bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical outcomes of WF10 adjunct to standard treatment of diabetic foot ulcers
Authors: Yingsakmongkol N.
Published: May 2014

Objective:

To study clinical outcomes and safety of WF10 as an adjunct to standard treatment for diabetic foot ulcers (DFU) and to determine the optimal number of WF10 cycles that should be administered.

Method:

A prospective, open-label study of WF10 adjunct to standard treatment for severe DFU but salvageable foot was carried out between July 2009 and June 2010. Patients were classified into three groups, according to common clinical presentations: neuropathic ulcer, ischaemic ulcer and severely infected ulcer. Ulcer assessments were monitored using the wound severity score (WSS; range 0–16). The clinical outcomes at 24 weeks were defined as ‘good’ (ulcer achieved endpoint [WSS=0–1]), ‘fair’ (improved from baseline [WSS=2–4]) and ‘poor’ (not improved or worsened [WSS > 4]).

Results:

From a total of 129 patients, 21 (16%) presented with neuropathic ulcers, 49 (38%) with ischaemic ulcers and 59 (46%) with severely infected ulcers. All neuropathic ulcers achieved either a good or fair outcome, with 81% achieving a good outcome, as did 49% and 81% of ischaemic and severely infected ulcers, respectively. Minor amputations were necessary for 14 patients (11%), but no major amputation was required. Twenty seven patients (21%) had transient reduction of haematocrit after WF10 therapy. One hundred and one patients (78 %) received only 1 cycle of WF10.

Conclusion:

WF10 as an adjunct to standard DFU treatment showed good clinical outcomes in the neuropathic ulcer group and the severely infected ulcer group. A side effect of WF10, transient reduction of haematocrit, was observed in 21% of patients. Most patients required only one cycle of WF10.

Declaration of interest:

There were no external sources of funding for this study. The author has no conflicts of interest to declare.
Back to basics: an introduction to statistics
Authors: Halfens R.J.G. , Meijers J.M.M.
Published: May 2014

In the second in the series, Professor Ruud Halfens and Dr Judith Meijers give an overview of statistics, both descriptive and inferential. They describe the first principles of statistics, including some relevant inferential tests.
Difficult leg wounds successfully closed with decortication, bioresorbable ECM and NPWT
Authors: Heiney J. , Redfern R.
Published: May 2014

Complications of a missed compartment syndrome are severe. This case demonstrates the difficulty in dealing with such complications, including the difficult situation of being faced with limb salvage when amputation is the best option. Through a short case description and several images, it is demonstrated how even the most difficult wounds in cases like this can be dealt with and achieve a non-painful limb salvage. In particular, an extreme technique of decorticating the bone and applying bioresorbable extracellular matrix with negative pressure wound therapy was applied in order to achieve final wound closure and pain relief. This case demonstrates integration of multiple modalities for complex wound closure.
Treatment of ulcerated necrobiosis lipoidica with ovine forestomach matrix
Authors: Simcock J.W. , Than M. , Ward B.R. , May B.C.H.
Published: May 2014

Necrobiosis lipoidica (NL) results from degradation of the collagen extracellular matrix; these recurring ulcerated lesions are an especially challenging condition to treat. Ovine forestomach matrix (OFM) is a decellularised extracellular matrix and was used to successfully close a pretibial ulcer resulting from NL. Complete closure of the wound was achieved in 22 weeks, after four applications of OFM. This suggests OFM may be considered for the treatment of these challenging wounds.
Is it time to re-appraise the role of compression in non-healing venous leg ulcers?
Authors: Guest J.F. , Charles H. , Cutting K.F.
Published: May 2014

• Objective: to evaluate the role of compression in non-healing venous leg ulcers (VLUS) of > 3 months’ duration.

• Method: patients’ records from three independent data sets of non-healing VLUS of > 3 months’ duration were re-analysed. Two data sets were separate audits of clinical practice and the third comprised patients’ records from a randomised controlled trial. Some patients in each data set were never treated with compression. the effect of compression on healing at 6 months was tested with logistic regression.

• Results: In each data set, patients in the compression and no-compression groups were matched according to ulcer size and duration; there were no differences in comorbidities. Comparing the no-compression with the compression groups, the healing rate at 6 months was 68% vs 48% in study 1, 12% vs 6% in study 2, and 26% vs 11% in study 3. Use of compression was found to be an independent predictor of not healing with an odds ratio of 0.422, 0.456 and 0.408 in studies 1, 2 and 3 respectively.

• Conclusion: the healing rate of non-healing VLUs of > 3 months’ duration in the no-compression groups was double that of VLUs in the compression groups. these findings have the potential for treatment modification if confirmed in a prospective trial.

• Declaration of interest: there were no external sources of funding for this study. the authors have no conflicts of interest that are directly relevant to the content of this manuscript, which remains their sole responsibility.
W.A.R. scores in patients with chronic leg ulcers: Results of a multicentre study
Authors: Jockenhöfer F. , Gollnick H. , Herberger Katharina , Isbary G. , Renner R. , Stücker M. , Valesky E. , Wollina U. , Weichenthal M. , Karrer S. , Stoffels-Weindorf M. , Dissemond J.
Published: May 2014

Objective:

To assess the individual patient's risk of wound infection using the wounds-at-risk (W.A.R.) score developed by a group of interdisciplinary experts.

Method:

The W.A.R. score is a clinical test in which, based on anamnestic and clinical criteria, wound patients are assigned point values, where a score of ≥3 indicates a need for antimicrobial treatment.

Results:

:The data of 970 patients (553 women, 417 men) with chronic leg ulcers were evaluated at 10 dermatological wound clinics in different regions within Germany. The age of the patients was between 10 and 100 years (mean of 69.8 years); the duration of the wounds was between 2 months and 68 years (mean of 41.1 months). Wound sizes were between 1 and 736 cm² (mean of 42.8 cm²). Overall, W.A.R. scores of <3 points were found in 26.9% of patients and scores of ≥3 were found in 73.1% of patients. There were significant differences in W.A.R. scores by regions with respect to the bacterial species detected and the aetiologies of the wounds.

Conclusion:

Our multicentre study is the first evaluation of clinical data using the newly established W.A.R. scores. We were able to show that the W.A.R. scores are able to identify a segment of the patient population for whom it can be assumed that they are prone to an increased risk of wound infections unless appropriate antimicrobial action is taken. The W.A.R. score is a simple clinical score that identifies patients with an increased risk of wound infection.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
The influence of different dressings on the pH of the wound environment
Authors: Milne S.D. , Connolly P.
Published: May 2014

Objective:

This study examines the effect of various wound dressings on the pH levels of a wound, using a simulated wound environment.

Method:

The pH levels of a 4 different wound dressings (manuka honey dressing, sodium carboxymethylcellulose hydrofiber dressing, polyhydrated ionogen-coated polymer mesh dressing, and a protease modulating collagen cellulose dressing) were tested in a simulated horse serum wound environment. The effect of local buffering was observed and pH changes in real time were measured.

Results:

All dressings were found to have low pH (below pH 4), with the lowest being the protease modulating collage cellulose dressing, with a pH of 2.3. The dressing with the strongest acid concentration was the polyhydrated, ionogen-coated, polymer mesh dressing.

Conclusion:

The low pH and strong acidic nature of the dressing investigated indicate that they may play a role in influencing the healing process in a wound.

Declaration of interest:

The authors have no conflicts of interest to declare. This study was funded by the EPSRC.
Factors in rehospitalisation for severe pressure ulcer care in spinal cord injury/disorders
Authors: Goodman B.L. , Schindler A. , Washington M. , Bogie K.M. , Ho C.H.
Published: May 2014

Objective:

Repeated hospital admissions (RHA) for ongoing pressure ulcer (PU) care remains a significant challenge in the clinical management of the spinal cord injury/disorders (SCI/D) population. The current study investigated the significance of risk factors for PU treatment and RHA.

Method:

A retrospective chart review of veterans admitted to the Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC) Spinal Cord Injury (SCI) unit for Category III or IV PUs was carried out. A random sample of 105 individuals with SCI/D, evaluated by the Wound Care Team (WCT) from 2006 to 2009 was assessed. Multiple PU development risk factors were extracted from the electronic health record system using standardised data collection forms and entered into the Spinal Cord Injury Pressure Ulcer Database (SCIPUD). Potential associations with RHA were analysed.

Results:

Twenty variables were initially identified as potentially related to PU development. Descriptive statistics and statistically significant associations between risk factors and RHA were determined. Demographic factors showed no significant association with RHA. Duration of injury, power wheelchair use and sub-optimally managed spasticity (SMS) were significantly associated with higher RHA. Suboptimally managed neurogenic bowel (SMNB) at admission was significantly associated with reduced RHA.

Conclusion:

Factors previously found to be predictive of initial PU development may not, in fact, be predictive of RHA. Some protective trends were observed, such as polypharmacy and marital status, but these did not reach statistical significance in this preliminary study of admission characteristics, warranting further research.

Declaration of interest:

There were no external sources of funding for this study. The authors have no conflicts of interests to declare.
Nutrition-related status and granulation tissue colour of pressure ulcers evaluated by digital image analysis in older patients
Authors: Iizaka S. , Koyanagi H. , Sasaki S. , Sekine R. , Konya C. , Sugama J. , Sanada H.
Published: May 2014

Objective:

Granulation tissue colour may be an indicator for nutritional assessment in pressure ulcer (PU) care. This study evaluated the relationship between nutritional status, anaemia and diabetes, and granulation tissue colour of PUs by colour analysis of digital photographs in the clinical setting.

Method:

The cross-sectional study included 42 older patients with 51 full-thickness PUs from 10 institutions. Patient demographics, wound status, nutritional status and dietary intakes were obtained from medical charts. From a wound image, the granulation red index was processed by computer software and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (%GRI80) was calculated.

Results:

Haemoglobin levels were positively associated with %GRI80 levels (p=0.007) in the crude model, but not in the adjusted model (p=0.260). The interaction term between diabetes and protein intake was significantly associated with %GRI80 levels in the adjusted models (p=0.010). At protein intakes of 0.95 g/kg or higher, diabetic wounds exhibited lower %GRI80 levels than non-diabetic wounds (p=0.002). At protein intakes of less than 0.95 g/kg, %GRI80 levels did not differ between diabetic and non-diabetic patients (p=0.247). Protein intakes of 0.95 g/kg or higher were associated with higher %GRI80 levels in non-diabetic patients (p=0.015), but not in diabetic patients (p=0.127).

Conclusion:

Granulation tissue colour, evaluated by the objective and quantitative analysis of digital photography, is related to haemoglobin level, diabetes and dietary intakes in clinical settings.

Declaration of interest:

This study was funded by a grant from the Japanese Society of Pressure Ulcers and a Grant-in-Aid for Fellows of Japan Society for the Promotion of Science (#22-2766). The funding organisations had no role in the design, data collection, analysis, review, or approval of the manuscript. The authors report no relevant conflict of interests.
Bacterial colonisation of the burn wound: A UK experience
Authors: Alrawi M. , Crowley T.P. , Pape S.A.
Published: May 2014

Objective:

Bacterial colonisation of the burn wound remains a major source of morbidity and mortality in burns patients. This study aimed to determine the presence of different micro-organisms in a UK regional burns centre and to examine the relationships between bacterial colonisation, burn size, length of hospital stay and delayed referral.

Method:

A retrospective review of microbiology surveillance swab results on all adult patients admitted to a regional burns centre over a 12-month period was performed.

Results:

139 adult patients were included in the study. Approximately 68% of patients showed evidence of burn wound colonisation at some point during their inpatient stay. The remaining 32% had negative microbiology swabs throughout their hospital stay. A total of 202 micro-organisms were isolated. Staphylococcus aureus was found to be the most common micro-organism, found in 79% of patients with positive swab results. A direct link was found between an increased incidence of bacterial colonisation and delay in referral of >24 hours, larger burn size and length of hospital stay.

Conclusion:

By understanding the potential sources of bacteria and the effect of patient factors on their susceptibility to bacterial colonisation, we can form better management and treatment strategies to reduce morbidity and mortality from burns wound sepsis.

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 contents.
The theory and application of pulse oximetry
Authors: Mildenhall Joanne L
Published: May 2014

Pulse oximetry is widely used in the prehospital environment, yet researchers question whether health professionals fully understand the theory to support the practical application of its use.

This article explores the fundamental theory of pulse oximetry to give applied understanding. From a prehospital perspective, it details and examines the advantages and limitations of this observational aid, which must be considered when making clinical decisions regarding a patient's care.
Traumatic amputation and limb preservation
Authors: Garratt Mark
Published: May 2014

Although the nature and circumstances of traumatic amputation are beyond the control of prehospital emergency care providers, their actions on scene and during transportation may still have a great influence upon both morbidity and mortality. Familiarity with the body's physiological response to major trauma and the military paradigm of treatment may well prove life-saving, as will understanding the potential need for an aggressive approach to haemorrhage management (including the use of tourniquets) and rapid transportation to definitive care. Where appropriate, effective cooling of the amputated part will maximize the possibility for successful replantation (surgical reattachment), although a poor cooling technique is likely to cause further cellular damage through either freezing or tissue maceration. This article will discuss the types of amputation and the key factors in the management of these types of injuries.
Skills benefits of advanced simulation training
Authors: Alinier Guillaume
Published: May 2014

The phrase ‘practice makes perfect’ is mainly used for practical skills acquisition. The ambulance staff training curriculum has always had a strong emphasis on skills development. While the simplest technology may be used for rehearsing protocols or practising basic skills, newer technologies, such as advanced patient simulators coupled with digital audio and video recording systems, could bring fresh opportunities which can help staff develop better team working skills. Such types of higher level skills can only be addressed through realistic simulation training scenarios, which are safe re-enactments of real-life situations that may involve other emergency services. There is now an increasing body of evidence to demondtrate that using simulation training can significantly enhance the level of preparedness for health care professionals to deal with a range of situations and help them develop clinical skills and knowledge. Ambulance personnel still have too few opportunities to take part in highly realistic simulation exercises followed by structured debriefings that enhance reflection. Quality of patient care may be improved by increased investment of ambulance services in this area of continuing professional development for their staff..
Managing neck breathing patients in the prehospital setting: review of best practice
Authors: Brooke Mike , Brown Andrea
Published: May 2014

An increasing number of patients with long-term tracheostomies or laryngectomies are being managed in the community. However, recent evidence suggests that many clinicians from both the hospital and prehospital setting lack sufficient skills and knowledge to safely manage them in emergency situations. This article describes the anatomical and pathophysiological variations that may be encountered in tracheostomy and laryngectomy patients, and relates them to the adaptations that may be required when managing this group of patients in the prehospital setting.
A guide to setting up a simulation training unit within an ambulance trust
Authors: Alinier Guillaume
Published: May 2014

Education and training departments are a core element of UK ambulance services. There is an emphasis on ensuring the adequate provision of continuing professional development opportunities to staff, as well as an increased focus on patient safety across all aspects of healthcare provision. In the light of technological developments, the ways of delivering certain aspects of training or monitoring competencies and the actual physical infrastructures of educational facilities sometimes requires to be adapted. This article provides guidance on how to set up a simulation training unit within an ambulance service by either reconfiguring existing facilities or starting from a blank canvas.
Mentorship for paramedic practice: a path to assessment
Authors: Sibson Lynda , Mursell Ian
Published: May 2014

This penultimate article will focus on knowledge, learning theories and the assessment of students. If we understand the important elements of adult-centred learning, we can then begin to understand how our students learn and also, therefore, how best to assess them. The article will identify some assessment methods and also outline and describe their application to paramedic practice.
Paramedic clinical decision-making in mental health care: a new theoretical approach
Authors: Parsons Vaughan , O'Brien Louise
Published: May 2014

This article aims to present a new theoretical approach for examining paramedic clinical decision-making in relation to mental health care. Recent theorizing has begun exploring key clinical decision-making approaches that are particularly relevant to paramedic practice. These approaches have also revealed some important factors that influence clinical decision-making behaviours among paramedics such as prior experience and clinical and tacit knowledge. The literature, however, provides very little insight into the clinical decision-making strategies paramedics draw on and use when dealing with mental health patients, in particular, those patients who are dealt with under involuntary provisions of mental health legislation. In addition, the literature provides limited coverage to account for how paramedics deal with and mitigate risk factors relating to patients experiencing a mental health emergency. Following these shortcomings, this article will propose the use of hermeneutic phenomenological methods as a suitable and innovative interpretive research approach for examining paramedic clinical decisionmaking in relation to prehospital mental health care. It is argued that this approach is well suited for exploring how paramedics make sense of their experience providing emergency mental health care, how they perceive their role within the clinician-patient relationship, and the particular circumstances in which paramedics exercise their legislative responsibilities under mental health legislation.
Prehospital management of paediatric supracondylar fractures
Authors: Park Hye-Sung , Joel Ang Seong-Jin , Hau Raphael
Published: May 2014

Supracondylar humeral fractures are common in paediatric trauma. Prehospital management should focus on assessing and preserving the neurovascular integrity of the affected limb and on reducing pain. Secure immobilization and adequate analgesia are vital to achieving these aims. Currently, there is no consensus as to how to best immobilize the limb or to provide analgesia in the prehospital setting for a suspected supracondylar fracture. This article suggests an examination technique to assess the neurovascular status of the injured limb, and reviews some of the current methods of immobilization and analgesia used for prehospital management of supracondylar fractures.
Acute stroke management: an online course
Authors: Jones Stephanie , McLoughlin Alison , Watkins Caroline
Published: May 2014

This article will explore the development and evaluation of an online course tailored specifically for emergency health professionals. Methods: a literature search was undertaken to inform the development of the course. Included studies related to stroke and positioning, oxygen therapy, blood pressure, body temperature and blood glucose. Following development and roll out of the course, all participants were invited to complete an online evaluation of the course, which consisted of eight closed and four open questions. Results: between February 2006 and July 2009, 1446 emergency health professionals completed the RESPONSE course. Of these, 570 (39%) completed the online evaluation. 555 (97.2%) participants reported that they were either very satisfied or satisfied with the course and 546 (95.6%) reported an increased knowledge in the management of acute stroke. Conclusion: the positive aspects of this web-based course have been identified as its usability, interactive nature, and flexibility. This online acute stroke course has also been shown to increase knowledge among emergency health professionals and provides a flexible approach to learning.
Listening and communication styles of undergraduate paramedic students
Authors: Boyle Malcolm , Williams Brett , Brown Ted , Molly Andrew , McKenna Lisa , Palermo Claire , Molloy Liz
Published: May 2014

There is a need to identify if current undergraduate paramedic students have the appropriate attributes to ensure they are effective listeners and communicators and whether additional or specific elements need to be added to the paramedic curriculum. The objective of this study was to identify the listening and communication style preferences of undergraduate paramedic students at a major Australian university. Methods: a cross-sectional study using paper-based versions of the listening styles profile (LSP) and the communication styles measure (CSM) were administered to a cohort of students enrolled in the Bachelor of emergency health (paramedic). Ethics approval was granted. Results: students reported a preference for the people listening style and to a lesser extent, the content listening style. Consistent with this, they also reported a preference for the friendly and attentive communication styles and exhibited little preference for the dominant and contentious communication styles. Conclusion: the students’ self-reported preferences are well suited for the role of paramedic and it is likely that a disposition towards these styles of listening and communication also lead these people to enrol in a paramedic course given their preferences are associated with an interest and concern for the welfare of others.
Which paediatric weight formula is best suited for the out-of-hospital field?
Authors: Winship Christian , Williams Brett , Boyle Malcolm
Published: May 2014

Background: Weight estimation in pre-hospital paediatric emergencies is often required for the calculation of drug dosages, fluid therapy and defibrillation. In the pre-hospital field the treatment of a patient needs to occur in a timely and accurate fashion, this necessity drives the need for an accurate weight estimation formula. The objective of this study was to identify a paediatric weight estimation formula relevant to the pre-hospital field.

Methods: A literature review was undertaken using a variety of electronic medical databases from their commencement date until the end of May 2012. Keywords used in the search included: Weight estimation, drug calculations, pediatric, paediatric, EMS, EMT, paramedic, emergency medical service, emergency medical technician, pre-hospital, out-of-hospital and ambulance. The keywords were used individually and in combination. The inclusion criterion was any study type that described the development or evaluation of a paediatric weight calculation in the pre-hospital or hospital setting.

Findings: There were 635 articles located with 25 meeting the inclusion criteria. The commonly used APLS weight estimation formula significantly underestimates a child’s weight. The best guess formula appears to be more accurate at estimating the weight; however more research needs to be conducted to validate this method for the pre-hospital field.

Conclusion: As the average weight of children increases, the accuracy of weight estimation formulas decreases, suggesting that these methods will be unable to sufficiently adjust to deal with future rises in average weights of children. Further research is required to determine the most appropriate formula for paramedics to use in the pre-hospital setting.
Headaches: recognizing a serious cause
Authors: Ahmed Fayyaz
Published: May 2014

Headache is one of the most frequent medical complaints with an estimated 95% of the general population experiencing it at some stage in their lifetime, and 90% of people experiencing it per year ( Latinovic, 2006 ). Although serious causes of headache are fairly uncommon, their recognition is important as the vast majority can be treated. They usually present in the acute setting to accident and emergency and acute assessment units. A considerable proportion of acute headaches are benign and patients seek medical attention because of an underlying concern of brain tumour or haemorrhage. Symptoms that indicate a high risk of a serious underlying pathology, or ‘red flags’, may enable clinicians to differentiate those in need of urgent medical attention.
Organ donation after death in the community or emergency department
Authors: Roberts Keith
Published: May 2014

The transplantation of human organs is entirely dependent upon organ donation. With increasing numbers of patients on transplant waiting lists, there is evergrowing pressure to recruit organ donors. Modern society, however, presents many challenges to organ donation. Ethical, cultural, and legal issues strongly influence donation, while an ageing population with a falling rate of traumatic death provides fewer donors ( NHS Blood and Transplant, 2011 ). In order to meet these demands, surgeons are developing techniques to obtain organs from donors who would have not previously been suitable for donation; one such technique seeks to obtain organs from patients who die in the pre-hospital environment. This article presents an overview of the current process of deceased organ donation and a detailed review of the potential of organ donation from patients who die outside hospital or in the emergency department. The UK NHS paramedic staff would play a key role in such a system.
Lactate measurement in pre-hospital care: a review of the literature
Authors: McClelland Graham , Younger Paul , Byers Sonia
Published: May 2014

Background:

Lactate has been identified as a useful marker of shock. Lactate can be measured in the pre-hospital environment rapidly and accurately.

Method:

A comprehensive literature search was conducted using a targeted search strategy. Additional literature was located through reference list searching and prior awareness by the authors. This identified a number of papers which were appraised for relevance. This appraisal identified 29 papers which were included in the review.

Conclusion:

Lactate has been shown to be measurable in the pre-hospital environment and to be prognostic of mortality. Lactate measurement needs to be linked to specific treatment algorithms with improved outcomes for patients in order to justify inclusion in pre-hospital practice.
Paramedics' ‘end-of-life’ decision making in palliative emergencies
Authors: Wiese Christoph HR , Taghavi Mahmoud , Meyer Nicole , Lassen Christoph , Graf Lassen
Published: May 2014

Background:

Paramedics in Germany routinely treat palliative care patients at the end-of-life (EoL). For this, they play a legally significant role in EoL decision making in the outpatient emergency setting. This study was undertaken to determine paramedics’ understanding of their role in withholding or withdrawing resuscitation/EoL-treatment of palliative care patients when an advance directive is present.

Methods:

Using a self-administered survey, participants/paramedics were asked about (1) ‘their occupational experience’ (less/more than 10 years, (2) ‘emergency responses’ (less/more than 100/month), (3) ‘their experiences in palliative emergencies’ (less/more than 10 palliative emergencies/year), (4) ‘palliative emergency sheets concerning end-of-life decisions’, and (5) ‘their treatment options during resuscitation’. Participants were paramedics from two cities in Germany.

Results:

Overall, 728 questionnaires were returned (response rate: 81%). Seventy-three percent of respondents were older than 20 years, 98.5% were male. Most paramedics dealt with palliative emergencies and terminally ill patients during their work (71%). Work experience and training in palliative care shows statistically significant differences concerning our dependent variables.

Conclusions:

Our results underline the necessity for more training in EoL. Paramedics stated that improved guidelines regarding EoL decisions/advance directives and the possibility to withdrawing resuscitation for appropriative cases are necessary. The treatment of terminally ill patients by paramedics may present an ethical problem: if paramedics honour patients' wishes, they will violate juridical regulations. In future, a change concerning current regulations seems to be necessary as well.
The art and science of mentorship in action
Authors: Jones Paul , Comber Jason , Conboy Adrian
Published: May 2014

The authors have collaborated to produce this article bringing together more than 60years of combined experience of paramedic practice, education and management. All maintain their paramedic registration and have among their goals the advancement and development of knowledge, skills and professionalism to promote an effective contemporary paramedic who continues to meet the care needs of the communities they serve.

Practice mentors are pivotal to the success of a modern, fit-for-purpose paramedic curriculum that requires a significant proportion of learning and assessment to take place in the practice setting. This article focuses on the support that is needed for mentors during major professional and organisational change. Change which is aligned to localised multifaceted organisational strategies and change which includes supporting mentors, enabling them to carry out their function professionally, effectively and with confidence. This article discusses experiences of a collaborative, structured approach to mentorship support which is achieved through organisational, educational and professional alliances. It also explores other approaches and suggests a way forward in terms of a national governance framework.
Integrating clinical research into paramedic practice:current trends and influences
Authors: Wood Kate
Published: May 2014

This article aims to evaluate some of the major influencing factors on the integration of research into paramedic practice. It looks at national research and development policies, the paramedic role, training developments, the influence of the College of Paramedics and the HPC, research funding bodies, support of organisational structures and ambulance culture. It also looks at the collaborative research between ambulance services and academic institutions and how these influencing factors impact on the integration of research into practice in the pre-hospital setting. Strategies are proposed to overcome some of the barriers to the integration of clinical and research practice by the paramedic. These focus on changing national policy to promote greater clinician involvement in research and greater communication between UK universities and research networks to make academic research careers more accessible to university-trained paramedics. The development of roles within ambulance trusts to incorporate both clinical practice and research engagement is also discussed as well as a focus on increasing the College of Paramedics’ representation of the profession to enable more paramedics to access opportunities to become actively involved in research.
The decision-making process in an emergency: a reflection on paramedic practice
Authors: Lindsey Louise
Published: May 2014

This article will use a case study to critically reflect and analyse the decision-making process used in an emergency situation. It will discuss a range of factors that influenced the clinical decision-making process and how this prompted immediate transport to a local hospital. A wide range of supporting evidence will be explored and the decision-making process will be questioned and challenged. Relevant professional, ethical and legal issues will be considered and discussed. The inclusion of other colleagues, patients, relatives and their involvement, within the decision-making process, will also be deliberated.
Death notification education for paramedics: Past, present and future directions
Authors: Douglas LeeAnne , Cheskes Sheldon , Feldman Michael , Ratnapalan Savithiri
Published: May 2014

Objective:

To explore paramedics' experiences with death notification education.

Methods:

Four focus group sessions attended by paramedics were mediated by a professional facilitator mn urban and urban/rural areas of Ontario, Canada. Paramedics were asked about their experiences with death notification education and what format and content of education they would like. Transcripts were analysed using the constant comparative method. Themes were generated inductively.

Results:

Twenty primary care paramedics and eight advanced care paramedics with mean experiences of 8.5 and 21.5 years respectively, participated. They reported minimal death notification education in their initial and professional education. They support education in college programmes, new paramedic orientation, and through mentoring. Paramedics learn to communicate death notifications by observing others and by trial and error. They want to learn about this topic through evidence-based continuing education (CE) sessions delivered by a trained facilitator or through online independent study. Experiential methods incorporating role-play and feedback are supported. A trained peer or health care professional with similar experiences would be best to teach paramedics about death notification. Paramedics want to learn about the practical aspects of communicating death notifications, managing the reactions of the bereaved, the cultural and religious aspects of death, as well as their personal reactions to death. Paramedics’ attitudes to death notification education are influenced by their work environment.

Conclusions:

There is a lack of formal death notification education for paramedics. Formal education should be implemented to reduce the stress of communicating death notifications for the paramedic and for the bereaved.
Rhabdomyolysis: an overview for pre-hospital clinicians
Authors: Nellist Emily , Lethbridge Kris
Published: May 2014

Rhabdomyolysis is a potentially life-threatening condition that occurs when muscle tissue breaks down, leading to the release of the cellular contents into the circulation. There are broad ranges of causes for this, both physical and non-physical.

This article aims to introduce pre-hospital clinicians to what rhabdomyolysis is, the causes of the condition, and also discusses the implications for pre-hospital practice before outlining management.

The authors highlight how many of the causes for the condition are frequently encountered in pre-hospital practice and how even those cases which may appear initially simple, such as the elderly fall, can be complicated by rhabdomyolysis in as little as an hour.

Finally, recommendations are made for more work to be undertaken to understand the frequency with which patients encountered by ambulance services go on to develop this condition, as well as encouraging those responsible for producing national guidelines to include this condition in their future publications.
Appropriate morphine administration by paramedics: a review of the literature
Authors: Weber Anthony , Dwyer Trudy , Maguire Brian
Published: May 2014

Objective: This paper focuses on three main areas: pain management practices for paramedics; in service continuing education programs and, possible pain-management differences between two levels of paramedics.

Methods: A literature search was performed using four databases to identify literature reviews and journal articles from 1997 to 2013. The search was focused around three core areas: 1) Pre-hospital pain management 2) barriers to pain management; and 3) pain management education. There was a five stage process to identify the relevant literature based on specific terminology in the abstracts.

Results: The literature search located 1 240 articles, incorporating five stages with each stage having specific terms relevant to the research. Thirty two articles met the inclusion criteria. The breakdown of the articles included stage one – 6 articles, stage 2 – 10 results, stage 3 – 11 results, stage four – 5 articles and stage 5 – 0 articles.

Conclusions: There remains little high-quality published evidence of systemic theoretical approach with which to validate many aspects of pain management in paramedic practice. Future research must identify if concepts taught in the classroom are being transferred to the clinical setting. Potential findings of such a study could be used to improve organisational awareness of factors that contribute to the behaviour and development of paramedics.
Paramedics developing rapport with the elderly: a pilot study
Authors: Ross Linda , Williams Brett
Published: May 2014

Objective:

The objective of this study was to investigate whether paramedic students’ active engagement with elderly patients would enhance their ability to develop rapport with elderly patients and what impact guided self-reflection would have on this.

Methods:

This pilot study utilised mixed methodology incorporating an interventional study design with focus groups. Paramedic students from Monash University, Melbourne, Australia participated in an engagement activity with independently living elderly residents. The Rapport Questionnaire (RQ) and focus groups were used to evaluate the project.

Results:

Eleven undergraduate paramedics participated (n=11). Data analysis of the RQ revealed three items to be statistically significant and have a large effect size: Confident (p<0.01, r=0.55), Empathetic (p=0.03, r=0.48) and Overall ability to develop rapport (p<0.01, r=0.58). The guided self-reflection group improved most substantially across three areas: Confident (p=0.09, r=0.37), Empathetic (p=0.18, r=0.29) and Overall (p=0.14, r=0.3), while the control group improved in the Empathetic item only (p=0.75, r=0.07).

Conclusion:

Student's recorded improved confidence, empathy and overall ability to build rapport with the elderly through this engagement activity. In addition, students who receive guided self-reflection displayed greater improvements in the above three areas than their control counterparts. The results were substantial and warrant further research in this area.
Developing leadership in the UK's ambulance service: a review of the consultant paramedic role
Authors: Hodge Andrew
Published: May 2014

Background:

This study seeks to understand part of the emerging clinical leadership framework implemented in the UK's NHS ambulance services in recent years. The aim is to explore the relatively new role of consultant paramedics and understand their leadership activities in relationship to nationally determined requirements, and the challenges they face performing this crucial leadership role.

Methods:

Semi-structured interviews were conducted with all consultant paramedics in the UK in 2013. Thematic analysis and coding were used to analyse the data and identify emergent themes. Additionally, basic demographic data was collected for comparison against national requirements.

Findings:

The findings illustrated three key themes: credible clinical leadership, an emerging empowered profession, and role expectations. There is a clear indication that consultant paramedics are a key part of clinical leadership for the paramedic profession. However, they are challenged to remain clinically competent by undertaking regular clinical practice and providing visible leadership on the ground, while strategically taking the profession forward. Operational resistance and power issues were highlighted as some of the problems faced by these clinical leaders.

Implications:

The findings may prove useful for employers in reviewing their clinical leadership structures, and in workforce planning for future consultant paramedics. The paramedic profession and its professional body may equally find this study useful for informing future strategic planning.
Diagnosing urolithiasis in small ruminant colic cases
Authors: Miesner Matt D
Published: May 2014

During lethargic sheep or goat consultation, obstructive urolithiasis is a differential diagnosis to be specifically investigated and ruled out rather than a chance problem of occasional occurrence. The problem arises often as a primary dietary-induced disorder, but can also develop after an acute dehydrating illness, indigestion and even the result of direct urinary tract trauma. Complete obstruction is recognised much more commonly in the male than the female, although uroliths may form and cause inflammatory clinical signs in either sex. A history of stranguria, vocalisation, waxing and waning lethargy are regular historical complaints from the client. Stranguria is often misinterpreted as tenesmus or intestinal obstruction. Signalment, history, and physical examination are often sufficient for diagnosis, however some additional diagnostic tests such as ultrasound, bloodwork and abdominocentesis can assist in confirmation, therapeutic planning and prognosis. Multiple treatment options have been described for clinical cases, however, with the cost of individual treatment and limitations of success, prevention should always be part of overall case management.
The importance of the differential diagnosis of COPD and asthma
Authors: Booker Rachel
Published: May 2014

Many of the symptoms and some of the pharmacological approaches to asthma and chronic obstructive pulmonary disease (COPD) are the same, but the two conditions have different causes and prognoses. Therefore, it is essential to distinguish between them to ensure the correct treatment. This article presents the chacteristics of each condition and explains how to differentiate them.
The past, present and future of nurse prescribing in the United States
Authors: Plonczynski Donna , Oldenburg Nancy , Buck Michelle
Published: May 2014

Nurse prescribing facilitates access to health care for many individuals and enhances the nurse’s ability to provide comprehensive care. In the United States, the only nurses who are authorized to prescribe medications are Advanced Practice Nurses (APNs), registered nurses with advanced knowledge and skills. For over 30 years, APNs have worked to achieve recognition of nursing prescriptive authority. Currently, APNs in all 50 states have some level of prescribing ability, however requirements, standards, and practice vary from state to state. Additionally, many of the barriers that hindered initial approval of nurse prescribing still persist. Ongoing legislative and educational efforts are necessary to realize the achievement of truly independent prescriptive authority in every state.
Supplementary prescribing by a diabetes specialist nurse on a hospital ward
Authors: James June
Published: May 2014

Non-medical prescribing is here to stay. With over 25500 district nurses and health visitors and 1300 supplementary prescribers already registered, many nurses and pharmacists are waiting to enrol on courses. The Department of Health has demonstrated its enthusiasm for nurses prescribing. This paper discusses a trial of diabetes nurse prescribing in a hospital ward setting. The benefits and pitfalls are considered and feedback on the trial from ward staff and patients with diabetes is reviewed. The future development of nurse prescribing practice in diabetes is also assessed.
Wound management: The considerations involved in dressing selection
Authors: Vowden Kathryn
Published: May 2014

Dressing selection requires a careful assessment of the patient and wound, the development of an individualized clinical management plan and an evaluation of treatment effectiveness. Dressings have specific functions and appropriate product selection can aid healing and improve outcome and therefore the patient’s quality of life by minimizing their symptoms. TELER (Treatment Evaluation by Le Roux’s method) provides an effective way of monitoring care, both from the health professional’s and the patient’s perspective, and is a useful tool to assess progress.
The impact of nurse prescribing on the role of the district nurse
Authors: Bowden Louise
Published: May 2014

This article details the results of a small qualitative research study which was conducted to explore the experiences of nurse prescribing by a group of district nurses working within one of the UK pilot sites. Semi-structured interviews were undertaken with seven (n=7) district nurses, who had a range of prescribing experience. The focus of the study was to evaluate changes in their roles as a result of being able to prescribe. Although the participants in the study identified many positive aspects of nurse prescribing in relation to their roles as district nurses, evidence presented indicates an overwhelming inconsistency among the participants, in terms of how each actually prescribed.
The management of gastro-oesophageal reflux disease in primary care
Authors: Baird Anne
Published: May 2014

It has been estimated that heartburn and acid reflux, common symptoms which may indicate gastro-oesophageal reflux disease (GORD), are experienced by 5% of the population several times a month. The prevalence of dyspeptic symptoms in the population is estimated to be between 23% and 41%. It accounts for approximately 4% of general practice consultations per year and as such it is likely that both patients with dyspepsia and those with diagnosed GORD will present to the nurse prescriber. This article will discuss the diagnosis and management of GORD, and the professional issues relating to nurse prescribing which may arise. It will not discuss the management of other causes of dyspepsia, other than to briefly mention the recognition of more serious disease.