Listening to New Zealand nurses: a survey of intent to leave, job satisfaction, job stress, and burnout

Human and financial costs generated by nurse shortages, within a context of increasing numbers of patients requiring nursing care, demonstrate the potential significance of this study which aims to identify work related factors contributing to New Zealand nurses' intent to leave the job. Two hundred and seventy five usable paper and pencil surveys (Response rate = 68.8%) from a random sample of 400 nurses employed in one New Zealand District Health Board were used to explore intent to leave the job. Three research questions directed the description of levels of job satisfaction, job stress, and burnout found in nurse participants, correlations between the three variables, and the identification of variables predicting intent to leave the job through regression analyses. Levels of job satisfaction were high, job stress was low, and burnout was average. Specifically, lack of opportunity to participate in organisational decision making, control over work conditions, control over what goes on in the work setting (key Magnet Hospital characteristics) were not evident, and with pay rates, were the main sources of job dissatisfaction. Workload was the most frequently experienced source of stress by nurse participants. Twenty-five per cent of nurse participants reported high levels of intent to leave the job. Correlations suggested that reductions in job satisfaction influenced increases in job stress and burnout. Job stress was associated with increases in emotional exhaustion. Emotional exhaustion was influenced by eight job satisfaction, job stress, and burnout subscales. Five subscales (professional opportunities, praise and recognition, interaction opportunities, extrinsic rewards, lack of support) explained 26.2% of the variance in nurse participant's intent to leave. Issues of power and control were associated with job dissatisfaction, job stress and burnout in nursing practice. However, predictors of intent to leave the job suggest a growing realisation by nurse participants that postgraduate education and nursing research may provide the tools to create positive change in the health care environment and make nursing visible, valued and appropriately rewarded

Opportunities for post-market surveillance of high cost medicines in Australia: Observing trastuzumab-treated women from early through late stage HER2-positive breast cancer (HER2BC)

ABSTRACT Objectives In 2001 the Australian government circumvented traditional drug subsidy listing processes to create the Herceptin Program (HP) for HER2 metastatic breast cancer (MBC) patients; in 2006 trastuzumab was subsidised for early breast cancer (EBC) on the Pharmaceutical Benefits Scheme (PBS) creating opportunities for data linkage and observing patients across both treatment settings. Clinical trials established the efficacy of trastuzumab for MBC in trastuzumab-naïve patients but little is known about patients initiating trastuzumab in the adjuvant setting and subsequently receiving trastuzumab for MBC. We characterise patterns of treatment and outcomes for these patients in Australia. We estimate time from adjuvant trastuzumab initiation to metastatic trastuzumab initiation and overall survival (OS). Approach We identified a cohort of patients with a trastuzumab claim in both PBS and HP records. We calculated duration of EBC treatment as date of first trastuzumab dispensing until 21 days after the last PBS dispensing for trastuzumab or observation of a trastuzumab dispensing record in HP claims, whichever came first. We used Kaplan-Meier methods to estimate time-to-MBC treatment and OS. Results Of 11,477 EBC patients treated with trastuzumab between December 2006 and December 2012, 637 were also treated with trastuzumab for MBC. Median age at EBC treatment initiation was 53 (range 17 – 87). 94% of EBC patients received a taxane, anthracycline, cyclophosphamide and/or carboplatin as part of their treatment protocol. 61% of MBC patients received trastuzumab with a taxane, 18% as monotherapy and 7% with capecitabine. Median duration of trastuzumab therapy in EBC and MBC therapy was 11.3 (95% CI 10.7-11.6) and 9.3 (8.6-10.4) months, respectively. Median time-to-MBC therapy was 27.3 (25.5-28.2) months. Median OS from initiation of EBC and MBC treatment was 58.1 (52.9-65.7) and 23.2 (20.5-25.4) months, respectively. Conclusion HER2BC patients initiating trastuzumab for EBC therapy and progressing to MBC treatment are little examined in the clinical trial and observational literature. Australia’s unique funding arrangements allowed us to clearly distinguish between treatment for EBC and MBC which is not always possible in dispensing claims alone. We demonstrated: most EBC patients are treated according to guideline recommendations; that this patient cohort receive approximately 20 months of trastuzumab therapy across both settings; and median OS from initiation of MBC trastuzumab is approximately 2 months shorter than in the pivotal clinical trial (25.1 months)

Adherence to prescribing restrictions for HER2-positive metastatic breast cancer in Australia: A national population-based observational study (2001-2016)

Background: Targeted cancer therapy is often complex, involving multiple agents and chemotherapeutic partners. In Australia, prescribing restrictions are put in place to reflect existing evidence of cost-effectiveness of these medicines. As therapeutic options continue to expand, these restrictions may not be perceived to align with best practice and it is not known if their use in the real-world clinic adheres to these restrictions. We examined the treatment of women receiving trastuzumab for HER2-positive metastatic breast cancer (HER2+MBC) to determine the extent to which treatment adhered to national prescribing restrictions. Patients and methods: Our population-based, retrospective cohort study used dispensing records for every Australian woman initiating publicly-subsidised trastuzumab for HER2+MBC between 2001±2013, followed through 2016. We used group-based trajectory models (GBTMs) to cluster patients, first on their patterns of trastuzumab exposure, and then on their patterns of lapatinib and chemotherapy exposure. We described the characteristics of patients within each cluster, and examined their treatments and combinations of treatments to determine restriction adherence. Results: Of 5,052 patients initiating trastuzumab, 1,795 (36%) received at least one non-adherent HER2-targeted treatment. The most common non-adherent treatments were trastuzumab combinations involving vinorelbine (24% of non-adherent treatments); capecitabine (24%); and anthracyclines (10%). Non-adherent lapatinib use was observed in 4% of patients. GBTM identified three trastuzumab exposure clusters, each containing three further subclusters. The largest proportions of non-adherent treatments were in sub-clusters with longer trastuzumab exposure and more non-taxane chemotherapy. Patients in these sub-clusters were younger than those in sub-clusters with less non-adherent treatment. Conclusions: Our study highlights that, even during the relatively simpler treatment era of our study period, a substantial amount of treatment did not adhere to prescribing restrictions. As more trials are conducted exploring pertuzumab and T-DM1 in combination with different chemotherapies and other HER2-targeted therapies, the regulation and funding of HER2-targeted treatment will become more challenging

Role of telavancin in treatment of skin and skin structure infections

Skin and skin structure infections (SSSIs) are a common diagnosis encountered by ambulatory and inpatient practitioners across the country. As the SSSIs become more complicated, they require increased health care resources and often involve hospitalization and intravenous antimicrobials. Complicated SSSIs are caused by a variety of pathogens, including Gram-positive, Gram-negative, and anerobic bacteria. Empiric broad-spectrum antibiotic coverage is warranted, taking into account area disease-state epidemiology and antimicrobial susceptibility data. Telavancin is an antimicrobial agent with a broad Gram-positive spectrum of activity which was recently approved for the treatment of SSSIs. It may especially benefit patients with resistant organisms, such as methicillin-resistant Staphylococcus aureus. This article reviews telavancin and its pharmacology, efficacy, and safety data to enhance the practitioner’s knowledge base on the appropriateness of telavancin for the treatment of SSSIs

Benthic community metabolism in deep and shallow Arctic lakes during 13 years of whole–lake fertilization

Benthic primary production and oxygen consumption are important components of lake biogeochemical cycling. We performed whole–lake nutrient manipulations in Arctic Alaska to assess the controls of lake morphometry, nutrients, and light on benthic community metabolism. One deep, stratified lake (Lake E5) and one shallow, well–mixed lake (Lake E6) in the Alaskan Arctic were fertilized with low levels of nitrogen (56 mg N m−3 yr−1) and phosphorus (8 mg P m−3 yr−1) from 2001 to 2013. Benthic primary production was not stimulated by fertilization in either lake. In the deep lake, decreased water clarity is consistent with an increase in phytoplankton biomass during fertilization. Benthic GPP decreased by 7–47 mg C m−2 d−1 (not statistically significant) and benthic respiration increased from 87 ± 20 to 167 ± 9 (SE) mg C m−2 d−1. The areal hypolimnetic oxygen deficit increased by 15 mg O2 m−2 d−1 each year during the 13 yr of monitoring, apparently driven by lower (more negative) benthic NEP. In the shallow lake, phytoplankton concentration did not change with fertilization. As a result, the light environment did not change and benthic GPP did not decrease. Overall the data suggest that (1) benthic algae are not nutrient limited in either the deep or shallow lake, (2) lake morphometry modulated the overall nutrient impact on benthic metabolism by controlling the response of phytoplankton, and by extension, light and organic carbon supply to the benthos, (3) year–to–year variability in light attenuation explains considerable variability in benthic GPP between lakes and years, (4) correlations between both dissolved organic carbon concentrations and light attenuation coefficients (kd) between lakes suggests a regional control on light attenuation, and (5) the dissolved oxygen concentrations in the deep experimental lake are highly sensitive to nutrient enrichment.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/113758/1/lno10120.pd

Use and outcomes of targeted therapies in early and metastatic HER2-positive breast cancer in Australia: Protocol detailing observations in a whole of population cohort

Background: The management of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC) has changed dramatically with the introduction and widespread use of HER2-targeted therapies. However, there is relatively limited real-world information on patterns of use, effectiveness and safety in whole of population cohorts. The research programme detailed in this protocol will generate evidence on the prescribing patterns, safety monitoring and outcomes of patients with BC treated with HER2- targeted therapies in Australia. Methods/design: Our ongoing research programme will involve a series of retrospective cohort studies that include every patient accessing Commonwealth-funded HER2-targeted therapies for the treatment of early BC and advanced BC in Australia. At the time of writing, our cohorts consist of 11 406 patients with early BC and 5631 with advanced BC who accessed trastuzumab and lapatinib between 2001 and 2014. Pertuzumab and trastuzumab emtansine were publicly funded for metastatic BC in 2015, and future data updates will include patients accessing these medicines. We will use dispensing claims for cancer and other medicines, medical service claims and demographics data for each patient accessing HER2- targeted therapies to undertake this research. Ethics and dissemination: Ethics approval has been granted by the Population Health Service Research Ethics Committee and data access approval has been granted by the Australian Department of Human Services (DHS) External Review Evaluation Committee. Our findings will be reported in peer-reviewed publications, conference presentations and policy forums. By providing detailed information on the use and outcomes associated with HER2-targeted therapies in a national cohort treated in routine clinical care, our research programme will better inform clinicians and patients about the real-world use of these treatments and will assist third-party payers to better understand the use and economic costs of these treatments

Evidence based approach to the treatment of community-associated methicillin-resistant Staphylococcus aureus

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased dramatically over the last two decades. The types of infections can range from complicated skin and skin structure infections (cSSSI) to pneumonia and endocarditis. Oral antimicrobial therapy, such as trimethoprim-sulfamethoxazole, clindamycin, long-acting tetracyclines, or linezolid may provide enhanced benefit to those with uncomplicated cutaneous lesions when used in conjunction with incision and drainage in an outpatient setting. However, resistance, susceptibilities, patient-specific circumstances, and adverse effects can impact a healthcare professional’s choice of antibiotics. In patients with complicated infections requiring hospitalization or parenteral treatment, vancomycin remains the drug of choice, even though increased resistance and decreased efficacy have crept into clinical practice. Linezolid, quinupristin/dalfopristin, daptomycin, and tigecycline are alternative intravenous agents for the treatment of CA-MRSA. Investigational agents such as dalbavancin, telavancin, oritivancin, iclaprim, ceftobiprole, ceftaroline, and others may expand our therapeutic armamentarium for the treatment of infections caused by CA-MRSA in the future

Critical thinking, peer-writing, and the importance of feedback.

Critical thinking is one of the key competencies listed by OECD (Organisation for Economic Co-operation and Development) [1], a central European Community organization, and is also mentioned as a learning outcome for higher education by international organizations, such as ABET, ACM, and IEEE, as well as in numerous national and university legislations regarding higher education degrees. The ability to communicate, not least in writing, is another important competence our students are supposed to gain during their education. There is thus high agreement regarding the importance of these competencies, but it is not clear how to achieve this

Protecting The Oral Health Of Those Who Protected Us

Research poster addressing the question: What oral health programs in long-term care facilities improve oral health outcomes? The need for effective oral hygiene programs in long-term care (LTC) veterans facilities is crucial due to the rise in the elderly population, as well as untreated caries in older adults. As a state, Maine has 15% of older adults with untreated caries, 41% with gingivitis, 14% with periodontal diseases, and 2.7% with oral and pharyngeal cancer death rates. It would serve the residents and team of caregivers well to have an interprofessional approach to the overall care of their patients. It is essential for LTC residents to receive proper oral hygiene care and dental professionals are not often staffed by these facilities. Of the literature reviewed, one study indicated 48% of the LTC staff were very satisfied with the quality of oral care provided to the residents and 77% reported considering on-site oral care services. Another study indicated care conferences conducted in LTC facilities (LTCF) influenced the staff\u27s awareness of oral health. While studies have shown that improving the oral health in the older adult population is of great importance, additional research is needed to determine the most effective interventions to improve the oral health of LTC residents. Although interdisciplinary teams are often used in LTCF, the teams often lack a dental professionals. As a result, there is a lack of oral health care within LTCF and further research needs to be conducted in order to bring further awareness to this issue.https://dune.une.edu/dh_studpost/1008/thumbnail.jp