Implementing SBAR Training with Acute Care Nurses

Background In 1999, the Institute of Medicine reported 98,000 deaths in US hospitals due to medical errors. The Joint Commission posits 70% of sentinel events are rooted in communication errors. The US military and aviation industry had developed structured communication tools to reduce communication error and shared this with healthcare in the form of the Situation Background Assessment Recommendation (SBAR) tool. The Joint Commission recommends use of the SBAR tool. Objective Formal training on SBAR was not present at one acute care facility, constituting a gap between evidence and practice. This practice improvement project aimed to close this evidence-practice gap. The objective was to incorporate educating nurses on one floor of a 118 bed acute care medical facility in the Southeastern US. The goals were to achieve increased knowledge about SBAR and to achieve greater satisfaction with interprofessional communication. Methods 27 nurses were educated on SBAR using didactic plus role-playing. Prior to the education, a multiple choice knowledge test (MCKT) was administered and a short version survey of communication satisfaction was administered (the ICUNPQ-SV, nurse version). After four weeks, the same MCKT and ICUNPQ-SV were administered to the nurses. Results For the objective of educating nurses on SBAR, the first goal was to increase knowledge. Means from the posttest were higher than the pre-test, but not significantly p=.55. The second goal of increasing satisfaction was met, difference in means was p=.049 and individual item analyses of means demonstrated that overall job satisfaction increased significantly p=.024. Conclusions The knowledge about SBAR did increase with these nurses, but not significantly. Many nurses are introduced to SBAR as part of their curriculum and the initial scores indicated familiarity with the tool. Satisfaction with communication increased, as did overall job satisfaction, but the reasons were likely multifactorial. Limitations of the study included sample size, homogeneity of subjects and inability to control such experiential factors as staffing or patient acuity at the times of the education or follow up. Direct causation from the education cannot, therefore, be concluded

Women with Methylenetetrahydrofolate Reductase Gene Polymorphism and the Need for Proper Periconceptional Folate Supplementation

Maternal folate supplementation is critical for fetal development. Women with MTHFR (methylenetetrahydrofolate reductase) gene polymorphisms may not be getting the proper folate form to support fetal development. The objectives of this review were to: (1) undertake a comprehensive review on the association of MTHFR polymorphisms with the risk for various congenital diseases and other adverse pregnancy outcomes, (2) assess the efficacy and safety of current folic acid and other supplementations in women with the MTHFR polymorphism, and (3) provide guidance on the appropriate supplementation for women of childbearing potential with the MTHFR gene polymorphism in order to decrease these adverse pregnancy outcomes. Our assessments show that women with MTHFR gene polymorphism cannot efficiently convert folic acid to L-5-methyl-tetrahydofolate, the predominant active form of folic acid, due to reduced MTHFR enzymatic activity. L-5-methyl-tetrahydrofolate is currently commercially available under several brand names. Based on our comprehensive review and knowledge of the biochemistry of the folates, we recommend that L-5-methyltetrahydrofolate be given in combination with folic acid to women with MTHFR polymorphism that are pregnant or planning to become pregnant. Further study is needed to determine the optimal dose

From Shibboleths to Shared Terminology? The Divisive Place Names of Northern Ireland

In Northern Ireland, terminology has become a war zone due to the region’s longstanding ethno-political conflict. Unfortunately, with the exception Hawes-Bilger’s work (2007), there is little current research exploring this phenomenon. This paper aims to fill this current gap in knowledge by conducting a quantitative analysis on the use of contentious place names in Northern Ireland. The terms in this corpus linguistic study will be limited to ‘Londonderry,’ ‘Northern Ireland,’ and ‘the Republic of Ireland’ and their variants. Ultimately, the goal of this paper is to determine if the relative peace throughout the last 15 years has led to less use of politically charged toponyms among the main actors in the conflict: the Republicans and Unionists within Northern Ireland itself

Ocean Thermal Energy Conversion: The Codification of a Potential Technology

Rapid technological advancement has been the hallmark of post-industrial societies for more than a quarter of a century. This progress is forever disrupting our established legal systems. Nowhere is this tension more evident than in the discoveries of the developing energy industry. An exception to this process is the infant industry of ocean thermal energy conversion (OTEC). The United States Congress recently enacted legislation establishing the legal framework for the OTEC process, which has not yet been proven on a commercial scale. OTEC is a form of solar energy that takes advantage of the vertical temperature differentials in those regions of the ocean generally between twenty degrees North latitude and twenty degrees South latitude. An OTEC system consists of a power plant, a floating platforms to house the plant, a surface-level seawater system, a deep water seawater system, and a method of transmitting or utilizing the energy produced. Warm surface water is pumped into a heat exchanger to vaporize a working fluid. A turbo-generator converts the resulting vapor\u27s thermal energy into mechanical and then electrical energy. The vapor leaving the turbine flows into a condenser where it is cooled by cold water pumped up from the deep ocean through a long pipe descending as much as 700 meters or deeper. Although commercial facilities are not expected to be available prior to the late 1980\u27s, two types of OTEC systems are presently under consideration. The closed cycle system6 is closer to commercial realization. In this system, heat derived from surface waters evaporates a working fluid such as ammonia and forces the resulting vapor through a turbine. The turbine powers a generator to create electricity. The vapor returns to liquid form after being chilled with cold water from the ocean depths. The second system is the open cycle system. In this process, warm surface seawater is evaporated in a vacuum. The resulting steam powers a turbine and is then condensed with cold seawater drawn from the ocean depths. OTEC has the potential to fulfill the energy needs of oil-dependent communities. Because OTEC\u27s energy source is solar, it is renewable. Unlike other solar technologies, however, OTEC can operate twenty-four hours a day, year-round due to the ocean\u27s immense solar-collection properties. Yet OTEC will be used for much more than electrical power generation. It has the potential for ammonia production, which presently requires nearly three percent of the total United States output of natural gas. OTEC can be used to process and refine minerals and produce other energy-intensive products such as aluminum. OTEC power can be used to produce fuel for fuel cells that can be transported and used for electricity elsewhere. Considering all these potential uses, OTEC will be a promising area of renewable energy technology if it evolves in a cost-effective and environmentally acceptable manner

Novel norovirus recombinants detected in South Africa

BACKGROUND: Noroviruses (NoV) are the leading cause of viral gastroenteritis worldwide. Recombination frequently occurs within and between NoV genotypes and recombinants have been implicated in sporadic cases, outbreaks and pandemics of NoV. There is a lack of data on NoV recombinants in Africa and therefore their presence and diversity was investigated in South Africa (SA). RESULTS: Between 2010 and 2013, eleven types of NoV recombinants were identified in SA. Amplification of the polymerase/capsid region spanning the ORF1/2 junction and phylogenetic analysis confirmed each of the recombinant types. SimPlot and maximum x(2) analysis indicated that all recombinants had a breakpoint in the region of the ORF1/2 junction (P < 0.05). The majority (9/11) were intergenotype recombinants, but two intragenotype GII.4 recombinants were characterised. Three combinations represent novel recombinants namely GII.P not assigned (NA)/GII.3, GII.P4 New Orleans 2009/GII.4 NA and GII.P16/GII.17. Several widely reported recombinants were identified and included GII.P21/GII.2, GII.P21/GII.3, GII.Pe/GII.4 Sydney 2012, and GII.Pg/GII.12. Other recombinants that were identified were GII.Pg/GII.1, GII.Pe/GII.4 Osaka 2007, GII.P4 New Orleans 2009/GII.4 Sydney 2012, GII.P7/GII.6. To date these recombinant types all have a reportedly restricted geographic distribution. This is the first report of the GII.P4 New Orleans 2009/GII.4 Sydney 2012 recombinant in Africa. CONCLUSIONS: Over the past four years, remarkably diverse NoV recombinants have been circulating in SA. Pandemic strains such as the GII.Pe/GII.4 Sydney 2012 recombinant co-circulated with novel and emerging recombinant strains. Combined polymerase- and capsid-based NoV genotyping is essential to determine the true diversity and global prevalence of these viruses

Expanding health care perspectives: policy making towards the year 2000

Humanities Research Group Working Papers 5 Proceedings of the workshop held at the Humanities Research Group, University of Windsor, March 31, 1995https://scholar.uwindsor.ca/hrg-working-papers/1001/thumbnail.jp

Dimensions of Time

Humanities Research Group Working Papers 8 Time: whether we’ve too much time on our hands or no time to stop and think, whether time flies or marches slowly, whether we are clock watchers or don’t own a watch, perennially late or inevitably early, the nature of time preoccupies us all. It is fitting, then, that this volume, the last to appear in the century beginning with “nineteen,” should take as its theme “Dimensions of Time.” This volume, as have all in the series, examines a topic of contemporary interest from a variety of historical and disciplinary perspectives.https://scholar.uwindsor.ca/hrg-working-papers/1007/thumbnail.jp

Quantification and molecular characterisation of human sapoviruses in water sources impacted by highly polluted discharged wastewater in South Africa

Sapoviruses (SaVs) were detected and quantified in 8/10 water samples collected from wastewater treatment works (WWTW) and water sources impacted by these WWTWs in Limpopo Province, South Africa. The median SaV concentration was 2.45 x 106 copies/L and SaV genotypes I.2 and IV were characterised. This study provides new data on the high concentrations of clinically relevant SaVs in rivers and dams impacted by poor-performing WWTWs.This study was funded, in part, by the Poliomyelitis Research Foundation, and in part by an on-going solicited Water Research Commission research project co-funded by Department of Agriculture, Forestry and Fisheries, SA. “An investigation into the link between water quality and microbiological safety of fruit and vegetables from the farming to the processing stages of production and marketing” (Project No K5/1875//4, Water Research Commission Abridged Knowledge review 2009/10, Pretoria).http://jwh.iwaponline.comhb2016Medical Virolog