Seacole an inspiration for all nurses.

After more than 12 long years of fundraising a memorial statue to Jamaican-Scottish Crimean War nurse and businesswoman Mary Seacole was unveiled on 30 June. The sun shone brightly and it was one of my proudest days.

Thank you for your support.

I would like to give my heartf elt thanks to all your readers who supported the Mary Seacole Memorial Statue Appeal over the past 12 years.

Mary Seacole: global nurse extraordinaire.

AIMS: A discussion of recently discovered literature that reveals how after the Crimean War ended in 1856, Jamaican nurse, doctress and entrepreneur Mary Seacole travelled more widely and gained further international recognition than had previously been appreciated. BACKGROUND: New findings demonstrate that Seacole's international charitable and business activities were reported more widely than realised. Recently discovered literature uncovers her networking and strategic skills in various social milieus. A former Scutari nurse and 39 other women, offered their service to Seacole to nurse British soldiers in India. Newspapers also reported the medal she had been awarded from the Turkish government. DESIGN: Discussion paper. DATA SOURCES: Digitized 19th-century newspaper reports, and 1857 Dutch and 1858 French translations of Seacole's autobiography and a recently discovered handwritten letter dated 1 October 1857 from Seacole to Sir Henry Storks, at the time Secretary for Military Correspondence at the War Office, London. IMPLICATIONS FOR NURSING: Awareness of the findings affords a more thorough understanding of the scope and diversity of nursing history. This can provide valuable role models for the 21st century generations of competent and self-confident healthcare professionals. The new evidence offers further testimony that Seacole can truly be considered as one such figurehead. CONCLUSIONS: British and international primary sources reveal Mary Seacole as an historical and charismatic global phenomenon, more than had been previously realised.

Modeling the complex activity of sickle cell and thalassemia specialist nurses in England.

OBJECTIVE: Specialist advanced practice nursing in hemoglobinopathies has a rich historical and descriptive literature. Subsequent work has shown that the role is valued by patients and families and also by other professionals. However, there is little empirical research on the complexity of activity of these services in terms of interventions offered. In addition, the work of clinical nurse specialists in England has been devalued through a perception of oversimplification. PURPOSE: The purpose of this study was to understand the complexity of expert nursing practice in sickle cell and thalassemia. DESIGN: The approach taken to modeling complexity was used from common methods in mathematical modeling and computational mathematics. Knowledge discovery through data was the underpinning framework used in this study using a priori mined data. This allowed categorization of activity and articulation of complexity. RESULT: In total, 8966 nursing events were captured over 1639 hours from a total of 22.8 whole time equivalents, and several data sources were mined. The work of specialist nurses in this area is complex in terms of the physical and psychosocial care they provide. The nurses also undertook case management activity such as utilizing a very large network of professionals, and others participated in admission avoidance work and education of patients' families and other staff. CONCLUSION: The work of nurses specializing in hemoglobinopathy care is complex and multidimensional and is likely to contribute to the quality of care in a cost-effective way. An understanding of this complexity can be used as an underpinning to establishing key performance indicators, optimum caseload calculations, and economic evaluation.

New light on Seacole.

The discovery of a signed letter by Crimean nursing heroine Mary Seacole to a War Office official may give an important clue that she was lobbying to be allowed to nurse British soldiers in India. Together with a letter from another anonymous nurse, and contemporary news reports, it reveals and active and well regarded nurse leader who knew how to network.

Voices - 'Winners of Mary Seacole awards make me so proud,' says Elizabeth Anionwu.

There was a wonderful buzz among those attending the recent Mary Seacole Leadership and Development Awards.

A history that lives on.

The contribution of Florence Nightingale and Mary Seacole was immense. Their similarities and differences are described in this article.

Confidence of primary care physicians in their ability to carry out basic medical genetic tasks-a European survey in five countries-Part 1.

Western health care systems are facing today increasing movement of genetic knowledge from research labs into clinical practice. This paper reports the results of a survey that addressed the confidence of primary care physicians in their ability to carry out basic medical genetic tasks. The survey was conducted in five countries (France, Germany, The Netherlands, Sweden and the UK). Stratified random samples were drawn from primary care physicians in the five countries representing a sampling frame of 139,579 physicians. Stepwise binary logistic regression procedures were performed to identify the predictor variables for self-reported confidence. Three thousand six hundred eighty-six physicians participated and filled out a self-administered questionnaire. The margin of error for accurate representation of each group of European general practitioners and specialists in the total sample is 2.9% for GP, 2.8% for obstetricians/gynaecologists (OB/GYN) and for paediatricians (PAED) 2.6% (95% confidence level). Confidence in their ability to carry out basic medical genetic tasks is low among participating primary care physicians: 44.2% are not confident, 36.5% somewhat confident, confident or very confident are 19.3%. In each country, those confident/very confident represent less than 33% of the participating physicians. Primary care physicians who report the lowest levels of confidence prove to be those least exposed to medical genetics information and training. Although there are significant differences in the way in which professional education is organised and practice is regulated across European countries, there is a need for a coordinated European effort to improve primary care physicians' background in medical genetics.

A skills framework for sickle cell disease and thalassaemia.

The standard care that people with sickle cell disease or thalassaemia experience varies widely. A specialist nurse was inspired to address this by developing a competency framework for these haemoglobin disorders, which has been accredited by the Royal College of Nursing. This article looks at the rationale for creating competencies for nurses caring for people with these conditions, and outlines the standards required to achieve optimum patient care.

Voices - Sickle cell disease has some little-known complications, says Elizabeth Anionwu.

Recently I attended an event aimed at raising awareness about the increased risk of stroke among people with sickle cell disease.

Dora opoku's achievements made inspirational reading.

I was shocked to learn of the death of midwife and educationalist Dora Opoku (obituary January 26).

VOICES-Sexually sidelined Elizabeth Anionwu says that fresh air and spring flowers lift her spirits.

I have never understood why my mood seems to lift once January is over. Is it because I have submitted my online tax return by the dreaded deadline? Or maybe it is hope that the weather will start to improve.

Effectiveness of earlier antenatal screening for sickle cell disease and thalassaemia in primary care: cluster randomised trial.

OBJECTIVE: To evaluate the effectiveness of offering antenatal screening for sickle cell disease and thalassaemia in primary care as a way of facilitating earlier uptake of screening. DESIGN: Partial factorial cluster randomised controlled trial. SETTING: 25 UK general practices from deprived inner city areas. PARTICIPANTS: Anonymised data on all pregnant women attending participating practices during a six month period before randomisation and a seven month period after randomisation. This included 1708 eligible women. INTERVENTION: Practices were randomised to three groups for seven months: parallel testing in general practice (tests for sickle cell disease and thalassaemia offered to both parents when pregnancy was first reported); sequential testing in general practice (tests offered to mothers when pregnancy was first reported, and subsequently to the partners of women who were found to be carriers); and midwife care (tests offered to mothers at first consultation with a midwife). MAIN OUTCOME MEASURES: The primary outcome (available for all women) was the proportion of eligible women screened before 10 weeks' (70 days') gestation. Secondary outcomes were an offer of screening to women before 10 weeks' gestation, gestational age at testing, mean interval from first visit to the general practice visit to screening, and women's knowledge of the carrier status of their baby's father before 77 days' (11 weeks') gestation. The study was designed to detect a 20% absolute increase in screening uptake. Cluster level analyses were adjusted for age group, parity, ethnic group, primary care organisation, and number of general practitioners per practice. RESULTS: Data were analysed for 1708 eligible women. In the midwife care arm, 2% (9/441) of women were screened before 10 weeks' gestation compared with 24% (161/677) in the GP parallel testing arm and 28% (167/590) in the GP sequential testing arm. The estimated adjusted difference between the midwife care and GP parallel testing arms was 16.5% (95% confidence interval 7.1% to 25.8%; P=0.002) and between the midwife care and GP sequential testing arms was 27.8% (14.8% to 40.7%; P<0.001). By 26 weeks' gestation the proportion of women screened across the three trial arms was similar (81%). The proportion of women who knew the carrier status of the baby's father by 11 weeks' gestation was 0% (0/441) in the midwife care arm, 2% (13/677) in the GP parallel testing arm (P=0.003), and 1% (3/590) in the GP sequential testing arm (P=0.374). CONCLUSION: Offering antenatal screening for sickle cell disease and thalassaemia as part of consultations for pregnancy confirmation in primary care increases the proportion of women screened before 10 weeks' gestation. Even with intervention, however, only a minority of women were screened before 10 weeks. Additional interventions should be considered to achieve testing early in pregnancy for most women wanting such tests so that couples with affected pregnancies have less time pressure to choose options, which may include termination of the pregnancy. TRIAL REGISTRATION: Current Controlled Trials ISRCTN00677850.

General practitioner management of genetic aspects of a cardiac disease: a scenario-based study to anticipate providers' practices.

It is increasingly recognised that genetics will have to be integrated into all parts of primary health care. Previous research has demonstrated that involvement and confidence in genetics varies amongst primary care providers. We aimed to analyse perceptions of primary care providers regarding responsibility for genetic tasks and factors affecting those perceptions. Postal questionnaire including a hypothetical case management scenario of a cardiac condition with a genetic component was sent to random samples of medically qualified general practitioners in France, Germany, Netherlands, Sweden and UK (n = 1,168). Logistic regression analysis of factors affecting primary care practitioners' willingness to carry out genetic tasks themselves was conducted; 61% would take a family history themselves but only 38% would explain an inheritance pattern and 16% would order a genetic test. In multivariate analysis, only the country of practice was consistently predictive of willingness to carry out genetic tasks, although male gender predicted willingness to carry out the majority of tasks studied. The stage of career at which education in genetics had been provided was not predictive of willingness to carry out any of the tasks analysed. Country of practice is significantly predictive of attitudes towards genetics in primary care practice and therefore genetic education structure and content in Europe will need to be significantly tailored towards country-specific approaches.