bluuebunny/crossref_metadata_2025 huggingface dataset:
Subclinical Peripheral Neuropathy in Patients With Multiple Myeloma Before Chemotherapy Is Correlated With Decreased Fingertip Innervation Density
Authors: Kosturakis Alyssa K. , He Zijing , Li Yan , Boyette-Davis Jessica A. , Shah Nina , Thomas Sheeba K. , Zhang Haijun , Vichaya Elisabeth G. , Wang Xin Shelley , Wendelschafer-Crabb Gwen , Kennedy William R. , Simone Donald A. , Cleeland Charles S. , Dougherty Patrick M.
Published: August 2014

Purpose

The goal in this study was to determine the incidence of subclinical neuropathy in treatment-naive patients with multiple myeloma (MM) with no history of peripheral neuropathy using quantitative sensory tests (QSTs) and its correlation with innervation density of the extremities using noninvasive laser reflectance confocal microscopy.

Patients and Methods

QST results were collected for 27 patients with a diagnosis of MM and compared with data collected from 30 age- and sex-matched healthy volunteers. Skin temperature, sensorimotor function (grooved pegboard test), and detection thresholds for temperature, sharpness, and low-threshold mechanical stimuli (von Frey monofilaments and bumps detection test) were measured. Meissner's corpuscle (MC) density in the fingertips was assessed using in vivo laser reflectance confocal microscopy.

Results

Patients showed a high incidence (> 80%) of ≥ one subclinical QST deficit. These included increased von Frey, bumps, and warmth detection thresholds as compared with healthy volunteers. Patients also showed increases in cold pain, sensorimotor deficits (grooved pegboard test), and higher overall neuropathy scores. MC density was significantly lower in patients than controls and showed significant inverse correlation with bumps detection threshold.

Conclusion

Patients with MM commonly present with sensory and sensorimotor deficits before undergoing treatment, and these deficits seem to result from disease-related decreases in peripheral innervation density.
Efficacy of Skin-Directed Therapy for Cutaneous Metastases From Advanced Cancer: A Meta-Analysis
Authors: Spratt Daniel E. , Gordon Spratt Elizabeth A. , Wu Shenhong , DeRosa Antonio , Lee Nancy Y. , Lacouture Mario E. , Barker Christopher A.
Published: August 2014

Purpose

To perform the first meta-analysis of the efficacy of skin-directed therapies for cutaneous metastases.

Methods

MEDLINE, EMBASE, The Cochrane Library, and ClinicalTrials.gov databases were searched for reports of prospective clinical studies published between 1960 and 2013 that assessed the response of skin-directed therapy for cutaneous metastases (47 of 2,955 unique studies were selected). Primary end points of the study were complete and objective response rates. Secondary analyses were preplanned and included subgroup analyses by skin-directed therapy, histology, and recurrence rates. Meta-analyses were performed with random-effect modeling, and extent of heterogeneity between studies was determined with the Cochran Q and I2 tests.

Results

After applying exclusion criteria, 47 prospective studies of 4,313 cutaneous metastases were assessed. Five skin-directed therapies were identified: electrochemotherapy, photodynamic therapy, radiotherapy, intralesional therapy, and topical therapy. Among all cutaneous metastases, complete response rate was 35.5% (95% CI, 27.6% to 44.3%) and objective response rate was 60.2% (95% CI, 50.6% to 69.0%). Overall recurrence rate was estimated to be 9.2% (95% CI, 3.7% to 21.2%). Melanoma and breast carcinoma comprised 96.8% of all cutaneous metastases studied and had similar objective response rates (54.5% [95% CI, 48.3% to 60.7%] and 54.0% [95% CI, 48.3% to 59.7%], respectively). Grade ≥ 3 toxicity was reported in less than 6% of patients.

Conclusion

Response to skin-directed therapy for cutaneous metastases is high but heterogeneous across treatment modalities, with low rates of recurrence post-treatment. Treatment was generally well tolerated and conferred improvements in quality of life. Standardization of response criteria for cutaneous metastases and treatment algorithms to optimally use the available skin-directed therapies are needed.
Chemotherapy-Refractory Diffuse Large B-Cell Lymphoma and Indolent B-Cell Malignancies Can Be Effectively Treated With Autologous T Cells Expressing an Anti-CD19 Chimeric Antigen Receptor
Authors: Kochenderfer James N. , Dudley Mark E. , Kassim Sadik H. , Somerville Robert P.T. , Carpenter Robert O. , Stetler-Stevenson Maryalice , Yang James C. , Phan Giao Q. , Hughes Marybeth S. , Sherry Richard M. , Raffeld Mark , Feldman Steven , Lu Lily , Li Yong F. , Ngo Lien T. , Goy Andre , Feldman Tatyana , Spaner David E. , Wang Michael L. , Chen Clara C. , Kranick Sarah M. , Nath Avindra , Nathan Debbie-Ann N. , Morton Kathleen E. , Toomey Mary Ann , Rosenberg Steven A.
Published: August 2014

Purpose

T cells can be genetically modified to express an anti-CD19 chimeric antigen receptor (CAR). We assessed the safety and efficacy of administering autologous anti-CD19 CAR T cells to patients with advanced CD19+ B-cell malignancies.

Patients and Methods

We treated 15 patients with advanced B-cell malignancies. Nine patients had diffuse large B-cell lymphoma (DLBCL), two had indolent lymphomas, and four had chronic lymphocytic leukemia. Patients received a conditioning chemotherapy regimen of cyclophosphamide and fludarabine followed by a single infusion of anti-CD19 CAR T cells.

Results

Of 15 patients, eight achieved complete remissions (CRs), four achieved partial remissions, one had stable lymphoma, and two were not evaluable for response. CRs were obtained by four of seven evaluable patients with chemotherapy-refractory DLBCL; three of these four CRs are ongoing, with durations ranging from 9 to 22 months. Acute toxicities including fever, hypotension, delirium, and other neurologic toxicities occurred in some patients after infusion of anti-CD19 CAR T cells; these toxicities resolved within 3 weeks after cell infusion. One patient died suddenly as a result of an unknown cause 16 days after cell infusion. CAR T cells were detected in the blood of patients at peak levels, ranging from nine to 777 CAR-positive T cells/μL.

Conclusion

This is the first report to our knowledge of successful treatment of DLBCL with anti-CD19 CAR T cells. These results demonstrate the feasibility and effectiveness of treating chemotherapy-refractory B-cell malignancies with anti-CD19 CAR T cells. The numerous remissions obtained provide strong support for further development of this approach.
Rituximab Extended Schedule or Re-Treatment Trial for Low–Tumor Burden Follicular Lymphoma: Eastern Cooperative Oncology Group Protocol E4402
Authors: Kahl Brad S. , Hong Fangxin , Williams Michael E. , Gascoyne Randy D. , Wagner Lynne I. , Krauss John C. , Habermann Thomas M. , Swinnen Lode J. , Schuster Stephen J. , Peterson Christopher G. , Sborov Mark D. , Martin S. Eric , Weiss Matthias , Ehmann W. Christopher , Horning Sandra J.
Published: August 2014

Purpose

In low–tumor burden follicular lymphoma (FL), maintenance rituximab (MR) has been shown to improve progression-free survival when compared with observation. It is not known whether MR provides superior long-term disease control compared with re-treatment rituximab (RR) administered on an as-needed basis. E4402 (RESORT) was a randomized clinical trial designed to compare MR against RR.

Patients and Methods

Eligible patients with previously untreated low–tumor burden FL received four doses of rituximab, and responding patients were randomly assigned to either RR or MR. Patients receiving RR were eligible for re-treatment at each disease progression until treatment failure. Patients assigned to MR received a single dose of rituximab every 3 months until treatment failure. The primary end point was time to treatment failure. Secondary end points included time to first cytotoxic therapy, toxicity, and health-related quality of life (HRQOL).

Results

A total of 289 patients were randomly assigned to RR or MR. With a median follow-up of 4.5 years, the estimated median time to treatment failure was 3.9 years for patients receiving RR and 4.3 years for those receiving MR (P = .54). Three-year freedom from cytotoxic therapy was 84% for those receiving RR and 95% for those receiving MR (P = .03). The median number of rituximab doses was four patients receiving RR and 18 for those receiving MR. There was no difference in HRQOL. Grade 3 to 4 toxicities were infrequent in both arms.

Conclusion

In low–tumor burden FL, a re-treatment strategy uses less rituximab while providing disease control comparable to that achieved with a maintenance strategy.
Apelin Counteracts Vasopressin-Induced Water Reabsorption via Cross Talk Between Apelin and Vasopressin Receptor Signaling Pathways in the Rat Collecting Duct
Authors: Hus-Citharel Annette , Bodineau Laurence , Frugière Alain , Joubert Fanny , Bouby Nadine , Llorens-Cortes Catherine
Published: August 2014

Apelin receptors (ApelinRs) are expressed along an increasing cortico-medullary gradient in collecting ducts (CDs). We showed here that iv injection of apelin 17 (K17F) in lactating rats characterized by increases in both synthesis and release of arginine vasopressin (AVP) increased diuresis concomitantly with a significant decrease in urine osmolality and no change in Na+ and K+ excretion. Under these conditions, we also observed a significant decrease in apical aquaporin-2 immunolabeling in CD, with a cortico-medullary gradient, suggesting that K17F-induced diuresis could be linked to a direct action of apelin on CD. We then examined the potential cross talk between V1a AVP receptor (V1a-R), V2 AVP receptor (V2-R) and ApelinR signaling pathways in outer medullary CD (OMCD) and inner medullary CD microdissected rat CD. In OMCD, expressing the 3 receptors, K17F inhibited cAMP production and Ca2+ influx induced by 1-desamino-8-D-arginine vasopressin a V2-R agonist. Similar effects were observed in inner medullary CD expressing only V2-R and ApelinR. In contrast, in OMCD, K17F increased by 51% the Ca2+ influx induced by the stimulation of V1a-R by AVP in the presence of the V2-R antagonist SR121463B, possibly enhancing the physiological antagonist effect of V1a-R on V2-R. Thus, the diuretic effect of apelin is not only due to a central effect by inhibiting AVP release in the blood circulation as previously shown but also to a direct action of apelin on CD, by counteracting the antidiuretic effect of AVP occurring via V2-R.
Divergent Effects of Oxytocin Treatment of Obese Diabetic Mice on Adiposity and Diabetes
Authors: Altirriba Jordi , Poher Anne-Laure , Caillon Aurélie , Arsenijevic Denis , Veyrat-Durebex Christelle , Lyautey Jacqueline , Dulloo Abdul , Rohner-Jeanrenaud Françoise
Published: August 2014

Oxytocin has been suggested as a novel therapeutic against obesity, because it induces weight loss and improves glucose tolerance in diet-induced obese rodents. A recent clinical pilot study confirmed the oxytocin-induced weight-reducing effect in obese nondiabetic subjects. Nevertheless, the mechanisms involved and the impact on the main comorbidity associated with obesity, type 2 diabetes, are unknown. Lean and ob/ob mice (model of obesity, hyperinsulinemia, and diabetes) were treated for 2 weeks with different doses of oxytocin, analogues with longer half-life (carbetocin) or higher oxytocin receptor specificity ([Thr4,Gly7]-oxytocin). Food and water intake, body weight, and glycemia were measured daily. Glucose, insulin, and pyruvate tolerance, body composition, several hormones, metabolites, gene expression, as well as enzyme activities were determined. Although no effect of oxytocin on the main parameters was observed in lean mice, the treatment dose-dependently reduced food intake and body weight gain in ob/ob animals. Carbetocin behaved similarly to oxytocin, whereas [Thr4,Gly7]-oxytocin (TGOT) and a low oxytocin dose decreased body weight gain without affecting food intake. The body weight gain-reducing effect was limited to the fat mass only, with decreased lipid uptake, lipogenesis, and inflammation, combined with increased futile cycling in abdominal adipose tissue. Surprisingly, oxytocin treatment of ob/ob mice was accompanied by a worsening of basal glycemia and glucose tolerance, likely due to increased corticosterone levels and stimulation of hepatic gluconeogenesis. These results impose careful selection of the conditions in which oxytocin treatment should be beneficial for obesity and its comorbidities, and their relevance for human pathology needs to be determined.
Animal-oriented virtual environments: illusion, dilation, and discovery
Authors: Alicea Bradly
Published: August 2014

As a research tool, virtual environments (VEs) hold immense promise for brain scientists. Yet to fully realize this potential in non-human systems, theoretical and conceptual perspectives must be developed. When selectively coupled to nervous systems, virtual environments can help us better understand the functional architecture of animals’ brains during naturalistic behaviors. While this will no doubt allow us to further our understanding of the neural basis of behavior, there is also an opportunity to uncover the diversity inherent in brain activity and behavior. This is due to two properties of virtual environments: the ability to create sensory illusions, and the ability to dilate space and/or time. These and other potential manipulations will be characterized as the effects of virtuality. In addition, the systems-level outcomes of virtual environment enhanced perception will be discussed in the context of the uncanny valley and other expected relationships between emotional valence, cognition, and training. These effects and their usefulness for brain science will be understood in the context of three types of neurobehavioral phenomena: sensorimotor integration, spatial navigation, and interactivity. For each of these behaviors, a combination of illusory and space/time dilation examples will be reviewed. Once these examples are presented, the implications for improving upon virtual models for more directly inducing the mental phenomena of illusion and space/time dilation will be considered. To conclude, future directions for integrating the use of VEs into a strategy of broader biological inquiry will be presented.
Cytoscape: the network visualization tool for GenomeSpace workflows
Authors: Demchak Barry , Hull Tim , Reich Michael , Liefeld Ted , Smoot Michael , Ideker Trey , Mesirov Jill P.
Published: August 2014

Modern genomic analysis often requires workflows incorporating multiple best-of-breed tools. GenomeSpace is a web-based visual workbench that combines a selection of these tools with mechanisms that create data flows between them. One such tool is Cytoscape 3, a popular application that enables analysis and visualization of graph-oriented genomic networks. As Cytoscape runs on the desktop, and not in a web browser, integrating it into GenomeSpace required special care in creating a seamless user experience and enabling appropriate data flows. In this paper, we present the design and operation of the Cytoscape GenomeSpace app, which accomplishes this integration, thereby providing critical analysis and visualization functionality for GenomeSpace users. It has been downloaded over 850 times since the release of its first version in September, 2013.
Shooting the messenger: the neurobiology of depression
Authors: McCrae Niall , Khan Ehsan
Published: August 2014

Depression is a very common disorder with both psychological and biological manifestations. The prevailing rationale for antidepressant drug treatment is the serotonin hypothesis, but this is no longer accepted as an adequate explanation for depressive disorder. The role of other neurotransmitters such as glutamate may be important, but there is much to be learned. This review considers current evidence for neurophysiological factors in depression, and implications for care and treatment.
Identifying and meeting people's post-stroke emotional needs: a service evaluation
Authors: Platten Melanie
Published: August 2014

Background:

Post-stroke emotional needs were highlighted as going unmet in a recent report by the Stroke Association.

Aim:

To determine local service provision of emotional support.

Method:

Questionnaires were distributed to 200 stroke patients and their carers. The survey aimed to gather information on emotional needs post-stroke and the service people had received.

Results:

A total of 88 sets of questionnaires were returned by post. Some 47% of patients and 35% of carers/relatives felt that their emotional needs had been met by the stroke team. Chi-squared analysis of the data revealed differences in the information, advice and support received by those who felt their emotional needs were met and those with unmet needs.

Conclusions:

Suggestions to improve the service are made, including more frequent use of standardised measures of emotional difficulties, providing more information about emotional impacts of stroke at an appropriate time in recovery and consistently providing service users with the opportunity to discuss emotional difficulties and support needs.
Research Roundup
Authors: Kirkcaldy Andrew
Published: August 2014

Andrew Kirkcaldy 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.
Stress in mental health nurses: comparison of ward and community staff
Authors: Carson Jerome , Leary John , de Villiers Nicollette , Fagin Leonard , Radmall Janet
Published: August 2014

Work place stress is an increasing concern for mental health nurses. This article reports the findings of two research studies of ward and community-based staff, identifying specific stressors. Reducing staff stress levels is essential if patient care is not to suffer.
Body image of patients with ESRD and following renal transplantation
Authors: Beer Jeanette
Published: August 2014

This article, the winner of the 1994 Nuffield award, in association with British Journal of Nursing, examines the need for all health care professionals to appreciate the social consequences and emotional aspects of living with a longterm illness. The treatment therapy for renal patients includes both dialysis (haemodialysis and continuous ambulatory peritoneal dialysis) and transplantation. Although the patients in this study accepted the need for dialysis access, they had considerable difficulty adjusting to the disfiguring changes that occurred to the body.
Drug therapy for patients with rheumatoid arthritis
Authors: Arthur Valerie
Published: August 2014

Many rheumatic diseases such as rheumatoid arthritis are chronic with no known cure. In mild rheumatic disease analgesia and nonsteroidal anti-inflammatory drugs are often sufficient to control symptoms; however, when the disease is severe disease-modifying and antirheumatic drugs are prescribed which are potentially toxic. Nurses have an important role in the monitoring and administration of these drugs.
Ethics and accountability in health visiting
Authors: Naish Jane
Published: August 2014

This article discusses the ethical considerations involved in population-focused work. Identification and selection of appropriate health promotion interventions are also addressed.
Ear syringing: a clinical skill
Authors: Thurgood Kathy , Thurgood Graham
Published: August 2014

Ear syringing is performed by nurses in various care settings. Nurses must ensure that this skill is practised safely. An understanding of the ear's structure and functions must be applied when carrying out this procedure.
Counselling the overdose patient in casualty
Authors: McLaughlin Columba
Published: August 2014

This article investigates the competency of casualty nurses in counselling overdose patients. Significant differences exist between nurses’ competence in counselling an overdose patient as opposed to other patients. Examination of a study raises doubts concerning the casualty nurse's competence in counselling overdose patients. Its implications for theory and practice are outlined.
Children who care: a case for nursing intervention?
Authors: Dearden Chris , Becker Saul , Aldridge Jo
Published: August 2014

A large number of children are providing primary care for family members. This article aims to alert nurses to the issues involved and highlight the plight of these hidden and neglected carers.
Ethical issues in research
Authors: Behi Ruhi , Nolan Mike
Published: August 2014

This article discusses the important issues that researchers need to resolve in order to make research ethically acceptable to all concerned.
Verbal handover reports: what skills are needed?
Authors: Thurgood Graham
Published: August 2014

Nurses require appropriate knowledge, skills and attitudes in order to give and receive verbal handover reports effectively. Reports are important for ensuring and maintaining continuity and quality of patient care, complying with legal and professional requirements and maintaining high team morale. This article will discuss the five main reasons for the importance of handover reports, and suggestions for further study will be made.
A descriptive evaluation of pressure-reducing cushions
Authors: Banks Sylvia , Bridel Jane
Published: August 2014

This article provides a descriptive evaluation of HNE Huntleigh's Vaperm, Multitec and Supatec pressure-reducing cushions in relation to skin response, comfort and posture and their effectiveness in an overall pressure sore prevention strategy.
Shared governance: developing a British model
Authors: Geoghegan Jacqueline , Farrington Andy
Published: August 2014

This article will examine the concept of shared governance and describe the development of a model for a British NHS trust. The philosophy of shared governance will be related to a decentralised style of management and the consequences that this will have for managers and staff nurses. The introduction of shared governance in the USA has realised many benefits. However, limitations have also been illustrated and these will be discussed in relation to the proposed model for Leicester General Hospital.
Hyperbaric oxygen therapy in wound management
Authors: Young Trudie
Published: August 2014

Hyperbaric oxygen therapy is emerging as a possible treatment in wound management. It may be delivered systemically or topically. A review of the literature is undertaken to establish the extent of the research base of this practice.
CAMI: a basis for assessment and support with family carers
Authors: Nolan Mike , Keady John , Grant Gordon
Published: August 2014

This article describes the development of a new index for assessing the coping strategies employed by family (informal) carers. It considers the nature of coping and suggests ways that professional interventions can augment the coping repertoires that carers employ.
Triangulation: the best of all worlds?
Authors: Nolan Mike , Behi Ruhi
Published: August 2014

This article considers the concept of triangulation. The meaning, purposes and types of triangulation are discussed and the barriers to applying this approach are highlighted.
Who regulates the profession?
Authors: Castledine George
Published: August 2014

Most nurses give little thought to the subject of registration and regulation. It was not surprising, therefore, that the UKCC's second International Standing Conference on the Regulation of Nursing and Midwifery went relatively unnoticed last month.
The role of clinical supervision in mental health practice
Authors: Morris Mervyn
Published: August 2014

This article draws on insights from experience in developing and implementing supervision within clinical practice. It provides an introduction to the nature and purpose of supervision as an essentially interpersonal activity and a dynamic process. Rather than describing skills, the aim is to provide a focus on processes that are useful to the understanding of supervision.
Common problems associated with necrotic and sloughy wounds
Authors: Milward Pam A
Published: August 2014

Effective wound management is dependent on the removal or control of causative factors, implementation of systemic support and application of appropriate wound management. This article examines the management of necrotic and sloughy wounds.
Confessions of a migraine sufferer
Authors: Castledine George
Published: August 2014

Tweedledum was heard to say in Alice Through the Looking Glass: ‘I'm very brave really...Only today I happen to have a headache.’
Identifying ‘cause for concern’ clients: the role of the health visitor
Authors: Carr Susan Mary
Published: August 2014

‘Cause for concern’ is an umbrella term used for a multitude of factors that generate concern of some level for the health visitor and often refers to grey or ambiguous situations involving difficult and complex decision-making processes.
Preoperative visiting from the perspective of the theatre nurse
Authors: Alexis Webb Rosalind
Published: August 2014

Many issues surround the concept of preoperative visiting. This article explores these issues in the light of recent research findings which question the benefits of using ‘psychological’ techniques to reduce preoperative anxiety, and examines the strategies in current use.
The politics of specialist/advanced practice: conflict or confusion?
Authors: Brown Roswyn A
Published: August 2014

This article explores the discrepancies between bench marks and the ad hoc development of specialisms. It suggests an agenda for remedying the invisibility of nursing in the shaping of health-care policy. Particular reference is made to the need for nurses to shape future policy on how the nursing workforce should be developed and utilised.
Common problems in wound care: malodorous wounds
Authors: Haughton William , Young Trudie
Published: August 2014

Malodour is a problem for patients with various types of wounds. The problem has a physical and psychological component. Accurate assessment of the cause will facilitate treatment with wound management products that are designed to alleviate the odour.
Student nurses must be supported
Authors: Castledine George
Published: August 2014

In the educational world August is traditionally seen as a holiday period. It is a time to reflect, recuperate and get away from it all. However, for me, this has not been the case.
Homosexuality: a neglected issue in stoma care
Authors: Caldwell Kay
Published: August 2014

Problems of living with an altered body image following stoma surgery have long been recognised, but the specific needs of homosexual patients undergoing such surgery have been largely disregarded. This article examines the ways in which nurses can support their homosexual stoma clients.
Grief: a cognitive-behavioural perspective
Authors: Ricketts Tom
Published: August 2014

Models of grief utilised by nurses remain largely descriptive. This article considers a cognitive-behavioural model of grief and applies it to the problems of morbid grief. Two case studies illustrate how the model may be used to guide interventions.
Assisting patients living with long-term oxygen therapy
Authors: Heslop Angela , Shannon Caroline
Published: August 2014

The nurse has an important role in assisting chronically ill patients disabled by breathlessness to adjust to long-term oxygen therapy. This article provides a simplified summary of the changed physiology necessitating additional oxygen.The focus, however, is on nursing and the educational and rehabilitation strategies that may be used to support patients in living with long-term oxygen therapy.
Opportunities and obstructions for enrolled nurses
Authors: Castledine George
Published: August 2014

Recently I spent a whole day listening and trying to reassure enrolled nurses about their future.
Living wills: how do they inform care?
Authors: Watt Peter
Published: August 2014

Recent publicity about living wills has heightened nurses' awareness about the growing number of completing them. However, there appears to be considerable confusion and growing anxiety about the legality of living wills as documents, the authority they have in informing care, and the role of health-care professionals in using them.
‘Last resort’ dressings for intractable pressure sores
Authors: Lowthian Peter
Published: August 2014

Twenty-five years of recommending dressing techniques for the most intractable pressure sores has taught the author some interesting lessons about the practical problems of wound healing when all else has failed. It is hoped that these personal experiences and opinions will be of some help to the many nurses who are involved in the management of pressure sores and chronic wounds.
Nursing and health education: victim blaming
Authors: Caraher Martin
Published: August 2014

Health education may contribute to creating victims. In this article, the concept of victim blaming, and how the victim role is created, is explored using transactional analysis. Specifically, the Drama Triangle is used as a tool for analysis rather than a model for practice.
A basic guide to the principles of drug therapy
Authors: John Alison , Stevenson Tamsin
Published: August 2014

Why must glyceryl trinitrate tablets be given sublingually? Why can you crush some tablets but not others? Can drug therapy cause red urine? How can suppositories stop vomiting? This article discusses why certain drugs are given by specific routes of administration and examines issues related to drug therapy, giving examples of drugs used in practice. Clinical tutors may wish to use this and subsequent articles for teaching purposes.
Caring for the ‘new’ family in palliative care
Authors: Adam Joan
Published: August 2014

A knowledge of societal changes within the family and bereavement theories increases the nurse's understanding of the loved ones' needs in palliative care. The encouragement of self-awareness and reflective practice facilitates staff to support the new family or patient's partner effectively.
The value of mental health nursing
Authors: Morris Mervyn
Published: August 2014

In a previous issue of the British Journal of Mental Health Nursing (Vol 4(10): 571–86) we took an indepth lookat the eduction of stress in the workplace. Carson et al (1995: p. 579–82) identified the most significant stress factors for nurses as being: ack of sufficient resources, e.g. poor staffing levels; lack of facilities in the community; and having to deal with people waiting for access to services. When situations with castastrophic outcomes occur, e.g. suicide or homicide, one is always confronted with the question: ‘Would this have happened had sufficient resources been available?’
Self-empowerment in health promotion: a realistic target?
Authors: Mackintosh Nici
Published: August 2014

There have been many calls for nurses to adopt a self-empowerment model for health promotion practice rather than continuing to work from the medical model. Continuing with our series on health promotion, this article examines features of the self-empowerment approach and questions whether its goals are achievable.
The development of postgraduate surgical courses
Authors: Crapnell Denis
Published: August 2014

Postgraduate education opportunities for registered nurses working in surgical areas are increasing. Sound course programmes are an essential prerequisite for specialist practice but require effective collaboration between education and clinical managers. This article describes the successful validation and implementation of three postgraduate surgical nursing courses in 1994.
Nurse practitioners: the American experience
Authors: Winson Glenda , Fox Jane
Published: August 2014

Nurse practitioners have been used in the USA for 30 years and have been shown to provide better and more cost-effective care than doctors in primary care settings. Consequently, they are a powerful vehicle for professional change in the current cost-cutting healthcare reforms. This article examines the American experience.
Marketing specialist practice to managers and purchasers
Authors: Notter Joy
Published: August 2014

Specialist nurses need to find a way of describing their practice that leaves managers and purchasers in no doubt about the level of service they offer and the contribution they make to the provision of high-quality care. This article suggests how they might market their expertise.
Hazards of sharps disposal
Authors: Branson Marie
Published: August 2014

The disposal of sharps continues to be one of the most hazardous procedures for clinical staff. This article looks at the dangers encountered and the precautions necessary to ensure the safe disposal of sharps.
The aftermath of suicide
Authors: Morris Mervyn
Published: August 2014

This article discusses the aftermath of a suicide. It describes the patient who died and discusses the review that followed the suicide. Many of the issues raised are relevant to both community-based and hospital-based care.
Suicide: the crisis in the prison service
Authors: Burrow Stephen
Published: August 2014

Suicide presents major management difficulties in the prison service. This article examines factors that contribute towards suicide in prisons and discusses recommendations for tackling the problem more effectively.
Implementing professional profiling
Authors: Kaur Surrinder , Hamer Susan
Published: August 2014

This year, UKCC requirements for maintaining an effective registration will necessitate practitioners keeping professional development details in a personal professional profile. This article describes the former Yorkshire Regional approach in preparing for this event and the workshop experiences.
The impact of reducing junior doctors’ hours on nursing
Authors: Fish Jane
Published: August 2014

In 1993, the Trent Regional Taskforce (TRT) allocated £500000 to hospitals in the region to fund a number of innovative nursing posts (Read and Graves, 1994). These were primarily designed to help reduce the workload of doctors in training. The services that have been established as a result of this project include nurse-led preadmission clinics, minor injury services, emergency psychiatric assessment and cardiology day care.
Reducing bacterial contamination in enteral tube feeds
Authors: Anderton Annette
Published: August 2014

It is well known that enteral tube feeds may become contaminated with bacteria and other microorganisms during preparation and administration and that this may lead to the development of infectious complications in patients. This article describes potential sources and routes of microbial contamination of these feeds and suggests procedures that can be implemented to reduce the risk of contamination.
Men's health promotion in the UK: a hidden problem
Authors: Robertson Steve
Published: August 2014

Health promotion services for men are often medically oriented or sporadic in nature. To meet men's health needs, issues of changing socioeconomic patterns and patriarchal dominance need to be addressed. An understanding of the basis for destructive male lifestyles, combined with innovative health promotion initiatives, must be implemented if men's health is to improve.
Children's understanding of treatment in the A&E department
Authors: Williams Caroline
Published: August 2014

This article focuses on the abilities of a child to understand the treatment given to him/her in an accident and emergency department. Piaget's theory of cognitive development is used as a framework to suggest ways of altering the approach to the child, thus helping to remove possible misunderstandings. This will lead to a reduction in stress and improved care, both for the child and his/her parents.
Opsite Flexigrid
Authors: Williams Clare
Published: August 2014

Opsite has a history dating back to the original work by George Winter (1962), who first demonstrated the value of a moist environment for wound healing. This article describes the development of Opsite to Opsite Flexigrid, incorporating a flexigrid application system.
Breast cancer treatment
Authors: Fentiman Ian S
Published: August 2014

This article reviews the developments in the management and prognosis of women with early breast cancer. Early diagnosis and the relevant therapies are examined and the value of good communication with breast cancer patients is explored.
Nurse management of corneal abrasion
Authors: Knox Keith A , Mclntee John
Published: August 2014

Corneal abrasion is a commonly occurring eye injury accounting for approximately 12.5% of clients seen in the Nottingham eye casualty department. This article describes the anatomy of the cornea and outlines the nurse management and treatment of traumatic corneal abrasion within a clinical setting.
The experience of advocacy 2: a group member's perspective
Authors: Drage Hilary , McNally Steve
Published: August 2014

This article examines advocacy and is written from a client's perspective. Hilary Drage is an experienced selfadvocate and founder member of the Banbury Advocacy Group for Adults with a Learning Disability. Here she gives a personal account of the practice of self-advocacy and the functioning of a self-advocacy group. The article is based on an interview with Steve McNally.
Advantages of primary nursing in geriatric day hospitals
Authors: Booth Joanne
Published: August 2014

This article presents a rationale for the introduction of primary nursing as the most suitable method of organisation in geriatric day hospitals. Working conditions, the status of the nurse within the multidisciplinary team and the opportunities afforded by primary nursing for enhancing the nurse-pàtient relationship are examined.
Are British nurses lethargic?
Authors: Castledine George
Published: August 2014

Christman (1995) recently suggested that the trouble with American nurses is lethargy. He states that: ‘The future image of nurses depends on how quickly and effectively nurses can lose the lethargy that is a major restraining force in their professional growth and development.’
From methodology to method: the building blocks of research literacy
Authors: Nolan Mike , Behi Ruhi
Published: August 2014

Last year, the British Journal of Nursing published a series of articles outlining some of the major concepts underpinning the research process. This article is the first in a second series which will develop further a number of themes. This series begins with a description of broad methodological approaches before moving on to consider specific methods. The main aim is to assist nurses to improve their research literacy so that they may become more informed and critical readers of research. Before beginning the series proper this article identifies some of the main barriers to research utilization and argues that, in order to overcome these barriers, both decision-driven and knowledge-driven approaches are required.
Isolation in BMT: a protection or a privation?
Authors: Dunleavey Ruth
Published: August 2014

Bone marrow transplantation (BMT) is an increasingly important therapy not only in the treatment of haematological oncology, but also of solid tumours. How best to protect the profoundly immunosuppressed transplant patient is controversial. This article presents a brief resume of the literature on isolation in BMT and an account of observations made by the author when visiting a selection of BMT centres in the UK, USA and Canada.
Critically ill patients' perspectives of hope
Authors: Cutcliffe John
Published: August 2014

This study examines critical care patients' perspectives of hope. It focuses on the patients' expression of their experience of hope while being critically ill on a coronary care unit. Using a phenomenological methodology, the data were coded and underwent a thematic analysis. The resulting theory of the critical care patients' perspectives of hope comprised four key themes: hope relative to help; hope interwoven with caring; the presence of hope as synonymous with a personal future; and hope as a coping resource. The researcher believes that hope is of great therapeutic benefit for these critically ill individuals, and that the nurse's role is pivotal in inspiring this hope. Furthermore, due to the often subtle, unobtrusive nature of hope inspiration, these interventions may enhace the more visible, tangible nursing interventions.
The role of the clinical nurse specialist in tissue viability
Authors: Flanagan Madeleine
Published: August 2014

The development of tissue viability clinical nurse specialists in the UK has occurred rapidly and haphazardly over the last decade. Lack of role definition has created ambiguity and additional demands which are not so apparent within more established specialist nurse roles. Many specialist nurses in tissue viability are currently practising without adequate supervision frameworks which may compromise both personal and professional role satisfaction. Evaluation of the specific contribution of tissue viability specialist nurses is problematic for a variety of reasons. These, together with the identification of those factors thought to contribute to role conflict, will be discussed.
A survey of specialist and advanced nursing practice in England
Authors: McGee Paula , Castledine George , Brown Roswyn
Published: August 2014

This report is the result of a 1-year research project which aimed to develop a contemporary account of the expectations of senior personnel in 371 NHS trusts in England with regard to specialist and advanced nursing roles. The main findings covered employment issues, work activities and fields of practice. This study raises many questions about specialist and advanced nursing practice which will form the basis of an ongoing programme of research.
Types of pressure-relieving equipment available: 1
Authors: Fletcher Jacqui
Published: August 2014

This is the first of two articles which consider the practical difficulties in selecting pressure-relieving devices for patients. The selection of pressure-relieving equipment has become increasingly difficult as the number of commercially available products rises. This article reviews the modes of action of the equipment, including alternating pressure and constant low pressure, outlining the differences between individual pieces of equipment. It will also include a brief summary of the factors which are important to acknowledge when selecting seating.
Critical care pathway development: the way forward
Authors: Wigfield Andy , Boon Elizabeth
Published: August 2014

In many NHS trusts throughout the UK, critical pathways are being used as a method of managing patient care, enabling trusts to ensure that patients receive appropriate, high quality, cost-effective care. At the same time they can meet some of the requirements of The Patient's Charter, such as involving patients in decision making and keeping them informed during periods of treatment. This article first describes critical pathways and then discusses briefly the reasons why pathways were developed at the Guy's and St Thomas' Trust, and the stages of development before their introduction.
Childhood cancer — a family crisis 1: the impact of diagnosis
Authors: Heath Samantha
Published: August 2014

There have been substantial improvements in both treatment and survival of childhood cancer in recent decades. However, the diagnosis of cancer in a child still poses a threat to the whole family unit. In this article, the first of a two-part series, the nature, purpose and functioning of the family are explored to suggest how families may perceive a cancer diagnosis in a child. Review of the literature indicates that the level of threat correlates with indicators such as overall family reaction, information and communication, position within the disease continuum, prognosis and the presence of metastatic disease. The second article in this series will discuss the nature of family coping strategies and consider the internal and external influences that prompt family members' responses to a diagnosis of childhood cancer.
Experimental designs
Authors: Behi Ruhi , Nolan Mike
Published: August 2014

This article discusses randomized clinical trials, double blind designs and factorial designs and describes and explains their main requirements. It is shown that the randomized clinical trial is not a different experimental design, but is one that reflects the purpose for and the scale on which the post-test only or pretest/post-test designs are often used. A common method for the prevention of experimenter bias in clinical trials is the double blind trial. Factorial designs make the simultaneous manipulation of two or more independent variables possible, thus producing data about their effect on the dependent variable.
Are nurses still underestimating patients' pain postoperatively?
Authors: Field Linda
Published: August 2014

This article presents an empirical study of nurses’ and patients’ assessment of patients’ pain following surgery. The study aimed to replicate and extend previous research which indicated that nurses tend to underestimate patients’ pain. The independent variables were type of operation, patient gender, time since surgery and nurses’ experience. Results confirmed that nurses give consistently lower pain ratings than patients. The prediction that nurses’ pain ratings would be influenced by the type of operation was not confirmed. Not surprisingly, pain ratings were lower on day four than on day one. The data failed to confirm previous findings that the more junior the nurses the greater pain they infer in their patients. The main conclusion of this research is that nurses continue to underestimate the severity of pain suffered by patients postoperatively.
Guided self-management and patient education in asthma
Authors: Osman Liesl
Published: August 2014

Asthma is a disease characterized by fluctuation in symptom severity which often requires alterations in management in response to symptom changes. Patient awareness and skill in decision making is important for effective self-management of asthma. Patient education helps patients to develop these skills. However, patient education that is based solely on general asthma information is not effective in improving patient self-management. Individual management plans improve patient outcomes in asthma. These asthma management plans give clear guidelines about how and when the patient should vary medication. They provide a basis for discussion and improved communication between the patient and health-care professionals. Management plans use severity of symptoms or peak flow measurements to guide patient action. They also address the concerns of asthma patients, e.g. the need to know how to control their symptoms and to understand how to use their own medication.
Survey of GPs’ views of learning 798 disability services
Authors: Marshall Sue , Martin David , Myles Fiona
Published: August 2014

This survey aimed to examine GPs’ awareness of the learning disabilities services in Sandwell, West Midlands, and their attitudes towards them. Sixty-two per cent of GPs participated in the study which involved completion of a short questionnaire or interview. The questionnaire was either administered to the GP during a short interview, or completed by a GP who returned the completed questionnaire to the researcher. Only information obtained in response to the questionnaire has been used in collating the data for this survey. The results show that GPs are very confused about what constitutes a learning disability and have only a limited knowledge of the specialist services available to this client group; furthermore, where they were aware of the services available, accessing them was often problematic. Reasons for these findings, along with recommendations, are discussed.
Offenders who have a learning disability
Authors: McNally Steve
Published: August 2014

This article examines aspects of the criminal justice system in relation to offenders with learning disabilities. Questions relating to the vulnerability and responsibility of suspects are explored in the light of recent literature. The legal rights of detainees are considered with reference to the Police and Criminal Evidence Act 1984. The role of the ‘appropriate adult’ is reviewed and implications for service workers are explored. Future directions are considered with reference to innovative developments in services. Victims and witnesses will be considered in a subsequent article.