bluuebunny/crossref_metadata_2025 huggingface dataset:
Championing your pursuit of best practice
Authors: Johnston Adrian
Published: May 2014

As publisher of the Journal of Paramedic Practice (JPP), may I begin with a big thank you to our subscribers for your support of this new publication. JPP is our response to heartfelt representations from the UK's most prominent paramedics expressing the urgent need for a paramedic journal that encompasses clinical, professional and research issues in a serious but accessible way.
Overview of management of minor head injuries
Authors: Bleetman Anthony
Published: May 2014

Head injuries are very common and paramedics will therefore see many patients with head injuries. Most of these patients will not require any specific treatment. The challenge for pre-hospital and hospital carers is to identify the small minority of patients in whom a computed tomography scan is required and to expedite safe transfer to a neurosurgical unit for those very few that require specialist intervention. The key to identifying these is a broad understanding of the anatomy and pathophysiology of head injuries and also learning the important features of assessment and examination.
Update on healthcare-associated infections
Authors: Peate Ian
Published: May 2014

Healthcare-associated infections (HCAIs) receive much attention and often receive much media coverage which can cause much political and public alarm. This article provides an update in relation to HCAIs and will serve as an introduction to a forthcoming series of articles in infection prevention and control. It is acknowledged that not all infections are preventable but managing infection control and ensuring best practice can improve patient outcomes significantly and enhance service user safety, as well as individual practitioner safety. Four areas of paramedic practice are addressed with the intention of reviewing current practice.
Leading the way in clinical effectiveness
Authors: Morris Phil
Published: May 2014

The Bradley Report heralded a fundamental change in the operation of the ambulance services and one of its main objectives was to improve clinical leadership. Here, we learn about the man charged with delivering these improvements and the initiatives that he has spearheaded in the East Midlands Ambulance Service and beyond.
Don't forget to pay and sign: renewing your registration
Authors: Gayle Ebony
Published: May 2014

As you will know, paramedics need to renew their registration with the Health Professions Council (HPC) every 2 years to retain their place on the HPC Register and continue to practise using the title ‘paramedic’. This article provides some very useful information about renewing your registration with the HPC.
Administering naloxone: is the answer under our noses?
Authors: Bisset Elspeth
Published: May 2014

The intranasal (IN) administration of naloxone to treat opioid overdoses offers many benefits over the current, often problematic intravenous and intramuscular routes. Such problems include using sharps around potentially aggressive patients; a high risk of transmitting blood-borne infections and difficulty obtaining intravenous access in injecting drug users. A literature search was undertaken to examine the effectiveness of the IN route of naloxone administration in comparison to these other routes. Research suggests that the IN route is safe to introduce into practice and it is effective: the time taken from ambulance staff arriving at opioid overdose patients to them responding to IN naloxone appears to equal that of the intravenous route. Intranasal naloxone is not yet licensed for use in the UK and this needs to be reviewed. In the future this method of drug administration should result in considerable benefits and improved safety to both ambulance staff and patients, particularly for the treatment of opioid overdoses.
Medical students in prehospital care
Authors: Cleveland Laura , Broughton Rebecca
Published: May 2014

Medics' First Responders are medical student volunteers from Cardiff University who respond to life-threatening (category A) 999 calls, providing crucial assistance to patients in partnership with the Welsh Ambulance Service. It was the first UK Community Responder Scheme to consist entirely of medical students (Cardiff Medics' First Responders Website, 2006). The main benefit is to the local community through the management of cardiac arrests. Aims: First responders aim to arrive on the scene within 6 minutes, which should be achievable in 80% of cases. Students are fully trained in the necessary skills required for callouts, including basic life support and the use of automated external defibrillators. Limitations: Currently, there is no sustainable fundraising policy in place and many logistical difficulties face the community, with responders being spread across Wales because of University placement commitments. Progress: A new committee was formed in 2008, which has built on the society's previous successes, training over 100 members in one year. Fundraising and publicity have increased. In the future, the society aims to provide responders at large national events (such as rugby matches), as well as aiming to have two teams responding simultaneously, covering a larger area of Cardiff.
Edge Hill University opens new Manchester base
Authors: Crompton Phil
Published: May 2014

Edge Hill University has won a major contract to train paramedics for North West Ambulance Service NHS Trust.
Paediatric disaster preparedness: essential concepts for paramedics
Authors: Upperman Jeffrey , Pierce James
Published: May 2014

Children are the world's most valuable resource and its best hope for the future (John F Kennedy, 1963). Recent natural disasters and terrorist attacks have shown how imperative it is that communities and nations address the needs of children to ensure that they thrive in the face of adversity. As first responders and front line workers during disasters involving children, paramedics have a unique and important role in planning paediatric disaster preparedness as well as facilitating personal disaster preparedness. Paediatric disaster preparedness on all levels, from individual to institutional, will lead to improved outcomes in disasters involving children. Although different medical, legal, and administrative structures exist between the UK and the US, some of the lessons learned in the US can enhance paediatric disaster preparedness in all countries. This article aims discuss how paramedics and other first responders can close the gap between available and needed paediatric providers. Specifically, we review how paramedic primary and continuing education can target deficiencies identified by various supervising organizations, and how training can be performed using several successful high fidelity models produced through these resource centres
Wilderness medicine: a fellowship programme
Authors: Mallinson Tom
Published: May 2014

The Fellowship of the Academy of Wilderness Medicine qualification (FAWM) was set up in 2005 by the Wilderness Medical Society based in America and currently has 640 candidates, and 176 Fellows. It provides a great opportunity to gain and demonstrate knowledge of expedition and wilderness medicine and to gain recognition for practical experience you have gained in this area. The Wilderness Medical Society also offers a number of other benefits to its members and continues to develop new services and qualifications year after year.
Finding the missing link
Authors: Sibson Lynda
Published: May 2014

Last month, the National Audit Office (NAO) published Major trauma care in England. Published with little fanfare, it evaluated trauma care services in England; the cost-effectiveness of planning and delivery of these services; and the quality of care, including patient outcomes. Every year in England alone, 193 hospitals manage the estimated 20 000 cases of major trauma, which although only account for 0.2% of total activity, result in over 5000 deaths. However, this fraction of clinical care costs over £3 billion in hospital treatment, as well as further care and rehabilitation.
Improving systems for research management and governance
Authors: McLure Sally A , Dorgan Sharon , Smith Justine
Published: May 2014

The North East Ambulance Service NHS Trust (NEAS) is committed to the implementation of a number of nationally proposed initiatives following the introduction of the research strategy Best Research for Best Health (Department of Health, 2006). The ambitious strategy introduces several measures to improve the research environment and ensure that studies commence more efficiently. This article provides an overview of the national initiatives, i.e. the Research Passport Scheme and the National Institute for Health Research Coordinated System for gaining NHS Permissions. These initiatives aim to strengthen and streamline research management and governance across England, which NEAS are actively embracing.
Prehospital care: the case of the misplaced tube
Authors: Mursell Ian
Published: May 2014

This article critically reviews a fictional case study regarding a misplaced tracheal tube that was initially unrecognized despite a rigorous assessment to verify placement. It critically reviews the evidence surrounding verification techniques, tracheal tube securing and the principles of legal and ethical responsibility in patient handovers and transfer of care.
A review of trauma patients taken to hospital by air ambulance
Authors: Whittingham Eleanor , Bleetman Tony
Published: May 2014

Introduction

Doctors are being introduced on air ambulance services in the UK. Meaningful assessment of air ambulance services is difficult owing to inter-service variation. County air ambulance (CAA) (rebranded as Midland's Air Ambulance after this article was written) progressively introduced doctors into their service from 2006 providing an opportunity to gather data and quantify the sample size that will be required to assess their impact on patient survival.

Method

CAA trauma alerts to Selly Oak Hospital (the main receiving hospital for the service) between 1 January 2006-30 June 2007 were reviewed. Crew composition, mission data and patient notes were examined and the abbreviated injury score 98 and injury severity score were used to calculate the probability of survival. Survival outcome was ascertained at 90 days. Data analysis included survival analysis; Cox regression; logistic regression; tests for association (CI 95%, P<0.05). Post-hoc power calculations were undertaken.

Results

299 cases were identified, 186 met the inclusion criteria. The probability of survival ranged between 5.56-99.48%. There was no statistically significant association found between crew composition and survival (P=0.355) and post-hoc power calculations showed 54 258 events would be required to assess this. If accepting 80% power and assuming our proportion of 14% mortality ± 5%, 800 events would be required in each arm of future studies.

Conclusions

Our post-hoc power calculations revealed that a national or multi-centre study is needed to assess this aspect of aircrew composition in order to prove or discount associations between crew composition and survival at 90 days. Now that a power estimate is available, designing adequately powerful studies will be possible; enabling monitoring the increasing deployment of this expensive resource and examining the effect of doctors on air ambulances. This is of increasing importance to assess as medically-led air ambulance missions increase.
The neurological outcome of post-cardiopulmonary resuscitation
Authors: Stancil Stewart A
Published: May 2014

EMS personnel immediately see the results of resuscitation failures, but rarely are they able to see the long-term positive outcomes of their efforts. Paramedics are occasionally involved in successful cardiopulmonary codes. They have insight into the situation by seeing the location and events surrounding the emergency first-hand, but without having much awareness of the long progression to recovery or of specifically how their team's interventions may have aided that recovery. During medical school, the author had the opportunity to follow such patients and observe their progression daily through the emergency department (ED), intensive care unit (ICU), hospital medical wards, and finally to discharge.

This case report discusses the neurological recovery of Mr L, a patient who was successfully resuscitated from a cardiopulmonary code. The case report will highlight his recovery, as well as examine some of the interventions that were made at the prehospital and emergency department level that played a positive role in the patient's recovery. To focus on the specific components of the case which are relevant to EMS, only information essential to the case discussion is presented.
Bridging the gap in evidence base
Authors: Sibson Lynda
Published: May 2014

The JPP aims to support and encourage the continuing professional development of paramedic practice. Part of this development focuses on the evidence and research underpinning clinical practice in the prehospital and urgent care setting, which has been relatively limited compared to other clinical areas. As the paramedic profession develops, so the evidence base is also beginning to grow.
Paramedic management of shock in trauma: unlocking the potential
Authors: Hitt Andy
Published: May 2014

Globally, traumatic injury is a leading cause of death for patients under 45 years old. A consequence of serious or poorly managed trauma is shock—a clinical syndrome that is both preventable and treatable if spotted in time. Heightened pathophysiological awareness and a review of diagnostic methods may promote early circulatory support rather than aggressive resuscitation. This could reduce the risk of iatrogenic complications and avoid unnecessary delay. The aim of this article is to critically appraise the treatment options currently available to UK paramedics and postulate realistic improvements based on underlying pathophysiology.
Mentorship for paramedic practice: is it the end of the road?
Authors: Sibson Lynda , Mursell Ian
Published: May 2014

This final article in the series of mentorship for paramedic practice concludes with the identification and management of the struggling or failing student. Although fortunately a relatively uncommon occurrence in practice, mentors will occasionally be required to manage their own students and also other mentors' students who are experiencing difficulties in practice. This article addresses some of these issues, such as identifying and managing problematic behaviour and also the use of various strategies by which to manage to students, including the use of action plans. The article concludes with the issue of inconsistent mentorship and the effect that this can have on the students.
Urgent & Emergency Care Review: response of the Association of Ambulance Chief Executives
Authors: Flaherty Martin
Published: May 2014

Following the publication of Sir Bruce Keogh's end-of-phase-1 report of the Urgent and Emergency Care Review on 13 November 2013, Martin Flaherty provides a response on behalf of the Association of Ambulance Chief Executives.
Is the role of the paramedic lecturer practitioner fit for purpose?
Authors: Lavender David
Published: May 2014

Lecturer practitioners have been in existence in nursing since the late 1980s ( Elcock, 1998 , Ramage, 2004 ). Since then the role has been developed and refined, but the overarching concept has remained the same: that is to support students and staff in their workplace ( Redwood et al, 2002 ). Paramedic education has moved into the higher education arena, and with it comes the responsibilities of supervising and managing students in clinical practice. The lecturer practitioner role is currently one of the ways in which this issue is tackled.

Within this literature review the role of the lecturer practitioner in the wider health care context is considered, followed by an examination of the successes and problems encountered in the role. An evaluation of future strategies to improve the role then ensues followed by a discussion section that relates the identified literature to paramedic practice. The overall conclusion is that the lecturer practitioner role is suitable for paramedic practice but some adjustments should be made to the nursing model in order to accommodate the peculiarities of paramedic practice.
Sexually transmitted infections: impact in the remote and overseas environment
Authors: Osborne Stephen
Published: May 2014

Sexually Transmitted Infections (STIs) and remote areas workers have a direct relationship more so than in other workforces. Overseas and migrant workers appear to be affected by these types of infectious diseases in greater numbers than in other workforces (apart from the commercial sex industry) for a differing number of reasons. The relative loneliness and isolation, being away from spouses or regular partners for long periods of time, and relative high disposable income associated with the work all contribute to a large proportion of workers engaging in risky sexual practices whilst away on projects.

The contracting of these infectious diseases obviously has a cost to the worker, their families, health services, and also to their employer in terms of family cohesion, treatment, and possible lost productivity/time. It is important that greater preventative measures are required to ease the suffering and cost to all concerned.
Exploring emergency airway management techniques for paramedics
Authors: Parry Andy , Higginson Ray
Published: May 2014

Any patient's condition can deteriorate rapidly and for many different reasons. Maintaining a patient's airway and facilitating breathing is the main priority in any emergency situation, although achieving airway control can be difficult. All health professionals need to be able to safely undertake airway management and the key to the management of an airway is through a thorough assessment to firstly ensure whether the airway is patent or not. This paper will discuss airway management in the emergency and intensive care setting.
Videoscopes: an additional tool for managing the pre-hospital airway
Authors: Hodkinson Mark
Published: May 2014

Airway management by pre-hospital care providers is often the subject of intense debate. It is recognised that there are wide variations in clinical training and skill fade is high among paramedics due to lack of experience and exposure ( Hodkinson, 2010 ). Recent years have seen the development of a wide variety of video based laryngoscope devices, several of which have potential application to the pre-hospital field. There are a number of advantages and disadvantages to these devices, which are explored in more detail. Prior to any recommendations being made, further research including clinical trials would be required in the pre-hospital field, to assess the suitability of videoscope devices for paramedic airway management.
Reviewing the standards of proficiency for paramedics
Authors: Peate Ian
Published: May 2014

Following the recent consultation concerning the profession-specific standards of proficiency for paramedics which closed on 31 January 2014, Ian Peate outlines the role of the standards and how they impact a paramedic's ability to practise safely and legally.
Private ambulances—from nowhere to Government recognition in two years
Authors: Davis David
Published: May 2014

With the Independent Ambulance Association's conference The Vital Link taking place next month, David Davis, Director, Independent Ambulance Association, explains the emergence of private ambulances and the impact they will likely have on the future of healthcare.
Paramedic attitudes to deliberate self-harming behaviour in Ireland
Authors: O'Sullivan Brian
Published: May 2014

The National Suicide Research Foundation tells us there were 12 210 presentations of deliberate self harm (DSH) to emergency departments in the Republic of Ireland in 2012 ( National Suicide Research Foundation, 2012 ). They note the highest rate of DSH was among 15–19-year-olds.

The purpose of this article is to stimulate discussions and reflections among paramedics around DSH, to identify beliefs around this issue and perhaps, to challenge some of these beliefs.

The paramedic may be the first point of contact for increasing numbers of mental health patients. Our focus is on repairing physical injuries with little attention being given to the patient's experience
Diagnosis of granulosa cell tumours and cryptorchids — using anti-Müllerian hormone to confirm clinical suspicions
Authors: Rendle David
Published: May 2014

Retained testicles and granulosa cell tumours may be suspected, or even diagnosed, from a history and clinical examinations. However, endocrine assessment is typically required to confirm the diagnosis and provide greater confidence of clinical findings prior to surgical excision of the affected gonad being performed. Anti-Müllerian hormone provides a convenient, reliable and cost-effective option for diagnosing both conditions. The following article discusses the use of this new assay.
Equine Review
Authors: Parker Russell
Published: May 2014

Introduction:

This edition of Equine Review considers papers on laparoscopic castration without orchidectomy, parasagittal fracture of the proximal phalanx, and swellings of the angle of the mandible.
Practical management of equine metabolic syndrome
Authors: Dyson Jo
Published: May 2014

Equine metabolic syndrome (EMS) is a clinical syndrome, the components of which are increased adiposity, hyperinsulinaemia and insulin dysregulation resulting in a predisposition to developing laminitis. It has been described as EMS because it has many similarities to metabolic syndrome in man, which designates a set of risk factors which predispose to coronary heart disease and type 2 diabetes mellitus. The aim of this article is to describe the diagnosis and management of EMS in ambulatory practice.
Nausea and vomiting in terminally ill patients: towards a holistic approach
Authors: Close Helen
Published: May 2014

Nausea and vomiting are common and distressing symptoms of advanced cancer for which there are currently no systematic and rigorous assessment tools. The advent of extended nurse prescribing gives nurses the opportunity to address these symptoms but puts the onus on them to provide a clear rationale for prescribing decisions. A care study is used to illustrate aspects of holistic management of these symptoms. An assessment tool described by Twycross and Back (1998) is suggested as a method for the nurse prescriber to manage nausea and vomiting in a rigorous, holistic manner. Recommendations are made regarding the development of an holistic assessment model and a flow chart to guide decisions regarding the management of terminally ill patients with nausea and vomiting.
Bringing practice up to date: progress with nurse prescribing
Authors: Crown June
Published: May 2014

Baroness Cumberlege (2003) has described the introduction of nurse prescribing in the United Kingdom. Her report on Neighbourhood Nursing (Department of Health and Social Security (DHSS), 1986) was followed by the establishment of an Advisory Group on Nurse Prescribing, which was asked to consider the extension of prescribing rights to nurses working in the community. The key recommendation of the Advisory Group's report (Department of Health (DH), 1993) was that specially trained district nurses and health visitors should be able to prescribe from a limited list of products. The legislation to implement this was passed in 1992. There followed a prolonged series of pilots, aimed at establishing the clinical effectiveness and economic impact of nurse prescribing. The national roll-out of this programme was not completed until 1998.
Nurse prescribing of the combined oral contraceptive pill
Authors: Little Carole
Published: May 2014

The introduction of extended nurse prescribing will enable nurses to prescribe the combined oral contraceptive pill either to a first-time user or as a repeat prescription. This article outlines how essential it is to assess and take a good history from women. It looks at the health benefits and health risks associated with taking combined oral contraception and at why they differ depending on the age of the woman. It will also discuss how nurses who are not extended prescribers can initiate and repeat supply the pill under patient group directions.
The 5th Association for Nurse Prescribing conference, Birmingham 11–12 February, 2003: ‘Nurse Prescribing Re-engineered’
Authors: Allen Daniel
Published: May 2014

It may not have had much to do with nursing but it was a good way to ease the audience into the second day's proceedings at the Association for Nurse Prescribing's fifth annual conference. The chair for the day, Baroness Julia Cumberlege, asked delegates to write down a favourite colour, animal and place and three words to describe each. The colour, she said later, and the words you chose to describe it, was how you saw yourself; the animal represented the way others saw you; and your chosen place represented your love life. For those of us who chose an elephant for favourite animal and described our favourite place as windswept, lonely and barren, the day could only get better.
The impact of nurse prescribing in a changing primary care environment
Authors: Colin-Thome David
Published: May 2014

The shape of the NHS is changing radically under the auspices of the NHS Plan - a 10-year strategy to put the patient back at the centre of the health service. The vision is for prompt, convenient and high-quality services built around the needs of the patient rather than the system itself.
Drugs for chronic obstructive pulmonary disease (COPD): what works and why
Authors: Booker Rachel
Published: May 2014

Chronic obstructive pulmonary disease (COPD) causes considerable morbidity, but appropriate drug therapy can reduce symptoms and exacerbations and can result in improved quality of life for patients. The mainstays of symptomatic treatment are beta2-agonist bronchodilators (β2-agonists) and/or anticholinergic bronchodilators. Long-acting β2-agonist and anticholinergic bronchodilators have been shown to reduce exacerbation ates in clinical trials. Inhaled corticosteroids may also reduce exacerbation rates in patients with moderate-to-severe disease and combination inhaled corticosteroid and long-acting β2-agonist inhalers have recently been licensed for use in COPD.
Maximizing effectiveness and minimizing cost: improving patients' use of medicines
Authors: Khurana Vinni
Published: May 2014

The Medicines Management Service Collaborative programme is an important new government initiative. Its overall aim is to ensure that patients get the most from their medicines. This programme focuses mainly on repeat prescribing issues. Small, gradual quality improvements can occur through the sharing of ideas and outcomes. These bite-sized changes are the essence of this project’s collaborative approach. All practitioners that prescribe can gain vital knowledge from this collaborative project.
Pharmaceutical add,on therapies for patients with type 2 diabetes
Authors: Fisher Miles
Published: May 2014

The management of type 2 diabetes can be based on structured guidelines. If a patient is not controlled by changes in lifestyle, then oral hypoglycaemic agents should be introduced at an early stage. The doses of oral agents should be titrated until HbA1c targets are met, and many patients will require a combination of oral agents. The new agents,thiazolidinediones (glitazones) can be used in combination with metformin or sulphonylureas to reduce insulin resistance.
Ensure you are legally covered by patient group directions
Authors: Jack Kirsten
Published: May 2014

Patient group directions (PGDs) are ‘written instructions for the supply or administration of medicines to groups of patients who may not be individually identified before presentation for treatment’ (NHS Executive, 2000). They enable a doctor (or dentist) to give a general direction to another health professional to administer or supply certain medicines to a specified group of patients. Legislation to enable PGDs came into force in 2000 in amendments to the Medicines Act 1968.
The powers of independent nurse prescribers in the acute sector
Authors: WILLIAMS MAUREEN
Published: May 2014

A reader asks, what are the boundaries of independent nurse prescribing in a hospital?
Exercising new flexibility to source mentor funding
Authors: Scott Linda
Published: May 2014

In many primary care trusts (PCTs),a major obstacle for nurses wishing to embark on the extended and supplementary prescribing course has been one of finding a supervising medical practitioner (SMP) to support the required ‘12 days learning in practice’ (DH, 2004). Medical practitioners on the front line of primary care (i.e. GPs) have so far had limited involvement in the educational support that they have been asked to deliver, and finding GPs who are both willing and have the time and experience to mentor and assess a trainee nurse prescriber as a gesture of goodwill, has been difficult. Of course GPs have contractual agreements to fulfil in primary care and their own access targets to meet.
The management of constipation by nurse prescribers
Authors: Duncan Julie
Published: May 2014

Constipation is a common, troublesome symptom. In most cases it can be managed successfully in primary care, although chronic, intractable constipation may need further investigation. First-line therapy should involve simple life-style measures. If these are not successful, a laxative regimen is a useful adjunct. Behavioural therapy (biofeedback) is an effective treatment of chronic constipation.
The Sixth Annual Conference of the Association for Nurse Prescribing: ‘revolution or evolution?’
Authors: Lewis Carol
Published: May 2014

Nurse prescribing has been the subject of much enthusiasm among nurses, and at the Association for Nurse Prescribing (ANP) Sixth Annual Conference, 12,13February, there was no shortage of speakers eager to tell delegates that they were ‘breaking down barriers’, ‘creating waves’ and ‘at the forefront of change’.
Choosing the right pharmacological therapy in allergic rhinitis
Authors: Salib Rami J , Howarth Peter H
Published: May 2014

Allergic rhinitis is a global health problem affecting 10-% of the world population. Its impact is often under-appreciated with afflicted patients having a significantly impaired quality of life. It has a profound socio-economic impact with direct medical costs, and considerable indirect costs relating to absences from work and school, and reduced productivity. Its prevalence has been steadily increasing over the past decade. Pharmacological therapy in allergic rhinitis can be confusing as there are many treatment choices to consider. An overview of the pharmacological agents available for the treatment of allergic rhinitis is provided in the context of a stepwise management approach.
The new consultation on the Nurse Prescribers’ Extended Formulary
Authors: Baird Anne , Jones Kathryn , Heywood Sally
Published: May 2014

The primary care perspective The acute care perspectived
Nurse prescribing for an exacerbation of hay fever in general practice
Authors: Lea Sarah
Published: May 2014

This is a reflective account written by a practice nurse who specializes in minor illness management. She became an extended nurse prescriber in early 2003. The patient in this case study already suffers from hay fever. He then develops symptoms of rhinitis during the winter months. The scenario explains how the nurse diagnosed and treated the patient.
Appropriate prescribing for older people: managing the effects of ageing
Authors: Banning Maggi
Published: May 2014

The National Service Framework for Older People (DH, 2001) was developed in response to the need for increased pharmacovigilence with regard to the prescribing of medication for people with increasing age. The effects of ageing on the ability of the body to respond to the effects of medication is fairly widely researched. Nurse prescribers should understand the effects of age on how the body handles medication and consider the implications of age when prescribing medication to older people.
Nurse prescribing in a palliative care setting: brachial plexus pain
Authors: Bamkin Diane
Published: May 2014

The author has been working in the community for the past 6 years as a clinical nurse specialist in palliative care. She has been an extended formulary nurse prescriber for the last 18 months, during which time the list of drugs available for her to prescribe has increased substantially (Department of Health (DH), 2004). This study describes how the author’s prescribing skills were used to provide effective relief for a patient whose pain was not well managed.
A trainee prescriber's questions on interpreting the Extended Formulary
Authors: Fitzsimmons Lyn , Baird Anne , Courtney Molly , Otway Chris
Published: May 2014

Lyn Fitzsimmons: In the article, ‘Ibuprofen for migraine: on prescription or over the counter?’ (Nurse Prescribing 2003; 1(3): 142), it was stated that extended formulary nurse prescribers cannot prescribe ibuprofen for migraine, because migraine is not a listed condition. However, ibuprofen is precribable under the Nurse Prescriber’s Formulary (NPF) for district nurses and health visitors, which extended nurse prescribers can also prescribe from. Are extended nurse prescribers only allowed to prescribe from the NPF for the medical conditions listed? If so, which condition are we supposed to prescribe catheter maintenance solution for? And can we not prescribe ibuprofen or paracetamol for a pyrexial child with a viral illness (viral illnesses and otitis media are not listed conditions and yet are commonest causes for pyrexia in children);? It seems to be an incredibly complicated system.
Prescribing antibiotics: how closely are local guidelines adhered to?
Authors: Dale Maria
Published: May 2014

In the light of the overuse and misuse of antibiotics, and increasing resistance to these drugs, an audit was undertaken to examine how closely local guidelines are adhered to in the author’s workplace. Examining the prescribing of ciprofloxacin, it was ascertained that this drug is prescribed appropriately as second line in 79% of cases, although specific antibitotic sensitivities were obtained in only 16% of patients. This audit was conducted before the publication of the new 2004 NHS Tayside Area Prescribing Guide, therefore this article reveals how closely the 2002 guidelines were adhered to.
Consent to examination and treatment 2: the incapable adult patient
Authors: Griffith Richard
Published: May 2014

In the second of three articles on consent and nurse prescribing, Richard Griffith considers how the law allows a nurse prescriber to proceed with the examination and treatment of a patient who is unable to consent to treatment. How nurse prescribers should determine whether treatment is in an incapable adult patient’s best interests is also considered.
The voice of nurse prescribers is getting louder
Authors: Stuttle Barbara
Published: May 2014

February marked the Seventh Annual Association for Nurse Prescribing conference. This year’s conference was excellent, with a range of prominent speakers including Professor Sir George Alberti and Beverly Malone, General Secretary of the Royal College of Nursing. Both days were superbly chaired by Dr June Crown and Baroness Julia Cumberlege respectively.
Getting it right: diagnosing chronic obstructive pulmonary disease in primary care
Authors: Booker Rachel
Published: May 2014

Chronic obstructive pulmonary disease (COPD) is an under-diagnosed but important respiratory disease that kills 30 000 people a year in the UK and utilizes a large amount of health service resources. Earlier diagnosis has the potential to reduce morbidity and health service utilization, but diagnosis is not always straightforward. The presenting symptoms, clinical history, examination findings, spirometry and results of diagnostic tests all need to be considered before a diagnosis of COPD can be reached.
The Seventh Annual Conference of the Association for Nurse Prescribing: looking towards the future
Authors: Saunders Kate
Published: May 2014

There was a sense of achievement at this year’s annual Association for Nurse Prescribing (ANP) conference. Held in London on the 21st and 22nd February, the ANP’s President, June Crown, opened the conference full of enthusiasm, excited to see how much nurse prescribing has grown since its introduction in May 1998. In addition to praising the progress of nurse prescribers, June also looked to the future and towards the goal of one formulary for all health professionals–a theme which was to run throughout the conference. Other key themes emerging from the two days included the importance of full prescribing rights for nurses and the impact of the Shipman inquiry.
Childhood immunization: encouraging the uptake of key vaccinations
Authors: Griffith Richard
Published: May 2014

Childhood immunization is a key tool in protecting the health of the nation's children from indigenous infectious diseases such as measles, mumps and rubella. However, vaccination rates have fallen from the 95% required for population immunity to around 84% and the Health Protection Agency is concerned that an epidemic might result. This concern has fuelled a renewed debate on the use of compulsory vaccination particularly as the decline in uptake is put down to publications suggesting a link between the measles, mumps and rubella (MMR) vaccine and autism or inflammatory bowel disease, although the validity of this research is disputed. This article considers the likelihood of compulsory vaccination in childhood and the nurse prescribers role in educating parents on the benefits of childhood immunization.
Asssessing and improving the consultation skills of nurses
Authors: Hastings Adrian
Published: May 2014

Consultation Assessment and Improvement Instrument for Nurses (CAIIN) provides a set of competences that describe what a practitioner does when consulting with patients. These include behaviours to develop good relationships with patients, ways of communicating that allow the patient to tell the story of illness in their own words, practical procedures such as using diagnostic instruments and the thinking processes needed to make accurate diagnoses and negotiate the most appropriate care plan. This approach facilitates the development of a patient-centred, problem-solving style of consultation. This talk will describe the importance of this approach, and will describe how the CAIIN was developed from a similar instrument used with GPs and medical students, and continue by discussing how it can facilitate the teaching of advanced consultation skills to nurses in extended roles.
Hormonal control and the endocrine system: achieving homeostasis
Authors: Davis Geraldine
Published: May 2014

The endocrine system is one of the primary control mechanisms in the body. This article defines some of the terminology used in describing the endocrine system and describes some examples of hormone systems and how drugs may be used to help manage these.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

Is soya contraindicated in patients taking thyroxine?
Oral contraception: past, present and future
Authors: Ainsworth Steve
Published: May 2014

It was 45 years ago this month that Britain entered a new era. The launch of the first method of oral contraception dubbed the ‘Pill’ became synonymous with the ‘swinging sixties’. In this article Steve Ainsworth looks at the history of oral contraception, its impact and its future.
The management of sexually transmitted infections in a primary care setting
Authors: Baird Anne
Published: May 2014

Genitourinary medicine clinics are struggling to cope with the increase in sexually transmitted infections. Primary care has been identified as a possible area within which screening and treatment can be offered, and there are many opportunities within the general practice setting for this to take place. This article will consider the role of the primary care nurse in the screening, diagnosis and treatment of patients with sexually transmitted infections. It will also discuss the specific opportunities open to the nurse prescriber.
Adverse drug reactions and non-compliance with prescribed medication
Authors: Griffith Richard
Published: May 2014

Adverse drug reactions are one of the most common causes of patient non-compliance with prescribed medication. It is essential that nurse prescribers have up to date knowledge of adverse reactions in order to exercise their duty of care to their patients by giving appropriate advice and ensuring adequate monitoring and early detection of unwanted effects. This article outlines the extent of the non-compliance problem due to adverse reactions and makes recommendations to nurse prescribers for improving patient concordance with prescribed medicines, reporting adverse drug reactions via the yellow card scheme and how to obtain up-to-date information on unwanted side effects.
Highly active anti-retroviral therapy in children with HIV
Authors: Houghton Juliet
Published: May 2014

There are increasing numbers of human immunodeficiency virus (HIV) positive children in the UK; the majority of whom are receiving highly active anti-retroviral therapy (HAART). This article describes the aetiology and transmission of HIV, the common treatment of children with HIV, and the specific issues that affect children and families with HIV, with a particular focus on medications used and factors affecting adherence or concordance with these therapies and the long-term issues associated with HAART.
Continuing professional development: what is it and how do I get it?
Authors: Bramley Ian
Published: May 2014

Continuing professional development (CPD) is an essential requirement for prescribers. This article discusses its contribution to patient and practitioner safety and how it assists service development and clinical governance. It is proposed that CPD activity should address a wide range of issues: legal, professional and ethical, therapeutic, pharmacological and economic. A number of suggestions of ways in which practitioners can achieve their CPD goals are suggested. These range from ad hoc to formal arrangements which can be validated as the prescriber records CPD activity and reflects on its impact on their practice.
Supporting the changes in nurse prescribing
Authors: Baird Anne
Published: May 2014

On 1 May 2006, the Nurse Prescribers’ Extended Formulary ceased to exist. All extended formulary nurse prescribers were automatically registered as independent prescribers by the NMC. Independent prescribers are able to prescribe from the entire British National Formulary (BNF), within their scope of practice, with the exception of unlicensed drugs and most controlled drugs. This exciting step is not without risk. A strong clinical governance framework is essential to manage a safe and effective transition (Royal Pharmaceutical Society of Great Britain, 2006).
Tick-borne encephalitis: effective prevention of a growing problem
Authors: Mayor Sue
Published: May 2014

Growing awareness of the countries within the expanded European Union is increasing interest in travel to ‘new Europe’. Many of these locations have a natural landscape and attractions that appeal to travellers looking for places to enjoy outdoor pursuits and activities. Travel to these rural areas (and also to more established European locations) is increasing the risk of contracting tick-borne encephalitis (TBE). This article highlights the countries with risk areas, how TBE is contracted, its symptoms and the preventative measures that can be taken (including vaccination) before travelling.
Hayfever: diagnosis and everyday management
Authors: Willington Jenny
Published: May 2014

The estimated incidence of hay fever (seasonal allergic rhinitis) is 10-25% worldwide. Although it is considered by some to be a trivial complaint, this is not always the case, with some individuals affected severely, to the extent that their choice of career or summer activities is restricted. This article focuses on the current thinking on hay fever, its diagnosis, and its practical everyday management.
Bird flu: putting the risks in perspective
Authors: Ainsworth Steve
Published: May 2014

An outbreak of bird flu is certainly bad news for chickens, but the risks to humans are less clear. Is it possible to predict and prepare for an outbreak of a virus that can mutate as readily as influenza?
Epilepsy: the challenges facing the non-medical prescriber
Authors: Truscott Tracey Ann
Published: May 2014

Epilepsy is a tendency to experience srepeated seizures, and diagnosis is based on the information provided by the person who experiences seizures and witness accounts. This paper includes a case study that focuses on issues that influence prescribing for women of child-bearing age, highlighting the many challenges for the non-medical prescriber, i.e. establishing accurate diagnosis, understanding epilepsy syndromes and treatment options. Key issues such as teratogenic potential of antiepileptic medication and interactions with the combined oral contraceptive pill are explored.
A nurse prescriber's guide to the Mental Capacity Act 2005
Authors: Griffith Richard
Published: May 2014

In April 2007 the Mental Capacity Act 2005 will come into force and change the law relating to the care and treatment of incapable adults in England and Wales. Nurse prescribers will be required to assess capacity and determine an incapable adult's best interests by reference to the 2005 Act. This article outlines the major changes to be introduced by the Mental Capacity Act 2005 and how these will affect nurse prescribers.
A heated health hazard
Authors: Cheesman Sarah
Published: May 2014

Summer is well and truly here and I was recently reminded of an important piece of health advice we should be passing on to our patients in this hot and humid weather. I was rummaging in the cupboard under the basin in the downstairs toilet - I had a headache and I knew I had some paracetamol in there somewhere. I eventually found them in the plastic box that is my first aid kit. The expiry date on the package was still valid, but when I popped them out of the bubble pack something clearly was not right. The tablets were crumbly and soft, and my initial, if somewhat irrational, thought was that I had been sold counterfeit drugs.
Managing the care and treatment of type 2 diabetes patients during Ramadan
Authors: Capaldi Brenda
Published: May 2014

Type 2 diabetes is more common in those of South Asian origin than in the general population in the UK. Fasting and feasting are important parts of cultural heritage for this patient group and present a challenge in terms of management of blood glucose levels. Patients with diabetes who choose to fast during the month of Ramadan need to be particularly careful with regard to their blood glucose monitoring and may need to adjust their treatment regimen.
Blood pressure: anatomy and physiology in relation to drug therapies
Authors: Davis Geraldine
Published: May 2014

This article examines how heart rate and the stroke volume (i.e. cardiac output) affect blood pressure and also at the different causes of resistance to blood flowing freely through the blood vessels. It also notes the influence of sympathetic nervous system activity on the release of adrenaline and noradrenaline which also have an effect on blood pressure. The action of drugs commonly prescribed to combat hypertension are then examined in this context.
Clinical ethics and the commercial pressures
Authors: Spicer John
Published: May 2014

The NMC specifies that a nurse's professional judgement should not be influenced by commercial pressures, but this guidance is limited to rather broad statements of intent. More specific guidelines tend to be written by employing bodies such as primary care trusts. Prescribers are contrained by local or national guidelines on whether they may or may not prescribe certain medicines. However, parmaceutical companies continue to offer gifts emblazoned with logos and invitations to attend sponsored educational events - indicating that they still believe that prescribers have a certain amount of automony. This article reflects on whether it is ever acceptable to accept gifts or invitations from pharmaceutical companies and offers suggestions for arriving at a personal ‘code of conduct’ when faced with commercial pressures.