bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of wound dressings on the pH stability of fuids
Authors: Uzun M. , Anand S.C. , Shah T.
Published: May 2014

Objective:

To investigate and evaluate the effect of 20 commercial wound dressings on the pH values of selected fluids upon contact, over a period of 7 days.

Method:

The effect of the dressings on the pH of two different solutions, solution a (2.298g sodium chloride [NaCl], 0.368g calcium chloride [CaCl2] dihydrate added to 1 litre of de-ionised water) and distilled water, was investigated over a period of 7 days. Two different methods for contacting fluid with the dressings were used, to simulate wounds with different levels of exudate: i) immersing the dressing in 35ml fluid, and ii) adding 5ml drop-wise onto the dressing's absorbent pad on a daily basis.

Results:

on immersion of the dressings, the pH values of the fluids changed quite appreciably over time, with similar results for both methods. The lowest pH values were found with the hydrocolloid dressings, for both solution a and distilled water. The foam dressings had an alkaline effect on the fluids; in most cases, they increased the fuid's pH significantly. The non-woven dressings reduced the pH of both fluids to a lesser extent than the hydrocolloid dressings. The hydroactive dressings decreased the pH value of solution a and increased the pH of distilled water.

Conclusion:

This study demonstrates that the pH values of the fluids are not constant, likely due to the complicated nature of the dressings’ chemical structures and designs. Thus, optimisation of pH level to meet the requirements of any specific wound types and healing processes must consider the complex nature of the dressing. The increase in pH value of the wound over time needs to be minimised in order to maximise the effectiveness of the healing therapy.

Declaration of interest:

This work was supported by a financial grant from the Turkish Council of Higher education in collaboration with Marmara university, Turkey and the university of Bolton, UK. The authors have no conflict of interest to declare.
The impact of atraumatic vs conventional dressings on pain and stress
Authors: Upton D. , Solowiej K.
Published: May 2014

Objective:

To compare the pain and stress experiences of patients with chronic wounds being treated with atraumatic vs conventional dressings at dressing change.

Method:

This exploratory study adopted an independent samples design to identify any differences between reported levels of pain and stress associated with the use of atraumatic and conventional dressings used in treatment regimens of patients with chronic wounds. Physiological and psychological assessments of pain and stress were recorded at dressing change (including numerical ratings, heart rate, blood pressure, respiration rate, GSR, salivary cortisol and the Perceived Stress Scale (PSS) and State Trait anxiety Inventory (STAI) questionnaire surveys).

Results:

In total, 49 patients with chronic wounds took part in the study. Fifty-three percent of patients were male (n=26) and 47% were female (n=23). Patients were aged 38–95 years, with a mean age of 69.11 ± 14.08 years. overall, 10 patients were receiving atraumatic dressings with Safetac technology as part of their routine wound treatment and 39 were receiving conventional dressings. Patients receiving atraumatic dressings reported significantly lower numerical pain and stress ratings and experienced significantly lower GSR at dressing change. Mean heart rate, blood pressure, salivary cortisol were also lower for patients with atraumatic dressings. However, patients' PSS (atraumatic=24.60, conventional=22.72) and STAI (atraumatic=34.90, conventional=33.21) scores were similar for both dressing type groups.

Conclusion:

This study provides a basis for understanding how different dressing types can impact pain and stress at dressing change. acute episodes of pain and stress were much lower in patients receiving atraumatic dressings;0 however factors associated with the overall experience of living with a chronic wound may be contributing to underlying and ongoing feelings of stress and anxiety. The impact of these implications on selection of dressings and cost of care are also discussed.

Declaration of interest:

This research was commissioned by Mölnlycke Health Care. None of the authors work for Mölnlycke Health Care or have any financial interests with the company. There are no additional conflicts of interest to declare.
The use of larval therapy to reduce the bacterial load in chronic wounds
Authors: Blueman D. , Bousfield C.
Published: May 2014

Objective:

To ascertain the effect of larval therapy against bacteria associated with infected chronic wounds, and determine if larvae therapy actively reduces the bacterial load in chronic wounds.

Method:

An extended literature review was undertaken using online databases: Athens, Medline, EMBASE, British Nursing Index and Allied and Complementary Medicine via OVID and Cumulative Index to Nursing and Allied Health. Key terms were searched worldwide from 1950 to 2011.

Results:

Four themes emerged: Gram-positive and Gram-negative bacteria, MRSA, quorum sensing: biofilm consideration and bacterial burden. This suggests larvae debridement therapy is differentially effective against both Gram-positive and Gram-negative bacterial strains, namely Staphylococcus aureus, Pseudomonas aeruginosa and meticillin-resistant Staphylococcus aureus.

Conclusion:

The evidence supports the use of antimicrobial properties of larvae therapy against the bacteria of infected chronic wounds.

Declaration of interest:

There were no external sources of funding for this literature review. This paper is based on an independent study submitted as part of the BSc Health Care Studies, (Tissue Viability), University of Nottingham, UK. The authors have no competing or financial interest to declare and ethical approval and funding were not required to undertake the study.
Use of acellular dermal regeneration template combined with NPWT to treat complicated extremity wounds in children
Authors: Hutchison R.L. , Craw J. R.
Published: May 2014

Objective:

The treatment of open wounds with exposed bone, tendon, or nerve is a challenging reconstructive problem, especially in children. The purpose of this study is to evaluate the safety and effectiveness of using acellular dermal templates combined with negative pressure wound dressings in the treatment of complicated paediatric soft tissue extremity wounds.

Method:

A retrospective review of eight patients treated with acellular dermal templates for closure of complicated extremity wounds was performed. After debridement, all patients were treated with a template and a negative pressure wound treatment (NPWT) system.

Results:

The average age was 8.8 years with 4 females and 4 males. Four wounds were at the foot/ankle, with tendon exposed in all 4, nerve in 2, and bone in 3. There were 3 lower leg wounds, all with exposed bone. One patient had arm/hand wounds with exposed tendon. The size of the wounds and dermal graft averaged 86cm2 and 57cm2. The average time to wound closure was 65 days. The majority of the treatment was received as an outpatient, including NPWT. For inpatient and outpatient care, the average number of sponge system changes was 2.6 compared to 4.6, and time between changes was 3.5 compared to 6.8 days. Each patient had only one procedure each for application of the dermal substitute and later one skin grafting procedure. Complications were minimal, and all patients healed their wounds without the need of flaps. One patient required wound revision.

Conclusion:

Our study demonstrates that a dermal template combined with NPWT can safely and effectively be used to treat complicated wounds in children. Closure was obtained without flaps, the majority of the treatment time was spent in the outpatient setting, and the complication rate was low.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Focused rigidity casts: an overview
Authors: Dagg A.R. , Chockalingam N. , Branthwaite H.
Published: May 2014

Focused rigidity casts (FRCs) are a novel treatment made from polymer semi-flexible cast material, used in the management of plantar foot ulceration to offload the site of ulceration. Current anecdotal evidence suggests that use of FRCs helps achieve quicker healing time. While FRCs were first used in the treatment of fractures, previous reports suggest that the FRC may be effective in the treatment of plantar foot ulceration. Although there is a paucity of evidence to support the use of FRCs in the treatment of foot ulceration, current evidence demonstrates a decrease in both wound healing time and plantar pressure. The aim of the paper is to examine the importance of offloading plantar ulcerations and introduce FRCs.
Distinctive stages and strain variations of A. baumannii biofilm development under shear flow
Authors: Feng S.H. , Stojadinovic A. , Izadjoo M.
Published: May 2014

Objective:

To examine and characterise the process of Acinetocbacter baumannii biofilm development under shear flow.

Method:

Using an automated flow-cell system with microfluidic channels connected to an imaging system, 10 clinical wound isolates of A. baumannii were examined for their ability to form biofilms under shear flow, on the glass surface of the flowthrough device. Flow biofilm development by this organism was observed to comprise four stages: attachment, microcolony formation, maturation with three-dimensional structures, and dispersion.

Results:

A. baumannii adheres readily to glass surfaces and quickly forms biofilm. Significant variations were observed among these 10 clinical strains in their ability to attach and form flow biofilms.

Conclusion:

These specific characteristics in biofilm formation may contribute to this organism's ability to disseminate within health-care environments.

Declaration of interest:

This study was funded by the Combat Wound Initiative Program and Henry M. Jackson Foundation for the Advancement of Military Medicine. The authors have no conflicts of interest to declare.
A new objective evaluation method for PU cleansing using a rapid bacteria counting system
Authors: Nakagami G. , Yoshida S. , Matsumoto M. , Koyano Y. , Yamamoto Y. , Sugama J. , Sanada H.
Published: May 2014

Objective:

To assess a new rapid bacterial counting device for evaluating wound cleansing effectiveness based on dielectrophoretic impedance measurement.

Method:

Three patients with pressure ulcers with undermining were recruited, and pressure ulcer severity assessed using the DESIGN-R tool. The number of bacteria was measured using this new apparatus both before and after wound cleansing, performed by wound, ostomy, and continence nurses using a pH-balanced cleanser for periwound skin and with normal saline for the wound bed and undermining area.

Results:

The results showed that wound cleansing effectively reduced bacterial counts on the periwound skin, wound bed and undermined site, with a median number of bacteria of 3.6×106 CFU/ml before cleansing, which decreased to 1.1×106 CFU/ml after cleansing.

Conclusion:

This pilot study result suggests the usefulness of this new device for assessing the effectiveness of wound cleansing on reduction of bacterial number. Standardisation of wound cleansing technique may be achieved by hands-on education using this apparatus at bedside.

Declaration of interest:

This study was partly supported by a Grant-in-Aid for Scientific Research A from the Japan Society for the Promotion of Science. The authors have no conflicts of interest to declare
Collagen matrix wound dressings and the treatment of DFUs
Authors: Haycocks S. , Chadwick P. , Cutting K.F.
Published: May 2014

Objective: To obtain clinical evidence on the use of a collagen wound dressing in patients with diabetic foot ulcers (DFUs).

Method: A convenience sample of patients managed in the podiatry outpatient clinic over an 8-month period were included in the evaluation, if their DFUs were not progressing. All participants received traditional adjunctive wound care as part of their treatment. Wound surface-area measurements and imaging of patients was carried out on a regular basis to allow the tracking of wound healing.

Results: Six patients, with seven wounds were included in this study. There was an overall decrease in wound surface area over time. Three patients showed a relatively swift reduction in wound area, while one patient showed a slight increase in wound area. The percentage decrease in wound area levelled out quite quickly in three patients, with a mean wound duration of 14 months compared with 7.3 months in the remaining four wounds. One patient died of an unrelated cause.

Conclusion: This case series evaluation provides a snapshot of experience at one clinical centre and the treatment of DFUs, and suggests that an active biological collagen dressing may support progression to healing by modulating the wound environment.

Declaration of interest: S. Haycocks and P. Chadwick received supplies of ProHeal from MedSkin Solutions Dr Suwelack for use on patients in this evaluation. K.F. Cutting is a consultant to MedSkin Solutions Dr Suwelack and received a honorarium for his participation. MedSkin Solutions Dr Suwelack did not have any editorial control over the production of this manuscript.
Rapid sequence induction on an air ambulance service
Authors: Spencer Neil , Bleetman Anthony , Hopkins Danny
Published: May 2014

Rapid sequence induction (RSI) is one of the key additional skills that an appropriately-trained doctor can bring to the prehospital environment. Controversy remains over the most appropriate person to perform RSI.

Aims

To review the scope of RSI activity on one helicopter emergency medical service (HEMS) unit and assess paramedic involvement and leadership in delivering prehospital RSI.

Methods

Prospective review of clinical database for air ambulance service

Results

Crews performed 72 RSIs over a 13-month period. Paramedics intubated 47 patients (65%). None of the intubations performed by paramedics required any intervention by the doctor. Of the RSIs 55 (76%) were performed on trauma patients and 17 (24%) for patients with medical emergencies; 31 (43%) were carried out in the presence of emergency physicians, 30 (42%) with anaesthetists present and 11 (15%) with a surgical specialist registrar. One doctor (consultant emergency physician) was present at RSIs on two patients at one scene; the paramedic intubated one of the patients. Six adverse events were reported. There were no reported serious technical complications of the RSI procedure such as incorrect tube placement or oxygen desaturation.

Conclusions

Our experience supports the growing recognition that appropriately-trained non-anaesthetists can perform RSI as safely as anaesthetists in both the hospital and prehospital environments. Our study also suggests that with appropriate training and supervision, paramedics carry no greater risks in RSI than their anaesthetic and non-anaesthetic medical colleagues.
Book Reviews
Authors: Fellows Bob
Published: May 2014

This is a small pocket guide written by a pair of eminent doctors with a clear market for other doctors who want to be more involved in the ‘sexy’ world of pre- and out-of-hospital care.
Higher education for paramedics—why?
Authors: Donaghy John
Published: May 2014

This article is intended to provide an overview of the historical, current and future trends in paramedic education.Over the past 15 years, the training and education of technicians and paramedics has seen a shift from the more traditional approach initiated by the Institute of Health Care Development (IHCD) towards an academic route developed in association with Higher Education Institutes (HEIs). This shift reflects the curriculum framework put forward by the British Paramedic Association (BPA) which acts as an educational basis for future paramedic education. The framework does not exist in isolation and is influenced by the Health Professions Council's (HPC) Standards of Proficiency (2007) and Standards of Education and Training (2006) and the Quality Assurance Agency (QAA) Benchmarking Statements (2004). This BPA framework represents new ways of working for paramedics and technicians as front line practitioners. Essential transition from training to education is viewed as key for the future of ambulance service delivery. This paper endeavours to ask the question: Higher education for paramedics—why?
Forensic paramedics: setting the standards with CRFP
Authors: Allen Mike
Published: May 2014

Mike Allen explains how the Council for the Registration of Forensic Practitioners (CRFP) offers forensic paramedics the opportunity to establish and maintain standards and to establish competence in court.
The anatomy of a book review
Authors: Peate Ian
Published: May 2014

Ian Peate offers some suggestions for new book reviewers
Trauma or medical prehospital cardiac arrest?
Authors: Steggall RIchard
Published: May 2014

This case study covers an incident when the decision of whether to recognize life extinct (ROLE) at an out-of-hospital asystolic cardiac arrest resuscitation attempt after 5 minutes or to complete the full 20 minutes of resuscitation as recommended by the Joint Royal Colleges Ambulance Liaison Committee guidelines, when the cause of cardiac arrest was undetermined, was required. It was also necessary to weigh up the benefits of when to, or indeed if to, transport the asystolic patient by helicopter to the district general hospital.

This incident provided evidence of what could have been a cardiac arrest prior to trauma but also trauma followed by cardiac arrest. Questions posed by this incident included whether the introduction of a 1-month trial period of a doctor on the helicopter assisted the crews in the decision-making process or changed the dynamics of the group and the normal decision-making process.
Does emergency transportation induce stress in ACS patients?
Authors: Williams Julia
Published: May 2014

UK ambulance service guidelines note that patients with acute coronary syndrome (ACS) should be transferred to hospital as blue-light emergencies. This study examines whether emergency transportation increases stress levels in patients with ACS. Patients aged between 50 and 90 years with clinical signs of ACS were screened for inclusion in the trial and 32 patients consented to participate. Venous plasma levels of epinephrine, norepinephrine and lactate as well as pain and anxiety scores were measured before and after transportation to hospital. In addition, heart rate, blood pressure and oxygen saturation were recorded every 3 minutes.
Outlining the NIHR-funded masters in research
Authors: Brooke Mike , Scutt Diane
Published: May 2014

Over the next 3 years, the National Institute of Health Research, in conjunction with the Chief Nursing Officer for England, is supporting 210 scholarships for nurses, midwives and allied health professionals to study towards a masters in research qualification. The programme aims to provide learners with the skills to plan, manage and execute research projects in a rigorous and scientific manner; so that the non-medical professions begin to develop a cadre of staff who are capable of executing high quality, safe and ethical research programmes.
Ketamine: a unique drug with several potential uses in the prehospital setting
Authors: Svenson James , Biedermann Marc
Published: May 2014

Ketamine is an anaesthetic agent that does not depress a patient's respiratory drive, setting it apart from other sedatives such as benzodiazepines. It has historically been used in austere environments with few resources for close monitoring under anaesthetia. More recently, it has found frequent use in paediatric specialties to facilitate painful procedures, but also seen use in adults. Commonly used in emergency departments by physician-level providers, it has found a use in the prehospital setting. Case reviews, as well as retrospective and prospective studies, have examined its use by physicians and paramedics in the prehospital setting. Ketamine offers several potential uses for paramedics including analgesia, sedation, and airway management; but thorough understanding of the drug and its unique effects is critical for safe use.
Changes in vital signs of trauma victims from prehospital to hospital settings
Authors: Lin Guy , Becker Alexander , Lynn Mauricio
Published: May 2014

The objective of this article is to characterize changes in vital signs of trauma victims from prehospital to hospital settings, their associations with injury severity, and the need for an emergency operation. Methods: a prospective cohort included 601 patients admitted to a level one trauma centre from 1 July to 30 September 2007. All prehospital and hospital admission values of Glasgow coma score (GCS), systolic blood pressure (SBP), heart rate (HR), respiratory rate (Resp) and oxygen saturation (SpO2) were recorded. All urgent major surgical procedures were graded in real-time as: emergency, urgent, or not urgent. Injury severity score (ISS) was calculated following completion of all the diagnostic work-up. Patients were classified as major trauma victims if their calculated ISS was 16 or greater, and those who needed an urgent intervention or intensive care. Vital signs trends were analyzed using the students' T—test. Associations with injury severity and the need for an emergency operation were analyzed using chi-squared test. The statistical significance level was set at 5% (P ≤ 0.05). Results: 243(40%) patients were classified as major trauma. 39(6.5%) patients required an emergency operative intervention—29 for active bleeding and 10 for imminent cerebral herniation. The time from injury to hospital arrival was 44.8 ± 17.63 minutes (mean±standard deviation), the time did not differ for those needing an emergency operation. Prehospital GCS ≤12 and SBP ≤90 were associated with a severe injury (a relative risk(RR) of 4.95, 95% confidence interval(CI) 3.25–7.58 for low GCS and 4.60, 2.67–7.94 for low SBP) and emergency surgical procedures (RR, 95% CI 4.43, 2.28–8.58 for low GCS and 11.69, 5.85–23.36 for low SBP). These values changed significantly from the field to the hospital with the mean GCS increasing 1.65 points and the mean SBP decreasing 7.23 mmHg (p<0.001). One patient out of 473 with a GCS ≥14 in the field and no one out of 483 patients with a GCS ≥14 on admission needed a neurosurgical procedure. 15/533(2.8%) patients with a prehospital SBP >90, and only 2/542(0.4%) patients with a SBP >90 on admission required emergency bleeding control (P<0.005). HR ≥120 and changes in HR of 20 beats per minute (bpm) or more were not associated with injury severity. The respiratory rate and the SpO2 did not change significantly, and were not associated with injury severity. Conclusion: prehospital vital signs values are expected to change significantly over time. Prehospital GCS ≤12 and SBP ≤90 predict major trauma, while the HR is not a good indicator of haemodynamic status. When these parameters normalize on admission, an emergency operation is rarely needed.
Out-of-hospital treatment of acute myocardial infarction
Authors: Schofield Rebecca
Published: May 2014

Patients who experience an acute ST-elevation myocardial infarction (STEMI) present a common clinical problem. While the treatment for this condition has undergone various changes in recent years, the underlying pathophysiology has remained the same. The patient experiences an acute coronary atheromatous plaque which fissures or ruptures, leading to the development of thrombus associated with the acute plaque causing occlusion of the vessel. This causes the typical symptoms of acute STEMI of chest pain, breathlessness, sweating and nausea/vomiting, as well as the classical changes on the resting electrocardiogram (ECG). Once the coronary artery is blocked, the myocardium supplied by the vessel is at risk of necrosis, unless the vessel can be reopened and the blood supply is restored. Time is of the essence, since the quicker the vessel can be reopened, the less myocardial damage occurs. In this article, the use of thrombolysis to treat patients with STEMI is described. This covers its administration within the hospital setting and its use prehospital. The treatment of patients with STEMI using coronary angioplasty/stenting is addressed, including the assessment of the patient, the procedure itself and also the care of the patient following the procedure.
Tension pneumothorax: are prehospital guidelines safe and what are the alternatives?
Authors: Simons Phil
Published: May 2014

Tension pneumothorax is a life-threatening complication of chest injury. It can cause rapid physiological decompensation, cardiac arrest and death. The Joint Royal Colleges Ambulance Liason Committee (JRCALC) provide guidelines on the prehospital diagnosis and treatment of this condition. The aim of this article is to ask whether or not these guidelines are effective and if there are feasible alternatives to the management of tension pneumothoraces in the prehospital environment.
The paramedic kairotope theory: findings
Authors: Campeau Anthony
Published: May 2014

Scene-management is an important, yet under-researched aspect of paramedic practice. Using a grounded theory methodology, this qualitative inquiry acquired data from in-depth interviews with paramedics working in rural, suburban, and urban settings in Ontario, Canada. The findings comprise a theory of how expert paramedics accomplish the very difficult task of managing emergency scenes, which is a crucial pre- and co-requisite for the provision of patient care. This theory introduces a new term, the ‘paramedic kairotope’ as a conceptualization of this expertise, comprised of knowing when and where to act in a field/clinical situation. The theory further describes this competency as being informed by two social processes: substantial use of interpersonal communication and innovative problem solving.
Scabies: a problem that can really get under your skin
Authors: Pocock Helen
Published: May 2014

This article explores the assessment, diagnosis and current recommended treatment for scabies in the UK. There are many myths surrounding scabies which could lead to misdiagnosis. Using a case from clinical practice, some of the common features of a history suggestive of infestation are explored and the social and psychological effects of such a diagnosis are considered. As a result of reading this article, prehospital practitioners should be more aware of scabies and more able to identify it in the community setting.
Use of intranasal drug administration in the pre-hospital setting
Authors: Creed Chloe
Published: May 2014

This article explores the benefits of intranasal as a recommended route for drug delivery in the pre-hospital setting for healthcare professionals. It is currently used in Australia, USA and some UK Ambulance services and remains a preferred route in certain patient groups. Intranasal can lead to a reduction in needle stick injuries for the healthcare professional and allowing immediate drug therapy in a emergency setting for bystanders. Randomised control trial's and evidence-based practice to discuss the absorption rate and different drugs that could be used through this route. After reading this article paramedics should be more aware of this safe route and its benefits in the emergency setting.
A journey with mechanical chest compression
Authors: Halliwell David , Box Martyn
Published: May 2014

This article explains how and why two UK paramedics chose to review, and lead, the UK arm of one of the worlds largest resuscitation research studies. The article begins with an outline of their original work presented in 2002, and their desire to improve upon that study by gaining a greater insight into chest compression practice.

This article is the first of 3 papers by the authors into the theories of resuscitation linked to mechanical resuscitation and best practice.
Fundamentals of blood pressure measurement
Authors: Bostock Beverley
Published: May 2014

A healthy blood pressure is vital to life and both low and high blood pressure can be life-threatening. This article looks at how the body regulates blood pressure, what a healthy blood pressure is, how it should be measured and what happens when blood pressure rises or falls. Paramedics may see patients who have a previous diagnosis of hypertension or who have suffered the devastating consequences of undiagnosed and uncontrolled hypertension such as myocardial infarction and stroke ( Law et al, 2003 ). Hypotension may be a presenting sign in conditions such as haemorrhage, both obvious as in the case of trauma and concealed as in the case of a slow gastro-intestinal bleed ( Dutton et al, 2002 ) and may also be a sign of chronic disease such as neurological or endocrine disease ( NHS Direct Wales, 2013 ). It is therefore important to understand how to recognise possible causes of blood pressure changes, understand how these fluctuations occur and how to measure blood pressure accurately in order to accurately assess the patient's condition.
A clinical audit of the pre-hospital paediatric respiratory assessment in London
Authors: Clark Sophie , Shaw Joanna , Wrigley Fenella
Published: May 2014

Assessing a child with difficulty in breathing is a challenge in a pre-hospital setting, especially children under 3 years old. Nevertheless, hypoxia must be treated early, and a respiratory assessment is essential to ensuring the well being of these patients. The aim of this audit was to update the research, as there have been changes in equipment and training since this was last addressed. A criterion-based clinical audit was undertaken of 253 patient report forms collected from the London Ambulance Service over a one-month period. The pre-hospital clinician must have coded dyspnoea (difficulty in breathing) and the patient's age must be under three years. The observations audited were: respiratory rate, auscultation attempt and oxygen saturations, any exceptions were noted. The results showed that 85% (n=220) had two respiratory rates recorded, 70% (n = 178) recorded an auscultation attempt, whilst two oxygen saturation recordings were documented for 52% (n=131). The main reason for no oxygen saturations was ‘no kit’, accounting for 38% (n= 45) of the non-compliance. Overall, 39% (n=99) recorded all three observations in this audit. It was concluded that there has been progress since the last review; however, there is still potential for better compliance. Recording oxygen saturations especially needs improving and the availability of equipment requires addressing.
Is there scope for an observational pain scoring tool in paramedic practice?
Authors: Harvey Christopher
Published: May 2014

In the pre-hospital environment, attending an older person can pose many challenges, including a lack of a detailed history, polypharmacy and co-morbidities, as well as a lack of out-of-hours support to name but a few. These challenges are enhanced further when the patient is cognitively impaired by syndromes such as dementia.

There appears to be very little research available into how the pain of older people with dementia is assessed and managed by paramedics.

This article highlights a literature review that was carried out to explore the evidence base and possible implementation of the Abbey Pain Scale, with the view of conducting a study in the near future. Particular focus is made on the education and training required to implement the tool, other environments where it has been adopted, as well as benefits and limitations.
Our next challenge:winning hearts and minds
Authors: Clegg Anthea
Published: May 2014

We are now in the midst of a great drive to change the way health services are delivered and patients receive their health care. It has taken this major shake-up of the NHS to recognize the value that nurse prescribing can bring to patients and to the service as a whole. The move for nurses to prescribe has not come about as a result of this change programme – nurses long ago heralded the potential benefits to patients and called for the changes we are now seeing.
The future of nurse prescribing lies in the stars
Authors: Clegg Anthea
Published: May 2014

The NHS has rarely been out of the news recently and much of the coverage, and the criticism, has centred around a perception of ever-increasing bureaucracy. The very word bureaucracy conjures up negative connotations of hierarchies, rules and regulations and, of course, the relatively new words on the bureaucratic block - ‘targets’ and ‘delivery’.
New opportunites are waiting to be seized
Authors: Stuttle Barbara
Published: May 2014

I am delighted to be taking over from Anthea Clegg as Consultant Editor ofNurse Prescribing. It is difficult to follow in someone’s footsteps, especially when that person has been involved since the inception of nurse prescribing and has had such a tremendous impact. On your behalf I would like to thank Anthea for her pioneering work on what, I believe you will agree, is an excellent journal.
Consent to examination and treatment 1: the capable adult patient
Authors: Griffith Richard
Published: May 2014

In the first of three articles on consent, Richard Griffith outlines the elements of a valid consent and how important obtaining consent is to the propriety of a nurse prescriber’s practice. The right to self-determination is accorded very high priority by the courts. The law considers capable adults as sui juris, free from the power of others, with the legal right to make decicions for themselves. Consent is, therefore, a clinical necessity to ensure the patient’s cooperation with treatment.
Nurse-led care: the role of nurses in eczema clinics
Authors: Lawton Sandra
Published: May 2014

Atopic eczema is the most common inflammatory skin disease of childhood, affecting 15-20% of children in the UK at any one time and accounts for 30% of dermatological consultations in general practice and 10-20% of all referrals to dermatologists. Nurses are now using additional knowledge and skills to enhance their contribution to nurse-led care for patients with atopic eczema. This paper will focus on the developments of nurse-led care and the prescribing issues that should be considered for this client group.
Functional dyspepsia: aetiology, diagnosis and treatment
Authors: Banning Maggi
Published: May 2014

It is estimated that functional dyspepsia is reaching epidemic proportions in the United Kingdom (Quigley, 2004). In primary care, 4% of all consultations are related to functional dyspepsia. Because the presenting symptoms can vary, the nurse should take a careful history from the individual and consider the underlying aetiology of the syndrome.
Simvastatin over the counter: a prescribing controversy
Authors: Chowdhury Shefali
Published: May 2014

The NHS Plan (Department of Health (DH), 2000a) highlighted self-care as one of the key building blocks for a patient-centred health service. To encourage the growth of self-care, the plan set out the government's commitment to make more medicines available over the counter. It is against this background that many former prescription only medicines (POMs) have been reclassified to Pharmacy (P) or General Sales List (GSL) status.
Acne vulgaris: clinical considerations for nurse prescribers
Authors: Jackson Karina
Published: May 2014

Acne is a common problem presenting at primary care services. The condition is one of the medical conditions listed in the Nurse Prescribers’ Extended Formulary and a range of topical preparations and oral antibiotics avavilable to independent nurse rpescribers. This article outlines key aspects of assessment of acne that inform treatment choice.
Reducing the risk of coronary heart disease: targeting cholesterol
Authors: Teasdale Sue
Published: May 2014

Coronary Heart Disease (CHD) remains the leading cause of death in the UK. If morbidity from CHD is to be reduced, those at high risk of developing it need to be identified and offered preventative advice and treatment. This article explores how to identify those who are at risk, what can be done to reduce the risk and how supplementary nurse prescribing can be used in the primary prevention of CHD. The focus of the article is on targeting cholesterol levels as a key intervention and a sample clinical management plan is given along with what factors need to be considered before starting a patient on cholesterol lowering treatment.
Bold changes are ahead for Nurse Prescribing
Authors: Allen Mark
Published: May 2014

One week in politics may be, in the immortal words of former Prime Minister Harold Wilson, a long time, but two and a half years in nurse prescribing is a veritable lifetime. So much has happened since Nurse Prescribing took its first tentative steps into a brand new world, the first nursing journal to do so.
Investigating endometriosis: symptoms, diagnosis and treatment
Authors: Banning Maggi
Published: May 2014

Endometriosis is a hormonal disease that affects childless women in their 30s. Up to 2 million women in the UK have the condition. The condition presents with a range of symptoms where some women may be asymptomatic and others may have continual excruciating pelvic pain. Due to the variability of symptoms, some women wait up to 10 years to gain an accurate diagnosis. Treatment is either surgical or pharmacological. The nurse prescriber should be knowledgeable about the condition and the treatment options available.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

Clarifying how PCT prescribing budgets works
Looking back on 2006: some of the stories in the news
Authors: Foran Brian
Published: May 2014

The National Institute for Health and Clinical Excellence (NICE) was set up by the Labour government in 1999, with a remit of looking at a range of areas including public health, new and existing medicines and procedures and the care of people with particular conditions. Since its inception, it has looked at illnesses including flu, multiple sclerosis, hip replacements, coronary heart disease and some cancers. It also issues guidance on how best to manage medical conditions.
Treatment and management of hypertension: the path is becoming clearer
Authors: Dryden Christine
Published: May 2014

Hypertension is often asympomatic and recording blood pressure is often opportunistic. A major concern, until recently in primary care has been the disparity between two main guidelines from NICE and the British Hypertension Society. With the growing evidence that beta blockers can increase the risk of diabetes, and are less effective in reducing stroke and the positive effects of angiotensin-converting enzyme inhibitors/calcium channel blockers, revised guidelines had to happen. Poor blood pressure control results in approximatley 125 000 unnecessary cardiovascular events each year, and evidence suggests specially trained nurses may be associated with better blood pressure control than routine care.Hypertension is often asympomatic and recording blood pressure is often opportunistic. A major concern, until recently in primary care has been the disparity between two main guidelines from NICE and the British Hypertension Society. With the growing evidence that beta blockers can increase the risk of diabetes, and are less effective in reducing stroke and the positive effects of angiotensin-converting enzyme inhibitors/calcium channel blockers, revised guidelines had to happen. Poor blood pressure control results in approximatley 125 000 unnecessary cardiovascular events each year, and evidence suggests specially trained nurses may be associated with better blood pressure control than routine care.
Medicines on trial: TGN1412 and the implications for future drug testing
Authors: Ainsworth Steve
Published: May 2014

Last month, six volunteers on a clinical trial became critically ill after suffering adverse reactions to the drug TGN1412. In this article, Steve Ainsworth takes a close look at the dangers of, and regulations for, clinical trials and explores the lessons that can be learned from the trial.
Why mental health nurses should prescribe
Authors: Snowden Austyn
Published: May 2014

This article explores the reasons why mental health nurses in Scotland have been slow to engage with nurse prescribing. Although much of this has been blamed on practical and organizational issues, it is also possibly indicative of a more subtle agenda. In order to support this position, an analysis of biology and psychopharmacology of mental illness is presented. It is suggested that as a result of philosophically incongruent positions some mental health nurses may view the therapeutic relationship as being discrete from medical intervention. Some nurses may consequently be reluctant to prescribe treatments they do not see as part of the nursing role. It is argued that this should not be the case.
The history of prescribing
Authors: Snowden Austyn
Published: May 2014

100 years ago responsibility for medication management lay with the individual. Patent medicines had been the norm for the previous 300 years. It was as a direct consequence of the laws designed to restrict the use of opiates that prescription only medicines became the norm. This paper tells the story of the regulation of medicines. Of major relevance from the mental health aspect is the recognition that psychiatry as opposed to general medicine rather fortuitously came to control the psychotropic medicines discovered last century. It is within this context that the consequences for mental health nurse prescribers are discussed.
The Mental Capacity Act 2005 in practice: influenza immunization
Authors: Griffith Richard
Published: May 2014

The government’s flu vaccination policy seeks to protect individuals at risk from the complications of flu by annual immunisations. Despite this policy people at risk have the right to choose whether or not to participate in the scheme. Nurse prescribers who administer the vaccine need to be sure that they have a valid consent or are acting in the best interests of the patient. In a series of articles Richard Griffith discusses how the requirments of the Mental Capacity Act 2005 and its code of practice apply in cases where nurses are considering prescribing and administering the ‘flu vaccine to patients at risk of the virus.
The Mental Capacity Act 2005 in practice: best interests
Authors: Griffith Richard
Published: May 2014

In this second article on the use of the Mental Health Capacity Act in practice, the principle of best interest in discussed. Any decision taken on behalf of a person who lacks capacity must be in their best interests. The article expains that the Mental Capacity Act 2005 provides a checklist of factors to be followed when determining whether a decision is in the best interest of a person without capacity. It is a more holistic approach than was previously required by the common law balance sheet approach.
Challenges in paediatric prescribing
Authors: Paul Siba Prosad , Whibley Jennifer , John Sharon
Published: May 2014

Children are not ‘small adults’, and are a heterogenous group of patients who are constantly changing, particularly in the way they metabolize specific drugs. The prescriber caring for children needs to be aware of the pharmacokinetic and the pharmacodynamic challenges associated with this patient population, and also needs to decide on the best route of drug administration for each individual case. Compliance poses an additional challenge, and both parents and carers may need repeated counselling and support from the practitioner to safely and efficiently help in the process. A paediatric drug formulary such as the British National Formulary for Children should always be consulted when prescribing for children. Adverse drug events should be readily identified, managed and reported. Nurse prescribers have an important role to play in paediatric practice, not only by safely prescribing drugs but also in educating and supporting colleagues. There is a need for continuing education and regular revalidation, to ensure the highest-quality and safest drug prescribing. This article addresses the complexities that may arise in paediatric drug prescribing.
Medication in mental heath: a case study
Authors: Tong Evelyn
Published: May 2014

In Scotland, between 25 and 30% of all GP consultations involve depression, stress or anxiety. The incidence of depression is high and rising, with mental health problems in old age being very common. Depression can be reliably diagnosed and treated in primary care, and a range of treatments are available; however, the effectiveness of all treatments is limited by non-concordance with the treatment plan. There are many reasons why medicines may not be taken as prescribed, including adverse effects, poor communication between health professional and patient, the effects of the illness, including cognitive impairment and patients' disagreement with the need for treatment. A case study on a patient with depression is presented, using the Situation, Background, Assessment, Recommendation (SBAR) format. The case study demonstrates a critical understanding of how issues of role, concordance and psychopharmacology impacted on the recovery of the patient.
Lowering cholesterol naturally alongside prescribed medication
Authors: Kale Vaishali , Pottle Alison
Published: May 2014

Raised levels of cholesterol are an important risk factor for coronary heart disease (CHD). There are a variety of medications that can be used to reduce cholesterol levels. In addition, it is important that patients make changes to their lifestyle. Changes to diet, stopping smoking and increasing exercise can all help in cholesterol reduction. Health professionals need to help and support patients in making these lifestyle changes.
Nurse-led clinics: Accountability and practice
Authors: Griffith Richard
Published: May 2014

The numbers of nurse-led clinics are continuing to grow in primary and acute care, and they provide timely intervention for patients. The clinics provide exciting opportunities for nurse prescribers but also carry an increased risk of exposure to liability. In this article, some of the key areas of accountability underpinning the duty of care of nurse prescribers working in nurse-led clinics are discussed.
Case study: elderly woman presents with bothersome bladder problems
Authors: Nazarko Linda
Published: May 2014

Lower urinary tract symptoms may be incorrectly ascribed to urinary tract infection. Incorrect diagnosis can lead to patients being inappropriately treated with antibiotics. This exposes the person to the hazards of antibiotic therapy and increases antibiotic resistance. It also causes delays in providing appropriate effective treatment. This article uses a case history approach to examine the possible causes of urgency, frequency and nocturia in an older woman. This article aims to enable readers to use an evidence based approach to accurately diagnose and treat lower urinary tract symptoms in older women.
How nurses can help patients with heart conditions to stop smoking
Authors: Percival Jennifer
Published: May 2014

Nurses are ideally placed to help patients who smoke to consider the adverse health implications of their smoking habit. This article describes the effect of smoking on the cardiovascular system and details various different nicotine-replacement therapy products and smoking-cessation support services available to smokers who are committed to smoking cessation. Nurses are provided with template, guideline conversations designed to assist them in approaching the subject of smoking cessation and embarking on a non-argumentative, ongoing, supportive conversation with patients, which has been shown to motivate and guide smokers towards the process and practicalities of successful smoking cessation.