Sepsis Education for the Primary Nurse with Swift Intervention leads to Successful Outcomes

The mortality rate for sepsis in the US exceeds those for common cancers. It has been identified that patients who are admitted from the regular nursing floor to the ICU with sepsis have a statistically significant higher mortality rate and hospital length of stay than those patients admitted directly to the ICU. This research echoes the findings within BHSF. Early identification and aggressive treatment are primary goals in the treatment of sepsis in preventing septic shock. The medical surgical nurse must be empowered to take action when faced with a decision how to manage the septic patient. The use of a sepsis screening tool, along with the initiation and implementation of an initial management bundle is important in decreasing patient mortality rates. We will conduct a quasi-experimental pre and post intervention via an educational session for the medical surgical nurse as well as a retrospective chart review to compare the mortality outcomes of those patients identified as having sepsis. Data collection is through surveys and retrospective chart reviews. Research questions include: 1. Does the implementation of an evidenced based educational intervention increase medical-surgical nurses’ knowledge of early sepsis identification on post-test when compared with pre-test? 2. Does the implementation of an evidenced based educational intervention increase the rate of code rescue initiation for sepsis intervention at 3 months post education when compared to 3 months pre-education? , 3. Does the implementation of an evidence based educational intervention on early sepsis recognition for medical-surgical nurses, decrease the rate of patients with severe sepsis on medical surgical units

God\u27s Law or State\u27s Law: Authority and Islamic Family Law Reform in Bahrain

This dissertation examines the role of religious authority in the debate over the codification of family law in Bahrain. It analyzes the grounds upon which three sets of actors claim authority over family law: religious scholars, women activists, and the state. While the state already holds the power to determine its laws simply by nature of its character as an authoritarian regime, religious scholars and women activists challenge that power by referencing sources of authority outside the state, such as religious texts and institutions, international human rights treaties, and regional ideals of justice. Elements of Bahrain’s debate are similar to legal debates in other Muslimmajority countries. However, Bahrain’s demography adds a layer of complexity that is not present in any other state. Bahrain’s Shii majority is ruled by the Sunni Ᾱl Khalīfa family. Therefore, the debate regarding the fate of religious law takes on a specifically political tone. The research involved a combination of ethnography, textual analysis, and archival research. A multi-disciplinary approach is used which draws upon work in the fields of religious studies, the history of Islamic law, anthropology, and political science in order to understand, primarily, the workings of power. For instance, the state may have the power to enact a family law, but it does not have the legitimacy to do so ix in the eyes of many Bahrainis. For those citizens, religious scholars have legitimate authority over family law, however, they do not have power. Considering Foucault’s phrase “where there is power, there is resistance,” as well as its inverse, “where there is resistance, there is power,” women’s activism is analyzed here as a “diagnostic of power.” By discovering where and when women activists exert influence reveals relationships of power between and among the state and non-state actors. While the family law debate in Bahrain is about many things: women and the family, the role of sharīʻa in contemporary Muslim society, sectarian relations between a Sunni ruling elite and its Shii population, it is, at the broadest level, a symbolic referendum on the authority of the modern nation-state and its relationship to religious authority

Predicting System Success using the Technology Acceptance Model: A Case Study

Determining what makes an Information System (IS) successful is an ongoing concern for both researchers and practitioners alike. Arriving at an answer to this problem is compounded by the subjective nature of success and therefore trying to make judgements of what is and is not a success is problematic. Despite these difficulties system use has become more accepted as a measure of system success. Following this logic if a system is accepted it will have a higher likelihood of being used and therefore impact positively on success. The Technology Acceptance Model (TAM) is one of the more widely accepted theoretical frameworks that has been used to measure system acceptance. This paper combines the TAM, as the theoretical framework, with case study research to provide a more holistic account of why a specific IS, an online assignment submission system, has become successful. Initial findings suggest that the TAM measures of perceived usefulness and perceived ease of use are effective predictors of systems success

Involving the public in decision-making about large-scale changes to health services: a scoping review

BACKGROUND: Public involvement in large-scale changes (LSC) to health services is strongly promoted - and even mandated - in several health systems. This scoping review aimed to describe the evidence about how public involvement is conceptualised and conducted in LSC, with what impact, and how different stakeholders perceived this process. METHODS: After searching eight databases, 34 publications were included. Data were extracted and charted using a standardised form. Findings from the literature were discussed with frontline stakeholders. RESULTS: Public involvement remains poorly defined and its aims lack clarity in LSC. Public meetings are most often used to gather public views but raise the issue of representativeness. However, evidence in the literature is scarce about which involvement methods - informative and deliberative - are appropriate for the different stages of the LSC and with what impact. In several cases, the involved public felt they had no influence on decision-making regarding LSC proposals, sometimes leading to an environment of mistrust. In those instances, the public understood the technical arguments for change and actively questioned them, opposed LSC plans and sought alternative routes to voice their views. CONCLUSION: More research and consideration are needed regarding who should be involved, with what purpose and how. We argue that in practice two models of involvement, invited and uninvited participation, coexist and therefore interactions between the two should be given further consideration in LSC

Sun protection: North and South – a comparison of attitudes and behaviours of young adults in the UK and NZ: implications for UK interventions

Skin cancer rates have steadily risen in the UK, doubling approximately every twenty years. There has been no significant mass media expenditure within the UK on improving public awareness of the link between sun exposure and skin cancer risk. In countries such as New Zealand, where extensive mass media and population segment-specific interventions have run for several years, melanoma rates show a decline, suggesting that mass media interventions should be considered within the UK and other European countries to help reduce skin cancer rates. Before considering the possibility of using similar mass media-based communication strategies to those used in New Zealand, an understanding of the attitudes and beliefs that underpin existing sun protective behaviours in both countries would be beneficial. We focus on adolescents as a target as this segment has particularly poor sun protective behaviours and appears resistant to health-based interventions .We therefore compare the attitudes, beliefs and actual reported behaviours of young adults in the UK and New Zealand identifying less than optimal sun protective behaviours in both countries. The findings suggest that the UK or other countries - should not adopt similar communication strategies to New Zealand without addressing underlying normative factors underpinning behaviours

Expression profiling of metalloproteinases and tissue inhibitors of metalloproteinases in normal and degenerate human achilles tendon

To profile the messenger RNA (mRNA) expression for the 23 known genes of matrix metalloproteinases (MMPs), 19 genes of ADAMTS, 4 genes of tissue inhibitors of metalloproteinases (TIMPs), and ADAM genes 8, 10, 12, and 17 in normal, painful, and ruptured Achilles tendons. Tendon samples were obtained from cadavers or from patients undergoing surgical procedures to treat chronic painful tendinopathy or ruptured tendon. Total RNA was extracted and mRNA expression was analyzed by quantitative real-time reverse transcription–polymerase chain reaction, normalized to 18S ribosomal RNA. In comparing expression of all genes, the normal, painful, and ruptured Achilles tendon groups each had a distinct mRNA expression signature. Three mRNA were not detected and 14 showed no significant difference in expression levels between the groups. Statistically significant (P < 0.05) differences in mRNA expression, when adjusted for age, included lower levels of MMPs 3 and 10 and TIMP-3 and higher levels of ADAM-12 and MMP-23 in painful compared with normal tendons, and lower levels of MMPs 3 and 7 and TIMPs 2, 3, and 4 and higher levels of ADAMs 8 and 12, MMPs 1, 9, 19, and 25, and TIMP-1 in ruptured compared with normal tendons. The distinct mRNA profile of each tendon group suggests differences in extracellular proteolytic activity, which would affect the production and remodeling of the tendon extracellular matrix. Some proteolytic activities are implicated in the maintenance of normal tendon, while chronically painful tendons and ruptured tendons are shown to be distinct groups. These data will provide a foundation for further study of the role and activity of many of these enzymes that underlie the pathologic processes in the tendon

OUTdoor Swimming as a nature-based Intervention for DEpression (OUTSIDE): study protocol for a feasibility randomised control trial comparing an outdoor swimming intervention to usual care for adults experiencing mild to moderate symptoms of depression

Background Depression is common and the prevalence increasing worldwide; at least 1 in 10 people will experience depression in their lifetime. It is associated with economic costs at the individual, healthcare and societal level. Recommended treatments include medication and psychological therapies. However, given the long waiting times, and sometimes poor concordance and engagement with these treatments, a greater range of approaches are needed. Evidence for the potential of outdoor swimming as an intervention to support recovery from depression is emerging, but randomised controlled trials (RCTs) evaluating clinical and cost-effectiveness are lacking. This study seeks to investigate the feasibility of conducting a definitive superiority RCT, comparing an 8-session outdoor swimming course offered in addition to usual care compared to usual care only, in adults who are experiencing mild to moderate symptoms of depression. Feasibility questions will examine recruitment and retention rates, acceptability of randomisation and measures, and identify the primary outcome measure that will inform the sample size calculation for a definitive full-scale RCT. This study will also explore potential facilitators and barriers of participation through evaluation questionnaires, focus-group discussions and interviews. Methods/design To address these aims and objectives, a feasibility superiority RCT with 1:1 allocation will be undertaken. We will recruit 88 participants with mild to moderate symptoms of depression through social prescribing organisations and social media in three sites in England. Participants will be randomised to either (1) intervention (8-session outdoor swimming course) plus usual care or (2) usual care only. Both groups will be followed up for a further 8 weeks. Discussion If findings from this feasibility RCT are favourable, a fully powered RCT will be conducted to investigate the clinical- and cost-effectiveness of the intervention. Findings from the definitive trial will provide evidence about outdoor swimming for depression for policymakers and has the potential to lead to greater choice of interventions for adults experiencing symptoms of depression. Trial registration Current controlled trial registration number is ISRCTN 90851983 registered on 19 May 2022