Search

Aims and Objectives: This literature review aims to define best nursing practice for lower limb ulcer care promoting stabilisation of this physiological consequence of diabetes mellitus and to help provide improved integration of health-within-illness for the patients., Background: According to the Centers of Disease Control, the number of people with diabetes has risen from 20·8 million in 2005 to over 23·6 million in 2007. Research has identified best practice algorithms for care of the diabetic foot, yet none for the ulcerations on the limb from the knee to the ankle., Design: The design of this literature review is to compile research from both nursing and medical communities to develop a best practice for the stabilisation of a lower limb ulcer. A literature search was conducted based on the theoretical framework of stabilisation of a chronic condition., Methods: Twenty-nine articles were identified for use in the evaluation of best practice of lower limb ulcerations. Each article was synthesised using a protocol tool., Results: Control of hyperglycaemia, infection control, ulcer debridement, use of dressings and compression therapy to relieve venous congestion were all identified as important factors in the treatment of lower limb ulcerations., Conclusions: This systematic literature review has resulted in a 'best nursing practice algorithm' for the stabilisation and care of lower limb ulcerations regardless of underlying cause. This care algorithm could be used in collaboration with other health care providers to promote stabilisation of lower limb ulcers and improve the overall quality of life of patient cohort., Relevance to Clinical Practice: The results of this study yield a suggested 'best practice' algorithm for the stabilisation of a lower limb ulcer--treat and control hyperglycaemia; prevent and/or control infection of the ulcer; routine debridement of the ulcer; using the most appropriate type of dressings for each patient; and the application of compression therapy. This algorithm can also be used for to frame patient teaching regarding appropriate treatments and therapies to promote the patient's self-care and stabilisation of the ulcer., (© 2010 Blackwell Publishing Ltd.)

Copyright of Züchtungskunde is the property of Verlag Eugen Ulmer and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

1. The two major classifications of stroke are ischemic and hemorrhagic. Ischemic strokes account for 75% of all strokes and result from the complete occlusion of an artery. Hemorrhagic strokes, often caused by aneurysm or hypertension, are caused by the rupture of a cerebral blood vessel and bleeding into the surrounding tissue. 2. The signs and symptoms of stroke may include unilateral weakness or paralysis, a sagging of one side of the face, double or blurred vision, vertigo, numbness or tingling, and language disturbances. 3. Management of ischemic stroke may include thrombolytic agents (e.g., heparin, warfarin) if the individual is treated within 6 hours after the onset of symptoms. Diagnostic tests may include, computed tomography scan, transesophageal echocardiagraphy, Doppler ultrasonography, and electrocordiography. 4. Occupational health nurses can be actively involved in helping workers modify their risks for stroke, developing and implementing an action plan if an individual is experiencing a stroke, and facilitating the individual's reentry into the worksite after rehabilitation is completed.

We evaluated the Iowa Return to Community, a service demonstration designed to coordinate care and reduce preventable healthcare utilization among at-risk older persons living at home in rural communities. During 2021, 262 older persons elected to participate in the IRTC program. Individuals who participated were more likely to live in micropolitan areas (OR = 2.30, 95% CI 1.34–3.95) relative to metropolitan locations. Individuals who used recommended services were more likely to be men (OR 3.65, 95% CI 1.16–11.51) and more likely to live in rural (OR 17.48, 95% CI 1.37–223.68) and micropolitan areas (OR 3.17, 95% CI 1.00–10.05). However, prevention of health care use corresponded more with consistent and prolonged IRTC program engagement rather than volume of service use. The IRTC constitutes a population aging and rural health strategy to reduce unnecessary health care use while supporting individual preferences to remain at home. [ABSTRACT FROM AUTHOR]

Background: The presence of a wound can be anywhere from non-problematic to life-threatening on a severity spectrum, with bacterial infection and resistance playing a major role in the development of chronicity, delaying wound healing. Wound colonization with multiple organisms and the limited number of effective antibiotics place a heavy burden on the healthcare system, with patients going through multiple surgeries during a prolonged hospitalization time. By analyzing the resistance patterns of pluri-bacterial populations and the approach used in managing complex cases, we aim to improve the protocols applied in caring for chronic wounds in our practice and share our experiences and observations. Methods: We designed a retrospective study on 212 diabetic and non-diabetic patients, aiming to evaluate the course of chronic wound treatment in our practice. We focused on the impact that MDR bacteria and diabetes have on surgical outcomes and their role in the healing process. Results: Patients who received empiric antibiotic therapy before being admitted eventually presented with multiple MDR bacteria compared to those who did not receive antibiotics (p = 0.014). The presence of at least one MDR bacteria in the wound bed was associated with ulcers reaching bone (p = 0.02) and was positively correlated with the number of surgeries performed (p < 0.001). Diabetes played a significant role in surgery-related complications (p = 0.02) and hospitalization time (p < 0.001). Conclusions: Proper management of chronic wounds requires a comprehensive, multidisciplinary approach and a thorough understanding of antibiotic usage. To address this need, we have developed and implemented a chronic wound treatment protocol in our clinic, with the goal of discharging patients once their ulcers have been treated and closed. A key summary of the protocol presented is to reduce the incidence of MDR bacteria and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

Aim: Transitional care as the journey between different caregivers in multiple healthcare centres is crucial for the provision of care to people with cancer, but it is often complex and poorly coordinated. This study aimed to analyse the concept of transitional care for people with cancer. Design: Rodgers' evolutionary concept analysis. Methods: A systematic literature search was conducted on the databases of PubMed (including MEDLINE), EMBASE, Scopus and Web of Science to retrieve articles published between 2000 and 2022. Results: Twenty‐nine eligible articles were selected and their findings were classified in terms of related concepts and alternative terms, antecedents, attributes and consequences. Attributes included three main categories, namely 'nurse‐related attributes', 'organisation‐related attributes' and 'patient‐related attributes'. Antecedents of transitional care for people with cancer were categorized into two main categories: 'patient‐related antecedents' and 'caregiver‐related antecedents'. Consequences were categorized into 'psychological consequences' and 'objective consequences'. [ABSTRACT FROM AUTHOR]

Background: Lower limb oedema is a common co-morbidity in those with diabetes and foot ulceration and is linked with increased amputation risk. There is no current guidance for the treatment of concurrent diabetic foot ulcers and lower limb oedema, leading to uncertainty around the safety and efficacy of combination approaches incorporating offloading and compression therapies. To determine indications and contraindications for such strategies and identify any other supplementary treatment approaches, a scoping review was undertaken to map the evidence relating to off-loading and compression therapy strategies to treat both diabetic foot ulcers and lower limb oedema in combination. Methods: Following the Joanna Briggs Institute (JBI) and PRISMA – Scoping Review (ScR) guidance, this review included published and unpublished literature from inception to April 2022. Literature was sourced using electronic databases including Cochrane Library, PubMed, CINAHL, AMED; websites; professional journals and reference lists of included literature. Eligible literature discussed the management of both diabetic foot ulceration and lower limb oedema and included at least one of the treatment strategies of interest. Data extraction involved recording any suggested off-loading, compression therapy or supplementary treatment strategies and any suggested indications, contraindications and cautions for their use. Results: Five hundred twenty-two publications were found relating to the management of diabetic foot ulcers with an off-loading strategy or the management of lower limb oedema with compression therapy. 51 publications were eligible for inclusion in the review. The majority of the excluded publications did not discuss the situation where diabetic foot ulceration and lower limb oedema present concurrently. Conclusions: Most literature, focused on oedema management with compression therapy to conclude that compression therapy should be avoided in the presence of severe peripheral arterial disease. Less literature was found regarding off-loading strategies, but it was recommended that knee-high devices should be used with caution when off-loading diabetic foot ulcers in those with lower limb oedema. Treatment options to manage both conditions concurrently was identified as a research gap. Integrated working between specialist healthcare teams, was the supplementary strategy most frequently recommended. In the absence of a definitive treatment solution, clinicians are encouraged to use clinical reasoning along with support from specialist peers to establish the best, individualised treatment approach for their patients. Trial registration: Open Science Framework (osf.io/crb78). [ABSTRACT FROM AUTHOR]

Background and Objectives Older adults are at increased risk of frequent transitions between care settings, even though some care transitions are avoidable. The term "avoidable care transitions" is not clearly defined in the research literature. This study aimed to find a consensus-based definition for "avoidable care transitions." Research Design and Methods This study was conducted as part of the TRANS-SENIOR research network. A 4-round Delphi survey was based on a literature review that identified existing definitions of "avoidable care transitions." Articles in MEDLINE via PubMed and CINAHL were searched. In total 95 references were included, and 106 definitions were identified. Definitions were coded to find themes, resulting in 3 themes with 2 codes for each. Results In total, 99 experts from 9 countries were invited, and the response rates in Delphi Rounds 1, 2, 3, and 4 were 37.5%, 19.1%, 33.3%, and 23.3%, respectively. Upon reaching the predefined minimum of 90% agreement, the following definition was declared as final: "Avoidable care transitions (a) are without significant patient-relevant benefits or with a risk of harm outweighing patient-relevant benefits and/or (b) are when a comparable health outcome could be achieved in lower resource settings using the resources available in that place/health care system, and/or (c) violate a patient's/informal caregiver's preference or an agreed care plan." Discussion and Implications Consensus on a definition for "avoidable care transitions" was reached by a multidisciplinary and international panel of experts comprising researchers and providers. The resulting definition consists of 3 distinct dimensions relating to the balance of benefit and harm to a patient, resource consumption, and a patient's or informal caregiver's preferences. The new definition might enhance the common understanding of avoidable care transitions and is now ready for application in research and quality and safety management in health care. [ABSTRACT FROM AUTHOR]

Aims: The aim was to assess the current literature investigating health activism within nursing practice. Design: This was a scoping review of the literature utilizing the updated Levac et al.'s framework. Data Source/Review Methods: A search of the CINAHL, PubMed, Scopus and Allied Health databases was conducted for peer‐reviewed, English research published between January 2000 and April 2021. Results: Thirty‐one articles met the criteria for inclusion in this study. The included research in nursing and health activism was heterogeneous in topic and method and primarily conducted in North America. Four themes resulted from the inductive thematic analysis: (1) Doing Health Activism, (2) Facilitators to Engaging in Health Activism, (3) Barriers to Health Activism Engagement and (4) Limited Education. Activism was not consistently defined and the term was used interchangeably with advocacy. Conclusion: There is a gap between nursing scope of practice, and education and skills in health activism. There is limited research regarding health activism and what constitutes as health activism. There is an opportunity to improve health activism awareness and skills within the nursing profession and undergraduate education and to produce nursing research on health activism. Impact Health activism is integral to the nursing role, however, evidence suggests nurses lack confidence to engage in activism as practice. This is important for nurses across the world and in all care specialities. [ABSTRACT FROM AUTHOR]

We aimed to examine acute trauma outcomes, specifically among those with neurotrauma (NT), in patients with preexisting cerebrovascular accident (CVA). We identified patients treated for neurotrauma or orthopedic trauma at hospitals in Pennsylvania with and without an identified history of stroke with residual deficits, aged 50–99 across four groups of N = 11,648 each. We assessed mortality, craniotomy, and total hospital, ICU, step-down, and ventilator days, functional status at discharge (FSD), and discharge destination. Stroke history did not influence mortality but was predictive of patients undergoing craniotomy (OR = 1.25, p = 0.008). There was a moderate group effect on total ICU days, with the CVA+NT group in the ICU the longest (η2 = 0.10, p < 0.001). Patients with stroke history were less likely to be discharged to home (OR = 0.65, p < 0.001) and had poorer FSD scores across the various domains assessed. Trauma patients with preexisting CVA were found to have poorer outcomes on a number of different metrics when compared to those without stroke history. While it is possible that functional differences pre-injury influenced FSD and discharge destination, given these results, clinicians should assess for possible comorbidities that may influence treatment. [ABSTRACT FROM AUTHOR]

Marking or tagging salamanders increases efficiencies in the operations and management of captive populations and facilitates techniques for monitoring demographics of wild populations. Tags facilitate monitoring of longitudinal data for individual animals such as age or estimated age, growth, reproduction, and health. We evaluated three different tagging methods on Texas Blind, San Marcos, and Comal Springs Salamanders to determine success of each as a longterm marker of individual animals. For this study, we selected visible implant elastomer (VIE), visible implant alphanumeric tags (VIA), and passive integrated transponders (PIT). Of these, only VIE tagging has been evaluated in San Marcos Salamanders; none have been evaluated for use in the other two salamander species studied; and comparison studies among these tags for fully aquatic salamander species have not been performed. These tag types were selected for their effectiveness with other salamander species, ability to be quickly and easily identified tank-side, minimal negative effects on organisms, and perceived ease of implanting the tags. The VIE tags were retained by all species and had high readability scores. However, the issues of tag breakage and deterioration should be considered when using VIE tags. VIA tags were rejected in all but one San Marcos Salamander and all Comal Springs Salamanders, but 90% of Texas Blind Salamanders retained them. PIT tags were not tested on San Marcos, Comal Springs, and smaller Texas Blind Salamanders due to size of tag and low retention rate in larger salamanders. Of the tags evaluated in this study, VIE was the most effective in terms of retention, readability, and ease of insertion. [ABSTRACT FROM AUTHOR]

Introduction: An advancing healthcare system in which patients are often required to self-manage care needs across countless settings and clinicians is increasing focus on participation in care. Mismanagement of care during already risky care-transitions further increases adverse care outcomes. Understanding factors of patient participation in transitional care in an adult population can help guide ways to reduce this burden. Methods: A systematic review of the literature guided by the PRISMA method was conducted to identify factors of patient participation in transitional care. Quantitative studies in which patient participation was measured as an outcome variable and related statistics reported, and data were collected from an adult sample, were included. Two authors independently reviewed, critiqued, and synthesized the articles, and later categorized study variables according to identified trends. Results: Twelve studies across international and multidisciplinary backgrounds were identified. Across studies, efforts were largely based on understanding or improving patient self-management of care during transitions. The majority of studies were experimental and care interventions grounded in patient and healthcare team partnerships, delivered beyond the hospital setting. An array of measures was used to quantify patient participation. Factors of patient participation in transitional care included higher perceived levels of self-efficacy, confidence, and skills to participate in care. Conclusion: The results of this study suggest patient participation in transitional care is largely based on perceptions of self-efficacy, confidence, and skill. Patient-centric transitional care interventions targeting these factors and delivered beyond the hospital setting may improve care outcomes. Implications and direction for further studies includes conceptual clarity, the study of a broader-reaching patient population demographic, and use of multidisciplinary interventions. Outcome variables should remain focused on patient perception of care involvement and participation and expanded to include variables such as functional abilities and social determinants of health. [ABSTRACT FROM AUTHOR]

Species interactions are important for determining the biological organization of natural communities. Presumably, as interacting organisms become more similar in resource niches, the magnitude of competition strength increases. However, the strength of interactions can be context dependent and mitigated by abiotic factors. In western North Carolina, headwater-stream salamanders and crayfish coexist across broad and fine spatial scales throughout their ranges. These dissimilar taxa occupy similar ecological niches within streams, yet there is limited understanding of the role that species interactions play in their local coexistence at fine spatial scales. We used both in-situ and ex-situ methods to evaluate the mechanisms promoting coexistence between stream salamanders (Desmognathus quadramaculatus [Holbrook, 1840] and Desmognathus marmoratus [Moore, 1899]) and Appalachian Brook Crayfish (Cambarus bartonii [Fabricius, 1798]). We conducted field surveys and documented factors potentially associated with refuge cohabitation between crayfish and salamanders within natural streams. We also used a stream mesocosm experiment to test if refuge density and competitor identity affected salamander and crayfish growth and behavior. In our in-situ approach, we found low interspecific cohabitation among desmognathan salamanders and C. bartonii with no detected effects of abiotic or biotic factors. Similarly, in our ex-situ experiment, we found that neither refuge density nor the presence of hetero- or conspecifics influenced the frequency of cohabitation and refuge use, growth, and mortality of D. quadramaculatus and C. bartonii. Although it is possible that local adaptation facilitates coexistence between our focal species, it is more likely that other abiotic (e.g., flow or temperature) and biotic factors (e.g., predators and other community members) in headwater streams besides the presence or absence of our focal taxa affect their distributions, or their interactions are size structured. These results support existing concepts that distantly related species are less likely to compete because of their morphological and phylogenetic dissimilarities, but future evaluations of interactions through time, space, and ontogeny would be useful to fully understand how these 2 taxa interact in headwater streams. [ABSTRACT FROM AUTHOR]

Healthy aging requires people to adopt and maintain beneficial behaviors in all stages of the life span. Supporting behavior change, including via the motivation to make and maintain those changes, is therefore important for the promotion of healthy aging. The aim of this overview is to introduce theoretical frameworks from the psychology of motivation that lend themselves to the development of effective interventions promoting behavior change conducive to healthy aging. We discuss theoretical frameworks referring to the determinants, properties, and functionality of goals aimed at behavior change, and consider the implications of the various theories for designing interventions to support healthy aging. We first consider theories that focus on beliefs and attitudes as determinants of goals, then we address theories that focus on the structure and content as important properties of goals, and, finally, we examine theories drawing on conscious and nonconscious processes underlying the functionality of these goals. We will present if–then planning and mental contrasting, as well as nudging and boosting, that is, novel strategies of behavior change that support the creation of scalable interventions for healthy aging across the life span. Against this background, new perspectives emerge for modern, state-of-the-art, and individually tailored interventions with the aim of enhancing older people's healthy living. [ABSTRACT FROM AUTHOR]

Copyright of Züchtungskunde is the property of Verlag Eugen Ulmer and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Egitania Sciencia is the property of Egitania Sciencia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

To date, assessment tools for older people are different between hospitals and nursing homes in China. The difference between assessment tools can lead to poor communication of information between hospitals and nursing homes, which causes discontinuity of care and adverse outcomes when older people are transferred between these different settings. Continuity Assessment Record and Evaluation (CARE) is a comprehensive geriatric assessment tool developed in the United States of America. This study aimed to evaluate the reliability and validity of the Mandarin Version of CARE for older people who are transferred between hospitals and nursing homes. Using a convenience sampling method, 120 older people in hospitals and 120 older people in nursing homes in Shanghai were selected to test the internal consistency, interrater reliability and criterion‐related validity of CARE from May to November 2017. When used among hospital, 70.0% (7/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an intraclass correlation coefficient (ICC) of greater than 0.75. When used in nursing homes, 90.0% (9/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an ICC of greater than 0.75. For both settings, the correlation coefficients of the subscales with their corresponding instruments for criterion‐related validity were all greater than 0.8 (p <.01). The Mandarin version of CARE exhibits good reliability and validity. It can be used as an assessment tool for transition between hospitals and nursing homes. [ABSTRACT FROM AUTHOR]

All aspects of nursing practice are regulated by politics and affected by changes in public policy. For that reason, nurses need to be active in the political process through which they may influence public policies on health. However, nurses' participation in political activities in many countries is either low or moderate at best. Studies that explore political participation among nurses are rare in Africa. We conducted this study to identify factors that may enhance or hinder nurses' political participation. Through a cross-sectional survey, we collected data from 225 registered nurses sampled from three hospitals and two nursing training schools in Tamale, Ghana, using a structured questionnaire. We analyzed the data using descriptive statistics and correlations. The most frequently reported barriers to political participation were having little free time, lack of trust in politicians, fear of conflict/confrontation, lack of educational preparation, and lack of access to the right connections. The major facilitators of political participation were identified as availability of free time and money, civic skills, personal interest in politics, self-belief and confidence, and a strong party affiliation. These findings call for integration of political content into the nursing education curriculum and for professional nursing organizations to create opportunities for their members to learn about the political process. [ABSTRACT FROM AUTHOR]

Aims and objectives: To explore home care nurses' experiences of implementation and use of checklists developed for improving continuity of care for older patients (65+ years). Background: The Norwegian Coordination Reform was implemented to improve coordination between hospitals and communities and facilitate a quicker return to home community after hospital discharge. To follow‐up, national learning networks were initialised to improve pathways for chronically ill older patients, including the development and use of standardised checklists. Design: An explorative qualitative design was chosen. Methods: Three focus group interviews were conducted, including 18 registered nurses from eight municipalities in southern Norway. Systematic text condensation was used to analyse the interview texts. The COREQ checklist was followed. Results: Three categories emerged from the analysis. (a) "The implementation process" included the experiences of a chaotic beginning, the importance of involvement, the leaders' role and resource allocation. (b) "Pros and cons of checklists in use" included the informants' experiences of checklists' usefulness for nurses and the patients. (c) "Competence needed" included the need for a comprehensive set of formal, experiential and social competences. Conclusion and relevance to clinical practice: The leaders' role, support and engagement are decisive for a successful implementation. To succeed and establish solid routines, allocating resources when implementing new laborious routines, such as checklists, is important. To improve holistic continuity of care to chronically ill older patients, checklists should be customisable to each patient's needs, be comprehensive enough to grasp the essence in what to be done at several time points, but at the same time brief enough to be operational. Checklists can be a useful tool for home care nurses, if customised to the individual municipality and the staffs' working routines. It is important that the staff have versatile and extensive competencies enabling them to use the checklists appropriately. [ABSTRACT FROM AUTHOR]

Background: Compelling evidence indicates that gaps in quality, safety, and experiences occur when patients encounter transitions across the care continuum. Differences in the organization of healthcare services as well as disparities in health across the globe, may have a unique impact on processes associated with transitions of care for client populations. Purpose: Increased attention to the concept of transitions of care has resulted in disparate meanings and lack of clarity about its nature. Therefore, the purpose of this manuscript is to address this knowledge gap by analyzing the concept of transitions of care at the population level. Methodology: To address the knowledge gap of what constitutes transitions of care at the population level, a concept analysis was done guided by the methodology of Walker and Avant. A comprehensive search of the literature yielded a small but relevant number of publications. Results: This analysis identified four defining attributes, together with antecedents and consequences of transitions of care at the macro-system level of healthcare. A synthesized definition of transitions of care was developed. Implications for Practice: This analysis provides conceptual clarity for the concept of transitions of care at the macro-system level of care. It can be used to guide the development of a middle-range theory to inform clinical practice and health policy. [ABSTRACT FROM AUTHOR]

The incidence rate of middle-aged ischemic stroke patients has been increasing. Because of their high risk of recurrence, it is important for them to adhere to their self-care performance. The purpose of this study was to investigate predictors of self-care performance among middle-aged ischemic stroke patients. A descriptive correlational and cross-sectional survey design was used. About 140 participants who had been diagnosed with ischemic stroke within a year and visited neurological outpatients were investigated. Participants answered self-report questionnaires, the Secondary Stroke Prevention Knowledge Scale, the Health-Related Hardiness Scale, and the Subjective Self-Care Performance Scale. Hardiness, secondary-stroke-prevention knowledge, age, and stroke-diagnosis duration had statistically significant influences on self-care performance; hardiness had the largest effect. This study highlighted hardiness as the major predictor of self-care performance. To improve middle-aged ischemic stroke patients' self-care performance, nurses need an integrated approach that considers a patient's age, diagnosis duration, secondary-stroke-prevention knowledge, and, especially, hardiness. [ABSTRACT FROM AUTHOR]

Introduction: Studies are needed to inform the preparation of community nurses to address patient behavioral and social factors contributing to unnecessary readmissions to hospital. This study uses nurses’ input to understand challenges faced during home care, to derive a framework to address the challenges. Methods: Semistructured interviews were conducted to saturation with 16 community nurses in Singapore. Interviews were transcribed verbatim and transcripts independently coded for emergent themes. Themes were interpreted using grounded theory. Results: Seven major themes emerged from 16 interviews: Strained social relationships, complex care decision-making processes within families, communication barriers, patient’s or caregiver neglect of health issues, building and maintaining trust, trial-and-error nature of work, and dealing with uncertainty. Discussion: Community nurses identified uncertainty arising from complexities in social-relational, personal, and organizational factors as a central challenge. Nursing education should focus on navigating and managing uncertainty at the personal, patient, and family levels. [ABSTRACT FROM AUTHOR]

Introduction The adequate use of compression in venous leg ulcer treatment is equally important to patients as well as clinicians. Currently, there is a lack of clarity on contraindications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients. Methods The project aimed to optimize prevention, treatment and maintenance approaches by recognizing contraindications, risk factors, adverse events and complications, when applying compression therapy for venous leg ulcer patients. A literature review was conducted of current guidelines on venous leg ulcer prevention, management and maintenance. Results Searches took place from 29th February 2016 to 30th April 2016 and were prospectively limited to publications in the English and German languages and publication dates were between January 2009 and April 2016. Twenty Guidelines, clinical pathways and consensus papers on compression therapy for venous leg ulcer treatment and for venous disease, were included. Guidelines agreed on the following absolute contraindications: Arterial occlusive disease, heart failure and ankle brachial pressure index ( ABPI) <0.5, but gave conflicting recommendations on relative contraindications, risks and adverse events. Moreover definitions were unclear and not consistent. Conclusions Evidence-based guidance is needed to inform clinicians on risk factor, adverse effects, complications and contraindications. ABPI values need to be specified and details should be given on the type of compression that is safe to use. Ongoing research challenges the present recommendations, shifting some contraindications into a list of potential indications. Complications of compression can be prevented when adequate assessment is performed and clinicians are skilled in applying compression. [ABSTRACT FROM AUTHOR]

The purpose of this pilot study was to assess the cost-effectiveness of four different doses (based on patients’ level of cognition and activation) of a home-based care transitions intervention compared with usual care at 2 and 6 months after hospital discharge to home for 126 adult patients with three or more chronic diseases. Health care utilization was measured, and a cost-effectiveness analysis was used to estimate incremental costs and quality-adjusted life-years associated with each intervention arm. At 6 months, results from this pilot study are very promising and support cost-effectiveness for Group 2-low cognition/high activation, Group 3-normal cognition/low activation, and Group 4-normal cognition/high activation patients. However, Group 1-low cognition/low activation needs a more intensive treatment than what was provided in the intervention, because of their low cognition and activation levels. Our intervention strategies provided to the groups would be scalable to a larger patient population and across different facilities. [ABSTRACT FROM AUTHOR]

Background: Baseline stroke knowledge in a targeted population is indispensable to promote the effective stroke education. We report the baseline knowledge, attitude, and practice (KAP) of high school students with respect to stroke from Nepal. Materials and Methods: A self-structured questionnaire survey regarding KAP about stroke was conducted in high school students of 33 schools of Bharatpur, Nepal. Descriptive statistics including Chi-square test was used, and the significant variables were subjected to binary logistic regression. Results: Among 1360 participants, 71.1% had heard or read about stroke; 30.2% knew someone with stroke. 39.3% identified brain as the organ affected. Sudden onset limb/s weakness/numbness (72%) and hypertension (74%) were common warning symptom and risk factor identified. 88.9% would take stroke patients to a hospital. Almost half participants (55.5%) felt ayurvedic treatment be effective. 44.8% felt stroke as a hindrance to a happy life and 86.3% believed that family care was helpful for early recovery. Students who identified at least one risk factor were 3.924 times (P < 0.001, confidence interval [CI] = 1.867-8.247) or those who identified at least one warning symptom were 2.833 times (P ≤ 0.023, CI = 1.156-6.944) more likely to take stroke patients to a hospital. Conclusion: KAP of high school Nepalese students regarding stroke was satisfactory, and the students having knowledge about the risk factors and warning symptoms were more likely to take stroke patients to a hospital. However, a few misconceptions persisted. [ABSTRACT FROM AUTHOR]

The importance of competition among stream salamanders and other stream vertebrates in headwater systems is understudied. We conducted a replicated artificial stream experiment to evaluate competitive interactions among three common vertebrates. In this experiment, we measured change in body condition of salamanders in the black-bellied dusky complex ( Desmognathus quadramaculatus/ folkertsi) in the presence of two different fish species, Common Creek Chub ( Semotilus atromaculatus) and Coosa Darter ( Etheostoma coosae). There was no statistically significant change in body condition between the control and darter present treatments. However, salamander body condition was significantly reduced in the presence of the creek chubs suggesting an asymmetric competitive interaction between those two species. While predation is often cited as a potential mechanism limiting the distribution of stream species, the role of interspecific competition may be just as vital. Overall, our results highlight that competition, and not solely predation, may explain why some stream salamanders are restricted to headwater reaches. [ABSTRACT FROM AUTHOR]