bluuebunny/crossref_metadata_2025 huggingface dataset:
Administering intramuscular injections to children: what does the evidence say?
Authors: Barron Carol , Cocoman Angela
Published: May 2014

Many author’s argue that intramuscular injections (IM) are rarely used routinely in children’s nursing (Hemsworth, 2000). Owing to the decreased exposure of children’s nurses in administering intramuscular injections to children, there is a need for nurses to update themselves on the latest evidence-based practice regarding the theory and technical aspects of this clinical skill. There is a reasonable body of literature focussing on immunization of the young child (under two years of age); however, there is a serious deficit of literature relating to administering intramuscular injection to children and adolescents. The vastus lateralis is the site of choice for children under the age of two, followed by the deltoid site for children two years old and above (RCPCH, 2002). Current literature cites the ventrogluteal muscle as being the site of choice for IM injection in adults (Greenway, 2004). However, there is no recommendation given on the land marking of this site for children.

With the exception of new born babies or premature neonates, evidenced-based practice demonstrates that a needle size of 25 Gauge (1 inch) 0.6mm by 25mm length, is the most appropriate size to ensure a true intramuscular injection occurs and also minimizes local irritation and pain (Diggle et al, 2006). Invasive procedures, such as intramuscular injections can cause substantial anxiety and pain to children (Ellisand Bentz, 2004). This paper includes a brief examination of the pharmacological and non-pharmacological treatments used in the management of injection procedures in children.
Prescribing for medical aesthetic patients outside of nurse prescribers’ immediate care
Authors: Rankin Andrew , Traill Frances Turner , Bowes Lorna , Goddard Rachel , Lockett Karen , Harding Kate , Sal-Cedo Kerrie-Jayne , Beaumont-Thomasall Tatiana
Published: May 2014

Foreword

by Lorna Bowes

Much work has been put in by a dedicated team of aesthetic nurses, all members of the British Association of Cosmetic Nurses, who volunteered their knowledge, time and varied experiences to put together a document in the immediate aftermath of the BBC's expose on remote prescribing and subsequent positions of the General Medical Council and Nursing and Midwifery Council. The draft guidelines were then reviewed by a further group of aesthetic nurses and examined for relevance and accuracy. This is, as would be expected, a work that will develop and evolve as aesthetic medicine changes and guidelines from the Nursing and Midwifery Council, Medicines and Healthcare Products Regulatory Agency and other bodies affect practice. The first review of the guidelines is set for as early as October this year. The document is intended for use by nurse independent prescribers prescribing for patients outside of their immediate care, and the non-prescribing nurses who will be administering the prescribed treatments. The guidelines are published in full here, and thanks must go to the team expertly led by prescriber and nurse practitioner Andrew Rankin.
Reconstitution of botulinum toxins: preserved saline versus normal saline
Authors: Traill Frances Turner , Williams Adam , Beaumount-Thomas Tatiana
Published: May 2014

The three main aesthetic pharmaceutical companies in the UK (Allergan, Merz Pharma and Galderma) have all recommended that their botulinum toxin products should only be reconstituted with unpreserved saline. However, several recent studies have highlighted that, owing to the reduction of pain associated with injection, the vast majority of aesthetic nurses and doctors use preserved saline (Liu et al, 2012). In this article, the authors highlight the common practice of using bacteriostatic saline rather than following manufacturers’ summary of product characteristics to reconstitute botulinum toxins.
Non-surgical aesthetic nasal enhancement: indications, contraindications and anatomy
Authors: Adami Raina Zarb
Published: May 2014

The non-surgical facial aesthetics arena is rapidly evolving and there has been a high demand over recent years for the correction of mild-to-moderate external nasal deformities. The minimally invasive rhinoplasty combines the adjuvant use of botulinum toxin type A and dermal fillers to rectify or improve a range of perceived or actual nasal defects (e.g. drooping tip, depressed areas). The procedure takes place in an outpatient setting and involves virtually no discomfort, little associated downtime, and is considered very safe and efficient, yielding high patient satisfaction rates. This article will explore the history of the procedure, describe the ideal nasal proportions, outline the anatomy of the external nose and cover the indications and contraindications for the procedure. A second article will look at the products used and provide readers with a treatment protocol. Both articles are reflective of the author's experience.
Managing clinic recruitment: sourcing the right skills for administrative roles
Authors: Deakin Barbara
Published: May 2014

Receptionists and administrators often serve as the ‘face’ of a clinic, giving clients the first impression of your practice. Exceptional customer service is key, so the person in this role needs to be friendly, professional and welcoming. In this series discussing recruitment for specific roles, Clinic Manager Barbara Deakin advises on the steps to take to find the perfect administrative employee
Using hyaluronidase medication to correct adverse events post soft tissue augmentation
Authors: COSTA NAOMI SILVA
Published: May 2014

As hyaluronic acid (HA) has become one of the most common facial aesthetic augmentation filler agents, the need to effectively deal with procedure-related complications is much greater. Adverse events such as overcorrection and asymmetries owing to product misplacement through poor injection technique can undermine positive treatment outcomes because, although they are classed as temporary, HA-based dermal fillers can last up to 12 months or longer. Hyaluronidase treatment fortunately offers aesthetic practitioners a potential solution to multiple HA-filler based adverse effects. When used correctly, hyaluronidase is also an effective treatment for some serious adverse reactions to HA and can help to remove unwanted HA deposits. It has also been shown to be useful in managing rare granulomatous foreign-body reactions to HA and delayed onset nodules, once infection or inflammation have been treated or ruled out.
Involving service users and carers in ODP interviews
Authors: Richardson Tricia , Hughes Robert , Morley John , Duggan Sandra
Published: May 2014

This paper describes the meaningful involvement of service users (or patients) and carers as co-interviewers during the last 3 years, in the selection of students to the operating department practitioner programme at Teesside University. The authors discuss the background to this initiative and the journey that was undertaken. The process of involving service users and carers includes careful preparation and continuous evaluation. The authors suggest that the added value that service users and carers bring to the interview process not only enhances the quality of the interview, but also increases the confidence of the professional interviewers in selecting students with the right qualities. Furthermore, it reinforces the fact that service users and carers are the main focus of the profession. The feasibility and sustainability of service user and carer involvement in the interview process is also discussed.
Using technology to teach anatomy and physiology
Authors: Huggins David , Goacher Penelope
Published: May 2014

The teaching of anatomy and physiology to health-care students has always raised challenges for staff. The diversity of ability of the students and the need to apply theoretical concepts to clinical practice are particularly difficult for some lecturers. These lecturers may be non-clinical physiologists or clinical specialists with less detailed understanding of the scientific rationale. This project looks at the development of a new teaching strategy using computer software to supplement existing teaching methods to support a range of pre-registration health-care students in learning anatomical and physiological principles.
Situational awareness and theatre practitioner education
Authors: Hauxwell Jonathan
Published: May 2014

Following his wife's death during anaesthesia, the husband of the late Elaine Bromiley began an initiative, based on aspects of his training as a pilot, that was a catalyst for the inception of the World Health Organization checklist for surgery and team briefings in theatre. This paper describes the background to this and also suggests how the crew resource management aspect of his training highlights situational awareness. This is a concept that can be used to augment the development of operating department practitioners and theatre practitioners by getting them to think and transfer the perception of the environment across contexts from aircraft to operating theatre.
Treating Parkinson's disease: deep brain stimulation
Authors: Owen Sarah LF
Published: May 2014

Deep brain stimulation (DBS) is a well-established treatment for Parkinson's disease ( Jenkinson et al, 2005 ; Green et al, 2006 ). However, the number of indications that DBS can be used for are on the increase, including pain ( Owen et al, 2006 ; Owen et al, 2007a ; Franzini et al, 2008 ; Leone et al, 2008 ; Owen et al, 2008 ; Grover et al, 2009 ) and psychiatric illness ( Tass et al, 2003 ; Greenberg et al, 2006 ; Lipsman et al, 2013 ). A patient undergoing DBS surgery has some unique needs in relation to the perioperative environment, with comfort and anxiety levels of paramount importance to allow for patient participation during the procedure. As the majority of patients undergoing DBS are Parkinson's disease sufferers, this paper aims to highlight some of the key factors unique to DBS surgery that help to provide optimum conditions, alongside the general perioperative care given for most procedures to optimise a successful outcome to the procedure.
New ways of working: Promotional interviewing in health visiting practice
Authors: Barlow Jane , Coe Chris
Published: May 2014

An increasing number of trusts are commissioning health visitors to deliver promotional interviewing as part of the Healthy Child Programme (HCP). This paper reports the results of the first study to examine the implementation of promotional interviewing in the UK since its inclusion in the HCP ( Department of Health (DH), 2009 ). It was conducted in a highly innovative Early Implementer Site (EIS), in which promotional interviewing was implemented early and with all practising health visitors. A mixed-method evaluation was conducted to assess the level of implementation and stakeholder perceptions. A range of benefits, facilitators and barriers were identified, and the findings are discussed in terms of the implications for other trusts embarking on the introduction of promotional interviewing into health visiting practice.
Sudden infant death syndrome: How can health visitors help?
Authors: Bates Francine , Mullan Louisa
Published: May 2014

Every year in the UK, around 300 apparently healthy babies will die suddenly and unexpectedly ( Office for National Statistics, 2013 ). Although it is still not known how to prevent these deaths, there are practical steps that parents can take to reduce their baby's risk. Health visitors play a pivotal role in the delivery of ‘safer sleep’ advice to new parents. Families bereaved through sudden infant death syndrome (SIDS) are often left feeling isolated and searching for answers; specialist services can provide the necessary and appropriate support at this time. This article gives an overview of evidence-based recommendations that can help to save more lives, and looks at the health visitor's role in supporting parents who have lost a child.
Everyone's business: Why health visitors should embrace the venous thromboembolism agenda
Authors: Carter Kim
Published: May 2014

Pregnancy-related venous thromboembolism (VTE) remains one of the leading causes of maternal morbidity and mortality, the incidence of which peaks in the post-partum period. From the time of discharge from midwifery services at around 2 weeks post delivery until the postnatal check by the GP at 6–8 weeks, VTE remains a significant risk. During this period, although the health visitor may be the only health-care professional to have contact with families, they currently have no training in VTE or VTE risk assessment, and early recognition of symptoms is not currently part of their role. Using a case study to demonstrate the potential need for targeted service provision for families living with pregnancy-related VTE, this paper analyses its impact on women and families. It explores the introduction of VTE education, risk assessment and early recognition to the health visiting agenda in line with other professional groups to improve physiological and psychosocial outcomes for affected families.
Smoking cessation: Reducing harm and improving the health of children
Authors: Percival Jennifer
Published: May 2014

This evidence-based, practical overview of parental smoking and its effect on infants describes the role health visitors can play in educating pregnant women and parents/carers of young children on effective ways to stop smoking tobacco. A range of examples are offered of effective communication strategies which can engage pregnant women and other adults who smoke in reducing their children's risk of exposure to tobacco smoke. If parents and carers are contented smokers and not ready to change their habit, techniques to raise the issue of protecting children from exposure to second-hand smoke are explained. The article provides an overview of treatment for nicotine dependence, including nicotine replacement therapy, NHS Stop Smoking Services and harm-reduction approaches to smoking.
Promoting active ageing in older people from black and minority ethnic groups
Authors: Horne, Maria
Published: May 2014

Promoting active ageing among older adults from black and minority ethnic (BME) groups through the uptake and subsequent adherence of physical activity is an important public health issue. Although health promotion among older people is no longer a focus of practice for health visitors, they still have a key role as part of the multidisciplinary team by assessing levels of physical activity, identifying actual and potential barriers to increasing physical activity, facilitating equitable access to physical activity programmes and services, and enabling older adults from BME groups to achieve the recommended physical activity levels through adapting and tailoring information and advice. Additionally, health visitors can act on the wider social determinants of health that may influence behaviour change to reduce inequalities in access to physical activity, provision and referral by lobbying locally and nationally for improvements in local access to exercise and physical activity programmes, transport and creating built and natural environments that promote and support physical activity.
Identifying outcomes relevant to health visiting services
Authors: Cowley Dame Sarah
Published: May 2014

The need to articulate and identify outcomes from health visiting services has been recognized for many years. Early challenges about underlying theory and suitable research methods are beginning to be overcome. Sarah Cowley explains the linear process that helps to identify evidence-based practice and outcomes for targeted prevention.
The importance of maintaining appropriate vitamin D levels
Authors: Patience Sara
Published: May 2014

Health visitors have a key role to play in the prevention of vitamin D deficiency. This article gives health visitors an understanding of why vitamin D is important, through an explanation of vitamin D metabolism, function, sources and toxicity, as well as helping health visitors identify those at particular risk of deficiency. This will allow health visitors to knowledgeably discuss the need for vitamin D supplementation with parents, hopefully increasing adherence to advice. The current UK advice is discussed.
Taking a lead in compassionate care: The challenge for health visitors in responding to the six Cs
Authors: Chambers Claire
Published: May 2014

With a media and policy spotlight on the importance of compassion in the health service, Claire Chambers discusses the challenges and opportunities for health visitors in following the ‘six Cs’ model and take a leading role in compassionate care.
SAFER: Boosting quality and efficiency of urgent child protection referrals
Authors: Adams Cheryll
Published: May 2014

The Institute of Health Visiting has recently updated a tool to aid health visitors in making safeguarding referrals. Cheryll Adams explains what it is and how it is used.
An opportunity for answers: Student Health Visitor Question Time
Authors: Cummings Emma-Louise
Published: May 2014

The Student Health Visitor Question Time (North West) event provided a forum in which students could ask an expert panel about issues affecting the sector. Emma-Louise Cummings shares some of the main themes and talking points.
Management of eczema in babies and young children
Authors: Robinson Jean
Published: May 2014

This article reviews current advances in the understanding of eczema, a common chronic inflammatory and itchy skin condition where there are subtle defects in the protein structure and function of the skin barrier. Parent and carer education in management and use of treatments is key and, as most children develop eczema under the age of 4 years, health visitors are well placed to help and support families with education and practical demonstrations about the use of emollients and topical corticosteroids. Food allergy in young children with moderate or severe atopic eczema should be considered in the presence of faltering growth and gastrointestinal symptoms.
The importance of outcomes
Authors: Oldman Crystal
Published: May 2014

It is crucial for health visitors to be able to evidence the outcomes of their prevention and health promotion work, which are not always measurable, says Crystal Oldman.
Iron-deficiency anaemia in infants: How can health visitors help?
Authors: Patience Sara
Published: May 2014

Iron deficiency is the most common mineral deficiency both in the UK and across the world. Iron is essential for the transport of oxygen and is a component of many proteins and enzymes. Iron requirements in infants and toddlers are greater than at any other time in life, because of the substantial amount of growth taking place at that time. Minority ethnic infants and children in the UK are at the greatest risk of iron-deficiency anaemia; this may be due to feeding practices, socio-economic conditions or loss of access to traditional or known foods. Health visitors are required to give nutritional advice to families. This article updates knowledge of iron and suggests evidence-based advice for families with young children.
Unaccompanied asylum-seeking children: A personal account
Authors: Thomas Sara
Published: May 2014

Asylum seekers often have complex health needs, and children among this group are particularly vulnerable. It is important for health professionals to understand the circumstances faced by such children in order to offer support. Health visitor Sara Thomas shares the story of two boys who came to England from Afghanistan.
The desire to fix versus the need to empower
Authors: Taylor Tracey
Published: May 2014

The transition from hospital-based nursing to becoming a health visitor brings numerous challenges. This month, Tracey Taylor considers how her urge to find solutions can be reconciled with the need to empower the families she serves.
Itching in preschool children: An overview of causes and management
Authors: Watkins Jean
Published: May 2014

Itching is a common problem in children and may stem from a number of causes such as eczema, urticaria, insect bites, infections or occasionally from more serious generalised disease. Health visitors should be able to recognise common conditions and recommend treatment and management options to parents. If the health visitor is in doubt as to the cause, unable to prescribe treatment or in a situation where the condition is deteriorating or not responding to treatment, it will be necessary to refer the family to the GP or specialist for further advice. This article discusses signs and symptoms that help in diagnosis, and appropriate treatments and management of these conditions.
Parents' experiences of early support
Authors: Brook Judy
Published: May 2014

In this section, a range of brief synopses of recently published articles that may be of interest to health visitors is 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.
Debating global nursing issues
Authors: Oldman Crystal
Published: May 2014

Crystal Oldman recently attended an international nursing conference in Manila, and was encouraged to see widespread agreement on the importance of community nursing.
Child public health in 21st-century practice: Examples of collaborative working with the paediatrician
Authors: Blair Mitch
Published: May 2014

Public health is central to health visitors’ work, and a key element of effective health promotion is joint working with other professionals. Paediatrician Professor Mitch Blair discusses the health visitor's crucial role in primary prevention, and shares examples from his own practice of working with health visitors in child public health.
Renal services in the UK: how far have we come?
Authors: O'Donoghue Donal , McManus Breeda
Published: May 2014

This year marks the half-way point in the planned implementation of the National Service Framework (NSF) for Renal Services. So what have we achieved since its launch in 2004 and what needs to be done? There is no doubt we have made significant progress in the last five years. And initiatives such as the National Renal Dataset and My Kidney Care Plan enable us to continue this progress.
High blood pressure and renal disease: an overview
Authors: Strain David
Published: May 2014

Kidneys play a key role in keeping a person's blood pressure in a healthy range, and blood pressure, in turn, can affect the health of the kidneys. David Strain gives an overview of how high blood pressure (hypertension) and chronic kidney disease (CKD) are linked and what the treatment options are.
What every renal nurse should know about depression
Authors: Dobbels Fabienne , Duerinckx Nathalie , Breunig Carine , De Geest Sabina
Published: May 2014

In this article Fabienne Dobbels and co-authors give an overview of depression and renal disease. They look at the relationship between depressive disorder, chronic kidney disease, renal failure and kidney transplantation, and what tools nurses may be able to use to diagnose depression.
The first randomized trial in dialysis: Setting the standards for haemodialysis
Authors: Turner Neil
Published: May 2014

The National Cooperative Dialysis Study (NCDS) in March 1980 was the first randomized controlled trial and led to the widespread acceptance of minimum standards for ‘dialysis dose’ worldwide. However, few people have read the full study. It is hard to find in libraries and not available online.
Raising awareness: mental health and renal patients
Authors: Santhouse Alastair M
Published: May 2014

It is probably safe to assume that most people choosing a career in nephrology did not do so because of an enduring love for psychiatry. Yet there are few aspects of renal medicine into which the tentacles of psychiatry have not spread. Renal disease is often complex, chronic, and threatening to the patient, requiring a major change in lifestyle and reappraisal of priorities. Adjustment to this new set of circumstances is not always easily made, and perhaps understandably mental health problems are often found in its wake. Some are self-limiting, and resolve as the individual adapts to a change in life circumstances. Others, however, are more enduring, and have a profound impact on the patient's sense of wellbeing. Illnesses such as depression, dementia and drug-related disorders are all more common in renal illness than in other comparable chronic illnesses (Kimmel et al, 1998) and suicide rates have been shown to be higher in end-stage renal disease (Kurella et al, 2005)
Delivering a more sustainable NHS: key strategies and policies
Authors: Pencheon David
Published: May 2014

David Pencheon is the director of the NHS Sustainable Development Unit. Here he gives an overview of the strategies and policies this national unit, based in Cambridge, developed to help the NHS lessen its impact on climate change, promoting a sustainable and low-carbon quality health care service.
The option grid: a shared decision-making tool for renal patients
Authors: Prichard Alison , Thomas Nerys
Published: May 2014

The challenge for the pre-dialysis team is to educate and involve renal patients on deciding their treatment options, which many find overwhelming. We developed an option grid that provides a summary of renal replacement therapy options. Using a ‘decision-quality measure’, we can demonstrate that patients showed a clear improvement in their knowledge of the options and a noticeable shift from being undecided to being able to make a choice. We hope that our option grid may form the basis for information that could be used more widely, across many renal units.
High-volume online haemodiafiltration: the gold standard in thrice-weekly dialysis
Authors: Mitra Sandip
Published: May 2014

Online haemodiafiltration refers to a dialysis technique in which replacement fluid is generated with the use of specialised filters in the water treatment system, without the need for additional fluid infusion bags. This article will review the most recent evidence on the benefits of the technique in improving dialysis patient outcomes.
From fitness to illness, on to wellbeing
Authors: Watson Jonathan
Published: May 2014

Father of one and husband Jonathan Watson had just got back on the road to fitness when he found himself at the resuscitation room at Kingston Hospital with immunoglobulin A nephropathy. After receiving a kidney from his brother Chris, he has now re-established his family life and career.
Managing hyperphosphataemia in chronic kidney disease
Authors: Huckerby Clair , Dasgupta Indranil
Published: May 2014

Hyperphosphataemia occurs when there is insufficient filtering of phosphate from the body by poorly functioning kidneys. Although it is a common complication of chronic kidney disease, there is wide variation between units and practices in the UK when it comes to managing the condition. Clair Huckerby and Indranil Dasgupta summarise the recommendations from recent guidance.
Establishing and maintaining trust: the role of the renal unit manager
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Once trust has been established, the renal unit manager can feel confident that the quality of the work and the attitudes and behaviours demonstrated by members of his or her team will be the same whether he or she is present or not. Peter Ellis and Jane Abbott define the concept of trust, outline how to maintain it in the workplace, and explore the benefits to managers, staff and patients.
Key presentations at the 19th annual Sanofi Renal Forum in Madrid
Authors: Flint Jan
Published: May 2014

This year's Sanofi Renal Forum for health professionals treating chronic kidney disease mineral bone disorder was recently held in Madrid, Spain. In this short article, Royal Free London NHS Trust's clinical lead renal dietitian, Jan Flint, gives readers an overview of the forum's key sessions and take-home messages, and reports on recent research findings on phosphate binders.
Renal rehabilitation: the benefits, barriers and exercise options
Authors: O'Connor Ellen , Koufaki Pelagia , Clark Rachel , Lindup Herolin , Mercer Thomas H , Macdougall Iain , Greenwood Sharlene
Published: May 2014

This article discusses the benefits of well-designed exercise provision, appropriate for chronic kidney disease (CKD), such as enhanced functional capacity, improvements in quality of life, and weight maintenance. However, these things are not usually provided as part of routine care for CKD patients.
SBK Healthcare: how to set up and deliver nurse-led renal services
Authors: Curran David
Published: May 2014

A conference discussing the tools required to deliver new service models and ensure their ongoing effectiveness took place on 27 November 2013 in Manchester. David Curran, Renal Lead Nurse at the Renal Transplantation Unit in the Royal Free London NHS Foundation Trust summarises the seminars he led to support renal nurses in planning and delivering new services.
Prevention of central venous catheter infections in renal dialysis patients
Authors: Collier Sophie
Published: May 2014

Infections from vascular access and central venous catheters continue to be challenging for dialysis patients, and are associated with high morbidity rates and treatment costs. Sophie Collier outlines the necessary steps to take for the prevention of central venous catheter infections in renal patients. She offers guidance on best practice pre-insertion, during insertion and post-insertion.
Pressure sore survey: part one
Authors: Torrance C. , Maylor M.
Published: May 2014

Prevalence and equipment surveys were performed annually in the first of a three-part survey investigating the prevalence of pressure sores in an NHS trust, and the effect of staff knowledge and attitudes. The study was undertaken in an integrated trust with acute and community services. The surveys investigated prevalence of pressure sores and availability of equipment, and identified characteristics of the patient population for comparison with other studies. The results of the equipment survey indicated that there is enough suitable pressure-reducing apparatus to treat those patients with existing severe and superficial sores and more than enough to provide preventive assistance to patients at medium and low risk. The results over the five year period studied suggest that the introduction of pressure sore incidence monitoring is helpful in focusing attention on the pressure sore problem.
The prevalence of pressure damage in acute care hospital patients in the UK
Authors: O'Dea K.
Published: May 2014

This paper aims to provide information on the prevalence of pressure damage in UK hospital patients since 1992. A survey method and data handling service provided by a medical device company was used to set targets and monitor trends. The results of these surveys provide evidence that over a six year period, the prevalence of pressure damage in this population in the UK has shown a significant reduction.
Hospital monitoring of pressure ulcers in the UK
Authors: Scott F. , Newens A.
Published: May 2014

Hospital trusts and health authorities are increasingly being expected to report on numbers of patients with pressure ulcers. Although pressure ulcer audits should be undertaken in a systematic way, there are no agreed standards and little is known about the current status of pressure ulcer monitoring. A postal survey was conducted to establish a national picture of both assessment and audit of pressure ulcers.

Questionnaires were sent to 276 acute hospital trusts throughout the UK; 204 were returned, giving a response rate of 74%. Fewer than half of the trusts (40%) employed a tissue viability nurse, and 28.5% of respondents were another type of clinical nurse specialist. Most hospitals used single scales for grading pressure ulcers and risk assessment but the frequency and method of such surveys varied considerably. Relatively few hospitals (5%) monitored the number of pressure ulcers on a daily basis, 30% made some form of weekly return and 22% made monthly returns.

The authors conclude that there are national variations with respect to the pressure ulcer assessment tools used to provide audit data, and to the methodology and documentation used to collate data. A national consensus is recommended on auditing of pressure ulcers in the UK.
Interface pressure measurements during ambulance journeys
Authors: Parnham A.
Published: May 2014

This study investigated the risk of developing pressure damage associated with surfaces used in ambulances. One subject's journey in an ambulance was evaluated to identify the intensity of interface pressures (in mmHg) at particularly susceptible areas (the ischial tuberosities, sacrum and heels) while the vehicle was both stationary and moving. Interface pressures measured on a standard ambulance stretcher and a spinal board were also compared. Results indicate that the pressure readings obtained are likely to lead to capillary occlusion with the potential development of pressure damage. Manufacturers of ambulances therefore need to consider incorporating pressure-relieving surfaces in seats and stretchers in the future.
Prescribing for leg ulcers in general practice, Part 2
Authors: Barlow J.
Published: May 2014

This study, the second of a two-part article, reports the findings of a survey undertaken to establish who selects the product used in the management of leg ulcers, and the factors influencing their decision making.

The use of interviews (n = 9) followed by postal questionnaires (n = 197) confirms that the majority of decisions are made by practice nurses and district nurses. The findings suggest that, of the factors considered, patient comfort and compliance are the most important factors influencing product selection. This study also suggests that nurses are not using the best available evidence because of inaccessibility of resources and lack of time to search the literature. Nurses also cited difficulty in discriminating between a biased presentation and reliable research.
In-situ irradiation of keloid scars with Nd:YAG laser
Authors: Kumar K. , Kapoor B.S. , Rai P , Shukla H.S.
Published: May 2014

In-situ coagulation of keloid with Nd:YAG laser irradiation was carried out in a cohort study of 17 patients, each with one keloid scar situated on either the sternum (six), abdomen (seven), shoulder (two), hip (one), or ear lobe (one). The duration of scarring was three to 17 years and size varied from 3–8cm long. One to tow doses of laster irratiation was required for complete coagulation. At three months, 10 (58.8%) keloids had completely healed; but in seven (41.1%) 25-50% of residual keloid persisted. Intralesional triamcinolone infection, once in four patients and twice in three patients, produced complete resolution in all seven patients. At 18 months to five years follow-up, 14 patients remain keloid-free but in three keloid recurred and was re-treated with laser coagulation with compelte resolution. The treatment was carried out as an outpatient procedure under local anaesthesia. There were no complications. The results of this initial study suggest that Nd:YAG laser irradiation coadulation is effective treatment for keloid scarring.
How effective are prevention strategies in reducing the prevalence of pressure ulcers?
Authors: Whitfield M.D. , Kaltenthaler E.C , Akehurst A.L. , Walters S.J. , Paisley S.
Published: May 2014

The prevalence of pressure ulcers has remained constant at about 7% over the past 20 years, even though considerable time and money has been invested in various prevention strategies. This literature review explores whether pressure-prevention programmes can reduce the prevalence rate still lower or whether they are working but are limited by an increasingly aged population and rising patient acuity
Assessment of infection in diabetic foot ulcers
Authors: Senior Clare
Published: May 2014

Typical signs of infection in diabetic foot ulcers are often absent or late. The literature review outlines the factors practitioners must take into account when assessing for and managing such infections.
Investigating the bacterial barrier properties of four contemporary wound dressings
Authors: Ameen H. , Moore K. , Lawrence J.C. , Harding K.G.
Published: May 2014

The ability of four wound dressings (CombiDERM, Allevyn Hydrocellular, Tegaderm and Tielle) to resist penetration of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecalis and Pseudomonas aeruginosa was investigated in vitro using a dedicated test apparatus.

With the exception of Tielle, each dressing prevented bacterial transmission over an 11-day challenge period. When both the wound contact surface and the external surface of Tielle were directly challenged with a bacterial suspension, penetration of the dressing was observed within three to five days. The breakdown of its outer membrane could explain the inability of Tielle to maintain a barrier to the passage of the test bacteria used in this wound model. On the basis of these data, CombiDERM, Allevyn Hydrocellular and Tegaderm dressings may facilitate infection control by acting as a physical barrier to the transmission of potentially pathogenic and antibiotic-resistant wound bacteria. However, further research is urgently required to determine whether or not the same results are observed in clinical practice.
A dynamic regulator: the role of growth factors in tissue repair
Authors: Krishnamoorthy L. , Morris H.L. , Harding K.G.
Published: May 2014

Growth factors have the potential to improve wound healing during the three main phases of wound repair. This review, the first in a two-part series, explains how they do this.
Meeting educational needs: postgraduate diploma/MSc in wound healing and tissue repair
Authors: Jones V.
Published: May 2014

The postgraduate diploma offered by the Wound Healing Research Unit, Cardiff, has attracted students from different settings and countries around the world. This article outlines the course.
How to assess a patient's seating needs: some basic principles
Authors: Collins F.
Published: May 2014

When patients have to sit for a long time, it is vital that their seating is assessed for suitability to protect them against pressure ulcers and postural problems. Important factors include the type of chair used and its dimensions.
Let's work together to create an integrated leg ulcer service
Authors: Douglas V.
Published: May 2014

With the number of older people set to soar, there is an urgent need to prevent variations in leg ulcer care at both national and local level, says Val Douglas.
The role of Graftskin (Apligraf) in difficult-to-heal venous leg ulcers
Authors: Bello Y.M. , Falabella A.F.
Published: May 2014

A relatively recent option for treating leg ulcers that have lasted longer than a month is to use living bilayered skin equivalent alongside cornerstone compression therapy. This article discusses Graftskin and considers its practical use.
Mouseyes revisited: upgrading a computer program that aids wound measurement
Authors: Taylor R.J.
Published: May 2014

A computer program (Mouseyes) for measuring wounds has been upgraded to incorporate the use of photographic images taken with a digital camera. This evaluation showed that the upgrade produced accurate and reproducible results.
Interface pressure measurement: testing and selecting sensors
Authors: Bethaves T.
Published: May 2014

Interface — or contact — pressure measurements play a key role in the design of many patient support surfaces aiming to protect areas vulnerable to pressure ulceration. But testing and selecting appropriate devices can be problematic.
Errors and discrepancies: a patient perspective on leg ulcer treatment at home
Authors: Haram R.B. , Dagfinn N.
Published: May 2014

Objective:

This Norwegian study explored the treatment experiences of nine patients with a leg ulcer who lived at home.

Method:

The study was descriptive and exploratory, with open-ended interviews. Five women and four men aged 60–96 years who had had a leg ulcer for more than six weeks participated. Most had a venous/arterial leg ulcer, lasting from between four months to ‘my whole adult life’.

Results:

Treatment was not always carried out in a correct and caring manner. The patients experienced trial and error in their treatment, delays in the arrival of the helpers, unhygienic methods and lack of information about the cause and treatment of their ulcer. Despite these problems, they had confidence in the treatment they received.

Conclusion:

The treatment, hygiene and organisation of the care of patients with leg ulcers living at home needs improving.

Declaration of interest:

None.
Identifying the causes of increased wound pain: the role of the tissue viability nurse
Authors: Tudor Mike
Published: May 2014

A leg ulcer that had stopped healing was causing a patient increased pain. Heavy infection was identified as the cause, and found to be exacerbated by a range of factors. An assessment resulted in treatment changes, leading to complete healing.
Pain in pure and mixed aetiology venous leg ulcers: a three-phase point prevalence study
Authors: Nemeth K.A. , Harrison M.B. , Graham I.D. , Burke S.
Published: May 2014

Objective:

This study aimed to determine the point prevalence of venous leg ulcer pain over three seasons (autumn, winter and spring). It also collated profiles of individuals with venous ulceration and described the characteristics of people with and without venous leg ulcer pain.

Method:

The study sample comprised 255 people with pure and mixed venous leg ulcers who were receiving care in a Canadian community leg ulcer service. Prevalence was determined by the number of individuals who had experienced pain in the past 24 hours. The profile of individuals was developed by analysing sociodemographic, circumstance-of-living, clinical and health-related quality-of-life data collected on admission to the leg ulcer service.

Results:

Over the three prevalence periods, the prevalence of pain for the total sample ranged from 48% to 54%. Prevalences at each of the study periods for individuals who had been receiving care for less than 13 weeks, and for the first measure of pain only, were almost identical, ranging from 48–59%. The mean pain-severity score was less than three (out of 10) in all three periods. Of the individuals with pain, 50% or more used analgesia and, of these, over 75% reported it was effective. The profile of participants with pain was similar to those without it, except that the former were significantly more likely to have osteoarthritis, a foot ulcer, to have been attending the leg service for a shorter time period and to have a lower SF-12 mental health component score.

Conclusion:

These results demonstrate that leg ulcer management must include pain assessment and consideration of the factors that may be associated with pain. A large prospective repeated measures study is needed to increase understanding of the extent of pain, the use and efficacy of analgesia, and the factors that may be related to experiencing pain.
The effects of age-related skin changes on wound healing rates
Authors: Norman D.
Published: May 2014

As human skin ages, its structure undergoes significant changes. Research into the cellular events involved has brought about a common belief that wound healing in older people is slower and that all phases of healing are affected.
A small study in healing rates and symptom control using a new sheet hydrogel dressing
Authors: Hampton S.
Published: May 2014

Objective:

This study set out to investigate the pain control and absorptive properties of a new sheet hydrogel dressing (ActiFormCool, Activa).

Method:

This was a simple evaluation involving 20 wounds. Compression was used when appropriate, although each patient receiving compression had used short-stretch bandages before entering the study.

Results:

Pain was reduced from an average of 8.65 to an average of 3.75, where 10 represents the worst pain possible and one represents no pain. Exudate reduction was assessed by the number of dressing changes required each week. The dressing-change rate reduced from an average of 2.8 times weekly to an average of 1.3 times weekly. Skin condition improved in all three cases in which the surrounding skin had been a problem before the study. Over a four-week period, two wounds healed, four healed by 90% and two by 80%, with an overall average healing rate of 46%.

Conclusion:

ActiFormCool provides an optimum wound-healing environment, reduces pain and absorbs fluid, making it an excellent alternative to loose hydrogels.

Declaration of interest:

This study was funded by Activa Healthcare.
An unusual complication of Vacuum Assisted Closure in the treatment of a pressure ulcer
Authors: Fox A. , Tadros A. , Perks A.G.B.
Published: May 2014

Vacuum Assisted Closure (VAC; KCI) has been shown to be an efficacious and economic treatment for many types of wound, and studies have shown a high success rate in wound healing. The technique is considered to reduce chronic oedema and bacterial count at the wound surface, increasing localised blood flow and facilitating the formation of granulation tissue.
Infection prophylaxis of gunshot wounds using probiotics
Authors: V.I. Nikitenko
Published: May 2014

Objective:

To report a new method of surgical infection prophylaxis for postoperative gunshot wounds to the extremities.

Method:

Gunshot wounded animals were divided into three groups: treatment (probiotic Sporobacterin), antibiotic (cephalosporin cefamezin) and control (no treatment). Histological studies of wound-bed tissue were taken on days 1, 3, 5 and 10 of the study.

Results:

The probiotic administered per os was more effective than antibiotics for prophylaxis of surgical infection.

Conclusion:

The probiotic’s effect is based on the natural defence mechanism activated after injury — the bacterial translocation of saprophytic bacteria from the gut to the wound.

Declaration of interest:

None.
How much do we understand about the effects of ageing on healing?
Authors: Toy L.W.
Published: May 2014

In 1900 the life expectancy in the US was only 47 years, and people aged 65 years and over comprised just 4% of the population. Currently, this group represents 13% of the population and by 2030 they will constitute 20% of the population.
Measuring the impact of venous leg ulcers on quality of life
Authors: Hareendran A. , Bradbury A. , Budd J. , Geroulakos G. , Hobbs R. , Kenkre J. , Symonds T.
Published: May 2014

Objective:

To identify health-related quality-of-life (HRQoL) issues in patients with venous leg ulcers, with the aim of generating items for a treatment outcome measure.

Method:

Thirty-eight patients with venous leg ulcers were interviewed by a psychologist using a semi-structured guide; they also completed a HRQoL questionnaire (modified Skindex). Data from the questionnaire were examined to explore the impact of venous leg ulcers on patients’ lives. Interview transcripts were analysed using qualitative methods to identify additional venous leg ulcer-specific HRQoL items.

Results:

Skindex scores indicated that older patients had worse HRQoL (p<0.05), as did those with pain and non-healing ulcers. Ulcer duration and size did not correlate with HRQoL. Interviews revealed the following effects of ulceration: pain (80.5%); itching (69.4%); altered appearance (66.7%); loss of sleep (66.6%); functional limitation (58.3%); and disappointment with treatment (50%). Based on the interview transcripts, items were generated and discussed with an expert panel, with a view to including them in a venous leg ulcer-specific HRQoL questionnaire.

Conclusion:

Disease-specific HRQoL outcome measures should be considered when evaluating treatments for venous leg ulcers.

Declaration of interest:

This study was funded by Pfizer, Sandwich, UK.