bluuebunny/crossref_metadata_2025 huggingface dataset:
Coexistent renal and heart failure: the importance of recognizing ‘congestive cardio-renal failure’
Authors: Jones CH , Will EJ
Published: May 2014

The coexistence of heart disease and renal failure is common in clinical practice (Packer et al, 1986). The pathophysiology of both conditions results in sodium and water retention. In accordance with Starling's law, cardiac function decreases once an optimum left ventricular end diastolic volume is exceeded, such that the dysfunctional heart will perform even less well when challenged by salt and water retention secondary to intrinsic renal disease. The differentiation between end stage heart disease and the failing heart that is exposed to salt and water overload in renal failure is important, both for determining clinical management and prognosis (Braunwald, 1991).
The role of the autopsy in medical education
Authors: Galloway Malcolm
Published: May 2014

The autopsy can make an important contribution to medical education. The decline in the hospital autopsy rate threatens this role. This article examines the educational opportunities that the post-mortem still provides.
Radionuclide imaging of the heart
Authors: Prvulovich Elizabeth M , Underwood S Richard
Published: May 2014

Nuclear cardiology is an established part of diagnosis and assessment of patients with possible heart disease, the two most common tests being myocardial perfusion imaging and radionuclide ventriculography. Myocardial perfusion imaging comprises approximately 75% of nuclear cardiology studies in the UK, and is used in diagnosis and management of coronary artery disease.
The role of laboratory investigations in identifying body fluids
Authors: Murphy Michael
Published: May 2014

In diverse clinical situations it may be important to establish the nature and origin of fluid samples. This article sets out to provide some practical guidance on the role of laboratory investigations in this process.
The adverse effects of drugs
Authors: Pirmohamed Munir , Park B Kevin
Published: May 2014

Adverse drug reactions vary in presentation and severity, and can mimic almost any disease. The article explores the importance of adverse drug reactions in modern clinical practice, highlighting the mechanisms and how to manage patients.
Induction down under
Authors: Ewing Hamish
Published: May 2014

An Australian hospital revamped its induction arrangements for new interns (the equivalent of pre-registration house officers in the UK) in response to negative comments about the traditional programme. The programme was rebuilt to meet their challenge — the result being both more practical and more enjoyable. The three major components of the new programme were skills stations, intern shadowing and a treasure hunt.
Research and clinical assessment of eating and exercise behaviour
Authors: Abraham Suzanne , Lovell Nigel
Published: May 2014

The Eating and Exercise Examination (EEE-C) is an efficient, self-report, computergenerated and computer-reported examination of eating and exercise behaviour, attitudes and feelings. It is clinically useful for assessment of eating and exercise disorders, as a therapeutic tool to provide feedback to patients and as an instrument to provide standardized data for cost effective and relapse prevention studies.
Epidural and spinal anaesthesia and the use of anticoagulants
Authors: Armstrong RF , Addy V , Breivik H
Published: May 2014

Neurological injuries after epidural/spinal analgesia are a serious but uncommon problem. Spinal haematoma cause a proportion of these complications, and can be minimized by avoiding central nervous blockade in high-risk patients, especially those receiving anticoagulant therapy. Early recognition of spinal haematoma by basic neurological monitoring allows early interventiron and improves outcome.
Spontaneous ilioiliac arteriovenous fistulas
Authors: Flarup Sren
Published: May 2014

A69-year-old previously healthy man came to the emergency room because of sudden pain in the right groin for 6 hours. He was in shock and had a tender pulsatile mass distally in the right iliac fossa. The creatinine level was in the normal range. Electrocardiography showed sinus tachycardia and normal P-waves, but no signs of myocardial ischaemia or ventricular hypertrophy. His systolic blood pressure was <70 mmHg. The central venous pressure was not measured. Emergency operation revealed a 6 × 8 cm right-sided common iliac aneurysm which had ruptured into the right common iliac vein and also retroperitoneally. A gigantic haematoma had formed in the mesentery of the small intestine and because of the tension from the haematoma the right kidney was separated from both the aorta and the inferior vena cava during dissection and retraction of the tissues. The left common iliac artery was also aneurysmatic and the aorta was ectatic. At operation an endoaneurysmal closure of the 2 cm long fistula was performed and a bifurcated aortoiliac bypass graft was inserted. The right kidney was removed. The patient lost 9 litres of blood during the operation which lasted 165 minutes. The patient died the day after the operation after anuria had developed.
Stents: an overview
Authors: Nicholson Tony
Published: May 2014

Over the last 10 years the development of stent technology has had a major effect on the treatment of patients with cardiac vascular and non-vascular disease. However, no two abnormalities are ever alike and stents differ hugely in their properties.
The use of probiotics in paediatrics
Authors: Isolauri Erika
Published: May 2014

The interactions between microbes and the host have prompted active research. This followed the discovery that the intestinal flora provide maturational signals for the gut-associated lymphoid tissue, particularly for the immunoglobulin (Ig) A plasma cells, which confer the first line of host immunological defence. Specific strains of the gut microflora have been shown to alleviate intestinal inflammation, normalize gut mucosal dysfunction, and downregulate hypersensitivity reactions. Thus modification of gut microflora with probiotics may have therapeutic potential in clinical conditions associated with gut barrier dysfunction and inflammatory response.
Finding health information on the Internet: health professionals
Authors: Kiley Robert
Published: May 2014

This article discusses some of the key problems that clinicians encounter when searching the Internet for health information. Guidance is provided on how best to search the Internet to find high-quality information and resources. The Internet is a dynamic and valuable source of information for health professionals, but information accessed through the Internet should be critically evaluated before being applied to practice.
Pitfalls in the diagnosis of motor neurone disease
Authors: Hardiman Orla
Published: May 2014

Motor neurone disease is characterized by progressive degeneration of upper and lower motor neurones with preservation of cognition. Recognition of classical motor neurone disease is not difficult, but during the early stages both false positive and false negative diagnoses are common. Careful examination, frequent follow-up and ancillary tests are necessary to avoid erroneous diagnoses.
Improving reporting of sharp injuries
Authors: Debnath D
Published: May 2014

There is considerable under-reporting of contaminated needlestick and other sharp object injuries among health-care workers. Some general and psychological factors contribute to such low reporting. Continued training of staff, a sympathetic attitude and clarification of some general issues might improve reporting of such incidents.
Wegener's granulomatosis: unusual presentations
Authors: Watts Richard A
Published: May 2014

Wegener's granulomatosis is a necrotizing vasculitis characterized by respiratory tract involvement and focal glomerulonephritis. Rare presentations include abdominal pain as a result of gut involvement, pericarditis, cardiac arteritis and blindness. Detection of antineutrophil cytoplasmic antibodies should not be used as a substitute for a histological diagnosis.
Giant diverticulum of colon treated by diverticulectomy
Authors: Gendy RK , Jeffery PJ
Published: May 2014

Giant diverticulum of the colon is a rare condition. If left untreated it will enlarge and give rise to symptoms or serious complications so it is best treated electively once the diagnosis is made. Local excision of the diverticulum could be adequate surgical treatment as an alternative to sigmoid colectomy.
Hydroxyurea-induced leg ulcers
Authors: Murphy J , Morley SM
Published: May 2014

Hydroxyurea is an analogue of urea that inhibits DNA synthesis. It inhibits ribonucleotide reductase, the enzyme which converts ribonucleotide diphosphates to their deoxyribonucleotide forms. This causes selective killing of cells in the S phase of the cell cycle. Hydroxyurea is well absorbed orally, has a plasma half-life of 4 hours and is mostly excreted in the urine. It is used to treat chronic myeloid leukaemia, polycythemia vera, thrombocythaemia, sickle cell anaemia and at lower doses psoriasis. It is generally well-tolerated. The most frequently encountered sideeffects are nausea, vomiting and diarrhoea. The most serious side-effect, myelosuppression, is usually rapidly reversed on cessation of the drug.
Subfertility following treatment for childhood cancer
Authors: Waring Angela B , Wallace W Hamish B
Published: May 2014

The majority of children with cancer can now expect to be cured. Recent advances in assisted reproduction have focused attention on the long-term fertility outcome for these survivors. This article summarizes the current state of our knowledge about who is at risk of subfertility after childhood cancer and discusses possibilities of fertility preservation that are currently being researched.
Beware of groin pain in the elderly athlete
Authors: Williams EV , Hughes JL , Foster ME , Pemberton D
Published: May 2014

A62-year-old man, who was a keen amateur swimmer, presented to the orthopaedic department in June 1996 with a 4-month history of lower back pain, which had developed after he had been swimming. Mild tenderness was noted over his left sacroiliac joint, straight leg raising was normal, and resisted movements failed to reproduce his pain. He was advised to alter activity and discharged.

His pain persisted, however, and 10 months later had become localized to his right groin. Further review in the orthopaedic clinic revealed a full range of movement of his hips, but extreme abduction was painful. Plain radiographs of the lumbar spine showed degenerative changes. His pain was attributed to lumbar root irritation, and so he was referred for physiotherapy.

By October 1997, 16 months after initial presentation, there was no real improvement. A soft tissue magnetic resonance imaging scan confirmed spondylosis and degenerate discs, but no actual disc prolapse. As he was still troubled with pain, specifically in the right groin, a general surgical opinion was requested.

Localized tenderness was demonstrated at the deep ring, but no herniation noted. ‘Gilmore's groin’ was suspected, but his advancing age aroused suspicion, therefore other causes needed to be excluded. There was nothing else to find on clinical examination of his abdomen, but rectal examination revealed a hard nodular prostate. A prostate-specific antigen (PSA) test was performed, and this was significantly elevated at 168 ng/ml (normal Ã4 ng/ml). Plain pelvic X-rays were obtained, and reported as sclerotic lesions involving left ischium, right superior pubic ramus and adjacent pubic bone (Figure 1). An isotope bone scan later revealed multiple areas of increased activity consistent with metastatic disease (Figure 2). A subsequent tru-cut biopsy confirmed carcinoma of the prostate.
Caelyx: treatment for relapsing ovarian cancer
Authors: Johnston Stephen RD , Kaye Stan
Published: May 2014

Although there have been significant improvements in the first-line treatment of ovarian cancer, the options for patients who relapse have been limited. Caelyx is a new treatment using long-circulating liposomes to target delivery of doxorubicin to the tumour. This article reviews the treatment of ovarian cancer and looks at the place of Caelyx as a new second-line treatment option.
Permacol™: clinical experience with a new biomaterial
Authors: Harper Catherine
Published: May 2014

Permacol™ (Tissue Science Laboratories plc, Aldershot, Hants) is a new biomaterial which combines the strength and permanence of synthetic surgical repair materials with the biocompatibility of natural materials. This article examines the clinical application of Permacol™ in a range of different surgical procedures.
The place of the electrocardiogram in modern cardiology
Authors: Sporton Simon
Published: May 2014

The electrical activity of the heart generates currents that flow throughout the tissues of the body, creating potential differences between different areas of the body surface. The electrocardiogram is a measurement of these potential differences as a function of time.
Management of a lump in the neck
Authors: Roland Nicholas J , Fenton John , Bhalla Rajiv K
Published: May 2014

This article reviews the management of adults who present with a neck lump, and discusses the potential causes and relevant investigations. The review emphasizes the avoidance of open biopsy and need for early referral to the appropriate specialist.
Being a journal editor
Authors: Linssen Rebecca
Published: May 2014

Editing a journal can be a very difficult but very rewarding job. This article discusses the different areas that are involved in editing Hospital Medicine, to give readers an idea of the scope of the role.
Case 4: collapse as a result of bradycardia
Authors: Sporton Simon , Holdright Diana
Published: May 2014

A 73-year-old woman was being monitored on a medical admissions ward following an episode of collapse. She gave a history of recurrent dizzy spells. With the exception of bruising related to her collapse, examination was normal, as was her resting 12-lead electrocardiogram. A further presyncopal episode occurred on the ward and was captured on the electrocardiogram (Figure 1). What was the diagnosis?
Noonan syndrome: a brief overview
Authors: Chakraborty A
Published: May 2014

Noonan syndrome is a relatively common dysmorphic syndrome. The typical features include short stature, cardiovascular abnormalities and a characteristic facies. Children with Noonan syndrome have a considerable number of potential health problems, which are highlighted in this article. However, most individuals with this condition live a normal life.
Pseudodextrocardia in bronchiectasis
Authors: Kelly MG , McGarvey LPA , Lawson JT , Elborn JS
Published: May 2014

Bronchiectasis is a chronic inflammatory pulmonary disorder characterized by chronic productive cough, recurrent bronchial sepsis and haemoptysis, with airflow obstruction and progressive tissue destruction. Kartagener's syndrome, associated with dysfunctional cilia, sinusitis and situs inversus, is a rare cause of bronchiectasis (Marwah and Sharman, 1995). This article reports two cases where patients had been erroneously diagnosed as having Kartagener's syndrome based on misinterpretations of chest radiographs.
TOBI®: reducing the impact of pseudomonal infection
Authors: Govan John
Published: May 2014

Pseudomonas aeruginosa infection is associated with impaired lung function and reduced life expectancy in cystic fibrosis patients. Tobramycin nebulizer solution (TOBI®, Chiron Corporation Ltd, Hounslow) has been specifically formulated for use against P. aeruginosa infection in the lung.
Uterine haemorrhage controlled by an intrauterine balloon insufflated with hot water
Authors: Turner George DS
Published: May 2014

Controlling uterine haemorrhage can be difficult. One cause is uterine atony, which is a rare and dangerous complication associated with halothane anaesthesia.
The genetics of inflammatory bowel disease
Authors: Baburajan Bijay , Parkes Miles
Published: May 2014

Over the past 10 years major progress has been made in understanding the genetic contribution to inflammatory bowel disease. NOD2 was recently identified as a major susceptibility gene for Crohn's disease. This and a number of other strong genetic leads are discussed.
Inhaled foreign bodies in children: diagnosis and treatment
Authors: Kumar Pankaj , Athanasiou Thanos , Sarkar Pradip K
Published: May 2014

An inhaled foreign body in children is a rare but potentially fatal condition. This article reviews this clinical condition, in particular highlighting the high index of suspicion needed on behalf of the clinicians involved in the care of children. The literature relating to this condition is reviewed and a summary of the clinical course is presented.
Use of carvedilol in the treatment of heart failure
Authors: Coats Andrew
Published: May 2014

Carvedilol is a multiple action, non-specific, adrenergic beta-blocker, licensed for the treatment of mild, moderate and severe chronic heart failure. This article considers the evidence for using beta-blockers in general, and carvedilol in particular, in the treatment of heart failure. Evidence suggests that carvedilol should be considered as an alternative first-line initiation therapy.
Visceral leishmaniasis misdiagnosed as probable acute lymphoblastic leukaemia
Authors: Jones SG , Forman KM , Clark D , Myers B
Published: May 2014

A4-year old girl was transferred from a local district general hospital with a presumptive diagnosis of acute lymphoblastic leukaemia. She had been referred with coryzal symptoms and recurrent epistaxes for 6 months. Her parents had noticed pallor, lethargy and anorexia.
Intravenous artificial oxygen carriers
Authors: Farrar Daniel , Grocott Mike
Published: May 2014

Haemoglobin-based oxygen carriers and perfluorocarbons have been developed as artificial oxygen carriers which can be safely administered intravenously. Mixed results from clinical trials to date suggest that further work is required to clearly demonstrate clinical efficacy and safety for these exciting products.
Botulinum toxin and the eye
Authors: Marsh Ian B
Published: May 2014

Botulinum toxin in ophthalmology is used to reduce the function of the eyelid muscles in spasms or therapeutically. Therapeutic and diagnostic use in strabismus is also discussed, along with the controversial treatment of nystagmus.
The eye and skin disease
Authors: Barnes JA , Lightman S
Published: May 2014

Ocular abnormalities associated with disease of the skin may involve any part of the eye or its adnexae. This review will discuss:
Pulmonary fibrosis in a tool sharpener
Authors: Rao U , Ganeshalingam K , Davies BH
Published: May 2014

A36-year-old man who had been employed as a tool grinder and sharpener for the last 18 years presented with dyspnoea, dry cough and left-sided pleuritic chest pain of 6 weeks duration. He recalled an episode of a very small amount of haemoptosis. He described his work environment as dusty and under ventilated. His work involved sharpening tungsten carbide parts.
Cerebral venous thrombosis presenting as unilateral headache and visual blurring in a man with nephrotic syndrome
Authors: Chan KH , Mak W , Cheung RTF , Ho SL , Au-Yeung KM
Published: May 2014

A 44-year-old man presented with persistent left-sided headache for 2 weeks. His ankylosing spondylitis was in remission following a course of sulphasalazine and methotrexate in the past. Six months before admission, he developed nephrotic syndrome as a result of minimal change glomerulopathy. Prednisolone was started at 60 mg daily and later tailed down to 15 mg daily plus azathioprine 50 mg daily. His 24-hour urinary protein decreased from 5.89 to 1.08 g/day. He ran out of prednisolone for 1 week before he developed persistent throbbing headache over his left temporal and occipital regions together with mild neck pain and stiffness. The headache was worse in the morning and aggravated by straining and sneezing. He also noticed more than 20 episodes of transient visual blurring without diplopia, each episode lasting up to 30 seconds. There was no visual aura, photophobia or phonophobia. He did not have any fever, nausea, vomiting or temporal tenderness.

He was afebrile. Neck stiffness and loss of physiological cervical lordosis could be attributed to his ankylosing spondylitis. Mild facial puffiness and ankle oedema were caused by his nephrotic syndrome. Apart from bilateral papilloedema, his neurological examination was normal. Complete blood count, erythrocyte sedimentation rate, liver and renal function tests, autoantibodies, serum complement levels and serum immunoglobulins were normal except for the serum albumin of 36 g/litre. Computed tomography brain scan was normal. X-ray of the cervical spine revealed spondylitic changes. Magnetic resonance imaging brain scan was normal, but magnetic resonance venography (MRV) revealed a loss of venous flow over the right transverse and sigmoid sinuses, indicating cerebral venous thrombosis (Figure 1).

Anticoagulation was commenced initially with subcutaneous low-molecular weight heparin and followed later with warfarin. His headache gradually subsided after 2 days of anticoagulation. Warfarin was continued for 6 months with the international normalized ratio kept between 2 and 2.5. Repeated MRV after completion of anticoagulation showed recanalization of the thrombosed cerebral venous sinuses. Subsequent screening was negative for deficiency in protein C, protein S or antithrombin III, resistance to activated protein C, and anti-cardiolipin antibodies. In the past 4.5 years, the patient remained well with no evidence of malignancy or relapse of nephrotic syndrome.
Ectopic pregnancy deaths: what should we be doing?
Authors: Kirk Emma , Condous George , Bourne Tom
Published: May 2014

Ectopic pregnancy is the leading cause of maternal mortality in the first trimester of pregnancy. A greater awareness of risk factors and improved diagnostic techniques now allow ectopic pregnancies to be identified before the development of life-threatening events. Non-surgical management options also decrease maternal morbidity.
Early signs of the trainee in difficulty
Authors: Paice Elisabeth , Orton Victor
Published: May 2014

A series of high-profile medical scandals and tragedies has generated increasing interest in the earlier detection of doctors whose health, conduct or performance may pose a risk to themselves or others. The earliest signs of problems often emerge during the training years, when it may be possible to take remedial action to prevent the doctor derailing. This article describes the early signs that have identified doctors in difficulty in a large postgraduate deanery.
Understanding schizophrenia and diabetes
Authors: Dinan Ted , Peveler Robert , Holt Richard
Published: May 2014

Alongside other risk factors for the development of type 2 diabetes, the presence of severe mental illness is often overlooked. A person with schizophrenia has a two to four times greater risk of developing diabetes than the general population and the prevalence of type 2 diabetes is between 15 and 18% in the schizophrenia population. A full understanding of this issue is vital.
Keeping schools secure
Authors: Lee-Potter Emma
Published: May 2014

School security is a vital issue for leadership teams to consider. Emma Lee-Potter finds out that it is all about striking the right balance
Magic of the movies
Authors: Middleton Janice
Published: May 2014

FILMCLUB offers pupils the chance to watch a wide range of films after the school day has finished. Janice Middleton, headteacher of Edlington Victoria Primary School in Doncaster, discusses how the scheme has worked at her school
School library budgets – the bigger picture
Authors: Horsfield Karen
Published: May 2014

The library is facing an uncertain future in some schools due to the never-ending threat of budget cuts. Karen Horsfield, treasurer of the School Library Association, argues that the school library is unique in its ability to support teaching and learning
Are lesson observations raising standards?
Authors: Quigley Chris
Published: May 2014

The government is calling for headteachers to observe more lessons as a way of driving up standards. Former headteacher Chris Quigley looks at the current techniques in place and asks if we are monitoring the right things
Asbestos: A hidden killer
Authors: Lees Michael
Published: May 2014

Eleven years ago, Michael Lees lost his wife, a teacher, to the asbestos-related disease mesothelioma. He is fighting for special guidance and regulations to govern asbestos management in schools. Here he presents his case
Improving progress through Assessment for Learning
Authors: Goodman Joanna
Published: May 2014

Dr Joanna Goodman reflects on the role of Assessment for Learning
Connecting with the continent
Authors: Stead Sarah
Published: May 2014

The British Council offers a host of international education programmes for UK schools. Sarah Stead tells us about the projects her school has got involved with, and the benefits they have seen for both teachers and pupils
The social revolution
Authors: Cregan David
Published: May 2014

St Matthew Academy in Lewisham works with parents and the community to promote its success and good work. Vice principal David Cregan explains how social media has become an integral part of the school's public relations strategy
Making school count for young carers
Authors: Dale Michelle
Published: May 2014

Michelle Dale discusses the importance of supporting young carers and explains how her primary school is making a difference for those pupils who have caring responsibilities
The wi-fi debate
Authors: Lepkowska Dorothy
Published: May 2014

Experts are split on the safety of exposing children to wi-fi in schools, with some concerned about evidence of health risks. Dorothy Lepkowska looks at the issue
Supporting White working class boys
Authors: Atkins Kate
Published: May 2014

Of those groups eligible for free school meals in schools, one of the worst performing is White, British boys. Tom Welch has been involved in a project to discover what factors can help these students to buck the trend
Making the time to be creative
Authors: Cross Cathy
Published: May 2014

While many of us agree that a creative, broad education is crucial, the pressures of targets and SATs often interferes. Cathy Cross discusses the power of immersive learning, creativity, the role of basic technology, and how schools can make the time
Heroes Day
Authors: Glavin Danny
Published: May 2014

The second annual Heroes Day will see pupils dressing up as the person who most inspires them and raising money for charity while they do it. Primary school teacher and founder Danny Glavin urges you to get involved
How to spend your Pupil Premium…
Authors: Bannister Nick
Published: May 2014

The Pupil Premium marked its first anniversary in April. What have primary heads done with the extra cash and is it making a difference? Nick Bannister reports
Lessons in railway safety
Authors: Shaoul Mark
Published: May 2014

Trains are popular with children – making rail safety education all the more vital. Mark Shaoul introduces some new resources to help primary schools in this area
Christmas time: Santa brings the gift of standards
Authors: Bigland Brenda
Published: May 2014

How can you maintain a focus on key standards during the more relaxed Christmas period? Brenda Bigland offers her advice
What does the Equality Act mean for schools?
Authors: Bolloten Bill
Published: May 2014

The Equality Act 2010 replaced nine major pieces of legislation and should make it easier for school leaders and governors to understand their legal responsibilities and tackle inequalities in education. Bill Bolloten explains
How to spend the Pupil Premium
Authors: O'Connell Suzanne
Published: May 2014

Having increased to £900 in 2013/14, the Pupil Premium is expected to make all the difference to disadvantage in our communities. Suzanne O'Connell speaks to schools about how it is being used, including how Ofsted is reporting its use
Poverty: Just how much can schools do?
Authors: O'Connell Suzanne
Published: May 2014

The Pupil Premium is on the up, but so is child poverty. With the number of children below the minimum income standards set to grow by 400,000, can schools really bridge the disadvantage gap on their own?
Engaging boys with and through dance
Authors: Wilkie Louise
Published: May 2014

Dance can be a powerful medium to engage pupils, especially boys. Experienced dance teacher Louise Wilkie explains why and offers some practical advice and ideas
Transforming the quality of teaching
Authors: Aubrey-Smith Fiona
Published: May 2014

Two headteachers speak to Fiona Aubrey-Smith about how the use of the Teacher Effectiveness Enhancement Programme after an Ofsted inspection has helped them to sustainably improve the quality of teaching
The hunt for LGBT equality
Authors: Maddock Paul
Published: May 2014

What can schools do to meet their legal requirements and ensure staff are treated equally, irrespective of sexuality. Legal expert Paul Maddock advises.
Pre-procedural education on anxiety levels during intravitreal injections
Authors: Beasley Rebecca
Published: May 2014

Aim

This paper aims to explore the role of pre-procedural education on the anxiety and/or pain levels of macular degeneration patients during intravitreal injections.

Background

The significance of pre-procedural education has been debated for many years, with many authors/clinicians alleging that informative preparation reduces pre-surgery anxiety levels and peri/post-procedural pain levels experienced by patients.

Methods

A comprehensive methodological analysis was employed in order to critically evaluate relevant research. A range of electronic databases and ancestry resources were searched for current contemporary articles published between January 2000 and March 2010. Search terms incorporating ‘anxiety’ ‘education’ ‘fear’ ‘discomfort’ ‘pain’ ‘ranibizumab’ and ‘macular degeneration’ were combined. The types of methodological studies were not specified in the strategy in order to prevent elimination of potentially applicable literature, therefore, both anecdotal and empirical articles were considered pertinent.

Results

Seven articles met the identified inclusion/exclusion criteria. Data abstraction was undertaken and all eligible studies were evaluated for quality, validity and reliability. Collectively, each of the studies reviewed placed emphasis on the importance on pre-procedural patient education and counselling. Nevertheless, individual differences exist in the amount, type and specificity of information provision provided. In general, the research articles reviewed also demonstrate the assumed existence of high anxiety levels pre-ophthalmic surgery commonly relating to patient anticipation and apprehension.

Conclusion

Greater understanding of the context within which educational provision impacts on patient anxiety and/or pain levels during intravitreal injections will facilitate the design of effective education and support systems for macular degeneration patients throughout the disease process.
Diabetes and diabetic retinopathy
Authors: Bentley Peter , Gibbons Helen , Mapani Adam
Published: May 2014

It is estimated that in the UK alone there are 2.6 million people diagnosed with diabetes and a further half a million unknown people with diabetes. Although diabetes is seen across all ethnic groups it is more common in those of Afro-Caribbean populations living in the UK.

One of the most common complications of diabetes is diabetic retinopathy, which features in a third of the population of those affected by the condition. This article will give a brief overview of diabetes and then it will focus on diabetic retinopathy, and will conclude with a case study.
The United Kingdom and Ireland Society of Ophthalmic Professionals (UKISOP) 2013 annual meeting
Authors: Turner Rebecca , Collett Helen
Published: May 2014

The United Kingdom and Ireland Society of Ophthalmic Professionals (UKISOP) held their annual educational program on 6th September at the Old Trafford Football Ground, Manchester, UK. UKISOP is part of the United Kingdom and Ireland Society of Cataract and Refractive Surgeons (UKISCRS) which offers twice yearly conferences and well a being an educational and networking resource.
Paediatric strabismus–timing is everything: a literature review
Authors: McCutcheon Karen , Hutchinson Shelly
Published: May 2014

This literature review explores the management of paediatric strabismus. It highlights the current screening process in the UK and the controversy that exists around the treatment and timing of any surgical intervention. Paediatric strabismus is not a preventable condition; however, it is apparent from this literature review that there are many areas that need continued research and development to prevent the complications of this condition having an unnecessary negative impact on a child's life.
Short-term results from a slit-lamp Training-of-Trainers workshop in Greater Accra, Ghana
Authors: Poore Sophie , Buxton Eileen NA , Gibbons Helen
Published: May 2014

A slit-lamp Training-of-Trainers (ToT) workshop was held for ten ophthalmic nurses in Ghana who subsequently trained 23 of their colleagues within a three-week period. This article outlines the methods, results and reflections from the training sessions held following the ToT course.
Stereo imaging in ophthalmology
Authors: Hancock Richard
Published: May 2014

Stereo imaging in ophthalmology is an important diagnostic modality and a task not often undertaken in many ophthalmic photography departments. Origins of retinal stereo imaging date back to over 100 years ago. Stereo imaging is recommended, for example, for all photographs of the optic nerve head and for ocular angiography intended to determine clinically significant macular oedema. It is also useful in determining sub types of wet-form age-related macular degeneration. Stereo fundus photography and angiography facilitate the diagnostic process by clearly defining retinal structure and elevation. This allows the clinician to assess the patient's retina, presenting a 3D image that does not move and is not light sensitive. Stereo imaging of the fundus is useful for follow-up management of the patient, and is used extensively in clinical trials.

This article will look at the history of stereo photography, its application and rationale to ophthalmology, and the different methods of attaining stereo images of the retina.
Death anxiety amongst nurses
Authors: Boyle Moira , Carter Diana E
Published: May 2014

The literature indicates an abundance of empirical evidence relating to nurses’ communications with and care of the dying patient and his family. Evidence is scant however pertaining to the concept of death anxiety, how nurses cope with death, and ultimately the impact nurses’ levels of death anxiety may have on their ability to prescribe and deliver palliative nursing care. This discussion paper explores the concept of death anxiety, coping strategies nurses adopt in the attempt to ameliorate or reduce the threat of this complex emotional response and the role of nurse education in the preparation of nurses to effectively deliver quality care and professional support in the event of death related incidents within the health care setting.
Depression among the palliative care oncology population
Authors: McVey Peta
Published: May 2014

Depression occurs at a relatively high incidence among terminally ill patients, yet only a small percentage of this population is diagnosed and treated appropriately (Brietbart, Brueura, Chochinov and Lynch, 1995). The lack of appropriate treatment ultimately affects the patient’s quality of life and has significant ramifications for health care workers in this area. This paper provides a review of current literature regarding assessment, management and treatment modalities of depression. Common misconceptions and myths in relation to depression will be described and deficits in the literature are identified. Implications for nursing and the role of the nurse will be explored.
The pharmacological management of respiratory tract secretions
Authors: O’Donnell Valerie
Published: May 2014

Audible respiratory tract secretions in the dying patient are often referred to as the ‘death rattle’. This reflects the distressing nature of this symptom. The management of respiratory tract secretions in the dying patient is a challenge for all healthcare professionals involved in palliative care; this symptom can cause considerable distress for patients, their relatives and carers. A review of the literature was undertaken to identify the incidence and management of respiratory tract secretions. Research on this subject is limited and focuses on the pharmacological management. Only one study (Hughes et al, 1997) was identified that considered a non-pharmacological approach to treatment. This article discusses current practice in palliative care settings and examines the research relating to pharmacological management.
The use of bisphosphonates in the palliative care setting
Authors: Heatley Sarah , Coleman Robert
Published: May 2014

Metastatic bone disease results from the many interactions between tumour cells and bone cells, which result in disruption of normal bone metabolism. In addition to the known benefits of both external beam radiotherapy and systemic endocrine and cytotoxic treatments, it is now clear that the bisphosphonates provide an additional palliative treatment strategy which reduces both the symptoms and complications of bone involvement. Ongoing research is aimed at trying to define the optimum route, dose, schedule and type of bisphosphonate, and their potential adjuvant use to inhibit the development of bone metastases and treatment-induced osteoporosis.
Decision making in palliative nursing practice
Authors: Kennedy Catriona
Published: May 2014

Decision making is a cognitive and often complex process and health professionals are accountable for the decisions they make in their professional practice (UKCC, 1992). Nursing curricula at pre- and postregistration levels embrace a wide knowledge base derived from a variety of disciplines and a range of practical and technical skills. Knowledge and skills regarding nurse/patient interaction are synthesized using the nurse’s professional judgment. This article explores the two main perspectives — intuitive and analytical decision making — and these are applied to palliative care education and nursing practice. It is suggested that decision analysis, the formal technique of decision theory, may enhance the quality of decision making in palliative care nursing. However, many of the decisions made by palliative care nurses are associated with intuitive decision making. The quality of intuitive decision making remains largely unexplored, therefore in a healthcare system where the debate on evidence-based practice is paramount a paradox appears to exist between the predominantly intuitive approach to patient care and the move towards developing a more research-based and analytical framework.
Anticipatory grief: coping with the impending death of a partner
Authors: Costello John
Published: May 2014

This article reports on the findings from an exploratory study of 12 bereaved older people and their experiences during the time when their partner was receiving terminal care in hospital. The aim was to examine the nature of the spouses’ experiences in relation to anticipatory grief (Rando, 1986). The findings indicate that anticipatory grief had a cumulative, rather than a specific influence on the spouse’s bereavement. In its broadest sense, the experience of anticipatory grief allowed for adaptation to the loss to begin prior to their partner’s death. The role of the nurse in giving emotional support to the family before death is discussed. This raises issues concerning the implications of anticipatory grief for nurses in being able to recognize and understand this phenomenon and the impact it can have on the grieving spouse.
Audit of cancer pain management in a cancer centre
Authors: Menzies Kate , Murray Jim , Wilcock Andrew
Published: May 2014

Despite the availability of effective methods of controlling pain, many patients continue to receive inadequate pain relief. An audit was carried out on a single day to identify the prevalence, severity and management of cancer pain in adults in the two teaching hospitals in the Nottingham Cancer Centre. Of 186 patients with cancer, 52 had experienced pain as a result of their cancer during their admission. Of these 52 patients, 47 were assessed. More than half had unrelieved pain that was ‘severe’ at its worst and interfered greatly with activities. Compared with patients whose pain had been relieved, patients with uncontrolled pain were likely to have spent less time in hospital, to have not had a formal assessment or reassessment of their pain and not to have a pain-care plan in the nursing notes or to have been seen by the hospital specialist palliative care team. We use our results to highlight areas of good practice, to identify where improvements could be made, and to inform the development of local standards and future audits.
A model of palliative care for the adolescent with cancer
Authors: Edwards Jackie
Published: May 2014

Adolescents are a distinct group in paediatric and adult cancer and palliative care specialities. The process that is experienced by the patient and his/her family of the transition from health to living with a life-threatening illness and from a life-threatening to a life-limiting illness raises specific issues for service provision. The adolescent population presents with a wide variety of physical and emotional maturity that highlights the need for health professionals to be equipped with skills in adolescent care, cancer care and specialist palliative care. Due to the small number of patients who will require such a service in any one health district in the UK this is not usually realistic. This article discusses a model of care that promotes collaborative professional practice in a cancer centre between the paediatric department and adult specialist palliative care team that in turn extends a philosophy of care into cancer units and the community setting.
Views of nurses, patients and patients’ families regarding palliative nursing care
Authors: Taylor Bev , Glass Nel , McFarlane Jennifer , Stirling Kate
Published: May 2014

This article presents the findings of a 3-phase project, that used the qualitative approach of storytelling to examine the degree of congruency between the perceptions of nurses, patients and patients’ families respectively, in relation to the nature and effects of palliative nursing care. The major difference in the stories was the slight emphasis on the personal qualities palliative nurses bring to their work and the activities in which they engage. Nurses emphasized their work activities, whereas patients and relatives gave equal emphasis to the positive and negative aspects of nurses’ qualities and activities.
The role of aromatherapy massage in reducing anxiety in patients with malignant brain tumours
Authors: Hadfield Nancy
Published: May 2014

Research suggests that aromatherapy massage (AM) is increasingly being used by cancer patients, especially in the palliative care setting, although few studies have assessed its effectiveness. I wanted to find out whether AM reduces anxiety in patients with a primary malignant brain tumour attending their first follow-up appointment after radiotherapy. Eight patients were recruited to the study, which comprised three methods of data collection: the measurement of physical parameters; the completion of Hospital Anxiety and Depression Scales (HADS); and semi-structured interviews. The results from HADS did not show any psychological benefit from AM. However, there was a statistically significant reduction in all four physical parameters, which suggests that AM affects the autonomic nervous system, inducing relaxation. This finding was supported by the patients themselves, all of whom stated during interview that they felt ‘relaxed’ after AM. Since these patients are faced with limited treatment options and a poor prognosis, this intervention appears to be a good way of offering support and improving quality of life.
Randomized controlled trials in palliative care: overcoming the obstacles
Authors: Hudson Peter , Aranda Sanchia , McMurray Nancy
Published: May 2014

Problems associated with conducting randomized controlled trials (RCTs) in palliative care are well documented. Palliative care researchers commonly report difficulties with recruitment, attrition, and randomization. Despite these difficulties, there is a crucial need to enhance the evidence base of palliative care and RCTs are a recognized method for achieving this. Few publications to date have provided clear strategies for researchers considering RCTs in palliative care. This article presents an overview of the features of the RCT and reasons for using this research method. Problems with conducting RCTs are considered with discussion focusing on an approach for managing these hurdles. Examples are provided from an ongoing RCT investigating a support and information programme for lay caregivers of people receiving palliative care at home. The aim of the article is to provide a guide to conducting RCTs and to promote their use in palliative care when researchers are evaluating new interventions.
Reflexology audit: patient satisfaction, impact on quality of life and availability in Scottish hospices
Authors: Milligan Mary , Fanning Maureen , Hunter Sheena , Tadjali Miriam , Stevens Elaine
Published: May 2014

Complementary therapies are being accessed increasingly by cancer patients. The aims of this audit were to investigate the impact of reflexology on the quality of life of 20 cancer patients, to determine their satisfaction with the service provided and to investigate the availability of this therapy within Scottish hospices. The audit findings suggest that the clients were satisfied with the service received. Respondents noted that their quality of life was improved through a reduction in physical and emotional symptoms. It was found that the provision of reflexology within Scottish hospices varied, with less than half providing this service. The results of this audit suggest that reflexology may be a worthwhile treatment for other cancer patients and requires further research to evaluate the benefits.
Developing an integrated care pathway to manage cancer pain across primary, secondary and tertiary care
Authors: Cringles Marilyn C
Published: May 2014

Throughout the palliative care journey, the patient encounters many different health professionals in a variety of settings so good channels of communication between these professionals is a prerequisite for successful continuity of care (Scottish Partnership Agency for Palliative and Cancer Care (SPA), 1994). Pain control has also long been documented as being ineffective and it has been indicated that pain affects up to 88% of cancer patients in the last year of their life (Addington-Hall and McCarthy, 1995). In order to attempt to resolve these important issues, a joint project was established between primary, secondary and tertiary care in the south sector of Glasgow to establish an integrated care pathway (ICP) for the management of chronic cancer pain. This article discusses how the joint project was successfully established, was instrumental in breaking down existing barriers across the traditional boundaries and developed a uniform system of assessing and managing chronic cancer pain with ICP documentation held in a patient-held record.
Reflections on pain management: a case study
Authors: Cunliffe Jill
Published: May 2014

This article discusses issues relating to pain mangement at the end of life. Through reflections on a case study of a single patient many aspects of pain management are highlighted. These include difficulties in assessing pain, the need to respect patient autonomy, out-of-hours concerns and the possible role of integrated care pathways. The need to be aware of the potential value of non-pharmaceutical approaches is also discussed.