Similarities and Differences in Nurse-Reported Care Rationing Between Critical Care, Surgical, and Medical Specialties

Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved OBJECTIVE: The aim of this study was to determine the similarities and differences in elements of nursing care that are commonly rationed in the critical care, medical, and surgical specialties within an acute hospital environment. METHODS: Registered nurses who provide bedside nursing care within the medical, surgical, and critical specialties at a single center were invited to anonymously complete the self-administered MISSCARE questionnaire. The frequency of rationing for each individual care element within the 4 broader care groups (assessment, intervention—individual needs, intervention—basic care, and planning) of the MISSCARE questionnaire was determined. A mean score for each care group was also determined, and multiple regression analysis was undertaken to determine the demographic predictors of care rationing. RESULTS: Interventions related to basic care was the most frequently rationed care group in the critical care/emergency specialty (missed care mean of 50.1%), whereas planning was the most frequently rationed care group among both the medical (missed care mean of 43.6%) and surgical (missed care mean of 44.8%) specialties. Assessment was the least frequently rationed care group among all 3 specialties (missed care mean of 19.7%–26.7%). Length of time practicing as a registered nurse was an independent predictor of care rationing in the critical care/emergency specialty, and age older than 50 was an independent predictor in the medical specialty. CONCLUSIONS: There are numerous similarities and differences in care rationing between critical care, surgical, and medical nurses. The development and implementation of specialty-based strategies should be undertaken to reduce the incidence of nursing care rationing

Hormonal contraceptive methods and risk of HIV acquisition in women : a systematic review of epidemiological evidence

Peer reviewedPublisher PD

Factors contributing to nursing team work in an acute care tertiary hospital

© 2015 Australian College of Nursing Ltd Background Effective nursing teamwork is an essential component of quality health care and patient safety. Understanding which factors foster team work ensures teamwork qualities are cultivated and sustained. Objective This study aims to investigate which factors are associated with team work in an Australian acute care tertiary hospital across all inpatient and outpatient settings. Methods All nurses and midwives rostered to inpatient and outpatient wards in an acute care 600 bed hospital in Sydney Australia were invited to participate in a cross sectional survey between September to October 2013. Data were collected, collated, checked and analysed using Statistical Package for the Social Sciences (SPSS) Version 21. Factors reporting a significant correlation with where p < 0.05 were analysed in a multiple regression model. Results A total of 501 surveys were returned. Nursing teamwork scores ranged between 3.32 and 4.08. Teamwork subscale Shared Mental Model consistently rated the highest. Mean scores for overall communication between nurses and team leadership were 3.6 (S.D. 0.57) and 3.8 (SD 0.6) respectively. Leadership and communication between nurses were significant predictors of team work p < 0.001. Conclusion Our findings describe factors predictive of teamwork in an acute care tertiary based hospital setting across inpatient and outpatient specialty units. Our findings are of particular relevance in identifying areas of nurse education and workforce planning to improve nursing team work

Environmental risk assessment studies on new plant protection products which have been elaborated from coniferous tree bark

ArticleNowadays there are still various chemical pesticides being applied in the course of ensuring plant protection. Since 2010, we have been working on the development of new, environmentally-friendly plant protection products which will provide an effective tool against pathogenic fungi and bacteria which cause disease in crop plants. The specific aim of this study was to evaluate a risk assessment for new plant protection products that have been elaborated on the basis of coniferous tree bark. Various products were tested which are extracted during the processing of wood bark from pine (Pinus sylvestris L.) and spruce (Picea abies (L.) Karst.). Ethanol extracts were formulated and applied during these experiments. Two formulations, which showed anti-fungal activity in vitro and in field trials on fruit crops (involving strawberries and raspberries) were selected for the risk assessment studies. The impact was studied of formulation treatment on crop plants and soil biological activity, and the accumulation of residues of active substances in crop plants and soil. The application of new formulations did not show any negative effect on the chlorophyll content and the chlorophyll fluorescence of plant leaves. The results showed that pine and spruce bark extract formulations contain active compounds (coumaric acid, quercetin, epicatechin, and ferulic acid) within the range of 5.1–5.9 mg kg-1 and 11.1– 443.9 mg kg-1 respectively. The amount of active substances which were determined in most cases was higher in the spruce bark extract formulation when compared to the pine bark extract formulation. Our results confirmed the presence of active compounds – epicatechin, quercetin, and coumaric acid – in strawberry fruits which remained untreated and in those that were treated with spruce ethanol extract formulation. Untreated raspberry fruits contained all four active substances within the range of 81–5,300 µg kg-1. We observed a significant increase of coumaric acid and quercetin in raspberries after their having been treated with spruce bark extract formulation in a 2% concentration, P < 0.05, and did not find any negative impact for spruce bark extract formulations when used on soil microbial biomass

Cannibalism as a life boat mechanism

Under certain conditions a cannibalistic population can survive when food for the adults is too scarce to support a non-cannibalistic population. Cannibalism can have this lifeboat effect if (i) the juveniles feed on a resource inaccessible to the adults; and (ii) the adults are cannibalistic and thus incorporate indirectly the inaccessible resource. Using a simple model we conclude that the mechanism works when, at low population densities, the average yield, in terms of new offspring, due to the energy provided by one cannibalized juvenile is larger than one

Test Characteristics of Urinary Lipoarabinomannan and Predictors of Mortality among Hospitalized HIV-Infected Tuberculosis Suspects in Tanzania.

Tuberculosis is the most common cause of death among patients with HIV infection living in tuberculosis endemic countries, but many cases are not diagnosed pre-mortem. We assessed the test characteristics of urinary lipoarabinomannan (LAM) and predictors of mortality among HIV-associated tuberculosis suspects in Tanzania. We prospectively enrolled hospitalized HIV-infected patients in Dar es Salaam, with ≥2 weeks of cough or fever, or weight loss. Subjects gave 2 mLs of urine to test for LAM using a commercially available ELISA, ≥2 sputum specimens for concentrated AFB smear and solid media culture, and 40 mLs of blood for culture. Among 212 evaluable subjects, 143 (68%) were female; mean age was 36 years; and the median CD4 count 86 cells/mm(3). 69 subjects (33%) had culture confirmation of tuberculosis and 65 (31%) were LAM positive. For 69 cases of sputum or blood culture-confirmed tuberculosis, LAM sensitivity was 65% and specificity 86% compared to 36% and 98% for sputum smear. LAM test characteristics were not different in patients with bacteremia but showed higher sensitivity and lower specificity with decreasing CD4 cell count. Two month mortality was 64 (53%) of 121 with outcomes available. In multivariate analysis there was significant association of mortality with absence of anti-retroviral therapy (p = 0.004) and a trend toward association with a positive urine LAM (p = 0.16). Among culture-negative patients mortality was 9 (75%) of 12 in LAM positive patients and 27 (38%) of 71 in LAM negative patients (p = 0.02). Urine LAM is more sensitive than sputum smear and has utility for the rapid diagnosis of culture-confirmed tuberculosis in this high-risk population. Mortality data raise the possibility that urine LAM may also be a marker for culture-negative tuberculosis

Analytical solution of a model for complex food webs

We investigate numerically and analytically a recently proposed model for food webs [Nature {\bf 404}, 180 (2000)] in the limit of large web sizes and sparse interaction matrices. We obtain analytical expressions for several quantities with ecological interest, in particular the probability distributions for the number of prey and the number of predators. We find that these distributions have fast-decaying exponential and Gaussian tails, respectively. We also find that our analytical expressions are robust to changes in the details of the model.Comment: 4 pages (RevTeX). Final versio