Workplace Violence in Emergency Departments: Addressing Barriers to Reporting Through Education

Background: Workplace violence (WPV) in emergency departments is a national health care concern. Nurses practicing in emergency departments are at greater risk for violence than other health care professionals. Published literature suggests that WPV is underreported because of inadequate understanding of its definition and associated reporting processes, which contributes to a lack of evidence-based interventions to reduce its frequency. Purpose: Consistent utilization of a reporting database can assist in identifying trends in emergency departments’ violence occurrences and subsequent interventions, as reviewed by the organization’s WPV Committee. WPV education was offered with the intent of improving reporting accuracy and promoting better understanding of WPV. The WPV Committee’s lack of engagement was addressed. Methods: Emergency department employees and leaders were offered education on the definition and reporting process of WPV through a free continuing nursing education module. The WPV Committee was simultaneously tasked with updating policies and creating engagement strategies to reduce WPV. Evaluation: Reporting system effectiveness was measured by comparing the frequency of documented occasions of violence before and after an educational intervention. Continuing nursing education pre- and posttest score comparison via paired t test was used to gauge WPV and reporting process knowledge. The WPV Committee’s participation was increased. Clinical Implications: Utilization of a consistent WPV definition and reporting process aided accuracy of incident reports, exemplifying a culture that supports reporting incidents. This practice can inform data-driven interventions, when funneled through the WPV Committee, to reduce WPV, and may contribute to a safer emergency department environment for employees.D.N.P., Nursing Practice -- Drexel University, 201

Conceptually plausible Bayesian inference in interval timing

In a world that is uncertain and noisy, perception makes use of optimization procedures that rely on the statistical properties of previous experiences. A well-known example of this phenomenon is the central tendency effect observed in many psychophysical modalities. For example, in interval timing tasks, previous experiences influence the current percept, pulling behavioural responses towards the mean. In Bayesian observer models, these previous experiences are typically modelled by unimodal statistical distributions, referred to as the prior. Here, we critically assess the validity of the assumptions underlying these models and propose a model that allows for more flexible, yet conceptually more plausible, modelling of empirical distributions. By representing previous experiences as a mixture of lognormal distributions, this model can be parametrized to mimic different unimodal distributions and thus extends previous instantiations of Bayesian observer models. We fit the mixture lognormal model to published interval timing data of healthy young adults and a clinical population of aged mild cognitive impairment patients and age-matched controls, and demonstrate that this model better explains behavioural data and provides new insights into the mechanisms that underlie the behaviour of a memory-affected clinical population

Immune Reconstitution Inflammatory Syndrome and the Influence of T Regulatory Cells: A Cohort Study in the Gambia

The factors associated with the development of immune reconstitution inflammatory syndrome in HIV patients commencing antiretroviral therapy have not been fully elucidated. Using a longitudinal study design, this study addressed whether alteration in the levels of T regulatory cells contributed to the development of IRIS in a West African cohort of HIV-1 and HIV-2 patients. Seventy-one HIV infected patients were prospectively recruited to the study and followed up for six months. The patients were categorized as IRIS or non-IRIS cases following published clinical guidelines. The levels of T regulatory cells were measured using flow cytometry at baseline and all follow-up visits. Baseline cytokine levels of IL-2, IL-6, IFN-(Gamma), TNF-(Alpha), MIP-1(Beta), IL-1, IL-12, IL-13, and IL-10 were measured in all patients

Actin-dependent activation of serum response factor in T cells by the viral oncoprotein tip

Serum response factor (SRF) acts as a multifunctional transcription factor regulated by mutually exclusive interactions with ternary complex factors (TCFs) or myocardin-related transcription factors (MRTFs). Binding of Rho- and actin-regulated MRTF:SRF complexes to target gene promoters requires an SRF-binding site only, whereas MAPK-regulated TCF:SRF complexes in addition rely on flanking sequences present in the serum response element (SRE). Here, we report on the activation of an SRE luciferase reporter by Tip, the viral oncoprotein essentially contributing to human T-cell transformation by Herpesvirus saimiri. SRE activation in Tip-expressing Jurkat T cells could not be attributed to triggering of the MAPK pathway. Therefore, we further analyzed the contribution of MRTF complexes. Indeed, Tip also activated a reporter construct responsive to MRTF:SRF. Activation of this reporter was abrogated by overexpression of a dominant negative mutant of the MRTF-family member MAL. Moreover, enrichment of monomeric actin suppressed the Tip-induced reporter activity. Further upstream, the Rho-family GTPase Rac, was found to be required for MRTF:SRF reporter activation by Tip. Initiation of this pathway was strictly dependent on Tip's ability to interact with Lck and on the activity of this Src-family kinase. Independent of Tip, T-cell stimulation orchestrates Src-family kinase, MAPK and actin pathways to induce SRF. These findings establish actin-regulated transcription in human T cells and suggest its role in viral oncogenesis

Longitudinal assessments of therapeutic alliance predict work performance in vocational rehabilitation for persons with schizophrenia

OBJECTIVES: To promote functional recovery in persons diagnosed with a psychotic disorder, vocational interventions have emerged over the last few decades which range from sheltered employment to supported employment in the community.DESIGN: Using data from a 6-month vocational rehabilitation programme, we examined whether assessments of the therapeutic alliance were related to the quality of work performed in this work placement. Our first hypothesis was that stronger alliances would be related to better work performance. Second, we expected that client assessments of the TA would better predict outcomes than therapist assessments. Third, we expected that the discrepancy between assessment scores from the client and therapist (client rating minus therapist rating) would be a better predictor for outcome than individual assessments by the therapists or clients.RESULTS: Clients systematically rated the alliance higher than therapists. Modelling the data longitudinally, we found both therapist and client ratings predictive of outcome, though client assessments over time were inversely related to work performance.CONCLUSIONS: Discrepancy in scores was also shown to be predictive of work performance during the program. Clinicians are advised to routinely assess the therapeutic alliance from both client and therapist perspectives and calculate the discrepancy between them as they may indicate ruptures are occurring and thus hamper the intervention.PRACTITIONER POINTS: Clinicians are advised to regularly assess the therapeutic alliance from both their own and the client's perspective. Growing discrepancy in scores may impede intervention effectiveness. Therapeutic alliance may help buffer against work stresses experienced by participants in a vocational programme. Be aware that therapists tend to rate the alliance lower than their clients.</p

Clinically suspect arthralgia and rheumatoid arthritis:patients’ perceptions of illness

Objectives: Clinically suspect arthralgia (CSA) is an at-risk stage of rheumatoid arthritis (RA), in which patients experience symptoms and physical limitations. Perceptions of CSA-patients have remained largely unknown. Therefore, we aimed to map perceptions of CSA-patients and compare these to RA-patients. Additionally, we studied changes in perceptions in CSA over time. Methods: Three hundred and ninety-nine consecutively included CSA-patients from the Leiden and Rotterdam CSA-cohorts and 100 recently diagnosed RA-patients from the Leiden Early Arthritis Clinic were included. Patients’ illness perceptions (IP) were assessed using the Brief Illness Perception Questionnaire (BIPQ), consisting of 8 questions (scale 0–10; higher score indicating more negative IP) covering cognitive, emotional and comprehensibility domains, and one open question about causes of disease. IP were measured at baseline in both populations and during 2 years follow-up in the CSA-cohorts. Results: Total BIPQ-scores were comparable at CSA-presentation and RA-diagnosis (40 ± 11 and 40 ± 10; range 0–80). Comparing dimensions separately revealed that CSA-patients were less worried about physical complaints compared to RA-patients. However, CSA-patients were more negative about expected treatment-effect on symptoms. IP over time in CSA improved in patients without development of clinical arthritis (from 38 ± 11 to 34 ± 14; P = 0.005) but remained similar in CSA-patients who progressed to arthritis/RA (mean 40 at both timepoints). CSA-patients mainly perceived physical strain and heredity as causes of their complaints. Conclusions: Although CSA-patients have not developed clinical arthritis, illness perceptions at CSA-presentation and RA-diagnosis are equally severe. Knowledge on worries and expectations may contribute to improving patient-contact and care in patients at risk of RA.</p

Clinically suspect arthralgia and rheumatoid arthritis:patients’ perceptions of illness

Objectives: Clinically suspect arthralgia (CSA) is an at-risk stage of rheumatoid arthritis (RA), in which patients experience symptoms and physical limitations. Perceptions of CSA-patients have remained largely unknown. Therefore, we aimed to map perceptions of CSA-patients and compare these to RA-patients. Additionally, we studied changes in perceptions in CSA over time. Methods: Three hundred and ninety-nine consecutively included CSA-patients from the Leiden and Rotterdam CSA-cohorts and 100 recently diagnosed RA-patients from the Leiden Early Arthritis Clinic were included. Patients’ illness perceptions (IP) were assessed using the Brief Illness Perception Questionnaire (BIPQ), consisting of 8 questions (scale 0–10; higher score indicating more negative IP) covering cognitive, emotional and comprehensibility domains, and one open question about causes of disease. IP were measured at baseline in both populations and during 2 years follow-up in the CSA-cohorts. Results: Total BIPQ-scores were comparable at CSA-presentation and RA-diagnosis (40 ± 11 and 40 ± 10; range 0–80). Comparing dimensions separately revealed that CSA-patients were less worried about physical complaints compared to RA-patients. However, CSA-patients were more negative about expected treatment-effect on symptoms. IP over time in CSA improved in patients without development of clinical arthritis (from 38 ± 11 to 34 ± 14; P = 0.005) but remained similar in CSA-patients who progressed to arthritis/RA (mean 40 at both timepoints). CSA-patients mainly perceived physical strain and heredity as causes of their complaints. Conclusions: Although CSA-patients have not developed clinical arthritis, illness perceptions at CSA-presentation and RA-diagnosis are equally severe. Knowledge on worries and expectations may contribute to improving patient-contact and care in patients at risk of RA.</p