bluuebunny/crossref_metadata_2025 huggingface dataset:
Point prevalence of wounds and cost impact in the acute and community setting in Denmark
Authors: Gottrup F. , Henneberg E. , Trangbæk R. , Bækmark N. , Zøllner K. , Sørensen J.
Published: May 2014

• Objective: To estimate the wound-care related costs in two hospitals in Denmark.

• Method: A point-prevalence survey with a focus on resource consumption was carried out during a representative 1-week period in March 2010, in two hospitals in Denmark: Regional Hospital viborg, in the Viborg Municipality and Hillerød Hospital, in the Hørsholm Municipality. Data were collected during a 2-day period for inpatients and outpatients in the hospitals and over a full week in the municipalities. The survey included information on the numbers, types and locations of the wounds, as well as resource consumption related to dressing changes. The estimation of costs was based on representative cost levels, including the salaries of health professionals or nurses and the cost of dressings and hospitalisation provided.

• Results: In total, 33% (n=830) of inpatients had a wound. The majority of these were surgical/trauma wounds (25%), while pressure ulcers, leg ulcers and diabetic foot ulcers accounted for 3.3%, 1.7% and 1.6%, respectively. In the municipalities, there was a wound patient prevalence of 2.8 per 1000 population (1/1000 acute wounds, 0.7/1000 pressure ulcers, 0.5/1000 leg ulcers and 0.3/1000 diabetic foot ulcers). The extrapolated figures for nurse time related to wound care per year was equivalent to 10 full-time nurse positions in Hillerød Hospital, three in Viborg Hospital, 17 in Viborg Municipality and three in Hørsholm Municipality. The total annual costs related to wound care was estimated as 3.6 million for Viborg Hospital, 4.1 million for Hillerød Hospital, 1.2 million for Viborg Municipality and 232 548 for Hørsholm Municipality, accounting for approximately 1.8% (Viborg), 1.6% (Hillerød), 2.4% (Viborg) and 1.5% (Hørsholm) of the total annual budgets.

• Conclusion: In the survey, 33% of the patients treated in the hospitals had a wound. Primary costs were defined as hospitalisation costs and nurse time related to dressing changes. Total annual costs of treatment, including hospitalisation, were estimated as approximately 1.6–1.8% for the hospitals and 1.5–2.4% for the municipalities. The level of costs support the relevance of increased efforts to secure better wound prevention and treatment to reduce the staff-time consumption and hospitalisation costs.

• Declaration of interest: This survey was initiated by the European Wound Management Association (EWMA) and Danish Wound Healing Society (DWHS). It was supported by unrestricted grants from ConvaTec, Mölnlycke Healthcare, KCI and Smith & Nephew. The authors have no commercial or social conflicts of interest with respect to the article or its content.
Evaluating the reasons underlying treatment nonadherence in VLU patients: Mishel's theory of uncertainty. Part 2 of 2
Authors: Brown A.
Published: May 2014

Part one of this review discussed how self-efficacy is an appropriate health behaviour change model to encourage patients with healed venous leg ulceration (VLU) to undertake self-care activities which may help reduce the incidence of recurrence. However, it has been highlighted within the literature that some patients demonstrate little understanding about the aetiology of their leg ulcer, despite having received explanations from health care professionals. This knowledge deficit is a potential barrier to changing health behaviours. In the second part of this two-part review, the literature on this knowledge deficit will be reviewed together with a discussion on the potential implications this may have for healthcare professionals (HCPs) in attempting health behaviour change in this patient group. In order to offer a possible explanation for this knowledge deficit, an overview of Mishels’ Theory of Uncertainty in Illness will be given and its potential relevance to VLU patients will be discussed.
A clinical algorithm for wound biofilm identification
Authors: Metcalf D.G. , Bowler P.G. , Hurlow J.
Published: May 2014

Recognition of the existence of biofilm in chronic wounds is increasing among wound care practitioners, and a growing body of evidence indicates that biofilm contributes significantly to wound recalcitrance. While clinical guidelines regarding the involvement of biofilm in human bacterial infections have been proposed, there remains uncertainty and lack of guidance towards biofilm presence in wounds. The intention of this report is to collate knowledge and evidence of the visual and indirect clinical indicators of wound biofilm, and propose an algorithm designed to facilitate clinical recognition of biofilm and subsequent wound management practices.
Photographic assessment of burn size and depth: reliability and validity
Authors: Hop M.J. , Moues C.M. , Bogomolova K. , Nieuwenhuis M.K. , Oen I.M.M.H. , Middelkoop E. , Breederveld R.S. , Baar M.E. van
Published: May 2014

Objective:

The aim of this study was to examine the reliability and validity of using photographs of burns to assess both burn size and depth.

Method:

Fifty randomly selected photographs taken on day 0–1 post burn were assessed by seven burn experts and eight referring physicians. Inter-rater reliability in both groups (experts vs. referrers) was calculated. The validity of burn size assessment was calculated using live assessment as the gold standard, and of burn depth using clinical assessment in combination with laser Doppler imaging as the gold standard. The validity of the photographically-assessed indication for surgery was calculated using laser Doppler imaging and actual treatment as the gold standard. Finally, agreement in referral indication was calculated.

Results:

Using photographs, burn size could be assessed reliably and validly by experts (ICCs of 0.83 and 0.87), but not by referrers (ICCs of 0.68 and 0.78). Photographic assessment of burn depth was neither reliable nor valid, with ICCs respectively of 0.38 and 0.28 for experts and 0.24 and 0.13 for referrers. The indication for surgery could also not be assessed validly. Agreement between assessors regarding referral indication was low.

Conclusion:

Burn size, but not burn depth, can be assessed reliably and validly by experts using photographs of the burn wound. We recommend exploring other forms of telemedicine, like live interactive video, to investigate whether this leads to an improved burn depth assessment where clinical assessment is not possible.

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 the manuscript or its content.
Perceptions of doctors in prehospital care: a study
Authors: Skeldon Rebekah , Donald Michael , Paterson Brodie
Published: May 2014

The Tayside Trauma Team has been providing a physician-staffed primary retrieval service in Angus and Tayside for many years. This study aims to explore the experiences and current opinions of paramedics and ambulance technicians in Tayside and Angus regarding the role of physicians in prehospital care as well as their understanding of what physicians bring to the on-scene management of trauma patients.

Methods

An anonymous questionnaire was devised and circulated electronically to all paramedics and ambulance technicians in Tayside and Angus.

Results

More than three quarters of respondents agreed that the ability of physicians to perform specific advanced practical procedures were advantageous on scene. Most disagreed that doctors carried out unnecessary interventions on scene and that a doctor's presence prolonged scene times, compromised scene safety or meant patient care was ‘taken over’.

Discussion

There appears to be a high level of understanding of the role of physicians in prehospital care among paramedics and ambulance technicians in Tayside and Angus. The majority of ambulance crews recognize that there are a key set of skills that a doctor can provide on scene to trauma patients.
Paramedic education: the significance of graduate attributes
Authors: Williams Brett , Onsman Andrys , Brown Ted
Published: May 2014

The Australian health care system and delivery of health services is under increasing pressure. Therefore, preparing health care graduates for these expected changes requires careful alignment of graduate attributes to core components of academic curricula. The Australian paramedic discipline has seen a remarkable change in a number of areas over the past three decades including education, training, health care identity, and scope of clinical practice. However, the Australian paramedic discipline is currently in a tenuous position for a number of reasons: it is not registered or regulated nationally and university paramedic education programmes are not formally accredited. This has led to non-standardized curriculum standards and uncertainty whether graduates are meeting industry and health service needs. This article will discuss why graduate attributes are important in registration, regulation and curricula development, and how and why graduate attributes are integral in providing graduates with the employability skills expected by employers. While this paper focuses on the issues in Australia, many of these issues are also faced by the paramedic profession and higher education sector in the UK. Therefore, it should provide the readership with germane material in their quest for curriculum and graduate attribute renewal.
Human factors within paramedic practice:the forgotten paradigm
Authors: Summers Andy , Willis Sam
Published: May 2014

It would seem hard to imagine how you could draw a comparison between a commercial airline pilot struggling to land a stricken plane in a storm and a paramedic fighting to save the life of a patient in cardiac arrest. Although very different circumstances, they both have one thing in common: that is, they are both vulnerable to a condition known as ‘the human factor’. Examples of where Human Factors (HFs) exist within the prehospital profession can be various, common examples are environmental distractions e.g. noise from bystanders, mobile phones, machines, or more simply caused by lack of sleep and inadequate nourishment. This article discusses human factors within the prehospital environment and will highlight the benefits of being able to recognize and act upon them, with a specific focus upon the impact they can have on the ambulance practitioner operating in the field. It discusses human factors training and recognizes the role of crew resource management (CRM) and its importance within the prehospital profession.
Adult sepsis in a pre-hospital environment
Authors: Langley Mark , Langley Carrie
Published: May 2014

Sepsis is a syndrome with a high mortality rate, increasing incidence, and a huge financial impact that must be recognised earlier and treated more effectively both in hospital and pre-hospitally. This article serves to focus on the improvements that need to be made in pre-hospital recognition and management in order to maximise patient outcome, as a high standard of care initiated at an early stage has been demonstrated to decrease morbidity and mortality. There are currently no ratified guidelines for pre-hospital practitioners to follow for the management of sepsis, severe sepsis or septic shock, although the authors recognise that steps are being taken to remedy this. Current guidelines for fluid resuscitation also do not currently support the need for aggressive treatment of sepsis and cryptic shock. Improvements need to focus on education around the sepsis syndrome, recognition of sepsis and early, goal-directed treatment for the benefit of our patients and in order to meet the standards required of paramedics as professionals.
Occupational stress, paramedic informal coping strategies: a review of the literature
Authors: Mildenhall Joanne
Published: May 2014

Frontline ambulance staff have high rates of sickness absence; far greater than any other National Health Service worker. Reports suggest that many of these instances are attributable to stress, anxiety and depression. Indeed, studies have observed that occupational stress is significant within the Ambulance Service. While academics frequently associate the causative factor as being related to traumatic incident exposure, there is a small, growing trend of researchers who have found that daily hassles are equally, if not a greater source of stress. Many of the studies investigating the psychological aftermath of a stressful occupational experience focus on formal coping strategies such as critical incident debriefing and trauma risk incident management. However, it has been found that paramedics often prefer to manage stressful feelings informally within their own occupational culture. This literature review explored these informal coping strategies, and found that cognitive mechanisms and peer support were the most used methods. Research in this domain is currently very limited; therefore, this review identifies several areas for further study.
Ambulance CPAP Saves Lives: why don't we use it?
Authors: Mullen Robert
Published: May 2014

Continuous positive airway pressure (CPAP) is an established in-hospital therapy for the treatment of multiple aetiologies of breathlessness, primarily for acute cardiogenic pulmonary oedema (ACPE) due to acute exacerbations of congestive heart failure (CHF), but also (amongst others): exacerbations of chronic obstructive pulmonary disease (COPD), asthma and pneumonia ( Gray et al, 2009 ; Wesley et al, 2011 ).

The use of CPAP as an adjunctive treatment for ACPE patients in front-line ambulances has been proven to improve patient outcome, preventing them from reaching the ‘point of no return’ and a downward spiral into total respiratory failure.

This article will discuss current UK ambulance practice and examine the issues surrounding the introduction and use of CPAP as an adjunctive therapy in the treatment of ACPE, secondary to acutely exacerbated CHF, whilst also briefly discussing its use in other aetiologies of breathlessness.
Pre-hospital femoral neck fracture management: A review of the literature
Authors: Perillo Samuel , Boyle Malcolm J
Published: May 2014

Introduction:

Falls are a common incident in the pre-hospital setting with a significant number resulting in fractures to the femoral neck. There is some disagreement as to the best way to manage this injury, especially the immobilisation of the affected leg. The objective of the study was to review the literature evaluating the best practice management of patients who present with a femoral neck fracture in the Australian pre-hospital setting.

Methods:

A literature search was conducted using medical electronic databases, Medline, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) from the beginning of each database until the end of September 2012. Articles were included if they reported the pre-hospital management of a patient with a femoral neck fracture. Non-English and hospital-based articles were excluded. References from articles retrieved were reviewed.

Results:

There were 49 articles located with five articles meeting the inclusion criteria. All five articles described the evaluation of pain management techniques for patients presenting with injuries to the femoral neck. There were no studies that investigated the immobilisation of a femoral neck fracture.

Conclusions:

This study found a lack of evidence for the management of pre-hospital femoral neck fractures in Australia. Further pre-hospital studies are required to determine the most effective pain management technique as well as the best method to immobilise a femoral neck fracture.
International student paramedic exchange: the student perspective
Authors: Ashton Kate , Davies Rebecca , Corkhill Shaun , Anthony Daniel , Krantsevich Violetta
Published: May 2014

An annual student exchange between Liverpool John Moores University (LJMU) and Centennial College of Ontario, Canada, has taken place within the paramedic programmes of each educational institute since 2009. The exchange allows students to take part in observation shifts on ambulances and gain an overview of healthcare systems within a different national setting. It also allows students to gain lifetime friendships and links to students and colleagues within the paramedic field on an international basis. This article gives the perspectives of five students who have taken part in this exchange, from both Centennial College and Liverpool John Moores University, looking at what each of them has gained from the experience, and how it will benefit their future careers.
The transnational delivery of paramedic education: the Gibraltar case study
Authors: Rice Alan
Published: May 2014

Higher education is becoming increasingly more international, with both governments and universities seeking to expand beyond traditional markets as globalisation increases. The internationalisation of education is a broad term that describes the ‘process of integrating an international, intercultural or global dimension into the purpose, function or delivery of post-secondary education’ ( Knight, 2003 ). Transnational Education (TNE) is a more defined area of internationalisation, where students are able to study a higher education course away from the host country ( British Council, 2013 )

This article is a case study account with personal reflections of an example of the transnational provision of higher education to develop paramedic services in an overseas region. In November 2013, a small cohort of students successfully graduated from an HCPC validated paramedic programme in Gibraltar.
Supplementary prescribing in cystic fibrosis: responding to an acute exacerbation
Authors: Donaghy Berni
Published: May 2014

Tom is a 19-year-old man who has cystic fibrosis. He self-referred to the hospital-based cystic fibrosis unit with worsening chest symptoms. This scenario described demonstrates how the unit’s cystic fibrosis nurse specialist, as a supplementary prescriber, was able to provide Tom with immediate care both in hospital and on his transfer home without the need to refer to a doctor. As Tom is typical of many of the patients on the cystic fibrosis unit, this scenario demonstrates how supplementary prescribing can benefit patients in this specialized area of care.
The progress of nurse prescribing: a commentary
Authors: Bradley Eleanor , Nolan Peter
Published: May 2014

The government set a target in 2002 to have 10000 nurses qualified as supplementary and extended formulary prescribers by the end of 2004. In retrospect, this was optimistic. Despite the rhetoric, and the exhortations from ministers and managers, the uptake of training for nurse prescribing has been slow. Recent figures from the Department of Health (DH) suggest that there are currently 1807 nurses registered to prescribe from the Extended Formulary, and 1087 nurses registered as supplementary prescribers (Mullally, 2004). Of the 1087 supplementary prescribers, only 110 are mental health nurses and a quarter of those are employed by one trust. However, such modest progress is not perhaps surprising considering the scale of the innovation and the fact that nurses often combine a desire to be progressive with a cautious attitude.
In praise of medical supervisors
Authors: Otway Chris
Published: May 2014

In my experience, having talked to successful prescribing students and evaluating their learning experience, one of the most valuable components of the non-medical prescribing course is the 12 days of learning in practice. This is the time when nurses can step aside from their normal working role and take time to observe and reflect with their medical and nursing colleagues on prescribing issues and decision making in the practice setting. This experience forms the all-important link between theory and practice, and without it the course would be incomplete.
Venous leg ulcers: methods and devices in compression therapy
Authors: Anderson Irene
Published: May 2014

Compression therapy is the most important factor in the management of venous leg ulcers. To ensure effective treatment and patient safety, it is vital to understand the scientific principles underpinning compression. There are a variety of ways to deliver effective compression therapy and this article explains the principles of compression, the key components of each method and assessment points to consider before prescribing therapy.
Comparing nurses' and doctors' views of nurse prescribing: a questionnaire survey
Authors: Courtenay Molly , Berry Dianne
Published: May 2014

Nurses have successfully adopted the role of prescriber in numerous health care settings in the UK. Existing research has not addressed how Nurse Independent and Nurse Supplementary Prescribers compare with doctors in terms of the perceived advantages and disadvantages of nurse prescribing, nor has the perceived importance of nurses providing patients with an explanation about their medicines been established. The current study utilized a random sample of 31 qualified Nurse Independent and Nurse Supplementary Prescribers and 30 general practitioners who self-completed a written questionnaire in an independent groups design. The study establishes nurses' and doctors' perceptions of the advantages and disadvantages of independent and supplementary nurse prescribing and provides some indication of the importance that nurses and doctors place on nurses providing an explanation about medicines, and the categories of information perceived to be important.
Chronic pain: nociceptive versus neuropathic
Authors: Greener Mark
Published: May 2014

Humanity has long sought the perfect painkiller and nurse prescribers can now chose from a wide analgesic armamentarium. Acute pain usually responds to simple painkillers. However, current analgesics produce adequate responses in fewer than half of patients with neuropathic pain. Often even opiates do not produce a substantial improvement. This article focuses on chronic pain, which persists for at least 6 months. Chronic pain arises from two broad causes: nociceptive and neuropathic, although some cases do not fi t into either category. Nociceptive pain, mediated by receptors, follows disease or tissue trauma. A wide variety of conditions can damage peripheral nerves or the central nervous system and, therefore, produce neuropathic pain. Nevertheless, the cause of neuropathic pain may prove elusive. So, prescribers need to take each patient's report of the severity and location of their pain at face value, even if careful examination and history-taking does not reveal an obvious cause. Current analgesics attenuate pain by acting at one of three levels: peripheral sites; pain perception; and pain transmission in the central nervous system. Understanding the causes of chronic pain and analgesic mechanisms should help prescribers tailor treatment to each patient more accurately.
Views on implementing nurse prescribing in a specialist children’s hospital
Authors: Carey Nicola , Stenner Karen , Courtenay Molly
Published: May 2014

This study aimed to explore the views of health care professionals on the implementation of nurse prescribing in a specialist children’s hospital. An intrinsic case study approach was taken using thematic analysis on semistructured interview data collected during 2006 and 2007. Participants were seven children’s nurses who were qualified nurse prescribers, 11 doctors and three clinical leads in one specialist children’s hospital.

Nurses varied in their actual and desired levels of autonomy, and this was refl ected in the way that prescribing was used in practice. Some nurses tended to treat existing patients, had less assessment and diagnostic skills and felt little need for support. The original selection of nurses focused around the needs and wishes of individuals, but was quickly superseded by the adoption of a more strategic approach.

Nurses’ expectations of prescribing may infl uence the extent to which they use their prescribing qualification and their subsequent support needs. Adopting a strategic approach to workforce planning and preparation should help ensure that the full potential of nurse prescribing is realized.
Accountability for medication management
Authors: Griffith Richard
Published: May 2014

Several inquiry reports have shown that there is still a need to further improve levels of quality and safety in health and social care in order to strengthen public confidence in these services. The reports have particularly emphasized the need for stricter regulation of health and adult social care providers, and the need to use statutory powers to ensure compliance with quality and safety standards. In this article, Richard Griffith outlines how the provisions of the Health and Social Care Act 2008 creates a new sphere of accountability on nurse prescribers, by imposing essential standards for the quality and safety of the service they provide, including the quality of their medicines management.
Advances in epilepsy management: the role of the specialist nurse
Authors: Lewis Sheila
Published: May 2014

The past decade has seen advances in clinical guidelines for the diagnosis, which has improved the management and treatment of children and adults with epilepsy. The existence of guidelines does not equate to their implementation in clinical practice. There are many specialist centres providing gold-standard epilepsy care; however, there are still children and adults with epilepsy having difficulty accessing epilepsy services, especially adults with epilepsy and learning disability. Despite the findings by the National Sentinel Audit of epilepsy-related deaths, service provision continues to be fragmented in the UK. This article will review some aspects of the current guidelines, and the latest advancements in firstline antiepileptic drug options for newly diagnosed epilepsy. Drug-resistant epilepsy, newer antiepileptic drugs options, pre-conception education for women with epilepsy, the risk of sudden unexpected death in epilepsy, and the management of prolonged and/or repeated convulsive seizures will also be discussed. The evolving and multifaceted role of the epilepsy specialist nurse (ESN) will be highlighted.
Monoamine-oxidase inhibitors: pharmacological profile
Authors: Lovatt Penny
Published: May 2014

This third article in the series on antidepressants reviews the monoamine-oxidase inhibitors (MAOIs). A chance discovery by chest clinicians led to the development of this class of antidepressant medications. Although MAOIs are not the first choice in modern-day drug therapy due to significant side-effects and drug interactions, they have played an important role in the development of the pharmaceutical management of depression. Focusing on moclobemide for clarity, this article discusses the pharmacokinetics and pharmacodynamics of this class of drugs, before discussing precautions and prescribing in special populations. A summary of MAOIs currently in use and their alternative therapeutic indications is also presented.
Drug therapies for post-menopause urinary incontinence
Authors: Bardsley Alison
Published: May 2014

Physiological effects of declining circulating oestrogen and ageing result in a high prevalence of urinary incontinence among post-menopausal women. Urinary incontinence is embarrassing and causes many women to alter their social, sexual, and occupational activities. Available treatment options include conservative treatments, such as pelvic floor exercises and pharmacological therapy. Pharmacological therapy has an important role in the treatment and management of urinary incontinence in post-menopausal women; however, women should always be counselled regarding potential side effects as well as potential benefits. In this article, the current pharmacological treatment options for post-menopausal women with urinary incontinence, including botulinum toxin and oestrogens, are considered.
Prescribing emollients for dry skin conditions
Authors: Penzer Rebecca
Published: May 2014

Emollients are a key therapeutic product for the treatment of dry skin conditions. This article examines how emollients can be effectively prescribed to enhance patient outcomes and improve quality of life.
Pressure sores: a preventable problem
Authors: Arblaster Gillian M
Published: May 2014

Pressure sores are a growing problem in an ageing population. However, they are not an inevitability of old age. The majority are preventable and their prevention is one of the most challenging and rewarding aspects of caring for the elderly.
Nutrition for older adults in nursing and residential care
Authors: Howell Sharran
Published: May 2014

Sharran Howell highlights the importance of addressing the changing nutritional needs of the elderly in a residential and nursing care home setting, in order to ensure that they remain healthy.
Identifying and managing pain in people with dementia
Authors: McClean William J
Published: May 2014

Clients with dementia may be suffering from pain but have difficulty telling about the symptoms. William J McClean outlines strategies to help staff to diagnose and manage the problem.
Strategies to personalize care for older people
Authors: Kydd Angela
Published: May 2014

Lack of time and resources can make the provision of person-centred care difficult to achieve. Angela Kydd suggests ways to think creatively about working within existing resources.
Stimulating memories through a museum-based project
Authors: Heathcote Julie , Curteis Mark
Published: May 2014

Julie Heathcote and Mark Curteis describe a model for community working, which involves training, loan boxes to use in care homes and visits to and activities in museums.
Thinking beyond cancer: Neurological palliative care
Authors: Byrne Judi
Published: May 2014

Combining its expertise in palliative and neurological care, Sue Ryder Care aims to meet the care needs of people with neurological conditions.
Using reminiscence: Questions and answers
Authors: Heathcote Julie
Published: May 2014

Reminiscence therapy can stimulate and empower older people, having a positive impact on general wellbeing. Julie Heathcote begins a reminiscence series by offering practical advice and answering questions frequently asked by staff.
Sexual health and the older person
Authors: Peate Ian
Published: May 2014

The enjoyment of sex does not necessarily diminish with age, however, sexuality and the older person has not been fully addressed and remains somewhat taboo. Ian Peate discusses the importance of providing a service that fully addresses the sexual health of older adults.
Cardiology: understanding atrial fibrillation
Authors: Nazarko Linda
Published: May 2014

If untreated, atrial fibrillation increases risk of stroke, disability and death. Linda Nazarko explains why older people develop this condition, and discusses the risks and benefits of treatments.
Transient ischaemic attack: diagnosis and treatment
Authors: Nazarko Linda
Published: May 2014

Transient ischaemic attack (TIA) or minor stroke is often an early warning that a major stroke is about to occur. This article provides details of how early assessment and prompt referral save lives.
Effective administration of medicines
Authors: Pountney David
Published: May 2014

Following best practice in the management of medicines in residential care homes is vital to improve care and reduce drug errors. This article explains how this can be achieved.
Addressing the skin-care needs of older people
Authors: Lawto Sandra
Published: May 2014

The importance of using emollients on the skin of older people is often overlooked. Here, Sandra Lawton looks at issues relating to assessment and management
Addressing pain in wound care and dressing removal
Authors: Benbow Maureen
Published: May 2014

Pain and trauma during dressing removal causes distress and delays healing, which is why it is a priority for health professionals. Maureen Benbow explains how you can help to minimize it.
Dementia care: Assess wander walking and apply strategies
Authors: Dewing Jan
Published: May 2014

Wander-walking in people with dementia has been dismissed in the past as something that should be controlled. Here, Jan Dewing explains how new evidence has shed light on its causes, and how to assess it and intervene.
Forward into the future with Rainbow Lives
Authors: Renate Rev. Sr Maria
Published: May 2014

Homophobic and transphobic prejudice may persist in care homes, and can lead to fellow-residents shunning those who express their identity. rev. Maria renate explains how the rainbow lives project can help.
Helping people to prepare for and settle into a new home
Authors: Green Danielle
Published: May 2014

This optional, competence based unit assesses the health and social care worker's ability to support individuals as they move into new home environments
Dementia and reminiscence: not just a focus on the past
Authors: Swann Julie I
Published: May 2014

Julie Swann explores the development of reminiscence as an activity in the care home for patients with dementia. Ways that care staff can facilitate memory recall with their residents, by using person-centred methods, are also described
A shoulder to cry on: support through bereavement
Authors: Green Danielle
Published: May 2014

This optional unit assesses the health and social care worker's ability to support bereaved individuals through their loss
Barrier film: providing protection in continence care
Authors: Stephen-Haynes Jackie , Stephens Caire
Published: May 2014

Protection and maintenance of skin integrity in residents with incontinence is a challenge. Jackie stephen-Haynes and claire stephens investigate the clinical effectiveness of barrier film
End-of-life care: implementing the Gold Standards Framework
Authors: Covington Maria
Published: May 2014

The Gold standards Framework programme for care homes aims to ensure quality end-of-life care. One home shares its experience of implementing the programme and achieving Beacon status
Studying the outdoors to stimulate mental health
Authors: Wilkie Carol
Published: May 2014

A nature watch activity, initiated by activities coordinator Carol Wilkie, to engage residents with their surroundings, has become a popular activity, with noticeable benefits to wellbeing for those taking part
Looking after the stoma and the surrounding peristomal skin
Authors: Burch Jennie
Published: May 2014

Nurses and care assistants need to have the appropriate knowledge in order to support residents to care for their stoma. Jennie Burch outlines how and why stomas are formed and how to ensure the peristomal skin remains intact and healthy
One too many: alcohol consumption and the health risks
Authors: Phillips Adele
Published: May 2014

Adele Phillips explains how alcohol misuse can impact on the health of older people who reside in care home settings. This article offers advice to care home staff in order to help them to understand and manage the problem
Accountable Travel Health
Authors: Howell Karen
Published: May 2014

You are accountable for your actions is a phrase that strikes a sense of foreboding in many practice nurses. Accountable is defined in the dictionary as to answer as one responsible (Chambers, 1983). Being responsible means that a person is morally or legally bound to be called to account as being in charge of their actions.
Letter
Authors: Morris A P
Published: May 2014

I felt I had to reply to the article published in Volume 11 (14) of Practice Nursing on Methadone. Professor Henry propounds the view that there is no clinically apparent behavioural impairment seen in patients on methadone: I am sure this would come to a surprise to many police officers, police surgeons and indeed A&E staff who deal with drivers whose impairment has brought them to notice either through erratic driving or road traffic accident.
Do you have a role in pulmonary rehabilitation?
Authors: Gibbons Denise
Published: May 2014

There is a great shortage of pulmonary rehabilitation programmes for those who need them. Denise Gibbons asks if practice nurses could make a contribution
Managing heart failure in a primary care clinic
Authors: Oliver Jan
Published: May 2014

Jan Oliver discusses the key aspects of the management and education of heart failure patients in primary care
Leishmaniasis
Authors: Skeet Joyce
Published: May 2014

Joyce Skeet reviews the transmission and presentations of leishmaniasis and considers the risks for travellers abroad
Influenza
Authors: Watkins Jean
Published: May 2014

The flu epidemic was at its height when 75-year-old Mrs P fell ill. Suddenly, one evening, she felt hot, cold and shivery. By the next morning she was worse. Her temperature was 38.6ºC and she felt so ill that she rang the surgery for advice.
Patients' views of proactive care for those at risk of diabetes
Authors: Speake Natalie , Wakefield Janet , Heald Adrian , Chew-Graham Carolyn
Published: May 2014

Background: The National Service Framework for Diabetes (standard 1) recommends development, implementation and monitoring of systems to reduce the risk of developing type 2 diabetes in the UK population. In response to the NSF's recommendation that people at risk of diabetes be identified before they acquire the disease, general practice patients may be labelled as ‘at risk of diabetes’ and offered tests and advice on behavioural modifications to reduce their potential risk. The aim of this study was to examine the impact on these patients of being labelled ‘at risk of diabetes’. Methods: Twenty-one patients on one Manchester general practice's ‘at risk of diabetes register’ underwent a semi-structured interview. Themes were defined by constant comparison analysis until category saturation was reached. Results: Respondents reported confusion and unawareness that they were included in such a register and uncertainty about what being on the register meant. They reported feelings of guilt because they had not changed their life style, particularly their diet. None of the patients reported seeking any further information about their risk of diabetes. Respondents expressed uncertainty over the roles of GP and practice nurse and this seemed to have influenced their receptiveness to information provided. Conclusion: This study demonstrated that general practice professionals' clinical objectives may not match patients' experiences and perceptions of care, and revealed a gulf between professionals and patients' understandings of the behavioural interventions required to reduce the risk of diabetes.
Audit highlights prevalence of dysphagia
Authors: Morris Heather
Published: May 2014

Heather Morris looks at how to detect the signs of dysphagia and manage them
Drug-induced reactions of the skin
Authors: Watkins Jean
Published: May 2014

Skin rashes are often associated with prescription and overthe-counter medications. Drugs should be considered as a possible cause of any cutaneous eruption. At least 1% of rashes seen in general practice and 3% in the hospital setting will be related to the use of medications, particularly in older people and the immunocompromised (Ehrlich et al, 2004). A nurse's ability to recognize a drug-induced rash and discontinue treatment quickly can help relieve suffering and reduce the potentially toxic effects of the drug. Although such reactions are usually mild, sometimes they can be serious or even life threatening (Lee and Thomson, 1999).
Inform women about the options
Authors: Jenkins Alison
Published: May 2014

Alison Jenkins argues that practice nurses should inform women under the age of 50 years about the options for breast screening.
How to manage lung cancer in primary care
Authors: Lakasing Edin , Tester Melanie
Published: May 2014

Edin Lakasing and Melanie Tester present an overview of the pathology of lung cancer and how to manage the symptoms of treatment.
Flu vaccination: National guidance
Authors: Benison Liam
Published: May 2014

On the eve of the flu vaccination season, Liam Benison reviews the guidance from the Chief Medical, Nursing and Pharmaceutical Officers for the 2006/2007 season
Looking toward better management of COPD
Authors: Cox Bev
Published: May 2014

Bev Cox welcomes the announcement that a new NSF will be developed for COPD. She considers how it could help improve care for patients
Grace Vanterpool: Thinking differently
Authors: Vanterpool Grace
Published: May 2014

Grace Vanterpool has been awarded an MBE for her work educating the community about diabetes. She spoke with Lucy Jolin
Ideas to improve concordance in diabetes
Authors: Hicks Debbie
Published: May 2014

The Target Compliance meetings showcase communication techniques that can improve concordance in people with diabetes. Debbie Hicks explains
Varicella zoster: An infection that lasts
Authors: Winter George
Published: May 2014

George Winter investigates the consequences of chickenpox
Syphilis:‘Cupid’s disease’ makes a comeback
Authors: Winter George
Published: May 2014

George Winter investigates the epidemiology of syphilis (which, among many names, has been known as 'Cupid's disease'), and explains the screening tests available.
Rachel Chiou: The village nurse
Authors: Chiou Rachel
Published: May 2014

Rachel Chiou is affectionately known as ‘the village nurse’ in her semi-rural community. She spoke to Liam Benison
Know about pneumo
Authors: Richards Sara
Published: May 2014

In April 2005 the Department of Health recommended that everyone aged 65 years and over should receive a one-off pneumococcal vaccination. This was the third stage of a phased recommendation which bought England and Wales in line with Scotland and Northern Ireland.
Is your practice ready to deal with an emergency?
Authors: Lambert Jane , Baker Karen
Published: May 2014

Jane Lambert explains what is needed to respond to a medical emergency such as cardiac arrest or anaphylactic shock should it occur.
Better patient care in prescribing for diabetes
Authors: Mead Anne
Published: May 2014

Anne Mead considers the nurse prescriber's role in the management of type 2 diabetes
Obesity: A complication or an opportunity?
Authors: Phillips Anne E
Published: May 2014

Anne Phillips argues that national targets for addressing the rising prevalence of obesity should be regarded as opportunities to improve the care of people with type 2 diabetes and help others avoid it.
Tick-borne encephalitis
Authors: Mayor Susan
Published: May 2014

Susan Mayor considers the risk of infection with tick-borne encephalitis in Europe and the preventive measures available for travellers.
Changing lives
Authors: Martin Jeannett
Published: May 2014

People are living longer and the government has put a huge emphasis on the need to ensure that care is available for the increasing numbers of people who are living with long-term conditions, sometimes with more than one condition, and social problems.
What to do when children squabble
Authors: Tassoni Penny
Published: May 2014

Children of all ages squabble. Toddlers snatch and grab, school-aged children shout and teenagers bicker! It drives parents insane and can take up so much of your time each day. So what is squabbling about and do children gain anything from it? Penny Tassoni explains
Words you need to know: Montessori
Authors: Ellyatt Wendy
Published: May 2014

Maria Montessori was an Italian dcotor who gave her name to a whole philosophy of education. Wendy Ellyatt looks at the woman and the approach to teaching that she inspired
Perimeter security: fences, hedges and gates
Authors: Griffin Sue , Brierley David , Waters Mike
Published: May 2014

Children have a right to be safe and to feel safe when playing outside, but you don’t want your garden or outdoor play area to look like a prison. We examine what you need to think about to meet national standards
Singing songs together
Authors: Jackson Caroline , Miller Collette
Published: May 2014

We all love to sing our favourite nursery rhymes with children and young babies. We sing them when they are in the bath, in the car or at changing times. Here’s a way to get your child joining in
Working with children who will not speak
Authors: O’Dell Lindsay
Published: May 2014

Some children stay silent in certain social situations. This behaviour is called selective mutism. Lindsay O’Dell looks at why some children choose not to speak and what can be done to help them
Coping with divorce and family breakdown
Authors: Smith June
Published: May 2014

About one in three marriages now ends in divorce and as most divorces happen in the first ten years of marriage, many involve young children. June Smith explains the effect this can have and the important role you can play in a child’s life as they face the upheaval
Let’s pretend!
Authors: Lindon Jennie
Published: May 2014

Babies watch, listen and try to copy a lot of what they observe – they learn a great deal through imitation play. But they also make their own sounds and actions. So when and how do they make the move into what we can genuinely call imagination? When do they start to pretend and how can you tell?
Clapping for fun
Authors: Jackson Caroline , Miller Collette
Published: May 2014

Think of the times when someone has clapped you for one of your achievements and how that made you feel — happy, proud? Children respond in exactly the same way, so why not use this for an activity to share? As well as being fun, it is absolutely free!
Words you need to know: Special needs and statements
Authors: Fisher Sue
Published: May 2014

Some children will already have been identified as having a special educational need (SEN) when they come to you but there is a chance that you (or a member of your team if you are in group provision)may be the first to identify it. Are you confident about what this might mean? Sue Fisher explains
Enjoying quiet time with your child
Authors: Jackson Caroline , Miller Collette
Published: May 2014

Most young children have a sleep as part of their daily routine so why not make this quiet time as relaxing and enjoyable as possible for you and your child. Sharing this time together will encourage them to relax with you
What to do when children bite
Authors: Riddall-Leech Sheila
Published: May 2014

Some young children, especially between the ages of 14 months to three years, go through a phase of biting. For most, biting will disappear once they are able to express their feelings and needs with words, but in some cases it can continue. Sheila Riddall-Leech offers some advice
How children find out about their world
Authors: Lindon Jennie
Published: May 2014

Babies and young children are interested in the world around them. They are ready to be delighted in almost anything because everything is new. You need to share in this delight, giving time and attention, says Jennie Lindon
Printing with leaves
Authors: Jackson Caroline , Miller Collette
Published: May 2014

We have been on an autumn walk together to encourage your child to find out about the world around them. We have looked at leaves - touching them to feel the wonderful textures and walking through them to hear the sounds they make. You can help your child to learn more at home by making leaf prints
When children are clingy or tearful
Authors: Riddall-Leech Sheila
Published: May 2014

For some children separating from their parent or main carer can be distressing, even if only for a short time. Separation can also be distressing for the parent. Sheila Riddall-Leech looks at some common scenarios and suggests how you might respond
Protecting children against infections
Authors: Farley Audrey
Published: May 2014

Immunisation is the process by which children become resistant or immune to certain types of childhood diseases. Audrey Farley looks at the role it plays in protecting children from infections
Inventing stories together
Authors: Donbavand Tommy
Published: May 2014

Storytelling is one of the great delights of working with children; those moments when the tale becomes real and the characters seem to leap off the page. Here’s an exciting way to involve children in the creation process and make story time even more fun!
Relationships matter: making it personal
Authors: Lindon Jennie
Published: May 2014

Children need adults around them who show affection and show they care. Close relationships are crucial to young children’s well-being not an optional extra, says Jennie Lindon
Preventing the spread of infection
Authors: Farley Audrey
Published: May 2014

Effective hygienic measures are critical in safeguarding the health of both children and staff. Audrey Farley looks at the habits that should be part of your daily routine