Missed Nursing Care Reported by Medical-Surgical RNs in a Community Hospital

Background: Missed nursing care is defined as any lapse in essential patient care. It is a previously studied, persistent phenomenon. If unrecognized, it can compromise patients’ recoveries, trigger adverse events, and increase healthcare costs. Objectives: To examine the prevalence of missed nursing care reported by medical-surgical registered nurses (RNs) and contributing factors for its occurrence. Methods: The project used a cross-sectional, correlational design. A convenience sample of 96 RNs, recruited from three medical-surgical units, completed the MISSCARE Survey between September and October 2017. An analysis of survey responses quantified the frequency, nature, and common contributing factors for care omissions. The project was set in a small, Northeast, Pathway to Excellence® designated hospital. Results: Fifty-two RNs completed surveys, most who were female (94.2%), held a Bachelor’s in Nursing degree (53.8%), and had 10+ years of work experience (34.6%). Over 1 in 5 respondents reported five nursing tasks were “frequently” or “always” missed: care conferences (46.1%), scheduled ambulation (36.5%), turning (34.6%), monitoring intake and output (23.1%), and timely medications administration (23.1%). Significant contributors to care omissions were: heavy admission/discharge activity (57.7%), fewer assistive personnel (55.8%), staff shortages (50.0%), and unbalanced patient assignments (40.4%). Conclusions: RNs identified the top five missed nursing care items in a small, community hospital and cited patient turnover, labor resource shortages, and unbalanced assignments as key, contributing factors. Inter-professional communication and teamwork effectiveness were not reported as contributing factors. Project results should inform nurse leaders’ efforts to devise interventions to safeguard patients, improve quality, and decrease cost

The Effectiveness of Increasing Frequency of Central-Line Dressing Changes and Monitoring on CLABSI Rates: A Scoping Review

Abstract Purpose/Background Central lines provide many benefits to critically ill patients; however, there are additional risks with them, including central line-associated bloodstream infections (CLABSIs). CLABSIs place patients at increased risk for morbidity and mortality, longer length of stay, and higher medical costs. Studies evaluating various methods of reducing CLABSIs have been performed. This scoping review was completed to determine the effectiveness of frequent central-line dressing changes and increased monitoring on the incidence of central-line associated blood stream infections in adults with central-lines. Methods An extensive database search through the University of Tennessee Health Science Center (UTHSC) Online Library was performed between September of 2019 and November of 2022. EBSCO/CINAHL, PubMed, Cochrane, and Scopus databases were utilized, using key terms: monitoring, CLABSI, dressing changes, central line, infection, bundle care, and central venous catheter. Of the 2,341 articles resulted, 15 articles were chosen based on relevance, results, and quality of the articles. Tables were created to identify levels of evidence and evidence outcomes. Results Out of the fifteen articles selected, eight reported a decrease in CLABSI rates. Many facilities reduced their CLABSI rate while lowering frequency of CVC dressing changes. Increased CVC bundle compliance, CVC surveillance, improved documentation, and use of checklists contribute to these reduced rates, but confound the results. Implications for Nursing Practice The articles revealed that the utilization of CVC surveillance decreased CLABSI rates. It is unclear how the frequency of CVC dressing changes affects CLABSI rate. Most studies failed to mention dressing changes, and when mentioned, the frequency of dressing changes was reduced with continued reduction in CLABSI rate. Further studies isolating these variables is recommended

Metallopanstimulin as a marker for head and neck cancer

BACKGROUND: Metallopanstimulin (MPS-1) is a ribosomal protein that is found in elevated amounts in the sera of patients with head and neck squamous cell carcinoma (HNSCC). We used a test, denoted MPS-H, which detects MPS-1 and MPS-1-like proteins, to determine the relationship between MPS-H serum levels and clinical status of patients with, or at risk for, HNSCC. PATIENTS AND METHODS: A total of 125 patients were prospectively enrolled from a university head and neck oncology clinic. Participants included only newly diagnosed HNSCC patients. Two control groups, including 25 non-smokers and 64 smokers, were studied for comparison. A total of 821 serum samples collected over a twenty-four month period were analyzed by the MPS-H radioimmunoassay. RESULTS: HNSCC, non-smokers, and smokers had average MPS-H values of 41.5 ng/mL, 10.2 ng/mL, and 12.8 ng/mL, respectively (p = 0.0001). CONCLUSION: We conclude that MPS-1 and MPS-1-like proteins are elevated in patients with HNSCC, and that MPS-H appears to be a promising marker of presence of disease and response to treatment in HNSCC patients

The generalised NMSSM at one loop: fine tuning and phenomenology

We determine the degree of fine tuning needed in a generalised version of the NMSSM that follows from an underlying Z4 or Z8 R symmetry. We find that it is significantly less than is found in the MSSM or NMSSM and extends the range of Higgs mass that have acceptable fine tuning up to Higgs masses of mh ~ 130 GeV. For universal boundary conditions analogous to the CMSSM the phenomenology is rather MSSM like with the singlet states typically rather heavy. For more general boundary conditions the singlet states can be light, leading to interesting signatures at the LHC and direct detection experiments.Comment: 20 pages, 9 figures, matches published versio

MRI in multiple myeloma : a pictorial review of diagnostic and post-treatment findings

Magnetic resonance imaging (MRI) is increasingly being used in the diagnostic work-up of patients with multiple myeloma. Since 2014, MRI findings are included in the new diagnostic criteria proposed by the International Myeloma Working Group. Patients with smouldering myeloma presenting with more than one unequivocal focal lesion in the bone marrow on MRI are considered having symptomatic myeloma requiring treatment, regardless of the presence of lytic bone lesions. However, bone marrow evaluation with MRI offers more than only morphological information regarding the detection of focal lesions in patients with MM. The overall performance of MRI is enhanced by applying dynamic contrast-enhanced MRI and diffusion weighted imaging sequences, providing additional functional information on bone marrow vascularization and cellularity. This pictorial review provides an overview of the most important imaging findings in patients with monoclonal gammopathy of undetermined significance, smouldering myeloma and multiple myeloma, by performing a 'total' MRI investigation with implications for the diagnosis, staging and response assessment. Main message aEuro cent Conventional MRI diagnoses multiple myeloma by assessing the infiltration pattern. aEuro cent Dynamic contrast-enhanced MRI diagnoses multiple myeloma by assessing vascularization and perfusion. aEuro cent Diffusion weighted imaging evaluates bone marrow composition and cellularity in multiple myeloma. aEuro cent Combined morphological and functional MRI provides optimal bone marrow assessment for staging. aEuro cent Combined morphological and functional MRI is of considerable value in treatment follow-up

The luminosity function of field galaxies

Schmidt's method for construction of luminosity function of galaxies is generalized by taking into account the dependence of density of galaxies from the distance in the near Universe. The logarithmical luminosity function (LLF) of field galaxies depending on morphological type is constructed. We show that the LLF for all galaxies, and also separately for elliptical and lenticular galaxies can be presented by Schechter function in narrow area of absolute magnitudes. The LLF of spiral galaxies was presented by Schechter function for enough wide area of absolute magnitudes: . Spiral galaxies differ slightly by parameter . At transition from early spirals to the late spirals parameter in Schechter function is reduced. The reduction of mean luminosity of galaxies is observed at transition from elliptical galaxies to lenticular galaxies, to early spiral galaxies, and further, to late spiral galaxies, in a bright end, . The completeness and the average density of samples of galaxies of different morphological types are estimated. In the range the mean number density of all galaxies is equal 0.127 Mpc-3.Comment: 14 page, 8 figures, to appear in Astrophysic

Scaling properties of protein family phylogenies

One of the classical questions in evolutionary biology is how evolutionary processes are coupled at the gene and species level. With this motivation, we compare the topological properties (mainly the depth scaling, as a characterization of balance) of a large set of protein phylogenies with a set of species phylogenies. The comparative analysis shows that both sets of phylogenies share remarkably similar scaling behavior, suggesting the universality of branching rules and of the evolutionary processes that drive biological diversification from gene to species level. In order to explain such generality, we propose a simple model which allows us to estimate the proportion of evolvability/robustness needed to approximate the scaling behavior observed in the phylogenies, highlighting the relevance of the robustness of a biological system (species or protein) in the scaling properties of the phylogenetic trees. Thus, the rules that govern the incapability of a biological system to diversify are equally relevant both at the gene and at the species level.Comment: Replaced with final published versio

Repressing Anarchy in Neutrino Mass Textures

The recent results that $\theta_{13}$ is relatively large, of the order of the previous upper bound, and the indications of a sizable deviation of $\theta_{23}$ from the maximal value are in agreement with the predictions of Anarchy in the lepton sector. The quark and charged lepton hierarchies can then be reproduced in a SU(5) GUT context by attributing non-vanishing $U(1)_{FN}$ charges, different for each family, only to the SU(5) tenplet states. The fact that the observed mass hierarchies are stronger for up quarks than for down quarks and charged leptons supports this idea. As discussed in the past, in the flexible context of $SU(5)\otimes U(1)_{FN}$, different patterns of charges can be adopted going from Anarchy to various types of hierarchy. We revisit this approach by also considering new models and we compare all versions to the present data. As a result we confirm that, by relaxing the extreme ansatz of equal $U(1)_{FN}$ charges for all SU(5) pentaplets and singlets, better agreement with the data than for Anarchy is obtained without increasing the model complexity. We also present the distributions obtained in the different models for the Dirac CP-violating phase. Finally we discuss the relative merits of these simple models.Comment: v1: 12 pages, 3 figures; v2: 13 pages, 3 figures, text improved, matches version accepted for publication; v3: submitted to add an acknowledgment to a networ