevent and treat secondary injury.
Unexplained inflammation and deformity of the foot
Authors: Jeffcoate WJ , FL Game , Connor H
Published: May 2014

A 64-year-old Caucasian man was referred to a specialist diabetic foot clinic with unexplained deformity of the left foot. The problem had started an indeterminate time earlier – possibly 2 weeks. There was no history of trauma or of any underlying significant medical problem. The foot was displaced laterally, suggesting distortion of the tarsal bones. The skin was intact. There was generalized inflammation with swelling of the lower leg, and the skin was noticeably warmer than on the other side. There was some discomfort but no frank pain. Peripheral circulation was intact but there were signs of distal symmetrical sensory neuropathy, with loss of soft touch, pin prick and vibration sense. Ankle jerks were missing. Proprioception and deep pain sensation were preserved. There were no signs of other neurological or systemic disease, including sepsis, and he was taking no medication. Plain X-ray of the foot confirmed fracture dislocation of the calcaneum, and there was loss of fat signal, with enhancement of T2-weighted images on magnetic resonance imaging (Figure 1). Diabetes was excluded by 75 g glucose tolerance test.
Quality of stroke care in 2004
Authors: Rodgers Helen , Rudd Anthony
Published: May 2014

Someone in the UK has a stroke every 5 minutes and the consequences can be devastating – 48% are dead or disabled at 6 months (Mant et al, 2004). Despite this, until relatively recently stroke patients were regarded as boring and bed blocking by some clinicians and stroke services were not a priority for health policy makers.
The spectrum of autistic disorders
Authors: Wing Lorna
Published: May 2014

For decades after Kanner first described ‘early infantile autism’ in 1943, it was thought to be rare. Then, in the 1990s, autism became headline news because of the measles, mumps and rubella vaccination scare and fears of an ‘autism epidemic’.
Atrial fibrillation 2: management
Authors: Alchaghouri Samir
Published: May 2014

Chemical or electrical cardioversion of atrial fibrillation is attempted when spontaneous conversion to sinus rhythm does not occur. Sinus rhythm following cardioversion should be maintained with antiarrhythmic drugs. Non-pharmacological methods are reserved for highly symptomatic patients not controlled by, or intolerant of, medications.
Early care of severe sepsis and multiple organ failure in children
Authors: Peters Mark J , Lister Paula
Published: May 2014

Sepsis is the systemic response to infection, defined in terms of simple clinical and laboratory observations which have been adjusted for age for use in childhood (Table 1). This definition has been
A young woman with urinary symptoms, septicaemia and a pectoral muscle abscess
Authors: Murphy Seamus J , Glynn Gerard , O'Connor Frank A
Published: May 2014

Apreviously healthy 18-year-old woman was admitted to a medical ward with a 5-day history of lower abdominal pain, dysuria and fever. She had no past history of urinary tract disease. Her GP sent a urine sample for analysis at the onset of symptoms. Urine microscopy showed pus cells and culture revealed a positive growth of coliforms (>105/ml), sensitive to penicillin. The patient was given oral amoxycillin but her symptoms worsened. Hospital admission was therefore arranged. On admission her temperature was 38.7°C and she was dehydrated with suprapubic tenderness. There was no lymphadenopathy and chest examination was normal. Her haemoglobin was 10.3 g/dl, white cell count 7.75x109/litre and platelet count 110×109/litre. Liver function tests revealed a bilirubin of 67μmol/litre (normal range 5–17μmol/litre), alkaline phosphatase 140 IU/litre (normal range 20–90 IU/litre), alanine aminotransferase 238 IU/litre (normal range 5–40 IU/litre) and gamma glutamyl-transferase 105 IU/litre (normal range 0–40 IU/litre). Electrolytes, urea and creatinine were normal. She was treated initially with intravenous cephradine. Repeat urine examination demonstrated a sterile pyuria: microscopy showed pus cells but urine culture was negative. Anaerobic blood culture was positive for gram-negative rods after 1 day. Chest X-ray revealed multiple soft shadows throughout both lung fields. Computed tomography scan of the chest and abdomen showed multiple cavitating nodules in both lung fields (Figure 1), and multiple gas bubbles in the left pectoral muscle consistent with abscess formation (Figure 2). The pectoral muscle abscess was drained under ultrasound guidance and gram-negative rods were cultured from pus. Cultures from blood and pus were subsequently identified as Fusobacterium necrophorum using a Biomerieux (Basingstoke, Hampshire) rapid ID 32A kit. The patient made a full recovery with 10 days of treatment with intravenous metronidazole, benzylpenicillin and meropenem. The presumed source of primary infection was the urinary tract with metastatic abscesses arising in the lungs and pectoral muscle.
Should a fibreoptic bronchoscope be used to confirm double lumen tube placement?
Authors: McGlennan Alan P , Ashley Elizabeth MC
Published: May 2014

The authors commonly use PVC BronchoCath double lumen tubes (DLTs) (Mallinckrodt Medical Inc., St. Louis, MO, USA). The DLT is introduced through the vocal cords after appropriate sizing, the stylet removed, the DLT rotated anti-clockwise and advanced down the airway. The airway is secured by inflating the tracheal cuff. The patient is ventilated with a volume of 8 ml/kg, the chest auscultated and peak airway pressure recorded. To isolate a lung the bronchial cuff is inflated with <3 ml of air until there is no audible leak. The connector on the redundant side is clamped, the limb is opened to air and ventilation occurs via the appropriate lumen.
Targeting truancy
Authors: Cameron Val
Published: May 2014

Every headteacher will have had to deal with unauthorised absence for one reason or another. Val Cameron, head of Park Lane Primary School in Peterborough, tells us of her experiences and how she has dealt with the issue
One small step towards good pupil behaviour…
Authors: Bannister Nick
Published: May 2014

Small steps and consistent language can have a huge impact on children's behaviour. Nick Bannister looks at the successful approaches of two schools to behaviour management
Staying secure when going online
Authors: Temple Martin
Published: May 2014

With schools looking at services such as online communication and parent payment systems, what security issues do they need to understand and how can they reassure parents that they provide a safe and secure service? Martin Temple offers his advice
Sustainable solutions
Authors: Parker Daniel
Published: May 2014

The UK is facing the possibility of an energy crisis in the coming years. Daniel Parker looks at some ways schools can become more sustainable and how this can help educate the next generation
The rise and rise of business managers
Authors: Bannister Nick
Published: May 2014

The school business manager is an established part of the leadership of England's secondary schools, but primaries are still some way behind. That's now changing, as Nick Bannister discovers
Setting vs mixed ability
Authors: O'Connell Suzanne
Published: May 2014

Sir Michael Wilshaw tells us that mixed-ability can harm the more able. Boris Johnson stands up in favour of grammar schools. Should our schools be more selective and put children back into sets? Suzanne O'Connell takes a look
Diagnosis, treatment and progression: Using research in the classroom
Authors: Durbin Ben
Published: May 2014

Evidence is everywhere – but what are teachers to think? Ben Durbin says teaching can be enhanced by the use of evidence in practice and, inspired by medical practice, gives three steps for its effective use
Tackling truancy and driving up attendance
Authors: Jarana Nadia
Published: May 2014

Deputy headteacher Nadia Jarana explains some of the strategies her inner city school employed to help transform their attendance figures
Creative approaches to literacy and the SPAG tests
Authors: Wilcox Alison
Published: May 2014

Will the new spelling, punctuation and grammar tests produce an assembly line of rote-learning at the expense of creativity? Alison Wilcox looks at how we can tackle the tests, but still engage our pupils
Arguing for a creative curriculum
Authors: Bull Anne
Published: May 2014

Headteacher Anne Bull has been awarded an honorary degree by Bath Spa University in recognition of her contribution to education. She argues why a creative focus across the curriculum is vital
Oracy – teaching your pupils to talk
Authors: Gross Jean
Published: May 2014

Schools can make great strides in tackling underachievement by improving pupils' spoken language skills across the curriculum. Jean Gross, the former government Communication Champion for children, reports on some of the great practice she has seen
Pupil Premium: Evidence and impact
Authors: Aubrey-Smith Fiona
Published: May 2014

The pressure is on schools to ensure that Pupil Premium spending is evidence-based and to show the impact of their strategies. Fiona Aubrey-Smith looks at what practical guidance and resources are out there to help
Despatches from Birmingham
Authors: McKeown Sal
Published: May 2014

From inspection survival advice to the curriculum and dyslexia, seasoned Education Show delegate Sal McKeown offers her highlights from last month's event at Birmingham's NEC
A blueprint for ICT innovation
Authors: Luckin Rosemary , Bligh Brett , Crook Charles , Ainsworth Shaaron , Manches Andrew
Published: May 2014

The recent Decoding Learning study seeks to pinpoint innovative practice by teachers and students when it comes to exploiting technology in education. It offers eight approaches to innovation with ICT. Professor Rosemary Luckin explains
Meet the Pupil Premium Champion
Authors: Lepkowska Dorothy
Published: May 2014

Respected educationalist Dr John Dunford began work this term as the National Pupil Premium Champion. He spoke to Dorothy Lepkowska about how he will be helping to support effective Pupil Premium practice
Improving communication and language skills
Authors: Constant Clare
Published: May 2014

Faced with a new intake whose lack of speech and language skills meant they were still operating as toddlers, Clare Constant implemented a range of strategies to overcome this significant learning barrier
Planning your primary school's curriculum
Authors: O'Connell Suzanne
Published: May 2014

As the new draft curriculum is published, Suzanne O'Connell asks some good and outstanding schools how they go about crafting the prescribed curriculum to make it right for them
How do you get Ofsted outstanding for your achievement?
Authors: O'Connell Suzanne
Published: May 2014

In the final of our articles focusing on core Ofsted inspection judgements, we tackle the most crucial of all – achievement. With a slightly different framework in place, Suzanne O'Connell looks at how three schools have achieved outstanding in this area
What makes outstanding schools outstanding?
Authors: Aubrey-Smith Fiona
Published: May 2014

What really makes ‘outstanding’ schools outstanding? Fiona Aubrey-Smith looks at some SSAT schools which have achieved this status to try and find out.
Pensions: Avoiding the LTA
Authors: Downie David
Published: May 2014

Yet more changes are afoot when it comes to your pensions. The latest cuts to the lifetime allowance could affect more teachers than you'd think. Expert David Downie explains.
Wellies at the ready in the outdoor classroom
Authors: Schofield Mike
Published: May 2014

Making the most of every centimetre of the school grounds has ensured that learning at Boston West Academy is inspiring and embedded in the real world. Headteacher Mike Schofield explains.
Two examples of cross-phase collaboration
Authors: Woolfrey Christopher
Published: May 2014

Collaboration between primary and secondary schools can have a notable impact on key areas, such as assessment, numeracy and literacy and transition. Christopher Woolfrey looks at the work of two partnerships.
Nurses performing YAG laser capsulotomy — the UK perspective
Authors: Gibbons Helen
Published: May 2014

YAG laser capsulotomy is a safe procedure for appropriately trained nurses, with many benefits to the patient and nurse.
Focus on slit lamp examination
Authors: Gibbons Helen , Masih Mary
Published: May 2014

Slit lamp skills are becoming an essential requirement for all nurses, technicians and allied healthcare professionals working in ophthalmology. Developing such skills enhances practice and gives greater job satisfaction.
APEL, APL or CPD?
Authors: Cox Carol L
Published: May 2014

Acquired prior experiential learning (APEL), acquired prior learning (APL) and/or continuous professional development (CPD) in the form of short courses or degree courses can ensure current and future employment.CPD is a requirement of regulatory and professional bodies and supported by healthcare organizations.It has been recognized that patients and healthcare institutions benefit when healthcare practitioners are competent. Through CPD health professionals can keep their skills and knowledge up to date and work safely, legally and effectively.
Diabetes, diabetic retinopathy and the National Service Framework
Authors: Catherine Dardis
Published: May 2014

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes mellitus.

Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness within the working population. This article provides a brief overview of diabetes(diabetes mellitus), particularly in terms of microvascular complications and diabetic retinopathy, and considers current procedures of diabetes care in the context of the National Service Framework(NSF) and current clinical practice. Treatment of diabetes mellitus and its complications presents a huge and increasing burden on the National Health Service and the NSF represents an initial response to this. It sets out 12 standards to help improve the care of patients with diabetes, emphasizing, in particular, the need to empower patients with diabetes to take charge of their own health care, and the necessity of organizing regular surveillance programmes for the detection and early treatment of long-term complications associated with diabetes mellitus. To these ends, a national retinal screening programme was developed over a 10 year period, with concurrent continuing professional development and the encouragement of evidence-based best practice. Establishment of empowerment programmes has had only limited development, probably because most resources are necessarily focused on dealing with the cure rather than prevention of the disease(i.e. retro treatment).
Optical Coherence Tomography (OCT): background and applications
Authors: Millbank Lyn
Published: May 2014

Optical Coherence Tomography (OCT) has had a revolutionary impact within the ophthalmic environment and is available in most eye units and indeed many optometry practices in the UK.

OCT is a relatively new medical diagnostic imaging technology, which provides real time, in situ imaging of tissue structure or pathology with resolutions of 1 to 15 μm, 1 to 2 orders of magnitude finer than conventional clinical imaging technologies, such as ultrasound, magnetic resonance or computed tomography ( Fujimoto et al, 2000 ). In addition to ophthalmology, OCT has many other applications, including industry, material thickness and surface roughness characterisation ( Merken et al, 2011 ). OCT is also used in art conservation, diagnostic medicine, and, more recently, in interventional cardiology and audiology.

This article will discuss the applications of OCT within ophthalmology with an overview of the evolution of OCT in ophthalmic practice. The practicalities of using OCT, including the preparation of patients, some tips for best practice when using OCT, scans, and potential artefacts that may challenge the scan quality, along with a simple guide to interpretation, are also included.
Singapore National Eye Centre: an ophthalmic nursing journey
Authors: Wah Goh Beng , Tee Aw Ai , Ngim Low Siew , Chee Lim Mein , Lin Margaret Tan Swee , Fong Tan Joon , Vallei Chitra , Ho Loh Huey Peng , Hiong Shin , Lea Charity Wai Sue , Chandran Ravi , Jayabaskar Thiyagarajan
Published: May 2014

The growing demand for eye care services and a lack of training opportunities for ophthalmic healthcare professionals have prompted the launch of new educational programmes in Singapore. This article outlines the development of ophthalmic nursing in Singapore and provides an introduction to the Singapore National Eye Centre (SNEC). The new Ophthalmic Academic Clinical Programme at the SNEC focuses on developing a comprehensive framework of research and training capabilities to ensure effectiveness in promoting clinical competence and performance. It is hoped that the pilot project to form a Dedicated Education Unit will act as an innovative model of transforming clinical nursing education into an environment of support. This will enable nurses to continue to provide high-quality care to ophthalmic patients. SNEC aims to provide continuing education, in partnership with other educational institutions, for nurses across the continuum of care as they navigate the rapidly changing ophthalmic nursing environment. This education and training has introduced a diversity of career paths, which provide nurses and allied healthcare professionals with innovative opportunities to advance their opthalmic nursing practice.
Implementing a shared care medical retina sub-speciality
Authors: Mapani Adam
Published: May 2014

This article discusses the implementation of shared care in the medical retina author's practice area. Contributing factors, examples of shared care models and training and development is discussed. The discussion is mainly based on author's practice area and his anecdotal experience.
Clinical characteristics and visual outcome in patients with Pseudomonas keratitis
Authors: Pacheco Patricio A , Clare Gerry
Published: May 2014

Aim:

To study the clinical and microbiological features and visual outcomes of patients with Pseudomonas keratitis.

Methods:

The clinical records of 37 patients affected by microbial keratitis with positive corneal scrapes for Pseudomonas sp., who were diagnosed and treated at Moorfields Eye Hospital, London, UK over a 12-month period were retrospectively reviewed. Predisposing factors, microbial culture results, clinical course and visual outcomes were analysed.

Results:

Contact lens wear (25 cases [67.5%]) and surface ocular diseases (6 cases [16.2%]) were the main predisposing factors. No ocular trauma aetiology was present in this series. All contact lens-related keratitis were observed in soft contact lens users (19 cases [51.3%] monthly disposable lenses, and 6 cases [16.2%] daily disposable lenses). A total of 14 cases (37.9 %) of the Pseudomonas sp. isolates were early suspected in the direct gram examination. There was only one case resistant to ofloxacin. Four (10.8 %) of the 37 eyes required surgical intervention, 90% of the patients had some degree of anterior chamber activity at presentation, 30% had an hypopion level. There was a ‘good’ clinical outcome (best corrected visual acuity [BCVA] >6/12) in 32 patients (86.4 %), a residual corneal scar was seen in 72.9 % of the cohort.

Conclusions:

A ‘good’ visual outcome was described even when a very high rate of intraocular inflammation and severe corneal compromise had occurred; this is due to a highly specialised management of the cases with a prompt use of corticosteroids that helped to manage the massive inflammatory reaction often associated to Pseudomonas sp. However, the presence of residual corneal scarring explains the loss of BCVA lines in 60% of the cases and limited final visual outcome.
The eye and phacomatoses: ocular and neuro-opthalmic manifestations
Authors: Joshi Lavnish , Taylor Simon RJ , Lightman Sue
Published: May 2014

This article reviews the ocular and neuro-ophthalmic manifestations of phacomatoses, while emphasising important differential diagnoses that exist based on their clinical features. Variations in the definition of phacomatoses do exist, but conditions not meeting the classical definition are also presented.
Offline viewing saves your phone bill when there’s so much to read
Authors: Sweeney John
Published: May 2014

This is great, ‘From Scotland to the English speaking world’; CancerPoint provides more than simply a host of links to quality cancer related sites. The emphasis is on sites with a patient’s perspective and answering questions about cancer, treatments and supportive services. This grounding in the reality of patient experience gives the site an authority that some others lack.
Difficult transitions
Authors: Webber Jeanette
Published: May 2014

Over the last 6 months I discovered exactly why ‘moving house’ merits such high scores on social readjustment scales! The irony is that I had no special plans to move my weekend base to another part of the country until, out of the blue, I happened upon a small part of the Kent coastline and promptly fell in love with it. My decision to move was taken in 10 minutes flat. However, achieving this goal proved to be more time consuming.
Community cancer support – the Neil Cliffe Cancer Care charity approach to supportive care
Authors: Leedham Kay , Platt Kim
Published: May 2014

Supportive care is now recognised as an important part of good practice in the management of people with cancer. However, few models exist which describe such services. The Neil Cliffe Cancer Care Charity was established five years ago in response to a perceived need to provide a local, community based service for people with cancer, and their carers, from the point of diagnosis. The nature of the problems identified by people using the service have been closely monitored and professional and voluntary staff have been recruited to develop the service in response to client need. Evaluation of the service, including both the impact of the service on individual well-being and the specific therapeutic interventions which are components of the service is underway, however early indications are that the type of supportive care offered has a positive effect on an individual’s self report of coping and sense of well being. This article describes the role of the service in supporting people with cancer and their carers.
Metrotop: a topical antimicrobial agent for malodorous wounds
Authors: Moody Marion
Published: May 2014

The eradication of pungent wound odour is one of the most challenging problems for health professionals involved in wound management. The presence of malodour can cause immeasurable distress for the patient and his/her family, making many sufferers’ lives one of self-imposed exile. Clinical research using topical metronidazole over the past 20 years clearly indicates that metronidazole is effective against the anaerobic bacteria that cause these foul and distressing odours. Seton Healthcare produces a commercial preparation called Metrotop — a topical metronidazole gel which is available on prescription.
Listen up: the sound of palliative care
Authors: Sweeney John
Published: May 2014

Behind the stark home page, National Public Radio in Washington have put together a site offering information which is less about death and more about those who try to cope with and understand it.
Nutritional supplements and tube feeds: what is available?
Authors: White Gillian
Published: May 2014

A wide range of specialized nutritional feeding products are now available. One condition for which nutritional feeding products are commonly prescribed is disease-related malnutrition. Nutritional support for poorly nourished clients consists of more than simply prescribing a specialized product. Key nutrition messages need to be applied to individual situations to promote optimal nutritional intake. However, in many situations clients are unable to meet their nutritional requirements by food alone and nutritional supplement products are then extremely useful. The nutritional status of all those receiving nutritional support should be monitored regularly; as the client’s nutritional status improves, his/her intake of these products may need to be reduced or stopped. If clients are unable to maintain or improve their nutritional status despite the use of nutritional supplements, additional help from an alternative feeding product may be required.
Communication in cancer care: introducing patient-held records
Authors: McCann Christine
Published: May 2014

The Calman and Hine (1995) Report, A Policy Framework for Commissioning Cancer Services, emphasizes the importance of good communication between all those caring for cancer patients (Calman and Hine, 1995). The report also stresses the need for appropriate procedures to be set up to facilitate the communication process. Taking this into consideration a study was undertaken to examine existing practices in communication between specialists working in cancer care and GPs. The aim of the study was to discover any problematic areas within the service, e.g. any failures or delays in the transmission of information. This article also examines ways in which improvements to the service could be made. The study findings led to a decision to introduce patient-held records. These records belong to the patients and are used by the patients and all health professionals involved in their care during the course of their illness. This scheme is currently being piloted and evaluated by cancer patients in four general practices.
Reflections on mourning in the modern world
Authors: Craib Ian
Published: May 2014

The article highlights the important contribution psychoanalysis makes to contemporary understanding of mourning. It is argued that over the past century the emphasis has changed from looking at internal psychological processes and individual meanings of mourning to the way that people deal with feelings, and that these feelings have come to be viewed as a form of mental illness. These changes are then examined in the light of significant changes in society over the same period. It is suggested that the development of bereavement counselling can not only help to people to develop self-understanding but also represents a form of social control.
Chemotherapy in palliative cancer care: changing perspectives
Authors: McPhail Gaye
Published: May 2014

The role of chemotherapy for patients with advanced cancer is likely to expand, as new cytotoxic drugs and routes of administration are developed, and adverse effects are better controlled. The move towards integration of acute and palliative cancer care services should facilitate the use of chemotherapy to alleviate symptoms of advanced cancer, where appropriate and acceptable for individual patients. As the boundaries traditionally perceived between phases of cancer care become blurred, new challenges will arise for oncology and palliative care nurses.
‘Global guides: the web shows the way’
Authors: Sweeney John
Published: May 2014

This site addresses bereavement as it affects and is experienced by children. It does so in a crisp and clear format of which the designers and founders at the Hospice of Seattle should be proud.
A profile of dying residents in South Australian nursing homes
Authors: Parker Deborah , De Bellis Anita
Published: May 2014

Most residents in Australian nursing homes end their life in these settings and therefore palliative care, death and dying are a major concern within these institutions. However, to date, a detailed profile of dying residents in Australian nursing homes has not been undertaken. This study describes the profile of 45 residents in 10 South Australian nursing homes who were identified as dying by nursing home staff. These residents were highly dependent on nursing staff for their day-to-day needs; they had deteriorating mental states and experienced symptoms such as weakness, fatigue, pain, anorexia, constipation and dysphagia. The main difficulties experienced by nursing home staff in providing palliative care for these residents included pain management issues and the lack of time available to care for residents and their relatives. This was compounded by the care needs of these dying residents. The study findings demonstrate that the provision of good palliative care requires adequate time, skill-mix, staff development and support, and the provision of palliative care education for staff and GPs.
Campto®: effective chemotherapy for advanced colorectal cancer
Authors: Ferns Helen
Published: May 2014

Palliative chemotherapy in advanced colorectal cancer prolongs survival and maintains quality of life compared with best supportive care alone. Campto® is indicated for use, in either first-line treatment in combination with fluorouracil (5-FU) and folinic acid or second-line monotherapy. Results from three multi-centred randomized trials, have shown that Campto provides clinically relevant and statistically significantly improved response rates, time to progression and survival vs 5-FU/folinic acid alone or best supportive care, while maintaining the quality of life in patients with advanced colorectal cancer.
Presenting positive images of palliative care
Authors: McPhail Gaye
Published: May 2014

Several years ago I was asked to write an article on the psychological aspects of breast cancer treatment. When the completed article had been typeset, proofs were forwarded to me for checking. The editors had inserted a photograph to accompany my text: the silhouetted figure of a woman alone in a hospital waiting room, holding her head in her hands, clearly in great despair. Keen to avoid such a negative representation, I set about finding replacement images.
Breast cancer: net gains for patients
Authors: Sweeney John
Published: May 2014

Dominated by the pink ribbon logo now so clearly linked with breast cancer, this site offers a range of material and highlights the support services offered by this charity to the 1 in 11 women in the UK who develop the disease in any one year.
Male cancers: the great taboo
Authors: Sweeney John
Published: May 2014

Linked as they are with taboos on age, sex and continence, it is perhaps no surprise that male cancers have not received the same exposure as, for instance, breast cancer. This is also the case on the Internet, which is often criticized for its male dominance. However, a growing number of efforts are being made to redress this balance.
Mindful messages: surfing for spirituality
Authors: Sweeney John
Published: May 2014

As it becomes clearer that spiritual concerns are very much part of the work of palliative care nurses, it is interesting to note the many ways in which patients express their needs and the different approaches adopted by carers in addressing them. This site, although not specific to palliative care, reflects many concerns familiar to those working with people whose illness may focus their thoughts on death or dying either at diagnosis, or as a longer-term source of distress.
Audit in practice: the referral of dying patients to palliative care
Authors: Ling Julie
Published: May 2014

Audit should be an integral part of any palliative care service. Terminal care is a continuum of palliative care. When looking for an objective measure for referrals to a new palliative care service within a specialist cancer hospital in Ireland, patient death was used as an end point. Audits were carried out looking at inpatient deaths during two separate 8-month periods. All inpatient deaths during the study periods were noted and records compared to find those who were referred to the palliative care service before death. The first audit revealed that relatively few dying patients were referred to the newly-formed palliative care team; by the time the second audit was carried out, referrals had increased. For many patients their final hospital admission was for active anti-cancer treatment and was of short duration. Data from these audits were presented on several different occasions to both nursing and medical staff. This article describes these audits in detail and highlights some of the issues raised. Audit in palliative care is discussed.
A British nurse’s view of palliative care in Russia
Authors: Salmon Irene
Published: May 2014

This article describes the various factors influencing the delivery of palliative care in Russia today. It is based largely on the author’s personal experience of working for over 2years as a volunteer nurse and in two Russian hospices. The article examines the economic situation, the health-care system and culture, nurse education and how palliative care principles are applied, together with the attitude to strong opioids. These are discussed in the context of the difficulties encountered in the delivery of care to patients and their families. Current educational initiatives are summarized with implications for future support and education. The need for changes to the law controlling the prescribing of narcotics are discussed.
Successful management of malignant bowel obstruction
Authors: Gamlin Richard
Published: May 2014

Although perhaps not one of the most common symptoms encountered in specialist palliative care units, health professionals frequently come across malignant bowel obstruction in general hospital wards, emergency rooms and in the community. The age-old approach to management of this problem using a nasogastric tube and intravenous therapy may still have its place for some patients, but specialists in palliative care have pioneered a kinder approach aimed at treating associated symptoms of colicky pain, nausea and vomiting. We owe it to our patients to ensure that all our colleagues are familiar with the most up-to-date treatment of malignant bowel obstruction to minimize distress and enhance quality of life.
The safe use of syringe drivers for palliative care: an action research project
Authors: McCormack PJ , Cooper R , Sutherland S , Stewart H
Published: May 2014

A palliative care team in north Scotland identified serious drug errors occurring in the local health-care trust. These were connected with the use of variable rate syringe drivers (IVAC P100) to deliver pain and symptom management rather than the more suitable Graseby MS26. An action research approach was taken to effecting change. An educational workshop was set up which 23 nurses attended. Clinical support was provided and 3months later an evaluation was carried out. Of the 13 nurses who had used an MS26, most were able to correctly follow the process of setting up the driver and had made appropriate observations, but drug calculations were a problem. Change was stated to have taken place in seven clinical areas but the degree of change was variable. Facilitators and obstacles to the change process are identified and recommendations made for the next round in the action research cycle.
The management of constipation in people with advanced cancer
Authors: Campbell Tanya , Draper Sarah , Reid Janet , Robinson Layonee
Published: May 2014

Constipation represents a significant problem for people with advanced cancer. It ranks in the top three most uncomfortable symptoms experienced, causing pain and anorexia that ultimately result in misery. The negative impact upon the quality of life of the patient and their carers is significant. The key to the provision of effective care lies in the informed application of the nursing process, underpinned by a sound knowledge base in relation to the management of constipation. Theoretical knowledge enables appropriate preventative interventions to be planned in collaboration with other members of the multidisciplinary team. When preventative measures are not applied or are unsuccessful, informed assessment and care planning enables appropriate interventions to be applied in order to resolve constipation. This article will discuss the causes and management of constipation. The discussion focuses on assessment, setting goals with the patient and their carers, planning appropriate nursing interventions to support medical interventions and evaluating clinical outcomes.
Specialist palliative care in the UK: its future and the effects of NHS reforms
Authors: Trueman Ian
Published: May 2014

This article examines the impact legislative developments in the UK have had, and are likely to have, on health care in general and how specialist palliative care providers may need to adapt to these changes. The focus of adaptation is on communication and multidisciplinary teamwork. A brief review of the previous Conservative government’s reforms offers a background to understanding how the current Labour government agendas affecting health and social care have been developed. Ideas are put forward to ensure that specialist palliative care provision is maintained and developed within the current structure of the health service.
Metastatic bone disease and tumour-induced hypercalcaemia: the role of bisphosphonates
Authors: Heatley Sarah
Published: May 2014

Tumour-induced hypercalcaemia (TIH) is the most common metabolic disorder associated with cancer, and if left untreated is associated with a low survival rate. Bisphosphonates are potent inhibitors of bone resorption. They have emerged as the standard method of treatment for TIH and a new form of medical therapy for bone metastases in addition to current treatments. Newer forms of bisphosphonates are 100–1000 times more potent than pamidronate, the current gold standard. One of these third generation bisphosphonates, zoledronic acid (Zometa®▼, Novartis Pharmaceuticals) has already been shown to provide more effective treatment of TIH than pamidronate. Ongoing research is aimed at choosing the optimum route, type of bisphosphonate and combination therapy to inhibit the development of bone metastases and TIH.
A practical approach to nutritional support for patients with advanced cancer
Authors: Hill Deborah , Hart Katherine
Published: May 2014

Palliative care can last from a few days to months and, in some cases, years. Consequently the nutritional needs of palliative care patients also vary, as does the extent to which nutrition intervention is pursued. Anorexia and cachexia are common side-effects of advanced cancer. They are characterized by physical depletion of the patients and an emotional drain on them, their families and carers. Pulling together the practical aspects of nutrition support and the emotional and social significance of food requires a skillful practitioner; an experienced dietitian can be a valued member of the palliative care team. This article examines the role of nutrition support in the palliative care setting, focusing upon practical advice including food modification, the use of oral supplements and enteral feeding.
What role for the arts in palliative care?
Authors: Kelly Daniel
Published: May 2014

We can try to improve palliative care in different ways. Usually we look to published accounts of research, textbooks, teachers or colleagues to question the work we do. There are other ways of learning, however, and other ways of trying to improve our patients’, and our own, sense of wellbeing. A movement which is gaining momentum involves the arts and the contribution they can make to health care.
The dilemmas of resource allocation
Authors: Mula Carole
Published: May 2014

In today’S health-care service, resource allocation has become an increasingly important subject for debate, not only for those who are directly concerned with the provision of health-care services but also for society as a whole. As citizens of a civilised society who should have an equal entitlement to health care regardless of age, prognosis and reasons for the illness, people who come into contact with health-care services generally expect, and indeed demand, to be treated on an equal basis. But in reality, does this happen?
Education and high quality community care
Authors: Ream Emma
Published: May 2014

Only a quarter of those with a terminal illness die at home (Lee, 2002), yet it is acknowledged by the nursing profession, and by patients, that many would like to stay at home for as long as possible rather than be admitted to a hospital or hospice for terminal care. Caring for people at home places an enormous burden on informal carers – a responsibility which often leaves them feeling isolated, scared, and physically and emotionally exhausted. The importance of high quality palliative care services cannot be overstated, yet in some areas of England there are insufficient resources to allow this. As such, many carers find they are unable them to look after their loved ones at home.
Sedation, the doctrine of double effect and the end of life
Authors: Thorns Andrew
Published: May 2014

The blurring of boundaries between appropriate symptom control and hastening death is a matter of concern in palliative care. The use of sedation at the end of life is a key example and Beel and colleagues provide an excellent review of the research available in this area and the difficulties in definition that need to be addressed (Beel et al, 2002).
What is it like being a sibling of a child with cancer?
Authors: Johnson Ben
Published: May 2014

Ben Johnson lost his brother to leukaemia 10 years ago. Here, he writes of his experiences and the issues faced by the siblings of children with cancer. Ben’s experiences led him to help set up the charity Siblinks. Siblinks aims to support those who have, or have had, a sibling or other family member affected by cancer.
Correspondence
Authors: Twycross Robert
Published: May 2014

Dear Editor

I read Andrew Thorns’ article (2002) with great interest. If I may, I should like to make one or two observations. First, although the Christian church may have been foremost in highlighting the issue of double effect, it is (and always has been) a general axiom of clinical practice. It is better, therefore, to recognize this by referring to the ‘principle’, not ‘doctrine’ of double effect.