bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community perceptions of the professional status of the paramedic discipline
Authors: Murcot Pauline , Williams Brett , Morgans Amee , Boyle Malcolm 
Published: May 2014

Background: Despite proactive steps towards professionalism, the Australian out-of-hospital emergency care sector has not been formally recognised as a healthcare profession among other healthcare professions and Government bodies. The objective of this study was to examine community perceptions of the ‘professional’ status of the paramedic discipline and explore which attributes community members perceive as being most desirable for paramedics. Methods: Two structured focus groups were conducted with volunteer community members (n=10) from regional and metropolitan Victoria, Australia. Participants were asked a range of questions, including what title they used in describing paramedics, whether they considered the paramedic a professional, and what they perceived the desirable paramedic attributes were. Thematic analysis and incidence density qualitative data analysis methods were used to examine the responses. Results: The results suggest that the paramedic discipline is perceived as a ‘profession’ by the general community. Participants consistently reported the following attributes as most desirable for paramedics: high levels of skills, caring, empathetic, non-judgemental, culturally sensitive, quick thinkers, inclusive (including family members) trustworthy, honest, good communicators, highly educated, maintain confidentiality, physical fitness and being well groomed. Interestingly, community members used a variety of titles in referring to paramedics, these included: ‘ambulance drivers’, ‘ambulance officers, ‘ambos’, and ‘paramedics’, although it was clear that the term paramedic confused many participants. Conclusions: The general community recognises paramedics as professionals. Interestingly, the term paramedic is still not synonymous among community members, suggesting further lobbying and role clarification is required. The public perceptions of the paramedic role and the desirable attributes of a paramedic provide important information and an extra dimension regarding curriculum development, core competencies, and establishment of standardised curricula.
Participatory action research and action learning: changing clinical practice in nursing handover and communication
Authors: Wilson Val , Ho Aileen , Walsh Raelene 
Published: May 2014

Combining participatory action research (PAR) and action learning (AL) is an effective mechanism for healthcare practitioners who wish to change clinical practice: The outcome of a study on nursing handover and multi-disciplinary communication. Traditionally verbal handovers are lengthy and time consuming resulting in nurses spending an unacceptable time away from patient care. They lack structure and the information presented is often repetitive, incomplete, inadequate, or incorrect and therefore does not always present sufficient information to plan appropriate patient care. The primary purpose of this study was to review the effectiveness of the traditional nursing handover (in one clinical unit) with the aim of developing and implementing evidence-based strategies that would improve practice. In addition, this study aims to highlight the appropriateness and effectiveness of using PAR and AL within ePD. The results of the project indicated early adoption by nursing and medical staff of a database tool developed to assist handover. This improved multi-disciplinary communication, increased staff satisfaction, focussed staff on discharge planning and problem solving as well as reducing the time spent in handover. There remained however, areas for improvement and these were identified in order to begin the next rotation of the PAR cycle. This study suggests that by combining PAR with AL clinicians not only succeeded in changing handover practice but were then able to take what they learned and use it to further develop projects within the unit. It is therefore important to consider carefully the process by which knowledge utilisation takes place in order to ensure that learning is an intended outcome rather than an unexpected consequence of participation.
Administering intramuscular injections to children: what does the evidence say?
Authors: Barron Carol , Cocoman Angela 
Published: May 2014

Many author’s argue that intramuscular injections (IM) are rarely used routinely in children’s nursing (Hemsworth, 2000). Owing to the decreased exposure of children’s nurses in administering intramuscular injections to children, there is a need for nurses to update themselves on the latest evidence-based practice regarding the theory and technical aspects of this clinical skill. There is a reasonable body of literature focussing on immunization of the young child (under two years of age); however, there is a serious deficit of literature relating to administering intramuscular injection to children and adolescents. The vastus lateralis is the site of choice for children under the age of two, followed by the deltoid site for children two years old and above (RCPCH, 2002). Current literature cites the ventrogluteal muscle as being the site of choice for IM injection in adults (Greenway, 2004). However, there is no recommendation given on the land marking of this site for children. With the exception of new born babies or premature neonates, evidenced-based practice demonstrates that a needle size of 25 Gauge (1 inch) 0.6mm by 25mm length, is the most appropriate size to ensure a true intramuscular injection occurs and also minimizes local irritation and pain (Diggle et al, 2006). Invasive procedures, such as intramuscular injections can cause substantial anxiety and pain to children (Ellisand Bentz, 2004). This paper includes a brief examination of the pharmacological and non-pharmacological treatments used in the management of injection procedures in children.
Prescribing for medical aesthetic patients outside of nurse prescribers’ immediate care
Authors: Rankin Andrew , Traill Frances Turner , Bowes Lorna , Goddard Rachel , Lockett Karen , Harding Kate , Sal-Cedo Kerrie-Jayne , Beaumont-Thomasall Tatiana 
Published: May 2014

Foreword by Lorna Bowes Much work has been put in by a dedicated team of aesthetic nurses, all members of the British Association of Cosmetic Nurses, who volunteered their knowledge, time and varied experiences to put together a document in the immediate aftermath of the BBC's expose on remote prescribing and subsequent positions of the General Medical Council and Nursing and Midwifery Council. The draft guidelines were then reviewed by a further group of aesthetic nurses and examined for relevance and accuracy. This is, as would be expected, a work that will develop and evolve as aesthetic medicine changes and guidelines from the Nursing and Midwifery Council, Medicines and Healthcare Products Regulatory Agency and other bodies affect practice. The first review of the guidelines is set for as early as October this year. The document is intended for use by nurse independent prescribers prescribing for patients outside of their immediate care, and the non-prescribing nurses who will be administering the prescribed treatments. The guidelines are published in full here, and thanks must go to the team expertly led by prescriber and nurse practitioner Andrew Rankin.
Hospital monitoring of pressure ulcers in the UK
Authors: Scott F. , Newens A. 
Published: May 2014

Hospital trusts and health authorities are increasingly being expected to report on numbers of patients with pressure ulcers. Although pressure ulcer audits should be undertaken in a systematic way, there are no agreed standards and little is known about the current status of pressure ulcer monitoring. A postal survey was conducted to establish a national picture of both assessment and audit of pressure ulcers. Questionnaires were sent to 276 acute hospital trusts throughout the UK; 204 were returned, giving a response rate of 74%. Fewer than half of the trusts (40%) employed a tissue viability nurse, and 28.5% of respondents were another type of clinical nurse specialist. Most hospitals used single scales for grading pressure ulcers and risk assessment but the frequency and method of such surveys varied considerably. Relatively few hospitals (5%) monitored the number of pressure ulcers on a daily basis, 30% made some form of weekly return and 22% made monthly returns. The authors conclude that there are national variations with respect to the pressure ulcer assessment tools used to provide audit data, and to the methodology and documentation used to collate data. A national consensus is recommended on auditing of pressure ulcers in the UK.
Prescribing for leg ulcers in general practice, Part 2
Authors: Barlow J. 
Published: May 2014

This study, the second of a two-part article, reports the findings of a survey undertaken to establish who selects the product used in the management of leg ulcers, and the factors influencing their decision making. The use of interviews (n = 9) followed by postal questionnaires (n = 197) confirms that the majority of decisions are made by practice nurses and district nurses. The findings suggest that, of the factors considered, patient comfort and compliance are the most important factors influencing product selection. This study also suggests that nurses are not using the best available evidence because of inaccessibility of resources and lack of time to search the literature. Nurses also cited difficulty in discriminating between a biased presentation and reliable research.
Investigating the bacterial barrier properties of four contemporary wound dressings
Authors: Ameen H. , Moore K. , Lawrence J.C. , Harding K.G. 
Published: May 2014

The ability of four wound dressings (CombiDERM, Allevyn Hydrocellular, Tegaderm and Tielle) to resist penetration of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecalis and Pseudomonas aeruginosa was investigated in vitro using a dedicated test apparatus. With the exception of Tielle, each dressing prevented bacterial transmission over an 11-day challenge period. When both the wound contact surface and the external surface of Tielle were directly challenged with a bacterial suspension, penetration of the dressing was observed within three to five days. The breakdown of its outer membrane could explain the inability of Tielle to maintain a barrier to the passage of the test bacteria used in this wound model. On the basis of these data, CombiDERM, Allevyn Hydrocellular and Tegaderm dressings may facilitate infection control by acting as a physical barrier to the transmission of potentially pathogenic and antibiotic-resistant wound bacteria. However, further research is urgently required to determine whether or not the same results are observed in clinical practice.
Errors and discrepancies: a patient perspective on leg ulcer treatment at home
Authors: Haram R.B. , Dagfinn N. 
Published: May 2014

Objective: This Norwegian study explored the treatment experiences of nine patients with a leg ulcer who lived at home. Method: The study was descriptive and exploratory, with open-ended interviews. Five women and four men aged 60–96 years who had had a leg ulcer for more than six weeks participated. Most had a venous/arterial leg ulcer, lasting from between four months to ‘my whole adult life’. Results: Treatment was not always carried out in a correct and caring manner. The patients experienced trial and error in their treatment, delays in the arrival of the helpers, unhygienic methods and lack of information about the cause and treatment of their ulcer. Despite these problems, they had confidence in the treatment they received. Conclusion: The treatment, hygiene and organisation of the care of patients with leg ulcers living at home needs improving. Declaration of interest: None.
Pain in pure and mixed aetiology venous leg ulcers: a three-phase point prevalence study
Authors: Nemeth K.A. , Harrison M.B. , Graham I.D. , Burke S. 
Published: May 2014

Objective: This study aimed to determine the point prevalence of venous leg ulcer pain over three seasons (autumn, winter and spring). It also collated profiles of individuals with venous ulceration and described the characteristics of people with and without venous leg ulcer pain. Method: The study sample comprised 255 people with pure and mixed venous leg ulcers who were receiving care in a Canadian community leg ulcer service. Prevalence was determined by the number of individuals who had experienced pain in the past 24 hours. The profile of individuals was developed by analysing sociodemographic, circumstance-of-living, clinical and health-related quality-of-life data collected on admission to the leg ulcer service. Results: Over the three prevalence periods, the prevalence of pain for the total sample ranged from 48% to 54%. Prevalences at each of the study periods for individuals who had been receiving care for less than 13 weeks, and for the first measure of pain only, were almost identical, ranging from 48–59%. The mean pain-severity score was less than three (out of 10) in all three periods. Of the individuals with pain, 50% or more used analgesia and, of these, over 75% reported it was effective. The profile of participants with pain was similar to those without it, except that the former were significantly more likely to have osteoarthritis, a foot ulcer, to have been attending the leg service for a shorter time period and to have a lower SF-12 mental health component score. Conclusion: These results demonstrate that leg ulcer management must include pain assessment and consideration of the factors that may be associated with pain. A large prospective repeated measures study is needed to increase understanding of the extent of pain, the use and efficacy of analgesia, and the factors that may be related to experiencing pain.
A small study in healing rates and symptom control using a new sheet hydrogel dressing
Authors: Hampton S. 
Published: May 2014

Objective: This study set out to investigate the pain control and absorptive properties of a new sheet hydrogel dressing (ActiFormCool, Activa). Method: This was a simple evaluation involving 20 wounds. Compression was used when appropriate, although each patient receiving compression had used short-stretch bandages before entering the study. Results: Pain was reduced from an average of 8.65 to an average of 3.75, where 10 represents the worst pain possible and one represents no pain. Exudate reduction was assessed by the number of dressing changes required each week. The dressing-change rate reduced from an average of 2.8 times weekly to an average of 1.3 times weekly. Skin condition improved in all three cases in which the surrounding skin had been a problem before the study. Over a four-week period, two wounds healed, four healed by 90% and two by 80%, with an overall average healing rate of 46%. Conclusion: ActiFormCool provides an optimum wound-healing environment, reduces pain and absorbs fluid, making it an excellent alternative to loose hydrogels. Declaration of interest: This study was funded by Activa Healthcare.
Infection prophylaxis of gunshot wounds using probiotics
Authors: V.I. Nikitenko 
Published: May 2014

Objective: To report a new method of surgical infection prophylaxis for postoperative gunshot wounds to the extremities. Method: Gunshot wounded animals were divided into three groups: treatment (probiotic Sporobacterin), antibiotic (cephalosporin cefamezin) and control (no treatment). Histological studies of wound-bed tissue were taken on days 1, 3, 5 and 10 of the study. Results: The probiotic administered per os was more effective than antibiotics for prophylaxis of surgical infection. Conclusion: The probiotic’s effect is based on the natural defence mechanism activated after injury — the bacterial translocation of saprophytic bacteria from the gut to the wound. Declaration of interest: None.
Measuring the impact of venous leg ulcers on quality of life
Authors: Hareendran A. , Bradbury A. , Budd J. , Geroulakos G. , Hobbs R. , Kenkre J. , Symonds T. 
Published: May 2014

Objective:To identify health-related quality-of-life (HRQoL) issues in patients with venous leg ulcers, with the aim of generating items for a treatment outcome measure.Method:Thirty-eight patients with venous leg ulcers were interviewed by a psychologist using a semi-structured guide; they also completed a HRQoL questionnaire (modified Skindex). Data from the questionnaire were examined to explore the impact of venous leg ulcers on patients’ lives. Interview transcripts were analysed using qualitative methods to identify additional venous leg ulcer-specific HRQoL items.Results:Skindex scores indicated that older patients had worse HRQoL (p<0.05), as did those with pain and non-healing ulcers. Ulcer duration and size did not correlate with HRQoL. Interviews revealed the following effects of ulceration: pain (80.5%); itching (69.4%); altered appearance (66.7%); loss of sleep (66.6%); functional limitation (58.3%); and disappointment with treatment (50%). Based on the interview transcripts, items were generated and discussed with an expert panel, with a view to including them in a venous leg ulcer-specific HRQoL questionnaire.Conclusion:Disease-specific HRQoL outcome measures should be considered when evaluating treatments for venous leg ulcers.Declaration of interest:This study was funded by Pfizer, Sandwich, UK.
Stimulation of the proliferation of human dermal fibroblasts in vitro by a lipidocolloid dressing
Authors: Bernard F.X. , Barrault C. , Juchaux F. , Laurensou C. , Apert L. 
Published: May 2014

Objective: The effect of Urgotul on normal human dermal fibroblast proliferation was studied in vitro and compared with that of two other dressings: Mepitel and Tulle Gras. Method: Proliferation was measured by the extent of thymidine incorporation into the replicating DNA of proliferative fibroblasts in contact with the complete dressing. Additional cell viability and metabolism were evaluated using MTT assay. Morphology and ultrastructure analysis were based on immunolabelling and confocal laser microscopy. Results: Only Urgotul significantly stimulated thymidine incorporation, generally with a maximal proliferative effect at a contact time of 48 hours. This was confirmed by the observation of a greater number of dividing cells (mitotic cells) than in the control cultures. No cytotoxicity was observed following treatment with this dressing. Cells exhibited normal structural and ultrastructural features. Conclusion: Fibroblasts play a key role in dermal wound repair. The ability of Urgotul to promote fibroblast proliferation could explain its efficiency in the healing process of acute and chronic wounds. Declaration of interest: This study was supported by Urgo Laboratories.
Benefits of surgical reconstruction in pressure ulcers with a non-advancing edge and scar formation
Authors: Ichioka S. , Ohura N. , Nakatsuka T. 
Published: May 2014

Objective: To highlight the difficulty in treating pressure ulcers associated with scar formation and the benefits of surgical treatment in these cases by presenting a series of clinical cases. Method: Nine sacral ulcers surrounded by significant scar formation and 14 sacral ulcers without significant scars were treated using the same conservative management protocol. Healing status was quantitatively estimated using an assessment tool called DESIGN, which classifies pressure ulcer severity and allows healing to be monitored; a decreasing score indicates progressive improvement. Results: Ulcers with scar formation showed little response to the treatment, while those without remarkable scars exhibited a significant decrease of the DESIGN scores. Surgical reconstruction was conducted in five ulcers surrounded by scar formation, and all showed complete healing within extremely short periods. Conclusion: Conservative treatment of pressure ulcers with a non-advancing edge surrounded by scar formation presents considerable difficulties. Surgical reconstruction offers many benefits for non-healing ulcers. Declaration of interest: None.
Use of ulcer size and initial responses to treatment to predict the healing time of leg ulcers
Authors: Prince S. , Dodds S.R. 
Published: May 2014

Objective: To test the following two hypotheses: the initial healing profiles of individual leg ulcers determine the longer-term outcome; healing time can be predicted from an initial ulcer size measurement and a sequence of further measurements recorded after treatment has started. Method: Twenty-three patients with venous leg ulcers were studied (10 male, 13 female). Digital images of the ulcers were taken at weekly intervals; ulcer size was measured electronically and the information stored in an electronic patient record. The healing profile for each ulcer was analysed by linear regression using the correlation coefficient (r) to indicate linearity. For |r| >0.85 (|r| = modulus of r, [where r is negative], that is good linearity and hence wound healing), the predicted healing time was calculated from the initial size (cm2) and initial healing rate (cm2/week), and was compared with the actual healing time. Results: The majority of ulcers (17/23) healed with linearity (|r| >0.85). For these ulcers there was agreement between the predicted healing time and the actual healing time (correlation coefficient 0.95). Conclusion: Venous ulcers that respond to treatment appear to heal at a near constant rate. The initial response to treatment can be used to reliably estimate the healing time. Declaration of interest: None.
Split-thickness skin graft donor sites: a comparative study of two absorbent dressings
Authors: Terrill P.J. , Goh R.C.W. , Bailey M.J. 
Published: May 2014

Objective: To identify the optimal dressing for split-thickness skin graft (SSG) donor sites. Method: This prospective randomised controlled trial compared two dressings — a new absorbent form of a polyurethane film dressing (Tegaderm Absorbent, 3M) and our standard alginate dressing (Kaltostat, ConvaTec) — on SSG donor sites in 40 patients. Primary outcome measures were: reduced time to full healing; reduced postoperative pain; reduced leakage rates from the dressing. Secondary outcome measures related to acceptability of the dressings to the patient. Results: On removal of the dressings at the first assessment, 79% of the Tegaderm Absorbent donor sites had healed completely, compared with 16% of the Kaltostat ones (p<0.001). A significantly greater median area had healed with Tegaderm Absorbent (100%), when compared with Kaltostat (89%) (p<0.001). Mean time to complete healing was also significantly faster for Tegaderm Absorbent than Kaltostat (14 versus 21 days) (p<0.001). Significantly fewer subjects experienced postoperative pain with Tegaderm Absorbent on both day 1 (21% versus 67%, p=0.006, NNT=3) and day 2 (17% versus 75%, p<0.001, NNT=2). Leakage rates reduced by 48% with Tegaderm Absorbent, with no leakage in the smaller donor sites. Tegaderm Absorbent was significantly easier to apply than Kaltostat (89% versus 27% found it ‘very easy’) as was ease of removal (84% versus 11% found it ‘very easy’) (p<0.0001). Patients found Tegaderm Absorbent dressings significantly more convenient to manage and bathe with. At one month post-surgery, Vancouver scar scores showed that Tegaderm Absorbent donor sites were less red, flatter, softer and less itchy. Conclusion: Tegaderm Absorbent provides a significant improvement in terms of donor-site pain, healing and ease of management. Declaration of interest: None.