bluuebunny/crossref_metadata_2025 huggingface dataset:
The evolving mental health landscape in Singapore
Authors: Ho Cyrus S. H. , Ho Roger C. M. , Mahendran Rathi
Published: July 2014

Singapore is a multi-ethnic Asian society with a unique sociocultural and economic background. This is an overview of the characteristics of psychiatry in this nation in terms of service provision, mental health funding, education and training, and the challenges it faces in the midst of an evolving mental health landscape. Over the past 5 years, Singapore has maintained a closer tie with the Royal College of Psychiatrists through the the College's Membership examination.
Bent π-Conjugated System Composed of Two Dibenzocyclooctatetraene Units: Multifunctional Properties of Dynamic Molecular Tweezers in Solution and the Solid State
Authors: Nishiuchi Tomohiko , Iyoda Masahiko
Published: July 2014

A series of bent π-conjugated compounds, 2a, 2b, 3a, and 3b, composed of two tub-shaped dibenzocyclooctatetraene (DBCOT) units with two cyano substituents on each cyclooctatetraene (COT) ring were designed and synthesized by using improved synthetic procedures. The anti- and syn-conformers of 2a, 2b and 3a, 3b, which coexist in equilibrium in solution, were independently observed by using 1H NMR spectroscopy at room temperature, and the signals of the anti- and syn-forms coalesced at 130 °C to give signals assigned to a D2h symmetric molecule. The ratio of the anti- and syn-isomers of these dynamic molecular tweezers (DMTs) were dependent on the position of the cyano substituents on the COT rings due to the difference in either torsional strain or dipole moments between the anti- and syn-isomers (2a, 2b: syn > anti; 3a, 3b: syn < anti). The dynamic guest incorporation ability of these DMTs in solution was investigated by using 1H NMR and UV–vis spectroscopic titration experiments and evaluated on the basis of the calculated affinity for a guest molecule. We found that 2a, 2b and 3a, 3b exhibited unique aggregation-induced emission in solution and crystalline-state emission induced by incorporated solvents in the crystal lattices of the DMTs. The emission wavelength and quantum yield of the aggregation-induced and crystalline-state emissions depended on their restricted flexibility and syn–anti ratio. Theoretical calculations confirmed that the dihedral angle between the central and terminal benzene rings had the largest effect on the emission wavelength in the crystalline state.
Patterning of Alkylamine Molecules on Highly Oriented Pyrolytic Graphite Surfaces via Deep UV Light Irradiation
Authors: Sato Yusuke , Kawaguchi Toshikazu
Published: July 2014

A method for the removal of alkylamine groups and patterning of alkylamine monolayer on carbon surfaces is proposed. Deep UV light irradiation (172 nm) was used to remove alkylamine monolayers from carbon surfaces. When a photomask was employed, patterned alkylamine monolayers were obtained. Labeling of COOH- and NH2-terminated alkylamine monolayers on carbon surfaces with redox probes and fluorescent dyes, respectively, via amide coupling clearly indicated that deep UV light patterning was successfully achieved.
Nutritional screening: a community dietitian's perspective
Authors: Merrick Susan
Published: July 2014

Malnutrition in the UK is well documented and highlighted by the British Association of Parenteral and Enteral Nutrition, who advocate the use of a screening tool to facilitate the identification and subsequent management of undernutrition. Nurses are ideally placed to support this process, but their role has many conflicting priorities. For nurses working in the community, there also exists the problem of identifying those who are at risk of undernutrition but remain unknown to nursing services. This article provides a review of malnutrition and nutrition screening and aims to promote a pragmatic approach to the identification and management of undernutrition in the community. The article concludes with a brief review of current opportunities for improving nutritional care in the community.
Popular ethical theories: their use and function in midwifery
Authors: Henry Christine , Kendrick Kevin
Published: July 2014

Current midwifery practice takes place in ever-changing political, social and cultural settings. In order for midwives to justify and validate their practice, a theoretical understanding of ethics is essential. Professional ethics involves reflecting upon practice, weighing alternatives and applying ethical theories within the clinical arena. This article examines some popular ethical theories and attempts to apply these to midwifery practice through exemplars and situational analysis.
Childbearing losses
Authors: Schott Judith , Henley Alix
Published: July 2014

In this article Judith Schott and Alix Henley discuss potential cultural and religious variations in belief and practice which may influence the needs of parents who experience a childbearing loss.
Breaking the chains
Authors: Crompton Judy
Published: July 2014

The articles in this supplement have been derived from papers presented at an innovative conference, ‘Breaking the Chains: Positive Care in Childbirth’, which took place in London on 21 September 1996. The ‘chains’ referred to are those which often bind women and their midwives, and midwives/doctors and each other, in a sense of disempowerment and alienation.
Positive care in childbirth
Authors: Page Lesley
Published: July 2014

Positive care in childbirth is more likely to be provided when there is a sensitive and supportive relationship between the woman and her carer, doctor or midwife. Instead of enabling that relationship, many maternity services, because of the organizational structure and systems of care, alienate women from midwives and doctors, and midwives from each other. They become a chain which prevents professionals from providing sensitive care and using their skills to the full.
Finding our voices
Authors: Buggins Elisabeth , Newburn Mary , Fletcher Gillian , Gready Meg , Dodds Rosemary , Draper Janet
Published: July 2014

This is the first of three articles looking at women's involvement in the planning and monitoring of the maternity services. This article focuses on the role of user representatives on maternity services liaison committees and the Voices training project.
Caesarean — by force
Authors: Robinson Jean
Published: July 2014

It was not long after the first court-ordered caesarean case was publicized that the anxious calls started coming in to the Association for Improvements in the Maternity Services (AIMS) helpline. Women in different parts of the country who were querying treatment of any kind by their obstetricians were being told firmly: ‘Well if you don't agree, we can go to court and get an order and do it by force — you won't have a choice.’ When they described the problems and circumstances to us, it was obvious that there was no immediate danger, and that there was a choice of treatment — or no need for treatment at all. The threat of court order was being used as yet another means of browbeating women into being ‘compliant’ patients. It was clear that the obstetric power game was now being played by different rules.
The advanced nurse practitioner in neonatal care: two views
Authors: Clark Margaret , Bibby Elizabeth
Published: July 2014

The clinical role of the advanced neonatal nurse practitioner (ANNP) within neonatal care is the subject of much debate. This article examines the role of one ANNP from the perspective of both the unit nursing manager and the ANNP herself. It offers practical guidance to any unit considering the implementation of an ANNP and draws on the personal experiences of the authors. (This supplement comes from City Hospital NHS Trust, Birmingham.)
Primary nursing as a system of care delivery within a neonatal unit
Authors: Lindsay Sadie , Clark Jenny
Published: July 2014

This article is the first of two articles on primary nursing as a system of care delivery within a neonatal unit. It presents a brief review of the literature on primary nursing and attempts to define primary nursing, explain its dimensions and describe its implementation on one neonatal unit.
Practice nurses and antenatal care
Authors: Steene Jill
Published: July 2014

In April 1996 the UKCC circulated a position statement stating the Council's position in respect of the involvement of practice nurses in antental care. Jill Steene examines some concerns.
Community-based breastfeeding initiatives in Somerset
Authors: Hill A , Harrison VM
Published: July 2014

A long series of breastfeeding surveys in Somerset has shown a slight but steady fall in the prevalence of breastfeeding. Hospital-based initiatives had increased the prevalence of initial breastfeeding which was not sustained after departure from the maternity unit. This article reports on some community-based support for breastfeeding mothers.
Potential and problems: the value of feminist approaches to research
Authors: Draper Janet
Published: July 2014

As a predominantly female profession caring for women and their families, midwives are arguably in an ideal position to execute feminist research. The term, however, is often poorly understood and shrouded with misconceptions. This article seeks to clarify understanding by exploring the meaning of feminist research, describing its distinguishing characteristics, and examining both the potential and the problems associated with this approach.
Postnatal social support: counting the cost
Authors: Morrell C Jane , Spiby Helen , Crowther Sue
Published: July 2014

This article describes work in progress, funded by the Department of Health's Health Technology Assessment programme. The study is in the recruitment and concurrent follow-up phase. The final follow-up will be complete in May 1998 and a full report will be available in the autumn of 1998.
Should midwives learn Karate?
Authors: Pacanowski Lynne
Published: July 2014

A few weeks ago, I was asked to deal with a particularly aggressive visitor who was unhappy with an aspect of his partner's care. The man was well built, hostile, and threatening to assault certain members of the staff. The same evening, as my 7-year-old son demonstrated some self-defence moves which he had been practising at his karate class, I wondered whether karate should become a compulsory part of the midwifery curriculum, so that if verbal communication skills fail, at least midwives would be able to defend themselves!
Midwifery education: Part 10 Northern Ireland
Authors: Pollock Eileen , Malone Rosaleen
Published: July 2014

Northern Ireland is composed of six counties, with a population of approximately 1.5 million people. In 1996, the number of live births was approximately 25000. It is serviced by four health and social services boards (Northern, Eastern, Southern and Western), containing some 18 trusts; the number of trusts in each board depending on whether it is a largely rural or urban setting.
Research and audit in midwifeiy: does the difference matter?
Authors: Hundley Vanora , Graham Wendy
Published: July 2014

There is increasing pressure on midwives to prove that their practice is research based and to audit the quality of care they provide. However, there appears to be some confusion about which activities are research and which are audit. This article aims to clarify the differences and to show that there are implications for practice.
You (and your baby) are what you eat
Authors: Hawkey Mary
Published: July 2014

While dietary advice in the main is more often than not susceptible to the whims of fashion, advice directed at pregnant women or women planning pregnancy is clear and unequivocal: eat a balanced diet. This year a leaflet issued by Tommy's Campaign, advised by the Royal College of Midwives, defines balance as: ‘...a variety of bread, cereals, fruit, vegetables, milk, dairy foods, meat, oily fish, eggs, pulses (peas, bean and lentils) and nuts.’ While at first glance such advice seems both eminently sensible and easy to follow, the larger picture is somewhat more complex. Issues surrounding food safety proliferate, and nutritional information is rapidly expanding. Furthermore, many pregnant women in Britain are unable to afford those ingredients that make for good nutrition.
Letters
Authors: Rampersad KN , Gbolade Babatunde A
Published: July 2014

I feel very saddened that some midwives feel they need to be able to perform a ventouse extraction to be recognized as ‘practitioners in their own right’.
Midwifery education: Part 7 The South Thames region
Authors: Collington Val
Published: July 2014

Between the late 1980s and early 1990s, the regional strategy for nursing and midwifery education led to the merger of several schools/colleges. These followed various staff changes and some reductions in student numbers. Following these amalgamations, with the resultant staff insecurities and redundancies, all colleges of nursing and midwifery integrated into higher education.
Mothers who need to grieve: the reality of mourning the loss of a baby
Authors: Jones Margaret
Published: July 2014

The grief mothers suffer through the death of a baby at any time after conception must be recognized. A miscarriage, stillborn baby or the death of a newborn baby is often not acknowledged by society as a real loss. The sense of loss and grief felt by mothers is increased by the physical changes occurring in her body, but she needs the support and understanding of family and/or friends to work through her grief. The different aspects of grief: disbelief, anger, guilt, use up the mother's emotional energy and can produce a sense of feeling lost, a lack of confidence and isolation from family and friends. Freedom to mourn is important. Women without physical reminders of their lost babies suffer more problems. The extent and quality of social support directly affects the recovery from grief. Midwives can help to lay a basis for a healthy response for grieving mothers by accepting the reality of their suffering, and acknowledging the mother's loss of a special precious child and her need to grieve.
Horses for course: developing services for women with special needs
Authors: Hepburn Mary
Published: July 2014

All women do not have the same health-care requirements and for those with particular characteristics or problems appropriate services should be developed to meet their needs. Women's views are essential in the development of such services.
A community obstetric service for women with special needs
Authors: Hepburn Mary , Elliott Lawrie
Published: July 2014

Since 1990, the Glasgow Women's Reproductive Health Service has provided a citywide service for women with social problems. This study examined consumer views to ensure it provided appropriate care and to inform future developments.
Sharing care: Competition and duplication or cost-effective collaboration
Authors: Leap Nicky
Published: July 2014

For many years, midwifery in the Netherlands has been a source of inspiration to midwives in the West. The Dutch maternity system has kept alive the concept of government-funded, independent midwifery, and has a clear delineation of autonomous professional roles: the midwife is the practitioner of ‘physiology’ and the obstetrician is the practitioner of ‘pathology’.
Antenatal HIV antibody testing: a survey of maternity units in the UK
Authors: Ruby Christine , Siney Catherine
Published: July 2014

Antenatal HIV antibody testing allows a woman who suspects that she may be seropositive to make informed decisions in relation to her pregnancy outcomes. The controversial nature of antenatal HIV antibody testing is recognized in the Department of Health (1994) Guidelines for Offering Voluntary Named HIV Antibody Testing to Women Receiving Antenatal Care. This research project assessed the extent and level of antenatal HIV antibody testing in the UK and the influence of the Department of Health guidelines on these programmes.
Supervision and Litigation
Authors: Davies Sarah , Symon Andrew
Published: July 2014

Andrew Symon's article on supervision and litigation (Vol. 5(2) 1997, p.70) made interesting reading. The article discussed, among others, the case of a junior midwife (qualified for less than 6 months) who failed to ensure that medical help was obtained in order to effect a forceps delivery for a woman in her care. The fetal heart rate had been 100-115 for about an hour before help arrived. Although Symon's main point is to emphasize the support that must be given to less experienced staff from their senior colleagues, and also the importance of accurate record keeping, I think that his article throws up some other important issues that need to be discussed further.
Drugged babies: drugged adults?
Authors: Robinson Jean
Published: July 2014

‘From ghoulies, and ghosties and long leggety beasties, and things that go bump in the night, good Lord deliver us’ — says the traditional Cornish prayer. This is the time of year when we snuggle up to the fire and tell each other ghost stories. Here we are, safe and warm, getting a pleasant shiver because we know the horrors don't exist, and can't harm us. I re-read my favourite spooky story — Marghanita Laski's ‘The Victorian Chaise Longue’. But just to give a seasonal thrill to our readers, I am going to tell not a ghost story, but a horror story that just might be true …
Stress: the art of keeping your cool when all around are losing theirs
Authors: Hawkey Mary
Published: July 2014

Although health service professionals have in the main always been thought of as cool, calm and collected, it is an image that has recently been found to be far from accurate. The results of a survey by Wall et al (1997) state, ‘Compared to a level of 17.8% in the general population, 28.5% of nurses and 27.8% of doctors had a minor psychiatric disorder, such as anxiety.’ This is hardly surprising, when — according to recent press reports — nurses and doctors are now at more risk from attacks from members of the general public than either the police or security personnel. Although midwives are the exception in that they are rarely subjected to a similar level of violence or verbal abuse, they often find themselves caring for clients who have suffered in this way. A November (1997) ‘Position Paper’ from the Royal College of Midwives asserts, ‘Conclusive evidence has shown that pregnancy, far from being a time of peace and safety, may trigger or exacerbate male violence in the home.’ On top of the inherent stress of being a midwife, the additional stress generated by traumatized patients can, if allowed to go untreated, lead to inefficiency, exhaustion and even illness.
A trial of cetrimide/chlorhexidine or tap water for perineal cleaning
Authors: Keane HE , Thornton JG
Published: July 2014

A trial was performed to test the hypothesis that the use of cetrimide/chlorhexidine for perineal toilet In labour would reduce maternal and fetal Infections. 3905 mothers were ‘randomly’ allocated by alternate months to have either cetrimide/chlorhexidine solution (n=1813) or tap water (n=2092) used as a perineal cleaning solution prior to vaginal manipulations in labour. Results are presented as the odds ratio and 95% confidence intervals, for adverse outcomes in the cetrimide/chlorhexidine months. Neither measures of maternal morbidity, temp >38°C; OR 1.2 (95% CI 0.8-1.9), use of antibiotics; 1.02 (0.86-1.2), perineal infection; 1.4 (0.77-2.7), perineal breakdown; 5.8 (0.3-999), Caesarean wound infection; 1.3 (0.8-2.0), nor fetal morbidity, temp >38°C; 1.4 (0.66-3.0), use of antibiotics; 0.99 (0.82-1.2), eye infection; 1.1 (0.78-1.7), or cord infection; 1.3 (0,7-2.1), differed significantly between the groups. We conclude that tapwater is a satifactory solution for cleaning the perineum in labour.
Referral of labouring women from community to consultant unit
Authors: Smith Lindsay FP
Published: July 2014

The incidence of transfers to consultant care is likely to increase and have clinical and finalcial costs. Historically, transfer decisions have been ascribed to GPs. This work investigated who was involved in 240 labour transfers from community units to the central Bath unit. Professionals agreed that community unit midwives were involved in 87.5% of transfer decisions, GPs in 74.9%, Women in 33.3% and their companions in only 3%. Professionals disagrees about the involvement of consultant unit staff (p<0.001). Labour transfer decisions are not made by GPs alone and their removal from intrapartum care may affect future decisions. Communication and involvement with transfer decisions merits further research and audit.
Evaluation of midwifery services a personal reflection
Authors: Ness Mary
Published: July 2014

This article originates from a DoH funded survey of midwifery services based on three sites in England in 1994-1996 conducted by the NPEU. The author, the project researcher, outlines her personal concerns that Increased choice and Individualized care for pregnant women, advocated by the Expert Medical Committee, were not feasible, given the existing financial and political situation In the NHS. There was also a dearth of reliable data on which to plan and monitor change. Furthermore, pursuit of the principle of a woman knowing the midwife present at her child's birth may lead to fragmented antenatal and postnatal care, compromised safety and an unsustainable service.
Communication: create barriers or develop therapeutic relationships?
Authors: Ralston Ronana
Published: July 2014

Communication is essential wherever there are people living and working together. It is even more important when people are faced with change and uncertainty, frightening or anxiety-provoking situations and illness. Midwives continually face these difficult situations as they work with their clients (women), colleagues and other health professionals. Communication can either facilitate the development of a therapeutic relationship or create barriers (Stuart and Sundeen, 1991). Relationships are built on communication and this must involve sensitivity from the midwife to ensure good maternity care (Cartwright, 1987), and therefore midwives should have sound knowledge and understanding of its process.
Midwifery in the Gambia
Authors: Holliday Mary
Published: July 2014

The Gambia is a developing country with a rapidly rising population and limited economic potential. Despite lack of equipment and resources, the government is determined to provide a comprehensive health and education service. This article examines the approach to midwifery education and practice in a developing country. In particular, it outlines the structure of midwifery care and the issues faced by the practitioner in the field in the effort to reduce maternal and infant mortality and morbidity. Practical guidelines are suggested for western midwives considering practicing in a developing country and the challenges they may face compared to modern European practice.
Caring for women in poverty: a critical review
Authors: Salmon Debra , Powell Julie
Published: July 2014

This paper argues that midwives should have a more detailed knowledge of the complex ways in which women living in poverty make ends meet. This is because without understanding this struggle midwives can give inappropriate advice that may leave women feeling inadequate and alienated from midwifery care.
Letters
Authors: Rickitt Cynthia
Published: July 2014

I applaud the content of Christine Henderson's editorial, Beliefs, breastfeeding and brouhaha, (Vol 5, No 8, 1997 p,452). Put breastfeeding on to the agenda of any conference/seminar/meeting and the usual response is either ‘not breastfeeding again’ or ‘well, my views/feelings/problems are...’ I have spoken in many venues, usually to people who are interested enough to forfeit a day's holiday and/or have to pay for the study day, and the response I have quoted is endemic.
Aspects of care 4: views of professionals and mothers
Authors: Pope Rosemary , Cooney Margaret , Graham Lesley , Holliday Mary , Patel Swatee
Published: July 2014

This is the fourth in a series of six papers presenting key findings from a national study that was undertaken to investigate the role and responsibilities of midwives and to identify continuing educational need. The background to the study and the titles of the other papers in the series have been outlined in the first paper. This paper focuses on midwives', supervisors', doctors' and mothers' views regarding quality of care Issues, with particular emphasis on what makes a ‘good’ midwife.
Was it ‘informed’? Was it ‘consent’? Lessons from the ECMO trial
Authors: Robinson Jean
Published: July 2014

No-one was doing anything unethical. In fact, everyone bent over backwards to get it right. Researchers and consumer groups knew that it was going to be difficult for anxious parents to take in information about a clinical trial. The babies involved were critically ill with respiratory failure, and there would be little time to think a bout the decision. Consumer groups were consulted about the ethics of the trial and they helped to create a leaflet which we all hoped parents would understand.
Hospital Postnatal Care
Authors: Marchant Sally , Garcia Jo , Alexander Jo , Kirkham Mavis , Bick Debra , MacArthur Christine , Fortune Helena , Winter Heather
Published: July 2014

We welcome the opportunity Denis Walsh's editorial offers to discuss and debated the neglected areas of postnatal health, but we feel the direction of his argument is misleading.
Bournemouth: bright and beautiful
Authors: Lewis Paul
Published: July 2014

Celebrating 50 years of NHS midwifery, the Royal College of Midwives held its 116th Annual Conference at the Bournemouth International Centre on the sunny south coast. Unlike the turbulent and stormy waters of last year's conference in Harrogate, the Council managed to steer a more steady course. In fact, under the skillful and often humourous directions of Jane Todd, the Chairman of the Council, the 700 delegates were made to feel at ease and a spirit of enthusiasm and encouragement appeared to be the order of the day.
Letters
Authors: Leach Joanne , Fern Elizabeth , Pritty Liz , Dale M
Published: July 2014

The Standing Nursing and Midwifery Advisory Committee, which advises Health Ministers in England and Wales on the provision of Nursing and Midwifery Services, produced Midwifery: Delivering Our Future (Department of Health, 1998).
Clinical credibility in midwifery education
Authors: Hunt Sheila C
Published: July 2014

In March 1994, the UKCC in its document, The Future of Professional Practice, set out its standards for teachers of nursing, midwifery and health visiting; they said that teachers must be graduates, possess an appropriate teaching qualification and must possess and maintain: ‘relevant and up-to-dare clinical experience and relevant and up-to-date research based clinical expertise.’ These then are the requirements, midwifery educationalists must be clinically credible. But how can this be achieved within the constraints and demands of Higher Education? Involvement in clinical practice has to be planned, organized and managed. It also has to be realistic, achievable, practical, credible, fair and sustainable.
A strategy for raising research awareness among midwives
Authors: Milne Joan , Hundley Vanora
Published: July 2014

There is increasing pressure on health care professionals to ensure that clinical practice is based on sound research evidence. Midwives and nurses face a number of obstacles in trying to achieve this. In this paper we describe a strategy which has been developed to try to increase research awareness and overcome some of the obstacles associated with both using and doing research. The strategy focuses on four main areas: education and training; access to facilities; changing the climate/culture and practice; and policy and documentation.
Offering the BCG vaccine to all neonates in the prevention of TB
Authors: Lloyd Jo
Published: July 2014

The previous article (Br J Midwifery 8(5): 327-29) examined some of the current issues surrounding tuberculosis (TB). With many neonates now being offered the BCG vaccine, this article will examine research which can influence the decision of whether or not to vaccinate. The conclusions drawn from this article and the previous article should enable the wellbeing and interests of neonates to be promoted as a result of research-based practice.
Maternal nutrition and life expectancy
Authors: Coutts Alison
Published: July 2014

Conventional wisdom stated that, during pregnancy, small deficiencies in the diet, such as is common in the UK, may adversely affect the mother, but that the fetus will thrive. This position is no longer tenable.
The abused perineum
Authors: Steen Mary
Published: July 2014

Following the rapid escalation in the number of midwives performing routine episiotomies in the 1970s, it is now clearly evident that, internationally, the episiotomy rates have decreased dramatically during the last two decades. There has been a noticeable increase in spontaneous tears, however, and perhaps not surprisingly, more intact perinea have been reported (Graham, 1997; East and Webster, 1995).
Women's priorities for care before and after delivery
Authors: Rennie Anne-Marie , Hundley Vanora , Gurney Elaine , Graham Wendy
Published: July 2014

The provision of maternity services in the UK is increasingly consumer-driven. This paper reports the findings of a pilot study to identify factors which are important to women in childbirth and whether these factors differ in the postnatal period when compared with those ascertained antenatally. It was a comparative survey using a self-complete questionnaire given to women at two time intervals, 34 weeks gestation and 10 days postpartum. Two hundred and nineteen women who attended the antenatal clinic at 34 weeks gestation were approached and 217 agreed to participate in the study, of which 136 were expecting their first baby and 81 were expecting their second baby. The results showed that women change their minds regarding their priorities for care when asked antenatally compared with postnatally. Therefore, maternity services should be sensitive to these changing needs and be able to respond with relative ease to the changing demands and expectations of the childbearing woman and her family.
Involvement in litigation: emotional responses
Authors: Symon Andrew
Published: July 2014

Emotional responses to poor outcomes and subsequent litigation vary widely, but no practitioner involved in such a case will be unaffected. The lack of available data concerning the scale of poor outcomes or litigation means this problem is impossible to quantify. Risk management programmes offer an opportunity for staff counselling/debriefing.
Deciding when to stop treatment: interpersonal conflicts
Authors: McHaffie Hazel E , Fowlie Peter W
Published: July 2014

This article is the second in a two-part series. The first article reviewed the issues involved in withdrawing treatment (Br J Midwifery 6(6): 384–388). When decisions are being made about whether or not treatment is in a baby's best interests, some tension is inevitable. But staff currently working in neonatology have identified areas of potential stress which might be preventable or reducible. This paper discusses both the sources of tension and suggested ways forward.
A survey of short- and long-term pre-lubricated intermittent catheters
Authors: Rew Maggie , Lake Helen
Published: July 2014

The prospect of having to undertake clean intermittent self-catheterisation (CISC) for a short time, or for the rest of a patient's life, can be very daunting. It has an impact on their social, sexual, work and family life. Despite the challenges of the practical performance of the procedure, CISC has many advantages and is a means of reducing the subsequent problems and cost implications associated with long-term indwelling catheter use. There are many different products available on prescription for patients performing CISC and it can be a challenge to choose the right one. This article discusses the impact CISC has on the individual and focuses on a regional survey conducted in a district in the UK of nearly 100 patients who agreed to complete a confidential questionnaire about their experiences using a pre-lubricated CISC catheter (Actreen®). It also discusses the challenges facing nurses with patients practising CISC and offers advice to help patients come to terms with this procedure and its effect on their daily life.
Treatment of ketamine-associated cystitis with chondroitin sulphate
Authors: Smart Clare , Kabir Mohammed , Pati Jhumur
Published: July 2014

Chronic cystitis associated with ketamine use is a growing problem among a young patient population who use the drug recreationally. Patients may present with symptoms such as urinary frequency, dysuria, urgency and haematuria in accident and emergency departments, GP surgeries, urology outpatient departments, drug rehabilitation or substance misuse units, genitourinary medicine clinics or continence services. Nurses in these areas therefore need to be aware of the symptoms associated with ketamine-associated bladder damage and be prepared to ask patients about recreational drug use and inform them of possible treatments. This case report illustrates one patient's successful response to treatment with chondroitin sulphate 0.2% (Gepan) over a 1-year period.
Ketamine is toxic to chondrocyte cell cultures
Authors: Ozturk A. M. , Ergun M. A. , Demir T. , Gungor I. , Yilmaz A. , Kaya K.
Published: July 2014

Ketamine has been used in combination with a variety of other agents for intra-articular analgesia, with promising results. However, although it has been shown to be toxic to various types of cell, there is no available information on the effects of ketamine on chondrocytes.

We conducted a prospective randomised controlled study to evaluate the effects of ketamine on cultured chondrocytes isolated from rat articular cartilage. The cultured cells were treated with 0.125 mM, 0.250 mM, 0.5 mM, 1 mM and 2 mM of ketamine respectively for 6 h, 24 hours and 48 hours, and compared with controls. Changes of apoptosis were evaluated using fluorescence microscopy with a 490 nm excitation wavelength. Apoptosis and eventual necrosis were seen at each concentration. The percentage viability of the cells was inversely proportional to both the duration and dose of treatment (p = 0.002 and p = 0.009). Doses of 0.5 mM, 1 mM and 2mM were absolutely toxic.

We concluded that in the absence of solid data to support the efficacy of intra-articular ketamine for the control of pain, and the toxic effects of ketamine on cultured chondrocytes shown by this study, intra-articular ketamine, either alone or in combination with other agents, should not be used to control pain.

Cite this article: Bone Joint J 2014; 96-B:989–94.
A review of outcomes of the surgical management of femoroacetabular impingement
Authors: MacFarlane RJ , Konan S , El-Huseinny M , Haddad FS
Published: July 2014

Introduction

Femoroacetabular impingement (FAI) resulting from abnormal contact between the acetabulum and femur has been studied extensively in recent years owing to its association with acetabular labrum tears and possible contribution to the development of osteoarthritis.

Methods

A comprehensive PubMed, MEDLINE® and Embase™ literature search was conducted. Search terms included ‘femoroacetabular impingement’, ‘pathophysiology’, ‘diagnosis’, ‘dGEMRIC’, ‘arthroscopic’, ‘open’, ‘mini-open’ and ‘outcome measure’.

Results

A range of radiographic features have been described, and computed tomography and magnetic resonance imaging are both commonly used in the diagnosis of the bony abnormalities in FAI. Treatment of FAI is surgical with methods of treatment ranging from open surgical hip dislocation to arthroscopic osteochondroplasty.

Conclusions

In recent years, a trend towards the use of arthroscopic treatment for FAI has been seen, with promising results from a range of studies. However, only short-term outcome data are available and a range of different outcome measures have been used in studies to date. We present an overview of the outcomes for a range of surgical treatment methods for FAI and discuss the outcome measures used.
Mediastinal lymphangioma in an adult
Authors: Fokkema JPI , Paul MA , Vrouenraets BC
Published: July 2014

Lymphangiomas are rare benign neoplasms derived from portions of lymph sacs. They most often occur in children in the cervical region and 90% have manifested by the end of the second year of life. An isolated mediastinal lymphangioma in an adult is an uncommon disease entity. We report the case of a mediastinal lymphangioma in a 29-year-old man presenting as a suprasternal lump, which was resected through a partial sternotomy/hemiclamshell thoracotomy.
The role of surgery in a case of diffuse mucormycosis with haematemesis and gastric necrosis
Authors: Bini R , Addeo A , Maganuco L , Fontana D , Viora T , Leli R
Published: July 2014

Mucormycosis is a life threatening condition caused by invasion of fungi of the order Mucorales. Gastrointestinal invasion is very rare and often lethal, particularly in disseminated mucormycosis. We present the case of a 26-year-old woman from North Africa with type 2 diabetes who, after a cholecystectomy, developed unexplained septic shock and haematemesis due to gastric necrosis. Computed tomography (CT) revealed a disseminated fungal invasion of the lungs, kidney and paranasal sinuses. A gastrectomy and subsequent amphotericin B treatment resolved her condition. The number of patients with mucormycosis is increasing. Early diagnosis of high risk patients with CT and biopsies from which fungi are directly isolated must be followed by surgery and systemic amphotericin B infusion.
Unintended consequences of policy change to watchful waiting for asymptomatic inguinal hernias
Authors: Hwang MJ , Bhangu A , Webster CE , Bowley DM , Gannon MX , Karandikar SS
Published: July 2014

Introduction

In 2009 the Department of Health instructed McKinsey & Company to provide advice on how commissioners might achieve world class National Health Service productivity. Asymptomatic inguinal hernia repair was identified as a potentially cosmetic procedure, with limited clinical benefit. The Birmingham and Solihull primary care trust cluster introduced a policy of watchful waiting for asymptomatic inguinal hernia, which was implemented across the health economy in December 2010. This retrospective cohort study aimed to examine the effect of a change in clinical commissioning policy concerning elective surgical repair of asymptomatic inguinal hernias.

Methods

A total of 1,032 patients undergoing inguinal hernia repair in the 16 months after the policy change were compared with 978 patients in the 16 months before. The main outcome measure was relative proportion of emergency repair in groups before and after the policy change. Multivariate binary logistic regression was used to adjust the main outcome for age, sex and hernia type.

Results

The period after the policy change was associated with 59% higher odds of emergency repair (3.6% vs 5.5%, adjusted odds ratio [OR]: 1.59, 95% confidence interval [CI]: 1.03–2.47). In turn, emergency repair was associated with higher odds of adverse events (4.7% vs 18.5%, adjusted OR: 3.68, 95% CI: 2.04–6.63) and mortality (0.1% vs 5.4%, p<0.001, Fisher’s exact test).

Conclusions

Introduction of a watchful waiting policy for asymptomatic inguinal hernias was associated with a significant increase in need for emergency repair, which was in turn associated with an increased risk of adverse events. Current policies may be placing patients at risk.
Is it the beginning of the end for specialist lists?
Authors: Leahy Patrick
Published: July 2014

The GDC is reviewing the future of specialists lists...again. Its reasons include placing more emphasis on protecting patients, meeting national oral health needs and generally trying to be an ‘effective’ and ‘modern’ regulator. With such broad aims, we ask how singling out specialist lists can hope to meet these expectations.
Estado de saúde, stress e desempenho académico numa amostra de estudantes do ensino superior
Authors: Amaral Ana Paula , Silva Carlos Fernandes da
Published: July 2014

Ao longo do presente trabalho procurámos estudar o impacto do estado de saúde (física e psíquica) do estudante no desempenho académico, assim como, as repercussões nesse mesmo desempenho de uma actividade profissional paralela. A amostra foi constituída por 195 estudantes, no primeiro momento, tendo ficado reduzida a 177 no segundo momento de avaliação. Os principais resultados e conclusões sugerem que: 1) Os trabalhadores estudantes têm um desempenho académico inferior; 2) De todos os factores estudados, apenas a idade se pode considerar como variável preditora do desempenho académico; 3) Os indivíduos que recorrem ao médico têm um desempenho académico inferior; 4) Não existem diferenças estatisticamente significativas entre as médias do desempenho académico dos indivíduos com, e sem, doença crónica e daqueles que apresentam, ou não, perturbação emocional; 5) Não existem diferenças estatisticamente significativas entre o princípio e o final do ano lectivo, quanto à sintomatologia física e psíquica avaliada.
A formação contínua de educadores e professores do 1º Ciclo em Tecnologias da Informação e Comunicação: Bases para um modelo conceptual de formação
Authors: Rego Belmiro , Gomes Cristina Azevedo , Silva Maria João
Published: July 2014

A importância da formação de professores em TIC é reconhecida como factor crítico para a integração das TIC no contexto educativo. Este artigo apresenta algumas linhas de reflexão sobre os desafios da formação, fundamentando-se em modelos de referência internacionais e na experiência dos vários programas/medidas desenvolvidos em Portugal nas últimas décadas, desde o Projecto Minerva ao ainda recente Plano Tecnológico da Educação. As linhas de orientação que aqui se apresentam, para o desenvolvimento de um modelo de formação, convocam o quadro de referência internacional e nacional discutido e defendem uma abordagem que enfatiza as teorias construtivistas de aprendizagem, a importância dos contextos significativos para os alunos e professores, as actividades colaborativas, a avaliação formativa e qualitativa e a importância da investigação.
Nuevos escenarios y metodologías didácticas en los entornos virtuales de enseñanza-aprendizaje.
Authors: Salinas Jesús
Published: July 2014

Os processos de ensino-aprendizagem apresentam-se como campos privilegiados de exploração das possibilidades comunicativas das redes informáticas, afectando e modificando alguns dos elementos desse processo. O estudo e investigação relativa a esses elementos constituem um dos pontos necessários na agenda pedagógica: a introdução das tecnologias da informação e da comunicação como um processo de inovação educativa evitando discursos pouco fundamentados, a atenção aos novos cenários de aprendizagem que se vão configurando, e a concepção de novas metodologias mais centradas nos alunos, são alguns deles.
Gilt leather/guadameci in Coimbra – comments on documents of the 12th and 16th centuries
Authors: Pereira Franklin
Published: July 2014

Amidst different footwear, the taxes of Coimbra, dated from 1145, refer boots made in gilt leather/“gudemiciz”; it seems this is the first reference to gilt leather in the kingdom of Portugal, and in particular in a city recently conquered from the Muslims. In late 16th century, several documents of Coimbra University refer wall hangings, a table cover and large door frames made by a maker of gilt leather. These historic data take us into a journey of mudejar and medieval fashions where gilt leather was a part.
Cordia verbenacea DC e Mikania sp.: INTERFERÊNCIA NO ENSAIO DE CONTROLE DA QUALIDADE MICROBIOLÓGICO
Authors: Pereira Catarina Bernardes , Fonseca Suelen de Castro , Gomes Lorena Ferreira , Tironi Felipe Lipparelli , Neto Júnior Nilton L. , Fagg Christopher William , Simeoni Luiz Alberto , Magalhães Pérola Oliveira , Silveira Dâmaris , Fonseca-Bazzo Yris Maria
Published: July 2014

Este estudo visa avaliar a contaminação microbiana de Mikania sp. (droga vegetal, tintura e xarope) e Cordia verbenacea (droga vegetal, tintura e pomada). Além disso, foi investigada a possível interferência ocasionada pelos metabólitos secundários presentes nos dois derivados vegetais. A contaminação microbiana foi determinada seguindo o método de semeadura em profundidade. O estudo da interferência no método de avaliação da qualidade microbiológica foi realizado por determinação da recuperação de microrganismos viáveis, utilizando as cepas Escherichia coli (ATCC 25922) e Candida albicans (ATCC 90028). Na avaliação da qualidade microbiológica, as folhas secas oriundas de C. verbenacea e Mikania sp. apresentaram 4,5 x 104 UFC/g e 2,08 x 104 UFC/g de bactérias, respectivamente. Em relação à tintura de C. verbenacea, foi encontrada a contagem de 3,3 x 103 UFC/mL para bolores e leveduras e 2,2 x 103 UFC/mL para bactérias. Para a pomada contendo a tintura de C. verbenacea foram encontradas 1,1 x 103 UFC/g de bactérias, e não houve crescimento de fungos. No xarope não foi observado crescimento de bactérias, bolores e leveduras em nenhuma das repetições realizadas. Quanto à atividade antimicrobiana, os produtos derivados das duas espécies mostraram inibir o crescimento das cepas de E. coli e C. albicans. Assim, a presença de metabólitos secundários com atividade antimicrobiana em C. verbenacea e Mikania sp. parece interferir na avaliação da qualidade microbiológica de produtos derivados da droga vegetal.
ANÁLISE DE INFORMAÇÕES TÉCNICO-CIENTÍFICAS EM BULAS DE MEDICAMENTOS ANTICONVULSIVANTES UTILIZADOS NA GRAVIDEZ
Authors: Santos Junior Aníbal de Freitas , Tannus Caroline de Aragão , Alcantara Junior Jose dos Prazeres , Junior Edimar Caetite
Published: July 2014

O objetivo deste trabalho foi analisar as informações técnico-científicas contidas nas bulas de medicamentos anticonvulsivantes, quanto a possíveis riscos e alterações farmacológicas durante a gravidez. Foram analisadas informações, sobre os processos farmacológicos e possíveis riscos de quatro fármacos (ácido valpróico, carbamazepina, diazepam e fenitoína) usados como anticonvulsivantes, confrontando os dados obtidos nas bulas de medicamentos com as informações científicas difundidas na literatura pesquisada e na legislação de bulas vigente. A coleta de dados foi efetuada com a investigação das seções Informações ao Paciente e Informações aos Profissionais de Saúde das bulas obtidas em dicionários de especialidades farmacêuticas (DEF), em sites oficiais dos próprios fabricantes ou de instituições que exercem atividades na área da saúde. Das bulas analisadas, 100% apresentaram ausência do item alterações na farmacocinética das drogas antiepilépticas durante a gravidez; regulação das doses para gestantes e classificação da droga quanto à categoria de risco para mulheres grávidas. No item, advertências e riscos na gravidez e lactação, 40% das bulas analisadas foram consideradas incompletas por não apresentarem os possíveis riscos teratogênicos ao feto. Os riscos da automedicação e interrupção do tratamento estavam ausentes em cerca de 33% das bulas analisadas e, cerca de 40% destas, apresentavam informações sobre interações medicamentosas com contraceptivos. Portanto, as informações presentes nas seções Informações ao Paciente e Informações ao Profissional da Saúde (ou Informações Técnicas), em sua maioria, foram insatisfatórias como material informativo para as gestantes, segundo os critérios considerados.