Pain assessment in the older population: what the literature says.

Assessment of pain in the older adult presents a number of challenges, especially related to communication. This commentary summarises the revised evidence-based Guidelines on the Assessment of Pain in Older Adults which have been developed by the British Pain Society and British Geriatrics Society. The guideline summarises the pain assessment tools that have been developed and validated for use in the older population.

The development and implementation of the structured training programme for caregivers of inpatients after stroke (TRACS) intervention: the London Stroke Carers Training Course.

Objective: To describe the content and delivery of the adapted London Stroke Carers Training Course intervention evaluated in the Training Caregivers after Stroke (TRACS) trial.

Setting: The London Stroke Carers Training Course is a structured training programme for caregivers of inpatients who are likely to return home after their stroke. The course was delivered by members of the multidisciplinary team while the patient was in the stroke unit with one recommended 'follow through' session after discharge home.

Management of complications after laparoscopic Nissen's fundoplication: a surgeon's perspective.

Introduction: Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countries, and the interest in the minimal access surgical approaches to treat GORD is increasing. In this study, we would like to discuss the presentations and management of complications we encountered after Laparoscopic Nissen's fundoplication in our District General NHS Hospital. The aim is to recognise these complications at the earliest stage for effective management to minimise the morbidity and mortality.

Contralateral incipient posterior canal benign positional paroxysmal vertigo: complication after Epley maneuver.

Background: Particle repositioning procedures give consistent results for the treatment of benign positional paroxysmal vertigo (BPPV). However, little consideration has been given to the possibilities of bilateral disease.

Objective/hypothesis: To report contralateral symptoms and signs suggestive of revealed or incipient BPPV as a complication of Epley maneuver.

Welfare benefit promotion within a district general hospital rheumatology centre: a joint project with the local Citizens Advice Bureau.

Objectives: The Health Assessment Questionnaire (HAQ), used in arthritis provides an overall disability index and has been used previously to indicate those patients with arthritis who may be eligible for welfare benefits such as Attendance Allowance (AA) or Disability Living Allowance (DLA) (Langley et al., 2004, Memel et al., 2002, Powell et al.

An assessment of the validity of tympanometry compared to myringotomy performed under a nitrous oxide-free general anaesthetic.

To assess the validity of tympanometry as a test for the presence of middle ear effusion using a 'gold-standard' of myringotomy performed after a nitrous oxide-free general anaesthetic, we performed a prospective validity study comparing tympanometry traces obtained immediately pre-operatively from patients undergoing grommet insertion, with the otomicroscopic findings at myringotomy. Nitrous oxide was omitted from the anaesthetic gaseous mixture as it has been reported to displace middle ear effusions. One hundred and seventy-two patients (aged 1.

Intraocular lens power calculation in short eyes.

Purpose: To compare the accuracy of the Hoffer Q and SRK-T formulae in eyes below 22 mm in axial length, using biometry measured with partial coherence inferometry (PCI), without a customised ACD constant.

Methods: Data were retrospectively and prospectively collected by identifying eyes of axial length below 22 mm in the records of the intraocular lens (IOL) master and in preoperative notes. Biometry was performed using PCI and IOL power was calculated using both SRK-T and Hoffer Q formulae.

Implications of the new curriculum for medical trainers.

The increasing complexity of the role of trainer, highlighted in the expectations of the Modernising Medical Careers curriculum, currently out for consultation, exposes inadequacies in the current system. Changes in the supervisory structure are required and further training is essential if consultants are to fulfil this role adequately.

Introduction of nurse led DC cardioversion service in day surgery unit: prospective audit.

Problem: Atrial fibrillation is the most common persistent arrhythmia in adults and carries an increased risk of thromboembolism and stroke. Electrical (DC) cardioversion is an effective treatment, but logistical difficulties in many institutions lead to problems providing a prompt service. This reduces the rate of long term success, delays relief of symptoms, and increases the burden on anticoagulation clinics.

Proximal interphalangeal joint release in Dupuytren's disease of the little finger.

We present a prospective study, with 3-year follow-up, of the role and outcome of fasciectomy plus sequential surgical release of structures of the proximal interphalangeal joint in Dupuytren's contracture of the little finger. Our treatment programme involves fasciectomy for all patients followed by sequential release of the accessory collateral ligament and volar plate as necessary. Of the 19 fingers in the study, eight achieved a full correction by fasciectomy alone, and in these cases there was a fixed flexion deformity of 6 degrees at 3 months and 8 degrees at 3 years.

A randomized controlled trial of an enhanced balance training program to improve mobility and reduce falls in elderly patients.

Objectives: To evaluate the effectiveness of an enhanced balance training program in improving mobility and well-being of elderly people with balance problems.

Design: Prospective, single-blind, randomized, controlled trial.

Setting: District general hospital.

Use of antithrombotic measures for stroke prevention in atrial fibrillation.

Objective: To evaluate appropriateness of antithrombotic use to prevent stroke in atrial fibrillation.

Design, Patients: 344 patients with atrial fibrillation, stratified by age, were assessed clinically for contraindications to anticoagulation and stroke risk. The use of warfarin and aspirin was compared with recommendations for anticoagulation derived from pooled clinical trial data.

Measuring fatigue in patients with cancer.

Our current state of knowledge of the fatigue experienced by patients with cancer is limited, and further development is hampered by the definitions of fatigue, which remain numerous, inconsistent, and varied according to the discipline of the author and the nature of the research. It is fairly well established within the healthcare literature that it is multidimensional in nature. This has implications for the reliable and valid assessment of this phenomenon.

Fatigue in patients receiving chemotherapy: patterns of change.

Fatigue is reported to be a significant and distressing problem for people receiving chemotherapy, but the phenomenon is poorly understood and little is known about the factors influencing it. Nurses need to understand the dimensions of fatigue in order to provide effective help for individuals with cancer who experience it. This article describes a study that employed a daily diary with the aim of prospectively charting the onset, pattern, duration, intensity, and distress associated with fatigue in 109 patients receiving chemotherapy.

Pharmacological treatment of dysphagia in stroke.

The pharynx is important for a normal swallow and it has been suggested that pharmacological agents may play a role in the management of pharyngeal dysphagia, but none have been formally evaluated. A pilot double-blind, placebo-controlled study was undertaken in 17 hospitalized patients with persistent dysphagia 2 weeks after stroke. Patients were randomized to treatment with slow-release nifedipine 30 mg orally (n = 8) or placebo (n = 9) following specialist swallowing assessment and videofluoroscopy to exclude severe dysphagia.

The role of a specialist team in implementing continuing health care guidelines in hospitalized patients.

Background: Assessment of continuing health care needs is unstandardized and often undertaken by professionals not trained in the management of complex disability.

Methods: A 6 month prospective study to evaluate the role of a specialist team in implementing continuing care guidelines in hospitalized patients. The team was responsible for assessment and facilitation of access to continuing health care throughout the hospital between hospital and community on a non-age-related basis.

Effects of the purchaser/provider split on research implementation.

The issues surrounding the use of research to inform practice and the potential problems involved in this process have been the subject of debate within nursing for many years. The purchaser/provider relationship has led to an increase in the number of challenges nursing encounters regarding the implementation of research. These challenges and relationships, which will either promote or prevent the implementation of research in nursing practice, are explored using Nolan and Grant's (1993) framework.

Medical complications during stroke rehabilitation.

Background And Purpose: We sought to evaluate the effect of setting on the rate of medical complications during stroke rehabilitation.

Methods: A study of the frequency and nature of medical complications in stroke rehabilitation was undertaken in 245 patients managed either on a stroke rehabilitation unit (n = 124) or on general medical wards (n = 121). The stroke unit setting was characterized by established protocols for prevention, early diagnosis, and management of complications (eg, aspiration, infections, thromboembolism, pressure sores, depression, stroke progression).

An integrated system for multidisciplinary assessments in stroke rehabilitation.

Background And Purpose: There is increasing emphasis on the use of integrated systems for timely, accurate, and efficient data collection for a range of service, audit, quality, and research applications. The present study evaluates the acceptability and the quality of data collected on a ward-based system over a 6-month period.

Methods: A multidisciplinary system specific for stroke rehabilitation was used.

Psychomotor performance and antihypertensive treatment.

1. The aim of treatment of hypertension is prevention of cardiovascular complications without adverse drug reactions. Psychomotor performance can be measured objectively yet there remains uncertainty concerning the psychomotor effects of antihypertensive drugs during chronic treatment.