bluuebunny/crossref_metadata_2025 huggingface dataset:
Quality Assurance of Torrefied Biomass Using RGB, Visual and near Infrared (Hyper) Spectral Image Data
Authors: Lindström Susanne Wiklund , Nilsson David , Nordin Anders , Nordwaeger Martin , Olofsson Ingemar , Pommer Linda , Geladi Paul
Published: June 2014

Visible and near infrared imaging techniques for analysing characteristics of torrefied biomass were evaluated for possible use in future online process control. The goal of such a control system is to identify products with the desired properties and reject products outside the specification. Two pushbroom hyperspectral cameras with different wavelength regions and a commercial digital colour camera were evaluated. The hyperspectral cameras, short wave infrared (SWIR) and visible–near infrared (VNIR), covered the ranges of 1000–2500 nm and 400–1000 nm, respectively. The biomass was produced according to an experimental design in a torrefaction pilot plant at different temperatures, residence times, and nitrogen and steam flow rates to obtain a wide range of different characteristics and qualities of torrefied material. Chemical characteristics, heating values and milling energy of the different torrefied materials were analysed or calculated using standardized procedures and were used for calibration. For the hyperspectral images, a principal-component analysis was performed on the absorbance spectra. The score plots and score images were used interactively to separate background, outlier pixels and shading effects from sample signal. Averaged spectra of individual torrefied woodchips were used. Partial least-squares regression was used to relate average spectra to heating values and chemical characteristics of the torrefied biomass. Owing to the small size of the data sets, cross-validation using leave-one-out validation was used for testing the models. The ratio of standard error of prediction to sample standard deviation ( RPD) values were used for comparing the imaging techniques. For RGB images, all RPD values were 4 or lower. The RPD values for the VNIR technique were all below 5, while the SWIR images produced RPD values above 5 for eight of the 13 properties. The promising results of the SWIR technique strongly suggested that the torrefied biomass undergoes changes to chemical structures, which are not necessarily manifested as changes to the colour of the material.
Detection of Hydrate Forms of Lithium and Sodium Perchlorates in Aqueous Solutions Using near Infrared Spectroscopy
Authors: Davidian Anna G. , Kudrev Andrei G. , Myund Lyubov A. , Khripun Maria K.
Published: June 2014

A new approach to the study of concentrated electrolyte water solutions is proposed. NIR spectra of aqueous solutions of LiClO4 and NaClO4 were studied. The pure spectra and concentration profiles of spectral forms in the solutions were found by deconvolution of an experimentally measured data matrix. The chemometric analysis and the generalised phenomenological model of the structure of aqueous electrolyte solutions were used to establish that the variation in spectra of LiClO4 solutions with concentration is due to antibatic changes in the fractions of water that is unbonded with ions and of water in the structure of the cybotactic group of lithium perchlorate trihydrate. Corresponding changes in NaClO4 solutions are also associated with interconversion of sodium perchlorate forms of di- and monohydrates. Hydrate forms of lithium and sodium perchlorates in aqueous solutions are described, and a cybotactic group in a saturated solution is found to be equivalent to a solid-phase structure fragment. A strategy for selecting the nature of a background electrolyte is recommended.
Patient dosimetry in interventional radiology using slow films.
Authors: Vañó E , Guibelalde E , Fernández J M , González L , Ten J I
Published: June 2014

A method for the evaluation of patient doses in interventional radiology procedures is presented and discussed. The method requires the analysis of slow non-screen films such as those used in radiotherapy. Dose area product and patient skin dose can be estimated with fair accuracy depending on the interventional procedure type. The agreement between the slow film method and diamentor measurement is better than 5% after the application of appropriate corrections. The cost is reasonable (pounds 5 per film) making it a worthwhile option in patient dosimetry, especially when the X-ray equipment does not include any fixed dose-area measuring device. Additional valuable information which may be applied to optimization of procedures (e.g. irradiated areas, number and types of projections check of appropriate use of beam limiting devices) is achieved by examining the different irradiation fields on the film.
Demonstration of a combined filter to improve the field uniformity of a 90 kV superficial X-ray therapy machine for different treatment field sizes.
Authors: Meyer J , Mills J A
Published: June 2014

The field uniformity of a superficial X-ray machine operating at 90 kV, 10 mA and filtered with a 1.1 mm aluminium beam hardening filter was investigated at a depth of 1 cm below the surface. Uniformity measurements were carried out using films and a densitometer to detect the relative absorbed dose across the field. Film dosimetry was assessed by comparison with ionization chamber dosimetry in a water tank. The original flat hardening aluminium filter was replaced by a combined, profiled filter to improve the uniformity across field sizes 20 cm, 5 cm and 2 cm diameter as well as hardening the beam. Flatness of the beam profile was improved for the 20 cm field size from +/-7.5% to +/-1.3% across the anode/cathode direction and from +/-7.9% to +/-4.7% in the anode/cathode direction. For the 5 cm field size the improvement was from +/-4% to +/-3% and from +/-5.3% to +/-3.6% and for 2 cm field size from +/-3.4% to +/-2.8% and from 10.5% to +/-9.7% in the same directions, respectively. Beam quality measurements were made and the original half-value-layer was reduced from 2.21 +/- 0.09 mm to 2.07 +/- 0.09 mm. The project demonstrated that it was possible to build a filter capable of flattening the beam profile for different sized applicators without significantly changing the penetrating ability of the beam.
Radiotherapy for hypoglycaemia associated with large leiomyosarcomas.
Authors: Kishi K , Sonomura T , Sato M
Published: June 2014

A patient with recurrent severe hypoglycaemia attacks due to a large, irresectable retroperitoneal leiomyosarcoma was treated with radiotherapy (60 Gy). The blood glucose level gradually and steadily improved as the cumulative radiation dose was increased. Weaning of hyperalimentation was started when the cumulative dose reached 21.6 Gy. The patient became completely free from hypoglycaemic attacks despite no significant diminishment of local tumour size and untreated multiple lung metastases. The patient was discharged and the attacks did not recur until expiration as a result of tumour bleeding. This case report supports the clinical usefulness of radiation therapy in treating hypoglycaemia induced by non-islet cell tumour.
The incidence of coronary artery calcification on standard thoracic CT scans.
Authors: Callaway M P , Richards P , Goddard P , Rees M
Published: June 2014

Coronary artery calcification indicates the presence of atheromatous disease and can represent an area of severe stenosis. The absence of calcification does not correlate with the absence of coronary artery disease, but an incidental finding of calcification has important prognostic implications. The best method available at present is electron beam computed tomography (EBCT) but these are often dedicated units in specialist centres and currently this modality is not widely available in the UK. This is the first study to establish the age/sex frequency with which incidental coronary artery calcification is detected using standard CT scanning in a large population. The methods used are simple, reproducible and based on standard thoracic protocols. The presence of calcification is easily detected using readily available equipment. The reported incidence of calcification using EBCT, the most sensitive method available, was compared with standard CT detection rates. While standard CT underestimates the presence of calcification, the age/sex trends are very similar. Standard CT probably detects the most dense lesions, missing areas of mild calcification, recent studies having shown that these lesions are most likely to represent areas of stenosis. This study shows that, with very little change in current practice and on readily available equipment, it is possible to obtain important diagnostic information suggesting the presence of severe coronary artery disease.
The combined use of ultrasound and densitometry in the prediction of vertebral fracture.
Authors: Cepollaro C , Gonnelli S , Pondrelli C , Martini S , Montagnani A , Rossi S , Gennari L , Gennari C
Published: June 2014

Measurement of ultrasonographic parameters provides information concerning not only bone density but also bone architecture. We investigated the usefulness of ultrasonographic parameters and bone mineral density for evaluating the probability of vertebral fracture. 397 postmenopausal women (59.1 +/- 6.0 years) with (n = 178) or without (n = 219) atraumatic vertebral fractures were studied. In all women, bone mineral density (BMD) of the lumbar spine was evaluated by dual X-ray absorptiometry (DXA) and speed of sound (SOS); broadband ultrasound attenuation (BUA) and Stiffness in the calcaneus were evaluated by an Achilles unit (Lunar Corporation). Ultrasonographic parameters and BMD were compared by examining the magnitude of the odds ratios, to determine which produces the highest estimate of the probability of odds of fracture, and by examining widths of the respective confidence intervals (CI) to show which estimate of odd ratio is the most precise. The relative risk of vertebral fracture, after adjusting for potential confounders, was 3.5 (CI 2.6-4.8) for BUA; 4.5 (CI 3.2-6.2) for SOS; 5.8 (CI 4.0-8.4) for Stiffness and 7.5 (CI 4.8-11.5) for BMD. Ultrasound (US) parameters were still significant independent predictors of vertebral fracture, even after adjusting for BMD. The relative risk of fracture for a simultaneous decrease by 1 SD of BMD and by 1 SD of each ultrasound parameter was 17.3 (CI 9.4-39.6) for BMD and SOS; 18.3 (CI 8.4-30.6) for BMD and BUA and 22.1 (CI 8.9-52.7) for BMD and Stiffness. Our data suggest that US and BMD provide complementary information which can be combined to improve estimates of vertebral fracture risk.
Comparison of T2 weighted fat suppressed turbo spin echo and contrast enhanced T1 weighted spin echo MRI in nasopharyngeal carcinoma.
Authors: King A D , Lam W W , Leung S F , Chan Y L , Metreweli C
Published: June 2014

Fat suppressed T2 weighted fast imaging sequences have recently been favoured in MRI of head and neck tumours. The purpose of this study was to evaluate the use of T2 weighted fat suppressed turbo spin echo (T2W SPIR) and compare it with our standard technique, the gadolinium-enhanced T1 weighted spin echo (Gd-T1W SE). The MR images of 36 patients with nasopharyngeal carcinoma were analysed for local tumour extent. T2W SPIR was better in evaluating tumour extension into the clivus and fascia. In all other regions Gd-T1W SE was either better (nasopharyngeal walls, small parapharyngeal muscles, parapharyngeal fat space, paranasal sinuses, pterygomaxillary fissure and pterygoid process) or equal (nasal cavity, oropharynx, cranial fossa and cavernous sinus) to T2W SPIR. T2W SPIR was unable to replace Gd-T1W SE in evaluation of tumour extent because of loss of signal from magnetic susceptibility artefact, poor delineation of anatomical detail and reduced tumour conspicuity. The use of T2W SPIR as an additional sequence may be warranted in selected cases but cannot replace Gd-T1W SE.
Digital radiography in paediatrics: radiation dose considerations and magnitude of possible dose reduction.
Authors: Hufton A P , Doyle S M , Carty H M
Published: June 2014

The purpose of this study was to evaluate the radiation doses received by paediatric patients examined using a digital radiography unit, and to compare these doses with those received from conventional screen-film systems. In this way, guidelines could be drawn up concerning the magnitude of possible dose reductions achievable using digital radiography. The study was undertaken on approximately 900 patients undergoing abdomen, chest, pelvis and skull examinations. Patients were categorized into the following age groups: 0-1 month, 1-12 months, 1-5 years, 5-10 years and 10-15 years. Approximately half were X-rayed using a Fuji computed radiography system and half using a conventional screen-film system. Entrance surface dose was calculated from the recorded exposure parameters and measured X-ray tube outputs. Dose-area product was recorded directly. Image quality was assessed clinically using criteria recommended by a working group of the Commission of the European Communities. Apart from chest examinations, it was found possible to reduce doses by about 40% on average, by using a computed radiography system instead of a 600 speed screen-film combination. There was no significant difference in the dose for chest examinations. Satisfactory image quality can therefore be achieved by using computed radiography as a 1000 speed system for abdomen, pelvis and skull examinations, and as a 600 speed system for chests. Since very few departments appear to use screen-film systems of speeds greater than 400, then, for most departments, the use of computed radiography would result in dose reductions of at least 60%, or 33% for chests.
The clinical radiobiology of brachytherapy.
Authors: Dale R G , Jones B
Published: June 2014

The unique geometrical features of brachytherapy, together with the wide variety of temporal patterns of dose delivery, result in important interactions between physics and radiobiology. These interactions exert a major influence on the way in which brachytherapy treatments should be evaluated, both in absolute and comparative terms. This article reviews the main physical and radiobiological aspects of brachytherapy and considers examples of their influence on specific types of treatment. The issues relating to the optimization of high dose rate brachytherapy are presented, together with the implications of multiphasic repair kinetics for low dose-rate and pulsed high dose rate brachytherapy. The opportunities for application of radiobiological principles to improve various brachytherapy techniques, together with the integration of brachytherapy with teletherapy, are also outlined. Equations for the numerical evaluation of brachytherapy treatments are presented in the Appendices.
Lens injuries induced by occupational exposure in non-optimized interventional radiology laboratories.
Authors: Vañó E , González L , Beneytez F , Moreno F
Published: June 2014

Several cases of ophthalmologically confirmed lens injuries, caused by occupational radiation exposure, have occurred in two X-ray rooms devoted to vascular and visceral interventional radiology procedures. Both laboratories were equipped with overcouch X-ray systems not designed for interventional radiology and without specific tools for radiation protection of the eyes. Typical workloads ranged from between two and five procedures per day. For the two radiologists affected, estimates for the dose to eye lens ranged from 450 to 900 mSv per year, over several years. Once the incidents had been detected, the X-ray systems in both rooms were removed and new equipment specifically designed for interventional radiology was installed, including suspended shielding screens. Since these lens injuries were only detected accidentally, measures to avoid similar occurrences in the future are discussed.
Radiation exposure to medical staff in interventional and cardiac radiology.
Authors: Vañó E , González L , Guibelalde E , Fernández J M , Ten J I
Published: June 2014

The aim of this work has been to determine typical occupational dose levels in interventional radiology and cardiology installations and to relate doses to patient and occupational dosimetry through the dose-area product. An experimental correlation between environmental dosimetric records and dose-area products in the centres studied was established. The study covered a sample of 83 procedures performed by 10 specialists in six laboratories. The radiologists and cardiologists monitored wore nine thermoluminescent chips next to eyes, forehead, neck, hands, left shoulder, left forearm and left arm during each single procedure. In addition, direct reading electronic devices for environmental dosimetry were placed in the C-arm of the X-ray system, to estimate roughly the occupational radiation risk level. Typical shoulder doses derived from electronic dosimetry range between 300 and 500 muSv per procedure, assuming no lead protective screens were used. Using these values and patient dose-area data from two laboratories, averaged ratios of 84 and 120 muSv per 1000 cGy cm2 are obtained for cardiology procedures. Finally, occupational dose reductions of approximately 20% when using highly filtered X-ray beams with automatic tube potential (kV) reduction (available in some facilities), and by a factor of about three when using ceiling mounted screens, have been found.
The cost of MRI: changes in costs 1989-1996.
Authors: Fletcher J , Clark M D , Sutton F A , Wellings R , Garas K
Published: June 2014

A study was conducted to provide an up-to-date analysis of the costs associated with operating an MRI facility in a mainstream National Health Service (NHS) setting. This paper presents an analysis of the costs associated with the acquisition and operation of an MRI scanner installed at the Walsgrave NHS Trust in Coventry in 1988. Costs arising immediately after the introduction of the MRI facility in 1988 are compared with the costs arising towards the end of the scanner's useful life during the 1995/96 financial year. The findings suggest that although the nominal total costs of MRI have increased marginally, from 403,223 Pounds to 434,037 Pounds (an increase of 30,814 Pounds), the increase in total costs is below the rate of inflation, and the nominal average costs of MRI have fallen from 179.20 Pounds to 115.77 Pounds over the period.
Enhanced normal tissue doses caused by tumour shrinkage during brachytherapy.
Authors: Dale R G , Jones B
Published: June 2014

Published data concerning shrinkage rates of low-grade gliomas implanted with 125I seeds have been used to determine the likely influence of such shrinkage on normal tissue doses. It is demonstrated that a tumour volume shrinkage of 50% over 6 months can bring about a 30% increase in the dose delivered to tissues which shrink centripetally towards the implanted volume. The use of radionuclides with a half-life shorter than that of 125I would substantially reduce shrinkage-induced dose increments.
Female adnexal tumour of probable Wolffian origin: MR findings.
Authors: Matsuki M , Kaji Y , Matsuo M
Published: June 2014

Female adnexal tumour of probable Wolffian origin is a rare tumour that arises from remnants of the Wolffian duct. Clinical and pathological findings of this tumour have been documented, but the MR findings have not been previously reported. We report the MRI features of an adnexal tumour of probable Wolffian origin.
Acoustic Wave Focusing by Non-Uniform Mean Flow in a Rectangular Duct with Viscous Walls
Authors: Markesteijn Anton P. , Karabasov Sergey A.
Published: June 2014

The high-frequency acoustic wave focusing by a viscous flow profile and reflective duct walls encasing the flow is considered. For a range of the non-uniform meanflow and duct parameters, the problem of image sources generation upstream of the physical source in a rectangular duct is investigated computationally and analytically. This is done first by solving the Navier-Stokes equations at high Reynolds number in the Eulerian framework, then by using a Lagrangian particle method based on the high-frequency approximation, and finally, with a simple analytical plug-flow-profile model based on geometrical acoustics. It is shown that both the meanflow-refraction and wall-reflection play a key role in the focusing of acoustic waves. The analogy with geometrical acoustics is further emphasized by comparing the Navier-Stokes simulation results with the experimental data from the literature on acoustic wave focusing by a lens made of a negatively refractive material.
Policy‐Based Approach to Emergency Bio‐Data Management for Mobile Healthcare
Authors: Chun Seung-Man , Park Jong-Tae
Published: June 2014

In m‐healthcare service, accurate detection and notification of emergency situation are critical to chronic patients′ life. Since they are usually performed by a limited number of medical staff, it is difficult to simultaneously support many patients in real‐time. This article presents an architecture to support the emergency bio‐data management for m‐healthcare service using personalized emergency policy. The salient feature of the proposed architecture is that the decision on emergency is made using personalized emergency policy. Specifically, the structure of the detailed system components has also been designed. The emergency condition of the individual bio‐data collected from wireless body area network is detected automatically using personalized emergency policy. The message flow diagram based on the personalized emergency policy is described. This enables quick emergency rescue service provided to the patient both accurately and immediately. The prototype of proposed system has been built to demonstrate the design concept.
Ultrasound of the groin region following surgical intervention of the great saphenous vein
Authors: Mendoza E.
Published: June 2014

Ein wichtiger Bestandteil der phlebologischen chirurgischen Therapie ist die Kontrolle nach der Operation – die auch im Wesentli-chen der Qualitätskontrolle dienen sollte. Hierbei spielt die Sonographie die Hauptrolle, um insbesondere auch frühe Rezidive darzustellen (1). Die Rezidive nach chirurgischem Eingriff am saphenofemoralen Übergang bilden das größte Problem nach Varizenbehandlung. Verschiedene Versuche, diese zu stratifizieren sind noch nicht zu einem hinreichend übersichtlichen Ergebnis gekommen (1, 5–7). Der vorliegende Beitrag möchte die duplexsonographische Untersuchung der Region des sapheno-femoralen Übergangs nach Krossektomie und nach endoluminal thermischen Verfahren beleuchten. Der Normalbefund und die verschiedenen Rezidivmöglichkeiten werden beschrieben.
Compression treatment in venous insufficiency and arterial disease
Authors: Mosti G.
Published: June 2014

Compression therapy is one of cornerstone in the treatment of venous and lymphatic disorders.

It may be applied by means of different elastic or inelastic stockings, bandages, or other devices. Inelastic material is much more effective improving venous impaired haemodynamics than elastic material. Due to its physical properties inelastic material is able to exert a significantly higher pressure than elastic devices moving to the standing from the supine pressure; furthermore it is able to exert significantly higher pressure peaks during muscle exercise. This high pressure can overcome the intravenous pressure and cause intermittent occlusion of leg veins, restoring a kind of valve mechanism. Elastic material gives way to the muscle expansion during standing and walking and the pressure increase in these conditions is very low. Due to this low increase with muscle activity, elastic material does not exert an intermittent pressure but rather a sustained pressure not able to overcome the intravenous pressure. As a consequence, elastic material is hardly able to influence the venous diameter and its haemodynamic effects are minimal.

Compared to elastic, inelastic material is significantly more effective in reducing venous reflux, increasing venous pumping function and reducing ambulatory venous hypertension.

Compression therapy proved to be beneficial, over time, in every clinical condition from CEAP C1 to C6.

Due to their characteristics and effects, in-elastic compression needs to be applied in the acute stages of venous disorders when a strong haemodynamic effect is necessary, while elastic stockings may be used in the chronic stages to maintain the results and prevent recurrences.

A new concept in compression therapy is the inversely graduated compression pressure profile, higher over the calf than over the ankle, also named “progressive compression.” Both specially designed elastic stockings and appropriately applied bandages can exert a progressive compression which showed some interesting outcomes both in experimental and clinical settings in patients with chronic venous disorders and in athletes. Nevertheless its effectiveness in many pathological conditions (oedema treatment, venous leg ulcer, thromboprophylaxis, etc.) needs to be proved in future trials.
Routing and Staffing in Customer Service Chat Systems with Impatient Customers
Authors: Tezcan Tolga , Zhang Jiheng
Published: June 2014

We consider customer service chat (CSC) systems where customers can receive real time service from agents using an instant messaging (IM) application over the Internet. A unique feature of these systems is that agents can serve multiple customers simultaneously. The number of customers that an agent is serving determines the rate at which each customer assigned to that agent receives service. We consider the staffing problem in CSC systems with impatient customers where the objective is to minimize the number of agents while providing a certain service level. The service level is measured in terms of the proportion of customers who abandon the system in the long run. First we propose effective routing policies based on a static planning LP, both for the cases when the arrival rate is observable and for when the rate is unobservable. We show that these routing policies minimize the proportion of abandoning customers in the long run asymptotically for large systems. We also prove that the staffing solution obtained from a staffing LP, when used with the proposed routing policies, is asymptotically optimal. We illustrate the effectiveness of our solution procedure in systems with small to large sizes via numerical and simulation experiments.
Deaf Nest: Time for change!
Authors: Sporek Paulina Ewa
Published: June 2014

Student midwife Paulina Sporek discusses providing care to Deaf parents
Why asthma is killing and patient care is falling short
Authors: Tingle John
Published: June 2014

John Tingle discusses the findings and recommendations of the National Review of Asthma Deaths (NRAD).
Theory into practice (sometimes doesn't go)
Authors: Freshwater Ed
Published: June 2014

Ed Freshwater is a third-year mental health nursing student. In this month's column, he writes about his concerns surrounding care provision for patients with mental ill health. At a time when health professionals are under numerous pressures, is the patient still at the centre of everything we do?
Health improvement and health promoting practitioners
Authors: Nicholson Wendy
Published: June 2014

Ahead of the Department of Health and Public Health England's ‘week of action’, Wendy Nicholson shares her views on the important leadership role school nurses can play in health promotion, as well as some information on a new project.
Preventing visual loss in age-related macular degeneration: a summary of findings from the AREDS
Authors: Wanger Peter
Published: June 2014

Both the Age-Related Eye Disease Study (AREDS) 1 and AREDS 2, combined with the analysis of polymorphisms in complement factor H and age-related maculopathy susceptibility 2 genes, provide robust evidence for the value of prophylactic treatment of age-related macular degeneration using zinc, antioxidants (beta-carotene, vitamins C and E, lutein and zeaxanthin) or a combination of both these treatments. The implementation of this knowledge in general ophthalmic care can be expected to have a significant effect on public health.
Nutritional management of encapsulating peritoneal sclerosis
Authors: Campbell Rosalind , Summers Angela
Published: June 2014

Encapsulating peritoneal sclerosis (EPS) is a complication of peritoneal dialysis. Although incidence is low, for patients who do develop the condition it can be debilitating and life-threatening. It has therefore received great interest and awareness from the renal community in the last 10 years. EPS is usually a progressive condition, with early clinical signs ranging from mild gastrointestinal (GI) symptoms and weight loss, to inflammation, severe GI symptoms and, eventually, encapsulation. Over time, the clinical picture deteriorates, affecting biochemistry, nutritional status, overall health and quality of life, which can eventually be fatal. A multidisciplinary approach and high index of suspicion are needed to identify patients at risk of developing EPS, so early diagnosis can be made and timely treatment initiated. Thorough nutritional assessment, monitoring and support are essential. This article raises awareness of EPS, describes how to optimise nutritional care, and hopes to improve patient outcomes through earlier identification and intervention of this potentially devastating disease.
Identifying goals with the NHS Healthcare Leadership Model
Authors: Ellis Peter , Abbott Jane
Published: June 2014

The new NHS Healthcare Leadership Model is made up of nine dimensions of leadership that work both independently and together to enhance leadership. In the third part of this series on this subject, Peter Ellis and Jane Abbott discuss the dimensions of shared purpose, aid teamwork, and evaluating information.
Bilateral simultaneous ureteroscopy: a tool for removing renal calculi
Authors: Biela Chris
Published: June 2014

Kidney stones is a condition humans have suffered with for thousands of years, with the first recorded occurrence in the 8th century BC. Bilateral simultaneous ureteroscopy is a relatively new technique for removing the stones that has recently gained wider attention due to its reduced treatment time.
Communication and the team
Authors: Bolden Keith
Published: June 2014

Expanding primary health care teams can lead to confusion over roles. In a new series on communication, Keith Bolden demonstrates ways in which the practice team can work together more effectively.
New weapon for old virus
Authors: Crawford Moira
Published: June 2014

A new hepatitis A vaccine has made its debut in the UK market. Moira Crawford finds out why the manufacturer claims it is different.
Fast Foods: A Nutritional
Authors: Crombie N E
Published: June 2014

Time is of the essence in nearly every aspect of modern life. It seems there is nothing that is not influenced by the need for haste, even in our so-called leisure time. Part of this increased pace of living has resulted in the evolution of our eating habits to cope with this increasing pressure on time. Eating ‘on the go’ has become part of our everyday existence. Changes in family structures such as both parents working, single-parent families and an increase in people living alone have also engendered a huge demand for food that is either ready to eat or requires little or no preparation.
COPD: What the practice nurse can do
Authors: Coutts Ian
Published: June 2014

December saw the publication of the BTS guidelines for the management of chronic obstructive pulmonary disease (COPD). By now each general practice in the UK should have received a copy of the guidelines and a summary has been sent to every GP and practice nurse.
How To…Doppler Ultrasound Examinations
Authors: Evans Catherine
Published: June 2014

In the first of our ‘How to…’ series Catherine Evans looks at Doppler ultrasound examinations.
Hydrocolloid Dressings
Authors: Pudner Rosie
Published: June 2014

This is the first in a series of articles which will examine the use of various types of wound dressings in clinical practice. The properties of the specific wound dressing, the types of wound the dressing is most suitable for, and the correct application and removal of the dressing will be discussed in each article. The hydrocolloid dressings to be examined are Granuflex, DuoDerm Extra Thin, Comfeel, Tegasorb Advanced Formulation and Combiderm, which all come in a variety of shapes and sizes.
Childhood Growth And Inhaled Steroids
Authors: Pearce Linda
Published: June 2014

A number of studies have been undertaken looking at the effect of inhaled steroids on growth. Linda Pearce takes a look at the findings.
Legal Aspects of Travel Medicine
Authors: Parker Sue
Published: June 2014

MDU head of nursing services, Sue Parker, explains how to get patients to and from their holiday destinations without visiting court.
Travel Vaccination Schedules
Authors: Mahon-Smith Alma
Published: June 2014

Vaccines offer protection against some of the hazards of travelling. Alma Mahon-Smith takes a closer look at when they should be given.
The Protocol of Protocols
Authors: Saunders Diana
Published: June 2014

Nurse prescribing in the home is going to be rolled out. I expect that many practice nurses, those without health visiting or district nursing qualifications, will still feel marginalized and in many respects quite rightly. However, practice nurses will by now have seen and read the Crown report Review of prescribing, supply and administration of medicines (DoH, 1998).
Travellers' Diarrhoea
Authors: Cartwright Rodney
Published: June 2014

Diarrhoea is almost inevitable when visiting underdeveloped countries. Rodney Cartwright explains what precautions can be taken.
Walk-in Clinic: Athlete's Foot
Authors: Johnson Wendy , Johnson Stephen
Published: June 2014

Once caught the fungus causing this common complaint can be difficult to get rid of. Wendy and Stephen Johnson look at how to avoid catching athlete's foot and how to treat it effectively.
MMR Vaccination: Is It A Hazard?
Authors: Campbell Helen , Elliman David
Published: June 2014

The recent controversy over MMR has worried parents and professionals alike. Helen Campbell and David Elliman review the evidence suggesting there is a risk.
Vapour-Permeable Film Dressings
Authors: Pudner Rosie
Published: June 2014

This is the second in a series of articles on wound dressings, which will examine the use of vapour-permeable film dressings in clinical practice. This article will discuss the specific properties of vapour-permeable film dressings, appropriate types of wounds on which they can be used, and their correct application and removal.
Perennial allergic rhinitis
Authors: Cross Sue
Published: June 2014

The nose is the first part of the natural airway, a fact often forgotten by doctors and nurses alike. Airflow in the nose is rapid, and during a sniff it ean easily reach the speed of a hurricane! It draws in all the airborne pollutants and particles and filters most of them out of the inhaled air before they reach the sensitive lining of the lungs. The mucosa of the nose are, however, as prone to irritation and allergy as any other part of the skin, and where an allergen is constantly present inflammation of the mucous membranes, rhinitis, can be a permanent condition (Mygind et al, 1996). Perennial allergic rhinitis, where a substance that is not harmful causes an immune response, can be separated from non-allergic rhinitis, where the offending substance cannot be identified.

Sue Cross discusses the management of this unpleasant complaint.
It Came From Outer Whitehall
Authors: Richards Sue
Published: June 2014

Is the Government's dream of an effective and integrated service turning into a bureaucratic nightmare?
Podiatry: Scope of Practice
Authors: Prior Trevor D
Published: June 2014

As with many of the professions allied to medicine (PAMs), the role and scope of practice of the chiropodist or podiatrist is widely misunderstood. Indeed, there is even confusion over the correct title for the profession. This article attempts to clarify these issues and highlight some of the conditions that may commonly present to the practice nurse.
Occupational Therapists and The Practice Nurse
Authors: Hales Kathy
Published: June 2014

As one of the few professions where basic training encompasses almost all aspects of health care, occupational therapy has often suffered from difficulty in succinctly defining its scope of practice. The image of ‘baskets and bunnies’ is probably as great an anathema to occupational therapists as ‘bandages and blood pressure’ is to practice nursing. There is a place for these, but only within a scientific framework of reference.
Dietitians and The Practice Nurse
Authors: Noble Louise
Published: June 2014

Diet has an essential role to play in the promotion of health and in the treatment of a variety of conditions. Many of these are managed predominantly in primary care, including obesity, diabetes, coronary heart disease and hypertension. The publication of The Health of the Nation in 1992 established a role for nutrition and dietetics in primary care (DoH, 1992).
A Sick Joke On A Sick Service
Authors: Richards Sue
Published: June 2014

Are we wasting our time and energy? What happened to the vision of a new NHS? What happened to the equality and parity for all professionals on the new PCGs?

It all went down the pan when Alan Milburn, Secretary of State for Health, lost his bottle and gave in totally to the GPs demands to hand all power over to them.
Non-drug Management Of Hypertension
Authors: Daly Gloria
Published: June 2014

Lifestyle changes can help reduce blood pressure and influence numbers suffering from coronary heart disease and stroke. Gloria Daly explains.
Walk-in Clinic: Acne Vulgaris
Authors: Fisher Pam , Warren Clive
Published: June 2014

Acne warrants active, focused intervention to minimize both physical and mental scarring.

Pam Fisher and Clive Warren outline the treatment options available.
Non/Low Adherent Dressings
Authors: Pudner Rosemary
Published: June 2014

This sixth article in the series on wound dressing products examines the use of non/low-adherent dressings, some of which are medicated, in the management of lightly exuding wounds. The properties of each dressing will be discussed, followed by the application and removal of the dressings. The dressings which will be examined are: N-A Dressing, N-A Ultra, Tricotex, Melolin, Metalline, Release, Skintact, Paraffin tulle dressings, Mepitel, Tegapore, Inadine and the medicated tulle dressings
Walk-in Clinic: Earache
Authors: Fisher Pam , Holmes Peter
Published: June 2014

Earache is often perceived as a trivial complaint, but it can be extremely painful and sometimes even serious. Pam Fisher and Peter Holmes look at which conditions should be referred.
Antidepressant therapy
Authors: Smart David , Corbett Janet
Published: June 2014

Depression is common with roughly 5% of those consulting with major depression, another 5% with milder episodes, and a further 10% some depressive symptoms (Paykel and Priest, 1992). This means knowledge of the management of the depressed patient, including advantages and disadvantages of antidepressant therapy, is essential to the daily work of the practice nurse.
The PNs role in cognitive therapy
Authors: Stopa Lusia
Published: June 2014

Major depressive disorder affects around 5% of the population at any one time (Williams 1992; Hollon and Beck 1995) and most of these cases are treated in general practice. Practice nurses often help to support patients recovering from depression but may not be sure of the most effective way to do this.
Headache
Authors: Johnson Wendy , Johnson Stephen
Published: June 2014

Headaches are mostly trivial and temporary problems, but a thorough background knowledge can help the practice nurse advise on the best treatment.
Axsain
Authors: Beckwith Sue
Published: June 2014

Axsain has been used for treating post herpetic neuralgia for some time, but has recently been licenced for the treatment of diabetic neuropathy. Sue Beckwith discusses its use for treating patients in pain.
Work hard and play hard
Authors: Richards Sue
Published: June 2014

Some evenings ago there was a TV programme on the problems of substance abuse amongst doctors. It highlighted the manner in which their addictions had been hidden from colleagues and the horrendous dangers their patients were exposed to. Nurses also have amongst their number those who use addictive and performance diminishing drugs. It seems incredible that we are unable to detect psychological problems in our colleagues.
Readers respond
Authors: Clarke Kathy , Sullivan Claire
Published: June 2014

The uniform is a mark of distinction, but is it being devalued in the public's eye?

The physical reality for RSI proven at last
Guidelines and protocols
Authors: Fennessy Gabby
Published: June 2014

Making decisions about caring for patients is a complicated process where pros and cons of interventions need to weighed against benefits to patients and the health service's ability to pay. To help nurses integrate knowledge about practice into the decision making process, guidelines and protocols have been introduced to help achieve the best practice.
Pneumonia in COPD patients
Authors: Fehrenbach Christine
Published: June 2014

Pneumonia is acute inflammation of the pulmonary parenchyma (i.e. gas exchanging tissue) usually caused by bacterial or viral infection. Around half a million people in the UK are admitted to hospital with pneumonia each year, making it one of the commonest causes of admission (BTS, 1993).
Book Reviews
Authors: Stones Marian , Archer Trudi , Willcox Adrienne
Published: June 2014

Computer aided guide to grant and research

Expert guide to the menopause

Recipes for disaster?
Injectable progestogens
Authors: Szarewski Anne
Published: June 2014

Injectable contraceptives are still a minority use method of contraception in this country. In women under the age of thirty the most commonly used method is the combined oral contraceptive pill. In 1995, three and a quarter million women were using the pill. Sterilisation of one or other partner is also common in this country, especially in couples where the woman is over thirty.

Injectable progestogens may be the right choice of contraceptive for some patients, as Anne Szarewski explains.
Interpreting blood tests
Authors: Parker N E
Published: June 2014

Blood tests are often requested, but frequently misused. Dr Parker discusses how to use these tests to the best effect.
Testing for INRs: A computer approach
Authors: Treharne Jones Robert
Published: June 2014

Warfarin can be successfully monitored using a computer software program such as that used by Robert Treharne Jones.
Oral anticoagulation in the community
Authors: Baird Anne
Published: June 2014

The primary and secondary prevention of stroke, ischaemic heart disease and other thromboembolic disorders is now an accepted part of the role of many practice nurses. Various drugs are used in these disorders to inhibit the clotting process (Lancaster et al, 1997) and an understanding of their mode of action is vital to nurses working in this area.

In the first of three articles Anne Baird outlines the fundamentals of the clotting process.
The unstable bladder and urinary incontinence
Authors: Kelham Ian
Published: June 2014

Bladder problems of one sort or another are very common and are estimated to affect up to 6 million people in the UK. Of these, between 2 and 3 million suffer from urinary incontinence (Thomas et al, 1980).

However, it is thought that less than a third of those with moderate or severe urinary incontinence seek medical help (Largo-Janssen et al, 1990), because of embarrassment, denial or the mistaken, but widespread, belief that their problem cannot be effectively treated.
Causes and assessment of faecal incontinence
Authors: Chelanayagam Sonya , Norton Christine
Published: June 2014

Faecal incontinence is defined as the involuntary or inappropriate passing of liquid or solid stool (Royal College of Physicians, 1995). Anal incontinence is the term used to define any involuntary leakage from the anus, whether of solid, liquid or flatus.

Faecal incontinence remains a taboo subject as Sonya Chelvanayagam and Christine Norton explain.
The paradox of rhetoric and reality
Authors: Richards Sue
Published: June 2014

All the recent discussion about the increasing value of the nursing role doesn't seem to be reflected in practice, according to Sue Richards.
HIV infection: an overview
Authors: Kiernan Martin
Published: June 2014

Human Immunodeficiency Virus (HIV) infection is an important cause of morbidity and mortality in the United Kingdom. Although fears of a vast epidemic appear on the surface not to have been supported by a huge increase in clinical cases, the figures tell us that the disease is far from conquered and that new cases still occur at about a rate of 100 per month. This article will examine some of the issues regarding HIV infection, with particular emphasis being placed on the epidemiology of the disease, where so much still can be done in the field of health education.
HIV treatment: where are we now?
Authors: Staveley Sarah
Published: June 2014

The widespread use of highly active anti-retroviral therapy (HAART) since the summer of 1996 has brought many changes to the outlook and care of HIV positive clients and service provision.

The routine use of increasingly intensive anti-retroviral therapies has resulted directly in dramatic declines in morbidity and mortality among HIV-infected patients with advanced immune depletion (Palella et al, 1998).
Pre and post HIV test discussion
Authors: Stubbs Sue
Published: June 2014

Human immunodeficiency virus (HIV) antibody testing has been available since late 1985 and the patients' right to give fully informed consent to the test, led to formal pre and post-test counselling being performed from the outset. Departments of Genito-Urinary Medicine (GUM) are the main providers of this service; primarily because patients can self refer and be assured of confidentiality under the National Health Service (NHS) (Venereal Diseases) Regulations (1974), but also because the necessary expertise already existed in this setting.
Drug Focus Humalog Mix 25
Authors: Wells Mei
Published: June 2014

Mei Wells gives a brief history of the use of insulin in treating diabetes and looks at newer methods of management.
Walk-in Clinic Fever
Authors: Fisher Pam , Warren Clive
Published: June 2014

Fever is a symptom that can mean anything between nothing and a life-threatening illness

Fever or a febrile state is defined as a high body temperature associated with a systemic inflammatory response (Thibodeau, 1992). It can occur when bacteria, toxins, viruses or other agents are phagocytozed by leucocytes, which in turn produce chemicals called pyrogens: literally, fever makers (Uphold, 1994).

Pam Fisher and Clive Warren consider the possible causes and treatments
Beating bowel cancer
Authors: Faulds Wood Lynn
Published: June 2014

Lynn Faulds Wood talks about her own fight with bowel cancer and how she became involved with the Crocus Trust
Nurses, patients and OTC medicine
Authors: Martin Margaret , Meek Ros
Published: June 2014

The last 5 years have seen a huge rise in self-care, a wider availability of over-the-counter (OTC) medicines, and increased public demand for more information and advice about their treatments and medicines. How are practice nurses responding to this challenge?

In this series of three articles, we explore patients' expectations and nurses' views on making OTC recommendations, and consider the issues raised by these for teaching, research and health policy.
OTCs: what patients ask nurses
Authors: Martin Margaret , Meek Ros
Published: June 2014

In the second article of this series exploring patients' expectations and nurses' views on making OTC recommendations, we hear from three practice nurses about the questions the public ask, the evidence-base nurses can use when responding to those questions, and what kind of guidance would be helpful.

There has been a significant rise in self-care and in the public's demand to have more information and advice about their treatments. The public may use a wide range of sources of health information, but the role of the health professional as expert broker is still paramount.