bluuebunny/crossref_metadata_2025 huggingface dataset:
Standard principles of infection control: infection control series, part 2
Authors: Nazarko Linda
Published: May 2014

Last year, 15.146 million people were admitted to NHS hospitals as inpatients; the number of people admitted has been rising over the past ten years ( NHS Confederation, 2014 ).

Changes in healthcare practice have led to a major decline in healthcare-associated infections (Walker and Fowler, 2011:69; Health Protection Agency (HPA), 2012 ). Standard principles of infection control are the rock on which all efforts to reduce infection rates are embedded. Population changes have led to the NHS treating greater numbers of older people, who are extremely vulnerable to infection ( Nazarko, 2014 ). Increasing levels of antibiotic resistance mean that infections are more difficult to treat ( Department of Health (DH), 2013 ). These changes mean that good practice in infection control is vital.

Every single person who works in healthcare has a responsibility to reduce infection risks by practising standard principles of infection control. This article aims to enable readers to be aware of what infection control is, what infection risks exist, how infection spreads and what can be done to reduce infection risks.
It's good to talk and even better to listen
Authors: Wilson Jo
Published: May 2014

Effective communication is not only one of the best forms of risk prevention, but can have an important and profound impact on health outcomes.
Liberal Democrats avoid headlines with ‘sane’ criticisms
Authors: Roth Andrew
Published: May 2014

You may have not heard about my friend, 38 year old Nick Harvey, the Liberal Democrat's new Health Spokesman since October, despite his debut speech on the NHS a week later. This is partly because, as in currency, over the top speeches from a smart-arse young doctor like Nick's predecessor, Dr Evan Harris, tend to drive out of the headlines shrewder speeches like his.
NHS Direct Online - hypochondriac's charter?
Authors: Harvey Trevor
Published: May 2014

The arrival of the NHS Direct Online site, http://www.nhsdirect.nhs.uk/ , is the most convincing evidence yet of the web's credibility within government. This resource logically augments NHS Direct, the round-the-clock nurse led service, launched last April. A brave step; a legitimate NHS innovation.
Will NICE herald regional rationing?
Authors: Maynard Alan
Published: May 2014

The National Institute for Clinical Excellence (NICE) is trundling along nicely with a ‘bash’ in Harrogate before Christmas, and its Director appearing all over the place, preaching the virtues of his organisation.
Ethics, genetics and new dilemmas for managers
Authors: Greener Mark
Published: May 2014

Ethical philosophers’ deliberations may seem far removed from NHS managers’ everyday concerns it's certainly easy for them to become buried under a mound of paperwork, hidden behind NHS targets and blurred by the current focus on structural reform. But health care managers, perhaps more than their colleagues in any other sector, need to consider the ethical consequences of their daily working lives.
Soft services crucial to successful NHS renewal
Authors: Davis Michael
Published: May 2014

This article questions the ASB's recent exclusion of ‘soft’ non-clinical services from the scope of PFI contracts.
Privatisation: the zero-sum game
Authors: Charny Mark
Published: May 2014

This series reflects on the gap between policy as it is made in the centre and policy as it is lived in the trenches.
Learning from devolution: UK policy since 1999
Authors: Freeman Richard , Woods Kevin
Published: May 2014

This article considers what has been learned regarding health policy in the process of political devolution in the UK.
‘Shape up or ship out': with regard to the remedy
Authors: Davies Lynn
Published: May 2014

This articles considers the potential fates of the Chief Executives and board Chairmen of the 12 acute hospital trusts who were awarded no stars in the recently-published league tables.

A failure to improve their Trusts’ performance within the time scales given by the Secretary of State (three months for long-serving Chief Executives, and 12 months for those who are newly appointed) could result in their dismissal.
A miraculous journey: exchange rate values
Authors: Harvey Trevor
Published: May 2014

Driving along and preoccupied, I caught a news story on my car radio: apparently, I was hearing Alan Milburn justifying the sending of nineteen NHS patients to Lourdes! I had misheard; it was not, of course, Lourdes but Lille.
‘Constrained innovation’ and The NHS Plan
Authors: Eyres Jacky , Dewar Steve
Published: May 2014

This article considers the inherent problems in attempts to realise The NHS Plan, and suggests some solutions to the paradoxes to be confronted.
Free at the point of need
Authors: Harvey Trevor
Published: May 2014

Acardboard placard on the window sill in my dentist's waiting room displays a broadly grinning young woman, and the words ‘We're here to look after your smile!” A principle of psychology called the James-Lange effect predicts that, if you smile, often enough and hard enough, you will start to actually feel happier. Which may explain the jolly disposition of John Major, the bouncy cheerfulness of Tony Blair or indeed, the happy-go-lucky appeal of Lionel Blair? Indeed, one might begin to confuse the two, if the soccer ball-heading PM ever breaks into a tap routine. Moral: that those remorseless cheesy grins may be working up a frenzy of glee within.
Comedy: the sudden incongruity between concept and percept
Authors: Cowper Andy
Published: May 2014

Arthur Schopenhauer, author of the classic The World as Will And Representation, once defined comedy as ‘the sudden incongruity between concept and percept’. What, you might ask, is this doing in an editorial comment following the month when a major and sustained increase in health service funding over two decades has been promised? The answer is, quite a lot.
How to win friends and influence people
Authors: Bell Andy
Published: May 2014

Alot has been written over the past few weeks on the abilities of primary care trusts and strategic health authorities to do the jobs required of them. Much of this has focused on concerns that they lack the management capacity, the experience and the basic bargaining power to achieve many of their core functions, such as commissioning better hospital services for their populations.
Riding off in all directions
Authors: Roth Andrew
Published: May 2014

Health Secretary Alan Milburn is beginning to remind me of the hero of the Canadian humourist who ‘jumped on his horse and rode off in all directions’. I had given him the benefit of the doubt, thinking he was trying to develop a coherent devolved federal system for the NHS, with centrally-set standards and controls applied sensitively and differentially in the regions according to their varying circumstances.
Keeping staff out of court and in the hospital
Authors: Stay Adam
Published: May 2014

This article examines how to avoid potential litigation against NHS staff in relation to Point-of-Care Testing (POCT).
Standing as a Dobsonite for my Foundation hospital
Authors: Roth Andrew
Published: May 2014

I have been drafting my manifesto for election to the ruling council of the Royal Free Hospital, when and if it becomes a ‘oundation’ trust. Since it will be ‘utualised’, according to Health Secretary Alan Milburn and owned by its local users (like the Mill Lane Co-op I joined when I arrived in Britain in 1950), I think I am eminently suited to contest the election.
Nursing a grievance
Authors: Ainsworth Steve
Published: May 2014

Exactly why we should be importing Filipino nurses by the planeload is something of a mystery to me, if to no-one else. Well, OK, I understand perfectly that on the face of it there's a shortage of qualified nurses of our own, and that we're having to scour the globe for human resources to make up for that deficiency.
Policy Developments
Authors: Halpern Stephen
Published: May 2014

The reported claims that many parts of the NHS are failing to implement NICE guidance on the breast cancer drug, Herceptin, can scarcely provide a clearer illustration of how this Government is failing to translate policy into reality.
How faster A&E has helped ten million people
Authors: Howard Kerrin
Published: May 2014

This article describes the need for senior managers to support efforts to bring down waiting times in A&E.
Let the triangular health conflict commence!
Authors: Roth Andrew
Published: May 2014

At the same time as the two-sided 2004 USA presidential election campaign is warming up, the three-sided 2005 British election battle over health is entering its prelininary phase with three new(ish) hitters. In the pink corner is the battling Blairite Dr John Reid, who took over as Health Secretary in the summer when Alan Milburn repsponded to the ‘resign or divorce’ ultimatum from his consultant psychiatrist wife.
Perspectives on modernisation: progress or stasis?
Authors: Cowper Andy
Published: May 2014

To mark the month when the National Insurance rise to fund higher NHS spending kicks in, British Journal of Health Care Management asked a range of commentators and participants in the field for their views with regard to issues including the status of NHS reform; the Modernisation Board's recent report; and the Conservative Party's consultation document on their emerging health policy.
Making leadership work in today's NHS
Authors: Goodwin Neil
Published: May 2014

This article considers definitions and applications of leadership in the NHS.
Healthy information
Authors: Bell Andy
Published: May 2014

It is a truism of the highest order that our society is offered all kinds of information about health. Through the mass media (latterly including the internet), a wealth of material awaits anyone with even a passing interest in all kinds of health topic, from which foods prevent cancer to how to treat schizophrenia.
Are they bonkers or what?
Authors: Maynard Alan
Published: May 2014

In the 1980s, BBC Television's political situation comedy ‘Yes Minister’ introduced a grateful public to ‘The Politicians’ Syllogism’. It runs as follows: Step One: We must do something. Step Two: This is something. Step Three: Therefore we must do this (Source: ‘Yes Prime Minister'Volume 2 1988, Jay and Lynn).
Will CPPIH really be democratically diverse?
Authors: Sang Bob , Dabbs Chris
Published: May 2014

The Provocations series continues with a piece looking at the Commission for Public and Patient Involvement in Health. Can it help involve patients, or is it doomed to repeat old mistakes?
Where there is no vision, people die
Authors: Harvey Trevor
Published: May 2014

One of the points made by Clare Short in her valedictory speech as a minister to the House of Commons was that policies central to encouraging change throughout our public services are now emerging half-baked, undiscussed and poorly considered.
‘So it's goodnight from Alan and it's good morning from John'
Authors: Cowper Andy
Published: May 2014

Tony Blair and Ruth Briel aside, the health community was surprised and shocked by the news of Alan Milburn's resignation as Secretary of State for Health. Widely viewed as the gritty ‘hard man of health’, Milburn told Blair on the Monday and then the world on the Thursday that he was quitting to spend more time with his partner (NHS psychiatrist Dr Ruth Briel) and their two young sons, Joe and Danny. Milburn's decision was apparently prompted by nearly missing his younger son's school concert.
Six months: hard Labour
Authors: Cowper Andy
Published: May 2014

Let's call it The Black Report Syndrome. A fine Department of Health media management tradition was upheld with the timing of Dr John Reid's speech to the New Health Network on 15th July: the publication day of the new star ratings, including the first set for Primary Care Trusts.
Trouble in store with the ‘miracle Polypill'
Authors: Ainsworth Steve
Published: May 2014

The ‘Provocations’ series returns with a heartfelt argument why we should not seek to prolong human life beyond a reasonable ‘innings’.
Race and mental health
Authors: Halpern Stephen
Published: May 2014

Good health care cannot be delivered in a social and cultural vacuum. If this dictum is to apply anywhere, it belongs in the psychiatric services. The astonishing diversity of London's population means that if psychiatric services are to be effective, this is the one place that they must be more culturally sensitive.
The 23-hour ward: an efficient alternative to day case surgery
Authors: Kok K , Hayhurst C. , Wilson PS
Published: May 2014

Emergency admissions reduce available inpatient bed spaces, impacting on elective operating lists and reducing surgical efficiency. Emphasis has been placed on day case surgery to improve throughput and reduce waiting lists in recent times.
The good ship NHS tossed by stormy high seas
Authors: Roth Andrew
Published: May 2014

The good ship NHS has been breasting heavy waves and tossed by severe crosswinds as it steams slowly ahead. Luckily, its million-plus staff proceed with their many tasks with little realisation of what is happening abovedecks.
A tool to develop specialist practice in health care
Authors: Whale Zoe , Whyte Fiona
Published: May 2014

Current health policy has reiterated the importance of the development of specialist knowledge and skills in order to respond proactively to meet current and future trends in health care (DoH, 2001, DoH, 2002, DoH, 2003).
Heading for the cliff edge?
Authors: Maynard Alan
Published: May 2014

The Labour Government - if re-elected - seems intent on maintaining its evidence-free policies that have a potential to destabilise the NHS. If they are re-elected on May 5th, John Reid may be moved.
They that have power to hurt and will do none
Authors: Bell Andy
Published: May 2014

The word schizophrenia, like so many in the English language, has a given meaning in one context but is too often used loosely in a wider sphere. (The word psychotic is in a similar vein.)
RAB is undermining the best hospital trusts
Authors: Roth Andrew
Published: May 2014

You would expect some publicity in the press and on TV when there was a 90-minute Parliamentary debate on famous, top-performing hospital trusts threatened with bankruptcy with their top people falling on their swords to avoid the sacking of more essential top executives. You would not have seen any. Why?
3-month nursing vacancy figures:
Authors: Batata Amber
Published: May 2014

The Department of Health Vacancy Survey began collecting data on vacancies across the NHS in 1999. Rather than collect point-in-time estimates of all vacancies as of 31 March of every year, the survey counts only those positions that have remained vacant (and have been actively recruited) for at least three months (as of 31 March of each year).
Financial risk in health purchasing: risk pools
Authors: Jones Rod
Published: May 2014

Part one of this series explored the financial risk associated with the size of a practice-based commissioning (PBC) group. A process for determining the point of minimum possible financial risk was illustrated by excluding high cost admissions from the core PBC budget (Jones, 2008). By implication, such exclusions will be gathered into a risk pool held on behalf of the PBC group.
Financial risk at the PCT/PBC interface
Authors: Jones Rod
Published: May 2014

The Department of Health (DH) states that ‘PBC [practice based commissioning] is … a crucial method through which PCTs [primary care trusts] and practices can work together to improve health outcomes and reduce inequalities’ (DH, 2007a).
Limitations of the HRG tariff: day cases
Authors: Jones Rod
Published: May 2014

The introduction of ayment by results (PbR) Department of Health (DH), 2002) rought together Government olicy and DH implementation. he following provides clues to how policy direction was nterpreted (DH, 2003):
Addressing the stigma
Authors: Bell Andy
Published: May 2014

Later this month, a major national initiative to tackle the stigma attached to mental ill health will begin. Time to Change, managed by the national charities Rethink and Mind, funded by the Big Lottery Fund, will be the biggest single attempt yet to uproot the prejudice and ignorance that have such a significant effect on the lives and life chances of people with mental health problems.
Save versus spend
Authors: Timmins Nick
Published: May 2014

September 2009 was the month in which health ministers could not resist spending more money, despite the financial pressures the NHS is about to face. And a month when proof positive came—if anyone doubted it—that Gordon Brown's Labour Government is less keen on choice and competition than Tony Blair's was.
Evaluating coding sheets and cost implications
Authors: Lewis Christopher J , Singhal Hemant , Reichert Robert A
Published: May 2014

The correct coding of surgical procedures is signicicant as it influences departmental funding, as well as providing accurate figures of operations performed. The reality, however, is sometimes different. Specific surgical coding sheets may improve the overall effectiveness and accuracy of this process. This audit highlights the positive impact that the introduction of coding sheets has had in a breast surgery department.
Improving care, reducing cost
Authors: Leaman Alan
Published: May 2014

In recent years, the NHS has enjoyed unprecedented increases in funding, leading to significant improvements in the quality of patient care and a closing of the gap between supply and demand. Over the last 60 years, NHS spending has grown as a share of national income from around 3% in 1950 to nearly 9% today.
Reward vs compassion: a fine line
Authors: Hill Rosalind
Published: May 2014

Payment by results should be scrapped. At least, that's the message from the NHS Alliance and Liberal Democrat Shadow Health Secretary, Norman Lamb.
Promised cuts and cutting promises
Authors: Timmins Nick
Published: May 2014

October 2009 was the month in which the vice within which the NHS will be operating in the coming years became a little more closely defined.
Wireless technology is leading the way
Authors: Wyre Edward
Published: May 2014

The unrelenting progression of communications technology has shown no signs of slowing over the last 10 years, and as the first decade of the 21st century draws to a close, technology is continuing to gather pace at a staggering rate. A sector that can leave generations bewildered, the communications industry has infiltrated every aspect of life as we know it with potentially dramatic results. The subject is vast, the influence massive and modern health care has been a particular focus for the integration of advanced communications technologies.
Crafting efficient bed pools
Authors: Jones Rod
Published: May 2014

The process of streaming implies grouping patients with similar needs so that they can receive dedicated input of clinical care. It is best known for its application in achieving efficiency in accident and emergency departments (Cooke et al, 2002).
End of an era, but looking ahead
Authors: Moyes Bill
Published: May 2014

This is my final column for this journal as Executive Chair of Monitor. In the run up to the General Election, there will be no shortage of opinion expressed on the success of various NHS reforms. Instead of contributing by reflecting on Monitor's achievements during the past 6 years, I would prefer to discuss what lies ahead.
Doubts and more doubts
Authors: Timmins Nick
Published: May 2014

January 2009 was a busy one. A brand new NHS constitution. A warning from the Commons Public Accounts Committee that the NHS IT programme should not be given more than six months to prove itself in its current form. The launch of plans for pilots to give patients individual budgets. The opening for business of the awkwardly named Cooperation and Competition Panel. And fresh evidence that NHS spending over the coming years is going to be very, very tight indeed.
Accelerating performance
Authors: Glossop Paul
Published: May 2014

What do a car plant and a hospital have in common? More than you might think: both environments run complex processes where the scope for errors, quality problems, poor communication, waste and the failure to put the customer first is colossal. That's why Lean methodologies that have revolutionised automotive and manufacturing performance can work wonders in hospitals too.
Are patients choosing?
Authors: Henderson Sarah , Robertson Ruth , Dixon Anna
Published: May 2014

The Government has promised patients a choice of hospital when referred by their GP for treatment, and much time and money has been spent on implementation. But are patients being offered a choice of hospital, and if so, how are they choosing? This article presents findings from interviews with NHS patients about whether and how they chose a hospital, and discusses the implications.
Worth a Ceasar's salary: chief executives' pay
Authors: Ainsworth Steve
Published: May 2014

Senior managers’ pay is a fascinating topic. Ideas about what constitutes fair pay change in time and place.
Limitations of the HRG tariff: the RCI
Authors: Jones Rod
Published: May 2014

The reference cost index (RCI) is promoted by the Department of Health (DH) as the definitive measure of organisational efficiency (NHS Networks, 2008). A somewhat more cautious approach could well be warranted.
The Old Problem: rationing access
Authors: Maynard Alan
Published: May 2014

Everyone in the NHS studiously ignores the rationing of health care, while recognising that it is ubiquitous. Rationing involves depriving patients of care from which they would benefit and they would like to have.
Leadership development: does it make a difference?
Authors: Prosser Stephen
Published: May 2014

‘Leadership is necessary not just to maintain high standards of care but to transform services to achieve even higher levels of excellence...
Lost in (a lack of) communication
Authors: Timmins Nick
Published: May 2014

March 2009 was a month that proved a tough time for regulators. Her Majesty's Press had a field day with the Healthcare Commission's report on Mid-Staffordshire NHS Foundation Trust, which revealed such ‘appalling’ standards of emergency care that ‘there is no doubt that some patients will have suffered and some of them will have died,’ according to Sir Ian Kennedy, the outgoing Commission's chair.
Incentivizing quality: time for an apology?
Authors: Maynard Alan
Published: May 2014

The Government has discovered ‘quality’, but remains confused as to whether this is a process and/or an outcome issue. From the patients’ perspective the ultimate hope when consuming health care is that it will make them ‘better’. They envisage ‘better’ as meaning they will live longer and better quality lives in terms of observable improvements in physical and psychological functioning.
Interprofessional learning in practice
Authors: Simpson Trevor
Published: May 2014

The NHS provides a rich culture of innovation, change and opportunities to improve patient care. This article will discuss the setting required to enable the inclusion of interprofessional learning (IPL) and interprofessional working (IPW) to become an inherent part of an organisation's learning and working strategy. The focus of activity in relation to IPL and IPW is currently associated with academia and delivery of programmes for pre- and post-registration learners in universities, from all areas of the healthcare team, including nurses, physiotherapists, occupational therapists, and social workers. This article argues the need for NHS trusts and social care organisations to embrace interprofessional learning and working in a more unified and coordinated way. This will need extensive investment with controlled change management programmes from central government.
Cycles in emergency admissions
Authors: Jones Rod
Published: May 2014

Part one of this series discussed how the more widely recognised factors such as an ageing population and re-admissions only contribute to a baseline increase in emergency admissions. Short stay admissions (mainly zero day stay) account for the bulk of the increase. Most diagnoses appear to show a roughly linear trend over time. These are unable to explain the observed cyclical events occurring about every 4–6 years in medicine, and even longer cycles in surgical and trauma admissions.
Regulating quality
Authors: Moyes Bill
Published: May 2014

Publication of the Healthcare Commission's report on its investigation in to Mid Staffs put the quality of NHS hospitals under intense scrutiny. The public rightly expects the highest standards from its local hospital, and national reaction to the report's findings was a stark reminder of how passionately people feel about the NHS.
Using emergency theatre facilities
Authors: Metcalfe Sarah , Cosgrove Joseph F
Published: May 2014

National guidelines exist for optimal provision of emergency theatre services. Through publicised audits, the Freeman Hospital, Newcastle—a tertiary referral centre—has significantly reduced median waiting times for surgery and the incidence of ‘unnecessary’ delays, increasing daytime operating and consultant anaesthetic input into patient care. A subsequent ‘unpublicised’ audit demonstrated maintenance of such standards despite a significantly increased workload, suggesting long-term changes in theatre management.
Achieving open, fair and consistent decisions
Authors: Carr Anne-Marie , McKendrick Kelly Anne , McGhee Carol
Published: May 2014

This article describes how, within one Health Board in Scotland, a system has been established to manage disclosure checks based on fair, consistent and accountable decision-making on employment, while ensuring protection of patients is maximised and that the rights of prospective employees in relation to disclosure are upheld. As well as consistency in decision-making, there was a desire to demonstrate that this was open and fair, and that decision-makers could account for how and why decisions were made. The outcome of the new risk assessment procedure for disclosure checks is that the Board is confident that managers are enabled to make accountable and consistent decisions. The Board wishes to share the disclosure risk assessment process with other Health Boards and public sector employers in the interests of innovative and robust practice.
Ian Cumming
Authors: Cumming Ian
Published: May 2014

In the late 1980s I took a six-month career break and spent the winter managing a hotel in a ski resort in France, and acting as the Head Ski Guide for a British tour operator. Being responsible for managing a team of predominantly 18-year-old staff and running a 60-bed hotel taught me a huge range of people skills that have stood me in extraordinarily good stead throughout my career.
10 million X-Prize for healthcare
Authors: Terheyden Nick van
Published: May 2014

Many will be familiar with the race to space and the original X-Prize concept promoted some time back–as they put it, ‘revolution through Competition’ was awarded to Mojave Aerospace Ventures in October 2004, for their success in building a manned spaceship that could be launched into space and reused.
PCTs: world class failure?
Authors: Maynard Alan
Published: May 2014

Where is the evidence that the purchaser–provider split is cost-effective? Several countries (e.g. New Zealand and Scotland) have abolished the distinction between buyers and sellers of public health services. Other countries, such as the Netherlands, have endeavoured to introduce competing purchasers or insurers of patient risks and competition in the supply of care with mixed success.
Analysis of the employer based award scheme
Authors: Gupta Romesh , Vaidya Abhay , Verma Raj , McHugh Sandie , Campbell Robert
Published: May 2014

The employer based award scheme is a facet of the clinical excellence awards that are administered locally. There remains widespread dissatisfaction regarding implementation, fairness, transparency, and the appeal mechanism. This study reflects on the views of consultants and recommends ways to improve the credibility of the scheme.
Assessing use of the two-week rule in urology
Authors: Gillooly John Joseph , Tang Vincent , Walker Roger
Published: May 2014

Since the implementation of the two-week rule in urology in December 2000, no studies have yet assessed whether the system is being used appropriately. The authors of this study reviewed the medical records of all patients referred under the two-week rule, and by other routes, to the Urology Departments of Epsom and St Helier Hospitals during a consecutive eight-week period in October and November 2005.
What next for 18 weeks?
Authors: Jones Rod
Published: May 2014

The 18-week referral to treatment time target was largely achieved by December last year, and it comes as no surprise that the Government has only recently proposed that this will now become a patient right.
Recession: good for health?
Authors: Appleby John
Published: May 2014

The bad news: The UK has now suffered five successive quarters’ declines in GDP. Over the year from September 2008 to September 2009, the economy has shrunk by nearly 6%. The first six quarters of the current recession now look worse than the recessions of 1979–83 and 1990–93. The economic output loss already totals the peak to trough loss experienced in the early 1980s recession, and still the economy has not yet reached a turning point.
Evaluation of treatment options for fractured tibia
Authors: Taylor Matthew , Posnett John , Trueman Paul
Published: May 2014

Objectives: To evaluate the cost-effectiveness of casting, casting plus low-intensity pulsed ultrasound, or intramedullary (IM) nailing for fresh tibial fractures at risk of non-union. To evaluate the cost-effectiveness of surgery and ultrasound for non-unions. Methods: Economic analysis, including all direct costs incurred by the NHS in the period from first surgical intervention to 12 months post-intervention. Costs and outcomes (fractures healed within 12 months) were modelled using probabilities of healing derived from the literature. Results: For patients at particular risk of non-union (such as smokers), reamed IM nailing produces better expected outcomes than casting alone (91.5% healed compared with 89.2%), but at a higher cost (£6264 per patient vs £4351). The incremental cost of IM nailing is £83 200 per additional fracture healed. The combination of ultrasound and casting is a dominant option compared with IM nailing or casting alone, assuming that the addition of ultrasound improves healing by more than 25% compared with casting alone. The literature is consistent with an improvement of around 60%. Where the nature of the fracture allows, the most cost-effective strategy for non-unions is to postpone surgery and try a course of ultrasound first. Expected cost with surgery is £6718 compared with £3926 for ultrasound. Expected healing is the same in both cases. Conclusions: From an NHS perspective, adjunctive ultrasound offers a cost-effective choice for patients at particular risk of non-union, and for non-union fractures which are stable and well-aligned.
Involving, listening, learning
Authors: Hasler Frances
Published: May 2014

One of the things that marks out the Care Quality Commission (CQC) from the previous regulators in health and social care is the far-reaching nature of the requirement on us to involve people.
Common mental health conditions in primary care
Authors: Lee Jenny , Lyon David
Published: May 2014

Every year approximately 2.75 million people of working age consult a GP for a mental health condition, and 80% of these go no further than the GP (Layard, 2005). It has been estimated that one in four consultations with a GP concern mental health issues, second only to respiratory conditions. Practice nurses also report that their consultations contain many people with a range of mental health problems, such as anxiety, depression, bereavement and relationship difficulties (Crosland and Kai, 1998).
Mental health and substance use
Authors: Mistral Willm
Published: May 2014

Coexisting mental health and substance use problems are highly prevalent, but psychiatric and addiction services often fail to identify them or provide integrated treatment (Weaver et al, 2002; Bell, 2007). In the health services, this association has been given a number of titles including dual diagnosis, comorbidity, concurrent or coexisting problems, and all of these will appear in this article.
Intelligent leadership in mental health
Authors: Horne Alex
Published: May 2014

For decades, the focus in healthcare business intelligence has been on acute hospitals, almost to the exclusion of all other sectors. Even when other areas began to acquire systems, the tendency was to start with primary care, and then commissioners, and leave mental health care as something of an afterthought.
Public trust demands greater openness
Authors: Williams Simon
Published: May 2014

Very few people would claim that transparency and honesty in any relationship is a bad thing. However, strong doubts remain that there is a conspiracy of silence between many patient groups and the pharmaceutical industry. This is despite such relationships being under constant and increasing scrutiny by the media, Parliament, regulators and pressure groups.
The barriers and solutions to integrated care
Authors: Williams Siân , Davison Tony , Holmes Steve , Restrick Louise
Published: May 2014

The integration of care, both between primary and secondary care, and between health and social care, for people with chronic obstructive pulmonary disease (COPD) is an aspiration achieved in very few places in the UK. This article will describe the benefits of integration and the barriers to achieving it, while offering practical solutions.
Better breathing for life
Authors: Nair Raj , White Patrick , Davidson Craig , Ireland Joanna , Baxter Noel
Published: May 2014

The chronic obstructive pulmonary disease (COPD) ‘Better Breathing for Life’ Project is an exciting and innovative scheme that aims to improve care for patients with COPD throughout Lambeth and Southwark. Charitable funding was secured in the expectation that successful improvement of patient outcomes would be reflected in reduced hospital admissions, and that the associated savings would justify long-term funding of the initiative. This article will highlight the aims and interventions of the project.
A maximum price tariff
Authors: Jones Rod
Published: May 2014

The Department of Health (DH) has indicated that from 2011/12 the tariff will become an uppermaximum rather than the unique price for each healthcare resource group (HRG) (DH, 2009). The need for such cost containment measures needs no discussion. However, notwithstanding over 15 years of development, the tariff still contains a long list of fundamental flaws (Jones, 2009).
Simtomax®: a new screening tool for coeliac disease
Authors: Mizen Linda
Published: May 2014

Coeliac disease (CD) is a growing healthcare concern in many parts of the world. Its clinical presentation is variable, the condition is under-diagnosed and the existing laboratory-based serological tests are underused. Simtomax® is a rapid, point-of-care CD screening test, which—unlike current screening methods—is not invasive, and there are no specific requirements for training in its use, equipment or storage. The test will considerably facilitate screening and allow for faster counselling and treatment. Validation studies confirmed the accuracy of Simtomax® relative to standard ELISA methods and the high negative predictive value and sensitivity observed further supported its use as a screening tool. The budgetary impact of replacing the current CD screening process with the Simtomax® testing kit showed a potential saving to the NHS of over £7 million per year.
Major incidents: are middle grade doctors ready?
Authors: Khan Hiba
Published: May 2014

The Civil Contingencies Act places a legal obligation upon emergency services and local authorities to plan for major incidents. In these high-pressure situations, middle grade doctors would not only be expected to respond appropriately but also provide guidance to junior members of their team. It is therefore essential that these doctors are familiar with their hospitals major incident plans and are well-rehearsed in their role during a response. This article assesses whether middle grade doctors are familiar with the major incident plan at their hospital, and feel confident in their roles during the response. A standardised questionnaire was used to interview the on-call registrars for five specialties at the 13 major receiving hospitals in Wales. The major incident coordinator at each hospital was also interviewed to assess administrative aspects of their major incident plans. Despite all hospitals having a comprehensive major incident plan in place, only 55% of middle grade doctors were aware of it and only 19% had seen a copy. Only 16% had received formal major incident plan orientation and overall 49% did not feel confident about responding to a major incident alert at their hospital. Despite comprehensive major incident plans being in place, the levels of training and confidence are lacking within middle grade doctors. An educational need has been identified and recommendations have been made to improve the situation.
Planning for procurement: challenges facing CCGs
Authors: Gandy Rob , Case-Upton Peter
Published: May 2014

Clinical commissioning groups (CCGs) have inherited contracts and service-level agreements from their pre-existing primary care trusts. They are expected to effect improved services, outcomes and value for money, together with significant cash savings, through the process of procurement and re-procurement. For many services this is the only means of making savings and once a contract is awarded it cannot be amended (beyond set parameters) until it is renewed, thereby limiting CCGs’ room for manoeuvre. This article describes key issues and challenges facing CCGs in developing their approach to procurement and sets out how they might usefully be addressed. They include: assuring the quality of service specifications; staggering contract end dates; designing procurement plans to make best use of key commissioning skills and resources; and timing independent evaluations of contract performance and delivery. Decisions about how CCGs can and should work together are of critical importance given the resulting implications, particularly with regard to balancing cost-efficiency with plurality.
The lessons learned from two quality improvement forums
Authors: Parker Samuel , Martin Fionna , Lipton Joseph , Lock Bridget , Gately Annette , Sloman David , Garside Pam
Published: May 2014

The British Medical Association (BMA) and the King's Fund have recommended that ‘shop-floor doctors’ in all hospitals should feedback the everyday management challenges they face to the senior management via doctor-management forums known as quality improvement forums (QIFs). This collaborative partnership between junior doctors and management should help to tackle these challenges and improve the service. We discuss how we set up QIFs in two hospitals, the difficulties faced and the lessons learned. The QIFs were held every two months. At each forum, speakers had five minutes to present a management problem, then five minutes to propose a possible solution. Forum attendees were asked that all discussions be helpful and productive. Many management changes were made including: changing investigation requests from paper to digital; improving the on-call bleep system, improving the on-call medical handover; and improvements to the hospitals' induction process.
Capacity Building for Mental Health
Authors: Hayes Catherine
Published: May 2014

Patients with a diagnosis of mental illness are statistically less likely to access physical healthcare services, resulting in increased mortality rates and diminished quality of lifes. This article identifies interactions with healthcare providers as a fundamental mechanism whereby engagement with patients may make an impact on these statistics. It highlights key aspects of the need for capacity building in and between all professional healthcare disciplines and includes two theoretical bases to demonstrate the relevance of psychosocial interventions to pharmacy practice and policy.
Borderline personality disorder: a psychotherapeutic approach
Authors: Podmore Claire
Published: May 2014

This article discusses how mental health practitioners continue to face challenges in selecting effective therapeutic interventions for borderline personality disorder. It outlines how there is a significant evidence base to support the efficacy of dialectical behaviour therapy approaches.
The search for a professional identity continues
Authors: Nolan Peter
Published: May 2014

Peter Nolan outlines the post-institutional era of mental health nursing and the profession’s shift to university-based education
Brain tumour-related epilepsy: The experience of a nurse-led seizure clinic in Scotland
Authors: Campbell Jean
Published: May 2014

Brain tumour-related epilepsy is often difficult to control and referral to epilepsy specialists can be very variable. For patients with high-grade tumours life expectancy is limited and the aim of treatment is to prolong survival and maintain quality of life. Seizures are a great concern to patients and can have a negative impact on physical, psychological and social functioning, disrupting family life and adversely affecting the quality of an already compromised life. In an effort to improve the continuity and supportiveness of care, a nurse-led seizure clinic was introduced in the regional cancer centre for this patient group and their carers.
Addressing economic realities: How to maintain the benefits of MS specialist nursing?
Authors: Gutteridge Victoria
Published: May 2014

Multiple sclerosis (MS) specialist nurses are under increasing pressure as the government′s modernization programme moves toward the creation of a more cost-effective health service and trusts seek ways to reduce financial deficits. The emphasis of health policy is also shifting toward the provision of greater patient choice. MS nurses have always used a model of care that is focused on patients′ individual needs, and may have assumed that this approach was sufficient to justify their role. The new challenge for MS nurses is to ensure that their effective work for patients continues while meeting the new demands for cost-efficiency and patient choice. MS nurses must therefore understand these new demands and find ways to meet them. Most importantly, MS nurses need to learn how to explain their work and demonstrate their effectiveness in terms of the objectives of a more cost-effective NHS that offers greater patient choice. MS nurses have been confident about their contribution to the health-care system in the past. They must now adapt to meet the new requirements, ensure that their services will be viable into the future, and become the nurse leaders of tomorrow.
Syringomyelia
Authors: Woodward Sue
Published: May 2014

Syringomyelia is characterized by the presence of a cystic cavity (syrinx) or cavities within the spinal cord. This is a rare neurological complication of a variety of other conditions and the incidence is estimated to be 8.4 per 100 000 per annum (Di Lorenzo and Cacciola, 2005). The peak age of onset is 25-40 years. Males are affected more commonly than females.
Metabolic responses after severe head injury and how to optimize nutrition: A literature review
Authors: Mestecky Ann-Marie
Published: May 2014

It was established by studies conducted in the 1980s and early 1990s that significant increases in basal metabolic rate and protein catabolism occur in the acute stages following severe head injury. These metabolic responses can rapidly result in malnutrition and can have significant effects on the patient's neurological recovery, immunity, and length of stay in intensive care. This paper reviews the randomized studies that have been conducted on early versus delayed feeding and on enteral versus parenteral nutrition to determine how best to manage the nutritional needs of severely head injured patients. There is insufficient evidence to advocate one route of feeding over the other, however, studies do indicate that, independent of the route, early adequate nutrition has more favourable outcomes particularly in relation to lower infection rates. The protein and caloric requirements of these patients should be based on their individual requirements as determined by their basal energy expenditure, urinary nitrogen balance and plasma protein levels. It is advocated that calories are replaced based on the patient's basal energy expenditure plus 20-40% and 2 g/kg of protein. Failure to make every attempt to meet the increased nutritional requirements of these patients puts them at risk of malnutrition with potentially detrimental consequences.
Making waves for encephalitis
Authors: Easton Ava
Published: May 2014

The Encephalitis Society welcomed its fi rst president with a river cruise on the Thames last month, and even attended by some special guests.
Making time to toilet: Caring for patients' bowel and bladder dysfunction after stroke
Authors: Ayers Tim , Wells Mandy
Published: May 2014

Incontinence is a common problem for patients who have suffered a stroke According to data from the Royal College of Physicians' National Audit of Continence Care in Older People (2006), almost 40% of hospitalized stroke patients with a diagnosis of incontinence are catheterized. Incontinence causes substantial disruption to a patient's quality of life as a result of the diffi culties of managing such a problem while trying to maintain a sense of dignity and independence. Neuroscience nurses can help these patients, yet it would appear that assessment and management is currently suboptimal and that there is a lack of structured education in incontinence assessment and management for health professionals. The aim of this article is to provide some of the fundamental information required by the neuroscience nurse to undertake an assessment for incontinence in stroke patients and initiate a treatment programme for bladder and bowel dysfunction.
Two tribes go to war
Authors: Winter George
Published: May 2014

George Winter wonders why art and science seem to be continually at loggerheads, despite the sharing of ideas.
A guide to deep brain stimulation surgery: A treatment for Parkinson's disease
Authors: Breen Kieran , Heisters Daiga
Published: May 2014

Parkinson's disease is a progressive, debilitating neurological disorder associated with nerve cell death in the substantia nigra region of the brain. While a neurosurgeon will ultimately assess a patient's suitability for surgery, nurses play a key role in helping patients manage their condition and make informed decisions about their options. This article, therefore, aims to highlight what those options are and the issues to consider regarding surgery, so that nurses are equipped with the knowledge to offer effective care and advice.
Recognizing 15 years of support for neurological conditions
Authors: Martin Veronica
Published: May 2014

Veronica Martin celebrates 15 years of the Brain and Spine Foundation, and provides an overview of the charity's aims and objectives.
Telling lies in neuroscience
Authors: Winter George
Published: May 2014

George Winter wonders about the ethics of companies promoting machines to single out liars by assessing brain activity.