bluuebunny/crossref_metadata_2025 huggingface dataset:
CPR compression depth and rate in relation to physical exertion in paramedic students
Authors: Gutwirth Hendrik , Williams Brett , Boyle Malcolm , Allen Trevor
Published: May 2014

The International Liaison Committee on Resuscitation (ILCOR) guidelines suggest rescuers deliver cardiopulmonary resuscitation (CPR) in cycles of 30 chest compressions and 2 ventilations (30:2) at a rate of 100 compressions per minute with a compression depth of 4-5 cm. Given this increase from the previous CPR cycle of 15:2, there is now also greater emphasis on pushing faster and deeper with minimal interruption. This has led to speculation surrounding rescuer fatigue and compression inefficiency. The purpose of this pilot study was to assess the level of work intensity and fatigue among undergraduate students during simulated CPR, including the quality of chest compressions. Methods: this was an observational pilot study investigating second year undergraduate paramedic students’ fatigue levels and quality of chest compressions following 20 minutes of simulated CPR. Data were collected at baseline and after every 2 minutes until conclusion of twenty minutes. Measurements of work intensity and fatigue included heart rate, rating of perceived exertion (Borg), compression depth and compression frequency. Results: a total of 7 subjects participated (2 male, 5 female), with five students aged 21-25 years. Male subjects showed a significantly slower compression rate when compared to females (108.0 vs 125.6 chest compressions per minute, P=0.006). Heart rate was significantly higher than rest (prior to commencing CPR) after 14 minutes of CPR (P=0.045). Perceived exertion was significantly higher than at rest at 2, 6, 10, 14, and 18 minutes, (P<0.01). Conclusion: this pilot study suggests that high levels of fatigue and perceived exertion are present early when undertaking CPR in a controlled setting, with some fatigue attributed to the faster than recommended chest compression rates.
Implantable cardioverterdefibrillators: a case report
Authors: Isenberg Derek
Published: May 2014

Implantable cardioverter-defibrillators (ICDs) are devices placed into patients with a variety of cardiac conditions to prevent sudden death from dysrhythmias. On occasion, these devices can malfunction, presenting a challenge to both prehospital and emergency department providers. In this article, we present a case in which pre-hospital providers encountered a patient whose ICD was firing continuously in a patient with sustained ventricular tachycardia. We then discuss the prehospital management of patients whose ICDs have fired. Scenarios discussed include management of the single appropriate ICD shock, management of multiple appropriate ICD shocks, and management of inappropriate ICD shocks.
They think it’s all over-managing post cardiac arrest syndrome
Authors: Page Michael
Published: May 2014

Return of spontaneous circulation (ROSC) is the first stage in the successful management of the cardiac arrest patient. The care that the patient receives during the immediate post-ROSC period, has a major impact on subsequent survival from out of hospital cardiac arrest (OHCA), particularly in terms of surviving to hospital discharge neurologically intact. For the first time, the 2010 Resuscitation Council (UK) ( Nolan, 2010 ) guidelines incorporates a section specifically relating to the mangement of OHCA.

This review will outline the guidance from the Resuscitation Council (UK) and the International Liaison Committee On Resuscitation (ILCOR) on the management of post cardiac arrest syndrome (PCAS) and how this can be practically implemented in the pre-hospital environment. interventions directly applicable to the pre-hospital phase until handover at the emergency department (ED) will be considered. In addition, specific guidance relating to the management of the ROSC patient in the pre-hospital phase of their care will be provided.
Wound ballistics: exploring the wounding potential of penetrating projectile injury
Authors: Garratt Mark
Published: May 2014

Within the civilian pre-hospital environment, penetrating projectile injury may be caused by an extremely broad range of firearms and explosive propellants. Despite a great variance in the potential for injury however, a basic knowledge of how penetrating projectiles behave and interact with living tissues is likely to assist emergency healthcare professionals with making informed decisions, as well as establishing priorities for treatment and transportation. Amoung such important considerations is the transference of kinetic energy from a projectile to the tissues, itself influenced by factors such as the area of presentation, deformation, fragmentation, mass and velocity. Projectile retardation, along with correlating levels of energy transference, will also be influenced by the density of the affected tissues, and the permanent disruption caused by the stretching and shearing forces of temporary cavitation will be largely dictated by the elastic tolerance of the tissues and their capacity to expand. The presence and location of entrance and exit wounds, if they exist, can offer some clue to the nature of the projectile/tissue interaction, though caution is required when interpreting such signs. Focussing upon the civilian pre-hospital environment, this article will seek to highlight some of the key features of wound ballistics, and explore some of the misconceptions that can exist concerning the impoprtance of projectile velocity, as well as the dangers of drawing potentially erroneous clinical conclusions based solely upon the nature of the firearm involved, or visible signs of injury.
Paediatric anaphylaxis: triggers and management
Authors: Huang Faith , Smithwick Susan , Nowak-Wegrzyn Anna
Published: May 2014

Anaphylaxis is an acute-onset, potentially life-threatening allergic reaction that involves at least two organ systems and usually occurs after exposure to a likely allergen. Anaphylaxis is a common presentation seen in children, and it is critical that ambulance clinicians are able to recognise the symptoms of this condition and appropriately manage it, as prompt treatment has been shown to lead to improved outcomes. This article presents an overview of paediatric anaphylaxis including epidemiology, triggers, diagnosis, clinical manifestations, and management, with a focus on how infants and children are similar and different than adult patients. Also discussed is why paediatric anaphylaxis is often underdiagnosed and undertreated, as well as paediatric populations who may require special attention for the management of anaphylaxis, such as infants, patients with a history of multiple emergency department visits for anaphylaxis, and asthmatics.
Reflex anoxic seizure: an important diagnosis to remember
Authors: Paul Siba Prosad , Zengeya Stanley , Blaikley Sarah , Powell Leanne
Published: May 2014

Children may present with a sudden collapsing episode, and the paramedic team is often requested to attend such emergencies. It is important that these episodes are correctly categorised as being either epileptic or non-epileptic events. A reflex anoxic seizure (RAS) is one such presentation. RAS is a paroxysmal, spontaneously-reversing, brief episode of asystole triggered by pain, fear or anxiety.

RAS occur due to a brief stoppage of the heart caused by overactivity of the vagus nerve. This is usually triggered by an unpleasant stimulus, following which the child may appear pale and lifeless. The diagnosis is usually made by a paediatrician but it is important that the paramedic team are aware of this condition. A child with a diagnosis of RAS may be managed by reassurance from paramedic practitioners if the child is judged to be well after an episode.
‘A pain in the back’: Psoas abscess and the importance of red and yellow flags
Authors: Rees Nigel
Published: May 2014

A case of low back pain is reported. The patient presented with low back pain, and while in the Emergency Department (ED) sepsis was observed. Following investigations including CT lumber spine and pelvis, Ileopsoas abscess (IPA) was found. This case report reflects the difficulties in early diagnosis of the rare presentation of IPA, while highlighting the importance of red and yellow flags in the assessment of low back pain.
Pre-hospital coronary heart disease: Analysing performance indicators
Authors: Fletcher David
Published: May 2014

The prevalence of coronary heart disease is massive within the UK and is the leading cause of myocardial infarction. Between a third and two thirds of associated deaths occur in the pre hospital setting, many within the first few minutes of symptom onset. Immediate quality treatment is proven to improve patient survival however recent evidence suggests patients are not receiving all the elements of a quality care bundle. Pain management has been identified as one area which requires national improvement to meet standards directed by the National Service Framework for Coronary Heart Disease. In response, Ambulance services nationally have used clinical performance indicators to address quality issues in order to enhance practice and achieve target. This article reviews the importance of pain relief in the treatment of acute coronary syndrome and analyses the use of clinical performance indicators in the pursuit of best practice within the North West.
Future electric vehicles for ambulances (FEVA)
Authors: Baker William , Mansfield Neil , Storer Ian , Hignett Sue
Published: May 2014

The Future Electric Vehicles for Ambulances (FEVA) project is a proof of concept study to explore the feasibility of introducing electric vehicles as smaller, lighter and more compact solo responder vehicles as part of an ambulance fleet. The limited use of electric vehicles in the ambulance service is largely due to the initial cost and performance (journey duration and charging) of the battery technology. In the next 10 years it is likely that the capabilities of electric vehicles will significantly improve to the point where they will become a viable and fully operational option. The Nissan NV200 vehicle was used as a concept platform to represent the size of future electric vehicles for the delivery of solo response emergency and pre-hospital care. A full-size interior mock-up was built using the knowledge gained from previous research projects (Smart Pods and CURE). It was taken to five NHS Ambulance Trusts to firstly explore expectations for low carbon electric vehicles including range and performance and fuel economy / taxation benefits; and secondly evaluate a mobile mock-up of a FEVA interior for solo responders.
Traumatic brain injuries: Continuing dilemmas in the pre-hospital care arena
Authors: Griffin Dylan
Published: May 2014

This article examines the clinical assessment, diagnosis and management of an agitated traumatic brain-injured patient in the pre-hospital setting by a UK Helicopter Emergency Medical (HEMS) Team. Using a case study from clinical practice, the signs and symptoms, aetiology and clinical management options are discussed and compared against current best evidence, with the specific aims of improving mortality and morbity in critically-ill traumatic brain-injured patients.
Sticking the knife in: Time to review management of tension pneumothorax
Authors: Heavyside Andrew
Published: May 2014

Outcomes from traumatic cardiac arrest are poor ( Lockey et al. 2006 ; Soar et al, 2010 ). Those who do survive tend to have had a quickly reversible cuase for their arrest ( Vanden Hoek et al, 2010 ).

One such mechanism is tension pneumothorax; and in a retrospective database review of London HEMS traumatic arrests six patients regained cardiac output immediately following decompression of a tension pneumothorax ( Lockey et al. 2006 ).

Had their tension pneumothoraces not been rapidly decompressed successfully prior to transport to hospital, the continuation of positive pressure ventilation during CPR would likely have further increased intrathoracic pressure. This would render chest compressions ineffective and almost certainly lead to death.

There is currently much doubt surrounding the effectiveness of needle decompression for tension pneumothoraces, and needle decompression without release of air certainly does not rule out this important reversible cause of cardiac arrest ( Rojas et al. 1983 ). In order to improve the outcomes for patients in traumatic cardiac arrest in the UK there is an argument for introducing finger thoracostomy to a paramedics skill set as a safe and effective method of both draining and ruling out tension pneumothorax in the limited setting of traumatic cardiac arrest.
SQIFED: A new reflective model for action learning
Authors: Pocock Helen
Published: May 2014

Action learning is a much under-used aid to professional development within the NHS. As a reflective tool its strength lies in the contribution of a group to an individual's interpretation of real-life problems. With the increasing demand on clinicians to maintain records of their professional development a structured reflective model for action learning would provide the vehicle by which the action learning experience may be recorded and presented. The SQIFED model is presented and described here. SQIFED facilitates not only reflection on the immediate key issue but also the opportunity to revisit the scenario with a fresh focus.
Assessing the accuracy of Internet-based patient information for whiplash
Authors: Power Andrew , Nash Adam , McLoughlin Terence
Published: May 2014

Objective: The aim of this study was to evaluate the quality and reliability of websites which provide information to patients on whiplash injury using an Internet search tool.

Methods: On the application of inclusion criteria, 16 relevant websites were found that met the criteria. These were evaluated using the DISCERN tool, which assesses and scores the reliability and quality of consumer information for health problems. The maximum possible score awarded for an excellent website is 80.

Results: Of the 16 websites scored by DISCERN, the majority fell below the maximum. The highest score achieved was 63 and the lowest score 30.

Conclusions: The results confirm that clinicians should ensure that they direct patients only to high-value validated websites so that they access appropriate and accurate information.
Exploring paramedic patient assessment
Authors: Thompson James
Published: May 2014

Objective:

This study explored the topic of paramedic patient assessment, investigating how they informed clinical decisions, the challenges associated with performing assessments and the perceived effectiveness of current approaches.

Methods:

Using a Delphi research method, expert participants were independently interviewed which encouraged them to share experiences and views. A thematic analysis approach was then used and the data coded and organised into a series of statements to represent the collective expert views. Statements were then returned to the expert participants for validation and comment.

Results:

A process of paramedic care delivery was defined, whose activities were largely identified as representing areas of assessment. Protocols and guidelines which are designed to inform paramedic interventions influenced every stage of care delivery. The depth and breadth of a paramedic's patient assessment were found to be limited once indications for a treatment guideline have been satisfied and the main contraindications are excluded. Current formal assessment tools skills being utilised by paramedic staff (including protocols and practice guidelines) were considered only effective for encounters with critically ill patients, and were of limited benefit to the assessment of patients of a lower clinical acuity. There was a direct correlation between the increased paramedic confidence in their patient assessment skills and the more critical the patient's condition. Paramedics were the least familiar or confident with the assessment principles and skills linked with the lower acuity of patient illness.

Conclusion:

When compared to both national and international ambulance case loads, it is significant that those groups of patient complaints representing the vast majority of ambulance work are the same patient cohorts for whom the paramedic has the least knowledge, preparation and confidence in relation to assessment. Findings relating to the defining of a paramedic's role and process of care distinctly features assessment skills to be both a major component of all pre-hospital activities and integral to the effectiveness of all interventions to follow. This should firmly place
Clinical placements in residential care facilities part 1: positive experiences
Authors: Lucas Peter , McCall Michael , Lea Emma , Eccleston Claire , Stratton Brigit , Crisp Elaine , Andrews Sharon , Robinson Andrew
Published: May 2014

Objective: This paper analyses aged care clinical placements undertaken by undergraduate paramedic students participating in the Wicking Dementia Research and Education Centre's ‘Teaching Aged Care Facilities Program’. Student views on positive learning experiences during placement are identified in order to support further development of high-quality evidence-based clinical placements.

Setting: A cohort of final year undergraduate students (n=17) completed a 5-day clinical placement in two participating residential aged care facilities in Tasmania, Australia.

Method: The research involved the collection of qualitative data during weekly student feedback meetings whilst on placement that were recorded and transcribed. Quantitative data from pre- and post-placement questionnaires were collected and analysed using IBM SPSS Statistics 20.0.

Results: Positive learning experiences identified by students include: an increased understanding of dementia and dementia palliation; development of ‘soft skills’ such as empathy and communication skills; and improved understanding of the operations of residential aged care facilities.

Conclusions: Paramedic practice is an emerging discipline that needs to consider the positive learning experiences identified in this analysis. This will facilitate further development of quality, evidence-based models of undergraduate paramedic student learning in residential aged care.
Automated external defibrillation: implications for paramedic practice
Authors: Parry Andy , Higginson Ray
Published: May 2014

Sudden cardiac arrest is a life-threatening condition but is one that can respond well to timely intervention such as early defibrillation. The use of Automated External Defibrillators has been shown to reverse serious cardiac arrhythmias and improve patient survival. Automated External Defibrillators analyse patients’ cardiac rhythm and advise on whether or not a patient is in a cardiac arrhythmia that requires a shock as part of the resuscitation attempt. This paper will explore the use of these devices, providing information on when and how they are used.
Response to ‘Paramedic treatment—wherever that may be?’
Authors: Boor Sally
Published: May 2014

Sally Boor, paramedic, East of England Ambulance Service NHS Trust responds to James Price's article on the Hazardous Area Response Team (HART), published in last month's issue of the Journal of Paramedic Practice.
What makes clinicians decide to use spinal immobilisation? A review of the literature
Authors: Cornah Julia
Published: May 2014

Current practice of spinal immobilisation appears to be based heavily on historical practice rather than scientific precedence. Evidence shows that it is common practice to immobilise patients, yet studies demonstrating the benefit of this is limited. The decision made by the clinician to immobilise a patient is based on fear of reprisal, caution and ritualised practice rather than robust clinical assessment or a definitive criteria. A global, standardised criteria and robust immobilisation method is yet to be established.

This article will examine and critically analyse existing literature surrounding patient immobilisation following a suspected or confirmed acute neck injury. In particular, literature on the use of a cervical collar and head blocks and the use of clinician decision tools will be critically analysed.
Maintaining nurse prescribing competence: experiences and challenges
Authors: Basford Lynn
Published: May 2014

The development of nurse prescribing has extended the roles and responsibilities of nurses. It is a great achievement not only for the nursing profession but also because it improves the quality and efficiency of care. However, in training to prescribe, nurses have undertaken one of three models of education and training, which have significantly varied in the levels of prescribing competence achieved. Following this initial preparation the issue of maintaining prescribing competence has become a source of concern.. This article therefore explores the issue drawing on the findings from a small-scale study that explored the ‘lived experience’ of nurse prescribers in maintaining their competence to practice. The discussion begins by examining the frequently ill-defined and poorly-articulated concept of ‘competence’ from professional, occupation and behavioural perspectives. Whilst the focus addresses the individual responsibility the article also highlights the employer as a partner with conjoint responsibility. Nurse prescribers have a professional and moral duty to maintain their prescribing competence and must seek ways in which this can be achieved as part of continuing professional development and lifelong learning. The employer must support the maintenance of competence as part of clinical governance and pursue the notion of becoming a learning culture with adequate learning resources. Further studies are recommended to give a wider perspective of the issue of maintaining prescribing competence.
Medication errors: considerations for nurse prescribers
Authors: Banning Maggi
Published: May 2014

Medication errors continue to be a problem involving patients in both primary and secondary care settings. Current evidence suggests that medication errors are costly and increasing (Dobrzanski et al, 2002). For this reason, the Department of Health (2001) aims to reduce the incidence of medication errors by approximately 40% by 2005. Prescribing medication is a relatively new task for nurse prescribers and because of this, vigilance with regard to prescription writing standards is required in order to avoid mistakes in the writing of prescriptions. Nurse prescribers need to maintain the currency of their knowledge in applied pharmacology and therapeutics in order to prevent prescribing errors that involve medications with complex pharmacokinetic and pharmacodynamic profiles.
The importance of earnest record keeping
Authors: Griffith Richard
Published: May 2014

Record keeping is an integral part of a nurse prescriber's care and treatment that is every bit as important as the direct care you provide to patients. Record keeping also has a vital legal purpose. It provides evidence of your involvement with patients and needs to be detailed enough to demonstrate that you have fulfilled your legal and professional duty of care. In this article, Richard Griffith considers how nurse prescribers should write records to ensure that these legal and professional requirements are met.
Nurse prescribing in older persons' mental health
Authors: Murray Aileen
Published: May 2014

This paper will outline how nurse prescribing can be applied to older persons' mental health inpatient services, and the challenges its introduction has had both on the organization as well as the individual practitioner. It introduces how the development of a ward-based nurse prescribing protocol can ensure that the principles of nurse prescribing are maintained in that the patient receives a timely, flexible service yet the nurse is practicing within the clearly defined legal guidelines available as well as detailing more localized arrangements for clinical support, supervision and continuing professional development.
Communication skills: challenges encountered
Authors: Timmins Fiona
Published: May 2014

The final part of the series briefly explores key aspects of change theory and related communication skills that can be applied to improve management of change in relation to innovations in nurse prescribing practice. Change is an inevitable component of life and resistance to it is frequent. Even when innovations are welcome, and indeed an obvious improvement to services, changing practices within an organization inevitably encourages a cascade of responses. Conceptualizations of change such as Lewin's Stages of Change model (Lewin, 1952) and Roger's (1996) ‘Diffusion of Innovation’, can assist those in the midst of change to both understand it and manage it. Rather than simply directing that new directions in care delivery be implemented, it becomes obvious that a systematic, collaborative process is more likely to achieve success. This can begin by identifying organizational barriers that exist, providing relevant information and bringing together the multidisciplinary team to manage the change.
Management of otitis media
Authors: Mills Linda
Published: May 2014

Although ear care is not as high on the health agenda as asthma or diabetes, ear infections can be just as dangerous. The World Health Organization (WHO) attributes 51 000 deaths each year to otitis media in children under 5 years. In terms of disability-adjusted life years, otitis media compares with meningitis, polio and trachoma (WHO, 1993). Although the aetiology of acute otitis media is similar in both developed and developing countries, the complication rates of chronic serous otitis media and mastoiditis in developing countries are comparable to those in Europe and the USA in the pre-antibiotic 1930s and 1940s (Crosby et al, 2004). Treatment of otitis media can be confusing and it is important to have clear guidelines in order to decide which children should be treated and for which children a watchful waiting approach may be preferred.
Making medicines safe: a focus on good prescribing
Authors: Brown Stephen J
Published: May 2014

Patient safety is on every health professional's mind. However, evidence has shown that medication-related harm is a signifi cant issue for healthcare organizations, and many reported incidents are actually avoidable. This article addresses the critical success factors for improving the safety of prescribing and reducing avoidable clinical incidents, by applying guidance and tools provided by the National Patient Safety Agency and Patient Safety First.
An efficacious and competitively priced option for asthma and COPD
Authors: Greener Mark
Published: May 2014

Asthma and chronic obstructive pulmonary disease (COPD) are among the most common conditions managed in primary care – healthcare professionals currently treat 5.4 million patients for asthma. In 2005, there were 842,100 cases of COPD in England, equivalent to one person in every 59 of the population. Yet despite a growing armamentarium and evidence-based guidelines, management often remains suboptimal. Better management could potentially avoid 75% of hospital admissions and up to 90% of deaths from asthma. Even mild COPD may impair daily activities and undermine health-related quality of life. Choosing the most appropriate inhaler for each patient can help optimise outcomes. Moreover, before increasing the dose or introducing another treatment, healthcare professionals need to exclude, as far as possible, factors that could compromise the treatment response including non-adherence, trigger factors and poor inhaler technique. There is no evidence suggesting the order in which asthma patients should use devices other than metered dose inhalers. Therefore, clinicians should consider cost and patient preference when deciding which inhaler to prescribe. This feature examines the place of the Easyhaler range in COPD and asthma management.

This product focus has been supported by an educational grant from Orion Pharma.
Diabetes monitoring: risk factors, complications and management
Authors: Hill Jill
Published: May 2014

Diabetes is a very common, complex condition. It requires management of blood glucose, blood pressure and cholesterol, changes in lifestyle and behaviours, and taking a significant number of medications to prevent the development of costly acute and long-term complications. Type 2 diabetes in particular is a progressive condition. Changes in therapy and additional treatments will depend on regular monitoring (usually during the annual diabetes review process) for the early detection of complications, the risk factors for developing them, and side-effects from increasing polypharmacy.
Roflumilast: a new agent for the treatment of COPD
Authors: Greener Mark
Published: May 2014

Approximately three million people in the UK suffer from chronic obstructive pulmonary disease (COPD). Conventional therapies alleviate symptoms, improve lung function, reduce the risk of exacerbations and enhance quality of life, but COPD still commonly causes considerable morbidity and mortality. Roflumilast (Daxas®) is a recently launched maintenance treatment for adults with severe COPD associated with chronic bronchitis and frequent exacerbations. Roflumilast inhibits phosphodiesterase 4 (PDE4), a second messenger that downregulates many of the inflammatory cells contributing to COPD. In a year-long study that enrolled COPD patients with severe airflow limitation, bronchitic symptoms and a history of exacerbations, roflumilast (500 µg once daily) increased pre- and post-bronchodilator FEV1 and FVC, while reducing the number of, and increasing the time until, moderate or severe exacerbations. Nurses should remind patients that the full effects of roflumilast might take several weeks to emerge, and stress the importance of complying with treatment, even if the benefits are not immediately apparent. Common adverse events with roflumilast include diarrhoea, weight loss, nausea, abdominal pain and headache. While future studies need to resolve several outstanding issues, roflumilast seems to be an important new drug for adults with severe COPD associated with chronic bronchitis and frequent exacerbations.
Thalidomide’s shadow: drug-induced teratogenicity
Authors: Greener Mark
Published: May 2014

Drugs, which cause about 1% of all congenital defects when investigations reveal the aetiology, can induce teratogenicity through: altered gene expression; abnormal apoptosis, cell migration or proliferation; dysfunctional histogenesis; changes in synthesis or function of proteins or nucleic acids; and inadequate energy supply. Stem cells, from which organs emerge—beginning between the third and eighth week of development—are highly sensitive to potential teratogens. Unfortunately, many mothers are unaware that they are pregnant at this time. Gestational stage, dose, route of exposure, pharmacological characteristics, concurrent exposures, and maternal and fetal biological susceptibility influence the risk of teratogenicity following in utero exposure to certain drugs. Nurses need to ensure that drugs taken by expectant mothers or women planning pregnancy are, whenever possible, not associated with birth defects. If the summary of product characteristics suggests a risk, nurses should refer the woman to the prescriber. When prescribing a potential teratogen is unavoidable, nurses need to counsel women about the risks and benefits, and ensure, as far as possible, that the patient adheres to any restrictions. Furthermore, nurses may need to address expectant mothers’ concerns about other drugs taken during pregnancy. Finally, nurses need to remain alert for, and take precautions to avoid, accidental occupational exposure to teratogens and carcinogens.
Estimating the true impact of urinary tract infections
Authors: Greener Mark
Published: May 2014

Half of women suffer at least one symptomatic uncomplicated urinary tract infection (UTI) ( Platt and Keating, 2007 ) at some point in their lives, usually following superficial infection of the bladder mucosa with Escherichia coli ( Zalmanovici Trestioreanu et al, 2010 ). Although serious complications are rare, UTIs commonly compromise quality of life, work and daily activities ( Platt and Keating, 2007 ). Nevertheless, physicians may underestimate the impact of UTIs, while differences in disease ‘models’ between patients and health professionals can create confusion. For instance, describing the female urethra as short led ‘some women to believe that they were deformed’ ( Platt and Keating, 2007 ). Furthermore, most women ‘struggle’ to discuss the signs, symptoms and natural history of UTIs ( Leydon et al. 2010 ). Cotrimoxazole, fluoroquinolones, beta-lactams and nitrofurantoin broadly show equal efficacy at achieving short- and long-term symptomatic cures in uncomplicated UTIs ( Zalmanovici Trestioreanu et al, 2010 ). However, 8–15% of women with UTIs require another course of antibiotics within 4 weeks ( Hummers-Pradier and Kochen, 2002 ), and 40–50% experience recurrence within a year ( Ejernæs, 2011 ). When choosing between antibiotics, prescribers should consider likely susceptibility, adverse events, resistance and patient preference ( Zalmanovici Trestioreanu et al, 2010 ). Pregnant women should avoid trimethoprim either alone or combined with sulphonamides whenever possible ( Sivojelezova et al. 2003 ). In contrast, since the introduction of nitrofurantoin in 1952, ‘its suitability in human pregnancy has been well documented’ ( Macrodantin SPC, 2010 ). Rashes are more common with co-trimoxazole than with nitrofurantoin ( Zalmanovici Trestioreanu et al, 2010 ). In addition, during long-term treatment, fewer patients taking modified-release nitrofurantoin developed drug-related adverse events than with co-trimoxazole or trimethoprim ( Spencer et al. 1994 ). Resistance to co-trimoxazole, and probably to fluoroquinolones, is increasing ( Zalmanovici Trestioreanu et al, 2010 ), in contrast to the low levels seen with nitrofurantoin ( Nicolle et al, 2006 ). In conclusion, nitrofurantoin is a rational firstline empiric treatment for uncomplicated UTIs and ‘more widespread use is justified from a public health perspective as a fluoroquinolone-sparing agent’ ( Zalmanovici Trestioreanu et al, 2010 ).
Fibrinolytic agents: pharmacology, indications and prescribing
Authors: Potts Katherine
Published: May 2014

Fibrinolytic (thrombolytic) agents are used thrombolysis (clot breakdown) in several indications, including acute ST-elevation myocardial infarction, acute pulmonary embolism and acute ischaemic stroke. The pathophysiology of each condition is discussed, as well as indications for the use of fibrinolytic agents. The pathophysiology of thrombosis and the coagulation cascade—which comprises an extrinsic and an intrinsic pathway, leading to a common pathway—are outlined. Commonly used fibrinolytic agents include tenecteplase, reteplase, alteplase, streptokinase and urokinase. Each fibrinolytic agent is reviewed, including indications for use, mode of action, method of administration and dosage, side-effects and contraindications. This enables the reader to be well-informed about fibrinolytic agents and their uses, and provides up-to-date information on their prescription.
For an effective management of gout
Authors: Greener Mark
Published: May 2014

Management of gout, the most common inflammatory joint disease among men older than 40 years of age, is often suboptimal. Uric acid—a by-product of purine metabolism—scavenges free radicals and is associated with a reduced risk of several conditions, including multiple sclerosis, Parkinson’s disease and Alzheimer’s disease. However, crystals of sodium urate in joints produce extremely painful attacks of acute gout during which some people cannot wear socks or bear the touch of bed sheets. If drugs and lifestyle changes do not adequately treat the underlying hyperuricaemia, patients can develop recurrences and chronic tophaceous gout. Co-morbidities are common. Therefore, nurses should consider screening patients with gout for hypertension, dyslipidaema, glucose intolerance and microalbuminuria. Effective gout management depends on good communication with patients. Nurses may need to overcome misconceptions, such as gout being solely self-inflicted through over-indulgence. Most patients need NSAIDs, colchicine, or oral or intra-articular corticosteroids to alleviate acute gout. NSAIDs users at increased risk of peptic ulcers, bleeds or perforations should receive gastro-protective agents. Nurses should consider whether certain medications—such as analgesic aspirin doses, diuretics and ciclosporin—might contribute to hyperuricaemia. Nurses should suggest that patients tackle the risk factors for gout, including being overweight, consumption of purine-rich foods and alcohol. Uric acid-lowering therapy reduces the risk of recurrence and complications. However, nurses need to stress the importance of compliance. This article suggests some ways nurses can enhance management of this extremely common, exquisitely painful, yet often misunderstood, condition.
Community-based systems for medicines administration
Authors: Emblin Kate
Published: May 2014

Community-based systems for medicines administration describe the systems in place to support the management of medicines in a community setting. They may describe both the process by which medicines are administered and the storage systems for the medicines. Many community-based systems for medicines administration are designed to support patients who have practical problems in adhering to their medication regimen. Support systems should be patient-specific and may include: provision of information about medicines to patients and/or carers; simplification or modification of medication regimens; written information such as medicines reminder charts; devices to help with administration of medicines (e.g. eye drop aids, inhaler aids); and multi-compartment compliance aids. A patient’s needs may change over time, so support systems must be regularly reviewed to ensure that they are still appropriate. No single intervention or system will suit all patients, and many will need a combination to support them most appropriately.
Keys to understanding the clinical significance of NNT and NNH
Authors: Greener Mark
Published: May 2014

In some cases, even highly statistically significant results may not matter clinically. Nurses can use the number needed to treat (NNT) and the number needed to harm (NNH) to help assess the clinical advantages and disadvantages of competing interventions. However, although the NNT and NNH are simple and intuitive, nurses still need to employ clinical judgement and critically evaluate the evidence.For example, nurses should use the confidence interval to estimate the precision of the estimate, and consider the clinical validity of any conversion of continuous outcomes. Even if the paper does not include NNT or NNH, they are easy to calculate and are among the most clinically useful statistics.
Emergency contraception: a case study
Authors: Robinson Gina M
Published: May 2014

Two methods of emergency contraception are currently available in the UK: oral emergency contraception (levonelle and ellaOne) and the copper intrauterine device (IUD). Time limit for use differs between the various methods, and this can be useful in determining which option is most appropriate. Most women are aware that a pill formulation of emergency contraception is available, but they are less aware of the IUD option. Being able to advise on a suitable form of emergency contraception relies upon the nurse undertaking a detailed assessment that should not only include an extensive review of the patient’s medical history and pharmacy, but also consider the patient’s values and beliefs.
Prevention and treatment of diabetic retinopathy
Authors: Morris David
Published: May 2014

Retinopathy is a common complication of diabetes that can lead to enormous personal and economic sequelae. Interventions that address the risk factors for developing retinopathy, such as tight glycaemic control, blood pressure control and lowering of lipids, and early identification of any problems, through the national screening programme, can help to limit the damaging effects of diabetic retinopathy. Available treatments include laser photocoagulation, vitrectomy and intravitreally injected steroids and anti-vascular endothelial growth factor which can halt the progress of neovascularizaton.
The role of diet in the management of IBS
Authors: Shepherd Alison
Published: May 2014

Irritable bowel syndrome (IBS) is a syndrome with no single cause and heterogenous presentation. Potential triggers include psychological factors, abnormal gastric secretion, visceral hypersensitivity, acute infectious gastroenteritis, alterations to the gut flora, food allergies and genetic causes. Although there are several treatments for IBS, and new drugs are in the production pipeline, dietary advice may be a useful adjunct to treatment in the management of IBS. People with IBS should according to their symptoms but should also continue to consume a balanced diet without any restrictions
Pubic lice and scabies: an opportunity for STI screening
Authors: Keefe Alison
Published: May 2014

Health Protection Agency data in 2011 have revealed another increase in diagnoses of sexually transmitted infections (STIs) of 2% in the UK, with nearly 247 000 new cases, which reverses a small decline in the previous year. Increased rates are partly due to increased rates of STI testing and better tests. Gonorrhoea, genital warts, herpes, chlamydia, and syphilis all rose in incidence, especially among young heterosexual adults aged 15–24 years and men who have sex with men, who continue to have the highest risk. The data also include the incidence of infestation with the ectoparasites pubic lice and scabies mites, which present in genitourinary medicine clinics; however, these conditions may also present in primary care and other settings where healthcare providers may also have an opportunity to screen for concurrent STIs. In this article, factors associated with infestation and STIs are discussed.
Prescribing established and new therapies in COPD
Authors: Bostock-Cox Beverley
Published: May 2014

In this article, the pharmacological management of chronic obstructive pulmonary disease (COPD) is discussed based on current evidence and guidelines. Examples from two anonymized case studies from practice are provided. The discussion focuses on current National Institute for Health and Clinical Excellence (2010) guidance for COPD, and furthermore presents information on newer therapies that have become available since the NICE guidelines were published. The article includes information on both drug and device options for treating COPD.
Introducing nurse prescribing in a substance misuse treatment service
Authors: Turner Steve , Roberts Hazel , Andrews Angela
Published: May 2014

In this article, a project commissioned by a drug and alcohol action team in the south west of England is described. The project brief is to implement non-medical prescribing (NMP) within a substance misuse treatment service in order to increase flexibility of resources for delivery of care. All nurses working within the substance misuse service who are paid at agenda for change band 6 are involved in delivery ( NHS Careers, 2012 ). It is the intention that all will take on a prescribing role, which will introduce more than 10 non-medical prescribers. The project is linked to a strategically led service redesign; one of the aims of which is to improve access to the substance misuse service in isolated rural areas ( Cornwall and Isles of Scilly Primary Care Trust and Drug and Alcohol Action Team, 2010 ). This article outlines the background for the change; the strategies used to implement the project, particularly those used to motivate and involve participants including users of services; and the agreed deliverables. It concludes with a critical evaluation of the project progress to date, together with an outline of how the new arrangements will be sustained and measured, and lessons learned for future similar projects. The project, which started life as a NMP project, has been developed in to an overarching ‘prescribing project’. An additional benefit of the project has been increased engagement and acceptance of change.
Uncovering the basis of nicotine addiction
Authors: Greener Mark
Published: May 2014

Although smoking rates in the UK are declining, by some measures nicotine is more addictive than alcohol, heroin and cocaine. Moreover, tobacco kills many more people than street drugs. This feature examines new research that offers unprecedented insights into the molecular and genetic basis of nicotine addiction. For instance, CNS nicotinic acetylcholine receptors (nAChRs) directly or indirectly influence numerous brain functions and pathways. To take one example, nAChRs modulate dopaminergic activity in pathways responsible for reward, memory and learning. Indeed, in many ways addiction arises from dysfunctional mental processes involved with learning. Partly as a result, nurses could consider tobacco dependence as a chronic disorder that requires repeated episodes of treatment. Genetic factors probably account for approximately 50% of the risk of nicotine dependence; they might also help to explain why only one-third of people who experiment with tobacco become regular smokers; and may influence the efficacy of smoking cessation aids. Such insights from molecular and genetic studies chould help nurses alleviate the persistent problem posed by nicotine addiction and reduce the associated morbidity and mortality.
Topical capsaicin for the treatment of neuropathic pain
Authors: Greener Mark
Published: May 2014

This review examines neuropathic pain, one of the most common and difficult to treat manifestations of chronic pain. Neuropathic pain follows damage to neural tissue, and can result from numerous causes and manifest in several ways. It can also persist long after any identifiable primary cause resolves. Conventional painkillers produce adequate analgesia in fewer than half of people suffering from neuropathic pain. In some cases, even opiates fail to induce adequate analgesia. Topical capsaicin is an effective treatment for postherpetic neuropathy, painful diabetic neuropathy, osteoarthritis, and rheumatoid arthritis. Nurses should counsel patients about the possibility of a burning sensation during initial treatment. Studies have shown that a single application of 8% capsaicin patch can reduce neuropathic pain for up to 12 weeks.
Allergic rhinitis: assessment and treatment
Authors: Holmes Steve , Scullion Jane
Published: May 2014

Allergic rhinitis is a very common condition presenting in primary care in the UK, especially in our population of patients with asthma. The impact of allergic rhinitis is often underestimated, with evidence that it can affect performance at work and school, including other aspects of life. This article describes the important aspects of history, examination, investigations and differential diagnoses, as well as looking into the common causes of allergic rhinitis. The article also looks at the common evidence-based treatments and the pitfalls in therapy. The structure of the article should encourage a more active approach to those presenting with rhinitis in primary care, and help encourage a more accurate diagnosis.
Amiodarone and its role in arrhythmia
Authors: O'Donovan Kate
Published: May 2014

Amiodarone was initially used in the 1960s as an anti-angina agent, but was coincidentally found to have a role in arrhythmia suppression. Despite its high adverse effect, amiodarone is one of the most frequently prescribed anti-arrhythmic agents. Although it is a common anti-arrhythmic in clinical practice, its potential benefits in arrhythmia suppression must be weighed against its onset of action and its many adverse effects. From a nurse prescribing perspective, it is necessary to develop an awareness and knowledge about its mode of action, potential for toxicity and drug interactions, as well as the importance of follow-up and continuing care. This article provides an overview of the agent and its implications for nursing practice.