Nurses are research leaders in skin and wound care

The World Health Assembly declared 2020, the International Year of the Nurse and the Midwife. Recent editorials and commentaries support the leading role of nurses and midwives as frontline caregivers emphasizing the need to invest in the nursing workforce worldwide to meet global health needs. Today nurses are also leaders in research and one example is skin and wound care. In order to reflect on the contribution of nurses as researchers we conducted a systematic review of published articles in five international leading wound care journals in the years 1998, 2008 and 2018. We aimed to determine the type of research publication and percentage of nurses as first, second or senior authors. The place in the authorship was selected as indicative of leadership as it implies responsibility and accountability for the published work. Across the years 1998, 2008 and 2018, 988 articles were published. The overall proportion of nurse-led articles was 29% (n = 286). The total numbers of articles increased over time and so too did the nurse-led contributions. Nurse-led research was strongest in the design categories 'cohort studies' (46%, n = 44), 'systematic reviews' (46%, n = 19), and 'critically appraised literature and evidence-based guidelines' (47%, n = 55).Results of this review indicate that, in addition to the crucial clinical roles, nurses also have a substantial impact on academia and development of the evidence base to guide clinical practice. Our results suggest that nurse led contributions were particularly strong in research summarizing research to guide skin and wound care practice

British images of the Chinese trader; 1865-1880

The purpose of this thesis is to examine the evolution of British images of the Chinese trader during the years 1865 to 1880 and to determine the factors which influenced these changing concepts. A careful examination of articles and editorials from the North China Herald, personal reminiscences, government publications and other primary and secondary sources prove that British opinion of the Chinese trader changed from the acceptance of certain "myths" of Sino-British commercial alliance in 1865, to a belief in 1880 that Chinese merchants imperiled Britain's Asian trade. British images of the Chinese merchant were influenced by the complexities of Sino-British diplomacy and by the rapid commercial innovations inspired by Europe's industrial revolution. Special attention had to be paid to the unique political and cultural setting of Shanghai, a port on the central coast of China. Shanghai's prolonged commercial predominance and wealth of published materials, including the North China Herald, made it the natural selection for a focal point in this study. The North China Herald was perhaps the finest British publication in Asia and was noted for its pro-mercantile attitude, even in the face of recurrent charges of racism. No European dealt more frequently with Chinese traders than did the treaty port merchants, so the pro-mercantile Herald represents an excellent source of information about British images of native traders

A profile of male mid-life concerns

This investigation examined mid-life males' morale and concern about physical condition, psychological themes related to aging, career issues, family relationships, and interpersonal relationships. The main purpose of the study was to determine if there were age-related differences between men in morale and concern about these five life domains. Men between the ages of 34 and 51 were studied in age groupings suggested by previous research. It was hypothesized that there would be no differences in morale between men in age groupings 34-39, 40-45, and 46-51. It was also hypothesized that there would be no differences in concern about physical condition, psychological themes related to aging, career issues, family relationships, and interpersonal relationships between men in the selected age groups. The sample for the study was composed of 150 married men from a large corporation in Greensboro, North Carolina. Fifty men were selected from the three age groupings by a stratified random procedure. Data were collected by personal interviews administered by trained interviewers

Oral aspirin for treating venous leg ulcers

Background Venous leg ulcers (VLUs) or varicose ulcers are the final stage of chronic venous insufficiency (CVI), and are the most common type of leg ulcer. The development of VLUs on ankles and lower legs can occur spontaneously or after minor trauma. The ulcers are often painful and exudative, healing is often protracted and recurrence is common. This cycle of healing and recurrence has a considerable impact on the health and quality of life of individuals, and healthcare and socioeconomic costs. VLUs are a common and costly problem worldwideprevalence is estimated to be between 1.65% to 1.74% in the western world and is more common in adults aged 65 years and older. The main treatment for a VLU is a firm compression bandage. Compression assists by reducing venous hypertension, enhancing venous return and reducing peripheral oedema. However, studies show that it only has moderate effects on healing, with up to 50% of VLUs unhealed after two years of compression. Non-adherence may be the principal cause of these poor results, but presence of inflammation in people with CVI may be another factor, so a treatment that suppresses inflammation (healing ulcers more quickly) and reduces the frequency of ulcer recurrence (thereby prolonging time between recurrent episodes) would be an invaluable intervention to complement compression treatments. Oral aspirin may have a significant impact on VLU clinical practice worldwide. Evidence for the effectiveness of aspirin on ulcer healing and recurrence in high quality RCTs is currently lacking. Objectives To assess the benefits and harms of oral aspirin on the healing and recurrence of venous leg ulcers. Search methods In May 2015 we searched: The Cochrane Wounds Specialised RegisterThe Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library)Ovid MEDLINEOvid MEDLINE (In-Process & Other Non-Indexed Citations)Ovid EMBASE and EBSCO CINAHL. Additional searches were made in trial registers and reference lists of relevant publications for published or ongoing trials. There were no language or publication date restrictions. Selection criteria We included randomised controlled trials (RCTs) that compared oral aspirin with placebo or no drug intervention (in the presence or absence of compression therapy) for treating people with venous leg ulcers. Our main outcomes were time to complete ulcer healing, rate of change in the area of the ulcer, proportion of ulcers healed in the trial period, major bleeding, pain, mortality, adverse events and ulcer recurrence (time for recurrence and proportion of recurrence). Data collection and analysis Two review authors independently selected studies for inclusion, extracted data, assessed the risk of bias of each included trial and assessed overall quality of evidence for the main outcomes in the 'Summary of findings' table. Main results The electronic search located 62 studies. We included two RCTs of oral aspirin (300 mg/daily) given in addition to compression compared with compression and placebo, or compression alone. To date, the impact of aspirin on VLUs has been examined by only two randomised clinical trials, both with a small number of participants. The first RCT was conducted in the United Kingdom (n=20) and reported that daily administration of aspirin (300mg) in addition to compression bandages increased both the rate of healing, and the number of participants healed when compared to placebo in addition to compression bandaging over a four month period. Thirty-eight per cent of the participants given aspirin reported complete healing compared with 0% in the placebo group. Improvement (assessed by reduction in wound size) occurred in 52% of the participants taking aspirin compared with 26% in those taking placebo). The study identified potential benefits of taking aspirin as an adjunct to compression but the sample size was small, and neither the mechanism by which aspirin improved healing nor its effects on recurrence were investigated. In 2012 an RCT in Spain (n=51) compared daily administration of aspirin (300mg) in addition to compression bandages with compression alone over a five month period. There was little difference in complete healing rates between groups (21/28 aspirin and 17/23 compression bandages alone) but the average time to healing was shorter (12 weeks in the treated group vs 22 weeks in the compression only group) and the average time for recurrence was longer in the aspirin group (39 days: [SD 6.0] compared with 16.3 days [SD 7.5] in the compression only group). Although this trial provides some limited data about the potential use of aspirin therapy, the sample size (only 20 patients) was too small for us to draw meaningful conclusions. In addition, patients were only followed up for 4 months and no information on placebo was reported. Authors' conclusions Low quality evidence from two trials indicate that there is currently insufficient evidence for us to draw definitive conclusions about the benefits and harms of oral aspirin on the healing and recurrence of venous leg ulcers. We downgraded the evidence to low quality due to potential selection bias and imprecision due to the small sample size. The small number of participants may have a hidden real benefit, or an increase in harm. Due to the lack of reliable evidence, we are unable to draw conclusions about the benefits and harms of oral daily aspirin as an adjunct to compression in VLU healing or recurrence. Further high quality studies are needed in this area.Evidence Based Actions Department From Marilia Medical School - FAMEMA, BrazilFAPESP-Fundacao de Amparo a Pesquisa do Estado de Sao Paulo, BrazilNational Institute for Health ResearchEvidence Based Health Actions Department and Thoracic Surgery Department, Marilia Medical School, Marilia, BrazilDepartment of Medicine, Federal University of São Paulo, São Paulo, BrazilDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, AustraliaDepartment of Medicine, Federal University of São Paulo, São Paulo, BrazilWeb of Scienc

Stratus Ocean Reference Station (20˚S, 85˚W), mooring recovery and deployment cruise R/V Ronald H. Brown cruise 05-05, September 26, 2005–October 21, 2005

The Ocean Reference Station at 20°S, 85°W under the stratus clouds west of northern Chile is being maintained to provide ongoing, climate-quality records of surface meteorology, of air-sea fluxes of heat, freshwater, and momentum, and of upper ocean temperature, salinity, and velocity variability. The Stratus Ocean Reference Station (ORS Stratus) is supported by the National Oceanic and Atmospheric Administration’s (NOAA) Climate Observation Program. It is recovered and redeployed annually, with cruises that have come between October and December. During the October 2005 cruise of NOAA’s R/V Ronald H. Brown to the ORS Stratus site, the primary activities were recovery of the WHOI surface mooring that had been deployed in December 2004, deployment of a new WHOI surface mooring at that site, in-situ calibration of the buoy meteorological sensors by comparison with instrumentation put on board by staff of the NOAA Environmental Technology Laboratory (ETL), and observations of the stratus clouds and lower atmosphere by NOAA ETL. The ORS Stratus buoys are equipped with two Improved Meteorological (IMET) systems, which provide surface wind speed and direction, air temperature, relative humidity, barometric pressure, incoming shortwave radiation, incoming longwave radiation, precipitation rate, and sea surface temperature. The IMET data are made available in near real time using satellite telemetry. The mooring line carries instruments to measure ocean salinity, temperature, and currents. The ETL instrumentation used during the 2005 cruise included cloud radar, radiosonde ballons, and sensors for mean and turbulent surface meteorology. In addition, two technicians from the University of Concepcion collected water samples for chemical analysis. Finally, the cruise hosted a teacher participating in NOAA’s Teacher at Sea Program.Funding was provided by the National Oceanic and Atmospheric Administration under Grant No. NA17RJ1223 and the Cooperative Institute for Climate and Ocean Research (CICOR)

Concepciones culturales del VIH/Sida de adolescentes de Bolivia, Chile y México

OBJETIVO: Comprender las dimensiones culturales del VIH/Sida de estudiantes adolescentes. MÉTODOS: Estudio antropológico cognitivo. Realizado en Cochabamba (Bolivia), Talca (Chile) y Guadalajara (México) entre 2007 y 2008. Un total de 184 jóvenes (de 14 y 19 años de edad) fueron seleccionados por muestreo propositivo en centros de estudios de educación media superior de cada país. Fueron utilizadas las técnicas de listados libres y el sorteo de montones. Se indagaron términos asociados al concepto VIH/Sida y grupos de dimensiones conceptuales. Posteriormente se aplicó análisis de consenso mediante factorización de componentes principales y análisis dimensional mediante conglomerados jerárquicos y escalas multidimensionales. RESULTADOS: Las diferencias entre los contextos fueron en el grado de consenso en relación al término de VIH/Sida, ya que fue mayor en Cochabamba. En Talca y Guadalajara los jóvenes mencionaron metáforas de lucha frente a la enfermedad, mientras en Cochabamba se refirieron a la ayuda, apoyo y amor que las personas infectadas deberían recibir. Las coincidencias entre las conceptualizaciones de los jóvenes de los tres países fueron: los riesgos (las prácticas sexuales desprotegidas y el contacto con algunos grupos poblacionales específicos), las consecuencias (muerte física y social, entendida ésta última como el rechazo de la sociedad hacia los enfermos) y la prevención de la enfermedad (con base en la información así como uso del condón). CONCLUSIONES: Para los estudiantes adolescentes el VIH/Sida es una enfermedad causada por prácticas sexuales y consumo de drogas que implica daño, dolor y muerte. Los programas preventivos del VIH/Sida para los adolescentes deben promover la búsqueda de información sobre el tema con bases científicas, y no centrarse en las consecuencias emocionales y sociales de la enfermedad.OBJETIVO: Compreender as dimensões culturais do HIV/Aids por estudantes adolescentes. MÉTODOS: Estudo antropológico cognitivo realizado em Cochabamba (Bolívia), Talca (Chile) e Guadalajara (México), entre 2007 e 2008. O total de 184 jovens (de 14 e 19 anos de idade) foi selecionado por amostragem propositiva em centros de estudos de educação média superior de cada país. Foram utilizadas técnicas de listas livres e classificação da pilha. Foi feita a indagação de termos associados ao conceito HIV/Aids e grupos de dimensões conceituais. Posteriormente, fez-se análise de consenso mediante a fatorização dos componentes principais e análise dimensional mediante conglomerados hierárquicos e escalas multidimensionais. RESULTADOS: As diferenças entre os contextos foram no grau de consenso em relação ao termo HIV/Aids, que foi maior em Cochabamba. Em Talca e Guadalajara os jovens mencionaram metáforas de luta diante da doença, enquanto em Cochabamba eles referiram ajuda, apoio e amor que as pessoas infectadas deveriam receber. As coincidências entre as conceitualizações dos jovens dos três países foram: os riscos (as práticas sexuais desprotegidas e o contato com alguns grupos populacionais específicos), as conseqüências (morte física e social, entendida esta última como o rechaço da sociedade aos doentes) e a prevenção da doença (com base na informação e no uso do preservativo). CONCLUSIONES: Para os estudantes adolescentes, o HIV/Aids é uma doença causada por práticas sexuais e uso de drogas que envolve dano, dor e morte. Os programas preventivos do HIV/Aids para os e as adolescentes devem promover a busca de informação com bases científicas sobre o tema, e não só a que se centra nas conseqüências emocionais e sociais da doença.OBJECTIVE: To understand the cultural dimensions of HIV/AIDS among adolescent students. METHODS: A cognitive anthropological study was undertaken in Cochabamba (Bolivia), Talca (Chile) and Guadalajara (Mexico), during 2007 and 2008. A total of 184 teenagers (from 14 to 19 years old) were selected by purposeful sampling at secondary schools in each country. Free association lists and pile sorts were utilized. Terms associated with the concept of HIV/AIDS and groups of conceptual dimensions were investigated. Subsequently, consensus analysis was performed using factorial principal components and dimensional analysis through hierarchical clusters and multidimensional scales. RESULTS: The differences between the country contexts were in the degree of consensus in relation to the term HIV/AIDS, which was greater in Cochabamba. In Talca and Guadalajara the youths mentioned metaphors of fighting against HIV/AIDS, while in Cochabamba participants talked about help, support and love that infected people should receive. The similarities among conceptions by youth from the three countries were: the risk factors (unprotected sexual practice and contact with specific population groups), the consequences (physical and social death, being the latter understood as social rejection of people living with HIV/AIDS) and the prevention of illness (based on information and condom use). CONCLUSIONS: For adolescent students, HIV/AIDS is a disease caused by sexual practices and drug use and involves harm, pain and death. HIV/AIDS prevention programs for adolescents should promote science based information on the topic and not concentrate only on the emotional and social consequences of HIV/AIDS

Protocol for a pilot randomised controlled clinical trial to compare the effectiveness of a graduated three layer straight tubular bandaging system when compared to a standard short stretch compression bandaging system in the management of people with venous ulceration: 3VSS2008

<p>Abstract</p> <p>Background</p> <p>The incidence of venous ulceration is rising with the increasing age of the general population. Venous ulceration represents the most prevalent form of difficult to heal wounds and these problematic wounds require a significant amount of health care resources for treatment. Based on current knowledge multi-layer high compression system is described as the gold standard for treating venous ulcers. However, to date, despite our advances in venous ulcer therapy, no convincing low cost compression therapy studies have been conducted and there are no clear differences in the effectiveness of different types of high compression.</p> <p>Methods/Design</p> <p>The trial is designed as a pilot multicentre open label parallel group randomised trial. Male and female participants aged greater than 18 years with a venous ulcer confirmed by clinical assessment will be randomised to either the intervention compression bandage which consists of graduated lengths of 3 layers of elastic tubular compression bandage or to the short stretch inelastic compression bandage (control). The primary objective is to assess the percentage wound reduction from baseline compared to week 12 following randomisation. Randomisation will be allocated via a web based central independent randomisation service (nQuery v7) and stratified by study centre and wound size ≤ 10 cm²or >10 cm². Neither participants nor study staff will be blinded to treatment. Outcome assessments will be undertaken by an assessor who is blinded to the randomisation process.</p> <p>Discussion</p> <p>The aim of this study is to evaluate the efficacy and safety of two compression bandages; graduated three layer straight tubular bandaging (3L) when compared to standard short stretch (SS) compression bandaging in healing venous ulcers in patients with chronic venous ulceration. The trial investigates the differences in clinical outcomes of two currently accepted ways of treating people with venous ulcers. This study will help answer the question whether the 3L compression system or the SS compression system is associated with better outcomes.</p> <p>Trial Registration</p> <p>ACTRN12608000599370</p

Understanding implementability in clinical trials : a pragmatic review and concept map

Background The translation of evidence from clinical trials into practice is complex. One approach to facilitating this translation is to consider the 'implementability' of trials as they are designed and conducted. Implementability of trials refers to characteristics of the design, execution and reporting of a late-phase clinical trial that can influence the capacity for the evidence generated by that trial to be implemented. On behalf of the Australian Clinical Trials Alliance (ACTA), the national peak body representing networks of clinician researchers conducting investigator-initiated clinical trials, we conducted a pragmatic literature review to develop a concept map of implementability. Methods Documents were included in the review if they related to the design, conduct and reporting of late-phase clinical trials; described factors that increased or decreased the capacity of trials to be implemented; and were published after 2009 in English. Eligible documents included systematic reviews, guidance documents, tools or primary studies (if other designs were not available). With an expert reference group, we developed a preliminary concept map and conducted a snowballing search based on known relevant papers and websites of key organisations in May 2019. Results Sixty-five resources were included. A final map of 38 concepts was developed covering the domains of validity, relevance and usability across the design, conduct and reporting of a trial. The concepts drew on literature relating to implementation science, consumer engagement, pragmatic trials, reporting, research waste and other fields. No single resource addressed more than ten of the 38 concepts in the map. Conclusions The concept map provides trialists with a tool to think through a range of areas in which practical action could enhance the implementability of their trials. Future work could validate the strength of the associations between the concepts identified and implementability of trials and investigate the effectiveness of steps to address each concept. ACTA will use this concept map to develop guidance for trialists in Australia