The leadership characteristics registered nurses perceive as important in their clinical nurses

Limited research exists about the leadership attributes registered nurses (RNs) want from their clinical nurses (CNs). This study explored the leadership attributes Western Australian RNs considered important in CNs and determine if there were differences in the choice of preferred CN attributes according to RNs years of experience; types of nursing education; level of seniority and nursing specialty. A modified version of the Emerging Workforce\u27s Preference Survey was distributed to 403 RNs with a 30% response rate. The respondents ranked their top three preferences from 4 clusters of traits. S.P.S.S. 15.0 was used to summarise demographic data and then analyse data from the 4 clusters of traits for the main group. Cross tabulations identified between group variations. The RNs wanted CNs to be clinically competent, approachable and supportive; to show understanding and integrity whilst being team players and good communicators. The between groups analysis revealed similar patterns. However, RNs with \u3e5years nursing experience also wanted their CNs to show respect for subordinates while those with mentoring as an important quality for a CN to possess. Hospital-diploma educated RNs most preferred the attributes of motivator of others; respect for subordinates, and integrity; whilst university educated RNs chose team player, followed by calm and understanding. RNs educated via hospital diploma then university favoured the attribute of motivated. RNs employed as Level 1 nurses chose similar attitudes to Level 2 RNs although the former selected the intrinsic quality of understanding while Level 2 RNs preferred dependable. Unlike the main group, RNs in peri-operative and critical care units favoured the personal attribute receptive to people and ideas while nurses employed in management preferred the intrinsic quality of intelligent. Some respondents commented on the negative effect that heavy workloads have on CNs\u27 performance. Others mentioned that RNs are not prepared for the CN role. Competent CNs create a positive work environment which aids staff retention and improves morale. If CNs are to be effective first-line leaders, employers and the nursing profession must espouse both current and potential CNs in developing the knowledge and skills needed for the leadership and mentoring roles required of the CN

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Assessing the incremental contribution of common genomic variants to melanoma risk prediction in two population-based studies

It is unclear to what degree genomic and traditional (phenotypic and environmental) risk factors overlap in their prediction of melanoma risk. We evaluated the incremental contribution of common genomic variants (in pigmentation, nevus and other pathways) and their overlap with traditional risk factors, using data from two population-based case-control studies from Australia (n=1,035) and the UK (n=1,460) that used the same questionnaires. Polygenic risk scores were derived from 21 gene regions associated with melanoma and odds ratios from published meta-analyses. Logistic regression models were adjusted for age, sex, centre and ancestry. Adding the polygenic risk score to a model with traditional risk factors increased the area under receiver operating characteristic curve (AUC) by 2.3% (p=0.003) for Australia and by 2.8% (p=0.002) for Leeds. Gene variants in the pigmentation pathway, particularly MC1R, were responsible for most of the incremental improvement. In a cross-tabulation of polygenic by traditional tertile risk scores, 59% (Australia) and 49% (Leeds) of participants were categorized in the same (concordant) tertile. Of participants with low traditional risk, 9% (Australia) and 21% (Leeds) had high polygenic risk. Testing of genomic variants can identify people who are susceptible to melanoma despite not having a traditional phenotypic risk profile

Prevalence and predictors of germline CDKN2A mutations for melanoma cases from Australia, Spain and the United Kingdom

Background: Mutations in the CDKN2A and CDK4 genes predispose to melanoma. From three case-control studies of cutaneous melanoma, we estimated the prevalence and predictors of these mutations for people from regions with widely differing latitudes and melanoma incidence. Methods: Population-based cases and controls from the United Kingdom (1586 cases, 499 controls) and Australia (596 early-onset cases, 476 controls), and a hospital-based series from Spain (747 cases, 109 controls), were screened for variants in all exons of CDKN2A and the p16INK4A binding domain of CDK4. Results: The prevalence of mutations for people with melanoma was similar across regions: 2.3%, 2.5% and 2.0% for Australia, Spain and the United Kingdom respectively. The strongest predictors of carrying a mutation were having multiple primaries (odds ratio (OR) = 5.4, 95% confidence interval (CI: 2.5, 11.6) for 2 primaries and OR = 32.4 (95% CI: 14.7, 71.2) for 3 or more compared with 1 primary only); and family history (OR = 3.8; 95% CI:1.89, 7.5) for 1 affected first- or second-degree relative and OR = 23.2 (95% CI: 11.3, 47.6) for 2 or more compared with no affected relatives). Only 1.1% of melanoma cases with neither a family history nor multiple primaries had mutations. Conclusions: There is a low probability (<2%) of detecting a germline CDKN2A mutation in people with melanoma except for those with a strong family history of melanoma (≥2 affected relatives, 25%), three or more primary melanomas (29%), or more than one primary melanoma who also have other affected relatives (27%).10 page(s

Risk factors for melanoma by anatomical site: an evaluation of aetiological heterogeneity

Background: Melanoma aetiology has been proposed to have two pathways, which are determined by naevi and type of sun exposure and related to the anatomical site where melanoma develops. Objectives: We examined associations with melanoma by anatomical site for a comprehensive set of risk factors including pigmentary and naevus phenotypes, ultraviolet radiation exposure and polygenic risk. Methods: We analysed harmonized data from 2617 people with incident first invasive melanoma and 975 healthy controls recruited through two population-based case–control studies in Australia and the UK. Questionnaire data were collected by interview using a single protocol, and pathway-specific polygenic risk scores were derived from DNA samples. We estimated adjusted odds ratios using unconditional logistic regression that compared melanoma cases at each anatomical site with all controls. Results: When cases were compared with control participants, there were stronger associations for many naevi vs. no naevi for melanomas on the trunk, and upper and lower limbs than on the head and neck (P-heterogeneity < 0·001). Very fair skin (vs. olive/brown skin) was more weakly related to melanoma on the trunk than to melanomas at other sites (P-heterogeneity = 0·04). There was no significant difference by anatomical site for polygenic risk. Increased weekday sun exposure was positively associated with melanoma on the head and neck but not on other sites. Conclusions: We found evidence of aetiological heterogeneity for melanoma, supporting the dual pathway hypothesis. These findings enhance understanding of risk factors for melanoma and can guide prevention and skin examination education and practices.</p

Exemplar Training and a Derived Transformation of Function in Accordance with Symmetry: II

The main purpose of the present study was to determine whether exemplar training in symmetry relations would readily facilitate the transformation of function in accordance with symmetry, when subjects were not provided with explicit name training. The study also examined whether pretraining that was formally similar to the symmetry test, but did not reinforce symmetry relations, would have the same facilitative effect as exemplar training. Sixteen children, aged between 4 and 5 years, were employed across three experiments (i.e., 4 children each in Experiments 1 and 2, and 8 children in Experiment 3). In Experiment 1, subjects were trained in an action-object conditional discrimination using familiar actions and objects (e.g., when the experimenter waved, choosing a toy car was reinforced, and when the experimenter clapped, choosing a doll was reinforced). Subjects were then exposed to a test for derived object-action symmetry relations (e.g., experimenter presents toy car-*child waves and experimenter presents doll-*child claps). Across subsequent sessions, a multiple-baseline design was used to introduce exemplar training (i.e., explicit symmetry training) for those subjects who failed the symmetry test. Experiment 2 replicated Experiment 1, except that the trained and tested relations were reversed (i.e., train object-action, test action-object relations). Experiment 3 replicated Experiment 1, except that subjects were exposed to object-action pretraining. Across Experiments 1 and 2, none of the 8 subjects show derived objectaction (Experiment 1) or action-object (Experiment 2) symmetry until they received explicit symmetry training. Pretraining objectaction responding in Experiment 3 appeared to facilitate symmetry, but only for 4 of the 8 subjects. For the 4 subjects who failed , symmetry emerged following exposure to exemplar training. Overall, the data are consistent with Relational Frame Theory

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to &lt; 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of &amp; GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P &lt; 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo

Alirocumab and cardiovascular outcomes after acute coronary syndrome

BACKGROUN