Taxonomic studies in the Acanthaceae: The Peristrophe grandibracteata complex

Examination of material of Peristrophe grandibracteata Lindau sensu lato has shown that it comprises a complex that we treat as three species (one of which has two subspecies). The species are P. grandibracteata sensu stricto, P. hereroensis (Schinz) Balkwill and the new P. namibiensis Balkwill, with two subspecies, ssp. namibiensis and ssp. brandbergensis Balkwill. A key to these taxa, descriptions and distribution maps are provided. All three species are endemic to Namibia

Continence technologies whitepaper: Informing new engineering science research

Advances in healthcare technology for continence have historically been limited compared to other areas of medicine, reflecting the complexities of the condition and social stigma which act as a barrier to participation. This whitepaper has been developed to inspire and direct the engineering science community towards research opportunities that exist for continence technologies that address unmet needs in diagnosis, treatment and long-term management. Our aim is to pinpoint key challenges and highlight related research opportunities for novel technological advances. To do so, we draw on experience and expertise from academics, clinicians, patients and patient groups linked to continence healthcare. This is presented in four areas of consideration: the clinical pathway, patient perspective, research challenges and effective innovation. In each we introduce seminal research, background information and demonstrative case-studies, before discussing their relevance to engineering science researchers who are interested in approaching this overlooked but vital area of healthcare

Catheter-associated urinary tract infection in primary and community health care

Introduction: Although often a last resort, urinary catheterisation is a relatively common management option for bladder dysfunction in older people and others cared for in community settings. Catheter-associated urinary tract infection (CAUTI) is a well-recognised source of increased morbidity and economic burden in acute care services, but much less is known about the prevalence and impact of CAUTI in primary and community care.Objectives: The aim of this study was to examine the criteria and outcome measures used in reporting CAUTI, to identify sources and quality of data recorded on CAUTI and to determine a base-line prevalence rate for CAUTI in community settings.Methods: (i) A mapping exercise to identify local, national and international sources of data on CAUTI and (ii) a retrospective prevalence survey of CAUTIs, recorded within three Primary Care Trusts in England during 1 month (October 2004).Results: Published or other recorded data on CAUTI in community settings were very limited. Criteria and outcome measures were variable and commonly failed to distinguish between symptomatic and asymptomatic CAUTI. A prevalence rate of 8.5% was determined by retrospective survey of patient records.Conclusions: Limitations in the quality and consistency of catheter-related information collected by healthcare services present a major obstacle to robust epidemiological analysis of risk and impact of CAUTI in primary and community care. Standardised routine data collection is essential to determine the magnitude of risk associated with CAUTI, to enable the development of a longitudinal database of long-term catheterised patients and to provide base-line data against which infection-control initiatives in primary and community care can be evaluated

Clinical guidelines for the promotion of continence in primary care: Community nurses' knowledge, practice and perceptions of their role

Urinary incontinence is a common and debilitating problem. Its prevalence increases with advancing age, and heavy reliance on containment products results in high costs for community services, yet evidence exists that effective treatments can be provided in primary care. This quasi-experimental study compared the knowledge, practice and perceptions of their role by community nurses before (Phase 1) and after (Phase 3) the introduction of evidence-based clinical guidelines for continence care. Local guidelines were developed from nationally published guidelines and introduced into two localities of a community NHS trust (the intervention group) with a supporting educational programme during Phase 2. An audit of patient notes showed statistically significant improvements in assessment details recorded by the intervention group, and in the numbers of patients for whom a treatment plan was identified at Phase 3. Data collected from questionnaires, interviews and focus groups showed that the majority of community nurses in both the intervention and control groups believed that their role should involve the assessment and first-line treatment/management of urinary incontinence. However, limitations in their knowledge of continence care and difficulties in enhancing that knowledge base were identified. Three themes relating to role perceptions emerged from interviews, namely assessment skills, patient capacity and role restrictions. The study raises questions about what may constitute realistic expectations of role development for community nurses. Greater development of multidisciplinary teamworking, including enhancement of the link nurse role to provide co-ordination in continence care, could be a way forward

Improving continence services - a case study in policy influence

This article presents a case history of the process followed by a group of nurses who used their power and influence to improve the provision of continence services within the National Health Service in England. The process and outcomes demonstrate how nurses can achieve change using their political influence combined with a planned or evolving strategy