bluuebunny/crossref_metadata_2025 huggingface dataset:
Consumers’ perspectives on their involvement in recognizing and responding to patient deterioration—Developing a model for consumer reporting
Authors: King Lindy , Peacock Guy , Crotty Mikaila , Clark Robyn
Published: December 2018

Background

Adverse events occur in health care. Detection and reporting of deterioration therefore have a critical role to play. Patient and family member (consumer) involvement in patient safety has gained powerful support amongst global policymakers. Few studies, with none taking a rigorous qualitative approach, have drawn upon consumers’ experiences to establish their preferences in consumer reporting of patient deterioration programmes.

Objective

To explore consumers’ experiences of previous reporting of patient deterioration; their preferred educational strategies on this role and recommended pathways in a consumer reporting of patient deterioration model.

Design, setting and participants

An interpretive, qualitative research design was utilized. Nine focus group interviews were undertaken across Adelaide, capital city of South Australia. Interviews were audio‐taped, transcribed and analysed thematically. Twenty‐six adults described, then reflected, on previous experiences of reporting patient deterioration.

Results

Overarching themes incorporated consumers’ experiences and patient/family education. Three themes emerged in relation to consumers’ experiences: feelings, thoughts and actions. Five themes arose on educating consumers: content, timing, format, information providers and information recipients. The consumers’ deep reflections on their past reporting experiences led to the development of a new model for consumer reporting of patient deterioration.

Conclusions

Consumers’ views on ways to improve consumer reporting of patient deterioration processes emerged. These improvements include structured educational programmes for staff advocating open health‐care professional/consumer communication, educational materials developed and tested with English‐speaking and culturally and linguistically diverse consumers and a model with three consumer reporting pathways.
Inter‐ and intrapatient heterogeneity of indoleamine 2,3‐dioxygenase expression in primary and metastatic melanoma cells and the tumour microenvironment
Authors: Gide Tuba N , Allanson Benjamin M , Menzies Alexander M , Ferguson Peter M , Madore Jason , Saw Robyn P M , Thompson John F , Long Georgina V , Wilmott James S , Scolyer Richard A
Published: December 2018

Aims

Indoleamine 2,3‐dioxygenase (IDO), an immunomodulatory enzyme, facilitates immune escape by tumours and promotes tumour progression. IDO inhibitors with and without additional anti‐PD‐1 therapy have been evaluated in recent and ongoing melanoma clinical trials, but IDO expression in melanoma tumours, and therefore its potential role as a predictive biomarker remains unknown. This study sought to evaluate IDO expression in immunotherapy‐naive metastatic melanoma patients in order to determine patterns of expression in corresponding primary melanomas, locoregional metastases and distant metastases.

Methods and results

Here, we evaluated IDO expression using immunohistochemistry in 99 melanoma tumour samples from 43 immunotherapy‐naive patients with metastatic melanoma to determine patterns of expression in primary melanomas (n = 29), locoregional metastases (n = 36) and distant metastases (n = 34). Thirty‐seven per cent of patients demonstrated tumour IDO expression in at least one specimen. Twelve of 35 patients (34%) with longitudinal specimens (i.e. two or more separate specimens from different disease stages in the same patient) displayed heterogeneous IDO staining between samples. Tumour IDO expression positively correlated with tumour‐infiltrating lymphocyte (TIL) score as well as the number of IDO‐expressing mononuclear cells in the primary melanoma (P < 0.0001 and P = 0.0011, respectively) and nodal metastases (P = 0.049 and P = 0.037, respectively), but not in distant metastases. Furthermore, tumour IDO expression correlated positively with PD‐L1 expression by melanoma cells among all specimens (P = 0.0073).

Conclusions

Therefore, while assessment of tumour IDO expression warrants evaluation in melanoma patient cohorts treated with IDO inhibitors dosed at levels proven to inhibit the target by pharmacodynamic assessment, its utility as a biomarker may be limited by intertumoral heterogeneity.
A seasonal population matrix model of the Caribbean Red‐tailed HawkButeo jamaicensis jamaicensisin eastern Puerto Rico
Authors: Gallardo Julio C. , Vilella Francisco J. , Colvin Michael E.
Published: December 2018

Reliable estimates of life history parameters and their functional role in animal population trajectories are critical, yet often missing, components in conservation and management. We developed seasonal matrix population models of the Red‐tailed HawkButeo jamaicensis jamaicensisin the upper and lower forests of the Luquillo Mountains, Puerto Rico, to describe the influence of early life stages (nestling and clutch survival) on population growth. Modelled populations exhibited positive discrete rates of growth in forests above 400 m (λhighlands = 1.05) and in forests below 400 m (λlowlands = 1.27) of the Luquillo Mountains. Further, adult survival was the parameter with the highest proportional effect and direct contribution to growth of the population. Besides survival of adults, our results identified that nestling survival had the second greatest influence onλ, stressing the importance of this life stage for the population growth rate of Red‐tailed Hawks in our study area. Seasonal matrices are not commonly used to describe population dynamics of birds. However, these may be a useful tool to analyse the influence of life stages in the annual cycle to better address conservation and management needs, especially for species inhabiting oceanic islands.
Adolescent body composition and associations with body size and growth from birth to late adolescence. The Tromsø study: Fit Futures—A Norwegian longitudinal cohort study
Authors: Evensen Elin , Emaus Nina , Furberg Anne‐Sofie , Kokkvoll Ane , Wells Jonathan , Wilsgaard Tom , Winther Anne , Skeie Guri
Published: December 2018

Background

Fat and fat‐free masses and fat distribution are related to cardiometabolic risk. Objectives: to explore how birth weight, childhood body mass index (BMI) and BMI gain were related to adolescent body composition and central obesity.

Methods

In a population‐based longitudinal study, body composition was measured by dual‐energy X‐ray absorptiometry in 907 Norwegian adolescents (48% girls). Associations between birth weight, BMI categories, and BMI gain were evaluated by fitting linear mixed models and conditional growth models with fat mass index (FMI, kg/m2), fat‐free mass index (FFMI, kg/m2) standard deviation scores (SDS), and central obesity at 15 to 20 years, as well as change in FMI SDS and FFMI SDS between ages 15 to 17 and 18 to 20 as outcomes.

Results

Birth weight was associated with FFMI in adolescence. Greater BMI gain in childhood, conditioned on prior body size, was associated with higher FMI, FFMI, and central overweight/obesity with the strongest associations seen at age 6 to 16.5 years: FMI SDS: β = 0.67, 95% CI (0.63‐0.71), FFMI SDS: 0.46 (0.39, 0.52), in girls, FMI SDS: 0.80 (0.75, 0.86), FFMI SDS: 0.49 (0.43, 0.55), in boys.

Conclusions

Compared with birth and early childhood, high BMI and greater BMI gain at later ages are strong predictors of higher fat mass and central overweight/obesity at 15 to 20 years of age.
Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study
Authors: Van Besien Jeroen , Uvin Pieter , Weyne Emmanuel , Van Praet Charles , Merckx Luc , De Graeve Nico , Van Renterghem Koenraad , Cartuyvels Reinoud , Van den Abeele Anne‐Marie
Published: December 2018

Objectives

To investigate whether switching ciprofloxacin to fosfomycin in the case of fluoroquinolone‐resistant rectal bacteria influences the incidence of infectious complications after transrectal prostate biopsy.

Methods

From December 2015 until December 2017, patients undergoing prostate biopsy were randomly assigned to a control group or an intervention group in a prospective, open‐label fashion at three different centers. The presence of fluoroquinolone‐resistant organisms was detected by rectal swabs. Patients in the control group received ciprofloxacin. Patients in the intervention group received fosfomycin instead of ciprofloxacin in the case of fluoroquinolone‐resistant bacteria on rectal swab culture. The primary end‐point was the difference in occurrence of major (febrile) and minor (afebrile) infections between both groups.

Results

A total of 102 patients were randomized to the control group, and 102 patients to the intervention group. In the control group, nine complications occurred, of which five were major febrile complications. In the intervention group, six complications occurred, of which four were major febrile complications. The total number of complications (major and minor) did not differ between both groups (P = 0.59). A subgroup analysis of patients with fluoroquinolone‐resistant bacteria on rectal swab showed five complications in the control group and one complication in the intervention group (P = 0.09).

Conclusions

This represents the first prospective randomized study using rectal cultures for targeted antibiotic prophylaxis. Study findings show promising results for use of fosfomycin in patients with fluoroquinolone resistance.
Paucity of high‐quality studies reporting on salt and health outcomes from the science of salt: A regularly updated systematic review of salt and health outcomes (April 2017 to March 2018)
Authors: Petersen Kristina S. , Rae Sarah , Venos Erik , Malta Daniela , Trieu Kathy , Santos Joseph Alvin , Thout Sudhir Raj , Webster Jacqui , Campbell Norm R. C. , Arcand JoAnne
Published: December 2018

The purpose of this review is to identify, summarize, and critically appraise studies on dietary salt and health outcomes that were published from April 2017 to March 2018. The search strategy was adapted from a previous systematic review on dietary salt and health. Identified studies were screened based on a priori defined criteria to identify publications eligible for detailed critical appraisals. Overall, 6747 citations were identified by the search strategy, and 42 health outcome studies were identified. Three of the 42 studies met the criteria for methodological quality and health outcomes and underwent detailed critical appraisals and commentary. In addition, a systematic review and meta‐analysis was critically appraised, although it did not strictly meet our methodological criteria. All four of the studies critically appraised found that sodium reduction improved blood pressure, especially in individuals with hypertension. In addition, sodium reduction reduced albuminuria in patients with stage 1‐3 chronic kidney disease. Examination of the time course of blood pressure responses to sodium reduction revealed lowering sodium in the context of an average American diet may not produce maximal blood pressure reductions within a 4‐week intervention period. This review provides further evidence of the benefit of sodium reduction for blood pressure lowering and gives insights into the subgroups of the population that may derive the greatest benefit from sodium reduction and the time course required to see benefit. Only three high‐quality studies were identified during this 12‐month review period, highlighting the critical need for more well‐conducted rigorous studies in this area.
Alteration in gut microbiota caused by time‐restricted feeding alleviate hepatic ischaemia reperfusion injury in mice
Authors: Ren Jinjun , Hu Dandan , Mao Yilei , Yang Huayu , Liao Wenjun , Xu Wei , Ge Penglei , Zhang Hongbing , Sang Xinting , Lu Xin , Zhong Shouxian
Published: December 2018

Time‐restricted feeding (TRF), that is, no caloric intake for 14‐16 hours each day leads to favourable nutritional outcomes. This study is the first to investigate TRF through a surgical perspective verifying its efficacy against liver ischaemia reperfusion (I/R) injury. We randomly assigned 100 10‐week‐old wild‐type male C57BL/6 mice into two feeding regimens: TRF and ad libitum access to food. Main outcomes were evaluated at 6, 12 and 24 hours post‐I/R surgery after 12 weeks of intervention. TRF group demonstrated minor liver injury via histological study; lower serum levels of liver enzymes, glucose and lipids; higher concentrations of free fatty acid and β‐hydroxybutyrate; decreased oxidative stress and inflammatory biomarkers; as well as less severe cell apoptosis and proliferation. Further exploration indicated better gut microenvironment and intestinal epithelial tight junction function. TRF employed its positive influence on a wide spectrum of biochemical pathways and ultimately revealed protective effect against hepatic I/R injury possibly through adjusting the gut microbiota. The results referred to a strong indication of adopting better feeding pattern for surgical patients.
An evaluation of the methods to estimate effective population size from measures of linkage disequilibrium
Authors: García‐Cortés Luis Alberto , Austerlitz Frederic , de Cara M. Angeles R.
Published: December 2018

In 1971, John Sved derived an approximate relationship between linkage disequilibrium (LD) and effective population size for an ideal finite population. This seminal work was extended by Sved and Feldman (Theor Pop Biol 4, 129, 1973) and Weir and Hill (Genetics 95, 477, 1980) who derived additional equations with the same purpose. These equations yield useful estimates of effective population size, as they require a single sample in time. As these estimates of effective population size are now commonly used on a variety of genomic data, from arrays of single nucleotide polymorphisms to whole genome data, some authors have investigated their bias through simulation studies and proposed corrections for different mating systems. However, the cause of the bias remains elusive. Here, we show the problems of using LD as a statistical measure and, analogously, the problems in estimating effective population size from such measure. For that purpose, we compare three commonly used approaches with a transition probability‐based method that we develop here. It provides an exact computation of LD. We show here that the bias in the estimates of LD and effective population size are partly due to low‐frequency markers, tightly linked markers or to a small total number of crossovers per generation. These biases, however, do not decrease when increasing sample size or using unlinked markers. Our results show the issues of such measures of effective population based on LD and suggest which of the method here studied should be used in empirical studies as well as the optimal distance between markers for such estimates.
Medication safety knowledge, attitude, and practice among hospital pharmacists in Lebanon
Authors: Hallit Souheil , Hajj Aline , Shuhaiber Patricia , Iskandar Katia , Ramia Elsy , Sacre Hala , Salameh Pascale ,   on behalf of the Order of Pharmacists of Lebanon scientific committee—Medication safety subcommittee
Published: December 2018

Background

Studies showed that pharmacists have little experience with adverse drug reactions (ADRs) reporting due to insufficient knowledge of the concept of ADR and pharmacovigilance (PV). There is an urge to assess hospital pharmacists' knowledge in medication safety practices.

Objective

To evaluate the knowledge, attitude, and practice, among hospital pharmacists in Lebanon concerning ADRs and PV concepts.

Methods

A cross‐sectional study, conducted between March and July 2016, enrolled 187 hospital pharmacists in all Lebanese districts.

Results

Concerning knowledge, 60.8% of the pharmacists said that ADR is an injury caused by appropriate and suboptimal care, while 74.6% of them said it can be preventable and nonpreventable. Moreover, 47.5% of them defined PV as being the study that detects, assesses, understands, and prevents adverse effects. Furthermore, 55.1% believed that PV concerns drug, herbal, medical devices, and vaccine problems. Concerning attitude, 61% of the pharmacists said they do not support direct ADR reporting by the patient. Of them, 78.6% confessed that ADR reporting is a professional obligation to them while 88.2% admitted that it is time‐consuming with no outcome. When it comes to practice, 64.2% had been trained to report ADRs. Only 20.8% and 24.2% confessed reporting ADRs more than once a week, respectively. More than half (54.5%) said that they report the ADR to the patient's prescriber.

Conclusion

Lebanese hospital pharmacists have little knowledge about the concept and process of PV and spontaneous ADRs reporting system. However, these pharmacists have positive attitudes, but very little practice with reporting systems. Educational programs are urgently needed to emphasize the role and responsibility of pharmacists in PV practices and to raise awareness towards ADR reporting process.
Supporting participative pre‐flood risk reduction in a UNESCO biosphere
Authors: O'Grady Michael J. , Evans Barry , Eigbogba Sylvester , Muldoon Conor , Campbell Abraham G. , Brewer Paul A. , O'Hare Gregory M. P.
Published: December 2018

Disaster Risk Reduction (DRR) has become the predominant strategy for pre‐emptively countering the havoc threatened by natural hazards, complementing traditional disaster management, and recovery activities. An important component of DRR activities is community involvement, imbuing the community with a sense of ownership of the risk reduction process, and thus increasing resilience to deal with natural hazards. Though the desirability for community engagement is acknowledged, the differing hazards, environments and community contexts, all pose many obstacles to enabling meaningful participation. This paper describes a participative, community‐oriented initiative for DRR in a context of the most common hazard faced by communities worldwide, that of flooding. A novel platform is presented which embraces participatory science principles in facilitating active community engagement in all stages of the flooding lifecycle. It is demonstrated how observations contributed by a community can contribute both to the practical mitigation of the effects of flooding and the calibration of inundation models. The novelty of the platform lies in its emphasis on mitigation activities during the pre‐flood stage, as well as its innovative use of image capture for enabling the safe assessment of water levels by the community.
A rapid flood inundation model for hazard mapping based on least squares support vector machine regression
Authors: Bermúdez María , Cea Luis , Puertas Jerónimo
Published: December 2018

Two‐dimensional shallow water models are widely used tools for flood inundation mapping. However, even if High Performance Computing techniques have greatly decreased the computational time needed to run a 2D inundation model, this approach remains unsuitable for applications that require results in a very short time or a large number of model runs. In this paper we test a non‐parametric regression model based on least squares support vector machines as a computationally efficient surrogate of the 2D shallow water equations for flood inundation mapping. The methodology is initially applied to a synthetic case study consisting of a straight river reach flowing towards the sea. A coastal urban area is then used as a real test case. Discharge in three streams and tide levels are used as predictor variables to estimate the spatial distribution of maximum water depth and velocity in the study area. The suitability of this regression model for the spatial prediction of flood hazard is evaluated. The results show the potential of the proposed regression technique for fast and accurate computation of flood extent and hazard maps.
A methylated‐DNA‐binding complex required for plant development mediates transcriptional activation of promoter methylated genes
Authors: Zhao Qiang‐Qiang , Lin Rong‐Nan , Li Lin , Chen She , He Xin‐Jian
Published: December 2018

Although the mechanism of DNA methylation‐mediated gene silencing is extensively studied, relatively little is known about how promoter methylated genes are protected from transcriptional silencing. SUVH1, an Arabidopsis Su(var)3‐9 homolog, was previously shown to be required for the expression of a few promoter methylated genes. By chromatin immunoprecipitation combined with sequencing, we demonstrate that SUVH1 binds to methylated genomic loci targeted by RNA‐directed DNA methylation. SUVH1 and its homolog SUVH3 function partially redundantly and interact with three DNAJ domain‐containing homologs, SDJ1, SDJ2, and SDJ3, thus forming a complex which we named SUVH‐SDJ. The SUVH‐SDJ complex components are co‐localized in a large number of methylated promoters and are required for the expression of a subset of promoter methylated genes. We demonstrate that the SUVH‐SDJ complex components have transcriptional activation activity. SUVH1 and SUVH3 function synergistically with SDJ1, SDJ2, and SDJ3 and are required for plant viability. This study reveals how the SUVH‐SDJ complex protects promoter methylated genes from transcriptional silencing and suggests that the transcriptional activation of promoter methylated genes mediated by the SUVH‐SDJ complex may play a critical role in plant growth and development.
A group of SUVH methyl‐DNA binding proteins regulate expression of the DNA demethylase ROS1 in Arabidopsis
Authors: Xiao Xinlong , Zhang Jieqiong , Li Tao , Fu Xing , Satheesh Viswanathan , Niu Qingfeng , Lang Zhaobo , Zhu Jian‐Kang , Lei Mingguang
Published: December 2018

DNA methylation is typically regarded as a repressive epigenetic marker for gene expression. Genome‐wide DNA methylation patterns in plants are dynamically regulated by the opposing activities of DNA methylation and demethylation reactions. In Arabidopsis, a DNA methylation monitoring sequence (MEMS) in the promoter of the DNA demethylase gene ROS1 functions as a methylstat that senses these opposing activities and regulates genome DNA methylation levels by adjusting ROS1 expression. How DNA methylation in the MEMS region promotes ROS1 expression is not known. Here, we show that several Su(var)3‐9 homologs (SUVHs) can sense DNA methylation levels at the MEMS region and function redundantly to promote ROS1 expression. The SUVHs bind to the MEMS region, and the extent of binding is correlated with the methylation level of the MEMS. Mutations in the SUVHs lead to decreased ROS1 expression, causing DNA hypermethylation at more than 1,000 genomic regions. Thus, the SUVHs function to mediate the activation of gene transcription by DNA methylation.
Longing to get back on track: Patients’ experiences and supportive care needs after lung cancer surgery
Authors: Kyte Kristin , Ekstedt Mirjam , Rustoen Tone , Oksholm Trine
Published: December 2018

Aims and objectives

This study aims to describe surgically treated lung cancer patients’ experiences of coming home after discharge from hospital to expand the knowledge about their supportive care needs.

Background

Existing research reports that patients suffer from a high symptom burden after lung cancer surgery. Such burden has negative impacts on their physical, emotional and social wellbeing. Few studies have explored the surgically treated patients’ supportive care needs after being discharged from hospital.

Design

This study used a qualitative descriptive design, following the EQUATOR guidelines (COREQ).

Methods

The information about 14 patients’ experiences was collected from semi‐structured interviews. The interviews were conducted in their homes within three weeks after their discharge from hospital. The data were analysed using qualitative content analysis.

Results

The main theme of the study, “Longing to get back on track with their lives”, consisted of four categories: “Burdened with problems related to postoperative symptoms and treatment”, “Struggling for the needed support”, “A pendulum between being in need of support and being independent”, and “Striving to adapt to a new way of life”. The participants experienced many problems related to postoperative symptoms and treatment. Information and support from healthcare professionals were deficient. Life was characterised by striving to be independent and adapting to a new lifestyle.

Conclusions

The findings demonstrate the supportive care needs of surgically treated lung cancer patients. Nurses and other healthcare professionals could offer more individualised support during the first few weeks after the patients’ discharge by including them and their caregivers in the discharge planning.

Relevance to clinical practice

Knowledge of patients’ perspectives and experiences of everyday life at home after lung cancer surgery can provide hospital nurses with a better understanding of what is important for such patients beyond hospitalisation. This knowledge should be included in discharge planning.
The borderline between life and death
Authors: Hultsjö Sally , Wärdig Rikard , Rytterström Patrik
Published: December 2018

Aims and objectives

To explore mental health professionals’ experiences in regard to circumstances that cause the patient to take their own life during ongoing care.

Background

Suicide is a worldwide health problem, and of those who take their own life, nearly 20% have had contact with a psychiatric unit. Mental health professionals may have extended intuitive knowledge that has not been made visible. Mental health professionals’ experiences can contribute knowledge that can complement suicide risk assessments and can be helpful in developing approaches and strategies where the hope is to identify and draw attention to people at risk of taking their own life.

Design

A reflective lifeworld research.

Methods

Twelve interviews with mental health professionals with experience of working in caring relationships with patients that had taken their life during the period of care. The study was performed in accordance with COREQ (see Supporting Information Data S1).

Results

Mental health professionals’ experiences regarding circumstances that cause the patient to take their own life are related to the patient’s life circumstances that led to a loss of dignity, and finally beyond retrieval. Mental health professionals share patients’ struggle to choose between life and death, the darkness of their life and their hopeless situation. This shared experience also makes the mental health professionals wish to relieve patient’s suffering but also gives them an understanding of why patients take their own life.

Conclusions

The mental health professionals experience how the patient loses the possibility of living a worthwhile life, recognise darkness within the patient and see how the patient’s life is fragile. Suicide described as logical and expected, based on their life and life circumstances, has not been found in previous research. Bearing this in mind, should psychiatric care focus on a proactive approach and act when these circumstances are identified?

Relevance to clinical practice

The Mental health professionals’ tacit knowledge may be used to strengthen uncertain suicide assessments.
Workplace bullying, biased behaviours and performance review in the nursing profession: A qualitative study
Authors: Johnson Susan L.
Published: December 2018

Aims and objectives

To explore staff nurses’ discourses of workplace bullying, to critically examine how these discourses affect their responses to bullying.

Background

Workplace bullying has been identified as a pervasive problem within the nursing profession. Efforts to eradicate workplace bullying need to involve staff—targets as well as bystanders. By understanding how this population conceptualises workplace bullying, more effective and targeted solutions to the problem can be devised.

Design

This qualitative study used a critical discourse analysis method which was based on the work of Foucault.

Methods

Thirteen staff nurses who worked in a variety of settings in the USA were interviewed. COREQ checklist was used for this article.

Results

Three interrelated discursive strands were identified: “biased behaviour manifested as workplace bullying, workplace bullying disguised as performance review and workplace bullying as entrenched behaviour in nursing”. Actions in response to bullying varied according to which discursive strand was invoked.

Conclusions

The central theme at the intersection of the discursive strands was that workplace bullying is a mechanism for driving out nurses who are different.

Relevance to clinical practice

Efforts to address workplace bullying among nurses need to include training on legitimate methods of performance review, workshops on how to interact with diverse co‐workers, and examination of how practices with nursing education contribute to the perpetuation of bullying in clinical settings.
Implementing evidence‐based practices on the therapeutic relationship in inpatient psychiatric care: A participatory action research
Authors: Moreno‐Poyato Antonio R. , Delgado‐Hito Pilar , Leyva‐Moral Juan M. , Casanova‐Garrigós Georgina , Montesó‐Curto Pilar
Published: December 2018

Aims and objectives

To produce changes in the therapeutic relationship between clinical practice nurses and patients in psychiatric units by implementing evidence‐based practices through participatory action research.

Background

The therapeutic relationship is the cornerstone of nursing care in psychiatric units. The literature suggests that theoretical knowledge alone is insufficient to establish the therapeutic relationship in practice. Therefore, strategies are needed to adequately establish the therapeutic relationship in psychiatric units.

Design

Participatory action research.

Methods

Participants consisted of nurses from two psychiatric units of a university hospital. Data were collected through focus groups and reflective diaries, which were analysed using the content analysis method. The COREQ guidelines were followed to ensure rigour.

Results

Nurses conceptualised the therapeutic relationship in their practice, identifying facilitating elements and limitations. They were able to compare their clinical practice with the recommendations of scientific evidence and constructed three evidence‐based proposals to improve the therapeutic relationship: (a) a customised nurse intervention space, (b) knowledge updating and (c) reflective groups, which they subsequently implemented and evaluated.

Conclusions

This study shows that nurses in psychiatric units can generate changes and improvements in the therapeutic relationship. The process of implementing evidence‐based practice enhanced participants’ awareness of their clinical practice and allowed them to make changes and improvements.

Relevance to clinical practice

The process confirmed that the implementation of evidence‐based practice through participatory methods, such as participatory action research, is valid and produces lasting changes. This study also reveals the need to rethink nurses’ functions and competencies in current psychiatric units.
Incidence, severity and risk factors of peripheral intravenous cannula‐induced complications: An observational prospective study
Authors: Simin Dragana , Milutinović Dragana , Turkulov Vesna , Brkić Snežana
Published: December 2018

Aims and objectives

To determine the incidence, severity and risk factors of peripheral intravenous cannula‐induced complications.

Background

Peripheral venous cannulation in hospitalised patients may cause complications such as phlebitis, infiltration, occlusion and dislodgement. A review of the literature reveals the discrepancy in their incidence and identification of a wide range of risk factors, whereas the data on the occurrence and degree of severity are insufficient.

Design

An observational prospective study.

Methods

The study observed 1,428 peripheral intravenous cannula insertion among 368 adult patients hospitalised at the tertiary healthcare clinics. The data collection and analysis included patients’ medical data and the data related to each cannula (including placement, monitoring and the reasons for removal), as well as the data on the type of administered medications and solutions. Reporting of this research adheres to the STROBE guidelines.

Results

Phlebitis ranked first among complications with occurrence of 44%, followed by infiltration of 16.3%, while the incidence of occlusion and catheter dislodgement was 7.6% and 5.6%, respectively. In assessing the occurrence of phlebitis, multivariate analysis highlighted the presence of comorbidity, current infection, catheter size, time in situ and the number of administrations of infusion solutions associated with risk, whereas 20‐gauge catheter, two or more attempts at cannulation and administration of a high‐risk solutions during the first day have been singled out with regard to infiltration. As for the severity, the most common was medium stage of phlebitis, whereas grade 2 was most commonly observed for infiltration.

Conclusion

The incidence of infiltration, occlusion and dislodgment is almost congruent with the average incidence of previous studies. However, the incidence and degree of severity associated with the occurrence of phlebitis were significantly higher.

Relevance to clinical practice

The results of the study draw attention to vulnerable groups of patients, cannula‐specific and pharmacological risk factors for the development of peripheral intravenous cannula‐induced complications.
Analysis of oral dietary supplement use in rural older adults
Authors: Shade Marcia Y. , Witry Matthew , Robinson Katie , Kupzyk Kevin
Published: December 2018

Aims and objectives

To describe and explore characteristics associated with oral dietary supplement use and identify potential interactions with prescription medications in a sample of rural community‐dwelling older adults.

Background

Older adults use polypharmacy to help manage chronic diseases. Due to healthcare access disparities, rural older adults may consider dietary supplement use as an alternative approach to maintain health and manage disease. Oral dietary supplement use is expected to increase among ageing adults; placing them at risk for potential interactions and adverse events.

Design

A secondary analysis was conducted on oral dietary supplement, medication and health characteristic data collected on N = 138 participants. The original study was adherent to STROBE guidelines.

Results

Researchers found that 83% of the rural older adults used oral dietary supplements in addition to their prescribed medications. Participants took additional single‐dose vitamins along with their multivitamin; 57% took vitamin D, 52% took calcium, 15% took vitamin C and 13% took additional potassium and vitamin E. Participants also used oral dietary supplements with medications that had a potential for interaction.

Conclusions

Compared with national samples of older adults, a high percentage of rural older adults used oral dietary supplements in addition to their prescribed medications. In the rural setting, older adults are at risk for potential drug–oral dietary supplement interactions.

Relevance to clinical practice

Nurses can conduct vigilant medication reconciliation that includes documenting characteristics of oral dietary supplement use. Nurses can assist with providing appropriate dietary supplements education that promotes patient knowledge and prevent inappropriate use; particularly when caring for older adults from rural settings.
Surgical patients’ experiences of readiness for hospital discharge and perceived quality of discharge teaching in acute care hospitals
Authors: Nurhayati Nurhayati , Songwathana Praneed , Vachprasit Ratjai
Published: December 2018

Aims and objectives

To examine the level of perception of the quality of discharge teaching and its associations with the readiness for hospital discharge among surgical patients in acute care hospitals.

Background

Discharge teaching is a primary strategy to facilitate patients’ readiness for hospital discharge. The extent to which the surgical ward was perceived as providing patient‐focused education when discharged has never been explored. Its impact on a patient's readiness is also unknown in the Indonesian context.

Design

A correlational descriptive study was used to collect data from four hospitals in Indonesia.

Methods

Ninety‐six surgical patients who were in the discharge process enrolled in this study. The demographic form, the quality of discharge teaching scale (QDTS) and the readiness for hospital discharge scale (RHDS) were utilised for data collection. Data were collected from January–February 2018. Descriptive statistics and Spearman rank‐order correlation were applied for data analysis.

Results

The discharge teaching quality was perceived as being at a low level. The readiness for hospital discharge was reported to be at a moderate level. Overall, the discharge teaching quality was not statistically associated with the patients’ readiness. However, positive correlations were found in QDTS and RHDS subscales such as content received and delivery, knowledge, coping ability and expected support. Patient's readiness for hospital discharge was also greater for those who had a caregiver, a short hospital stay, a health insurance and occupation.

Conclusions

Surgical patients perceived a low quality of discharge teaching, which may decrease their readiness for hospital discharge.

Relevance to clinical practice

This study provides baseline information reflecting the patient learning needs in discharge preparation to guide surgical nurses for improving the discharge teaching quality and enhancing the patients’ readiness for hospital discharge.
Shift‐work nurses’ work environments and health‐promoting behaviours in relation to sleep disturbance: A cross‐sectional secondary data analysis
Authors: Lim Sungju , Han Kihye , Cho Hyeonmi , Baek Hyang
Published: December 2018

Aims and objectives

To examine the association of nursing work environments and health‐promoting behaviours with shift‐work nurses’ sleep disturbance.

Background

Shift‐work nurses reportedly have sleep problems, which affect their sleep quality and quantity. Given the high risk of developing performance decrements and medication errors in sleep‐disturbed nurses, factors related to sleep disturbance among shift‐work nurses should be investigated.

Design

A cross‐sectional secondary data analysis.

Methods

Our study analysed data from 339 nurses who had been involved in rotating shift work including night shifts for more than 6 months. To examine associations of nursing work environments and health‐promoting behaviours with sleep disturbance, multiple linear regression models were generated. This study is reported in accordance with the STrengthening the Reporting of OBservational studies in Epidemiology guideline.

Results

Nurses with more collegial relations with physicians were significantly less likely to have high levels of sleep disturbance (B = −4.01, p = 0.04). Those with higher levels of sleep disturbance were significantly more likely to report less stress management (B = −9.56, p < 0.01) and higher health responsibility (B = 9.30, p < 0.01).

Conclusions

To alleviate shift‐work nurses’ sleep disturbance, organisational supports for collaborative relations with physician and increased healthcare accessibility are needed. Individual nurses should develop healthy lifestyles to reduce occupational stress and alleviate sleep disorders.

Relevance to clinical practice

To improve shift‐work nurses’ sleep, collegial relations with physicians and healthy lifestyles should be promoted.
Maternal and neonatal screening methods for congenital cytomegalovirus infection
Authors: Tanimura Kenji , Yamada Hideto
Published: December 2018

Human cytomegalovirus (CMV) is a common cause of congenital infection that may lead to severe long‐term sequelae. Because there are no established vaccines, fetal interventions or neonatal treatments, neither maternal nor neonatal screening is recommended. However, recent studies have indicated that early antiviral treatment may improve neurological outcomes in symptomatic infants with congenital infection. Therefore, prenatal detection may be important in newborns at high risk of such infection. Polymerase chain reaction for CMV DNA in the amniotic fluid is considered the gold standard for diagnosis of intrauterine infection, but its use is limited because amniocentesis is an invasive procedure. In a prospective cohort study, we have reported that the presence of CMV DNA in secretions of the maternal uterine cervix were predictive of congenital infection in groups at high risk. However, we also recently demonstrated that maternal serological screening for primary CMV infection using specific immunoglobulin G, the immunoglobulin G avidity index or specific immunoglobulin M can overlook many cases. Previous research has indicated that the combination of early detection by universal neonatal screening of urinary CMV DNA combined with early antiviral therapy can improve outcomes in infants with symptomatic congenital infection. In this article, we review the current state of maternal and neonatal screening for congenital CMV infection.
Efficiency and stability of sampling equilibrium in public goods games
Authors: Mantilla César , Sethi Rajiv , Cárdenas Juan Camilo
Published: December 2018

Most models of social preferences and bounded rationality that are effective in explaining efficiency‐increasing departures from equilibrium behavior cannot easily account for similar deviations when they are efficiency‐reducing. We show that the notion of sampling equilibrium, subject to a suitable stability refinement, can account for behavior in both efficiency‐enhancing and efficiency‐reducing conditions. In particular, in public goods games with dominant strategy equilibria, stable sampling equilibrium can involve the play of dominated strategies with positive probability both when such behavior increases aggregate payoffs (relative to the standard prediction) and when it reduces aggregate payoffs. The dominant strategy equilibrium prediction changes abruptly from zero contribution to full contribution as a parameter crosses a threshold, whereas the stable sampling equilibrium remains fully mixed throughout. This is consistent with the available experimental evidence.
Specific immune response in mucosal and systemic compartments of Cirrhinus mrigala vaccinated against Edwardsiella tarda: In vivo kinetics using different antigen delivery routes
Authors: Qadiri Syed Shariq N. , Makesh Marappan , Rajendran Kooloth V. , Rathore Gaurav , Purushothaman Chandra S.
Published: December 2018

Mucosal immune barriers confer protection against invading fish pathogens. Here, we conducted an experiment for 60 days to assess the mucosal and systemic immune response in Mrigal (Cirrhinus mrigala), an Indian major carp. Fish were immunized with inactivated Edwardsiella tarda by four different routes, namely, oral, immersion, injection, and anal intubation. An indirect enzyme‐linked immunosorbent assay (ELISA) was used to measure the specific immune response (antibody) in serum and mucus (collected from skin, gill, and gut) of the fish on 0, 15, 30, 45, and 60 days postimmunization. For specific immune response in the serum, significantly higher (p < 0.05) optical density (OD) values were obtained in the anal group (0.52 ± 0.03) and in the oral group (0.48 ± 0.03). In the skin mucus, significantly higher OD values were obtained in the oral group (0.48 ± 0.04) and immersion group (0.32 ± 0.03). In the gill mucus, significantly higher OD values were obtained in the oral group (0.82 ± 0.08) and the immersion group (0.73 ± 0.03). In the gut mucus, significantly higher OD values were obtained in the immersion group (0.080 ± 0.007) compared to the rest of the treatments. Fish from all the groups were challenged with LD50 dose of E. tarda at the end of the experiment. We conclude that oral and immersion immunization routes offer better protection of C. mrigala compared to other antigen delivery routes.
Coagulation failure is associated with bleeding events and clinical outcome during systemic inflammatory response and sepsis in acute‐on‐chronic liver failure: An observational cohort study
Authors: Premkumar Madhumita , Saxena Priyanka , Rangegowda Devaraja , Baweja Sukriti , Mirza Roshni , Jain Priyanka , Bhatia Puja , Kumar Guresh , Bihari Chhagan , Kalal Chetan , Vyas Tanmay , Choudhury Ashok , Sarin Shiv K.
Published: December 2018

Background

Patients with acute‐on‐chronic liver failure (ACLF) have coagulation failure in the setting of systemic inflammatory syndrome (SIRS), sepsis and extra‐hepatic organ failures.

Methods

Consecutive ACLF patients without sepsis at baseline were assessed at days 0, 3 and 7 with thromboelastography (TEG) and specific assays (Factor VIII, von Willebrand factor [vWF], protein C and antithrombin III [ATIII]) and followed for development of sepsis, bleeding and outcome.

Results

Of 243 patients, 114 (63% ethanol related; mean age 44.3 ± 11.7 years; 90% male) were recruited. SIRS was noted in 39 (34.2%), 45 (39.5%) and 46 (40%) patients at days 0, 3 and 7 and sepsis in 28 (24%) and 52 (56.1%) patients at days 3 and 7 respectively. The 28‐ and 90‐day survivals were 62% and 51% respectively. A hypocoagulable TEG at baseline was a predictor of bleeding (hazard ratio [HR] 2.1; CI 1.6‐4.9; P = 0.050) and mortality (HR 1.9; CI 1.3‐7.9; P = 0.043). ACLF patients had increased Factor VIII, vWF, tissue factor levels and tissue plasminogen activator (tPA) activity with reduced protein C and ATIII. Coagulation parameters like Coagulation Index (HR 2.1; CI 1.1‐4.5; P = 0.044),clot lysis (HR 3.2; CI 1.9‐3.4; P = 0.033), low protein C < 30% (HR 2.1; CI 1.5‐2.8; P = 0.017), ATIII (HR 1.4; CI 1.7‐3.1; P = 0.052) and tPA (HR 1.5; CI 1.1‐2.4; P = 0.052) were predictors of mortality at day 28. Protein C activity <30% (HR 1.3; CI 1.0‐2.9; P = 0.042) and tPA >20 ng/mL (HR 1.2; CI 1.1‐2.1; P = 0.040) predicted mortality when adjusted for age, gender and baseline MELD.

Conclusions

Dynamic coagulation derangements, measured by TEG, determine the likelihood of bleeding and mortality in ACLF.
, Jost's D, and FST are similarly constrained by allele frequencies: A mathematical, simulation, and empirical study
Authors: Alcala Nicolas , Rosenberg Noah A.
Published: December 2018

Statistics and Jost's D have been proposed for replacing FST as measures of genetic differentiation. A principal argument in favour of these statistics is the independence of their maximal values with respect to the subpopulation heterozygosity HS, a property not shared by FST. Nevertheless, it has been unclear if these alternative differentiation measures are constrained by other aspects of the allele frequencies. Here, for biallelic markers, we study the mathematical properties of the maximal values of and D, comparing them to those of FST. We show that and D exhibit the same peculiar frequency‐dependence phenomena as FST, including a maximal value as a function of the frequency of the most frequent allele that lies well below one. Although the functions describing , D, and FST in terms of the frequency of the most frequent allele are different, the allele frequencies that maximize them are identical. Moreover, we show using coalescent simulations that when taking into account the specific maximal values of the three statistics, their behaviours become similar across a large range of migration rates. We use our results to explain two empirical patterns: the similar values of the three statistics among North American wolves, and the low D values compared to and FST in Atlantic salmon. The results suggest that the three statistics are often predictably similar, so that they can make quite similar contributions to data analysis. When they are not similar, the difference can be understood in relation to features of genetic diversity.