bluuebunny/crossref_metadata_2025 huggingface dataset:
Cornwall's funding does not fit its rurality
Authors: Bennett Simon , Bastin John , Salter Leo , Watt Alex , Morris Jenny
Published: May 2014

This article examines the formula for NHS funding in England and its implications for Cornwall. Parameters that make up the formula (age, need, market forces etc.) are examined for recognition of rurality. Comparison is made with Scotland and Wales and with those English areas funded through the EC ‘Objective One’ programme
Eight years on: long march or road to discovery?
Authors: Hardacre Jeanne , Keep Jane
Published: May 2014

Two full parliamentary terms later, and we face an NHS quite different from that left to us by Stephen Dorrell. If a week is a long time in politics, eight years is certainly a long time in NHS management. In career terms, eight years has meant several job moves for most managers; a proliferation of opportunities for many; and rapid exits for some.
Audiology and psychiatry battle over Blair's head
Authors: Roth Andrew
Published: May 2014

Tony Blair should be warned. The next time he visits a hospital for a check-up on his back, there may be a battle between its audiology and psychiatric departments to examine his head. Audiology may want to find out how a listening’ Prime Minister can seem to hear only a quarter of the electorate's loud grumbles. Psychiatrists should be curious about what enables him to downplay blows aimed at him while re-interpreting others as endorsements.
Politics as usual? Don't bet on it.
Authors: Timmins Nicholas
Published: May 2014

Whatever happens over the next few years, May 2005 will be remembered as the moment when it seemed as though everything would carry on exactly as already planned, election or no election. Or will it?
Sleepy politicians who are dancing on the precipice
Authors: Maynard Alan
Published: May 2014

How is the NHS to manage demand? The combined effects of scarce resources and the inevitability of death and decay continue to put intense pressure on the NHS. Meanwhile, the Government have raised expectations of improvements in both the process quality of health care and waiting times. These are noble and sensible goals, but demand continues to exceed supply and rationing remains unavoidable.
Divergent staff responses to change in primary care
Authors: Hockly Anthea , Caan Woody , DeBell Diane
Published: May 2014

A research questionnaire was developed in an area that had previously identified a shortage of general practitioners. This questionnaire was completed at multiple sites by 43 staff - a mix of doctors and nurses in two primary care trusts
Missing: 1,500 girls in the past 15 years
Authors: Ainsworth Steve
Published: May 2014

In December the BBC broadcast a programme revealing that, according to the Department of Social Policy and Social Work at the University of Oxford, up to 1,500 baby girls have gone missing from Britain's books. Research suggests that between 1990 and 2005, about 1,500 fewer girls were born to Indian mothers living in Britain than would have been statistically probable.
Paying for non-performance
Authors: Maynard Alan
Published: May 2014

Is there a revolution afoot? If so, caveat emptor – buyer beware!
The future cost of mental health care
Authors: Lawton-Smith Simon
Published: May 2014

The NHS in England spent over £9 billion in 2006/07 providing services to people with mental health disorders. The overall service cost of mental health (health, social care and informal care) is £22.5 billion. With consistently high prevalence rates and expected increases in the numbers of people with mental health disorders over the next 20 years, this article looks at what might be done to reduce the future cost of mental health care
Working in and learning from a troubled system
Authors: Leech Darren , Cox Dennis
Published: May 2014

Crisis, what crisis? Recognising that there is a problem and often, moving away from ‘group–think denial’, is critical in any troubled business and the same applies to organisations in the modern NHS. It is unusual for a crisis to creep up on any organisation, as those in financial turmoil usually have a number of contributory pressures, all of which aid identification of the cause.
Governance and accountability
Authors: Moyes Bill
Published: May 2014

Anyone familiar with Monitor's quarterly updates will know the current financial health of NHS foundation trusts is very good, as is performance against national targets and core standards. Based on this evidence, you can make a strong case that the introduction of foundation trusts has been an overall success. We certainly feel there is cause to be satisfied with the progress to date. But, looking at the longer term, a financially viable hospital that meets its service obligations should be a basic expectation for the NHS. So, how do these organisations demonstrate that the freedoms they were given are delivering better results than decisions taken in Whitehall?
Supporting palliative services
Authors: Hill Rosalind
Published: May 2014

Last month the National Audit Office (NAO) published a report examining the provision of end of life care services and areas that could be improved (NAO, 2008).
The ageing time bomb (defused)
Authors: Appleby John
Published: May 2014

In a deeply ironic, if not perverse, twist, one of the measures of the success of healthcare services–that people live longer–has often been used to suggest that at some point (just around the corner) a tide of elderly people will overwhelm health services and all manner of radical things will need to be done–often involving switching sources of funding away from taxation.
Why do we need a culture for innovation?
Authors: Farrar Mike , Tonge Alison , Colin-Thomé David , Maynard Alan , Maher Lynne , Harmond Kate , McGregor Tricia
Published: May 2014

It's really easy to think that it is other people who innovate. However, you can't expect to change something radically if it were easy.
Cost of outpatient viscosupplementation
Authors: Jacobs Neal , Kane Timothy PC , Clarke Hugh J
Published: May 2014

Payment by results was introduced to provide a transparent system of funding for trusts, rewarding efficiency. The authors are aware that outpatient joint injections currently carry no mandatory tariff. Hyaluronic acid (HA) viscosupplementation in particular, is frequently performed by departments at significant pharmaceutical cost. This study investigates the size of the problem, and discusses issues of cost-effectiveness.
Disability discrimination law 2: law in action
Authors: Griffith Richard
Published: May 2014

The first article on the Disability Discrimination Act (DDA) 1995 considered the components that made up the statutory definition of disability (Griffith, 2008). To be considered disabled, a person must have a condition that:
PROMs will be no walk in the park
Authors: Maynard Alan
Published: May 2014

Tucked away in an obscure appendix of the NHS Operating Framework for 2008-9 is a recommendation that patient reported outcome measures (PROMs) should be introduced for hip and knee replacements, varicose vein procedures and hernia repairs.
Effective quality improvement: BPR
Authors: Powell Alison , Rushmer Rosemary , Davies Huw
Published: May 2014

Developed in the US in the 1990s, Business Process Reengineering (BPR) soon filtered into health care, and was the focus of several high-profile NHS initiatives in the late 1990s. However, the radical ‘fresh start’ approach of BPR, and many of its underlying principles, did not fit well into healthcare settings. Its most enduring legacy is likely to be its emphasis on processes, which has contributed to the growing interest in redesigning patient pathways and clinical processes.
Electronic health information and long-term conditions
Authors: Hewitt-Taylor Jaqui , Bond Carol S
Published: May 2014

This article discusses the increasing availability of health-related information, and the impact that this can have for people with long-term conditions' expectations of healthcare providers. The article suggests a framework for decision making about the role that healthcare staff should play in the information searching, retrieval, and synthesis activities which people with long-term conditions engage in. The framework is based on a series of decisions related to: perceptions of ownership of long-term conditions; whether intermediatory or apomediatory approaches to information management are deemed to be most appropriate; and, as a result of these considerations, what, if any, place healthcare staff should take in the process of patients searching or and interpreting information about long-term health needs. These decisions will enable healthcare providers to plan services based on clear decision pathways, and to clarify to all concerned what are deemed to be reasonable expectations of health service provision.
Early attitudes to women and sexuality
Authors: Allan Kate
Published: May 2014

Kate Allan discusses attitudes to female anatomy and physiology in early modern Europe.
You are a manager: should you be a leader?
Authors: Stonehouse David
Published: May 2014

In this article the author will examine the two important and distinct roles of both manager and leader. Often, out of necessity, these two roles are performed by the same individual, but this however, is not always ideal or practical. Therefore, as a manager, it is vital to recognise the focus of your role and to support and develop those staff within your department who can and are already fulfilling their leadership potential. This article will start by demonstrating the differences between a leader and a manager. Change management will be discussed before finishing with how the manager can support and develop their own staff to become successful leaders, thereby allowing the manager to concentrate upon the vital job of managing.
Operating efficiency: a six-month review
Authors: Mohan Arvind , Dalal Milind
Published: May 2014

Efficient use of operating theatres is important to ensure optimum cost-benefit for the hospital. We used the elective plastic surgery theatre as a model to assess theatre efficiency at our institution. Data were collected retrospectively on every operation performed in the elective plastic surgery theatre between 1 June and 30 November 2012. Each component of the operating theatre process was considered and integrated to calculate values for surgical/anaesthetic time, changeover time and ultimately theatre efficiency. A total of 594 operations were carried out over 1140 hours of allocated theatre time (ATT). Actual operating time represented 57.0%, anaesthetic time 28.4% and changeover time 12.0% of ATT. The average changeover time between patients was 21 minutes. Lists started on average 8 minutes late each day. There were a total of 8.8 hours of overruns and 5.1 hours of no useful activity. Operating theatre efficiency was 81% for the six-month period. Our study has highlighted areas where theatre efficiency can be improved. We have been able to suggest various strategies to improve this that may be applied universally.
Markets, mergers and mixed messages
Authors: Sturgeon David
Published: May 2014

Choice has become the defining characteristic of service users’ relationship with the NHS in England. Decades of market-orientated policy have encouraged greater customer focus, and the NHS is now subject to the same consumer drivers that can be identified elsewhere in society. Competition between service providers is intended to encourage improvements in efficiency and ensure services are more responsive to users’ needs. In 2013, the Competition Commission intervened for the first time in the English NHS to prevent a merger between two hospital trusts on the basis that it would damage patients’ interests by eliminating competition and choice. At the same time, senior healthcare professionals and managers are warning that hospital closures are essential if the NHS is to continue to offer high quality care to all. This article examines whether market principles encourage or deter the equitable provision of hospital services in England as consumer rights are increasingly upheld in law. It also considers the difficulties of persuading service users that service reconfiguration will be of benefit having been promised greater choice and personalisation of care.
Patient satisfaction in the fracture clinic
Authors: Basso Oreste
Published: May 2014

Moving to a health service that works with patients is a priority. To this end, knowledge of the level of patient satisfaction is instrumental. A paper questionnaire was handed over to patients attending 10 consecutive fracture clinics. The time spent in the waiting area to see a doctor, satisfaction levels, quality of doctor's consultation, a list of concerns and suggestions for service improvement were obtained. The survey was conducted over a two-week period and was repeated after changes had been introduced, following analysis of patients’ recommendations. The primary survey included 387 respondents. Median waiting time was 48 minutes (interquartile range 30–64). This decreased to 42 minutes (17–57) in the secondary survey, which also demonstrated an improvement in level of satisfaction with the waiting time. The quality of consultation with the doctor improved, according to the secondary survey. Overall, 87% of patients felt the service provided in our fracture clinic was average or above. This increased to 95% after changes were implemented. Among patients’ recommendations, getting additional clerical staffing was of particular importance. We found the survey to be an important monitoring tool of customers’ satisfaction. A secondary survey, obtained after the system had been changed, revealed significant improvements.
PTSD: Overview and the Way Forward
Authors: Koch Hugh , Bird David , Hetherton Jacqueline , Williams Joshua
Published: May 2014

The purpose of this article is to clarify the current state of describing traumatic reactions resulting in post-traumatic stress disorder (PTSD) so that the disorder can be understood, assessment and treatment can be optimised and recovery can be facilitated. This article describes what PTSD is and how it can be most effectively treated. The key challenges to PTSD diagnosis, treatment and psychoeducation are discussed.
Recognising the effect of depression on partners
Authors: Carr Caroline
Published: May 2014

Caroline Carr shares her experience of depression’s effects on partners, and how the issue can be somewhat misunderstood
Self-harm by children and young people: care and compassion
Authors: McDougall Tim , Armstrong Marie , Trainor Gemma
Published: May 2014

This article discusses self-harm by young people and highlights the role of the nurse in providing compassionate care. The views of young people about the services they receive following self-harm are discussed, and the complicated link between self-harm and suicide is explored. Some good practice points for assessment are included, and a summary of self-harm treatments is provided. Nurses are encouraged to consider their attitudes towards self-harm, and consider how they respond to young people who may be distressed and struggling.
The MASC: screening for anxiety in vulnerable young males
Authors: Carroll Denise , Martin Colin R , Duffy Tim
Published: May 2014

181 participants aged 13–16 years old were recruited from a Scottish residential centre for young males with severe emotional and behavioural difficulties. They completed a health assessment and the Multidimensional Anxiety Scale for Children (MASC). Three observations over 24 weeks were conducted to evaluate the effectiveness of the MASC self-rating scale as a screening instrument for vulnerable adolescent males. Over the three observations, further comparison of the MASC detection rates of anxiety were made with the findings of the health assessment. The MASC failed to identify any of the young people who had a clinical diagnosis of anxiety previously assessed by the child and adolescent mental health services. Notably the MASC only identified 5–9% of the young people with current concerns raised about anxiety. This raises issues about the sensitivity of the MASC in identifying anxiety in this vulnerable population.
Improving access to psychological therapies: the HEAT is on
Authors: Kyle Catherine , Sloan Graham , Davies Janet
Published: May 2014

The evidence base demonstrating the effectiveness of psychological therapies has grown significantly in the last 20 years. These interventions now feature strongly in both NICE and SIGN guidance. Improving access to these evidence-based psychological therapies is a major priority in mental health services. There is recognition that psychologists and accredited psychological therapists cannot and should not be the sole providers of psychological interventions. By introducing skill mix there is scope to increase capacity in the wider staff resource. A number of projects in one NHS board in Scotland aimed at improving access to all levels of psychological expertise. This included a redesign of community adult mental health services, an increase in the delivery of training, the establishment of psychological therapies-focused clinical supervision and other governance systems for the delivery of psychological interventions.
Changing legislation: a reflection on returning to practice
Authors: Hopton John
Published: May 2014

Returning to the practice of acute mental health nursing after an absence of more than thirty years the author reflects on the changes that have occurred during this time. There is a summary of the changes that have taken place during this time and there is an acknowledgement that the standard of mental health nursing care is generally now much higher than it was circa 1980. A particular focus of the discussion is the significance of section 17 of the 1983 Mental Health Act (as amended by the 2007 Mental Health Act), which is used to illustrate an apparent contradiction between official government mental health policy which champions user centredness and the very stringent controls that are placed on patients who are detained under the 1983/2007 Mental Health Act. The article includes a discussion of the lack of discretion which a registered mental health nurse who is not the responsible clinician for a sectioned patient has to grant leave to such a patient.
Integrating values into the mental health nursing curriculum
Authors: Cambers Walter
Published: May 2014

In this article, the author relects on the changes and uncertainty surrounding mental health pre-registration nurse education. The article looks at new recommendations on the education of nurses and the explores how student nurses need to be aware of the values of their profession.
In a different league: The State of Mind campaign
Authors: Cooper Phil , Benbow Ernie
Published: May 2014

State of Mind is the rugby league mental health wellbeing campaign formed in 2011 to increase awareness and support for rugby league players with mental ill-health and depressed mood, and their communities. League 13 is the Super League Players Association that support player welfare issues in the game. The members of League 13 were asked to prioritise areas of concern for full-time rugby league players in terms of their wellbeing. The survey sent to all members identified the following priority areas for support: playing and associated family pressures; stress and anxiety; and managing money. The survey approach can be applied to other sports and health initiatives.
A comprehensive care package for young people with ADHD
Authors: Padmore Jane
Published: May 2014

Attention deficit hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder seen in young people in the UK and, as such young, people with this disorder are classified as having a disability. Without intervention the impact on the individual, families and society as a whole can be great. To meet the complex and multi-faceted needs of this group of young people, comprehensive care plans need to be developed. Many myths periodically appear in the media and in public opinion that can, unhelpfully, lead to misunderstandings about these young people. Involvement of all professionals working with the young person is needed to develop a comprehensive care plan in partnership with the family that enables them to both manage the symptoms and explain their difficulties. These care plans can usefully include addressing psychoeducation needs, psychopharmacology, family support and parenting programmes, educational support, individual work and transition planning.
Administering LAAIs: an education and training workshop
Authors: Hemingway Steve , Stephenson John , Holliday Lindsay , Covill Carl
Published: May 2014

This is the second of two articles that focus on the inter-collaborative work, between education and practice, to enhance theoretical and practical delivery for mental health nurses when administrating long-acting antipsychotic injections (LAAIs). By designing two questionnaires, we were able to evaluate knowledge gain and the satisfaction level of the course delivery by the mental health nurses. These appear initially to identify that such educational strategies can make a positive impact in clinical practice.
The impact of exploring ageism through reflective writing
Authors: Jenkins Catharine , Macken Gemma
Published: May 2014

Reflective writing is used as part of a patchwork assessment in mental health nursing education to explore student nurses’ perspectives on ageing and ageism. Reflective writing is a useful means of addressing individual ageism and harnessing commitment to positive values and practice through promoting critical thinking and encouraging self-examination. The insight shown in mental health nursing students’ writing indicates that they can develop the awareness, motivation and determination to achieve change, but success will depend on implementation of policy aims and related changes to the structure and processes of healthcare services in which they will work.
Reflective analysis of a critical incident: professional development
Authors: Burgess Corinne , Kerr Joanne
Published: May 2014

Prolonged seclusion and restraint has been criticised by the Council of Europe Committee for the Prevention of Torture, yet may be common clinical practice in some mental health settings. This article uses reflective practice to describe and discuss a clinical event in a mental health inpatient unit, in which the clinical team held differing views on the application of these techniques to manage the perceived risk of violence from a particular patient.
Exploring the non–specialist neuroscience nurse's professional accountability
Authors: Stanley Robert , Eberhardie Christine
Published: May 2014

Accountability is a preparedness to give an explanation to relevant others for one's judgments, intentions, acts and omissions when called on to do so. A central tenet of professional accountability is that each nurse is personally accountable for his/her own practice. A less negative definition of accountability is proposed, through discussion of the concept of collective accountability held by the profession. The accountability of the non-specialist nurse engaged in neuroscience care is examined using a case study analysis which compares the expectations of care held by a patient and his neuroscience specialist carers. As increasing demands are placed on health services, specialist patients will be placed in non-specialist clinical areas. There is a requirement for the profession to demonstrate a collective accountability, and for specialist nurses to more actively support the accountability of their non-specialist colleagues in meeting the needs of the specialist patient.
Budget cuts risk future skills deficits
Authors: Woodward Sue
Published: May 2014

The Council of Deans and Heads of UK University Faculties for Nursing and Heath Professionals has expressed serious concerns over cuts in funding for nursing education (2006). The Council of Deans is right to be concerned. So should the entire nursing profession as cuts could have an impact on us all for many years to come.
Sexuality and MS: A Guide for Women
Authors: Matthews Victoria
Published: May 2014

Sexuality and MS: A Guide for Women is an invaluable resource for women with multiple sclerosis (MS) who may experience difficulties with sexual activity. It is not an in-depth exploration of sexuality and how the diagnosis of MS impacts on female sexual identity and sexuality in a wider sense.
An investigation into the use of the Glasgow Coma Scale in one case using root cause analysis
Authors: Waterhouse Cath
Published: May 2014

The Glasgow Coma Scale observation chart is well established nationally and internationally as the primary tool that enables nurses to make quick, repeated evaluations of several key indicators of neurological status. However, coroners' inquiries have reported incidents in which the GCS has been inaccurately and ineffectively used in some areas of clinical practice. This article presents a clinical incident study to examine why practitioners may find difficulties in using the GCS. Root cause analysis has been used to investigate the attributes and antecedents of an adverse incident to try and raise awareness of some of the problems and pitfalls of recording Glasgow Coma Scale observations.
The management of intermittent catheterization: assessing patient benefit
Authors: Pomfret Ian , Winder Ann
Published: May 2014

A catheter is a hollow tube, which is inserted into a body organ or cavity for the purpose of draining or instilling fluids. Urinary catheterization is a common medico-nursing procedure in both acute and primary care. Common reasons for urinary catheterization are discussed and the options of intermittent and indwelling catheterization are described. The advantages and disadvantages of both methods are explored and the value of combining both methods, for individual patient needs, is examined. The physical and emotional needs of patients and carers who may be suitable for this method of treatment are discussed. The role and responsibility of those teaching catheterization is discussed.
Prepared to discuss assisted suicide?
Authors: Woodward Sue
Published: May 2014

Patients may plan to end their lives in the event that their quality of life or level of pain becomes unbearable. … any of our patients may be considering ending their own lives and may ask their nurse for advice.
Presumed consent: Altruism or a door to abuse?
Authors: McDonald Sheena
Published: May 2014

Sheena McDonald raises concerns about the government's proposal to presume citizens have given consent to have their organs donated
RESEARCH ROUNDUP
Authors: Woodward Sue
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Shake well before use: Facing a diagnosis of Parkinson's
Authors: Isaacs Tom
Published: May 2014

Tom Isaacs was diagnosed with Parkinson's disease at 27 years of age. Unable to walk without the aid of medication, he recently completed a 4500-mile walk around Britain, a journey described in his book, Shake Well before Use. In this extract, he tells the experience of being diagnosed
The nature of evil
Authors: Winter George
Published: May 2014

George Winter reflects on the problem of evil and its moral, psychological and biological explanations
Nurse support crucial to self-management of migraine
Authors: Rickarby Liz , Anthony Alli
Published: May 2014

Migraine Awareness Week is 7-13 September 2008. Liz Rickarby and Alli Anthony argue for the importance of the nurse's role in managing this common condition
Non-traumatic spinal cord injury: Less well-known causes and the challenges to nurses
Authors: Pellatt Glynis Collis
Published: May 2014

Patients with non-traumatic spinal cord injury (SCI) are encountered in increasing numbers in rehabilitation units. This article discusses some lesser known causes of non-traumatic SCI which include inflammatory disease, tumours, vascular disease, spinal stenosis and syringomyelia. The demographic and clinical pattern of non-traumatic SCI differs from that of traumatic SCI. This article addresses the challenges to nurses and other members of the healthcare team to provide individualized care and rehabilitation for patients who have an SCI plus an associated disease or condition.
Research Roundup
Authors: Eberhardie Christine
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Nursing management of subarachnoid haemorrhage: A reflective case study
Authors: Lange Fiona
Published: May 2014

Subarachnoid haemorrhage is a life-threatening event that presents with a number of discrete signs and symptoms making diagnosis problematic. A delay in diagnosis significantly increases morbidity and mortality and therefore places vulnerable patients at risk. Advanced nursing assessment and management is imperative to promote optimum patient outcomes and therefore decrease morbidity and mortality in acutely ill patients.

In this article a case study is discussed with reference to relevant literature to explore an evidence-based approach to the nurse's role, care and management of an acutely ill neuroscience patient with subarachnoid haemorrhage. In keeping with the reflective case study approach, Gibbs's reflective cycle (1988) and case study guidelines by Aitken and Marshall (2007) are used to identify areas of effective clinical practices and identify gaps in the literature. On the basis of this evaluation, suggestions for clinical improvements are made.

A reflective cycle can identify areas where clinical practice could be improved. It is hoped that this article will help nurses critically reflect on their own practice in the care and management of an acutely ill patient with subarachnoid haemorrhage.
RESEARCH ROUNDUP
Authors: Hibbins Stuart
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Clinical standards for phenytoin administration: The application of evidence to practice
Authors: Waterhouse Catheryne , Hale Heather
Published: May 2014

Phenytoin is an anticonvulsant drug used in the treatment of epileptic seizures. It has complex pharmacokinetics with a particularly narrow therapeutic index that emphasizes the importance of rigorous monitoring to optimize treatment and reduce the possibility of developing toxicity and other complications. This paper will discuss phenytoin administration in terms of its pharmacological properties, the indications for use, method of administration, and potential complications and interactions. It is predominantly aimed at nurses working with neurological patients but will be of interest to nurses working in other clinical fields where the drug may be infrequently prescribed. The administration of phenytoin should only be carried out by health professionals who have been appropriately educated and deemed to be competent.
Considering the impact of trauma on carers
Authors: McDonald Sheena
Published: May 2014

Suffering a traumatic brain injury (TBI) is very hard. Caring for and being close to a sufferer is traumatizing in a different way. I've written before about taking part in a research study being conducted by a clinical psychologist at the University of Glasgow into the relationship between TBI and post-traumatic stress disorder (PTSD). Dr Reid recently contacted everyone who participated in her study and reported back on her findings. She had used a very kinetic form of research involving colour-identification in order to help her to assess whether some people with severe or very severe head-injuries were being misdiagnosed: PTSD might have been overlooked, to the disadvantage of the patient, given that there are now psychological treatments to address the condition which can be offered.
The impact of pain on personal socio-economic disadvantage
Authors: Morgan Christopher , Barrie Janette
Published: May 2014

Clinical nurse specialists need to have an indepth knowledge of pain, its impact and management to help enable affected individuals to improve their quality of life.
The Mental Capacity Act 2005: Making decisions on capacity
Authors: Hill Jacqueline , Seymour Jane
Published: May 2014

It is the duty of health professionals to be informed about the rights and support available to patients at risk of losing their capacity to make decisions.
Adolescent epilepsy transition services: Empowering and informing young people
Authors: Crosby-McKenna Nicole
Published: May 2014

Young people with epilepsy who are well-informed and feel able to speak to their health professionals are at lower risk of experiencing poor health-related quality of life, according to a recenty survey into young people's experiences of living with epilepsy (Epilepsy Action, 2010). The health care young people receive during transition should inform and empower them to more effectively self-manage their condition, yet the majority are transferred to adult care without the dedicated support of a transitional care service. In this article, guidelines for the care of young people with epilepsy and the transfer of young adults from paediatric care to adult care will be considered.
Meeting the board: Roles and interests
Authors: Preece Anne
Published: May 2014

The British Association of Neuroscience Nurses (BANN) represents and promotes the interests of neuroscience nurses throughout the UK. Anne Preece, president of BANN introduces some of the executive board
Equity and excellence with your help
Authors: Preece Anne
Published: May 2014

The British Association of Neuroscience Nurses (BANN) represents and promotes the interests of neuroscience nurses throughout the UK. Anne Preece, president of BANN introduces some of the executive board.
CORRESPONDENCE
Authors: McLafferty Rachel
Published: May 2014

August/September diary: Headway celebrates its annual Way Ahead conference
Promoting sleep in neurorehabilitation patients: theory and practice
Authors: Pywell Alison
Published: May 2014

Sleep disorders are very common following brain injuries, with estimates ranging from 27–80% of patients being affected ( Thaxton and Myers, 2002 ; Parcell et al. 2006 ). Inappropriate use of sedating medications can be detrimental to patients, and this practice appears to be widespread ( Dorris et al. 2008 ; Makley et al, 2008 ). Patients who are discharged with sleep problems are more likely to be restrained by their carers ( Makley et al, 2008 ). Depression and cognitive and behavioural disorders can all be compounded by lack of sleep ( Thaxton and Myers, 2002 ). It is the nurse's role to ensure that the patient experiences the best possible sleep at every stage of their recovery, from injury to discharge.
Understanding narcolepsy: the wider perspective
Authors: Cook Neal
Published: May 2014

Narcolepsy is a relatively new condition in the field of neurology, having been established as a neurodegenerative condition only over the past 20 years. The full extent of the condition's impact on health and its complexity continue to be unravelled by research. The emerging insight into narcolepsy illustrates that it is not confined to the realm of sleep, but also affects pain response, mental health, cognition, metabolism and autonomic regulation. This paper examines recent evidence of importance to understanding narcolepsy and managing its effects on health-related quality of life.
Research Roundup
Authors: Harrison-Dening Karen
Published: May 2014

Karen Harrison-Dening provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail.
Parkinson's disease: top 10 causes of sudden deterioration
Authors: Magennis Brian , Corry Margarita
Published: May 2014

Sudden deterioration in Parkinson's disease is frequently encountered in clinical practice. It usually occurs over several days or weeks, and the cause is most likely related to a symptom rather than progression of the condition. It is important that the cause of the deterioration is treated and prioritised over the obvious presenting symptoms of Parkinson's. In most instances effective management of the root cause will prevent worsening of the symptoms of Parkinson's and enable patients to adopt health behaviours that help avoid recurrence. All members of the multidisciplinary team play a crucial part in identifying, managing and treating the condition. The top 10 causes of sudden deterioration in Parkinson's were identified from a review of clinical practice in a large teaching hospital in 2009; this paper outlines and explains current strategies for managing these top 10 causes.
The challenges that clinicians and patients face when selecting first-line treatments for multiple sclerosis
Authors: Barker Noreen
Published: May 2014

Over the past 12 years the treatments available to people with the relapsing-remitting form of multiple sclerosis (MS) have changed dramatically, with the introduction of the disease-modifying therapies (beta-interferons and glatiramer acetate). For clinicians the challenge is to select the most appropriate treatment while considering a myriad of issues such as age, culture, literacy, health literacy, education, treatment history, duration of disease, degree of disability, working status, family support, risk tolerance, social situation, preferences and choices. Patients may have to face up to fears about the future and concerns about managing injections before they even consider which treatment may be better suited to them. MS specialist nurses have a unique role in caring for patients and facilitating the decision-making process.
Newer drug treatments for focal-onset epilepsy
Authors: Lewis Sheila A
Published: May 2014

Over the past decade many new anti-epileptic drugs have been approved as adjunct treatment for people with epilepsy experiencing focal-onset seizures with or without secondary generalised tonic-clonic seizures. The 2012 update of the 2004 National Institute for Health and Care Excellence Clinical Guideline 20 evaluated the efficacy and cost-effectiveness of the newer anti-epileptic drugs. This article provides an overview of some of these drugs and their use in the management of focal-onset seizures, including their mechanism of action, dosing schedule and side-effects.
Can we measure empathy?
Authors: Robinson Jean
Published: May 2014

We were both adult students when we married, and although philosophy was not my subject I managed to learn about it because my husband always talked in his sleep the night before tutorials. When I realized that one essay subject was Can I have a pain in your leg? I was not surprised that his mind was working overtime.
Can continuity of care be the only answer?
Authors: Warwick Kathy
Published: May 2014

Years ago, I read about a piece of research which I sought to prove that it was beneficial to women to have a constant supportive companion with them in labour. I remember wondering why time had to he spent researching something which seemed so obvious
Thromboembolic disorders: treatment and diagnosis
Authors: Allotey Janette C , Louca Onsy
Published: May 2014

Thromboembolism is the highest cause of maternal mortality during childbirth (Figure 1 and Table 1). Midwives are in a prime position to identify women likely to be at higher than average risk and initiate medical referral. They can also assist with diagnosis of thromboembolic disorders and discuss preventive or curative care with affected women.

Maternal mortality rates in the UK have declined from 10.3 per 100 000 (1988-90) to 9.8 per 100 000 maternities between 1991 and 1993 (Department of Health, 1996). Unfortunately, deaths from thrombosis and thromboembolism have remained relatively high over the past 20 years. Some maternal deaths, including those from cerebral thrombosis, occurred following sudden collapse or demise in previously asymptomatic women. However, in a significant number of cases reported in the latest enquiry (Department of Health, 1996), possible symptoms were misdiagnosed by professional carers.

With extra mindfulness of who is at risk and by providing appropriate preventive treatment, it may be possible to achieve a reduction in deaths from this cause. This article reviews the risk factors which may be amenable to prophylactic treatment and the signs, symptoms and treatment of thromboembolism.
The effects of stress on the childbearing woman and her family
Authors: Graham Deirdre
Published: May 2014

This article examines the concept of stress and the effect this may have on the childbearing woman and her family. The positive and negative effects of stress are explored, hopefully dispelling the commonly held belief that stress can only be detrimental. The need for sensitive, holistic midwifery care and good social support during pregnancy are seen as being essential. All midwives have a duty to gain an understanding of all aspects which may affect the health of women.
Dangerous doctors: can they be retrained?
Authors: Robinson Jean
Published: May 2014

No one is perfect. Anyone can make a mistake. But then there is another. And another. Many experienced midwives will have come across doctors they do not trust.
Case report. Maternal serum screening: a team approach
Authors: Fairgrieve S , Magnay D , White I , Burn J
Published: May 2014

The development of a team approach, headed by a core of personel with coodinators in each unit, to enhance service delivery of the meternal serum screening programme was evaluated after 2 years of operation. Responses were obtained from 17 out of 18 maternity units involved. Whereas coordinators felt this approach was beneficial, the survey did indicate a lack of recognition of their role by other professionals.
Ster-Zac powder in the care of the umbilical cord following childbirth
Authors: Teece Jill
Published: May 2014

Various research projects have evaluated the care of the umbilical chord following childbirth. This article summerises three of them, two from the Bristol Maternity Hospital 1958 and 1967, and one from Whiston Maternity Hospital 1994, with reference to the reduction of staphylococcal infection.
What is ‘childbirth’: time to interpret the act?
Authors: Downe Soo
Published: May 2014

I used to feel (rather smugly, I must confess) that midwives were uniquely protected in their role. After all, according to the Midwives Act, only a midwife or a doctor can attend a woman in childbirth, unless there is an emergency, and the Rules state that a midwife must attend a woman in labour if called.
First class delivery? Auditing the auditors
Authors: Robinson Jean
Published: May 2014

First the good news. Maternity service care popular with Women and midwifery is most popular of all. About 90% of women are pleased With their midwifery care in pregnancy and labour Medical cafe fates rather lower, at about 80%. A large random sample of women Was questioned for the Audit Commissions (1997) study of maternity services.
Midwifery in 20 years time: future perfect?
Authors: Hall Jennifer
Published: May 2014

Midwifery practice has changed. Twenty years ago the advances of technology meant encouraging all births to be in hospital, and some bright spark suggesting babies should be born in daylight hours brought an increase in induction and caesarean rates.
First class delivery: a review of the Audit Commission report
Authors: Fitzsimons Beverley
Published: May 2014

National policy has focused on making maternity services more ‘woman centred’. Most women are satisfied with the care they get but services could still be improved. In addition, the NHS would make better use of the £1.1 billion it spends anually on maternity care by making changes in the organization of care and bringing evidence on clinical effectiveness into routine practice. This is the first in a series of articles based on the Audit Commission's national review of maternity services, First Class Delivery. It describes the study methods and key messages. Later articles will focus on local audits of maternity services following from this study and on key issues highlighted by the study.
Midwifery education: Part 6 The North Thames region
Authors: Hallworth Chris , Sisto Sheila , Dickenson Angela , Emery Sandy
Published: May 2014

The midwifery educational provision at the Anglia Polytechnic University (APU) spans five health districts and incorporates five NHS trusts. Since incorporation in 1992, a series of structural changes within the university organization have occurred. These internal changes are set against a backdrop of marked external change in health and in the public service sector at large.
Results of seeing mothers as partners in antenatal care
Authors: Thorley Kevan , Rouse Trish , Campbell Ian
Published: May 2014

We have developed a new system of antenatal care in partnership with mothers. The basis of this system is a meeting for mothers and professionals which provides education and support. Our preliminary results in an uncontrolled study are encouraging, showing an increase in normal deliveries and a low caesarean section rate, and an increase in breastfeeding. Perineal damage was reduced. Fewer mothers defaulted from care.
Stress and the midwife
Authors: Dimond Bridgit
Published: May 2014

Several recent cases brought by employees suffering from the effects of stress at work have resulted in substantial compensation payments. This article analyses what a midwife would have to prove to win such a case and the role of the manager and supervisor in preventing stress arising.
Consent and women in labour: a review of the issues
Authors: Griffith Richard , Tengnah Cassam , Grey Robert
Published: May 2014

The refusal of treatment by a mother in labour presents the midwife with a dilemma between upholding the autonomy of the woman and saving the life of the mother and fetus. This article reviews four recent court cases concerning consent to treatment and women in labour. The main legal principles are explored and implications for midwifery practice considered.
Pregnant women in prison and the law on human rights
Authors: Dimond Bridgit
Published: May 2014

It is inevitable that some pregnant women will commit offences which are punishable by imprisonment, it is inevitable that some mothers of young dependent children will face imprisonment. In sentencing, the court is not only sentencing the mother and the fetus, but also the youngsters dependent on that mother. What rights do they have? In what way does the prison service provide adequate care of the mother's maternity needs?
Midwives, experts and higher awards
Authors: Downe Soo
Published: May 2014

This column is about the vexing question: what is a midwife? Actually, more specifically, it is about the what is an expert midwife? question. The proposed higher level of practice has, once again, excited our enthusiasm and antagonisms. We seem to have been through this before, what with the ENB Higher Award, the UKCC advanced practitioner, and the governments desire for consultant nurses and midwives. It is all very confusing.
Step 38: NHS Plan 1: patients
Authors: Dimond Bridgit
Published: May 2014

The NHS Plan (Department of Health (DoH), 2000) aimed to increase investment in the NHS and at the same time meet the five challenges identified by the Prime Minister as: partnership; performance; professions and the wider NHS workforce; patient care and prevention. Underlying the Plan are a set of 10 core principles of which the third is that: The NHS will shape its services around the needs and preferences of individual patients, their families and their carers.