Carolyn Middleton

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Lamicel is a synthetic osmotic cervical dilator reported to work within two hours. To evaluate its efficacy and side effects, we conducted a double-blind, randomized clinical trial comparing Lamicel with multiple laminaria for cervical dilation in 219 patients before second-trimester abortion. A single Lamicel produced significantly less initial dilation(More)
Despite major advances in the management of pain since the Royal College of Surgeons and the Royal College of Anaesthetists announced in 1990 that postoperative pain management in British hospitals was inadequate, pain continues to be an unacceptable but common sequel to surgery (Wood, 2002). Pain assessment is simple, but unfortunately it is infrequently(More)
Rib fractures are a common injury to the chest. The mainstay of treatment is adequate analgesia coupled with meticulous respiratory care in order to prevent complications. Treatment can be as an outpatient, but patients with more severe fractures may be admitted to hospital for oxygen therapy, ventilation, aggressive analgesic techniques and physiotherapy.(More)
AIM To discuss the implementation of the Welsh Government's Advanced Practice Framework into a Welsh University Health Board. BACKGROUND A plethora of advanced practice roles have evolved across all health-care areas in response to the European Working Time Directive and workforce shortage drivers, leading to confusion and lack of structure. EVALUATION(More)
Almost all patients who undergo amputation suffer 'phantom sensations', a sensory perception of the missing limb, possibly caused by a neural imprint or memory of the limb within the brain. The patient may experience abnormal kinaesthetic sensation, such as the feeling that the limb is in an abnormal position. Perceived changes in length, size or(More)
AIM To report an analysis of the concept of acquired pharmaco-dynamic opioid tolerance. BACKGROUND Acquired pharmaco-dynamic opioid tolerance is a complex and poorly understood phenomenon associated with strong opioid therapy for managing pain. Critical review of the concept provides greater clarification of the attributes, assisting healthcare(More)