British journal of nursing (Mark Allen Publishing)
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This literature review reports the effectiveness of two peripheral opioid antagonists to relieve constipation caused by prolonged use of opioids, primarily in patients with advanced cancer. ⋯ The recent development of methylnaltrexone into a commercially-viable drug indicates its effectiveness. It may help patients suffering from the intense discomfort that constipation can cause.
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This article is the first of a two-part review focusing on mechanical ventilation, with particular emphasis on non-invasive ventilation when managing patients suffering from respiratory failure. This article explores the principles underpinning artificial ventilation, explains the difference between positive and negative pressure ventilation, and differentiates between invasive and non-invasive modes of ventilation. ⋯ Optimum ventilatory practice requires knowledge to ensure the choosing of the 'right' ventilator. It ensures informed practice and maintains optimum patient safety.
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Intravenous therapy has evolved to form a fundamental cornerstone of modern health care, but there are significant groups of patients in whom obtaining peripheral venous access is a difficult and drawn out process. An ultrasound guided peripheral venous access service could potentially stop multiple 'blind' attempts, and subsequent damage. A pilot scheme to look at nurse-led ultrasound cannulation was established, and its early results are presented in this article. ⋯ An average of 6.4 attempts at cannulation were undertaken prior to referral and an average of 1.3 attempts were needed to place a cannula under ultrasound guidance. Sixty-nine percent of the cannulae were inserted into the veins of the anterior forearm and 12% into the basilic veins. Overall, 2D ultrasound guided peripheral cannulation is a reliable technique for obtaining vascular access on any adult patients who have already undergone multiple cannulation attempts or in those who it is thought cannulation may be difficult.
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This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors' hospital between June 2007 and July 2008. ⋯ This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.