bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing as a nurse prescriber in mental health care: a case study
Authors: Smith Margaret , Hemingway Steve
Published: May 2014

Non-medical prescribing is the prescribing (either supplementary or independent) of medication by non-medical health professionals. Initially only limited to nurses, non-medical prescribing is now moving forward to include pharmacists and other allied health professionals (Department of Health, 1999; National Prescribing Centre, 2005). In this article, Margaret Smith and Steve Hemingway discuss the role of non-medical prescribing for mental health nurses. A case study is used to illustrate how one mental health nurse incorporated prescribing into her role in the Memory Clinic at Forest Gate Day Hospital, Tickhill Road Hospital, Doncaster.
Managing difficulties in swallowing solid medication: the need for caution
Authors: Griffith Richard
Published: May 2014

Difficulty in swallowing tablets is a relatively common problem among patients in the care of nurse prescribers. Swallowing difficulties can result in poor medication compliance and undermine the therapeutic benefit of medication for the patient. The temptation, therefore, is to advise patients to crush medication before swallowing in order to ensure compliance. However, crushing tablets carries risks and it is essential that nurse prescribers are aware of those risks and of the legal implications of advising that tablets should be crushed to aid compliance.
How to ensure nurse prescribing is the right choice for you
Authors: Hobden Alison
Published: May 2014

In November 2005, the Government announced plans to extend the independent prescribing powers of nurses. While this is a welcome step forward in recognizing our skills and capabilities, it is important for nurses to consider how prescribing will fit into their role before commencing a prescribing course.
An exploration into the pharmacology of analgesics
Authors: Chowdhury Shefali
Published: May 2014

The first article in this series explores the pharmacology of a commonly prescribed group of therapeutic agents. The mode of action, pharmacokinetics, adverse effects and interactions of analgesic drugs available to the nurse prescriber are examined. The article also considers the appropriate use of the different drugs.
The musculoskeletal system: physiology, conditions and common drug therapies
Authors: Davis Geraldine
Published: May 2014

Diseases of the musculoskeletal system represent the largest non-neurological threat to health. This article looks at the anatomy and physiology of bones, joints and skeletal muscle in order to enhance understanding of how drugs for conditions such as arthritis, osteoporosis and gout work.
Potential drug interactions: recognising and minimising the risks
Authors: Reddy Bhavana
Published: May 2014

A drug interaction occurs when the administration of one drug modifies the clinical effect of another drug that is administered at the same time. This modification can lead to toxicity or an adverse effect, putting the wellbeing of the patient at risk. Therefore, it is important for all health care workers are aware of common adverse drug interactions, and how to minimise them.
Health risks of winter: pollution, cold and infectious diseases
Authors: Ainsworth Steve
Published: May 2014

Pollution, the cold and infectious diseases such as influenza all contribute to winter deaths. As people get older, their thermo-regulatory systems become less efficient. Advances in medication, fuel supplements for pensioners and better housing all play their part in reducing winter deaths. Steve Ainsworth explains.
Medication review as a route to optimising treatment
Authors: Reddy Bhavana
Published: May 2014

Medication accounts for approximately 15% of the total NHS budget in the UK. There is now increasing evidence for the effectiveness of medication review as a route to optimising therapy, improving health outcomes, reducing the likelihood of medicine-related problems and cutting waste. Targeted medication review can enable people to maintain their independence and avoid admission to residential care or hospital. Nurses have a potentially important contribution to make in educating patients about medications and this role is likely to become increasingly significant as the number of nurses independently prescribing grows.
NHS charges: Select Committee recommends a prescription for change
Authors: Ainsworth Steve
Published: May 2014

Prescription charges were originally brought in more than 50 years ago to fund repayments of a Government debt to the USA. A House of Commons Select Commitee has now drawn attention to the inconsistencies in the system and the outmoded criteria for deciding who must pay, and who is exempt from, prescription charges.
Diagnosis, treatment and management of urinary tract infections in primary care
Authors: Mahaffey Wendy
Published: May 2014

Urinary tract infection (UTI) is the most common bacterial infection managed in general practice. Following the introduction of extended nurse prescribing, it is now possible for suitably qualified nurses to assess, manage and treat uncomplicated UTIs in primary care without the need for a GP consultation. This article provides a guide to the diagnosis, treatments available and management of UTIs in primary care.
The Road to Recovery Nurse Adviser Programme
Authors: Saxon Louise
Published: May 2014

Relapse prevention is a major goal of schizophenia management and failure to comply with medication is a significant cause of relapse in mental health patients. The Road to Recovery Nurse Adviser Programme was launched in 2002 initially to provide effective training in the correct administration of risperidone long-acting injection (Risperdal Consta). This article details the elements of the programme and how it is run, and includes some thoughts of a community mental health nurse who has completed the training.
The country doctor who armed the world to fight killer diseases
Authors: Ainsworth Steve
Published: May 2014

Well-constructed counter-arguments and feasible sounding statistics have been used by opponents of vaccinations since the time of Edward Jenner. Despite his use of rather unethical research methods, most of us are now able to recognise the vast contribution that Jenner and subsequent vaccination programmes have made to world health.
Prescribing self help manuals for mental health problems
Authors: McEvoy Phil
Published: May 2014

For patients with common mental health problems, self help manuals are increasingly being used to bridge the gap between the supply and demand for mental health care. This article explores the advantages and disadvantages of prescribing self help manuals. It briefly reviews the research evidence and offers some guidance for health workers who are providing support to patients.
Antiplatelet therapy in treatment and prevention of thrombus formation
Authors: Walthall Helen
Published: May 2014

It is established practice to administer antiplatelet drugs to patients with known coronary heart disease (Department of Health, 2000). This pharmacological prevention is based on the findings of a number of randomized controlled trials that have set out to establish a drug of choice and the dose required to reduce the risk of thrombosis formation. The following paper will review the role of platelets in maintaining haemostasis and in cardiovascular diseaseand will discuss how antiplatelet drugs can inhibit the function of platelets and so reduce the risk of thrombosis formation. The pharmacology of aspirin and clopidogrel will be reviewed and the evidence base for their use presented.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

What post-qualifying training and support and training is available for nurse prescribers?
Prescribing nicotine patches to children: caution required
Authors: Griffith Richard
Published: May 2014

Nurse prescribers are now able to prescribe nicotine replacement therapy to children from the age of 12. Even though nurse prescribers have prescribing authority for this therapy they can only proceed with valid consent. In this article, Richard Griffith considers the legal requirements for obtaining valid consent from children.
Prescribing psychotropic medication: what nurse prescribers need to know
Authors: Robson Deborah , Gray Richard
Published: May 2014

Mental health problems are common, and conditions such as depression are leading global causes of disability. Care of these illnesses, at least initially, is often provided by primary care services. Less common mental illnesses, such as schizophrenia and bipolar disorder, are longterm conditions that often require input from specialist mental health services. Antidepressant and antipsychotic medicines are central to the effective treatment of mental illness.
Research and development round-up: June 2007
Authors: O’Connell Nicola
Published: May 2014

New data presented at the European League Against Rheumatism (EULAR) congress demonstrates that rituximab’s (MabTh era) benefits are sustained, or further improved, over the long term for rheumatoid arthritis (RA) patients.
Management of hypoactive sexual desire disorder
Authors: Hallam-Jones Ruth
Published: May 2014

Female sexual dysfunction has, in the past, been viewed mainly as a psychological or relational difficulty disorder. As our understanding of some of the possible physical aetiology, and with the beginning of specific researched physical treatments, it is vital that nurses understand more about the assessment, treatment options and the complexity of these disorders (Table 1). Hypoactive sexual desire disorder (HSDD) in surgically menopausal women, is the first of these issues needing consideration by nurse prescribers (Senagore, 2003). It will bring new considerations for practitioners as it involves the possible need to link with other professionals for a total care package.
New year, new challenge
Authors: Otway Christine
Published: May 2014

Welcome to our first edition of 2008 and best wishes from us all for a happy, healthy and successful New Year.
Questions, questions, and more questions
Authors: Otway Christine
Published: May 2014

This month, at my place of work, we have the seasonal hustle and bustle of the start of a new academic year. All across the country parents are missing their teenage sons and daughters as they start their university education. My personal tutor group of pre-registration nurses has said goodbye to us after 3 years hard work and set out into their new careers. I will really miss them but they have been swiftly replaced by a new group, which I will be taking care of until 2011, so no opportunity for me to develop empty nest syndrome!
Managing threadworms in children and adults
Authors: White Sharon
Published: May 2014

Threadworms affect a considerable number of young children. Threadworms are highly contagious and may lead to intense perianal itching. Threadworm eggs survive for up to 2 weeks in the environment, where they may be swallowed or ingested, leading to new worms developing. Reinfection commonly occurs after treatment unless strict hygiene measures are adhered to alongside drug management. Drug treatment is 90% effective but only acts on the worms, not the eggs. This article discusses the management options available.
Nurse prescribers, care pathways and the law
Authors: Griffith Richard
Published: May 2014

Nurse prescribers use care pathways to ensure the efficient delivery of evidence-based high quality care. However, some health professionals have expressed concern that comparing the actual care delivered with a care pathway makes them more susceptible to litigation should the patient suffer harm during the course of treatment. In this article, Richard Griffith considers the legal implications of care pathways.
Your vote counts
Authors: Otway Christine
Published: May 2014

This month, news programmes have been dominated by the run-up to the American presidential elections and subsequent celebrations, because the United States, a country which had, until 40 years ago, racial segregation in schools, hospitals and diners (BBC 2008) has elected the first black president. But Barack Obama has been elected by the people because of the strength of his character, and not just the colour of his skin. This constitutes the realization of the dream that Martin Luther King shared with us 45 years ago. The election of Barack Obama will, I believe, change the political landscape considerably, and my understanding is that this has happened because the American population cared enough to think, debate and then vote for what they wanted in the future.
Benzodiazepines: uses, mode of action and prescribing issues
Authors: Anwar Anila
Published: May 2014

The use of benzodiazepines, such as diazepam, chlordiazepoxide, lorazepam and temazepam, are commonly used for insomnia and anxiety. They act on the GABAA receptors in the central nervous system, thus having central effects. This article discusses the acute and long-term side effects of benzodiazepines, as well as their prescribing issues amid fears of tolerance, dependence and withdrawal effects.
Research and development round-up: November 2008
Authors: O'Connell Nicola
Published: May 2014

Low-dose aspirin as primary prevention does not appear to significantly reduce the risk of a combined end point of coronary, cerebrovascular and peripheral vascular events in patients with type 2 diabetes, according to a new study.
Non-medical prescribers in primary care: practitioners or policemen?
Authors: Garrett Dawne
Published: May 2014

The prime motivation for non-medical prescribing should be to improve care for patients. The impact of prescribing is far beyond that of the nurse–patient relationship and needs to be considered in legal, ethical and financial terms. The role of the non-medical prescribing lead is a relatively new concept and this article covers the key elements of the role, the potential challenges that can be encountered and ways in which the role can be developed further.
Prescribing in osteoporosis
Authors: Munson Eileen
Published: May 2014

Osteoporosis is a silent chronic disease that is not a visible condition, as it is only diagnosed once a fracture has occurred. It affects all age groups, but is most prevalent after the age of 50 years old, when it affects 1:2 women and 1:5 men during their remaining life time. This has a huge impact on the cost to the nation. Low bone density is the major risk factor for having a fracture. But several other clinical risk factors can be identified. The role of the nurse prescriber is to predict and prevent a fracture occurring, by initiating cost effective recommended therapies.

The National Institute for Health and Clinical Excellence (NICE) has recently evaluated the therapies for secondary prevention of osteoporosis. How long a therapy should be continued for remains unavailable but re-evaluation of risk factors and need for therapy after 5 years is advised.
The role of adalimumab in treating Crohn's disease
Authors: Younge Lisa
Published: May 2014

Crohn's disease is a chronic inflammatory bowel disease. It typically presents with symptoms including abdominal pain, bloody diarrhoea, fistulae and stricturing of the bowel, resulting in obstruction. There is no medical cure for the condition; current medical approaches are concerned with symptom reduction and promotion of quality of life. These outcomes can be difficult to achieve, and involve invasive treatments, often with undesirable side-effects for the patient.

Traditionally, Crohn's disease has been managed with anti-inflammatory drugs including steroids and aminosalicylates, with the more refractory cases requiring the introduction of immunomodulating drugs such as azathioprine. Despite these approaches, a significant number of patients will continue to experience ongoing and troublesome symptoms, severely impacting on their quality of life, and often resulting in surgery. Adalimumab (Humira) was the second biological agent to be licensed for the treatment of Crohn's disease in late 2007. Similar to infliximab, it is a monoclonal antibody which binds to anti-tumour necrosis factor α (anti-TNFα). This article will outline the clinical use of adalimumab, and discuss its current place in the therapeutic pathway of patients with Crohn's disease.
The feel-good factor
Authors: Otway Christine
Published: May 2014

I have just returned from a relaxing break at a local health spa. Following a soothing massage and facial, I jolted when the beauty therapist said: ‘I'm just going to write your prescription!’ For a few fleeting moments I was able to dream that cosmetics were available on the NHS and pampering days part of our remuneration package. However, I was also able to reflect on how easily these words tripped off her tongue. Of course, when I reached the counter and tried to obtain all my prescribed items, it was apparent that this ‘prescription’ was going to cost me significantly more than one from the NHS, so my dreams were dashed, concordance went out of the window, and I was back to reality. I purchased a few of the cheaper items and left it at that!
Management of paediatric-onset atopic eczema
Authors: Dawber Steve
Published: May 2014

Atopic eczema (atopic dermatitis) is a chronic, inflammatory, itchy skin condition that usually develops in early childhood. It is best described as an episodic disease of exacerbation (flaring) and remission, except in severe cases where it may appear continuous. The National Institute for Health and Clinical Excellence (NICE) recently commissioned the UK's first ever national guideline on childhood atopic eczema management. Notably, the guidance covered vital clinical areas such as diagnosis, assessment, trigger factors, stepped-care treatment, referral, and patient education. The key points of this document and management of this condition are discussed here.
Bronchodilators: uses and prescribing rationale
Authors: Anwar Anila
Published: May 2014

The use of bronchodilators plays an important role in respiratory conditions such as asthma and COPD. This article looks at the types of bronchodilators available, their onset and duration of action, side-effects and contraindications. It is hoped that by taking these into consideration, prescribing of bronchodilators in combination with other medication such as corticosteroids (which will be discussed in the next issue of the journal), will lead to effective therapy and reduced morbidity and mortality for the patient.
Managing seasonal allergies
Authors: Cross Sue
Published: May 2014

Seasonal allergies especially allergic rhinitis can be considered by many patients as the worst effect on their quality of life when it should be the best time of the year. Seasonal allergies, although considered by some to be trivial complaints, can affect certain individuals severely and cause considerable distress. Nurses and GPs can go a long way to help patients prevent their annual symptoms from occurring. This article will help you find the answers to recognizing, diagnosing, treating and helping patients manage allergic rhinitis and other allergic diseases that may arise from it.
Happy birthday NHS
Authors: Otway Christine
Published: May 2014

Welcome to our July edition, and congratulations to all members of our NHS, which celebrates its 60th anniversary on 5 July. Many reporters on the event are taking the opportunity to make derogatory comments about the NHS yet again. I heard a brief excerpt from the Jeremy Vine Show today, and one listener commented that she had been a nurse in the 1960s, when hospitals were cleaner and better because they smelled of disinfectant! What she failed to convey was that in stark reality, there was no regulation of medicines and that the public were generally unaware and uneducated about medical matters and risks of certain behaviours, such as smoking.
How safe is your holiday destination?
Authors: Bramham Lynda
Published: May 2014

Travel medicine tends to focus on the health risks for those visiting exotic, developing countries. However, nearly 80% of the overseas travel by UK residents is to destinations within Europe. This article highlights some of the potential health risks for travellers visiting European countries. Basic information on prevention and the benefits of travel health insurance are highlighted. Travellers should be encouraged to research health risks at their destination and a list of reliable travel health websites are provided.
Biologic drug therapy in rheumatoid arthritis
Authors: Nicholl Karl
Published: May 2014

Rheumatoid arthritis is a chronic, debilitating disease that affects both young and old alike. It can be very mild or, it can be life-shortening. In the past, treatments have only been moderately effective but biologic drug therapies are now available. These have, without a doubt, revolutionized the management of this condition. These therapies may not be able to repair bone surfaces or stop someone from having future orthopaedic surgery but, due to their efficacy, they may well lessen the patients' dependency on others and hopefully help them to regain some of their autonomy. This article gives an insight into the current therapies, their modes of action and future treatments.
Coffee and tea for health?
Authors: O'Connell Nicola
Published: May 2014

Cutting out caffeine may seem like an effective and simple way to improve one's diet, but before people give up that daily cup of tea or coffee, it is worth weighing up the pros and cons. There is now an increasing amount of research showing that there are distinct benefits associated with moderate tea and coffee consumption.
Challenges in the treatment and management of psoriasis
Authors: Thorrat Anne
Published: May 2014

For 90% of patients with psoriasis, the condition follows an unremitting course interspersed with periods of remission and/or relapse, the time period and severity of which is unpredictable. There is no cure for psoriasis. It can be treated topically or systemically in the expectation of suppression or inducing a remission. This article details the challenges in finding an optimum management regimen that may achieve either for a patient.
Antipsychotics: uses, actions and prescribing rationale
Authors: Pandya Sangita
Published: May 2014

Antipsychotics are commonly prescribed for patients suffering from a number of disorders including agitated depression, tics, hiccups and dementia. They are included in the most recent National Institute for Health and Clinical Excellence (NICE) guidelines (2006) for managing bipolar affective disorder and in the NICE guidelines (2002) for managing schizophrenia. This article provides an overview of the mode of action of these medicines, adverse effects, drug interactions and patient contraindications for their clinical use. The article includes the clinical roles of these medicines, and aims to provide essential information for health professionals prescribing these medicines.
Equivalence studies: the devil’s in the details
Authors: Greener Mark
Published: May 2014

With NHS budgets under increasing pressure, generics and biosimilars help control spiralling prescribing costs. So, nurses should consider prescribing generically whenever clinically appropriate. However, this article suggests that the pharmacokinetic rationale underpinning generic substitution and the subtle, but potentially clinically significant, differences in some biosimilars underscore the importance of brand name prescribing in certain circumstances. Regulatory authorities approve generics and biosimilars based, partly, on equivalence studies. As developing more effective pharmaceuticals becomes increasingly difficult, some new products rely predominately on associated benefits to differentiate the brand from the competition. This shift in emphasis, as well as commercial considerations, encouraged an increase in the number of non-inferiority and equivalence studies. However, these raise ethical and practical concerns compared with classic superiority trials. This feature introduces non-inferiority and equivalence studies to help nurse prescribers critically evaluate published studies and pharmaceutical companies’ promotional activities.
Eczema: what lies beneath?
Authors: Greener Mark
Published: May 2014

Eczema is one of the most common dermatological diseases and the number of cases has risen markedly over recent years. Emollients and topical steroids are the first-line treatments for mild-to-moderate eczema. Emollients reduce itching and irritation, rehydrate skin, protect against further drying and may reduce the need for topical steroids by up to 50%. Some eczema patients respond adequately to emollients alone. However, patients with moderate-to-severe eczema, and those who do not respond to first-line treatments, might require second-line therapies, such as calcineurin inhibitors, ultraviolet phototherapy and systemic drugs. The inflammatory changes that cause eczema may persist between flares. Therefore, patients with mild-to-moderate eczema can now apply tacrolimus proactively to skin areas prone to flare and that previously responded to the calcineurin inhibitor to reduce the frequency and severity of exacerbations. Doctors often lack the time to offer the education that allows patients and their carers to manage eczema effectively and that dispels the myths and misconceptions surrounding the disease and its treatment. Nurse-led clinics provide adequate time to educate patients and demonstrate treatments and, in turn, improve patient satisfaction and adherence.
Controversies in migraine
Authors: Anthony Alli
Published: May 2014

Migraine is a prevalent disorder that is frequently the subject of media attention and scientific controversy. Making sense of the data can be a challenge for nurses. This article looks at some of the more scientific controversies on the potential link between patent foramen ovale and migraine; the link between migraine and stroke; the use of Botox injections as a treatment and food intolerance in relation to migraine.
Research and development round-up: September 2009
Authors: O'Connell Nicola
Published: May 2014

Pandemic swine flu can infect cells deeper in the lungs than seasonal flu can, according to a new study.
Smoking cessation management must become more individualized
Authors: O'Connell Nicola
Published: May 2014

Conventional approaches to smoking cessation are, it seems, increasingly becoming ‘old hat’. There is now a recognition that different smokers often need different kinds of support, and health professionals need to look beyond some of the long tried and trusted methods if they are to help more smokers quit.
Taking the lead in the new decade
Authors: Peniston-Bird Fiona
Published: May 2014

At the beginning of November, nmprescribing held its 3rd Annual National Non-Medical Prescribing Leads Conference at the Royal Pharmaceutical Society of Great Britain. I think we had the best line-up of speakers for a non-medical prescribing event that I have seen, and the evaluations from those who attended certainly reflected that.
The role of community nurses in the management of depression
Authors: Shia Nessie
Published: May 2014

Today one in six people in England suffer from a mental health disorder equating to around eight million people being affected in UK. Mental health problems are very common with depression ranked as the third most frequent cause of consultation in general practice. Depression is a common condition with 9 of every 10 cases is treated in primary care. The costs of treating depression have been shown to outweigh those of treating psychoses. It is now widely seen to be a burden for those who suffer from the condition including the economic and health costs. In clinical practice, it is important for clinicians to identify and accurately assess depression and have an awareness of some of the pharmacological treatment and psychological management strategies available. This article focuses on the concept of depression, assessment or screening, considers treatment options, management and educational preparation for specialist community public health nurses. Community nurses especially name professionals have a crucial role in identifying mental health problems, tackling stigma and developing models of collaborative working with mental health specialists to promote the overall mental wellbeing across the whole population lifespan from young children to older people
Research and development round-up: November 2009
Authors: O'Connell Nicola
Published: May 2014

Addition of capecitabine to a standard chemotherapy regimen for breast cancer improves recurrence-free survival. However, increased adverse events mean treatment with capecitabine is frequently discontinued.
Fascinating pharmacokinetics: understanding ADME
Authors: Greener Mark
Published: May 2014

Pharmacokinetics, the study of the body’s actions on a drug (absorption, distribution, metabolism and excretion), underpins every therapeutic decision. Furthermore, pharmacokinetic variations account for many complications and complexities in prescribing. This series of articles reviews those pharmacokinetic principles that can bolster your prescribing skills, beginning by defining pharmacokinetics and examining absorption. Bioavailability refers to the proportion of the administered drug available at the site of action. Numerous factors potentially influence oral bioavailability including gastric acid secretion, gastrointestinal blood flow, gastric transit time, metabolism by microbes and enzymes in the gut, and the action of ‘transporter’ proteins. Following a single dose, blood levels peak, and then decline exponentially. Several factors influence the relationship between blood concentration and pharmacodynamics, including tachyphylaxis and pharmacogenomic variations. Understanding how such factors interact to produce the pharmacokinetic profile help nurses take better-informed prescribing decisions.
Using methylnaltrexone in opioid-induced constipation
Authors: Canham Jonathan
Published: May 2014

Methylnaltrexone (Relistor) is the first peripherally-acting mu (¼)-opioid receptor antagonist to be licensed for the treatment of opioid-induced constipation in adults with advanced illness receiving palliative care, when response to regular laxative therapy has been inadequate. Methylnaltrexone is a new drug in its own classification. It is not classed as a laxative but is designed to target the underlying cause of opioid-induced constipation by reversing the peripheral effects of opioids on the gastrointestinal tract. This article explores the uniqueness of the drug and how it has been used in clinical practice at the London Bridge Hospital.
Researching the barriers to mental health nurse prescribing
Authors: Ross Jane
Published: May 2014

Although nurse prescribing has been established in many countries for a number of years, the same cannot be said for mental health nurse prescribing. Although there is evidence of ‘pockets’ of practice throughout Scotland, it appears to be the exception rather than the rule. Why is this the case?

Because mental health nurse prescribing has been so slow on the uptake, this prompted the question ‘What are the barriers to implementing mental health nurse independent prescribing in Scotland?’ This article illustrates the importance of the research question. It concludes that in order for nurse independent prescribing to progress that it is essential that barriers are identified.
Pharmacological options for treatment of migraine
Authors: Haydon Susan
Published: May 2014

Migraine is a common and chronic disorder characterized by attacks of moderate to severe headache, and often associated with nausea, vomiting, photophobia or phonophobia. It is both common and disabling, and can have a huge impact on quality of life of sufferers. Management includes lifestyle modification, and acute and prophylactic drugs. Patient education and involvement in their care is very important.
Oral hypoglycaemic agents: uses, actions and prescribing rationale
Authors: Bennett Stephen
Published: May 2014

The range of medication available for treating diabetes mellitus is currently a rapidly expanding field. The mainstay of treatment of type 2 diabetes in the early stages are oral agents, which reduce the absorption of glucose, augment the secretion of insulin, or improve sensitivity to it. This article discusses the major classes of these oral antidiabetic medications.
Research and development round-up: June 2009
Authors: O'Connell Nicola
Published: May 2014

People with memory problems who are depressed are more likely to develop Alzheimer's disease compared with people who are not depressed, according to a new study. However, the research also shows that the Alzheimer's disease drug donepezil may delay the progression to Alzheimer's disease for depressed people with mild cognitive impairment (MCI)—described as the period in-between normal aging and Alzheimer's disease—or memory problems.
Research and development round-up: August 2009
Authors: O'Connell Nicola
Published: May 2014

There is insufficient evidence to support using gels and creams containing rubefacients for chronic and acute pain, according to a systematic review by Cochrane Researchers.
Mood stabilizers: use, actions and prescribing rationale
Authors: Pandya Sangita
Published: May 2014

Mood stabilizers are commonly prescribed for patients suffering from a number of mental health disorders, including bipolar affective disorder, chronic depression and schizophrenia. They are included in the most recent National Institute for Health and Clinical Excellence (NICE, 2006) guidelines for managing bipolar affective disorder. This article provides an overview of the mode of action of these drugs, adverse effects, drug interactions, and patient contraindications for their clinical use.
Research and development roundup: October 2010
Authors: Brown Harry
Published: May 2014

The National Prescribing Centre (NPC) has published a timely review on the place of simvastatin 80 mg in therapy, in light of the recent Medicines and Healthcare products Regulatory Agency (MHRA) guidance (MHRA (2010) Simvastatin: increased risk of myopathy at high dose (80 mg). Drug Safety Update 3(10): 7–8). This is a particularly welcome article in the fast-moving context of lipid-lowering therapy.
Paracetamol may cause hypothermia in children
Authors: Prosad Paul Siba , Whibley Jennifer
Published: May 2014

Antipyretic agents such as paracetamol or ibuprofen are routinely used in paediatric practice. They are sometimes used in combination, or even prophylactically, because of concerns about hyperthermia causing adverse events—such as febrile seizures or distress to the child. Available evidence published by the National Institute for Health and Clinical Excellence (NICE) suggests that antipyretic agents do not prevent febrile convulsions, and should not be used specifically for this purpose (NICE, 2010). It is also suggested not to administer paracetamol and ibuprofen at the same time, but to consider using the alternative agent if the child does not respond to the first drug (NICE, 2010).
The structure of the eye and common drug therapies
Authors: Davis Geraldine
Published: May 2014

Conditions of the eye that the nurse may deal with frequently include conjunctivitis and glaucoma. A knowledge of the structures and function of the eye related to these conditions, and the use of medications to cure or minimize their effect, are discussed in this article. The use of mydriatics to enlarge the pupil during eye examination is explained, and best practice for application of eye drops or ointment is considered.
A new approach to wound management
Authors: Greener Mark
Published: May 2014

Wounds are among the most common conditions that nurses manage. Bacterial infections pose particular problems and can transform relatively minor trauma into persistent, chronic wounds. Bacterial biofilms make an important contribution to the need for long-term care, mortality and costs associated with chronic wounds. Furthermore, chronic wounds harbour a diverse range of bacteria, underscoring the importance of broad-spectrum antimicrobial treatment. The Drug Tariff now includes Octenilin Wound Irrigation Solution and Octenilin Wound Gel for skin wounds, including burns, pressure sores and leg ulcers. Both contain octenidine, a broad-spectrum antimicrobial that is effective against biofilms and shows a more favourable balance of antibacterial activity to cytotoxicity than a number of other commonly used antibacterials. Octenilin Wound Irrigation Solution has a low surface tension, which increases octenidine's contact time with the wound. Octenilin Wound Gel combines hydrogel and octenidine to provide a moist healing environment that loosens even heavily encrusted coatings. Experimental evidence, clinical trials, and surveys of nurses show that Octenilin Wound Irrigation Solution and Octenilin Wound Gel are valuable additions to the wound care arsenal.
Nurse and midwife prescribing in Ireland: the Minimum Dataset
Authors: Adams Elizabeth , Cuddy Annette , Flynn Maureen , Lorenz Rose , MacGabhann Clare
Published: May 2014

A national Resource and Implementation Group for Nurse and Midwife Prescribing was established by the Irish Minister for Health and Children to guide the introduction of prescriptive authority for nurses and midwives in Ireland. The steering group recognized at an early stage that this significant service development would require a standardized approach to monitoring. It was agreed to develop a National Nurse and Midwife Prescribing Minimum Dataset to record and monitor prescribing activity across the country. Thisarticle describes how the minimum dataset was developed; the design of a web-based system for data collection; and the main features of the Nurse and Midwife Prescribing Data Collection System. Reports from the system are used to demonstrate the activity of registered nurse prescribers in Ireland during the first two years of the new expanded role.
Hypnotics: prescribing issues and mechanism of action
Authors: Waterfield Jon
Published: May 2014

This article provides an overview of some of the key issues to consider when prescribing hypnotics. There is a consideration of the importance of sleep hygiene factors in the ongoing management of insomnia. Prescribing issues associated with the use of benzodiazepines and z-drugs are discussed, with a description of their mechanism of action. The reader has the opportunity to self-check his/her own knowledge with a prereading self-assessment.
Prescribing newer antiepileptics
Authors: Stone Margaret
Published: May 2014

There are many newer antiepileptic drugs, which have been designed to reduce the side effects and drug interactions associated with the older drugs. However, they do still have side effects and some have drug interactions which affect the blood levels of other drugs. The mechanisms of action of the newer antiepileptic drugs vary, but can be split into three different mechanisms. The licensing details vary from drug to drug, and some of them are licensed for use in children. There is no ‘perfect’ newer antiepileptic that has no side-effects or drug interactions and which can be used for many different types of epilepsy. Some newer antiepileptics are licensed for use in clinical conditions other than epilepsy.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

I am a Community Practitioner Formulary Nurse Prescriber (CPFNP) and work as a Health Visitor. I am unclear about what medicines I can prescribe for babies who have oral thrush. Please would you confirm?
Drug profile: tramadol for moderate to severe pain
Authors: Lovatt Penny
Published: May 2014

Tramadol, while classified as an opioid analgesic, works through a combination of both opioid and non-opioid mechanisms. It is an effective analgesic in the management of visceral moderate to severe pain, and is ideal for use in the minor injuries setting. This article will consider the pharmacological basis of tramadol and how it works by giving an overview of the physiology of pain and neurotransmitters. Discussion will focus on the safe prescribing of tramadol in clinical practice, including the vulnerable patient groups requiring extra consideration, potential drug interactions and how to avoid complications when prescribing this drug. Finally, by outlining the prescribing pyramid, it is demonstrated how safe practice is guided in the clinical setting.
Research and development roundup: September 2010
Authors: O'Connell Nicola
Published: May 2014

New evidence linking the use of acetaminophen to the development of asthma and eczema suggests that even monthly use of the drug in adolescents may more than double the risk of asthma in adolescents, compared with individuals who use none at all. Yearly use was associated with a 50% increase in the risk of asthma.
The management of chronic kidney disease
Authors: Thomas Nicola
Published: May 2014

This article will provide background information on the main changes made to the management of chronic kidney disease (CKD) since the publication of the National Institute for Health and Clinical Excellence (NICE) guidance in 2008. Ways in which people with CKD can be identified and ways in which independent prescribers can manage their care will be presented. Key references and further learning resources are provided at the end of the article.
Psychosis and schizophrenia: a mental health nurse's perspective
Authors: Pringle Rose
Published: May 2014

This article outlines the key areas for nurse prescribers to consider when involved in the clinical management of service users experiencing psychosis or schizophrenia. The author considers key issues concerning mental health service users, including the side effects and physical health implications of being prescribed antipsychotic medication. Consideration is also given to the latest guidance on the management of psychosis and schizophrenia in young people and children ( National Institute for Health and Care Excellence (NICE), 2013 ).
Treatment and prevention of influenza
Authors: Duncan Deborah
Published: May 2014

The outbreak of influenza, commonly known as flu, is something we prepare for in general practice in September each year. We are aware that influenza is a contagious respiratory illness caused by specific viruses, but how much more do we know about it? The difference between influenza and the common cold is confused by our patients, as the symptoms do overlap ( Prior et al, 2011 ). It is, therefore, important to be able to differentiate whether a patient is presenting with influenza or the common cold, as influenza can be a serious condition in at-risk groups. Management of patients with influenza in the at-risk groups is dependent on early diagnosis and treatment with antivirals. There is also general advice we can give patients about the management of their symptoms. The best course of treatment is prevention of the disease through vaccination and education. This article provides an overview of the treatment and prevention of influenza.
Solve the case of red legs: Preventing misdiagnosis of cellulitis
Authors: Nazarko Linda
Published: May 2014

Red legs are commonly diagnosed as cellulitis; however, around 28–33% of the time this diagnosis is incorrect. Incorrect diagnosis can lead to patients being inappropriately treated with antibiotics. This exposes the person to the hazards of antibiotic therapy and increases antibiotic resistance. It also causes delays in providing appropriate effective treatment.
Prescribing in medical aesthetics: Good professional practice
Authors: Rankin Andrew
Published: May 2014

In this article, an outline of good professional practice in prescribing in aesthetic nursing is provided. In private practice, the safety net of local policies, procedures, and national guidance may be absent. However, Nursing and Midwifery Council and British Association of Cosmetic Nurses standards can be used to guide professional practice.
Applying pharmacology to practice: The case of dementia
Authors: Mitchell Gary
Published: May 2014

The role of a nurse has greatly expanded over the past number of years. One area of clinical expertise being sought by patients in particular is that of medications. Medicines used to treat dementia are particularly important as nurses are often the main point of contact for a patient following diagnosis. A good working knowledge of the treatments available to dementia and how they impact on the body can certainly bolster a nurse's confidence when delivering information to the patient. They can also benefit society at a macro-level, as many patients in nursing care receive treatments that are inappropriate and some pharmacological expertise can enable a nurse to recognise when re-assessment is needed. This article will provide nurses with information about pharmacodynamics (what the drug does to the body) and pharmacokinetics (what the body does to the drug) specific to cholinesterase inhibitors and antiglutamatergic therapy—the two approved classes of medications used for treatment of Alzheimer's disease.
Using the prescribing pyramid in managing wound infections: part 2
Authors: Reynolds Val
Published: May 2014

Wound infection has a significant impact on a patient's quality of life, it is therefore important that nurse prescribers use a holistic approach when assessing and managing wound infections. Part 1 of this series (volume 11, issue 3) discussed the importance of assessment of wound infection. This article discusses the management of wound infections with a particular emphasis on nurse prescribing, with reference to the prescribing pyramid. This framework identifies seven principles of safe prescribing, and it is an invaluable tool for nurse prescribers. Part 1 of the series considered the first principle, considering the patient. This article explores the remaining six principles applied to managing wound infection.
Overview on the safe management of controlled drugs
Authors: Thompson Audrey
Published: May 2014

New arrangements for controlled drugs (CDs) have been established in the last few years to encourage good practice in the management of CDs, as well as help to detect at the earliest opportunity unusual or poor clinical practice systems, criminal activity, or risk to patients. This is a response to the Shipman Inquiry which examined how a GP was able to kill many of his patients with CDs over his career without being detected. One of the guiding principles of the new arrangements is that they should not interfere with the appropriate use of CDs and good clinical care. The safe governance principles should apply to all health and social care settings where CDs are supplied, prescribed, stored, administered or transported. All NHS bodies, hospices and registered independent hospitals (general and psychiatric) have a responsibility to assure that the quality of their CD management is an integral part of their clinical governance processes. Requirements for collaboration and information sharing between all health and social care providers, and relevant regulators and agencies have also been introduced.
Pharmacological management of overactive bladder in women
Authors: Rantell Angie
Published: May 2014

Overactive bladder syndrome (OAB) is a chronic long-term condition whose frequency increases with age. Previous articles have shown that OAB is a prevalent condition, with 16.6% of adults over 40 years of age reporting symptoms ( Milson et al, 2001 ). This article aims to provide an overview of the National Institute for Health and Care Excellence (NICE) guidelines CG171 for the management of female urinary incontinence ( NICE, 2013 ). The guidance includes revised recommendations for the pharmacological treatment of OAB and new treatment pathways.
An inspector calls
Authors: Spear Bridget
Published: May 2014

Bridget Spears introduces this regular column with an overview of the role of inspectors, and the importance of the regular statutory assessments of care homes for both care staff and residents.
The structure and function of the skin
Authors: Tonge Hazel
Published: May 2014

In the first article of the tissue viability series, Hazel Tonge describes the structure and function of healthy skin and highlights the risk factors which compromise the integrity of the skin.