Rectal prolapse associated with anorexia nervosa: a case report and review of the literature.

Anorexia nervosa is one of a few mental health diagnoses that affects every organ system. Patients with AN often present with multiple secondary effects of starvation at the time of first assessment, including gastrointestinal (GI) complaints. In extreme cases, severe GI complications such as rectal prolapse may be encountered as a consequence of the illness although formal studies investigating the frequency of such occurrences are lacking. We present the case of a 16 year old female previously diagnosed with anorexia nervosa that developed a rectal prolapse as a consequence of her disease as well as a detailed literature review investigating the frequency and prevalence of such occurrences in this population.

Epidemiology and prevention of head injuries: literature review.

AIM AND OBJECTIVES: To identify evidence-based reports on the epidemiology of head injuries to develop guidelines for primary prevention activities by public health nurses. BACKGROUND: Head injury is a major cause of morbidity, mortality, disability and lost years of productive life in the population under 40-45 years of age. Prevention strategies such as legislation on car seat belts, drink driving and health and safety at work have led to reductions in its incidence. As well as the personal repercussions for those injured and their families, there are resource implications for healthcare provision. There is a potential role for public health nurses in reducing this burden. METHODS: A search of MEDLINE, PubMed, Science Direct, BNI and CINAHL was carried out for the period 1990-2005 using the keywords: head injury, brain injury, traumatic brain injury, head trauma, incidence, prevalence, epidemiology and prevention of head injuries. RESULTS: Comparison of the data is difficult because of the use of different definitions of injury, criteria for severity, geographical bases and timeframes. Those at greatest risk seem to be young men and older people. The former are more implicated in traffic and work accidents and in physical violence, while older people are more susceptible to traffic accidents as pedestrians and to falls. The incidence in lower socio-economic groups is greater. CONCLUSIONS: The evidence-base for the primary prevention of head injury is weak. Standardized definitions and classification systems need to be used in future epidemiological studies to permit comparisons across studies. RELEVANCE TO CLINICAL PRACTICE: There is a role for public health nurses in developing primary prevention campaigns in schools and local communities. Key target groups are young men and older people and campaigns need to tackle the particular issues relevant to these groups.

User perceptions of the knowledge underpinning practice orientation dial (KUPOD) as a tool to enhance learning.

The concern of academics and clinicians about the alleged dichotomy between theoretical concepts and the practice of nursing has been the catalyst for the development of a pocket-sized aid for nurses, known as the Knowledge Underpinning Practice Orientation Dial (KUPOD [N]/The Dial). A mixed method approach was used incorporating a questionnaire and a focus group of educators. The Dial was introduced, as part of a module, undertaken by a cohort of second-year Diploma in Nursing (Adult Branch) students. Twenty-eight students returned the questionnaire (response rate=85%). Results revealed that the Dial was easy to use in a variety of situations and locations. Respondents used the Dial within clinical and classroom settings and for self directed study. They reported that it was a practical and effective aid to learning, assisting in correlating theory and practice. It supported reflection and enhanced confidence in the clinical area, indicating that this economically produced tool helps to bridge the theory-practice gap. The Dial is now being introduced as a learning resource to a wider range of students.

Perceptions of young people about decision making in the acute healthcare environment.

AIM: This study explored young people's perceptions of their involvement in healthcare decisions affecting their management of care. METHOD: A phenomenological approach was used to allow in-depth examination of the young people's personal accounts of their experiences. Data were obtained from 10 hospitalised young people between the ages of 12-16 years from both genders and from different medical and surgical specialities using focused interviews. Transcribing, reading and listening to the data enabled data analysis through reflection and analysis. FINDINGS: Three themes were identified: level of involvement in decision-making; psychological impact of involvement in decision making; and communication. CONCLUSION: Professional practice in the care of young people should include effective communication, a policy of inclusion and active assessment of competence.

Patient handover: time for a change?

BACKGROUND: Receiving a patient handover from an ambulance crew occurs many times during the day across the country. Handover has major implications for subsequent patient care but there has been little investigation of the handover process between ambulance and emergency department staff. METHODS: Four emergency departments and one ambulance service were included within one geographical area in the UK. The research was based on a quantitative approach using a descriptive, non-experimental cross-sectional survey. A questionnaire was distributed to a convenience sample of ambulance paramedics and emergency department nurses and doctors. The questionnaire was constructed using mainly closed questions with some qualitative date collected through open questions. Data was analysed using SPSS version 11.5. RESULTS: Of the 101 questionnaires distributed, a total of 80 (68%) participants contributed towards the study. The results indicated emergency department staff need to appreciate that a lack of active listening skills can lead to frustration for ambulance staff. Ambulance staff must expect to repeat their handover, especially for patients in the resuscitation room. Handovers for critically ill patients should be delivered in two phases, with essential information given immediately and again thereafter to give further information when initial treatment has been undertaken. RECOMMENDATIONS: Suggestions are made for improving handovers by developing national guidelines and by incorporating handover in emergency department education.

Conserved patterns of nuclear compartmentalization are not observed in the chordate Oikopleura.

BACKGROUND INFORMATION: Recent results from a limited number of eukaryotic model organisms suggest that major principles governing spatial organization of the genome in functionally distinct nuclear compartments are conserved through evolution. RESULTS: We examined the in situ spatial organization of major nuclear components and nuclear patterns of gene loci with strictly defined expression patterns in endocycling cells of the transparent urochordate Oikopleura dioica, a complex metazoan with a very compact genome. Endocycling cells with different functions and similar DNA content displayed distinct topologies of nuclear components. However, the generation of the diverse nuclear architectures did not involve specific local organization of active genes or their preferential amplification. Interestingly, endocycling cells lacked nuclear-envelope-associated heterochromatin and prominent splicing-factor domains, which in mammalian cells associate with transcriptionally silent and active loci respectively. In addition, no correlation was found between transcriptional activity of a locus and its association with chromatin domains rich in specific histone modifications. CONCLUSIONS: Together, these findings and the absence of typical eukaryotic replication patterns reveal a surprisingly limited functional compartmentalization of O. dioica endocycling nuclei. This indicates that robust cell-type-specific gene expression does not necessarily require high levels of spatial genome organization.

Change on the horizon: issues and concerns of neophyte advanced healthcare practitioners.

AIMS AND OBJECTIVES: The aim was to interview new entrants to a Master's level programme of educational preparation for advanced healthcare practice roles. The objectives were to gain an understanding of their issues and concerns as they looked ahead to their future development and to illuminate issues concerning their experiences as students and as employees. BACKGROUND: As advanced practice roles become more widespread in the United Kingdom and abroad, nurses and other healthcare professionals are becoming more involved in innovation and service development and experiencing greater autonomy in many areas, particularly in regard to clinical examination and diagnosis. DESIGN: A qualitative design was employed to illuminate issues and concerns of new students on a Master's degree programme of educational preparation for advanced healthcare practitioners. METHODS: Two focus group interviews were conducted in 2004. Sixteen students from two programme cohorts participated in the two groups. FINDINGS: Two main themes were outlined. These were: 'opportunities for development' and 'time pressures'. Subcategories within these two themes are also discussed. CONCLUSIONS: Students undertaking Master's level preparation for advanced healthcare practitioner roles perceive personal and professional benefits and opportunities to develop innovative services to improve patient care as accruing from the programme. These opportunities and benefits were related to the United Kingdom national health policy agenda. Some role difficulties were experienced. The additional burdens that the programme of study provided were an issue for some, but these were perceived as a temporary problem, worth undergoing for the likely long-term benefits. RELEVANCE TO CLINICAL PRACTICE: Students undertaking educational preparation for advanced practice roles see themselves as innovators, specifically aiming to develop and improve aspects of service provision. Education for advanced practice roles should not be undertaken lightly, but can equip students with various skills, particularly regarding clinical assessment, and these skills should underpin practitioners' autonomy.

Developing lecturer practitioner roles using action research.

BACKGROUND: Lecturer Practitioner roles are well established in the United Kingdom. The national literature demonstrates that these staff are valuable to National Health Service trusts and universities however, their roles are busy and demanding, with conflicting expectations from the two employers. In addition, their role in addressing the theory-practice gap - a major reason for their establishment - is at best unclear. Although a number of qualitative studies have explored the topic, there have been no systematic attempts to develop the role or to quantify the effects on postholders. AIM: This paper reports a study that aimed to develop aspects of Lecturer Practitioners' work roles, examine the effects of this on individuals at one English university, and to quantify Lecturer Practitioners' occupational stress and burnout. METHODS: A flexible, 'spiral' action research framework and 'collaborative group approach' were used, with mixed methods of data collection. Data were collected through focus groups, meetings and participant feedback, and participants' reflective diaries. A questionnaire using previously validated psychological attitude rating scales was also used to measure occupational stress and burnout, the extent to which the project influenced these, and the influence of Lecturer Practitioners' experience and qualifications. Six null hypotheses were constructed to measure these ideas. Findings from qualitative and quantitative perspectives were triangulated to give depth to the analysis. FINDINGS: Five themes emerged from the focus groups: personal motivation, workload pressures, role clarity, preparation and support, and gains from the role. Specific policies and documentation were developed as a result of this initial project planning work. The findings from the questionnaire indicated that Lecturer Practitioners were no more stressed or burnt out than comparable workers. Synthesis of findings indicated, broadly speaking, that these LPs were 'thriving rather than just surviving'. CONCLUSION: Action research was an effective methodology for uncovering new knowledge, and bringing about organizational change in this project.