bluuebunny/crossref_metadata_2025 huggingface dataset:
Striatal and extrastriatal dopamine transporter levels relate to cognition in Lewy body diseases: an 11C altropane positron emission tomography study
Authors: Marquie Marta , Locascio Joseph J , Rentz Dorene M , Becker J Alex , Hedden Trey , Johnson Keith A , Growdon John H , Gomperts Stephen N
Published: August 2014

Introduction

The biological basis of cognitive impairment in parkinsonian diseases is believed to be multifactorial. We investigated the contribution of dopamine deficiency to cognition in Parkinson disease (PD) and dementia with Lewy bodies (DLB) with dopamine transporter (DAT) imaging.

Methods

We acquired 11C altropane PET, magnetic resonance imaging and cognitive testing in 19 nondemented subjects with PD, 10 DLB and 17 healthy control subjects (HCS). We analyzed DAT concentration in putamen, caudate, anterior cingulate (AC), orbitofrontal and prefrontal regions, using the Standardized Uptake Volume Ratio with partial volume correction, and we related DAT concentration and global cortical thickness to neuropsychological performance.

Results

DAT concentration in putamen and in caudate were similar in PD and DLB groups and significantly lower than in HCS. Reduced caudate DAT concentration was associated with worse Clinical Dementia Rating Scale-sum of boxes (CDR-SB) scores and visuospatial skills in DLB but not in PD or HCS groups. Adjusting for putamen DAT concentration, as a measure of severity of motor disease, caudate DAT concentration was lower in DLB than in PD. Higher AC DAT concentration was associated with lower putamen DAT concentration in DLB and with higher putamen DAT concentration in PD. Higher AC DAT concentration in DLB correlated with greater impairment in semantic memory and language.

Conclusions

Caudate and AC dopamine dysfunction contribute in opposing directions to cognitive impairment in DLB.
Clinical, Biologic, and Prognostic Differences on the Basis of Primary Tumor Site in Neuroblastoma: A Report From the International Neuroblastoma Risk Group Project
Authors: Vo Kieuhoa T. , Matthay Katherine K. , Neuhaus John , London Wendy B. , Hero Barbara , Ambros Peter F. , Nakagawara Akira , Miniati Doug , Wheeler Kate , Pearson Andrew D.J. , Cohn Susan L. , DuBois Steven G.
Published: August 2014

Purpose

Neuroblastoma (NB) is a heterogeneous tumor arising from sympathetic tissues. The impact of primary tumor site in influencing the heterogeneity of NB remains unclear.

Patients and Methods

Children younger than age 21 years diagnosed with NB or ganglioneuroblastoma between 1990 and 2002 and with known primary site were identified from the International Neuroblastoma Risk Group database. Data were compared between sites with respect to clinical and biologic features, as well as event-free survival (EFS) and overall survival (OS).

Results

Among 8,369 children, 47% had adrenal tumors. All evaluated clinical and biologic variables differed statistically between primary sites. The features that were > 10% discrepant between sites were stage 4 disease, MYCN amplification, elevated ferritin, elevated lactate dehydrogenase, and segmental chromosomal aberrations, all of which were more frequent in adrenal versus nonadrenal tumors (P < .001). Adrenal tumors were more likely than nonadrenal tumors (adjusted odds ratio, 2.09; 95% CI, 1.67 to 2.63; P < .001) and thoracic tumors were less likely than nonthoracic tumors (adjusted odds ratio, 0.20; 95% CI, 0.11 to 0.39; P < .001) to have MYCN amplification after controlling for age, stage, and histologic grade. EFS and OS differed significantly according to the primary site (P < .001 for both comparisons). After controlling for age, MYCN status, and stage, patients with adrenal tumors had higher risk for events (hazard ratio, 1.13 compared with nonadrenal tumors; 95% CI, 1.03 to 1.23; P = .008), and patients with thoracic tumors had lower risk for events (HR, 0.79 compared with nonthoracic; 95% CI, 0.67 to 0.92; P = .003).

Conclusion

Clinical and biologic features show important differences by NB primary site, with adrenal and thoracic sites associated with inferior and superior survival, respectively. Future studies will need to investigate the biologic origin of these differences.
Open-access approach for atrial fibrillation
Authors: Izzat Lena
Published: August 2014

Lena Izzat outlines the thinking behind a multidisciplinary atrial fibrillation assessment clinic in south west Wales.
The Glasgow Coma Scale 40 years on: a review of its practical use
Authors: McLernon Siobhan
Published: August 2014

This year sees the celebration of the 40th anniversary of the Glasgow Coma Scale (GCS), which is as relevant in clinical decision making now as it was 40 years ago. The GCS was originally devised in 1974 as a simple bedside tool to improve clarity and consistency in communication about patients with impaired consciousness in a wide range of disorders. Impaired consciousness is an expression of dysfunction of the brain as a whole. Over the decades there has been increasing evidence of variation in the consistency of GCS assessment in clinical practice. Education and experience in the use of the GCS are important factors that have been shown to improve the reliability and accuracy of GCS scoring. The use of different examination techniques, especially the application of painful stimulation, contributes to inconsistency. A standardised approach is required for safe therapeutic clinical decision making and clear communication between health professionals. Novel approaches to education are required to standardise practice, and explicit guidelines aimed at improving its overall application in clinical practice are needed.
Cavity wound management in the community
Authors: Chaloner Donna , Poole Maria
Published: August 2014

Health care professionals in all specialties strive for high standards of care for their patients. This is particularly relevant in the area of wound management as major advances have been achieved over the past decade. However, there are many areas where improvements can still be achieved. This article highlights the area of cavity wound management in the community.
Promoting a healthy workforce: a clinical case presentation
Authors: Hardy Sally
Published: August 2014

This article presents the treatment of a group of health care workers admitted to a psychiatric hospital and considers the prevention of emotional exhaustion and the risk of mental illness among health care workers. A psychotherapy group provides the case material in which the carers discuss and describe their inability to seek help through fear of recrimination.
Alternative approaches to establishing reliability and validity
Authors: Nolan Mike , Behi Ruhi
Published: August 2014

This article considers a variety of alternatives to the classical notions of reliability and validity. It suggests that there are no hard and fast rules that can be applied to all research studies and that what constitues ‘authentic’ research depends upon the paradigm within which a given study is conducted.
Competency through being: the enemy within?
Authors: Gee Kate
Published: August 2014

Nurses are taking on more medical tasks but is this appropriate? If so, does this advance nursing practice? The issue hinges on the nurse's competency which is central to professional nursing practice.
Parameters of wound assessment
Authors: Benbow Maureen
Published: August 2014

Close examination of all aspects of a patient's condition as well as the wound itself will minimise the risk of failure in wound management. Involving the patient and the patient's carer can secure cooperation and compliance with treatment and can positively influence the outcome of care.
Care Study: A critical event in tracheostomy care
Authors: Clarke Lyndsay
Published: August 2014

Albert Collis is an 80-year-old man who was admitted to the intensive care unit with an episode of acute pancreatitis, 6 weeks before a critical incident in his tracheostomy care. His pancreatitis was managed medically, with part of this treatment involving mechanical ventilation.

Although the pancreatitis responded well to treatment, Albert developed a chest infection and proved difficult to wean from the ventilator. A tracheostomy was therefore performed 2 weeks after admission, both for Albert's comfort and to facilitate the weaning process. Albert's muscles had wasted considerably during his admission and his respiratory muscles were very weak. In the 4 weeks following his tracheostomy he had progressed slowly from pressure control mode to synchronised intermittent mandatory ventilation and pressure support, to pressure support only. He then went on to a continuous positive airway pressure circuit, and for the 2 days before the incident had been on a T-piece with a thermovent humidifier with 28% oxygen.

Despite copious loose yellow secretions, which Albert was now managing to cough clear of the tube himself, his oxygen saturations ranged constantly between 96% and 98%. As a result of his strong cough, Albert was only occasionally suctioned and was encouraged to clear his own secretions with the aid of nurses, physiotherapists and tissues! Albert's main problem at this time was boredom and irritability, which caused him to remove the T-piece from his tracheostomy tube frequently; when he was breathing on air alone his oxygen saturation was only 89-90%.

The importance of both the oxygen and humidification was explained to Albert and the T-piece was replaced as often as he allowed. At approximately 8.30 am on the third morning of being on the T-piece, Albert's oxygen saturation level dropped to 85% from 96%. His T-piece was still in position and the supply was connected. The oxygen saturation probe site was checked and was shown to be reading correctly. Air entry on auscultation was quiet in all areas, but was present. As a temporary measure, the inspired level of oxygen was increased to 40%, but had no effect. A decision was therefore made to hand-ventilate Albert with the aid of a re-breathing bag and 100% oxygen. Sterile saline 3 ml was instilled into his tracheostomy tube and suctioned.

On suctioning, the lumen of the tube was found to be very narrow, and difficulty was experienced in passing the suction catheter. Further hand-ventilation, saline and suctioning produced thick yellow secretions and the lumen of the tube cleared sufficiently to enable the suction catheter to be passed easily. Albert's oxygen saturations were now 99% on 100% oxygen and he was placed back on the thermovent and T-piece with 28% oxygen. His saturations returned to their baseline level of 96% and remained at this level. Auscultation revealed good air entry to all areas of the lungs.
Identification of non-infected urine specimens in children
Authors: Kelly Rosemary
Published: August 2014

The research study reported in this article set out to establish whether reagent strip testing of urine specimens could be used to identify non-infected specimens accurately, thereby reducing the number of specimens sent for laboratory testing.
The development of advanced nursing practice: 2
Authors: Elliott Patricia Anne
Published: August 2014

The first part of this article discussed the development of the advanced nursing practitioner role. In this article the author describes how she interpreted the role in an initiative at Evesham Community Hospital by integrating clinical practice, management, research and education elements into her nursing role.
Transporting critically ill patients
Authors: Eagle Sarah
Published: August 2014

Some 10000 patients a year are moved to or between intensive care units (ICUs) in the UK (Royal College of Anaesthetists, 1989). This figure looks set to increase considerably with plans to further develop regional ICUs already under discussion.
Care of a woman with Down's syndrome using the Neuman Systems Model
Authors: Owens Melissa
Published: August 2014

Care study

Alice Bird is a 26-year-old women with Down's syndrome and a severe learning disability. Following a long illness, Alice's father passed away just before my involvement with the family. Alice now lives at home with her mother, aged 70, and an older sister, Janice, aged 34, who has a mild learning disability and is also being treated for mental health problems.

Two other brothers live nearby and are in regular contact with the family. My initial contact with this family followed a request for help in planning long-term care for Alice in the event of the mother's death. Mrs Bird, having recently lost her husband, realised that her daughter would almost certainly live longer than her and wanted to feel that appropriate plans had been made.
Care Study: Acute renal failure due to drug-induced rhabdomyolysis
Authors: Davies Annette
Published: August 2014

Care study

David, a 25-year-old man who had been an intermittent, intravenous drug abuser since he was 15 years old, was found unconscious by his girlfriend 12-16 hours after he had injected an overdose of heroin. He was admitted to the casualty department with a swollen and blistered left arm that he had compressed in his unconscious state. His abnormal blood chemistry, in particular the rise in creatine kinase, combined with his history, led to an initial diagnosis of rhabdomyolysis due to a heroin overdose.
Assessment and monitoring of alcohol-related problems
Authors: Cooper David B
Published: August 2014

Employers are increasingly requesting employees to submit to screening for alcohol-related problems (ARPs). Holistic assessment, leading to problem identification and treatment, can lead to a reduction in the number of accidents occurring in the workplace. This article argues against the practice of assessment based solely on blood levels of liver enzymes and mean corpuscular volume of erythrocytes and introduces a new diagnostic test which, if used with a full and systematic assessment, may lead to more accuracy in diagnostic interpretation.
The pathophysiology of Guillain-Barré syndrome
Authors: Waldock Elizabeth
Published: August 2014

Landry-Guillain-Barré-Strohl syndrome is a demyelinating disorder affecting the peripheral nervous system. It is also known as postinfectious polyneuropathy or acute idiopathic polyneuritis (Prydun, 1983). Within days, the disorder can replace an individual's busy and active lifestyle by one of total dependence, sometimes lasting months. Despite modern intensive medical care, the mortality rate is still high at 5% (Rajah, 1992).
Professional accountability and industrial action: contradictory or compatible?
Authors: Pyne Reg
Published: August 2014

The decision of the RCN to jettison its rule forbidding industrial action has generated a great deal of debate, much of which is fairly ill-informed. This article examines the industrial action issue against the background of the UKCCs Code of Professional Conduct, explores the arguments for and against and draws some conclusions.
A person-centred approach to education audit
Authors: Haigh Diane , Lee Wendy , Parsons Sue
Published: August 2014

This article looks at how the person-centred approach to education audit was developed following a review of the literature and current practice which identified a need for change. Literature covering general and nurse education was studied, together with specific initiatives relating to the audit of the learning environment. A profile tool was designed and tested in a range of practice settings used by students of nursing. The results were evaluated.
Children: Parental responsibility
Authors: Luke Susan
Published: August 2014

The Children Act 1989 brought about some fundamental changes in the law. This is the first in a series of seven articles dealing with legal issues relating to children that are important for health-care professionals.
Post-anaesthetic shaking
Authors: Fotheringham Diane
Published: August 2014

Although shaking in the post-anaesthetic period is common, the cause of this phenomenon is obscure. Many predisposing factors have been identified, but the medical treatments and measures of care for patients with postanaesthetic shaking are as controversial as the causes.
Blood and blood transfusion reactions: 2
Authors: Bradbury Martyn , Cruickshank Jeremy Pope
Published: August 2014

The first of this two-part article examined the therapeutic indications for blood replacement. This article describes the immediate complications of blood transfusion and offers guidelines for their nursing management.
Biological therapy in the treatment of cancer
Authors: Ward Ursula
Published: August 2014

Despite improvements in treatment and survival rates for some types of cancer, there remains a need to develop new treatment strategies for the majority of solid tumours. This article describes the cytokines most commonly used and examines the implications for the patient and nursing management.
Models of clinical supervision
Authors: Farrington Andy
Published: August 2014

This article describes several schools of practice in relation to clinical supervision and discusses models of supervision, particularly an integrative approach to clinical supervision in mental health practice. While it is recognised that clinical supervision is more likely to occur in mental health nursing, the article concludes by suggesting a broader application of the underlying principles described.
Handwashing: the fundamental infection control principle
Authors: Horton Rozila
Published: August 2014

This article examines the evidence linking handwashing practices with hospital-acquired infections, the basis for the selection of an appropriate handwashing agent, and ways in which health-care workers may be encouraged to comply with handwashing.
Setting up nurse practitioner roles: issues in practice
Authors: Marsden Janet
Published: August 2014

This article examines the process of developing a nurse practitioner role. Areas which must be considered before and during the implementation of such a role are general and may be applied to any area of practice, although examples here are from the author's own practice.
Nebulised therapy and nursing knowledge
Authors: Cattell Richard , Jones Suzannah
Published: August 2014

Authoritative training from a multidisciplinary resource provides nurses with an excellent breadth and depth of knowledge. This study examines the impact of such training on nurses' knowledge of nebulised therapy and shows an encouraging improvement. Follow-up measures are also described.
Is marketing an obligatory skill in the nursing role?
Authors: Young Ann P
Published: August 2014

The introduction of an internal market to the NHS is altering the culture to one that is more customer-oriented. This article argues that nurses, whether in the public or private sector, need to develop marketing skills in order to function effectively.
Children: Suspected child abuse
Authors: Luke Susan
Published: August 2014

Where a child may be at risk of suffering significant harm, local authority social services departments have a duty to investigate. Many agencies are expected to refer concerns about suspected harm to social services and have a duty to assist with their investigation. ‘Harm’ means impairment of physical and mental health, all forms of ill treatment (including sexual abuse) and all aspects of development (Section 31 (9) Children Act 1989).
Stoma care: is there room to extend our practice?
Authors: Breeze Julia
Published: August 2014

Much is written about the scope of nurses' professional practice. This article examines the ways in which clinical nurse specialists in stoma care may strive to extend their practice without losing sight of their ideals.
Education and professional development in specialist practice
Authors: Allison Marion
Published: August 2014

This article explores issues of particular relevance to nurses involved in stoma care, including formal additional education and preparation, and continuing professional development for those already in practice.
The continent colonic conduit in the management of severe constipation
Authors: Stuchfield Barbara
Published: August 2014

The continent colonic conduit is an innovative surgical technique which has great potential for improving the quality of life of certain patients with severe evacuatory problems for whom other treatment methods have failed.
Pegasus Airwave and Bi-Wave Plus
Authors: Lowthian Peter
Published: August 2014

This article describes two of the modern generation of alternating-pressure air mattresses and discusses their role in pressure sore prevention and management.
Is the nursing-midwifery alliance at an end?
Authors: Castledine George
Published: August 2014

The rift between midwifery and nursing seems to be growing. Recent reports show that there is a strong lobby from midwives to align themselves with doctors not nurses, and for there to be a separate Midwives Act (Cassidy, 1995).
Whistle-blowing: a legal perspective
Authors: Lunn Joanne E
Published: August 2014

Whistle-blowing needs to be explored from a legal perspective. Nurses who become aware of confidential information which they feel is a matter of public concern are faced with a legal as well as a moral dilemma as to when and how they may ‘blow the whistle’.
Children: Treatment and examination
Authors: Luke Susan
Published: August 2014

A child (under 18 years old) cannot law fully be treated unless consent is given by a person with the authority to do so or the child is competent to give his/her own consent.
Surgical nurse principles of audit and clinical practice
Authors: West Bernice JM , Lyon Michael H
Published: August 2014

Health-care providers and purchasers have been concerned with developing methods to assure the quality of the service provided in clinical contexts. Crucial to this is the integration of multidisciplinary clinical audit techniques which facilitate good practice.
Health education and safer sex
Authors: Winship Gary , Peachey Alison
Published: August 2014

Recent studies (e.g. Klee et al, 1991) of human immunodeficiency virus prevalence among drug users indicate that the greatest increase in transmission rates has been a result of sexual contact. This article examines safer sex health education and the development of a programme of education that aims to confront negative attitudes towards condoms.
Fast-track care after cardiac surgery
Authors: Howard Claire
Published: August 2014

This article explains the rationale for fast-track management of low-risk cardiac surgical patients and describes the selection process and care received by these patients at the Royal Brompton Hospital. A review of the fast-track audit is presented and discussed.
Coronary care unit ST-trending system: interpreting complex output data
Authors: Flisher Denise , Lilley Debbie , Sharpies Linda , Thwaites Barnaby
Published: August 2014

Analysis of the ST segment is an accepted part of the assessment of coronary ischaemia. Traditionally, such analysis has been applied to 12-lead surface electrocardiograms, but it is increasingly applied to 24-hour Holter recordings and bedside monitoring systems, using complex computer algorithms. There is a potential for results to be misleading as a consequence of uncritical acceptance of complex medical data processing.
Sexuality and people with learning disabilities
Authors: Carr Linda T
Published: August 2014

Despite the excellent pioneering work of the Family Planning Association and Brook Advisory Centres, sexuality and people with learning disabilities remains a largely unexplored area (Brandon, 1990). This article highlights the need for such individuals to receive sex education alongside social education. It is proposed that learning disability nurses are the most suitable health-care professionals to be the primary educators on such issues because of their expertise and unique relationships with their clients.
Ward manager systems in learning disability services
Authors: Gilbert Tony , Spackman Angela
Published: August 2014

Drawing on two separate research projects, this article examines the ward manager system within learning disability services and highlights issues for consideration by services about to embark on such systems.
Is restricted visiting in conflict with patients' needs?
Authors: Blanchard Helen
Published: August 2014

This article explores the issue of restricted visiting in coronary care units and questions whether this practice is in conflict with individualised patient care. After reviewing the literature on this subject, it proposes that the practice of such restricted visiting should be addressed.
Practice nursing: will it survive?
Authors: Paniagua Hilary
Published: August 2014

According to Handy (1989), if you put a frog in water and slowly heat the water up. ‘…the frog will eventually let itself be boiled to death.’ In common with the frog, some practice nurses are being lulled into a false sense of security as they swim aimlessly in the waters of general practice?
Oral contraception scare has reduced confidence in medical services
Authors: Notter Joy
Published: August 2014

So, here we go again on the seesaw of changing medical advice! It only seems like yesterday that women taking oral contraception were told to change to new ‘safer’ pills (e.g. Femodene, Mercilon, Minulet, Marvelon, etc). However, having obligingly changed, they now find out that they were wrong to change in the first place and that they need to go back to where they started.
Oral health in elderly patients
Authors: Sweeney MP , Shaw A , Yip B , Bagg J
Published: August 2014

A study of the oral health of elderly institutionalised patients and their oral care has revealed significant deficiencies, illustrating the need for a multidisciplinary approach to oral health care centred on the development of mouth care regimens for nursing staff.
The training of nurse surgical assistants
Authors: Tuthill Vanessa
Published: August 2014

This article discusses the development and training of nurse surgical assistants within the Royal Berkshire and Battle Hospitals NHS Trust. The training used the National Vocational Qualification (NVQ) framework to facilitate application for accreditation of prior knowledge in any future NVQ award.
Transfer anxiety in patients with myocardial infarction
Authors: Jenkins David A , Rogers Helen
Published: August 2014

When patients are transferred from a coronary care unit to a general ward they often experience transfer anxiety. A structured pre-transfer teaching programme is suggested as a tool which may improve patient care.
Impact of The Patients Charter on A&E departments: 1
Authors: Crinson Iain
Published: August 2014

In the first of a two-part series presenting the results of a national survey of senior nurses in accident and emergency (A&E) departments, developments in the delivery of nursing care are examined within the context of the major organizational changes within the NHS since 1990; in particular, the requirements of meeting The Patient's Charter (Department of Health, 1991, 1995a) standards are discussed. The second article in this series will examine the developing role of the nurse practitioner in A'E departments.
Twenty-four hour pressure area management: study report
Authors: Clifford Ian , Candler Steve , Starling Mark
Published: August 2014

The aim of the pilot study presented in this article was to evaluate the effectiveness of an alternating-pressure mattress overlay (AlphaXcell) used in combination with a pressure-reducing cushion (Multitec) in providing 24-hour pressure area care in a wide range of patients within a district general hospital.
Alcohol home detoxification: a way forward
Authors: Cooper David B
Published: August 2014

Alcohol detoxification within the home environment is a safe, cost-effective alternative to inpatient care and the problem drinker is more likely to complete the treatment. Yet health trusts continue to ignore this community approach for those individuals with alcohol-related problems.
FADE: a strategy for action in the mild stage of dementia
Authors: Keady John , Nolan Mike
Published: August 2014

This article introduces the Framework for Action in Dementia (FADE), a new strategy aimed at the mild stage of dementia. It suggests that empowering people with dementia from the onset of their illness is a crucial role for nurse practitioners.
HNE Diagnostics Dopplex ultrasound machines
Authors: Williams Clare
Published: August 2014

Doppler ultrasound is a technique that has a variety of uses. These include venous and arterial circulation assessment, pre- and postoperative arterial assessment, digital pulse assessment, carotid stenosis screening, penile blood flow measurement and fetal heart rate assessment.
Is nursing the Cinderella of academic disciplines?
Authors: Castledine George
Published: August 2014

The move of nurse education into universities or higher education (HE) has been a stressful and frustrating experience for nurse teachers. The process of integration has usually been preceded by a number of mergers and institutional changes which has caused some teachers to go through as many as five moves in as many years. There have also been threats to job security and the pressure of adjusting to an academic culture and role change. This has caused bewilderment and demoralization.
Stoma care: finding the most appropriate appliance
Authors: Black Patricia K
Published: August 2014

Over the last 25 years a wide range of stoma appliances have become available via the Drug Tarriff because of the post-war development of plastics. Before deciding which is the most appropriate appliance for the stoma patient to use, it is important to carry out an holistic assessment and understand which type of stoma bag is correct for the appropriate stoma.
Use of physical restraints 2: alternatives
Authors: Molasiotis Alexander
Published: August 2014

The first article in this two-part series considered the consequences of physical restraints. This article considers the alternatives to physical restraints and argues that their use in daily nursing practice raises the quality of care provided to elderly patients.
Supervising suicidal patients within a hospital setting
Authors: Thomas Ben
Published: August 2014

Recent reports have highlighted areas of inadequacy within mental health services which can lead to suicide. This article examines the support mental health nurses should be given to improve their clinical practice in an effort to reduce the risk of suicide.
The nature of scientific knowledge: fact or theory?
Authors: Behi Ruhi , Nolan Mike
Published: August 2014

The complex and confusing literature on nursing theories and theory building is considered in this article. The distinction between facts and theories is explained.
Nurses need a more flexible grading and pay structure
Authors: Castledine George
Published: August 2014

Why are nurses once again at the bottom of the pile when it comes to pay awards? Is it because nursing is still not valued at a level that demands fair remuneration, or is it because the NHS cannot afford to pay more?
Consent to treatment
Authors: McHale Jean
Published: August 2014

The patient must be given a reasonable explanation of treatment to be undertaken and of any major risks posed by that treatment.
Should resource allocation influence treatment decisions?
Authors: McHale Jean
Published: August 2014

Over the last decade the courts have become increasingly involved in treatment decisions. In a number of cases they have been asked to rule as to whether a particular course of action is in a patient's best interests. Many of these cases have attracted considerable publicity, e.g. the Tony Bland case which concerned withdrawal of treatment from a patient in a persistent vegetative state (Airedale NHS Trust v Bland [1993]).
IMMEL: assessing coping responses in the early stages of dementia
Authors: Keady John , Nolan Mike
Published: August 2014

A sufferer's perspective on ways of coping with the initial and evolving impact of dementia is a largely unexplored area of theory and practice. This article, the first of two parts, outlines the development of a new instrument: the Index for Managing Memory Loss (IMMEL), which considers the early sufferer's response to the experience of dementia and can be used to assist practitioners assess individuals' coping strategies. Some additional avenues for professional intervention are also suggested.
Use of transcendental mediation to relieve stress and promote health
Authors: Knight Susan
Published: August 2014

The relief of stress is an important part of health promotion. This article examines the effects of transcendental meditation on stress and discusses how it can improve health.
A holistic approach to pressure sore management
Authors: Oke Sheran , Davies Sandra
Published: August 2014

Care study

Olu is a 19-year-old African boy who was referred to the Tissue Viability Unit after returning from a visit to his family in Nigeria. During his vacation he experienced altered and reduced sensation in his legs. Investigations revealed a tumour, which resulted in him becoming paraplegic from T5 level on his spinal cord. Olu did not receive any form of rehabilitation or preparation for the dramatic change in his lifestyle. The main issues upon presentation in the clinic were: • An 18-month-old grade 3 sacral pressure sore, which resulted from sitting in an inappropriate wheelchair with a car seat cushion. Olu had never seen his sore and had no understanding of the concepts involved. • Loss of bladder and bowel control which was managed with an indwelling catheter and disposable nappies.
Stress incontinence: treatment using pelvic floor re-education
Authors: Unsworth John
Published: August 2014

Care study

Mary Tiverton, a 66-year-oid woman, referred herself to our local continence promotion clinic in November 1993, complaining of incontinence. Although she had suffered from leakage during exertion since going through the menopause 18 years ago, the problem was becoming increasingly troublesome, At the time of her first visit to the clinic she had a chest infection, and the extra coughing was making her incontinence worse. Over a 5-month period, Mary underwent a programme of pelvic floor re-education, consisting of a normal pelvic floor exercise programme and a programme of resisted exercises using pelvic floor weights. At her final appointment, Mary had good pelvic floor muscle tone and no symptoms of stress incontinence, even on exertion.
An investigation of the uncurling forces of indwelling catheters
Authors: Lowthian Peter T
Published: August 2014

An elastic catheter in the male urethra produces an ‘uncurling’ force as it attempts to straighten itself. Where this force is sustained, it may result in some pressure necrosis, or pressure atrophy. This article describes how this in-vivo situation was modelled and the resultant pressures checked and recommends the type and size of catheter that should be used if it is needed for more than 2 days of continuous use.
Nurses' role in the decision-making process
Authors: Castledine George
Published: August 2014

Nurses must consider the repercussions of current trends in the health care decision-making process. In the past, doctors made decisions and if a second opinion was required it was sought from another doctor. Control of the decision-making process was believed to distinguish the professional from the lay person and the semi-professional. Doctors guard their right to be accountable and have resisted attempts to relinquish this authority.
Use of a phlebotomy service in a paediatric unit
Authors: Buckingham Sylvia , Bailey Linda
Published: August 2014

This article evaluates the literature and research concerning venepuncture and the use of a phlebotomy service in an acute paediatric setting. It also highlights concerns expressed by nursing and medical staff about the introduction of such a service.
Nursing uniform preferences of parents and children in a paediatric setting
Authors: Livingston Mark
Published: August 2014

There is a growing movement towards more casual uniforms within paediatric nursing. However, children's and parents' preferences should be considered before deciding what type nurses should be wearing.
Measurement in research
Authors: Nolan Mike , Behi Ruhi
Published: August 2014

This article discusses the importance of measurement in research and in nursing generally. The process of operationalisation is described and different levels of measurement are outlined.
Intrinsic factors affecting the management of chronic wounds
Authors: Benbow Maureen
Published: August 2014

Chronic wounds are a common feature in the elderly or in people with multisystem failure. In order to promote uncomplicated healing, nurses must have the necessary clinical knowledge about the patient's condition and the wound-healing process. This article discusses the intrinsic factors associated with chronic or indolent wounds. The next article in the series will examine the extrinsic factors.
Infection control and the bedside nurse
Authors: Morton Rozila
Published: August 2014

Safe infection control practice implies that caregivers have an insight into the factors that contribute to hospital-acquired infections which enables them to provide informed care and examine patient treatment outcomes. However, results of recent studies suggest that this is far from the case. This article examines why this area of nursing knowledge and practice has remained unquestioned and urges for an examination of how nurses are prepared for safe, informed infection control practice.
Empowering consumers: the caring challenge
Authors: Sines David
Published: August 2014

This article considers current issues relating to power relationships that exist between learning disability nurses and their clients. It examines the changing role of learning disability nurses and considers their influence on enhancing the quality of life for people with learning disabilities, whose autonomy and right to decision making has been consistently challenged throughout society.
Self-advocacy in learning disabilities
Authors: Holmes Anne
Published: August 2014

This article examines the complexities of helping people with a learning disability to develop self-advocacy skills and accordingly proposes that self-advocacy should take an explicit place in the RNMH curriculum.
Should nurses be politically aware?
Authors: Albarran John W
Published: August 2014

In the present atmosphere of change, nurses need to develop political awareness. This article reviews the many factors that have mitigated against such a development and examines how these have adversely affected the profession. It proposes that nurses must develop political awareness as only by becoming politically knowledgeable can they can control and shape their own destiny, and effectively contribute to the decisions that affect their patients.
Reliability: consistency and accuracy in measurement
Authors: Behi Ruhi , Nolan Mike
Published: August 2014

This article explores the issue of reliability in measurement which is a key factor in determining the credibility of research findings.
The challenge of the Children's Charter: rhetoric vs reality
Authors: Glasper Edward Alan , Powell Catherine
Published: August 2014

The rights of children are not enshrined in statute. However, over recent years, a number of organizations such as Action for Sick Children and The Children's Trust, Tadworth, have produced guidelines related to the rights of children and their families in hospital. The voluntary sector has led the way in influencing policy makers. This is exemplified in the publication of the Department of Health's draft Children's Charter. This article explores the strengths, weaknesses, opportunities and threats of this recent innovation.
Service provision for sickle-cell disease: school-based education
Authors: Oluchukwu Eboh Winifred , van den Akker Olga
Published: August 2014

Screening and genetic counselling for individuals at risk of having children affected by sickle-cell disease are often innovation are school children informed of the potential risk that this disorder can pose for them in the future. School children should receive instruction about the possible risks and effects of sickle-cell disorders as part of a health education programme, to enable them to make informed decisions about their future.
Parent participation 1: literature review and methodology
Authors: Neill Sarah J
Published: August 2014

A qualitative exploratory study was undertaken to examine parents' views and experiences of participation in the care of their child in hospital and to identify factors that inhibit or facilitate participation. Parents of children aged 2-5 years of age were interviewed within 2 months of discharge, using tape-recorded, semi-structured interviews. The findings demonstrate that parents clearly wish to participate in their children's care at a level of their own choosing. However, they preferred professionals to be responsible for their children's clinical care, while they continue to be responsible for the children's normal day-to-day care. Problems were identified in the area of relationships between parents and professionals, centred on communication and the continuing paternalistic nature of these relationships. Parents of children who experienced single, short hospital admissions found involvement in their children's care particularly difficult. Guidelines were developed from the results, to facilitate parent participation in the care of children in this age*group.
The background to the national clinical guidelines for the prevention and management of pressure sores
Authors: Dealey Carol
Published: August 2014

Clinical guidelines are systematically developed statements to assist health-care professionals in decision-making and should be viewed as a means of improving clinical effectiveness. The NHS Executive wishes to encourage their development and use. To this end it has commissioned a number of clinical guidelines. As these will be used in a number of health-care settings, the need for multiagency and multiprofessional care is recognized. The main themes of the guidelines are that care should be patient focused, clinically useful and multidisciplinary. This article introduces a monthly series in the British Journal of Nursing examining the national clinical guidelines for pressure sore prevention and management.
Care and management of peripherally inserted central catheters
Authors: Gabriel Janice
Published: August 2014

It is estimated that 85% of all patients admitted to hospitals in the USA in 1991 were recipients of a vascular access device (Barbone, 1995). Down-sizing of hospitals and the shift towards more outpatient and day-care procedures has meant that patients admitted to hospitals in the UK are more likely to be recipients of a vascular access device than they were 10 years ago, as their conditions are more likely to be acute. This article will discuss how, with careful management, peripherally inserted central catheters can improve the reliability and quality of vascular access for many patients.
Living with eczema: the dermatology patient
Authors: Lawton Sandra
Published: August 2014

This article gives an overview of eczema, including its assessment, the needs of patients with eczema and the management of eczema. The prevalence of all forms of eczema is unknown but there is evidence that atopic eczema is increasing. Nurses can play a vital role in the management of this condition by giving patients time for explanation and discussion.
Eye examination and vision testing
Authors: Kelly John S
Published: August 2014

This article discusses some of the more common eye problems that nurses may encounter during their day-to-day practice. It describes some of the observations and simple testing that may be used to help determine the need for specialist consultation. A principal aim is to remind nurses that by the use of careful observation and simple examination techniques, they can play an important role in the detection of ocular pathology and the unmet need for specialist services. Manifestations of a variety of disorders are highlighted, together with some of the key points for nurses to consider when examining the external eye and lid.
Care study: Caring for a man with Alzheimer's disease
Authors: Price Bob
Published: August 2014

Sylvia remembered Gerrard as he used to be. A man of few words but sharp witted, often humorous and observant of the special days that had mapped their courtship, marriage and early parenthood. Now, as Gerrard approached his 80th birthday, he was very different. It had started with a change in temperament. He became progressively more irritable and quick to blame Sylvia for not doing the things which he said he had asked her to do. She had fretted, feeling confused by his sudden sarcasm, and the cruelty with which he had accused her of sloppiness and disorganization. It had taken perhaps 5 or 6 months before she saw that his temper was a cover up. At times he looked at her with such pain in his eyes: how could she deny that he had ever asked her to collect something from the shops? Gerrard was beginning to realize that he was losing his memory. He was angry that he just might have forgotten to tell her something. There was doubt in his mind and he searched for proof that he had been right and she had been wrong. Sylvia knew that old people became forgetful. She herself was in her mid-70s and both she and Gerrard had their share of the ‘niggles’ that seem to haunt old age, disrupted sleep or ‘waterwork problems’. Gerrard's problem, however, was worrying and she searched through her women's magazines to see what they had to say on senility. Gerrard, a headmaster for 15 years, had been so bright and had prided himself on his mental prowess. Over the next 3 years his memory deteriorated progressively to a point where he forgot not only events but also the names of his children. He seemed lost in a world of his own and out of step with the world around his family. At times Gerrard would reminisce lucidly about their honeymoon. However, on other days Sylvia would panic when she walked into the bedroom with the breakfast tray to discover a stranger staring at her with quizzical eyes. She knew that Gerrard wondered who she was. It was when he wandered in the night and banged his head or arms that she knew he was not quite himself anymore.
The value and purpose of physical examinations
Authors: Castledine George
Published: August 2014

In order to develop the scope of the nurse's role it seems that the taking of medical histories and the performance of physical examinations are being encouraged. It is debatable whether or not this is a good thing.
Impact of poor record-keeping on leg ulcer care in general practice
Authors: Somerset Maggie , Turton A Patricia
Published: August 2014

The number of practice nurses has substantially increased since the introduction of the new GP contract and the implementation of the White Paper Working for Patients. Unlike district nurses and health visitiors, practice nurses frequently do not keep nursing records. This project investigated the impact of poor record-keeping on patient care and on the professional identity of practice nurses. Results show that few practice nurses keep their own records, but that those who do appear to offer a more holistic model of care. The project also identified links between poor standards of record-keeping and unsafe practice, suggesting a need for further research into the recording of nursing activity in general practice. Factors influencing the ability of practice nurses to work collaboratively as a professional group are also explored. It is suggested that health commissions have a role in supporting the professional development of practice nurses to ensure good standards of patient care.
Trauma nursing: the team approach
Authors: Cudmore Jessica E
Published: August 2014

The team approach to trauma care has demonstrated benefits for patients in terms of both quality of care and outcome. This article examines the current management and organizational strategies of trauma care and the effect these have on patient outcome. The four main roles of the nurse within the trauma team are discussed. Research has shown that during the resuscitation of patients only 26% of nurses felt confident that the care they gave was satisfactory. However, 81 % of these nurses may be responsible for the care of patients with multiple injuries at least once a week (Hamilton, 1991). Although medical staff have a vital role to play within the trauma team, this article will focus predominantly on the role of the nurse.