Decision-making on the use of compression hosiery and compression bandaging: a systematic review.

This systematic literature review was carried out by a final-year nursing student in response to clinical experience, and to understand the rationale and evidence around managing venous ulcers. In the student's clinical experience, the two most commonly used treatment methods were forms of compression hosiery and compression bandaging. The CINAHL, Science Direct, Cochrane Library, Internurse and MEDLINE databases were searched for literature published over the period 2003-2023. From the resulting five papers, five key themes were identified: types of compression systems used and the rationale for decision-making; clinical effectiveness; the impact on patient experience and quality of life; pain levels following application of compression systems; and cost effectiveness. Conclusion: Management and prevention of venous ulceration is complex. The decisions should be made in partnership with the patient and will be influenced by context. Overall, compression hosiery was identified as the more favourable system.

Caseload profiling in district nursing: a systematic literature review.

This systematic literature review aims to identify and appraise current evidence to establish if caseload profiling (CP) provides a strategy to support district nurses to evidence and manage increasingly complex caseloads. A total of 17 studies where thematically synthesised and recurrent themes were identified and summarised under the headings of: defining caseload profiling; caseload profiling in the context of caseload management; workload analysis and its relationship to caseload profiling; potential impact of caseload profiling; and potential barriers to caseload profiling. The literature review showed CP is a robust method of articulating the complexity of care and practitioners could use it to help manage their own caseloads. However, the literature is mainly founded on expert opinion and further research is needed to strengthen the validity of the evidence.

The role of the community nurse in care provision for people with multiple sclerosis.

Multiple sclerosis (MS) is a degenerative neurological condition that is often diagnosed in young adults in their 20s and 30s and is more common in women than in men. The long-term and unpredictable nature of the condition poses significant challenges for care delivery. The UK has one of the highest incidences of MS in the world, and care delivery for people with long-term conditions such as MS in the UK is changing: whereas previously it predominantly took place from a hospital setting, it now more commonly occurs in a primary care setting. In addition, patients and carers are recognised as equal partners in the planning and delivery of care. This article explores the approaches used by community nurses providing care to patients and families in a multiagency context.

Exploring clinical wisdom in nursing education.

The recent interest in wisdom in professional health care practice is explored in this article. Key features of wisdom are identified via consideration of certain classical, ancient and modern sources. Common themes are discussed in terms of their contribution to 'clinical wisdom' itself and this is reviewed against the nature of contemporary nursing education. The distinctive features of wisdom (recognition of contextual factors, the place of the person and timeliness) may enable their significance for practice to be promoted in more coherent ways in nursing education. Wisdom as practical knowledge (phronesis) is offered as a complementary perspective within the educational preparation and practice of students of nursing. Certain limitations within contemporary UK nursing education are identified that may inhibit development of clinical wisdom. These are: the modularization of programmes in higher education institutions, the division of pastoral and academic support and the relationship between theory and practice.

Insulin-like growth factor-binding protein 7 and risk of congestive heart failure hospitalization in patients with atrial fibrillation.

BACKGROUND: The occurrence of congestive heart failure (CHF) hospitalization among patients with atrial fibrillation (AF) is a poor prognostic marker. OBJECTIVE: The purpose of this study was to assess whether insulin-like growth factor-binding protein 7 (IGFBP-7), a marker of myocardial damage, identifies AF patients at high risk for this complication. METHODS: We analyzed 2 prospective multicenter observational cohort studies that included 3691 AF patients. Levels of IGFBP-7 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured from frozen plasma samples at baseline. The primary endpoint was hospitalization for CHF. Multivariable adjusted Cox regression analyses were constructed. RESULTS: Mean patient age was 69 ± 12 years, 1028 (28%) were female, and 879 (24%) had a history of CHF. The incidence per 1000 patient-years across increasing IGFBP-7 quartiles was 7, 10, 32, and 85. The corresponding multivariable adjusted hazard ratios (aHRs) (95% confidence interval [CI]) were 1.0, 1.05 (0.63-1.77), 2.38 (1.50-3.79), and 4.37 (2.72-7.04) (P for trend <.001). In a subgroup of 2812 patients without pre-existing CHF at baseline, the corresponding aHRs were 1.0, 0.90 (0.47-1.72), 1.69 (0.94-3.04), and 3.48 (1.94-6.24) (P for trend <.001). Patients with IGFBP-7 and NT-proBNP levels above the biomarker-specific median had a higher risk of incident CHF hospitalization (aHR 5.20; 3.35-8.09) compared to those with only 1 elevated marker (elevated IGFBP-7 aHR 2.17; 1.30-3.60); elevated NT-proBNP aHR 1.97; 1.17-3.33); or no elevated marker (reference). CONCLUSION: Higher plasma levels of IGFBP-7 were strongly and independently associated with CHF hospitalization in AF patients. The prognostic information provided by IGFBP-7 was additive to that of NT-proBNP.