bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of chronic leg ulcers by nurses working in the community in Sweden and the UK
Authors: Hjelm K. , Rolfe M. , Bryar R.M. , Andersson B-L. , Fletcher M. 
Published: May 2014

Objective: This study compared the management of chronic leg ulcers by nurses in community, primary health care and nursing home settings in Kronoberg, Sweden, and East Riding, UK. Method: A questionnaire was sent to all nurses in the two areas enquiring about their occupational background, leg ulcer management, resource utilisation and education and training. It also asked about their preferred treatment choices for four types of chronic leg ulcers described in case studies. Response rates of 50% (UK) and 54% (Sweden) were achieved. Results: Nurses in the UK undertook diagnostic investigations of non-healing leg ulcers as part of the initial assessment, whereas in Sweden these were undertaken by physicians. In Sweden daily dressing changes were more frequent and often involved nurse auxiliaries. Patients and relatives almost never participated in dressing changes in the two countries. Sodium chloride was the most commonly used cleansing agent in the UK, as opposed to warm water in Sweden. The use of antibacterial/antiseptic dressings and antibiotics was more frequent in the UK. Nurses there also used scientific and professional literature more frequently. Swedish nurses experienced more problems in obtaining new information. Conclusion: Differences exist between the two countries in leg ulcer management. These may be related to differences in the health-care systems, staff training and attitudes to evidence-based practice. Declaration of interest: None.
Risk, prevalence and prevention of pressure ulcers in three Swedish health-care settings
Authors: Gunningberg L. 
Published: May 2014

Objective: This cross-sectional survey set out to delineate risk, prevalence and prevention of pressure ulcers in a university hospital, a general hospital and a nursing home in Sweden. It also looked at the differences in risk factors and preventive strategies between patients with and without pressure ulcers. Method: The one-day survey followed the methodology developed by the European Pressure Ulcer Advisory Panel (EPUAP). It was conducted on Tuesday 5 February 2002. Each patient was visited by two registered nurses, their skin was inspected and any pressure ulcer classified according to the EPUAP grading system. A total of 695 patients were included: 612 from the university hospital, 38 from the general hospital and 45 from the nursing home. Results: The prevalence of pressure ulcers was 23.9% (university hospital), 13.2% (general hospital) and 20.0% (nursing home). Most (60–66%) of the pressure ulcers in the hospitals were assessed as grade 1. Only half of the patients at risk or with pressure ulcers were placed on a pressure-reducing mattress and a third of these patients had a plan for repositioning. Significant variables associated with pressure ulcers were old age, geriatric care, low Braden score and incontinence. Conclusion: Prevalence of pressure ulcers was higher than expected. Results relating to both prevalence of pressure ulcers (grade 1 excluded) and the preventive care given to patients at risk or with pressure ulcers accord with those of a larger Dutch study. Attention must focus on the appropriate risk-assessment skills, highlighting grade 1 as pressure damage, and the use of appropriate preventive strategies, based on the level of risk. Declaration of interest: None.
Evaluation of a lipidocolloid wound dressing in the local management of leg ulcers
Authors: Meaume S. , Ourabah Z. , Cartier H. , Granel-Brocard F. , Combemale P. , Bressieux J.M. , Bohbot, S. 
Published: May 2014

Objective:To evaluate the efficacy, tolerance and acceptability of Urgotul and DuoDERM E dressings in the local management of venous or mixed-aetiology leg ulcers.Method:This was a prospective multicentre randomised phase IV clinical trial conducted open-label in parallel groups. It involved 20 investigating centres, including hospital dermatology and vascular medicine departments, and private practices. Dermatologists and angiologists/phlebologists took part. Subjects were adult, non-immunosuppressed patients presenting with a non-infected, non-malignant leg ulcer of predominantly venous origin (ABPI >0.8). Ulcers were between 4cm2and 40cm2in size, with granulation tissue covering more than 50% of their surface area. Ulcer duration ranged from three to 18 months. Patients were followed-up by the investigating physician for eight weeks on a weekly basis; this included clinical examination, wound area tracings and photographs. Nurses (hospital or visiting) assessed exudate volume and clinical appearance at dressing changes.Results:Ninety-one patients were included: 47 in the Urgotul group and 44 in the DuoDERM E group. Baseline patient demographic data and wound characteristics were comparable in the two groups. After eight weeks of treatment wound surface area had reduced by a mean of 61.3% in the Urgotul group and 52.1% in the DuoDERM E group (NS); dressings were changed more frequently in the DuoDERM E group (2.54 ± 0.57 times per week versus 2.31 ± 0.45 in the Urgotul group, p=0.047). Thirty-three local adverse events were recorded in 27 patients: 10 in the Urgotul group and 23 in the DuoDERM E group (p=0.039). Nurses reported better acceptability for the Urgotul dressing, based on pain on removal, maceration and odour (p<0.0001).Conclusion:Both dressings showed similar efficacy for the local treatment of venous leg ulcers. Nevertheless, medical and nursing staff reported better tolerance and acceptability for the Urgotul dressing.Declaration of interest:This study was sponsored by Laboratoires Urgo, Dijon, France.
Microbial investigation of venous leg ulcers
Authors: Howell-Jones R.S. , Baker I.B. , McNulty C.A.M. 
Published: May 2014

Objective: To investigate microbiology laboratory reporting policies, whether practitioners working in primary care adhered to the relevant guidelines when submitting swabs from venous leg ulcers (VLUs), and the impact of laboratory reports on antibiotic usage for VLUs. Method: Questionnaires were sent to all microbiology laboratories in England and Wales, and to clinicians who had submitted VLU swabs to one laboratory. Results: Ninety-five (47%) laboratories responded. Laboratories processed a mean of 7.3 leg ulcer swabs/100,000 population/week but were often unable to identify the leg ulcer aetiology from the clinical details provided. All laboratories stated that they routinely reported group A haemolytic streptococci and meticillin-sensitive and resistant Staphylococcus aureus; 75% always reported antibiotic susceptibility for these isolates. The majority reported other beta-haemolytic streptococci. A total of 126 clinicians (64%) returned their questionnaires; 100 had confirmed in their swab submission that the ulcer was of venous aetiology and so were included in the analysis. Eighty per cent of the swabs were submitted in accordance with guidelines, with increased pain (61%) being the most common reason. Discharge/exudate (52%) and malodour (41%) were common reasons for swab submissions, even though the guidelines do not cite them as clinical signs of infection. Reporting of antibiotic susceptibilities was associated with increased antibiotic usage. Conclusion: Clinicians in primary care generally adhere to guidelines when submitting VLU specimens for microbiological investigation. Clinicians need to include clinical information with the swab so that laboratories can interpret the microbiology results. To reduce the use of antibiotics in the management of VLUs, laboratories need to be selective in their organism and antibiotic-susceptibility reporting. Declaration of interest: None.
A hydrocellular foam dressing versus gauze: effects on the healing of rat excisional wounds
Authors: Kunugiza Y. , Tomita T. , Moritomo H. , Yoshikawa H. 
Published: May 2014

Objective: Hydrocellular foam dressings are characterised by their ability to create a moist wound healing environment and absorb high amounts of exudate. In this study, we examined the effect of a hydrocellular foam dressing on the healing of rat excisional wounds. Method: One full-thickness wound was made on the back of rats and wounds were treated with hydrocellular foam dressing or gauze dressing. To examine the histology of the wound, haematoxylin and eosin (HE) staining was performed. Gene expression of vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), hepatocyte growth factor (HGF) and hypoxia inducible factor-1 alpha (HIF-1α) in granulation tissue was examined by real-time reverse transcription polymerase chain reaction (real-time RT-PCR). VEGF protein was measured by ELISA. Results: The hydrocellular foam dressing promoted formation of granulation tissue and significantly promoted wound closure. A scab formed on the surface of granulation tissue in the gauze-treated wounds, which disturbed epithelialisation. In addition, the expression of VEGF and mRNA was higher in the gauze-treated wounds. Conclusion: These results supports the hypothesis that gauze encourages scab formation, which impairs epithelialisation and increases VEGF expression. In contrast, hydrocellular foam dressing accelerates epithelialisation and new vessel formation in granulation tissue. Declaration of interest: None.
Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds
Authors: Stansby G. , Wealleans V. , Wilson L. , Morrow D. , Gooday C. , Dhatariya K. 
Published: May 2014

Objective The primary aim of this pilot observational study was to assess the reduction in wound depth and area achieved with a new negative pressure wound therapy (NPWT) system in diabetic patients with foot ulcers and post-amputation wounds. Secondary aims were to assess pain levels, extent of exudate removal, and ease of use of the system for both the patient and care giver. Method Patients in both acute and home care settings were enrolled into this 4-week study. Dressings were changed three times per week. Wound area and depth, exudate removal and pain severity were evaluated at each dressing change. At the final visit, the investigators and patients were surveyed with respect to equipment and dressings used in the study.. Results Sixteen patients were enrolled into the study. Data relating to 14 patients with a variety of post-amputation wounds were included in the intention-to-treat (ITT) analysis. The post-amputation wounds showed a general trend for a reduction in the median wound surface area between baseline (22.9cm2; range 0.5–55) and the final visit (15.3cm2; range 2.4–63.5). This equates to a median change (calculated from the percentage change in wound area for each patient individually) of -41% (range -82% to +15%). There was also a general trend in reduction in the median depth between baseline (17mm; range 0–35) to final visit (5mm; range 0–35). One patient presented with a foot ulcer that demonstrated a 50% reduction in depth from baseline to the final assessment. The device effectively managed wound exudate and most patients reported low pain levels during therapy. Ease of use of the system was rated very highly by investigators and patients. Conclusion This pilot study indicates that the use of the new NPWT system can be expected to have a positive effect on the healing of post-amputation wounds and foot ulcers in patients with diabetes. The findings demonstrate that the system is easy to use, effectively controls exudate and minimises pain and inconvenience for patients being treated with NPWT. Declaration of interest This study was sponsored by Mölnlycke Heath Care (Gothenburg, Sweden) and Medela AG (Baar, Switzerland). The authors have no other conflicts of interest that are directly relevant to the content of this manuscript.
The psychosocial impact of chronic wounds on patients with severe epidermolysis bullosa
Authors: Adni T. , Martin K. , Mudge E. 
Published: May 2014

• Objective: To explore the lived experience of individuals with chronic wounds associated with dystrophic and junctional epidermolysis bullosa (EB), to improve understanding and, therefore, enhance the care provided to this group of patients by acquiring in depth data on the psychosocial issues that affect them. • Method: A phenomenological study using interpretive phenomenological analysis was employed. A purposive sampling method was used with six individuals replying to postal invitation to participate. • Results: Following one-to-one interviews, six superordinate themes were identified. These were: coping, pain, perceptions, emotional impact, social impact and support network, each with subordinate themes. All of the superordinate themes have been identified by previous research into chronic wounds, burns and disfiguring conditions; however, new subordinate themes arose. • Conclusion: This study highlighted the need for individuals with EB to have a multidisciplinary approach to their care with a particular need for pain management, psychological intervention and nursing support from those whom clients perceive as understanding the requirements of patients with EB. Further research into identity issues in individuals with EB is advocated. • Declaration of interest: There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
Feelings of powerlessness in patients with venous leg ulcers
Authors: Salomsé G.M. , Openheimer D.G. , de Almeida S.A. , Bueno M.L.G.B. , Dutra R.A.A. , Ferreira L.M. 
Published: May 2014

Objective: To assess feelings of powerlessness in patients with venous leg ulcers. Method: An exploratory, descriptive, analytic, cross-sectional study was conducted at the Plastic Surgery outpatient Clinic of the São Paulo Hospital (HSP) and at the outpatient Wound-Care Clinic of the Sorocaba Hospital Complex (CHS), brazil, from may 2010 to April 2012. Sixty patients with venous leg ulcers (VLUs), of both sexes, aged s≥18 years, from the two outpatient wound-care clinics were selected to participate in the study. All participants responded to the Powerlessness Assessment Tool (PAT) for adult patients. Statistical analysis was performed using the Chi-square test, Mann-Whitney U test and Kruskal-Wallis test at a significance level of 5% (p<0.05). Results: Forty-four (73%) patients were women and 38 (63%) were aged 61–70 years. Eight (13%) patients were alcoholics and 46 (77%) were smokers. Thirty-two (53%) patients had a VLU for more than 10 years; the ulcer area ranged from 11–20 cm2 in 19 (32%) patients and was s>30 cm2 in 18 (30%) patients. Mean total PAT score was 47.83 s± 7.99 and ranged from 51–60 for 31 (52%) patients and from 41–50 for 19 (32%) patients. Conclusion: Most patients with venous leg ulcers reported high PAT scores, revealing the presence of strong feelings of powerlessness. Declaration of interest: The authors have no conflicts of interest to declare.
The seizurogenecity of naloxone in tramadol overdose
Authors: Cowley Alan 
Published: May 2014

Tramadol is the most widely prescribed opiate analgesic ( National Treatment Agency for Substance Misuse, 2011 ) and, as a result, is present in a large number of overdoses that present in the pre-hospital arena. Naloxone is indicated for use by ambulance personnel where the GCS is reduced due to a known, or possible, overdose of an opiate containing substance ( JRCALC (Joint Royal Colleges Service Liaison Committee), 2006 ). A case study of a tramadol overdose shows a close temporal relationship between naloxone administration and a seizure. While seizure is a symptom of tramadol intoxication (Saidi et al, 2008), the speed with which it occurred after naloxone administration seemed too fast to be merely coincidence. A study of the literature shows evidence that naloxone can instigate seizure in the case of a tramadol overdose ( Rehni et al, 2008 ; Raffa and Stone, 2008 ). This information is particularly pertinent to the ambulance clinician as the consequence of a seizure can be important, both practically and clinically. The findings do not suggest that naloxone should be withheld, but that the potential for seizure should be noted and any forthcoming seizure dealt with. More research is needed to further define the factors that affect the seizurogenicity of naloxone in tramadol overdose.
Patient comfort in prehospital emergency care: a challenge to clinicians
Authors: Melby Vidar , Deeny Pat , Hagiwara MagnusAndersson , Jonsson Anders , Kängström Anna , Kernohan W George , Suserud Björn-Ove 
Published: May 2014

Aim: The aim of this paper is to report on a study that compared ambulance clinicians’ views of two different types of patient coverings, focusing on core caring concepts such as comfort, dignity, and safety. Design: Ambulance clinicians’ views were gathered in respect of two types of patient coverings, and 128 ambulance patients were randomly distributed into a control or experimental group receiving respectively either the traditional cotton blanket or a multi-layered TelesPro rescue covering. Views were gathered using a short questionnaire developed by the authors. Findings: Ambulance clinicians, in their own view, maintained the core caring concepts no matter which type of covering was used. Findings suggest strongly that the rescue covering provided for a superior patient experience in respect of all core concepts and one functional aspect. Conclusions: Ambulance clinicians undertake caring that encompasses the core caring concepts of comfort, safety, and dignity, while remaining vigilant to threats to these constituents of caring.
A good death: key conceptual elements to end of life care
Authors: Brady Mike 
Published: May 2014

Humanity is aware that death is an unavoidable inevitability of life; however, for most it is not a subject that overwhelms our everyday lives. For patients with life limiting, palliative, and end of life conditions, however, this is different, and with what little control they do retain over their health, experiencing a “good death” remains a priority. Paramedics in their capacity as community workers are frequently called to assist end of life care patients and their families, and whilst they may be au fait with practical and clinical elements of practice, such as pain relief, the conceptual and philosophical elements are perhaps less well known. This article introduces the concept of a “good death” before expanding on epistemology, existentialism, death anxiety, spiritual pain, grief, as well as the role of person and family-centred care, and empowerment. In addition, this article draws upon the author's personal experience of end of life care, in the hope that paramedics might have a better holistic understanding of the concepts related to those dying patients and families with whom we come into contact, ensuring a high quality, family centred, peaceful death for all.
Clinical placements in residential care facilities part 2: negative experiences
Authors: Lucas Peter , McCall Michael , Lea Emma , Eccleston Claire , Stratton Brigit , Crisp Elaine , Robinson Andrew 
Published: May 2014

Objective: This paper analyses clinical placements undertaken by final year undergraduate paramedic students in residential aged care facilities. Barriers to effective teaching and learning are identified in order to tailor such placements to better meet future health system demands. Design: The research employed qualitative methodology using thematic analysis to identify key themes in the data. Setting: A cohort of final year paramedic undergraduate students (n=17) completed a five-day clinical placement in one of two residential aged care facilities in Tasmania, Australia. Method: This component of the research involved the collection and analysis of qualitative data from student and mentor feedback meetings during placement. Results: Barriers to teaching and learning while on clinical placement were identified and categorised into a number of key themes. These include: a lack of clarity of the placement structure, inadequate clinical liaison support, and limited contact with residents and facility staff. Conclusions: Developing placements that consider the barriers to effective learning identified in this research will facilitate further development of quality, evidence-based, best practice models of undergraduate paramedic student learning in residential aged care facilities.
Co-codamol: formulating a solution to pain
Authors: Greener Mark 
Published: May 2014

This article illustrates the importance of considering the most appropriate formulation for each patient when prescribing co-codamol (codeine and paracetamol) after paracetamol alone fails to alleviate pain adequately. For example, guidelines for managing low back pain recognize the importance of considering patient preference when choosing analgesics ( NICE, 2009 ). Because many patients prefer capsules to tablets (Goldshield personal communication; Overgaard et al. 2001 ), Codipar capsules offer an effective option for moderate pain that helps prescribers meet patient preferences. Furthermore, pain is under-recognized and under-treated in the elderly, who may also be especially susceptible to analgesics’ adverse events ( BPS/BGS, 2007 ). Moreover, up to 60% of elderly pesle experience problems swallowing tablets or capsules, reflecting the interplay between physiological senescence, pharmacological factors and age-related diseases as causes of dysphagia ( Strachan and Greener, 2005 ; Wilkinson and de Picciotto, 1999 ). Medication-related dysphagia commonly results in non-adherence. Yet many health professionals are probably unaware that swallowing difficulties contributed to non-adherence ( Wright et al, 2006 ; Strachan and Greener, 2005 ). Against this background, the recent launch of effervescent Codipar offers a potentially valuable addition to the analgesic armamentarium. This product focus is supported by a grant from Goldshield Pharmaceuticals and abbreviated prescribing information for Codipar can be found on page 547
Research and development roundup: April 2011
Authors: Brown Harry 
Published: May 2014

In brief ▪ The diagnosis of sarcoidosis may be difficult, and steroids are still the mainstay of therapy ▪ Folic acid supplementation to prevent neural tube defects should be promoted to increase use in women of childbearing age ▪ Polypharmacy: a pressing prescribing issue ▪ The risk of cardiovascular morbidity rises after first exposure to antipsychotic treatment
Clinical leadership for general practice nurses, 2: Facilitating factors
Authors: Burns Dianne 
Published: May 2014

As UK primary care undergoes rapid change, general practice nurses face great challenges in providing quality care in a cost-contained environment. These challenges require the application of clinical leadership. Aim: To describe the concept of clinical leadership from a general practice nurse's perspective and determine nurses’ clinical leadership needs. Methods: A small qualitative study (n×12) adopting a phenomenological approach and using one-to-one, in-depth interviews. Findings (presented in three articles). Part 2: Factors infl uencing the development of clinical leadership skills in general practice include role development opportunities and the structure and culture of the organization or setting which can act as either enablers or barriers.
Egg yolk coelomitis in a North Island brown kiwi
Authors: Wisker Joannah 
Published: May 2014

In December 2009 at Wellington Zoo a female North Island brown kiwi was diagnosed and treated for egg yolk coelomitis. The following article will discuss how it was discovered and diagnosed, using computed topography and radiographs. Also discussed is the treatment for this condition, which involved a laparotomy to remove the yolk in the coelomic cavity. The reason this occurs will be discussed and the complications that are associated with egg yolk coelomitis.