bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ascertaining GP demand for a full-time paediatric emergency assessment unit
Authors: Aitken Penny , Glasper Edward Alan , Wiltshire Maureen , John Patricia , Abay June 
Published: May 2014

Changes in the general practitioner (GP) contract have led to the development of a variety of models for managing children who become sick outside of GP surgery hours. One such model is the hospital-based 24-hour paediatric emergency assessment unit (PEAU). This study sought to assess the demand for such a service in one English regional health authority. The opinions of general practitioners (GPs) regarding the service were sought via a fax survey, and a retrospective analysis of out-of-hour admissions staying less than 24 hours, over two discrete three-month periods. Differences in GP referral outcomes were also examined. GPs using the current PEAU (N=431) were invited to participate. GP’s responses, and analysis of PEAU out-of-hours throughput and admission trajectories were obtained. Results indicate that 83.9% of respondent GPs strongly agreed or agreed that the unit should provide a 24-hour PEAU service. 987 sick children were admitted to hospital out of PEAU opening hours, of which 404 had a stay of less than 24 hours. There was widespread approval by GPs to implement a 24-hour PEAU service, however, analysis of the hospital data showed that there were currently insufficient out-of-hours admissions to warrant changes in service delivery.
Every child matters, but what matters to them? Using teenagers’ views to shape health services
Authors: Wicke Dorothy , Coppin Richard , Doorbar Pat , May Andrée Le 
Published: May 2014

UK policy explicitly values children’s health, safety, achievement, contribution and economic wellbeing and emphasizes the need to ensure that ‘every child matters’ when services are designed and implemented (Department for Education and Skills, 2003). In order to find out how a new, school-based, ‘confidential health service’ might best address their needs we consulted 106 teenage pupils from two comprehensive secondary schools each providing education for children/young people from 11–16 years, and a pupil referral unit (PRU). The PRU provided education to a more disadvantaged group of students excluded, for both academic and behavioural reasons, from main stream school. The study design incorporated individual and group exercises and discussion. Qualitative data were generated and analysed thematically. Results were compared with 241 responses from a concurrent questionnaire survey, of similar content, of all pupils in one of the schools. The results suggest that the establishment of a confidential school-based health service is feasible and would be supported by its intended users. Its priority should be the provision of advice and support, rather than ‘treatments’, and its success would be dependent on a continuing guarantee of confidentiality in its dealings with pupils. The service worker would not necessarily require formal qualifications but should demonstrate strong listening and counselling skills. The extent to which young people were happy to participate in this project not only suggests the appropriateness of the methods used, but also that the pupils would be able and willing to continue to shape and support the new service. Three teenagers with recent school experience guided the research planning team to ensure a fit between the design of the study and the realities of fieldwork.
An investigation of the terminology used for children with life-limiting conditions
Authors: Nicholl Honor 
Published: May 2014

The purpose of this quantitative study was to investigate the terminology that Irish nurses used when referring to children with life-limiting conditions. The study was part of the preliminary work that was undertaken as part of a Doctoral study that explored mothers’ experiences of caring for children with complex needs. Given the sensitivity that can surround the term ‘life-limited’, this study was undertaken to identify the terminology that nurses use in their practice. Data were collected from a sample of 46 registered nurses using a specifically-designed, structured questionnaire administered by telephone interview. The questionnaire was based on the definitions of life-limited outlined by the Association for Children with Life-Threatening or Terminal Conditions and their Families (ACT) and the Royal College of Paediatrics and Child Health, and the four broad groups of life-limited children they describe. The results indicate that a wide range of terms are used by nurses for children with life-limiting conditions. Terms used refer to the child’s diagnosis, the chronic nature of the illness and the limitations that the illness causes. The study findings suggest that the terminologies used differ despite a common available definition that, because of its diagnostic focus, may not accurately reflect the complex nature of these children’s nursing and care needs.
Practices and perceptions of family-centred care among children’s nurses in Ireland
Authors: Murphy Maryanne , Fealy Gerard 
Published: May 2014

Family-centered care embraces the child and family as a unit and encourages the inclusion of the family in both the planning and provision of the child’s care in the health-care setting. Children’s nurses have signified their acceptance and knowledge of family-centered care and they have also indicated that they do not always incorporate this knowledge into their practice. The literature suggests that children’s nurses find it easier to offer descriptions of family-centered care than to implement it in practice.While a wealth of literature relating to family-centered care practices from an international perspective exists, there was a dearth of literature on family-centered care practices among children’s nurses in Ireland. Descriptive quantitative methodology was employed to guide this study. Data were collected using the Family-Centered Care Questionnaire Revised on a purposive sample of 300 children’s nurses in two children’s hospitals in Ireland. The findings of this study concur with international literature; as significant differences were found in the respondents practice and perception of family-centered care.
How does clinical supervision impact on staff development?
Authors: Rouse Joanne 
Published: May 2014

The aim of the study was to examine how clinical supervision impacts on staff development within acute paediatric care settings. The author analysed existing work, definitions and understanding of clinical supervision and explored the experiences of clinical supervision on staff working in paediatric wards and the effect of the clinical supervision on staff development. The first part of this study was quantitative and involved participants who were registered child health nurses and non-registered nursing staff (n= 24). The second part was a qualitative study, involving registered child health nurses (n=4) and non-registered staff (n=2). The research was carried out at two acute paediatric wards at two hospitals comprising one NHS Trust. The research incorporated a mixed-method approach. Initially a quantitative study using the Likert scale of measurement was conducted inviting all participants of clinical supervision to be involved. Secondly, a qualitative study, informed by phenomenology, was conducted using semi-structured interviews. While the image of clinical supervision continues to require embedding within nursing culture, positive effects of clinical supervision on paediatric staff development such as reflection on practice, autonomy and problem solving, are experienced by the participants. Development, as a result of clinical supervision, occurs both on a personal professional level and on a team level. Further study into the view of managers on the importance of clinical supervision and the role of the supervisor is required.
How does clinical supervision impact on staff development? Part 2
Authors: Rouse Joanne 
Published: May 2014

The aim of the study was to examine how clinical supervision impacts on staff development within acute paediatric care settings. The author analysed existing work, definitions and understanding of clinical supervision and explored the experiences of clinical supervision on staff working in paediatric wards and the effect of the clinical supervision on staff development. The first part of this study was quantitative and involved participants who were registered child health nurses and non-registered nursing staff (n=24). The second part was a qualitative study, involving registered child health nurses (n=4) and non-registered staff (n=2). The research was carried out at two acute paediatric wards at two hospitals comprising one NHS Trust. The research incorporated a mixed-method approach. Initially a quantitative study using the Likert scale of measurement was conducted inviting all participants of clinical supervision to be involved. Secondly, a qualitative study, informed by phenomenology, was conducted using semi-structured interviews. While the image of clinical supervision continues to require embedding within nursing culture, positive effects of clinical supervision on paediatric staff development such as reflection on practice, autonomy and problem solving, are experienced by the participants. Development, as a result of clinical supervision, occurs both on a personal professional level and on a team level. Further study into the view of managers on the importance of clinical supervision and the role of the supervisor is required.
Facilitating student nurses’ learning using online enquiry-based activities
Authors: Jepson Jenny 
Published: May 2014

Health and social care pre-qualifying education has a long established association with small group learning and teaching. The transition from traditional learning and teaching approaches to the use of a Virtual Learning Environment within Higher Education Institutes is not without its complexities. This paper presents evidence from a previous pilot study exploring the use of an online learning activity and discusses how the findings have influenced the development of online scenario-based learning activities. A review of current health-care literature informs the developmental processes, which include using a pedagogic framework for implementing a specifically designed online learning activity developed to allow child health student nurses to follow an online evidence-based enquiry learning process. This paper, written as the online activity process is being introduced to child health branch student nurses, discusses the benefits and challenges of developing the activity and debates the facilitation of an evidence-based approach through autonomous student learning to all branches of pre-registration nursing programmes.
Pressure sore survey Part 2: nurses' knowledge
Authors: Maylor M. , Torrance C. 
Published: May 2014

This is the second of a three-part article which investigates the prevalence of pressure sores and nurses' knowledge and attitudes in one NHS trust. This study was designed to explore the assumption that lack of knowledge might be a contributory factor to pressure sore formation. A cross-section of trained and untrained staff over several areas of work in the acute and community settings were represented. Overall, the differences in awareness and opinions among staff were not indicative of major deficits in knowledge that could account for failure to prevent pressure sores. It is suggested that the problem may well be one of individual or organisational motivation.
Developing skills in leg ulcer nursing: the lessons learned
Authors: Loftus S. , Wheatley C. 
Published: May 2014

The high treatment costs of inappropriate leg ulcer management are well referenced. Wide variations in practice have also been reported. A training programme for community nurses has been in place in Leicestershire and Rutland NHS Trust for five years. Its objective is to promote evidence-based leg ulcer management. The aim of this prospective audit was to assess and compare the effectiveness of the compression bandage systems used in the trust: the original Charing Cross system (August 1996 to September 1997) and Robinson's Ultra Four kit (October 1997 to December 1998). All patients with leg ulceration were assessed using the Leicestershire leg ulcer assessment form. This was submitted along with an audit tool to the tissue viability service in exchange for a 12-week supply of compression bandages. The audit form was resubmitted after each subsequent 12-week period until the patient either had healed or was withdrawn from the audit. Differences between the two groups in mobility, previous deep vein thrombosis, fixed ankle deformity, the male to female ratio, duration of ulcer and ulcer surface area were noted. Patients using the Ultra Four kit had faster healing times than those given the Charing Cross system, but this was not statistically significant. Cost comparisons between the previous dressing regimen and compression bandaging showed a significance difference (p<0.001). There was also a significant reduction in nurse time (p<0.001). The audit results showed that compression bandaging therapy was an effective method of achieving healing in patients with venous leg ulcers and that significant cost savings were made in terms of dressing cost and nurse time. Furthermore, there were potential benefits in continuing compression therapy for the group of non-healers.
The healing properties of Promogran in venous leg ulcers
Authors: Vin F. , Teot L. , Meaume S. 
Published: May 2014

Objective: To evaluate the healing rate of venous leg ulcers treated with Promogran. Method: Patients with stagnating venous leg ulcers were recruited. Target wounds were ≥2cm but ≤10cm in any one dimension. Subjects were randomly allocated to receive either Promogran or a non-adherent dressing (Adaptic) with a secondary dressing of gauze followed by short-stress compression (Biflex). Weekly wound assessments occurred over 12 weeks and dressings were changed twice weekly by the investigator and/or nurse team. Planimetry tracings and photographs were blindly reviewed and assessed by two independent investigators. An intent-to-treat analysis was performed. Results: Seventy-three patients were included. Thirty-seven were randomly allocated Promogran and 36 Adaptic. Twenty-nine patients completed the 12-week follow-up visit, 25 healed before week 12 and 19 stopped follow-up before week 12 for reasons unrelated to healing. Significantly more patients in the Adaptic group than in the Promogran group switched to another dressing (22.2% versus 5.4%; p=0.035). Eleven venous leg ulcers healed in the control group (31%) and 15 in the Promogran group (41%) (p=0.373). Overall, 15 venous leg ulcers healed or improved in the control group (42%) and 23 in the Promogran group (62%) (p=0.079). Surface area decreased, on average, by 36.5 ±11.4% (median decrease: 44.6%) in the Adaptic group and by 54.4 +10.9% (median decrease: 82.4%) in the Promogran group (p<0.001). A ≤20% surface area reduction was observed in 15 patients in the Adaptic group and in seven in the Promogran group (42% versus 19%; p=0.034). No severe local adverse events were noted in either group, although poor tolerability caused a dressing switch in five patients in the control group and three in the Promogran group. Dressing acceptability was good or excellent in more than 60% of subjects in both groups. Conclusion: The results suggest that Promogran may accelerate healing in venous leg ulcers and was well tolerated compared with the current standard of care. Declaration of interest: This study was funded by Johnson and Johnson Wound Management, France.
Reliability and validity of DESIGN, a tool that classifies pressure ulcer severity and monitors healing
Authors: Sanada, H. , Moriguchi T. , Miyachi Y. , Ohura T. , Nakajo T. , Tokunaga K. , Fukui M. , Sugama J. , Kitagawa A. 
Published: May 2014

Objective: This study reviews the validity and reliability of DESIGN, a tool for classifying pressure ulcer severity and monitoring progression towards healing. Only the tool’s healing progression component was evaluated. Method: Inter-rater reliability was evaluated by calculating the agreement rate of scores, based on eight photos of pressure ulcers and six actual ulcers, made by a panel of seven nurses. Validity was assessed, using the same eight photos, by comparing DESIGN scores with those made using the validated Pressure Sore Status Tool (PSST). Results: The DESIGN inter-rater reliability results showed a high correlation of r=0.98 for the photos and r=0.91 for the real-life patients with pressure ulcers, respectively, for all seven raters based on total scores. For validity, a correlation greater than 0.91 was found between the DESIGN and PSST scores. Conclusion: Based on our results, DESIGN was found to have both high inter-rater reliability and high validity among the seven nurses who quantitatively evaluated the wound-healing progress of the pressure ulcers in this study. Declaration of interest: None.
Nurse-led education sets out to improve patient concordance and prevent recurrence of leg ulcers
Authors: Brooks J. , Ersser S.J. , Lloyd A. , Ryan T.J. 
Published: May 2014

Objective: This study evaluated the effects of a structured nurse-led education programme that aimed to improve patient concordance and prevent venous leg ulcer recurrence. Method: The design was quasi-experimental. Subjects (average age: 80) had venous leg ulceration that had healed within the previous two years, and were cared for at home by a district nurse. Data were available on 49 patients with 97 legs, 72 of which had had venous leg ulcers. Patients were divided into two groups: a control group, which received ‘usual’ care, and an experimental group, which was exposed to the education programme. Recurrence rates, the effects of the education on patient behaviour and the effect on recurrence of having both ankle movement and general mobility were measured over one year. Results: Patients in the experimental group experienced significantly less recurrence over the year (log rank test=8.28, p=0.004). To control for differences in mobility and ankle movement in the control and experimental groups at baseline, simultaneous logistic regression analysis was undertaken. This revealed a significant advantage for patients in the experimental group (p=0.035; OR=4.45, 95% CI=1.11–17.74), who spent more time with their legs elevated each day. This difference was sustained throughout the 52 weeks (f=2.88, p=0.015). Those who had both full ankle movement (>60 degrees) and full mobility (without aid) had significantly less recurrence (p=0.042). Education had no significant effect on the amount of time patients wore compression hosiery (f=2.1). Conclusion: A structured nurse-led patient concordance programme is effective in preventing venous leg ulcer recurrence and increasing the time patients spend with their legs elevated at heart level. Having both full ankle movement and full mobility reduces the risk of recurrence. Declaration of interest: None.
Safety and performance of a new non-adhesive foam dressing for the treatment of diabetic foot ulcers
Authors: Lohmann M. , Thomsen J.K. , Edmonds M.E. , Harding K.G. , Apelqvist J. , Gottrup F. 
Published: May 2014

Objective: This study aimed to document the safety and performance of a new non-adhesive foam dressing (Biatain Non-adhesive Dressing, Coloplast A/S) in the treatment of established foot ulcers in patients with diabetes. Method: This was an open non-comparative prospective study. Participants had an ankle brachial pressure index score of over 0.4 (neuro-ischaemic) and an ulcer bigger than 1cm2 and less than 8cm2 in any direction. The treatment period was six weeks. Results: Thirty-five out of 37 patients completed the study. The mean wound area reduced from 5.4cm2 to 2.5cm2. Relative wound area reduced from 100% at baseline to 40% at week 6. ‘Wearing comfort’ improved throughout the study (p=0.039). Maceration remained stable or improved. None of the four reported adverse events were device related. Conclusion: This study demonstrates that treatment of diabetic foot ulcers with Biatain Non-adhesive Dressing results in considerable wound area reduction and prevents any deterioration in maceration. The dressing is safe and effective in the management of these ulcers. Declaration of interest: This study was support by Coloplast A/S, Humlebaek, Denmark.
How echographic image analysis of venous oedema reveals the benefits of leg elevation
Authors: Xia Z.D. , Hu D. , Wilson J.M. , Cherry G.W. , Ryan T.J. 
Published: May 2014

Objective:Venous insufficiency, leading to venous oedema, is a key pathogenic factor for the non-healing of venous leg ulcers. This study aimed to evaluate the effects of leg elevation on venous oedema.Method:Ten patients aged 44–89 years (median: 61) with leg oedema had high-frequency B-mode ultrasound scanning and digital image analysis before and after three to four hours of leg elevation. The echographic image analysis system was used, where oedema is represented by the hypoechogenic part of the image — that is, the total number or density of low echogenic pixels (LEPs) in a particular area.Results:Compared with pre-elevation, the volume of the lower leg decreased by 2.9% ±0.6 (138cm3 ±39) after three to four hours’ elevation (p<0.05). After elevation, the LEPs in the upper, middle and lower sites of the limb decreased by 8.8%, 15.6% and 17.3% respectively, reaching statistical significance (p<0.05) in the lower site. The ratio of LEPs in the upper and lower dermis in the upper, middle and lower sites decreased by 30.3%, 45.8% and 22.5% respectively. This was significant in both the middle and lower sites (p<0.01). After elevation dermal thickness increased by 0.047mm, 0.194mm and 0.232mm respectively. This change was statistically significant in the middle (p<0.05) and lower sites of the limb (p<0.01).Conclusion:Leps Are A Sensitive Marker Of Dermal Oedema And Its Effects. Leg Elevation Is Extremely Effective In Reducing Oedema, Even If Only For Three To Four Hours.Declaration of interest:None.
An investigation of the long-term bioactivity of endogenous growth factor in OASIS Wound Matrix
Authors: Hodde J.P. , Ernst D.M.J. , Hiles M.C. 
Published: May 2014

Objective: To examine the retention and bioactivity of endogenous FGF-2 after prolonged storage within a complex matrix. FGF-2 is a growth factor found in Oasis Wound Matrix, a purified collagen wound-care product containing other endogenous components of the extracellular matrix. Method: FGF-2 content was measured by ELISA. FGF-2 activity was measured using an in vitro bioassay in rat pheochromocytoma (PC12) cells. Results: FGF-2 content ranged from 15.3ng/g to 84.3ng/g. The bioassay showed that the FGF-2 retained in the matrix was present in a bioactive form able to cause differentiation of cells in culture Conclusion: The results demonstrate that wound-care products can be developed to retain their bioactivity over time and that inherently unstable purified growth factors are preserved if stored as bound factors within their natural extracellular matrix. The results also suggest that use of acellular matrices containing active growth factors would have advantages in terms of simplicity and cost over purified recombinant growth factor therapies. Declaration of interest: This study was supported by Cook Biotech Inc, West Lafayette, USA.