Impact of physical and psychological factors on health-related quality of life in adult patients with liver cirrhosis: a systematic review protocol

REVIEW QUESTION/OBJECTIVE: What is the impact of physical and psychological factors on health-related quality of life in adult patients diagnosed with liver cirrhosis?BACKGROUND: All chronic liver diseases stimulate a degree of repetitive hepatocyte injury that alters the normal liver architecture and ends in cirrhosis.Liver cirrhosis and hepatocellular carcinoma secondary to livercirrhosis are a major public health burden, reporting increasing mortality and morbidity both in Australia and globally.The four leading causes of cirrhosis include harmful alcohol consumption, viral hepatitis B and C and metabolic syndromes related to non-alcoholic fatty liver disease and obesity.A cirrhotic liver is characterized by the presence of regenerative nodules surrounded by fibrous bands that inhibit the passing of molecules between blood and functional units of liver hepatocytes, leading to liver dysfunction.Additionally, the presence of fibrous bands disrupts the normal vascular architecture, increasing resistance within the liver sinusoids and contributing to increased portal vein pressure.The early stages of cirrhosis are referred to as compensated liver disease with no reported symptoms or evidence of impaired liver function.However, the signs and symptoms of liver failure, as well as the mortality rate, increase as the severity of cirrhosis increases.Transition from compensated to decompensated cirrhosis is marked by one or more physiological changes. The physiological changes include increased portal vein pressure, impaired synthetic function, electrolyte imbalance and malnourishment.These physiological changes trigger the development of physical signs and symptoms and impact on the psychological wellbeing of the individual living with cirrhosis. The physical signs and symptoms include esophageal varices, ascites, hepatic encephalopathy, jaundice, irregular sleep patterns, muscle cramps, pruritus, fatigue, impaired mobility, breathlessness, abdominal discomfort, gastrointestinal symptoms, change of body image and pitting edema.Psychological symptoms include stress, depression and anxiety.Living with liver cirrhosis has a marked impact on the quality of life of the individual. Health-related quality of life (HRQOL) is the individual's perception of their physical, cognitive, emotional and social functioning.Studies report that physical and psychological factors affect the quality of life of patients with cirrhosis which can be problematic and debilitating.There is strong evidence which indicates that disease severity is associated with an impairment of the patient's HRQOL.For example, gross ascites causes abdominal discomfort, breathlessness, increased stress and anxiety related to body image, immobility and an increased likelihood of falls. In addition, the management of ascites involves frequent invasive procedures, an increase in pill burden and implementation of dietary restrictions, all of which impact on HRQOL.Despite the clear relationship between HRQOL and severity of disease, there has been no systematic review undertaken to determine the physical, psychological and physiological factors that affect the HRQOL of patients with liver cirrhosis. This systematic review will therefore identify the best available evidence related to the impact of physical, psychological and physiological factors on the health-related quality of life of adult patients with liver cirrhosis. The results of the review will increase clinicians' knowledge and highlight areas of clinical management that may require additional strategies and treatment plans to improve symptom relief and HRQOL

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

Comparative Study of 3-Dimensional Woven Joint Architectures for Composite Spacecraft Structures

The National Aeronautics and Space Administration (NASA) Exploration Systems Mission Directorate initiated an Advanced Composite Technology (ACT) Project through the Exploration Technology Development Program in order to support the polymer composite needs for future heavy lift launch architectures. As an example, the large composite structural applications on Ares V inspired the evaluation of advanced joining technologies, specifically 3D woven composite joints, which could be applied to traditionally manufactured barrel segments. Implementation of these 3D woven joint technologies may offer enhancements in damage tolerance without sacrificing weight. However, baseline mechanical performance data is needed to properly analyze the joint stresses and subsequently design/down-select a preform architecture. Six different configurations were designed and prepared for this study; each consisting of a different combination of warp/fill fiber volume ratio and preform interlocking method (z-fiber, fully interlocked, or hybrid). Tensile testing was performed for this study with the enhancement of a dual camera Digital Image Correlation (DIC) system which provides the capability to measure full-field strains and three dimensional displacements of objects under load. As expected, the ratio of warp/fill fiber has a direct influence on strength and modulus, with higher values measured in the direction of higher fiber volume bias. When comparing the z-fiber weave to a fully interlocked weave with comparable fiber bias, the z-fiber weave demonstrated the best performance in two different comparisons. We report the measured tensile strengths and moduli for test coupons from the 6 different weave configurations under study

Cosmetische rostrale neusreconstructie na plaveiselcelcarninoomresectie bij twee honden

Two male Golden retrievers, each one about ten years old, were presented with a visible mass in the nose, showing symptoms of sneezing and epistaxis. The histopathological examination of biopsies indicated that both dogs were affected by a squamous cell carcinoma. Further staging did not reveal any indications for metastases. Surgical removal of the tumor through a planectomy or nosectomy was proposed. Since the classical removal of the nose was cosmetically unacceptable for the owners of both dogs, a rostral nose reconstruction was opted for in both cases. As the tumor in the first dog was rather superficial, resection of the cartilaginous part of the nose (planectomy) turned out to be sufficient. In the second dog however, there was also evidence of bony involvement. Therefore, not only the nose but also the os incisiva was removed (nosectomy). In both cases, remission of the tumor was obtained after a 35 and 29 months follow-up, respectively, accompanied by an excellent cosmetic result

Nature of Viscoelasticity in Lamellar Block Copolymers: Contraction Correlated to Strain Localization

We determined the local strain profile in sheared lamellar block copolymers. A trilayer model, based on elastic brushes separated by viscous interpenetration zones, captures the rheological response of these materials and provides a measure of the relative contributions of elastic versus viscous strain. The elastic chain distortions were evident from a reversible lamellar contraction, as measured from in situ small-angle x-ray scattering. The contraction was directly correlated to the elastic strain from our trilayer model; three distinct diblock copolymers conform to the predicted relationship, thus suggesting universal behavior