bluuebunny/crossref_metadata_2025_split huggingface dataset:
Do Leadership Style, Unit Climate, and Safety Climate Contribute to Safe Medication Practices?
Authors: Farag Amany , Tullai-McGuinness Susan , Anthony Mary K. , Burant Christopher 
Published: January 2017

OBJECTIVES:
This study aims at: examining if leadership style and unit climate predict safety climate; and testing the direct, indirect, and total effect of leadership style, unit climate, and safety climate on nurses’ safe medication practices.

BACKGROUND:
The Institute of Medicine and nursing scholars propose that safety climate is a prerequisite to safety practices. However, there is limited empirical evidence about factors contributing to the development of safety climate and about the association with nurses’ safe medication practices.

METHOD:
This cross-sectional study used survey data from 246 RNs working in a Magnet® hospital.

RESULTS:
Leadership style and unit climate predicted 20% to 50% of variance on all safety climate dimensions. Model testing revealed the indirect impact of leadership style and unit climate on nurses’ safe medication practices.

CONCLUSION:
Our hypothesized model explained small amount of the variance on nurses’ safe medication practices. This finding suggests that nurses’ safe medication practices are influenced by multiple contextual and personal factors that should be further examined.
Wired to the Workplace
Authors: Gardner Candace , Hailey Amy , Nguyen Christi , Prichard Charlsea , Newcomb Patricia 
Published: January 2017

OBJECTIVE:
The aim of this study is to describe the beliefs and behaviors of nurse leaders regarding electronic connectedness with their workplace and workplace support.

BACKGROUND:
Electronic communication enables leaders’ continuous availability to the workplace. This may blur home-work boundaries and contribute to burnout.

METHODS:
This mixed-methods study surveyed nurses in 6 acute care hospitals in north Texas. A qualitative phase employed focus groups composed of nurses from participating hospitals to validate and enrich data collected in the quantitative phase.

RESULTS:
Data showed that leader support directly influenced work-related electronic communication by influencing expectations regarding connectedness. Furthermore, leaders who frequently thought of leaving employment reported significantly lower levels of supervisor support and stronger beliefs that work interfered with home life than other respondents did. Focus group data supported survey findings.

CONCLUSIONS:
Electronic availability of nurse leaders did not directly affect satisfaction, but supervisor support and perception that work interferes with home life strongly and directly affected satisfaction.
Accountable Care Organization Implementation Experiences and Rural Participation
Authors: Bagwell Matt Thomas , Bushy Angeline , Ortiz Judith 
Published: January 2017

BACKGROUND:
Little is known about how accountable care organizations (ACOs) participate with rural health providers. This pilot study examines ACO participation with rural health clinics (RHCs).

METHODS:
Telephone interviews with 8 ACO administrators were conducted to determine the early implementation experiences of these organizations, and their participation with rural health providers, such as RHCs, using qualitative content analysis, ACO characteristics, and emerging themes from the ACO executive responses was identified.

RESULTS:
Three predominant themes emerged: 1) ACOs are growing in size and number and have various organizational structures; 2) there is an expanding emphasis on preventive primary care and chronic disease management for patients; and 3) there is a need for improved information technology integration with clinical services and financial systems.

CONCLUSION:
Of 8 participants, 7 reported that their ACO was planning to expand into rural areas and partner with rural providers.
The Effect of Reported Sleep, Perceived Fatigue, and Sleepiness on Cognitive Performance in a Sample of Emergency Nurses
Authors: Wolf Lisa A. , Perhats Cydne , Delao Altair , Martinovich Zoran 
Published: January 2017

OBJECTIVE:
The aim of this study is to explore the relationship between reported sleep, perceived fatigue and sleepiness, and cognitive performance.

BACKGROUND:
Although evidence suggests that fatigue and sleepiness affect the provision of care in inpatient units, there is a lack of research on the sleep patterns of emergency nurses and the effects of disturbed sleep and fatigue on their cognitive abilities and susceptibility to medical errors.

METHODS:
A quantitative correlational design was used in this study; in each of 7 different statistical models, zero-order relationships between predictors and the dependent variable were examined with appropriate inferential tests.

RESULTS:
Participants reported high levels of sleepiness and chronic fatigue that impeded full functioning both at work and at home.

CONCLUSIONS:
Although high levels of self-reported fatigue did not show any effects on cognitive function, other factors in the environment may contribute to delayed, missed, or inappropriate care. Further research is indicated.
Clinician Perceptions of Teamwork in the Emergency Department
Authors: Weaver Amy L. , Hernandez Susan , Olson Daiwai M. 
Published: January 2017

OBJECTIVE:
This study was intended to determine whether positioning emergency department (ED) physicians, physician assistants, and nurse practitioners at the same workstations as registered nurses (RNs) improved communication and teamwork.

BACKGROUND:
Historically in this organization, providers and staff had separate physical locations (workstations). Construction of a new ED provided the opportunity to redesign the physical layout and to study whether a new design improved the perception of communication and teamwork among medical providers.

METHODS:
A prospective, self-administered presurvey-postsurvey using the TeamSTEPPS Teamwork Perceptions Questionnaire (TPQ) was completed at 2 medical centers with the same staff premove and postmove but different ED designs. The presurvey was conducted while the staff were at the older facility with a more linear floor design and separated nurse and physician stations. The postsurvey was conducted 3 months after employees and physicians were relocated to a new hospital with a pod design and communal workstations in the ED.

RESULTS:
Forty-six staff members completed both the presurvey and the postsurvey. There was a statistically significant improvement in the total TPQ scores (P = .0009) and 4 of the 5 components of the TPQ: team structure (P = .0283), situation monitoring (P = .0006), mutual support (P < .0001), and communication (P < .0001). There was no change in the leadership component (P = .4519).

CONCLUSIONS:
Adopting a more communal physical layout was associated with improved overall TPQ scores and most of the TPQ components. The lack of change in the leadership component was explained by the lack of change in leadership structure. The physical placement of medical providers and RNs in an ED is important and can increase the perception of communication and teamwork and thereby improve patient outcomes.
Improving the Use of Evidence-Based Practice and Research Utilization Through the Identification of Barriers to Implementation in a Critical Access Hospital
Authors: Stavor Dawn Carol , Zedreck-Gonzalez Judith , Hoffmann Rosemary L. 
Published: January 2017

OBJECTIVE:
This study explored the relationship between perceived barriers to research use and the implementation of evidence-based practice (EBP) among rural hospital nurses.

BACKGROUND:
The Institute of Medicine recommends that 90% of clinical decisions be evidence based by 2020.

METHODS:
This descriptive, quality improvement study used a convenience sampling of registered nurses (RNs). Participants completed multiple questionnaires.

RESULTS:
Overall the attitude toward EBP was positive. Nurses recognize the importance to their practice but identified a lack of educational preparation regarding the process of research utilization.

CONCLUSION:
Providing education on research process and supportive monitoring during implementation may increase compliance with EBP initiatives.
Transmission Behaviors and Prevalence of Chlamydia and Gonorrhea Among Adult Film Performers
Authors: Javanbakht Marjan , Dillavou M. Claire , Rigg Robert W. , Kerndt Peter R. , Gorbach Pamina M. 
Published: January 2017

Background
Adult film work involves multiple sex partners, unprotected intercourse and frequent oral/rectal contact. Data on sexual networks and sexual behaviors of adult film performers (AFP) are limited.

Methods
From August 2012 to May 2013, AFPs in Los Angeles, CA, seeking care at 2 clinics that provide sexually transmitted infections (STIs) testing to performers were offered urogenital, pharyngeal, and rectal chlamydia/gonorrhea testing. Participants were 18 years or older and performed in at least 1 adult film scene within the past year. A Web-based survey was used to collect sexual behavior information.

Results
A total of 360 AFPs were enrolled; 75% (n = 271) were women, and the median age was 25 years (interquartile range, 22–31 years). Most reported a main partner (73%), 23% reported non-film transactional partners, and only 6% reported always using condoms on-set. Overall, 24% (n = 86) tested positive for chlamydia or gonorrhea; 15% for chlamydia (n = 54) and 11% for gonorrhea (n = 41). Prevalence of chlamydia/gonorrhea varied by time as a performer (median, year 2 vs year 3; P = 0.06), and days of adult film-work in the past 30 days (median, 6 days vs 4 days; P = 0.02). In multivariable analyses, age (adjusted odds ratio, 0.90; 95% confidence interval, 0.85–0.96) and type of scene (adjusted odds ratio for double vaginal = 2.89; 95% confidence interval, 1.29–6.48) were associated with chlamydia/gonorrhea positivity.

Conclusions
Adult film performers had a high prevalence of STIs and reported low levels of condom use in the context of most sexual partnerships. Targeted intervention strategies—both in and outside the workplace—are needed to limit the spread of STIs.
Expression of Glucose-Regulated Protein 78 and miR-199a in Rat Brain After Fatal Ligature Strangulation
Authors: Feng Xueying , Zhang Dongchuan , Gong Qingjin , Zhang Zhiyong , Quan Li 
Published: January 2017

Abstract
The roles of endoplasmic reticulum (ER) stress and microRNA in the brain tissue after fatal mechanical asphyxia have not been clearly elucidated. We examined the expression of glucose-regulated protein 78 (GRP78), the key regulator of unfolded protein response, and miR-199a in the brain tissues of rats subjected to fatal ligature strangulation to understand the roles of ER stress and microRNA in ligature strangulation. The expressions of GRP78 and miR-199a in rat cortex, hippocampi, and midbrain were measured by immunohistochemistry and Western blot analysis in a rat model of ligature strangulation. Furthermore, the levels of miR-199a-3p and miR-199a-5p were detected by real-time fluorescent quantitative polymerase chain reaction. Glucose-regulated protein 78 was highly expressed in the cortex and midbrain in the ligature strangulation group (P < 0.01) when compared with the control group. The expression of GRP78 in the hippocampi showed no significant difference between the 2 groups. miR-199a-3p in the cortex and midbrain was significantly down-regulated in the ligature strangulation group (P < 0.01). However, miR-199a-5p in each brain region showed no significant difference between the 2 groups. In conclusion, ER stress was involved in the physiological and pathological processes of ligature strangulation. Furthermore, upstream miR-199a may play an important regulatory role in mechanical asphyxia.
Does the Use of a Vein Visualization Device for Peripheral Venous Catheter Placement Increase Success Rate in Pediatric Patients?
Authors: Demir Duygu , Inal Sevil 
Published: January 2017

Background
Peripheral intravenous catheterization is one of the most frequently encountered medical procedures for hospitalized children and is one that can often be painful. Pediatric nurses should therefore use techniques that increase the success rate or shorten the duration of peripheral intravenous catheterization.

Objectives
This study was performed with the objective of determining the effect of using a vein visualization device on the success of the procedure. Success was determined based on the number of attempts per patient, the duration of the procedure, and the first stick success rate.

Methods
This was a randomized, controlled experimental study on 129 children aged 3 to 18 years.

Results
The duration of peripheral intravenous catheterization was shorter in the study group (S) than in the control (C) patients (37.24 ± 20.07 vs 172.65 ± 153.21 seconds; P = 0.001), with fewer attempts (S, 1.08 ± 0.28; C, 2.23 ± 1.57; P < 0.01). The first stick success rate was higher in the control group (S, 91.7%; C, 47.4%; P = 0.001).

Conclusions
Peripheral intravenous catheterization using vein visualization device support reduces the number of attempts per patient and the operation duration but increases the rate of first stick success. We may therefore state that vein visualization device support improves the success of peripheral intravenous catheterization.
Swimming Pool Electrical Injuries
Authors: Tashiro Jun , Burnweit Cathy A. 
Published: January 2017

Objective
Electrical injuries in swimming pools are an important pediatric public health concern. We sought to (1) improve our understanding of the clinical presentation and outcomes following and (2) describe the epidemiology of swimming pool electrical injuries in the United States.

Methods
We reviewed 4 cases of pediatric (<18 y old) electrical injury from a single, urban level 1 pediatric trauma center. We also queried the National Electronic Injury Surveillance System (NEISS) for emergency department visits due to electrical injury associated with swimming pools, occurring between 1991 and 2013.

Results
Overall, 566 cases were reported, with a mean (SD) age of 9.2 (4.1) years. Patients were mostly treated and released from the emergency department (91.8%), whereas 8.2% were hospitalized. When stated, injuries occurred most frequently at home (57.0%), followed by public (23.9%) and sports facilities (19.1%). Electrical outlets or receptacles (39.8%) were most commonly implicated, followed by electrical system doors (18.2%), electric wiring systems (17.0%), thermostats (16.3%), hair dryers (4.6%), and radios (4.1%). Pediatric cases represented 48.4% of swimming pool–related electrical injuries reported to NEISS.

Conclusions
Electrical injuries occurring in and around swimming pools remain an important source of morbidity and mortality. Although NEISS monitors sentinel events, current efforts at preventing such cases are less than adequate. All electrical outlets near swimming pools should be properly wired with ground fault circuit interrupter devices. Possible approaches to increasing safe electrical device installation are through strengthening public awareness and education of the potential for injury, as well as changes to current inspection regulations.
Instruments to Identify Commercially Sexually Exploited Children
Authors: Armstrong Stephanie 
Published: January 2017

Objective
This review examines the screening instruments that are in existence today to identify commercially sexually exploited children. The instruments are compared and evaluated for their feasibility of use in an emergency department setting.

Methods
Four electronic databases were searched to identify screening instruments that assessed solely for commercial sexual exploitation. Search terms included “commercially sexually exploited children,” “CSEC,” “domestic minor sex trafficking,” “DMST,” “juvenile sex trafficking,” and “JST.” Those terms were then searched in combination with each of the following: “tools,” “instruments,” “screening,” “policies,” “procedures,” “data collection,” “evidence,” and “validity.”

Results
Six screening instruments were found to meet the inclusion criteria. Variation among instruments included number of questions, ease of administration, information sources, scoring methods, and training information provided. Two instruments were determined to be highly feasible for use in the emergency department setting, those being the Asian Health Services and Banteay Srei's CSEC Screening Protocol and Greenbaum et al's CSEC/child sex trafficking 6-item screening tool.

Conclusions
A current dearth of screening instruments was confirmed. It is recommended that additional screening instruments be created to include developmentally appropriate instruments for preadolescent children. Numerous positive features were identified within the instruments in this review and are suggested for use in future screening instruments, including succinctness, a simple format, easy administration, training materials, sample questions, multiple information sources, designation of questions requiring mandatory reporting, a straightforward scoring system, and an algorithm format.
World Health Organization Framework: Multimodal Hand Hygiene Strategy in Piedmont (Italy) Health Care Facilities
Authors: Bert Fabrizio , Giacomelli Sebastian , Ceresetti Daniela , Zotti Carla Maria 
Published: January 2017

Objectives
In 2009, the World Health Organization (WHO) introduced the “Hand Hygiene Self-Assessment Framework” (HHSAF) to evaluate the level of the application of the Multimodal Hand Hygiene Improvement Strategy (MHHIS), which defines preventive interventions, standards, and tools conceived to improve hand hygiene in healthcare facilities. The aim of our study was to evaluate the implementation of the MHHIS in Piedmont healthcare units in 2014 using the HHSAF document.

Methods
Our surveillance was performed through collection and analysis of the data from 50 Piedmont healthcare facilities recorded through the HHSAF in 2014. The HHSAF describes the hand hygiene level evaluating the following 5 parameters: system changes, education/staff training, evaluation and feedback, reminders in the workplace, and promotion of an institutional safety climate.

Results
We reported that 70.4% of the healthcare facilities involved in the study achieved the intermediate hand hygiene level, 19% the advanced level, and 11% the basic level. No facility exhibited an inadequate level of WHO multimodal implementation. Only 55% of the healthcare units provided information about hand hygiene to patients, and only 15% actively involved patients and their families.

Conclusions
The implementation of the MHHIS has achieved important results all over the world in terms of hand hygiene. Piedmont has reached an overall good level, particularly in terms of the supply and availability of hand washing products and staff education. Our results revealed, however, some critical issues related to direct and indirect monitoring of hand hygiene, providing reminders and the active involvement of patients, family members, and caregivers.
Feasibility and Technique for Transvaginal Natural Orifice Transluminal Endoscopic Surgery Liver Resection: A Porcine Model
Authors: Katagiri Toshio , Otsuka Yuichiro , Horgan Santiago , Sandler Bryan J. , Jacobsen Garth R. , Coker Alisa M. , Tsuchiya Masaru , Maeda Tetsuya , Kaneko Hironori 
Published: January 2017

Introduction:
Natural orifice transluminal endoscopic surgery (NOTES) is a challenging minimally invasive procedure. Although laparoscopic techniques for liver resection are gaining acceptance worldwide, few studies have investigated NOTES liver resection. We used a porcine model to assess the feasibility and safety of transvaginal NOTES liver resection (TV NOTES LR).

Materials and Methods:
Nine female pigs underwent TV NOTES LR. A nonsurvival acute porcine model with general anesthesia was used in all cases. Using hybrid NOTES technique, we placed only 1 umbilical 12-mm umbilical trocar in the abdominal wall, which was used to create pneumoperitoneum. A laparoscope was then advanced to obtain intra-abdominal visualization. A 15-mm vaginal trocar was inserted under direct laparoscopic vision, and a flexible endoscope was introduced through the vaginal trocar. A long, flexible grasper and endocavity retractor were used to stably retract the liver. The liver edge was partially transected using energy devices inserted through the umbilical trocar. To transect the left lateral lobe, a flexible linear stapler was inserted alongside the vaginal trocar. A specimen extraction bag was deployed and extracted transvaginally. Blood loss, bile leakage, operative time, and specimen size were evaluated. Necropsy studies were performed after the procedures.

Results:
Eighteen transvaginal NOTES partial liver resections and 4 transvaginal NOTES left lateral lobectomies were successfully performed on 9 pigs. Mean operative time was 165.8 minutes, and mean estimated blood loss was 76.6 mL. All TV NOTES LRs were performed without complications or deaths. Necropsy showed no bile leakage from remnant liver.

Conclusions:
Our porcine model suggests that TV NOTES LR is technically feasible and safe and has the potential for clinical use as a minimally invasive alternative to conventional laparoscopic liver resection.
The Comparison of Etomidate and Propofol Anesthesia in Patients Undergoing Gastrointestinal Endoscopy: A Systematic Review and Meta-Analysis
Authors: Ye Limin , Xiao Xiangyang , Zhu Liyi 
Published: January 2017

Introduction:
Etomidate and propofol played an important role in the sedation of patients undergoing gastrointestinal endoscopy. We conducted a systematic review and meta-analysis to compare their efficacy and safety.

Materials and Methods:
PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials assessing the effect of etomidate versus propofol for the anesthesia of patients undergoing gastrointestinal endoscopy were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were anesthesia duration and recovery time. Meta-analysis was performed using random-effect model.

Results:
Six randomized controlled trials involving 1115 patients were included in the meta-analysis. Overall, compared with propofol, etomidate resulted in comparable anesthesia duration [standard mean difference (Std. MD)=−0.03; 95% confidence interval (CI), −0.16 to 0.10; P=0.66], recovery time (Std. MD=0.25; 95% CI, −0.42 to 0.92; P=0.47), mean arterial pressure at intubation (Std. MD=0.44; 95% CI, −0.26 to 1.15; P=0.21), heart pulse at intubation (Std. MD=0.93; 95% CI, −0.69 to 2.55; P=0.26), SPO2 at intubation (Std. MD=−0.52; 95% CI, −1.04 to 0.01; P=0.05), patient satisfaction [odds risk (OR)=0.42; 95% CI, 0.11-1.66; P=0.22], hypotension (OR=0.14; 95% CI, 0.02-1.22; P=0.07), changes of heart rate (OR=0.97; 95% CI, 0.61-1.53; P=0.88), nausea-vomiting (OR=2.02; 95% CI, 0.73-5.57; P=0.17), and the reduction in apnea or hyoxemia (OR=0.39; 95% CI, 0.24-0.64; P=0.0002), and injection pain (OR=0.03; 95% CI, 0.01-0.08; P<0.00001), but the increase in myoclonus (OR=8.54; 95% CI, 3.14-23.20; P<0.0001).

Conclusions:
Between etomidate and propofol, no significant difference was revealed regarding anesthesia duration, recovery time, mean arterial pressure at intubation, heart pulse at intubation, SPO2 at intubation, patient satisfaction, hypotension, changes of heart rate and nausea-vomiting. Compared with propofol, etomidate showed reduced apnea or hyoxemia, and injection pain, but with an increased myoclonus.