Nurse Practitioner Impact on Quantitative Patient Outcomes in Four Healthcare Settings' System Context: A Systematic Review and Meta-Analysis

Nurse Practitioners (NPs) are frequently integrated into interprofessional teams to improve quality and efficiency of healthcare delivery, especially in complex systems. Research on the NP role has grown dramatically, yet an aggregate analysis had never been performed. The purpose of this review was to systematically describe the nature and impact of NP interventions in healthcare settings, to establish a comprehensive understanding of NPs with respect to healthcare delivery, including discovery of information gaps. The specific objectives of the study were to describe the types of: 1) intervention activities that NPs have performed in randomised controlled trials (RCTs); 2) quantitative study endpoints measured in RCTs; and 3) impact of NPs on all quantitative patient outcomes in four settings: primary health care, long term care, outpatient care, and acute care, conducting meta-analysis where possible. Eligible studies included low risk of bias RCTs that tested NP interventions on quantitative endpoints in healthcare settings; data sources included peer reviewed or grey literature in English, from the year 2000 forth. The literature search performed by a professional librarian (MH) yielded 1,188 unique citations. Screening for relevance and risk of bias by two independent reviewers (LT and NL) resulted in a set of included studies comprised of 39 articles (29 different RCTs). Data extraction by LT was cross-checked by the second independent reviewer NL. Findings were systematically summarized according to pre-specified protocol. Out of 89 classes of endpoint-outcomes, results for 43 patient outcome classes (43/89; 48%) were statistically significant, associated with 26/29 (90%) interventions. Meta-analysis was conducted to compare the proportion of hospitalizations between intervention and control groups of two homogenous studies, systematically completing the review’s data analysis. Transparent data presentation within an explicit, reproducible methodology minimizes bias, resulting in reliable findings that were organized, synthesized and summarized in a clear and comprehensive fashion. To the extent of its findings, this systematic review may support improvements in access to quality healthcare, and may provide insight into long term strategies that have potential to contribute toward enhanced balance within the healthcare continuum, from delivery of preventive primary health care services to treatment in acute care

Fractionnement de la fertilisation azotée d'appoint à la suite de l'incorporation au sol de bois raméaux fragmentés: modifications de certaines propriétés biologiques et chimiques d'un sol cultivé en pomme de terre.

En 1992 et 1993, une expérience au champ a été réalisée dans une culture de pomme de terre (Solanum tuberosum L.). Les propriétés biologiques et chimiques du sol ont été étudiées à la suite de l'incorporation de bois raméaux fragmentés (BRF), combinée à un fractionnement de la fertilisation azotée d'appoint. La population fongique du sol a augmenté temporairement suite à l'incorporation de BRF à faible rapport C/N, alors que les populations de bactéries et d'actinomycètes sont demeurées stables. Les BRF n'ont pas favorisé le développement de la gale commune ni de la rhizoctonie sur les tubercules. Le carbone (C) total et la capacité de rétention en eau du sol ont augmenté avec l'apport de BRF. Par contre, les BRF n'ont pas eu d'effet sur le rapport C/N et le pH. Seule la teneur en P disponible a diminué avec l'amendement, probablement en raison de son immobilisation par les microorganismes. Le fractionnement de la fertilisation azotée d'appoint a eu peu d'effet sur les propriétés chimiques du sol. Cependant, il a réduit l'incidence de la gale commune sur les tubercules en 1992. L'amendement en BRF combiné à un fractionnement de la fertilisation azotée d'appoint a donc amélioré l'activité biologique et augmenté la teneur en C total du sol à court terme. Mots clés: Bois raméaux fragmentés, fractionnement azoté, population fongique, biomasse microbienne, immobilisation, phosphoreA field experiment was conducted in 1992 and 1993 in a potato crop (Solanum tuberosum L.). Biological and chemical soil properties were investigated following incorporation of chipped ramial wood (chipped fine branchwood) combined with split applications of supplementary N fertilizer. Fungal populations showed a a temporary increase following incorporation of low C/N chipped wood, whereas bacteria and actinomycete populations remained unchanged. Chipped ramial wood did not induce development of common scab or rhizoctonia on tubers. Soil total carbon (C) and water-holding capacity increased with inputs of chipped wood but C/N ratio and pH were not affected. Only available P content decreased following incorporation of chipped wood, likely due to immobilization by microorganisms. Splitting supplementary N fertilizer showed little effect on soil chemical properties, but it reduced the incidence of common scab on tubers in 1992. Soil amendment with chipped ramial wood in combination with split N applications improved biological activity and caused a short-term increase of total C

Association between recurrent dreams, disturbing dreams and suicidal ideation in adolescents

Disturbing dreams and recurrent dreams have both been linked to a wide range of psychological difficulties in children. There is growing evidence that the experience of frequent disturbing dreams is associated with suicidal ideation in adults but studies in young adolescents have been limited and the results inconsistent. In addition, the possible relationship between suicidal ideation and recurrent dreams has yet to be studied. We thus investigated the relation between disturbing dreams, recurrent dreams and suicidal ideation in a sample of young adolescents. Self-report measures of disturbing dream frequency, recurrent dream frequency, and suicidal ideation were collected at age 12 years and again at age 13 years from 170 children from a prospective population-based birth cohort. While the rate of disturbing dreams and recurrent dreams dropped between ages 12 and 13, the rate of self-reported suicidal ideation increased between the ages of 12 and 13 years. Analyses taking sex and age into account revealed that young adolescents who reported having had suicidal thoughts over the past year had significantly greater frequencies of disturbing dreams and of recurrent dreams than adolescents who had not thought about suicide. These findings highlight the potential clinical value of assessing disturbing and recurrent dreams as part of the screening process for suicidal ideation in young adolescents

Associations of substance use patterns with attempted suicide among persons who inject drugs: Can distinct use patterns play a role?

Background: While the elevated risk of suicide attempt among persons who inject drugs (PWID) is well documented, whether use of different substances is associated with varying degrees of risk remains unclear. We sought to examine the associations between substance use patterns and attempted suicide in a prospective cohort of PWID in Montreal, Canada. Methods: Between 2004 and 2011, participants completed an interviewer-administered questionnaire eliciting information on socio-demographic, substance use patterns, related behaviors, and mental health markers. Generalized estimating equations were used to model the relationship between self-reported use of six common substances (cocaine, amphetamine, opioids, sedative-hypnotics, cannabis and alcohol), associated patterns of use (chronic, occasional and none), and a recent (past six-month) suicide attempt. Results: At baseline, of 1,240 participants (median age: 39.1, 83.7% male), 71 (5.7%) reported a recent suicide attempt. Among 5,621 observations collected during follow-up, 221 attempts were reported by 143 (11.5%) participants. In multivariate analyses adjusting for socio-demographic and psychosocial stressors, among primary drugs of abuse, chronic [Adjusted Odds Ratio (AOR): 1.97] and occasional (AOR: 1.92) cocaine use, and chronic amphetamine use (AOR: 1.96) were independently associated with attempted suicide. Among co-used substances, chronic sedative-hypnotic use was independently associated with an attempt (AOR: 2.29). No statistically significant association was found for the remaining substances. Conclusion: Among PWID at high risk of attempted suicide, stimulant users appear to constitute a particularly vulnerable sub-group. While the mechanisms underlying these associations remain to be elucidated, findings suggest that stimulant-using PWID should constitute a prime focus of suicide prevention efforts

HCO3 dependent impact of Na+,K+, 2Cl cotransport in vascular smooth muscle excitation-contraction coupling

In smooth muscles, inhibition of Na(+),K(+),2Cl(-) cotransport (NKCC) by bumetanide decreased intracellular Cl(-) content ([Cl(-)](i)) and suppressed the contractions triggered by diverse stimuli. This study examines whether or not bicarbonate, a regulator of several Cl(-) transporters, affects the impact of NKCC in excitation-contraction coupling. Addition of 25 mM NaHCO(3) attenuated the inhibitory action of bumetanide on mesenteric artery contractions evoked by 30 mM KCl and phenylephrine (PE) by 5 and 3-fold, respectively. In cultured vascular smooth muscle cells, NaHCO(3) almost completely abolished inhibitory actions of bumetanide on transient depolarization and [Ca(2+)](i) elevation triggered by PE. In bicarbonate-free medium, bumetanide decreased [Cl(-)](i) by approximately 15%; this effect was almost totally abrogated by NaHCO(3). The addition of NaHCO(3) resulted in 2-fold inhibition of NKCC activity and 3-fold attenuation of [Cl(-)](i). These data strongly suggest that extracellular HCO(3)(-) diminishes the NKCC-sensitive component of excitation-contraction coupling via suppression of this carrier