Ciclopirox nail lacquer and podiatric practice.

Ciclopirox 8% nail lacquer has recently been approved by the US Food and Drug Administration (FDA) for the management of mild-to-moderate dermatophytic onychomycosis not involving the lunula. Previously, the agents that were approved for the treatment of dermatophytic pedal onychomycosis--griseofulvin, itraconazole, and terbinafine--were administered orally. When ciclopirox nail lacquer is used, it is recommended that the infected nail undergo debridement by a health-care professional as frequently as monthly. It is important to be aware of the circumstances under which debridement of the mycotic nail may be considered medically necessary and therefore potentially eligible for reimbursement by third-party payers. For many nail presentations, nail debridement is an important component of a treatment protocol involving either the oral medications or the topical lacquer, as it serves to reduce the fungal load and ameliorate symptoms. With the availability of a new FDA-approved topical treatment alternative, it remains to be seen if podiatrists will embrace the definitive treatment of onychomycosis using the newer oral agents, the new nail lacquer, or both in combination with nail debridement to treat the disease.

Patients' perceptions of a pre-admission clinic.

AIM: Patients' perceptions of a pre-admission clinic in an orthopaedic hospital were explored. The clinic was developed as a collaborative initiative between nursing and medical staff. METHODS: The methodological approach to this study was inductive and informed by grounded theory. Data was collected using unstructured interviews and analysed using constant comparative analysis. RESULTS: The clinic appeared to relieve patients' anxiety, however, the way in which it did so was complex. Patients thought they were given factual information relating to surgery in the clinic and this was conceptualized as 'given information'. Patients also told of certain experiences in the clinic, which included the caring environment, individualized care and efficiency. These experiences were powerful tools in giving information to patients and are conceptualized as 'experienced information'. CONCLUSION: Both 'experienced information' and 'given information' were important in relieving anxiety. Coping styles of patients differed. Individual patients selected from the clinic what they found useful in terms of 'given information' and 'experienced information' in accordance with their individual coping styles.

A standard for professional development: the use of self and peer review; learning contracts and reflection in clinical practice.

An initiative to develop a standard for professional development is outlined. The standard takes a structure, process, outcome format. Its development resulted in several initiatives being introduced to the unit including: the introduction of a self and peer review system, the introduction of learning contracts and the introduction of the concept of reflection. It was considered that these initiatives would promote individual professional accountability, increases self-awareness and reflective practice. The initiatives may be viewed in the context of PREP, United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1990) and the Higher Award, English National Board for Nursing, Midwifery and Health Visiting (1991). The audit of the standard may be a tool to measure 'value for money' used in professional development.