bluuebunny/crossref_metadata_2025 huggingface dataset:
The ‘Pushmi-Pullyu’ of contracting out services
Authors: Ainsworth Steve
Published: May 2014

In the cinema version of Dr Dolittle, the Pushmi- Pullyu was a llama with a head at each end of its body. Hugh Lofting's original Dr Dolittle books, however, picture the Pushmi-Pullyu as a kind of double-headed antelope.
The case to separate patient and public involvement
Authors: Bell Andy
Published: May 2014

Plans to once again reshape patient and public involvement in the NHS are, according to stories in the Health Service Journal late last month, soon to be upon us.
The proof of the public-private pudding
Authors: Sang Bob
Published: May 2014

Will the 15th June 2006 go down as the day when the privatisation of the NHS really began? Or will it be remembered as the start of an important experiment in health care reform? Or will it soon be forgotten?
‘So What’: how to deal with productivity and efficiency
Authors: Hardacre Jeanne , Keep Jane
Published: May 2014

It's the holiday season, and some of you will be away in countries where you will be speaking broken (or even fluent) foreign languages. For those of you who are staying local and who would have liked to try out some of your rusty foreign languages, fear not … a new parlance has emerged in the NHS.
The silly season gets serious
Authors: Timmins Nicholas
Published: May 2014

August 2006 was a febrile one. The time was when August meant the politicians were on holiday, no-one reported on anything, and the service quietly ticked over awaiting the return to the fray in the autumn.
Clinical systems: using IT to improve care
Authors: Mangalampalli Ashish , Chakravarthy Rama , Raja M , Jain Ajeet K , Parinam Aparna Mudganti
Published: May 2014

Manual ‘paper’ patient health records are giving way to electronic health records (EHRs) internationally. In turn, EHRs have been developed using various information system technologies including databases, data warehouses, and data-mining.
Stating the obvious … time and time again
Authors: Maynard Alan
Published: May 2014

Stating the obvious, and repeating it, can be tiresome but seem essential in all health care systems! Take, for instance, the notion of opportunity cost, which is much emphasised by economists. They argue that a decision to fund an expensive cancer drug of low cost-effectiveness consumes resources that could treat folk in the elective queue or patients with declining health because of the paucity of investment in chronic diseases.
The watching brief of management consultancy
Authors: Cowper Andy
Published: May 2014

Happy New Year, and welcome back to what promises to be one hell of a year. Quite literally, if you are in serious deficit. We will return to the financial issues soon - we always do. This time, it's about management consultants and their uses and abuses.
The NHS Alliance Conference 2006
Authors: Cowper Andy
Published: May 2014

Dear old Matron Strangelove has an unhealthy effect on me. I know it's not fair, but I'm torn between wanting to sleep and weep when she is making a speech. It's no fun. And a Health Secretary should be at least just a little bit fun.
Will Brown reform the private sector?
Authors: Timmins Nick
Published: May 2014

September 2007 was the month in which a mischievous, and from the NHS point of view, somewhat worrying thought occurred. Could Gordon Brown and Alan Johnson be about to repeat history? Could they, like Barbara Castle, be about to become, however unintentionally, the patron saints of private medicine?
The NHS as a crematorium
Authors: Maynard Alan
Published: May 2014

“I once asked a worker at a crematorium, who had a curiously contented look on his face, what he found so satisfying about his work. He replied that what fascinated him was the way in which so much went in and so little came out. I thought of advising him to get a job in the NHS: it might have increased his job satisfaction, but decided against it. He probably gets his kicks from a visual demonstration of the gap between input and output. A statistical demonstration might not have worked so well” (A L Cochrane, 1971).
Seeking pearls in the Brown soup
Authors: Maynard Alan
Published: May 2014

What is the NHS policy of the Brown administration? There are clear signs of reduction in emphasis of investment in private NHS suppliers. But what else is intended?
An upstart caterer
Authors: Cowper Andy
Published: May 2014

Truly memorable faxes are few and far between. We know about some fax wars of words (between queen-bitch journalist Julie Burchill and provocative feminist Camille Paglia). We also know that bald pop midget Phil Collins and hirsute actor chap Daniel Day-Lewis dumped their other halves by fax.
So where are the alternative providers in primary care?
Authors: Walsh Nicola , Maybin Jo , Lewis Richard Q
Published: May 2014

In April 2004, a new contracting route for primary medical care services was introduced - alternative provider medical services (APMS).
Back to black, but at what price?
Authors: Timmins Nicholas
Published: May 2014

February 2007 was the one in which Patricia Hewitt's job looked appreciably safer, at least until Gordon Brown becomes prime minister; in which NICE, the government and the pharmaceutical industry were left with hot towels around their heads, courtesy of the Office of Fair Trading; and when the King's Fund sounded a note of cautious optimism about the NHS.
The Conservative future: The policy prescriptions
Authors: Lansley Andrew
Published: May 2014

In the midst of the many NHS reorganisations of increasing regularity since 1974, it has often been overlooked that one has achieved nearuniversal political support.
The costs of choice give more power to the people
Authors: Cable Vincent
Published: May 2014

The principle of individuals, rather than the state, deciding what is good for them is a fundamental tenet of liberalism. In practice, it must be balanced against wider social obligations and the provision of public goods. But it is a good place to start when looking at the debate on ‘choice’ in public services.
Not such a NICE idea for Europe
Authors: Rawlin Michael
Published: May 2014

One of the greatest surprises to me has been the interest that NICE's existence has aroused amongst the international healthcare community.
Robert Naylor
Authors: Naylor Robert
Published: May 2014

As a graduate trainee in the 1970s, my mentor and then-CEO, Ken Lewis taught me a lesson that all managers need to learn early in their careers.
Why reconfigure the perfectly imperfect?
Authors: Ainsworth Steve
Published: May 2014

Reorganisation, reformation, reconfiguration. Fine words, bearing promise of a better future. What a pity that in the NHS they have been devalued by decades of unhappy experience.
New mirage or long overdue change?
Authors: Maynard Alan
Published: May 2014

After contentious, ill-focused, often naïve and politically-driven change, is that the light of rationality illuminating the end of the tunnel?
Where is NHS reform policy going now?
Authors: Timmins Nick
Published: May 2014

July 2007 was the month in which BUPA Hospitals became the first private operator to advertise choice direct to patients. In which Health Secretary Alan Johnson gave the go-ahead to a third ISTC from the second round, but fired Atos Healthcare for failing to deliver on its two diagnostic contracts.
It's all change for complaints again
Authors: Ainsworth Steve
Published: May 2014

Swamped, shocked and sinking, the white flag of surrender has finally been raised by the Healthcare Commission (formerly CHAI and before that, CHI) regarding its appellate role in dealing with NHS complaints.
Bridging worlds and balancing interests
Authors: Clark Stella , Hotho Sabine
Published: May 2014

The pace of change within the NHS is relentless. Tensions between the medical profession and the managers of the service are considerable. Yet some of these tensions could be eased if we developed a better understanding of how and why professionals engage with organisational change.
Are LINks and HOSTs fit for PPI purposes?
Authors: Sang Bob , Drinkwater Chris
Published: May 2014

In recent years, there have been a number of attempts to legislate for a system of patient and public involvement (PPI) that could address the democratic and regulatory deficits of the NHS. Public involvement in local decision-making and now, ‘World Class Commissioning’ patient involvement in services' development and improvement; and citizen commitment to prevention and self-care are seen as important factors to achieve the goals of healthcare reform.
Changing faces, changing names
Authors: Bell Andy
Published: May 2014

Andy Bell, director of public affairs at Sainsbury Centre for Mental Health, considers the implications of a name change for primary care trusts
Why are doctors so resistant to change?
Authors: Maynard Alan
Published: May 2014

Alan Maynard, professor of health economics at the University of York, discusses the medical profession's ‘pessimistic’ measurements of success
Ask a sensible question…
Authors: Appleby John
Published: May 2014

The Healthcare Commission published the latest results from the 2007 NHS staff survey last month. Packed with the usual fascinating questions…
Computing for the NHS: 45 years of support
Authors: Roberts Jean
Published: May 2014

This article tracks the development of healthcare computing from its inception almost 50 years ago to the present day. It examines the key phases of development from unconnected unidisciplinary solutions to the complex multi-agency solutions that underpin effective healthcare now, and some areas for the future.
Land of opportunity and threat
Authors: Timmins Nick
Published: May 2014

June 2008 was the month of huge opportunity and massive threat. Start with the huge opportunity.
Monitor: marking a milestone
Authors: Moyes Bill
Published: May 2014

At Monitor we've just celebrated authorising the 100th NHS foundation trust. To give you a sense of how significant the foundation trust sector has become, NHS foundation trusts have now recruited over 1.2 million members, employ over 300 000 staff, and account for 43% of turnover on NHS acute and mental health care.
ConvaTec
Authors: Jones Rod
Published: May 2014

Over 30 years ago ConvaTec began with a clear focus and a single mission: to improve the lives of the patients whose needs we meet.
Patient choice: is it worth it?
Authors: Appleby John
Published: May 2014

Given the latest Department of Health survey of patients‘ awareness about choice, you would be forgiven for thinking that this policy was perhaps not being promoted–to the public at least– as vigorously as it might be.
The hidden cost of switching medication
Authors: Cannon John
Published: May 2014

Most primary care trusts (PCTs) are overspent on their drug budget. In an endeavour to minimise this overspend and break even, prescribing advisers are encouraging ‘switch’ programmes and quotas for more expensive medicines. Switching simply refers to the act of changing a patient's medication, which may often be necessary. However, this article will discuss switching, or changing, that occurs when it is felt that there is a cheaper alternative with an equivalent effect.
Sick of work: employer liability for bullying
Authors: Perera Anthony , Arbuthnot Jamie
Published: May 2014

Bullying appears to be endemic in the NHS and this can have a huge cost to both the individual and the trust in which he/she works. Following the recent case of Majrowski v Guy's and St Thomas's NHS Trust [2006], there may also be great financial implications for NHS employers if this problem is not tackled effectively.
The Darzi Report and tissue viability services
Authors: White Richard , Cutting Keith
Published: May 2014

The recent report Transforming community services: Ambition, Action, Achievement (Department of Health (DH), 2009), is the second to be authored by Lord Ara Darzi and follows in the wake of his review of the NHS in England, High Quality Care for All (DH, 2008).
Tory health plans: more of the same?
Authors: Appleby John
Published: May 2014

First day back at school (4 January) and both Labour and the Conservatives are out of the 2010 general election starting blocks, even though no one (aka the Prime Minister) has fired the starting pistol or set the finishing line.
Benefits of the two-week rule in lower GI patients
Authors: Lloyd Geraint , Kemp Rebecca , Kelkar Ashish , Kelly Michael
Published: May 2014

Colorectal cancer is a common malignancy affecting approximately 30000 patients in the UK every year. The two-week wait scheme is designed to allow selected patients thought to have colorectal cancer to be investigated early. However, the scheme has significant failings. The aim of this study was to determine the benefit of seeing all patients with symptoms that may be attributable to colorectal cancer within two weeks. Objective: To assess the potential benefit of introducing a new outpatient referral system whereby all patients with lower gastrointestinal symptoms are seen within two weeks of referral to hospital. Methods: A retrospective study was made of all new patients seen in the colorectal outpatient clinics in Leicester during October 2005. All patients with lower gastrointestinal symptoms were identified and included in the study. Time intervals between initial referral and outpatient appointment and investigation were recorded, as well as the provisional and final diagnoses. Results: A total of 136 new patients were referred with lower gastrointestinal symptoms and therefore met the criteria for potentially being seen within two weeks. These included eight patients found to have colorectal cancer, two of whom had been referred under the two-week wait scheme. The remaining six patients with colorectal cancer had a median wait of 49 days (range 20-96 days) for an outpatient appointment. Conclusions: Six patients with colorectal cancer over one month would have been diagnosed sooner if a policy of seeing all patients with lower gastrointestinal symptoms within two weeks had been adopted. In order to accommodate the extra workload involved, it was calculated that each colorectal surgeon would need to hold an extra 0.5-1 clinics per week for a number of months while ‘mopping up’ the current backlog.
The value of productivity
Authors: Appleby John
Published: May 2014

There can't be a single manager with a pulse that does not know that the NHS has got to get serious about generating productivity improvements to the value of £15 to £20 billion over the next few years. And while economists are used to expressing things in monetary units, when politicians talk about productivity, what the public hear is the word ‗cuts‘.
Trends in applications for higher surgical training
Authors: Sabanathan Sivakumaran , Thomas Mathew , Jenkinson Lloyd R
Published: May 2014

Introduction: Over the past 5 years, there have been radical changes in working hours and selection processes throughout UK for the surgical specialties. A survey by the British Medical Association in 2004 revealed increasing unemployment (even among UK trainees) following a number of changes. This study investigates the effect of these changes on applications for the All-Wales Higher Surgical Training (HST) programme. Methods: A total of 107 applications werereceived for HST jobs in Wales advertised in 2004, 144 in 2006, and 202 in 2008. A comparison was made between the three cohorts by analysing nationality, qualifications, clinical experience, and academic activities. Results: There has been a 25% (n=8) and 120% (n=35) increase in the number of UK nationals applying for the HST programme in the years 2006 and 2008 respectively, compared with 2004 (32 in 2004; 40 in 2006; 67 in 2008). There has been a corresponding increase in the number of Indian applicants by 50% (n=22) and two-fold (n=45) in the same time period (40 in 2004; 62 in 2006; 85 in 2008). The number of female applicants almost tripled in 2006 (n=7), and ultimately increased nine-fold (n=33) over the same time period (4 in 2004; 11 in 2006; 37 in 2008). The proportion of applicants possessing an additional higher degree rose in 2006 by approximately 9%, reflected by a similar rise in those undertaking formal research. In 2008, this rate had fallen by 12% and 16% respectively. The duration of surgical training at middle-grade level dramatically reduced from 2 years to 5 months in 2008. The median numbers of audit remain unchanged in all three cohorts. The median number of presentations by the applicants rose in 2006, while courses fell in the same year. These trends reversed back to original figures in 2008. The median number of published works improved from one to two in 2008. Discussion: The total number of applicants to the HST programme has steadily increased by more than 30% over the two years from 2004 to 2006, and has nearly doubled over the 4-year period. The most significant changes have been the increase in the number of female applicants, and the numbers of UK graduates, with a steady increase in graduates from the subcontinent, suggesting that neither the European Working Time Directive nor the Medical Training Application Service has deterred the applicants towards general surgical training.
More with less and the role of IT
Authors: Hill Rosalind
Published: May 2014

The HC2010 Health Informatics Congress, held in Birmingham last month, examined the future of informatics in a time when the NHS has to do more with less.
Access to services for older BME patients
Authors: Shah Ajit
Published: May 2014

This article examines avenues of improving the inequity in access to services experienced by older people with mental illness from black and minority ethnic (BME) communities by examining demography, epidemiology, and potential explanations for inequity in service access. A series of strategies to improve access to mental health services for BME older people are provided in the final section of the article.
Revolution versus evolution
Authors: Timmins Nick
Published: May 2014

Back in 2006, when the Conservatives, with considerable chutzpah, published their very own ‘autonomy and accountability’ bill for the NHS, David Cameron and Andrew Lansley ruled out ‘any more [pointless] organisational upheavals for the NHS’.
Opportunities and threats in mental health: part 3
Authors: Breakey William , Ghedia Reshma , Soo Ha Joon , Patel Nitisha , Sinha Khushboo , Smith James A
Published: May 2014

Recent growth in the mental healthcare market has led to traditional service providers havingto rethink their conventional approach. The rate at which the current market is changing, as well as the impact of the financial downturn, call for an urgent review of the status quo. This article seeks to highlight the opportunities offered by an integration of the services currently supplied by multiple providers. It is proposed that this will lead to a more efficient mental healthcare service.
The diabetes centre in a macroeconomic context
Authors: Grant Paul
Published: May 2014

The role of the diabetes centre looks set to change, with the governmental policy initiativesof ‘care closer to home’ and the Primary Care Trusts' desire to stimulate service redesign and competition through the ‘any willing provider’ scheme. While we advocate the diabetes centre model as the gold standard, we must ask the question: does this particular model work and, if so, does it offer a cost-effective alternative or adjunct to other models of diabetes care? Strategic analysis is needed in this situation to help address the opportunities and threats diabetes centres are subject to. This article applies Porter's five forces model to analyse the role of the diabetes centre in a macroeconomic context and to help plan for the future.
Is demand for beds about death or demography?
Authors: Jones Rod
Published: May 2014

The leading edge of the post World War II baby boom turned 65 in 2010. Most of a person's utilization of a hospital bed is concentrated in the last 12 months of life (irrespective of age at death). Studies show that demographic-based forecasts for emergency admission underestimate future demand by over 60% (the underestimation increases in the higher age bands). However, despite large differences in the trends for death over the past 15 years, the ratio of bed days per death in both Australia and England has been remarkably stable. A 10% increase in deaths leads to a 9.6% to 11% increase in occupied beds. The current methods used to size acute hospitals require urgent investigation. If the current model of care continues then hospitals constructed in the past 10 years are likely to be too small for both current and future demand given the anticipated increase in total deaths from 2015 onward.
Diagnoses, deaths and infectious outbreaks
Authors: Jones Rod
Published: May 2014

Over the years 2002–2003 and again in 2007–2008 there were up to 31 100 and 23 100 excess deaths respectively across the entire UK. These excess deaths have been linked to the spread of a presumed infectious agent. Analysis of death within 90 days of admission to hospital during 2008/09 reveals that the majority of the excess deaths were associated with just 460 diagnoses (out of 1,380 potential diagnoses associated with deaths within 90 days of admission). Of these 460 diagnoses the main causes for excess deaths (number of excess deaths in brackets) were lower respiratory tract diseases and infections (3,020), symptoms and unknown causes of morbidity (2940), cancers (750), injury and poisoning (340), diabetes (290), perinatal and congenital conditions (200), mental health (170), other infectious diseases (140). Approximately 70% of patients died in hospital. This pattern of diagnoses is consistent with increased hospital admission following recurring events which appear to be outbreaks of a previously uncharacterised infectious immune impairment, hence, an increase in diagnoses related to inflammation or infection including poor outcomes after trauma or anaesthesia.
End of life and financial risk in GP commissioning
Authors: Jones Rod
Published: May 2014

Rising health and social care costs toward the end of life represent an area of high financial risk. A study of the year-to-year volatility in deaths at local authority level across the whole of the UK shows that this volatility is highly location-specific. Some locations will experience higher volatility in end of life costs. Other types of healthcare costs also exhibit high spatio-temporal granularity. Across the UK, two events in 2002 and 2007 led to increases in deaths which were as high as that observed in major influenza epidemics seen in the 1980s and 1990s, yet without the presence of unusual levels of influenza. These dates correspond to step-like increases in emergency admissions, A&E attendances and GP referrals. Potential reasons are discussed.
GPs' perceptions of physiotherapy services
Authors: Parkes Sally , Ali Ashraf
Published: May 2014

Chronic non-specific low back pain (LBP) is a burden to society in terms of cost, loss of productivity and personal function. NHS physiotherapy services are seeking to deliver quality, effective care that meets the needs of the patient and other stakeholders. In the current climate services are facing pressure from cutbacks and competition for contracts. GPs are key referrers in to the service, therefore it is essential to seek their perceptions of current services provision. An exploratory study using semi-structured telephone interviews was conducted using a purposeful sample of 16 GPs. Ethical approval was sought and approved. Interviews were recorded, transcribed and checked for accuracy by a second party. Thematic analysis was done to identify key themes. Three key themes were identified: Patient waiting times, effectiveness and quality of the service and effective communication. Clinical and cost-effectiveness, service integration, use of appropriate data including outcome measures and the need for effective discharge summaries were highlighted as being instrumental in the chronic non-specific LBP service development.
Diabetes: complications and the economic burden
Authors: Meetoo Danny
Published: May 2014

Diabetes mellitus (DM), a chronic metabolic disorder, has been recognised as a major public health problem with far-reaching consequences not just for its adverse impact on the health of people affected by this condition, but also for the economic burden it places on the healthcare system. To reduce cost, it is imperative that diabetes management aims to achieve optimal glucose control to minimise the risk of long-term complications and to enable the person with diabetes to lead a good quality of life. This is often achieved through the use of a vast array of lifestyle and pharmaceutical interventions designed to prevent and control hyperglycaemia. However, evidence asserts not maintaining blood glucose within a normal range can result in chronic hyperglycaemia. This in turn leads to the development of micro and macrovascular complications. Such complications incur additional indirect costs to patients, employers and society due to absence from work caused by sickness and early retirement.
Structural change within a plastic surgery unit
Authors: Mohan Arvind , Thirumalai Andal , Chester Darren
Published: May 2014

Following complaints from junior trainees, consultants and nursing staff, the Queen Elizabeth Hospital, Birmingham plastic surgery department underwent a structural overhaul with the aim of increasing training opportunities for senior house officers (SHOs) and improving healthcare delivery to patients. The unit was divided into teams each with dedicated SHOs allowing more trainees, to undertake shorter ward rounds, enabling quicker and more effective management of patients. This allowed trainees more time in theatre and clinic. Weekly rotas for 12 weeks prior to change were compared with those 12 weeks after. The number of clinic, theatre, ward cover and on-call sessions that SHOs were allocated to was calculated. Satisfaction was assessed using questionnaires for nurses, SHOs and consultants. Trainee logbooks were analysed to assess whether trainees gained more operative experience. Following the change, trainees were assigned to 58.5% more theatre sessions and 127% more clinic sessions. Trainees who were responsible for ward cover were still able to attend theatre and clinic sessions as workload was shared. Logbook analysis demonstrated that trainees performed 33.6% more, and assisted with 44.7% more operations on average. Satisfaction among trainees and consultants was high. Concurrently, nursing satisfaction was high, since patients were being seen and managed earlier in the day. Carefully thought out, planned change can be effective in even the busiest units. Our example highlights how constructive feedback was used to improve working conditions and training opportunities for trainee surgeons, while improving healthcare provision for patients.
The efficacy of the enterprise culture in the English NHS
Authors: Turner Paul , Kane Ros , Jackson Christine
Published: May 2014

This article examines the role and appropriateness of different research paradigms in exploring whether the enterprise culture (the NHS policy to produce resource utilisation, quality and efficiency improvements demonstrated by leading private organisations) has provided a framework for performance improvement in a rural district general hospital (DGH). The discussion and conclusions are intended to provide a broad understanding of different paradigms and methodologies in order to inform choice for a robust research protocol for a PhD study. The article is also intended to be used as a guide to other researchers in this area. The paper concludes that a stance between realism and idealism, positivism and interpretivism applied through a mixed-methodology is justified to design the research protocol.
Concordance in Action: Training Needs Analysis
Authors: Snowden Austyn , Gilfedder Maria , Ferries Elizabeth , Bartling Leigh , Barron Derek T
Published: May 2014

This is the first of two articles examining the role and function of concordance in clinical medicine management. It records the development of a questionnaire designed to help facilitate a training needs analysis for registered mental health nurses. The purpose of this is to generate ward-based training in concordance that is clinically meaningful and accessible to those in need of it. Both articles will show that the clinical impact of concordance can be measured and facilitated.
Do nurses have functionality for inter-professional practice?
Authors: Illingworth Paul
Published: May 2014

This article explores the functionality of mental health nurses when contributing to the modern health, social and wider care sectors. Functionality is described and a working definition is offered. It also explores definitions of nursing and the development of inter-professional practice and education and examines the broad functionality of the mental health nurse within the context of inter-professional practice and links it to inter-professional learning. Mental health nurse functionality needs to be researched further in collaboration with other professions and agencies before truly functioning effectively inter-professionally.
Supporting childhood sexual abuse survivors with disclosure
Authors: McNay Lisa , Marland Glenn , Hampson Sue
Published: May 2014

Childhood sexual abuse can have a profound and diverse impact on the wellbeing of adult survivors, their families and their communities. Despite being a highly significant aetiological factor in mental and physical illness, the approach of health and social care workers is often based on misunderstanding, prejudice and fear. Front line workers need to develop a confident, safe, objective and self-aware approach to responding to initial disclosure and dealing with ongoing referral if necessary. This article outlines and justifies the embedding of the ‘Safe to Say’ training programme into a BSc pre-registration course.
On the inside: being paranoidly deluded in hospital
Authors: Chadwick Peter
Published: May 2014

Peter Chadwick, a psychologist who has himself been psychotic, tries to help staff see through the eyes of paranoia sufferers when they are first admitted to hospital
Coping: is this the foundation of wellbeing? A narrative review
Authors: Muhammad Shahid , Banks Pauline , Martin Colin R
Published: May 2014

From a psychological viewpoint, coping is a route that develops in milieu of a challenging state or taxing on an individual's present resources. This is a narrative review of the coping concept and why it is an important but misunderstood concept. A comprehensive literature search was carried out in January 2011 using a variety of databases and keywords. The review scrutinised papers to get a definition of coping related to mental health and disease, the nervous, psychology, endocrine and immune systems. This review asserts that coping is the foundation behind wellbeing. More research is required to produce a symbiotic model between psychology and physiology for coping and efforts should collaborate across disciplines—this is achievable. Unequivocally, coping, adaptation and mechanisms are topics to contemplate in future for further understanding.
Practitioners undertaking modular family intervention training: measuring competence
Authors: Fleming Mick P , Savage-Grainge Anita , Allinson Rob , Martin Colin R.
Published: May 2014

Family interventions based on the principles of behavioural and cognitive therapy, delivered for more than three months or 10–15 sessions have proved efficacious in reducing relapses and re-hospitalisation for people with schizophrenia. They are recommended as a first-line treatment in clinical guidelines. Recent developments in the field have included the development of scales to measure family intervention adherence and skill competency. This study reports the findings of a preliminary investigation into the accuracy of sub-scales of the family intervention scale. This scale measures the skills required to manage a family intervention session as well as delivery of a specific family intervention. The findings show a highly significant correlation between the two sub-scales (r = 0.61, n = 82, p < 0.001), however, this correlation only accounts for 37% of the common variance (r2 = 0.37). Use of the core session item sub-scale separately from the specific intervention sub-scale is recommended and supported by the internal consistency of the sub-scale (α = 0.87). Further larger powered and robust studies are required on the family intervention scale to determine its psychometric properties.
Reductions in hospitalisations following admission to a day hospital treatment programme
Authors: Drymalski Walter Matthew
Published: May 2014

This article examines whether a day hospital treatment programme (DTM) can reduce psychiatric inpatient re-hospitalisations and thereby serve as a community-based alternative to inpatient care. Using a retrospective review of database records, the total number of hospitalisations in the two years prior to DTM entry was compared to the total number that occurred subsequent to treatment entry for a diagnostically heterogeneous group of 277 patients. Data were further analysed to determine if reductions varied by diagnostic subgroup or number of pre-treatment hospitalisations. There was a significant reduction in re-hospitalisations after beginning treatment, independent of diagnosis. This reduction was strongest among those patients with the greatest number of pre-treatment hospitalisations. This preliminary study indicates that DTM may be an effective alternative to psychiatric inpatient treatment for patients with heterogeneous psychiatric disorders—particularly those with the greatest degree of psychiatric instability.
‘Take an aspirin and stop making a fussߣ: Misunderstanding migraine
Authors: Turner Ann
Published: May 2014

Although over 6 million people in the UK suffer from migraine, it remains a widely misunderstood condition, commonly regarded as synonymous with headache, instead of the debilitating neurological condition it is known to be. Sufferers are frequently regarded as wimps, malingerers or hypochondriacs and often told to ‘take a couple of aspirin and stop making a fuss’.
The pathophysiology and treatment of dementia with Lewy bodies: An overview
Authors: Woodward Sue
Published: May 2014

Kosaka in Japan first identified dementia with Lewy bodies as a distinct form of dementia in 1990. It has been known by a variety of names such as diffuse Lewy body disease, Lewy body dementia, Lewy body variant of Alzheimer's disease and senile dementia of the Lewy body type. It is now thought by many to be the second most common form of dementia affecting those over 65 years of age, although it shares many features with other forms of dementia and is sometimes difficult to differentiate clinically or diagnostically. This paper is an overview of the pathophysiology of the disease and diagnostic criteria. Current treatment options are identified and the case of James, a 65-year-old man who presented with the disease, is reviewed.
The development of the role of nurse consultant in paediatric neurosurgery
Authors: May Lindy
Published: May 2014

The aim of the paper is to encourage the development of additional nurse consultants in neurosurgery where appropriate, and to provide a framework of what that job might entail. Following a needs analysis, the role of nurse consultant in paediatric neurosurgery was approved in spring 2004 and came into being in September 2004. The development of key roles is discussed and specific examples of clinical expertise, leadership, education and research are given. Areas of advanced nursing practice are illustrated and a SWOT analysis provided to explain why these areas of advanced nursing practice were taken forward. Achievements, innovations and obstacles are discussed.
CORRESPONDENCE
Authors: Harrison Paul , Heggie Moyra M
Published: May 2014

The Spinal Injuries Association has sold out of its entire stock of the first edition of Spinal Injury: The First 48 Hours. A revised second edition should be available in Summer 2006.
Extending choice over where patients with motor neurone disease receive end-of-life care
Authors: Storey Les , Callagher Pauline , Mitchell Douglas , Addison-Jones Robert , Bennett Wendy
Published: May 2014

The law allows every individual to make decisions about his/her medical treatment and the care that he/she is offered. High profile coverage in the popular media on assisted suicide and euthanasia has brought decisions made by people with terminal diseases to the forefront. However, people living with motor neurone disease (also known as amyotrophic lateral sclerosis) often lose their ability to communicate their preferences in the later stages of the disease, and have more difficulty accessing services than those individuals with other life-limiting and life-threatening conditions such as cancer. A number of systems are being put into place to improve palliative care services for all care groups. One of the tools promoted by the NHS End of Life Care programme is the Preferred Place of Care initiative. This paper provides an overview to the development of the Preferred Place of Care process and describes how it has been implemented for the benefit of people living with motor neurone disease in Lancashire and South Cumbria.
A concept analysis of self-management in long-term conditions
Authors: Embrey Nikki
Published: May 2014

Self-management is a complex, ill-defined concept often promoted in the clinical management of chronic disease. Ambiguity about the meaning of self-management can cause confusion and misunderstanding among health professionals about its purpose and application.

Aim and method

: The aim of this article is to help define and clarify what is meant by self-management through a critical appraisal of the evidence using an abridged version of Walker and Avant′s approach to concept analysis.

Findings

: Self-management is regarded as an intervention in health care which increases a patient′s power and responsibility for making decisions, and helps ensure that necessary health-care actions are taken.

Conclusions

: It is recommended that self-management be adopted more widely.
The importance of specialist nurses in Parkinson's
Authors: Raymond Rachel
Published: May 2014

Rachel Raymond argues that access to care from a Parkinson's disease nurse specialist is pivotal to effective management of people with Parkinson's disease.
Spinal cord injury services: The development of a modern care pathway
Authors: Harrison Paul
Published: May 2014

This is the first in a series of articles intended to promote the speciality of spinal cord injuries services. The topics chosen have been informed by colleagues both within and outside of the UK network of spinal cord injuries centres as essential to maintaining an appropriate appreciation of both the initial and lifetime care needs of people living with spinal cord injuries. Within this series, a range of essential knowledge and skills expectations will be defined for those health professionals expected to care or provide for people with spinal cord injuries outside of specialist centres. This first article reviews the current incidence and characteristics of traumatic spinal cord injuries within the UK population and outlines the current provision of specialist services for people with spinal cord injuries within the initial patient referral pathway.
RESEARCH ROUND-UP
Authors: Lythgoe Lucy
Published: May 2014

This section presents a synopsis of a selection of recently published research articles of interest to those nurses working in the field of the neurosciences. The aim of this round-up is to provide a brief overview, rather than a detailed critique, of the research papers selected. A full reference is provided for those who wish to look at the research in further detail.
Inclusion in the mainstream: Challenges in the care of people with intellectual impairment
Authors: Clark Louise L , Barriball K Louise
Published: May 2014

The effect of care in the community and integration into mainstream health services for people with intellectual impairment (including learning disabilities and other neurological disorders such as acquired brain injury that result in diminished cognition) has proved variable. The Department of Health's policy Valuing People: A New Strategy for Learning Disability for the 21st Century (2001) advocates continued ‘inclusion’ into mainstream services for this client group. While the development of specialist services under the Learning Disability Development Fund is planned for clients who present with complex issues such as severe behavioural problems, there are concerns that such provision is inadequate.

The aim of this paper is to highlight some of the challenges associated with the drive to inclusion for many people with intellectual impairment, and the factors that limit their integration with the non-intellectually impaired community. A consideration of the conceptual foundations of the policy of inclusion will help shed light on these challenges and on ways to address them. It is important that nurses working in all fields of neuroscience are aware of some of the pitfalls and problems associated with the policy of inclusion so that they can support their patients and advise colleagues working in mainstream services on caring for this group. It is argued that the benefits of inclusion and the initiatives that have resulted from its development have not been proved and cannot be assumed.
Developments in drug therapies for MS
Authors: Mayor Susan
Published: May 2014

Susan Mayor reports from the the 5th Teva and sanofi-aventis International Symposium on MS, held in Tenerife, 12-13 May.
What to do when a patient refuses evidence-based treatment: An ethical dilemma
Authors: McGowan Susan L
Published: May 2014

Ethical dilemmas are posed when patients do not agree or comply with health professionals' advice. This case study discusses the ethical dilemma and values which emerged following a patient's refusal to follow safe swallowing advice in a neuro-critical intensive care unit. Central to this dilemma are the principles of informed refusal of care (involving autonomy and patients' preferences) and the professional's desire to protect the patient from harm. In the environment of a neuro-critical intensive care unit, expressing a beneficent paternalism may enable the health professional to tie all the loose ends of a complex case where different principles clamour to be heard. Complex ethical dilemmas in neurorehabilitation require communication, discussion and reflection on ethical theories and principles.
Patent foramen ovale and cryptogenic stroke
Authors: Fitzpatrick Maria
Published: May 2014

Stroke is common, affecting approximately 150 000 people every year in the UK, of which 10 000 people are of working age. While most strokes occur as a result of atherosclerosis and other major risk factors, there are a minority of patients in whom rare causes of stroke are present. Of these, patent foramen ovale (PFO) is becoming increasingly important, especially in younger patients presenting with embolic stroke, who have no vascular risk factors, are in normal sinus rhythm and do not have valvular heart disease.
Toward proactive management of constipation following stroke: A community nursing initiative
Authors: McParland Mary , Mitchell Elizabeth A
Published: May 2014

Each year over 150 000 people in the UK will experience stroke. It has been estimated that constipation can effect up to a quarter of the general population at some stage in their lifetime. Many factors can combine to contribute to constipation in stroke survivors, such as reduced mobility, reduced bowel motility, inadequate fluid and fibre intake. Therefore patients who have survived a stroke have a higher risk of suffering from this distressing syndrome than the general public. This paper explores the rationale for changing from a reactive toward a proactive approach in the management of constipation in stroke survivors. It also outlines the initial steps taken by one district nursing team to bring about this change.
Counselling of women with epilepsy on anti-epileptic drugs: The value of nurse-led clinics
Authors: Lewis Sheila , Smith Dave
Published: May 2014

Objective:

To improve the information received by women with epilepsy of childbearing age about gender-specific issues.

Methods:

The case-notes of 100 women of childbearing age (including pubertal adolescents) attending epilepsy clinics were examined before and after the introduction of a specialist nurse-led clinic. Data were collected on the documentation of counselling about contraception, pregnancy and the genetic risk of epilepsy.

Results:

The introduction of a nurse-led clinic for women demonstrated an increase in the amount of information given. There was a 30% increase in advice given about contraception, 89.7% of those on enzyme-inducing anti-epileptic drugs were informed of the risk of failure of the oral contraceptive pill compared to 53.2% before the intervention. Information given about the risks associated with experiencing generalized tonic-clonic seizures during pregnancy, as well as the need for compliance, increased by 40%.

Conclusions:

The introduction of a nurse-led clinic resulted in an increase in the amount of information given, and has also provided a better basis for evaluating that information.
The use of rasagiline in conjunction with levodopa in Parkinson's disease
Authors: Brown Joanne , Lewis Simon
Published: May 2014

The key goals of drug treatment for idiopathic Parkinson's disease are to control symptoms, maintain function and minimize side effects. Modern therapeutic strategies aim to introduce levodopa as late as possible, thereby postponing the development of levodopa-related motor complications, as well as preventing the emergence of drug-related symptoms such as confusion and hallucinations.

Levodopa-sparing strategies include the use of dopamine agonists and catechol-o-methyltransferase inhibitors. While these drugs are effective, some patients cannot tolerate them at the doses required to control their symptoms, and they lack a simple dosage regimen or titration schedule. As a result, new treatments are needed.

Rasagiline is a second-generation, potent, irreversible and selective inhibitor of monoamine-oxidase type B. A 1 mg tablet is licensed in the UK for use as monotherapy in idiopathic Parkinson's disease and as adjunct therapy to levodopa in those patients with end-of-dose motor fluctuations. It offers once-a-day dosing, with no need for titration, which makes it simple to use in a condition where complicated dosing regimens are common. It has an acceptable side-effect profile and three key trials show it to be effective in, and well tolerated by, patients in early and advanced Parkinson's disease, including the elderly. Trials have also shown a high rate of compliance that should be mirrored in practice. For nurses managing Parkinson's disease patients with end-of-dose fluctuations and for newly diagnosed patients, rasagiline offers a promising new treatment option.
The management of hepatic encephalopathy and cerebral oedema in acute liver failure
Authors: Sargent Suzanne , Fullwood Danielle
Published: May 2014

Acute liver failure is a term that first became established in the 1960s to describe a rare clinical syndrome that is characterized by severe hepatocyte injury, jaundice and hepatic encephalopathy, usually in the absence of pre-existing chronic liver disease. Acute liver failure has a variety of aetiologies. It is associated with high mortality and morbidity. While acute liver failure is a disease of multi-organ failure, all patients with acute liver failure will have some degree of hepatic encephalopathy, which, when advanced, is associated with a high incidence of cerebral oedema and intracranial hypertension. When these symptoms are combined with other failing bodily systems, this group of patients are extremely challenging to manage. This article presents an overview of hepatic encephalopathy and the management of cerebral oedema in this group of patients, examining current medical and nursing strategies.