bluuebunny/crossref_metadata_2025_split huggingface dataset:
Audit of referrals for cataract extraction: are they appropriate?
Authors: Tattersall Chris , Sullivan Shona 
Published: May 2014

Aim: To investigate the correlation between community cataract referral information and hospital ophthalmic opinion in order to assess if the referrals for cataract extraction are appropriate. The secondary aim is to identify if any streamlining of the service is indicated. Method: Patients referred from the community with a cataract were assessed with regard to the given referral data against the hospital ophthalmic opinion at their first outpatient assessment. Results: Twenty-three (76.7%) patients referred with cataract were listed for a cataract extraction. The reason for not listing patients was due to lifestyle issues in 86% (n= 7) of cases. There proved to be no association (P = 0.62) between an indication of a compromised lifestyle on the referral letter and being listed for cataract surgery. Conclusion: Community cataract referral data only appears lacking in their consideration of patients’ quality of life, which needs to be clarified prior to a hospital visit – either by better communication with the community optometrists or by contact with the patient. A nurse led service receiving cataract referrals direct from the community is warranted if current practice uses multiple preoperative hospital visits.
Nurses’ knowledge of mouth care practices
Authors: Costello Thomas , Coyne Imelda 
Published: May 2014

Aim: To assess nurses’ knowledge and practices concerning oral care on surgical and medical wards in a district general hospital in Ireland Methods: A survey of all qualified nurses on three medical and three surgical wards was carried out. Two hundred questionnaires were distributed and 50 were returned with 43 of these rendered useable. Results: The majority of nurses (90%) viewed oral care as an important aspect of nursing care. However, nurses lacked adequate knowledge of oral care practices, and experienced problems attending to oral care as a result of time constraints, lack of oral care packs, patients being confused or uncooperative, lack of toothpaste and toothbrush, limited education and low status attached to oral care. Although most nurses (over 70%) had received education on oral care, this was of short duration. Sixty-four per cent did not use an assessment tool to measure the condition of the patients oral cavity, while 73% believed that an assessment tool would be important to measure a baseline of the condition of the patients oral cavity. Conclusion: Although oral care is an essential component of quality nursing care, it appears to be given low priority by some nurses. This study indicates the need for educational updates for qualified nurses, adequate supply of oral care equipment and promotion of formal assessment tools usage in the hospital setting.
Older people and laxative use: comparison between community and long-term care settings
Authors: Cusack Siobhán , Day Mary Rose , Wills Teresa , Coffey Alice 
Published: May 2014

Constipation is a common problem affecting many older people's quality of life. The aim of the study was to describe and compare the frequency of use of laxative medication in Irish adults, aged 65 years and older, from the community and a long-term care setting. Participants (n=207) were part of the Irish ELDERMET project. The project aims to find out how diet and lifestyle influence, and are influenced by, the bacteria in the gut, and how this knowledge can be used to promote health in older Irish people. It has recruited over 450 people, aged 65 and older, and will use the information gathered from the extensive proforma to develop-recommendations, as well as functional foods/functional food ingredients specifically designed to promote and support health in older populations. Data were collected between June 2008 and April 2010 using a survey questionnaire. A quantitative descriptive correlational design was used. Analysis was conducted using PASW Statistics 18.0. Participants in long-term care received a greater number of both laxatives and prescribed medications than community-dwelling participants. Increased polypharmacy was also seen in participants taking laxatives, with participants in long-term care significantly (p<0.001) more likely to take multiple laxatives. Nurses are in a key position to develop proactive approaches to the prevention and treatment of constipation.
Chronic Oedema: Impact and Management
Authors: Todd Marie 
Published: May 2014

Chronic oedema of all causes is thought to be more prevalent than studies have shown. The impact of this chronic condition encompasses many physical, psychological and social domains, many of which are not acknowledged nor addressed. Successful management relies on three factors. The first is early detection and commencement of treatment to prevent complications occurring. The second is an holistic multidimensional approach to address all the associated physical, psychological and social sequellae. Finally, collaboration between specialist and generalist health professionals is essential to ensure the best treatment is delivered in the best healthcare location. To achieve these there needs to be a network of suitably qualified practitioners who are upskilled by robust awareness and education systems, all of which should be supported by stable financial and human resources.
Facilitating nursing and midwifery research
Authors: Nixon Eileen , Young Sarah , Sellick Victoria , Wright Karen 
Published: May 2014

Background: Competing demands on the clinical time of nurses and midwives presents challenges to developing a research active culture. Aim: To engage nurses and midwives in a trust-wide research project. Method: A needs assessment of the local obstacles to participating in research was undertaken and a nursing and midwifery research strategy developed by representatives from clinical, research and academic departments. Following consultation with nursing and midwifery groups, an infection control research project was initiated and participatory workshops established. Findings: In total 50 nurses and midwives contributed to questionnaire design, data collection and analysis. Initial results were discussed at nursing/midwifery forums and presented at a newly formed grand round. Overall there were 573 nursing and midwifery contacts throughout the research process. Conclusions: This approach to facilitating nursing and midwifery research across an NHS trust has enabled large numbers of clinical staff to experience and contribute to a ‘live’ research project.
Facilitating an accelerated experience-based co-design project
Authors: Tollyfield Ruth 
Published: May 2014

This article describes an accelerated experience-based co-design (AEBCD) quality improvement project that was undertaken in an adult critical care setting and the facilitation of that process. In doing so the aim is to encourage other clinical settings to engage with their patients, carers and staff alike and undertake their own quality improvement project. Patient, carer and staff experience and its place in the quality sphere is outlined and the importance of capturing patient, carer and staff feedback established. Experience-based co-design (EBCD) is described along with the recently tested accelerated version of the process. An overview of the project and outline of the organisational tasks and activities undertaken by the facilitator are given. The facilitation of the process and key outcomes are discussed and reflected on. Recommendations for future undertakings of the accelerated process are given and conclusions drawn.
Combining the delivery of the human papillomavirus vaccine and the Td/IPV teenage booster
Authors: Gordon Jenny , Lansley Marilyn , Mitchell Dee 
Published: May 2014

The school nursing service in East Berkshire follows the national immunisation schedule and offers the human papillomavirus vaccine (HPV) to girls aged 12-13 years (year 8). A booster dose of tetanus, diphtheria and polio (Td/IPV) is offered to girls and boys aged 14-15 years (year 10). In the autumn of 2011, the school nursing service offered the HPV vaccine to girls in year 8 and the Td/IPV vaccine to boys and girls in year 8 on the same day. This had a number of important advantages including an improvement in the uptake of both vaccines. There were additional benefits to the school nursing service in terms of cost savings, and to the school such as minimising disruption to classes and the students.
Oral health knowledge, attitudes, and practices among secondary school students
Authors: Khamaiseh Abdullah , ALBashtawy Mohammed 
Published: May 2014

Objectives: To evaluate the oral health knowledge, attitudes, and practices among secondary school students in the Al-Karak Governorate. Method: A cross-sectional school-based study was conducted from February to May 2012. Multi-stage random sampling was used. Six secondary public schools within Al-Karak Directorate were chosen randomly. Data was analysed using SPSS and P value was considered significant at 0.05. Results: The results show that the mean knowledge scores for the secondary school children was 60.8 with a statistically significant difference between male and female students (P<0.05). Nearly three-quarters of them reported that regular visits to the dentist are necessary. In contrast, nearly half of them visited the dentist regularly and nearly one fifth of them would only visit the dentist when they felt pain. Nearly 80% of them brushed their teeth with a toothbrush, and about 35.5% of them brushed their teeth at least twice a day or more. Conclusions: The findings of this study indicate that the mean knowledge score of the school students was poor. A health education programme to be integrated within the school curriculum emphasizing oral health is highly recommended.
Developmental dyspraxia 1: the diagnosis
Authors: Chu Sidney 
Published: May 2014

Developmental dyspraxia is a specific disorder in which an individual presents deficits in the conceptualization and planning of motor acts. There is inconsistency in the use of this diagnostic term. Some professionals use it to describe a child with general motor impairment, others use it more specifically for children whose difficulties in motor execution result from poor praxis, especially in the processes of ideation and motor planning.Clinically, it is important to differentiate the underlying deficits as the treatment for practic dysfunction is different from that for motor execution dysfunction. Part 1 of this article aims at promoting the use of the term to describe a primary dysfunction in the processes of ideation and motor planning. A brief historical perspective of the condition, the concept of praxis and dyspraxia, and issues of diagnosis will be presented. Part 2 will address issues related to evaluation and treatment.
Running a community clinical trial: lessons from the CAMELOT project
Authors: Stewart S , Lloyd-Smith W , Poland F 
Published: May 2014

It is now well understood that rigorously conducted research is required to provide evidence of efficacy in the interventions of the therapy professions. However, undertaking or participating in research in clinical areas can pose problems for both clinicians and researchers. This article identifies some of the issues that challenged the successful completion of the CAMELOT project and the lessons learnt from running such a randomized, controlled trial in the community. Key findings included the need for early involvement and good communication and cooperation between clinicians and research teams. Particular attention needed to be given to optimizing informal as well as formal strategies for sharing information at the grass roots in the research setting. The development of trust with participants, collaborators and the wider health- and social-care provider network is essential if researchers are to complete projects.
What is the evidence for the effectiveness of postural management?
Authors: Farley Robert , Clark Janice , Davidson Claire , Evans Gail , Maclennan Kate , Michael Shona , Morrow Marina , Thorpe Sarah 
Published: May 2014

Postural management is assumed to be a valid and necessary strategy in the care of individuals with neuromuscular disorders who may be at risk of developing musculoskeletal deformity. To date, the evidence base for postural management remains relatively unexplored. This article reviews 150 articles that relate to the evidence for postural management in some common clinical conditions. The work was undertaken by members of the Scottish Seating and Wheelchair Group. The sample of literature was graded according to Sackett’s levels of evidence, which describe on a scale of one to five the scientific rigour of each study. The areas explored were physiological function, neonates and children under 5 years of age, progressive neuromuscular disorders, cerebral palsy, activities of daily living, older people, neuromuscular scoliosis and neurological disorders. The reliability and distribution of this evidence for postural management is discussed.
The integration of disabled children into mainstream education in Belarus
Authors: Varenova Tamara 
Published: May 2014

This article describes the development of the integration of children with different kinds of disabilities into mainstream education. The idea of integration, which was suggested and substantiated by the Belarusian-born psychologist Lev Vygotski (1896–1934), was recognized in western European schools and in the USA and has only recently started actively developing in Russia and in Belarus, the former Soviet Union. However, the concept of integrated education remains an object of controversial discussion. Mainstream education has its positive and negative features. It is not clear enough whether criteria such as social status, academic success and level of skills can provide the evidence that integrated education is or is not effective. This article gives an insight into the integrative education system in Belarus. It describes the current situation of the use of special education and attitudes towards disabled children, and the professional training of educators who work with these children.
Supporting nurse endoscopists in practice
Authors: Fretwell Ian A 
Published: May 2014

There is no shortage of topics on which to write an editorial there is so much going on! The options for this piece included: ▪ The regional nurse role for the Bowel Cancer Screening Programme (East Midlands) and the Joint Advisory Group on Gastrointestinal Endoscopy (JAG) accreditation of endoscopy units ▪Issues from my role as Association of Coloproctology for Great Britain and Ireland (ACPGBI) Nurse Forum Chair; specifically, the Department of Health (DH) consultation paper, Arrangements under Part IX of the Drug Tariff for the provision of stoma and incontinence appliances −and related services − to primary care: revised proposals: consultation document (DH, 2007) ▪The work of the National Endoscopy Training Programme 2007 nurse survey: the National Nurse Endoscopy Project.
A case of ocular myasthenia gravis and Miller-Fisher syndrome
Authors: Mak W , Chan KH , Ho SL 
Published: May 2014

A40-year-old Chinese man with myasthenia gravis presented to the emergency department with worsening of ocular symptoms and the authors were asked for an opinion. He first presented 7 years ago with diplopia and ptosis that were responsive to edrophonium. His acetylcholine receptor antibody titre was elevated at 0.8 optical density unit (ODU) (laboratory reference <0.43 ODU), although repetitive nerve stimulation study did not produce a significant motor potential decrement. He improved with regular pyridostigmine (40 mg three times a day) but there was still mild ptosis and limited abduction of his left eye. His condition did not change in the last few years. For the current presentation, he had progressive deterioration of ocular movements over 1 week. Physical examination showed complete ophthalmoplegia bilaterally, partial ptosis of the left eye and absent pupillary light reflex in the right. Intravenous edrophonium 10 mg produced minimal improvement in right eye abduction. On further questioning, he also complained of numbness of his extremities, difficulties in fine hand functions, and unsteadiness while walking. He recalled a flu-like illness 2 weeks before the neurological symptoms. All his tendon reflexes were unobtainable and he had an ataxic gait. There was no demonstrable limb or facial weakness. Cerebrospinal fluid analysis showed increased protein concentration at 1.33 g/litre (reference range 0.12–0.6 g/litre) with total cell count of <1×106/litre. Anti-GQ1b antibody level was elevated at 43 enzyme immunoassay (EIA) Units (reference range <10 EIA). Nerve conduction studies only showed marginal reduction of F-wave persistence in the upper limbs. Magnetic resonance imaging of his brain revealed no abnormalities. Miller-Fisher syndrome (MFS) was diagnosed. He was treated with three sessions of plasmapheresis. His symptoms started to improve over the next week and he subsequently made a full clinical recovery. Moreover, he was completely free from his myasthenia gravis-related ophthalmoplegia in the following 2 months. Pyridostigmine was later recommenced when his baseline symptoms returned.
Intrapulmonary shunting and hepatopulmonary syndrome
Authors: Cannon John , Usmani Omar , Chambers John , Thompson Richard P , Twort Charles 
Published: May 2014

A57-year-old woman was referred for assessment of progressive dyspnoea, decreasing exercise tolerance and worsening bluish facial discolouration. She had congenital cirrhosis complicated by portal hypertension aged 4 years, for which she underwent a portacaval shunt. She was an exsmoker of 30 years. On examination, she was centrally cyanosed and clubbed. Her jugular venous pressure was not elevated, cardiac examination was normal and there were no focal chest signs. Spider naevi were noted, but no palpable organomegaly or ascites. Her oxygen saturation, however, was 88% breathing room air, which did not alter when recumbent or supine. A chest radiograph showed normal lung fields and vasculature, and no effusions. Renal and liver profile blood tests and international normalized ratio were normal. Arterial blood gas analysis revealed: pH 7.43 (normal 7.35–7.45), Pa∘2 7.21 kPa (normal >10.6 kPa), PaC∘2 3.96 kPa (normal 4.6–6.0 kPa) breathing room air. Her AaPa∘2 was 7.8 kPa (predicted agecorrected AaPa∘2 2.10 kPa). Pa∘2 increased to 69.8 kPa breathing 100% inspired oxygen delivered using continuous positive airway pressure. Her calculated intrapulmonary shunt fraction was 7% (normal <5%). Pulmonary function tests showed normal spirometry and preserved lung volumes, however, carbon monoxide diffusing capacity was only 38% predicted, adjusted for haemoglobin 17.8 g/dl. Transthoracic echocardiography demonstrated normal structure and function of all cardiac chambers. Contrast echocardiography established the presence of intrapulmonary shunting (Figure 1) and confirmed the diagnosis of hepatopulmonary syndrome. She was established on long-term oxygen therapy and is currently under consideration for a liver transplant.
Spontaneous intracranial hypotension
Authors: Nour EM , Charles TJ , White RP 
Published: May 2014

A 47-year-old woman presented with a 4-week history of headaches. These were present from waking, and the preceding night's sleep had been disturbed by a sudden popping sensation associated with tinnitus. She described pounding frontal headaches on sitting or standing which were associated with nausea and vomiting, but relieved with bed rest. She had a past history of migraine without aura, which were qualitatively different, lacking a postural component associated with sensory sensitivity (photophobia and phonophobia). There was no history of trauma. Detailed neurological examination was normal. There was no evidence of nasal or auditory meatal CSF leakage. Magnetic resonance imaging of brain demonstrated bilateral subdural effusions and there was diffuse enhancement of the pachymeninges following gadolinium (Figures 1 and 2). Magnetic resonance imaging (MRI) of cervical spine showed a small extradural collection of CSF density at the level of C6. The patient was treated with bed rest and intravenous caffeine sodium benzoate (500 mg). Her headaches reduced in severity post caffeine such that she was able to sit and mobilize. Caffeine gave immediate but temporary benefit. Her headaches resolved completely over a further 4 weeks and a repeat MRI showed resolution of her collections and gadolinium enhancement. At 6-month review she remains free of postural headache.
An unusual case of cardiomyopathy
Authors: Miller Christopher A , G Williams Simon 
Published: May 2014

A 56-year-old man presented with a 3-week history of worsening dyspnoea and lethargy. Clinical examination revealed signs of marked congestive cardiac failure and hypotension with a systolic blood pressure (BP) of 70 mmHg. Laboratory investigations revealed a urea of 29 mmol/litre and a creatinine of 310 μmol/litre with normal liver function tests, apart from a bilirubin of 40 μmol/litre. Initial treatment included oxygen, intravenous diuretics and ionotropes although his BP remained low. Subsequently, an intra-aortic balloon pump (IABP) was inserted with 1:1 augmentation and his clinical picture improved gradually. Cardiac catheterization was performed which showed normal coronary arteries and high right-sided heart pressures with a right ventricular pressure of 58/14 mmHg, pulmonary artery pressure of 58/28 mmHg, and a mean pulmonary capillary wedge pressure of 29 mmHg. His electrocardiogram (ECG) 1 year before his current admission is shown in Figure 1. This revealed an atrial tachycardia with a cycle length of approximately 320 ms with upright P waves in lead V1 and inverted P waves in the inferior leads. There was a left bundle–branch block morphology with a QRS duration of around 100 ms and relatively high degree atrioventricular block with a ventricular rate of around 60–70 beats per minute. He had initially presented 5 years earlier in congestive cardiac failure. ECG at that time showed first degree heart block with a QRS duration of 100 ms. Transthoracic echocardiography revealed a dilated left ventricle at 6.1 cm in diastole and a left ventricular ejection fraction <20%. Viral serology at the time was negative, he did not drink alcohol and did not suffer from ischaemic heart disease. His only other medical history consisted of hypothyroidism for which he was treated with thyroxine. His brother had died at the age of 44 years suffering from liver cirrhosis, diabetes and heart failure, which raised the question of hereditary haemochromatosis (HHC). The diagnosis of HHC was confirmed by HLA testing showing he was homozygous for the C282Y mutation of the responsible gene, a raised serum ferritin at 900 mg/litre and a liver biopsy in keeping with HHC (increased iron deposition in the liver cells but with normal acinar architecture and no inflammation or cirrhosis). After stabilization with an IABP, his treatment options for cardiogenic shock included either insertion of a left ventricular assist device to improve BP and renal function or cardiac transplantation. Unfortunately the patient became septic from his IABP insertion site and so neither were viable options. He died shortly afterwards.