bluuebunny/crossref_metadata_2025 huggingface dataset:
Innovation in tissue viability documentation for acute services
Authors: Parnham A.
Published: May 2014

This paper discusses the developmental process, outcome and delivery of an innovative approach to standardising tissue viability documentation across two sites within Nottingham University Hospitals NHS Trust, following the results of benchmarking pressure ulcer preventive care strategies and recommendations from pressure ulcer root cause analysis. It refects upon the process, highlighting the lessons learnt.
Evidence-based dressing selection
Authors: White Richard , Cowan Tracy , Glover Deborah
Published: May 2014

A wide range of considerations determine dressing selection. Taking into account the wound type, the patient's holistic needs and his or her own clinical experience, the practitioner will then look to the literature for guidance. To support practitioners with their decision-making, this supplement provides an in-depth review of the evidence on Urgo's Technology Lipido-Colloid range of dressings. Its objective is to summarise the literature, as opposed to critiquing it
Clinimetrics of tristimulus colourimeters in scar assessment: a review of evidence
Authors: Jones H.G.
Published: May 2014

Objective:

To review the evidence regarding the use of tristimulus colourimeters (TC) in scar assessment.

Method:

A literature search was performed using ovid and the Cochrane database with the search terms ‘scar assessment’, ‘clinimetrics’, ‘tristimulus colourimeter’, ‘microcolour’, ‘chromameter’ and ‘colour spectrometer’.

Results:

Wound colour is usually assessed with a visual analogue scale, such as VSS or POSAS. Research on objectifying the assessment by using an assessment tool has so far been encouraging, but has failed to show a benefit over the visual analogue scales in terms of validity, accuracy and reproducibility. Studies vary in methodological quality.

Conclusion:

Research on TC clinimetrics has shown moderate to high concurrent validity, reliability and reproducibility of these products in terms of assessing vascularity, but less correlation in terms of pigmentation, when compared with the visual scoring systems. The evidence for using TC is based on a relatively small number of studies, and more research is needed before widespread implementation of TC for assessing scar maturation is recommended.

Declaration of interest:

The authors have no conflicts of interest to declare. There were no external sources of funding for this report.
Total contact casting combined with human fibroblast-derived dermal tissue in 15 DFU patients
Authors: Kashefsky H , Marston W.
Published: May 2014

Objective:

To investigate the use of a cryopreserved human fibroblast-derived dermal substitute (Dermagraft; DG) in combination with total contact casting (TCC) in patients with diabetic foot ulcers, compared with previously published rates of healing with TCC alone.

Method:

Fifteen consecutive diabetic foot ulcer patients were referred to a multi-speciality clinic to be managed with a combination of DG and TCC, after showing no progress toward healing following at least 4 weeks of standard, conservative therapy. Follow-up visits were scheduled every 7 days, for a period of 12 weeks, or until fully healed. At each visit, DG and TCC were applied by the investigating clinician, and ulcer size and depth were recorded. Photographs were taken once a month, or when healed. If indicated, debridement was done to remove fibrotic tissue, callus and slough.

Results:

The results demonstrated an average healing rate of 23.7 ± 16.3 days. The average number of DG applications was 2.1. There was no correlation observed between ulcer duration, or ulcer location (forefoot or mid-foot), and time to healing; however, a correlation was found between wound size and healing time.

Conclusion:

The findings may suggest combining advanced healing modalities, such as DG with TCC, can be done and that they may have a benefit of limiting the time spent in TCC, as well as a reduction in time to heal. The study size was small and further studies into combining modalities are warranted to validate these findings.

Declaration of interest:

Both authors have been paid consultants for Advanced Biohealing, the producers of Dermagraft (DG). There are no financial disclosures for Med Efficiency, Inc. (MedE-Kast Ultra; TCC), or any other conflicts of interest to declare.
Back to basics: histological, microbiological and biochemical sampling in wound care
Authors: Voegeli D. , Lwaleed B.
Published: May 2014

Despite the advances in our understanding of normal and abnormal wound healing over the past decade, a specific biomarker which can be used clinically to identify ‘hard-to-heal’ wounds still remains elusive. Tissue and exudate samples extracted from the site of the wound are traditionally analysed using histological, microbiological and biochemical laboratory techniques. The aim of this paper is to review the advantages of these techniques, their limitations and the rapid developments in the fields of microbiology and proteomics, which are offering new insights into the differences between healing and non-healing wounds.
Retinervus luffae fructus (RLF): a novel material for use in negative pressure wound therapy
Authors: Zuo H.Y. , Chen Y.
Published: May 2014

Objective:

To describe a modified negative pressure wound therapy (NPWT) apparatus, made mainly of an environmentally-friendly material derived from the retinervus luffae fructus (RLF; or loofah) plant.

Method:

We retrospectively reviewed the charts of patients with skin defects on their limbs who underwent treatment with the RLF-NPWT device from September 2012 to October 2012. The endpoint of the study was healing by secondary intention; the time (days) to endpoint was evaluated.

Results:

The RLF-NPWT device was used in 16 patients. The age of the patients ranged from 15–82 years, with a mean age of 43±17 years. Six patients sustained crush injuries, nine patients had open limb injuries from motor vehicle accidents and a further patient had a diabetic foot ulcer. The mean time to healing was 8.5±2.4 days. Following RLF-NPWT, fresh granulation tissue was observed in all wound beds, with no evidence of macroscopical necrosis. All 16 patients in the study achieved secondary healing.

Conclusion:

The environmentally friendly RLF-NPWT apparatus is easy to use and able to provide continual negative pressure for optimal preparation of the wound bed. The cost-effectiveness of RLF-NPWT compared to standard NPWT requires further investigation.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
The role of end-tidal carbon dioxide monitoring in rapid sequence intubation
Authors: Lah Katja , Grmec Štefek
Published: May 2014

Rapid sequence intubation (RSI) is the cornerstone of emergency airway management. It is a safe procedure when used by adequately trained personnel, even in the prehospital setting. Measurements of the partial pressure of exhaled carbon dioxide (PetCO2) via capnometry/capnography have several useful clinical applications and are extensively used by prehospital providers to monitor critically ill and injured patients. This article reviews the role of monitoring PetCO2 values during RSI.
Top up course for paramedics at Teeside University
Authors: Millins Mark
Published: May 2014

Since 2007, Teesside University has been successfully running a foundation degree in paramedic science for pre-registration student paramedics. The programme is run in conjunction with both the North East Ambulance Service and Yorkshire Ambulance Service NHS Trusts and is now well established with over two hundred students graduating since its conception.
Prehospital care: a patient's story
Authors: Griffiths Kelly
Published: May 2014

This article provides a real life patient account of one woman's experience of prehospital care following being injured in a serious road traffic collision in August 2006. The article will focus largely on the prehospital phase of her experience, but also draw upon the patient's wider experience of treatment following the collision.
Postgraduate opportunities in research at NEAS
Authors: McLure Sally , Willis Mark , Fox Ann , Newton Julia , Hirst Barry
Published: May 2014

The North East Ambulance Service NHS Trust (NEAS) is offering a unique opportunity to qualified and enthusiastic paramedics who wish to understand the research process and assist with the delivery of high quality clinical research. Recently, joint funding has been secured to support four dedicated paramedics to undertake a master of clinical research at Newcastle University. These academic posts are a joint initiative between the research and development (R&D) department and the clinical education and development department at the trust. Together, we anticipate that this successful collaboration will strengthen working relationships and maximize our common objectives in the future. This article highlights these novel scholarships which are currently available in the North East region.
Improving call-to-balloon times for ST-elevation myocardial infarction
Authors: Sampson Fiona , Goodacre Steve , Carter Angela , Wailoo Alan
Published: May 2014

Objectives: The National Infarct Angioplasty Project (NIAP) pilots were set up in 2005 to test the feasibility of implementing a countrywide primary angioplasty (PCI) service for patients with ST-elevated myocardial infarction in England. The authors undertook an evaluation of these pilot sites along with a small number of control sites to assess the workforce and staff implications, patient and carer experience and the cost-effectiveness of primary angioplasty-based care in the real world. Methods: this was a mixed methods study, incorporating four main components: description of models of service delivery, evaluation of workforce and organizational issues, patient and carer evaluation and economic evaluation. Results: pilot sites varied considerably in size and configuration. Many offered ambulance bypass for patients within the catchment for nearby feeder (non-PCI) hospitals or received transfers from these non-PCI hospitals. During the pilot year, 70% (1449/2072) of patients were admitted directly to a PCI site, with a further 21% (435/2072) being transferred from a non-PCI site. Median call-to-balloon times (CTB) were 120 minutes for patients taken directly to a PCI site and 161 minutes for patients who went via a non-PCI site. CTB times can be reduced considerably by improving pathways so that ambulances can bypass non-PCI sites and bypass emergency departments by taking patients directly to the catheter laboratory for assessment. The use of telemetry to enable ECGs to be examined by staff within the coronary care unit can also reduce the number of patients being wrongly transferred to primary angioplasty centres. Time delays that incurred from transferring patients from non-PCI sites to PCI sites indicated that promptly administered thrombolysis may be more cost-effective than PCI in certain circumstances. Patients reported very high levels of satisfaction with care and reported higher levels of satisfaction with speed of treatment and the ambulance journey at NIAP site than control sites. Conclusion: primary PCI was found to be a cost-effective and feasible service, providing CTB times can be minimized by streamlining patient pathways.
Paramedics in need of user friendly body armour
Authors: Kaiser Robert
Published: May 2014

Robert Kaiser, CEO of PPSS Group, Knaresborough, UK, discusses the results of a recent survey, highlighing the issue of paramedics using body armour.
A non-guidelines approach to cardiocerebral resuscitation
Authors: Ewy Gordon , Kern Karl
Published: May 2014

Cardiovascular disease is a leading cause of death in most Western industrialized nations, making out-of-hospital cardiac arrest (OHCA) a major public health problem ( Atwood et al, 2005 ; Lloyd-Jones, 2010 ). Unfortunately, the first sign of cardiovascular disease is often the last, as the first sign is often sudden cardiac arrest ( Roger et al, 2011 ). It is not just a problem of the elderly as the average decade of adults with OHCA is the sixth ( Bobrow et al, 2010 ). In the US, a 40 year-old-male has a 1 in 8 chance of dying from cardiac arrest ( Lloyd-Jones, 2010 ). This article will present a non-guidelines approach to the management of patients with primary OHCA that significantly improves survival. It is called ‘cardiocerebral resuscitation’ as it limits interruptions of blood flow to the heart and the brain by emphasizing near continuous chest compressions not only by bystanders but also by advanced life support (ALS) providers. It deemphasizes assisted ventilation, as patients with primary cardiac arrest have nearly normal arterial blood oxygenation at the onset of their arrest. We present the details of cardiocerebral resuscitation and the published studies that have documented improved survival of patients with OHCA so treated. It emphasized that guideline cardiopulmonary resuscitation (CPR) and ALS should be reserved for patients with secondary cardiac arrest; secondary to drowning, drug overdose and other forms cardiac arrest that are secondary to respiratory failure.
Aspects of military prehospital care
Authors: Wood Ryan , Jeevaratnam JA , Clasper Jon
Published: May 2014

The military prehospital care experience has adapted civilian practice to reflect the nature of injuries sustained in recent conflicts. The main adaptations stem from differences in the mechanism of injury, clinical timelines and personnel. The large number of blast injuries and resulting extremity trauma means that an emphasis is placed on the control of catastrophic haemorrhage using a number of novel haemostatic strategies. This paradigm of ABC is now universally followed and differs from civilian practice in a number of other ways— particularly in the management of C-spine, airway, chest injuries and circulatory access. This review highlights these differences in practice and outlines military techniques and protocols. It also emphasizes those areas in which civilian practice has borrowed from its military counterparts and successfully employed their techniques. This may become more relevant in the modern, post-September 11th era, in which urban mass casualty incidents are no longer a fictional fear.
New cardiac arrest guidelines: implications for paramedic practice
Authors: Fullerton James , Soar Jasmeet
Published: May 2014

New UK, European and international guidelines for cardiopulmonary resuscitation (CPR) were published in October 2010 ( Nolan et al, 2010 ). These guidelines marked the 50th anniversary of modern CPR ( Kouwenhoven et al, 1960 ). The new guidelines give greater emphasis on early bystander CPR, high quality chest compressions with minimal interruption, early effective defibrillation and good quality post cardiac arrest care for achieving neurological survival in cardiac arrest victims. Guidelines 2010 recommendations also attempt to make it easier for rescuers to achieve this in any setting. The full UK guidelines can be accessed from the Resuscitation Council (UK) website ( www.resus.org.uk ). In this article, the authors discuss issues relating to the new guidelines that they feel are relevant for paramedic practice.
Smallpox and the origins of vaccination
Authors: McClelland Graham
Published: May 2014

Smallpox is a highly infectious virus with a high mortality rate. Until the 19th century, smallpox epidemics regularly swept the UK. In some areas of the world, smallpox epidemics continued well into the 20th century. Smallpox has now been eradicated by an international effort led by the World Health Organisation (WHO). The eradication of smallpox was achieved by vaccination, and the history of vaccination is closely linked to the treatment of this disease. Despite being eradicated in the natural environment, there are still stocks of smallpox kept by two governments which are the cause of ongoing debate. Today, biological weapons are considered part of the threat posed by terrorist organizations and a deliberate smallpox release is a conceivable scenario. This article will describe smallpox, its connection with vaccination and why knowledge of diseases such as smallpox can be valuable to paramedics.
A review of the pre-ROSC intranasal cooling effectiveness study
Authors: Glencorse Mark , Glencorse Sandra
Published: May 2014

With the publication of the 2010 European Resuscitation Council Guidelines, therapeutic hypothermia has been recommended as part of the treatment algorhythm for the management of adult cardiac arrest. As ambulance services around the world struggle to decide on the best method of cooling a patient at the time of the return of spontaneous circulation (ROSC), the ground-breaking ‘PRINCE’ study has been published describing the novel approach of ‘trans-nasal’ evaporative cooling during the peri-arrest period. This study describes a significant difference found on arrival at hospital between the mean tympanic temperatures of the two groups (cooled vs control) following a period of cooling (34.2 °C [SD 1.5 °C] vs 35.5 °C [SD 0.9 °C], P<0.001). In addition, when looking at survival to discharge following out-of-hospital (OOH) cardiac arrest, there was a statistically significant difference in a subgroup of patients where CPR was commenced within 10 minutes of cardiac arrest (56.5% of trans-nasally cooled patients survived to discharge compared with 29.4% of control patients (P=0.04, relative risk =1.9)). This article examines the PRINCE study and considers the implication of this method of inducing therapeutic hypothermia in the out-of-hospital cardiac arrest patient within the UK.
Recognising and managing severe sepsis in the pre-hospital environment
Authors: Small Mark
Published: May 2014

Severe sepsis is a complex medical condition in which the immune system overreacts to an infection leading to circulatory shock and organ failure. Patients with severe sepsis are critically ill and have a high mortality rate in the absence of early aggressive treatment, however, recognition and treatment of the condition remains poor. Recent improvements in the care of patients with myocardial infarction, stroke and multiple trauma have demonstrated how pre-hospital recognition and treatment can greatly improve outcomes for patients, and paramedics are well placed to provide similar improvements to the care of patients with severe sepsis. This article will explore the pathophysiology of sepsis, the recommended treatment bundles suggested by the ‘sepsis six campaign’ and the difficulties faced in implementing such treatments. Finally, it will explore the interventions that could be undertaken by Paramedics to improve patient care.
Cultural challenges in getting it right for every child: a reflective account
Authors: Haley Tony
Published: May 2014

Paramedics working within health care services are faced with difficult decisions almost every day. They are required to work within organizational and professional boundaries and in the best interests of their patients at all times. In cases involving children it is especially important to ensure the child is properly empowered and included in the decision-making process. Sometimes these requirements are difficult to assess and paramedics will draw on professional and personal experience to assist them in deciding how best to ensure appropriate empowerment and that patient care has taken place. When dealing with patients from cultural backgrounds they are unfamiliar with, language barriers and cultural differences may make it difficult for paramedics to assess whether their patient has been properly empowered and included.
Qualitative interview study of clinicians’ opinions of which intubation aids to use following a CBRN incident
Authors: Castle Nick
Published: May 2014

Aim: to ascertain what intubation aids clinicians believed should be consideredfor further evaluation for use while wearing CBRN-PPE

Introduction: Intubation remains a key treatment option for the managementof casualties with respiratory failure following a chemical biological radiationnuclear (CBRN) incident. However, CBRN personnel protective equipment (CBRN-PPE) adversely affects intubation performance. To date, only the IntubatingLaryngeal Mask airway has been evaluated as an intubation aid for use whilewearing CBRN-PPE within a randomized control study.

Methods: This is a qualitative, interview based study involving 25 clinicians fromvarious backgrounds. All interviewees had previously been involved in a numberof manikin based CBRN-PPE research studies involving airway managementincluding intubation.

Results: Five different intubation aids were identified by the interviewees, including the gum elastic bougie, Airtraq™, stylet, Intubating Laryngeal MaskAirway and the McCoy laryngoscope as well as non intubation aids such aspractising intubation techniques while wearing CBRN-PPE, training with regardsto optimal techniques for intubation/airway management while wearing CBRN-PPE, correct/optimal patient position as well as the availability of a skilledassistant.

Conclusion: This interviewed opinion based study involving UK clinicianswith experience of performing intubation and other related resuscitationtechniques while wearing CBRN-PPE has identified a number of intubation aidsthat clinicians believe may assist with intubation performance by potentiallyimproving speed and/or intubation success within the CBRN environment.However, the loss of fine motor movement and tactile sensation has beenidentified as a possible limitation of the devices and therefore these intubationaids warrant further evaluation. The role of training in skill performance andsimulation based practise, while wearing CBRN-PPE, also requires furtherinvestigation.
Pre-hospital management of cystic fibrosis patients presenting with haemoptysis
Authors: Sofianopoulos Sarah , Williams Brett
Published: May 2014

This paper discusses the pre-hospital clinical management of cystic fibrosis (CF) patients suffering with haemoptysis. While clear guidelines and procedures exist within hospitals in regard to the management of such patients, the same cannot be said for the pre-hospital setting, with very limited clinical practice guidance. Massive haemoptysis is a serious threat to life, though for some patients such as the CF population, even a minor bleed can have devastating effect on quality of life. This paper proposes a pre-hospital clinical guideline based on a retrospective case series from a large Australian tertiary hospital. It is hoped this paper will provide important clinical information regarding CF patients suffering with haemoptysis as it is imperative the management of these patients is undertaken promptly and is well-informed.
Cattle
Authors: Barrett David C
Published: May 2014

Introduction: This edition of Cattle Review considers papers on the relationship between lying behaviour and somatic cell counts (SCC), and the effect of body condition score (BCS) on lameness.
Cattle Review
Authors: Barrett David C
Published: May 2014

Introduction:

This marks the 100th edition of Cattle Review (formerly Cattle News) stretching back to 1999. This time around I've included papers on infrared thermography as a diagnostic tool and dairy farmers’ willingness to pay for measures to reduce lameness.
Worming in adult horses
Authors: Rendle David
Published: May 2014

Most horse owners worm their horses inappropriately and rarely consult veterinary surgeons. The majority perform a form of interval dosing regardless of need, increasing selection pressure for anthelmintic resistance. Targeted worming programmes should be adopted and individually tailored to all populations of adult horses to delay the onset of resistance. When instigating targeted worming regimens the use of faecal egg count reduction tests (FECRT) should be strongly encouraged; they are simple and inexpensive. Targeted strategies are cheaper for horse owners and provide an opportunity for veterinary surgeons to engage with, and profit from, preventive health care. As a profession, veterinary surgeons are better placed to implement effective strategies that are tailored to individual animals than other providers. Currently those owners that do choose to use faecal egg counts (FEC) and targeted worming plans frequently depend on online providers when they could be better served by their veterinary surgeons who have more direct involvement in the management of the property and general health care of individual horses.
The responsible use of antimicrobial therapy in the control of bovine mastitis in dairy herds
Authors: Breen James
Published: May 2014

Although antibiotic use in the dairy sector is relatively low when compared with other species such as pigs and poultry, dairy herds are likely to come under increasing scrutiny regarding the use of antimicrobials to prevent endemic diseases, particularly in the context of mastitis control. While the treatment of existing infections remains an important part of mastitis herd health, it is prudent to consider the use of antibiotics in mastitis control within the framework of the British Veterinary Association's recent guide to the responsible use of antimicrobial drugs in veterinary practice. Working with clients to avoid the need for antimicrobials using disease control programmes is the first of eight points in the guide and the most important; the recent roll-out of the national DairyCo Mastitis Control Plan has prompted renewed interest in the prevention and control of new intramammary infections and therefore minimising the use of antibiotics in mastitis control.
Write a prescription
Authors: Shaw Matthew
Published: May 2014

Think of the patient

All of the rules and regulations relating to how prescriptions should be written are in place simply to make sure that the patient receives the medicine that is right for them at the right time.
Competency and the use of clinical management plans in rheumatology practice
Authors: Hennell Sheena L , Wood Barbara B , Spark Eileen W
Published: May 2014

Nurse prescribing is now well established. To date six specialist nurses at Wirral Hospital NHS Trust have completed the V300 Extended Formulary Nurse Prescribing and Supplementary Prescribing course. Of those nurses, three are currently working in rheumatology. This article analyses the role of supplementary prescribing and the use of clinical management plans in rheumatology practice. It also considers the competencies required for safe prescribing in rheumatology.
Nicotine replacement therapy: a proactive intervention
Authors: Ford Karen
Published: May 2014

The author has been a health visitor for 8 years and was previously a sister in both an intensive care unit and an acute medical ward. She has been prescribing from the nurse prescriber’ formulary for 6years and prescribing as an extended and supplementary prescriber for 18months. She has undertaken training to become a smoking cessation counsellor in order to extend her public health role so that she can provide a seamless service for her clients. To prescribe nicotine replacement therapy (NRT) alone without the supportive element of counselling is less likely to lead to success, but using NRT doubles the chance of being able to quit smoking (Raw McNeil and West, 1998). This is clearly demonstrated in the following case study.
Consent to examination and treatment 3: knowledge of risks
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The final article on consent considers the nurse prescriber’s duty to disclose information about the risks inherent in the treatment of his/her patients. It considers how the law requires a different level of disclosure for patients who ask no questions about risks, those who make general enquiries about risks and those who ask specific questions about the risks inherent in treatment.
Developing a concordant approach for the management of constipation
Authors: Campbell Pam
Published: May 2014

The common occurrence of constipation means that the majority of nurse prescribers will encounter patients who request laxatives. The cost to the NHS of prescribing laxatives merits a considered approach that recognizes the patient’s position as an equal in the decision making process. This approach of concordance should link naturally to the nursing role.
Moving prescribing forwards: the new DH consulation
Authors: Campbell Pam
Published: May 2014

Independent nurse prescribing from a nurse prescribers’ extended formulary was introduced in spring 2002. Ever since, nurses have continually complained that the formulary (comprising 180 prescription only medicines (POMs), plus all pharmacy (P) and general sales list (GSL) medicines), does not suit their needs and does not enable them to deliver the right care to their patients. This ongoing dissatisfaction around the Nurse Prescribers’ Extended Formulary (NPEF) is inevitable and will continue until the entire British National Formulary (BNF) is opened to nurses.
Lady Justice Smith: the lessons to be learned from the case of Harold Shipman
Authors: Saunders Kate
Published: May 2014

Following the recent publication of the sixth and final report from the Shipman Inquiry (The Shipman Inquiry, 2005), Lady Justice Janet Smith held an informal lecture on her investigations into the case of Harold Shipman, on Tuesday 22 February 2005, at the Institute of Electrical Engineers, London.
Nurse prescribing and the issue of patient confidentiality
Authors: Griffith Richard , Channon Ceri
Published: May 2014

During the course of their practice, nurse prescribers are given intimate and personal information about their patients, but generally they are required not to disclose this information. Nurses have a legal and professional obligation to maintain confidentiality, however, this obligation is not absolute. There are circumstances where confidential information can, and occasionally must, be disclosed. This article outlines the legal basis for the duty of confidence and the exceptions to that duty which allow a nurse prescriber to disclose confidential information about patients.
Developing a computer-based clinical management plan for supplementary prescribing
Authors: Belton Julie
Published: May 2014

Supplementary prescribing was introduced in April 2003 with the vision of reducing waiting times, improving patient care and easing the burden of doctors. However, one of the barriers to fully utilizing supplementary prescribing is the time required to create a clinical management plan. With this in mind, in July 2004 Ealing PCT sought to create a template to use with IT clinical systems, in particular with the EMIS clinical system used in general practice. This article details the ideas behind, and the development of, a computer-based CMP for Ealing PCT.
New government, but the same challenges remain
Authors: Stuttle Barbara
Published: May 2014

Don't the months fly by. Since the last issue of Nurse Prescribing there has been a general election and the appointment of a new Secretary of State for Health. This means that we can get on with business rather than speculating about which party would be in and what would happen to health services.
The importance of reflective practice for nurse prescribers
Authors: Fowler John
Published: May 2014

This paper explores the interconnections between experiential learning, refection, single and double loop learning and expert practice, within the context of nurse prescribing. It provides a solid theoretical rationale that establishes the need for experienced and expert nurses to continue to reflect upon their practice as they develop new ways of working.
Medication review: the role of nurse prescribers and community matrons
Authors: Banning Maggi
Published: May 2014

Medication review is one aspect of medication management and is used to assess older people and their medicines, and to assess health and social care needs. This article aims to explore the concept of medication review, the single assessment process, the educational preparation of the community matron’s role and their impact in medication review, and the future direction of supplementary nurse prescribing.
Promoting concordance: the implications for prescribers
Authors: Cheesman Sarah
Published: May 2014

Up to 50% of patients fail to take their medicine correctly and, in addition to this, over £230 million worth of medicines are returned to pharmacies each year for disposal. This article offers an overview of how, through promoting concordance, the prescriber can enhance patients’ knowledge and understanding of their medicines and empower them to make the best possible use of their medication.
A judicious way forward
Authors: Novak Barbara
Published: May 2014

As we adopt a new perspective on independent non-medical prescribing, we should reflect on how best to prepare experienced nurses for this challenging role. Cautious but critical deliberations are vital if the growing demands on nurses are to be rationalised and adapted to cope with the overwhelming advances in pharmaceutical and health care practice.
Prescribing and advising on oral contraception
Authors: Campbell Pam , Pickard Sally
Published: May 2014

Prescribing oral contraceptives is atypical because it involves prescribing to clients who are generally fit, healthy and not complaining of symptoms requiring relief. It is likely that a large number of nurse prescribers will be called on to prescribe or offer advice on these drugs. This article facilitates clear understanding of the differences between various types of ‘the Pill’ that are essential to appreciate before prescribing.
Management of chronic cough in primary care
Authors: Barnett Margaret
Published: May 2014

Chronic cough is commonly seen in primary care, which often prompts the patient to consult his/her GP or practice nurse. It is essential to consider the variety of reasons why patients may present with a troublesome chronic cough, other than smoking, and initiate the most appropriate treatment. A chronic cough, which may persist for weeks, months or even years, can have a profound affect on the patient's life, as well as a strain on relationships. It is often a symptom that may be viewed by professionals as trivial and consequently, not managed particularly well. This article considers the most common causes of a chronic cough and the steps to take to resolve the problem so the patient can regain a quality of life.
Communication skills: information giving
Authors: Timmins Fiona
Published: May 2014

In the second of three articles, the essential communication skills required by nurse prescribers are considered further. Following from paper one, wherein fundamental communication skills were addressed, this article closely examines the key skill of information giving. Considered essential to the role by both nurse prescriber and patient alike, key information areas are identified. In addition, a process approach to information giving is outlined, wherein the first step is assessment of individual patient information needs. This is followed by the planning, implementation and evaluation of information giving strategies. This will be followed in part 3 with an exploration of communication challenges that may exist, and ways to overcome these.
Covert administration of medicines to adults must be the last resort
Authors: Griffith Richard
Published: May 2014

The Mental Welfare Commission for Scotland recently reported that it found, during its inspections, that covert administration of medicines was routine practice. The commission has warned that the law demands that this type of administration is only to be used as a last resort. This article looks at the legal and professional obligations on the nurse prescriber when they consider the use of covert medicines.
Therapeutic management of erectile dysfunction
Authors: McCoid John Dougan
Published: May 2014

ED is a common and treatable condition which can have serious implications for the patient's quality of life. There is an array of risk factors, from lifestyle factors such as smoking and alcohol to relationship issues and depression. It has a devastating impact on the patient both physically and psychologically, causing them to experience anxiety, and a loss of confidence and self-esteem. However, there is now a range of treatment options available, including PDE5 inhibitors which are less invasive than other treatments and acceptable to both the patient and their partner.
Pharmacology update: Factfile on statins
Authors: Ali Omar
Published: May 2014

Cholesterol targets never cease to stray far from the limelight and the use of statins is increasing year on year. This is the first of a two-part contemporary synopsis on statin prescribing that is aimed at nurse prescribers, but is also useful for those working in the field of cardiology, diabetes and general medicine.
HPV vaccines: life savers or ‘green lights’ for promiscuity?
Authors: O’Connell Nicola
Published: May 2014

The development of new vaccines that protect against the human papillomavirus virus (HPV) has led to plenty of excitement among the medical profession – and some less enthusiastic response among certain right-wing groups. Excitement has surrounded a vaccine that could prevent a cancer, but there has been a degree of moral and political backlash.
Personal reflections on non-medical prescribing in substance misuse
Authors: Harniman Beverley
Published: May 2014

Prescribing interventions have an important role in the care offered to substance misusing clients, and treating drug users within a primary care setting is becoming increasingly accepted as normal practice. More GPs are being trained in substance misuse management and prescribing, often within a Locally Enhanced Service framework. However few nurses have so far grasped the opportunities and challenges provided by non medical prescribing within this field. In this article, Beverley Harniman, one of the first nurse prescribers in the country to prescribe controlled drugs under supplementary prescribing arrangements, reflects on her experiences over the past 2 years in the field of substance misuse.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

I have been offered a job as a manager working for a private nursing home and will no longer be working for the local PCT. I know the nursing home well and have visited them and prescribed for the residents because I have been working with the GP practice linked to the home. Can I still prescribe as a nurse independent prescriber?
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

I am thinking of undertaking the nurse independent prescribing training and am unsure about being tested for numeracy. Please would you advise me how exactly to go about submitting my application and also advise on what the University will test.
International Diabetes Federation announces new care guidelines
Authors: Hill Rosalind
Published: May 2014

Over 2 million people in the UK have diabetes and it is estimated that another 750 000 people have the disease but are unaware (Diabetes UK, 2006). With statistics such as these, but on a global scale, the International Diabetes Federation (IDF) has announced new guidelines for diabetes care.
Liability for spreading sexually transmitted disease
Authors: Griffith Richard
Published: May 2014

In the second of a series of articles for nurse prescribers working in sexual health, Richard Griffith considers the development of the offence of biological grievous bodily harm that imposes criminal liability for recklessly spreading sexual infection.
Resurgence of nitrofurantoin in urinary tract infections
Authors: Greener Mark
Published: May 2014

Uncomplicated urinary tract infections (UTIs) are common, often unpleasant and, occasionally, cause serious complications. Escherichia coli causes more than three-quarters of UTIs and the HPA advocates trimethoprim or modified-release nitrofurantoin as first-line empirical treatment for uncomplicated cases. However, high levels of resistance to trimethoprim may hinder its empirical use. Despite being used for half a century, nitrofurantoin resistance does not seem to be increasing. Used as a first-line empirical treatment for uncomplicated UTIs, nitrofurantoin often produces cure rates in excess of 90% and is generally well tolerated.
Research and development round-up: October 2008
Authors: O'Connell Nicola
Published: May 2014

Results of the REFLEX study, presented at the American College of Rheumatology Annual Scientific Meeting, show that the number of people with rheumatoid arthritis (RA) achieving clinical remission from their disease doubled over three successive treatment courses with rituximab (MabThera) when used in combination with methotrexate (from 8.8% achieving clinical remission after the first course to 17.6% after the third course).
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

If you are an independent prescriber, can you still use patient group directions (PGDs)?
Research and development round-up: January 2008
Authors: O'Connell Nicola
Published: May 2014

Statin therapy reduces the risk of major vascular events in a wide range of individuals with diabetes, irrespective of whether they already have cardiovascular disease, and regardless of age, sex, and other clinical characteristics. As such, most people with diabetes should now be considered for statin therapy, according to an article in The Lancet.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

I would like your views on nurses signing prescriptions for nurses. I have discussed this with other nurse prescribers and this is something that we have developed over the last 12 months. I was taught not to do this during the prescribing training, but I have recognized that it fits with the main aims of access to medicines for patients, relieving GPs of their workload and helping nurses get on with their patients by having to wait for the GP signature. It makes sense, and it is proving to help with the smooth running of the treatment room. I use a risk assessment approach which includes the nurse's knowledge skills, experience and use of protocols and guidelines. I consult with the nurse on many prescriptions required around diagnosis and management but with certain conditions such as urinary tract infections or regular Pill check I am signing other nurses' prescriptions— mostly with two of my nurses who are educated to level 3 in certain modules.
A spring in your step
Authors: Otway Christine
Published: May 2014

If, like me, you are delighted to see the first signs of Spring, you will no doubt be looking to get outside more than you have for the last few weeks; but before you do, don't file this issue away on the shelf until you have read it!
Smoking cessation: the ongoing challenge
Authors: O'Connell Nicola
Published: May 2014

Once again, the UK's 12 million smokers were asked to stub out their cigarettes and refrain from their habit on No Smoking Day, held on 12 March this year.
Calcium channel blockers: uses and prescribing rationale
Authors: Salama Rasha
Published: May 2014

Calcium channel blockers are commonly prescribed for patients suffering from hypertension and angina. They are included in the most recent National Institute for Health and Clinical Excellence (NICE) guidelines (2006) for managing hypertension. They are also used with beta-blockers and nitrates in the management of angina. Specific drugs in this group, e.g. verapamil and nimodipine, have additional clinical uses. This article provides an overview of the mode of action of these medicines, adverse effects, drug interactions and patient contraindications for their clinical use. It will touch on the clinical roles of these medicines. and aims to provide essential information for health professionals prescribing these medicines and for those who can prescribe for patients who are taking these medicines.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

I am an independent nurse prescriber working in primary care as a practice nurse. I would like your advice on the legalities surrounding travel immunizations for nurse prescribers.
Public policy implementation of nurse prescribing
Authors: Camp Jane
Published: May 2014

The public policy and legislation for nurse independent prescribing intends to make it easier for patients to get the medicines they need and to make better use of health professionals' time and skills. This legislation was introduced in 1994 and has been enhanced with additional legislation introduced in 2006 allowing nurses to prescribe from the full British National Formulary (BNF) including a limited list of controlled drugs for specific conditions. Nurse prescribing is a development of the nurses' role that has been long awaited and supported by the Royal College of Nursing. This article will review the process of implementation of the policy and legislation from a Scottish perspective. The difficulties of providing the evidence on which the policy is based are described along with the evaluation of its impact on NHS services and staff. This is a policy that affects the underlying way in which nurses work and presents opportunities for different ways of working to improve patient care.
Assessing decision-making capacity: children under 16
Authors: Griffith Richard
Published: May 2014

Consent is a fundamental element of the lawfulness of treatment. It upholds the principle of autonomy and a person's right to decide whether or not to have treatment. This right to decide presupposes an ability to make decisions. Decision making capacity is the key to a person's autonomy and it is essential that nurse prescribers are able to assess whether the patients in their care have the necessary capacity to make decisions about their care and treatment. This article considers the test for decision making capacity for children younger than 16 years of age.
Research and development round-up: May 2008
Authors: O'Connell Nicola
Published: May 2014

Obesity may increase adults' risk of having dementia, according to a new analysis of published obesity and dementia prospective follow-up studies over the past two decades, which shows a consistent relationship between the two diseases.
Introducing public health to prescribing practice
Authors: Nuttall Dilyse
Published: May 2014

Public health is an issue continually on the UK Government agenda and one in which, it is anticipated, all health professionals will participate. Although historically a very specialist role, public health requires a multi-level, collaborative approach in order to achieve national and local targets. Nonmedical prescribers are often in an ideal position to develop their role in public health activity.
Cough medicines: actions, uses and prescribing rationale
Authors: Waterfield Jon
Published: May 2014

This article provides an overview of the different types of cough medicine. There is a consideration of the mechanism of action of each group and the evidence base for the use of cough medicines. The use of cough medicines in children is highlighted as guidelines in this area have recently changed. The prescriber is reminded of some common prescribing issues relating to this group of medicines.
Dementia: symptoms, diagnosis and management
Authors: Salama Rasha
Published: May 2014

This article provides an overview of dementia. It looks at the incidence of dementia, the three main types of this condition and the suggested clinical management guidelines for Alzheimer's disease dementia, with specific focus on the main pharmacological approach to this condition. The management is discussed with specific reference to the National Institute of Health and Clinical Excellence (NICE) guidelines released in 2006 with regards to Alzheimer's disease dementia.
Combating antibiotic resistance in urinary tract infection
Authors: Nazarko Linda
Published: May 2014

Antibiotics revolutionized health care in the 20th century; however, growing antibiotic resistance threatens to undermine their usefulness. Most antibiotics are prescribed in primary care and urinary tract infection is the most common infection in general practice. Many evidence-based guidelines focus on the selection and duration of antibiotic therapy to treat urinary tract infection, and there is less emphasis of clinical diagnosis. This article addresses diagnosis and treatment of urinary tract infection and how prescribers can contribute to reducing the rise of antibiotic resistance.