bluuebunny/crossref_metadata_2025_split huggingface dataset:
Personal Medical Services pilots: two years on
Authors: Jenkins Clare , Lewis Richard , Gillam Steve 
Published: May 2014

Last year in the British Journal of Health Care Management, we published an article looking at early learning from a local evaluation of four London Personal Medical Services pilots (Jenkins, Lewis, & Gillam 1999). We now return to examine how these pilots are now faring in their third year of operation. How far have they achieved the aims and objectives set for them of improving accessibility, initiating new roles and increasing skill-mix?
‘Mind the gap!’ Managing across boundaries
Authors: Hunter David J , Kernick David 
Published: May 2014

Based on Professor Hunter's speech to the IHM Conference in Belfast in October 2001, this article examines the distance between the desirable theory and difficult realities of collaborative working. A commentary follows from Dr David Kernick, an advocate of a postmodern approach to managing health care, in which he considers Professor Hunter's views in the light of relevant critical theory.
Adverse events or patterns of failure?
Authors: Higgins Joan 
Published: May 2014

Why do organisations set up to protect sick and vulnerable people sometimes do them harm? We now have a mass of data, from a series of Enquiry Reports, which illustrates that there are typically 6 conditions present when serious failures of care take place in the NHS. This article suggests that it may be misleading to refer to them as ‘adverse events’ or ‘untoward incidents’ when clear patterns of failure can be identified.
Clinical directorates: stakeholders’ knowledge
Authors: Dunnion Mary , Dunne Elizabeth A 
Published: May 2014

Achieving the goal of clinicians-in-management operationalised in the ‘clinical directorate’ structure, requires a more systematic, research-based approach to change than is usual in health care management. We describe the pre-intervention knowledge and expectations of clinical directorates of representatives of the professions most affected by the move to a directorate structure, and note key issues that can impact on its successful introduction.
Care closer to home: aspirations and delivery
Authors: Nazarko Linda 
Published: May 2014

Although successive governments have aspired to provide care closer to home there's still a gap between aspiration and delivery. In their report the Audit Commission produced a report that stated ‘PCTs made little or no in-road in 2008/09 to transferring care from hospitals into the community.’ ( Audit Commission, 2009 ). This article analyses the reasons why intermediate care services are not being fully utilised and sets out the case for increased investment in intermediate care services.
Nurses' views about caring for patients receiving botulinum toxin type A for focal spasticity
Authors: Curtis Elizabeth A , Tracey Catherine 
Published: May 2014

Background Few research studies have explored the role of nurses in caring for patients receiving botulinum toxin type A (BTX-A) injections for focal spasticity. This lack of research provided the impetus for the present study, which was carried out in a rehabilitation centre. Aim The aim of the study was to explore and describe nurses' views about their role in caring for patients treated with BTX-A for focal spasticity. Design A qualitative descriptive design was used. Methods Data were collected using focus groups, and volunteer sampling was used to recruit 12 nurses who met the inclusion criteria. Results Thematic analysis illustrated that although the participants felt nurses play an important part in caring for patients receiving BTX-A treatment, clarification is required on the role of the nurse, the efficacy of the nursing role, and the education and training required. Conclusion Although the literature has reported that nurses have an important role in the multidisciplinary team caring for patients receiving BTX-A treatment, it has not specifically identified what that role is. In this study, nurses reported that, although they feel they have an important role in caring for these patients, there is ambiguity about the specifics of that role. Furthermore, the participants felt that further education and training were important for preparing nurses to care for these patients adequately. Relevance to clinical practice In view of the relative newness of BTX-A in the treatment of focal spasticity and the paucity of research about the role of the nurse in caring for patients, the findings from this study make a contribution to evidence-based practice by raising awareness about the role of the nurse.
Caring for the newborn: infant nutrition part 1
Authors: Venter Carina , Dean Tara 
Published: May 2014

This article is part 1 of an overview of infant nutrition. It discusses government and European Union advice, as well as the specific nutrients contained in breast milk and breast milk substitutes. Essentially breastfeeding should be recommended to all infants for at least the first six months of life and continued for as long as the mother wishes. Breastfeeding women and breastfed infants over six months should be advised to take a vitamin D supplement. Weaning should not begin before six months, but at least not before four months. Breast milk is the ideal source of nutrition for infants because of its immunomodulatory components and its nutritional profile. If mothers choose not to breastfeed, cannot breastfeed or need to use a top-up feed, ordinary cows' milk should not be used for a number of reasons. Cows' milk based infant formula is the only suitable alternative. Midwives should be well informed regarding the benefits of breast milk and how the different formulas compare to breast milk and to each other. This will enable them to convey up-to-date information to pregnant women/mothers. Part 2 will discuss allergy prevention in small babies.
Developing a bid proposal to advertise school nursing services
Authors: Pearson Natalie 
Published: May 2014

‘As a practising school nurse facilitating a specialist practice mentor role, I have the opportunity to review assignments, research and audits on a regular basis. I felt that the piece of work below had to be shared with the wider professional community as an example of good practice. I would encourage all child and adolescent professionals/students to share any research completed as the information may influence and inform care delivered to all children and young people.’
Education-based support for self-harming adolescents 2
Authors: Norman Amanda 
Published: May 2014

This article is based on the author’s research dissertation for an MA in Interprofessional Healthcare Education. It is the second of two parts looking at educational support systems for young people experiencing self-harm. The first article focused on the rationale behind the study, its context in relation to practice, and its aims as well as its value to current school nursing and educational-based support for young people experiencing emotional difficulties. This article concentrates on the review’s findings, providing insight into how these can be used in practice to best support young people, and highlights areas for future research.
Supporting children with nocturnal enuresis
Authors: Norfolk Sally , Wootton Janet 
Published: May 2014

Nocturnal enuresis can have a serious impact on a child’s self-esteem and emotional wellbeing. It is therefore important that school nurses are able to provide adequate support and information on the management of the condition to the child and his/her family. This article aims to provide an overview of the condition, its assessment, and management.
A qualitative study of headache in school children
Authors: Kernick David , Reinhold Deborah , Stone Christine 
Published: May 2014

Background: Despite a high prevalence and substantial impact of headache, the needs of young sufferers often remain unmet. The aim of this paper is to describe a qualitative investigation by lay researchers (school students), which explores the experience of fellow students with troublesome headache and provides information to help reduce the burden of headache in the school setting. Method: A purposeful sample participated in semi-structured interviews undertaken by students and taped for thematic analysis by students and professional researchers. The setting was a large state secondary school in Exeter, UK. Results: Four themes were identified: health seeking behaviour, emotional response to headache, attitude of others towards the problem and ideas for help. Conclusion: Useful insights can be obtained from developing a research team of patients and professional researchers. A number of children suffer with headache at school, do not get help and in general are fatalistic about their problem. An awareness of the impact of headache in schools is important and simple measures are available that could help reduce its effects. Further qualitative work is needed with teachers, school nurses and parents to reduce the burden of headache in this setting.
Diabetes in children and young people: Type 1, where are we now?
Authors: Mullier Caroline 
Published: May 2014

This article, the first of a short series on diabetes, provides an overview of diabetes in children and young people looking at the prevalence, signs and symptoms, diagnosis and treatment, targets and the support needed in order to help meet these. School nurses can play an important role in supporting children and young people with diabetes and it is important that they have a good understanding of the condition and work together with paediatric diabetes specialist teams to improve outcomes.
Developing effective public health nursing practice: The nurse educator's role
Authors: Klinkhamer Frits 
Published: May 2014

With governmental and organisational drives to improve quality and outcomes, developing and assessing staff competence is essential. Current school nursing workforce complexities, including differing skills and qualifications and an increased use of non-nursing staff, pose challenges to the delivery of effective public health nursing interventions. Because the workforce operates predominantly unsupervised, mainly in the school setting, organisations may be unclear as to the quality of care being delivered. The nurse educator could play an important role in public health nursing by helping to remedy these issues. The nurse educator has an in-depth understanding of teaching and learning processes, including andragogy, learning styles and theories. Nurse educators can also act as leaders and change agents, and have the scope to work alongside staff in the clinical setting to develop, support and assess clinical practice using competency frameworks and creating a learning environment. Ultimately the use of nurse educators could help provider organisations remain the service of choice by offering quality public health-care in today's competitive landscape.
Traumatic brain injury in children part 1—initial assessment and management
Authors: Braine Mary E , Smith Joanna 
Published: May 2014

Traumatic Brain Injury (TBI) as a result of road traffic accident or falls is the leading causes of death or disability in children. Children and young people frequency access health services as a result of a TBI. Consequently many nurses working with children and young people, in both primary and secondary care settings will care for a child following a TBI and have a role to play in accident prevention. Understanding the initial stabilisation of a child who has sustained a TBI, and the principles of pre-hospital management are essential to ensure optimal care of the child and family. This article provides an overview of TBI and its management in children and the key role of primary care practitioners in relation to the identification of TBI and accident prevention.
Working with people who have HIV and AIDS: a health professional's guide
Authors: Thomas Joanne , McArthur Margaret 
Published: May 2014

The incidence of HIV and AIDS continues to rise internationally. Advances in treatment have decreased mortality and increased life expectancy for people with a positive diagnosis. This article details the epidemiology of HIV and AIDS and, while highlighting the low transmission risk to therapists, outlines the precautions that health-care professionals should take when dealing with body fluids of patients. The authors advise on how therapists should sensitively treat patients with HIV or AIDS, covering important ethical and confidentiality issues.
The Lomax Active wheelchair range: intermediate provision for clients with spinal injury
Authors: J Linley Emma 
Published: May 2014

The author was asked to share her experience of the Lomax Active wheelchair range, in relation to working within the specific field of spinal cord injury. From clinical experience, it is the author's opinion that, on returning home from initial rehabilitation, the majority of this client group benefits from a relatively high specification wheelchair that allows them to maintain as independent a lifestyle as possible. Such provision allows clients to optimize their potential and promotes reintegration into the community, while allowing the clients to identify their long-term wheelchair specification requirements.
An assessment of the Quickie Classic range of lightweight wheelchairs
Authors: Collins Fiona 
Published: May 2014

Selecting a wheelchair to meet the needs of individual users involves a number of considerations, such as the diagnosis or disability of the person, his or her projected long-term needs and his or her functional ability, size and sitting ability. Many of the current NHS wheelchairs are heavy and cumbersome and in some instances limit the user’s ability to remain independent. Many clients are provided with or purchase a lightweight wheelchair. However, at the budget end of the market, the wheelchairs available offer limited adjustability to meet the changing needs of the user. The Quickie Classic range of lightweight wheelchairs offers a wide range of adjustment, allowing users to purchase a highly adjustable chair at a modest price.
Optimizing knee arthroscopy documentation using a new template
Authors: Al-Dadah Khalid , Evans Owain , Ali Fazal 
Published: May 2014

Introduction: The purpose of the study was to assess the quality of documentation of knee arthroscopy and evaluate the implementation of a novel operative template. Method: A 34-point assessment was undertaken based on published national guidelines. A retrospective study of 50 operative notes of patients (group A) undergoing knee arthroscopy was completed. A new operative note template was devised to include important criteria and assessed in 49 patients (group B) for its efficacy in providing appropriately detailed findings. Results: Group A was lacking the minimum essential documentation standards expected. Some essential criteria for arthroscopic procedures were as low as 4%. Group B showed a statistically significant increase (P<0.001) in documentation accuracy throughout the essential criteria compared to the findings in group A. Conclusions: The authors conclude that the use of an evidence-based operative template for knee arthroscopy significantly improves the quality and accuracy of documentation compared to conventional free-hand operative notes.
Unusual severe hypercholesterolaemia and xanthomas in a patient with hepatolithiasis
Authors: Chou Shuo-Chi , Chen Kwang-Wen , Lin Jen-Der , Hwang Tsann-Long 
Published: May 2014

A 47-year-old woman had undergone cholecystectomy for gallstones in December 1994 at a local hospital. In December 1995 she presented at the surgical outpatient department with intermittent right upper quadrant pain. Laboratory studies revealed serum albumin 4.3 g/dl (normal 3.5–5.3 g/dl), total cholesterol 307 mg/dl (normal <200 mg/dl), total bilirubin 1.8 mg/dl (normal 0.0–1.3 mg/dl), alkaline phosphatase 602 U/litre (normal 28–94 U/litre), aspartate aminotransferase (AST) 129 U/litre (normal 0–34 U/litre), and alanine aminotransferase (ALT) 196 U/litre (normal 0–36 U/litre). Liver sonography revealed multiple stones in dilated intrahepatic and common hepatic ducts. However, the patient did not receive further studies of her hepatolithiasis at that time. The patient underwent percutaneous transhepatic cholangiostomy drainage for intrahepatic stones and jaundice in a medical centre in January 1998. In February 1998 she was transferred to the surgical department because of persistent jaundice. Physical examination revealed that the woman was markedly icteric, with an old scar on the right upper abdominal wall, and no xanthoma was found on the body. Laboratory results included that serum albumin was 4.1 g/dl, total cholesterol was 256 mg/dl, total bilirubin was 12 mg/dl, alkaline phosphatase was 512 U/litre, AST was 101 U/litre and ALT was 100 U/litre. Cholangiogram showed a dilated biliary tree with multiple stones in intrahepatic ducts, common hepatic ducts and the common bile duct. The patient underwent choledocholithotomy with choledochojejunostomy, Roux-en-Y jejunojejunostomy, and a T-tube drainage in the common bile duct in February 1998. The liver biopsy displayed cholestasis and no cirrhotic change. Following surgery the woman was regularly followed up in the outpatient department and intrahepatic stones were removed intermittently via a T-tube. Cholangitis was noted during follow-up, and the patient received five 7-day courses of amoxicillin 1000 mg/day in divided doses from September 1998 to February 1999. The jaundice was persistent during follow up, and painful xanthomas developed on both hands and elbows in February 1999, particularly on the palmar side (Figure 1). Laboratory tests revealed significantly raised serum total cholesterol, total bilirubin, and alkaline phosphatase levels (Figure 2). Lipoprotein electrophoresis displayed that total cholesterol was 1046 mg/dl, β-lipoprotein (low-density lipoprotein) was 72.6% (normal 36–61%), pre-β-lipoprotein (very low-density lipoprotein) was 15.7% (normal 2–30%), and α-lipoprotein (high-density lipoprotein) was 11.7% (normal 22–48%). Subsequently, the patient received no more amoxicillin, and the xanthomas gradually regressed. Total regression of hypercholesterolaemia and xanthomas was achieved in November 2000, at which point total serum cholesterol was 200 mg/dl, total bilirubin was 12 mg/dl, and alkaline phosphatase was 676 U/litre.
Unfolding spirituality: Working with and beyond definitions
Authors: Collins Mick 
Published: May 2014

Spirituality is undergoing a revival in relation to clinical practice across many health disciplines and is an emerging area of clinical practice. Currently, there is no consensus that reflects a coherent understanding of what spirituality means across different health professions. It is being proposed in this article that health professionals use definitions for spirituality cautiously, until an adequate understanding of the connection between health and spirituality has been addressed. It is suggested that a working definition for spirituality in health-care practice should emerge from research that considers a client's spiritual need, experience and journey. The emphasis of this article is to consider how spirituality can unfold in a health-care context.
Audit of use of a common undergraduate physiotherapy clinical assessment form
Authors: Morris J 
Published: May 2014

Assessment of student performance in clinical settings is common practice in healthcare education. As part of quality procedures, a three-part audit was undertaken of the use of a common undergraduate physiotherapy clinical education assessment form. Part one involved comparative statistical analysis of the marks awarded to students from the four participating institutions in relation to five variables – student age, gender, race, level of study, and clinical speciality. Significant differences were found for some variables. In Part two, the final marks and clinicians' comments were compared. Content analysis identified perceived differences in some forms. Part three involved clinician completion of a postal questionnaire survey of how they used and completed the form. Appropriate use of the form was found for the vast majority of respondents. Overall, the audit found the form to be a useful, sensitive tool. Recommendations were made for small improvements in form detail and specific focus areas during clinician educator training.
Involving people with spinal cord injuries in the education of rehabilitation professionals
Authors: Kroll Thilo , Neri Melinda T , Groah Suzanne L , Gilmore Brenda , Elrod Matthew W , Libin Alexander 
Published: May 2014

The Consumer Professional Partnership Programme (CPPP) was developed to increase service user participation of people with spinal cord injury in the education of rehabilitation professionals. The programme seeks to inform physiotherapists and other rehabilitation professionals about disability and health issues from the perspective of individuals with spinal cord injury. This article discusses its development, describes the details and rational behind the programme and reports on first experiences of rehabilitation professionsals using the programme.
Flexor retinaculum division: does it contribute to the success of carpal tunnel release?
Authors: Krieger Yuval , Moses Avia , Silberstein Eldad , Weitzman Shimon , Liberman Naftali , Sagi Amiram 
Published: May 2014

Yuval Krieger, Avia Moses, Eldad Silberstein, Shimon Weitzman, Naftali Liberman, Amiram Sagi Aims: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. Open decompression of the median nerve is considered the standard surgical treatment for CTS. This article describes a study to assess and compare the clinical efficacy of operative treatment performed by transverse carpal ligament release alone (limited carpel tunnel release (CTR)), to that achieved after transverse carpal ligament release with additional division of the proximal portion of the flexor retinaculum (extended CTR) which is continuous with the deep investing fascia of the forearm. Methods: A retrospective cohort study was performed by telephone interview, using a modified Levine scale to assess symptoms and functional impairment 4–7 years post-operatively in two patient groups who were operated using two different techniques, over a two year period. One group (N = 73) had open CTR by limited transverse carpal ligament division alone, performed by one hand surgeon; the second group (N = 83) had open CTR by division of the transverse carpal ligament and the proximal portion of the flexor retinaculum, performed by another hand surgeon. Findings: Pre-operatively the two groups were similar, both in terms of patient characteristics and of disease severity. Both groups improved significantly. No clinical difference was demonstrated in terms of symptom relief, recurrence or complication rate. Conclusions: This study suggests that adjunctive division of the proximal portion of the flexor retinaculum, although safe, offers no advantage over division of the transverse carpal ligament alone in standard open carpal tunnel release.