bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of education on knowledge, skills and attitudes around pain
Authors: McNamara Mary C , Harmon Dominic C , Saunders Jean 
Published: May 2014

Aims: The purpose of this study was to assess the effectiveness of an acute pain educational programme in improving nurses' knowledge, skills and attitudes around postoperative pain management. Background: Poor postoperative pain management is consistently reported as a problem for patients ( Chung and Lui, 2003 ; Klopper et al, 2006 ; Bell and Duffy, 2009 ). This is often attributed to health professionals' lack of knowledge and access to training programmes, which have been cited as barriers to effective pain management ( Wilkes et al, 2003 ; Dihle et al 2006 ). The Acute Pain Service (APS) team at HSE Mid-Western Regional Hospital, Limerick, and the Centre for Nurse and Midwifery Education developed a training programme for nurses in pain management based on the International Association for the Study of Pain (2005) curriculum for nurses. Methods: A convenience sample of 59 nurses attending an educational programme on acute pain management was studied. Validated questionnaires were completed before, immediately after and 6 weeks after the educational programme to assess knowledge and attitudes towards acute pain management. Nurses were also asked to rate their views on 18 statements on acute pain management. Results: The acute pain educational programme intervention improved nurses' knowledge and attitudes towards pain assessment and management (p<0.01). It was most effective immediately after the pain education programme. Conclusion: Continuing evidenced-based educational programmes in pain management can improve nurses' knowledge of pain. The results of this study could guide the development and implementation of continuing educational programmes for nursing staff in providing patients with evidence-based pain management.
The benefits of a ward simulation exercise as a learning experience
Authors: Stirling Kevin , Smith Gill , Hogg George 
Published: May 2014

This article describes the findings from a pilot study undertaken to identify the potential benefits of a ward simulation exercise in developing the capabilities of newly qualified nurses. Eight newly qualified nurses were recruited to participate in this pilot study which was based in the Clinical Skills Centre, Ninewells Hospital, Dundee. This pilot study was performed in conjunction with NHS Tayside Practice Education Facilitators and the University of Dundee. Data collection methods involved reflective learning logs which were reviewed independently by an expert group of teachers and practitioners. A focus group session was also undertaken to understand the lived experience of the newly qualified nurse during the ward simulation exercise. Core themes (listed in order of importance) related to the professional development of newly qualified nurses that were identified through this pilot study were: an increase in confidence, development of stress management skills, improved management of the acutely unwell patient, the transfer of skills learnt in simulation to the clinical setting, development of communication skills and reflection skills. Participants in this pilot study demonstrated increased levels of confidence in their communication skills, their ability to prioritize care and to engage in collaborative teamworking.
Clinical competency assessment in intravenous therapy and vascular access: part 1
Authors: Hulse Anna Louise 
Published: May 2014

Nurse training and education programmes have changed in recent years, moving from a ‘learning on the job’ process of training and learning to a much more structured and academic approach. As professionals in health, we must continually update and refresh our knowledge and skills ( Mann et al, 2009 ), a view supported by Fry et al (2003) who highlight that nurses are now encouraged to continue with lifelong learning. The Nursing and Midwifery Council (NMC) Code of Conduct 40 states: ‘You must keep your knowledge and skills up to date throughout your working life’. Code 41 states: ‘You must take part in appropriate learning and practice activities that maintain and develop your competence’ ( NMC, 2010 ). Within the hospital setting, most patients will receive some form of intravenous therapy (IV) treatment ( Peterson, 2002 : cited by RCN, 2010 ). Infusion therapy has therefore become an integral part of professional practice for most nurses, who must learn the initial skills in IV therapy and vascular access and achieve clinical competence. Education and clinical training by specialist teams in organisations must be delivered to ensure safe skills are learnt ( RCN, 2010 ). This education and training must incorporate both theoretical and practical elements, with appropriate means of assessment. The delivery methods should be diverse, recognising that individuals have different approaches to learning. Clinical competency assessment frameworks are widely used within nurse education. But are they the most appropriate method of assessment, or can other methods be used? An in-depth literature review in this paper will highlight different approaches to learning, assessment and clinical competence.
Graft-versus-host disease in oncology nursing practice
Authors: Lieow Yukki , Christensen Martin 
Published: May 2014

Introduction: Gastrointestinal graft-versus-host disease (GI-GvHD) is extremely debilitating and is multifactorial in its causative factors, management and treatment. It is an exaggeration of normal physiological mechanisms wherein the donor immune system attempts to rid itself of the host. The inflammatory process that follows has the benefit of providing an anti-tumour effect for many diseases, but unfortunately in patients undergoing human stem-cell transplantation, the nature of the inflammation can result in disability, wasting and death. Aim: The aim of this article is to discuss the pathophysiology of this often misunderstood or misdiagnosed condition, as well as its signs and symptoms, management and considerations for nursing care. Considerations for nursing practice: While the medical management is aimed at minimising GvHD through the reduction of T-cell production and proliferation and gastrointestinal decolonisation, the nursing care is often focused on the signs and symptoms that can have the most prominent impact on patients. Conclusion: GI-GvHD has serious life-threatening complications, namely wasting syndrome, diarrhoea and dehydration. The basis of signs and symptomology is easily recognisable owing to the stages of progression through the human stem-cell transplantation process. Oncology nurses are in a prime position to identify these serious risks, initiate treatment immediately and collaborate effectively within the multidisciplinary team to minimise GvHD onset and provide expert support to patients, family and caregivers.
Pupils’ perspectives on preventive health dialogues
Authors: Golsäter Marie , Sidenvall Birgitta , Lingfors Hans , Enskär Karin 
Published: May 2014

Aim: The aim of the study was to understand pupils’ perspectives on health dialogues with school nurses. Background: A preventive health dialogue with a school nurse is offered to pupils in grades 4 and 7 in compulsory school and during their first year of upper secondary school in Sweden. The dialogue has been developed by school nurses as a method in health prevention work, but knowledge of how it is experienced from the pupil’s perspective is scant. Method: A total of 15 focus group interviews comprising 74 pupils altogether were performed. The data was subjected to qualitative content analysis. Results: The results emerged in four categories: Preparation creates preparedness and Adaptability creates dialogues based on wishes and needs, which were seen as prerequisites for a satisfactory health dialogue; the health dialogue benefits were Providing opportunity for knowledge and insight about health and lifestyle and Providing opportunity to develop a trustful relationship with the school nurse, which could result in a satisfactory outcome of a health dialogue. Conclusions: These results highlight that it is essential to create a respectful and open atmosphere in the encounter between pupil and school nurse. The pupil can gain insight into his or her health situation and get advice based on his or her individual needs if the nurse can adapt to the pupil’s wishes and needs through the dialogue.
Smoking part 3: Young people and cessation
Authors: Edwards Sarah Matthes 
Published: May 2014

Currently, a total of 6% of 11–15-year-olds regularly smoke, which shows a substantial decrease since 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 cessation as part of the wider tobacco control interventions aimed at young people.
School nursing in regional and rural Queensland
Authors: Baigrie Karina Ann 
Published: May 2014

The importance of school health and school health nursing (SHN) continues to be acknowledged within Australia and internationally. Since its inception in Queensland in 1911, SHN has been regarded as an important innovation in public health nursing, particularly in regional and rural settings. A number of issues that have an impact on the ongoing development and effectiveness of the SHN role can be identified from the available literature, including a lack of standardized position descriptions and corresponding role and function of SHNs; and a lack of overall understanding of and evidence to support the depth and breadth of SHN scope of practice. These factors, in turn, hinder greater recognition and support for the SHN role. Such factors also affect the ability of SHN roles to address key policy and program initiatives in rural and regional areas.
Assessing and evaluating students on placement
Authors: Sherwin Sarah , Muir Faith 
Published: May 2014

The role of the practice teacher is pivotal in supporting the development of students undertaking Nursing and Midwifery Council (NMC) approved Specialist Community Public Health (SCPHN), School Nursing programmes. It is a mandatory requirement that students of school nursing are supported and assessed by a named practice teacher, who must have met the requirements defined within the practice teacher standard ( NMC, 2008a ). In the fourth article of this series Faith Muir and Sarah Sherwin discuss the practice teacher’s role in assessing and evaluating SCPHN students on placement with the school health team.
Multi-disciplinary care in juvenile-onset systemic lupus erythematosus
Authors: Kelly Jane , Dunnage Jane , Beresford Michael W , McCann Liza J 
Published: May 2014

Juvenile onset systemic lupus erythematosus (JSLE) is a chronic autoimmune disease that can affect any part of the body including skin, joints and organs and can be associated with significant morbidity and mortality. Multi-disciplinary care of children and young people with JSLE is essential, in close partnership with schools. Aggressive treatment prescribed and monitored by a specialist team (usually a paediatric rheumatology team) is key to treating this difficult and life-threatening condition. There may be times when a child needs to be reviewed by other specialist teams including nephrology, neurology, haematology and cardiology. The school nurse is one of the key partners in supporting these children and families in the school environment.
A successful approach to reduce youth smoking in Leicestershire
Authors: Thomson Heather 
Published: May 2014

Smoking is a leading cause of ill-health and premature death in the UK, and an important public health issue. However, there is little evidence for effective smoking cessation programmes aimed at young people, particularly school-based. This article reviews the findings of a 3-year local area agreement to reduce the prevalence of smoking in young people and adults, and improve the health and wellbeing of the local population in Leicestershire, including some areas of substantial deprivation.
Isotretinoin-related optic disc swelling
Authors: Wenham CJ , Clarke I , Shun Shin GA 
Published: May 2014

A 19-year-old Asian woman presented to eye casualty via her optician. She complained of a 3-week history of an intermittent ‘misty’ patch in her left vision. This lasted less than 5 seconds at a time and occurred more frequently in the mornings. There were no other symptoms and she was systemically well. The patient was currently in the 11th week of a 16-week course of oral isotretinoin for recalcitrant acne, but was on no other medication. She had been using oral tetracycline until 1 year previously. Examination revealed visual acuities of right 6/6, left 6/9 with pharmacologically dilated pupils. Clinical examination was unremarkable (including normal ocular movements, visual fields to confrontation, colour vision and cranial nerves) with the exception of grossly swollen optic discs, left greater than right (Figure 1). The isotretinoin therapy was stopped and blood tests, Goldman visual fields (Figure 2), Heidelberg retinal tomography (Figure 3), computed tomography (CT) scan of the head and electro-diagnostic tests (EDTs) were arranged. Fields showed an enlarged left blind spot but no other abnormality. Blood tests showed elevated cholesterol, alkaline phosphatase and alanine aminotransferase levels. CT head scan revealed no intracranial abnormality and EDTs were normal. Neurology review corroborated a diagnosis of druginduced raised intracranial pressure and lumbar puncture was felt to be unnecessary. Eleven weeks later the patient was asymptomatic with a clear reduction in the swelling of both discs. Liver function tests and Goldman visual fields were returning to normal. The patient remains asymptomatic and under regular review.
Superior mesenteric artery syndrome in a young girl following spinal surgery for scoliosis
Authors: Amarawickrama H , Harikrishnan A , Krijgsman B 
Published: May 2014

A 15-year-old girl was admitted with nausea, severe bilious vomiting, loss of appetite and loss of weight of 2 weeks' duration. She underwent spinal surgery for thoracic scoliosis with multiple congenital abnormalities of the spine 3 weeks before admission. Examination revealed a thin, dehydrated patient with distended upper abdomen, positive succussion splash and normal bowel sounds. Blood investigations including urea and electrolytes were normal except for mild leucocytosis. Abdominal X-ray was unremarkable. A nasogastric tube was inserted which drained 2–3 litres of bilious fluid each day. She was treated conservatively with intravenous fluids and anti-emetics. The history of spinal surgery and copious amount of bilious nasogastric aspirate suggested upper gastrointestinal obstruction for which a barium meal with follow through was done on day 3 (Figures 1 and 2). It revealed a distended stomach and dilatation of the first and second parts of the duodenum with an abrupt linear cut-off at the third part, suggesting extrinsic compression. On the basis of her history and radiological findings, the diagnosis of superior mesenteric artery syndrome was made. Conservative treatment was continued with total parenteral nutrition for about 3 weeks, by which time the nasogastric output gradually reduced to less than 100 ml and the patient was tolerating oral fluids The patient was discharged after 4 weeks on soft diet. She was reviewed in clinic after a month and was found to be completely asymptomatic and comfortable.
Doctors and demons
Authors: Syed Hafiz , Liakis Iannis , Gompertz Patrick 
Published: May 2014

Mrs MB is a 68-year-old woman of Bangladeshi origin who presented to the acute stroke unit with dense right-sided hemiplegia. Computed tomography scanning confirmed that she had had an acute infarction of the left middle cerebral artery territory. Her past medical history included type 2 diabetes mellitus of 14 years' duration. Apart from serum cholesterol of 6.5 mmol/litre there were no other risk factors for cerebral infarction identified. On admission she was not taking an antiplatelet agent or statin. She denied having previously suffered a stroke. She was widowed and had been independent with all aspects of daily living. On further discussions with her daughter it came to light that Mrs MB had experienced mild weakness and ‘lack of feeling’ in her right arm and leg approximately 4 years ago. This was thought to be caused by what is literally translated from Bangla as ‘evil or demonic wind’. At the time she urgently consulted the help of a local spiritual healer in East London as recommended by neighbours and family. The diagnosis of a ‘demonic processes’ was confirmed by the healer who massaged the affected limbs with ‘holy’ water. The patient's symptoms resolved completely within hours so a consultation with her GP was not sought.
Spinal cord tumour presenting as neck pain
Authors: Freitas Ryan P De , Choudhari Kishor A 
Published: May 2014

In April 2003, a 48-year-old GP was admitted to the authors' hospital with severe neck pain. He had a 2-week history of progressively worsening neck pain without antecedent trauma or strain. Pain was initially relieved by paracetamol, but progressed to waking him from sleep and became continuous during the day. Physiotherapy and opiates did not alleviate symptoms. Power, sensation and sphincter functions were unaffected. After a further week of unremitting pain, neurosurgical referral was made. A magnetic resonance imaging scan showed an intrinsic spinal cord tumour extending from C3 to C6 level (Figure 1). Urgent laminectomy and resection of tumour was performed. Complete excision was possible as the tumour had not infiltrated into surrounding normal cord. Pathology confirmed intramedullary ependymoma. After a short period in a spinal rehabilitation unit followed by regular outpatient physiotherapy the patient regained full function, resuming work, and was even able to participate in a local relay marathon 2 years later.
Hypoalbuminaemia and colonic polyps: a case of protein-losing enteropathy with cap polyposis?
Authors: Longcroft-Wheaton G , O’Brien J , Woolfe K 
Published: May 2014

A 69-year-old woman was admitted in September 2005 dehydrated and unwell. She had a 6-month history of constipation, poor appetite and weight loss, and was hypoalbuminaemic (21 g/litre). She had initially been referred for colonoscopy in March to exclude colonic malignancy. Multiple pedunculated polyps up to the splenic flexure were seen, with histology felt to be consistent with hyperplastic polyps and mild inflammation. Her symptoms persisted, and by August she had lost 3 stone in weight. She started to experience loose stools, and repeat colonoscopy was planned. However, the bowel preparation made her feel unwell. She couldn't walk, and so presented to the acute medical take. The patient looked pale and dehydrated. Her chest was clear, with a diffusely tender abdomen. Bowel sounds were present, and there were no palpable masses. Bloods showed a corrected calcium of 1.58 mmol/litre. Fluid resuscitation and calcium replacement was started. A malignant process was queried. Liver function tests showed a low albumin of 21 g/litre but were otherwise unremarkable. A computed tomography scan of the abdomen and chest were normal. A gastroscopy showed mild oesophagitis with Candida in the mid and lower oesophagus, gastritis in the antrum of the stomach with heavy Helicobacter pylori growth, and a normal duodenum. Biopsies showed no evidence of coeliac disease or giardia. The patient's albumin fell to 8 g/litre. A 24-hour urine protein collection was 0.46 g, excluding nephrotic syndrome. Nasogastric feeding was commenced. Gut hormones showed a modestly elevated chromogranin A (164 pmol/litre) and gastrin (307 pmol/ litre) but were not diagnostic of a neuroendocrine tumour. Amyloid was queried and the original colonic biopsies re-examined. This was not found, but cap polyposis was suggested. The patient failed to improve and died 15 days after admission. Post mortem found the distal large bowel to contain multiple dark sessile polyps, looking like slugs, on exaggerated mucosal folds (Figure 1). The histological findings comprised elongated, tortorous and distended crypts, with evidence of inflammation and a 'cap' of granulation tissue, confirming cap polyposis. In addition the patient had a right haemothorax. This was caused by a dissection in the pulmonary artery, with evidence of atheroma identified. The right ventricle was hypertrophic, with the lungs showing multiple haemorrhagic infarcts. These changes suggested pulmonary hypertension. Whether this was related to the cap polyposis was unclear. A reasonable explanation is that the patient had showered off pulmonary emboli from a deep vein thrombosis (DVT) for some time, secondary to immobility associated with her poor state of health. This was supported by a right calf DVT identified at post mortem. The dissection of the pulmonary artery was probably secondary to the low protein state and pulmonary artery hypertension.
Too old to exercise? Unusual muscular uptake on 99mTc methylene diphosphonate bone scintigraphy
Authors: Griffiths Grant , Rees John 
Published: May 2014

An 81-year-old man was referred for bone scintigraphy. He had recently been diagnosed with prostatic carcinoma. Images obtained 3 hours after injection of technetium-99m methylene diphosphonate showed no evidence of metastatic bone disease, but symmetrical increased soft tissue uptake was seen extending from the inferior margin of the scapula to the neck of the humerus (Figure 1). This was confirmed on single photon emission computed tomography/computed tomography to lie within the teres major muscles. There was also focal radiotracer uptake within the lower cervical and first thoracic vertebral end plate, secondary to osteoarthritis (as confirmed by single photon emission computed tomography/computed tomography).
Antibiotic use and women in preterm labour
Authors: Peebles Donald 
Published: May 2014

Preterm birth before 32 weeks' gestation is the leading cause of perinatal morbidity and mortality; the incidence appears to be rising and interventions to reduce the trend are urgently needed (Anonymous, 2006). Inflammation appears to be the final common pathway to preterm birth, causing uterine contractions, cervical ripening and rupture of the membranes; increased levels of pro-inflammatory cytokines are found in the myometrium, membranes and amniotic fluid of women in preterm labour and there is an associated influx of inflammatory cells into the uterus (Lindström and Bennett, 2005).