The majority of the evidence reviewed was poorly reported and there is therefore an inherent risk of bias. Given the recent improvement in resolution and reduction in cost of MR imaging, ABR can no longer be considered appropriate as the primary test used to screen for acoustic neuroma. T2W or T2*W sequences enable accurate evaluation of the VIIIth and VIIth cranial nerves within the cerebellopontine angle and internal auditory canal as well as evaluation of the cochlea and labyrinth, and inclusion of GdT1W sequences is unlikely to contribute information that would alter patient management in the screening population. The quality of the imaging chain and experience of the reporting radiologist are key factors determining the efficacy of a non-contrast screening strategy. Based on a cost-effectiveness model developed to reflect UK practice it was concluded that a diagnostic algorithm that deploys non-contrast MR imaging as an initial imaging screen in the investigation of acoustic neuroma is less costly than and likely to be as effective as available contrast MR imaging.

Objective: Family can play a vital role in promoting the overall well-being of the critically ill patient. Despite this positive attribute, some nurses, for various reasons are hesitant to include family in patient care. The study explored family members and nurses' perspectives and experiences of family involvement in caring for patients in intensive care units. The objectives were to describe both nurses and family members' perspectives and experiences of family involvement in care. Methods: A descriptive exploratory qualitative study. Focus-group interviews were conducted using a purposeful sample of six family members of critically ill patients and six nurses from two intensive care units of a hospital in Bahrain. Results: A central finding was that overall critical care nurses were reluctant to involve family in care, despite the fact that generally family members were willing to participate in care. Themes that were common to both participant groups were that caring practices and active communication were central to quality patient care. Both groups agreed that kinship roles and relationships were pivotal to caring practices and enabled a sense of security and reassurance for family and patients. Despite the fact that nurses were aware that family knowledge of the patient made it possible for them to personalize patient care, they were reluctant to have open communication with family members and to include them in care. Instead they favored policy development to guide family involvement. Conclusions: Family members expressed the need to be part of caring practices. While the nurses acknowledged that family involvement in patient care benefited the patient they wanted policy guidelines to guide this participation in care. The findings suggest that role clarification of family members and clarification on the responsibilities of nurses are needed if family members are to be involved so that patient care adheres to international standards while maintaining cultural sensitivity to Islamic family values.

No abstract

Despite the avoidance of death talk and nurses' lack of professional autonomy, they created awareness that death was imminent to family members and ensured that end of life care was given in a culturally sensitive manner and aligned to Islamic values.

The BNIM interview technique and analytic framework are useful tools to help with an in-depth qualitative exploration of life stories in context.

No abstract

Focal femoral inlay resurfacing has been developed for the treatment of full-thickness chondral defects of the knee. This technique involves implanting a defect-sized metallic or ceramic cap that is anchored to the subchondral bone through a screw or pin. The use of these experimental caps has been advocated in middle-aged patients who have failed non-operative methods or biological repair techniques and are deemed unsuitable for conventional arthroplasty because of their age. This paper outlines the implant design, surgical technique and biomechanical principles underlying their use. Outcomes following implantation in both animal and human studies are also reviewed.

Research has evidenced a marked increase in the prevalence of cancer among younger people with up to one in five, parenting children under the age of 18 years of age. When a parent is diagnosed with cancer they experience fears and anxieties as they attempt to simultaneously manage their role as parent, with the illness experience. Parents have expressed difficulties in knowing how to communicate appropriately with their children throughout the illness trajectory as they are primarily focused on protecting or shielding their children from knowledge of the illness. Understandably parents may become overwhelmed with significant parental stress impacting on their psychological wellbeing. This subsequently effects the well-being of the entire family unit, coupled with changes to routines, roles and responsibilities. This study was carried out to examine how a group psychosocial intervention Children's Lives Include Moments of Bravery (CLIMB®) helped young children to navigate parental cancer. A qualitative research design utilizing focus group methodology, artwork and individual interviews was used to generate data from 19 participants (parents, children and healthcare professionals). Three key themes emerged from the data, navigating the diagnosis, navigating emotions and changed routines, creating spaces to talk about cancer. The findings evidenced that attending CLIMB® was a positive experience for both children and parents. It gave the children the language and opportunity to express their fears and worries. CLIMB® equipped them with tools and skills to both express and manage their negative emotions, life skills that could be transferred to other challenging life events. All techniques that created spaces to talk and appeared to have a reassuring effect on the children. The parents appreciated the professional support that the structured intervention offered to them and helped them communicate more openly with their children. Creating spaces to talk about cancer reduces mistrust and tension between parents and children, when parental cancer occurs, and hopefully minimizes future psychological and social problems.