bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving clinical coding in otorhinolaryngology
Authors: Mirza Showkat
Published: May 2014

In the English NHS Payment by Results system, clinical coding of a surgical operation results in one of a range of healthcare resource groups (HRG), each of which has a specific payment national tariff that the hospital receives for each spell of care. Our aim was to audit the clinical coding of our adult otolaryngology operations with a view to prospectively improve coding accuracy and ensure appropriate reimbursement via national tariffs. We reviewed the clinical coding of operations at the end of each month, before national submission of data, over a 9-month period. Using a system that groups operation codes according to anatomical site/type we analysed cases to see if the OPCS codes recorded for the procedure reflected the actual procedure performed or whether accuracy could be improved. Over the 9-month period there were 1087 operations; 1057 (97.2%) were coded accurately and 30 (2.8%) were suboptimally coded, but when corrected for accuracy resulted in a total increase in national tariff income of £33 364. A system that groups related operation codes according to anatomical regions and types of procedure, aids the accuracy of clinical coding. It may be used before coding submission national deadlines to ensure that the appropriate remuneration is received via national tariff, for the care delivered.
New horizons in the treatment of alcohol dependence
Authors: Gournay Kevin
Published: May 2014

This article provides mental health nurses with an overview of alcohol dependency, and up-to-date information on treatment approaches. It aims to assist mental health nurses to refocus their attention to this topic, bearing in mind that when most nurses think of alcohol dependency they will focus on those with problems at the severe end of the spectrum—particularly those with accompanying serious and enduring mental illnesses. It is argued that a shift of focus is necessary as there are many more people who are not moderately or severely dependent, who nevertheless are either drinking at hazardous levels, or have a mild level of alcohol dependency. Targeting this group may prevent physical and mental health problems developing. These patients will usually be encountered in primary care settings.
Use of the Avance® NPWT system: wound care and learning disabilities
Authors: Porter Michelle
Published: May 2014

Over the past two decades, topical negative pressure wound therapy has gained wide acceptance as a genuine strategy in the treatment algorithm for a wide variety of acute and chronic wounds ( Bovill et al, 2008 ) and over 1000 peer-reviewed publications describing the clinical efficacy and safety of negative pressure wound therapy (NPWT) for all wound types have been published over this period ( Vig et al, 2011 ). Wound care and learning disabilities are very rarely discussed as joint issues. This case study aims to highlight the successful use of topical NPWT on a patient with moderate learning disabilities and examines how wound management should be individualised to meet the needs of the patient.
Correspondence
Authors: Crawford Belinda
Published: May 2014

In 2005 are we right to consider nursing within the neurosciences as ‘special’ or different to that performed within other areas? There is some evidence to support this view (Modernisation Agency and Department of Health (DH), 2004), but is it enough?
The value of working with charities and voluntary agencies
Authors: Kent Wendy
Published: May 2014

Individuals with neurological conditions have particularly complex and diverse needs, and diagnosis often results in profound life changes which can affect an individual's relationships, career prospects and expectations for the future. The recently published National Service Framework (NSF) for Long-Term Conditions (Department of Health, 2005) states that good communication and the provision of appropriate information are essential features of a quality care service; however, information continues to be given a low priority in the NHS. This is evident from the survey conducted by the Neurological Alliance (2001). Less than a quarter of respondents were happy with the information they received about their conditions from the NHS and felt that voluntary organizations provided the best support. However, it must be recognized that individuals often do not absorb all of the information they are given at time of diagnosis and, therefore, the NHS should not be held solely responsible for the provision of health information. Patients should be given the opportunity to discuss their diagnosis at a time that is convenient to them and from a source that they choose, for example, a specialist health organization.
Understanding the side effects of cranial irradiation and informing patients and carers
Authors: Guerrero Douglas
Published: May 2014

The diagnosis of a brain tumour is devastating, shattering an individual's and his/her family's lives. Many patients are diagnosed with malignant tumours such as glioblastoma multiforme which are infiltrating tumours and carry a poor prognosis. Treatment for this group of patients tends to be palliative with radiotherapy often used as part of the therapy. The majority of patients undergoing radiotherapy are treated as outpatients, and the side effects of radiotherapy can be numerous. Patients often feel vulnerable, frightened and out of control of their lives. An understanding of the side effects of treatment can help both the hospital and community professional educate, support and provide the best possible care to the patient, his/her carers and family.
Nurses' perceptions of their role in fluid and electrolyte management
Authors: Cook Neil F
Published: May 2014

The nurse's role in managing fluids and hydration in neurosurgical patients is poorly defined. This paper reports on one stage of an action research project that looks at the nurse's role in managing fluid and hydrational status in patients with acute subarachnoid haemorrhage. It reports the results of a focus group of nurses of a variety of grades, which assessed how they managed this aspect of their role and how they guide their practice. The focus group discussions reveal that the nurse's role is ill-defined and that nurses are uncertain about aspects of their role and accountability.
BOOK REVIEWS
Authors: Clark Louise L
Published: May 2014

I originally ventured out to buy this book as a stocking filler for my 19-year-old son who, like many of his generation, is not a stranger to marijuana. However, the usual delays on the London transport system resulted in my thumbing through the very expensive pages of this slim hardbacked book before it reached his stocking. I devoured this academic yet compulsive book as I would a novel, unable to release it until it was finished.
CORRESPONDENCE
Authors: Russell Nicola
Published: May 2014

The MS Trust is extremely concerned about the current threat to MS specialist nurses as part of the latest wave of NHS cuts. A recent survey carried out by the MS Trust showed that 27% of these posts are at risk.
District general hospitals are no place for the spinal cord injured
Authors: Smith Paul
Published: May 2014

For many people, a stay in hospital is a daunting, disempowering experience. This feeling is exacerbated in those who find it difficult not to be in control of their surroundings and of what they can and cannot do. Hospital is also a confusing environment when the flow of information is poor, particularly for patients with a new spinal cord injury (SCI), but also for those who have had an SCI for some time.
Lumbar puncture by nurses extends competencies and improves patient access
Authors: Warner Richard , Fuller Geraint , Lindhal Andrea
Published: May 2014

Lumbar punctures in the UK are usually performed by doctors, although nurses perform this procedure elsewhere in the world. The authors' experience of developing the role of the nurse to perform lumbar puncture is described in this article. The issues that needed to be addressed to make this service work are highlighted, including training and audit and how the nurse's competence was demonstrated. The potential risks and benefits of a nurse-performed lumbar puncture service will be discussed.
The hidden face of Parkinson's disease
Authors: Gillam Tony
Published: May 2014

Tony Gillam gives a personal report from the 5th International Conference on Mental Dysfunction in Parkinson's Disease held on 13 June.
Sue Ryder Care awarded by MS Society
Authors: Beety Dan
Published: May 2014

Dan Beety reports on an innovative residential centre in Aberdeen which has been awarded preferred provider status by the MS Society.
The benefits of specialist care
Authors: Woodward Sue
Published: May 2014

Receiving a diagnosis of motor neurone disease (MND) is akin to being given a death sentence, often to be carried out in a very short period of time. Patients and their families want to be able to make the most of the time they have left to enjoy the best quality of life they can for as long as possible.
CORRESPONDENCE
Authors: Crawford Belinda
Published: May 2014

Many neuroscience nurses may not realize that from 14 August the majority of NHS band 5 and 6 nursing posts have been removed from the UK Shortage Occupation List (Home Office, 2006). This means that such posts will need to be advertised nationally before a work permit application can be lodged and will benefit UK and EU nurses. However, some band 5 and 6 posts remain on the list of national shortage.
Debate needed on how to fund long-term care
Authors: Doeg Rachael
Published: May 2014

The Alzheimer's Society is unhappy with proposals to reform the system for deciding eligibility for continuing care. Rachael Doeg explains.
An evaluation of use of the HADS scale to screen for post-stroke depression in practice
Authors: Dundas Jane
Published: May 2014

Widely differing methods of diagnosis and definition mean that the incidence of post-stroke depression has been reported at between 30% and 60%. Despite this apparent disparity, these statistics reveal that depression after stroke is common and that the symptoms may cause a great deal of distress to both the patient and his/her family. Post-stroke depression may also limit rehabilitation and have a profound impact on outcome and quality of life. The National Service Framework for Older People and the Royal College of Physicians' National Clinical Guidelines for Stroke stipulate that stroke patients should be screened for depression within 1 month of stroke, and that the patient's mood should be kept under review. A number of difficulties are encountered in screening patients for depression after stroke and a number of different screening tools are available. The aim of the pilot described here was to evaluate the use of one of these tools, the Hospital Anxiety and Depression Scale (HADS), to screen patients for post-stroke depression in practice. The HADS was found to be an effective screening method for those patients who can self-assess or require minimal assistance. A number of recommendations are made for monitoring depression in stroke patients in line with national guidelines.
Flaws and contradictions in NICE decision
Authors: Doeg Rachael
Published: May 2014

Rachael Doeg highlights the dismay and anger of many at NICE's decision to reject appeals against its guidance on Alzheimer's drug treatment.
Living with epilepsy: Exploring the psychosocial ramifications
Authors: Davies Rebecca
Published: May 2014

Epilepsy is a psychosocial condition as well as a medical disorder. It can significantly impair a person's quality of life, including mental health and social life. For some, the psychosocial consequences can be more debilitating than the seizures themselves. This article explores the far-reaching psychosocial ramifications that can frequently accompany epilepsy. A greater awareness of the psychosocial implications of epilepsy is essential to provide individuals with the support to help them manage their lives. Given the dynamic nature of epilepsy, person-centred and person-directed treatment are both essential to help people maintain a good quality of life and attain a greater sense of control and optimism for their future.
The future in nurse-led stroke management
Authors: Dawber Steve
Published: May 2014

Steve Dawber reports on nursing-related discussions at the inaugural Stroke Forum Conference, held on 7–8 December
RESEARCH ROUND-UP
Authors: Eberhardie Chris
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
The use of hybrid embryos in stem-cell research: A step to far?
Authors: O'Brien Mary
Published: May 2014

The use of hybrid embryos in stem-cell research: A step to far?
Testing for neutralizing antibodies
Authors: O'Connell Nicola , Roper Bronwen
Published: May 2014

Interferon-beta drugs for multiple sclerosis sometimes give rise to immune proteins that neutralize their effects. Nicola O'Connell and Bronwen Roper look at testing for these neutralizing antibodies
Slow progress in meeting aims of MS guideline
Authors: Russell Nicola
Published: May 2014

Awareness weeks are a useful way of focusing activity for an organization such as the Multiple Sclerosis (MS) Trust, and demonstrating to individuals with MS that their situation is recognized. MS Awareness week in the UK takes place 23—29 April 2007, and events are being planned involving health professionals and people with MS.
Joined-up-care: Neurological and obstetric services working in partnership. A case study
Authors: Keenan Elizabeth , M Dalton Catherine , Barry Cheri , Buckley Lisa , Jarrett Louise , L Stevenson Valarie
Published: May 2014

Spasticity is a complex symptom that often needs to be managed with medication such as baclofen. In severe cases, baclofen can be delivered directly into the intrathecal space. Historically patients receiving baclofen intrathecally were advised against pregnancy. This paper outlines the lessons learnt when a patient became pregnant while receiving baclofen intrathecally, and how teams worked across neurology and obstetric boundaries, to minimize risk, ensuring a positive safe outcome for mother and baby. A robust clinical governance framework facilitated teams working in partnership, and highlighted that specialist services need to be engaged for women who are planning pregnancy or who are pregnant. A neurology-obstetric clinic has been established for pregnant women with complex disability at this trust, which facilitates this partnership
Research Round-Up
Authors: Bennett Beverley
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
More evidence needed to sell specialist nurses' worth
Authors: Thomas Sue
Published: May 2014

In my estimation, and the estimation of thousands of people living with neurological conditions, the development of the nurse specialist post has been a hugely successful initiative in raising the standards of patient care. Nurse specialists are often a catalyst for service development across the wide range of long-term conditions that include neurological diseases. It is no wonder that many of the third sector patient charities like the Parkinson's disease Society and the Multiple Sclerosis (MS) Society have invested signifi cant amounts of money over the last few years in the development of these posts. To be precise, for just three conditions Parkinson's disease, MS and epilepsy, almost £16 million has been given to the NHS to date (MS Society et al, 2007). This is a signifi cant amount of cash–hard earned–often by people shaking collecting tins on street corners.
Post-operative cognitive decline, dementia and anaesthesia
Authors: Ballard Clive , Clack Hannah , Green David
Published: May 2014

There are now an estimated 700 000 people with dementia in the UK and one in three people currently end their life with dementia. Surgical procedures involving anaesthesia for people with dementia are therefore becoming increasingly commonplace. This article discusses the potential impact of anaesthesia on the development of cognitive impairment in older people, and explains why a better understanding of the impact of anaesthetic agents in people with dementia is imperative.
Research Round-Up
Authors: Catherine Queally
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Selecting the correct option for the supply and adminstration of medicines to patients
Authors: Hobden Alison
Published: May 2014

There are a number of different options available to nurses needing to supply and administer medicines to their patients. This article outlines how to find the right approach by discussing where each method works best and the associated training required to use that option. Questions about accountability and scope of practice are explored and emphasis is placed on the fact that nurses are accountable for all of their actions and omission, regardless of which option is selected to supply and administer medication.
Comment: High Court Ruling On Nice
Authors: Millward Harriet
Published: May 2014

On 10 August 2007, Justice Linda Dobbs handed down the High Court's judgment on a legal challenge to the guidance on the use of cholinesterase inhibitors for the treatment of people with Alzheimer's disease published by the National Institute for Health and Clinical Excellence (NICE). In November 2006, NICE amended its 2001 guidance and recommended that donepezil (Aricept), rivastigmine (Exelon) and galantamine (Reminyl) should no longer be available to patients in the mild stages of Alzheimer's disease. The makers of Aricept, Eisai, brought the High Court challenge and the Alzheimer's Society took part as an interested party. Four comments on the implications of the judgment follow.
Cerebral abscess: A review of its pathophysiology, diagnosis and management
Authors: Hacking Reena , Hunt Katharine
Published: May 2014

Cerebral abscess is associated with a high morbidity and mortality. Symptoms and signs tend to be difficult to differentiate from other neurological disease and so clinical suspicion should be high. Diagnosis with contrast computerized tomography or magnetic resonance imaging ensures early aggressive treatment with a combination of surgical intervention and antibiotic therapy. Cerebral abscess can be secondary to direct infection or from haematogenous spread. The primary source of infection should be sought and treated as part of the definitive management.
CORRESPONDENCE
Authors: Matthews Vicki , Hassall Mandy
Published: May 2014

We received a number of letters in response to Sue Woodward′s December editorial, ‘Hungry in Hospital: Patient Nutrition’ (BJNN 3(12): 549).
Allies in the fight against brain tumours
Authors: Oliver Kathy
Published: May 2014

Kathy Oliver explains why tackling the challenges of brain tumours requires an army of allies from within and without the scientific community
Impact of care interventions on children with severe traumatic brain injury in intensive care
Authors: Tume Lyvonne
Published: May 2014

Paediatric intensive care nurses managing children with severe traumatic brain injury often face the dilemma of performing essential nursing interventions in children with unstable physiology. Although these interventions are essential, they can produce considerable physiological instability to the childXy2s cerebrovascular parameters. This article provides an updated review of the literature in relation to the physiological effects of essential nursing interventions and cares in children with severe traumatic brain injury in the intensive care unit. It also highlights implications for practice and gives recommendations for future research.
RCN: Let′s get political for patient dignity
Authors: Thomas Sue
Published: May 2014

Sue Thomas discusses the barriers that nurses face when trying to influence policy development and highlights how working to ensure patient dignity can enable nurses to bring about policy change
CORRESPONDENCE
Authors: Razi Emma , Hassall Mandy
Published: May 2014

Epilepsy Scotland is currently running a campaign entitled More Specialist Nurses, Better Epilepsy Care. The campaign calls on the Scottish Government and the 14 Scottish health boards to recognise the valuable care provided by epilepsy specialist nurses and asks that more is invested in this service.
Head injuries
Authors: Winter George
Published: May 2014

George Winter commemorates the 160th anniversary of the injury that brought fame to Phineas Gage
End-of-life care for people with dementia should be dicussed early
Authors: Chapman Simon
Published: May 2014

Early discussion of end-of-life care is of benefit to the whole pathway for people with dementia. This helps to involve the patient while he/she still has the language, cognition and capacity to participate
Teleneurology: ethics of devolving responsibilities from clinicians to families and/or carers
Authors: Mackenzie Robin , Sakel Mohamed
Published: May 2014

E-care involving telemedicine, telecare, telehealth and teleneurology is the focus of health-care policy makers seeking to respond to demographic changes and the increasing prevalence of long term neurological conditions by adapting means of service delivery. E-care and teleneurology promise to provide high quality health-care services at a distance, allocate clinicians' time more effectively and enable the elderly and ill to remain in their own homes rather than occupy expensive beds in hospitals and care homes. The evidence base underpinning this is unsystematic, with marked shortcomings in economic evaluation methodology and a troubling paucity of ethical evaluations. Specific ethical issues arise in the application of teletechnologies to neurological conditions, particularly clinicians' ethical relations with family and/or carers. These ethical considerations should be recognized explicitly in policies promoting teleneurology in telemedicine, telecare and telehealth, that research needs to be directed towards them and there should be widespread debate on their implications.
Self-management for neurological conditions
Authors: Whitehead Bridget
Published: May 2014

Bridget Whitehead 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.
Helmet use by cyclists and head injury
Authors: Cook Neal
Published: May 2014

Although the use of helmets by cyclists reduces head injury deaths and hospitalizations, their compulsory use is hotly debated. Neal Cook discusses both the positive and negative impact of cycling helmet legislation.
The most effective surgical treatment option for congenital hydrocephalus: a review
Authors: Warren Diana
Published: May 2014

There are two types of hydrocephalus: communicating and obstructive. Historically, hydrocephalus treatment has almost exclusively belonged to ventricular-peritoneal (VP) shunting due to its ease of insertion by neurosurgeons and immediate clinical response. However, VP shunts do have high failure rates predominantly due to infection, and endoscopic third ventriculostomy is fast becoming a frontline treatment despite its complexities. This literature review was performed to find out that surgical treatment option is the most effective in those with congenital hydrocephalus. A MEDLINE search was conducted retrieving 15 studies, 6 of which were reviewed. Each of the studies was reviewed to detail the relevance to the research question looking at the research designs, methodology and type of studies. Themes are discussed and critically debated against best practice in life-threatening and critical situations. Ethical considerations for the production of a standardized policy detailing the best treatment option is discussed, and recommendations for future practice are also noted.
Nurses' views about caring for patients receiving botulinum toxin type A for focal spasticity
Authors: Curtis Elizabeth A , Tracey Catherine
Published: May 2014

Background

Few research studies have explored the role of nurses in caring for patients receiving botulinum toxin type A (BTX-A) injections for focal spasticity. This lack of research provided the impetus for the present study, which was carried out in a rehabilitation centre.

Aim

The aim of the study was to explore and describe nurses' views about their role in caring for patients treated with BTX-A for focal spasticity.

Design

A qualitative descriptive design was used.

Methods

Data were collected using focus groups, and volunteer sampling was used to recruit 12 nurses who met the inclusion criteria.

Results

Thematic analysis illustrated that although the participants felt nurses play an important part in caring for patients receiving BTX-A treatment, clarification is required on the role of the nurse, the efficacy of the nursing role, and the education and training required.

Conclusion

Although the literature has reported that nurses have an important role in the multidisciplinary team caring for patients receiving BTX-A treatment, it has not specifically identified what that role is. In this study, nurses reported that, although they feel they have an important role in caring for these patients, there is ambiguity about the specifics of that role. Furthermore, the participants felt that further education and training were important for preparing nurses to care for these patients adequately.

Relevance to clinical practice

In view of the relative newness of BTX-A in the treatment of focal spasticity and the paucity of research about the role of the nurse in caring for patients, the findings from this study make a contribution to evidence-based practice by raising awareness about the role of the nurse.
Nutrition in pregnancy: what the papers say
Authors: Seaman Claire EA
Published: May 2014

The importance of nutrition before and during pregnancy has been highlighted by recent research, but, as is common in many areas of nutrition research, there is gap between research findings and the context in which nutrition advice is presented to pregnant women or those who are planning a pregnancy. Recent research findings therefore need to be set in the context in which they are to be used by midwives, to provide a useful basis from which appropriate clinical advice can be derived. Individual studies may make headline news, but there are major dangers if individual studies are allowed to form the basis of policy decisions. This article looks at some nutrients which have been the subject of recent research and about which advice is commonly given.
The importance of communication
Authors: Symon Andrew
Published: May 2014

Communication between staff and between staff and patients is vital to efficient and sensitive health care; this Is particularly so when events are not straightforward. Communication must be tailored to each patient and her family; the ability to comprehend clinical Information varies between different people, and will be reduced generally In times of stress. Poor or insensitive communication will increase patient dissatisfaction, and Is a factor In litigation.
More worries about ultrasound
Authors: Robinson Jean
Published: May 2014

One of the best kept secrets on ultrasound is the huge increase in exposure unborn babies are getting from the newer, more powerful equipment. Obstetricians are so excited by the great pictures they get from the triple colour Doppler, they dont want to hear the bad news. You dont hear the scary stuff until you start talking to the physicists, and when they get worried, consumer groups start to listen.
Drug trials and pregnancy
Authors: Downe Soo
Published: May 2014

I am a member of a research ethics committee. In general, I enjoy my time on the committee: it is useful, informative, and a fascinating insight into the kind of general research being undertaken in health care. The other committee members are insightful and interesting. The submissions involve all disciplines, all methods, and all sizes of study. It almost involves all kinds of participants, although those who don't speak English are often excluded since it is felt that they cannot be reliably informed about the risk and benefits of participating. I have a number of objections to this rationale, but they are not the subject of this article. My main problem is related to statements in protocols for drugs trials which run something like this:
The magpie trial: magnesium sulphate for pre-eclampsia
Authors: Duley Lelia , Watkins Karen
Published: May 2014

Pre-eclampsia is common and is a major cause of morbidity and mortality. Magnesium sulphate is the best anticonvulsant for eclampsia, but whether it also helps women with pre-eclampsia is unclear. The Magpie Trial is an international randomised trial comparing magnesium sulphate with placebo for women with pre-eclampsia. The trial is coordinated from Oxford, and in the UK women are entered into the study by telephoning a randomisation service. Primary outcomes are eclampsia and death of the baby. The planned sample size is 14000 women. Recruitment began in July 1998, and by September 1999 over 2000 women had been randomised. The collaboration already involves more than 80 hospitals in 23 countries. Results of the Magpie Trial will provide reliable evidence about whether magnesium sulphate for women with pre-eclampsia does more good than harm.
Professional views on randomised controlled trials
Authors: Reid M , Barbour R , Tucker J
Published: May 2014

This paper reports findings from a survey of the views of midwives, general practitioners (GPs), and obstetricians involved in a randomised controlled trial of antenatal care in Scotland. The findings indicate that overall the practitioners reported few differences in attitudes towards the trial conditions. Where variations in professionals' responses occurred, however, the midwife group reported more satisfaction with trial care, and more opportunities in the trial situation to provide women with psychosocial support and to discuss life style changes. Midwives and GPs were more likely to agree that they could provide total antenatal care to low-risk women and to disagree that decision making for this group was best left to obstetricians. Given the increasing importance of community-based midwifery care within the primary care team, these findings suggest that a proportion of midwives welcome these opportunities.
An analysis of the concept of advanced midwifery practice
Authors: Sookhoo Maureen L , Butler Margaret S
Published: May 2014

This paper presents an overview of published material in which the concept of advanced practice is discussed in relation to results from a qualitative research study. The paper incorporates a discussion of published material, the background to the study, a description of research methods and a discussion of the results. Three emerging themes are discussed: the identification of what constitutes advanced midwifery practice, the relationship between advanced practice for midwives, the role of the midwife and psychomotor skills and the potential role for midwives following completion of a masters degree in advanced midwifery practice. Advanced practice in midwifery is not synonymous with extending the role of midwives, and it is not about achieving psychomotor skills and knowledge currently identified in medicine and obstetrics, rather it is about developing midwifery practice in order to enhance quality of care.
Parental choice and the welfare of the child
Authors: Dimond Bridgit
Published: May 2014

A court has recently overruled parental wishes by ordering a baby to be tested for the HIV virus. This article considers the law relating to the determination of the best interests of the child and how this applies to decisions by parents and the exercise of the midwives' professional judgment.
In conversation with Jennifer Sleep
Authors: McCandlish Rona
Published: May 2014

At the end of August this year Jennifer Sleep retired as Professor of Nursing and Midwifery Research at Thames Valley University. Over many years she has been a generous source of knowledge, wisdom, support and inspiration to me and countless other midwifery colleagues and fellow researchers working in perinatal care. So it seemed fitting that we should mark this important event in some tangible way. But when I first proposed to Jennifer that we wanted to put together a series of articles celebrating her work, she was aghast, embarrassed and almost silent! Fortunately she was persuaded to talk with me about her experiences as a midwife, teacher, and pioneering researcher as well as her thoughts about what midwifery research needs in the future. This article is based on that conversation.
Jennifer Sleep: a born researcher, a great facilitator
Authors: Chalmers Iain
Published: May 2014

One of the pleasures of the jobs that I have had over the past quarter century is that, occasionally, I have met people who have no professional background in research, but who have a ‘natural understanding’ of what reliable research looks like and why unbiased assessment of the effects of health care is so important. Two decades ago, Jennifer Sleep, now one the world's most respected pioneers in midwifery research, was such a person.
Migraine in women: hormones, triggers and pregnancy
Authors: Stevens Georgina
Published: May 2014

Migraine is estimated to affect 8-10% of the adult population, with women affected three times more often than men (Johnson and Johnson, 1998). Before puberty, boys and girls suffer in equal numbers, suggesting the hormonal changes that occur during puberty in girls, and remain throughout adulthood, trigger migraine attacks in women. About 60% of female migraine sufferers have menstrually-related migraine, with attacks exacerbated around this time of the month (Epstein et al, 1975).
The NHS white paper and the midwife
Authors: Dimond Bridgit
Published: May 2014

The implementation of the White Paper on the NHS raises opportunities and challenges for the midwife. Clinical governance, the National Institute of Clinical Excellence, the National Standards Framework and a Commission for Health Improvement will assist in raising standards for midwifery care and the implementation of Changing Childbirth (Department of Health, 1993). They will also, however, provide more information and evidence for complaints and litigation for those who allege they or their babies have suffered harm.
The midwife and her caseload: the legal issues
Authors: Dimond Bridgit
Published: May 2014

This paper discusses the legal principles which would apply in determining whether satisfactory levels of staffing are provided in midwifery service. Research findings on workloads are considered and specific issues relating to the comparison between different kinds of midwifery practice and the content of the midwife's role and the needs for delegation are discussed. The legal issues arising from lack of time for effective documentation are discussed.
Review of the Nurses, Midwives and Health Visitors Act
Authors: Lewis Paul
Published: May 2014

In early February, the long-awaited publication of the JM Consulting report on its review of the Nurses, Midwives and Heath Visitors Act hit the streets. Reaction was swift, and for some, the report was cautiously welcomed (RCM, 1999). Indeed, while falling short of a separate Midwifery Council, it appeared that for the first time in 20 years, midwives were to achieve equal representation with the profession of nursing and, for the time being at least, Statutory Supervision would remain. The following article explores the tensions and contradictions between the recommendations of the JM consulting review and the Governments response and it begs the question: where to now?
Administration of pethidine in labour
Authors: Heelbeck Lesley
Published: May 2014

Concern by midwives and clients about the potentially harmful effects that pharmacological analgesia has upon the mother's birth experience, coupled with the potential compromise of the fetus (Mander, 1992), is not reflected by the common and widespread use of pethidine within normal midwifery practice. Research based evidence does not support the use of four-hourly regimes of intramuscular analgesia to control acute pain (Royal College of Surgeons and Royal College of Anaesthetists, 1990) Uniform doses of pethidine, often designated by parity rather than the individual requirements, result in intermittent and unsatisfactory analgesia for the majority of women during labour (Moore and Dundee, 1993; Oloffson et al, 1996). The huge client variability in the absorption of drug from the injection site (Austin et al, 1980), is also exacerbated by physiological modification and maternal posture during labour. This affects venous return from the lower extremities (Drummond et al, 1984; Nation, 1980), and therefore absorption and efficacy of the drug. Where a more rapid and predictable response is desired, it is suggested that the injection site should be changed to the deltoid muscle (Lazebnik et al, 1989). Personal reflection, adaptation and integration of this scientific logic into practice has improved the efficacy of intramuscular administration of pethidine significantly. Flexibility of dose and timing, combined with using the deltoid route for injection, has resulted in increased speed of onset and duration of analgesia and reduced total duration of drug given in labour. Pain assessment strategies are also central to this success, as it is argued that it is no longer justifiable or safe to administer a ‘controlled drug’ without evidence of client requirement or assessment, prior to or after administration.
The Development of a midwifery council
Authors: Turnock Jane , Smith Lorraine , Brown Rebecca
Published: May 2014

This abstract illustrates the development of shared governance through a midwifery council at the Leicester General Hospital Maternity Unit. It incorporates a general introduction to the model of shared governance developed, and demonstrates the unique and exciting development of a specialized midwifery council. The main focus is on the early implementation of the midwifery council, challenges encountered and benefits derived.
Counselling for Down's syndrome screening
Authors: Lawrence Sandra
Published: May 2014

There are psychological implications for the pregnant woman when the Down's syndrome screening test is offered. Midwives and doctors need to understand and appreciate those psychological implications. Adequate knowledge and good communication skills can help staff offer the Down's syndrome screening test in a facilitative rather than a prescriptive manner. Facilitating patients to own their decisions, means involving them in their decision making. This article promotes the need for more medical non-directive counselling and less medical directive counselling, when offering the Down's syndrome screening test. It also highlights the need for early recognition and referral of those patients needing psychotherapeutic and non-directive counselling.
Euphemisms for an obstetric-led agenda
Authors: Walsh Denis
Published: May 2014

I am becoming increasingly concerned that all the talk in obstetric and midwifery journals about the importance of teams and multidisciplinary approaches is just the old-fashioned obstetric hegemony dressed up as professional equality.
ICM congress report
Authors: Basak Carolyn
Published: May 2014

The 25th triennial congress of the International Confederation of Midwives (ICM) was held between the 15–27 May in Manila, Philippines. The Philippines is a country of contrasts, with evidence of wealth and modern development side by side with poverty and deprivation. On reflection the council meeting held in the first week have also left very differing impressions. The agenda for this years council was long and by day three many of the delegates began to feel frustrated as they realised many of the important midwifery issues raised by their submitted resolutions were not going to be discussed.
ICM congress
Authors: Bharj Kuldip
Published: May 2014

Approximately 800 candidates joined in to sing If we hold on together… our dreams will never die to mark the opening ceremony of the 25th triennial congress of the International Confederation of Midwives in Manila, Philippines this year. The conference was declared open by a candle-lighting ceremony by representatives of midwives organizations from all over the globe followed by a flag ceremony and addresses by the President and the First Lady of the Republic of the Philippines, launching its theme ‘Midwifery and Safe Motherhood: Beyond the Year 2000’.
Anatomy of a case: lessons for midwives
Authors: Dimond Bridgit
Published: May 2014

Lessons can be learnt from studying cases which have been decided by the courts. In this case a midwife failed to summon the doctor at the appropriate time and as a consequence the baby suffered brain damage.
Part 7: harm and compensation
Authors: Dimond Bridgit
Published: May 2014

Even if it can be established that there has been a breach of the duty of care, unless harm can be shown, the claimant will lose the case. Thus for example if a midwife were to give the medication to the wrong patient, which would clearly be a negligent act, no compensation would be payable unless harm could be proved to have resulted from that carelessness. The requirement to prove harm contrasts with an action for trespass to the person where an individual has not given consent to a touching of their person.
Oral history and research part 1: uses and implications
Authors: Hunter Billie
Published: May 2014

Much of the history of ‘ordinary’ midwives has gone unrecorded. This is a great loss to midwifery knowledge, as the experiences of midwives in the past have potential relevance for current practice. This article is the first of two that discuss the use of oral history research to access such information. The article describes how oral history research may be performed, and considers the relative advantages and disadvantages of the method. Its uses and implications for midwifery are discussed.
CESDI: the sixth annual report
Authors: Sidebottom Mary
Published: May 2014

The Sixth Annual CESDI Report published in June contains important messages for all of those professionals concerned with the care of mothers and babies. The findings represent the work of a large number of individuals from different professional groups who have contributed to data collection, or confidential enquiry panels. For this report to remain on the shelf unread devalues the basic principle of the work of CESDI as an organization ‘to improve the understanding of how the risks of death in late fetal life and infancy fom 20 weeks of pregnancy to one year’. This report, therefore, should bre essential reading and should form the basis of discussion within a multidisciplinary forum to look at ways of disseminating the findings and moving practice forward in ways to improve care.
Part 8: the contract of employment
Authors: Dimond Bridgit
Published: May 2014

Each employed midwife has a contract of employment. She is entitled in law to have a statement in writing giving particulars of the contract of employment. The terms of the contract derive from a variety of sources as shown below:
Infant nutrition: equipment and breastfeeding practice
Authors: Wilson Jean , Allen Rose
Published: May 2014

It has been suggested that some inappropriate breastfeeding interventions implemented by practitioners commonly occur because of lack of appropriate education, information, ineffectual practices and poor interpretation of policies Dodds and Peattie (1997) and Henschel and Inch (1996).
Midwives make a difference
Authors: Page Lesley
Published: May 2014

Midwives make a profound difference to the women and families in their care — affecting not only physical but also the emotional wellbeing of the mother and the family.
Some common baby skin conditions
Authors: Allison Francis
Published: May 2014

Skin conditions are common in babies and young children. Often they can be a source of embarrassment, guilt and anxiety to the parent. Therefore, midwives and other primary health-care professionals are all too aware of the need for professional advice and support in order to help parents overcome their concerns and devise a suitable treatment plan.
Antenatal stress and midwife management
Authors: Hall Jennifer
Published: May 2014

Pregnancy is acknowledged to be a stressful time for a woman and her partner. The sources of stress may be physical or psycohological, external or internal in origin, with possible association with her personality traits. Stress is often seen as negative, yet we all have a certain amount of stress, and it is believed to be necessary in order to develop effective coping strategies (Sherr, 1995). It is also described as an element that enables personal growth and development (Graham, 1997).
Partnership in research — ORACLE update
Authors: Kenyon Sara
Published: May 2014

ORACLE is a large double blind placebo controlled trial to test the hypothesis that ‘the treatment of women in idiopathic preterm labour and with preterm prelabour ruptured membranes with broad spectrum antibiotics (Augmentin 375mg and Erythromycin 250mg) rcduces neonatal mortality and morbidity’. The Trial is funded by the MRC and has been recruiting women since July 1994. It is running in 169 maternity units worldwide, 135 of which are in the UK. The required sample size of 10000 women will be reached in the first quarter of 2000 — 8800 women have been randomized to date. Since women are recruited when they are admitted to the labour ward where staff are busy and time precious, recruitment procedures are simple and data collection minimal.
Part 9: statutory employment rights
Authors: Dimond Bridgit
Published: May 2014

In the last step by step article it was noted that within the contract of employment are many terms which are imposed upon the employer by Act of Parliament and are therefore known as the statutory rights of the employee. They are set out in a variety of legislation and many have been consolidated in the Employment Rights Act 1996.
The woman who said 'No'
Authors: Robinson Jean
Published: May 2014

Emma was well into labour with her second child when the student midwife came in. You dont mind if I look after you, do you? Please note the form of words. Not May I? but the assumption that there would be no objection.
New midwifery for the new millennium
Authors: Page Lesley
Published: May 2014

Babies born at the dawn of the new millennium were big news. These new lives welcomed into the world at such a memorable point in time were the symbols of the hope and optimism that the new millennium brought with it. Hopes of a new start — of making things better. Midwives are in contact with this hope and optimism of newborn life on a daily basis and the way we practise will have a great effect on the realization of such hope. Midwifery care and the experience of birth will affect the health of the newborn and mother's bonds of love within the family and the mother's confidence and competence in caring for her child.
How to cope with nosebleeds in pregnancy
Authors: Reece Philip
Published: May 2014

Nosebleeds or epistaxes will happen to 60% of the normal population at sometime in their life (Doyle, 1986). It has been noted that there is an increased incidence in pregnancy although the actual increase has not been quantified. The actual mechanism of increased risk is thought to be related to the rise in oestrogen which produces nasal congestion from its effects on the parasympathetic nervous system and also the increase in systemic blood pressure seen in pregnancy.