bluuebunny/crossref_metadata_2025 huggingface dataset:
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

I work for an independent health care company that provides health care to people taken into custody. We use private prescriptions but I am hoping to develop my role and link up with the local PCT so that I can issue FP10s to the detained patients to take away with them once released from custody. This would allow for the gap in GP services over long weekends. If, for example, the patient has an infected IV site, then I will be able to prescribe a whole course of antibiotics, ensuring faster access and treatment for the patient. What is your advice?
Prescribing in older people
Authors: Reddy Bhavana
Published: May 2014

Older patients are often prescribed multiple drug regimens for multiple disease states. This increases the risk of adverse drug reactions and interactions. The elderly, through changes in the ageing body, are also more prone to the effects of certain drugs. These factors may also affect patient concordance and can be a risk factor for falls. It is essential therefore that these points are considered when prescribing for the elderly. Repeat medication must also be reviewed more regularly, ensuring that medicines that are not of benefit are discontinued.
The central, peripheral and autonomic nervous system: an overview
Authors: Davis Geraldine
Published: May 2014

Starting with an overview of the nervous system, and the links between neurons, this article describes chemical synapses and neurotransmitters. The action of neurotransmitters is linked to the actions of many prescribed medications providing a knowledge base for the nurse prescriber.
Questions & Answers
Authors: Peniston-Bird Fiona
Published: May 2014

Woundcare: As a nurse independent prescriber, can I prescribe maggots?
Research and development round-up: October 2007
Authors: O'Connell Nicola
Published: May 2014

Taking antidepressant selective serotonin reuptake inhibitors (SSRIs) together with painkillers can substantially increase the risk of bleeding from the stomach, according to new research by the University of East Anglia (UEA).
Pharmacological management of stable COPD in primary care
Authors: Barnett Margaret
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease in the UK which appears to be increasing. It is a disease that progressively becomes worse over time and can have a devastating affect on individual patient's lives. Pharmacological management in primary care is an important part of patient's treatment in obtaining control of symptoms and enabling the patient to live their life to the full. This article focuses on the key principles identified by the National Institute for Health and Clinical Excellence guideline for the management of COPD and highlights the role of the prescribing nurse to ensure patients with COPD receive optimal drug management.
Management of COPD exacerbations in primary care
Authors: Barnett Margaret
Published: May 2014

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are common in primary care. Many patients with mild and moderate COPD are managed effectively in their own homes during such events. However, as the disease advances, patients with severe COPD are more likely to develop complications during an exacerbation and might require management in hospital rather than at home. This article looks at how exacerbations are best managed in primary care and the role the nurse prescriber has to play in ensuring appropriate treatment is prescribed as well as promoting self-management plans to enable patients to manage their condition and its symptoms more effectively. The National Institute for Health and Clinical Excellence (NICE, 2004) guideline for the management of COPD provides recommendations related to best practice in the management of exacerbations.
Drug-induced QT prolongation: consequences and current dilemma
Authors: Dubrey Simon W , Grocott-Mason Richard
Published: May 2014

The QT interval usually represents a period of time of approximately 400 ms on a resting electrocardiogram (ECG). Prolongation of this interval of time is now the commonest cause for drugs failing to be developed (Roden, 2004). The concern is an association with ventricular rhythm disturbance and particularly torsade de pointes (TDP), with its propensity to decay into ventricular fibrillation and death. This article describes a case of extreme QT interval prolongation in association with drug therapy and the measures required to treat it. An overview of the current situation is also presented.
Research and development round-up: March 2007
Authors: O'Connell Nicola
Published: May 2014

Men who regularly take pain relievers such as paracetamol, Ibuprofen and aspirin could have an increased risk of high blood pressure compared with those who do not use these medications, according to a report the Archives of Internal Medicine.
Numeracy skills: a student-centred approach to gaining confidence
Authors: Chapman Linda , Halley Liz
Published: May 2014

Miscalculations are a common cause of drug errors. These can occur because practitioners do not always have the numeracy skills and knowledge fundamental to the safe prescribing and administration of medicines. This article discusses how the University of Reading has developed an ‘Introduction to Numeracy’ module which is enabling practitioners to increase their confidence and competence in calculating doses when prescribing and administering drugs. The provision of learning is flexible in how, when and where students learn.
Understanding clinical trials: the regulatory framework
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Clinical trials are crucial to the development of new medicines as they test the safety and efficacy of the drug on humans; however, the trials do pose a risk to the participants. To minimize this risk, all clinical trials must meet the requirements of the Clinical Trials Directive and the Medicines for Human Use (Clinical Trials) Regulations (SI 2004/1031) (2004). In the first of a two-part series, Richard Griffith and Cassam Tengnah discuss the legal framework that regulates clinical trials in the UK.
Health benefits of folic acid
Authors: Novak Barbara
Published: May 2014

Folic acid, as the anionic folate, is a watersoluble vitamin B9 considered to be of immense health benefit. Folic acid is a synthetic product that can be used to supplement the naturally occurring dietary folate. Links between dietary folate deficiencies and megaloblastic anaemia provided the early impetus for a more critical review of evidence concerning the biological role of this vitamin. The current scientific evidence supports the view that good dietary folate intake and folic acid supplementation are not confined to haematopoiesis but also play important roles in cell division and cellular metabolism throughout life. The biochemical mechanisms are complex and not fully understood, although the benefits of folate/folic acid in reducing the occurrence of major congenital defects and sustaining more tolerable homocysteine plasma values should not be ignored.
Understanding clinical trials: recruitment and patient protection
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

In the second article on clinical trials, Richard Griffith and Cassam Tengnah discuss how participants are recruited and what measures are in place to protect their health and safety.
Research and development
Authors: O'Connell Nicola
Published: May 2014

A randomized, double-blind, placebo-controlled trial of infliximab showed that the drug failed to improve symptoms of moderate to severe chronic obstructive pulmonary disease (COPD).
Legal requirements for prescribers conducting intimate examinations
Authors: Griffith Richard
Published: May 2014

In the course of their duties nurse prescribers will need to touch patients to be able to examine them or provide the treatment that has been prescribed. This can frequently involve touching an intimate part of the body. To ensure that patients are protected the law makes specific provisions that must be followed for intimate touching to be lawful. This article outlines the legal requirements that nurse prescribers must follow when carrying out intimate examinations and treatments to ensure that their actions are above reproach.
The informatics revolution: are you ready for it?
Authors: Hosker Neil
Published: May 2014

This is the first in a series of three articles that will look at the background to the development of information technology (IT) in health care, its impact on nursing practice, what nurses need to know and why, as well as discussing the benefits and issues associated with the use of IT by nurses.
Non-adherence in HIV: a life-threatening problem
Authors: O’Connell Nicola
Published: May 2014

The importance of medication adherence in HIV is now increasingly recognized. In June, the European HIV Adherence Network (EHAN) held what has now become an annual event; EHAN’s objective is to help HIV physicians, pharmacists and nurses identify factors that influence adherence to long-term HIV therapy. Workshops were held throughout the 2-day event, held in Nice, to look specifically at the consequences of poor adherence, measuring adherence and developing strategies to implement in clinical practice, e.g. using practical tools, motivational interviewing and individualizing treatment regimens.
Research and development round-up: July 2007
Authors: O’Connell Nicola
Published: May 2014

Two pivotal phase III clinical trials, PRECiSE 1 and PRECiSE 2, demonstrate the safety and sustained efficacy of certolizumab pegol, the first and only PEGylated anti-TNF (tumor necrosis factor) therapy.
Working with computers: learning the essential skills
Authors: Hosker Neil
Published: May 2014

The work of nurses and other health professionals increasingly involves using computers, either in support of patient care or their own formal and informal learning. Using computer systems in health care has its own challenges and responsibilities, which require users to be both competent in the use of IT and knowledgeable about the systems they use. It is also very important that individuals are familiar with the relevant legislation and guidelines as any failure to meet professional and legal obligations are likely to result in compromised patient care, making the individual vulnerable to legal action and allegations of misconduct. Opportunities for healthcare staff, and particularly nurses, to develop their skills and knowledge appear to be variable, making this an area where you should consider taking responsibility for your own learning and developing a personal action plan.
World Osteoporosis Day:raising awareness
Authors: O'Connell Nicola
Published: May 2014

Osteoporosis currently affects one third of postmenopausal women and one in 10 men over the age of 50 years, so there is clearly a need to reach out to the public and inform them about this debilitating disease. World Osteoporosis Day, on 20 October, aims to do just that, by increasing bone health awareness and encouraging people to take modifiable action to reduce the risk of developing osteoporosis.
Exploiting the potential of informatics in health care
Authors: Hosker Neil
Published: May 2014

The electronic records and systems being introduced across the UK have the potential to contribute to high quality patient-centred care. Decision support, telemedicine, telecare and automation of clinical and administrative processes are all demonstrating benefits. In the last article of the series, Neil Hosker examines the use and benefits of informatics in health care.
Legal regulations for management of health care waste
Authors: Griffith Richard
Published: May 2014

European concerns over the environmental impact of waste have led to a dramatic increase in legislation regulating waste management. In this article Richard Griffith considers the law regulating the nurse prescriber's duty to safely dispose of the waste generated in the course of their work with patients.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

Myself and eight other registered mental nurses intend to run a pilot for independent prescribing for our mental health trust, but we feel strongly that the responsibility that goes with prescribing should be recognized by Agenda for Change and the Trust. Are there any Trusts that have recognized this qualification by changing the banding? We are currently working to Band 6.
Treatment of otitis externa
Authors: Mills Linda
Published: May 2014

Otitis externa is a condition commonly seen in primary care. Treatment options are many and varied; however, if otitis externa is not treated appropriately symptoms may persist and cause patients unnecessary discomfort and deafness. This article looks at the different types of otitis externa and the various treatment options available.
Research and development round-up: December 2007
Authors: O'Connell Nicola
Published: May 2014

Researchers report that just 4 months of hormonal therapy before, and with standard external beam radiation therapy slowed cancer growth by as much as 8 years—especially the development of bone metastases —and increased survival in older men with potentially aggressive prostate cancer.
Don't forget the boys
Authors: Otway Christine
Published: May 2014

As Christmas hurtles towards us, and time for shopping is counted in days rather than weeks, some of you may, like me, be completely stuck for present ideas for the men in our lives. My husband never gives any clues as to what he would like Santa to bring, and more oft en than not, I end up buying something at the very last minute because of a lack of inspiration. I then feel guilty, thinking I have neglected him, and wish I had thought about what he really needed a little earlier. Over the years I have learned something about what I think my husband likes—only to be disappointed at the times when I get it wrong. I, on the other hand, give my husband so many clues and suggestions as to what I'd like, the only thing he has to worry about is whether he can afford me!
Prescriptions, PSDs and PGDs
Authors: Griffith Richard
Published: May 2014

The Medicines Act 1968 and its regulations authorize the supply and administration of prescription only medicines. The 1968 Act generally requires an appropriate practitioner to provide a prescription for the supply of such drugs. The Prescription Only Medicines (Human Use) Order 1997, however, allows for a more flexible approach to the supply and administration of prescription only medicines through the use of patient specific directions (PSDs) and patient group directions (PGDs). This article outlines the legal requirements for a valid prescription, PSD and PGD.
More help for quitters
Authors: Otway Christine
Published: May 2014

Our February edition offers you lots of interesting articles as usual, but one of particular interest to me is the article by Rhona Bishop and Susan Redman on improving smoking cessation services for patients. In my health visiting days, before I was a prescriber, I used to run a ‘stop smoking support group’. Now with the ability to prescribe nicotine replacement products, I look back and can see just how much more successful that clinic might have been. Attitudes towards providing help and support for patients have improved over the last decade and it is good to see that nurse prescribers are taking an active role in this process.
Improving smoking cessation services for patients
Authors: Bishop Rhona , Redman Susan
Published: May 2014

Recent policy relating to smoking cessation, including the ban on smoking in public places across the UK, has encouraged practitioners delivering smoking cessation services to consider ways of improving and enhancing services to clients who wish to stop smoking. This article discusses how a smoking cessation practitioner, working in a primary care setting improved the smoking cessation services provided to clients by becoming a nurse independent prescriber.
Fifth Annual Nurse Prescribing Conference: challenges discussed
Authors: Peniston-Bird Fiona
Published: May 2014

The fifth annual Nurse Prescribing conference considered the use of independent and supplementary prescribing and patient group directions for all nurses and nurse managers. The challenges and issues facing nurse prescribing were also discussed.
Patient confidentiality: rights and duties of nurse prescribers
Authors: Griffith Richard
Published: May 2014

The need to share information about patients is particularly necessary for nurse prescribers to ensure effective care and treatment for patients. The requirement to work collaboratively with colleagues is a fundamental duty shared by all nurse prescribers. However, this duty to share information is often met with reluctance because of a misunderstanding over the extent of the duty of confidence to patients. This has resulted in the needs of patients being unmet and in some cases, tragic deaths have occurred. This article outlines the extent of a nurse prescriber's duty of confidence and considers the examples when sharing patient information is lawful.
Research and development round-up: February 2008
Authors: O'Connell Nicola
Published: May 2014

Vitamin supplements do not protect against lung cancer, according to a study of more than 77 000 vitamin users, and some supplements may even increase the risk of developing it.
End the Easter confusion
Authors: Otway Christine
Published: May 2014

Hope you all had a good Christmas—sorry, I mean Easter—forgive my confusion after the Spring snowfall! However, it's not just the weather that's been perplexing recently, but also some developments in prescribing in my area.
Cerumen and its function
Authors: Cragg Gwen
Published: May 2014

Wax, or cerumen, its impaction in patients' ears and its removal, may not seem the most exciting topic but can be very interesting if time is taken to appreciate the complexity of its nature and function. The successful removal of impacted cerumen can be very gratifying and can instantaneously improve the quality of life for our patients. The following article will discuss the constituents of cerumen, its purpose, how to remove it safely and how to educate our patients, leading to a reduction in the need for nursing intervention.
Research and development round-up: March 2008
Authors: O'Connell Nicola
Published: May 2014

A small dose of aspirin on alternate days can cut the risk of developing asthma among women, suggests a large study.
Research and development round-up: April 2008
Authors: O'Connell Nicola
Published: May 2014

A large, randomized drug trial has shown for the first time that statin drugs result in a modest, but significant, reduction in blood pressure. These effects may contribute to the reduced risk of stroke and cardiovascular events reported for patients on statins, according to study lead investigator Beatrice Golomb. Th e double-blind, placebo-controlled study involved 973 men and women.
Don't forget to take the tablets
Authors: Otway Christine
Published: May 2014

I think that June is my favourite month of the year, especially when the sun is shining and I am reminded how lucky I am to live in such a green and pleasant land.
Cannabis: Class B or Class C?
Authors: O'Connell Nicola
Published: May 2014

The news that cannabis will return to being a Class B drug from early next year will please those who have long warned of the drug's association with a range of short-and long-term mental health problems—despite the fact that an expert panel of advisers said there was currently a lack of scientific evidence and did not recommend the move back up to Class B.
Research and development round-up: June 2008
Authors: O'Connell Nicola
Published: May 2014

Findings from a novel, randomized, double-blind, placebo-controlled Phase III study showed that patients with moderately-to-severely active rheumatoid arthritis (RA) who were previously treated with anti-tumor necrosis factor (TNF)-alpha agents, experienced significant improvements aft er receiving anti TNF-alpha therapy golimumab.
Prescribing in anxiety
Authors: Snowden Austyn
Published: May 2014

Anxiolytics are effective treatments for anxiety. This article discusses prescribing decisions against a backdrop of current NICE guideline for anxiety. As in treatment of psychosis and depression the article argues that pharmacological intervention is warranted then accurate, replicable, structured and systematic diagnosis is the key to a clear decision. Prescribing should encompass extensive knowledge of potential adverse events and risk factors. These issues are outlined.
Research and development round-up: July 2008
Authors: O'Connell Nicola
Published: May 2014

Pregnancy rates decrease and miscarriages increase when a father is over 35 years of age, according to new data.
Insomnia: management and treatments
Authors: Snowden Austyn
Published: May 2014

The National Institute for Health and Clinical Excellence (NICE) guideline for treatment of insomnia suggests non-pharmacological interventions should take priority. This article discusses the rationale for this and grounds it in the evidence for and against pharmacological intervention. Different definitions of primary insomnia are elaborated alongside current understanding of normal sleep. Prescribing decisions are considered against this backdrop and it is concluded that optimal treatment will take place within an evidence-based concordant partnership.
Antidepressants: prescribing rationale and uses
Authors: Bennett Stephen
Published: May 2014

This article aims to provide an introduction to the pharmacological agents available for the treatment of depression. Brief information on the different classes of drugs will be provided along with their major members, common side-effects, and special issues relating to their clinical use.
Research and development round-up: August 2008
Authors: O'Connell Nicola
Published: May 2014

New results from three phase III clinical studies for the novel centrally-acting analgesic tapentadol show similar high efficacy of tapentadol immediate release tablets (IR) compared with standard opioid oxycodone IR, among patients treated for severe pain. Those taking tapentadol, however, benefited from lower incidences of side effects, particularly gastrointestinal (GI) side-effects.
Prescribing innovation in the NHS: cost cutting and enhanced care
Authors: Carroll Martyn
Published: May 2014

An increasing number of primary care organisations are tackling rising healthcare costs and drug wastage through the use of a prescribing decision support tool called ScriptSwitch. Martyn Carroll, Head of Medicines Management at ScriptSwitch, examines the financial challenges that prescribers are currently facing in the NHS and provides an insight into a simple yet innovative solution.
Research and development round-up: December 2008
Authors: O’Connell Nicola
Published: May 2014

An analysis of previous studies indicates that smoking is significantly associated with an increased risk for colorectal cancer and death, according to a new article published in JAMA.
Reducing the risks inherent in paediatric therapeutics
Authors: Tomlin Steve , Morris Heather
Published: May 2014

Paediatric prescribing is fraught with difficulties, underlined by the paucity of appropriately tested medicines. As a result, between 11% (general practice) and 80% of children (neonatal intensive care units) receive unlicensed or off-label drugs. A lack of suitable formulations compound the inherent problems with paediatric therapeutics, and dosing errors are relatively common. Guidelines aim to help minimize these problems and improve our understanding of the clinical, ethical and legal issues surrounding unlicensed paediatric medicines. Each type of unlicensed medicine has advantages and disadvantages; however, specials or licensed imports should be used in preference to extemporaneous medicines, which usually lack rigorous quality control. Manipulating medicines (such as opening capsules or crushing tablets) should be used only if all other approaches are impracticable or inappropriate. Good communication between primary and secondary care, and with patients and carers, is critical. Finally, legal liability can rest with community health professionals, even if secondary care instigated the unlicensed or off-label medicines. Community health professionals can take several steps to reduce their potential liability and help ensure quality treatment for children.
Getting ahead of tinea capitis
Authors: Greener Mark
Published: May 2014

The clinical presentation of tinea capitis (fungal infections of the scalp) ranges from mild scaling, to widespread alopecia, to markedly inflamed and suppurating kerions. Tinea capitis tends to be most common in children aged between 6 and 10 years, although adolescents and adults can contract fungal scalp infections and be asymptomatic carriers. The dermatophyte Trichophyton tonsurans causes between 50% and 90% of tinea capitis cases in the UK. However, the wide range of potential pathogens—especially among people originating in, or who have visited, foreign countries—and diagnostic difficulties mandate mycological testing. Fungi can infect the hair shaft, which protects the dermatophyte from topical antifungals. Yet despite tinea capitis being common, there are relatively few approved oral antifungals licensed for the condition. Nevertheless, a 6–12-week course of oral griseofulvin produces mycological cures in between 70% and 100% of tinea capitis cases. Topical antifungals may reduce transmission and nurses can encourage the family to follow some simple steps that reduce the risk of further infection.
Research and development round-up: October 2009
Authors: O'Connell Nicola
Published: May 2014

People with high levels of C-reactive protein (CRP), a marker for infl ammation in the blood, may be at higher risk for heart attack and death but not stroke, according to a recent study.
Prescribing antibiotics: penicillins and cephalosporins
Authors: Palit Piali
Published: May 2014

This article provides a brief overview of the actions of penicillins and cephalosporins, members of the β-lactam family of antibiotics, the most widely used class of antibiotics. It discusses the factors influencing the prescribing of antibiotics, and the significance of bacterial resistance. It considers adverse reactions and drug interactions, and also outlines the use of the β-lactam family of antibiotics in combating some important infections, including meningitis, community- and hospital-acquired pneumonia, infective endocarditis, and Staphylococcus aureus.
New professional body signals pharmacy change
Authors: O’Connell Nicola
Published: May 2014

These are times of great change and upheaval for pharmacy. Last year the Government published a White Paper, Pharmacy in England: building on strengths, delivering the future, which sets out a vision to consolidate the strengths of pharmacy, as part of an overall strategy to ensure safe, effective, fairer and more personalized patient care (Department of Health (DH), 2008).
Statins for dyslipidaemia: actions and prescribing rationale
Authors: Panchmatia Shailesh
Published: May 2014

This article provides a summary of the issues associated with the prescribing of statins. The importance of cardiovascular disease is discussed, and shows how statins can help to reduce this disease. The pharmacology of this drug class is discussed, along with adverse drug reactions and drug interactions. Information on patient counselling is included.
Antihistamines: mode of action, prescribing rationale and uses
Authors: Waterfield Jon
Published: May 2014

This article provides a summary of some of the issues associated with the prescribing of antihistamines for seasonal allergic rhinitis. There is a consideration of their pharmacological mode of action and a brief overview of sedating and non-sedating antihistamines. A pre-reading self assessment provides the opportunity for the reader to assess prior knowledge of this area. There is a discussion of some of the more important prescribing issues including adverse effects and drug interactions.
Research and development round-up: March 2009
Authors: O’Connell Nicola
Published: May 2014

Women with higher intake of calcium appear to have a lower risk of cancer overall, and both men and women with high calcium intakes have lower risks of colorectal cancer and other cancers of the digestive system, according to a new report.
Management and treatment of the person with psoriasis
Authors: Peate Ian
Published: May 2014

Psoriasis is a common, chronic recurring skin condition. The condition is characterized by an eruption of sharply demarcated red papules and plaques that have overlying silvery scales and it affects men and women equally and can occur at any age. This article provides an insight and understanding into the common condition, while outlining the signs and symptoms and the investigations required to make a diagnosis.
Opioids: prescribing rationale and uses in pain management
Authors: Hall Sandra
Published: May 2014

This article provides a summary of the issues associated with prescribing opioids. It includes a definition of pain and the factors affecting the perception of pain and the pain threshold. The article addresses what opioids are, how they work and the common side-effects associated with them. Finally, it briefl y signposts the reader to further information that can be accessed when required to convert one opioid to another, deciding on the dose and frequency of an opioid to be prescribed and writing the opioid prescription itself.
Pharmacological symptom relief in end-stage COPD
Authors: Barnett Margaret
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is a chronic condition, which is on the increase, causing 29 000 deaths a year in the UK with many more patients undiagnosed. Those patients with end-stage COPD often have signifi cant palliative care needs that are unmet and many receive little or no specialist input. The symptoms these patients experience, particularly breathlessness, are frequently distressing. It is therefore essential that health professionals caring for these patients ensure optimal medication is prescribed to achieve adequate symptom control and relief in order to enable the patient to regain some quality in the remainder of their life. This article provides some guidance to health professionals on the most common symptoms experienced by patients with end-stage COPD and drugs available to help achieve adequate symptom control.
Role of the law in controlling the spread of tuberculosis
Authors: Griffith Richard
Published: May 2014

The incidence of infectious respiratory tuberculosis is increasing in the UK and represents a real risk to public health if not identified and treated. Nurse prescribers are often charged with the extended management of these patients. It is therefore essential that nurse prescribers are aware of the legal powers that are available, if a patient fails to cooperate with treatment, to ensure the effective management of infectious respiratory tract tuberculosis and prevent the spread of the disease.
Panic pandemic or is swine flu a real cause for concern?
Authors: O'Connell Nicola
Published: May 2014

It has been described as a ‘media illness’ and as a major pandemic sweeping across the globe, ultimately affecting one third of the world's population and leaving many thousands of deaths in its wake. But just how worried should we be about swine flu? With the constant hype and ever-changing predictions, it's becoming increasingly difficult to separate the facts from the fiction.
Topical diclofenac: formulations for treating inflammatory pain
Authors: Banning Maggi
Published: May 2014

Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) commonly used for symptom control in osteoarthritis (OA) of the knee and soft tissue injuries. Topical formulations of diclofenac are preferred as they are associated with good efficacy but do not have the potentially serious adverse effects involving the gastrointestinal and renal systems. Numerous studies have shown that topical diclofenac can be a practical alternative method of treatment for patients with OA of the knee, acute blunt trauma, as well as soft tissue injury involving the ankle, knee or shoulder without causing major adverse effects.

Numerous topical formulations of diclofenac are available. Mobigel has been recently launched in the UK and has an improved pharmacokinetic profile with greater plasma concentrations than commonly used diclofenac formulations such as DHEP plaster. In addition, Mobigel is well tolerated and its use is enhanced by the convenient packaging, non-greasy formulation and ease of application.
Realizing the potential of membrane ion channels
Authors: Greener Mark
Published: May 2014

Cells use ions — such as sodium, potassium and calcium — to perform essential biological functions. However, ions cannot cross the cell's lipid membrane; instead ion channels form ‘tunnels’through cell membranes and control the fl ow of ions. Nurse prescribers use drugs targeting ion channels to manage angina, hypertension, cardiac arrhythmias, pain, epilepsy and even influenza. Nevertheless, drugs targeting ion channels have not realized their full potential. Furthermore, alterations in ion channels — which are often genetically determined — contribute to the risk of developing several diseases, including epilepsy, alcoholism and atrial fibrillation. Some alterations can potentially result in serious adverse events with commonly used drugs, and contribute to inter-patient differences in outcomes. This article considers some ion channels currently attracting researchers' attention, to exemplify their clinical potential, and to help nurse prescribers understand how certain drugs act and appreciate the link between abnormal ion channels and disease.
Research and development round-up: July 2009
Authors: O'Connell Nicola
Published: May 2014

Researchers from the Centers for Disease Control and Prevention (CDC) found that survival among women with ovarian cancer is influenced by age of menarche and total number of lifetime ovulatory cycles.
Tackling the burden of pain
Authors: Greener Mark
Published: May 2014

Pain is an almost universal human experience that is essential for survival. Nevertheless, pain is also a deeply, intensely personal event. Patients with a congenital inability to perceive pain can walk over burning coals, stab knives through their arms and drive spikes through their hands. Some patients with congenital limb abnormalities endure phantom pain in an arm or leg they have never had. The wide range of currently available analgesics allows nurse prescribers to tailor treatment to each patient. For example, as paracetamol acts through a different mechanism to codeine, combination therapy increases the proportion of patients that experience adequate analgesia. This feature examines the neurological basis of pain and reviews the role of co-codamol.
Prescribing for psoriasis: choosing the best option
Authors: Wheeler Tracey
Published: May 2014

Psoriasis is a chronic inflammatory skin condition with significant physical and psychological impact, which is also associated with the risk of some significant co-morbidities. It is important for the prescriber to be aware of all the options available for treatment, including details of topical treatment application and monitoring needs. All potential risks need to be discussed with the patient before prescribing.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

I work as a Health Visitor and so prescribe from the Nurse Prescribers Formulary (NPF) and not from the British National Formulary.
Non-medical prescribing will remain key in years to come
Authors: Stuttle Barbara
Published: May 2014

The committee members of the Association for Nurse Prescribing (ANP) are now, and for the next few months, presenting a regular column in the pages of the journal. In this second instalment, Barbara Stuttle, CBE, explains why non-medical prescribing, and particularly nurse prescribing, is still high on the agenda for health care
Prescribing for depression: a case study
Authors: Laird-Measures Jeanette
Published: May 2014

Medication can play a crucial role in alleviating symptoms in moderate to severe depression, and psychosocial interventions are also extremely important. In this article, a case study of prescribing —within a community mental health team including a visiting psychiatrist—for a patient suffering from depression is presented. The SBAR (Situation, Background, Assessment, Recommendations) format was used to present the history. This case study presents a typical progression of a depressive episode at the severe end of the spectrum. Prescribing decisions were made by the Community Psychiatric Nurse based on clinical assessment, presenting features, her knowledge and skills, and in consultation with the patient, his wife, and at times the Consultant Psychiatrist. When it became clear that the initial drug was not providing the symptom relief anticipated, alternatives were sought, and ultimately progress was made.
Nurse prescribing in the field of contraception
Authors: Proctor Tina
Published: May 2014

This article looks at the prescribing practices of nurses working within the area of contraception. It highlights the most common methods of contraception and emphasizes when it is important not to issue/prescribe specific methods because of certain co-existing medical conditions.
Risk assessment for new therapies in inflammatory bowel disease
Authors: Stansfield Catherine
Published: May 2014

The article reflects on the use of risk assessment in preparing to introduce a new therapy in a patient with a concurrent diagnosis of Crohn's disease and multiple sclerosis. It reflects upon the process by which the author considered the prescribing of azathioprine and allopurinol (as a combination therapy) as an alternative to introducing infliximab—a biological therapy—for the management of patients with Crohn's disease. Particular emphasis is placed on the undertaking of a risk assessment, the implementation of therapy change, and the impact on the author's role as an advanced practitioner.
CPD for Non-Medical Prescribers – A Practical Guide
Authors: Novak Barbara V
Published: May 2014

This book consists of three distinctive sections, each of which represents a specific focus on carefully selected aspects of continuing professional development (CPD) for non-medical prescribers.
Research and development roundup: November 2010
Authors: Brown Harry
Published: May 2014

An important lesson in drug regulation was recently provided in the New England Journal of Medicine. The main learning point is that if a problem is flagged up about a drug, it is not always necessary to hastily tighten or restrict its use, unless strong, thoroughly evaluated scientific evidence is available to support the case.
Improving adherence: the role of long-acting reversible contraception
Authors: Kipps Sarah
Published: May 2014

Some women do not engage with contraception, which can lead to increased financial costs for health services, and to an emotional cost for the women themselves. Encouraging adherence is discussed in the context of the NICE guidelines (2009). Reasons for nonadherence, both intentional and unintentional, are considered. Long-acting reversible contraception, which does not require daily concordance, can be useful in tackling unintentional non-adherence. Reasons for intentional non-adherence are considered, including pre-existing fears and concerns. Prescribers need to be skilled communicators, and understand and take into account a woman's personal belief system around contraception.
Reducing the risk of VTE: the new NICE clinical guideline
Authors: Duggan-Keen Margaret
Published: May 2014

Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), is responsible for an estimated 25 000 preventable deaths each year in patients admitted to hospital in the UK. The latest clinical guideline on VTE prevention from the National Institute for Health and Clinical Excellence (NICE; CG92) recommends that all patients be assessed for VTE risk on admission to hospital and then provided with preventive treatment tailored to their individual needs. The NICE guideline includes clear advice on assessing the risk of VTE according to the reason for admission and other relevant factors, such as age and comorbidities, selecting the most appropriate treatment (including balancing the risk of VTE versus the risk of bleeding) and effective communication with patients. Implementation of this guideline has the potential to prevent unnecessary deaths due to VTE, and to reduce long-term illnesses associated with non-fatal symptomatic VTE.
Prescribing anti-obesity preparations
Authors: Waterfield Jon
Published: May 2014

After a brief consideration of body mass index as a measure of obesity and the types of pharmacological interventions available, the article focuses on orlistat, the only licensed anti-obesity drug described in the British National Formulary. A consideration of the mechanism of action of this agent and a discussion of specific prescribing issues are presented. The reader has the opportunity to self-check his/her own knowledge with a pre-reading self-assessment.
Doing Objective Structural Clinical Examinations differently
Authors: Cheesman Sarah
Published: May 2014

The Objective Structured Clinical Examination (OSCE) is identified by the Nursing & Midwifery Council (NMC, 2006) as an important element of the assessment strategy for independent and supplementary prescribing programmes. Traditionally, OSCEs have involved students being assessed at a number of stations, generally within a clinical skills laboratory, through involved scenarios rather than real-life situations. This article describes how the OSCE has evolved at one Higher Education provider in England.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

With the recent amendment to legislation around the mixing of medicines and nurse independent prescribers and pharmacist independent prescribers being able to prescribe unlicensed medicines independently, am I correct in thinking that for nurses, until the change to the Misuse of Drugs Regulations 2001, related to the consultation in 2007 around nurses and pharmacists independently prescribing controlled drugs happens, controlled drugs are not included in the mixing/unlicensed change? Specifically, does this include mixing diamorphine and midazolam for use in palliative care, despite the fact that they are two of the 13 controlled drugs listed in the back of the British National Formulary, which nurses are able to independently prescribe. It occurs to me that in mixing them they become another drug so are no longer within that list of 13.
Drug development: bench to bedside
Authors: Greener Mark
Published: May 2014

Developing new medicines is risky, costly and time consuming. Fewer than one-in-ten drugs that enter human trials reach the market, developing a new medicine takes, on average, 10–12 years and may cost more than £550 million. Increasingly, clinical development does not end with the new drug's launch: postmarketing studies collect evidence about the medicine's safety and efficacy in clinical practice. Nevertheless, nurses should still ensure that they use the Yellow Card system to report possible adverse events. This article introduces the stages in the clinical development of a new drug to help place the scientific literature and pharmaceutical companies' promotional and educational initiativesin context. In particular, the review discusses the gulf between many pivotal trials and practice, that may limit nurses' ability to extrapolate the result to their clinics. Clinical programmes may aim to meet the needs of the regulatory authorities first and clinicians, at best, second. Therefore, nurse prescribers must critically and closely read the papers supporting any drug they use rather than rely on promotional aids and pharmaceutical sales pitch alone.
Prescribing in lipid management
Authors: Bostock-Cox Beverley
Published: May 2014

Lipid management is a key element in the treatment of both diabetes and cardiovascular disease (CVD). Best practice in primary prevention will assess the risk of CVD in the patient, and the prescribing of statins to reduce any risk possibility; and in secondary prevention— for those with established CVD—the routine use of a statin is advised, unless there are clear contraindications. This article examines the range of treatments available for lipid management, including both statins and other treatments, based on the most recent guidance from the National Institute for Health and Clinical Excellence.
Prescribing for acute diarrhoea
Authors: Waterfield Jon
Published: May 2014

This article provides an overview of the main drugs used in the treatment of acute diarrhoea. There is reference to some of the prescribing issues associated with oral rehydration therapy and the use of antimotility agents. Other prescribing issues associated with acute diarrhoea are also discussed. The reader has the opportunity to self-check his/her own knowledge with a pre-reading self-assessment.
Atopic eczema: diagnosis and management
Authors: Watkins Jean
Published: May 2014

This article discusses the common problem of atopic eczema, together with the range of complications that would require urgent interference with the appropriate medication, and/or referral to a specialist (or even admission to hospital). It is paramount that the patient and his/her family understand how and when to use the treatments, and when and where to seek help quickly should it be required.
Prescribing in travel health: malaria
Authors: Umeed Margaret
Published: May 2014

Half of the world's population, approximately 3.3 billion people, live in a malarious risk area. Every year, this causes 250 million cases and approximately 1 million deaths globally (World Health Organization, 2010a). Recent UK figures (Health Protection Agency (HPA), 2010) indicates there was almost 1500 cases of malaria imported into the UK during 2009, and the group that were consistently likely to acquire malaria were those visiting friends and relatives (VFRs). Where ethnicity was recorded, almost 1000 travellers were African or of African descent: 54% of those diagnosed with malaria had travelled to West Africa and a staggering 84% had not taken any malaria chemoprophylaxis. It is essential that any health professional advising travellers should be aware of the risk of malaria and of the ABCD steps which a consultation should follow in order to provide the traveller with the most appropriate advice and chemoprophylaxis.
Parasites: nature's marvellous squatters
Authors: Greener Mark
Published: May 2014

Parasites are a diverse group of organisms that rely on host animals for nutrition, transport and protection. Humans and their parasites co-evolved, often over millions of years. During this time, parasites developed, as Darwin remarked, ‘beautiful co-adaptations’, while hosts evolved effective defences. As a result, most parasites common in the UK usually produce mild symptoms. However, the balance can tip towards humans—if we develop effective treatments—or towards the parasite. If resistance emerges, they move to a new host, or in vulnerable patients. Furthermore, some parasites can transmit potentially deadly microorganisms. This article examines a number of common parasites that nurses may encounter, introduces management strategies, and describes how some parasites influence the risk of developing asthma and cancer.