bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and cost-effectiveness of absorbent dressings in the treatment of highly exuding VLUs
Authors: Panca M. , Cutting K. , Guest J.F.
Published: May 2014

Objective:

To estimate the clinical effectiveness and cost effectiveness of using a sodium carboxymethylcellulose dressing (CMC [Aquacel]) and four superabsorbent dressings (DryMax Extra [DM], Flivasorb [F], Kerramax [K] and sachet S [S]) in the treatment of highly exuding chronic venous leg ulcers (VLUs) in the UK, from the perspective of the National Health Service (NHS).

Method:

A decision model was constructed depicting the patient pathways and associated management of a cohort of 439 patients with highly exuding chronic VLUs of ≥ 3 months of age. The model was based on the case records of a cohort of matched patients from The Health Improvement Network (THIN) database (a nationally representative database of patients registered with general practitioners (GPs) in the UK) who were treated with one of the five dressings. The model estimated the costs and outcomes of patient management over 6 months and the relative cost-effectiveness of using each dressing.

Results:

Patients' mean age was 73.1 years, and 46% were female. Between 39% and 56% of VLUs healed by 6 months. CMC-treated wounds that remained unhealed increased in size by 43% over the study period, whereas unhealed wounds treated with the other dressings decreased in size by a mean 34%. Consequently, CMC was excluded from the cost-effectiveness analysis. The 6-monthly NHS cost of managing a VLU with S was £3700 per patient, which was 15–28% lower than the cost of managing patients with the other three superabsorbents. Additonally, use of S improved patients' health status to a greater extent than the other three superabsorbents, since S-treated patients accrued 0.3–3% more QALYs. Starting treatment with S was the preferred strategy followed by DM, K and F in that order.

Conclusion:

Within the limitations of the data set, S affords the NHS a cost-effective treatment for managing highly exuding chronic VLUs of ≥3 months of age, compared with DM, F, K and CMC.

Declaration of interest:

This study was funded with an unrestricted research grant from Sorbion GmbH & Co. KG, Senden, Germany, manufacturers of sachet S. However, Sorbion did not have any control of the methodology, conduct, results or conclusion of this study, or editorial involvement in this manuscript. The authors have no other conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility
SAP-containing dressings exhibit sustained antimicrobial effects over 7 days in vitro
Authors: Wiegand C. , Abel M. , Muldoon J. , Ruth P. , Hipler U.C.
Published: May 2014

Objective:

To investigate the antimicrobial activity of SAP-containing wound dressings in vitro over a prolonged period of time (7 days) and to assess their ability to sustain the antimicrobial effect.

Method:

SAP dressings were tested according to the JIS L 1902:2002 against the pathogens Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli and Candida albicans. Additionally, effect on S. aureus and P. aeruginosa growth was investigated after a prolonged incubation period of 7 days. Furthermore, both SAP dressings were repeatedly inoculated with P. aeruginosa suspension and, after 7 days, microbial growth under the dressings was evaluated.

Results:

Both SAP-containing wound dressings tested exhibited a significant to strong antimicrobial activity against Staphylococcus aureus, MRSA, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Candida albicans in vitro. Moreover, it could be shown that they were able to sustain antibacterial efficacy over a prolonged period of time. Using a direct incubation method with repeated re-inoculation of the dressing samples, it could be shown that growth of P. aeruginosa was reduced after 4 days of treatment and completely inhibited after 7 days. No significant differences were observed between the two SAP-dressings tested.

Conclusion:

These in vitro experiments impressively demonstrated the antimicrobial mechanism of SAP-containing wound dressings: rapid up-take of fluid, binding of microorganisms to the SAP-core, and retention of the bacteria inside the dressing. Moreover, it could be shown that they are able to exhibit their antimicrobial activity over a prolonged period of time unless the amount of fluid present exceeds their fluid-handling capacity.

Declaration of interest:

This work was supported by Lohmann & Rauscher GmbH & Co KG. Authors M. Abel and P. Ruth are employees of Lohmann & Rauscher; J. Muldoon is an employee of Activa Healthcare UK, a company of Lohmann & Rauscher. C. Wiegand received travel grants from Lohmann & Rauscher, to participate at wound healing conferences.
Handling the sequelae of breast cancer treatment: use of NPWT to enhance patient independence
Authors: Awad T. , Butcher M.
Published: May 2014

A cancer diagnosis can be an overwhelming experience and has devastating implications for an individual, their family and friends. Radical treatment, although often essential, can have its own health consequences. This case study describes the management of a 38-year-old woman with a portable, non-electrical negative pressure wound therapy device, suggesting benefits in terms of healing, patient independence and improved quality of life. The case study also highlights the importance of effective communication, patient involvement and empowerment in clinical decision-making, showing that an effective client-clinician relationship can help overcome the physical and emotional sequelae of this diagnosis.
Inaugural professorial lecture: the progression of trauma wound care—why delay wound closure?
Authors: Shanahan D.R.
Published: May 2014

Despite advances in wound management in recent years, systemic wound infection remains the most common cause of death in patients with large trauma wounds; therefore, it is important that the wound is closed as soon as it is safe, not before and not too long after. However, all surgeons know that many acute trauma wounds cannot be safely closed on the day of injury, so how to judge when this critical window is open? In his inaugural lecture as Professor of Wound Study at Birmingham City University's Tissue Viability Practice Development Unit, Lt Col Professor Steven Jeffery addresses this issue.
Binding and inhibition of protease enzymes, including MMPs, by a superabsorbent dressing in vitro
Authors: Wiegand C. , White R.J.
Published: May 2014

Objective:

To demonstrate the binding and inactivation action of a superabsorbent dressing on proteolytic enzymes MMP-2, MMP-9 and collagenase using an established methodology.

Method:

An in vitro assay of MMP binding and collagenase inactivation has been conducted using the superabsorbent wound dressing (Eclypse; Advancis Medical UK). Dressings in this category, and other absorbents, have been claimed to possess MMP-binding characteristics; however, for most there is no published evidence as yet. In this series of experiments, we have used validated experimental techniques to evaluate such activity.

Results:

Results show that the superabsorbent dressing does have a statistically-significant effect in binding two of the most important MMPs, MMP-2 and MMP-9, as well as inhibiting collagenase.

Conclusion:

These results support this activity for the superabsorbent dressing and indicate a probable beneficial clinical action in reducing the influence of these enzymes in delayed wound healing.

Declaration of interest:

This study was funded by an unrestricted grant from Wound Resources Ltd. The authors have no financial interests in the products concerned. RW is a consultant to numerous wound products companies, including Advancis Medical. CW carried out all experimental tests and data analysis. The analysis of data and manuscript does not imply approval or endorsement of any products mentioned.
The effects of focused-rigidity casts on forefoot plantar pressures: a pilot investigation
Authors: Dagg A.R , Chockalingam N. , Branthwaite H.
Published: May 2014

Objective:

To establish if focused rigidity casts (FRCs) reduce forefoot pressures in healthy participants, and to examine the effects of FRCs on contact area, contact pressure, peak pressure and force–time integral on the forefoot and the plantar pressures of the whole foot in participants with differing foot posture.

Method:

Thirty-one healthy participants were recruited from a convenience sample of university staff and students. This study employed a repeated measures design, where walking in FRCs was compared with a control (canvas shoe). An in-shoe pressure measuring system was used to record changes in plantar pressure and the foot posture index was used to record foot posture.

Results:

A statistically significant reduction in contact pressure (p ≤ 0.000; n=31) and peak pressures (p ≤ 0.002; n=31) was observed in the forefoot. A statistically significant reduction in contact area and contact pressure over the whole foot and rear foot when participants wore the FRC was also found. The greatest decrease occurred in participants with a supinated foot posture while the least occurred in participants with a pronated foot posture. An increase in peak pressure was found in the mid foot for participants with a normal and supinated foot postures when the FRC was worn.

Conclusion:

The results suggest that FRCs are an effective way of reducing forefoot pressures when compared with the control shoe. FRC's work by redistributing pressure away from the forefoot to the area of increased rigidity beneath the cast.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Use of maggot debridement therapy for tropical diabetic hand syndrome
Authors: Jiang K.C. , Luo N. , Chen Y.C. , Liu L. , Wang A.P.
Published: May 2014

Diabetic patients with infectious hand ulceration, known as tropical diabetic hand syndrome (TDHS), are generally less well recognised than those with foot ulcers. Maggot debridement therapy (MDT) is usually used for the treatment of diabetic foot ulcers and, in these wounds, the remarkable wound cleansing properties can be of considerable value. However, it is less commonly used in TDHS. Here we present a case of TDHS in a 51-year-old man with type II diabetes, hypertension and dilated cardiomyopathy, in which conventional therapy had minimal effect, but significant wound debridement was achieved with MDT. This suggests that MDT may be a cost-effective alternative to conventional treatments for the debridement of TDHS.
Wound healing and the role of fibroblasts
Authors: P. Bainbridge
Published: May 2014

Fibroblasts are critical in supporting normal wound healing, involved in key processes such as breaking down the fibrin clot, creating new extra cellular matrix (ECM) and collagen structures to support the other cells associated with effective wound healing, as well as contracting the wound. This article explores and summarises the research evidence on the role of fibroblasts, their origins and activation, and how they navigate the wound bed, as well as how their activity leads to wound contraction. This article also explores the local conditions at the wound site, which activate, regulate and ultimately reduce the fibroblast activity as the skin's integrity returns on healing.
A pilot study on the potential of remote support to enhance wound care for nursing-home patients
Authors: Vowden K. , Vowden P.
Published: May 2014

• Objective: to evaluate the effectiveness of a Telehealth system, using digital pen-and-paper technology and a modifed smartphone, to remotely monitor and support the effectiveness of wound management in nursing home residents.

• Method: A randomised controlled pilot study was conducted in selected nursing homes in bradford, which were randomised to either the control or evaluation group. All patients with a wound of any aetiology or severity, resident in the selected nursing homes were considered eligible to participate in the study. residents in the control homes who had, or developed, a wound during the study period, continued to receive unsupported care directed by the nursing home staff (defined as ‘standard care’), while those in the evaluation homes received standard care supported by input from the remote experts.

• Results: thirty-nine patients with a wound were identified in the 16 participating bradford nursing homes. Analysis of individual patient management pathways suggested that the system provided improved patient outcomes and that it may offer cost savings by improving dressing product selection, decreasing inappropriate onward referral and speeding healing. Despite initial anxiety related to the technology most nursing-home staff found the system of value and many were keen to see the trial continue to form part of routine patient management.

• Conclusion: the current study supports the potential value of telemedicine in wound care and indicates the value that such a system may have to nursing-home staff and patients.

• Declaration of interest: this study was funded by a regional Innovation Fund grant from the Yorkshire and Humberside Strategic Health Authority. the authors have no conflict of interest to declare with respect to the article or its contents.
Evaluation of two fibrous wound dressings for the management of leg ulcers: Results of a European randomised controlled trial (EARTH RCT)
Authors: Meaume S. , Dissemond J. , Addala A. , Vanscheidt W. , Stücker M. , Goerge T. , Perceau G. , Chahim M. , Wicks G. , Perez J. , Tacca O. , Bohbot S.
Published: May 2014

Objective:

To evaluate the performance (efficacy, safety and acceptability) of a new micro-adherent absorbent dressing (UrgoClean®) compared with a hydrofiber dressing (Aquacel®) in the local management of venous leg ulcers, in their debridement stage.

Method:

A non-inferiority European randomised controlled clinical trial (RCT) was conducted in 37 centres, on patients presenting with venous or predominantly venous, mixed aetiology leg ulcers at their sloughy stage (with more than 70% of the wound bed covered with slough at baseline). Patients were followed over a 6-week period and assessed weekly. The primary judgement criteria was the relative regression of the wound surface area after the 6-week treatment period. Secondary endpoints were the relative reduction of sloughy tissue and the percentage of patients presenting with a debrided wound.

Results:

Altogether, 159 patients were randomised to either UrgoClean (test group; n=83) or Aquacel (control group; n=76) dressings. Regarding the wound healing process predictive factors (wound area, duration, ABPI value, recurrence), at baseline, the two groups were well balanced, for both wound and patient characteristics. Compression therapy was administered to both groups and after a median 42-day treatment period, the percentage of relative reduction of the wound surface area was very similar (-36.9% vs -35.4% in the UrgoClean and control groups, respectively). When considering the secondary criteria at week 6, the relative reduction of sloughy tissue was significantly higher in the UrgoClean group than in the control group (-65.3% vs -42,6%; p=0.013). The percentage of debrided wounds was also significantly higher in the test group (52.5% vs 35.1%; p=0.033).

Conclusion:

This ‘EARTH’ RCT confirmed that the UrgoClean dressing has similar efficacy and safety compared to Aquacel. However, UrgoClean also showed better autolytic properties than the control group in the management of venous leg ulcers at the sloughy stage. The new UrgoClean dressing therefore represents a promising therapeutic option within the current range of autolytic dressings available.

Declaration of interest:

This study was sponsored by a grant from the pharmaceutical company Laboratoires Urgo. S. Bohbot and O. Tacca are employees of Laboratoires Urgo. S. Meaume, J. Dissemond and G. Perceau have received monetary compensation as presenters for Laboratoires Urgo. Data management and statistical analyses were conducted independently by Vertical (Paris, France).
Negative pressure wound therapy in the management of postoperative infections after musculoskeletal tumour surgery
Authors: Anagnostakos K. , Mosser P.
Published: May 2014

Objective:

The aim of the present retrospective study was to report on the effectiveness of the negative pressure wound therapy (NPWT) in the treatment of infected wounds after musculoskeletal tumour surgery.

Method:

A total of 12 patients (10 male, 2 female, mean age 44.9 years with 9 early and 3 late infections) were included in the study. Patient parameters measured include age, gender, tumour diagnosis and localisation, pathogen organism, foam used, pressure height and modus, number of NPWT dressings changes, total duration of NPWT, need for secondary wound closure, length of hospitalisation, complications, and follow-up.

Results:

The NPWT dressings were changed on average 6.7 (SD±6.9) times after a mean duration of 5.6 (SD±2.4) days. The total duration of NPWT was 37.7 (SD±32.9) days. The mean hospital stay was 77.5 (SD±58.8) days. In 7 out of 12 cases, a split-thickness skin graft transplantation was performed. In these cases, no seroma or hematoma formation beneath the skin graft could be observed. At a mean follow-up 39.2 (range: 9–73) months, no reinfection or infection persistence was apparent.

Conclusion:

NPWT can be of valuable assistance in the treatment of infected wounds following musculoskeletal tumour surgery. The patients should be informed about the long treatment period.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interests to declare.
Neonatal necrotising fasciitis managed conservatively: An experience from a tertiary centre
Authors: Pandey V. , Gangopadhyay A.N. , Gupta D.K. , Sharma S.P. , Kumar V. , Tiwari P.
Published: May 2014

Objective:

Conventional therapy for neonatal necrotising fasciitis (NF) involves resuscitation and aggressive surgical debridement of necrotic tissue. This approach adds surgical stress in septicaemic neonates with low reserves. The present study reports a more conservative approach to the management of neonatal NF.

Method:

A prospective study was conducted between July 2010 and June 2013 and included 11 cases of neonatal NF. Demographic characteristics of patients were noted. No debridement was performed. Dressings were applied after cleaning with normal saline every 24 hours. The necrotic slough was allowed to separate spontaneously. A record was made of type and duration of supportive modalities and complications. The primary outcome was recorded as final recovery, need of surgical intervention or need of grafting.

Results:

Out of 11 neonates, 6 were males and 5 were females. Age ranged from 13 to 24 days (mean age 18.45±3.24 days), and weight varied from 1.8 to 2.6 kg (mean weight 2.12±0.24kg) at presentation. Duration of illness before admission to hospital ranged from 3 to 9 days (mean 4.84±2.13 days). The most common site of the initial involvement was the neck and upper thoracic region (n=4), scalp (n=3), lower back (n=2), face (n=1) and extremities (n=1). In all cases, the wound was cleaned with normal saline, dressed, necrotic slough was allowed to separate spontaneously and granulation tissue was allowed to develop; this took approximately 14 to 28 days (mean 20.45±5.78 days).

Conclusion:

As opposed to the conventional approach of aggressive debridement in neonatal NF, these cases can be managed conservatively without increase in morbidity or mortality. This approach also minimises the surgical risk and requirement of blood transfusion. Antifungal drugs have a definitive role in management of these immunologically deficient babies.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interests to declare.
Prehospital cardiac auscultation: friend or foe?
Authors: Mallinson Tom
Published: May 2014

A review of the literature was carried out seeking research into paramedic cardiac auscultation skills. No articles were found which addressed the issue of the accuracy of paramedic cardiac auscultation and a number of potential causes for poor quality auscultation in a prehospital environment were discussed. Furthermore, due to the lack of evidence for or against the effectiveness of paramedic cardiac auscultation, two main areas in which cardiac auscultation is strongly advocated in prehospital care were discussed and the importance of this area of clinical practice was highlighted. The lack of research in this area cannot be equated to a lack of ability in this area and further research is needed to influence professional practice and training.
The role of ambulance clinicians in management and leadership
Authors: Taylor James
Published: May 2014

Ambulance clinicians are ‘professional problem solvers’. As such, they share much in common with managers within organizations, and have much to offer in terms of the contribution that they can make to the management and leadership of the organisations within which they work. This article highlights the importance of management and leadership development opportunities being made available for ambulance clinicians. A practical approach is advocated, whereby ‘hybrid roles’ are developed to enable individuals to gain practical experience of management and leadership within a structured and supportive environment, while retaining an element of clinical practice. A case study is used to illustrate the article, based upon the author's own career within the NHS to date which has combined both management and clinical practice with structured management and leadership development. Practical advice is offered for those ambulance clinicians who may be interested in undertaking such development in future, or who wish to explore further their role as clinical leaders.
Glucagon treatment for symptomatic beta blocker overdose
Authors: Fell Matthew
Published: May 2014

Symptomatic beta blocker overdose is a relatively uncommon, but potentially life-threatening condition ( Sheppard, 2006 ; Health Protection Agency, 2010 ). Current definitive treatment for these patients involves intravenous glucagon therapy, and as such, glucagon is considered both a first-line treatment and an antidote in cases of symptomatic beta blocker overdose ( Joint Formulary Committee, 2011 ; National Poisons Information Service, 2011a ; 2011b ). This case report examines an intentional overdose of propranolol, including paramedic prehospital management, and subsequent in-hospital definitive treatment involving intravenous glucagon therapy. Paramedics have experience and knowledge of administering intramuscular glucagon as part of their formulary, and possess the necessary skills for obtaining intravenous access. Therefore, could intravenous glucagon be considered appropriate for administration by paramedics as a prehospital intervention in cases of symptomatic beta blocker overdose?
Prehospital capnography or capnometry: are we going in the right direction?
Authors: Booth Sean , Bloch Mark
Published: May 2014

End tidal carbon dioxide (etCO2) measurements enable accurate monitoring of airway patency, ventilation (self or assisted) and metabolism. It is mandatory in current in-hospital anaesthetic practice and now recommended in the prehospital setting. Traditional methods of capnography have used either mainstream or sidestream devices, but both are not without their disadvantages, which may be potentiated in the prehospital environment. Portable devices either display a waveform (capnography) or a numerical reading alone (capnometry). Waveform capnography is often the preferred mode of CO2 detection in prehospital practice (mirroring experiences from in-hospital), however, there is no published evidence comparing the superiority of either method. The most recent advancement in prehospital capnometry is the introduction of a compact, light-weight, battery powered, self-contained mainstream capnometer. This device has been shown to be accurate when compared with anaesthetic equipment and appears to meet all the qualities required for inclusion as a tool for the improved care of the prehospital patient. It displays only a numerical reading as opposed to some new defibrillators used by certain ambulance services which include waveform capnography. The authors feel this difference would have very little detrimental effect on patient management out-of-hospital. This, coupled with the advantages gained by greater access to etCO2 monitoring, related to both cost and training, considerations have enabled the conclusion that this type of mainstream capnometer should be considered more often for prehospital care.
Paramedic non-technical skills: aviation style behavioural rating systems
Authors: Shields Allan
Published: May 2014

The Department of Health (DH) estimated that in 2000 , approximately 10% of patients were harmed in some way while being cared for by the NHS. This equates to 850 000 patients and approximately £2 million in extended bed stays ( DH, 2000 ). These adverse events are found in all areas of health care. For example, it is estimated that errors in surgery can be attributed to poor communication between members of the surgical team in 43% of cases ( Gawande et al, 2003 ). In addition, cognitive and diagnostic errors contributed to 27% of claims against a healthcare organization ( Wilson, 1999 ). Such errors, once analyzed, often show no lack of technical knowledge or skills on the part of the clinicians, and instead may be attributed to a failure in the non-technical skills of the clinicians and clinical team involved. Non-technical skills are defined as the cognitive (thinking) and social (team working) skills that, when combined with technical knowledge and skills, allow a practitioner to deliver safe and effective patient care ( Flin et al, 2008 ). They help to reduce the frequency of errors and reduce the chance of adverse events. There appears to be little published literature detailing errors made by paramedics or discussing their non-technical skills. Generally, errors made by paramedics in the UK are highlighted through complaints from either hospital clinicians, patients’ families, or patients themselves. These complaints could result in lengthy investigations and often place stress on the ‘offending’ paramedic. It could also be argued that few lessons are learnt by the investigating organization or the profession as a whole. Once the error has occurred, it is too late for the patient, and a pro-active error avoidance approach is required.
Out-of-hospital cardiac arrests in older age groups
Authors: Deasy Conor
Published: May 2014

Cardiopulmonary resuscitation (CPR) in elderly patients requires careful consideration. As the population ages and the burden of chronic diseases grow, paramedics will inevitably encounter, with greater frequency, out-of-hospital cardiac arrests (OHCA) in this population. Attitudes toward resuscitation in elders have shown to vary, based on the perceived likelihood of a successful outcome. Therefore, it is important that the paramedic has available age specific results on what the likelihood is of their patient, who they are deciding to resuscitate, achieving return of spontaneous circulation (ROSC) and, more importantly, surviving to leave hospital. Likewise, it is important for paramedics to understand OHCA outcomes when they are communicating with families of elderly victims of OHCA. Rates of survival to hospital discharge have recently been reported as 8% for those aged 65–79 years, 4% for octogenarians and 2% for nonagenarians. In patients aged 65 years or older, ROSC rates have improved for shockable and non-shockable rhythm OHCAs over the last decade, though survival to hospital discharge has improved in the shockable rhythm group only. Future research needs to address functional and quality of life outcomes for this age group and consider a community-wide approach to expected natural deaths occurring outside of hospital, so that inappropriate resuscitation efforts are avoided.
A response to ‘Fighting the fire’: fire chiefs’ proposal to run England’s ambulance service
Authors: Jone Peter
Published: May 2014

In October 2010, JPP published a comment by Prof Malcolm Woollard, titled ‘Fighting the fire: a response to fire chiefs’ proposal to run England’s ambulance service’, expressing his view as to why the proposal by the Chief Fire Officers Association (CFOA) is not workable. JPP has received a letter regarding this, which is printed below, along with a response from Prof Woollard that also discusses the latest report published by the CFOA.
UK Survey of emergency physicians’ priorities for clinical decision rules
Authors: Mason Suzanne , Bryan Elizabeth , Bircher Thomas , Clesham Katherine , Eagles Debra , Clement Cathy , Stiell Ian
Published: May 2014

One of the first stages in the development of new clinical decision rules (CDRs) is determination of perceived need because this is the most important predictor of ultimate adoption. This study examined the current use of two common CDRs and the clinical priorities of UK emergency physicians (EPs) for the development of future CDRs. Methods: The authors administered an e-mail and postal survey to a random sample of 350 members of the British Association of Emergency Medicine (total membership n=1700). Results: The total response rate was 44.5% (155/350). The respondents were predominantly male (67.7%), with a mean age of 44.0 years (SD +/- 10), and a mean of 10.8 years experience (SD +/- 7). Regarding the two pre-existing Canadian C-spine and CT head rules, 62% of responders were aware of these rules. Regarding a proposed acute headache CDR, 94.6% of those surveyed indicated that they would consider using a highly sensitive and well-validated decision rule if it was developed. The top priorities in the four main categories were admission with anterior chest pain (42.8%), imaging for suspected transient ischaemic attack (34.5%), management of serious vertigo (29.7%) and investigation of febrile child <36 months (40.6%), respectively. Discussion: This UK survey identified the sampled emergency physicians’ priorities for the future development of CDRs. The top priority was investigation of the febrile child < 36 months. These results will be valuable to researchers for future development of CDRs in emergency medicine in the UK.
Are current feedback methods optimal for student understanding and learning?
Authors: Gubbins Karen
Published: May 2014

Student feedback provided to paramedic students is often a contentious issue, with tutors and student paramedics not always agreeing upon the best techniques to employ. It is identified that feedback provided to students should be a learning tool, therefore it should be meaningful. It is also identified that meaning can be lost in the written form, and that face-to-face verbal and visual feedback is the best methods of giving feedback. A research project was undertaken take to elicit the views and opinions on feedback methods, from a group of student paramedics who were new to higher education. the research was undertaken with a view to changing current practice, and improve the experience of student paramedics. Most of the student paramedics opted for tutorial feedback, although one student requested feedback via email. All students were provided with their choice of feedback method and the standard feedback method usually employed. It became obvious during the tutorial time allocated, that time management was going to be largest issue, as the tutorials took a considerable amount of time. The students were then asked how useful each method was to them. Most students stated that the tutorial feedback was where they learnt the most and therefore was the most beneficial. A number of issues were raised during the research, for example: how best to use tutorial time, and how much time should be allocated per student.
Planning and writing an evidence-based critical reflection
Authors: Wade Caroline
Published: May 2014

The shift of training and education of technicians and paramedics towards an academic pathway in higher education Institutes has placed greater emphasis on the need for students to demonstrate clinical effectiveness through evidence– based practice (EBP) and critical reflection in and on practice. However, the health care literature highlights that students often find it difficult to grasp the elements involved in asking questions about their practice, searching the literature and applying their findings to their critical reflections on practice. Evaluation of the learning needs of a group of nursing students reflected these findings. As a result, a guide was formulated to support student nurses in the development and application of these skills when using the Gibbs' model of reflection and this has been adapted for student paramedics. This article presents a set of guidelines which incorporate the Lenburg competency, outcomes and performance assessment (COPA) model (2002); a patient intended outcome, paramedic intervention (PIP) model, and an adapted Gibbs' reflective cycle model ( Figure 1 ) which paramedic students can use to develop the skills required to systematically plan and write evidence based critical reflections on practice.
Can apprenticeships provide an alternative pathway?
Authors: Gregory Pete
Published: May 2014

In a recent Career Development article published in the JPP ( Howson, 2011 ), Alan Howson opened our eyes to the concept of emergency care apprenticeships and posed the question; can the apprenticeship route provide an alternative pathway to paramedic? This is an interesting question and one that should be considered carefully because the consequences of the paramedic profession making a mistake in terms of the future education of its registrants could prove to be hugely damaging to patients and the profession. Here, Pete Gregory, Consultant Editor, JPP and Senior Lecturer in Paramedic Practice, Coventry University, discusses this in more depth.
Evaluation of the use of portfolios in paramedic practice: part 1
Authors: Armitage Ewan
Published: May 2014

2009 saw the first audit of paramedic portfolios by the Health Professions Council (HPC) and later this year, the second national audit will take place. In the first of a two-part evaluation of the use of portfolios in paramedic practice, the history of professional portfolios is chartered including their current position within the paramedic profession. A number of contemporary issues with portfolios are identified, including format and how they relate to a paramedic's continuing professional development. The impact of the Knowledge and Skills Framework on portfolio use is also discussed.
The paramedic kairotope theory: methodology and rationale
Authors: Campeau Anthony
Published: May 2014

Scene management is an important, yet under–researched aspect of paramedic practice. Using a grounded theory methodology, this qualitative inquiry acquired data from in-depth interviews with paramedics working in rural, suburban, and urban settings in Ontario, Canada to generate a theory of expertise in scene management. The methodology and rationale comprise an effective approach for exploring this area of paramedic practice.
A mannequin study comparing suitability of the i-gelTM with a laryngeal mask airway device
Authors: Mark Julian , Walker Alison , Davey Christine
Published: May 2014

Objectives: To compare the suitability of the i-gelTM (Intersurgical Ltd, UK) supraglottic airway device with a single-use laryngeal mask airway (LMA) in the hazardous area response team (HART) environment and the urban search and rescue (USAR) environment. Method: five chemical, biological, radiological and nuclear trained urban search and rescue paramedics attempted five insertions of each supraglottic airway device into a Laerdal® ALS mannequin (Laerdal, Norway) in three separate environments: normal (supine, waist high), HART (wearing gas-tight suits and respirators) and USAR (in a simulated confined space). As a control group, five anaesthetists also attempted five insertions of each supraglottic airway device into a Laerdal® Airway Trainer (Laerdal, Norway) under normal conditions. Time from first touching the device to successful inflation of the mannequin's lungs’ using a self-inflating bag-valve device was recorded and operator opinion was captured using a four-point Likert scale. Results: insertion of the i-gel airway was significantly faster than insertion of the LMA in simulated USAR conditions (P<0.001), there was no significant difference in control conditions or when wearing gas-tight personal protective equipment. There was no difference in the number of attempts required to achieve correct placement of either supraglottic airway device in any situation. Conclusions: this study has demonstrated that, in simulated USAR conditions, the i-gel supraglottic airway device performs at least as well as the LMA and is significantly quicker to insert. The authors therefore recommend that the i-gel is introduced into the USAR HART environment with further clinical evaluation in this and other prehospital settings.
Community resilience: what significance does it have for an ambulance service?
Authors: Jackson Angela
Published: May 2014

The Scottish Ambulance Service (SAS) has developed a strategy for community resilience. This article explains what community resilience is from an ambulance service perspective, and why this approach is considered critical for the service to meet its objective of delivering quality patient care, and to address some of the major challenges currently experienced. Important benefits for communities and partners from other sectors are identified, and an outcome-focused approach indicates how these will be achieved. The five key strategic components are outlined, with examples related to practice. Challenges and opportunities for taking the agenda forward are discussed.
Determining the paediatric educational needs of prehospital providers: part 2
Authors: Breon Alia , Yarris Lalena , Law Junwen , Meckler Garth
Published: May 2014

Caring for paediatric patients presents unique challenges to prehospital personnel who may have limited training, experience and confidence caring for children. These challenges exist worldwide. Specific recommendations for paediatric educational content and learning strategies are lacking. The purpose of this study was to characterize the paediatric educational needs, barriers, and preferences of prehospital providers in Oregon and to examine these findings in the context of international emergency medical services (EMS) training. This was a qualitative analysis of 9 focus group discussions with a total of 64 prehospital providers from the state of Oregon. An iterative process of theme identification was used to generate themes, and then inter-rater checking was applied to confirm themes and assure inter-rater reliability. A review of the literature was conducted to compare the paediatric training of prehospital providers in the US and the UK. Participants identified a need for more paediatric training and they described knowledge gaps in assessing medically ill children, working with children with long-term medical conditions, and dealing with issues related to communication and the emotional difficulty of caring for children. Barriers included distance and cost, especially for rural providers, as well as time for training and lack of availability of courses designed specifically for the prehospital provider. Participants recommended increasing time spent with children during training by involving local schools and paediatricians. They recommended expanding the courses to include the areas where they felt less comfortable and increasing hands-on training opportunities. Simulation and online training were suggested as effective modalities to augment their trainings. Our findings support previous studies that show prehospital providers feel less comfortable providing care to children and face barriers such as time, cost, distance, and availability of relevant paediatric education. Although identified challenges are likely related to the demographics of Oregon, providers offered suggestions that may be applicable to prehospital providers more broadly, and include: 1) spending more time with children in a variety of setting and increasing the emphasis on assessing medically complicated children; 2) assuring local, affordable and relevant paediatric training opportunities; and 3) using online training modules and simulation to bring flexible ‘hands-on training to providers. Both the challenges and recommendations from this study have potential applicability to prehospital paediatric training in the US and UK.
Are early warning scores too early for paramedic practice?
Authors: Roland Damian , Jahn Haiko
Published: May 2014

The use of early warning scores (EWS) is now widespread in medical practice. Typically, EWS are used in inpatient settings to identify patients who require additional intervention to avoid unexpected intensive care admission or death. Prehospital care involves the rapid identification of critical illness but also undifferentiated urgent care. This large range of variation in acuity means EWS systems must be particularly accommodating. This article explores the use of scoring systems in paramedic practice and argues the need for more research, especially in non-trauma based tools.
PaRAMeDIC: a randomized controlled trial of a mechanical compression device
Authors: Smyth Mike
Published: May 2014

Survival from out-of-hospital cardiac arrest (OHCA) is influenced by the quality of cardiopulmonary resuscitation (CPR). However, research shows that in the out-of-hospital environment, and particularly during ambulance transport, CPR quality is frequently sub-optimal. Mechanical compression devices can deliver high quality CPR, yet there is an absence of high quality evidence to demonstrate improved clinical or cost effectiveness outcomes. The PaRAMeDIC trial will compare manual CPR with mechanical CPR in adult patients with non-traumatic OHCA. Objectives: the primary objective is to evaluate the effectiveness of mechanical chest compressions using the LUCAS (Lund University Cardiopulmonary Assistance System)-2 on mortality at 30 days post-OHCA. Secondary objectives include survived event (return of spontaneous circulation at hospital admission), quality of life and cognitive function at 3 and 12 months, survival at 12 months and cost effectiveness. Method: the trial is a pragmatic, cluster randomized controlled trial. Ambulance vehicles are randomized to control or LUCAS arms. Patient allocation is determined by the first ambulance vehicle which arrives first on scene (manual CPR vehicle or LUCAS CPR vehicle). The trial will assess the clinical and cost effectiveness of the LUCAS-2 device. Trial Registration: The trial is registered on the International Standard Randomised Controlled Trial Number Registry (ISRCTN08233942).
Leadership within the ambulance service: rhetoric or reality?
Authors: James Taylor , Ewan Armitage
Published: May 2014

Just as part 1 of this article ( Armitage and Taylor, 2012 ) introduced the concept of management and leadership, specifically within the context of the ambulance service, part 2 will stimulate further discussion in connection with the development of leadership related knowledge, skills, experience and behaviours among paramedics. Throughout the piece, the need for leadership development at an organisational and professional level will be promoted, and the authors will explore why leadership and leadership development is a key component to paramedic practice, as well as considering how ‘human factors’ and ‘non-technical’ skills are central to a sucessful process of leadership. The NHS Leadership Framework will be reviewed and the authors will consider how it can be used by individuals, organisations and the paramedic profession as a whole to drive leadership development in the future.
Acute exacerbation of COPD: Are we still over-oxygenating?
Authors: Douglas Anita
Published: May 2014

Chronic obstructive pulmonary disease (COPD) affects thousands of people across the UK. It accounts for a large amount of hospital admissions, which are often seen by the ambulance service during acute exacerbations. Discussion has surrounded the amount of oxygen this type of patient should be receiving during acute exacerbations. Research to provide evidence–based practice for the use of oxygen in the hospital and pre-hospital environment has been ongoing for several years. In 2009 the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) changed their guidance following the British Thoracic Society's (BTS) release of new guidelines in oxygen use in adult patients, thus determining that oxygen should be delivered in a more precise manner. However in light of current evidence could further changes be made in the delivery of oxygen, by using air–driven nebulisation during the delivery of drugs to patients presenting in the pre-hospital environment with an acute exacerbation of chronic obstructive pulmonary disease (AECOPD). This would allow patients to receive an appropriate amount of oxygen during their transfer to hospital, giving improved care and treatment of patients at risk of hypercapnic respiratory failure. This article will discuss the changes to practice which have already been identified and recommended and also discuss the potential implications these changes may have on patient care.
Developing communication skills in occupational therapy, and paramedic students
Authors: Twinley Rebecca
Published: May 2014

Communication is considered to be a core skill for healthcare professionals. The teaching, learning and development of communication skills are discussed with a focus upon occupational therapy and paramedic practitioner students.

A mixed methods approach was taken to gather data; questionnaires were administered to evaluate the final year student opinions regarding how they are taught and learn about communication skills, and how well prepared they felt for practice. Programme Lead feedback was gained regarding student opinions and programme handbooks were analysed to further inform the research.

The majority of students prioritised listening skills as the most important communication skill required for practice and held the pre-course expectation to be taught communication skills required for practice. Difference in opinion was highlighted regarding how adequately taught and prepared students felt, with a proportion of OT students feeling inadequately taught communication skills.

Findings provide a clear indication of student opinions regarding how they are taught, learn about and are prepared for the communication skills required for practice; students value this training and would welcome more to be included in their programmes. The difference in learning experience is attributed to there being no specific module for communication skills on the OT programme.