bluuebunny/crossref_metadata_2025 huggingface dataset:
Sedentary behaviour: redefining its meaning and links to chronic disease
Authors: Stamatakis Emmanuel , Hamer Mark
Published: May 2014

Sedentary behaviour, characterized by excess sitting, is a growing public health problem across the whole population, from the young and healthy to elderly and infirm. This article gives an overview of sedentary behaviour as a chronic disease risk factor in its own right and discusses possible solutions.
Pathophysiology, management and complications of hypothermia
Authors: Lantry James , Dezman Zachary , Hirshon Jon Mark
Published: May 2014

Hypothermia, either accidental or therapeutic, is when the body’s core temperature is less than 35.0°C. This article examines the pathophysiology, clinical features and management of both intentional and unintentional hypothermia with a focus on the current literature regarding treatment protocols.
Surgical management of end-stage heart failure
Authors: Sharkey A , Warriner D , Braidley P
Published: May 2014

This review explores the history, methods and evidence surrounding the various surgical therapeutic options which are available for patients with end-stage heart failure.
Spondylolisthesis: a pictorial review
Authors: Burke Christopher J , Shah Dhiren , Saha Shouvik , Houghton Russell
Published: May 2014

Spondylolisthesis is often poorly understood by clinicians and radiologists. Incorrectly perceived as being chiefly related to pars defects, in reality spondylolisthesis has multiple aetiologies with differing clinical implications. This article addresses the salient radiological findings in the assessment of spondylolisthesis.
Peripheral occipital nerve stimulation to treat chronic refractory migraine
Authors: Ashkan Keyoumars , Dowson Andrew
Published: May 2014

Peripheral nerve stimulation of the occipital nerve has a favourable efficacy to safety profile for chronic migraine, which is notoriously difficult to treat. This article covers the rationale, surgical procedure and clinical data for this treatment option.
Cauda equina syndrome: a clinical review for the frontline clinician
Authors: Mukherjee Soumya , Thakur Bhaskar , Crocker Matthew
Published: May 2014

Cauda equina syndrome is a combination of symptoms and signs resulting from cauda equina compression. It requires a prompt diagnosis and emergency surgical referral. There is a large medicolegal burden surrounding the condition.
Extended-duration hospital shifts, medical errors and patient mortality
Authors: Leroyer Elodie , Romieu Valérie , Mediouni Zakia , Bécour Bertrand , Descatha Alexis
Published: May 2014

A meta-analysis was undertaken to study the association between extended medical shifts and consequences for patients. In six studies, the meta odds ratio was increased for mortality and for serious medical errors, but not for preventable medical errors and for physicians who slept >6 hours.
Nasal packing for epistaxis: an evidence-based review
Authors: Killick Neil , Malik Vikas , Kumar B Nirmal
Published: May 2014

Nasal packing is a commonly used but seldom taught technique for management of epistaxis. When used by non-ear, nose and throat specialists with minimal training and limited knowledge of nasal anatomy nasal packs are often placed incorrectly, leading to multiple attempts, unnecessary discomfort and wasted resources.
Radiology of the duodenum
Authors: Darrah E Rachel A , Nolan Daniel J
Published: May 2014

Radiological imaging techniques play an important role in the diagnosis of duodenal disorders. The radiological appearances of a variety of interesting but uncommon disorders that involve the duodenum, particularly the duodenal loop, are reviewed.
Novel treatments in inflammatory bowel disease
Authors: Pathmakanthan Shri , Stack William A
Published: May 2014

Recent advances in inflammatory bowel disease therapeutics have led to improved formulations of existing treatments and new indications for established drugs. Truly novel therapies based on recent understanding of pathogenesis are also being developed. These new treatments and their likely impact on the management of inflammatory bowel disease in the future are discussed.
Anaesthesia for a patient with severe cardiorespiratory disease
Authors: Stocker Mary , Soar Jasmeet , Koehli Nik
Published: May 2014

A 76-year-old, 45 kg female, with severe aortic stenosis, angina, paroxysmal atrial fibrillation (AF), osteoporosis and asthma presented for a left dynamic hip screw for a fractured neck of femur. She was short of breath at rest with audible wheeze. She had 3 pillow orthopnoea and a hiatus hernia. She was taking frusemide 80 mg daily, amiodarone 200 mg daily, isosorbide mononitrate 25 mg daily, salbutamol and steroid inhalers, and gaviscon. She had an O2 saturation of 88% on air, biventricular cardiac failure, an ejection systolic heart murmur loudest in the aortic area radiating to the carotids, widespread expiratory wheeze and severe kyphosis.
Prostatitis
Authors: Thin RNT
Published: May 2014

Prostatitis, especially chronic prostatitis, is sometimes regarded as an obscure, ill-defined condition, perhaps because the anatomical location of the gland and ill-defined symptoms make diagnosis difficult. Treatment may appear time consuming and tiresome for doctor and patient, but by following established principles, diagnosis is often simple and management straightforward.
Diagnosis of hip pain in children
Authors: Maroo Sanjay
Published: May 2014

Hip pain is uncommon in children and imaging plays a central role in diagnosis and follow-up. The commonest cause of hip pain is acute transient synovitis. Other causes, which vary according to the age group of the child, include Perthes' disease and slipped capital femoral epiphyses. This review discusses the differential diagnosis and imaging pathways required.
Postgraduate education and training: challenges for the future
Authors: Orme Michael
Published: May 2014

In spite of much attention to the needs of doctors in the training grades over the last decade, the current agenda for change in the NHS is very large and much needs to be done to fit these trainees for the career grade doctors of the future. This article looks briefly at some of the issues facing training grade doctors as they train for a career in the NHS in the first part of the twenty-first century.
A rare cause of non-cardiogenic pulmonary oedema
Authors: Meghjee SPL , Li Kam Wa TC
Published: May 2014

Venous air embolism (VAE) is a wellknown complication of trauma and many surgical, diagnostic, and therapeutic procedures. We present an unusual case of a male health-care worker who attempted suicide by venous injection of air (in the knowledge that a small amount of air embolus could be fatal), resulting in severe pulmonary oedema.
Surgery for voice
Authors: Davies D Garfield
Published: May 2014

Preoperative assessment in a multidisciplinary voice clinic, using stroboscopy, is essential. In the treatment of benign vocal fold mucosal disorders precise phonosurgical techniques, using high magnification which respects the multilayered structure of the vocal fold, are mandatory. A paralysed vocal fold can be assessed by electromyography and medialization thyroplasty procedures offer excellent ‘fine tuning’ of the voice.
Nuclear cardiology in clinical practice
Authors: Appleby Mark A , Pennell Dudley J
Published: May 2014

This article is an overview of nuclear cardiology for the busy clinician. We discuss the use of myocardial perfusion scans, radionuclide ventriculography, positron emission tomography scans and the interpretation of nuclear scan reports.
Carotid endarterectomy under local anaesthesia
Authors: O'Hare DJ , Bodenham AR
Published: May 2014

Carotid endarterectomy has been widely used for the surgical treatment of carotid stenosis, and may be performed under either general or local anaesthesia. This article examines the relative merits of both techniques for carotid endarterectomy, and describes the local anaesthetic technique used by the authors for this procedure.
Imaging and stenting for renal artery stenosis
Authors: Dowling RJ , Laing AD , Vincent JM
Published: May 2014

Renal artery stenosis is a potentially correctable cause of hypertension and renal failure, using endoluminal or, less commonly, surgical techniques. A number of imaging techniques can be used to diagnose renal artery stenosis, all with similar accuracy.
Combination therapy for chronic hepatitis C: interferon and ribavirin
Authors: Christie John ML , Chapman Roger WG
Published: May 2014

Hepatitis C virus (HCV) infection is one of the commonest causes of liver cirrhosis and hepatocellular carcinoma. This review deals with treatment of chronic HCV infection with a combination of interferon and ribavirin. Recent trials have shown that approximately 40% of patients will clear HCV with combination treatment. This is an important advance in the treatment of this serious viral infection.
Using the Internet for postgraduate medical education
Authors: Church RD , Elves AWS , Inman R , Scriven PM
Published: May 2014

Obtaining information from the Internet can be fun. As the Internet is unregulated, the quality of this information can vary enormously and time can be wasted searching poor quality websites. Despite this, use of the Internet for postgraduate medical education is increasing.
Interferon-alpha induced ‘tertiary mania’
Authors: Kingsley David
Published: May 2014

A 32-year-old woman with no previous history of psychiatric illness was admitted to an acute psychiatric unit, having been behaving increasingly bizarrely over the previous week. She had persecutory delusions and grandiosity, but admitted to a 2-week history of low mood. Her sleep was disturbed and she had not slept at all on the night before admission. At admission she fluctuated between elation and aggression. Her speech was pressured and she demonstrated flight of ideas as well as poor attention and marked distractability.

She had been treated for the previous 4 years with recombinant interferon-alpha by subcutaneous injection for essential thrombocythaemia, her dose having been gradually reduced to 3 megaunits twice-weekly at the time of admission. Physical examination on admission revealed no abnormalities. However, routine biochemical investigation revealed her to be profoundly hypothyroid, with a free thyroxine of 1 pmol/litre (10–26) and a thyroid- stimulating hormone of >84 mU/litre (0.5–6.5). Further investigation revealed a raised thyroid microsome antibody at 6400 units (<400). Her platelet count was 435×109/litre, revealing her essential thrombocythaemia to be well controlled. All other investigations, including electrocardiogram, lipids, creatinine kinase and lactate dehydrogenase, were normal.

The patient required restraint and sedation. Her mental state improved rapidly over the following few days on oral haloperidol 5 mg three times daily. On discovery of her hypothyroidism, she denied a history of any classical physical symptoms. She was commenced on thyroxine 50 μg daily and her interferon-alpha discontinued. Her haloperidol was reduced and then discontinued at 1 month post-discharge. She has since remained well during the subsequent 12 months.
Institutional abuse of older people
Authors: Bennett GCJ
Published: May 2014

‘It is self-evident that when elderly, often confused residents are made to eat their own faeces, are left unattended, are physically manhandled or are forced to pay money to care staff and even helped to die, there is something seriously wrong’ (Vousden, 1987).
Flixotide Nebules: new for chronic severe asthma
Authors: Mukherjee Subir K
Published: May 2014

Allen & Hanburys recently launched Flixotide Nebules for prophylactic management of severe chronic asthma in patients requiring high-dose inhaled or oral corticosteroid therapy.
Provision of an out-of-hours imaging service: expectations vs reality
Authors: Weir Jamie
Published: May 2014

I believe there are fundamental principles underlying the provision of an out-of-hours imaging service. These include fairly dogmatic statements such as those listed on page 5 of the Royal College of Radiologists (1996) document on out of hours working, namely:
Continuous combined hormone replacement therapy and its effects
Authors: Sturdee David W
Published: May 2014

The cessation of menstruation at the menopause is a great relief for most women. Hormone replacement therapy (HRT) in sequential regimens re-creates a monthly cycle and period-type bleeds, which are a major cause for dissatisfaction, especially for older, postmenopausal women. Continuous combined therapy aims to provide the benefits of HRT without cyclical bleeding.
Anaesthetic management of a patient with multiple system atrophy (Shy-Drager syndrome) for urgent hip surgery
Authors: Dewhurst Alex , Sidebottom Paul
Published: May 2014

A 71-year-old male was admitted with a fractured left neck of femur. He had multiple system atrophy (MSA) (Schatz, 1996) diagnosed by a neurologist 18 months previously. MSA shows features of parkinsonism and severe autonomic dysfunction, and a common finding is extreme orthostatic hypotension with failure to mount a reflex tachycardia.
Sample size determination in clinical research: 1
Authors: Ogundipe Laofe
Published: May 2014

In this two-part series, the main designs in clinical research are considered and, using examples, sample size calculation is explained. The information required in order to calculate the sample size for clinical research is highlighted to enable researchers to spend their time most efficiently with statisticians.
Zyban: an effective treatment for nicotine addiction
Authors: Steele Chris
Published: May 2014

Recent research has identified nicotine as a powerfully addictive substance. This article outlines how the new non-nicotine smoking cessation drug, Zyban, can help people to break the cycle of addiction and stop smoking.
Thyroid disease in pregnancy
Authors: Girling Joanna C
Published: May 2014

Some interesting recent developments have influenced the modern management of thyroid disease in pregnancy and enhanced our understanding of the interaction between maternal and fetal thyroid function, including the complex role of the placenta. This article will review the latest ideas in this area.
A triple dose of iron deficiency anaemia
Authors: Levison John , Bhandari Sunil
Published: May 2014

A81-year-old ex-smoker, who previously smoked 20 cigarettes/day, and had an alcohol consumption of 8–10 units/week, presented with a 3-month history of ‘indigestion’ and breathlessness. He denied weight loss, dysphagia, vomiting, change in bowel habit or melaena. He denied taking aspirin or other non-steroidal anti-inflammatory medication. He suffered from ischaemic heart disease with biventriciular dysfunction. He was pale and had a blood pressure of 140/60 mmHg with no postural drop. The rest of the examination was unremarkable.

Investigations showed a hypochromic (mean corpuscular volume 56.1 fL) microcytic (mean corpuscular haemoglobin 13 pg) anaemia with numerous hypersegmented neutrophils on blood film, a haemoglobin of 7.1 g/dl and serum ferritin of 4 μg/litre. Vitamin B12 and serum folate concentrations were normal. Upper gastrointestinal endoscopy demonstrated a 5 mm prepyloric ulcer and a 10 mm benign duodenal ulcer. Multiple biopsies were negative for Helicobacter pylori. Histology showed chronic gastritis and no malignant or dysplastic cells.

He was transfused 3 units of packed cells, and commenced on ferrous sulphate and omeprazole before discharge home with a stable haemoglobin (11.4 g/dl). Six months later he again developed iron deficiency anaemia. His haemoglobin remained low (haemoglobin 8.2 g/dl, mean corpuscular volume 62.5 fL and ferritin 6 μg/litre). His appetite remained reasonable, weight steady and bowel habit unchanged.

Repeat upper gastrointestinal endoscopy showed an abnormal ulcerated duodenal cap. Biopsy excluded neoplasm, Helicobacter pylori or infestation with giardiasis. Flexible sigmoidoscopy revealed grade II haemorrhoids and a large 2 cm tubulovillous adenomatous polyp in the sigmoid colon at 30 cm (Figure 1). Chest X-ray, abdominal ultrasound and carcinoembryonic antigen level were normal. Double contrast barium enema showed sub-total obstruction in the ascending colon (Figure 2). Radical right hemicolectomy and mesenteric node clearance of a bulky, Dukes B moderately differentiated mucinous adenocarcinoma was performed. Three years on he remains well, his haemoglobin level is 11 g/dl and there is no evidence of tumour recurrence.
Alcohol: matters of life and death
Authors: Paton Alex
Published: May 2014

Most of us enjoy alcohol and drink moderately, but some 7 million people in Britain drink more than the old ‘safe’ levels of alcohol — 21 and 14 units a week for men and women respectively. This represents one in eight of the population, or one in six if you exclude children under 15 years of age, difficult to justify these days given the amount of drinking by young children.
Is childbirth safe in the UK and are there enough obstetricians? Letter to a Chief Executive
Authors: Eddy John W
Published: May 2014

If you are at term after a normal pregnancy and are not lucky enough to live in Portsmouth, then your chance of losing the baby during labour is higher in Great Britain than in nine other European countries, including Slovenia. The NHS Litigation Authority have put aside £1.3 billion for the next 5 years to cover litigation relating to cases of cerebral palsy, the majority of which will occur in GP- and midwife-led units. The European work directive will severely restrict staff grade and consultant hours of work over the next few years and this can only be made up by appointing more consultants.
Adverse obstetric sequelae of bacterial vaginosis
Authors: Adinkra P , Lamont RF
Published: May 2014

Bacterial vaginosis is increasingly associated with adverse sequelae in obstetrics such as preterm prelabour rupture of membranes, preterm labour and preterm birth. It is important to diagnose the condition early in pregnancy where appropriate treatment can be administered to women who are symptomatic or who are at high risk of adverse sequelae.
Continuous wear contact lenses: have we been here before?
Authors: Edwards Keith
Published: May 2014

New developments in contact lens materials have led to the introduction of new lenses designed for up to 30 days of continuous wear. Will these lenses lead to safer and healthier overnight use of lenses?
Refining the use of inhaled steroids
Authors: Miles Jon
Published: May 2014

Inhaled corticosteroids remain the most significant aspect of asthma therapy. An increasing number of drugs, devices and formulations are available to health-care professionals. This article aims to address the goals of inhaled steroid therapy and asks how well the available options meet these goals.
Acute respiratory distress syndrome in adults
Authors: Quinlan GJ , Evans TW
Published: May 2014

The acute respiratory distress syndrome (ARDS) can arise from a range of predisposing insults. Mortality rates are high for patients with ARDS and survivors require extended and expensive intensive care treatment. This article presents evidence that implicates the production of toxic and damaging reactive oxygen species in the pathogenesis of ARDS.
Use of the laryngeal mask airway for laparoscopic procedures
Authors: Aveling W , Armstrong RF
Published: May 2014

The first thing any anaesthetic trainee is taught is how to ventilate on a face mask: ‘if you plan to paralyse, first make sure you can ventilate’. In the days when the laryngeal mask airway (LMA) was still a prototype in Archie Brain's garage, anaesthetists ventilated for short periods on a mask electively or for longer periods when intubation proved difficult.
Thromboprophylaxis in medical patients
Authors: Hampton KK
Published: May 2014

Recent clinical studies have confirmed that acutely ill medical patients are at substantial risk of venous thromboembolism, which can be reduced by thromboprophylaxis with low molecular weight heparin. These studies have resulted in approval of a low molecular weight heparin (enoxaparin) for the prophylaxis of venous thromboembolism in medical patients bedridden as a result of acute illness.
Fractured neck of femur in the elderly patient
Authors: Marchant Warwick , Goldsack Craig
Published: May 2014

The 6-month mortality for these patients is quoted as up to 50%, so optimal technique is needed. General anaesthesia (GA) is better for these patients for both practical and theoretical reasons.
Medical management of facial pain
Authors: Romer HC
Published: May 2014

This article describes some of the means used to manage facial pain once serious pathology or any treatable cause has been excluded. It includes pharmacological, physical and psychological therapies.
Acute thrombosis in an aortic prosthesis: all mechanical valves are not the same
Authors: Burgess Malcolm , Millane Teri , Deiraniya Abdul
Published: May 2014

A 65-year-old man presented with symptomatic aortic valve disease and underwent aortic valve replacement with a 21 mm Hall—Kaster valve. Warfarin was commenced, and an international normalized ratio (INR) of 2.5—4.0 was recommended. Twelve years later, the patient developed a large (10 cm) ascending aortic aneurysm not involving the descending aorta. Graft replacement of the ascending aorta was performed. Inspection of the prosthesis at that time revealed it to be clean and competent, although the aortic root was heavily calcified. Eight months later, the patient was re-admitted in extremis with acute dyspnoea. For the preceding 48 hours, the intermittent absence of valve clicks had been reported by the patient's daughter. The INR on admission was 2.5 and had ranged between 2.0 and 3.6 for the 3 months before presentation. It had not been below 2.0 for at least 4 years, but on six out of the last 20 visits to the anticoagulant clinic it had been between 2.0 and 2.5. Examination revealed cardiogenic shock with a to-and-fro murmur audible at the left sternal edge. Transoesophageal echocardiography revealed free aortic regurgitation and showed thrombosis of the valve elements. Emergency surgery was considered but deemed inappropriate since the patient was moribund. Thrombolysis was attempted but the patient deteriorated relentlessly. Post-mortem confirmed the clinical impression of prosthetic valve thrombosis with no evidence of primary mechanical failure, pannus overgrowth or endocarditis (Figure 1).
Caring for others can seriously damage your health
Authors: Alexander David A , Klein Susan
Published: May 2014

To care for others is a privilege and a source of personal and job satisfaction. However, caregivers must also consider the implications of their work for their own health and welfare.
The Medical Masterclass: a new tool for continuing professional development
Authors: Firth John
Published: May 2014

The Medical Masterclass comprises twelve paper-based modules, two CD-ROMs and a companion website. Its main aim is to help doctors in their first few years of training to improve their medical skills and knowledge, and in particular in their preparation for the MRCP examination. It will also be a valuable tool for continuing professional development.
The CE mark for implantable medical devices
Authors: Randall Hazel , Croft Rodney J
Published: May 2014

A vital aspect of device and implant regulation is continual surveillance of performance after approval. Most permanent implants seldom reveal their strengths and weaknesses until they have been in clinical use for a number of years. It is vital that clinicians report problems to the manufacturers and regulatory authorities to enable emerging hazards to be promptly identified.
Abdominal actinomycosis following a forgotten intrauterine contraceptive device
Authors: Smith Simon , Dils Ruth , Fairbairn Julia , Page Renee , Finch Roger , Minton Jane
Published: May 2014

A 57-year-old housewife presented with a 4-month history of anorexia and weight loss of 3 stone, abdominal distention and discomfort. Her medical history included diet-controlled diabetes mellitus, diagnosed 6 years previously, as well as long-standing hypertension and arthritis affecting the knees and hands. She took atenolol to control her blood pressure and naproxen for her arthritis. She had stopped smoking 6 years previously and drank minimal quantities of alcohol.
Infectious mononucleosis: not always what it seems
Authors: Nye Fred
Published: May 2014

Infectious mononucleosis (IM) is a benign disease of healthy young people. Patients and their relatives therefore expect a speedy and complete recovery. This editorial explores some of the unexpected diagnostic and management problems encountered in this otherwise commonplace illness.
Salivary gland stones: diagnosis and treatment
Authors: Bull Peter D
Published: May 2014

Salivary calculi are a common cause of salivary gland disorder and may occur in any of the salivary glands and at almost any age. The stones may be small and intraductal or lie within the gland substance when they may become very large. They cause symptoms by obstructing salivary flow. Diagnosis is usually straightforward, and treatment is aimed at stone removal.
Should the neutropenic patient with respiratory failure be ventilated?
Authors: Parry-Jones Jack
Published: May 2014

The prospect of admitting a neutropenic haematology patient with respiratory failure onto an intensive care unit fills many intensivists with dread, compounded by the referring team's sometimes misplaced optimism.
The aetiology and epidemiology of faecal incontinence
Authors: Francombe James , Carter Paul S , Hershman Michael J
Published: May 2014

Faecal incontinence is experienced by at least 2% of the population and 7% of those over 65 years of age. The true incidence is probably much higher because of the stigmata of the affliction leading to underreporting. The common causes of faecal incontinence are discussed.
Percutaneous balloon mitral valvuloplasty
Authors: Prendergast Bernard D , Shaw Stuart
Published: May 2014

Mitral stenosis is commonly encountered in the elderly and among immigrant communities. Percutaneous balloon mitral valvuloplasty provides effective treatment. The present article provides a brief overview of the principles of patient selection, technical details of the procedure itself and information concerning complications and follow-up.
Writing your curriculum vitae
Authors: McKenzie Sheila
Published: May 2014

Your curriculum vitae (CV) is your gateway to shortlisting. A good CV takes a long time to prepare. It should not only record your training but, more importantly, should reflect your 'physicianly' qualities, management skills and knowledge of health-care systems.
Necrotizing fasciitis: an unusual cause
Authors: Raman S , Joseph A , Haray PN
Published: May 2014

A 76-year-old woman was admitted through the accident and emergency department with a paraumbilical lump of 2 weeks' duration and a sinus which was discharging foul-smelling pus since that morning. One month before this, she was treated for abdominal pain with diarrhoea and vomiting by her GP with loperamide. On examination, she was febrile but was stable. Abdominal examination revealed a 10 cm x 5 cm fluctuant paraumbilical swelling with a sinus discharging foul-smelling pus. The surrounding skin was erythematous with patchy blackened areas. The provisional diagnosis at this stage was of an abdominal wall abscess with a possible colocutaneous fistula.
Appropriateness ratings for coronary revascularization
Authors: Hemingway Harry
Published: May 2014

Deciding to revascularize a patient with coronary artery disease is among the most common, costly and complex decisions in clinical medicine. Coronary angiography is the most commonly performed hospital procedure among those aged over 65 years in the USA and rates of revascularization, particularly percutaneous intervention, continue to rise in many countries. For each patient the clinician must decide whether the benefit of revascularization exceeds harm sufficiently to justify the procedure. This involves weighing half a dozen or so patient characteristics: degree of symptomatic impairment, number of diseased vessels, left ventricular function, extent of medical therapy and the results of exercise electrocardiography (ECG). Combinations of these variables define the specific patient indication.
Functional imaging in stroke
Authors: Jäger HR , Ward NS
Published: May 2014

Recent advances in magnetic resonance techniques make it possible to image physiological parameters such as molecular diffusion, tissue perfusion and cortical activation. These techniques greatly contribute to the early detection and to the understanding of the pathophysiological evolution and recovery from ischaemic stroke.
Common injuries of the shoulder
Authors: Jennings Simon , Cohen Brian
Published: May 2014

Shoulder injuries may occur by direct impact, e.g. as the result of high-energy collisions as in a road traffic accident or sport, or indirectly where the force is transmitted via the arm to the shoulder complex, e.g. a fall onto an outstretched hand. Standard assessment begins by taking a history of the injury and fully examining the patient. Imaging should relate to clinical findings.
The first reported presentation of rickets with metabolic seizures
Authors: Stebbing Claire , Mansy Salah , Kanabar Dipack
Published: May 2014

A 5-month-old Afro-Caribbean infant presented to the accident and emergency department in December 2000 following a tonic-clonic seizure that lasted 5 minutes. He had been born by normal vaginal delivery and remained fully breast-fed. He had no past medical history of note and in particular no previous history of fits or abnormal movements. There was no family history of epilepsy.
A case of Bannwarth syndrome
Authors: Farrugia Maria E
Published: May 2014

A 72-year-old woman presented with a short history of radicular pain down her left leg. She was admitted to a cottage hospital where she developed progressive weakness in both legs. She was noted to develop a rash with target-like lesions, thought to be erythema multiforme. She was otherwise well and apyrexial.
What are you going to do about the base deficit?
Authors: Grocott MPW , Stephens R , Hamilton MA
Published: May 2014

The management of elevated blood acid (metabolic acidosis) is poorly understood and standard therapies are often initiated without consideration of the underlying pathophysiology.
Anorectal sepsis
Authors: Hughes F , Mehta S
Published: May 2014

Anorectal sepsis is a common cause of hospital admission, presenting with abscess or fistula formation. This article discusses the aetiology of acute anorectal sepsis and its management.
Culinary delights in kitchen pathology
Authors: Patel Freddy
Published: May 2014

It is fascinating that so much of the descriptive pathology appears to have originated in the kitchen. The evidence is plain to the past medical students of the older textbooks of general pathology from an era dominated by male pathologists. It is curious that in modern times it is no longer trendy to use the cook's vocabulary when more and more pathologists are women.

One wonders how often the mortuary apron was changed for the kitchen variety to transform into the naked chef, or has there always been a good wife behind the pathologist. The tabby cat must have wandered into the kitchen when the pathologist was trying to imagine the tabby heart in anaemia. An amusing spin is that the red kidney bean would not have been so named but for the clinical gourmet at the kitchen table.

A compilation of delightful culinary ingredients has been prepared in alphabetical order and served up with the associated morbid anatomical diagnosis. The author would be grateful for other interesting gems from the cookery book which can be added on to the list.
Management of osteoid osteoma
Authors: Witt Johan
Published: May 2014

An osteoid osteoma is a benign bone tumour which can cause severe pain. Diagnosis is often delayed, as it may mimic other musculoskeletal conditions. The most pertinent investigations for diagnosis are a bone scan and computed tomography of the area of increased uptake. Treatment with minimally invasive techniques allows early return to full function.
Distance learning to support postgraduate training in obstetrics and gynaecology
Authors: Finch Rob , Duffy Sean
Published: May 2014

A number of major distance learning programmes have been launched by the medical Royal Colleges for the purposes of training and/or continuing medical education. The most recent is ‘StratOG’, a modular programme published by the Royal College of Obstetricians and Gynaecologists (RCOG) and aimed primarily at candidates for the part 2 RCOG Membership examination.
Combined spinal and epidural anaesthesia after a failed epidural
Authors: Chelliah Subbiah
Published: May 2014

A 27-year-old woman had had a lumbar epidural inserted 8hours previously during labour. Epidural top-ups had given her some relief (0.125% bupivacaine with 2mg/ml fentanyl initially and later 0.25% bupivacaine) but she continued to use entonox. The baby was occipitotransverse. Since the cervix was fully dilated and there was no fetal distress, the obstetrician wanted to perform a trial of forceps and proceed to a caesarean section if that was unsuccessful.
Children's fractures ‘not to be missed’
Authors: Paterson J Mark H
Published: May 2014

As the title of this article suggests, this is not a comprehensive guide to childhood injury, but rather a selective review of those injuries which are commonly overlooked, misdiagnosed or whose significance tends to be underestimated.
Patient safety: how are we doing in Australia and England?
Authors: Smallwood Richard
Published: May 2014

In both Australia and England, the harm we do to patients has become a very public issue, provoking somewhat different government responses in each country. It is too early to tell how effective those responses will be.
Management of amiodarone-induced thyrotoxicosis
Authors: Younis Naveed , El-Houni Ali , Soran Handrean , Jones Ian R
Published: May 2014

Thyrotoxicosis occurs in up to 3% of people prescribed amiodarone in the UK. The management of amiodarone-induced thyrotoxicosis remains a clinical challenge, as data on optimal treatment from controlled trials are not available. This review will focus on current lines of management.
Induction for overseas qualified doctors
Authors: Ong Yong-Lock , McFadden Gráinne , Gayen Anita
Published: May 2014

This study describes a strategy for the integration of overseas doctors with different professional and cultural backgrounds. A central induction course, complementing local trust-based induction programmes, was developed and evaluated by the London Deanery. Most participants found the course helpful, and their comments were used to further improve it.
A study on surgical knowledge of house officers and their role in consent
Authors: Arumugam PJ , Harikrishnan AB , Carr ND , Morgan AR , Beynon J
Published: May 2014

This study shows a targeted training for house officers relating to surgical procedures and consenting issues was helpful. The authors recommend that advice on obtaining consent should be a part of the induction programme for surgical house officers.
New drugs in glaucoma therapy
Authors: Cunliffe Ian
Published: May 2014

The balance between surgery and medical therapy in glaucoma management has changed significantly in recent years. This can be traced primarily to the availability of several new therapeutic agents. This article takes a more detailed look at the prostaglandin analogues latanoprost and travoprost and the prostamide bimatoprost.
The future of meningitis vaccines
Authors: Segal S , Pollard AJ
Published: May 2014

Without effective vaccines meningitis remains a substantial worldwide threat with major health-care implications. A number of advances have been made in vaccine design and implementation over the last decade, with new vaccine initiatives providing substantial promise for the future reduction of global disease burden.
The role of the specialist nurse in pelvic floor dysfunction
Authors: Blackwell Helen
Published: May 2014

Pelvic floor dysfunction can have a devastating effect on people's lives. The specialist nurse can play a vital role within the multidisciplinary team to help improve the quality of life for these patients by offering conservative management and support through surgical treatment options.
Modern dressings: healing surgical wounds by secondary intention
Authors: Dziewulski Peter , James Stuart , Taylor David , Bosanquet Nick , Cutting Keith , West Peter
Published: May 2014

There is a lack of robust research evidence on many aspects of wound care. The inaugural Professional Select Committee on Wound Care, held at the Royal College of Surgeons, explored the relative value of modern and traditional dressings in treating wounds healing by secondary intention. This article outlines its main findings.
Computed tomography of the brain: a pictorial review
Authors: Cook Chris KL
Published: May 2014

This pictorial review briefly describes the basic principles of computed tomography scanning of the brain. A series of commonly encountered intracranial pathologies is then reviewed.
Retrograde ejaculation and male infertility
Authors: Aust Thomas R , Lewis-Jones D Iwan
Published: May 2014

Incompetence of the internal urethral sphincter causes semen to pass into the bladder. Infertility can be successfully treated by restoring normal ejaculation or by sperm retrieval techniques.
Lights, camera, action!
Authors: Russell Mike
Published: May 2014

Longhill Primary School has introduced television production to help teach speaking and listening skills. Mike Russell explains
Outstanding school FAQs
Authors: Roche Fergal
Published: May 2014

What is it that headteachers at outstanding schools focus on? Fergal Roche takes a look.
Ofsted: Leadership and Management
Authors: O'Connell Suzanne
Published: May 2014

In the third of our series focusing on the four core inspection judgements, we hear from schools judged outstanding for leadership and management and offer advice for other schools seeking to improve in this crucial area. Suzanne O'Connell reports
Chlamydial conjunctivitis: presentation and investigations
Authors: Tallouzi Mohammad
Published: May 2014

Chlamydial conjunctivitis results from infection by chlamydia parasite and typically affects sexually active teenagers and young adults. It is the most frequent infectious cause of neonatal conjunctivitis in the UK. It is also the most common curable sexually transmitted infection in the UK. Its clinical manifestations in the eye involve the conjunctiva and the cornea. Untreated disease leads to a chronic remittent course of infection, keratitis (infection to the cornea) and possibly iritis (infammation to the iris) and can lead to total loss of vision if left untreated. This article will focus on the main clinical manifestation of chlamydial conjunctivitis and its investigations. Furthermore, the article will focus on the early management and referral of those patients who present with chlamydial conjunctivitis. Early diagnosis and early management help to prevent ocular and sytemic complications.
The role of the Macmillan carer in a new community care service
Authors: Ferguson Claire , Nelson Catherine , Rhodes Penny , Clark David
Published: May 2014

Care in the community has become a central feature of government policy for health and social care in the, 1990s. Reflecting this there is now widespread interest in the provision of palliative care services in community and domiciliary settings. In, 1995 Macmillan Cancer Relief embarked on a programme of development projects concerned to provide support in the home to patients who have palliative care needs, together with their informal carers. The key workers in the schemes are specially trained health care assistants, known as Macmillan Carers. An evaluation of the English schemes has been conducted and this paper draws on one distinct element of the study. Based on interviews with 37 Macmillan Carers, the paper highlights a number of key issues: first, the role of the qualified and unqualified nurse; second, the implications of the health and social care divide for this type of service; third, wider concepts of formal and informal care
A multidisciplinary approach to managing breathlessness in lung cancer
Authors: Scullion Jane E , Henry Claire
Published: May 2014

Patients with lung cancer often experience symptoms, especially breathlessness, that they put down to the disease process, but which may respond to both pharmacological and non-pharmacological interventions. Breathlessness can lead to a significant impairment in the ability of a person to lead a normal life. The consequent reduction in quality of life may be experienced by the person in terms of emotional or social limitations as well as that expressed in actual physical suffering. Ahmedzai (1988) states that whilst doctors are well trained and motivated in the investigation and current management of disease, the are often unable (or reluctant) to undertake the terminal care of the same patient with equal vigour and commitment. To the patient, there is often the feeling of devastation when faced with the fact that medically there is little more that can be done for them. The following paper looking at a multidisciplinary approach to dealing with breathlessness in lung cancer aims to provide a quality of life enhancing service, to fill a perceived gap in service provision and to show that there is nearly always something that can be done.
The Lived Experience of Irish palliative care nurses
Authors: Larkin Philip J
Published: May 2014

Hermeneutic phenomenology has been identified as a valuable framework for undertaking nursing research and enables nurses to explore aesthetic knowledge about their practice. The existential perspective of Hans-Georg Gadamer (1976) emphasizes the unique place of history in shaping meaning about the current lifeworld. The active role of the researcher, i.e. creating data with the respondent, rather than passive objectivity, is valued in hermeneutic phenomenology. This study focuses on the lived experience of 16 registered nurses working in a palliative home care setting. The aim of the study was to gain a deeper understanding of the meaning palliative nurses derive from working with the dying and also to establish how this is reflected in Irish culture. Five expressions of unique commonality which encapsulated the essence of being an Irish palliative care nurse were derived from bilingual in-depth interviews using Irish poetry — a culturally sensitive research tool. Gadamer’s hermeneutic philosophy provided a valuable approach to exploring this previously unexplored area of nursing research (Gadamer, 1976) and its use as a potential framework for subsequent palliative nursing research warrants further investigation.
Hidden dimensions
Authors: Webber Jeanette
Published: May 2014

Recently I have given some thought to what makes nurses tick and have asked myself why it is that, despite the demands of the job, heavy workloads and lack of financial incentives, many nurses continue to be committed to the care of patients in their chosen fields.
Chemotherapy for advanced colorectal cancer: ‘Tomudex™’
Authors: Meehan Marie
Published: May 2014

Palliative chemotherapy in advanced colorectal cancer prolongs survival and maintains quality of life, compared with best supportive care alone. For several decades, only chemotherapy regimens based on 5-fluorouracil, with or without leucovorin (LV), were available, and the recent availability of ‘Tomudex’ (raltitrexed) has provided an additional therapeutic option. The efficacy of ‘Tomudex’ (response rates, survival and palliative benefits) is similar to that of 5-fluorouracil-based regimens. A large clinical trial (495 patients with advanced colorectal cancer) showed that the superior tolerability profile of ‘Tomudex’ compared with 5-fluorouracil/LV, especially during the first cycle of treatment, led to better maintained quality of life (Zalcberg, 1997). Furthermore, the administration of ‘Tomudex’ is simpler for patients and nurses, and patients have identified the side-effect and administration profiles of ‘Tomudex’ as less upsetting than standard chemotherapy regimens. Where chemotherapy regimens provide equivalent response rates and survival, treatment should be guided by additional criteria that are relevant to the ways in which chemotherapy affects patients’ day-to-day lives. In this regard, ‘Tomudex’ displays a number of important advantages over standard 5-fluorouracil-based chemotherapy. The discovery of ‘Tomudex’ is a significant step forward in the development of chemotherapy for advanced colorectal cancer.
A pilot study of an outcome measure in palliative care
Authors: Norris Ann
Published: May 2014

In all areas of health care, including palliative care, there is an increasing demand to demonstrate the effectiveness of interventions using outcome measures. Occupational therapists have an increasing role to play in palliative care and the purpose of this study was to assess the effectiveness of the Canadian Occupational Performance Measure (COPM) as an outcome measure for occupational therapy intervention within a palliative care day unit. Twenty patients from a day unit participated in the study over a six-month period and the COPM was administered using a semi-structured interview pre- and post-intervention. The results show that the COPM focuses on the patient’s role in the intervention thereby ensuring that issues important to the patient are emphasized. However, it was noted that the concept of self-rating proved difficult to use in practice, the final scores were subjective and that interpretation using the score system alone could prove difficult.
Death and dying: exploring the web
Authors: Sweeney John
Published: May 2014

The dictum that ‘Death and the sun are not to be looked at steadily’ is overturned by this ambitious site which offers a broad perspective on death and dying. The pressures of symptom control and interactions with patients may often prevent those working in this area from considering wider issues in palliative care. However, this site provides an interactive experience which is worth a visit from anyone interested in how he/she or indeed society feels about dying.
An integrated approach to wound management
Authors: Mallett Jane , Mulholland Jane , Laverty Diane , Fuller Frances , Baxter Amanda , Faithfull Sara , Fenlon Deborah
Published: May 2014

Patients with cancer or those undergoing palliative care may have complex and/or chronic wounds accompanied by a range of distressing symptoms. Therefore, the management of these wounds is primarily aimed at reducing their impact on patients and their families (Laverty et al, 1997). An interdisciplinary Wound Management Group was set up at The Royal Marsden Hospital with the aim of promoting good quality wound management and care for patients with cancer. This article highlights the ways in which this Group has been instrumental in facilitating best practice while outlining the difficulties in ensuring evidence-based care where little research has been conducted into the efficacy of wound management interventions for complex and/or chronic wounds.
Palliative care in Europe: ethics and communication
Authors: Wilkinson Susie
Published: May 2014

Communication is a complex issue and one that raises ethical questions within all areas of medicine and in particular palliative care. A group of researchers from England, Italy, the Netherlands and Spain have joined together in a European Commission Biomed 2 project entitled Palliative Care in Europe: Ethics and Communication. The project commenced in August 1998 and aims to address the ethical issues relating to communication within European palliative care services.