bluuebunny/crossref_metadata_2025 huggingface dataset:
Stimulation of the proliferation of human dermal fibroblasts in vitro by a lipidocolloid dressing
Authors: Bernard F.X. , Barrault C. , Juchaux F. , Laurensou C. , Apert L.
Published: May 2014

Objective:

The effect of Urgotul on normal human dermal fibroblast proliferation was studied in vitro and compared with that of two other dressings: Mepitel and Tulle Gras.

Method:

Proliferation was measured by the extent of thymidine incorporation into the replicating DNA of proliferative fibroblasts in contact with the complete dressing. Additional cell viability and metabolism were evaluated using MTT assay. Morphology and ultrastructure analysis were based on immunolabelling and confocal laser microscopy.

Results:

Only Urgotul significantly stimulated thymidine incorporation, generally with a maximal proliferative effect at a contact time of 48 hours. This was confirmed by the observation of a greater number of dividing cells (mitotic cells) than in the control cultures. No cytotoxicity was observed following treatment with this dressing. Cells exhibited normal structural and ultrastructural features.

Conclusion:

Fibroblasts play a key role in dermal wound repair. The ability of Urgotul to promote fibroblast proliferation could explain its efficiency in the healing process of acute and chronic wounds.

Declaration of interest:

This study was supported by Urgo Laboratories.
Benefits of surgical reconstruction in pressure ulcers with a non-advancing edge and scar formation
Authors: Ichioka S. , Ohura N. , Nakatsuka T.
Published: May 2014

Objective:

To highlight the difficulty in treating pressure ulcers associated with scar formation and the benefits of surgical treatment in these cases by presenting a series of clinical cases.

Method:

Nine sacral ulcers surrounded by significant scar formation and 14 sacral ulcers without significant scars were treated using the same conservative management protocol. Healing status was quantitatively estimated using an assessment tool called DESIGN, which classifies pressure ulcer severity and allows healing to be monitored; a decreasing score indicates progressive improvement.

Results:

Ulcers with scar formation showed little response to the treatment, while those without remarkable scars exhibited a significant decrease of the DESIGN scores. Surgical reconstruction was conducted in five ulcers surrounded by scar formation, and all showed complete healing within extremely short periods.

Conclusion:

Conservative treatment of pressure ulcers with a non-advancing edge surrounded by scar formation presents considerable difficulties. Surgical reconstruction offers many benefits for non-healing ulcers.

Declaration of interest:

None.
Chronic abdominal wall sinus and recurrent abscesses caused by a foreign body after laparotomy
Authors: Fajobi O.A. , Bari N. , Mekwan J. , Harrison C. , Myint F.
Published: May 2014

The failure of a wound to heal due to the existence of a foreign body that has resulted in chronic sinuses and fistulae are recognised in humans and has been reported in animals. Superficial suture-related abscesses are often seen in surgical practice and may occur within weeks or months of placement. Chronic sinuses and fibrosis may arise from forgotten rubber drains or other surgical and non-surgical implants. More uncommon are foreign bodyinduced complications from non-surgical materials such as gallstones and food matter. Moreover, chronic morbidity lasting several years is rarely seen.
Unstable acute and chronic Charcot’s deformity: staged skeletal and soft-tissue reconstruction
Authors: Zgonis T. , Roukis T.S. , Frykberg R.G. , Landsman A.S.
Published: May 2014

The ultimate goal of soft-tissue coverage is to restore form and function, and this is especially true of plantar foot wounds. Ideally, coverage would be in primary fashion under minimal tension, utilising adjacent, sensate native tissue that is capable of withstanding the shear and tangential forces sustained during ambulation. Soft-tissue wound coverage employs conservative and surgical techniques aimed at providing the most appropriate means of creating rapid, durable and functional closure using the simplest and least invasive modalities. These include delayed primary closure, skin grafting, local, pedicle or free-tissue transfer.
The potential effect of fibroblast senescence on wound healing and the chronic wound environment
Authors: Henderson E.A.
Published: May 2014

The human body ages as a result of failure in the replication cycle of cells, otherwise known as cell senescence. In humans, cell senescence is thought to prevent genetic mutations and disease, but has the sideeffect of organismic ageing. All replicating cells senesce, but this occurs heterogeneously across the cell population, where the structure and biochemical make-up is altered. This review focuses on the fibroblast cell as senescence has been shown to have several effects on its function, including reduction in number and size and decreased mobility and proliferation. As the fibroblast plays a key role in wound healing by initiating the proliferative phase and mediating remodelling, failure of this mechanism could lead to failure of healing.
Use of ulcer size and initial responses to treatment to predict the healing time of leg ulcers
Authors: Prince S. , Dodds S.R.
Published: May 2014

Objective:

To test the following two hypotheses: the initial healing profiles of individual leg ulcers determine the longer-term outcome; healing time can be predicted from an initial ulcer size measurement and a sequence of further measurements recorded after treatment has started.

Method:

Twenty-three patients with venous leg ulcers were studied (10 male, 13 female). Digital images of the ulcers were taken at weekly intervals; ulcer size was measured electronically and the information stored in an electronic patient record. The healing profile for each ulcer was analysed by linear regression using the correlation coefficient (r) to indicate linearity. For |r| >0.85 (|r| = modulus of r, [where r is negative], that is good linearity and hence wound healing), the predicted healing time was calculated from the initial size (cm2) and initial healing rate (cm2/week), and was compared with the actual healing time.

Results:

The majority of ulcers (17/23) healed with linearity (|r| >0.85). For these ulcers there was agreement between the predicted healing time and the actual healing time (correlation coefficient 0.95).

Conclusion:

Venous ulcers that respond to treatment appear to heal at a near constant rate. The initial response to treatment can be used to reliably estimate the healing time.

Declaration of interest:

None.
A review of the use of a dermal skin substitute in burns care
Authors: Nguyen D.Q.A. , Dickson W.A.
Published: May 2014

The National Burn Care Review estimates that a quarter of a million people present to burn treatment centres in the UK each year. A burn injury is first and foremost an injury to the skin. However, the visible skin injury is only one component of a disease process that has life-threatening systemic and metabolic effects remote from the site of injury. There are three phases to recovery from a burn injury:
Split-thickness skin graft donor sites: a comparative study of two absorbent dressings
Authors: Terrill P.J. , Goh R.C.W. , Bailey M.J.
Published: May 2014

Objective:

To identify the optimal dressing for split-thickness skin graft (SSG) donor sites.

Method:

This prospective randomised controlled trial compared two dressings — a new absorbent form of a polyurethane film dressing (Tegaderm Absorbent, 3M) and our standard alginate dressing (Kaltostat, ConvaTec) — on SSG donor sites in 40 patients. Primary outcome measures were: reduced time to full healing; reduced postoperative pain; reduced leakage rates from the dressing. Secondary outcome measures related to acceptability of the dressings to the patient.

Results:

On removal of the dressings at the first assessment, 79% of the Tegaderm Absorbent donor sites had healed completely, compared with 16% of the Kaltostat ones (p<0.001). A significantly greater median area had healed with Tegaderm Absorbent (100%), when compared with Kaltostat (89%) (p<0.001). Mean time to complete healing was also significantly faster for Tegaderm Absorbent than Kaltostat (14 versus 21 days) (p<0.001). Significantly fewer subjects experienced postoperative pain with Tegaderm Absorbent on both day 1 (21% versus 67%, p=0.006, NNT=3) and day 2 (17% versus 75%, p<0.001, NNT=2). Leakage rates reduced by 48% with Tegaderm Absorbent, with no leakage in the smaller donor sites. Tegaderm Absorbent was significantly easier to apply than Kaltostat (89% versus 27% found it ‘very easy’) as was ease of removal (84% versus 11% found it ‘very easy’) (p<0.0001). Patients found Tegaderm Absorbent dressings significantly more convenient to manage and bathe with. At one month post-surgery, Vancouver scar scores showed that Tegaderm Absorbent donor sites were less red, flatter, softer and less itchy.

Conclusion:

Tegaderm Absorbent provides a significant improvement in terms of donor-site pain, healing and ease of management.

Declaration of interest:

None.
Venous leg ulcer treatment and practice — part 3: the use of compression therapy systems
Authors: Rajendran S. , Rigby A.J. , Anand S.C.
Published: May 2014

The third article in this four-part series discusses the role of compression in the management of leg ulcers, lists the range of compression delivery systems available and discusses their modes of action and the pressures they can achieve
Clinical performance of a hydrogel dressing in chronic wounds: a prospective observational study
Authors: Zoellner P. , Kapp H. , Smola H.
Published: May 2014

Objective:

This prospective, multicentre application study was conducted to assess the clinical performance of Hydrosorb comfort hydrogel dressing.

Method:

Eighty-one patients (average age 67 years) with acute or chronic wounds received three dressing changes. The condition of the wound and patient-reported pain were assessed at the beginning and end of the study period.

Results:

The mean proportion of the wound surface covered with slough fell from 63% to 34%, and the mean area of new granulation and epithelial tissue increased from 25% to 37% and 13% to 28%, respectively. The average wound size decreased from 4.7 x 2.9cm to 3.7 x 2.3cm; 29.6% of the patients reported no pain at baseline, increasing to 56.3% at the final assessment.

Conclusion:

Both acute and chronic wounds can be effectively treated with the Hydrosorb comfort hydrogel dressing.

Declaration of interest:

This study was sponsored by Paul Hartmann Ag, Heidenheim, Germany.
A prospective analysis of the role of silicon in wound care
Authors: Lansdown A.B.G , Williams A
Published: May 2014

Silicon is an important micronutrient associated with the development of bone and connective tissue. This article discusses the properties of silicon, its absorption in the human body and its current and potential use in wound management
A dynamic care pathway to coordinate the use of advanced therapy in diabetic foot ulceration
Authors: Chadwick P. , Haycocks S. , Bielby A. , Milne J.
Published: May 2014

The non-coordinated use of advanced therapies is not clinically or cost effective. A care pathway for the sequential use of these interventions on complex wounds provides a more restructured approach, and helped improve patient outcomes
Clinical and scientific data on a silver-containing soft-silicone foam dressing: an overview
Authors: Chadwick P. , Taherinejad F. , Hamberg K. , Waring M.
Published: May 2014

Antimicrobial agents, including silver, are often used either alone or with antibiotics to treat or prevent infection. This paper reviews the existing in vitro and in vivo evidence on one such antimicrobial commonly used on wounds
Are community leg ulcer clinics more cost-effective than home care visits?
Authors: Patton L.R.
Published: May 2014

The literature suggests that leg ulcer clinics are more expensive than home visits, but are associated with faster healing times. Providing district nurses with better postgraduate education on wound care may make better use of this resource
Does liquid tissue adhesive increase satisfaction with wound and stoma management after
Authors: Aslam M.I. , Hunter D.C.
Published: May 2014

Objective:

This pilot study reviews the impact of tissue adhesive to seal skin wounds in elective large bowel resections where a stoma is fashioned.

Method:

Patients undergoing elective colorectal resection over six-month period were prospectively evaluated for wound infections rates, length of inpatient stay and patient satisfaction with their wound and stoma management. The wounds were observed for 30 days in both inpatient and outpatient settings. A patient satisfaction questionnaire was used with respect to the stoma and wound management.

Results:

Fifty patients undergoing elective colorectal resection over a six-month period were prospectively evaluated. The median patient ages were 63.5 years (40–83) for males and 60 years (33–85) for females. Ninety-two per cent of the patients found their wound management satisfactory (overall satisfaction score >5, where 5 represents ‘high satisfaction’). Eighty-six per cent reported a stoma management satisfaction score of >4 (where for 4 represents ‘satisfaction’). Stoma site leakage was reported by 16%, but none of these developed a SSI. Two patients who had laboratory-confirmed SSI; they had an average length of inpatient stay of 18 days compared with 6.5 days for patients without SSI.

Conclusion:

Liquid tissue adhesive provides a flexible, water-resistant and protective coating which increases the satisfaction and ease of surgical wound and stoma management. We recommend a randomised controlled trial be conducted to evaluate these results in larger cohorts.

Declaration of interest:

None.
Psychological stress and pain in wound care, part 2: a review of pain and stress assessment tools
Authors: Solowiej K. , Mason V. , Upton D.
Published: May 2014

Several tools are available for the assessment and measurement of stress and pain. While it takes time and money to train practitioners in their use, this will soon be offset by benefits in terms of patient care, satisfaction and reduced costs
Health locus of control theory in diabetes: a worthwhile approach in managing diabetic foot ulcers?
Authors: Przybylski M.
Published: May 2014

The current global epidemic of type two diabetes mellitus has led to an accompanying increase in both foot ulceration and amputations, which pose significant health problems to populations worldwide. If improved treatment options are to be offered, then we clearly need a better understanding of all aspects of this disease. To date the major focus of diabetes research has been on physical factors, which are undeniably important, but there has been little acknowledgement of the significant psychological effects that can influence health and delay wound healing. The ‘health locus of control’ (HLC) theory, a psychological theory concerning patients' perceptions of how much control they have over life events (both positive and negative) may well be of use in this patient group. It has been suggested that concordance with treatment is improved when patients have a high ‘internal’ HLC (as measured by a questionnaire), which aligns with the belief that they have greater control over their health. It has further been suggested that through the implementation of ‘group-care’ education programmes, patients' attitudes can change, with a shift towards higher ‘internal’ HLC values. Thus a new approach in patient management might be to implement such education programmes, in the hope of improving adherence to treatment regimens and, hence, patient outcomes. To date there has been little conclusive evidence of the application of this theory, and although various studies have been performed in diabetic populations, only one study has been conducted specifically regarding diabetic foot ulcers. Clearly more research is needed.
The MOEWAT as a proposed method of evaluating orbital exenteration wounds
Authors: Cooper J. , Waterman H.
Published: May 2014

Orbital exenteration is a disfiguring and life-changing surgical procedure that involves the removal of the socket contents, including the eye, surrounding adnexa and, in some cases, the eyelids, orbital bone and sinuses. Wound healing of exenterated sockets can be complex and may take several months to completely heal. In an attempt to provide a framework for continuity of care for patients who undergo orbital exenteration surgery, we propose a socket wound assessment tool, which will allow professionals to track changes in orbital exenteration wounds. The Manchester orbital exenteration wound assessment tool (MOEWAT) has been developed to facilitate assessment and evaluation of postoperative exenterated sockets at any given time. Consequently, as the first assessment instrument specifically developed for use in orbital exenterated patients, the MOEWAT could provide a basis for wound-care decision-making in relation to clinical findings.
The effect of temperature and humidity on the permeability of film dressings
Authors: Thomas S. , Barry L. , Fram P. , Phillips P.J.
Published: May 2014

The moisture vapour permeability of a dressing can make an important contribution to its overall fluid handling capacity. Despite the fact that this parameter is often quoted in scientific literature and manufacturers' promotional material, it is a concept that is not generally well understood. In particular, the effect of changing environmental conditions upon experimentally determined permeability values for particular dressings is rarely acknowledged. The present study was undertaken to derive and validate a method that could be used to predict the permeability of a self-adhesive semipermeable film dressing under specific conditions of temperature and humidity using a single set of data generated in the laboratory. A calculator that facilitates this process is also described.
The use of acellular dermal regeneration template for recalcitrant pilonidal disease
Authors: Vaughn C.J. , Lalikos J.F.
Published: May 2014

Numerous techniques have been described for the treatment of pilonidal disease, yet there remains no consensus on the optimal management of recurrent pilonidal disease. Pilonidal wounds often lack the structural integrity to heal over and Integra provides a scaffold for the regrowth of an autogenous dermis from the patient's own fibroblasts and collagen. Postoperative negative pressure wound therapy (NPWT) may speed vascularisation of Integra, re-epithelialisation, and wound closure. This case report concerns two patients with chronic pilonidal sinuses who underwent wide excision and placement of Integra with postoperative NPWT. Postoperatively, the patients were assessed for complications and recurrence. Both patients went on to heal and did not require further surgical treatment after a median follow-up of 29 months. Integra may help prevent pocket or cyst formation during the closure process and provides a neodermis, allowing for full re-epithelialisation. More research and a longer follow-up are needed to evaluate the role of Integra and NPWT in recurrent pilonidal disease.
Comparison of the interface pressure and stiffness of four types of compression systems
Authors: Wong I.K.Y. , Man M.B.L. , Chan O.S.H. , Siu F.C. , Abel M. , Andriessen A.
Published: May 2014

Objective:

To compare interface pressure (IP) and static stiffness index (SSI) of four different compression systems currently in use for the treatment of patients with venous leg ulcer.

Method:

Fifty-two ambulatory adults with healthy legs were recruited at random at a study centre after they had consented. The evaluated systems were: short-stretch system (SSB), Rosidal sys (Lohmann & Rauscher), multilayer bandaging (LSB) Profore (Smith & Nephew), Vari-stretch (VSB) ProGuide (Smith & Nephew) and tubular compression (CS) Rosidal Mobil (Lohmann & Rauscher). Interface pressure was measured using Kikuhime (Harada Corp.), placing a 3cm-diameter probe at the B1 point. IP recording took place in the supine and standing positions, while sitting and during walking, on application of the compression systems and every 15 minutes thereafter for 4 hours.

Results:

The IPs of SSB, LSB and VSB, measured immediately after bandage application, were significantly higher than that of CS (all p < 0.05). During the 4-hour study period, the IP for both VSB and LSB measured in the supine position initially increased to > 60mmHg. Their overall mean IPs in the supine position were 48.96 ± 3.99mmHg and 48.12 ± 4.57mmHg, respectively. SSB and CS demonstrated more tolerable IP levels in this position of < 40mmHg, which was similar to those when sitting. All systems maintained at least 40mmHg in walking. SSB had a high SSI of 20 throughout the study. LSB followed with an SSI of 18 at the start, which reduced to 13, while the SSI for VSB decreased from 17 to 12 and CS, with an SSI of 6, lagged behind.

Conclusion:

These results may contribute to the understanding of IP and SSI of the four different compression systems evaluated. The IP and SSI data presented give clinicians an indication of the appropriate frequency of re-application of compression, and preliminary data on choosing a safe and effective compression treatment for their patients.

Declaration of interest:

The investigators received an educational grant from Lohmann & Rauscher GmbH & Co KG for this study.
Use of wound drains following open reduction and internal fixation of femoral shaft fractures
Authors: Akinyoola A.L. , Odunsi A. , Yusuf M.B.
Published: May 2014

Objective: To determine if routine use of closed suction wound drainage is justified following open reduction and internal fixation of femoral-shaft fractures. Method: Patients undergoing reduction and internal fixation of 75 femoral shaft fractures were prospectively randomised into two groups: one receiving closed-suction drainage (CSD) and one no wound drainage (NWD). The state of the wound dressing at 24 and 48 hours post-surgery, blood transfusion requirements, status of the wound (presence of hyperaemia, surgical site infection, undue wound tenderness, presence of induration at the wound edge and wound healing) at days 7, 14, 28 and 90 postoperatively, and duration of wound healing, were assessed. Results: A total of 65 patients, with 75 femoral shaft fractures, completed the study: 37 fractures in CSD group and 38 in the NWD group. No significant difference was observed between the two groups in terms of the state of wound dressing at 24 hours (p=0.192) or 48 hours (p=0.365). There was no statistically significant difference in the incidence of wound infection (χ2=3.339, df=2, p=0.188) or duration of wound healing (χ2=3.168, df=1, p=0.075) between the two groups. However, more patients in the CSD group had blood transfusions than in the NWD group (21.6% vs 15.8%), although this was also not statistically significant (p=0.181). Conclusion: No benefit was observed in the routine use of wound drains following open reduction and internal fixation of fractures. Declaration of interest: There were no external sources of funding for this study. The authors have no additional conflicts of interest to declare.
Negative pressure wound therapy: improving the patient experience Part 3 of 3
Authors: Upton D. , Andrews A.
Published: May 2014

Negative pressure wound therapy (NPWT) is considered to be an effective wound treatment, yet research has highlighted a clear need for its improvement, particularly in reducing pain. This is important not only for patient well-being and treatment satisfaction but also for the healing process. In parts 1 and 2, wound care clinicians were invited to share their views on patients’ experiences of NPWT. Part 3, presented here, explores the views of patients who have had NPWT, through use of a questionnaire survey and interview (n = 50). Findings show that the majority of patients felt that NPWT had a positive impact on their wound (94%) and that their overall experience was positive (88%). However, respondents identified a number of challenges associated with NPWT, such as reduced mobility, noise issues, and sleep disturbance. Respondents also identified a number of areas for improvement with NPWT, including greater training for nurses, practical alterations to the equipment, and methods of minimising pain and skin damage during NPWT. Taken together with the findings from part one and two, this study highlights several key considerations for future research and clinical practice with NPWT.
Characterisation of epidermal regeneration in vivo: a 60-day follow-up study
Authors: Kottner J. , Hillmann K. , Fimmel S. , Seite S. , Blume-Peytavi U.
Published: May 2014

• Objective:To characterise the long-term course of epidermal regeneration in a suction-blister wound model in healthy humans.

• Method:A single-centre, prospective cohort study was conducted. Suction blister wounds of 8mm diameter were created on the volar forearms of healthy volunteers. Planimetry was used to measure the wound surface area. tansepidermal water loss was estimated to characterise the skin barrier function. skin brightness was measured using the chromametric luminance L* parameter and skin (visco) elastic properties were measured by a controlled suction device.

• Results:Thirty-two subjects (mean age 28.6 years) participated. Epithelisation was nearly completed after 8 days, but it took approximately 3 weeks for complete skin barrier restoration. Post-inflammatory hyperpigmentation was observed at the end of day 60 in the majority of skin areas. Elastic and viscoelastic deformation and recovery at the end of the follow-up period did not reach baseline values.

• Conclusion:Newly formed epidermis requires considerable time before reaching complete recovery of the skin barrier function. Up to 2 months after the injury, regenerated epidermis in junction with the reticular dermis is stiffer compared to before. Under mechanical loading increased local stiffness might increase the risk for subsequent injuries at the same or adjacent skin areas. Due to its increased vulnerability it is recommended to protect or to offload the epidermal tissue as long as possible to support the structural long-term regeneration. Artificial suction blister wounds are well standardised and controlled models for a wide range of clinical studies and they offer advantages over uncontrolled patient conditions in wound healing studies.

• Declaration of interest:This study was funded by la Roche-Posay Laboratoire Pharmaceutique (Asnieres, France). The sponsor had no influence on the design, conduct, and analysis and presentation of the data and on the content of this manuscript. The authors have no financial interest in this article.
Venous leg ulcers: What about well-being?
Authors: Upton D. , Andrews A. , Upton P.
Published: May 2014

The impact of having a leg ulcer is well-documented in terms of the pain, restrictions and psychosocial difficulties that patients experience. However, the current focus on quality of life as a patient reported outcome measure overlooks the importance of the individual's well-being. In this article, we argue that a shift in focus from quality of life to well-being will contribute to the more proactive patient centred approach to care to which we should all aspire in contemporary care settings.
Evaluating the reasons underlying treatment nonadherence in VLU patients: introducing the VeLUSET Part 1 of 2
Authors: Brown A.
Published: May 2014

Although healing rates have improved with the use of compression therapy, venous leg ulceration recurrence rates remain very high. There is evidence that certain self-care activities may reduce the risk of recurrence, however, many patients do not adhere to performing these self-care activities. The reasons for this may be multifactorial. Furthermore, the literature indicates that some patients appear to have a poor understanding of their condition despite having received information from health professionals. Since a concordant relationship is dependent on shared decision-making, this apparent knowledge deficit may have major implications in changing health behaviours and achieving adherence with self-care. This article is in two parts – part one will briefly discuss health behaviour change models underpinned by social cognitive theory. It introduces the VeLUSET, a newly developed and validated tool which provides an objective measure of nursing interventions designed to increase self-efficacy.
Normal labour and birth
Authors: Lingen-Stallard Andrew
Published: May 2014

Normal birth is a common outcome for the ambulance service following an imminent birth dispatch. In 2008, the London Ambulance Service attended over 1000 imminent births calls, with the crew either in attendance for a birth, transporting prior to birth or the infant born before arrival of a crew. The majority were full-term, low risk pregnancies with a normal birth, and the mother having birthed previously (personal communication, London Ambulance Service, 2009).

The aim of this paper is to review the issues of normal birth. It will explore the concept of normal birth and encourage practitioners to reflect on care after a normal birth. It discusses the physiology and mechanism of normal labour, birth and physiological placental expulsion. The paper will explore the ambulance clinician's role in securing and maintaining a normal birth outcome and explore care required for the woman, newborn infant and family. This paper will not discuss complications in pregnancy and during labour or in depth discuss birth, postnatal complications or newborn resuscitation. Ambulance personnel must follow the guidelines issued by the Joint Royal Colleges Ambulance Liaison Committee UK Ambulance Service Clinical Practice Guidelines (2006) (JRCALC, 2006).
Think carbon monoxide: A timely reminder
Authors: Channarayapatna Krishna
Published: May 2014

Krishna Channarayapatna discusses efforts to raise awareness on carbon monoxide (CO) poisoning this winter, and why paramedics should keep it in mind as a possible cause of illness
Recording a standard 12-lead ECG: filling in gaps in knowledge
Authors: Crawford Jacqui , Doherty Linda
Published: May 2014

Electrocardiography is a routine clinical examination performed by a wide range of health care staff. and is a core skill for paramedics. Guidelines exist in relation to the performance of this technique but may not always be adhered to. This article addresses possible reasons why ECG accuracy is declining and focuses on some common gaps in practitioner knowledge to improve understanding and practice.
Trauma Care: 10th International Conference
Authors: Bakewell Joanna
Published: May 2014

Trauma Care, the UK-registered charity that works to promote and define best practice in the management of trauma, held its 10th International Conference at the Park Inn in Telford this month. The first day of the week-long meeting saw paramedics and paramedic students arrive from all over the UK for a programme of talks on paramedic practice. Before the talks began, paramedics chatted over coffee with medical delegates who were attending a concurrent programme on torso trauma, and despite the early start for many, the mood was buoyant and all were eager to hear the first talk.
Still a Cinderella service?
Authors: Sibson Lynda
Published: May 2014

The revised Resuscitation Council (UK) Guidelines have recently been published and include, for the first time, a chapter on prehospital cardiac arrest that aims to ‘bring together those resuscitation topics of specific relevance to the prehospital emergency medical emergency services’ (Resuscitation Council, 2010: 36).
To move or not to move: are the general public confused about moving patients?
Authors: Johnson Sarah , Blackham Julian
Published: May 2014

The management of trauma patients who have possible spinal cord injury with immobilization is standard professional practice. However, very little is known about how the general public, who are often first to arrive at the scene of an accident, manage such patients. A primary cross-sectional survey was conducted which asked members of the public how they would manage a fictional patient who had been knocked off his bicycle in a road traffic accident. The survey found that for some members of the public (8%), their overriding priority was that the patient must not be moved under any circumstances. Their fear of causing or exacerbating spinal injury was so great that they would not move the patient—even in order to undertake life-saving procedures such as cardiopulmonary resuscitation. The survey found that although only a small number of patients risk being affected by misinformed or confused members of the public, the consequences for such patients could be fatal. Given the seriousness of the consequences, there is a case for a public information campaign to remind the public of the correct prioritization of immediately life-saving interventions over spinal cord protection.
Left bundle branch block: simplified Sgarbossa criteria applied to prehospital ECGs
Authors: Viner Alexandra , McLean Scott , Fitzpatrick David , Flapan Andrew
Published: May 2014

In patients presenting with chest pain, the presence of left bundle branch block (LBBB) on the electrocardiogram (ECG) may obscure the diagnosis of acute myocardial infarction (AMI). Patients with LBBB caused by AMI are shown to benefit significantly from rapid provision of reperfusion therapy, yet evidence suggests this is often underprovided. Difficulties in the identification of AMI in these patients is the most commonly cited reason. The aim of the research was to determine whether the application of the simplified Sgarbossa criteria to undifferentiated chest pain patients presenting with ECG changes of LBBB, transmitted during the prehospital phase of care, will be positively predictive of a discharge diagnosis of AMI.
Hypertension: update for paramedics
Authors: Gregory Pete
Published: May 2014

Hypertension is recognized by the World Health Organisation (WHO) as being one of the leading causes of premature death in the developed world (WHO, 2003). It increases the risk of stroke, heart failure and renal failure (Vasan et al, 2001), yet it is often a hidden disease that is not recognized by those who suffer from it. Hypertension is a significant problem in the UK, with a prevalence of 31.7% in men and 29.5% in women. The prevalence increases steeply with age in both sexes, so that by the age of 75, at least two thirds of men and women have high blood pressure according to current definitions (Health and Social Care Information Centre, 2008).
Oxygen therapy in acute MI: role uncertainty
Authors: Burls Amanda , Cabello Juan B , Emparanza Jose I , Bayliss Sue , Quinn Tom
Published: May 2014

Administration of inhaled oxygen to patients with acute myocardial infarction (AMI) has been recommended in national and international guidelines (Kallstrom, 2002; Antman et al, 2004; American Heart Association, 2005; International Liaison Committee on Resuscitation, 2005; Anderson et al, 2007; Van de Werf, 2007) and has been a mainstay of prehospital management for decades.
Development of paramedic courses at the University of Worcester
Authors: Hardwick Sharon
Published: May 2014

This article discusses the prehospital programmes on offer at the University of Worcester. The three courses offered are directed at both pre-registration and post-registration students. The newest edition to the university prospectus is the development of a higher education diploma in paramedic science for IHCD trained and Health Professions Council (HPC) registered paramedics. The programme has been designed in recognition of the HPC requirements for the paramedic to ensure that they maintain their fitness practice by continual professional development through keeping their knowledge and skills up-to-date (Health Professions Council, 2007).
New regulations for the quality and safety of ambulances
Authors: Hutchinson Linda
Published: May 2014

Linda Hutchinson, Care Quality Commission Director, talks about the new system of registration for providers of independent and voluntary ambulance services, and the implications for paramedics.
August roundup of the EMS blogging world
Authors: Glencorse Mark
Published: May 2014

This month, it is the turn of one of our own UK bloggers to share his story. You met him briefly last month, but this time he takes centre stage. I would like to introduce you all to the ‘Insomniac Medic’, an anonymous blogger who goes by the alias of Ben Yatzbatz.
Neutropenic sepsis: preventing an avoidable tragedy
Authors: Barrett Kevin , Dikken Clare
Published: May 2014

Neutropenic sepsis is a life-threatening side-effect of chemotherapy—patients are still dying from this complication of treatment, and these deaths are largely preventable. The purpose of this article is to raise awareness of the condition, its severity and the importance of timely responses to it. The main issue for prehospital clinicians is that symptoms of neutropenic sepsis, especially in the early stages, are so vague that they are easily misinterpreted or dismissed as opposed to being indicative of a time-critical patient. The patient's history is of paramount importance in identifying patients in the community that are vulnerable to the condition—those recovering from chemotherapy. These patients are highly prone to infection and are temporarily immune compromized due to the medications that they have been prescribed. They are incapable of mounting a response to infection and infective agents can overwhelm them rapidly. It is imperative in this patient group to have a high degree of suspicion about ‘simple’ assessment findings and non-specific symptoms as these can progress very quickly to haemodynamic collapse and death. Timely hospital-directed antibiotic therapy and support can prevent this possible tragedy.
The revision of the primary survey: a 2011 review
Authors: Halliwell David , Jones Paul , Ryan Lizzie , Clark Robert
Published: May 2014

This article outlines changes that have been made to the patient assessment primary survey for ambulance staff that was adopted by South Western Ambulance Service NHS Foundation Trust (SWAST). It provides a brief history of the airway, breathing and circulation approach (ABC), and the transition to (C) ABCDE undertaken in 2007, following the publication of the paper by Hodgetts et al (2006 ). The article intends to describe and build on the lessons learned from the last 4 years of using a standardized approach to patient assessment. The article is designed to create further debate among our peers regarding hybrids of patient assessment.
Can wikis be used to support case-based learning in paramedic education?
Authors: Williams Brett , Bearman Margaret
Published: May 2014

Higher education has seen a rapid increase in the use of Web 2.0 applications, such as wikis, blogs, podcasts and vodcasts. While their use and integration has been investigated by other cognate and non-cognate disciplines, this has yet to be formally undertaken by the paramedic discipline. Therefore, this article describes a pilot study that examines the student use of wikis to support case-based learning (CBL) within a Bachelor of Emergency Health (BEH) degree at Monash University. The aim of this study is to report student attitudes on group work using wikis during weekly CBL activities. Methods: a cross-sectional study using a convenience sample of second year undergraduate students enrolled in the BEH degree were surveyed using a short paper-based self-reporting questionnaire focused on attitudes towards wikis. Included with the questionnaire was a brief set of demographic questions. Results: overall, participants reported positive attitudes and perceptions towards the use of wikis and peer-based learning during the weekly clinical cases. For example, item 1: ‘I found the group wiki useful in completing the team task’ reported a median score of 3 (IQR 2-3), while item 3: ‘using wiki encouraged better participation of each group member in the case’ reported a median score of 2 (IQR 2-3). Despite the positive results, there were areas that require further attention such as social loafing, and development of a more flexible learning management system. Conclusion: although findings from this study are preliminary, it appears that wikis are a useful addition to CBL in paramedic clinical units. Further research is warranted using a larger sample size, and integrated and compared across both clinical and non-clinical units. Closer examination of discrete pedagogical issues such as peer- and self-based learning is also necessary, particularly with the increasing use of educational technology being used throughout higher education.
Scenario-based electronic learning: a viable educational method
Authors: Ellis Ricky , Collins Niamh
Published: May 2014

All prehospital practitioners should participate in the task of establishing a body of knowledge that relates specifically to prehospital care ( Gregory, 2011 ). The rapid pace of change in prehospital knowledge and the release of new clinical practice guidelines would indicate that systems need to be developed to disseminate this knowledge effectively and efficiently. Electronic learning (e-learning) is one method. Prehospital personnel's reaction to electronic learning has not been widely evaluated. Aims: this article presents an overview of the lessons learnt through a structured evaluation of a pilot e-learning module which was delivered to advanced paramedics. Methods: A series of scenario-based educational modules encompassing recent changes in advanced paramedic clinical practice guidelines were developed. In February 2011, the pilot module was made available to 207 advanced paramedics in Ireland. A quantitative and qualitative assessment of this programme was performed. Results: during a four-week trial period, 51 out of 64 registered advanced paramedics who participated in the e-Learning programme, completed an extensive evaluation of the pilot module. The results indicate a strong positive response towards e-learning as a method of delivering learning to advanced paramedics. Discussion: e-learning is a medium set to gain popularity as a method of training in the future due to the ability to rapidly transfer new and updated clinical knowledge within a cohort of practitioners. The medium offers flexibility and cost efficiencies. Conclusion: e-learning has proved a successful tool for delivery of prehospital educational information. Practitioners are prepared to take responsibility for their own education and appreciate the ability to schedule their own learning time.
Equality of care: substance users, the emergency care perspective
Authors: Jones Paul
Published: May 2014

It is important that paramedics demonstrate equality in the care and treatment they provide; however, Paul Jones argues that a discussion of the topic is needed, due to variations in the quality of care provided to certain patients.
Single patient use versus reusable laryngeal mask airways: a comparison
Authors: Hodkinson Mark
Published: May 2014

The laryngeal mask airway was first developed in the 1980s by Dr Archie Brain. The market for supraglottic airways has rapidly expanded since the 1980s, incorporating both reusable and single patient use devices, varying in design, application, cost and durability. Here, the author considers theoretical and anecdotal evidence when comparing single patient use and reusable supraglottic airways. Particular attention has been drawn to the I-Gel, pro-seal laryngeal mask airway and conventional laryngeal mask airway.
Sources of wellbeing: sharpening a sociological tool for diverse populations
Authors: Lazarsfeld-Jensen Ann , O’Meara Peter
Published: May 2014

Undergraduate paramedics studying health sociology routinely reported that they could not see the relevance of a topic judiciously added to the curriculum by Australian universities ten years ago: spirituality. The topic aimed to help students better serve their patients through an understanding of attitudes, reactions and subtle influences on health. However, when discussions shifted to the more concrete concept of religion, students became more engaged and wrote essays which revealed a deeper understanding of ethnicity, culture, and its effect on paramedic practice. Religion had been regarded as a blunt instrument in other disciplines such as nursing and social work, which utilised spirituality as a more inclusive concept. Yet for paramedics it was religion that was the key to seeing the difference in the way some patients made decisions, grieved, expressed modesty or faced death, and how religious beliefs shaped responses to treatment and transport. Shared common knowledge of religions emanating from classroom discussions helped students find strategies for their future career. Students found no difficulty in seeing religion as a definitive element in contemporary society.
Understanding the process and treatment of meningitis and meningococcal disease
Authors: Hodkinson Mark
Published: May 2014

Meningococcal septicaemia is a potentially life-threatening disease process which requires early recognition and rapid management in both pre-hospital and hospital phases of patient care. It is estimated that there are around 3 500 confirmed cases annually in the United Kingdom and, as such, widespread campaigns and national guidelines have been developed and adopted throughout NHS trusts. Standard treatment protocols have been developed and adopted to manage patients appropriately; however, other emerging treatment options are becoming more widely acknowledged, but require further investigation before recommendations can be made. It is vitally important that clinicians in patient-facing roles who are likely to come into contact with meningococcal-related diseases adopt a high index of suspicion, basing diagnosis on history, physical examination and clinical investigations. Rapid intervention should be undertaken for any patient where the disease process is suspected.
The need for paramedics to be able to identify cauda equina syndrome
Authors: Nellist Emily , Lethbridge Kris
Published: May 2014

Cauda equina syndrome (CES) is a rare but serious neurological emergency, which may require urgent neurosurgical intervention. If left untreated it can lead to devastating consequences of paraplegia with bladder or bowel sphincter deficits. It is the experience of the authors that this is a condition that pre-hospital clinicians may encounter but does not currently feature in all paramedic education curricula.

This article looks at what the cauda equina is and how CES can occur. It describes the common signs and symptoms as well as identifying those which should be considered as red flags in practice.

After also considering the medico-legal aspects associated with the incorrect or delayed diagnosis of cauda equina syndrome, the authors will recommend that this condition should feature on the future curriculum of all paramedic education and should be a differential diagnosis, considered whenever a clinician assesses a patient with back pain, especially of a non-traumatic nature.
Clinical Practice Guideline Update—Birth Imminent: Normal Delivery and Delivery Complications
Authors: Brown Simon , Hinshaw Kim , Millins Mark
Published: May 2014

In line with new medical guidance the following update is issued to supplement the UK Ambulance Service Clinical Practice Guidelines 2013
Should we change the Mental Health Act 1983 for emergency services?
Authors: Brown Michael
Published: May 2014

Following the government's announcement in March that it would be undertaking a review of sections 135 and 136 of the Mental Health Act 1983, Michael Brown considers whether emergency services should be provided with better tools for attending mental health crises in public places and private premises.
Conditions of neonatal lambs
Authors: Stevenson Heather
Published: May 2014

Lamb mortality rates are unacceptably high with associated welfare and economic costs. Stillbirths/dystocia, starvation/hypothermia and infectious disease account for the majority of deaths in the neonatal period. Many of the problems are preventable but multifactorial aetiologies and retrospective investigation can make them a challenge to resolve. Ewe nutrition, genetics, management and the environment all need to be considered providing opportunity for veterinary involvement on sheep farms.