bluuebunny/crossref_metadata_2025 huggingface dataset:
School nurse independent prescribing in practice
Authors: Day Patricia
Published: May 2014

Nurse prescribing offers school nurses the opportunity to make a difference to the health of teenagers who often present with multiple health damaging behaviours. School nurses should be able to give teenagers access to a one stop shop where salient health issues are tackled.
Hearing impairments part 1: An overview of glue ear
Authors: Benge Sarah , Williamson Ian
Published: May 2014

Otitis media with effusion, also known as glue ear, is a very prevalent condition in young children. Assessment in the primary care setting is difficult as specific diagnostic equipment (e.g. tympanometry) is not readily available in most practices. The current management guidance is for children to be entered into a 3-month period of active monitoring, at the end of which, if natural resolution has not occurred, the child would be referred with a view to possibly having surgery for grommets. Further research into other management techniques, such as autoinflation, is currently underway to pave the way for better management in primary care but also because the long-term effectiveness of grommets is questionable.
Conceptions of school-based youth health nursing
Authors: Sendall Marguerite C , Fleming MaryLou , Lidstone John
Published: May 2014

The aim of this research is to explore the meaning of the experience of school-based youth health nursing in Queensland, Australia. The research follows a qualitative approach and is based on in-depth interviews.

The dominant experience is negative because participants feel they have to battle to gain respect and survive in the school environment. The small, positive experience of school-based youth health nursing is related to student consultations. Student consultations are a ‘golden egg’ because participants gain a sense of reward from making a difference to student wellbeing.

This paper proposes operational recommendations including those related to health promotion and professional development and strategic recommendations regarding this model of school nursing.

The authors conclude, first, that this ‘golden egg’ should be promoted to ensure all school nurses reap the rewards, second, that this model of school nursing is not the most effective model.
Analysing issues in sexual health outreach provision
Authors: Enson Stephanie
Published: May 2014

Although sexual health outreach provision is a valuable service, issues regarding young people's sexual health remain prominent. A number of research papers have sought to investigate these issues and understand gaps in service provision. This article systematically reviews these studies and analyses the various issues that need addressing to increase service use.
The health promoting school and the school nurse: A content analysis of school staff's views
Authors: Alexandropoulou Marianthi
Published: May 2014

Aim: To explore school staff perspective on health promoting school (HPS) and on school nurses.

Background: The literature mainly refers to health professionals’ perspective while clients’ views are not widely documented.

Method: A content analysis was conducted on textual data from two open-ended questions answered by 180 people through a self-completed questionnaire.

Findings: Data produced three categories of HPS staffs’ views (positive, sceptical, negative), and five categories of HPS attributes (methods used in activities, content of health promotion, target population, purpose of activities, person in charge). School nurse data were divided into four categories (scope of school nursing practice, school nurse's target group, school nurse's position among the school staff, school nurse's legal responsibility over health situations).

Conclusions: Participants believed schools could contribute to health promotion, focusing more on health education and ill-health prevention. Essential elements of school nurse practice included providing first aid, medication, and involvement in health education for pupils and school staff.
Supporting positive mental health development in adolescents with a group cognitive intervention
Authors: Garmy Pernilla , Berg Agneta , Clausson Eva K
Published: May 2014

Background:

Supporting positive mental health development in adolescents is an important school health concern, but there is a need to investigate the suitability of the interventions used.

Aim:

The aim is to investigate the experiences of school health professionals in conducting a universal school-based programme aimed at preventing depressive symptoms in adolescents.

Methods:

Twenty-two school health professionals participated in four focus groups. The interviews were analysed using qualitative content analysis.

Findings:

The overall theme identified in the study consists of ‘striking a balance between strictly following the manual and meeting the students’ needs’. Three subthemes emerged: ‘doing good and sowing seeds for the future’, working with insufficient tools, and ‘personal development as a professional and as an individual’.

Conclusions:

School health professionals conducting the programme found it valuable in a school setting, but considered support from the school administration essential.
Clinical assessment of pain by the visual analogue scale
Authors: Waterfield Jackie , Sim Julius
Published: May 2014

This article reviews the use of the visual analogue scale as a method of assessing pain in the everyday clinical situation. The advantages and disadvantages of this method of assessment are examined, and some practical issues regarding its use are considered.
Rehabilitation through advocacy and empowerment
Authors: MacLaren Julie-Ann
Published: May 2014

Effective rehabilitation can be achieved by involving clients in all decisions concerning their care. This promotes compliance, autonomy and independence, and encourages them to fufil their physical and psychosocial potential. Practitioners can facilitate this client empowerment through unbiased information giving and supporting decisions made.
Forensic occupational therapy: is it a developing specialism?
Authors: Chacksfield John D
Published: May 2014

Occupational therapists work in various specialisms within the field of mental health. Forensic psychiatry is one which is rapidly developing. Any occupational therapist wishing to work in this specialism would probably wish to know what they were ‘in for’. Media images of mentally ill criminals have shaped public attitudes and have hidden the realities about how interesting forensic psychiatric work can be.
The ‘pusher’ syndrome in elderly stroke patients
Authors: Bailey Maggie J , Leivseth Linda
Published: May 2014

Reports on the ‘pusher’ syndrome have been conflicting. A small survey was undertaken to examine the relationships between ipsilateral pushing, unilateral visual neglect and motor performance in stroke patients, and an association was found. Therapists should identify perceptual as well as physical deficits in such patients to enable appropriate management.
Exploring the power balance in physiotherapy
Authors: Harrison Karen , Williams Shelley
Published: May 2014

All social interactions involve an element of power negotiation. In the physiotherapeutic situation, there are a number of interesting opportunities to exercise power to a greater extent than would be possible in normal day-to-day life. The power balance of the clinical encounter is explored from both the patient’s and the physiotherapist's perspective.
Introduction to veterinary physiotherapy
Authors: Price Hannah
Published: May 2014

Veterinary physiotherapy is gaining recognition for its importance in the rehabilitation of companion animals. The Association of Chartered Physiotherapists in Animal Therapy (ACPAT) now has over 300 Category A members in the UK, and with two upgrading routes, advances to this profession are constantly developing. This introductory article in a series of physiotherapy articles, looks at the benefits of physiotherapy and assessment and treatment options available to the therapist.
Canine insulinoma: part 1 – diagnosis
Authors: Housley Daniel , Tappin Simon
Published: May 2014

Insulinomas are rare tumours, which inappropriately secrete excessive amounts of insulin and result in signs attributable to hypoglycaemia. Animals become well adapted to this chronic hypoglycaemic state, thus the associated clinical signs are usually only triggered by exertion or fasting. As a result, diagnosis can be difficult and is largely based on the exclusion of other differentials. The diagnosis is best confirmed by documenting hypoglycaemia, in the presence of appropriate clinical signs and inappropriately raised insulin levels. Further investigations, to identify the site of the primary pancreatic tumour and to stage any metastatic disease, will aid decision-making and guide treatment options. The first article in this series discusses the diagnosis of insulinoma, with the second article concentrating on therapeutic management.
Advanced degenerative mitral valve disease and congestive heart failure in dogs
Authors: Harris Joanne
Published: May 2014

Degenerative mitral valve disease (DMVD) is the most common cardiovascular disease in dogs and is a major cause of congestive heart failure (CHF) in this species. This article reviews the pathophysiology and natural history of the disease and provides a summary of current recommendations for diagnosis and treatment of dogs with advanced DMVD and CHF.
Considerations and options for pain management in elective surgery
Authors: Hunt James
Published: May 2014

Surgical treatment of cats and dogs is a routine, but painful, intervention. Effective, licensed analgesic drugs are available, and should be incorporated into anaesthetic plans for animals undergoing surgery. Local analgesic techniques have the potential to contribute significantly to intra- and postoperative analgesia. Pain-related behaviours have been documented in cats and dogs during the days following surgery; consideration of postoperative analgesia is encouraged.
Diagnosis, treatment and management of TMJ disorders
Authors: Cope Graham , Cope Anwen
Published: May 2014

Temporomandibular joint disorders, commonly called TMJ, are a group of conditions that cause pain and dysfunction in the jaw joint and the muscles that control jaw movement. It is important that dental nurses can identify these patients and provide them with information and support about their condition
Conscious sedation. Part three: the patient care pathway
Authors: Macpherson J Avril
Published: May 2014

Conscious sedation is an integral part of pain and anxiety management in dentistry. This series of three articles provides a contemporary review of dental sedation with particular emphasis on the role of the dental nurse as part of the sedation team
Xylitol: A healthier way to prevent tooth decay
Authors: Tillen Dominique
Published: May 2014

Xylitol, a naturally occurring sugar found in plants and fruits, is becoming an increasingly important agent against tooth decay. Dominique Tillen, Founder and Direct of Brushbaby, looks further at its application in dentistry
Sight matters: equine eyes
Authors: Hawthorn Amy
Published: May 2014

Amy Hawthorn BVet MRCVS, Wessex Equine, gives an overview of the diagnosis and treatment of common problems associated with the horse's vision
Hot spots
Authors: Sells Patrick
Published: May 2014

Patrick Sells BVSc BSc (Hons) CertAVP MRCVS explains the science behind thermology
TRANSPORT
Authors: Waterhouse Jessica
Published: May 2014

Different forms of transport prove extremely fascinating for nursery-aged children and, therefore, off er many learning opportunities. Here are some ideas to get a topic on the road.
The power of pointing
Authors: Jones Michael
Published: May 2014

In the fifth article in our series on children's communication from birth to three, we explore the reasons why babies and toddlers’ point, and the role this plays in moving them towards beginning to use words.
Active learning
Authors: Scott Rachel
Published: May 2014

Rachel Scott writes how children can learn through play by using a philosophy of connect, construct, contemplate and continue
Barrett's oesophagus, part 3: A study into patients' perceptions of surveillance
Authors: Bailey Karen
Published: May 2014

Barrett′s oesophagus is a recognized precursor to the development of oesophageal cancer. Guidelines from the British Society of Gastroenterology recommend 2-yearly surveillance for those at high risk of developing cancer, providing they are fully informed of the risks and benefits of surveillance. A qualitative study was undertaken by Karen Bailey to explore whether patients on a surveillance programme for Barrett′s oesophagus were fully informed of these risks and benefits. Thematic analysis revealed the patients were accepting and knowledgeable about their condition and reasons for surveillance, and all were aware of the low risk of cancer. Most were satisfied with the information received, but interestingly just over half (53%) felt too much information could be worrying and preferred to have more detailed information as and when appropriate. All were happy with the care they received and felt reassured at being monitored.
Postoperative ileus in GI surgical patients: pathogenesis and interventions
Authors: Lafon Caroline , Lauren Lawson Dr
Published: May 2014

Postoperative ileus is a common complication following surgery that causes signifcant discomfort and pain to the patient, while increasing hospital costs and length of stay. The development of postoperative ileus is multifactorial, infuenced by the autonomic nervous system, enteric nervous system, hormones and neuropeptides, infammation, anaesthesia, and narcotics. The multitude of factors involved in postoperative ileus necessitates a holistic approach to care. A combination of pharmacological agents, surgical techniques and postoperative nursing care can quicken the return of normal gastrointestinal motility. In this article, Caroline Lafon and Dr Lauren Lawson discuss the clinical course, the traditional treatment approaches, and current evidence-based research in the care of postoperative ileus.
Prevention of alcohol-related assault and injury
Authors: Cusens Byrany , Shepherd Jonathan
Published: May 2014

There is a causal link between alcohol intoxication and injury in assault, mediated by individual, contextual and cultural factors. Harm reduction can be achieved through practical measures like plastic glasses and bottles in licensed premises, controlling drinks prices and targeted policing organized on the basis of police and accident and emergency data.
Isolated facial diplegia: a diagnostic dilemma
Authors: Tayal V , Hollingsworth J , Cooke RPD
Published: May 2014

A 43-year-old man presented to his GP with a right facial palsy of 1 day's duration. He was prescribed a 5-day course of oral prednisolone for a diagnosis of Bell's palsy. Two weeks later he presented to the emergency department with a left facial palsy. He had a 2-month history of back pain, generalized myalgia and paraesthesia. There was no history suggestive of any other neurological deficit. There was no history of fever or weight loss. However, he had travelled to the Scottish Highlands 3 months previously and had noticed an itchy red rash over his buttock (approximately 3 cm in size) 4 weeks after his holidays. The rash was diagnosed as cellulitis and he was prescribed a 5-day course of oral flucloxacillin. The patient, however, did not recall having sustained a tick bite or having a characteristic migrating rash.

Examination revealed a bilateral lower motor neurone facial palsy. Detailed examination of the central and peripheral nervous system was otherwise normal. No vesicles were found in either external auditory canal. Tuning fork tests were normal. The initial investigations undertaken in the emergency unit are listed in Table 1.

Repeat serology 8 weeks later was positive for Borrelia burgdorferi immunoglobulin G (IgG) antibody by both enzyme-linked immunosorbant assay (ELISA) and immunoblot assay. The initial CSF sample was not subsequently examined for B. burgdorferi antibody as the sample had been discarded. A repeat lumbar puncture was not considered appropriate.

This patient's right-sided facial weakness showed spontaneous improvement over 4 weeks from the initial presentation by which time his left-sided weakness had improved.

Based on the history of travel to a tick-infested area, together with the neurological and serological findings, a diagnosis of early Lyme neuroborreliosis was made. Although antibiotic treatment does not hasten resolution of 7th cranial nerve palsy associated with B. burgdorferi infection, doxycycline was prescribed to prevent further sequelae.
A practical approach to symptom management in palliative care
Authors: Harris Dylan , Noble Simon
Published: May 2014

Doctors in all specialties will be involved in the care of patients with terminal malignant and non-malignant disease where the aim is palliation rather than cure. An understanding of the principles of symptom management in this context is therefore a generic skill that all doctors require. This article provides practical guidance on how to manage common physical and psychological symptoms encountered in palliative medicine.
Urinary tract injuries at caesarean section: prevention and management
Authors: Sorinola Olanrewaju , Murthy Varini N , Nallaswamy Vanitha , Srivastava Shalini
Published: May 2014

This article focuses on predisposing risk factors and mechanism of injury for urinary tract injuries at caesarean section. Tips on prevention of injury are followed by a detailed discussion of the management options when injury occurs.
Parkinson's disease and sexuality
Authors: Balami Joyce , Robertson Dorothy
Published: May 2014

Sexual dysfunction rarely threatens physical health but can take a heavy psychological toll. Sexual dysfunction is common in Parkinson's disease, occurring as a non-motor manifestation of the illness but often compounded by secondary problems relating to physical disability, psychological factors and medication effects.
Acute abdominal pain in a 16-year-old woman: the pitfalls of sexual history
Authors: George Akram , Aziz Omer , Shah Anand , Baxter Steve
Published: May 2014

A 16-year-old woman presented to the authors' emergency department in the early hours of the morning with a 3-day history of cramping lower abdominal pain and watery diarrhoea, following a meal of reheated rice. The remainder of her history (including gynaecological history) was unremarkable. Examination revealed that she was clinically dehydrated, had a tachycardia of 100 beats per minute, and although she did not display any signs of peritonism, she did have lower abdominal tenderness, not more so on any one side. Rectal examination was deferred by the patient. Chest and abdominal radiographs (Figures 1 and 2) were unremarkable, and initial blood tests revealed a white blood cell count of 3.4×109/litre, with C-reactive protein of 156 mg/litre. Her urine did not contain nitrites, leucocytes or blood, and a beta-human chorionic gonadotrophin pregnancy test was negative. A diagnosis of gastroenteritis and tachycardia secondary to dehydration was made and the patient was admitted to hospital.

The following day her abdominal pain worsened and despite rehydration she remained tachycardic, developing profound swinging pyrexia (peak of 40°C). On examination, her abdomen was noted to be extremely tender and peritonitic below the umbilicus, with marked guarding on examination. She was immediately referred to both general surgery and gynaecology teams. The on-call gynaecologist was able to question the patient about her sexual history separate from her family, who until now had been with her at all times. At this stage, the patient admitted that she had sexual intercourse for the first time 4 days before admission, but denied any relation to the onset of symptoms. Vaginal examination was refused, but the patient did allow a rectal examination, performed by the general surgical consultant, revealing marked tenderness and fullness in the pouch of Douglas. Although the sexual history was noted, it was felt that appendicitis was the most likely cause for her pain, and the patient was taken to theatre for a diagnostic laparoscopy.

At laparoscopy, a large amount of pus was seen in the abdomen limiting visualization and necessitating conversion to laparotomy. Although a mildly inflamed appendix was seen and appendicectomy performed, this did not account for the pus, and further careful examination of the abdominal cavity was carried out. In the pelvis and careful palpation of the pouch of Douglas revealed a traumatic, full thickness, 1 cm transverse tear of the posterior vaginal wall, through which the cervix could be felt. After discussion with the gynaecology team, this was treated with copious pelvic lavage and a carefully placed pelvic drain. Further questioning during the postoperative period revealed that the intercourse had been consensual but very painful. The patient had an uneventful postoperative recovery and was discharged after 7 days to be followed up in the gynaecology outpatient department.
The limping child: a clinical approach to diagnosis
Authors: Abbassian Ali
Published: May 2014

Acute limp in childhood is associated with considerable anxiety for parents and clinicians alike. It can be a diagnostic challenge in the uncooperative child and any delay in diagnosis can result in significant morbidity and even mortality. A thorough clinical evaluation is of utmost importance. This review revisits the clinical assessment of a limping child and explores the relevant literature.
Ivabradine: a new strategy for management of stable angina
Authors: Menown Ian BA
Published: May 2014

Ivabradine is not only the first of a new class of selective If channel inhibitors, but is also the first new medical treatment for stable angina to be approved in Europe for 10 years. By selectively reducing heart rate without adversely affecting myocardial contractility or blood pressure, ivabradine offers a valuable new option for patients with stable angina in whom beta-blockers are not tolerated or are contraindicated.
The applied anatomy of chest drain insertion
Authors: Ellis Harold
Published: May 2014

A chest drain insertion as an emergency procedure may be required under a number of circumstances. The most common are:
Aspirin and clopidogrel use in the perioperative period for non-cardiac surgery
Authors: Price Jennifer , Tadbiri Shahrzhad
Published: May 2014

Perioperative management of patients taking aspirin and clopidogrel is an increasingly common dilemma. The use of these antiplatelet agents for primary and secondary prevention of ischaemic heart disease and cerebrovascular disease is well established. Consequently more patients presenting for surgery are taking these medications and need advice about whether to continue taking them preoperatively. There are no formally agreed national guidelines in this area, but most hospitals have developed their own protocols.
The genitourinary complications of HIV infection in men
Authors: Masarani M , Dinneen M , Coyne KM , Hawkins DA
Published: May 2014

This article discusses infective and malignant complications of HIV affecting the genitourinary tract in men. Immunosuppression increases both the frequency of infections, and the range of organisms that may be involved. Cancers are common and presentations may be atypical.
Thoracic outlet syndrome: an overview
Authors: Sadat Umar , Weerakkody Ruwan A , Varty Kevin
Published: May 2014

Thoracic outlet syndrome is a non-specific label that encompasses the various presentations resulting from compression of neurovascular structures at the thoracic outlet. This overview focuses on its underlying aetiology and management.
Management of acute coronary syndrome
Authors: Mount Richard , Waqar Salman , Jutley Rajwinder S , Sarkar Pradip K
Published: May 2014

This is a review of acute coronary syndrome as a clinical entity. An appreciation of acute coronary syndrome as a disease spectrum is presented along with contemporary evidence for its diagnosis and approach to medical and surgical management.
The blood film as a diagnostic tool
Authors: Jenkins Christopher , Hewamana Saman
Published: May 2014

In the general haematology laboratory the patient's samples are usually analysed on an automated machine which will produce the full blood count result, together with a digital plot of the blood cells depending on the cell's volume and density of staining. An abnormal full blood count is a common finding with many different conditions. However, the result may give little information about the actual cause of the abnormality, and therefore further investigations such as a blood film are necessary.
The hazards of blood transfusion
Authors: Marik Paul E
Published: May 2014

Blood transfusion-related immunomodulation results in either immune activation, associated with a variety of transfusion reactions, or immunosuppression, associated with an increased predisposition to infections and post-surgical cancer recurrence. This article reviews the major complications associated with blood transfusion.
Blood conservation in practice: an overview
Authors: Shander Aryeh , Moskowitz David M , Javidroozi Mazyar
Published: May 2014

Allogeneic blood transfusions are associated with risks and unfavourable outcomes. Blood conservation provides an alternative, with potential to improve patient care with limited or no blood transfusion. Many approaches are available, but the most essential ones are simple and cost free.
Damage control resuscitation: addressing trauma-induced coagulopathy
Authors: Duchesne Juan C , Holcomb John B
Published: May 2014

Damage control resuscitation attempts early, aggressive correction of trauma-induced coagulopathy in conjunction with interventions designed to achieve early surgical haemostasis and control of contamination. This article reviews the basis of damage control resuscitation and looks at implications for optimizing prognosis after trauma.
Peripheral arterial disease
Authors: Hills Alexander J , Shalhoub Joseph , Shepherd Amanda C , Davies Alun H
Published: May 2014

Peripheral arterial disease is commonly caused by atherosclerosis, and symptoms depend on the location and size of the affected artery, metabolic demands on the tissue, and the presence or absence of a collateral circulation. This article reviews the current evidence for the diagnosis and management of peripheral arterial disease.
Aggregation of marginal gains in the care of acute stroke
Authors: O'Brien Anthony , Guyler Paul
Published: May 2014

The chain of events between a patient first suffering symptoms of acute ischaemic stroke and receiving treatment in an acute stroke unit contains the potential for many delays. Identifying and minimizing these delays can make the difference between life and death, serious debilitation and complete recovery.
Assisted dying: a review of international legislation
Authors: Field Charlotte , Curtice Martin
Published: May 2014

The issue of assisted dying in the UK is increasingly receiving media and academic journal attention. Such reporting often cites, but in little depth, existing legislation in other countries. Such international legislation may also shape future UK assisted dying legislation.
Practical free flap monitoring techniques in head and neck surgery
Authors: Shakib Kaveh , Newman Laurence , Kalavrezos Nicholas
Published: May 2014

A myriad of techniques varying in complexity and sophistication for monitoring flaps have been described but systematic clinical assessment is regarded as the most reliable monitoring tool. This article reviews the contemporary clinical methods in monitoring free flaps.
Early management of ruptured abdominal aortic aneurysm: a practical guide
Authors: Assar Ahmed N
Published: May 2014

An abdominal aortic aneurysm is a permanent localized dilatation which most commonly affects the infrarenal segment of the abdominal aorta. Rupture, the most common and most fatal complication of abdominal aortic aneurysm, is an acute vascular emergency that requires an immediate life-saving operation which has a high mortality rate. Approximately 30–50% of patients with ruptured abdominal aortic aneurysm die before they reach the hospital, and 30–40% of those who reach the hospital alive die without surgical intervention (Bengtsson and Bergqvist, 1993). With an average mortality rate of 45% among patients who undergo emergency repair of ruptured abdominal aortic aneurysm, the overall mortality rate is estimated at 80–90%.
Interprofessional learning
Authors: McKimm Judy , Brake Dulcie-Jane
Published: May 2014

Well-functioning multiprofessional teams are key to delivering effective and safe health care. Clinical teachers need to be able to provide opportunities for learners from different health professions to work collaboratively and learn about and from one another.
Refeeding syndrome: a clinical review
Authors: Ormerod Clare , Farrer Kirstine , Harper Lindsay , Lal Simon
Published: May 2014

Refeeding syndrome can result in a wide variety of complications and may be life threatening. Although well described in hospital practice, refeeding syndrome is often under-recognized and inadequately treated.
Interface geriatrics: evidence-based care for frail older people with medical crises
Authors: Conroy Simon , Ferguson Cassandra , Woodard James , Banerjee Jay
Published: May 2014

Frail older people are at risk of long hospital stays, and there is growing emphasis on identifying alternative care pathways in the community. Rapid decisions to discharge older people may not always serve the patient well. Specialist assessment from geriatricians could improve outcomes.
Methods of hearing assessment in children
Authors: Alaani Ausama , Bulmer Nicola , Hodgkins Carol , Raut Vivek
Published: May 2014

Hearing problems can have a significant impact on a child's language and general development, and therefore early detection is important. Doctors dealing with children need to understand the various types of hearing assessment and their limitations.
Sorafenib in hepatocellular carcinoma
Authors: Josephs Debra H , Ross Paul J
Published: May 2014

Sorafenib, a small molecule multikinase inhibitor, is the standard of care in the USA and Europe for the treatment of advanced hepatocellular carcinoma. This article reviews its development from the basis of molecular hepatocarcinogenesis to phase III trials and discusses the future for sorafenib in hepatocellular carcinoma.
How to perform a lumbar puncture
Authors: Armstrong Sarah
Published: May 2014

Lumbar puncture is a practical clinical procedure involving access to (and often collection of ) CSF. It may be performed for diagnostic or therapeutic purposes. Indications and contraindications to lumbar puncture are listed in Table 1.
Full body low radiation radiography using Lodox Statscan
Authors: Tabbara Malek , Evangelopoulos Dimitrios S , Zimmermann Heinz , Exadaktylos Aristomenis
Published: May 2014

Lodox Statscan provides high-speed, high-quality, low radiation, full body imaging in a single scan, combined with three-dimensional reconstructive and zooming functionality. Several trauma centres have incorporated it into their advanced trauma life support protocol. This review gives a brief overview of the system.
Chronic obstructive pulmonary disease and its comorbidities
Authors: Rabinovich Roberto A , MacNee William
Published: May 2014

Systemic consequences and associated comorbidities are highly prevalent in patients with chronic obstructive pulmonary disease and have a strong impact on morbidity and mortality. This review examines their prevalence and clinical features, and discusses the pathogenic mechanisms, prognosis and implications for therapy.
Treatment of articular cartilage defects of the knee
Authors: Giebaly Dia Eldean , Twaij Haider , Ibrahim Mazin , Haddad Fares
Published: May 2014

Defects of the articular surface are among the most disabling of all orthopaedic injuries. Many methods of treatment have been used, but these have numerous shortcomings. Consequently, recent research has focused on laboratory-engineered osteochondral tissue.
Preconception care for women with mental health conditions
Authors: Green Lucinda , Vais Alina , Harding Kate
Published: May 2014

Pregnancy is associated with a number of specific risks for women with mental health conditions. This article outlines the important issues to discuss with women who have a current or previous mental illness and who are planning a pregnancy.
Applications of Laplace's law in clinical medicine: a radiological pictorial review
Authors: Shelmerdine SC , Barber JL , George CD
Published: May 2014

Laplace's law describes the relationship between wall tension, thickness, pressure and radius in a tubular structure. This article provides radiological examples of disease and uses Laplace's law to explain the rationale behind their screening, early diagnosis and treatment.
Catatonia 1: history and clinical features
Authors: Clark T , Rickards H
Published: May 2014

Catatonia is commonly encountered in psychiatric and medical practice but is underrecognized. It occurs in association with a wide range of disorders and drugs. Psychiatric education and textbooks mistakenly only consider catatonia as a subtype of schizophrenia. This article, the first of two, reviews the development of the concept of catatonia, its epidemiology, clinical features and pathophysiology.
Migraine: which triptan?
Authors: Peatfield RC
Published: May 2014

A wide variety of drugs are now available for the acute treatment of migraine attacks. Although the new triptans are expensive, clinical trials have shown them to be highly effective, and they are the treatment of choice for disabling attacks unresponsive to cheaper medication. This article discusses the different clinical circumstances in which each preparation may prove the most effective.
Stalking (obsessive pursuit)
Authors: Dunne Francis J , Schipperheijn Johanna A
Published: May 2014

Stalking behaviour has long been recognized as causing great distress and prolonged psychological problems in many victims. Individuals subjected to stalking often feel powerless and helpless in the face of such unwelcome intrusions into their daily lives. There now seems to be a greater awareness and understanding of the phenomenon which, in turn, may encourage individuals affected to seek help.
Coronary arteritis in Wegener's granulomatosis causing fatal myocardial infarction
Authors: Parry SD , Clark DM , Campbell J
Published: May 2014

Wegener's granulomatosis is a systemic, granulomatous, inflammatory disorder affecting small vessels, which classically presents with respiratory tract involvement and focal segmental necrotizing glomerulonephritis but not usually with cardiac manifestations. Post-mortem histological examination revealed a diffuse coronary arteritis with an inflammatory infiltrate producing arterial occlusion and subsequent infarction of the myocardium. Post-mortem also showed lung granulomas, generalized small vessel vasculitis and focal segmental necrotizing glomerulonephritis.
Peripheral infusion of Diazemuls
Authors: Jackson Maurice A
Published: May 2014

Diazemuls is a very powerful anxiolytic agent with sedating and antiepileptogenic properties. Unfortunately, until now it has not been possible to give Diazemuls accurately and safely as an infusion. A new delivery system ensures that, as an infusion, this drug is potentially very effective in treating patients with terminal agitation, status epilepticus, drug and alcohol withdrawal.
Psychiatric treatments: an exciting new century
Authors: Martin Rodger , Adawi Samir al
Published: May 2014

At the beginning of the 1900s, effective psychiatric treatments were almost non-existent (Freud's discovery of the unconscious and his psychoanalysis based on this perhaps being the noteworthy exception). In many parts of the world a person with unusual behaviour was thought to be possessed by evil spirits. These demons were exorcised by such techniques as prayer, incantation, magic and the use of purgatives concocted from herbs. If these interventions were unsuccessful, more extreme measures were taken to ensure that the body would be an unpleasant dwelling place for the evil spirit. Flogging, starving, burning, and causing the person to bleed profusely were frequent forms of intervention (Atkinson et al, 1998).
The tracheostomy tube change: a review of techniques
Authors: Mirza S , Cameron DS
Published: May 2014

Tracheostomy tube changing is a routine procedure. However, occasional problems can arise and result in fatalities. This article reviews the various measures and techniques used to optimize the safeguarding of the airway during a tracheostomy tube change, including the 'railroad' technique. The management of accidental decannulations is also reviewed.
Quetiapine: a well-tolerated and effective atypical antipsychotic
Authors: Hellewell Jonathan SE
Published: May 2014

Quetiapine is an atypical antipsychotic, licensed in the UK for the treatment of schizophrenia. This review of published literature identifies the evidence that quetiapine is both effective and well-tolerated and highlights the particular indications in which quetiapine will be of most value to clinicians and patients.
The uses and abuses of drains in abdominal surgery
Authors: Memon Muhammed A , Memon Breda , Memon Mohammed I , Donohue John H
Published: May 2014

Controversy surrounds the indications for and effectiveness of the abdominal drain. There are a variety of factors which mitigate against formulating rigid guidelines for the indications of drains, but surgeons should understand the benefits and applications of drainage and the tissue responses to the constituent materials. Drains are not a substitute for meticulous surgical technique.
Preventing and managing aggression and violence in the NHS
Authors: Bleetman Anthony , Fayeye Oloruntoba O-O
Published: May 2014

Streaming in emergency departments reduces waiting times and stress, and removes the causes of most violent attacks against staff. In spite of this some people will still attack staff. Staff must be protected by a sound trust policy and effective and realistic training, monitored by a good reporting system.
Emergency management of pelvic fractures
Authors: Day Adrian C
Published: May 2014

Pelvic fractures are relatively uncommon, accounting for 1–3% of all fracture. Around 60% occur in men. This article discusses the multidisciplinary management of pelvic ring disruptions resulting from high energy transfer.
Fatty liver
Authors: Allison Michael ED
Published: May 2014

Fatty liver is increasingly becoming more problematic from a clinical perspective. This article describes fatty liver and its clinical presentation. The current understanding of processes underlying fatty liver is reviewed, as well as the evidence for therapeutic options.
Dopamine agonist switching in Parkinson's disease
Authors: Stewart David , Morgan Elizabeth , Burn David , Grosset Donald , Chaudhuri K Ray , MacMahon Douglas , Needleman Fiona , Macphee Graeme , Heywood Peter
Published: May 2014

There are a number of situations for patients with Parkinson's disease in which a safe and efficacious switch from treatment with one dopamine agonist to another may be required. This article explores reasons for making such a switch, and provides practical guidance on performing it.
Nasal polyps
Authors: Drake-Lee AB
Published: May 2014

Nasal polyps are as common as adult onset asthma and unilateral polyps require histological examination. Medical therapy with corticosteroids should be tried before surgery. The anatomy should be demonstrated with computed tomography before endoscopic surgery.
Stroke medicine: a new subspecialty
Authors: Starke Ian
Published: May 2014

The specialist management of patients with stroke has assumed increasing importance over the last 10 years. In recognition of this the Specialist Training Authority has accepted stroke medicine as a subspecialty. The scope of the training programme and the route into it are described.
Coaching blind tennis: an interview with Odette Battarel
Authors: Battarel Odette
Published: May 2014

Metro Blind Sport, a London-based sport and social club for blind and partially sighted people of all ages aims to encourage visually impaired people to not let their disability prevent them from taking part in a range of sports. Odette Battarel, a tennis coach at Metro Blind Sport who also has Stargardt disease explains how sight loss does not mean the end of taking part in competitive sport, and how being part of this community gives people much more than improved fitness: it improves coordination, boosts self esteem, and provides people with a valuable support network.
Understanding palliative care in residential and nursing homes
Authors: Katz Jeanne , Komaromy Carol , Sidell Moyra
Published: May 2014

This article presents the research findings from the qualitative stages of a study which investigated the care of dying residents in residential, nursing and dual-registered homes for older people in England. The study explored the degree to which the principles and practices of palliative care have permeated the care ethos of these settings in order to assess the feasibility of applying appropriate aspects of palliative care. The degree of understanding regarding palliative care varied between the different types of homes and among different categories of staff. The term ‘palliative’ was not familiar to most of the home staff. However, findings from interviews with home managers and observations in case study homes revealed that most homes aspired to provide residents with many aspects of the palliative care approach. The homes were constrained by many factors including the nature of support and the perspectives of attached GPs, specialist palliative care and community nurses. Staffing levels and access to training also determined the quality of care provided.
Ethical issues in qualitative research at the end of life
Authors: Seymour Jane Elizabeth , Ingleton Christine
Published: May 2014

This article discusses some of the ethical issues associated with the use of qualitative research methods in two doctoral studies conducted by nurses in a department of palliative medicine. These issues are of particular relevance with the increasing emphasis on evidence-based practice in palliative care. Both studies used multiple methods of data collection within a case study design. Study one (Seymour, 1997), an ethnography of death and dying in two critical care units, used participant observation, documentary analysis and semi-structured interviews to construct 14 detailed case studies. Each case consisted of the interactions and perceptions of those involved with a purposively selected series of critically ill individuals. Study two (Ingleton, 1997) was based on externally commissioned work and provided a longitudinal analysis of the evaluation of two palliative care services. Triangulated data from documentary analysis, structured and unstructured interviews, questionnaire surveys and observation were used. Specific ethical challenges which arose during the conduct of these studies are highlighted, showing how these were present at all stages of the research process. The article concludes by proposing a guide for the conduct of ethically responsible qualitative research.
Euthanasia: a perspective from Australia
Authors: Aranda Sanchia , Bence Gabrielle , O’Connor Margaret
Published: May 2014

The topic of euthanasia is receiving renewed attention worldwide. Public calls for legalized access to active voluntary euthanasia are gaining momentum in many countries. The majority of nurses working in palliative care report having received a request from a patient to assist in hastening death (Aranda and O’Connor, 1995). It is imperative that nurses give consideration to their practice role in the context of this end-of-life issue. This discussion draws on the authors’ experience in both researching palliative care and responding to those who seek assistance to die. This article argues that in addition to debates about the rights and wrongs of euthanasia nurses, must consider their response to patient requests for assistance to hasten death.
A hope is not a promise: fostering hope within palliative care
Authors: Penson Jenny
Published: May 2014

In palliative care, where patients have to live with a degree of uncertainty as to the possible course their illness may take and the length of life they may expect, hope is a major issue. It has been said that individuals who know they are going to die soon, can be literally dying for hope. Ahmedzai (1994) points out that a major challenge for palliative care is to find ways of inspiring patients towards new directions for hope. This reflective article will explore the nature of hope and discuss the potential problems surrounding false and unrealistic hope, and will focus on how nurses may foster and support hope throughout life-threatening illness and during the palliative phase of life.
Paediatric palliative care: a lack of research-based evidence
Authors: Cooley Candy , Adeodu Sharon , Aldred Hilary , Beesley Susan , Leung Anne , Thacker Lynette
Published: May 2014

Providing the best possible care for the child and family is paramount to health professionals working in paediatric palliative care. However, there is little research which enables practitioners to question their current practice. There are concerns about conducting research on children receiving palliative care at such a sensitive time for the child and his/her family. These concerns must be considered against the growing demand for clear standards and guidelines for practice within health care. According to the Department of Health (DoH) there is no place within the modern healthcare system for the adoption of unproven theories or outdated care (DoH, 1998). While no-one would question the dedication and care being delivered to children and their families by well-trained staff, the lack of research is a cause for concern. A group of students undertaking a degree module in paediatric palliative care identified the lack of literature and research in this area and have undertaken a review of the available literature.
Staff stress in the children’s hospice: causes, effects and coping strategies
Authors: Barnes Kelly
Published: May 2014

Although there are an increasing number of hospices opening around the country, the concept of the children’s hospice is still relatively new. Although stress involved in giving palliative care to adults has been examined quite extensively, very little work has been done on the impact of caring for children in the hospice setting. This article is a literature review, examining the causes and effects of staff stress in the children’s hospice, as well as the factors that enable staff to cope with working in this environment. It concludes that the main causes of stress are often related to conflicts within the staff group, communication problems and role conflict. Poor relationships with the child’s family as well as the inability to relieve distressing symptoms the child may be experiencing have also been identified as common sources of stress. Teamwork, good communication and the home-like atmosphere of the hospice all contribute to enabling staff to deal with work stress. Staff support groups may be beneficial, but need to be run well, by someone experienced in leading such groups. Additionally, stress can be reduced by providing staff with the appropriate training and education and by encouraging them to take some responsibility for preventing and relieving stress themselves.