The Presence of Compassion Fatigue in the Private Practice Setting

Nurses play an intricate role in healthcare and may carry a burden while providing patient care. Bearing this burden could lead to a significant level of stress, which in turn could cause compassion fatigue. Many nurses face issues of stress and fatigue during their daily nursing practice, lending to unsafe conditions for patients and a decrease in quality of life. The purpose of this study was to assess nurses’ perception of the presence of compassion fatigue for nurses working in the private practice setting. This quantitative study, guided by the Neuman Systems Model, consisted of a non-randomized convenience sample of 15 nurses at a private neurology practice. The measurement tool used for the study was the Professional Quality of Life, Version 5 (ProQOL V5), consisting of 30 questions on a 5-point Likert scale. The ProQOL V5 includes three subscales: compassion satisfaction, burnout, and secondary traumatic stress. The burnout and secondary traumatic stress subscales combine to form compassion fatigue; therefore, the data analysis was focused on questions related to burnout and secondary traumatic stress. One sample t-test portrayed minimal difference between the responses to the questions about burnout (M = 48.27, SD = 6.724, p = .335) and secondary traumatic stress (M = 47.00, SD = 8.552, p = .196) when compared to previous responses from the ProQOL V5 questionnaire measuring compassion fatigue (M = 50, SD = 10). Findings from the study indicated that although compassion fatigue, consisting of the subscales burnout and secondary traumatic stress, was present in the private practice setting, there was minimal difference in the prevalence of compassion fatigue in the private practice setting compared to other healthcare settings

Does Training Reduce Computer Anxiety?

This study uses a modified version of the Computer Anxiety Rating Scale (CARS) (Heinnsen, Glass, & Knight, 1987) to longitudinally analyze levels of student anxiety over time. We predict that computer anxiety will behave as a transitory state (Spielberger, 1970) that will respond favorably to interventions. Specifically, we predict that levels of computer anxiety will decrease after students in an introductory computer applications course complete assignments and receive training using personal productivity software tools. Further, we also plan to analyze gender differences in levels of computer anxiety. We propose that women will experience higher levels of computer anxiety than men both before and after training. We have already collected data and plan to statistically test our hypotheses and draw conclusions based on the results obtained

Commissioning and quality control of a dedicated wide bore 3T MRI simulator for radiotherapy planning

Purpose: The purpose of this paper is to describe a practical approach to commissioning and quality assurance (QA) of a dedicated wide-bore 3 Tesla (3T) magnetic resonance imaging (MRI) scanner for radiotherapy planning.Methods: A comprehensive commissioning protocol focusing on radiotherapy (RT) specific requirements was developed and performed. RT specific tests included: uniformity characteristics of radio-frequency (RF) coil, couch top attenuation, geometric distortion, laser and couch movement and an end-to-end radiotherapy treatment planning test. General tests for overall system performance and safety measurements were also performed.Results: The use of pre-scan based intensity correction increased the uniformity from 61.7% to 97% (body flexible coil), from 50% to 90% (large flexible coil) and from 51% to 98% (small flexible coil). RT flat top couch decreased signal-to-noise ratio (SNR) by an average of 42%. The mean and maximum geometric distortion was found to be 1.25 mm and 4.08 mm for three dimensional (3D) corrected image acquisition, 2.07 mm and 7.88 mm for two dimensional (2D) corrected image acquisition over 500 mm × 375 mm × 252 mm field of view (FOV). The accuracy of the laser and couch movement was less than ±1 mm. The standard deviation of registration parameters for the end-to-end test was less than 0.41 mm. An on-going QA program was developed to monitor the system’s performance.Conclusion: A number of RT specific tests have been described for commissioning and subsequent performance monitoring of a dedicated MRI simulator (MRI-Sim). These tests have been important in establishing and maintaining its operation for RT planning.</p

Commissioning and quality control of a dedicated wide bore 3T MRI simulator for radiotherapy planning

Purpose: The purpose of this paper is to describe a practical approach to commissioning and quality assurance (QA) of a dedicated wide-bore 3 Tesla (3T) magnetic resonance imaging (MRI) scanner for radiotherapy planning.Methods: A comprehensive commissioning protocol focusing on radiotherapy (RT) specific requirements was developed and performed. RT specific tests included: uniformity characteristics of radio-frequency (RF) coil, couch top attenuation, geometric distortion, laser and couch movement and an end-to-end radiotherapy treatment planning test. General tests for overall system performance and safety measurements were also performed.Results: The use of pre-scan based intensity correction increased the uniformity from 61.7% to 97% (body flexible coil), from 50% to 90% (large flexible coil) and from 51% to 98% (small flexible coil). RT flat top couch decreased signal-to-noise ratio (SNR) by an average of 42%. The mean and maximum geometric distortion was found to be 1.25 mm and 4.08 mm for three dimensional (3D) corrected image acquisition, 2.07 mm and 7.88 mm for two dimensional (2D) corrected image acquisition over 500 mm × 375 mm × 252 mm field of view (FOV). The accuracy of the laser and couch movement was less than ±1 mm. The standard deviation of registration parameters for the end-to-end test was less than 0.41 mm. An on-going QA program was developed to monitor the system’s performance.Conclusion: A number of RT specific tests have been described for commissioning and subsequent performance monitoring of a dedicated MRI simulator (MRI-Sim). These tests have been important in establishing and maintaining its operation for RT planning

IRC/The Hague:

Contract HRN-I-00-99-00011-0

Pediatric patient asthma-related emergency department visits and admissions in Washington, DC, from 2001–2004, and associations with air quality, socio-economic status and age group

BACKGROUND: The District of Columbia (DC) Department of Health, under a grant from the US Centers for Disease Control and Prevention, established an Environmental Public Health Tracking Program. As part of this program, the goals of this contextual pilot study are to quantify short-term associations between daily pediatric emergency department (ED) visits and admissions for asthma exacerbations with ozone and particulate concentrations, and broader associations with socio-economic status and age group. METHODS: Data included daily counts of de-identified asthma-related pediatric ED visits for DC residents and daily ozone and particulate concentrations during 2001–2004. Daily temperature, mold, and pollen measurements were also obtained. After a cubic spline was applied to control for long-term seasonal trends in the ED data, a Poisson regression analysis was applied to the time series of daily counts for selected age groups. RESULTS: Associations between pediatric asthma ED visits and outdoor ozone concentrations were significant and strongest for the 5–12 year-old age group, for which a 0.01-ppm increase in ozone concentration indicated a mean 3.2% increase in daily ED visits and a mean 8.3% increase in daily ED admissions. However, the 1–4 yr old age group had the highest rate of asthma-related ED visits. For 1–17 yr olds, the rates of both asthma-related ED visits and admissions increased logarithmically with the percentage of children living below the poverty threshold, slowing when this percentage exceeded 30%. CONCLUSION: Significant associations were found between ozone concentrations and asthma-related ED visits, especially for 5–12 year olds. The result that the most significant ozone associations were not seen in the age group (1–4 yrs) with the highest rate of asthma-related ED visits may be related to the clinical difficulty in accurately diagnosing asthma among this age group. We observed real increases in relative risk of asthma ED visits for children living in higher poverty zip codes versus other zip codes, as well as similar logarithmic relationships for visits and admissions, which implies ED over-utilization may not be a factor. These results could suggest designs for future epidemiological studies that include more information on individual exposures and other risk factors

The Australasian Resuscitation In Sepsis Evaluation : fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Methods: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Results: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87–100). Median time to first intravenous antimicrobials was 77 min (42–148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500–3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000–5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4–8.5%). Conclusion: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy

Effects of ocean sprawl on ecological connectivity: impacts and solutions

The growing number of artificial structures in estuarine, coastal and marine environments is causing “ocean sprawl”. Artificial structures do not only modify marine and coastal ecosystems at the sites of their placement, but may also produce larger-scale impacts through their alteration of ecological connectivity - the movement of organisms, materials and energy between habitat units within seascapes. Despite the growing awareness of the capacity of ocean sprawl to influence ecological connectivity, we lack a comprehensive understanding of how artificial structures modify ecological connectivity in near- and off-shore environments, and when and where their effects on connectivity are greatest. We review the mechanisms by which ocean sprawl may modify ecological connectivity, including trophic connectivity associated with the flow of nutrients and resources. We also review demonstrated, inferred and likely ecological impacts of such changes to connectivity, at scales from genes to ecosystems, and potential strategies of management for mitigating these effects. Ocean sprawl may alter connectivity by: (1) creating barriers to the movement of some organisms and resources - by adding physical barriers or by modifying and fragmenting habitats; (2) introducing new structural material that acts as a conduit for the movement of other organisms or resources across the landscape; and (3) altering trophic connectivity. Changes to connectivity may, in turn, influence the genetic structure and size of populations, the distribution of species, and community structure and ecological functioning. Two main approaches to the assessment of ecological connectivity have been taken: (1) measurement of structural connectivity - the configuration of the landscape and habitat patches and their dynamics; and (2) measurement of functional connectivity - the response of organisms or particles to the landscape. Our review reveals the paucity of studies directly addressing the effects of artificial structures on ecological connectivity in the marine environment, particularly at large spatial and temporal scales. With the ongoing development of estuarine and marine environments, there is a pressing need for additional studies that quantify the effects of ocean sprawl on ecological connectivity. Understanding the mechanisms by which structures modify connectivity is essential if marine spatial planning and eco-engineering are to be effectively utilised to minimise impacts

EpiNet as a way of involving more physicians and patients in epilepsy research: validation study and accreditation process

Objective EpiNet was established to encourage epilepsy research. EpiNet is used for multicenter cohort studies and investigator‐led trials. Physicians must be accredited to recruit patients into trials. Here, we describe the accreditation process for the EpiNet‐First trials. Methods Physicians with an interest in epilepsy were invited to assess 30 case scenarios to determine the following: whether patients have epilepsy; the nature of the seizures (generalized, focal); and the etiology. Information was presented in two steps for 23 cases. The EpiNet steering committee determined that 21 cases had epilepsy. The steering committee determined by consensus which responses were acceptable for each case. We chose a subset of 18 cases to accredit investigators for the EpiNet‐First trials. We initially focused on 12 cases; to be accredited, investigators could not diagnose epilepsy in any case that the steering committee determined did not have epilepsy. If investigators were not accredited after assessing 12 cases, 6 further cases were considered. When assessing the 18 cases, investigators could be accredited if they diagnosed one of six nonepilepsy patients as having possible epilepsy but could make no other false‐positive errors and could make only one error regarding seizure classification. Results Between December 2013 and December 2014, 189 physicians assessed the 30 cases. Agreement with the steering committee regarding the diagnosis at step 1 ranged from 47% to 100%, and improved when information regarding tests was provided at step 2. One hundred five of the 189 physicians (55%) were accredited for the EpiNet‐First trials. The kappa value for diagnosis of epilepsy across all 30 cases for accredited physicians was 0.70. Significance We have established criteria for accrediting physicians using EpiNet. New investigators can be accredited by assessing 18 case scenarios. We encourage physicians with an interest in epilepsy to become EpiNet‐accredited and to participate in these investigator‐led clinical trials