bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of metabolic syndrome in Nepalese type 2 diabetic patients according to WHO, NCEP ATP III, IDF and Harmonized criteria
Authors: Pokharel Daya Ram , Khadka Dipendra , Sigdel Manoj , Yadav Naval Kishor , Acharya Shreedhar , Kafle Ram Chandra , Shukla Pramod Shankar
Published: November 2014

Background

Metabolic syndrome (MetS) present in type 2 diabetic patients greatly increases the risk of strokes and cardiovascular diseases. Timely detection and mapping of MetS facilitates appropriate preventive and therapeutic approaches to minimize these risks. Our study aimed to determine the prevalence of MetS among Nepalese type 2 diabetic patients using WHO (1999), NCEP ATP III (2001), IDF (2005) and Harmonized (2009) definitions and identify the diagnostic concordance and disparity resulting from these four definitions.

Methods

Clinical and biochemical data were collected for 1061 type 2 diabetic patients at Manipal Teaching Hospital, Pokhara, Nepal. The data was analyzed in order to identify prevalence of MetS in these patients. Statistical analysis included usage of Student’s t- and Chi-square tests, kappa statistics and 95% confidence intervals.

Results

The total age adjusted prevalence rates of MetS were 80.3%, 73.9%, 69.9% and 66.8% according to Harmonized, NCEP ATP III, WHO and IDF definitions, respectively. Prevalence increased with the age and was higher in females (p <0.001) according to WHO, NCEP ATP III and Harmonized definitions. Patients of Dalit community had the highest prevalence (p<0.05) according to NCEP ATP III and Harmonized definitions while Mongoloid and Newar patients had the highest prevalence (p <0.05) according to WHO and IDF definitions, respectively. Prevalence was also highest among patient engaged in agriculture occupation. Central obesity and hypertension were respectively the most and the least prevalent components of MetS. The highest overall agreement was between Harmonized and NCEP ATP III definitions (k =0.62, substantial) and the lowest between WHO & IDF definitions (k=0.26, slight). The Harmonized definition had the highest sensitivity (99.9%) and negative predictive value (98.9%) while NCEP ATP III definition had the highest specificity (98.9%) and positive predictive values (99.9%) in identifying the cases of MetS.

Conclusions

The prevalence of MetS among Nepalese type 2 diabetic patients was very high suggesting that these patients were at increased risk of strokes, cardiovascular diseases and premature death. The Harmonized definition was the most sensitive while NCEP ATP III and IDF definitions were the most specific in detecting the presence of MetS in Nepalese type 2 diabetic patients.
Functional roles of evolutionary conserved motifs and residues in vertebrate chemokine receptors
Authors: Nomiyama Hisayuki , Yoshie Osamu
Published: November 2014

Chemokine receptors regulate cell migration and homing. They belong to the rhodopsin-like family of GPCRs. Their ancestor genes emerged in the early stages of vertebrate evolution. Since then, the family has been greatly expanded through whole and segmental genome duplication events. During evolution, many amino acid changes have been introduced in individual chemokine receptors, but certain motifs and residues are highly conserved. Previously, we proposed a nomenclature system of the vertebrate chemokine receptors based on their evolutionary history and phylogenetic analyses. With the use of this classification system, we are now able to confidently assign the species orthologs of vertebrate chemokine receptors. Here, we systematically analyze conserved motifs and residues of each group of orthologous chemokine receptors that may play important roles in their signaling and biologic functions. Our present analysis may provide useful information on how individual chemokine receptors are activated upon ligand binding.
TLR9 and TLR7/8 activation induces formation of keratic precipitates and giant macrophages in the mouse cornea
Authors: Chinnery Holly R , Leong Cheng Mee , Chen Weisan , Forrester John V , McMenamin Paul G
Published: November 2014

Macrophage adherence to the inner corneal surface and formation of MGCs in the stroma are common signs of chronic inflammation following corneal infection. To determine whether macrophage adherence (known clinically as KPs) and giant cell formation were specific to innate immune activation via particular TLR ligands, macrophage activation was examined in a murine model of TLR-mediated corneal inflammation. The corneal epithelium was debrided and highly purified TLR ligands were topically applied once to the cornea of TLR7−/−, TLR9−/−, Cx3cr1gfp/+, CD11ceYFP, and IL-4−/− mice. At 1 week post-treatment macrophage activation and phenotype was evaluated in the cornea. Treatment with TLR2, TLR3, TLR4, and TLR5 ligands caused an increase in the number of activated stromal macrophages in the central cornea at 1 week post-treatment. However, treatment with TLR9 ligand CpG-ODN and the TLR7/8 ligand R848/Resiquimod led to an accumulation of macrophages on the corneal endothelium and formation of multinucleated giant macrophages in the corneal stroma. We suggest that giant cell formation, which is a characteristic feature of granuloma formation in many tissues, may be a unique feature of TLR9- and TLR7/8-mediated macrophage activation.
Protein interference applications in cellular and developmental biology using DARPins that recognize GFP and mCherry
Authors: Brauchle Michael , Hansen Simon , Caussinus Emmanuel , Lenard Anna , Ochoa-Espinosa Amanda , Scholz Oliver , Sprecher Simon G. , Plückthun Andreas , Affolter Markus
Published: November 2014

Protein–protein interactions are crucial for cellular homeostasis and play important roles in the dynamic execution of biological processes. While antibodies represent a well-established tool to study protein interactions of extracellular domains and secreted proteins, as well as in fixed and permeabilized cells, they usually cannot be functionally expressed in the cytoplasm of living cells. Non-immunoglobulin protein-binding scaffolds have been identified that also function intracellularly and are now being engineered for synthetic biology applications. Here we used the Designed Ankyrin Repeat Protein (DARPin) scaffold to generate binders to fluorescent proteins and used them to modify biological systems directly at the protein level. DARPins binding to GFP or mCherry were selected by ribosome display. For GFP, binders with KD as low as 160 pM were obtained, while for mCherry the best affinity was 6 nM. We then verified in cell culture their specific binding in a complex cellular environment and found an affinity cut-off in the mid-nanomolar region, above which binding is no longer detectable in the cell. Next, their binding properties were employed to change the localization of the respective fluorescent proteins within cells. Finally, we performed experiments in Drosophila melanogaster and Danio rerio and utilized these DARPins to either degrade or delocalize fluorescently tagged fusion proteins in developing organisms, and to phenocopy loss-of-function mutations. Specific protein binders can thus be selected in vitro and used to reprogram developmental systems in vivo directly at the protein level, thereby bypassing some limitations of approaches that function at the DNA or the RNA level.
Phospho-regulated Drosophila adducin is a determinant of synaptic plasticity in a complex with Dlg and PIP2 at the larval neuromuscular junction
Authors: Wang Simon Ji Hau , Tsai Amy , Wang Mannan , Yoo SooHyun , Kim Hae-yoon , Yoo Byoungjoo , Chui Vincent , Kisiel Marta , Stewart Bryan , Parkhouse Wade , Harden Nicholas , Krieger Charles
Published: November 2014

Adducin is a ubiquitously expressed actin- and spectrin-binding protein involved in cytoskeleton organization, and is regulated through phosphorylation of the myristoylated alanine-rich C-terminal kinase (MARCKS)-homology domain by protein kinase C (PKC). We have previously shown that the Drosophila adducin, Hu-li tai shao (Hts), plays a role in larval neuromuscular junction (NMJ) growth. Here, we find that the predominant isoforms of Hts at the NMJ contain the MARCKS-homology domain, which is important for interactions with Discs large (Dlg) and phosphatidylinositol 4,5-bisphosphate (PIP2). Through the use of Proximity Ligation Assay (PLA), we show that the adducin-like Hts isoforms are in complexes with Dlg and PIP2 at the NMJ. We provide evidence that Hts promotes the phosphorylation and delocalization of Dlg at the NMJ through regulation of the transcript distribution of the PAR-1 and CaMKII kinases in the muscle. We also show that Hts interactions with Dlg and PIP2 are impeded through phosphorylation of the MARCKS-homology domain. These results are further evidence that Hts is a signaling-responsive regulator of synaptic plasticity in Drosophila.
Interaction of NANOS2 and NANOS3 with different components of the CNOT complex may contribute to the functional differences in mouse male germ cells
Authors: Suzuki Atsushi , Niimi Yuki , Saga Yumiko
Published: November 2014

NANOS2 and NANOS3 belong to the Nanos family of proteins that contain a conserved zinc finger domain, which consists of two consecutive CCHC-type zinc finger motifs, and contribute to germ cell development in mice. Previous studies indicate that there are redundant and distinct functions of these two proteins. NANOS2 rescues NANOS3 functions in the maintenance of primordial germ cells, whereas NANOS3 fails to replace NANOS2 functions in the male germ cell pathway. However, the lack of a conditional allele of Nanos3 has hampered delineation of each contribution of NANOS2 and NANOS3 to the male germ cell pathway. In addition, the molecular mechanism underlying the distinct functions of these proteins remains unexplored. Here, we report an unexpected observation of a transgenic mouse line expressing a NANOS2 variant harboring mutations in the zinc finger domain. Transcription of Nanos2 and Nanos3 was strongly compromised in the presence of this transgene, which resulted in the mimicking of the Nanos2/Nanos3 double-null condition in the male gonad. In these transgenic mice, P-bodies involved in RNA metabolism had disappeared and germ cell differentiation was more severely affected than that in Nanos2-null mice, indicating that NANOS3 partially substitutes for NANOS2 functions. In addition, similar to NANOS2, we found that NANOS3 associated with the CCR4-NOT deadenylation complex but via a direct interaction with CNOT8, unlike CNOT1 in the case of NANOS2. This alternate interaction might account for the molecular basis of the functional redundancy and differences in NANOS2 and NANOS3 functions.
Multiple regulatory levels influence cell integrity control by PKC ortholog Pck2 in fission yeast
Authors: Madrid Marisa , Jiménez Rafael , Sánchez-Mir Laura , Soto Teresa , Franco Alejandro , Vicente-Soler Jero , Gacto Mariano , Pérez Pilar , Cansado José
Published: November 2014

Fission yeast PKC ortholog Pck2 controls cell wall synthesis and is a major upstream activator of the cell integrity pathway (CIP) and its core component, MAP kinase Pmk1, in response to environmental stimuli. We show that in vivo phosphorylation of Pck2 at the conserved T842 activation loop during growth and in response to different stresses is mediated by the PDK ortholog Ksg1 and an autophosphorylation mechanism. However, T842 phosphorylation is not essential for Pmk1 activation, and putative phosphorylation at T846 might play an additional role for Pck2 catalytic activation and downstream signaling. These events together with turn motif autophosphorylation at T984 and binding to small GTPases Rho1 and/or Rho2 stabilize and render Pck2 competent to exert its biological functions. Remarkably, the TORC2 complex does not participate in catalytic activation of Pck2, but instead contributes to de novo Pck2 synthesis which is essential to activate the CIP in response to cell wall damage or glucose exhaustion. These results unveil a novel mechanism whereby TOR regulates PKC function at a translational level and add a new regulatory layer to MAPK signaling cascades.
Disease mutant analysis identifies a novel function of DAXX in telomerase regulation and telomere maintenance
Authors: Tang Mengfan , Li Yujing , Zhang Yi , Chen Yuxi , Huang Wenjun , Wang Dan , Zaug Arthur J. , Liu Dan , Zhao Yong , Cech Thomas R. , Ma Wenbin , Songyang Zhou
Published: November 2014

Most human cancers depend on the telomerase to maintain telomeres; however, about 10% of cancers are telomerase negative and utilize the Alternative Lengthening of Telomeres (ALT) mechanism. Mutations in the DAXX gene have been found frequently in both telomerase-positive and ALT cells, and how DAXX mutations contribute to cancers remains unclear. We report here that endogenous DAXX can localize to Cajal bodies, associate with the telomerase, and regulate telomerase targeting to telomeres. Furthermore, disease mutations that are located in different regions of DAXX differentially impacted its ability to interact with its binding partners, and its targeting to Cajal bodies and telomeres. In addition, DAXX inhibition by RNAi led to reduced telomerase targeting to telomeres and telomere shortening. These findings collectively support a DAXX-centric pathway for telomere maintenance, where DAXX interaction with the telomerase regulates telomerase assembly in Cajal bodies and telomerase targeting to telomeres.
Temporally distinct roles of ATM and ROS in genotoxic-stress-dependent induction and maintenance of cellular senescence
Authors: Nair Raji R. , Bagheri Meisam , Saini Deepak Kumar
Published: November 2014

Cells exposed to genotoxic stress induce cellular senescence through a DNA damage response (DDR) pathway regulated by ATM kinase and reactive oxygen species (ROS). Here, we show that the regulatory roles for ATM kinase and ROS differ during induction and maintenance of cellular senescence. Cells treated with different genotoxic agents were analyzed using specific pathway markers and inhibitors to determine that ATM kinase activation is directly proportional to the dose of the genotoxic stress and that senescence initiation is not dependent on ROS or the p53 status of cells. Cells in which ROS was quenched still activated ATM and initiated the DDR when insulted, and progressed normally to senescence. By contrast, maintenance of a viable senescent state required the presence of ROS as well as activated ATM. Inhibition or removal of either of the components caused cell death in senescent cells, through a deregulated ATM–ROS axis. Overall, our work demonstrates existence of an intricate temporal hierarchy between genotoxic stress, DDR and ROS in cellular senescence. Our model reports the existence of different stages of cellular senescence with distinct regulatory networks.
Blanket bans on treatment: conflict in healthcare resourcing
Authors: Reid Jane
Published: November 2014

Blanket bans of specific treatments have been controversially introduced by some NHS trusts as a means of rationing health care and prioritizing funding for services. This article examines the perceived value conflicts that emerge in relation to blanket bans on specific treatments. Following an initial overview of rationing in contemporary society the needs and wants of given individuals are compared with those of a wider society. Ethical values and philosophical considerations are explored as an analysis of the continuing debate is attempted.
Correspondence
Authors: Davies Helen , Jones Lesley
Published: November 2014

TRANSPLANTATION AND CJD: ETHICAL CONCERNS

WARD ROUNDS: IS THE NURSING CONTRIBUTION STILL DEVALUED?
Professional protectionism and anaesthesia
Authors: Castledine George
Published: November 2014

Distrust between the nursing and medical professions has not been helped by the latest Audit Commision report on the current state of British anaesthesia (Audit Commission, 1997). Faced with shortages of anaesthetists and problems in maintaining an adequate service, the Audit Commission has suggested that nurses, among others, should be trained to help out. This is not a new idea. Several countries in the EEC train nurses in anaesthetics.
Nurses may end up being jacks of all trades
Authors: Murray Cyril
Published: November 2014

There is increasing pressure to create new clinical roles within the health service in response to ongoing organizational changes and greater consumer expectation. The publication of the research report (NHSP, 1997) Innovative Job Design for Clinical Roles in the NHS is therefore both welcome and timely. Ten roles are presented covering a variety of specialties, e.g. emergency nurse practitioner in A&E, laparoscopic nurse practitioner in surgery, and medical support nurse in acute and mental health.
Setopress vs Elastocrepe in chronic venous ulceration
Authors: Gould David J , Campbell Sandra , Newton Heather , Duffelen Patricia , Griffin Margaret , Harding Edward F
Published: November 2014

Venous ulceration is a major problem, particularly in the elderly population. It causes stress to the patient and treatment can be time-consuming. Compression therapy is considered to be the most appropriate non-invasive treatment of venous ulcers. It is generally accepted that composite bandage systems are most efficacious using a long-stretch or short-stretch bandage system. The study reported has compared a long-stretch bandage (Setopress) with a short-stretch bandage (Elastocrepe) over a 16-week period in the treatment of patients with venous ulceration. The trial was a prospective, randomized, observer-blind, parallel group study. Thirty-two patients (male and female) with a total of 39 ulcers completed the trial. After 15 weeks, 11 of 19 ulcers treated with the long-stretch bandage and 7 of 20 ulcers treated with the short-stretch bandage had healed. The differences were not statistically significant. After 15 weeks, the ulcer healing rate for the long-stretch bandage was 58% compared with 35% for the short-stretch bandage. The combined proportion of ulcers healed or improved was statistically significantly greater in the long-stretch bandage group.
The importance of oral hygiene in nutritional support
Authors: Jones Christine V
Published: November 2014

Disorders of the mouth can significantly impair the quality of life of the ill patient. For patients requiring nutritional support, especially those who are unable to take food via the oral route, good oral hygiene is of prime importance. This article, the third in a series on nutrition, suggests aims and objectives for mouthcare plus an assessment tool for recording the oral state of patients on admission. The role of saliva in oral health is explored along with the problems and alleviation of a dry mouth. The current range of oral hygiene products and their use are discussed. A sound scientific knowledge of the oral environment in nurse education is advocated; it is suggested that the dental team could help to provide this.
Consent in Medical Law
Authors: Stauch Marc
Published: November 2014

The need for patients to consent to any form of medical intervention is well established. As stated in Schloendorff vs Society of New York Hospital [1914]: ‘Every human being of adult years and sound mind has a right to determine what shall be done with his own body, and a surgeon who performs an operation without his patient's consent commits an assault, for which he is liable in damages.’ Consent thus ensures respect for the patient's autonomy and bodily integrity.
Breaking bad news to people with a learning disability
Authors: Read Sue
Published: November 2014

This article identifies the difficulties often associated with breaking bad news, from a nursing perspective. The additional considerations involved in breaking bad news to people with learning disabilities are identified, and a six-step protocol (Buckman, 1991) is introduced and explored in relation to this client group. Effective communication is seen to be crucial when working with people with a learning disability, and a system for accurate listening is offered (Conboy-Hill, 1992). Finally, recommendations for helping professionals to learn how to break bad news sensitively to this client group are suggested. They include multi-agency working, education and training opportunities, standard statements, resources, support and research initiatives.
Equity and access to health care for women with learning disabilities
Authors: Parrish Alan , Markwick Anne
Published: November 2014

The increased expectation for women with learning disabilities to become more autonomous and independent is generally a positive and dynamic force. However, care must be taken to ensure that, within this environment, women with learning disabilities are not isolated or lack support as this increases their vulnerability. These issues exist for all women within our society, but women with learning disabilities are more vulnerable because of their lack of voice both individually and politically. Within this new culture of independence and rights for women with learning disabilities, nurses must ensure that they address their own accountability and responsibility.
Rehabilitation following spinal injury: the nursing response
Authors: Nolan Mike , Nolan Janet
Published: November 2014

Spinal cord injury is one of the most unexpected and devastating of events that typically affects young people, often males. Thus it stands in stark contrast to both multiple sclerosis and arthritis, the conditions considered in the previous two articles of this series. The differences do not end here as spinal injury is relatively stable once the initial phase has passed, whereas both multiple sclerosis and arthritis are progressive. However, despite this variation the literature suggests that rehabilitation in all three conditions raises similar concerns. This article focuses on these concerns and how nurses can respond to them.
Nurses need improved working conditions
Authors: Morris Mervyn
Published: November 2014

A mid the disappointment of this year's pay settlement the problem of nurse shortages has once again surfaced as an increasingly critical issue within the health service. Money is not the only reason influencing nursing recruitment and retention. Many other factors determine whether people find nursing an attractive career prospect.
Diabetic control in the patient with acute myocardial infarction
Authors: Noy Karyn
Published: November 2014

Diabetes mellitus affects 2% of the population and up to 5% of people over 65 years of age (Thomas, 1993). Diabetic patients have more coronary artery disease and a higher mortality from acute myocardial infarction (AMI) than the rest of the population (Patmore and Jennings, 1996). They have similar-size infarcts to those without diabetes, but the total mortality post-MI is higher (Karlson et al, 1993). This article examines the literature on AMI in diabetic patients to ascertain the most effective management of these patients and hence improve their prognosis.
An introduction to the reading of electrocardiograms
Authors: Woodrow Philip
Published: November 2014

This article introduces the basic principles of reading electrocardiograms (ECGs) for nurses who are unfamiliar with reading them. For more experienced practitioners there are a number of useful articles and books (e.g. Hampton, 1992a,b) that will help further their knowledge. The ECG records cardiac electrical activity as a graph; interpretation is illustrated here by sinus rhythm. A single ECG lead (lead II) is used throughout this article. Atrial fibrillation is described to show a contrasting dysrhythmia. Specific nursing care is suggested for patients being monitored or having ECGs taken.
Educating nursing home staff in the reduction of pressure sores
Authors: Davies Sue , Nolan Mike
Published: November 2014

Care-related work within continuing care settings is often perceived as being of low status and requiring little skill. In reality, however, creating a positive long-term care environment requires imagination and creativity. Education and training are a key element in any effort to improve the quality of care in nursing homes and similar settings, yet recent evidence suggests that opportunities for continuing education and training for staff in such environments are limited. This article considers the context of continuing education for nurses and care assistants employed in nursing homes, and uses a pilot evaluation of an educational package aimed at reducing the incidence of pressure sores as a case example to raise important issues. The difficulties in providing sufficient opportunities for education are highlighted and the need to embed any educational programme within a well-developed staff support structure is stressed.
Cancer of the prostate 1: promoting men's healthcare needs
Authors: Peate Ian
Published: November 2014

This three-part series explores the nurse's role in promoting men's health with regard to cancer of the prostate. This article presents the incidence of prostatic cancer and its relationship to geographical environment. Diagnosis, early detection and screening are also discussed and the possible contribution of diet to the rising incidence of the disease is examined. In the next article health education models and the role of the nurse are described and recommendations for practice are offered.
Critical thinking and analysis: a model for written assignments
Authors: Edwards Sharon L
Published: November 2014

The purpose of this article is to propose a model for critical analysis which can be incorporated into nurse education to enhance nurses' understanding of the concepts and to assist students in undertaking academic assignments. It provides a definition and conceptualization of critical thinking and critical analysis, and highlights the differences, similarities and interrelationships between them. The model suggests that there are 10 components of critical analysis. This provides the first step for developing further research on the content of the model, i.e. certain components are accepted and those which are unsuitable are rejected. The model assists the development of educational strategies to promote critical analysis skills, which are an essential element of the autonomous, critical thinking nurse practitioner.
The standard of nursing records should be raised
Authors: Castledine George
Published: November 2014

In today's healthcare environment, maintaining accurate nursing records is essential. Nursing documentation should demonstrate that all nursing care meets the needs and expressed wishes of the patient, and that it is based on acceptable standards and evidence. The purpose of documentation has changed little over the past 20 years except that today there is greater emphasis on involving the patient.
Integrated Care Management
Authors: Wilson Jo , Tingle John
Published: November 2014

Some clinicians are at the leading edge of good practice in the introduction of integrated care management (ICM) (Wilson, 1996) based on partnership, quality and driven by performance. The new Government White Paper (Department of Health, 1997) outlines proposals for integrated care with all care planners and providers working collaboratively. A number of health and social care organizations have worked collaboratively to develop care programmes based on patient-centred care. One of the vehicles is multidisciplinary pathways of care (MPCs) which is the risk management tool for monitoring jointly agreed quality and patient outcome criteria from the performance of planning and providing individual patient care.

ICM views the multidisciplinary approaches to collaborating care delivery by activity, cost and quality, and using a process approach to problemand outcome-based care delivery. Involving patients and their carers in determining the process and outcomes of care provides a route to better communication, patient and staff satisfaction and the overall quality of care.

This article deals with the use of ICM through the monitoring system of multidisciplinary pathways of care (MPCs) as a tool for minimizing risk and improving the continuous quality improvement of patient care. MPCs are one of the components of ICM which need to incorporate clinical guidelines, protocols, interdisciplinary standards, evidenced-based practice and clinical outcomes which are continuously monitored across all sectors of care.
Exploring mutuality within the nurse–patient relationship
Authors: Briant Steve , Freshwater Dawn
Published: November 2014

This article explores the concept of boundaries within the nurse–patient relationship. Drawing on child development theories the authors explore the difficulties of boundary maintenance and link this to the professional aspects of therapeutic alliance. The ability to establish clear boundaries between ourselves and others is closely related to the capacity to function as a healthy adult and as such may be said to play an important role in the development of mental health difficulties. However, it is generally accepted by psychological theorists that a certain amount of projection and transference are likely to occur in every two-person relationship and as a result boundary confusion is likely to be experienced by both parties to a greater or lesser extent in the nurse–patient relationship. If, as is currently asserted by the nursing profession, the nurse–patient relationship is based on the principle of equality then it follows that both the nurse and the patient carry equal responsibility for maintaining the boundaries within which their interactions take place. The authors argue that it may be more appropriate to think in terms of a relationship founded on the concept of ‘mutuality’. Such a position enables the concept of therapeutic reciprocity to be embraced alongside the reality that ultimately it is the nurse who carries the responsibility for ‘holding’ the boundaries within which the relationship is ‘acted out.’
Clinical assessment for posttraumatic stress disorder
Authors: Finnegan Alan P
Published: November 2014

Post-traumatic stress disorder (PTSD) is an increasingly fashionable diagnosis used to describe an individual who experiences psychological problems following his/her involvement in a traumatic event. However, PTSD can prove difficult to assess accurately owing to the unique problems of co-morbidity with other psychological disorders or the late onset of symptoms. Paradoxically, PTSD may be misdiagnosed by a healthcare professional which may result in inappropriate therapeutic intervention. This article introduces a simple five-stage assessment that is designed to help the clinician determine whether the client's distress is caused by PTSD or another disorder. These guidelines are structured and explore the five stages of PTSD assessment: collecting background information; initial contact with the client; correctly identifying the problem; general assessment; and summary. Finally, some recommended structured clinical assessment guidelines and psychometric rating scales are outlined.
Cardiac rehabilitation following myocardial infarction
Authors: Nolan Mike , Nolan Janet
Published: November 2014

Coronary heart disease is the major cause of death in the UK, but cardiac rehabilitation programmes have tended to develop in an ad hoc and unsystematic way. This article considers some of the deficits in current practice and suggests ways in which nurses can contribute more fully to care in this area. The need for better training and the necessity to develop skills in psychological care are highlighted. The authors also emphasize the importance of giving greater attention to a number of areas such as family involvement, sexuality and gender issues, and community follow-up
Nurse occupational stress research 6: methodological approaches
Authors: Wheeler Herman H
Published: November 2014

This article, the final in the series on nurse occupational stress, reviews the most common methodological approaches used to study nurse stress. It also discusses the methods that are rarely used and alternative methods that have not previously been used to research nurse stress. The strengths and limitations of the different approaches are examined.
Is the heyday of the hospital finally over?
Authors: Castledine George
Published: November 2014

The role of the hospital is rapidly changing. Economic constraints and increasing demands have forced hospitals to adopt a much more stringent approach to treatment and length of patient stay. This is particularly evident when it comes to elderly patients and those suffering from chronic illnesses.
Nurses must improve their record keeping skills
Authors: Tingle John H
Published: November 2014

The Clinical Systems Group (CSG) of the Department of Health has produced a report entitled Improving Clinical Communications (CSG, 1998) which reveals that there are difficulties in providing good healthcare information to health carers.
Nutritional supplements and tube feeds: what is available?
Authors: White Gillian
Published: November 2014

A wide range of specialized nutritional feeding products are now available. One condition for which nutritional feeding products are commonly prescribed is disease-related malnutrition. Nutritional support for poorly nourished clients consists of more than simply prescribing a specialized product. Key nutrition messages need to be applied to individual situations to promote optimal nutritional intake. However, in many situations clients are unable to meet their nutritional requirements by food alone and nutritional supplement products are then extremely useful. The nutritional status of all those receiving nutritional support should be monitored regularly; as the client's nutritional status improves, his/her intake of these products may need to be reduced or stopped. If clients are unable to maintain or improve their nutritional status despite the use of nutritional supplements, additional help from an alternative feeding product may be required.
Palliative care: promoting the concept of a healthy death
Authors: Russell Philip , Sander Ruth
Published: November 2014

The thought of having a life-limiting disease and/or dying can be a fearful prospect. However, a positive approach to palliative care can help the individual and his/her family to approach the last stages of life with hope and, for some people, fulfilment. This article explores a positive health promotion approach to palliative care. This approach is underpinned by the principles of the Ottawa Charter (World Health Organization (WHO), 1986) which specifies advocacy, enabling, and mediacy as the three central elements of health promotion. The nurse as patient advocate can help to ensure that the wishes of the dying person are met. The principles of enabling can help the dying person and his/her family to remain involved in key decisions while mediacy between caregivers can ensure that death occurs in the most appropriate setting for the individual. Through this approach nurses can play a pivotal role in the multidisciplinary team both as agents of change and as providers of care and support to the dying person and his/her family.
Cancer of the prostate 3: men's healthcare needs
Authors: Peate Ian
Published: November 2014

This article, the third in a three-part series, addresses the complex issues surrounding screening for prostate cancer. The purpose of screening in health care is discussed and the advantages and disadvantages of the various screening tests for the early detection of prostate cancer are outlined. The use of one specific technique to screen men for prostate cancer is questioned. It is suggested that several techniques should be used to assess risk in detail. Employing only one technique, for example prostate specific antigen, may result in men undergoing unnecessary surgery or inappropriate treatment. Nurses have a professional duty to ensure that they are aware of the advantages and disadvantages with respect to screening men for cancer of the prostate. Patients' must be in possession of the facts before they make important decisions about their health. In order to reduce harm the nurse can become the patient's advocate and act in such a way as to safeguard and promote the patient's interests.
Nursing's knowledge base: does it have to be unique?
Authors: Nolan Mike , Lundh Ulla , Tishelman Carol
Published: November 2014

An International Seminar held at the University College of Health Sciences, Jönköping, Sweden, in May 1996, was the stimulus for this article. The purpose of the seminar was to consider the contribution that nursing theory has made to the development of the profession and to identify ways in which this contribution could be enhanced. This article briefly traces the emergence of nursing theory and argues that despite its relatively short history, theory has failed fully to inform practice and is increasingly seen as irrelevant. It is suggested that two trends − the abstract and esoteric nature of much nursing theory and the desire to create a ‘unique’ body of nursing knowledge − must be countered before theory can establish its value. It is argued that these are manifestations of professional and academic insecurity which nursing must overcome before it can reach maturity.
Metrotop: a topical antimicrobial agent for malodorous wounds
Authors: Moody Marion
Published: November 2014

The eradication of pungent wound odour is one of the most challenging problems for health professionals involved in wound management. The presence of malodour can cause immeasurable distress for the patient and his/her family, making many sufferers' lives one of self-imposed exile. Clinical research using topical metronidazole over the past 20 years clearly indicates that metronidazole is effective against the anaerobic bacteria that cause these foul and distressing odours. Seton Healthcare produces a commercial preparation called Metrotop − a topical metronidazole gel which is available on prescription.
How to improve the morale of nursing students
Authors: Castledine George
Published: November 2014

Many reasons are put forward to explain why there is low morale among nurses and problems with recruitment. For example, some healthcare managers blame the new system of nurse education as they feel university life stops students identifying with their local hospitals. Therefore, some managers believe that students should be attached to specific hospitals for their entire experience. In their defence, educationalists argue that it is not the educational system that is at fault, but the service side for not providing enough incentives and support for nursing staff.
Correspondence
Authors: Parrish Alan , Scott Helen
Published: November 2014

LEARNING DISABILITY AND SEXUALITY

HUMAN CLONING: A STEP TOO FAR?
Have enrolled nurses just been reinvented?
Authors: MacAlister Lynn I
Published: November 2014

The Ashworth branch of the RCN is petitioning this year's RCN Congress to establish a category of membership that will enable healthcare assistants with nursing related S/NVQs, at level 3 and above, to become members of the RCN. As healthcare assistants comprise an everincreasing part of healthcare teams it is easy to understand how they might wish to establish a group identity and gain formal recognition for their contribution to the provision of direct care to patients. Membership of the RCN might be perceived as helping this process. In addition, the benefits of membership of a trade union familiar with the needs and difficulties of those in caring roles might well appear attractive.
Stroke 2: expanding the nurse's role in stroke rehabilitation
Authors: Nola Mike , Nolan Janet
Published: November 2014

This article, the second of two considering the nurse's role in stroke rehabilitation, focuses on potential nursing contributions in a number of areas. There is scope, particularly in the community, to develop a far greater nursing role in both the acute and the postacute phases of rehabilitation. However, nurses often have ambivalent attitudes towards rehabilitation − seeing acute care as more prestigious and important. Such attitudes are developed and reinforced in basic training which gives relatively little emphasis to chronic illness.
Eating disorders and adolescent diabetes: is there a link?
Authors: Barber Corinna Jane , Lowes Lesley
Published: November 2014

Issues commonly associated with normal adolescent development can affect the management of insulin-dependent diabetes mellitus, and similarities between psychosocial issues relating to diabetes and eating disorders have been suggested. This article discusses the issues and the problematic coexistence of eating disorders and diabetes in adolescence. The aetiology of eating disorders is multifactorial, and this article explores whether the existence of diabetes in adolescence potentially increases susceptibility to the development of eating disorders. Finally, the authors suggest ways in which paediatric nurses can approach the care of adolescents with coexisting diabetes and eating disorders.
Sociodemographic factors associated with nocturnal enuresis
Authors: Hanafin Sinead
Published: November 2014

This study examined the school nursing/medical examination records of 6206 national school children for sociodemographic factors associated with reported nocturnal enuresis. A point prevalence of 10.7 % (n = 666) for nocturnal enuresis was reported by parents during 1970–1993 in children aged 4–14 years. Although a downward linear trend (from 11.5 % to 10.7 %) was seen for the reported prevalence of nocturnal enuresis over the 23-year period, this trend was not statistically significant. Age, as expected, large family size and low ordinal position in the family were all statistically associated with reported nocturnal enuresis. Gender was statistically associated with reported nocturnal enuresis only in the 8–14 years age group. Paternal social class was not statistically associated with reported nocturnal enuresis, although 15 % of children in families where the father was absent were reported enuretic compared with only 10 % of children whose father was in social class 1. These findings contribute to an understanding of the relationship between sociodemographic factors and enuresis as reported at school medical examinations and have implications for the planning and development of health services at local levels.
Reflection: does it enhance professional nursing practice?
Authors: Andrews Margaret , Gidman Janice , Humphreys Amanda
Published: November 2014

It is generally accepted that nurses who engage in reflective activity do so to develop their practice. However, there is little empirical evidence to suggest that practice development or improved patient care occurs as a direct result of reflection. The UKCC, as part of its framework for postregistration education, expects all nurses to engage in some form of reflective activity and to provide written accounts within a personal professional profile. This article examines some of the assumptions surrounding the practice of reflection and asserts that, in the main, nurses do not readily engage in reflection in a purposeful way.
Correspondence
Authors: Caan Woody , Peate Ian , Leiba Tony
Published: November 2014

DOES NURSING NEED ITS OWN KNOWLEDGE BASE?

NURSES ARE NOT DOCTORS' HANDMAIDENS

NURSES AND USERS MUST UNITE
Nursing assessment of patients with non-acute wounds
Authors: Miller Mick
Published: November 2014

Accurate and thorough assessment of patients with wounds is essential in order to provide correct treatment. In relation to patients with open, non-acute wounds, the areas that need assessing include general health and specific underlying disease process, care being given and local wound environment. This article outlines specific details of the assessment process. It includes a breakdown of factors affecting healing, a discussion of the importance of diagnosis of cause, an outline of factors within care provision that may have a negative effect on healing, and areas relevant to the wound itself that should be assessed.
Update on clinical guidelines
Authors: Tingle John , Wilson Jo
Published: November 2014

Clinical guidelines are increasingly being seen as an important clinical tool for those working within the NHS, ensuring the quality and promoting the standardization of interventions.
Assessing children's spirituality: what is the way forward?
Authors: Kenny Gerard
Published: November 2014

This article identifies the difficulties facing nurses working with the spiritual experiences of children. There is a lack of literature and education available in this field and as a consequence paediatric nurses are forced to use adult-based research. The benefits, as well as the drawbacks of this approach, are examined. In doing so it is hoped that the article might generate debate and discussion as to how to address this valued but under-investigated area of nursing practice.
HIV and combination therapy: meeting the challenge of a new era
Authors: Hodgson Ian
Published: November 2014

With the advent of combination therapy in the treatment of human immunodeficiency virus (HIV) infection, there has been a vast reduction in the number of people admitted to AIDS units as inpatients, and a marked improvement in the quality of life for people infected with HIV. Combination therapy comprises the combined administration of various powerful antiviral drugs to prevent CD4 cell destruction and minimize the chance of a rapidly replicating virus becoming resistant. This article presents an overview of the basic elements of this therapy, discussing some of the challenges that are a corollary of this new era. In particular, the implications of an extended period of survival and wellness for a group of people previously thought to be the victims of a strictly acute condition are addressed. These implications relate to therapeutic, psychological, employment, social and sexual issues. Finally, the issues facing carers (both lay and professional) are discussed.
Nurses in academic departments of general practice and primary care
Authors: Lempp Heidi , Woodfield Stephen , Wilson Alison , Stacy Rosie
Published: November 2014

in 1997, the authors conducted a survey of registered nurses working in the academic departments of general practice and primary care in UK and Irish medical schools. The survey aimed to determine the number, demographic and professional profile of nurses employed in these academic departments, including their employment status and their views on their clinical work and professional development. The majority of nurses were professionally experienced, had higher degrees, worked in a research capacity, and were likely to have short-term contracts. Contrary to professional perceptions, the majority of nurses stated that clinical work is important to their current job and expressed a need for research support and recognition of their autonomy as healthcare professionals.
Facial surgery and children with Down's syndrome
Authors: Glasper Edward , Powell Catherine
Published: November 2014

Abrief flurry of media coverage followed a recent television documentary which looked at cosmetic surgery for children and adults with Down's syndrome (‘Changing Faces’, Carlton, 24 November, 1998). The use of cosmetic surgery to improve looks, and therefore social acceptance, was pioneered during the early years of the Second World War. Since then many consenting adults have used cosmetic facial surgery as a method of altering, and perhaps improving, looks.
A nursing ‘peace’ vs the medical ‘war’ model
Authors: Castledine George
Published: November 2014

Nursing is on the verge of moving into a new and exciting era. However, we first have to revisit our roots and reflect carefully on what we mean by the terms ‘health’, ‘illness’ and ‘nursing’. Health and illness have become associated with medical definitions and the medical model. However, descriptions of illness go beyond physical symptoms and the treatments handed out by doctors. Psychosocial and spiritual dimensions give us the real lived experience of what it is that we and our patients are going through. This is the link for the sufferer when he/she is trying to make the necessary adjustments to lifestyle and routine following illness.
Correspondence
Authors: lowthian Peter , Alien Jon
Published: November 2014

Catheter drainage debate

In defence of psychiatric nursing