bluuebunny/crossref_metadata_2025 huggingface dataset:
A single center experience with retrievable IVC filters
Authors: Renno Anas , Khateeb Faisal , Kazan Viviane , Qu Weikai , Gollapudi Anurekha , Aplin Brett , Abbas Jihad , Zelenock Gerald , Nazzal Munier
Published: September 2014

Objective

To evaluate retrievable IVC filters in our institution and assess their retrieval following a well-structured follow up program.

Design

Retrospective cohort study.

Materials

The medical records of patients implanted with retrievable IVC filters were reviewed.

Methods

All retrievable filter insertions between July 2007 and August 2011 at our institution were reviewed. Data was analyzed for age, gender, indication, complications, retrieval rate, and brand of filter inserted. Statistical analysis was done using SPSS software v19. Chi-square was used to compare discrete data and t-test for continuous data. P < 0.05 was significant.

Results

A total of 484 patients were reviewed of which 258 (53.1%) had a complete medical record. And 96 (37.2%) filters were placed as permanent at the time of insertion. An additional 40 (15.5%) filters were converted to permanent (total permanent filters 136; 52.7%). Death was reported in 26 (10%) patients and 96 (37.2%) out of the remaining 232 patients presented for potential retrieval. Also, 73 (28.2%) had an attempt to retrieve the filters, 69 (94.5%) were successful and 4 (5.4%) failed to retrieve. The remaining 23 (8.9%) patients declined retrieval. Filters studied include Celect (38%), Bard (31.4%), Option (26.2%), Tulip (4.1%), and Recovery (0.2%). Bard was more commonly used as a retrievable filter (80.9%). Retrieval on the first attempt was 90.4% ( n = 66) successful. Of the remaining seven filters, three were successfully retrieved on a second attempt, and four failed to retrieve due to filter tilt. The success rates of retrieval for Celect and Tulip were significantly lower than for Bard ( p = 0.04 and 0.023, respectively).

Conclusion

Our study showed that a variety of IVC filters can be retrieved successfully with minimal complication rates. In more than half of our patients, IVC filters were used as permanent. Failure of retrieval was most frequently due to filter tilting.
Cosmopolitanism as Translation
Authors: Bielsa Esperança
Published: September 2014

Whereas globalization theory was predominantly silent about the role of translation in making possible the flow of information worldwide, assuming instant communicability and transparency, translation has gained central importance in recent accounts of cosmopolitanism that emphasize global interdependence and the negotiation of difference. In this context, a specification of translation processes provides a way of analysing the form in which interactions between different modernities take place and of specifying a notion of cosmopolitanism as internalization of the other. This article approaches translation as much more than the linguistic transfer of information from one language to another. Widely defined as the experience or the test of the foreign, a process which mobilizes our whole relationship to the other, translation appears as a material, concrete practice through which cosmopolitanism, conceived as openness to the world and to others, can be empirically examined. After having thus identified the central role of translation in a cosmopolitan context, the article examines how it can be used to approach current notions of aesthetic or artistic cosmopolitanism with reference to the key notion of world literature. Finally, it outlines the most important implications that a conception of cosmopolitanism as translation has for cosmopolitan social theory.
Neck lumps
Authors: Jolly Karan , Harrington Philip , Upin Eli Saritha , Douglas James
Published: September 2014

Neck lumps are commonly encountered by GPs, with 15% of all patients presenting to GPs having an upper respiratory tract or head and neck complaint. In addition, between 1990 and 2006, the incidence of cancers relating to the head and neck increased. These include primary malignancies of the oral cavity, salivary glands, oropharyngeal mucosa and thyroid gland. It is therefore important that GPs are able to recognise red flag symptoms and signs suggestive of these cancers, as well as being able to effectively manage the more common conditions that may present with head or neck lumps that do not require urgent referral to secondary care. This article will consider this as well as the learning outcomes detailed in the curriculum box to provide a base of information that GPs can draw on to aid in the diagnosis of neck lumps.
Abdominal wall hernias
Authors: Head Elizabeth , Madurska Marta
Published: September 2014

A hernia is an abnormal protrusion of a viscus, part of it, or its coverings from the wall of the cavity containing it. There are many different types of abdominal wall hernias and they can occur in any age group. The most common hernia occurs in the groin and this article explores these in some depth. It is important for a GP to be able to recognise in all abdominal wall hernias, those that are beginning to develop, as well as those already causing complications, in order to adequately treat them. This article explains the pathophysiology of hernias, their complications and when to refer to secondary care.
Cancer pain physiology
Authors: Falk Sarah , Bannister Kirsty , Dickenson Anthony H
Published: September 2014

Mechanisms of inflammatory and neuropathic pains have been elucidated and translated to patient care by the use of animal models of these pain states. Cancer pain has lagged behind since early animal models of cancer-induced bone pain were based on the systemic injection of carcinoma cells. This precluded systematic investigation of specific neuronal and pharmacological alterations that occur in cancer-induced bone pain. In 1999, Schwei et al. described a murine model of cancer-induced bone pain that paralleled the clinical condition in terms of pain development and bone destruction, confined to the mouse femur. This model prompted related approaches, and we can now state that cancer pain may include elements of inflammatory and neuropathic pains but also unique changes in sensory processing. Cancer-induced bone pain results in progressive bone destruction, elevated osteoclast activity and distinctive nocifensive behaviours (indicating the triad of ongoing, spontaneous and movement-induced hyperalgesia). In addition, cancer cells induce an inflammatory infiltrate and release growth factors, cytokines, interleukins, chemokines, prostanoids and endothelins, resulting in a reduction of pH to below 5 and direct deformation of primary afferents within bone. These peripheral changes, in turn, drive hypersensitivity of spinal cord sensory neurons, many of which project to the parts of the brain involved in the emotional response to pain. Within the spinal cord, a unique neuronal function reorganization within segments of the dorsal horn of the spinal cord receiving nociceptive input from the bone are discussed. Changes in certain neurotransmitters implicated in brain modulation of spinal function are also altered with implications for the affective components of cancer pain. Treatments are described in terms of mechanistic insights and in the case of opioids, which modulate pain transmission at spinal and supraspinal sites, their use can be compromised by opioid-induced hyperalgesia. We discuss evidence for how this comes about and how it may be treated.
Splice variation of the mu-opioid receptor and its effect on the action of opioids
Authors: Gretton Sophy K , Droney Joanne
Published: September 2014

Summary points

An individual’s response to opioids is influenced by a complex combination of genetic, molecular and phenotypic factors. Intra- and inter-individual variations in response to mu opioids have led to the suggestion that mu-opioid receptor subtypes exist. Scientists have now proven that mu-opioid receptor subtypes exist and that they occur through a mechanism promoting protein diversity, called alternative splicing. The ability of mu opioids to differentially activate splice variants may explain some of the clinical differences observed between mu opioids. This article examines how differential activation of splice variants by mu opioids occurs through alternative mu-opioid receptor binding, through differential receptor activation, and as a result of the distinct distribution of variants located regionally and at the cellular level.
Choosing a career in paediatrics: do trainees’ views change over the first year of specialty training?
Authors: Goodyear Helen M , Lakshminarayana Indumathy , Wall David , Bindal Taruna
Published: September 2014

Summary

Objectives

To look at why a regional cohort of UK doctors chose a paediatric career and to ascertain views on their career near the end of training year one.

Design

A 20-item questionnaire was sent to all new regional paediatric specialty trainees. Three focus groups were held with trainees near the end of year one to elicit key themes.

Setting

West Midlands Deanery, UK

Participants

Twenty-nine new regional paediatric specialty trainees in year one completed the questionnaire. A total of 15 trainees participated in the focus groups near the end of year one training.

Main outcome measures

Reasons for choosing a paediatric career and factors which further influence career choice for trainees during their first specialty training year.

Results

Key influencing factors for choosing paediatrics were enjoying working with children and positive undergraduate experience of the specialty. All trainees had paediatrics as their first choice specialty and undertook a paediatric Foundation post. Near the end of year one, doubts were cast on career aspirations due to seeing middle grade colleagues struggling with work–life balance and a growing feeling that family came first.

Conclusions

Senior trainees need to be aware that they act as powerful role models for their more junior colleagues and therefore have an influential role on how juniors perceive a paediatric career. Family friendly flexible working patterns in paediatrics are vital to retain junior trainees. All paediatric staff are role models and need to be enthusiastic, keen to teach and to promote a positive working environment.
A man who collapsed after using the internet
Authors: Braithwaite Irene , Maxwell Gordon , Sparks Sarah , Beasley Richard , Shirtcliffe Phillipa
Published: September 2014

Lesson

Recognising prolonged seated immobility as a provoking factor in the development of venous thromboembolism can influence management including duration of anticoagulation therapy.
The Effects of a Working Memory Load on Delay Discounting in Those With Externalizing Psychopathology
Authors: Finn Peter R. , Gunn Rachel L. , Gerst Kyle R.
Published: September 2014

This study investigated the influence of executive working memory (EWM) capacity on impulsive decision making in a sample of young adults ( N = 623) who varied in degree of externalizing psychopathology (EXT) by examining (a) the effects of WM load on delay discounting rates and (b) the association between EWM capacity and delay discounting rates. EXT was measured as a latent variable indicated by lifetime problems with alcohol, marijuana, nicotine, other drugs, childhood conduct, and adult antisocial behavior. Results showed that (a) the WM load increased discounting rates throughout the spectrum of EXT, (b) EXT was associated with higher discounting rates and lower EWM capacity, and (c) EWM capacity was significantly associated with higher discounting rates when controlling for IQ, but only after a WM load. The results are discussed in terms of the role of EWM capacity in impulsive decision making in EXT.
Dominant unit CD34+ cell dose predicts engraftment after double-unit cord blood transplantation and is influenced by bank practice
Authors: Purtill Duncan , Smith Katherine , Devlin Sean , Meagher Richard , Tonon Joann , Lubin Marissa , Ponce Doris M. , Giralt Sergio , Kernan Nancy A. , Scaradavou Andromachi , Stevens Cladd E. , Barker Juliet N.
Published: September 2014

Key Points

Dominant unit infused viable CD34+ cell dose determines engraftment after double-unit CBT. Postthaw CD34+ cell recovery and viability are strongly associated with differences in CB banking practices.
Do large-scale hospital- and system-wide interventions improve patient outcomes: a systematic review
Authors: Clay-Williams Robyn , Nosrati Hadis , Cunningham Frances C , Hillman Kenneth , Braithwaite Jeffrey
Published: September 2014

Background

While health care services are beginning to implement system-wide patient safety interventions, evidence on the efficacy of these interventions is sparse. We know that uptake can be variable, but we do not know the factors that affect uptake or how the interventions establish change and, in particular, whether they influence patient outcomes. We conducted a systematic review to identify how organisational and cultural factors mediate or are mediated by hospital-wide interventions, and to assess the effects of those factors on patient outcomes.

Methods

A systematic review was conducted and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Database searches were conducted using MEDLINE from 1946, CINAHL from 1991, EMBASE from 1947, Web of Science from 1934, PsycINFO from 1967, and Global Health from 1910 to September 2012. The Lancet, JAMA, BMJ, BMJ Quality and Safety, The New England Journal of Medicine and Implementation Science were also hand searched for relevant studies published over the last 5 years. Eligible studies were required to focus on organisational determinants of hospital- and system-wide interventions, and to provide patient outcome data before and after implementation of the intervention. Empirical, peer-reviewed studies reporting randomised and non-randomised controlled trials, observational, and controlled before and after studies were included in the review.

Results

Six studies met the inclusion criteria. Improved outcomes were observed for studies where outcomes were measured at least two years after the intervention. Associations between organisational factors, intervention success and patient outcomes were undetermined: organisational culture and patient outcomes were rarely measured together, and measures for culture and outcome were not standardised.

Conclusions

Common findings show the difficulty of introducing large-scale interventions, and that effective leadership and clinical champions, adequate financial and educational resources, and dedicated promotional activities appear to be common factors in successful system-wide change.

The protocol has been registered in the international prospective register of systematic reviews, PROSPERO (Registration No. CRD42103003050).
Adsorptive interaction of bisphenol A with mesoporous titanosilicate/reduced graphene oxide nanocomposite materials: FT-IR and Raman analyses
Authors: Nguyen-Huy Chinh , Kim Nayoung , Nguyen-Phan Thuy-Duong , Yoo Ik-Keun , Shin Eun Woo
Published: September 2014

Nanocomposite materials containing graphene oxide have attracted tremendous interest as catalysts and adsorbents for water purification. In this study, mesoporous titanosilicate/reduced graphene oxide composite materials with different Ti contents were employed as adsorbents for removing bisphenol A (BPA) from water systems. The adsorptive interaction between BPA and adsorption sites on the composite materials was investigated by Fourier transform infrared (FT-IR) and Raman spectroscopy. Adsorption capacities of BPA at equilibrium, q

e
(mg/g), decreased with increasing Ti contents, proportional to the surface area of the composite materials. FT-IR observations for fresh and spent adsorbents indicated that BPA adsorbed onto the composite materials by the electrostatic interaction between OH functional groups contained in BPA and on the adsorbents. The electrostatic adsorption sites on the adsorbents were categorized into three hydroxyl groups: Si-OH, Ti-OH, and graphene-OH. In Raman spectra, the intensity ratios of D to G band were decreased after the adsorption of BPA, implying adsorptive interaction of benzene rings of BPA with the sp2 hybrid structure of the reduced graphene oxide.
Preparation TiO2 core-shell nanospheres and application as efficiency drug detection sensor
Authors: Yue Jingli , Chen Zhenhua , E Yifeng , Chen Lianshan , Zhang Jing , Song Yimeng , Zhai Yuchun
Published: September 2014

In this paper, we report the facile preparation of monodisperse titanium dioxide-diltiazem/tetrachlorobismuth core-shell nanospheres (TiO2@DTMBi), in which, diltiazem (DTM)/tetrachlorobismuth (BiCl4) complexes were employed as electroactive materials. The morphology, size, formation, and structure of the obtained TiO2@DTMBi spheres were investigated by transmission electron microscopy, scanning electron microscopy, dynamic light scattering, Fourier transform infrared spectroscopy, and X-ray diffraction. The optimal condition of obtained monodisperse 40-nm TiO2@DTMBi spheres was researched. The results of using TiO2@DTMBi nanospheres as proposed drug sensor indicate a wide linear range (10-7to 10-1 M) and a very low detection limit of 0.20 μg/mL.
Statistical detection of the influence of solar activities to weak earthquakes
Authors: Qin Pan , Yamasaki Tomohiko , Nishii Ryuei
Published: September 2014

In the literature, it has been hypothesized that the solar wind released by the Sun affects the Earth as a trigger to cause earthquakes. This hypothesis is on the basis of the observation that the frequency of earthquakes rises at the period of solar minimum. In recent years, various physical measurements on the solar wind like velocity and temperature etc. became available. With these data, we focus on investigating the relation between the solar activities and the earthquakes. For this purpose, we constructed generalized auto-regressive models with exogenous variables obeying a Poisson or a negative binomial distribution, in which the response variable is the frequency of earthquakes with Richter magnitude scales 4-4.9 (EQ4-4.9), and the explanatory variables are nine physical measurements about the solar wind, the magnetospheres of the interplanetary magnetic field and the Earth. Model selection was conducted by using Bayesian information criterion based forward stepwise selection. Finally, numerical results showed that the exogenous variables of solar wind are statistically significant for the frequency of EQ4-4.9.
Federal state educational standard of General education: problems and their solution
Authors: �������  , Evplova Ekaterina
Published: September 2014

In the article the urgency of introduction of the Federal state educational standard (GEF) basic General education, are the main characteristics of this new generation standard: the emphasis in education; inter-personal, meta (cognitive, communicative, regulatory universal learning activities) and substantive results. An attempt is made to analyze the shortcomings of the old format of education and the benefits of the standard of the second generation, and also lists the problems of implementation of this standard in basic school and possible ways of their solution. Problems and ways of their solution identified by the method Edward de Bono´s "Six thinking hats. Information for this article are collected in the process of cooperation with educational institutions of the city, other educational and research institutions, conferences on the subject, at courses of improvement of qualification and professional retraining of teaching staff and heads of educational institutions, during the meetings urban professional associations of teachers and specialists, and other
The complexities of caring for a patient with an ICD in end-stage heart failure
Authors: Whittingham Katharine , Hodgson Louise J
Published: September 2014

Despite comprehensive guidelines relating to the issue of implantable cardioverter defibrillator (ICD) deactivation in end-stage heart failure, complexities with implementation of the guidance continue to be raised in clinical practice. It is widely recognized that patients should be given the opportunity to discuss the issues surrounding deactivation of the ICD at the earliest opportunity. In practice, the process of facilitating these discussions can be challenging.

This article explores relevant literature to illustrate complexities in ICD deactivation. A case study is presented to describe how a community heart failure specialist nurse succeeded in negotiating these challenges to support the timely deactivation of an ICD in a patient with end-stage heart failure.
Staffing cardiothoracic units: Developing a new workforce
Authors: Livesey Steven , Bartley Tara
Published: September 2014

Steven Livesey and Tara Bartley discuss the changes to the traditional model for cardiothoracic services needed in order to develop a workforce more suited to future requirements, and consider the progress made so far on bringing about these changes.
Why nurses need to be engaged with clinical research
Authors: Wrigley Martha J , Humphreys Caroline
Published: September 2014

Martha J Wrigley and Caroline Humphreys argue the case for a better understanding of what clinical research involves, and the contribution that nurses in practice can make
Learning disabilities and equity of access
Authors: While Alison
Published: September 2014

Asignificant proportion of the population needs additional support in daily life because of disabilities. Primary health care is the gateway to most health-care resources and as such provides a crucial access point to additional health support for all citizens. However, although primary health care is acknowledged as a source of help for those with physical disabilities, it has been slower to adopt strategies to ensure that high-quality care may be similarly available to those with learning disabilities. In part this reflects the legacy of segregated specialized service provision before the 1990 NHS and Community Care Act, which excused primary health care from meeting the normal health-care needs of those with learning disabilities. However, an acceptance that people with learning disabilities should live in community settings and be entitled to the fulfilment of their basic needs as all other members of society means that they should have equal rights to highquality primary and specialist care.
Shingles vaccination: background and advice for community nurses
Authors: Purssell Edward
Published: September 2014

Shingles (or zoster) is a reactivation of an existing varicella–zoster virus (VZV) infection. During the initial infection, VZV causes a systemic disease known as varicella or chickenpox, and this initial infection normally occurs early in childhood in the absence of routine vaccination. Although varicella is normally a mild disease, shingles is associated with significant morbidity and some mortality, particularly in older people. The most significant severe consequence is post-herpetic neuralgia. There is an effective vaccine available for this, known as Zostavax, which is a live-attenuated VZV vaccine. Guidelines in the UK recommend that this is offered to everyone when they become 70 years of age, plus those aged 79 years as part of a catch-up campaign, with those between these ages not being eligible. It is important for all health-care professionals, including district and community nurses, to proactively promote this vaccine, so that those eligible can make an informed decision about whether to receive it.
Urostomy management in the community
Authors: Nazarko Linda
Published: September 2014

Around 11 000 people in the UK have a urostomy. A urostomy is now usually carried out for bladder cancer. Most urostomists are older men and around half require assistance with routine care. Complications such as parastomal skin soreness are common. Community nurses can work with urostomists and formal and informal carers to encourage and enable the person to manage their urostomy independently whenever possible and provide support, advice and help when complications occur. This article provides an overview of effective care and possible complications.
Long-term conditions and the Government agenda
Authors: Mendes Aysha
Published: September 2014

In the first of a monthly column examining long-term conditions and their impact upon individuals, community nursing and health care as a whole, Aysha Mendes considers current UK policy in this area and detects a positive, but sluggish, change
Standardized training for HCAs in general practice
Authors: Vaughan Paul , Griffiths Julie
Published: September 2014

A recent study was carried out in London entitled Health Care Assistants in General Practice: An evaluation of the impact of trained Health Care Assistants in General Practice across 4 Primary Care Trusts within the North Central London NHS Sector. One of the key findings was that a local specialist adviser should be set up at primary care trust (PCT) level to assist with healthcare assistant (HCA) issues in general practice.
Mental health:London managers' views 1996–9
Authors: Gulliver Pauline , Peck Edward , Howells Valerie
Published: September 2014

Since July 1996, researchers at the Centre for Mental Health Services Development have surveyed senior managers of London mental health services to identify changing positions and attitudes. This paper compares positions and attitudes between 1998 and 1999. Central themes in the views of managers are discussed and potential implications for the management of mental health services are examined.
EPR projects and organizational change
Authors: Beale Tom
Published: September 2014

Electronic Patient Records (EPRs) are at the forefront of new IT developments which will have wide-ranging consequences for managers. This article considers the importance of organizational change and process re-engineering in relation to the advent of EPRs.
Governing medical practice
Authors: Maynard Alan
Published: September 2014

The serial killer, Dr Harold Shipman, appears to have murdered 175 patients, if not more, over the course of his career as a GP. While his motivation is unclear, it is evident that general practice can never be the same again.
October 2005 – Patricia Hewitt's month from Hell
Authors: Timmins Nicholas
Published: September 2014

October 2005 proved pretty tough for Patricia Hewitt. The “right rollicking” that a Cabinet colleague predicted at the Labour party conference would occur once Parliament reassembled over the decision to end most direct provision by primary care trusts duly materialised.
The NHS riccochets from the anti-Blair revolt over education
Authors: Roth Andrew
Published: September 2014

Luckily or unluckily, the NHS is not in the front line of the gathering revolt in Labour ranks over PM Tony Blair's last-gasp “irreversible” radical ‘reform’ of secondary education. Perhaps because of the parade of taunts he has suffered from waving the ‘Education! Education! Education!’ banner since 1996, the Prime Minster has decided to make the demolition of the comprehensive system and its control by local authorities the final monument of the Blair era.
Bird on a wire: flu in the cockoo's nest
Authors: Ainsworth Steve
Published: September 2014

Are we all living in cloud-cuckoo land when it comes to the threat posed by bird flu? Is the Government unduly complacent about the true level of risk; or is the media responsible for spreading needless anxiety? Is the risk of dying from influenza about as likely as the Earth being struck by a massive meteorite? Or are the odds much less remote?
A new way of life on NHS street
Authors: Keep Jane , Hardacre Jeanne
Published: September 2014

Jeanne Hardacre and Jane Keep continue BJHCM's new column on organisational development issues
Healthcare services and the single EU market
Authors: Mountford Lyndsay , Dawson Diane
Published: September 2014

While the NHS was celebrating its 60th birthday earlier this year, and attention was also very much focused on the fi nal report of Lord Darzi's Next Stage Review, a prospective piece of European legislation slipped rather more quietly into the public domain than either its history, or its possible future impact, might merit. The European Commission's draft proposal for a‘Directive on the application of patients’ rights in cross-border health care’ (COM, 2008) has been a long time in preparation, and has had a much more diffi cult gestation than its quiet appearance in July might suggest.
A golden opportunity to improve and save
Authors: Jones David
Published: September 2014

This article aims to expose a major opportunity for NHS trusts to improve the quality of the patient experience, while simultaneously reducing costs. Discussion is focused on an area of healthcare management that has been starved of senior management attention for too long and makes the case for elevating equipment management from an underrated technical chore to a key strategic issue.
Quality of care in a franchised GP group
Authors: Parkin Tim , Orchard John , Parkin Tracey
Published: September 2014

The development of alternate personal medical services (APMS), as part of the 2003 new GP contract, allowed for the granting of contracts to provide GP services beyond the traditional partnership model (British Medical Association (BMA), 2003).
Adapting to change: dental prescriptions
Authors: Richards Wayne , Ameen Jamal , Higgs Gary
Published: September 2014

Dentistry in England and Wales has faced a great number of changes, the first of which pertains to remuneration. April 2006 saw the introduction of a new dental contract for the NHS. This contract included a new method of remuneration for general dental practice, replacing the old ‘item of service’ payment with a system in which funding was independent of the amount of treatment provided.
A national patient safety agency to be launched
Authors: Tingle John
Published: September 2014

On the 17 April 2001, the Chief Medical Officer, Liam Donaldson, announced the setting up of a new agency to boost patient safety in the NHS — the National Patient Safety Agency (NPSA). The NPSA will be an independent body running a mandatory reporting system for logging all failures, mistakes, errors and near misses across the health service. Details of the agency are revealed in a new report, Building a Safer NHS for Patients (Department of Health (DoH), 2001). All nurses will need to be aware of the functions of the agency and of its mandatory requirement of incident reporting.
Perceptions of older people who have experienced physical restraint
Authors: Gallinagh Róisín , Nevin Rosemary , McAleese Lynda , Campbell Linda
Published: September 2014

It is well documented that the use of physical restraints in older people has been linked to negative clinical outcomes. However, less is known about the personal perspective of those who have been restrained. This study examines the perceptions of older people who have experienced physical restraints in a rehabilitation ward. A purposive sample was used of 17 male and female patients who were restrained. The patients were interviewed using the Subjective Experience of Being Restrained instrument (Strumpf and Evans, 1988) which is a semi-structured interview schedule. The most commonly used restraint devices included side rails, screw-on table tops and reclining chairs. The data were analysed using content analysis. The results indicate mixed feelings regarding physical restraints. Patients' impressions of physical restraints included indifference of the devices to their perceived safety value. Overall, a minority of patients (n = 4) had positive feelings about physical restraints as they provided a sense of security to them. However, the negative comments of the patients were more prevalent and their responses were categorized in terms of institutional control, ritualized care, entrapment and discomfort, and possible alternatives.
Breakthrough pain: assessment and management in cancer patients
Authors: McMillan Catriona
Published: September 2014

This article provides an overview of breakthrough pain in cancer patients, what causes it, current treatment options and the impact it has on individuals. It considers the importance of accurate assessment, the use of assessment tools and the growing role of nurses in managing this challenging pain syndrome. The article aims to open the debate on the need for new choices in pain management. While many advances have been made in the treatment of pain, there is still room for improvement in both the pharmaceutical and general management of the condition. Suggestions are made as to how these may be met.
Health facilitation in learning disability: a new specialist role
Authors: Jukes Mark
Published: September 2014

This article attempts to examine the important role of the health facilitator in learning disability and recommends that the specialist community learning disability nurse already has the appropriate skills and knowledge to carry out competently the role across the acute, primary and secondary care sectors. A model for community specialist learning disability practice already exists (Bollard and Jukes, 1999) but for health facilitation to have an impact a model of leadership and change is recommended to be aligned to a model for practice. A CALECT model (a mnemonic which represents essential core roles and skills of a health facilitator) is proposed as a complementary vehicle to make facilitation work.
Benefits of a course in behavioural analysis for health visitors
Authors: Lane Eleanor , Hutchings Judy
Published: September 2014

Twenty-four health visitors participated in a 12-week course in behavioural intervention methods for work with children with behavioural difficulties. Each health visitor identified a family with child behavioural problems and worked with this family while attending the weekly training sessions. The course was run in 1998/99 and in 2000/01 for 12 health visitors. The 1998/99 trainees established a control group by identifying a second family experiencing similar difficulties. These families received the standard service for the same duration as the course. After the course, all health visitors demonstrated a significant increase in knowledge of behavioural terminology and reported an increased practice of behavioural techniques. Significant improvements were seen in measures of child behaviour and maternal mental health for both groups of intervention families, compared with non-significant improvements in the control families. The course's success in giving health visitors the skills and practice to develop effective behavioural strategies in work with child behavioural problems is also discussed.
Cardiorespiratory physical assessment for the acutely ill: 1
Authors: Docherty Brendan
Published: September 2014

This article, the first of two parts, aims to develop core cardiovascular and respiratory knowledge and to enhance practice for the practitioner caring for an acutely ill patient on a general ward setting. The second part will focus on advanced cardiorespiratory assessment. With increasing acuity of illness in general ward settings, patients' needs are becoming more complex in terms of their nursing and medical management. Nurses must be able to respond to subtle clinical signs and symptoms and act appropriately to ensure that a safe, patient-focused environment is maintained and that the care delivered is evidence-based. By increasing knowledge of the theory and practice of nursing physical assessment, and the ensuing management, acutely ill patients nursed in general ward areas may be provided with timely and appropriate care and may avoid further deterioration and an intensive care admission. This article describes core physical assessment skills, the normal physiology of the cardiovascular system, and the management of cardiovascular and respiratory dysfunction.
Assisting carers using the ACTION model for working with family carers
Authors: Magnusson Lennart , Hanson Elizabeth , Nolan Mike
Published: September 2014

This article is the first in a series of four that describes recent developments in Sweden aimed at promoting partnerships between older people, their families and formal service providers. The focus in this article is on the use of information and communication technology (ICT) to help family carers to be more prepared for their caregiving role. It is based upon the PREP (preparedness, enrichment and predictability) model of nursing intervention (Archbold et al, 1995) which is applied in the context of a major ICT project called ACTION (Assisting Carers using Telematics Interventions to meet Older persons' Needs). The way in which ACTION has developed is briefly considered and the range of interventions used is described. Subsequent articles in the series reflect upon users' perceptions of the acceptability of the ACTION approach and a case study of the benefits of ACTION is also presented. Finally, the series concludes with an article which outlines the development of a call centre which is used to complement and augment the ACTION service.
Paediatric continence in children with neuropathic bladders
Authors: McMonnies Gill
Published: September 2014

Over the last 8 years in Nottingham we have been developing a comprehensive teaching package for children requiring clean intermittent catheterization. Clean intermittent catheterization can be a traumatic procedure to undertake for both the child and carers. Our aim is to support the child from home to hospital providing a link service from our community colleagues through to the child's consultant. Over a number of years we have expanded our knowledge and care, writing information booklets and preparing photographic demonstrations of techniques and operations which some of our children require. We have now developed a communication network for schools, helping them to support these children in their daily life.
The RCS’ Core Laparoscopic Skills Course is very effective: evidence based on objective assessments
Authors: Popper Katie , Sarker Shah-Jalal , Patel Bijendra
Published: September 2014

Surgical training has recently undergone significant changes. Much pressure has been placed on the surgical trainee as a result of decreased training opportunities. This is secondary to new working time constraints, changes in the health service, and changes in disease pattern and procedures. 1
The novel use of a biodegradable stent placed by percutaneous transhepatic cholangiography for the treatment of a hepaticojejunostomy biliary leak following an extended left hepatectomy and pancreaticoduodenectomy
Authors: Jones L , Moir J , Brown C , Williams R , French JJ
Published: September 2014

A 61-year-old man presented with jaundice, and subsequently underwent an extended left hepatectomy and pancreaticoduodenectomy for a cholangiocarcinoma invading the head of the pancreas. The patient developed sepsis due to a biliary leak at the hepaticojejunostomy. We describe the original use of a biodegradable stent, deployed via percutaneous transhepatic cholangiography into the Roux limb, resulting in good drainage and resolution of sepsis. The chief benefit of this procedure is the lack of need for subsequent removal as well as purported reduced biofilm accumulation. We believe this to be the first reported case of this type and the literature surrounding the subject is also discussed.
Genomic insights into abdominal aortic aneurysms
Authors: Bown MJ
Published: September 2014

Introduction

An individual’s genetic background plays a significant role in his or her chances of developing an abdominal aortic aneurysm (AAA). This risk is likely to be due to a combination of multiple small effect genetic factors acting together, resulting in considerable difficulty in the identification of these factors.

Methods

Methods for the identification of genetic factors associated with disease are usually based on the analysis of genetic variants in case-control studies. Over the last decade, owing to advances in bioinformatics and laboratory technology, these studies have progressed from focusing on the examination of a single genetic variant in each study to the examination of many millions of variants in a single experiment. We have conducted a series of such experiments using these methods.

Results

Our original methods using candidate gene approaches led to the initial identification of a genetic variant in the interleukin-10 gene associated with AAA. However, further studies failed to confirm this association and highlighted the necessity for adequately powered studies to be conducted, as well as the need for confirmatory studies to be performed, prior to the acceptance of a variant as a risk for disease. The subsequent application of genomic techniques to our sample set, in a global collaboration, has led to the identification of three robustly verified risk loci for AAA in the LRP1, LDLR and SORT1 genes.

Conclusions

Genomic studies of AAA have led to the identification of new pathways involved in the pathogenesis of AAA. The exploration of these pathways has the potential to unlock new avenues for therapeutic intervention to prevent the development and progression of AAA.
Single site multiport umbilical laparoscopic appendicectomy versus conventional multiport laparoscopic appendicectomy in acute settings
Authors: Jategaonkar PA , Yadav SP
Published: September 2014

Introduction

Although conventional multiport laparoscopic appendicectomy (CMLA) is preferred for managing acute appendicitis, the recently developed transumbilical laparoscopic approach is rapidly gaining popularity. However, its wide dissemination seems restricted by technical/technological issues. In this regard, a newly developed method of single site multiport umbilical laparoscopic appendicectomy (SMULA) was compared prospectively with CMLA to assess the former’s efficacy and the technical advantages in acute scenarios.

Methods

Overall, 430 patients were studied: 212 in the SMULA group and 218 in the CMLA group. The same surgeon performed all the procedures using routine laparoscopic instruments. The SMULA technique entailed three ports inserted directly at the umbilical mound through three distinct strategically placed mini-incisions without raising the umbilical flap. The CMLA involved the traditional three-port technique.

Results

Both groups were comparable in terms of demographic criteria, indications for surgery, intraoperative blood loss, time to ambulation, length of hospital stay and umbilical morbidity. Although the mean operative time was marginally longer in the SMULA group (43.35 minutes, standard deviation [SD]: 21.16 minutes) than in the CMLA group (42.28 minutes, SD: 21.41 minutes), this did not reach statistical significance. Conversely, the mean pain scores on day 0 and the cosmetic outcomes differed significantly and favoured the SMULA technique. None of the patients developed port site hernias over the follow-up period (mean 2.9 years).

Conclusions

The favourable outcomes for the SMULA technique are likely to be due to the three small segregated incisions at one place and better trocar ergonomics. The SMULA technique is safe in an acute setting and may be considered of value among the options for transumbilical appendicectomy.
An unusual place to find a lost needle in laparoscopic surgery
Authors: Al Jaafari F , Christofides AG , Bell CRW , Beatty JD
Published: September 2014

Losing a needle during laparoscopic surgery is an uncommon but potentially challenging scenario for the surgeon. The prolonged operative time to search for a small retained foreign body such as a needle can cause clinical and medicolegal complications. As a result, it is considered a ‘never event’. This report describes a case of a lost needle during a laparoscopic prostatectomy, when a meticulous and systematic search for the foreign body was initiated and completed with the use of x-rays, only to find it in an unusual place.
The importance of intraoperative transoesophageal monitoring when operating on renal cancers that involve the right atrium
Authors: George J , Grebenik K , Patel N , Cranston D , Westaby S
Published: September 2014

The surgical treatment of advanced renal cancers is challenging. Renal cell carcinoma is interesting in that it invades the vasculature and can extend up as far as the right atrium. Extension of tumour thrombus into the right atrium represents level IV disease, according to Robson staging. Transoesophageal echocardiography is useful for diagnostic purposes. It is also of great value for intraoperative cardiac monitoring and to confirm the extent of vascular involvement.
Combined use of hyperbaric oxygen and sprayed keratinocyte suspension to tackle a difficult wound
Authors: Jackson PC , Wilks D , Rawlins J , Matteucci PL
Published: September 2014

This is the first reported case in the literature to combine the use of a well established therapy to achieve wound healing (ie hyperbaric oxygen treatment) and a novel sprayed keratinocyte suspension technique to treat a challenging wound successfully. The merits and potential issues associated with these treatments are outlined and the case is detailed.
Prediction of complications after partial nephrectomy by RENAL nephrometry score
Authors: Reddy UD , Pillai R , Parker RA , Weston J , Burgess NA , Ho ETS , Mills RD , Rochester MA
Published: September 2014

Introduction

Discussing and planning the appropriate management for suspicious renal masses can be challenging. With the development of nephrometry scoring methods, we aimed to evaluate the ability of the RENAL nephrometry score to predict both the incidence of postoperative complications and the change in renal function after a partial nephrectomy.

Methods

This was a retrospective study including 128 consecutive patients who underwent a partial nephrectomy (open and laparoscopic) for renal lesions in a tertiary UK referral centre. Univariate and multivariate ordinal regression models were used to identify associations between Clavien–Dindo classification and explanatory variables. The Kendall rank correlation coefficient was used to examine an association between RENAL nephrometry score and a drop in estimated glomerular filtration rate (eGFR) following surgery.

Results

An increase in the RENAL nephrometry score of one point resulted in greater odds of being in a higher Clavien–Dindo classification after controlling for RENAL suffix and type of surgical procedure (odds ratio [OR]: 1.29, 95% confidence interval [CI]: 1.04–1.64, p=0.043). Furthermore, a patient with the RENAL suffix ‘p’ (ie posterior location of tumour) had increased odds of developing more serious complications (OR: 2.60, 95% CI: 1.07–6.30, p=0.042). A correlation was shown between RENAL nephrometry score and postoperative drop in eGFR (Kendall’s tau coefficient -0.24, p=0.004).

Conclusions

To our knowledge, this is the first study that has shown the predictive ability of the RENAL nephrometry scoring system in a UK cohort both in terms of postoperative complications and change in renal function.
Does error feedback improve the learning of a simple surgical skill?
Authors: Nagala S , Brar R , Phillips GA , Van Wyk C , Lee M
Published: September 2014

The European Working Time regulations (EWTr) have led to a decrease in training opportunities for surgical trainees in the uk. it is therefore imperative that effciency of training is optimised to enable trainees to attain procedural competence within their curtailed training period. Workplace-based assessments are central to the intercollegiate Surgical curriculum Programme. These tools are important as not only do they give a formal way of assessing the trainee but they also trigger formal feedback of performance. The importance of feedback in learning surgical skills has been highlighted for procedures ranging from simple subcuticular suturing 1 and knot tying 2 to more complex vascular anastomoses 3 and laparoscopic work. 4 lack of feedback has been shown previously to have a detrimental effect on learning. 5