bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Management: Are Times About to Change?
Authors: Rodrigues Ian A , Bladen John C
Published: May 2014

Relationships between clinicians and those in management within the NHS are often difficult and increasingly strained. We present the views from a survey conducted of UK ophthalmologists in training, regarding their opinion on various management and leadership issues. The viewpoint of 95% of those surveyed was that managers have a poor understanding of doctors' responsibilities while 82% of doctors believed they had a poor understanding of their hospital management team. 95% thought that a good knowledge of management and leadership was important and as a consequence, 85% wanted more management and leadership experience. Nearly all surveyed thought that more doctors should be involved in management roles within the NHS. This demonstrates a positive shift in the opinion of junior doctors regarding their desire to partake in clinical management and leadership. It provides encouragement that clinicians will be taking on more management responsibilities in the future, which will be important to deal with the numerous challenges facing the NHS.
The positive effects of accurate documentaiton
Authors: Isherwood John D , Patel Meera , Thomson Helen , Metcalfe Matthew S , Dennison Ashley , Garcea Giuseppe
Published: May 2014

Medical notes are often the only record of interaction between a doctor and patient and play a critical role in the investigation of complaints and medico-legal actions. With the introduction of the European Working Time Directive leading to increased shift work, the importance of documentation and handover has been highlighted to reduce the occurrence of adverse incidents, complaints and litigation. We undertook a retrospective audit of 100 admission clerkings pre- and post-introduction of a clerking pro forma using a previously standardised 36 point audit criteria. The admission document was introduced following several pilot versions. 200 patient notes were reviewed. Clerking was largely undertaken by foundation year 1 and senior house officer doctors (69% and 86%). There was improvement in documentation in 27 of 36 factors following introduction of the admission form. Overall documentation improved from 77.5% to 92.8% (p < 0.001). Analysis demonstrated a significant improvement in 11 of 36 documented factors including; consultant on call (p < 0.01), origin of patient admission (p < 0.01), bleep number (p < 0.01), allergies (p < 0.04), family history (p < 0.01), social history (p < 0.01), observations (p < 0.01), general appearance (p < 0.01), respiratory examination (p < 0.01) and cardiovascular examination (p < 0.01). Our document is adaptable to other surgical units. Accurate documentation is important in handover, continuity of care, maintaining good clinical practice and is vital in medico-legal issues. Accurate documentation also improves coding accuracy and hence, payment to departments. This completed audit cycle with the introduction of a clerking document clearly improves admission records, however regular audits and updates are required to maintain high standards.
Can professionalism and regulation of hours co-exist?
Authors: Collum Joseph , Moreton Adam , Booth Thomas
Published: May 2014

There has been substantial controversy and debate concerning the regulation of working hours for doctors in the UK. Two key regulatory sources are responsible for this: the junior doctors' contract— the ‘New Deal’; and the UK Working Time Regulations (previously known as the European Working Time Directive). The impact of reducing working hours has been variably anticipated for its effect on the overlapping themes of patient safety, training of doctors and medical professionalism. There appears to be broad agreement that hours regulation poses a challenge to professional values. However, professionalism is multifaceted, hard to define, and harder still to measure. There is also recognition that a modern health service must impose some restriction on the working hours of its professionals in the interest of quality, patient safety, and doctors' health. Clinicians and policy makers must find creative solutions that allow professional values to thrive in the real working environment of modern health services.
Creating enterprise efficiencies in the NHS
Authors: Turner P , Kane R , Jackson C
Published: May 2014

This review of the literature examines how political ideologies have converged around English health policy and why command and control management techniques using performance indicators and targets are used to achieve policy and judge its efficacy. Performance indicators and their role in an enterprise culture, which health policy has introduced to replicate the efficiency successes from the private sector, is evaluated in this article. The article concludes that although performance indicators are valuable for efficiency improvement, the way they are implemented and managed in the English NHS does not assure the successes seen in the private sector but can lead to damaging defensive management actions.
Insulin: an evolving paradigm in diabetes management
Authors: Meetoo Danny D
Published: May 2014

The global incidence of diabetes mellitus has reached an alarming epidemic proportion. Of this large proportion, 5–10% are affected by type 1 diabetes while the remaining 90% with type 2 diabetes. In the UK, estimates suggest that this condition affects 2.9 million people. Insulin therapy is vital in the former category while this therapeutic mode is often included at a stage of the latter category to prevent respective hyperglycaemia and related micro and macrovascular complications. The modern pre-filled and re-usable pen devices used as insulin delivery system hold many advantages over the conventional approach which was often associated with dosage errors. The ease and flexibility offered by pen devices into a busy lifestyle aims to improve diabetes management with much less effort without impacting on people’s quality of life. Despite the promise of future developments in insulin delivery, serious considerations to cost implications should always be given in the management of diabetes.
Lean in a community learning disability service
Authors: Lees-Warley Gemma , Rose John
Published: May 2014

This article describes an evaluation of staff members’ perspectives regarding the implementation of a pilot Lean initiative in a community learning disability service within the West Midlands. The evaluation aimed to develop an understanding of staff experiences of Lean implementation including staff perceptions of the benefits and challenges of implementation and their recommendations for improvements to Lean within the service. The methodology employed was a survey design in which a questionnaire was administered to 28 staff members directly involved in the implementation of Lean initiatives. The questionnaire incorporated closed questions which enabled analysis pertaining to frequencies and comparisons between participant responses and open questions which enabled identification of emergent themes in the data. The findings indicated staff members have mixed opinions towards Lean implementation; benefits of implementation were improved team working, tracking of referrals and service planning. The challenges to implementation were a lack of understanding of Lean; duplication of processes; implementation of a standardised referral process; and constraints of meetings and recording information. The results are discussed in relation to the facilitating factors and obstacles faced during implementation.
Nursing in the digital age: telehealth and telecare provision
Authors: Johansen Ron
Published: May 2014

This is the first of two articles looking at the role of the nurse consultant in NHS 24, Scotland’s national provider of telehealth services. The key issues around the growth in telehealth are outlined and mental health nursing in telehealth is explored. The perception that professional’s attitudes are contributing to the slow uptake of telehealth is considered in relation to the values base for mental health nursing. Their role in challenging systems and processes that compromise safe, effective and person-centred care is emphasised.
Motivational interviewing in alcohol reduction
Authors: Hutcheson Catriona
Published: May 2014

The cost of alcohol problems to the NHS across the UK is £2.7 billion each year. Motivational interviewing (MI) is a popular treatment with proven efficacy for the reduction of hazardous drinking behaviours. MI was disseminated widely and rapidly which has resulted in the boundaries becoming unclear. It is possible that reinvention by clinicians has removed some critical elements of the innovation and reduced its efficacy. MI is a complex set of skills used flexibly, responding to moment to moment changes in what the client says. Learning MI requires training, supervised practice and feedback.
Mindfulness-based CBT for carers of service users
Authors: Clark Jim , Doyle Mary-Jo , Walsh Hannah , Robson Debbie
Published: May 2014

Mindfulness training may be helpful to reduce stress for informal carers of mental health service users. However, this training is intensive and it is not known if carers can commit the time required. This article describes a service evaluation of mindfulness-based cognitive therapy for stress reduction (MBCT-SR) course for eight carers of relatives with mental health problems. The course was feasible and acceptable for the majority of carers who attended and their caring role was not a barrier to engagement with the programme.
Adverse events: traumatic or potential for growth?
Authors: Koch Hugh , Cann Arnie , Williams Joshua
Published: May 2014

Exposure to stress, adverse events and catastrophic trauma is not unusual in the course of a lifetime, and the consequences can be significant for many. Events including terrorist attacks, tsunamis, hurricanes as well as other man-made adverse events such as work accidents, road traffic accidents and medical negligence make the study of such reactions important. Most exposed individuals, due to their resilience do not develop a psychological disorder. From the clinical and public health perspective, can individuals who may be vulnerable be helped to become more resilient? Are we both resilient and vulnerable simultaneously? Can a perspective of post-traumatic growth promote a greater awareness of ‘stress inoculation’, thereby providing necessary tools to foster prevention of adverse reactions and facilitate recovery and growth at both individual and social levels? Can contemporary CBT encourage personal growth after trauma?
Fostering clinical links between the UK and Somaliland
Authors: Doyle Mary-Jo , Askar Abdikani
Published: May 2014

In this article, the authors describe meeting during the first mental health nursing course for Amoud University's students in Somaliland. They have since remained in contact, teaching together in 2011, and discussing clinical issues via email and ‘Medicine Africa’. They discuss their plans for the growing health link and development of mental health nursing education in Somaliland.
A need to identify research priorities
Authors: Woodward Sue
Published: May 2014

With the advent of evidence-based practice, neuroscience nurses increasingly need to access quality research to underpin their practice. As we become more committed to the utilization of research to support care and to provide an evidence base for practice, the numbers of studies conducted by neuroscience nurses and reported have increased (Dilorio et al, 2004). Many aspects of our practice, however, lack a sound evidence base, and further research into a wide variety of areas is required. It would make sense, therefore, for neuroscience nurses to identify priority areas for research to help both researchers and funding organizations decide which projects to propose and fund.
It is time to close the epilepsy treatment gap
Authors: Josephs David
Published: May 2014

Epilepsy is once again in the news. Over the last few weeks national newspapers have carried two particularly tragic stories. One was the case of a young woman who died following a seizure while on a waiting list to receive expert diagnosis. The other featured a young boy of nine who died while on the waiting list for an operation in London. In both cases no one can be sure that the expert treatment they were waiting for would have saved their lives. Even so, for those people affected, such outcomes are extremely unfortunate.
Agenda for Change: Risks and benefits
Authors: Woodward Sue
Published: May 2014

Staffing levels and skill mix have long been of concern to neuroscience nurse managers and specialist nurses working in this field. Recommendations for the nursing workforce are contained in the Neuroscience Critical Care Report (Modernisation Agency, 2004). Many neuroscience units, however, are not staffed according to these recommendations, with vacancies being filled by bank and agency staff without specialist neuroscience knowledge and skills. On top of this, neuroscience nurses are now grappling with implementation of Agenda for Change.
Leading the way: Speakers look to the future in Edinburgh
Authors: Benison Liam
Published: May 2014

Liam Benison reports on the debates at this year′s British Association of Neuroscience Nurses (BANN) annual conference held in Edinburgh 28-30 October.
Introducing an outreach liaison nurse to improve access and reduce cancellations
Authors: Bates Alan
Published: May 2014

The Neurosciences Nursing Development Unit in Nottingham had an unacceptably high cancellation rate for its elective patients, delayed access for emergency admissions, and neurological patients who had to be transferred to other wards in the hospital. The neurosciences outreach liaison nurse role was introduced in January 2005 with the objective of improving the quality of service to patients and to review existing processes with the aim of reducing the amount of cancellations. Since the introduction of this role, the number of cancellations as a result of a lack of beds has fallen dramatically, patients ‘slept-out’ to other wards has become a practice of the past, all emergency patients referred to the unit are admitted within 24 hours, and the waiting list has been halved. All this has been achieved using existing capacity in an effective way.
RESEARCH ROUND-UP
Authors: Braine Mary E
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
RESEARCH ROUND-UP
Authors: McLeod Anne
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Fatal familial insomnia
Authors: Rhymes Chris
Published: May 2014

There is a move in the scientific community away from using disease classifications which refer to the symptoms of inherited prion illnesses, such as Gerstmann-Sträussler-Scheinker syndrome, fatal familial insomnia and familial Creutzfeldt Jakob disease (CJD). This is because the same mutation can present with different symptoms and it is more accurate to name them after the mutation itself (e.g. P102L, D178N or E200K). Fatal familial insomnia is most commonly associated with the D178N mutation.
Restless legs syndrome: A condition in search of recognition
Authors: Thomas Sue , MacMahon Douglas
Published: May 2014

This paper presents an overview of the diagnosis, management and treatment of restless legs syndrome (RLS). RLS can be a distressing condition which can cause serious sleep deprivation and have significant impact on an individual's quality of life and safety. The prevalence of adults whose RLS is severe enough to warrant medical consultation has been estimated to be around 3% of the population (Henning, 2004), but the disease is under-recognized and a much larger proportion of the population (up to 10%) may have RLS symptoms (Phillips, 2000). Nurses can be at the forefront in managing individuals with RLS more appropriately in several areas: through early identification of those who may have the condition so that a diagnosis can be established, by alerting sufferers to self-management strategies that help them to cope with their symptoms and by referring those who have more severe problems for pharmacological treatment.
CORRESPONDENCE
Authors: Davies Rebecca
Published: May 2014

In 1494 it was believed that one of the ways of identifying a witch was by the presence of seizures. In the early 19th century, people who had severe epilepsy were cared for in asylums but were kept separated from other groups of people because seizures were thought to be contagious. And, what's more, centuries back, seizures were thought to be a curse from the gods. What thoughts and images do the words ‘epilepsy’ and ‘seizure’ conjure up in your mind? How dissimilar do you feel they are from the beliefs held centuries ago?
Women with Epilepsy: information needs
Authors: Pamela Mantri
Published: May 2014

County Durham primary care trust's Epilepsy Service held its fi rst annual epilepsy conference, ‘Women with Epilepsy,’ on 26 September 2007. The conference was chaired by Dr Tricia Cresswell, Executive Director of Public Health, County Durham and Darlington PCTs, and divided into three sections: women with epilepsy, women of childbearing age and epilepsy, and older women and epilepsy.
Research Roundup
Authors: Fitzpatrick Maria , Davis Amanda
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Searching for real results in the dementias
Authors: O'Rourke Juliana
Published: May 2014

Nurses are being placed at the centre of a strategy to transform research conducted in the NHS. Juliana O'Rourke explains
Book Review
Authors: Podmore Susan
Published: May 2014

This book explores theories about the causes of the recent rise in cases of autism and autistic spectrum disorders. Lathe offers an interesting and alternative perspective to consider as a practitioner.
Seeking balance in relationships with patients: Understanding ‘over-involvement’
Authors: Collins Lorraine
Published: May 2014

The aim of this paper is to undertake a concept analysis of ‘over-involvement’, a term often used in nursing to describe a nurse's excessive personal investment in a patient's fate. Over-involvement can cause unrealistic expectations that are detrimental to the patient, the nurse and the organization, but there has been a lack of attention in the literature to the management of personal involvement in nurse-patient relationships. Walker and Avant's (2005) framework is used to provide a step-by-step analysis and clarification of the concept of over-involvement and to propose a definition that may contribute to the generation of the knowledge needed to improve nursing practice in this area.
The pathogenesis of myasthenic syndromes: A practical guide to diagnosis and management
Authors: Viegas Stuart , Jacob Saiju , Hilton-Jones David
Published: May 2014

Myasthenic syndromes are a group of disorders that primarily affect the neuromuscular junction resulting in muscle weakness. They include myasthenia gravis and Lambert-Eaton myasthenic syndrome, and result from circulating antibodies directed against specific targets present at the neuromuscular junction. The remaining cases are a result of underlying genetic defects in the number or function of the key components required for neurotransmission. This review will focus on how these disorders present in clinical practice, how they are diagnosed. The therapeutic options will be outlined.
No laughing matter
Authors: Winter George
Published: May 2014

In the first of a new series of columns, George Winter asks where laughter comes from and why is it hard to find at the Edinburgh Fringe
How effective are specialist nurses?
Authors: Woodward Sue
Published: May 2014

There has been much concern expressed in both the medical literature and the public media recently about the reforms to the training of junior doctors. We have yet to see the full impact of these reforms, and the picture may become clearer once August is upon us. The British Medical Association (BMA) has expressed concern about the latest figures, which show that 34 250 doctors are chasing 18 500 specialist training posts in the UK (BMA, 2007). The government has suggested that those junior doctors who were unsuccessful in obtaining a training place would be able to remain employed in the NHS in staff grade posts, which do not qualify as training posts.
Assessment and management of myasthenic crisis: an evidenced-based approach
Authors: Jacob Saiju , Viegas Stuart , Hilton-Jones David
Published: May 2014

Myasthenic crisis is defined as severe muscle weaknes resulting from defective neuromuscular transmission, and leading to respiratory failure requiring airway protection or respiratory support. This can occur in a known patient with myasthenia or can be the initial presentation in a proportion of patients. Most patients require monitoring andtreatment either in specialized units or intensive care. With improvement of immunomodulatory and intensive therapies, the prognosis of this condition has improved dramatically over the last few decades. The practical aspects of thediagnosis and management of this potentially life-threatening condition are discussed in this article.
Using benchmarking to improve standards of care
Authors: Gandhi Sarla
Published: May 2014

Benchmarking within neuroscience nursing has been growing for over 10 years. We have a number of regional groups who feed back into the national group (3 meetings a year) in order that each regional group takes on the responsibility of developing particular evidence-based benchmarks and there is no reinvention of the wheel. Review dates are set for completed benchmarks (2 years from completion), and another region will review that benchmark for new developments in practice.
Let's play games
Authors: Winter George
Published: May 2014

Each year Edinburgh hosts a variety of official book, fringe, film, jazz and blues, and television festivals. However, one gathering which regularly creeps under the media radar is the Edinburgh Interactive Entertainment Festival (EIEF). Last year the front of its dayglo publicity leaflet featured a generously trousered, baseball-hatted youth who was plainly enjoying some interactive entertainment. It also carried the assurance that the EIEF was ‘the essential event for videogame fans’. Inside it answered its own question (‘Serious about having fun?’) with the exhortation to ‘go play games’.
A better deal for brain tumour patients?
Authors: Pybus Ella
Published: May 2014

Kathy Oliver's comment in the May edition of this journal, ‘Brain tumour treatments: the view of patients and caregivers’ (Oliver, 2007), highlighted the recent campaign during which she and I worked together for NHS-funded access to promising new therapies for high-grade brain tumours. She wrote about living in an era of ‘high-tech’ medicine, where developments are moving faster, and told of being the mother of a brain tumour patient who has benefi ted from recent advances in neurosurgery. She referred to the advances in treatment that benefit patients, and the increasing technological sophistication of operating theatres equipped with such facilities as imageguided surgery, helping to enable maximal resection. Yet, she says, despite these advances, we still have no cure for this devastating and rare cancer.
Sir Ludwig Guttmann: The father of spinal cord injury care in the UK
Authors: Collis Pellatt Glynis
Published: May 2014

Sir Ludwig Guttmann (1899–1980) has been described as the father of spinal cord injury care in the UK. This article traces events in his life that culminated in the opening of the National Spinal Injuries Centre at Stoke Mandeville Hospital. His vision that people with spinal cord injury could survive and eventually return to an independent and fulfilling life revolutionized spinal cord injury management in the UK. The effects of this on nursing care and the foundation of competitive sport for disabled people are discussed.
Book Reviews
Authors: May Lindy
Published: May 2014

This book discusses the legal, medical and social consequences which arise when a baby or young child presents with a suspected non-accidental head injury. It discusses and incorporates empirical research. The book provides a logical and thorough overview of a complex and often emotive subject from a professional and objective stance without any obvious bias.
Keeping watch over the development of CJD
Authors: Bathgate-Smith Blaire , Chohan Gurjit , Knight Richard
Published: May 2014

The prion diseases are a group of rare, invariably fatal, brain disorders affecting both humans and animals. The most common human prion disease is Creutzfeldt-Jakob disease (CJD) which exists in four different subtypes: sporadic CJD, genetic CJD, iatrogenic CJD and variant CJD (vCJD) (Table 1).
An assessment of the ketogenic and modified Atkins diets for controlling epilepsy in children
Authors: Muthugovindan Deivasumathy , Davis Jennifer E , Kossoff Eric H
Published: May 2014

Since 1994, the ketogenic diet has re-emerged as a popular therapy for children with intractable seizures. The ketogenic diet was first created in the 1920s and has shown, in multiple studies, to be efficacious in all age groups and seizure types. The diet consists of very high fat, adequate protein, and extremely low carbohydrate intake, which induces persistent ketosis and can be maintained for several years if necessary. In the last few years, the modified Atkins diet has also emerged as a viable therapy for epilepsy, with similar ketogenic properties but less restriction on calories and carbohydrate content. Additionally, the ketogenic diet has recently been recognized as helpful for neurological conditions other than epilepsy. In this review, the efficacy of the diet, mechanism(s) of action, indications, side effects, and its recent modifications will be discussed.
A David and Goliath struggle
Authors: Winter George
Published: May 2014

When Oliver Wendell Holmes Jr (1841–1935) wrote these words in his Natural Law (1918), I wonder whether he had the Bible in mind. It seems to me that we live in an age of certainty and belief in absolute truth, and nowhere is this more apparent than among religious believers, who cling to their respective texts with a protective, and often disconcerting, zeal. Thus, many of the adherents of Islam, Judaism and Christianity not only hold that divine supervision, uniquely, favours their respective faiths but also that we are all under a permanent, supernatural surveillance. Furthermore, from time to time the faithful promote their respective scriptures as revealed truth, thus saving us the bother of working out acceptable codes of ethics and moral behaviour for ourselves.
Filling the void: Will patients ever be better off?
Authors: Hassall Mandy
Published: May 2014

In response to recent research by Sue Ryder Care, Mandy Hassall asks whether the National Service Framework′s quality requirements can improve patient care in neuroscience
Glatiramer acetate (Copaxone) and its use in the management of relapsing-remitting MS
Authors: Mutch Kerry
Published: May 2014

Multiple sclerosis (MS) affects approximately 85000 people in the UK and is the commonest cause of disability in young adults. About 80% of patients begin with relapsing-remitting MS, where relapses are separated by periods of stability or improvement. A lifetime condition such as MS requires long-term treatment. Therefore, an important concern is to have a treatment that will not only remain effective over many years, but also one that patients find acceptable to use. This article focuses on the use of glatiramer acetate (Copaxone) in the management of MS. Copaxone was licensed in the UK in August 2000 for the reduction of relapse frequency in ambulatory patients with relapsing-remitting MS. This discussion considers the implications for patients′ relapse rates and disease progression of a 10-year clinical trial of glatiramer acetate.
Survey highlights work to be done in service planning
Authors: Thomas Sue
Published: May 2014

Sue Thomas reviews the findings of a major survey by the Parkinson′s Disease Society which shows that access to nursing and neurology specialists needs to be improved
Finding a more secure financial future for MS
Authors: Newbold David
Published: May 2014

David Newbold sets out his analysis of the impact of Payment by Results on MS specialist nursing and argues for an alternative vision for the future
RESEARCH ROUNDUP
Authors: Aird Thomas
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the fi eld of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those whO wish to look at the research in further detail.
The assessment of mood after stroke: A need for improvement in the use of measurement tools
Authors: McGinnes Alison
Published: May 2014

One third of stroke patients suffer from a mood disorder. The psychological wellbeing of patients should be explicitly assessed at key points in the patient's pathway (Intercollegiate Stroke Working Party, 2008). This review aims to examine and bring together the evidence in relation to the assessment of mood in stroke patients. An array of screening tools are used within stroke, three of which were analysed in this review.

The review shows that health professionals have limited confidence and knowledge in detecting and managing the complications of depression and anxiety following stroke. Consideration should be given to ensuring that staff providing this type of care are adequately trained and supervised.
Managing malignant spinal cord compression in a patient with advanced progressive disease
Authors: Whigham Jackie
Published: May 2014

Malignant spinal cord compression is estimated to occur in approximately 5–10% of all patients with cancer and is a major cause of morbidity. It is frequently diagnosed late, by which time damage to the spinal cord has resulted in paraplegia. Signs and symptoms such as new spinal pain especially thoracic, significant change in the nature of longstanding pain, pain described as burning, numbing or shooting, and new difficulty walking should be investigated promptly. Magnetic resonance imaging (MRI) is considered the gold standard investigation providing early diagnosis. Treatment options, radiotherapy surgery or chemotherapy are dependant on the type of malignancy, performance status and life expectancy. The goal of treatment, in most cases palliative, is to preserve or maintain neurological function, reduce pain and optimize a patient's quality of life. This article uses a fictional case study in a patient with advanced disease and highlights how early detection, diagnosis and treatment can improve a patients remaining quality of life.
Dementia: the challenge and importance of diagnosis in Europe
Authors: Bamford Sally-Marie
Published: May 2014

Early diagnosis of dementia can make a big difference to the effective management of symptoms, and boost quality of life. Sally-Marie Bamford discusses the discrepancies in diagnosis across Europe.
Homecare support to improve adherence in multiple sclerosis
Authors: Roper Knowles Mary
Published: May 2014

There are approximately 100 000 people in the UK who have been diagnosed with multiple sclerosis (MS). Long-term adherence by patients to the widely used treatment disease modifying therapies (DMTs) can be a challenge. The aim of this survey was to understand the critical points of contact where homecare support could impact adherence and provide suggestions to improve the homecare support services provided to MS patients. Homecare support is defined as any sponsored patient support programme from a homecare company. Surveys were sent to 5 025 MS patients and 150 MS nurses working within the NHS. Completed survey responses were obtained from 1 868 MS patients (37%) and 42 MS nurses (28%). Patients and specialist nurses reported that training and support in the early stages of treatment could influence adherence, particularly when that training is tailored specifically to the patients’ requirements and unlimited by time and resources.
End-of-life care, dementia and care homes
Authors: Harrison Dening Karen
Published: May 2014

Karen Harrison Dening provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail.
Gastrostomy and ventilatory support for people with motor neurone disease
Authors: Warner Richard
Published: May 2014

Richard Warner provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail.
Transient global amnesia and hemiplegic migraine following MPI with dipyridamole: a case report
Authors: Christie Robert James
Published: May 2014

Myocardial perfusion imaging (MPI) is a common form of cardiac radionuclide testing used in acute coronary syndromes (ACS) to assess myocardial perfusion when the heart is at rest and under stress. Dipyridamole is used in some UK nuclear medicine departments to simulate the effects of physiological stress on the cardiovascular system. This article reports an idiosyncratic reaction experienced by the author’s mother, a 71 year old lady called Sally, following routine MPI with dipyridamole, which manifested as severe headache and an episode of transient global amnesia (TGA), followed by the delayed onset of stroke-like symptoms which were later attributed to a migrainous event. Reference is made to limited evidence within the literature to support the link between dipyridamole and these adverse effects. It is recommendation that pre-MPI screening procedures be adapted to incorporate methods of identifying those patients at increased risk of experiencing a similar adverse reaction to that described.
Sexual dysfunction and multiple sclerosis: part 2
Authors: Ward-Abel Nicki , Hall Joy
Published: May 2014

Sexual dysfunction (SD) is a common but frequently overlooked symptom of multiple sclerosis (MS). It is identified as one of the most distressing aspects of living with MS for both the individual and their partner and can have a negative impact on quality of life. Partners can find living with the physical and/or psychological effects of MS difficult, especially if it affects their intimate relationship. Therefore, intimacy is a particularly important area of sexual interaction that needs to be encouraged, and the patient's understanding of the link between this and sexual desire and sexual activity needs to be explored. Patients want to be provided with the opportunity to discuss their sexual difficulties. Some nurses will never feel entirely comfortable discussing these sensitive issues, although developing a strong therapeutic relationship with the patient helps. Nurses need to source the sexual assessment tools that are available and that they feel comfortable with, as these can help initiate and develop conversations with patients. There is also the need to ensure that the language used within these discussions is appropriate and acceptable to the patient.

This is the second of two articles that aim to demystify SD as experienced by those with MS. It will explore methods of communicating with the patient who is experiencing these distressing symptoms before describing specific assessment techniques that nurses can utilise in their practice. It aims to increase nurses’ knowledge and understanding of SD and provide them with a range of tangible treatment options that can be suggested to the patient. Sexual difficulties are important to many people affected by MS and it is essential that nurses do what they can to recognise, assess, treat and then enable the patient to self-manage them effectively.
Bell's palsy: an overview
Authors: Sarhan Firas , Saif Ahmad , Saif Danah
Published: May 2014

Facial nerve palsies can have a dramatic effect on patients’ quality of life, leaving them permanently disfigured. Bell's palsy is thought to be the most common cause of acute unilateral facial paralysis. Its hallmark is its rapid onset, but the exact aetiology of Bell's palsy remains elusive, with some attributing it to viral, inflammatory or autoimmune causes and others to ischaemia. There is also some controversy as to the appropriate treatment. This article provides an overview of each of these areas, with a view to increasing awareness of this usually temprary but often distressing condition.
Treatment of faecal incontinence: current and emerging therapies
Authors: Schwandner Oliver
Published: May 2014

This article reviews current and emerging treatments for faecal incontinence (FI), focusing in particular on the innovative use of submucosal injection of dextranomer hyaluronic acid as a bulking agent. FI is a common condition that affects up to 21% of adults, and its severity increases with advancing age. It has a significant negative impact on patient quality of life, psychological wellbeing and social life. A variety of treatment modalities, including sacral nerve stimulation, have been shown to be effective in incontinence due to external anal sphincter dysfunction. However, treatment options for passive FI resulting from internal anal sphincter dysfunction are limited; a new injectable bulking agent offers a relatively minimally invasive and technically simple way to treat passive FI more effectively.
Pain associated with multiple sclerosis:epidemiology, classification and management
Authors: Ghaaliq Lalkhen Abdul , Paul Bedford Jonathan , Devina Dwyer Alison
Published: May 2014

Pain is a common and disabling symptom in multiple sclerosis (MS). Current understanding of pain is that it is a complex phenomenon involving cognitive, emotional and behavioural dimensions. A biopsychosocial framework is therefore best used to manage pain, particularly in the context of a chronic disease such as MS that has a significant impact on health-related quality of life. This article describes the epidemiology of MS pain and its common types, particularly neuropathic pain, as well as the evidence for MS pain management strategies. It also outlines a pragmatic approach to the pharmacological management of neuropathic pain and highlights the role of specialist pain services in the management of MS pain.
The pathophysiology of traumatic brain injury: a case study approach
Authors: Leon-Villapalos Clare , McLernon Siobhan
Published: May 2014

Traumatic brain injury (TBI) is an acquired brain injury of sudden onset, caused by a significant impact to the cranium from a sudden external force. The energy exerted by the external force causes intracranial injury owing to distortion of the brain and initiates a cascade of changes at ionic, cellular, metabolic and inflammatory levels. TBI is the leading cause of morbidity and mortality in individuals under the age of 45 years worldwide ( Werner and Engelhard, 2007 ). It is considered a lifelong disease process, as those who survive significant TBI often experience long-term physical disability, neurocognitive deficits and neuropsychiatric sequelae (Masel and De Witt, 2010). It is associated with high socioeconomic costs in terms of both lost income potential and health-care provision, as many of those who survive significant TBI would otherwise be socially and financially self-sufficient. Caring for patients who have suffered a TBI requires nurses to have an in-depth knowledge and clear understanding of the pathophysiology of brain injury. However, there is evidence that nurses caring for this patient group do not perceive that they have a strong knowledge base ( Watts et al. 2011 ). This article aims to explain the complex pathophysiology that follows TBI using a case study approach. Fundamental concepts of intracranial physiology are presented with an explanation of altered cerebral haemodynamics and cellular changes following TBI.
Management of sleep disturbance in multiple sclerosis: a survey of current practice in the UK
Authors: Freeman Jennifer , Cowan Paula , Hourihan Susan , Johansson-Charles Ewa , McDowall Kay , Nock Alison , Rowlands Helen
Published: May 2014

Purpose: This cross-sectional survey explored the management of sleep disturbance by multiple sclerosis (MS) nurses and therapists.

Method: 256 MS professionals were invited to anonymously complete a survey to describe their current practice regarding management of sleep disturbance.

Results: The 181 respondents (71% response rate) worked across a range of settings, typically within a multidisciplinary team (74%) and an MS (58%) or neurology (29%) environment; almost half (44%) had worked in this area for over 10 years. Although most (86%) considered sleep management part of their role, only 9% felt very confident in their knowledge. Relatively few used specific assessment instruments (33%). Varying interventions were used (e.g. advice, fatigue management programmes, exercise), typically on an individual basis (91%).

Conclusions: This survey provides an initial understanding of practice by experienced MS nurses and therapists in the UK. It suggests that their knowledge about management of sleep disturbance, particularly assessment instruments, is limited. Verification of these findings is needed.
Development and implementation of a percutaneous endoscopic gastrostomy (PEG) nursing care plan
Authors: Catangui Elmer J , Mejia Carlito , Amorim Alcina
Published: May 2014

Stroke is a common cause of swallowing difficulty. Problems such as dysphagia may affect a patient's nutrition and hydration status and increase the chance of aspiration pneumonia. In certain situations, therefore, when dysphagia is prolonged, it is necessary to place a percutaneous endoscopic gastrostomy (PEG) tube to facilitate the nutrition and hydration support of patients for whom either oral intake is insufficient to meet their needs or anatomical or neurological abnormalities preclude safe swallowing. Complications of PEG tube insertion include infection, swelling, bleeding, leakage, peritonitis, hyper-granulation and blockage. Many of these can be prevented with meticulous nursing care. PEG-related complication rates were audited on an acute stroke unit. Subsequent to this, a PEG nursing care plan (PEG-NCP) was devised to optimise management and reduce complication rates on the unit.
An exciting era of treatments for relapsing-remitting multiple sclerosis
Authors: Ward-Abel Nicki , Vernon Karen , Warner Richard
Published: May 2014

‘Sustained disease-activity-free’ is now the overarching goal of treatment for multiple sclerosis (MS). Relapsing–remitting MS (RRMS) is still not curable, but it is increasingly regarded as treatable if targeted with disease-modifying therapies early on. It is an exciting time in the MS treatment arena, with a range of licensed drugs available and others poised to enter the market soon. Treatment with injectable products such as beta interferon and glatiramer acetate has been increasingly common since the 1990s; these products have proven efficacy in reducing relapses, conservative side effects and a good risk-to-benefit ratio. In 2006, natalizumab, a targeted monoclonal antibody that is highly efficacious but can be associated with severe adverse events, was licensed as a monotherapy for rapidly evolving severe RRMS. Novel oral drugs with proven efficacy are also emerging. The first of these—fingolimod (Gilenya)—was launched in 2013 and is now used by more than 78 000 people worldwide, and 1500 in the UK. Other oral therapies are under investigation. Although oral therapies offer the potential for increased patient tolerability and convenience, their varying efficacy and tolerability as well as potentially serious side effects need to be considered and monitored to ensure patient safety. The MS nursing role continues to be necessary to ensure that patients are educated regarding realistic treatment expectations and are closely supported and monitored.
Midwives and litigation: allegations of clinical error
Authors: Symon Andrew
Published: May 2014

Later articles in this series will focus on more specific headings such as supervision and the importance of cardiotocographs (CTGs), but I start with a selected overview which will describe
HELLP Syndrome
Authors: Nutt Janice
Published: May 2014

The syndrome of haemolysis, elevated enzymes and low platelets, is potentially fatal (Whittaker and Clochesy, 1986).

In 1982, the acronym HELLP was attributed to this syndrome by Weinstein to call attention to this group of subtle yet potentially deadly findings.
The art of the possible
Authors: Jackson Kate
Published: May 2014

Last month I went to Goole for the official opening of the midwifery home-from-home unit based in the community hospital, some 25 miles from the main maternity unit in Scunthorpe. For those of you who wonder whether trying to change things is worth the effort it should act as in inspiration.
Midwifery education: a crisis in progress?
Authors: Henderson Christine
Published: May 2014

In listening to a number of people, including midwifery educators, one might be forgiven for thinking that midwifery education is in danger of becoming extinct. Education is fundamental to our practice and therefore is an extremely important area for all practitioners. How we train midwives of the future, and how we continue lifelong learning, is the responsibility of all midwives in all spheres of practice. Our education base is fundamental to practice and current concerns need to be debated at all levels.
The midwife in the Northern region's 1993 homebirth study
Authors: Davies Jean
Published: May 2014

A study carried out in the northern region in 1993, under the auspices of a multidisciplinary steering group and funded by the Regional Health Authority, looked at the outcomes of pregnancy in women requesting a homebirth, place of birth, and their experience o exercising this choice. Data were collected from women, their midwives and their GPs.
The demise of the traditional community midwife
Authors: Smith Megan
Published: May 2014

As Changing Childbirth brings new initiatives into the midwifery profession the personal and financial cost of continuity of carer schemes requires urgent review. An enhancement of the role of the traditional community midwife could provide a care system of the highest quality. If so, there is a need to change the indicator of success advocating a known midwife for delivery which necessitates the establishment of team or caseload midwifery.
Consent and choice: the rights of the patients
Authors: Symon Andrew
Published: May 2014

Consent and choice are critical features of modern maternity care, and consent in particular has distinct (but largely well understood) legal implications. Choice may be more problematic in the clinical setting, with practitioners sometimes divided on the question of how much a patient's wishes must be respected.
Pregnancy, childbirth and continence
Authors: Cardozo Linda , Glesson Carmel
Published: May 2014

This article looks at the effect of pregnancy and delivery on the lower urinary tract and stresses the importance of identifying those women who are at risk of bladder damage because of complicated childbirth.