bluuebunny/crossref_metadata_2025 huggingface dataset:
The Best Practice Tariff helps improve management of neck of femur fractures: a completed audit loop
Authors: Khan SK , Weusten A , Bonczek S , Tate A , Port A
Published: May 2014

Background: The Best Practice Tariff incentivizes hospitals in the UK to improve the care they deliver, and includes a requirement to deliver multiprofessional care to patients with neck of femur fractures. The Best Practice Tariff for 2010–11 included six targets: (1) surgery within 36 hours, (2) admission under consultant-led joint orthopaedic–geriatric care, (3) admission using a multidisciplinary assessment protocol, (4) review by a geriatrician within 72 hours, (5) geriatrician-directed multi-professional rehabilitation, and (6) assessment for falls and bone protection. The authors chose to audit their Trust's compliance with these targets.

Methods: A retrospective audit was conducted in 2011 at the authors’ university-affiliated tertiary care hospital, which is a regional major trauma centre. Only patients 65 years or older, with fragility-type neck of femur fractures who were treated surgically at the authors’ unit and were eligible for geriatric review and multiprofessional rehabilitation, were included. The results of this audit (2010–11 Best Practice Tariff targets) were analysed and a series of procedural and logistical measures were introduced. A re-audit was performed in April 2012 for 2011–12, and the results for the 2 years were compared using appropriate statistics (Chi square tests and analysis of variance). Thirty-day mortality was compared using the summary hospital-level mortality indicator.

Results: A total of 410 patients were eligible for Best Practice Tariff in 2010–11, which increased to 463 in 2011–12. The changes from the first year's audit helped increase the rates for 36-hour surgery from 48.3% to 73.4% and for 72-hour geriatric review from 68.8% to 81.8% (P<0.05). The annual Best Practice Tariff achievement increased from 31.7% to 61.3% (P<0.05). The summary hospital-level mortality indicator declined from 96.5 to 61.3.

Conclusions: Focusing on poorly satisfied Best Practice Tariff indicators can produce a significant improvement in the per capita Best Practice Tariff achievement. Further studies are needed to assess the health and financial gain in detail.
How to appraise a qualitative study
Authors: Gadoud Amy , Taylor Paul , Hussain Jamilla A
Published: May 2014

Qualitative research is increasingly being published in medical journals to explore important clinical questions. Methods, vocabulary and theoretical underpinnings may be unfamiliar to some doctors. This article explores an approach to understanding qualitative studies.
The septic obstructed kidney: a urological emergency
Authors: Arneill M , Hennessey DB , Glackin AJ
Published: May 2014

The septic obstructed kidney is a urological emergency and, as such, prompt diagnosis and management are critical in achieving good outcomes. This article highlights the presenting features, radiological investigation and surgical management of this condition, and compares the two methods of surgical decompression.
Splenic injury following routine colonoscopy
Authors: Melsom DS , Cawthorn SJ
Published: May 2014

Colonoscopy is a safe procedure (Ong et al, 1991) but serious injuries to the abdominal viscera are described (Habr- Gama and Waye, 1989). In this report a single case of splenic injury is described after routine surveillance colonoscopy.
Clinical features and management of benign prostatic hyperplasia
Authors: Lane Tim , Shah Julian
Published: May 2014

Benign prostatic hyperplasia represents the most common benign neoplastic condition afflicting men and has a major impact on the health of the population. It refers to a regional and nodular growth of stromal proliferation which, because of its proximity to the urethra, causes varying degrees of bladder outflow obstruction.
Hip pain in the third trimester of pregnancy
Authors: Hockings M , Surwaliwala KH
Published: May 2014

Transient osteoporosis of the hip (TOH) is characterized by disabling hip joint pain, a limited range of hip motion, focal loss of radiodensity on plain radiographs and increased tracer uptake in bone scintigraphy (Hoffman and Kramer, 1997).
AmBisome: an overview of current use
Authors: Myint Han
Published: May 2014

Although amphotericin B has been the gold standard in treating systemic fungal infections, its use is limited by side-effects including nephrotoxicity. In contrast the empiric or therapeutic use of AmBisome is better tolerated, with less nephrotoxicity.
Methadone: where are we now?
Authors: Henry John A
Published: May 2014

Methadone is now widely used as opioid replacement therapy because it reduces crime and prevents spread of disease by the intravenous route. However, it is potentially toxic, especially to drug naive patients, and requires careful prescribing.
Osteoporosis and its management
Authors: Liggett Nathaniel W , Reid David M
Published: May 2014

Osteoporosis is a common systemic disease leading to premature fractures. This article reviews the state of the art of assessing the risk of future osteoporotic fracture and summarizes the prevention and treatment of the condition.
Should all images be reported?
Authors: de Lacey Gerald
Published: May 2014

The work of a consultant radiologist is absorbing; a combination of interpreting radiographic, computed tomography (CT) and magnetic resonance imaging (MRI) examinations, performing ultrasound studies, carrying out interventional procedures (most commonly drainages and biopsies), and taking a lead role in regular patient management conferences with speciality clinical teams.
Ventilator-associated pneumonia: risk factors and patient mortality
Authors: van Nieuwenhoven Christianne A , Bergmans Dennis CJJ , Bonten Marc JM
Published: May 2014

Among critically ill and mechanically ventilated patients, ventilator-associated pneumonia (VAP) is the most common nosocomial infection. Although VAP has a high mortality rate, it is unknown whether patients die from VAP or underlying illness. This article reviews the association between VAP and mortality, and discusses whether prevention of VAP will improve the outcome of mechanically ventilated patients.
The changing patterns of the Part 2 MRCOG examination
Authors: Paul Sudipta
Published: May 2014

Several changes to the Part 2 Membership of the Royal College of Obstetricians and Gynaecologists (MRCOG) examination have taken place over the last 2 years. The pass rate fell drastically from 38% in 1998 to 15% in March–May 1999 following a change in the marking system. This article gives a few suggestions about approaches to the examination.
Tuberculosis: still the great pretender!
Authors: Thomas Merlin , Walker Robert , Hung Noelyn
Published: May 2014

Tuberculosis is more common in uraemic patients, possibly related to impaired cell-medicated immunity, and previous or ongoing immunosuppressivetherapy. Tuberculous peritonitis makes up to 2–65% of all cases of peritonitis complicating continuous ambulatory peritoneal dialysis (CAPD) (Vas, 1994). It is often difficult to diagnose, as tuberculosis iscapable of mimicking most intraabdominal pathologies including carcinoma and CAPD-peritonitis. Peritoneal white cell count (total and and cell type) are mostly unhelpful and culture is often negative or clouded by concurrent or seemingly resistant bacterial peritonitis (Lui et al, 1996).
Stenting in peripheral vascular disease
Authors: Cleveland Trevor J , Gaines Peter
Published: May 2014

Metallic stents have made an enormous impact on the percutaneous treatment of arterial and venous disease, allowing a range of lesions to be treated using this minimally invasive technique which was not possible previously. This article details the range of stents which are available and how these have revolutionized the treatment of vascular disease.
Objective assessment of surgical dexterity using simulators
Authors: Smith SGT , Torkington J , Darzi A
Published: May 2014

Surgical skill, like training for any craft, has traditionally been learnt as an apprenticeship. However, whereas carpenters learn on wood that is never displayed, operative training is done on real clinical cases. Over recent years surgical skills training laboratories have in part, replaced the apprenticeship. This article discusses some of the tools used within such laboratories to ensure optimal surgical performance.
Clinical governance: what it is, what it isn't and what it should be
Authors: Gilmore Ian
Published: May 2014

Clinical governance is as much about setting standards and putting in place management systems to achieve them as it is about poorly performing doctors. Medical Royal Colleges are well placed to support individual hospital doctors in setting and monitoring clinical standards appropriate to their specialty.
Islet cell tumours: diagnosis and medical management
Authors: Taheri Shahrad , Meeran Karim
Published: May 2014

Islet cell tumours are difficult to diagnose. They are rare tumours that secrete hormones resulting in symptoms and signs that are often mistaken for more common conditions. Benign and solitary tumours are surgically resected, while medical therapy aims at symptom control and palliation of malignant disease.
Islet cell tumours: surgical treatment
Authors: Aldridge MC
Published: May 2014

The majority of neuroendocrine tumours of the pancreas are malignant and surgical resection is the mainstay of treatment. The tumours are often small and intraoperative tumour localization is an important part of the operation. The type of tumour will dictate specific treatment.
Basilar artery aneurysm: an unusual cause of intractable hiccups
Authors: Li ML , Gupta A , Thomas P , Richards AJ
Published: May 2014

A70-year-old retired lorry driver was admitted as an emergency with a 2-day history of moderate amount of haematemesis, nausea, vomiting and intractable hiccups. He was a known hypertensive and 5 years previously had an episode of subarachnoid haemorrhage. Complications required the insertion of a Rickman reservoir shunt. Since the time of the subarachnoid haemorrhage, his hiccups had been almost constant despite taking chlorpromazine tablets 25 mg three times a day.

On examination, he had intractable hiccups. Cardiovascular, respiratory and abdominal examination were normal. Neurological examination revealed a right-sided partial third nerve palsy (with ptosis and pupillary sparing). He also had a right-sided squint operation during childhood. More detailed examination of the cranial nerves revealed mild right-sided glossopharyngeal and hypoglossal nerve palsies. Routine full blood count, blood biochemistry, chest X-ray and abdominal ultrasound scan were normal. Upper gastrointestinal endoscopy revealed a hiatus hernia with mild oesophagitis. He was started on omeprazole.

In view of the neurological findings and past history of subarachnoid bleed, a magnetic resonance imaging brain scan was performed. This revealed a large basilar artery aneurysm with a significant mass effect on the brainstem at the level of the border of fourth ventricle (Figures 1–3).

Alternative drug treatment in the form of nifedipine 10 mg three times a day was initiated instead of chlorpromazine and the hiccups resolved completely. On follow-up in the clinic a few months later, there was no recurrence of the hiccups.
Coronary artery fistula: a rare cause of a left to right shunt
Authors: James P Rachael , Davies Robert H , Hardman Suzanna MC
Published: May 2014

A48-year-old woman presented with increasing breathlessness on exertion. A continuous murmur had been noted 6 years earlier and attributed to a patent ductus arteriosus. At referral, examination revealed a systolic murmur (2/6) continuing across the second sound into late diastole (1/4), audible at the left sternal edge. Her electrocardiogram showed sinus rhythm, a normal axis and non-specific ST changes in the inferior leads.

A transthoracic echocardiogram demonstrated impaired left ventricular function, most marked in the anterior wall, and a well circumscribed area of turbulent flow in the region of the interatrial septum but no shunt at this level (using Doppler and colour coding). These findings were suggestive of a vessel running through the interatrial septum which was subsequently confirmed using transoesophageal echocardiography (Figures 1 and 2). Running a tortuous course from its origin at the left main coronary artery, through the interatrial septum to drain into the right atrium, the serpiginous appearance of the vessel was typical of a coronary artery fistula. The left ventricular hypokinesia and fistula were confirmed at cardiac catheterization but no additional atherosclerotic disease was demonstrated. A thallium perfusion scan, including adenosine vasodilation, failed to demonstrate any perfusion defect. Nonetheless the left coronary artery to right atrial fistula and left ventricular impairment suggested the patient's symptoms were a function of inadequate myocardial perfusion resulting from coronary artery steal and the patient was referred for surgical ligation. At surgery a 1 cm fistulous dilatation of the left main stem of the left coronary artery was found: the fistula then coursed over the roof of the left atrium and down through the interatrial septum to drain into the right atrium. The fistula was ligated as it crossed over the roof of the left atrium. The patient made an uneventful postoperative recovery. When assessed several months later her symptoms had fully resolved and repeat echocardiography confirmed normal left ventricular function.
Prevention and treatment of malaria in UK travellers
Authors: Evans Mark RW , Day John H , Behrens Ron H
Published: May 2014

With around 2500 new cases of malaria being reported each year and more than a million UK residents visiting malaria endemic countries, there has never been a greater need for effective prevention and treatment. The latest information on malaria management is outlined below.
Update on antiendotoxin therapies
Authors: Stephens Robert , Hamilton-Davies Colin
Published: May 2014

Endotoxin has been implicated in the processes that can lead to organ failure and death after surgery and critical illness. While there are no currently available commercial therapies directed against endotoxin, many have been tried or are in an experimental stage. In this article we outline past, present and future approaches to antiendotoxin therapy.
Clinical governance in action: radiology
Authors: Chandy John , Goodfellow Thomas , Vohrah Anil
Published: May 2014

Articles and conferences on clinical governance abound, but much of the content is theoretical. This article describes how clinical governance may be introduced in a busy radiology department in a straightforward and practical way, with benefits to both the radiologist and patient.
Leflunomide: a new DMARD for rheumatoid arthritis
Authors: Emery Paul
Published: May 2014

Early diagnosis and referral of rheumatoid arthritis may significantly improve patient outcomes. Arava (leflunomide) is the first new disease modifying antirheumatic drug (DMARD) to be introduced in the UK for over a decade. Arava has a rapid onset of action and has been shown to retard radiographic disease progression and significantly improve patients’ functional ability.
Child psychiatry in Bombay: the school mental health clinic
Authors: Vaidya Girish , Dhavale Hemangee S
Published: May 2014

The school mental health clinic is an unusual amalgamation of the mental health and education sectors in Bombay. It aims to detect emotional problems in schoolchildren, increase mental health awareness in teachers and other professionals and determine any risk or causal factors in schoolchildren suffering from mental health problems. It also offers cross-cultural research opportunities.
The clinical presentations of urticaria
Authors: Black Anne Kobza
Published: May 2014

Urticaria is a common skin condition. Although an episode may be mild and last only a few days, chronic urticaria can significantly affect the quality of life. The condition is frequently misunderstood by patients who believe the condition is always the result of an allergy and is dangerous.
Self-harm and unemployment
Authors: O'Shea Brian
Published: May 2014

Unemployment is an important variable in both suicide and attempted suicide, acts that are themselves woven from a complex tapestry of interacting factors. The manner in which being unemployed leads to acts of self-destruction can often be better understood from detailed case histories than from the cold fruits of epidemiological research.
Vault haematoma and febrile morbidity after vaginal hysterectomy
Authors: Thomson AJM , Farquharson RG
Published: May 2014

Vaginal hysterectomy is associated with significant risk of vaginal vault haematoma (40%) and febrile morbidity (30%). Numerous interventions have been used to try and avoid these complications but very few have been shown to be effective.
The madness of Nietzsche: a misdiagnosis of the millennium?
Authors: Cybulska Eva M
Published: May 2014

This article represents a personal discussion about Nietzsche's mental illness, which formed part of a larger paper ‘The masks of Nietzsche and eternal return of the repressed’. This was presented at the 6th Annual Conference of The Friedrich Nietzsche Society, September 1996, Manchester UK, as reported by Nussbaumer-Benz (1998).
Epidemiology
Authors: Ellis Michael , Richardson Malcolm , de Pauw Ben
Published: May 2014

Invasive fungal infections have emerged as important causes of hospital related morbidity and mortality. They are increasingly seen in patients not previously considered at risk, e.g. patients on an intensive care unit. Candida albicans and Aspergillus spp. are the most common pathogens, posing challenges in epidemiology, control and treatment.
The use of lasers in dermatology
Authors: Sheehan-Dare Robert A
Published: May 2014

There are now a range of lasers capable of effective treatment of vascular, pigmented and other skin lesions with a high degree of selectivity. Understanding the complex interactions between laser irradiation and often diverse lesion morphology is the key to determining the appropriateness of treatment.
Current status of safety of diagnostic ultrasound
Authors: Barnett Stanley B
Published: May 2014

Diagnostic ultrasound is generally accepted as a safe procedure in the absence of plausible and confirmed evidence of adverse health effects. However, it is impossible to rule out the possibility of adverse effects, as the scientific database is incomplete and cannot keep pace with technological developments and the enthusiasm to adopt new clinical applications. While acoustic outputs from diagnostic devices have increased considerably in the past decade, there have been no human studies on possible health effects from such exposures. Users of modern sophisticated ultrasonographic equipment are responsible for risk/benefit assessment.
Risk management on the labour ward
Authors: Luckas Murray , Walkinshaw Stephen
Published: May 2014

Risk management describes a process whereby the risk of adverse events is eliminated or where the effects of those events are reduced as far as possible. This is particularly relevant to the labour ward setting with respect to intrapartum care.
Sexually-acquired reactive arthritis
Authors: Hopkinson Neil
Published: May 2014

Reactive arthritis is the most frequent cause of acute peripheral arthritis in young men. The aetiopathogenesis of reactive arthritis is reviewed, together with the varied clinical features. Finally the treatment and prognosis of this challenging condition are discussed.
Case 2: the interpretation of ST segment changes in the presence of bundle—branch block
Authors: Sporton Simon , Holdright Diana
Published: May 2014

A 63-year-old man presented to casualty with a 1-hour history of crushing retrosternal chest pain associated with nausea and sweating. An electrocardiogram (ECG) was recorded (Figure 1). What was the diagnosis?
Abdominal tuberculosis: the great mimic
Authors: Ahmed Ayesha , Pereira Stephen P , Steger Adrian , Starke Ian
Published: May 2014

A 22-year-old woman, who had immigrated from India 2 years earlier, presented to casualty in May 1997 with cough and atypical chest pain. Sputum microscopy was positive for acid-fast bacilli, there was an equivocal right apical shadow on chest X-ray and she had a grade three Heaf test. Consequently, she was commenced on triple antituberculous therapy, but this was stopped 2 months later on the advice of the Mycobacterial Reference Laboratory when Mycobacterium fortuitum (a presumed contaminant) was isolated from one sputum culture.
The challenge of multidrug resistant tuberculosis
Authors: Davies PDO
Published: May 2014

Multidrug resistant tuberculosis (MDRTB) is defined as resistance to the two principal drugs used to treat TB, isoniazid and rifampicin, whether there is resistance to other drugs or not. It is a relatively new phenomenon and poses one of the most difficult therapeutic problems in medicine because failure may not only mean death of the patient but infection and disease in others including healthcare staff.
Nasal manifestations of granulomatous disease
Authors: Hughes RGM , Drake-Lee A
Published: May 2014

Granulomatous disease frequently affects the head and neck region, particularly the nose and sinuses. This article describes the most common infectious and non-infectious conditions and their clinical features.
Vertebral artery dissection secondary to prolonged telecommunication
Authors: Farrugia Maria Elena
Published: May 2014

A 35-year-old man presented with acute onset diplopia associated with a sense of dysequilibrium and nausea. At the onset, he complained of right-sided neck pain. Over 24 hours, he developed further symptoms with left sensory disturbances and pyramidal weakness. On examination, he was mildly ataxic. He had diplopia on right lateral gaze. There was evidence of reduced perception of pain in a left hemisensory distribution that also included the left side of his face with a mild left pyramidal weakness and hyperreflexia. The plantar responses were flexor.
Violence on psychiatrists: preventing future increases
Authors: Chaloner Jill M
Published: May 2014

Psychiatrists suffer the highest rate of violence compared with other specialities; current developments are likely to increase this.
Large airway involvement in relapsing polychondritis
Authors: Greenstone Michael , Baguley Elaine
Published: May 2014

A 67-year-old man presented with conjunctivitis and deafness followed by bilateral uveitis, weight loss and a vasculitic rash. His nasal bridge had collapsed (Figure 1) and the upper part of his left ear was thickened and distorted (Figure 2).
The current state of cartilage transplantation
Authors: Richardson James , Taylor Joanne
Published: May 2014

The avascular and aneural structure of cartilage is both its downfall and its saviour. The very features that limit the capacity of articular cartilage to self-repair make it an ideal candidate for tissue engineering. While more traditional techniques have relied upon the stimulation of natural processes, tissue engineering has opened a whole new chapter in the modern treatment of cartilage defects.
The implantable cardioverter defibrillator
Authors: Rinaldi CA , Gill JS
Published: May 2014

The implantable cardioverter defibrillator is the optimal treatment for both primary and secondary prevention in patients with previous aborted sudden death and with life-threatening cardiac arrhythmias. This article will review the indications and the evidence supporting implantable cardioverter defibrillator use.
Managing side effects of radiotherapy in head and neck cancer
Authors: Mendes RL , Nutting CM , Harrington KJ
Published: May 2014

Curative radiotherapy for head and neck cancer causes very significant side effects. In addition to their considerable impact on the patient's quality of life, these effects can prejudice treatment outcome. This review looks at the management of the adverse effects of radiotherapy for head and neck cancer.
Acute intestinal obstruction: diagnosis and management
Authors: Burke Michael
Published: May 2014

In acute intestinal obstruction, the clinician must distinguish between acute small bowel obstruction (ASBO) and acute colonic obstruction (ACO). In cases of ASBO, management depends on whether the patient has had previous abdominal surgery. Most cases of ACO require surgery, although mechanical causes must be distinguished from pseudo-obstruction for different management techniques.
Can we measure the quality of perioperative care?
Authors: Grocott Mike , Levett Denny , Stephens Robert
Published: May 2014

Data showing that perioperative interventions can significantly improve postoperative outcomes have become commonplace. In the 21st century being unable to measure the quality of perioperative care and the consequent outcomes is unacceptable. Any organization that consumes such huge amounts of public resources as the NHS has an obligation to justify this expenditure and demonstrate quality service delivery.
Gamma camera positron emission tomography: implications for clinical and research studies
Authors: S Vinjamuri
Published: May 2014

Positron emission tomography (PET) was first developed in the 1970s in research establishments as a useful functional imaging tool. The geographical spread and distribution of this technology has been restricted because of the requirement for a cyclotron either on site or in close proximity. Along with a range of research applications, the role of PET scanning in clinical practice has received renewed interest recently.
Once-weekly treatment for osteoporosis
Authors: Stone Mike
Published: May 2014

Daily oral bisphosphonates are a well-established treatment option for osteoporosis. However, many patients find the daily dosing regimen inconvenient. Once-weekly alendronate offers greater convenience to patients while providing equal efficacy.
Patient confidentiality: where are we now?
Authors: Lugon Myriam
Published: May 2014

Every day the NHS collects a lot of information relating to individual patients. This information is not gathered solely for the effective management of patients' clinical conditions, but also for many other purposes such as planning services, agreeing the amount of services provided at local hospitals and public health. With the advent of modern technology, increasingly data are transferred electronically and with the rapid development of electronic patient records, the amount of information stored and shared electronically will increase and with it the potential for breach of security and confidentiality. A lot of attention has been given to this issue nationally.
Setting priorities in waiting lists
Authors: Nolan John F
Published: May 2014

Traditionally, surgical waiting lists have served to prioritize care, with the worst cases addressed first, along, in some instances, with those who have shouted the loudest. Patients with less severe symptoms have usually waited for much longer periods. This is now politically unacceptable. Setting priorities in waiting lists would be far simpler and much less relevant were it not for the major discrepancies between demand and supply. These discrepancies, which have for so long been the norm in the NHS, lead to the creation of long waiting times.
Acute renal failure in the intensive care unit: does it really increase mortality?
Authors: Whitehouse Tony
Published: May 2014

‘Mortality is proportional to the number of failing organs’ has been the mantra of the intensivist for many years. Medical students soon learn that oliguria not reversed by the administration of fluid is a bad sign. The incidence of acute renal failure (ARF) in the intensive care unit (ICU) can be as high as 40% and in fulfilment of the mantra, many studies have shown that the presence of ARF increases mortality on the ICU.
Treating alcohol dependence in a district general hospital
Authors: Burnill Rebecca , Daly Chris
Published: May 2014

A strategy for managing alcohol problems within the general hospital setting should involve improved recognition of acute physical complications of alcohol withdrawal and dependence. Research shows that opportunistic interventions at this stage can reduce alcohol consumption by 25% in excessive drinkers. Support should be available from a local community alcohol service.
Do the Royal College curriculum statements guide the assessment and learning for specialist registrars?
Authors: Wall David , Wakefield Sarah , Bullock Alison
Published: May 2014

The Royal College curriculum statements should be a vital part of the teaching and learning of specialist registrars, and of their assessments. This does not appear to be the case in the four specialties studied.
Current management of ovarian hyper-stimulation syndrome
Authors: Shanbhag Smruta , Bhattacharya Siladitya
Published: May 2014

Ovarian hyperstimulation syndrome is an iatrogenic and usually self-limiting condition which can occasionally be life threatening. This article reviews methods of prevention and management of ovarian hyperstimulation syndrome.
Cialis (tadalafil): a new treatment for erectile dysfunction
Authors: Minhas S , Kalsi JS , Ralph DJ
Published: May 2014

Oral phosphodiesterase inhibitors have become the mainstay of treatment for erectile dysfunction. A novel and potent phosphodiesterase inhibitor, tadalafil, known as Cialis, has been introduced in the UK as an alternative to the other currently available phosphodiesterase inhibitors for the treatment of erectile dysfunction.
Cervical lymphenadenopathy in children
Authors: Umpathy N , De R , Donaldson I
Published: May 2014

The management of cervical lymphadenopathy in children varies widely between clinicians. It is recognized that clinical management can be improved by standardizing the diagnostic and treatment methods. This article presents an algorithm based on the available evidence for the management of cervical lymphadenopathy in children.
A rough guide to research for senior house officers and specialist registrars
Authors: Sanders David S , Azmy Iman AF
Published: May 2014

Although not mandatory, a period of formalized research leading to a higher degree is still commonplace for doctors wishing to pursue a career in hospital medicine. This may be undertaken before or during specialist registrar training. This article provides practical information for those planning to undertake research. The potential pitfalls of research are discussed and strategies are suggested to ensure that this phase of medical training is both productive and fulfilling.
The thoroughly modern consultant? Modernizing consultant careers
Authors: Black Carol
Published: May 2014

You have become a consultant. After many years of training you have reached your goal. You are well aware of your new responsibilities. The next few years are spent getting to know your new colleagues and institution, and their ways, and working with them.
Thromboprophylaxis in patients undergoing total hip replacement
Authors: Brenkel IJ , Cook RE
Published: May 2014

Venous thromboembolism is a common complication following a hip replacement. It was the authors' impression that prophylaxis of deep vein thrombosis has changed in recent years. The authors felt that it was important to repeat a survey, done in 1997, on the use of thromboembolism prophylaxis among British orthopaedic surgeons.
The colorectal cancer clinical nurse specialist in chemotherapy
Authors: Wright Kathy , Myint A Sun
Published: May 2014

Over the past decade, chemotherapy has been increasingly used in patients with colorectal cancer. The impact of treatment on the patient can be substantial both physically and psychologically. The colorectal nurse specialist plays an important role in providing support and advice for the patient and their families, and also has a valuable role in coordinating the multidisciplinary team.
Management of the neuropathic bladder
Authors: Bycroft John A , Hamid Rizwan , Shah Julian , Craggs Michael
Published: May 2014

Neurological injury and disease are common, and intimately related to abnormalities of the urinary system. The prevention and treatment of urological sequelae in patients with neurological injury or disease requires a clear multidisciplinary management strategy.
Breaking bad news: practical advice for busy doctors
Authors: Mir Nusrat U
Published: May 2014

Breaking bad news is a difficult task faced daily by the busy doctor. This article draws on some of the literature on the topic and offers some practical advice on how to break bad news.
Nutritional support and stroke
Authors: Singh I , Vilches A , Narro M
Published: May 2014

Following stroke poor nutritional status is common, under recognized and associated with worse outcomes. This article explores existing assessment and management strategies aimed at recognizing and reducing the impact of malnutrition in stroke patients.
Comparison of aspects of preregistration house officer training from traditional and new medical curricula
Authors: Brown Jeremy , Ryland Ida , Chapman Tom , Graham David
Published: May 2014

As medical graduates from the new (problem-based learning) curriculum at University of Liverpool undertook their first post in the postgraduate clinical setting, this study investigated whether their views of preregistration training in the Mersey Deanery differed from the last cohort of preregistration house officers who had graduated from the traditional lecture-based medical curriculum at University of Liverpool.
Antiplatelet agents in atherothrombotic diseases
Authors: Rao U , Weston C
Published: May 2014

Atherothrombotic disease places a huge financial and social burden on the nation, and antiplatelet therapy is important in preventing this. Aspirin is most widely used but newer compounds are valuable, especially on top of standard therapy in patients with unstable angina or non-ST segment elevation myocardial infarction. This article reviews the changing use of antiplatelets.
New antifungal agents
Authors: Shetty Anjali , Barnes Rosemary A
Published: May 2014

With the relentless increase in invasive fungal infections, particularly in critically ill and immunocompromised patients, it is good to know that there are new additions to the antifungal armamentarium. These include not only new formulations of existing drugs and the development of new triazole agents, but also the introduction of a new class of antifungal drug.
Giving up smoking
Authors: Jackson Graham
Published: May 2014

Smoking is the most important public health problem in the UK, developed and now the developing world (Royal College of Physicians, 2000). Currently there are 13 million smokers in the UK and 120 000 of these die as a consequence of smoking each year (Jackson et al, 2001). The death rate is therefore approximately 330 smokers per day – equivalent to one jumbo jet crashing each day.
Vaccination against cervical cancer
Authors: Tristram Amanda , Fiander Alison
Published: May 2014

The link between human papillomavirus (HPV) and cervical cancer raises the question, can the burden of cervical cancer be reduced using HPV vaccination strategies? The clinical trials to date will be reviewed, along with the challenges and potential for future development.
Diabetic emergencies in children
Authors: Fortune Peter-Marc
Published: May 2014

Diabetic ketoacidosis (DKA), a common paediatric presentation, carries a significant mortality primarily as a result of cerebral oedema. The aetiology remains poorly understood. However, an understanding of the process of treatment and current guidelines discussed in this article is essential to maximize good outcome.
Assessment and management of dysphagia
Authors: Ramsey DJC , Smithard DG
Published: May 2014

Swallowing problems are common in hospital inpatients and may affect morbidity and mortality. Accurate assessment of dysphagia is important, allowing optimal management and minimizing potential complications. This article considers the methods of swallow assessment available and ways in which problems can be addressed.
Hirsutism: diagnosis and management
Authors: Ali Iaisha , Dawber Rodney
Published: May 2014

Hirsutism can be a source of great distress and social embarrassment and in some cases can indicate underlying endocrine or malignant disease. More is known about the metabolic consequences of hyperandrogenism including risk of developing cardiovascular disease, insulin resistance or diabetes. Full assessment is vital in light of the potential health consequences of hirsutism.
An evaluation by doctors in training of a pilot programme of physician assistants
Authors: Roberts C Michael , Proctor Ian , Forrer Michael
Published: May 2014

New grades of health-care workers have been introduced to support trainee doctors and facilitate the implementation of the New Deal and the European Working Time Directive. This study surveyed the views of junior doctors regarding their experience of one such new post, called a physician assistant, and found trainees generally positive, welcoming this innovation.
Epidemiology of adhesions: the burden
Authors: Parker Michael C
Published: May 2014

Until recently the epidemiology of adhesion-related disease was unclear and lack of awareness of the clinical impact and extent of the problem has been cited as the greatest impediment to reducing adhesion formation. The clinical consequences and burden of disease are reviewed.
Pregnancy and pre-existing diabetes: key concerns
Authors: Crocker Alison , Farrell Tom
Published: May 2014

Women with pre-existing diabetes in pregnancy are at increased risk of fetal loss, fetal congenital anomaly and abnormal fetal growth. Obstetric complications are more likely and good peripartum care is essential. This article also considers preconceptual counselling which may minimize these risks.
Helping you deliver RE
Authors: Smalley Sarah
Published: May 2014

Many primary teachers feel apprehensive when teaching RE. Sarah Smalley looks at a range of useful resources and websites
Top 10 tips for buying school furniture
Authors: Wright Caroline
Published: May 2014

With all the pressures of Ofsted and pupil outcomes, school furniture may not be top of your list of priorities, but making wise investment choices is important nonetheless. Caroline Wright offers some advice
Introducing a staff coaching programme
Authors: Hughes Pauline
Published: May 2014

Faced with a decline in teaching standards and low staff morale, deputy head Pauline Hughes instigated a coaching programme to help staff develop and share best practice across their school.
Preparing the new primary curriculum – geography, history & languages
Authors: O'Connell Suzanne
Published: May 2014

The new primary curriculum has been published and the process of implementation has begun. In the coming months, we will be examining different subjects and looking at how schools are preparing. Suzanne O'Connell begins with geography, history & languages
Third party contractors – are you still liable?
Authors: Collingwood Ben
Published: May 2014

When bringing in third parties to carry out certain functions, to what extent is your school liable when things go wrong? Legal expert Ben Collingwood explains the ‘non-delegable duty of care’.
Developing learning habits and skills in your pupils
Authors: Chapleau Sebastien
Published: May 2014

School leader Sebastien Chapleau reports on his recent work to develop learning habits with his pupils and the impact it has had, both for the children and the teachers.
KidsMeet: When the pupils take over!
Authors: Brooks Matt
Published: May 2014

You've heard of a TeachMeet – now we have KidsMeet! Matt Brooks shares his experience of hosting a day of exchanging ideas and inspiration across seven schools. The best part? It's the pupils doing the presentations – and providing the inspiration
SEN and action research
Authors: Fleming Sarah
Published: May 2014

It takes a special kind of insight to meet some pupils' unique and complex needs. Sarah Fleming reports on one school that has boosted their expertise through action research.
Learning perimetry: the Swedish way
Authors: Martin Lene M
Published: May 2014

Aim: To report experiences from teaching perimetry to ophthalmic nurses during their education at the Karolinska Institutet, Stockholm, Sweden.

Subjects and methods: The number of occasions for performing perimetry, both under supervision and independently, during clinical practice were counted and the students' comments analyzed. A computer program for simulation of manual perimetry using the Goldmann apparatus was developed and tested by 20 students.

Results: The number of occasions during which students could practise perimetry was variable, depending on the site where the clinical practice period took place, especially regarding manual Goldmann perimetry. The median number of computerized perimetry examinations performed, both under supervision and independent, was approximately 40. The median number Goldmann perimetry examinations performed was two (range zero to five), all under supervision. The students underwent 5-25 training sessions with the computer program. They reported that the program was easy to use, even fun, and that they appreciated the opportunity to practise when and where they wanted. Some student also reported that the simulation training improved confidence and performance in the real perimetry testing situation.

Conclusion: Training in planning, performing and evaluating visual field examinations using computerized perimetry appears to be sufficient during current clinical practice periods, but there is a lack of training possibilities for Goldmann Perimetry. A simulation program provides unlimited training opportunities and can be used in parallel to clinical practice.
Ophthalmic risk from aspergillus in the clinical setting
Authors: Nemeth Christina
Published: May 2014

Many ophthalmic units in the UK are housed in old buildings that may be in the process of being renovated. Outbreaks of nosocomial aspergillus infections have been reported among immunocompromised ophthalmic patients, which have been associated with hospital renovation and construction. Infection with aspergillus poses a serious threat to the vulnerable patient group, therefore, it is important to ensure that preventative measures are taken to decrease the risk of exposure to aspergillus spores during construction work. Early involvement of the infection control team in the planning stages and prior to commencement of any work is important to ensure that correct guidance is adhered to in order to minimize the risk of aspergillus infection in the vulnerable patient population.
Glaucoma expert patient programme
Authors: Amro Raed , Cox Carol L. , Waddington Kathryn , Siriwardena Dilani
Published: May 2014

Expert patient programmes (EPPs) are becoming an increasingly important aspect of chronic disease management, resulting in improved health outcomes for patients. Patients with chronic open angle glaucoma (COAG) require lifelong therapy. However, to date, no EPPs have been designed specifically for patients with chronic eye conditions like COAG. This article describes the development and implementation of the Glaucoma Expert Patient Programme (GEPP), a glaucoma-specific educational self-management programme which aims to improve glaucoma patients' knowledge, self-management skills, expectations and adherence to treatment. A review of theoretical frameworks and models which underpin the design, use and conduct of EPPs was undertaken, and the GEPP was designed based on the model by Kate Lorig (2003) . The result is an educational programme which offers COAG patients a different perspective on their condition and supports them with knowledge, skills and strategies to better manage their condition on a daily basis.
The feasibility and acceptability of a low vision self-management programme for older Singaporeans: A pilot study
Authors: Drury Vicki , Mackey Sandra , Peter Tay Kay Chai
Published: May 2014

Background: The self-management needs of patients suffering from vision impairment are often overlooked during routine clinical care.

Aim: The primary aim of this study was to develop a socially and culturally acceptable self-management programme for people with low vision in Singapore.

Method: This mixed method study was conducted in two phases. Phase 1 gathered information from community groups and phase 2 involved integrating these suggestions with an Australian programme which was modified for delivery in Singapore. A pre- and post-test design using standardized instruments was used. Narrative data were integrated with the quantitative results to provide a rich description of patients' experiences.

Results: Participants reported using more low vision aids, being able to perform activities of daily living with more ease and improved self efficacy. All participants attended every session demonstrating that the programme was both feasible and acceptable.

Conclusion: Despite the small sample size, the programme was well received by the participants demonstrating that acceptance of the programme was high and supporting its feasibility. The experiential format of the sessions and the recommended activities appeared enjoyable with participants reporting that it enabled them to practice what was learned in the sessions. The qualitative findings suggest that the programme was effective in improving functional ability especially in relation to activities of daily living. Participants evaluated the programme positively and felt the session time and number of sessions was acceptable. These findings support the further development and evaluation of the programme.
Patients' experiences of a period of intravitreal injection treatment for wet macular degeneration
Authors: Rönn Emsfors Åsa , Elgán Carina
Published: May 2014

Aim:

To describe patients' experiences of intravitreal injections for wet macular degeneration.

Method:

16 informants, aged 62–89 years (11 women and _five men) were interviewed after a treatment period of intravitreal injections (IVI). The first question was open ended: ‘Can you please describe, in as much detail as possible, your experiences of the period when you received three IVI?’. Qualitative content analysis was employed to analyse the transcribed interviews.

Results:

The main theme demonstrated that the patients submitted themselves to and allowed the process to run its course. Four categories emerged: handing over responsibility — they placed their trust in the healthcare professionals; being given an opportunity — they appreciated that action was taken; enduring discomfort — they endured physical discomfort and mental unease; having nothing to lose — they accepted the treatment offered.

Conclusions:

It is necessary to strengthen patient participation during IVI treatment. The ophthalmic nurse can inform the patient about the effects of the treatment in a pedagogical manner. Patient participation can be strengthened by increased knowledge of the treatment effects.
The use of vascular endothelial growth factor inhibitors (anti-VEGFs) for the treatment of diabetic retinopathy
Authors: Pacheco Patricio A , Mapani Adam , Lazic Ratimir
Published: May 2014

This article explores the current treatment for diabetic retinopathy (DR), and the recent advent of intraocular vascular endothelial growth factor inhibitors (anti-VEGF injections) for macular oedema and proliferative DR. These new agents, including bevacizumab (AvastinTM) and ranibizumab (LucentisTM), are now widely used in the arsenal for treating DR, and have substantially changed the treatment approach, indications and algorithms for the traditional laser treatment and vitrectomy surgery.
Reflections on a slit-lamp teacher-training workshop for ophthalmic nurses in Korle Bu, Ghana
Authors: Poore Sophie , Gibbons Helen , Murdoch Ian
Published: May 2014

Korle Bu Eye Unit based in Accra, Ghana is linked with Moorfields Eye Hospital in a VISION 2020 partnership. Its primary aim is to support and strengthen ophthalmic services within the eye unit at Korle Bu. This article outlines a recent initiative whereby ten ophthalmic Korle Bu nurses undertook a three-day training course with a final day of assessment to become trainers of slit lamp skills.