P12. The Influence of Leader-Member Exchange and Structural Empowerment on Nurses Perception of Patient Safety Climate

Background: Reports have illustrated the lack of supportive and inclusive work environments is a causative factor of health related absences and nursing attrition. This has been reported to lead to increased risk to nurses’ safety, patients’ safety and poorer patient outcomes. Methods: The purpose of this study is to examine the impact of the four dimensions of Leader-Member Exchange (LMX) (contribution, affect, loyalty, and professional respect) of nurse managers and access to the four structures of structural empowerment (SE) (support, opportunity, resources, and information) on nurses’ perceptions of patient safety climate (PSC). A cross-sectional survey is conducted using a random sample of 230 nurses across Ontario in acute care settings. Leader-Member Exchange-MDM, Conditions for Work Effectiveness Questionnaire-II, and Patient Safety Climate Questionnaire are used to measure study variables. Results: No specific research has examined the influence of LMX, and structural empowerment, on patient safety climate. This research proposal will meet the needs of the gap identified within the literature. Currently data is collected and waiting for analysis. Discussion & Conclusion: This study may uncover some of the processes by which each of these variables influences the next. Interdisciplinary Reflection: This study targets nursing leaders in front-line managerial positions, possibly increasing their awareness of SE allowing them to develop a more positive working environment on their unit that will lead to increased productivity and increased patient safety. Middle and upper management will be interested in these findings to examine positive influences to LMX and developing strategies and training to be provided to front-line managers to enhance a PSC

Factors Affecting Nurses’ Job Satisfaction in Rural and Urban Acute Care Settings: A PRISMA Systematic Review

This review aims to systemically describe the findings of primary studies in order to identify the intrinsic and extrinsic factors that affect nurses’ job satisfaction using PRISMA guidelines. It also aims to analyze the finding according to the two-factor theory; and compare studies based on rural and urban settings. Two reviewers completed study selection, screening, and quality assessment. After data extraction, content analysis was used to categorize identified factors into themes. Thirty-eight studies were selected for this review. Extrinsic factors reported in the findings were: work conditions (n=17), monetary benefits (n=5), hospital policies (n=6), supervision (n=7), interpersonal relationships (n=8), organization culture and emotional display norms in the organization (n=2), job security (n=1), and professional status (n=2). Intrinsic factors reported in review were responsibility (n=9), growth and advancement (n= 7), psychological demands (n=2), recognition (n=2), and job achievement (n=1). Furthermore, personal factors were classified into demographic variables, and behavioral/emotional factors and each of them reported in seven studies. Two studies reported community factors. Twenty-two studies reported the hospital location. Urban studies focused on extrinsic factors while there was more balance in rural studies. There have been many published studies discuss the factors associated with nurses’ job satisfaction. However, more studies are needed to examine the impact of intrinsic and extrinsic factors on nurses’ job satisfaction using more robust research methodology especially in rural and urban context. The two-factor theory can be used to provide conceptual clarity regarding the impact of intrinsic and extrinsic factors on job satisfaction

Hypertensive eye disease

Hypertensive eye disease includes a spectrum of pathological changes, the most well known being hypertensive retinopathy. Other commonly involved parts of the eye in hypertension include the choroid and optic nerve, sometimes referred to as hypertensive choroidopathy and hypertensive optic neuropathy. Together, hypertensive eye disease develops in response to acute and/or chronic elevation of blood pressure. Major advances in research over the past three decades have greatly enhanced our understanding of the epidemiology, systemic associations and clinical implications of hypertensive eye disease, particularly hypertensive retinopathy. Traditionally diagnosed via a clinical funduscopic examination, but increasingly documented on digital retinal fundus photographs, hypertensive retinopathy has long been considered a marker of systemic target organ damage (for example, kidney disease) elsewhere in the body. Epidemiological studies indicate that hypertensive retinopathy signs are commonly seen in the general adult population, are associated with subclinical measures of vascular disease and predict risk of incident clinical cardiovascular events. New technologies, including development of non-invasive optical coherence tomography angiography, artificial intelligence and mobile ocular imaging instruments, have allowed further assessment and understanding of the ocular manifestations of hypertension and increase the potential that ocular imaging could be used for hypertension management and cardiovascular risk stratification

The relationship between Lp(a) and CVD outcomes: a systematic review

Summary of QUIPS quality assessment domains (60 studies). (DOCX 54 kb

Really Underage Drinkers: Alcohol Use Among Elementary Students

Despite the current societal concern with underage drinking, little attention has been paid to alcohol use within the preadolescent population. This article presents the proceedings of a symposium held at the 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida, that was organized and chaired by John E. Donovan. The intent of the symposium was to kick start research on alcohol use among elementary school children by reviewing what is known regarding drinking in childhood. Presentations included (1) The Epidemiology of Children's Alcohol Use, by John E. Donovan; (2) The Validity of Children's Self-Reports of Alcohol Use, by Sharon L. Leech; (3) Predicting Onset of Drinking From Behavior at Three Years of Age: Influence of Early Child Expectancies and Parental Alcohol Involvement Upon Early First Use, by Robert A. Zucker; and (4) Parent, Peer, and Child Risk Factors for Alcohol Use in Two Cohorts of Elementary School Children, by Carol J. Loveland-Cherry. Presentations indicated the need for better nationwide surveillance of children's experience with alcohol; suggested that children's reports of their use of alcohol tend to be reliable and valid; supported children's alcohol use schemas and parental drinking and alcoholism at child age three as independent predictors of early onset drinking; and showed that onset of drinking before fourth or fifth grade, peer pressure, and parental norms and monitoring predict elementary student alcohol use and misuse.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/65944/1/01.ALC.0000113922.77569.4E.pd

Reliability and Determinants of Retinal Vessel Oximetry Measurements in Healthy Eyes

METHODS. Subjects older than 40 years without a history of stroke and heart disease were recruited from a community-based clinic. Subjects underwent standardized systemic and ocular examinations. Normal eyes were defined as eyes without major eye diseases such as age-related macular degeneration, glaucoma, or retinopathy. Retinal vessel oximetry levels were measured by using the Oxymap T1 Retinal Oximeter. Intra-and intergrader reliability of retinal vessel oximetry measurements were assessed by using 50 images. Intravisit repeatability of retinal vessel oximetry measurements was assessed by using 20 paired images. Univariable linear regression was performed to examine the associations between retinal vessel oximetry measurements and systemic determinants. CONCLUSIONS. The Oxymap Retinal Oximeter allows reliable and repeatable retinal vessel oximetry measurements. Age is the main factor that influences retinal venular oximetry levels and should be taken into account when retinal oximetry measurements are interpreted

Clinicopathologic Features of Primary Merkel Cell Carcinoma: A Detailed Descriptive Analysis of a Large Contemporary Cohort

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98776/1/dsu12194.pd

The impact of factors beyond Breslow depth on predicting sentinel lymph node positivity in melanoma

BACKGROUND. In addition to Breslow depth, the authors previously described how increasing mitotic rate and decreasing age predicted sentinel lymph node (SLN) metastases in patients with melanoma. The objectives of the current study were to verify those previous results and to create a prediction model for the better selection of which patients with melanoma should undergo SLN biopsy. METHODS. The authors reviewed 1130 consecutive patients with melanoma in a prospective database who underwent successful SLN biopsy. After eliminating patients aged <16 years and patients who had melanomas that measured <1 mm, 910 remaining patients were reviewed for clinical and pathologic features and positive SLN status. Univariate association of patient and tumor characteristics with positive SLN status was explored by using standard logistic regression techniques, and the best multivariate model that predicted lymph node metastases was constructed by using a backward stepwise-elimination technique. RESULTS. The characteristics that were associated significantly with lymph node metastasis were angiolymphatic invasion, the absence of regression, increasing mitotic rate, satellitosis, ulceration, increasing Breslow depth, decreasing age, and location (trunk or lower extremity compared with upper extremity or head/neck). Previously reported interactions between mitotic rate and age and between Breslow depth and age were confirmed. The best multivariate model included patient age (linear), angiolymphatic invasion, the number of mitoses (linear), the interaction between patient age and the number of mitoses, Breslow depth (linear), the interaction between patient age and Breslow depth, and primary tumor location. CONCLUSIONS. Younger age, increasing mitotic rate (especially in younger patients), increasing Breslow depth (especially in older patients), angiolymphatic invasion, and trunk or lower extremity location of the primary tumor were associated with a greater likelihood of positive SLN status. The current results support the use of factors beyond Breslow depth to determine the risk of positive SLN status in patients with cutaneous melanoma. Cancer 2007. © 2006 American Cancer SocietyPeer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/55870/1/22382_ftp.pd