bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing the risk of postpartum haemorrhage in paramedic practice
Authors: McCreesh Samuel
Published: May 2014

Primary postpartum haemorrhage is the most common form of obstetric haemorrhage. Poor recognition and treatment of this condition has been linked to cases of mortality in recent years. Greater choice over birth settings for mothers and a national shortage of midwives are likely to result in more frequent exposure to maternity cases for paramedics in future years. Active management of the third stage of labour reduces the risks of primary postpartum haemorrhage and shortens the length of the third stage of labour. UK ambulance service guidelines are currently based upon physiological management of the third stage of labour, so in the absence of a midwife, paramedics cannot actively manage the third stage. Paramedic training has moved to higher education university programmes in recent years and undergraduate paramedic students receive additional training about the management of obstetric emergencies. This article discusses current clinical practice and recommends that paramedics adopt active management of the third stage of labour, in order to reduce the risk of primary postpartum haemorrhage. In addition, the author asks whether current paramedic practice is effective in treating primary postpartum haemorrhage within the pre-hospital setting, when a midwife is not present at the scene.
Management of an isolated neck-of-femur fracture in an elderly patient
Authors: Eaton Georgette
Published: May 2014

Femoral neck fractures affect up to 75 000 elderly people per year, with up to a third of these patients dying within twelve months. While there is a paucity of research specific to the pre-hospital field, current evidence demonstrates that optimal treatments include appropriate and adequate analgesia, fluid management and correct immobilisation of the injured leg. Analgesia should be considered in a step-wise approach and should be progressive to the patients' needs.

Pain relief should be sought through the variety of options open to paramedics and should be initiated immediately. Transfer to the ambulance should be done in a safe manner, ensuring the patient is immobilised and remains pain free. This pre-hospital management of the patient with a femoral neck fracture ensures they receive adequate analgesia and fluid replacement before any definitive treatment at hospital.
High-risk non-ST elevation acute coronary syndromes (NSTEACS) for paramedics
Authors: Reed Ashley
Published: May 2014

Pre-hospital clinicians frequently encounter patients suffering acute coronary syndromes (ACS) and they form an integral part in recognising and conveying the ST-elevation myocardial infraction (STEMI) patient to the most appropriate destination, namely the heart attack centre (HAC). The emphasis has been upon the recognition and subsequent management of the STEMI patient. The non-ST elevation acute coronary syndrome (NSTEACS) patient has a similar mortality and morbidity yet does not receive the same pathways as STEMI. This article aims to provide an understanding based on a case study around NSTEACS with supporting evidence relating to risk stratification, clinical trials and clinical guidelines of what needs to be developed to enhance the care we provide to the NSTEAC patient in the pre-hospital arena.
Severe burn injury—pre-hospital paramedic response—if it goes wrong
Authors: Bourke Patrick M , Dunn Ken W
Published: May 2014

Internationally burn injury is one of the major causes of death and disability. Serious burn injuries are devastating events that leave patients with longterm physical and psychological challenges that are recognised by paramedics worldwide as one of the most horrific and challenging injuries known to the emergency medical and rescue services. Burn injuries may be extremely complex in their presentation, and any resulting complications may extend the need for expensive long-term management from months to years.

This paper provides an overview of the complication of pre-hospital response to severe burn injury, if it goes wrong.
Ambulance Services Benevolent Fund seasonal messages
Authors: Leopold Paul , Weston Simon
Published: May 2014

As 2013 comes to a close, ASBF Chairman Paul Leopold and ASBF patron Simon Weston OBE thank everyone for the generous support and contributions made to the charity throughout the year.
Investigating gout: taking a new approach to an old disease
Authors: Sibson Lynda
Published: May 2014

Gout is a very painful and common form of acute arthritis, which is becoming increasingly prevalent in many Western societies. Gout was first identified by the Egyptians and is caused by a disorder of the body’s purine metabolism, resulting in raised serum uric acid level, known as hyperuricaemia.

Gout tends to affect the older population, particularly obese patients and others with rather negative lifestyle habits, such as a high alcohol intake. However, in the majority of patients suffering from idiopathic gout (75–90%) the evidence suggests that these patients may actually have a genetic disposition to the reduced renal excretion of urate acid.

Gout has a rapid onset and the most commonly affected joint is the first metatarsophalangeal, although other joints can also be affected such as the mid-foot, ankle, knee, wrist, finger and elbow.

Recommended gout treatment includes non-steroidal anti-inflammatory drugs, colchicine and corticosteroids. Preventative treatments include allopurinol, which aims to lower uric acid levels. The definitive diagnostic test for gout is the aspiration of the joint or tophus and the confirmed identification of monosodium urate crystals. The presence of urate crystals confirms a diagnosis of gout and the absence of evidence of infection will rule out the key differential diagnosis of septic arthritis.
Diabetes mellitus: balancing blood glucose
Authors: Heardman Jessica
Published: May 2014

This case study seeks to explore the pathophysiology of diabetes mellitus and the effects that this condition has upon the individual. The aetiology of diabetes mellitus will be discussed, in conjunction with an analysis of clinical signs and symptoms presented by the disease reflecting the underlying pathophysiological processes. Clinical treatment options will also be discussed, in relation to their influence on the management of disturbances in the underlying disease process. In line with patient confidentiality guidelines ( Department of Health (DH), 1997 ), patient-identifiable information will be omitted.
End of life care in the community: the role of ambulance clinicians
Authors: Pettifer Annie , Bronnert Rosanna
Published: May 2014

Ambulance clinicians are frequently called to patients who are approaching the end of their life. This article presents an overview of some of the issues that impact on the delivery of care to patients at the end of life, including symptom and urgent care needs in the last few days of life, preferences for care/place of care and coordination of care. Each of these areas pose different challenges for ambulance clinicians. As a way of addressing some of the issues, this article outlines an online education package in end of life care, which has been specifically designed for ambulance clinicians in response to an analysis of their training needs. The learning outcomes and educational approach is described. The education aims to help equip ambulance clinicians with the knowledge and confidence that they need to deliver high-quality urgent end of life care.
A study into pre-alerts to North East hospitals for sepsis
Authors: McClelland Graham , Younger Paul
Published: May 2014

A study of sepsis patients pre-alerted into hospitals was conducted in the North East of England from October 2011 to March 2013. This study was conducted to assess the effectiveness of the introduction of a sepsis education programme, which included a sepsis screening tool, and to try and establish the number of sepsis cases encountered by paramedics in the region. The results of this study show that the number of cases pre-alerted into the hospitals increased with the introduction of the screening tool, and gave some indications as to the number of sepsis patients encountered in pre-hospital care. We interpret the increase in pre-alerts as an increased awareness of sepsis, but see little impact on the treatment delivered by paramedics. We draw some conclusions on the number of suspected cases of sepsis seen in the pre-hospital environment but without linking to hospital data are unable to give definitive figures.
Impact of increasing obesity on primary health carers: an Australian perspective
Authors: Cowley Stephen , Bowman Bindi , Leggett Susan
Published: May 2014

Increasing levels of obesity in Australia are having a direct impact on those associated with primary care and patient transport.

Whether the patient movement is undertaken in the uncontrolled environment of the home or the controlled environment of the hospital, design features generally limit the use of equipment and the application of safe handling procedures.

Ambulance and fire services are increasingly developing policies and procedures that address the movement of obese and morbidly obese (bariatric) patients and the purchase and use of equipment. Yet the efficacy of these procedures is hampered by the absence of a standard definition of the term ‘bariatric’. Various definitions of ‘bariatric’ are applied in different sectors and risk-based approaches rather than those based on weight, body dimensions or BMI may be more useful.

Substantially more work is required to inform the development of intervention strategies that will lead to significant and sustained risk reduction. Further work is also needed to quantify the frequency of bariatric patient movement within the emergency services across Australia. A clear representation of the journey and the interfaces between the agencies and carers and their respective roles would assist with defining the problem and understanding the solutions.
Equine Review
Authors: Rendle David
Published: May 2014

Introduction

This edition of Equine Review considers papers on respiratory disease in racehorses, antimicrobial use in foals, laminitis, intra-articular corticosteroid, and the risk of African Horse Sickness.
Prescribing options for treating people with diabetes mellitus
Authors: Hackett Elizabeth
Published: May 2014

The introduction of supplementary prescribing will be of benefit to patients with diabetes as this is likely to help to achieve the standards of care which have been promised for those with diabetes and also ease doctors’ workloads. More rigid control of blood glucose levels leads to better outcomes for patients with both type 1 and type 2 diabetes. This article outlines the different medications which can be prescribed for patients with diabetes and discusses some issues surrounding their prescription.
What are the options? Future methods of providing medicines
Authors: Taylor Beth
Published: May 2014

The introduction of supplementary prescribing marks maybe the most significant phase of the development of non-medical prescribing. This article discusses the options available for practitioners to provide medication and details an option appraisal tool which has been developed by the London Specialist Pharmacy Service to allow clinical teams to compare the options available to them and decide which one suits them best.
Sneezing, runny, blocked or itchy nose: is it hay fever, a cold or something else?
Authors: Wood Stuart F
Published: May 2014

Nasal symptoms such as a runny, itchy or blocked nose and sneezing indicate rhinitis but may have a variety of causes. This article describes the differential diagnosis of rhinitis and includes an explanation of the rarer conditions which need to be excluded when assessing patients for treatment. The treatment of infectious, allergic, occupational, hormonal and drug-induced rhinitis is discussed.
Freebies, favours and the seven deadly sins: keeping on the straight and narrow
Authors: Shaw Matthew
Published: May 2014

In the editorial of the British Medical Journal, dated 31 May 2003, the writer commented on the avarice and excess that characterize the nature of our professional relationships with the pharmaceutical industry. As avarice is one of the seven deadly sins, this article considers how applicable the others may be to our relationship with the industry. This article looks at guilt, the nature of greed and the ways in which we, as professionals, can work to make sure that we stay on the straight and narrow.
The importance of strategic planning and the sustainability of non-medical prescribing
Authors: Rashid Claire , Clarke Ian
Published: May 2014

The Department of Health (DH) has recently released £7million to the 28 workforce development confederations (WDCs) in England for non-medical prescribing training in 2004-05. Along with each WDC’s allocation of funding is a target number of nurses and pharmacists the DH expects to be trained. The DH has also issued an indicative budget for 2005-06, when it is proposed, subject to the adoption of the consultation document MLX305 (DH, 2004a), that radiographers, optometrists, podiatrists and physiotherapists will also be eligible for funding for supplementary prescribing training.
Non-Medical Prescribing Conference: Kent and Medway and Surrey and Sussex Strategic Health Authorities
Authors: Pollard Tom , Benison Liam
Published: May 2014

The Kent and Medway and Surrey and Sussex Strategic Health Authorities’ Non-Medical Prescribing Conference was held on Thursday 14 October at the Queen Elizabeth II Conference Centre in London. The conference ws facilitated by Cheryl McKay and Fiona Peniston-Bird from Kent and Medway and Surrey and Sussex Strategic Health Authorities.
The importance of recognizing adverse drug reactions
Authors: Kieve Millie
Published: May 2014

When I was a small child in 1946, my baby sister was critically ill and the doctor in charge of her care told my parents to prepare for her death. A nursing sister suggested that they should try a new drug known as M&B, an antibacterial named after its manufacturer May & Baker. This drug was prescribed, plus infusion of plasma, and saved her life. Antibacterial drugs were hardly used at this time. My sister is alive and well today and I have never forgotten the nurse who refused to give up on the life of a baby girl.
Glucocorticoid-induced osteoporosis: what nurse prescribers need to know
Authors: Cooper Alun
Published: May 2014

A significant proportion of the adult population in the UK is prescribed oral glucocorticoids (glucocorticosteroids), most commonly for respiratory, musculoskeletal and skin conditions. These drugs are associated with an increased risk of osteoporosis and patients who are taking them need careful management to reduce the risk of developing osteoporosis. The advent of nurse prescribing provides nurses with the opportunity to take greater responsibility for the prevention and treatment of osteoporosis in such patients. An understanding of the 2002 guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis is therefore important for nurse prescribers who wish to develop their competency in this area of care.
The increasing strength of the nursing profession
Authors: Stuttle Barbara
Published: May 2014

At present, nurses are still awaiting the Minister's decision on the consultation for the future of independent nurse prescribing. I am advised that this will probably be in the autumn (October or November), but this could be anything up to Christmas.
An evaluation of the role of the diabetes specialist nurse
Authors: Courtenay Molly , Carey Nicola
Published: May 2014

Approximately 10% of hospital inpatients suffer from diabetes. These patients are likely to be admitted to hospital twice as often and stay twice as long as people without diabetes (Currie et al, 1997), and this figure is expected to rise in the future. At present there is a lack of understanding about diabetes among hospital staff (Audit Commission, 2000) and a dearth of written information for patients suffering from diabetes (Hiscock et al, 2001). Patients are suffering from discharge delays (Davies et al, 2001; Cavan et al, 2001), there are many errors in the administration of insulin (Hiscock et al, 2001) and shortfalls have been identified at a national level in the diabetes service.
Community acquired pneumonia: common causes, treatment and resistance
Authors: Banning Maggie
Published: May 2014

In the UK, older people are particularly prone to developing community acquired pneumonia. The most common pathogen is the bacterium Streptococcus pneumoniae. In the environment, S. pnumoniae is a robust microbe that can adapt and survive in hostile conditions and in the human body. Antibiotic therapy targets the mechanisms and processes that bacteria use to metabolize, replicate and survive. However, the inappropriate use of antibiotics has allowed bacteria to become resistant to the actions of specific antibiotics, and this has led to difficulties in treating infections caused by S.pneumoniae. Although immunization is available, older people continue to die from pneumococcal pneumonia. Penicillin is still used as the main method of treatment against S. pneumoniae, but the threat of antibiotic resistance is increasing.
Non-medical prescribing in an outpatient setting: renal services
Authors: Brown Wendy , McDermott Jen
Published: May 2014

Patients with chronic disease are increasingly managed by nurse practitioners and nurse prescribing affords the full completion of patient episodes in the absence of the medical team ensuring a proactive approach to patient care. In the renal services at St. Mary's Trust, it was decided to develop individualized clinical management plans to include not only those patients seen in the pre-dialysis clinic but also those patients receiving haemodialysis, peritoneal dialysis, day case procedures and transplantation.
Immune mediated inflammatory disorders: the role of the nurse prescriber
Authors: Fairclough Allan
Published: May 2014

Immune mediated inflammatory disorders (IMIDs) are a group of diseases characterized by acute or chronic inflammation. IMIDs include Crohn's disease, rheumatoid arthritis and psoriasis. Although traditionally treated by their respective specialities, the emergence of new biologic therapies, which have been shown to be effective in treating these conditions, offers the opportunity for cross therapeutic collaboration and new clinical services. This article outlines the potential role of the nurse prescriber in establishing and delivering these services.
The Vitality Index: Vital decisions in locally advanced prostate cancer
Authors: Marley Jerome , Mason Malcolm
Published: May 2014

Treatment discussions in the field of locally advanced prostate cancer have seen an increasing emphasis on issues of patient choice and quality of life, particularly as active treatment interventions can result in side effects such as bladder, bowel and sexual problems. The Vitality Index (VI) has been developed as a new simple decision tool to support the specialist nurse in patient consultations. The VI helps nurses and other health professionals, as well as patients, to discuss and assess the side effects of available treatments and their impact on the individual's lifestyle. The aim is to limit the compromise of a patient's quality of life within the context of disease management.
Protelos: new pharmacological treatment for post-menopausal osteoporosis
Authors: Zarev Janette
Published: May 2014

An estimated 3 million people in the UK suffer from osteoporosis costing the NHS and government over £1.7 billion each year. Osteoporosis is not painful in early stage but if left untreated it can cause substantial damage to bone structure resulting in multiple fractures. Development of new pharmacological treatments helped very elderly, patients with gastro-intestinal symptoms or non-compliant patients to recieve treatment as well.
Managing hypertension: the challenges facing the non-medical prescriber
Authors: Easton Nikki
Published: May 2014

About 40% of the adult population of Britain has hypertension. Prevalence varies according to age, gender and ethnicity, and it is more common in those of Black African, Caribbean and Indian descent, and in those with diabetes. Hypertension represents a considerable cost burden to the NHS. The two main cardiovascular consequences – heart disease and stroke – costing around £7 billion and £6 billion, respectively. The new guidance issued recently by the National Institute for Health and Clinical Excellence in conjunction with the British Hypertension Society updates the recommendations for pharmacological management of hypertension and give a clear step-wise approach to the management of hypertension in primary care. This article covers measures that are used to manage hypertension that should help nurse prescribers in their difficult task of acheiving blood pressure targets.
Reducing medication administration errors in learning disability nursing
Authors: Dickens Geoff , Doyle Colin , Calvert John
Published: May 2014

It is essential that people with a learning disability and mental disorder receive the appropriate medicines in order to promote both their physical and mental health. However, medication administration errors (MAEs) are relatively frequent occurrences, and can have serious consequences. There is mixed evidence as to whether they can be reduced through a two-nurse administration system. Two-nurse administration is relatively expensive, but could be more cost-effective if the second administrator were a specially trained health care assistant (HCA) rather than a registered nurse. Such a system may also be more practicable in areas where only one registered nurse is available. This paper describes the evaluation of the introduction of an HCA observer into the medicines administration process utilising a before and after audit design. There was a significant fall in the MAE rate 9 months after the introduction of an observer, from 2.92% to 0.85% of all prescribed doses.
Medical mentors: finding and maintaining successful partnerships
Authors: Lakasing Edin
Published: May 2014

In recent years nurse prescribing has grown and with it have come many supplementary and extended prescribing courses. This article advises potential candidates on selecting and maximizing the benefit of a medical mentor whether in general practice or in the hospital service. The political background and reasons for considering training as a nurse prescriber are also discussed.
Counterfeit medicines: a localized problem or a global phenomenon?
Authors: Ainsworth Steve
Published: May 2014

Counterfeit medicines are a cause of concern for today's health professionals, but they are not a new phenomenon. In this article, Steve Ainsworth looks briefly at the history of counterfeit drugs, but also explores where they come from and how they find their way into the modern pharmaceutical industry.
Prescribing for skin and wound care: the nurse prescriber's perspective
Authors: Newton Heather
Published: May 2014

The introduction of non-medical prescribing has greatly enhanced patient management within the field of skin and wound care. This article explores the function of the skin with specific reference to prescribing options of skin care products. The use of emollients, topical steroid preperations and skin barrier products will also be discussed.
Schizophrenia: `the biggy in mental health’
Authors: Sage Jill
Published: May 2014

As many as half of psychiatric outpatients that are diagnosed with schizophrenia do not take their medication in the first year of it being prescribed. This article give some of the history of the diagnosis and management of schizophrenia and outlines the current prescribing practices in relation to the successful management and treatment of schizophrenia.
New compression products for managing lymphoedema of the limb
Authors: Williams Anne
Published: May 2014

Lymphoedema affects over 100000people in the UK and has a significant impact on quality of life. This article overviews relevant physiology, focuses on upper and lower limb lymphoedema and discusses approaches to lymphoedema treatment including the use of compression hosiery. A product focus on ActiLymph arm and leg lymphoedema compression garments, newly available on Drug Tariff, is provided.
The role of nurse prescribers in the management of controlled drugs
Authors: Griffith Richard
Published: May 2014

This article outlines the extension of the right to prescribe controlled drugs to independent and supplementary nurse prescribers. The additional responsibility and accountability that this right bestows is discussed and the recent changes to the regulation of controlled drugs introduced by the Government in response to the recommendations of the Shipman Inquiry are considered.
The developing role of the night nurse practitioner: the impact of nurse prescribing
Authors: Whitaker Lynne
Published: May 2014

Advanced nursing roles such as the night nurse practitioner (NNP) have been introduced into NHS trusts in response to the reduction in junior doctors hours. The NNP role is diverse and constantly evolving to meet patient need. The NNP undertakes advanced clinical assessment of patients and undertakes interventions to facilitate optimum patient care. Is the step towards nurse prescribing a natural progression or are professional working boundaries being destroyed= Recent controversial developments surrounding the nurse prescribers role will have a significant impact on the NNP. This article looks at the potential implications for practice development considering the ongoing changes within the nurse prescribing arena.
Thalidomide: establishing when the risks outweigh the benefits
Authors: Ainsworth Steve
Published: May 2014

The birth defects and miscarriages caused by thalidomide are a reminder to every prescriber to be alert to adverse drug reactions. Deciding when the benefits outweigh the risks for any drug is part of the challenge of prescribing.
Questions & Answers
Authors: Peniston-Bird Fiona
Published: May 2014

QI have recently passed the prescribing module and there are a few issues that I hope you can offer advice on. I have found the change from supplementary and extended prescribing to independent prescribing confusing. Most of the literature I have looked at for clarification still refers to supplementary extended.
Prescribing improved patient care in the acute sector
Authors: Keenan Jan
Published: May 2014

I registered as a nurse in 1987 and spent some time working in cardiac medical and surgical services in Gloucester, Sheffield and London before settling in Oxford when the cardiac centre opened in 1989. One of the many great things about working here is that we have an enlightened manager who values the nursing contribution to patient management and supports the development of autonomous practice across professional groups.
Saving lives or saving money: what do we really think about NICE?
Authors: Ainsworth Steve
Published: May 2014

The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health. Since its launch in 1999, it has been subjected to more criticism than praise by the popular press. Steve Ainsworth looks at the reasons why.
Questions & Answers
Authors: Peniston-Bird Fiona
Published: May 2014

Should an independent nurse prescriber only prescribe for patients he or she has seen, or is it acceptable to give verbal prescriptions based on other nurses' assessments of a patient?
Euthanasia and assisted suicide current law and attempts at reform
Authors: Griffith Richard
Published: May 2014

Nurse prescribers are often required to assist in the management of patients who are chronically sick or terminally ill. Patients with these conditions often face intolerable suffering or intractable pain. In some cases patients or their relatives believe they have suffered enough and contemplate death to bring it to an end. This article considers the law relating to euthanasia in the UK and outlines recent attempts at reforming the law.
Prescribing medication in first episode psychosis
Authors: Roberts Lynne
Published: May 2014

First episode psychosis affects adolescents/young adults in a crucial stage in their development. The type of symptoms that are likely to be experienced include hallucinations, delusions and thought disorder, which understandably is an extremely frightening experience that a young person will struggle to make sense of. There is growing literature suggesting better outcomes for people if the psychosis is treated early within the fi rst onset of the illness (Loebel at al, 1992). Strategic guidelines such as those from NICE (2003) have recommended introducing atypical antipsychotic medication as the fi rst-line treatment option for fi rst episode psychosis. Treatment with antipsychotic medication should be part of an overall package of care that addresses the person's medical, emotional and social needs. The role of the nurse prescriber in this process can promote the quality of service provision within this specifi c client group. This article focuses on a nurse prescriber framework that can be used for the prescription and monitoring of antipsychotic medication.
Questions and Answers
Authors: Peniston-Bird Fiona
Published: May 2014

If a non-medical prescriber has not practised for 3 years can they still prescribe now or would they need to retrain? If they can still prescribe would they need to be assessed as competent to prescribe, and who would do this?
Public health and men: needs and strategies
Authors: Nuttall Dilyse
Published: May 2014

Population-based public health targets require consideration at local and individual level in order to be addressed effectively. Men have a range of specific health needs, including those relating to disease susceptibility, perceptions of health and illness and use of health services. Public health should be integral to the role of the non-medical prescriber and as such, awareness of men's health needs and strategies to improve the effectiveness of interventions is essential.
An evaluation of community matron prescribing
Authors: Brookes Dawn
Published: May 2014

Community matrons are part of the national plan to improve the health management of patients with highly complex or multiple long-term conditions through a system of case management. Prescribing is an integral part of the community matron's role. An evaluation was carried out in order to find out what impact community matrons were having on medication reviews and prescribing costs for patients on their caseloads.
ACE inhibitors: use, actions and prescribing rationale
Authors: Waterfield Jon
Published: May 2014

This article provides a summary of some of the issues associated with the prescribing of angiotensin-converting enzyme inhibitors (ACEIs). There is a consideration of their pharmacological mode of action and a brief overview of the history of the introduction of this important group of drugs. A pre-reading self assessment provides the opportunity for the reader to assess prior knowledge of this area. There is a discussion of some of the more important prescribing issues including adverse effects and drug interactions.
Older people, prescribing and public health
Authors: Nuttall Dilyse
Published: May 2014

Although public health concerns issues pertinent to society as a whole, it is recognized that particular groups have public health issues to which they remain particularly susceptible. One such group is older people.

The specific public health issues relevant to this group, and the factors responsible for their increased susceptibility, are important considerations in non-medical prescribing practice.
Latest advances in the management of sleep disorders
Authors: Greener Mark
Published: May 2014

The functions of sleep include consolidating memories and learning, protection, and recuperation. Two processes regulate the sleep– wake cycle: the suprachiasmatic nucleus (SCN), which acts as a self-sustained ‘master clock’; and the ‘homeostatic process’, which tracks the need for sleep. Numerous neurotransmitters mediate the sleep-wake cycle, including melatonin, orexin and melaninconcentrating hormone (MCH). Insomnia can be either primary (not associated with another condition) or secondary to another disease. Optimizing management of the many concurrent disorders associated with insomnia is the first line of therapy, before resorting to hypnotics. With an increasing number of available treatments for insomnia, prescribers need to remain cognisant of the effects of drugs on sleep architecture. However, hypnotics are an addition to, rather than a replacement for, good sleep hygiene, and are indicated for short periods only. Around one person in every 2000 suffers from narcolepsy. Current treatments for narcolepsy may be ineffective on some symptoms, and can cause side-effects. New approaches could transform the management of this distressing disease.
Widening access to contraception: the impact of pharmacy prescribing
Authors: Hand Helen
Published: May 2014

In a bid to tackle the high rates of teenage pregnancy currently experienced in the UK, pilot schemes are underway to assess the effect of making oral hormonal contraception more widely available through local pharmacies. This article explores the extent of the teenage pregnancy problem, and analyses the potential impact of contraceptive prescribing on the patient, the pharmacist, and other services that supply contraception (e.g. GPs and family planning clinics).
Selective serotonin reuptake inhibitors
Authors: Stone Margaret
Published: May 2014

Selective serotonin reuptake inhibitors (SSRIs) are used widely for the treatment of depression and anxiety disorders, and different SSRIs have different licence indications. They prevent the reuptake of serotonin in the synapse between nerve cells; they should be used with caution in children and adolescents owing to the possible side-effect of an increase in suicidal behaviour, particularly in this age group. They are generally safe in overdose, however. SSRIs have a number of side-effects, which are largely self-limiting, and a number of drug interactions of note, with both prescribed, over-the-counter and herbal preparations. This article examines to mode of action of SSRIs, prescribing issues, adverse effects and licencing issues.
Back to basics in a complex world
Authors: Otway Christine
Published: May 2014

This month I have been thinking about the basics of prescribing, as I have been working with health visitor (V100) prescribers who qualified some time ago, and who have either lost confidence and stopped prescribing; qualified and yet have never actually started prescribing; or they prescribe, but stick to a very limited formulary consisting of one or two items. The aim of my work has been to reintroduce them to prescribing and help them to feel more confident in their decision-making and prescribing competence.
Research and development roundup: July 2010
Authors: O'Connell Nicola
Published: May 2014

Angiotensin-receptor blockers (ARBs), commonly used in the treatment of high blood pressure, heart failure, and kidney damage due to diabetes, are associated with a modestly increased risk of developing cancer. Although the limited data makes it impossible to calculate the exact cancer risk associated with each individual drug, these fi ndings demand further investigation, concludes an article in The Lancet Oncology.
New agents in the management of Alzheimer's disease: a case study
Authors: Grainger Mervyn , Keegan Kenny
Published: May 2014

Acetylcholinesterase inhibitors are presently the only treatment available to ameliorate the devastating effects of Alzheimer's disease. Their use is predicated on the cholinergic hypothesis, which identifies the neurotransmitter acetylcholine as crucial in maintaining healthy brain function. In the UK, the most commonly prescribed acetylcholinesterase inhibitor is donepezil (Aricept). Treatment with this medication is however dependent on the patient being at a relevant functional and behavioural level. A case study approach is presented to demonstrate the appropriate assessment strategies to estimate the individual's functional and behavioural level, as well as the potential benefits and risks associated with this pharmacological therapy. The importance of involving patients and their family at each stage of the treatment, its initiation and the ongoing regimen are highlighted.
ellaOne: a new emergency contraceptive choice
Authors: Norton Wendy , Feehan June
Published: May 2014

Emergency contraception is an important means of preventing unwanted pregnancy up to 5 days (120 hours) following unprotected sex or contraception failure. This article explores the evidence and clinical considerations when prescribing emergency contraception, and the role of a new agent, ellaOne, as a new additional choice.
Effective management of hypoglycaemia in diabetes
Authors: Holt Paula
Published: May 2014

As the number of people diagnosed with type 1 and type 2 diabetes escalates, health professionals will be responsible for prescribing insulin and insulin secretagogues for ever-increasing numbers of people. Unfortunately, hypoglycaemia is a main side effect of therapy with these classes of drugs. This article considers the relationship between insulin production and secretion and its link to type 1 and type 2 diabetes. It explores the incidence and some of the causes of hypoglycaemia in people with diabetes. Finally, effective treatment options to increase blood glucose levels quickly and safely are discussed.
Easing the burden of COPD: NICE guidelines and new agents
Authors: Greener Mark
Published: May 2014

Around three million people in the UK suffer from chronic obstructive pulmonary disease (COPD), which occurs when chronic inflammation results in airway obstruction. The condition is usually progressive, at least partially irreversible, and does not change markedly over several months. However, health professionals have only diagnosed around 900 000 of these cases. COPD kills approximately 30 000 people each year; it is the most common respiratory cause of emergency hospital admissions, and costs the UK economy £1.2 billion annually. This underscores the importance of improving case ascertainment and optimizing management. NICE guidance published in 2010 established evidence-based diagnostic and therapeutic principles for COPD. In the guidance, NICE emphasizes the importance of considering the clinical features of COPD rather than over-relying on lung function tests. Therapeutic advances since the publication of the guidelines offer the opportunity to enhance treatment further. This article updates nurse prescribers about COPD management.
Prescribing antimuscarinics for women with an overactive bladder
Authors: Stewart Ellie
Published: May 2014

Overactive bladder (OAB) syndrome is a common condition that can significantly affect a sufferer's quality of life. Treatments for OAB are varied and although conservative measures are used initially, antimuscarinics are often the mainstay of treatment. This article will look at treatments available for those presenting with OAB, as well as the medications available to help improve the symptoms.
The management of VTE: a practical guide for nurse prescribers
Authors: Bacon Sue
Published: May 2014

Venous thromboembolism (VTE) is increasingly being managed in the community, and nurses are involved in either prescribing or overseeing anticoagulation therapy in patients diagnosed with VTE. Therefore, an overview of the diagnostic algorithm for VTE and a discussion of the potential issues associated with initiation of oral anticoagulation therapy is timely. In addition, a good knowledge of the coagulation cascade is useful to understand the mechanisms involved in anticoagulation, keeping in mind that each patient is an individual and that the guidelines are only that: guidelines. New oral anticoagulants have now reached the clinic, with additional new agents on the horizon, and nurses need to be aware of their existence.
Prescribing update on smoking cessation
Authors: Percival Jennifer , McEwen Andy
Published: May 2014

Smokers attending NHS Stop Smoking Services are four times more likely to quit successfully than those who quit without help. Varenicline and buproprion are prescription-only medicines, whereas NRT is also available over the counter, and some products (i.e. gum, path and lozenge) are on sale in many supermarkets. By providing clear information on the range of treatments available and making a referral to the NHS Stop Smoking Services, nurses can help to reduce the death toll from tobacco use and save lives.
Exploring nurse prescribing through practitioner research
Authors: Reed Jan
Published: May 2014

Practitioner research can be a way of taking responsibility for the monitoring and evaluating of practice. Practitioner research also fits with practitioner values, including holism and autonomy. This paper focuses on these two themes, and explores the way that practitioner research can develop them. This can be done by using the skills that are fundamental to practice, and this paper describes what some of these skills might be.
Serotonin–norepinephrine inhibitors: pharmacological profile
Authors: Lovatt Penny
Published: May 2014

The final article in the series on antidepressants reviews the serotonin–norepinephrine reuptake inhibitors (SNRIs). The most recent addition to modern-day antidepressant drugs, the SNRIs were developed to combine the positive action and effects of selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). After discussing the mechanism of action of this class of antidepressants, the pharmacodynamic and pharmacokinetic properties will be addressed, using venlafaxine as an example drug. The article will then examine the vulnerable populations and due considerations when prescribing these drugs, before reviewing the current and alternative uses of SNRIs in practice.
Management of seasonal and pandemic flu
Authors: Geary Katie , Beckett Gail
Published: May 2014

In this article, prevention and treatment of influenza are discussed. Management of influenza involves standard infection control procedures, surveillance of viral disease strains, use of available preventive vaccines, and swift, responsive treatment of influenza and its complications.
Diagnosis and management of COPD
Authors: Cornforth Amber
Published: May 2014

This article defines COPD and its diagnosis and looks at the essential treatment, management and care of patients with the condition, outlining the importance of patient education, self-management and regular primary care review. Using current guidelines and available clinical evidence, the pharmacological management approaches will be considered alongside justification for their choice.
Incretin-based therapies for type 2 diabetes
Authors: Morris David
Published: May 2014

The prevalence of type 2 diabetes mellitus continues to increase both in the UK and worldwide. There is a continuing need to identify novel therapeutic agents that offer improved efficacy and safety over existing anti-diabetic treatments. An increased understanding of the incretin hormone pathway has been the catalyst for development of two new classes of drugs: the DPP-4 inhibitors (gliptins) and the GLP-1 agonists (incretin mimetics). This article provides a summary of when and how to use these agents.
Adherence, compliance, and concordance: an ethical perspective
Authors: Felzmann Heike
Published: May 2014

Concordance has become the widely accepted ‘gold standard’ of prescribing. In this article, the ethical underpinnings of adherence-related decision making will be analyzed. The goal of this article is to identify the ethical dimensions of adherence-related decisions using core concepts of health care ethics. It draws on the principles of biomedical ethics, as presented by Beauchamp and Childress (2009 ), core ethical concepts like paternalism and informed consent, and considerations from relational ethics and care ethics. The article starts by outlining initial ethical reasons for attention to the phenomenon of non-adherence, in particular the ethical requirement of prevention of harm. The rejection of the notion of compliance is then discussed in the context of the problem of paternalism, as a conflict between the patient's autonomy and the prescriber's view of what is in the patient's best interest. Informed consent will then be addressed as the standard solution to avoiding paternalism, as an attempt to facilitate the patient's autonomous decision making. The elements and practices of informed consent are discussed. A discussion of the notion of concordance highlights the importance of the therapeutic relationship between patient and prescriber. In this context, relational ethics and care ethics become relevant to the extent that they identify important characteristics of a constructive ethical approach to this relationship.
The challenges of prescribing in out-of-hours care
Authors: Cheesman Sarah , Hartwell Matthew
Published: May 2014

Although many patients seen in out-of-hours treatment services have a minor ailment or illness, this does not make the job of the out-of-hours practitioner any less challenging than that of those treating acutely ill patients. With no, or very limited, access to the medical records of patients, taking a complete and accurate history can be challenging when faced with a patient who cannot remember exactly what it is they are allergic to, or the name of the pink tablet they take every morning or why they take it. In this article, some of the challenges facing practitioners who work in out-of-hours services are explored.
Breaking down the barriers to nurse prescribing
Authors: Blanchflower James , Greene Leah , Thorp Christine
Published: May 2014

There are many obstacles to implementing nurse prescribing after nurses have undergone the initial training required in order to prescribe. This article examines some of these obstacles and makes suggestions about how they may be overcome.
Research roundup: December 2013
Authors: Greener Mark
Published: May 2014

In brief

■ ACE-Is and ARAs potentially account for up to 15% of the recent increase in AKI admissions ■ Treating patients taking antiepileptic drugs (AEDs) for low bone mineral density may prevent the development of fractures associated with AEDs ■ GABA analogues prescribed as anticonvulsants, muscle relaxants and to relieve neuropathic pain are being misused as recreational drugs in the UK ■ Lifestyle factors account for at least some of the increased incidence of diabetes among people with psoriasis, psoriatic arthritis and rheumatoid arthritis
An update on hypertension for nurse prescribers
Authors: Williams Helen
Published: May 2014

In 2011, National Institute for Health and Clinical Excellence (NICE) guidance for hypertension endorsed the use of ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension. When ABPM is not available, home blood pressure monitoring (HBPM) is preferred over clinic blood pressure readings. The diagnostic threshold for hypertension using ABPM or HBPM is any blood pressure of 135/85 mmHg or higher. Once diagnosed, patients should be offered lifestyle advice, and, if appropriate, drug therapies, aiming to control blood pressure to lower than 140/90 mmHg. A revised treatment algorithm recommends angiotensin-converting enzyme inhibitors/angiotensin receptor blockers or calcium channel blockers as first- and second-line therapy options. Ensuring appropriate ongoing monitoring as well as identifying and addressing non-adherence are key issues.
Diagnosis and management of sepsis in adults
Authors: Robson Wayne , Daniels Ron
Published: May 2014

Sepsis is a common medical emergency with a high risk of mortality. This article will examine the diagnosis and management of sepsis in adult patients from a nurse prescribing perspective. It will focus on two key interventions: prescribing of antibiotics and intravenous fluids. Prompt recognition and management can dramatically improve survival in patients with severe sepsis, and nurse prescribers have an important role to play in ensuring patients receive life-saving antibiotics.