bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sick children’s perceptions of clown doctor humour
Authors: Weaver Katy , Prudhoe Gill , Battrick Cath , Glasper Edward Alan 
Published: May 2014

Clowns and their humour have entertained human beings for centuries. However the literature as yet fails to demonstrate a significant research evidence base on the efficacy of clown humour as a therapy within children’s hospitals/units. Despite this, many health professionals with an interest in both the psychological and physical aspects of patients well-being are showing an increased interest in the use of clown humour within health-care settings. This study focuses on the perceived effects of clown doctor humour as experienced by children in a large children’s inpatient facility in the South of England. 42 children between the ages of four and 11 years were approached and 20 participated fully in the 2 stage process. Data was collected from 17th January 2007–16th May 2007 (over 4 month period). The draw and write/draw and tell technique was used to elicit information from the children. The results pertaining to the draw and write/draw and tell study were considered in two categories, i.e. ‘written’ words and ‘spoken’ words. Before the clown visit the majority of written comments made by the children to annotate their drawings were negative (scared/worried/nervous) and ‘negative’ and ‘sad’ appeared to be the prominent theme. Subsequent to the clown doctor visit to the children there was a significant increase in positive written comments made with no negative comments recorded. There were 34 negative spoken comments articulated by the children and only 14 positive comments, suggesting that the dominant theme before a clown visit was totally negative. Analysis of data elicited after the clown doctor visit showed a much more positive theme, with 57 positive comments being articulated by the children with only three negative comments being generated. This qualitative study of children’s perceptions of hospital clown humour, using the draw and write /draw and tell techniques, has shown that children appreciate the beneficial effects of a clown visit to them during their hospital stay. The data suggests that clown humour can mitigate some of the negative effects of hospitalisation for sick children. Of the 23 suggestions made by the children after the clown encounter, 19 of them were requests for more frequent clown visits or more clown doctors.
Meeting the emotional needs of parents who have a child with complex needs
Authors: Narramore Naomi 
Published: May 2014

The physical and financial demands of caring for a child with complex needs are acknowledged by health professionals. However, the emotional needs of parents are not often recognized by health professionals until parents are at a heightened level of stress. This paper is based on a literature review of current articles, research papers and government documentation. The focus is on the emotional impact to parents who have a child with complex needs, particularly at the point of diagnosis. The paper explores how health professionals, and nurses in particular, should meet the emotional needs of parents in order to support them more effectively. Giving birth to a child with severe health problems impacts upon parents at an emotional time of transition, particularly if there were no concerns identified during pregnancy. For some parents a grief response or state of chronic sorrow may be triggered. The reality of caring for a baby who is critically ill or disabled can be an enormous and unexpected shock for both parents. Parents need emotional support and guidance, as they may have to change their expectations for their child’s development and even life span. It is important for nurses to realise that if parents’ emotional needs are unmet it can lead to clinical depression or mental illness. Primary support often comes from parent support groups rather than health professionals. The review highlights factors affecting parents’ emotions and discusses how early support, home visits and practical help can all help to alleviate parents’ emotional stress.
Understanding advocacy in children’s nursing: a Hermeneutic Study
Authors: Howlin Frances 
Published: May 2014

This study describes how Irish registered children’s nurses understand and interpret the experience of being an advocate. Advocacy, both internationally and nationally, is endorsed as being an integral component of the role of the nurse. In children’s nursing, advocacy is viewed as central to the care of the child because of their perceived vulnerability and developing maturity. Despite its centrality in nursing care, advocacy continues to be difficult to define and operationalize in clinical practice. Few studies have explored advocacy in the context of children’s nursing therefore the advocacy role of the children’s nurse is not clearly delineated. Sampling was purposive and eight registered children’s nurses volunteered to participate in the study. This study used a qualitative approach, based on Gadamer’s hermeneutic philosophy. Data collection methods included identification of the researcher prejudices, purposive sampling, twelve hermeneutic interviews and the compilation of the researcher’s reflexive journal. Benner’s (1994) method of data analysis was used and paradigm cases, exemplars and themes were identified. The themes identified included advocacy as protection, advocacy as representing the expressed wishes of the parent/child, advocacy as enabling the voice of the child and the work of advocacy. The study identified advocacy as being integral to the role of the children’s nurse. Advocacy was described as a complex concept capable of encompassing various models of advocacy including those of Kohne, Gadow Curtin, Jezewski and Mallik. It highlights the interdisciplinary differences that exist in the conceptualization and operationalization of the concept. In particular, advocacy in children’s nursing comprised both acting in the best interests of the child and facilitation of child self-advocacy, thus supporting the differing ethical principles of autonomy and best interests. Representation of the parents and child’s views were also central to the role.
Pressure-induced skin lesions in pigs: reperfusion injury and the effects of vitamin E
Authors: Houwing R. , Overgoor M. , Kon M. , Jansen G. , van Asbeck B.S. , Haalboom J.R.E. 
Published: May 2014

The pathogenesis of the development of pressure ulcers is still unclear. The aim of this study was to investigate the role of ischaemia and reperfusion in pressure-induced tissue necrosis in the trochanteric region in pigs. Pressure application was achieved with a newly developed computer-controlled pressure device. Histological examination showed damage in the subcutis and muscle tissue comparable with inflammation, extending in a vascular pattern beyond the area of pressure application. Electron-microscopic studies revealed neutrophil adherence to the capillary endothelium, which showed signs of injury. These observations were manifest two hours after the cessation of pressure. Pre-treatment with 500mg vitamin E per day resulted in significantly less tissue damage compared with untreated animals. Pressure alone caused a significant decrease in reduced glutathione and total glutathione, suggesting oxidative stress. After pressure release there was a significant increase in hydrogen peroxide concentration, suggesting a decreased antioxidant protection. After pre-treatment with vitamin E, however, there was no increase of hydrogen peroxide. It is concluded that the early signs of necrosis after pressure application are concordant with typical ischaemia-reperfusion damage and this can be prevented in part by treatment with vitamin E. Prophylactic administration of vitamin E may influence the occurrence of pressure ulcers in humans undergoing elective surgery.
Effect of visco-elastic foam mattresses on the development of pressure ulcers in patients with hip fractures
Authors: Gunningberg L. , Lindholm C. , Carlsson M. , Sjödén P.-O. 
Published: May 2014

This study had three aims: to investigate if visco-elastic foam mattresses are more effective than standard hospital mattresses in reducing the incidence of pressure ulcers in patients with hip fractures; to compare pressure ulcer grade and location and documented nursing prevention and treatment interventions in patients using the two types of mattresses; and to identify possible predictors of pressure ulcer development. Using a prospective randomised controlled trial design 101 patients (mean age: 84 years) were randomly allocated either a visco-elastic foam mattress or a standard mattress. There was no significant difference in the incidence of pressure ulcers between the two groups, but patients on standard mattresses tended to develop more severe pressure ulcers. Furthermore, according to the documentation, patients with grade I pressure ulcers who were allocated a standard mattress received more preventive interventions, which may have reduced the differences in outcomes between the two groups. The researchers conclude that the results support the use of the test mattress. Significant predictors of pressure ulcer development were long waiting times for surgery and low haemoglobin levels at hospital admission
The physics of sub-bandage pressure measurement
Authors: Melhuish J.M. , Clark M. , Williams R. , Harding K.D. 
Published: May 2014

Compression therapy is the principal treatment for leg ulcers associated with venous disease. The extent of compression generally can be estimated from the general Laplace equation relating pressure, bandage tension and leg radius. This study aimed to investigate the physical forces under long stretch bandages applied under constant tesnions to cylinders of three defined radii (‘model limbs’). Force expressed as pressure was measured under one, two and three layers of eight long stretch bandages and a plastic film (control) using temperature-compensated, strain-gauge pressure transducers. The bandages were applied at the manufacturers' recommended extensions/tensions and at constant tensions (2–10N) to three rigid plastic tubes of increasing size, covered with a layer of soft foam. Foams of different hardnesses ranging from 20 to 230N were assessed. The median applied pressure and observed bandage characteristics changed with bandage type. The median applied pressure also changed with tension, number of layers, tube radius adn foam hardness. The inter-layer shear component also tended to increase with the number of layers. An increase in sub-bandage pressure was observed relative to the radius, tension, foam hardness and number of layers but the relationship was not directly proportional. The shear force tended to be associated with increased bandage layers.
Effect of four treatment variants on the functional and cosmetic state of mature scars
Authors: Klopp R. , Niemer W. , Fraenkel M. , von der Weth A. 
Published: May 2014

A randomised, intra-individual, comparative study demonstrated that both qualitive improvements and significant changes in skin functional condition can be achieved in the tissue of older, mature scars. Four treatment modalities were studied in an intra-individual comparison involving 12 volunteers with 2.5 to 4-year-old scars. The treatments were: a self-adherent, hydroactive, polyurethane dressing alone; polyurethane plus compression; silicone sheeting plus compression; and compression alone. Evaluation criteria were changes in the microcirculation, roughness and the skin temperature of the scar tissue. All treatment modalities were found to have significant effects both on the tissue function ad scar tissue surface structure. The most pronounced effects were achieved with the combination of polyurethane dressing plus compression or silicone sheeting plus compression. The positive effect of the polyurethane alone on scar tissue was slighly superior to that of compression therapy alone.
Nurses' views about pain and trauma at dressing changes: results of a national survey
Authors: Hollinworth H. , Collier M. 
Published: May 2014

Research findings and professional concerns that patients still experience pain and tissue trauma at dressing changes led specialist nurses to develop a postal questionnaire to elicit the views of 1000 nurses with an interest in wound management. The questionnaire asked practitioners to identify the primary considerations underpinning their approach to pain and tissue trauma at dressing changes, the strategies they adopted, and the factors which determined their treatment choices. The higher than anticipated response rate (37%) illustrates the importance nurses attach to this aspect of practice. The practitioners' main considerations during dressing changes were the need to prevent trauma to the wound (47%) and to avoid causing the patient pain (34%). Significantly, 81% noticed that patients experienced most pain when dressing products were removed, highlighting the need to re-emphasise the principles of moist wound healing. A total of 225 respondents (60%) were aware of dressings specifically designed to prevent pain and trauma during dressing changes. Practitioners also had the freedom to use the product of choice all (61%) or most (36%) of the time. However, respondents also demonstrated confusion about the properties and availability of many dressings. Recommendations for practice include reviewing the number of dressings currently available, together with ongoing education and update on all wound management dressing products and related issues.
Profiling beds versus standard hospital beds: effects on pressure ulcer incidence outcomes
Authors: Keogh A. , Dealey C. 
Published: May 2014

Most standard hospital beds are flat based with a pull-out backrest, resulting in a tendency for the patient to slide down the bed. This study aimed to compare the outcome for patients at high risk of developing pressure ulcers nursed on either this type of bed or an electrically operated, multi-sectioned profiling bed. A total of 100 patients were randomly assigned either to the profiling bed with a pressure-reducing foam mattress (experimental group) or a flat-based bed with an appropriate pressure-redistributing mattress (control group) for a maximum of 10 days. Risk status and pressure damage were assessed daily. Both a patient and a nurse questionnaire were completed. Data from 70 patients who participated in the study for five days or more were included in the analysis. Pressure ulcer incidence was 0% in both groups. All patients (35) in the experimental group were able to maintain a sitting position compared with only 12/35 in the control group (p=0.0001). While the questionnaire results suggest there were significant differences in postural control and ease of transfer between patients in the two groups, it was not possible to map this to pressure ulcer formation. Poor recruitment into the study was due to the ‘blocking’ of electric beds by heavily dependent patients who did not meet the inclusion criteria, precluding a significant result in terms of pressure ulcer outcomes. This nurse-led use of the profiling beds was examined alongside the main study to investigate why they were allocated in this way.
Exploring the use of an alginate dressing for diabetic foot ulcers
Authors: Bale S. , Baker N. , Crook H. , Rayman A. , Rayman G. , Harding K.G. 
Published: May 2014

Few studies have investigated the use of dressings on patients with diabetic foot ulceration. This paper reports the results of a non-comparative, two-centre study investigating the performance characteristics of SeaSorb dressing in patients with this condition. This was an exploratory study to determine the potential use of this dressing, and not a large randomised control trial. All patients had diabetic foot ulceration of 1cm or more in diameter, classified as Wagner grade I or II, with an ankle brachial pressure index of >0.4. The investigators carried out objective assessments including photography and ulcer tracing as well as subjective assessments of exudate levels, wound bed condition, peri-ulcer skin condition, ease of application and removal of the dressing, dressing conformability, discomfort during dressing application and removal, and clinical signs of infection. Investigators recruited 41 patients in two sites (31 in site one and 10 in site two). Of these, the findings relating to 39 patients could be evaluated. The patients were treated for a maximum of six weeks or until the ulcer healed. The study found that 28.2% (11/39) of the ulcers healed within the six-week period. Overall, there was a significant reduction in mean ulcer area from 2.8cm2 to 1.02cm2 from week 0 to week six. The relative ulcer area showed a significant decrease from 100% to 33%. For patients who experienced ulcer pain (11 patients), its intensity decreased over the six weeks. Severe maceration was not reported for any patient throughout the study. Six patients required treatment for infection. A total of 12 adverse events were reported: seven mild to moderate and five severe. None were directly attributed to the study dressing.
Do we need to reappraise our method of interpreting the ankle brachial pressure index?
Authors: Carser D.G. 
Published: May 2014

This prospective study aimed to investigate if there is a relationship between ankle brachial pressure index (ABPI) and brachial systolic pressure when measured using Doppler ultrasound. Sixty-two limbs (36 patients) in which arterial disease and diabetes mellitus could be excluded using published blood pressure and flow criteria were included in the study. All measurements were made with a Scimed PVL 50 (Bristol UK) using a revised version of the Whiston method and a one-minute treadmill walk. Statistical analysis was carried out using Pearson's product moment correlation and the t test. A relationship was found between the ABPI and brachial systolic pressure, with statistical analysis indicating that the ABPI was highest in hypotensive patients and lowest in hypertensive patients (r=−0.385, p<0.01). This may suggest that the current practice of assigning one particular ABPI value as normal (1.00) is not reliable and that the way in which the index is interpreted needs to be reappraised.
An exploration of patients' understanding of leg ulceration
Authors: Edwards L.M. , Moffatt C.J. , Franks P.J. 
Published: May 2014

Objective:This study aimed to identify patients' understanding of leg ulceration by examining their knowledge of the disease process and their expectations of their treatment outcomes. It also aimed to identify their attitudes to any patient information provided to them.Method:A total of 101 patients (median age: 75 years, range: 23–91; 54% female) with current leg ulceration of 16 months' median duration (range: 1–480) were asked about their understanding of their condition and treatment and their expectations of patient information provided by health-care professionals.Results:The majority of patients believed they knew the cause of their ulceration (66%), most frequently attributing it to trauma (28%). The most important part of the treatment was felt to be bandaging (27%) and visiting the clinic (12%). Thirty-nine percent did not know what the term ‘venous' meant. ‘Trauma’ was frequently described as a psychological problem, with only 7% associating the word with a knock or wound. Over half of the patients (64%) expressed an interest in acquiring further information, particularly on how they could assist ulcer healing (51%).Conclusion:For patient education to be effective, it must be tailored to the patients' vocabulary using simple concepts and straightforward, unambiguous messages.Declaration of interest:None.
Cost-effectiveness of wound management in France: pressure ulcers and venous leg ulcers
Authors: Meaume S. , Gemmen E. 
Published: May 2014

Objectives: This study set out to define realistic protocols of care for the treatment of chronic venous leg ulcers and pressure ulcers in France and, by developing cost-effectiveness models, to compare the different protocols of care for the two ulcer groups, enabling the calculation of direct medical costs per ulcer healed in a typical French health insurance plan. Method: Clinical outcomes and some treatment patterns were obtained from published literature. Validations of different treatment patterns were developed using an expert consensus panel similar to the Delphi approach. Costs were calculated based on national averages and estimates from the UK and Germany. The models were used to measure costs per healed ulcer over a 12-week period. Results: For both the pressure ulcer and venous leg ulcer models, three protocols of care were identified. For pressure ulcers and venous leg ulcers, the hydrocolloid DuoDERM (ConvaTec, also known as Granuflex in the UK and Varhesive in Germany) was most cost-effective in France. Conclusion: The combination of published data and expert consensus opinion is a valid technique, and in this case suggests that treating pressure ulcers and venous leg ulcers with hydrocolloid dressings is more cost-effective than treating them with saline gauze, in spite of the lower unit costs of the latter. Declaration of interest: This study was sponsored by a grant from ConvaTec.
How living with a leg ulcer affects people's daily life: a nurse-led study
Authors: Rich A. , McLachlan L. 
Published: May 2014

Objective:This descriptive phenomenological study explored patients' experiences of living with a leg ulcer.Method:Eight participants (five female and three male) were recruited from a secondary care leg ulcer clinic in a large UK teaching hospital. All had current venous leg ulceration, lasting between five months and 34 years. Data collection was via in-depth semi-structured interviews. Data categories were: symptoms; treatment; perceptions, emotions and coping strategies; and restrictions.Results:Leg ulcers have a significant impact on individuals' lives. The degree to which this occurs varies between each person.Conclusion:Patients need consistent treatment that incorporates benchmarking. A support network to address the needs of those living with a leg ulcer should be considered. This study's findings should be promoted to raise awareness among health-care professionals, enabling them to provide more responsive care.Declaration of interest:The Band Trust and the Florence Nightingale Foundation provided a scholarship to fund the second year of the lead author's research degree.
How sedative medication in older people affects patient risk factors for developing pressure ulcers
Authors: Lindquist L.A. , Feinglass J. , Martin G.J. 
Published: May 2014

Objective:This US study set out to examine the relationship between pressure-ulcer risk and sedation. The researchers examined the frequency of sedative use and the severity of pressure ulceration among older patients hospitalised for skin-ulcer treatment. They compared 91 patients who had been sedated before admission to hospital with 101 who had not.Method:A retrospective chart-review study was carried out between August 1994 and September 2001 in a tertiary-care metropolitan teaching hospital in the US. A total of 278 patients were identified from computerised discharge records. They were aged 60 years or more and had been discharged with medically treated skin ulcers, skin grafts, debridements or cellulitis. They had a principal or secondary diagnosis of chronic skin ulceration.Results:Of the patients with pressure ulcers, 45.5% had been on sedation before admission. They were only slightly more likely to have come from nursing homes and there were no significant differences in prevalence of conditions such as oncological diseases or spinal-cord injury between them and non-sedated patients. However, patients sedated before admission were more likely to be female (67.1%, p=0.04) and had almost a fivefold higher incidence of extremely severe ulceration (p<0.0001).Conclusion:Almost half of the older patients hospitalised with pressure ulcers had been taking sedatives before admission. They were more likely to have extremely severe ulcers with necrotic tissue, pressure ulcers in multiple sites, and the largest and deepest ulcers.