The Psychological Consequences of Wounds - a Vicious Circle that Should not be Overlooked.

Wounds and wound healing are often considered to be purely medical phenomena, but there is growing evidence that the psychological impact on the patient is of equal importance. The psychological consequences of having a wound may include stress, sleep disturbances, negative mood and social isolation. These outcomes may be a result of the physical effects of the wound, such as pain or high levels of exudate. Wound management problems, mobility issues and malodour will also have an impact on the patient’s psychological well-being. These consequences may, in turn, have a profound impact on the healing of a chronic wound and therefore affect an individual’s quality of life

The Impact of Ramadan on Lifestyle Behaviours and Implications for Cardiac Rehabilitation: A Review

Introduction: The Muslim population worldwide have a higher incidence of cardiovascular disease than that of the non-Muslim population, and this may become exaggerated during the religious observances of Ramadan. This review assessed the evidence regarding the impact of Ramadan on lifestyle behaviours in Muslims with cardiovascular disease. Method: This article reviews the literature concerning the impact of Ramadan on lifestyle behaviours and its effects on cardiac rehabilitation between 2000 and 2012. Studies were identified, using Academic Search Complete, Google Scholar, Psyclnfo, PsycARTICLES, Medline and CINAHL Plus. The search terms used were: 'cardiac rehabilitation'; 'cardiovascular disease'; 'Ramadan'; 'fasting'; 'physical activity'; 'exercise'; 'diet'; 'smoking'; 'sleep'; 'behaviour change'; 'medication'; and 'treatment'. Findings: Evidence suggests that fasting during Ramadan can have a beneficial effect on factors such as cholesterol levels, body weight and blood pressure; however, benefits are rarely sustained in the long term. Other behavioural changes such as non-adherence to medication, and diet and exercise regimes have more negative consequences for sufferers of cardiac disease. Conclusions: Lifestyle behaviours adopted during Ramadan can have a negative impact on cardiovascular disease. Health professionals are urged to find innovative ways to engage this population in healthy lifestyle choices throughout this period

Understanding the Development Needs of the Primary Care and Community Health Workforces With Regard to Sexual Health in NHSScotland to Enable the Successful Implementation of ‘The Sexual Health and Blood Borne Virus Framework 2011-2015’: a Scoping Study

The Sexual Health and Blood Borne Virus Framework (Scottish Government, 2011) was published in July 2011 providing a single overarching strategy to bring together and address four linked policy areas: sexual health and wellbeing, including teenage pregnancy, HIV, Hepatitis C and Hepatitis B. The need for the delivery of sexual health services to be a multi-agency, multi-disciplinary responsibility is highlighted throughout the Framework, as is the importance of having adequately trained staff in both health and non-health roles. The primary care workforce are often responsible for delivering a large proportion of frontline sexual health services, often by staff who have little specialist education and training in sexual health. Understanding the training and development needs of this workforce is therefore important in ensuring effective delivery of service, and implementing The Sexual Health and Blood Borne Virus Framework. The main aim of the scoping study was to understand the development needs of the primary care and community health workforces with regard to sexual health in NHS Scotland to enable the successful implementation of ‘The Sexual Health and Blood Borne Virus Framework 2011-2015’. For the purposes of this study, the primary care workforce considered included the following groups: general practitioners, general practice nurses, public health nurses (health visitors and school nurses), community midwives, receptionists and administrative staff, health care assistants and healthcare support workers

Evaluation of a Novel Cardiac Rehabilitation Programme

MyAction is an intensive 16 week behaviour change programme which integrates the medical care and lifestyle support of patients with cardiovascular disease and those at high risk of developing the disease. Based on the methodology used for the EUROACTION trial (Wood et al., 2008). Incorporates a family centred approach, actively involving patient’s partners. The MyAction programme has been delivered in number of primary care trusts across the UK as part of a national demonstration project. However the validity is not known in some of the most deprived and culturally diverse communities in an inner city location

Safety and effectiveness of nurse telephone consultation in out-of-hours primary care: randomised controlled trial

Objective: To determine the safety and effectiveness of nurse telephone consultation in out of hours primary care by investigating adverse events and the management of calls. Design: Block randomised controlled trial over a year of 156 matched pairs of days and weekends in 26 blocks. One of each matched pair was randomised to receive the intervention. Setting: One 55 member general practice cooperative serving 97 000 registered patients in Wiltshire. Subjects: All patients contacting the out of hours service or about whom contact was made during specified times over the trial year. Intervention: A nurse telephone consultation service integrated within a general practice cooperative. The out of hours period was 615 pm to 1115 pm from Monday to Friday, 1100 am to 1115 pm on Saturday, and 800 am to 1115 pm on Sunday. Experienced and specially trained nurses received, assessed, and managed calls from patients or their carers. Management options included telephone advice; referral to the general practitioner on duty (for telephone advice, an appointment at a primary care centre, or a home visit); referral to the emergency service or advice to attend accident and emergency. Calls were managed with the help of decision support software. Main outcome measures: Deaths within seven days of a contact with the out of hours service; emergency hospital admissions within 24 hours and within three days of contact; attendance at accident and emergency within three days of a contact; number and management of calls in each arm of the trial. Results: 14 492 calls were received during the specified times in the trial year (7308 in the control arm and 7184 in the intervention arm) concerning 10 134 patients (10.4% of the registered population). There were no substantial differences in the age and sex of patients in the intervention and control groups, though male patients were underrepresented overall. Reasons for calling the service were consistent with previous studies. Nurses managed 49.8% of calls during intervention periods without referral to a general practitioner. A 69% reduction in telephone advice from a general practitioner, together with a 38% reduction in patient attendance at primary care centres and a 23% reduction in home visits was observed during intervention periods. Statistical equivalence was observed in the number of deaths within seven days, in the number of emergency hospital admissions, and in the number of attendances at accident and emergency departments. Conclusions: Nurse telephone consultation produced substantial changes in call management, reducing overall workload of general practitioners by 50% while allowing callers faster access to health information and advice. It was not associated with an increase in the number of adverse events. This model of out of hours primary care is safe and effective. <br/