An in-service evaluation of hip protector use in residential homes.

Background: The establishment of a hip protector service has allowed us to study eligibility, acceptability and compliance with use, reasons for non-use, and the effect of dementia, confusion, incontinence and risk of falling.

Methods: All residents in all residential homes in Poole were assessed at baseline. All eligible residents were offered 1 week's trial of protectors and those who wished to continue were given a set of protectors.

Understanding the experience of training for overseas nurses.

Aim: To explore the perceptions of overseas nurses during their induction programme.

Sample: A pilot cohort of 20 overseas nurses.

Method: A qualitative research approach was used.

Emotional processing and panic.

In this paper Rachman's concept of emotional processing was extended and a model highlighting the psychological operations underpinning processing was specified. Using this model, the aim was to investigate, by means of a questionnaire, whether patients with panic disorder (n=50) have more emotional processing difficulties than two samples of healthy controls (London, n=406; Aberdeen, n=125). The panic disorder group did have significantly more emotional processing difficulties than the control groups, showing a marked tendency to control feelings of anger, unhappiness and anxiety.

Carbon monoxide poisoning in a parturient and the use of hyperbaric oxygen for treatment.

We report a case of carbon monoxide (CO) intoxication in a pregnant woman who presented with acute non-specific symptoms and fetal distress. She was scheduled for urgent caesarean section but this was averted after consultation, advice and discussion from a National Poisons Centre, obstetricians and physicians managing the local hyperbaric oxygen facility. Hyperbaric oxygen (HBO) was used successfully to treat both the woman and her fetus.

The use of thromboembolic deterrent stockings and a sequential compression device to prevent spinal hypotension during caesarean section.

Hypotension is a common side effect of spinal anaesthesia for caesarean section. We have performed a randomised, controlled study to determine the efficacy of a sequential compression device (SCD) (Kendall) in combination with thromboembolic deterrent (TED) stockings (Kendall) to reduce the incidence of hypotension in this setting. Within 20 min of spinal injection, there was no statistically significant difference in the incidence of hypotension (defined as less than 100 mmHg and less than 80% of baseline blood pressure) (TED/SCD group 65%, control 80%, P = 0.

Written information about epidural analgesia for women in labour: did it improve knowledge?

There is evidence that despite a distressed appearance, women in labour should be informed about the side effects and risks associated with epidural analgesia. An audit of 100 women who had used epidural analgesia for labour in our hospital and who had received a verbal explanation of the benefits, risks and side effects of epidural analgesia showed that the level of knowledge was low. An A5 laminated epidural information card was prepared summarising this information.

Visual disturbances and seizures associated with pregnancy: a diagnostic dilemma and the role of radiological techniques as an aid to diagnosis.

We present two cases of visual disturbances associated with tonic-clonic seizures during pregnancy and the associated radiological findings. We review the use of neuroimaging techniques as an aid to diagnosis and their role in elucidating the pathophysiology of cortical blindness.

Quantitative ultrasound (QUS) of the heel predicts wrist and osteoporosis-related fractures in women age 45-75 years.

This study was designed to determine the ability of quantitative ultrasound (QUS) of the heel to predict fracture risk at different sites in postmenopausal women between the ages of 45 and 75 years. Heel QUS was measured at baseline using a Lunar Achilles scanner, and subsequent fractures were identified over 3 yr. The results were analyzed graphically after age adjustment and using Cox's proportional regression to estimate odds ratios for fracture risk; 3180 women were scanned (79% of sample).

Health needs of children in prison.

At the end of September 2002 there were 2633 children in prison in England and Wales. Since November 2002, the Children Act 1989 applies to children held in prison. The challenge to paediatricians is to recognise and meet the needs of these vulnerable and needy children.

Fixation of tibial pilon fractures with percutaneous cannulated screws.

Closed reduction and internal fixation with percutaneous cannulated screws was performed on seven patients with closed pilon fractures. The mean follow-up was 30.6 months.

Caffeine reduces cerebral blood flow in patients recovering from an ischaemic stroke.

Background: Caffeine is present in a variety of beverages and food and is widely consumed. In a previous study of patients recovering from an acute ischaemic stroke using transcranial Doppler ultrasound we demonstrated a fall in middle cerebral artery blood velocity of 12% following ingestion of 250 mg caffeine. The aim of this study was to investigate if this velocity change reflected a change in cerebral blood flow.

The annual incidence and seasonal variation of fractures of the distal radius in men and women over 25 years in Dorset, UK.

Adults who suffer fractures of the distal radius are at increased risk of further osteoporosis related fractures and represent a high-risk group in whom therapies are available to reduce the risk. We have undertaken a prospective study of distal radius fracture patients over the age of 25 years to establish the extent of the problem in Dorset. All patients presenting with any forearm fracture to hospitals serving Dorset residents during 1 year were identified.

Piloting a nurse-led gynaecology preoperative-assessment clinic.

This article outlines a pilot project to develop and evaluate a nurse-led gynaecology preoperative-assessment clinic at an acute hospital trust. The main aim of the clinic was to offer an effective preoperative-assessment service that provided high quality individualised and sensitive patient care. Further aims were that the clinic could be a template for other preoperative-assessment clinics, an educational resource for staff, a tool for clinical nursing career progression and a service to help ease junior doctors' workloads.

Lifelong learning--the key to competence in the intensive care unit?

With continual advances in technology and changes in medical and nursing practice there is a need to continue professional development whilst working within the Intensive Care environment. This paper aims to consider why and how nurses working within the Intensive Care environment learn knowledge and skills. To explore nurses' experiences, a qualitative approach using a semi-structured questionnaire comprising open questions was used.

Simultaneous measurement of instantaneous heart rate and chest wall plethysmography in short-term, metronome guided heart rate variability studies: suitability for assessment of autonomic dysfunction.

Instantaneous heart rate and chest wall motion were measured using a 3-lead ECG and an air pressure chest wall plethysmography system. Chest wall plethysmography traces were found to accurately represent the breathing pattern as measured by spirometry (average correlation coefficient 0.944); though no attempt was made to calibrate plethysmography voltage output to tidal volume.

Is the risk of adult coeliac disease causally related to cigarette exposure?

Objective: Previous studies have shown an association between cigarette smoking and coeliac disease, but it has yet to be established whether this relationship is causal. The aim of this study was to assess causality using the Bradford Hill criteria.

Methods: A matched case-control study using a questionnaire to establish a detailed smoking history for 138 incident cases of adult coeliac disease and 276 age-matched and sex-matched controls.

Effects of multi-sensory stimulation for people with dementia.

Background: Over recent years multi-sensory stimulation (MSS) has become an increasingly popular approach to care and is used in several centres throughout Europe. This popularity could be explained by the limited alternatives available to staff and a widely held belief that MSS is a friendly and highly humane approach. A randomized controlled trial was therefore essential to evaluate the effectiveness and extent of the benefits of MSS.

BRCA1 and BRCA2 genetic testing for ovarian cancer: is it all good news?

In England and Wales, ovarian cancer is responsible for about 15 deaths per 100,000 women annually (NHS Executive 1999). It is estimated that only 5-10% of ovarian cancer cases have a hereditary basis (Watson et al. 1996, Hallowell 1999, Eeles & Powles 2000), although recent media excitement may have led some people to believe the odds are higher.

A novel accelerometer tilt switch device for switch actuation in the patient with profound disability.

We describe the design and operation of a new switch that can be operated by patients with severely limited movement. The basis for the switch is an inexpensive single-chip accelerometer device. The switch responds to a relatively rapid rotation of the active components.

Managing pain.

Managing pain effectively is one of the biggest challenges in medicine, and one of the areas of clinical practice where a good doctor-patient relationship can, potentially, help improve the end result. But it takes time to get this right—and requires help from other healthcare professionals, argues a nurse consultant in pain management