Case study: obesity, genital oedema and lower limb compression bandaging

The purpose of this article is to present an evidenced based rationale for lymphoedema compression bandaging one aspect of treatment for a patient with complex lower limb lymphoedema. The current health care climate requires treatment decisions to be transparent based on the best available evidence. The challenge faced by community nurses is to formulate treatment plans which incorporate the patients’ preferences and best utilise limited resources provided by clinical environments. The article appraises research in order to formulate a suitable treatment plan and provides discussion and reflection regarding the challenges faced by the nursing profession in achieving evidence based practice. Evidence based practice is beneficial in formulating patient centred and cost effective treatment plans, developing competence is not straightforward, however clinical guidelines can provide much needed guidance

Clinical innovation: wider collaboration on lymphoedema research is needed — footwear and gait analysis

Extending teams that research and manage lymphoedema to include orthotists and podiatrists may extend our understanding of the condition and component parts of treatment. New technology, some of which is low cost, enables an increasing range of data and outcome measures. This article highlights the reality of a shortage of studies involving gait analysis and a lack of consideration of the impact of inappropriate footwear on exercise as a key component of lymphoedema management

The interpretation of spikes and trends in concentration of nitrate in polar ice cores, based on evidence from snow and atmospheric measurements

Nitrate is frequently measured in ice cores, but its interpretation remains immature. Using daily snow surface concentrations of nitrate at Halley (Antarctica) for 2004 - 2005, we show that sharp spikes (> factor 2) in nitrate concentration can occur from day to day. Some of these spikes will be preserved in ice cores. Many of them are associated with sharp increases in the concentration of sea salt in the snow. There is also a close association between the concentrations of aerosol nitrate and sea salt aerosol. This evidence is consistent with many of the spikes in deposited nitrate being due to the conversion or trapping of gas- phase nitrate, i. e. to enhanced deposition rather than enhanced atmospheric concentrations of NOy. Previously, sharp spikes in nitrate concentration (with concentration increases of up to a factor 4 seen in probably just one snowfall) have been assigned to sharp production events such as solar proton events (SPEs). We find that it is unlikely that SPEs can produce spikes of the kind seen. Taken together with our evidence that such spikes can be produced depositionally, we find that it is not possible to track past SPEs without carrying out a new multi- site and multi- analyte programme. Seasonal and interannual trends in nitrate concentration in cores from any single site cannot be interpreted in terms of production changes until the recycling of nitrate from central Antarctica to coastal Antarctica is better quantified. It might be possible to assess the interannual input of NOy to the Antarctic lower troposphere by using a network of cores to estimate variability in the total annual deposition across the continent (which we estimate to be 9 +/- 2 x 10(7) kg/a - as NO3-), but it will first have to be established that the outflow across the coast can be ignored

Interprofessional education (IPE) in clinical practice for pre-registration nursing students: a structured literature review

Objectives: To explore the experiences of nursing students after clinical IPE activities through a review of contemporary literature then use the context of nursing programmes in Singapore to consider the transferability of the findings. Design: Structured literature review. Data Sources: A search of international qualitative literature no older than five years and published in English was conducted on CINAHL, Embase, Medline and Pubmed. Review Methods: A systematic and structured approach was guided by Cooper's five-step approach to review the literature. The Critical Appraisal Skills Programme qualitative checklist and the Appraisal of Guidelines Research & Evaluation reporting checklist were used to critically appraise literature in this review. Results: 13 papers were included for qualitative synthesis. The literature most commonly reported that students had a better understanding of professional roles, improved communication and teamwork. In contrast, the most commonly reported negative experience involved some examples of disparity within the team. Conclusion: Overall findings show that positive student experiences outweigh negative ones. Nursing programmes might be able to reap similar outcomes subject to contextual and cultural differences. However, further research is recommended before IPE in clinical practice is implemented in current nursing programmes in the local setting

Rape and sexual violence in war: establishment of a non-derogable norm?

International rules and custom have not always out-rightly condemned and punished rape and sexual violence against women as a war crime. Its contemporary evolution under the jurisprudence of the International Criminal Tribunal for Yugoslavia (ICTY), the International Criminal Tribunal for Rwanda (ICTR) and its strategic inclusion in the Rome Statute of the International Criminal Court (ICC) is therefore of significance and demands continued support and protection. This paper examines Sexual and Gender Based Violence (SGBV) against women in conflict and the legal mechanisms of addressing these crimes in the modern responses under international criminal courts

Self-reported training and confidence levels among practitioners managing genital lymphedema

Introduction Genital lymphedema (GL) can present with significant psychological, social, and physical impairments. Barriers to treatment include under-reporting, socio-cultural issues, patient/healthcare practitioner (HCP) perception/comfort, and lack of knowledge among HCPs.1-4 General lymphedema training utilizes hands-on approaches to learning for extremities; yet GL training is often minimal with little to no hands-on component. This self-reporting retrospective study investigates GL training, instruction methods, and confidence levels among HCPs. Methods An online 20 question survey was disseminated via direct email to HCPs that had previously downloaded tools for males/females with GL, announcements on social media pages related to lymphedema, links provided at conferences/courses, and in a published article. Respondents include 245 HCPs from 19 countries. Results Respondents presented from different countries, professions, and practice settings. Initial lymphedema training included a genital component for 66% of HCPs but included hands-on learning for less than 50%. Only 29% reported confidence in treating GL post training. Additional GL training was sought by 37% of HCPs, 63% of which included a hands-on component. HCPs reported higher confidence post hands-on learning for both initial and additional training. The most common type of hands-on training included models attached to another HCP and 96% of HCPs who used this type reported it increased their confidence over other types/no models. 86% of all HCPs felt training with genital models attached to another participant would increase their confidence, and 75% said they felt they needed additional training to treat GL. Significance This study showed courses that not only included specific GL focused training, but included a hands-on component, lead to higher levels of confidence.Additionally, genital models on other HCPs also increased this perception in all HCPs who utilized this technique. This highlights HCPs’ need for comprehensive training in GL and lack of confidence following current training methods

Development of the Lymphoedema Genito-Urinary Cancer Questionnaire

The aim of this study was to develop a patient self-report tool to detect symptoms of genital and lower limb lymphoedema in male survivors of genitourinary cancer. The study incorporated the views of patients and subject specialists (lymphoedema and urology) in the design of a patient questionnaire based on the literature. Views on comprehensiveness, relevance of content, ease of understanding and perceived acceptability to patients were collated. The findings informed the development of the next iteration of the questionnaire. The overall view of participants was that the development and application of such a tool was of great clinical value and the Lymphoedema Genito- Urinary Cancer Questionnaire (LGUCQ) has significant potential for further development as a research tool to inform prevalence of this under-reported condition

The Asset-based Collaborative Working model (ACW model): pragmatic action research in healthcare service development

Embedding researchers in clinical practice may not be an obvious consideration in asset-constrained healthcare settings. However, with increasing calls for best practice and value-for-money, understanding what works, for whom and why, is of paramount importance. This article illustrates how a researcher embedded in a healthcare professional group not only facilitated a service development within existing resources, but also enabled the group to identify relevant theories, and their interrelationships, underpinning the group's actions during the developmental process. This resulted in the construction of a new theoretical model, the Asset-based Collaborative Working model. This research suggests that embedding research in service development is feasible and can result in substantive learning and an understanding of group working which is required in contemporary healthcare provision. While developed in the clinical field of lymphoedema, the Asset-based Collaborative-Working model may be applicable in other care settings