Nursing management of paediatric asthma in emergency departments.

Childhood asthma is a complex disease which may be resistant to treatment and varies in its clinical presentation. The number of children admitted to emergency departments (EDs) with acute exacerbation of asthma is high and many are managed solely in the department. The correct assessment of the severity of an exacerbation can be achieved through competent history taking, examination and accurate recording of observations.

Recognition and nursing management of abusive head trauma in children.

Abusive head trauma (AHT) describes an injury to the head caused by a deliberate impact or shaking by a parent or carer. It can cause significant morbidity and mortality in infants, and is most commonly seen in those aged under 2 years. The initial presentation of AHT can include vague symptoms and the correct diagnosis may be missed by health professionals.

Degenerative inter-vertebral disc disease osteochondrosis intervertebralis in Europe: prevalence, geographic variation and radiological correlates in men and women aged 50 and over.

Objectives: To assess the prevalences across Europe of radiological indices of degenerative inter-vertebral disc disease (DDD); and to quantify their associations with, age, sex, physical anthropometry, areal BMD (aBMD) and change in aBMD with time.

Methods: In the population-based European Prospective Osteoporosis Study, 27 age-stratified samples of men and women from across the continent aged 50+ years had standardized lateral radiographs of the lumbar and thoracic spine to evaluate the severity of DDD, using the Kellgren-Lawrence (KL) scale. Measurements of anterior, mid-body and posterior vertebral heights on all assessed vertebrae from T4 to L4 were used to generate indices of end-plate curvature.

Estimated generic prices of cancer medicines deemed cost-ineffective in England: a cost estimation analysis.

Objectives: The aim of this study was to estimate lowest possible treatment costs for four novel cancer drugs, hypothesising that generic manufacturing could significantly reduce treatment costs.

Setting: This research was carried out in a non-clinical research setting using secondary data.

Participants: There were no human participants in the study.

A novel missense mutation in the transcription factor FOXF1 cosegregating with infantile hypertrophic pyloric stenosis in the extended pedigree linked to IHPS5 on chromosome 16q24.

Background: The aim was to identify susceptibility alleles for infantile hypertrophic pyloric stenosis (IHPS) in a pedigree previously linked to IHPS5 on chromosome 16q24.

Methods: We screened the positional and functional candidate gene FOXF1 by Sanger sequencing in a single affected individual. All family members for whom DNA was available were genotyped to determine cosegregation status of the putative causal variant.

Whistleblowing in medicine and in Homer's Iliad.

'Thinking with Homer', or drawing creatively on themes and scenes from Homer's Iliad and Odyssey, can help us to better understand medical culture and practice. One current, pressing, issue is the role of the whistleblower, who recognises and exposes perceived poor practice or ethical transgressions that compromise patient care and safety. Once, whistleblowers were ostracised where medical culture closed ranks.

Genetic contributions to visuospatial cognition in Williams syndrome: insights from two contrasting partial deletion patients.

Background: Williams syndrome (WS) is a rare neurodevelopmental disorder arising from a hemizygotic deletion of approximately 27 genes on chromosome 7, at locus 7q11.23. WS is characterised by an uneven cognitive profile, with serious deficits in visuospatial tasks in comparison to relatively proficient performance in some other cognitive domains such as language and face processing.

The natural history of autoimmune hepatitis presenting with jaundice.

Background: Forty percent of patients with autoimmune hepatitis (AIH) present with acute jaundice/hepatitis. Such patients, when treated promptly, are thought to have a good prognosis.

Objectives: The objective of this study was to describe the natural history of AIH in patients presenting with jaundice/hepatitis and to determine whether the diagnosis could have been made earlier, before presentation.

Does measuring the range of motion of the hip and knee add to the assessment of disability in people undergoing joint replacement?

Background And Hypothesis: Range of motion (ROM) is a core component of some commonly used measures of disability, such as the American Knee Society Score and Harris Hip Score. However, the relationship between ROM and function is contested. The aim of this cross-sectional analysis was to investigate the relationship between pre-operative range of motion (ROM) and disability in patients undergoing hip and knee joint replacement.

Can the science of communication inform the art of the medical humanities?

Context: There is increasing interest in establishing the medical humanities as core integrated provision in undergraduate medicine curricula, but sceptics point to the lack of evidence for their impact upon patient care. Further, the medical humanities culture has often failed to provide a convincing theoretical rationale for the inclusion of the arts and humanities in medical education.

Discussion: Poor communication with colleagues and patients is the main factor in creating the conditions for medical error; this is grounded in a historically determined refusal of democracy within medical work.

'Continuity of care': a critical interpretive synthesis of how the concept was elaborated by a national research programme.

Introduction: A Continuity of Care Research Programme was undertaken in England in 2000-9. The Programme was informed by a conceptual framework proposed by Freeman and colleagues in an earlier scoping study. At the end of the Programme, a conceptual synthesis was carried out in order to confirm or refine the 'Freeman model' of continuity of care.

Hepatitis E.

Hepatitis E virus (HEV) was discovered during the Soviet occupation of Afghanistan in the 1980s, after an outbreak of unexplained hepatitis at a military camp. A pooled faecal extract from affected soldiers was ingested by a member of the research team. He became sick, and the new virus (named HEV), was detected in his stool by electron microscopy.

Reporting of adverse effects in randomised clinical trials of chiropractic manipulations: a systematic review.

Objective: To systematically review the reporting of adverse effects in clinical trials of chiropractic manipulation.

Data Sources: Six databases were searched from 2000 to July 2011. Randomised clinical trials (RCTs) were considered, if they tested chiropractic manipulations against any control intervention in human patients suffering from any type of clinical condition.

Ofatumumab for the treatment of chronic lymphocytic leukaemia in patients who are refractory to fludarabine and alemtuzumab: a critique of the submission from GSK.

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of ofatumumab for the treatment of refractory chronic lymphocytic leukaemia (CLL), based upon the manufacturer's submission (MS) to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The submitted clinical evidence included one study: a non-randomised, single-arm study. Two other studies were identified but both were non-comparative and provided evidence for therapies other than ofatumumab.

'Achieving ensemble': communication in orthopaedic surgical teams and the development of situation awareness--an observational study using live videotaped examples.

Focused dialogue, as good communication between practitioners, offers a condition of possibility for development of high levels of situation awareness in surgical teams. This has been termed "achieving ensemble". Situation awareness grasps what is happening in time and space with regard to one's own unfolding work in relation to that of colleagues, and is necessary to maintain patient safety throughout a surgical list.

The management of low-risk primary upper gastrointestinal haemorrhage in the community: a 5-year observational study.

Background: Acute upper gastrointestinal haemorrhage is a common medical emergency, initially managed with inpatient care. Bleeding stops spontaneously in over 80% of cases, indicating that patients with low-risk upper gastrointestinal haemorrhage may be more optimally managed in the community, without the need for admission to hospital.

Aim: To assess the safety of managing patients with low-risk upper gastrointestinal haemorrhage without admission to hospital.

Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis.

Objective: To assess the impact of exercise referral schemes on physical activity and health outcomes. Design Systematic review and meta-analysis.

Data Sources: Medline, Embase, PsycINFO, Cochrane Library, ISI Web of Science, SPORTDiscus, and ongoing trial registries up to October 2009.

Writing out prescriptions: hyperrealism and the chemical regulation of mood.

Using contemporary literary sources, we explore the powerful ideological framework that normalises prescription dependency as part of everyday life, focusing upon the treatment of mood disorders. Through a literary critical methodology, we read novels by American hyperrealists such as Bret Easton Ellis, David Foster Wallace and Rick Moody as symptomatic of prescription culture. Though we argue that these writers brilliantly understand the dangers of mood medication, they do not escape its logic, rather, 'writing it out' as they write against it.

Spinal manipulation: an update of a systematic review of systematic reviews.

Objectives: The aim of this update is to critically evaluate the evidence for or against the effectiveness of spinal manipulation in patients with any type of clinical condition.

Design: Four electronic databases were searched to identify all relevant systematic reviews of the effectiveness of spinal manipulation in any condition published between 2005 and January 2011. Reviews were defined as systematic, if they included an explicit and repeatable inclusion and exclusion criteria for studies.

Host risk factors and autochthonous hepatitis E infection.

Introduction: In developed countries autochthonous hepatitis E infection is caused by hepatitis E virus (HEV) genotype 3 or 4 and mainly affects middle aged/elderly men. Host factors might explain why older men develop clinically overt disease.

Methods: Retrospective review of 53 patients with symptomatic autochthonous hepatitis E infection to determine putative host risk factors.

Yulu Shequ - a unique rehabilitation program for illicit drug users in Kaiyuan in southwest China.

Introduction: In China, illicit drug use and addiction have been rapidly increasing over the last two decades. Traditional compulsory rehabilitation models in China are widely considered ineffective. Recently, a new model of drug user rehabilitation called the 'Yulu Shequ Program' has gained a national reputation for successful rehabilitation in the city of Kaiyuan in southwest China.

Sing, muse: songs in Homer and in hospital.

This paper progresses the original argument of Richard Ratzan that formal presentation of the medical case history follows a Homeric oral-formulaic tradition.The everyday work routines of doctors involve a ritual poetics, where the language of recounting the patient’s ‘history’ offers an explicitly aesthetic enactment or performance that can be appreciated and given meaning within the historical tradition of Homeric oral poetry and the modernist aesthetic of Minimalism. This ritual poetics shows a reliance on traditional word usages that crucially act as tools for memorisation and performance and can be linked to forms of clinical reasoning; both contain a tension between the oral and the written record, questioning the priority of the latter; and the performance of both helps to create the Janus-faced identity of the doctor as a ‘performance artist’ or ‘medical bard’ in identifying with medical culture and maintaining a positive difference from the patient as audience, offering a valid form of patient-centredness.

Quality achievement and disease prevalence in primary care predicts regional variation in renal replacement therapy (RRT) incidence: an ecological study.

Background: Diabetes Meillitus (DM) and hypertension (HT) are important causes of end-stage renal disease (ESRD) and renal replacement therapy (RRT) is the standard active treatment. Financially, incentivized quality initiatives for primary care include pay-for-performance (P4P) in DM and HT. Our aim was to examine any effect of disease prevalence and P4P on RRT incidence and regional variation.

Pre-surgery briefings and safety climate in the operating theatre.

Background: In 2008, the WHO produced a surgical safety checklist against a background of a poor patient safety record in operating theatres. Formal team briefings are now standard practice in high-risk settings such as the aviation industry and improve safety, but are resisted in surgery. Research evidence is needed to persuade the surgical workforce to adopt safety procedures such as briefings.