bluuebunny/crossref_metadata_2025 huggingface dataset:
Report on a clinical evaluation of the KerraPro Heel silicone heel pad
Authors: Knowles A. , Young S. , Collins F. , Hampton S.
Published: May 2014

Heels are at increased risk of injury due to the posterior prominence and lack of padding over the calcaneus. Pressure injuries, once established, are extremely costly, both in terms of the detrimental effect on psychosocial wellbeing and threat to life, as well as financially due to length of hospital stay and resources used to heal the wounds. A new and inexpensive silicone heel pad has been designed to simplify the necessary decisions and to address the problems associated with pressure injuries to the heels. This article will describe an observational evaluation of the product. KerraPro Heel pads were evaluated in two separate cohorts of 17 participants over a 4-week period with the primary aim to evaluate the efficacy of the product in preventing and alleviating pressure injuries on the heels. All participants had been reported as ‘at risk’ or ‘at high risk’ of pressure injury to the heels and had a history of developing such lesions. The KerraPro heel pads were compared with the participant's standard protocol. The outcome of the evaluation demonstrated the effectiveness of the KerraPro Heel pads in the prevention and treatment of heel pressure injuries.
Back to basics: an introduction to economic evaluation
Authors: Guest J.F.
Published: May 2014

The first in a series aimed at demystifying complex subjects in wound-care research. Professor Julian Guest provides an introduction and overview of health economics, and economic evaluation, an area of increasing importance in wound care.
Repeatability and clinical utility in stereophotogrammetric measurements of wounds
Authors: Davis A.J. , Nishimura J. , Seton J. , Goodman B.L. , Ho C.H. , Bogie K.M.
Published: May 2014

Objective:

To investigate the hypothesis that stereophotogrammetric wound size monitoring shows suitable inter-observer reliability and user acceptance for clinical practice use.

Method:

Veterans admitted for conservative management of severe pressure ulcers were eligible for inclusion in the study. Three-dimensional (3D) digital wound images were independently captured by two expert and two non-expert nurse-observers using a commercially available stereophotogrammetry system, weekly for 6 weeks. A double-blinded analyst generated 3D wound reconstructions, using software to determine geometry. Clinical opinion of wound progression was provided by an expert physician.

Results:

Thirteen wounds were assessed with more than 80% of all images being readable. Interclass correlation of 0.9867 (p < 0.0001) was observed. Compared with clinical opinion, 3D wound measurement was sensitive between improving and static wounds for wound perimeter, volume, depth and length.

Conclusion:

These preliminary findings suggest that 3D wound measurement minimises differences in wound measurement between expert and non-expert observers, suggesting it could be implemented with high reliability in health-care settings where several observers are involved in wound care management.

Declaration of interest:

This study was funded in part by a grant from the Department of Veterans Affairs VISN10 Research Initiative Program. All study personnel contributed to the paper. AJD's effort was provided in partial fulfilment of the requirements for the MD degree from Case Western Reserve University School of Medicine. The authors declare they have no conflict of interests with regard to the information presented in this paper.
The pernicious cycle of VLUs in Brazil: epidemiology, pathogeny and auxiliary healing methods
Authors: de Araújo I.C.F. , Yoshida W.B. , Abbade L.P.F. , Deffune E.
Published: May 2014

Venous leg ulcers (VLUs) represent the most advanced stage of chronic venous insufficiency. Despite the large body of knowledge available regarding the risk factors and aetiopathogeny of the condition, patients referred to public health care systems in developing countries often do not receive adequate diagnosis or early treatment, leading to clinical evolution and disease recurrence. This review collates updated information about the epidemiology, risk factors, aetiopathogeny, diagnosis, ulcer healing methods and determinant factors of the pernicious cycle of VLUs in developing countries, with a focus on the Brazilian setting.
Development of anin vitrofibrin clot model to evaluate fibrinolytic agents for wound care application
Authors: Viennet C. , Laurensou C. , Goydadin A.C. , Faivre B. , Muret P. , Humbert P.
Published: May 2014

Objective:

To describe an in vitro fibrin clot model that could reliably assess the fibrinolytic activity of enzymatic debriding agents for wound care application.

Method:

A model of a fibrin clot was reconstructed in vitro by mixture of human fibrinogen and a-thrombin supplemented with factor XIII. These clots were then treated with enzymatic ointments. Fibrinolytic activity was investigated by measuring D-dimer levels, using an automated immunoturbidimetric Liatest D-dimer assay.

Results:

Collagenase and papain-urea ointments demonstrated fibrinolytic activity which was macroscopically visible. Their effect was identical on the in vitro reconstructed fibrin clot and ex vivo collected wound fibrin clot; collagenase and papain-urea both induced a complete degradation and dissolution of both fibrin clots after 24 hours of treatment. This was associated with an increase in D-dimer concentration.

Conclusion:

This reconstructed fibrin clot in vitro model has the potential to predict the efficacy of fibrinolytic agents and therefore appears to be a suitable model for in vitro assays.

Declaration of interest:

This study was supported by a grant from URGO Laboratory.
Laboratory evaluation of Drawtex Hydroconductive Dressing with LevaFiber technology
Authors: Edwards-Jones V. , Vishnyakov V. , Spruce P.
Published: May 2014

Objective:

The aim of this study was to assess absorption, sequestration and retention of microorganisms by Drawtex Hydroconductive dressing with LevaFiberTM technology.

Method:

The absorption over time and the ability to sequester and retain bacteria were assessed in the laboratory using an in vitro model where known amounts of fluid and microorganisms were allowed to absorb and sequester over a 24 hour period. The reduction in numbers of microorganisms following sequestration was determined using standard plate counting methods. Retention of the organisms was visualised by scanning electron microscopy.

Results:

Drawtex was shown to absorb eight times its own weight in fluid over time and it showed a 90% reduction in bacterial numbers over a 24 hour period in sequestration experiments. Direct observation by scanning electron microscopy demonstrated bacterial retention in the dressing fibres.

Conclusion:

Drawtex is a recent addition to the formulary for absorbent dressings available in the UK.It demonstrates excellent absorption properties, while maintaining integrity. In addition, it sequesters and retains microorganisms, which will help with removal of exudate and bioburden from the wound bed to help facilitate wound healing.

Declaration of interest:

This study was funded by an educational grant from Martindale Pharma, UK. The authors have no conflicts of interest to declare with regard to the manuscript or its content
Paramedic research methods: importance and implications
Authors: Jones Colin , Jones Paul
Published: May 2014

The modern paramedic will now undertake their professional training within a UK higher education institution (HEI). In addition to their specialist clinical training, other critical elements such as research methods will feature as an integral part of their programme. Often this component of the programme is not delivered by academic paramedical staff, but by personnel with other professional backgrounds. In this paper we acknowledge that the base of paramedic practice is still developing in HEIs and the development of the academic paramedic is ongoing.

Students often face many challenges when undertaking the research methods module within their programme and to best facilitate this, we advocate that this part of the programme is delivered by academics with a background as a paramedic to give the best contextual learning experience.
Risk and benefits of paramedic-initiated shoulder reduction
Authors: Bath Tegwyn , Lord Bill
Published: May 2014

The introduction of prehospital reduction of shoulder dislocation by paramedics is a huge departure from previous teachings. Although shoulder reduction is recommended for use in specific circumstances, such as wilderness areas, little published evidence exists either to provide a solid foundation for its prehospital use, or advise against the introduction of this procedure. Shoulder dislocations, while affecting a minority of the community, are painful and debilitating and require early reduction, as muscle spasm increases with time, making reduction more difficult. In areas associated with prolonged ambulance transport times, the delay to definitive treatment may cause needless pain and suffering to patients sustaining shoulder dislocation. In order to assess the risks and benefits of paramedic reduction of shoulder dislocation, this study systematically evaluated the available evidence. No evidence from clinical studies in the prehospital setting was found: studies from other health settings are used to synthesize recommendations for paramedic practice that enable timely, safe and humanitarian care of patients with shoulder dislocation.
Expecting the unexpected: emergency preparedness
Authors: Norbury Mark
Published: May 2014

Dealing with emergencies is all part of the job for ambulance staff, and putting strategies into place to cope with all eventualities is vital to provide an effective response in the face of a major incident. Mark Norbury, National Emergency Preparedness Coordinator for the Ambulance Service, explains.
Role of paramedic mentors in an evolving profession
Authors: Armitage Ewan
Published: May 2014

In an increasingly demanding profession, the role of a paramedic mentor in the development of paramedics is of pivotal importance. This article aims to review the existing position of paramedic mentors and examine the key challenges facing the mentors themselves and the paramedics they support.
November roundup of the EMS blogging world
Authors: Glencorse Mark
Published: May 2014

Mark Glencorse, NHS Operational Paramedic Team Leader, Author of 999medic.com, and Co-Host and European Programme Director of ‘The Chronicles of EMS’, updates JPP on the main issues that emergency medical services (EMS) blogs are focusing on and the topics that are creating the best discussions this month. Email for correspondence: mglencorse@yahoo.co.uk
Why take a peak flow in asthma – a review
Authors: van Wamel Annelies , Procter Shaun
Published: May 2014

Current asthma protocols advocate the measurement of peak flow expiratory rate (PEFR) by staff in pre-hospital care in their assessment and management of acute asthma. Yet in practice many, if not most, omit to do this. The limited amount of recent research available – which has been conducted by doctors and accident and emergency staff and concerns patients admitted to accident and emergency departments – shows that PEFR is one of the best, if not the best, predictive assessment tool available to ambulance staff. Pulse oximetry and PEFR do not measure the same things and cannot replace each other. Not taking a pre- and post-treatment PEFR is potentially detrimental to patient care and does not comply with Joint Royal Colleges Service Liaison Committee and British Thoracic Society standards. Paramedic-led research on assessment and management of acute asthma in pre-hospital settings is lacking.
Informed consent
Authors: Sibson Lynda
Published: May 2014

While delivering care to patients, are we always sure that patients are consenting to treatment? Informed consent is a legal term that is used to indicate that a patient has provided consent that meets agreed minimal standards. Informed consent can be seen to be given if it is based upon a clear understanding and appreciation of the facts, implications and further consequence of action.
Mentorship for paramedic practice: are we there yet?
Authors: Sibson Lynda , Mursell Ian
Published: May 2014

Mentorship is a key element of professional life, underpinning student development and supporting qualified staff as they advance their own clinical and professional practice. Mentorship has its origins in industry in the US and was adopted, largely unchallenged, into nursing practice in the UK in the 1980s. Although there is a wealth of evidence surrounding mentorship in nursing, very little published literature exists for mentorship in paramedic practice. The first of four articles, this paper will outline some of the definitions of mentoring and concepts related to mentorship, such as the attributes and qualities of an effective mentor.
Becoming a reflective practitioner: frameworks for the prehospital professional
Authors: Willis Sam
Published: May 2014

The concept of reflective practice within healthcare is not new. Reflection is a process which enhances learning and knowledge acquisition and is popular among health professionals. It appears that paramedics, emergency clinicians and student paramedics are using reflective practice as the learning tool of choice. Reflective practice is undertaken for a variety of reasons including self-development, and as a means of demonstrating accountability to the Health Professions Council (HPC). The HPC recognize reflective practice as one option that will contribute towards satisfying continuous professional development requirements for the paramedic. This article discusses origins of reflection and critical inquiry, drawing upon the work of influential characters who have allowed the reflective paradigm to become what it is today. It further discusses reflective practice, critiquing three popular models and in addition, identifies alternative models of reflection specifically designed to be used by those who work within the prehospital care setting.
The pathophysiology of labyrinthitis
Authors: Mildenhall Joanne
Published: May 2014

Labyrinthitis is an inflammatory response within the membranous inner ear structures in response to infection. It is a generally short-lived minor illness that has the potential to cause temporary or permanent disablement in terms of hearing loss. Other symptoms include nausea and vomiting, pain in the affected ear, vertigo, and fever. Subsequently, it is an illness commonly diagnosed by health care practitioners working in the community setting. Understanding the pathophysiological development and the inflammatory and immune response to such an illness enables the clinician to comprehend the underlying processes of the presenting signs and symptoms, and to treat accordingly.
Can paramedics clear the cervical spine?
Authors: Blackham Julian
Published: May 2014

Clinical decision rules to allow clinical ‘clearing’ of the cervical spine are widely used in emergency departments. This topic review considers the literature relating to whether paramedics can clinically clear the cervical spine in the prehospital environment. A comprehensive literature review was undertaken which found eight relevant articles for review. Overall, prehospital professionals, when applying the two commonly used in-hospital clinical decision rules, have a similar sensitivity to their in-hospital colleagues.
Emergency prehospital care of burn injuries: thermal, electrical and chemical burns
Authors: Hirche Christoph , Hrabowski Manuel , Kolios Leila , Daigeler Adrien , Lehnhardt Marcus , Wölfl Christoph
Published: May 2014

The prehospital approach to severly burnt patients still remains challenging for prehospital carers. The adequate approach for thermal, electrical and chemical burns, with special focus on paediatric burnt patients, still needs to be further clarified and some controversies remain. This article addresses the preclinical algorithm for burn treatment and discusses contoversial aspects. After the burning process is stopped, the prehospital carer has to deal with cooling the surface, maintaining a balanced body temperature to avoid hypothermia, identify life-threatening injuries, assess the burn size and severity, and provide adequate dressings. Furthermore, airway management in case of inhalation injury, fluid replacement and analgesia/ sedation must be approached before transportation to a specialized centre. In this article, available formulas for fluid replacement and a guide for paramedics, as well as certain criteria for direct delivery to a burn centre, are discussed. Special aspects of the pathophysiology and primary care of electrical and chemical burns, which particularly require measures of self protection, are evaluated. Basic recommendations of paediatric burn treatment are also addressed. All aspects are integrated into the algorithmic approach in order to make the prehospital carer feel sufficiently prepared.
Retail Store-Related Traumatic Injuries in Paediatric and Elderly Populations
Authors: DeMers Gerard , Lynch Catherine , Vilke Gary
Published: May 2014

Retail stores are often frequent sources of emergency medical service (EMS) calls responding to traumatic injuries. At risk populations for trauma due to falls are paediatric and elderly persons. Methods: the authors reviewed the English literature for incidence and outcomes of EMS response to retail store injuries in paediatric and elderly populations. Articles were chosen based on EMS response and emergency department (ED) visits for age ranges younger than 18 and older than 65. Injury patterns and mechanism of injury were reviewed and alcohol or assault related injuries were excluded from analysis. Results: 22 relevant articles from 5 countries, with the majority of studies from the US, were found; these included 7 descriptive national surveillance database reviews, 4 retrospective record reviews, 4 randomized trials, a survey based study, with the remainder case reports and editorials. Modes of conveyance are the sources for majority of injuries including trauma from the use of shopping carts, stairs, escalators, and elevators. Other areas of injury include trip hazards. Falls are the most common mechanism of injury for both populations and account for more than half of injuries associated with store environments. The use of safety devices and efforts to reduce injury risk are not universal in the retail industry and interventions have variable efficacy. Conclusion: retail stores are common settings responded to by paramedics for paediatric and elderly traumatic injuries. Scene management and extrication of injured persons is an issue for EMS personnel responding to these settings, with methods tailored to injury mechanism. There are several avenues for intervention with the focus on injury prevention though community education.
The Liverpool Care Pathway: a tool for paramedics?
Authors: Nellist Emily
Published: May 2014

This short review examines the implementation of the Liverpool Care Pathway in health care settings and asks whether it would be suitable for paramedics to use in the bid to improve end of life care in the UK. Improvement of end of life care is now a government agenda and subsequently greater attention is being given to it. Currently, very few people achieve a death they would have wished for. Many would prefer to die at home, however, only 18% of deaths do occur at home. The knowledge and implementation of the Liverpool Care Pathway into paramedic practice could help improve end of life care and reduce unnecessary transfers of patients to emergency departments.
Mental health in the care of paramedics: part 1
Authors: Hawley Chris , Singhal Ankush , Roberts AG , Atkinson Heather , Whelan Caroline
Published: May 2014

Mental health disorders are common, presenting frequently in emergency and prehospital settings. Patients suffering from psychotic disorders, mood and anxiety disorders, substance misuse disorders, maternal psychiatric disorders, personality disorders and parasuicidal behaviours commonly present to the emergency services. Although the advanced management of such conditions requires considerable therapeutic sophistication, emergency health care services can contribute greatly to the initial management of patients. In the first of a two-part series, this article will provide an overview of mental health services and provide guidance on the early management of personality disorders, depression, anxiety and psychotic conditions.
Mental health in the care of paramedics: part 2
Authors: Hawley Chris , Singhal Ankush , Roberts AG , Atkinson Heather , Whelan Caroline
Published: May 2014

Mental disorders are common and frequently present in emergency and prehospital settings. Conditions presenting to emergency care services include new onset psychiatric disorder, relapse or exacerbation of a pre-existing psychiatric condition, acute reactions to social adversities or problems associated with substance misuse. Although the advanced management of such conditions requires considerable therapeutic sophistication, paramedical services can contribute greatly to the initial management of such patients. In the second of a two article series on mental disorders, this article will provide guidance on the early assessment and management of bipolar disorder, psychiatric conditions in women, parasuicidal behaviours, acutely disturbed patients and substance misuse disorders. Some relevant legal issues in mental health are also discussed.
Potential applications of capnography in the prehospital setting
Authors: Percival David
Published: May 2014

End-tidal carbon dioxide (ETCO2) monitoring is well established in hospital theatre and critical care settings ( Lah and Grmec, 2010 ), employed for observation and monitoring in anaesthesia. Its application has now extended to the prehospital environment, primarily for the verification of endotracheal tube (ETT) placement, endeavouring to reduce the occurrence of oesophageal intubations ( Grmec and Malley, 2004 ). In recent times, technological advances, coupled with an increased appreciation of the importance of prehospital interventions, has resulted in the production of additional equipment capable of monitoring ETCO2 in non-intubated, self-ventilating patients via a non-invasive nasal cannula. Despite having an extensive range of potential uses, the apparatus is widely underused ( Langhan and Chen, 2008 ). In this article, potential applications in the prehospital setting will be discussed via a review of contemporary literature.
Baby on the way: Was an ambulance in the plan?
Authors: Foster Theresa , Maillardet Victoria
Published: May 2014

Objectives

The East of England Ambulance Service NHS Trust (the trust) sought the views of patients it attended who were imminently about to give birth at the time of the 999 call to the trust. This was a patient group who had previously never been specifically targeted by the trust as part of its on-going patient feedback activity to inform service development.

Methods

All imminent birth patients during a four consecutive month period from August to November 2008 were sent a questionnaire asking them about their contact and satisfaction with the ambulance service at the time of the birth.

Results

Results of this survey have shown that almost a fifth (19.4 %) of patients who had intended to give birth in hospital had planned to use the ambulance service for their transport. Perceived complications, severe pain, labour not progressing, or the advice of a midwife were the main reasons given for unplanned use of the service. In this sample, a greater percentage of patients who planned to give birth at a hospital or maternity centre actually gave birth at home (25.5 %), than was achieved by patients who had planned a home birth (16.7 %).

Conclusions

Further investigation is needed to inform developments in partnership working between ambulance and maternity services to better serve this patient group.
Observations from a student exchange programme: UK and Sweden prehospital care
Authors: Owen Tim , Woodyatt Alison
Published: May 2014

As part of the prehospital unscheduled and emergency care course at the University of Worcester, the authors were selected to take part in an exchange programme arranged between the University of Worcester, England and Halmstad University in Sweden. The exchange took place in January 2011 and lasted two weeks, during which time the authors were based with the Halland Regional Ambulance Service. Halland is a county on the west coast of Sweden, directly south of Gothenburg. It has an area of approximately 2100 square miles or around the same size as Devon. The total population, however, is just over 299 000 ( Statistics Sweden, 2010 ), making the total population density slightly less than half that of Devon. The county is divided into six regions, each centred on a town of the same name ( Statistics Sweden, 2010 ) and in which the ambulance stations are located. During the programme, the authors were based in the town of Varberg and attended incidents as supernumerary crew members. They were also permitted to treat patients, provided this did not exceed levels of competency, complied with local protocols, and was agreed by the responsible clinician. During the visit, observations were made regarding all aspects of ambulance operations. The majority of practice was found to be very similar to the UK, however, a number of important differences were found and these are analysed and contrasted with UK practice. The authors would like to thank the staff and management of the Halland ambulance service for their hospitality, warm welcome and for their generosity in passing on their knowledge. They would also like to thank the staff of the universities of Worcester and Halmstad, without whom the exchange would not have taken place.
Serotonin toxicity: pre-hospital recognition and management
Authors: Hodges Ross
Published: May 2014

Serotonin toxicity is a preventable, potentially serious condition caused by an increase in the neurotransmitter serotonin. The condition can produce a wide variety of symptoms ranging from mild to life threatening. Common signs of severe life threatening toxicity include clonus, myoclonus, hyperreflexia, muscle rigidity and hyperthermia. Serotonin toxicity is caused by taking one or more serotonergic agents which are responsible for raising intrasynaptic serotonin to an abnormally high level. Severe and fatal toxicity are usually associated with taking two different serotonergic agents with different pharmacological actions such as selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs). There is no specific pre-hospital treatment for serotonin toxicity. It is based mainly on patients presenting signs and symptoms. The cessation of any serotonergic agents will normally resolve symptoms within 24 hours. Unfortunately it is a condition still not widely recognised by health care professionals (HCP), therefore it is important pre-hospital clinicians are aware of the clinical features of the condition and how best to manage them.
Post-traumatic stress disorder among ambulance personnel: a review of the literature
Authors: Simpson Karen
Published: May 2014

It is becoming increasingly apparent that ambulance personnel are vulnerable to developing post-traumatic stress disorder (PTSD) and associated symptoms.

The aim of this literature review is to identify PTSD within the scope of emergency ambulance work and think of potential ways to reduce it.
History taking, assessment and documentation for paramedics
Authors: Jenkins Steven
Published: May 2014

Paramedic practice is progressing at a more rapid pace now than at any time in its history. Paramedics need to align their method of assessing patients to integrate into the multi-disciplinary team involved in the patient's journey of care and treatment. The review of systems (RoS) approach is widely used and accepted in healthcare, and easily assimilates into paramedic practice. RoS improves patient care by holistically assessing the patient, and can make the inter-professional handover of a patient to another team more professionally acceptable. Documentation using the RoS is more comprehensive and less prone to errors.
Management of patients following cold water immersion
Authors: Strange Barnaby
Published: May 2014

Sudden immersion in cold water results in a number of physiological changes within the human body. This disruption of homeostasis can have a detrimental effect on normal body function and lead to life-threatening consequences including drowning, hypothermia and sudden death. This article will examine the changes in physiology from the point of initial immersion through to rescue or death. Particular attention is given to the profound effects upon the respiratory, cardiovascular and neurological systems as a consequence of cold water immersion. This is then reviewed and observed from the perspective of paramedics practising within the United Kingdom, who may face challenges that arise from this phenomenon. The pre-hospital assessment of immersed patients will be discussed in order to identify and address potential and immediate life threats, with specific focus on rewarming hypothermic patients post immersion.
Is there a lawyer on board? In-flight emergencies and other Good Samaritan acts
Authors: Bracken Jonathan
Published: May 2014

The legal liability of paramedics and other health professionals who perform Good Samaritan acts, particularly in response to in-flight emergencies on commercial aircraft, is a topic about which there is disproportionate and largely unwarranted concern. It is often a surprise to many people that English law imposes no ‘duty of rescue’ and also makes no special provision for the person who does intervene as a Good Samaritan.

The common law principle is that a bystander has no legal obligation to come to the aid of another person but, if they choose to do so, then they must exercise due care and may be liable if they fail to do so and end up causing harm.

This article explains the concept of the ‘duty of care’ in relation to paramedics and other health professionals, highlighting circumstances when they may be liable for negligence, and provides guidance for dealing with in-flight emergencies.
Camelids as a host of bovine viral diarrhoea virus infection — what we have learned to date
Authors: Bedenice Daniela
Published: May 2014

Bovine viral diarrhoea virus (BVDV) has been associated with reproductive loss, diarrhoea, immune-suppression with increased susceptibility to opportunistic infection (such as parasitism and pneumonia), wastage and death in South American Camelids (SAC). Unidentified BVDV infection thus poses a significant threat to herd health. BVDV type 1b strains predominate in alpacas and are able to establish transplacental infection, potentially leading to persistently infected (PI) offspring in >80% of naive, pregnant alpacas naturally exposed to BVDV type Ib during early gestation. PI alpaca crias experience a high degree of morbidity and mortality in the first 6 months of life, associated with a variety of clinical disease manifestations. Peripartum phenotypic and haematological characteristics of PI crias may be clinically indistinguishable from those of chronically infected crias with extended viraemia. Low birth weight, stunted growth, anaemia, relative and absolute monocytosis are commonly observed in affected animals. PI crias may have host defense deficits similar to PI calves and experience widespread viral tissue distribution. Both clinical and epidemiological studies underscore the importance of routine BVDV-specific diagnostic testing in order to identify persistently (lifelong) and chronically infected camelids, which serve as an important source of viral spread within and between farms.
Recognising pain and the practical use of pain relief in the disbudding of calves
Authors: Hudson Chris , Reader Jon
Published: May 2014

The past decade has seen a major increase in the recognition of pain in cattle by both farmers and veterinary surgeons, along with a trend towards a more active approach to pain management. This has resulted in an increase in the use of analgesic medication across a wide variety of clinical scenarios, both as an adjunct to potentially painful treatments and routine procedures and as a response to painful disease states.
Optimising early youngstock management
Authors: Wood Sarah , Barrett David
Published: May 2014

The period from birth to first calving for a dairy heifer has not always received much attention on dairy farms, but success in this non-productive period is key to ensuring a profitable system of replacements. For calving at the optimum time of 24 months, growth must be on target and disease incidence must be minimised. This article covers aspects of management that influence growth and disease in this period; starting with colostrum management and success of passive transfer, then feeding of milk and other requirements pre-weaning, optimum housing for disease prevention, through to timing of first service. It is also crucial to record, monitor and assess the success of this period, and practical and applicable methods to do this on farm are discussed.
Prescribing the pill for non-contraceptive purposes
Authors: Jack Kirsten , Otway Chris , Knott Mary
Published: May 2014

In a new regular feature, Anne Baird asks if an extended nurse prescriber can prescribe the pill for the relief of heavy and painful periods. We asked three specialists in nurse prescribing to comment or suggest an answer.
A review of the legal framework for accountable nurse prescribing
Authors: McHale Jean
Published: May 2014

Jean McHale explores the development of the legal framework that underpins nurse prescribing and looks at the legal changes that have taken place. Nurses’ need to safeguard their position is highlighted because enhanced powers and responsibilities may increase litigation against nurse prescribers.
Organizations can no longer ignore nurse prescribing
Authors: Clegg Anthea
Published: May 2014

A lack of vision and application from senior managers and nurses themselves is impeding the development of nurse prescribing in some organizations. This will not do.
The supply of continence aids and products: navigating the choices
Authors: Rogers June
Published: May 2014

While promotion of continence is the aim for all professionals working with those suffering from incontinence there are a number of individuals for whom, despite active intervention and the provision of appropriate aids, the complete resolution of incontinence is not possible. For these individuals the provision of appropriate appliances and containment products is the next step. This article gives an overview of the range of products available and makes suggestions regarding suitability and usage. The number and different types of products and appliances available can be very confusing so it is important that nurses keep themselves up to date; there is no single product suitable for everyone. The key to finding the correct product is an holistic assessment that takes into account not only the underlying problems but also the individual’s needs, life style and preferences. It must also be remembered that an individual’s needs can change and that assessment should be a continuous process in order to ensure products are used appropriately and the individual’s needs are continuously met.
The mental health nurse's perspective on implementing nurse prescribing
Authors: Hemingway Steve
Published: May 2014

Nurse prescribing has been developing in the UK for over a decade, and now offers mental health nurses (MHNs) the opportunity to adopt ‘prescriptive authority’ to their role in the form of supplementary prescribing. This paper describes the results of a questionnaire survey of MHNs’ attitudes to the implementation of nurse prescribing and the educational needs of MHNs who become nurse prescribers.
Nurse prescribing: the higher education institutions’ perspective
Authors: Campbell Pam
Published: May 2014

This article explores the issues relating to teaching nurse prescribing from the viewpoint of higher education institutions (HEIs). A workshop, organized by the Association for Nurse Prescribing, drew together representatives from HEIs across England to establish the major issues facing lecturers of nurse prescribing. The article discusses the challenges and proposed solutions put forward by educationalists in the workshop.
Nurses should be praised, not demoralized
Authors: Otway Chris
Published: May 2014

Reflecting on the current situation for everyone who works in the field of prescribing, it seems that we are living in rather strange times. On the one hand nurses are being pilloried for the ills of the NHS, unclean hospitals, the spread of methicillin-resistant Staphylococcus aureus (MRSA) and even the promotion of unsafe sex in the ‘Big Brother’ house. But when the terrorists struck London nurses were there saving lives, forgetting their own safety when travelling in to work on a depleted public transport system and working long hours without a second thought. The media praised us briefly, before turning the tables and screening a documentary entitled ‘Undercover Nurse’. Although I missed the programme, I understand that they portrayed the very worst practice imaginable.
Rapid response: two examples of mental health prescribing in the community
Authors: Sage-Carrim Jill
Published: May 2014

In 2002, supplementary prescribing was introduced for nurses and other allied health professionals, including pharmacists. The driving force behind this expansion was the desire to improve the quality and speed of service to patients. To meet the requirement for equitable and accessible treatment for mental health patients, the Welland Resource Centre, Lincolnshire, established a rapid response team, of which one member was a nurse prescriber. In this article, two case studies will be presented of how both independent and supplementary prescribing has aided the care of mental health patients and how it has benefitted the rapid response team.
Health visitors’ perceptions of nurse prescribing: a qualitative field work study
Authors: Davies Jill
Published: May 2014

This article details the findings of a study on the perceptions and opinions of health visitors towards nurse prescribing. The study was undertaken in a primary care trust in the north of Britain. Following a pilot study, eight prescribing health visitors from different areas of the trust were interviewed on their own perceptions of nurse prescribing. Several themes emerged from the interviews, including the belief that nurse prescribing led to an increase in workload for the health visitors, but also that it has provided a better level of service to patients.
Classroom versus practice-based OSCEs: a comparative evaluation
Authors: Forward Judy , Hayward Mary
Published: May 2014

The objective structured clinical examination (OSCE) forms a central component of the assessment process of non-medical prescribing. A comparative evaluation was conducted of classroom and workplace OSCEs to identify the strengths and limitations of each method in assessing non-medical prescribing competence and the level of student satisfaction. The study demonstrated that the OSCE requires the support of a structured portfolio assessment to ensure that students are able to articulate knowledge embedded in practice through reflective discussion.
Anatomy of the eye in relation to common drug therapies
Authors: Davis Geraldine
Published: May 2014

The eyes are part of the nervous system. The retina, located at the back of the eye, senses objects by detecting light and transmits impulses to the brain. The brain then processes and interprets this information as a picture. Most of the drugs used on the eye primarily affect structures other than the retina, and this article describes some of the structures of the eye in relation to drug therapy for conjunctivitis, use in eye examinations and glaucoma.
Asthma: managing the change to CFC-free inhalers
Authors: Cross Sue
Published: May 2014

Climate change is a major environmental concern and chlorofluorocarbons (CFCs) are contributing to the problem. Most reliever inhalers are chlorofluorocarbon (CFC) free but many preventer inhalers still contain CFCs. The withdrawal of some CFC-containing preventer inhalers later this year means some patients will need to be switched to alternative inhalers. Nurses need to be aware of the options available and how to manage the transition to ensure it is safe and easy for patients.
Meeting the targets: managing type 2 diabetes
Authors: Capaldi Brenda
Published: May 2014

Diabetes is an progressive condition that requires aggressive treatment. The nGMS contract has helped in the management of diabetes by creating greater flexibility for GPs, and represents an unprecedented level of investment in primary care which provides benefits to primary healthcare professionals, the NHS and, more importantly, patients. Achieving nGMS targets can lead to a reduction in microvascular and macrovascular complications as the framework recognises the importance of minimising these risks.
Consensus guideline on the management of medication related dysphagia
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

Connect Medical has published a consensus guideline in response to the problems health professionals, including nurse prescribers, encounter when managing the growing numbers of patients who have difficulties swallowing their medication. In this article Richard Griffith and Cassam Tengnah describe how the guideline will assist medication management and protect nurse prescribers from liability when treating patients with medication-related dysphagia.
Continuing professional development for nurse prescribers
Authors: Hobden Alison
Published: May 2014

All registered nurses and midwives are required to take part in continuing professional development (CPD) in order to maintain their professional registration (NMC, 2004). This is part of the post-registration education and practice (PREP) requirements (NMC, 2004). In addition to this, the NMC (2006) stated that nurse and midwife prescribers have to undertake CPD within their own area of prescribing practice. This article considers the CPD requirements for nurse prescribers under three sections: personal responsibility; accessing CPD; and employer's responsibility. Tools to help identify your own learning needs are discussed and some useful competency frameworks are identified, both of which will assist in identifying and planning your CPD requirements.
Personal reflections of pharmacist independent prescribing
Authors: Thompson David
Published: May 2014

This article gives the personal reflections of a pharmacist independent prescriber on the nature of independent prescribing, and possible future models of care using non-medical prescribing by nurses and pharmacists. Comparison is drawn between the respective training of nurse and pharmacist practioners and the opportunity that exists for collaborative working between the two professions.
Research and development round-up: September 2007
Authors: O'Connell Nicola
Published: May 2014

New research shows that the addition of trastuzumab (Herceptin) to chemotherapy given before surgery (neoadjuvant treatment) for inflammatory breast cancer that is HER2-positive, completely eradicated tumours in nearly three-times the number of women with HER2-positive tumours compared with chemotherapy alone.
Challenges and hope for younger women with breast cancer
Authors: O'Connell Nicola
Published: May 2014

October is Breast Cancer Awareness month, and once again we can expect to see plenty of reminders that this most common form of cancer affects one in nine women during their lifetimes in the UK (Cancer Research UK, 2008). Hopefully, we will also hear about the variety of advances and promising new therapies for treating this disease.
Young people's health: a public health concern
Authors: Nuttall Dilyse
Published: May 2014

Young people have specific health issues and risk factors requiring multi-level input, through a multiagency approach. The non-medical prescriber is often in a position to impact on the public health issues of young people, at a range of levels. An increased awareness of young people's needs and employment of strategies in individual practice can facilitate effective identification and management of public health issues.
Non-opioid analgesics: prescribing rationale and uses
Authors: Waterfield Jon
Published: May 2014

This article provides an overview of non-opioid analgesics. There is a consideration of the mechanisms of action of paracetamol, aspirin and the nonsteroidal anti-inflammatory drugs (NSAIDs). The contraindications, cautions and side-effects of NSAIDs are summarized in a series of tables. There is a discussion of some of the common prescribing issues that relate to this group of analgesics. The reader has the opportunity to self-check their own knowledge with a pre-reading self-assessment.
Non-hormonal treatment options during the menopause
Authors: Holloway Debra
Published: May 2014

The standard treatment for women who have menopausal symptoms was previously hormone replacement therapy (HRT); however, for a variety of reasons, women are increasingly looking for alternatives. This article gives an overview of prescribed alternatives to HRT and discusses lifestyle and diet, alternative and complementary therapies, vaginal problems and patient support, as well as nurse education.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

Can community practitioner prescribers prescribe for thrush on the nipple for a breastfeeding mother? Would you be able to advise on this?
Prescribing in Ireland: the National Implementation Framework
Authors: Adams Elizabeth , Cuddy Annette , Flynn Maureen , Lorenz Rose , MacGabhann Clare
Published: May 2014

Nurse and midwife medicinal product prescribing is one of the key initiatives of the Irish Minister for Health and Children, Mary Harney, TD. There are now over 155 nurses and midwives with prescriptive authority. This has a real potential to enhance the efficiency and responsiveness of the health services for patients and service users. The initiative endorses the government's policy for the expansion of nursing and midwifery roles. This article sets out the national processes used in the introduction of nurse and midwife medicinal product prescribing in Ireland from inception, to legislative/regulatory changes, educational preparation, governance arrangements, registration requirements and clinical practice outcomes. The critical success factor was the introduction of a standardized approach applied in a systematic manner by each health service provider, with the ongoing support of the Office of the Nursing Service Director within the Irish Health Service Executive (HSE). This change management process was finalized with the commissioning and completion of an independent external evaluation of the first two years' experience of nurse and midwife prescribing in Ireland.
Diclofenac 4% spray for acute pain and inflammation
Authors: Panchmatia Shailesh
Published: May 2014

Mobigel, a topical spray solution containing diclofenac sodium 4%, is used for the local symptomatic relief of mild to moderate pain and inflammation following acute blunt trauma of small- and mediumsized joints and periarticular structures. This article examines the pathophysiology of inflammation and the mechanism of action of diclofenac, before presenting the evidence base for the efficacy and tolerability of Mobigel, along with a literature review of the use of topical NSAIDs in acute injuries. Studies show that Mobigel is a useful preparation for the treatment of acute pain caused by traumatic blunt injuries to small- and medium-sized joints (MHRA, 2008; Zacher et al, 2008; Massey et al, 2010).