bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy Evaluation of Blood Glucose Monitoring Systems in Children on Overnight Closed-Loop Control
Authors: DeSalvo Daniel J. , Shanmugham Satya , Ly Trang T. , Wilson Darrell M. , Buckingham Bruce A.
Published: May 2014

Objective:

This pilot study evaluated the difference in accuracy between the Bayer Contour® Next (CN) and HemoCue® (HC) glucose monitoring systems in children with type 1 diabetes participating in overnight closed-loop studies.

Research Design and Methods:

Subjects aged 10-18 years old were admitted to a clinical research center and glucose values were obtained every 30 minutes overnight. Glucose values were measured using whole blood samples for CN and HC readings and results were compared to Yellow Springs Instrument (YSI) reference values obtained with plasma from the same sample. System accuracy was compared using mean absolute relative difference (MARD) and International Organization for Standardization (ISO) accuracy standards.

Results:

A total of 28 subjects were enrolled in the study. Glucose measurements were evaluated at 457 time points. CN performed better than HC with an average MARD of 3.13% compared to 10.73% for HC ( P < .001). With a limited sample size, CN met ISO criteria (2003 and 2013) at all glucose ranges while HC did not.

Conclusions:

CN performed very well, and would make an excellent meter for future closed-loop studies outside of a research center.
Effect of Whole Body Vibration on Skin Blood Flow and Nitric Oxide Production
Authors: Johnson Paula K. , Feland J. Brent , Johnson A. Wayne , Mack Gary W. , Mitchell Ulrike H.
Published: May 2014

Background:

Vascular dysfunction due to hyperglycemia in individuals with diabetes is a factor contributing to distal symmetric polyneuropathy (DSPN). Reactive oxygen species reduce the bioavailability of nitric oxide (NO), a powerful vasodilator, resulting in reduced circulation and nerve ischemia. Increases in blood NO concentrations and circulation have been attributed to whole body vibration (WBV). The purpose of this study was to the determine the effects of low-frequency, low-amplitude WBV on whole blood NO concentrations and skin blood flow (SBF) in individuals with symptoms of DSPN.

Methods:

Ten patients with diabetes and impaired sensory perception in the lower limbs participated in this crossover study. Each submitted to 2 treatment conditions, WBV and sham, with a 1-week washout period between. Blood draws for NO analysis and laser Doppler imager scans of SBF were performed before, immediately after, and following a 5-minute recovery of each of the treatments.

Results:

Low-frequency, low-amplitude WBV significantly increased SBF compared to the sham condition (F2,18 = 5.82, P = .0115). Whole blood NO concentrations did not differ between the WBV and sham conditions immediately or 5 minutes after treatment (F2,18 = 1.88, P = .1813).

Conclusions:

These findings demonstrate that patients with diabetes respond to WBV with increased SBF compared to the sham condition. The implication is that WBV is a potential nonpharmacological therapy for neurovascular complications of diabetes.
Hexagonal core-shell and alloy Au/Ag nanodisks on ZnO nanorods and their optical enhancement effect
Authors: Zhang Junming , Lai Boya , Chen Zuxin , Chu Sheng , Chu Guang , Peng Rufang
Published: May 2014

Au and Ag hybrid hexagonal nanodisks were synthesized on ZnO nanorods' (0002) surface via a new two-step deposition-annealing method. The structural, compositional, as well as optical investigations were carried out systematically to find out the nanodisks' formation mechanism and optical enhancement effect. It was shown that the core-shell Au/Ag nanodisk can be formed under rapid annealing temperature of 500°C, while Au/Ag alloy nanodisks are formed if higher temperatures (>550°C) are applied. The optical effect from these nanodisks was studied through photoluminescence and absorption spectroscopy. It was found that the carrier-plasmon coupling together and carrier transfer between metal and ZnO contribute to the emission enhancement. Furthermore, the results suggest that the composition of nanodisk on the vicinity of metal/ZnO interface plays an important role in terms of the enhancement factors.
Earthworm coelomocytes as nanoscavenger of ZnO NPs
Authors: Gupta Shruti , Kushwah Tanuja , Yadav Shweta
Published: May 2014

Earthworms can ‘biotransform’ or ‘biodegrade’ chemical contaminants, rendering them harmless in their bodies, and can bioaccumulate them in their tissues. They ‘absorb’ the dissolved chemicals through their moist ‘body wall’ due to the interstitial water and also ingest by ‘mouth’ while soil passes through the gut. Since the advent of the nanotechnology era, the environmental sink has been continuously receiving engineered nanomaterials as well as their derivatives. Our current understanding of the potential impact of nanomaterials and their natural scavenger is limited. In the present investigation, we studied the cellular uptake of ZnO nanoparticles (NPs) by coelomocytes especially by chloragocytes of Eisenia fetida and their role as nanoscavenger. Results from exposure to 100- and 50-nm ZnO NPs indicate that coelomocytes of the earthworm E. fetida show no significant DNA damage at a dose lower than 3 mg/l and have the potential ability to uptake ZnO NPs from the soil ecosystem and transform them into microparticles.
Implementing a multifaceted tailored intervention to improve nutrition adequacy in critically ill patients: results of a multicenter feasibility study
Authors: Cahill Naomi E , Murch Lauren , Cook Deborah , Heyland Daren K
Published: May 2014

Introduction

Tailoring interventions to address identified barriers to change may be an effective strategy to implement guidelines and improve practice. However, there is inadequate data to inform the optimal method or level of tailoring. Consequently, we conducted the PERFormance Enhancement of the Canadian nutrition guidelines by a Tailored Implementation Strategy (PERFECTIS) study to determine the feasibility of a multifaceted, interdisciplinary, tailored intervention aimed at improving adherence to critical care nutrition guidelines for the provision of enteral nutrition.

Methods

A before-after study was conducted in seven ICUs from five hospitals in North America. During a 3-month pre-implementation phase, each ICU completed a nutrition practice audit to identify guideline-practice gaps and a barriers assessment to identify obstacles to practice change. During a one day meeting, the results of the audit and barriers assessment were reviewed and used to develop a site-specific tailored action plan. The tailored action plan was then implemented over a 12-month period that included bi-monthly progress meetings. Compliance with the tailored action plan was determined by the proportion of items in the action plan that was completely implemented. We examined acceptability of the intervention through staff responses to an evaluation questionnaire. In addition, the nutrition practice audit and barriers survey were repeated at the end of the implementation phase to determine changes in barriers and nutrition practices.

Results

All five sites successfully completed all aspects of the study. However, their ability to fully implement all of their developed action plans varied from 14% to 75% compliance. Nurses, on average, rated the study-related activities and resources as ‘somewhat useful’ and a third of respondents ‘agreed’ or ‘strongly agreed’ that their nutrition practice had changed as a result of the intervention. We observed a statistically significant 10% (Site range -4.3% to -26.0%) decrease in overall barriers score, and a non-significant 6% (Site range -1.5% to 17.9%) and 4% (-8.3% to 18.2%) increase in the adequacy of total nutrition from calories and protein, respectively.

Conclusions

The multifaceted tailored intervention appears to be feasible but further refinement is warranted prior to testing the effectiveness of the approach on a larger scale.

Trial registration

ClinicalTrials.govNCT01168128. Registered 21 July 2010.
Oyama and Anxieties About the Feminization of Japanese Film
Authors: Reichert James
Published: May 2014

“Oyama and Anxieties about the Feminization of Japanese Film” offers an alternative perspective on the gender politics behind the switch from oyama, or male actors specializing in female roles, to actresses in early Japanese film. To date, most treatments of this issue have operated under the assumption that in one way or another the decision to abandon the use of oyama arose out of perceptions that the male actors failed to fully and/or realistically evoke femininity on the screen. In short, there has been a general agreement that dissatisfaction with the oyama derived from a sense that their performance was deficiently feminine. Although not denying the relevance of this consensus view, my article explores the issue from a different angle. I consider how criticism of the oyama was often expressed in terms that highlighted the excess of femininity that was thought to accrue around these female impersonators. Taking a cue from the work of feminist film historian Miriam Hansen, my study devotes particular attention to how opponents of the oyama often linked their criticism of the practice with disapproving commentary on the troublesome impact that the female fans of the actors purportedly had on Japanese film. It was widely assumed among these critics that oyama, particularly the popular actor Tachibana Teijirô, served as the focal point for a community of female moviegoers who took excessive pleasure in the sentimental melodramas that were the specialty of these performers. More disturbing still was the apprehension that the female fans of oyama exhibited an overwrought fixation on their favorite stars that transgressed the bounds of womanly propriety. In short, it was judged that this community of fans, egged on by unscrupulous studios that supplied them with vehicles starring their oyama idols, embraced a feminine sensibility that threatened to derail attempts to elevate Japanese film culture.

The article begins with an examination of positive treatments of oyama to get a sense of how the personae of these performers were constructed in commercial movie magazines and received by fans. The second half of the article focuses on the way that reformers and fans critical of the practice couched their objections in terms that highlighted the undesirable nature of the distinctive feminine sensibility attributed to oyama, their melodramatic vehicles, and their vocal female fan base.
Adsorptive Removal of Cr(VI) from Aqueous Solution on Hydrous Cerium—Zirconium Oxide. Part I: Process Optimization by Response Surface Methodology
Authors: Corredor C.A. Rivera , García M.Á. Gómez , Dobrosz-Gómez I.
Published: May 2014

Hydrous cerium–zirconium oxide (Ce0.25Zr0.75O2) was used for Cr(VI) removal by adsorption. The response surface methodology (RSM) was applied as a tool for the optimization of adsorption operational conditions (temperature, pH and adsorbent dose) with the combined effects of the key processing variables on the Cr removal efficiency (%RCr). The following conditions were found to be optimal: pH = 2, temperature = 28 °C, adsorbent dose = 4 g l−1. The %RCr obtained experimentally (92%) was in agreement with the value predicted by RSM (88%). The adsorption process followed the pseudo-second-order kinetic model and obeyed the Langmuir isotherm model. Thermodynamic parameters (ΔH°, ΔS° and ΔG°) indicated the exothermic and spontaneous nature of adsorption governed by physisorption interactions. Hydrous Ce0.25Zr0.75O2 showed high adsorption capacity (25 mg g−1), high desorption efficiency (80%), reached adsorption equilibrium quickly (30 minutes) and high chemical stability. The Cr(VI) adsorption on hydrous Ce0.25Zr0.75O2 was not completely reversible. The reduction of Cr(VI) to Cr(III) under acidic conditions was also responsible for Cr(VI) removal.
Violence against midwives in Cape Town
Authors: Khalil Doris
Published: May 2014

This study covered various aspects of violence in nursing and midwifery. The objective was to determine levels of violence against midwives in two hospitals. A confidential survey of midwives working in two large public hospitals in the southern suburb of Cape Town was undertaken. A significant number of respondents (75.6%) had been practising as midwives for over 13 years. Verbal abuse, threats and assaults are the main types of violence directed against midwives. Among the perpetrators of violence against midwives were patients’ relatives, women in labour and sometimes doctors. Increased visibility of security personnel within the hospital settings is needed. There is also a need for political will to prosecute perpetrators of violence against midwives. Finally, all midwives must be empowered to protect themselves by using basic self-defence skills.
Non-pharmacological treatment of premenstrual syndrome
Authors: Montazeri Shabnam
Published: May 2014

Premenstrual syndrome (PMS) can be defined as a recurrent disorder that occurs every month in the luteal phase of the menstrual cycle, and remits with the onset of menstruation. It is believed to affect up to 80% of women of the reproductive age group. PMS is characterized by a complex set of symptoms which include physical, psychological and behavioural changes of varying severity. This can interfere with the lives of the affected, as well as their interpersonal relationships. Physiological theories of the aetiology of PMS have lead to proposals for treatment. A wide range of therapeutic interventions have been advocated in the treatment of PMS, many of which have side effects. As symptoms of PMS can be chronic and long-term, special attention should be paid to the side-effects of pharmacological interventions. For this reason, alternative approaches may be recommended. In this article, the non-pharmacologic therapeutic approaches advocated for the treatment of PMS will be briefly reviewed to assess their efficacy. Available evidence up to 2010 on non-pharmacologic treatment of premenstrual syndrome will be considered.
Past use of and current satisfaction with a nurse-led hospital cardiac helpline
Authors: McEwen Andy , Billings Lis
Published: May 2014

Objectives: To review the use of a nurse-led cardiac helpline since its inception, and to assess the current satisfaction of recent callers to the helpline.

Design and setting: The study took place in a cardiac unit that provides a service to an inner-city London population, but is also a tertiary centre providing highly specialized services to a wider population. Call records to the cardiac helpline between 1996 and 2004 (n=8429) were analysed. Additionally, a postal satisfaction survey was sent to the last 100 callers to the helpline in 2005 (response rate=79%).

Results: At its peak the cardiac helpline was called on average more than four times a day, but was still called at least once a day in 2004. Over half (54%) of calls were about a physical complaint and 15% concerned medication. In more than one-quarter (29%) of cases the caller was advised to contact his/her GP and 8% were directed to attend accident and emergency (A&E). Surveyed callers to the cardiac helpline were highly satisfied with the service and 39% of respondents said that without the helpline they would have visited their GP while 29% would have attended A&E.

Conclusions: This hospital-based, nurse-led cardiac helpline achieved a high degree of satisfaction with callers and offers patients an instant access alternative to consulting with their GP or attending their local A&E department.
Supervision for health visitors dealing with sexual abuse
Authors: Scott Linda
Published: May 2014

Child sexual abuse is a complex health issue. This study sought the views of health visitors involved in this work. In addition to focussing on the needs of children through child protection responsibilities, some health visitors worked with adults in attempting to resolve the sadnesses of child sexual abuse.

The literature provided an evidence base to the concept of an ‘unseen’ loss of childhood protection and of the health visitors who worked to aid resolution, bereavement counselling principles appeared to provide an effective approach.

Health visitor inhibitions were identified and for some health visitors, personal life had altered as a result of the work. The need for a confidante was identified to support practitioners affected by the work.

Supervision was considered to offer a necessary structure and accountability for the exploration of complex health issues.
The effectiveness of preschool vision screening by health visitors
Authors: Thorburn Rosalind , Roland Martin
Published: May 2014

The aim of this study was to determine the effectiveness of preschool vision surveillance by health visitors in Warrington, a district with a secondary community orthoptic service. Of the 2041 children screened by health visitors at 3–3½ years 12% were referred to the orthoptist for further assessment. Sixty-three per cent of these required more than one examination by the orthoptist and 28% were subsequently referred to an ophthalmologist for further assessment. Amblyopia was detected in 11 children, 5 had squints without amblyopia, and in addition 25 children had significant refractive errors. A retrospective review of the records of children identified with amblyopia following a school entry medical at 5 years was undertaken to detect possible failure of the earlier health visitor examination (i.e. false negatives at age 3–3½ years). Possible failure of early screening was found in only two children, one of whom had a minor defect only (6/9). Vision screening for children aged 3–3½ years by health visitors is an effective alternative to primary screening by orthoptists. However, the use of health visitors in this role is contrary to current national guidelines. The findings suggest that using health visitors to screen vision in preschool children makes efficient use of existing routine checks and may be the best use of orthoptic time.
The effect of bacteria on leg ulcer healing
Authors: Harker Judy
Published: May 2014

It is a common belief that bacterial infection will delay the healing of leg ulcers, or lead to a deterioration in the wound bed or surrounding skin. Despite many years of research, however, there is still no agreement on whether this is in fact the case. This article reviews a selection of the available literature regarding the effects of bacteria on leg ulcer healing. Attempts have been made to distinguish differing levels of bacterial presence (e.g. contamination, colonization, infection), but these terms are still loosely applied and consequently ill-defined. Furthermore, the variety of treatment and assessment methods used in the various studies hampers their comparison. The article concludes that future studies should adhere to a uniform methodology in order to provide clear evidence on which to base practice.
Food and wounds: nutritional factors in wound formation and healing
Authors: Todorovic Vera
Published: May 2014

Nutrition is a crucial aspect of a holistic approach to the healing of wounds, including pressure ulcers and leg ulcers. Poor nutritional status and support can delay the wound healing process or cause inadequate healing when nutritional deficiencies are not corrected. Nutritional screening is an important part of the overall clinical assessment of patients. Nurses based in hospital and the community have a key role to play in identifying and monitoring patients who may be nutritionally at risk and require nutritional support to aid the wound healing process. Patients’ nutritional requirements may need to be met through the use of nutritionally complete supplements or, if oral intake is poor, with enteral or parenteral nutrition.
Exploring methods of wound debridement
Authors: O’Brien Mark
Published: May 2014

Dead tissue, in the form of slough and necrosis, can if present in a wound, delay healing and promote infection. Debridement describes any method by which such materials are removed and, as a consequence, the potential to achieve wound healing enhanced. In this article, the first of two, the author discusses the history of debridement, cell death, the nature of necrotic tissue and a variety of debridement techniques. All methods of debridement have associated risks and benefits and while this article examines its clinical application there are also legal and professional issues to consider particularly in relation to conservative sharp debridement. These issues will be addressed in the second article.
So you want to do research? 5: Questionnaire design
Authors: Meadows Keith A
Published: May 2014

This article describes the key aspects in the design, construction and adaptation of survey questionnaires. There are different types of questionnaire, each of which has its advantages and disadvantages. Aspects of constructing the questionnaire are discussed in detail; choosing the mode of administration; the objectives of the survey; availability of resources; characteristics of the target population; and quality of data. Issues concerning the identification of the questionnaire’s content, wording and sequencing of the questions, through to the overall appearance and layout of the questionnaire are also considered. Differences in the role of open-ended and closed questions, together with their strengths and weakness, are outlined, and the need to undertake pre-testing and piloting as an integral part of questionnaire development is highlighted. Finally, issues around the adaptation of existing questionnaires are discussed with particular emphasis on their use in different language and cultural groups, and the need to achieve conceptual, content, semantic, operational and functional equivalence is described. An overview of the translation process is provided.
The influence of health professionals on the uptake of the influenza immunization
Authors: Nuttall Dilyse
Published: May 2014

Influenced by the Department of Health’s aim to increase the uptake of the influenza immunization to 70% among those eligible, this study aimed to compare three methods of promoting influenza immunization among over 65 year old patients in a GP practice, and to identify if a particular promotion method was more effective among either of two defined age groups. The sample (n=90) was randomly allocated into three intervention groups, and then subdivided into two age groups. A different subject experimental design was used to compare the groups. Statistical analysis of the data showed no significant difference in influenza immunization uptake between the three intervention groups, or the age-defined sub-groups. However, although not significant at 5% significance level, participants aged 72 years and over showed a greater uptake among those visited by a health professional. The findings suggest that a larger study using the same interventions would produce significant results.
Povidone-iodine as a topical antiseptic for treating and preventing wound infection: a literature review
Authors: Flynn James
Published: May 2014

With the proliferation of antibiotic and antiseptic resistant strains of bacteria around the world, attention is increasingly being focused on more ‘traditional’ methods of combating and preventing wound infections. This article examines the research literature pertaining to the use of povidone-iodine, a form of iodine commonly used for skin cleansing, as a prophylaxis or treatment for wound infection. The literature is discussed as it relates to the ideal characteristics of an antiseptic for use on wounds proposed by König et al (1997) and Liptak (1997). On the basis of available research, it appears that povidone-iodine should be promoted by nurses and other health-care professionals involved in wound care as a means of preventing and treating infection in a range of acute and chronic wounds.
Wound exudate: composition and functions
Authors: Cutting Keith F
Published: May 2014

Wound exudate is all too often perceived as a clinical management problem. While this can be the case, it should be recognized that exudate does fulfil an important function in the healing process. Gradual acceptance of the benefits of moist wound healing, combined with the current goals of the ‘ideal’ moist environment, focuses attention on the role of exudate. This review is intended to define the components and functions of ‘normal’ exudate and differentiate it from abnormal exudate.
Effective team management by district nurses
Authors: Bliss Julie
Published: May 2014

This article considers the key role played by the district nurse in managing the district nursing team in order to provide high quality health care. It considers how the district nurse can use key managerial roles (interpersonal, informational and decision-making) in order to ensure unity within the team. The importance of shared goals and trust to achieve unity is explored and a strategy for managing conflict is discussed. Finally, the article suggests a set of ground rules which could be used to facilitate effective team working.
The use of maggot therapy in the treatment of a malignant foot wound
Authors: Sealby Nina
Published: May 2014

Mrs T presented with a necrotic wound to her right foot secondary to malignant adenocarcinoma. Maggot therapy was used to successfully debride the wound, which had failed to respond to conventional treatments. The maggot therapy removed the necrotic tissue and appeared to initiate the process of granulation, which allowed the wound to be dressed with conventional materials and progress towards healing.
Nursing intervention in care homes: district nurses’ views
Authors: Anderson Evelyn E
Published: May 2014

Nursing need within residential care homes has been reported as increasing for the district nursing workforce (Audit Commission, 1999). This report presents the findings from a small exploratory study to discover the views of district nurses regarding a project to provide nursing care to clients in residential care homes. Named nurses work within some of the homes in the city on specified days and are available to carry out nursing interventions required by clients, thus precluding the need for a member of the district nurse team to visit on that day. The background to the study is discussed followed by the qualitative research methodology used. Three broad themes emerged from the findings: roles and responsibilities, communication and organisational issues. Each of these is discussed and recommendations suggested with a view to enhancing the potential benefit of the project for its users.
Public health 3: Legal regulation of tattooing and body art
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

District nurse Mandy Grey is currently treating a thirteen year old girl who has a seriously infected tattoo on her buttock and infected tongue and nipple piercing all of which were performed at a local tattoo parlour. The teenager wanted the tattoo and piercing as all her friends have had similar body art and she felt pressured into having the same. Sister Grey wonders how this ever popular and increasingly intimate form of bodily adornment is regulated.
Use of a hydrogel dressing for management of a painful leg ulcer
Authors: Moody Ann
Published: May 2014

This case study is of an 82-year-old lady who was widowed and lives alone in a council house. A left lateral leg ulcer had developed over the gaiter area, and the community team were asked to assess in 2004. The main issues were her inability to tolerate compression (even when reduced) because of the pain. Nevertheless, the community nurses had tried very hard with compression, using different compression techniques at different times to try to encourage her to persevere. The nurses felt they were running out of ideas and therefore the tissue viability nurse (TVN) was asked to assess the wound. The TVN recommended ActiFormCool dressing. This article will examine the background for wound healing, provide the rationale for the recommendation and describe the progress of the patient.
An update on the Lymphoedema Framework Project
Authors: Morgan Phil , Moffatt Christine
Published: May 2014

The Lymphoedema Framework Project (LFP) launched its best practice document in lymphoedema at the British Lymphology Society Conference in Birmingham on 2 October. This document represents a huge amount of work over a number of years in defining the care required for patients with lymphoedema and other forms of chronic oedema.
Work-related stress, work/life balance and personal life coaching
Authors: Hawksley Barbara
Published: May 2014

Work related stress adversely affects personal performance, organizational efficiency and patient care as well as costing the NHS millions of pounds each year. Reducing the effects of work related stress is a legal duty for all employers. There are a number of resources available to help both employees and employers, such as the Health and Safety Executive stress management standards. Personal life coaching is one approach to reducing work-related stress which is well established amongst business and management executives as well as some public sector organizations.
Stuctured group-based education for type 2 diabetes in primary care
Authors: Mujika Zabaleta Agurtzane , Forbes Angus
Published: May 2014

To determine the effectiveness of structured group-based diabetes education programmes in improving glycaemic control in adults with type 2 diabetes in primary care a criteria-based review was conducted. The review of the three controlled trials identified showed that although HbA1c decreased in two of the studies, these differences were not statistically significant. Based on the present review, there is no evidence to recommend such programmes. However, due to limitations of these studies and opposing results of another trial not included in the review because of the uncertainty about criteria requirements caution is recommended in the interpretation of these findings.
Health of community nurses: a case for workplace wellness schemes
Authors: Blake Holly , Lee Sandra
Published: May 2014

Community nursing is associated with stress and burnout, which can impact heavily on the individual and the NHS both economically and on the quality of patient care. Recent Government publications have called for an increase in workplace health schemes, with the public sector ‘leading by example’. As the largest employer in Europe, the NHS is well placed to develop workplace wellness schemes to address the health needs of staff and to indirectly influence primary prevention among patients. Lessons from an innovative employee wellness programme in an NHS hospital setting demonstrates that such schemes may positively alter individual health and attitudes towards the employer. There is scope for development of such schemes to improve health and well-being in community nurses.
A guideline for managing medication related dysphagia
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Difficulty swallowing medicines affects about a quarter of people seen by health professionals in primary care yet the issue is rarely discussed with patients and often poorly managed. In response to the problems district nurses encounter in patients who have difficulties swallowing their medication Connect Medical have published a consensus guideline outlining best practice in managing the problem.

In this article Richard Griffith and Cassam Tengnah describe how the guideline will assist medication management and protect district nurses from liability when treating patients with medication related dysphagia.
How to care for uncomplicated skin and keep it free of complications
Authors: Rich Anna
Published: May 2014

Many of the skin problems associated with lymphoedema and other chronic oedemas can be reduced or even prevented with appropriate and effective skin care. In particular, the use of emollients to maintain skin condition and integrity can reduce the frequency and severity of cellulitic episodes. This article describes best practice in the care of the skin in cases of uncomplicated lymphoedema.
Exploring the aetiology and management of venous eczema
Authors: Middleton Heather
Published: May 2014

Many older people living at home or in residential settings in the community suffer from inflammation of the skin of the lower legs, or venous eczema. Management of this condition may depend on the background of the professional who carries out the initial assessment. Those with a tissue viability background may plan their care based on an assessment of the patient for suitability for compression, to reverse the venous hypertension which may be a causative factor of the eczema. On the other hand, professionals with a background in dermatology may base initial care plans on the use of emollients and topical steroids to reduce inflammation. This article examines the evidence base for our understanding of what causes venous eczema, questions whether current management of the condition is truly evidence-based, and argues for a more pro-active approach to both assessment and management of venous eczema.
Dealing sensitively with sexuality in a palliative care context
Authors: Woodhouse Jan , A Baldwin Moyra
Published: May 2014

Sexuality is integral to a person’s identity and is encompassed in holistic palliative care. Current directives emphasize psychosocial support that is sensitive to a variety of issues, including sexuality, and offer community nurses the mandate to facilitate expressing sexuality. Nurses fail to address sexuality for a variety of reasons. Appreciating patients’ individuality and avoiding making assumptions are some of the requirements to enabling expression of sexuality. Nurses need wisdom and determination to discuss such issues, and it is important that they recognize opportunities and cues as they arise. This article provides an examination of the issues surrounding sexuality outlining an approach that captures ‘constant attention to detail’. This guides the ‘what’, ‘how’ and ‘why’ sexuality in palliative care can be addressed. Ethics and safety aspects are briefly discussed and implications for practice suggested. Educating staff and focused education for the patient can positively influence sexuality and individuals’ quality of life.
A guide to cancer pain management
Authors: Hutton Natalie , McGee Anne , Dunbar Catherine
Published: May 2014

Most, if not all, cancer patients require care from community teams at some stage during their disease trajectory. For many of these patients, community nurses and General Practitioners are the main point of contact. Pain is reported by between 55–95% of patients with advanced or terminal disease. Optimal pain control positively impacts on the physical, emotional and functional well-being of the patient. Despite the existence of guidelines (WHO, 1996) (SIGN, 2000) and a wealth of literature on cancer pain management, half of all patients in Western countries still do not receive adequate pain relief. This article looks at the reasons behind this and provides community nurses with an overview of up-to-date information on pain pathophysiology and management, so that the control of cancer pain can be optimized in the community.
Caseload analysis in district nursing: the impact on practice
Authors: Kane Kay
Published: May 2014

This paper describes a ten-year journey in managing a district nursing service using caseload analysis as a method of workforce planning and performance management. Caseload management is at the heart of district nursing practice and the process of measuring and comparing caseload information can be used to improve the quality of care. However, it is crucial to assess the information provided by district nurses for reliability and validity. Allocating staff to teams on the basis of accurate information on patient case-mix, nursing need, and dependency can result in every member of the population gaining equitable access to a consistent quality nursing service.
An overview of the role of diet during the ageing process
Authors: Denny Anna
Published: May 2014

The UK is experiencing an ageing population but this is not matched by a similar increase in healthy life expectancy. Some of the major biological life changes associated with ageing result from the accumulation of lifelong molecular damage to cells, but many health problems are attributable to lifestyle and environmental factors. Diet is one factor believed to play a key role in the prevention and treatment of chronic diseases associated with ageing. Diets that are high in total fat, saturated fat and salt, and low in fibre, fruits and vegetables, are central to the development of CVD, type 2 diabetes and cognitive decline among elderly people. In contrast, under nutrition is also a major problem in this age group, with many elderly people having low intakes of essential vitamins and minerals. Good nutrition is essential for healthy ageing and a multi-disciplinary, life-course, approach to ageing is vital in minimising its implications for quality of life and public health.
Screening for malnutrition in the community: the MUST tool
Authors: Scott Anna
Published: May 2014

The National Screening Survey (Bapen, 2008) revealed that malnutrition is common in all care settings, all diagnostic categories and all age groups, and originates largely in the community. The report recommends that community-based strategies should be established to detect, prevent and treat malnutrition. Community nurses are well-positioned to impact this problem and the first step is identifying those individuals who are at risk. Part 1 of this two-part article will provide an overview of nutritional screening and look at how malnourished patients can be identified in the community, with a focus on the practicalities of the Malnutrition Universal Screening Tool (BAPEN, 2003). Part 2 will offer practical guidance on how to manage patients identified as being at high risk of malnutrition.
A community nursing guide: multilayer lymphoedema bandaging
Authors: Hopkins Anita
Published: May 2014

Multi-layer lymphoedema bandaging (MLLB) has been clinically proven to reduce oedema, improve skin complications and reduce infection. MLLB differs from four layer bandaging traditionally used to treat leg ulceration. This article identifies some of the differences between the two methods, suggests when best to use MLLB, describes an MLLB technique and considers the implications for training.
An overview of negative pressure wound therapy (NPWT)
Authors: Thompson Geoff
Published: May 2014

Negative pressure wound therapy (NPWT) is often called topical negative pressure (TNP) or by the trade name: ‘VAC’ (Vacuum assisted closure, KCI ®). NPWT is a technique that uses negative pressure applied to wounds of diverse aetiology to promote healing. Over the last 50 years clinicians have described how certain wounds respond to sub-atmospheric pressure used within a closed dynamic delivery system. Several companies are now able to offer devices that deliver NPWT, giving greater choice to decision-makers in Healthcare authorities. This article provides an overview of NPWT.
Moving and handling education in the community: technological innovations to improve practice
Authors: Wanless Stephen , Page Andrea
Published: May 2014

Efforts to reduce injuries associated with patient handling are often based on tradition and personal experience rather than sound educational theory. The purpose of this article is to summarize current evidence for educational interventions designed to reduce primary care staff injuries: a significant problem for decades. Evidence suggests that the current ‘classroom’ teaching of moving and handling is ineffective. There is a growing body of evidence to support newer interventions that are effective or show promise in reducing musculoskeletal injuries in health professionals (Freitag et al, 2007). The authors discuss potential solutions through moving and handling-related motion capture simulation and the use of e-learning to promote an understanding of the principles associated with patient handling tasks.
Diagnosis and treatment of venous eczema
Authors: Nazarko Linda
Published: May 2014

Venous eczema is part of a continuum of venous disease that affects around 20% of people over 70 years of age. It is not always appropriately diagnosed and treated. This article aims to enable community nurses to understand the pathophysiology of venous disease and how to offer evidence based management to patients with this condition.
Emotional intelligence: district nurses’ lived experiences
Authors: Davies Sarah , Jenkins Emrys , Mabbett Gaynor
Published: May 2014

Emotional Intelligence, recognizing and handling ones’ own and others’ emotions is beginning to figure in nursing literature, with potential to enhance care, teamwork and wellbeing. District nursing is laden with complex and emotional issues yet little research investigates the value of emotional intelligence in district nursing specifically. This qualitative study adopts interpretative phenomenological analysis with five district nurses, (of different grades), to illuminate perceptions and experiences of emotional intelligence. Findings show district nurses perceive emotional intelligence to be an essential part of their role, regardless of grade or position. Despite being a relatively new concept to nurses, each participant perceived relevant attributes as essential to quality care in the home, especially in relation to palliative care. Themes identified include: self awareness, control, assessment, experience, palliative care and leadership. Only some of these are consistent with existing literature and illustrate a need to investigate this interesting area further.
District nurses prescribing as nurse independent prescribers
Authors: Downer Frances , Shepherd Chew Kim
Published: May 2014

Nurse prescribing has been established in the UK since 1994, however, limited focus has been placed on the experiences of district nurses adopting this additional role. This phenomenological study explores the experiences of district nurses prescribing as nurse independent prescribers across the West of Scotland. A qualitative Heideggarian approach examined the every-day experiences of independent prescribing among district nurses. A purposive sample was used and data collected using audio taped one-to-one informal interviews. The data was analysed thematically using Colaizzi’s seven procedural steps. Overall these nurses reported that nurse prescribing was a predominantly positive experience. Participants identified improvements in patient care, job satisfaction, level of autonomy and role development. However, some of the participants indicated that issues such as support, record keeping, confidence and ongoing education are all major influences on prescribing practices.
Sense of coherence and health among home-dwelling older people
Authors: Söderhamn Olle , Söderhamn Ulrika
Published: May 2014

Sense of coherence (SOC) is important for maintaining health. The aim of this study was to investigate if the SOC experience among home-dwelling physically active older people differs from that of hospital patients with the same age and sex. Data were collected with questionnaires and structured interviews containing Antonovsky’s SOC scale in an age- and sex-matched study group (n=160). Non-parametric statistical analyses were performed. No differences were found in SOC between home-dwelling individuals and patients. Ninety-five percent of the home-dwelling individuals perceived themselves as being in good health and 42.5% among the patients (p<0.001). SOC and disease were predictors for health in the total study group. Among the home-dwelling individuals, SOC, disease and being single were predictors for health and among the patients solely SOC. When using the components of the SOC concept, comprehensibility and disease predicted health for the home-dwelling individuals and meaningfulness predicted health for the patients.
Activity promotion for community-dwelling older people: a survey of the contribution of primary care nurses
Authors: Goodman Claire , Davies Susan L , Dinan Susie , Tai Sharon See , Iliffe Steve
Published: May 2014

Study aims:

To discover the current level of nurse-led involvement in activity promotion for older people in primary care and to explore the knowledge and attitudes of primary care nurses about health benefits of activity promotion for older people.

Background:

The importance of improving and maintaining activity levels in later life is well established. However, intervention studies show that the uptake of and adherence to physical activity programmes by older people are highly variable. The optimal approach to activity promotion for older people is not well understood. Although many activity promotion schemes and evaluations assume that specialist exercise trainers are needed, it remains unclear who is best placed to facilitate activity promotion for older people, and if this is something in which existing primary care practitioners (specifically nurses) could and should take a leading role.

Methods:

This study surveyed all nurses and health visitors working in five primary care organizations in an inner city area. A semi-structured postal questionnaire asked about their knowledge and attitudes to the benefits of exercise in later life, their current levels of involvement in promoting physical activity with older people, and their personal activity levels.

Findings:

The overall response rate was 54% (n=521). The responses of 391 district nurses and practice nurses are presented here. Nurses had the commitment and (depending on the focus of their work) different opportunities to promote physical activity with older patients. There were organizational and individual constraints on their ability to be involved in this aspect of health promotion work themselves, or to refer older people to local activity promotion schemes. Nurses did not have a structured approach when promoting physical activity with older people and had only a partial awareness of the limitations of their knowledge or skills when promoting activity with older people.

Conclusions:

For promotion of physical activity by older people to be meaningfully incorporated into primary care nursing work there is a need to develop a more strategic approach that can optimize the opportunities and interest of primary care nurses and develop the knowledge and skills of the workforce in this area of nursing work.
Supporting patients with enterocutaneous fistula: from hospital to home
Authors: Slater Rebecca C
Published: May 2014

The aim of this article is to discuss the care of patients with enterocutaneous fistula (ECF) requiring long-term support in the community. The discussion of what ECF are and aspects of nutrition will support the knowledge required to care for this group of patients effectively in their homes. This article focuses on the management of ECF appliances and gives a basic guide of skin care and how to reduce the prevalence of appliance leaks.
Moisture in wound healing: exudate management
Authors: Dowsett Caroline
Published: May 2014

Wound exudate can have a significant impact on patient's quality of life and delay wound healing. It is also challenging for clinicians and can be costly in terms of clinical time and dressing cost. Understanding the difference between acute and chronic wound fluid is essential in order for clinicians to select the most appropriate treatment for their patients. Good patient assessment is the starting point for successful management and should include assessment of the patient, their wound and the type and amount of exudate. The management pathway should aim to address contributory factors, improve the patient's quality of life, optimise the wound bed and ensure the correct level of moisture at the wound bed. Dressings and topical negative pressure therapy are the main option for managing exudates and selection should be based on their clinical and cost effectiveness. A structured approach to exudate assessment and management as outlined in this article will help to reduce complications such delayed wound healing, prolonged treatment and patient suffering.