Satisfaction and journalism: a study of newsroom happiness and its implications in print design

Title from PDF of title page (University of Missouri--Columbia, viewed on March 8, 2013).The entire thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file; a non-technical public abstract appears in the public.pdf file.Thesis advisor: Dr. Timothy VosIncludes bibliographical references.M.A. University of Missouri--Columbia 2012."December 2012"The implementation of news design studios has sparked questions among news professionals. Little research has been done about the removal of the designers from the newsroom, and this could be some of the first academic work. This study used 10 semi-structured interviews with print designers to investigate what facets of job satisfaction designers in newsrooms and news design studios derive. Two sets of attitudes were found, but the difference was driven by whether the designer self-identified as a journalist, not necessarily from the organizational structure the designer worked in. Seven of the ten designers self-identified as journalists, and they valued the quality of the whole newspaper, content creation and how their work impacted readers. They also felt collaboration produced the highest quality. Three of the ten designers did not self-identify as journalists. They focused on creative freedom and using artistic elements to tell the story. These findings provided further evidence that designers who self-identified as journalists shared similar facets of satisfaction as other journalists. By identifying what the designers value, the designers and newspaper editors can determine if they share expectations on job responsibilities and quality

GASTRIC REFLUX IN MECHANICALLY VENTILATED GASTRIC FED ICU PATIENTS

Background: Reflux of gastric contents in gastric fed patients is a contributor to pulmonary aspiration. Aspiration events are reported in approximately 50-75% of patients with endotracheal tubes. Aspiration of oral and gastric secretions in ventilated patients is a major cause of ventilator associated pneumonia (VAP). Guidelines that recommend head of bed (HOB) elevation greater than 30◦ to prevent reflux, aspiration and VAP conflict with guidelines to prevent pressure ulcers which recommend HOB elevation no greater than 30◦. Studies are lacking on direct comparison of HOB elevation at 30◦and 45◦ for reflux, aspiration and pressure ulcer outcomes simultaneously. Esophageal probe pH measures are used to detect reflux. No studies have examined the predictive relationship of reflux and aspiration in mechanically ventilated gastric fed patients or the role of pH measurement at the bedside with pH paper to detect gastric reflux. Purpose: This study had 6 aims: 1) To describe the frequency and duration to which patients¡¯ HOB angles are temporarily lowered for treatment purposes below 30◦ or below 45◦, 2) To describe the occurrence of reflux (pepsin-positive oral secretions) and aspiration (pepsin-positive tracheal secretions) with HOB elevation at 30◦ and 45◦, 3) To determine the association between reflux and aspiration with the 2 different HOB elevations in adult intensive care unit (ICU) mechanically ventilated gastric fed patients, 4) To determine the association between a temporarily lowered HOB position for treatment purposes and reflux of gastric contents, 5) To determine the association between 7 patient characteristics (gender, age, body mass index, gastric residual volume, sedation level, disease severity, and use of prokinetic agents) and reflux, 6) To determine the association between the pH (range 0-14) of oral secretions and pepsin presence in oral secretions. Methodology: Human Research Protection Office approval was obtained. Consent was acquired from patient surrogates the day prior to enrollment in the study. A randomized 2-day crossover trial was conducted in a surgical and medical ICU. Mechanically ventilated gastric fed subjects were randomly assigned to 1 of the 2 HOB elevation sequences, HOB 30◦ for 12 hours (hrs) on day 1 and 45◦ for 12 hrs on day 2 or HOB at 45◦ for 12 hrs on day 1 and 30◦ for 12 hrs on day 2. A HOB measurement device stored HOB angles every 30 seconds over the 36 hrs. Subject preferences for positioning for comfort were considered and HOB was lowered at any time by clinicians as the clinical situation warranted or during procedures and diagnostic tests. Usual care for the elevation of the HOB was considered 30◦ and experimental was 45◦. Oral secretions were obtained hourly or as needed and tracheal secretions every 2 hrs or as needed. All samples of oral secretions were examined for the presence of pepsin and pH measurement. Subjects were repositioned every 2 hrs as their condition allowed. Skin assessment of sacral/coccyx and greater trochanter areas were assessed for pressure ulcers every 2 hrs with each reposition. Data were analyzed using Wilcoxon Signed Rank Tests, Friedman tests for repeated measures and Kendall¡¯s tau correlations. Results: Fifteen subjects were enrolled; 11 subjects completed both days, 4 subjects had partial data collection due to endotracheal tube removal. The total number of hrs was 150 hrs at 30◦ and 160 hrs at 45◦. No subjects developed pressure ulcers per National Pressure Ulcer Advisory Panel staging guidelines. Subjects were maintained at 30◦ for 96% of possible minutes and at 45◦ for 77% of possible minutes (p = .035). The mean HOB angle when lowered was 8.2◦ in the 30◦ condition and 19.4◦ in the 45◦ condition (p = .008). Subjects¡¯ HOB angles were lowered 66 times (mean = 4.7/patient) in the 30◦ hrs and 76 times (mean = 5/patient) in the 45◦ hrs. Overall mean angle for HOB was 30◦ for usual care hrs and 39◦ for the experimental hrs. A total of 188 oral secretions were obtained, 106 (56%) were pepsin-negative and 82 (44%) were pepsin-positive. A total of 174 tracheal secretions were obtained, 66 (38%) were pepsin-negative and 108 (62%) were pepsin-positive. No significant association was found with the minutes the HOB was lowered or the mean angle when lowered and percent pepsin-positive oral secretions. Mean HOB angle on each day was significantly negatively correlated with percent pepsin-positive oral secretions. The mean percent of pepsin-positive oral secretions was not significantly higher (p=.108) at 30◦ HOB elevation (48.4 ¡À 31.3) compared to 45◦ HOB elevation (32.3 ¡À 33.2). The mean percent of pepsin-positive tracheal secretions was not significantly higher (p = .366) at 30◦ HOB elevation (69.4 ¡À 33.8) than 45◦ HOB elevation (62.5 ¡À 34.5). The median frequency that oral secretions were obtained, (mean, SD, median) 8.5 ¡À 3.6, 9.5 at 30◦ and 5.7 ¡À 3.2, 5, at 45◦, was significantly lower at 45◦ (p = .035). The only significant patient characteristic in relationship to the percent of pepsin-positive oral secretions was deeper sedation. No relationship between reflux and aspiration or pH measures and reflux were found. Conclusions: With the cross over design of 15 subjects, the number of oral and tracheal specimens collected provided over 360 samples. Lower mean HOB angles as well as deeper sedation levels were associated with a significantly higher frequency of reflux. Results of this study provide evidence that HOB positioning 30◦ is feasible and superior to HOB ¡Ü 30◦ in mechanically ventilated gastric fed ICU patients to reduce reflux and aspiration without development of pressure ulcers

Heparin versus 0.9% sodium chloride intermittent flushing for prevention of occlusion in central venous catheters in adults

Background Heparin intermittent flushing is a standard practice in the maintenance of patency in central venous catheters. However, we could find no systematic review examining its effectiveness and safety. Objectives To assess the effectiveness of intermittent flushing with heparin versus 0.9% sodium chloride (normal saline) solution in adults with central venous catheters in terms of prevention of occlusion and overall benefits versus harms. Search methods The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched December 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2013, Issue 11). Searches were also carried out in MEDLINE, EMBASE, CINAHL and clinical trials databases (December 2013). Selection criteria Randomised controlled trials (RCTs) in adults 18 years of age and older with a central venous catheter (CVC) in which intermittent flushing with heparin (any dose with or without other drugs) was compared with 0.9% normal saline were included. No restriction on language was applied. Data collection and analysis Two review authors independently selected trials, assessed trial quality and extracted data. Trial authors were contacted to retrieve additional information, when necessary. Main results Six eligible studies with a total of 1433 participants were included. The heparin concentrations used in these studies were very different (10-5000 IU/mL), and follow-up varied from 20 days to 180 days. The overall risk of bias in the studies was low. The quality of the evidence ranged from very low to moderate for the main outcomes (occlusion of CVC, duration of catheter patency, CVC-related sepsis, mortality and haemorrhage at any site). Combined findings from three trials in which the unit of analysis was the catheter suggest that heparin was associated with reduced CVC occlusion rates (risk ratio (RR) 0.53, 95% confidence interval (CI) 0.29 to 0.94). However, no clear evidence of a similar effect was found when the results of two studies in which the unit of analysis was the participant were combined (RR 0.21, 95% CI 0.03 to 1.70), nor when findings were derived from one study, which considered total line accesses (RR 1.08, 95% CI 0.84 to 1.40). Furthermore, results for other estimated effects were found to be imprecise and compatible with benefit and harm: catheter duration in days (mean difference (MD) 0.41, 95% CI -1.29 to 2.12), CVC-related thrombosis (RR 1.22, 95% CI 0.74 to 1.99), CVC-related sepsis (RR 1.02, 95% CI 0.34 to 3.03), mortality (RR 0.77, 95% CI 0.45 to 1.32) and haemorrhage at any site (RR 1.37, 95% CI 0.49 to 3.85). Authors' conclusions We found no conclusive evidence of important differences when heparin intermittent flushing was compared with 0.9% normal saline flushing for central venous catheter maintenance in terms of efficacy or safety. As heparin is more expensive than normal saline, our findings challenge its continued use in CVC flushing outside the context of clinical trials

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat