bluuebunny/crossref_metadata_2025 huggingface dataset:
Examine the patient first, then look at the X-ray
Authors: Anderson WR , Davies RJ , Cave APD
Published: May 2014

A56-year-old woman was admitted acutely with sepsis of unknown origin. She described a 2-day history of offensive-smelling urine, rigors and lower abdominal pain. Her axillary temperature was 39.6°C, her white cell count was 24.2x109/litre and a midstream urine analysis showed a large numbers of white cells. She was treated with intravenous antibiotics and subsequent urine culture grew Escherichia coli and Proteus species.

An abdominal ultrasound scan revealed a highly echogenic linear structure within the bladder (Figure 1). Plain abdominal radiography indicated that this was a clinical thermometer (Figure 2).

Once clinically stable, she proceeded to cystoscopy under general anaesthetic, with endoscopic extraction of an intact but highly-encrusted mercury thermometer (Figure 3). Her subsequent recovery was uneventful.

The patient adamantly denied placing the thermometer within her own bladder. Instead, she believed that someone had mistaken her urethra for her anus when measuring her rectal temperature several years earlier. However, the most interesting feature of this case is not the X-ray appearance itself. Most notably, it was discovered that, while living elsewhere, her previous GP had organized a plain abdominal X-ray 1 year beforehand to investigate her recurrent urinary tract infections. This film was reported as being normal, but the following comment was made:

‘The patient appears to have been lying on a thermometer when the X-ray was taken. This is an artefact.’

No further tests were ordered at that time as her symptoms subsequently settled.
Tacrolimus ointment for the management of atopic dermatitis
Authors: Rustin Malcolm
Published: May 2014

The management of atopic dermatitis is set for a major shift with the introduction of the first new topical treatment for the condition in 40 years – the non-steroidal topical immunomodulator tacrolimus (Protopic®). Backed by strong clinical data, tacrolimus ointment is a valuable addition to topical steroids in the management of moderate-to-severe atopic dermatitis.
The role of the nurse in behavioural therapy (biofeedback)
Authors: Duncan Julie , Wright Jacquie , Butcher Lesley
Published: May 2014

The clinical nurse specialist plays an essential role in the treatment of patients with functional bowel disorders, a group of patients who are traditionally difficult to manage medically or surgically.
Management of premenstrual dysphoric disorder
Authors: Brechin Susan , Owen Philip
Published: May 2014

Premenstrual dysphoric disorder is a complex disorder characterized by severe physical and psychological symptoms. The pathophysiology and effective treatment of premenstrual dysphoric disorder are presented. Evidence for the effective treatment of premenstrual dysphoric disorder by correction of neuroendocrine abnormalities or suppression of cyclical ovarian activity is reviewed.
Occupational disorders and their diagnosis
Authors: Tamin Jacques
Published: May 2014

There are government targets for reductions in the incidence of work-related diseases. Legislation regarding control of workplace exposures will be described with specific reference to chemicals. Knowledge of such exposures is key in diagnosing whether a condition could have an occupational cause.
Leuprorelin: a leading role in advanced prostate cancer therapy
Authors: Persad Raj
Published: May 2014

Leuprorelin is a luteinizing hormone-releasing hormone analogue, licensed in the UK for the treatment of advanced prostate cancer. This review highlights the efficacy and tolerance of this agent and the benefits provided for developing patient-centred therapy and optimizing patient quality of life.
Strangulated hernias secondary to generalized peritonitis: an old lesson relearnt
Authors: Courtney Edward DJ , Melville David , Leicester Roger J
Published: May 2014

A78-year-old woman presented to the accident and emergency department having collapsed at home. She was fully conscious and had no neurological deficit. Abdominal examination revealed a soft upper abdomen, suprapubic tenderness on deep palpation and a 4×5 cm hard, tender, irreducible swelling at the left mid-inguinal point. Investigations revealed a raised white cell count of 19.5×109/litre and a markedly elevated C-reactive protein of 437 mg/ml. A plain abdominal film (Figure 1) showed several gas-filled loops of small bowel in the lower abdomen and faecal loading of the colon. Suspecting a strangulated hernia, she was taken to theatre for exploration of the left inguinal mass. An irreducible left femoral hernia was found, the hernial sac containing necrotic omentum with pus draining from within the peritoneal cavity. A midline laparotomy was performed, finding generalized peritonitis secondary to perforated appendicitis with approximately 300 ml of pus in the pelvis. An appendicectomy and thorough peritoneal lavage was performed. The hernia was repaired through the abdominal incision and the groin wound closed. Initially she recovered well, but then developed a metabolic acidosis with no obvious cause, a epeat laparotomy proving negative. Unfortunately she had a large perioperative stroke and died a few days later.
The working day in medicine: lessons from the air
Authors: Castelló Ana , Verdú Fernando
Published: May 2014

This article discusses whether it would be wrong to explain a mistake involving medical responsibility on the basis of an opinion that the professional was not in the optimum physical or mental state at the moment the mistake took place.
Cardiopulmonary resuscitation: attitudes and perceptions of junior doctors
Authors: Scott Glyn , Mulgrew Emma , Smith Tom
Published: May 2014

Many junior doctors feel cardiac arrests are unsatisfactorily managed and experience high levels of stress during the procedure, often feeling they are inadequately trained for the task. Juniors also regard ‘do not resuscitate’ orders as decisions for teams, not individuals.
The use of botulinum toxin in head and neck disorders
Authors: Hawthorne Maurice R
Published: May 2014

Not only can botulinum toxin be used for cervical and laryngeal dystonia but in this article its use and complications in the management of oromandibular dystonia, Frey's syndrome, crocodile tears and drooling is described.
Traumatic dislocation of the fourth metatarsophalangeal joint
Authors: Dawson James S
Published: May 2014

A32-year-old man presented to the accident and emergency department 2 hours after twisting his ankle. He had been running down stairs, barefoot, and missed a step, inverting his left ankle and landing on the lateral aspect of his left foot before falling to the ground. He was weight-bearing on his left heel, but complaining of intense pain over the lateral aspect of his forefoot. He mentioned that his wife had noticed a dimple on the sole of his foot. Besides the dimple on the plantar aspect of the left foot, about 2 cm proximal to the base of the fourth toe, no other deformity, swelling or bruising was evident. The patient was markedly tender over the dorsum of the foot over the area of the fourth metatarsophalangeal joint and over the dimple, which marked the same place on the plantar surface. Distal sensation and capillary refill were normal.
The cost of national service frameworks
Authors: Boyle Roger
Published: May 2014

A bleak view of the programme of the Government’s national service frameworks (NSFs) might suggest that they create a great deal of hard work for clinicians and divert resources away from one’s own particular interest. Another view suggests that, together with the Cancer Plan, they have been a major lever in bringing about real improvements in the care of many patients being treated by the NHS.
Cerebral sinus thrombosis in a young adult with activated protein C resistance and homocysteinaemia
Authors: Ghalib Mohammad BM , Hassan Imad SA
Published: May 2014

A man of 28 years of age with no past history of note was admitted with a history of progressive severe diffuse headache, nausea, vomiting, blurring of vision and diplopia of 3 weeks' duration. He denied any fever or recent head trauma and had no preceding ear, nose or throat symptoms. He occasionally experienced oral ulcers, usually when he missed his routine daily brushing of his teeth. He denied having any genital ulcers. He never smoked and did not drink alcohol. He had a brother who died at a young age from possible thrombosis. His mother developed leg deep venous thrombosis after her first child was born. His father was diabetic. He worked as an interpreter. On examination, he looked ill and was slightly drowsy. He was afebrile, in sinus rhythm and normotensive. The major findings were confined to the nervous system. He had bilateral sixth nerve palsy and bilateral papilloedema, more pronounced on the right side. There were no other neurological signs. Ear, nose and throat examinations were normal.

Magnetic resonance imaging of the brain showed a right sigmoid and superior sagittal sinus thrombosis with no cerebral infarction (Figures 1, 2 and 3). Full blood count, erythrocyte sedimentation rate, liver, renal and thyroid function and glucose levels were all normal. His vitamin B12 level was 694 pg/ml (normal 180–710 pg/ml). Autoantibodies including antinuclear antibodies, double-stranded DNA and antineutrophil cytoplasmic antibodies were negative. Cryoglobulins, anticardiolipin antibody, haemoglobin electrophoresis, immunoglobulin levels, antithrombin III, protein C and protein S were all normal or negative. Homocysteine level was markedly raised (confirmed on repetition) at 48.5 μmol/litre (normal <10.3 μmol/litre). Activated protein C ratio was low (less than 2) suggesting resistance. Genotypic confirmation for factor V Leiden mutation was not possible.

He was fully anticoagulated with intravenous heparin and later warfarin was started. The international normalized ratio was kept between two and three. Dexamethasone at a dose of 4 mg intravenously 6-hourly was added initially and slowly tapered over a 3-week period. He gradually improved with complete resolution of his headaches, ocular palsies and papilloedema.
Should all day-case anaesthesia patients be given prophylactic antiemetics?
Authors: Dering Andrew , Dill-Russell Patrick
Published: May 2014

As the safety of anaesthesia has improved, anaesthetists are judged increasingly by quality indicators, such as management of postoperative pain or postoperative nausea and vomiting (PONV). While it would be reassuring to believe that the use of prophylactic antiemetics would eliminate PONV, this is not true. The decision whether to give prophylactic antiemetics to prevent PONV must be based on risk–benefit analysis and cost effectiveness.
Intermediate care and diversity: principles and practice
Authors: Singh I , Vilches A , Gupta RC
Published: May 2014

The last few decades have seen a dramatic reduction in the number of hospital beds, despite the UK being an ageing society and the elderly being major users of hospital resources. The National Beds Inquiry (Department of Health, 2000a) and the British Geriatrics Society’s (2001) bed-blocking surveys confirmed the lack of sufficient community alternatives to hospital care, inappropriate use of hospital beds, and delays in hospital discharges as key factors for the high numbers of people who stay in an acute hospital longer than is desirable. At the same time the expectations of patients and their families have risen, and it is therefore easy to understand how many medical departments struggle to cope with large numbers of sick older people.
Vaccination metastasis following percutaneous endoscopic gastrostomy
Authors: Raman S , Siddiq TO , Joseph A , Jones AH , Masoud AG , Haray PN
Published: May 2014

A 72-year-old woman presented in April 2001 with a history of progressive dysphagia to solids of 4 months’ duration with associated weight loss. An initial gastroscopy was unsuccessful. Examination under anaesthetic by the ear, nose and throat surgeons revealed a fungating, posterior hypopharyngeal wall tumour extending to the lateral walls of both pyriform fossae and up to 22 cm of the cervical oesophagus distally (Figure 1). Histology of the lesion showed it to be a squamous cell carcinoma. Computed tomography of the neck showed bilateral involvement of level 3 and 4 cervical lymph nodes and the tumour was staged as T4 N2. A decision was made to treat the patient with chemoradiotherapy because the tumour was large and exophytic.

On May 1 2001, a Freka® (Fresenius Kabi, Hamburg, Germany) percutaneous endoscopic gastrostomy (PEG) tube was placed under anaesthetic, using the pull (Ponsky-Gauderer) technique, for feeding purposes before the planned oncological management. Between May and December 2001, the patient underwent a course of chemoradiotherapy. This period was complicated by neutropenic sepsis, mucositis, confusional state and peripheral neuropathy (secondary to cisplatin therapy), but responded to conservative management. A computed tomography scan of the head excluded cerebral metastases.

Follow up in January 2002 showed complete clearance of the hypopharyngeal tumour and hence a decision was made to wean her off the PEG feeding and encourage an oral diet. At the time of removal of PEG tube in April 2002, nearly a year after insertion, the PEG site appeared to show an overproliferation of granulation tissue (Figure 2). This was surgically debrided, and histology showed this to be a well-differentiated keratinizing squamous cell carcinoma (Figure 3) identical to the primary hypopharyngeal lesion, raising the possibility of tumour implantation secondary to the pull technique used for PEG tube insertion. Gastroscopy confirmed tumour infiltration (Figure 4) into the lumen of stomach, and biopsy of this also proved to be of squamous cell carcinoma.

Further staging investigations revealed the advanced nature of the tumour with liver metastases and hence she was referred for palliative radiotherapy. Radiotherapy alleviated the malodour from the tumour and also bleeding and overproliferation. She died peacefully in October 2002, about 6 months after the diagnosis of the stomal site cancer.
Use of the laryngeal mask airway in the prone position
Authors: Usher Stephen
Published: May 2014

The prone position is a challenge to the anaesthetist because of the inaccessibility of the airway once the patient is turned. Traditionally the patient is intubated supine and the endotracheal tube (ETT) well secured so that the airway will not be compromised during the procedure. The patient is then repositioned, with care being taken to protect pressure points and to allow free movement of the abdomen so as not to compromise ventilation or cardiovascular stability. More cases are now being performed as day case surgery so increasing the need for rapid turnover of patients and the need for low morbidity during the anaesthetic.
Emergency management of collapsed infants
Authors: Lister Paula
Published: May 2014

Infants have a limited repertoire of clinical signs in severe illness. Lethargy, respiratory distress, apnoea and poor perfusion can result from a wide spectrum of disorders. Fortunately for the emergency physician, the resuscitation of infants with respiratory and/or circulatory collapse remains universal for all aetiologies (Table 1). Investigations can be initiated during the stabilization of the child that will narrow the differential diagnosis. This article will discuss the resuscitation of collapsed infants, the causative disorders in the first few weeks of life, their early investigation and management.
Bilateral simultaneous spontaneous rupture of the Achilles tendon
Authors: Mehra A , Maheshwari R , Case R , Croucher C
Published: May 2014

Ciprofloxacin is an antibiotic with a broad spectrum of activity. It belongs to the fluoroquinolone group, which are relatively safe and effective antibacterial agents. The adverse reactions most commonly occur in the gastrointestinal tract, skin and the CNS (Ball et al, 1999). Its use is restricted in children because of the risk of damage to the cartilage. Inflammation and rupture of the Achilles tendon is a rare but potential side effect of fluoroquinolones (Jorgensen et al, 1991; LeHuec et al, 1995; Ball et al, 1999; van der Linden et al, 1999).
Adhesions: the cellular science
Authors: Menzies Don
Published: May 2014

Failure of fibrinolysis of the inflammatory fibrin exudate which appears following peritoneal trauma allows fibroblast in-growth and neovascularization of the fibrinous adhesion to develop a fibrous adhesion.
Copying letters to patients: are we ready yet?
Authors: Vaidya, G
Published: May 2014

Four years ago, The NHS Plan (Department of Health, 2000) made it obligatory for letters to GPs and other health professionals to be copied to patients. Draft guidelines for consultation have been issued and pilots across England and Wales have been completed (Meredith, 2002). While the idea has been generally welcomed (Chantler and Johnson, 2002; Lloyd, 2004), concerns remain around training of health professionals and their fear of causing unexpected distress among patients (Murray et al, 2003).
The keys to success
Authors: Mills Steve
Published: May 2014

William Ransom School has won numerous national level awards and is seen as an excellent educational establishment in
Cloud computing: Look beyond the silver lining
Authors: Williamson Paula
Published: May 2014

Cloud computing may save money but choose the wrong cloud service provider and the school could find itself in breach of the Data Protection Act. Paula Williamson and Harvey Davies look at the possible pitfalls
Government-funded, privately provided
Authors: Botton Oli de
Published: May 2014

With government-funded, privately provided schools a growing feature of education systems around the world, the CfBT Education Trust has carried out research into what works and why. Oli de Botton explains
Removing barriers for BME pupils
Authors: Tanner Linda
Published: May 2014

Are schools doing enough to meet the needs of their increasingly diverse population? Linda Tanner reports on programmes that have been proven to make the difference for Black and minority ethnic children
Data protection – legal advice for schools
Authors: Foster Ros
Published: May 2014

A survey of 1,000 schools has found that around half have inadequate policies on data protection and security. Expert Ros Foster looks at the challenges facing schools and the need for many to update their policies and practices on managing data
Working with your parents
Authors: Bannister Nick
Published: May 2014

Nick Bannister reviews some recent research and talks to primary leaders about how schools can take their parental engagement to the next level
Homework: To set or not to set…
Authors: Lepkowska Dorothy
Published: May 2014

While one union has branded homework a waste of time, many others argue the benefits. With government guidelines scrapped, Dorothy Lepkowska looks at the pros and cons of setting homework
A strategy for school nursing
Authors: Voogd Caroline
Published: May 2014

The government has published its long-awaited strategy for the future of school nursing. Caroline Voogd, editor of the British Journal School Nursing, offers her analysis
School exclusions and the SEN expert
Authors: Wilkins Richard
Published: May 2014

Independent SEN experts are playing an increasingly common role in exclusion processes. Legal expert Richard Wilkins explains more
Embedding Comic Relief across the curriculum
Authors: Higgins Emma
Published: May 2014

With Comic Relief approaching, headteacher Emma Higgins explains why and how her school makes charity fundraising an integral part of the school year and how it can tie in to the curriculum
Investing in film education
Authors: Middleton Janice
Published: May 2014

The British Film Institute is investing £26 million in a unified programme of film education. Headteacher Janice Middleton explains
Five ideas to get pupils reading
Authors: Cooper Martin
Published: May 2014

Promoting reading and improving literacy is an on-going challenge for all primary schools. Deputy head Martin Cooper looks at five approaches that have proven successful at his school
Beating head lice in four steps
Authors: Brown Christine
Published: May 2014

Former school nurse Christine Brown offers four steps schools can take to win the fight against head lice this September
Case study: Supporting transition
Authors: Lockwood Christine
Published: May 2014

Using its Pupil Premium funding, Frederick Bird School has engaged the services of clinical and educational psychologists as part of its work to help prepare their year 6 pupils for transition to secondary school. Headteacher Christine Lockwood explains
Teaching on the Falkland Islands
Authors: Potter Emma Lee
Published: May 2014

Tom Hill has been head of a 260-pupil infant and junior school delivering the English curriculum for two years. Nothing unusual about that – other than its location. Emma Lee Potter caught up with him
Booktime – Page-turning learning
Authors: Weaving Harriet
Published: May 2014

As pastimes go, reading has to compete hard for children's attention these days, but research suggests that the gift of a book still has the power to excite. Harriet Weaving explains
Case study: Creating Good Learners
Authors: Thomson Heather
Published: May 2014

The Good Learner project at Inkberrow First School has for the past three years focused on improving children's learning skills. Heather Thomson and Sharon Cole explain
Avoiding common mistakes on grant applications
Authors: Ellery John
Published: May 2014

Filling in grant applications is much harder than many of us think. Expert Jon Ellery offers some advice on avoiding common mistakes on application forms
Getting the whole school singing
Authors: Sheppard Penny
Published: May 2014

Becoming a ‘singing school’ can have a range of knock-on benefits. Penny Sheppard, headteacher of Queen's Hill Primary, explains why and how she has embedded singing in every aspect of school life
Primary curriculum – the debate continues
Authors: O'Connell Suzanne
Published: May 2014

It seems everyone has an opinion about the draft primary school curriculum. The consultation has now closed and as we await the final document, Suzanne O'Connell listens to what has been said so far
Raising the primary standards bar, again
Authors: O'Connell Suzanne
Published: May 2014

Just when schools thought they were safe, the floor standards have been raised again. Suzanne O'Connell looks at what the new expectations will mean for primary schools
Ensuring strong primary school governance
Authors: Hanson David
Published: May 2014

In the face of the many challenges embroiling education, David Hanson looks at why and how strong governance, and good working relationships with headteachers, can help schools to be successful
Achieving Ofsted outstanding for Quality of Teaching
Authors: O'Connell Suzanne
Published: May 2014

Quality of teaching is key to a positive inspection outcome. In the second of our series focusing on Ofsted's four core indicators, Suzanne O'Connell speaks to four schools who have been graded outstanding for their teaching quality
Independent learning, resilience and reflection skills
Authors: Willmott Alison
Published: May 2014

Two schools have taken some creative approaches to helping their pupils become more independent, resilient and reflective. Alison Willmott reports
The shifting sands of safe-guarding
Authors: Durbridge Dai
Published: May 2014

Safe recruitment is a constant concern for schools and an ever-changing statutory regime and lack of guidance don't help. With new changes in force since September and more expected this spring, Dai Durbridge offers his advice
Ten steps to successful school fundraising
Authors: Gordon Rachel
Published: May 2014

Squeezed budgets and government cuts have made life difficult for schools and placed a new importance on raising additional monies locally. Rachel Gordon offers 10 dos and don'ts for successful school fundraising and bid-writing
Spending the Pupil Premium well in primary schools
Authors: Henshaw Pete
Published: May 2014

Ofsted's latest report into how schools are spending the Pupil Premium finds that while more schools are using the funding effectively, a ‘significant minority’ are still struggling. Pete Henshaw takes a look
Introducing peer observation to primary school staff
Authors: Donohoe Tom
Published: May 2014

The introduction of a peer observation programme at Anton Junior School has led to a much stronger focus on pedagogy, improvements in teaching and learning, and has been embraced by staff. Headteacher Tom Donohoe looks at how this has been achieved
Health schools – A focus on food
Authors: Frostick Helen
Published: May 2014

After the publication of the School Food Plan, new food standards are being introduced. Helen Frostick explains how her school ensures healthy eating and food education is an engaging experience for their pupils.
Putting in-school research into action
Authors: Palmer Lindsay
Published: May 2014

Lindsay Palmer and Nicola Theobald describe their collaboration to promote professional learning through school-based research and innovation.
In it together – running a Teaching School Alliance
Authors: Bretherton Marie-Claire
Published: May 2014

What is it like to run a Teaching School Alliance? Marie-Claire Bretherton describes the opportunities that working as part of a 27-strong Teaching School Alliance has presented and some of the challenges they have faced.
Making the most of educational apps in your classroom
Authors: Handley Tim
Published: May 2014

Ahead of his CPD session at the Bett Show 2014 this month, Tim Handley (alongside some of his pupils) looks at how teachers can make the best use of apps and lists some of his pupils' favourites.
HLA-B27 positivity: associated health implications
Authors: Cox Carol L. , Gibbons Helen , Evans Patricia , Withers Timothy P. , Titmuss Karen
Published: May 2014

HLA-B27 positivity makes the onset of autoimmune diseases such as uveitis, ankylosing spondylitis and Crohn's disease more likely to occur. Ankylosing spondylitis and Crohn's disease are two types of HLA-B27 positive diseases that demonstrate a direct association with uveitis. Although the possession of HLA-B27 positivity is not mandatory for autoimmune diseases such as uveitis to occur, HLA-B27 positivity not only makes it more likely but may modify the clinical picture in which a patient presents. In relation to assessment and diagnosis it is imperative that the medical history of patients is thoroughly examined to ensure pathological sequelae are appropriately treated. Nurses play an important role in assessing patients that have uveitis and should suspect ankylosing spondylitis or Crohn's disease may be present.
Public health knowledge of glaucoma: implications for the ophthalmic nurse
Authors: Seewoodhary Ramesh , Watkinson Sue
Published: May 2014

Glaucoma is the second leading cause of blindness in the world.The disease is progressive and it destroys the optic nerve fibres. Public health knowledge of this eye disorder is varied and many sufferers have little or no knowledge about glaucoma. This is demonstrated by a study by Baker and Murdoch carried out in 2004 in West London and the Isle of Wight.The role of the ophthalmic nurse is important to educate patients and their family members as soon as a diagnosis is made. Understanding the patient's health beliefs and attitudes is essential in promoting concordance. Patients must make full use of learning resources and opportunities by becoming more actively involved. Patient empowerment through a multidisciplinary team approach is very important in managing this silent disease that robs many people of their valuable sight.
Contact lens related microbial keratitis – avoidable blindness
Authors: Tallouzi Mohammad , Khodabukus Rehana
Published: May 2014

Aim: The aim of this article is to review the literature on microbial keratitis, exploring the pathophysiology, causes, diagnosis, and management strategies of this ocular condition which can lead to blindness and can be avoided. The main focus is contact lens-related microbial keratitis. The author analyzed some statistics for this condition from his work place (Birmingham and Midland eye hospital) in order to provide an indication of the number of patients attending the eye hospital with contact lens-related microbial keratitis and non contact lens-related microbial keratitis.

Methods: Extensive review of the literature on microbial keratitis and a retrospective review of all cases with contact lens-related microbial keratitis over a period of 4 months (August 2010 and November 2010). Case files were retrieved and relevant information was extracted and analyzed.

Results: The data collected indicated that 192 patients attended the eye casualty with contact lens-related problems. Out of these 110 cases were diagnosed as infective microbial keratitis and were treated with intensive antibiotics.

Conclusion: Microbial keratitis is one of the main eye traumas for people using contact lenses and can lead to blindness. One feature of bacterial keratitis is rapid progression if left untreated — microbial keratitis is a true ocular emergency that requires immediate and intensive evaluation and treatment. Understanding the pathophysiology of microbial keratitis and its relationship to contact lenses is key in choosing the right treatment and ensuring a good prognosis.
A practical guide to eyelid eversion
Authors: Rodger Susan , Gibbons Helen
Published: May 2014

Eyelid eversion is a common procedure carried out during ophthalmic examination. It is part of the routine examination of patients attending with a foreign body sensation or a ‘lost’ contact lens and is a vital part of eye irrigation. Ophthalmic practitioners should be confident that they can carry out this procedure safely and easily.
Contact lenses and teenagers
Authors: Speedwell Lynne
Published: May 2014

Teenagers' contact lens requirements differ from those of adults. The reasons for wanting lenses are similar, but the emphasis varies. Extra caution is needed when fitting adolescents due to the difference in their attitude to lenses and lens care and also to hormonal effects. The practitioner must explain to both the patient and their parent about the choice of lenses and the importance of lens hygiene. Information must be given in a format that will be of interest to a teenager if it is to have the desired effect.

On the whole teenagers do well with contact lenses, which not only provide a visual aid, but also improve self perceptions and boost self confidence as they mature. This article discusses the aspects that must be considered for teenage patients and ways of overcoming problems that can occur.
Assessing reading and visual processing skills of young struggling readers: a pilot study
Authors: Northway Nadia
Published: May 2014

Aim: A pilot study was conducted between September 2010 and May 2011 to determine the nature of visual processing problems that might be affecting children aged 7–9 who were struggling to learn to read.

Methods: A full eye test and binocular vision assessment were conducted. In addition assessment for visual stress using coloured overlays and a measure of reading level and speed were taken.

Results: The results showed that about one fifth of the children had problems with binocular vision and/or visual stress and that correction of these visual difficulties had a positive effect on reading development. The possible benefits may differ depending on the nature of reading difficulties, for example slow but average readers gained in reading speed, whereas children with low reading levels saw improvements in level rather than speed gains.

Conclusions: It would appear that assessing visual processing by eye care professionals is recommended due to the high number of children who had binocular vision problems and visual stress who were struggling to learn to read.
Fundus autofluorescence — with the Canon CR-2 PLUS
Authors: Månsson Mirjam , Brautaset Rune , Ramsay Marika Walberg , Nilsson Maria
Published: May 2014

The aim of this report is to describe the principles of the fundus autofluorescence (FAF) technique, and to illustrate common findings in normal and abnormal ocular conditions by presenting both colour and FAF images captured with the Canon CR-2PLUS™. The colour and FAF images are discussed in relation to scientifically published reports on FAF findings in similar ocular conditions and with other FAF cameras.

Based on our experience the FAF images should be regarded as a supplement to colour fundus images and has highest relevance when it comes to slow progressing conditions rather than acute conditions. At present the knowledge about what FAF shows and how it should be interpreted is broad, and it seems likely that the technique will have a future not only in research and highly specialized retinal evaluations, but also in daily clinical work.
Visual fields: why they matter and tips to improve quality
Authors: Bull Susan
Published: May 2014

Most patients, and indeed many operators, dislike visual fields. This article looks at why this is so, what can be done to ameliorate the difficulties and why doing fields well is essential. Practical tips to improve test quality will be discussed. The article will focus on the Humphrey field analyzer but other methods will be mentioned and the principles apply to fields testing of any type.
Chemical eye injury: basic science and implications for practice
Authors: Smith Joy , Marsden Janet
Published: May 2014

This article discusses the basic science associated with a chemical eye injury caused by an alkaline substance. It uses the case of Mr P who presented to an ophthalmic emergency department having sustained an injury caused by wet plaster having fallen into his eye, to link the basic science to the care and treatment of a patient. Having a knowledge of the basic science underpinning ophthalmic injury and disease enables practitioners to understand the mechanisms involved and, therefore, enables them to choose the most appropriate, evidence-based care and treatment.
Prevention of nosocomial adenoviral keratoconjunctivitis
Authors: Cook Catherine
Published: May 2014

A literature review of nosocomial cases of adenoviral keratoconjunctivitis was undertaken to identify the preventative measures that could assist ophthalmic teams in minimising the risks associated with management of the infectious patient. In addition to the published actions, the use of surveillance to continually monitor and action changes in trend is advocated as an important preventative measure.
Vision aids: products for patients
Authors: Woodward Caroline
Published: May 2014

This article explores a small selection of the many products that are designed specifically to help blind and partially sighted people. These products can play an important role in helping people with sight loss to carry out everyday tasks and activities. It is vital that people with sight loss are made aware of the range of vision aids so that they can benefit from them.
St John Eye Hospital, Jerusalem: an optometrist's experience
Authors: Dilley Joanna
Published: May 2014

With the help of the Royal College of Ophthalmologists, in August 2013, Joanna Dilley, a qualified optometrist and a 4th-year medical student at Barts and The London Medical School was lucky enough to have the opportunity to visit the infamous St John Eye Hospital in the unsettled city of Jerusalem, Israel. This hospital is dedicated to providing access to eye care for many, including Palestinians living in the occupied Palestinian territory. In this article, Joanna reviews her experience and provides a snapshot of the day-to-day challenges faced by staff and patients at this inspiring hospital.
‘A good candidate’: how to make the right impression at interviews
Authors: Gibbons Helen , Nemeth Tina
Published: May 2014

Interviews are an opportunity to demonstrate to a future employer your knowledge, skills and why you should be chosen above the other candidates being interviewed. It is therefore essential that careful preparation is carried out prior to attending for the interview and that you have read the job specification carefully and can articulate a sound knowledge of recent public reports relevant to the post you are applying for. Meticulous planning and preparation will ensure you appear calm and confident throughout the process.
Allergic eye disease in children: identifying the signs and symptoms
Authors: Choleva Paraskevi , Tole Derek , Churchill Amanda
Published: May 2014

Allergic conjunctivitis is a common trigger for patients to attend primary care and A&E departments. Children can be affected from a young age with seasonal, perennial and occasional allergic eye disease. There can be a range of symptoms from mild allergic eye disease affecting their quality of life to more severe disease, which can result in visual impairment. Vernal keratoconjunctivitis is a more rare form of allergic eye disease but can lead to sight-threatening complications.
Age-related eye disease and risk of falling: a review
Authors: Moenter Vera M , Glen Fiona C , Crabb David P
Published: May 2014

Falls in older people are common events and are associated with decreased quality of life and huge health costs. Visual impairment is a risk factor for falls. Some common causes of visual impairment in older people, such as cataract and presbyopia (age-related long-sightedness), can be treated relatively simply, so this review will focus on two common, irreversible visual diseases in older people: glaucoma and age-related macular degeneration (AMD). Risk of falls in people with these conditions seems to be related to failing to detect hazards, and to postural instability caused by missing visual input. Decreased contrast sensitivity has been suggested as the strongest predictor for falls in AMD. Binocular visual field (VF) loss, especially in the inferior VF and in the periphery, seems to be most closely associated with an increased fall risk in glaucoma; however, more research is needed to better understand which precise aspects of vision are the best predictors of fall risk. In the meantime, those with impaired vision, whether treatable or not, should be advised on how to reduce fall risk factors. A useful intervention could be directly highlighting the risk of falling to people with glaucoma and AMD.
Community nurses’ descriptions of stress when caring in the home
Authors: Wilkes Lesley , Beale Barbara , Hall Eve , Rees Ellen , Watts Bill , Denne Carol
Published: May 2014

Nurses often experience both positive and negative dimensions of caring for dying clients and their families. This project used descriptions of the lived experience of 21 community (district) nurses, from the Wentworth Area Health Service in Sydney, Australia, to determine the stressors involved in caring for palliative care clients at home. Data was collected using an open ended questionnaire and semi-structured audiotaped interviews. Sources of stress for the nurses were poor family dynamics, the family wanting the nurse to be part of the family unit, workloads, and others’ expectations. Another dominant stressor was the family and/or client’s denial of the possibility of no cure. This often conflicted with the nurses’ expectation of good dying as accepting and peaceful. The nurses coped with their stress by developing a support network, talking about their stress and sharing experiences in groups at work, the latter having important implications for employers.
Nurses’ beliefs about suffering and their managment of pain
Authors: Warden Sherry , Carpenter Janet S , Brockopp Dorothy Y
Published: May 2014

It has been well documented that nurses do not effectively manage pain and several factors have been identified that contribute to this outcome. Because pain and suffering often coincide, it seems likely that nurses beliefs about suffering could affect their management of pain. The purpose of this study was to examine nurses’ beliefs about suffering as a potential barrier to effective pain management. Graduate level nursing students (n=53) completed questionnaires on suffering and pain management. Results indicated that nurses held a neutral view of suffering and ineffectively managed hypothetical pain scenarios. Nurses’ beliefs about suffering were not related to their pain management responses. Discussion focuses on interpreting results within the current value neutral context of health care within the United States. Implications for practice and future research are also discussed.
Humour in palliative care: a review of the literature
Authors: Kanninen Marketta
Published: May 2014

Humour and laughter are an integral part of everyday life and often occur without conscious thought; the same is probably true in health care also. Relating the concepts of humour and health is attributed to the ancient Greeks, who placed amphitheatres for entertainment beside temples for healing. The concept of linking humour and health appears to be undergoing a renaissance, especially in North America, where the association between humour and health is receiving major recognition. There is much anecdotal evidence from nurses and patients to support the positive benefits of humour in health and palliative care. However, there is little empirical research to substantiate these benefits. Rigorous, well-conducted research and clinical evaluation needs to be undertaken in order for humour to become recognized as a valued aspect of nursing care in all settings.
Multiprofessional teamwork in hospital palliative care teams
Authors: Hill Alison
Published: May 2014

This study aims to identify and explore the internal dynamics within multiprofessional hospital palliative care teams (HPCTs). Various factors within the host organizations which are perceived by professionals as affecting team working are broadly examined. The theoretical stance is based on a managerial model devised by Plant (1987), which demonstrates the value of a process approach to change and team development. The study design is qualitative and uses an interpretative and exploratory approach to enable findings to emerge from focused interviews. The sample comprised eight professionals working in a variety of HPCTs in London. Results were coded and analysed using the Plant (1987) model and the study demonstrates that HPCTs have similar internal dynamics to other multiprofessional teams. The main areas examined in this study include communication, decision making, professional roles and leadership. HPCTs experience specific difficulties in relation to professional roles and boundaries associated with an emphasis on desirable role blurring within palliative care. Other issues considered are effecting change in large organizations and the prevention of professional isolation and marginalization. All study participants viewed working in a mutiprofessional team as beneficial and identified HPCTs as providing a high level of support for team members.
Resuscitation in palliative care
Authors: Thorns Andrew
Published: May 2014

‘They were going to let me die’, said Jill Baker, a 67-year-old woman who found herself ‘not for resuscitation’ during a hospital stay in 1999 (The Guardian, 2000). This demonstrates the misconceptions held by both public and professionals regarding cardiopulmonary resuscitation (CPR).
Cancer in Western Australian Indian families: concerns and coping strategies
Authors: Sellappah Sue , Kristjanson Linda J , Maltby Hendrika
Published: May 2014

Discussion with families of Indian clients with cancer living in Western Australia and their anecdotal reports of stress related to care lead to the development of this descriptive, qualitative study. In particular, the study addresses the concerns of Western Australian families of Indian clients with cancer and the coping strategies they employed. Six family members participated in face-to-face interviews. Content analysis revealed a four-phase process that family members described in response to the cancer diagnosis: initial reactions, immediate concerns, ongoing concerns, and coping strategies used. Culturally-specific observations and recommendations are offered for nursing practice and further research.
Developing empathy to improve patient care: a pilot study of cancer nurses
Authors: Hope-Stone Laura D , Mills Belinda J
Published: May 2014

Empathy has been identified as an important communication skill that can improve psychological outcomes for patients with cancer and palliative care patients; as such there is a need for cancer nurses to be empathic. The majority of research that has been carried out has been concerned with the definition and measurement of empathy. Exploration into the concept of empathy has shown that there is a need to examine the nature of it and to identify exactly where it succeeds and fails. The questions of how empathy is nurtured and sustained and under what conditions it flourishes and diminishes need to be addressed. This study aimed to investigate how cancer nurses interpret and acquire empathy, and to identify the conditions that influence it. It was also important to establish what cancer nurses considered to be the benefits and disadvantages of expressing empathy. The findings demonstrated that nurses are aware of the concept of empathy and do use their empathic skills; however, there are barriers that could inhibit the expression of empathy, including lack of time, poor environment and communication difficulties. This study highlights the recognition of empathy as a discrete communication skill and the need for more structured courses.
Education in palliative care: making a difference to practice?
Authors: Kenny Lesley J
Published: May 2014

This article presents part of a multiphase evaluation project, which aims to investigate the effectiveness of a number of palliative care educational programmes provided by a hospice education network in the north of England. Information is reported from four cohorts of students (n=46) who undertook courses between October 1998 and April 2000. Particular emphasis was placed on the views of students and whether education made a difference to their clinical practice. An action research approach was used which asked the question ‘Does education develop competent confident practitioners, who are able to initiate changes in their practice?’ Early indications suggest that education does make a difference to practice. Students reported feeling more confident, having a greater knowledge of palliative care and being more skilled in caring for patients and their families. Furthermore, students have made recognizable changes to their practice, some of which are detailed here.
Intensive care nurses’ experiences of caring for dying patients: a phenomenological study
Authors: Yang Mei-Hua , Mcilfatrick Sonja
Published: May 2014

The experiences of nurses working in end-of-life care, particularly those caring for cancer patients in the hospice setting, have been well researched. Yet despite the fact that intensive care units (ICUs) are frequently the site of patient death, studies of the nurses working in these units are uncommon. This study was designed to provide qualitative data to explore the experiences of intensive care nurses caring for patients who are dying. Semi-structured interviews were conducted with ten nurses who had experience of caring for dying patients in ICUs in two teaching hospitals in Taiwan. Data were analysed using a phenomenological descriptive approach. Participants’ descriptions revealed the following core themes: considering nurses’ attitudes to caring for the dying, stressors associated with this care and coping strategies that intensive care nurses adopt. The study concludes that education for ICU nurses must address these issues to facilitate better care of dying patients in the ICU.