bluuebunny/crossref_metadata_2025 huggingface dataset:
ED staff knowledge and attitudes towards the paramedic profession in Israel
Authors: Wacht Oren , Dopelt Keren , Schwartz Dagan , Goldeberg Avishay , Aharonson-Daniel Limor , Davidovitch Nadav
Published: May 2014

Objective:

To examine the level of knowledge and attitudes of emergency department (ED) personnel towards the paramedic profession in Israel, and to examine opinions of the ED staff regarding integration of paramedics into the ED work staff.

Study design:

Cross-sectional survey conducted among health care workers.

Sample and setting:

The research population was physicians and nurses in four level 1 hospitals in Israel. The sample population includes 92 physicians (approximately 61%) and 102 nurses (approximately 34%).

Methods:

The questionnaire, distributed from November 2011 to February 2012, was composed of five parts: demographics, questions examining interactions with paramedics, knowledge about the paramedics’ work, their assessment of paramedics’ skills, and their attitudes about expanding the paramedic's scope of practice. The questionnaire was sent to 150 personal emails of ED staff members (physicians and nurses). 68 additional questionnaires were filled in EDs.

Results:

About one fifth of the physicians (21.7%) reported encountering a paramedic on a daily basis, while 87.3% of the nurses reported encountering a paramedic on a daily basis. 72% of the physicians and 77.5% of the nurses knew how to distinguish between a paramedic and a basic or intermediate EMT based on differences in their uniforms. Only 31.5% of the physicians and 43.1% of the nurses knew that the majority of MICUs (Mobile Intensive Care Unit) in Israel have no physician on board. Most physicians and nurses had a high degree of knowledge of the scope of practice of paramedics and a high regard for their clinical skills. Although both physicians and nurses agreed that paramedics can expand their scope of practice to EDs, physicians supported such a measure more than nurses.
Providing feedback on clinical performance to student nurses in children’s nursing: challenges facing preceptors
Authors: Clynes Mary
Published: May 2014

While the importance of providing feedback to student nurses on clinical practice is widely acknowledged, there appears to be inconsistency in the amount, type and timing of feedback they receive (Cahill, 1996; Pertab, 1999; Glover, 2000; Gray and Smith, 2000; Raftery, 2001). However, little is known of preceptors/mentors’ experiences of providing feedback and the challenges they face in this area. This study explores preceptors’ experiences of giving feedback to student nurses undertaking a post-registration programme in children’s nursing.

Data were collected from ten preceptors using semi-structured interviews. Thematic content analysis was carried out. The main themes that emerged from the data related to the provision of negative feedback and the factors that may inhibit the provision of feedback.

Preceptors described challenges in terms of providing negative feedback, both oral and written and maintaining student relationships. A number of factors such as insufficient student contact time, busy wards and inadequate preparation for the role were viewed as inhibiting the feedback process.
Is it time to discuss where practitioners are treating their patients?
Authors: Traill Frances Turner
Published: May 2014

As changes are happening rapidly within aesthetic medicine as to how nurses practise independently and treat their patients, many feel it is time to discuss where patients are treated. Exploring this topic, advanced nurse practitioner Frances Turner Traill debates the pros and cons of the environments in which aesthetic treatments are carried out and, ultimately, if they are fit for practice
An account of shared decision-making on the use of local anaesthesia
Authors: Lockett Karen
Published: May 2014

From the outset of a career in nursing, the individual appreciates that he/she has chosen to enter into a ‘caring’ profession. Aesthetic nurses must strive to provide, along with a high degree of professionalism, a continued caring environment for our clients within this speciality. Therefore, when considering treatment for any aesthetic procedure, safe, reliable pain control is a critical factor. Aesthetic treatments for the most part are treatments of choice as opposed to necessity; lip augmentation is by definition administered to a particularly sensitive area, and so the pain associated with such treatments requires expert but sensitive handling. The decision, taken as part of an in-depth consultation, as to which method of pain control is to be used, must be a mutual agreement between the health professional and patient in order to support concordance. A prescription-only medication is not necessarily required to facilitate this treatment, and so various options need to be considered by the prescriber to ensure the best choices are presented to the patient.
An introduction to clinical lasers: what they are and how they work
Authors: Hughes Jacqueline
Published: May 2014

Clinical lasers are currently used in outpatient clinics to treat a variety of skin conditions, ranging from acne vulgaris to the removal of birthmarks. However, over the years, nurses have seen the growth in the number of aesthetic clinics and salons that are also using lasers for the purpose of skin rejuvenation, thread vein removal and tattoo removal, but what is a laser and how does it work? This article outlines some of the basic properties of a laser and its light, and the applications and safety considerations before becoming a laser operator. Although it takes years for practitioners to perfect their skills, advancements in technology have enabled lasers to become more accessible and treatments continue to adapt and develop.
Self-consciousness: what is it and how does it relate to cosmetic procedures?
Authors: Bradbury Eileen
Published: May 2014

Many patients present to aesthetic practitioners with a number of concerns that could be a result of self-consciousness following a significant life event. Exploring this issue further, Consultant Psychologist Eileen Bradbury defines the factors closely associated with appearance-related anxiety and explains how these relate to male or female patients seeking cosmetic procedures
Is it worth offering mesotherapy on your clinic's treatment menu?
Authors: Warren Lynn
Published: May 2014

In this regular feature in the Journal of Aesthetic Nursing, experienced aesthetic nurses answer your questions relating to clinical and professional issues. This issue, a range of practitioners in the field offer their opinions on mesotherapy and reflect on their previous experience with this treatment.
Is it worth offering mesotherapy on your clinic's treatment menu?
Authors: Russell Nikki
Published: May 2014

In this regular feature in the Journal of Aesthetic Nursing, experienced aesthetic nurses answer your questions relating to clinical and professional issues. This issue, a range of practitioners in the field offer their opinions on mesotherapy and reflect on their previous experience with this treatment.
Is it worth offering mesotherapy on your clinic's treatment menu?
Authors: Meharg Tracy
Published: May 2014

In this regular feature in the Journal of Aesthetic Nursing, experienced aesthetic nurses answer your questions relating to clinical and professional issues. This issue, a range of practitioners in the field offer their opinions on mesotherapy and reflect on their previous experience with this treatment.
Looking beyond the surface of the skin: how does nutrition relate to aesthetics?
Authors: Pearson Kim
Published: May 2014

Patients who present to aesthetic nurses with unrealistic expectations about the way treatments will affect their skin often fail to remember health basics such as a good diet, sleep and exercise. In this short interview with clinical nutritionist Kim Pearson, she describes her clients' concerns relating to anti-ageing and puts forward a case for nutrition and diet consultations in medical aesthetic practice
‘2012 was a challenging year, but we have gained a clearer vision for a stronger future’
Authors: Davies Emma
Published: May 2014

Last year saw many aesthetic nurses winning awards for their contribution to medical aesthetics. To celebrate this well-deserved recognition, the editor of the Journal of Aesthetic Nursing spoke to some of the leading lights in the field about their plans and aspirations for the year ahead
‘Being officially crowned best clinic is testament to our team and wonderful clients’
Authors: Moore Sharon
Published: May 2014

Last year saw many aesthetic nurses winning awards for their contribution to medical aesthetics. To celebrate this well-deserved recognition, the editor of the Journal of Aesthetic Nursing spoke to some of the leading lights in the field about their plans and aspirations for the year ahead
‘We have strived to create a successful business with a genuine caring culture’
Authors: Dilazzaro Fiona
Published: May 2014

Last year saw many aesthetic nurses winning awards for their contribution to medical aesthetics. To celebrate this well-deserved recognition, the editor of the Journal of Aesthetic Nursing spoke to some of the leading lights in the field about their plans and aspirations for the year ahead
Topical retinoids: exploring the mechanisms of action and medical aesthetic applications
Authors: Fromage Gemma
Published: May 2014

Although the skin is able to naturally rejuvenate itself, this process significantly slows with age, leaving the skin progressively thinner, drier and less elastic. Skin ageing is dependent on a number of factors, which can lead to alterations of structure, function and appearance; however, solar ultraviolet radiation is undoubtedly the most influential factor. Topical retinoids are used to treat an array of dermatological conditions owing to their ability to address several inflammatory and keratitis dermatoses. Moreover, retinoids are able to normalise abnormal growth, differentiation and hyperkeratinisation, and have significant anti-inflammatory effects. All-trans retinol is considered to be a weaker form of the prescription tretinoin; it is now commonly found in over-the-counter cosmetic products and is marketed as being able to produce a more youthful appearance by reducing wrinkles, firming the skin and counteracting photoageing. However, the ‘retinoid reaction’ is a common adverse affect experienced while using topical retinoids, where effects include itching, erythema, burning at site of application and peeling. Having said that, topical tretinoin has been shown to have no effect on endogenous plasma levels or its metabolites and, in the past 30 years, no systemic side effects have been noted with its use in young adults. This article will explore the structure, mechanisms of action and cosmetic applications of topical retinoids, also looking at the marked differences between types.
Is there a strong evidence base for pain relief prior to medical aesthetic procedures?
Authors: Costello Kelly
Published: May 2014

Cosmetic interventions can be painful for patients who have not been treated with an appropriate anaesthetic before their treatment. In this article, aesthetic nurse practitioner Kelly Costello discusses results of her survey on pain relief prior to dermal fillers, botulinum toxin, chemical peels, laser and dermal needling, which was completed by 54 aesthetic nurses
Persuading patients to attend psychological services: considerations for aesthetic nurses
Authors: Bradbury Eileen
Published: May 2014

Patients' motivations to seek cosmetic interventions can be complex and varied, leading aesthetic practitioners to have doubts about moving forward with a procedure. In this article, Consultant Psychologist Eileen Bradbury outlines the role of psychiatrists, psychologists and therapists in psychological assessment and discusses the role of aesthetic nurses' instinct in their decision-making
What does the latest research tell us about sun safety among young people?
Authors: Cerny Caroline
Published: May 2014

Not only is excessive sun exposure a major contributor to skin ageing, but also it is a trigger for skin cancer. Following the publication of new research, which highlighted that 45% of sunbed users who are 18–34 years old are unhappy with their appearance, JAN editor Natasha Devan speaks to Caroline Cerny, Senior Health Campaigns Manager at Cancer Research UK
A critical incident post injection of botulinum toxin to the glabellar and orbicularis muscles
Authors: Warren Lynn
Published: May 2014

This case study was originally written by the author in 2007 while she was undertaking her non-medical prescribing course. Despite her considerable experience in the field of medical aesthetics, reflecting on the case study of Neil resulted in positive and necessary changes to her practice. The case study served to illustrate the self-doubt that independent nurses often demonstrate in crisis. Complications can, will and do occur and the author hopes that readers will be able to learn from her experience and recognise the importance of the‘reflective tool’. The author also hopes that this case study will instil confidence in others to not only identify their own learning needs, but also celebrate their knowledge, ability and experience, making the non-medical prescribing course a true learning process.
Is it worth offering financial packages to your aesthetic clinic's clients?
Authors: Collier Darryl
Published: May 2014

In a tough economic climate, clients may not be able to afford the procedure they need regardless of how good the offer is. However, depending on your business model and approach to practice management, financial packages could be of benefit. To find out more about the pros and cons of this service, JAN Editor Natasha Devan had a brief interview with Clinic Director Darryl Collier
Vitiligo: clinical issues, treatment options and how to support patients in practice
Authors: Van Onselen
Published: May 2014

Vitiligo is a common, disfiguring skin condition that affects 1% of the population ( Anstey, 2010 ). There are a range of treatment options for patients, from topical therapies and phototherapy to surgical techniques and medical aesthetic laser procedures. In general, aesthetic nurses are well placed to provide support to patients with vitiligo in their clinics and help them to cope with this highly visible skin condition, which can have far-reaching psychosocial effects. This article will update aesthetic nurses’ knowledge of vitiligo as a skin condition, available treatment options and procedures that can be performed in the aesthetic clinic.
FACE 2013: looking back at this year's meeting of aesthetic minds in London
Authors: Devan Natasha
Published: May 2014

At the end of June 2013, hundreds of aesthetic practitioners attended London's biggest aesthetic conference to learn from some of the most influential speakers in the world and network with friends and colleagues. In this short article, the journal reports on attending aesthetic nurses' highlights for those of you who missed the event this time around
Smoking and skin ageing: how aesthetic nurses can identify and prevent damage
Authors: Cope Graham
Published: May 2014

Whether cigarette smoke has direct contact with individuals or enters through their blood supply, smoking has a significant impact on the skin, leaving it dry, wrinkled and discoloured. While carbon monoxide reduces oxygen availability, carcinogens damage DNA and disrupt cell turnover. Free radicals also disturb the chemical structure of collagen, reducing its flexibility, and nicotine suppresses the immune system, leading to poor wound healing and increased risk of infection. Aesthetic nurses are in a prime position to counsel patients about their smoking habits and provide support to those who wish to quit. This may improve the efficacy of any treatments provided. Patients should be offered advice on ways to give up smoking and directed toward health services and websites that may help them.
Tunic, badge and belt with silver buckle: should aesthetic nurses wear a uniform?
Authors: Scanlon Cherie
Published: May 2014

In July, the Royal College of Nursing (2013 ) published guidance on uniforms and work wear, which clearly stated that when uniform is ‘not deemed appropriate, clothing should still meet certain essential requirements’. The rationale for a uniform refects the need to uphold nurses’ professional image, so why are aesthetic nurses who are trying to assert authority choosing not to take part in this? This article shares the thoughts of an aesthetic nurse on the need for uniforms in clinics and what her research has taught her about perceptions of this among her colleagues.
Long versus short PR campaigns: what is the best option for your clinic?
Authors: Zadah Kate
Published: May 2014

All the hard work involved in creating an aesthetics business could be put in jeopardy by a dose of bad publicity, says PR professional, Kate Zadah. Public relations can not only project a long-term good image for a company, it can keep it in the spotlight, even when ‘nothing much’ seems to be going on. And in extremes, a speedy PR response can help undo the damage of media negativity
Are psychological screening tools ft for purpose in medical aesthetics?
Authors: Sandler Deborah
Published: May 2014

To ensure that patients are suitable for medical aesthetic procedures, psychological assessment should form part of the initial consultation. However, to complete this task, the right tools need to be in place. In this debate feature, cosmetic surgery counsellor Deborah Sandler discusses whether psychological screening tools are appropriate to use for both patients and aesthetic practitioners
Focus on customer service: how to build and maximise your client database
Authors: Deakin Barbara
Published: May 2014

An essential part of running a medical aesthetic clinic is striking the balance between expanding your customer base and maintaining a positive relationship with existing clients. In her monthly column, Clinic Manager Barbara Deakin advises aesthetic nurses on building a loyal database, prioritising customer experience and learning directly from clients themselves
Aesthetic nasal enhancement: products, techniques and treatment protocols
Authors: Adami Raina Zarb
Published: May 2014

Minimally invasive facial aesthetic procedures are very frequently performed owing to the reduced risk of adverse events, decreased level of pain, and virtually negligible downtime. The non-surgical rhinoplasty is no exception to this and is very rapidly gaining popularity. In this procedure, volumising agents such as dermal fillers and neuromodulators such as botulinum toxin type A are judiciously employed to create subtle changes in the outward appearance of the nose. This article describes the various methods of correction or enhancement of nasal features, as well as the potential side effects and the impact of their occurrence. This article is reflective of the author's experience.
Do aesthetic clinics need to register with the Information Commissioner's Office?
Authors: McEnroe Lindsey
Published: May 2014

All aesthetic nurses hold personal, sensitive data about their patients—such as their medical history, ethnic origin and date of birth—and are therefore legally obliged to protect this information in line with the Data Protection Act 1998. Lindsey McEnroe, an advanced aesthetic nurse practitioner based in West Yorkshire, outlines key data-protection principles and defines the role of the Information Commissioner's Office
Royal College of Nursing to exclude aesthetic practice from its indemnity scheme
Authors: Devan Natasha
Published: May 2014

From 1 July 2014, the Royal College of Nursing (RCN) will be ‘closing the indemnity loophole’ by removing aesthetic practice from its insurance scheme. In this article, the editor Natasha Devan shares chief executive Peter Carter's response to the aesthetic nursing profession's concerns. The thoughts of several practitioners who commented on the Journal of Aesthetic Nursing's LinkedIn group will also be featured
Treatment modalities for neck rejuvenation in aesthetic practice: benefits and limitations
Authors: KUBICKA BARBARA
Published: May 2014

Aesthetic practitioners have access to a plethora of tools, products and techniques, all of which can be used to help patients achieve younger, fresher skin. However, many practitioners tend to focus treatment on the areas that trouble their patients the most, such as wrinkles on the forehead, lines around the eyes and creases around the nasolabial folds. When practitioners focus their efforts on these facial areas, there can be a noticeable difference when compared to other parts of the body, such as the neck. If an individual's face looks smooth and line-free and his or her neck is wrinkled with loose skin, this can result in a stark aesthetic contrast. This article explores various anti-ageing neck treatments, outlining the benefits of the different available modalities. The most appropriate treatment plan should be chosen by the aesthetic practitioner based on each individual patient's needs, requirements and expectations.
Diathermy smoke: hazardous to health?
Authors: Brown Steven , Dunn Lynda
Published: May 2014

The heat used in electrocautery causes cells to boil and explode, or simply dry up, producing a gaseous by-product known as diathermy smoke. This smoke may have mutagenic and carcinogenic potential, similar to that of cigarette smoke ( Spearman et al, 2007 ). A search of electronic databases was performed and selected articles were reviewed using the Critical Appraisal Skills Programme (CASP) tool to enable a review of relevant material to be undertaken. The findings of the review identified 45 compounds, 9 of these were found to be hazardous when cross referenced against the Control of Substances Hazardous to Health (COSHH) list of approved workplace exposure limits ( Health and Safety Executive (HSE), 2011 ) and 4 were carcinogens. This research indicates that the use of an extraction device to remove smoke when using diathermy is best practice. However, until more conclusive evidence is available on the actual health risks of diathermy smoke, as opposed to the potential health risks, it will be difficult for organisations that govern health and safety at work to create legislation on the need to extract it from the operating theatre air.
Single-use laryngoscopes: a risk assessment
Authors: Maestre-Ania Ana
Published: May 2014

The debate concerning the use of single-use vs reusable devices, such as laryngoscopes, in order to prevent cross-contamination of medical equipment between patients remains a major issue in clinical practice. There are several points to consider before taking a clinical decision, the most important one being patient safety. With that priority in mind, other issues can be discussed, for example, the financial implications (in terms of budget allowance). While it might appear that single-use devices are the best option—due to the lowered risk of cross-contamination, and a consequent reduction in the cost of sterilisation—patient safety is not solely concerned with cross-contamination; it is also about the appropriateness of the tool being used and the reliability it offers. This paper will focus on laryngoscopes and will assess safety—understood as cross-contamination, light quality and blade rigidity—and cost, enabling the reader to take action on evidence-based practice when considering laryngoscopes and their fitness for purpose. This article is informed by a literature review and, as such, no ethical approval was required.
The ‘Eat Better, Start Better’ programme and opportunities for health visitors
Authors: Mucavele Patricia , Wall Claire , Sharp Laura
Published: May 2014

Children's early years are critical for their health and wellbeing. Establishing good eating habits early in life positively influences growth, development and achievement. Health and early years practitioners play an important role to help children and their families develop healthy eating habits. An independent advisory panel in 2010 emphasized the importance of practitioners working together and in partnership with families using evidence-based, age-appropriate nutrition advice, so there is a a consistent and shared understanding of how to eat well. The Children's Food Trust's ‘Eat Better, Start Better’ programme has been designed to foster this collaboration via delivery of food and nutrition training for the health and early years workforce. The training enhances practitioner's knowledge, skills and confidence to use new national Voluntary Food and Drink Guidelines for Early Years Settings in England, and supporting practical tools with early years settings and families. Health visitors who have participated in this programme have reported how useful the training and guidelines have been when explaining how to provide healthy, balanced and nutritious meals and snacks for children aged 1–5 years.
The new Institute of Health Visiting: A UK centre of excellence supporting high-quality health visiting practice
Authors: Adams Cheryll
Published: May 2014

The iHV was launched in November 2012 to promote excellence in health visiting practice. Founder, Cheryll Adams, highlights the importance of this new centre of excellence.
Childhood obesity: An overview of the health visitor's role
Authors: Patience Sara
Published: May 2014

Evidence suggests that the path to overweight and obesity is set in the early years, with multiple causes and risk factors having been identified. Methods of identification, intervention and prevention of obesity in infants and families are multifaceted, and health visitors have a unique range of skills that—with appropriate training and resources—could be effectively used in the prevention of obesity and subsequent associated diseases, as well as a reduction in costs to individuals, families and society as a whole.
Research roundup: February 2013
Authors: Salmon Debra
Published: May 2014

In this section, brief synopses of a range of recently published articles that may be of interest to health visitors are presented. The aim of this roundup is to provide an overview, rather than a detailed summary, of the research papers selected. Should you wish to look at any of the papers in more detail, a full reference is provided.
Double the pleasure, double the pain
Authors: Garland Zelina
Published: May 2014

When a mother has two newborns to deal with at once, it can often feel more than twice the struggle. A mother of twins talks to Ruth Donnelly about the difficulties she faced in the early months, and how her local health visitors helped to make things a little bit easier.
Helping families cope with violence
Authors: Dennis Tanya
Published: May 2014

Identifying domestic violence and taking appropriate action has the potential to break the cycle and prevent repeat victimization.
Reconnecting to practice: Working as an early implementer site of the new service offer for health visiting
Authors: Smikle Marcia
Published: May 2014

This paper provides an overview of the journey the Homerton University Hospital NHS Foundation Trust has taken as one of three early implementer sites in London for the new service vision and offer outlined in the Health Visitor Implementation Plan ( Department of Health, 2011a ). The Trust's objectives in becoming an early implementer site were to: develop a three-year service implementation plan; achieve growth in the health visitor workforce in line with local population needs; improve partnership working with other health services and Children's Centres; and develop a new professional development programme to support health visitors and equip them to deliver the new service offer. The journey is ongoing and has so far seen positive outcomes in the areas of commissioning, workforce expansion, professional development, service offer, and communication and user engagement. Becoming an early implementer site brought about a period of internal and external scrutiny for the Trust, which proved to be both challenging and stimulating.
Getting the most out of the service
Authors: Donnelly Ruth
Published: May 2014

Over the past six months, Ruth Donnelly has been talking to first-time mothers to find out what aspects of the health visiting service they have found most useful in the early days of motherhood. This month, she summarises the key themes that have emerged.
Online module focuses on genetics
Authors: Cooley Candy
Published: May 2014

An e-learning module has been launched to enable health visitors to build their skills and knowledge regarding the role that genetic and genomic information can play in their practice. Candy Cooley explains the premise and purpose of the new resource.
Research roundup: February 2014
Authors: Potter Barbara , Murray Joy , Jenkins Annie
Published: May 2014

In this section, a brief synopsis of a range 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.
Early Start programme: Improving outcomes for vulnerable families
Authors: Hunt Jackie
Published: May 2014

Early intervention health visiting programmes have been shown to have a positive effect on child development and future outcomes. In Blackburn with Darwen, the Early Start programme was developed to offer intensive support to the most vulnerable families during the first 2 years of a child's life. Its key aims were to improve health and wellbeing, reduce health inequalities and break the intergenerational cycles of deprivation in vulnerable families, thereby improving wider public health issues in the community. The seven-phase programme focuses on building relationships and partnership working with families, and has seen key achievements in areas including immunisation uptake, smoking cessation and tackling drug and alcohol use. The lessons learned from the programme pilot will now be disseminated into the generic health service in Blackburn with Darwen, and with local partners.
PANDAS: Helping families in need
Authors: Marriage Hannah , Dobson Stuart , Dobson Rachael
Published: May 2014

Having been unable to locate local peer support when she suffered perinatal depression, Rachael Dobson and her husband Stuart decided to set up a charity so that others would have someone to turn to in their time of need.
Choosing the right path
Authors: Robinson Effie
Published: May 2014

Effie Robinson was convinced her future lay in district nursing, until her experience of end-of-life care ignited an interest in prevention that led her to seek a different career.
research roundup
Authors: Ellis Peter
Published: May 2014

This section presents a synopsis of a selection of recently published research of interest to renal nurses. The aim of this roundup is to provide a brief overview, rather than a detailed critique, of the papers selected. A full reference is provided for those who wish to look at the research in further detail.
At home with peritoneal dialysis
Authors: Walker Gwyneth
Published: May 2014

Gwyneth Walker, 71, suffered kidney failure three years ago. Unwilling to give up her work, she opted for peritoneal dialysis which she can carry out herself at home. Here, she discusses her condition and treatment and explains why more older people should be encouraged to have home peritoneal dialysis.
The evolution of peritoneal dialysis for end-stage renal disease: Medical challenges on its way to success
Authors: Turner Neil
Published: May 2014

Peritoneal dialysis (PD) for end-stage renal failure was first given as intermittent intensive treatments (IPD) given continuously for 1–2 days once weekly. Patients would generally have a new rigid PD catheter inserted each week under local anaesthetic, be treated for up to 48 hours, then receive no dialysis for 5 days. Its first use this way is attributed to Richard Ruben in 1959, but the shortage of haemodialysis (HD) facilities led to it being widely used, despite its many problems, in the 1960s and 1970s. Even in the early 1980s some patients were being treated by intermittent puncture IPD in the UK.
A general practitioner's perspective on renal care
Authors: Ackland Penny
Published: May 2014

Until recently, the care of renal patients has been largely the domain of nephrologists. However, as a rising number of people are diagnosed with chronic kidney disease (CKD), along with the more active treatment of end-stage renal disease, more of the care has been streamlined into nurse-led clinics, and the earlier stages of renal disease are now being managed in the community. Looking at the overall number of patients within primary care, those with end-stage renal failure comprise only a tiny proportion. The UK annual incidence of stage 5 CKD is about 100 per million population (Hamer and El Nahas, 2006). This would mean that in a practice of 8000 patients, a GP would expect each year, on average, to have only one (or no) patients with newly diagnosed end-stage renal disease. Likewise, as the prevalence of people who rely on dialysis or transplant for survival is 600 to 800 per million, the same practice would expect five or six such patients on its list at any one time.
Peritoneal dialysis: what next?
Authors: Davies Simon
Published: May 2014

The place of peritoneal dialysis (PD) in the treatment of advanced kidney failure has evolved over the last thirty years. Changes in practice, e.g. pre-emptive transplantation, combined with a patient demography that is increasingly elderly with multimorbidity, undoubtedly create particular challenges for PD, which is now used by a decreasing proportion of dialysis patients. Yet the main reasons for offering this treatment—lifestyle, independence, avoidance of hospitals—have never been clearer or more needed. For too many elderly, comorbid patients, haemodialysis has become an unquestioned default therapy.
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Authors: Ellis Peter , Abbott Jane
Published: May 2014

Dear Editor, As nurses we talk a lot about the quality of the care that we provide to our patients and how good we are at it. As a result of recent admissions to hospital, it struck both my wife that perhaps we are not so good at this when looking after fellow nurses. Why is it that nurses are afraid of caring for other nurses?
Haiti and elsewhere: global disaster nephrology
Authors: Feehally John
Published: May 2014

On 12 January 2010, a major earthquake struck Port-au-Prince, Haiti. Immediately, the International Society of Nephrology (ISN) Renal Disaster Relief Task Force—a worldwide network of experts in the management of patients with acute kidney injury (AKI)—swung into action. Within 12 hours an assessment team—a nephrologist and a nurse—flew out. The next day, a technician and another nurse flew out with equipment including four dialysis machines, a water treatment system, and a chemistry device for spot measurements of creatinine and potassium. Their hand luggage was full of crucial lightweight items including resonium and dialysis catheters.
Celebrating the achievements of renal managers and their teams
Authors: Ellis Peter , Abbott Jane
Published: May 2014

In this article, Peter Ellis and Jane Abbott celebrate the unique features of managing a renal unit, contrasting them with the modern health and social care agenda of increased managerialism. Readers are reminded of the positive aspects of working in this interprofessional, inter
Children's Transplant Games 2010
Authors: Lush Vicky
Published: May 2014

Vicky Lush gives an account of this year's Children's Transplant Games which took place in Bath in August. The games aim to celebrate the benefits of transplant surgery and the courage of transplant athletes, as well as promoting an awareness of the need for more organ donors.
Why do haemodialysis patients refuse to have fistulas?
Authors: Leonard Niall , Woodman Alastair , Smyth John
Published: May 2014

Arteriovenous (AV) fistulas are considered the gold standard for haemodialysis vascular access. They are associated with better blood flow, reduced risk of infection and decreased mortality—yet many patients refuse to have them. Niall Leonard and his colleagues investigated the reasons for the refusal.
Financial savings through environmental changes
Authors: Thomson Mary , Chigaru Temby
Published: May 2014

Mary Thomson, Scotland's first appointed Green Nurse, describes how the NHS Renal Services in Fife, with her help and initiative, first assessed the waste produced by haemodialysis treatments and then introduced measures to minimize the waste from each dialysis treatment.
A patient's view of green nephrology
Authors: Williamson Andy
Published: May 2014

Andy Williamson crashlanded at Guy's Hospital in March 2006, and started dialysis immediately. After three months of haemodialysis and 14 months of peritoneal dialysis, his friend and fellow musician Maff Potts gave him a kidney. Three weeks later they formed a new band ‘The Organ Grinders’.
Cardiovascular risk in children with chronic kidney disease
Authors: Jones Helen , Sinha Manish D
Published: May 2014

With this article, Helen Jones and Manish Sinha summarize the current knowledge of the prevalence of cardiovascular disease (CVD) and of CVD risk factors in paediatric patients with chronic kidney disease (CKD). They explain the high cardiovascular morbitity and mortality associated with CVD in CKD and what clinical targets should be used to reduce risk of CVD.
Sexual concerns: living with end-stage renal disease
Authors: Murphy Fiona
Published: May 2014

Patients living with end-stage renal disease face many physical and psychosocial challenges on a day-today basis. One important area, which is not often discussed with patients and their partners, is sexuality and how renal disease can impact on this aspect of their lives. Fiona Murphy looks at the issues surrounding sexuality and outlines how members of the renal team can help patients manage them.
Nutritional changes associated with kidney disease
Authors: Cope Graham
Published: May 2014

Under-nutrition is common in patients with chronic kidney disease and is associated with poor clinical outcome. This article by Graham Cope describes factors important to the nutritional status of renal patients in terms of macro- and micronutrients and how nutrition education may help.
In memoriam: cycling to Paris
Authors: Angove Juliette
Published: May 2014

Juliette Angove took part in this year’s London to Paris charity bike on behalf of Kidney Research UK. She joined in memory of her father who had died of kidney disease last year. Here she remembers her dad and shares her account of the journey she found herself on—metaphorically and physically.
Iron deficiency anaemia: its impact in chronic kidney disease
Authors: Jenkins Karen
Published: May 2014

According to statistics from the World Health Organization, around 2 billion people are anaemic. Highlighting iron deficiency anaemia as a common condition in those who have chronic kidney disease (CKD), Karen Jenkins defines types of iron, describes the iron cycle, and informs renal nurses about diagnosis of iron deficiency in patients suffering from CKD.
Human leukocyte antigens typing system
Authors: Walsh Grainne , Page Gareth , Booth Caroline , Ward Geraldine
Published: May 2014

This article explains how blood grouping and human leukocyte antigens typing helps to ensure that organs can be matched accurately, hopefully reducing the number of rejection episodes that may occur and the amount of immunosuppression needed.
Assisted peritoneal dialysis: a costly exercise or a viable growing service?
Authors: Hurst Helen , Vardhane Anand , Wright Loretta
Published: May 2014

Many patients like to live independently and so by providing assisted automated peritoneal dialysis (aAPD) it enables them to stay at home and out of the hospital setting. This article discusses the reliability of this treatment modality and any practical problems the unit may encounter.
Highlights of the EDTNA/ERCA’s 42nd international conference
Authors: Dainton Marissa
Published: May 2014

This year’s EDTNA/ERCA conference ‘Innovation of Renal Care through Multi-professional Leadership’ was recently held in Malmo, Sweden. In this short article, the assocation’s UK Key Member Marissa Dainton tells renal nurses about her event highlights, including lectures on psychological aspects of care, leadership and patient empowerment.
Angiotensin-converting enzyme inhibitors and acute kidney injury
Authors: Coleman Adrian , Chai Mee Onn
Published: May 2014

Kidney disease and diabetes are both complex conditions that cost the NHS millions to treat. Therefore, it is essential to prescribe the right drugs and understand how they work. In the first drug focus, Adrian Coleman and Mee Onn Chai outline the mechanisms of action of angiotensin-converting enzyme inhibitors and discuss their use in acute kidney injury using a case study
What is an independent assessor and are they really necessary?
Authors: Gordon Elizabeth , Nelson Gill , Newton Barrie
Published: May 2014

In order for approval to be granted for a kidney transplant from a living donor to a known recipient, the Human Tissue Authority must be satisfied that no reward has been offered to the donor and that full consent has been given. Independent assessors play an important part in identifying any unlawful discrepancies in this transaction and in understanding the relationship between the individuals.
Are renal health professionals overdiagnosing chronic kidney disease?
Authors: Cope Graham
Published: May 2014

Over a decade ago, guidelines were established to aid health professionals in the diagnosis of chronic kidney disease and remove regional variations in practice. However, these guidelines did not account for gender differences and age-related factors. Graham Cope explores the evidence available to support the idea that chronic kidney disease is being diagnosed inappropriately, especially in elderly patients.
Treatment of the hyperglycaemic patient on haemodialysis
Authors: Jenkins Kathleen M
Published: May 2014

Patients with established kidney disease often present with several comorbidities, including diabetes mellitus. Diabetes is a complex and challenging condition to manage, and it is imperative that renal nurses are aware of the impact dialysis has on glycaemic control. Kathleen Jenkins discusses blood glucose monitoring, urine testing and appropriate nursing interventions.
Blanching and non-blanching hyperaemia
Authors: Collier M.
Published: May 2014

A review of terms and definitions involved in the identification of risk of pressure ulcer development
A systematic review of laser therapy for venous leg ulcers
Authors: Flemming K.A. , Cullum N.A. , Nelson E.A.
Published: May 2014

A systematic review of randomised controlled trials (RCTs) was conducted to establish the effectiveness of low-level laser therapy as a treatment for venous leg ulcers. Wound-care journals, conference proceedings and electronic databases (including Medline and Cinahl) were searched up to October 1997 for RCTs comparing low-level laser therapy with sham laser, no laser, or non-coherent light of other wavelengths. In addition, companies who manufacture or distribute therapeutic lasers were contacted for any unpublished or ongoing studies.

Results from searches were scrutinised by one reviewer to identify possible RCTs and full reports of these were obtained. Details of eligible studies were extracted and summarised using a data extraction sheet. Data extraction was checked by a second reviewer. Meta-analysis was used to combine the results of trials where the interventions and outcome measures were sufficiently similar.

A total of four eligible RCTs were identified. Two compared treatment with laser therapy to sham or placebo laser treatment. One study compared laser therapy with ultraviolet therapy. The fourth was a three-armed study which compared the effects of laser therapy alone, laser therapy plus infrared light, and non-coherent unpolarised red light.

The comparisons of laser therapy with placebo, and laser therapy with ultraviolet therapy, showed no significant difference between treatments with regard to ulcer healing rates. The comparison of laser with red light showed a significant increase in complete healing at nine months for the combination of laser and infrared light compared to non-coherent unpolarised red light. We have not found any evidence of the benefit of low-level laser therapy per se on venous leg ulcer healing. It appears that a combination of HeNe laser and infrared light may promote the healing of venous ulcers, however more research is needed.
The causes and prevention of maceration of the skin
Authors: Cutting K.F.
Published: May 2014

A discussion of how to control exudate levels and select appropriate dressings in order to avoid maceration in patients with wounds.
A follow-up study of leg ulcer patients in South Stockholm
Authors: Ebbeskog B. , Lindholm C. , Grauers M. , Öhman S.
Published: May 2014

The objective of this study was to follow up patients with leg ulcers, previously identified in an epidemiological study in South Stockholm. Rate of healing, non-healing, recurrence, amputation and mortality were recorded. A total of 254 patients were identified for follow-up after 18 months, using a questionnaire; at the time of the follow-up study, 61% of the ulcers were healed, 29% of the patients still had open ulcers, and 8% of the ulcers had recurred after healing. During this period, 20% of the patients had died, with arterial disease (39%) being more common than venous insufficiency.

A further objective was to investigate 21 patients with non-healed venous leg ulcers by means of a structured assessment instrument, and to study if wound healing could be encouraged by using a triple-layer bandage for three months. Patients with non-healed venous leg ulcers treated in community care were recruited for assessment by means of a standardised form and given a triple-layer bandaging treatment for a three-month period. Two ulcers had healed and nine ulcers had improved and were healing. In the group of patients with healed or improved ulcers, five had normal mobility. Venous aetiology was also more common than arterial aetiology
Short-stretch bandaging in the treatment of venous leg ulcers
Authors: Charles H.
Published: May 2014

A review of the benefits of short-stretch bandages and techniques that have been developed for their application.
The structure and composition of chronic wound eschar
Authors: Thomas A.M.L. , Harding K.G. , Moore K.
Published: May 2014

Wounds with a covering of eschar require debridement before optimal wound healing can proceed. There are several different methods available but these have been derived empirically with no direct evidence of the structure or composition of the tissue they are designed to remove, or of the potential autolytic mechanisms which are the targets for some of these treatments. The aim of this study therefore was to determine the composition of chronic wound eschar and hence identify potential targets for the induction of autolytic debridement.

Chronic wound eschar was removed by surgical debridement and analysed using immunohistochemistry, polyacrylamide gel electrophoresis (PAGE) and gelatin zymography. Immunohistochemistry using antibodies specific for extracellular matrix (ECM) proteins revealed a definite tissue structure, consisting of many fibrous regions and fine fibrillar elements separated by areas of tissue which were of a more irregular and amorphous nature. An antibody specific for all leucocytes revealed the presence of leucocytes in the region of tissue closest to the wound bed. The presence of this leucocyte population correlated to elevated levels of gelatinase activity as identified by gelatin zymography. PAGE analysis identified various protein species in the range 3.5-60 kDa molecular weight.

These data indicate that wound debridement is likely to require multiple enzyme specificities to degrade the eschar and that these enzymes may be supplied by inflammatory leucocytes infiltrating the eschar from the wound bed. The various protein species demonstrated by PAGE may represent ECM proteins, those with lower molecular weight possibly representing the degradation products of autolytic debridement.