bluuebunny/crossref_metadata_2025 huggingface dataset:
Professional compassion fatigue: what is the true cost of nurses caring for the dying?
Authors: Melvin Christina S
Published: May 2014

Background: Emerging evidence describes some of the heavy tolls that health professionals experience as they deal with the continual loss of patients. Each patient and family has particular needs (physical, psychological, social, and spiritual) and is deserving of expert end-of-life care, and it is this intensity of need that places nurses at risk of professional compassion fatigue (PCF). Aim: This pilot study aimed at further exploration of the prevalence of PCF among hospice and palliative care nurses, as well as the nature of its effects and any coping strategies that nurses adopt. Methodology: A descriptive qualitative study was undertaken using semi-structured interviews with six highly experienced, purposively sampled nurses from a home health agency in northeast USA. Results All six of the participants recognised the risks of developing PCF, and one was clearly experiencing PCF at the time of interview. Signs and symptoms were described and strategies for avoiding and alleviating PCF were discussed. Conclusion: There are clear physical and emotional health consequences for nurses who provide hospice and palliative care over extended periods of time. Further research is needed into the extent of the problem, specific causes, and coping strategies.
Parents' perspectives on the deaths of their children in two Brazilian paediatric intensive care units
Authors: El Halal Gilda MC Abib , Piva Jefferson P , Lago Patrícia M , El Halal Michel GS , Cabral Felipe C , Nilson Cristine , Garcia Pedro CR
Published: May 2014

Objectives:

To evaluate the quality of care offered to terminally ill children and their families in the last days of life in two Brazilian Paediatric Intensive Care Units (PICUs) from the parents’ perspectives.

Methods:

This was a qualitative, exploratory study. Parents of a child who had died in one of the PICUs 6–12 months previously were invited to take part in two interviews: a private meeting with the PICU assistant physician who cared for their child, to discuss and review any outstanding issues related to the diagnosis, treatment, and prognosis, and a recorded interview with a researcher who was not involved in the child's treatment. Data from the interviews with the researcher were posteriorly grouped in categories according to recurrent terms.

Results:

Six categories emerged, three of which are reported here. The quality of communication was low; the medical staff frequently used technical terms, limiting understanding. Parental participation in the decision-making process was scarce; decisions were based on the medical perspective. Finally, families reported uncompassionate attitudes from the medical staff and excessive technology in the final moments surrounding the child's death, although nurses were highly involved with palliative care measures and demonstrated sympathetic and supportive postures.

Conclusion:

The interviews uncovered deficiencies in the care provided to parents in the PICUs, indicating a need for changes in practice.
The role of a community palliative care specialist nurse team in caring for people with metastatic breast cancer
Authors: Leadbeater Maria
Published: May 2014

An audit was undertaken of people with a diagnosis of breast cancer who were referred to a community palliative care specialist nursing team over a 12-month period, to explore the reasons for referral to the service and the duration of involvement with the service. Breast cancer patients accounted for 10% of the total referrals to the specialist service, with symptom management (including pain control) and emotional support being the main reasons for referral. The majority of people referred with breast cancer had metastatic breast cancer (87%); interestingly, 13% had primary breast cancer. The mean duration of intervention was 3 months and 1 week. Referrals seemed to occur late in patients’ disease trajectories, and total numbers were lower than might be expected. It may be concluded that there is scope for the specialist palliative care team to be a more integral part of care for patients with metastatic breast cancer.
Constipation in palliative care: treatment options and considerations for individual patient management
Authors: Andrews Amanda , Morgan Gwyneth
Published: May 2014

Constipation is an all too common symptom in palliative care patients and may be associated with a range of severe issues and experiences. Its effects on patients contribute to both physical and psychological scarring during a very distressing stage of life not only for the patient but also for their caregivers. It is during this time that, too often, the complexity of managing the condition moves the locus of control away from the patient toward the health professionals. This article considers a number of different treatment options and facets of individual management that may enable patients to move the locus of control back to a position of joint management by patients, caregivers, and health professionals.
Three approaches to delivering end-of-life education to care homes in a region of south east England
Authors: Booth Michele , Springett Angela , Nash Sue , Banks Chris
Published: May 2014

There has been considerable investment in end-of-life care education for the care home sector in recent years. This article looks at three recent initiatives in West Sussex in south east England and appraises the advantages and disadvantages of each. The three initiatives were an action learning project, a Six Steps to Success care home programme, and a Gold Standards Framework for Care Home programme. The details of how each approach was operationalised and the initial results and evaluations are discussed. It is essential that end-of-life educators working in the same geographical area communicate and build on one another's contributions, and this article is an instance of such collaboration.
Challenges UK paramedics currently face in providing fully effective end-of-life care
Authors: Brady Mike
Published: May 2014

Paramedics play an integral part in community end-of-life care (EoLC) in the UK, especially given the lack of out-of-hours cover by palliative care specialists. Despite this, there remain multiple barriers to their fully effective provision of such care. This article provides a brief historical overview of paramedic practice, before highlighting some of the barriers to effective paramedic EoLC provision and introducing examples of collaborative work in the UK that aim to overcome these. The author hopes this will support improvements in paramedic-led EoLC. Given the similarities in the international evolution of paramedic education, readers from other countries will be able to relate to these findings.
Assessment of the need for palliative care for children in South Africa
Authors: Connor Stephen , Sisimayi Chenjari , Downing Julia , King Evelyn , Ken Patricia Lim Ah , Yates Rachel , Marston Joan
Published: May 2014

UNICEF and the International Children's Palliative Care Network undertook a joint analysis in three sub-Saharan countries—Zimbabwe, South Africa, and Kenya—to estimate the palliative care need among their children and to explore these countries' capacities to deliver children's palliative care (CPC). This report concerns the findings from South Africa. The study adopted a cross-sectional mixed-methods approach using both quantitative and qualitative data obtained from primary and secondary sources. CPC need was estimated using prevalence and mortality statistics. The response to the need and existing gaps were analysed using data obtained from a literature review, interviews with key persons, and survey data from service providers.The findings show very limited CPC service coverage for children in the public sector. In addition, services are mainly localised, with minimal reach. Less than 5% of the children needing care in South Africa are receiving it, with those receiving it being closer to the end of life. Barriers to the delivery of CPC include fear of opioid use, lack of education on CPC, lack of integration into the primary care system, lack of policies on CPC, and lack of community and health professional awareness of CPC needs and services. Estimating the need for CPC is a critical step in meeting the needs of children with life-threatening conditions and provides a sound platform to advocate for closure of the unacceptably wide gaps in coverage.
Access and attitude of rural allied health professionals to CPD and training
Authors: Stagnitti Karen , Schoo Adrian , Reid Catherine , Dunbar James
Published: May 2014

Continuing professional development (CPD) activities for allied health professionals are becoming mandatory as a means for professionals to maintain accreditation or skills. To access CPD activities, rural allied health professionals have the added costs of travel, accommodation and information technology access. It is assumed that health professionals in rural areas want access to training and CPD.

In 2003, a survey of allied health professionals was carried out in Southwest Victoria, Australia, with the aim of identifying access and attitudes to CPD. Results showed that allied health professionals in Southwest Victoria were highly qualified, wished to access CPD more than four times a year and were prepared to spend a mean rate of $1000 (£300) per annum on CPD activities.
Exploring environmental control unit use in the age group 10-20 years
Authors: Paul SN , Frank AO , Hanspal RS , Groves R
Published: May 2014

The purpose of this retrospective study was to analyse the demography and use of Environmental control units (ECU's) within a regional setting in the age group 10–20 years. It was envisaged that this information might raise awareness and use of ECUs by health care professionals.

The North Thames Regional ECU database was interrogated to identify users provided with an ECU between the ages of 10–20 years and also examined for sex, type of school attended, diagnosis, and source of referral.

Of those involved in the study 54 users (39 male) with a mean age at first assessment of 14 years (range 10—20 years) had been provided with ECUs as of September 2003. Eighty nine per cent of school age users attended mainstream schools. Muscular dystrophy and cerebral palsy accounted for 42% and 29% of diagnoses respectively. Seventy nine per cent of referrals came from community occupational therapists (OTs). No referrals resulting in the provision of an ECU were received directly from a neurologist or rehabilitation physician. One referral was received from a paediatrician.

In North Thames, community OTs are the commonest referrers for ECUs and muscular dystrophy is the most common medical diagnosis in paediatric and adolescent users of ECUs respectively. The potential for ECUs to enable young people to remain independent and to ease the strain on their families may not be understood among other healthcare professionals.
Patient satisfaction with accelerated discharge following unilateral knee replacement
Authors: Barker Karen L , Reilly Kathleen A , Minns Lowe Catherine , Beard David J
Published: May 2014

The aim of this study was to identify and describe patients' satisfaction after accelerated and usual discharge from hospital following elective orthopaedic surgery. It identified patients' perceived discharge preferences and describes factors that they believed to be important. The research was conducted with 41 patients who had participated in a randomized controlled trial comparing accelerated discharge after Oxford unicompartmental knee replacement with standard care. A qualitative study design using a combination of a validated questionnaire and supplementary open questions was used. The data from this open question underwent content analysis.

Both accelerated and usual care patients appeared to be highly satisfied following their knee replacement. This study indicates that patients seem satisfied with early discharge and that the majority who had experienced accelerated discharge would prefer accelerated discharge again in the future, if they required similar surgery. The benefits of being at home, altruism, experience and knowledge were reasons provided for this view.
An audit of patient records into the nature of pulsed shortwave therapy use
Authors: Mansour Al-Mandeel Maryam , Watson Tim
Published: May 2014

This evaluative audit aimed to investigate the nature of pulsed shortwave therapy (PSWT) use in outpatients clinics in England through the analysis of patient records. Eight randomly selected hospitals were chosen to reflect variations in practice across the country. Information concerning the total number of patients seen in these departments, the proportion of patients treated with PSWT, the mode of treatment (duration of exposure, PSWT parameters, treatment frequency and outcome) and the conditions treated were collected and analysed.

A total of 1750 sets of physiotherapy patient notes were evaluated of which, 192 patients were treated with PSWT, averaging 11% of all treatments.

The treatment records were found to be of generally poor quality. None of the files examined fulfilled the Chartered Society of Physiotherapy standards of documentation. Eighty eight percent of the files did not have reproducible treatment plans in terms of dose parameters.

The issues raised by this evaluative audit are considered in the context of therapy treatment notes and in relation to PSWT.
The physical self-concept in patients with depressive and anxiety disorders
Authors: Knapen Jan , Vermeersch Joeri , Van Coppenolle Herman , Cuykx Veerie , Pieters Guido , Peuskens Joseph
Published: May 2014

Patients suffering from depressive and/or anxiety disorders are characterized by a low physical selfconcept. The objective of the present study was to investigate which variables were related to the physical self-concept in these patients.

One hundred and ninety-one patients (67 males and 124 females) hospitalized in a university psychiatric hospital in Belgium took part in the study. The severity of depression and anxiety, level of physical activity, physical self-concept, perceived benefits and barriers towards physical exercise, and motivation towards psychomotor therapy were assessed by means of questionnaires and a visual analogue scale. A stepwise multiple linear regression analysis was used to ascertain the explaining variables of the physical self-concept.

The explaining variables, in order of importance, were: severity of depression, barriers towards physical exercise, motivation towards psychomotor therapy, level of physical activity, age and gender.

Patients with a low physical self-concept are characterized by a high severity of depression, a low level of physical activity and a low motivation towards psychomotor therapy. They also experience many barriers towards physical exercise.
A UK survey of therapists' perspectives on post-amputation hopping
Authors: Stokes D , Curzio J , Bacon E , Barker L , Berry A , Morten M
Published: May 2014

Aims: There is a lack of evidence to guide therapists on early mobility with patients post-amputation. Guidelines were published in the UK in 2006 to assist therapists with decision making in this area. In light of these guidelines, the author sought to explore UK therapists’ views, experiences and sources of knowledge on hopping with and without aids post amputation, and identify further areas for research.

Methods: A survey methodology was adopted. Data were analysed using descriptive statistics and respondents’ written remarks were explored to support the analysis.

Findings: Survey responses were returned by 88 therapists; 27 occupational therapists and 61 physiotherapists. Hopping without aids was not recommended by any therapist. 61% of respondents would recommend hopping with aids in some circumstances; 63% felt that some patients have to hop to get around the home; 52% felt that hopping was inadvisable and 40% thought it would delay rehabilitation. 90% of therapists have had amputees report they are hopping. Senior staff and colleagues were the most cited source of knowledge on post-amputation mobility.

Conclusions: In the absence of evidence, therapists rely on other colleagues and personal observations to inform their practice in this area. Findings suggest that therapists are following the guidelines which advise that wheelchair mobility is the ideal, but specified reasons may lead therapists to teach amputees to ambulate with aids. Further research is required on the use of hopping post-ambulation.
Discovering powered mobility skills with children: ‘Responsive partners’ in learning
Authors: Durkin Josephine
Published: May 2014

Aims

This qualitative grounded theory research study was designed and carried out as a PhD thesis to explore the question ‘How does a child learn to use powered mobility to explore their environment?’.

Methods

The research took place in four interconnected stages. Initially 11 typically developing children were observed and video-taped learning to use a powered wheelchair. Comparison and coding of the video data to develop the emerging themes led to three further data sets: consulting with seven experienced power mobility users in focus groups; observing 11 children with disabilities using powered wheelchairs; and focus groups with 22 peer professionals.

Findings

The findings identified three stages of developmental learning and the themes of ‘partnerships and models’, ‘listening to disabled children’ and ‘engaging with children through play’. Analysis of these themes led to the emergence of the core category ‘responsive partner’.

Conclusions

A constructivist methodology of exploration enabled child-centred research to take place. Components of learning were identified and stages of progression for powered mobility discovered. Findings revealed that services should focus on the clinician being a responsive partner who does not command but is able to elicit new learning, and future research should explore this framework further.
Comparing stabilization training with balance training in recreationally active individuals
Authors: Aggarwal Anoop , Zutshi Kalpana , Munjal Jitender , Kumar Suraj , Sharma Vijai
Published: May 2014

Aims

The present study was undertaken to compare the efficacy of lumbar core stability training with that of balance training, at improving the balance performance in the recreationally active individuals. Most of the studies to date have been conducted on sporting professionals, whose activity demands are higher than the norm. The present study focuses on the recreationally active population, for which the activity demands are comparatively lesser.

Methods

Thirty recreationally active subjects (15 males and 15 females) were selected for this study. Subjects were randomly divided into three groups: core stability training group (CSTG), balance training group (BTG), and the control group. All subjects were assessed at baseline, and after six weeks, for balance performance, including static, dynamic and functional balance tests. Data were analyzed by paired t-test, ANOVA, Wilcoxon signed-rank test and Kruksal Wallis test.

Findings

Both training groups (BTG and CSTG) showed significant (P < 0.05) improvement in balance performance compared to the control group, however the improvement in the mean value for the CSTG was greater than that of the BTG.

Conclusions

Balance training as well as core stabilization training leads to improvement in static and dynamic balance. However none of these training leads to improvement in the functional balance performance.
The role of an Australian homeless health outreach team. Part 1: background
Authors: Lloyd Chris , Bassett Hazel
Published: May 2014

Background

The aim of this article is to describe the development, principles and practices of the Homeless Health Outreach Team in Queensland, Australia. The following article, in the next issue, builds upon this with a case study.

Contents

Relevant documentation and literature was reviewed. The Homeless Health Outreach Team has developed a model of practice based on local and international experience.

Conclusions

Specialized mental health services for the homeless have been able to successfully engage and manage clients by working in collaboration with local mental health services, housing, and non-government organisations.
The 8th September: World Physical Therapy Day
Authors: Chanou Konstantina
Published: May 2014

Every day physiotherapists around the world strive to provide the best quality of services to their patients. The World Confederation for Physical Therapy (WCPT), which was founded on 8th September 1951, has a goal to promote international health by encouraging the use of research in education and by exchanging opinions and information. For that reason, 8th September has been established as a day which ‘marks the unity and solidarity of the physical therapy community from 101 countries around the world’ (WCPT, 2010) and highlights the contribution of the physiotherapy profession to patient rehabilitation.
Burnout and engagement among physiotherapists
Authors: Martinussen Monica , Borgen Per-Christian , Richardsen Astrid Marie
Published: May 2014

Monica Martinussen, Per-Christian Borgen, Astrid Marie Richardsen

Aims: This article describes a study examining predictors of burnout and engagement, including job demands, job resources and Type A behaviour, in a sample of Norwegian physiotherapists (N = 244).

Methods: This study measured demographic and work characteristics, job demands, job resources, burnout, work engagement and type A behaviour for all members of the sample.

Findings: Both job demands and resources predicted burnout and engagement, and after controlling for these factors, Type A behaviour patterns accounted for additional variance in both burnout and engagement. Finally, Type A behaviour (Achievement Strivings and Impatience-Irritability) moderated several of the predictor-burnout relationships.

Conclusions: These findings support the need for studying personality traits in addition to work related factors when predicting both positive and negative work related emotions such as burnout and engagement.
Comparative efficacy of methyl salicylate iontophoresis and moist heat pack in the management of knee osteoarthritis
Authors: Wani Surendra K , Gaikwad Pallavi
Published: May 2014

Objective: To investigate the effectiveness of methyl salicylate iontophoresis in reducing pain and disability in patients with knee osteoarthritis (OA).

Materials and methods: A total of 40 patients with knee OA patients who were admitted at the outpatient physiotherapy clinic participated in this study. The patients were randomly assigned into two groups. Group A received methyl salicylate iontophoresis while group B received moist packs daily for a period of two weeks. Patients were evaluated for pain and functional capacity using numerical pain rating scale (NPRS), walking speed test (WST), modified get up and go test (MGUGT), total single limb standing test (TSLST) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) before therapy and after 2 weeks of intervention.

Results: The mean age and duration of symptoms were 56.45±6.30, and 2.27±1.05 years respectively for individuals treated with methyl salicylate iontophoresis and 56.8±5.47, 2.12±0.86 years for individuals treated with moist pack. After 2 weeks of intervention, significant differences were observed in all outcome parameters for both groups when compared to baseline values (P<0.01). Also, significant difference was found in most of the parameters except MGUGT in both groups post interventionally (P<0.001, P=0.103).

Conclusion: Methyl salicylate iontophoresis can be included in the treatment of knee osteoarthritis to enhance pain relief and functional activity.
Intra-rater reliability of timed ‘up and go’ test for children diagnosed with cerebral palsy
Authors: Sanjivani N Dhote , Prema A Khatri
Published: May 2014

Background: The ‘timed up and go’ (TUG) test is a quick test, used in clinical practice as an outcome measure to assess functional mobility in adults. However, little information is available for TUG test use in people with cerebral palsy (CP).

Aim: To assess within-session and test-retest reliability of TUG test and to find the mean score of it with respect to the Gross Motor Function Classification System (GMFCS) in children diagnosed with CP.

Methodology: An observational study of 30 children with CP of 4-12 years, those within GMFCS level I, II, and III, and an IQ>50. The sampling technique used was purposive sampling excluding children with cognitive deficit. The documented data was analyzed by using intraclass correlation coefficient (ICC). Subjects performed TUG on three occasions—at initial assessment; 30 min after initial assessment; 1 week after initial assessment. On each of these three occassions three TUG tests were performed. A mean score of the three trials was documented as a final score. Within session and test-retest reliability was analyzed using scores of trial 1 and 2; and trials 1 and 3 respectively. To find the mean score of the TUG test with respect to GMFCS level, a mean of all scores from all TUG tests performed within the particular GMFCS levels was calculated.

Result: Reliability of TUG test was high, with ICC of 0.99 within session, and 0.99 was test-retest relibility. Significant variation was seen in the TUG score for the three levels of GMFCS.

Conclusion: Intra-rater reliability of TUG test in children with CP was found to be highly reliable.
Situational analysis–framing approaches to interpretive inquiry in healthcare research
Authors: Fulton John , Hayes Catherine
Published: May 2014

This paper outlines the emergence of Clarke's situational analysis as a fundamental and key progression of approaches to grounded theory (Clarke, 2006). Developed within the context of sociological inquiry to frame and contextualise perceived and actual reality, grounded theory became a seminal starting point for naturalistic inquiry. This paper provides an insight into several theoretical engagements with the technicalities of grounded theory and ultimately explicates where post-modernism has facilitated and aided construction of theoretical standpoints encompassing the dynamic nature of contemporary society. Key philosophers and modern theorists from the fields of Discourse and Actor Network Theory such as Foucault and Latour, Callan and Law, respectively, are used to further develop and illustrate the schemata which represent long traditions of interpretive inquiry and how they have progressed in recent years. The paper is a direct attempt to make fundamental aspects of interpretive inquiry open and accessible to healthcare practitioners.
Effectiveness of a patient/carer empowerment programme for people with hip fractures
Authors: Louie Stephanie Wai-Shan , Poon Mei-yee , Yu Shuk-yiu , Chan Wai-ling , Au Kai-ming , Wong Kam-man
Published: May 2014

Aims: The study compared the effects of a patient and carer empowerment programme and conventional hip fracture protocol on hip fractures related knowledge, activity of daily living (ADL) independence, fall efficacy on ADL; and application frequency of adapted ADL skills in individuals with hip fracture.

Methodology: 134 participants were recruited with 63 and 71 participants allocated to Patient and Carer Empowerment Programme (PCEP) and conventional hip fracture protocol respectively. Paired t-test was used to compare the pre-post scores of hip fracture knowledge test, Functional Independence Measures-motor scores, Lawton Instrumental ADL scales and Chinese version of Fall Efficacy Scales within groups. Independent t-test was used to compare the outcome measures and application frequency of adapted ADL skills between groups.

Results: It showed that both groups have improvement on hip fracture related knowledge, ADL, instrumental ADL independence and fall efficacy on ADL (P<0.05). However, the participants who underwent the PCEP were found to apply adapted ADL skills more frequently.

Conclusion: It appears that participants who underwent the PCEP were more ready to build up habit on adapted ADL skills use. Further studies to investigate carers’ stress and hands-on caregiving skills after the programme were recommended.
Mental health vocational rehabilitation–occupational therapists’ perceptions of individual placement and support
Authors: Baxter Claire , Prior Susan , Forsyth Kirsty , Maciver Donald , Meiklejohn Alison , Irvine Linda , Walsh Mike
Published: May 2014

Research purpose:

Vocational rehabilitation (VR) has been the focus of recent UK government policy, which outlines objectives to support individuals with mental illness into work. To provide such support, individual placement and support (IPS) as one approach, is frequently referred to. This has ignited both discussion and research within the occupational therapy (OT) profession to re-examine its contribution to VR and consider IPS as part of its practice.

Aim:

To explore occupational therapists’ (OTs) perceptions about their role within mental health (MH) VR and IPS.

Method:

Semi-structured interviews were used to generate data in this qualitative study. The interview transcripts were subject to thematic framework analysis.

Findings:

The findings revealed similarities and compatibility with OT and IPS. Participants acknowledged the value of IPS for clients who wish to obtain paid employment but also recognized the value of all worker roles which is in keeping with the professions values.

Conclusion:

The findings are congruent with discursive literature regarding OT and VR. Consideration given by OTs to the uniqueness and complexities of work as an occupation reinforces their distinct contribution to VR and could extend to IPS. Further research is needed to verify and extend this study's findings.
Contemporary splinting practice in the UK for adults with neurological dysfunction: A cross-sectional survey
Authors: Kilbride Cherry , Hoffman Karen , Baird Tess , Tuckey Joanne , Marston Louise , Souza Lorraine De
Published: May 2014

Aim:

To explore the contemporary splinting practice of UK occupational therapists and physiotherapists for adults with neurological dysfunction.

Method:

Cross-sectional online survey of members of the Association of Chartered Physiotherapists in Neurology and College of Occupational Therapists Specialist Section Neurological Practice.

Results:

Four hundred and twenty therapists completed the survey. Contracture management is the most common rationale for therapists splinting adults with neurological dysfunction. Other shared therapeutic goals of splinting include maintaining muscle and joint alignment, spasticity management, function, pain management and control of oedema. Considerable clinical uncertainty was uncovered in practice particularly around wearing regimens of splints. Most therapists have access to locally-derived splinting guidelines, which may contribute to this diversity of practice.

Conclusions:

This study provides a unique insight into aspects of contemporary splinting practice among UK therapists, who belong to a specialist neurological professional network and work in a number of different health-care settings with adults who have a neurological condition. Study findings show a wide variation in splinting practice, thereby indicating a potential need for national guidance to assist therapists in this area of clinical uncertainty. Further research is required to establish best practice parameters for splinting in neurological rehabilitation.
The impact of spinal cord stimulation for upper extremity complex regional pain syndrome on level of function
Authors: Haynes Louise , Goebel Andreas , Flynn Maria
Published: May 2014

Background/aims

Spinal cord stimulation (SCS) is able to provide significant pain relief in individuals with complex regional pain syndrome (CRPS). Less is known about how this treatment impacts on function, particularly from the patients' perspective. This qualitative exploratory study was part of a larger service evaluation into current and future management of this patient group. This evaluation aimed to gain insight into the influence of SCS on daily activity and work and to explore the patients' journey from symptoms to diagnosis, SCS implant and afterwards.

Methods

A purposive sample of three patients took part in semi-structured interviews. Thematic content analysis of the data was then used to extract themes and subthemes.

Results

Thematic content analysis identified two emerging concepts: freedom and conflict. Within these two concepts, seven subthemes were apparent. Although participants described feelings of independence due to the effect of SCS on activity levels, other less encouraging issues were identified. These include a dependence on the stimulator, a lack of control over the future, and a perceived lack of understanding of their condition by others.

Conclusion

How these concepts relate to patients' ability to return to work is explored and areas for further research are identified.
Subjective experiences of occupational performance of activities of daily living in patients with mild stroke
Authors: Kristensen Hanne , Postat Annemette , Poulsen Trine , Jones Dorrie , Minet Lisbeth Rosenbek
Published: May 2014

Aim

To investigate the subjective experiences of occupational performance of activities of daily living (ADL) in patients with mild stroke.

Methodology

Data was generated from January – December 2011 and consisted of 41 individual ADL-I interviews with patients in hospital and another 41 interviews with the same patients 1 month after discharge. The last eight interviews were extended with semi-structured interviews.

Results

The study participants consisted of 16 women and 25 men with a mean age of 69 years. The majority of the participants were independent in the PADL- and IADL-activities included in the ADL-I interviews. However, a minority of participants experienced difficulties in performing normal daily activities without the help of alternative strategies or assistive devices. This resulted in them having to spend more time on these activities, and this increased their fatigue and risk of accidents.

Conclusion

It is important to view the patients with mild stroke as heterogeneous, and consider post-stroke fatigue and emotional reactions when evaluating rehabilitation needs. Therefore, it is important to look further into structured tools, which examine how well the participant performs daily activities and how this is perceived, to understand fully the patient's rehabilitation needs.
Eureka! A reliable, home-made water volumetry device
Authors: Kimmel Lara A , Prescott Jonathan G , Holland Anne E , Bedi Harvinder S
Published: May 2014

Background

Water displacement is considered to be the gold standard for measuring foot volume; however, it is time-consuming and infrequently used in clinical practice. The objectives of this study were to determine whether a home-made water displacement device is a reliable and time-efficient method for determining foot volume.

Methods

Thirty participants with no foot pathologies were enrolled and had their foot volume measured in two home-made water volumetry devices (Preski and PreskiLite). The participants' foot volumes were measured on two occasions on each of two different days.

Results

All measurements were achieved in less than 90 seconds. Within-day reliability was high (intraclass correlation [ICC]=0.997–0.999) with the minimal detectable change (MDC) at the 90% confidence level (MDC90) of less than 25 ml for both devices. Mean differences in volume displaced between days were small (range 0.6– -5.4 mls). For between-day measures on the same leg, the mean coefficient of variation ranged from 0.65–1 with associated ICCs of 0.989–0.997. The MDC90for between-day measures was 46 ml for the PreskiLite and 23 ml for the Preski. The difference in volume displaced between right and left legs was less than the MDC90for both devices.

Conclusions

A novel, home-made water volumetry device provides reliable measures of foot volume both within and between days. Measurements taken on the contralateral leg provide an adequate control. These portable devices provide rapid measurements and only one measurement is needed per day.
Dealing with cholesteatoma
Authors: Mills Linda
Published: May 2014

Repetitively discharging ears may indicate a cholesteatoma.
Treating nosebleeds
Authors: Croton Lizzie
Published: May 2014

Recurrent or heavy nosebleeds must not be dismissed as trivial problems, explains Dr Lizzie Croton
Tackling childhood obesity
Authors: Haslam David
Published: May 2014

The first step in effective management of obese children is to identify those who will respond best to treatment.
Screening for diabetic retinopathy
Authors: Hill Robert , Bain Steve
Published: May 2014

The expansion in diabetic retinopathy screening should help reduce sight loss, say Mr Robert Hill and Professor Steve Bain
Gallstones
Authors: Sanders Grant
Published: May 2014

Contributed by Mr Grant Sanders, consultant in upper GI surgery at Derriford Hospital, Plymouth.
Clinical Focus - Renal colic
Authors: DasGupta Ranan , Olsburgh Jonathan
Published: May 2014

Epidemiology, aetiology, diagnosis and management.
Managing chronic pain
Authors: Cox Felicia
Published: May 2014

Pain is a subjective experience that requires structured assessment. Felicia Cox outlines the medications available for treating chronic pain.
Understanding tinnitus
Authors: Jacobs Christine
Published: May 2014

Tinnitus Awareness Week runs from 8-14 February. Christine Jacobs describes this common condition and how best to manage it.
Effect of low dose high frequency training on paramedic cognitive skills
Authors: Kardong-Edgren Suzan , Brouhard Rod , Bourn Scott , Oermann Marilyn , Odom-Maryonuzan Tamara
Published: May 2014

Background: Paramedics in many parts of the US are required to obtain advanced cardiac life support (ACLS) recertification every two years. However, like other healthcare providers, they may experience problems with retention of this knowledge.

Study objectives: This year-long study examined the difference in ACLS cognitive performance, measured by a modified Megacode, between two groups of paramedics: those who practiced for 10 minutes monthly over 10 months using brief computer-based ACLS scenarios, and those who did not refresh.

Methods: Participants were randomised into the experimental group using computer gaming for a minimum of 10 minutes a month, and a control group that did not. In month 12, all participants took a post-test Megacode.

Results: 27 (79%) of the experimental and 18 (95%) of the control group successfully completed the pre-test Megacode. 38 (72%) of all participants passed both the pre- and post-test Megacodes; three (6%) failed both Megacodes, five (9%) of the experimental group who failed the pretest passed the post-test at month 12. Four participants in the experimental group and three in the control group failed the post-test at month 12.

Conclusions: paramedics recalled ACLS algorithms with or without practice.
Community paramedics: a scoping review of their emergence and potential impact
Authors: O'Meara Peter
Published: May 2014

Objectives: This paper reports on the extent of the peer-reviewed literature relating to community paramedics since the inaugural meeting of the International Roundtable on Community Paramedicine in 2005. A scoping review was undertaken to: examine the extent, range and nature of research activity; determine the value of undertaking a full systematic review; summarise and disseminate research findings; and identify research gaps in the existing literature.

Methods: This scoping study systematically searched and located literature on community paramedics from 2005 to 2012 irrespective of study design. It mapped the key concepts underpinning the emergence of community paramedics and the main sources and types of evidence available. In this review the concept of community paramedics as defined by the International Roundtable on Community Paramedicine was used as the key reference point.

Results: The community paramedicine literature fell into three broad categories: theoretical studies; empirical studies measuring outcomes; and reviews. While there are few peer-reviewed articles, a growing number of empirical studies are beginning to emerge as a result of programme evaluations in various regions of the world. At this time there are a handful of relevant reviews in the literature that are focused on innovations in paramedic practice. One Australian research team has published all of the peer-reviewed theoretical papers underpinning this innovation in paramedic practice.

Conclusions: There is growing evidence of community paramedicine research in the literature, including some links with related studies, such as that of the extended care paramedic programmes in the United Kingdom. There remains a strong focus on commentaries and opinion papers in both peer-reviewed and trade publications. Nonetheless, there is an emerging research literature that is contributing to the development of community paramedicine programme models and the evaluation tools that will contribute toward the future evolution of the model.
Pain assessment and management in cognitively impaired children
Authors: Thompson Karen
Published: May 2014

This article identifies primary themes in the literature regarding the assessment and management of pain in children with cognitive impairment (CI). The principal focus is an evaluation of methods, effects and outcomes of assessment and pain management. The review entailed a systematic and rigorous search of appropriate health-care databases using appropriate search terms in conjunction with preset inclusion and exclusion criteria. The review divided the harvested papers into four key themes:

(1) The prevalence and severity of pain in children with CI (2) The reliability and validity of available assessment tools (3) Parental ratings of their child’s pain and its reliability (4) Pharmacological management of pain in children with CI versus that of children without CI.

It was generally acknowledged that children with CI were more vulnerable to experiencing pain, not only owing to condition-associated and surgical reasons, but also because of a lack of adequate pain assessment caused by their inability to adequately communicate their pain. Pain assessment tools found in the literature were all based on the assessment of altered behaviours and other non-verbal cues and suggested parents provide a realistic approximation of pain, especially when pain tools are employed. Some debate exists regarding the management of pain in children with CI; however little research has been carried out in this area and therefore much more is required to ensure that children with CI are not being under-medicated and allowed to endure unnecessary pain. Health professionals need to review their practice in relation to the assessment and management of pain in children with CI and ensure their practice reflects the best available evidence.
Critical engagement with practice
Authors: Coyne Imelda
Published: May 2014

At the paediatric nursing congress in Athens, two keynote speakers discussed the importance of nurses being a caring presence for children and parents. More recently, at a mental health conference in Dublin, I heard Phil Barker (Professor of Psychiatric Nursing Practice) warn about nurses ‘backing out of caring into doctoring’ and of the importance of nurses’ responsibility to provide comfort and compassion. I had déjà vu, as I recalled 10 years ago hearing Patricia Benner speak passionately of the need for nurses to provide a caring human presence and warning of the danger of them discarding this aspect of their role in the pursuit of professionalism. This led me to think, why do respected nursing leaders from different disciplines and different countries feel the need to remind us of the importance of caring? Is this not an essential aspect of nurses’ role which they perform daily?
First clinical placement: the student ODP experience
Authors: Hardcastle Teresa
Published: May 2014

Much has been written about the attrition from health-care programmes in the past, and the reasons why a student leaves are multifactorial. Most students leave in their first year and the first clinical placement is instrumental in helping a student to decide if they have made the right career choice. This was a small study involving student operating department practitioners (ODPs) from the same cohort, exploring their experiences of their first clinical placement in the operating theatre. A focus group was used to collect the data and the data was thematically analysed using Collaizzi's (1978) Framework for Analysis. The thematic analysis revealed that students want to feel that they are welcome in the clinical environment by staff and mentors. They want to feel that they belong and are part of the team. Relationships with staff and mentors are important and strongly influenced the students’ learning experiences.
The effects of supplementation of creatine on total homocysteine
Authors: D Shelmadine Brian , M Hudson Geoffrey , W Buford Thomas , Grothe Ann , J Moreillon Jen , L Gutierrez Jean , G Bowden Rodney , L Wilson Ronald , W Willoughby Darryn
Published: May 2014

Background

Small increases in homocysteine are associated with increased risk for cardiovascular events patients with end-stage renal disease (ESRD). Endogenous creatine intake may decrease homocysteine via negative feedback inhibition, as creatine is a by-product of methionine and homocysteine metabolism. Therefore, this study was conducted to examine whether oral supplementation of creatine would affect levels of plasma homocysteine in ESRD patients. Methods: 16 ESRD patients with hyperhomocysteinemia completed the study. Patients supplemented 5 g/day of creatine monohydrate for 30 days. Results: Homocysteine levels significantly increased (t=-2.315, p=0.035) in ESRD patients (pre-test 18.9±14.0 mg/dlitre, 139.80±103.56 μmol/litre; post-test 28.8±11.2 mg/dlitre, 213.03±82.85 μmol/litre). Conclusions: The current study suggests that ingestion of 5 g/day of creatine monohydrate in ESRD patients results in an increase in homocysteine. Combined with previous studies it appears that dosages ≥ 5 g/day of creatine increase homocysteine in patients with decreased renal function.
The role of tissue engineering in wound care
Authors: Mulder G.T.
Published: May 2014

An update on the most recent developments and treatments in tissue engineering with recommendations and considerations for practice.
Hypergranulation tissue
Authors: Dunford C.
Published: May 2014

A review of the formation, causes and management of hypergranulation tissue.
The use of hydrocolloids in the treatment of diabetic foot
Authors: Gill. D.
Published: May 2014

A review of the literature on the use of hydrocolloids in the management of diabetic foot disease.
Comparative cost-effectiveness of four-layer bandaging in the treatment of venous leg ulceration
Authors: Carr L. , Phillips Z. , Posnett J.
Published: May 2014

This paper reports the results of an analysis designed to estimate the expected annual cost per patient of treating venous leg ulcers, and to evaluate the relative cost-effectiveness of a systematic treatment regimen using a four-layer compression bandaging system (Profore) compared with usual care.

A Markov model has been developed which simulates the transition of patients between health states (healed and unhealed) over a 52-week period. Healing rates used in the model are derived from those reported in the literature. By running the model for a cohort of 100 patients over 52 weeks it is possible to estimate expected outcomes and annual budgetary costs for alternative treatment regimens.

Results suggest that, when compared with usual care, a systematic treatment regimen using Profore is unambiguously more cost-effective. Patient outcomes are improved and annual treatment costs reduced. An important implication is that failure to co-ordinate treatment policies and to use the most cost-effective treatments may result in substantial inefficiency in the use of NHS resources. This inefficiency could represent the equivalent of between £350,000 and £1.08 million annually for a typical health authority.