bluuebunny/crossref_metadata_2025 huggingface dataset:
Trauma: narrative perspectives on growth and therapist resilience
Authors: Koch Hugh , Cann Arnie
Published: May 2014

Developments in the area of post-traumatic growth are described and discussed with particular reference to the possible trauma of being involved in a road traffic accident. Research and clinical experience from both the USA and UK are outlined. Several different types of road accidents are described in terms of impact, physical injury and psychological reaction. Common areas of post-traumatic growth are described when building a positive growth-oriented narrative with victims. The importance of developing a robust set of core beliefs which can foster resilience to face future challenges is outlined. Reflections are given as how post-traumatic growth can occur both for victims and, vicariously for assessing or treating clinicians. There is an impact on clinicians of working with accident victims and this potential ‘vicarious traumatisation is discussed.
Can stem cells cure Parkinson's disease? Embryonic steps toward a regenerative brain medicine
Authors: Wainwright Steven P
Published: May 2014

Cell replacement therapy for Parkinson's disease (PD) is currently based on the use of primary human fetal dopaminergic neurons. The use of aborted fetal tissue raises ethical issues, and it can never supply enough cells for this approach to be more than an experimental therapy. Clinical trials in about 350 patients, however, demonstrate that fetal cell transplants can give significant symptom relief in patients with advanced PD. What is required if cell replacement is to become a more routine therapy, therefore, is the discovery of a new potentially unlimited source of dopaminergic neural cells. Embryonic stem cells are regarded by many neuroscientists and clinicians as the most promising way to bridge the gap between the laboratory and the clinic in regenerative brain medicine. This paper presents an update on the state of stem cell research as a potential cure for PD. Its aim is to provide a concise overview of the key scientific and medical literature in a new and exciting field of neuroscience to enable neuroscience nurses to give PD patients and carers evidence-based advice on the prospects for cell transplant therapy as a potential cure for PD.
Legal and ethical issues in seeking the consent of adults with learning disability
Authors: Leyshon Stephen , Clark Louise L
Published: May 2014

The way in which clients with a learning disability are cared for has changed. In recent years, there has been a growing shift towards recognizing their right to make use of, and have access to, general health services such as primary care and acute district hospitals. Nurses working in these services are expected to provide care using a partnership approach that promotes choice and involvement in decision-making. This approach is more difficult, however, when seeking consent from clients with learning disability. Therefore nurses require an up-to-date understanding of the law and ethics of consent. This paper provides an overview of how English law applies to the partnership approach to seeking consent from learning disabled adult clients. Relevant principles on seeking consent set down in the new Mental Capacity Act 2005, which applies to incapacitated adults, will also be considered.
A measure to assess the impact of Huntington's disease on the quality of life of spousal carers
Authors: Aubeeluck Aimee , Buchanan Heather
Published: May 2014

The purpose of this article is to provide a current update and extended overview on a series of studies that aimed to systematically investigate the factors that enhance and compromise the lives of Huntington's disease spousal carers by using the theoretical construct of quality of life. Three exploratory studies provided evidence that spousal carers have specific difficulties maintaining their quality of life while continuing in a primary care-giving role. These initial findings prepared the way for the development of a disease-specific quality of life questionnaire for spousal carers of Huntington's disease patients, the Huntington's Disease Quality of Life Battery for Carers (HDQoL-C). A final study found that the questionnaire demonstrated good internal consistency, test-retest reliability and face validity. It is hoped that the HDQoL-C will be used in the future to quantify the caregiving experience in Huntington's disease in order to implement and assess therapeutic interventions.
Online illness narratives about living with motor neurone disease: A quantitative analysis
Authors: O'Brien Mary R , Clark David
Published: May 2014

Background:

To date, no published work has sought to investigate internet-based writing about life with motor neurone disease (amyotrophic lateral sclerosis) or to determine who is using this genre to publicize their illness narratives

Objectives:

To identify and locate illness narratives written by people diagnosed with motor neurone disease posted on the Internet and to ascertain who is using this vehicle to tell the story of their illness.

Method:

Systematic searches were conducted using Internet search and Meta search engines, local and national motor neurone disease association information sites and by following links from personal websites and motor neurone disease chat rooms, newsgroups and forums.

Results:

Ultimately, 64 personal websites containing illness narratives written by people with motor neurone disease were identified. Demographic details of the authors are presented.

Conclusion:

This novel study demonstrates that health professionals can access an invaluable source of personal illness narratives from the internet using a systematic approach.
Management of severe traumatic brain injury: The need for the knowledgeable nurse
Authors: Mestecky Ann-Marie
Published: May 2014

In the hours and days following severe head injury, the main goals of treatment are to maintain an adequate cerebral perfusion pressure and to reduce and prevent rises in intracranial pressure. In addition, it is imperative to optimize ventilation and minimize systemic complications. Management strategies aim to achieve a cerebral perfusion pressure of >60mmHg and intracranial pressure <20–25mmHg. There are several interventions that are employed to achieve these goals. Some are used as first line treatments, i.e. 30º head elevation, sedation, drainage of cerebrospinal fluid, and others as second-line interventions, i.e. mannitol, mild hyperventilation and induced hypothermia. Surgical interventions include evacuation of mass lesions and decompressive craniectomy. There is a lack of grade I evidence to support most treatments, but guidelines published by the US Brain Trauma Foundation and the European Brain Injury Consortium provide recommendations for management based on the best evidence available. This article reviews the medical and nursing management of the severely head-injured patient during the acute phase in the intensive care unit. It will begin with the presentation of the pathophysiology of injury.
The role of a Parkinson's disease nurse specialist as perceived by professionals in Northern Ireland
Authors: Cook Neal , McNamee Deirdre , McFetridge Brian , Deeny Pat
Published: May 2014

Parkinson's disease (PD) nurse specialists have been in existence in the UK since 1989. Few studies to date have analysed the perceptions of health professionals in relation to this service. Such perceptions are vital to the implementation of specialist nursing roles. The aim of the study discussed in this article was to analyse the role of the PD nurse specialist from the perspective of health professionals who would be in day-to-day contact with the PD nurse specialist and other professional stakeholders associated with development of the role in one health-care trust in Northern Ireland. A sample of GPs (n=100), community nurses (n=100), acute care nurses (n=100) and nursing home managers (n=40) were surveyed using a specially designed questionnaire (Cronbach's alpha 0.9328). Stakeholders (n=6) who were associated with development of the role were also interviewed. Findings show that, on the whole, health professionals and stakeholders view the PD nurse specialist role as being central to the care and support of patients and carers. All are positive about the advice they receive from the PD nurse specialist especially in relation to medication management. Concerns exist in relation to the low level of awareness of the role among some GPs and most acute care nurses. More clarification is needed in relation to how the PD nurse specialist is involved at all stages of the Parkinson's disease illness trajectory.
Progress made, but more to be done for infection control
Authors: Pellatt Glynis
Published: May 2014

Following a recent report by the Healthcare Commission on infection control at Stoke Mandeville, Glynis Pellatt offers her comments
How you can help people with Parkinson's ‘get it on time’
Authors: Buxton Val
Published: May 2014

Parkinson's disease is a fluctuating and progressive neurological condition, and its symptoms are best controlled through a complex regime of medication. When this medication is not given on time, people's symptoms can become out of control and they can get very ill.
Conducting a risk assessment in neuroscience practice: principles and procedure
Authors: Mills Helen , Bowker Erika
Published: May 2014

The aim of this article is to raise awareness among health-care practitioners of the benefits and effectiveness of using a structured risk assessment process. Making informed decisions in neuroscience practice requires practitioners to have an understanding of the risk assessment process. This article will outline The principles of risk assessment will be outlined using a five-step approach. The concept of a risk matrix is discussed. The risk assessment process is illustrated using a practical example of a patient with brain injury who demonstrates behaviour that challenges in the neuroscience setting. Embedding risk assessment into the organizational culture supports staff to ensure that risks are managed effectively for the benefit of patients, staff and the health-care organization.
Personal health budgets: The pros and cons
Authors: Thomas Sue
Published: May 2014

Sue Thomas looks at the new personal health budgets which are soon to be piloted, and how these could affect patients and practitioners.
Communicating to meet patients' expectations
Authors: Benison Liam , Voogd Caroline
Published: May 2014

A focus of this year's BANN annual conference in Leeds was understanding patients' needs and expectations. Liam Benison and Caroline Voogd report
Considering spirituality
Authors: Winter George
Published: May 2014

George Winter refl ects on the role of religion in health.
Asking for patients' musical preferences
Authors: Woodward Sue
Published: May 2014

How often do we ask relatives to bring in music for brain-injured patients or ask which radio stations they prefer? Critical care nurses are aware of the dangers of sensory overload that constant noise may lead to. We are also well aware that hearing is the last sense to be lost, following a reduction in level of consciousness, and the first one to come back. So our unconscious patients may well still be able to hear all that is going on around them. While nurses may play music or put on a radio with the intention of reassuring a patient who is comatose by surrounding them with familiar sound, or hoping to stimulate a damaged brain, are we using music and sound indiscriminately? Could we enhance recovery from brain injury by using music in a more targeted manner?
Developing and auditing multiple sclerosis relapse management guidelines
Authors: Ennis Maureen , Shaw Pauline , Barnes Fiona , Regan Joan , McCarthy Kitty , McMillan Debbie , Hurst Sylvia , Knights Catherine , Mason Catriona , Brand Geraldine , Holmes Susan , Speed Maureen , Silber Eli , Brex Peter A
Published: May 2014

This article describes the development and audit of local guidelines on how to manage multiple sclerosis (MS) relapses based on the National Institute for Health and Clinical Excellence (NICE) guidelines (2003). This was a collaboration between MS specialist nurses and neurologists with a specialist interest in MS working in southeast London, Kent and Medway. The aim was to promote a consistent approach to the management of relapses that reflected best practice and prescribing guidelines as outlined in the NICE guidelines (2003). The audit revealed that patients benefited from the use of high-dose oral methylprednisolone steroids by offering them swift access to treatment that was generally well tolerated and cost effective. In the process of the evaluation other methods of relapse management were reviewed. Further evaluation of the use of high-dose oral methylprednisolone for MS relapses is required, with particular reference to its efficacy when compared to the more established treatment with intravenous methylprednisolone.
Speak up for your patients' future care
Authors: Thomas Sue
Published: May 2014

Sue Thomas discusses the aims and objectives of the Government's public consultation on health and social care, and encourages nurses to contribute
Piecing it together to meet end-of-life care needs
Authors: Sam Emily
Published: May 2014

Emily Sam reports on an event which explored ways to improve the palliative care of people with long-term neurological conditions held jointly by the National Council for Pallaitive Care and the RCN
An overview of palliative care for patients with brain tumours: An interprofessional approach
Authors: McNamara Shanne
Published: May 2014

The aims of palliative care are to maintain and improve quality of life, control distressing symptoms and facilitate a dignified death. Patients and their families should be involved in decision-making about management and be provided with education, support and information to facilitate this process. A brain tumour has a substantial impact on a person's lifestyle and can impair communication, cognition, movement, vision, personality, memory. The treatment of brain tumours is often palliative. Management of the symptoms of brain tumours and the side effects of treatments present a challenge to all health professionals involved in patients' care. An interprofessional approach to care is recommended.
Widespread variations remain in local NHS spending
Authors: Thomas Sue
Published: May 2014

Sue Thomas looks at a new report revealing substantial variations in the spending priorities of PCTs, and asks what is being spent on neurology
Correspondence
Authors: Burn Robin , Hassall Mandy
Published: May 2014

Papers presented at the 116th Annual Convention of the American Psychological Association (APA) (2008) suggest a link between otitis media, and obesity onset with age. While it may be considered that any direct link between the two conditions, to quote Professor Mark Haggard from the charity Deafness Research UK, ‘is not impossible but, to be frank, is extremely unlikely’, an indirect link is considered to be more of a possibility.
Citrullination in MS: Potential for a new diagnostic test
Authors: Bradford CM , Cross AK , Haddock G , Woodroofe MN
Published: May 2014

Multiple sclerosis (MS) is a chronic inflammatory neurodegenerative disease, which predominantly affects the white matter of the central nervous system (CNS). It is the most common neurological disease in young adults with a mean age of onset of 30 years (Trapp and Nave, 2008). The disease is characterized by destruction of the myelin sheath, which insulates the axons of nerves, resulting in lesions of demyelinated axon fibres (Lassman, 2004). Within these lesions there is infi ltration of T and B lymphocytes and macrophages, as well as locally activated CNS resident cells, astrocytes and microglia (Musse and Harauz, 2007).
Raising the profile of migraine: research, education and awareness
Authors: Scurr Kate
Published: May 2014

Migraine and affects 8 million people in the UK. The Migraine Trust works to raise awareness and improve education of the UK's most common long-term neurological condition.
Will the Year of Care improve care planning?
Authors: Thomas Sue
Published: May 2014

The involvement of people with long-term neurological conditions in planning their own care and choosing to manage their own condition is a crucial step towards improving patient reported outcomes, and improving patient care (Department of Health (DH), 2005). While some aspects of patient care have improved with government targets (e.g. waiting times), and while patients are in general appreciative of the NHS care they receive, the NHS still has a long way to go to ensure that care is truly patient-centred (Picker Institute, 2007).
The unpredictable consequences of trauma
Authors: McDonald Sheena
Published: May 2014

Traumas can be life-changing, physically and psychologically. But their aftermaths are unpredictable. Take my friend, not yet 50 years old, who was not diagnosed with breast cancer until it had reached stage 3—a critical level. She has just been given a 5-year all-clear, following appropriate treatment, her hair has grown back, she has taken up golf for the first time in her life and invested in every accessory the sport offers. Is she any good? She doesn't care—she loves playing!
RESEARCH ROUNDUP
Authors: Preece Anne
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.
‘The mind's the standard of the man’
Authors: McDonald Sheena
Published: May 2014

Though neurofibromatosis currently eludes a cure, dedicated research gives hope for the future to many people. In the absence of a cure, Sheena MacDonald admires the strength of the human condition.
The role of the hypothalamus, part 2: Regulation of sleep-wake cycles and effect on pain
Authors: Braine Mary E
Published: May 2014

The hypothalamus forms part of the so-called central autonomic network, regulating body homeostasis, sleep and controlling pain. Although several parts of the brain have been implicated in the complex mechanism of sleep, this paper will explore the key hypothalamic regions in the regulation of sleep: its anterior region is implicated in sleep facilitation, while the posterior hypothalamus region acts in a balanced way to maintain wakefulness. To simplify this sleep-wake cycle, key individual areas involved are firstly described. Disruption of the sleep-wake cycle can result in a wide range of diseases and disorders, causes of a few of these are discussed, along with their symptoms, including seasonal affective disorder, cancer, Parkinson's disease, narcolepsy and other neurological conditions. Finally the influence on the perception of pain is presented along with the role the hypothalamus plays in pain disorders such as cluster headaches and migraine.
RESEARCH ROUNDUP
Authors: Coggrave Maureen
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.
Understanding and managing spinal muscular atrophy
Authors: Pountney David
Published: May 2014

The spinal muscular atrophies comprise a group of autosomal-recessive disorders characterized by degeneration of motor neurones causing muscle weakness (Kostova et al, 2007). It is estimated that about 1 million people in the UK are spinal muscular atrophy (SMA) carriers and that approximately 1 in 20 000 babies are affected with severe spinal muscular atrophy, with both genders being affected equally (Iannaccone, 2007; Lunn and Wang, 2008).
In search of Zen at the Edinburgh Book Festival
Authors: McDonald Sheena
Published: May 2014

What does ‘consciousness’ mean? And what does it imply? Phew, in less than ten words I have articulated two enormous questions, which continue to defy absolute and definitive answers. So I was excited to hear that the renowned psychologist Susan Blackmore would be speaking and answering questions at last month's Edinburgh International Book Festival, and volunteered to interview her.
Scottish guidelines recognize issues in diagnosing Parkinson's disease
Authors: Breen Kieran
Published: May 2014

The SIGN guideline on Parkinson's disease recommends that people with suspected Parkinson's should be referred untreated by a GP to a consultant with expertise in movement disorders
What is at the top of the policy agenda in 2010?
Authors: Thomas Sue
Published: May 2014

2010 is the mid-point of the National Service Framework for Long-term Conditions, and Sue Thomas discusses the work of Quality Neurology in assisting the implementation of the NSF
Defining a strategy for modernization
Authors: Preece Anne
Published: May 2014

The British Association of Neuroscience Nurses (BANN) is very excited about our new working relationship with the British Journal of Neuroscience Nursing (BJNN) which we know will go from strength to strength. It has been a goal for many years to have a high quality journal associated with the association, and we are very pleased to announce that as the result of the hard work of several people this has come to fruition.
The importance of a team approach
Authors: McClinton Pam
Published: May 2014

I am delighted to introduce BJNN's new regular column which will cover topics relating to end-of-life care for people living with long-term neurological conditions. With over 10 million people currently living with a neurological condition in the UK and 600 000 people newly diagnosed each year (The Neurological Alliance, 2003), quality end-of-life care for people living with conditions including Parkinson's disease, Huntington's disease and motor neurone disease is essential.
Aphasia after stroke: Enabling communication through speech and language therapy
Authors: Clarkson Katrina
Published: May 2014

Aphasia is an acquired language disorder affecting an individual's ability to understand the spoken word and to speak, read and write after stroke. In this article, an overview of the management of aphasia will be considered. The incidence, clinical symptoms and available treatment approaches will be outlined alongside an overview of the efficacy and current national provision of speech and language therapy services, including the results from the Royal College of Speech and Language Therapists' stroke survivors survey. Practical strategies to facilitate communication with a person with aphasia and the specific role of the speech and language therapist when working with this population group will also be discussed.
RESEARCH ROUNDUP
Authors: Eberhardie Christine
Published: May 2014

Caring for children at home after severe traumatic brain injury

Neuro-paediatric nurses working in acute and rehabilitation settings may find helpful this report of a small qualitative study into the day-to-day strategies of parental caregiving in children who have had a severe traumatic brain injury (TBI) defined as a GCS score of 3–8. It is a study carried out by occupational therapists in New Zealand.
Mapping the direction of health policies after the election
Authors: Thomas Sue
Published: May 2014

In the face of uncertain health policies under the new government, neuroscience nurses need to watch developments and keep neuroscience on the agenda.
Demonstrating that multiple sclerosis specialist nurses make a difference to patient care
Authors: Ward-Abel Nicki , Mutch Kerry , Huseyin Huseyin
Published: May 2014

An audit project was undertaken by a group of multiple sclerosis (MS) specialist nurses who were seeking to establish whether or not they were providing appropriate care. The authors wanted to ascertain if the care being provided met the patients' requirements and whether their input had a direct impact on the quality of life of people with MS. An audit tool was collectively designed to enable them to conduct a retrospective evaluation of service users who have regular contact with an MS specialist nursing service, identify key ways MS nurses contribute to the outcomes and overall quality of patient care, identify patient opinions and experiences of the MS specialist nursing service, and to identify where improvements can be made. There was a response rate of 55% from 1350 questionnaires, and results showed that 94.9% of patients responded positively to ten statements relating to their involvement with MS specialist nurses, ranging from emotional support to educational and clinical input in a timely manner. Additionally, 83% reported preferring to contact their MS nurse for MS-related problems rather than any other health professional.
Carers of patients with a primary malignant brain tumour: Are their information needs being met?
Authors: Arber A , Hutson N , Guerrero D , Wilson S , Lucas C , Faithfull S
Published: May 2014

Providing care in the home is very demanding, particularly where people with a primary malignant brain tumour (PMBT) are concerned, as there are physical, cognitive and behavioural alterations that can make significant demands on family caregivers.

Aim: The aim of this article is to consider carers' access to information following diagnosis of a PMBT and information on managing the caring role.

Method: A grounded theory approach was used, with 22 open-ended interviews carried out with active carers at the time of the interview.

Findings: Carers identified a lack of attention to their need for information particularly regarding medication, caring and working, and becoming a carer. They develop strategies such as using the Internet to search for information and support and using friends to filter information so they are not overwhelmed with depressing information. Using these strategies, carers reduce uncertainty, alleviate stress and find a way to continue to hope.

Conclusions: Carers lack guidance on how to access information at different stages of the caring journey. However, they are resourceful in finding support and information and expect health services to include and signpost them to the most appropriate sources of information.
Bridging the gap—delivery of mental health provision in neurological services
Authors: Askey-Jones Sally , Brown Richard G
Published: May 2014

Patients with long-term neurological disorders have an increased risk of mental health problems. With further training specialist neurology nurses will play an important role in liaising with mental health nurses.
Neuro-disabilities: What impact could volunteers make?
Authors: Baker Mark , Hopley Rosie
Published: May 2014

Volunteerism is widespread across almost every sphere of health and social care. In this article, volunteerism with people with neuro-disabilities will be considered, using one UK independent sector specialist medical charity in South West London as a case study for illustration. The anecdotal views of volunteers are considered as a way of highlighting the work they undertake and to signify the contributions they make. In light of the paucity of literature surrounding volunteerism with people with neuro-disabilities, it is hoped that this article will help toward starting a dialogue and debate about the future role of volunteers in helping patients with complex neurological conditions.
Access to care services for rural dwellers with idiopathic Parkinson's disease
Authors: Walker Richard , Sweeney William , Gray William
Published: May 2014

Background and aims: This study aimed to assess the care use of people with Parkinson's disease (PD) living in North Northumberland a mostly rural area of the UK.

Methods: during a single home visit, 106 people with PD identified by a prevalence study were invited to complete a questionnaire and semi-structured interview, providing demographic information and details of care services currently used.

Results: 75 people agreed to participate. Ten patients (13.3%) were living in institutional care, representing 1.8% of the total nursing and residential care population in the study area. Of the 65 patients living in their own homes, 18 (27.7%) had domestic home care services provided and 17 (26.2%) used personal home care services.

Conclusions: Living in a rural area appeared to be no hindrance to accessing care services when they were required.
A collaborative care pathway to reduce multiple sclerosis admissions to secondary care
Authors: Quinn Debbie
Published: May 2014

A multiple sclerosis (MS) nursing team has developed a rapid response service to reduce hospital inpatient stays. This is done through partnership with the local acute hospital and GPs to develop a care pathway for people with MS to prevent unnecessary hospital admissions through accident and emergency, acute admissions unit and the out of hours service. This rapid response service is driven by patient choice, bringing care closer to home, reducing costs, increasing earlier diagnosis, enhancing speciality for MS in the community and reducing infection risks due to decreased hospital stays and user support. People with MS who have received this service have found it effective and efficient, and report that it accelerated their recovery and improved the patient journey. Cost savings were also identified that secured the funding of an additional 7 hours of MS nursing time to facilitate the project.
Pause for thought—a chance for amendments?
Authors: Thomas Sue
Published: May 2014

The newly proposed health policy is facing a pause while the government considers amendments to the controversial Health and Social Care Bill
Promoting the safe administration of immunoglobulins in neuroscience
Authors: Waterhouse Catheryne
Published: May 2014

Intravenous immunoglobulins (IVIGs) have been used as a replacement therapy for primary immunodeficiency for many years. In other neurological systemic autoimmune conditions IVIGs have proven beneficial, often when the patient has been unresponsive to other therapies and interventions.

While some conditions, such as Guillain Barré syndrome, can be managed with a single course, many other long-term/progressive diseases require repeated infusions. IVIGs are expensive and the cost is increasing, largely due to global shortages and increased demand. Measures to prioritize the use of the product are based on clinical need, where there is evidence of effectiveness and where the benefits outweigh potential risks.

This paper aims to explain the mechanism of action of immunoglobulin therapy and review some of the benefits and risks associated with their administration.
End-of-life care guidance for Parkinson’s disease
Authors: Lee Mark
Published: May 2014

Due to the lack of guidelines and the challenges that Parkinson’s disease presents at the end of life, a consensus guidance has been developed to help health professionals in their considerations for the optimal care.
Guide to best practice between the medico-legal process and rehabilitation
Authors: Horton Jane
Published: May 2014

The British Society of Rehabilitaion Medicine has produced a guide to best practice at the interface betwen rehabilitation and the medico-legal process. This guide addresses how the medical and the legal team can work side-by-side to ensure that a person who has been injured is provided with timely and appropriate rehabilitation.
Difficult conversations: talking about dying well with dementia
Authors: Black Joanna
Published: May 2014

‘Conversations with people with dementia early on in the disease, at the appropriate time, to establish their wishes about their end-of-life care are of prime importance’ Professor Alistair Burns, National Clinical Director for Dementia
A multidisciplinary approach to Parkinson's disease
Authors: Lindop Fiona
Published: May 2014

Parkinson's disease is a progressive neurological condition with motor and non-motor symptoms resulting in a complex range of problems, and a multidisciplinary team approach offering integrated care is indicated. The importance of an understanding of the function and dysfunction of the basal ganglia is described, which forms the basis for the use of cues and strategies which all team members can employ, and the Derby Parkinson's Disease Service model of multidisciplinary team working is described. Individual roles within the team are provided as examples and the importance of evidence-based practice and the use of outcome measures to ensure efficacy of practice are highlighted.
Are cannabinoids more effective than placebo in decreasing MS-related bladder dysfunction?
Authors: Guerra Sonia Sevilla
Published: May 2014

Bladder dysfunction is one of the most common symptoms in people with multiple sclerosis (MS). The estimated prevalence of bladder difficulties in MS has varied, depending on the populations studied. Estimates of between 52 and 97% have been cited ( Hawker and Frohman, 2001 ). Bladder dysfunction may affect quality of life and some people with MS use cannabis to alleviate urinary and other MS symptoms ( Brady et al. 2004 ). It has been reported that cannabinoids and cannabinoid agonists decrease motility in normal and inflamed bladders ( Merriam et al. 2008 ). This mini-review aims to provide the summary of evidence of a single question and its outcomes with limited scope as described by Griffiths (2002) . The author will analyse new evidence of the use of cannabinoids in bladder management to identify whether cannabinoids are more effective than placebo in decreasing MS-related bladder dysfunction. A systematic literature search was undertaken to identify all studies comparing the effects of cannabinoids with placebo. The MEDLINE and Embase databases were searched. Two randomized controlled trials were identified. Results showed that both studies compared the effectiveness of cannabinoids with placebo in decreasing MS-related bladder dysfunction; however, they used different protocols, different cannabinoids and a different number of subjects. One of the studies was underpowered and showed no statistical significance in the reduction of daily incontinence episodes. The other study was a sub-study that assessed secondary outcomes. The studies showed a number of limitations and, considering that the main outcome for both studies was the number of incontinence episodes, they showed some evidence that cannabinoids provided some benefit in different symptoms of bladder dysfunction in people with MS. Further research in the effectiveness of cannabinoids on MS-related bladder dysfunction is recommended to answer this question. Randomized controlled trials that include all aspects of bladder dysfunction and differentiate between the different types of bladder incontinence will be recommended.
Fatigue in multiple sclerosis: our evolving understanding of the concepts
Authors: Warner Richard
Published: May 2014

The purpose of this paper is to explore the symptom of fatigue in multiple sclerosis (MS). Previous papers in this journal have focused on general management ( Maclean, 2006 ), exploratory measurement techniques ( Warner, 2006 ) and patient education programmes aimed at improving self-care ability ( Ward and Winters, 2003 ). This paper considers our evolving understanding of the pathophysiological concepts that might underpin the development of fatigue, the extent of the disabling impact of fatigue on people with MS as well as advances in the understanding of managing this clinical problem.
Hyper-acute stroke care provision in London: the journey to improvement
Authors: Fitzpatrick Maria
Published: May 2014

Over the past two decades, stroke care has been directed toward a rehabilitation and social focus. Initially, much attention was paid to what can be done for a patient in the days after their admission, with little attention given to the ‘hyper acute’ stage of admission. A diagnosis of stroke formerly elicited a nihilistic approach, but this has substantially changed in the past decade. Currently ‘time is brain’, and it is important for all disciplines to work together to initiate acute stroke protocols in the emergency department and identify patients within the therapeutic time window for thrombolytic and neuro-protective therapies. Evolving protocols, management, and nursing care all have important implications during the acute phase of ischaemic stroke. In the past few years, timely assessments and interventions have been the focus of government strategies. With recent research emphasising ways to reduce length of stay and post-stroke complications, the spotlight is now on providing stroke care in centres with the appropriate equipment and trained staff. This new research focus addresses an important need in stroke care and provides challenges and opportunities that can be used to improve patient outcomes.
Too choosy about choice: the responsibility of the midwife
Authors: Richards Jacqueline
Published: May 2014

One of the priciple of good maternity care identified by the Expert Maternity Group, suggest that:

‘The woman must be the focus of…care. She should be able to feels that she is in control of what is happening to her and able to make decisions about her care, based on her needs, having discussed matters fully with the professionals involved.’

Calls for a shift in the balance of power, reassert the ethical principles — autonomy, justice, beneficence and non-maleficence. But what are the professional and legal constraints? How well can we fulfil this ideal? In meeting her clients' needs, the individual midwife faces conflict, and often accusations of negligence, radicalism or whistle-blowing. Her role as advocate, communicator, educator and facilitator is here examined.
Return to breastfeeding: a global health priority
Authors: Dykes Fiona
Published: May 2014

Dramatic changes in infant feeding practices have taken place globally, this century. This article analyses the associated political, socioeconomic and health issues and describes international initiatives that aim to restore optimum patterns of breastfeeding.
Transcutaneous electrical nerve stimulation in pain management
Authors: Johnson Mark I
Published: May 2014

Transcutaneous electrical nerve stimulation (TENS) is an analgesic technique used in clinics worldwide. However, its potential value for pain control in labour is often overlooked. The purpose of this study was to evaluate patients' views after experience with TENS in labour. A questionnaire (12 multiple choice questions) was distributed to 17896 parturients in the UK who had used TENS to manage labour pain. The questionnaire was completed and returned by post within the 2 weeks following delivery by 10 077 women. The survey was analysed using descriptive statistics and It was found that 71% of the 10 077 respondents reported ‘excellent’ or ‘good’ relief of labour pain by TENS and 91% would use TENS again in the future. However, 86% of parturients who completed the questionnaire reported receiving additional analgesics during labour and it is therefore impossible to determine whether analgesic effects were directly due to TENS alone. Of the 14% of respondents who completed labour without additional analgesia 1187 (83%) reported ‘excellent’ or ‘good‘ pain relief. Although one must be cautious in the interpretation of the results of a postal survey, the favourable reports of satisfaction while using TENS supports a possible role for TENS as an adjuvant in the management of labour pain.
A new style of midwife-managed antenatal care: costs and satisfaction
Authors: Young Denise , Shields Noreen , Holmes Ann , Turnbull Deborah , Twaddle Sara
Published: May 2014

Policy makers involved in planning maternity services should evaluate the effects on women receiving care as well as the implications for the NHS. This study considered the effect on women and their families receiving a new style of midwife-managed care in the antenatal period, in terms of both the cost to themselves and their satisfaction with the accessibility of care. This study was carried out as part of a randomized controlled trial to compare midwife-managed care with the traditional model of shared care. The setting for the randomized controlled trial was the Glasgow Royal Maternity Hospital, a major urban teaching hospital providing an integrated maternity service. The results demonstrated that decisions concerning the frequency and location of antenatal visits have significant cost implications for women and their families. The costs to women of attending antenatal clinics in different settings were found to vary widely. Women receiving midwife-managed antenatal care had slightly lower costs than women attending for shared care and higher levels of satisfaction with the accessibility of care.
Midwives, informed choice and power: part 3
Authors: Levy Valerie
Published: May 2014

Qualitative data were gathered in a study of how midwives facilitate and women make informed choices in pregnancy. Issues of power permeated the data. This series of three articles will interpret and discuss these issues in relation to Lukes' (1974) conceptualization of power, and theories regarding empowerment. This final article discusses Lukes' third dimension of power, and relates data from the study to more recent ideas about empowerment.
The Breastfeeding Network Supportline
Authors: Broadfoot Mary , Britten Jane , Sachs Magda
Published: May 2014

The Breastfeeding Network has set up a telephone support service for women, the Supporterline. A single call puts women directly in touch with their nearest breastfeeding supporter, and where this is not possible it gives the phone numbers of the other lay breastfeeding organizations. The service operates every day of the year, from 9.30am to 9.30pm. Early analysis of the calls received indicates that the greatest number of calls are from women experiencing difficulties related to poor positioning, and supports anecdotal evidence of widespread problems with nipple and breast thrush.
Is there a legal right to choose a caesarean?
Authors: Dimond Bridgit
Published: May 2014

Evidence shows that the rate of caesarean section operaions is increasing. Part of this increase is due to pressure from women to have a caesarean section when it is not clinically recommended. The paper considers the legal situation of professionals when faced with a request in such circumstances and looks at a hypothetical situation where a woman's request is refused. The additional risks of birth by caesarean section contrasted with vaginal delivery are considered. The educative role of the midwife is emphasized.
Graduate midwives and clinical practice
Authors: Mosley Caroline
Published: May 2014

This article describes a research study undertaken to explore the anticipated effects of graduate education on the clinical practice of midwifery. The author predicts an increase in the number of midwifery graduates because of the continued development of midwifery degree courses, and the fact that midwifery diploma students are being encouraed to undertake post-registration degrees. During an extensive literature search no studies that investigated the benefits of this trend for midwifery education or the profession as a whole were found. Therefore as part of the author's post-registration BSc (Hons) Midwifery studies eight midwives who had accessed this course were selected and tape recorded using a semi structured interview schedule which was formulated by reviewing studies of nursing graduates. Findings explore their experience of undertaking this degree focusing on motives and incentives; positive and negative aspects; the impact on clinical practice and their career goals. Their personal and professional views on mandatory degree courses were included as food for thought only, as there are currently no proposals to introduce mandatory graduate education for midwives.
Women's views on being weighed during pregnancy
Authors: Warriner Sian
Published: May 2014

This study examines how the experience of being weighed through pregnancy affects women. The women openly discussed their attitudes towards weight, the practicalities of being weighed while pregnant, and the positive and negative effects this had on them in terms of eating habits, body image and self-esteem. A qualitative approach using interviews with a convenience sample of 10 women along with a focus group of six women was used. Most women reported regular and routine weighing throughout their pregnancies, although none of the three maternity units used reported routine weighing as policy. For most women, very little or no information was made available to them on the reasons why weighing formed part of their antenatal care. In pursuing a tradition of weighing, health professionals endorse many women's perceptions of its importance, adding to concerns over body weight and image. Health professionals need to consider the impact that routine weighing may have on women experiencing normal pregnancies.
A comparison of intrapartum care in four maternity units
Authors: Mead Marianne , O'Connor Rory , Kornbrot Diana
Published: May 2014

This study presents a comparison of the intrapartum care of women suitable for midwifery-led care in four neighbouring maternity units. The computerized maternity data were systematically reduced to exclude: previous medical history; multiple pregnancies; present pregnancy abnormalities; previous operative or instrumental deliveries; inductions and elective caesarean sections; as well as home births. The differences in ethnic distribution led to the exclusion of non-Caucasian women. This meant that out of an initial 12856 women 4203 cases remained. The rates of normal, instrumental deliveries and caesarean sections were compared in association with the use of augmentation of labour, electronic fetal monitoring and epidural analgesia. There were major differences between the four units in the rates of these three interventions. A higher rate of intervention was associated with higher rates of instrumental deliveries and caesarean sections in the first stage of labour.
Evidence-based care series 2: Free-standing birth centres
Authors: Walsh Denis
Published: May 2014

The trend to establishing ‘mega-maternity units in England and Wales’ should be resisted because alternative models e.g. free-standing birth centres and integrated midwifery-led birthing facilities, have a growing evidence base as to their suitability for women at low obstetric risk. Women are probably also more likely to receive continuity of carer within these facilities. Continuity of midwife relationships have clear benefits as demonstrated through a number of randomized controlled trials.
Mothers' and fathers' concerns and needs postpartum
Authors: Nyberg Karin , Sternhufvud Lena Bernerman
Published: May 2014

Twenty Swedish parents were interviewed regarding concerns and needs after delivery. The most common areas of concern among primiparas regarded breast-feeding, post-delivery concerns and baby-caring while multiparas had concerns regarding the newborn's siblings. The fathers’ most important concerns regarded the baby and work/economy.
Alternative positions in labour and childbirth
Authors: Deakin Barbara-Ann
Published: May 2014

This essay will examine what women want compared with what they receive during childbirth and view this against a background of choice and control. In particular, the question will be considered as to why three-quarters of women in England and Wales give birth in a supine position (MIDIRS, 1996) when various studies have reported the benefits of remaining active (Gardosi et al, 1989; Golay et al, 1993). It will also examine the way midwifery care is delivered on labour wards and its influence on labour and birthing positions. From a critical review of the factors influencing this situation, the implications for midwifery practice will be considered.
The Bristol Inquiry Report: respect and honesty
Authors: Dimond Bridgit
Published: May 2014

This article analyses the recommendations of the Bristol Inquiry Report which aims to place the patient at the centre of everything which the NHS does. The implications for the midwife in respect of partnership with the woman, communications and responding when things go wrong are considered.