bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tuberculous meningitis in the developed world: a lurking menace
Authors: Booth Stuart A , Appadu Balraj , Nielsen Peder B 
Published: May 2014

A 37-year-old Caucasian woman presented with headache, neck stiffness, confusion and vomiting. She had no history of respiratory symptoms, nor had there been any recent foreign travel or known contact with persons with tuberculosis. She was pyrexial (38°C) with signs of meningism. A month earlier she had developed a flu-like illness and remained generally unwell with fever, fatigue, anorexia and weight loss, before her condition acutely deteriorated. A computed tomography scan of her brain showed extensive low attenuation areas in the white matter of the parietal and occipital lobes bilaterally. CSF analysis, after a lumbar puncture, showed a raised white cell count of 144/μl, with a preponderance of lymphocytes (72% lymphocytes, 28% polymorphs). Protein levels were elevated (1.27 g/litre) and glucose levels low (0.6 mmol/litre). No bacteria were seen on Gram stain analysis. On further questioning, she had emigrated to the UK from Holland in 1991 and had never received a bacille Calmette–Guérin (BCG) vaccination. Magnetic resonance imaging (MRI) showed severe basal meningitis, extensive parenchymal abnormalities with enhancing multifocal areas consistent with tuberculomas. Further CSF analysis and polymerase chain reaction techniques confirmed the diagnosis of Mycobacterium tuberculosis meningitis with pulmonary involvement. Treatment included rifampicin, pyrazinamide, isoniazid, ethambutol and dexamethasone. Human immunodeficiency virus and cytomegalovirus tests were negative. She developed severe cardiac and respiratory failure, but following treatment she gradually improved, such that by day 14 she was off all intensive care support. Neurological examination showed mild left leg weakness and diplopia. Investigation into this patient's contacts showed that a fellow office worker in England had contracted tuberculosis from his wife who had worked in an Aboriginal colony in Australia. During the following 3 months her problems included a fluctuating right-sided hemiparesis, expressive dysphasia and focal motor seizures. Repeat MRI showed left middle cerebral artery stenosis as a result of surrounding basal meningeal inflammation, a left basal ganglia infarct and a left transverse sinus thrombosis. Treatment included dexamethasone, warfarin, cyclosporin and thalidomide. Ten months after her admission there had been a marked improvement in coordination, speech and right-sided strength. Warfarin had been discontinued. Unfortunately, her condition deteriorated as a result of a large intraventricular haemorrhage with hydrocephalus, followed later by encephalitis and multiple cerebral infarctions. Despite intensive management she died 4 weeks later.
Tuberculous osteomyelitis: chasing the elusive tubercle
Authors: Busteed S , Beeching NJ , Nye FJ , Thompson RN 
Published: May 2014

A 61-year-old man presented to the rheumatology clinic with a 2-year history of rightsided low back pain without radiation. There were no systemic features such as weight loss, pyrexia or sweats. He had been recently admitted with epididymo-orchitis. However, a chest X-ray was normal and acid and alcohol-fast bacilli (AAFB) were not demonstrated on microscopy of pus from a scrotal sinus. Clinical examination was unremarkable. Initial investigations revealed a mild microcytic anaemia (haemoglobin 11.1g/dl and mean cell volume 79.9 fl) and normal inflammatory parameters (C-reactive protein 6 mg/litre and erythrocyte sedimentation rate (ESR) 20 mm/hr). A white cell count was 9.8 x109/litre and rheumatoid factor was negative. Total globulin was elevated at 36 g/litre but immunoglobulins and prostate specific antigen were normal. A repeat chest X-ray was normal. Lumbar spine X-rays showed obliteration of the right sacroiliac joint with adjacent sclerosis and suspicion of erosive change. Magnetic resonance scan of the area demonstrated destructive change in the right sacroiliac joint and a possible soft tissue mass anteriorly, suggestive of either a low-grade tumour of cartilage or an infective process (Figure 1). Subsequent computed tomography-guided biopsy of the soft tissue mass was unsuccessful. The patient continued to experience increasing pain in the right lumbar area and underwent a right sacroiliac joint biopsy under image intensification at another centre. Histology of the biopsy specimen was consistent with low-grade active chronic osteomyelitis but no organism was isolated. Empirical treatment with flucloxacillin was started. Brucella serology was subsequently negative. A repeat magnetic resonance scan showed worsening of the right sacroiliac joint destruction with bone oedema and ring-enhancing lesions post-gadolinium. An open biopsy of the right sacroiliac joint was performed and histological examination of this specimen demonstrated AAFB on microscopy. Mycobacterium tuberculosis was eventually found on culture. Histology of the de-calcified specimen showed non-caseating granulomata and a Ziehl–Nielsen stain was negative. He was treated with antituberculous treatment for a total of 12 months. Repeat investigations on discontinuing therapy showed sclerosis of the affected joint on plain films with a normal haemoglobin level (15.0 g/dl) and ESR (8 mm/hr).
Diabetes, diabetic retinopathy and the National Service Framework
Authors: Catherine Dardis 
Published: May 2014

Diabetic eye disease refers to a group of eye problems that people with diabetes may face as a complication of diabetes mellitus. Diabetic retinopathy is the most common diabetic eye disease and a leading cause of blindness within the working population. This article provides a brief overview of diabetes(diabetes mellitus), particularly in terms of microvascular complications and diabetic retinopathy, and considers current procedures of diabetes care in the context of the National Service Framework(NSF) and current clinical practice. Treatment of diabetes mellitus and its complications presents a huge and increasing burden on the National Health Service and the NSF represents an initial response to this. It sets out 12 standards to help improve the care of patients with diabetes, emphasizing, in particular, the need to empower patients with diabetes to take charge of their own health care, and the necessity of organizing regular surveillance programmes for the detection and early treatment of long-term complications associated with diabetes mellitus. To these ends, a national retinal screening programme was developed over a 10 year period, with concurrent continuing professional development and the encouragement of evidence-based best practice. Establishment of empowerment programmes has had only limited development, probably because most resources are necessarily focused on dealing with the cure rather than prevention of the disease(i.e. retro treatment).
Optical Coherence Tomography (OCT): background and applications
Authors: Millbank Lyn 
Published: May 2014

Optical Coherence Tomography (OCT) has had a revolutionary impact within the ophthalmic environment and is available in most eye units and indeed many optometry practices in the UK. OCT is a relatively new medical diagnostic imaging technology, which provides real time, in situ imaging of tissue structure or pathology with resolutions of 1 to 15 μm, 1 to 2 orders of magnitude finer than conventional clinical imaging technologies, such as ultrasound, magnetic resonance or computed tomography ( Fujimoto et al, 2000 ). In addition to ophthalmology, OCT has many other applications, including industry, material thickness and surface roughness characterisation ( Merken et al, 2011 ). OCT is also used in art conservation, diagnostic medicine, and, more recently, in interventional cardiology and audiology. This article will discuss the applications of OCT within ophthalmology with an overview of the evolution of OCT in ophthalmic practice. The practicalities of using OCT, including the preparation of patients, some tips for best practice when using OCT, scans, and potential artefacts that may challenge the scan quality, along with a simple guide to interpretation, are also included.
Clinical characteristics and visual outcome in patients with Pseudomonas keratitis
Authors: Pacheco Patricio A , Clare Gerry 
Published: May 2014

Aim: To study the clinical and microbiological features and visual outcomes of patients with Pseudomonas keratitis. Methods: The clinical records of 37 patients affected by microbial keratitis with positive corneal scrapes for Pseudomonas sp., who were diagnosed and treated at Moorfields Eye Hospital, London, UK over a 12-month period were retrospectively reviewed. Predisposing factors, microbial culture results, clinical course and visual outcomes were analysed. Results: Contact lens wear (25 cases [67.5%]) and surface ocular diseases (6 cases [16.2%]) were the main predisposing factors. No ocular trauma aetiology was present in this series. All contact lens-related keratitis were observed in soft contact lens users (19 cases [51.3%] monthly disposable lenses, and 6 cases [16.2%] daily disposable lenses). A total of 14 cases (37.9 %) of the Pseudomonas sp. isolates were early suspected in the direct gram examination. There was only one case resistant to ofloxacin. Four (10.8 %) of the 37 eyes required surgical intervention, 90% of the patients had some degree of anterior chamber activity at presentation, 30% had an hypopion level. There was a ‘good’ clinical outcome (best corrected visual acuity [BCVA] >6/12) in 32 patients (86.4 %), a residual corneal scar was seen in 72.9 % of the cohort. Conclusions: A ‘good’ visual outcome was described even when a very high rate of intraocular inflammation and severe corneal compromise had occurred; this is due to a highly specialised management of the cases with a prompt use of corticosteroids that helped to manage the massive inflammatory reaction often associated to Pseudomonas sp. However, the presence of residual corneal scarring explains the loss of BCVA lines in 60% of the cases and limited final visual outcome.
Correspondence
Authors: Twycross Robert 
Published: May 2014

Dear Editor I read Andrew Thorns’ article (2002) with great interest. If I may, I should like to make one or two observations. First, although the Christian church may have been foremost in highlighting the issue of double effect, it is (and always has been) a general axiom of clinical practice. It is better, therefore, to recognize this by referring to the ‘principle’, not ‘doctrine’ of double effect.
Promoting ownership in palliative care audit
Authors: Cooper Jan , Pettifer Annie 
Published: May 2014

Audit in health care is the systematic and critical analysis of the quality of care (Department of Health (DoH), 1989). Although not new to palliative care, it has been given fresh impetus in the UK through the introduction of clinical governance (DoH, 1998). Clinical governance has been described as: ‘a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish’ (DoH, 1998)
Identifying the palliative care role of the nurse working in community hospitals: an exploratory study
Authors: Hamilton Faye , McDowell Joan 
Published: May 2014

Aim To ascertain registered nurses’ and GPs’ perceptions of and influences on the nurse’s role in providing palliative care in community hospitals. Design Qualitative exploratory/descriptive study. Setting Two community hospital sites within Perth and Kinross, Scotland. Method Taped semi-structured interviews with four registered nurses and two GPs. Participants’ perceptions were sought on the roles of nursing and medical professionals and of factors facilitating and hindering the provision of palliative care within the community hospital setting. Findings Six key themes were identified through thematic analysis of the information: communication, teamwork and relationships, holistic care, resources, culture, professional role. Conclusion The themes were inter-related and gave valuable insight into the multi-dimensional nature and significance of the nurse’s role in palliative care in the community hospital setting.
Health professionals’ opposition to euthanasia and assisted suicide: a personal view
Authors: de Vocht Hilde , Nyatanga Brian 
Published: May 2014

This commentary evaluates the motives of health professionals’ opposition to the legislation of assisted dying. We argue that there are no rational or justifiable grounds for such opposition in the case of patients who are suffering unbearably and whose request to be helped to die is competent, enduring and voluntary. We then engage in plausible speculation about what other, more hidden motives of health professionals might lead to them reject the legislation of assisted dying. We assert that, while these hidden motives are understandable from a psychological perspective, they also suffocate the self-determination of palliative patients. Therefore, the challenge is for health professionals to reconsider extending their own limits in order to fully support their patients’ needs. Finally we discuss the consequences of NOT legalising assisted dying, and conclude that this position might be more detrimental than legalising it.
Quality of life in palliative care: being at ease in the here and now
Authors: Crang Clare , Muncey Tessa 
Published: May 2014

Quality of Life (QoL) is an important issue for users of hospice services and may be assessed in a quantitative way. This study set out to evaluate the effectiveness of the Schedule for the Evaluation of Individual Quality of Life – Direct Weighting (SEIQoL-DW). A sequential mixed methods design was used to examine both quantitative and qualitative factors relating to quality of life. Five participants were recruited from an inpatient specialist palliative care (hospice) unit in East Anglia. Each participant completed the SEIQoL-DW followed by unstructured interviews, which were analysed using Giorgi’s (1985) psychological phenomenological method. It was found that SEIQoL-DW provided an opening or ‘window’ onto participants’ QoL as they travelled from their past to their future. Themes emerging from the unstructured interviews suggest that QoL was about ‘being at ease’ in the ‘here and now’ and was influenced by past experiences and future expectations. Existential and spiritual issues, which were not all captured by the SEIQoL-DW, were of more importance than physical symptoms. This needs to be taken into account when caring for those nearing the end of their lives and particularly when using medications that have an adverse effect on mental acuity.
Implementation and evaluation of a palliative care resource scheme within a district general hospital
Authors: Rees Yvonne , Jones Sian , Parry Maria 
Published: May 2014

This article explores the development, implementation and evaluation of a palliative care resource scheme in a district general hospital in Mid Gamorgan, Wales. The evolution of the resource scheme and how the hospital specialist palliative care team identified the need for improved patient care on hospital wards is discussed, in addition to how using their specialist role combined with education can implement change. The project evolved from initially recruiting two nurses on an in-house educational programme, to what has since become a formal arrangement with the local university, whereby students can access taught palliative care modules at degree and diploma levels as part of a distance learning degree in cancer care and a distance learning post-graduate certificate in palliative care. The resource enhances the knowledge of the practitioners who have completed it and also formalizes and expands the working links between education and clinical practice. It is hoped to continue and develop the scheme to further enhance the collaborative partnerships.
Psychological distress in Icelandic patients with repeated recurrences of cancer
Authors: Hjörleifsdóttir Elísabet , Óskarsson Guðmundur Kr. 
Published: May 2014

Aim: The main aim was to investigate differences between the psychological distress of patients with a first diagnosis of cancer, those experiencing their first recurrence, and those experiencing later recurrences. Little is known about the development of cancer patients' psychological distress and whether it becomes more severe with greater incidence of recurrence. Method: A total of 218 patients from 3 oncology outpatient clinics in Iceland were assessed with the Brief Symptom Inventory Scale 18 (BSI 18). Results: Several aspects of cancer patients' psychological distress seem to positively correlate with number of recurrences, and women experience a recurrence of cancer differently to men. Conclusion: Health-care professionals need to be aware of patients' likely distress levels at different stages of their illness and the ways in which their gender might affect their psychological state.
Can art therapy reduce death anxiety and burnout in end-of-life care workers? A quasi-experimental study
Authors: Potash Jordan S , Ho Andy HY , Chan Faye , Wang Xiao Lu , Cheng Carol 
Published: May 2014

Background The need for empathy and the difficulties of coping with mortality when caring for the dying and the bereaved can cause psychological, emotional, and spiritual strain. Objective The aim of this study was to examine the effectiveness of art-therapy-based supervision in reducing burnout and death anxiety among end-of-life care workers in Hong Kong. Methods Through a quasi-experimental design, 69 par ticipants enrolled in a 6-week, 18-hour art-therapy-based supervision group, and another 63 enrolled in a 3-day, 18-hour standard skills-based supervision group (n=132). Pre- and post-intervention assessments were carried out with three outcome measures: the Maslach Burnout Inventory—General Survey, the Five Facet Mindfulness Questionnaire, and the Death Attitude Profile—Revised. The data was analysed using paired sample t-tests. Results Significant reductions in exhaustion and death anxiety and significant increases in emotional awareness were observed for participants in the art-therapy-based supervision group. Conclusion This study provides preliminary evidence that art-therapy-based supervision for end-of-life care workers can reduce burnout by enhancing emotional awareness and regulation, fostering meaning-making, and promoting reflection on death.
A review of the Wardmaster and Clinicmaster patient handling systems
Authors: Collins Fiona 
Published: May 2014

There are many risks associated with transferring highly dependent patients from bed to chair, owing to their reduced functional ability and the various attachments, such as drips and ventilator tubes. Hoisting these patients can be very difficult. This article considers the Wardmaster chair, a new patient handling system that can also be used as a trolley, thereby allowing lateral sliding transfers without the need for a hoist. The chair can be used in a critical care setting. The article also mentions the Clinicmaster patient handling transfer system; the Wardmaster's sister chair, which offers the same positional functions but without the electrical operation facility. Both systems are a novel approach to moving and handling patients in a variety of settings.
An audit of anticipated discharge planning for acute medical and orthopaedic admissions
Authors: Shiu Kin Yee , Radu Margaret , McFarlane Lindsay , Dooley John , Thomas David 
Published: May 2014

The authors of this article audited an anticipated discharge survey on acute medical and orthopaedic admissions to a UK hospital over a 2-month period. An anticipated discharge form was filled in on admission by an experienced clinician and a discharge date set based on the patient's clinical condition, age and social circumstances. In total, 31 patients (51%) went home on the day planned or within one day of this date. The reasons for delays in discharge included failure of doctors to review patients, slow response to treatment and waiting for social services. Slow mobilization in eight patients accounted for the longest length of stays. The authors found that discharge plans may break down at weekends and are exploring innovative ways of solving this problem.
Physiotherapy in the management of TMD: A review of the literature part 1
Authors: Smith Toby Oliver 
Published: May 2014

‘Temporomandibular disorders’ (TMD) is a generic term encompassing a group of musculoskeletal conditions that affect the temporomandibular joint, masticatory muscles and surrounding soft tissues. Physiotherapy is used to treat TMD. The first of this two-part article reviews the current literature to determine what TMD are and how effective physiotherapy is in their treatment. This section defines TMD and examines the evidence investigating the effectiveness of exercise, postural correction and acupuncture. The author concludes from the studies reviewed that there is insufficient evidence to establish the effectiveness of exercise, postural correction or acupuncture in treating TMD. He recommends that a number of large, well designed blinded randomized controlled trials, with between-group comparison assessing individual treatment interventions, are required to evaluate the effectiveness of these three techniques in the treatment of TMD.
Use of self-applied TENS for low back pain in people with multiple sclerosis
Authors: Warke K , Al-Smadi J , Baxter GD , Walsh DM , Lowe-Strong AS 
Published: May 2014

The aim of this study was to evaluate the use of self-applied transcutaneous electrical nerve stimulation (TENS) for low back pain in a population of people with multiple sclerosis (MS). In total, 15 participants diagnosed with MS (aged 37–71 years) presenting with low back pain were recruited and randomized into two active TENS groups and a placebo group under double-blind conditions (n=5 per group). Treatment involved self-application of TENS on a daily basis for 6 weeks. Outcome measures were recorded at weeks 1, 6, 10 and 32. Statistical analysis indicated significant changes in the McGill Pain Questionnaire affective subsection (P=0.01) throughout the trial. However, trends observed seem to indicate an improvement in both active TENS groups during the treatment period, with differential improvement maintained into the follow-up period. The findings of this study thus warrant further investigation by means of a randomized, controlled clinical trial within this population.
Attention deficit hyperactivity disorder: Current status and future perspectives
Authors: Saadah MA , Saadah LM 
Published: May 2014

Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioural syndrome of childhood onset. It can be diagnosed by a competent paediatric neuropsychiatrist, although a multidisciplinary team approach is preferable. As yet, there is no single treatment strategy proven to cure this syndrome and no long-lasting documented effects once the adopted line of treatment is withdrawn. A combined therapeutic approach that includes pharmaceutical and nonpharmaceutical treatments is used in the management of ADHD in the developed countries – an approach that cannot be used in the developing countries, which do not have well structured health services. The need for further research is paramount, as a deeper understanding of the complex neural network is an important preliminary step. This article argues that multiple paradoxes found within the concept of ADHD will open new horizons in the aetiopathogenesis, molecular basis and treatment approaches of this syndrome.