bluuebunny/crossref_metadata_2025 huggingface dataset:
Preconception care for healthy women and those with medical conditions
Authors: Vais Alina , Green Lucinda , Harding Kate
Published: May 2014

All women benefit from some pre-pregnancy care. Those with co-existing medical conditions need advice about their medication, the impact of pregnancy on their disease and the impact of their disease (particularly their medication) on their pregnancy. This article will help health professionals give evidence-based advice.
Local excision of rectal tumours by minimally invasive transanal surgery
Authors: Hershman Michael J , Mohammad Hassan , Hussain Anwar , Ahmed Awais
Published: May 2014

Rectal tumours which are not amenable to endoscopic resection have been managed traditionally by radical surgery. Transanal techniques are less invasive and have a lower mortality and morbidity, but a higher local recurrence rate. This article reviews and compares some of these techniques.
New developments in cardiac resynchronization therapy
Authors: Sankaranarayanan Rajiv , Visweswariah Rajaverma , Fox David J
Published: May 2014

Cardiac resynchronization therapy significantly reduces mortality and morbidity in patients with heart failure and ventricular dyssynchrony. This is a dynamic field with some exciting recent advances, and these future directions are discussed in this review.
Management of lower urinary tract symptoms in men
Authors: Jefferies Matthew , Cox Adam , Bennett Adam , Kynaston Howard
Published: May 2014

Lower urinary tract symptoms in men are common, increase with age and can become bothersome, causing significant morbidity such as urinary retention or the need for surgery. This article outlines how to assess a man with lower urinary tract symptoms and when to refer to a specialist, and summarizes current treatment options.
Promoting antimicrobial stewardship: using video tools for junior doctors’ induction
Authors: Hadjiphilippou Savvas , Odogwu Sarah-Elizabeth , Jeyaratnam Dakshika
Published: May 2014

Antimicrobial prescribing is linked to key issues in infection control and patient safety. This article presents a novel video tool for junior doctors promoting antimicrobial stewardship, and thus safe antimicrobial prescribing, through improved awareness of local information technology systems.
Traumatic disorders of forearm rotation: anatomy, biomechanics and treatment
Authors: Mehta Nisarg , MacFarlane Robert J , Brown Daniel
Published: May 2014

The forearm is a complex structure which produces a wide range of movement. Forearm injuries are very common, but many injuries are missed or poorly treated. This article examines the anatomy and biomechanics of the forearm, and describes the important injuries to be recognized.
Spontaneous rupture of the spleen as a result of infectious mononucleosis in two siblings
Authors: Pullyblank AM , Currie LJ , Pentlow B
Published: May 2014

The first confirmed case of splenic rupture complicating infectious mononucleosis was reported by King (1941) and is well recognized as a rare complication. Enlargement of the spleen and intrinsic changes in the splenic parenchyma during the course of the disease make the spleen susceptible to rupture without a notable traumatic insult.
Spontaneous rectus sheath haematoma mimicking an enlarged urinary bladder
Authors: Riaz AA , Phylactides L , Smith F , Cheng KS , Law NW , Hamilton HEC
Published: May 2014

Rectus sheath haematoma (RSH) is an uncommon but well-described clinical entity. It is defined as an accumulation of blood in the sheath of the anterior rectus muscles. The functional characteristics of the rectus abdominis muscle are such that the commonest site for a haematoma is in the lower abdomen.
Other uses of non-vascular stents
Authors: Nicholson Tony
Published: May 2014

New generation metallic stents are making an impact on coronary, peripheral vascular and biliary diseases. However, their use is not limited to these: other areas include the oesophagus and upper gastrointestinal tract, the small bowel, large bowel and dacryocystic duct.
Orthopaedic surgery in the elderly
Authors: Treml Jonathan , Kroker Peter B
Published: May 2014

Demographic estimations for the UK predict an increase in the number of major orthopaedic surgical procedures in elderly people. The two major indications for surgery are osteoporotic fractures and severe osteoarthritis of weight-bearing joints. Coexisting medical disease makes elderly patients a surgical high-risk group, and mortality and morbidity after emergency surgery remains high.
Mechanisms underlying urticaria
Authors: Powell Jenny , Powell Sheila
Published: May 2014

Urticaria, a clinically distressing disorder, is dermal oedema resulting from vascular dilatation and leakage of fluid into surrounding tissue, often in response to histamine (and other mediators) released from mast cells. A clear history of events surrounding the onset, together with laboratory investigations, in some cases allows us to find a cause and eliminate it.
Classification and diagnosis of facial pain
Authors: Jones Nick S
Published: May 2014

This is an interesting time to consider the classification of facial pain because of the emergence of new ideas that challenge our understanding of the mechanisms involved. The new hypotheses that have been proposed appear to be of clinical relevance.
Treatment of vascular naevi in children
Authors: Lanigan SW
Published: May 2014

This article will summarize the treatment options available for the two commonest vascular birthmarks of childhood: port wine stains and capillary haemangiomas. The treatment of port wine stains is primarily cosmetic and performed with lasers. The treatment of capillary haemangiomas is needed for both cosmetic and medical reasons and can include lasers, corticosteroids, interferons and surgery.
Cryopreservation of human ovarian tissue
Authors: Salha Osama , Balen Adam , Rutherford Anthony , Picton Helen
Published: May 2014

As survival rates for young cancer patients continue to improve, protection against iatrogenic infertility caused by chemotherapy and/or radiotherapy assumes a higher priority. As things stand, women patients have few options to preserve their fertility while children have none at all.
The National Confidential Enquiry into Perioperative Deaths 2000: then and now
Authors: Mythen Monty , Grocott Michael , Webb Andrew R
Published: May 2014

The most recent report from the National Confidential Enquiry into Perioperative Deaths (NCEPOD) was published on 21 November 2000 (Department of Health, 2000a). The data presented in the report relate to a randomized 10% sample of perioperative deaths occurring in the UK (excluding Scotland) occurring between 1 April 1998 and 31 March 1999. Comparisons are drawn in the report with the randomized 20% sample examined in 1990 (Department of Health, 1990).
An unusual presentation of acute cholecystitis: biliary ascariasis
Authors: Amjad Nasser , Nor Azmi Md , Singh Harbajan
Published: May 2014

A 37-year-old Malay lady from the state of Pahang was admitted to the surgical unit with colicky upper right quadrant abdominal pain radiating to the right shoulder and scapula region. This was accompanied by nausea and vomiting. She needed intramuscular analgesics for the pain. There was no past history of similar episodes. Clinically, she was not icteric, and examination of the abdomen revealed marked tenderness and guarding over the upper right quadrant with a positive Murphy's sign. Clinical diagnosis of acute cholecystitis was made, and she was commenced on intravenous antibiotics.
Traumatic brain injury: assessment and management
Authors: McNaughton Harry , Harwood Matire
Published: May 2014

Suspected traumatic brain injury is a common presenting problem for emergency department staff. Sorting out who needs to have a computed tomography scan, who should be admitted and who should be followed up can be difficult. A framework for making these decisions is provided in this article.
A right atrial mass: thrombus, tumour or other?
Authors: Lau G , Hunjan J , Pawsey C , Eisenberg H , Lim S
Published: May 2014

A 71-year-old man was admitted with right lower lobe pneumonia, right-sided pleural effusion and congestive cardiac failure. He had been well until a left occipito-parietal embolic stroke (documented on computed tomography; CT) 2 years previously. Chronic atrial fibrillation and hypertension were noted and he was commenced on digoxin, warfarin and amlodipine. A transthoracic echocardiogram showed normal left ventricular contractility, mild mitral regurgitation and a severely dilated left atrium. He made a full neurological recovery.
Assessment and management of the head-injured patient
Authors: Bavetta S , Benjamin JC
Published: May 2014

Head injury is one of the most important causes of serious morbidity and mortality in young adults. Each year in Britain, there are approximately 5000 deaths from serious head injuries. Appropriate multidisciplinary assessment and management of systemic and intracranial pathology can significantly improve the outcome.
Using a competence framework to select future medical specialists
Authors: Heard Shelley , Appleyard Jane , Aitken Maryanne , Paice Elisabeth
Published: May 2014

Postgraduate deans in one UK region have developed a competence framework for selection of specialist registrars. This paper describes the process by which this was developed and adapted to 62 specialties. Evaluation demonstrated high levels of acceptability for applicants and to a lesser extent for selectors. An external review confirmed that the process was in keeping with good employment practice.
Antibiotic-loaded cement in revision joint replacement
Authors: Youngman James R , Haddad Fares S , Ridgway Geoffrey L
Published: May 2014

The infected joint replacement remains a difficult clinical challenge. Antibiotic-loaded cement provides one therapeutic solution that combines mechanical stability and antibiotic delivery.
Robotic surgery: a review
Authors: Purkayastha Sanjay , Athanasiou Thanos , Casula Roberto , Darzi Sir Ara
Published: May 2014

Minimally invasive techniques have revolutionized surgery by reducing surgical trauma and therefore hospital stay and subsequently cost. There are limitations, however. Robot-assisted surgery endeavours to minimize these technical hindrances and so allow better, more precise surgical practise while still minimizing surgical trauma.
Osteochondroma: an unusual cause of lower limb claudication
Authors: Osborn GD , Raman S , Evans P , Lewis MH
Published: May 2014

An 18-year-old semi-professional rugby player presented with a 4-month history of a gradually increasing swelling in his left popliteal fossa associated with claudication-type symptoms in his left leg. He was an otherwise healthy young man, with no significant past medical history.

Clinical examination revealed a rounded 7 cm visible pulsatile mass in the left popliteal fossa. The popliteal pulse was easily palpable, which was associated with an underlying nontender, hard mass on the posterior aspect of the tibia.

Plain radiographs (Figure 1) revealed a 5.5 cm bony mass arising from the posterior aspect of the proximal tibial metaphysis, suggestive of an osteochondroma. A magnetic resonance imaging scan of the left knee was arranged to confirm the diagnosis and its relationship to adjacent structures (Figure 2).

The patient underwent an uncomplicated excision of the bony mass, which showed the 6 cm × 5 cm lesion to be an osteochondroma.
All change for education
Authors: Mynard Steve
Published: May 2014

On Thursday May 6 there was a ‘seismic shift’ in the way we do politics in this country. Steve Mynard looks at the benefits and disadvantages for education of the Conservatives and Liberal Democrats working together
Funding in the new public sector landscape
Authors: Cloynes Tiffany
Published: May 2014

With the whole public sector facing up to a bleak funding landscape, schools are facing some tough decisions. Legal expert Tiffany Cloynes looks at some alternative funding options
Changes ahead for the primary curriculum
Authors: Barker Ray
Published: May 2014

The government is currently undergoing another curriculum review. Ray Barker looks at the possible outcomes and suggests how schools can achieve their objectives on a limited budget
Focus on academies
Authors: Lucas Mark
Published: May 2014

As of April 2011, 162 schools had become academies and a further 473 were in the pipeline. We asked Mark Lucas, vice-chair of governors of Moss Lane Primary School in Surrey, and a partner in a firm of solicitors, to answer some essential questions
What will the Tickell Review mean for you?
Authors: Dubiel Jan
Published: May 2014

Dame Clare Tickell reported the results of her Early Years Foundation Stage review in March. Jan Dubiel provides an overview of the recommendations and asks what they will mean for pupils entering key stage 1
The best of both worlds
Authors: Ladley Paul
Published: May 2014

Games-based learning has lead to much debate in recent times. Paul Ladley looks at how the industry is developing and asks if it likely to become mainstream in the classroom
Teaching effective, high quality sport
Authors: Donohoe Tom
Published: May 2014

How can school leaders support their teachers to lead PE effectively and to ensure that their pupils experience high quality PE? Headteacher Tom Donohoe offers his strategies and advice
Attendance – how tough are you?
Authors: O'Connell Suzanne
Published: May 2014

If children do not attend in the first place, schools cannot even begin to raise their attainment. But how far should we go with punishing pupils and their parents? Suzanne O'Connell takes a look
Lessons from Finland
Authors: Henshaw Pete
Published: May 2014

Finnish education is considered the best in the world. Pete Henshaw looks at the five key ideals that have guided Finland's schools
Six steps to using data well
Authors: Logan Colin
Published: May 2014

Colin Logan asks six questions which will help schools to ensure they are using their data effectively
Creative thinking
Authors: Mills Gareth
Published: May 2014

Gareth Mills looks at how engaging teachers in research to inform best practice can unleash untapped creativity and bring about sustainable improvement in schools
Down on the farm – school trips to the country
Authors: Falkingham Jonathan
Published: May 2014

Farming and Countryside Education works to connect schools with farms and farmers. Jonathan Falkingham explains what a farm visit can bring to your curriculum
Data for self-evaluation
Authors: Easton Claire , Houghton Emily
Published: May 2014

Claire Easton looks at the importance of gathering evidence to help self-evaluation and school improvement and offers best practice guidance
Ofsted offers guidance on literacy
Authors: O'Connell Suzanne
Published: May 2014

Ofsted's latest literacy report talks of too little improvement across England's primary schools and has been published alongside hints of an increase in the key stage 2 target. Suzanne O'Connell reports
A new approach to CPD
Authors: Farrar Maggie
Published: May 2014

Maggie Farrar discusses joint practice development, a peer-to-peer approach to CPD which is prioritised and modelled by school leaders too
Techniques to get your boys reading
Authors: Twist Liz , Clarkson Rebecca
Published: May 2014

Boys' underachievement in reading is a perennial problem for our schools and teachers. The NFER's Liz Twist and Rebecca Clarkson examine recent test results and look at what the evidence tells us about the kind of literacy activities which boys – and gir
Bouncing back from a poor school inspection
Authors: Bannister Nick
Published: May 2014

Some of the most challenging times in a headteacher's career can be after a poor inspection outcome. Nick Bannister meets leaders who have helped their schools to bounce back after inspection setbacks
Putting teacher-led research to work
Authors: Handscomb Graham
Published: May 2014

Graham Handscomb argues the case for practitioner-led enquiry, reflection and research at the heart of successful schools
Priorities for September
Authors: Bannister Nick
Published: May 2014

What are your key priorities as you approach the end of the academic year, prepare for the summer break and start to think about September? Nick Bannister asks three headteachers for their ‘top five’ lists
Speed Learning – a new form of CPD
Authors: Aubrey-Smith Fiona
Published: May 2014

Speed Learning is a new concept in grass-roots, profession-led CPD, offering practical and high-impact ideas. Fiona Aubrey-Smith explains
Case study: A living Olympic legacy
Authors: Bannister Nick
Published: May 2014

A year on from the London Olympics Nick Bannister revisits a Cornish school to find out how the leadership is not only keeping the Games' legacy alive, but is spreading it far and wide
What has happened to sustainability?
Authors: Bannister Nick
Published: May 2014

The sustainable schools agenda used to be a key element of government policy, but now it is up to schools to decide how they approach the issue. Nick Bannister talked to one head about how and why his school continues prioritise environmental issues
10 steps to a world class education system
Authors: Crossley David
Published: May 2014

Ahead of this year's Whole Education conference, David Crossley draws on the views of national and international education leaders to define how we can build a world class system. He offers 10 key ways forward for our schools
‘I'll tell you what stress is…’
Authors: Latham Vanessa
Published: May 2014

In a climate of austerity and constantly changing working conditions, stress is on the rise among teachers. Vanessa Latham looks at the legal position of teachers and schools when stress levels are running high
Closing the maths gap from year 1
Authors: Castledine Sara
Published: May 2014

Primary schools are invited to apply for funded places on Mathematics Mastery, a programme which helps schools to foster a deeper understanding of maths among pupils. Sara Castledine explains
Retained intraocular metallic foreign body post phacoemulsifcation
Authors: Upchurch Janet , Woodruff Sarah
Published: May 2014

The purpose of this article is to raise awareness to health professionals of a little reported complication of cataract surgery. To this aim we present a case report of a patient who developed an unusual post-operative phacoemulsification complication: retained intraocular metallic foreign body. A retrospective review of the patient's case notes was carried out and the findings presented.

An extensive literature search to investigate the rate of occurrence of this adverse event showed that when the phacoemulsification technique was new, and now it is a widely established procedure, the problem of retained particles exists, and that metal fragments embedded in the iris following cataract surgery can be linked to surgical technique.

The need for knowledge and vigilance regarding this unusual but significant complication by those seeing cataract surgery patients at the post-operative check, whether hospital ophthalmic staff or community optometrists, is highlighted and for the need of accurate reporting and recording of such incidents. The importance of contacting the relevant manufacturers and Department of Health agency of such complications as they occur is emphasized to ensure staff and patients have accurate and up to date information.
Non medical personnel carrying out intravitreal injections — against
Authors: Taylor Sandy
Published: May 2014

Medical retina is a rapidly expanding area, it is especially exciting for nurses working in ophthalmology as the challenges and advances that can be made via the skills and range of extended roles is particularly interesting. How ophthalmic nurses of today and the future see their roles evolving is at an interesting phase and this discussion could possibly spark some debate. Who does, what, where and how is often a refection of the availability of staff and the skills that each staff member has but should it be that way ? We are in an evolving profession but why and how we manage those challenges is the real question!
The psychological care of patients undergoing an evisceration of the eye
Authors: Wilson-Miller Rebecca
Published: May 2014

This paper examines the need for patients undergoing evisceration surgery to remove their eye to receive psychological support. The removal of an eye has serious consequences on various aspects of a patient's personal and family life, yet despite this there is a notable lack of literature and research relating to the physical, psychological and emotional care of patients undergoing this life-changing treatment. Patients are often listed for surgery in a busy, under staffed outpatient setting with no nurse present and if surgery is required immediately, due to severe pain or trauma, the patient may not receive pre assessment. As a result there may be little opportunity for the patient to come to terms with their altered body image which can have devastating effects on their recovery.

An in-depth literature review identifies the lack of literature in this complex area of nursing, however, it offers insight to the reader with clear recommendations for practice. Hehir (2000 ) states that the psychological aspect of disfigurement is highlighted as one of the main concerns of patients undergoing removal of an eye. Indeed this study indicates that an ocular plastic specialist nurse to provide psychological support for these patients at all stages of their journey would be beneficial, as would ophthalmic ward nurses receiving basic counselling training. Such nurses would help patients to come to terms with their altered body image, offering support at all times.
Cellphones in ophthalmic care: a review of current developments
Authors: Wanger Peter
Published: May 2014

This article provides a short review of the current development of cell phone apps, relevant for ophthalmic care. A handful of devices with potential use in ophthalmic care and a large number of information sources, accessible on smart phones, were identified. Current cell phone technology, with optical or other add-ons, can be assumed to have considerable impact on future eye care.
Glycopyrrolate induced mydriasis: a case presentation to highlight the importance of comprehensive history taking
Authors: Gwenhure Tendai
Published: May 2014

History taking is an integral part of patient assessment. Practitioners need to be skilful, pragmatic and knowledgeable for history to be meaningful. Any history of associated events or occurrences prior to the onset of symptoms should be explored as it might provide relevant clues to the cause of the presenting complaint. Incidences of glycopyrrolate induced mydriasis are relatively rare, as the drug itself is not in common use. Apart from mydriasis and cycloplegia, which can cause blurring of vision, glycopyrrolate does not have any serious untoward ocular effects.
Affordable eye care models for developing countries
Authors: Pradhan Keerti Bhusan
Published: May 2014

With increased life expectancy and ageing populations there is a surge in the requirement of eye care. However there are many parts of the world where people do not have access to a secondary eye hospital within 50 km of their residence. This article outlines through a case study from India that it is possible to set up a good secondary eye hospital provided a few principles are followed. Such a hospital can cater for the needs of all in the society through differential pricing and therefore become self sustainable.
Confrontation visual field testing: detecting gross visual field defects
Authors: Smith Chris
Published: May 2014

Performing confrontation visual fields is a quick and relatively easy way of detecting gross visual field defects. It requires little or no special equipment and can be performed in practically any situation, including during domiciliary visits. The practitioner should be familiar with the types of confrontation visual field tests and their uses and also the limitations of such tests.
The benefits and development of a personal portfolio
Authors: Gilsenan Irene
Published: May 2014

Portfolios/profiles are used widely across many professions including health care. They highlight where the practitioner has come from, where they are today and where they are planning to go in the future. There are many ideas and theories about how a practitioner should compile such a personal portfolio and this article discusses some of the practical activities in portfolio building.
Clinical audit on acute management of ocular chemical injury
Authors: Tallouzi Mohammad
Published: May 2014

Aim:

To assess the acute management of ocular chemical injuries to all patients who attended the eye casualty and compare this management with the standard protocol of chemical eye injury.

Methods:

Retrospective review of all cases with ocular chemical injury over a period of 4 months (August 2010 to November 2010). Case -files were retrieved and relevant information was extracted and analyzed. The audit was registered with the clinical effectiveness department of the author's trust.

Results:

There were a total of 72 patients under review during the study period consisting of 54 males and 18 females. Ages ranged from 3–85 years. The major cause of chemical eye injury was work related. However, other causes such as school, university and home accidents and assaults were noticed. The severity of ocular injury and damage was noted on reading of the pH value, as were the delay of the ocular irrigation, the amount of the chemical the patient had been exposed to and the duration of exposure. Additionally, the mismanagement of cases by the medical team was also noted in some cases.

Conclusion:

The major cause of chemical eye injury presenting to the Birmingham Eye Hospital was work related. The degree of the chemical eye injury varies, however, the disability and blindness caused seems to be more in the assault cases. In order for there to be a good prognosis in managing the chemical eye injury there is a need for effective assessment and examination. This would involve the prompt irrigation for all patients who attend the eye casualty complaining of chemical eye injury. Additionally, both eyes should undergo detailed examination which would include rapid afferent papillary defect (pupil reaction), intraocular pressure and fundus checks (particularly in severe cases). The effectiveness of the management includes the use of preservative-free topical medications for all patients, which includes the use of topical antibiotics and lubricants. Also the use of the topical steroid and systemic oral medications should be indicated in severe chemical eye injury cases. Effective follow up and understanding of cases of chemical eye injury requires detailed documentation following examination, assessment and management of patients' chemical eye injuries. The documentation could involve medico-legal aspects for the assault cases, and practitioners should understand these, and detailed documentation is useful should there be complaints against the hospital and medical team.
Peter's anomaly: why early detection is important
Authors: Jacob-Parayil Anita , Okoronkwo Irene , Mancuso Peggy
Published: May 2014

Peter's anomaly is a rare congenital anomaly. Healthcare providers only have a small ‘window of opportunity’ to diagnose the anomaly after birth and save the sight of a child. In this case, a 9-day-old African American presented to the paediatric primary care clinic for a well-child examination. His initial vision check in the newborn nursery had revealed no abnormalities of the eyes. As the paediatric nurse practitioner was performing his physical examination, she assessed the absence of the red reflex and referred the infant to the appropriate specialist. A child's sight was saved. The most important message from this case is that primary care practitioners must perform complete physical examinations of newborns, including the basic assessment of the infant's eyes.
Losing driver's license - patients' point of view
Authors: Ekman Christer , Clewestam Jan
Published: May 2014

A not uncommon result of glaucoma diagnosis is that the physician has to consider the withdrawal of the patients' driver license. A few years ago, the requirements for license withdrawal were lowered within the EU. Previously the medical condition had to be described as ‘clearly inappropriate’ for car driving, the current expression is ‘inappropriate’. For the glaucoma patient, it may be close to a personal disaster to lose the license, perhaps after decades of problem-free driving.
Non-compliant children undergoing occlusion therapy: a route to good practice
Authors: Bradshaw Jilly
Published: May 2014

Amblyopia is a prevalent condition that causes a diminution of the visual acuity of the affected eye. The condition is usually diagnosed in early life but if it is not treated by the age of between 6 and 8 years, it can lead to permanently reduced vision in the affected eye. Treatments are limited. Occlusion when complied with, is generally regarded as the treatment of choice, ‘forcing’_ the use and visual experience of the amblyopic eye. For that reason, amblyopia is an avoidable form of visual impairment.

Compliance is central to the success of the treatment. However, it has been documented for many decades that non compliance is widespread and is extremely difficult for some families, and professionals to manage.

This article explores the deeper reasons that underpin non compliance and describes an innovative programme of care – ‘An Intensive Occlusion Therapy Programme’ – devised and developed by the author, with the support of colleagues, on the Eye Unit at The Royal Bournemouth Hospital. For the past 10 years, using techniques including positive parenting and distraction, the Programme has been motivating and educating children and parents to successfully implement occlusion treatment at home. It has achieved some excellent visual outcomes, children at ease with ‘patching’ and confident parents who are in control of the occlusion regimen. The Programme has also proved highly cost effective by reducing consultant, orthoptic and clinic time, removing the need for admitting children for several days for supervized occlusion and created a coordinated, structured clinical pathway for the multi-disciplinary team to follow, thus providing seamless, family-centred care. As many testimonies demonstrate, parents thoroughly recommend and advocate this Programme to other parents facing similar problems with compliance.
Antibiotics in ophthalmology
Authors: Sherratt Amanda
Published: May 2014

Antibiotics, in any practice, are a significant asset to clinically effective treatments. This paper presents a clinical overview of antibiotic agents that are commonly used in ophthalmology. It seeks to advise on how particular agents are identified, grouped, and how they are chosen so that they may affect specific organisms. The aim of this article, is to refresh the reader's knowledge with regards to common pathogens, how they are identified, and how their patients may be appropriately treated in practice.
On being a mentor
Authors: Jones Mark , Rutkowski Krzysztof , Cox Carol L.
Published: May 2014

This article explores issues relating to mentoring students, particularly ophthalmic nursing students. It highlights the importance of mentorship in learning in practice, which in turn is critical to students' education in a competency-based profession. It considers the factors essential in successful mentoring, including two-way feedback, and the importance of mentors understanding the nature of the psychological processes involved and how to assess students' learning and competencies. It also highlights the crucial gate-keeping role of mentors in ensuring that students are fit to practise, and the importance of nurse mentors themselves being fit to practise.
Anaesthesia and cataract surgery: a review of the literature
Authors: Garland David , Marsden Janet
Published: May 2014

This review of the literature considers anaesthetics in relation to cataract surgery in particular, while recognising that the principles apply to all ophthalmic surgery. The origins and history of each type of anaesthetic are considered along with the advantages and disadvantages in relation to their use in cataract surgery.
Effectiveness of nurse practitioners in glaucoma diagnosis: implications for shared care
Authors: Munneke Robert , Kingett Jane , Byles Daniel , Smith Michael
Published: May 2014

Aim

To compare the diagnostic assessment for glaucoma performed by nurse practitioners with that of a consultant ophthalmologist with subspecialty training in glaucoma.

Method

Twenty patients undergoing assessment for glaucoma were examined by a nurse practitioner and a consultant ophthalmologist with subspecialty training in glaucoma. Three intraocular pressure (IOP) measurements were performed, and a mean taken. Disc assessment using the disc damage likelihood scale and visual field interpretation in one eye were also recorded. The assessor subsequently allocated a diagnostic category to each patient. The examinations were performed within one hour of each other to reduce the influence of diurnal variations, and both the nurse practitioner and consultant ophthalmologist were masked to the other's findings.

Results

An interclass correlation coefficient between the two sets of IOP measurements was calculated to be 0.98, suggesting a strong degree of correlation. A weighted kappa value of 0.062 was calculated for disc assessment indicating a poor correlation. Weighted kappa values of 0.364 for field interpretation and 0.259 for diagnostic agreement were calculated indicating a fair correlation for both.

Conclusions

The correlation for IOP compares favourably with previously reported results for community optometrists. Although the correlation for disc assessment was poor and for field interpretation only fair, the tendency was for over-diagnosis of pathology with the nurse assessments. This implies that the nurse practitioner assessments would provide a safe method of screening patients for glaucoma but may have economic implications in terms of unnecessary follow-ups.
Ophthalmic photographer-led age-related macular degeneration review clinics: a pilot study
Authors: Hancock Richard
Published: May 2014

At Aintree Hospitals NHS Foundation Trust, an innovative model of care for the management and surveillance of patients with treatable age-related macular degeneration of the eye (ARMD) has been achieved through introducing ophthalmic photographer-led diagnostic assessment review clinics. The main objective of this initiative was to create additional capacity, thus reducing the risk of delayed follow-up that can lead to a loss in vision. The ophthalmic photographer relies on diagnostic imaging and makes a decision as to whether the patient requires more treatment or should be seen back in clinic. A robust diagnostic informatics network is essential in the assessment of patients but also for clinical documentation, as we move towards a paperless environment. This new patient pathway has proven to be robust, safe, cost effective and innovative, and it has increased clinic capacity while increasing patient satisfaction.

This article will provide the reader with an overview of how the new patient pathway for ARMD diagnostic assessment at, implemented through a pilot study, and will discuss audit findings and the effect of the new care pathway on patient outcomes.
The evolving role of ophthalmic professionals
Authors: Collett Helen
Published: May 2014

The roles of ophthalmic professionals are evolving to provide quality cost effective care, diagnostic assessment and treatment for patients in many different aspects of ophthalmology. This paper looks at how professionals have worked with consultants to develop new skills and patient care pathways beyond their traditional job descriptions.

Orthoptist Helen Collett reflects on her personal journey from orthoptist and manual perimetrist, to developing roles in ophthalmic technology and providing her own private practice in ophthalmic diagnostics and specialist orthoptics.
Update from the International Palliative Nursing Network
Authors: Bosch Annie , Ferguson Alison , Holge-Hazelton Bibi , Webber Jeanette
Published: May 2014

The International Palliative Nursing Network was born at the 9th International Cancer Nursing Conference (ICNC) in Brighton in August 1996. As the 10th ICNC to be held in Jerusalem 30 August – 4 September 1998 moves ever closer it is timely to keep you up to date with our progress. The coordinating group of the International Palliative Nursing Network (IPNN) have met formally four times. Janssen-Cilag generously sponsored the second meeting which took place in London. On the third occasion we were able to combine our meeting with our attendance at the European Association for Palliative Care Congress in September 1997 at the Barbican in London. We have been able to put into place significant building blocks that will speed our progress in the future. We are planning to meet with as many members as possible in Jerusalem to progress the network still further and to discuss next steps.
Providing hydration for the terminally ill patient
Authors: Patchett Marie
Published: May 2014

The question of whether or not to administer artificial hydration to the patient who is terminally ill and receiving palliative care in the last few days of his/her life is problematic and causes much concern for healthcare professionals. The literature on terminal hydration is examined and some of the benefits and ill-effects of dehydration in dying patients are explored from both a theoretical and a practical viewpoint. This article also considers how different care settings can influence the management of this common problem. The author recognizes that there are many complex moral and ethical issues surrounding this subject; however, these are not discussed in this article.
Recent progress in understanding cancer-related fatigue
Authors: Richardson Alison , Ream Emma
Published: May 2014

Fatigue is increasingly being recognized as one of the most pervasive problems likely to arise from having cancer and/or related treatment. Fatigue occurs regardless of whether an individual is in the early or advanced stages of the disease process. This article will provide a summary of the progress that has been made in recent years in furthering understanding of this symptom. It examines key studies that have been published since 1995 in the following four areas: the experience of fatigue from the patient, family and healthcare provider perspective; development and testing of ways to measure fatigue; examination of the course, causes and correlates of fatigue; and, finally, the development and testing of interventions to prevent, alleviate and manage fatigue.
An audit of non-cancer-related lymphoedema in a hospice setting
Authors: Hardy Denise , Taylor John
Published: May 2014

The morbidity of non-cancer-related lymphoedema is becoming more generally recognized, but current treatment and research remain focused on cancer patients, particularly those with breast cancer. From the commencement of a new lymphoedema service at St Giles Hospice, Lichfield, Staffordshire, in 1994, referral of non-cancer patients was also encouraged. Over a 4-year period, 218 such patients were seen, accounting for 24% of the total cases referred to the clinic. The treatment outcomes of all patients were measured using simple assessment tools devised by the authors. This article presents a retrospective audit of the results achieved with the non-cancer patients. The results confirm that these patients also obtain benefits from treatment, with improvement in many aspects of the quality of their lives. They should therefore continue to be provided with opportunities for treatment.
Progress in palliative nursing
Authors: Webber Jeanette
Published: May 2014

Over the last four years, I have derived enormous pleasure from my association with IJPN — first as founding Editor and subsequently as Editor in Chief. The journal has become well established and credible in the world of palliative nursing, and it is therefore with a mixture of regret and satisfaction that I hand over to my successor.
Technology in palliative care: steering a new direction or accidental drift?
Authors: Tinnelly Karen , Kristjanson Linda J , McCallion Aine , Cousins Kerry
Published: May 2014

Technological advances have been helpful in alleviating the suffering of many dying patients. For some, however, use of technology appears to augment distress. This article presents a discussion of issues associated with use of technology in palliative care nursing: pain management approaches, use of invasive procedures, decision-making concerns, the ways in which technology may serve as replacement for other types of care, and cost considerations.
Skin changes in lymphoedema: pathophysiology and management options
Authors: MacLaren Julie-Ann
Published: May 2014

Appropriate skin care and prevention of infection are important cornerstones of effective lymphoedema management, which can play a vital role in patient comfort and acceptance of swelling. Management of the patient or client with lymphoedema requires input from an appropriately qualified and skilled practitioner, however skin care is one area of care, which may be addressed by all levels of healthcare professionals involved in direct patient care. This article highlights the pathophysiology of both the skin and lymphatics in lymphoedema. It also aims to give the reader a practical understanding of potential skin problems and suggestions for how they may be identified and remedied.
Spiritual care for the dying and bereaved
Authors: Gamlin Richard
Published: May 2014

Spirituality and spiritual care are acknowledged as central themes to the delivery of a high quality palliative care service. Spirituality, however, is difficult to define and many professionals feel ill at ease in their attempts to provide spiritual care for those who are dying and/or bereaved.
Symptom control outcomes in a community palliative care nursing team
Authors: Newbury Jenny
Published: May 2014

Measuring outcomes of care is an essential component of clinical governance. This article describes a pragmatic approach to auditing symptom control outcomes in a community specialist palliative care nursing team. Using a palliative care assessment tool, it demonstrates that the team make a positive difference to the patient’S experience of most symptoms and a plan for further development of practice is formulated in response to the results of the audit. Unexpected outcomes reveal some of the realities of community specialist palliative care and demonstrate that audit is worthwhile despite some of the pitfalls in this area of practice.
Using philosophy, knowledge and theory to assess a patient with lymphoedema
Authors: Woods Mary
Published: May 2014

The way that the world around us is interpreted, the selective use of knowledge to inform patients and different theories to support nursing practice are concepts outlined in this article that have great importance in the holistic nature of the assessment of all patients. The development of lymphoedema is a unique experience for any patient and one that is interpreted by the patient according to previous experiences and knowledge. Patients bring to the assessment their own thoughts, beliefs and understanding of the world around them, together with knowledge acquired from many sources. In order to plan the most appropriate management for a patient’s lymphoedema, the nurse is challenged to recognize his/her own thoughts and beliefs and the role they play in understanding the meaning that lymphoedema has for each patient. Relevant knowledge, together with a theoretical background to practice can then be incorporated into a holistic framework for assessment of the patient with lymphoedema.
A personal exploration of the power of poetry in palliative care, loss and bereavement
Authors: Robinson Ann
Published: May 2014

This article is a personal reflection and exploration of the potential of poetry in palliative care. Poetry can help enable expression of individuals’ deepest unspoken concerns and may provide a means of providing spiritual care. The author draws on her personal experience as a community nurse, together with the views of patients and colleagues, and discusses the literature. Some limitations to the use of poetry are considered, as are the skills needed to help patients use poetry. To illustrate the potential therapeutic value of poetry in palliative care, examples of poems by poets, patients and the author are included. The article concludes that poetry can bring about a sense of healing, and should be considered as a possible addition to other holistic therapies.
Ignorance of palliative care clouds the debate
Authors: Coyle Nessa
Published: May 2014

Nurses are not neutral in the debate surrounding legalization of physician-assisted suicide (PAS) and euthanasia for the terminally ill. They bring to the arena their experience in caring for the dying, and their skill in controlling symptoms and ameliorating existential distress. They also bring their own ethical stance, religious beliefs, cultural background, knowledge of the law and professional practice guidelines. Specialized palliative care nurses have a responsibility to educate their nursing colleagues in all aspects of care of the dying.
Nurse prescribing reaches new horizons
Authors: Mula Carole
Published: May 2014

The new year witnessed the advent of expanded prescribing powers for nurses in England, as promised by the Government in late 2005. Today, nurses who undergo specialist training, are allowed to prescribe a selection of controlled drugs for palliative care conditions: diamorphine, diazepam, lorazepam, midazolam, morphine, oxycodone, codeine phosphate, dihydrocodeine tartrate and transdermal buprenorphine and fentanyl that was not possible under the previous restrictions. This is a positive move forward for patients who will receive an improved service with more patient choice and improved access to health care.
Management of venous thromboembolism in the palliative care setting
Authors: Noble Simon
Published: May 2014

Recent literature has highlighted the unique challenges facing professionals involved with the management of venous thromboembolism (VTE) in cancer patients. Although research favours the use of low molecular weight heparin (LMWH) rather than warfarin, no studies have been conducted exclusively in the palliative care population. Likewise, active treatment may not always be appropriate in the advanced cancer patient.

This paper highlights the issues to be considered when facing a palliative care patient and suspected VTE. In particular, consideration must be given to the practicalities and acceptability of investigating suspected VTE, the dose and length of anticoagulation, and management of the patient nearing death. An understanding of the current evidence must be applied to the individual patient, taking into account their needs and wishes.
The challenge of providing palliative care to terminally ill prison inmates in the UK
Authors: Wood Felicity Juliette
Published: May 2014

Terminally ill prison inmates have a right to all aspects of health care including palliative care provision. However, there are numerous difficulties in providing palliative care to high-security prisoners in the UK. Local community hospices may be reluctant to admit terminally ill prisoners and therefore initiatives must be established to provide appropriate palliative care within the prison itself.

Dying prisoners need companionship and to be shown respect and compassion to avoid feelings of loneliness and hopelessness. Inmate volunteers can provide an invaluable source of support and friendship for the terminally ill prisoner, helping to improve quality of life.