bluuebunny/crossref_metadata_2025_split huggingface dataset:
Counterpulsation in cardiogenic shock: the belief is there but where is the evidence?
Authors: Smith Duncan 
Published: May 2014

In the context of acute myocardial infarction (MI) cardiogenic shock remains a serious complication associated with high mortality. European heart failure guidelines recommend the use of an intra-aortic balloon pump (IABP) as a beneficial adjunct in the supportive management of patients who develop shock following acute MI. Despite the high levels of ‘clinical belief’ in IABP therapy a review of the literature reveals a less than compelling body of evidence to support its use; specifically in reducing 30-day mortality in those treated with percutaneous intervention. Conversely, patients who have received fibrinolytic drug therapy may benefit from the ‘bridging support’ of an IABP, in the absence of immediate and definitive revascularisation. In light of the conflicting evidence surrounding the use of IABP, attention has been drawn to the potential of left ventricular assist devices (LVAD). However, small randomised studies have yet to reveal improved 30-day mortality in patients supported with LVAD compared with IABP, in the context of cardiogenic shock. More critical and individualised consideration is required regarding which patients may benefit from such support systems. This decision-making may be supported by prognostic biomarkers, specifically interleukin-6, which has been correlated with increased mortality in several small cohort studies. Education for nurses surrounding the holistic management of cardiogenic shock and a broader understanding of the complex sequelae is also required.
Screening for diabetic retinopathy in the community
Authors: Vinall Helen , Terry Anne 
Published: May 2014

Diabetes affects approximately 1-2% of the population and diabetic retinopathy is now the leading cause of blindness in the 20-74 age group. This paper outlines the various approaches that can be used to screen for diabetic retinopathy and describes an approach taken in the West Midlands to address the problem through the implementation of community diabetic eye screening. Optometrists received specific training and over 1000 patients have now been screened, with those identified as needing treatment referred to appropriate ophthalmology services. An audit of the clinic demonstrated that optometrists are sensitive screeners of diabetic retinopathy and the project team have identified the critical managerial and operational factors for success, in this and other similar projects.
Nutritional knowledge, dieting, and pattern of exercise in adolescents
Authors: Rabiee Fatemah 
Published: May 2014

A survey of 625 pupils aged 14-15 years was conducted in Birmingham in 1991. The survey was part of a larger study to develop programmes for the promotion of a healthy heart in young people. Nutritional knowledge, attitude to body weight, dieting and pattern of exercise were explored. Of the pupils studied, 7% were overweight and 1% were obese. Although more boys than girls were overweight, the proportion of girls who were currently dieting was significantly higher than boys (11% versus 2%). The proportion of girls claiming to be dieting at the time of the study, or being on a diet at some point in their life (34%), is alarmingly high. Gender, ethnic and social class differences were observed in pupil’s nutritional knowledge, dieting behaviour, body weight and pattern of exercise. Only 52% of pupils followed the recommended level of exercise. This paper will discuss the implications of those findings for nutrition education and school health education programmes.
Development of the Read Code Thesaurus for community nursing
Authors: Thirkettle Barry 
Published: May 2014

Paper-based documentation systems have been found to be time consuming to maintain and do not necessarily support and enhance the care provided by nurses, midwives and health visitors. There is evidence that computerised clinical information systems can improve the quality and completeness of care planning, assessments, evaluations and audits, in addition to improving resource utilisation. An important infrastructural component of the Information Management and Technology Strategy for the NHS in England is the development of a multiprofessional national thesaurus of coded clinical terms, utilising Read Codes for use in computerised clinical information systems. The contribution made by community nurses, midwives and health visitors reflects how their work focuses on prevention, health promotion and health education, involving the whole community. Feedback from real working implementations of the thesaurus in operational clinical information systems is required in order to fully evaluate its comprehensiveness and usability.
A student's of view of creative partnership in action
Authors: Kent Michele 
Published: May 2014

The aim of this paper is to bring a student's perspective to the discussion paper presented by MacLellan in the British Journal of Community Health Nursing (1996:8) and illuminate the issues that the assessment process, by means of a specialist practice profile, has raised for me as a student on the BSc (Hons) course in community nursing. This reflection will be personal, although some aspects may be shared by the peer group. It will also be formative, as any summative evaluation can only take place after July when the degree programme is complete. Also, since one of the factors determining the development of the assessment tool was given in the article as, ‘a plea from service managers that graduates should be ‘fit for purpose’ that is, ready to function as community nurses’ any evaluation programme would have to assess whether this outcome has been achieved.
Anatomy and physiology of pain
Authors: Dobson Fiona 
Published: May 2014

Community nurses have a pivotal role to play in managing pain. Sound knowledge of nervous system structures and physiological mechanisms involved in the perception, transmission and interpretation of pain signals, provides an important background to the decision-making processes underpinning effective pain treatment. Traditional explanations of the mechanisms involved in pain perception focus on a ìhard-wiredî system of specific pain receptors, connecting nerve pathways and centres of interpretation in the thalamus and somatosensory cortex. Whilst this approach offers helpful insights into the subject, recent scientific advances have served to expand and clarify many, previously inadequately explained, aspects of pain perception. Better understanding of primary and secondary hyperalgesia, ìwind-upî and central sensitisation has encouraged the use of pre-emptive balanced analgesic techniques, whilst identification of a whole host of neurochemical transmitters and modulators has potentiated the search for new analgesic agents. Traditional and current explanations of pain perception can enhance community nursesí understanding of acute and persistent pain problems and illustrate how to select pain therapies according to the underlying pathophysiology.
The use of syringe drivers & Hickman lines in the community
Authors: Smith Elaine Coleridge 
Published: May 2014

Caring for patients with life threatening illnesses places great demands on both health care professionals and family members. Community nurses in particular will find themselves caring for these patients while they remain in the community. During this time these patients may be receiving drugs via a syringe or Hickman line. The holistic and family focussed nature of community nursing means that psychological and social implications of the use of such devices can be taken into account, as well as the technical skills necessary to operate and maintain them.
Developing databases to inform service delivery
Authors: Dilloway Mark 
Published: May 2014

Databases offer healthcare professionals at all levels the opportunity of collecting robust data that can inform service development through audit and the commissioning process. Using diabetes as an example, this paper shows how a simple database can be developed and used to collect robust data for the development of services. Taking a random sample of 256 patients attending a weekly diabetes clinic, the data show the distribution of the patients by district of residence and their treatment. These databases benefit from clinical input at the development stage and can be designed to assess adherence to clinical guidelines, process audit and produce information to influence the commissioning process, either with GP fundholder or GP commissioning groups. In addition, they can be used to inform continuing professional development activities. The approach outlined here is a generic one and can be applied to most clinical situations.
Implementing KSF competency testing in primary care. Part 2: evaluation of the pilot of an appraisal tool
Authors: Bentley Jenny , Dandy-Hughes Harlene 
Published: May 2014

Assessment of competence is a way of measuring if staff are fit for purpose. Clinical competences, against which performance is measured, have been developed in a wide range of clinical settings in recent years (Department of Health (DH), 2008). Several trusts also operate an assessment centre in the recruitment and selection of staff, and these frequently involve competency testing in order to be certain that their new recruits are fit for their post. Agenda for Change (DH, 2004a) firmly links pay to the competences expressed in the Knowledge and Skills Framework (DH, 2004b; c) yet the KSF has not been implemented in all trusts. In part 1 of this article (Bentley and Dandy-Hughes, 2010), the process of Southwark PCT’s competency project was described. This involved the process of writing measurable, manageable competences from the KSF, in order to develop staff to be fit for purpose. Part 2 evaluates the use of the appraisal tool that was developed from the KSF, and examines the role of the nurse consultant in education who led the competency project.
Made to measure? Assessing feasibility of quality indicators for district nursing
Authors: Horrocks Sue , Cook Jane , Ashton Nikki , Wye Lesley 
Published: May 2014

Scant empirical information exists regarding the quality of district nursing (DN) services. This article reports the testing of 31 quality indicators (QI) in practice. Method: Twelve DN teams provided patient notes for audit. External auditors completed audit forms by cross-referencing between DN office records, patient notes from home, electronic GP records and discussions with DN team leaders. A patient experience questionnaire was piloted. Findings: 277 (77%) patients’ records were audited. Access to records was problematic. QIs required further refinement of their wording, modification of inclusion criteria, deletion of some QIs and inclusion of others. Telephone administration of the patient experience questionnaire was not feasible for the DN patient population. Conclusions: QIs can not be used ‘off the shelf’ and need testing and modification before routine use. Trained, external auditors with clinical backgrounds ensure an informed, uniform, objective approach to data collection, which is desirable as QIs might inform commissioners in a competitive field in future.
Meeting the needs of the workforce
Authors: Moss Diana 
Published: May 2014

Healthcare assistants wishing to expand their role are able to access primary-care based education centres in order to develop knowledge and skills complementary to the wider workforce modernization of nurses, doctors and other healthcare professions. Primary-care based education centres provide a range of training opportunities; short courses, one-to-one mentorship and supervision, bespoke learning events, PCT-protected learning time activities and resource development. Such centres serve the development needs of the primary care workforce through locally accessible training opportunities. Demand for practice learning experience in primary care from nursing, medical and other healthcare professions is stretching service placement provision. A network of multi-professional learning organizations has potential to capitalize on educator expertise providing development opportunities spanning the primary care workforce
Paediatrics: safeguarding children
Authors: Moores John , Lane Dave 
Published: May 2014

Providing healthcare for children when they are ill, or are in need of some specialist support service in their lives, are times when children are and feel vulnerable. The healthcare assistant (HCA) in such situations is working in an environment where they may have concerns about a child's welfare, or where a child chooses to disclose abuse and/or neglect. Through their daily contact with children, sometimes over a prolonged period of time and because of the personal nature of the care they provide for children, the HCA is often in a position where they get to know the children they are caring for really well. They are therefore in a position to recognize signs of abuse and neglect and observe changes in a child's behaviour and mood. The following article is a brief practice guide to help in the recognition of child abuse and/or neglect and to outline and highlight good practice in dealing and coping with a child's disclosure of abuse and/or neglect.
Caring for people with hypertension
Authors: Peate Ian 
Published: May 2014

Hypertension (high blood pressure) is known to affect at least 37% of the UK population (Primatesta et al, 2001); it can be symptomless until it causes organ damage. The key aim is to detect and treat hypertension prior to any organ damage occurring. There is a glossary at the end of the article which provides definitions of words you may not be familiar with.
Falls part 1: causes and consequences
Authors: Nazarko Linda 
Published: May 2014

Falls are a major health issue for older people. Each year 1.57million older people fall more than three times and 70000 fracture their hips. Falls can lead to disability and even death. The National Service Framework for Older People identified falls prevention as a major health priority. This article is the first in a series which will be of particular interest to healthcare assistants studying for NVQ level three or assistant practitioner qualifications. It explains how ageing affects the risk of falls, how falls affect older people and how to identify those at risk of falls.
Caring for people with appendicitis
Authors: Peate Ian 
Published: May 2014

Appendicitis is a condition that can affect people of all ages, however, it commonly affects and is associated with younger people. Appendicitis can be a difficult complaint to diagnose as it can mimic other diseases such as a urinary tract infection or even some gynaecological conditions. Failure to diagnose and treat appendicitis can result in severe complications and in some cases death. If the healthcare assistant or assistant practitioner is to provide safe and effective care using a holistic approach, understanding the anatomical and pathophysiological issues associated with the appendix and the care and treatment of the person is vital. This article provides an outline of the anatomy and pathophysiological issues associated with the appendix, the signs, symptoms, treatment options and care requirements for the person who has appendicitis. There is a glossary at the end of the article which provides definitions of words you may not be familiar with.
Body fluids: components and disorders of cerebrospinal fluid
Authors: Peate Ian 
Published: May 2014

Cerebrospinal fluid (CSF) is an essential body fluid which protects the brain; it also acts as a shock absorber. Analysis of CSF can help to provide a diagnosis related to a person's central nervous system. Healthcare assistants and assistant practitioners are sometimes involved in caring for a person who has to undergo a lumbar puncture (spinal tap), it is therefore important to have an understanding of the procedure as well as the function and purpose of CSF.
No VAT concession
Authors: Munro Ian 
Published: May 2014

It beggars belief that, in the current climate, the Government has seen fit to continue with the abolishment of the VAT staff hire concession on healthcare assistants (HCAs) and other temporary healthcare staff. At best, this decision compounds the burgeoning financial woes reverberating across all industry sectors. At worst, it has ethical implications for the healthcare industry and, quite frankly, poses a direct threat to the lives of patients and the jobs of healthcare workers. HCAs and support staff account for a significant proportion of the temporary workers within the UK's health and social care sector and play a large part in the direct care of the elderly or infirm. Not only is the part HCAs play in the provision of around-the-clock support underestimated, but the fact that they are fundamental to the function of frontline care is often overlooked.
Palliative and end-of-life care: Bolton's AP foundation course
Authors: Smith Joanne , Brown Trish 
Published: May 2014

There is nothing more certain in life than death. How we as individuals approach this challenging event will be influenced by personal experiences of the care we receive from health and social care providers. To ensure those experiencing the end of life receive a high-quality service, a fully trained and competent workforce is essential to turn the policy rhetoric into practice. Provision of excellence by the workforce is clearly linked to continuing professional development (CPD) and the education of frontline workers. As assistant practitioners (APs) have an important role to play in the provision of end-of-life care, accessing education and training in this aspect of their role is essential. The University of Bolton Foundation Degree in Health and Social Care Programme currently has a cohort of students who are undertaking a two-year foundation degree programme. This cohort of students works in 4 distinct areas—hospice inpatient services; hospice at home; day care services; and nursing homes in the north-west—and these students will specialise in palliative and end-of-life care in their second year. In this article, the first of four, the aim is to discuss provision of palliative and end-of-life care and how the AP will be enabled to access the knowledge and skills required to ensure the diverse and holistic needs of palliative and end-of-life patients are met.
Abertawe Bro Morgannwg UHB and the Open University
Authors: Williams Julie , Hughes Louise , Suffin Majella 
Published: May 2014

Delivery of appropriate education and training is imperative in an ever changing and developing NHS. Professional Development for Health Care Support Workers (HCSWs) is a particular priority in Wales as we look to service change through role redesign and a significant shift from secondary care to community and primary care. Difficulties releasing staff from clinical care cannot be ignored and distance learning and ‘e’ learning becomes increasingly attractive to employers and employees alike. The experience of working with the Open University in Wales (OU), www.open.ac.uk/wales , has proven invaluable in meeting the demands of education, service change and staff support. There has been positive evaluation of the impact of the learning on the professional development and practice of HCSWs.
Integration of APs-using the critical incident technique
Authors: Jones Colin , Waller Caroline 
Published: May 2014

It is unquestioned that the assistant practitioner (AP) is a valuable member of the healthcare team; however, some APs have reported challenges in being accepted into their roles. Using a critical incident technique, a purposive sample of 5 assistant practitioners took part in a study, which explored their experiences of working within a multidisciplinary team. More specifically, the objectives of the study were to identify examples of good practice and also to uncover those areas that could be improved. Four key themes emerged from the data: Being acknowledged; professional put-downs; role ambiguity; expectation boundaries. Despite being small-scale, the study concluded that the integration of the AP role is fraught with challenge. The study also concluded that the critical incident technique is a valuable method when undertaking research in this area.
Increasing skills and confidence in caring conversations: a course
Authors: Dosser Isabel , Smith Tracy 
Published: May 2014

This paper describes a service development in healthcare support workers (HCSWs) across departments in a large Scottish teaching hospital. In any healthcare setting, communication can be complex and challenging. Many healthcare support workers and ward clerks are often the first face seen by patient or family entering the ward. As junior members of the team, this task can appear daunting, particularly as there is limited access to formal training or support. There are also few chances to reflect on practice and develop skills, such as communication. The course was designed to fill this gap and give 15 support workers an opportunity to practise and reflect in a supported manner using patient, staff and family stories as a vehicle for deeper learning. Evaluation of this course, which was highly valued, showed that this was a successful method of encouraging reflection and self-awareness, as a way of improving their communication skills.
Here comes the ‘bloody nurse’
Authors: Ruiz Keith 
Published: May 2014

Keith Ruiz works as a member of a small but dedicated team of staff who provide phlebotomy services to the people of Gibraltar, its visitors and the daily influx of migrant workers. He was nominated by Ian Peate, Head of the School of Health Studies, Gibraltar Health Authority: ‘Observing Keith at work and his interacting with patients and staff demonstrates how dedicated he is to the work he does and the people he provides services to. ‘He goes that extra mile with people, explaining in detail in a language they understand (literally and metaphorically) what is to be done; he makes sure his patients are safe and comfortable before, during and after the procedure. He truly adopts a holistic approach. Keith Ruiz is a skilled, confident, competent, considerate and kind practitioner, respected by patients and staff alike. He has outstanding communication skills and adopts a positive attitude to all he takes on.’
Pathophysiology series 1: iron deficiency anaemia
Authors: Peate Ian , Jones Noleen 
Published: May 2014

This article considers the issue of iron deficiency anaemia. Iron deficiency anaemia is the most common form of anaemia in the UK. This article provides an overview of blood composition and an explanation of a full blood count. There are many reasons why a person may be iron deficient. Some of the causes of iron deficiency anaemia are discussed; in the UK, the most common cause of iron deficiency is menorrhagia (heavy menstrual periods). Other causes include gastrointestinal bleeding, pregnancy and the side effects of certain medications. Tests and investigations required to determine the cause of the anaemia are described, along with the signs and symptoms and the impact the condition can have on the person's health and wellbeing. Treatment options are discussed; treatment is aimed at correcting the anaemia. A glossary of terms is included.
Fostering the spirit of innovation in PCTs
Authors: Ayres Ian , Sang Bob 
Published: May 2014

This article is based on the innovative organisational design work conducted to support the creation of the Nelson and West Merton Primary Care Trust. The project, funded by the NHS Executive, and conducted in co-operation with the King's Fund, sought to test the potential of PCTs as ‘new paradigm’ modern learning organisations, capable of delivering a modernised NHS at a locality level.
Private finance, public headache: the PFI future
Authors: Boyle Sean , Harrison Anthony 
Published: May 2014

The ‘Provocations’ series continues after a summer holiday. Labour came to power in May 1997 and embraced Private Finance Initiative funding with unexpected enthusiasm. This has been done with virtually no consideration of the strategic direction which the NHS is taking, and without clear evidence that better value for money and better design is resulting from the first schemes.