Observational Evidence of For-Profit Delivery and Inferior Nursing Home Care: When Is There Enough Evidence for Policy Change?

This research was financially supported by the Social Sciences and Humanities Research Council

Artificial Skin – Culturing of Different Skin Cell Lines for Generating an Artificial Skin Substitute on Cross-Weaved Spider Silk Fibres

Background: In the field of Plastic Reconstructive Surgery the development of new innovative matrices for skin repair is in urgent need. The ideal biomaterial should promote attachment, proliferation and growth of cells. Additionally, it should degrade in an appropriate time period without releasing harmful substances, but not exert a pathological immune response. Spider dragline silk from Nephila spp meets these demands to a large extent. Methodology/Principal Findings: Native spider dragline silk, harvested directly out of Nephila spp spiders, was woven on steel frames. Constructs were sterilized and seeded with fibroblasts. After two weeks of cultivating single fibroblasts, keratinocytes were added to generate a bilayered skin model, consisting of dermis and epidermis equivalents. For the next three weeks, constructs in co-culture were lifted on an originally designed setup for air/liquid interface cultivation. After the culturing period, constructs were embedded in paraffin with an especially developed program for spidersilk to avoid supercontraction. Paraffin cross-sections were stained in Haematoxylin & Eosin (H&E) for microscopic analyses. Conclusion/Significance: Native spider dragline silk woven on steel frames provides a suitable matrix for 3 dimensional skin cell culturing. Both fibroblasts and keratinocytes cell lines adhere to the spider silk fibres and proliferate. Guided by the spider silk fibres, they sprout into the meshes and reach confluence in at most one week. A well-balanced, bilayered cocultivation in two continuously separated strata can be achieved by serum reduction, changing the medium conditions and the cultivation period at the air/liquid interphase. Therefore spider silk appears to be a promising biomaterial for the enhancement of skin regeneration

Institutional effects on nurses’ working conditions: a multi-group comparison of public and private non-profit and for-profit healthcare employers in Switzerland

Background: In response to the need for competitive recruitment of nurses resulting from the worldwide nursing shortage, employers need to attract and retain nurses by promoting their competitive strengths in their working conditions (WCS) and by addressing their competitive weaknesses. This study investigated workplace differences between public hospitals (PuHs), private for-profit hospitals (PrHs), socio- medical institutions (SOMEDs), home care services (HCs), private medical offices (PrOs) and non-profit organisations (NPOs), helping to provide a foundation for competition-oriented institutional employer branding and to increase transparency in the labour market for nurses. Methods: Data from the Swiss Nurses at Work study of the career paths of 11 232 nurses who worked in Switzerland between 1970 and 2014 were subjected to secondary analysis, assessing the effect of institutional characteristics on self-reported determinants of job satisfaction (such as WCS) using multivariate linear regression and post hoc tests with Bonferroni-adjusted significance levels. Principal component analysis was used to reduce the number of WCS in the original study. Results: Nurses at PuHs and PrHs were less likely to experience autonomy, flexibility of work hours and participation in decision-making than those at other workplaces. Although PuHs were rated higher than PrHs in terms of satisfaction with salary and advancement opportunities, they were associated with more alienating work factors, such as stress and aggression. SOMED workplaces were significantly more often associated with alienating conditions and low job satisfaction, but were rated higher than the other institutions in terms of participation in decision-making. The nurses’ ratings implied that PrO workplaces were more likely to offer a mild work environment, social support and recognition than other institutions, but that advancement opportunities were limited. NPO workplaces were associated with the highest degree of autonomy, flexibility, participation, recognition, organisational commitment and job satisfaction. In these respects, HC and NPO workplaces received similar ratings, although the HC workplaces were associated with a significantly lower organisational commitment and significantly lower job satisfaction. Conclusions: Due to their structural characteristics, NPOs, SOMEDs and HCs can attract nurses seeking greater self-determination, PuHs can attract career-oriented nurses, and PrOs and PrHs are likely to attract nurses through offering less-stressful working conditions

Barriers and facilitators to uptake of systematic reviews by policy makers and health care managers: a scoping review.

Background: We completed a scoping review on the barriers and facilitators to use of systematic reviews by care managers and policy makers, including consideration of format and content, to develop recommendations for systematic review authors and to inform research efforts to develop and test formats for systematic reviews that may optimise their uptake. Methods: We used the Arksey and O’Malley approach for our scoping review. Electronic databases (e.g.,MEDLINE, EMBASE, PsycInfo) were searched from inception until September 2014. Any study that identified barriers or facilitators (including format and content features) to uptake of systematic reviews by health care managers and policy makers/analysts was eligible for inclusion. Two reviewers independently screened the literature results and abstracted data from the relevant studies. The identified barriers and facilitators were charted using abarriers and facilitators taxonomy for implementing clinical practice guidelines by clinicians. Results: We identified useful information for authors of systematic reviews to inform their preparation of reviews including providing one-page summaries with key messages, tailored to the relevant audience. Moreover, partnerships between researchers and policy makers/managers to facilitate the conduct and use of systematic reviews should be considered to enhance relevance of reviews and thereby influence uptake. Conclusions: Systematic review authors can consider our resultswhen publishing their systematic reviews. These strategies should be rigorously evaluated to determine impact on use of reviews in decision-making.</p