ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children

Atopic dermatitis (AD) is a highly pruritic, chronic inflammatory skin disease. The diagnosis is made using evaluated clinical criteria. Disease activity and burden are best measured with a composite score, assessing both objective and subjective symptoms, such as SCORing Atopic Dermatitis (SCORAD). AD management must take into account clinical and pathogenic variabilities, the patient’s age and also target flare prevention. Basic therapy includes hydrating and barrier‐stabilizing topical treatment universally applied, as well as avoiding specific and unspecific provocation factors. Visible skin lesions are treated with anti‐inflammatory topical agents such as corticosteroids and calcineurin inhibitors (tacrolimus and pimecrolimus), which are preferred in sensitive locations. Topical tacrolimus and some mid‐potency corticosteroids are proven agents for proactive therapy, which is defined as the long‐term intermittent anti‐inflammatory therapy of frequently relapsing skin areas. Systemic anti‐inflammatory or immunosuppressive treatment is a rapidly changing field requiring monitoring. Oral corticosteroids have a largely unfavourable benefit–risk ratio. The IL‐4R‐blocker dupilumab is a safe, effective and licensed, but expensive, treatment option with potential ocular side‐effects. Other biologicals targeting key pathways in the atopic immune response, as well as different Janus kinase inhibitors, are among emerging treatment options. Dysbalanced microbial colonization and infection may induce disease exacerbation and can justify additional antimicrobial treatment. Systemic antihistamines (H1R‐blockers) only have limited effects on AD‐related itch and eczema lesions. Adjuvant therapy includes UV irradiation, preferably narrowband UVB or UVA1. Coal tar may be useful for atopic hand and foot eczema. Dietary recommendations should be patient‐specific, and elimination diets should only be advised in case of proven food allergy. Allergen‐specific immunotherapy to aeroallergens may be useful in selected cases. Psychosomatic counselling is recommended to address stress‐induced exacerbations. Efficacy‐proven 'Eczema school' educational programmes and therapeutic patient education are recommended for both children and adults

Conceptual design of E-health services by, and for support of, home care staff

Together with staff from home care from four municipalities we investigated how e-health services can improve the work environment. In a series of four workshops we coached the participants in (1) describing their work process and pinpointing the problematic situations in the process, (2) formulating their wishes for an ideal work process, (3) conceptualizing how e-health solutions can be used to obtain the ideal work process and describing scenarios (4) illustrating the scenarios and the design process on storyboards. The storyboards describe, amongst other, how support through e-health systems may be used to: gain access to adequate information; get in touch with other professionals as doctors or other colleagues; prevent medication errors, and to transfer images or physiological data to an expert who can directly provide personal support

Notes on the geology and oil possibilities of the northern Diablo Plateau in Texas

Atopic dermatitis (AD) is a complex disease with elevated risk of respiratory comorbidities.1,2 Severely affected patients are often treated with immune-modulating systemic drugs.3,4 On March 11th 2020, the World Health Organization declared the 2019 novel coronavirus severe acute respiratory syndrome (SARS-Cov-2) epidemic to be a pandemic. The number of cases worldwide is increasing exponentially and poses a major health threat, especially for those who are elderly, immuno-compromised, or have comorbidities. This also applies to AD patients on systemic immune-modulating treatment. In these days of uncertainty, reallocation of medical resources, curfew, hoarding, and shutdown of normal social life, patients, caregivers and doctors ask questions regarding the continuation of systemic immune-modulating treatment of AD patients. The ETFAD decided to address some of these questions here

Development and testing of an evidence-based model of mentoring nursing students in clinical practice

Abstract Background: Mentoring in clinical settings is an important factor in the development of nursing students’ professional knowledge and competences, but more knowledge of mentors’ current and required competences is needed to improve nursing students’ clinical learning. Objectives: This study aimed to develop and test an evidence-based model of mentoring nursing students in clinical practice. Design: An international cross-sectional survey coordinated in five European countries: Finland, Italy, Lithuania, Slovenia and Spain. Methods: Mentors, 4980 registered nurses working in both primary and specialist healthcare organizations, were invited to participate in the study during 2016—2019. The final sample consisted of 1360 mentors (mean age 41.9 ± 11). Data were collected with background questions and the Mentor Competence Instrument. The instrument was psychometrically validated then the data were used to construct a Structural Equation Model (SEM) with Full Imputation Maximum Likelihood (FIML) estimation. Results: All of six hypotheses were verified. In summary: mentors’ characteristics related to their motivation and reflection are positively related to mentoring practices in the workplace, which (together with constructive feedback) are positively related to and foster goal-orientation in students’ clinical learning and student-centered evaluation. All parameters in the SEM model were significant and the model’s fit indexes were verified (RMSEA = 0.055; SRMR = 0.083; CFI = 0.914, TLI = 0.909). Conclusion: Our evidence-based modeling confirms the research hypotheses about mentorship, and identifies focal competences for designing mentors’ education to improve students’ clinical learning and establish a common European mentoring model. Mentorship is important for both healthcare organizations and educational systems to enhance students’ clinical competences, professional growth and commitment to the nursing profession and organizational environments

Assessment of nursing students´ competence in clinical practice:a systematic review of reviews

Abstract Background: The assessment of nursing students’ nursing competence is a matter of concern worldwide and the complexity of assessing students’ clinical competence has challenged educators for decades. It has been recognized that there is inconsistency among assessment methods and tools between countries and institutions. Objective: To identify the current best evidence on the assessment of nursing students’ competence in clinical practice. Design: Systematic review of reviews. Data sources: The electronic databases CINAHL, PubMed, Eric, Medic and the JBI Database of Systematic Reviews and Implementation Reports were searched in autumn 2018. Review methods: Two researchers independently assessed the eligibility of the studies by title, abstract and full-text, and then assessed the methodological quality of the included studies. Analysis of study findings was conducted using the thematic synthesis approach. Results: Six reviews were included following critical appraisal. Assessment tools used to assess students’ nursing competence commonly focus on the domains of professional attributes, ethical practices, communication and interpersonal relationships, nursing processes, critical thinking and reason. Clinical learning environments and mentoring provide important support structures and guide the learning of students. The availability of assessment tools and criteria along with providing individualized feedback and time for reflection strengthen the objectivity and reliability of assessment. Conclusions: There continues to be a need to develop consistent and systematic approaches in assessment, and to use reliable and valid instruments in assessment. Mentors find assessment of students’ competence to be particularly challenging and emphasize the importance of clear assessment criteria, support from nurse educators and further education on assessment. Further development in feedback practices and providing students with opportunities for reflection are important in supporting the continuous learning process of students

Mentors’ self‐assessed competence in mentoring nursing students in clinical practice:a systematic review of quantitative studies

Abstract Aims and objectives: To examine registered nurses’ self‐evaluation of their competence in mentoring nursing students in clinical practice. Background: Clinical mentors have significant roles and responsibility for nursing students’ clinical learning. Moreover, the mentors’ role is becoming increasingly important internationally, as the role of nurse teachers in mentoring students in clinical practice has declined. However, in most EU countries there are no specific educational requirements for clinical mentors, although they need targeted education to increase their competence in mentoring nursing students. Design: The systematic review of quantitative studies was designed according to guidelines of the Centre for Reviews and Dissemination and PRISMA protocol. Methods: Studies published during 2000–2019 that met inclusion criteria formulated in PiCOS format were systematically reviewed by three independent reviewers. CINAHL (Ebsco), PubMed (MEDLINE), Scopus, ERIC and Medic databases were used to retrieve the studies. Three independent reviewers conducted the systematic review process. The studies were tabulated, thematically compared and narratively reported. Results: In total, 16 peer‐reviewed studies met the inclusion criteria. The studies identified various dimensions of mentors’ competence and associated environmental factors. Generally, participating mentors rated competences related to the clinical environment, mentoring, supporting students’ learning processes and relevant personal characteristics fairly high. They also rated organisational practices in their workplaces, resources in the clinical environment and their mentor–student and mentor–stakeholder pedagogical practices, as respectable or satisfactory. Conclusion: The results indicate considerable scope for improving mentors’ competence, particularly through enhancing organisational mentoring practices and relevant resources in clinical environments. Relevance for clinical practice: Pedagogical practices of mentors in relations with both students and stakeholders should be enhanced to improve future nurses’ learning. This systematic review addresses a gap in knowledge of mentors’ self‐evaluated competence that could assist the formulation of effective educational programmes for mentors internationally and improving clinical environments

European task force on atopic dermatitis position paper:treatment of parental atopic dermatitis during preconception, pregnancy and lactation period

Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults, including a large number of adults of reproductive age. Several guidelines for the treatment of AD exist, yet specific recommendations for the treatment of pregnant or lactating women and for adults planning to have a child are often lacking. This position paper from the European Task force on Atopic Dermatitis (ETFAD) is based on up-to-date scientific literature on treating pregnant and lactating women as wells as adults with AD planning to have a child. It is based on the expert opinions of members of the ETFAD and on existing safety data on the proposed treatments, many of which are derived from patients with other inflammatory diseases or from transplantation medicine. For treating future parents, as well as pregnant and lactating women with AD, the use of topical treatments including moisturizers, topical corticosteroids, tacrolimus, antiseptics such as chlorhexidine, octenidine, potassium permanganate and sodium hypochlorite (bleach) is deemed to be safe. Ultraviolet (UV) therapy may also be used. Systemic treatment should be prescribed only after careful consideration. According to the opinion of the ETFAD, treatment should be restricted to systemic corticosteroids and cyclosporine A, and, in selected cases, azathioprine