bluuebunny/crossref_metadata_2025_split huggingface dataset:
Laryngeal tuberculosis: not the usual suspect
Authors: Street I , Gillett D , Sawyer A , Weighill J 
Published: May 2014

A 40-year-old Caucasian male patient of Irish origin residing in Brighton and of no fixed abode presented to the ear nose and throat outpatient clinic with dysphonia and dyspnoea for approximately 3 months. He consumed about 110 units of alcohol per week and smoked about 40 cigarettes each day. On examination, he had two palpable nodes in the right posterior triangle. Flexible nasal endoscopy showed an immobile left vocal cord and a transglottic mass. A chest X-ray resulted in a picture consistent with infection, although metastases could not be excluded (Figure 1). Blood test results showed a normal white cell count and an erythrocyte sedimentation rate of 118.Eleven days later, laryngoscopy and biopsy from the left supraglottis was performed; a mass with an irregular surface and without ulceration was noted over the left arytenoid cartilage and false cord. After 4 days a staging computed tomography (CT) scan of the neck and chest was done.The patient was seen in the outpatient clinic within 2 weeks: histology showed only mild subepithelial chronic inflammation; no specific mention of granulomata was made. The CT scan showed extensive cervical lymphadenopathy, the lungs showed multiple poorly defined soft tissue lesions with cavitation consistent with multiple metastases, while laryngeal appearances were consistent with a T2/T3 supraglottic lesion (Figure 2).The possibility of pulmonary tuberculosis was realized. The respiratory physicians reviewed his chest CT and, on further questioning, he had no history of intravenous drug abuse or other risk factors for immunodeficiency. Human immunodeficiency virus testing was not performed. A repeat biopsy was arranged the next day to search for acid-fast bacilli. However, this was cancelled preoperatively because the patient was dyspnoeic and had a pyrexia of 38°C. The next morning, his sputum sample showed acid-fast bacilli. The patient was isolated and started on once-daily doses of rifampicin, isoniazid, pyrazinamide and ethambutal. These were given as a 6-month course consisting of 2 months of treatment with the four drugs, followed by a 4-month period of daily treatment with isoniazid and rifampicin.The patient remained as an inpatient under the care of the respiratory medicine department for 2 weeks and improved on the antituberculous medication regimen – at that point, he went to theatre for a repeat laryngoscopy and biopsy. This was taken from the left arytenoid region, where a defined mass was noted.His next appointment was less than a fortnight later in the outpatient clinic. The histology report showed that there was only chronic inflammation; there were no acid-fast bacilli on staining and no granulomata were seen. The original biopsy specimen was re-examined and stained with a view to finding acid-fast bacilli, which were definitively identified within the laryngeal tissue.On longer-term follow-up, he was seen in clinic 3 months later. His voice had improved, his vocal folds were moving normally and the left arytenoid mass was no longer present.
Splenosis: a management conundrum in acute abdominal pain
Authors: Burger AEE , Stuart S , Rasheed A 
Published: May 2014

A 38-year-old woman presented with a 4-day history of left upper quadrant pain and nausea, on the background of occasional mild left upper quadrant pain over the previous year. She gave a history of emergency splenectomy 18 years previously following a jet skiing accident, and was otherwise fit and well. On admission she was in pain, lying in the right lateral position with normal vital signs, a blood pressure of 126/60 mmHg, pulse rate of 72 beats per minute and respiratory rate of 16 breaths per minute. Examination confirmed tenderness in the left upper quadrant and left flank, with no signs of peritonism.Microscopic haematuria was noted; however, intravenous urogram was normal. The patient continued to complain of pain and developed peritonism in the left subcostal region. All haematological and biochemical indices remained normal. An abdominal computed tomography (CT) was performed to rule out any unexpected pathology. This revealed extensive intra-abdominal nodules thought to represent splenosis, based on the history of traumatic splenic rupture and subsequent splenectomy. Splenosis is defined as autotransplantation of splenic tissue to unusual sites after splenic trauma. Two large nodules were located close to the splenic vein (Figure 1). There were no features to suggest either haemorrhage in or infarction of these presumed splenunculi, nor other radiological abnormalities to account for her pain.In light of normal blood indices and equivocal CT result, an active observation strategy of repeated examination, haematological and biochemical testing was adopted. On day three post-admission her left upper quadrant pain became refractory to morphine patient-controlled analgesia, and arterial blood gases on this occasion confirmed a metabolic acidosis with a base deficit of 8.4.The decision was taken to proceed to laparotomy looking for devitalized or ischaemic tissue. Except for adhesions and extensive splenic implantation as per CT findings, this was unremarkable. Multiple spenunculi were noted throughout the abdomen, none appeared to have bled or infarcted.Postoperatively the pain did not settle, requiring increasingly large doses of morphine and necessitating high dependency unit admission. A repeat CT scan, however, showed no change from the previous scan. As the pain failed to resolve or be alleviated by any analgesia, the patient was taken for re-laparotomy 48 hours later. A decision was made to resect the largest splenunculi, which coincided with the anatomical site of the pain. One large splenunculus, lying against the diaphragm, was resected from the splenic vein, another from the omentum and two smaller splenunculi from the region of the pancreatic tail (Figure 2).Postoperatively the patient improved dramatically, was mobilizing well by day 5 and was discharged home pain free 8 days after the second laparotomy. Although the large splenunculus was dusky at resection, histology revealed congestion of the red pulp with no other significant abnormalities.
Antidepressants, thiazide diuretics and alcoholism: central pontine myelinolysis waiting to happen?
Authors: Crosland Lucy , Longcroft-Wheaton Gaius , Fraser Jocelyn , Stone Adam 
Published: May 2014

A 50-year-old man, with a known weekly alcohol intake of almost 100 units, presented to his GP feeling drowsy. Routine blood tests revealed a profound hyponatraemia of 100 mmol/litre, and he was referred to hospital for investigations. On admission he was drowsy, but had a Glasgow Coma Scale score of 15, an abbreviated mental test score of 10/10 and an entirely normal neurological examination. Liver function tests were consistent with excessive alcohol consumption. He had been prescribed bendroflumethazide and clomipramine (a tricyclic antidepressant) by his GP. In view of their potential tocause hyponatraemia these were subsequently withheld and he was fluid restricted to 1.5 litres per day. His sodium level rose gradually and on day 5 of admission it had increased to 122 mmol/litre. He was discharged on day 8 having been advised to stop drinking. Less than a week after discharge he represented to his GP with symptoms of excessive sweating, shaking, constipation, disorientation and dysarthria. He was febrile at 38.6°C , and had a blood pressure of 180/90 mmHg. Electrolytes were normal (Na+ 135 mmol/litre). Although he denied consuming any alcohol since his initial admission, his symptoms were consistent with acute alcohol withdrawal and he was treated accordingly. He failed to improve on two attempts at reducing doses of chlordiazepoxide. His dysarthria progressed until his speech was difficult to understand and his swallow became unsafe. He continued to spike temperatures throughout the admission and although a catheter specimen of urine was positive for enterococcus, treatment with a prolonged course of antibiotics had not resolved his fever. A computed tomography scan of his head and a lumbar puncture were performed. Other than cortical atrophy in keeping with alcohol abuse, neither investigation provided any answers. It was considered that his symptoms could be explained by autonomic dysfunction. In view of his corrected hyponatraemia, central pontine myelinolysis was suggested and a magnetic resonance imaging head scan was performed (Figure 1). This confirmed the presence of central hyperintensity on the water sensitive sequences within the central pons, in keeping with an osmotic demyelination syndrome. Additionally these changes were identified within the caudate nuclei, possibly accounting for the patient's inability to fully control voluntary movement. The ongoing temperatures without sepsis suggested hypothalamic involvement. Following diagnosis this patient failed to improve. Treatment became supportive, and he died 7 weeks later.
Paraoesophageal hernia: an overview
Authors: Hennessey D , Convie L , Barry M , Aremu M 
Published: May 2014

Paraoesophageal hernias are a rare but clinically important type of hiatus hernia. Gastric volvulus and perforation may ensue. Investigation and management is determined by patient presentation. This review summarizes current research regarding paraoesophageal hernias.
Using audit to improve provision of analgesia for insertion of permanent pacemakers in children
Authors: Boynton Claire , Jaggar Sian I 
Published: May 2014

Pain has an adverse effect on the patient experience in hospital. The authors' institution used audit to improve the use of analgesia in the paediatric population. The audit cycle was repeated five times. Using education and training the institution was able to improve analgesia provision. A significant reduction in the number of children receiving no analgesia was demonstrated. In addition no further adverse event forms were submitted. Using audit can be an effective way to improve delivery of quality care.
Recurrent alcoholic ketoacidosis with hyperglycaemia in a non-diabetic patient
Authors: Gill Geoffrey , Yong Alice 
Published: May 2014

A39-year-old man was admitted urgently with abdominal pain and vomiting to a surgical ward. He had a history of excessive alcohol intake and previous attacks of acute alcoholrelated pancreatitis. Examination was unremarkable apart from a tachycardia of 120/minute in sinus rhythm and generalized abdominal tenderness. Investigations revealed normal haemoglobin, urea and electrolyte levels. White cell count (WCC) was 11.5/mm3 and plasma glucose 13.1 mmol/litre (there was no past or family history of diabetes). Urine was heavily positive for ketones. Serum amylase was normal. Arterial blood gases showed a metabolic acidosis (pH 7.18, pCO2 2.1 kPa, pO2 18.7 kPa, base deficit 19 mmol/litre and standard bicarbonates 10 mmol/litre). No definite diagnosis was made, but the patient was treated with intravenous 0.9% sodium chloride (NaCl) infusion, and his symptoms settled and the blood gases normalized spontaneously over the next 1–2 days. Apart from the initial raised plasma glucose, all subsequent levels were normal. Three months later the patient was again admitted urgently with abdominal pain and vomiting, this time to a medical ward. In the period since his last admission he had continued to drink excessive amounts of alcohol, and had had a particularly heavy ‘binge’ over the preceding 2–3 days. On examination he was moderately dehydrated and tachycardic, with hyperventilation and generalized abdominal tenderness. Serum amylase and electrolytes were normal, but urea and creatinine were slightly raised at 8.1 mmol/litre and 142 μmol/litre respectively. WCC was 22.1/mm3 and urine was heavily positive for ketones. Plasma glucose was 13.9 mmol/litre. Arterial blood gases again showed a metabolic acidosis (pH 7.22, pCO2 1.5 kPa, pO2 18.5 kPa, base deficit 20 mmol/litre and standard bicarbonate 8 mmol/litre). A serum lactate level was taken at the time and later returned at 3.9 mmol/litre. A diagnosis of either euglycaemic diabetic ketoacidosis or alcoholic ketoacidosis was made. He was treated with 0.9% NaCl intravenous rehydration, as well as a glucose–potassium–insulin infusion. He improved clinically and biochemically over the next 2 days, and again, apart from the initial raised plasma glucose level, all subsequent levels were normal. Six weeks after the second admission an outpatient glucose tolerance test was performed, with the patient on a free diet and no medication. The fasting plasma glucose level was 7.3 mmol/litre, and the plasma glucose level 2 hours after a loading dose of 75 g of glucose was 6.4 mmol/litre. Over the subsequent 2 years the patient had 3 further hospitalizations (one with a haematemesis as a result of a Mallory–Weiss oesophageal tear, and two with non-specific abdominal pain). No further episodes of alcoholic ketoacidosis occurred, nor did the patient develop diabetes.
Interprofessional working: factors that contribute in practice
Authors: Tapper Gissel 
Published: May 2014

Aim: This paper comments on the processes involved in promoting interprofessional working in practice and elements that detract from the process. Analysis of empirical research data was carried out to answer the question: ‘How is interprofessional working promoted in practice?’ Background: The common concern between all the authors of the studies selected was to identify contributing and detracting factors to effective interprofessional working. Results: The main findings were derived from views expressed by professionals interviewed regarding their experiences of interprofessional working. One most common theme that emerged was that trust developed over time and was vital for the process. Other features included professional's confidence, knowledge and skill in their own practice. Difficulties that arose were mostly attributable to the blurring of boundaries, lack of respect and understanding towards each others’ professional duties and responsibilities. Conclusions: The valuable knowledge gained can be used as the foundation for future studies in health and social care. As a result of the complexity of relationships in interprofessional working further exploration is needed to identify potential issues of professional differences. This study has identified a gap regarding the impact of interprofessional working in an ophthalmology setting. Further research could be conducted to identify how patients and various professionals could benefit from active interprofessional working in the area of ophthalmic practice.
Formulae and lens constants for IOL power calculation on the IOL Master
Authors: Millbank Lyn 
Published: May 2014

Optical biometry using the Zeiss IOL Master has become synonymous with measurement precision, simple operation and excellent outcomes. The IOL Master is easy to use, however it is important to understand the procedure and technique and that the measurements are applied to modern formulae using optimized A constants. Following on from ‘Accurate optical biometry using the IOL Master’ ( Millbank, 2011 ), the aim of this article is to discuss and explain the formulae to which the biometry measurements on the IOL Master are applied and to attempt to demystify the commonly misunderstood lens constant' issue.
Determining the availability and accessibility of online learning tools for ophthalmic nurses in developing and emerging economy regions of the world
Authors: Machin Heather , Marsden Janet 
Published: May 2014

As online education and resources continue to grow at a rapid rate for nurses in developed nations, the knowledge gap between developed and developing nation nurses continues to grow. Computer technology, while accessible and easy to use within developed countries, is new and unchartered territory for many others around the world, and issues such as bandwidth access, cost, local language content, translation and computer literacy, and computer skills remain key elements that need to be addressed before nurses in developing regions of the world can effectively benefit from such technology, otherwise they will be subject to an ever increasing digital divide. This paper will discuss the issues facing many developing nation ophthalmic nurses as they seek current evidence-based practice, evidence-based tools and training, connection with the wider nursing community, and an enhanced ability to apply new knowledge to their own practice advancement and patient care. This paper was compiled during a strategic research development phase for ORBIS Internationals' Cyber-Sight ( www.cyber-sight.org ) online learning tool for nurses. To date, Cyber-Sight has predominantly provided telemedicine and education support to international ophthalmologists around the world. The goal to develop a similar nursing page required initial research to determine the accessibility and availability of this internet resource, as it appeared far more difficult due to the language and affordable-access variances between doctors and nurses. Additionally, this task was considered uncharted waters in ophthalmic online nurse training within developing, emerging economy and war-torn areas of the world. Therefore, as part of a preliminary strategy, ORBIS decided that analysis of the online ophthalmic nursing community was necessary prior to commencing development of their on-line nurse training tools on Cyber-Sight. This paper presents the accumulation of investigations undertaken in order to develop a potential ophthalmic nursing programme for online nurse trainee groups in developing and emerging economy nations.
The impact of unrelieved patient suffering on palliative care nurses
Authors: White Kate , Wilkes Lesley , Cooper Karen , Barbato Michael 
Published: May 2014

Aim To describe the impact of unrelieved patient suffering on nurses working with palliative care patients. Design This was a qualitative descriptive design using semi-structured interviews. Sample Nine experienced palliative care nurses were interviewed. Results Nurses acknowledged that the term ‘suffering’ generally was not used in the workplace. The nurses identified that only a small group of patients died with suffering that could be classified as ‘unrelieved’ but that the impact of these patients’ suffering on themselves was enormous. Nurses described the impact in terms of perceptions of suffering (difficult situation), feelings (helplessness, distress, feelings of failure), bearing the burden (alcohol consumption, headaches) and effects on their relationships with family. The nurses identified several factors that increased the personal impact of unrelieved patient suffering. The most important strategy for ameliorating the impact of unrelieved patient suffering was informal support from work colleagues. Conclusion The nurses’ stories indicate that the personal impact of unrelieved patient suffering could be reduced through acknowledgment of this suffering and better formal and informal support mechanisms.
End-of-life care in a nursing home: a study of family, nurse and healthcare aide perspectives
Authors: Goodridge Donna , Bond John B , Cameron Cynthia , McKean Elizabeth 
Published: May 2014

Aim To examine the perspectives of family members, registered nurses and healthcare aides regarding the last 72 hours of Canadian nursing home residents' lives. Study design Exploratory, descriptive design using semistructured interviews. Sample Consisted of 14 registered nurses and eight healthcare aides who had provided care within the last 72 hours before a resident's death and four family members who had visited within the same time frame. Setting A 220-bed nursing home located within a larger long-term care facility in Canada. Methods Thematic analysis was conducted independently and through consensus identified themes and subthemes emerging from the interviews. Findings Dyspnea was a more common end-of-life (EoL) symptom for nursing home residents in this sample than was pain. Caring behaviours of staff were central to the resident's dying process and involved assessment, coordination of care, physical care, family education and nurturance. Family members' ambivalence about the resident's death and fear of the resident dying alone were frequently noted. Conclusions Appropriate and timely symptom management and a range of caring behaviours of staff are critical elements in the dying experience of nursing home residents. Additional education and support for personnel involved with caring for this group will enhance end-of-life care.
Exploring terminally ill patients’ and their families’ perceptions of holistic care in Malaysia
Authors: Loh Keng Yin 
Published: May 2014

Aim: To document the perception of terminally ill patients and their family members on the care provided to them, and to look at the components of holistic care that are viewed as inadequate. Methods: Thirty cancer patients from a 10-beded palliative ward and their family members who were the chief carers were interviewed. They were asked to give their perceptions on four major areas of care: physical, social, psychological and spiritual. The participants were asked to report which area(s) of the service were inadequate. Results: Most patients and family members perceived that they received adequate physical care. However, the psycho-social and spiritual aspect of care were perceived as inadequate by the majority of patients and their families. None of the patients interviewed had ever been asked about spiritual distress. Conclusion: The holistic model of care in caring for terminally ill patients is not practised fully. Further development in the psycho-social and spiritual aspects of care is necessary. There is a need to conduct further research to address these domains.
Factors influencing the referral of non-cancer patients to community specialist palliative care nurses
Authors: Andrews Nicola , Seymour Jane 
Published: May 2014

Aim: To understand why non-cancer patients are under-represented on the caseloads of community Macmillan specialist palliative care nurses by exploring what influences community health professionals' referral patterns of non-cancer patients in one locality of a primary care trust. Design: The study adopted a qualitative design, making use of semi-structured interviews with a purposive sample of community health professionals comprising three GPs, three district nurses, and three community matrons. The framework approach was used for analysis. Findings: The classification of patients, the perception of the palliative care service, the existence of different pathways of care for cancer and non-cancer patients, and the role of other specialist nurses all seem to influence the referral patterns of community health professionals. Conclusion: Although further research is required to fully understand all of the relevant viewpoints, in particular those of patients and carers, it appears that innovative new models of service delivery could be developed that address the engrained perception of the Macmillan nursing service as being for dying cancer patients only, as well as the blurred boundaries between Macmillan nurses and other senior clinical nurses.