bluuebunny/crossref_metadata_2025_split huggingface dataset:
Addressing the effects of ageing in persons who have had a spinal cord injury
Authors: Sarhan Firas 
Published: May 2014

Spinal cord injury has a catastrophic effect on an individual′s life causing multisystem physiological dysfunctions that lead to a series of complications: medical, physical, psychological, social and financial. These physiological impairments and nonclinical changes remain in a dynamic state for the rest of a person′s life. Owing to medical advances and early interventions the prognosis for a person following a spinal cord injury has improved markedly from nearly certain early death to a survivable disability for the majority who may lead active, productive lives into their 60s and 70s and beyond. Therefore it has become necessary to address the effects of normal ageing on the injuries and lifestyles of people with spinal cord injury. Ageing produces physiological and psychosocial changes in all people, but in people with a spinal cord injury ageing increases the wear and tear that living with such an injury imposes on cardiovascular, metabolic, respiratory, immune, musculoskeletal, gastrointestinal, genitourinary and nervous systems, as well as on skin health and psychosocial aspects of ageing. People with a spinal injury need lifelong follow-up, treatment and monitoring by multi- and interdisciplinary teams of health and social care professionals to minimize the complications of ageing with a spinal cord injury.
Shedding greater light on the natural history and prevalence of multiple sclerosis
Authors: Burgess Megan 
Published: May 2014

This is the first in a series of articles giving a comprehensive and up-to-date review of the theory and practice of multiple sclerosis (MS). This article examines the natural history of multiple sclerosis. MS is an autoimmune, demyelinating disease of the central nervous system with a complex and uncertain aetiology. MS was first described clinically by Jean-Martin Charcot in 1863 although the first documented case is thought to date back to the 14th century with an account of the life of St Lidwina. The cause of MS is unclear although it is known that genetic susceptibility in combination with exposure to certain environmental factors in childhood is required for someone to develop MS. The various studies exploring the epidemiology of MS and the possible environmental factors which have been implicated will be reviewed.
Successful multidisciplinary team working: an evaluation of a Huntington's disease service
Authors: Kenny Rebecca , Wilson Eleanor 
Published: May 2014

Background: Huntington's disease (HD) is a neurodegenerative condition that affects motor, behavioural and cognitive functioning. This triad of complex symptoms often requires input from a number of different services. Methods: An evaluation of a multidisciplinary, nurse-led, community-based service was conducted by undertaking interviews with 11 health and social care professionals who had worked with or as part of the HD service. Findings: The participants identified two elements as being key to the successful working of the HD service: team working and the role of the clinical nurse specialist (CNS). Those working as part of the HD service recognised that they contributed to a ‘virtual’ team, often not physically in the same place but coordinated and led by the CNS. Conclusion: The success of the HD service was due to not only the multidisciplinary nature of the team but also the specific people in those roles.
Practice makes perfect: maternal emergency training
Authors: Cro Suzanne , King Ben , Paine Patti 
Published: May 2014

Deficiencies in the care of mothers have been identified by the report Why Mothers Die and improved multidisciplinary training has been identified as a priority. In response to this statement an initiative has been set up at Gloucestershire Royal NHS Trust to teach midwives and trainee doctors how to manage maternal emergencies. The 1-day course has been called ‘Maternal Emergencies and Resuscitation Course’. The course teaches the theory and practice of the assessment and immediate management of life threatening situations. It aims to enable practitioners to maintain their skills and to be confident of their practice in situations that they are likely to meet infrequently. Clinical governance demands that we take responsibility for the quality of the service we provide. By organising and arranging a good training course we can hope to improve the clinical effectiveness, confidence and team building skills of the staff who work within the unit.
Antenatal classes: women can't think beyond labour
Authors: Wiener Andrew , Rogers Cathy 
Published: May 2014

There is interest in refocusing NHS antenatal classes to support parents in the transition to parenthood. However anecdotal reports suggest many midwives believe women in antenatal classes cannot focus on postnatal issues. This study set out to evaluate the prevalance of this view, with a postal survey of 144 midwives in a Hospital NHS Trust. There was a 58% return rate. 48% of respondants thought that women were not interested in postnatal topics. Midwives thought women were unable or unwilling to be realistic about the changes and difficulties a baby brings. Discussion focuses on a comparison of the client-centred/facilitative approach to antenatal education with the traditional directive/lecture type approach. It is argued that a facilitative approach enables women to discuss fears and anxieties about the transition to parenthood more openly. It is suggested that group facilitation training should be an integral part of midwifery training.
Student midwives' experiences of hospital-based postnatal care
Authors: Kroll Debra , Ahmed Shamoly , Lyne Michelle 
Published: May 2014

This mixed method study explored whether concerns raised by student midwives about the quality of their mentorship and teaching in the postnatal ward environment enabled them to meet the Nursing and Midwifery Council standards of proficiency for postnatal care, to qualify as a midwife. Some concerns were supported and it was found that effective, supportive teaching and mentorship was affected by many factors owing to the physical environment and the competing demands placed on mentors. The primary findings were that students felt less valued on the wards and better supported in the community. There was recognition that some skills could only be learnt in the hospital setting. There was no significant difference between the needs of students on long or shortened pre-registration programmes. Students will therefore continue to need teaching and mentorship in the hospital setting and trusts have an obligation to actively support this commitment.
Student midwives' satisfaction with enquiry-based learning
Authors: Tully Susan L 
Published: May 2014

Studies have evaluated enquiry-based learning (EBL) and problem-based learning in terms of student learning (Connelly and Seneque, 1999; Yeung et al, 2003; Williams, 2004), but the aim of this study was to listen to student midwives' experiences of EBL and evaluate their satisfaction with EBL as a teaching and learning strategy. The study took a qualitative phenomenological research approach. Analysis of the data identified five themes: students' satisfaction with EBL; impact on clinical learning; students' motivation; issues around group work; and the role of the facilitator. These themes are discussed in detail in this article with relation to available published literature. Overall, the students enjoyed and valued EBL as a learning strategy. A number of issues were identified and this article makes various recommendations to inform future developments in midwifery education.
Papanicoloau smear uptake among substance-using mothers in Western Australia
Authors: Geraghty Sadie , Bayes Sara , McLaurin Renate , O'Connor Angela 
Published: May 2014

Background: Papanicoloau (Pap) smear screening has helped to reduce cervical cancer rates significantly through the detection of premalignant cells ( Bray et al, 2005 ). Uptake among women who use alcohol and other drugs (AOD) is known to be low ( Chau et al, 2002 ) so they are at increased risk of being under-represented in the adequately screened population. AOD-using women experience disproportionately increased morbidity and mortality from cervical dysplasia and cancer ( Nogara et al, 2013 ). Pregnancy may provide the midwife an opportunity to offer this vital screening test. Objective: The audit investigated Pap smear uptake and results among AOD-using pregnant women. Setting: Pregnant women cared for by an obstetric AOD service based in a tertiary hospital in Perth, Western Australia, were eligible for inclusion in the study. Results: Across a period of 12 months, 333 childbearing-aged AOD-addicted women were audited: 142 had a Pap smear in the previous 3 years; 80 had not had a Pap smear in the previous 3 years; 80 declined a Pap smear; and 31 were either illegible or no record was available. Conclusion: This audit emphasises the importance of Pap smears being offered and followed up among the population of AOD-using pregnant mothers. Encouraging early booking and access to early antenatal care with midwives who are proficient in Pap smear collection is essential in order to provide optimal care.
Assessment matters—mentors need support in their role
Authors: Bennett Maggie , McGowan Brian 
Published: May 2014

Background In the UK the Nursing and Midwifery Council (NMC) standards to support learning and assessment in practice state that mentors are responsible and accountable for the assessment of pre-registration nursing students in practice. This study was undertaken to explore mentors' experience of assessing nursing students in practice post implementation of the NMC standards. Method Five focus groups were conducted with mentors (N=35) who had assessed adult pre-registration nursing students in the previous 12 months. The focus groups were recorded, transcribed and analysed to generate categories. Results Five categories were identified from the data: Changing roles and responsibilities; Exploring the past to understand the present; Just knowing; The odds; Time to mentor. The findings highlighted that mentors were aware of their role and responsibility for the assessment of students in practice. However, many felt this was a new responsibility and role in which they lacked experience. Some existing mentors felt that they may not have had the necessary preparation to effectively assess students in practice and identified their need for support. Conclusion Given that mentors are expected to be competent assessors of students in practice and protect the public through gate-keeping professional registration, this study suggests that serious consideration should be given to how mentors are prepared and the ongoing support and education they receive in assessment.
Creating an optimum environment for learning
Authors: Sherwin Sarah , Stevenson Liz 
Published: May 2014

The role of the practice teacher is pivotal in supporting the development of students undertaking Nursing and Midwifery Council (NMC) approved Specialist Community Public Health (SCPHN), School Nursing programmes. It is a mandatory requirement that students of school nursing are supported and assessed by a named practice teacher, who must have met the requirements defined within the practice teacher standard (NMC, 2008). In this series of short papers, Sarah Sherwin and Liz Stevenson explore the developing role of the practice teacher in relation to school nursing, since the advent of the revised standards. Although specifically geared towards practice teachers within the school nursing arena, mentors who provide support to a range of students within the community health setting may also find the series useful.
SAPHNA NEWS – The Department of Health School Nurse Development Programme
Authors: White Sharon , Upson Elaine 
Published: May 2014

SAPHNA: Raising the Profile of School and Public Health Nurses SAPHNA is a professional organisation dedicated to the promotion of excellence in children and young people's health services. SAPHNA was formed by a group of experienced school and public health nurses from around the UK who share a vision to improve services and take forward the public health agenda. SAPHNA represents school and public health nurses providing a voice locally, nationally and internationally. New members are encouraged to sign up to SAPHNA This is free of charge! Members of SAPHNA are kept regularly updated with policy, resources and learning opportunities throughout the UK. Sign up via www.SAPHNA-professionals.org [Figure: see text]
Protecting pupils from female genital mutilation
Authors: Momoh Comfort 
Published: May 2014

Female genital mutilation (FGM) presents important risks to the physical and mental health and wellbeing of girls and women affected. The practice of FGM is still an issue in the UK depite being despite being illegal. School nurses can play an important role in raising awareness on the subject, protecting at-risk girls and young women, and offer them the support they need. This article looks at the types of FGM, their risks, and the role school nurses can play in raising awareness.
FOCUS ON: HPV immunisation programme
Authors: Davies Elaine 
Published: May 2014

SAPHNA: Raising the Profile of School and Public Health Nurses SAPHNA is a professional organisation dedicated to the promotion of excellence in children and young people's health services. SAPHNA was formed by a group of experienced school and public health nurses from around the UK who share a vision to improve services and take forward the public health agenda. SAPHNA represents school and public health nurses providing a voice locally, nationally and internationally. New members are encouraged to sign up to SAPHNA This is free of charge! Members of SAPHNA are kept regularly updated with policy, resources and learning opportunities throughout the UK. Sign up via www.SAPHNA-professionals.org [Figure: see text]
Fungal infection of the skin, part 2: Cutaneous candida
Authors: Watkins Jean 
Published: May 2014

It is important that school nurses are able to recognise common dermatological conditions to be able to support and advise children and young people and refer them when appropriate. Some dermatological conditions can also be the sign of a more severe underlying condition or can worsen if left untreated. This article is the second of a two part series, offering practical information on common fungal skin infections, including an overview of presentation, complications and management. It looks at cutaneous candida infections, including oral thrush, intertrigo, vulvovaginal candida, balanitis and nail infections.
Wheelchair services and providers: discriminating against disabled children?
Authors: Staincliffe Sue 
Published: May 2014

Government strategy to promote the inclusion of disabled children has failed as more people apply to charities for help. This article aimed to investigate the eligibility criteria of NHS wheelchair services for all children's powered chairs. A postal survey of 145 wheelchair services investigated referrals and eligibility policy for different wheelchairs for children of all ages. Responses were analyzed manually, catagorized and themed. In total, 46% of respondents (n = 69) never received referrals for children under 5 years of age, and 20% fewer services offered indoor power chairs to such children than to those over 5 years of age. A total of 46% more services offered indoor/outdoor chairs to children over 5 years of age than to those under 5 years of age; 10% of services excluded children under 5 years of age from all power chair provision; and 13% offered outdoor-only chairs to children over 5 years of age, compared with 7% offering these to children under this age. Many services discriminated against children without providing training or assessment. Eligibility criteria were inconsistent. The NHS seldom provided chairs for use only outdoors. NHS provision of powered wheelchairs for children needs to be reviewed in the light of clinical evidence and children's rights.
The practice microscope: part 2 – basic set-up and care
Authors: Scarff David H. 
Published: May 2014

The practice microscope is a precision instrument, and careful set-up and routine maintenance are required to get the best out of the investment. Most modern microscopes are designed to be simple to operate, whereas older, research standard instruments, while capable of producing quality images, demand more effort if the best is to be achieved. In this article, the set-up of a modern compound microscope will be discussed, including the adjustments required for Köhler illumination; important if photomicroscopy is intended. In the second section of the article, basic care of the microscope will be discussed, including cleaning and routine maintenance.
Arterial dissection and cerebral venous thrombosis in sickle cell trait
Authors: Cardenas Doris , Ovbiagele Bruce 
Published: May 2014

A 26-year-old African-American male with no significant past medical history first presented in 1994 to another hospital with sudden onset headache, right-sided weakness, and language expressive difficulties 3 days after mild and otherwise uneventful head trauma while playing football. Magnetic resonance imaging (MRI) of the head and neck demonstrated a large left middle cerebral artery territory infarct and a left internal carotid artery mass interpreted as a pseudoaneurysm suggestive of arterial dissection. Workup at that time included evaluation for protein C/S, antithrombin III, antinuclear antibody, lupus anticoagulant, the factor V Leiden mutation and erythrocyte sedimentation rate levels, all of which were negative or within normal limits. A transoesophageal echocardiogram did not show a thrombus or a patent foramen ovale. Haemoglobin electrophoresis, however, showed that the patient was a carrier of the sickle cell trait (haemoglobin A1 = 61%, haemoglobin A2 = 3%, haemoglobin S = 36%). He was discharged from the hospital on an antiplatelet agent. He presented 10 years later to the authors' emergency room with 2 days of left frontal headache accompanied by nausea, vomiting and photophobia. Days before this headache there were no other precipitating factors such as illness, trauma or obvious dehydration. His general exam was unremarkable. Pertinent findings on neurological exam were non-fluent speech, mild right upper extremity distal weakness and brisk right-sided reflexes. All of these findings were unchanged from the prior stroke per previous medical records. An MRI of the brain done 2 days after symptom onset demonstrated the old left middle cerebral infarction without evidence of a new ischaemic or haemorrhagic lesion but with increased signal in the superior sagittal (Figure 1) and transverse sinuses. Computed tomography (CT) angiogram of the brain revealed enlargement and hyperdensity involving the superior sagittal, transverse and sigmoid sinuses consistent with widespread thrombosis. CT angiogram of the neck showed focal stenosis (about 40%) of the high cervical internal carotid artery, and a more proximal thrombosed pseudoaneurysm (Figure 2), all likely residual from his prior arterial dissection. New laboratory workup included the anticardiolipin antibody, beta-2-glycoprotein, factor VIII, activated protein C resistance, prothrombin 20210A mutation, homocysteine and alpha-1- antitrypsin, all of which were either negative or within normal limits. The patient was started on anticoagulation 3 days after symptom onset and within 1 week experienced complete resolution of his headache.
Goodpasture's syndrome, haemodialysis and pregnancy
Authors: Shah Alpa , Bailey Elizabeth , Hughes Sean 
Published: May 2014

A 29-year-old Caucasian woman had been diagnosed with Goodpasture's syndrome 12 months previously. Her renal function did not recover, she required haemodialysis and was put on the transplant list. She developed amenorrhoea on haemodialysis. She was seen at 22 weeks gestation in her second pregnancy. She was counselled regarding the high risk of fetal and maternal complications. She was offered medical termination of pregnancy but decided to continue. management plan was devised aiming to maintain the health of the mother, allow growth of the fetus and to support the patient and her partner. The plan included referral to a specialist obstetric unit. All drugs were evaluated and potentially dangerous medication, i.e. losartan, was stopped. Her haemodialysis was increased to six times a week (at least 24 h/week) to maintain a pre-dialysis urea of less than 16 mmol/litre. Her dialysate bicarbonate levels were reduced to prevent the usual post-dialysis alkalosis and avoid pre-dialysis acidosis. Intradialystic hypotension was avoided by careful fluid balance assessment and low ultrafiltration rates on dialysis, and post-dialysis hypercalcaemia was avoided by adjusting the dialysate calcium concentration. Hypocalcaemia was avoided by close monitoring of calcium and vitamin D levels and ensuring adequate doses of calcium and alfacalcidol. Hypertension was controlled with a safe antihypertensive (methyldopa), her haemoglobin was maintained between 10 and 11 g/dl with iron and erythropoietin and adequate nutrition with increased calorie and protein intake, water-soluble vitamins (B and C), and folic acid. Fetal growth and liquor volumes were monitored by regular ultrasound scanning. At 24 weeks methyldopa 250 mg twice a day was started to control her blood pressure. Her growth scan at 24 and 26 weeks was satisfactory. At 27 weeks and 2 days she was admitted with severe epigastric pain. There were no other features of pre-eclampsia. She was given a course of betamethasone for fetal lung maturity. Two days later tests revealed a low platelet count (67×109/litre; normal value 150–400×109/litre) and high alanine aminotransferase (ALT) levels (113 iu/litre; 0–40 iu/litre). The next day a repeat test showed platelet count of 47×109/litre and an ALT level of 415 iu/litre. A working diagnosis of HELLP (haemolysis, elevated liver enzyme and low platelet) syndrome was made. The multidisciplinary team decided to deliver her electively by caesarean section the next day. A healthy baby boy weighing 540 g was delivered without any difficulty. She recovered well after the operation and was back on haemodialysis three times a week. The baby was doing well at 6 months of age.
A swallowed toothbrush causing perforation 2 years after ingestion
Authors: Cox David , Donohue Peter , Costa Vanda 
Published: May 2014

A 33-year-old woman presented with a 3-day history of abdominal distension, ten-out-of-ten abdominal pain and rigors. She had had her bowels open every day since the onset of the pain, and her stools were normal. She had vomited once on the day of presentation. She mentioned she had been in a tussle with another person 3 days previous, and her pain had come on after this. She looked unwell, and was found to be hypotensive and tachycardic. Abdominal examination showed generalized tenderness and a tightly distended abdomen. There was no overt guarding and bowel sounds were normal. There was a palpable hardness in the right upper quadrant, which the patient identified as a toothbrush which she had swallowed 2 years previously as a suicide attempt. She said that it often gave her some discomfort but never anything like the pain she was experiencing at presentation. She had refused intervention to remove it at the time of ingestion and ever since. Erect chest radiography (Figure 1) revealed a large amount of free gas under both hemidiaphragms, and the bristles of a toothbrush to the right of the midline below the diaphragm. Arterial blood gas sampling showed a profound acute metabolic acidosis. The patient was taken to emergency theatre for a laparotomy. In theatre a 1.5 cm prepyloric anterior ulcer was found, and the toothbrush was removed, head-first, having been lying transversely in the stomach. The patient made a slow recovery and was discharged from hospital a month after initial admission, having suffered episodes of adult respiratory distress syndrome and hypoalbuminaemia-related pleural effusion before discharge.