Patient education has been regarded as having a key role in the self-management of atopic eczema. However, the relationship between the educational interventions and clinical outcomes including severity of eczema, quality of life, and family impact has not been rigorously examined. The purpose of this longitudinal randomized controlled study was to evaluate the impact of an intensive education program with a focus on dermatology and immunology designed for parents and children diagnosed with atopic eczema. The intention of this study was not to change treatment regimes prescribed by the patient's physician. The Scoring Atopic Dermatitis rating system was used for assessment of disease impact, and the impact on quality of life was quantified by using the Children's Dermatology Life Quality Index, Infants' Dermatology Quality of Life Index, and Dermatitis Family Impact. A total of 61 pediatric patients (0-16 years) diagnosed with atopic eczema from the metropolitan area of Adelaide were randomized to either the control or intervention group. Results of the study showed that the intervention group had a significant improvement in the scoring atopic dermatitis measure when compared to the control group at week 4 and week 12. Quality of life measures did not significantly improve with decreased severity of eczema except in the group of children aged 5-16 years which, despite small numbers, showed a significant improvement in quality of life scores. These findings suggest that education provides an important role in decreasing the severity of eczema.

Background To address the growing burden of disease and long waiting lists for sleep services, a simplified twostage model was developed and validated for identifying obstructive sleep apnoea (OSA) in primary care using a screening questionnaire followed by home sleep monitoring. Methods 157 patients aged 25e70 years attending their primary care physician for any reason at six primary care clinics in rural and metropolitan regions of South Australia participated. The first 79 patients formed the development group and the next 78 patients the validation group. A screening questionnaire was developed from factors identified from sleep surveys, demographic and anthropometric data to be predictive of moderate to severe OSA. Receiver operating characteristic (ROC) curve analysis was used to validate the two-channel ApneaLink device against full polysomnography. The diagnostic accuracy of the overall two-stage model was then evaluated. Results Snoring, waist circumference, witnessed apnoeas and age were predictive of OSA and incorporated into a screening questionnaire (ROC area under curve (AUC) 0.84, 95% CI 0.75 to 0.94, p<0.001). ApneaLink oximetry with a 3% dip rate was highly predictive of OSA (AUC 0.96, 95% CI 0.91 to 1.0, p<0.001). The two-stage diagnostic model showed a sensitivity of 0.97 (95% CI 0.81 to 1.00) and specificity of 0.87 (95% CI 0.74 to 0.95) in the development group, and a sensitivity of 0.88 (95% CI 0.60 to 0.98) and specificity of 0.82 (95% CI 0.70 to 0.90) in the validation group. Conclusion A two-stage model of screening questionnaire followed by home oximetry can accurately identify patients with OSA in primary care and has the potential to expedite care for patients with this common sleep disorder.

The clinical learning environment (CLE) is an interactive network of forces influencing student learning outcomes in the clinical setting. This study used mixed methods to identify factors characterizing students' perceptions of the CLE. The sample consisted of 229 undergraduate students in the second or third year of their biophysical nursing strand. The five subscales of the Clinical Learning Environment Scale, 'staff-student relationships', 'nurse manager commitment', 'patient relationships', 'student satisfaction' and 'hierarchy and ritual', were supported by qualitative data obtained from student interviews. Interpersonal relationships between the participants in the CLE were crucial to the development of a positive learning environment. Student satisfaction with the CLE was both a result of, and influential in creating, a positive learning environment. Nurse educators, clinical venues, and all others participating in the undergraduate nursing students' clinical education, must collaborate in order to create a CLE which promotes the development of well-educated registered nurses capable of providing safe, cost-effective patient care.

Within nursing, there is a strong demand for high-quality, cost-effective clinical education experiences that facilitate student learning in the clinical setting. The clinical learning environment (CLE) is the interactive network of forces within the clinical setting that influence the students' clinical learning outcomes. The identification of factors that characterize CLE could lead to strategies that foster the factors most predictive of desirable student learning outcomes and ameliorate those which may have a negative impact on student outcomes. The CLE scale is a 23-item instrument with five subscales: staff-student relationships, nurse manager commitment, patient relationships, interpersonal relationships, and student satisfaction. These factors have strong substantive face validity and construct validity, as determined by confirmatory factor analysis. Reliability coefficients range from high (0.85) to marginal (0.63). The CLE scale provides the educator with a valid and reliable instrument to evaluate affectively relevant factors in the CLE, direct resources to areas where improvement may be required, and nurture those areas functioning well. It will assist in the application of resources in a cost-effective, efficient, productive manner, and will ensure that the clinical learning experience offers the nursing student the best possible learning outcomes.

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Generic standards for nurse practitioner practice will support a standardised approach and mutual recognition of nurse practitioner authorisation across the two countries. Additionally, these research outcomes can more generally inform education providers, authorising bodies and clinicians on the standards of practice for the nurse practitioner whilst also contributing to the current international debate on nurse practitioner standards and scope of practice.

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