bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving outcomes: Overcoming the challenges of epilepsy in people with learning disabilities
Authors: Hanson Christine
Published: May 2014

Epilepsy is common among people with learning disabilities, and is associated with other physical and mental disorders and an increased risk of premature death. Effective control of epileptic seizures is crucial, since seizures themselves, their underlying cause and/or treatment may result in significant problems for the individual. Anti-epileptic drugs are the mainstay of treatment, and choice is determined by the type of seizure. Accurate diagnosis is therefore essential, but can be more difficult in people with learning disabilities because communication problems and behavioural disturbance are more frequent than in the general population. Other challenges include swallowing problems, side effects of medication, comorbidity and polypharmacy, and risk management. As professional leaders, epilepsy specialist nurses and neuroscience nurses have a particular role in overcoming these challenges to improve quality of life and outcomes in people with learning disabilities and epilepsy.
Discovery and invention
Authors: Winter George
Published: May 2014

George Winter reflects on the power of discovery and invention over the scientific mind
Travels in the land of no self-awareness
Authors: McDonald Sheena
Published: May 2014

In her second column, Sheena McDonald describes how she developed an obsession for mail-order catalogues and hoovering up left-overs following an acquired brain injury
Women with epilepsy and pregnancy: From preconception to the postnatal period
Authors: Bagshaw Jan
Published: May 2014

Women with epilepsy are at greater risk of complications or death during pregnancy than women in the general population and therefore need support and informed advice. This article outlines recommendations for support and care contained in a pack put together by the Epilepsy Action working party based on the following guidelines: NICE guideline 20, SIGN guideline 70 and the reports from the Confidential Enquiry into Maternal and Child Health, formerly the Confidential Enquiry into Maternal Death. These recommendations can help nurses provide safe and effective care and advice to women with epilepsy during pregnancy.
Eyesight
Authors: Winter George
Published: May 2014

George Winter reflects on individuals' differing interpretations of the same visual data
Combining equity and autonomy: The debate on access to medicines
Authors: Oliver Kathy
Published: May 2014

A new report has been published on improving access to medicines for NHS patients. Kathy Oliver considers the implications from a patient/caregiver perspective
Aromatherapy: Reviewing evidence for its mechanisms of action and CNS effects
Authors: Cook Neal , Lynch Jacinta
Published: May 2014

Aromatherapy is an ancient and well established discipline, with its roots based in herbology. While aromatherapy has existed in health care practice in many cultures for thousands of years, the mechanisms of its actions, and therefore its place in contemporary health care, are often not widely known. This article explores such mechanisms of action in the nervous system, illustrating the principles of how this health care discipline can potentially provide a successful adjunct to the care of those with neurological disorders.
A new guide may hold the key to securing specialist nurse roles
Authors: Eastwood Keeley
Published: May 2014

Keeley Eastwood explains how a unique partnership has led to the launch of a guide that validates the role of the specialist nurse for long-term neurological conditions, including epilepsy
Addressing palliative and end-of-life care needs in neurology
Authors: Sutton Lucy
Published: May 2014

Lucy Sutton describes how the palliative care needs of people with non-cancer diagnoses are being addressed through the development of a neurological care pathway
A reward for nurses and patients
Authors: Holmes Susan , Speed Maureen
Published: May 2014

Susan Holmes and Maureen Speed received the 2008 Multiple Sclerosis Nursing Award for saving and extending their MS specialist nursing service. They explain how they went about it
Reviewing and updating the clinical basics
Authors: Benison Liam
Published: May 2014

One hundred delegates enjoyed a broad range of clinical updates at the third National Neuroscience Nursing Conference on 20 May. Liam Benison reports
Development of a website for multiple sclerosis: Involving service users and providers
Authors: Burgess Megan
Published: May 2014

The Greater Manchester Multiple Sclerosis Management Audit was carried out in 2006 by Taylor and Walton to compare the management of multiple sclerosis (MS) in Greater Manchester against national recommendations for the management of MS set down by NICE (National Collaborating Centre for Chronic Conditions, 2004). This audit revealed that MS services in Greater Manchester were only partially compliant with the standards defined in this audit, which were derived from the NICE guidelines. Discussion within the MS Clinical Governance Group resulted in a proposal for a website to supply information about local services. This article discusses the development of the website with reference to the relevant audit results and the standards defined in the audit for information giving.

It was identified at an early stage that service user involvement would be essential to the success of the website project. A period of consultation by MS Society branches was led by volunteers, followed by an email consultation of the health and social care professionals via the MS Special Interest Group. The website content was then agreed and compiled and the website went live in December 2007. The website gives details of local MS services as well as information about events and courses for people affected by MS, details of research trials and links to other relevant websites. A summary of service user and service provider feedback is included alongside quantitative data relating to the use of the website since going live.
Correspondence
Authors: Burn Robin , Hassall Mandy
Published: May 2014

The July 2008 publication of the Bercow Review of Services for Children and Young People (aged 0-19 years) with Speech, Language and Communication Needs (SLCN) commissioned by the Department for Children, Schools and Families, identifi ed fi ve key themes in the executive summary:
Supporting people with motor neurone disease
Authors: Barry Mel
Published: May 2014

Few disorders are as devastating as motor neurone disease (MND). Imagine a healthy and alert mind trapped inside a body that cannot move, but can still think and feel—this is the reality of MND.
Election promises for long-term care funding
Authors: Woodward Sue
Published: May 2014

During the recent round of political party conferences health care has been high on the agenda. Long-term care has been targeted as a policy priority by both Labour and Conservative parties, which will have potential implications for many patients with long-term neurological conditions and their families. Currently anyone in need of long-term residential care has to pay for the costs of that care if they have assets in excess of £23 000.
Making a difference in Parkinson's disease: An audit of patient perspectives
Authors: Reading Sharon , McGee Patricia , Brechany Una
Published: May 2014

Parkinson's disease (PD) affects approximately 120 000 people in the UK with an age range from people in their 30s upwards. The classic signs of PD are slowness and poverty of movement, tremor and rigidity. Patients experience motor and non-motor complications and some papers suggest up to 80% of patients may go on to develop dementia. PD is a chronic progressive illness with no known cure. Treatment is based on individual need as there is much variation in symptoms. Three years ago, National Institute for Health and Clinical Excellence (NICE) guidelines for the care of people with Parkinson's were published (2006). However, two leading charities have recently completed surveys which show that large numbers of patients remain unhappy with the overall care they receive.

In Newcastle, a team of Parkinson's disease nurse specialists conducted an audit of the service they provide. The main aims were to survey the quality of the service from the patients' perspective and to provide a model for future development based on the findings. The key tool was a patient satisfaction survey of 300 people attending the outpatient clinics.

From 209 completed questionnaires, only two patients reported overall dissatisfaction. This article looks at the areas that patients found particularly helpful such as daily telephone advice lines and home visits and those where there was room for improvement such as access to information.
Improving access to self-management services
Authors: Phillips Jim
Published: May 2014

The term ‘expert patient’ was first introduced to the health arena in the White Paper Saving Lives: Our Healthier Nation (Department of Health (DH), 1999). The concept was simple—that people living with long-term health conditions often have more knowledge and experience of dealing with the day-to-day impact of the condition on their lives than the health professional. The idea was to develop a partnership in managing the condition. In this partnership the clinical team is seen as being primarily responsible for diagnosis and monitoring, through to tests and treatment. The patient is responsible for implementing lifestyle changes, taking medication as recommended, and accurately reporting on changes in symptoms.
Management of severe traumatic brain injury in the first 48 hours: A systems-based approach
Authors: Christie Robert James , McLernon Siobhan
Published: May 2014

Severe traumatic brain injury (TBI) presents significant challenges to clinical staff working in the critical care setting. Patients who have sustained a severe TBI require prompt diagnosis and referral, and timely assessment and intervention if secondary brain injury is to be minimized. This article reviews these aspects of care in the context of a patient case study, using an ABCDE (airway, breathing, circulation, disability, external examination) systems-based approach to assessment. Management of the patient in the pre-hospital phase, accident and emergency department and intensive care unit during the first 24–48 hours after injury is reviewed and analysed incorporating current recommendations and guidelines based on existing evidence. A discussion of the extent and limitations of the existing evidence base pertaining to this patient group is included, as well as an analysis of the strengths and weaknesses of care in TBI management. The physiological effects of TBI during the acute phase, and the patient's outcome, are discussed. Recommendations for future practice are made and the implications for future service organization and delivery considered.
A matter of non-exemption from prescription charges
Authors: Thomas Sue
Published: May 2014

During January the government began a consultation over the issue of whether people who have long-term conditions (which includes many neurological conditions such as Parkinson's disease and multiple sclerosis) should be exempt from prescription charges. A coalition of patient organizations has been campaigning for this for some time.
Understanding Huntington's disease
Authors: Stanley Cath
Published: May 2014

Huntington's disease is a progressive neurological illness which is hereditary. The illness begins gradually and can affect individuals cognitively, emotionally and can impair mobility. The onset of Huntington's is insidious as a series of subtle changes takes place which characterize the early stages of the disorder. The progression of the illness is slow with a typical time span of 15–20 years. However, each affected individual is different and assessment should take this into account.
Identifying and managing tuberous sclerosis complex
Authors: Pountney David
Published: May 2014

Tuberous sclerosis, also known as tuberous sclerosis complex (TSC) is a multisystem genetic disorder (Table 1). The condition derives its name from tuberous benign growths in the brain that calcify with age and become hard or sclerotic (Crino et al, 2006). Napolioni et al (2009) have identified three types of brain tumours which are associated with tuberous sclerosis
Living with idiopathic normal pressure hydrocephalus: A grounded theory study
Authors: Gelling Leslie , McVicar Andy
Published: May 2014

Idiopathic normal pressure hydrocephalus (iNPH) is a complex and multifaceted disorder of cerebrospinal fluid (CSF) circulation. This paper presents the findings of grounded theory research undertaken to explore the health and illness experiences of individuals diagnosed with iNPH. Purposive and theoretical sampling was used to recruit 26 participants who all had a confirmed diagnosis of iNPH for at least 6 months before data collection. Data were collected through in-depth semi-structured recorded interviews (n=15) and written personal biographies (n=11) and analysed using the Glaserian grounded theory method. Four themes emerged from the data: hope, frustration, isolation and life-long illness, and are used to explore and explain the experiences of those living with iNPH. Greater understanding of patients' experiences will help health professionals provide meaningful and effective care for patients and their families.
How nurses can help cure Parkinson's
Authors: Breen Kieran
Published: May 2014

Parkinson's disease is currently incurable and affects 120 000 people in the UK. Research using donated brain tissue is essential in the search for a cure. The Parkinson's Disease Society has launched a nationwide Brain Donor Appeal to raise awareness and encourage more people—with or without Parkinson's—to pledge to donate their brains, as some celebrities have done, such as BBC Newsnight presenter Jeremy Paxman and actress Jane Asher.
Understanding and adapting after head injury: Impact of awareness on rehabilitation
Authors: Stroud Amanda
Published: May 2014

A practical way of working with patients with impaired insight following traumatic brain injury is described. A sensitive team approach is advocated, with psychological support and clear goal-planning. This will enable the patient to make use of critical incidents and ‘aha moments’ within rehabilitation to understand their problems better and therefore to start adjusting to life after head injury. This article is based on a workshop given at the BANN conference in October 2008.
Is intermediate care alive and kicking?
Authors: Thomas Sue
Published: May 2014

In 2000 the NHS Plan (Department of Health (DH), 2000) signalled the development of a new type of care service, ‘intermediate care’ which turned out to be one of the major initiatives for health care at that moment in time. Reflecting back on the intermediate care initiative, I remember attending a plethora of meetings about what it should be, how it could be defined and more importantly how it would be delivered. Intermediate care is a sweeping phrase which encompasses a wide diversity of practices in a range of venues. Initially promoted to facilitate rehabilitation and restore independence for older people, the concept spread to other clients—particularly those with neurological problems—young and old, all of whom needed rehabilitation. Intermediate care was led by increasing pressure on the government to reduce hospital waiting lists and this slowly led to a growth of interest in ‘intermediate care’ schemes, the common theme of which was the avoidance or reduction of periods of hospitalization.
CORRESPONDENCE
Authors: Hassall Mandy
Published: May 2014

Headway's 30th anniversary: Showcasing local support groups
To clip or to coil? Choosing the best treatment for cerebral aneurysms
Authors: Fox Sally , Choi David
Published: May 2014

Treatment of cerebral aneurysm has undergone many changes over the past 15 years. With the introduction of coiling under radiological guidance, surgical clipping is no longer the only available treatment. Many factors need to be considered when planning treatment including the patient's general health and the size and location of the aneurysm. The International Subarachnoid Aneurysm Trial (ISAT) (Molyneux et al, 2005) found that coiling is more likely to result in independent survival than clipping (P=0.0001). Further investigation and technological developments in both surgery and radiology have indicated that a multidisciplinary approach is required to achieve the best outcomes, and the most appropriate intervention for the individual patient is best decided on a case-by-case basis. Further research is needed to determine in which circumstances one treatment is superior to the other.
Charcot-Marie-Tooth disease: Enabling interaction and support
Authors: Butcher Karen
Published: May 2014

Charcot-Marie-Tooth (CMT) disease is the most common inherited neurological condition in the UK, affecting upwards of 20 000 individuals. However, a lack of knowledge about the condition in the health professions and in the public domain leaves most affected families isolated, not knowing anyone with the condition outside of their families.
The need to understand end-of-life care
Authors: Thomas Sue
Published: May 2014

Policy concerning end-of-life care has increased significantly over the last few years and quite rightly now includes specific reference to people with neurological problems. Around 500 000 people die in England each year and statistics show that the average age at death is increasingly becoming older. With older age comes a raised incidence of neurological disease and so neuroscience nurses should be aware of policy to promote good end-of-life care.
Accessing the right equipment at the right time
Authors: Thomas Sue
Published: May 2014

How much does the provision of equipment for your patients impact on your practice? If you work in an acute environment perhaps the impact is minimal, as the equipment you need is generally readily at hand—but what about community-based nurses?
Would Scrooge have carried a donor card?
Authors: McDonald Sheena
Published: May 2014

The parlour-game season is over for another year. This time we tried debating fantastical conundrums, to which there is no absolutely correct conclusion. Here is one: would Scrooge have carried a donor card? It is more ticklish than you think.
Understanding inflammation's role in the pathogenesis of multiple sclerosis
Authors: Burgess Megan
Published: May 2014

MS is an immune-mediated disease affecting the central nervous system (CNS); this article reviews current understanding of the pathology which underpins this disease. The primary focus for immune ‘attack’ within the CNS is myelin, a lipoprotein produced by oligodendrocytes which forms a coating along the length of axons so facilitating saltatory conduction along the nerves within the CNS. There are two processes which occur in MS, both occur simultaneously and from onset of the disease though inflammation tends to dominate in the earlier phases of MS while neuronal degeneration and axonal loss typically becomes clinically more evident in the later stages. The impact and interrelationship of the two processes is reviewed and discussed in the context of the clinical manifestations of MS and its underlying pathology.
Diagnosing multiple sclerosis: Recognizing symptoms and diagnostic testing
Authors: Burgess Megan
Published: May 2014

Approximately 2300 people in the UK are diagnosed with multiple sclerosis (MS) each year. There is no definitive test for MS and the diagnosis is based on evidence of dissemination in time and space of inflammatory episodes within the central nervous system in the absence of any better explanation. There have been many attempts in recent years to establish diagnostic criteria to ensure consistency of approach to diagnosis (particularly important when reviewing treatment options and for the purposes of research). These have evolved to include changes in practice and new evidence such as MRI scanning. The criteria currently in use are the revised McDonald criteria, which are predominantly based on MRI scanning. These are explained in a little more detail as are the relevant paraclinical tests. The importance of the recommendations made in the National Institute for Health and Clinical Excellence clinical guidelines for the management of MS regarding best practice when making and giving a diagnosis are also discussed.
Managing the cardiovascular status of an organ donor after brain stem death
Authors: Reesaul Ramesh
Published: May 2014

After brain stem death, the management of a patient going for organ donation presents some major challenges for the nurses and the doctors in the critical care setting. The death of the brain stem precipitates so many significant pathophysiological changes in the donor's state that preventing hypoxia and hypotension become primordial for the survival of the organs to be transplanted. This article discusses the pre-organ donation phase using a case study to better understand the complexity of the procedure. The demand for organs greatly exceeds the availability of organ donors (Sque and Payne, 2007): a good clinical management of the organ(s) is very important to both the NHS and the recipients of organs. A total of 8099 people were still waiting for an organ at the end of November 2009 (NHS Blood and Transplant, 2009), so timely interventions and expertise of the professionals to maintain haemodynamic stability of the donor are very important.
The process of adjustment: Providing support after a diagnosis of multiple sclerosis
Authors: Burgess Megan
Published: May 2014

This article reviews the impact a diagnosis of multiple sclerosis (MS) can have emotionally on an individual and his/her significant other, and discusses some of the ways in which the needs of this patient group can be met. The way in which the diagnosis of MS is communicated to the individual and the support he/she receives is known to have a bearing on subsequent coping with life with MS (Johnson, 2003). Response to diagnosis varies, although feelings of abandonment, isolation, anxiety, depression and anger are common reactions for both the patient and his/her partner or family (Porter and Keenan, 2003; Johnson, 2003) and the need for support at this life-changing time is crucial. Continuity of care following diagnosis, access to tailored information as and when required and having a point of contact are all important aspects of care following a diagnosis of MS. The role of the neurologist, the MS specialist nurse and the voluntary agencies in meeting these needs within the context of the wider multi-disciplinary team will be discussed in this article.
Understanding the types of multiple sclerosis and prognostic indicators
Authors: Talbot Paul
Published: May 2014

The current terminology concerning the diagnosis of multiple sclerosis (MS) and the identification of disease types is closely linked. Although our ability to diagnose MS has improved with the advent of magnetic resonance imaging (MRI), this has also led to the identification of people who are at high risk of developing the condition but for whom appropriate diagnostic labelling is difficult. Unfortunately, our ability to offer a reliable prognosis is rather limited—clinical and MRI indicators are of some value but we still need betters ones in order to provide more reliable information about the future and improve the targeting of disease modifying drugs.
Primary-progressive multiple sclerosis: A separate disease entity or part of a clinical continuum?
Authors: Talbot Paul
Published: May 2014

Primary-progressive multiple sclerosis (MS) is usually considered as a separate disease entity to other forms of the disease. Indeed, it is generally helpful to identify people with primary-progressive MS because it can have important implications with regard to prognosis and therapeutic options at the earlier stages of the condition. However, it is also clear that people with primary-progressive MS share important clinical characteristics and prognostic indicators with those who develop secondary-progressive MS following a relapsing-remitting onset, but only if comparisons are made from the time of onset of disease progression. This has important implications with regard to the use of disease-modifying drugs in MS at a later stage of the condition.
Raising awareness that dying matters
Authors: Lakhani Mayur
Published: May 2014

People suffering from brain injuries or progressive conditions need to communicate their preferences in dying well before they reach the end of life, when it may be too late.
Relapse management strategies in multiple sclerosis: Theories and practice
Authors: Burgess Megan
Published: May 2014

Relapses are experienced by 85–90% of people at and following onset of multiple sclerosis, as a feature of their disease (Lublin and Reingold, 1996). There is a great deal of uncertainty and variation with regards to presentation, duration and frequency of recurrence of relapses which varies for each individual. Guidance from the National Institute for Health and Clinical Excellence (2003) recommend treating a relapse with high doses of methylprednisolone over a 3-5-day period. The evidence underpinning these recommendations as well as some of the theory and practice behind this will be reviewed in this article.
Managing acoustic neuroma: Observation, surgery or radiation?
Authors: McNamara Shanne
Published: May 2014

The management of acoustic neuromas has been controversial, with a range of management options available and varying from centre to centre. Despite the lack of guidelines, there does appear to be a consensus that small, asymptomatic tumours should initially be observed with serial scanning. When tumours are large and growing, and symptoms are developing, the best approach may be microsurgical resection, although recently radiation has been recognized as a minimally invasive alternative to control the growth of the tumour with decreased morbidity. Patients need to be supported by nurse specialists throughout the decision-making process.
Transient loss of consciousness: The new NICE clinical guideline
Authors: Braine Mary E , Goodwin Melesina
Published: May 2014

NICE has released new guidance on the assessment, diagnosis and referral of adults and young people who have experienced transient loss of consciousness.
Promoting respect and dignity at the end of life
Authors: Chapman Simon
Published: May 2014

It is much easier to provide respectful, person-centred care at the end of life if the person's wishes have been discussed before reaching that stage.
An overview of traumatic spinal cord injury: part 2. Acute management
Authors: Sarhan Firas , Saif Danah , Saif Ahmad
Published: May 2014

Spinal cord injury (SCI) is a serious and debilitating condition that affects both patients and their families. Initial management focuses on the ‘ABCs’ of trauma care—airway, breathing and circulation. Although these are aimed at supporting the life of a patient, with regard to trauma of the spinal cord the ABCs sustain the microcirculation of the cord in an attempt to reduce cell death. In addition to these critical procedures, acute management of traumatic SCI involves the appropriate selection of medical and surgical interventions for the patient, with the aim of enhancing eventual recovery.
Empowering stroke patients to have their say in a person-centred NHS in Scotland
Authors: MacKellaig Juliet , Cotter Nicola , Peardon Louise , Bertin Dave
Published: May 2014

‘Stroke Voices’ is a fully inclusive communication and public involvement training and support programme from Chest Heart & Stroke Scotland. It is applicable to the majority of patients with experience of stroke, including those with cognitive and communication difficulties, and supports their voices in the development of Scottish NHS stroke services. Stroke Voices is a workshop presented over 3 days, with each session being around 3 hours in duration. It teaches participants how to present their ‘case for change’ for stroke service improvement across Scotland. This article describes the course content, training delivery methods and resource development. It also includes a suggested pathway and model for public involvement that NHS bodies such as Managed Clinical Networks can use to become person-centred organisations. Stroke Voices suggests that it is possible, through training and quality support, to support people who have had a stroke to present their views for stroke service development. Stroke Voices is now offered for free across the 14 Scottish NHS boards.
Eclampsia in a mission hospital in India
Authors: Firth Shirley
Published: May 2014

Frances Newton Hospital is a mission hospital in a small but busy town in Ferozpur Punjab, India. The area is mainly agricultural, and the patients travel considerable distances for both outpatient consultations and admission.
Midwives and Litigation: an introduction
Authors: Symon Andrew
Published: May 2014

Midwives and litigation will be a series of articles which looks at perinatal legal files concerning events since 1980. The examination of these cases, which concern allegations of negligence, constituted part of doctoral research based in the Social Policy Department at the University of Edinburgh, begun in 1993 and due to finish in 1997.
Are Vegetarians receiving adequate dietary advice for pregnancy?
Authors: Drake Rana , Reddy Sheela , Davies Jill
Published: May 2014

Vegetarian diets are generally considered adequate but during pregnancy additional care is needed. A questionnaire was used to evaluate the dietary changes made by vegetarians compared with non-vegetarians during pregnancy. In addition, sources of dietary advice were explored.
Re-evaluating the role of midwives as smoking cessation counsellors
Authors: Ellison George , Holliday Mary
Published: May 2014

The recent development of an educational package by the Health Education Authority for training midwives as smoking cessation counsellors assumes that antenatal counselling will be effective for promoting smoking cessation during pregnancy and will not place the midwife-client relationship at risk.
Cracking the code: babymilk companies breaking the rules
Authors: Taylor Anna
Published: May 2014

Research published on 8 January 1997 shows that manufacturers of breast milk substitutes are breaking the International Code adopted by the World Health Assembly (WHA) in 1981. The Code is there to protect mothers from companies seeking to sell a substitute to breast milk and to ensure that the decisions they make over how to feed their babies are well informed.
Midwifery education: part 2 The South and West region
Authors: Betts Helen
Published: May 2014

The South and West Region is composed of the original South West and Wessex Regional Health Authorities. It stretches from the Isles of Scilly up to Gloucestershire and across to and including Hampshire. It is therefore a large geographical area.
The ills of the profession and search for a cure
Authors: Chesney Margaret
Published: May 2014

It is with the heart that one sees rightly: what is essential is invisible to the eye (Antoine Dc Saint Exupery, The Little Prince).

The ills of the profession are indeed visible to the eye. I read of midwifery education being in crisis (Henderson, 1997) and listen daily to teachers who feel out of control in the shifting sands of higher education.
Artificial feeding: choosing to bottle feed
Authors: Hughes Pamela , Rees Colin
Published: May 2014

Given all the advantages of breastfeeding, why do some women choose to bottle feed? Is this a failure of women to convince women of the evidence? This study set out to identify the factors which influence bottle feeding. Using a qualitative approach, a sample of 20 women were interviewed in depth. The results show that the decision to bottle feed is based on practical considerations, strongly influenced by social circumstances.
Piggie in the middle: whose patient?
Authors: Robinson Jean
Published: May 2014

When professionals fall out, patients suffer. Of course it is not just in maternity care that this happens. I recall one scandal where two hospital consultants hated each other so much they forbade their junior staff to communicate, and another where two surgeons stood over an accident victim quarrelling y as to whether his leg should be amputated.
New Labour: new approach to women's health
Authors:   Baroness Jay Of Paddington Minister for Health
Published: May 2014

As Minister for Health, with particular responsibility for maternity Services, I am delighted to have been asked to contribute an editorial to this respected journal.
Choice in childbirth: whose agenda?
Authors: Downe Soo
Published: May 2014

The rhetoric of choice has been prevalent in the political agenda through the late 1980s and into the 1990s. It has been pronounced as a good thing in education, council house sales, and, some may say belatedly, the provision of health care. Maternity care has been at the forefront of this movement.
Nappy rash at a glance: from top to bottom
Authors: Herreboudt Ann , Sigalov Joanna
Published: May 2014

The Birth Unit at the Hospital of St John and St Elizabeth provides care and support for families from pregnancy and throughout the important first months at home. It has international recognition as one of the most forward-thinking centres for preparing for parenthood and has pioneered the application of complementary therapies in parallel with conventional treatment. This combination is extremely powerful in dealing with problems for both mother and baby. While nappy rash can be dealt with using prescribed medication and over-the-counter treatments, there are alternatives available, e.g. herbs, homeopathy and acupuncture, and extend to the nutritional requirements of mother and baby. Before a decision can be taken on an appropriate treatment, one must first diagnose the relevant condition which can be caused by several factors, including allergens in the baby's system. This article is designed as a guide to the various types of nappy rash and the range of complementary and conventional therapies available.
Risk management in midwifery practice
Authors: Aslam Robina
Published: May 2014

Risk management has recently gained a high profile in all areas of clinical practice. It is particularly important in obstetrics and gynaecology because of the large volume of litigation in these areas. Evidence from the literature indicates that midwives are also showing an increased awareness of and interest in risk management (Nightingale, 1995; Williams, 1995; Dineen, 1996; O'Connor and Beard, 1996; Smith and Mitchell, 1996). However, the focus is often on litigation avoidance (Dineen, 1996). This article supports the increased use of risk management in midwifery practice. It is argued, however, that enhancement of client care, rather than litigation avoidance, should be the principal driving force in implementing risk management procedures.
Physiological third stage of labour
Authors: Featherstone Izumi E
Published: May 2014

Active management of the third stage of labour is common practice, and many midwives do not have the opportunity to become practised in caring for a woman having a physiological third stage of labour (Inch, 1988; Levy, 1992; Enkin et al, 1995). Changing Childbirth recommends the provision of choice (Department of Health, 1993), and this choice extends to declining the use of oxytocic agents for third stage of labour. Where a woman chooses a physiological third stage it is important that the midwife attending her understands how to perform this option safely. This article describes research undertaken to find out to what extent midwives understand the conduct of a physiological third stage. According to Inch (1988), adaptive practice, i.e. where care appropriate for the woman who has had syntometrine is used for the woman having a physiological third stage, can predispose the mother to postpartum haemorrhage, retained placenta or inversion of the uterus.
Midwives' experience of stress on the labour ward
Authors: Mackin Patricia , Sinclair Marlene
Published: May 2014

The word stress is used to describe both mental and physical conditions that may be beneficial and harmful in its sources and effects. The objectives of this study were to measure stress levels as perceived by midwives working on the labour ward, to identify both personal and professional sources of stress for midwives, to examine the perceived effects of stress on midwives, to identify stress relieving methods used by midwives, and to identify the sources of support for midwives in labour wards. This research utilized the McGrath et al (1989) and the GHQ-12 (Goldberg, 1978) self report questionnaires to measure labour ward midwives' stress in a large urban maternity unit. Results from the study highlighted the stressful effects of poor communication between doctors and midwives.
Record keeping — a risk management perspective
Authors: Byrne Ursula
Published: May 2014

The issue of poor record keeping by health-care professionals is a recurrent one in the risk management literature. Two aspects of this issue are identified — the quality of client care and the investigation of medicolegal claims. In this article, the implications of poor quality record keeping are outlined. Criteria for good record keeping are discussed and methods of improving and maintaining standards are identified.
Midwives perceptions of supervisors and managers
Authors: Burden Barbara , Jones Tricia
Published: May 2014

One of the key concerns of midwives regarding statutory midwifery supervision has been the conflicting role of supervisor and manager (Isherwood, 1988; Flint, 1993; Kirkham, 1994; Walton, 1995). The debate centres on whether an individual should undertake the dual role of supervisor and manager, an arrangement that can result in the blurring of boundaries between the roles and in consequence dissonance for midwives. This study was undertaken to determine midwives' views of supervision in a local maternity unit when supervision was in the process of being evaluated. The aim of the review was to increase the profile of supervision and of supervisors within the local maternity unit, by assessing the views of midwives on a number of key issues.
The Human Rights Act 1998: Implications for practice
Authors: Dimond Bridgit
Published: May 2014

The Human Rights Act 1998 came into force on 2 October 2000. It enables those who consider their rights as recognized in the European Convention of Human Rights to have been violated to bring action in the courts of this country. This article considers the implications for midwives and suggests that proactive steps should be taken.
The thinking midwife: arriving at judgement
Authors: Axten Su
Published: May 2014

Think! Midwives do it all the time and yet, are they aware of how and why? More importantly how do they arrive at the decisions and judgements they make? Who benefits from these decisions, the midwife, the woman they are caring for or their colleagues? In this age of reflective practice and living, conscious awareness of how and why should form the foundation for all care that touches the lives of others. This article considers only a small fragment of all that is absorbed, both consciously and unconsciously and covers a broad subject area; purposely, not concentrating on any one. It seeks to awaken the inquisitive nature that is an integral part of human nature, touching on psychology, cognitive processes and philosophy. The purpose is to heighten the professionals' awareness, giving insight and illuminating the thinking process without which midwives are non existent.
The influence of grandparents on infant feeding choice
Authors: Duddridge Emma
Published: May 2014

Despite being informed by health professionals of the proven benefits of breast milk for their infants, many women choose to use artificial milk substitutes. This article looks at how grandparents influence feeding choice, the emphasis being on how they fed their own children. A personal reflection is included which illustrates the problem. A recommendation is made to include grandparents in antenatal education. Providing grandparents with evidence-based information should prevent conflicting advice being given to women as it enables the midwife and family to work to the same agenda.
Amniotomy in spontaneous, uncomplicated labour at term
Authors: Clements Cathy
Published: May 2014

This article concerns the use of amniotomy in spontaneous, uncomplicated labour at term. A selection of the extensive available research regarding the perceived risks and benefits of this procedure has been analysed in an attempt to clarify some of the controversial and contradictory attitudes surrounding its use.
Comparing administration of paracetamol for perineal pain
Authors: Moffat Helen , Lavender Tina , Walkinshaw Stephen
Published: May 2014

To assess the effect of two different methods of paracetamol administration on perineal pain management a prospective randomised clinical trial was conducted in a regional teaching hospital in the north west of England. Sixty primigravid women following a normal vaginal delivery who had sustained a first or second degree tear were randomised to have their pain managed using either self administration or staff administration of paracetamol. The primary outcome measure was the level of pain experienced at 48hours post delivery. Secondary outcome measures included — level of pain at 24hours, level of pain at 72hours, women's and midwives' satisfaction with the method of administration, number of paracetamol tablets taken, number of women requiring stronger analgesia and length of hospital stay. Data was retrieved from specifically designed questionnaires and a pain assessment chart. There was no difference in the median pain scores, length of hospital stay or number of women requiring additional analgesia. However, women in the self administration arm were more satisfied with their pain management (30/30 vs 20/30, P<0.01) when compared to the women in the staff administration arm. This finding was reinforced by the open responses. Similarly, midwives were more satisfied with self administration than staff administration. As the evidence on which to base the method of administration remains inconclusive further research is required. However, until such time, women should be allowed to choose their method of pain management.
Striking a fair deal for student midwives
Authors: Jacobs Sue
Published: May 2014

There is an acute shortage of midwives, the worst affected areas being south east and central London; the government's human resource strategy aims not only to recruit but also to retain the existing staff by improving their working lives through the introduction of family friendly policies.
The normal way of birth?
Authors: Page Lesley
Published: May 2014

Now it is official. The year 2000 rates for caesarean birth for England and Wales and the 2001 rates for Northern Ireland are comparable to those in Italy and the USA (Thomas and Paranjothy, 2001). What has been predicted and expected for some time is true. The UK, with one of the strongest midwifery systems in the world, has one of the highest rates of caesarean section (CS). Where have we gone wrong? Is there something more we could have done? Is there more we can do now?
Practice recommendations for obstetric emergencies
Authors: McGeown Pat
Published: May 2014

Obstetric emergencies were the focus of the second multidisciplinary perinatal forum held by the West Midlands Perinatal Institute. Cord prolapse, placental abruption, uterine scar rupture and shoulder dystocia account for less than 4% of all deliveries. However, they are important to consider because many of the deaths associated with these emergencies are considered avoidable (CESDI, 1998; 1999). In dealing with these emergencies a coordinated, multidisciplinary approach is essential. Staff in delivery suites should have regular emergency drills and key personnel should have advanced life support obstetrics (ALSO) or managing obstetric emergencies and trauma (MOET) training. Good communication with parents is vital. This article covers the first three topics, the next issue considers shoulder dystocia.
What are the advantages of transitional care for neonates?
Authors: Duddridge Emma
Published: May 2014

Transitional care has been shown to be very beneficial to moderately compromised neonates (such as babies who need regular blood sugar estimation or photo therapy) and their families. Care provision varies in individual maternity units. The evidence suggests that units situated away from the postnatal wards or the neonatal intensive care unit are potentially able to provide the most advantageous mode of care (Boxall et al, 1989). This article aims to review the literature and discuss the benefits of transitional care units and the provision of family-centred care. It addresses location and staffing issues, and the physical and psychological development of neonates receiving transitional care.
Improvements to supervision are essential for best practice
Authors: Burden Barbara , Jones Trish
Published: May 2014

Evaluating the changing role of midwifery supervision and its impact on the midwife is fundamental to the development of the midwifery profession. The first component of this study was completed in 1995. This was followed by the implementation of a range of new concepts into the process of supervision and these were subsequently reassessed in 1997. The results show that a supportive and humanistic approach to midwifery supervision enhances the midwife's view of the process as a friendly, caring system that guides her personal and professional development while maintaining the integrity of supervision in relation to professional accountability.
Informed choice: infant feeding and HIV
Authors: Drozdowska Theresa M
Published: May 2014

There are many factors which influence how an HIV positive mother will feed her infant. In order to offer informed choice, midwives should be aware of the many issues regarding HIV transmission before discussing them in an unbiased way. Only then will women be enabled to make proper informed choices regarding their care. Government policy advocates artificial feeding for HIV positive women based on Dunn et al's (1992) conclusions, yet new research reveals conflicting findings. It appears that transmission of HIV through breast milk is dependant on the pattern of breastfeeding. Further research is necessary to substantiate these findings.
Developing a tool to assess perineal trauma
Authors: Gomme Clare , Yiannouzis Katie , Ullman Rosina
Published: May 2014

Perineal trauma during childbirth is an extremely common phenomenon and 60–70% of women with perineal trauma will require suturing. Although the evidence to support non-suturing of the perineum is limited and inconclusive, in recent years there has been an increasing unexplained trend among midwives to leave some second-degree tears to heal without sutures. Second-degree trauma can be slight or severe, with complicated muscle damage, and midwives often disagree on what constitutes a tear that needs suturing. Lack of conformity in assessing perineal trauma would be a potential threat to the validity of a randomised, controlled trial to compare the effects of suturing and non-suturing of perineal trauma. The aim of this study was to develop a tool that would allow uniform evaluation of perineal trauma. The use of a perineal assessment tool is recommended to improve documentation and promote a standardised approach to perineal assessment.
One-to-one midwifery—making it happen
Authors: Gould Debby
Published: May 2014

Midwives, like other NHS staff, are being called upon to work in new ways that are more community-based and put women and their families at the centre of care (Department of Health (DoH), 1993; DoH, 2000; Royal College of Midwives (RCM), 2000). One-to-one midwifery schemes achieve just that and women receiving this kind of care report increased maternal satisfaction and feel better prepared for labour and parenting than women receiving traditional care. They are also more likely to receive one-to-one care during labour and have fewer medical interventions in labour including lower caesarean and instrumental birth rates (McCourt and Page, 1996; Page et al, 2001).