bluuebunny/crossref_metadata_2025_split huggingface dataset:
Future proofing supervision in Wales: Improving the quality of statutory supervision
Authors: Ness Vinny , Richards Julie 
Published: May 2014

The Local Supervising Authority (LSA) in Wales, working closely with Directors of Nursing, Heads of Midwifery, Nursing and Midwifery Council (NMC), Welsh Government and the Royal College of Midwives (RCM) have mapped out a revised model for the delivery of statutory supervision that will be sustainable, cost effective, minimise the current risks facing Health Boards and the LSA, and one that will enable supervision to demonstrate quality and added value whilst meeting its main objective of enhancing public protection. The overarching purpose of this change is to improve the quality of statutory supervision in Wales through the appointment of supervisors, to work full time as a Supervisor of Midwives (SoM) for a rotational 18 month period. The SoMs will be dedicated to the role of supervision, increasing their visibility and accessibility to midwives and service users. It is considered that this model will enable more efficient and proactive management of investigations, external to employing Health Boards, and ensure timely remedial support for midwives. There will be an all Wales 24-hour on-call rota for regulatory advice and guidance and supervisors will provide supervision through clinics/surgeries for midwives, students and user group forums. Midwives will benefit from a more robust annual supervisory review process through group supervision and sharing of best practice, all of which aims to enhance public protection. The model will be evaluated with key performance indicators including; regular updates of workforce planning in line with NMC requirements; a focus on the timeliness and quality of the whole investigation process; 100% of students in the clinical area meet a supervisor at least twice a year and collation of the trends and themes from supervisory on-calls to inform service development.
The use of antiembolic stockings. Part 2: a clinical audit
Authors: Walker Linda , Lamont Sue 
Published: May 2014

Aim: To audit current practice regarding selection and use of graduated elastic compression stockings (GECS) in the authors’ Trust. Following a literature review it was important for the Trust that the authors audited current practice before the development and implementation of any new guidelines. Background: A literature review enabled the authors to establish best practice principles for the use of GECS and develop guidelines for use across their Trust. However, feedback from various sources highlighted conflicting practices regarding the methods by which patients either did or did not receive stockings, and which lengths and brands were used. As the guidelines aimed to allow implementation of standardized change across the Trust, it was important to establish current practice with regard to GECS selection and use. Therefore, an audit tool was developed carried out on the use of GECS Methods: An audit tool was developed and implemented to establish the practices before the implementation of the guidelines Results: The audit demonstrated that there was no consistent policy within the surgical services directorate for the correct use of GECS Conclusions: It is important that all healthcare providers have a local policy for GECS use, which makes it clear how an assessment for patients requiring GECS needs to be conducted and how that assessment is documented.
Middle-aged women and everyday life: implications for health
Authors: Elgán Carina , Fridlund Bengt 
Published: May 2014

The aim of this study was to describe middle-aged women's perceptions of lifestyle and how it was experienced in their daily lives. Interviews with 15 women selected using network sampling were analysed using a phenomenographic approach. Lifestyle was perceived as either ‘handle life’, describing a framework of how everyday life should manifest itself in different areas of life, or ‘relate to life’ implying accepting life as it is and making the best of it based on previous experiences. In terms of providing preventive and health-promoting guiding, it is essential that nurses have an insight into people's reasoning to support them to improve health or deal with illness.
Moving and handling and patient safety: analysis of clinical incidents
Authors: Cornish Jocelyn , Jones Anne 
Published: May 2014

Aim: The aim of this study is to identify the potential contribution of moving and handling practice to clinical incidents through an analysis of incident data. Background: Previous studies focusing on moving and handling have highlighted potential harm to patients through poor practice, and have suggested that this might be an issue for patient safety. However, this has not been identified in studies analysing clinical incident reports, where the potential contribution of moving and handling has not been recognized. This study reports an analysis of clinical incident data from the specific perspective of moving and handling. Design: Survey of clinical incident reports in hospital in-patient care settings Method: A random sample of 500 incident reports was analysed using descriptive statistics and thematic analysis of qualitative data. Results: There is an indication that some staff are not following recommended moving and handling policy through a lack of risk assessment; for example, in the selection of appropriate actions to assist patients, and in the prevention of further occurrences of incidents where patients had fallen. The limited detail within the reports affected consideration of the causes of the incidents and actions that could be taken to prevent a further occurrence. Conclusions: Some of the reported staff actions may contravene policy guidelines. Missing detail in the incident reports inhibited investigation of incidents that could lead to appropriate and safe systems of work being identified.
Meningitis part 2: Prevention and protection
Authors: Donovan Claire 
Published: May 2014

This is the second of three articles about meningitis. It provides information about the vaccinations currently available to prevent meningitis and the procedures which are followed when a case occurs in a school setting. Vaccines have been extremely effective in reducing the numbers of cases caused by Haemophilus influenzae type b and Neisseria meningitidis (meningococcus) group C bacteria. Cases of pneumococcal meningitis have also reduced since the introduction of the pneumococcal conjugate vaccine. However, there is no vaccine currently available to protect against Neisseria meningitidis group B, the most common cause of bacterial meningitis in the UK. As vaccines cannot prevent all types of meningitis, cases in school settings will continue to occur. The procedures undertaken by the Health Protection Unit will reduce the chance of a second case occurring. The school nurse can play an important role in giving accurate information and helping to reassure staff, pupils and parents.
Are sexual health services in schools adequate?
Authors: Dodds Elizabeth 
Published: May 2014

Background: Nottingham has one of the highest teenage pregnancy rates in England. One of the Teenage Pregnancy Strategy's aims was to improve Sex and Relationships Education (SRE) and sexual health services (SHS) in schools. However, evidence suggests that some schools do not prioritize these topics.Methods: A mixed qualitative and quantitative questionnaire was distributed to teaching staff and school nurses within Nottingham secondary schools to ascertain what SRE and SHS were offered and their attitudes towards them. The results were descriptively analysed.Results: A total of19 participants responded from seven schools. Four of the schools indicated that high quality SRE was being provided. Three schools appeared to only offer minimal SRE. Provision of SHS was varied, with few members of the teaching staff fully aware of the services provided in their school. Three schools indicated that no SHS were provided.Conclusions: The study has highlighted inconsistencies in how SRE and SHS are implemented and prioritized in Nottingham secondary schools. This results in a postcode lottery as to whether teenagers receive appropriate SRE and SHS. Participants were unaware of what SRE or SHS are offered in their school. School nurses must promote the services they offer so that both teaching staff and students are aware of how and what services can be accessed.
Exploring educationalists' views on the need for school nurses in secondary schools in Greece
Authors: Mastrogiannis Dimos , Deltsidou Anna , Noula Maria , Poulaka Maria-Apostolia , Gesouli-Voltyraki Eftyhia , Fouka Georgia , Plakas Sotiris , Mantzorou Marianna 
Published: May 2014

School nurses promote pupils' health, and their balanced physical, mental and social development. School nurses working in the Greek public sector are only employed in special schools and are supervised by the Ministry of Education and Religious Affairs, Culture and Sports. A study was undertaken to explore public secondary school teachers' beliefs about the role of school nurses and whether they thought they would be useful in schools. The majority of respondents believed that the role of the school nurse is to provide first aid (63.9%). Teachers who said that they would feel more secure by the presence of a school nurse in their school were 41 times more likely to believe a school nurse would be useful in the case of school accidents (chi square=57.125, p<0.001,OR=41). The researchers believe that public schools in Greece need to employ school nurses and that the Greek government should consider taking appropriate measures towards this end.
Recreation in stroke rehabilitation part one: a review of the literature
Authors: Cowdell Fiona , Garrett Dawne 
Published: May 2014

Stroke is one of the most significant causes of morbidity and mortality in the UK. However, a review of the literature reveals a paucity of studies on stroke rehabilitation. The majority of literature is quantitative in nature, with relatively few studies seeking patients' own views. This article reviews the studies that have investigated the concept of recreation as a part of stroke rehabilitation. It reveals that at present, no research has been undertaken specifically to investigate patients’ perceptions of the need for recreational activity while undergoing stroke rehabilitation.
Update on Echinococcus multilocularis: with particular emphasis on its impact on humans
Authors: Fisher Maggie 
Published: May 2014

The range of Echinococcus multilocularis has extended over the past 4 years, effectively removing the ‘buffer zone’ of land between the channel coast and the western-most edge of its endemic area. This means that pet owners taking their dogs and cats across the channel should consider treating their dogs or cats at monthly intervals with a suitable cestocide containing praziquantel or equivalent if there is any chance of the pet having access to rodents. The role of cats as significant producers of eggs is markedly less than that of foxes or dogs. However, the role of the cat as a source of infection within the domestic environment is less well defined. Infection of humans has a lag time of between 5–15 years before clinical signs are seen, thus it will be some time before the scale of zoonotic infections is known from the areas where the infection has now spread to. Diagnosis in humans relies on serology, PCR, and magnetic resonance imaging (MRI) or computer tomography (CT) scans to detect characteristic cystic lesions normally in the liver. Cure is most likely to be achieved if resection of the entire lesion is possible. Long-term benzimidazole treatment is normally administered to ensure control. In addition to regular cestocidal treatment of dogs and cats, cleanliness measures including hand washing before eating and wearing gloves when gardening can help with preventing human infection.
Carotid artery pseudoaneurysm with Horner's syndrome: delayed complication of internal jugular venous cannulation
Authors: Maston M 
Published: May 2014

A58-year-old man presented to hospital with a 1-week history of left arm swelling. Two days after admission he became pyrexial. Chest X-ray revealed a right-sided effusion, which was an empyema. He further deteriorated and developed respiratory failure. He was intubated and ventilated. Right internal jugular venous cannulation was conducted to allow central venous pressure monitoring. He was transferred to intensive care, where he gradually improved and was weaned off ventilation. The right internal jugular venous cannula was removed without difficulty 9 days later. Four days after removal of the internal jugular venous catheter, miosis and moderate ptosis on the right side (Horner's syndrome) was noticed. The remainder of the cranial nerves were intact. A computed tomography scan (CT) of the head and neck was done to investigate the cause of the right Horner's syndrome and the left arm swelling. The CT scan (with contrast) showed an enlarged carotid artery (Figure 1). Ultrasonography showed this to be a 4 cm × 2.5 cm false aneurysm. The carotid artery pseudo aneurysm corresponded to the site of internal jugular vein cannulation. The scan did not reveal a cause for the swollen left arm, which was resolved gradually. Later he was referred to the vascular unit where he underwent angiography and successful stenting of the aneurysm.
Angiosarcoma: a difficult diagnosis
Authors: O'Donnell ME , Scally N , Carson J , Kenny B , Whiteside MCR 
Published: May 2014

A 28-year-old nulliparous lady was referred to the breast clinic with a 5-month history of persistent, cyclical, left-sided mastalgia. She was otherwise fit and healthy with no previous breast or nipple complaints. She was originally from Hong Kong with no family history of breast cancer. She was not prescribed any medications and was a non-smoker. On examination, tender nodularity was elicited below the left nipple. There were no other abnormalities. Ultrasound scan (USS) of this area demonstrated an irregular area of mixed echogenicity, probably in keeping with fibroadenosis (Figure 1). Mammography performed subsequently demonstrated dense fibro-glandular tissue with no mass (Figure 2). Fine needle aspiration (FNA) of the area demonstrated fibro-fatty tissue with very scanty ductal cells. This was unsatisfactory for diagnosis (C1 cytology). A clinical core biopsy was desired but not completed on this consultation at the patient's request. At subsequent review, a clinical core biopsy was performed in view of persistent nodularity. The core biopsy demonstrated a well-differentiated, vasoformative endothelial tumour, which appeared haemangioma–like, involving the surrounding fat and fibrous tissue, between breast ducts. In areas the lesion appeared to have an infiltrative pattern with vessels dissecting the septal fibrous tissue present. The cells showed a high degree of vascular endothelial differentiation but had enlarged hyperchromatic and mildly pleomorphic nuclei. Although mitotic figures were not identified, the appearances were suggestive of well-differentiated, grade-1 angiosarcoma (Figure 3). An expert second opinion was sought and concurred with this interpretation. There was positive immunohistochemical staining for CD34, CD31, and for factor VIII. MIB-1 proliferation was low. This is a polyclonal antibody used in paraffin embedded tissue against the Ki-67 antigen and is an indicator of cell proliferation. A magnetic resonance image (MRI) scan was recommended but was unhelpful, demonstrating no abnormality. An USS guided localisation-biopsy was performed without complication. Macroscopically the tissue was haemorrhagic. Histology confirmed the presence of a 2.2 cm, well-differentiated, invasive angiosarcoma extending to three of the resection margins. Following counselling, she subsequently had a left mastectomy with immediate expandable implant reconstruction. This was completed without complication. Macroscopic analysis of the resected mastectomy specimen demonstrated an ill-defined residual haemorrhagic lesion measuring 4 cm × 4 cm × 2 cm. Histology confirmed the presence of residual angiosarcoma, up to intermediate-grade malignancy. Unfortunately, the inferior-superficial margin was still not clear of disease and she required re-excision to achieve a clear margin. The breast implant was not disturbed and remained in-situ during the re-excision. She is awaiting radiotherapy to the operative site, which has had to be delayed, as she is now seven weeks pregnant. She is otherwise well.
A sting in the tail of Hurricane Charley
Authors: Ramsdale David R , Aziz Shahid , Beeching Nick 
Published: May 2014

A 76-year-old man with maturity onset diabetes mellitus, hypercholesterolaemia, hypertension and a history of coronary artery bypass surgery was well until his home in Punta Gorda was devastated by Hurricane Charley. He and his wife had remained in their home as it was torn apart by the ferocious wind and rain but amazingly they survived. He received numerous insect bites while searching among the flooded ruins. Within 48 hours, he became unwell, with fatigue, lethargy, myalgia, rigors and anorexia. Despite deteriorating, he did not seek medical attention until returning to the UK 3 weeks later by which time he had lost 2 stones in weight. He had received oral cephalosporin but this was not based on the evidence of infection or the result of any investigation. On examination, he looked unwell with a sallow complexion. He was initially apyrexial. An abdominal examination revealed fullness but no palpable mass. Investigations showed leucocytosis 19.0 × 109/litre – 95% neutrophils. C-reactive protein (CRP) was 160 mg/litre. Abdominal ultrasound confirmed splenomegaly with a suggestion of an intrasplenic mass. Computed tomography (CT) scanning demonstrated a large multilobulated, low density mass within the spleen extending close to the capsular surface, indicative of an abscess (Figure 2). Five days after cessation of antibiotics, he was pyrexial (37.8°C) and blood cultures yielded Gram-negative bacillus, Escherichia coli. Echocardiography showed no evidence of infective endocarditis. Percutaneous drainage of the intrasplenic abscess using a pigtail catheter revealed 500 ml of chocolatebrown coloured pus. A Gram stain showed Gram-negative bacilli and culture of the aspirate revealed Escherichia coli sensitive to ceftriaxone. He was treated with a single intravenous dose of gentamicin 360 mg, intravenous ceftriaxone 1 g twice daily for 2 weeks and metronidazole 500 mg three times daily for 2 weeks and the abscess resolved. He improved rapidly and 7 days after draining the abscess, the CRP fell to 13 mg/litre and the leucocyte count to 6.9 × 109/litre. Subsequent CT scanning showed resolution of the splenic abscess. Although genitourinary investigation revealed no abnormality, a barium enema showed a 5 mm polyp and diverticula in the sigmoid colon.
Endobronchial actinomycosis: is a repeat bronchoscopy after treatment necessary?
Authors: How Soon Hin , Ramachandram K , Aziz Azian Abd 
Published: May 2014

A 51-year-old Chinese woman without any significant past medical history was admitted in October 2003 for cough of 18 months' duration. There was minimal clear expectoration and no haemoptysis. She denied any shortness of breath, anorexia and weight loss. There were no symptoms of rhinitis, gastrooesophageal reflux or choking. She was afebrile with good dental hygiene. There were fine crepitations and localized rhonchi over the right lung base. Despite short courses of antibiotics from her general practitioner there was no improvement in her symptoms. The initial chest radiograph showed opacity in the right middle lobe with a subtle air-bronchogram. Blood investigations revealed an erythrocyte sedimentation rate of 113 mm/hr, and fasting and random blood glucose levels of 10.4 mmol/litre and 13.4 mmol/litre respectively. The full blood count, renal and liver function tests were within normal limits. Contrast enhanced chest computed tomogram (Figure 1) revealed a right middle lobe consolidation with air-bronchogram. A few pre-tracheal and subcarinal lymph nodes of less than 1 cm in diameter were present. Bronchoscopy showed nodular lesions causing subtotal occlusion of the middle lobe bronchus. Biopsy of these lesions revealed filamentous-like bacterial colonies which were Gram stain positive and modified Ziehl–Neelson stain negative with a background of acute and chronic inflammation consistent with actinomycosis. Bronchoalveolar lavage specimens were culture-negative. She was treated with intravenous benzylpenicillin 5 mega units 6-hourly for 1 month followed by oral penicillin V 1 g 6-hourly for 6 months. She returned to the clinic with complete resolution of symptoms 7 months after the treatment and a follow-up chest radiograph showed near complete resolution the right middle lobe opacity. Repeat bronchoscopy still showed nodular lesions in the right main bronchus which appeared much smaller now. The bronchoscope could now be passed beyond the lesion and a piece of ‘tissue’ was seen at the bifurcation of the middle bronchus. The ‘tissue’ was grasped with a biopsy forceps. However, it dropped above the vocal cords and most likely was swallowed by the patient. A repeat biopsy of the nodule showed persistence of actinomycosis. In addition, necrotic vegetative matter was present. Oral penicillin at the same dose was continued. Three months later, a third bronchoscopy showed complete resolution.
Myositis ossificans progressiva
Authors: Waller SL , Porter DE , Huntley JS 
Published: May 2014

A 23-year-old man with myositis ossificans progressiva was seen in the orthopaedic clinic with pain on sitting as a result of a bony spur extending caudally from the right ischiopubic eminence. The fragment of bone was mobile and exquisitely tender on palpation. There was a recent history of falling out of bed which was thought to be relevant to its onset. A pelvic radiograph (Figure 1a) showed an ischiopubic spur in conjunction with a substantial ischiofemoral bar that had effectively fused the right hip. He also had ectopic ossification deformities of the spine, left shoulder (Figure 1b) and thoracic cage (Figure 1c). He initially presented at 6 years of age with a palpable exostosis of the proximal right tibia. Over the next 3 years he developed several haematomas with subsequent calcification often following minor trauma. By the age of 9 years, at which time the diagnosis was made, calcification was present at multiple sites and corresponding joint mobility was reduced. A maternal history of Addison's disease had prompted the exclusion of autoimmune disorders. Repeated coagulation screens were also normal. The diagnosis was eventually made on the basis of short hypoplastic halluxes (Figure 2) which are the classical dysmorphic markers of this condition. This was supported by biopsy, the tissue showing features of fibroblastic proliferation. Unfortunately the biopsy site was further affected by ossification. He was commenced on a course of etidronate and physiotherapy. It was decided to proceed with limited surgery to excise the ischial spur. The patient accepted the possibility of recurrence or exacerbation following the procedure, the rationale being that any subsequent ossification was unlikely to form such a sharp spur (Figure 1a). Following surgery discomfort has been dramatically reduced and he is able to sit without pain.