Topological relationships between perivascular spaces and progression of white matter hyperintensities: A pilot study in a sample of the Lothian Birth Cohort 1936.

Enlarged perivascular spaces (PVS) and white matter hyperintensities (WMH) are features of cerebral small vessel disease which can be seen in brain magnetic resonance imaging (MRI). Given the associations and proposed mechanistic link between PVS and WMH, they are hypothesized to also have topological proximity. However, this and the influence of their spatial proximity on WMH progression are unknown. We analyzed longitudinal MRI data from 29 out of 32 participants (mean age at baseline = 71.9 years) in a longitudinal study of cognitive aging, from three waves of data collection at 3-year intervals, alongside semi-automatic segmentation masks for PVS and WMH, to assess relationships. The majority of deep WMH clusters were found adjacent to or enclosing PVS (waves-1: 77%; 2: 76%; 3: 69%), especially in frontal, parietal, and temporal regions. Of the WMH clusters in the deep white matter that increased between waves, most increased around PVS (waves-1-2: 73%; 2-3: 72%). Formal statistical comparisons of severity of each of these two SVD markers yielded no associations between deep WMH progression and PVS proximity. These findings may suggest some deep WMH clusters may form and grow around PVS, possibly reflecting the consequences of impaired interstitial fluid drainage via PVS. The utility of these relationships as predictors of WMH progression remains unclear.

Developing a 'model of transition' prior to preceptorship.

It has long been recognized (Kramer, 1974) that the transition from student to qualified nurse or midwife is a steep learning curve which Kramer famously described as a 'reality shock'. The University Hospital of North Staffordshire (UHNS) NHS Trust has recently taken its established preceptorship programme a step further by integrating 'key' components into the final module (module 9) of nurse/midwifery training, now referred to as the 'transition' module. The development of this new and exciting 'shared learning' approach has been the result of collaborative working with the tutors at Keele University and the clinical education team at the UHNS Trust. The subject material introduced into module 9 aims to both reflect and support the current university curriculum. Initial verbal and written feedback from students who have progressed through the 'transition' module has been both positive and encouraging. Students have identified that they feel more prepared to take on their new roles, confident in the knowledge that they can seek support from the lead preceptor nurse/midwife prior to qualifying.

Reducing the incidence of back pain: student nurses' recommendations.

National Back Care week (3-9 October 2009) embraced the promotion of back care. However, over a decade has pasted since the RCN Safer Patient Handling campaign (1996), and reports continue to highlight the high incidence of back pain within the nursing profession. This article reveals student nurses' experiences of back pain and their recommendations to reduce the incidence of back pain in the workplace. Statistics by the Department of Health (2002) report 24% of NHS staff experience back pain, reflecting the high prevalence of this study, where 34% of student nurses experience back pain during their clinical placement. The student nurses' recommendations clearly underpin the evidence-based research previously published, and as our future workforce the student nurses' voices need to be heard.

Erasing the word 'lift' from nurses' vocabulary when handling patients.

The incidence of back injuries is catastrophic to the nursing profession. It is paramount that individual practitioners attempt to significantly reduce the number of back injuries in nursing teams. Erasing the word 'lift' from nurses' vocabulary when handling patients can empower patients and promote good safe practice. This article offers a literature-based discussion of patient handling in relation to safety for both patients and nurses. Nurses' handling practice is governed by legislation and NHS Trust policies. This article suggests ways of developing safe practice that is empowering for both nurses and patients, advocating team working and safeguarding the interests of the patient and handler.