bluuebunny/crossref_metadata_2025 huggingface dataset:
Accuracy of bag ventilation in simulated resuscitation
Authors: Nehme Ziad , Boyle Malcolm J
Published: May 2014

The efficacy of manual bag ventilation during cardiopulmonary resuscitation (CPR) is often a difficult task to undertake, however, very little is known about its accuracy.

Aims

The objective of this study was to evaluate operator delivery of ventilation rate, tidal volume and minute volume in a simulated cardiac arrest using two different capacity self-inflating bags in an undergraduate paramedic cohort.

Methods

An observational single blinded study with third year university undergraduate paramedic students using a mechanical lung model and a simulated adult cardiac arrest to assess their ventilation ability. Students ventilated using 1600 ml and 1000 ml bag for 2 minutes at a rate and tidal volume for a patient undergoing CPR with an advanced airway. Ventilation rate and tidal volume were recorded using an analogue scale with mean values calculated.

Results

Mean tidal volumes were significantly higher for the 1600 ml bag: 528.4 ml (95% CI 491.3–565.5) versus 648.7 ml (95% CI 603.7–693.7) (P < 0.0001), while no statistically significant differences were found in mean ventilation rates and minute volumes between the two bags.

Conclusion

Smaller self-inflating bags reduce the incidence of overzealous tidal volumes and produce greater guideline-consistent results for cardiac arrest patients.
Personal protection in the workplace
Authors: Fox Jonathan
Published: May 2014

Jonathan Fox of the Association of Professional Ambulance Personnel outlines the need for the provision of a complete package of safety measures, including personal protective equipment, to protect the front-line paramedic from assault and injury.
Wound closure on scene: ethical analysis and reflection
Authors: Winch Spencer
Published: May 2014

This case study involves the critical analysis and reflection of the ethics involved when an emergency care practitioner closed a 16-year-old patient's self-inflicted wounds at scene, rather than transporting to A&E.

The article aims to show the challenges faced by ambulance personnel in the pre-hospital setting when faced with issues surrounding patient autonomy, consent and capacity and how these should be considered on a ‘case by case’ basis.
Quality-assured online CPD modules
Authors: Johnston Adrian
Published: May 2014

At this time, when Journal of Paramedic Practice (JPP) launches its new online continuing professional development (CPD) modules, it seems appropriate to consider just how groundbreaking the journal has been over the past year. As the publisher of 19 healthcare titles, including British Journal of Nursing, British Journal of Midwifery and British Journal of Hospital Medicine, Mark Allen Healthcare has great experience in launching clinical journals that are applicable to daily practice. We were confident that a quality journal solely dedicated to championing the paramedic's pursuit of best practice would be eagerly received.
October roundup of the EMS blogging world
Authors: Glencorse Mark
Published: May 2014

Mark Glencorse, NHS Operational Paramedic Team Leader, Author of 999medic.com, and Co-Host and European Programme Director of ‘The Chronicles of EMS’, updates JPP on the main issues that emergency medical services (EMS) blogs are focusing on and the topics that are creating the best discussions this month. Email for correspondence: mglencorse@yahoo.co.uk
Paramedic training and higher education: a natural progression?
Authors: Emms Claire , Armitage Ewan
Published: May 2014

The paramedic profession has undergone a period of transition in the past decade. One of the most fundamental changes is the emergence of higher education (HE) as central to the development of qualified paramedics and those looking to enter the profession for the first time. Amidst a back-drop of regulation and increasing expectations, the position of HE has become one of the key drivers for a profession facing increasing challenges. This article explores the theoretical concepts which underpin the delivery of paramedic training within the HE setting. A number of different teaching strategies are examined which demonstrate how HE equips paramedic students with the skills needed to operate effectively in the prehospital setting. The concept of an autonomous practitioner is discussed and specifically, the role which HE has to play in their development. Consideration is also given to the way in which HE can empower paramedics to continue their development post qualification.
Making the most of your journal articles
Authors: Johnston Adrian
Published: May 2014

I will never forget the Autumn months of 2008. The JPP editorial team were putting the finishing touches to our first issue. Hundreds of paramedics from all over the UK had even subscribed in advance of seeing a copy of the journal.
Care Quality Commission: regulating ambulance services
Authors: Alexander Malcolm
Published: May 2014

The Patients' Forum is a voluntary sector organization that has been monitoring the London Ambulance Services (LAS) since 2003. The Forum was originally a statutory sector body and has continued actively monitoring LAS services and collaborating with staff to improve services. Here, Malcolm Alexander, Chair of the Patients' Forum Ambulance Services (London) and National Association of LINks Members, reflects on current developments with the regulation of ambulance services and uses material from a public meeting with senior Care Quality Commission (CQC) staff who are leading on the regulation of ambulance services.
Life as a paramedic: an introduction to blogging
Authors: Glencorse Mark
Published: May 2014

Mark Glencorse, NHS Operational Paramedic Team Leader, Author of 999medic.com, and Co-Host and European Programme Director of ‘The Chronicles of EMS’, introduces the world of blogging and the role it can play in the paramedic profession. Each month, he shall be writing an update for JPP on the main issues that emergency medical services (EMS) blogs are focusing on and the topics that are creating the best discussions. Email for correspondance: mglencorse@yahoo.co.
Seizures in the prehospital setting
Authors: Cashmore Jamie
Published: May 2014

Seizures are a common occurrence in the prehospital arena, however, with numerous conditions causing seizures, prehospital clinicians can be left with a dilemma in the treatment of these patients. Patients who are actively seizing will predominately have their airway maintained, oxygen administered and therapeutic intervention (diazepam) initiated. One form of seizure, non-epileptic attack disorder or psychogenic seizures, are often called ‘pseudo’ seizures—an acronym synonymous in the ambulance service, this gives connotations that the patient is ‘faking it’. However, these patients often have deep psychological trauma that needs careful handling and empathy.
The foundations of paramedic science and beyond
Authors: Tanner Kieron , Knights Ashley , Strange Barnaby
Published: May 2014

This article explores the inception and design considerations of the foundation degree in paramedic science (FDSc), within the School of Health at The University of Northampton (TUoN). It is written as a collaboration between a student, practice educator and lecturer. It discusses preparation for practice, academic progression and quality assurance considerations. The construction of the programme is outlined with reference to feedback and reflection on its predecessor, a diploma in higher education in paramedic science (DipHE) delivered by TUoN. The FDSc is intended to prepare students for the challenges of contemporary paramedic practice and life-long learning, the latter having become a requisite for UK healthcare professionals (Gopee, 2010; Health Professions Council (HPC), 2010).
Advice for paramedics: how to spot the really sick child
Authors: Davies Ffion
Published: May 2014

Time is of the essence when dealing with a child in need of emergency care. Here, Dr Ffion Davies, Consultant in Emergency Medicine at Leicester Royal Infirmary, provides advice for paramedics dealing with ill children.
Emergency planning: major incidents and command training
Authors: Macklin David , Marsden Janet
Published: May 2014

Major, complex, multi-casualty incidents occur with surprising regularity and previously, the command of these from a health perspective was often delegated to those with the most experience. Time served in the ambulance service was often the measure of one's ability to take command of such an event. The police and fire and rescue services have long established training programmes for their commanders. This training is in addition to their normal day job and is specific to incident command. Police and fire officers can only perform in that role if they have successfully completed the training required. The same cannot be said of health incident commanders.
Simulation in prehospital care: teaching, testing and fidelity
Authors: Jones Colin , Jones Paul , Waller Caroline
Published: May 2014

This article explores imperative issues related to the use of simulation in the education of prehospital care personnel. While the literature shows a growing interest in the effectiveness of the use of simulation in medicine and healthcare ( McGaghie, 2010 ), the authors wished to review those areas especially pertinent to higher education institutions (HEIs) with an emphasis on maximizing learning opportunities and the process of learning in prehospital care programmes. The contention of this article is that the use of simulation can become assessment-driven and may overlook the equally important process issues involved.
Increased threat of suicide attack: a need for NHS ambulance services to adapt?
Authors: Overton Matthew
Published: May 2014

Suicide attacks are an emerging threat within the UK that carry with it specific risks which must be managed in order to ensure safety and minimise injury and loss of life, both to emergency services personnel and bystanders. Major incident planning is usually based on an ‘all-hazards approach’. The aim of this article is to evaluate the current ‘all-hazards’ approach taken by NHS ambulance services for responding to a major incident and recommend if any changes need to occur as a result of the current threat from suicide attacks. In the same way that chemical, biological, radiological, and nuclear (CBRN) was the new emerging threat a few years ago, it could be argued that suicide attacks are the new emerging threat that requires a rethink on how the ambulance service operates. Scene safety is the main issue raised in this article. Solutions ranged from the adoption of US-style tactical medicine allowing paramedics to work within the ‘hot zone’ to training police firearms officers in triage and more advanced skills of clinical care. Some of these solutions assume deployment to the scene in the first place and it is considered what level of risk is acceptable when operating in a hazardous area such as this.

Further issues identified were adaptations required to time on scene and whether to screen casualties for explosives and firearms, so as to avoid an armed terrorist being conveyed to hospital. The recommendations from this report rely heavily on cooperation between emergency responders not only during the time of a suicide attack but also during the pre-incident planning phase. Although modifications to the ambulance service response are suggested within the recommendations they do not present a radical change to how the ambulance service operates at present.
Pre-hospital psychosocial care: changing attitudes
Authors: Brady Mike
Published: May 2014

Holistic care is often a term widely associated with mental health professions, self help and alternative therapies, and often wrongly deemed irrelevant by those working in the pre-hospital care arena. The paradigm of an individual being much more than just the skin and bone holding itself together has gained increasing emphasis over recent decades in medicine, nursing, and now paramedicine. This article reviews the current literature and focuses on the concept of paramedics exploring not just the traditional physical needs of their patients but also the psychological and sociological. It further explores the drive to change attitudes held by pre-hospital practitioners that holistic care as irrelevant and meaningless. By distancing ourselves as a profession from the outdated perception of paramedicine as merely an emergency transportation service, we can change attitudes and thus expand the constraints of biomedical models of emergency and unscheduled health and appreciate the importance of biopsychosocial care for both patients and practitioners.
The use of simulation mannequins in education
Authors: Rice Alan
Published: May 2014

Effective and realistic simulation training is an important part of preparing paramedics for the pre-hospital environment. Alan Rice considers the various benefits and negatives of mannequin-based simulation training for paramedics.
Clinical handover of the trauma and medical patient: a structured approach
Authors: Loseby Jez , Hudson Anthony , Lyon Richard
Published: May 2014

Handovers are vital to the continuity of patient care and can influence patient outcome. Several structures exist to facilitate handover delivery but further work is needed to prospectively evaluate them.

This article advocates the implementation of a suitable pre-hospital handover template and the introduction of handover training. We believe the introduction of trauma networks into the UK provides the ideal opportunity to prompt hospitals and ambulance services to co-operate to standardise the approach to handover, improve training and carry out further prospective research into the most effective methods of patient handover.
Is paramedic practice ready to adopt the NICE Transient Loss of Consciousness Guideline?
Authors: Thoburn Steve
Published: May 2014

In 2010 the National Institute for Health and Care Excellence (NICE) published a guideline to assist clinicians, across various healthcare settings, to diagnose and subsequently manage patients experiencing a transient loss of consciousness (TLoC). The guideline emphasises that patients who are diagnosed as having had an ‘uncomplicated faint’ or ‘situational syncope’, from the initial assessment process, may not require conveyance to the nearest emergency department. JRCALC have included these recommendations within the latest published guidelines. Evidently, this may reduce inappropriate admissions and reduce unnecessary NHS expenditure. In addition it enables clinicians to provide care to patients within their home environment thus improving their experience and outcome as a service user. Furthermore, non-conveyance may reduce ambulance turn-around times enabling clinicians to become available to respond to life-threatening emergencies sooner. However, to utilise the guideline, clinicians are expected to be proficient in aspects of history taking, physical examination and 12-lead ECG interpretation. The current paucity of pre-hospital evidence base provides no support for use of the guideline by paramedics. It is questionable as to whether further education and training are required, before paramedics can utilise the guideline, to diagnose and discharge patients at scene without causing any detriment to patient outcome.
Hands off: can paramedics be educated at a distance?
Authors: MacQueen Hilary
Published: May 2014

This article looks at the challenges and opportunities presented by the use of distance methods to teach student paramedics. It examines distance learning from the perspective of the employer, the student and the higher education provider, and shows that there are considerable benefits for student paramedics and their employers in adopting a distance teaching approach to paramedic education. There are no short cuts to a successful outcome, and it is important to adopt the highest quality distance education.
Students' views of teachers using the Clinical Teaching Effectiveness Inventory
Authors: Ross Linda , Wallis Jaime , Huggins Chris
Published: May 2014

Objectives: The aim of this study was to examine undergraduate students' views of paramedic clinical teachers from a large Australian university.

Methods: A cross-sectional study involving a paper-based questionnaire employing a convenience sample of undergraduate paramedic students. Student attitudes towards paramedic clinical in-field teachers were measured using a standardised self-reporting instrument: Clinical Teaching Effectiveness Inventory (CTEI). Participants rate their level of agreement with each item on a 5-point Likert scale (1=never/poor to 5=always/superb).

Results: This research indicates that the clinical teachers are able to assist the graduates with the integration of the theory into the practice. There was significant difference between subscale 1‘Learner-centred instructional skills’ and those aged between <20 years and those aged between 35–39 years (p=0.013).

Conclusion: This study has provided some insight into this important area. Before any definitive conclusions can be made this study needs to be repeated on a larger scale and across other jurisdictions. To establish a clearer picture we need a greater knowledge and understanding of the levels of education and experience of the clinical teachers. This should assist in building the graduates' epistemology of practice.
Violence in the workplace: implementing the Instant Aggression Model
Authors: Bourne Iain
Published: May 2014

Paramedics, by the nature of their work, often enter into unknown, critical and sometimes hostile situations. Danger can emanate from the patient, particularly if they are confused, in a state of panic, inebriated or psychotic, from friends and family, work colleagues, or from members of the public. In such situations the best advice is undoubtedly to withdraw and summon support. This paper, however, addresses those situations where that is either not possible or appropriate. A model for understanding aggression as it unfolds is offered together with an examination of the interpersonal defusing and de-escalating skills.
An audit of 4679 consecutive emergencies for an emergency care practitioner
Authors: Gaisford Matthew
Published: May 2014

An audit using a sample of 4679 consecutive emergency patients seen by a single emergency care practitioner working for a statutory ambulance service in England between November 2007 and November 2013. The results show that the most common type of call attended are traumatic injuries followed by medical problems. The data shows that 53% of patients attended were discharged at scene, with another 8.3% referred to specialist pathways and just 29.3% sent to the majors side of the emergency department. Additionally, it is shown that referrals are made appropriately in the vast majority of cases with just 2.4% of attempted referrals being rejected as inappropriate. Whilst further work is needed to quantify how these figures compare to a more traditional paramedic role, it is suggested that the introduction of a few specific skills such as skin glue and the use of antibiotics for chest infections to general paramedic practice could dramatically reduce unnecessary hospital admissions.
Case study: acute joint sepsis in a pedigree Charolais bull calf
Authors: Hopker Andy , Brabant Olivia , Kane-Smyth Justine
Published: May 2014

Sepsis of the distal interphalangeal joint is a commonly encountered problem in bovine practice. Treatments include conservative management, joint resection and digit amputation; however all of these options are associated with poor long-term outcomes. Referral for arthroscopic treatment may be an economically viable option for certain selected cases. This article describes such a case in detail.
Dairy cow welfare: A common theme at the ICPD
Authors: Cosgrave Francis
Published: May 2014

Introduction: Francis Cosgrave reports back on the 2013 International Conference on Production Diseases in Farm Animals.
Investigation and management of sheep abortion
Authors: Hovers Kate , Lovatt Fiona , Hopkins Jim , Roger Paul , Mearns Rebecca
Published: May 2014

Abortion and stillbirth account for approximately 30% of UK annual lamb losses so have significant financial implications. Enzootic abortion of ewes (EAE) and toxoplasmosis are the commonest infectious causes, followed by Campylobacter spp, unfortunately in less than 50% of submissions a diagnosis is not made. This article reviews investigation and diagnosis of common causes of ovine abortion plus flock management of both the initial outbreak and for long-term control and prevention of abortion.
Use of stem cells in equine orthopaedics
Authors: Fiske-Jackson Andy
Published: May 2014

The use of stem cells in equine orthopaedics is gaining popularity. This article summarises the principles and applications of stem cells in tendon, ligament and joint disease.
Disinfectant footbathing agents for the control of bovine digital dermatitis in dairy cattle
Authors: Bell Nick J , Potterton Sarah , Blowey Roger , Whay Helen Rebecca , Huxley Jonathan N
Published: May 2014

The use of biocidal agents in footbaths for dairy cows as an alternative to antibiotics is becoming standard practice in the UK. However, with numerous biocides available for use in footbaths and varying advice on the frequency with which footbaths should be used, practitioners may refer to the published literature for guidance. The evidence would suggest a variety of biocides are effective at improving bovine digital dermatitis (BDD) lesion score in cows with lesions. However, little published data is available on the protective effective of regular (such as daily) foot disinfection protocols for cows without BDD lesions despite the widespread anecdotal evidence for its efficacy. Formalin and copper sulphate are the most commonly used biocides, both of which should be used with significant precautions. Whichever biocide is used, practical considerations with regard to footbath design and care with making solutions to the correct concentration should be addressed.
Milk fever prevention: a clinical review of current prevention strategies
Authors: Gammon Dan
Published: May 2014

Prevention of periparturient hypocalcaemia has been an active area of research and development within the dairy sector for over 60 years. Absolute dietary restriction of calcium to the pre-partum animal is the traditional method but can be challenging in typical UK dairy cow diets. Supplementation of calcium binding compounds will effectively lower the dietary calcium by decreasing absorption across the gut wall, allowing calcium restriction on a ‘normal’ diet. Manipulation of the dietary acid/base balance of the pre-partum animal is another effective tool for prevention of hypocalcaemia. Reduction of dietary cations (sodium and potassium) relative to the anions (chloride and sulphur) induces a mild to moderate metabolic acidosis which stimulates the parathyroid hormone homeostatic mechanisms, up-regulating bone resorption and gut absorption while reducing renal excretion of calcium. The physiology of normal calcium regulation and how these hypocalcaemia prevention strategies exploit this understanding will be discussed in this article along with other important considerations.
A triumph of sense over tradition: the development of nurse prescribing
Authors: Cumberlege Julia
Published: May 2014

In 1985, sitting in my office as the new Chair of the Brighton Health Authority, I was surprised when my secretary rushed in. ‘Chairman,’ she said (we were less gender-conscious in those days) ‘the CNO is on the ‘phone’. I almost curtseyed as I took the receiver. I didn't know who the CNO was but I knew what the initials stood for (Chief Nursing Officer). The chief of anything was important and the chief of the largest profession in the health service had to be very, very important.
Oral nutritional supplements and the treatment of adults at risk of malnutrition
Authors: Todorovic Vera
Published: May 2014

In adults, prescribable oral nutritional supplements (ONS) are commonly used as a method of nutritional support in the prevention and treatment of malnutrition. There is growing evidence to suggest that when used appropriately in treatment plans, individuals at risk of malnutrition will benefit from functional and clinical improvements. Nurse prescribers have a key role to play in working with dietitians to plan how ONS should be incorporated into the clinical management plans of vulnerable patients. Decisions should be based on evidence for need, intended benefit and indicate a clear pathway of care.
Long-acting reversible contraception: new guidelines from NICE
Authors: Jarvis Sarah
Published: May 2014

Until now there has been relative paucity of comprehensive, up-to-date advice on the provision of long-acting reversible contraception (LARC). However, this has recently been addressed by the National Institute for Clinical Excellence guideline. In this article, the author looks at the different types of LARC available and provides some tips for nurse prescribers.
An emerging picture of mental health nurses as non-medical prescribers
Authors: Hemingway Steve
Published: May 2014

In this article, the author will provides a picture of the development in clinical areas and specialisms of mental health nurses as supplementary prescribers. Secondly and importantly, the author explores what the nurses in the sample perceived as helping or hindering factors toward their journey as a prescriber.
Prescription writing standards: why they are important
Authors: Reddy Bhavana
Published: May 2014

The root causes of medication error are diverse. They include confusion over similar packaging and labelling, checking errors and misidentification of patients. The main focus of this article is errors that arise from the prescription writing process. It is important that new prescribers adhere to local or national prescription writing standards to ensure that prescriptions are clear, unambiguous and leave no doubt as to the prescriber's intentions.
Independent nurse prescribing for patients with tuberculosis
Authors: Karim Kelvin
Published: May 2014

Nurse prescribing is an exciting development that is increasing the nurse's ability to provide flexible patient care (Ryan, 2004). Moreover, specialist nurses are ideally placed to take up the challenge presented by the recent changes in prescribing regulations opening up most of the British National Formulary. This article describes the role of the nurse specialist as independent prescriber in the context of patients affected by tuberculosis.
Managing lower UTI in adults in the community
Authors: Couling Rowena
Published: May 2014

Urinary tract infections (UTI) are more common in women than in men. They are one of the most common bacterial infections managed by general practitioners and within the community. About 50% of women will be treated for a symptomatic UTI in their lifetime. The judicial use of antibiotics in the treatment of UTIs is important to prevent resistance to commonly used antibiotics. Patient education regarding the proper use of antibiotics and preventative measures is important in preventing recurrent and resistant infections. This article will discuss the diagnosis, treatment and education of women with acute, uncomplicated lower UTI.
Diuretics: use, actions and prescribing rationale
Authors: Bennett Stephen
Published: May 2014

This article aims to familiarize readers with the uses and features of diuretic agents as used in the treatment of different cardiac disorders. Attention will be given both to the roles of individual agents in current therapy and to the pharmacological methods by which they exert their effects.
Development of nurse-led clinics in genitourinary medicine
Authors: Keefe Alison
Published: May 2014

The role of the nurse is evolving, and nurses are increasingly undertaking responsibilities traditionally carried out by medical personnel. One area of practice in which nurses' roles have become more advanced is genitourinary medicine (GUM), with the development of nurse-led GUM clinics. There has been an escalating incidence of sexually transmitted infections (STIs) and HIV in society, despite a concerted improvement in accessibility and delivery of GUM services. This has led to a greater pressure on GUM departments, which provide services in detection and treatment of STIs, as well as health promotion, to limit further/ onward transmission of infections. This article explores issues around nurse-led GUM clinics and how these clinics can work to halt the rising
Health visitor prescribing: the need for CPD
Authors: Ford Karen , Otway Christine
Published: May 2014

Health visitors were one of the first groups to gain prescribing status, yet their continuing professional development (CPD) needs in the area of prescribing practice appear to have been neglected until now. This article describes how the learning needs of a group of health visitors were assessed and partially met, during a refresher day provided by a university in the Midlands. Issues which were raised by students are explored and analysed, and the day is evaluated with the purpose of informing future practice.
More than skin deep: the psychosocial impact of acne
Authors: Pountney David
Published: May 2014

Acne is a common problem among teenagers and young adults and can have a significant impact on quality of life. The condition is often not fullly appreciated by medical staff and the general public as being anything more than a superficial nuisance. The interaction of acne and psychosocial issues is complex, and in many individuals acne may result in depression, stress and anxiety and severely impact upon work, education and social and personal relationships. These effects should not be ignored and can often be effectively managed by appropriate clinical intervention and support.
Independent nurse prescribing for older people's mental health
Authors: Oldknow Helen , Bottomley John , Lawton Mark , McNulty Carolyn , Earle Emily
Published: May 2014

This article discusses the history of non-medical prescribing and how a team of doctors and nurses in community settings within the mental health service for older people moved from supplementary to independent prescribing, and how the pilot was evaluated gaining the views of colleagues and patients.
Adjuvant analgesics in pain management
Authors: Hall Sandra
Published: May 2014

The use of adjuvant analgesia is becoming a more routine part of pain management. Adjuvant analgesics can be used alone or in conjunction with primary analgesics to relieve pain which is unresponsive to conventional treatment. Prescribers must be aware that many of the drugs used as adjuvant analgesics are not licensed for the management of pain (i.e. pain is an unlicensed indication). When a medication is prescribed for an unlicensed indication the prescriber is assuming the responsibility and liability for the consequences of this prescribing.
Management of diabetes: latest guidance from SIGN
Authors: Grant Paul
Published: May 2014

New Scottish Intercollegiate Guidelines Network (SIGN) guidelines regarding the management of diabetes mellitus have recently been issued and, as always, there is a great deal of interest in both the recommendations for changes to traditional practice and the evidence base for doing so. There is guidance over the controversial area of psychological and weight management issues in diabetes. However, the major problem in the recommended treatment pathway is the continued vague instructions to review, up-titrate and move on to the next level. This reflects the fact that clinical practice varies widely in the sense that there is a lack of clarity about the optimum timeframe in which to maintain a patient on a combination of therapies before moving on.
Prescribing for mild to moderate acne
Authors: Van Onselen Julie
Published: May 2014

Nurse perscribers have the potential to help treat people with acne, advise on general skin care, provide education into the causes and course of acne, and offer essential psychological support. To achieve this, nurse prescribers need to understand the aetiology of acne and the four key stages that define acne as comedonal, mild, moderate and severe, as treatments need to be advised and prescribed according to severity and extent of the condition.
The management of childhood atopic eczema
Authors: White Sharon
Published: May 2014

Atopic eczema is a common chronic condition in children. Emollients are the mainstay of treatment but advice and support, which can be given by the nurse are also vitally important in successfully managing this long-term condition.
Recent advances in the management of acute diarrhoea
Authors: Hall Veronica
Published: May 2014

Diarrhoea is fairly complex in both its causation and its definition. Patients may consider it to be liquid stools, yet medically it is also defined in terms of frequency and volume. Acute diarrhoea has a major impact on morbidity, is a cause of absenteeism from work and decreases quality of life.

Diarrhoea occurs as a consequence of impaired gut function, which may be due to the failure of many mechanisms: digestion, secretory impairment, peristalsis, failures within the gut immune system, viruses or bacteria, where secretions overwhelm the absorptive capacity, and infections.
Legal considerations for nurse prescribers
Authors: Armstrong Amanda
Published: May 2014

In this article, the English legal system will be explained in relation to non-medical prescribing, in particular the areas of accountability where the nurse prescriber could be judged. The civil law of negligence will be examined in detail, particularly in the context of the expanded role of the nurse prescriber. In addition, using case studies and scenarios, the benchmarks by which nurse prescribers will be judged by the law in relation to their roles as practitioners and the ways that nurse prescribers can defend themselves against a claim of negligence will also be discussed.
Towards concordance in schizophrenia: a case study
Authors: Snowden Austyn , Flemming Mick , Marland Glenn , McNay Lisa
Published: May 2014

Schizophrenia remains a contentious concept. Kraepelin’s presumption that schizophrenia has a biological origin still predominates despite consistently inconclusive evidence. Current research consequently favours finding a cure as opposed to focusing on more pragmatic solutions. Nevertheless, alternative viewpoints are gaining more credence, as their practical efficacy increasingly becomes empirically demonstrable. This article focuses on one such demonstration, showing how a nurse prescriber can achieve concordance with someone diagnosed with schizophrenia. It starts by briefly reviewing the origins of the concept of schizophrenia. It then introduces current classification, based on the latest DSM-V criteria for diagnosis. The limits of this classification are then highlighted by introducing research that challenges the salience of these criteria. The paper then goes on to demonstrate the practical consequences of understanding all of this research by presenting an evidence-based approach to helping someone diagnosed with schizophrenia. It uses the SBAR (situation, background, assessment, recommendations) format to frame the case study. The case study shows how important it is to understand what effects (good and bad) antipsychotic drugs can have, and goes on to demonstrate that as in any case of medicine management, the concept of concordance underpins optimal outcome.
The pharmacology and prescribing of antiplatelet drugs
Authors: Panchmatia Shailesh
Published: May 2014

This article provides a review of the pharmacology of antiplatelet drugs, and of their use in practice. The review covers mechanisms of action, the different conditions for which antiplatelets are indicated, and some prescribing aspects. Finally, patient counselling issues for some of the common antiplatelet drugs are discussed.
Prescribing diuretics in the management of heart failure
Authors: Khatib Rani
Published: May 2014

Diuretics have always been, and still are, one of the main classes of medicines used in the management of patients with heart failure (HF). They relieve oedema, congestions and dyspnoea, and improve patients’ quality of life. Loop diuretics are usually the agents of choice in patients with HF. Thiazide, thiazide-like diuretics and potassium-sparing diuretics are mostly used with loop diuretics to augment the diuretic effect, and in the case of potassium-sparing diuretics, also to reduce the risk of hypokalaemia. Diuretics should be administered in addition to angiotensin-converting enzyme inhibitors (ACEIs) (or angiotensin receptor blockers (ARBs)) and beta-blockers (BBs), if tolerated, to reduce decompensation and maintain clinical stability. This article reviews the pharmacological, therapeutic and practical considerations that prescribers need to take into account when prescribing diuretics in order to maximize their benefits and minimize their adverse effects.
Prescribing for mild-to-moderate rosacea
Authors: Van Onselen Julie
Published: May 2014

Non-medical prescribers (NMPs) have the potential to support patients with the distressing and often disfiguring condition rosacea. NMPs can provide patients with education on rosacea, advice on general skin care and measures to reduce the severity, and psychological support. NMPs can offer treatment options for mild-to-moderate rosacea, and can advise when referral for severe rosacea is necessary. In order to achieve this, NMPs need to extend their knowledge of rosacea fully understanding how to recognise different subtypes of rosacea because treatment needs to be advised and prescribed according to the severity of the condition.
Using the British National Formulary 62
Authors: Ahuja Jaya , Armstrong Amanda
Published: May 2014

The BNF, which is published twice a year in March and September, is an essential resource for all prescribers that contains sound, easy-to-access and up-to-date information on the use of medicines. Although some prescribers might refer only to sections that are relevant for their specialty, anyone who uses the BNF is recommended to familiarize themselves with the general structure and layout, which is consistent among each issue, and the general sections at the beginning. Users should also practice navigating their way through BNF, to gain confidence and be aware of the different ways in which information can be accessed.
New pharmacological treatments for prostate cancer
Authors: Turner Bruce , Drudge-Coates Lawrence
Published: May 2014

In this article, a summary of new drugs available for patients with prostate cancer, such as degarelix, abiraterone acetate, sipuleucel-T, bone-targeted therapies, and chemotherapeutic agents, and their pharmacologies is provided.
Aspects of the pharmacology and prescribing of oral anticoagulants
Authors: Panchmatia Shailesh
Published: May 2014

This article covers the pharmacology and prescribing aspects of prescribing oral anticoagulants. The main drug discussed is warfarin but also mentioned is the newer oral anticoagulants such as dabigatran. The pathophysiology of thrombus formation is described, as well as how warfarin therapy is initiated and monitored. Drug interactions, contraindications, adverse effects, and patient counselling issues are also discussed.
Protective effects of including whole grains in the diet
Authors: Phillips Frankie
Published: May 2014

Grains are the staples for many people's diet, and some countries recommend eating more foods made with whole grain. There is no specific recommendation in the UK, but there is robust evidence to support eating three servings of whole grains daily. Established and emerging evidence shows that whole grains can help to prevent some chronic diseases. This article discusses the evidence and provides advice on how health professionals can encourage patients to eat more whole grains.
Milrinone therapy in adults with heart failure
Authors: O'Donovan Kate
Published: May 2014

Heart failure is a chronic progressive condition where the myocardial pump fails to maintain peripheral perfusion. Treatment aims to alleviate signs and symptoms, reduce hospitalizations and mortality. Heart failure patients may experience episodes of acute decompensation where cardiac output fails to maintain adequate peripheral perfusion. Inotropes such as dobutamine and milrinone have a role in augmenting contractility as a means of increasing cardiac output. Milrinone is a phosphodiesterase III inhibitor with inotropic and vasodilatory properties. The added benefit of its vasodilatory action is reduction in afterload and pulmonary pressures, therefore reducing the myocardial workload. Two main adverse effects associated with this therapy are arrhythmias and hypotension.
An evidence-based guide to smoking cessation therapies
Authors: Dogar Omara F , Siddiqi Kamran
Published: May 2014

Despite a general decline in smoking rates in the UK, smoking prevalence remains high among young adults, pregnant women and those from socio-economically disadvantaged backgrounds. These three groups are also more likely to benefit from targeted smoking cessation interventions. Clinical contact between health professionals and patients who smoke creates an opportunity for offering cessation interventions and to reduce smoking-related harm. This article summarises evidence, based on high quality systematic reviews, on smoking cessation interventions that could be offered by health professionals coming in to contact with patients who smoke. The evidence presented here suggests that brief advice by a health professional is beneficial in achieving smoking cessation and so is intensive behavioural support alone or in combination with pharmacotherapies (nicotine replacement therapies (NRTs), bupropion and varenicline). Pharmacotherapies are also effective individually in promoting smoking cessation; a combination of NRTs (oral or skin patch) can be particularly helpful in promoting cessation among highly dependent smokers. Pharmacotherapies in combination with behavioural support delivered in health care settings are more effective than when used alone and delivered in community settings, respectively.
ADHD in children: An overview of treatment
Authors: Laver-Bradbury Cathy
Published: May 2014

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with an incidence of 3.62% in boys and 0.85% in girls between 5 and 15 years of age in the UK ( Ford et al, 2003 ). ADHD is recognised by a triad of symptoms within three domains: overactivity, impulsivity, and inattention. Diagnosis of ADHD is generally performed by psychiatrists, paediatricians and specialist nurses. Interventions for ADHD can be non-pharmacological, including parenting programs, or pharmacological. Drug treatments for ADHD include methylphenidate, atomoxetine and lisdexamfetamine. This article provides an overview of the assessment and diagnosis, treatments used and side effects experienced in children with ADHD.
Drug formulations and delivery systems
Authors: Emblin Kate
Published: May 2014

The aim of this article is to discuss some of the common dosage formulations and delivery systems and how and why they are used.
Practical tips for prescribing in renal impairment
Authors: Armstrong Amanda
Published: May 2014

This article discusses the implication for nurses prescribing for patients with renal impairment. It offers practical prescribing tips as well as dosage advice on common drugs. Since renal impairment signs can be vague and non-specific, nurses are advised to carry out a renal assessment. This is especially important in high risk groups such as the elderly, patients with diabetes and/or hypertension. Key reference and further learning resources are provided at the end of the article.
The SIMPLE approach to asthma consultations
Authors: Scullion Jane , Holmes Steve
Published: May 2014

During a consultation it is important to undertake not only an effective assessment, but also support patients to ‘buy-in’ the management of their condition. This is particularly important in chronic diseases because a significant emphasis is placed on self-management. An effective consultation will help formulate a plan of management that both practitioner and the patient can agree to. This article looks at the essential elements of a consultation using the a SIMPLE acronym (stop smoking, inhalers, monitoring, pharmacology, lifestyle and education) approach, developed by Anna Murphy, consultant pharmacist, and East Midlands NHS Improvement Network, which covers the important areas essential to effective asthma consultations.
Acute coronary syndrome: potent oral antiplatelets
Authors: Wright Paul , Antoniou Sotiris
Published: May 2014

The thienopyridine clopidogrel, which irreversibly blocks the adenosine diphosphate (ADP) receptor P2Y12 on platelets, has become an essential component of therapy in patients with acute coronary syndromes. However, clopidogrel has drawbacks which has led to the development of newer more potent antiplatelet agents: prasugrel, and ticagrelor. Prasugrel, a thienopyridine, also irreversibly binds to P2Y12. Prasugrel has a more rapid onset of action and a stronger inhibitory effect than clopidogrel. Ticagrelor is a new class of antiplatelet which binds reversibly to P2Y12 with a stronger and more rapid antiplatelet effect than clopidogrel. This article discusses the newer antiplatelet agents and their role in acute coronary syndromes compared to clopidogrel. The article also highlights some of the side effects associated with these newer agents.
Childhood atopic eczema: Adherence to treatment
Authors: Lawton Sandra
Published: May 2014

Atopic eczema is a common skin condition in children, which can have a significant impact on the lives of the children as well as their families. Patients and families see a variety of health professionals during the course of their eczema journey. It is important when caring for these children that the health professional has a depth of knowledge and the expertise to provide a comprehensive plan of care and is able to answer the many questions children and their parents have ( Lawton, 2014 ). This article will focus on the evidence to support the role of nurse prescribers, what impact eczema care can have on families, issues which may affect adherence, and strategies to support practice.
Equipment to enable safe handling of people
Authors: Beresford Susan A
Published: May 2014

Susan A Beresford discusses the legislation that guides the use of moving and handling equipment by carers, and outlines the different types of equipment that are available.
Nothing is as constant as change
Authors: Moody Marion
Published: May 2014

Considerable change has occurred over the past three decades in the structure of health and social care management. Changes in the pattern of care delivery, training and education of nurses and other professional carers, the introduction of NVQs for health and social care, developments in health-care technology, and changing expectations of society have all played a major role.
Principles of infectious diseases control in the community
Authors: Kingston Joanna E
Published: May 2014

Joanna E Kingston looks at the causative organisms involved in infection, and the ways in which these can be controlled and reduced in a care home environment
Records and record keeping
Authors: Moody M
Published: May 2014

Communication is an essential and integral part of the caring process. Marion Moody outlines the importance of accurate, clear record keeping, and looks at the legal professional implications if this is not adhered to.
An inspector calls
Authors: Ashurst Adrian
Published: May 2014

Adrian Ashurst highlights the importance of thorough staff preparation and accurate record keeping before an announced inspection.
Health & Safety
Authors: Jones Phil
Published: May 2014

Phil Jones looks at the different aspects of food hygiene which must be considered in terms of health and safety, and outlines the preventative measures which should be taken in care homes.