Accelerating effects of epidermal growth factor on skin lesions of pemphigus vulgaris: a double-blind, randomized, controlled trial

BACKGROUND: Pemphigus vulgaris (PV) is a severe blistering disease involving the skin and mucous membranes. The most common causes of death in these patients are adverse effects of drugs, and infection. Skin lesions are one of the important sources of infection. Thus, any local treatment that could reduce healing time of lesions and consequently reduce the total dosage of drugs needed to treat is favourable. OBJECTIVE: To evaluate the efficacy of epidermal growth factor (EGF) in reducing healing time of lesions in patients with pemphigus vulgaris. METHODS: In this randomized, double-blind, within-patient, left/right, controlled trial, 20 hospitalized patients with pathologial and immunohistologial (direct and indirect immunoflourecence) proven pemphigus vulgaris (PV) were chosen. In addition, all patients had at least one appropriate pemphigus lesion on each side of the body that had not healed after 2-week systemic therapy and sterile saline washing. EGF (10 microg/g) in 0.1% silver sulfadiazine cream vs. 0.1% silver sulfadiazine cream alone was applied randomly on one side of the body. RESULTS: Kaplan-Meier survival analysis suggested that median time to heal with application of EGF plus silver sulfadiazine cream was 9 days, in comparison with 15 days for silver sulfadiazine cream alone (log-rank test, P=0.0003). No intervention-related adverse effect was observed during the study. CONCLUSIONS: EGF can significantly reduce healing time of skin lesions in patients with pemphigus vulgaris, at least when this cream base is applied (Cochrane skin group identifier: CSG20).     

Evaluating clinical educators: an employer's perspective

An Australian school of nursing's attempt to introduce an evaluation process required by management for clinical educators involved in undergraduate preregistration education is discussed Reliance on student feedback and clinical agencies' perceptions of the quality of teaching were seen as inadequate mechanisms for evaluation The evaluation process adopted incorporated observation of the educators together with self-reflection on their performance We conclude that post-briefings were poorly used and generally not reflective Educators relied heavily on their clinical skills and used a limited range of teaching strategies Whilst evaluation of clinical educators was time consuming and therefore costly, it is argued that it is essential to the integrity of the course The evaluation process has provided direction for support and development of clinical educators within the context of the curriculum     

The lived experience of clinical educators

This phenomenological study was undertaken to discover the everyday meanings which clinical educators of pre-registration Bachelor of Nursing students attached to their experiences as clinical educators The researcher employed a qualitative design using audiotaped in-depth interviews with four registered nurses employed as clinical educators in four different schools of nursing in Victoria, Australia Using hermeneutics, thematic analysis revealed five themes of meaning central to the lived experiences of clinical educators They are (a) being human, (b) having standards, (c) developing own teaching style, (d) learn as you go, and (e) not belonging The first three themes are described in the literature on clinical education, however, the latter two are unique to this research The results of this study indicate there is need for extensive preparation and on-going support of clinical educators The researcher, who is respectful of the enormity of the task which educators face in preparing students for practice, speculates whether clinical educators are the vanguards of student learning in the clinical field It is evident that the participants of this study did not possess many of the role requirements of clinical educators identified in the literature Further studies are needed which explore the link between student learning and clinical educator support     

Characterization of the major neutrophil-stimulating activity present in culture medium conditioned by Staphylococcus aureus-stimulated mononuclear leucocytes.

Culture medium conditioned by stimulating human mononuclear leucocytes (MNL) with killed Staphylococcus aureus (Scm) was found to contain a substantial amount of tumour necrosis factor-alpha (TNF-alpha) but no detectable tumour necrosis factor-beta (TNF-beta). Culture medium conditioned by MNL in the absence of bacteria contained no TNF-alpha activity. When Scm was fractionated by high-performance liquid chromatography (HPLC) on Bio-Sil TSK 250, TNF-alpha co-eluted with neutrophil-stimulating activity measured by chemiluminescence. Similarly, the ability of neutrophils to kill opsonized S. aureus was enhanced in fractions that contained this neutrophil-stimulating activity. The stimulating activity could be almost completely removed by pretreatment of the Scm with a TNF-alpha-specific monoclonal antibody (mAb). The ability of neutrophils to kill S. aureus in response to Scm was also substantially reduced by mAb to TNF-alpha. These results demonstrate that bacterial interaction with MNL leads to the release of neutrophil-stimulating activity that consists predominantly of TNF-alpha.     

Remodeling Adult Nursing

This article describes a nursing education experience in which a critical thinking approach was planned and implemented. Background discussion on critical thinking concepts and related research provides a foundation for presentation of the Mackie teaching model. The model uses a community-based, family-centered scenario as the basis for developing problemfocused nursing intervention skills from a holistic viewpoint. Role expectations of students and faculty are outlined, and related implementation difficulties, together with their resolution strategies, are described. Evaluation methods and outcomes are reviewed in the conclusion.     

Teaching About HIV/AIDS: The Lessons Learned

To learn and teach about HIV/AIDS is to enter complex and senstitive territory that at times may be personally challenging. ⁵ In the vast literature on HIV infection and nursing two main themes recur: nurses' lack of understanding, negative attitudes and anxieties related to HIV/AIDS and the need for education to change such attitudes and enhance nurses' knowledge and skills.