The working environment in Health Care — Does the working environment influence the psychosocial health of nurses and are modifications of this working environment needed?

Context: Ageing of the population and an increase of the life expectancy are worldwide phenomena that result in a growing demand for health care professionals. Future problems are expected in providing for this demand. Not only difficulties in attracting new potential professionals, but also difficulties in retaining the existing workforce are suspected to be a part in a possible future shortage of workforce. A statistical significant relationship exists between the working environment and the developmental level of the workforce. The working environment can therefore be interpreted as a key factor in the prevention of potential future problems. Setting: The work of nurses is often characterised as both mentally- and physically demanding. Properties of the working environment in health care like changing supervisors, colleagues, workplaces, working hours and tasks can intensify both the workload and psychosocial influences of this workload. Objectives: To describe the most common influences of the working environment on the psychosocial health status of nurses. Recommendations in order to modify the working environment will be given if necessarily. Design: Systematic review of relevant information from the following databases: Pubmed, Medline, Google Scholar, Blackwell Synergy, British Medical Journal, CINAHL, Embase, Esmerald Insight, Oxford Journals, ScienceDirect, Wiley InterScience. Main outcomes: The working environment influences: job satisfaction, emotional exhaustion, moral distress/stress of conscience (depersonalization), reduced personal accomplishment, overall burnout, work engagement, home life, sickness absence, leaving the profession. Recommendations: empowerment, creating a more attractive working environment through modifications of the organizational structure, management style, and interdisciplinary relations

Quality and Process Improvement in Cardiothoracic Surgery

This is a summary of a doctoral thesis on quality and process improvement in cardiothoracic surgery, addressing challenges in resource scarcity and overburdened healthcare professionals. Two systematic reviews explore the successes and barriers of implementing improvement methodologies, focusing on hospitals and cardiothoracic surgery. The first article reviews quality improvement methodologies, such as Lean and Six Sigma, from the manufacturing industry, showing successful applications in cardiac surgery. These methodologies consistently improve patient and process outcomes, emphasizing the importance of multidisciplinary engagement, data-driven approaches, urgency, and sustainability. The second article focuses on improving the efficiency of intraoperative lung cancer surgery, revealing significant reductions in operative time, complications, and improved staff morale through implementation of improvement methodologies. The third study addresses last-minute surgical cancellations in a Dutch academic hospital, using Lean Six Sigma's DMAIC cycle. The project reduces cancellations by 50%, repeated diagnostics by 67%, referral to treatment time by 35%, and improves patient satisfaction by 14%, showcasing Lean Six Sigma's effectiveness in healthcare.The fourth article details a Lean Six Sigma study to enhance the quality and process of multidisciplinary Heart Team meetings. It identifies and implements seven improvements, optimizing the team and establishing a best practice design for patient-centered decision-making. The fifth article introduces a Quality Process Index to translate clinical data into insights for cardiosurgical procedures. Despite stable mean index values, the study explores correlations with mortality rates, providing a comprehensive measurement of quality and process improvement. The sixth article addresses the challenge of balancing quality improvement and cost containment in hospitals. Drawing on case-based reasoning, the study emphasizes education, management support, and continuous improvement, suggesting a combination of Lean management and Lean Six Sigma for performance excellence. Collectively, these articles contribute to the foundation for further innovations in cardiothoracic surgery and healthcare. They highlight the potential of Lean and Six Sigma methodologies, identify factors for success, and underscore the need for evidence-based knowledge. The studies advocate for continuous adaptation to resource challenges, emphasizing the importance of a positive culture for sustained quality and process improvement in healthcare

Development of different peroxidatic activity patterns in peritoneal macrophages in vivo and in vitro

Contains fulltext : 4311.pdf (publisher's version ) (Open Access

Culture of human bone marrow in the Teflon culture bag : Identification of the human monoblast

Contains fulltext : 4419.pdf (publisher's version ) (Open Access

Enrichment and characterization of dendritic cells from human bronchoalveolar lavages

In the present study about 0.3% to 1.6% of human bronchoalveolar lavage (BAL) cells were identified as typical dendritic cells (DC), having an irregular outline, lobulated nucleus, and clear distinguishable acid phosphatase activity or EBM11 (anti-CD68) reactivity in a spot near the nucleus. After DC enrichment, using transient adherence to plastic, FcR-panning, and a density metrizamide gradient, a population containing 7-8% typical DC was obtained. This DC-enriched low density fraction, containing the highest percentages of DC, very strongly induced T cell proliferation in an allogeneic mixed leucocyte reaction (MLR), which was significantly higher than that induced by other partly (un)fractionated BAL cells. These data indicate that DC seem to be the major accessory cells in the BAL fluid, and therefore may be important in the regulation of T cell immune responses in the lung

Systemic LRG1 Expression in Melanoma is Associated with Disease Progression and Recurrence

The response rates upon neoadjuvant immune checkpoint blockade (ICB) in stage III melanoma are higher as compared with stage IV disease. Given that successful ICB depends on systemic immune response, we hypothesized that systemic immune suppression might be a mechanism responsible for lower response rates in late-stage disease, and also potentially with disease recurrence in early-stage disease. Plasma and serum samples of cohorts of patients with melanoma were analyzed for circulating proteins using mass spectrometry proteomic profiling and Olink proteomic assay. A cohort of paired samples of patients with stage III that progressed to stage IV disease (n = 64) was used to identify markers associated with higher tumor burden. Baseline patient samples from the OpACIN-neo study (n = 83) and PRADO study (n = 49; NCT02977052) were used as two independent cohorts to analyze whether the potential identified markers are also associated with disease recurrence after neoadjuvant ICB therapy. When comparing baseline proteins overlapping between patients with progressive disease and patients with recurrent disease, we found leucine-rich alpha-2-glycoprotein 1 (LRG1) to be associated with worse prognosis. Especially nonresponder patients to neoadjuvant ICB (OpACIN-neo) with high LRG1 expression had a poor outcome with an estimated 36-month event-free survival of 14% as compared with 83% for nonresponders with a low LRG1 expression (P = 0.014). This finding was validated in an independent cohort (P = 0.0021). LRG1 can be used as a biomarker to identify patients with high risk for disease progression and recurrence, and might be a target to be combined with neoadjuvant ICB. Significance: LRG1 could serve as a potential target and as a biomarker to identify patients with high risk for disease recurrence, and consequently benefit from additional therapies and intensive follow-up