bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of circuit classes in stroke rehabilitation
Authors: Blennerhassett Jannette
Published: May 2014

I write with reference to the article Patient Satisfaction with circuit class therapy and individual physiotherapy (vol 15(4), 2008, p.167). Circuit classes of task-related practice have become a popular means to enhance patient practice during stroke rehabilitation (Blennerhassett and Dite, 2004; Salbach et al, 2004; English et al, 2007). The organization and supervision provided in these classes enables patients to increase the amount of practice of relevant functional skills that are tailored to the individual's ability. Stroke patients who participate in circuit class therapy as a sole therapy (Salbach et al, 2004; English et al, 2007) or in conjunction with individual therapy (Blennerhassett and Dite, 2004) make statistically signifi cant and clinically meaningful gains in walking (Blennerhassett and Dite, 2004; Salbach et al, 2004; English et al, 2007) and upper limb ability (Blennerhassett and Dite, 2004; Salbach et al, 2004). Circuit classes of task-related practice therefore seem to offer a practical and efficient use of health-care resources to optimize patient outcome during stroke rehabilitation.
Verbal mediation as a treatment strategy for children with non-verbal learning difficulties
Authors: Fox Tania , Lincoln Nadina
Published: May 2014

Aim

The aim of this case study was to investigate the effectiveness of verbal mediation training in children with non-verbal learning difficulties.

Methods

Two A-B-A single case experimental design studies were conducted. In the intervention phase each child was asked to complete non-verbal construction tasks using verbal mediation. Children also completed a digit span task, as a control measure of overall development. During the training and follow-up phases they completed a jigsaw, as a measure of generalization of training to a related task. Findings: The results suggested that the children improved in their ability to complete non-verbal construction tasks, unrelated to changes in their overall developmental level.

Conclusions

Findings suggest that verbal mediation training was beneficial for two children with non-verbal learning difficulties but further research, in the form of randomized controlled trials is needed.
Hearing loss: a potential deterrent to successful rehabilitative therapy
Authors: Scott Jack M
Published: May 2014

If untreated, hearing loss can greatly impact on patients' ability to understand speech and their overall quality of life and sense of wellbeing. Any or all of these factors may affect a patient's willingness and ability to carry out clinic or home-based therapeutic activities.
The Delphi technique: A review
Authors: Vernon Wesley
Published: May 2014

Background

The Delphi technique is an approach with much to offer health-care research. It was first devised by the RAND corporation in the 1950s and later, in the 1970s, was rediscovered by the nursing profession. Delphi is one of a range of consensus techniques, all of which fall under the broad classification of action research approaches. The purpose of the Delphi technique is to test opinion consensus amongst a group of experts.

Content

A brief overview of the various consensus methods is given. The development and operation of the Delphi technique is then considered and a critical assessment of the technique is offered.

Conclusions

Delphi is potentially useful across a wide range of applications, however, it is important to appreciate the strengths, weaknesses and pitfalls to avoid in its application.
Deciding to attend cardiac rehabilitation: A female perspective
Authors: Pullen SA , Povey RC , Grogan SC
Published: May 2014

Aims: Despite the documented benefits, women have been found to have both lower rates of cardiac rehabilitation attendance and completion than men. This article explores womens decisions to attend cardiac rehabilitation. The aim was to provide an analysis of how women think about their illness and cardiac rehabilitation, and examine how this relates to their decisions about whether or not to attend a cardiac rehabilitation programme. Methods: A qualitative cross-sectional design was adopted. Semi-structured interviews were conducted with five women who had decided to attend cardiac rehabilitation, and three women who had declined cardiac rehabilitation. An interpretative phenomenological analysis was conducted on the transcripts. Findings: The declining group believed their understanding to be complete, from having experienced a previous cardiac event, whereas the attending group were in the preliminary stages of making sense of their condition. The attending group valued the support offered from others and cardiac rehabilitation, whereas the declining group described an independent attitude and did not perceive a need for cardiac rehabilitation. The experience of negative emotions was evident in both the attending and declining groups. However, the attending participants had greater perceptions of control over the condition compared to the declining group. Conclusions: Based on this preliminary research, recognizing the need for control, identifying and receiving social support, and valuing the role of cardiac rehabilitation are factors influencing whether women decide to attend cardiac rehabilitation. Illness and cardiac rehabilitation beliefs should be targeted at the time of in-patient assessment.
Grip strength and functional balance in community-dwelling older women
Authors: Barron Joan , Guidon Marie
Published: May 2014

Background: Effective detection and treatment of balance impairment in older people is a matter of clinical urgency. 4 screening tool for impaired balance is required, as is clarity regarding the role of muscle strength in balance control.

Methods: This observational study examined the relationship between grip strength and balance in 40 community-dwelling women aged 65-95 years. Measures included grip strength, Functional Reach test, Single Leg Stance Test, Timed Up and Go test and the Berg Balance Scale. Correlation analyses were used to investigate relationships between the variables.

Findings: Significant correlations were found between grip strength and each of the balance measures. The strongest correlation (r=0.55, P<0.001) was found between right grip strength and the Berg Balance Scale. The weakest correlation (r=-0.36, P=0.012) was between left grip strength and the Timed Up and Go test. Grip strength accounted for only 14%-31% of the variance in balance test scores

Conclusions: The association between grip strength and balance was not sufficiently robust for grip strength to be recommended as a screening tool for balance impairment in older people.
Developing clinician expertise in paediatric dysphagia: what is an effective learning model?
Authors: Duivestein Janice , Gerlach Alison
Published: May 2014

Background: Developing and maintaining clinician expertise in specialized rehabilitation practice areas can be challenging, and requires effective education and learning strategies. To widen the scope of this series, this article looks at education and learning models, how to develop and assess them, and their value in practice. This article provides an example relevant to any specialized learning.

Content: The authors use the example of paediatric feeding and swallowing difficulties (dysphagia) to describe the evaluation and exploration of the education and learning models at two paediatric agencies in British Columbia, Canada. These models are designed to support occupational therapists and speech language pathologists in developing expertise for performing videofuoroscopic swallow studies (VFSS), a component of a comprehensive paediatric dysphagia evaluation. Clinicians involved in providing specialized paediatric dysphagia services, including VFSS, were engaged in this study through a participatory action research approach. Data on current education and learning models and clinicians’ experiences were collected through questionnaires and a focus group. Results identified three interconnected themes: ‘dynamic and interactive learning is necessary to refect the complex and changing practice environment’; ‘supports and resources provide infrastructure to enhance learning’; and ‘personal characteristics influence learning.’

Conclusions: Findings from this preliminary participatory action research study suggest that education and learning models to facilitate the development of clinician expertise in paediatric VFSS should consider employing a multi-faceted approach in which the necessary supports, resources and interactive learning environments are available for both new and experienced clinicians.
Interventions for post-stroke disturbances of mood and emotional behaviour: recommendations from SIGN 118
Authors: Gillespie David C , Joice Sara , Lawrence Maggie , Whittick Janice
Published: May 2014

David C Gillespie, Sara Joice, Maggie Lawrence, Janice Whittick

Background: Stroke is a leading cause of death and disability. A high proportion of those who survive participate in programmes of rehabilitation. Clinical practice guidelines have come to play an increasingly important role in stroke rehabilitation, providing accessible summaries of the evidence for the management of specific consequences of the condition. Among the most common - and disabling - consequences of stroke are disorders of mood and emotional behaviour.

Content: This article reports the development of clinical practice recommendations for post-stroke emotional disturbance for the Scottish Intercollegiate Guidelines Network (SIGN). SIGN 118 Management of Patients with Stroke: Rehabilitation, Prevention and Management of Complications and Discharge Planning was published in June 2010. Suggestions are made for ways in which the SIGN 118 recommendations for disorders of mood and emotional behaviour can be implemented in routine clinical practice. Limitations of the guidelines are also discussed.

Conclusions: Although gaps in the evidence base exist, SIGN guideline 118 has an important role to play in closing the gap between what stroke multi-disciplinary teams do to promote good psychological outcomes, and which aspects of practice are supported by a robust evidence base.
Evaluation of a radiographic technique: one dimension of critical thinking
Authors: Castle Alan
Published: May 2014

Background:

Previous articles in this series (July 2010 and April 2011) have looked at examples of how undergraduate students can demonstrate their ability to interpret data and generate new ideas as part of developing their critical thinking skills. As a final example, the evaluation component of critical thinking is explored that requires students to recognize arguments, separate fact from opinion and verify the value of evidence. In this way they can fully engage with evidence-based practice.

Contents:

The evaluation component of critical thinking encourages students to ask the right questions when considering research data and dig deeper into the motives, expertise and assumptions underlying the evidence presented. The worked example is for an evaluation of the effectiveness of X-ray imaging of the lumbar spine in patients presenting with persistent nonspecific low back pain (LBP). The structure of the evaluation includes clinical indications, diagnostic yield, effectiveness of current practice and comparison with other diagnostic imaging options.

Conclusions:

Since critical thinking is not a single entity, understanding the key components that contribute to the whole is important if undergraduate students are to be encouraged and supported in developing their critical thinking skills. The example of an evaluation of a radiographic technique illustrates how students are expected to go about demonstrating their understanding of the intentions and motivations behind judgements, protocols and guidelines that are aimed at improving the delivery of health care.
Active exercise in critically ill adults affected by thrombocytopaenia
Authors: Polastri Massimiliano , Vianelli Nicola
Published: May 2014

Introduction

Thrombocytopaenia (TCP), or low platelet count, is a haematological disorder that commonly occurs in critically ill patients and is defined as a platelet count below 100 000/μL. Patients are at higher risk of muscular atrophy and other complications after prolonged bed rest. This literature review aims to clarify the appropriateness of active exercise in critically ill adult patients with TCP.

Methods

A review of the literature was conducted using the following key words that are PubMed medical subheading (MeSH) terms: ‘critical illness’, ‘exercise therapy’, ‘manual therapy’, ‘physical therapy’, ‘physiotherapy’, ‘postoperative care’, ‘rehabilitation’, ‘thrombocytopenia’, and ‘thrombopenia’. The search was limited by publication date (2000 to 2013) and language (English only) in three main databases: PubMed, SCOPUS, and CINAHL.

Results

The key word searches found a total of 78 citations. Of these, only those meeting the inclusion criteria were selected after reading the title and abstract. Two studies were included after reading the full-texts. Exercise is used to treat muscular atrophy in critically ill adult patients, and rehabilitation plays an important role in the care pathway. Results of our analysis do not support evidence for or against exercise in critically ill adult patients with TCP; therefore, health professionals must pay close attention to the presence of signs of bleeding in these patients when proposing exercise.

Discussion

Surprisingly, no study was found that directly covered this issue. Aggressive exercise may not be appropriate in patients with very low platelet counts. On the other hand, critically ill patients are at high risk of muscular atrophy due to the forced bed rest, especially after complex surgery or in prolonged hospitalisation. Physiotherapists and those providing care must share their observations with the rest of the multidisciplinary team before treatment starts.

Conclusions

Active exercise in critically ill adult patients with severe TCP must be personalised and platelet count carefully monitored before proposing physical activity. Physical recovery can be challenging in critically ill adult patients, and it can be limited by severe TCP, mostly when bleeding is present.
A pilot thoracic exercise programme reduces early (0–6 weeks) sternal pain following open heart surgery
Authors: Sturgess Tamica , Denehy Linda , Tully Elizabeth , El-Ansary Doa
Published: May 2014

Aims

To investigate whether thoracic exercises result in improved pain, range of movement and health-related quality of life (HRQOL) following open heart surgery (OHS), and to evaluate patient perception of the role of thoracic exercises in recovery.

Methods

A single-blinded pilot trial was conducted in a tertiary public hospital in Australia. Thirty-eight participants who underwent OHS were randomly allocated to an experimental (Group 1, n=23), or control (Group 2, n=15) group. All participants were prescribed a twice-daily walking programme postoperatively. The experimental group also completed a progressive, individualised thoracic exercise programme. Baseline pre-operative measures of shoulder and thoracic range of movement, pain and HRQOL were repeated at 4 weeks following discharge and 3 months postoperatively. Participants also rated their perceptions of the role of exercise and its contribution to physical recovery.

Findings

At 4 weeks following discharge, the experimental group reported 1.7 cm on the visual analogue scale (VAS) less sternal pain (95% CI of median 2.8–0.0, P=0.03) than the control group. The experimental group reported a trend toward greater perception of the contribution of their physiotherapy programme than the control group (median difference 1.2 cm, 95% CI -2.1–-0.0, P=0.04). There were no other differences between the two groups.

Conclusions

Thoracic exercises following OHS may be effective in reducing sternal pain and warrant further investigation.
Case Study: Preventing glucocorticoid induced osteoporosis
Authors: Barnardo Jonathan
Published: May 2014

Older patients who need to take corticosteroids should be assessed for their osteoporosis risk.
Eating disorders
Authors: Wilson Jonathan
Published: May 2014

Diagnosis and treatment.
Treating bullous pemphigoid
Authors: Frost Tessa
Published: May 2014

This blistering disorder requires careful management, writes Dr Tessa Frost.
Managing eczema in older patients
Authors: Van Onselen Julie
Published: May 2014

Community nurses can support older people with eczema by understanding the condition and treatment principles.
Practical commissioning: your questions answered about influencing clinical commissioning
Authors: Gupta Andrea
Published: May 2014

Should the clinical commissioning group (CCG) board role be a full-time position for a nurse or does this depend on local strategy?
Basal cell carcinoma in pictures
Authors: Watkins Jean
Published: May 2014

Basal cell carcinoma is the most common type of cancer in humans, and it most often occurs in elderly people who have enjoyed excess exposure to ultraviolet light, particularly during childhood, writes
Treating Pneumothorax
Authors: Kochhar Suneeta
Published: May 2014

Intervention

Suneeta Kochhar explains how to diagnose and treat the different presentations of pneumothorax
Hand, foot and mouth disease
Authors: Kochhar Suneeta
Published: May 2014

PAEDIATRICS

Hand, foot and mouth disease is a highly infectious disease which commonly affects young children, says Suneeta Kochhar
An evaluation of high fidelity simulation training for paramedics in Ireland
Authors: Power David , Henn Patrick , O'Driscoll Paul , Power Theresa , McAdoo John , Hynes Helen , Cusack Stephen
Published: May 2014

• Introduction: The requirement for pre-hospital practitioners to perform additional interventions is ever increasing. In Ireland the training of pre-hospital practitioners is currently developing and evolving to meet this demand. This requires the use of simulators with the capability to simulate more advanced interventions.

• Objectives: We wished to explore the views of pre-hospital care practitioners post participation in a pilot high fidelity simulation in emergency care, to gauge its acceptability, relevance and application.

• Method: Pre-hospital care practitioners’ participated in 12 full immersion high-fidelity simulated scenarios, over three consecutive days. Live video recording was during the scenarios and replayed during debriefing sessions. The participants completed a voluntary and anonymous evaluation of the training using six statements on a five point Likert scale and free text written comments to three open-ended questions.

• Results: The overall response to the training was overwhelming positive with 94.4 % of the participants either strongly agreed or agreed that the course met their learning needs. All agreed that they found the course relevant to their stage of training and that the course will impact beneficially on their clinical practice.

• Conclusion: This pilot study has shown that high-fidelity simulation is both applicable and relevant to pre-hospital practitioner.
Reflective account of a delayed adverse reaction to a large molecular filler
Authors: Traill Frances Turner
Published: May 2014

This is a reflective account of a 62-year-old woman (Jean) who developed delayed hypersensitivity reactions to a large molecular hyaluronic acid (HA) filler in 2009. Jean had previous injections in August 2008 of 1 ml of HA filler to her nasolabial folds, of 1 ml of HA filler to the peri-oral area in November 2008 and 1 ml of HA filler to nasolabial folds in May 2009, all with excellent results and high patient satisfaction. However, Jean presented 10 weeks after her initial treatment for mid-face volume loss with a volumising HA dermal filler and developed an adverse delayed reaction. Following this experience, the author formed a protocol for her clinic and has taken part in discussions about protocols in practice, prescribing and managing complications.
Management of tear trough complications post lower eyelid rejuvenation
Authors: Collier Helena
Published: May 2014

Non-surgical rejuvenation of the lower eyelid incorporating the correction of a tear trough deformity can be a treacherous procedure for the aesthetic practitioner. The anatomy of the nasojugal region is challenging and, combined with the fragility of the lower eyelid skin, this can create a suboptimal outcome that is not only problematic with iatrogenic complications, but can also lead to a patient experience fraught with dissatisfaction. However, the benefits of injecting a hyaluronic acid-based dermal filler to rejuvenate the lower eyelid include high satisfaction, immediate results, minimum recovery, reduced morbidity and the potential to reverse outcomes hyaluronidase medication.
Nurse prescribing in aesthetic medicine: what are the legal requirements?
Authors: Fromage Gemma
Published: May 2014

Nurse prescribing was first brought to practice in 1998 with the introduction of the Nurse Prescribers’ Formulary. Since then, nurses have been divided into three categories, each with different prescribing rights and restrictions. Prescription-only medications (POMs) require a prescription to be sold or supplied and, as the level of expertise of nurse prescribers has increased, so too has the range of POMs. Regardless of who the appropriate prescriber is, prescriptions must follow a number of guidelines. The most notable difference in prescribing rights was that of the authority to prescribe controlled drugs. However, as of 23 April 2012, after a two-decade battle, nurses were given the same prescribing rights as doctors.
Antioxidant serums, botulinum toxin injection precautions and conferences
Authors: Goddard Rachel
Published: May 2014

In this regular feature in the Journal of Aesthetic Nursing, experienced aesthetic nurses answer your questions relating to clinical and professional issues. In this issue, nurses focus on travel advice for patients following treatment with botulinum toxin, the benefits of antioxidant serums and the best aesthetic medicine conferences to attend
From nurse to practice manager: discover an international success story
Authors: Little Jenny
Published: May 2014

After working as a nurse in the NHS, the idea of running your own business can be particularly daunting. However, this short interview with nurse turned practice manager Jenny Little shows that the transition is more than possible, enabling you to build positive relationships with those in the industry and potentially creating your own product range. Prepare to be inspired…
Microsclerotherapy: following the patient journey in cosmetic practice
Authors: Collier Helena
Published: May 2014

This article captures the journey of a 42-year-old female patient who presented to the author's medical aesthetic clinic with telangiectasia of the lower limbs. Telangiectasia is the visible surface manifestation of an underlying problem with reverse venous flow; whereas mild forms are uncomfortable or cosmetically disfiguring, severe venous disease can produce serious systemic consequences and can lead to loss of life or limb ( Weiss et al, 2001 ). Microsclerotherapy is considered the gold standard in the treatment of telangiectasia, venulectasia and the problematic connecting reticular veins of the legs ( Goldman et al, 2007 ). This paper will explore the consultation process, appraise the pre- and post-treatment regimens performed before and after microsclerotherapy, demonstrate how ethical, legal and professional responsibilities contribute to the decision-making process in relation to microsclerotherapy, and offer contemporary evidence to support the patient journey and treatment outcomes.
Correct disposal of healthcare waste in the medical aesthetic clinic setting
Authors: Sommereux Lou
Published: May 2014

For the purposes of this article, the author has focused only on infectious and medicinal healthcare waste pertinent to an aesthetic clinic or mobile aesthetic nurse. As it is presumed that cytotoxic or cytostatic medicines are not administered in these environments, these waste streams are not discussed. Not only does avoiding producing unnecessary waste reduce disposal costs, but implementing waste policies should also allow a critical review of the volume and types of waste produced in the clinical setting. It is important to identify and implement practical steps to reduce the volume of waste and consider the environment and carbon footprint. Effective segregation using the correctly-coloured waste receptacles can go a long way to ensuring adequate disposal. Audit policies are important to demonstrate compliance with regulations.
Do No Harm in medical aesthetics: an overview of the regulations and ethics
Authors: Bowes Lorna
Published: May 2014

In January of this year, the author presented a session on the topic Do No Harm in medical aesthetics. Considering the current importance and supremacy of ensuring best practice and patient safety, now is a relevant time to provide the background on how the Nursing and Midwifery Council's (NMC's) (2008) code of conduct should govern aesthetic nurses' practice and provoke thought and discussion on these issues. Areas covered in the original lecture were the Hippocratic Oath and NMC code, ethics and aesthetic business and evidence-based medicine. In this article, the author will provide an overview of the first two parts of the presentation.
Skin rejuvenation using mesotherapy: indications, techniques and ingredients
Authors: O'Mahony Malti
Published: May 2014

Mesotherapy is a skin rejuvenation procedure that has gained popularity in recent years. The products that are used for mesotherapy can be administered using multiple intradermal injections, either individually or through use of a dermal roller, which penetrates usually 192 needles at the same time, and also through topical creams. In this article, the author, who has gained experience in using this procedure over the past 10 years, provides information on the background to mesotherapy's development, the contents of the products used, techniques of administration, and her personal experiences with clients. A random sample from of 100 clients who received mesotherapy via individual injections was selected and descriptive data on their age, gender, ethnicity, and frequency of treatments are presented in this article. Use of the dermal roller technique is also presented, with similar data on the client group who had received this treatment at the same clinic. The data can be interpreted as inferring that the procedure of individual injections is particularly well tolerated by clients. However, further evidence is needed on client outcomes and satisfaction with this treatment, and its use in conjunction with procedures such as botulinum toxin and dermal fillers.
Gender matters: a guide to attracting male and female clients to your website
Authors: Brechon Sarah
Published: May 2014

The idea that only women seek appearance-related procedures is now dated, with an increasing number of male clients routinely presenting to aesthetic nurses. For this reason, among others, it is important to keep an eye on the image your website creates and how elements such as colour and copy format affect the audience you capture online. Sarah Brechon explores the importance of gender in aesthetic business
Launching a new clinic: what to consider when planning your first PR campaign
Authors: Zadah Kate
Published: May 2014

When you have worked so hard to launch your own premises, it can be exciting to invite new clients and press representatives to celebrate; however, it is important to do this in the most effective way. In her regular column providing PR advice, Kate Zadah provides her top tips on planning a PR event, including capturing the right audience and getting the timing right
Hand rejuvenation using a dermal filler to promote volume and skin hydration
Authors: Sommereux Lou
Published: May 2014

Dorsal hand rejuvenation using dermal fillers to restore hydration and volume is now commonplace on the treatment menu of aesthetic clinics. This is a case study of 60-year-old Carol, whom the author treated with Restylane Vital for the rejuvenation of her hands. Carol had previous aesthetic treatments to her face and decolletage using hyaluronic acid (HA) fillers Restylane and Restylane Vital, and botulinum toxin type A, with excellent results. Her hands presented with premature senile actinic purpura, extreme loss of dermal volume, severe tissue atrophy, architectural changes with visible dorsal veins and tendons, and fragility with a lack of skin elasticity and hydration. Following the success of Carol's treatment, with no complications and high patient satisfaction, the author has formed a simple grading scale protocol for hand rejuvenation procedures in her clinic.
Advances in technology and their impact on aesthetic practices in the UK
Authors: Knight Diana
Published: May 2014

Long gone are the days when people used to book appointments using an A4 diary. Nowadays, people access and update their electronic booking systems on their computers, phones and tablets, which has forced business owners not in the know about technology to learn about it fast. In this short article, Practice Manager Diana Knight reflects on her experience of going from paper to power
An introduction to superficial, medium, deep and combination chemical peels
Authors: Bowes Lorna
Published: May 2014

Chemical peels are popular, affordable and relatively safe procedures for use in medical aesthetic clinics and at home. However, in the twenty-first century, the term ‘chemical peel’ has as broad a scope as the term ‘transport’. For example, patients can travel by bicycle (superficial), car (medium) or helicopter (deep). To identify each type of peel, this article will review the most frequently used ingredients, including alpha hydroxy acids, beta hydroxy acids and phenol. The content of this article will also support aesthetic practitioners in choosing appropriate chemical peels for best clinical response.
What is the role of appearance concerns in exercise participation?
Authors: Townsend Daisy
Published: May 2014

Despite the several health-related benefits associated with regular exercise, such as improvements in anxiety and depression, individuals who feel uncomfortable with their bodies are likely to avoid physical activity for fear of being judged negatively by others. Daisy Townsend, PhD Researcher at the Centre for Appearance Research, delves into the psyche of those who feel self-conscious about their body image
Expanding the horizons of your business: to diversify or not to diversify?
Authors: Deakin Barbara
Published: May 2014

If you are thinking of ways to move forward with business development, it could be worth adding new treatments and services to your clinic's menu. However, it is also possible to achieve equally effective results by enhancing your existing offering. Clinic Manager Barbara Deakin offers her top tips on discovering what will work for your clinic and how to stand out from the crowd
Non-surgical rhinoplasty: how to choose the right patients and products in practice
Authors: Revell Kathryn
Published: May 2014

Non-surgical rhinoplasty can build up the bridge of a patient's nose, camouflage a hump (straightening his/her profile), balance an asymmetry, correct defects and shape the nose's tip. Through using dermal fillers, patients no longer have to wait to see aesthetic results, as they are immediate and long-lasting. In this article, the author will give an overview of non-surgical rhinoplasty and its growing popularity in todays aesthetic marketplace. To provide context, the author will also cover in brief the anatomy of the nose, the history of this procedure from its beginnings in the early nineteenth century to present day, and the importance of appropriate patient and product selection. The author will also discuss the benefits of this in--clinic procedure to the patient and its role in finessing and augmenting the results of traditional surgical rhinoplasty.
Not such a quick fix: defining the challenges and myths associated with disfigurement
Authors: Stock
Published: May 2014

One in five people have an appearance that is considered ‘different’ to the normal population. This can have a profound impact on the lives of those affected and their families and partners. Nicola Stock, Research Associate at the Centre for Appearance Research explores the challenges associated with disfigurement and stresses the importance of focusing on positive attributes and relationships
Treatment of a 25-year-old female patient with moderate acne vulgaris
Authors: Baker Adrian
Published: May 2014

Acne vulgaris is a chronic skin condition that affects up to 80% of people aged 11-30 years ( National Institute for Health and Care Excellence, 2013 ). In this article, the author presents a case study of a 25-year-old female patient with acne vulgaris who attended a consultation with a nurse independent prescriber at a private aesthetic skin clinic. The case study discusses best practice for acne vulgaris diagnosis, such as using clinical grading severity scoring and comedone identification. Comedonal identification is found to be a key diagnostic indicator of acne, as it is the root in which all acne lesions form. While many acne treatments are available, four treatment options are analysed using the literature. The patient was prescribed a once-daily administration of lymecycline 408 mg antibiotic in conjunction with Epiduo (adapalene 0.1%, benzoyl peroxide 2.5%), which was found to be most efficacious for this patient's presenting condition, targeting three out of the four pathogenic factors of acne. It is also a cost-effective treatment, when medicines adherence is taken into account.
Caring for the critically ill patient: the ethical issues
Authors: Bancroft Denise
Published: May 2014

The critically ill patient poses many ethical issues in relation to the provision of critical care. The increased demand for critical care facilities has prompted health care organisations worldwide to look for suitable alternatives for delivering critical care, which has led to post-anaesthesia care units (PACU) being used as an intensive care unit overflow facility. This raises ethical issues and concerns in relation to the quality of care delivery, and the patient's right to have equitable access to critical care in terms of the following ethical principles: beneficence/non-maleficence, deontology, justice and resource allocation, autonomy, utilitarianism, paternalism. Ethical principles need to be explored individually when clinical decisions are made to provide holistic ethical care, that preserves the moral and ethical integrity of both the PACU practitioner and patient. To apply ethical principles in clinical crises requires expert knowledge and experience within critical care, which needs to be underpinned with robust protocols and validated critical care training so that PACU practitioners can act in the patient's best interests and deliver safe, ethical high quality care.
Recognising and managing malignant hyperthermia
Authors: Lay Ryan
Published: May 2014

Malignant hyperthermia results from an abnormal reaction to certain anaesthetic drugs and is therefore of particular importance to perioperative practitioners. Although it is acknowledged as an emergency situation, recognition of its symptoms and diagnosis remains a challenge for the theatre team. Its management can also involve many simultaneous tasks, relying on coordination and teamwork. This article explores the condition and its management, demonstrating the importance of awareness, teamwork and preparation.
Exploring the dynamics and purposes of teams
Authors: Lewis Tim
Published: May 2014

In the second article in this series, the nature, dynamics and purposes of teams will be explored, with links made to the communications principles discussed previously. Again, this article sets out to introduce and to explore the relevance of these topics to practice, rather than acting as a critique of recent research.
The importance of leadership development for health visitors
Authors: Baldwin Sharin
Published: May 2014

Leadership continues to be an important facet of health care, particularly so in the NHS. With the rollout of the Health Visitor Implementation Plan ( Department of Health, 2011 ) there has never been a more vital time for effective leadership within health visiting. It is imperative that health visitors take on the role of effective leaders as ascribed to them, in order to continue to develop the profession in its unique right. This article explores the varying theories of leadership, discusses whether it can be learnt, and why leadership needs to be developed within health visiting.
Talking with and advising parents about childhood immunisation
Authors: Bedford Helen
Published: May 2014

Immunisation is the most highly effective public health intervention available, after clean water, for preventing ill health and its consequences in children. The promotion of immunisation is a key component of the Healthy Child Programme ( Department of Health (DH), 2009) , and therefore it is an important part of health visitors' work. This article describes the main factors affecting vaccine uptake, focusing specifically on advising parents and responding to their questions and concerns.
Postnatal depression support for mothers: A personal story
Authors: Williams Michelle
Published: May 2014

In the January issue of JHV, Mark Williams, founder of Father's Reaching Out, a support group for men whose partners are suffering from postnatal depression, told his story about his wife suffering from the condition. Now his wife, Michelle Williams, describes her story.
Return to health visiting: Realising the potential conference
Authors: Newland Rita , Bryar Ros
Published: May 2014

The return to health visiting: realising the potential conference took place on 27 March at City University London. The day celebrated the success of the return to practice programme and health visitors outlined what they have been doing since returning to the profession.
Providing advice and guidance on complementary feeding
Authors: Tuck Claire
Published: May 2014

Part of the role of the health visitor includes providing advice on complementary feeding—the introduction of solids to an infant's milk diet. This advice is largely based on research and government recommendations from almost 20 years ago. Recommendations from the government on the timing of introduction of solids were updated in 2003. While the Scientific Advisory Committee on Nutrition has commenced an examination of recommendations and advice on complementary feeding, what should health visitors be advising in the interim? This article provides a brief update on new research and key areas to consider when providing advice on complementary feeding.
Facilitating health visitors' learning and normative practice
Authors: Ebeid Ann
Published: May 2014

Health visitors use an evidence-based, public health approach to identify family and child health needs. Ann Ebeid outlines a plan to implement a new, accessible health visiting service that enhances practitioners' experience and learning in the workplace.
Mixed feeding in infants and how to wean onto solid foods
Authors: More Judy
Published: May 2014

Breast milk provides infants with adequate nutrition until about 6 months of age. Among the many advantages of breast milk over infant formula is the reduced risk of illness because breast milk contains antibodies. Infants develop and grow at different rates, and parents should be supported to decide when their infant is ready for solid foods, around the age of 4–6 months. Weaning is a learning process and should progress with the introduction of a wide range of tastes and increasingly complex textures, so that infants are eating minced and chopped, nutritious family foods by 12 months of age. Additionally, drinks in cups should be introduced after the age of 6 months to enable infants to learn to sip rather than suck their drinks.
Beyond the ‘red book’: The Early Years Developmental Journal
Authors: Oates John
Published: May 2014

The new Early Years Developmental Journal was launched in February 2013 by Early Support. This journal provides a supplement to the Personal Child Health Record. John Oates explains the benefits of the journal for health professionals and parents.
Using the principles of Vygotsky in the home environment: A health visitor's perspective for under-fives
Authors: Thomas Sara
Published: May 2014

Vygotsky's socio-constructivist theory and the zone of proximal development is as valid today as when it was written in the early 20th century. An awareness of a child's current level of understanding is necessary in order to challenge and question their further potential. There appears to be a need for parents to be re-educated as to their role as educators within the home environment, where everyday objects and scenarios can hold a wealth of possible learning experiences for children. Health visitors are in an ideal position to remind parents of how they can help to facilitate their child's learning. A knowledge of how Vygotsky's principles can be applied to the home environment will enable health visitors to provide simple tips to parents on how to maximize their potential as educators.
Offering support to partners of people suffering from depression
Authors: Carr Caroline
Published: May 2014

Depression and anxiety come in many forms and affect more people than the sufferer alone, with partners taking a great deal of strain. Caroline Carr shares her experience of working with partners of people with depression, and offers advice on how to help.
Should breastfeeding mothers establish a feeding routine?
Authors: Patience Sara
Published: May 2014

Breastfeeding mothers may feel that it is beneficial to quickly establish a routine for feeding their babies. This is in contradiction to guidance from the UNICEF Baby Friendly Initiative ( UNICEF UK, 2010 ). There is evidence to suggest that attempting to establish a feeding routine may result in a more unsettled baby, disruption to the mother-baby feeding relationship and potentially the early cessation of breastfeeding.
Changes in commissioning
Authors: Cowley Dame Sarah
Published: May 2014

The move to local authority commissioning feels like a major culture change for health visiting, but there is potential for new opportunities, says Professor Dame Sarah Cowley.
book review
Authors: Jones Chris
Published: May 2014

Drug Prescribing in Renal Failure, Dosing Guidelines for Adults and Children is another comprehensive publication providing detailed and informative pharmacological information for those dealing with renal disease. The main difference between this reference book and the Renal Drug Handbook is that it is a US publication. While this is still a useful reference book, there are a number of issues that make it less easy to use. US drug names for instance are not the same as those in the UK, making quick reference difficult. Abbreviations for frequency are also not universal and can lead to confusion if the user is unaware.
Dialysis in the UK in 1959 How dialysis caught on in the UK 50 years ago
Authors: Turner Neil
Published: May 2014

In 1958 there were only three renal units operating in the UK: at Leeds, Hammersmith, and RAF Halton. The Leeds unit had been the first, using a modified version of the original Kolff dialysis machine, but the other two units had newer technology made by Travenol with Kolff's help. This was a machine that looked rather like a washing machine, but was more controllable and used disposable artificial kidneys (coils). 1959 was the beginning of a boom, with new renal units opening in Edinburgh, Glasgow, Newcastle, Belfast and London.
Extended access to peritoneal dialysis for frail older patients
Authors: Brown Edwina A , Judge Caroline
Published: May 2014

Edwina Brown and Caroline Judge provide an overview of how access to peritoneal dialysis for elderly patients varies from country to country. They go on to discuss different ways of organizing assisted peritoneal dialysis to help the more dependent older patients. They also explore the benefits of training staff to care for peritoneal dialysis patients in nursing homes and the barriers to accessing training.
Renal nursing basics: nail care and facial shaving
Authors: Mackie Sarah
Published: May 2014

Nail care and facial shaving are two important activities associated with basic nursing care. Nurses and healthcare assistants play a key role in ensuring that the individual care needs of the patient are met. Providing a high standard of basic nursing care is vital for the wellbeing of the patient.
The prevention of CKD: the reality in primary care
Authors: Bridger Jane
Published: May 2014

The need to effectively manage the quarter of the UK population affected by long-term health conditions has been a major driver of health-care policy over recent years. As data began to emerge about the numbers affected by CKD, coupled with the rise in obesity, hypertension and diabetes, the major impact that this posed was recognized by headlines in the medical press such as ‘Facing an epidemic of chronic kidney disease’. A plethora of CKD focused-actions has followed: Part Two of the Renal National Service Framework, the laboratories reporting estimated glomerular filtration rates (eGFR), and the addition of CKD to the Quality and Outcomes Framework. Furthermore, the new NHS Health Checks will help identify CKD patients.
Why do renal teams work so well together?
Authors: withheld Name
Published: May 2014

Your correspondent in the last issue posed the questions as to why renal teams work together so well? (Anon, 2009) The answer is quite simply that they have to. There are two main reasons: The first is that they are all working to the same goal, the care of the renal patient, and they all know that it is well established that renal patients do best when supported by a multiprofessional team. It is therefore to their benefit to work as part of that team as it achieves their own goals as well as those of the team and patient.
Looking at basics: World Kidney Day and diabetes
Authors: Jones Chris
Published: May 2014

World Kidney Day this year focuses on diabetic kidney disease, an increasing concern given the continued rise in incidence of diabetes worldwide. Despite the high priority diabetes has been given, public health measures aimed at prevention and earlier detection of diabetes in the general population are less successful than hoped. Perhaps our attention should instead focus on treating those with known disease to prevent complications such as diabetic kidney disease.
Immunosuppressive drugs and non-adherence in transplantation
Authors: De Geest Sabina , Burkhalter Hanna , De Bleser Leentje , Berben Lut , Duerinckx Nathalie , De Bondt Katleen , Dobbels Fabienne
Published: May 2014

Non-adherence to immunosuppressive drugs is a major risk factor for poor clinical outcomes in renal transplantation. Sabina de Geest discusses the evidence on the magnitude of non-adherence as well as its consequences and provides an overview of interventions to improve medication adherence.
The role of communication skills in end-of-life care
Authors: Lewis Debbie , Kitchen Cathy
Published: May 2014

Debbie Lewis and Cathy Kitchen explain how verbal and nonverbal communication skills play key roles in the delivery of good quality end-of life care. They give an overview of models and strategies that help improve quality of life for all patients, including renal patients, near or at the end of life.
Globally motivated
Authors: Moseley Polly
Published: May 2014

Polly Moseley's kidneys failed in 1993. Since then she has had peritoneal dialysis, a non-successful kidney transplant, haemodialysis at hospitals and at home. This did not stop Polly from travelling the world, gathering dialysis experiences from around the globe. This an account of her experiences.
What are phosphate binders and how do they work?
Authors: Akinlade Stephanie
Published: May 2014

Phosphate binders are a group of medications used to reduce the absorption of phosphate and taken with meals and snacks. Here, Stephanie Akinlade gives an overview of the different types of phosphate binders available and explains how they work. She also takes into account other factors that may influence choice of phosphate binder.