bluuebunny/crossref_metadata_2025_split huggingface dataset:
Broken heart syndrome
Authors: Alrubaiy Laith KQ , Rehman Habib 
Published: May 2014

A 56-year-old Asian woman presented with severe shortness of breath and chest tightness for 4 days. Her past medical history included well-controlled type 2 diabetes mellitus and hypertension. She was a non-smoker. On examination, she was afebrile with a blood pressure of 160/90 mmHg, a pulse of 90 beats per minutes, and a respiratory rate of 30 breaths per minutes with a PaO2 of 7.4 kPa on air. Auscultation of the chest revealed bi-basal crackles and expiratory rhonchi. Cardiac examination was normal. Chest radiograph showed pulmonary congestion with normal heart size. Electrocardiogram (Figure 1) showed deep T-wave inversions in the anterolateral and inferior leads. Her troponin T level was raised at 0.243 ng/ml (normal <0.03 ng/ml). The patient was treated as having an acute coronary syndrome with supplemental oxygen, low molecular weight heparin, aspirin and clopidogrel. She was referred to a tertiary cardiothoracic centre for percutaneous coronary intervention. Bedside echocardiography showed reduced ejection fraction. Angiogram showed normal coronary arteries (Figures 2 and 3), and left ventriculography showed extensive anterior and inferio-apical areas of dyskinesia (Figures 4 and 5), consistent with Tako–Tsubo syndrome. With supportive therapy (aspirin, nitrate and diuretics), she made a good recovery. Her left ventricular function was normal on follow-up echocardiography 6 weeks later.
Audit of audit: review of a clinical audit programme in a teaching hospital intensive care unit
Authors: Anderson Peter , Fee Peter , Shulman Rob , Bellingan Geoffrey J , Howell David CJ 
Published: May 2014

Objective: A comprehensive review of the clinical audit programme in a teaching hospital intensive care unit. Design: A retrospective analysis of the clinical audit projects undertaken within the intensive care unit over the preceding 2 years and compared with published national guidelines for clinical audit. Setting: A 27-bedded teaching hospital intensive care unit in the UK. Measurements: Each audit project was reviewed independently by two assessors. The following questions were assessed: 1) Were the projects true audits? 2) Were they prospective or retrospective? 3) Did the projects have input from appropriate members of the multidisciplinary team? 4) How many of the audit projects were re-audits? 5) Of the re-audits how many showed evidence of service improvement? Each audit project was also scored against the Audit Project Assessment Tool produced by the UK Clinical Governance Support Team. Results: Of the twenty five audit projects reviewed twenty two were considered to be true audits. All of the projects used only retrospective data. Audit projects were contributed from all sections of the multidisciplinary critical care team but there were few truly multidisciplinary projects. Four of the audit projects were re-audits, of these three showed service improvement and one showed deterioration. Of the twenty two true audit projects reviewed, eleven were classified as good quality projects using the Audit Project Assessment Tool. Conclusions: Despite the clinical audit programme being active and well supported, objective evidence of clinical governance benefit was lacking. The overall clinical audit programme has been revitalised by a series of improvements since undertaking this review and this approach is recommended to other organizations who are interested in improving their clinical audit performance.
Osteochondroma: an unusual cause of lower limb claudication
Authors: Osborn GD , Raman S , Evans P , Lewis MH 
Published: May 2014

An 18-year-old semi-professional rugby player presented with a 4-month history of a gradually increasing swelling in his left popliteal fossa associated with claudication-type symptoms in his left leg. He was an otherwise healthy young man, with no significant past medical history. Clinical examination revealed a rounded 7 cm visible pulsatile mass in the left popliteal fossa. The popliteal pulse was easily palpable, which was associated with an underlying nontender, hard mass on the posterior aspect of the tibia. Plain radiographs (Figure 1) revealed a 5.5 cm bony mass arising from the posterior aspect of the proximal tibial metaphysis, suggestive of an osteochondroma. A magnetic resonance imaging scan of the left knee was arranged to confirm the diagnosis and its relationship to adjacent structures (Figure 2). The patient underwent an uncomplicated excision of the bony mass, which showed the 6 cm × 5 cm lesion to be an osteochondroma.
Retained intraocular metallic foreign body post phacoemulsifcation
Authors: Upchurch Janet , Woodruff Sarah 
Published: May 2014

The purpose of this article is to raise awareness to health professionals of a little reported complication of cataract surgery. To this aim we present a case report of a patient who developed an unusual post-operative phacoemulsification complication: retained intraocular metallic foreign body. A retrospective review of the patient's case notes was carried out and the findings presented. An extensive literature search to investigate the rate of occurrence of this adverse event showed that when the phacoemulsification technique was new, and now it is a widely established procedure, the problem of retained particles exists, and that metal fragments embedded in the iris following cataract surgery can be linked to surgical technique. The need for knowledge and vigilance regarding this unusual but significant complication by those seeing cataract surgery patients at the post-operative check, whether hospital ophthalmic staff or community optometrists, is highlighted and for the need of accurate reporting and recording of such incidents. The importance of contacting the relevant manufacturers and Department of Health agency of such complications as they occur is emphasized to ensure staff and patients have accurate and up to date information.
The psychological care of patients undergoing an evisceration of the eye
Authors: Wilson-Miller Rebecca 
Published: May 2014

This paper examines the need for patients undergoing evisceration surgery to remove their eye to receive psychological support. The removal of an eye has serious consequences on various aspects of a patient's personal and family life, yet despite this there is a notable lack of literature and research relating to the physical, psychological and emotional care of patients undergoing this life-changing treatment. Patients are often listed for surgery in a busy, under staffed outpatient setting with no nurse present and if surgery is required immediately, due to severe pain or trauma, the patient may not receive pre assessment. As a result there may be little opportunity for the patient to come to terms with their altered body image which can have devastating effects on their recovery. An in-depth literature review identifies the lack of literature in this complex area of nursing, however, it offers insight to the reader with clear recommendations for practice. Hehir (2000 ) states that the psychological aspect of disfigurement is highlighted as one of the main concerns of patients undergoing removal of an eye. Indeed this study indicates that an ocular plastic specialist nurse to provide psychological support for these patients at all stages of their journey would be beneficial, as would ophthalmic ward nurses receiving basic counselling training. Such nurses would help patients to come to terms with their altered body image, offering support at all times.
Clinical audit on acute management of ocular chemical injury
Authors: Tallouzi Mohammad 
Published: May 2014

Aim: To assess the acute management of ocular chemical injuries to all patients who attended the eye casualty and compare this management with the standard protocol of chemical eye injury. Methods: Retrospective review of all cases with ocular chemical injury over a period of 4 months (August 2010 to November 2010). Case -files were retrieved and relevant information was extracted and analyzed. The audit was registered with the clinical effectiveness department of the author's trust. Results: There were a total of 72 patients under review during the study period consisting of 54 males and 18 females. Ages ranged from 3–85 years. The major cause of chemical eye injury was work related. However, other causes such as school, university and home accidents and assaults were noticed. The severity of ocular injury and damage was noted on reading of the pH value, as were the delay of the ocular irrigation, the amount of the chemical the patient had been exposed to and the duration of exposure. Additionally, the mismanagement of cases by the medical team was also noted in some cases. Conclusion: The major cause of chemical eye injury presenting to the Birmingham Eye Hospital was work related. The degree of the chemical eye injury varies, however, the disability and blindness caused seems to be more in the assault cases. In order for there to be a good prognosis in managing the chemical eye injury there is a need for effective assessment and examination. This would involve the prompt irrigation for all patients who attend the eye casualty complaining of chemical eye injury. Additionally, both eyes should undergo detailed examination which would include rapid afferent papillary defect (pupil reaction), intraocular pressure and fundus checks (particularly in severe cases). The effectiveness of the management includes the use of preservative-free topical medications for all patients, which includes the use of topical antibiotics and lubricants. Also the use of the topical steroid and systemic oral medications should be indicated in severe chemical eye injury cases. Effective follow up and understanding of cases of chemical eye injury requires detailed documentation following examination, assessment and management of patients' chemical eye injuries. The documentation could involve medico-legal aspects for the assault cases, and practitioners should understand these, and detailed documentation is useful should there be complaints against the hospital and medical team.
Non-compliant children undergoing occlusion therapy: a route to good practice
Authors: Bradshaw Jilly 
Published: May 2014

Amblyopia is a prevalent condition that causes a diminution of the visual acuity of the affected eye. The condition is usually diagnosed in early life but if it is not treated by the age of between 6 and 8 years, it can lead to permanently reduced vision in the affected eye. Treatments are limited. Occlusion when complied with, is generally regarded as the treatment of choice, ‘forcing’_ the use and visual experience of the amblyopic eye. For that reason, amblyopia is an avoidable form of visual impairment. Compliance is central to the success of the treatment. However, it has been documented for many decades that non compliance is widespread and is extremely difficult for some families, and professionals to manage. This article explores the deeper reasons that underpin non compliance and describes an innovative programme of care – ‘An Intensive Occlusion Therapy Programme’ – devised and developed by the author, with the support of colleagues, on the Eye Unit at The Royal Bournemouth Hospital. For the past 10 years, using techniques including positive parenting and distraction, the Programme has been motivating and educating children and parents to successfully implement occlusion treatment at home. It has achieved some excellent visual outcomes, children at ease with ‘patching’ and confident parents who are in control of the occlusion regimen. The Programme has also proved highly cost effective by reducing consultant, orthoptic and clinic time, removing the need for admitting children for several days for supervized occlusion and created a coordinated, structured clinical pathway for the multi-disciplinary team to follow, thus providing seamless, family-centred care. As many testimonies demonstrate, parents thoroughly recommend and advocate this Programme to other parents facing similar problems with compliance.
Effectiveness of nurse practitioners in glaucoma diagnosis: implications for shared care
Authors: Munneke Robert , Kingett Jane , Byles Daniel , Smith Michael 
Published: May 2014

Aim To compare the diagnostic assessment for glaucoma performed by nurse practitioners with that of a consultant ophthalmologist with subspecialty training in glaucoma. Method Twenty patients undergoing assessment for glaucoma were examined by a nurse practitioner and a consultant ophthalmologist with subspecialty training in glaucoma. Three intraocular pressure (IOP) measurements were performed, and a mean taken. Disc assessment using the disc damage likelihood scale and visual field interpretation in one eye were also recorded. The assessor subsequently allocated a diagnostic category to each patient. The examinations were performed within one hour of each other to reduce the influence of diurnal variations, and both the nurse practitioner and consultant ophthalmologist were masked to the other's findings. Results An interclass correlation coefficient between the two sets of IOP measurements was calculated to be 0.98, suggesting a strong degree of correlation. A weighted kappa value of 0.062 was calculated for disc assessment indicating a poor correlation. Weighted kappa values of 0.364 for field interpretation and 0.259 for diagnostic agreement were calculated indicating a fair correlation for both. Conclusions The correlation for IOP compares favourably with previously reported results for community optometrists. Although the correlation for disc assessment was poor and for field interpretation only fair, the tendency was for over-diagnosis of pathology with the nurse assessments. This implies that the nurse practitioner assessments would provide a safe method of screening patients for glaucoma but may have economic implications in terms of unnecessary follow-ups.
Ophthalmic photographer-led age-related macular degeneration review clinics: a pilot study
Authors: Hancock Richard 
Published: May 2014

At Aintree Hospitals NHS Foundation Trust, an innovative model of care for the management and surveillance of patients with treatable age-related macular degeneration of the eye (ARMD) has been achieved through introducing ophthalmic photographer-led diagnostic assessment review clinics. The main objective of this initiative was to create additional capacity, thus reducing the risk of delayed follow-up that can lead to a loss in vision. The ophthalmic photographer relies on diagnostic imaging and makes a decision as to whether the patient requires more treatment or should be seen back in clinic. A robust diagnostic informatics network is essential in the assessment of patients but also for clinical documentation, as we move towards a paperless environment. This new patient pathway has proven to be robust, safe, cost effective and innovative, and it has increased clinic capacity while increasing patient satisfaction. This article will provide the reader with an overview of how the new patient pathway for ARMD diagnostic assessment at, implemented through a pilot study, and will discuss audit findings and the effect of the new care pathway on patient outcomes.
The evolving role of ophthalmic professionals
Authors: Collett Helen 
Published: May 2014

The roles of ophthalmic professionals are evolving to provide quality cost effective care, diagnostic assessment and treatment for patients in many different aspects of ophthalmology. This paper looks at how professionals have worked with consultants to develop new skills and patient care pathways beyond their traditional job descriptions. Orthoptist Helen Collett reflects on her personal journey from orthoptist and manual perimetrist, to developing roles in ophthalmic technology and providing her own private practice in ophthalmic diagnostics and specialist orthoptics.
Management of venous thromboembolism in the palliative care setting
Authors: Noble Simon 
Published: May 2014

Recent literature has highlighted the unique challenges facing professionals involved with the management of venous thromboembolism (VTE) in cancer patients. Although research favours the use of low molecular weight heparin (LMWH) rather than warfarin, no studies have been conducted exclusively in the palliative care population. Likewise, active treatment may not always be appropriate in the advanced cancer patient. This paper highlights the issues to be considered when facing a palliative care patient and suspected VTE. In particular, consideration must be given to the practicalities and acceptability of investigating suspected VTE, the dose and length of anticoagulation, and management of the patient nearing death. An understanding of the current evidence must be applied to the individual patient, taking into account their needs and wishes.
The challenge of providing palliative care to terminally ill prison inmates in the UK
Authors: Wood Felicity Juliette 
Published: May 2014

Terminally ill prison inmates have a right to all aspects of health care including palliative care provision. However, there are numerous difficulties in providing palliative care to high-security prisoners in the UK. Local community hospices may be reluctant to admit terminally ill prisoners and therefore initiatives must be established to provide appropriate palliative care within the prison itself. Dying prisoners need companionship and to be shown respect and compassion to avoid feelings of loneliness and hopelessness. Inmate volunteers can provide an invaluable source of support and friendship for the terminally ill prisoner, helping to improve quality of life.
Evaluating the care of patients with malignant spinal cord compression at a regional cancer centre
Authors: Warnock Clare , Cafferty Christine , Hodson Suzanne , Kirkham Elizabeth , Osguthorpe Charles , Siddall Jan , Walsh Rebecca , Foran Bernadette 
Published: May 2014

The consequences of malignant spinal cord compression (MSCC) can be devastating. If not detected early, MSCC can result in paralysis and significant bowel and bladder dysfunction that is not improved by treatment. Patients have to cope with sudden and unexpected disability alongside a diagnosis of advanced cancer. A multidisciplinary group was established within a cancer centre to review the care of patients with MSCC. Two linked studies were carried out: a staff questionnaire sent to senior medical staff and all nurses and an audit of documentation. The documentation audit reviewed the notes of 50 patients who had received radiotherapy for MSCC. The symptoms patients presented with on admission and before discharge demonstrated that many experienced significant physical problems as a consequence of developing MSCC. Usually, these symptoms were either unaffected by treatment, or had deteriorated further by the time of their discharge from hospital. The average number of days between admission with MSCC and death was 58.6 days (range 2 to 319 days). The project identified variations in practice in a range of aspects of care and provided clear evidence for the need to develop interventions in relation to specific concerns.
Developing clinical guidelines for end-of-life care: blending evidence and consensus
Authors: Dunning Trisha , Savage Sally , Duggan Nicole , Martin Peter 
Published: May 2014

Background: Developing clinical practice guidelines (CPGs) is challenging, particularly in areas that are difficult to research such as end-of-life care. Aim: To describe the process that staff in a large regional health-care service in Victoria, Australia, used to develop CPGs for managing diabetes at the end of life. Method: An interdisciplinary advisory group was appointed, a structured literature review undertaken, personal illness accounts sourced, and a guiding philosophy formulated. Individual interviews were conducted with people with diabetes and their carers. Formative and summative evaluation was undertaken. Results: No level I or II evidence was identified. The interviews yielded important information about how people wanted their diabetes managed. Formative evaluation enabled stakeholders to participate in developing the CPGs. The summative evaluation confirmed the CPGs are easy to use and appropriate to clinical staff. Conclusions: The CPG development process yielded the best current evidence on which to base care plans and person-centred CPGs.
Validation of the Japanese version of the Fatigue Barriers Scale (JFBS)
Authors: Komatsu Hiroko , Watanabe Chie , Yagasaki Kaori , Sakakibara Naoki , Nakamura Seigo 
Published: May 2014

Background: The Fatigue Barriers Scale (FBS) is an instrument to identify patient-derived barriers to fatigue management. Objective: To assess the reliability and validity of the Japanese version of the FBS (JFBS). Methods: Participants were 112 cancer patients. Reliability was determined through internal consistency using Cronbach's alpha coefficient and through test–retest reliability using Spearman's intra-class correlation coefficient (ICC). Construct, convergent, criterion-referenced, and concurrent validities were assessed. The Cancer Fatigue Scale (CFS), Patient Fatigue Knowledge Tool (PFKT), and Kessler 6-item distress scale (K6) were used for comparisons. Results: Cronbach's alpha coefficients were 0.74, 0.78, 0.72, and 0.54 for the JFBS total and for each subscale, respectively. All ICCs exceeded 0.65 (P<0.05). The JFBS had a weak negative correlation with the PFKT and a positive correlation with the CFS. The K6 scores showed weak positive correlations with the JFBS total and fatalism subscale scores. Conclusions: The JFBS can be used to measure fatigue barriers in Japanese people with cancer.
An evaluation of routine specialist palliative care for patients on the Liverpool Care Pathway
Authors: Thompson Jo , Brown Jayne , Davies Andrew 
Published: May 2014

Introduction: This report describes a service evaluation of the ‘added value’ of routine specialist palliative care team (SPCT) involvement with patients on the Liverpool Care Pathway for the Dying Patient (LCP). Methods: In the authors’ hospital, patients that are commenced on the LCP are routinely referred to the SPCT. They are reviewed on the day of referral and then at least every other day, depending on the clinical situation. The data for this report was obtained by reviewing the SPCT's clinical database and the patients’ LCP proformas. Results: The SPCT intervened in the care of 80% of 158 newly referred patients, e.g. for alteration of continuous subcutaneous infusion (23%) or alteration of use of non-pharmacological interventions (21%). Furthermore, 11% of patients were taken off the LCP, around one quarter of whom were later put back on. Conclusions: The authors’ model of care could overcome many of the issues relating to the LCP and would ameliorate the developing vacuum of care for patients at the end of life.
Time for change? An exploration of complexity in health-care practice
Authors: Sweeney Kieran 
Published: May 2014

In everything that health-care professionals do, in every evidence-based procedure or service they deliver, they are practitioners of a particular philosophy. However implicitly, they embrace a particular view of the world and a preference for some types of knowledge to make sense of the world from that perspective. In this article, the basis for the conventional world view held by health-care professionals is explored. Its basis in science is set out and compared to the development of two other traditions: naturalistic (giving rise to the principles of qualitative research) and complex (based on the non-linear dynamics of complex systems). At stake, in this challenge to the conventional explanatory model in health care, is the way in which three different types of knowledge have become recognized as relevant and acceptable. The conventional world view, and by extension the explanatory model inhealth care, is now challenged at its very core by the emergence of our understanding of chaos, complexity and complex adaptive systems. The nature of complexity and its relevance to professional practice is explored.