bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting concordance with multilayer compression bandaging
Authors: Miller C. , Kapp  , Newall N. , Lewin G. , Karimi L. , Carville K. , Santamaria N.
Published: May 2014

Objective: To examine the relationship between concordance with multilayer compression bandaging and a number of client and wound characteristics, including wound severity, health status and client independence with respect to activities of daily living. Method: Using data gathered for a randomised controlled trial that compared two types of antimicrobial dressings on infected or critically colonised lower leg ulcers, we explored the level of concordance with compression therapy by patients with wounds that had an ankle brachial pressure index of between 0.8 and l.2. Results: A logistic regression analysis found that increased pain and wound size, older age and shallow wound depth were all significant predictors of non-concordance with multilayer compression bandaging. conclusion: Although the results suggest that pain, wound size, age and wound depth are all significant predictors of non-concordance with multilayer bandaging, the generalisability of these results is limited, given that data were gathered in the context of a RCT. Further studies are required to explore the relative contribution of predictors of concordance with compression therapy, in order to help inform strategies that promote it and, thereby, optimise healing. conflict of interest: None.
Biofilms and their management: from concept to clinical reality
Authors: Cowan T.
Published: May 2014

How can a better understanding of wound biofilms change your clinical practice? And what is the likely impact on clinical outcomes? At this year's JWC lecture, sponsored by sorbion, two of the world's leading microbiologists, Steve Percival and Randy Wolcott, answered these questions. Steve Percival explained what a wound biofilm is, and what diagnostic and management techniques can be used to overcome it. Randy Wolcott described the astonishing success this can bring, with healing rates of up 90% being recorded in patients with recalcitrant chronic wounds
An RCT to determine the effect of a heel elevation device in pressure ulcer prevention post-hip fracture
Authors: Donnelly J. , Winder J. , Kernohan W.G , Stevenson M.
Published: May 2014

Objective: A randomised controlled trial set out to determine whether there are differences between complete offloading and standard care in terms of the number of new pressure ulcers (PUs) developing on the heels of older patients with fractured hips and the number or severity of new Pus on other areas of their bodies. Method: Patients aged over 65 years in a fracture trauma unit with fractured hips were randomly allocated to receive heel elevation (DM Systems, Evanston, Illinois) plus pressure-redistributing support surface or standard care (pressure-redistributing support surface alone). Exclusion criteria included existing heel damage. Patients were assessed on pre-and postoperative days for the occurrence of new pressure damage. Patients completed a satisfaction questionnaire at discharge. Results: 119 patients were recruited into the control group and 120 into the intervention group. Independent t-tests and chi-squared analysis showed both groups were comparable at baseline. Thirty-one subjects (26%) in the control group developed Pus compared with eight in the intervention group (7%, p < 0.001). No subjects in the intervention group developed a Pu on their ankles, feet or heels, whereas 29 subjects in the control group did (p < 0.001). Kaplan-Meier survival curves indicated that subjects in the control group were more likely than those in the intervention group to suffer pressure damage at all time points (p = 0.001). A sensitivity analysis showed that when subjects lost to follow-up were assigned the worse outcome (Pu positive) those in the intervention group were still less likely to develop Pus than the control group (p = 0.001). The offloading device was rated as comfortable overall by 59% of subjects. Conclusion: The findings suggest that offloading reduces the incidence of heel ulcers. Conflicts of interest: None
Study to evaluate the effect of low-intensity pulsed electrical currents on levels of oedema in chronic non-healing wounds
Authors: Young S. , Hampton S. , Tadej M
Published: May 2014

Objective: To evaluate the efficacy of a medical device, Accel-Heal, which generates a low-intensity pulsed direct current, on the management of oedema in chronic leg ulcers, using high-frequency diagnostic ultrasound. Method: High-frequency diagnostic ultrasound (20MHz) with an axial resolution of 60pm was used to assess the effect of an electrical stimulation device delivering a low-intensity pulsed current on levels of oedema in chronic non-healing venous and mixed aetiology leg ulcers for a period of 10 days. Thirty patients' wounds were monitored over a 3-month period, during which time changes in levels of oedema in the wound bed and surrounding tissues were imaged and measured. Results: A significant fall in the, previously high level, of periwound oedema was noted in the patient population after 10 days of device application. By 20 days after the first application of the device the level of periwound oedema had decreased by approximately 60% of the original level, which was maintained up to the 90-day follow-up. Occurring in parallel with this, scans of the wound bed showed a rapid decrease in the levels of oedema as the new wound matrix was laid down. Conclusion: The electrical stimulation device appeared to be effective in reducing oedema levels in a range of chronic wounds and their surrounding tissues. Conflict of interest: The study was funded by a grant from Synapse micro-current Ltd.
Porcine urinary bladder matrix: a retrospective study and establishment of protocol
Authors: LeCheminant J. , Field C.
Published: May 2014

Objective:

To summarise our experience with porcine urinary bladder matrix extracellular matrix (UBM) for the treatment of diabetic, venous, ischaemic or decubitus ulcerations and to outline appropriate protocol for its application.

Method:

A retrospective review was also conducted on all patients who received UBM (MatriStem; ACell, Inc.) from January to December 2011. Information regarding patient demographics, wound aetiology and location, as well as any prior treatments and follow-up data, were collected and reviewed from patients’ medical records.

Results:

Thirty-four patients were evaluated for this study. Mean patient age was 62.4 ± 13.4 years (range 29–88 years) and 76% (n=26) were male. The most common comorbidities were peripheral neuropathy (n=20), diabetes mellitus type 2 (n=19) and hypertension (n=13). Mean wound duration prior to UBM application was 25.5 ± 43.5 weeks, and mean time to healing following initial application was 9.8 ± 9.3 weeks. All patients treated with UBM progressed to full healing.

Conclusion:

After addressing modifiable risk factors, our study suggests UBM is effective in the treatment of acute and recalcitrant diabetic or venous ulcerations when applied correctly with an appropriate dressing.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Porcine bladder extracellular matrix for closure of a large defect in a burn contracture release
Authors: Mitchell K.B. , Gallagher J.J.
Published: May 2014

Porcine bladder extracellular matrix (PBEM) is an innovative wound healing alternative to traditional wound closure and reconstruction. By stimulating blood vessel formation and chemotaxis of progenitor cells to the site of injury, it promotes a unique healing environment favouring regeneration of native tissue over scar formation. This is the first clinical report describing the novel use of PBEM scaffold material to close a large defect resulting from a burn contracture release. The benefits of this method are the improved functional and cosmetic result. PBEM-moderated tissue regeneration may serve a valuable role in burn reconstruction.
Economic analysis of soft-heel casting for diabetic foot ulcer: prevention and treatment
Authors: Craig J. , Shenton R. , Smith A.
Published: May 2014

Objective:

To model the benefit of an innovative measure to manage patients with diabetes and a foot ulcer, or at high risk of ulceration, using a soft-heel casting, which can be applied by a podiatrist or other trained staff member and used in the hospital or community setting.

Method:

An audit of the patient outcomes associated with the casting at NHS Borders was undertaken for inpatients with ulcers. These data were combined with other published data and expert opinion to model the benefit of the casting for prevention and curative purposes compared to standard practice. Cost of healed and unhealed ulcers in various settings was estimated based on the treatment pathways adopted.

Results:

The data from the economic model suggest that soft-heel castings could reduce the costs of managing these patients by approximately 10%; about £500 per inpatient and £425 per outpatient with an ulcer, and £205 per high-risk patient, when used for prevention.

Conclusion:

This cost-consequence analysis suggests the intervention could save about 10% of costs for managing patients with an active ulcer in inpatients or outpatients and offers potential savings if used as a preventative measure. Further studies are required to confirm the estimated clinical benefit and reduced resource use.

Declaration of interest:

Funding for this study was provided by the Scottish Government Health Department. The authors have no financial or commercial conflicts of interest to declare.
Superior gluteal artery perforator flap: A reliable method for sacral pressure ulcer reconstruction
Authors: Khurram M.F. , Khan A.H. , Ahmad I. , Nanda M. , Masoodi Z.
Published: May 2014

Objective:

To study the feasibility and reliability of the superior gluteal artery perforator (SGAP) flap for the reconstruction of sacral pressure ulcers.

Method:

A prospective study was conducted between 2009 and 2012 where a total of 15 patients with sacral pressure ulcers underwent reconstructive surgery with an islanded pedicled SGAP flap. Success of the flap reconstruction and primary healing were defined as a healed wound within 30 days of the procedure. Reconstructive failure was defined as those cases that resulted in a non-healed wound, thereafter.

Results:

Of the 15 patients in the evaluation, 12 were male and 3 were female. Eleven patients were paraplegic, 3 were ambulatory and one was quadriplegic. All reconstructed flaps survived completely with no mortality or major donor site complications. Three patients had a minor infection and wound dehiscence that healed spontaneously. All wounds healed within 30 days of surgery following local wound care and culture-sensitive antibiotics. No recurrence of the pressure ulcer occurred during follow-up. The non-paraplegic patients did not develop gait disturbances following the surgery.

Conclusion:

These observations suggest that the islanded pedicled SGAP fasciocutaneous flap is a relatively easy flap to raise, with good reliability and minimal complications, and is therefore highly recommended for the reconstruction of the sacral pressure ulcer.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Wound ‘dechronification’ with negatively-charged polystyrene microspheres: a double-blind RCT
Authors: Shoham Y. , Kogan L. , Weiss J. , Tamir E. , Krieger Y. , Barnea Y. , Regev E. , Vigoda D. , Haikin N. , Inbal A , Arnon O. , Bogdanov-Berezovsky A. , Silberstein E. , Rosenberg N. , Govrin-Yehudain J. , Zeilig G.
Published: May 2014

Objective:

To compare the efficacy and safety of negatively-charged polystyrene microspheres (NCM) with controls (saline soaks) in the treatment of hard-to-heal wounds of various aetiologies.

Method:

Patients with one or more hard-to-heal wounds, defined as refractory to healing for at least 4 weeks, or those with exposed bone, tendon or ligament, were eligible for inclusion and were randomised to either NCM (PolyHeal; MediWound Ltd.) or controls, both applied twice daily for 4 weeks. Patients were monitored bi-weekly for an additional 8 weeks, while treated by standard wound care, at the investigators' discretion, and were re-evaluated 2 years after inclusion. The primary endpoint was defined as coverage of > 75% of the wound area by light-red granulation tissue after 4 weeks of treatment.

Results:

Fifty-eight patients completed the study, 32 in the NCM group and 26 in the control group. The two most common wound types were those with primary etiologies of venous insufficiency and post operative/post trauma. In the NCM group 47% of patients achieved > 75% light red granulation tissue after 4 weeks compared with 15% of patients in the control group (p=0.01). The mean wound surface area in the NCM group was reduced by 39.0% after 4 weeks compared with 14.9% in the control group (p=0.02). The achievement of > 75% light red granulation tissue and reduction of mean wound surface area was also observed in the two main sub-groups (venous insufficiency and postoperative/post trauma), although it was not statistically significant, possibly due to the small sample size in each sub-group.

Conclusion:

This study demonstrates that compared to control treatment, NCM treatment of hard-to-heal and chronic wounds improves formation of healthy granulation tissue and reduces wound size thus in fact ‘kick-starting’ the healing process and ‘dechronifying’ chronic wounds.

Declaration of interest:

This study was conducted with financial support from Polyheal Ltd. D. Vigoda and Y. Barnea received honorarium for their contribution to the study. Y. Shoham and Y. Barnea are paid consultants for MediWound Ltd. and Polyheal Ltd., respectively. J. Govrin-Yehudain is a board member of MediWound Ltd. and Polyheal Ltd.
Net costs of hospital-acquired and pre-admission PUs among older people hospitalised in Ontario
Authors: Chan B. , Ieraci L. , Mitsakakis N. , Pham B. , Krahn M.
Published: May 2014

Objective: To determine the net cost of hospital-acquired and pre-admission pressure ulcers (PUs) in an acute-care setting in Ontario, Canada.

Method: Cases of PUs were identified among hospitalised patients using Ontario Case Costing Initiative (OCCI) data from 2002–2006. Inpatient costs included direct and overhead costs. To determine the net cost of PUs, cases were matched controlling for age, gender, most responsible diagnosis and comorbidity. Mean net costs were estimated using Bayesian linear mixed models methods. Results were also reported by PU severity.

Results: In our study, there were 1351 cases of hospital-acquired PUs and 2523 cases of pre-admission PUs over 5 years. Net cost of hospital-acquired PU ranged between CA$44 000 for a category II PU to CA$90 000 for a category IV PU. For pre-admission PU net cost was between CA$11 000 to CA$18 500 for category II and category IV PU, respectively. The net cost of treating hospital-acquired PU is higher than pre-admission PU. Costs increase with increasing PU severity.

Conclusion: The total net adjusted hospitalisation cost of a hospital-acquired PU in Ontario was CA$44 000–90 000, compared with CA$11 000–18 500 for a pre-admission PU. Future studies should determine the attributable cost of PU using patient-level data to verify the accuracy of the study results.

Declaration of interest: No authors received any payment for services from a third party for any aspect of this study. At the time of this study, B. Chan was funded by the Ontario neurotrauma Foundation for his doctoral studies.
Assessing quality of life in patients with hard-to-heal ulcers using the EQ-5D questionnaire
Authors: Öien R.F. , Åkesson N. , Forssell H.
Published: May 2014

• Objective:To assess health-related quality of life (HRQoL) in an unselected patient population with hard-to-heal ulcers from baseline through healing and at follow-up 6 months after healing.

• Method:Fifty patients were recruited and the sex and age of the patient and the ulcer aetiology, duration, and size were recorded. The generic instrument EQ-5D was used for two purposes. The first was to investigate the feasibility of this instrument for assessing HRQoL in this patient group. The second was to see if the EQ-5D results would add information to the Swedish Registry of Ulcer Treatment (RUT), a national quality registry which includes variables for pain, disturbed sleep, and mobility.

• Results:We found a significant difference in HRQoL between patients with an open ulcer and those with a healed ulcer (p=0.02), but no significant difference between patients with a just-healed ulcer and patients at follow-up six months after ulcer healing (p=0.08). Sex, age, and length of ulcer duration at inclusion did not influence HRQoL (p=0.55, p=0.4, and p=0.9, respectively). Ulcer size seemed to influence HRQoL, though not significantly (p=0.07).

• Conclusion:This study confirms that HRQoL was improved after ulcer healing. Pain, as one of the five constructs measured by the EQ-5D, was significantly associated with open ulcers. The results from the EQ-5D questionnaire were hard to interpret in terms of capturing HRQoL in this unselected patient population. Despite some limitations, we consider that the simplicity of EQ-5D could make it feasible to use in the clinical setting. However, the results from EQ-5D did not add consistent information to RUT; therefore, this questionnaire will not be included in the registry.

• Declaration of interest: This study was partly funded by Blekinge County Council and by the Council of Sciences in Blekinge County. The authors have no conflicts of interest to declare.
Maggot debridement therapy for the treatment of diabetic foot ulcers: a meta-analysis
Authors: Tian X. , Liang X.M. , Song G.M. , Zhao Y. , Yang X.L.
Published: May 2014

Objective:

To assess the potential efficacy of maggot debridement therapy (MDT) compared with standard care for diabetic foot ulcers (DFUs).

Method:

A meta-analysis was performed on the evidence for MDT for DFUs. Databases, including PubMed, Web of Science, the Cochrane library, EMbase, EBSCohost, Springer link, ScienceDirect and Ovid-Medline, were electronically searched for randomised controlled trials, case-control studies and controlled clinical trials, up to 31 December 2012, and relevant references of the included articles were also manually searched. the literature was screened, the data were extracted and the methodological quality of the included studies was assessed. meta-analyses were performed on the included data, for the outcomes healing rate, time to healing, incidence of infection, amputation rate and antibiotic-free days or antibiotics usage.

Results:

Overall, four studies comparing MDT with standard therapy on a total of 356 participants were included. the results of meta-analyses suggested that the MDT group was significantly superior to the control group in the percentage of DFUs to achieve full healing (RR=1.8, 95%CI=1.07; 3.02; p=0.03), amputation rate (RR=0.41, 95%CI=0.20; 0.85; p=0.02), time to healing (RR=–3.70, 95%CI=–5.76; –1.64; p=0.0004) and number of antibiotic-free days (126.8 ± 30.3 days vs 81.9 ± 42.1 days; p=0.001); however, collated differences in incidence of infection after intervention revealed no evidence of a difference between the MDT and control groups (RR=0.82, 95%CI=0.65; 1.04, p=0.10).

Conclusion:

Although MDT may be a scientific and effective therapy in treatment of DFUs, the evidence is too weak to routinely recommend it for treatment. large studies and sample sizes are needed to assess the efficacy and safety of MDT in the treatment of DFUs.

Declaration of interest:

There were no external sources of funding for this study. the authors have no conflicts of interest to declare with regard to this work or its contents. X. Tian and X.M. Liang contributed equally to this work.
Inhibition of biofilms of Pseudomonas aeruginosa by Medihoney in vitro
Authors: Cooper R. , Jenkins L. , Hooper S.
Published: May 2014

Objective:

Pseudomonas aeruginosa has been linked to chronic wound infections, where its ability to form biofilms and to tolerate antimicrobial agents helps to facilitate its persistence. This study aimed to investigate the susceptibility of biofilms of Pseudomonas aeruginosa to Medihoney™ in vitro.

Method:

Biofilms were cultivated in microtitre plates with and without a range of concentrations of Medihoney, and effects on biofilm were monitored by optical density (at 650nm), biomass (by staining with crystal violet), metabolic activity (using an esterase assay) and viability (by determining total cell counts). Structural effects on established biofilms were examined by scanning electron microscopy and epifluorescence following staining by LIVE/DEAD® BacLight™, which also showed effects on vitality.

Results:

The lowest concentration of Medihoney found to prevent biofilm formation was 17%(w/v), whereas on average 35.5%(w/v) of Medihoney was required to inhibit established biofilms. Susceptibility did not vary with length of biofilm establishment between 24 and 72 hours. Extensive structural changes in established biofilms were seen in the sample with ≤30%(w/v) Medihoney using scanning electron microscopy and loss of viability was found in test samples with ≤20%(w/v) Medihoney concentration using fluorescent staining, together with loss of biofilm structure.

Conclusion:

Using a range of methods to evaluate biofilm integrity, this study demonstrates that Medihoney inhibits Pseudomonas aeruginosa biofilms in vitro at concentrations that are attainable in clinical use. Whether Medihoney has the potential to disrupt Pseudomonas aeruginosa biofilms in cutaneous wounds must now be tested in patients.

Declaration of interest:

This study was sponsored by Derma Sciences Inc, NJ. An unrestricted grant was provided and the sponsors were not involved in the design of the experiments or the preparation of this manuscript.
The direct inhibition of MMP–2 and MMP–9 by an enzyme alginogel: A possible mechanism of healing support for venous leg ulcers
Authors: Grzela T. , Niderla-Bielinska J. , Litwiniuk M. , White R.
Published: May 2014

Flaminal Forte is an enzyme alginogel, whose activity depends on the absorption and binding of matrix metalloproteinases (MMPs), which are known to play a crucial role in delayed wound healing. The aim of the study was to evaluate the influence of Flaminal on MMP–2/–9 activity in ulcer exudate, ex vivo. Eight patients with bilateral venous leg ulcers were treated for 4 weeks with Flaminal Forte covered by hydrocolloid (”F” wounds), or with hydrocolloid alone (”H” wounds) as a reference control. Clinical assessment did not reveal any differences between F and H wounds regarding surface reduction and general wound condition. Nevertheless, although non-significant, there was a visible difference in peri-wound skin appearance in F wounds, as compared to H wounds. The wound exudate contained high MMP–2/–9 levels, which gradually decreased as wounds healed. The attenuation of MMPs was stronger in F than in H exudate, however, in standard zymography this difference appeared non-significant. Realtime zymography revealed that Flaminal mediated a powerful direct inhibition of gelatinolytic activity of wound exudate and of recombinant MMP–2/–9 in vitro.
ECPs: avoiding emergency department attendance or hospital admission?
Authors: Coates David
Published: May 2014

The aim of the literature review was to identify and appraise studies that have compared the effectiveness and decision-making of emergency care practitioners with other health professionals.

There is no ‘gold standard’ for determining whether the actions of an emergency care practitioner (ECP) results in a patient avoiding attendance at an emergency department (ED) or hospital admission. Consequently, reporting on the cost effectiveness of ECPs is potentially spurious, especially as the cost difference between ED attendance and hospital admission is considerable.

Medline and EMBASE databases were searched for publications relevant to the study area. Additional searches were carried out using the online search function offered by the Cochrane Library and the Emergency Medicine Journal.

Twenty-nine publications met the inclusion criteria. Nineteen of these papers were considered suitable for background information only. Ten studies were analyzed in further detail and three main themes identified: non-conveyance rates, decision-making and admission avoidance.

Studies show that patients assessed by ECPs are less likely to be conveyed to the ED, than when attended by a traditional ambulance response. The Department of Health (DH, 2005) refer to a traditional ambulance service response to a 999 call as sending a double-crewed paramedic ambulance to the patient, provide any necessary life support to stabilize the patient and transport to the ED.

The decision-making of ECPs compares favourably with other health professionals when deciding whether a patient can be treated at home, or requires ED attendance or hospital admission. No studies were found that determined whether an ECP is able to accurately decide whether their intervention results in patients avoiding ED attendance or admission. There is a need to evaluate the validity of data collection methods which differentiate between emergency department and admission avoidance as a result of the actions of ECPs.
Assessment and management of chronic pain in adults: implications for paramedics
Authors: Lord Bill , Deveson Mae
Published: May 2014

Chronic pain represents a complex health problem that affects a significant number of individuals living in the community. Paramedics will encounter patients with a complaint of pain that may be associated with injury, malignancy, and degenerative diseases such as osteoarthritis. In some cases, the patient may have a diagnosis of ‘neuropathic pain’ where there is no obvious basis for the pain. Some individuals with chronic pain may experience exacerbation of pain. This may occur in association with malignancy and disease progression, and when the pain becomes unmanageable, this becomes a health emergency. These individuals may rely on paramedics to manage this distressing symptom. However, in order to care for patients with chronic pain, paramedics need to understand the physiology of pain, use validated tools to assess pain, and appreciate the range of therapeutic approaches used to manage this debilitating symptom. As such, this article aims to provide information to support the paramedic's assessment and management of patients with chronic pain. Paramedics have practice guidelines for the management of acute pain, and these may be adapted to care for patients with acute exacerbation of chronic pain.
Paramedic administration of glycoprotein inhibitors for ST elevation myocardial infarction
Authors: Dykes Simon
Published: May 2014

Until recently, paramedics were routinely delivering out-of-hospital thrombolysis for ST segment elevation myocardial infarction (STEMI). Now that primary percutaneous coronary intervention (PPCI) is the favoured reperfusion strategy, STEMI patients are by-passing the local emergency department and taken directly to the catheterisation laboratory via ambulance. STEMI patients within a rural setting are facing the prospect of extended transfer times for reperfusion of an already ischaemic myocardium, a potentially perilous strategy. Empirical research conducted outside the UK has identified that the pre-hospital administration of a glycoprotein inhibitor improves clinical outcome for STEMI patients. Glycoprotein naturally helps to build the fibrin mesh essential within the clotting process. Inhibition of this process by glycoprotein inhibitors IIb/IIIa (GPI IIb/IIIa) prevents aggregation at receptor sites on platelets. Original research supports the notion that GPI IIb/IIIa involvement improves patient clinical outcome for STEMI in the out-of-hospital phase. Paramedics are typically the first contact for the STEMI patient and it is tangible that paramedics have the appropriate skill and knowledge to diagnose the out-of-hospital STEMI. With this in mind, it is the purpose of this article to discuss the use of pre-hospital GPI IIb/IIIa administration and to argue that this intervention should be administered by paramedic personnel.
Paramedic decision-making–how is it done?
Authors: Ryan Lizzie , Halliwell David
Published: May 2014

In 2005, The Bradley Report called for a move to higher education and the ambulance services saw the advent of the degree and diploma paramedic. Historically, ambulance services have used the Institute of Healthcare Development (IHCD) vocational educational programmes to develop and educate their own staff, using a skills escalator approach to paramedic status, rather than supporting their development in the Higher Education (HE) environment. More recently the services have started to use graduate paramedics educated and developed to the requirements of the HPC Standards of Proficiency (2007) in universities across the UK. This article considers the decision-making process of the graduate paramedics against that of the IHCD paramedic, and involves the hyperthetico-dedutive and intiuitive approaches used by paramedics to inform their decisions, and the treatment that they provide. In addition, it involves the initial work of two research ethics approved empirical studies, currently in progress, that form part of the the authors doctoral studies involving sample groups of graduates from an IHCD programme, and a foundation degree and BSc Honours degree at two UK universities.
Using clinical decision making and reflection strategies to support practice
Authors: Hibberd Jane M , Chia Swee Hong , Spindler Alicia , Walsh Michaella , Wigginton Sophie
Published: May 2014

Clinical decision making and reflection are essential skills for any health care professional to possess in that they underpin and enhance practice by providing a robust framework for structuring one's thinking and subsequent actions.

This article highlights the need for the study of clinical decision making which forms a vital part of the paramedic's practice. It provides a background to clinical decision making before presenting an example case study.
Pain management: re-evaluating the risks and benefits of diclofenac
Authors: Banning Maggi
Published: May 2014

Diclofenac is a widely used non-steroidal anti-inflammatory drug (NSAID) that is used to relieve pain and inflammation in rheumatic disease (including juvenile arthritis) and gout, and has been used both pre- and post-operatively as an analgesic. There are extensive side-effects and contraindications associated with diclofenac (in particular gastrointestinal problems) of which the nurse prescriber should be aware. However, given the recent move away from prescribing cyclo-oxygenase 2 (COX 2) inhibitors it is timely to re-evaluate the risks and benefits of this drug.
Mission statements
Authors: Ashurst Adrian
Published: May 2014

In this article Adrian Ashurst describes the importance of implementing a ‘mission statement’ that illustrates to the public clearly what your company's philosophy and approach is to customer care.
Bereavement and people with learning disabilities
Authors: Read Sue
Published: May 2014

Sue Read discusses how carers can enable people with learning disabilities to deal with bereavement and gives advice on how to respond to the individual's needs in a positive, supportive way.
The electronic tagging and tracking debate
Authors: Hughes Julian , Campbell Gill
Published: May 2014

Julian Hughes and Gill Campbell consider the apparent conflict between the desire of people with dementia to wander, and the duty of carers to maintain a person's safety.
The ethics of using dolls and soft toys in dementia care
Authors: Andrew Alexa
Published: May 2014

Recent advancements in dementia care have moved away from a custodial type of care where people have been considered well cared for if they were clean, dry, fed, quiet and not at any risk. This type of care often failed to recognize the person with dementia as an adult human being with a right to lead a dignified and meaningful life. In this new culture of care, which promotes a person-centered approach (Kitwood and Bredin, 1992), infantilization can be seen as inappropriate.
Preserving memories: using reminiscence techniques
Authors: Swann Julie
Published: May 2014

Reflecting on the past and sharing memories with others is an excellent way of facilitating communication. Julie Swann discusses the application of some reminiscence techniques and their positive effects on wellbeing.
Maintaining skin integrity and preventing pressure damage
Authors: Benbow Maureen
Published: May 2014

Early identification of patient risk is the first step in preventing pressure damage. Maureen Benbow discusses the importance of maintaining residents' skin integrity to ensure that damage is minimized.
Dementia care: coping with aggressive behaviour
Authors: Moniz-Cook Esme , Clarke Chris
Published: May 2014

Many factors contribute to aggressive behaviour in dementia care settings. Esme Moniz-Cook and Chris Clarke consider a framework for understanding the causes and providing creative individually tailored solutions.
The elephant in the room: communication at end of life
Authors: Newson Pauline
Published: May 2014

Talking about the sensitive issue of death with residents and their families is complex. Pauline newson highlights what to be aware of when talking about the end of life and the care tools that can be applied
Pin sites: Do we need to clean them?
Authors: Henry Chris
Published: May 2014

Chris Henry describes how she developed a draft protocol for pin site care in external fixators.
Dementia: Key factors in recognition and support
Authors: Martin Anne-Marie
Published: May 2014

Anne-Marie Martin provides a succinct overview of the different types of dementia that may be seen in general practice and explains how to recognize them.
Web innovation for weight management
Authors: Brotherton Ailsa , Pinder Carol
Published: May 2014

Weight problems and obesity are common and it can be difficult to encourage patients to change their lifestyles. Ailsa Brotherton and Carol Pinder explain how a new web?based resource can help
Self-harm: working with vulnerable adolescents
Authors: Burton Maddie
Published: May 2014

Self-harm is one of the top five causes of acute medical admission for adolescents in the UK. Maddie Burton explains how practice nurses can recognize and respond to this vulnerable patient group
What a wonderful world
Authors: Jenkins Janet
Published: May 2014

One of the delights of being a parent is sharing in your child's amazement at new experiences - the first time they see a rainbow or the patterns of frost on a window pane. Make time to stop and look together at some of the wonders of the world around us.
Coping with loss and bereavement
Authors: Sansom Jill
Published: May 2014

When a child starts pre-school she experiences and responds to a form of loss as she transfers from the support of her parent or carer and forms a relationship with the new adults in her world. You will all be aware of the different reactions displayed as a child adjusts to their new environment - some are confident and excited, others appear withdrawn and unsure of themselves and need support and reassurance.
Tell me about God
Authors: Harries Judith , Andrews Ruth
Published: May 2014

The nursery we work in is a Christian nursery and the parents who choose to send their children to us know that all the staff are Christians. However, for many of the children who come to us it is the first time they have heard God talked about in a positive way.
Being creative with cardboard boxes
Authors: Harries Judith
Published: May 2014

Children need the time and freedom to discover the properties of the materials they are working with. They need to explore and experiment and use their own ideas and imagination. Only then will the more structured or prescribed activity with a defined end product be worthwhile.
Learning to use scissors
Authors: Frankish Lorraine
Published: May 2014

Before children can use any tools effectively they need to have good hand and eye co-ordination. Providing children with plenty of experiences in their play is an important part of developing good coordination and manipulative skill. Planning activities in all areas of learning will contribute to developing the skill required to use scissors.
News
Authors: Lepkowska Dorothy
Published: May 2014

The cost of nursery and childminding places in England has risen by almost double the rate of inflation.
A look at developmental milestones
Authors: Barber Jenny
Published: May 2014

Although we may think about developmental milestones in the separate areas of development, those being physical, intellectual, language, emotional and social, we cannot really look at them in isolation as they impinge on each other, in terms of a child's capabilities, skills and knowledge.
The benefits of yoga
Authors: Doyle Phoebe
Published: May 2014

Yoga is increasingly being used in schools and early years settings with the hope of bringing a time for calm and focus. Phoebe Doyle investigates.
Maria Montessori
Authors: Smart Julie
Published: May 2014

Maria Montessori (1870-1952) developed a philosophy of teaching based on scientific observations of how children learn. Julie Smart investigates why she won worldwide recognition for her work in education.
Revelations of a teaching assistant
Authors: Parish Alison
Published: May 2014

Alison Parish took up a post as a teaching assistant at her son's school, but found that she spent more of her time cleaning and tidying up than supporting students.
Thanks for the memories
Authors: Bradley Angela
Published: May 2014

Students at Monkseaton High School have been taking part in a scientific experiment to test out a method of teaching that is based on the discovery of how memories are formed. Angela Bradley and Paul Kelley explain
Learning for life
Authors: Lucey Stephen
Published: May 2014

Becta's Stephen Lucey talks learning platforms – the benefits, good practice, and the challenges ahead
An open data challenge
Authors: Parkes Ed
Published: May 2014

A new £40,000 challenge is seeking ideas that make effective use of open data to help parents engage with their children's education. Ed Parkes explains.
Creating a research culture – lessons from other schools
Authors: Godfrey David
Published: May 2014

How can schools develop a research-engaged culture that has a positive impact on teaching and learning? Former teacher and research co-ordinator David Godfrey shares some insights from his PhD work in this important area.
Triage in the veterinary emergency room: part 1
Authors: Jordan Lynn A , Brainard Benjamin M
Published: May 2014

The triage examination is a rapid assessment of patients presented to the emergency room. The primary survey assesses the respiratory, cardiovascular, neurologic, and urogenital systems in patients to identify life-threatening conditions requiring immediate veterinary attention. Observation of respiratory pattern and rate while listening for respiratory noise can indicate and localize diseases of the respiratory system. The cardiovascular system is assessed by observation of mucous membrane colour and capillary refill time, combined with palpation of peripheral pulses. Neurologic and urogenital triage will be covered in part 2 of this series. Combined with a capsule history, the triage examination is used to identify and stratify emergency room patients so that the patients most in need are assessed and treated first.
Blood parameter monitoring in the intensive care unit
Authors: Chapman Angela
Published: May 2014

Blood tests performed in the emergency and critical care setting are essential to determine the patient’s current clinical status, to enable a diagnosis to be made and to monitor stabilisation and treatment. Thus the veterinary nurse should be proficient in prompt and accurate testing, regular monitoring of the patient in the intensive care unit and early recognition of abnormal results that need to be brought to the immediate attention of the veterinarian. This article highlights commonly screened blood parameters in the emergency setting, giving normal ranges and critical values that necessitate immediate intervention to optimise patient care. Veterinary nurses with a sound knowledge of routinely screened blood parameters will be best placed to contribute to the smooth running of the intensive care unit and to provide excellent nursing care.
Gait analysis: an introduction to its use for clinical evaluation and performance assessment of the equine athlete
Authors: Williams Jane
Published: May 2014

Equine locomotion is complex to measure and has warranted clinical interest since early high-speed photography in the late 19th century produced the first accurate representation of a galloping horse. The advancement of gait analysis technology has produced easy to use systems that have enabled scientists and clinicians to evaluate equine gait characteristics in more detail and with increased objectivity and accurately. Goniometry, force plate, videography and optoelectric systems provide methods for subjective analysis of equine gait. A review of the literature concludes that simple objective, repeatable and user friendly assessment tools have worth in the monitoring of clinical efficacy of therapeutic interventions used in orthopaedics and rehabilitation, and to evaluate locomotor performance in combination with traditional veterinary examinations and equine training practices.
Understanding the mechanisms behind acute pain in dogs and cats
Authors: Flaherty Derek
Published: May 2014

A basic understanding of the processes involved in nociception is a pre-requisite for successful management of acute pain. Peripheral and central sensitisation are key components contributing to pain in most cases, and a number of important concepts are now widely recognised as being crucial with regard to minimising their occurrence, and thereby improving the effectiveness of analgesia therapy. Although somewhat controversial in human medicine, pre-emptive analgesia — whereby analgesic agents are administered in advance of noxious stimulation — appears to be of importance in animals. Optimal pain relief is only likely to be achieved if a multimodal approach to analgesia is undertaken, utilising pharmaceutical agents acting at different points within the ‘pain pathway’. In addition, preventive analgesia — wherein adequate pain relief is provided throughout the peri-operative period and well into recovery — is now considered one of the most significant areas in which acute pain management can be advanced.
How to reduce stress in the veterinary waiting room
Authors: Greenfield Stuart
Published: May 2014

The veterinary environment has been seen to be a stressful environment for patients. This stress can have a negative impact on the welfare of inpatients and result in dangerous interactions between owners/staff and patients.

The waiting room is the first exposure a patient has to the veterinary environment. By taking measures to ensure the environment is as stress free as possible the likelihood of patient stress can be reduced.

This article highlights measures that can be taken to reduce stress within the waiting room. These range from building layout to pheromone therapy. By utilising as many of the highlighted options as possible stress within the waiting room may be reduced. This will have a positive effect on the consultation and subsequent visits to the practice.
A fauna de peixes nas bacias do norte do Espírito Santo, Brasil
Authors: Sarmento-Soares Luisa Maria , Martins-Pinheiro Ronaldo Fernando
Published: May 2014

The hydrographic basins of northern Espírito Santo comprises the systems of Itaúnas and São Mateus rivers. The present work is part of a series of studies on the fish fauna along Espírito Santo’s river basins. Forty-nine geo-referred points in rivers and rivulets of the area were evaluated, 20 in the Itaúnas basin and 28 in São Mateus basin. The environment and the taxonomic composition of the fish fauna were documented at every point, reporting a total of 83 species, including 47 freshwater species and 36 marine, belonging to 35 families and 11 orders. Among the freshwater fish species, the Siluriformes predominated, with 20 species, followed by the Characiformes, with 17 species. The Atlantic forest of northern Espírito Santo, known as “floresta de tabuleiros”, was originally composed of ombrophylous forest as well as swamps, coastal sand dunes, and mangroves. With the suppression of native forests, the region has suffered from desertification, and environmental conditions are similar to the northeastern semiarid region, where the run-off waters are dispersed or intermittent. The loss of environmental quality along river valleys is associated with the need to reestablish riverine aquatic conditions. Exotic species and risks of introductions need further studies in these areas. Rare or endangered species whose distributional range has diminished in response to environmental changes may function as biological indicators. Potentially new species are identified, and regional endemism and distribution patterns for freshwater fishes are discussed.
Calendário agrícola, agrobiodiversidade e distribuição espacial de roçados Kulina (Madija), Alto Rio Envira, Acre, Brasil
Authors: Haverroth Moacir , Negreiros Paula Rosane Menezes
Published: May 2014

O presente trabalho objetiva avaliar a composição e distribuição espacial e temporal de roçados entre os Kulina(Madija) do Alto Rio Envira, estado do Acre, sudoeste da Amazônia Brasileira. A população estudada vive em aldeias àsmargens do rio Envira, distribuídas em três Terras Indígenas, e sua língua pertence à família linguística Arawá. A pesquisade campo foi realizada com base em entrevistas semiestruturadas e abertas, observação direta e participante, marcação dosroçados com aparelho de GPS e fotografias. Foram observados 64 roçados, com áreas que variam de 50 m2 até 2 ha. Sãocultivadas entre 3 e 15 espécies em cada roçado. O calendário agrícola segue a sazonalidade regional. O trabalho nos roçadosenvolve a abertura, ano após ano, de novos espaços de cultivo, tendo em vista a manutenção das plantas cultivadas e aprodução de alimentos. O sistema de cultivo segue o ciclo roça-capoeira-floresta, integrado em mosaico com outrosespaços da floresta. Além das áreas florestais, são aproveitadas as praias para cultivo de algumas espécies. Os roçados, adespeito do uso do fogo, seguem alguns princípios agroflorestais sucessionais e contribuem para a conservação daagrobiodiversidade e recomposição da floresta. As áreas abertas para cultivo são relativamente pequenas e, após o“abandono”, como está cercada pela floresta, rapidamente ocorre a regeneração florestal.
The Transmission of Suetonius’s Caesars in the Middle Ages
Authors: Kaster Robert A.
Published: May 2014

The medieval manuscript tradition (9th–13th centuries) of Suetonius’s De vita Caesarum has not been fully understood, and no complete and accurate stemma of the earliest extant witnesses has been drawn. This paper, based upon a fresh collation of the manuscripts, describes in detail the constitution of the tradition’s two main branches, the main lines of contamination that can be traced within and between them, and the “family tree” best suited to reconstructing the archetype from which all extant copies of the work ultimately descend.
Inscribing Performances in Pindar’s Olympian 6
Authors: Stamatopoulou Zoe
Published: May 2014

This Paper Explores the Performances Inscribed in the Text of Olympian 6, thus offering a new perspective to the question surrounding the intended location of the ode’s premiere. A careful consideration of the poem points to a first performance in Stymphalos of Arcadia. I argue, however, that at the same time the ode creates and reiterates the anticipation of a subsequent choral performance in Syracuse. This expectation of a future reperformance is constructed primarily through the poem’s treatment of the visual and the visible.