bluuebunny/crossref_metadata_2025 huggingface dataset:
Providers’ Perceptions of Medical Interpreter Services and Limited English Proficiency (LEP) Patients
Authors: Michalec Barret , Maiden Kristin M. , Ortiz Jacqueline , Bell Ann V. , Ehrenthal Deborah B.
Published: September 2014

Patient’s ability to understand and effectively communicate health information facilitates disease prevention, self-management of illness, the adoption of healthy behaviors, and their ability to act on important public health information. However, patients who have limited English proficiency (LEP) are significantly disadvantaged. Previous studies have shown the benefit of medical interpreter services in bridging the health communication gap between patients and providers. This qualitative study, focusing on medical interpreter utilization within obstetrical and neonatal services, provides perspectives from multiple types of providers to further explore the role of medical interpreter services and specific barriers to the use of such services. Five separate focus groups were conducted with postpartum nurses, labor and delivery/triage nurses, obstetrics and gynecology (OBGYN) resident physicians, neonatal intensive-care unit (NICU) nurses, and faculty physicians, nurse practitioners, and midwives. The data show that barriers to the utilization of professional medical interpreters can be categorized by distinct but related institutional- and individual-level factors. Further interpretation of the barriers, however, suggests that providers’ use/non-use of interpreter services is merely one piece of a much “bigger picture” regarding difficulties and challenges in delivering care to a growing culturally diverse patient population, and that these cultural challenges, not just the availability of interpreter services, may affect providers’ ability to deliver effective and efficient care. It is argued that simply adding additional communication-based resources may not be sufficient to impact providers’ attitudes and behaviors or the overarching organizational culture regarding LEP patients.
Positive Drawer Test Combined With Radiographic Deviation of the Third Metatarsophalangeal Joint Suggests High Grade Tear of the Second Metatarsophalangeal Joint Plantar Plate
Authors: Klein Erin E. , Weil Lowell , Weil Lowell Scott , Bowen Michael , Fleischer Adam E.
Published: September 2014

There is uncertainty regarding the most accurate and cost-effective method for diagnosing plantar plate injuries within the foot. The purpose of this study was to examine the combined value of using clinical and radiographic findings to diagnose high grade tears (> 50% disruption) within the second metatarsophalangeal (MTP) joint. Ninety-eight consecutive patients (117 feet) who underwent corrective surgery for plantar forefoot pain at a single foot and ankle specialty clinic were included in this retrospective analysis. All patients received a structured intraoperative assessment of the second MTP joint plantar plate by a single trained observer. Twenty-five clinical and plain film radiographic variables obtained prior to surgery were tested for their association with a high grade plantar plate tear using multiple logistic regression techniques. A positive drawer sign was the most informative individual test for differentiating high from low grade tears (odds ratio [OR] = 2.9; 95% confidence interval [CI], 0.92-9.5; sensitivity 91.5%; specificity 22%). Patients with longstanding forefoot symptoms (> 2 years) tended to be more likely to have low grade tears only (OR = 2.1; 95% CI, 0.98-4.5; sensitivity 61.7%; specificity 58.1%). Most radiographic measurements did little to distinguish high from low grade tears; however, the addition of ipsilateral third MTP joint transverse deviation angle showed a trend toward improving upon the diagnostic accuracy of strategies that used clinical findings alone (area under the curve [AUC] improved from 0.63 to 0.67; P = .11). A third MTP joint deviation angle greater than 15° in either direction combined with drawer testing and duration of symptoms achieved the highest specificities of any combination of variables examined in the study (specificities 82.4% [95% CI, 73.7%-91.1%] and 89.1 [95% CI, 82.1-96.3], respectively). The combination of a positive drawer test coupled with transverse deviation of the third MTP joint (> 15°) on plain films strongly suggests an underlying high grade plantar plate tear of the second MTP joint. However, this study highlights the need for using advanced imaging to distinguish between high and low grade tears in many instances (eg, positive drawer test and normal or near-normal alignment of the third MTP joint).

Level of Evidence: Diagnostic, Level II
A review on the use of cell therapy in the treatment of tendon disease and injuries
Authors: Ho Jasmine OY , Sawadkar Prasad , Mudera Vivek
Published: September 2014

Tendon disease and injuries carry significant morbidity worldwide in both athletic and non-athletic populations. It is estimated that tendon injuries account for 30%−50% of all musculoskeletal injuries globally. Current treatments have been inadequate in providing an accelerated process of repair resulting in high relapse rates. Modern concepts in tissue engineering and regenerative medicine have led to increasing interest in the application of cell therapy for the treatment of tendon disease. This review will explore the use of cell therapy, by bringing together up-to-date evidence from in vivo human and animal studies, and discuss the issues surrounding the safety and efficacy of its use in the treatment of tendon disease.
Electrospun silk fibroin fiber diameter influences in vitro dermal fibroblast behavior and promotes healing of ex vivo wound models
Authors: Hodgkinson Tom , Yuan Xue-Feng , Bayat Ardeshir
Published: September 2014

Replicating the nanostructured components of extracellular matrix is a target for dermal tissue engineering and regenerative medicine. Electrospinning Bombyx mori silk fibroin (BMSF) allows the production of nano- to microscale fibrous scaffolds. For BMSF electrospun scaffolds to be successful, understanding and optimizing the cellular response to material morphology is essential. Primary human dermal fibroblast response to nine variants of BMSF scaffolds composed of nano- to microscale fibers ranging from ~250 to ~1200 nm was assessed in vitro with regard to cell proliferation, viability, cellular morphology, and gene expression. BMSF support of epithelial migration was then assessed through utilization of a novel ex vivo human skin wound healing model. Scaffolds composed of the smallest diameter fibers, ~250 -300 nm, supported cell proliferation significantly more than fibers with diameters approximately 1 μm (p < 0.001). Cell morphology was observed to depart from a stellate morphology with numerous cell -fiber interactions to an elongated, fiber-aligned morphology with interaction predominately with single fibers. The expressions of extracellular matrix genes, collagen types I and III (p < 0.001), and proliferation markers, proliferating cell nuclear antigen (p < 0.001), increased with decreasing fiber diameter. The re-epithelialization of ex vivo wound models was significantly improved with the addition of BMSF electrospun scaffolds, with migratory keratinocytes incorporated into scaffolds. BMSF scaffolds with nanofibrous architectures enhanced proliferation in comparison to microfibrous scaffolds and provided an effective template for migratory keratinocytes during re-epithelialization. The results may aid in the development of effective BMSF electrospun scaffolds for wound healing applications
Prospective isolation of human bone marrow stromal cell subsets: A comparative study between Stro-1-, CD146- and CD105-enriched populations
Authors: Gothard David , Greenhough Joanna , Ralph Esther , Oreffo Richard OC
Published: September 2014

Stro-1 has proved an efficacious marker for enrichment of skeletal stem and progenitor cells although isolated populations remain heterogeneous, exhibiting variable colony-forming efficiency and osteogenic differentiation potential. The emerging findings that skeletal stem cells originate from adventitial reticular cells have brought two further markers to the fore including CD146 and CD105 (both primarily endothelial and perivascular). This study has compared CD146-, CD105- and Stro-1 (individual and in combination)-enriched human bone marrow stromal cell subsets and assessed whether these endothelial/perivascular markers offer further selection over conventional Stro-1. Fluorescent cell sorting quantification showed that CD146 and CD105 both targeted smaller (2.22% ± 0.59% and 6.94% ± 1.34%, respectively) and potentially different human bone marrow stromal cell fractions compared to Stro-1 (16.29% ± 0.78%). CD146+, but not CD105+, cells exhibited similar alkaline phosphatase–positive colony-forming efficiency in vitro and collagen/proteoglycan deposition in vivo to Stro-1+ cells. Molecular analysis of a number of select osteogenic and potential osteo-predictive genes including ALP, CADM1, CLEC3B, DCN, LOXL4, OPN, POSTN and SATB2 showed Stro-1+ and CD146+ populations possessed similar expression profiles. A discrete human bone marrow stromal cell fraction (2.04% ± 0.41%) exhibited positive immuno-labelling for both Stro-1 and CD146. The data presented here show that CD146+ populations are comparable but not superior to Stro-1+ populations. However, this study demonstrates the critical need for new candidate markers with which to isolate homogeneous skeletal stem cell populations or skeletal stem cell populations which exhibit homogeneous in vitro/in vivo characteristics, for implementation within tissue engineering and regenerative medicine strategies.
A randomized phase II clinical trial of nab-paclitaxel and carboplatin compared with gemcitabine and carboplatin as first-line therapy in locally advanced or metastatic squamous cell carcinoma of lung
Authors: Yang Jin-Ji , Huang Cheng , Chen Gong-Yan , Song Yong , Cheng Ying , Yan Hong-Hong , Zhou Qing , Wu Yi-Long
Published: September 2014

Background

Recent advances have shown that histology and genetic biomarkers are important in patient selection, which have led to significantly better outcomes for lung cancer patients. However, most new treatments only apply to adenocarcinoma or non-squamous, and in squamous carcinoma there is little breakthrough. In a phase III trial nab-paclitaxel plus carboplatin showed superior response rate over paclitaxel and carboplatin. In subgroup analysis the squamous histology appeared to be a predictive factor to nab-paclitaxel treatment.

Methods/Design

This is an open-label, randomized, active controlled phase II trial. A total of 120 untreated advanced squamous lung cancer patients are randomized at a 1:1 ratio to receive nab-paclitaxel (135 mg/m2, d1, 8, q3w) plus carboplatin (AUC 5, d1, q3w) or gemcitabine (1,250 mg/m2, d1, 8, q3w) and carboplatin (AUC 5, d1, q3w). The primary endpoint is objective response rate and the second endpoints are progression free survival, overall survival, safety and biomarkers associated with nab-paclitaxel. The treatment will continue up to six cycles or intolerable toxicity.

Discussion

This ongoing trial will be the first prospective randomized trial to explore the efficacy of nab-paclitaxel as the first-line treatment specifically in squamous carcinoma of lung.

Study number

CTONG1002

Trial Registration

Clinicaltrials.gov reference: NCT01236716
Flexible carbon nanotube/mono-crystalline Si thin-film solar cells
Authors: Sun Huanhuan , Wei Jinquan , Jia Yi , Cui Xian , Wang Kunlin , Wu Dehai
Published: September 2014

Flexible heterojunction solar cells were fabricated from carbon nanotubes (CNTs) and mono-crystalline Si thin films at room temperature. The Si thin films with thickness less than 50 μm are prepared by chemically etching Si wafer in a KOH solution. The initial efficiency of the thin-film solar cell varies from approximately 3% to 5%. After doping with a few drops of 1 M HNO3, the efficiency increases to 6% with a short-circuit current density of 16.8 mA/cm2 and a fill factor of 71.5%. The performance of the solar cells depends on the surface state and thickness of Si thin films, as well as the interface of CNT/Si. The flexible CNT/Si thin-film solar cells exhibit good stability in bending-recovery cycles.
Fetal growth and psychiatric and socioeconomic problems:
population-based sibling comparison
Authors: Class Quetzal A. , Rickert Martin E. , Larsson Henrik , Lichtenstein Paul , D'Onofrio Brian M.
Published: September 2014

Background

It is unclear whether associations between fetal growth and psychiatric
and socioeconomic problems are consistent with causal mechanisms.

Aims

To estimate the extent to which associations are a result of unmeasured
confounding factors using a sibling-comparison approach.

Method

We predicted outcomes from continuously measured birth weight in a
Swedish population cohort (n = 3 291 773), while
controlling for measured and unmeasured confounding.

Results

In the population, lower birth weight (⩽2500 g) increased the risk of all
outcomes. Sibling-comparison models indicated that lower birth weight
independently predicted increased risk for autism spectrum disorder
(hazard ratio for low birth weight = 2.44, 95% CI 1.99–2.97) and
attention-deficit hyperactivity disorder. Although attenuated,
associations remained for psychotic or bipolar disorder and educational
problems. Associations with suicide attempt, substance use problems and
social welfare receipt, however, were fully attenuated in sibling
comparisons.

Conclusions

Results suggest that fetal growth, and factors that influence it,
contribute to psychiatric and socioeconomic problems.
Stat3 signaling regulates embryonic stem cell fate in a dose-dependent manner
Authors: Tai Chih-I , Schulze Eric N. , Ying Qi-Long
Published: September 2014

Stat3 is essential for mouse embryonic stem cell (mESC) self-renewal mediated by LIF/gp130 receptor signaling. Current understanding of Stat3-mediated ESC self-renewal mechanisms is very limited, and has heretofore been dominated by the view that Stat3 signaling functions in a binary “on/off” manner. Here, in contrast to this binary viewpoint, we demonstrate a contextual, rheostat-like mechanism for Stat3's function in mESCs. Activation and expression levels determine whether Stat3 functions in a self-renewal or a differentiation role in mESCs. We also show that Stat3 induces rapid differentiation of mESCs toward the trophectoderm (TE) lineage when its activation level exceeds certain thresholds. Stat3 induces this differentiation phenotype via induction of Tfap2c and its downstream target Cdx2. Our findings provide a novel concept in the realm of Stat3, self-renewal signaling, and pluripotent stem cell biology. Ultimately, this finding may facilitate the development of conditions for the establishment of authentic non-rodent ESCs.
Myosin II does not contribute to wound repair in Dictyostelium cells
Authors: Yumura Shigehiko , Hashima Sayaka , Muranaka Satsuki
Published: September 2014

Cells are always subjected to mechanical stresses, resulting in wounds of the cell membrane, but cells are able to repair and reseal their wounded membrane. Previous reports have shown that actin and myosin II accumulate around the wound and that the constriction of this purse-string closes the membrane pore. Here, we developed a microsurgical wound assay to assess wound repair in Dictyostelium cells. Fluorescent dye that had been incorporated into the cells leaked out for only 2–3 sec after wounding, and a GFP-derived, fluorescent Ca2+ sensor showed that intracellular Ca2+ transiently increased immediately after wounding. In the absence of external Ca2+, the cell failed to repair itself. During the repair process, actin accumulated at the wounded sites but myosin II did not. The wounds were repaired even in myosin II null cells to a comparable degree as the wild-type cells, suggesting that myosin II does not contribute to wound repair. Thus, the actomyosin purse-string constriction model is not a common mechanism for wound repair in eukaryotic cells, and this discrepancy may arise from the difference in cell size.
Validation of serum IGF-I as a biomarker to monitor exogenous growth hormone agonist and antagonist bioactivity in rabbits
Authors: Bielohuby Maximilian , Zarkesh-Esfahani Sayyed Hamid , Manolopoulou Jenny , Wirthgen Elisa , Walpurgis Katja , Toghiany Khorasgani Mohaddeseh , Aghili Zahra Sadat , Wilkinson Ian Robert , Hoeflich Andreas , Thevis Mario , Ross Richard J. , Bidlingmaier Martin
Published: September 2014

Development of new growth hormone (GH) agonists and antagonists (GHA) requires animal models for pre-clinical testing. Ideally, effects of treatment can be monitored using the same pharmacodynamic marker later used in clinical practice. However, intact rodents are of limited value for this purpose because serum IGF-I - the most sensitive pharmacodynamic marker for GH-action in humans - shows no response to recombinant human GH (rhGH) treatment and there is little evidence for effects of GHA except when administered at very high doses or overexpressed. As an alternative, more suitable model we explored pharmacodynamic markers of GH action in intact rabbits. We performed the first validation of an IGF-I assay for rabbit serum and tested precision, sensitivity, linearity, and recovery using an automated human IGF-I assay (IDS-iSYS). Furthermore, IGF-I was measured in rabbits of different strains, age groups and sexes, and we monitored IGF-I response to treatment with rhGH or GHA. In a subset of samples we used LC-MS/MS to measure IGF-I and quantitative Western-ligand blot to analyze IGF-binding proteins. Results: Although recovery of recombinant rabbit IGF-I was only 50% in the human IGF-I assay, sensitivity, precision (1.7-3.3%CV) and linearity (90.4-105.6%) were excellent in rabbit samples. As expected, sex, age and genetic background were major determinants of IGF-I in rabbits. IGF-I and IGFBP-2 levels increased after single and multiple rhGH injections (IGF-I: 286±22 vs. 434±26ng/ml; p<0.01) and were highly correlated (p<0.0001). GHA treatment lowered IGF-I from the fourth injection onwards (p<0.01). In summary, we demonstrated that the IDS-iSYS IGF-I immunoassay can be used in rabbits. Similar to rodents, rabbits display variations in IGF-I depending on sex, age and genetic background. Unlike in rodents, the IGF-I response to rhGH or GHA treatment closely mimics the pharmacodynamics seen in humans suggesting rabbits as a suitable new model to test human GH agonists and antagonists.
Ostensibilities in Geometry
Authors: Гирш  , Girsh A.
Published: September 2014

Ostensibilities in geometry play a large role and are a

little shined in literature. Their presence at geometry is much

broader, than it actually is perceived. Work explains a status of

ostensibilities in geometry and proves that geometry becomes the

closed rule only taking into account its ostensibilities. A new way

related to creation of two circles’ radical axis and two conics’

chordal straight lines based on machine graphics tool «Central

Proportional Increase of Graphic Object» is offered. The way allows

select ruled degenerations from a bunch of quadrics.
Non-physicians performing caesarean sections: a review
Authors: McNamara Mariah , Ahn Roy , Burke Thomas F
Published: September 2014

The crisis in human resources for global health is negatively impacting maternal health. In particular, access to emergency obstetric care is vital to prevent maternal deaths. In response to a severe shortage of physicians, various non-physician clinicians (NPCs), including midwives, perform caesarean sections in under-resourced environments. We reviewed the literature on the practice of any cadre of NPCs performing caesarean sections. The very limited literature on this topic finds that caesarean sections performed by NPCs and physicians appear to result in similar clinical outcomes. NPCs perform caesarean sections successfully and are more likely to stay in district hospitals than physicians. NPCs, including midwives, equipped with caesarean section skills may represent an extraordinary opportunity for solving a critical and unmet gap in the global maternal health crisis.
Students' perceptions of Zambian women: choosing where to deliver
Authors: Kwaleyela Concepta , Gottvall Karin , Maimbolwa Margaret , Arvidson Anna-Berit Ransjo
Published: September 2014

In Zambia 57% of births occur at home under the supervision of unskilled attendants. This situation poses a danger to the lives of both delivering mothers and their newborns. The 2001–2002 Zambia Demographic Health Survey revealed that nearly two thirds of mothers who died in childbirth had delivered at home and most of the maternal deaths reported at health facilities were as a result of late referrals from home. The purpose of the study, therefore, was to explore Zambian midwifery students' perceptions of Zambian women's choice of place of delivery, either home or health facility. Four focus group discussions were held with 40 students from Lusaka School of Midwifery. The study deduced that in order to make childbirth safer midwives need to see themselves as change agents not as victims of external factors over which they have no influence.
Transvaginal sonography acceptance: a cognitive behavioural perspective
Authors: Ugwu AC , Erondu OF , Imo AO
Published: September 2014

This study investigated the cognitive behaviours of patients undergoing transvaginal sonography (TVS) and the impact of demographic factors on them.

A total of 160 self-completion questionnaires were distributed in image diagnostics, Port Harcourt, River, State, Nigeria. The questionnaire included questions on patient demographics as well as ordinal scales for patients to rate perceptions of TVS on various cognitive indices. All the questionnaires were distributed and collected. Both descriptive and inferential statistics were done. Tests were two-tailed with P<0.05 indicating statistical significance results. A score of above 50% was recorded on all the indices. The least score was recorded for no fear of contagion scale. A significant difference was noted in patients' perception of explanation of procedure and waiting time prior to procedure between first and previous experience patients. Perception of comfort significantly correlated with age while perception of explanation significantly correlated with educational qualification. Patients' satisfaction with the procedure showed the highest correlation with acceptance of TVS conclusion. Patients' acceptance of TVS has a positive relationship with some psychosocial factors. Proper health education could also improve patients' acceptance of TVS.
Placenta praevia: can ultrasound scanning reduce maternal deaths?
Authors: Yilla Mohamed Drissa , Gordon-Harris Leonard
Published: September 2014

Reducing maternal mortality remains a major moral and socioeconomic imperative that poses policy challenges especially across developing countries. Sierra Leone has among the worst maternal outcomes despite the causes for maternal mortality and interventions being firmly established. The feasibility of ultrasound in reducing adverse maternal outcomes from placenta praevia in Sierra Leone is explored. Placenta praevia causes severe haemorrhage which, in turn, accounts for one fourth of maternal deaths. Ultrasound is the gold standard in diagnosing placenta praevia. In 524 cases revieweda 10% incidence of praevia was found which rationalizes the integration of obstetric ultrasound into antenatal care. Literature searches were conducted across databases including Ovid Medline, NHS-e-Library, Cochrane Library, NICE, Heath Technology Assessment website, United Nations and World Health Organization search engines. Data was collected from the practice records of a city centre diagnostic radiology facility. 524 cases were retrospectively reviewed and patients with grades placenta praevia identified.
Awareness of mammography and breast self-examination: a survey
Authors: Okaro AO , Eze CU , Ohagwu CC
Published: September 2014

The aim of the study was to assess the level of awareness of the women in Enugu, South-Eastern Nigeria about breast cancer, mammography and breast self-examination (BSE). A crosssectional prospective survey that targeted women between 17 and 40 years old was conducted. The survey instrument was a 13-item self-completion questionnaire distributed to the respondents directly. There was high level of awareness about breast cancer (72%, n=212). The level of awareness about breast cancer was significantly positively influenced by respondents' level of education (P> 0.05). The level of awareness about mammography was low (25%, n=75) and was significantly positively influenced by respondents' level of education. The awareness about breast self-examination was encouraging (56%, n=166) but regular practice of breast self-examination was not as encouraging (45%, n=132). The awareness about breast self-examination was matched by the same level of awareness about breast cancer presenting sometimes as a painless breast lump (56%, n=166 vs 57%, n=168; P> 0.05). The television was the major source of the respondents' information about breast cancer, breast self-examination and mammography. Awareness of breast cancer and breast self-examination among the women in South-Eastern Nigeria is encouraging but their level of awareness about mammography is poor. Education plays an important role in breast cancer awareness and its aggressive pursuit is recommended.
When to seek care in pregnancy and childbirth: a study in Uganda
Authors: Hansen Karin , Johansson Elisabeth , Byaruhanga Emmanuel K , Pettersson Karen Odberg
Published: September 2014

The overall aim of the project was to study pregnant women's knowledge of danger signs during pregnancy and childbirth and actions taken in case danger signs occurred.

Both quantitative and qualitative methods were used. A questionnaire was administered at the antenatal care clinic (ANC). Non-participant observations of the midwives at the ANC were also performed. Individual interviews were conducted with pregnant and newly delivered women as well as with clinical officers. A retrospective study of maternity records was also conducted.

A majority of the women attended their first ANC visit late in the pregnancy. Women's general knowledge of danger signs was low. A lack of discrepancy between common pregnancy related and dangerous symptoms was noted. The observations revealed that little or no health education concerning danger signs were given and inadequate examination of the women were conducted. The ANC reaches around 92% off the pregnant women. This provides an ideal opportunity for information on danger signs and when and where to seek care. It is important to encourage early ANC attendance and complete examinations in order to identify high-risk pregnancies and prevent treatable illnesses.
Community perceptions of trained traditional birth attendants
Authors: Ngoma Catherine M , Himwiila Lucensia
Published: September 2014

In developing countries, especially in communities devoid of access to health facilities, many births take place at home under the supervision of trained traditional birth attendants. Therefore, trained traditional birth attendants remain the only source of maternal and newborn health care in such areas unless the issues of access to health facilities are addressed.

The aim of this study was to determine community perceptions of trained traditional birth attendants. The study used a qualitative study design. Data was collected using five focus group discussions from a total of 48 participants. All the participants were married men and women between the ages of 19 and 39 years residing in villages in the study site.

Qualitative data derived from focus group discussions were analyzed using content analysis. This entailed reading, rereading and vigorous study of each question to come up with concepts in the responses through the process of coding. Notes and observations were sorted into categories representing different themes and five themes were identified. These include knowledge about trained traditional birth attendants' functions, access to trained traditional birth attendants, cultural practices and attitudes towards traditional birth attendants.

The study revealed that the community members were aware of the presence of the trained traditional birth attendants and their functions. The community was appreciative of the services rendered by the trained traditional birth attendants except that access was hindered by poverty, lack of transport and security for trained traditional birth attendants.
Clinical teaching in midwifery: an overview
Authors: Tagutanazvo Oslinah Buru , Mngadi Patricia Thuli
Published: September 2014

There is a wide range of literature available on clinical teaching in the health professions and limited focus has been made on the art and science of clinical teaching for student midwives. This article provides an overview of clinical teaching and discusses the various areas of practice, teaching methods used and personnel involved in clinical teaching in midwifery. The information presented has been compiled through a review of handbooks, training manuals and websites created by various health professionals, the World Health Organization as well as PUBMED, Science direct, MEDLINE data bases and health science libraries.
Fatty foods in pregnancy linked to fatter babies
Authors: Daniel Lincia
Published: September 2014

Women who eat a diet of high glycaemic foods in the later stages of pregnancy are having babies with higher birth weights and putting their babies at greater risk of childhood obesity.
Peace of mind for patients
Authors: Smith Julie
Published: September 2014

Following the miserable excuse for a summer we have just had in the UK, it is likely that more and more of the population will be looking to go abroad for future holidays. As a result healthcare support workers across the health sector will come across patients and clients with plans to leave the country in search of warmer climes. As Sharon Graham points out in her article on travel health in this issue of BJHCA, as healthcare assistants (HCAs) you are in the ideal position to give good advice to Brits who plan to travel abroad. After conversations with HCAs, it has become patently clear to me that patients will often confide in them where they may not a doctor or a nurse.
Creating a continent care environment for patients
Authors: Nazarko Linda
Published: September 2014

Care assistants working in hospitals often care for people who are incontinent of urine. Incontinence affects 2–6 million adults in the UK and some people develop continence problems for the first time when admitted to hospital. This article explains how the urinary system functions and how ageing, illness, hospital treatment and care practices can lead to incontinence developing. It also offers advice to enable care assistants to enable people to maintain continence.
New skills for HCAs — ear care in patients with hearing loss
Authors: Picking Jo , Thornett Andrew
Published: September 2014

As a healthcare assistant (HCA), you will come across many patients or clients with deafness or ear pain. This article looks at your role as a HCA in ear care assessment and management, and then explains how to syringe ears safely.
Your questions answered…
Authors: Kemp Philip , Seed Sandra
Published: September 2014

Is my hijab a health hazard

Was my NVQ a waste of time?
Pressure ulcers part 2: prevention and management
Authors: Morris Clare
Published: September 2014

This is the second article in a series relating to pressure ulcers. This article focuses on the prevention of pressure ulcers and how clinical guidelines help healthcare professionals to prevent pressure ulcers.

The key to pressure ulcer prevention is risk assessment and being able to understand what makes a person vulnerable to pressure ulcers.

The article also discusses the importance of repositioning and involving patients, carers and relatives in discussions about care.
Mental health: self harm
Authors: McRory Barry
Published: September 2014

Individuals who deliberately self harm are not just based within mental health services within the UK. Assistant practitioners and healthcare assistants working across a variety of clinical and community settings may have to work with such clients or patients. This article aims to define the term ‘self harm’ and discuss why it happens. It will also look at current treatments available.
Chaperoning — a role for the healthcare assistant?
Authors: Rawles Zoe
Published: September 2014

In recent years the role of chaperone in healthcare has been recognized as increasingly important for patients and healthcare providers alike. It is a role that may fit very well within the remit of the healthcare assistant (HCA) but does require appropriate training.

This article explores the roles and responsibilities of the chaperone and considers the part the HCA may play in delivering this essential task.
Travel health: an introduction for healthcare support workers
Authors: Graham Sharon R
Published: September 2014

Vaccinations for travel afford protection for only a small amount of risks a person may encounter while travelling abroad. This article explains why risk assessment is important and it outlines your role in the health promotion of safe travel and directs you to some resources you and your patient may access for further information.
Delegating administration of medicines to HCAs
Authors: Dickens Geoff
Published: September 2014

The delegation of medicines administration to healthcare assistants can be controversial, but it can also ensure that patients receive their medicines on time. Administration of medicine can be passed onto HCAs in a dafe and effective manner, this article examines how.
A plaster technician assistant practitioner
Authors: Butler Diane
Published: September 2014

Diane Butler was a plaster technician for five years before qualifying as an assistant practitioner. She works at The Royal Blackburn Hospital and describes the skills and expectations of her role from day to day.
Getting to grips with reflection
Authors: Hood Adele
Published: September 2014

Reflection is something that we all do throughout our lives but how can it be applied to our working day in relation to learning and development? For some healthcare assistants (HCAs) and assistant practitioners (APs) who may be new in post or accessing training programmes for the first time, the term ‘reflection’, in relation to learning and development, may be something they have never heard of. For others who have heard of it, they may have little or no understanding as to what it means. This article aims to explore what reflection is, at a basic level, and how models and cycles of reflection can be used by HCAs and APs to aid learning and development.
HCA development opportunity
Authors: Adams Stephan Spencer
Published: September 2014

Many healthcare assistants (HCAs) and assistant practitioners (APs) choose to develop their skills further by taking advantage of the education and training programmes available. Most will take up NVQs or SVQs to widen their skills spectrum and the next natural step is often to work towards a nursing or mifwifery qualification. However, this is not the path that all HCAs and APs looking to further their career take. The role of NVQ assessor and internal verifier is also an option which should be considered for those who do not feel the pull towards nursing. This article explains how HCAs and APs can qualify in these roles and is written by a former HCA who has done it himself.
What's in a name?
Authors: Vaughan Paul
Published: September 2014

Summer — what summer? With the lack of sunshine this year I have found myself inside a few times thinking, now what can I do?! So I have found myself browsing the internet and finding a host of strange and wonderful websites some of which would not be suitable to mention in this column! On one site I came across a piece that spoke about a national survey that was undertaken which found that some people would rather have a grander job title than a pay rise. It gave an example of an estate agent being described as a ‘space consultant’ and a shelf stacker as an ‘ambient replenishment controller’. I ask you, would this happen in the health sector? Well actually, yes. A chiropodist has been given the title of ‘foot health gain facilitator’!
Modes of treatment for cerebral vasospasm following aneurysmal subarachnoid haemorrhage
Authors: Mestecky Ann-Marie
Published: September 2014

Delayed cerebral vasospasm (DCV) is a life-threatening complication of aneurysmal subarachnoid haemorrhage (SAH). Advances in understanding the pathogenesis of DCV have led to the development of new forms of treatment, some of which are currently undergoing clinical trials. Although some treatments have demonstrated improved outcomes for patients following SAH, none has been found to unequivocally overcome DCV. This article reviews current treatments and those undergoing clinical trials. It focuses on the mode of action of each treatment and possible complications, and reviews some of the clinical trials that have been conducted to determine their efficacy. To gain a greater understanding of the mode of action of each treatment, the current theories of the pathogenesis of DCV are discussed briefly. With increasing use of new therapies to treat vasospasm, nurses need to be familiar with how they are used, their mode of action and possible complications.
Historical origins of neuroscience nursing in the UK
Authors: Aird Thomas
Published: September 2014

This article considers the origins of neuroscience nursing in the UK. Using both primary and secondary sources, the role of the National Hospital is highlighted. The hospital is often associated with medical advances in neurology and neurosurgery but less is written about nursing. Material tends to be descriptive and makes little attempt at analysis regarding the impact nursing has made upon the development of the specialism.
Secondary prevention of stroke
Authors: Birns Jonathan , Fitzpatrick Maria
Published: September 2014

Patients who have already suffered a stroke or transient ischaemic attack (TIA) are 10–15 times more likely than the general population to have another episode in the following year. The risk is greatest soon after the first event. This article describes approaches to secondary prevention of stroke, outlining specific lifestyle changes and treatment options that can lower a patient's risk. The specialist stroke nurse plays a central role in the successful implementation of these strategies, particularly with regard to patient education, monitoring and compliance.
Research round-up
Authors: Woodward Sue
Published: September 2014

This section presents a synopsis of a selection of research articles published in January and February 2005 of interest to neuroscience nurses. Providing a brief overview rather than a detailed critique, full references are provided for those who want to find out more.
Comment and book reviews
Authors: Wigglesworth Simon
Published: September 2014

The National Service Framework for Long-Term Conditions: turning intentions into reality

Neurodevelopment and Schizophrenia

The A-Z of Neurology Practice: A guide to Clinical Neurology
Management of neurogenic bowel
Authors: Coggrave Maureen
Published: September 2014

Individuals suffering from a variety of neurological conditions share bowel-related symptoms that can have a major impact on their quality of life. Active management of bowel function is required to avoid faecal incontinence and other complications. In the absence of sound evidence as to which interventions are the most suitable and effective in any specific situation, bowel management programmes must be based on thorough assessment and developed to meet the needs of the individual. The interventions available for bowel management are discussed and the importance of education for both patients and their carers is highlighted
Focusing on money and investment
Authors: Thomas Sue
Published: September 2014

As part of the QIPP agenda, new resources are being developed to identify costs and variations of service delivery across care sectors.
Count epilepsy out of any plans for generic substitution
Authors: Duncan John
Published: September 2014

The National Society for Epilepsy's campaign to ‘Count Epilepsy Out’ has succeeded in excluding antiepileptic drugs from the proposed changes to the Pharmaceutical Price Regulation Scheme.
A mid-term review of the NSF for long-term neurological conditions
Authors: Thomas Sue , Davies Alun , Peel Charlotte
Published: September 2014

A recent audit to assess the progress of the National Service Framework for Long-term (neurological) Conditions has found limited progress.
Rapid eye movement sleep behaviour disorder in parkinsonism
Authors: Kershaw Chris
Published: September 2014

Rapid eye movement sleep behaviour disorder (RBD) is one of many sleep disorders seen in patients with parkinsonism. RBD is a parasomnia in which there is loss of normal skeletal muscle atonia and prominent motor activity during rapid eye movement sleep. Sufferers exhibit vigorous limb movements and dream enactment. RBD may occur occasionally or on a regular basis. This phenomenon is closely associated not only with idiopathic Parkinson's disease but also with the other synucleinopathies. RBD was first identified as a disease entity by Schenk and co-workers in 1986. In this article, the relationship between RBD, parkinsonism and areas of the brain involved in sleep regulation will be examined. It will also explore patient assessment, possible exacerbating factors and treatment options.
Surgery for vertebral compression fractures: Understanding vertebroplasty and kyphoplasty
Authors: Sinha Priyank , Sedgley Laura , Sutcliffe Denise , Timothy Jake
Published: September 2014

Osteoporosis is a disease of the bones, which leads to an increased risk of fractures and is most common in postmenopausal women. It is estimated that more than 2 million people in England and Wales have osteoporosis and each year there are 180 000 osteoporosis-related symptomatic fractures. Vertebral compression fractures are associated with significant morbidity and the standard treatment for such fractures used to be conservative and symptomatic. However, nowadays vertebroplasty and kyphoplasty have emerged as novel treatment methods and involve percutaneous injection of bone cement into the vertebral body with the aim of stabilizing the vertebral fracture, relieving pain and preventing further loss of vertebral body height.
The MS nurse's role in managing natalizumab therapy in patients with relapsing-remitting MS
Authors: Meehan Michelle
Published: September 2014

In this article, an overview of current pharmacological therapies used in the treatment of relapsing-remitting multiple sclerosis (MS) will be provided. MS is the most common neurological disease affecting young adults in the Western world. While there is no cure, recent advancements in drug therapy may alter the long-term outcome of this disease, offering more hope to individuals living with MS. This article will focus on natalizumab (Tysabri), a monoclonal antibody (mAb) that significantly reduces relapses and disease progression in relapsing-remitting MS. However, it has been associated with increased risk of a potentially fatal brain infection, progressive multifocal leukoencephalopathy (PML). The MS nurse's role in educating, administering and monitoring patients on this drug will be considered. In the future, mAb therapy will alter the way in which MS is treated, and therefore the skills and knowledge of the MS nurse will have to continually evolve in order to care for patients on this therapy and administer these drugs safely.
Temperature physiology, assessment and control
Authors: Garner Anne , Fendius Adam
Published: September 2014

Body temperature is closely regulated by the hypothalamic preoptic area using a variety of mechanisms to control heat generation and heat loss. Abnormalities of temperature can be harmful, particularly in brain injured patients. It is therefore important to know how and where to measure temperature and the pitfalls of doing so. Patients' carers can also affect and control body temperature, although it is important to remember that there are potential side effects in shifting body temperature. In this article, the physiology of temperature homeostasis, measurement and therapeutic hypothermia is outlined, as well as fever control.
Assessing how changes in health and social care are making a difference
Authors: McLafferty Rachel
Published: September 2014

Conference season has been upon us, always the perfect opportunity to analyse how changes in health and social care are beginning to make a difference to the lives of individuals, their carers and families, as well as the statutory and third sector agencies that provide these services.
Recognizing when a change in care is needed
Authors: Chapman Simon
Published: September 2014

Regular assessment of the patient's condition is needed to recognize symptom escalation or deterioration of function toward the end of life.
Pseudoaneurysm of the superficial femoral artery after retrograde intramedullary nailing for a supracondylar femoral fracture
Authors: Hirota Ryosuke , Emori Makoto , Ito Toshiro , Watanabe Kota , Hirano Akira , Kamiya Tomoaki , Terashima Yoshinori , Yamashita Toshihiko
Published: September 2014

Vascular complications of distal femoral fractures are rare but can have disastrous consequences if not recognised and treated promptly. We present the case of a 55-year-old woman who developed a pseudoaneurysm of the superficial femoral artery after osteosynthesis to repair a supracondylar femoral fracture. Eight weeks after surgery, swelling of the right thigh persisted and was accompanied by severe pain. Enhanced computed tomography revealed a pseudoaneurysm in the medial aspect of the affected thigh. Open surgical repair was performed by direct arterial suture. Although the true aetiology of the development of the pseudoaneurysm is unknown, a bony fragment from the reduction manoeuvre may have damaged the adventitia of the superficial femoral artery. In cases of continuous thigh swelling after osteosynthesis to repair a supracondylar femoral fracture, a diagnosis of pseudoaneurysm should be considered and treatment should be initiated immediately.
An apical left ventricular aneurysm rupture presenting as left breast mass 11 years after surgical repair
Authors: Fok M , Bashir M , Hammoud I , Harrington D , Kuduvalli M , Field M , Oo A
Published: September 2014

Left ventricular (LV) pseudoaneurysm is a rare entity and, consequently, there is limited knowledge of the condition’s natural history. The most frequent mode of presentation for LV pseudoaneurysm is heart failure with chest pain. However, the variable presentation of this condition requires a high index of suspicion for diagnosis.

We report the case of a 75-year-old woman who had suffered an acute myocardial infarction 23 years previously, which resulted in a calcified LV apical aneurysm. Three weeks prior to being referred to our hospital, she was noted by her general practitioner to have a left-sided breast mass although mammography was negative. One week later, she attended the accident and emergency department; she was haemodynamically unstable but was resuscitated successfully. Contrast enhanced computed tomography showed a large haematoma located in the left chest wall communicating with the left ventricle. She underwent emergency cardiac surgical repair. On arrival at the intensive care unit following surgery, her haemodynamic status was unstable, and she deteriorated rapidly and died.

With this report, we aim to raise the level of awareness for an apical LV pulsatile mass that could anatomically expand and present as a breast mass or tumour. An early diagnosis and timely surgical intervention is essential in order to achieve better outcomes and avoid detrimental complications.