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Introduction: Performance standards drive current instructional practice. Disability-specific curricula is a critical component in preparing children for postsecondary transition. Currently, no standards govern instruction in orientation and mobility (O&M) skills for children with visual impairments. Standards for O&M would provide structure for educational equity in assuring that students with visual impairments receive a free and appropriate education. Method: This study used Delphi survey methods to determine consensus on the validity of the Orientation and Mobility Career, College, and Community Readiness Standards (O&M CCCRS). Consensus was measured as 80% or better agreement. Three survey rounds were initiated and two were completed by a purposive sample of certified orientation and mobility specialist (COMS) from two participant groups: Seven COMS from primary and secondary school–based settings and three from personnel preparation. Results: This Delphi study achieved consensus on the O&M CCCRS five student-performance standards (end of Grade 12 or age 21 years) as well as the corresponding age- and grade–level performance indicators at ages 24 months, 4 years, end of Grade 3, end of Grade 7, and end of Grade 12. Consensus was reached on all but two performance indicators (83 of the 85). Discussion: The Round 1 survey established validity of five O&M Domains: (1) Concept Development, (2) Sensory Development, (3) Orientation and Mapping, (4) Travel Techniques, and (5) Communication, Personal Safety, and Advocacy. Subsequent survey rounds found that 80% of participants agreed on the inclusion of 83 of the 85 performance indicators corresponding to those domains. Implications for practitioners: Alignment of O&M standards to Common Core Standards empowers teams to justify the instructional time, to document skill acquisition relative to the benchmarks of general-education peers, and to show where O&M skills support progress in common core and state learning standards.

BackgroundLaboratorians have the opportunity to help minimize the frequency of adverse drug reactions by implementing pharmacogenomic testing and alerting care providers to possible patient/drug incompatibilities before drug treatment is initiated. Methods combining PCR with MALDI-ToF MS have allowed for sensitive, economical, and multiplexed pharmacogenomic testing results to be delivered in a timely fashion.MethodThis study evaluated the analytical performance of the Agena Biosciences iPLEX® PGx 74 panel and a custom iPLEX panel on a MassARRAY MALDI-TOF MS instrument in a clinical laboratory setting. Collectively, these panels evaluate 112 SNVs across 34 genes implicated in drug response. Using commercially available samples (Coriell Biorepository) and in-house extracted DNA, we determined ideal reaction conditions and assessed accuracy, precision, and robustness.ResultsFollowing protocol optimization, the Agena PGx74 and custom panels demonstrated 100% concordance with the 1000 Genomes Project Database and clinically validated hydrolysis probe genotyping assays. 100% concordance was also observed in all assessments of assay precision when appropriate QC metrics were applied.ConclusionsSignificant development time was required to optimize sample preparation and instrumental analysis and 3 assays were removed due to inconsistent performance. Following modification of the manufacturer’s protocol and instituting manual review of each assay plate, the Agena PGx74 and custom panel constitute a cost-effective, robust, and accurate method for clinical identification of 106 SNVs involved in drug response.

Knowledge of the correct levels of tissue fluid is vital to ensure a smooth healing process. Leanne Cook and Clare Barker offer advice on selecting appropriate dressings for residents

The incidence and prevalence of lymphoedema and chronic oedema is increasing as a result of the aging population and increased obesity rates. Oedema is frequently recognised but not promptly treated ( Hedger, 2006 ). Practitioners must remember that oedema is a symptom and the cause needs to be established to ensure that appropriate treatment can be initiated. Successful management of chronic oedema involves a continuing partnership between the patient and practitioner to promote self-management. This article describes the progression of chronic oedema and subsequent skin changes, and highlights some of the challenges faced by the practitioner in facilitating effective care.

Wound infection delays healing and impairs quality of life. Leanne Cook and Karen Ousey discuss the recognition and treatment of wound infections, which are essential skills for practice nurses

It is important to undertake a holistic assessment of the patient who presents with a wound. Karen Ousey and Leanne Cook give an overview of the key responsibilities of the practice nurse

Management and treatment of wounds is costly to health care. As such, accurate wound assessment is an essential skill required to enhance the wound healing process. Wound assessment tools are available to assist practitioners to ensure that wounds are correctly assessed, healing is documented, and factors that could delay healing are identified and appropriately managed. In an attempt to understand current practices a survey was undertaken of delegates attending the Wound Expo 2011 wound assessment zone to provide a clearer insight into today’s practises and opinions relating to wound assessment. The results were collated and are presented in this article.

Wound infection delays healing and impairs quality of life. Leanne Cook and Karen Ousey discuss the recognition and treatment of wound infections, which are essential skills for practice nurses

Venous leg ulcers can be highly exuding and moisture management is often challenging. The emergence of super-absorbent dressings have been marketed as a tool to manage high levels of exudate, in combination with compression therapy, for the management of venous leg ulcers. Compression bandages are designed to give precise amounts of compression which is calculated by considering the circumference of the limb. Super-absorbent dressings contain a form of polymer that swells as it locks in moisture. This study was designed to evaluate the effects of super-absorbent dressings on sub-bandage pressure. A series of controlled tests were performed using four different super-absorbent dressings which were applied to a volunteer's limb beneath compression bandaging. Sub-bandage pressures were recorded as fluid was introduced to the super-absorbent dressing. The results identified that sub-bandage pressure increases and the pressure profile changes following the expansion of the super-absorbent dressing. Further research needs to be performed to assess whether the use of these super-absorbent dressings under compression could be detrimental to venous ulcer healing.

Linguists, logicians and literary theorists all have their own ways of explaining the interplay between real and non-real worlds. None of these explanations adequately accounts for the use of language in situations where both real and imagined worlds are manipulated and discussed simultaneously, such as roleplaying and acting. In this paper, I investigate the shortcomings of these theories when applied to referring expressions in these contexts. I suggest an approach to multiple world discourse to address these shortcomings by combining elements of possible worlds as presented by Saul Kripke literary fictional worlds and the mental space theory of Gilles Fauconnier.

It is important to undertake a holistic assessment of the patient who presents with a wound. Karen Ousey and Leanne Cook give an overview of the key responsibilities.

It is important to undertake a holistic assessment of the patient who presents with a wound. \ud Karen Ousey and Leanne Cook give an overview of the key responsibilities of the practice nurse.

Right from the start of my nursing career, even as a student nurse, I was mystified by the question ‘what dressing should I put on that wound?’ and even more mystified by my qualified colleagues’ decision-making processes and the inconsistency that often came with this. This fuelled the desire to be able to answer the question for myself. Once qualified, I worked on a general surgery ward, which included patients undergoing vascular surgery. This is where I was exposed to extensive ulceration and looking back quite disfiguring forms of foot debridement which would be unacceptable in today’s world. This gave me the opportunity to put the little theory of wound healing and the limited knowledge of dressing actions I had into practice. Looking back I now realise I knew very little but worryingly was seen as one of the more knowledgeable in terms of wound care on the ward. In the 1990s vascular surgery started to separate into its own speciality and with it came huge advances in the options for re-vascularization. This came around the same time that the choices of wound care products were expanding; compression therapy became standard treatment for venous ulceration and my desire for knowledge grew and grew. I then had the unique opportunity to set up an out-patient vascular wound clinic while still being a ward sister, this slowly grew into a full time job and I was appointed as vascular nurse specialist in 2005. The learning curve continues to this day and I have just completed a Masters in Advancing Practice and I have recently been appointed as a part-time lecturer practitioner at Huddersfield University focusing on wound healing and peripheral vascular disease.

This article reports on research to explore if pre-registration nursing students felt prepared to manage patients' skin integrity effectively on registration. Final year nursing students completing adult, child and mental health fields were invited to complete questionnaires to investigate the amount of teaching sessions delivered in university in relation to managing skin integrity during their 3-year training programme, discover if pre-registration nursing students received supplementary management of skin integrity teaching in the clinical areas, explore which member of staff in the clinical areas supported the students' learning in the area of skin integrity. Data was collected on 217 final year students (196 females and 21 males) at two higher education institutions in the north of England. The majority of respondents (n=146; 68%) reported receiving less than 10 hours formal teaching at university on the subject of skin integrity over their 3-year courses. Of those registered on degree courses, 134 students (71%) reported receiving less than 10 hours formal teaching over their 3-year courses, compared with only 12 students (46%) registered on diploma courses. Some 198 (99%) of respondents reported that their clinical teaching was undertaken by registered nurses all or some of the time. Other health professionals were reported to provide substantially less clinical teaching; with the next largest contribution reported to be provided by specialist nurses, who provided all clinical teaching to 36 respondents (19%) and some clinical teaching to 115 respondents (59%). Some 149 respondents (70%) reported that the teaching they received had developed their knowledge and skills to maintain skin integrity for all patients. Respondents claimed that teaching received had developed their knowledge and skills, reporting an average of 16.9 hours spent in directed study; whereas those who did not claim that teaching they had received had developed their knowledge and skills reported an average of 7.6 hours spent in directed study. The results of this study suggest that diplomate nurses are likely to feel more confident and competent than their graduate counterparts, despite spending the same amount of time with mentors and their peers.

The use of Negative Pressure Wound Therapy (NPWT) has been widely documented as a technique to help heal complex wounds. This paper presents the findings of a preliminary study which aimed to explore quality of life experienced by patients undergoing negative pressure wound therapy (NPWT) as part of their wound care treatment in comparison to that of patients with a wound using traditional (standard) wound care therapies. A quasi-experimental study was undertaken, with patients treated in wound care/vascular clinics with chronic/acute wounds. Quality of life impact was measured using the Cardiff Wound Impact Schedule and administered post consent at timed intervals. Our results identified that there were no real differences in quality of life scores recorded by patients over the 12 week period. Although there was no overall interaction between the therapies used for wound healing, NPWT did have an effect on social life: during the first 2 weeks of the application of therapy, patients in the NPWT group reported an increase in the social life domain. The authors conclude that true QoL can only be elicited if an accurate baseline is established or if data is collected over a long enough period to allow comparison of scores over time.

Patient-reported outcome measures (PROMs) have been identified as being measures of a patient's health status or health-related quality of life, allowing for health status information to be collected from patients before and after an intervention through completion of a questionnaire. The information collected will provide an indication of the outcomes or quality of care delivered to NHS Patients. The collection of data commenced in April 2009 for specific conditions; NHS-funded unilateral hip replacements, unilateral knee replacements, groin hernia surgery or varicose vein surgery. PROMs will be developed for further conditions in the future, however, at present there are none relating to tissue viability or leg ulceration.