bluuebunny/crossref_metadata_2025 huggingface dataset:
Survey into fetal monitoring practices and attitudes
Authors: Birch Linda , Thompson Belinda
Published: July 2014

This article evaluates an audit of attitudes to, and practice of, monitoring the fetal heart rate during labour. All grades of maternity care givers were included in the audit The overall perception was that continuous electronic monitoring has improved maternal and neonatal outcomes. This is despite overwhelming evidence to the contrary. This may be attributed to practice being based on previous experience, with literature review secondary in its influence. The definition of intermittent fetal monitoring remains ambiguous. When individual scenarios were presented, wide variation of opinion was demonstrated both between disciplines and within grades of staff. The midwife is placed in an intolerable position. Conflict exists between theory and practice. If this Is to be resolved, there is a need for compulsory interdisciplinary education. Furthermore, if the medicalization of childbirth is to be reduced, it is midwives themselves who need to address their philosophy of care.
Ethics and informed consent in labour
Authors: Harrison Eileen
Published: July 2014

This article examines the influence of ethical theory on informed consent and explores its importance and application in labour. Informed consent is demonstrated as an essential component of health care.
Midwifery educators: analysis of numbers and quality
Authors: Larkin Val , Smith Gill
Published: July 2014

There is a paucity of information concerning the practicalities of human resource calculations for health care education programmes. In this article, key factors which determine the need for accurate assessment of human resource calculations within midwifery education are explored. Potential methods of human resource calculations are discussed and evaluated using a hypothetical example. A theoretical model is proposed as a framework to outline the elements of and factors for consideration, to guide the process of future calculations.
Birthmarks, body image and their implications: part two
Authors: Wheeler Heather MD
Published: July 2014

The first article in this series of three dealt with definitions and types of birthmark, sites of occurrence, physiological effects and complications. Part two discusses the psychological effects of birthmarks. People's reactions to facial disfigurement are examined, along with various forms of treatment, where help can be found for those concerned about birthmark disfigurement, and recommendations for midwives, health visitors and other health care workers.
‘Normal pregnancy and labour’: is it limiting midwifery practice?
Authors: Hartley Jo
Published: July 2014

The future of midwifery is threatened by the limitations of the phrase ‘normal pregnancy and labour’. Already midwives perform tasks that a short time ago would have been described as abnormal. Midwives must be prepared to extend their role, to take greater responsibility and thus raise the status of the profession. Although traditional skills should provide the foundation of good midwifery care, midwives must not be swept along by change; rather, they must lead the way.
False alarm – but real harm?
Authors: Robinson Jean
Published: July 2014

A healthy three-year-old-boy played happily while Mummy and Daddy talked to the doctor. His parents were arranging an amniocentesis because they were so anxious about their expected baby. I hope he did not overhear his father telling the consultant that they were having the test because they did not want another ‘brain-damaged’ child like him. In fact their son was perfectly normal — but an ultrasound picture of him in the womb had shown a choroid plexus cyst and the father now saw his son as disabled (Mason and Bailie, 1997). The authors of the report — one of whom is a consultant in fetomaternal medicine at Leeds — say that they no longer report such cysts in younger women because they think the anxiety outweighs any possible gain.
Bridging the gap between evidence and practice
Authors: Sandall Jane
Published: July 2014

This article considers the requirement to make nursing and midwifery practice evidence based, and puts forward issues for further discussion. Wide variations in clinical Interventions and clinical outcomes, the continuation of treatment that does more harm than good, and the failure to provide beneficial treatment have all been factors in the drive to base maternity care on the the best available evidence (Chalmers, 1995). The possibility that patients may sue when available research isn't put into practice (Hurwltz, 1996) and the white paper on the NHS, with its emphasis on quality and concept of clinical governance has given added impetus to the importance of basing practice on good evidence (Department of Health, 1998).
Neuroendocrinology and birth 1: stress
Authors: Ginesi Laura , Niescierowicz Rose
Published: July 2014

The aim of this review is to offer a new perspective of the subtle and dynamic hormonal balance that may develop during physiological labour. We have drawn on current understanding of adaptation and, in particular, the role of the limbic cortex and the hypothalamus in fear responses. We have noted remarkable similarities between the changes and behaviour of the birthing woman and those of other sexual responses. We feel that this work adds weight to the body of evidence which suggests that creating a calm, safe environment for the birthing woman is vitally important (Odent, 1996). The human body is unimaginably complex. Physiology is the study of the overall logic and order of living organisms (Boyd and Noble, 1993), but a multl-disciplinary approach is now essential. It is relatively simple to describe the components of the systems but much more challenging and rewarding to understand how and why they work in the way they do. There is order among the complexity and an integrative approach that combines aspects of psychology and physiology can help our understanding of the interplay between mind and body in states of stress.
Caesarean section: women's choice
Authors: Robinson Jean
Published: July 2014

‘Unfortunately the law does not distinguish between the rights of a mentally competent but foolish pregnant woman and other adults. Therefore, if caesarean section is the preferred mode of delivery by the mother, her choice, however foolish or irrational, must be respected’ (Amu et al, 1998).
Motherless mothers and social support
Authors: Downe Soo
Published: July 2014

A number of midwives locally have been thinking for a while around the issue of social support for childbearing women. This thinking has become concentrated in an attempt to understand how long term friendships could improve the outcomes of unsupported, and in particular motherless, mothers. We have been asking ourselves, just what is social support, and who needs it? It may seem obvious that the greatest need for support of any kind would be among women in poverty, or those experiencing other kinds of deprivation. It may also seem reasonable to assume that women having their first baby, who don't have much experience of mothering, may be prime candidates for any study in the area. However, the literature indicates that it is not uncommon for women who have had more than one baby, or those in relatively wealthy but isolated environments to feel unsupported. The most important factor in helping women through early motherhood, whatever their background and circumstances, appears to be a sense of support from their partner or their mother.
Consultant midwives: what are they made of?
Authors: Warwick Cathy
Published: July 2014

Nobody could complain that there isn't enough for the Midwifery Profession to be thinking about this Autumn. Recruitment and retention of midwives is a particularly worrying issue and, as anyone who participated in the Midwives' Lobby of Parliament on the 21st October will realise, pay and conditions of employment are high on the agenda. However, at a time when the idea of Clinical Governance is being widely discussed, the Prime Minister has floated the idea of the Consultant Nurse and the Royal College of Midwives has circulated a questionnaire on this latter topic, the issue I want to talk about is that of standards -- in particular basic standards of midwifery care.
CESDI: the fifth annual report
Authors: Sidebotham Mary
Published: July 2014

The Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) was established in 1992 to ‘improve understanding of how the risks of death in late fetal life and infancy from 20weeks of pregnancy to one year after birth may be reduced.’ Data is collected on a regional basis using a network of regional and district coordinators. All fetal losses and deaths under one year are reported using the standard rapid reporting forms, and ascertainment when compared with Office for National Statistics (ONS) data continues to rise. The current level of reporting is 1.3% below that of the ONS, compared to 4.0% below in 1995.
Maternal and child health in a Calcutta clinic
Authors: McCrystal Angela
Published: July 2014

Calcutta, with a population of approximately 12 million, is one of India's most overcrowded cities. It provides insufficient housing, inadequate sanitation and a low standard of health care and education for many of its people. There are many non-governmental organizations working within Calcutta trying to augment the services provided by the government. Calcutta Rescue is one such organization. This article is a brief account of the work done by Calcutta Rescue in their Mother and Child clinic. For background information for this article, Table 1 provides information on the socioeconomic characteristics of West Bengal (Calcutta is in the state of West Bengal), and Table 2 compares maternal and infant mortality rates between India and the UK.
Resource Reviews
Authors: Deery Ruth , Hopkins Catherine
Published: July 2014

Clinical supervision remains a confusing and misunderstood concept in the field of midwifery. Some supervisors of midwives believe they are already providing clinical supervision and other health professionals have tended to believe that midwives have been providing clinical supervision for many years.
The benefits of the known and trusted midwife
Authors: Page Lesley
Published: July 2014

Childbearing women generally appreciate care that is provided by a midwife they have come to know and learned to trust, especially for labour and birth. A recent experience brought home to me in a very direct way just how important this is. I have been a midwife to a particular woman four times, and she was expecting another baby. Over the years we have become good friends. Because she had moved and lived a fair distance away from me, she decided that this time she would have a midwife from the local maternity service. She was wishing for a home birth.
Dying for sex? Intercourse in the puerperium
Authors: Robinson Jean
Published: July 2014

It was, of course, inevitable that the press would pick up on the story after it appeared in a medical journal. The combination of birth, sex and death provided irresistible headlines. Two women had died from air embolism during sexual intercourse, one 8days after delivering her third chid, the other 5days after giving birth to her fourth (Batman et al, 1998). Such deaths are extremely rare, and the coincidence of their both happening in the same town led local doctors to publish the cases as a separate report, which led to a predictable press hunt to find the bereaved families. One of the cases had already been published in the last report on Maternal Deaths (Department of Health, 1996) — the only case of air embolism among 298 direct and indirect maternal deaths in the UK 1991–3.
Crisis in midwifery staffing: the legal aspects
Authors: Dimond Bridgit
Published: July 2014

Maternity services are one of the few specialities where you cannot have a waiting list. To tell the pregnant woman on the point of delivery: ‘We don't have a bed for you at present, but there will be one available in three months’ is not compatible with the force of nature. Waiting lists, until recent initiatives of the former and present governments to reduce size and time, have been the traditional way in which NHS services are rationed: giving priority to those whose medical need is greatest. This has never been an option in maternity services. So how does a hospital equate the resources available to the existing demand?
Suture materials used for perineal repair following childbirth
Authors: Kettle Chris
Published: July 2014

In the UK approximately 750 000 women give birth each year and of these approximately 70% will have a spontaneous vaginal delivery. It is estimated that two thirds of these women are likely to sustain some degree of labial, vaginal or perineal trauma during childbirth. For those women who need stitches, the repair will be the responsibility of the midwife. Most of these women will experience short-term perineal pain and some will continue to have long term problems. Following a detailed literature review, the type and extent of trauma, skill of the operator, technique of repair and suturing materials used were all identified as contributing factors to perineal morbidity during the healing process.
Suicide: a major cause of maternal deaths
Authors: Robinson Jean
Published: July 2014

Suicide kills more mothers than hypertensive disease, yet it receives far less attention as a cause of maternal death. And the numbers seem to be increasing, though that could be because more cases are now being identified. Unfortunately the total will never be known since deaths only count as ‘maternal’ up to one year after delivery and AIMS knows of suicides two or three years later of women who had never recovered from giving birth. Appleby claimed that motherhood ‘protected’ women against suicide, since the rate in new mothers with surviving child was lower than the population average (Appleby, 1991). We pointed out that this meant that for the sake of their children, many mothers were living with a depth of misery which others found intolerable (Robinson and Beech, 1991).
Surrogate motherhood: demystifying the controversies
Authors: van der Akker Olga
Published: July 2014

Surrogate motherhood is a ‘hot topic’ for discussion in the media, the medical and scientific community and in government For the people using surrogate arrangements, it is a way of overcoming childlessness. This article outlines some of the controversies surrounding the debates, and seeks to demystify them by suggesting that we focus on the evidence available. Failing the availability of sufficient evidence, we could borrow from the experiences of alternative forms of reproductive technology or adoption and fostering practices. The recent government report commissioned by Tessa Jowell the health minister, recommends we do not pay surrogates, except for the expenses, and that surrogates should only be allowed to offer themselves once for this practice, or twice for the same couple with a two year gap. Fostering practice has shown that payment for fostering services and repeated or professional fostering practice is an advantage. This demonstrates we have not consulted alternative practices, and have not learned from our past experiences for which evidence is available.
Episiotomy and decision making
Authors: Barwise Catherine
Published: July 2014

This article explores the decision-making process, using episiotomy as an example. There is a vast array of literature concerning the use of episiotomy, and in this era of increasing accountability it is interesting to examine how the midwife applies the information when faced with the decision as to whether or not to perform the procedure. A number of theoretical aspects of decision-making are examined including reflective and analytical approaches, and implications for practice. Despite the strong evidence that there are a number of disadvantages associated with episiotomy, the procedure is still commonly performed, and so it is suggested that midwives need to continue to develop their skills of interpreting and applying research findings, and also reflecting on the long term implications of their decisions.
Smoking and pregnancy
Authors: Tiffany Sue , Allen Rose
Published: July 2014

The facts that confront midwives about the effects that smoking has on society is without question. The risk of lung cancer and coronary heart disease are just two of the serious conditions related to cigarette smoking. The evidence on harmful effects smoking and indeed passive smoking has on the health of mothers and babies is continually being produced. Golding's research (Health Education Authority, 1997a) provided evidence that pregnant women who smoke are also more likely to suffer from less serious conditions — such as nausea and vomiting – compared to women who do not smoke. Risks to the unborn baby such as low birthweight and stillbirth are well documented. Sudden infant death and respiratory problems in the newborn are also associated with smoking (Confidential Enquiry into Stillbirths and Deaths in Infancy, 1998).
A conflict of outcomes
Authors: Lavender Tina , Walkinshaw Steve
Published: July 2014

While there has been a steady rise in intrapartum studies, most designs have included obstetric outcomes as the primary measure of analysis. Few randomized trials have assessed the maternal perspective on various treatments or interventions. Despite recommendations supporting women centered care and research into maternal preferences (DoH, 1993), studies which have assessed maternal views have usually placed them as a secondary outcome. This suggests that these views may not be considered sufficient in their own right to advance clinical practice.
From face to face to distance: experiences of a midwife teacher
Authors: Williams Jacqui
Published: July 2014

Distance learning has become an accepted and highly regarded mode of study. The role of supporting distance learning students, however, presents new challenges to the tutor and necessitates a change in role. This article describes the challenges the author has had to face as a result of working independently as a midwife teacher supporting midwives studying distance education courses abroad. The author offers an insight into the roles, responsibilities and skills required of a distance education tutor and how her role has changed as a result. The results of the author's survey that was sent to her students to gain insights into their reactions to the course and the demands it, makes upon them are included. Their responses have been helpful to the author in self-evaluating her own performance and how her current role will be helpful for any future education posts.
Dangers of debriefing
Authors: Robinson Jean
Published: July 2014

It started out so well. The need seemed obvious. It was comparatively cheap. A couple of days training would do. One intervention seemed effective. The women were grateful.
Complaints and litigation within the health service
Authors: Symon Andrew
Published: July 2014

Complaints appear to be increasingly common within the health service. Whether this reflects diminishing standards of care or simply a contemporary reluctance to accept certain outcomes is unclear. The relationship between complaints and litigation is similarly difficult to establish, but both are expressions of dissatisfaction which cannot be ignored by health service managers.
Court-ordered caesarean sections: a midwife's dilemma
Authors: Ashcroft Brenda
Published: July 2014

This article gives an overview of the situation regarding court-ordered caesarean sections in the last five years and provides an up-to-date summary of the current situation. It also discusses the implications for midwives caught up in these and other situations involving non-consensual treatment and gives clear guidlines for practice. It is imperative that midwives are aware of the legal and professional issues involved, to protect them from the threat of litigation and professional misconduct.
Who will deliver primary care groups?
Authors: Smith Judith
Published: July 2014

Locality commissioning has come in and out of fashion since the inception of the 3.990 NHS reforms, and was seen by many to be a front runner for the preferred commissioning approach in the NHS of 3.998 and beyond. The White Paper on the future of the NHS has now been published (Department of Health, 3.997) and the central position of primary care led commissioning, based on localities of 3.00 000 people, has been confirmed. A key factor in the White Paper proposals is the involvement of the wider primary care team in commissioning, including midwives. So what can we learn from the experience of locality commissioning to inform the process of development of primary care groups?
The role of childbirth as preparation for looking after a small baby
Authors: James Jessica
Published: July 2014

Childbirth is discussed in relation to a woman's needs in labour (as the most intense phase of the childbearing year) and their similarity to those of her new baby. Some psychoanalytic ideas, particularly from DW Winnicott, are used to illustrate processes that are involved. These include physical and bodily holding, non-verbal human contact, opportunity for reparation, holding feelings, environmental sensitivity, omnipotence and vulnerability. The emotional significance of unconscious processes at birth are considered in relation to their potential for strengthening adaptation to parenthood. There is recognition that women's psychological needs cannot always be met in labour (although Changing Childbirth gives this area increased prominence) and that this constitutes a missed opportunity. There are detailed descriptions of women's experience in labour, their link to caring for a small baby with the care given by birth partners or midwives. Mention is made of the role of complicated deliveries, parenthood education and the needs of caregivers in emotionally sensitive provision.
Aspects of care 6: continuing educational needs of midwives 2
Authors: Pope Rosemary , Cooney Margaret , Graham Lesley , Holliday Mary , Patel Swatee
Published: July 2014

This is the last in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives in England and to identify and address continuing educational needs. The background to the study and the titles of other papers in the series have been outlined in the first paper. The first five papers have provided an overview of the main research findings that have been used to determine the continuing educational needs of midwives. This paper provides a more detailed picture of the issues that were identified in relation to educational need, and an overview of the way in which an educational package was developed on the basis of the research findings for use by midwives nationally.
Monitoring the fetal heart in labour: stop and think
Authors: Page Lesley
Published: July 2014

The midwife is the only expert in the maternity services who specializes in normal pregnancy and birth. Part of the specialist role of the midwife is to support physiological processes. Clearly, in this regard, something has gone badly wrong with British midwifery. The amount of routine interference with labour and birth, such as electronic fetal heart monitoring, does not seem to have declined in recent years, and the operative birth rate is climbing steadily, despite a mandare from Changing Childbirth initiatives for midwives to take on a stronger role. The National Report of the Audit Commission says that the use of caesarean section has increased in most developed countries to a level that concerns clinicians (1997:43). Through their national survey they found that the use of caesarean section at 11 NHS Trusts varied between 11% to 18% of deliveries. The operative delivery rate of 12 NHS Trusts varied between 13% to 5%. In some teaching hospitals, the rate of caesarean sections reaches above 25% on occasion. Our operative delivery rate may exceed that of North America in the near future.
Letters
Authors: Aherne Val
Published: July 2014

I read with interest and excitement the article by Salmon and Powell on caring for ‘Women in poverty.’ As part of a Masters Degree I am just about to send out a questionnaire to community midwives about the skills, attitude and knowledge needed when working in areas of social and economic deprivation. This is of particular reference to Stockport, the area in which I work, as about eight years ago the Health Visiting Service re-thought and re-structured to provide appropriate support in areas of social and economic deprivation. This restructure involved both targeting caseload and working in different ways. It also relates to the interest of the Health Authority in targeting services and the concern that midwives are under-represented in the New Public Health movement in Stockport.
The changes in tuberculosis as we approach the millennium
Authors: Lloyd Jo
Published: July 2014

Many NHS trusts have commenced offering the Bacillus Calmette-Guérin vaccine (BCG) to all neonates. This is due to the increasing incidence of tuberculosis (TB) in the community. Previously, only those considered high risk, i.e. with active TB in a close family member, were offered BCG. This article will critically examine both seminal and contemporary quantitative research which can influence the decision of whether or not to vaccinate. Following a review of TB and multi drug resistant TB, the impact of HIV and AIDS on TB will also be examined, followed by a look at the incidence of TB in Britain. A further article will explore issues surrounding the vaccine itself. The conclusions drawn will enable Health Care Professionals to be aware of current issues associated with TB.
The transition to parenthood
Authors: Underdown Angela
Published: July 2014

The focus of attention during the transition to parenthood is still with the birth process and the physical health of the mother and baby. This article considers current research into the emotional and social implications of the transition to parenthood, for men as well as for women, and whether this can be applied to support families effectively. Research clearly shows that some couples cope better than others during the transition to parenthood, often showing sensitivity and understanding to each other's needs. Is it the midwife's role to consider the holistic care of the family and to promote communication skills and conflict resolution skills? Should ante-natal classes be co-facilitated with health visitors to really prepare couples for the transition to parenthood?
Gaining approval for clinical research in third stage management
Authors: Harris Tina
Published: July 2014

Gaining approval for clinical research can be a long and drawn out process. For midwives considering clinical research the process of gaining access and approval needs to be explored well in advance. This article outlines the process of gaining approval and access based upon the author's experiences in a study currently being conducted on midwifery practice in the third stage of labour. This particular project involved approval from several institutions and individuals. Approval was required from the university where students who may be observed were studying, approval for the researcher to be released to conduct the research and approval from the NHS Trusts and Ethics Committee where observation of clients and interviews with midwives was to be conducted. The important issue of indemnity will also be explored
Ruptured uterus: the prostaglandin risk
Authors: Robinson Jean
Published: July 2014

There was one section of the latest CESDI report I could not wait to read — the chapter on the rupture of the uterus (CESDI, 1998). So often the Confidential Enquiries into Stillbirths and Deaths in Infancy describes a problem we have seen in creasing in the AIMS postbag for several years. We had written to all the Chief Medical Officers in the UK and to the RCOG saying how worried we were. The classic picture was described over and over again by the mothers themselves. There was a previous section. This time someone tries to induce labour. In goes the prostaglandin gel. Maybe later a second dose. In some cases oxytocin follows, and the labouring woman reports pain. ‘There, there, yes I know it hurrs,’ says the kindly midwife, not picking up the difference in location or the type of pain, and not checking the woman's pulse.
Resource Reviews
Authors: Mander Rosemary , Archibong Uduak E , Sandall Jane
Published: July 2014

The consistent focus of this text is social research in all its complexities, making it particularly suitable for students, practitioners and researchers in midwifery. The style is certainly accessible, the approach being reader-friendly without being patronising. The authors also attempt to make research user-friendly and fire largely successful.
Do women share midwives' views of their educational role?
Authors: Collington Val
Published: July 2014

Parents need sufficient information to enable them to make informed decisions about their care. Midwives must share relevant professional knowledge to empower parents, enabling them to make real choices and accept responsibility for decisions made. The article in the previous issue presented results of an investigation into the extent to which midwives see themselves DS educators of childbearing women. This second article alms to discover whether women share midwives' views of their educational role.
Midwifery model in Pontefract
Authors: Shaw Carol , Mamujee Yasmin , Fox Tracy
Published: July 2014

As a group of midwives having recently completed the A26 course for developing the accountable practitioner, we were requested to develop a midwifery model for use in Pontefract. This evolved not only as a result of the Department of Health's Changing Childbirth report (1993), but also due to criticism of the apparent lack of a suitable midwifery model in our unit.
Will midwifery cuts kill babies? More lessons from CESDI
Authors: Robinson Jean
Published: July 2014

Is anyone else out there worried about the reduction in midwives' postnatal home visits? Once upon a time, your midwife called everyday for ten days after the birth. ‘Selective’ visiting (a euphemism for cuts) is what they are doing now, and it snuck in with no warning, no discussion, no consumer consultation, no monitoring and no research. What price are we paying in untreated perineal problems, missed depression and loss of breastfeeding?
Nutritional requirements of lactating women
Authors: Coutts Alison
Published: July 2014

The benefits of breastfeeding, as opposed to formula feeding for the baby are well known, and it is widely understood that the mother is also likely to gain from breastfeeding (Mepham, 1987). Lactation offers some protection from breast cancer and will assist her in regaining her pre-pregnancy figure and weight. Much less is known, however, about the nutritional needs of the mother — the only advice she is likely to receive is to: ‘eat a well-balanced diet and drink plenty.’ This article seeks to review the literature into what lactating women require.
How prepared are UK midwives for their role in child protection?
Authors: Halsall Sarah , Marks-Maran Di
Published: July 2014

This article reviews the UK literature about the extent to which midwives are prepared for their role in child protection in order to identify the evidence and to make recommendations for further research. Findings from the studies reviewed revealed a number of themes related to child protection in midwifery including: midwives perspectives, educational perspectives, multi-agency working and organisational perspectives. The review revealed that there is a dearth of empirical studies in this area with no studies found related to vulnerable groups such as those with mental health problems, learning disabilities, women with problems of substance abuse and teenagers.
Individualised care in midwifery
Authors: Sporek Paulina Ewa
Published: July 2014

Student midwife Paulina Sporek discusses the importance of having a good midwife
Patient care and management: reduced skin integrity of the foot
Authors: Bateman Sharon D
Published: July 2014

The development and deterioration of pressure ulcers are a frequent occurrence across all healthcare settings and specialties, posing daily challenges to the healthcare worker and unnecessary suffering to the patient. Reduced skin integrity occurs within those patients deemed high risk, particularly to the vulnerable areas such as the heel and ankle ( American Physical Therapy Association (APTA), 1996) . The incidence of pressure ulcers, alongside diabetes, vascular insufficiency and obesity, is on the increase, posing additional demands on current clinical resources; specialist clinics, debridement therapies and appropriate dressing management regimes. This article will focus on the heel and ankle in regards to reduced skin integrity and the positive introduction of an innovative dressing product as an adjunct to the overall care and management of this patient group.
The role of barrier protection in pressure ulcer prevention
Authors: Haynes Jackie Stephen
Published: July 2014

This article considers the anatomy and physiology of the skin, the natural protection the skin provides in relation to barrier protection and the importance of barrier protection in pressure ulcer prevention. The current national pressure ulcer agenda including high impact actions and the SSKIN care bundle, along with their implementation within one NHS Health Care Trust are discussed.
Small Animal Review
Authors: Tennant Bryn
Published: July 2014

Introduction:

Uterine biopsies are a useful method of identifying potentially treatable endometritis in bitches with reproductive failure
Canine keratoconjunctivitis sicca: an overview
Authors: Rhodes Mike
Published: July 2014

Keratoconjunctivitis sicca (KCS) is a relatively common condition in dogs, which is caused by a deficiency of the aqueous component of the tear film. The most common cause is immune-mediated disease but other aetiologies include neurogenic, congenital, endocrine and infectious disease, drug-induced, iatrogenic, evisceration/prosthesis and irradiation. Diagnosis is made by performing a Schirmer Tear Test. Clinical signs include ocular discomfort, conjunctival hyperaemia, a tenacious mucopurulent ocular discharge and a lacklustre appearance to the corneal surface. Topical medication forms the mainstay of treatment but in refractory cases surgical intervention should be considered. This article gives an up-to-date overview into the management of canine KCS.
Case study: generalised demodicosis in a Chihuahua
Authors: Wright Ian
Published: July 2014

Canine demodicosis is a common dermatosis and occurs when there is excessive proliferation of Demodex canis within the hair follicles and sebaceous glands. The mite is not entirely responsible for the pathological process and the disease is multifactorial with genetics, immune status, other cutaneous fauna and hormones all playing a part to varying degrees. The disease is classified as canine localised demodicosis or canine generalised demodicosis according to the extent of the disease. This article considers a case of demodicosis encountered by the author in practice. It demonstrates the need to consider demodicosis as a differential in juvenile onset seborrhea and the need to sometimes consider a variety of treatments before resolution of clinical signs is achieved.
Disease facts: canine sarcoptic mange (scabies)
Authors: Craig Mark
Published: July 2014

This article discusses sarcoptic mange in the dog, including transmission and life cycle, general features, clinical signs, diagnosis, prognosis and treatment. Aspects of human infestation are considered.
Acute moist dermatitis
Authors: Paterson Sue
Published: July 2014

Acute moist dermatitis is a common dermatological condition seen in both the dog and cat. Even though most cases respond quickly and completely to symptomatic therapy, it is still important to assess each animal on an individual basis and undertake a few quick basic diagnostic tests on each one in order to prescribe the most appropriate therapy.
Comment: choosing the correct flea and tick product
Authors: Wright Ian
Published: July 2014

Clients have an array of options for treatment of fleas and ticks, with two tablets available, a collar and numerous spot-ons; how do we help advise them to choose the right one? The answer lies not in efficacy but in considering individual aspects of the client's needs.
Formulating a successful fundraising strategy
Authors: Best Brin
Published: July 2014

Brin Best provides seven ways to enhance your fundraising strategy by using the methods employed by some of the UK's most successful schools.
Finance in the new National Curriculum
Authors: David Anthony
Published: July 2014

Anthony David looks at the importance of teaching finance to pupils, how it fits in with the new National Curriculum, and different approaches to the subject.
Understanding the physiology, pharmacology and therapeutic uses of vitamin D
Authors: Hughes Philip J , Brown Geoffrey , Kutner Andrzej
Published: July 2014

Vitamin D was identified nearly a century ago as an important regulator in the absorption and transport of essential minerals (particularly calcium, phosphorus and magnesium), and as such is a key determinant of normal bone development. Vitamin D is now seen as a potentially key hormonal regulator in the cardiovascular, musculoskeletal, renal, nervous, adipose and immune systems. An adequate supply of vitamin D at all stages of life is essential for the maintenance of good health. It has, however, been estimated that upwards of 1 billion people, in both the developed and developing world, can be categorised as being vitamin D deficient. This article discusses some key aspects of the biochemistry, physiology and pharmacology of vitamin D.
Correction and management of dermal filler misplacement post lip augmentation
Authors: Costa Naomi Silva
Published: July 2014

This paper outlines a case study of a 30-year-old woman who presented to the author, an aesthetic nurse consultant, with concerns about her lip after having a dermal filler injected a few weeks before. During her consultation, it was discovered that she was initially seen by another aesthetic nurse practitioner in the US, who injected a hyaluronic acid (HA) based dermal filler for the purpose of lip volume augmentation. This case study will reflect on how the patient was assessed and treated, considering accountability, legal and ethical issues, as well as concordance with the medical advice given to the patient. The author will also discuss diagnosis and differential diagnosis, and describe the best available treatment options that were sought to resolve the patient's condition.
Avoiding litigation: what aesthetic nurses need to know about handling complaints
Authors: Luckman Mandy
Published: July 2014

Litigation is often pursued by clients who have not received follow-up care or who are not aware of the practitioner's complaints procedure. In the fifth of this series of legal articles, Mandy Luckman highlights the importance of having an accessible, transparent pathway for patients, which can be followed if and when a procedure goes wrong. In particular, she outlines how this approach can achieve positive outcomes
Plans to share the new educational framework with association members
Authors: Senior Yvonne
Published: July 2014

As part of Health Education England's expert reference group for the non-surgical cosmetic procedures educational framework, PIAPA has been instrumental in pushing forward the agenda for nurses and patients. However, the journey to consensus has been challenging, with a vast range of opinions to consider. In this column, Yvonne Senior reports on PIAPA's plans to inform nurses of new developments
Understanding the practice nurse's role in the cancer care tapestry
Authors: Campion-Smith Charles , Doyle Natalie , Henry Richard
Published: July 2014

Background:

The are 2 million people in the UK living with or after cancer, and this is expected to double by 2030 ( Maddams et al, 2012 ). Many report unmet physical and psychological needs.

Aim:

To determine the learning needs of practice nurses for them to take on an enhanced role with people affected by cancer, particularly after primary treatment, and to develop a course to meet these needs.

Method:

The Macmillan Steering Group designed a course for practice nurses to identify their learning needs and enable them to work collaboratively. There was strong patient involvement throughout. The course was evaluated by self-assessment, patient satisfaction questionnaires and in-depth telephone interviews with the practice nurses and their supporting GPs.

Results:

Practice nurses reported changed practice, with increased confidence in discussing issues relating to cancer and its treatment. They understood the importance of supported self-management and could signpost patients to appropriate sources of information and support. Many practice nurses started to initiate Cancer Care Reviews.

Conclusions:

With appropriate training and protected time to include cancer care into their everyday work, practice nurses can take on an important role in the care of people affected by cancer.
Testing for vitamin D deficiency in adults
Authors: Thomas Susan
Published: July 2014

More than 50% of adults in the UK are vitamin D deficient. Susan Thomas explains the importance of measuring serum levels to determine vitamin D status
What Is “Urban Wood Waste”?
Authors: Lyon Scott , Bond Brian
Published: July 2014

Researchers, governing agencies, and other stakeholders frequently use the term “urban wood waste” to describe either waste from wood products, municipal trees, or some combination. The materials that actually make up the waste may come from very different sources. For example, those utilizing recovered building materials and municipal waste describe urban wood waste as construction and demolition debris. Arborists and other urban tree stakeholder groups define urban wood waste as material from pruning or tree removal operations that would otherwise be discarded in a landfill. In addition to diverse definitions among stakeholder groups, the term “wood waste” has evolved over time due to advances in processing and technologies. The objective of this article is to review the current usage of the terminology regarding urban wood waste and to develop a clear definition that can be accepted across stakeholder groups. It was determined that a universal definition does not exist and may not be appropriate.
Islamic Architecture on the Move
Authors: Gruber Christiane
Published: July 2014

This study aims to explore a number of conceptual models that may prove fruitful in the study of architectural mobilities within and beyond Islamic lands from the eighteenth century until today. Beginning with a discussion of the ‘new mobilities’ paradigm, the essay explores several examples of architecture on the move via textile metaphors, micro-architecture, flows and hubs, tentage traditions and urban ‘slumming’. The use of the kiswa and small-scale models reveals how the Ka‘ba and the Dome of the Rock have been symbolically dispersed and repurposed in new geographical and religious contexts. Moreover, tensile forms are frequently cited in order to promote notions of authenticity and transience while also serving as weapons within urban warfare, as seen in the 2013 Gezi Uprisings in Turkey. These types of movement between media, spaces and places highlight the fact that architectural practices are never wholly distinct or dichotomous; that mobility and fixity are very often mutually dependent; that the past is frequently ‘moved’ – both conceptually and emotionally – into the present; and that manipulations of urban space can serve as highly visible stages for the enunciation and performance of ideological conflict today.
The Mobile Matrix: The Hijaz Railway as Ritual Space and Generator of Space
Authors: Simonowitz David
Published: July 2014

Despite a revolution two months earlier, the Ottoman Sultan Abdülhamid II (r.1876–1909) still sat on the throne upon the inauguration of the Hijaz Railway in September 1908. Dismissed as military strategy or as propaganda, the railway nevertheless signified more to many Muslims. This article examines the Hijaz Railway from an uncommon perspective, beginning with a component of the train largely neglected by scholars, the cami-vagonu or ‘mosque wagon’. A mobile space recapitulating historic loci of Ottoman Islamic ritual, it contributed to the production of an imperial discourse of legitimacy and authority. Within this wagon, the designers reproduced architectural forms and calligraphic motifs to incorporate the railway in a larger representational space. They also deployed modern maps to orient the mosque wagon and represent the railway, linking the calligraphic and the cartographic in a distinctly Ottoman visual-cultural language. These factors would inform the conception and reception of the sultan’s project in local and trans-imperial networks of patronage. The planners of the railway enhanced the functions of this network by sacralizing modern technological resources. In documenting architectural, aesthetic and ritual aspects of the mosque wagon, this study presents a more nuanced picture of the Hijaz Railway and its infrastructure in both the Hamidian and the Second Constitutional periods and explains how it was a ‘pious’ as well as a ‘pragmatic’ project.
Mobility and Ambivalences: Negotiating Architectural Identities during Khedive Ismail’s Reign (1863–79)
Authors: El-Ashmouni Marwa M.
Published: July 2014

This article explores the role of human mobility in the reconfiguration of Egypt’s modern identity in the nineteenth century. It connects James Clifford’s Routes: Travel and Translation in the Late Twentieth Century (1997) with Homi Bhabha’s The Location of Culture (1994) to interpret the construction of identities during the reign of Khedive Ismail (1863–79). The argument focuses on Ismail’s attempts to modernize the country passed through discursive ‘routes’ that were manifested in socio-political systems and architectural practices. While the Suez Canal represents the new routes advocated by the Khedive, its inauguration in 1869 manifests the notion of ambivalence between imperialism and anti-imperialism. This ambivalence materialized in the hybrid designs of both the Gezira Palace (1863–68) and the ‘Abdin Palace (1863–74), and in the emulation of the Haussmann Plan – which resulted in, this article argues, a ‘contact zone’ or ‘interstitial’ spaces in which political coalitions with global powers were prefigured. This material history cannot be dismissed as exotic follies, accidental hybrids or romantic Occidentalism.
‘In the Absence of Originals’: Replicating the Tilework of Safavid Isfahan for South Kensington
Authors: Carey Moya
Published: July 2014

In 1877, Robert Murdoch Smith, the Victoria and Albert Museum’s agent in Iran, undertook a brief project that differed from his more typical modus of bulk purchasing from local dealers and private collectors. Unable to purchase original decorative tilework from Safavid Isfahan’s sacred monuments, he commissioned flat, full-size copies of 33 designs, traced directly from the tiled surfaces of six building complexes, and painted in full colour. Thus the South Kensington Museum (as it then was) would possess a record of these historic surface designs, and not the glazed tiles themselves. As such they still satisfied the Museum’s mission to inform and improve contemporary practice in British industry. The primary site was the Madrasa-ye Madar-e Shah complex on Chahar Bagh Avenue, a prominent monument close to Murdoch Smith’s offices in Isfahan. Since the seventeenth and early eighteenth centuries, the madrasa and two other major Safavid mosques had been recorded and illustrated by European visitors, and published by these outsiders as national epitomes. The 1877 project marks a waystage in this increasingly international visibility, occurring long after these monuments were first built as Safavid projections of splendour, and not long before their cosmetic appearance acquired renewed political significance in Pahlavi Iran.