bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypertension: Plugging the Gaps in Care
Authors: Beevers Michèle
Published: May 2014

Michèle Beevers identifies the areas where monitoring of hypertension could be improved.
Clinical Audit And The Practice Nurse
Authors: Fox Julia
Published: May 2014

Most nurses are already familiar with the evaluation of their interventions through the ‘nursing process’. Very little is known about the level of nurses' involvement in clinical audit within primary health care and this paper describes how the audit experience of Avon's primary care nurses was explored and identifies how further involvement might be facilitated.

A questionnaire was sent to practice-based nurses in Avon. Over half of respondents (55%) were currently involved with the audit of patient care within their own practices. The respondents were predominantly involved in data collection although awareness of the need to be involved in the full cycle was certainly evident. Initiation of audit was thought to be the responsibilty of the whole primary health care team by almost half of the respondents (46%) and should be routine for 37%. Over half (57%) had been able to demonstrate improvements in patient care as a result of audit with benefits for both patient and practice.

A lack of knowledge about the process of audit and a lack of evidence that audit can improve patient care were among the main factors affecting involvement in audit.

As a result of audit many improvements in patient care have been demonstrated. Nurses need further training to enable them to effectively carry out audit and implement change.

If audit is to be accepted it should be relevant to practice, patient-centred, and should be able to demonstrate improved care.
Hay Fever
Authors: Fisher Pam , Holmes Peter
Published: May 2014

During the spring and summer months most people are enjoying the smells of young grass and the sights of colourful blossom, but 10% of the UK population are preparing themselves for the miseries of hay fever. Currently there are between 2 and 3 million sufferers, making this one of the most common respiratory conditions presenting in general practice, and incidence is on the increase (Scadding, 1997). As symptoms are not life threatening, patients are likely to turn to a practice nurse for advice.
Cardiac Counselling: Birth of a Speciality
Authors: Foren Jenny
Published: May 2014

The Cardiology Nurse Counsellor is a valuable resource. Jenny Foren explains what the role entails.
Hearing loss need not be a barrier
Authors: Mangan Marie
Published: May 2014

In this article, Marie Mangan outlines some of the main problems that present to people with hearing loss and how they may be overcome
Nutrition requirements for children
Authors: Chan Wynnie
Published: May 2014

Wynnie Chan outlines the specific nutritional requirements of children of different ages, and considers how the research which has been undertaken in this field can be applied to all children
An introduction to reflexology
Authors: Williamson Jan
Published: May 2014

Reflexology is an ancient healing therapy. Practitioners believe that by applying pressure to ‘reflex points’, it is possible to treat a range of disorders.
An introduction to aromatherapy
Authors: Hall Gillan
Published: May 2014

Health-care delivery has changed dramatically over the past decade. Developments, techniques and interventions in modern medicine, such as transplants, joint replacements and pacemakers, have influenced client care to such an extent that people are living longer and experiencing better health. However, health hazards have arisen through the use of some painful and invasive treatments and drugs. An increased interest in complementary medicine has subsequently occurred. There are contrasts between the medical perspective, which has a rational fix/reduction of impairment approach and a perspective that views the person's psyche as a centre for health management.
Telemedicine: setting up the service
Authors: Sibson Lynda
Published: May 2014

Lynda Sibson considers the practical aspects of establishing a nursing telemedicine service, in the final article in this series
The practical implications of diagnosis
Authors: Creer Dean , Johnston Sebastian L
Published: May 2014

Patients with influenza respond best to rapid diagnosis and treatment, but this is often hindered by the difficulty of diagnosing symptoms that are not specific to influenza. Dr Dean Creer and Professor Sebastian Johnston review the problem.
Understanding and recognizing ADHD
Authors: Myttas Nikos
Published: May 2014

Attention deficit hyperactivity disorder (or ADHD) is a severe educational and social handicap to those affected. Dr Nikos Myttas explains how to recognize and diagnose this condition and argues that early intervention can prevent further psychosocial complications for those affected.
Vigilance for measles in primary care
Authors: Watkins Jean
Published: May 2014

Dr Jean Watkins argues that health professionals need to be ready to diagnose and treat measles because controversy over the MMR vaccine has discouraged some parents from having their children immunized.
Stroke:Recognizing risk and advising prevention
Authors: Perry Margaret
Published: May 2014

A stroke is now the third commonest cause of death in the world and is the most frequent cause of acquired disability (Kumar and Clark, 2001). The incidence of stroke rises with increasing age, and the annual incidence in younger people is about 1.5 in 1000 rising to 10 in 1000 in those aged 75 years or older (Longmore et al, 2001). It is estimated that strokes affect about 200 people per 100000 population in the UK (Kumar and Clark, 2001).
Psoriasis: Its treatment and psychological effects
Authors: Kownacki Stephen
Published: May 2014

Psoriasis is one of the more common inflammatory dermatoses. It affects 2% of both males and females (British Association of Dermatologists, 1997). Psoriasis is a chronic condition and presents as raised, dull, red patches on the skin (mostly called ‘plaques’), which are usually round with silvery scales. It can take other forms and plaques usually appear initially on the scalp, elbows or knees (Camp, 1998).
Implications of the new Code of Conduct
Authors: Dimond Bridgit
Published: May 2014

The most important document that a registration body can produce is a code of professional conduct. Such a document defines professional conduct and the right of a registered practitioner to remain on the Register. On the basis of its clauses, conduct and competence committees decide if a practitioner is guilty of failing to perform according to professional expectations.
An identification system for hidden conditions
Authors: Allen Jeanette
Published: May 2014

MedicAlert is a non-profit making, registered charity that provides a life-saving identification system for individuals with hidden medical conditions and allergies. Each member of MedicAlert receives a tailor-made emblem (Figure 1), a bracelet or necklet that is engraved with the member's main medical condition(s) or vital details and a personal identity number. The 24-hour emergency telephone number, which appears on the back of the emblem, provides access to the member's medical details in over 100 languages. This enables medical personnel around the world to obtain the information required to give the member appropriate treatment in an emergency.
New guidelines for allergic rhinitis
Authors: Wood Stuart F
Published: May 2014

Dr Stuart Wood discusses the recommendations of new evidence-based guidelines on rhinitis (hay fever) from the World Health Organization.
Making the most of your data with analysis
Authors: Paniagua Hilary
Published: May 2014

Previous articles in this series (Table1) were intended to explain how to design a robust piece of research capable of generating comprehensive and valuable information. Once data has been collected, the last step is to capture its meaning with analysis that reveals its strengths and unique findings.
The gatekeeper's role:A need for more evidence
Authors: Cullen Julie
Published: May 2014

Julie Cullen presents a proposal for research into the practice nurse's role in providing same-day access to primary health care
A project to increase cervical screening
Authors: Hill Marie C
Published: May 2014

Marie Hill has designed an information package to assist practice nurses to increase cervical cytology rates
New malaria guidelines
Authors: Chiodini Jane
Published: May 2014

Jane Chiodini reviews the new 2003 guidelines for malaria prevention which have just been published
Award for practice nurse's obesity clinic
Authors: Ashfield Elaine
Published: May 2014

Elaine Ashfield has won an award worth £1 000 for her work to help tackle obesity. She spoke to Lucy Jolin about her weight-loss clinic
Patient focus the key to new asthma guidelines
Authors: Stearn Ruth
Published: May 2014

The Royal College of Nursing (RCN) believes that partnerships with patients are key to the future of the NHS (RCN, 2000). In its response to the NHS Plan (Department of Health, 2000), the RCN set out its vision of a health service which values patients as informed consumers and makes the most of the skills of all its staff.
The link between asthma and rhinitis
Authors: Owen Olwen Glynn
Published: May 2014

Rhinitis and asthma have been regarded traditionally as two distinct clinical entities but interest is growing in observations that they often occur together and appear to be linked. Rhinitis is now regarded as a risk factor for the development of asthma and it is acknowledged that viral rhinitis in people with asthma often triggers acute asthma attacks (British Society of Allergy and Clinical Immunology (BSACI), 2000). This observation of a link has clinical implications. If rhinitis exacerbates or precipitates asthma, it follows that effective treatment of rhinitis should also impact on asthma, reducing its severity and in some cases possibly preventing or at least delaying its development. More examinations of rhinitis patients will include measurements of peak flow and the nose is attracting the interest of asthma specialists. This topic was discussed at the annual meeting of the BSACI.
Birch pollen allergy and oral allergy syndrome
Authors: Carr Vicky , Walker Samantha
Published: May 2014

Allergic rhinitis is defined as a symptomatic disorder of the nose, triggered by allergen exposure via immunoglobulin E (IgE)-mediated inflam-matory mechanisms. Symptoms include rhinorrhoea (runny nose), itching, sneezing and nasal blockage. Allergic rhinitis has a huge impact on the lives of its sufferers and is a global health problem (Bousquet et al, 2001). Its prevalence is increasing and around 15% of adults and 20% of children now suffer from allergic rhinitis, often accompanied by conjunctivitis and asthma (Strachan, 1995).
Malaria
Authors: Umeed Margaret
Published: May 2014

Imagine the scene: It is a cold, wet winter's night and Mr Xavier is the last person of the day's surgery. Fitted in at the last minute, this normally fit, healthy individual has become a shivering, feverish, aching wreck. Because you are the practice's newly qualified independent nurse prescriber, Mr Xavier has been fitted into your minor ailment surgery. Everyone you have seen today has been suffering from the ‘flu. Some have required an antibiotic for a chest infection, most have required some simple advice: bed, fluids and paracetamol. But does Mr Xavier need this simple advice?
CLINIC Lung function testing
Authors: Booker Rachel
Published: May 2014

In the final part of this 3-part series, Rachel Booker explains the basics of interpreting lung function testing in primary care
SARS
Authors: Townend Mike
Published: May 2014

Mike Townend explains how to advise travellers about severe acute respiratory syndrome (SARS)
The practice nurse's role in insulin therapy
Authors: Davies-Lyons Maire
Published: May 2014

The practice nurse's role in managing insulin therapy is evolving. Maire Davies-Lyons highlights the therapies that are currently available
Diagnosis and treatment in the community
Authors: Howie Kate
Published: May 2014

In the second of a series of articles on practice nursing in the Winchester area, Kate Howie explains the work of the UK's first primary care diagnosis and treatment centre
Dietary guidelines for good diabetes care
Authors: Vaughan Lisa
Published: May 2014

Lisa Vaughan explains the importance of good diet in effective diabetes management
Current thinking on antioxidant nutrients
Authors: McKevith Brigid , Kelly Colette , Stanner Sara , Hughes Joyce , Buttriss Judy
Published: May 2014

Brigid McKevith and colleagues consider the evidence for the nutritional benefits of antioxidants
Chris Pamphilon: Shiatsu specialist
Authors: Pamphilon Chris
Published: May 2014

Chris Pamphilon spoke to Lucy Jolin about combining alternative therapies with conventional health care
An audit of hypertension management
Authors: Sanderson Bob , Massey Debbie
Published: May 2014

Bob Sanderson and Debbie Massey present the results of an audit of hypertension management in one general practice
From hearing loss to Hearsay
Authors: Sanderson Janet
Published: May 2014

Janet Sanderson lost her hearing over several years and is now profoundly deaf. She founded Hearsay, a patient support group
Marian Stones: Education advocate
Authors: Stones Marian
Published: May 2014

Marian Stones took up practice nursing in the 1980s. She bemoans practice nurses’ continued lack of access to education
Concordant care for the individual with psoriasis
Authors: Maguire Susan
Published: May 2014

Susan Maguire looks at what constitutes concordance in the management of people with psoriasis.
Lynn Faulds Wood: Fighting bowel cancer
Authors: Wood Lynn Faulds
Published: May 2014

Lucy Jolin talks to Lynn Faulds Wood about her experience with bowel cancer and her campaign to help raise awareness.
Supporting women with breast health concerns
Authors: Graham Helen
Published: May 2014

Helen Graham reviews the key aspects of breast awareness and surveys national guidelines for referral for breast screening
Viral warts
Authors: Watkins Dr Jean
Published: May 2014

Viral warts are common presentations in general practice. Prevalence rates are 3.9–4.9% in children and adolescents (Williams et al, 1993). Adults may also be affected—the adult prevalence rate is 3.5% (Williams et al, 1993). Patients usually ask nurses and doctors to get rid of them, but treatment is not always the best option; 60–70% of warts resolve spontaneously in 3months and no single treatment of warts is 100% effective (Sterling et al, 2000). The following discussion considers the types of warts that may present in general practice and highlights causes for concern and the options available to deal with them.
Abnormalities of the ear lobe
Authors: Watkins Jean
Published: May 2014

The ear lobe is obvious for all to see. The practice nurse may often be asked for advice about a particular lesion and is in a position to notice and comment on any unmentioned changes. Many lesions of the ear may be associated with years of exposure to the sun or created by desire for beauty and adornment. For others, more serious underlying problems may need to be considered, such as deafness in the presence of what might appear to be minor abnormalities of the earlobe.
Seeing travel health in the round
Authors: Wilcox Adrienne
Published: May 2014

Adrienne Willcox reports from the first International Conference of the Journal of Travel Medicine and Infectious Disease, 10–11 November 2005, London
Chaperoning: Are your skills present?
Authors: Bates Mavis
Published: May 2014

Patients are increasingly demanding chaperones for intimate medical procedures. Mavis Bates considers the need for training
Emotional stress and asthma
Authors: Watkins Jean
Published: May 2014

Michael has an asthma attack during emotional tensions between his parents. Dr Jean Watkins discusses how to advise Michael and his family
Nurse-requested X-rays in primary care
Authors: Baird Anne , Nutton Sue
Published: May 2014

Anne Baird and Sue Nutton find that, with appropriate training, primary care nurses can refer patients for X-rays
Minimizing pain in paediatric wound care
Authors: Young Trudie
Published: May 2014

Trudie Young reviews a consensus document which provides practical guidance on how to minimize trauma and pain when dressing wounds in children
Maggie Cooper: Putting training first
Authors: Cooper Maggie
Published: May 2014

Lucy Jolin talked to Maggie Cooper about this year's Practice Nurse Conference in Guildford and the importance of women's health
Managing the risk of sensitization to latex
Authors: Kinay Aleks
Published: May 2014

Aleks Kinay outlines the types of allergic sensitization to natural rubber latex and measures to reduce the risk of exposure in health services
Delegation to health care assistants
Authors: Storey Les
Published: May 2014

Les Storey examines the health care assistant's role in general practice and the key questions of delegation and accountability that practice nurses should know
Scabies
Authors: Watkins Jean
Published: May 2014

Patients often come to the surgery complaining of itching. In many cases there will be an obvious cause. For example, patients with eczema, lichen planus, urticaria or some other disease will usually have something to show for it. The rash may be distinctive or easily described, even if, as in urticaria, it may have gone by the time they attend.
Is your practice ready for a choking patient?
Authors: Lambert Jane
Published: May 2014

Jane Lambert explains how safely and effectively to help an adult, child or infant who is choking
Erectile dysfunction and diabetes
Authors: Ladds Tom
Published: May 2014

Erectile dysfunction can be defined as the persistent inability to obtain or maintain an erection sufficient for satisfactory sexual activity (NIH Consensus Conference on Impotence, 1993). Its causes can be organic, psychogenic or a combination of the two.
Life is sexually transmitted: Live with it
Authors: Evans David T
Published: May 2014

David T Evans argues that practice nurses have a duty to prepare themselves to provide proactive sexual health advice as part of their role in holistic health care
Epstein-Barr virus and the kissing disease
Authors: Winter George
Published: May 2014

George Winter explains the tests used to diagnose glandular fever
A digital nursing future
Authors: Clark Dame June
Published: May 2014

Information and communication technologies (ICTs) have the potential to transform the delivery of health care. Digital Healthcare, a report published by the Royal Society (2006), identifies some of the exciting developments which we can expect over the next decade. It also points out that realizing ICTs' potential depends on the people who use them—and that includes nurses.
Nails 2: The traumatized nail
Authors: Watkins Jean
Published: May 2014

In the previous article the way that a patient's nails can help clinicians indentify underlying problems in a patient's health was examined (Watkins, 2007). This article follows a slightly different approach, looking at how trauma to the nails can create problems for the patient, and how the patient can learn to manage these problems or even prevent them from occuring.
Listening carefully
Authors: Benison Líam
Published: May 2014

n less than 20 years' time 1 million people in the UK will have dementia, according to Dementia UK, a report published by the Alzheimer's Society in 2007. The authors concluded that dementia needs to given greater priority. In general, people with dementia spend more years living with the disease than people with many other long-term conditions; yet only 1.4% of research published in the last 5 years concerns dementia, compared with 23.5% on cancer, for example.
The learning journey 3: Changing behaviour
Authors: Rivers Sue
Published: May 2014

Education entails changing the self. In her third article in this series, Sue Rivers shows how educational approaches can also be applied to public health promotion
Mental health training for practice nurses
Authors: Scanlan Mike
Published: May 2014

Mike Scanlan describes a distance learning programme developed in Northampton to help practice nurses gain competencies in mental health care provision
The benefits of artistic expression in healing
Authors: Wood Michèle
Published: May 2014

Michèle Wood discusses the evidence for the potential of art therapy to improve the wellbeing of patients with a variety of health problems
Malaria: new guidance
Authors: Swales Claire , Bannister Barbara
Published: May 2014

Claire Swales and Barbara Bannister highlight revised guidelines on malaria prevention published in January.
Smoke-free legislation: Time to have an impact
Authors: Percival Jennifer
Published: May 2014

Smoke-free legislation came into effect in England on 1 July. Jennifer Percival looks at ways to take advantage of this opportunity to encourage more people to stop smoking
Competencies
Authors: Willcox Adrienne
Published: May 2014

Adrienne Willcox highlights a new publication from the RCN outlining the competencies nurses need to provide safe and effective travel health advice
Clinical Q&A
Authors: Carrier Judith , Brassey Jon
Published: May 2014

The NLH Question-Answering Service was set up for primary care practitioners to ask any question related to their clinical practice. Below are two questions asked recently. For full answers and references please refer to the NLH website at www.clinicalanswers.nhs.uk
Sandra Grieve: Travelling and writing
Authors: Grieve Sandra
Published: May 2014

Sandra Grieve's passion for travel, both privately and professionally, is evident in her career experiences. She spoke to Rosalind Hill.
Avoiding rabies
Authors: Hall Sheila
Published: May 2014

It has become increasingly common for people to travel to rabies endemic countries. Sheila Hall explores the key considerations that practice nurses should review with the individual traveller
Knowing the early signs of pulmonary embolism
Authors: Perry Margaret
Published: May 2014

Pulmonary embolism is one of the most common causes of unexpected death. Margaret Perry discusses the risk factors and preventive measures
Managing urinary incontinence in women
Authors: Rantell Angie , Vosloo Riette
Published: May 2014

Angie Rantell and Riette Vosloo provide an overview of the conservative management of urinary incontinence in women
Now we are sixty
Authors: Martin Jeannett
Published: May 2014

Sixty years ago Nye Bevan's dream was for a National Health Service that provided care free at the point of delivery, as needed from the cradle to the grave. He believed that this would result in increased life expectancy.
Conjunctivitis
Authors: Stevens Deborah
Published: May 2014

Conjunctivitis is the term used for inflammation and/or infection of the conjunctiva, and is the commonest eye problem encountered in general practice (Simon et al, 2002). The conjunctiva is a thin transparent mucous membrane that covers the white of the eye and extends to cover the inner surface of the eyelids (Bickley and Szilagyi, 2003).
Intrauterine contraception
Authors: Vaughan Alison J
Published: May 2014

Alison Vaughan discusses the assessment and recommendations for methods of intrauterine contraception
Behind the high-tech at NHS Direct
Authors: Collins Elaine
Published: May 2014

Elaine Collins left acute hospital nursing to help develop staff at NHS Direct. She explained her role and aspirations to Lucy Jolin
Clinical Q&A
Authors: Richards Sara
Published: May 2014

The Clinical Knowledge Summaries (CKS) (2007) guideline on head lice contains full information on diagnosis and management including first-line treatment, treatment failure/reinfestation and recommendations:
Supporting pregnant women with disabilities
Authors: Barber Gillian
Published: May 2014

Practice nurses have opportunities to support pregnant women with a disability in many circumstances. Gillian Barber explains what support and advocacy they may need
Larva migrans
Authors: Watkins Jean
Published: May 2014

British tourists frequently seek holidays abroad, where sun, sea and golden sands abound. Unaware of some of the potential health problems, they often take unnecessary risks and are subsequently surprised when they return home with illness, stomach upsets or rashes.
How a child's behaviour can affect a consultation
Authors: Edwards Marilyn
Published: May 2014

A difficult consultation, caused by a child resisting an immunization, resulted in a prescription error. This could have been averted if the consultation had been terminated by the practice nurse. Marilyn Edwards investigates.
Lichen planus
Authors: Watkins Jean
Published: May 2014

Patients often present in the surgery complaining of a rash. Their particular concerns tend to be ‘What is it?’, ‘Is it contagious?’ or ‘Could it be meningitis?’
Addressing MRSA in the community
Authors: Gould Dinah
Published: May 2014

Dinah Gould explains why MRSA is becoming an increasing problem in the community and what practice nurses need to know to help affected patients and prevent new infections
Principles of pressure ulcer prevention
Authors: Benbow Maureen
Published: May 2014

Pressure ulcers occur in all care settings and can be life-threatening, but some people seek no professional advice and are cared for by family at home. Maureen Benbow discusses aetiology, assessment and management
Antiviral treatment and hygiene measures
Authors: Beckett Gail , Geary Katie
Published: May 2014

Gail Beckett and Katie Geary explain the treatment of seasonal and pandemic flu, including the use of antivirals for the A(H1N1)v (‘swine flu’) strain
Anne Reed: Reaching the rural community
Authors: Reed Anne
Published: May 2014

Anne Reed's 3-minute health screening service in rural Yorkshire gives people in remote locations a greater access to care. She spoke to Lucy Jolin.
Good control and few hypos possible with basal insulin starts
Authors: Siddall Rhonda
Published: May 2014

Evidence from a recently published study on the efficacy of complex insulin regimens in type 2 diabetes shows that good blood glucose control with a low rate of major hypoglycaemia is possible
Lipid management in secondary prevention
Authors: Cox Bev
Published: May 2014

Bev Cox reviews the key evidence and recommendations on the prescribing of statins for the management of hyperlipidaemia in coronary heart disease
Diabetes and learning disabilities
Authors: Phillips Anne
Published: May 2014

Diabetes is more common in people with learning disabilities, and people with conditions such as Down's syndrome may find it more difficult to discuss their needs. Anne Phillips considers the experience of Sally
Evidence into practice: Welsh training initiatives
Authors: Kenkre Joyce
Published: May 2014

Joyce Kenkre outlines some training and professional development initiatives in public health offered by the Welsh Assembly Government
Safe ear care: Informed advice and safe practice
Authors: Rodgers Rosemary W
Published: May 2014

Rosemary Rodgers highlights some case studies and reviews some of the evidence on ear irrigation, and makes recommendations for safe and effective ear care
Interventions to trigger quit attempts
Authors: McEwen Andy , Percival Jennifer
Published: May 2014

Andy McEwen and Jennifer Percival discuss why the practice nurse is well placed to help people give up smoking
Diabetes Year of Care
Authors: Roberts Sue
Published: May 2014

For the last few years, the way in which people with diabetes interact with their health professionals and services has been slowly changing. The long?standing rhetoric of putting people at the heart of care has finally penetrated the consciousness of the NHS.
Hypoglycaemia unawareness
Authors: Gibson Helen
Published: May 2014

Hypoglycaemia is more common in type 1 than type 2 diabetes, and may be complicated by patients becoming unaware of hypoglycaemia. Helen Gibson discusses the importance of recognition.
Diabetic neuropathy, part 1: Pharmacology
Authors: Mann Eileen
Published: May 2014

In the first of two articles on painful diabetic neuropathy, Eileen Mann discusses its epidemiology and assessment, and gives an overview of pharmaceutical management
Infected eczema
Authors: Watkins Jean
Published: May 2014

The family was desperate. Ten month-old Louise had suffered days of a worsening of her eczema. Constant itching and scratching had aggravated the condition which now affected her face and most of her body and limbs. As a young baby she had been diagnosed with atopic eczema—a condition well-known to her parents who had both had similar problems themselves as children. They had been meticulous in applying emollients to the dry areas and sometimes thickened or inflamed areas of skin, avoided the use of soaps and bubble baths and resorted to the additional use of mild topical corticosteroids when the eczema flared.
Penile cancer: Helping men to take lumps seriously
Authors: Edwards Marilyn
Published: May 2014

Adrian is an expatriate living abroad. When his doctor told him that a lump on his penis was benign, Adrian believed him despite the lump growing and producing discharge. He left it too late to get a second opinion and had to have a penectomy.Adrian is an expatriate living abroad. When his doctor told him that a lump on his penis was benign, Adrian believed him despite the lump growing and producing discharge. He left it too late to get a second opinion and had to have a penectomy.
Understanding venous thromboembolism
Authors: Bacon Sue
Published: May 2014

Treatment of venous thromboembolism is increasingly taking place in primary care. Sue Bacon emphasizes the importance of clinical expertise in treating this life-threatening condition
Japanese encephalitis
Authors: Driver Carolyn
Published: May 2014

A new vaccine has been licensed to protect against Japanese encephalitis in adults. Carolyn Driver considers the transmission, risk assessment and use of the new vaccine
Preparing to lead
Authors: Hinton Gerry
Published: May 2014

In 1988 I had the privilege of attending the 5th Practice Nurse Conference, ‘The Challenge of Change’, in Exeter when more than 350 nurses attended. While much has changed since that date, what has not changed is the need for general practice nurses to come forward to take the lead both within the profession and within the health service as a whole.
Hepatitis C: Detection in general practice
Authors: Peate Ian
Published: May 2014

Hepatitis C infection frequently remains undiagnosed. Ian Peate outlines the role of the practice nurse in identifying which patients may need to be assessed, diagnosed and treated
Chronic liver disease: Signs to look out for
Authors: Bhamidimarri RS Kumar
Published: May 2014

RS Kumar Bhamidimarri explains why it is important to understand the presenting signs of chronic liver disease, which is rising in prevalence
How to recognise the early signs of dementia
Authors: Robinson Louise
Published: May 2014

Louise Robinson explores the reasons why the early signs and symptoms of dementia are sometimes overlooked, ignored, misunderstood or misdiagnosed. She explains the key signs and symptoms of the different types of dementia and provides an overview of the key assessments used in diagnosis. The importance of referral for specialist assessment and issues about communicating a diagnosis are considered.
Beware substitutions
Authors: Mantri Pamela
Published: May 2014

The NHS is funded by public money with many competing priorities so there is a responsibility to use this money as efficiently as possible. The House of Commons Committee of Public Accounts proposed in 2008 that the NHS could reduce costs by over £200 million annually through price cuts and substituting branded medicines with equivalent generic medicines. The Department of Health (DH) (2009) has advised that it is going to introduce generic substitution in primary care in January 2010 following discussion with interested parties.
Time to address a dependency culture
Authors: Wrixon Sarah
Published: May 2014

It has been estimated that a general practice spends £250 000 on care for people who could care for themselves. Sarah Wrixon investigates
Reviewing the data on the effect of probiotics
Authors: Weichselbaum Elisabeth
Published: May 2014

Elisabeth Weichselbaum clarifies some uncertainties about the possible benefits of probiotics and how they work, drawing on a recent report
Letters
Authors: Cosgrave Rebecca , Willcox Adrienne
Published: May 2014

Rebecca Cosgrave raises some questions about the cost of the new Menveo meningitis vaccine following recent articles on this subject, and Adrienne Willcox responds.
The principles of glucose management in type 1 diabetes
Authors: Oliver Lindsay
Published: May 2014

A diagnosis of type 1 diabetes has a life−changing impact, with a focus on regulating blood glucose levels, carbohydrate counting and insulin administration. Lindsay Oliver outlines some approaches to glucose management, such as DAFNE
Inspiring the extraordinary
Authors: Beal Juliet
Published: May 2014

NHS Barking and Dagenham held an inspirational day for practice nurses on 5 October on the theme of ‵making the ordinary extraordinary′. Juliet Beal explains
Be Active: promoting physical activity in overweight people
Authors: Copeland Robert J , Crank Helen , Hall Anna , Millbourn Alison
Published: May 2014

As the prevalence of obesity is increasing, interventions need to focus on improving lifestyle, losing weight and preventing the onset of type 2 diabetes. Be Active is an initiative supporting overweight people in Barnsley
NSAIDs in children
Authors: Paul Siba P
Published: May 2014

I read with interest the excellent article by Edward Purssell (2010) in the October issue highlighting the use of ibubrofen in pyrexial infants. Antipyretic agents such as paracetamol or ibuprofen are routinely used in paediatric practice. Of late diclofenac suppositories are fast gaining popularity because it is convenient to administer rectally in non-compliant children. Sometimes these are used in combination, even prophylactically, because of concerns about hyperthermia causing febrile seizures and distress to the child.
Causes of tinnitus and approaches to treatment
Authors: Kennedy Veronica
Published: May 2014

Although tinnitus is a commonly experienced symptom, for some people it can be troublesome and have a negative impact on their quality of life. Veronica Kennedy reviews the causes and mechanisms of tinnitus and outlines approaches to treatment
A new standard needed
Authors: Mehigan Shelley , Moore Wendy , Hayes Linda
Published: May 2014

Shelley Mehigan, Wendy Moore and Linda Hayes argue for nationally recognized standards in training for sexual and reproductive health care
A practice research nurse: Ceri Walsh
Authors: Jolin Lucy
Published: May 2014

Ceri Walsh works as a dedicated research nurse at a GP practice in Somerset. She explains how the role works
Pruritis, part 3: Compulsive itch
Authors: Watkins Jean
Published: May 2014

It may all start with something as simple as an insect bite or sting. The patient naturally responds to the intense irritation that may follow by scratching, which in turn may lead to skin damage and secondary infection, or at times be followed by an eczematous reaction that may in itself be itchy. More scratching will follow and the so called ‘itch-scratch-itch‘ cycle may follow, leading to further skin damage, excoriations and lichenification (Oakley, 2009).
Safeguarding children: An essential guide
Authors: Thornberry Michele
Published: May 2014

Recent reports of child deaths at the hands of parents and carers have highlighted health professionals’ important role in safeguarding children. Michele Thornberry provides some guidance
Supporting the mother-infant relationship
Authors: Nelki Julia , Power Cheryl , Göpfert Michael
Published: May 2014

Brain development is affected by the quality of a baby's relationship with its mother and their circumstances. Julia Nelki, Cheryl Power and Michael Göpfert consider ways to support mothers in difficult circumstances
The Buteyko technique in asthma management
Authors: Godfrey Kathryn
Published: May 2014

Kathryn Godfrey considers the evidence for the use of Buteyko breathing technique in addition to medications to help patients control asthma symptoms
Variability in BP: A need to vary the approach?
Authors: Bostock-Cox Beverley
Published: May 2014

Beverley Bostock-Cox considers the clinical implications of findings published recently in The Lancet on the significance of variability in blood pressure readings
Travelling with diabetes
Authors: Owen Rebecca
Published: May 2014

Pre-travel planning is essential for people with diabetes to have a safe trip. Travel advice needs to be readily accessible to patients to help reduce the incidence of problems and ensure patients enjoy their holidays
Are our tools safe?
Authors: Greenfield Gillian
Published: May 2014

‘Yes!’ we all reply. All of the practice's clinical equipment is serviced annually, as specified in the Quality and Outcomes Framework (worth 3 points). Practice partners make an annual declaration to PCT commissioners saying so, and in some areas of the UK, practice staff complete self-assessment clinical governance toolkits stating that equipment has been serviced-boxes ticked! But what assurances do we have that the equipment has been properly checked and calibrated and is reading accurately?
The management of heart failure
Authors: Butler Jane
Published: May 2014

Jane Butler outlines the need for vigilance in order to detect the early signs of heart failure in order to ensure diagnosis and optimal therapy.
Providing updates for general practice
Authors: Aston Jennifer
Published: May 2014

Jennifer Aston introduces a online resource which provides monthly knowledge updates and challenges for general practice
40,000 reasons
Authors: Capewell Simon
Published: May 2014

In the UK, over 5 million men and women are living with the devastating and disabling effects of cardiovascular disease (CVD). Over 40,000 people die from premature CVD each year. However, CVD is a largely preventable condition and it can be effectively tackled by making simple changes to diet, smoking and physical activity.
No deciding for me
Authors: Young Lynn
Published: May 2014

The media has been whipped into a frenzy about the new White Paper (Secretary of State for Health, 2010), which describes the way in which the NHS in England is to be run in the future. A wide range of views has been expressed on the government's decision to give most of the commissioning decisions to general practices in the form of GP consortia, with many experts voicing concerns over such dramatic reform
Options for the future practice nurse workforce
Authors: Lovett-Clements Suzie
Published: May 2014

The practice nurse workforce is ageing and faces difficulties in recruitment and retention. In light of the new White Paper, Suzie Lovett-Clements reviews five workforce development models and proposes some recommendations for commissioners and stakeholders
Managing medications in schizophrenia
Authors: White Jacquie , Hardy Sheila
Published: May 2014

General practice is taking on a greater role in managing the drug regimens of people with schizophrenia. Jacquie White and Sheila Hardy outline the principal considerations for nurses
BMA clarifies uncertainty over validation of PGDs and PSDs
Authors: Umeed Margaret
Published: May 2014

After a long impasse during which primary care organizations were reluctant to authorize PGDs, the British Medical Association published guidance last month to clarify the situation. Margaret Umeed reports
Understanding the use of antidepressants
Authors: Haddad Mark , Young Norman
Published: May 2014

Mark Haddad and Norman Young discuss the indications for prescribing antidepressants and their appropriate use
A brief guide to human papillomavirus vaccination
Authors: Lamming Tracey , Beckett Gail
Published: May 2014

Tracey Lamming and Gail Beckett review the implementation of the HPV immunization programme to date and discuss some key aspects
The management of obesity in primary care: a pilot study
Authors: Saeidi Saeideh , Johnson Mark , Sahota Pinki
Published: May 2014

Background:

Obesity is recognized as a global public health issue, with prevalence in the UK increasing sharply during the 1990s and early 2000s. The National Institute for Health and Care Excellence (2006 ) recommends that ‘managers and health professionals in all primary care settings should ensure that preventing and managing obesity is a priority, at both strategic and delivery levels’. The aim of this study was to develop and evaluate a facilitated self-help weight-management intervention for obese adults attending general practice.

Method:

A two-phased study was used. Phase 1 developed a facilitated self-help weight-management intervention, and phase 2 delivered and evaluated the 6-month intervention using a pre- and post-test design. Semi-structured interviews and focus groups were used in phase 1. Measurements of height, weight and waist circumference were taken during phase 2. Nurse interviews and patient questionnaires were used to evaluate the quality and acceptability of the results obtained.

Results:

The intervention was successful in attaining statistically significant reductions in mean weight of 4.20 kg (95% CI 2.43, 5.97), in mean BMI of 1.52 kg/m2 (95% CI 0.88, 2.16) and in mean waist circumference of 4.66 cm (95% CI 2.38, 6.94) at post-intervention. Patients reported that they valued regular contact with the practice nurse, and that increased knowledge about healthy eating and the educational material provided had facilitated behavioural change. Practice nurses felt the intervention was easy to implement and relevant to primary care. The monthly supervision meetings were valuable and provided an opportunity for the nurses to reflect on practice and discuss new ideas.

Conclusions:

The intervention was effective and practice nurses attending a short training course followed by minimum supervision were able to successfully deliver the programme.
New benchmark for training and education is introduced
Authors: Close Anne
Published: May 2014

Skills for Health has revealed a new quality mark to provide support to health sector employers who are looking to invest in the training, education and skills development of their workforce
Treating IBS in practice: a round table discussion
Authors: Akbar Ayesha , Desaid Nisha , Jenkins Gill , O'Malley John , Rampersad-Smith Lystra , Read Nick , Smith Tom , Williams Marianne
Published: May 2014

A multidisciplinary panel of health professionals come together to share their experience in treating chronic gastrointestinal symptoms
Ensuring support for people quitting smoking
Authors: Percival Jennifer
Published: May 2014

Many people struggle to stop smoking without professional support. Jennifer Percival identifies the role practice nurses can play in helping people to quit
Frank Bruno: Fighting the good fight
Authors: Bruno Frank
Published: May 2014

Many people with mental health problems are stigmatized, ignored and given inappropriate treatment. Frank Bruno is helping them to fight back
Type 2 diabetes: the importance of managing weight
Authors: Pipe-Thomas Paul , Storey Catherine
Published: May 2014

Weight management and weight maintenance cannot be overestimated in individuals with type 2 diabetes. Paul Pipe-Thomas and Catherine Storey consider the management implications for practice nurses
Measuring ankle brachial pressure index
Authors: Thomas Susan
Published: May 2014

When a patient presents with a leg ulcer, ankle brachial pressure index (ABPI) measurements can help in providing key information to aid future treatment
Low back pain: tackling a common problem
Authors: Perry Margaret
Published: May 2014

Margaret Perry discusses the common problem of low back pain and how to address and treat it
Universal flu vaccination for children starts
Authors: Craig Laura
Published: May 2014

Laura Craig looks at the introduction of a universal childhood flu programme in the UK
Intuitive practice and skill development in diabetes care
Authors: Phillips Anne
Published: May 2014

Anne Phillips evaluates the importance of intuition during decision-making in nursing practice and patient communication. She investigates how the quality of care provided by practice nurses may benefit from it
Safeguarding adults with diabetes: identifying triggers of abuse
Authors: Phillips Stephen , Phillips Anne
Published: May 2014

There are many categories of abuse for vulnerable adults that are recognized within care. Stephen Phillips and Anne Phillips discuss diabetes-related factors that need special consideration when assessing patients at risk of abuse
Using computers safely
Authors: Iannuzzelli Paul
Published: May 2014

Children today see computers as an essential part of everyday life but many adults still see them as a problem. Understanding them is the key to making the most of their possibilities, says Paul Iannuzzelli. It’s not the technology but how it’s used that makes the difference
Fun and games for Christmas
Authors: Donbavand Tommy
Published: May 2014

Christmas is coming, and the kids are getting bored! So, here’s a selection box of games and activities to fill the holidays, and keep everyone happy!
Childcare in a multicultural society
Authors: Houston Gina
Published: May 2014

It is important to embrace and celebrate the differences which enrich the new British culture of the 21st century. By doing this we can all benefit rather than feel concerned that they threaten our individual cultures and traditional ways of life, says Gina Houston
Falling leaves
Authors: Youngman Angela
Published: May 2014

Autumn is a great season for going on walks. Angela Youngman suggests some outdoor activities to help children learn about and have fun with, their surroundings.
Giving children a sporting chance in life
Authors: Cruickshank Sarah
Published: May 2014

Doing exercise is crucial to maintaining a healthy lifestyle. Sarah Cruickshank suggests how to encourage physical development through sport.
Personal hygiene and disinfection
Authors: Chapleo Rob
Published: May 2014

The 1989 Children Act says that there must be a minimum of one toilet to every 10 children regardless of the age of the children, the premises or the type of care. There is no stipulation about separate boys' and girls' toilets. If possible, urinals and toilet pedestals should be of a size to suit small children.
Teaching number
Authors: Burton Ann
Published: May 2014

Children are taught number so they can make sense of the world around them. They already use number, in its widest context, innately from an early age, such as judging the height/width of spaces where they might crawl. Helping a child understand number enables them to solve practical problems and gives them the taste of success and confidence to tackle the next hurdle. The ability to deal with shape, size, pattern and quantity in the pre-school environment prepares them for their entry to compulsory schooling.
Approaches to snack time
Authors: Kirby Heather
Published: May 2014

There are always a few surprised faces when I inform parents (and teachers, I should add!) that we do not have a set time for our drinks, but instead allow the children to decide WHEN to have their drink, WHAT to have and WHO to sit with.
Comparing measures
Authors: Jones Caroline
Published: May 2014

Comparison of measures is often overlooked in the pre-school. However, it is an important element of early mathematical experiences which will lay the foundations for a whole range of concepts in science as well as in mathematics. More importantly children will learn that mathematics can be fun!
Batteries, bulbs and wow!
Authors: Creary Carole
Published: May 2014

To work, any electrical device must have a complete circuit. Complicated devices obviously have many complex circuits and investigating these is best left to the qualified electrician but simple circuits can be great fun.
Happy hands
Authors: Wright Kate
Published: May 2014

Use this game to help your child in their physical development - it's also an ideal way to help calm down an over excited child
Arrival time: making families welcome
Authors: Murley Sarah
Published: May 2014

Imagine arriving at a party that you didn't really want to go to, being dropped off by someone you would rather stay with, entering a loud and busy room and being left to find your way around or pluck up courage to join in established conversations. If your host is ignoring you into the bargain you would be forgiven for turning tail and leaving straightaway!