bluuebunny/crossref_metadata_2025 huggingface dataset:
Reporting national clinical audits in quality accounts
Authors: Black Nick , Nossiter Julie
Published: May 2014

The requirement for providers of NHS services in England to produce annual Quality Accounts for the public was one component of the Next Stage Review in 2008. Introduced in 2010, apart from aiming to improve the public accountability of providers, it is anticipated that the Quality Accounts will prompt boards to engage more in considering quality, and encourage quality assessment and improvement among clinicians and managers. Our aim was to appraise one section of Quality Accounts, the reporting of national clinical audits (NCAs). A review of a random sample of 50 acute Trusts revealed that for the 94% of Trusts that provided an account of their participation in the 34 NCAs deemed eligible by the Department of Health, the overall participation rate was 69%. Rates varied between Trusts, from less than 40% to 100%. Although most Trusts did not provide examples of local quality improvement, interventions stimulated by NCAs, those that did demonstrated some innovative and effective ways of improving quality. We propose several ways in which the quality of Quality Accounts can be improved in 2011.
Health mela: a novel way of health promotion
Authors: Gupta Romesh , Vaidyab Abhay , Rajbhandari Satyan , Campbell Robert , Guptad Abha
Published: May 2014

South Asians living in the UK have higher prevalence of cardiovascular and metabolic disease, yet their access to health services is poor. The health Mela is a culturally sensitive way of addressing this issue. In the Health Mela, various health and social service providers attend the South Asian community centre and inform them about various services available to them. They also provide facilities for instant health check-ups and offer health education with particular focus on prevention. Undergraduate medical students take an active role in this, which they value in improving their communication skills and awareness of various cultures and health beliefs. This model has been replicated in various part of the country.
Medical tourism: overview and cost comparisons
Authors: Boultbee Elizabeth
Published: May 2014

Medical tourism is a term which has come into common usage. It is a segment of the broader health tourism market, which can be broken down into several major components. This article seeks to provide an overiew of the subject, the reasons for its popularity and comparisons of cost to the patient involved.
The cost of consumables in intensive care
Authors: Anjum Imran
Published: May 2014

Cost-effective nursing practice is essential today as resources allocated to healthcare are declining. It is imperative that frontline staff and clinicians be permitted to participate in decision-making processes affecting their work. An honest, open exchange of ideas aimed at achieving cost-effective practices should be encouraged. Intensive care unit (ICU) staff should know the price of consumables they are using. It helps them to decide on cost-effective treatment and involves them in decision-making with the physicians, achieving savings at the unit level. While strategic health authorities and the Department of Health are re-structuring the NHS to make it more viable, in any particular unit, staff members can make their input by controlling costs at a micro level and this will contribute to savings in running costs. Staff should be involved in making their unit cost-effective and this will in turn help to make their trust a cost-effective organisation.
On the inside: What is a psychotic spiritual crisis like?
Authors: Chadwick Peter
Published: May 2014

Peter Chadwick argues for more understanding of the experiences of spiritual crises and a greater awareness of the role of positive spiritual values in recovery.
Patients and professionals' views of the patient's role in spinal cord injury rehabilitation
Authors: Collis Pellatt Glynis
Published: May 2014

Rehabilitation is defined in the National Service Framework for Long-Term Conditions as a multidisciplinary process. Partnership between health professionals and patients is a key component of the government's modernization of the NHS. Research has been undertaken to define the roles and functions of health professionals but there has been little investigation of the patient's role in the rehabilitation process. The aim of this study was to investigate patients' and professionals' perceptions of the patient's role in spinal cord injury rehabilitation. A qualitative approach using ethnographic techniques was adopted. Purposive sampling was used to select participants in a spinal cord injury unit in England. The sample comprised 30 professionals and 20 patients. Inductive analysis enabled patterns and themes to emerge from the data using a variant of the constant comparison method.

A model of the patient's role was identified and tension was found between the concepts of ‘taking control’, ‘working in partnership’ and ‘doing as you are told’.

An understanding of the complexity of the patient's role in spinal cord injury rehabilitation may help professionals support patients in an exacting role.
Rehabilitation after traumatic brain injury: A survey of clients' needs and service provision in one English region
Authors: Abelson-Mitchell Nadine , Watkins Mary J
Published: May 2014

Aim:

The aim of this article is to report the findings of a study were: (1) to assess the current needs of survivors of traumatic brain injury and (2) to assess current service provision for these clients.

Design:

A questionnaire survey design was used. Sample and setting data were collected from 31 service users and 67 service and 29 education providers in South West England in 2002-03.

Results:

The findings showed that up to 10 years after the injury, all respondents experienced at least one related health problem and 13 were taking medication for pain and/or depression. Only one had returned to their pre-injury occupation, and only eight had been assessed for return to work or education. Service provision by charitable organizations covered a variety of specific services for this client group, including life skills and leisure activities. Some also offered informal training and help with seeking work. Eight education providers had a total of 42 students with traumatic brain injury, but only one offered specific courses for this group. Access facilities varied from full in eight cases to none in five.

Conclusions:

The findings suggest that survivors of traumatic brain injury should have regular, comprehensive and multidisciplinary needs assessments to ensure that they achieve their potential in terms of health status and employment, with appropriate educational provision if this is needed. A ‘one stop’ approach would be ideal. Most importantly, continued follow-up by relevant professionals, working as part of a coherent rehabilitation team, should be undertaken to ensure that all clients are maintaining or advancing their potential. Further research will be needed to evaluate whether the National Service Framework for Long-term Conditions will lead to improved services and health outcomes for survivors of traumatic brain injury.
The role of patient-centred goal planning in spinal cord injury rehabilitation
Authors: Williams Sue
Published: May 2014

Spinal cord injury is a sudden, unplanned event with devastating consequences, that requires a structured rehabilitation programme to equip the individual to adjust and cope with a newly acquired disability. Individuals will face a number of psychological challenges as they progress throughout this adjustment process. Key to an ineffective outcome is the development of appropriate coping strategies. This paper explores the utility of patient-led goal planning, the development of self-autonomy and the role of peer support in the rehabilitation process.
The management of raised intracranial pressure: A multidisciplinary approach
Authors: Garner Anne , Amin Yogen
Published: May 2014

Raised intracranial pressure (ICP) impairs cerebral perfusion, resulting in cerebral ischaemia if the pressure is not controlled. In the normal brain cerebral blood fl ow is autoregulated. Brain tissue is dependent on a constant supply of blood, glucose and oxygen to maintain normal function; it lacks any substrate storage ability. In acute brain injury the normal cerebral homeostatic mechanisms fail, hypoperfusion and hypoxia will severely exacerbate neuronal damage. Treatment of raised ICP should be multi-modal and involve the manipulation of intra-cranial contents (cerebrospinal fl uid, blood and brain volumes) through a combination of simple manoeuvres, pharmacological therapies and surgical interventions, in an attempt to reduce the potential for continued neurological damage.
Living in a 'neurosociety': Hype or hope?
Authors: Power Richenda
Published: May 2014

A recent conference considered the social implications of the growth of neuroscientifi c knowledge and medicine. Richenda Power reports
The future of nursing: Your profession, your say
Authors: Thomas Sue
Published: May 2014

Sue Thomas discusses two new documents that have the potential to change the face of nursing as we know it.
Neuroscience benchmarking: A process for sharing success and learning from experience
Authors: Braine Mary E
Published: May 2014

Benchmarking is a useful means of comparing outcomes among health-care institutions. In this article benchmarking will be discussed in terms of its purpose and process within UK health-care. In particular, the work to date of the National Neuroscience Benchmarking Group will be reviewed. This article describes the development of the group, outlines the various stages in the benchmarking process and considers some of the obstacles encountered.
Exploring the evidence for the emotional response to stroke: Biomedical research sources
Authors: Bennett Bev
Published: May 2014

During three decades of clinical research, depression has been identified as the primary mood disorder following stroke. The quest for appropriate assessment tools, diagnostic criteria and effective interventions has attracted considerable investment and the cumulative outcomes of this research have been translated into recommendations for best practice; as outlined in the National Clinical Guidelines for Stroke. However, although the drive towards evidence-based practice and systematic reviews of clinical trials research has contributed significantly to explaining and responding to the emotional effects of stroke, it has also revealed some of the limits of biomedical research evidence. Directing attention toward other sources of evidence could offer further important insights into the emotional response to stroke.
The importance of the immune response in multiple sclerosis, part 1: Pathophysiology
Authors: Ward-Abel Nicki , Burgoyne Tracey
Published: May 2014

There is no doubt that people with multiple sclerosis (MS) now require therapies that are not traditionally prescribed in the neurology setting and, as such, many practitioners who provide day to day care of MS patients may find themselves unfamiliar with the administration of these therapies and their associated side effects. These new treatment approaches will result in neurology practitioners needing to develop their knowledge and understanding of different physiological mechanisms and consider different supportive strategies for people with MS. The following article is the first of a two-part series aimed at increasing knowledge and understanding of MS. It will provide an overview of the immune system, then examine the specific cells that are affected in a person who has MS. It will provide the reader with an insight into the physiological changes that take place in MS and highlight how the immune system affects the disease trajectory.
Dementia Strategy will require better training
Authors: Woodward Sue
Published: May 2014

Dementia is widely acknowledged to be one of the most signifi cant health issues facing the UK and the NHS. As the population ages, the numbers of people diagnosed with dementia are growing, and are expected to double to 1.4 million over the next 30 years (Department of Health (DH), 2008). Dementia is currently estimated to cost the UK £17 billion a year, and the cost of caring for people with dementia is expected to treble in the next 30 years to over £50 billion a year. The health minister, Ivan Lewis MP, launched a Department of Health consultation ‘Transforming the Quality of Dementia Care’ (DH, 2008) recently. This consultation will inform a National Dementia Strategy for England, and one of the key aims is to ensure accurate and early diagnosis. The consultation follows the launch of the Alzheimer's Society (2008) campaign ’Worried about your memory?’ which aims to prompt people concerned about memory loss, or that of a relative, to seek medical advice.
Sacral nerve stimulation for treatment of refractory urinary urge incontinence: A review
Authors: Fitzpatrick Maria
Published: May 2014

Urge incontinence is common in post-stroke and neurology patients as a result of overactive bladder. It is usually resistant to available treatments such as biofeedback, pharmacotherapy and behavioural therapies. A number of studies have proven the efficacy and safety of sacral nerve stimulation in the treatment of refractory urinary incontinence.

A systematic literature search was undertaken to identify randomized controlled trials on the efficacy of sacral nerve stimulation in refractory cases of urinary incontinence. Two trials fulfilled the criteria for inclusion in this review. The meta-analysis indicated that sacral nerve stimulation is an efficient means of treating refractory urinary incontinence. Although the review of limited data suggests that sacral nerve stimulation is an effective and safe treatment for refractory urge incontinence, further research is needed to strengthen these findings.
Caring about carers: Valuing their role
Authors: Hill Matt
Published: May 2014

Matt Hill highlights the substantial contribution that carers make to society, and the aims of Carers UK, a charity set up to support them
Book Review
Authors: May Lindy
Published: May 2014

This book is aimed at student nurses who wish to understand the basics of nursing children undergoing neurosurgery. For more current practice and a more thorough understanding, further reading is required, but the book provides an introduction.
A summary of the guidance relating to four lifestyle risk factors for recurrent stroke
Authors: Lawrence Maggie , Kerr Susan , Watson Hazel E , Jackson Jennie , Brownlee Margaret G
Published: May 2014

Background: Stroke is a major cause of mortality, disability and family disruption; yet prevalence continues to rise despite advances in prevention and treatment. Many risk factors for stroke are modifiable, including life style behaviours, i.e. tobacco and alcohol use, diet and physical activity. Patterns that influence lifestyle behaviour are believed to be embedded in family life. Primary and secondary prevention of stroke are important health promotion issues. Objective: To summarize government recommendations and contemporary evidence-based guidelines regarding four lifestyle risk factors for recurrent stroke. Methods: Structured review methods were used. Conclusions: Modifiable lifestyle risk factors for stroke and recurrent stroke have been identified and brief interventions are known to be cost effective health promotion tools. However, very few studies have tested the effectiveness of behavioural interventions designed to address lifestyle risk factors for recurrent stroke and none have tested the effectiveness of family-centred behavioural interventions. Recommendations for education, practice and research are presented.
Motor neurone disease: Carers' experiences, behaviour and coping methods
Authors: Gent Carol , McGarry Julie , Pinnington Lorraine
Published: May 2014

Background: Motor neurone disease (MND) is a neurodegenerative life-limiting condition. The literature suggests that carers are potentially at risk of stress, depression and anxiety.

Aim: To explore the experiences of carers to identify the coping strategies adopted and potential implications for service provision.

Sample and setting: A purposive sample of six family members recruited from one community outreach rehabilitation team.

Methods: A qualitative approach involving semi-structured interviews.

Analysis: An iterative approach undertaken to data analysis informed by the analytical hierarchy.

Findings: Three main themes emerged from the data: support for carers, coping strategies and the nature of the caring role. These offer an account of the experiences of carers.

Conclusions: Findings suggest that health and social care professionals need to balance objectivity with an empathetic approach. They should be willing to share the limits of their knowledge. Flexible management procedures are needed when developing strategies or plans for continuing professional development activities.
Identifying and managing Charcot-Marie-Tooth disease
Authors: Pountney David
Published: May 2014

Charcot-Marie-Tooth disease (CMT), also known as hereditary motor and sensory neuropathy (HMSN) or peroneal muscular atrophy (PMA), is a collection of related disorders, and is classified as a form of muscular dystrophy (Carter et al, 2008). However, unlike muscular dystrophy in which the defect occurs within muscle tissue, in CMT the defect affects the peripheral nerves that control the muscles (Jani-Ascadi et al, 2008) (Figure 1). Disorders that affect the peripheral nerves are called peripheral neuropathies. The disease takes its name from the three clinicians attributed to its discovery, namely Jean-Martin Charcot, Pierre Marie and Howard Henry Tooth (Carter et al, 2008).
What young people know about epilepsy and how they are affected by recurrent seizures
Authors: Erichsen Torunn , Hamilton Glenys , Nakken Karl Otto , Smeby Nina Aarhus
Published: May 2014

This study's aim was to investigate what young people with epilepsy know about their disorder and how epilepsy and epilepsy treatment affects their lives. By means of a self-reporting questionnaire, information about their knowledge of epilepsy, clinical, demographic, and psychosocial data were collected. The subjects were recruited at a summer camp for young people with epilepsy in Norway.

Forty-five people aged 14–30 years volunteered to participate. The majority of those questioned reported that epilepsy and its treatment had a negative impact on their daily lives and their social adjustment. Approximately 50% reported that suffering from epilepsy made them feel useless and more dependent on others; 39% felt they were a burden to their family and friends; and 40% experienced a moderate or high degree of stigmatization. However, none of those with a high level of epilepsy knowledge reported that they felt stigma. Findings from this study emphasize the need for continued education and support for young people with epilepsy. In order to prevent psychological and psychosocial problems it is important to include both medical and psychosocial sessions in educational programmes.
Putting users at the heart of health service development and delivery
Authors: Thomas Sue
Published: May 2014

User involvement in health service development and delivery recognizes the active role that can be played by this group in securing appropriate, effective safe and responsive health care. Users can contribute to quality improvement within the health service at both individual and group levels in areas like improving health literacy, clinical decision making, self-care, patient safety, access to health advice, the care experience and service development.
RESEARCH ROUNDUP
Authors: Potter Claire , Ahmed Iram
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 roundup 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.
Neurological services need the regulator to take a closer look
Authors: Moonan Clare
Published: May 2014

Improvements in health services for people with neurological conditions have not been a priority in spite of the NSF for long-term conditions, argues the Neurological Allance
The management and treatment of trigeminal neuralgia: Considering the options
Authors: Warren Diana
Published: May 2014

This article discusses the diagnosis and treatment options for people suffering from trigeminal neuralgia and the treatment options available to prevent future acute exacerbations of pain. A case study is included to highlight the needs of a patient suffering from the condition. Trigeminal neuralgia is a condition characterized by paroxysms of facial pain, which may be initiated by touch, heat/cold, or eating. Pain occurs in the areas supplied by the trigeminal nerve such as the cheeks, jaw, teeth and gums.
Using fMRI to facilitate communication
Authors: Woodward Sue
Published: May 2014

I am sure that the publication of a study in February that demonstrated awareness in some patients who had been diagnosed in a permanent vegetative state (Monti et al, 2010) cannot have escaped your attention. This study was the culmination of a Medical Research Council (MRC)-funded programme of research collaboration between centres in the UK and Belgium and used functional magnetic resonance imaging (fMRI) to assess patients' ability to generate wilful responses to communicate ‘yes’ and ‘no’ to simple questions. Of the 54 patients who were assessed, 5 were able to wilfully modulate their responses, demonstrating a level of awareness. Patients and healthy volunteers were asked to imagine playing tennis, which generated a response in the pre-motor cortex when the response to a particular biographical question was ‘yes’.
RESEARCH ROUNDUP
Authors: O'Brien Mary
Published: May 2014

Huntington's disease: Families' experiences of health services
A brief history of resuscitation and beyond: As easy as ABCDE
Authors: Brunker Chris
Published: May 2014

The development of the ABCDE mnemonic is a useful device to help health professionals remember priorities in dealing with acutely ill patients. While its meaning has developed over the decades, the assessment algorithm it represents demonstrates an effective, highly organized, yet simple method of ensuring that the priorities of checking the airway, breathing, circulation, for any disabilities and exposure for full examination are followed. Various initiatives helped to extend these basic principles of resuscitation to ensure quick, appropriate and effective treatment to all patients undergoing acute in-patient care.
Experiences of people with Parkinson's disease and their carers of a specialist nursing service
Authors: Cook Neal , McNamee Deirdre , McFetridge Brian , Deeny Pat
Published: May 2014

The results of the second phase of a research study into the perceived role of the Parkinson's disease (PD) nurse specialist in an area health board are presented and discussed in this article.

Aim: The aim of the second phase of the study was to further clarify the role of the PD nurse specialist and make recommendations for enhancing the role and improving services to those with PD and their families.

Method: Questionnaires and semi-structured interviews were employed to determine the perceptions of the role of the PD nurse specialist. One hundred people with PD and 100 carers were sent questionnaires relating to different aspects of the role of the PD nurse specialist. Eight carers and 8 people with PD were interviewed using semi-structured questionnaires. Quantitative data were analysed using descriptive statistics, and qualitative data analysed for emerging themes and concepts.

Findings: The results illustrate the pivotal role that the PD nurse specialist has in enabling people with PD and their carers to live with the condition. Results are used to develop recommendations for future development of the role.
Understanding restraint in the context of law
Authors: Amin Yogi , Irwin Anne-Marie , LLP Irwin Mitchell
Published: May 2014

The key to lawful intervention is the proportionate and least restrictive use of physical restraint through assessment and planning.
Assessment of airway and breathing in adults
Authors: Hassall Sarah , Butler-Williams Carole
Published: May 2014

It has been well documented that patients who become critically unwell or suffer cardiorespiratory arrest frequently display signs and symptoms of deterioration in the preceding hours, which, if recognized and acted on, can prevent the critical attack (Smith and Wood, 1998; Cullinane et al, 2005; National Institute for Health and Clinical Excellence, 2007). In this article, the airway and breathing aspects of a complete A to E assessment are discussed, along with an introduction to the process of carrying out a physical assessment. Basic but potentially lifesaving interventions are outlined for the treatment for airway and respiratory compromise.
Blood glucose monitoring in critically ill patients
Authors: Hassall Sarah , Williams Carole Butler-
Published: May 2014

Critical illness or trauma may trigger a rise in levels of cortisol, noradrenaline and glycogen which stimulate glycogen and fat breakdown causing a rise in blood glucose levels. However, the normal mechanisms to increase insulin production may be impaired by critical illness. Additionally, sedation and causes of reduced level of consciousness can mask the neurological symptoms of hypo or hyperglycaemia, making it particularly important to monitor blood glucose in this group of patients. It is important that health professionals understand the physiological affects of hypo and hyperglycaemia and know the safeguards required in order to minimize the potential for erroneous or misleading blood glucose results, and improve care for this group of patients.
Ensuring records stand up to legal scrutiny
Authors: Lynch Jane
Published: May 2014

Health professionals need to ensure that full records are kept to enable the safe treatment of patients and to reconstruct events.
Focusing on quality outcomes
Authors: Thomas Sue
Published: May 2014

The NHS Outcomes Framework is to be developed to refocus the NHS on patient outcomes and remove arduous process targets.
RESEARCH ROUNDUP
Authors: Baker Mark , Clegg Marietta
Published: May 2014

Predicting falls in Parkinson's disease
Non-malignant disease: a pathway for quality care at the end of life
Authors: O'Connor Margaret , Harris Rodney , Lee Susan
Published: May 2014

The philosophy of palliative care promotes care for all those in need who are facing the end of life. Although long-term, neurological and nonmalignant illnesses are included in palliative care policies, there remains a reticence to accept referrals from these groups. The practical application of palliative care principles for non-cancer diagnoses has been difficult to achieve. The reasons for this are multi-factorial, from both patient and family perspectives as well as health professionals' experiences. This paper addresses some of those issues and discusses an Australian model of care which has successfully increased referrals to palliative care services through a number of key strategic links with palliative care services.
Development of a support group for stroke survivors and their carers and/or families
Authors: Slark Julia , Makahamadze Christwishes , Catangui Elmer , Stear Sally , Amorim Alcina
Published: May 2014

Aims: To develop a focussed support group for stroke survivors, their carers and families using participant's opinions to design and develop the service.

Methods: All patients with a diagnosis of stroke or at high risk of transient ischaemic attack (TIA) and their carers were invited to attend a monthly meeting. A structured programme was created for each session. All participants recruited have been seen as either inpatients or outpatients at Imperial College healthcare NHS trust

Results: 84 participants have to date attended the Stroke Support Group over 6 months. The participants were made up of ex-patients, carers, high-risk TIA patients and inpatients.

Conclusions: Patients were not afraid to speak out as the groups were not too big. Illustration of information in Powerpoint pictures was useful for clarification and better understanding. Patients found the doctors' session most informative. Patients found it worthwhile to share similar experiences. Inpatients generally appreciated receiving information in a setting different from the ward.

Recommendations: Too much statistical information on slides was not favourable in view of low concentration span.

Future plans: Plans to provide a similar service at the other sites in the trust are underway. The provision of an evening session to benefit patients and carers that work is being reconsidered. A clinical nurse specialist-led surgery for ‘drop-in’ clinics in the evenings on the stroke wards is to be considered to provide support for inpatients and their carers planning discharge.
Multidisciplinary team working in motor neurone disease: patient and family carer views
Authors: O’Brien Mary , Whitehead Bridget , Jack Barbara , Mitchell J Douglas
Published: May 2014

Background: Motor neurone disease (MND) results in systemic disabilities due to progressive muscle weakness. Patients and families affected by the illness will require input from a wide range of health and social care professionals. Evidence for the efficacy of a multidisciplinary team approach to care in MND is limited, with a Cochrane review calling for ‘real life’ research on the topic. The views of patients and family carers have not been dominant in published studies. To ensure that services are meeting their needs it was important to obtain the perspectives of those living with the illness. Aim: To obtain the views of people with MND and family carers regarding multidisciplinary team (MDT) working. Method: A qualitative study involving narrative style interviews was conducted in Northwest England. People with MND (24), family carers (18) and former carers (10) were recruited through an MND Care and Research Centre. Results: A number of themes emerged from a thematic analysis: having a single point of access; specialist knowledge and skills; saving time and energy; regular follow up; valued members of the MDT; working together as a team. Conclusion: The findings greatly enhance our understanding of the effect of MDT working on people with MND and their family carers
Effects of nursing procedures on ICP in paediatric TBI
Authors: Eberhardie Christine
Published: May 2014

Christine Eberhardie provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail.
Working together: multiple sclerosis and mental health nurses
Authors: Askey-Jones Sally , Shaw Pauline , Silber Eli
Published: May 2014

Mental health issues and emotional distress are a common occurrence in multiple sclerosis (MS), and are often under diagnosed and under treated; resulting in reduced functioning, increased disability and reduced quality of life. Research has suggested that treatments such as antidepressants and cognitive behaviour therapy are effective in alleviating mental health issues in MS, although it appears that many people with MS have difficulty accessing the appropriate mental health care. This paper outlines an initiative to improve access to mental health care and treatment for people with MS. It highlights the importance of joint working across boundaries for improved patient care and suggests management strategies for people experiencing mental distress in the context of multiple sclerosis.
Care of the person with epilepsy in the hospital environment—getting it right
Authors: Queally Cathy , Lailey Sara
Published: May 2014

This article provides a general update regarding the definition of epilepsy, explanation of seizure classification, a brief outline of the treatment options available. The main theme is the safety implications for the patient with epilepsy reducing the risk of injury and death as a consequence of seizure activity in an acute setting. Sudden unexplained death in epilepsy (SUDEP) is discussed together with the nurse’s role and responsibilities when caring for a patient with epilepsy along with nursing assessment and management issues that should be considered. These include patient safety, observation pre-ictal, ictal and post-ictal.
Goal setting in stroke rehabilitation: part 2. How do health professionals set goals and what is the nurse's role?
Authors: Hartigan Irene
Published: May 2014

Setting goals for the rehabilitation of people who have suffered a stroke can be challenging for health professionals. A review of the literature demonstrates that there are several barriers to this process, and these barriers are discussed in this paper. Often the nurse's role in the process is ambiguous. Given the continual nature of the relationship that nurses have with patients during their rehabilitation, nurses can empower, advocate, support and educate the patient at any stage during the process of goal setting. This acronym, EASE, signifies the role of the nurse in the process of goal setting through a range of activities that support patients in the aftermath of a stroke. This paper examines opportunities the nurse can create to EASE the process of goal setting.
Developing a staged Year of Care model for progressive supranuclear palsy
Authors: Peel Charlotte , Chand Debra , Thomas Sue , CM Wilkinson Nicola
Published: May 2014

In 2011 the PSP Association, supported by Neurological Commissioning Support, created a ‘Year of Care’ staged pathway model for progressive supranuclear palsy (PSP). It is the first UK-wide staged pathway to have been created for this condition. A Year of Care model demonstrates the full range of services and support that someone with a specific condition might need to access in the course of one year and suggests the costs that might be associated with that care. The Year of Care pathway for PSP provides clinical guidance for disease management as well as acting as an educational tool for health and social care professionals, commissioners and lay people. This paper describes the development of the pathway as well as plans for its future evolution.
User perspectives on rehabilitation
Authors: O’Brien Mary
Published: May 2014

Mary O’Brien provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail.
Post-traumatic hypopituitarism (PTHP): an under-diagnosed complication
Authors: Waterhouse Catheryne
Published: May 2014

One of the main objectives of this article is to advance understanding of a substantially under-diagnosed complication of brain injury. Damage to the hypothalamus or pituitary gland can affect the production and secretion of several hormones, specifically growth hormone, luteinising hormone, follicle stimulating hormone, prolactin, cortisol, adrenocorticotropic hormone, thyroid stimulating hormone, testosterone and oestradiol. Low levels of these hormones can lead to a variety of clinical manifestations and can have serious physical and/or psychological effects including on a person's quality of life. Even small disruptions in hormone levels can affect growth and development, concentration, and sexual function, causing depression, difficulty with personal intimacy and difficulty sustaining personal relationships. Collaboration between neurosurgeons, neuropsychologists and endocrinologists is required to review which effects may be related to pituitary levels and which may be physiological results of the brain injury. However, for patients presenting with overt signs of hypopituitarism it is not unreasonable to advocate baseline pituitary function tests to diagnose biochemical deficiencies.
One hospital’s collaborative pathway for the optimal management of transient ischaemic attack
Authors: Javier Catangui Elmer , Slark Julia
Published: May 2014

A transient ischaemic attack (TIA) is a warning sign that a stroke may occur unless preventive steps are taken. All suspected TIA patients should be assessed by a specialist. This paper describes a collaborative service developed by one acute hospital with the intention of improving the way that TIA patients are screened, assessed and managed based on available national guidelines. Working collaboratively is key to improving the patient’s journey from the TIA clinic.
Sleep disturbance following traumatic brain injury in children: a case study
Authors: Wilson Nicola
Published: May 2014

Sleep disturbance in children recovering from traumatic brain injury presents a significant challenge for nurses in paediatric neuroscience. This article aims to increase the understanding of the normal physiology of sleep and uses a paediatric case study to contrast this with the pathophysiology of sleep in patients who suffer sleep disturbance as a result of severe head injury. The long-term effects of sleep disturbance are discussed and analysis of recent literature is used to explore the nursing management of this problem. The article concludes by putting forward several strategies to facilitate the management of this patient group, including nurse education.
Parkinson's Disease Nurse Specialists and the King's College Hospital model of care
Authors: Martin Anne , Mills Jane
Published: May 2014

Parkinson's is the second most common neurodegenerative disorder. Characterised by both motor and non-motor symptoms, it affects the young as well as the old. Offering treatment with minimal disruption as well as providing an easily accessible support network is vital for the quality of life of people living with Parkinson's, particularly younger people. King's College Hospital offers full specialist care for people with Parkinson's. At the heart of this is the Parkinson's Disease Nurse Specialist (PDNS), who provides continuous care both within the health-care setting and in people's homes. The PDNS also liaises with members of the multidisciplinary team. This article reviews the challenges faced when treating people with Parkinson's and shows how the model set up by King's College Hospital has overcome these obstacles. It is hoped that more centres in the UK and Europe will adopt this model, ensuring that all people with Parkinson's receive the best care possible.
Managing urinary incontinence in people with neurological disorders. Part 1: assessment
Authors: Woodward Sue
Published: May 2014

Urinary incontinence is common among people with neurological disorders and adversely affects quality of life for many patients. Much can be done to alleviate symptoms and in many cases urinary incontinence can be better managed. This article provides the reader with an overview of the types of urinary incontinence in people with neurological disorders and outlines the detailed assessment of lower urinary tract symptoms.
A pilot study of the effects of progressive muscle relaxation on fatigue specific to multiple sclerosis
Authors: Moriya Rika , Ikeda Nanae
Published: May 2014

This study aimed to examine the effect of progressive muscle relaxation (PMR) on fatigue over 3 months in four people with multiple sclerosis (MS) and to identify implementation problems. Subjective fatigue was measured using the Visual Analogue Scale (VAS), quality of life using the SF-8, and mood using the Profile of Mood States (POMS) after 1, 7 and 14 days and 1, 2 and 3 months following initiation of PMR. The participants also maintained diaries of their experiences. For three of the four participants, VAS scores reduced and mental quality of life (QoL) and mood stability improved over the period of the study. By contrast, physical QoL was reduced, and the diary entries indicated problems such as difficulty in maintaining the programme and paraesthesia associated with implementation. These findings suggest that PMR has a beneficial effect on fatigue in some people with MS and may enable it to be predicted and controlled.
Managing urinary incontinence in people with neurological disorders. Part 2: interventions
Authors: Woodward Sue
Published: May 2014

Urinary incontinence is common among people with neurological disorders and adversely affects quality of life for many patients. People with neurological disorders often present with urinary incontinence due to a failure of the bladder to adequately store or adequately empty urine. Much can be done to alleviate symptoms and in many cases urinary incontinence can be better managed. Conservative and behavioural methods are often implemented before pharmacological or invasive surgical interventions. Problems of bladder storage are treated by pelvic floor muscle training, bladder training, anti-muscarinic medication, botulinum toxin-A injections and augmentation cystoplasty. Problems of bladder emptying are treated by intermittent or indwelling catheterisation, or in extreme cases an ileal conduit may be formed. Neuroscience nurses are pivotal to supporting patients with urinary incontinence as a result of neurogenic bladder dysfunction. This article provides the reader with an overview of the interventions used in the treatment of urinary incontinence in people with neurological disorders.
The nursing role in thrombolysis treatment for acute ischaemic stroke: an overview
Authors: Catangui Elmer
Published: May 2014

Clot-busting thrombolysis treatment is recommended for some patients with stroke if it can be administered within 4.5 hours of stroke onset. Over the past few years, initiatives across the UK stemming from the Department of Health's (2007) National Stroke Strategy have attempted to improve various aspects of stroke treatment, including rates and speed of administration of thrombolysis ( NHS Improvement, 2010a ; 2010b ). Specialist stroke nurses have played an important part in these efforts, but there is a limited amount of literature defining the nursing role in thrombolysis treatment. This article provides an overview of the nursing role in delivering thrombolysis treatment in acute ischaemic stroke and the factors that affect it.
Hemispatial neglect: clinical features, assessment and treatment
Authors: Gallagher Maria , Wilkinson David , Sakel Mohamed
Published: May 2014

Hemispatial neglect is a disorder of attention that commonly follows from damage to the right side of the brain. Patients with neglect show symptoms of lateralised inattention, failing to acknowledge or report information on the left side. Neglect is a poor prognostic indicator for general functional recovery from stroke, and is associated with a range of co-morbid conditions including denial or indifference to the brain injury, hemiplegia and visual field loss. Mild-to-moderate cases can be overshadowed by the more gross symptoms that accompany brain injury; however, assessment and diagnosis are relatively quick and simple. Current treatment guidelines suggest that patients should be taught compensatory strategies, but these are largely ineffective. Although recent research has identified more promising treatment approaches, investigations are still preliminary. Given the prevalence and debilitating nature of neglect, there is a clear need to raise awareness and understanding of the condition among carers and health professionals.
Research Roundup
Authors: Mestecky Ann-Marie
Published: May 2014

Ann-Marie Mestecky provides a synopsis and brief review of a selection of recently published research articles of interest to neuroscience nurses, highlighting the key points to keep you up to date. A full reference is provided for those who wish to read the research in more detail.
Technology for rehabilitating the upper limb after stroke: the hand
Authors: Graham Jon
Published: May 2014

Complete recovery of upper-limb function occurs in less than 20% of surviving stroke patients. Functional task-oriented training has been demonstrated to be the most effective therapeutic intervention. However, the number of repetitions of an action required within a session to stimulate cortical changes is significantly higher than is achieved in standard hands-on therapy sessions. New technology is enabling patients to engage in high-intensity, repetitive training and has augmented feedback to improve performance.
The less we do, the more we give
Authors: Downe Soo
Published: May 2014

Across the country cost improvements in maternity care are beginning to bite deeply, just as areas with pilot continuity-of-carer schemes begin to contemplate the costs of roll-out. The effect of these resource restraints is causing some hard thinking. On the one hand, it seems that the door is open to us as midwives to regain what many have argued is our rightful place in the delivery of maternity care.
Midwives' burnout and continuity of care
Authors: Sandall Jane
Published: May 2014

This study aimed to examine the impact of Changing Childbirth (Department of Health, 1993) on midwives' work and personal lives. It reports findings from a multiple site case study of community-based maternity care.

Each site represented a model of continuity of carer along a continuum from complete one-to-one continuity to continuity within a team. The three sites represented the traditional model of GP-attached community midwives, a community team and a community-based group practice.

Three key themes emerged from the data relating to sustainable practice, the avoidance of burnout and the provision of flexible woman-centred care. These were occupational autonomy, social support and developing meaningful relationships with women.

Control over work and continuity of care are as important to midwives in how well they balance their work and home life as they are to women experiencing childbirth. Models of care such as personal caseloads that incorporate these factors may be more sustainable in terms of less burnout and greater personal accomplishment than team caseloads.
Fetal activity and maternal monitoring methods
Authors: Fisher Margaret Louise
Published: May 2014

An extensive literature search was conducted into the subject of fetal activity and maternal monitoring techniques. During the past three decades much research has been performed in response to the identification of an ‘alarm signal’ of reduced fetal activity preceding death. Various methods of maternal counting have been attempted and it has been concluded that routine monitoring is not cost-effective. Technological advances have enabled detailed observational studies of fetal activity and maternal perception. Various physical and psychological factors appear to influence the latter. Evidence shows that fetal activity varies between individuals and according to gestation. It is suggested that fetuses undergo a continuum of development, and patterns and types of movement change as they mature. Certain substances such as tobacco smoke, drugs, alcohol and caffeine have been shown to affect movements. Contrary to earlier beliefs, maternal glucose levels are unrelated. It is concluded that updated evidence needs to be incorporated into clinical practice and education of both mothers and professionals in order to improve assessment of fetal wellbeing.
Drug dependancy: a case for maternity services
Authors: Bharj Kuldip
Published: May 2014

There is no doubt that drug dependency causes a serious health problem for an individual and arguably for society, and can lead to economic and political instability. Over recent years, the number of women, particularly those of childbearing age, who are dependent on drugs is on the increase (Siney, 1995). Indeed, this issue has become of particular interest for healthcare professionals working within the maternity services as there has been an increase in the number of pregnant drug dependent women.
Huggies® announce lik with the British Skin Foundation
Authors: Communications Claron
Published: May 2014

Huggies® Nappies have recently announced that they are in partnership with the British Skin Foundation (BSF) to encourage and promote infant skin health among parents and professionals.