bluuebunny/crossref_metadata_2025 huggingface dataset:
Anaemia and the heart and kidneys
Authors: Tollitt James , Green Darren , Kalra Philip A , McIntyre Hugh N
Published: May 2014

Chronic kidney disease (CKD) and cardiovascular disease are intimately linked and both associated with anaemia. Anaemia in turn is associated with poor cardiovascular outcomes. Treatment with erythropoesis-stimulating agents (ESA) and iron therapy has long been a staple of care in CKD and is becoming more common in other areas such as anaemia associated with heart failure. ESA use can improve symptom control but cardiovascular benefit is contentious. For example, higher target haemoglobins achieved using ESA may actually worsen outcome. For this reason, iron has become the recommended first-line agent for correcting anaemia in CKD. However, the safety of long-term oral and intravenous iron in this setting is not known and there is little guidance for optimal iron replenishment. This is of potential concern as iron overload is known to cause cardiomyopathy in other clinical scenarios. There is a pressing requirement for further investigations in this area.
Non-alcoholic fatty liver disease: An important consideration in patients with CVD
Authors: Carter Rebeca , Marjot Jack , Mouralidarane Angelina , Ray Shuvra , Soeda Junpei , Oben Jude
Published: May 2014

Non-alcoholic fatty liver disease (NAFLD) describes a spectrum of diseases in which there is accumulation of fat in hepatocytes. It is now thought to affect up to a third of the world's population. Evidence suggests that NAFLD is associated with an increased risk of coronary heart disease. As such, health-care teams involved in the management of patients with cardiovascular disease should be alert for the presence of NAFLD, and equipped with strategies to minimise the risk it confers.
Computerised tomography coronary angiography
Authors: Fox Nicola , Call Andrew , Miller John H , Leslie Stephen J
Published: May 2014

In recent years advances in our understanding of coronary disease, risk stratification and technology developments in CT scanning have dramatically changed the way we investigate patients with suspected coronary artery disease. These developments have been refected in recent NICE guidance for the investigation of patients with new onset chest pain. These guidelines advise greater use of CT coronary angiography (CTCA) in low- to intermediate-risk patients and suggest there is no role for exercise tolerance testing in the assessment of patients with chest pain of uncertain origin. This article will describe the technique of CTCA and its use in the investigation of patients with suspected symptomatic coronary artery disease.
Heart failure: Why we don't talk about dying
Authors: Ashton-Clarkson Sjouke , Thackwray Jane
Published: May 2014

Heart failure is an incurable condition with a significant symptom burden. The prognosis is poor and yet patients continue to reach the end of life with little or no understanding of the ultimate outcome. Patients and carers are therefore denied the opportunity to make informed decisions about end-of-life care and are often inappropriately dying in hospital receiving medical pathways of care rather than at home accessing palliative care. This article will explore the causes of this trend and consider ways of improving end-of-life care for heart failure patients and their families with better access to palliative care.
New training and qualifications in electrocardiography
Authors: Richley David
Published: May 2014

The electrocardiogram (ECG) is the most commonly performed cardiac investigation in the world. It has been estimated that in Europe alone, up to 300 million ECGs may be recorded annually ( World Health Organisation, 1981 ). The test is fundamental to many cardiac diagnoses, and it is recorded in a wide range of healthcare settings.

Despite the clinical importance and ubiquity of the ECG, until very recently there has not been any nationally recognised qualification in the UK to certify competence either in carrying out the procedure or interpreting the result. The only professional group who have had to undergo formal training and assessment in ECG recording and interpretation in order qualify are cardiac physiologists, yet once they are qualified cardiac physiologists record very few ECGs, devoting their time instead to more specialist procedures such as echocardiography and the follow-up of implanted devices.

Most ECGs are probably recorded by healthcare practitioners who have not undergone formal training and assessment in practical electrocardiography and who do not hold a recognised qualification in the technique.
Examination of a case of suspected Marfan syndrome
Authors: Glover Dolores , Spiers Christine
Published: May 2014

Marfan syndrome is a heritable disorder affecting approximately 1 in 5000 of the UK population. The condition is a multisystem disorder principally affecting the ocular, skeletal and cardiovascular systems. The clinical variability and similarity with other heritable disorders makes Marfan syndrome difficult to diagnose and the condition may not be evident until the patient becomes symptomatic. This article provides an overview of the condition and the case study aims to illustrate how the use of physical assessment and cardiac auscultation can lead to suspicion of Marfan syndrome. In this case, the patient did not meet all of the criteria but had many of the traits. This highlights the importance of comprehensive history taking, management of symptoms and follow up of patients and their families.
ECG of the month
Authors: Regan Claire , Regan Martin
Published: May 2014

Claire Regan and Martin Regan present an ECG for you to analyse. The answer is given on page 562
Compression therapy in oedema and lymphoedema
Authors: Cooper Garry
Published: May 2014

In addition to managing a patient's presenting condition, e.g. heart failure, other problems or complications such as oedema may be observed that need to be treated. Compression therapy is one of the most important components in the management of chronic oedema and lymphoedema. It is important to identify cautionary or contraindicated factors for compression therapy, e.g. aterial insufficiency. Bandaging offers a means of reshaping and reducing limb size and long-term management requires graduated compression garments. These should be fitted by a health professional, who should provide advice, guidance on skin care and exercise.
Management of inappropriate sinus tachycardia
Authors: Meredith Tara , Griffiths Angela , Wong Kelvin
Published: May 2014

Inappropriate sinus tachycardia (IST) is a condition characterised by unusually fast heart rates at rest and/or minimal physical activity or both. The mechanisms of IST are not well understood and individuals suffering with the condition can present with an array of incapacitating symptoms. Although IST is a benign arrhythmia, it can have profound effects on quality of life. Diagnosis is a process of elimination and treatment may include drugs, lifestyle adjustment, and in some circumstances catheter ablation. Cardiac nurses should consider IST as a diagnosis in patients presenting with incessant palpitation and tachycardia in the presence of an otherwise normal ECG.
UK survey of patient cardiac rehabilitation attendance
Authors: Dressler Corinna , Lewin Robert J
Published: May 2014

Aim: In the UK, cardiac rehabilitation programmes differ in set-up and service provision is variable. No aggregate information is available on how programmes identify and invite patients. This study aimed to determine how patients are identified and invited to attend cardiac rehabilitation programmes.

Methods: A nine-item electronic survey was e-mailed to 354 publicly-listed UK cardiac rehabilitation coordinators. The survey included questions on the phases of cardiac rehabilitation on offer, how patients are identified, how they are invited, how non-attenders are followed up and which groups are least likely to attend.

Results: In total, 190 cardiac rehabilitation coordinators participated in the survey (53% response rate). The attendance rate was 83.5% for phase 1 and 66.3% for phase 3. Suitable patients were identified through referrals from hospital (82.6%), by the cardiologist/hospital physician (53.6%) and from going around wards (59%). In hospital invitation (70.5%), telephone (70%) and written invitations/reminders (50.5%) were the most frequently used modes of inviting patients. Most programmes used three (n=110) or more (n=127) methods of patient contact. People at work and older women were less likely to attend cardiac rehabilitation.

Conclusions: Variations in patient identification and invitation methods indicate that liaison and knowledge exchange could help optimise services. The importance of context-sensitive policies is highlighted.
The challenge of palliative care in heart failure
Authors: Uppal Sharon
Published: May 2014

The integration of palliation within non-malignant chronic disease is a particularly challenging yet important consideration in the management of terminal patients. Patients dying from life limiting chronic diseases, particularly within acute care settings, are susceptible to inadequate end-of-life care. Good palliation could improve communication, symptom management and quality of life. In heart failure, however, this service remains underused and poorly integrated, with only a small number of patients with non-malignant diseases receiving palliative care despite the strong evidence that supports it (National Council for Palliative Care, 2010 ; LeMond and Allen, 2011 ). Mortality risk is high in heart failure, and with the prevalence and incidence of heart failure set to rise within the ageing population, it has become a healthcare and nursing priority to address issues of equity in palliative care delivery ( National Institute of Health and Clinical Excellence [NICE], 2010 ). There are multidimensional barriers to palliative care within the cardiology setting and the development strategies will require an integrated approach. Key challenges that need addressing from a health professional perspective include health professionals’ knowledge of palliative care, poor recognition of end-stage heart failure by health professionals and, and health professionals’ lack of communication about prognosis with patients.
Novel oral antiplatelets for acute coronary syndrome
Authors: Wright Paul , Antoniou Sotiris
Published: May 2014

The thienopyridine clopidogrel, which irreversibly blocks the adenosine diphosphate (ADP) receptor P2Y12 on platelets, has become an essential component of therapy in patients with acute coronary syndromes. However, clopidogrel has drawbacks which has led to the development of newer more potent antiplatelet agents: prasugrel, and ticagrelor. Prasugrel, a newer thienopyridine, also irreversibly binds to P2Y12. Prasugrel has a more rapid onset of action and a stronger inhibitory effect than clopidogrel. Ticagrelor is a new class of antiplatelet which binds reversibly to P2Y with a stronger and more rapid antiplatelet 12 effect than clopidogrel. This article discusses the newer antiplatelet agents and their role in acute coronary syndromes compared to clopidogrel. The article also highlights some of the side effects associated with these newer agents.
Marfan syndrome: biological basis and genetics
Authors: Bentley Peter
Published: May 2014

This article discusses the biological basis of Marfan syndrome, a dominantly inherited genetic disorder that leads to abnormalities of the connective tissues. Genetics and its impact in Marfan syndrome will be reviewed. The features of the disease will be discussed, focusing mainly on changes in the heart and aorta, the skeleton and eyes. Diagnosis of Marfan syndrome will be discussed using the revised Ghent nosology. The implications of the condition in pregnancy and importance of a high standard of ante-natal care are considered. The role of health professionals in supporting those affected by Marfan syndrome is discussed. This also encompasses the importance of health promotion.
Quality of life with a cardioverter defibrillator
Authors: Eftekhari Helen , Osman Faizel
Published: May 2014

This article aims to examine quality of life issues for the implantable cardioverter defibrillator (ICD) patient, increase our understanding of the psychosocial issues for ICD patients, and identify their educational and counselling needs. It also explains how to recognise the psychological issues specific to those living with an ICD. It examines the important role health professionals have in supporting ICD patients and strategies to maintain good quality of life.
Milrinone therapy in adults with heart failure
Authors: Kate O'Donovan
Published: May 2014

Heart failure is a chronic progressive condition where the myocardial pump fails to maintain peripheral perfusion. Treatment aims to alleviate signs and symptoms, reduce hospitalizations and mortality. Heart failure patients may experience episodes of acute decompensation where cardiac output fails to maintain adequate peripheral perfusion. Inotropes such as dobutamine and milrinone have a role in augmenting contractility as a means of increasing cardiac output. Milrinone is a phosphodiesterase III inhibitor with inotropic and vasodilatory properties. The added benefit of its vasodilatory action is reduction in afterload and pulmonary pressures, therefore reducing the myocardial workload. Two main adverse effects associated with this therapy are arrhythmias and hypotension.
Reflection and the management of community nursing practice
Authors: Driscoll John
Published: May 2014

This paper contends that reflective practice and clinical supervision are synonymous with one another. Despite a seeming urgency to implement clinical supervision within community practice, such an initiative requires careful consideration of the implications which result from adopting reflective strategies in the workplace. It is argued that supporting such strategies to enhance the development of a more creative and independent clinical practitioner will present as many challenges as opportunities for community managers. A useful starting point is to consider that every individual practitioner – regardless of role or experience – is a continual learner and potential leader.
Help for bereaved children: a preventative approach
Authors: Davies Christine
Published: May 2014

This paper describes the work undertaken with children and adolescents who have lost a significant person in their lives through death. The author works with the paediatric nurse member of a palliative care team running groups for children and adolescents who have been bereaved.

The aim of the project is to invite the child/adolescent as soon as possible after bereavement to participate in groups with others who are grieving. This groups allow participants to express their feelings through art, play and discussion in a safe and confidential environment.

It is hoped by using a preventative approach such as this, that the incidence of some of the results of unresolved childhood grief, such as failed relationships, depression and ill-health in adult life can be minimised.
Teenage smoking
Authors: DeBell Diane , Wales Helen
Published: May 2014

Health education and promotion in secondary schools is generally under-resourced because of competing pressures on teachers to deliver the core national curriculum.

School nurses are well placed to work with teachers in providing such programmes in the school setting. However, for their role to be effective there is a need to ensure that they are informed by research-based knowledge of how young people make decisions about their own health. This research in Norfolk examined decision making about tobacco use amongst 13-18 year olds and contextualised young peoples’ attitudes to smoking within a study of attitudes to health risk behaviours generally.

Findings indicate a complex set of biopsychosocial factors which interact over a long maturation period and challenge the presumptions adults make about why young people do – or do not – decide to smoke tobacco.
Glossary of research terms
Authors: Leiba Tony , Notter Joy
Published: May 2014

Until recently, research was seen by most nurses as an academic subject that only a few pursued. This resulted in the majority of practising nurses perceiving research as a ‘closed book’. Nurses therefore tended to accept information and research reports at face value. This did not enable them to actively participate in developing and supporting evidence-based practice, or in preventing unsuitable approaches to care being implemented. In the community where so many different factors need to be considered when planning services this was a particular case for concern.
Assertive community treatment and severe mental illness
Authors: McFadyen John
Published: May 2014

Assertive community treatment can be considered the recipe under which inter-agency, interdisciplinary, operational and philosophical components are mixed to produce services which have a positive impact upon the severely mentally ill, and the communities in which they live. It pulls together processes, such as care management and the care programme approach and treatment and rehabilitation, as well as addressing the need for 24-hour services, housing, and matters of everyday survival for severely mentally ill people.
Allergen avoidance in asthma management
Authors: Buck Sallie
Published: May 2014

Allergy is increasing and it is a common cause of asthma (Burr 1993) – particularly within modern Western society. Traditionally, the emphasis on management of asthma has been heavily biased towards pharmacology and yet much research has shown that allergen avoidance in allergic asthma can reduce symptoms.

Although avoidance strategies have no side effects they can be onerous and involve some initial financial expense. It is therefore prudent that when advice is given on allergen avoidance, a positive skin prick test result is obtained to corroborate the history.

This paper discusses potential allergen triggers to asthma, the important role skin prick testing plays within a structured diagnosis and implications for both patients and staff in the community.
Postnatal mental health: co-operation in community care
Authors: Hardy Bill , Parke Sian
Published: May 2014

Postnatal mental health problems – particularly postnatal depression – affect approximately 15 per cent of women in the United Kingdom (UK). In smaller numbers puerperal psychosis affects one or two women per 1000 births and usually requires the support of the specialist psychiatric services.

This paper explores the roles of health visitors, midwives and community psychiatric nurses in the context of postnatal mental health. Different types of postnatal mental health issues are highlighted, and varying approaches to working with women who suffer with these problems are discussed.

The focus on interventions in the primary care setting offers a starting point for community practitioners to demarcate their roles and promote their skills for effective outcomes for clients and their families.

This paper concludes with a brief discussion about how community practitioners can collaborate in providing services for women with postnatal mental health problems.
The future of specialist nursing practice in the community
Authors: Castledine George
Published: May 2014

Following the recent UKCC debate over the future of specialist and advanced practice, it is imperative that community nurses are involved in discussions on the future of specialist nursing in the community.
Hospital at home: the use of a new series
Authors: Wilson Andrew , Wynn Alison , Bergström Jessie
Published: May 2014

Hospital at Home (HH) schemes can provide an alternative to acute hospital admission. However they create extra work for GPs, and might be used as an additional rather than alternative source of care. The introduction of a Hospital at Home scheme in Leicester enabled these issues to be examined. Case mix, service inputs, discharge destination and re-admission rates were monitored during the first 15 months of its operation. Also, hospital avoidance, GP workload and the scheme’s acceptability were estimated.

Routinely collected data about patients admitted during that period was used. In a sub-sample of patients, the general practitioner was asked to complete a postal questionnaire about admission avoidance and work load.
Whither community nursing?
Authors: While Alison
Published: May 2014

The changes in health care delivery, with a reduction of hospital inpatient facilities during the last ten years, have thrown the spotlight upon community health care provision. No one now seeks to challenge the reality that most health care is undertaken in peoples homes, even if that health care is delivered by informal carers.
The importance of nursing documentation
Authors: Castledine George
Published: May 2014

The use of the nursing record as a tool to document, plan and evaluate patient care has long been advocated but not always effectively implemented. In fact, recent reports by a Commons select committee and the health services ombudsman have resulted in the Chief Nursing Officer, Yvonne Moores, having to lead a government initiative to improve health care documentation. Medical and nursing records stand as the most important means of communication among those delivering care, especially in the community. Unfortunately, many doctors and nurses are not reaching the required standards or guidelines set out by the General Medical Council or UKCC. Writing and documenting nursing care is not easy and there is an urgent need to educate nurses at all levels to improve their skills. In fact, it seems that there is too little emphasis and time devoted to writing and recording nursing in pre-registration courses. The same is also true when one reviews the curriculum content of many post-registration, specialist community nursing courses. Everyone seems to assume that you eventually pick it up and gradually become a good writer and documents of care.
Forgotten or just overlooked?
Authors: While Alison
Published: May 2014

There are an increasing number of adults, including elders, living with disabilities which profoundly affect their lives and those of their informal carers.
Leadership in PCGs
Authors: Humphris Debra
Published: May 2014

As the health needs of communities and populations continue to change so too must the evolution of primary care and the response to those needs by a range of public services, not just health and social care but also education, the environment, the Home Office and the Treasury.
The unrealised potential of consumerism
Authors: While Alison
Published: May 2014

Consumerism arose in the 1980s from the desire of the Thatcher Government to challenge professional domination within care services. It represented an attempt to effect a shift in values so that consumers of statutory services could exercise power over professional providers. Indeed, the White Paper Working for Patients (Department of Health (DoH), 1989) explicitly outlined a new role for patients in the NHS and subsequent publications had advocated that purchasers take more account of local people’s preferences (DoH, 1999). But the ‘ideal’ in which consumer representation would affect the nature and level of services has yet to be realized.
Marginalization in PCGs
Authors: Fisher-Smith Jane
Published: May 2014

The Governments intentions for the reorganization of the NHS were introduced through their White Paper The New NHS: Modern, Dependable (DoH,1997). It outlined the proposals for a community-based framework of health professionals who would be working, in partnership, to identify and provide health care at local level. On first reading this was a highly commendable approach as it placed nurses and GPs at the forefront of health care while recognizing the call for locality-based decision making.
Developing Internet-based wound care information
Authors: Unsworth John , Boon Helen
Published: May 2014

The need for wound care information and education has never been so acute with the national roll out of nurse prescribing and the increasing emphasis on evidence-based practice. The requirement to underpin practice with evidence means that nurses are increasingly seeking newer sources of information, including information technology and the Internet. Such sources have an advantage over more traditional sources because they: are able to overcome the barriers of geographical location; allow for flexible study; and allow users to practice their decision-making skills in a relatively risk-free environment. The development of an evidence-based web site presents many challenges not only in relation to ensuring the accuracy of the information provided but also in developing interactive sections. Following the development of a web site on tissue viability, an evaluation of its usefulness was undertaken. This showed that users felt that the site was useful, although problems with access restricted its use when seeking advice about patient management.
Financial incentive: effects on work content and workload
Authors: Kingma Mireille
Published: May 2014

There is evidence that the clinical judgment and professional conduct of physicians and nurses are affected by economic incentives and disincentives. A study was undertaken to document a range of remuneration strategies and their effect on nurses’ attitudes and behaviour. Seven major areas of community nurses’ professional lives were identified as being influenced by economic incentives/disincentives. This article deals with their impact on work content and workload. Four major policies generated by economic interests were highlighted as agents of change: the distribution of tasks between the health and social sectors; the creation of the internal market; an increased focus on cost containment; and consumer empowerment. While nurses claim the right to determine their scope of practice, national and local realities often force them to renegotiate the legitimacy of their services within a framework of economic vested interests.
Legal issues arising in community nursing 3: consent and compulsion
Authors: Dimond Bridgit
Published: May 2014

It is clearly established in law that an adult (i.e. a person over 18 years) mentally competent person has the right to refuse or accept treatment. Even if the treatment is life saving, then the competent adult can refuse for a good reason, a bad reason or for no reason at all. This has recently been stated by the Court of Appeal (In re MB [1997]) in a case where the legality of giving a caesarean section to a pregnant woman without her consent was in issue.
Quality of life in leg ulcer assessment: patients’ coping mechanisms
Authors: Barrett Chris M , Teare J A
Published: May 2014

An increase in autonomous practice and the need to evidence professional update puts demands on individual nurses to reflect on their knowledge and practice. Community nurses have become expert at managing wounds, particularly leg ulcers, and using a variety of assessment strategies. However, reflections focused on the expert patient and their coping mechanisms may suggest that holistic assessment and treatment of these patients requires consideration of additional factors. The introduction of quality of life (QoL) tools may provide the rationale for an individual patient’s nursing care in this specific context. Placing emphasis on the social and psychological impact of living with a leg ulcer — from the patient’s perspective — may direct collaborative assessment and informed decision making.
Older people deserve better
Authors: While Alison
Published: May 2014

The growing older population presents society with the challenge of how to best meet their needs for guaranteed adequate income and suitable supportive care, including access to health care. The Royal Commission on the Long-Term Care of the Elderly (1999) made 24 recommendations to the Government, many of which concerned the financial burden of care in a supportive environment. The potential for the use of pooled budgets and the establishment of care trusts in the wake of the 1999 Health Act may go some way to enabling care in the home, but for those requiring residential care a number of financial and other challenges remain. Not least is the evidence that many older people in the greatest need of proper interdisciplinary care and rehabilitation are denied appropriate access to NHS resources (Royal College of Physicians, Royal College of Nursing and British Geriatric Society, 2000).
Legal issues arising in community nursing 5: elder abuse
Authors: Dimond Bridgit
Published: May 2014

The situation described below is possibly not an uncommon one for community nurses, health visitors and other health professionals or social workers visiting individuals at home. It is not easy to quantify the problem; many consider that situations such as this are likely to be under-reported.
Tuberculosis: a challenge for community nurses
Authors: Pollard Tom
Published: May 2014

Tuberculosis (TB), the ‘Great White Plague’ of the 19th century, is reemerging onto the healthcare agenda. Worldwide, TB kills more people than any other infection (World Health Organization, 1994). In the UK, a rapid decline in TB notifications followed the introduction of various public health programmes initiated in the 1940s and 1950s. From the 1960s onwards however, the decline slowed with the immigration to the UK of large numbers of people from TB-endemic areas of the world such as the Indian subcontinent, where TB control programmes had been only partially successful or did not exist.
Community nurses role in symptom management
Authors: While Alison
Published: May 2014

Concern to achieve maximum health gain within limited resources has focused attention on the potential contribution of different health professionals, including the distinct added value of the nursing and health visiting workforce. Importantly, health gain encompasses both years of life and quality of life, with much medical research now including quality of life measurement among outcome measures.
Writing for publication: informing clinical practice
Authors: Clarke Gwen
Published: May 2014

Primary health care is developing rapidly and is undergoing many challenging and exciting changes. Recent Government initiatives seek to promote patient care in the community setting; primary care groups and trusts provide new ways of working in partnership with patients; and the emphasis on clinical governance and improving the quality of care has contributed to a number of innovative professional developments.
Legal issues arising in community nursing 8: removal to a place of safety
Authors: Dimond Bridgit
Published: May 2014

The community nurse may be confronted with a situation where he/she believes that a patient should not be left on his/her own. In such a situation, there may be conflict between the individual’s right to make his/her own decisions and the need to protect the best interests of a mentally incompetent person or to protect public safety.
Improving quality of life for carers
Authors: Harrison Jill
Published: May 2014

There are 5.7 million carers across the UK, providing care and support to family members, relatives or friends who are ill, disabled or elderly and frail (Office of Populations, Censuses and Surveys, 1995). It is estimated that informal carers save the country £34 billion annually (Nuttall et al, 1993). If carers decided to stop providing informal care, health and social services would be overwhelmed by the increase in workload, many people would suffer and taxes would increase dramatically.
Postnatal pelvic floor screening clinics: a pilot study
Authors: Herbert Julia H
Published: May 2014

Information regarding the importance of pelvic floor muscle (PFM) exercises during and after pregnancy is now available to most pregnant women and to women who have just given birth. However, despite the apparent availability of this information, there are many women who do not perform these exercises following childbirth, and many who only practice them occasionally. A survey of 48 postnatal women in Bolton revealed that although they had all heard about pelvic floor exercises, less than 50% practised them post-delivery and of those that did only 10% continued with regular daily exercises for more than 2 weeks after the birth of their child. Of greater concern was the wide variety in exercise techniques. It was decided to address this problem by offering informative postnatal education on PFM exercises and by training health visitors to digitally assess the pelvic floor and run screening clinics for women 3–12 months post-delivery. This article discusses the results of a pilot study which includes data on the first 28 women to attend the clinic.
Concepts of health: implications for public health work
Authors: Ewens Ann , Richards Joanna
Published: May 2014

This article explores the health concepts of community health care (CHC) nurses in relation to their potential roles as public health workers. On examining Ewen’s (1998) study of CHC nurses’ role perceptions, it is evident that an individualized, person-centred, holistic approach to care continues to dominate practice. The public health role within CHC nursing remains underdeveloped and is equated with primary prevention with the well population. A ‘community-as-foreground’ model is proposed as a useful way of redefining CHC nursing practice to incorporate public health. The discussion revolves around the need for a broader view of health to include a political and social dimension, and considers the role of education and practice in achieving this.
Promoting planned care for patients with indwelling catheters
Authors: Doherty Willie
Published: May 2014

Indwelling urinary catheters are common among patients in the community. Use of a catheter entails a significant lifestyle adjustment on the part of the patient, who must learn a new regime of self-care. In order to help patients to cope with the new device, it is essential that nurses play an active role in educating patients and involving them in the decision-making process. By empowering patients through knowledge of their condition and care, nurses can encourage greater compliance with care plans and reduce the risk of potentially distressing complications that can arise from indwelling catheters.
Can everyone’s expectations be met?
Authors: While Alison
Published: May 2014

Over the last 15 years health-care delivery has undergone major changes in an attempt to offer optimum care with limited resources. It is generally accepted that the original blueprint for the NHS needs revisiting if current health needs, resulting from the growing ageing population and burden of chronic disease, are to be met. Changes in health need are coupled with a decrease in intra- and extra-family resources which reduce the capacity to support the chronically ill/disabled living at home. The high morbidity of single parents and those supporting disabled patients needing long-term care highlights the demands of caring. Additionally, the increase in women working has reduced their availability to be unpaid carers and volunteers.
The prevalence of bacteriuria in older institutionalized patients
Authors: Gazzani Margery , Willis P , Guy SP , Carney TA
Published: May 2014

We set out to determine the prevalence of bacteriuria in elderly patients institutionalised in 10 homes in Northumberland. Single mid-stream urine (MSU) specimens were collected from 161 asymptomatic patients aged 64–101 years. Thirty-four (21%) samples had >100 white blood cells (WBC/μl) on microscopy as well as a significant bacteriuria of >108 bacteria/l, being suggestive of a true urinary tract infection. A total of 115(71%) samples had <100WBC. Seventy-five (46%) samples could be described as ‘contaminated’ or ‘infection unlikely’ but of these only 31 (19.2% of all samples) were reported as ‘contaminated’ by the laboratory. This study confirms previous work in America to indicate the high level of bacteriuria in institutionalised elderly patients as well as the very high number (46%) who may show bacteriuria but no rise in the number of WBC suggesting contamination only. Nurses and GPs must be very cautious in interpreting MSU results from such patients.
Health inequalities in the firing line
Authors: Pollard Tom
Published: May 2014

Health Secretary Alan Milburn has announced plans to aggressively tackle health inequalities in England. Targets to be set by the Department of Health (DoH) will focus on reducing infant mortality and premature adult death in the poorest regions of the country. Much of the responsibility for meeting these targets will inevitably fall on primary care, with nurses in the vanguard.
Head lice: changing the expensive chemotherapy culture
Authors: Ibarra Joanna
Published: May 2014

The revulsion prompted by the discovery of head lice on a child’s head, and the money spent by the NHS each year on supplying licensed medicines for head lice, is disproportionate to the medical impact that lice have on their hosts. This article discusses the evidence available on the effectiveness of the commonest parasiticidal preparations, and argues the case for a more rational, simpler and cost-effective response to this common problem.
The case for researching the history of community nursing practice
Authors: Whitehead Dean
Published: May 2014

Despite a flurry of interest in the 1980s, the adoption of a positivist, objective, scientific paradigm for nursing research has led to to a rejection of the study of nursing history as a valid pursuit in recent years. In this article, it is argued that this is a precarious situation. By not examining the history of the profession, nursing – and in particular community nursing – undermines its efforts to validate itself within the wider health-care arena. Nursing must learn from the mistakes of the past, as well as the successes, but do so in a critical way that does not romanticize its history.
Intermittent self-catheterisation in urinary tract reconstruction
Authors: Leaver Rachel , Pressland Donna
Published: May 2014

It has been estimated that the average primary care group (PCG) has a population of approximately 102700. At least 5600 of these people will suffer from urinary incontinence (Royal College of Physicians (RCP), 1995) and one-in-six over-40’s is incontinent ‘several times a month’ (Perry et al, 2000). Those most affected are women after childbirth and after the menopause, and men in later life, especially those with prostate problems (Foldspang et al, 1999). The highest prevalence of urinary incontinence is found in those in residential and nursing homes (RCP, 1995). The cost to the average PCG is over £700 000 a year (Continence Foundation, 2000), but the cost to the patient in terms of quality of life, loss of personal control and self-esteem is inestimable (Button et al, 1998). Yet incontinence is very often a symptom of an underlying problem and may therefore be treatable. The RCP (2000) claims a 70–80% cure or improvement rate of suitable cases in primary care. According to recent guidance (Department of Health, 2000), primary care teams should identify all people with incontinence, give them a thorough assessment, involve them in drawing up a treatment/management plan, deliver first-line treatments and where applicable facilitate access to specialist services. This should lead to more people with the problem being treated with better results.
Clinical governance in the control of wound infection and odour
Authors: Scanlon Liz , Dowsett Caroline
Published: May 2014

This article explores the use of silver in the management of wound infection and odour from a clinical governance perspective. It relates issues of risk assessment and management, clinical effectiveness and evidence-based care, clinical audit and quality assurance to the care of patients with or at risk of a wound infection. A case study is included on the use of Actisorb Silver 220 in the management of a leg ulcer patient.
Intermediate care rapid assessment support service: an evaluation
Authors: Brooks Nicky
Published: May 2014

This study evaluated a rapid assessment support service (RASS) in an inner city location. The evaluation focus was provided by the two main objectives of the service, i.e. to reduce the number of unnecessary emergency admissions for people over 65 years to acute hospitals and to support the assessment of people over 65 years in their own homes. A case study design was employed and methods included documentary analysis of patients’ discharge summaries and/or notes, patient/carer diaries and patient/carer storytelling. The most common reasons for referral, and goals identified following assessment, were mobility/falls prevention and hygiene/activities of living. The key themes identified concerning the assessment process were partnership working, promoting patient independence, relief for carers, integration of health and social care assessment, effective use of health-care professionals’ time, integration with other services, satisfaction with the service and areas of dissatisfaction. Despite the methodological and practical limitations of this evaluation some of the early successes of this intermediate care service have been identified.
Does pacifier use cause ear infections in young children?
Authors: Hanafin Sinéad , Griffiths Peter
Published: May 2014

The aim of this review was to identify whether, in children under 2years of age, pacifier (dummy) use results in an increased risk of ear infection (acute otitis media). The Cochrane Library, Medline, CINAHL and Embase databases were searched for cohort studies and randomised controlled trials that compared infants who used pacifiers with those who didn’t or examined the effect of reducing pacifier use in a group of infants. One cluster randomised trial and two cohort studies met the review criteria and were available to be included in the body of the review. These studies show a clear increase in risk of ear infection to be associated with use of a pacifier that may well be causal. The risk of ear infections is up to three times higher in those who use a pacifier and there does appear to be a ‘dose response’ with continual users more at risk than occasional users. However, this relationship may be confounded by socio-demographic factors. Rather than advising a parent not to use a pacifier for fear of causing otitis media, advice in relation to this issue might best be restricted to pacifier users suffering from the problem in order to reduce the chances of recurrence.
The shape of primary care in the future
Authors: While Alison
Published: May 2014

Despite this Government’s declarations of ever more resources for the NHS, there have been few major improvements, partly because there has been little investment in infrastructure over the years. These poor working environments, together with chronic staff shortages, contribute to increased workload and low staff morale. This fuels difficulties in recruitment and retention, especially in areas of high living costs and low unemployment. There is, however, a recognition that nurses could be used more widely in creative ways to better meet the health-care needs of the population.
Nutritional advice for obesity management and health
Authors: Hunking Penny
Published: May 2014

Obesity is one of the fastest developing public health problems in the world and is associated with increased risks in morbidity and mortality. Any treatment programme for overweight and obese people should place equal importance on weight reduction and the maintenance of the weight lost. The National Service Framework for Coronary Heart Disease (Department of Health, 2000) identified the vital role of primary care teams in tackling overweight and obesity. The aim of this article is to give a basic overview of some of the issues and principles of weight management in primary care and to ensure nurses are equipped to provide good quality, evidence-based nutritional advice on weight management.
Good intentions will not meet older care needs
Authors: While Alison
Published: May 2014

The debate continues about how best to meet the support needs of the growing population of older people in an era of resource constraint. The proliferation of available treatments challenges society to declare whether access to health-care resources should be age-related. The NHS is increasingly focused on acute care leaving the independent care home sector as the main provider of long-stay and post-acute care. However, this sector is reducing its capacity in the wake of the Care Standards Act 2000 which set standards that are impossible for many care homes to meet in a relatively short period of time, especially in the light of their budgetary constraints. While few doubt the sound basis for the staffing and environmental requirements of the Act, the rapid reduction of care home places is further exacerbating an already critical situation. The ambitions of the National Service Framework for Older People (Department of Health, 2001) for the development of increased access to a range of intermediate care appear to be growing ever more distant.
Subcutaneous infusion: non-metal cannulae vs metal butterfly needles
Authors: Torre Maria Carrion
Published: May 2014

This review aimed to evaluate the effectiveness of non-metal cannulae compared to metal butterfly needles in maintaining subcutaneous infusion sites in patients receiving palliative care. The Cochrane Library, Medline, Pre-Medline, Embase, CINAHL, Amed and Cancerlit were searched for relevant studies. Controlled trials comparing non-metal cannulae with metal butterfly needles for giving subcutaneous infusion to palliative care patients were included. The outcome considered was site duration in terms of hours of patency or until change was required. Four trials met the inclusion criteria although overall quality was poor due to low follow-up. Studies examined either Teflon or Vialon-coated catheters. All studies showed non-metal cannulae to be superior to metal. In individual studies estimates in mean increase in duration of the site range from 21 to 159 hours. It seems that non-metal cannulae are more effective in maintaining the duration of subcutaneous infusion sites than butterfly needles. The both types of non metal catheter showed clear benefits This review has not examined other outcomes but in general adverse effects lead to the removal of the catheter and so would be reflected in the outcome of considered. Although historically non-metal cannulae have been considerably more expensive there is now little difference between metal and Teflon-coated catheters. This review recommends the use of non-metal cannula in preference to butterfly needles.
Let’s give a little for our common purpose
Authors: Pollard Tom
Published: May 2014

It was with perhaps rather naïve shock that I read a short paragrah in Carr et al’s research report in this issue. It states that among the GPs who did not complete the questionnaires sent to them, six would have considered doing so if there had been a financial incentive. Carr et al conclude that ‘this is a problem that should be highlighted since future studies may experience this’. Research budgets are stretched, and payment of informants in any case rarely figures in qualitative research funding proposals. Yet this may be an indicator of a wider trend: in another recent example, 13% of GPs who responded to a survey about why they had not taken part in a prescription event monitoring exercise cited ‘no payment included’ as the reason for not participating (Key et al, 2002). I believe such attitudes set a dangerous precedent.
Keeping up with practice: essential to the nursing role
Authors: Vernon Tracy
Published: May 2014

I am delighted to be able to welcome you to the launch issue of WoundCare. Published by British Journal of Community Nursing in association with the Wound Care Society, this is one of the many new ventures that the Wound Care Society will be undertaking in the coming months.