bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of patient death on nursing staff: a literature review
Authors: Wilson Janet , Kirshbaum Marilyn 
Published: May 2014

There were 509 090 deaths recorded in England and Wales for 2008 ( Office for National Statistics, 2010 ); of these, over 56% (260 000) occurred in NHS hospitals. The death of a patient is an event that most, if not all, nursing staff will encounter during their work. This experience can elicit physical, cognitive, behavioural, spiritual and emotional responses ( Parkes, 1998 ). Aim: The aim of this literature review is to explore how the death of patients in a hospital setting impact on nursing staff. Method: A review of the literature was undertaken using the online databases CINAHL, Medline and Psych Info. The search was limited to articles in the English language and those from peer-reviewed journals. Results: Themes arising from the literature review included: the theoretical context; the emotional impact; the culture of the healthcare setting; staff's previous life experiences; and support available for healthcare staff. Conclusions: The death of patients does have an impact on nurses. This can affect them both in their work environment and outside of work. Education around grief theory and support from others are helpful for staff in developing strategies for coping with patient deaths.
The use of complementary and alternative medicine by nurses
Authors: Buchan Shonagh , Shakeel Muhammad , Trinidade Aaron , Buchan Duncan , Ah-See Kim 
Published: May 2014

Background: Complementary and alternative medicine (CAM) use is common among patients attending the department of the authors of this article. With expanding roles of nurses in various clinics, the nurses are often asked for their advice on CAM use by their patients. CAM education is not part of the nursing curriculum in various parts of the world. The aim of this study was to establish the use of CAM by nurses along with their knowledge base and attitudes towards it. Methods: A questionnaire-based study based on the published literature was used among qualified nurses. The data were collected and analysed using SPSS for Windows. Results: The response rate was 86% (531/621; females were 91% and the mean age was 32 years (range 20–63). Eighty percent of the responders admitted to use of CAM and 41% were using CAM at the time. The most commonly mentioned CAM were massage, cod liver oil and cranberry juice. CAM was mostly used for relaxation, joint pain and urinary tract infection. Only five nurses believed CAM was not effective and 74% would recommend CAM use to others. Ninety-three percent of nurses did not have any formal education on CAM. Most nurses would consider some education on CAM to enable them to counsel their patients. Conclusions: The use of CAM is high among nurses. As patients are increasingly relying on nurses for advice on its use, it is important for nurses to be educated about CAM in order to guide their patients.
Medication administration practices among children's nurses: a survey
Authors: Murphy Maryanne , While Alison 
Published: May 2014

Aim and objectives: The overall aim of this study was to investigate the medication administration practices of children' nurses. The specific objective was to identify practices that may improve the medication administration process, where necessary. Design: Using a non-experimental survey design, a ‘Medication Administration Practices Survey’ was developed for use in this study. The survey was designed to include questions based on medication administration practices and not solely on medication errors. Ethical approval was obtained from the local research ethics committee where data were collected. All clinical staff working in all areas in a children's hospital were included. Results: Interruptions in the medication process, a heavy workload and fatigue were some of the findings that emerged from this study. Inadequate knowledge and skills and a failure to comply with hospital policy were also identified. Conclusion: A lack of adherence to hospital policy and the frequency of interruptions in the medication administration process are important practices that require change as indicated by this study. Several recommendations are made, directed toward preventing or reducing medication errors and supporting children's nurses in providing best practice.
Depression among nursing students in an Indian government college
Authors: Chatterjee Supantha , Saha Indranil , Mukhopadhyay Sujishnu , Misra Raghunath , Chakraborty Amitava , Bhattacharya Abantika 
Published: May 2014

BackgroundDepression is a major public health threat that can affect anyone including health professionals and nursing students.Objectives and MethodsThis analytical, cross-sectional study was conducted among 180 students of a nursing college to find out the burden of depression on them and possible contributing factors using the Beck Depression Inventory.Results63.9% of the students were found to be depressed, the majority being mild in grade. First-year students were found to be significantly more affected (P=0.008). Binary logistic regression showed that familial disharmony, disinterest in the course and insecurity about future placement were statistically significant factors behind the development of depression.ConclusionIt is imperative that the psychological condition of nursing students be viewed as an important aspect to be considered, particularly within the Indian population and others in which there is a paucity of data.
Smoking part 2: Preventing uptake among young people
Authors: Matthes Edwards Sarah 
Published: May 2014

Currently, a total of 6% of 11–15-year-olds regularly smoke, showing a substantial decrease on 1997 when prevalence stood at 13%. There is still much to do to bring the level further down and it is important that comprehensive approaches to tobacco control are not disinvested in as this could result in the smoking rates going up again. This article will briefly reflect on the importance of prevention, examine the evidence base for prevention in young people, and recommend different interventions, which may have an impact.
Intrahepatic portocaval shunt in dogs: diagnostic approach and therapy
Authors: Orioles Massimo , Fernandes Ricardo , Barreau Pierre 
Published: May 2014

Portosystemic shunt (PSS) is a relatively common phenomenon in dogs. PSS may be either intrahepatic (IHPSS) or extraheptic (EHPSS), congenital or acquired. The most commonly identified shunts are of congenital origin and consist of single, large intrahepatic or extrahepatic shunts. Since the discovery of the condition, PSS has been treated by medical or surgical methods, or a combination of both. Surgical techniques for partial attenuation of EHPSS and IHPSS include silk suture attenuation, ameroid constrictor placement, cellophane banding, and hydraulic occluders.This article describes the diagnostic process and the treatment of a case of IHPSS in a 7-month-old male entire Bull Mastiff, and provides an in depth discussion regarding clinical and diagnostic features, surgical treatment, complications, follow-up and prognostic factors.
Case study: Foleyella furcata from a wild-caught Graceful Chameleon
Authors: Pellett Sarah , Cope Iain , Fiddes Matthew 
Published: May 2014

A wild-caught Graceful Chameleon, Chamaeleo gracilis, presented with subcutaneous lesions. Microfilariae were observed from a freshly prepared blood smear. Live filariid parasites were removed from the subcutaneous lesions under a general anaesthesia and were identified as Foleyella species, presumed to be F. furcata.A single topical application of selamectin (Stronghold®, 60 mg/ml, Zoetis) at 12 mg/kg was applied.The chameleon displayed signs of inappetance and lethargy and was found dead 48 hours post treatment. Post mortem examination revealed large nematodes within the ventrocranial aspect of the chest and around the heart. These nematodes were still alive at the time of necropsy. Local inflammation could be seen.In this case report we discuss Foleyella furcata infection in an African chameleon and adverse effects of treatment with selamectin, while considering other treatment options for this parasite.
Anabolic steroid-induced rhabdomyolysis
Authors: Adamson Rosemary , Rambaran Curtis , D'Cruz David 
Published: May 2014

A 25-year-old male with no prior medical history presented with bilateral thigh and calf pain. He was a professional dancer, who had not been dancing for a year following an appendicectomy and was now getting back into training. Two days before presentation he had increased the intensity and duration of his workout to maximum 45 minutes on a cross-trainer. The next day he noticed pain in his legs which intensified with muscle cramps and 24 hours later he presented to accident and emergency. He was sent home on diclofenac tablets,with a diagnosis of musculo-skeletal pain. He re-presented 2 days later with difficulty walking. He admitted taking two preparations of anabolic steroids recently. On examination, his legs were diffusely tender in the region of the quadriceps and the inferior portion of gastrocnemius, but they were soft, with no warmth or swelling. He had reduced power at the hip flexors and occasional muscle spasms but no focal neurology. Creatinine kinase (CK) was 17 171 iu/litre (normal range for men <250 iu/litre), with normal renal function and no myoglobinuria. Orthopaedic review found no evidence of compartment syndrome and he was treated with intravenous fluids, diazepam and paracetamol. His CK initially decreased but then increased to peak at 22 226 iu/litre on day three, with evidence of myoglobinuria. Management continued with hydration and urinary alkalinization. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels were normal and human immunodeficiency virus (HIV) test was negative. Magnetic resonance imaging (MRI) of his legs showed areas of high signal in several muscle groups with no focal areas of necrosis (Figure 1). Following a muscle biopsy, he was started on oral prednisolone and then a course of methylprednisolone, during which CK levels decreased rapidly. His muscle biopsy and electromyography (EMG), were reported as normal and an autoantibody screen was negative, hence the steroids were rapidly tapered off. At discharge, his CK had continued to decrease (1100 iu/litre) and his mobility slowly improved. A diagnosis of anabolic steroid-induced rhabdomyolysis was made. He had been taking two steroid preparations; WinstrolTM (stanazolol) and PrimabolanTM (metenolon). He had used WinstrolTM several times in the past and on this occasion he had used four ampoules each a week apart. However, he used only one ampoule of PrimabolanTM a few days before presentation. He usually injected into his thighs.
False aneurysm caused by failed fracture fixation
Authors: Anderson OPG , Brookes JAS , Cobb J 
Published: May 2014

Patient JL was an 83-year-old man who suffered an unstable intertrochanteric fracture of the femoral neck reduced and fixed with a sliding hip screw. Over the following 2 months he developed pain in the right groin which prevented him from walking. A pulsatile mass in the right groin was found. A pelvic radiograph demonstrated that the plate had pulled away from the femur thus failing to maintain reduction of the fractured hip (Figure 1). Ultrasound and then arteriography confirmed the presence of a profunda femoris pseudoaneurysm. The profunda femoris artery was patent and compressed from below by a large pseudoaneurysm (3.2 cm by 4.0 cm in cross section and 5.0 cm in length) (Figures 2, 3 and 4)). The proximal end was 5.0 cm from the origin of the profunda femoris artery. Radiological intervention was considered to be the most appropriate option because of the technical difficulty and high risk of open surgery. Left common femoral artery puncture with use of an up and over technique to reach the right common femoral artery and right profunda femoris artery was used. The neck of the pseudoaneurysm was isolated and embolization achieved by placing coils distal and proximal to the neck using seven coils in total. Post-embolization arteriography showed no filling of the pseudoaneurysm and good collateral supply of the limb. The lump in the groin became non-expansile and gradually reduced in size. The patient made a good recovery from the procedure and revision of the sliding hip screw was now possible.
Second case report of a metachronous double primary gastric cancer
Authors: Ullah MZ , Patel H , Lauffer GL , Tanner A 
Published: May 2014

A 72-year-old man was referred to the authors' hospital in December 1999 with a 2–3-month history of dyspepsia, abdominal bloating and loss of appetite. Upper gastrointestinal endoscopy with biopsy revealed a moderate active atrophic gastritis with widespread intestinal metaplasia. Gastric biopsies also showed the presence of Helicobacter pylori which was subsequently treated with standard triple therapy. His symptoms improved with H. pylori eradication treatment and a subsequent 6-month follow-up endoscopy with biopsy showed no evidence of residual gastritis or H. pylori infection. He re-presented with similar symptoms 18 months later and a repeat upper gastrointestinal endoscopy showed a diffuse lesion in the gastric fundus. Histological biopsy showed features consistent with a highgrade diffuse non-Hodgkin's lymphoma of the stomach (Figure 1). There was no evidence of further H. pylori infection. A subsequent staging whole body computed tomography scan and laparoscopy revealed no other lymphoid tissue involvement. Omental biopsies undertaken at laparoscopy showed focal infiltration by malignant non-Hodgkin's lymphoma. Immunohistochemistry showed the cells to be CD20 (a B-cell lymphoid marker) positive and CD3 (a T-cell lymphoid marker) negative, confirming the tumour to be a non-Hodgkin's lymphoma of B-cell type. Immunohistochemistry of bone marrow aspirates showed no evidence of infiltration. He was treated with 6 cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) chemotherapy in November 2001. A carbon-13-urea breath test in December 2001 was negative. Repeat gastroscopy 4 months after starting chemotherapy showed only erosive gastritis at the gastro-oesophageal junction with no histological evidence of residual lymphoma. Subsequently, the patient's body weight started to increase and his initial symptoms resolved. A surveillance gastroscopy in October 2002 showed a new ulcerative lesion at the incisura of the stomach. Initially, this was thought to be a recurrence of the non-Hodgkin's lymphoma. However, subsequent histology of this lesion showed features of a gastric mucinous adenocarcinoma with signet ring features (Figure 2). He then underwent a subtotal gastrectomy and histological examination of the resected stomach confirmed the presence of a gastric adenocarcinoma with no residual non-Hodgkin's lymphoma. He made a good postoperative recovery and was further treated with chemoradiotherapy. Unfortunately the patient developed a recurrence of the adenocarcinoma in the gastric remnant 3 years later. He is currently alive and has declined any further treatment.
Lemierre's syndrome in association with a cholesteatoma
Authors: Healy Brendan , Llewelyn Meirion , Cavalle Ferran , Bernard Mark 
Published: May 2014

A 17-year-old man presented with headache, sore throat and dizziness. He had been feverish and suffering from rigors. He had suffered from recurrent ear infections for 2 years and 2 weeks before admission he had received a course of amoxicillin for an ear infection. On examination he was flushed, pyrexial, tachycardic (130 bpm) and hypotensive (90/41 mmHg). The skin over the lateral border of his right sternocleidomastoid muscle was erythematous and tender. He had marked erythema of his throat and a macular blanching erythematous rash on his wrists, arms and knees. There was no neck stiffness or photophobia. Examination of the ears on admission did not detect any abnormality. Blood tests revealed neutrophilia, thrombocytopenia and a raised C-reactive protein level of 206.3 iu. Lumbar puncture was unremarkable. Monospot test was negative. He was treated with intravenous benzylpenicillin 1.2 g four times per day and cefotaxime 2 g three times per day. Four days after admission two blood cultures grew a non-haemolytic streptococcus, later identified as Enterococcus avium. Antibiotics were changed to amoxicillin, gentamicin and metronidazole. An ultrasound scan of the neck showed lymphadenopathy along the right anterior lymphatic chain and a patent right internal jugular vein. Transthoracic echocardiogram was unremarkable. The patient remained unwell. His pyrexia persisted, his haemoglobin dropped to 7.1 g/dl and his albumin to 23 g/litre. Computed tomography (CT) scan of the mastoids revealed fluid in the right middle ear, which continued into the mastoid antrum and was associated with sclerosis of the right mastoid air cells. A third blood culture grew gram-negative bacilli. Co-amoxiclav was started and the fever settled. Escherichia coli sensitive to amoxicillin was isolated. A CT scan of the thorax showed small bilateral pulmonary nodules, some of which contained small cavities, suggesting pulmonary abscesses (Figure 1). An ultrasound scan of his neck was repeated on day thirteen of his admission and revealed thrombosis of the right internal jugular vein. This was confirmed with magnetic resonance imaging, which also demonstrated extension of the clot into the sigmoid and transverse sinuses (Figure 2). The patient was anticoagulated for 6 months. In total, the patient received 2 weeks of intravenous amoxicillin, gentamicin and metronidazole and 6 weeks of co-amoxiclav and metronidazole. Review in ear, nose and throat outpatient clinic revealed a cholesteatoma that required excision. No other source of sepsis was identified despite extensive investigation.
Squamous cell carcinoma arising in an epidermoid cyst
Authors: Jehle KS , Shakir AJ , Sayegh ME 
Published: May 2014

A 48-year-old Caucasian male presented with an inflamed, discharging left buttock mass. An asymptomatic mass, present for 28 years, had increased in size following blunt trauma to the buttock 3 months earlier. On examination a 5×5×3 cm tender fluctuant mass was found in the left gluteal region with an enlarged left inguinal lymph node. An infected epidermoid cyst was diagnosed and incision and drainage performed. Biopsies revealed proliferating squamous epithelium of the cyst wall with areas of cytonuclear atypia, in keeping with invasive well-differentiated squamous cell carcinoma (Figure 1). The patient was reviewed at 3 weeks, when an ulcerating lesion with overriding skin edges and enlarged left inguinal nodes were discovered (Figure 2). A wide local excision of the carcinoma and the left inguinal lymph node was performed. Histological examination showed the tumour infiltrating the subcutaneous tissue although the deep and lateral resection margins were clear. The lymph node had been replaced by necrotizing squamous cell carcinoma with prominent extra-nodal spread. A computed tomography scan revealed no distant metastases but an irregularity in the left groin was consistent with an enlarged left inguinal lymph node. The patient was referred for radiotherapy but, despite an initial response, the wound continued to discharge pus. Antibiotics were commenced. A followup examination 4.5 months later revealed tumour deposits in the left groin and ill-defined opacities on chest X-ray, suggestive of pulmonary metastases. He was admitted to hospital 10 days later in an acute confusional state, suffering from hypercalcaemia and pneumonia and died 5 days later, only 5 months after his initial presentation.
A confusing presentation of giant cell arteritis
Authors: Rogers Matthew , Young Laurel 
Published: May 2014

A 56-year-old woman presented with a pale, painful, paraesthetic right arm. Examination revealed a cold right hand, with absent right radial, ulnar and brachial pulses. A provisional diagnosis was made of thrombotic or embolic arterial occlusion; the patient was anticoagulated and referred to the vascular surgical service. Magnetic resonance angiography showed an occluded right brachial artery (Figure 1). Ultrasonography confirmed this, but also demonstrated widespread narrowing of the vessel, with surrounding hypoechoic tissue and fluid within the connective tissue suggesting an inflammatory process. On questioning, the patient admitted to occipital headache and scalp tenderness. The erythrocyte sedimentation rate was 63 mm/hr, and the C-reactive protein level 155.1 mg/litre. A temporal artery biopsy showed changes typical of giant cell arteritis. Prednisolone 60 mg daily was commenced with good effect. However, the patient's symptoms recurred when steroids were tapered below 50 mg daily. Moreover, 2 months later she developed bilateral calf claudication at 100 yards. Magnetic resonance angiography of the legs demonstrated narrow, diseased anterior and posterior tibial arteries bilaterally, but normal peroneal and proximal vessels. Cyclophosphamide treatment was started, with resolution of the claudication and other symptoms.
Bilateral ankle pain and quinolone use: a case of tendon rupture secondary to quinolone use
Authors: Panigrah R , Longcroft-Wheaton G , Laji K 
Published: May 2014

An 80-year-old man presented to the acute medical take in September 2007 with a mechanical fall at home. For the preceding 2 weeks he had developed progressive bilateral heel tenderness following a course of afloxacin prescribed by his GP for a chest infection. This spread to his calves, with the ankles giving way on weight-bearing. He had seen his GP after a week of symptoms, who had noted this as a possible rare side effect of the medication but continued the drug. He had started falling as a result of pain in the tendons, and had no history of trauma before developing these symptoms. On examination both Achilles tendons were tender with associated bruising. The ankles were hot to touch with flexion confined to 20° because of the pain. It was not possible for the patient to weight bear because of the pain. Simmonds test showed that there was no continuity of the Achilles tendon. Blood tests revealed a C-reactive protein level of 269 mg/litre. The impression was that there was bilateral Achilles tendonitis secondary to the quinolone. Simple analgesia was given and the patient was advised to immobilize because of the significant risk of rupture of the tendons. An orthopaedic opinion and magnetic resonance imaging was sought to confirm the diagnosis. This revealed bilateral rupture of Achilles tendons (Figures 1a and b), and repair was needed. A kersler suture repair and vicryl plication was performed.
Deadly acidosis but home in 24hours
Authors: Cegla Jaimini , Nimalan Nisha , Edwards C Mark B 
Published: May 2014

A 51-year-old man drank two bottles of whisky and passed out. He woke with epigastric pain, which worsened during the day, and he vomited six times. Although normally teetotal, he binged sporadically. On presentation, he was tachycardic with a normal blood pressure, and inebriated with a Glasgow Coma Scale of 15. Urinalysis revealed a trace of ketones and pH of 5. Arterial blood gas analysis demonstrated severe metabolic acidosis with pH 6.73 (normal range (NR)=7.35–7.45), pO2 19.1 kPa (NR >10.6 kPa), pCO2 2.54 kPa (NR 4.7–6 kPa), bicarbonate 4 mmol/litre (NR 22–28 mmol/litre) and lactate 22 mmol/litre (NR 0.5–1.6 mmol/litre). He was diagnosed with severe alcohol-related lactic acidosis. Fluid resuscitation, broad-spectrum antibiotics and a proton pump inhibitor were commenced. He was given 1 litre of 1.26% sodium bicarbonate. The next morning after 7 litres of crystalloid and 75 ml of 8.4% sodium bicarbonate the patient was much improved with only mild epigastric pain. He had a pH of 7.53, bicarbonate of 27 mmol/litre and lactate of 1.7 mmol/litre. He was monitored for 24 hours and discharged.