bluuebunny/crossref_metadata_2025 huggingface dataset:
Get into good habits!
Authors: Freeguard Sharon
Published: May 2014

Children are naturally curious about the world around them and it is an exciting challenge for to teachers to provide opportunities for them to explore familiar and new things.
Getting to know you
Authors: Croft Sue
Published: May 2014

With a new school year brings a new set of children. Help your children, and yourself to get to know one another with the following activities, which use names and birthdays to initiate some co-operative, maths-based activities.
Punishment doesn't work
Authors: Mill Patsy
Published: May 2014

Psychology has known for 100 years that punishment doesn′t work. So why is it still used in our schools?
Io, Saturnalia!
Authors: Hammond Paula
Published: May 2014

December marks the winter solstice-an astronomical event that happens when the earth′s axis is inclined as far away from the sun as possible
Guess How Much I Love You
Authors: Rhodes Liz
Published: May 2014

Show the class the book′s front cover and read them the blurb on the back. It says′love is not an easy thing to measure!′ How do we measure things? By weight (how heavy)? By height (how tall)? By volume (how many can you get in a bucket)? By number (how many)? By length (how long)? By time (again, how long)? Ask the children for examples of things you can measure and things that you can′t measure and make two lists.
Celebrating Eid ul-Fitr
Authors: Howard Christine
Published: May 2014

Sacred books are important for all the major world faiths. They are the means by which the beliefs and faith of the religion are handed down from generation to generation.
Using role play in year 1
Authors: Bromley Helen
Published: May 2014

In the second of a series of articles on creating a play-based curriculum, Helen Bromley considers how role play contributes to children′s development
Making magical music
Authors: Cruickshank Sarah
Published: May 2014

A good feeling for and appreciation of rhythm−known as ′beat competency′ −is vital for children to help them walk, run, use scissors, learn language and succeed in maths. This is one of the most important things a music education can give us, along with an opportunity to express our deepest thoughts and responses to the world around us. For further information, read Ros Bayley′s article at www.bbc.co.uk/cbeebies/grownups/children_learn/music/beat
News
Authors: Lepkowska Dorothy
Published: May 2014

Th e number of cases of measles among young children rose quicker between January and November last year, than for the whole of any year since the current method of monitoring was introduced in 1995, the Health Protection Agency said.
The urban element
Authors: Milchem Katherine
Published: May 2014

Building dens, splashing in muddy puddles, climbing trees and making mud pies were a part of past generations′ childhood but are activities today′s children should be experiencing.
Caputuring their imagination
Authors: Youngman Angela
Published: May 2014

The myth that children lack imagination and would rather play with computers is quickly disproved when you let them loose with dressing up boxes.
Can we spot a terror tot?
Authors: Mill Patsy
Published: May 2014

School teachers are being asked to spot potential terrorists in the classroom. What are the possible consequences of this?
Maths in their shoes!
Authors: Croft Sue
Published: May 2014

Use the story to introduce some maths activities. For many of the follow-up ideas you can use the children′s footwear. For others use some different types, in adults′ and children′s sizes. For example, slippers, trainers, wellingtons, sandals, and flip-flops.
News
Authors: Lepkowska Dorothy
Published: May 2014

The largest inquiry into primary education for 40 years has found that the current curriculum is impoverished because too much focus has been put on literacy and maths.
Taking learning outside
Authors: Duck Sarah
Published: May 2014

Using visits to museums and heritage sites to promote active and purposeful learning in history and the wider curriculum
Beware of the wolves!
Authors: Hoad Elizabeth
Published: May 2014

This article focuses on Lauren Child′s book Beware of the Storybook Wolves.This book and related activities will enable you to explore well-known stories and the children�s personal experiences in a fun and exciting way.
Just looking for attention?
Authors: Thornton Stephanie
Published: May 2014

Attention deficit hyperactivity disorder has always been a controversial topic. Stephanie Thornton offers new guidelines for managing this difficult behavioural problem
Auntie Sharon and Pippa
Authors: Croft Sue
Published: May 2014

During these activities, children will listen to the story, retell and sequence the events, and talk about the content. They will share picture-sorting, and story-writing activities. They will practise story-structure and story-writing.
Five, four, three, two, one
Authors: Croft Sue
Published: May 2014

Show the children this month′s poster and say the rhyme, or sing it to the first part of the tune Bobby Shaft o′s Gone to Sea, inventing suitable actions.
It's raining, it's pouring
Authors: Youngman Angela
Published: May 2014

Rain – we take it for granted in this country but it offers wonderful teaching opportunities crossing science, music, environmental studies, art and literacy. It is essential for life itself. There are lots of different words to describe rain, such as drizzle, storms, gales and monsoons. How do they differ? Which do the children prefer? Why do you only find monsoons in the Far East? Why can hurricanes appear anywhere?
Developing an approach to problem solving
Authors: Danaher Madeleine
Published: May 2014

Foundations laid in the early years and key stage 1 will be crucial in the later development of mathematical application
Solving cyber safety
Authors: Dunn Carrie
Published: May 2014

What kind of measures should you be taking to ensure children are safe on the Internet. And is it your responsibility to advise parents about online safety?
News
Authors: LOUIS SARA
Published: May 2014

Are teacher training away days worthwhile?
Mapping it out
Authors: Richardson Sarah
Published: May 2014

Looking at maps involves a combination of skills which include being to recognise street names, and reading abbreviations such as ′st′ for street, ′rd′ for road and ′sch′ for school. Both the written word and symbols help the reader to locate and orientate themselves. For example, ′H′ for a hospital and a cross for a church.
Developing body dissatisfaction early
Authors: LOUIS SARA
Published: May 2014

When it comes to body image and obesity, new research has raised a new issue
A focus on five-year-olds
Authors: Lindon Jennie
Published: May 2014

The first in a two-part extract from the book What Does it Mean to be Five? focuses on the personal, social and emotional development of five-year-olds
Living with dyslexia
Authors: Campbell Al
Published: May 2014

Dyslexia presents challenges for many more people than commonly acknowledged, but it can also lead to brilliance says dyslexic author Al Campbell
How to get cooking at school
Authors: Youngman Angela
Published: May 2014

Recent research by the British Potato Council found that 60 per cent of primary school children were convinced that potatoes grew on trees.
What is Epiphany?
Authors: Howard Christine
Published: May 2014

January 6 is a significant date in both the western and Orthodox Churches’ calendars. In the west, it is the Feast of the Epiphany that marks the last of the 12 days of Christmas.
Carrot or stick?
Authors: Thornton Stephanie
Published: May 2014

A look at how teachers can use reward and ′punishment’ to best effect
The best move I've made!
Authors: Keeling Anne
Published: May 2014

Anne Keeling asks four teachers about their experiences of working in international schools abroad, and finds out what to consider before taking the plunge
How to mark Remembrance Day
Authors: Griggs Amy
Published: May 2014

At 11 o′clock on the eleventh day of the eleventh month of the year 1918, the First World War ended in Western Europe. Countries like Britain and France chose this day and time to remember all the millions of soldiers who died during the war. The day became known as Armistice Day.
Behaviour in different situations
Authors: Milford Alison
Published: May 2014

Day 1 Ask the children what they are like in the park. Highlight that they can be loud when active! Compare this to bedtime when they are usually quiet and still. Explain that we change the way we act depending on where we are. Tell the children that you are going to read them a poem about a boy who has to keep changing the way he acts.
News
Authors: Lepkowska Dorothy
Published: May 2014

Ministers have pledged a further £100 million to help fight a shortage of places in reception classes around the country.
A different culture
Authors: Lepkowska Dorothy
Published: May 2014

One small Northumberland primary school speaks to Dorothy Lepknowska about how they forge international links with a school in Gambia
How to make Silly Putty
Authors: Hammond Paula
Published: May 2014

There′s a saying that inventions are 10 per cent inspiration and 90 per cent perspiration. It can take years to perfect new ideas and even then, not every invention works out as its creator thought it would! So, as we celebrate National Inventor′s Day on February 11, we′ll be looking one of science′s oddest inventions, Silly Putty.
All about different art
Authors: Johnson Emma
Published: May 2014

The work of the artist Kandinsky has enormous potential as a springboard for developing children′s art. As well as providing a host of opportunities for appraising and comparing, many of his paintings can be used to explore specific elements such as line, shape and colour.
News
Authors: Lepkowska Dorothy
Published: May 2014

Parents are to get more choice on when their children start primary school, following the publication of the revised School Admissions Code in December 2009.
Stating the bloomin' obvious?
Authors: Rhodes Liz
Published: May 2014

Liz Rhodes draws your attention to the findings of our Communication Champion′s first survey
An international dimension
Authors: Lepkowska Dorothy
Published: May 2014

Pupils attending Lyndhurst First School see the world around them every time they walk into their classrooms
Mysterious maths
Authors: Davis John
Published: May 2014

This is the first in a short series of articles that aims to stimulate children′s enthusiasm for mathematics by encouraging them to solve problems or puzzles.
New library scheme
Authors: Adams Tricia
Published: May 2014

Investment in school libraries must start early, argues the School Library Association (SLA) with the launch of its new Primary School Library Charter
Time for a digital detox
Authors: Hammond Paula
Published: May 2014

This year′s television-free week falls between April 19-25 and has the simple aim of encouraging people to spend less time watching life on TV and more time participating in it!
The Owl and the Pussycat
Authors: Rhodes Liz
Published: May 2014

This newly illustrated edition of The Owl and the Pussycat from Walker Books provides some fun for children in year 1. If you use it with a visualiser, all the children will easily be able to follow the text, although the text in the book itself is quite a good size.
Say no to cigarettes!
Authors: Hammond Paula
Published: May 2014

May 31, 2010 is world No Tobacco Day-an event instituted by the World Health Organisation to raise awareness of the dangers of tobacco
Volcanic activities!
Authors: Hammond Paula
Published: May 2014

It was on May 18, 1980 that Mount St Helens’ volcano famously erupted. It was the most destructive volcanic eruption in the United States and one of the most violent in recent history.
Time travelling maths
Authors: Davis John
Published: May 2014

For the third in this series of articles, intended to stimulate children′s enthusiasm for mathematics through problem solving, the focus switches to time. Once again there is a mystery linked to the theme to solve for each of the five assignments that can be spread over a week or used as one-off activities.
Recounts: Plants and growing seeds
Authors: Hoad Elizabeth
Published: May 2014

To start off this topic you could read the children I Really Wonder What Plant I am Growing by Lauren Child. As a class, share their experiences of growing seeds and plants both at home and at school. Encourage the children to tell you what they already know about how plants grow. Tell them that this week′s work is focusing on growing cress seeds and looking carefully about plants and how they grow.
Pressing problems-flower experiments
Authors: Hammond Paula
Published: May 2014

Today you′ll need a display of real flowers for the children to examine. If you have a school garden then it would be fun to move the group outside and look at living, growing flowers. That would also give you the opportunity to discuss the do′s and don′t′s of collecting wild flowers.
News
Authors: Yeatman-Biggs Bea
Published: May 2014

Students who are involved in a national literacy campaign are combining their university studies with volunteering to encourage children to read.
A historical challenge
Authors: Duck Sarah
Published: May 2014

Sarah Duck writes about her experiences planning and delivering a concept led enquiry unit, in part based on developing history skills in chronology, to a mixed age class
Postcards from abroad
Authors: Lepkowska Dorothy
Published: May 2014

By the time pupils leave Beddington Park Primary school they will have been transported, through their learning, to several different countries all over the world
The sound of music In harmony with music
Authors: Maiden Andrew
Published: May 2014

Youth Music works alongside formal and community−based sectors to support music−making and training for young people. Andrew Maiden reveals what they can offer students.
Straight from the art Developing partnerships
Authors: Baker Shari
Published: May 2014

Shari Baker explores how potential partnerships with local businesses, other schools, individual artists and arts organisations can enhance arts education within the curriculum, while providing much wider benefits to the community.
A home from home The helping hand
Authors: Maiden Andrew
Published: May 2014

When parents run short of funds, there are charities that can help them pay for their child′s education. Andrew Maiden offers a guide to some of the key bodies that could help parents at your school.
Food for thought Applying Gift Aid to dinners
Authors: Gower Barry
Published: May 2014

Barry Gower explains how Gift Aid can be applied safely to charity dinners.
Fundraising in action Writhlington School
Authors: Youngman Angela
Published: May 2014

Angela Youngman talks to the head teacher and finds out how the school achieved fundraising success.
Giving something back Jack Petchey Foundation
Authors: Maiden Andrew
Published: May 2014

A successful businessman set up a foundation in his own name to help others born into similar circumstances. Here, we profile the work of the Jack Petchey Foundation.
Communicating success Tips for networking a room
Authors: Dalton-Brown Lloyd
Published: May 2014

Fundraising campaigns are often dependent on having good links with the community. Lloyd Dalton-Brown gives some tips on building positive relationships with new contacts through networking meetings.
Going green Transport for schools
Authors: Baker Shari
Published: May 2014

Shari Baker takes a look at the alternatives to car transportation and what some innovative groups are offering to help schools teach students to become more environmentally aware.
Straight from the horse's mouth: Fundraising success
Authors: Berry Neil
Published: May 2014

Headteacher Neil Berry discusses his experiences of raising money in two different schools, and gives some tips and advice grounded in reality.
Building for the future: Boosting the budget
Authors: Baker Shari
Published: May 2014

Shari Baker takes a look at how schools can utilise the Private Finance Initiative strategy to increase their budget and begin generating their own income.
A winning formula: Grant-making workshops
Authors: Youngman Angela
Published: May 2014

Angela Youngman explains how your school could get help in decoding the application process and making a successful bid.
A click away: From raising funds
Authors: Youngman Angela
Published: May 2014

Angela Youngman contrasts and compares a range of websites designed to help schools add to ther funds.
Goodrich School Rocking and running
Authors: Youngman Angela
Published: May 2014

Angela Youngman finds out how one inner-city London primary school achieves fundraising success.
School companies Setting one up
Authors: Dickson Christine
Published: May 2014

Christine Dickson discusses the financial advantages of setting up a company.
New facilities Meeting the funding challenge
Authors: Renshaw Betty
Published: May 2014

Betty Renshaw discusses planning, funding, building, and running a sports hall for the school and local community. She also explains why being a business manager is a fulfilling and rewarding career.
Healthy kids: Happy school
Authors: Baker Shari
Published: May 2014

Shari Baker looks at how schools can work with local agencies and access funding to help develop projects, which can keep children healthy, from the inside out.
School facilities: For hire
Authors: Youngman Angela
Published: May 2014

Angela Youngman explores the way schools can use buildings and grounds to make extra funds.
Pure potential Maximise opportunities
Authors: Berry Neil
Published: May 2014

There are numerous opportunities to raise funds throughout the school year; all you need is a solid plan and a marketing strategy, writes Neil Berry.
Spread the word Success in numbers
Authors: David Anthony
Published: May 2014

Schools are at the heart of communities, and therefore provide the ideal setting for community projects. With a little creativity, there are many opportunities for inventive and varied projects to take place in your school, writes Anthony David.
Measuring the impact of the Pupil Premium
Authors: David Anthony
Published: May 2014

Anthony David looks at the impact of the Pupil Premium on school budgets and comments on the effects the pressure of measuring outcomes can have on schools.
Performance-related pay: Avoiding the legal pitfalls
Authors: Lyons Amanda
Published: May 2014

This term schools have to get to grips with the new system of performance-related pay. Employment lawyer Amanda Lyons looks at common pitfalls that new pay systems must avoid.
A patient with nicorandil−induced peristomal ulceration
Authors: Fake Jeanette , Skellet Ann-Marie , Skipper Gill
Published: May 2014

Healthy peristomal skin is imperative to ensure maximum pouch adhesion. There is widespread literature available on peristomal skin disorders, but little available on peristomal ulceration. It has been identified that nicorandil, an anti−anginal drug, may be the cause of non−healing peristomal ulceration. This article will highlight a problem that has not been widely documented, but caused us as health professionals, and our patient, much anguish. We will present a case study of a non-healing peristomal ulcer and review the appropriate literature to identify a possible cause.
Changes in bowel function after stoma closure
Authors: Bradshaw Elissa , Collins Brigitte , Williams Julia
Published: May 2014

Much of the evidence related to bowel dysfunction after stoma closure has been written from a medical oncological or surgical oncological perspective. Due to advances in surgical technique, most stomas formed are temporary or ′defunctioning′. Stoma closure can cause the common symptoms of frequency, urgency and incontinence, which are largely under−reported. Existing literature points to the fact that chronic bowel dysfunction is multi−factorial, and often related to a combination of damaged anal sphincters, shorter transit time, radiation damage and psychological issues relating to bowel function. There is very little evidence written from a nursing perspective on the quality of life of these patients after stoma closure. This article aims to show evidence−based and consensus theory regarding the subject from the current sources available.
Help-−seeking process in women with irritable bowel syndrome. Part 2: discussion
Authors: Bourgault Patricia , Devroede Ghislain , St-Cyr-Tribbl Denise , Marchand Serge , Barcellos de Souza Juliana
Published: May 2014

In part 1 of this 2−part study exploring the help−seeking process of women with irritable bowel syndrome (IBS), the authors presented the literature review, objectives, methodology and results. The reasons for seeking health care for IBS remain inadequately understood, and this process often seems complicated with poor outcomes. Thus, the aim of this study was to explore the entire help−seeking process of women with IBS. Specific objectives were to understand the roles of abdominal pain and psychological distress. A mixed method design was chosen to achieve the aim of the study: the qualitative part supports the help−seeking process′s theorization and the quantitative part serves to describe abdominal pain and psychological distress. The emergent model based on the interviews of nineteen women with IBS includes three categories: health problem, personal characteristics and help−seeking process. The last one represents the core of the process. In this second part, the authors′ provide a discussion of the results and propose future nursing interventions.
A tempting alternative
Authors: Smith Graeme
Published: May 2014

Complementary and alternative medicine (CAM) has become increasingly popular in the UK over the past couple of decades: one in five people have tried at least one form of CAM, with one in ten GPs actively involved in providing it for a variety of clinical reasons, including gastroenterology.
Is the use of intravenous opioids essential to control pain during colonoscopy?
Authors: Hutson Pauline
Published: May 2014

Introduction: The use of conscious sedation for colonoscopy investigation is not without risk, particularly when an opioid and benzodiazepine combination is administered. Aim: To consider the necessity for using an opioid during colonoscopy investigation and whether omission reduces patient satisfaction and perception of pain. Method: A comprehensive search process was employed and 16 studies were reviewed in-depth using a piloted quality appraisal tool. A mix of non-randomized and randomized controlled trials were included within the review and results focused on the patient′s perception of pain and cardiopulmonary side-effects. Results: The overall results demonstrated that the use of an opioid is not necessary for every patient undergoing colonoscopy. However, demographic characteristics, anxiety levels, therapeutic intervention and endoscopist experience were demonstrated as impacting on patients′ tolerance and satisfaction of the procedure. Conclusion: Cardiopulmonary risks are significantly reduced without compromising patient satisfaction and tolerance of colonoscopy if opioid administration is considered for selected patients and not given as a routine regime.
Endoscopic techniques for retrieving and manipulating ingested foreign bodies
Authors: Khan Nasser , Mann Steven , Ramdass Debbie
Published: May 2014

Endoscopic foreign body retrieval refers to the removal of ingested objects from the oesophagus, stomach and duodenum by endoscopic techniques. It does not primarily involve surgery, but rather encompasses a variety of techniques for grasping the foreign bodies, manipulating them, and removing them while protecting the oesophagus and trachea. Careful patient selection aids in determining the method of choice. The chosen strategy depends on the type and location of the foreign body, the length of time it has been in the oesophagus, and degree of experience of the endoscopist. All endoscopy units need to be prepared for such an eventuality as prompt treatment of a patient with a suspected oesophageal foreign body is crucial because of the potential for severe complications. This article looks at some of the common foreign bodies ingested and focuses on the techniques and equipment used to retrieve or manipulate them. Finally, the article discusses the vital role of the nurse in such a procedure.
No need to be negative
Authors: Macleod Elaine
Published: May 2014

Wimbledon is over. Andy Murray, although not victorious this year, has shown enough potential to indicate he could be following in Fred Perry′s steps. I consider him to be both Scottish and British, but this is not the case with health care. There are differences with, for example, prescription charges, delivery of personal care, bowel cancer screening age limits and colorectal cancer waiting list initiatives.
Advancements in the use of chemotherapy for colorectal cancer
Authors: Gee Caroline
Published: May 2014

This paper provides an overview of recent improvements in the use of chemotherapy for colorectal cancer. Consideration is given to the chemotherapy agents used for adjuvant, first-line, second-line and third-line treatments, in accordance with NICE guidance. Factors that influence treatment choices are discussed. Current chemotherapy treatments, the mode of administration and toxicities are highlighted. Recent progress of the newer biological agents and KRAS testing for patients with colorectal cancer are also addressed.
The effect of stoma formation on QOL in Crohn's disease: A literature review
Authors: Slater Rebecca
Published: May 2014

Patients with inflammatory bowel disease will require support and treatment from a variety of health professionals, and the input from specialist nurses working in this field can have positive effects on patients′ treatment pathway. Achieving an acceptable quality of life (QOL) is a priority to patients and is the main target of nursing intervention. In this literature review, Rebecca Slater discusses how patients with Crohn′s disease may perceive their QOL and how the formation of a stoma may affect or change this perception. This will help specialist nurses in providing a high quality of care specifically tailored for this group of patients.
Administration of sedation in endoscopy:Guidance, risks and skill requirements
Authors: Chapman Warren
Published: May 2014

Achieving a level of moderate sedation is necessary in order to carry out an endoscopy. Nurses who endoscope and administer sedation need to take particular care that they have sufficient knowledge and skills to optimize the safety of patients, and ensure they can adequately defend their practice should any legal challenges ensue. While the British Society of Gastroenterology has provided a framework for administering sedation, nurse endoscopists need to exercise good clinical judgment to avoid the considerable risks involved.
Managing the risks of prion disease transmission through flexible endoscopy
Authors: Puzey Annette
Published: May 2014

Creutzfeldt-Jakob disease (CJD) and a variant form, vCJD, are types of transmissible spongiform encephalopathies which are caused by abnormal, infectious prion proteins and lead to the degeneration of brain tissue. As vCJD is linked to the lymphoreticular system which includes the gastrointestinal tract, there is a possibility of transmission via a contaminated endoscope. Annette Puzey reviews the most recent advice on how to reduce the risk of transmitting prions to patients undergoing flexible endoscopy, considering patient assessment, the level of tissue infectivity, and the risk of invasive procedures.
Providing focused care
Authors: Hall Alice
Published: May 2014

The team here at GIN is very fortunate to be in a position to meet many dedicated and passionate nurses and organizations who leave us in no doubt that the speciality of GI nursing is thriving in the face of economic and political challenges in the run up to the 6 May election.
Adjusting to the assistant practitioner role
Authors: Harrison Penny
Published: May 2014

Gastrointestinal (GI) nursing has a long and honourable tradition of leading changes within the profession and advancing nursing practice. Traditionally, this has been in evidence with stoma care (one of the oldest and best established examples of nurse specialists) and more recently with the development of the nurse endoscopist role. These roles have focused on qualified nurses developing the range and complexity of their work plus advancing practice to enhance patient care and maximize service delivery (Johnston, 2008).
Faecal incontinence: Assessment and conservative management
Authors: Apau Daniel
Published: May 2014

Faecal incontinence can be incapacitating and embarrassing for patients and severely impact on their physical and emotional wellbeing, and that of their carers. It is imperative that health professionals working with this patient population adopt a holistic, patient-centred approach in exploring the causes and treatment options available. This should be done in partnership with the patient and carers, with the view to exploring the best management options through comprehensive assessment. In this article, Daniel Apau looks at the causes, assessment and conservative management of faecal incontinence.
Pre-registration education standards
Authors: Harrison Penny
Published: May 2014

Penny Harrison, senior lecturer in adult nursing, De Montfort University, Leicester, argues that, while the new pre-registration nursing standards set out by the Nursing and Midwifery Council have yet to be implemented, gastrointestinal nursing and endoscopy are well-placed to adapt to these new standards.
Adult jaundice—the pathophysiology, classification and causes
Authors: Sargent Suzanne
Published: May 2014

Jaundice (icterus) is the commonest presentation in patients with liver disease, and is caused by excessive bilirubin (>17μmol/litre) leading to deposits in subcutaneous tissue e.g. skin, sclera and mucous membranes. Jaundice can be confirmed by a number of simple investigations including patient history, physical examination and biochemical screening; however, the cause of the jaundice may require further investigation. In this article, Suzanne Sargent and Michelle Clayton provide an overview of the pathophysiology of the formation and metabolism of bilirubin and examines the most common causes of jaundice in the adult patient.
Percutaneous liver biopsy—an overview
Authors: Sargent Suzanne , Farrington Elizabeth
Published: May 2014

Liver biopsies have been used for the histological assessment for liver disease for the last century and are considered the ‘gold standard’; however, they are not without risk or complication. Advances in technology have lead to the development of several non-invasive markers for the assessment of the severity of liver fibrosis which is deemed as the primary hallmark of disease progression. In this article, Suzanne Sargent and Elizabeth Farrington provide an overview of percutaneous liver biopsy, the indications, contraindications, pre- and post-biopsy care, complications, and the role of the advanced nurse practitioner. A brief overview of serum and non-invasive markers of liver fibrosis is also provided.
Coeliac disease: the virtual clinic approach
Authors: A James Shirley , Mead Robert J , Smith Trevor
Published: May 2014

Good disease management is essential to the long-term care of many gastrointestinal disorders. The management of patients with coeliac disease requires a clear, coordinated patient pathway to identify and manage potential long-term complications. With the use of information systems, such a process can provide patients with the skills of self-efficacy and empowerment to manage their disease. In this article, Shirley James, Robert Mead and Trevor Smith outline the evidence-base for the long-term management of coeliac disease. The possible approaches to annual monitoring are discussed and the concept of the ‘virtual clinic’ introduced. The virtual clinic patient pathway will also be outlined and its implementation explained. Finally, the implications for ongoing management of coeliac disease are examined in the light of the changing health-care economy.
Irritable bowel syndrome: psychological comorbidities and cognitive behavioural therapy. A review of the literature
Authors: David Dainty Andrew
Published: May 2014

Irritable bowel syndrome (IBS) is a debilitating condition for which there is currently no cure. IBS can have a significant impact on quality of life ( Halder et al, 2004 ) and consumes a great deal of health-care resources ( Badia et al, 2002 ). Furthermore, health professionals are challenged by an inability to provide satisfactory explanations for the symptoms of IBS and often have difficulty in finding effective solutions to reduce the impact that IBS has on patients and the health-care system. In this article, Andrew Dainty critically discusses the current published literature, with a particular focus on studies that discuss the use of cognitive behavioural therapy (CBT) as a treatment for IBS. Recent randomised controlled trials (RCTs) that have evaluated the effectiveness of CBT in the management of IBS are presented and discussed, and the author argues that future research should evaluate the effectiveness of CBT for the treatment of IBS within the NHS.
Anal cancer: developments in treatment and patient management
Authors: Coakes Michelle , White Maddie
Published: May 2014

As anal cancer is rare, affecting one in every 100 000 people, patients need to have their disease managed by multidisciplinary teams with specialist knowledge and expertise. Michelle Coakes and Maddie White highlight the developments that have been made in the treatment of anal cancer, including studies showing that a combination of chemotherapy and radiotherapy provides better disease control and overall survival than surgery or radiotherapy alone. The impact this disease can have on an individual’s wellbeing should not be underestimated, including financial worries when work is impaired. The colorectal nurse specialist plays a key role in managing the complex physical and psychological needs of patients with anal cancer.
Effect of colorectal cancer surgery on female sexual function: a prospective cohort study
Authors: McIntosh Sue , Pardoe H , Brown K
Published: May 2014

Less is known about the negative effects of surgery for colorectal cancer on female sexual function than male sexual function, which has, in comparison, been documented more. Many of the studies are retrospective using non-validated questionnaires, with small numbers, thus making it difficult to draw conclusions. Preoperative discussions about the potential problems are often neglected. The authors used a prospective validated questionnaire to assess the effects of surgery for colorectal cancer on female sexual function and a validated quality of life questionnaire to assess physical and mental wellbeing. The completion rate was low (<20%)—a trend also observed in other studies. A minority of the respondents reported being in an active relationship, and overall, there was a reluctance to complete the sexual function questionnaire. The results are mixed, but 1 year after surgery, the group of respondents did not experience a significant deterioration in sexual function.
Ward nurses’ experience of enhanced recovery after surgery: a grounded theory approach
Authors: Jeff Angela , Taylor Claire
Published: May 2014

Many studies looking at enhanced recovery after surgery (ERAS) examine the clinical outcomes and patient satisfaction of the programme. This article reports on the findings of a qualitative study employing a grounded theory approach to explore the experiences of ward nurses involved in the postoperative stage of the ERAS programme with colorectal patients. Data were collected in 2012 using semistructured interviews. The basic social process that emerged from the analysis describes how ward nurses adapted their delivery of care in order to meet patient need. This process also explains why variance in individual patient recovery, lack of resources, and an inconsistent adherence to protocols necessitated the adapting of the ERAS nursing-care protocol. ERAS can provide a framework for nurses to deliver care but protocol-led care can have limitations. This study also developed the theory of adaptation, which describes how ward nurses adapt in certain situations to deliver care.
Duplication of the gall bladder
Authors: Geoghegan T , Tuite D , Torreggiani WC , Neary P , O'Riordan D
Published: May 2014

A 62-year-old woman was admitted to the intensive care unit of a university teaching hospital for the management of acute pancreatitis secondary to gallstone disease. An ultrasound performed at the time of admission was interpreted as a septated gall bladder containing gall stones (Figure 1). The pancreatitis was complicated by renal failure, sepsis and pancreatic pseudocyst formation. Seven months following initial presentation, the patient underwent an open cholecystectomy. Extensive adhesions were noted in the gall bladder bed at the time of surgery. The patient made an uncomplicated postoperative recovery.
Posterior reversible encephalopathy syndrome
Authors: Shrivastava A , Yousaf N , Vaidhyanath R
Published: May 2014

A57-year-old man presented to the medical admissions unit of the authors' hospital with headache and blurred vision. His blood pressure recorded at the time of admission was 234/124 mmHg. Fundoscopy revealed early papilloedema and laboratory examination revealed raised levels of serum creatinine and urinary proteins. The patient reported a similar episode of headache and blurred vision 6 weeks before admission.
Mental health law: compulsory treatment in a general medical setting
Authors: Linford Steven
Published: May 2014

Compulsory treatment of severe mental disorder can seem complicated even to psychiatrists. This article attempts to explain the current legal framework as it applies in common clinical situations in a general medical context.
Urological emergency: diagnosis and management of renal trauma
Authors: Rao Amrith R , Cherian Jacob , Arya Neehar , Kapasi Faiyaz , Shergill Iqbal S , Potluri Bernard
Published: May 2014

Renal trauma can be a life-threatening emergency and, because of its rarity, knowledge of its recognition and management is limited. This review discusses the clinical diagnosis, classification of injury, management and complications of this emergency condition.
A pilot study of the feasibility of trainee hospital doctors undertaking significant event analysis
Authors: McGregor JR , Bowie P , Mckay J
Published: May 2014

Participating in significant event analysis is proposed as an important method of reflective learning that can enhance patient care and safety. Peer review is one way of making informed judgments on the ability of participants to apply the technique.
Non-alcoholic fatty liver disease
Authors: Cua Ian Homer Y , George Jacob
Published: May 2014

This article reviews the nomenclature, clinical and histological basis for a diagnosis of non-alcoholic fatty liver disease or non-alcoholic steatohepatitis, its natural history, pathophysiology and an approach to clinical management.
Modernising Medical Careers: effect on NHS service delivery
Authors: Clough Chris
Published: May 2014

Modernising Medical Careers will be introduced from August 2005 and will significantly change the system of education and training for doctors in the UK. The impact of these changes on NHS service delivery needs to be fully understood and is discussed in this article.
Understanding psoriatic arthritis
Authors: Taylor William J
Published: May 2014

Previously, psoriatic arthritis was considered an uncommon, generally benign variant of ankylosing spondylitis or rheumatoid arthritis, with few therapeutic options. It is now recognized as a distinct, potentially serious disorder that can be effectively managed with a number of new agents.
The alcohol ‘epidemic’: What can be done?
Authors: Gilmore Ian
Published: May 2014

We are all guilty of hyperbole when it comes to our own interests. Alcohol misuse may not fit exactly the Oxford English Dictionary definition of an epidemic as ‘a sudden widespread occurrence of a particular unpleasant phenomenon’, but the definition has a resonance with the visible consequences for law and order in British inner cities at night, and for the emergency departments of hospitals. The government's own figures, drawn together in the Interim Analytical Report produced by the Cabinet Office in 2003 (Prime Minister's Strategy Unit, 2003) to support a national strategy, were stark. Annual alcohol-related costs of crime and public disorder are £7.3billion, workplace costs are £6.4billion, and health costs are £1.7billion, with hospital admissions of 150000 each year. Alcohol accounts for up to one third of all accident and emergency attendances (and 70% between midnight and 6am), and about 2.9million, or 7%, of the adult population are dependent on alcohol (Prime Minister's Strategy Unit, 2003).
Aesthetic and functional rhinoplasty
Authors: Constantinidis Jannis , Daniilidis Jannis
Published: May 2014

The authors stress that conservative correction should be the main goal in aesthetic and functional rhinoplasty. The surgeon controls the operative event and must be skilled at manipulating and controlling the dynamics of postoperative healing to achieve long-term functional and aesthetic results.
Assessment for improvement: a view from the coal face
Authors: Patterson Linda
Published: May 2014

Doctors think about quality of care from their own perspective – from experience and some wisdom gained from seeing many thousands of people over a lifetime of clinical practice. So how do doctors judge good quality care? They hope for a correct diagnosis, a treatment plan and an improvement in the clinical well-being of the patient. To cure or at least help the patient live better with a chronic condition; unpleasant symptoms may be controlled, an improvement of the quality of life achieved, and there may even be a reduction in disability, morbidity or mortality.
Carotid artery pseudoaneurysm with Horner's syndrome: delayed complication of internal jugular venous cannulation
Authors: Maston M
Published: May 2014

A58-year-old man presented to hospital with a 1-week history of left arm swelling. Two days after admission he became pyrexial. Chest X-ray revealed a right-sided effusion, which was an empyema. He further deteriorated and developed respiratory failure. He was intubated and ventilated. Right internal jugular venous cannulation was conducted to allow central venous pressure monitoring. He was transferred to intensive care, where he gradually improved and was weaned off ventilation.

The right internal jugular venous cannula was removed without difficulty 9 days later. Four days after removal of the internal jugular venous catheter, miosis and moderate ptosis on the right side (Horner's syndrome) was noticed. The remainder of the cranial nerves were intact. A computed tomography scan (CT) of the head and neck was done to investigate the cause of the right Horner's syndrome and the left arm swelling. The CT scan (with contrast) showed an enlarged carotid artery (Figure 1). Ultrasonography showed this to be a 4 cm × 2.5 cm false aneurysm. The carotid artery pseudo aneurysm corresponded to the site of internal jugular vein cannulation. The scan did not reveal a cause for the swollen left arm, which was resolved gradually. Later he was referred to the vascular unit where he underwent angiography and successful stenting of the aneurysm.
Is the move to the routine use of small endotracheal tubes evidence based?
Authors: Jones H , Mitchell V
Published: May 2014

Traditionally size 9 and 8 endotracheal tubes (ETTs) for men and women respectively have been used for anaesthesia. There is evidence to support this practice, but there is also growing evidence for the use of smaller tubes.
Osteoporosis and hypogonadism in men
Authors: Jamieson Andrew , Ingham Douglas G
Published: May 2014

It is estimated that almost 1 in 10 men will suffer a fracture caused by osteoporosis after the age of 50 years. Among those are a considerable number of men who will fracture their hip. A number of therapies have demonstrated efficacy in improving bone density in men, and the issue of which therapy and when to institute it is addressed in this article.
Angiosarcoma: a difficult diagnosis
Authors: O'Donnell ME , Scally N , Carson J , Kenny B , Whiteside MCR
Published: May 2014

A 28-year-old nulliparous lady was referred to the breast clinic with a 5-month history of persistent, cyclical, left-sided mastalgia. She was otherwise fit and healthy with no previous breast or nipple complaints. She was originally from Hong Kong with no family history of breast cancer. She was not prescribed any medications and was a non-smoker. On examination, tender nodularity was elicited below the left nipple. There were no other abnormalities.

Ultrasound scan (USS) of this area demonstrated an irregular area of mixed echogenicity, probably in keeping with fibroadenosis (Figure 1). Mammography performed subsequently demonstrated dense fibro-glandular tissue with no mass (Figure 2). Fine needle aspiration (FNA) of the area demonstrated fibro-fatty tissue with very scanty ductal cells. This was unsatisfactory for diagnosis (C1 cytology).

A clinical core biopsy was desired but not completed on this consultation at the patient's request. At subsequent review, a clinical core biopsy was performed in view of persistent nodularity. The core biopsy demonstrated a well-differentiated, vasoformative endothelial tumour, which appeared haemangioma–like, involving the surrounding fat and fibrous tissue, between breast ducts. In areas the lesion appeared to have an infiltrative pattern with vessels dissecting the septal fibrous tissue present. The cells showed a high degree of vascular endothelial differentiation but had enlarged hyperchromatic and mildly pleomorphic nuclei. Although mitotic figures were not identified, the appearances were suggestive of well-differentiated, grade-1 angiosarcoma (Figure 3). An expert second opinion was sought and concurred with this interpretation. There was positive immunohistochemical staining for CD34, CD31, and for factor VIII. MIB-1 proliferation was low. This is a polyclonal antibody used in paraffin embedded tissue against the Ki-67 antigen and is an indicator of cell proliferation. A magnetic resonance image (MRI) scan was recommended but was unhelpful, demonstrating no abnormality. An USS guided localisation-biopsy was performed without complication. Macroscopically the tissue was haemorrhagic. Histology confirmed the presence of a 2.2 cm, well-differentiated, invasive angiosarcoma extending to three of the resection margins.

Following counselling, she subsequently had a left mastectomy with immediate expandable implant reconstruction. This was completed without complication. Macroscopic analysis of the resected mastectomy specimen demonstrated an ill-defined residual haemorrhagic lesion measuring 4 cm × 4 cm × 2 cm. Histology confirmed the presence of residual angiosarcoma, up to intermediate-grade malignancy. Unfortunately, the inferior-superficial margin was still not clear of disease and she required re-excision to achieve a clear margin. The breast implant was not disturbed and remained in-situ during the re-excision. She is awaiting radiotherapy to the operative site, which has had to be delayed, as she is now seven weeks pregnant. She is otherwise well.
An important issue for the British Journal of Hospital Medicine
Authors: Tinker Jack
Published: May 2014

This issue marks an important milestone in the Journal's 40-year history – the name changes, reverting back to the British Journal of Hospital Medicine (BJHM), and a new design and format herald the return of blue. The ‘new’ title and colour will rekindle memories formany of our readers of that time in their professional lives when the ‘blue journal’ was a familiar and helpful friend, particularly at exam time.
Cardiac resynchronization therapy: the procedure and progress so far
Authors: Kohli Sanjay K , Elliott Perry
Published: May 2014

Cardiac resynchronization therapy, also known as biventricular or multi-site pacing, has been shown to be an effective adjunct to conventional pharmacological therapy for advanced heart failure. This review considers the rationale and evidence for cardiac resynchronization and discusses the indications for its use in clinical practice.