bluuebunny/crossref_metadata_2025 huggingface dataset:
Full of Eastern promise?
Authors: Smith Graeme D
Published: May 2014

This editorial was written while I was in the middle of a period of sabbatical research leave in Asia, which gave me a wonderful opportunity to gain an insight into the clinical working practice of doctors and nurses in gastroenterology in China. Although the general management of most gastrointestinal conditions is similar, the role and the development of the gastrointestinal nurse practitioners/specialists in Asia is different. I was particularly surprised by the limited numbers of nurses working specifically in gastroenterology.
Bowel CanceBowel Cancer UK − 20 years old and still going strong
Authors: Beaumont Ian
Published: May 2014

Bowel cancer affects more than 35 000 people a year and is the second most common cause of cancer death in theUK each year, in part because too many people do not act on their symptoms in time, due to the fear, embarrassment and ignorance that surrounds the disease. Also, the symptoms of bowel cancer, such as persistent changes in bowel habit, blood in your stools, anaemia, tiredness and abdominal pain, are often caused by other non life-threatening conditions, making it difficult to identify.
The European Colitis and Crohn's Organisation ... A meeting of minds
Authors: Younge Lisa
Published: May 2014

The last 10 years have seen a proliferation of inflammatory bowel disease (IBD) nursing posts developed within the UK. More recently, there has been the establishment of effective networking systems to provide support and promote best practice among nurses in those posts. However, less is known about the role of nurses in the management of IBD patients in the rest of Europe, and their support networks.
Biofeedback: compliance in women with faecal incontinence after childbirth
Authors: O'Brien Lorraine
Published: May 2014

Obstetric injury is a major cause of faecal incontinence in women. This can have a detrimental effect on both physical and psychological health. Biofeedback is considered a firstline treatment due to its efficiency and lack of side−effects. It was noted that a significant number of women attending a biofeedback clinic had difficulty complying with their treatment plans. Patient compliance is influenced by a number of factors, including: severity of symptoms; willingness to participate; self−efficacy; and support from family, friends and professionals. This article explores these factors and offer suggestions to overcome non−compliance.
Public health and the national bowel cancer screening programme
Authors: Twite Simon
Published: May 2014

′The next phase of public services has to be to move away from the letter box model [in which] ″we″ are waiting for ″them″ to deliver services to us, so we are no longer the individual sitting at home for the package to be delivered to us at the door. Citizens have to feel they have been listened to and can shape services.′ (Wintour, 2007)
Patient−controlled epidural analgesia: a nursing perspective
Authors: Rushworth Mark , Marshall−Lucette Sylvie , Coppard Sue
Published: May 2014

This article discusses the use of patient−controlled epidural analgesia (PCEA) for patients undergoing gastrointestinal surgery, from a nursing perspective. Despite progress in postoperative pain relief over the last decade, a number of patients experience severe pain after major surgery, which can include gastrointestinal surgery. Optimal postoperative pain relief needs to be further improved as it is not only about sensation management, but the whole person. Numerous studies have indicated that patient−controlled analgesia is generally an effective method of delivering postoperative analgesia, but more safety considerations are highlighted for PCEA. However, the literature suggests that these safety issues can be effectively managed with specific nurse and patient education programmes. Thus, the article addresses PCEA as a potentially useful post−surgical analgesic technique for gastrointestinal surgery that is not commonly used in the UK. The three issues discussed, as related to nursing, are efficacy, safety and the nursing implications in the management of PCEA.
Physical assessment in gastroenterology. Performing a rectal examination
Authors: Hibberts Fiona , Bushell Christine
Published: May 2014

The role of the specialist nurse continues to develop and it of vital importance that new knowledge and skills accompany the transition. Increasingly, specialist nurses need to swiftly and accurately assess, examine, diagnose and treat patients autonomously. Part one of this two−part series provided an overview of a systematic guide to abdominal assessment, guiding the practitioner towards a diagnosis and ultimately a treatment plan. The article propagated the importance of ensuring a full history is taken before any physical assessment. Part two will now examine another important physical assessment: rectal examination. Rectal examination is a vital part of abdominal examination as it can provide vital clues to the diagnosis of the patient. In conclusion, it is important that nurses gain the advanced assessment skills needed to perform physical assessment in patients, thus ensuring quality care of the patien
It takes guts to talk about bowels: The Gut Trust
Authors: Nunn Penny
Published: May 2014

In this thirteenth article in the series profiling charities and organizations pertinent to gastrointestinal nursing, Penny Nunn introduces The Gut Trust, the new name for the IBS Network
what the journals say
Authors: Williams Julia
Published: May 2014

JThis study was undertaken in Australia and set out to explore the quality of life and psychological adjustment of young adults with a diagnosis of, who were or at risk of, developing familial adenomatous polyposis (FAP). Little is known with regard to attitudes and psychosocial impact for young adults with FAP, and with the advent of genetic testing, improved surgical techniques and clinical management, opportunities arose to explore the impact of the condition on emotional wellbeing and psychological adjustment.
Obesity and liver damage: a crisis in the making?
Authors: Moffat Polly
Published: May 2014

This edition of GIN comes to you ahead of the British Society of Gastroenterology Annual Scientific Meeting, due to be held in Birmingham on 10−13 March 2008. The conference promises to address a variety of concerns facing nurses practising in the field of gastroenterology today, including new treatments for diseases such as IBD, and the pharmacological and surgical management of a range of GI conditions. Some of these topics are featured in this issue. In their article, Jamie Murphy and colleagues (p 32) discuss new ways to manage faecal incontinence. This condition is common, affecting 2% of the adult population, and the article focuses on advanced surgical techniques that can be used in patients where conservative treatment has failed.
The double−edged sword of probiotics
Authors: Moffat Polly
Published: May 2014

This edition of GIN comes to you ahead of the British Society of Gastroenterology Annual Scientific Meeting, due to be held in Birmingham on 10−13 March 2008. The conference promises to address a variety of concerns facing nurses practising in the field of gastroenterology today, including new treatments for diseases such as IBD, and the pharmacological and surgical management of a range of GI conditions. Some of these topics are featured in this issue. In their article, Jamie Murphy and colleagues (p 32) discuss new ways to manage faecal incontinence. This condition is common, affecting 2% of the adult population, and the article focuses on advanced surgical techniques that can be used in patients where conservative treatment has failed.
what the journals say
Authors: Williams Julia
Published: May 2014

The incidence of oesophageal cancer is rapidly increasing in the Western world, and with the majority of people being diagnosed at an advanced stage, palliative treatment becomes a more realistic option. The most debilitating and distressing symptom associated with the disease is dysphagia, and this article explores the use of endoluminal stenting in the management of malignant dysphagia and the implications this has for practice.
NICE guidelines for faecal incontinence: key priorities
Authors: Powell Marlene
Published: May 2014

This article considers the National Institute for Health and Clinical Excellence (NICE) document, Faecal Incontinence: the Management of Faecal Incontinence in Adults (NICE, 2007a), and discusses some practical issues for implementation. The Quick Reference Guide(NICE, 2007b) outlines key priorities for implementation, directed by answers to topic−specific clinical questions. Possibly the most practical and user−friendly guide to follow is the algorithm, which can be found in the Quick Reference Guide. The rationale underpinning recommendations can be found in the full version of the guide.
Assisting you in practice
Authors: Cox Carol
Published: May 2014

This issue of GIN features interesting concepts in relation to the Enhanced Recovery Programme and laparascopic surgery, reviewing colorectal cancer follow−up, the use of Asacol in ulcerative colitis, nicorandil−induced peristomal ulceration and incontinence in older people. I think you will find that these articles expand your knowledge and assist in advancing your practice.
The role of Asacol in the treatment of patients with ulcerative colitis
Authors: Hall Alex
Published: May 2014

Ulcerative colitis (UC) is a chronic inflammatory bowel disease, which typically presents with faecal urgency, diarrhoea (frequently occurring at night and after meals), blood and mucus in stool, and abdominal pain. Initially, UC involves the rectum and spreads proximally in a pattern to involve all or part of the colon. Features of UC are dependent upon the extent, as well as the activity, of the disease, which can be severe, moderate, mild or fulminant. There is no medical cure. Firstline therapy for patients with mild−to−moderate UC is the use of compounds containing 5-aminosalicylic acid (5−ASA). Asacol is a modified−release formula of mesalazine designed to release 5−ASA at a specific pH in the gut.
Reviewing the follow−up care of colorectal cancer patients
Authors: Taylor Claire
Published: May 2014

Specialist colorectal nurses have made a tremendous contribution to the follow−up care of patients treated for colorectal cancer in recent years. It is known that follow−up can provide an invaluable source of specialist information and professional support. Yet, the traditional format of regular outpatient appointments over five years may not always meet individual patients′ needs (Schoemaker, 1998). This article presents patient data from a small qualitative study which suggests that these appointments can create apprehension, uncertainty and frustration. While the provision of some type of surgical follow-up is advocated for these individuals, its form, frequency and purpose are in need of review. Nurses involved with the follow−up of colorectal cancer should consider if their services are patient−centred and best meet patients′ needs. Comparison with different models of follow−up is timely. Exciting possibilities for follow−up exist but if we are to capitalize upon them, we must be proactive and review our follow−up practices now.
Your experiences are worth sharing!
Authors: Williams Julia
Published: May 2014

Within specialist practice there seems to be an ever−changing need and demand for an evidence−based culture. This is a challenging process, but it can also be a motivating one.
Core ... Fighting gut and liver disease
Authors: Alexander Warren
Published: May 2014

With diseases of the gut being the third most common cause of death in the UK, and rising by 25% over the last 10 years, research has become paramount. In this article in the series profiling charities and organizations pertinent to gastrointestinalnurses, Warren Alexander introduces us to Core, the only national UK charity that funds research into all diseases of the gut, liver and pancreas.
Managing and treating opioid−induced constipation in patients with cancer
Authors: Stevens Anna−Marie , Droney Joanne , Riley Julia
Published: May 2014

Constipation is a common symptom in cancer and palliative care patients. It can affect this patient group at any stage of their disease and for a variety of reasons. This article aims to highlight the contribution opiods make in inducing the symptom of constipation and highlights the need for a detailed assessment and interventions tailored to the needs of the patient.
Time for herbal regulation?
Authors: Smith Graeme D
Published: May 2014

The number of people using complementary and alternative medicine (CAM) worldwide continues to grow and it is estimated that over half of patients with gastrointestinal (GI) conditions use some form of CAM therapy (Comar and Kirby, 2005). CAM covers a diverse range of therapeutic interventions, including herbal medicine, which is one of the most commonly used in gastroenterology. Herbalists make numerous GI health-related claims, including the ability to reduce inflammation, aid bowel motility and alleviate abdominal pain.
Successfully sharing at GASTRO 2009
Authors: Hutson Pauline
Published: May 2014

Those who attended the GASTRO 2009 world conference in London in November certainly had a rare opportunity to network and learn from over 700 participants who attended the nurses− sessions representing a diverse range of cultures. Learning about experiences outside the UK provided a unique insight and it was interesting to note how staff from other countries were equally eager to learn about our initiatives such as the Global Rating Scale and the work of the Joint Advisory Group (JAG) on gastrointestinal endoscopy.
Seasonal thoughts for GI nurses
Authors: Harrison Penny
Published: May 2014

As I write this column for the December/ January issue of Gastrointestinal Nursing, my thoughts turn to what has been a busy year both personally and professionally. I am sure that 2009 has also been a busy year for you and your team, an inevitable part of working in the NHS, other healthcare providers or an educational institution such as mine. When a rare and quiet few minutes allow for reflection, it is important to recognize and celebrate the challenges, complexities, pace and sheer volume of work that you as an individual will have contributed to patient care and services over the last 12 months. For many of you, reflection may also bring about questions of what 2010 will bring, how this will impact on you and your team and what the potential outcomes for the patients in your care will be in the new year.
what the journals say
Authors: Williams Julia
Published: May 2014

Current literature suggests cancer-related fatigue is a highly prevalent and distressing symptom that is associated with a decrease in physical activity, functional status and quality of life− regardless of diagnosis, treatment or prognosis. This study sets out to determine the relationship between fatigue and physical activity in older patients with cancer.
Role of the female pelvic floor muscles: a guide for gastrointestinal nurses
Authors: Dorey Grace
Published: May 2014

This clinical skills series is designed for the nursing professional as a basic overview on key clinical skills necessary for patient care, clearly presenting common clinical procedures and their rationale, together with the essential background theory. In this fourth article in the series, Grace Dorey describes the important role of the female pelvic floor muscles in supporting the abdominal contents, controlling urinary and faecal continence, preventing and supporting prolapses, and achieving orgasm.
Dermacol®: A unique stoma collar to protect the skin from leakages
Authors: Redmond Caroline
Published: May 2014

The aim of the formation of a stoma is to improve health and quality of life for patients with intestinal or urinary tract disorders. However, complications can occur; in particular, leakage of faecal matter or urine can cause skin damage, resulting in pain and irritation, and reducing the ability of the stoma pouch to adhere to the skin (thus worsening the risk of leakage). Several methods are available to improve contact between skin and pouch to reduce leakage, such as adhesives, paste, seals, washers, tape and belts. Most recently, Dermacol® has been launched; this is a unique collar that fits over the stoma to prevent output coming into contact with skin. It can be used with different stoma sizes and shapes, it is soft, pliable and comfortable, and it gives patients confidence because it effectively reduces leakage, thus protecting the skin and preventing irritation and pain.
Barrett's oesophagus, part 2: Enabling informed patient choice in surveillance
Authors: Bailey Karen
Published: May 2014

Endoscopic surveillance programmes for patients with Barrett′s oesophagus aim to detect high-grade dysplasia which may be a precursor to adenocarcinoma. However, Karen Bailey explains that before patients can be enrolled in a surveillance programme, they need to be made aware of the potential harms of surveillance, as well as the realistic chances of cancer developing. Patients need to be given simple, accessible and balanced information in order to make informed choices as to participation in surveillance or screening programmes for any condition. Health professionals also need to have an understanding of patients′ perceptions of surveillance and screening programmes and respect the informed decisions made by patients.
A clinical academic pathway for nurses
Authors: Kemp Karen
Published: May 2014

Following the initiative to reform and modernize nursing, midwives and allied health professionals, the Finch Report presents recommendations for preparing and supporting clinical academic nurses of the future and addresses the need to develop a clear career pathway for those nurses involved in clinical research (UK Clinical Research Collaboration (UKC(UKCRC), 2007).
what the journals say
Authors: Coutts Alison
Published: May 2014

Familial adenomatous polyposis (FAP) is an inherited condition that requires colectomy before the age of 20 years, and repeatedscreening to detect early stages of bowel cancer, often leading to further surgery. Most patients are symptom-free before the initial operation, but experience difficulties afterwards. The medical and surgicalmanagement of these peopleis well-established, but there is less awareness as to their psychological and social needs.
Does hypnotherapy have a role in managing inflammatory bowel disease?
Authors: Wahed Mahmood , Emmanuel Anton
Published: May 2014

Gut-focused hypnotherapy has been used in functional bowel disorders successfully for many years. As stress has a proven impact on the course of gastrointestinal disorders such as inflammatory bowel disease (IBD), hypnotherapy may not only have an effect on improving patients' psychological state but also on disease activity. While further formal well-designed randomized controlled trials of hypnotherapy in IBD are needed, Mahmood Wahed and Anton Emmanuel discuss the possible role of hypnotherapy as an adjunct to conventional therapy in managing IBD.
e-Endoscopy: Improving practice through a knowledge-based curriculum
Authors: Anderson John
Published: May 2014

e-Endoscopy was successfully launched at the annual British Society of Gastroenterology meeting in Liverpool in March 2010. Developed by the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) and e-Learning for Healthcare, e-Endoscopy is a web-based interactive resource available to all NHS users. The content is designed to support all aspects of endoscopy skills training and practice from the novice to the independent practitioner and beyond, explains John Anderson.
‘Quietening’ stoma patients' fears
Authors: North Jacqui
Published: May 2014

One of the issues for people with ostomies is the possibility of noise, leakage and smell coming from their pouch, which may effect the ostomate's quality of life. In this article, Jacqui North discusses the importance of discretion for people with an ostomy and investigates the effectiveness of the Hollister Quiet Wear material in reducing pouch noise by examining two case studies.
The low FODMAP diet: new hope for irritable bowel syndrome sufferers
Authors: Medlin Sophie
Published: May 2014

Management of irritable bowel syndrome (IBS) is often challenging—with current treatment options ranging from medication to psychotherapy (NICE, 2008), success rates are mediocre. Over the last 13 years, a new dietary approach to IBS treatment has been developed in Australia, with far more favourable outcomes (Gibson and Shepherd, 2009). Known as the ‘low FODMAP diet’, this approach is now gaining popularity in the UK. In this article, Sophie Medlin explains the physiological basis of the low FODMAP diet, compares it with current dietetic practice and explores its possible future application.
Sexual health following stoma surgery
Authors: White Craig
Published: May 2014

Sexuality is a term used across a wide range of sexual-health dimensions, which often leads to confusion. In recent years, frameworks have been developed that clearly outline the various dimensions of sexual health and allow nurses to focus their assessment and care-planning efforts on specific elements of self-concept, sexual functioning and sexual relationships. The provision of care in this area is more difficult when individual confidence about sexual-health issues is low and/or knowledge on important dimensions is patchy. In this paper, Craig White discusses how the provision of a comprehensive assessment of all dimensions and specific advice on the practical, emotional and sexual impact of surgery is likely to become an essential part of the follow-up care for people after stoma surgery.
Who should transfer children with an acute neurosurgical emergency?
Authors: Winton Pamela
Published: May 2014

Should local anaesthetic teams be responsible for transfer of children with an acute neurosurgical emergency to a neurosurgical unit, or should specialized paediatric teams retrieve?
Is there a future for academic medicine in the UK?
Authors: Pusey Charles , Thakker Rajesh
Published: May 2014

It has been clear for some years that academic medicine in the UK is under threat, as described in the report from the Academy of Medical Sciences (AMS), Clinical Academic Medicine in Jeopardy: Recommendations for Change (2002). This is perhaps surprising considering the high quality of clinical research in the UK, which is second only to that in the USA. However, the number of clinical academics continues to fall and action is urgently needed if academic medicine is to have a future in the UK. In this article, the authors summarize an initiative taken by the Academy of Medical Royal Colleges, with support from the AMS.
Anabolic steroid-induced rhabdomyolysis
Authors: Adamson Rosemary , Rambaran Curtis , D'Cruz David
Published: May 2014

A 25-year-old male with no prior medical history presented with bilateral thigh and calf pain. He was a professional dancer, who had not been dancing for a year following an appendicectomy and was now getting back into training. Two days before presentation he had increased the intensity and duration of his workout to maximum 45 minutes on a cross-trainer. The next day he noticed pain in his legs which intensified with muscle cramps and 24 hours later he presented to accident and emergency. He was sent home on diclofenac tablets,with a diagnosis of musculo-skeletal pain. He re-presented 2 days later with difficulty walking. He admitted taking two preparations of anabolic steroids recently.

On examination, his legs were diffusely tender in the region of the quadriceps and the inferior portion of gastrocnemius, but they were soft, with no warmth or swelling. He had reduced power at the hip flexors and occasional muscle spasms but no focal neurology. Creatinine kinase (CK) was 17 171 iu/litre (normal range for men <250 iu/litre), with normal renal function and no myoglobinuria. Orthopaedic review found no evidence of compartment syndrome and he was treated with intravenous fluids, diazepam and paracetamol. His CK initially decreased but then increased to peak at 22 226 iu/litre on day three, with evidence of myoglobinuria. Management continued with hydration and urinary alkalinization. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were normal and human immunodeficiency virus (HIV) test was negative. Magnetic resonance imaging (MRI) of his legs showed areas of high signal in several muscle groups with no focal areas of necrosis (Figure 1).

Following a muscle biopsy, he was started on oral prednisolone and then a course of methylprednisolone, during which CK levels decreased rapidly. His muscle biopsy and electromyography (EMG), were reported as normal and an autoantibody screen was negative, hence the steroids were rapidly tapered off. At discharge, his CK had continued to decrease (1100 iu/litre) and his mobility slowly improved. A diagnosis of anabolic steroid-induced rhabdomyolysis was made. He had been taking two steroid preparations; WinstrolTM (stanazolol) and PrimabolanTM (metenolon). He had used WinstrolTM several times in the past and on this occasion he had used four ampoules each a week apart. However, he used only one ampoule of PrimabolanTM a few days before presentation. He usually injected into his thighs.
False aneurysm caused by failed fracture fixation
Authors: Anderson OPG , Brookes JAS , Cobb J
Published: May 2014

Patient JL was an 83-year-old man who suffered an unstable intertrochanteric fracture of the femoral neck reduced and fixed with a sliding hip screw. Over the following 2 months he developed pain in the right groin which prevented him from walking. A pulsatile mass in the right groin was found. A pelvic radiograph demonstrated that the plate had pulled away from the femur thus failing to maintain reduction of the fractured hip (Figure 1). Ultrasound and then arteriography confirmed the presence of a profunda femoris pseudoaneurysm. The profunda femoris artery was patent and compressed from below by a large pseudoaneurysm (3.2 cm by 4.0 cm in cross section and 5.0 cm in length) (Figures 2, 3 and 4)). The proximal end was 5.0 cm from the origin of the profunda femoris artery. Radiological intervention was considered to be the most appropriate option because of the technical difficulty and high risk of open surgery.

Left common femoral artery puncture with use of an up and over technique to reach the right common femoral artery and right profunda femoris artery was used. The neck of the pseudoaneurysm was isolated and embolization achieved by placing coils distal and proximal to the neck using seven coils in total. Post-embolization arteriography showed no filling of the pseudoaneurysm and good collateral supply of the limb. The lump in the groin became non-expansile and gradually reduced in size. The patient made a good recovery from the procedure and revision of the sliding hip screw was now possible.
Delirium in the elderly
Authors: Vilches A , Singh I , Narro M
Published: May 2014

Delirium is a dangerous, common and preventable condition that causes significant stress to patients, carers and health professionals. This article explores the existing assessment and management strategies aimed at recognizing and reducing the impact of delirium in elderly patients.
Terrorist attacks: learning from the past and planning for the future
Authors: Chaloner Eddie
Published: May 2014

Terrorist bomb attacks on the UK mainland are not a new phenomenon. However, since the IRA ceasefire, such incidents have been relatively few. Unlike IRA bombings, which generally targeted commercial property or military personnel and were often preceded by warning phone calls, the attacks in London and Madrid deliberately targeted civilians with no warning. The detonation of devices at multiple sites and in densely packed, enclosed areas was intended to maximize the number of fatalities and inflict severe injuries on survivors. Indiscriminate outrages such as those perpetrated in London on 7 July are unlikely to be ‘one offs’ and may be repeated in the near future.
Evaluation of MMC foundation year 2 pilot scheme: the trainees' experience
Authors: Limbert Caroline , Jones Hywel , Bannon Michael
Published: May 2014

Interviews conducted with trainees on the foundation year 2 pilot programme in the Oxford Deanery identified positive and negative aspects of the programme. Overall attitudes towards the programme were positive, but several areas were identified for improvement.
Second case report of a metachronous double primary gastric cancer
Authors: Ullah MZ , Patel H , Lauffer GL , Tanner A
Published: May 2014

A 72-year-old man was referred to the authors' hospital in December 1999 with a 2–3-month history of dyspepsia, abdominal bloating and loss of appetite. Upper gastrointestinal endoscopy with biopsy revealed a moderate active atrophic gastritis with widespread intestinal metaplasia. Gastric biopsies also showed the presence of Helicobacter pylori which was subsequently treated with standard triple therapy. His symptoms improved with H. pylori eradication treatment and a subsequent 6-month follow-up endoscopy with biopsy showed no evidence of residual gastritis or H. pylori infection.

He re-presented with similar symptoms 18 months later and a repeat upper gastrointestinal endoscopy showed a diffuse lesion in the gastric fundus. Histological biopsy showed features consistent with a highgrade diffuse non-Hodgkin's lymphoma of the stomach (Figure 1). There was no evidence of further H. pylori infection.

A subsequent staging whole body computed tomography scan and laparoscopy revealed no other lymphoid tissue involvement. Omental biopsies undertaken at laparoscopy showed focal infiltration by malignant non-Hodgkin's lymphoma. Immunohistochemistry showed the cells to be CD20 (a B-cell lymphoid marker) positive and CD3 (a T-cell lymphoid marker) negative, confirming the tumour to be a non-Hodgkin's lymphoma of B-cell type. Immunohistochemistry of bone marrow aspirates showed no evidence of infiltration.

He was treated with 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) chemotherapy in November 2001. A carbon-13-urea breath test in December 2001 was negative. Repeat gastroscopy 4 months after starting chemotherapy showed only erosive gastritis at the gastro-oesophageal junction with no histological evidence of residual lymphoma. Subsequently, the patient's body weight started to increase and his initial symptoms resolved.

A surveillance gastroscopy in October 2002 showed a new ulcerative lesion at the incisura of the stomach. Initially, this was thought to be a recurrence of the non-Hodgkin's lymphoma. However, subsequent histology of this lesion showed features of a gastric mucinous adenocarcinoma with signet ring features (Figure 2). He then underwent a subtotal gastrectomy and histological examination of the resected stomach confirmed the presence of a gastric adenocarcinoma with no residual non-Hodgkin's lymphoma. He made a good postoperative recovery and was further treated with chemoradiotherapy. Unfortunately the patient developed a recurrence of the adenocarcinoma in the gastric remnant 3 years later. He is currently alive and has declined any further treatment.
Spectrum of abnormal skin scars and their clinical management
Authors: Bayat A , McGrouther DA
Published: May 2014

Skin scars vary from a fine line which is the best outcome that surgery can achieve to a variety of abnormal scars. Scarring can cause physical, cosmetic and psychosocial consequences producing significant emotional and financial costs to the patient, physician and the health-care system. This article reviews the spectrum of abnormal scar types, and offers advice on assessment and treatment with current and potential future therapies.
Hereditary angioedema: causes, manifestations and treatment
Authors: J Longhurst Hilary , Bork Konrad
Published: May 2014

Hereditary angioedema is a rare abnormality of the immune system that in severe cases can cause death by asphyxiation. The correct diagnosis and management of hereditary angioedema is vital and, for acute attacks, C1-esterase inhibitor concentrate is the therapy of choice.
Multi-resistant Escherichia coli sepsis following transrectal ultrasound-guided prostate biopsy
Authors: Davidson Adee-Jonathan , Webb David R , Lawrentschuk Nathan , Jennens Ian D , Sutherland Michael
Published: May 2014

A 63-year-old man with a family history of prostate carcinoma underwent a transrectal ultrasoundguided biopsy of the prostate for investigation of a slowly raising prostate-specific antigen 5.0 ng/ml. The patient had recently returned from a 4-week holiday in India, where he experienced an episode of self-limiting diarrhoea. Before biopsy he was given prophylactic norfloxacin 400 mg orally twice daily, started 1 day before biopsy and continued for 1 day post biopsy with 240 mg intravenous (IV) gentamicin given during the procedure. Three days post procedure he was admitted to hospital with fevers and rigors. Gentamicin and ceftriaxone were commenced but he remained febrile. Forty-eight hours later urine culture grew a multi-resistant gram-negative rod, and the patient was started on IV imipenem. Final sensitivities reported Escherichia coli with resistance to amoxicillin, amoxicillin and clavulanic acid, norfloxacin, ciprofloxacin, gentamicin and ceftriaxone, and with sensitivity to meropenem and nitrofurantoin. The fever settled and the patient was discharged on oral nitrofurantoin for a further 2 weeks, making a complete recovery.
Radiofrequency coblation tonsillectomy
Authors: Grobler Alethea , Carney A Simon
Published: May 2014

Radiofrequency coblation is a new technology that is finding favour as a method for performing tonsillectomy. Its benefits include reduced pain and postoperative morbidity but there is controversy regarding possible increased postoperative haemorrhage rates.
Management of chemotherapy-induced nausea and vomiting
Authors: Zubairi H Ishtiaq
Published: May 2014

Chemotherapy-induced nausea and vomiting are symptoms that cause major concern to oncology patients. This article explores the types of nausea and vomiting in the context of chemotherapy, and discusses their pathogenesis and management.
Assessment and management of a patient with a renal transplant
Authors: Welberry Smith Matthew P , Baker Richard J
Published: May 2014

Renal transplant recipients admitted on the medical take can be challenging for the clinician. Immunosuppressant medications, reduced renal functional reserve, increased vascular risk, and propensity to uncommon infections and malignancies all contribute to make management more complex than in other patients. This article reviews salient points in the management of such patients by the non-specialist.
Legal aspects of administering the flu vaccine
Authors: Griffith Richard
Published: May 2014

Although effective, the influenza vaccine is not compulsory and it is essential that doctors only administer the injection in accordance with a patient's real and informed consent. This article discusses the requirements for the lawful administration of flu vaccine to both capable and incapable patients.
Diabetic ketoacidosis: principles of management
Authors: Sharma V , Hadebe N
Published: May 2014

Diabetic ketoacidosis has a mortality of up to 14% in the UK, which could be attributed to varied treatment policies and a lack of a general consensus statement on its management. This article provides comprehensive guidelines for management of adult patients in diabetic ketoacidosis.
New-onset diabetes after transplantation
Authors: Wheeler David C , Krentz Andrew J
Published: May 2014

New-onset diabetes after transplantation is a serious complication of organ transplantation that is becoming increasingly more common. New-onset diabetes after transplantation has implications for graft and patient survival. This article reviews the pathogenesis, diagnosis and management of new-onset diabetes after transplantation.
Practical management of common atrial arrhythmias 2: common atrial flutter
Authors: Fitzpatrick Adam P , Earley Mark , Petkar Sanjiv , Diab Ihab , Fox David , Williams Paul
Published: May 2014

This is the second in a series of four practical articles highlighting the important management steps for noncardiologists and non-cardiac electrophysiologists dealing with patients with atrial fibrillation and common atrial flutter. This article will deal with care pathways and management principles for common atrial flutter.
How aggressively should cholesterol targets be pursued?
Authors: Wierzbicki Anthony S
Published: May 2014

Statins are universally acknowledged as one of the great successes of cardiovascular therapy in the last 25 years yet remain controversial in the popular media. Like many drugs they are under-prescribed and under-dosed in clinical practice. The statin controversy shows no sign of ending but at least it has now begun to rage over whether ‘lower is better’ when a high-dose statin is compared with a lower dose in prospective studies and in which groups of patients.
Management of atrial arrhythmias 3 paroxysmal atrial fibrillation
Authors: Earley Mark , Fox David , Fitzpatrick Adam P , Petkar Sanjiv , Diab Ihab , Williams Paul
Published: May 2014

This is the third in a series of four practical articles highlighting the important management steps for noncardiologists and non-cardiac electrophysiologists dealing with patients with atrial fibrillation and common atrial flutter. This article will deal with care pathways and management principles for paroxysmal atrial fibrillation.
How hospital trainees prefer to learn
Authors: Roberts C Michael , Caan Woody , Young Jane , Weatherstone Robert
Published: May 2014

Formal postgraduate training curricula must be delivered effectively and efficiently. This survey identifies the learning situations trainees prefer and the elements that constitute a learning experience. Greater understanding of these factors may help tutors plan more effective teaching and learning opportunities.
Lemierre's syndrome in association with a cholesteatoma
Authors: Healy Brendan , Llewelyn Meirion , Cavalle Ferran , Bernard Mark
Published: May 2014

A 17-year-old man presented with headache, sore throat and dizziness. He had been feverish and suffering from rigors. He had suffered from recurrent ear infections for 2 years and 2 weeks before admission he had received a course of amoxicillin for an ear infection.

On examination he was flushed, pyrexial, tachycardic (130 bpm) and hypotensive (90/41 mmHg). The skin over the lateral border of his right sternocleidomastoid muscle was erythematous and tender. He had marked erythema of his throat and a macular blanching erythematous rash on his wrists, arms and knees. There was no neck stiffness or photophobia. Examination of the ears on admission did not detect any abnormality. Blood tests revealed neutrophilia, thrombocytopenia and a raised C-reactive protein level of 206.3 iu. Lumbar puncture was unremarkable. Monospot test was negative.

He was treated with intravenous benzylpenicillin 1.2 g four times per day and cefotaxime 2 g three times per day. Four days after admission two blood cultures grew a non-haemolytic streptococcus, later identified as Enterococcus avium. Antibiotics were changed to amoxicillin, gentamicin and metronidazole. An ultrasound scan of the neck showed lymphadenopathy along the right anterior lymphatic chain and a patent right internal jugular vein. Transthoracic echocardiogram was unremarkable.

The patient remained unwell. His pyrexia persisted, his haemoglobin dropped to 7.1 g/dl and his albumin to 23 g/litre. Computed tomography (CT) scan of the mastoids revealed fluid in the right middle ear, which continued into the mastoid antrum and was associated with sclerosis of the right mastoid air cells. A third blood culture grew gram-negative bacilli. Co-amoxiclav was started and the fever settled. Escherichia coli sensitive to amoxicillin was isolated.

A CT scan of the thorax showed small bilateral pulmonary nodules, some of which contained small cavities, suggesting pulmonary abscesses (Figure 1). An ultrasound scan of his neck was repeated on day thirteen of his admission and revealed thrombosis of the right internal jugular vein. This was confirmed with magnetic resonance imaging, which also demonstrated extension of the clot into the sigmoid and transverse sinuses (Figure 2). The patient was anticoagulated for 6 months.

In total, the patient received 2 weeks of intravenous amoxicillin, gentamicin and metronidazole and 6 weeks of co-amoxiclav and metronidazole. Review in ear, nose and throat outpatient clinic revealed a cholesteatoma that required excision. No other source of sepsis was identified despite extensive investigation.
Epidemiology of attention-deficit/ hyperactivity disorder in the community
Authors: Sayal Kapil
Published: May 2014

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting around 5% of schoolaged children. However, in the UK, the majority of children with ADHD remain undiagnosed. This article reviews the epidemiology of ADHD in terms of its prevalence, correlates, recognition and outcomes with regard to community and clinical samples.
Vasopressin-receptor antagonist therapy in patients with hyponatraemia
Authors: Vachharajani Tushar , Vachharajani Vidula
Published: May 2014

Hyponatraemia often complicates the treatment of underlying conditions in patients who are seriously ill. Arginine vasopressin receptor antagonists block the action of arginine vasopressin and correct sodium and water imbalance in patients with euvolaemic or hypervolaemic hyponatraemia.
Squamous cell carcinoma in the head and neck
Authors: Al-Reefy Hiba , Dhar Vikram , Dilkes Mr
Published: May 2014

Head and neck cancers are responsible for 10% of male cancers in the UK, and used to be six or seven times more common in men than women. Now these cancers are only about twice as common among men. This article reviews the presentation and management of these cancers.
Metastatic endophthalmitis
Authors: Hussain Badrul , Lynn William , Lightman Susan L
Published: May 2014

Endophthalmitis carries a poor visual prognosis for patients and can be a potentially blinding condition that may result in loss of the eye. Early diagnosis and prompt treatment are imperative to save the eye. Delay in diagnosis affects visual prognosis and therefore doctors should be aware of the presenting features of endophthalmitis. Urgent ophthalmic referral is advised as soon as a diagnosis is suspected.
Colonoscopic perforation
Authors: Tiwari Alok , Meleagros Luke
Published: May 2014

Perforation is an uncommon but important complication of colonoscopy. This review looks at the incidence, clinical features, diagnosis and treatment of this condition.
Squamous cell carcinoma arising in an epidermoid cyst
Authors: Jehle KS , Shakir AJ , Sayegh ME
Published: May 2014

A 48-year-old Caucasian male presented with an inflamed, discharging left buttock mass. An asymptomatic mass, present for 28 years, had increased in size following blunt trauma to the buttock 3 months earlier. On examination a 5×5×3 cm tender fluctuant mass was found in the left gluteal region with an enlarged left inguinal lymph node. An infected epidermoid cyst was diagnosed and incision and drainage performed. Biopsies revealed proliferating squamous epithelium of the cyst wall with areas of cytonuclear atypia, in keeping with invasive well-differentiated squamous cell carcinoma (Figure 1).

The patient was reviewed at 3 weeks, when an ulcerating lesion with overriding skin edges and enlarged left inguinal nodes were discovered (Figure 2). A wide local excision of the carcinoma and the left inguinal lymph node was performed. Histological examination showed the tumour infiltrating the subcutaneous tissue although the deep and lateral resection margins were clear. The lymph node had been replaced by necrotizing squamous cell carcinoma with prominent extra-nodal spread.

A computed tomography scan revealed no distant metastases but an irregularity in the left groin was consistent with an enlarged left inguinal lymph node. The patient was referred for radiotherapy but, despite an initial response, the wound continued to discharge pus. Antibiotics were commenced. A followup examination 4.5 months later revealed tumour deposits in the left groin and ill-defined opacities on chest X-ray, suggestive of pulmonary metastases. He was admitted to hospital 10 days later in an acute confusional state, suffering from hypercalcaemia and pneumonia and died 5 days later, only 5 months after his initial presentation.
Depression in patients with Parkinson's disease: identification and treatment
Authors: Jamieson DRS , Jamieson AE
Published: May 2014

Recognizing depression in Parkinson's disease can be problematic but since it has such a significant impact on the quality of life in these patients and is easily treatable the value of therapeutic intervention should not be underestimated.
Local anaesthesia and its safe use in minor surgery
Authors: Selvaraasan Elankathir , Maguire Simon , Bayat Ardeshir
Published: May 2014

Local anaesthetics are drugs that are used clinically to produce reversible inhibition of excitation and conduction in peripheral nerve fibres and produce loss of sensation in a circumscribed area of the body. Local anaesthetics have a common structure (Figure 1) with a lipophilic (aromatic) group joined to a hydrophilic (amine) group by an intermediate chain. This intermediate chain may be either an amide or ester link, hence the two major groups of local anaesthetics are esters and amides (Figure 2). The linkage is important because of the metabolism of that group which has, in the case of esters, led to adverse reactions and limited their use. Knowledge of the physicochemical prop-Local anaesthesia and its safe use in minor surgery erties of a local anaesthetic is important as they influence the pharmacodynamics of that drug.
Learning styles: a guide for the foundation year doctor
Authors: Trivedi Deepali , Hooke Rachel
Published: May 2014

Learning, especially in the field of medicine, is a never-ending process. You have to keep continuously updating and upgrading yourself almost for ever in life, in order to keep up with rapidly-progressing advances, hence the concept of ‘lifelong learning’.
Spontaneous oesophageal rupture
Authors: Pilling John , Goldstraw Peter
Published: May 2014

Oesophageal rupture is a serious and lifethreatening condition. It usually presents to non-specialist medical and surgical staff through the emergency department. The clinical features are non-specific and can be easily confused with more common conditions. However, once considered the diagnosis is easily made. Untreated, the condition is rapidly fatal and delay in diagnosis rapidly adds to problems of treatment, and is associated with escalating morbidity and mortality risk. This article will focus on the presentation, investigation and initial management of ‘spontaneous’ rupture of the oesophagus. The management options that are available in specialist centres will then be considered in brief.
Team working: a guide for the foundation year doctor
Authors: Trivedi Deepali , Mitra Aveek , Hooke Rachel
Published: May 2014

Team working sounds like a simple term, but it is more complex than a spider's web. The human, being the most civilised and developed social animal, is involved in goals that are more complex than just making a web and require more than one spider to work in it to reach the goal. The idea of team working is not like every spider making its own web, but all spiders working towards making one large web.
Electroencephalography for the general physician
Authors: Tan S Veronica , Koutroumanidis Michael
Published: May 2014

Junior doctors in general medicine are often asked to request electroencephalograms or electroencephalographs (EEGs) on patients in their care. For many, however, the indications for an EEG, the nature of the test itself, and how the results obtained should influence patient management are poorly understood. Clinical neurophysiology is not usually included in the undergraduate curriculum, and under current training arrangements formal education in EEG will not occur unless doctors choose to specialize in neurology or clinical neurophysiology.