bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical issues to consider when treating patients with mesotherapy: a case study
Authors: Goddard Rachel
Published: May 2014

The aim of this case study is to identify and justify the choice of an aesthetic treatment for early photoageing and fine lines on the face, and use evidence to support this clinical decision. The pre- and post-treatment regimens will be appraised by the author, who willl also discuss the professional responsibilities involved in the treatment process, including legislation, ethical issues, patient safety and treatment management. Relevant research and clinical papers will be discussed to support the claims made in this article. In the case of the 28-year-old female the author treated, she chose to administer mesotherapy; this is a nonsurgical procedure which is considered to be an associate treatment within the practice of cosmetic medicine. Mesotherapy has a two-fold action: nourishing the upper skin layers to provide maximal physiological function, and promoting the stimulation of fibroblasts to increase collagen secretion.
Is it worth offering mesotherapy on your clinic's treatment menu?
Authors: Costello Kelly
Published: May 2014

In this regular feature in the Journal of Aesthetic Nursing, experienced aesthetic nurses answer your questions relating to clinical and professional issues. This issue, a range of practitioners in the field offer their opinions on mesotherapy and reflect on their previous experience with this treatment.
Core skills in medication management and assessment are key to the V300
Authors: Rutkowski Aleks
Published: May 2014

Aleks Rutkowski maintains that being mentored by someone with experience in aesthetics is not essential for passing the non-medical prescribing course. Instead, she suggests that designated medical practitioners ought to be GPs who are working on a daily basis with people from all walks of life, and that a sound knowledge of pharmacology and assessment is essential for those specialising in aesthetics
Going for gold: a guide to submitting award nominations for you and your clinic
Authors: Zadah Kate
Published: May 2014

From the Aesthetics Awards to My Face My Body, several awards ceremonies take place in the UK every year to acknowledge the best clinics, brands and health professionals. In her regular column providing PR advice, Kate Zadah offers aesthetic practitioners advice on how, when and why to submit award nominations to consumer-voted and industry-led panels
Lessons learned from IMCAS Paris 2013: what could aesthetic nurses gain?
Authors: Bowes Lorna
Published: May 2014

Every year, the International Master Course on Aging provides a professional forum for delegates to get to grips with the latest research in the field of cosmetic dermatology. In this short interview with Journal of Aesthetic Nursing Consultant Editor Lorna Bowes, she gives an overview of the day's highlights and what aesthetic nurses could gain from attending
Postpartum skin conditions: managing melasma gravidarum in cosmetic practice
Authors: Brackenbury Julie
Published: May 2014

Melasma gravidarum is just one specific dermatoses related to pregnancy or after ingestion of oral contraceptives that is often misunderstood in practice. Given that it affects 75% of women it is highly likely that aesthetic nurses will come into contact with this at some point in their career. This article looks at the treatment options available from topical agents, chemoexfoliation and laser light therapy with an explanation of contraindications and unpredictable results, which can leave the patient and practitioner frustrated. This article clearly identifies the important role aesthetic nurses play in assessing, implementing, managing and evaluating treatment for their patients with melasma gravidarum. Furthermore, it demonstrates that advances in technology are yet to provide the aesthetic industry with an evidence-based cure.
Combining laser and ultrasound technologies to deliver platelet-rich plasma
Authors: Shoaib Taimur
Published: May 2014

Combination therapies are often used by aesthetic practitioners to achieve the best possible results for their patients. Although laser therapies can produce good results when treating common skin conditions, ultrasound technologies can be used to push particles from one place to another. Platelet-rich plasma (PRP) treatment is also one of many injectable procedures available for the purposes of skin rejuvenation and revitalisation. This paper describes a case report of a 47-year-old woman who was treated with needle-free PRP, minor fractional laser treatment and an ultrasound probe. A carbon dioxide (CO2) laser was used to create perforations, PRP was applied topically to the skin, and then an ultrasound probe was used to force the PRP from the skin surface into the dermis. As PRP was administered without a needle, the procedure was performed without causing any post-procedure bruising. The patient was pleased with the treatment outcomes and the quality of her skin improved significantly.
Topical vitamin A: types, therapeutic effects, adverse reactions and delivery systems
Authors: Bowes
Published: May 2014

Retinoids describe all forms of vitamin A, including naturally and synthetically produced derivatives. Topical retinoids have now been in regular use in dermatology for half a century, and have been used to treat a variety of cutaneous disorders such as hyperpigmentation and photoageing, as well as fine lines and wrinkles ( Biro and Shalita, 1993 ). In this article, the author will describe several types of topical retinoids and highlight their functions relating to the treatment and prevention of photoageing and acne vulgaris.
Using topical anaesthetics before providing non-surgical facial aesthetic procedures
Authors: Muir
Published: May 2014

Topical anaesthetics are used by the majority of aesthetic practitioners before providing non-surgical cosmetic procedures such as injectables, laser and dermal needling. Moreover, today's dermal fillers now come with lidocaine, offering practitioners another option when it comes to pain relief. However, there is still a strong need for topical anaesthesia in practice, meaning that health professionals in aesthetic medicine should update their knowledge and understanding on nerve propagation and modes of action. In this article, the author gives an overview of the classification, pharmacokinetics and toxicity of topical anaesthetics. The author also provides information on the most common products used in aesthetics (e.g. Emla cream and LMX4).
Evaluating the performance of your PR team through key performance indicators
Authors: Zadah Kate
Published: May 2014

If you have made the decision to invest in the services of a PR team, you will want to see positive, measurable results in return. It is therefore important to evaluate PR performance on a regular basis. In her column, PR Professional Kate Zadah suggests several specific key performance indicators from which to measure the success of your campaign and decide how to move forward with your budgeting
Writing for publication: here's the answers to the most frequently asked questions
Authors: Devan Natasha
Published: May 2014

How many of you wish you had the confidence and/or time to write a paper for the journal? Contrary to popular belief, the task is easier than you would think, and well worth a try. In this month's Q&A feature, to answer some of your questions on writing for publication, JAN Editor Natasha Devan offers her top tips on putting pen to paper
Lesbians and body image: anorexia, bulimia and constructions of thinness
Authors: Jones Rebecca
Published: May 2014

Not only is being thin linked to femininity, but it is also significantly associated with heterosexuality. Although much research has been undertaken on the subject of women with eating disorders, the effect of these conditions on women with alternative sexual orientations has rarely been investigated. In this article, Rebecca Jones presents her findings on lesbians’ constructions of thinness in a modern world
Collagen-stimulating modalities in medical aesthetics: exploring the evidence base
Authors: Collier Helena
Published: May 2014

There is a plethora of medical aesthetic treatments on the market, all of which claim to stimulate varying degrees and types of collagen production in the body. For some modalities, hypotheses are reasonable with a well-established correlation in their use and visible signs of improvement to the condition of the skin; however, many are questionable in their evidence base and ability to stimulate true collagenesis with any significant long-term treatment outcomes. The aim of this paper is to offer a brief, balanced overview of a selection of collagen-stimulating modalities available today in the UK's aesthetic medicine arena. The article will also reveal how many existing collagen-stimulating modalities are reliant and driven by the body's inflammatory response to injury, and subsequently the wound healing cascade of events that follow. The author will also review the data underpinning each modality and interpret clinical findings in comparison to experiential findings in everyday practice. Short-term versus long-term benefits to patients will also be discussed, as well as the associated risk factors.
Safeguarding vulnerable children: The role of the Victoria Climbié Foundation
Authors: Dioum Mor , Yorath Stephanie
Published: May 2014

The Victoria Climbié Foundation (VCF) was established following the public inquiry into the tragic death of Victoria Climbié, and was set up to raise child protection awareness nationally and in particular within black and minority ethnic (BME) communities. VCF is the leading independent organisation campaigning for improvements to child protection policies and practices and effective coordination and links between statutory agencies and the community. Since its inception in 2003, VCF has worked with over 650 families to aid their understanding of roles and responsibilities of statutory agencies, and to navigate the system. They have worked with over 100 community groups, including faith organisations, to ensure that they have greater knowledge of the child protection framework in the context of the laws of this country as well as ensuring that they understand what is—and what is not—acceptable in raising children in the UK.
The assessment and management of an infant with bronchiolitis
Authors: Paul Siba Prosad
Published: May 2014

Bronchiolitis is a viral illness that is characterised by fever, nasal discharge, coughing and wheezing. Bronchiolitis is common in the winter months, however cases have been reported throughout the year in the UK. The most common pathogen is a respiratory syncytial virus. Health visitors will frequently encounter children with bronchiolitis and will need to make an assessment as to whether the severity of the illness warrants a referral to the medical professionals. It is important to consider the presence of risk factors which necessitates an early referral. While most cases can be safely managed in the community, some infants may need support with their breathing and feeding in hospital. Health visitors play a vital role in not only making an early referral but also by supporting the families in the community following discharge.
Health visiting and school readiness: An overview of policy and practice
Authors: Jones Deborah
Published: May 2014

This article considers the background evidence supporting the increasing policy support for intervention in the foundation years. Drawing on learning from infant development and neuroscience, it presents the argument that supporting parents to provide a stimulating, sensitive and nurturing home learning environment improves outcomes for children aged 0–5 years, protecting them from harm and increasing their life chances through promoting school readiness—a key government target. The article considers ways in which health visitors can support this process through the mechanisms of the Healthy Child Programme and home visiting.
MumsAid: An organisation that meets the challenges of postnatal depression
Authors: Donaghy Miriam
Published: May 2014

MumsAid is a non-profit organisation providing free counselling for women experiencing mental or emotional difficulties in pregnancy or after having a baby. Founder and director, Miriam Donaghy, discusses the successes MumsAid has had throughout its first year.
An integrated approach to perinatal support by Family Action
Authors: Smith Julie
Published: May 2014

Research suggests that at least one in ten women will suffer from depression during their pregnancy. In the experience of Family Action, many women suffering from mild to moderate maternal mental health issues cannot access the support they need. An integrated and innovative Perinatal Support Project from Family Action, working in partnership with local authorities and health professionals, is providing mothers suffering from perinatal depression a holistic programme of support through non-stigmatised support and volunteer befriending. This fills a gap in provision and offers support to those mothers who might traditionally miss out on support from NHS perinatal mental health services.
‘Breast is not always best’ South Asian women's experiences of infant feeding in the UK
Authors: Condon Louise
Published: May 2014

In this section, brief synopses of a range of recently published articles that may be of interest to health visitors are presented. The aim of this roundup is to provide an overview, rather than a detailed summary, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided.
Autonomous practice in health visiting: myth or reality?
Authors: Bailey Beverley
Published: May 2014

Autonomy in health visiting is not always straightfoward. Bev Bailey discusses how health visitors have to manage working independently within organisational expectations
Ensuring a better start for children to build a better future for society
Authors: Hosking George
Published: May 2014

Whatever one's opinion of this reorganization [of the NHS], it has happened, and we must now work with the CCGs to encourage them to promote prevention and the best possible support for babies from conception onwards.
Working together for families: Multi-agency cooperation
Authors: Houston Anna
Published: May 2014

One of the most significant recent changes to the profession of health visiting has been the advance of multi-agency working. Anna Houston considers the potential for working alongside other services to create better outcomes for families.
How health visitors can offer advice on calming a crying baby
Authors: Patience Sara
Published: May 2014

It is common for babies to cry, to varying degrees. Some parents will be better able to cope with infant crying than others. A ‘normal crying curve’ has been observed, in which infant crying increases after birth until around week eight, when it stabilizes and then decreases over the following weeks ( Barr, 1990 ). There may be no discernible reason for this type of crying, and health visitors should reassure parents that it is normal and support them to cope with it. However, there are potential causes of crying to consider, such as gastrointestinal problems, allergy or other illness. There is a link between excessive crying and postnatal depression; although it is unclear which is the cause and which the effect, it is worth noting that health visitors may wish to screen for postnatal depression in cases of extreme crying. It is also important that health visitors remember that crying can be a risk factor, as the safety of the baby must always be paramount.
Health visitor training: Time for change
Authors: Cowley Dame Sarah
Published: May 2014

The implementation plan has achieved a great deal, but there remains a need to improve the system of health visitor preparation, says Professor Dame Sarah Cowley.
Brain-based health visiting: How neuroscience is shaping practice
Authors: Lyon Steve , Adams Karen
Published: May 2014

Health visitors have always been faced with change and challenge to their role, partly as a result of health visiting being underpinned by a set of ‘soft’ skills that are difficult to articulate. This article suggests that the relationship-building skills of health visitors can now be underpinned by evidence from developments in neuroscience. In this paper, the aspects of neuroscience behind many of the core interventions health visitors have always used are discussed and their relationship to managing emotions and stress are addressed. Neurohormones such as oxytocin, cortisol and dopamine are described in the context of health visitor–parent relationships and how this can benefit babies. This paper explains important brain structures and how health visitors can work with these.
UKSC Conference: Developing Resilience as a Pathway to Health
Authors: Thurtle Val
Published: May 2014

A recent event held by the United Kingdom Standing Conference on Specialist Community Public Health Nurse Education focused on building resilience, not only in the community but among practitioners themselves.
Changing trends in renal replacement therapy
Authors: Jones Chris
Published: May 2014

Delivery of renal replacement therapy (RRT) is changing with more emphasis on dialysis modalities. Renal services in the UK have expanded considerably due to increasing demand for RRT and an understanding of the drivers of this trend is needed to prepare for the future.
Is it necessary to ask lay people to make complex medical decisions?
Authors: withheld Name
Published: May 2014

As a nurse of many years standing and having more than a passing interest in health-care trends, philosophies and the ethics of care, I was somewhat surprised by the nature of a couple of recent conversations I had with two ‘lay’ friends.
Clinical assessment of vascular access: an overview
Authors: Manuel Wilfredo
Published: May 2014

Clinical assessment of vascular access before cannulation is an integral component of haemodialysis care. Wilfredo Manuel provides renal nurses and technical staff with an overview of the types of vascular access—listing their advantages and disadvantages. He then outlines the basics of assessing, planning, implementing and evaluating a patient's vascular access before, during and after cannulation.
An overview of water treatment for haemodialysis patients
Authors: Maul Gary
Published: May 2014

Although historically water treatment has been in the renal technician s domain, understanding the technical aspects is important for the entire renal team working together toward the patient s wellbeing. Gary Maul describes the composition of water treatment systems for haemodialysis as well as the monitoring and testing necessary to ensure that both the quality of the water and dialysis fluid are safe for patient use.
Leadership and management skills in the renal unit
Authors: Ellis Peter , Abbott Jane
Published: May 2014

In the third article in this series, Peter Ellis and Jane Abbott explain some of the theories and concepts that new managers can draw on when leading a team. The authors then describe how the style of leadership can be adapted in relation to the situation and team a new manager has to take the lead in.
The role of the chronic kidney disease nurse in primary care
Authors: D'Souza Paula
Published: May 2014

Nurses working in general practice are well placed to recognize people at risk of chronic kidney disease (CKD), diagnose them and ensure that treatment is initiated promptly. Here Paula D'Souza describes a new initiative which helps general practices optimize treatment of their CKD patients.
The first successful kidney transplants:The last throw of the dice
Authors: Turner Neil
Published: May 2014

The first human kidney transplants were heroic operations undertaken at a time when dialysis was not a long-term option. A few inspiring stories kept hopes high, but in general, the outcomes of these early experiments were down-heartening.
Nutritional assessment of a renal patient
Authors: Jackson Helena
Published: May 2014

Malnutrition is a common and complex problem in renal patients. Assessment of nutritional status is the means to diagnose disorders involving undernutrition and overnutrition, should these occur, and to monitor the effect of any intervention. Nutritional assessment should be incorporated in the routine care of renal patients and contributions made by all members of the multidisciplinary team.
Bombs and rhabdomyolysis: War leads to the discovery of a new renal disease
Authors: Turner Neil
Published: May 2014

In the Summer of 1940, the German Luftwaffe switched its bombing targets from English airfields and aircraft factories to cities, and in September 1940 large scale air raids on London began. Shortly afterwards, a new type of acute renal failure was noticed in some of those rescued from fallen buildings.
A routine day in the life of a renal nurse in Nigeria
Authors: Emenyi Mary Abang
Published: May 2014

In this article, Mary Emenyi points out that end-stage renal disease is becoming a major issue in Nigeria due to an increase in its incidence. She gives an outline of the routine treatment for dialysis patients in her country and the role and tasks of renal nurses working in Nigerian dialysis units.
The role of a renal nurse on a Malaysian dialysis unit
Authors: Annamalai Pathma , Supermaniam Shirmini
Published: May 2014

Every year, more than 3000 Malaysians are diagnosed with end-stage kidney disease and have to go for dialysis. Today, over 15000 Malaysians are on dialysis treatment. Here, Pathma Annamalai and Shirmini Supermaniam give an overview of how Malaysian renal nurses cope with these demands.
Kidney care through the decades
Authors: Hope Jonathon
Published: May 2014

Jonathon Hope has been a patient for 30 years and has undergone four transplants, experiencing every step in the evolving renal care system. Here, he and other renal patients describe what they experienced in the past, how they perceive the present and what they want the future to look like.
Looking at different team cultures within renal units
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Peter Ellis and Jane Abbott look at different cultures that may exist within renal teams and departments. They demonstrate the need for renal nurse managers to understand the culture of their teams and the way it impacts on the team members' work and the care they give patients.
book reviews
Authors: Jones Chris
Published: May 2014

The Handbook of Nephrology and Hypertension is another excellent pocket guide from Oxford University Press. It is edited by four experienced nephrologists with expert contribution from urologists, obstetricians, intensivists and endocrinologists. The field of nephrology covers a huge spectrum and these advisors provide crucial insight.
The future of children's renal transplantation
Authors: Marks Stephen D
Published: May 2014

Congenital abnormalities of the kidney and urinary tract are the most common cause of paediatric chronic kidney disease and end-stage renal failure (ESRF). The best form of renal replacement therapy for children with ESRF is pre-emptive renal transplantation. There are improved patient mortality and morbidity rates and quality of life for those children who have successfully received a transplant compared to those receiving haemodialysis or peritoneal dialysis. The average renal allograft survival is better for living donors than deceased donors and is now approaching 15 years, so re-transplantation is common. In addition, some children require multi-organ combined or sequential transplants.
Human immunodeficiency virus and the kidney
Authors: Hamzah Lisa
Published: May 2014

Renal disease affects up to a quarter of people infected with human immunodeficiency virus (HIV). In this article, Lisa Hamzah looks at how successful HIV therapy has not only changed the prognosis for those patients with HIV, but also changed the spectrum of renal disease.
Role expansion of renal nurses: utilizing physical assessment skills
Authors: Jones Ann
Published: May 2014

Ann Jones explains how renal nurses need a wide range of clinical skills to effectively manage their patients at various stages of illness and undergoing a variety of treatments. She explains how the incorporation of physical assessment skills (PAS) into the renal nursing setting and the expansion of the role of renal nurse will potentially result in better patient care.
Back to basics: common renal blood tests
Authors: Davies Annette
Published: May 2014

This article is the second in a series looking at the basics of renal nursing-aimed at newcomers or anyone wanting a refresher. Annette Davies looks at common blood tests, outlining the normal range of levels for certain components in the blood and where abnormal levels may indicated disease.
My not-so-ordinary life
Authors: Steventon Victoria
Published: May 2014

Victoria Steventon, a 17-year-old teenager with a kidney transplant, shares her story that started as a seriously ill toddler and child with little appetite. Time on dialysis, the hunt for a suitable donor and a transplant in the nick of time made her into an insightful and driven young person.
Looking at and discussing philosophical ethics in research
Authors: Ellis Peter
Published: May 2014

Peter Ellis discusses the importance of applying ethics to research. He gives a definition of ethics and provides an overview of the key questions researchers need to ask themselves before embarking on their work, including examing the motives for the research
The challenge of managing hypertension in chronic renal disease
Authors: Jain Poorva , McManus Richard J
Published: May 2014

Poorva Jain and Richard McManus look at hypertension in the general population and in patients with chronic kidney disease. They give an overview of the findings of all the major trials undertaken on blood pressure and chronic kidney disease over the last 10 years, outlining current blood pressure management issues in the treatment of chronic kidney disease patients in the UK today.
Living with a new heart and kidney
Authors: Biscoe Michelle
Published: May 2014

At the age of twelve, Michelle Biscoe had developed the heart disease cardiomyopathy so severely that she needed a new heart to survive. Finally, after a long recovery, she managed to to lead a fullfilled and independent life, when she was told that her kidneys were failing her. Here is her extraordinary account.
Achieving quality: the need for a multiprofessional approach
Authors: O'Donoghue Donal
Published: May 2014

Donal O'Donoghue describes how the complexities of advanced renal disease result in the need for cohesive multidisciplinary team working to meet the patient's varied needs—clinical as well as practical, psychological and social. He argues that multidisciplinary team work includes involving patients in decision making about their treatment and health for a holistic care approach.
Improved outpatients pathway for giving intravenous iron to children
Authors: Connell Roy
Published: May 2014

Roy Connell describes how his unit at the Nottingham Children's Hospital first identified the need to shorten the time for paediatric outpatients during pre-dialysis and peritoneal dialysis. He and the renal team then discussed and designed a new pathway that radically cut down the hours spent on the ward, promoting use of intravenous iron and shortening the time it takes to administer it.
Immunization for infants and children before transplantation
Authors: Patey Sue
Published: May 2014

Sue Patey gives an overview of the immunization schedule for children with chronic kidney disease (CKD) and any additional live vaccines they require before receiving a kidney transplant. All children with CKD need to have completed their immunization schedule as only in exceptional circumstances would a child be transplanted before the full vaccination schedule was completed.
Back to basics: complications of peritoneal dialysis
Authors: Ellis Peter
Published: May 2014

Peter Ellis gives an overview of peritoneal dialysis—one of the common available forms of renal replacement therapy to treat patients with chronic kidney disease. He describes the basic physiological processes and techniques underpinning this form of dialysis and emphasizes that all renal nurses need a good understanding of peritoneal dialysis to best inform and support their practice.
Application of critical thinking diagnostics in the renal setting
Authors: Farrell Anita , Riley Kay , Wheeler Susan , McLean Scott
Published: May 2014

Lack of critical thinking was at the core of an incidence of an avoidable diabetic coma in a renal surgical ward. Here Anita Farrell, Kay Riley, Susan Wheeler and Scott McLean describe the actions that were taken afterwards and how the use of a critical thinking methodology enabled the nurses at the ward to develop new strategies for smarter working and better patient care.
Iron administration for patients with chronic kidney disease
Authors: Benton Sharon
Published: May 2014

Sharon Benton provides an overview of the benefits for introducing and administering intravenous (IV) iron to patients with chronic kidney disease (CKD) in a community setting. She describes iron deficiency and gives an overview of different treatment options. Her story of setting up a community IV iron service in Cornwall is another example of patient-focused care can saves costs as well.
Measuring quality of life in anaemia management
Authors: Jenkins Karen
Published: May 2014

Anaemia often develops in the early stages of chronic kidney disease (CKD) and gradually gets worse as renal function declines. Left untreated, anaemia can become the cause of poor quality of life in CKD patients. Karen Jenkins looks at the link between anaemia and quality of life in CKD patients, how quality of life may be measured and how anaemia in CKD patients may be best managed.
Minimising the infection risks associated with temporary haemodialysis away from base
Authors: Prout Virginia , Corbett Richard W
Published: May 2014

Patients who are dependent on maintenance haemodialysis will require temporary dialysis away from base (TDAFB) when travelling. An increased prevalence in the rate of West London haemodialysis patients travelling and hence needing to undergo TDAFB prompted Virginia Prout and Richard Corbett to evaluate the associated risk of infection, and to take action to minimise it.
The renal manager: the ethics of leadership
Authors: Ellis, Senior Lecturer Peter , Abbott Jane
Published: May 2014

The ethics of a manager will impact significantly on the culture and behaviour of their staff. Here Peter Ellis and Jane Abbott consider why ethical management is important and discuss how, through liaison, monitoring and resource handling, the renal manager can lead in an ethical way.
Diabetes and chronic kidney disease: a ticking time bomb
Authors: Killeen Siobhan
Published: May 2014

Chronic kidney disease (CKD) is one of the long-term complications associated with diabetes and is an independent risk factor for cardiovascular disease, which is why it was added to the Quality and Outcomes Framework (QOF) in 2006. In this article, Ruth Killeen identifies the cardiovascular risks associated with diabetes and CKD, discusses the assessment and management of this group of patients, and makes recommendations how to reduce long-term complications.
Management of diabetes in the dialysis patient
Authors: Allen Lyn
Published: May 2014

It is estimated that between 20 and 40% of patients requiring renal replacement therapy also have diabetes mellitus; diabetes, type 1 and type 2, adds further challenges to the management of these patients who already have many complex medical needs. This article by Lyn Allen aims to discuss those challenges, and offers some insights into managing these dialysis patients with diabetes in an efficient and friendly way.
The basic principles of continuous renal replacement therapy
Authors: Cope Graham
Published: May 2014

Continuous renal replacement therapy (CRRT) is the recommended treatment for patients with acute renal injury being treated in the intensive care unit. This article explains the principles behind it, the advantages over intermittent haemodialysis and the potential problems with the technique.
Tolerance of haemodialysis therapy in the elderly population
Authors: Goode Pandora
Published: May 2014

In this article, Pandora Goode explores the concept of patient tolerance of therapy, in particular, the impact of haemodialysis in older adults. She provides a brief literature review exploring quality-of-life issues in haemodialysis and discusses whether haemodialysis therapy can be justified if there is a low tolerance rate among the elderly population.
Haemodialysis central venous catheter care bundle to reduce MRSA
Authors: Jones Christine A
Published: May 2014

Over the past 7 years, the nephrology directorate at University Hospital Aintree have introduced, developed and put into common usage a comprehensive bundle of care. The bundle includes a care pathway from pre-insertion to post-insertion catheter care; use of Octenisan body wash and Bactroban nasal cream pre-insertion; Betadine paint immediately pre-insertion; introduction of novel use of exit site Actisorb silver dressing; and catheter incubation with Taurolock-heparin. The renal unit has developed the bundle and audited the catheter-related sepsis annually over the last 7 years (2005–2012). With the use of this bundle, the renal unit has reduced MRSA infection rates from 10% to 0% and kept it there for the past 3 years.
Of mice, men and stem cells: developments in cellular therapy
Authors: Biela Chris
Published: May 2014

Manufacturing mice in the laboratory may soon provide us with the technological know-how to offer cellular therapies for those who need treatment for a wide variety of serious disorders, ranging from Alzheimer's and renal disease to osteoarthritis and diabetes.
The next Millennium
Authors: Harding K.G.
Published: May 2014

It is appropriate to reflect on the achievements in wound care in recent years and to speculate on its future direction in the year 2000 and beyond. A wide variety of wound treatments has always been used – some sensible, some dangerous – mostly designed to care for or ‘dress’ wounds. There has been little scientific interest in understanding how best to achieve healing. The belief that dressing wounds is the only consideration in wound care is a major barrier to achieving acceptance by professional colleagues that wound healing is a subject worthy of clinical and academic endeavour.
Delayed primary closure in the management of gunshot wounds
Authors: Graham A.
Published: May 2014

A discussion on the methods of treating soft tissue damage caused by different types of gunshot wounds.
The management of diabetic foot disease in Finland
Authors: Seppänen S.
Published: May 2014

A review of the care of patients with diabetes in a country with a high incidence of the disease.
Implementation of patient-held records in diabetic foot care
Authors: Spencer J. , Widdows C.
Published: May 2014

A re-evaluation of the work of the multidisciplinary team at the diabetes foot clinic at The General Infirmary at Leeds led to a successful project to introduce patient-held records
Selecting cushions and armchairs: how to make an informed choice
Authors: Collins F.
Published: May 2014

The wide range of pressure-relieving or reducing cushions and armchairs can make selection a challenge. This article outlines the main considerations that should determine the practitioner's choice.
Using povidone-iodine to treat empyema
Authors: Mullins M.M. , Walker I. , Standridge R.D.L.
Published: May 2014

A feared complication of major thoracic surgery is infection leading to empyema. Choosing the most effective treatment option, if it does occur, will help achieve a positive outcome.
Understanding research: 2 Ensuring reliability and validity
Authors: Baxter H.
Published: May 2014

Study samples must be sufficiently large and representative to produce generalisable results and the methodology reliable to ensure valid findings. This article describes how this can be achieved
From the journals
Authors: Baxter Helena
Published: May 2014

As clinical guidelines are permeating every aspect of health care, this is a worthwhile investigation into how guidelines are implemented and the barriers to effective adoption of best practice. This UK study reports on one element of a larger trial. The title is perhaps misleading as there is no comparison between groups, or if there is, it is unclear.
From the journals
Authors: Baxter Helena
Published: May 2014

Little research has been done to explore the impact of diabetic foot ulcers on patients' lives. This qualitative study explores patient experiences using a phenomenological approach. Twenty-eight patients from an eligible group of 47 agreed to take part. Twenty-one interviews were recorded fully — 15 men (average age: 58.4 years) and six women (average age: 59.4). They were interviewed using a semi-structured, conversational approach within a health-related quality-of-life framework. The researchers were from podiatry, nursing and psychology backgrounds.
From the journals
Authors: Baxter Helena
Published: May 2014

This research study comprised a two-phase, non-experimental design to determine if there is an association between pressure sore risk assessment, severity of the sore and planning of patient care. In addition, methods used to prevent and treat pressure sores were identified.
Does lymphoedema bandaging reduce the risk of toe ulceration?
Authors: Todd M. , Key M.R. , Rice M.R. , Welsh J.
Published: May 2014

Pressure exerted by compression bandaging can cause swelling around the distal part of the foot, resulting in toe distortion and ulceration. Standard lymphoedema bandaging includes the toes, which may reduce the risk of such problems
Benefits of implementing a link nurse group across both an acute and a primary care trust
Authors: Everitt D.
Published: May 2014

This paper describes how two tissue viability nurses, one from an acute trust and one from a primary care trust, joined forces to set up a link nurse group. This helped raise the profile of wound care and improve standards of care
Treatment of chronic sternal fistulae following cardiac surgery with a bone substitute
Authors: Lamas M.J. , Centella T.
Published: May 2014

Chronic sternal infection is a relatively rare complication following cardiac surgery that can cause high morbidity and mortality and can require repeated surgical procedures, including sternal resection, to resolve. However, preserving sternal integrity is essential, particularly in children. A variety of conservative treatments for this complication of cardiac surgery have been reported. Here, we report three cases of children in whom a bone substitute containing tricalcium phosphate and hydroxyapatite was used to fill sternal defects. After extensive surgical debridement, this method yielded primary wound closure with good resolution, preventing the recurrence of sternal infection.
Endotracheal intubation by paramedics: Where to now?
Authors: Fisher Joanne , Brown Simon , Cooke Matthew
Published: May 2014

Joanne Fisher, Simon Brown and Matthew Cooke, on behalf of the Joint Royal Colleges Ambulance Liaison Committee Guideline Development Group, set out the position of the group
Improving awareness of substance misuse
Authors: Gallacher Alison
Published: May 2014

Substance misuse is becoming increasingly common and is a problem that is likely to be encountered by every prehospital clinician at some time. Substance misusers are frequently demanding and aggressive but the highest standards of management and protection for both patient and clinician must be given. Becoming more informed about the many potentials of patients with substance misuse is therefore an important issue for paramedics. It is useful to be able to actively source knowledge at times of crisis with a greater understanding of what inter-agency services are available in your area (including out of hours) to improve the management of these patients. This article gives a brief overview of some of the substances of misuse, some commons street names and details how education and research is not only a part of meeting standards for registration but provides a key element in the management of substance misuse.
Chest auscultation: is it as simple as it sounds?
Authors: Williams Julia
Published: May 2014

Chest auscultation is a simple but informative procedure which can make an effective contribution to clinical decision-making provided the sounds are interpreted accurately. Williams et al recruited 96 undergraduate paramedic students from two Australian universities and exposed them to six lung sounds of varying aetiology. Each cycle of sounds comprised five breaths followed by a pause before the next sound commenced.
A record for renewals
Authors: Gayle Ebony
Published: May 2014

From June to August 2009, a record number of paramedics renewed their registration. A series of collaborative working measures and projects to increase awareness of key dates have ensured the highest percentage of successful renewals across all professions since registration began in 2003.
Prehospital pleural decompression: a new way? : a new approach
Authors: Mursell Ian
Published: May 2014

Needle thoracocentesis is the current UK ambulance services sole method of pleural decompression in suspected tension pneumothorax; however, the effectiveness of this procedure is questionable. This article will discuss the viability of an alternative method of pleural decompression—tube thoracostomy—providing comparisons to needle decompression and other current techniques used in prehospital care. The efficacy and safety of available techniques will be critically analysed and recommendations for the assessment and management of tension pneumothorax will be provided.
National research guidance and support for Trusts
Authors: McLure Sally , McColl Elaine , Mason James
Published: May 2014

The Research Design Service (RDS) is one of the key components of the National Institute for Health Research (NIHR) which aims to position, manage and maintain world-class research in the National Health Service (NHS). Formed in 2008 as a component of the Department of Health's Research and Development (R&D) Strategy, Best Research for Best Health (Department of Health, 2006), the NIHR RDS is a major new initiative in which the NIHR will be investing around £50 million over 5 years. This article provides an overview of the RDS and highlights some of the major developments and consequential opportunities for Ambulance Trusts in England.
Drug regimes for acute cardiogenic pulmonary oedema
Authors: Mursell Ian
Published: May 2014

Cardiovascular disease management has met with success through programmes such as the National Service Framework for Coronary Heart Disease. However, this has led to increased survival and therefore higher prevalence of patients living with impaired cardiac function. Acute cardiogenic pulmonary oedema (ACPO) is one of a number of distinct clinical conditions that result from abnormal cardiac function, primarily referred to as acute heart failure. This article will review current evidence-based pharmacological management of ACPO and make recommendations for future practice in prehospital care. Current drugs used in both prehospital and emergency care will be analysed for safety and efficacy in the management of ACPO.
Reperfusion of old or new: left bundle branch block?
Authors: Fitzpatrick David , McLean Scott
Published: May 2014

Reperfusion options for patients suffering ST-elevation myocardial infarction (STEMI) have developed significantly over recent years and now include both thrombolytic therapy and primary percutaneous coronary intervention (PPCI). This system of care means that patients presenting with STEMI can be transferred directly to a heart-attack centre to receive immediate PPCI. National guidelines state that pre-hospital thrombolysis (PHT) is a crucial part of STEMI reperfusion where PPCI cannot be delivered within 90 minutes of diagnosis. There is evidence describing rates of in-hospital thrombolysis in both MI with ST elevation and MI with LBBB. There is a knowledge gap however describing treatment of MI with LBBB based upon a pre-hospital 12-lead ECG. This paper describes the challenges around PHT in the context of LBBB and offers potential solutions that may provide assistance in making the decision to undertake PHT or not.
People in rubber suits and how to treat them: decompression injuries in divers
Authors: McClelland Graham
Published: May 2014

The majority of our planet is covered in water and millions of people around the world enjoy exploring what lies beneath the surface of our seas and lakes. Diving is a popular activity, with a long history, that allows people to visit—for pleasure or for business—a different world. Diving is a sport with inherent risks. The hazards and potential for injuries, ranging from the minor to the life-threatening, are an unavoidable part of the activity. The factors involved in diving injuries and the signs and symptoms divers may present with, are many and varied. Decompression injuries are one of the potential injuries that will respond to appropriate treatment and may have the longest lasting effects. Confident treatment of decompression injuries is made easier by understanding the physics involved in breathing gases underwater. The definitive treatment involves recompression that should be provided at a specialist hyperbaric facility.
Changing standards of proficiency
Authors: Peate Ian
Published: May 2014

The Health Professions Council (HPC) is charged with establishing standards of proficiency that are prerequisites for entry to each part of the register. As well as ensuring safe and effective practice, these standards are the minimum standards expected of registrants. Changes are being proposed to the generic standards to ensure that they are applicable to all professions they regulate. A consultation process is now underway that will impact on the wording and the structure of the standards-currently there are 26 overarching generic standards and 53 detailed generic standards with a different number of profession specific standards. The proposal also aims to reduce the current generic standards to 15, with the express intention of ensuring that they are overarching and applicable to all professions.
Health care policy with ambulance clinicians in mind
Authors: Blaber Amanda
Published: May 2014

Governments decide health policy and control the NHS through the Department of Health (DH) (Williamson et al, 2010). For this reason, some of the most pertinent policies and documents published by the DH have been chosen for discussion within this article. The wealth of documents, policies, strategies and recommendations governing ambulance clinicians' working lives, can sometimes be overwhelming and cover an extensive range of topics. It can be a lengthy and onerous task to read through even the summaries of each document and deciding if the content pertains to the role. The DH is the principal government department with responsibility for health matters and publication of health policy for England. However, there may be some overarching principles that are similar for Scotland, Northern Ireland and Wales. Details and structures created are slightly different throughout the UK (Williamson et al, 2010). The focus of this article is on England and the application to the NHS, however some principles may be applicable to the whole of the UK. It is the intention of this article to summarize some DH documents, which will enable the ambulance clinician to reflect on the impact health care policy has on their care provision, role and responsibilities. Ambulance clinicians may benefit from the use of this article as a starting point to further enquiry into other agencies. For example, the Care Quality Commission and publications from local ambulance trusts, which often reflect the national government focus at a local level.