bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does clowning benefit children in hospital? Views of Theodora Children’s Trust clown doctors
Authors: Glasper Edward Alan , Prudhoe Gill , Weaver Katie 
Published: May 2014

This paper reports on one part of a service evaluation designed to assess the impact of clown doctors in English children’s hospitals and children’s units. With the objective to gain the opinions of Theodora Trust special clowns, senior fully trained and experienced clown doctors (n=5), and trainee clown doctors (n=7), were asked what works best and least during a clown encounter with a sick child in hospital. Focus group meetings using the nominal group technique were held in two centres in London. The main outcome measures were the description and analysis of those factors that inhibit or enhance clown doctor encounters with sick children and their families. The results provide five voted items of importance of what works best when a clown doctor (junior or senior) visits a sick child in hospital, including gaining the child’s consent. Five voted items of what works least best during a clown encounter, including disrespect of hospital procedure and staff were also recorded. The clown doctors were very supportive of the use of humour for sick children and their families in hospital, believing it to be beneficial, but were critical of some elements of the visit arrangements, including prejudice by some staff.
The future of post-registration education for children’s and young people’s nursing: a SWOT analysis
Authors: Ellis Judith , Glasper Edward Alan , McEwing Gill , Richardson Jim 
Published: May 2014

The primary aim of this paper is to elucidate the strengths, weaknesses, opportunities and threats surrounding the arena of post-registration education provision for children’s and young people’s nurses in the UK. The authors of this paper were approached by the Association of Chief Children’s Nurses (ACCN) in the autumn of 2006 and asked to conduct the analysis. An email letter was sent to the head of each children’s and young people’s nursing department in all higher education institutions offering children’s nursing in all four countries of the UK (n=63) inviting them to participate in the SWOT analysis. There was a tight timescale in which to prepare the presentation for the symposium and therefore two reminder emails were subsequently sent to the participants. Seventeen (26.9% of the sample) university child health departments representing the four countries of the UK participated in the analysis, generating useful data which was subsequently collated for presentation at the symposium. The respondents identified a number of strengths to the existing provision across the UK, including the availability of a good range of appropriate modules that promote evidence-based practice and strong partnerships with care providers. A number of weaknesses were highlighted, including difficulties experienced by managers in releasing staff from practice. Opportunities were identified, particularly that of collaborative working and changes to the way in which post-registration education is designed and delivered. The primary threat to post-registration education delivery was perceived to be financial cuts to the education budgets within NHS care provider institutions and within the higher education sector itself.
The development of the Glamorgan paediatric pressure ulcer risk assessment scale
Authors: Willock Jane , Baharestani Mona Mylene , Anthony Denis 
Published: May 2014

A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. Pressure ulcer risk assessment scales are used to identify patient risk, level of risk and type of risk. Most paediatric pressure ulcer risk assessment scales have been derived either from adult risk assessment scales, clinical observation or literature review. Detailed questionnaires were developed based on a review of pressure ulcer literature and discussion with experienced paediatric nurses. These were used to collect detailed data on the characteristics of 336 children (61 with pressure ulcers, 275 without pressure ulcers) who were inpatients in 11 hospitals in England and Wales. Using chi-square analysis, the significance of the children’s characteristics in relation to the presence of pressure ulceration was calculated. Eleven patient characteristics had a significance level of p<0.01. A paediatric pressure ulcer risk assessment scale (the Glamorgan Scale) was developed using the results of the analysis. Weightings for risk characteristics were devised using the significance values as a guide. Using the same data set, the sensitivity and specificity of the Glamorgan scale were calculated to be 98.4% sensitive and 67.4% specific at a cut off score of 15. With this data set, the Glamorgan scale was demonstrated to out perform the Braden Q scale paediatric pressure ulcer risk assessment scale. However, more work needs to be done with a new data set. The inter-rater reliability of the Glamorgan scale also needs to be determined.
Assessing communication between health professionals, children and families
Authors: Wales Sandra , Crisp Jackie , Moran Phyllis , Perrin Michelle , Scott Ella 
Published: May 2014

A great deal of work has been done worldwide addressing the rights of the child and their families to ensure they are involved in the decision-making processes of the management of the child’s health. Of equal importance is the need for all parties to be fully informed about the treatment strategies and plan of care. For an organization to be certain, effective communication does occur between the staff, the children and their families; systems, policies, and practices need to be in place and adhered to. International organizations with interests in child health, including CAI, WHO and UNICEF, have collaborated to set up the Child Friendly Healthcare Initiative (CFHI) (Southall et al, 2000; Nicholson and Clarke, 2007). The CFHI has developed 12 standards that have universal applicability across child health-care services. These standards focus on different aspects of child and family-friendly approaches to the delivery of health services. At our children’s hospital we aimed to gain an understanding of the level of communication that existed to enable us to develop recommendations for improvement. An overall assessment of communication within the hospital using CFHI–Standard 5 (parents and children will be kept fully informed and involved in all decisions affecting their care) was utilized. The assessment highlighted there is a satisfactory level of communication practices in place, however, the process has enabled the gathering of information to develop intervention strategies to further improve communication for parents and children.
Chronic wounds and nursing care
Authors: Lindholm C. , Bergsten A. , Berglund E. 
Published: May 2014

This study has collated data on the prevalence of chronic wounds and the demography of patients with these wounds. Diagnostic methods, nursing care, the presence of diabetes and pain are analysed, as well as data on healing, amputation and mortality three months post-study. A total of 694 patients were identified: 406 with leg or foot ulcers, 117 with pressure ulcers and 171 with other wounds. Most patients were treated in the community. Leg ulcer aetiology was verified with ultrasound Doppler examination. There was a correlation between low Norton score (< 20) and severity of pressure ulcer (Stage III or IV). The use of 113 different wound dressings or combinations of products was reported. Time spent on dressing changes was the equivalent of full-time employment for 57 nurses. Wound cleansing was not predominantly performed with tap water, as recommended, but with saline. Almost all patients with venous leg ulcers (88%) were treated with compression but in 35% of these support stockings were used. Pain was present in almost half of all patients, more commonly in Stage III or IV pressure ulcers than in Stages I and II, and was most often reported in older patients. Diabetes was present in 25% of all patients with leg and pressure ulcers, and in 57% of patients with foot ulcers. At three-month follow-up, 28% of pressure ulcers, 40% of leg ulcers and 61% of other wounds had healed. Mortality was 35% in patients with pressure ulcers, 4% in those with leg ulcers and 7% in those with foot ulcers. These data have been presented to politicians in the county, resulting in allocation of resources for a wound healing centre.
Infection control properties of some wound dressings
Authors: Bowler P.G. , Jones S.A. , Davies B.J. , Coyle E. 
Published: May 2014

The ability of some wound dressings to sequester and retain micro-organisms associated with wound fluid is perceived to provide beneficial properties regarding infection control. This study used an in vitro model to investigate and compare such properties in a range of fibrous absorbent dressings (alginate, hydrofibre and hydrophobic) . Dressings were challenged with a simulated wound fluid containing common wound pathogens (Staphylococcus aureus or Pseudomonas aeruginosa). Bacterial sequestering and binding levels were monitored over time. A hydrofibre dressing and two calcium alginate dressings were shown to effectively sequester challenge organisms from a simulated wound fluid. However, the hydrophobic and hydrofibre dressings produced statistically significant results in their ability to adsorb and retain challenge organisms (p < 0.05). These investigations have demonstrated that a hydrofibre dressing effectively sequesters and retains micro-organisms upon exposure to simulated wound fluid, and may therefore provide a passive mechanism for reducing the microbial load in wounds and in the surrounding environment. Further in vivo studies are required to investigate these dressing properties.
A simple severity index for pressure ulcers
Authors: Emparanza J.I. , Aranegui P. , Ruiz M.M. , Perez E. 
Published: May 2014

The aim of this study was to design and test a pressure ulcer severity score based on assessment by experienced clinicians. Fifty pressure ulcers were each evaluated independently by seven experienced clinicians, using a scale that ranged from 0 (mildest damage) to 10 (most severe). Ulcer characteristics were analysed to determine which factors related to the assessments. A second set of 50 ulcers was used to test the validity of the resulting scoring system. Inter- and intra-observer reliability were tested in a further 10 pressure ulcers. A multivariate linear model was produced, based on the following three variables: colour (CO-matched-matched) in the wound base; depth (DE)?of the ulcer; and mean diameter (D)?of the wound (‘CODED’). The coefficients for each variable were rounded to yield points in an additive equation, the CODED score. This score had a high correlation (r = 0.92, P<0.001) with the second set of evaluations, used to test the score performance. The CODED score is a simple and valid tool to quantify the progress of a pressure ulcer. It has a high correlation with the severity assessment of experienced clinicians and is reliable when used by non-experienced observers.
Acute and chronic wounds: differences in self-reported health-related quality of life
Authors: Price P.E. , Harding K.G 
Published: May 2014

Seventeen patients (10 female) with acute wounds (pilonidal sinus) and 32 patients (19 female) with chronic wounds (venous leg ulcers) attending a specialist wound clinic completed a condition-specific health-related quality of life (HRQoL) tool on two occasions five to seven days apart.The ratings from the two groups were statistically different for two sub-scales, with those with acute wounds rating themselves more positively.There were no differences between the groups for overall HRQoL or satisfaction with HRQoL – although there was a trend for those with chronic wounds to rate their overall HRQoL as higher than those with acute wounds, possibly indicating adaptation to their health status.While possible demographic and aetiological differences must be borne in mind, the tool used in this study appears to be sensitive to different types of wound.
Using a topical anaesthetic cream to reduce pain during sharp debridement of chronic leg ulcers
Authors: Rosenthal D. , Murphy F. , Gottschalk R. , Baxter M. , Lycka B. , Nevin K. 
Published: May 2014

This multicentre, double-blind, placebo-controlled, parallel-group study assessed the efficacy and safety of using Emla (lignocaine/prilocaine) anaesthetic cream to achieve pain control during sharp debridement of chronic leg ulcers of arterial, venous or arteriovenous aetiology. A total of 101 patients (51 Emla, 50 placebo), aged 29–99 years, who had experienced pain associated with previous debridement were included. Patients with an amide anaesthetic allergy, anaesthetic diabetic ulcers, or ulcers >50cm2 were excluded. Debridement was initiated approximately 30 minutes after the application of a thick layer of Emla or placebo cream to an ulcer occluded with a plastic wrap. The patient and investigator assessed the pain associated with debridement on a 100mm visual analogue scale (VAS).The median patient VAS scores were 18mm and 53.5mm in the Emla and placebo groups, respectively (p<0.0001). The corresponding investigator values in the two groups were 20mm and 49.5mm, respectively (p=0.004). Local reactions were mainly transient and mild, and were observed in roughly the same percentage of placebo and Emla-treated patients. After a 30-minute application Emla cream significantly reduced the pain of debridement compared with the placebo.
Can individualised nutritional support improve healing in therapy-resistant leg ulcers?
Authors: Wissing U.E. , Ek A-C. , Wengström Y. , Sköld G. , Unosson M. 
Published: May 2014

Objective: This study investigated whether an individually designed programme of nutritional support can improve healing in otherwise therapy-resistant venous leg ulcers. Method: Six primary health-care patients, aged between 79 and 93 years, with venous ulcers that had been open for one year or more (range: 1.5–8 years) were recruited into the study. The patients were asked to follow an individualised diet plan which included the use of liquid dietary supplements. Ulcer area, anthropometric and biochemical variables, and energy and nutrient intake were assessed before intervention and then regularly for nine months. Results: At nine months ulcer healing had occurred in two patients, of whom one had had ulcers on both legs. In a third patient the ulceration on one leg had healed and that on the other leg had almost healed. In a fourth patient, the ulcer area reduced by approximately 90%. Conclusion: The use of nutritional support might have assisted the wound healing in these patients. Although the relationship between nutritional supplementation and wound healing is not well defined, an appropriate nutritional plan is recommended if undernourishment is suspected and leg ulcers are not healing. Declaration of interest: Grants were obtained from the Swedish Nutrition Foundation, the research fund of the County of Östergötland and the ‘Vårdalstiftelsen’, Sweden. Nutricia AB provided the supplements.
Evaluating the cost and efficacy of leg ulcer care provided in two large UK health authorities
Authors: Ellison D.A. , Hayes L. , Lane C. , Tracey A. , McCollum C.N. 
Published: May 2014

Objective: This prospective study investigated the cost and efficacy of leg ulcer care over a three-month period during 1993, 1994 and 1999. It compared two health authorities (Stockport and Trafford) whose populations totalled 540,000. Method: All patients with active leg ulcers were invited to community leg ulcer clinics offering research-based innovations in care. Patients without significant arterial disease (ankle brachial pressure index less than 0.8) were treated with multilayer compression bandaging. Results: The 42% healing rate reported in the original Stockport study was maintained at 40% in 1999, although the 65% healing rate achieved by the leg ulcer clinics in 1993 was not replicated, with rates falling to 46%. Following the opening of community leg ulcer clinics in Trafford, healing rates rose from 20% to 42%. The annual expenditure on leg ulcer care in Stockport increased from £65,545.56 to £83,344.30, while in Trafford the cost of care dropped from £151,375.35 to £53,176.76 between 1994 and 1999. Conclusion: This study suggests that reductions in costs and improvements in healing rates can be sustained in a mature community leg ulcer clinic programme staffed by specialist leg ulcer nurses. Declaration of interest: The study was funded by the Wellcome Trust.
Evaluation of the stability and efficacy of rhGM-CSF as a topical agent in a gel formulation
Authors: Senet P. , Mons B. , Aractangi S. , Tilleul P. 
Published: May 2014

Objective: It has been reported that recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF), applied as a solution or an emulsion, improves wound healing. In order to confirm these data, the wound-healing efficacy of this growth factor was studied in a murine model. Method: In this double-blind randomised study, murine excisional wounds were treated with either sterilised rhGM-CSF gel (10μg/cm2) or a sterilised placebo gel (control group). rhGM-CSF was applied at dosages of 10μg/cm2/day to wounds until complete closure occurred. Results: rhGM-CSF stability in gel formulation was excellent during the first week but decreased thereafter. Full wound healing occurred within 9.7 days (mean time) in the intervention group compared with 10 days in the control group. This difference was not statistically significant. Histological evaluation of the healed wounds indicated that there was a similar percentage of neutrophils in the cellular infiltrate in both groups. Conclusion: rhGM-CSF sterile gel had an excellent safety profile and was easy to use, but did not significantly accelerate the healing rate in this model. Declaration of interest: None.
Effect of Traumacel P on the growth of human dermal fibroblasts in vitro
Authors: Hughes M.A. , Yang Y. , Cherry George W. 
Published: May 2014

Objective: It has been postulated that Traumacel P, a haemostatic powder, might assist the wound-healing process. This in vitro study investigated the effect of the powder on human dermal fibroblasts. Method: Experiments using fibroblasts from a 50-year-old donor were carried out using suspensions of Traumacel P ranging from 0.1 to 10.0mg/ml. Dulbecco's Modified Eagle Medium with 10% or 0.4% foetal calf serum (FCS) and 5.5mM or 25mM glucose was used. The powder was either placed in contact with the cells or separated from them by a porous membrane. The response of the fibroblasts was assessed using the MTT assay. Results: Concentrations of 0.5mg/ml and 1.0mg/ml stimulated the metabolic activity of the fibroblasts in both high and low glucose medium with 10% FCS, regardless of whether the powder was in contact with or separated from the cells. The greatest stimulation, to 174% of the controls, was produced by 0.5mg/ml Traumacel P in low glucose/10% FCS with the powder in contact with the cells (p<0.0001). Traumacel concentrations ranging from 0.5 to 5.0mg/ml in 0.4% FCS significantly stimulated the metabolic activity of fibroblasts in low glucose medium, but not in the high glucose medium. Conclusion: These studies indicate that direct stimulation of fibroblast proliferation may be one of the ways in which Traumacel P aids the healing of ulcers observed in the clinic. Declaration of interest: This study was funded by an educational grant from B Braun UK, who also provided the Traumacel P.
Pain at first dressing change after toenail avulsion: the experience of nurses, patients and an observer: 1
Authors: King B. 
Published: May 2014

Objective: Ingrowing toenails are often treated surgically by nail avulsion, with paraffin tulle gauze applied to the toenail bed afterwards. In one large city's primary care trusts, community nurses reported that patients felt pain when the gauze was removed postoperatively. This study looked at patients' general pain experience, and their pain during the first dressing change after toenail avulsion. Patients' perceptions of their pain were investigated, along with nurses' experience of redressing toenail beds, their technique and their interaction with patients, especially in relation to pain prevention. Method: First an extensive literature review was conducted. Then a collective instrumental case study design was used. This allowed triangulation of data sources using patient and nurse interviews, and non-participant observation, from six cases recruited from the city's primary care trusts. Data were subjected to thematic content analysis, with two main categories identified. These were ‘setting up of expectations’ and ‘a painful experience: but for whom?’ Results and conclusion: This study provides a unique description of the type of pain patients experience. It raises serious issues about the adequacy of nurses' management of pain, including assessment, documentation and advice on pain-relief strategies. It supports discontinuing the use of paraffin tulle gauze as the postoperative dressing, and raises ethical issues about changing treatments and lack of communication with secondary care. Finally, it identifies a gap in knowledge of the most suitable dressing product to apply immediately after surgery. A randomised controlled trial is needed to clarify these preliminary findings. Declaration of interest: None.
Comparison of different wound dressings on cultured human fibroblasts and collagen lattices
Authors: Viennet C. , Bride J. , Gabiot A.C. , Humbert P. 
Published: May 2014

Objective: We compared the effects on cultured human fibroblasts of a new non-adhesive wound dressing, Urgotul, with five other wound dressings. Urgotul is a hydrocolloid dressing; the comparator dressings included impregnated gauze and modern wound dressings. Method: Cultures in monolayer were used to study the morphology and growth of fibroblasts. The Bell model of cultured dermis equivalents was used to investigate myofibroblast differentiation. These cultures were labelled a-SM actin and F-actin. Results: Two of the tested dressings induced cytotoxic effects. They were found to inhibit cell growth (greater than 60%) and to disturb cell shape and cytoskeletal differentiation. Urgotul and the remaining three dressings showed no effect on proliferation. However, some of them modified fibroblast morphology and affected F-actin distribution. Conclusion: Depending on their nature and components, wound dressings may respect or affect fibroblast behaviour in vitro (proliferation, morphology and a-SM actin and F-actin distribution). The significance of these in vitro observed findings require further investigations. Declaration of interest: This study was supported by Urgo Laboratories.
Evaluation of mattresses using interface pressure mapping
Authors: Bain D. , Ferguson-Pell M. , McLeod A. 
Published: May 2014

Objective: To compare the ranking of mattresses using several different performance indices, calculated from interface pressure-mapping data. Method: Five mattresses were compared using interface pressure-mapping on 10 healthy volunteers. Mattresses were ranked in order, on the basis of several different specified performance indices. Results: Different performance indices ranked the mattresses in different orders. Conclusion: Elaborate performance indices should be used with care, since it is possible to construct a ‘tailor-made’ performance index to make any chosen mattress rank as the best. Care should be taken to ensure that a performance index is validated, preferably by some demonstrated link to clinical outcomes. Declaration of interest: This work was paid for by a grant from Huntleigh Technology Plc.