bluuebunny/crossref_metadata_2025 huggingface dataset:
Return to work services rendered for patients at stroke rehabilitation facilities in Gauteng Province, South Africa
Authors: Ntsiea Mokgobadibe Veronica , Van Aswegen Helena , Lord Sue , Olorunju Steve
Published: May 2014

Background:

Stroke survivors have lower quality of life than their apparently healthy counterparts and returning to work may contribute to their life satisfaction. The potential for people to return to work following stroke may be enhanced by targeted programmes or directed input, however little is known about the availability of such programmes in South Africa. The aim of this study was to establish current practice in return to work (RTW) intervention programmes for patients with stroke.

Method:

A cross sectional survey was performed using a self administered questionnaire which was posted with an information document to 53 stroke rehabilitation facilities within the Gauteng province in South Africa and 36 facilities responded.

Results:

Seventeen of the 36 clinical settings referred patients to facilities offering RTW services; 12 facilities did not refer patients for RTW and did not offer RTW services and seven facilities offered RTW services. Of the seven facilities that rendered post stroke RTW services five communicated with the employer to discuss reasonable accommodation and four did assessments for potential to return to work. The most common reason given by the 29 facilities for not offering RTW services was that they referred patients to other therapists who offered these services. The second most common reason was the unemployment status of the patient at the time of having stroke.

Conclusion:

A small number of clinical facilities in the Gauteng province of South Africa assess their patients in order to establish potential for return to work after stroke and a small number of clinical facilities render RTW intervention for patients with stroke.
How does cognitive ability affect stroke rehabilitation outcomes?
Authors: Gurr Birgit , Ibbitson Joseph
Published: May 2014

Background:

This paper discusses literature findings on the impact of pre-stroke degenerative cognitive impairments (pre-stroke dementia) on post-stroke rehabilitation outcomes. This association has practical implications for stroke rehabilitation services which are faced with the dilemma that pre-stroke cognitive impairment may be a cause of stroke and, on the other hand, stroke may cause cognitive deficits.

Content:

The link between pre-stroke dementia and stroke is described by explaining how vascular and neurodegenerative pathology contribute to stroke occurrence and to stroke related impairment. Stroke seems to be more closely related to dementia than previously thought and vascular factors appear to be at the core of a wide range of dementing disorders. The literature reviewed emphasises how cognitive performance at stroke onset can give indications about the anticipated level of post-stroke functional independence.

Conclusion:

The importance of assessing and monitoring cognitive performance of stroke survivors using reliable neuropsychological procedures is emphasised. The assessment results help to estimate rehabilitation potential, to plan the most effective interventions and to optimise post-hospital discharge arrangements. This helps clinicians on stroke units to make rehabilitation decisions addressing both cognitive variables and professional standards.
Breast health education
Authors: Graham Helen
Published: May 2014

Breast awareness has replaced self-examination but confusion remains
Respiratory tract infections
Authors: Little Paul
Published: May 2014

Paul Little examines the treatment of respiratory tract infections and looks at how to use antibiotics appropriately
The telemedicine revolution
Authors: Wild Sarah
Published: May 2014

Telemedicine can boost healing rates in wound care.
Cryotherapy in general practice
Authors: Stollery Nigel
Published: May 2014

Removal of lesions with cryotherapy is effective and simple to do
Hand, foot and mouth
Authors: Stollery Nigel A
Published: May 2014

The common viral illness hand, foot and mouth disease often affects young children
Surviving advanced nurse practitioner training
Authors: Barlow Lynne
Published: May 2014

Becoming a nurse practitioner takes time and dedication. Lynne Barlow provides straightforward advice for nurses who want to take on this role
Gastroenteritis
Authors: Sprague Debra
Published: May 2014

Continuing our series on common conditions in primary care, Debra Sprague examines gastroenteritis, looking at possible causes, treatment options, differential diagnoses and rehydration therapy
Managing scalp psoriasis
Authors: Bewley Anthony
Published: May 2014

Scalp psoriasis causes patients much distress, but with careful treatment they can obtain clearance, writes Dr Anthony Bewley
Pharmacotherapy for obesity
Authors: Morris David
Published: May 2014

Prescribers now have three options for treating patients who have failed to lose weight despite lifestyle changes, writes Dr David Morris
Improving diabetes care across a PCT
Authors: Davis Carol
Published: May 2014

A diabetes consultant nurse is leading the drive to deliver equality of care to 300,000 patients
Improving access to psychological therapies
Authors: Wild Sarah
Published: May 2014

A national initiative is prescribing more talking and less medication for people with common mental health problems
Delivering best practice in urinary incontinence
Authors: Townsend Joanne
Published: May 2014

Women's health - Effective treatment for urinary incontinence can be provided in primary care, writes Joanne Townsend.
Developing a one-stop shop for long-term conditions
Authors: Aston Jenny
Published: May 2014

Taking a more holistic approach streamlines the annual review process, writes Jenny Aston.
Battling fraud in primary care
Authors: Hill Barry
Published: May 2014

Each year the NHS loses millions of pounds as a result of fraudulent activity and the primary care environment is not immune to this.
Taking action when things go wrong
Authors: Holden John
Published: May 2014

The new NHS complaints procedure places emphasis on learning from adverse incidents.
Pulmonary tuberculosis
Authors: Barry Simon
Published: May 2014

Epidemiology, diagnosis, management and factors affecting prognosis.
Self-care and community nursing
Authors: Colling Jane
Published: May 2014

Community nurses must know how to facilitate patient self-care.
Using references in academic writing
Authors: Cornforth Paul
Published: May 2014

Reference with care or you could be marked down or even accused of plagiarism.
Infective conjunctivitis
Authors: Stevens Deborah
Published: May 2014

Epidemiology, aetiology, management, prognosis and follow-up
Cost-effective patient recall and reminder
Authors: Duncan Deborah
Published: May 2014

A practice has designed a text messaging service to improve communication with patients.
Promoting mental health in older men
Authors: Williamson Toby
Published: May 2014

Social isolation and deterioration in physical health can impact on wellbeing, writes Toby Williamson
Clinical focus - Diabetic nephropathy
Authors: Robins Victoria
Published: May 2014

Epidemiology, aetiology, diagnosis, management and referral
Clinical focus: Bell's palsy
Authors: Buchanan Malcolm , Lyons Marie
Published: May 2014

Epidemiology, aetiology, management and prognosis
Maternity services - Boosting preand post-natal care for BME patients
Authors: Andrews Crispin
Published: May 2014

A community-bridging organisation in Coventry is supporting the work of local health professionals.
Easing the burden of COPD
Authors: Greener Mark
Published: May 2014

A recent NICE guideline highlights the need to consider the clinical features of COPD, rather than over-relying on lung function tests.
Menopause, cancer and stress
Authors: Greener Mark
Published: May 2014

In-depth analysis of the latest research.
In your workplace
Authors: White Graham
Published: May 2014

NHS Trust HR director Graham White offers advice on employment issues affecting nurses
Travel advice in diabetes care
Authors: Kochhar Suneeta
Published: May 2014

Several factors should be considered before a person with diabetes travels abroad.
Managing diabetes mellitus in children and young people
Authors: Morris David , Morris James
Published: May 2014

Psychosocial issues should be addressed alongside pharmacological treatment for children and young people with diabetes,
Resuscitation from out-of-hospital cardiac arrest in an under-resourced environment
Authors: Stein Chris
Published: May 2014

Published data on the epidemiology of out-of-hospital cardiac arrest (OHCA) come mostly from developed countries. Few studies have described the nature of OHCA in developing countries, where resources guaranteeing rapid access to cardiac arrest cases may not be available. A retrospective case series on OHCA in Johannesburg, the first study of this type in an African population, showed that response times were comparatively long; less than half of patients were resuscitated and rates of shockable rhythms and return of spontaneous circulation were lower than those reported in most other published studies. These results are most likely caused by lack of resources; in the form of emergency vehicles, in a region with a very busy emergency medical service, providing prehospital care to a large population. Other factors caused by poor emergency service management tend to complicate this picture and exacerbate the response time problem. Although paramedic learning programmes in South Africa are of a high standard and prepare qualifying practitioners to treat OHCA cases adequately, a lack of effective emergency medical service management and organization means that these human resources cannot be put to good use in improving OHCA outcomes. To improve OHCA outcomes, under-resourced emergency medical services should focus on fundamental aspects of the system to guarantee rapid access to patients, rather than more advanced scopes of practice for paramedics.
Organizational models of prehospital care: experiences from Austria
Authors: Neumayr Agnes , Baubin Michael
Published: May 2014

When comparing the well-established model of functional-organization structures with the model of process-orientated organization structures, problems are perceived in the efficient coordination of all system partners in the prehospital emergency medical system (EMS). A lack of communication, documentation and feedback, a large number of unnecessary emergency missions, undue workload and costs in some areas of the system negatively effect motivation, efficient teamwork and satisfaction of staff and patients. Therefore and in the context of quality management, a restructuring of prehospital emergency medicine towards a process-orientated approach is highly recommended. The approval of the Ethics Committee of Innsbruck Medical University was received on 21 June 2007.
A model to embed clinical simulation training during ambulance shift work
Authors: Alinier Guillaume , Newton Andy
Published: May 2014

Paramedic education is now commonly delivered by educational institutions, but there is still a continuous need to ensure the competency of experienced staff and to help with orientation to newly adopted pieces of equipment, brief staff concerning new protocols or guidelines, and to allow them to practise in a safe and controlled environment. A complementary solution to traditional training rooms proposed in this article is to use a mobile simulation unit to take the training where ambulance staff are located, to fulfil their duty of care. The possibility of offering simulation training using a specially designed vehicle while a crew is waiting would improve the efficiency of the use of their time and enhance their training opportunities. There are several options regarding the training vehicle that could be used to fulfil this role depending on the budget and facilities that are to be offered during the training, but only two will be explored in this article. An additional key resource that will be discussed is the team of educators that are required to facilitate such training sessions to ensure they are effective and valuable learning experiences that will enhance pre-hospital care service delivery and benefit patient care. Over time, the training vehicle and its team, supported by an additional ambulance to cover for the team undertaking the training, would conduct their focused simulation training sessions with all the clinical staff of an ambulance service without affecting the rota of the crews or putting temporarily geographical areas at risk. The seeming strengthening link between enhanced levels of patient safety and the use of clinical simulation, while still not fully evidenced, is becoming more established, especially as ways of integrating such activities with day-to-day operations can be developed and adopted.
Which calculations do child branch student nurses find most difficult in the classroom setting?
Authors: Barrett Gary
Published: May 2014

The purpose of this study was to attempt to identify the types of calculations that cause most concern for student nurses.

A Solomon Four Group Testing system, using the pre-test, intervention and post-test experimental design was used. Student nurses studying on the child branch programme were recruited. Each participant was part of a cohort of students who were exposed to a variety of calculation tests in the classroom setting, without the use of a calculator, and were allocated to receive an intervention in the form of an interactive lecture or a calculation workbook, or assigned to the control cohort who received no intervention. The cohorts then received a post-intervention calculation test. The data collected was analysed and revealed that certain identified themed questions resulted in a significant and worrying failure rate.

Also emerging from the data, it was clear that identified interventions resulted in substantial improvements in subsequent scores of the students.
Using intravenous paracetamol in children following surgery: a literature review
Authors: Clarke Sonya , Richardson Olga
Published: May 2014

This paper presents an extended critical review of primary papers related to the efficacy and safety of intravenous (IV) paracetamol in children following surgery. The primary focus is a critical evaluation of the methods, effects, experiences and outcomes of using IV paracetamol in children following surgery.

Search strategies, inclusion/exclusion criteria, and methods were replicated as for Clarke and Richardson (2007a,b). Duplicate systems were also used to categorize the research papers into respective levels of evidence (Atkins et al, 2004; Petrisor et al, 2006) and Detsky et al’s (1992) scales were used to assess the quality of randomized trials which score randomization, statistical analysis and blinding.

IV paracetamol permeates readily into the central nervous system (CNS) of children and is detected in the cerebrospinal fluid within five minutes. The transfer is fast and enables central analgesic and antipyretic action of IV paracetamol. CNS penetration of IV paracetamol was reported as five times greater in girls than boys. A single dose of IV paracetamol 15mg/kg produced analgesia similar to a single infusion of propacetomol 30mg/kg. No serious adverse effects were reported, however, a very small number fo subjects reported vomiting, and burning sensation at the injection site. However, paracetamol 15mg/kg was better tolerated at the injection site than propacetamol.

This literary evidence provides a modest source of empirical research that supports the health care professional when using IV paracetamol in children post-surgery, therefore ensuring their practice reflects the best available evidence.
The history of aesthetic nursing: part 1 (1915–1987)
Authors: Campion Constance
Published: May 2014

The objective of this series is to highlight the history of nursing in the establishment, attainment and development of the nursing science of medical aesthetics. In this first article in a series of three, the author outlines the origins of medial aesthetics and the historic clinical facts that influenced developments in the speciality. Identifying the milestones, from aesthetic medicine's historic roots in plastic surgery, to the non-surgical services offered by specialists, the history is not only central to the origins of aesthetic nursing, but also charters the critical points in the arguments surrounding the competent practice of medial aesthetics. The author analyses the specialists' clinical role that was a vital component in the comprehensive care of patients throughout all the science's developments, and places specialist competency as the critical factor today for those who seek facial rejuvenation.
An exaggerated altered immune response following treatment with an HA dermal filler
Authors: Collier Helena
Published: May 2014

Facial soft tissue augmentation with a hyaluronic acid (HA) based dermal filler is a medical procedure that is normally well tolerated by patients. Side effects are usually predictable, mild and transient, including bruising, erythema, pain and swelling. These are minor local injection site reactions that will typically resolve within a number of days. However, despite the impressive safety profile of HA based dermal fillers, there is the potential for a myriad of complications to occur. Baumann (2009) has cited several HA dermal filler complications that range from infection, abscess formation, nodule formation, granulomatous reactions and altered immune responses to the most feared complication of all: occlusion or compression of a vessel(s) resulting in impending necrosis, skin ulceration or cutaneous necrosis. This case report will document a series of adverse events that were experienced by a 54-year-old patient who was injected with a HA-based dermal filler to the upper and lower vermillion borders of the lips, the marionette region of the lower face, and the malar and submalar region of the mid-face. Following treatment, the patient suffered months of recurring symptoms, including persistent immune system reactivity, eczematous changes to the skin and marked hypertrophic changes to the upper eyelids. To date, intermittent symptoms continue to occur with full resolution of symptoms yet to be achieved. To respect and protect patient confidentiality, the patient will not be referred to by her name.
The history of aesthetic nursing: part 3 (2005–2012)
Authors: Campion Constance
Published: May 2014

The objective of this series is to highlight the history of nursing in the establishment and development of the nursing science of medical aesthetics. In the third and final part of this series, the author discusses the future of advanced nursing practice and how it may shape the practice and structure of medical aesthetic nursing, taking it into the realms of functional preventative medicine and wellness anti-ageing nursing. The author also discusses some of the significant challenges for aesthetic nurses in the 21st century, focusing on the closing of the Royal College of Nursing Aesthetic Nurses Forum in 2007 and the role of commercial forces in this sector.
Next-generation treatments set to take the industry by storm
Authors: Lewis Wendy
Published: May 2014

In the fast-paced world of medical aesthetics, there is always new technologies and products on the market for practitioners to try and invest in. However, for those who have heavy caseloads, it can be hard to keep up with the latest trends and devices that have hit consumer demand. In this article, cosmetic industry expert Wendy Lewis explores the next-generation treatments set for success
Managing negative press, feedback and online reviews
Authors: Zadah Kate
Published: May 2014

Have you ever searched for your clinic online and wished you hadn't? Although review websites can potentially pose a threat to your business or services and cause a potential dent in profitability, there are ways to tackle this problem. In her regular column providing PR advice, Kate Zadah provides an overview of the actions to take when faced with negative press, feedback and online reviews
Exploring the science of cosmeceuticals used to achieve optimal skin health
Authors: Bowes Lorna
Published: May 2014

The world of cosmeceuticals is ever-changing, with new ingredients, products and technologies appearing in the market constantly. However, finding the best balance of ingredients that are well-formulated and suitably packaged is challenging. Although many patients are not aware of cosmeceuticals, they regularly seek nurses’ advice for an array of skin conditions, from the ravages of photoageing to simple dry skin conditions. Indeed, skin care is often not what brings the patient to us, but a search for aesthetic treatments is. Understanding the technology behind any products that nurses may discuss with them, as well as recognising how the ageing process affects the skin, is important in addressing aesthetic patients’ needs. In this article, the author outlines the most frequently used and effective ingredients for the management of a range of common aesthetic skin conditions, including acne vulgaris, rosacea and pigmentation.
Continuing professional development: the key to demonstrating fitness to practise
Authors: Peate Ian
Published: May 2014

Aesthetic nurses provide a myriad of services to a variety of people, in a number of ways. They must demonstrate to these people that they are up to date, competent and confident in the services provided. Ensuring standards and protecting those who use nursing services across the profession within the NHS, the voluntary and independent sectors lies in education and effective regulation, one aspect of regulation is the notion of continuing professional development (CPD). Patients have a right to expect the aesthetic nurses that advise and treat them to be up to date in their knowledge and skills and to be fit to practise. The majority of aesthetic nurses are compliant with the PREP standards, competent and confident; and PREP helps to assure this for the people they care for. This article reminds aesthetic nurses of their responsibilities to patients and their profession concerning Post Registration Education and Practice (PREP). The article also considers the issue of CPD, providing the reader with an example of a framework that can be used to identify and address CPD needs.
Keeping the media interested: creating a story when there is no news at the clinic
Authors: Zadah Kate
Published: May 2014

Whether you work on your own or are employed by an organisation, there are many ways to create a buzz around your clinic, even when there is nothing new to report. In her regular column providing PR advice, Kate Zadah recommends several ways to build positive relationships with the media by generating interesting local or national news stories
Is it worth offering mesotherapy on your clinic's treatment menu?
Authors: Beaumount-Thomas Tatiana
Published: May 2014

In this regular feature in the Journal of Aesthetic Nursing, experienced aesthetic nurses answer your questions relating to clinical and professional issues. This issue, a range of practitioners in the field offer their opinions on mesotherapy and reflect on their previous experience with this treatment.
Monitoring your employees' training needs and maximising sales internally
Authors: Deakin Barbara
Published: May 2014

Feeling confident in your clinic's customer service skills is invaluable, and treating clients well can increase internal sales and encourage repeat business. In this article, Barbara Deakin, Clinic Manager at Dr Rita Rakus Clinic in Knightsbridge takes a close look at the most important factors to consider when organising in-house training, including filling skills gaps, minimising costs and keeping up to date
‘Working from different locations enables us to gain insight into patients’ lives’
Authors: Lockett Karen
Published: May 2014

Last year saw many aesthetic nurses winning awards for their contribution to medical aesthetics. To celebrate this well-deserved recognition, the editor of the Journal of Aesthetic Nursing spoke to some of the leading lights in the field about their plans and aspirations for the year ahead
Checking out the competition: how it can benefit aesthetic clinics in the long term
Authors: Deakin Barbara
Published: May 2014

Medical aesthetics is an industry that moves fast and keeps in line with the latest treatments, technologies and social media pages. In her regular column on practice management, Barbara Deakin advises aesthetic clinic owners on the best ways to check out their competition and stresses the importance of using internal resources well, attending industry events and getting online-savvy
Was the Keogh report a step forward for medical aesthetics?
Authors: Devan Natasha
Published: May 2014

Following the publication of Sir Bruce Keogh's final recommendations for the regulation of cosmetic interventions, opinions among aesthetic practitioners and experts around the UK has been divided. In this debate article, eight professionals working in the field of medical aesthetics share their thoughts on the critical report and suggest ways forward based on the proposed actions
Treatment of a 19-year-old female patient with hyperhidrosis using botulinum toxin
Authors: Senior Yvonne
Published: May 2014

Although the author is experienced in the treatment of axillary hyperhidrosis with botulinum toxin, reflecting on the incident documented in this article demonstrated a need for her to make deeper enquiries into the psychological history of her patients. Failing to pursue this and ignoring her intuition led to a less than satisfactory outcome and lack of patient concordance. Treatment outcomes highlighted that, while knowledge and skill are extremely important, they are not finite. Although it is difficult to reach out to other professionals, such as counsellors and GPs, aesthetic nurses will do their practice and patients a disservice by not creating those links. The author also recognises the importance of knowing the limitations of knowledge and skill. She acknowledges that working in an environment that is not without its critics can make it difficult to admit to limitations for fear of drawing more criticism.
Do conversations about our appearance do us more harm than good?
Authors: Diedrichs Phillippa C
Published: May 2014

Research has shown that appearance conversations are commonly associated with increased body image concerns and anxiety about ageing. In this article, Research Health Psychologist and Senior Research Fellow Phillippa Diedrichs explores where these issues stem from and why reducing 'fat talk', 'old talk' and 'body talk' could be a useful way to improve body image
Managing anaphylaxis in aesthetic practice with rapid-onset adrenaline auto-injectors
Authors: Fromage Gemma
Published: May 2014

Anaphylaxis is a severe, life-threatening allergic reaction. The most common form of anaphylaxis is a type I hypersensitivity reaction involving immunoglobulin E-mediated activation of mast cells and basophils as a result of exposure to drugs, food, latex, insect venom and other allergens. Anaphylaxis can present in a variety of forms, however it is a medical emergency and immediate treatment of symptoms such as laryngeal oedema, bronchospasm and hypotension in particular are needed. As well as antihistamines and steroids, adrenaline is administered through intramuscular injections. It has a rapid onset and short duration of action. Patients at risk of anaphylaxis should carry a self-administered adrenaline auto-injector with them at all times to be injected intramuscularly in an emergency situation. Although there are cautions to be aware of when administering adrenaline, there are no absolute contraindications to its use in a life-threatening situation.
Absolute Aesthetics, The Whiteley Clinic: trying a new procedure outside of London
Authors: Zadah Kate
Published: May 2014

When providing advice on running a successful clinic, nothing is better than experiencing the patient journey yourself, from the reception to the treatment room. In this practice management series, PR professional Kate Zadah travels the UK visiting clinics and reviewing their layouts, customer service, treatment menus and follow-up care. She will also highlight areas for improvement for each one
Should aesthetic nurses be performing polydioxanone thread lifting?
Authors: Collier Helena
Published: May 2014

A discussion recently posted on the Journal of Aesthetic Nursing’s LinkedIn group surrounding polydioxanone thread lifting prompted debate among several nurses specialising in aesthetic medicine. Whereas some nurses feel that they are competent enough and insured to provide this treatment, others are concerned about safety and a lack of evidence. Helena Collier discusses this topic of contention
Communication and improving the quality of care
Authors: Lewis Tim
Published: May 2014

In the first article of this two-part series, several key concepts relating to interpersonal communications and their potential to improve the quality of care and teamworking within perioperative practice will be explored. Although communications is an immense subject, this article deliberately sets out to emphasise the relevance of these topics to different aspects of practice, rather than critiquing recent research. Hopefully, this approach will inspire operating department practitioners to read further into this fascinating subject area.
Research roundup: January 2013
Authors: Seal Joanne
Published: May 2014

In this section, brief synopses of a range of recently published articles that may be of interest to health visitors are presented. The aim of this roundup is to provide an overview, rather than a detailed summary, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided.
Enhancing maternal mental health
Authors: Hanley Jane
Published: May 2014

I was a health visitor for nearly 20 years, and I was fortunate to be able to take advantage of the educational opportunities that were available then, and still are today. Health visiting is not about assignments and deadlines, but having the passion to know that your work will make a difference, however small.
Prescribing skin-to-skin contact and baby-wearing: Interventions in Norfolk
Authors: Wagg Amanda (Mandy)
Published: May 2014

There are numerous and significant benefits of extended skin-to-skin contact between a mother and baby, including calming the babies heart rate, keeping the baby warm, helping to regulate the babies breathing, reducing stress hormone levels, and allowing the baby time to tune into their natural reflexes and initiate breastfeeding. Health professionals are becoming more and more aware of these health benefits. This article aims to describe how in Norfolk, a universal plus health visiting service, prescribing skin-to-skin contact and baby-wearing, is used in an effort to add to a multi-faceted approach to support breastfeeding.
Identifying domestic abuse during pregnancy
Authors: Murray Joy
Published: May 2014

In this section, brief synopses of a range of recently published articles that may be of interest to health visitors are presented. The aim of this roundup is to provide an overview, rather than a detailed summary, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided.
Presentation of (health visiting) self in everyday practice
Authors: Cowley Dame Sarah
Published: May 2014

Some organisations are beginning to introduce uniforms for health visitors, but a key health visiting attribute is presentation of self. Sarah Cowley discusses the challenges of changes that are introduced by people who may not fully understand the health visiting service.
Promoting breastfeediang in the Wirral: A hearts and minds approach
Authors: Whitehead Clare , McPhee Daria
Published: May 2014

Breastfeeding has many health benefits for both infants and mothers and offers cost savings over the use of infant formula. However, despite an increase in breastfeeding in the UK since 1990, rates of breastfeeding initiation remain among the lowest in Europe. An initiative was undertaken to increase breastfeeding in the Wirral, an area with one of the lowest rates of breastfeeding in England.
Supporting low-income families with nutrition
Authors: Patience Sara
Published: May 2014

Families with low income generally eat a less nutritious diet than those with a higher income, either because they cannot afford enough food or because they eat foods that are nutritionally poor. This leads to health inequalities, as low-income families are more susceptible to health problems associated with obesity or malnutrition. It has been shown that poor diet contributes to higher rates of child mortality. The current issue of food poverty in the UK is evidenced by the high rate of obesity and the growing number of people accessing food banks. The main factors contributing to food poverty in the UK are a lack of money to buy food, low availability of healthy foods and limited cooking skills. Health visitors are in a good position to help low-income families overcome these obstacles, as they can identify which families are in need, offer advice and support in a sensitive manner, and direct them to the appropriate services.
Achieving a sustainable diet: What are the issues?
Authors: Williamson Claire
Published: May 2014

The importance of good dietary habits from a young age is now well accepted, but there are growing concerns over how sustainable our food supply is and whether our dietary habits need to change in order to ensure a more sustainable food supply for the future. Health visitors have a key role in providing advice on diet and nutrition to families with young children and helping to encourage good eating habits from an early age. However, with growing pressures on the global food system, the need to consider sustainability issues when making dietary choices is of increasing importance. This is a very complex area but there are some initial steps that families can start taking to help ensure that our food supply remains sustainable for the future.
Navigating the motherhood maze
Authors: Rowland Cassie
Published: May 2014

Becoming a mother for the first time can be overwhelming, and sometimes the best thing is having someone to help make sense of the minefield of information available. This month, Cassie Rowland tells Ruth Donnelly how health visitors helped her find the right path.
Parental grieving and bereavement support needs identified by parents
Authors: Perfect Deborah
Published: May 2014

Infant and child death is relatively rare in the UK but does still happen, and it is important that health visitors are aware of the needs of parents following the death of a child. This article reviews the literature to discover the bereavement support needs identified by parents following the loss of their baby or child. Findings include how parents cope with loss, different responses to grief, differences between mothers’ and fathers’ needs and what kind of support is appropriate. The article makes recommendations to improve health visitors’ practice in this highly sensitive area.
Solution-focused work in practice
Authors: Bailey Beverley
Published: May 2014

Training in solution-focused brief therapy was transformational to Bev Bailey's practice. She urges other health visitors to explore the benefits of this approach for families.
Health visitors' perceptions of encouraging and supporting teenage mothers to breastfeed their babies
Authors: Bettison Jo
Published: May 2014

There is evidence to suggest that teenage mothers require extra support with breastfeeding to break away from the cultural norm of formula feeding among this age group ( Dyson et al, 2010 ), and health visitors are well placed to offer this support. This research project explored the perceptions of health visitors who were supporting a teenage mother to breastfeed her baby, using semi-structured interviews and focus groups. A qualitative research method was undertaken using the branch of phenomenology. The sample group comprised 13 health visitors who were provisionally required to take part in the study; six were involved in the focus group and seven were interviewed individually. Results show that while support and encouragement from the health visitor are vital, it may be that the past experience, self-confidence and support systems surrounding the teenage mother bear an important influence on the findings. Issues such as maturity and socio-economic background are perhaps not as significant in this study as other research has implied. However, this was a small-scale study and generalisations cannot be made.
The multidisciplinary nature of renal care
Authors: Ackland Penny
Published: May 2014

Penny Ackland gives an overview of why patients with renal disease require the input of many different health professionals. She describes each of the roles in the multidisciplinary team and at what stage they may become involved in the pathway of a renal patient.
Drugs used in unblocking occluded dialysis catheters
Authors: Chai Mee Onn
Published: May 2014

Using a central venous catheter (CVC) for haemodialysis provides immediate vascular access and can be life-saving in an acute situation. Long-term use of a CVC to provide access for chronic dialysis is not ideal. One of the most common problems associated with using CVC is catheter dysfunction. The use of thrombolytic drugs such as urokinase and alteplase are well established in treating and maintaining CVCs. If used appropriately these drugs are safe and effective.
Diagnosing and classifying acute kidney injury
Authors: Davies Annette
Published: May 2014

This article gives an overview of the traditional classification of acute renal failure and how and why the term ‘acute kidney injury’ was developed, outlining its categories. The limitations of AKI as a classification are reviewed and the future of detecting kidney damage even earlier discussed.
Quality improvement in chronic kidney disease in primary care
Authors: Jain Neerja , Thomas Nicola , Bridger Jane , Lumsdon Angela
Published: May 2014

Neerja Jain gives an overview of an ongoing project designed to help chronic kidney disease (CKD) patients through improved patient empowerment and self-management. Here she outlines the overall programme and tools used for the project, findings of which will be of interest to all renal professionals.
Enabling patients with chronic kidney disease to self-care
Authors: Bridger Jane
Published: May 2014

This study explored the illness experience of patients with mild to moderate chronic kidney disease (CKD). Using semi-structured and unstructured interviews and data from journals and drawings, the views of 23 affected individuals aged 35–84 years were explored. Data analysis produced a three-phase theory, integrated by a basic social process of ‘enabling’. There were six inter-related processes (which can either enable or disable): peer comparison, being affirmed, personal coping style, collaborative communication, personal health role and language of illness. The findings can help provide a greater understanding of the strategies required to reduce or prevent progression of CKD.
Developing the 18-week pathway for chronic kidney disease
Authors: Griffith Kathryn E
Published: May 2014

Kathryn Griffith helped to develop the 18 week pathway for chronic kidney disease (CKD). In this article she gives an overview of why it was necessary to develop the pathway and how to use it, ensuring patients wait a maximum of 18 weeks from being referred by their GPs to being treated at the hospital. The information and links below have been developed to support the implementation of the 18 weeks commissioning pathway for chronic kidney disease (CKD). These links will also be helpful for other pathways/specialties and can be read in conjunction with the commissioning pathways or on their own. They are specifically aimed at supporting local implementation of good practice, to improve efficiency, reduce delays, and improve quality of service provision in a safe and effective way.
book reviews
Authors: Jones Chris
Published: May 2014

This is an interesting book written by physicians while they were students completing a kidney disease and hypertension pathophysiology course.
How to perform fluid assessments in patients with renal disease
Authors: Davies Annette
Published: May 2014

Here, Annette Davies reviews the how and why of fluid assessments for patients with renal disease. She identifies important aspects of a patient's history in the assessment of fluid balance, describes the major techniques for the physical assessment that relate to fluid balance and lists relevant physiological data which help complete a patient's fluid balance assessment.
An overview of recent advances in treating chronic kidney disease
Authors: Roderick Paul
Published: May 2014

Paul Roderick gives an overview of how the prevention, detection and treatment of chronic kidney disease (CKD) has changed in recent years. He explains why CKD has become a major health problem and the actions required to deal with this life-threatening disease.
Renal artery stenosis: treatment options and procedures
Authors: Mackie Sarah
Published: May 2014

In this article, Sarah Mackie broadly defines and explains renal artery stenosis, focusing on atherosclerotic renal artery stenosis. She goes on to discuss the main treatment options—renal angioplasty with or without stenting—and describes the practical procedures involved when caring for renal patients before and after this intervention.
The continuum of transition from paediatric to adult renal care
Authors: Watson Alan R
Published: May 2014

Alan Watson looks at the current transition arrangements for moving young people with renal disease from a paediatric to an adult renal unit. He outlines the competencies young people need before they can be transferred, and how they can be best supported on their journey
How young people experience renal transplantation
Authors: Brown Katie , Brazier Anna , Frude Neil
Published: May 2014

The article draws on the experiences of three adolescent girls before, during and after transplantation who were interviewed by Katie Brown, a clinical psychologist. Their accounts hold valuable lessons for the renal care team and the nursing care these young patients ought to receive.
How can we learn to adopt green clinical practice?
Authors: Tomson Charlie
Published: May 2014

Achieving change in complex settings (like hospitals) is difficult, and is often as much about sociology and psychology as about the evidence. Much of what we understand about how to achieve change comes from the research on quality improvement, which focuses on increasing the reliability of implementation of evidence-based best practice by focusing on how healthcare is delivered. But the same principles can be applied to other areas of practice—in this case, persuading doctors (who often control budgets and clinical pathways) to change practice so as to improve sustainability of care without compromising other aspects of quality, such as safety or effectiveness. In both instances, we already know what we want to achieve; it's a question of how to achieve it.
Anaemia management—the key influences for modern treatment
Authors: Donovan Kieron
Published: May 2014

Kieron Donovan outlines the origins and development of the modern management of the anaemia of chronic kidney disease (CKD). He discusses some of the key literature and guidelines that dictate the way anaemia is treated, and the need for targets based on evidence and opinions.
Self-managing anaemia at home
Authors: Pearce John
Published: May 2014

After being diagnosed with chronic kidney disease and anaemia, John Pearce was taught how to self- administer erythropoiesis-stimulating agents (ESAs) and iron injections so that he could treat himself at home—a vital timesaver and relief from the stresses of having to get to the hospital.
Back to basics: what is peritoneal dialysis?
Authors: Ellis Peter
Published: May 2014

Peter Ellis gives an overview of peritoneal dialysis—one of the common forms of renal replacement therapy available to treat patients with chronic kidney disease. He describes the basic physiological processes and techniques underpinning this type of popular form of dialysis and emphasizes that all renal nurses need a good understanding of peritoneal dialysis to best inform and support their practice.
The Welsh Renal Clinical Network: how does it work?
Authors: Baker Liz , Heyburn David
Published: May 2014

Liz Baker and David Heyburn introduce the workings of the Welsh Renal Clinical Network. They examine when it came into operation and why, who the people are that make up the network and the areas of renal disease it supports and gives guidance for. They point out the key documentation that underpins the way renal services are delivered in Wales to the benefit of all renal patients.
Infection prevention and control: implementing root cause analysis
Authors: Walker Gwen
Published: May 2014

Every health professional dreads to think about the impact meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia has—not only for the already vulnerable renal patient but for everyone else involved in care of this patient. Gwen Walker, an infection control specialist nurse independent consultant, outlines the benefits of root cause analysis when dealing with an MRSA bacteraemia.
Post-transplant complications of immunosuppression
Authors: Nikolopoulou Aikaterini , Mason Philip D
Published: May 2014

To avoid rejection of the new kidney by the immune system, transplant recipients remain on lifelong immunosuppressant therapy. This life-saving medication, however, can put transplant patients at risk of cancer, infections and other diseases. In this article, Aikaterini Nikolopoulou and Philip Mason give an overview of the complications that transplant patients may encounter due to immunosuppression.
Diabetic foot disease on the renal unit
Authors: Game Fran
Published: May 2014

Diabetes remains the single most common cause of both end-stage renal disease and non-traumatic amputation of the lower limb. There is a close association between renal disease, peripheral symmetrical neuropathy, peripheral vascular disease, foot ulcers, amputation and survival in patients with diabetes. The risk of foot ulcers or major limb amputation appears to accelerate soon after the start of renal replacement therapy. All professionals involved in the care of patients with diabetes and renal disease should be aware of the extent to which the patients’ feet are at risk.
Back to basics: acute kidney injury
Authors: Ellis Peter
Published: May 2014

This is the first of a series of articles that looks at acute kidney injury (AKI). Presenting back-to-basics information on the incidence of AKI, Peter Ellis highlights the causes and categorisation of AKI, outlining the three potential sources of this sudden loss of kidney function.
My transplant and dialysis journey
Authors: Perks Liz
Published: May 2014

Liz Perks is a chartered accountant, wife and mother. She suffers from nephrotic syndrome and had two kidney transplants, giving her reprieves from the disease and dialysis, but which sadly did not last. Here she shares her extraordinary journey, letting us be part of her positive and life affirming outlook on life.
Managing stress in the renal team: the role of the manager
Authors: Ellis Peter , Abbott Jane
Published: May 2014

In the last previous papers in this series Peter Ellis and Jane Abbott looked at the causes and manifestations of stress. They elicited that there are many factors that make nursing potentially stressful and that some of these stressors are particularly present in the renal care setting. In this paper the authors look at the role of the renal unit manager in the management of stress and the effects of stress on the renal workforce.
How peritoneal dialysis solutions can affect the stability of drugs
Authors: Coleman Adrian
Published: May 2014

Renal patients on peritoneal dialysis (PD) often require treatment with medicines directly administered in to the peritoneal cavity. The administration of medicines via the intraperitoneal route requires careful consideration as there are various factors that can affect a medicines stability and compatibility. Adrian Coleman provides an overview of the different aspects of medicine stability with in standard peritoneal dialysis solutions.