bluuebunny/crossref_metadata_2025 huggingface dataset:
Review of a nurse practitioner led short stay unit
Authors: Basu Shimona , Garside Jonathan
Published: May 2014

To review the function of a novel paediatric nurse practitioner (PNP) led short stay assessment unit. A prospective observational study of acute attendances to this unit over 1 year, with 4 one-month data collection periods. Outcomes evaluated included: length of stay, diagnoses, discharges, transfers to the offsite inpatient paediatric ward and re-attendance rates. 270 acute attendances (mean age of 5 years, 23% < 1 year) and a further 107 patients for planned reviews/investigations were seen. The majority (65%) of acute patients spent less than 8 hours on the unit with a discharge rate of 76% and re-attendance of 3%. No significant differences were found in discharge or re-attendance rates for patients seen by PNPs compared to doctors (75% vs 78%, p = 0.66; 1.9% vs 4.4% p = 0.29 respectively). A predominantly PNP-led short stay paediatric assessment unit, with appropriate multidisciplinary support may be a viable and safe option.
An overview of musculoskeletal conditions
Authors: Walker Jennie
Published: May 2014

Musculoskeletal conditions affect a significant number of people regardless of age or race. Osteoporosis, osteoarthritis and rheumatoid arthritis are common conditions, which have a considerable impact on acute and primary healthcare services. The management of musculoskeletal conditions emphasises the need for patient empowerment and education. The involvement of the multidisciplinary team is essential to maximise timely and effective management principles.
Quality accounts and quality monitoring by acute trust boards
Authors: Ritchie Benjamin , Mays Nicholas
Published: May 2014

The Department of Health’s main objective in mandating NHS acute sector providers in England to produce annual Quality Accounts from 2009–10 onwards was to increase the level of engagement of provider boards in quality improvement in their organisations. Quality Accounts are also intended to encourage boards to assess quality across the full range of services they offer. This study analysed the meeting minutes of boards of directors from a random sample of 15 NHS acute trusts to determine the prevalence of recurring board reports providing information on quality of care over the period 2008–2010. An increase in several types of quality-related reports was found. The board minutes of three trusts suggested that the requirement to produce Quality Accounts had led to modifications to the regular performance reports at board meetings. However, there was little evidence to suggest boards were monitoring the quality of specific services provided by their trusts at the main board meeting. Boards should consider giving more attention in their meetings to the clinical effectiveness of specific services and an appropriate response (e.g. by using clinical audits) rather than focusing so much on topics that are the subject of national targets such as hospital-acquired infections and waiting times.
Lean management in the NHS: fad or panacea
Authors: McIntosh Bryan , Cookson Graham
Published: May 2014

Lean principles emerged in the Japanese manufacturing industry after the Second World War. Lean management focuses on improving product quality while eliminating waste—primarily through process redesign and the integration of employees, management, suppliers and customers into the quality management process. The NHS is under significant pressure to improve productivity while maintaining or improving service quality, at the same time as service demand increases. The Quality, Innovation, Productivity and Prevention (QIPP) programme's primary concern is to ensure that financial resources are used to bring maximum benefit and quality of care to patients ( Department of Health, 2010 ). Lean management could therefore offer a panacea for the NHS, although its applicability to the health service sector is contested. This article investigates whether lean management is merely a fad or whether it could alleviate the pressure the NHS faces. While specific clinical processes may easily adopt lean processes and practices, healthcare organisations will need a paradigm shift in their management philosophy to adopt lean more widely. The promise of lean management remains elusive but could be harnessed by willing organisations.
QIPP savings within the NHS: easier than perceived
Authors: Cantero Leigh
Published: May 2014

Finding QIPP (Quality, Innovation, Productivity, and Prevention) savings within the NHS can be an arduous task within an environment where there seems to be continual cuts to staff. Targets for NHS services can be as high as 10% of the annual budget, which is a tough ask for any leader to manage to those objectives, but with a few guided steps to provide direction and clarity on this agenda item, it may be easier than perceived. Within this article quick solutions towards cash release schemes are given to support this substantial requirement. Following these steps will enable a focus to provide the financial target to the betterment of the bottom line and efficiency to the service.
Financial risk in commissioning: cancer costs
Authors: Jones Rod
Published: May 2014

The financial risk and volatility in costs associated with cancer commissioning is very high. Depending on location, commissioning groups with an anticipated £10 million cancer spend can experience anywhere between 10% to 50% average year-to-year volatility in costs. Due to the effect of size the range associated with this risk drops to 3.2% to 15.8% for a cancer budget of £100 million, equivalent to the largest PCT populations (i.e. Hampshire, Leeds, Norfolk, etc). The wide range arises from the location-specific (environmental) nature of risk. Particular high volume cancers (rectum, colon, breast, etc), exhibit high volatility due to special sensitivity to the environment and show cyclic behaviour over extended time periods. The financial risk in cancer commissioning therefore involves a high degree of complex spatio-temporal trends which are reminiscent of infectious outbreaks. Especially high volatility in the costs for ‘miscellaneous’ cancers suggest they should be commissioned as part of wider regional risk pools.
Quality improvement leadership: it's child's play
Authors: Wilson Steven
Published: May 2014

Leading quality improvement is complex and challenging. It requires a broad range of skills and behaviours to bring about the big changes required. Looking outside of our normal sphere of experience and activity can give a new perspective to the task. As quality improvement (QI) leaders there is much we can learn from children about creativity, motivation, communication and resilience. This article sets out seven simple lessons that we can learn from children, and from this suggests the quality improvement skills that are essential to support successful QI leadership.
Hip fracture management and NICE guidelines
Authors: Hadi Saifullah , Itte Vinay , Bradshaw Beth , Pinkney Adreana , Blomfield Mark , Hahnel James
Published: May 2014

Hip fractures are an economic burden on the NHS. In view of the variety of practice nationwide, the National Institute for Health and Clinical Excellence released hip fracture guidelines in June 2011. After the draft in November 2010, we audited our own practice to examine what changes need to take place to reach compliance with the guidelines. 109 patients were prospectively identified to be included in the study with no exclusions. Demographic, operative and surgical data were collected and compared with the proposed guidelines. There were 8 undisplaced intracapsular fractures, 48 displaced intracapsular fractures, 47 simple extracapsular fractures and 6 complex extracapsular fractures. 17 patients were suitable for THR, but only 3 received this procedure. 43 hemiarthroplasties were performed, of which 93% were of a proven stem design. 53 patients sustained extracapsular fractures of which 90% received the approved implant fixation. 5 patients received cannulated hip screws and 4 patients were treated conservatively. Areas for rationalisation of equipment can provide economic savings for the trust. In particular, older-fashioned Thompson and Austin-Moore hemiarthroplasties may be completely replaced with the Stryker Exeter trauma stem. The institution needs to ensure that there is an available arthroplasty surgeon and an available trauma list every day. Rationalisation of trauma equipment and consignment will provide savings for the trust.
Developing a tri-laminate antiviral surgical gown
Authors: Parthasarathi V , Thilagavathi G
Published: May 2014

HIV and hepatitis B and C are prevalent in the healthcare patient population. To provide a surgical gown protective against the prevention of viral and blood borne diseases is essential in healthcare today. The aim of this research was to develop a tri-laminate surgical gown comprising of polypropylene nonwoven (outer layer), polytetrafluoroethylene film (middle layer) and polyester nonwoven (inner layer). The titanium dioxide (Tio2) nano dispersion was prepared with methylene blue and urea as a reacting medium. These nano particles have an average size of 9 nm which was revealed by high resolution transmission electron microscope. The polypropylene nonwoven fabrics were treated with nano dispersion by pad-dry-cure method and tri-laminate fabric was formed using a fusing machine. The presence of nanoparticles on the surface of the nonwoven fabric was confirmed by a scanning electron microscope. The tri-laminate surgical gown passes the ASTM 1671 of viral penetration test. The fabric has been tested for the tensile, tearing, puncture resistance, seam strength and moisture vapour permeability which is required in healthcare.
Increasing GP referrals: jump or infectious push?
Authors: Jones Rod
Published: May 2014

Over the past few decades GP referrals have been increasing much faster than implied by demographic change, i.e. the ageing population. Up to the present this has been assumed to be a problem with the GP referral process which should be remedied by US style scrutiny of GP referrals and GP training. While some of this is warranted the mechanism for growth appears to be localised, unexpected and unexplained, leading to a permanent increase of around 15% within a one to two month period. This growth moves across the UK in a manner reminiscent of the infectious spread of a persistent agent which exhibits moderately slow transmission. The relative inability of existing demand management schemes to halt this spread suggest that a genuine infectious agent is involved.
Changes in the relations and roles of doctors and nurses
Authors: Voyer Benjamin
Published: May 2014

The present article critically discusses how the relations and roles of doctors and nurses have changed over the last 40 years, and how these have been re-shaped by a growing focus on improving patient care while preserving and improving the economics of the health service. It suggests that the emphasis on more efficiency and more accountability has changed both the roles and span of control of doctors and nurses. Yet, it also argues that stereotypes held by doctors and nurses about one another remain difficult to change. Managers have emerged as new actors in the healthcare system, and have contributed to these role shifts. Overall, the relation between doctors and nurses has changed, over the last 40 years, from being a relation based on status, to a more balanced one, based on mutual trust and leadership, resulting in the emergence of more complex psychological processes between the main actors of the healthcare system.
Doing more with less: Opportunity for the NHS
Authors: Bosanquet Nick
Published: May 2014

Nick Bosanquet, Emeritus Professor of Health Policy, Imperial College, argues that financial pressures on the health service require a change in approach
Can the voluntary sector come to the aid of the NHS?
Authors: Woodward Paul
Published: May 2014

Paul Woodward, Chief Executive of Sue Ryder, explains the potential for increased partnership between the NHS and the voluntary sector to deliver specialist health services
Cancellations in elective ENT surgery
Authors: Bathala S , Tardolli A , Jaramillo M , Morgan N , Thomas M
Published: May 2014

Cancellations of elective surgeries are a common reason for wastage of theatre time. This study was conducted to evaluate the reasons for cancellation of elective ear, nose and throat (ENT) surgery in a district general hospital in Wales. To access local trends and reasons for cancelled ENT surgery, and to compare the local findings with the national figures, assessing reasons for any discrepancy. This study was done in two cycles. The first cycle was retrospective and included all the elective ENT surgeries performed between 1 April and 30 September 2010. The recommendations from the first cycle were then in cooperated and a second cycle of prospective study was carried out and included all the elective ENT surgeries performed between 1 March and 30 August 2011. A total of 596 elective ENT procedures were scheduled, of which 53 recorded cancellations, equating to a cancellation rate of 8.9% in the first cycle. A total of 572 elective ENT procedures were scheduled of which 26 recorded cancellations, equating to a cancellation rate of 4.5%. The cancellation rate decreased by 4.4% from the first to the second cycle. Centralisation of theatre list would potentially reduce overall cancellation rates and waiting times.
Cost-effectiveness in varicose vein treatment
Authors: Lattimer Christopher R. , Rebelo David , Trueman Paul , Piper Stephen , Berry Helen , Kalodiki Evi , Geroulakos George
Published: May 2014

Methods used in cost calculation have a profound effect on cost-effectiveness analyses, thereby influencing UK healthcare decision-making. The aim of this study was to quantify the impact of different cost assessments using data obtained alongside a recent randomised clinical trial (RCT) on endovenous treatments for varicose veins. National reimbursement data from payment by results (PbR) were compared to the service line report (SLR) and RCT micro-costing data. There were 18 laser and 205 foam treated patients from the 2010–2011 day-case activity SLR. There were 100 RCT patients which were separated for costing into session treatments (2 laser, 3 tumescent foam or 5 standard foam treatments per 3.5 hour session) as well as individually-timed treatments. Reimbursement was £1098, irrespective of treatment type. Using SLR derived data the cost of laser, tumescent foam and standard foam per patient was £1059, £603 and £551, respectively. This decreased to £812, £239 and £124 using session calculations and decreased further to a median (inter-quartile range) of £721 (677–774), £195 (176–209) and £100 (93–109) using individually timed treatments (P < 0.0005, Kruskal-Wallis). Cost differences between laser and foam increase significantly using micro-costing. Several costing approaches may be required for representative cost-effectiveness comparisons.
Maximising sensory awareness for patients with dementia
Authors: Hughes Lloyd D , Adams Laura
Published: May 2014

Patients with dementia often exhibit significant mental state disturbances including confusion, agitation and aggression and these may be provoked or exacerbated by many external factors. The research team hypothesised that optimising the sensory awareness of residents to their environment would reduce the number of documented aggressive episodes. During this four-month study the care team documented the number of aggressive episodes in a nursing home unit before, during and after the implementation of the following changes: residents had their hearing aids and glasses checked, cleaned and fitted on a daily basis to maximise the resident's sensory awareness. Living conditions were altered with improved lighting, signing and daily sensory stimulation in line with NICE guideline recommendations. Following the implementation of this intervention, the number of documented aggressive episodes reduced throughout the study period with an overall significant reduction of 25%. The research concluded that simple non-pharmaceutical measures aimed at maximising the ability of residents to sense their environment could indeed reduce aggressive episodes.
Vitamin D: the role of the sunshine vitamin
Authors: Mutsatsa Stanley , Mushore Manyara , Ncube Kelvin , Currid Thomas
Published: May 2014

The importance of vitamin D in physical disorders has been well documented. Deficiency in this vitamin is associated with a wide range of physical and mental disorders that include: heart problems, hypertension, stroke, diabetes, various cancers, and asthma. In mental health, vitamin D deficiency is associated with schizophrenia, depression, anxiety and Alzheimer's disease— among others. Risk factors for vitamin D deficiency include: darker skin, lack of adequate sun exposure, autoimmune diseases, influenza, old age and the use of certain medicines such as anticonvulsants. Vitamin D is likely to play an important role in the management and prevention of various mental health problems. In particular, adequate vitamin D during the perinatal stage is likely to impact positively on the long-term mental health of a person.
Improving health promotion in psychiatric inpatient settings
Authors: Ashworth Katrina , Sorsby Rachel , Green Barrie , Huxley Adam
Published: May 2014

This article describes some of the physical health needs of patients with severe and enduring mental health problems resident within psychiatric rehabilitation inpatient settings. Service providers often prioritise patient's mental—over physical—health needs, and patients face many barriers in accessing appropriate physical health monitoring. The comorbid presentation of physical health problems, such as obesity, heart disease, hypertension, emphysema and diabetes leave patients at risk of reduced life expectancy, decreased quality of life and restrictions on wider recovery goals. This article describes the development and implementation of a multidisciplinary team (MDT) psycho-education intervention that aims to increase patient's awareness of physical wellbeing, promote choice around healthy lifestyles, measure progress and outcomes and encourage screening and self-management of existing physical health problems.
Easing the path to the end of life
Authors: Woodward Sue
Published: May 2014

There has been much attention in the media in recent weeks about the potential for using stem cells in the treatment of patients with neurological conditions. More recently a BBC Horizon programme highlighted the work of Dr Huang Hongyun in Beijing, who is implanting olfactory ensheathing cells from aborted fetuses into patients with spinal cord injuries and motor neurone disease. It has been demonstrated that these cells have a remarkable ability to re-grow. Some western patients with these problems are flying to China to receive this treatment but there is little evidence to support this technique. The use of these cells remains experimental and, in spite of a lack of evidence, Dr Huang's waiting list now stretches until the end of 2006 (BBC, 2005).
Assessment of eating skills and the nutritional process in neurological disability
Authors: Eberhardie Christine
Published: May 2014

Each stage of the nutritional process from the search for and selection of food to the eating skills required for the chewing and swallowing of oral diet can present a variety of difficulties in neurological disability. This article is an examination of the complexity of the bio-behavioural activity involved in normal eating. The assessment tools currently available to the nurse caring for patients in a variety of settings are discussed.
A study of the burden of caring for patients with amyotrophic lateral sclerosis (MND) in Japan
Authors: Akiyama Miki Onishi , Kayama Mami , Takamura Soichi , Kawano Yuri , Ohbu Sadayoshi , Fukuhara Shunichi
Published: May 2014

Objective:

The purpose of this study was to explain the experiences of caregivers of patients with amyotrophic lateral sclerosis (ALS) receiving invasive ventilation in Japan.

Methods:

Subjects were 12 primary caregivers of ALS patients receiving invasive ventilation. Subjects were selected by theoretical sampling. Semi-structured interviews were undertaken with each subject. The data were analyzed using a grounded theory approach.

Results:

Caregivers tried to ‘find a meaning in prolonging life,’ which represented a core category. Two subcategories relate directly to the core category. These were ‘hesitation and regret over the decision’ and ‘feeling of being supported’. Each subcategory had four internal dimensions: ‘uncertainty of the future’, ‘communication’, ‘maintaining their own life’ and ‘support’.

Conclusions:

The process of caring for ALS patients is dynamic. The success or failure of continuing care depends on ‘finding a meaning of prolonged life’. It is important for nurses to be aware of that. Further investigation is required into appropriate intervention for caregivers of ALS patients.
Encephalitis, a service orphan: The need for more research and access to neuropsychology
Authors: Easton Ava , Atkin Karl , Dowell Elaine
Published: May 2014

Encephalitis and its consequences are often misunderstood, not only by the general public, but also by those providing health, educational and social services to those who have been affected. The aim of this paper is to provide a brief overview of the epidemiology and clinical consequences of encephalitis, and highlight the potential of approaches such as neurospsychology in its treatment, with the intention of helping health professionals improve the quality of care received by patients. It is argued that rehabilitation of people affected by encephalitis may benefit from interdisciplinary and biopsychosocial approaches, and that neuropsychological assessment can be a useful tool in recovery.
Urinary incontinence in Parkinson's disease
Authors: Woodward Sue
Published: May 2014

Parkinson's disease is a common neurological condition, affecting approximately one in 500 individuals in the UK (Parkinson's Disease Society, 2006). Symptoms are caused by damage to and loss of the dopamine secreting cells in the substantia nigra, within the basal ganglia. Nocturia and urinary incontinence symptoms have been shown to affect 30–70% of patients with Parkinson's disease and may be exacerbated by high dose levodopa treatment (Chaudhuri, 2003). These symptoms may be compounded by bradykinesia and difficulty getting out of bed and mobilising at night, contributing to sleep disruption for patients.
Types and causes of head injury: An overview
Authors: Mavin Claire
Published: May 2014

Road traffic, industry and sports accidents along with violence on the streets and at home are the main causes of head injury. The classification of head injury is underpinned by the pathological processes that have occurred as a result of injury and the effect of intracranial pressure. This article discusses an overview of types and causes of head injury including the assessment of head injury and possible interventions required.
CORRESPONDENCE
Authors: Hassall Mandy , Hamilton John Michael
Published: May 2014

The Northern Neurological Alliance (NNA) was launched on 6 October 2008. Alastair White, the Headway North-East regional coordinator a key member of the steering group, was instrumental in ensuring the success of the launch. He is now a member of the executive committee and ensures that brain injury has a profi le with regards to any developmental work the NNA undertakes.
RESEARCH ROUND-UP
Authors: Brunker Chris
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Out with Action Man: Time for change
Authors: McDonald Sheena
Published: May 2014

Sheena McDonald points out the need for change in the perception and care of mild traumatic brain injuries among the armed forces.
Best practice in management of stroke: Effective transfer of care from hospital to community
Authors: Fitzpatrick Maria , Dawber Steve
Published: May 2014

Transfer of care from hospital to the community after acute treatment for a stroke has been recognized as having a critical place in the stroke patient's pathway. Seamless transfer of care is a quality marker of the National Stroke Strategy. It is vitally important that patients receive good information and support after discharge from hospital because a failure to provide effective transfer of care can be detrimental to the long-term prognosis of the person with stroke and can compromise the care given in the acute setting. Effective transfer of care relies on good communication between health and social care providers in all settings, involvement of the patient and his/her family or carers in discharge planning, and the provision of appropriate information to the patient and his/her family.
New opportunities for stroke nurses
Authors: Williams Jane
Published: May 2014

Jane Williams looks forward to improvements in stroke care following the launch of the National Stroke Strategy
Promoting concordance with disease-modifying drugs in MS: The role of the nurse specialist
Authors: Shaw Pauline , McMillan Debbie
Published: May 2014

Studies have demonstrated that many people with long-term conditions do not take medications as prescribed. Not only does this compromise the health of the patient but also becomes a financial burden for the NHS. The National Service Framework for Long-Term Conditions cites research which shows that about 50% of medicines for long-term conditions are not taken as prescribed, which may compromise the health of the patient and become a cost pressure for the NHS. This paper reflects reasons why non-concordance may occur in a particular group of patients who have multiple sclerosis and the role of the specialist nurse in promoting concordance. The terms compliance, adherence and concordance are reflected upon and defined and critiqued. The authors report on the findings of a telephone survey which analysed the extent of concordance in the authors′ area of work. Finally, the article demonstrates how the MS nurse specialist is a key factor in promoting concordance with prescribed medications.
A difficult pill to swallow? Improving outcomes in epilepsy using sodium valproate
Authors: Smith Teresa , Greener Mark
Published: May 2014

Epilepsy is associated with considerable avoidable mortality and morbidity, however, optimal treatment could potentially halve current mortality rates. Numerous factors contribute to suboptimal management including, as illustrated in this review, poor adherence, an inadequate number of specialist nurses and weaknesses in the evidence base. Recent studies establish valproate as a first-line option for several seizure types. Neurology nurses can use the number of valproate formulations available to help address issues such as side effects, problems with swallowing and poor adherence. Furthermore, once-daily evening dosing may protect against the many seizure types that are more likely to start and/or generalize during sleep. While this review considers valproate, the principles discussed apply to other anti-epileptic drugs (AEDs). This article illustrates that a multifaceted, interdisciplinary approach that considers the most appropriate AED and optimal formulation for each patient should help epilepsy specialist nurses (and nurses with an interest in neurology) further reduce the morbidity and mortality associated with epilepsy.
A necessary evil? Interventions to prevent nasogastric tube-tugging after stroke
Authors: Horsburgh Dorothy , Rowat Anne , Mahoney Catherine , Dennis Martin
Published: May 2014

This study explores the perspectives of patients, relatives and carers on the use of interventions to prevent nasogastric tube-tugging following a stroke. The study was qualitative and involved focus groups with practitioners (n=3) and interviews with stroke patients (n=4) and relatives (n=4). Data were analysed using a grounded theory approach to identify key categories. The authors found that practitioners, patients and relatives viewed the use of interventions (e.g. hand mittens) to maintain nasogastric tube feeding in terms of benefits, harms and justice. The core category, linking all data, was ‘a necessary evil’, i.e. while interventions were undesirable their use as a final resort might be justified to maintain patients′ nutritional status post-stroke.
Antipsychotics: No quick fix for people with dementia
Authors: Ballard Clive
Published: May 2014

Clive Ballard argues that antipsychotics are prescribed inappropriately to people with dementia despite a lack of evidence for their benefits, risking serious side effects
Gunshot wounds of the brain and skull, part 1: A neurosurgical perspective
Authors: McIntosh Kelly , Roosen Norbert
Published: May 2014

Penetrating trauma to the brain and skull is commonly caused by gunshot wounds (GSWs), self-inflicted or otherwise, and carries a grave prognosis. After epidemic growth in the 1980s and 1990s, GSWs are currently endemic in our society. It is likely that many healthcare personnel will be confronted with victims of GSWs. Neuroscience nurses will be asked to care for patients with craniocerebral trauma caused by GSWs. To provide optimal care to these patients, neuroscience nurses will need a basic knowledge of GSW injuries. In this two-part review, the authors will focus on gunshot-related trauma to the brain and the calvarium. This first article will introduce the reader to the epidemiology, ballistics, pathophysiology and pathology of craniocerebral GSWs, as well as to the initial management and relevant diagnostics. The second article will discuss management, complications and outcomes of craniocerebral GSWs.
Research Round Up
Authors: Eberhardie Christine
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
A month in the life of the NSF for long-term conditions: December
Authors: Hassall Mandy
Published: May 2014

The National Director for Primary Care and medical adviser, David Colin-Thomé has said:

Delivering improvements for people with long term conditions isn't just about treating illness, it's about delivering personalised, responsive, holistic care in the full context of how people live their lives.
RESEARCH ROUNDUP
Authors: Queally Cathy
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
RESEARCH ROUNDUP
Authors: Warner Richard
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
An analysis of the impact of the NHS and social care model on patients with multiple sclerosis
Authors: Sanders Julie
Published: May 2014

This article analyses the impact of the Department of Health's policy document Supporting People with Long Term Conditions: An NHS and Social Care Model, on those who have multiple sclerosis. The application of a US managed care model to the UK is discussed, and the importance of effective commissioning in the success of the model highlighted. The impact of payment by results on the application of the model and the resulting impact on those with multiple sclerosis is analysed. Workforce issues, predominantly the recruitment of community matrons, and the reduction of multiple sclerosis specialist nurse posts are examined for the serious and unintended impact that they may have on the care and support that those with multiple sclerosis receive.
Identifying and managing post-polio syndrome
Authors: Pountney David
Published: May 2014

Post-polio syndrome can occur 20 years after the initial attack of the poliomyeletis virus, which affected hundreds of thousands of people in the epidemic of the 1950s and 1960s.
Lobby for specialist nurse posts before the coming election
Authors: Thomas Sue
Published: May 2014

As 2009 draws to a close, it leaves the NHS in a pre-election period with the strong possibility of a new government in 2010. Relatively few policy consultations are around at the moment and there is much speculation about how policy will change if the Conservatives gain power next year. Organizations are gearing themselves up for pre-election lobbying and, as usual, health care will be top of the political agenda, with nurses well placed to provide information about what is really happening in health care to those who aspire to govern. It is useful to know that there will be more than 1800 nurses and health-care assistants in each parliamentary constituency—so the nursing voice really can count.
RESEARCH ROUND-UP
Authors: Preece Anne
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
CORRESPONDENCE
Authors: Hassall Mandy
Published: May 2014

December diary: the Big Care Debate continues
CORRESPONDENCE
Authors: Edwards Tamara
Published: May 2014

Why can't an all-graduate profession work?
Assisted suicide and euthanasia: Unravelling the law
Authors: Dimond Bridgit
Published: May 2014

There is considerable confusion at present in people's minds as to what the law is on assisting someone to die. In February 2008 a husband, having suffocated his wife who was suffering from multiple sclerosis (MS), was given a 12-month suspended prison sentence (Fletcher, 2008). He had admitted manslaughter on the grounds of diminished responsibility and aiding and abetting his wife's suicide. Yet there have been no prosecutions where relatives have helped patients to go to Switzerland to end their lives. It is not surprising that Debbie Purdy went to court in 2008 to obtain clarification of the law to ensure that her husband would not be prosecuted should he take her to Switzerland for her life to be ended. This article seeks to identify the basic legal principles which apply in cases such as these.
Epilepsy service provision: Time for change
Authors: Thomas Sue
Published: May 2014

Findings from a study of epilepsy service provision in England, Epilepsy in England: Time for Change (Epilepsy Action, 2009) made me reflect on how epilepsy services, despite the huge amount of supportive policy published over the years, are failing to be prioritized. This report highlights the fact that, due to a basic lack of understanding of the condition, commissioners continue to design inadequate epilepsy services for the 382 000 individuals in England who have epilepsy. This is despite the fact that epilepsy is the most common, serious neurological condition in the population today and affects people of all ages.
When does a minor head injury become a major brain injury?
Authors: Hassall Mandy
Published: May 2014

The recent tragic death of actress Natasha Richardson following a seemingly innocuous head injury while skiing has highlighted the importance of personal safety when taking part in a ‘dangerous’ sport. Headway was inundated with calls from the media—we had to respond quickly but what does one say, what can one say? There is a very fine line between scaremongering and trying to promote personal safety
Is belief a help or hindrance in recovery?
Authors: McDonald Sheena
Published: May 2014

I was surprised by the email I received. ‘Can you believe it?’, I asked my husband. ‘I've been asked to do an after-dinner speech for one of the major head-injury charities!’ He gave me an old-fashioned look. ‘Depending on the quality and vintage of whatever tipple I'm enjoying,’ he said, ‘you would be amazed by what I'm capable of believing.’ And I felt duly chastened.
Developing hospice-based, nurse-led clinics to improve care for patients with MND
Authors: Bennett Wendy , Mitchell Douglas , Callagher Pauline , Addison Jones Robert
Published: May 2014

Motor neurone disease (MND) is a terminal, neurodegenerative disease. The aims of the MND specialist nurse team are to coordinate care and ensure the best outcomes for patients. The MND Care and Research Centre based in Preston, Lancashire covers a large geographical area. Many patients with MND were travelling long distances to hospital to access support and experienced difficulties parking. This became increasingly difficult as the disease progressed. It was decided to bring the nurse-led services closer to patients by developing partnerships with the six local community hospices in Lancashire and South Cumbria. The aims of this initiative were to reduce travelling times, provide access to better parking and enable people to enjoy the pleasant hospice environment. As a result, a significant number of MND patients are receiving care from the specialist nurses in a hospice setting. An audit of the new services has been undertaken by the MND Care and Research Centre, the results of which show high levels of patient satisfaction. Patients indicated that they find the hospice environments to be more relaxed, aiding communication and creating the conditions for more productive, less stressful appointments. Professional relationships have also been strengthened between the care centre and hospice staff.
Inquiry reveals gaps in care for Parkinson's
Authors: Moonan Clare
Published: May 2014

A report published by a parliamentary inquiry has found poor access to specialist nurse help among the difficulties patients face.
Assessing the use of artificial cervical disc implants in treating cervical spondylosis
Authors: Fox Sally , Choi David
Published: May 2014

Cervical spondylosis often affects people over 50 years of age. It is due to degenerative changes in the discs and facets joints which may impinge on the spinal cord, causing neurological symptoms and pain. Treatment may involve physiotherapy, analgesia, injection treatments or surgery to remove the worn disc. The disc space can be maintained by fusing the joint using synthetic bone or allograft. However, fusion can limit movement and place extra strain on surrounding discs. Disc replacement is a relatively new treatment to replace the degenerate disc with an artificial implant which has the same range of movement as a normal disc. This will theoretically decrease the strain placed on adjacent discs, but long-term evidence is needed. The traditional role of cervical fusion is under the spotlight and may in the future be replaced by artificial disc replacement.
A personal view on the future of neuroscience nursing
Authors: Eberhardie Christine
Published: May 2014

If neuroscience nurses are to shape the future of the speciality, it is essential to participate in consultations such as the Prime Minister's Commission on the Future of Nursing and Midwifery
Action potentials: Understanding generation, propagation and their clinical relevance
Authors: Mayer Jonathan , Garner Anne
Published: May 2014

Cells maintain a voltage gradient across their cell membrane, with the inside being ‘more negative’ than the outside. An action potential is a transient (<1 millisecond) reversal in this potential gradient occurring in excitable cells such as nerve and muscle. It is caused by a stimulus depolarizing the cell, and voltage-sensing sodium channels in particular, to threshold. This initiates an all-or-nothing response, in which sodium- and then potassium-specific channels open allowing their ions to pass down their concentration gradient. The action potential can then self-propagate along the cell at very high speeds of up to 100 metres/second. This enables neural information, encoded by these action potentials, to be very efficiently and rapidly transmitted around the body. Due to the underlying mechanism relying heavily on sodium and potassium ion channels and their diffusion gradients, any abnormality of these channels or the ionic concentrations can have wide-ranging and profound consequences. It is thus crucial for all health professionals to understand this process.
Generic substitution: Implications for safe medicines management
Authors: Mantri Pamela
Published: May 2014

The government and health authorities have a duty to provide safe, effective and efficient health care. The Office of Health Economics Compendium of Health Statistics shows that 10.5% of the NHS budget is spent on drugs (The Pharmaceutical Journal, 2008: 145). As the NHS is funded through public money with competing priorities there is a responsibility to use this money as efficiently as possible. The Pharmaceutical Price Regulation Scheme (PPRS) is the vehicle through which the Department of Health (DH) controls prices of branded medication. The House of Commons Committee of Public Accounts (2008) proposes that the NHS could reduce costs by over £200 million annually through price cuts and substituting branded medicines with equivalent generic medicines. The government has advised that it is going to introduce generic substitution in primary care in January 2010 following discussion with interested parties (DH, 2009).
Identifying and managing cerebral palsy
Authors: Pountney David
Published: May 2014

Cerebral palsy is a general term used to refer to a set of neurological conditions that affect movement and coordination. David Pountney considers the causes, characteristics and effective clinical management.
RESEARCH ROUNDUP
Authors: Eberhardie Christine
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Identity construction and meaning-making after subarachnoid haemorrhage
Authors: Berggren Elisabeth , Sidenvall Birgitta , Muhli Ulla Hellström
Published: May 2014

Aim

The aim was to analyse people's accounts of subarachnoid haemorrhage (SAH) and to describe how they initiate and create meaning for the onset and events surrounding the SAH.

Background

Being struck by a SAH is a dramatic event, often followed by unconsciousness. There is therefore a special need for a patient to try to create some kind of meaning for the event during recovery and afterwards.

Method

Nine interviews were carried out in home settings and discourse analysis was used to interpret the data.

Findings

People stricken by SAH seem to be able to judge from memory for when they were becoming ill. Critical events related to SAH were existential threats and existential insights; and time as ‘waiting’ and time as ‘structuring meaning’. The reconstruction of the illness event may be interpreted as an identity-creating process.

Conclusions

The reconstruction of the illness is a tool that can be used by nurses and other health professionals to understand a patient's self-positioning and identity-construction.
Foot drop: Explaining the causes, characteristics and treatment
Authors: Graham Jon
Published: May 2014

Foot drop is the inability to lift the foot at the ankle. It is a common symptom in neurological conditions including stroke and multiple sclerosis, but can also be a result of orthopaedic trauma. Health professionals treating these patients need to minimize further loss of range of movement at the ankle and prevent the negative impact that foot drop has on gait. The most effective forms of treatment include the provision of orthotics and the use of functional electrical stimulation.
Reflecting on the Long-term (Neurological) End-of-Life Conference
Authors: Baker Mark , Payne Sheila , Stanley Cath , Bowen Ceri , Webb Pat , Daveson Barbara , Morrey Vicki , O'Connor Margaret
Published: May 2014

The Long-term (Neurological) End-of-Life Conference was held on 25 February 2010 at the Royal Hospital for Neuro-disability in London, to discuss contemporary issues in non-malignant end-of-life care in the UK.
Recognition of stroke symptoms by stroke survivors
Authors: O’Connell Elizabeth , Hartigan Irene
Published: May 2014

Background: Stroke remains a leading cause of death and disability, and patient outcomes are dependent on early access to emergency treatment. However, despite public education campaigns, many patients and carers fail to recognize the symptoms of stroke and often delay accessing medical services

Aim: This paper reports first-time stroke patients’ description of their symptoms and the sequence of events which lead them to seeking medical treatment.

Methods: Secondary data analysis was conducted on transcripts (n=10) exploring patient perceptions of their stroke experience.

Results: Seven of the ten participants failed to recognize their symptoms as those associated with stroke. Limb weakness was the symptom most easily recognized by the participants as that of a stroke. Only three of the ten participants immediately recognized that their symptoms were that of a stroke. When symptoms were recognized either by the patient or a family member, participants accessed medical treatment promptly.

Conclusions: The study found that the majority of participants could not identify stroke warning signs. Furthermore, the participants descriptions of the event is conveyed in a language different to that used in various awareness campaigns. Further research is needed to explore the language used in stroke awareness campaigns and the language used by patients themselves interpretating their symptoms.
Management of psychosocial adjustment among people with multiple sclerosis: a critical analysis
Authors: Sevilla Guerra Sonia
Published: May 2014

Accepting a diagnosis of multiple sclerosis (MS) and adapting to the unpredictability of the condition throughout one's life can be overwhelming. People with MS are exposed to uncertain and variable symptoms and face the likelihood of reduced physical functioning and disability, with consequent disruptions in education, family functioning, friendships and activities of daily living. This paper looks at the effectiveness of psychological interventions and adjustment management that can be carried out by nurses. Studies have shown benefits for groups of people with MS and low mood using psychological therapies such as cognitive behavioural therapy and expressive group therapy. The creation of new adjustment groups whereby nurses can introduce cognitive behavioural principles for people with MS could be an effective way for individuals to learn new skills, new means of managing their emotions, and new behavioural techniques to improve existing mood disorders and aid adjustment to the condition that they can use throughout their lives.