bluuebunny/crossref_metadata_2025 huggingface dataset:
2008: a year of change and stability
Authors: Pollard Tom
Published: May 2014

Following MA Healthcare’s acquisition of JWC in 2007, we have been looking hard at what, if anything, we need to change or improve. Overall, the conclusion has been ‘very little’. This was confirmed by our recent readership survey, which indicated a very high level of satisfaction with the Journal.
Dressings used in epidermolysis bullosa blister wounds: a review
Authors: Ly L. , Su J.C.
Published: May 2014

There is little rigorous evidence on the management of epidermolysis bullosa, so management is based on the patient’s and clinician’s preferences. However, there is a consensus that advanced dressings help promote healing and reduce pain
Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds
Authors: Stansby G. , Wealleans V. , Wilson L. , Morrow D. , Gooday C. , Dhatariya K.
Published: May 2014

Objective:

The primary aim of this pilot observational study was to assess the reduction in wound depth and area achieved with a new negative pressure wound therapy (NPWT) system in diabetic patients with foot ulcers and post-amputation wounds. Secondary aims were to assess pain levels, extent of exudate removal, and ease of use of the system for both the patient and care giver.

Method:

Patients in both acute and home care settings were enrolled into this 4-week study. Dressings were changed three times per week. Wound area and depth, exudate removal and pain severity were evaluated at each dressing change. At the final visit, the investigators and patients were surveyed with respect to equipment and dressings used in the study.

Results:

Sixteen patients were enrolled into the study. Data relating to 14 patients with a variety of post-amputation wounds were included in the intention-to-treat (ITT) analysis. The post-amputation wounds showed a general trend for a reduction in the median wound surface area between baseline (22.9cm2; range 0.5-55) and the final visit (15.3cm2; range 2.4-63.5). This equates to a median change (calculated from the percentage change in wound area for each patient individually) of -41% (range -82% to +15%). There was also a general trend in reduction in the median depth between baseline (17mm; range 0-35) to final visit (5mm; range 0-35). One patient presented with a foot ulcer that demonstrated a 50% reduction in depth from baseline to the final assessment. The device effectively managed wound exudate and most patients reported low pain levels during therapy. Ease of use of the system was rated very highly by investigators and patients.

Conclusion:

This pilot study indicates that the use of the new NPWT system can be expected to have a positive effect on the healing of post-amputation wounds and foot ulcers in patients with diabetes. The findings demonstrate that the system is easy to use, effectively controls exudate and minimises pain and inconvenience for patients being treated with NPWT.

Declaration of interest:

This study was sponsored by Mölnlycke Heath Care (Gothenburg, Sweden) and Medela AG (Baar, Switzerland). The authors have no other conflicts of interest that are directly relevant to the content of this manuscript.
Escaping from the silo?
Authors: Pollard Tom
Published: May 2014

On 22 January, I was privileged to attend the inaugural lecture by the UK’s (and as far as I can tell, the world’s) first Professor of Tissue Viability, Richard White. Academic gowns and mortar boards aside, it was a relatively low-key affair, but was thoroughly enjoyable and notable for several reasons.
Use of an ionic sheet hydrogel dressing on fungating wounds: two case studies
Authors: Maund M.
Published: May 2014

Two patients with terminal cancer presented with painful, highly exuding and intensely malodorous wounds. In both cases, use of an ionic hydrogel controlled the malodour, absorbed the exudate and reduced pain, improving quality of life
Topical negative pressure therapy for para-ileostomal ulceration in a patient with Behçet’s disease
Authors: Ohura N. , Okazaki M. , Tanba M. , Kinoshita M. , Takushima A. , Harii K.
Published: May 2014

Behçet’s disease is a chronic, relapsing, inflammatory disorder. This case report describes how use of an improvised topical negative pressure (TNP) device in a patient with a non-healing para-ileostomal ulcer with Behçet’s disease
A new vision for wound healing
Authors: Pollard Tom
Published: May 2014

While there can be no questioning the passion and enthusiasm of the people engaged in delivering and researching tissue viability, few of them could honestly claim that it is a hugely dynamic field of clinical practice. So it is rare for me to read an article that offers the possibility of a significant shift in our whole approach to wound healing. The paper by Wolcott and Rhoads in this issue is one of these.
Letters
Authors: Zolghadrasli Ali Asghar , Zolghadrasli Abdolali
Published: May 2014

Pressure ulcers are complex chronic wounds for which no gold standard treatment has yet been established, although guidelines have been developed. At present, treatment involves assessment, reduction of pressure, friction and shear forces, optimising local wound care, debridement of necrotic tissue, managing bacterial contamination and correcting nutritional deficits.1 In addition, electrical stimulation, ultraviolet irradiation and local ointments including silver sulphadiazine, neomycin, polymixin and phenytoin have been applied, with varying results.
Home surveillance of leaking wounds after hip and knee arthroplasty: a prospective audit
Authors: Yousef A. , Angadi D. S , Nagare U. , Raymond C.
Published: May 2014

Leaking postoperative wound is a frequent finding after hip and knee arthroplasty. A prospective audit was undertaken to evaluate the feasibility and effectiveness of surveillance of leaking wounds at patients’ homes by trained orthopaedic nurses
Neovascularisation in wound healing
Authors: Stavrou D.
Published: May 2014

Through the process of angiogenesis, vasculogenesis or arteriogenesis, the vascular network regenerates and viable tissue fills the wound bed. Research has attempted to determine how this knowledge can be applied into the clinical setting
The evidence debate gains strength
Authors: Cowan Tracy
Published: May 2014

The debate on what constitutes suitable evidence for practice is gathering momentum. In the May issue of JWC, Keith Cutting asked whether high-level evidence from randomised controlled trials (RCTs) should dictate clinical practice or support it. On page 366 in this issue, Randy Wolcott takes this a step further by suggesting that the increasing demands being placed on tissue viability services require an innovative and bold approach that cannot be met by reference to RCT results alone.
Speculating to accumulate: reducing the cost of wound care by appropriate dressing selection
Authors: Hamilton C.
Published: May 2014

The key determinants of wound-care costs are well known. When undertaking local audits, practitioners are advised to collect data against each of these determinants and then use them to formulate cost-effective dressing formularies
Prophylactic antibiotics for clean, non-implant plastic surgery: what is the evidence?
Authors: Tadiparthi S.
Published: May 2014

Use of prophylactic antibiotics in clean surgery is widespread, but their timing and selection is often based on convention and personal and local departmental preferences. There is insufficient robust evidence on which to base such decisions
An 18th century account of the treatment of burns and acute wounds that is still relevant today
Authors: Thomas S.
Published: May 2014

In 1766, a French physician wrote a treatise on wound management. Despite the lack of knowledge on physiology of wound healing and causes of infection, much of the clinical advice given in the text still holds true today
Patient and observer scar assessment scale: how good is it?
Authors: Stavrou D. , Haik J. , Weissman O. , Goldan O. , Tessone A. , Winkler E.
Published: May 2014

This is the only scar assessment tool to include a component for patients to fill in. The few studies that investigated the effectiveness of this scale have found that it is a reliable, valid and feasible tool that is well suited for everyday practice
Negative pressure dressings for severe hidradenitis suppurativa (acne inversa): a case report
Authors: Walls B. , Mohammad S. , Campbell J. , Archer L. , Beale J.
Published: May 2014

Hidradenitis suppurativa (HS) is a frustrating disease to treat for both the patient and the practitioner. In severe cases, aggressive management will often have a more tolerable outcome. We present the case of a 46-year-old gentleman with a long-standing history of severe HS, who was treated successfully with wide surgical excision, followed by a full-thickness skin graft and negative pressure wound therapy (both pre- and post-operatively). A review of the literature revealed few reports of HS treatment using these sequential steps
Pilonidal sinus disease: a review. Part one
Authors: Bradley L.
Published: May 2014

This article is in two parts. The overall aim is to review the literature relating to the management of pilonidal sinus disease and to explore the impact the disease has on those who suffer with it, predominantly young people. Part one reviews the literature and provides the rationale for the study design. Part two will detail the study and outline implications for practice. In addition to stimulating debate of the pathophysiology of pilonidal sinus disease and its surgical management, most importantly, this study is designed to increase understanding of the impact the disease has on young people and the professional lessons that can be learned to support those who live with it over many months and sometimes years.
CONSORT 2010 statement: updated guidelines can improve wound care
Authors: Weller C. , McNeil J.
Published: May 2014

There is a growing need to add to the evidence base in wound care. Randomised controlled trials (RCTs) are one methodological approach for this. The CONSORT statement, which provides guidance on how to conduct a rigorous RCT, was updated earlier this year. Implementation of the Consort statement will clarify to the reader what exactly was done in the RCT, to whom and when. In this way, practitioners and health-care providers can determine its validity. The Consort statement has the potential to play a crucial role in influencing the quality of research and clinical practice, and so to improve wound care. The benefits of Consort 2010 are clear; the challenge is for clinicians and researchers to use it
Flammacrium in the formation and stabilisation of eschar in chronic wounds
Authors: Signe-Picard C. , Cerdan M-I. , Naggara C. , Trial C. , Téot L.
Published: May 2014

Objective

To determine the effectiveness of Flammacérium, a topical treatment used in the treatment of burns, in the stabilisation of necrosis in non-healing wounds. The therapy is designed to prevent the risk of infection, stop necrosis from spreading and improve the patient's quality of life.

Method

This retrospective survey involved patients with necrotic, non-healing wounds who had been treated with Flammacérium. In all cases, debridement was contraindicated. Available data on wound evolution were collected.

Results

Ninety-nine patient files were analysed and the wound aetiologies included in the survey were classified as arterial (n=42), malignant (n=5), pressure ulcers (n=30), traumatic wounds (n=10) and other wounds (n=12). The formation of a leather-like eschar induced by topical use of Flammacérium improved pain management, decreased exudate levels and malodour, and had a positive effect on quality of life, increasing patient comfort, participation in social activity and psychological wellbeing. Following application of the cream, an eschar develops that strongly adheres to wound edges. By preventing the necrosis from spreading, this gave the practitioners more time to prepare for subsequent treatment, including skin grafting.

Conclusion

Flammacérium seems to be effective in the stabilisation of necrosis in non-healing wounds in which debridement is contraindicated. However, this study is limited by its retrospective nature. A prospective study will hopefully confirm and strengthen these results.

Conflict of interest

None
The Leg Club model: a survey of staff and members' perceptions of this model of care
Authors: Stephen-Haynes J.
Published: May 2014

Objective

To determine the Leg Club members' perceptions of the Leg Club as a model for delivery of service.

Method

An explorative qualitative approach was used. All members and staff at two Leg Clubs in the UK were invited to participate. They were asked to nominate five key words that described their views of the Leg Club model of care. The researcher and a research supervisor then counted them and decided on categories. Members' themes were verified by 10 randomly chosen Leg Club members and staff themes by five randomly chosen staff.

Results

All of the 85 Leg Club members and 15 staff approached agreed to take part. Categories identified for the Leg Club members were: sociability, enabling, knowledge and experience, interpersonal relationships, caring and quality. Categories identified for Leg Club staff were: camaraderie, education, empowerment, sociability and tiredness.

Conclusion

These results indicate that the community Leg Club environment provides benefits in addition to those of guidelines, wound care expertise and evidence-based care. While the small sample size limits the generalisability of these exploratory data, the results identify the positive views of Leg Club members and highlights the need for further research. Similar data is not available for other health care delivery methods, so this also warrants further exploration.

Conflict of interest

This study was unsupported by any commercial sponsorship but was supported by Leg Club and Leg Club Life President, Mrs Ellie Lindsay.
Management of a complex wound in a person with spinal cord injury and mental illness
Authors: Phillips C. , Procter N.
Published: May 2014

This paper highlights the important nexus between physical and mental health by examining a case concerning a patient with a lower spinal cord injury andmental illness who subsequently developed two pressure ulcers. It examines how clinicians can benefit from looking beyond typical assumptions when caring for an individual with complex needs in the community setting. In such circumstances, the need for a holistic and collaborative approach to wound care is vital. This involves taking into account the individual's mental health care needs, which can be overlooked in the first instance. Recommendations for clinical practice centre on involving the patient in his or her dietary, psychological and physical care, thereby helping to build resilience to any mental health problems and promoting a positive physical recovery
Moist wound healing, exudate and management of the wound bed
Authors: Butcher Martyn
Published: May 2014

This paper reviews the current state of thinking and evidence on moist wound healing, and presents a new wound dressing technology that enables the purported ‘optimum’ moist environment to be maintained without risk of desiccation or maceration
A comparison of the antimicrobial efficacy of two silver-containing wound dressings on burn wound isolates
Authors: Thomas J.G. , Slone W. , Linton S. , Corum L. , Okel T. , Percival S.L.
Published: May 2014

Objective:

To evaluate and compare the efficacy of a silver alginate (SA) dressing and a silver carboxymethyl cellulose (SCMC) dressing on burn isolates grown within the quasi/non-biofilm state and the biofilm phenotypic states.

Method:

Antimicrobial activity was tested using 46 burn wound isolates with a corrected zone of inhibition (CZOI) assay on agar (quasi/non-biofilm) and poloxamer (biofilm).

Results:

All Gram-negative and positive isolates evaluated were found to be sensitive to both silver containing wound dressings, although superior antimicrobial activity was observed for a select number of specific bacteria when grown in the quasi/non-biofilm phenotypic state, for the SCMC dressing. However, the majority of isolates demonstrated reduced sensitivity to silver when grown as a biofilm, compared with growth in the quasi/non-biofilm phenotypic state. both dressings demonstrated equivalent antimicrobial activity on Gram-negative isolates grown in the biofilm phenotypic state. For the Gram-positive isolates growing in the biofilm phenotypic state, there appeared to be greater sensitivity to the SA dressing compared with the SCMC dressing, although this result was not statistically significant.

Conclusion:

This study demonstrated the antimicrobial effectiveness of an SA and SCMC dressing in inhibiting the growth of burn isolates residing in both the quasi/non-biofilm and biofilm phenotypic states. It also suggests the SA dressing could be more effective on Gram-positive isolates grown in the biofilm phenotypic state, compared with SCMC dressing.

Declaration of interest:

This research was supported by a grant provided by Advanced medical Solutions ltd.
An exploration of nursing documentation of pressure ulcer care in an acute setting in Ireland
Authors: Jordan O'Brien J.A. , Cowman S.
Published: May 2014

Objective: To explore the nature and quality of documented care planning for pressure ulcers in a large teaching hospital in the Republic of Ireland. Method: A mixed method design was used; this encompassed a descriptive survey that retrospectively evaluated nursing records (n=85) in two wards (orthopaedic and care of the older adult) and a focus group (n=13) that explored nurses' perspectives of the factors infuencing concordance and the quality of nursing documentation. only records of at-risk patients (Waterlow score of >10) were included. Results: It was identified that 47% (n=40) were assessed as at high or very high risk of developing a pressure ulcer. Fifty-two patients (61%) had a weekly risk assessment, but 25% (n=21) had only one follow-up assessment. only 45% (n=38) of charts had some evidence of documented care planning, and of those 53% (n=20) had no evidence of implementation of the care plan and 66% (n=25) had no evidence of outcome evaluation. only 48% (n=41) of this at-risk population was nutritionally assessed. of patients admitted with and without a pressure ulcer, there was no record of regular positioning in 70% (n=59) and 60% (n=51) respectively. Conclusion: Documentation on pressure ulcer care is not standardised and requires development. Conflict of interest: None.
Molecular diagnostics and personalised medicine in wound care: assessment of outcomes
Authors: Dowd S.E. , Wolcott R.D. , Kennedy J. , Jones C. , Cox S.B.
Published: May 2014

Objective: This large, level a, retrospective cohort study set out to compare healing outcomes in three large cohorts of wound patients managed universally for bioburden: standard of care group, who were prescribed systemic antibiotics on the basis of empiric and traditional culture-based methodologies; treatment group 1, who were prescribed an improved selection of systemic antibiotics based on the results of molecular diagnostics; treatment group 2 who received personalised topical therapeutics (including antibiotics) based on the results of molecular diagnostics. Method: apart from the differences in diagnostic methods and antibiotic treatments described above, all three cohorts were subjected to the same biofilm-based wound care protocol, which included evaluation of the host and bioburden, frequent sharp debridement, use of wound dressings and comprehensive standard care (reperfusion therapy, nutritional support, offoading, compression and management of comorbidities). Results: In all, 1378 patients were recruited into the study. In the standard of care group 48.5% of patients (244/503) healed completely during the 7-month study period. This increased to 62.4% (298/479) in treatment group 1 and 90.4% (358/396) in treatment group 2. Cox proportional hazards analysis revealed the time to complete closure decreased by 26% in treatment group 1 (p<0.001) and 45.9% in treatment group 2 (p<0.001) compared with the standard of care group. Patients in treatment group 2 had >200% better odds of healing at any given time point compared with the other cohorts. Conclusion: Implementation of personalised topical therapeutics guided by molecular diagnosis resulted in statistically and clinically significant improvements in outcome. The integration of molecular diagnostics and personalised medicine provides a directed and targeted approach to wound care. Conflict of interest: SED and RDW are owners of PathoGenius laboratories, a clinical diagnostic laboratory. SED and RDW are owners of Research and Testing laboratory, which develops molecular diagnostics. CJ and JK are clinical advisors for PathoGenius. CJ and JK are owners of Southeastern medical Compounding, Savannah, Ga and Southeastern medical Technologies, Savannah, Ga.
Connexins, a new target in wound treatment
Authors: Chin K.Y
Published: May 2014

Wound healing is a complex process requiring interaction between different cell types, each playing their part within the four main phases of wound healing. This process requires careful regulation, with communication between the different cell types via gap junction channels, which allow the passage of small molecules, including ions and second messengers, between cells. Gap junction protein (connexin) expression changes with the different stages of wound healing, playing important roles in regulating the process. The field of research looking into intercellular communication via gap junctions in skin and wound healing has shown encouraging results in experimental studies. As further developments and clinical studies are being carried out, practitioners should be introduced to this field, as a promising new wound treatment is currently in clinical trials. This paper aims to introduce practitioners to this field of study with a review of current available literature.
The psychological impact of split-thickness skin grafts
Authors: Hansen E.L.E. , Clarke A. , Austin-Parsons N. , Butler P.E.M.
Published: May 2014

Objective:

To measure the psychological distress associated with a split-thickness skin graft (STSG).

Method:

A retrospective postal questionnaire survey of 102 patients who had undergone a STSG procedure within the last 3.5 years. Outcome measures included the Hospital Anxiety and Depression Scale (HADS), Derriford Appearance Scale (DAS-59) and subjective ratings scales (SRS) of noticeability and worry about the grafted and donor area.

Results:

Scores on the SRS correlated positively with HADS and DAS-59 scores. Rates of anxiety were higher than depression (19% vs 13%, respectively). Greater than 10% of the sample experienced significant appearance-related distress when compared to standardised test norms. Concerns about the grafted area were higher than for the donor site, but those concerned about the graft were also likely to be concerned about the donor area. Age (< 60 years) and reason for surgery (trauma as opposed to cancer) were associated with significantly higher scores on appearance measures.

Conclusion:

STSG is not associated with high levels of psychological distress. However, there is a small but significant minority who experience appearance-related distress, low mood and anxiety who would benefit from targeted psychological intervention. Demographic factors, such as age or gender, and length of time since surgery, are not useful discriminators in identifying vulnerable individuals. Simple SRS of visibility and worry correlate significantly with standardised psychosocial measures. These can be used as a short and effective screening tool to identify individuals who would benefit from postoperative psychological input.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
The psychological wellbeing of patients following excision of a pilonidal sinus
Authors: Stewart A.M. , Baker J.D. , Elliott D.
Published: May 2014

• Objective:

To explore the effects of a pilonidal sinus wound on patients' psychological wellbeing.

• Method:

An interpretive descriptive approach, using the Model of Living conceptual framework, guided data collection and analysis. The Model of Living was chosen to elicit information on how a pilonidal sinus wound affected activities of living. Participants were recruited from a database of a community nursing service, using purposive sampling, until data saturation was evident. Semi-structured interviews were used to collect the data. Data were examined for frequent patterns, which were organised into themes.

• Results:

Seven males and four females with ages ranging 17–39 years were selected through purposive sampling. Five participants reported that their wound affected their psychological wellbeing. Three themes and eight subthemes were identified from the data: adaption, perception and control. Depression and stress were associated with pain, physical inactivity, body weight changes and delayed wound healing.

• Conclusion:

A pilonidal sinus wound can affect the psychological wellbeing of patients through pain, physical inactivity, changed body weight and delayed wound healing. Pre-existing conditions could also be exacerbated by the wound.

• Declaration of interest:

The study was part of the requirement of a Master of Nursing, and a scholarship of $2000 was granted by Regal Health Services to assist with the study. The authors have no conflicts of interest to declare.
An introduction to the biopsychosocial complexities of managing wound pain
Authors: Richardson C.
Published: May 2014

Using the Manchester pain management model (PAIN), this review discusses the care of acute and chronic wounds, focussing on the particular skills required to manage pain associated with different types of wounds, and addressing the important area of dressing change. Acute and chronic wounds can be associated with either acute or chronic pain, making management of wound pain a significant challenge. Pain can be of either nociceptive or neuropathic origin, and the longer it has been present, the more likely that psychological, social or cultural determinants influence the reactions seen in the patient. Understanding the biopsychosocial and cultural elements of pain enables the practitioner to prepare, assess, intervene and normalise effectively, during all aspects of wound care management. Utilising individualised evidence-based practice is essential to ensure that high-quality care is delivered in this key area.
Review of emergency department wound management in soft tissue trauma — is there a plan?
Authors: Jones A.P. , Barnard A.R. , Allison K. , Wright H.
Published: May 2014

Objective:

To assess current acute wound management in English emergency departments.

Method:

All English emergency departments including minor injury units (n=207) were successfully contacted and a telephone questionnaire was completed. This considered wound treatment policy; management including cleansing, analgesia, dressing selection, suturing, referral patterns, medical photography and antibiotic use.

Results:

There was a 100% response. Only 40% of departments had a wound treatment policy. Most had implemented staff training, however the nature and timing of this was variable. Wound cleansing was performed by all departments. Most administered analgesia. Suturing was selectively performed by all departments. There was great diversity regarding dressing selection. The most common reasons for referral to specialist units were the complexity of injury and cosmetically sensitive areas. Photographs were regularly taken in one third of units questioned.

Conclusion:

This study confirmed an absence of a standard protocol for early soft tissue wound management in the emergency department setting. Key areas that could be improved are dressing simplification, more defined referral criteria and introduction of standardised protocols with structured teaching programmes. We propose a simple approach to management of acute soft tissue wounds that can be applied to most situations.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Modulation of cutaneous wound healing by silymarin in rats
Authors: Oryan A. , Naeini A. Tabatabaei , Moshiri A. , Mohammadalipour A. , Tabandeh M.R.
Published: May 2014

Objective:

To investigate the effect of topical application of silymarin on full-thickness cutaneous wounds in rats.

Method:

A full-thickness cutaneous defect (2×2cm) was induced on the back of 85 male and female Wister rats. The animals were randomly divided into four groups (n=20 in each group), treated with 1ml basal cream (placebo group), low-dose (6mg/ml/rat) and high-dose (12mg/ml/rat) silymarin, and untreated (control). Five rats remained uninjured to serve as comparisons for biomechanical analysis. Wounds were evaluated 10, 20 and 30 days after injury, through histopathologic, biochemical and biomechanical analyses.

Results:

There was a significant (p < 0.05) increase observed in the amount of glycosaminoglycans and collagen present on days 10, 20 and 30 for both low-dose and high-dose silymarin groups. Low-dose silymarin reduced the number of lymphocytes and enhanced the number of fibrocytes at the earlier stages of wound healing; however, high-dose silymarin reduced both lymphocytes and macrophages, and increased number of fibrocytes at the later stages of wound healing. Silymarin significantly improved alignment of the healing tissue, enhanced maturity of the collagen fibres and fibroblasts (p < 0,05), and increased the ultimate tensile strength and stress of the healing tissue.

Conclusion:

The results suggest that topical application of silymarin improved the morphological, biochemical and biomechanical properties of experimentally-induced wound defects in rats.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Melanoma arising in chronic ulceration associated with lymphoedema
Authors: Turk B.G. , Bozkurt A. , Yaman B. , Ozdemir F. , Unal I.
Published: May 2014

Chronic ulceration can be complicated by development of a malignancy. The most frequent associated malignances are squamous cell carcinoma and basal cell carcinoma, although melanoma, leiomyosarcoma and adenocarcinoma are less commonly seen. Chronic lymphoedema may also predispose to development of some malignancies, including lymphangiosarcoma, squamous cell carcinoma and Kaposi's sarcoma. Here, we report the case of a 77-year-old man with primary lymphoedema, who developed melanoma in a chronic foot ulcer of 60 years' duration. The patient underwent wide excision for the melanoma, and remains free from metastases at 1-year follow up.
Use of 3D photography in complex-wound assessment
Authors: Savage J.M. , Jeffery S.L.A.
Published: May 2014

Objective:

To review the evidence to support three-dimensional (3D) photographic imaging in wound care and undertake a feasibility evaluation of one device in the clinical environment.

Method:

A literature review was undertaken of the role of stereophotogrammetry in wound care. Subsequently, a 3D imaging and data storage system was selected and evaluated in two representative case studies within the clinical environment of the Royal Centre for Defence Medicine.

Results:

The review suggested that 3D imaging has the potential to provide more accurate data on which to base treatment decisions. In practice, the device was found to be relatively easy to operate and sufficiently robust to handle the demands of clinical practice. However, the high initial cost of the unit and the time taken to download images to the database meant that its benefits were limited to more complex wound types.

Conclusion:

Three-dimensional photography has the potential to play a role in management options; however, current technical issues limit its potential and the incorporation of a highly defined image (similar to that of a standard digital 2D photograph) within its 3D representation would make it more powerful.

Declaration of interest:

Access to the digital imaging device and user software was provided by Eykona Medical Ltd. The company had no influence over the evaluation process or the content of this paper. The authors have no additional conflicts of interest to declare.
Why we need the Journal of Paramedic Practice
Authors: Furber Roland
Published: May 2014

Roland Furber reflects on the evolution of the paramedic profession and the place of this journal in the wider picture of professional development and self-regulation
The gum elastic bougie: One of anaesthesia's best-kept secrets
Authors: Hinds John D , Michalek Pavel
Published: May 2014

Recent guidelines for paramedic intubation have been published by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) (2008). One important recommendation for paramedic intubation is that: ‘When prehospital tracheal intubation is undertaken, a gum elastic bougie should be available routinely’.

Despite this, the bougie has not been universally available among ambulance services in the UK—up to a third do not include the bougie as part of their airway management strategy.

We aim to introduce the bougie, provide information on its use, advantages and pitfalls, and provide some tips as to how to get the most out of this invaluable device in clinical practice.
ALSG: continuing education and paramedic practice
Authors: Davis Mike , Wieteska Sue
Published: May 2014

The Advanced Life Support Group (ALSG) is a medical education charity based in Manchester. Its prime purpose is to: ‘preserve life by providing training and education to the general public and in particular but not exclusively to doctors, nurses and other members of the medical profession, in life-saving techniques’. In striving to achieve this aim, it currently offers 19 courses in the UK and in 27 other countries worldwide. Among the courses are some that are of particular interest to the paramedic community.
Recognition of life extinct and the processes of death
Authors: Shrehorn Thomas
Published: May 2014

A paramedic has the responsibility to confirm deaths within the community in which they work and there are distinct protocols to follow. They also have the responsibility to decide whether or not to carry out cardiopulmonary resuscitation on expected and unexpected deaths. The recognition of life extinct (ROLE) protocol included in the Joint Colleges Ambulance Liaison Committee Guidelines (2006) provides guidance on when, and when not, to perform cardiopulmonary resuscitation on patients but does not cover the processes occurring after death. Death is a process which occurs in stages and within certain time constraints, depending on intrinsic and extrinsic factors. This article covers the processes of death and the timelines in which they occur and aims to improve the paramedic's knowledge and ability to make sound judgements and assist with providing justifications of confirming death alongside the ROLE protocol to relatives, the police and the coroner.
Intranasal naloxone: not to be sniffed at!
Authors: Williams Julia
Published: May 2014

Treating patients with an opioid overdose is not uncommon in prehospital settings, with naloxone being the drug of choice to reverse effects of opioid toxicity.
Patient assessment: a reflective case study
Authors: Hitt Andy
Published: May 2014

The three ‘C's of physical assessment—capacity, consent and communication—could be compared to the ‘ABCs' of resuscitation; without all three you will make very little, if any, progress. But do we give these aspects the attention they deserve, especially in time critical situations? This case study is based on a 76-year-old female who presented at Accident and Emergency (A&E) with central chest pain, diarrhoea and vomiting, productive cough and pyrexia. The aims of this case study are to discuss the impact of 21st century legislation on patient assessment, demonstrate the importance of objective, structured history taken and investigate the subjective nature of physical examination. In a world of waiting lists and litigation some argue that we should let technology do the leg work—ultrasound, chest x-rays, magnetic resonance imaging (MRI) and computed tomography (CT)—why use a stethoscope?
Mentorship for paramedic practice: bridging the gap
Authors: Sibson Lynda , Mursell Ian
Published: May 2014

In the second of a series of four articles on mentorship for paramedic practice, this article focuses on the aspect of the assessment of competence and how these relate to everyday clinical practice in term of mentorship. The article will also address the concept of competence and performance and how these two concepts can be applied to bridging the theory-practice gap that can often be the cause of poor learning and subsequent inadequate clinical practice.
Complications from pre-hospital immobilisation
Authors: Biller David , Jacobson Ryan
Published: May 2014

This case report involves a 67-year-old-woman involved in a motor vehicle collision with an isolated complaint of minor hip pain. Pre-hospital personnel responding in the traditional manner quickly immobilized the patient in a cervical collar and long spine board in preparation for transport to a trauma centre. The patient developed progressively worsening respiratory distress while en route to the Emergency Department after immobilization. For unknown reasons, the patient's underlying medical conditions and deterioration were not recognized despite worsening vital signs and continued complaints of shortness of breath. She ultimately required intubation and admission to the Intensive Care Unit likely as a result of unnecessary immobilization. There is little evidence to show that routine spinal immobilization in the pre-hospital environment improves outcomes regardless of whether there is a true spinal injury or not. However, spinal immobilization has been found to cause pain, tissue injury, anxiety and decreased pulmonary function. This case report demonstrates the important role that pre-hospital providers have in deciding whether or not to immobilize a patient and that the consequences of unnecessary immobilization can be life-threatening.
From trade to profession-the professionalisation of the paramedic workforce
Authors: First Sue , Tomlins Lucy , Swinburn Andy
Published: May 2014

How do we achieve professionalisation of the paramedic? The Trait theory identifies profession as having 1. An exclusive body of knowledge 2. Self regulation and 3. Registration. Becoming a profession leads to improved remuneration and greater respect and knowledge, but this does not lead to a change in personal conduct. Professionalism however, is connected to behaviour, attitudes, accountability and responsibility. The behavioural changes and attitudes required of a ‘professional’ are brought about through the combination of higher education and clinical leadership. Academic input integrates clinical leadership with the career structure and all staff at all levels. Clinical leaders are at the coal face, accessible during and after the event, for training and clinical supervision and are therefore transforming practice at every level.However, clinical leadership is ineffective with an uneducated workforce and an uneducated workforce is ineffective without clinical leadership, thetwo go hand in hand So...

What is the way forward for the ambulance service?

What are paramedics doing to develop and maintain the profession and professional
First evaluation of CPD advanced paramedic teaching methods in Ireland
Authors: Knox Shane , Cullen Walter , Collins Niamh , Dunne Colum
Published: May 2014

Aim:

Continuing professional development (CPD) will soon be mandatory for advanced paramedics (APs) registered with Ireland’s pre-hospital regulatory body. Effective and efficient CPD methodologies are needed. We determined what type of training methods might be used to reduce associated costs while maintaining effectiveness and benefit.

Methods:

In 2010, an ‘up-skill’ programme for APs was introduced in Ireland comprising: a) self-directed learning using a purpose-designed manual; b) workbooks based on the manual and clinical practice guidelines; c) small group practical sessions with discussion-based skill stations; and c) practical scenario-based assessment. Participants were invited to complete a web-based survey assessing a) short-term effectiveness, b) medium-term effectiveness, and c) user friendliness of the educational modalities. The preferred learning styles and respondents’ perceptions of outcome were determined.

Results:

Overall 49 % of participants responded. Of those eligible, 73 % believed that practical learning encouraged knowledge retention and skills in the immediate and medium-term, 82 % believed practical learning influenced patient care immediately, while 75 % stated that it influenced patient care six months later. All respondents agreed that practical learning was important, with 90 % stating that it was enjoyable. Overall, 80 % found the provided manual accessible, while >40 % believed that the manual alone did not provide all necessary information, 77 % had referenced it since completing the programme.

Conclusion:

APs enjoyed, and benefited from, the educational programme and the knowledge gained benefited patients in the short and medium-term. This study suggests that educators and training sponsors should consider the benefits of small group-based practical learning for APs.
Exploring the developmental need for a paramedic pathway to mental health
Authors: Elliott Ruth , Brown Paul
Published: May 2014

The following article discusses an organisational development need of a national ‘Mental Health Pathway’ to enable paramedics to provide the appropriate care for people who present mental health issues. The Department of Health acknowledges the huge modernisation of the ambulance service in England and faster access to people with immediate life-threatening conditions; however, the service is also responding to an increasing number of patients who have an urgent primary care need, which includes mental distress, as opposed to clinical emergency.

The Department of Health (2009) policy calls for a ‘new vision’, where the ambulance service could increase efficiency and effectiveness towards patients who are experiencing non life-threatening emergencies. The key aims are to form a programme of advancement to address both improving mental health and accessibility of services for people with poor mental health. The vision of the policy is that by 2020 mental and physical health will have equal priority. The development of a mental health pathway within the ambulance service may help to reduce admissions or re-attendance, while improving care for patients.

An evidence-based approach is used to provide a balanced, logical and supported argument within a reflection of practice. This is evaluated against a hypothetical patient’s case study, which reflects common issues faced by paramedics and ambulance technicians. The analytical process considers patient, professional, organisational and multi-disciplinary team perspectives.
What is happening in urgent care?
Authors: Jones Rodney
Published: May 2014

With problems concerning bed occupancy and capacity within A&Es becoming widely recognised, Rodney Jones, statistical advisor, Healthcare Analysis and Forecasting, considers the reason for this apparent lack of capacity and the implications for paramedics and the ambulance service.
Cattle Review
Authors: Barrett David C
Published: May 2014

Introduction: This edition of Cattle Review considers recent papers on liver and rumen fluke, fertility is seasonal calving Irish dairy herds and calf diarrhoea pathogens in the American Midwest.
Prescribing in palliative care: the primacy of patient involvement
Authors: Bentley Jenny , Bloomfield Jacqueline
Published: May 2014

The involvement of the patient is a crucial element of prescribing in palliative care. Patients receiving palliative care have an incurable condition, and nurse prescribing will be centred on symptom control with this group of patients. Inadequate information and poor communication are the main complaints made by people with cancer (NHS Centre for Reviews and Dissemination, 2000), yet patient involvement is a feature of current health policy and in the National Cancer Plan (Department of Health (DH), 2000) where improvement in patient information and training in communication skills are among the targets set. One way in which patient involvement may be promoted with this patient group is by the use of the prescribing pyramid (National Prescribing Centre 1999a), taught on the original nurse prescribing course.
Write a clinical management plan
Authors: Baird Anne
Published: May 2014

The clinical management plan (CMP) is the cornerstone of supplementary prescribing and must be in place before the supplementary prescriber (SP) begins prescribing for the patient. The CMP can be drafted by either the independent prescriber (IP) or the SP, but both must agree to it before the SP can begin prescribing for the patient.
Submit a Yellow Card to report adverse drug reactions
Authors: Callaghan Eileen
Published: May 2014

The Yellow Card scheme involves the collection of voluntary reports of suspected adverse drug reactions by health professionals. It is operated jointly by the Committee on the Safety of Medicines (CSM) and the Medicines and Healthcare products Regulatory Agency (MHRA). The purpose of the scheme is to increase the understanding of the safety profile of medicines and to ensure that any unrecognized adverse effects of medicines are identified as quickly as possible.
Implementing supplementary nurse prescribing in the haemodialysis unit
Authors: Gerrish Martin
Published: May 2014

This article looks at the case study of Mr Ainsworth, a 42-year-old man on haemodialysis. Mr Ainsworth receives erythropoietin therapy intravenously twice per week to correct anaemia caused by end-stage chronic renal failure. The study describes how the renal nurse, as a supplementary prescriber, can manage his anaemia under a clinical management plan. Supplementary prescribing enhances nursing practice by empowering those who are best placed to make decisions regarding care and treatment for their patients. It is of benefit to patient care, meeting the demands of an expanding patient population.
Nurse prescribing for acute bacterial tonsillitis: to treat or not to treat?
Authors: Hames Andrea
Published: May 2014

This article is a reflective account by a practice nurse, whose clinical role involves providing care to patients with minor illnesses in general practice. Professional, legal and ethical issues faced by extended, independent and supplementary prescribers are discussed in relation to the diagnosis and management of acute bacterial tonsillitis.
A review of the usefulness and efficacy of independent nurse prescribing
Authors: Kimmer Eileen , Christian Ann
Published: May 2014

From January to March 2004, two extended nurse prescribers undertook a review in their general practice to monitor the usefulness and appropriateness of independent nurse prescribing. Data were collected over a period of 6 weeks, and showed a breakdown of patients’ reasons for visiting the surgery and the subsequent treatment offered. The results broadly demonstrated that extended nurse prescribing was useful and effective within its limitations. However, it failed to adequately address the needs of those patients requiring systemic antibacterial intervention. The authors believe that the restrictions of the Nurse Prescribers’ Extended Formulary will continue to prevent nurses from completing episodes of care until they are able to prescribe from the full British National Formulary, according to their competencies.