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Calcitroic acid, the excretory form of vitamin D, is the terminal product of a 5-step pathway catalyzed by CYP24A1, commencing with C24-hydroxylation of 1,25-dihydroxyvitamin D 3 (1,25-(OH) 2 D 3 ). Catabolism of 25-hydroxyvitamin D 3 (25-OH-D 3 ) proceeds via analogous steps culminating in calcioic acid; however this C23-truncated acid has not been reported in the circulation. It has recently been shown that 24,25-dihydroxyvitamin D 3 (24,25-(OH) 2 D 3 ) is an important factor in optimal bone fracture healing acting via an effector molecule FAM57B2 to produce lactosylceramide. Administration of 24,25-(OH) 2 D 3 was found to restore normal fracture repair in Cyp24a1 -/- mice devoid of 24,25-(OH) 2 D 3 . We set out to study the multi-step catabolism of D 3 metabolites in vivo using LC-MS/MS methods in vehicle or 24,25-(OH) 2 D 3 -treated mice. Vehicle-treated Cyp24a1 +/- mice possessed normal levels of serum 24,25-(OH) 2 D 3 (7 ng/mL) and 25-OH-D 3 -26,23-lactone (4 ng/mL). We also detected 24-oxo-25-OH-D 3 (3 ng/mL) and 24-oxo-23,25-(OH) 2 D 3 (0.4 ng/mL); which were not detectable in vehicle-treated Cyp24a1 -/- mice. In 24,25-(OH) 2 D 3 -treated Cyp24a1 +/- mice, serum 24,25-(OH) 2 D 3 rose to 200 ng/mL while 25-OH-D 3 -26,23-lactone remained unchanged in comparison to vehicle-treated Cyp24a1 +/- mice Concentration of serum 24-oxo-25-OH-D 3 and 24-oxo-23,25-(OH) 2 D 3 rose by 10-fold, when Cyp24a1 +/- mice were treated with 24,25-(OH) 2 D 3 Calcioic acid was increased to 0.030 ng/mL for 24,25-(OH) 2 D 3 -treated Cyp24a1 +/- mice. In 24,25-(OH) 2 D 3 -treated Cyp24a1 -/- mice, serum 24,25-(OH) 2 D 3 rose further to a striking 830 ng/mL due to lack of catabolism of the 24,25-(OH) 2 D 3 dose. Serum 1,25-(OH) 2 D 3 levels were suppressed in 24,25-(OH) 2 D 3 -treated Cyp24a1 +/- and Cyp24a1 -/- mice. Circulating 1,24,25-(OH) 3 D 3 rose from 73 pg/mL to 106 pg/mL when Cyp24a1 +/- mice were treated with 24,25-(OH) 2 D 3 . While undetectable in vehicle-treated Cyp24a1 -/- mice, 1,24,25-(OH) 3 D 3 rose unexpectedly to 153 pg/mL in 24,25-(OH) 2 D 3 -treated nulls suggesting conversion of 24,25-(OH) 2 D 3 to 1,24,25-(OH) 3 D 3 via 1-hydroxylation. Taken together, amplification of 24,25-(OH) 2 D 3 catabolism by exogenous doses of this metabolite have enabled detection of downstream C24-oxidation pathway products in vivo, including calcioic acid; and provides a platform for studying alternative routes of vitamin D metabolism that may occur in pathological states including hypervitaminosis D and idiopathic infantile hypercalcemia caused by mutations of CYP24A1., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

There is a shortfall of over 10% of the NHS workforce in the UK and the Nursing and Midwifery Council has reported that an estimated 18% of nurses leave the profession altogether within 3 years of qualification. Canada and the USA also face retention issues. The transition period from student to registered nurse is considered an important period during which the newly qualified nurse (NQN) gains experience. This article aims to analyse how the transition from student to registered nurse can be more effectively facilitated, thereby enhancing the delivery of patient care. It examines how NQNs perceive the transition period and discusses how effective transition supports the optimal management of patient care.

This article was migrated. The article was marked as recommended. Aims : The aim of this study was to gain the perspectives of men undergoing recruitment to a nursing degree programme by the process of multiple mini interviews (MMIs). Background : MMIs are used increasingly to select undergraduate students for degree courses, particularly in the healthcare sciences but the impact of MMIs on initiatives to increase gender diversity in these professions is unknown. Design : The study employed a qualitative research approach using a thematic framework of the MMI process. Methods : The study took place between January 2018 - April 2018 and a total of eight students attended for focus groups. Results : Respondents viewed the MMI process as stressful, and also reported that some of the stations created more stress than others, as they were conscious of the gender issues within some of the scenarios. Despite this they also reported the MMI to be a satisfactory selection tool. Conclusion : Participants found the use of MMIs to comprise a valid selection process which, while imperfect and female-dominated, did not unduly disadvantage male candidates. Further research involving multiple nursing schools as well as medical schools is needed to further evaluate the impact of the MMI as a selection tool on male applicants., (Copyright: © 2018 Traynor M et al.)

This research was performed to evaluate the impact of a novel ion-exchange treatment on the organoleptic, pH, color (hue and intensity), and oxidation-reduction potential (ORP) properties of commercial red wines. The ion-exchange treatment used in this study is a commercially available device containing a double cation-anion exchange resin. The device is applied, directly by the consumer, to finished bottled wines with the purpose of mitigating the effects of potentially noxious compounds such as biogenic amines and sulfites. Sensory evaluation tests included discriminative, affective, and Quantitative Descriptive Analysis sensory tests were employed to evaluate the impact on the perceived taste of treated wines. The pH, ORP and color parameters (hue and intensity) of wines were measured to assess any physicochemical alterations that may help to explain the results of the sensory evaluation. While no significant changes in color hue or intensity were found, the results showed a reduction in pH (0.07-0.12) and an increase in ORP (2.667-6.666 mV). However, the changes in pH and ORP did not result in a detectable change in wine taste for the sensory panelists. These findings have important implications for the wine industry, where many consumers select wines for their characteristic taste qualities. Thus, any treatment to potentially remove noxious compounds should not impact the characteristic organoleptic properties of a chosen wine.

Aim: To develop an instrument (Nurse Match: NM) for assessing a candidate's nursing values, their meaning, relative importance and emotional significance. Candidate's values to be scored against professionally preferred nursing values effectively and efficiently., Design: A case study-based qualitative process with quantified output. Perception of self and others in relevant contexts using bi-polar value dimensions., Methods: Respondents ( N  =   63) were first year nursing students completed the instrument and a feedback questionnaire. Data were analysed and scored by ipseus software using algorithm defined parameters. Statistical analysis: Minitab 17., Results: The instrument discriminated effectively and efficiently between year one nurses in terms of the professional quality of their inherent nursing values and attributes;created suitability scores (S TOT scores) for candidate screening purposes;suitability scores closely approximated normal distributions;was valid and reliable: robust in quantitative and qualitative terms;was administered, scored and interpreted in a standard manner;was easy to understand and complete and well received by participants. The NM instrument offers a standardized, effective, user friendly, screening process for values and attributes. Development work with a group of actual applicants is required. NM is complementary to other modes of assessment.

This present study is a report of an interview study exploring personal views on participating in group clinical supervision among mental health nursing staff members who do not participate in supervision. There is a paucity of empirical research on resistance to supervision, which has traditionally been theorized as a supervisee's maladaptive coping with anxiety in the supervision process. The aim of the present study was to examine resistance to group clinical supervision by interviewing nurses who did not participate in supervision. In 2015, we conducted semistructured interviews with 24 Danish mental health nursing staff members who had been observed not to participate in supervision in two periods of 3 months. Interviews were audio-recorded and subjected to discourse analysis. We constructed two discursive positions taken by the informants: (i) 'forced non-participation', where an informant was in favour of supervision, but presented practical reasons for not participating; and (ii) 'deliberate rejection', where an informant intentionally chose to not to participate in supervision. Furthermore, we described two typical themes drawn upon by informants in their positioning: 'difficulties related to participating in supervision' and 'limited need for and benefits from supervision'. The findings indicated that group clinical supervision extended a space for group discussion that generated or accentuated anxiety because of already-existing conflicts and a fundamental lack of trust between group members. Many informants perceived group clinical supervision as an unacceptable intrusion, which could indicate a need for developing more acceptable types of post-registration clinical education and reflective practice for this group., (© 2017 Australian College of Mental Health Nurses Inc.)

Competing Interests: Competing interests: Pramod Puligandla received a one-time honorarium, outside the submitted work, for participation in a meeting regarding the use of inhaled nitric oxide in adults and children hosted by Ikaria Canada Inc. Ian Adatia reports a forthcoming grant award from Malinkcrodt. No other competing interests were declared.

The 'dementia friends' programme was launched by the Alzheimer's Society in the UK two years ago with the purpose of educating members of the public about the things they can do which can enhance the lives of people living with dementia. The aim of this project was to deliver a two-hour 'Dementia Friendly Community Workshop' written by the Alzheimer's Society, to an entire cohort of first-year undergraduate nursing students in one Higher Education Institutions in Northern Ireland. Following delivery of the programme, students were asked to complete a short questionnaire on their knowledge and confidence in relation to dementia care before and after the Dementia Friendly Community programme. A total of 322 undergraduate first-year nursing students took part in the Dementia Friendly Community programme. Of these, 304 returned questionnaires; 31.25% of students stated their perceived improvement in dementia knowledge was 'good' while 49.01% stated their perceived improvement in dementia knowledge was 'very good' and 13.49% stated their perceived improvement in dementia knowledge was 'excellent'. In relation to confidence in engaging with people with dementia, 31.91% stated 'good' improvement, 40.79% stated 'very good' improvement and 11.84% stated 'excellent' improvement. The Dementia Friendly Community programme was positively reviewed by the undergraduate students as it enhanced knowledge and confidence in relation to care of someone living with dementia.

Aims: The aim of this study was to complement existing evidence on the suitability of Multiple Mini Interviews as a potential tool for the selection of nursing candidates on to a BSc (Hons) nursing programme., Background: This study aimed to trial the Multiple Mini Interview approach to recruitment with a group of first year nursing students (already selected using traditional interviews)., Design: Cross-sectional validation study. This paper reports on the evaluation of the participants' detailed scores from the Multiple Mini Interview stations; their original interview scores and their end of year results., Methods: This study took place in March 2015. Scores from the seven Multiple Mini Interview stations were analysed to show the internal structure, reliability and generalizability of the stations. Original selection scores from interviews and in-course assessment were correlated with the MMI scores and variation by students' age, gender and disability status was explored., Results: Reliability of the Multiple Mini Interview score was moderate (G = 0·52). The Multiple Mini Interview score provided better differentiation between more able students than did the original interview score but neither score was correlated with the module results. Multiple Mini Interview scores were positively associated with students' age but not their gender or disability status., Conclusion: The Multiple Mini Interview reported in this study offers a selection process that is based on the values and personal attributes regarded as desirable for a career in nursing and does not necessarily predict academic success. Its moderate reliability indicates the need for further improvement but it is capable of discriminating between candidates and shows little evidence of bias., (© 2016 John Wiley & Sons Ltd.)

For many events in professional life we are given guidelines, for example how to structure your job application or how to write a report about a patient.

Preceptorship was first promoted as part of the Project 2000 reforms, and evidence suggests it remains valuable to newly qualified nurses. Although there is a lack of research of its effect on patient care, what research there is highlights various positive aspects of preceptorship programmes for newly qualified nurses, preceptors, and organisations. This article summarises the results of a scoping review of the literature, published since 2009, on preceptorship. It also describes a preceptorship initiative in London led by Health Education England.

Interprofessional education (IPE) has long been considered an important means of improving communication and interaction between health professionals and of addressing patient safety concerns. This study aimed to explore whether a high-fidelity (HF) simulator could enhance a postgraduate IPE session on team-working and communication skills. A convenience sample of six doctors and six nurses, all recently qualified and working in an acute care setting, participated in teams of one nurse and one doctor in a typical clinical case scenario using a HF simulator. Pre-and post-test questionnaires and two focus groups were used to gather views on the IPE session. All of the participants agreed that all aspects of the IPE activity-the HF simulation, the scenarios and the debriefing-were 'effective' in attracting and retaining interest and attention. Future larger-scale research needs a more objective approach, such as a consideration of patient-related impact and outcomes.

Research concludes that professional socialisation in nursing is deeply problematic because new recruits start out identifying with the profession's ideals but lose this idealism as they enter and continue to work in the profession. This study set out to examine the topic focussing on the development of professional identity. Six focus groups were held with a total of 49 2nd and 3rd year BSc nursing students studying at a university in London, UK and their transcripts were subject to discourse analysis. Participants' talk was strongly dualistic and inflected with anxiety. Participants identified with caring as an innate characteristic. They described some qualified nurses as either not possessing this characteristic or as having lost it. They explained strategies for not becoming corrupted in professional practice. Their talk enacted distancing from 'bad' qualified nurses and solidarity with other students. Their talk also featured cynicism. Neophyte nurses' talk of idealism and cynicism can be understood as identity work in the context of anxiety inherent in the work of nurses and in a relatively powerless position in the professional healthcare hierarchy., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: The concerns of undergraduate nursing and medical students' regarding end of life care are well documented. Many report feelings of emotional distress, anxiety and a lack of preparation to provide care to patients at end of life and their families. Evidence suggests that increased exposure to patients who are dying and their families can improve attitudes toward end of life care. In the absence of such clinical exposure, simulation provides experiential learning with outcomes comparable to that of clinical practice. The aim of this study was therefore to assess the impact of a simulated intervention on the attitudes of undergraduate nursing and medical students towards end of life care., Methods: A pilot quasi-experimental, pretest-posttest design. Attitudes towards end of life care were measured using the Frommelt Attitudes Towards Care of the Dying Part B Scale which was administered pre and post a simulated clinical scenario. 19 undergraduate nursing and medical students were recruited from one large Higher Education Institution in the United Kingdom., Results: The results of this pilot study confirm that a simulated end of life care intervention has a positive impact on the attitudes of undergraduate nursing and medical students towards end of life care (p < 0.001)., Conclusions: Active, experiential learning in the form of simulation teaching helps improve attitudes of undergraduate nursing and medical students towards end of life. In the absence of clinical exposure, simulation is a viable alternative to help prepare students for their professional role regarding end of life care.

An objective structured long examination record (OSLER) is a modification of the long-case clinical examination and is mainly used in medical education. This study aims to obtain nursing students' views of the OSLER compared with the objective structured clinical examination (OSCE), which is used to assess discrete clinical skills. A sample of third-year undergraduate nursing students (n=21) volunteered to participate from a cohort of 230 students. Participants undertook the OSLER under examination conditions. Pre-and post-test questionnaires gathered the students' views on the assessments and these were analysed from a mainly qualitative perspective. Teachers' and simulated patient views were also used for data triangulation. The findings indicate that the OSLER ensures more holistic assessment of a student's clinical skills and particularly essential skills such as communication, and that the OSLER, together with the OSCE, should be used to supplement the assessment of clinical competence in nursing education.

In healthcare, occupational groups have adopted tactics to maintain autonomy and control over their areas of work. Witz described a credentialist approach to occupational closure adopted by nursing in the United Kingdom during the 19th and early 20th centuries. However, the recent advancement of assistant, 'non-qualified' workers by governments and managers forms part of a reconfiguration of traditional professional work. This research used focus groups with three cohorts of healthcare support workers undertaking assistant practitioner training at a London university from 2011 to 13 (6 groups, n = 59). The aim was to examine how these workers positioned themselves as professionals and accounted for professional boundaries. A thematic analysis revealed a complex situation in which participants were divided between articulating an acceptance of a subordinate role within traditional occupational boundaries and a usurpatory stance towards these boundaries. Participants had usually been handpicked by managers and some were ambitious and confident in their abilities. Many aspired to train to be nurses claiming that they will gain recognition that they do not currently get but which they deserve. Their scope of practice is based upon their managers' or supervisors' perception of their individual aptitude rather than on a credentialist claim. They 'usurp' nurses claim to be the healthcare worker with privileged access to patients, saying they have taken over what nursing has considered its core work, while nurses abandon it for largely administrative roles. We conclude that the participants are the not unwilling agents of a managerially led project to reshape the workforce that cuts across existing occupational boundaries., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

A focus group is usually understood as a group of people brought together by a researcher to interact as a group. Focus group research explicitly uses interaction as part of its methodology. This article summarises the practice of running focus groups, explores the nature of focus group data and provides an example of focus group analysis.

A policy consensus has not been reached regarding discontinuing contact precautions in patients with a history of methicillin-resistant Staphylococcus aureus (MRSA). We found that as many as 72% of outpatients flagged for past MRSA were no longer carriers, and a single nasal PCR test provided a reasonable negative predictive value for removing contact precautions.

This article is intended to contribute to the current debate as to whether the objective structured clinical examination (OSCE) should become a standard assessment tool for undergraduate nursing education as they currently are for medicine. The authors describe how one UK university developed an OSCE for a nursing undergraduate programme with the aim of emphasising the need for nursing students to be competent in clinical skills and offering a means of standardising the assessment of these skills. There has been an increasing number of research studies carried out in this area at international level and this article's main contribution to the literature is the description of the Angoff standard-setting procedure that was used to calibrate the OSCE at this University and which makes it the first nursing OSCE in the UK to incorporate a scientific standard-setting procedure.

Aim: To determine whether the use of an online or blended learning paradigm has the potential to enhance the teaching of clinical skills in undergraduate nursing., Background: The need to adequately support and develop students in clinical skills is now arguably more important than previously considered due to reductions in practice opportunities. Online and blended teaching methods are being developed to try and meet this requirement, but knowledge about their effectiveness in teaching clinical skills is limited., Design: Mixed methods systematic review, which follows the Joanna Briggs Institute User guide version 5., Data Sources: Computerized searches of five databases were undertaken for the period 1995-August 2013., Review Methods: Critical appraisal and data extraction were undertaken using Joanna Briggs Institute tools for experimental/observational studies and interpretative and critical research. A narrative synthesis was used to report results., Results: Nineteen published papers were identified. Seventeen papers reported on online approaches and only two papers reported on a blended approach. The synthesis of findings focused on the following four areas: performance/clinical skill, knowledge, self-efficacy/clinical confidence and user experience/satisfaction. The e-learning interventions used varied throughout all the studies., Conclusion: The available evidence suggests that online learning for teaching clinical skills is no less effective than traditional means. Highlighted by this review is the lack of available evidence on the implementation of a blended learning approach to teaching clinical skills in undergraduate nurse education. Further research is required to assess the effectiveness of this teaching methodology., (© 2014 John Wiley & Sons Ltd.)

Context: Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited., Objectives: To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI., Method: Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments., Results: Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant)., Conclusion: The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials.

Nursing has a gendered and religious history where ideas of duty and servitude are present and shape its professional identity. The profession also promotes idealized notions of relationships with patients and of professional autonomy both of which are, in practice, highly constrained or even impossible. This paper draws on psychoanalytic concepts in order to reconsider nursing's professional identity. It does this by presenting an analysis of data from two focus group studies involving nurses in England and Australia held between 2010 and 2012. The studies gave rise to data where extremely negative talk about nursing work seemed to produce, or to be expressed with, a high degree of energy, and a particular kind of enjoyment. In our analysis, we focus on the nurses' apparent enjoyment derived from their expression of a position of powerlessness in which they describe themselves as 'slaves' or 'martyrs' in the health care system. We interpret this as jouissance and suggest that the positions of slave or martyr provide a possible response to what we argue is the impossibility of the nurse's role. We argue that a remnant of a quasi-religious ethic within the profession makes it acceptable for nurses to talk about self-sacrifice and powerlessness as part of their working subjectivity. We further argue that this analysis offers a new consideration of the issue of power and professional identity in nursing that goes beyond seeing nurses as simply overpowered by, or engaged in, a gendered power struggle with other professional groups. We suggest that powerlessness and victimhood hold particular attractions and advantages for nurses and are positions that are more available to nurses than to other occupational groups. This research shows how psychoanalytic theory can help produce new insights into the problems and complexity of nursing and extend existing study of the professions., (© 2014 John Wiley & Sons Ltd.)

It is well established, following Menzies' work, that nursing practice produces considerable anxiety. Like Menzies, we bring a psychoanalytic perspective to a theorization of anxiety in nursing and do so in order to consider nursing practice in the light of psychoanalytic theory, although from a Lacanian perspective. We also draw on Bataille's notion of 'surplus'. These concepts provide the theoretical framework for a study investigating how some clinical nurses are able to remain in clinical practice rather than leave the profession or seek work at a distance from the bedside. We conducted focus groups and present here an analysis of two fragments of nurses' speech. We found the nurses responded from one of two positions. In the first position, the nurses focus on doctors, complain about the surplus afforded them, and call for it to be eliminated. In this way, the nursing group is similar to other groups, considered by Bataille, who also attempt to get rid of a surplus. However, in the second position, the nurses stay with the surplus, tolerating it as they nurse the patient. This latter position is one where the nurse practises with a focus on the patient rather than being distracted by their dispute over the doctor's privilege. The importance of this paper is in its illustration of two distinct positions from which the nurse can practise: one that is not optimal because the nurse is distracted and the other that is more focused on practice, and thus the nurse is in a position to provide the best care possible to patients., (© 2014 John Wiley & Sons Ltd.)

It is well established that nursing practice produces considerable anxiety, and it can also give rise to envy and jealousy. While envy in nursing was identified in the literature more than 50 years ago, there remains a paucity of articles addressing either envy or jealousy for nurses. In a recent research study on current experiences of clinical practice, we analysed a fragment of nurses' speech via Klein's theory of jealousy. The results revealed that the nurses expressed jealousy at the privilege afforded to doctors. We argue that it is important to acknowledge jealousy in nursing practice because it has the potential for 'spoiling' effective care delivery and as such, can have detrimental ramifications in the health system. Also, jealousy may keep the nurse from fully focusing on their nursing practice in that it divides the nurse's attention and so limits the nurse's treatment of the patient. Nurses' jealousy of doctors is a taboo topic in nursing, and yet it warrants serious consideration due to the potential deleterious consequences that can arise when this dynamic is present., (© 2013 John Wiley & Sons Ltd.)

The rise of managerialism within healthcare systems has been noted globally. This paper uses the findings of a scoping study to investigate the management of poor performance among nurses and midwives in the United Kingdom within this context. The management of poor performance among clinicians in the NHS has been seen as a significant policy problem. There has been a profound shift in the distribution of power between professional and managerial groups in many health systems globally. We examined literature published between 2000 and 10 to explore aspects of poor performance and its management. We used Web of Science, CINAHL, MEDLINE, British Nursing Index, HMIC, Cochrane Library and PubMed. Empirical data are limited but indicate that nurses and midwives are the clinical groups most likely to be suspended and that poor performance is often represented as an individual deficit. A focus on the individual as a source of trouble can serve as a distraction from more complex systematic problems., (© 2013 John Wiley & Sons Ltd.)

Resilience is one of the attributes nurses need if they are to deliver quality care successfully in an ever more demanding environment. But how does resilience enhance a healthcare setting and the wellbeing of patients, and is it a personal trait or something that can be taught?

Introduction: Tinea pedis is one of the world's most prevalent dermatophyte infections. MedSpray™ tinea pedis 1 % w/w (topical spray) is a novel, easy-to-use propellant-based spray formulation containing 1 % w/w terbinafine, requiring no manipulation at the site of infection. This is in contrast to the only formulation currently approved in Europe for single application (none are approved in the USA for single use), which is Lamisil(®) Once 1 % w/w (topical solution), containing 1 % w/w terbinafine hydrochloride, which requires manipulation on the affected area., Objective: The aim of this study was to evaluate the efficacy, tolerability and consumer acceptability of a topical spray versus a topical solution in the treatment of tinea pedis., Methods: This study is a phase IIa, randomised, observer-blind, non-inferiority comparative study of the topical spray compared with the topical solution over a 12-week study period. The study was conducted at Bioskin GmbH, Hamburg and Berlin. Patients (n = 120) who presented with the presence of interdigital tinea pedis caused by dermatophytes on one or both feet were enrolled in the study. Patients were randomly assigned between the two treatment groups. Either the topical spray or the topical solution was administered by the study nurse and consisted of a single application (equivalent to 20 mg of terbinafine per foot) on day 1 of the study. No further applications were made for the duration of the study. The hypothesis formulated before commencement of the study was that the topical spray would prove to be non-inferior to the topical solution. Efficacy assessments, including clinical signs and symptoms, mycology and microscopy were performed at baseline and 1, 6 and 12 weeks after treatment., Results: The rate of mycological cure at week 1 was statistically equivalent for both treatments. There was a significant reduction in the overall clinical score as assessed by the Physician's Global Assessment of signs and symptoms for both treatment groups., Conclusion: The topical spray and the topical solution showed comparable anti-fungal activity. Furthermore, the non-inferiority of topical spray to the topical solution was confirmed as determined by the proportion of patients categorised as successfully treated at week 1. This confirms that a topical spray product, which can be applied once without touching the affected skin, is equally as effective in the treatment of tinea pedis and removes the risk of organism transfer associated with touching infected areas., Clinical Trial Registration Number: EudraCT-No. 2008-002399-92.

There is consensus that enabling patient self-care and expertise leads to better management of chronic illness. Clinicians are being encouraged to manage clinical encounters in ways that promote these outcomes rather than perpetuate hierarchical relationships. This article describes one part of a larger study of 55 outpatient consultations conducted within 14 months of the diagnosis of Type 1 diabetes mellitus in young children. Participants were parents and the specialist doctors, nurses, dieticians and social workers who oversee the child's secondary care. Consultations were audio-recorded and transcribed. Our analysis draws on aspects of conversation analysis (CA) to investigate how parents' talk enacts a growing confidence in the management of their child's disease in the face of questioning from professionals. Analysis reveals how this talk distinguishes a duality of focus that combines the normal watchfulness exhibited by all parents as they protect their children, with an additional intense, parallel watchfulness for signs of potentially serious manifestations of diabetes. We term this phenomenon parallel vigilance and illustrate its development using five representative extracts from consultations. The concept of parallel vigilance extends the chronic illness literature and informs our understanding of a process that contributes to parents' developing expertise and provides new and important insights into the way in which parents conceptualize and implement their evolving role in the care of their child. Moreover, parallel vigilance serves as an enabler of parental contributions to the specialist consultation.

OBJECTIVES: This article examines how health professionals guide parental acquisition of knowledge and development of expertise following diagnosis of Type 1 diabetes in a young child. METHODS: Fifty-five consultations from two outpatient paediatric diabetes clinics, one in the UK and one in the US, were audio recorded, transcribed and analysed; eight exemplar extracts are presented here. Participants were parents, whose child younger than 6 years of age had been diagnosed with diabetes within the previous 14 months, and health professionals, who were experienced doctors, nurses, dieticians and social workers. RESULTS: Over the first year following diagnosis, experienced health professionals use four strategies to enable parental self-management of their child's diabetes. Clinicians begin by setting expectations to define the shared responsibilities for the management of the child's disease. Next, they introduce two concepts, trial and error, to help parents respond to variations in blood glucose values and pattern recognition, to help parents refine therapy. As parents gain confidence, clinicians encourage independent pro-active management. Together, these four strategies form a framework to enable development of parental expertise. CONCLUSIONS: This framework addresses the needs of parents and guides their socialization as they assume the role of an expert health care provider for their child. If incorporated into clinical guidelines and health professional training programmes, the framework could facilitate improved self-management of diabetes and perhaps of other chronic diseases.

This descriptive study evaluates whether the Immediate Life Support (ILS) course enhanced final year adult branch nursing students' ability to assess and initially manage the care of deteriorating patients. A thirty point likert scale questionnaire was used to collect quantitative data from final year adult branch nursing students in one Higher Education Institution in the United Kingdom. A comment box permitted the compilation of qualitative remarks. An 84% (n=149) response rate was achieved. The responses demonstrated a positive endorsement of the ILS course as part of the final year adult branch programme. Data also suggested that knowledge and skills learned during the ILS course were extremely useful for students and enhanced their clinical practice. Findings indicate that providing students with the opportunity to participate in the ILS course enhanced their ability to practice in a more confident manner. Furthermore, findings suggest that undertaking the ILS course provides the student with the skills to recognise the deteriorating patient and may have the potential of improving patient care. New knowledge from this research suggests that the ILS course does prepare students for practice and may go some way to assist students make the transition from student to registered nurse., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The nursing profession is rife with impossible ideals that nurses struggle to reconcile, argues the author. The result is a widespread sense of victimisation and powerlessness.

Aim(s): To examine the evidence of how poorly performing nurses and midwives are managed in the UK National Health Service (NHS)., Background: Nurses and midwives form the largest clinical group in the NHS. There is little evidence, however, about poor performance and its management in nursing and midwifery literature., Method(s): The present study comprised a literature search, analysis of recent Nursing and Midwifery Council (NMC) data and observation at NMC fitness to practice hearings., Result: Nurses and midwives are the clinical groups most likely to be suspended in the NHS; Trusts do not report data on suspensions therefore no data exist on numbers, reasons for suspensions, managerial processes, gender, area of work, or ethnicity of those suspended; the few major research projects identify variable management practices, the significant financial cost to the NHS and the personal cost to those suspended; there is evidence that inexperienced, poorly trained, or poorly supported managers use suspension inappropriately. Our observation supported this., Conclusion(s): There is a need for robust data gathering and research in the field of NHS managerial practice., Implications for Nursing Management: Managers should refrain from adopting punitive forms of performance management. Frontline staff and management need better training and support for dealing with poor performance., (2011 Blackwell Publishing Ltd.)

This paper is a report of an interview study exploring psychiatric hospital nursing staff members' reflections on participating in supervision. Clinical supervision is a pedagogical process designed to direct, develop, and support clinical nurses. Participation rates in clinical supervision in psychiatric settings have been reported to be relatively low. Qualitative research indicates that staff members appreciate clinical supervision, but paradoxically, do not prioritize participation and find participation emotionally challenging. Little is known about these contradictory experiences and how they influence participation rates. Twenty-two psychiatric hospital nursing staff members were interviewed with a semistructured interview guide. Interview transcripts were interpreted by means of Ricoeur's hermeneutic method. The respondents understood clinical supervision to be beneficial, but with very limited impact on their clinical practice. Neither management nor the staff effectively prioritized clinical supervision, which added to a downward spiral where low levels of participation undermined the potential benefits of clinical supervision. The respondents embraced and used alternative forums for getting emotional support among peers, but maintained that formalized supervision was the only forum for reflection that could solve the most difficult situations., (© 2011 The Authors. International Journal of Mental Health Nursing © 2011 Australian College of Mental Health Nurses Inc.)

This article reports on the introduction of simulation (using a high fidelity patient simulator) into an undergraduate nursing curriculum in Northern Ireland to develop confidence and proficiency without compromising patient safety. It also reports on how the students perceived the impact of this experience on their clinical practice. The simulation was developed for third-year adult branch nursing students (n=90). Students attended in groups of six for a 4-hour session over a period of 8 days. The students participated in three case scenarios using a high-fidelity patient simulator (HPS). Students' responses showed that the simulation helped them to gain a perspective on the role of a qualified nurse and also enhanced their understanding of the relationship between theory and practice. Students also reported that they valued the experience as a means of highlighting gaps in their knowledge, but it also had given them confidence for future clinical practice.

Group-based clinical supervision is commonly offered as a stress-reducing intervention in psychiatric settings, but nurses often feel ambivalent about participating. This study aimed at exploring psychiatric nurses' experiences of participating in group-based supervision and identifying psychosocial reasons for their ambivalence. Semi-structured interviews were conducted with 22 psychiatric nurses at a Danish university hospital. The results indicated that participation in clinical supervision was difficult for the nurses because of an uncomfortable exposure to the professional community. The sense of exposure was caused by the particular interactional organisation during the sessions, which brought to light pre-existing but covert conflicts among the nurses.

Autonomy in decision-making has traditionally been described as a feature of professional work, however the work of healthcare professionals has been seen as steadily encroached upon by State and managerialist forces. Nursing has faced particular problems in establishing itself as a credible profession for reasons including history, gender and a traditional subservience to medicine. This paper reports on a focus group study of UK nurses participating in post-qualifying professional development in 2008. Three groups of nurses in different specialist areas comprised a total of 26 participants. The study uses accounts of decision-making to gain insight into contemporary professional nursing. The study also aims to explore the usefulness of a theory of professional work set out by Jamous and Peloille (1970). The analysis draws on notions of interpretive repertoires and elements of narrative analysis. We identified two interpretive repertoires: 'clinical judgement' which was used to describe the different grounds for making judgements; and 'decision-making' which was used to describe organisational circumstances influencing decision-making. Jamous and Peloille's theory proved useful for interpreting instances where the nurses collectively withdrew from the potential dangers of too extreme claims for technicality or indeterminacy in their work. However, their theory did not explain the full range of accounts of decision-making that were given. Taken at face value, the accounts from the participants depict nurses as sometimes practising in indirect ways in order to have influence in the clinical and bureaucratic setting. However, a focus on language use and in particular, interpretive repertoires, has enabled us to suggest that despite an overall picture of severely limited autonomy, nurses in the groups reproduced stories of the successful accomplishment of moral and influential action., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Aim: This paper is a report of a study conducted to examine how nurses represent professional clinical decision-making processes, and to determine what light Jamous and Peloille's 'Indeterminacy/Technicality ratio' concept can shed on these representations., Background: Classic definitions of professional work feature autonomy of decision-making and control over the field of work. Sociologists Jamous and Peloille have described professional work as being high in 'indeterminacy' (the use of tacit judgements) relative to technicality (activity able to be codified). The rise of the evidence-based practice movement has been seen as increasing the realm of technical decision-making in healthcare, and it is relevant to analyse nurses' professional discourse and study how they respond to this increase., Method: Three focus groups with qualified nurses attending post-qualifying courses at a London university were held in 2008. Participants were asked to talk about influences on their decision-making. The discussions were tape-recorded, transcribed and subjected to discourse analysis., Findings: Participants described their decision-making as influenced by both indeterminate and technical features. They acknowledged useful influences from both domains, but pointed to their personal 'experience' as the final arbiter of decision-making. Their accounts of decision-making created a sense of professional autonomy while at the same time protecting it against external critique., Conclusion: Pre- and post-registration nurse education could encourage robust discussion of the definition and roles of 'irrational' aspects of decision-making and how these might be understood as components of credible professional practice.

Objectives: The aim of this study was to demonstrate the effect of a novel permeation enhancer system using two existing marketed nail lacquers and the delivery of terbinafine through human nail samples in vitro., Methods: Initially a modified Franz cell was used, where sections of human nail serve as the barrier through which drug penetrates into an agar-filled chamber infected with dermatophytes. A second study was performed using a novel infected nail model where dermatophytes are incubated with and grow into human nail and ATP levels are used as biological marker for antimicrobial activity., Key Findings: The novel permeation enhancing system increased the permeation of both existing drugs formulated in nail lacquers and terbinafine through human nail sections mounted in a modified Franz cell. Furthermore the ATP assay confirmed that the system also enhanced the permeation of terbinafine through infected cadaver nail resulting in a decrease in ATP levels equivalent to those of uninfected negative control samples., Conclusions: This study has clearly demonstrated that the use of a novel permeation enhancing system, which fundamentally alters the chemical structure of the nail, not only enhances the efficacy of the existing topical formulations but also enables the delivery and efficacy of terbinafine when applied ungually. Such a topically applied system has the possibility of overcoming the systemic side effects when terbinafine is delivered orally.

Objective: Renewed focus on public health has brought about considerable interest in workforce development among public health nutrition professionals in Canada. The present article describes a situational assessment of public health nutrition practice in Canada that will be used to guide future workforce development efforts., Methods: A situational assessment is a planning approach that considers strengths and opportunities as well as needs and challenges, and emphasizes stakeholder participation. This situational assessment consisted of four components: a systematic review of literature on public health nutrition workforce issues; key informant interviews; a PEEST (political, economic, environmental, social, technological) factor analysis; and a consensus meeting., Findings: Information gathered from these sources identified key nutrition and health concerns of the population; the need to define public health nutrition practice, roles and functions; demand for increased training, education and leadership opportunities; inconsistent qualification requirements across the country; and the desire for a common vision among practitioners., Conclusions: Findings of the situational assessment were used to create a three-year public health nutrition workforce development strategy. Specific objectives of the strategy are to define public health nutrition practice in Canada, develop competencies, collaborate with other disciplines, and begin to establish a new professional group or leadership structure to promote and enhance public health nutrition practice. The process of conducting the situational assessment not only provided valuable information for planning purposes, but also served as an effective mechanism for engaging stakeholders and building consensus.

Background: Cervical cancer is increasing at 1.5% per year in Ireland with 50% mortality giving 2.2% of all cancer deaths. In the Mid-West region a pilot screening programme has begun to screen all women 25-60 years. 66% of Genitourinary/Sexually transmitted disease (GU/STD) clinics' abnormal smears are <25 years. Requests to abandon "opportunistic" screening prompted this GU/STD clinic audit., Methods: 221(8.4%) patients referred to colposcopy over 4 years were audited. Retrospective analysis was carried out on GU/STD clinic files, hospital files and computer records for biopsy reports. Ethical approval was prospectively granted., Results: 2637 smears were carried out from November 1999 - September 2003.221 patients referred to colposcopy were audited.1%, 3%, 5% had severe, moderate and, mild dyskaryosis, respectively, on cervical screening while 0.8%, 1.2%, 1.5% had CIN3, CIN2, CIN1 abnormalities, respectively, on biopsy with 3.5% having no abnormality (Cervical Intraepithelial Neoplasia = CIN).53% referred to colposcopy were <25 years., Conclusion: 2% had high grade lesions. 37% of high grade lesions are <25 years.Of the high grade lesions 13% had Chlamydia trachomatis (27% of CIN3) and 44% had HPV despite Relative Risks (RR) being 0.75 and 1.09 respectively. Older women had higher grade changes. No statistical difference was found for progression, regression and persistence in those over and under 25.

Introduction: Nursing has come to play a prominent role in government health policy since 1997. Extending the scope of nursing practice into activities previously carried out by doctors can assist a managerialist and 'modernizing' project of increasing National Health Service (NHS) efficiency by removing demarcations between professional groups., Methods: Drawing on elements of poststructuralist linguistics, this paper presents an analysis of a key government speech in the context of a discussion of overall policy intentions., Results: The speech can be seen as an example of how government has attempted to use rhetoric to make its goals attractive to nurses., Conclusion: Policy-makers have to make their policies acceptable to those whom they expect to implement them. In this case, organizational efficiency, chiefly in terms of broader access to NHS services, as well as role substitution, is aligned with government policy promoting social enterprise and 'sold' to the nursing profession as enhancing its status compared with medicine.

First, a suggested definition of discourse: at its most general, discourse can be understood as any system of signs, whether spoken, written, or otherwise. I say 'otherwise', because it is possible to 'read' town planning or architecture, for example, as systems that reflect and enact political values and practices. Some use the term a little more specifically; so, for example a phrase such as 'medical discourse' implies an organised and more or less self-conscious system of concepts and language practice which reflects and is supported by an institutional base. Some while ago, Ian Parker set out certain characteristics of discourse and, importantly, questioned any notion of a simple distinction between discourse and 'reality' - something that can be comprehended outside of discourse.