bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical activity participation, functional exercise capacity and self-esteem in patients with schizophrenia
Authors: Vancampfort Davy , Hert Marc De , Maurissen Katrien , Sweers Kim , Knapen Jan , Raepsaet Julie , Probst Michel
Published: May 2014

Davy Vancampfort, Marc De Hert, Katrien Maurissen, Kim Sweers, Jan Knapen, Julie Raepsaet, Michel Probst

Aims: This article describes a study comparing level of physical activity functional exercise capacity and body image and self-esteem variables between patients with schizophrenia with high and low perceived sports competence and perceived physical fitness (HPSCPF and LPSCPF).

Methods: A cross-sectional study with 67 schizophrenia patients was undertaken. The final sample included 19 patients with HPSCPF and 19 with LPSCPF The Baecke Physical Activity questionnaire, the 6-minute walk test, the Physical Self-Perception Proflie (PSPP) and the B-WISE® were used. Body mass index (BMI) was incorporated as a covariate.

Findings: In LPSCPF-patients, sport (p = 0.008) and leisure time physical activity (p = 0.004) participation was poorer and the distance walked 20.4% shorter (p < 0.001) compared with HPSCPF-patients. Also all other PSPP scores (p < 0.001) and the B-WISE® total score (p < 0.001) were lower in LPSCPF-patients compared to HPSCPF-patients.

Conclusions: In order to motivate patients with schizophrenia to become more physically active, physical therapists should be aware of the detrimental effects of a LPSCPF.
Psychometric Properties of the Nottingham Assessment of Functional Footcare (NAFF)
Authors: Senussi Mie , Lincoln Nadina , Jeffcoate William
Published: May 2014

Aims:

The Nottingham Assessment of Functional Footcare (NAFF) was developed to assess the foot care behaviour of people with diabetes. The aim was to check the reliability and validity of the measure.

Methods:

Patients attending outpatient clinics were asked to complete the NAFF. A sample of respondents was asked to complete the NAFF again two weeks later. There were 86 participants, 60 (69.8%) of whom had current foot problems.

Findings:

The distribution of item responses indicated all four response categories were used on most items. Internal consistency was 0.61. Re-test data was available from 24 of 39 respondents who agreed to complete the NAFF a second time (61.5%). There was a significant correlation between test and retest (r = 0.91, p < 0.001).

Conclusions:

The NAFF was internally consistent and reliable over time. Patients with foot problems performed significantly more foot care behaviours that those without. A cut-off score of 50 is suggested to indicate further evaluation of foot care behaviour is needed.
Barriers and attitudes health professionals working in eating disorders experience
Authors: Walker Sarah , Lloyd Chris
Published: May 2014

Working with people with eating disorders is a matter of significant concern for health professionals. This study aimed to explore the attitudes of health professionals towards treating clients with eating disorders. 4 qualitative research design using consensual qualitative research (CQR) was used. 4 focus group consisting of 15 health professionals was held. The discussion was guided by a semi-structured interview schedule. Using the CQR procedure, three domains were identified: attitudes, counter-transference, and barriers to providing treatment. These findings have important implications in the treatment of eating disorders.
Video conferencing us talking face-to-face: is video suitable for supportive dialogue?
Authors: Taylor Teri
Published: May 2014

Aims:

This study aimed to explore the differences between conversations carried out face-to-face and those via video link, to see if the latter was suitable for supporting health care students. The study's objectives were: to determine perceived differences between supportive conversations conducted via video link and those carried out face-to-face; and to explore potential causes of any perceived differences between the two methods of conversation.

Methods:

The study used a mix of methods including dialogue simulation, transcript annotation, a questionnaire and focus group. Nine Participants' perceptions of differences between the two media and causative factors were explored.

Findings:

Participants expressed concerns over the use of video communication for emotionally-based dialogue because they perceived problems with eye contact, interpretation of non-verbal communication cues and limitations related to the two-dimensional nature of video conferencing.

Conclusions:

Reduced perceptions of shared space (a phenomenon that is present in face-to-face dialogue) with two-dimensional communication may explain participant discomfort with video communications. New three-dimensional technologies may overcome this. The findings suggest there are implications for using video conferencing in health care delivery. Careful consideration is needed before non-direct support/contact methods are introduced in both education and health care in general.
Reliability and validity tests of an evaluation tool based on the modified Barthel Index
Authors: Ohura Tomoko , Ishizaki Tatsuro , Higashi Takahiro , Konishi Kentaro , Ishiguro Rika , Nakanishi Kosuke , Shah Surya , Nakayama Takeo
Published: May 2014

Aims: To establish the reliability and validity of a performance evaluation tool based on the modified Barthel Index (PET-MBI) for elderly residents of long-term care facilities.

Methods: To develop the PET-MBI, the 10-task modified Barthel Index was translated into Japanese by three therapists, taking Japanese culture and lifestyles into account. Its reliability was independently assessed by two therapists who evaluated 16 participants (mean age 85.6 years; standard deviation (SD)=7.3) from one facility. The internal consistency and validity of the PET-MBI was then assessed by two therapists at three facilities, who evaluated a total of 110 participants (mean age 85.0 years; SD=7.1).

Findings: We excluded the item ‘stair climbing’ because participants did not have to do this. Kappa coefficients of intra-tester reliability based on the test-retest method were 0.70–1.00 for individual tasks of the PET-MBI; kappa coefficients for inter-tester reliability were 0.72–1.00. Cronbach's coefficient alpha of internal consistency was 0.93. Factor analysis according to the PET-MBI revealed that a single factor explained self-care in elderly residents.

Conclusions: The PET-MBI demonstrated high reliability, validity and internal consistency for the assessment of elderly residents in facilities.
Relationships between fall indices and physical function of stroke survivors in Nigeria
Authors: Akosile Christopher Olusanjo , Fabunmi Ayodeji A , Umunnah Joseph O , Okoye Cyril DA
Published: May 2014

Purpose: This study investigated the relationships between fall incidence, fall risk, fear of falling (FOF) and physical functioning of stroke survivors in a Nigerian sample.

Methods: This correlation study involved 26 stroke survivors (17 males, 9 females) recruited from two South-Eastern Nigeria teaching hospitals. The Modified Falls Efficacy Scale (MFES), Berg Balance Scale (BBS), oral interview and the Stroke Impact Scale (SIS version 16) were respectively used to assess fear, risk and incidence of falls and physical function of participants.

Results: Majority of participants were fearful (81%) and at risk of falling (69.2%) based upon a BBS score <45. Five survivors had experienced a total of 15 falls within the last six months and about 70% rated their physical functioning as being above average. Moderate relationships were found between participants' physical function and fall risk (r=−.52), fear of falling (r=.66) and fall incidence (r=.−52) (P<0.05) respectively. Fear of falling and fall risk were also moderately correlated (r=.61) (P<0,05). Both however only had weak inverse correlation with fall incidence.

Conclusions: Moderate relationships exist between each fall index and physical function. Clinicians should evaluate each of the fall indices to determine if it affects the physical functioning of stroke survivors. Intervention strategies should aim at modifying any variable found to have such effect.
Exercise perceptions among people with stroke: barriers and facilitators to participation
Authors: Simpson Lisa A , Eng Janice J , Tawashy Amira E
Published: May 2014

Background/aims: People with stroke continue to lead sedentary lives despite the multiple benefits of exercise. Knowledge regarding stroke survivors’ conception of exercise, which is essential for a thorough understanding of the barriers and facilitators to exercise, is lacking. This study aims to explore the perceptions of exercise among stroke survivors, including their concepts and definitions of exercise, as well as their perceptions of barriers and facilitators to exercise.

Methods: This study used a qualitative exploratory design. Focus groups were conducted with 11 community dwelling participants with stroke (mean 8 ± 3 years post stroke). Data were analyzed using content analysis methods.

Findings: Six themes that provided information regarding participants’ perceptions of exercise were identified: mobility, balance, self-efficacy, outcomes, support, and exercise as part of an active or healthy lifestyle. Although participants internalized specific benefits of exercise, they did not demonstrate an internalized link between exercise and stroke risk. Low self-efficacy was identified as a barrier to participating in exercise, whereas, support to exercise (e.g. external encouragement, qualified personnel) was identified as a facilitator.

Conclusion: These findings may provide insight when developing exercise interventions which optimize adherence for people with stroke.
Perceptions of group exercise in the management of multiple sclerosis
Authors: Aubrey Grace , Demain Sara
Published: May 2014

Background/aims: Exercise is a potentially useful self-management tool for people with Multiple Sclerosis (PwMS). Long-term rehabilitation services for PwMS are recommended but poorly implemented by the UK National Health Service (NHS). This qualitative study explores how a community-based exercise group is perceived to influence MS self-management.

Method: Data were collected from members of one MS Society branch who attended exercise interventions supported by fundraising. Three focus groups took place (n=25): one with a seated exercise group and two with a standing exercise group. Data were transcribed and thematic analysis used to identify and explore themes.

Findings: Four themes were identified: camaraderie, taking action, understanding MS and exercising outside this environment. Participants appeared empowered in their MS management by the opportunity to take action through suitable exercise and the support of peers.

Conclusions: This study indicates that group community interventions have the potential to meet the varying and long-term rehabilitation needs of PwMS. Given the evidence of exercise induced benefits in PwMS, and the problems of access to appropriate facilities, healthcare providers and commissioners should consider how to provide long-term access to appropriate exercise for PwMS.
Problem-based learning and clinical reasoning in sports therapy practice
Authors: Wilson Lynsey Munro
Published: May 2014

Aims/Background: Problem-based learning (PBL) has received little empirical study in sports therapy teaching in the UK. The purpose of this study was to examine the inclusion of case based learning (CBL) through case study scenarios on the development of clinical reasoning (CR) within a second year undergraduate module on the Sports Therapy degree programme at a higher education institution in the UK.

Method: The study was qualitative and exploratory in nature as a questionnaire was provided to the participants and common themes relating to the student experience of CBL were identified. Thirty-five students (n=35, 19 female and 16 male, mean age 21) completed the questionnaire relating to the student experience of the use of case studies and the impact on their CR.

Findings: The findings of the study suggested that the majority of students perceived the case studies as being beneficial in developing their CR. To develop CR, students suggested that clinical skills and knowledge of injury must be accurate. The use of CBL invoked responses which suggested that answer correctness was important to the students. This may emphasise a need for knowledge transfer and the reinforcement of theory before practice.

Conclusions: Problem-based learning and CR may be promoted through the use of case studies that provide a ‘real life, high fidelity’ type of scenario in addition to other methods of knowledge dissemination.
A pilot body image intervention programme for in-patients with eating disorders in an NHS setting
Authors: Caddy Patricia , Richardson Barbara
Published: May 2014

Background:

Body image distortion, a distressing problem that precipitates eating disorders, remains a struggle for patients after other symptoms are controlled. Despite a strong physical aspect there is little recognition of physiotherapy intervention. This study aims to assess the effect of a tailored physiotherapy intervention programme for patients with eating disorders in an NHS in-patient unit.

Methods:

The intervention programme, targeted at known, potentially modifiable factors relevant to body image distortion in 7 patients, used touch, massage, drawing exercises and listening skills. Patients received 8 to 38 sessions determined by length of stay on the unit. Self-drawings were completed at each session and a body shape questionnaire (BSQ-34) and a self-assessment silhouette scale in the first and last sessions.

Findings:

Self-drawings showed improved comparative proportions of body areas. Initial silhouette scores of more than 5 out of 10 reduced to less than five. There was a reduction in BSQ-34 questionnaire scores for all patients, and to less than half for 3.

Conclusions:

This pilot study suggests that a tailored programme based on principles of physiotherapy can help to improve body image perception and satisfaction. It draws attention to the potential of physiotherapy intervention programmes in the UK.
Carers and traumatic brain injury: a qualitative synthesis
Authors: Martin Katherine
Published: May 2014

Background:

Published research studying the effects of informal caregiving for an individual with traumatic brain injury (TBI) identified trends such as grief, depression, and lower quality of life. This systematic review examined qualitative research that explored adult carer experiences to describe their challenges and synthesise themes of importance to this population.

Contents:

An electronic search was undertaken of the following databases PsycArticles, ASSIA, MEDLINE, PILOTS, CINAHL and Proquest Nursing, from their inception to 2011. Studies were screened for inclusion and subject to quality assessment, data extraction and data synthesis by the Joanna Briggs Institute (JBI) Qualitative Assessment and Review Instrument (QARI) by one reviewer. Syntheses developed from the primary findings showed carers had concerns about their future roles and the adaptation of their relative with TBI. There were difficulties in balancing daily life with promoting independence. Carers became expert in their role but required quality information and support. There was a negative impact on carers’ occupational choices.

Conclusions:

This review has produced four synthesised findings to inform evidence-based practice. They underpin the need for inventive information provision, high quality inter-professional education, and a focus on the occupational balance and engagement of the carer.
Exercise instructor-led functional training programme for community dwelling stroke survivors: A qualitative study
Authors: Norris Meriel , Kilbride Cherry , Mohagheghi Amir , Victor Christina , Jones Taryn M , Dean Catherine M
Published: May 2014

Background:

Action for Rehabilitation in Neurological Injury (ARNI) is a novel community-based training programme that promotes functional independence and physical fitness in stroke survivors after formal rehabilitation.

Method:

We investigated the experiences of 22 stroke survivors enrolled in the 12-week programme, through their additional participation in one of four focus groups. Guidance topics informed the discussions, which were audio-recorded and transcribed. Thematic analysis was conducted by two independent researchers and consensus reached on the overarching themes.

Results:

The programme was described as overwhelmingly positive, with ascribed benefits in physical, functional and social activities, leading to a reported increase in active participation in life. Key contextual factors were discussed as being critical to develop these benefits including: the balance of group and 1:1 training, the nature of challenge in the activities and the de-medicalisation of both the environment and the intervention itself.

Conclusions:

Group-based ARNI was reported as having a positive impact on function and participation in life post-stroke. This study indicates a need for further examination of the objective impact of the ARNI programme.
Influence of second-degree flatfoot on spinal and pelvic mechanics in young females
Authors: Abdel-Raoof Neveen , Kamel Dalia , Tantawy Sayed
Published: May 2014

Objective:

To investigate the effect of bilateral flexible second-degree flatfoot on pelvic and spinal mechanics in young females.

Methods:

A case-control trial was conducted at the Faculty of Physical Therapy, Cairo University, Egypt, on 60 female participants who were assigned into two groups. Group A (the control group) included 31 healthy subjects, and group B (the study group) included 29 subjects with bilateral flexible second-degree of flatfoot deformity. For each subject in both groups, using lateral weight-bearing radiographs, foot assessments were performed bilaterally to measure the talus–first metatarsal angle. Using the formetric-II device, 3D assessments of the pelvis were performed on the frontal and sagittal planes in addition to lumbar and thoracic curvatures on the sagittal plane. Outcome measures were pelvic inclination, pelvic tilt, and lumbar lordotic and thoracic kyphotic angles.

Results:

There was a significant difference in pelvic inclination and in lumbar and thoracic angles (P=0.012, 0.009, and 0.028, respectively) between both groups. There was no significant difference between both groups in pelvic tilt (P=0.688).

Conclusion:

Subjects with bilateral flexible second-degree flatfoot demonstrated increased pelvic inclination, lumbar lordotic and thoracic kyphotic angles than normal subjects. Foot assessments should be performed as an essential part of the evaluation of female patients with spine and pelvic problems. Bilateral flexible second-degree flatfoot may act as a predictor for pelvic organs prolapse in their later lives.
Homeopathy
Authors: Ernst Edzard
Published: May 2014

Homeopathy is gaining popularity but robust evidence of efficacy is lacking.
Schizophrenia: the diabetes link
Authors: Holt Richard , Peveler Robert
Published: May 2014

Dr Richard Holt and Professor Robert Peveler describe the links between diabetes and schizophrenia and offer practical guidance for managing diabetes in this patient group
Breastfeeding makes a difference
Authors: Dodds Rosie
Published: May 2014

National Breastfeeding Awareness Week is 8-14 May. Rosie Dodds explains the evidence for ‘breast is best’
Supporting nurse prescribers
Authors: Griffiths Julie
Published: May 2014

Ongoing leaning will be vital for nurses prescribing from the full formulary.
Managing irritable bowel syndrome
Authors: Wilson Mary
Published: May 2014

Evidence-based care, support and information can help people with irritable bowel syndrome, writes Mary Wilson.
Anxiety disorders
Authors: Kelly Kathleen
Published: May 2014

Aetiology, signs and symptoms, management and follow-up.
Practical prescribing - Legislation changes for independent/supplementary prescribers
Authors: Courtenay Molly
Published: May 2014

Molly Courtenay helps resolve everyday issues for nurse prescribers.
Personal health budgets
Authors: Shrubb Richard
Published: May 2014

Personal health budgets are due to be rolled out in England from next year
Prevention strategies for type 2 diabetes
Authors: Holt Paula
Published: May 2014

NICE has published guidelines on preventing or delaying the onset of type 2 diabetes via diet and lifestyle programmes, writes Paula Holt
The traveller with a complex itinerary
Authors: Umeed Margaret
Published: May 2014

A detailed risk assessment is essential to giving good travel health advice. Margaret Umeed works step-by-step through a risk assessment process
Management of wound exudate
Authors: Dowsett Caroline
Published: May 2014

Greater understanding of the role of moisture in wound healing has shown that proper management is essential.
Paramedic clinical decision-making: results of two Canadian studies
Authors: Jensen Jan
Published: May 2014

Paramedics make many decisions while caring for patients in the out-of-hospital setting, including clinical judgments, such as assessment, treatment and transport decisions. As the decisions paramedics make can have an impact on patient safety and clinical outcome, it is important to focus on which clinical decisions are most important, when paramedics are required these, and how paramedics make clinical decisions, that is, what thinking strategies they rely on. This article will present the results of two recent Canadian studies, and will discuss the implications for paramedic clinical practice, education and research on this topic.
Clown humour: The perceptions of doctors, nurses, parents and children
Authors: Battrick Cath , Glasper Edward Alan , Prudhoe Gill , Weaver Katy
Published: May 2014

Clowns have entertained people for millennia. However, the use of humour as a therapy is receiving increasing attention from health-care professionals who are interested in both the psychological and physical effects on patients’ wellbeing. Nevertheless, there is however a paucity of English-language empirical data to underpin the use of clown humour in children’s health-care settings.

The primary objective of this study was to elicit the perceptions of doctors, nurses, parents and children regarding the efficacy of performances by Theodora Trust Special Clowns to sick children in a children’s hospital in the south of England. Participants included 49 children, 43 parents/carers, 17 doctors and 93 other health-care staff.

A questionnaire was used that employed a mixture of closed and attitudinal Likert-type questions, and descriptive statistics were calculated of how individual groups of respondents view the efficacy of clown doctor humour delivered to sick children in hospital.

The majority of children indicated that they liked playing with clowns during their hospital stay, and the majority of parents agreed that the presence of clown doctors has a positive impact on sick children and their families. The majority of the paediatricians who participated also agreed that the presence of clown doctors has a positive impact on sick children and their families during a hospital stay. However, six of them revealed that they did not personally like clowns.

Among the other health-care staff, a large majority agreed that clown doctors have a positive impact on the child and family and that the clown encounter was helpful to the sick child, although 22 did not personally like clowns.

The results show that the parents and children are enthusiastic about the presence of clown doctors in clinical environments where sick children are cared for. The majority of health care professionals including paediatricians are supportive of clown doctor activities for children, despite some of their own personal prejudices.
Sick children’s perceptions of clown doctor humour
Authors: Weaver Katy , Prudhoe Gill , Battrick Cath , Glasper Edward Alan
Published: May 2014

Clowns and their humour have entertained human beings for centuries. However the literature as yet fails to demonstrate a significant research evidence base on the efficacy of clown humour as a therapy within children’s hospitals/units. Despite this, many health professionals with an interest in both the psychological and physical aspects of patients well-being are showing an increased interest in the use of clown humour within health-care settings.

This study focuses on the perceived effects of clown doctor humour as experienced by children in a large children’s inpatient facility in the South of England. 42 children between the ages of four and 11 years were approached and 20 participated fully in the 2 stage process. Data was collected from 17th January 2007–16th May 2007 (over 4 month period).

The draw and write/draw and tell technique was used to elicit information from the children. The results pertaining to the draw and write/draw and tell study were considered in two categories, i.e. ‘written’ words and ‘spoken’ words.

Before the clown visit the majority of written comments made by the children to annotate their drawings were negative (scared/worried/nervous) and ‘negative’ and ‘sad’ appeared to be the prominent theme. Subsequent to the clown doctor visit to the children there was a significant increase in positive written comments made with no negative comments recorded.

There were 34 negative spoken comments articulated by the children and only 14 positive comments, suggesting that the dominant theme before a clown visit was totally negative. Analysis of data elicited after the clown doctor visit showed a much more positive theme, with 57 positive comments being articulated by the children with only three negative comments being generated.

This qualitative study of children’s perceptions of hospital clown humour, using the draw and write /draw and tell techniques, has shown that children appreciate the beneficial effects of a clown visit to them during their hospital stay. The data suggests that clown humour can mitigate some of the negative effects of hospitalisation for sick children. Of the 23 suggestions made by the children after the clown encounter, 19 of them were requests for more frequent clown visits or more clown doctors.
Meeting the emotional needs of parents who have a child with complex needs
Authors: Narramore Naomi
Published: May 2014

The physical and financial demands of caring for a child with complex needs are acknowledged by health professionals. However, the emotional needs of parents are not often recognized by health professionals until parents are at a heightened level of stress.

This paper is based on a literature review of current articles, research papers and government documentation. The focus is on the emotional impact to parents who have a child with complex needs, particularly at the point of diagnosis. The paper explores how health professionals, and nurses in particular, should meet the emotional needs of parents in order to support them more effectively.

Giving birth to a child with severe health problems impacts upon parents at an emotional time of transition, particularly if there were no concerns identified during pregnancy. For some parents a grief response or state of chronic sorrow may be triggered. The reality of caring for a baby who is critically ill or disabled can be an enormous and unexpected shock for both parents. Parents need emotional support and guidance, as they may have to change their expectations for their child’s development and even life span. It is important for nurses to realise that if parents’ emotional needs are unmet it can lead to clinical depression or mental illness.

Primary support often comes from parent support groups rather than health professionals. The review highlights factors affecting parents’ emotions and discusses how early support, home visits and practical help can all help to alleviate parents’ emotional stress.
Understanding advocacy in children’s nursing: a Hermeneutic Study
Authors: Howlin Frances
Published: May 2014

This study describes how Irish registered children’s nurses understand and interpret the experience of being an advocate. Advocacy, both internationally and nationally, is endorsed as being an integral component of the role of the nurse. In children’s nursing, advocacy is viewed as central to the care of the child because of their perceived vulnerability and developing maturity. Despite its centrality in nursing care, advocacy continues to be difficult to define and operationalize in clinical practice. Few studies have explored advocacy in the context of children’s nursing therefore the advocacy role of the children’s nurse is not clearly delineated.

Sampling was purposive and eight registered children’s nurses volunteered to participate in the study. This study used a qualitative approach, based on Gadamer’s hermeneutic philosophy. Data collection methods included identification of the researcher prejudices, purposive sampling, twelve hermeneutic interviews and the compilation of the researcher’s reflexive journal. Benner’s (1994) method of data analysis was used and paradigm cases, exemplars and themes were identified.

The themes identified included advocacy as protection, advocacy as representing the expressed wishes of the parent/child, advocacy as enabling the voice of the child and the work of advocacy. The study identified advocacy as being integral to the role of the children’s nurse. Advocacy was described as a complex concept capable of encompassing various models of advocacy including those of Kohne, Gadow Curtin, Jezewski and Mallik. It highlights the interdisciplinary differences that exist in the conceptualization and operationalization of the concept. In particular, advocacy in children’s nursing comprised both acting in the best interests of the child and facilitation of child self-advocacy, thus supporting the differing ethical principles of autonomy and best interests. Representation of the parents and child’s views were also central to the role.
The science of hydroxy acids: mechanisms of action, types and cosmetic applications
Authors: Bowes Lorna
Published: May 2014

Several studies have supported the use of hydroxy acids such as malic and citric acid in anti-ageing skin care and cosmeceutical formulations. Although first-generation hydroxy acids have been around since 1974, new hydroxyacids with additional benefits that help to support skin barrier function have grown in popularity. There are four different types of hydroxy acid, including polyhydroxy acids (PHAs), beta hydroxy acids (BHAs), aldobionic HAs (BAs) and aromatic hydroxy acids (AMAs) ( Draelos, 2011 ). This article will explore the differences between several types of hydroxy acids and their cosmetic applications. The author will also outline the essential formulation considerations with these ingredients.
Safety considerations for aesthetic nurses administering platelet-rich plasma
Authors: Bowes Lorna
Published: May 2014

Treatment with platelet-rich plasma (PRP) has been labelled with emotive terms such as the Vampire Facelift and dracula therapy, which have generated a significant level of media coverage in the UK and around the globe. However, it could be argued that the use of PRP is an example of procedures gaining popularity before an appropriate level of research has been completed. It is important to note that the majority of research carried out to examine the efficacy of PRP appears to be subjective, made use of small samples and has been based on specialities outside of medical aesthetics. To explore this issue further and outline essential safety considerations, the author will look at the critical issues surrounding the principles of PRP and particularly the questions arising when researching which PRP system to invest in.
Thoughts on a live debate: is psychological assessment robust enough for patients?
Authors: Brackenbury Julie
Published: May 2014

At the inaugural Clinical, Cosmetic and Reconstructive Expo held in London, a multiprofessional group got together at the ‘Great Live Debates’ to discuss how patients should be deemed suitable for treatments using psychological assessment. In this article, aesthetic nurse consultant Julie Brackenbury refects on the key points raised during the discussion and makes recommendations for the future
WHO safe surgery: how are we doing?
Authors: Hardcastle Teresa
Published: May 2014

Patient safety in the operating theatre is high on the agenda of every hospital trust in the UK. The World Health Organization (WHO) checklist— as part of the 5 Steps to Safer Surgery—was made mandatory in 2010. This was a major change that many clinicians and practitioners were unprepared for. The initiative was initially perceived by many as a management checklist. Progress has been slow to embed the checklist due to continual barriers to its compliance. The culture of the operating theatre, which is strongly hierarchical, has been highlighted as the main barrier. To enable this initiative to be adopted successfully, education and training are essential to change the culture and promote better team work, communication and ultimately patient safety.
Developing a coherent body of knowledge for health visiting
Authors: Cowley Sarah
Published: May 2014

The field of knowledge for health visiting has experienced exponential growth and dramatic developments in the past few years. Professor Dame Sarah Cowley highlights the importance of collating this research to build and develop a coherent body of knowledge.
The importance of falls assessment in people with rheumatoid arthritis
Authors: Stanmore Emma K
Published: May 2014

Health visitors regularly come into contact with parents and older people with rheumatoid arthritis and therefore they need to be aware of the high risk of falls in this group of individuals and the support that can be offered to try and reduce falls and fall related fractures and injuries. This article highlights the scale of the problem of falls in adults with rheumatoid arthritis, the underlying risk factors and the screening tools and interventions that may be useful to prevent further falls and improve the quality of life for these individuals.
The importance of secure attachment for infant mental health
Authors: Balbernie Robin
Published: May 2014

Attachment theory has provided both a language of relationships and a wide body of research that has confirmed just how important a positive and joyful relationship between babies and their parents can be. Secure attachment, which is built up by everyday sensitive and appropriately responsive parenting, means a child will be more likely to grow up in a way that will enable them to make the most of their life's opportunities. On the other hand, very insecure attachment, which often is a marker for maltreatment, puts the child at a greatly increased risk for exhibiting a range of antisocial behaviour, as well as significant emotional and mental health difficulties in later life.
The diagnosis, management and treatment of constipation in children
Authors: Paul Siba Prosad , Routley Christine , Haque Salma Yasmin
Published: May 2014

Constipation is common in children and can be associated with faecal incontinence. Most often, constipation is idiopathic in nature, and invasive investigations should be reserved for intractable cases and carried out by specialists. Children with constipation can present with a variety of symptoms, including faecal incontinence, rectal bleeding, and abdominal pain. Health visitors play an important role in detecting symptoms early, and the presence of any red flag symptoms should warrant an early referral to specialist services. An essential aim for treatment is to prevent pain associated with defecation, and laxatives are the first line of management for childhood constipation. Chronic constipation can be debilitating and may have long term behavioural and social consequences.
How to manage patients with acute kidney injury
Authors: Davies Annette
Published: May 2014

Annette Davies provides an overview of how to manage acute kidney injury (AKI). She emphazises the importance of preventing AKI and gives clear clinical management goals and instructions on how best to manage AKI patients, identifying fluid balance as one of the key issues for successful treatment.
Strategies for managing conflict within the team
Authors: Ellis Peter , Abbott Jane
Published: May 2014

Peter Ellis and Jane Abbott identify why the management of conflict is important. They outline some approaches and strategies in dealing with discord and take a look at what these strategies might mean for the management of particularly difficult-to-manage individuals.
Topical insulin in wound healing: a randomised, double-blind, placebo-controlled trial
Authors: Greenway S.E. , Filler L.E. , Greenway F.L.
Published: May 2014

Two studies were carried out to assess the relative roles of insulin and zinc in the acceleration of wound healing. In the first study, six diabetic and five non-diabetic human volunteers had two uniform cuts created, one on each forearm. One forearm wound was treated with topical regular insulin (Iletin-II) and the other with normal saline four times a day until healed. Treatment was double-blind and forearms were assigned randomly. The wounds treated with insulin healed 2.4 ± 0.8 days faster than the wounds treated with saline (P < 0.001 by paired t-test). Zinc is used to crystallise insulin. When wounds are treated with insulin, they are therefore also being treated with zinc. If insulin accelerates wound healing, it is not clear if the increase in the rate of healing would be due to insulin (a known growth factor), the zinc it contains, or a combination of the two. The second study used a randomised, double-blind, placebo-controlled design to compare the efficacy of insulin with that of a solution containing the same amount of zinc in accelerating the healing of standardised wounds in rats and humans. Although these pilot investigations did not have the power to define the relative roles of insulin and zinc with accuracy, the results suggest that zinc does play a role in the wound healing process. It is concluded that topical insulin accelerates wound healing in humans. More importantly, however, this study describes a method of creating uniform wounds in humans acceptable to an institutional review board, thus solving one of the major impediments to the scientific evaluation of human wound healing.
The impact of a bandage training programme
Authors: Reynolds S.
Published: May 2014

This study measured the impact of a training programme on nurses' bandaging skills and aimed to establish whether any improvements are maintained over time. Two commonly used high-compression bandages were investigated using the Oxford pressure monitor. A quantitative approach was taken using a quasi-experimental, pre- and post-test design. Using a sample of 23 community nurses, data were collected by means of a self-rating questionnaire, structured observation and objective measurement. Nurses' knowledge and competence significantly improved following training. However, the maintenance of skills requires further investigation. Nurses tended to overrate their competency in bandaging compared with actual proficiency. More nurses achieved better proficiency scores when using one bandage type compared with the other, but this was not statistically significant.
A new device for the treatment of perineal wounds
Authors: Steen M. , Cooper K.
Published: May 2014

The development and evaluation of a maternity gel pad for the alleviation of perineal pain
Topical negative pressure therapy in wound care
Authors: Banwell P.E.
Published: May 2014

A review of the development and use of sub-atmospheric pressures in the management of patients with different types of wound
Challenging the pressure sore paradigm
Authors: Price P. , Bale S. , Newcombe R. , Harding K.
Published: May 2014

This study determines the effectiveness of a new low-unit-cost support system in patients at very high risk of developing pressure sores. In a prospective randomised controlled trial, a low-pressure inflatable mattress and cushion system (Repose) was compared to a dynamic support mattress (Nimbus II) used in conjunction with an alternating-pressure cushion (Alpha TranCell) in 80 patients with fractured neck of femur and high scores on a pressure sore risk assessment scale. All patients received best standard care, including turning at regular intervals. Skin condition was assessed in 17 locations on admission, preoperatively, and seven and 14 days postoperatively. No difference was found between the groups in skin condition or the occurrence and severity of pressure sores at any time point.
Honey and wound bacteria
Authors: Lawrence J.C.
Published: May 2014

Chronic wounds pose a microbiological dilemma. Bacterial acquisition by acute skin wounds can be significantly minimised by prophylaxis with topical antiseptics such as chlorhexidine, povidone- iodine or silver compounds. However, such prophylaxis is probably impractical for chronic wounds which, by nature, have a protracted duration, and frequently develop insidiously. Consequently such wounds are colonised with a wide variety of bacterial species, many of which are potentially pathogenic. It is often unclear whether wounds so colonised are infected since often there is little obvious evidence of sepsis. However, it may be pertinent to note that tissues are normally bacteria free; moreover, in the absence of a microbiological flora, sepsis cannot develop nor can cross-infection occur.
Comparative study of a foam mattress and a water mattress
Authors: Groen H.W. , Groenier K.H. , Schuling J.
Published: May 2014

In order to determine the effectiveness of high-quality foam replacement mattresses in the treatment of pressure ulcers, one such mattress (TheraRest) was compared with a water mattress (Secutex). One hundred and twenty nursing home patients with pressure ulcers were randomised into two groups and nursed on one of the mattresses for four weeks. After four weeks, 45% of the patients using the foam mattress were completely healed, compared with 48.3% of those using the water mattress. This difference is not significant. Since high-quality foam mattresses are cheaper in the long term than water mattresses, and are easier for nursing staff to manage, it is suggested that these mattresses are preferable.
The assessment and treatment of wound pain
Authors: Emflorgo C.A.
Published: May 2014

A review of the causes of pain in wounds, and the interventions required to provide relief.
Measurement of interface pressures in the evaluation of operating theatre mattresses
Authors: Scott E.M. , Baker E.A. , Kelly P.J. , Stoddard E.J. , Leaper D.J.
Published: May 2014

This study compared the sacral interface pressures obtained in four mattresses (all supplied by the same manufacturer), in two positions adopted for surgical procedures, to determine the similarities and differences between them. The mattresses were all variations of the standard product used in operating departments. The null hypotheses were that there are no differences in interface pressures between the mattresses or between the two surgical positions, and that measurements are not influenced by subject body mass index. The measurement technology was also tested for reliability and suitability for intra-operative use. Sacral interface pressures of 25 healthy volunteers were recorded using each of the four mattresses (order individually randomised) in both the supine and the Lloyd Davies positions. A pressure-sensitive mat was used and one-way analysis of variance was the main statistical approach. Statistical significance was determined by p-values of ? 0.05. One mattress recorded significantly lower interface pressures than the others and all pressures were influenced by body mass index. Surgical position was a significant factor, measurements in the Lloyd Davies position being 9.5-14.2% higher than in the supine position. The pressure measurement technique has proved to be reliable and easy to calibrate, position and use. Indications are that it can be used safely and effectively in operating departments. These results have implications for researchers and clinicians.
Pressure-induced skin lesions in pigs: reperfusion injury and the effects of vitamin E
Authors: Houwing R. , Overgoor M. , Kon M. , Jansen G. , van Asbeck B.S. , Haalboom J.R.E.
Published: May 2014

The pathogenesis of the development of pressure ulcers is still unclear. The aim of this study was to investigate the role of ischaemia and reperfusion in pressure-induced tissue necrosis in the trochanteric region in pigs. Pressure application was achieved with a newly developed computer-controlled pressure device. Histological examination showed damage in the subcutis and muscle tissue comparable with inflammation, extending in a vascular pattern beyond the area of pressure application. Electron-microscopic studies revealed neutrophil adherence to the capillary endothelium, which showed signs of injury. These observations were manifest two hours after the cessation of pressure. Pre-treatment with 500mg vitamin E per day resulted in significantly less tissue damage compared with untreated animals. Pressure alone caused a significant decrease in reduced glutathione and total glutathione, suggesting oxidative stress. After pressure release there was a significant increase in hydrogen peroxide concentration, suggesting a decreased antioxidant protection. After pre-treatment with vitamin E, however, there was no increase of hydrogen peroxide.

It is concluded that the early signs of necrosis after pressure application are concordant with typical ischaemia-reperfusion damage and this can be prevented in part by treatment with vitamin E. Prophylactic administration of vitamin E may influence the occurrence of pressure ulcers in humans undergoing elective surgery.
Effect of visco-elastic foam mattresses on the development of pressure ulcers in patients with hip fractures
Authors: Gunningberg L. , Lindholm C. , Carlsson M. , Sjödén P.-O.
Published: May 2014

This study had three aims: to investigate if visco-elastic foam mattresses are more effective than standard hospital mattresses in reducing the incidence of pressure ulcers in patients with hip fractures; to compare pressure ulcer grade and location and documented nursing prevention and treatment interventions in patients using the two types of mattresses; and to identify possible predictors of pressure ulcer development.

Using a prospective randomised controlled trial design 101 patients (mean age: 84 years) were randomly allocated either a visco-elastic foam mattress or a standard mattress. There was no significant difference in the incidence of pressure ulcers between the two groups, but patients on standard mattresses tended to develop more severe pressure ulcers. Furthermore, according to the documentation, patients with grade I pressure ulcers who were allocated a standard mattress received more preventive interventions, which may have reduced the differences in outcomes between the two groups. The researchers conclude that the results support the use of the test mattress. Significant predictors of pressure ulcer development were long waiting times for surgery and low haemoglobin levels at hospital admission
Alginate dressings in surgery and wound management: part 3
Authors: Thomas S.
Published: May 2014

This final article in the series looks at the functioning of seaweed-derived dressings at a cellular level, as well as the importance of choosing appropriate secondary dressings