bluuebunny/crossref_metadata_2025 huggingface dataset:
Close your books and open your minds
Authors: Fox Eades Jenny
Published: May 2014

All teachers understand how important story telling is. Jenny Fox Eades offers some advice on how to tell your own fairy tales or stories
Exploring our world
Authors: Lepkowska Dorothy
Published: May 2014

One primary school uses global links as a means of swapping ideas and sharing educational resources. Dorothy Lepkowska reports
Make up silly poems
Authors: Croft Sue
Published: May 2014

These are new, silly poems. Share the different types with your class. Learn about some of the writing processes involved, and help the children to write their own poems.
Jeannie Baker's Belonging
Authors: Rhodes Liz
Published: May 2014

The book Belonging is an account of the reclamation of an urban landscape told wordlessly through detailed collage artwork. Observed through the window of a house, a city street gradually becomes a place to call home as the inhabitants begin to rescue their street by planting grass and trees in the empty spaces. Year by year, everything begins to blossom.
Settling in your new class
Authors: Philips Eleanor
Published: May 2014

Some top tips for helping your class readjust to school−life and for making the first term as stress−free as possible
Starting school at five
Authors: Mill Patsy
Published: May 2014

Are we starting formal education too young? A look at some of the latest theories
Up, up and away!
Authors: Hammond Paula
Published: May 2014

November is aviation month, so this month′s activities give the children the chance to get airborne with a series of activities exploring forces and motion. During a series of practical experiments, children will be encouraged to (a.) understand that when objects move, speed up or slow down it is caused by the application of a ′force′; (b.) know that ′gravity′, ′thrust’ and ′lift’ are all types of force; (c.) appreciate how birds’ bodies are adapted to fly ; (d.) learn about some of the ways that people have attempted to get airborne; (e.) design and test their own ′flying machines′; (e.) interpret and present their findings. For best results, it is suggested that these activities are planned out well in advance, with sufficient time to discuss each stage.
Managing chickenpox
Authors: Stevenson Jane
Published: May 2014

Chickenpox is often the first ′real’ illness a child experiences. It can be a particularly worrying time for parents and teachers who are coping with an outbreak
Telling winter tales
Authors: Hammond Paula
Published: May 2014

Winter can be a hard time of year for many. This assembly helps children to remember that
Where The Wild Things Are
Authors: Rhodes Liz
Published: May 2014

This is a bit of a misnomer, because there isn′t a big book of Where the Wild Things Are, but it′s such a wonderful story and the pictures in the ordinary edition are quite big, so I thought we should give it a try. Alternatively, if you search on the web, you can find a PowerPoint of the whole book.
News
Authors: Lepkowska Dorothy
Published: May 2014

Childcare workers are worth to society nearly 10 times what they actually earn, according to a new report.
What difference does a good night's sleep make?
Authors: LOUIS SARA
Published: May 2014

Is sleep deprivation affecting the children in your class? Sara Louis discusses
A really big piece of Pi
Authors: Hammond Paula
Published: May 2014

Pi Day is on the fourteenth day of the third month each year. Paula Hammond′s Pi-themed assembly aims to get children thinking about the problem of stereotyping
Don't Forget the Bacon
Authors: Rhodes Liz
Published: May 2014

This old favourite provides some fun for children in year 1. If you use it with a visualizer all the children will easily be able to follow the text, although the text in the book itself is quite a good size.
Catch a tiger by the tail ... or perhaps not
Authors: Rhodes Liz
Published: May 2014

A forth-coming publication suggests dangerous activities for children-surely not? Liz Rhodes looks at a book which your school probably won′t be buying any time soon
Being a bystander
Authors: LOUIS SARA
Published: May 2014

Even watching another child being bullied can have damaging effects on the young
A truly inspirational school
Authors: Lepkowska Dorothy
Published: May 2014

It took a serious incident for staff at Caedmon primary school to realise that something had to be done about improving social cohesion at the school
Spring science colours
Authors: Hammond Paula
Published: May 2014

The artist and inventor Leonardo da Vinci was born on April 15, 1452. To celebrate the work of this celebrated genius, this month we will be taking a closer look at paint.
Training myth busting
Authors: Adams Margaret
Published: May 2014

Margaret Adams asks if you have been taken in by any of the following Continuing Professional Development (CPD) myths
Role play in literacy
Authors: Hall Nigel
Published: May 2014

The way we use literacy in everyday life is often highly meaningful and related to our lives, our interests and our concerns. We read magazines, write letters, send birthday cards, and read labels on food. We usually read or write for a reason. We write letters to keep in touch, we read instructions to find out how to work our videos, cookers and microwaves, we follow directions to get to the right places and we write in diaries to remind us about appointments.
Information texts
Authors: Hoad Elizabeth
Published: May 2014

This article is designed to tie in with the geography curriculum and enhance the work the children will carry out about the seaside.
Mog the Forgetful Cat
Authors: Rhodes Liz
Published: May 2014

Show the class the front cover. Why is there only one name on the front cover? The book was written and illustrated by one person. Does the class think Judith Kerr wrote the words or made the pictures first? Would it be easier to do both or would the children prefer to do one or the other and work with someone else? Before turning to the back cover, ask the class whether they have read any of Judith Kerr′s other books.
Ideas for science
Authors: Sparks Linfield Rachel
Published: May 2014

Below is a list of examples on how you can teach children about energy and movement and life processes and living things. These lessons are suitable for both year 1 and year 2 children.
Do you think you've got the X Factor?
Authors: RHODES LIZ
Published: May 2014

Liz Rhodes examines the latest trend in interviewing techniques
The importance of doing absolutely nothing
Authors: LOUIS SARA
Published: May 2014

Research shows that at times, ′messing about’ has more value than working. Sara Louis explains
Are you sitting comfortably?
Authors: Youngman Angela
Published: May 2014

Angela Youngman discusses in this article why the art of storytelling is so valuable for school children
Summer sensations
Authors: Hammond Paula
Published: May 2014

With the weather finally warming up, this month′s assembly focuses on the great outdoors, with a tale about one of Britain′s most incredible natural spectacles
Solving mathematical word problems
Authors: Croft Sue
Published: May 2014

Some children calculate with ease but have difficulty solving word problems. Understanding the words and choosing the correct strategy to solve the problem needs practice, especially if English is not your first language. Although much of this work uses multiplication and division, the work can easily be covered using both year 1 and year 2 methods.
Let's try and bring back the bedtime story!
Authors: Rhodes Liz
Published: May 2014

Liz Rhodes discusses the importance of reading stories to young children
I like you just as you are!
Authors: Hammond Paula
Published: May 2014

Young children often worry about fitting in. These concerns can be especially acute at this time of the year when some are preparing to move to a new school or year group
Counting our blessings
Authors: Mill Patsy
Published: May 2014

Is it at all possible to find an educational upside to our current economic squeeze? Patsy Mill discusses
Retelling the Little Bear series
Authors: Hoad Elizabeth
Published: May 2014

This set of activities uses the Little Bear stories by Martin Waddell. Children will be investigating the similarities between Little Bear′s experiences and their own. There may well be circle-time opportunities to discuss the children′s fears and concerns in the context of these stories.
Some end of term fun: Making minibeasts!
Authors: Moran Jane
Published: May 2014

Before you start, the children must have looked at lots of pictures or photographs and observed minibeasts in their habitats wherever possible. This term is an ideal time to do this activity as it is warm enough outside to really see some great minibeasts in their natural habitats.
On the agenda: Colours and cuts
Authors: Rhodes Liz
Published: May 2014

Liz Rhodes looks at new ideas for classroom décor, and is dismayed at the Government′s plans for cuts to programmes which have proven to be successful
How to teach children self-control
Authors: Louis Sara
Published: May 2014

Self-control matters. Can teachers help the young to develop this crucial talent? Sara Louis explains
Numbers, shapes and stories
Authors: Griffiths Neil
Published: May 2014

How to use picture books to initiate mathematical activities
The bigger picture
Authors: Monahan Jerome
Published: May 2014

A look at what the annual National Schools Film Week could offer your class
New man, new plan? Changes for the future
Authors: Lepkowska Dorothy
Published: May 2014

With the dawn of a new Prime Minister, secretary of state and Department for Children Schools and Families (DCSF) Dorothy Lepkowska looks at funding pledges and asks leading professionals what government priorities should be.
Gift Aid Putting the fun into fundraising
Authors: Gower Barry
Published: May 2014

In a new series, Barry Gower suggests some innovative ways of obtaining Gift Aid for your school.
Business breakfasts Networking for you
Authors: Griggs Amy
Published: May 2014

Amy Griggs takes a look at the Business Referral Exchange and considers what membership could offer your school.
Working together School mergers
Authors: Lepkowska Dorothy
Published: May 2014

High−performing schools that take on the task of helping ‘problem’ schools are eligible for a significant amount of government funding. Dorothy Lepkowska examines the benefits of this scheme for all concerned.
Cost-saving strategies for school IT equipment
Authors: David Anthony
Published: May 2014

In this article, Anthony David looks at examples of cost-saving strategies when investing in new or updating school IT equipment.
Paper clinics: managing your nurse−led general and colorectal cancer clinics
Authors: Cuthill VJ , Porrett TRC
Published: May 2014

This article briefly discusses the current colorectal cancer initiatives which are necessitating service redesign to ensure waiting time targets are met. The role of the clinical nurse specialist (CNS) in facilitating timely service delivery is addressed. ′Paper clinics′ are described and their role in supporting colorectal clinics are identified.
The advanced practice role in gastrointestinal nursing
Authors: Cox Carol , Hall Alex
Published: May 2014

The question has been raised ′What is advanced nursing practice in gastrointestinal nursing?′ This article provides the background to advanced nursing practice in relation to Agenda for Change (Department of Health (DH), 2004a) and Modernizing Nursing Careers (DH, 2006a). It defines advanced practice and describes the role, educational preparation and domains of practice and competencies (Nursing and Midwifery Council, 2005) related to advanced nursing practice in the UK. Case studies highlight the role of the advanced nurse practitioner in gastrointestinal nursing. This article concludes by considering the profession of advanced practice nursing and its expanding role.
A guide to the appropriate use of convex stoma care products
Authors: Cronin Elaine
Published: May 2014

This article provides an overview of convex stoma products, and outlines the consequences of the inappropriate use of such products. Four separate problems are identified and examined: mucocutaneous separation; friction and granulomas; accumulative peristomal skin pressure; and capillary trauma/skin discolouration. It is noted that not every conceivable problem has been included, for example, peristomal ulceration. Summaries of each specified problem are shown against photographic evidence, along with advice about the use and management of convex products.
The use of traditional Chinese herbal medicine in irritable bowel syndrome
Authors: Smith Graeme D , Cuizhen Shen
Published: May 2014

Most nurses are aware of the widespread use of complementary and alternative medicines therapies. Such therapies are being increasingly used by gastrointestinal patients for a wide range of clinical conditions. In this article, the application of Chinese herbal medicine will be explored in relation to irritable bowel syndrome. An overview of the general theory of raditional Chinese medicine (TCM) will be followed with an examination of the approaches TCM therapists take in the management of functional bowel disorders. Specific focus will be placed on the afety issues to help gastrointestinal nurses understand the potential benefits of this alternative form of treatment.
Achieving RCN accreditation for SecuriCare stoma care clinical nursing standards
Authors: Waller Sylvia , Chalmers Frances , Jowett Annie , Disley Helen
Published: May 2014

Quality of care is a priority for the NHS. Written standards of care are statements that define a level of quality against which performance can be measured. They provide a benchmark against which quality may be assessed by describing either a minimum level required for safe and effective practice, or a level of excellence, thereby encouraging best practice. The Royal College of Nursing (RCN) accredits resources that can demonstrate compliance with RCN criteria for achieving appropriate quality and promoting best practice. Thus, the accreditation process ensures that all interested parties can have confidence in the resource. This article describes how a team of specialist stoma care nurses submitted their standards of care to the RCN Accreditation Unit and the process by which accreditation was achieved. Readers will gain an understanding of how the RCN accredits resources and how undertaking the process provided an opportunity for critical review and further development of the resource as an educational tool. A second associated article to follow will look at two further educational resources developed for ward−based staff, addressing the challenges a specialist nurse may face in sharing knowledge and expertise with non−specialist staff.
Out of the shadows
Authors: Cooper Joanne
Published: May 2014

As the following articles in this supplement will outline, understanding how best to care for individuals with inflammatory bowel disease (IBD) is an essential aspect of high quality gastrointestinal nursing care. As a long-term health condition, IBD shares characteristics with other chronic illnesses; for example, its cause is, as yet, not identified, its management rests predominantly on medical treatments, and individuals may have to make complex daily decisions as they try to limit its impact on their physical, psychological and social wellbeing.
Use of biological therapy during pregnancy in the treatment of IBD
Authors: Thomas Rosemarie
Published: May 2014

Ulcerative colitis and Crohn′s disease often occur in the younger population, which means they are likely to affect women of child-bearing age. Infliximab and adalimumab, both biological therapies, are being increasingly used to treat moderate-to-severe inflammatory bowel disease (IBD) when response to conventional therapy has been lost. Current practice contraindicates their use during pregnancy, as teratogenic effects are not fully known. Incidental use and the ongoing Crohn′s Therapy, Resource, Evaluation and Assessment Tool (TREAT) registry and Organization of Teratology Information Specialists (OTIS) studies provide evidence to support their use. This article reviews available literature to provide an insight for healthcare professionals into the risks and benefits of the use of biological therapy during pregnancy for the IBD patient, thus allowing for thorough and thoughtful counselling.
Understanding the rationale and use of probiotics in the treatment of IBD
Authors: Burch Jennie
Published: May 2014

Probiotics are often in the media, with promises of a reduction in bloating and the provision of ′good′ bacteria for all. However, there has also been an interest in their use for specific conditions. Probiotics are non-pathogenic bacteria that confer health benefits beyond their nutritional value when ingested. This article focuses on the use of probiotics in the treatment of ulcerative colitis and Crohn′s disease and to keep patients with these diseases in remission for longer periods. The use of probiotics in pouchitis is also discussed, along with other potential uses. There is some evidence that probiotics may be useful in the treatment of inflammatory bowel disease and to extend the duration of remission before relapse.
Improving bowel preparation for colonoscopy: A literature review
Authors: Steward Lindsay , Norton Christine
Published: May 2014

Colonoscopy has long been called the gold standard for investigating the large bowel. The success of colonoscopy as either a diagnostic or therapeutic procedure depends on the quality of the preprocedure bowel preparation. If the bowel is not suitably emptied of faecal matter, poor visualization of the mucosa follows. This can have considerable consequences. The literature shows a diversity of factors affecting bowel preparation. In any individual case, there may be many possible explanations for poor preparation. A small number of studies have consistently found that there is a difference in the quality of bowel preparation between inpatients and outpatients, with inpatients generally having poorer preparation. Most studies have been small-scale, retrospective audits, with all the limitations of that methodology, including possible bias and incomplete or inaccurate records. As inpatient and outpatient populations are likely to be very different in terms of general health, comorbidities, medication and the reason for needing a colonoscopy - the basis for these differences are likely to be complex, multifactorial and many may not be amenable to modification. A few studies have addressed the effectiveness of providing information (written, verbal, or both) to inpatients and/or clinical staff, as a means of improving colonoscopy preparation. Conflicting results have been found and further research is necessary.
what the journals say
Authors: Williams Julia
Published: May 2014

Complementary and alternatives medicines (CAM) are widely used within the UK. Research suggests that their usage is on a gradual increase. CAM includes specific treatments by therapists, such as massage and reflexology, or the purchase of simple over-thecounter remedies.
Pre- and postoperative steps to improve body image following stoma surgery
Authors: Noone Paula
Published: May 2014

The formation of a stoma creates many issues for patients undergoing stoma surgery. Of the 100 000 people with stomas in the UK (Burch, 2005), many may fear ridicule and embarrassment, and may struggle with issues of body image and sexuality. However, studies have suggested that these issues remain overlooked by nurses (Borwell, 1997). Through the use of a case study, Paula Noone explores practical steps that can be taken to minimize these concerns in patients with newly-formed stomas, focusing on pre- and postoperative counselling, education and psychological support, as well as best practice in providing holistic care.
Attitudes and Experiences of Adolescents in an Innovative IBD Transition Service
Authors: Greveson Kay , Morgan Natalie , Furman Mark , Murray Charles
Published: May 2014

The predominant focus of transition in inflammatory bowel disease (IBD) management is for the young person to develop autonomy and be educated in disease awareness, self-management and decision-making within the health care setting. A joint, bimonthly transition clinic was set up in the paediatric setting, to design an effective collaborative adolescent IBD transition service tailored to meet the needs of adolescents and their parents. In this article, the extent to which this service helped in preparing adolescents and their family for transfer to adult services, while enabling joint collaborative working, will be evaluated.
Living with inflammatory bowel disease: diagnosis during pregnancy
Authors: Cooper Joanne M , Collier Jacqueline , James Veronica , Hawkey Christopher J
Published: May 2014

IBD is a lifelong condition that can impose a substantial physical, psychological and social burden on individuals. In this article, Joanne Cooper, Jacqueline Collier, Veronica James and Christopher J Hawkey present a case study of one person's diagnosis of IBD during pregnancy. Taken from a larger qualitative research project exploring beliefs about personal control and self-management in inflammatory bowel disease (IBD), the challenges faced when developing symptoms of IBD during pregnancy are discussed. This offers new insight into the needs of pregnant women developing IBD and identifies the important role played by gastrointestinal nurses in supporting patients and educating non-IBD specialist staff.
Making the case for psychological supervision
Authors: Stern Julian
Published: May 2014

Biofeedback is an important tool in the treatment of gastrointestinal disorders such as constipation and incontinence. In this article, Julian Stern discusses a supervision workshop for biofeedback therapists, which focuses on the psychology of their patients as well as the responses of the biofeedback therapists. The extent to which biofeedback therapists are exposed to, and influenced by, substantial psychological disturbance in their patients, is described. A regular supervision workshop, which aims to enliven the work of the biofeedback therapists, help them understand their patients and own emotional responses, set boundaries and avoid burn-out is also described. The training and support systems of psychotherapists are compared with those of biofeedback therapists. The paper ends with a recommendation that psychological supervision be a mandatory part of the biofeedback therapists’ working life.
Perspectives of transition care in inflammatory bowel disease: a survey
Authors: Houston Yasmine , O Lindsay James , Jenkins Huw , McCartney Sarah , Ahmad Tariq , Arnott Ian , Croft Nick , Russell Richard , Sebastian Shaji
Published: May 2014

There is paucity of data on the transition of adolescents with inflammatory bowel disease (IBD) from paediatric to adult services. IBD nurses could play a crucial role in coordinating transition care. In this article, Yasmine Houston, James O Lindsay, Huw Jenkins, Sarah McCartney, Tariq Ahmad, Ian Arnott, Nick Croft, Richard Russell and Shaji Sebastian report on a survey of 106 IBD nurses regarding their views and experiences of transition care.
Helicobacter pylori: microbiology, transmission and health significance
Authors: Banning Maggi
Published: May 2014

Helicobacter pylori is a global pathogen that contributes to a high proportion of duodenal and gastric ulceration as well as gastric cancer. It is suggested that infection with this pathogen can commence in childhood; however, not everyone colonized with the pathogen will develop symptoms of gastritis. The high prevalence of H. pylori in developing countries may relate to socioeconomic difficulties and communal living. In this article, Maggi Banning discusses transmission, pathology and the clinical features of H. pylori infection.
Management of childhood diarrhoea
Authors: Morris Gordon Dr
Published: May 2014

Diarrhoea in childhood is extremely common and represents a considerable burden to health care. In this article, Morris Gordon discusses the distinction between acute and chronic diarrhoea. Different diagnostic pathways are considered and appropriate treatment modalities are laid out, with due consideration of the unique challenges offered by children and young patients. Finally, some rare yet important causes of diarrhoea are considered.
Assessment of health related quality of life (HRQoL) in irritable bowel syndrome
Authors: Smith Graeme D
Published: May 2014

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders, classically involving symptoms of abdominal pain, distension and altered bowel function. However, the aetiology and natural history of this complex and often unpredictable condition remain poorly-understood. In the absence of a specific pathophysiological explanation, diagnosis and assessment of patients with IBS can be challenging for health professionals. In a recent article in Gastrointestinal Nursing, the current perspectives of diagnosis and symptom assessment of IBS were critically explored. In this follow-up paper, Dr Graeme D Smith examines the role of health related quality of life measures in the assessment of IBS. Approaches to measurement of quality of life will be identified and the clinical uses and potential pitfalls of these scales will be addressed for nurses working in clinical gastroenterology.
Novel methods of imaging the GI tract in endoscopy
Authors: Castle Kerry
Published: May 2014

Capsule endoscopy involves ingesting a small capsule, containing a colour camera and transmitter, which records images of the digestive tract to diagnose gastrointestinal conditions that cannot be seen by other types of endoscopy. Double balloon enteroscopy is a technique for visualisation of the small bowel and allows the GI tract to be visualised in real time. In this article, Kerry Castle looks at the reasons for using these methods of bowel visualisation, and evaluates both, identifying the risk to benefit ratio when compared with conventional endoscopic procedures. Issues of consent, nursing care and expectations with both procedures.
Use of and attitudes to complementary and alternative medicine in patients with functional bowel disorders
Authors: Woodward Sue , Norton Christine , Barriball K Louise
Published: May 2014

In this article, Sue Woodward, Christine Norton and Louise Barriball report on a service evaluation audit which was conducted to determine the prevalence of CAM use among patients attending a specialist NHS biofeedback service, to identify their perceptions of CAM and to assess their preparedness to use complimentary therapies within the department. Over a six-month period, patients were asked to complete an audit questionnaire while waiting for their appointments. Ninety three questionnaires were completed and returned by individuals during this time. Sixty three respondents (68%) had used CAM previously or were current users, and respondents reported using a total of 21 different complementary and alternative therapies for their bowel and/or other health problems. Herbal medicine was the most commonly used therapy for bowel problems (29%). Both positive and negative drivers for CAM use were identifed. This audit reveals that CAM use is common in patients with functional bowel disorders.
Choosing the correct stoma appliance
Authors: Black Pat
Published: May 2014

Surgery to the bowel or bladder that results in a stoma, whether temporary or permanent, is designed to improve the individual’s situation by removing disease, reducing pain and improving health. Many people are able to adapt to the physical and psychological trauma of stoma surgery, as demonstrated by the return to their everyday activities and relationships. An extensive array of stoma appliances is now available in the drug tariff for General Practitioners (GP) to prescribe, but many GPs will have little knowledge of what to prescribe for the stoma patient. Modern stoma appliances are continually changing and being updated and this article will look at choosing the correct appliance for the patient with a bowel or bladder stoma.
Developing the role of the clinical nurse specialist in infammatory bowel disease. Part 2: scope of practice
Authors: Whayman Kathy , Stansfeld Cath , Duncan Julie , O’Connor Lead Clinical Nurse Specialist (IBD) Marian
Published: May 2014

This article is the second part of a two-part series exploring the role of the infammatory bowel disease clinical nurse specialist (IBD CNS) in relation to wider defnitions of advanced nursing practice. By drawing on the literature, reports and personal experiences of those who have established and are delivering specialist IBD nursing services, Kathy Whayman, Cath Stansfeld, Julie Duncan and Marian O’Connor provide a practical discussion on the role descriptives and scope of practice for the IBD nurse specialist.
The revised inflammatory bowel disease (IBD) standards and the IBD nurse role
Authors: Glatter Jackie , Sephton Mark , Garrick Vikki
Published: May 2014

It has been 4 years since the introduction of the inflammatory bowel disease (IBD) Service Standards ( IBD Standards Group, 2009 ). Promoted widely and supported by quality improvement initiatives, the IBD Standards have contributed to a marked improvement in the delivery of IBD services and care, as measured by the IBD audit. However, there remain many challenges. The 2013 updated IBD Standards aim to provide a comprehensive and up-to-date framework that will enable IBD services across the UK to address challenges and deliver a consistent and high-quality service to IBD patients. This article will outline the need for change and current trends in the NHS, the differences between the original and revised IBD Standards, the role of the new IBD Standards in improving care across the country, the role of the IBD specialist nurse in relation to the IBD Standards and what IBD patients can expect in the future.
The infammatory bowel disease (IBD) service: patient satisfaction survey
Authors: Pomeroy Debra
Published: May 2014

Infammatory bowel disease (IBD) is a long-term condition. Individual needs can vary greatly, and patients become experts. Engaging patients in their own healthcare produces better outcomes; this principle also applies to service development and delivery. The IBD Standards Groups recommends that IBD services obtain and respond to patient experience, and give patients opportunities to be directly involved in service development. In this study, an IBD quality improvement instrument was disseminated to patients attending specialist IBD services at a district general hospital in a rural county. Debra Pomeroy discusses the fndings.
Histamine-2 receptor blockers vs proton pump inhibitors part 1: a literature review
Authors: Regidor Ronnell
Published: May 2014

While the use of histamine-2 receptor blockers (H2RBs) and proton pump inhibitors (PPIs) have been useful for the prophylaxis of peptic ulcer disease (PUD), there has been little information regarding which medication should be used initially. In the hospital setting, PPIs are often prescribed for PUD prophylaxis, even when patients have no history of gastroesophageal reflux disease. While PPIs have been demonstrated to be stronger than H2RBs, their long-term use can be detrimental to health-care outcomes. Owing to this overuse of PPIs, the use of H2RBs should be re-examined. In the first part of this two-part series on H2RBs vs PPIs, Ronnell Regidor will review several studies that assess the clinical scenarios in which H2RBs and PPIs should be used. Ultimately, this article proposes that, for patients without any gastrointestinal medical history, H2RBs should be the initial medication for PUD prophylaxis.
Abdominal compartment syndrome: a guide for the gastrointestinal nurse
Authors: Delgado Lauren A
Published: May 2014

Abdominal compartment syndrome (ACS) is a complex process in which the pressure in the abdominal cavity rises, leading to multiple complications and possibly death. Most of the complications can be easily avoided if addressed quickly. Assessing for ACS and measuring intra-abdominal pressure can lead to life-saving treatment and decreased morbidity and mortality for gastrointestinal (GI) patients. Lauren Delgado has designed this paper to educate the GI nurse about the process and treatment of ACS, and she gives readers a detailed review of the literature, including an overview of the current research surrounding intra-abdominal hypertension and ACS. At the end of the paper, readers will understand the risk factors, pathophysiology, diagnostic tools, possible morbidities and management of patients with ACS.
Stoma siting: why and how to mark the abdomen in preparation for surgery
Authors: Cronin Elaine
Published: May 2014

The importance of siting a patient prior to stoma surgery (be it actual or potential) cannot be under estimated. Preparing the patient and significant others (i.e. family members, carers, and relatives) is hugely important to the outcome and optimises a good postoperative recovery. Assessing the patient, his/her abdomen, physical appearance (i.e. manual dexterity, vision), and gait (i.e. posture, spinal curves) all facilitate in highlighting potential positioning problems. This in turn allows the stoma care nurse to optimise the ideal stoma location—one that is accessible and, where possible, visible to the patient. It is important to remember that each patient is unique, and thus, the process of siting can vary from one to another; nurses should allow at least 1 hour for the completion of the task. The aim of this article is to take the nurse/nurse specialist through the act of siting in a comprehensive manner. It is hoped that this article outlines the need for preoperative assessment and, indeed, the marking of the abdomen.
Assessing support garments in the management of parastomal hernia
Authors: Readding Linda A
Published: May 2014

Many ostomates (people with a stoma) are affected by the complication of a parastomal hernia. The ostomate does not only need to adjust to the stoma but also to the presence of the parastomal hernia and its effect on the stoma function, appliance choice, and skin condition; moreover, it affects the ostomate's ability to manage his/her daily activities. The NHS spends over £1 million in the provision of support garments. While this is a cheaper management option compared with surgery to repair or refashion the stoma, it is important that the most appropriate type of garment is chosen. Selecting the most appropriate garment not only ensures that the person with a stoma can manage the garment easily but also avoids costly trial and wastage of NHS resources. Having knowledge of the type and range of support garments available enables the nurse to advise and assist people in the management of parastomal hernias.
A patient-centred approach to research and development
Authors: Davies Sally
Published: May 2014

The research consultation document, Best Research for Best Health, has just been published by the Department of Health, so the time is right to explain what they are trying to achieve with the proposals it contains.
Stem cells as future therapy in cardiology
Authors: Lindsay Alistair C , Halcox Julian PJ
Published: May 2014

This article focuses on the key studies relevant to the clinical application of stem-cell research in cardiovascular disease. The authors also discuss current and future directions in clinical cardiovascular stem-cell research, including the potential problems and pitfalls that must be addressed to ensure the safety, as well as the efficacy, of treatment regimens in this rapidly evolving theraputic field.
The ‘wandering’ abdominal lump: intussusception up to splenic flexure of an ileocaecal adenocarcinoma
Authors: Shah PR , Raman S , Barker RJ , Ginwalla RM , Kiberu S , Haray PN
Published: May 2014

A63-year old woman presented with a 4-day history of watery diarrhoea that was preceded by acute constipation. This was associated with intermittent colicky abdominal pain and one episode of fresh rectal bleeding on the previous day. Past history included haemorrhoids, cholecystectomy and reflux disease with no significant family history of cancer. She was seen in the accident and emergency department with a mass in right iliac fossa (RIF), which was managed as scabylous mass owing to the history of constipation.

The next day, the woman came back with continued symptoms. On this occasion, she had a firm, mobile mass, now palpable in the left hypochondrium associated with abdominal distension. Rectal examination revealed an empty rectum. Haematological and biochemical tests including tumour markers were essentially normal. Plain X-ray of the abdomen revealed a partial small bowel obstruction and the patient was commenced on conservative management.

The following day, although her symptoms resolved, the mobile abdominal mass was still persistent but now palpable in the RIF. An ultrasound examination of the abdomen and pelvis showed ‘a pseudo-kidney’ sign in the RIF (Figure 1). An unprepared contrast enema revealed a possible neoplastic lesion at the splenic flexure (Figure 2). Helical computed tomography showed a ‘bowel within bowel’ appearance in the left hypochondrium with proximally-dilated small bowel loops (Figure 3).

She underwent a laparotomy, which showed a mobile, ileocaecal tumour with intussusception reaching the splenic flexure. There was no evidence of disseminated disease. An extended right hemicolectomy with en-bloc resection of the intussuscepting mass was performed. She had an uneventful postoperative period.

Pathological examination of the resected specimen revealed a 4.0 cm × 4.5 cm × 3.0 cm nodular tumour of the ileocaecal valve with intussusception of a 6.0 cm length of terminal ileum. Histological examination showed a moderately well differentiated adenocarcinoma with clear resection margins (Figure 4). There was no nodal or vascular invasion. Pathological staging of the tumour was Dukes' A, T2 (tumor confined to bowel wall), N0 (no tumor deposit in 11 lymph node harvested) (0/11), M0 (no distance metastasis).
Severe proximal hypospadias
Authors: Johal N , Kumar P , Sellaturay S , Arya M , Cuckow P
Published: May 2014

A male neonate presented with severe proximal hypospadias. The image illustrates the key features of the condition, characterized by: an abnormal opening of the urethral meatus on the ventral aspect of the penile shaft, at a point proximal to the normal site; abnormal ventral curvature (chordee) of the penis; deficient foreskin ventrally and excess foreskin dorsally (‘hooded foreskin’).
Stress urinary incontinence: current understanding
Authors: Patki P , Woodhouse J , Bycroft J , Hamid R , Shah PJR
Published: May 2014

Many new concepts were introduced in epidemiology, a etiopathology and treatment of stress urinary incontinence. This review gives a short account of these concepts and compares the results of commonly used treatment options with new ones recently introduced.
The first parathyroidectomy
Authors: Ellis Harold
Published: May 2014

Eighty years ago, on 30 July 1925, an historic operation in the evolution of endocrine surgery took place – the first parathyroidectomy for hyperparathyroidism.
Large granular lymphocyte leukaemia
Authors: Howard Luke , Chatterji S , Morrell NW , Pepke-Zaba J , Exley AR
Published: May 2014

A38-year-old man was diagnosed with low-grade large granular lymphocyte (LGL) leukaemia in 1995 and observed until March 2000 when he developed pulmonary arterial hypertension (PAH) coincident with a rise in his LGL count. He was started on methotrexate and cyclosporin in June 2000 and referred to Papworth Hospital. Methotrexate was stopped because of neutropenia. Computed tomography (CT) pulmonary angiography and high resolution CT excluded both acute and chronic thromboembolic pulmonary hypertension. Lung windows showed minor discrete interstitial changes with septal thickening and ground glass opacities at both lung bases. This was thought possibly to represent leukaemic infiltration. Echocardiography and right heart catheter were performed to exclude any valvular or congenital heart disease. There was no clinical and/or laboratory evidence of other secondary causes of PAH, such as autoimmune disease, human immunodeficiency virus (HIV) or liver disease, and he had not taken any drugs that may have induced PAH. Surgical lung biopsy was not undertaken because of high perioperative risk. He had 27×109/litre gammadeltaT-cell LGLs, typed as Vdelta5 Jdelta1. He was started on a nebulized prostacyclin analogue, iloprost, but discontinued this within 3 months without seeking medical advice. His progress is shown in Table 1. Follow-up CT at 1 year showed resolution of the interstitial changes.
Optimal intraoperative haemodynamic management
Authors: Cook M , Rhodes A
Published: May 2014

Major surgery in high-risk patients is associated with significant morbidity and mortality. This review focuses on how, with appropriate haemodynamic management, patient outcomes can be improved.
Patient-controlled analgesia: does one regimen fit all?
Authors: Curran Natasha
Published: May 2014

Patient-controlled analgesia (PCA) has long been shown to be effective in reducing postoperative pain and increasing patient satisfaction. Intravenous morphine, fentanyl, pethidine, oxycodone and diamorphine have all been used effectively. The majority of PCA programs are standardized so that adults receive morphine 1mg as a stat dose with a 5-minute lockout. Is there any evidence to suggest which drug or dose is effective in different settings, and should this affect our PCA prescribing?
Fungal endocarditis
Authors: Ramsdale David R , Aziz Shahid , Zakhour Hani
Published: May 2014

Fungal endocarditis is a serious condition that affects particular groups of patients. This article reviews the aetiology, clinical features and relevant investigations required for diagnosis as well as the treatment necessary for a successful outcome.
Confidentiality and HIV: ethical issues in the care of patients with HIV
Authors: Warburton Damian
Published: May 2014

Confidentiality is a cornerstone requirement of a doctor's duty, but it appears to be an issue that consistently produces uncertainly in practitioners. The British Medical Association states that ‘the volume of [confidentiality enquiries] outstrips other issues of ethical concern raised by British Medical Association members’. This article looks at confidentiality in respect of the human immunodeficiency virus (HIV)-positive patient.
Emergency management of the unconscious patient
Authors: Mirza Zul Mirza
Published: May 2014

Acute presentation of an unconscious patient is a common medical emergency and presents a challenge in the emergency department. There is usually some history available and the list of potential causes and hence treatments is considerable. This review looks at the definition, pathophysiology, causes, history, examination and management of the condition.
Sedation for procedures in children: a guide for the non-anaesthetist
Authors: Sury MRJ
Published: May 2014

The aim of this review is to provide a succinct guide to sedation of children for procedures. Uncooperative children are notoriously hard to sedate and the choice of appropriate technique depends upon the intended procedure. It is too easy to exceed safe dose limits and cause airway obstruction or respiratory depression. ‘Sedationists’ must remember that safety is paramount; they must receive training and work within protocols. Published guidelines are available.
The beginning of modern kidney transplantation
Authors: Ellis Harold
Published: May 2014

One hundred years ago, in 1906, Alexis Carrel and Charles Guthrie published a paper in Science entitled ‘Successful transplantation of both kidneys from a dog into a bitch with removal of both kidneys from the latter’. This marked the beginning of the scientific study of organ transplantation. It established the technical possibility of kidney grafting, principally by the development of a satisfactory method of suturing fine blood vessels. However, another half century would pass before the biological problems of foreign organ rejection were to become first fully understood and overcome.
Work-based competency assessment: the way forward for run-through specialties?
Authors: Drake-Lee Adrian
Published: May 2014

Work-based assessments have been introduced recently into the foundation programmes and may be extended further into hospital training. They have not been quality assured. The same standards should be applied to work-based assessments as those for national postgraduate assessments. All may be built into a competency framework.
Right atrial myxomas and hairy cell leukaemia: coincidence or causal relationship?
Authors: Rao Archana , R Ramsdale David , Gosney John , Oo Aung , Goodrick M Jean
Published: May 2014

A 69-year-old man presented with a 6-week history of progressive breathlessness, fatigue and epistaxis. There was no significant past medical history apart from atrial fibrillation diagnosed 2 years earlier when echocardiography was normal. On examination, he was anaemic and had a new mid-systolic murmur. A full blood count revealed pancytopenia (haemoglobin=10.9 g/dl; white cell count=1.7×109/litre; platelets=52×109/litre) and bone marrow histology confirmed a diagnosis of hairy cell leukaemia (Figure 1). A ‘staging’ computed tomography scan of the thorax and abdomen showed no lymphadenopathy but splenomegaly and a mass in the right atrium. Transthoracic echocardiography confirmed the presence of a large right atrial mass, attached to the atrial free wall and a small pedunculated mass attached low on the interatrial septum (Figure 2). Both right and left ventricular contractility were impaired and there was mild tricuspid regurgitation.

He was treated with intravenous cladribine (2-chlorodeoxyadenosine) to a total dose of 0.9 mg/kg. His blood count recovered to normal levels over the next 3 months and the splenomegaly resolved. There was, however, no change in the size of the right atrial mass which was then removed surgically.

At open heart surgery, both the small pedunculated tumour and the larger, ovoid, more sessile, gelatinous right atrial mass (60 mm diameter) were excised (Figures 3 and 4). Histology showed fusiform cells in a myxoid stroma typical of myxoma (Figure 5), with the larger mass possessing laminated thrombus and degenerative changes.
The first anaesthetic
Authors: Ellis Harold
Published: May 2014

In my opinion, 16 October 2006 marks the 160th anniversary of the most important day in the whole long history of surgery. Yet it commemorates not some outstanding surgical discovery but merely the removal of a benign lump in the neck. However, on this occasion it marked the watershed between the agonies of the knife – the screaming and struggling patient being held down by muscular assistants – and the comparative calm of the modern operating theatre. It was the first public demonstration of general anaesthesia.
Educational supervisors' views on the competencies of preregistration house officers
Authors: Watmough Simon , Taylor David CM , Garden Anne , Ryland Ida
Published: May 2014

In 1996 The University of Liverpool reformed its medical curriculum from a very traditional lecture-based course to an integrated problem-based learning curriculum. This article outlines the results of questionnaires sent out to educational supervisors in the Mersey Deanery studying the competencies of the preregistration house officers they supervise.
Failing older hearts? Of myths and left-overs
Authors: McIntyre Hugh F
Published: May 2014

The failing heart is the common endpoint of all cardiac disease. While the syndrome of ‘heart failure’ encompasses both left and right heart dysfunction, impairment of left ventricular (LV) function carries the greatest consequences. Failure of contraction, or LV systolic dysfunction, is usually the result of epicardial coronary artery occlusion, with resultant muscle necrosis and myocardial scarring. Failure of myocardial relaxation, loosely termed ‘diastolic’ heart failure, usually results from connective tissue changes. These are typically seen in chronic hypertension and result from mechanical load disturbance but may also be the result of chronic metabolic imbalance – possibly through long-term smallvessel ischaemia.