Compression for Lower Extremity Venous Disease and Lymphedema (CLEVDAL): Update of the VLU Algorithm.

The Wound, Ostomy and Continence Nurses (WOCN) Society charged a task force with updating the venous leg ulcer (VLU) algorithm to include the addition of lymphedema with the new title of "Compression for Lower Extremity Venous Disease and Lymphedema (CLEVDAL)." As part of the process, the task force was charged to develop consensus-based statements to serve as clinical guidance related to CLEVDAL. The 3-member task force assisted by a moderator completed a scoping literature review to identify recommendations supported by research to qualify as evidence-based and to identify areas where guidance is needed to provide CLEVDAL. Based on the findings of the scoping review, the WOCN Society convened a panel of experts to develop consensus statements to direct care for those with lower extremity venous disease and lymphedema. These consensus statements underwent a second round of content validation with a different panel of clinicians with expertise in venous disease and lymphedema management. This article reports on the scoping review and subsequent evidence-based statements, along with the generation and validation of consensus-based statements to assist clinical decision-making in the CLEVDAL algorithm.

#Participating #Contesting: Studying Counterpublics' Discourses on Twitter About the Social Acceptability of Medical Assistance in Dying Legislation in Canada.

This article explores debates on medical assistance in dying (MAID) in Canada as they unfolded on Twitter before its adoption in June 2016. The opposition, which came from diverse groups-religious, experts, politicians-led to polarizing debates about the social acceptability of this measure. Our finding shows that the so-called lay citizens refused to leave the discussion to experts and politicians and got involved in the debates around the issue. Our results also show that Twitter was mainly used to share information, hence complementing the role of traditional media. Overall, the platform gave rise to an "ambient political participation," allowing minority or marginalized groups as well as lay citizens to share their knowledge and opinion about MAID. This may have favored a certain form of empowerment.

Cet article explore le déroulement des débats sur Twitter à propos de l'aide médicale à mourir au Canada avant son adoption en juin 2016. L'opposition, qui provenait de divers groupes - religieux, experts, acteurs politiques - a mené à des débats polarisés quant à l'acceptabilité sociale de cette mesure. Nos résultats montrent que les « simples citoyens ¼ ont refusé de laisser la discussion entre les mains des experts et des politiciens, choisissant plutôt de s'investir dans les débats liés à l'enjeu. Nos résultats montrent également que Twitter a principalement été mobilisé dans le but de partager de l'information, complémentant ainsi le rôle des médias traditionnels. De façon générale, la plateforme a laissé court à une « participation politique ambiante ¼, permettant aux minorités ou aux groupes marginalisés, de même qu'aux « simples citoyens ¼, de partager leur connaissance et opinion sur l'aide médicale à mourir. Le tout a pu mener à une certaine forme de capacitation.

Embracing the Concept, Defining the Practice, and Changing the Outcome: Setting the Standard for Medical Adhesive-Related Skin Injury Interventions in WOC Nursing Practice.

Medical adhesive-related skin injury (MARSI) is a comparatively new category of skin damage. Our current understanding of MARSI originates from an interdisciplinary consensus conference held in 2012 that generated and disseminated 25 statements pertaining to the assessment, prevention, and management of MARSI, along with gaps in research and knowledge related to this area. The 2012 MARSI Consensus Group also challenged each organization to refine the original statements to make them more relevant to their particular area of practice. In order to accomplish this refinement for WOC specialty nursing practice, the WOCN Society appointed a task force to create statements that extended recommendations to patients with an acute or chronic wound, ostomy, or incontinence. This article describes the formal consensus process used to generate consensus statements concerning MARSI in our specialty practice, presents the 8 statements, and provides a brief overview of the advances that underlie the medical adhesive end products used by WOC and other clinicians practicing in all health care settings.

Compression for Primary Prevention, Treatment, and Prevention of Recurrence of Venous Leg Ulcers: An Evidence-and Consensus-Based Algorithm for Care Across the Continuum.

Chronic venous insufficiency is a prevalent disease that frequently leads to development of venous leg ulcers. While a number of evidence-based clinical practice guidelines have been developed that provide guidance for clinicians when caring for patients with chronic venous insufficiency, they lack adequate detail concerning selection and application of compression for prevention and management of venous leg ulcers. In order to address this need, the WOCN Society appointed a task force to develop an algorithm for compression for primary prevention, treatment, and prevention of recurrent venous leg ulcers in persons with chronic venous insufficiency. The task force used findings from a scoping literature review to identify current best evidence needed to support decision points and pathways within the algorithm. In addition, the task force convened a panel of 20 clinicians and researchers with expertise in lower extremity venous disorders in order to establish consensus around pathways and decision points within the algorithm lacking robust evidence. Following initial construction of the algorithm, a second interdisciplinary group of expert clinicians established content validity and provided additional qualitative feedback used to complete final revisions of the algorithm. This article reviews the process used to create this landmark algorithm, including generation of the evidence- and consensus-based statements used in its construction, the various pathways, and rich supplemental materials embedded within the algorithm, and the process used to establish content validity.

Factors influencing mortality in a captive breeding population of Loggerhead Shrike, Eastern subspecies (Lanius ludovicianus ssp.) in Canada.

BACKGROUND: The Loggerhead Shrike, Eastern subspecies (Lanius ludovicianus ssp.) (LOSH) is a predatory songbird native to Eastern North America. It is estimated that there are fewer than 55 breeding pairs of this subspecies in North America. Captive breeding plays a critical role in preventing the extirpation of this subspecies from its Canadian range. Unfortunately, high numbers of unexplained deaths among young birds in the captive breeding population threatened the success of this program. This paper describes fledgling mortality in the captive breeding population, and seeks to identify factors associated with fledgling survival and, ultimately, to identify steps to mitigate fledgling mortality. RESULTS: Over the study period (2006-2011) at two breeding sites, 696 LOSH were fledged. Among these, 68 % (n = 474) were released, 10 % (n = 69) were retained in the captive breeding population, and 22 % (n = 155) died. Fledgling survival declined from 99 % in 2006 to 44 % in 2011. The odds of survival were significantly lower for fledglings that were part of a second clutch. As the number of fledglings in a clutch increased, the odds of surviving increased significantly. As the breeding female aged from one to four years of age, there was a marked increase in the odds of a fledgling surviving, which then subsequently declined as females aged further. CONCLUSIONS: Based on our analyses, clutch number (first or second), number of fledglings in the brood, and age of breeding females were significant predictors of fledgling survival. Long-term breeding management decisions will have to balance the need to increase the number of individuals and breeding pairs in the wild by releasing large numbers of young, against the need to maintain a genetically viable captive population, until the wild population is large enough to be self-sustaining.

Chronic venous disease and venous leg ulcers: An evidence-based update.

Chronic venous disease (CVD) is a complex chronic vascular condition with multifaceted primary and secondary etiologies leading to structural and functional changes in veins and valves and blood flow of the lower legs. As a consequence, a spectrum of clinical manifestations arise, ranging from symptoms of mild leg heaviness and achiness to debilitating pain, and signs of skin changes, such as eczema and hemosiderosis, to nonhealing, heavily draining venous leg ulcers (VLUs). Triggers such as trauma to the skin are responsible for a large majority of VLU recurrences. Diagnostic testing for venous reflux includes ultrasound imaging; unfortunately, there are no diagnostic tests to predict VLUs. The hallmark of treatment of both CVD and VLUs is compression. Leg elevation, exercise, and wound management with dressings and advanced healing technologies that provide an environment conducive to healing should focus on reducing pain, necrotic debris, drainage, and odor, as well as preventing infection. VLUs that become chronic without evidence of healing over a 4-week period respond best to multidisciplinary wound experts within a framework of patient-centered care. Nurses are in key positions to provide early recognition of the signs and symptoms as well as initiate prompt diagnostic and promote early treatment to offset the progression of the disease and improve quality of life.