bluuebunny/crossref_metadata_2025_split huggingface dataset:
An unusual case of enterococcal tricuspid valve endocarditis
Authors: Kelly J , Prasan A , Costello J 
Published: May 2014

A 52-year-old male smoker presented with a 10-week history of weight loss and malaise, together with a 1-week history of left-sided pleuritic chest pain, haemoptysis and mild dyspnoea. He had used intravenous drugs for a short time 30 years previously although he denied any intravenous drug use since. There was no other past medical history of note. On examination, he was thin and appeared chronically unwell. He was apyrexial. There was a left pleural rub. There were no murmurs or stigmata of endocarditis. There were no other findings of note. Full blood screen was normal apart from a white cell count of 11.2x109/litre (normal range 4.0–11.0x109/litre). Erythrocyte sedimentation rate was 52 mm/hr and C-reactive protein was 16 mg/litre (normal range <7.0 mg/litre). Urinalysis and urine culture were normal. The chest X-ray showed a circumscribed left lower zone lesion (Figure 1). Figure 2 shows the computed tomography appearance of the lesion. At this stage, pulmonary malignancy was suspected (either a primary or secondary). The following day, two sets of blood cultures were taken in view of a low grade pyrexia. Enterococcus faecalis grew from all four bottles and the patient was started on intravenous amoxycillin. Five days after admission a new soft pansystolic murmur at the left sternal edge was noted. Intravenous gentamicin was added. Transthoracic echocardiogram was normal but was repeated after an interval of 10 days in view of continuing low grade pyrexia and at this stage showed a vegetation adherent to the tricuspid valve (Figure 3). The patient was treated with intravenous amoxycillin and gentamicin for a total of 6 weeks. He did not develop any further complications and has remained well at follow up.
A simple sore throat?
Authors: Maher Bridget , Pirmohamed Munir , Carey Peter 
Published: May 2014

Apreviously healthy 26-year-old man presented with a 3-day history of sore throat, fever, rigors, loin pain and vomiting. He was pyrexial (40°C) and tachycardic (104 beats/minute), but had a normal blood pressure. Clinical examination revealed erythematous fauces without any exudates, and bilateral submandibular Iymph node enlargement. There was no meningism or para-spinal tenderness. The platelet count was decreased (108 × 109/litre, normal range (NR) 150–400x109/litre) and white cell count was elevated (16.1×109/litre, NR 4–11x109/litre) with a neutrophilia. Markers of inflammation (erythrocyte sedimentation rate 61mm/h and C-reactive protein 226mg/litre) and urea (11.1 mmol/litre, NR 3–7 mmol/litre) were also elevated. Chest X-ray and glandular fever slide test were both normal. The patient was started on intravenous ceftriaxone after blood, urine and throat swabs were sent off for culture. The patient's temperature settled over the next 4 days, and he was converted to oral antibiotics. Gram-negative anaerobes were cultured from the blood; these were identified as Fusobacterium nucleatum, suggesting that the patient had necrobacillosis. Throat swabs failed to grow the organism. In order to exclude an abdominal source for the organism, the patient also had an abdominal ultrasound and a radiolabelled white cell scan, both of which were normal. The patient's inflammatory markers and renal function returned to normal with antibiotic treatment, and he remains well 1 year after his illness.
False diagnosis of a catecholamine-secreting paraganglioma in a patient with hypertension and depression
Authors: Thomas Glyn , Winocour Peter 
Published: May 2014

A48-year-old man was referred to the accident and emergency department. He had been suffering from intermittent episodes of headaches, palpitations and sweating with ‘flushing’ for the past 2 years. On the day of presentation he had suffered a typical ‘attack’ while at work, and was found to be hypertensive (blood pressure 160/120 mmHg). He denied any intense anxiety associated with these symptoms, but had been receiving treatment with imipramine (150–225 mg daily) for depression over the past 12 months. There was no significant past medical history. On examination he was slightly obese and mildly tachycardic (rate 100 beats per minute) with normal heart sounds. Radial pulses were present and equal, with no radiofemoral delay. Fundoscopy revealed healthy discs and normal retinal vasculature. The remainder of the examination was unremarkable. Baseline renal function was normal with a serum creatinine of 96 μmol/litre, and urinary albumin:creatinine ratio of 0.5. Measurement of urinary catecholamine excretion revealed persistent elevation of noradrenaline on three subsequent samples, at 749, 764, and 1008 nmol/24 hours (reference range <590 nmol/24 hours). Values for adrenaline and dopamine, however, were well within normal limits at 48, 49, 88 nmol/24 hours (reference range <190 nmol/24 hours) and 2301, 2432, 2619 nmol/24 hours (reference range <3279 nmol/24 hours), respectively. On the basis of this clinical picture, a presumptive diagnosis of hypertension caused by a catecholamine-secreting tumour was made. Imipramine was stopped, and antihypertensive medication commenced. An attempt to locate the neuroendocrine tumour using both computed tomography and magnetic resonance imaging failed to locate any mass lesion in either the adrenal glands, retroperitoneum, mediastinum, abdomen or bladder. An 123I-MIBG scan was then performed (potassium perchlorate 400 mg once daily for 3 days beforehand, then 398 MBq of 123I-MIBG and 79 MBq of 99Tcm mercaptoacetyltriglycine (MAG3)), which revealed an isolated focal high uptake in the region of the lower pole of the left thyroid lobe (Figure 1). The presence of a 1.2 × 1.5 cm lesion at this site was confirmed on magnetic resonance imaging (Figure 2) and ultrasonography. An ultrasound-guided fine needle aspiration was performed on the lesion, before anticipated surgical intervention. This revealed simple cystic changes in a degenerative thyroid nodule, with no evidence to suggest the presence of a neuroendocrine tumour. Repeat measurement of both blood pressure and catecholamine excretion had returned to within the normal range.
Atrial myxoma: a cardiocutaneous syndrome
Authors: Conroy Simon , Wassif Wassif S , Cooper John , Jenkins David , Stratakis Constantine 
Published: May 2014

A52-year-old man presented with recurrent transient ischaemic attacks (TIA), predominantly causing visual disturbance. In the past he had suffered from migraine and had a horseshoe kidney on the right. Additionally, he had previously undergone surgery for several skin lesions (Figures 1a and b) that were myxoid or called 'neurofibromas', although he did not have any cafe-au-lait patches or axillary freckling and no clear family history to suggest neurofibromatosis. He underwent echocardiography to investigate the cause of his TlAs, which revealed a 3 cm mass attached to the junction of the inter-atrial septum and the annulus of the anterior leaflet of the mitral valve (Figure 2). The echocardiogram was otherwise normal, as was subsequent coronary angiography. Surgery revealed three masses: the first as documented by echocardiography, the second similar mass was located at the entrance of the right pulmonary veins and the third, smaller mass was also close to the mitral valve (Figure 3). All were completely excised and the atrial wall repaired. The recovery was uncomplicated. Histology confirmed that all three masses were completely excised atrial myxomas.
Introducing a nurse-led FFA: trials, tribulations and evaluation
Authors: Ring Lynn 
Published: May 2014

Introduction: This paper describes the implementation and evaluation of a nurse-led fundus fluorescein angiography (FFA) service following the development of an evidence-based protocol. A national survey was carried out resulting in evidence-based guidance to support implementation. Literature review: Research-based evidence is scarce however nurse-led FFA has been shown to be safe, improve efficiency, decrease clinic over booking and improve patient satisfaction. However, a clearly defined protocol remained elusive. Method: A national survey was carried out and 87 completed questionnaires were analyzed. Data analysis: 61 units ran a nurse-led FFA service. The majority had implemented their services using in-house training including intravenous (IV) cannulation, IV administration, intermediate life support and consent training. Discussion: Nurses with recognized ophthalmic training and experience were undertaking nurse-led FFA. The issue of informed consent, consistency of information given by nurses and doctors and using patient group direction to administer IV fluorescein raised interesting contradictions when compared with national guidance. This was addressed during implementation of the nurse-led FFA service within the author's unit. Implementation: A training workbook was formulated including nurse-led informed consent. Evaluation: The nursing service has been in place for 5 years and has undertaken investigations on 1313 patients. A prospective audit of adverse events has taken place since inception with only 99 patients, approximately 7.5%, being identified as having incomplete FFA performed because of adverse events. Only two patients showed signs consistent with cardiac and respiratory problems. Conclusion: The lack of robust national guidance limited the ability of the organization to develop practice efficiently, but the survey showed that nurses safely enhance their practice to run FFA clinics and adverse events remain consistently low over 5 years.
Patient experience of intravitreal injections in AMD
Authors: Henriksen Kristina , Adhami Setareh 
Published: May 2014

Background: Age-related macular degeneration (AMD) is a common sight-threatening disease in subjects above 50 years of age and new treatments include intravitreal injection of anti-angiogenic substances. The aim of this study was to evaluate patients’ experiences of such treatment. Subjects: Ten subjects, aged 66-95 (8 females and 2 males) participated. Nine of these had recently received their first injection and one the second injection. Methods: Interviews were performed in the patient's home and contained only one, open question: Can you tell us how you experienced the injection in your eye? The participants were allowed to speak freely, but follow-up questions were asked by the interviewers. Verbatim records were generated by tape recordings. Results: Four main topics were identified in the responses. 1. Information; the subjects experienced deficient information before treatment. 2. Fear and discomfort, related to treatment procedure or to visual loss. 3. Confidence in the care; a few subjects reported a few negative experiences, but no major complaints regarding the current procedure. 4. Subjective expectations on the effect on vision were that further visual impairment would be avoided, but there were also some reports of expected visual improvement, relevant for daily life activities. Conclusion: The dominating theme in the responses was fear of further visual loss, indicating a need for individually adapted/targeted information in order to provide the patients with a realistic view of the disease and the expected effects of current treatments.
Allergic ocular disease: from itchy eyes to visual loss
Authors: Johnson Paul 
Published: May 2014

It is estimated that allergic conjunctivitis is responsible for 4–5 cases per 1000 attendances in primary care in the UK. Seasonal allergic conjunctivitis is the most common presentation representing approximately 50% of all allergic conjunctivitis cases. Vernal keratoconjunctivitis and atopic keratoconjunctivitis are less common, but potentially more serious presentations that require management in specialist eye units. This article will provide an overview of the more common presenting forms of allergic ocular disease, their clinical features and suggested general measures and clinical management plans.
The practice of pilgrimage in palliative care: a case study of Lourdes
Authors: Lillie Alison Kate 
Published: May 2014

Aim To understand why healthcare professionals working in palliative care felt that pilgrimage to Lourdes could be a beneficial activity for the terminally ill. Design A qualitative study using a phenomenological framework. Methods Nine semistructured interviews with a purposive sample of hospice staff. Results The reasons given for accompanying the terminally ill to Lourdes reflected the general aims of palliative care. They included improving the quality of life through the provision of a holiday, maintaining patient choice and autonomy and enabling inner-transformations. The communitas, or altered relationships, formed during the pilgrimage were also seen as beneficial.
Advanced cancer in children: how parents decide on final place of care for their dying child
Authors: Hannan Julia , Gibson Faith 
Published: May 2014

Aim To explore retrospectively the decisions made by parents regarding their choice of place of care at time of death for their child with advanced cancer. Design Cross-sectional descriptive study. Analysis Interpretive phenomenological analysis. Sample Parents of five children who had died of advanced cancer, whose care was overseen by the participating paediatric oncology centre in the southeast of England. Three children died at home, and two in hospital. Results Seven themes were identified, four of which will be discussed: valuing time left; needing to feel safe and secure; we didn’t know what to expect; and the difference between specialist and non-specialist staff. Families’ decisions were instinctive or intuitive rather than a calculated weighing up of options. Families identified aspects of care that were both valuable and could be improved. Conclusion Parents value the time that their children have to live when they know that their child’s disease is incurable. Decisions around place of care are just that, decisions around place of care not place of death. Families valued the same types of support from staff regardless of the setting in which care was provided and found the same deficiencies difficult.
Is the Palliative Care Outcome Scale useful to staff in a day hospice unit?
Authors: Slater Adrienne , Freeman Elaine 
Published: May 2014

Aim This study was undertaken to elicit a day hospice team’s experience of using the Palliative Care Outcome Scale (POS), with the intention of determining its usefulness to staff. An adapted version of POS was used for the purpose of the study. Sample A multiprofessional team of eight day hospice staff took part in the study. All had used POS on a weekly basis for a minimum period of 3 months. Design A focus group was conducted at the hospice. It was tape-recorded and transcribed verbatim. The data were analysed using an interpretive phenomenological approach. Results Staff felt POS had limited value as an outcome measure for use in this day hospice. Other simultaneous organizational changes at the hospice may also have influenced staff negatively. Further research is needed to explore similar implementation issues in more depth, as practice developments may be abandoned for potentially the wrong reasons.
Aspects of caring for dying patients which cause anxiety to first year student nurses
Authors: Cooper Jan , Barnett Mandy 
Published: May 2014

Aim To examine what aspects of caring for dying patients cause anxiety in student nurses during their first year of training. Design Qualitative descriptive study. Setting A university in the UK delivering preregistration nurse education. Method A purposive sample of 38 student nurses who had just completed their first year of their programme consented to participate in the study. Data triangulation was employed, with data collected from students’ reflective diaries and two focus group meetings. Findings Eight themes emerged relating to students’ anxiety about caring for dying patients: coping with the physical suffering of patients: what to do or say; the severing of the relationship with the patient; the type of death; cardiopulmonary resuscitation; last offices; coping mechanisms; and interventions that would improve the student experience. Conclusion Findings from the study suggest that it is aspects of the caring role, rather than personal fear of death, that form the source of much of students’ anxiety.
Going on a journey: understanding palliative care nursing
Authors: Barnard Alan , Hollingum Christine , Hartfiel Bernadette 
Published: May 2014

Aim: To describe the qualitatively different ways a group of Australian nurses, understood their experience of being a palliative care nurse. Design: The research approach chosen was phenomenography. Fifteen nurses caring for people in a specialist palliative care unit in regional Australia were interviewed and transcribed interview data were analysed in order to identify understanding of experience. Findings: The research identified and described five ways of understanding the experience of being a palliative care nurse: doing everything you can; developing closeness; working as a team; creating meaning about life; and maintaining myself. Conclusion: The group of palliative care nurses involved in this research understood their experience as journeying with their patients through the final phases of the person’s life. The journey involved the patient, his/her family and members of the healthcare team. The journey was described further as a process of personal development which influenced how nurses construct meaning about life and maintain a sense of self. The experiences described reveal a great deal about palliative care nursing and provide useful knowledge and insights to assist practitioners, managers and educators.
Symptoms suffered by life-limited children that cause anxiety to UK children’s hospice staff
Authors: McCluggage Heather-Louise , Elborn J Stuart 
Published: May 2014

Background: Very little is published about the symptom profile of children with life-limiting illnesses other than cancer. Method: A postal questionnaire was sent to children’s hospice staff who were asked to identify symptoms experienced by life-limited children which caused them anxiety. Results: Staff in 23 hospices were sent questionnaires. Twenty eight questionnaires were returned from 10 doctors and 18 nurses. Just under half of the hospices contacted were represented. The staff were very experienced but had significant anxieties about treating some of Aims: This study aimed to identify the symptoms which cause anxiety to staff working in children’s hospices. More than 70% of all staff groups felt that identifying the symptom correctly caused more anxiety than treating identified symptoms. For doctors the top five symptom problems were, seizure control, spasms, pain assessment, unidentified distress and vomiting. For nurses the main concerns were the non-verbal child in distress, psychiatric or psychological problems, assessing pain, seizures, pain management, vomiting. Conclusions: Doctors and nurses perceive seizures, pain management, and vomiting as the most troublesome symptoms for children with life-limiting conditions. Further research is needed into symptom management in this area.
Assessment and monitoring of nutritional status in patients with advanced cancer: part 1
Authors: Dewey Ann , Dean Taraneh 
Published: May 2014

Using a qualitative approach, this study set out to explore nurses’ management of patients with advanced cancer, weight loss and eating-associated problems. Extreme weight loss is commonly seen in patients with incurable solid tumour cancer and, to date, it has proved difficult to manage successfully. Currently, little is known about how nurses (often directly involved in the delivery of palliative care) assess weight loss and nutritional status in everyday practice in order to provide appropriate support. In this study, 14 semi-structured interviews were conducted with nurses from both hospital and community settings. The findings revealed that many nurses did not routinely provide early identification and assessment of nutritional status including weight loss, nor did they continue to monitor the patient’s progress or deterioration. Many nurses were reluctant to initiate conversations with cancer patients about weight loss, but instead waited for patients and relatives to raise their concerns. As a result, it is likely that informal assessment may have resulted in the reactive style of nutritional management seen. However, nurses interviewed received limited training, but were keen to learn more about nutritional assessment and management.
Coping strategies, emotional outcomes and spiritual quality of life in palliative care nurses
Authors: Desbiens Jean-François , Fillion Lise 
Published: May 2014

It is in accompanying the dying that palliative care nurses say they find meaning in their work. To further explore this phenomenon, consideration of coping strategies is proposed. The main objective of this correlational study was to describe the association between coping strategies (using a revised version of the COPE scale (Carver et al, 1999)), emotional outcomes (distress and vigour; profile of mood states (POMS)), and spiritual quality of life (using the Functional Assessment of Chronic Illness Therapy – Spiritual Wellbeing Scale (FACIT-sp)). A sample of 120 nurses providing palliative care in acute care hospitals and the community in Quebec was included. Positive reinterpretation (β=.27; p<.01) and turning to religion (β=.33; p<.001), two strategies related to meaning-making coping and disengagement (β=–.19; p<.05), were the best predictors, accounting for 22% of variance of spiritual quality of life. These findings are consistent with recent studies and highlight the importance of meaning-making strategies in psychological adjustment to bereavement for palliative care nurses.
Learn Now; Live Well: an educational programme for caregivers
Authors: White Kate , D’Abrew Natalie , Auret Kirsten , Graham Nina , Duggan Geoff 
Published: May 2014

Aim: To evaluate the effectiveness of the Learn Now; Live Well (LNLW) educational programme on enhancing the knowledge and support of caregivers living with a life-threatening illness. Design: A combined summative and formative evaluation design was used. Both quantitative and qualitative data were collected using a questionnaire with a five-point response scale of strongly agree to strongly disagree and semi-structured interviews. Sample: Two hundred and five participants attended the LNLW programme, interviews were held with a selection of carers and key informants from organizations and the inpatient setting. Results: At completion of the programme, a substantial reduction in care isolation, and increase in care confidence and knowledge was evident. The findings from the interviews indicated strong support, reassurance and having a skilled facilitator as the fundamental components for the success of the programme. Conclusion: The LNLW programme successfully improved carers’ access to support across a range of sectors, increasing confidence through education and support.