North Walsham and District War Memorial Hospital

Clinical supervision has been an aspect of nursing practice in various forms for several years; however, it remains challenging to ensure its widespread implementation across healthcare organisations. There is an increasingly evident need for formalised support in nurses' busy practice settings, so it is important to improve the quality of clinical supervision in healthcare. This will also assist nurses in providing evidence of their continuing professional development as part of revalidation. This article provides an overview of clinical supervision, outlining its features and functions in healthcare practice. It includes three case studies related to group clinical supervision, discussing how this was implemented in each case and the various methods of group-working that were used.

Synopsis Conditions have been determined under which chlorination can be used to eliminate both faecal and spoilage bacteria from the water used for chilling eviscerated poultry carcasses, thus avoiding any hazard from cross‐contamination. All combinations of three rates of water usage (2.5, 5 or 8 1 per carcass) and three concentrations of total residual chlorine (10 to 15, 25 to 30 or 45 to 50 ppm), obtained by the addition of sodium hypochlorite, were compared. It was found that the majority of bacteria present were destroyed by the use of 45 to 50 ppm of total chlorine in conjunction with 5 1 of water per carcass. When the rate of water usage was increased to 8 1 per carcass it was found that 25 to 30 ppm of residual chlorine in the chill‐water gave comparable results. The effect of water usage on the concentrations of free residual chlorine present in the chill‐water during processing is discussed. When chlorine gas was added continuously at a fixed concentration to the input water the concentration of total residual chlorine decreased in each chiller. This method of chlorination was found to be less effective in destroying bacteria than the hypochlorite method which could be used to vary the amount of added chlorine in order to maintain the required total residual concentration during processing.

Live and dead racing pigeons (Columba livia) from five lofts in Norfolk and Suffolk were examined clinically and cultured for Mycoplasma spp. Both clinically healthy birds and those showing signs of mild respiratory disease were included. The oropharynx was the culture site for 130 live birds, the nasal sinuses and other tissues for 58 carcases. Mycoplasma columbinum, M. columborale and M. columbinasale were isolated from the oropharynges and nasal sinuses; M. columbinum and M. columbinasale from the brain and M. columbinum and M. columborale from lungs and air sacs. One or more of these three Mycoplasma spp. was isolated at necropsy from 28% of 58 pigeons. Only 11% of 37 pigeons reacted sero-logically by the metabolism inhibition test to M. columbinum and none to M. columborale. Twenty-five birds examined for M. gallisepticum antibody by the haemagglutination-inhibition test were negative. No sex or age predilection to infection with Mycoplasma was apparent. About 10% of pigeons in all five lofts showed clinical signs of the respiratory disease sometimes described as 'mycoplasmosis catarrh', but most dead birds from which Mycoplasma spp. were isolated also had concomitant infections of various kinds. Although suggestive, the results of these investigations provide no clear evidence that Mycoplasma spp. are aetiologically involved in natural respiratory disease of pigeons. No conclusive satisfactory treatment was found for the elimination of mycoplasmas.

The aim of the study was to compare the efficacy of the inhaled long-acting beta2-agonists eformoterol and salmeterol when added to existing inhaled corticosteroid (ICS) therapy in symptomatic asthmatic children. This randomized, 12-week, parallel-group study, performed in a primary care setting, included 156 children and adolescents (aged 6-17 years) with moderate persistent asthma. Patients were randomized to open-label eformoterol (Oxis) Turbohaler 9 microg (delivered dose) or salmeterol Accuhaler 50 microg, both b.i.d, added to current ICS. Assessments included: changes in daytime reliever beta2-agonist therapy (primary variable), total 24-h reliever use, lung function, clinic and diary symptom scores, patient and carer health-related quality of life (HRQL) and adverse events. Daytime reliever use decreased significantly (p < 0.001) from baseline by 65% and 52%, respectively in the eformoterol and salmeterol treatment groups. Compared with salmeterol, eformoterol produced a greater decrease in daytime (-0.46 inhalations/day; p = 0.081) and 24-h (-0.70 inhalations/day; p = 0.043) reliever use. The percentage of patients who did not require any reliever medication during the study was significantly higher in the eformoterol group (p < 0.05 vs. salmeterol at weeks 8 and 12). Clinic and diary card peak expiratory flow and symptom measures all improved from baseline in both treatment arms. There was a significantly greater effect in favour of eformoterol for the reduction in clinic-assessed overall night-time symptoms (p < 0.05 vs. salmeterol). Clinically relevant improvements in patient-assessed HRQL occurred during treatment with eformoterol and salmeterol, but carer-assessed HRQL was improved to a clinically relevant extent, only with eformoterol. Both treatments were well tolerated. In children and adolescents with moderate persistent asthma, add-on therapy with eformoterol was well tolerated and at least as effective as salmeterol.

Predictive models are becoming more and more commonplace as tools for candidate antigen discovery to meet the challenges of enabling epitope mapping of cohorts with diverse HLA properties. Here we build on the concept of using two key parameters, diversity metric of the HLA profile of individuals within a population and consideration of sequence diversity in the context of an individual's CD8 T-cell immune repertoire to assess the HIV proteome for defined regions of immunogenicity. Using this approach, analysis of HLA adaptation and functional immunogenicity data enabled the identification of regions within the proteome that offer significant conservation, HLA recognition within a population, low prevalence of HLA adaptation and demonstrated immunogenicity. We believe this unique and novel approach to vaccine design as a supplement to vitro functional assays, offers a bespoke pipeline for expedited and rational CD8 T-cell vaccine design for HIV and potentially other pathogens with the potential for both global and local coverage.

‘We didn’t do poems.’‘We used to do it as a punishment when we were talking.“Whenever we did something wrong, all the class had to stand up and say two poems, one was about Abu Ben Adam and the other was about a girl who went to a party and fell off her chair.’(First year pupils)

While checking the status of a population of Reboulia hemisphaerica near Felmingham in Norfolk, UK, on 13 March 2021, M.P.G. noticed a small Pottiaceous moss that was unfamiliar to her. She conside...

Hemorrhagic facet cysts are a rare condition including both synovial and ganglion cysts. Here, the authors present the first-ever reported case of a hemorrhagic ganglion cyst of the facet joint at L1 to L2 causing cauda equina syndrome. In this report, a 72-year-old woman presented with symptoms of cauda equina syndrome requiring urgent surgical consideration. Magnetic resonance imaging and computed tomography showed an extradural mass at the L1 to L2 level. Due to the giant size of the cyst, there was severe compression of the thecal sac and nerve roots. The patient underwent interlaminar contralateral decompression and cystectomy using a uniportal endoscopic approach. The patient had a quick postoperative recovery, with postoperative magnetic resonance imaging of the lumbar spine showing recovery of the facet cyst with no sign of recurrence or stenosis. This case demonstrates the successful surgical technique of interlaminar endoscopic contralateral decompression combined with cystectomy, showing that a hemorrhagic ganglion cyst at the facet at L1 to L2 can be removed completely under endoscopic view.

Standard techniques for the measurement of emissions for most products require the use of an OATS (open area test site). In reality, very few organisations (excluding the Test Laboratories) have access to such facilities. However, an increasing number of organisations, particularly in Europe and increasingly in the US, are intent on conducting their own emissions checks, either for self certification or pre-test purposes. A study of the measurement uncertainty associated with the checking of emissions on a typical test site shows that in general these sites will introduce massive errors, unrelated to the cost or complexity of the instrumentation. This situation has been largely ignored by the industry but it is hoped that this paper will open up discussion in this field. The sources of this uncertainty are discussed and a technique described for measuring and correcting for these errors.

This article introduces an integrative framework for working with clinical disorders and maladaptive behaviors. This framework is based on the author’s experience working with eating and weight issues. The term “eating disorders” is used to refer to both undereating and overeating or obesity. Existing psychotherapy approaches to eating disorders and weight-related issues are explored, and the transactional analysis literature on eating disorders is evaluated. The author presents a framework she has found useful, which she calls Nourish. She has developed this model following heuristic research with 19 long-term clients with eating disorders and weight issues, especially anorexia nervosa, bulimia, binge eating, and obesity. This integrative, holistic framework combines classical TA theory and a relational approach to working clinically with eating and weight and focuses on supporting therapists in private practice as well as in clinical teams.

House Martins Delichon urbica were examined for moult in autumn at breeding colonies on a north/south transect in W Spain. Adults and some early‐brood juveniles had started flight feather moult; most were in active moult immediately prior to migration. Estimates were made of the start dates of the laying of first clutches at various latitudes.

Editorial board member Trevor Harvey opens this month's issue with a discussion of the latest ‘state of care’ report from the Care Quality Commission and the implications for the sector in 2024.