Variation in restraint use between hospitals: a multilevel analysis of multicentre prevalence measurements in Switzerland and Austria

Background: In restraint use in the somatic acute-care hospital setting, routine and institutional culture seem to play an important role. This implies that similar patient situations would be managed with restraints in one hospital, while in another hospital the situation would be managed without restraints. This practice variation appears to be ethically and legally questionable. The influence of organisation-specific factors such as the availability of guidelines is discussed. However, the relevance of such factors at the hospital level has been rarely investigated to date. Therefore, the aims of this study were a) to determine how much variance in restraint use can be explained on the hospital level (hospital general effect) and b) to examine the impact of organisational factors on restraint use (specific contextual effects). Methods: A secondary data analysis of cross-sectional multicentre data was performed. Data were collected during three quality measurements (2016–2018) in acute-care hospitals in Switzerland and Austria. Hospitalised patients from different medical specialties aged 18+ with informed consent were included. Descriptive analysis and multilevel logistic regression analysis were performed. Results: The study included 29,477 patients from a total of 140 hospitals. The 30-day prevalence rate of patients with at least one restraint was 8.7% (n = 2577). The availability of guidelines regarding restraint use and refresher courses for nursing staff were associated with less restraint use (odds ratios = 0.60 and 0.75). By adding the hospital as a random effect, the explained variance of the model increased from 24 to 55%. Conclusions: The use of restraints varies widely between hospitals, even considering patient characteristics. The identification of situations in which restraints were used out of routine or institutional culture appears to be an important approach in restraint reduction. Investments in appropriate structures and employee knowledge can facilitate providing restraint-free care as much as possible. Keywords: Hospitals, Multilevel analysis, Organisational culture, Quality of health care, Restrain

With United Forces : How Design-Based Research can Link Theory and Practice in the Transdisciplinary Sphere of CLIL

This paper intends to exemplify how a design-based research (DBR) methodology can be used to put theory into practice by reporting on a first research cycle of a larger DBR project in the context of upper secondary CLIL history education in Austria. The project aims to identify design principles of teaching techniques and materials which both support the acquisition of subject-specific competences and language. To this end, this study draws on Dalton-Puffer's (2013) construct of Cognitive Discourse Functions (CDFs), comprising seven key categories of academic language functions which have also been shown to be closely linked to historical competences. In the course of this study, the researcher and a collaborating teacher systematically developed CDF-based history materials, which were then applied in the classroom and continuously evaluated, usinginterviews, observations, and written tasks for data collection.Results of the first research cycle suggest that students lack awareness of possible connections between content and language learning and struggle with expressing complex historical content. Both teacher and students responded positively to the intervention on a general level, but pointed out a number of potential refinements, such as a more continuous and balanced intertwining of content and language.Aquest article aspira a exemplificar com es pot utilitzar una metodologia d'investigació basada en el disseny d'una intervenció (DBR, sigles en anglès) per portar la teoria a la pràctica. A més a més, proporciona informació sobre el primer cicle d'investigació d'un projecte DBR de major abast, en un context educatiu d'història AICLE en el cicle superior de secundària a Àustria.L'objectiu del projecte és identificar els principis que inspiren les estratègies didàctiques i els materials d'ensenyament que fomenten l'adquisició de competències i llenguatge específics de la matèria. En aquest sentit, aquest estudi es basa en el concepte Funcions cognitivo-discursives (FCD), de Dalton-Puffer (2013), que comprèn set categories clau de funcions del llenguatge acadèmic, les quals, segons s'ha demostrat, estan estretament relacionades amb les competències històriques.En el curs d'aquest estudi, la persona investigadora i un docent col·laborador van desenvolupar sistemàticament materials de l'ensenyament de la història basats en el FCD que, posteriorment, es van pilotar i avaluar de forma continuada a l'aula, emprant entrevistes, observacions i tasques d'escriptura, utilitzades com a dades.Els resultats del primer cicle d'investigació suggereixen que els estudiants mostren una manca de consciència sobre les possibles connexions entre l'aprenentatge del contingut i el de la llengua, i tenen dificultats per expressar continguts històrics complexos. Tant el docent com els estudiants van respondre positivament a la intervenció en un nivell general, però van assenyalar una sèrie de possibles millores, tals com una interrelació més continuada i equilibrada de contingut i llengua.Este artículo aspira a ejemplificar cómo se puede utilizar una metodología de investigación basada en el diseño de una intervención (DBR, siglas en inglés) para llevar la teoría a la práctica. Además, proporciona información sobre el primer ciclo de investigación de un proyecto DBR de mayor alcance, en un contexto educativo de historia AICLE en el ciclo superior de secundaria en Austria.El objetivo del proyecto es identificar los principios que inspiran las estrategias didácticas y los materiales de enseñanza que fomentan la adquisición de competencias y lenguaje específicos de la asignatura. Para este fin, este estudio se basa en el constructo Funciones cognitivo-discursivas (FCD), de Dalton-Puffer (2013), que comprende siete categorías clave de funciones del lenguaje académico, las cuales, según se ha demostrado, están estrechamente relacionadas con las competencias históricas.En el curso de este estudio, la persona investigadora y un docente colaborador desarrollaron sistemáticamente materiales de enseñanza de la historia basados en el FCD, que luego se pilotaron y evaluaron de forma continuada en el aula, utilizando entrevistas, observaciones y tareas de escritura, utilizadas como datos.Los resultados del primer ciclo de investigación sugieren que los estudiantes muestran falta de conciencia sobre las posibles conexiones entre el aprendizaje del contenido y el de la lengua, y tienen dificultades para expresar contenidos históricos complejos. Tanto el docente como los estudiantes respondieron positivamente a la intervención en un nivel general, pero señalaron una serie de posibles mejoras tales como una interrelación más continuada y equilibrada de contenido y lenguaje

Análise prospectiva de risco do processo de administração de medicamentos anti-infecciosos

OBJECTIVE: The objective of this study was to analyze the potential risks involved in the administration process of intravenous anti-infective medication at a medical clinic, using the Failure Mode and Effect Analysis. METHOD: This exploratory study was conducted at the medical clinic of a hospital in the State of Goiás. For data collection we convened a team comprised of six professionals involved in medication treatment: a doctor, nurse, nursing technician, pharmacist, a nursing and a risk manager. A total of 24 meetings were held, for a total of 56 hours. The data were transcribed into an electronic database within Microsoft Excel®, and the Xfmea4 software was used. RESULT: The results indicated 52 failure modes, 79 effects of failure, and 285 causes of failure. The causes were related to: the management of organizational processes, human resources, physical and material structure. A total of 298 actions for improvement were recommended for 215 causes of high and average priority, 81.9% of which were short-term priorities. The simulation of the impact of the proposed interventions revealed a 79.7% reduction of the high-priority failure modes. CONCLUSION: It was concluded that the study identified potential risks to patients and recommended proactive actions, of rapid application and low cost, evaluated positively in the reduction of risk of occurrence of avoidable incidents, increasing reliability and safety of the medication administration process. Studies like this demonstrate that, with the application of a method of risk analysis, nurses can effectively assist in preventing medication incidents.OBJETIVO: Este estudio objetivó analizar los riesgos potenciales de administración de medicamentos anti-infecciosos por vía endovenosa en una unidad de Clínica Médica, utilizando el Método de Análisis del Modo y Efecto de Falla. MÉTODO: De naturaleza exploratoria, se realizó en la Clínica Médica de un Hospital del Estado de Goiás. Datos recolectados por equipo constituido por seis profesionales involucrados en la terapéutica medicamentosa: médico, enfermero, técnico de enfermería, farmacéutico y gerentes de Enfermería y de riesgo. Fueron efectuadas 24 reuniones, totalizándose 56 horas. Todos los datos fueron transcriptos a un banco, utilizando planilla de cálculo de Microsoft Excel® y analizados con software Xfmea4. RESULTADO: Los resultados indicaron 52 modos de falla, 79 efectos de la falla y 285 causas de falla. Las causas se relacionaron con la gestión de procesos organizacionales; recursos humanos; estructura física y material. Fueron recomendadas 289 acciones de mejora para 215 causas de alta y media prioridad, 81,9% de corto plazo. La simulación del impacto de las acciones propuestas posibilitó identificar una reducción de 79,7% de los modos de falla de alta prioridad. CONCLUSIÓN: Se concluye en que el estudio identificó riesgos potenciales para los pacientes y recomendó acciones proactivas, rápidamente aplicables y de bajo costo, evaluadas positivamente en la reducción del riesgo de ocurrencia de incidentes evitables, aumentando la confiabilidad y seguridad del proceso de administración de medicamentos. Estudios como éste comprueban que, con la aplicación de un método de análisis de riesgo, los enfermeros pueden colaborar activamente en la prevención de incidentes en la administración de medicamentos.OBJETIVO: este estudo teve o objetivo de analisar os riscos potenciais do processo de administração de medicamentos anti-infecciosos, por via intravenosa, de uma unidade de clínica médica, utilizando o método de análise do modo e efeito da falha. MÉTODO: de natureza exploratória, foi realizado na clínica médica de um hospital do Estado de Goiás. Para a coleta dos dados, foi constituída uma equipe composta por seis profissionais envolvidos na terapêutica medicamentosa: médico, enfermeiro, técnico de enfermagem, farmacêutico e os gerentes de enfermagem e de risco. Foram realizadas 24 reuniões, totalizando 56 horas. Todos os dados foram transcritos para um banco eletrônico, no programa Microsoft Excel® e analisados no software Xfmea4. RESULTADOS: os resultados indicaram 52 modos da falha, 79 efeitos da falha e 285 causas da falha. As causas estavam relacionadas à gestão dos processos organizacionais, recursos humanos, estrutura física e material. Foram recomendadas 298 ações de melhorias para 215 causas de alta e média prioridade, sendo 81,9% de curto prazo. A simulação do impacto das ações propostas possibilitou identificar redução de 79,7% dos modos de falha de alta prioridade. CONCLUSÃO: conclui-se que o estudo identificou riscos potenciais para os pacientes e recomendou ações proativas, de rápida aplicação e baixo custo, avaliadas positivamente na redução do risco de ocorrência de incidentes evitáveis, aumentando a confiabilidade e segurança do processo de administração de medicamentos. Estudos como este comprovam que, com a aplicação de um método de análise de risco, os enfermeiros podem auxiliar efetivamente a prevenção de incidentes na medicação

Neutrophil gelatinase-associated lipocalin (NGAL) predicts response to neoadjuvant chemotherapy and clinical outcome in primary human breast cancer

In our previous work we showed that NGAL, a protein involved in the regulation of proliferation and differentiation, is overexpressed in human breast cancer (BC) and predicts poor prognosis. In neoadjuvant chemotherapy (NACT) pathological complete response (pCR) is a predictor for outcome. The aim of this study was to evaluate NGAL as a predictor of response to NACT and to validate NGAL as a prognostic factor for clinical outcome in patients with primary BC. Immunohistochemistry was performed on tissue microarrays from 652 core biopsies from BC patients, who underwent NACT in the GeparTrio trial. NGAL expression and intensity was evaluated separately. NGAL was detected in 42.2% of the breast carcinomas in the cytoplasm. NGAL expression correlated with negative hormone receptor (HR) status, but not with other baseline parameters. NGAL expression did not correlate with pCR in the full population, however, NGAL expression and staining intensity were significantly associated with higher pCR rates in patients with positive HR status. In addition, strong NGAL expression correlated with higher pCR rates in node negative patients, patients with histological grade 1 or 2 tumors and a tumor size <40 mm. In univariate survival analysis, positive NGAL expression and strong staining intensity correlated with decreased disease-free survival (DFS) in the entire cohort and different subgroups, including HR positive patients. Similar correlations were found for intense staining and decreased overall survival (OS). In multivariate analysis, NGAL expression remained an independent prognostic factor for DFS. The results show that in low-risk subgroups, NGAL was found to be a predictive marker for pCR after NACT. Furthermore, NGAL could be validated as an independent prognostic factor for decreased DFS in primary human BC

MicroRNA-200c Attenuates the Tumor-Infiltrating Capacity of Macrophages

Macrophages constitute a major part of the tumor-infiltrating immune cells. Within the tumor microenvironment, they acquire an alternatively activated, tumor-supporting phenotype. Factors released by tumor cells are crucial for the recruitment of tumor-associated macrophages. In the present project, we aimed to understand the role of hsa-miR-200c-3p (miR-200c) in the interplay between tumor cells and macrophages. To this end, we employed a coculture system of MCF7 breast tumor cells and primary human macrophages and observed the transfer of miR-200c from apoptotic tumor cells to macrophages, which required intact CD36 receptor in macrophages. We further comprehensively determined miR-200c targets in macrophages by mRNA-sequencing and identified numerous migration-associated mRNAs to be downregulated by miR-200c. Consequently, miR-200c attenuated macrophage infiltration into 3-dimensional tumor spheroids. miR-200c-mediated reduction in infiltration further correlated with a miR-200c migration signature comprised of the four miR-200c-repressed, predicted targets PPM1F, RAB11FIB2, RDX, and MSN