bluuebunny/crossref_metadata_2025 huggingface dataset:
Prehospital management of a patient with severe sepsis
Authors: Boardman Sue , Richmond Chris , Robson Wayne , Daniels Ron
Published: May 2014

Paramedics have made a significant contribution to reductions in mortality for the time-critical conditions of acute myocardial infarction (AMI) and major trauma (Myocardial Ischaemia National Audit Project (MINAP), 2008), and they will be instrumental in helping to reduce stroke mortality in the near future (Department of Health 2006). These improvements have, and will be achieved by pre-hospital diagnosis and prompt aggressive treatment. There is however another time critical condition that is currently not being targeted, in which pre-hospital staff could significantly improve the patient's chances of survival. This condition is severe sepsis. This article presents a case study of a patient with severe sepsis who is transported from a nursing home to the emergency department (ED), and explores how paramedics can diagnose severe sepsis by use of a screening tool, and discusses the practicalities of delivering evidence-based care en route to hospital (high concentration oxygen, intravenous fluid challenges, intravenous antibiotics, measuring blood lactate). The benefits of alerting the receiving hospital of a patient with severe sepsis are also discussed.
Equipping the student for workplace changes in paramedic education
Authors: Donaghy John
Published: May 2014

This small scale study explores the relationship between universities curricula, to that of the student experience within their clinical placement. Students attending a UK university which has been delivering paramedic programmes for a number of years took part in the study. A sample of 60 paramedic students were randomly selected and asked to participate. Ethical approval was gained and relevant information and advice disseminated to the participants. A grounded theory approach was used—incorporating a structured questionnaire, allowing for quantifiable data to be retrieved and analysed. In addition, qualitative data was gathered, via the use of ‘free text’ to enrich the study, by allowing participants to expand on their feelings and experiences. Descriptive statistical analysis of the quantitative data revealed that many students felt their clinical competencies and personal confidence were sufficient within the clinical setting. In addition, through qualitative thematic analysis, a number of areas were identified which reflects the student experience of university curricula in relation to clinical practice.
Recording a standard 12-lead ECG: filling in gaps in knowledge
Authors: Crawford Jacqui , Doherty Linda
Published: May 2014

Jacqui Crawford and Linda Doherty discuss some of the reasons for inaccuracy in electrocardiography and ways to ensure correct placement of electrodes.
What is our unique selling point?
Authors: Capsey Matt
Published: May 2014

At the Trauma Care conference that took place in Telford in May 2010, Matt Capsey, Senior Lecturer of Paramedic Science at Teeside University, presented a very interesting discussion, titled ‘Paramedics—what is our unique selling point?’. Here, he discusses this in more detail, arguing that paramedics must develop a stronger sense of identity and value the unique contribution they bring to patient care. He presents a view that if paramedics value their unique skills, then they can contribute to wider healthcare practice—but without a strong sense of professional identity, their voice may be sidelined in future developments.
Hypoglycaemia: a case report
Authors: Hendy Philip , Audit Selena
Published: May 2014

Diabetes mellitus is one of the most important medical conditions, in terms of morbidity and mortality, and financial cost. Hypoglycaemia is the most common complication of diabetes, and can also be associated with other conditions. The role of the paramedic in the initial assessment and management of this presentation is paramount. A huge number of hypoglycaemic episodes occur on a day-to-day basis, and the recognition of those patients requiring hospital admission is of vital importance. Through a case study, and a review of the condition, this article acts as a guide to the patient journey, from initial symptoms through to hospital discharge. We also highlight important issues such as prolonged hypoglycaemic episodes, and a mental health review of those who have taken a deliberate anti-hypoglycaemic agent overdose.
Resuscitation from out-of-hospital cardiac arrest in an under-resourced environment
Authors: Stein Chris
Published: May 2014

Published data on the epidemiology of out-of-hospital cardiac arrest (OHCA) come mostly from developed countries. Few studies have described the nature of OHCA in developing countries, where resources guaranteeing rapid access to cardiac arrest cases may not be available. A retrospective case series on OHCA in Johannesburg, the first study of this type in an African population, showed that response times were comparatively long, less than half of patients were resuscitated and rates of shockable rhythms and return of spontaneous circulation were lower than those reported in most other published studies. These results are most likely caused by lack of resources, in the form of emergency vehicles, in a region with a very busy emergency medical service, providing prehospital care to a large population. Other factors caused by poor emergency service management tend to complicate this picture and exacerbate the response time problem. Although paramedic learning programmes in South Africa are of a high standard and prepare qualifying practitioners to treat OHCA cases adequately, a lack of effective emergency medical service management and organization means that these human resources cannot be put to good use in improving OHCA outcomes. To improve OHCA outcomes, under-resourced emergency medical services should focus on fundamental aspects of the system to guarantee rapid access to patients, rather than more advanced scopes of practice for paramedics.
Air ambulance tasking: why and how?
Authors: Parker Andrew , Corfield Alasdair
Published: May 2014

Air ambulances are a scarce and expensive resource and their use carries significant risk for crew and patients ( Hennesy; 2005 ; Holland et al. 2005 ; Hinkelbein et al, 2008 ; Lutman et al, 2008 ). To benefit appropriate patients while minimizing risk and cost, tasking of air ambulance assets should ideally be sensitive and specific. Within the UK and across Europe, there are no standardized criteria to dispatch these resources ( Littlewood et al, 2010 ; Wigman et al, 2010 ). Even where dispatch criteria are agreed, compliance is variable ( Tiamfook-Morgan et al, 2008 ). The purpose of this review is to look at the evidence and rationale for tasking of air ambulance assets.
Enhancing the student learning experience through interactive virtual reality simulation
Authors: Power Paul
Published: May 2014

A virtual simulation workshop took place at the University of Hertfordshire (UH) in 2010 as part of a small project funded by the UH Learning and Teaching Institute. The project saw the development and implementation of an innovative virtual simulation package (virtual paramedic scene management software). The project was a joint venture combining teams from the School of Health and Emergency Professions (paramedic science) and the School of Computer Science (real-time 3D team). Learning from simulation is already well established at UH through the Hertfordshire Intensive Care and Emergency Simulation Centre ( Alinier, 2007 ). Together with existing education and training for clinical skills and patient assessment and management, it was envisaged that introducing virtual e-learning might complement those approaches. This brief report serves to share our experience with those who may be considering using virtual reality scenarios as a teaching/learning approach in the future.
Prehospital assessment of stroke: time is brain
Authors: Rae Victoria , Ford Gary , Price Christopher
Published: May 2014

Prehospital identification is a vital initial step in the emergency medical management of stroke. There are several symptom-based screening tests which facilitate the identification of patients following a systematic clinical assessment. Screening also identifies conditions that mimic stroke and may require their own specific treatment. Between stroke recognition and arrival at hospital, there are important observations and treatment responses which will improve the outcome for patients. Rapid symptom identification and transportation to an appropriate unit will increase the probability that patients with ischaemic stroke can receive thrombolysis. The importance of prehospital stroke assessment is likely to increase with the development of future technologies.
Influence of life experience on undergraduate paramedic students’ placement
Authors: Henderson Tristan
Published: May 2014

Life experience has long been considered a vital aspect of paramedicine and paramedic education ( Cooper, 2005 ). This has become more relevant in the past few years with the advent of widespread higher education institute (HEI) undergraduate paramedic programmes nationally. This qualitative research, using semi-structured interviews and a focus group, aims to explore relationships between the prior life experience and placement engagement of first–year paramedic students. Findings highlighted the multi-faceted nature of engagement in placement and emphasised the need for provision of quality clinical placements and suitably qualified/experienced mentors. This ensures support and understanding can be provided on an individual basis to students.
Does understanding words used by the breathless COPD patient enhance therapeutic care?
Authors: Harrison Susan
Published: May 2014

Shortness of breath, dyspnea and breathlessness are collective terms to describe the awareness of inadequate gas exchange within the respiratory system.Varying mechanisms, behavioural and physiological changes are caused by this ventilation-perfusion mismatch. This complex sensation encompasses manydiverse concepts.

The spectrum of language and words used as a consequence of this sensation varies from quality and intensity to emotions and feelings. Matching the phrases to the cause supports understanding.

Current studies reviewed produced clusters of verbal descriptors which reflect the multi-dimensional input as a consequence of being out of breath. Using these clusters has produced a comprehensive list of twelve words known as ‘The Dyspnea 12’ which when used, quantifies the severity of this debilitating and extremely distressing symptom.

Could these verbal descriptors be used to aid the assessment and treatment of their cause in service users and provide a more holistic view to a widespread problem?
“Trojan Ambulances”: an emerging threat
Authors: Overton Matthew
Published: May 2014

A trusted vehicle such as an ambulance could be used as part of a terrorist plot to help deliver a vehicle borne improvised explosive device to its intended target. Such a vehicle being used in this manner is called a ‘Trojan’ vehicle. Examples of such use exist from other countries worldwide and it is not unreasonable to think that this type of terrorism attack could be used in this country. Drastic mitigation measures have been used abroad to prevent this form of terrorist attack from occurring; however, these can cause delay to patient care and hospital access. In this country more simple security measures (such as those used to prevent theft of property) can be utilised to mitigate against this type of attack, and paramedics, along with the wider ambulance sector, have a role to play in implementing such security measures and preventing such an attack.
Understanding a new model of leadership
Authors: Johnson David , Bainbridge Peter , Hazard Wendy
Published: May 2014

Leadership is an essential feature of the life of a paramedic. During incidents, whilst working with multi-agency colleagues, and within organisations, leadership is an expected quality of paramedics. Across health and social care organisations leadership is said to be of pivotal importance to future success. This has led to a large investment in leadership development programmes that organisations are now seeking to justify. Leadership as a concept is, however, complex and multifaceted. The nature of leadership has been debated over millennia and still disagreement exists as to how to define it. This paper utilises Critical Interpretive Synthesis to consider how approaches to leadership have developed over time. It concludes with a synthesising argument that leadership is a social construct; as such no single definition will ever be appropriate; however, the four elements that comprise the leadership equation should be considered if the paramedic leader is to be effective.
Pre-hospital lactate testing in the identification of patients with sepsis: a review of the literature
Authors: Kirby Kim
Published: May 2014

Sepsis is increasingly common and has a high mortality rate. Sepsis can be difficult to identify and patients with severe sepsis often initially present to the ambulance service. Lactate testing has been utilised successfully in other healthcare settings to assist with the identification of septic patients and stratification of illness severity.

A focused literature review has revealed that pre-hospital lactate testing has shown benefits to clinicians pre-hospitally in the identification of septic patients presenting to the ambulance service. Only four pieces of primary research were identified and small sample sizes and variability of lactate testing limit the generalisation of the findings. Further research is required to fully investigate the potential benefits of using pre-hospital lactate testing to identify those patients with sepsis, severe sepsis and septic shock presenting to the ambulance service.
Information and advice for prospective paramedics
Authors: Dunkley Mike
Published: May 2014

Mike Dunkley was recently asked to provide an article from the student perspective aimed at potential paramedic recruits, which describes what they should expect in the application process, the education programme, and the demands of training in the pre-hospital environment.
Understanding the difference between overweight, obese and bariatric
Authors: Swann Julie
Published: May 2014

Emergency care providers cannot help but notice that there has been an increase in obese and bariatric patients. This article discusses the differences between people who are overweight, obese or bariatric, and explores the ways that obesity can affect a person's health. The impact of this on the management of over-sized patients and the service delivery of emergency care professionals is outlined.
Essex and Herts Air Ambulance: a focused case series for pre-hospital practice
Authors: Ley Erica , Chesters Adam
Published: May 2014

Burns and scalds are relatively common in children and can be distressing for all involved. General principles of early management are to limit the progression of the burn through cooling, and to manage pain in order to perform a thorough assessment and improve the patient's experience. Assessment of burns includes an estimation of body surface area involved, an appreciation of the depth of burn, and the consideration of ‘special areas’ affected. A number of tools and guides exist that help standardise this assessment. However, it is impossible to truly know the size and extent of the burn during the first contact meeting in the pre-hospital environment as a burn matures and develops over the course of 72 hours. Treatment regimes are focused upon improving blood flow to the area of stasis, a fragile circumferential area between the zone of coagulation, in which the tissue is already unsalvageable, and the zone of hyperaemia, where blood flow to the surrounding tissues in increased.

We report the case of a 2-year-old boy who sustained a scald to the abdomen after pulling over a freshly made cup of tea. We describe an approach to burns in children, in collaboration with parents. This case highlights the need for early adequate analgesia, thorough assessment, and triage to the correct hospital where the patient's injury can be appropriately managed. We also highlight areas in which an extended care service such as a helicopter emergency medical service (HEMS) team can help, particularly in terms of supplementary analgesia and transfer to specialist units.
Principles of control of Johne's Disease in the dairy herd
Authors: Grove-White Dai , Oultram JW
Published: May 2014

Johne's disease, caused by infection with Mycobacterium avium subspecies paratuberculosis (MAP) is a chronic, debilitating disease of ruminants. In cattle the classic clinical signs are profuse diarrhoea and wasting. However such cases represent the ‘tip of the iceberg’ and it is estimated that for each clinical case there are 10–25 infected animals in the herd, incurring costs associated with sub-clinical disease and loss of production. This paper describes the diagnosis and strategies to control of Johne's disease in the dairy herd.
Diarrhoea in the foal
Authors: McGovern Kate
Published: May 2014

There are numerous causes of diarrhoea in neonates and older foals. As with adult horses, while cases can be managed symptomatically, a specific diagnosis is often challenging because of gaps in knowledge of the normal gastrointestinal flora and limitations in available diagnostic tests. Additionally, isolation of an organism from a faecal sample does not necessarily equal causation. Broad-spectrum antimicrobial therapy is advisable in a young foal with all but the mildest diarrhoea, due to the high likelihood of bacteraemia occurring and therefore secondary complications.
Neospora in cattle and dogs: an update
Authors: Pooley Fay , Remnant John , Wapenaar Wendela
Published: May 2014

The protozoan parasite Neospora caninum is one of the most frequently diagnosed abortifacient pathogens in cattle in the UK ( AHVLA Surveillance report, 2012 ). It is a leading cause of abortion worldwide but the mechanisms leading to abortion are not fully understood, which is hampering control on farms. In addition, N. caninum is a common cause of clinically relevant secondary inflammatory myopathies in dogs ( Podell, 2002 ). In this article we summarize current knowledge and recent research, and recommend options for control.
Bog asphodel toxicity in sheep and cattle
Authors: Strugnell BW
Published: May 2014

This article summarises the current knowledge of the pathogenesis and toxicology associated with bog asphodel (BA), which is common in wet upland areas. The plant causes hepatogenous photosensitisation in sheep and nephropathy in cattle. Government-funded schemes aimed at climate change mitigation and promotion of biodiversity in upland areas may have increased habitat for BA and therefore the risk of exposure by grazing livestock to BA, and joint approaches between those involved with these schemes and livestock farming may be required to maintain the health and welfare of livestock grazing these areas, without compromising biodiversity and other strategies for upland bog management.
EHM — what every equine practitioner needs to know
Authors: Ivens Philip
Published: May 2014

Equine herpesviruses (EHV) are some of the most widespread pathogens in the equine world. EHV-1 and 4 cause diverse and important disease syndromes. One of these, equine herpes myeloencephalopathy (EHM), is potentially increasing in frequency and is regarded as an emerging disease. The confusing terminology of neuropathogenic strains and non-neuropathogenic strains are explored and the reliance in a clinical setting on this molecular differentiation discouraged. The accurate diagnosis and treatment of EHM is a challenge and an evolving area which is explored with emphasis on recent advances. Practical biosecurity and herd health measures are critical to the prevention of EHM and laid out as per the national code of conducts. The complex role of vaccination is discussed and a framework given to vaccination use in a field setting.
Urinary tract infections: prevention and treatment of a common problem
Authors: Bardsley Alison
Published: May 2014

Urinary tract infection (UTI) is the commonest infection in women, affecting up to 50% of women at some point in their lives. Although generally uncommon in men, it is more common among older people and can lead to serious complications if untreated. This article discusses the presentation and diagnosis of UTI, and prevention and treatment from the perspective of the nurse prescriber.
The new GMS contract: what does it mean for nurse prescribing?
Authors: Rashid Claire
Published: May 2014

The new General Medical Services (GMS) contract (The NHS Confederation and British Medical Association, 2003) has the potential to transform community health services. Patients will register with a practice or provider rather than an individual GP and the emphasis will be on a team-based approach to delivering quality care.
A painless introduction to pharmacology for nurses:part 1
Authors: McKinnon John
Published: May 2014

This article explains some of the founding principles of pharmacology in simple terms while acknowledging the theoretical depth required for sound prescribing and medicines management. The first two pharmacokinetic phases: absorption and distribution, are defined and described. Anatomical structure and function together with laws of physiology are shown to form the basis for drug design and drug route choice. The effectiveness of three specialized capillary networks in place to protect vulnerable tissue from harmful substances is explored. Where appropriate there is application to clinical practice and the impact of some pathological states on absorption and distribution processes is described. Pharmacology is viewed as one of many components which feed professional judgment in the care setting.
Supplementary prescribing: one general practice’s experience of implementation
Authors: Baird Anne
Published: May 2014

This article discusses one practice’s experience in the implementation of supplementary prescribing. The factors which influence the situations in which supplementary prescribing is appropriate are discussed, including issues of diagnosis, comorbidity, hospital care, repeat prescribing, frequency of review and continuity of care. Supplementary prescribing can provide a useful addition to the care that nurse prescribers are able to offer to patients, but is not appropriate in every situation.
A question of negligence: the law and the standard of prescribing
Authors: Griffith Richard , Tengnah Cassam
Published: May 2014

The legal standard of prescribing is regulated by the law of negligence. This allows patients to sue if harmed by careless prescribing or drug administration, with damages of approximately £500 million being paid last year. This article, the first in a series about the legal issues surrounding nurse prescribing, outlines the elements of a negligence action and its implications for prescribing practice.
A painless introduction to pharmacology. Part 2: therapeutics and metabolism
Authors: McKinnon John
Published: May 2014

The second article in this series continues to explain the foundations of pharmacology in terms of its relevance for nurse prescribing practice. The fundamental principles underpinning pharmacodynamics are examined. The third and fourth pharmacokinetic phases - metabolism and elimination - are described. The importance of the pharmacokinetics, half-life and therapeutic index of agents to dosage calculation are considered along with the age of the host. Reference is made where appropriate to examples in clinical practice.
The use of the internet to support the education of nurse prescribers
Authors: Smith Anne
Published: May 2014

As extended and supplementary nurse prescribing is expanded there is a need to ensure that practitioners remain abreast of developments and competent to perform their roles. The internet affords opportunities for practitioners to communicate with their peers to explore the implications of the expanding formulary and Department of Health guidelines. This article describes how web-based technologies were embraced in a programme developed at Bolton Institute of Higher Education to support nurse prescribing students and newly qualified nurse prescribers.
Evidence and engagement in the introduction of nurse prescribing in New Zealand
Authors: Hughes Frances , Lockyer Helen
Published: May 2014

The extension of prescribing rights to nurses is complex from both a policy and a legal perspective. In New Zealand, like many other jurisdictions, it has taken time to develop and establish changes. There are a number of lessons that New Zealand has learned about the factors likely to contribute to success. These factors include building strong relationships with stakeholders; using robust evidence and information, including the latest developments internationally; and ensuring flexible policy and legal arrangements that can respond to change.
The importance of patient-centred planning in prescribing practice
Authors: McKinnon John
Published: May 2014

This paper draws on nursing theory to demonstrate the relevance of patient-centred planning as a mindset to the prescribing situation. A case study analysis approach using hypothetical scenarios based on the author’s experience of patients is deployed to describe and illustrate the dynamics of patient-focused principles at work in practice. The relationship between patient-centred planning and concordance is explored and defined. Deontological ethics are viewed as pre-packaged subsidiaries to patient-centred planning as a paramount concept. Arguments are tabled for reflection on the patient’s perspective as a means of preserving a nursing epistemology.
Helicobacter pylori-induced gastritis: pathophysiology, assessment and treatment
Authors: Banning Maggi
Published: May 2014

Gastrointestinal disorders occur in up to 40% of the population in the UK. Treatment of these disorders accounts for a large proportion of the NHS prescribing budget. Although the aetiology of gastrointestinal disorders is complex, the contribution of Helicobacter pylori in the development of gastric and duodenal ulceration, dyspepsia and various forms of cancer, continues to be discovered. The increasing interest in the bacterium and the need for its eradication continues. Exploration of how non-invasive biochemical tests can detect the bacterium and combination therapy can eradicate it has improved the management of H. pylori-associated conditions. The need for screening protocols which target ‘at-risk’ groups and routinely investigate people who suffer from dyspepsia, should be encouraged as this can maybe reduce the incidence of H. pylori-induced gastric infections. The nurse prescriber can have an educational and management role to play in the eradication of this bacterium.
A painless introduction to pharmacology. Part 3: adverse drug events
Authors: McKinnon John
Published: May 2014

The final article in this series examines adverse drug event pathogenenis in its various forms. Appropriate definitions are considered and epidemiological and predisposing factors are outlined. Distinctions are made as to types of reactions using Rawlins’ and Thompson’s adverse reaction typology, together with Gell and Coombs’ classification of drug hypersensitivity. This article will also consider the relevant application of adverse drug events to clinical practice. Proactive medicines management is viewed as a multifaceted approach involving multiprofessional and patient partnership.
Choosing the right prescribing options in wound debridement
Authors: Bentley Jenny
Published: May 2014

Wound debridement is an effective way of promoting healing in a chronic wound. There are a number of debridement options, some of which require the prescription of desloughing agents. There are other options which require additional skills, such as sharp debridement. The different options for wound debridement and the factors which influence the choice of which agent to use, e.g. cost, clinical effectiveness and clinical competence, will all be discussed in this article.
Controlling nausea and vomiting in palliative care patients
Authors: Kinley Julie
Published: May 2014

In May 2005, a new category focusing on the central nervous system was added to the Nurse Prescribers’ Extended Formulary (NPEF). This new category covers control of nausea and vomiting and also incorporates the prophylaxis and treatment of nausea and vomiting in the post-operative period. Therefore, the management of this medical condition is now an option for all extended non-medical prescribers not just those practising in the sphere of palliative care. While the focus of this article is on nausea and vomiting in palliative care, issues such as using licensed drugs for unlicensed purposes or via unlicensed routes will also be addressed.
Whatever happened to joined up thinking?
Authors: Otway Chris
Published: May 2014

I remember back in those heady days of the new labour government that ‘joined up thinking’ was the answer to everything. On every debate programme or interview with a government minister we were led to believe that ‘joined up thinking’ would solve most of our problems. All this talk of ‘joined up thinking’ gave us the distinct impression that someone at the top had a ‘plan’.
Understanding the biological differences between adults and children
Authors: Houghton Juliet
Published: May 2014

The use of medicines in children is rarely supported by robust data from clinical trials, and the physiological differences between children and adults is often poorly understood. In this article, the pharmacokinetic differences between children and adults are discussed along with the implications of concurrent disease states and adherence/concordance, and strategies for promoting safe and effective nurse prescribing are discussed. Suggested future developments are also explored.
Role of the advanced nurse practitioner in prescribing and general practice
Authors: Haidar Elizabeth
Published: May 2014

Acquisition of the skills of prescribing and clinically assessing patients is probably the most inspiring and interesting new area for nurses. These skills complement each other; nevertheless, their attainment is challenging and needs knowledge and experience. Skills aquisition according to the Dreyfus Model that was generalised by Benner (1984) to nursing is reviewed in this article.
A guide to working with the pharmaceutical industry
Authors: Simmonds Heather , Courtenay Molly , Griffiths Matt
Published: May 2014

The introduction of Nurse Independent Prescribing and Nurse Supplementary Prescribing means that over 10 000 nurses across the UK have virtually the same prescribing rights as doctors. Nurses are therefore faced with the challenges of working with the pharmaceutical industry. Such challenges include the extent to which promotional material can be relied upon, the acceptability with regards to the provision of free samples, hospitality, gifts, and the sponsorship of meetings. The Association of the British Pharmaceutical Industry (ABPI) Code of Practice for the Pharmaceutical Industry sets out how pharmaceutical companies are permitted to promote medicines to health professionals and others. It also covers the provision of information about prescription-only medicines to the public.
Developing decision support systems for nurse prescribers
Authors: Chapman Stephen R
Published: May 2014

Nurse prescribing is now established in UK practice and is set to increase in prevalence. However, signifi cant national variations in the prescribing of drugs indicate that evidence-based prescribing continues to present a challenge to both medical and non-medical prescribers. To a degree this is to be expected as the implementation of evidence-based medicine is inherently complex as well as being both time-, and resource-intensive. Although it could be argued that it is the job of bodies such as NICE to untangle the clinical evidence and provide clear practical guidance, it is also clear that NICE is only one ‘voice’ and that prescribing behaviour is shaped by many infl uences, both independent and commercial, data- and opinion-driven. Decision support systems, which have been shown to improve clinical practice, are able to marry the clinical evidence base in a given condition with patient-specifi c characteristics. The Department of Medicines Management at Keele University has developed a number of decision support systems which have the potential to support prescribers – particularly nurse prescribers – in the practical implementation of evidence-based prescribing as part of a patient-centred approach.
Finding a cure for the itch: pruritus for nurse prescribers
Authors: Karim Kelvin
Published: May 2014

Pruritus, a ubiquitous symptom with a wide range of presentations, often causes considerable distress for many individuals, resulting in a reduced quality of life. In recent years, there has been renewed interest and increased research activity in this previously neglected field. Although there is still much to be learnt about the mechanisms of pruritus, the clinician's antipruritic armoury is steadily improving. The key to successful management is early recognition together with accurate and holistic patient assessment. This article aims to provide an overview of the management and treatment of pruritus. The words ‘pruritus’ and ‘itch’ are used interchangeably in this article.
Introducing nurse prescribing: an Irish perspective
Authors: Creedon Rena , O'Connell Elizabeth
Published: May 2014

This article outlines the introduction of nurse prescribing to the Irish setting by reviewing the changes made to the legislation and the roles played by An Bord Altranais (the regulatory body for the nursing profession in Ireland), the Health Service Executive, and the University in delivering the education programme. The future of nurse prescribing and implications for practice is also addressed.
Nocturnal enuresis in childhood
Authors: Rogers June
Published: May 2014

Nocturnal enuresis is a common childhood problem that has the potential to have a negative impact on the social and emotional well being of the child. The multifactoral aspects of the condition are now better understood and successful treatment involves interventions that simultaneously address each contributory factor. This article gives an overview of those factors and discusses the treatment options.
The management of asthma in primary care
Authors: Cornforth Amber
Published: May 2014

There is a need for regular education and support of patients with asthma, in the context of an effective partnership with health professionals. Asthma reviews in primary care should be carried out at least annually, trigger factors—including factors that lead to occupational asthma—identified, inhaler use investigated, and personalized asthma action plans implemented. Pharmacological management should be tailored to the patient's needs, and should also take into account issues such as non-adherence and smoking.
Selective serotonin reuptake inhibitors: pharmacological profile
Authors: Lovatt Penny
Published: May 2014

Selective serotonin reuptake inhibitors (SSRIs) are one classification of antidepressant medications. Pioneered with the introduction of fluoxetine in 1987, the pharmaceutical industry has continued development in this area of therapy. After revisiting the serotonergic theory of depression, this article will consider the pharmacodynamic and pharmacokinetic properties of SSRIs, concentrating on fluoxetine to enable focused examination. Safe prescribing in special patient groups will also be considered, and a summary of current SSRIs and their therapeutic uses will be presented.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

Fiona is an independent advisor in the development of NMP and will be happy to assist organizations or individuals with their queries.
Nutrition related to obesity and diabetes as a public health issue
Authors: Coe Sarah
Published: May 2014

Obesity is set to be a major public health crisis. Recent data indicate that 24.5% of adults and 13.9% of children in England are obese, with the situation likely to worsen if no further action is taken. Obesity is directly linked to an increased risk of developing type 2 diabetes; and the number of adult people with diabetes is also predicted to grow. Both conditions are associated with an increased risk of incidence of several morbidities, which has a significant impact on health and wellbeing. The risk of both obesity and type 2 diabetes can be reduced through lifestyle advice, to achieve and maintain a healthy body weight. Diets that are low to moderate in fat and high in fibre, in combination with increased levels of physical activity, should be encouraged in order to help accomplish this. More recent evidence shows that the energy density of the diet may also help with weight loss and maintenance.
Getting to the bottom of nappy rash: skincare advice and treatment
Authors: Stevenson Jane
Published: May 2014

Nappy rash is generally a mild condition that affects most infants at some time. Community nurses are very well placed to reassure parents and give advice about managing and preventing this common condition.
The basics of pharmacokinetics in prescribing and clinical practice
Authors: Khan Ehsan U
Published: May 2014

Maintaining safe drug management requires an understanding of not just how a drug interacts with the body, but also how the body interacts with the drug; this process is known as pharmacokinetics. Pharmacokinetic processes involve the absorption, distribution, metabolism and clearance of a drug molecule, and they have considerable capacity to deal with drugs; however, when these process are exposed to multiple medications (polypharmacy) or when the organs involved in the processes are dysfunctional there is potential for
Interprofessional education within a university NMP programme
Authors: Davies Sheena , Gidman Janice
Published: May 2014

Although it is a difficult concept to prove, there is increasing evidence that well-planned interprofessional education (IPE) in the health service can ultimately improve patient care. Using Kolb's learning cycle, the authors were able to reflect on IPE within a university non-medical prescribing programme. IPE can be encouraged in this setting, if lecturers understand its advantages and barriers, and adapt learning to encourage its development in both colleagues and students. Many barriers to effective IPE have been identified, such as professional rivalry and historical uniprofessional education. The authors were also able to consider learning strategies to promote its use, such as problem-based learning, practice-based learning and exchange-based learning.
Functional constipation in childhood
Authors: Rogers June
Published: May 2014

Although idiopathic constipation is one of the commonest problems in childhood, it is often the most poorly managed.Left untreated, constipation can become chronic and result in devastating problems, including soiling, as well as pain and distress for the child and family. The recent NICE guidelines on the management of idiopathic constipation in children and young people not only provide evidence-based strategies for the improvement of assessment and treatment but may also lead to service improvements, with potential cost savings, by reducing the need for secondary care interventions. This article will give an overview of the management of functional or idiopathic constipation in childhood while reflecting on the NICE guidelines and discussing the keys to successful treatment.
Diagnosis and management of cluster headache
Authors: Edwards Julie
Published: May 2014

Cluster headache is a severe, disabling headache disorder, and current evidence suggests that it remains poorly diagnosed and managed. The aim of this article is to increase awareness of this disorder by identifying the key diagnostic features and current acute and prophylactic treatments available.
Early diagnosis and access to treatment for dementia patients
Authors: Boyd Robert
Published: May 2014

This article provides an overview of measures to improve early diagnosis and early access to treatment among people with dementia. Although specialist nurse prescribers have an increasing role to play in prescribing and offering support to people with dementia, the article is aimed at all nurse prescribers, many of whom may be treating people with early signs of dementia but are unaware that they are doing so or do not know where to direct such patients ( Stapleton, 2010 ). Akin to this, the article also looks at the rise of memory clinics in the UK, screening for dementia, and early signs and symptoms. It draws on National Institute for Health and Clinical Excellence (NICE) (2011) guidance, which updates the NICE (2006) guidelines.
Evaluation of nurse prescribing in a community palliative care team
Authors: Dawson Sheila
Published: May 2014

Nurse independent prescribing (NIP) within adult community palliative care has been implemented in many areas ito improve the quality of care for these patients by providing a more flexible and streamlined service. In order to evaluate whether NIP does benefit community palliative patients, a small case study was carried out comparing how long it took for patients to receive their medication following assessment or review by the palliative care clinical nurse specialist (CNS), both before and after implementation of NIP. The results suggest that NIP resulted in more timely access to medication for these patients.
Prescribing quetiapine using a medications management framework
Authors: Graham Judith
Published: May 2014

This article uses a fictitious case to explore prescribing decisions in mental health nursing practice. The article is specifically focused on prescribing quetiapine as an antipsychotic medication, using the structure of a medications management framework. The article discusses the pharmacokinetic and pharmacodynamic properties of the medication, and critically analyses the costs and benefits to the patient in regards to its prescription.
Hydrocoll: a new breed of wound dressing
Authors: Williams Clare
Published: May 2014

Clare Williams gives an overview of Hydrocoll, a new type of hydrocolloid dressing for wounds.
Approaches to death and bereavement
Authors: Read Sue
Published: May 2014

Loss is an event that most professionals working in a nursing or residential setting will encounter. Sue Read addresses the issues relating to death and grief responses.
Clostridium difficile infection in nursing homes
Authors: Gammon John
Published: May 2014

John Gammon examines the causes and effects of gastrointestinal associated disease caused by Clostridium difficile toxin and outlines the methods of infection control employed in the care home setting.
Urinary catheters: selection, maintenance and nursing
Authors: Stewart Elizabeth
Published: May 2014

Elizabeth Stewart reviews catheter selection, maintenance and nursing care, highlighting problem areas and suggesting measures that may be taken to reduce the risk factors. A problem-solving approach, based on research evidence relating to catheter care, is presented.
The new Neptune bathlift from Mountway
Authors: Fitzgerald Julia
Published: May 2014

Julia Fitzgerald gives an independent assessment of the new Neptune bathlift, which does not require any installation and can be used in most baths.
Nutrition requirements for children
Authors: Chan Wynnie
Published: May 2014

Wynnie Chan outlines the specific nutritional requirements of children of different ages, and considers how the research which has been undertaken in this field can be applied to all children.
Dysphagia: variety is the spice of life
Authors: McLaughlin Sharon
Published: May 2014

In the past various articles have been written on the subject of dysphagia. In this article, Sharon McLaughlin will look at the causes of dysphagia and how it can affect the patient.
How to… Create a sensory garden
Authors: Gee Gillian
Published: May 2014

Westbury Lodge is a residential home situated in the market town of Westbury in Wiltshire. Residents with learning disabilities and a variety of different needs, including those with sensory loss, enjoy a full and active life within a warm and friendly environment.
Care Caseload
Authors: Rodway Simon
Published: May 2014

Simon Rodway discusses the development of a strategy for good residential care, and necessary safeguards which must be put into place.
Aggression management training in health care
Authors: Brennan Walter
Published: May 2014

Walter Brennan gives a brief history of the use of control and restraint techniques in a psychiatric setting and highlights the need for training in aggression management for health-care workers.
Prevention and management of violence in a secure youth centre
Authors: Epps Kevin , Moore Claire L , Hollin Clive R
Published: May 2014

Physical restraint is common in some children's homes. In this paper, Kevin Epps, Claire Moore and Clive Hollin present the preliminary evaluation of the Protecting Rights in a Care Environment training course in a secure youth treatment centre.
How to… Cope with a computer 2
Authors: Ashurst Allan
Published: May 2014

In the first part of this article:

▪ I tried to dispel computerphobia ▪ I told you how useful a computer had proved to us ▪ I explained what a computer is ▪ I introduced you to Windows® (an interface program which displays icons on the screen from which you can select the programs you want to use). ▪ I advised you of the computer's usefulness in the caring profession (doing finances, records, correspondence, e-mails, newsletters and marketing).
Auditing to achieve an acceptable level of excellence
Authors: Cummins Frank
Published: May 2014

Frank Cummins describes how the auditing of care standards does not always occur in the independent sector and highlights how it can be use to ensure that an excellent standard of care is delivered to all clients.
Successful residential refurbishment
Authors: Ashurst Adrian
Published: May 2014

Adrian Ashurst provides a personal view on the principles of good practice concerning a refurbishment project.
The Great Escape
Authors: Rosenfield Steven
Published: May 2014

Steven Rosenfield recalls the night a resident escaped from a city centre nursing home. This incident highlights a number of points which all nursing and residential care home staff should take into account.
Diabetes mellitus in residents of long-term care
Authors: Walsh K , Bennett G
Published: May 2014

Kieran Walsh and Gerry Bennett look at the clinical features, assessment and management of diabetes in residents of long-term care.
The role of podiatry in nursing and residential care
Authors: Clelland Jeanette , McCann Margaret
Published: May 2014

Jeanette Clelland and Margaret McCann discuss their role in raising awareness of preventable foot problems within this vulnerable client group and highlight some preventative foot-health strategies.
Care documentation for the 21st century
Authors: Ashurst Adrian
Published: May 2014

Adrian Ashurst discusses the importance of keeping detailed, accurate records, both from a care and a legal perspective, and looks at how the Standex system can help staff maintain good records.
New national occupational standards for ‘heads of home’
Authors: Thomas Kevin
Published: May 2014

Kevin Thomas introduces the new draft national occupational standards for ‘heads of homes’ which set out what is expected of registered managers of residential and nursing homes. The standards are now out for consultation until 5 May 2000.
Introduction to day care centres: a case study
Authors: Merry Denny
Published: May 2014

Denny Merry explains how day centres can assist adults with learning difficulties to pursue leisure activities and help them gain invaluable personal development and social skills, so as to enable them to lead fulfiling lives.
Implementing the Boots MDS: a case study
Authors: Gardner Nicky
Published: May 2014

Nicky Gardner outlines her experiences of implementing the Boots Monitored Dosage System (MDS) and discusses the benefits of its use for both staff and clients.
Positive customer care
Authors: Ashurst Adrian
Published: May 2014

Adrian Ashurst explores the use of ‘mystery shoppers’ in other industries and suggests that staff working in care homes may benefit from a visit from a mystery shopper.