bluuebunny/crossref_metadata_2025 huggingface dataset:
A self-care, problem-solving and mindfulness intervention for informal caregivers of people with motor neurone disease: A pilot study
Authors: Ugalde Anna , Mathers Susan , Hennessy Anderson Nicole , Hudson Peter , Orellana Liliana , Gluyas Cathy
Published: December 2017

Background:

Informal caregivers of people with motor neurone disease (MND) take on an extensive role. Caregivers are at increased risk of experiencing psychological distress and burden, yet, there is a lack of intervention programmes to support them.

Aim:

The aim of this study was to investigate the feasibility and acceptability of a therapeutic group intervention promoting self-care, problem-solving and mindfulness to informal caregivers of people with MND.

Design:

Pilot study that utilised a one-arm pre- and post-design. Acceptability of the intervention was assessed 2 weeks post intervention with a questionnaire designed specifically for this study. Feasibility was assessed with consent, adherence and reasons for non-participation, refusal and attrition. Participants completed baseline and follow-up (6-week post intervention) questionnaires for psychological morbidity, burden, problem-solving, mindfulness and preparedness.

Settings/participants:

Caregivers of people with a diagnosis of MND within the past 12 months who were 18 years or older; who could speak, read and write in English and who were attending a progressive neurological diseases clinic were eligible.

Results:

A total of 13 caregivers participated in one of three group intervention sessions which were focused on self-care, problem-solving and mindfulness. The intervention appeared to be feasible and acceptable. All participants stated that they would recommend the intervention to others. The group format appeared to be highly valued. There was no significant change in measures between pre-intervention and 6 weeks post intervention.

Conclusion:

This pilot serves as an initial step for examining interventions for MND caregivers, with the hope of identifying effective, efficient and sustainable strategies to best support this group.
Comparing Pictures and Videos for Teaching Action Labels to Children With Communication Delays
Authors: Schebell Shannon , Shepley Collin , Mataras Theologia , Wunderlich Kara
Published: December 2017

Children with communication delays often display difficulties labeling stimuli in their environment, particularly related to actions. Research supports direct instruction with video and picture stimuli for increasing children’s action labeling repertoires; however, no studies have compared which type of stimuli results in more efficient, maintainable, or generalizable learning for children with communication delays. In the present study, we used a single-case adapted alternating treatments design to compare picture and video stimuli for teaching action labels to three preschool-aged children receiving special education services in a self-contained setting for communication delays. Results indicate that all children acquired target action labels using both picture and video stimuli, and all children generalized some targets to in vivo stimuli without direct instruction. Efficiency, generalization, and maintenance measures varied across children. Implications and future directions for researchers and practitioners are provided.
Public Expenditures for Mental Health Services in Canadian Provinces
Authors: Wang Jian , Jacobs Philip , Ohinmaa Arto , Dezetter Anne , Lesage Alain
Published: December 2017

Objective:

The purpose of this study is to measure provincial spending for mental health services in fiscal year (FY) 2013 and to compare these cost estimates to those of FY 2003.

Methods:

This study estimated the costs of publicly funded provincial mental health services in FY 2013 and compared them to the estimates for FY 2003 from a previously published report. Our data were obtained from publicly accessible databases. The cross-year cost comparisons for provincial mental health services were restricted to general and psychiatric hospital inpatients, clinical payments to physicians and psychologists, and prescribed psychotropic medications. Total public expenditures were inflation adjusted and expressed per capita and as a percentage of the total provincial health spending.

Results:

Total public spending for mental health and addiction programs/services was estimated to be $6.75 billion for FY 2013. The largest component of the expenditures was hospital inpatient services ($4.02 billion, 59.6%), followed by clinical payments to physicians or psychologists ($1.69 billion, 25%), and then publicly funded prescribed psychotherapeutic medications ($1.04 billion, 15.4%). Nationally, the portion of total public spending on health that was spent on mental health decreased from FY 2003 to FY 2013 from 5.4% to 4.9%.

Conclusion:

Our results reveal that mental health spending, as a proportion of public health care expenditures, decreased in the decade from FY 2003 to FY 2013. Due to large differences in how the provinces report community mental health services, we still lack a comprehensive picture of the mental health system.
On the Origin of Grooming
Authors: Burgess Ann Wolbert , Hartman Carol R.
Published: December 2017

The concept of grooming has long been identified with language in child sexual abuse. This article reviews a brief history of child sexual abuse with regard to efforts to identify and classify abuserand victim behavior. We examine the evolution of terms used to label different behaviors particularly those used to obtain initial control over the chlid victim including grooming.
The Interaction of Extremist Propaganda and Anger as Predictors of Violent Responses
Authors: Shortland Neil , Nader Elias , Imperillo Nicholas , Ross Kyrielle , Dmello Jared
Published: December 2017

In this study, and with a view to extending upon existing findings on the effects of general violent media on violent cognitions, we experimentally measured the relationship between exposure to extremist propaganda and violent cognitions. Our results countered our hypotheses and the wider findings of violent media and aggression that exposure to violent stimuli increases violent thoughts and that this effect is moderated by trait aggression. Specifically, this study found that participants with low and medium trait aggression became more pro-social after being exposed to extremist propaganda. We discuss these results with reference to theories of terror management and mortality salience, as well as the implications of these results for wider theories of the role of online extremist material in the wider “radicalization” process.
Philosophical Issues and Nursing Science
Authors: Reed Pamela G.
Published: December 2017

The author of this article introduces a new column that will explore philosophical issues of concern to nurse scientists. In this initial column, I review the general terrain of philosophy in nursing science and explore some philosophical issues relevant to theory development. One conclusion is that inquiry into philosophical issues may help expand our repertoire of conceptual tools useful in building scientific knowledge and facilitating theoretical progress.
Evaluation of a Pharmacist-Driven Aldosterone Antagonist Stewardship Program in Patients With Heart Failure
Authors: Sparks Eric R. , Beavers Janna C.
Published: December 2017

Objective:

To evaluate the impact of a pharmacist-driven initiative to optimize aldosterone antagonist use in patients with heart failure with reduced ejection fraction (HFrEF) at a large community hospital.

Methods:

This single-center, retrospective cohort study compared patients with heart failure before and after the implementation of the initiative. Data for pre- and postinitiative patients were retrospectively collected to assess patient characteristics and aldosterone antagonist use. The primary outcome was a composite of eligible patients with heart failure discharged on aldosterone antagonist therapy or with a documented reason for ineligibility before and after commencement of pharmacist-driven aldosterone antagonist initiative.

Results:

The preinitiative cohort included 96 patients and the postinitiative cohort contained 92 patients. When the 3 month pre- and postinitiative groups were assessed, the primary outcome was noted in 60 (63%) of 96 patients in the preinitiative group and 87 (95%) of 92 patients in the postinitiative group ( P < .0001).

Conclusion:

In patients with HFrEF, a pharmacist-driven aldosterone antagonist optimization initiative significantly increased appropriate prescribing and documentation for aldosterone antagonist therapy.
Modeling of surface roughness in the magnetorheological cylindrical finishing process
Authors: Grover Vishwas , Singh Anant Kumar
Published: December 2017

The magnetorheological cylindrical finishing process is developed for fine finishing of the internal surface of cylindrical objects. The process uses smart fluid known as magnetorheological polishing fluid. This fluid consists of carbonyl iron (CI) and silicon carbide (SiC) abrasive particles mixed in the base fluid. The magnetorheological cylindrical finishing process consists of an internal finishing tool, which induces magnetic field over its outer surface due to which CI particles experience magnetic force and form chains between the magnetized tool outer surface and inner surface of the cylindrical workpiece. The CI particles push SiC abrasive particles towards the inner surface of the cylindrical workpiece and with the movement of finishing tool inside the cylindrical workpiece, finishing is performed in the process. In the present work, a mathematical model is developed for calculating the change in surface roughness values in the magnetorheological cylindrical finishing process after consideration of forces as acting on SiC particles. To validate the proposed mathematical model, the experimentation is performed by the magnetorheological cylindrical finishing process for finishing the internal surface of cylindrical hardened ferromagnetic steel workpiece. Results of both i.e. mathematical modeling and experimentation are found to be in close agreement with least percentage error of 1.28%. The developed mathematical model is helpful in predicting the process performance, which proves to be useful for industries dealing with internal finishing like injection molding, gas, and liquid pipes, etc.
The Process of Adaptation Following a New Diagnosis of Type 1 Diabetes in Adulthood: A Meta-Synthesis
Authors: Due-Christensen Mette , Zoffmann Vibeke , Willaing Ingrid , Hopkins David , Forbes Angus
Published: December 2017

While Type 1 diabetes (T1D) is generally associated with childhood, half of all cases occur in adulthood. The adaptive strategies individuals employ during the initial adaptive phase may have an important impact on their risk of future diabetes complications and their psychosocial well-being. We conducted a systematic review of six databases and included nine qualitative studies in a meta-synthesis, the aims of which were to develop a better understanding of how adults newly diagnosed with T1D experience the diagnosis and the phenomena associated with the early process of adaptation to life with diabetes. The meta-synthesis identified five constructs that shaped and influenced the early adaptive process: disruption, constructing a personal view of diabetes, reconstructing a view of self, learning to live with diabetes, and behavioral adaptations. The adaptive processes of adults to a diabetes diagnosis are highly referenced to prior life experiences, social habitus, and psychological orientation.
Exploring the Experiences of Persons Who Frequently Visit the Emergency Department for Mental Health-Related Reasons
Authors: Digel Vandyk Amanda , Young Lisa , MacPhee Colleen , Gillis Katharine
Published: December 2017

In this qualitative study, the experiences of persons who frequently visit the emergency department (ED) for mental health-related reasons were explored. Interpretive Description guided the design, and data were collected through interviews with 10 adults who made 12+ ED visits within a 1-year time frame (2015). Thematic analysis was used to analyze data inductively. The participants’ experiences were described with the help of three themes emerging from the data: The Experience, The Providers, and Protective Factors. The participants felt compelled to come to hospital. For them, every visit was necessary, and dismissal of their needs by staff was interpreted as disrespect and prejudice. We noted differences in ED utilization patterns according to psychiatric diagnosis, and more research is needed to explore the phenomenon of frequent use by particular patient populations. Furthermore, health care providers implementing interventions designed to improve emergency care should consider tailored approaches rather than a one-size-fits-all strategy.
Making Claims that Matter: Heuristics for Theoretical and Social Impact in Qualitative Research
Authors: Huffman Tim , Tracy Sarah J.
Published: December 2017

Scholar activists draw on a variety of theoretical, methodological, and practical tools for creating and sustaining social justice. We argue that data analysis—in addition to research design, participation, and community engagement—can be leveraged to engage in scholarship for social good. This essay contributes to that effort by offering a set of data analytic heuristic devices for qualitative researchers. These heuristic devices include community cocktail party, conjecturing claims, Jeopardy research questions, phronetic claims, carrying claims, and tightening claims. We outline each heuristic device’s use, purpose, underlying philosophical commitments, and how it aids analytic thinking that serves the pursuit of justice. Using these devices provides opportunities for making claims that matter and strengthening the impact of qualitative research.
Political Inequality among Youth
Authors: Kudrnáč Aleš , Lyons Pat
Published: December 2017

This study explores what factors help explain why some young people have more internal political efficacy (IPE) than others. IPE refers to subjective competence to understand politics and make informed choices. IPE is important because it has a strong positive association with many forms of political participation and also enhances the legitimacy of democratic regimes. Consequently, IPE forms part of the foundations of political equality. Using data from the Czech Republic and insights from personal information, social resource and social learning models (SLMs), this study shows that variation in youth IPE is most strongly linked with discussions among family, friends and classmates. In contrast to previous work, open classroom climate was not found to have a positive link with IPE, and Campbell’s (2008, Political Behavior 30(4): 437–54) compensation hypothesis could not be accepted.
The Italian public debate on same-sex civil unions and gay and lesbian parenting
Authors: Lasio Diego , Serri Francesco
Published: December 2017

After many years of heated debate, in 2016 the Italian parliament approved a law to regulate same-sex civil unions. Although this can be considered a significant step towards the equality of lesbian and gay couples, the law preserves legal differences between heterosexual marriage and homosexual union and does not guarantee the rights of lesbian and gay parents and their children. In this article, we analyze the public debate on same-sex couples and gay and lesbian parenting that occurred in Italy while the parliament was discussing the law. Findings highlight that the ‘natural order’ argument and the irreducible differences between heterosexual marriage and same-sex union are the bedrock of the current expression of heteronormativity in Italy.
Relationship between proton affinities and structures of proton-bound dimers
Authors: Valadbeigi Younes
Published: December 2017

This work presents a structural approach for determination of proton affinities of molecules. In proton-bound dimer [X…H…M]+, M and X compete with each other to capture the proton. The correlation between proton affinities of a series of molecules, M, and X…H bond length was studied while X was a common molecule in the all proton-bound dimers. Linear relationships were observed between proton affinities of a series of alcohols, ethers, aldehydes, ketones and amines and X…H bond length, where H2O and HF were used as X. The method was employed for the measurement of proton affinities of (HF)1–10 clusters using NH3 and H2O as common molecules, [NH3…H…(HF)n]+ and [H2O…H…(HF)n]+. A linear correlation was observed for the PAs of (HF)n clusters versus N…H bond length.
Structural elucidation of fucosylated chondroitin sulfates from sea cucumber using FTICR-MS/MS
Authors: Agyekum Isaac , Pepi Lauren , Yu Yanlei , Li Junhui , Yan Lufeng , Linhardt Robert J , Chen Shiguo , Amster I Jonathan
Published: December 2017

Fucosylated chondroitin sulfates are complex polysaccharides extracted from sea cucumber. They have been extensively studied for their anticoagulant properties and have been implicated in other biological activities. While nuclear magnetic resonance spectroscopy has been used to extensively characterize fucosylated chondroitin sulfate oligomers, we herein report the first detailed mass characterization of fucosylated chondroitin sulfate using high-resolution Fourier transform ion cyclotron resonance mass spectrometry. The two species of fucosylated chondroitin sulfates considered for this work include Pearsonothuria graeffei (FCS-Pg) and Isostichopus badionotus (FCS-Ib). Fucosylated chondroitin sulfate oligosaccharides were prepared by N-deacetylation–deaminative cleavage of the two fucosylated chondroitin sulfates and purified by repeated gel filtration. Accurate mass measurements obtained from electrospray ionization Fourier transform ion cyclotron resonance mass spectrometry measurements confirmed the oligomeric nature of these two fucosylated chondroitin sulfate oligosaccharides with each trisaccharide repeating unit averaging four sulfates per trisaccharide. Collision-induced dissociation of efficiently deprotonated molecular ions through Na/H+ exchange proved useful in providing structurally relevant glycosidic and cross-ring product ions, capable of assigning the sulfate modifications on the fucosylated chondroitin sulfate oligomers. Careful examination of the tandem mass spectrometry of both species deferring in the positions of sulfate groups on the fucose residue (FCS-Pg-3,4- OS) and (FCS-Ib-2,4- OS) revealed cross-ring products 0,2Aαf and 2,4X2αf which were diagnostic for (FCS-Pg-3,4- OS) and 0,2X2αf diagnostic for (FCS-Ib-2,4- OS). Mass spectrometry and tandem mass spectrometry data acquired for both species varying in oligomer length (dp3–dp15) are presented.
‘A bigger living room required a bigger TV’: Doing and negotiating necessity in well-to-do households
Authors: Aro Riikka
Published: December 2017

This article investigates how necessity is ‘done’ and ‘negotiated’ in Finnish well-to-do households’ domestic practices and asks whether and how households are engaged in sustainable practices. The main research material consists of 14 in-depth interviews. In this study, necessities are viewed as something that householders perceive they ‘cannot manage without’ in their normal domestic daily life. At collective level, necessity is considered to construct ‘expectation horizons’: what is considered normal for people to have and to desire and how to live their lives normally within a certain socio-economic frame. With a novel theoretical approach, this article views necessity through three kinds of agentic capacities: distributed agency in the material world, socio-cultural surroundings and mental and bodily dispositions. This article contributes to the ongoing discussion on the problematics of rising living standards and household sustainability efforts. The findings show that in carrying out daily life, the leeway provided by higher income and education collides with the internalised ethos of ‘not wasting’ (habitus), lack of seeing real possibilities and often blurred views of responsibilities and power to pursue sustainability. Sustainability is seen as distant to daily life and as an inconvenience that requires familiarisation, time and/or money. It also lacks practical meaning. Instead, domestic necessity contributes to personal and family well-being and effortlessness and straightforwardness in daily life. This article provides three key conclusions. First, any vision or innovation for pursuing sustainability is inadequate if it does not carry meaning in everyday functionality. Second, it is important to critically account for the ‘stickiness’ (capacities for resisting change) of non-negotiable parts of domestic practices with embedded consumption of materials, water and electricity; third, based on the previous two, research and policy should take seriously the difficulty of thinking or seeing outside of the ‘expectation horizons’ that incorporate the co-evolving aspirations and conventions.
Cultural mosaic beliefs as a new measure of the psychological climate for diversity
Authors: Chuapetcharasopon Pylin , Neville Lukas , Adair Wendi L , Brodt Susan E , Lituchy Terri R , Racine Aimy A
Published: December 2017

This article introduces the concept of cultural mosaic beliefs (CMBs) as a component of effective multicultural work groups. Building on theories of group diversity and self-verification, and responding to calls to understand moderators that explain the impact of group diversity on performance outcomes, we conceptualize CMBs as a psychological climate that individual group members perceive to promote the recognition, acceptance and expression, and utilization of cultural diversity (values, traditions, and practices) in their work. We also propose that CMBs might attenuate conflict that can sometimes characterize culturally diverse work groups distinguishing groups that falter from those that flourish and benefit from the informational and other potential advantages associated with their diverse cultural composition. In a series of five studies ( N = 1119), we develop a 17-item CMB scale comprised of three factors: perceived group diversity, cultural acceptance and expression, and culture utilization. We present evidence of convergent and discriminant validity, showing that the CMB scale is related to but distinct from other measures of diversity. We also demonstrate predictive validity, showing that the CMB scale is related to work group members’ identification with the group, commitment to the group, satisfaction with the group, and learning from the group. We conclude by proposing applications of our CMBs concept and measure to multicultural workplaces and offer future directions for research on cultural diversity, specifically the study of group CMBs as a moderator of cultural diversity’s effects on groups.
Hierarchical framework for quantifying multiscale structures of two-dimensional woven carbon fibre-reinforced composites considering geometric variability
Authors: Zhu Chao , Zhu Ping , Liu Zhao , Tao Wei , Chen Wei
Published: December 2017

The processing and mechanical properties of two-dimensional woven carbon fibre-reinforced composites depend directly on the internal geometrical architecture, which presents typical multiscale nature, while the multiscale structures possess inevitable geometric variabilities during the manufacturing process. This work presents a stochastic multiscale geometric modelling framework containing two developed algorithms to facilitate reconstructing statistically equivalent structures on microscale and mesoscale of two-dimensional woven carbon fibre-reinforced composite considering internal geometric variability. The sequential random perturbation algorithm is proposed to realize the random distribution nature of fibres inside yarns on microscale by sequential smart movements of initial regular distributed fibres. Then, an algorithm based on Gaussian random sequence is developed to characterize the internal variabilities of yarn path and shape on mesoscale via reconstructing correlated stochastic deviations along yarns. The proposed modelling framework effectively reconstructs the geometric models of random microstructure and mesostructure, which is convenient to be implemented into computational micromechanical analysis on both scales, serving as the foundation of the numerical calculation of the multiscale processing and mechanical properties of the studied composite.
MiR-98 Promotes Apoptosis of Glioma Cells via Suppressing IKBKE/NF-κB Pathway
Authors: Wang Lingyan , Guo Shaolei , Zhang Heng
Published: December 2017

The inhibitor of kappa B kinase epsilon is overexpressed in glioma and plays antiapoptotic role via activating nuclear factor-kappa B. microRNA-98 can suppress glioma, modulate the activities of nuclear factor-kappa B, and bind to the 3′-untranslated region of inhibitor of kappa B kinase epsilon messenger RNA. This study was aimed to investigate the modulation of inhibitor of kappa B kinase epsilon/nuclear factor-kappa B by microRNA-98 in glioma. The results indicated that microRNA-98 was downregulated in glioma cell lines and human glioma tissues. Overexpression of microRNA-98 in U87MG and T98G glioma cells significantly increased the apoptosis induced by ultraviolet irradiation and suppressed nuclear factor-kappa B luciferase activity, nuclear factor-kappa B p50 subunit expression, and B-cell lymphoma-2 (Bcl-2) expression in glioma cells. Silencing inhibitor of kappa B kinase epsilon decreased the expression of nuclear factor-kappa B p50 subunit and the luciferase activity of nuclear factor-kappa B, while the nuclear factor-kappa B activity could be significantly retrieved when inhibitor of kappa B kinase epsilon was expressed in microRNA-98-transfected cells. These findings indicated that microRNA-98 could promote apoptosis of glioma cells via inhibiting inhibitor of kappa B kinase epsilon/nuclear factor-kappa B signaling and presented a novel regulatory pathway of microRNA-98 by direct suppression of inhibitor of kappa B kinase epsilon/nuclear factor-kappa B expression in glioma cells.
Receiving an on the spot penalty: A tale of morality, common sense and law-abidance
Authors: Snow Adam
Published: December 2017

This article examines citizens’ reactions to being issued with an on the spot penalty and the consequences this has for holding a law-abiding identity. Using mundane examples of statutory requirements regulating everyday life (motoring), it is found that people use common-sense purposive reasoning in their interpretation of law which does not match the actual black-letter law application of the specific statutes. The lack of congruence between the purposive understandings of legal requirements and the black-letter application of enforcement agencies allows citizens to maintain a moral position that is aligned with the aims of the law but not its actual requirements. This process reaffirms a belief in law-abidance even where the citizen has been found to break the law.
Exacerbating risks and diminishing rights for ‘at-risk’ prisoners
Authors: Harris Alexis , Stanley Elizabeth
Published: December 2017

At-Risk Units (ARUs) are dedicated facilities established in New Zealand prisons to assist those considered to be ‘at risk’ of self-harm or suicide. Their remit is ostensibly care-based and rights-conscious, with authorities noting that ARUs preserve the ‘right to life’. Drawing upon research within two correctional sites, alongside analysis of recent documents from oversight bodies and courts, this article considers ARU operations. It is argued that, all too often, ARUs have undermined humane practices towards suicidal or ‘at-risk’ prisoners. Four problems are apparent: (1) ARUs are misused and overused in such a way that secure punishment, rather than care, is prioritized; (2) within a context of ‘lesser eligibility’, ARUs operationalize degrading conditions and treatments towards prisoners; (3) humane treatments are further diminished by a correctional approach to prioritize legal or bureaucratic compliance; and (4) authorities avoid institutional sanction for prisoner harms or deaths, particularly through an emphasis on personal responsibilization or blame. The end-result is that ARUs are regularly operationalized in ways that exacerbate risks and diminish rights for prisoners. A question remains about their fundamental use as an appropriate response to those who suffer mental health distress within penal environments.
Anaesthesia: Circulation and Invasive Monitoring
Authors: Griffiths Rachelle
Published: December 2017

Circulation is very important to theatre nurses everywhere. (Excuse the pun, but 2000 - or YK2 as we are now to call it - has got to me.) Rachelle Griffiths continues our Back to Basics series with a consideration of cardiovascular circulation and monitoring. What topics would you like to see in the future in this series? Let me know via the editorial staff at NATN Headquarters.
The View from the other Side…
Authors: Fox Liam , Williams Marilyn
Published: December 2017

Continuing our political series, this article brings you the Opposition's views on the present day NHS. Remembering that they had 17 years in office in which to get it right, this should prove interesting reading. As with the article by Alan Milburn in the May issue, this article contains extracts from a keynote speech made by Liam Fox at the Conservative party conference last October. There have been some changes since then of course, with Frank Dobson no longer the Secretary of State for Health, and the budget announcement of extra spending. As with the Government, the Conservatives believe that nurses have a vital role to play in improving the NHS, so read on and compare these views with the others already published. If you're tempted to add your own views, they will be very welcome in Open Forum.
Body Language Non-Verbal Cues
Authors: Mason Lesley , Williams Marilyn , County Bernadette
Published: December 2017

Interviews for employment are significant events in peoples lives. Preparing for one and getting through it can be a memorable experience, good or bad. We all know that what we don't say can be as important as what we do say. In this fascinating piece of research Lesley Mason describes how she was able to relate the non-verbal communication of interview candidates to the outcome of the interview. Read on arid find out what you were really saying as you sat, squirmed or twiddled your way through that last interview…
Accidents Don'T Just Happen!
Authors: Campbell Libby , Walker Linda , Stevens Vivian
Published: December 2017

Risk management is a systematic approach to monitoring processes and systems to ensure that patients receive their care in a safe environment. The NHS management executive (1993) states that risk management should not lead to defensive practices but should be used to pinpoint deficiencies in a positive way, using mistakes as an opportunity for learning and to eliminate errors in the future.
Nurse-Assisted Peg in Children
Authors: Lee Alex Ch , Carter Helen P , Sugarman Ian D , Stringer Mark D , Crabbe David
Published: December 2017

The first of these two articles, published in last month's BJPN, discussed percutaneous endoscopic gastrostomy (PEG) in practice. This second article reviews 122 paediatric PEG procedures performed between 1998 and 2002 with the nurse as surgeon's assistant to a surgeon endoscopist.
Management of a Cjd Case Part 2 the Patient with Cjd in the Operating Theatre
Authors: McNeil Beverley
Published: December 2017

Along with details as to how CJD-associated instrumentation should now be handled, following a recent updating of DoH advice, this article contains comprehensive guidelines which can be followed in the event of a procedure involving a CJD patient. All the practicalities associated with managing a CJD case are dealt with step by step, from collection of the patient from the ward, through terminal cleaning of the theatre, to discharge of the patient from Recovery.
The Silent Danger Related to Patient Positioning and Surgery
Authors: Wilde Sarah
Published: December 2017

Compartment syndrome affecting the limbs is a well-documented condition and there are cases where it has become evident following surgery undertaken with the patient in the Lloyd Davies position. This article explores the contributory factors and the devastating effect it can have on the patient, and questions whether we practise evidence-based care when patients are undergoing certain types of surgery. It also discusses factors related to abdominal compartment syndrome, a condition usually affecting the critically ill patient.
Managing Prisoners in Theatres
Authors: Fyfe Alasdair
Published: December 2017

Dealing with the diverse healthcare needs of people in prison can be a very challenging role for a nurse. This article explores the care management issues which arise when caring for prisoners within a general hospital theatre environment. It is based on the author's experience working as a nurse in the operating theatre and in the prison environment – a ‘unique environment that presents unique challenges’.
Critical Incident a Nurse's Personal Reflection
Authors: Kenzi-Sampson Hayden
Published: December 2017

This thought-provoking article describes how a perioperative nurse of twenty years' experience reflected on a critical incident that happened in the hospital where she works, and what she gained from the experience. She also provides us with a survey of the literature pertaining to the processes underlying critical analysis.
The Nurse Cystoscopist Extending the Role
Authors: Forsyth Isobel , Shaikh Shafaque , Gunn Iain
Published: December 2017

Nurse-led cystoscopy has become an established service for bladder tumour surveillance patients. The role of the nurse cystoscopist has been developed to include diagnostic cystoscopy with telephone follow-up and counselling. Direct access to the service has reduced waiting times from presentation to diagnosis. The telephone follow-up has improved patients' experience of a diagnostic urology service.
Prewarming: Preventing Intraoperative Hypothermia
Authors: Kiekkas Panagiotis , Karga Maria
Published: December 2017

Perioperative hypothermia can be followed by severe complications. The greatest proportion of temperature decrease is attributed to heat redistribution, which mainly occurs during the first hour of anaesthesia and is difficult to treat intraoperatively. Prewarming, based on active warming techniques, has been proposed. Even a short period of prewarming may significantly increase peripheral tissue temperature, minimise normal core-to-peripheral temperature gradient, and keep core temperature within normal limits.
Promoting Correct Site Surgery: A National Approach
Authors: Edwards Peggy
Published: December 2017

Surgical procedures undertaken at the wrong site represent a potentially devastating event for everyone involved. Wrong site surgery is defined as surgery performed at the incorrect anatomical site – either the wrong side (left leg instead of right) or the incorrect anatomical location or level (incorrect finger on the correct hand). The National Patient Safety Agency (NPSA) and the Royal College of Surgeons of England (RCS) last year issued a joint alert (NPSA 2005a) to promote correct site surgery. This aims to clarify the steps required and ensure that the intended and correct surgical procedure is performed on the correct patient at the correct site.
Adolescents in the Perioperative Environment
Authors: Freeman Eleanor
Published: December 2017

The following paper discusses the experiences of the author with adolescents in the perioperative environment and explores issues of consent and ethics, including competency, treatment in Accident and Emergency, and terminations.
Awake Intubation
Authors: Peiris Kawshala , Frerk Chris
Published: December 2017

Securing the airway is a core skill in anaesthesia, the gold standard of which is tracheal intubation. Normally this is achieved after induction of anaesthesia. However, some circumstances demand an awake approach. Awake intubation can be achieved via several methods. Using the fibreoptic laryngoscope is the most widely used technique in the UK with minimal patient discomfort and a wide margin of safety. When compared with attempts at difficult direct laryngoscopy, awake fibreoptic intubation provides excellent cardiovascular stability when performed under good topical anaesthesia and conscious sedation. Understanding the equipment used as well as preparing the patient and being aware of potential pitfalls are important elements to performing a successful awake intubation.
Infection Control and Prevention in Perioperative Practice
Authors: Williams Marilyn
Published: December 2017

The personal and financial consequences of avoidable infection are enormous in personal and global terms (DH 2003, Stone, Larson & Kawar 2002). Patients expect to be treated and cared for in clean conditions, and not be exposed to the risks of acquiring an infection by poor practice on the part of healthcare workers (DH 2005, Health Care Commission 2005). Infection control and prevention in perioperative settings assumes an even greater significance because of the vulnerability of patients who are already ill or injured, and because surgery, anaesthesia and immediate postoperative recovery may expose them to invasive procedures, allowing more portals of entry for infection. There is ample evidence, widely available, to support best practice in all healthcare settings. The methods are cheap, easy to apply and very effective (Wright 2004, Pratt et al 2007). This article will examine a range of evidence applicable to perioperative infection control and prevention, including an assessment of current practice and how it may be improved, with a particular emphasis on surgical site infection associated with Meticillin Resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile (C.diff).
Safer Surgery: Update on Current Patient Safety Initiatives
Authors: Watts Fran
Published: December 2017

Surgery is an essential component of healthcare worldwide. However in industrialised countries, major complications occur in 3–16% of all inpatient surgical procedures, with permanent disability or death rates affecting approximately 0.4 – 0.8% of patients (Haynes et al 2009).
Safe Surgery: Reducing the Risk of Retained Items
Authors: Woodhead Kate
Published: December 2017

Research from the United States which explores events related to the surgical count has identified that there are opportunities to review our practice in order to reduce risks to surgical patients. The Safe Surgery Saves Lives Campaign highlights this aspect of perioperative patient safety, ensuring that poor processes and poor communication, often the reasons for retained surgical items, become part of the team ‘sign-out’ at the end of every operation.

‘People working in health care are among the most educated and dedicated workforce in any industry. The problem is not bad people; the problem is that the system needs to be made safer.’ (Kohn at al 1999 p49)
Tourniquet Failure during Total Knee Replacement Due to Arterial Calcification: Case Report and Review of the Literature
Authors: Barr Lynne , Iyer Uma Shridhar , Sardesai Anand , Chitnavis Jai
Published: December 2017

Use of a tourniquet for performing surgery in order to create a bloodless surgical field and reduce blood loss has been in use for many years. Tourniquets may fail perioperatively for various reasons, leading to ongoing bleeding. An important cause of tourniquet failure is calcification of the underlying artery. A patient undergoing total knee replacement surgery in whom the tourniquet failed, secondary to femoral artery calcification is reported. The implications of tourniquet use in patients with arterial calcification, including acute distal ischaemia, aneurysm formation and vessel fracture will be discussed. Recommendations include: thorough vascular assessment of all patients preoperatively, awareness of the possibility of tourniquet failure particularly in vasculopaths, and the provision of an alternative perioperative management plan such as use of a cell saver device, should the tourniquet fail.
Low Documentation of Postoperative Adhesions on Consent Forms for Laparotomy
Authors: Solomon Livingstone , Dhandapani Ramya , Brown Robin
Published: December 2017

Aim

To assess the documentation of postoperative adhesions as a potential complication of laparotomy on consent forms.

Method

Retrospective study of hospital notes of 102 adult patients that underwent laparotomy over a two year period.

Results

Intraperitoneal adhesions were documented as a postoperative risk on 10 consent forms (9.8%) only.

Conclusion

The results imply that most patients were not informed of this common postoperative complication and this may have medicolegal and risk management implications.
Nitrous Oxide Makes Me Sick: Or Does It? (Nitrous Oxide and Postoperative Nausea and Vomiting)
Authors: Ewart Luke
Published: December 2017

This article evaluates whether avoidance of nitrous oxide in general anaesthesia can improve clinical outcomes in surgical patients by reducing postoperative nausea and vomiting, and whether avoidance should become part of a routine clinical management strategy. Despite some controversy, the greatest strength of evidence suggests that avoidance of nitrous oxide may be justified as a pre-emptive perioperative strategy as part of a multimodal approach to postoperative nausea and vomiting, especially in those patients known to have a higher baseline risk.
Debridement: Development of the Concept
Authors: Huntley James S
Published: December 2017

Debridement - the surgical excision of dead and contaminated tissue - is an important component of the management of open wounds and fractures. Key components in the evolution of modern technique of wound management were:

• wound extension to relieve pressure (akin to a modern day fasciotomy) (Pare, Desault, Larrey)

• antiseptic technique (Lister) and

• wound and contaminant excision (Pare, Desault, Larrey, Reyher).

There has been confusion over the meaning and derivation of the term debridement.
Management and Treatment of Local Anaesthetic Toxicity
Authors: Parry Andrew
Published: December 2017

Local anaesthetics have been used within surgical practice since the late 1800s, when the ophthalmologist Carl Koller discovered the tissue numbing properties of cocaine (Odedra & Lyons 2010). Since that time, the ongoing development of anaesthetic drugs has provided many different local anaesthetics (LA) to clinical practice. The techniques for using these drugs in surgical practice have also developed, shaping the modern practices we know today. Increasing numbers of surgical procedures are now carried out under LA that once necessitated general anaesthetic, for example carotid endarterectomy as first described by Eastcott et al (1954). This type of procedure can now be safely carried out under LA but does require a large volume of the drug (up to 25 mls, see Table 1 for variations) to infiltrate a very vascular surgical field, and the LA may need supplementing during surgery (Allman & Wilson 2006). The practice of routinely injecting large volumes of LA agents into surgical wounds to aid post-operative pain control also increases the risk of inadvertent intravascular injection that could lead to LA toxicity (Parker et al 2009).
Enhanced Recovery after Surgery (ERAS) Workshop: Effect on Attitudes of the Perioperative Care Team
Authors: Kahokehr Arman A. , Thompson Lisa , Thompson Megan , Soop Mattias , Hill Andrew G.
Published: December 2017

Background

Enhanced recovery after surgery (ERAS) or ‘fast track’ surgery is heavily based on a multidisciplinary focused perioperative care model with all players being equally important for successful implementation. Several institutions run an ERAS course but few data are available on their effect on attitudes and perceptions to perioperative care principles.

Methods

A ten item survey was designed for perioperative care clinicians attending an annual ERAS workshop. The survey was administered one week before and three weeks after the workshop.

Results

Seventy seven eligible participants were identified. Forty four (57%) responded to the questionnaire prior to the course. On repeat administration of the survey three weeks after the course there were 28 (36%) responses. The results of the survey indicate that the majority of perioperative care staff were already aware of the evidence behind some of the principles applied in colectomy, with a high pre-course level of understanding shown. However the course significantly changed opinion regarding some other aspects of care to align opinion with evidence amongst the responders.

Conclusion

There appears to be a high rate of evidence agreement with some interventions but not others amongst perioperative staff. Attending a multidisciplinary ERAS workshop seems to align opinion with evidence.
Carers’ Perceptions of the Enhanced Recovery Programme in Colorectal Surgery
Authors: Rymaruk Sophy , Williams Julie , Kurrimboccus Salim
Published: December 2017

The Enhanced Recovery Programme (ERP) is widely used, especially within colorectal surgery. It is structured around a patient centred decision making process, and the evidence to support the ERP is well documented. Much of the literature focuses on patients’ perceptions of the ERP, with qualitative evaluation of their experiences. However, the experience of the ERP from a carer's perspective has yet to be explored.
Reflective Case Study on End of Life Care in Post Anaesthesia
Authors: Wade T
Published: December 2017

Operating department practitioners (ODPs) are well known for their technical abilities within the perioperative environment and are passionate about the care they deliver. This article will critically reflect on the post anaesthetic care of a dying patient, the challenges of having relatives present, the importance of having a good student/mentor relationship, and will show that student ODPs can deliver compassionate and personalised care.
What's in a Name? An Evaluation of Public Perceptions around Job Role Titles within the Modern Anaesthesia Team
Authors: Phillips Mj , Harris M
Published: December 2017

The aim of this study was to examine the association made by members of the public between a healthcare professional's title and the function they actually perform within the anaesthesia team. It was also the intention of this research to establish whether the public felt that the title ‘anaesthesia practitioner’ or ‘physicians’ assistant (anaesthesia)' was more synonymous with a member of the non-medical team trained to administer anaesthesia. The study population evaluated was 55 members of the public who were randomly selected from the outpatient department at Good Hope Hospital, part of Heart of England NHS Foundation Trust. Results demonstrated that the titles the general public felt were most synonymous with healthcare professionals who administer anaesthesia were ‘consultant anaesthetist’ and ‘anaesthesia practitioner’. Less than a third of those evaluated felt that an anaesthetic would be given by a ‘physicians’ assistant (anaesthesia)’.
How is Time Used within the Orthopaedic Trauma Theatre?
Authors: Rymaruk S , Buch K
Published: December 2017

Theatre efficiency has gained increasing attention though the Productive Operating Theatre (TPOT) initiative from the NHS Institute for Innovation and Improvement. However, literature specifically exploring how time is used within theatre is limited. Running a theatre is expensive and so it is essential to maximise efficiency (NHS III2009). A retrospective review of trauma lists in two district general hospitals has identified areas where time is wasted and highlighted areas for improvement.