bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV and the kidney: a UK perspective
Authors: Cheserem E , Mabonga E , Post FA
Published: May 2014

Kidney disease remains an important complication of HIV infection. This review provides an update on the burden of end-stage kidney disease, the cardiovascular morbidity associated with chronic kidney disease, and the effects of antiretroviral drugs on the kidney.
Total hip arthroplasty consent process: current evidence for junior doctors
Authors: Khan Mohsin , Gabr Ayman , Haddad Fares S
Published: May 2014

Junior doctors often obtain consent for total hip arthroplasty, despite recognized complications not being sufficiently taught during undergraduate medical training. This article provides current evidence regarding total hip arthroplasty complications which can be relayed to patients during the informed consent process.
Optimizing knee arthroscopy documentation using a new template
Authors: Al-Dadah Khalid , Evans Owain , Ali Fazal
Published: May 2014

Introduction:

The purpose of the study was to assess the quality of documentation of knee arthroscopy and evaluate the implementation of a novel operative template.

Method:

A 34-point assessment was undertaken based on published national guidelines. A retrospective study of 50 operative notes of patients (group A) undergoing knee arthroscopy was completed. A new operative note template was devised to include important criteria and assessed in 49 patients (group B) for its efficacy in providing appropriately detailed findings.

Results:

Group A was lacking the minimum essential documentation standards expected. Some essential criteria for arthroscopic procedures were as low as 4%. Group B showed a statistically significant increase (P<0.001) in documentation accuracy throughout the essential criteria compared to the findings in group A. Conclusions: The authors conclude that the use of an evidence-based operative template for knee arthroscopy significantly improves the quality and accuracy of documentation compared to conventional free-hand operative notes.
Paracetamol as a cause of anaphylaxis
Authors: Kumar R Kishore , Byard Ian
Published: May 2014

Paracetamol overdose is a well known subject among most practitioners and is well documented in the literature and textbooks. Anaphylaxis to paracetamol is virtually unheard of, despite occasional unsubstantiated reports in the past. We report a patient with anaphylaxis to paracetamol and review the literature regarding paracetamol hypersensitivity.
Physician-assisted suicide: issues facing doctors
Authors: Finlay Ilora
Published: May 2014

Physician-assisted suicide is sometimes presented as differing from euthanasia and without its inherent dangers; however, it does form an integral part of euthanasia. It has been estimated that up to half of those patients supplied with lethal drugs may be unable to commit suicide unaided; for psychological or physical reasons they then require active intervention by the doctor — or euthanasia (Onwuteaka-Philipsen et al, 1997).
Evidence-based management of reproductive problems
Authors: Farquhar CM
Published: May 2014

Evidence-based medicine has become the catch-cry phrase of the 1990s. It is about using evidence from well-designed research and applying it to everyday practice. It would be a difficult task to appraise all the evidence from research without the help of well-prepared systematic reviews. This article examines some aspects of this approach.
Listeria meningitis presenting in an immunocompetent adult patient
Authors: Kelly J , Barnass S , Sawicka E , Dean A
Published: May 2014

A case of fatal Listeria meningitis in an immunocompetent 39-year-old female is presented. Although most patients with CNS listeriosis are immunosuppressed, infection in immunocompetent individuals may also occur.
Reflux and the difficult airway
Authors: Rees SGO
Published: May 2014

A 74-year-old male presented for elective transurethral resection of the prostate with typical symptoms and signs of benign prostatic hypertrophy. He had a 35-year history of ankylosing spondylitis affecting his entire vertebral column with a fixed kyphosis, loss of the normal cervical and lumbar lordosis and inability to lie down without 3 or 4 pillows supporting his head and shoulders. Neck movement was very limited, but he had good mouth opening with uvula fully visible (Mallampati I), a full set of teeth and a thyromental distance of 7 cm.
Renal disease and the heart
Authors: Woolfson Robin G
Published: May 2014

Cardiovascular disease is responsible for significant morbidity and mortality in renal failure with increased prevalence of hypertension, left ventricular hypertrophy, ischaemic heart disease and valve disease. Optimum blood pressure control is fundamental to the management of these patients but the role of secondary prevention remains poorly defined.
Adult bacterial meningitis: new consensus statement and unusual cases
Authors: Nathwani Dilip
Published: May 2014

Bacterial meningitis is a medical and infectious disease emergency. Meningococcal meningitis is perhaps the most feared infection in the UK with many sporadic cases getting a disproportionate amount of media attention.
New quinolones: their role in clinical practice
Authors: Masterton Robert G
Published: May 2014

The starting point for the development of the new family of quinolones — with the recently released products grepafloxacin and levofloxacin shortly to be joined by trovafloxacin, and with others such as moxifloxacin and clinafloxacin in development — was recognition of the shortcomings of the existing preparations. The key question for the new quinolones is how well they address these deficiencies.
A labouring opera singer with idiopathic thrombocytopenia: ‘Its not over ’til the fat lady sings'
Authors: Cook TM , O'Higgins F
Published: May 2014

A 37-year-old primaparous woman requested epidural analgesia (EA) for labour. She was fit and well and taking no medications. Labour was being induced and intravenous syntocinon was planned. Recent blood tests were normal except for platelet counts of 73, 79 and 72x109/ml.
Cost-effectiveness of atypical antipsychotics in chronic schizophrenia
Authors: Amin Shazad
Published: May 2014

It is nearly a decade since the first atypical antipsychotic, clozapine, was launched in the UK. There are now several other similar drugs on the market. They are all more expensive than traditional antipsychotics and the question of whether they are a cost-effective use of scarce NHS resources is an important one. This article reviews the evidence in the area of treatment-resistant schizophrenia.
Clinical advances in the evaluation of oesophageal disease
Authors: Navaratnam RM , C Clayman C , Winslet MC
Published: May 2014

The rising incidence of gastro-oesophageal reflux disease and its sequelae means the evaluation of oesophageal disease is set to expand beyond routine endoscopic assessment. The techniques used in the evaluation of both benign and malignant oesophageal disease are outlined in this article.
Case 1: permanent pacemaker malfunction?
Authors: Sporton Simon , Holdright Diana
Published: May 2014

A 65-year-old man presented to casualty with a short history of palpitation and breathlessness. Some years earlier a dual chamber permanent pacemaker had been implanted for symptomatic 2:1 atrioventricular block. What abnormalities were present on the electrocardiogram (ECG) (Figure 1)?
Pulmonary artery sarcoma masquerading as pulmonary thromboembolism
Authors: Datta BN , Page MD
Published: May 2014

A46-year-old Caucasian female presented as an emergency with a 6-month history of dyspnoea. This had become much worse over the preceding 3 weeks. There was also a history of lethargy, right-sided pleuritic chest pain and 7 kg weight loss. She had suffered an anterior myocardial infarction 4 years before admission with minimal angina subsequently.
Upper airway obstruction
Authors: Baines PB , Sarginson RE
Published: May 2014

Upper airway obstruction in children is a life-threatening but treatable condition that is relatively rare. This article considers the more common acute causes:
Biventricular pacing in heart failure
Authors: Ellery S , Fluck D , Paul V
Published: May 2014

Optimal pharmacological therapy for heart failure improves patients' prognosis and symptoms. Despite this, the long-term prognosis for these patients is very poor and symptoms are debilitating. Biventricular pacing, or resynchronization therapy, should be considered for patients who remain symptomatic despite optimal therapy and have evidence of dyssynchrony.
Thrombolytic therapy for acute ischaemic stroke
Authors: Jenkinson Damian
Published: May 2014

Recombinant tissue plasminogen activator (rt-PA, also known as alteplase; Actilyse®) is the first and only licensed thrombolytic approved for use in acute ischaemic stroke in the UK. This article reviews the evidence for the role of rt-PA in acute stroke management and how it may improve long-term clinical outcome for selected patients as part of a comprehensive stroke service.
Unusual severe hypercholesterolaemia and xanthomas in a patient with hepatolithiasis
Authors: Chou Shuo-Chi , Chen Kwang-Wen , Lin Jen-Der , Hwang Tsann-Long
Published: May 2014

A 47-year-old woman had undergone cholecystectomy for gallstones in December 1994 at a local hospital. In December 1995 she presented at the surgical outpatient department with intermittent right upper quadrant pain. Laboratory studies revealed serum albumin 4.3 g/dl (normal 3.5–5.3 g/dl), total cholesterol 307 mg/dl (normal <200 mg/dl), total bilirubin 1.8 mg/dl (normal 0.0–1.3 mg/dl), alkaline phosphatase 602 U/litre (normal 28–94 U/litre), aspartate aminotransferase (AST) 129 U/litre (normal 0–34 U/litre), and alanine aminotransferase (ALT) 196 U/litre (normal 0–36 U/litre). Liver sonography revealed multiple stones in dilated intrahepatic and common hepatic ducts. However, the patient did not receive further studies of her hepatolithiasis at that time. The patient underwent percutaneous transhepatic cholangiostomy drainage for intrahepatic stones and jaundice in a medical centre in January 1998. In February 1998 she was transferred to the surgical department because of persistent jaundice. Physical examination revealed that the woman was markedly icteric, with an old scar on the right upper abdominal wall, and no xanthoma was found on the body. Laboratory results included that serum albumin was 4.1 g/dl, total cholesterol was 256 mg/dl, total bilirubin was 12 mg/dl, alkaline phosphatase was 512 U/litre, AST was 101 U/litre and ALT was 100 U/litre. Cholangiogram showed a dilated biliary tree with multiple stones in intrahepatic ducts, common hepatic ducts and the common bile duct.

The patient underwent choledocholithotomy with choledochojejunostomy, Roux-en-Y jejunojejunostomy, and a T-tube drainage in the common bile duct in February 1998. The liver biopsy displayed cholestasis and no cirrhotic change. Following surgery the woman was regularly followed up in the outpatient department and intrahepatic stones were removed intermittently via a T-tube. Cholangitis was noted during follow-up, and the patient received five 7-day courses of amoxicillin 1000 mg/day in divided doses from September 1998 to February 1999. The jaundice was persistent during follow up, and painful xanthomas developed on both hands and elbows in February 1999, particularly on the palmar side (Figure 1). Laboratory tests revealed significantly raised serum total cholesterol, total bilirubin, and alkaline phosphatase levels (Figure 2). Lipoprotein electrophoresis displayed that total cholesterol was 1046 mg/dl, β-lipoprotein (low-density lipoprotein) was 72.6% (normal 36–61%), pre-β-lipoprotein (very low-density lipoprotein) was 15.7% (normal 2–30%), and α-lipoprotein (high-density lipoprotein) was 11.7% (normal 22–48%). Subsequently, the patient received no more amoxicillin, and the xanthomas gradually regressed. Total regression of hypercholesterolaemia and xanthomas was achieved in November 2000, at which point total serum cholesterol was 200 mg/dl, total bilirubin was 12 mg/dl, and alkaline phosphatase was 676 U/litre.
Integrated cardiac care for improved pre-hospital thrombolysis
Authors: Vickers Debra , Ayers Helen , Barnes Neil , Coates Mark , Griffiths Beverly , Hargreaves Mark , Murray Stephen , Barry Gillian
Published: May 2014

The National Service Framework (NSF) for Coronary Heart Disease (CHD) (Department of Health, 2000) sets the standard of treating eligible acute myocardial infarction (AMI) patients within 60 minutes of call for help in order to improve survival rates and long-term quality of life for heart attack patients.
Intensive insulin therapy in type 1 and type 2 diabetes
Authors: Dean John , Sharp Patrick
Published: May 2014

Intensive insulin regimens can produce substantial clinical benefits for patients with type 1 and type 2 diabetes, but they are associated with an increased incidence of hypoglycaemia. This article discusses such regimens and whether the risk of hypoglycaemia can be reduced by using the new basal insulin analogue, insulin glargine.
Peer-led inspection and accountability
Authors: Aubrey-Smith Fiona
Published: May 2014

In Oxfordshire, a network of primary schools has formed an umbrella trust and is working together to place peer-led intelligent accountability at the heart of what they do. Fiona Aubrey-Smith finds out more
A headship masterclass
Authors: Lee-Potter Emma
Published: May 2014

Alison Peacock has now led her school through three outstanding Ofsted inspections. She is clear that professional courage and a focus on enabling learning progress is key. Emma Lee-Potter reports
Preparing the new primary curriculum: Music, art and DT
Authors: O'Connell Suzanne
Published: May 2014

In the second part of series on the new national curriculum, Suzanne O'Connell looks at the programmes of study for art, music and design technology. With September 2014 fast approaching, how should schools prepare?
Case study: Apps for Good
Authors: Stacey Rebecca
Published: May 2014

In preparing for the new computing curriculum in September, deputy head Rebecca Stacey has worked with the charity Apps for Good. She explains what the project entailed.
Avoiding the pitfalls of performance pay
Authors: Lyons Amanda
Published: May 2014

Schools are getting to grips this term with the new system of performance-related pay. Employment lawyer Amanda Lyons looks at common pitfalls that new pay systems must avoid.
Ask Brenda: The professional principles that define your school
Authors: Bigland Brenda
Published: May 2014

How can we set the bar for all our teaching staff in a user-friendly way, but which still ensures that all the team know what our expectations are?
Diagnosis and treatment of dry eye disease: an overview
Authors: Källmark Fredrik
Published: May 2014

Dry eye disease (DED) is a multifactorial condition that is complex to diagnose and treat. Our knowledge of how to define and diagnose different types of DED has increased over the last five to six years, but outdated or obsolete methods of looking at the problem prevent many patients from getting the correct diagnosis and treatment. By keeping up to date with new research and reports, healthcare professionals can provide the right diagnosis, information and treatment to patients suffering from the condition. To define and diagnose DED involves taking a thorough history and performing an examination of the eye. This article aims to provide a better understanding of DED and advice on how to define and diagnose DED correctly.
Developing ‘eye champions’ in a general hospital setting
Authors: Smith Francesca , Hadley Lynne
Published: May 2014

With the recent publication of the Public Health Outcomes Framework, objectives such as preventable sight loss as an outcome measure have placed ophthalmology high on the public agenda. This presents an opportunity to improve ophthalmology services at a hospital level. Meeting the £20 billion efficiency savings as set by the chief executive of the NHS increases the challenge to improve services by 2015 while meeting these targets. Healthcare staff receive very little exposure to specialist fields as part of their basic training, regardless of their career pathway. Consequently, they have little exposure to areas such as ophthalmology until after registration. Without directly working within the field of ophthalmology health care, workers may not receive the exposure required to adequately support patients in the general clinical setting. However, we are aware that there are a number of healthcare arenas that require ophthalmology input and support. These factors have contributed to a need within the hospital that we became increasingly aware of, affording us the chance to bridge the gap. National Eye Health Week (17–23 September 2012) presented an excellent opportunity to link in with national publicity to engage both staff and the public. By organising and promoting a series of events, using minimal resources, we aimed to put the ophthalmology department on the map.
Online inspiration and information on lung cancer
Authors: Sweeney John
Published: May 2014

John Sweeney's regular review of world wide web sites for Palliative Nursing
Grading clinical guidelines for the use of transmucosal immediate-release fentanyl products in breakthrough pain
Authors: Handsaker Scott , Dempsey Laura , Fabby Carole
Published: May 2014

Pain is a complex symptom that is commonly feared in palliative care owing to its significant effects on patients’ quality of life (QoL), and is directly associated with morbidity. More specifically, the management of breakthrough pain (BTP) is particularly important. Opioids play a major part in the management of BTP, and the various transmucosal immediate-release fentanyl (TIRF) products are a common treatment choice. This paper considers the strength of the evidence underlying recommendations regarding the use of TIRF. Failure to consider the quality of evidence in practice can lead to misguided recommendations. Guidelines should therefore be used to inform clinicians of the quality of the underlying evidence and whether recommendations are strong or weak. The GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach is increasingly being adopted worldwide as it provides a system for rating quality of evidence and strength of recommendations that is clear, comprehensive, transparent, and practical. This paper adopts the GRADE approach to assess the strength of recommendations made in a 2011 review by Zeppetella in order to develop guidelines for the use of TIRF. The recommendations include that TIRF products can be considered for first-line treatment and that they should be individualised to patients who are on a background opioid.
Moving and handling bariatric patients safely: a case study
Authors: Palmer Ray
Published: May 2014

Moving and handling is a potentially dangerous task, which is made even more complex when the patient who requires transferring is obese. This article reviews the factors that need to be taken into consideration when moving and handling an obese patient and describes how one hospital overcame the problem of moving a morbidly obese patient by using an electrically-operated profiling bed.
Conductive education: offering hope for people with multiple sclerosis?
Authors: Finucane Caroline
Published: May 2014

With the launch of the National Institute for Clinical Excellence's (2003) guidelines for the management of multiple sclerosis (MS) and the previous risk-sharing scheme from the Department of Health, which has seen better resources available for people with MS and greater access to drug therapies, things seem to be looking up. But how much thought has been given to alternative therapies that do not involve expensive, sophisticated treatments?
Community alarms: a guide for occupational therapists
Authors: Winchcombe Maggie , Etchell Lindsey
Published: May 2014

Community alarms can be a useful addition to the range of options that occupational therapists and other health-care workers can consider to help people to live independently at home. This article provides information about how community alarms work, considerations for their use and benefits for users. This technology could be more widely used as a preventative measure that older people, and those who feel vulnerable for other reasons, can have in place as an assurance that help is at hand. Occupational therapists are key professionals in ensuring that their clients obtain the right system. Further information and advice about what is available locally can be readily found from a range of sources.
Talking to people about their psychotic experiences
Authors: Blank Alison , Hayward Mark
Published: May 2014

Traditionally, psychiatrists and others working in the field of mental health have paid little attention to the content of psychotic experiences. What the voices say or the connections between an individual's unusual beliefs and life history have been dismissed as meaningless or not understandable. Boyle (1992) states that:
Unfolding spirituality: Working with and beyond definitions
Authors: Collins Mick
Published: May 2014

Spirituality is undergoing a revival in relation to clinical practice across many health disciplines and is an emerging area of clinical practice. Currently, there is no consensus that reflects a coherent understanding of what spirituality means across different health professions.

It is being proposed in this article that health professionals use definitions for spirituality cautiously, until an adequate understanding of the connection between health and spirituality has been addressed. It is suggested that a working definition for spirituality in health-care practice should emerge from research that considers a client's spiritual need, experience and journey. The emphasis of this article is to consider how spirituality can unfold in a health-care context.
Audit of use of a common undergraduate physiotherapy clinical assessment form
Authors: Morris J
Published: May 2014

Assessment of student performance in clinical settings is common practice in healthcare education. As part of quality procedures, a three-part audit was undertaken of the use of a common undergraduate physiotherapy clinical education assessment form.

Part one involved comparative statistical analysis of the marks awarded to students from the four participating institutions in relation to five variables – student age, gender, race, level of study, and clinical speciality. Significant differences were found for some variables.

In Part two, the final marks and clinicians' comments were compared. Content analysis identified perceived differences in some forms.

Part three involved clinician completion of a postal questionnaire survey of how they used and completed the form. Appropriate use of the form was found for the vast majority of respondents. Overall, the audit found the form to be a useful, sensitive tool. Recommendations were made for small improvements in form detail and specific focus areas during clinician educator training.
Healthcare provision: Swept away by the currents?
Authors: Morris Michelle
Published: May 2014

A number of years ago I heard a story which had a profound effect on my thinking about healthcare and, subsequently, on the way in which I provide and lead services to patients. Although it has been a number of years since I fi rst heard this allegory, its message has an even greater resonance now. Many readers will have had this epiphany long before me but the ideas embedded in this story, which was told to an audience to illustrate why public health is so important, might encourage some to take stock of what we as clinicians contribute to the health of our nations.
Can transcranial magnetic stimulation enhance neurorehabilitation?
Authors: McDonnell Michelle
Published: May 2014

Rehabilitation research over the past two decades has expanded enormously, with an increasing number of randomized controlled clinical trials testing well-defined physical interventions to improve function in patients with a neurological condition. In other research centres, perhaps in laboratories across the hallway, physiological scientists are conducting experimental studies in an effort to enhance our understanding of neuroplasticity in healthy and diseased states, with the eventual aim of enhancing functionally-beneficial plasticity following stroke.
Involving people with spinal cord injuries in the education of rehabilitation professionals
Authors: Kroll Thilo , Neri Melinda T , Groah Suzanne L , Gilmore Brenda , Elrod Matthew W , Libin Alexander
Published: May 2014

The Consumer Professional Partnership Programme (CPPP) was developed to increase service user participation of people with spinal cord injury in the education of rehabilitation professionals. The programme seeks to inform physiotherapists and other rehabilitation professionals about disability and health issues from the perspective of individuals with spinal cord injury.

This article discusses its development, describes the details and rational behind the programme and reports on first experiences of rehabilitation professionsals using the programme.
Flexor retinaculum division: does it contribute to the success of carpal tunnel release?
Authors: Krieger Yuval , Moses Avia , Silberstein Eldad , Weitzman Shimon , Liberman Naftali , Sagi Amiram
Published: May 2014

Yuval Krieger, Avia Moses, Eldad Silberstein, Shimon Weitzman, Naftali Liberman, Amiram Sagi

Aims: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Open decompression of the median nerve is considered the standard surgical treatment for CTS. This article describes a study to assess and compare the clinical efficacy of operative treatment performed by transverse carpal ligament release alone (limited carpel tunnel release (CTR)), to that achieved after transverse carpal ligament release with additional division of the proximal portion of the flexor retinaculum (extended CTR) which is continuous with the deep investing fascia of the forearm.

Methods: A retrospective cohort study was performed by telephone interview, using a modified Levine scale to assess symptoms and functional impairment 4–7 years post-operatively in two patient groups who were operated using two different techniques, over a two year period. One group (N = 73) had open CTR by limited transverse carpal ligament division alone, performed by one hand surgeon; the second group (N = 83) had open CTR by division of the transverse carpal ligament and the proximal portion of the flexor retinaculum, performed by another hand surgeon.

Findings: Pre-operatively the two groups were similar, both in terms of patient characteristics and of disease severity. Both groups improved significantly. No clinical difference was demonstrated in terms of symptom relief, recurrence or complication rate.

Conclusions: This study suggests that adjunctive division of the proximal portion of the flexor retinaculum, although safe, offers no advantage over division of the transverse carpal ligament alone in standard open carpal tunnel release.
Reliability and validity of a measure of work-related subjective experiences among people with psychiatric disabilities
Authors: Waghorn Geoffrey , Harris Meredith G , Gladman Beverly , Hennessey Nicole , Lloyd Chris , Mowry Bryan
Published: May 2014

Geoffrey Waghorn, Meredith G Harris, Beverly Gladman, Nicole Hennessey, Chris Lloyd, Bryan Mowry

Aims: To investigate aspects of the reliability and validity of the Work-related Subjective Experiences Scale (WSE-38), an instrument designed to help mental health professionals tailor mental health care to reduce employment restrictions.

Methods: Sixty community residents with schizophrenia or schizoaffective disorder were recruited from a register of previous research participants in an existing genetics study of people with schizophrenia. The WSE-38 was administered via telephone interview, repeated two-five days later. Short-cycle test-retest reliability internal structure, and concurrent validity were assessed. Face validity, utility, consumer and clinician acceptability were examined qualitatively.

Findings: Short cycle test-retest reliability for most items and the total score were found to be good to very good. Items with low reliability were removed. Concurrent validity was promising with respect to a range of relevant measures. Face validity, client acceptability, and user utility were adequate. Further scale development and modifications to administration instructions are indicated.

Conclusions: These results support further scale development and inform how it can be used for its intended purpose. Sensitivity to real change and predictive validity require ongoing investigation.
Generation of a project proposal for an undergraduate literature review: one dimension of critical thinking
Authors: Castle Alan
Published: May 2014

Alan Castle

Background: Higher education is concerned with developing the critical thinking skills of undergraduate students through academic study so that they are able to improve the delivery of health care in a dynamic and changing world of work. To continue his series on critical thinking from the July 2010 issue, the author discusses a second component of critical thinking.

Contents: The generation component of critical thinking encourages students to develop skills of independent thinking and produce original and creative work. The worked example of a project proposal for an undergraduate literature review to evaluate the effectiveness of a range of topical preparations in the treatment of radiation-induced skin reactions, has been used to illustrate how students might go about demonstrating these skills.

Conclusions: The worked example demonstrates how undergraduate students can be encouraged to analyse arguments, clarify their thinking and generate new ideas which constitutes the generation component of critical thinking.
Exploration of spirituality in doctor of physical therapy students and graduate students in non-health disciplines
Authors: Tapley Howell , Fell Dennis , Pitts Diane
Published: May 2014

Background/Aims: The purpose of this study was to explore spirituality in doctor of physical therapy (DPT) students, and to compare these findings with graduate students from other disciplines outside healthcare. An additional purpose was to determine DPT student attitudes towards spirituality and its relevance to their profession.

Methods: A brief survey was administered including the 16-item Daily Spiritual Experiences Scale (DSES).

Findings: A total of 65 DPT students and a total of 132 non-healthcare graduate students completed the survey. Age did not show a statistically significant relationship (r=.051, P>.05) to spirituality in our subjects and was therefore excluded from further analysis. A 2-way, between-subjects ANOVA was performed to test for differences in spirituality scores between the sexes and between the two student groups. There was a significant main effect for sex [F(1,173) =8.771, P=.004]. There was no significant main effect for Academic Major group (P>.05). There were no significant interactions (P>.05). The vast majority of physical therapy students indicated that physical therapists should be concerned with the spiritual health of their clients (81.5%), and that their education should include exposure to spiritual health issues (78.5%).

Conclusions: Spirituality in DPT students does not differ significantly from non-healthcare graduate students. DPT students, however, do have high levels of daily spiritual experiences, believe spirituality is important to the profession, and desire training in this area. Physical therapy educational programmes may want to consider expanding this component of the entry-level curriculum.
Idiopathic scoliosis and pelvic floor dysfunction
Authors: Perkins Jan , Boyer Alison , Mcleish Allison , Grossnickle Karen
Published: May 2014

Background: Research suggests that trunk and pelvic floor muscles work as a functional unit for postural and continence activities. Back pain increases the risk of incontinence, and practitioners treating incontinence often treat trunk muscles, while those treating back and sacroiliac problems often incorporate pelvic floor treatments in management programmes. It was hypothesized that women with scoliosis might have pelvic floor dysfunction.

Methods: Pelvic floor function was evaluated in a convenience sample of four nulliparous women with idiopathic scoliosis. Evaluation included scoliometer and perineometer measures, manual muscle testing of the pelvic floor, the Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20), and the Scoliosis Research Society Outcomes Instrument (SRS-22)

Findings: Half the participants reported clinically significant PFDI-20 score elevations. All had back pain, attributed to their scoliosis.

Conclusion: Pelvic floor strength assessments lacked sensitivity in this population of young women, but PFDI-20 scores identified who might benefit from further evaluation. Practitioners treating women with scoliosis should be aware of possible co-existing pelvic floor disorders and of the known link between back pain and incontinence. By raising this issue or using a sensitive tool like the PFDI-20 it may be possible to identify and treat problems early, and implement pelvic floor disorder prevention programmes.
External chest brace for clam shell sternal instability following bilateral sequential lung transplant: a case series
Authors: Fuller Louise , El-Ansary Doa , Nelson Elysia M , Gooi Julian
Published: May 2014

Background:

A common surgical incision for bilateral lung transplantation is the ‘clam shell’ approach via bilateral anterior thoracotomies and a transverse sternotomy to allow for the replacement of the lungs sequentially (Macchiarini et al, 1999; Karnak et al, 2006 ). Although popular, the clam shell incision (CSI) can be associated with significant postoperative pain, bony overriding or disruptions at the sternotomy site in 32%-60% of patients (Macchiarini et al, 1999; Venuta et al, 2003 ; Richards et al, 2004 ; Karnak et al, 2006 ). The subsequent non-union and sternal instability cause significant morbidity and mortality with reported rates of 34% and 26%, respectively ( Karnak et al, 2006 ).

Content:

The literature revealed a myriad of surgical approaches to this clinical problem, but a paucity of conservative external chest bracing solutions for transverse sternal instability. This case series describes the clinical management of three post bilateral sequential lung transplant (BSLTX) recipients that necessitated the design and development of a custom made external chest orthosis (brace) with input from a multidisciplinary team.

Conclusion:

This brace is offered as a solution for transverse sternal instability and pain following lung transplantation.
An exploratory study of patient assessment within the discharge and rehabilitation team
Authors: Gamble Susie
Published: May 2014

Aim:

Within the interdisciplinary Discharge and Rehabilitation Team, all disciplines undertake the initial holistic patient assessment. However, despite the development of interdisciplinary working, there is limited research of the nurses and allied health professionals (AHP) who undertake the initial patient assessment within the discharge and rehabilitation teams. This study explores interdisciplinary working among nurses and allied health professions who have experience of crossing professional boundaries while undertaking the initial assessment.

Method:

This was a small qualitative study. Nine participants, who included an equal mix of nurses and AHPs, were purposively selected and included in semi-structured interviews that were audio-taped. A content thematic analysis was then carried out.

Results:

Nurses reported no difficulties undertaking the patient assessment. However, AHPs undertook the patient assessment infrequently and described more difficulties. Despite concerns of where professional boundaries lie, cross-boundary working has the ability to enhance patient care and develop professionals.

Conclusion:

There is an appreciation of the role of the nurse within the initial patient assessment process. However, AHPs within the discharge and rehabilitation teams who undertake the initial holistic patient assessment would benefit from further training.
The Impact of Ramadan on lifestyle behaviours and implications for cardiac rehabilitation: A review
Authors: South Felicity , Upton Dominic , Upton Penney
Published: May 2014

Introduction:

The Muslim population worldwide have a higher incidence of cardiovascular disease than that of the non-Muslim population, and this may become exaggerated during the religious observances of Ramadan. This review assessed the evidence regarding the impact of Ramadan on lifestyle behaviours in Muslims with cardiovascular disease.

Method:

This article reviews the literature concerning the impact of Ramadan on lifestyle behaviours and its effects on cardiac rehabilitation between 2000 and 2012. Studies were identified, using Academic Search Complete, Google Scholar, PsycInfo, PsycARTICLES, Medline and CINAHL Plus. The search terms used were: ‘cardiac rehabilitation’; ‘cardiovascular disease’; ‘Ramadan’; ‘fasting’; ‘physical activity’; ‘exercise’; ‘diet’; ‘smoking’; ‘sleep’; ‘behaviour change’; ‘medication’; and ‘treatment’.

Findings:

Evidence suggests that fasting during Ramadan can have a beneficial effect on factors such as cholesterol levels, body weight and blood pressure; however, benefits are rarely sustained in the long term. Other behavioural changes such as non-adherence to medication, and diet and exercise regimes have more negative consequences for sufferers of cardiac disease.

Conclusions:

Lifestyle behaviours adopted during Ramadan can have a negative impact on cardiovascular disease. Health professionals are urged to find innovative ways to engage this population in healthy lifestyle choices throughout this period.
Screening and vaccination for cervical cancer
Authors: Szarewski Anne
Published: May 2014

Vaccines against cervical cancer are being developed but screening is still needed.
Good practice in prescribing
Authors: Newbury Amanda
Published: May 2014

Developing a partnership with patients is the key to concordance.
Q&A: Cardiac failure
Authors: Jarvis Sarah
Published: May 2014

Heart failure is a highly complex area that requires specialised treatments. Dr Sarah Jarvis answers two detailed questions on the most suitable agents to use
Gynaecology training for nurse practitioners
Authors: Young Ghislaine , Burt Lynda , Jollie Susie
Published: May 2014

Nurses in Bradford have worked with consultant colleagues to provide dedicated education for NPs.
Asthma and allergic rhinitis
Authors: Wolfe Stephanie
Published: May 2014

These conditions should be managed jointly if they occur together.
Recognising meningitis and septicaemia symptoms early
Authors: Ninis Nelly , Bailey Linda
Published: May 2014

Diagnosing meningitis early is crucial. Dr Nelly Ninis and Linda Bailey provide practical advice on spotting the infection
Opinion: Everyones views need to be heard
Authors: Sandford Tom
Published: May 2014

As community nurses in England face an uncertain future, Tom Sandford outlines the RCN's view on PCT reform
Prescribing for weight loss
Authors: Haslam David
Published: May 2014

Patients attempting to lose weight may benefit from pharmacological intervention.
Exploring the nurse practitioner role
Authors: Wild Sarah
Published: May 2014

It is almost two decades since NPs arrived in the UK, but their role still needs clarification according to research.
Q&A: Lipid management
Authors: Wierzbicki Anthony
Published: May 2014

Managing cholesterol and lipids can be complex. Should a fibrate be prescribed? Do long-lived parents mean the patient needs no statin? What do you tell the worried well?
Managing pain and depression in tandem
Authors: Katona Cornelius
Published: May 2014

Patients with pain and depression need effective management, explains Professor Cornelius Katona
Supporting physical health in serious mental illness
Authors: Wild Sarah
Published: May 2014

A nurse-led, holistic service is improving the physical health of patients with mental illness
Encouraging self-care
Authors: Chambers Ruth
Published: May 2014

Enabling patients to help themselves improves health outcomes and reduces pressure on resources
Differential diagnosis: Scleritis and uveitis
Authors: Gnanapragasam Vasa
Published: May 2014

Simple pictorial presentation highlighting the discriminatory signs and management of scleritis and uveitis
Case Study: Prescribing for a case of acne
Authors: Morris David
Published: May 2014

A stepwise regimen is the best way to tackle acne, but treatment takes time.
Boosting the workforce
Authors: Daniel Karen
Published: May 2014

As more services are set to move out of hospitals into the community it has never been so vital to fast-track nurses into primary care
Seasonal affective disorder
Authors: Rogers Melanie
Published: May 2014

Lack of sunlight in winter can instigate an annual depression in sufferers
Prescribing options for dementia
Authors: Morris David
Published: May 2014

The pharmacological management of this distressing condition and the role of primary care are outlined by Dr David Morris.
The role of mucolytics in COPD
Authors: Booker Rachel
Published: May 2014

Patients with COPD may benefit from mucolytics. Rachel Booker explains the evidence and options
Disease-modifying drugs and MS immunology
Authors: Porter Bernadette
Published: May 2014

To highlight Multiple Sclerosis Awareness Week, Bernadette Porter outlines disease immunology and treatment mechanisms
Managing trichomoniasis
Authors: Gilmour Cindy
Published: May 2014

Trichomoniasis may cause birth problems and aid HIV transmission.
Update on overactive bladder
Authors: Spinks Julian
Published: May 2014

Accurate diagnosis, lifestyle changes and pharmacotherapy can help relieve this distressing condition.
Tailored support for younger women suffering dementia
Authors: Wild Sarah
Published: May 2014

A support group aims to boost the confidence of dementia patients under 65 and encourage uptake of other services.
Managing adverse reactions to cosmetics
Authors: Gawkrodger David J
Published: May 2014

Clear advice and pragmatic management is needed for patients who react to cosmetics.
Encouraging green care initiatives
Authors: Wild Sarah
Published: May 2014

Exposure to nature can have a positive effect on peoples health and nurses have a role in supporting and signposting such initiatives, writes
Assessing and managing pre-school wheeze
Authors: Wilson Nicola
Published: May 2014

Wheezing is common in young children, but can be difficult to identify with certainty, writes Dr Nicola Wilson.
Lyme disease: at home as well as abroad
Authors: Greener Mark
Published: May 2014

Parasites

Lyme disease is a consideration for those travelling overseas but they are not the only ones at risk, explains Mark Greener
Helping hard to reach patients
Authors: Hatfield Jackie
Published: May 2014

Jackie Hatfield tells how she secured an award from the Queen's Nursing Institute to set up a drop-in woundcare clinic for injecting drug users, and the outcomes achieved
Understanding the dermal effects of heightened exposure to the sun
Authors: Bowes Lorna
Published: May 2014

The potential dangers of sun exposure to skin health, as well as a need for sun protection, are well documented in both the lay and professional press. However, there are variations between UK, EU and US regulations and guidelines, different interpretations of the term ‘sun protection’, and ongoing debate between advisory bodies on the level and frequency of application of sun protection factor (SPF) necessary to offer adequate protection. This article reviews the effects of exposure to ultraviolet radiation, the relevant regulations (including the imminent regulatory changes in the USA), and new ingredients that are making an impact on cosmeceutical sun protection and damage repair.
Rejuvenation of the skin using Radiesse: three patient case studies
Authors: Goldie Kate
Published: May 2014

Dermal fillers allow remarkable aesthetic rejuvenation using a minimally invasive procedure. Directly combating age-related volume loss, youthful contours may be recreated, lifting tissues and redefining lower face structures such as the jaw line. Achieving good clinical outcomes at an affordable price for patients requires the selection of an appropriate volumising filler with high elasticity and viscosity. Radiesse has been proven to have the highest visco-elastic properties of popularly used dermal fillers ( Sundaram et al, 2010 ) and is a dual action dermal filler which creates both initial volume and encourages long-term neocollagenesis ( Berlin et al, 2008 ). A successful overall treatment relies on knowledge and skill in product placement, holistic facial assessment, and an excellent patient consultation and follow-up.
Antioxidant serums, botulinum toxin injection precautions and conferences
Authors: Bowes Lorna
Published: May 2014

In this regular feature in the Journal of Aesthetic Nursing, experienced aesthetic nurses answer your questions relating to clinical and professional issues. In this issue, nurses focus on travel advice for patients following treatment with botulinum toxin, the benefits of antioxidant serums and the best aesthetic medicine conferences to attend
Building good relationships with your customers: the key to repeat business
Authors: Deakin Barbara
Published: May 2014

Given the high level of competition in the medical aesthetics industry, it is more important than ever to treat your patients well and manage their expectations. In this article, Barbara Deakin, Clinic Manager at Dr Rita Rakus Clinic in Knightsbridge, advises aesthetic nurses on the importance of rewarding loyalty and how to build lasting, positive relationships with their clients
Use of light therapy for the treatment of stubborn moderate long-term acne
Authors: Robson Sam
Published: May 2014

This case study offers a treatment account of a 25-year-old female (Helen) who had suffered moderate acne for 12 years with limited treatment success. Throughout the article, the author details her treatment with adjuvant light therapies in clinic (Omnilux) and continuous treatment at home with a portable blue light device (Lustre Pure Light). Helen experienced noticeable results within 3–5 weeks of treatment and, after 6 weeks, her acne was under control and required a modest home maintenance programme to keep her skin clear. Clinical outcomes demonstrate how in-clinic and home-based treatments made Helen feel more confident and in control, enhanced her compliance, reduced the need for clinic resources and was cost effective.
Dangers of counterfeit botulinum toxin: a brief review of the literature
Authors: Svolkinas Karen
Published: May 2014

Counterfeit medicine is now a truly global phenomenon. Organised crime has become increasingly involved in counterfeiting as it has become more profitable and has lower risks than other drug crime. Although counterfeit medicines are found in legitimate UK supply chains, to date, no fatalities have been attributed to counterfeit medicine in the UK, but fatalities have occurred worldwide. While the UK legitimate pharmaceutical supply chain is tightly regulated, it is recognised that no supply chain is impenetrable. For this reason, aesthetic practitioners must ensure that the botulinum toxin type A that they use in practice for the purpose of treatment is from a reputable medical supplier, with sufficient credibility and a supportive evidence base. Ensuring patient safety is paramount to all aesthetic practitioners.
What is an age spot and how can it be treated by the aesthetic nurse?
Authors: Collier Helena
Published: May 2014

In this regular feature in the Journal of Aesthetic Nursing, experienced aesthetic nurses answer your questions relating to clinical and professional issues. In the first half of this feature, Helena Collier defines the term ‘age spot’ and outlines the related treatment options