bluuebunny/crossref_metadata_2025 huggingface dataset:
Glasgow aneurysm scores in patients undergoing open surgical procedure for aortic aneurysm
Authors: Ozen Anil , Unal Ertekin Utku , Kubat Emre , Turkcan Basak Soran , Caliskan Aytac , Aytekin Bahadir , Aksoyek Aysen , Birincioglu Cemal Levent , Pac Mustafa
Published: September 2014

Background

To assess the applicability of the Glasgow aneurysm score (GAS) in patients with aortic aneurysm undergoing an elective open surgical procedure in our hospital.

Materials and methods

A total of 105 patients undergoing elective open surgical procedure between January 2006 and June 2012 were evaluated retrospectively. Glasgow aneurysm score (GAS) was calculated as age+7 points for myocardial disease, +10 points for cerebrovascular disease, and +14 points for renal disease. The best cut-off value for GAS was determined using the ROC curve analysis.

Results

The hospital mortality rate was 3.8% (4 patients). GAS was significantly lower in patients who survived the operation (76.05 ± 14.71 vs. 92.0 ± 10.8 respectively, p = 0.031). The ICU stay was also significantly lower in patients who survived the operation (2.37 ± 5.23) compared to the nonsurvivors (25.67 ± 13.80, p = 0.001). No significant difference was observed regarding age, duration of hospital stay, and aortic diameter. The area under the ROC curve was 0.818 and for a 100% sensitivity rate, the cut-off value for GAS was 77.5 with a 58.4% specificity rate ( p = 0.031). All patients with a GAS < 77.5 were alive after surgery.

Conclusion

The GAS appears to be a reliable clinical predictor for in hospital mortality following elective repair of abdominal aortic aneurysm following open surgical procedure.
Alfred Weber, ‘The Sociological Concept of Culture’
Authors: Loader Colin
Published: September 2014

Alfred Weber (1868–1958) was one of the early German formulators of cultural sociology. The address that he gave before the Second Congress of German Sociologists in 1912 was his first formal presentation of the discipline. He wrote that the task of cultural sociology was to examine the relationship of the unilinear, rational, utilitarian process of civilization and organic, vital configurations of culture. The latter attempted to establish meaning for the changes generated by the former. It is translated in its entirety.
A case of euglyacemic diabetic ketoacidosis in a patient with gestational diabetes mellitus
Authors: Graham UM , Cooke IE , McCance DR
Published: September 2014

A 30-year old woman at 30 weeks gestation with insulin-controlled gestational diabetes was admitted with nausea and vomiting. Plasma glucose was 3.3 mmol/l with pH 7.23 and raised capillary ketones at 6.1 mmol/l. She was diagnosed with euglycaemic diabetic ketoacidosis. Cardiotocography showed good fetal movement and accelerations. She was given intramuscular betamethasone and started on intravenous dextrose, insulin and 0.9% saline with potassium chloride with resolution of ketosis. Euglycaemic diabetic ketoacidosis has been reported during pregnancy in patients with type 1 and type 2 diabetes. We believe that this is a report of such an occurrence in a patient with gestational diabetes.
Viral infections in pregnancy
Authors: Carslaw Helen , Cosh Ayla
Published: September 2014

Acquiring a viral infection in pregnancy can have a significant impact on the development of the fetus, and lasting consequences for the unborn child. It is therefore important that GPs have a clear understanding of how to manage patients who have been exposed to a potentially harmful virus, or are complaining of viral symptoms themselves. This article will equip the reader with knowledge of the risks that different viral infections pose to the fetus. It will also explore how to assess exposure and manage viral infections in pregnancy.
Recurrent UTI and ureteric reflux in children
Authors: Eyre Katie , Livesey Emily
Published: September 2014

Urinary tract infection (UTI) is one of the most common childhood bacterial infections, affecting 8% of girls and 2% of boys. Recurrent infections can cause renal damage with potential health consequences into adulthood. Vesicoureteric reflux is a common childhood urological abnormality that increases the risk of recurrent UTIs and possible subsequent adverse consequences. GPs should know which children with a UTI will require further investigation to identify this potentially treatable underlying abnormality.
Treating Severe Hypoglycemia
Authors: Rylander Dick
Published: September 2014

Severe hypoglycemia (SH) is a common problem in type 1 diabetes (T1D). Annually, nearly 1 of 5 persons with long-standing T1D will have SH. Though injections of glucagon are effective in treating SH, liquid formulations of glucagon are biochemically very unstable. For this reason, available preparations of glucagon are lyophilized; the powder and the diluent must be mixed at the point of care prior to administration and any remaining drug must be discarded. The process of mixing and delivery is complex. Coupled with the emotional stress of the caregiver, errors in glucagon delivery are very common. For these reasons, workers at Enject, Inc are in the process of developing a device that addresses the shortcomings of this currently approved method of glucagon delivery. The Enject device will store the glucagon powder and the diluent in separate compartments and will rapidly mix and inject the components only upon activation of the pen at the point of care.
The Role of Cells in Meniscal Guided Tissue Regeneration
Authors: Jülke Henriette , Mainil-Varlet Pierre , Jakob Roland P. , Brehm Walter , Schäfer Birgit , Nesic Dobrila
Published: September 2014

Objective:

Successful repair of defects in the avascular zone of meniscus remains a challenge in orthopedics. This proof of concept study aimed to investigate a guided tissue regeneration approach for treatment of tears in meniscus avascular zone in a goat model.

Design:

Full-depth longitudinal tear was created in the avascular zone of the meniscus and sutured. In the two treatment groups, porcine collagen membrane was wrapped around the tear without (CM) or with injection of expanded autologous chondrocytes (CM+cells), whereas in the control group the tear remained only sutured. Gait recovery was evaluated during the entire follow-up period. On explantation at 3 and 6 months, macroscopic gross inspection assessed healing of tears, degradation of collagen membrane, potential signs of inflammation, and osteoarthritic changes. Microscopic histology scoring criteria were developed to evaluate healing of tears, the cellular response, and the inflammatory response.

Results:

Gait recovery suggested protective effect of collagen membrane and was supported by macroscopical evaluation where improved tear healing was noted in both treated groups. Histology scoring in CM compared to suture group revealed an increase in tear margins contact, newly formed connective tissue between margins, and cell formations surrounded with new matrix after 3 months yet not maintained after 6 months. In contrast, in the CM+cells group these features were observed after 3 and 6 months.

Conclusions:

A transient, short-term guided tissue regeneration of avascular meniscal tears occurred upon application of collagen membrane, whereas addition of expanded autologous chondrocytes supported more sustainable longer term tear healing.
A curious case of confusion
Authors: Joyce Natalie , Patel Kavil , Whitehead Andrew , Armstrong Richard , Virgincar Nilangi , Chatterjee Apurba
Published: September 2014

Lesson

Delirium secondary to pneumonia is expected in the elderly, but when persistent and incongruent with expectation, cerebral abscess should be considered.
Isolated tuberculosis of the posterior spinal elements: case report and discussion of management
Authors: Al-Khudairi Naji , Meir Adam
Published: September 2014

Lesson

In neurologically intact patients with isolated tuberculosis of the posterior spinal elements, surgical intervention can be of benefit in select patients by reducing instability, deformity and late complications.
Anomalies in carbon concentration determinations from nanostructured bainite
Authors: Bhadeshia H. K. D. H.
Published: September 2014

There are large discrepancies in the measured concentrations of carbon in the ferrite and austenite within nanostructured bainite and carbide-free bainitic steels in general. The concentrations are usually measured on the basis of lattice parameters determined using X-ray diffraction, lattice imaging in transmission microscopy, or using the atom probe technique, i.e. time-of-flight mass spectroscopy. We examine here a number of difficulties with these methods and assess the role of defects, crystal symmetry and the heterogeneous distribution of carbon in interpreting the experimental data. Issues where experimental and theoretical work is needed are identified.
Loss of STAT3 in murine NK cells enhances NK cell–dependent tumor surveillance
Authors: Gotthardt Dagmar , Putz Eva M. , Straka Elisabeth , Kudweis Petra , Biaggio Mario , Poli Valeria , Strobl Birgit , Müller Mathias , Sexl Veronika
Published: September 2014

Key Points

Loss of STAT3 in NK cells enhances the expression of granzyme B, perforin, and DNAM-1, resulting in enhanced tumor surveillance. STAT3 binds the IFN-γ promoter and interferes with cytokine-induced IFN-γ production in NK cells.
Carboxyl-terminal-dependent recruitment of nonmuscle myosin II to megakaryocyte contractile ring during polyploidization
Authors: Badirou Idinath , Pan Jiajia , Legrand Céline , Wang Aibing , Lordier Larissa , Boukour Siham , Roy Anita , Vainchenker William , Chang Yunhua
Published: September 2014

Key Points

C-terminal domain determines myosin II localization to the MK contractile ring and the specific role of NMII-B in MK polyploidization.
Hypertonic sodium lactate improves fluid balance and hemodynamics in porcine endotoxic shock
Authors: Duburcq Thibault , Favory Raphaël , Mathieu Daniel , Hubert Thomas , Mangalaboyi Jacques , Gmyr Valery , Quintane Laurence , Maboudou Patrice , Pattou François , Jourdain Mercé
Published: September 2014

Introduction

Based on the potential interest in sodium lactate as an energy substrate and resuscitative fluid, we investigated the effects of hypertonic sodium lactate in a porcine endotoxic shock.

Methods

Fifteen anesthetized, mechanically ventilated pigs were challenged with intravenous infusion of E. coli endotoxin. Three groups of five animals were randomly assigned to receive 5 mL/kg/h of different fluids: a treatment group received hypertonic sodium lactate 11.2% (HSL group); an isotonic control group receiving 0.9% NaCl (NC group); a hypertonic control group with the same amount of osmoles and sodium than HSL group receiving hypertonic sodium bicarbonate 8.4% (HSB group). Hemodynamic and oxygenation variables, urine output and fluid balance were measured at baseline and at 30, 60, 120, 210 and 300 min. Skin microvascular blood flow at rest and during reactive hyperemia was obtained using a laser Doppler flowmetry technique. Results were given as median with interquartile ranges.

Results

Endotoxin infusion resulted in hypodynamic shock. At 300 min, hemodynamics and oxygenation were significantly enhanced in HSL group: mean arterial pressure (103 [81–120] mmHg vs. 49 [41–62] in NC group vs. 71 [60–78] in HSB group), cardiac index (1.6 [1.2–1.8] L/min/m2 vs. 0.9 [0.5–1.1] in NC group vs. 1.3 [0.9–1.6] in HSB group) and partial pressure of oxygen (366 [308–392] mmHg vs. 166 [130–206] in NC group vs. 277 [189–303] in HSB group). At the same time, microvascular reactivity was significantly better in HSL group with a lower venoarterial CO2 tension difference (5.5 [4–10] mmHg vs. 17 [14–25] in NC group vs. 14 [12–15] in HSB group). The cumulative fluid balance was lower in HSL group (-325 [-655; -150] mL) compared to NC (+560 [+230; +900] mL, p = 0.008) and HSB (+185 [-110; +645] mL, p = 0.03) groups.

Conclusions

In our hypodynamic model of endotoxic shock, infusion of hypertonic sodium lactate improves hemodynamic and microvascular reactivity with a negative fluid balance and a better oxygenation.
Automatic design algorithms for securing the ground contact stability of mobile cranes
Authors: Lee Donghoon , Park Jun Young , Ho Jongkwan , Kim Sunkuk
Published: September 2014

Background

Mobile cranes overturn due to excessive lifting, heavy wind, or when appropriate ground contact pressure is not secured. Such accidents can be prevented by reviewing the force conveyed from the outrigger to the ground upon lifting, as well as the soil bearing force. The stability review of mobile crane overturn is classified into the following stages: reviewing lifting conditions, mobile crane selection and reviewing ground contact stability. However, a precise review of ground contact stability requires expertise and is extremely time-consuming. Thus, this study develops automatic design algorithms for securing the ground stability of mobile cranes for easy and quick stability reviews.

Methods

The stability review method and the algorithm models are created in connection with the proposed conceptual process. The algorithms proposed in this study conduct simulations for all possible candidate cases, save the results in a database, review practical alternatives, and select the solution that minimizes cost. To verify the effectiveness of the automatic design model, a case project was selected and the algorithm was applied assuming several conditions.

Results

Developed algorithms can select candidate cranes according to lifting conditions and design plates through simulations easily and quickly, and design components required for ground contact plate design are collected to build the database that allows easier and quicker stability review.

Conclusion

The algorithms proposed in this study conduct simulations for all possible candidate cases, save the results in a database, review practical alternatives, and select the solution that minimizes cost. Developed processes are useful for analyzing correlations of mobile crane performance, ground contact and soil bearing force reinforcement designs and so forth, and for systematically selecting optimal mobile cranes.
Chemotherapy and Targeted Therapy for Women With Human Epidermal Growth Factor Receptor 2–Negative (or unknown) Advanced Breast Cancer: American Society of Clinical Oncology Clinical Practice Guideline
Authors: Partridge Ann H. , Rumble R. Bryan , Carey Lisa A. , Come Steven E. , Davidson Nancy E. , Di Leo Angelo , Gralow Julie , Hortobagyi Gabriel N. , Moy Beverly , Yee Douglas , Brundage Shelley B. , Danso Michael A. , Wilcox Maggie , Smith Ian E.
Published: September 2014

Purpose

To identify optimal chemo- and targeted therapy for women with human epidermal growth factor 2 (HER2)– negative (or unknown) advanced breast cancer.

Methods

A systematic review of randomized evidence (including systematic reviews and meta-analyses) from 1993 through to current was completed. Outcomes of interest included survival, progression-free survival, response, quality of life, and adverse effects. Guideline recommendations were evidence based and were agreed on by the Expert Panel via consensus.

Results

Seventy-nine studies met the inclusion criteria, comprising 20 systematic reviews and/or meta-analyses, 30 trials on first-line treatment, and 29 trials on second-line and subsequent treatment. These trials form the evidence base for the guideline recommendations.

Recommendations

Endocrine therapy is preferable to chemotherapy as first-line treatment for patients with estrogen receptor–positive metastatic breast cancer unless improvement is medically necessary (eg, immediately life-threatening disease). Single agent is preferable to combination chemotherapy, and longer planned duration improves outcome but must be balanced against toxicity. There is no single optimal first-line or subsequent line chemotherapy, and choice of treatment will be determined by multiple factors including prior therapy, toxicity, performance status, comorbid conditions, and patient preference. The role of bevacizumab remains controversial. Other targeted therapies have not so far been shown to enhance chemotherapy outcome in HER2-negative breast cancer.
Primary Results of ROSE/TRIO-12, a Randomized Placebo-Controlled Phase III Trial Evaluating the Addition of Ramucirumab to First-Line Docetaxel Chemotherapy in Metastatic Breast Cancer
Authors: Mackey John R. , Ramos-Vazquez Manuel , Lipatov Oleg , McCarthy Nicole , Krasnozhon Dmitriy , Semiglazov Vladimir , Manikhas Alexey , Gelmon Karen A. , Konecny Gottfried E. , Webster Marc , Hegg Roberto , Verma Sunil , Gorbunova Vera , Abi Gerges Dany , Thireau Francois , Fung Helena , Simms Lorinda , Buyse Marc , Ibrahim Ayman , Martin Miguel
Published: September 2014

Purpose

Currently, antiangiogenic strategies in metastatic breast cancer have demonstrated modest improvements in progression-free survival (PFS) but not improved quality or duration of survival, warranting evaluation of new agents in a placebo-controlled setting. Ramucirumab is a human immunoglobulin G1 antibody that binds vascular endothelial growth factor receptor-2 and blocks ligand-stimulated activation. The ROSE/TRIO-012 trial evaluated ramucirumab with docetaxel in unresectable, locally recurrent, or metastatic breast cancer.

Patients and Methods

In this double-blind, placebo-controlled, randomized, multinational phase III trial, 1,144 patients with human epidermal growth factor receptor 2 (HER2) –negative breast cancer who had not received cytotoxic chemotherapy in the advanced setting were randomly assigned at a two-to-one ratio to receive docetaxel 75 mg/m2 plus ramucirumab 10 mg/kg or docetaxel 75 mg/m2 plus placebo once every 3 weeks. Treatment continued until disease progression, unacceptable toxicity, or other withdrawal criteria. Patients were stratified by previous taxane therapy, visceral metastasis, hormone receptor status, and geographic region. An independent data monitoring committee oversaw the trial. The primary end point was investigator-assessed PFS.

Results

Median PFS in patients treated with ramucirumab plus docetaxel was 9.5 months, compared with 8.2 months in patients who received placebo plus docetaxel (hazard ratio [HR], 0.88; P = .077). Median overall survival was 27.3 months in patients who received ramucirumab plus docetaxel, compared with 27.2 months in patients who received placebo plus docetaxel (HR, 1.01; P = .915). Toxicities seen at significantly higher rates in patients receiving ramucirumab included fatigue, hypertension, febrile neutropenia, palmar-plantar erythrodysesthesia syndrome, and stomatitis.

Conclusion

Addition of ramucirumab to docetaxel in HER2-negative advanced breast cancer did not meaningfully improve important clinical outcomes.
What is it about the French?
Authors: Jones Chris
Published: September 2014

After a trip to Bordeaux, Chris Jones wonders why French people have lower incidences of cardiovascular disease and manage to stay thin, despite consuming plenty of wine and fatty foods.
The challenges of balancing two roles as a heart failure sister
Authors: Pryse-Hawkins Hayley , Davies Lucy
Published: September 2014

Hayley Pryse-Hawkins works as a heart failure sister at the Royal Brompton Hospital in London and is seconded part time to the British Heart Foundation. Lucy Davies talks to her about her role, its challenges and how she sees the future for patients with heart failure.
Caring for patients with cocaine-associated chest pain
Authors: Kelly Jacinta
Published: September 2014

Cocaine use in Ireland has increased signifi cantly and poses considerable physical and psychological distress for drug users. Most patients who seek help for cocaine-associated complaints present with chest pain. However, many nurses in acute hospital facilties have limited knowledge of the management of cocaineassociated chest pain. This article will provide background information on the illicit drug cocaine and will focus on the holistic management of the patient who presents with cocaine-associated chest pain.
The Angina Plan: Correcting the misconceptions of patients with coronary heart disease
Authors: MacLean Elizabeth , Patience Fiona , Leslie Stephen
Published: September 2014

The Angina Plan is a brief cognitive behavioural intervention for patient with stable angina which aims to educate patients and correct cardiac misconceptions, thus improving symptoms and quality of life. It is a simple, inexpensive and effective programme which has been proven to reduce episodes of angina, GTN use, anxiety, depression and physical limitation and increase activity in patients with stable angina.

This paper describes the clinical importance of correcting cardiac misconceptions and the potential benefi ts of the Angina Plan. Practical advice on the delivery of the Angina Plan is given and results from a local patient satisfaction survey are reported.
Research Round-Up
Authors: Astin Felicity
Published: September 2014

This section presents a synopsis of a selection of recently published articles of interest to those nurses working in the fi eld of cardiovascular nursing. The aim of this round-up 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.
Interventions for smoking cessation
Authors: Linden Belinda
Published: September 2014

As part of our series keeping you up-to-date with developments in evidence-based practice, Belinda Linden presents a summary of two Cochrane Collaboration systematic reviews looking at ways to support smokers to stop
Assessment of acute chest pain
Authors: Oriolo Valentino , Albarran John W
Published: September 2014

Valentino Oriolo and John W Albarran present a systematic approach to assessing patients presenting with chest pain, and consider the management strategies that would be employed following this, in line with the latest NICE guidance
Expanding the focus of reflection
Authors: Bowden Tracey
Published: September 2014

Martha J Wrigley and Caroline Humphreys argue the case for a better understanding of what clinical research involves, and the contribution that nurses in practice can make
Prescribing analysis and cost tabulation (PACT) data: an introduction
Authors: Lovejoy Anne E , Savage Imogen
Published: September 2014

PACT (prescribing analysis and cost tabulation) data is a national data set which analyses prescribing data in terms of cost and number of items (volume). At an organizational level, PACT is used to monitor and control prescribing cost and to set prescribing budgets. At individual practitioner level, it is used as an educational and audit tool. The Prescription Pricing Authority (PPA) has sent general practitioners (GPs) quarterly summary reports of their own prescribing since 1988. From 2000 prescriptions written by nurse prescribers have been added to the national PACT data set, and health authorities, practices and trusts will now be analysing both nurse and GP prescribing quality. Because of differences in the way they work, nurse prescribers will not automatically receive individual reports of their own prescribing. However they should be able to access this information on request through their local health authority prescribing advisers and primary care group pharmacists. Based on GP experience, nurse prescribers should find PACT data a useful learning resource for individual and team practice development.
The concept of priority as it relates to a community mental health team
Authors: Bonner Gwen
Published: September 2014

This article illustrates how a concept clarification exercise can provide evidence to inform local policy development. Based on the framework developed in Walker and Avant's (1995) concept clarification theory, the concept of priority is examined in the context of a team of community mental health nurses. Themes of risk, multidisciplinary working, resources, and nursing role are identified as key areas for consideration, and the difficulties existing between government policy directives towards the severely mentally ill and health promotion are discussed. The article highlights how nursing theory can integrate the concept analysis of priority in planning client care. This is presented using Peplau's (1952) model as a guide to further enhance meaning of generated priorities to nursing practice.
Policy paradox and political neglect in community health services
Authors: Hudson Bob
Published: September 2014

Community health services (CHSs) have never had a settled organisational existence but the turmoil has intensified since the publication of Transforming Community Services in 2009. CHSs are now beset by three dilemmas: ongoing organisational fragmentation; the extension of competition law and the spread of privatisation; inadequate workforce development and lack of clarity on the nature of CHS activity. This has left the services in a position of policy and political vulnerability. The solution may be for the service to be part of horizontal integration models such as the accountable care organisation, with a focus on locality and multi-professional teams wrapped around patient pathways.
Recognition and treatment of life-threatening events in the community setting—part 1: the journey
Authors: Salim Sofia
Published: September 2014

Community-based care provision and the associated workload for health professionals working in the community are on the increase. In recent years, in particular, there has been a greater requirement for the acute aspect of care. It is of the utmost importance that patient deterioration is recognised, and that staff can escalate care in an appropriate and timely way. Of the 576 potentially avoidable deaths reported to the National Patient Safety Agency in 2005, 64 were related to patient deterioration not being recognised or acted upon. The community-specific ‘Acute Life-threatening Events Recognition and Treatment’ (CSA) course enables practitioners (both registered and non-registered) to identify deteriorating patients and to take appropriate action to ensure that safe, quality care is maintained through early recognition and improved clinical decision-making. North Somerset Community Partnership is the first community area in the UK to facilitate the CSA course. This article is the first of a two-part series on the course. It details the journey from the start, identifying the challenges that were overcome and the success that has followed.
District nurse consultations with vulnerable patients over wishes for end-of-life care
Authors: Griffith Richard
Published: September 2014

As part of an enhanced service under NHS England's Transforming Primary Care initiative, GP practices will begin to proactively case manage patients at risk of unplanned hospital admissions. At the centre of this service is a case management register and personalised care plan that indicates the patient's wishes for future care. The initiative, and particularly the asking of questions about ‘do not attempt resuscitation’ orders and end-of-life care, has drawn the criticism of district nurses who are frequently asked to complete the personalised care plans with patients—many of whom they have not previously met. This article considers whether the template for personal care plans is reflective of the law on consent and, in particular, the Mental Capacity Act 2005.
Body fluid: components and disorders of pleural and pericardial fluid
Authors: Peate Ian
Published: September 2014

Healthcare assistants (HCAs) and assistant practitioners (APs) are constantly striving to provide care that is safe and effective. Understanding how body fluids work, their function and the changes that may occur in ill health, can help HCAs and APs provide care that is informed.

Pleural and pericardial fluids are secreted by serous membranes, in ill health patho-physiological changes can occur that can impinge on a person's health and wellbeing. This article provides an overview of both body fluids.
Caring for the person with osteoarthritis
Authors: Peate Ian
Published: September 2014

Osteoarthritis refers to a clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life. It is the most common form of arthritis and globally one of the leading causes of pain and disability. There are a number of treatment options available to improve quality of life and enhance wellbeing. The healthcare assistant and assistant practitioner, as part of a multidisciplinary team, can contribute positively to the overall quality of care a person with osteoarthritis receives.

This article begins by providing an understanding of joints, a key requisite when helping and caring for people with osteoarthritis. The condition is outlined and possible causes discussed. Signs and symptoms, investigations that may be undertaken in order to reach a diagnosis, the care and treatment and the provision of a number of teaching points are given. Finally a glossary of terms is included.
A generic worker
Authors: Roberts Lynn
Published: September 2014

I am a generic worker working in the intermediate care team in a rural community in North Wales. We cover an area of approximately 25 miles circumference and so travelling takes up a lot of my time.
Support the health and safety of yourself and others
Authors: Stephenson Nina
Published: September 2014

The aim of this article is to provide an overview of some of the knowledge requirements of the NVQ, unit HSC22: Support the health and safety of yourself and individuals.
Healthcare support workers: everyone counts
Authors: Smith Julie
Published: September 2014

Ever since the launch of British Journal of Healthcare Assistants I have been attending as many HCA-related conferences as possible. At all of them I have had the pleasure of meeting enthusiastic healthcare support workers (HCSWs) who are there to learn and progress. The increase in frequency of such events is a reflection of this growing enthusiasm as well as the recognition that HCSWs are now getting from their fellow healthcare professionals. On 15th September I attended the ’Everyone counts‘ conference for HCSWs organized by University Hospitals Coventry and Warwickshire NHS Trust (UHCW) and the Royal College of Nursing (RCN), and it was no exception.
What are assistant practitioners?
Authors: Kilgannon Helen , Mullen Chris
Published: September 2014

In 2002, NHS and social care organizations in the North West recognized that there were a number of workforce problems. Vacancies were increasing and pressure was mounting for a more flexible and productive workforce. A number of political factors were beginning to impact on workforce planning and development, for example, the European Working Time Directive was introduced, requiring that doctors work no more than a 48-hour week by 2009. In 2002, the majority were working in excess of 60 hours a week. At the same time, the Department of Health published Human Resources in the NHS Plan (2002). This plan detailed the need for the NHS to:

‘build jobs round patients, rather than round professions and to reduce the procession of faces the patient sees’
Health workers around the world: Liberia
Authors: Desauh Martha
Published: September 2014

Martha Desauh, 62, is a midwife assistant at Tubman Memorial Hospital in Zwedru, Liberia.
HCAs: vital contributors to the NHS Health Check programme
Authors: Waterall Jamie
Published: September 2014

The NHS Health Check programme was introduced by the Department of Health in April 2009, in an attempt to make a significant impact on reducing the current burden attributed to cardiovascular disease morbidity and mortality across England. Although this is a nationally mandated programme, its delivery model is dependent on local commissioners and clinicians. This article describes an innovative approach taken in East and North Birmingham which uses cutting edge technology and is delivered by healthcare assistants (HCAs).
What if…? Reflective practice: Treating non-cooperative patients
Authors: Grainger Angela
Published: September 2014

Care and treatment regimes exist to serve patients. The services offered to them must centre on meeting the needs of each individual. While most patients co-operate with their care and treatment plans, some patients refuse to do so. Understanding why this might be and managing the situation appropriately is the basis of this article. Guided reflective practice is used to facilitate further learning and further understanding of the situation and to assist learning.
New qualifications explained: health and social care diploma
Authors: Harris Sarah
Published: September 2014

Changes have arisen to the structure of vocational qualifications owing to the introduction of the Qualifications and Credit Framework (QCF). In January, the NVQ in health and social care will change to the diploma in health and social care. Students can undertake a variety of units including infection control, sensory impairment and physical disability. Alternatively, there is a specialist pathway for those working in dementia and learning disabilities environments.
Ask the Board: what can nurses delegate to healthcare assistants?
Authors: Grainger Angela
Published: September 2014

Do you have a question about your work? Are you struggling to find an answer? Why not ask our expert Editorial Board? Email us your query to bjhca@markallengroup.com and we will make sure it is printed in the next edition.
Self care: empower your patients
Authors: Carter Julie
Published: September 2014

Self-care does not only empower patients, it also empowers the healthcare assistant (HCA). At Culm Integrated Centre for Health, self-care means educating patients to feel they can care for themselves at home. We want patients to feel confident enough to self care for coughs, colds, headaches, sprains, and sore throats, without feeling like they need to see a doctor.
Finding it hard to stay positive
Authors: Carr Caroline
Published: September 2014

Every month, Caroline Carr answers questions from readers on how to improve their wellbeing.

If you have a question for Caroline, email bjhca@markallengroup.com
How best to add value through continuous professional development: being lectured at by experts or the DIY approach?
Authors: Watts Eric
Published: September 2014

In the first of a new series entitled ‘Provocations’, Dr Eric Watts of Basildon Hospital expresses his anger and concern over time he feels was wasted at a recent conference. He examines traditional educational methods, and suggests that the lecture format widely used in many forms of CPD should no longer automatically be considered first choice.
Setting up public–private partnerships in pathology
Authors: Pattinson Sarah
Published: September 2014

This article discusses the benefits discovered by Ealing Hospital NHS Trust pathology services and The Doctors Laboratory when they worked together to set up a public–private partnership for pathology services.
Prescription Patricia: on ‘The Nation's Health’
Authors: Webster Charles
Published: September 2014

In this article, the eminent commentator Dr Charles Webster looks for messages about choice and contestability in the Secretary of State's speeches and writings
Why Connecting For Health needs joined-up thinking
Authors: Rothwell Tom
Published: September 2014

The ‘Provocations’ series returns with Connecting For Health in the sights of an IT supplier. CfH's aims for centralised IT efficiency are commendable, but keeping out niche expertise may prove a false economy in the end.
Reforming US health care
Authors: Appleby John
Published: September 2014

Professor John Appleby, chief economist of the King's Fund, considers the possibility that reforming US health care will be another opportunity missed.
Tackling concerns: addressing regulation
Authors: Martin Jeannett
Published: September 2014

Jeannett Martin, Director of Nursing for BarnDoc Ltd, reports on last month's Tackling Concerns conference and the changes to regulation and assessment that were discussed
Payment by results or payment by activity?
Authors: Hinchley Geoff , Rashid Shwan , Mbamalu David , Banerjee Ashis
Published: September 2014

In 2005, the Government introduced a new method of funding for secondary healthcare providers in England, known as ‘payment by results’, although a more appropriate term would be ‘payment by activity’.
Comparing total hip and knee replacement costs
Authors: Lemon Michael A , Hamilton Paul D , Field Richard E
Published: September 2014

Before 2003, all NHS trusts charged locally determined prices for the provision of hip and knee arthroplasty services to their primary care trust (PCT). These charges could be fi xed irrespective of the activity provided (Department of Health (DH), 2002). In 2003–2004, the DH set up a national tariff system so that hospitals would charge PCTs per treatment performed. Similar treatments are grouped together under the same tariff and referred to as a Healthcare Resource Group (HRG).
Independent sector CATS: a drive for change
Authors: Way Rosalind , Mackness John
Published: September 2014

Rosalind Way and John Mackness reflect on the role of the independent sector in the NHS
Mental health: time to rethink investment
Authors: Harris Jane
Published: September 2014

As the Mental Health Act Commission launches its new biennial report, Jane Harris, Head of Campaigns and Media for mental health charity Rethink, examines where investment can achieve the most.
Reframing the language barriers
Authors: Walker David
Published: September 2014

In response to last month's column, David Walker wonders whether managers need to be good liars.
Mental health and media manners
Authors: Bell Andy
Published: September 2014

Andy Bell, director of public affairs at Sainsbury Centre for Mental Health, considers the failings of the media in its portrayal of mental illness.
Foundation freedoms forgot
Authors: Timmins Nick
Published: September 2014

Nick Timmins, Financial Times public policy editor, reflects on the recent spat between Bill Moyes and David Nicholson and why it always comes down to money.
An NHS constitution: to be or not to be?
Authors: Hill Rosalind
Published: September 2014

Rosalind Hill reflects on the recent King's Fund debate of whether the NHS needs a constitution, and what the implications of any decision might be
Dysphagia: the management and detection of a disabling problem
Authors: Perry Lin
Published: September 2014

Dysphagia represents a varying group of swallowing difficulties commonly encountered in patients in both acute and community settings. It accompanies a variety of disease states, can be neuromuscular or mechanical/obstructive in origin and encompasses varied prognoses and outcomes. Its consequences include dehydration, malnutrition, bronchospasm, airways obstruction, aspiration pneumonia and chronic chest infection, social isolation, depression and detrimental psychosocial effects. Current ‘best evidence’ in screening, assessment and management is of variable quality but demonstrates that nurses have an important role to play in interventions entailing multiprofessional collaboration within individually tailored programmes. Clear benefits for patients have been indicated. There are gaps in the knowledge base, especially in relation to psychosocial effects and treatment strategies and the nursing contribution in this area.
Introduction of a new nursing Code of Professional Conduct
Authors: Tingle John
Published: September 2014

The Nursing and Midwifery Council (NMC) has produced a new Code of Professional Conduct which comes into operation on 1 June 2002 (NMC, 2002). It covers a lot more ground than its predecessor, which is not surprising as a great deal has happened in the intervening years since the publication of Exercising Accountability in 1992.
Correspondence
Authors: Bersey Kathlean , Jukes  , Bollard Martin , Farmer Paul
Published: September 2014

Any nurse can be a health facilitator

Nursing homes need cash very urgently
Setting up a multidisciplinary journal club in learning disability
Authors: Hunt Cath , Topham Lynne
Published: September 2014

This article presents an account of how a journal club with a multidisciplinary membership from learning disability practice was set up. It presents a review of the literature which discusses the purpose, function and setting up of journal clubs. It outlines how topics were selected, the appraisal tool used to review articles and how findings from the reviews were disseminated to practice areas. The article identifies the lack of research in the area of learning disability practice. It demonstrates the positive aspects of working in collaboration with other members of the multidisciplinary team and how this provides opportunities for professional development. It identifies that support from management is essential in enabling staff to take time to attend and participate in the journal club.
Workplace stress and bullying: liabilities of the employer
Authors: Dimond Bridgit
Published: September 2014

Case Scenario

Iris works in the intensive care unit at Roger Park Hospital. One of her responsibilities is to arrange the rota for staff cover. As a result of the shortage of intensive care nurses locally, she is compelled to use agency nurses and to plead with her colleagues to work additional shifts or overtime. On some occasions she has been close to asking senior management to consider halting admissions and leaving beds empty, because she is unable to arrange cover. She increasingly finds that she is unable to cope with the situation: she is unable to sleep, she is worrying about work when not on duty and feels that she is close to a nervous breakdown. What is the law?
Nurses' bedside manner: is it deteriorating?
Authors: Castledine George
Published: September 2014

Bedside manner is an old-fashioned term which relates to how a doctor or nurse behaves and interacts with patients. Nurses should always adopt a friendly manner. In the past, the nurse was encouraged to take every opportunity to get to know the patient but, as Pearce wrote in 1953, the nurse ‘should never permit personal interests to enter her professional relationships. She may have her own emotional problems, but should never attempt to discuss them with a patient. To him she is essentially a nurse, which in itself is a compliment as she is of more value to him as a nurse than she could ever be as a person’.
Correspondence
Authors: Tingle John , Buckingham Martha , Foster Brian
Published: September 2014

Need to clarify start of patient advocacy

Nurses must take time to talk to their patients

Closure of care homes must stop now
The InCare Retracted Penis Pouch: an alternative for incontinent men
Authors: Doherty Willie
Published: September 2014

Urinary incontinence in men is a common problem in the community setting and within the acute hospital sector, as well as for people with learning difficulties or those who have a mental illness. There are many causes of incontinence, some are the result of surgical intervention, as in post-prostatectomy urinary incontinence, bladder dysfunction caused by a congenital abnormality where the ability to develop bladder control is affected, or as a side-effect of tranquillizer or other medication. All patients with urinary incontinence episodes should have thorough investigation of this problem as it is often a sign or symptom of an underlying condition, such as an enlarged prostate, urethral stricture, or atonic or neuropathic bladder. Effective bladder voiding function must be established before the assessment for any urinary collection device. Advice on assessment and treatment modalities can be sought from local continence advisers or clinical nurse specialists (Doherty, 2001).
Selective non-operative management of penetrating liver injuries at a UK tertiary referral centre
Authors: MacGoey P , Navarro A , Beckingham IJ , Cameron IC , Brooks AJ
Published: September 2014

Introduction

Selective non-operative management (SNOM) of penetrating abdominal injuries has increasingly been applied in North America in the last decade. However, there is less acceptance of SNOM among UK surgeons and there are limited data on UK practice. We aimed to review our management of penetrating liver injuries and, specifically, the application of SNOM.

Methods

A retrospective review was performed of patients presenting with penetrating liver injuries between June 2005 and November 2013.

Results

Thirty-one patients sustained liver injuries due to penetrating trauma. The vast majority (97%) were due to stab wounds. The median injury severity score was 14 and a quarter of patients had concomitant thoracic injuries. Twelve patients (39%) underwent immediate surgery owing to haemodynamic instability, evisceration, retained weapon or diffuse peritonism. Nineteen patients were stable to undergo computed tomography (CT), ten of whom were selected subsequently for SNOM. SNOM was successful in eight cases. Both patients who failed SNOM had arterial phase contrast extravasation evident on their initial CT. Angioembolisation was not employed in either case. All major complications and the only death occurred in the operatively managed group. No significant complications of SNOM were identified and there were no transfusions in the non-operated group. Those undergoing operative management had longer lengths of stay than those undergoing SNOM (median stay 6.5 vs 3.0 days, p<0.05).

Conclusions

SNOM is a safe strategy for patients with penetrating liver injuries in a UK setting. Patient selection is critical and CT is a vital triage tool. Arterial phase contrast extravasation may predict failure of SNOM and adjunctive angioembolisation should be considered for this group.
A prospective study on the risk of glove fingertip contamination during draping in joint replacement surgery
Authors: Makki D , Deierl K , Pandit A , Trakru S
Published: September 2014

Introduction

The aim of this prospective study was to investigate the risk of contamination of surgical gloves during preparation and draping in joint replacement surgery.

Methods

During 46 hip and knee replacement procedures, the gloves of orthopaedic consultants (n=5) and registrars (n=3) were assessed for contamination immediately after draping by impression of gloved fingers on blood agar. Contamination was evaluated by the surgeon’s grade, the type of procedure, the role of the assistant and the dominance of the hand.

Results

A total of 125 pairs of top gloves were examined (79 pairs from registrars and 46 pairs from consultants). Bacterial contamination was isolated on 19 pairs (15.2%) (16 pairs from registrars and 3 pairs from consultants, p=0.04). Coagulase negative staphylococci were the main isolates and contamination was considered low in all cases (1–5 colonies). Contamination was seen more on the dominant hand (16 gloves from dominant hands and 6 from non-dominant hands, p=0.04), on the index finger and thumb. More contaminated gloves were seen in hip arthroplasty procedures (16 pairs from total hip replacements vs 3 pairs from total knee replacements, p=0.02).

Conclusions

Contamination of glove fingertips during draping in joint replacement procedures is more likely to occur among junior surgeons, in hip rather than knee arthroplasty procedures and on the dominant hand. It is therefore essential that surgeons of different grades replace gloves used in draping to avoid exposing patients to the risk of infection.