Transformational Leadership Assessment of Nurse Managers and Assistant Nurse Managers

Transformational Leadership behaviors are essential to build and sustain a healthy work environment in healthcare. Nurse Managers who possess transformational leadership behaviors lead nursing teams with a higher degree of engagement, work satisfaction, and retention. The purpose of this project was to perform an assessment of transformational leadership characteristics among nurse managers and assistant nurse managers, develop an educational program to teach transformational leadership behaviors, and incorporate a transformational leadership assessment into the orientation onboarding process of new nurse managers and assistant nurse managers. The Full Range Leadership Model (FRLM) asserts leaders should use multiple leadership characteristics or behaviors to effectively lead teams. A voluntary convenience sample of 21 Registered Nurses who held a nurse manger or assistant nurse manager role participated in this project. The tool used to assess leadership characteristics was the Multifactor Leadership Questionnaire-5X (MLQ-5X). Of the participants who attended the two presentations which were intended to review the MLQ-5X leadership characteristic assessment results, no one indicated the ability to discuss the importance of transformational leadership behaviors prior to the education, while 65% of the attendees indicated the ability to discuss the importance of transformational leadership behaviors following the education. In addition, 100% of the Nurse Manager and Assistant Nurse Manager participants who attended the education indicated the MLQ-5X leadership assessment tool should be administered to all newly hired nurse managers and assistant nurse managers as part an onboarding educational plan. Of the participants attending the two presentations to share transformational leadership behaviors to retain registered nursing staff, 82% indicated the presentation was “absolutely” beneficial. No one indicated the education was not beneficial to their individual leadership education

Using SmartPls in Online Loyalty Assessment

Because of the low cost, fast expansion of the Internet and increasing demand for innovative educational systems, online learning is becoming popular and attractive (Zhang, Zhao, Zhou, and Jr, 2004). As of 2009, almost 12 million out of 20.4 million post-secondary students, within the United States, took at least one online course and this number will reach 22 million by 2014 (Nagel, 2009). The explosion of the use of online learning systems in higher education, allows students to leave the online programs quite easily (Tham and Werner, 2005). Therefore, educational institutions should try to retain their existing students. Thus, student satisfaction and student loyalty with online learning systems, become crucial concerns for educational institutions (Tham and Werner, 2005). The purpose of this descriptive research is to investigate the relationships between factors that may lead to customer loyalty in online educational organizations

Evaluation of the Potential of Automated SEM-EDS Analysis for the Discrimination of Inorganic Soil Particles

Soil, that complex mixture of minerals, organic particles, chemicals, and anthropogenic materials, is ubiquitous and easily transferred, which gives it forensic relevance. Forensic soil analysis has traditionally included the identification and comparison of both organic and inorganic components, the inorganic portion being most commonly examined by light microscopy and other instrumental techniques. Predominantly, the inorganic materials in soil are naturally-occurring minerals, contributed as grains from the surrounding bedrock, which gives a soil its regional character. That parent material then undergoes physical, chemical, and anthropogenic changes producing wide geographic variation within a single region. This variation forms the basis for potential forensic comparison and inclusion/exclusion decisions. Although the forensic value of soil analysis has been repeatedly demonstrated for over 100 years, the comparison of evidentiary soil samples languishes in the modern forensic laboratory. This underutilization is due, in part, to the dangerous and time-consuming nature of preparing a collected sample for analysis by careful separation and chemical digestion of the organic components, but also to the difficulty in maintaining qualified forensic microscopists. In addition to these pragmatic concerns, the field faces substantial difficulty, due to the diversity of soil types and evidentiary types, when attempting to meet modern legal and scientific demands for standardized methods and numerical results. A simplified examination scheme, incorporating easily duplicated preparation and mounting steps, automated analysis of individual mineral grains, and statistical approaches for reporting results, could provide an accessible method for publicly-funded laboratories to screen samples before seeking out a forensic soil analyst. This research is a preliminary step towards realizing the potential of automated elemental analysis of individual soil particles for criminal justice applications. A protocol was developed that would allow for low-cost, low-risk, practical sample preparation and mounting of mineral grains for SEM-EDS analysis without the use of resin embedding techniques or polishing. In the process of that development, the nature of commercially-available “known” minerals was investigated, the destructiveness of plasma cleaning assessed, and a variety of mounting methods evaluated. Parameters were developed for fast, acceptably accurate automatic SEM identification of particles and the EDS spectral acquisition from those particles. The limits of a software package for classifying the results of that automated search and analysis were determined; upon determining the shortcomings of the instrument’s current software, the research was expanded to include the creation of an R program for the classification of mineral grains, based on their EDS spectra. The results were analyzed comparatively and through the use of multivariate chemometrics. Avenues for further research are also presented. The successful classification results presented in this research suggest that automated SEM-EDS analysis of inorganic soil particles down to the clay size range (50m) may, in the future, be a useful and widely accessible tool for the screening analysis of otherwise neglected soil evidence. The presented technique provides some quantitative, statistical reference for the individuality of soil samples, which serves as a foundation for both a defense against a Daubert challenge and possible future databasing of soils

Optimizing MRI sequences and images for MRI-based stereotactic radiosurgery treatment planning

© 2018 Aim: Development of MRI sequences and processing methods for the production of images appropriate for direct use in stereotactic radiosurgery (SRS) treatment planning. Background: MRI is useful in SRS treatment planning, especially for patients with brain lesions or anatomical targets that are poorly distinguished by CT, but its use requires further refinement. This methodology seeks to optimize MRI sequences to generate distortion-free and clinically relevant MR images for MRI-only SRS treatment planning. Materials and methods: We used commercially available SRS MRI-guided radiotherapy phantoms and eight patients to optimize sequences for patient imaging. Workflow involved the choice of correct MRI sequence(s), optimization of the sequence parameters, evaluation of image quality (artifact free and clinically relevant), measurement of geometrical distortion, and evaluation of the accuracy of our offline correction algorithm. Results: CT images showed a maximum deviation of 1.3 mm and minimum deviation of 0.4 mm from true fiducial position for SRS coordinate definition. Interestingly, uncorrected MR images showed maximum deviation of 1.2 mm and minimum of 0.4 mm, comparable to CT images used for SRS coordinate definition. After geometrical correction, we observed a maximum deviation of 1.1 mm and minimum deviation of only 0.3 mm. Conclusion: Our optimized MRI pulse sequences and image correction technique show promising results; MR images produced under these conditions are appropriate for direct use in SRS treatment planning

Chasing Zero Harm in Radiation Oncology: Using Pre-treatment Peer Review

Purpose: The Joint Commission has encouraged the healthcare industry to become “High Reliability Organizations” by “Chasing Zero Harm” in patient care. In radiation oncology, the time point of quality checks determines whether errors are prevented or only mitigated. Thus, to “chase zero” in radiation oncology, peer review has to be implemented prior to treatment initiation. A multidisciplinary group consensus peer review (GCPR) model is used pre-treatment at our institution and has been successful in our efforts to “chase zero harm” in patient care.Methods: With the GCPR model, policy-defined complex cases go through a treatment planning conference, which includes physicians, residents, physicists, and dosimetrists. Three major plan aspects are reviewed: target volumes, target and normal tissue dose coverage, and dose distributions. During the review, any team member can ask questions and afterwards a group consensus is taken regarding plan approval.Results: The GCPR model has been implemented through a commitment to peer review and creative conference scheduling. Automated analysis software is used to depict color-coded results for department approved target coverage and dose constraints. About 8% of plans required re-planning while about 23% required minor changes. The mean time for review of each plan was 8 min.Conclusions: Catching errors prior to treatment is the only way to “chase zero” in radiation oncology. Various types of errors may exist in treatment plans and our GCPR model succeeds in preventing many errors of all shapes and sizes in target definition, dose prescriptions, and treatment plans from ever reaching the patients

Interventions for treating hyperemesis gravidarum.

BACKGROUND: Hyperemesis gravidarum is a severe form of nausea and vomiting in pregnancy affecting 0.3% to 1.0% of pregnancies, and is one of the most common indications for hospitalization during pregnancy. While a previous Cochrane review examined interventions for nausea and vomiting in pregnancy, there has not yet been a review examining the interventions for the more severe condition of hyperemesis gravidarum. OBJECTIVES: To assess the effectiveness and safety, of all interventions for hyperemesis gravidarum in pregnancy up to 20 weeks\u27 gestation. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group\u27s Trials Register and the Cochrane Complementary Medicine Field\u27s Trials Register (20 December 2015) and reference lists of retrieved studies. SELECTION CRITERIA: Randomized controlled trials of any intervention for hyperemesis gravidarum. Quasi-randomized trials and trials using a cross-over design were not eligible for inclusion.We excluded trials on nausea and vomiting of pregnancy that were not specifically studying the more severe condition of hyperemesis gravidarum. DATA COLLECTION AND ANALYSIS: Two review authors independently reviewed the eligibility of trials, extracted data and evaluated the risk of bias. Data were checked for accuracy. MAIN RESULTS: Twenty-five trials (involving 2052 women) met the inclusion criteria but the majority of 18 different comparisons described in the review include data from single studies with small numbers of participants. The comparisons covered a range of interventions including acupressure/acupuncture, outpatient care, intravenous fluids, and various pharmaceutical interventions. The methodological quality of included studies was mixed. For selected important comparisons and outcomes, we graded the quality of the evidence and created \u27Summary of findings\u27 tables. For most outcomes the evidence was graded as low or very low quality mainly due to the imprecision of effect estimates. Comparisons included in the \u27Summary of findings\u27 tables are described below, the remaining comparisons are described in detail in the main text.No primary outcome data were available when acupuncture was compared with placebo, There was no clear evidence of differences between groups for anxiodepressive symptoms (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.73 to 1.40; one study, 36 women, very low-quality evidence), spontaneous abortion (RR 0.48, 95% CI 0.05 to 5.03; one study, 57 women, low-quality evidence), preterm birth (RR 0.12, 95% CI 0.01 to 2.26; one study, 36 women, low-quality evidence), or perinatal death (RR 0.57, 95% CI 0.04 to 8.30; one study, 36 women, low-quality evidence).There was insufficient evidence to identify clear differences between acupuncture and metoclopramide in a study with 81 participants regarding reduction/cessation in nausea or vomiting (RR 1.40, 95% CI 0.79 to 2.49 and RR 1.51, 95% CI 0.92 to 2.48, respectively; very low-quality evidence).In a study with 92 participants, women taking vitamin B6 had a slightly longer hospital stay compared with placebo (mean difference (MD) 0.80 days, 95% CI 0.08 to 1.52, moderate-quality evidence). There was insufficient evidence to demonstrate a difference in other outcomes including mean number of episodes of emesis (MD 0.50, 95% CI -0.40 to 1.40, low-quality evidence) or side effects.A comparison between metoclopramide and ondansetron identified no clear difference in the severity of nausea or vomiting (MD 1.70, 95% CI -0.15 to 3.55, and MD -0.10, 95% CI -1.63 to 1.43; one study, 83 women, respectively, very low-quality evidence). However, more women taking metoclopramide complained of drowsiness and dry mouth (RR 2.40, 95% CI 1.23 to 4.69, and RR 2.38, 95% CI 1.10 to 5.11, respectively; moderate-quality evidence). There were no clear differences between groups for other side effects.In a single study with 146 participants comparing metoclopramide with promethazine, more women taking promethazine reported drowsiness, dizziness, and dystonia (RR 0.70, 95% CI 0.56 to 0.87, RR 0.48, 95% CI 0.34 to 0.69, and RR 0.31, 95% CI 0.11 to 0.90, respectively, moderate-quality evidence). There were no clear differences between groups for other important outcomes including quality of life and other side effects.In a single trial with 30 women, those receiving ondansetron had no difference in duration of hospital admission compared to those receiving promethazine (MD 0.00, 95% CI -1.39 to 1.39, very low-quality evidence), although there was increased sedation with promethazine (RR 0.06, 95% CI 0.00 to 0.94, low-quality evidence) .Regarding corticosteroids, in a study with 110 participants there was no difference in days of hospital admission compared to placebo (MD -0.30, 95% CI -0.70 to 0.10; very low-quality evidence), but there was a decreased readmission rate (RR 0.69, 95% CI 0.50 to 0.94; four studies, 269 women). For other important outcomes including pregnancy complications, spontaneous abortion, stillbirth and congenital abnormalities, there was insufficient evidence to identify differences between groups (very low-quality evidence for all outcomes). In other single studies there were no clear differences between groups for preterm birth or side effects (very low-quality evidence).For hydrocortisone compared with metoclopramide, no data were available for primary outcomes and there was no difference in the readmission rate (RR 0.08, 95% CI 0.00 to 1.28;one study, 40 women).In a study with 80 women, compared to promethazine, those receiving prednisolone had increased nausea at 48 hours (RR 2.00, 95% CI 1.08 to 3.72; low-quality evidence), but not at 17 days (RR 0.81, 95% CI 0.58 to 1.15, very low-quality evidence). There was no clear difference in the number of episodes of emesis or subjective improvement in nausea/vomiting. There was insufficient evidence to identify differences between groups for stillbirth and neonatal death and preterm birth. AUTHORS\u27 CONCLUSIONS: On the basis of this review, there is little high-quality and consistent evidence supporting any one intervention, which should be taken into account when making management decisions. There was also very limited reporting on the economic impact of hyperemesis gravidarum and the impact that interventions may have.The limitations in interpreting the results of the included studies highlights the importance of consistency in the definition of hyperemesis gravidarum, the use of validated outcome measures, and the need for larger placebo-controlled trials