Nursing workload and staff allocation in an Italian hospital: a quality improvement initiative based on nursing care score

Aim: To develop, implement, and evaluate a Nursing Care Score (NCS) system, built into the electronic health record, to optimize nursing workload and staff allocation. Design: A quality improvement (QI) initiative with a pre- and post-implementation design was conducted by an interprofessional team in the 33-bed cardio-thoracic unit of a 72-bed hospital in Palermo, Italy. Methods: A seven-phase process was used to develop, implement, and evaluate the NCS, which lists 53 nursing work tasks, each assigned a score from 1.5 to 5.0. The nurse-to-patient ratio on all shifts was determined by the NCS. Nurse satisfaction with both the existing system and the NCS workload system was assessed. Descriptive statistics and McNemar's test were used to analyze the data. Results: At pre-implementation, 92.5% of nurses reported that the existing system was not effective, 87.5% reported it did not enable them to provide adequate nursing care, and 20.0% believed that workload was fairly distributed. At post-implementation, 75.0% of nurses reported that the NCS system was effective (p = 0.0348), 85.0% reported that the NCS system enabled them to provide adequate care, and 85.0% believed that workload was fairly distributed. An NCS score of 65 ± 5 was found to distribute workload most fairly. Conclusion: An automatic electronic operating system to generate a daily workload report based on the NCS was successfully implemented and evaluated. The NCS provided relevant information to guide nurse managers in defining nurse-to-patient ratio and determining staff allocation. Nurses were satisfied with the NCS system. The steps used to develop, implement, and evaluate the NCS system may be transferable to other units and other hospitals

Review of nutrient actions on age-related macular degeneration

The actions of nutrients and related compounds on age-related macular degeneration (AMD) are explained in this review. The findings from 80 studies published since 2003 on the association between diet and supplements in AMD were reviewed. Antioxidants and other nutrients with an effect on AMD susceptibility include carotenoids (lutein and zeaxanthin, β-carotene), vitamins (vitamin A, E, C, D, B), mineral supplements (zinc, copper, selenium), dietary fatty acids [monounsaturated fatty acids, polyunsaturated fatty acids (PUFA both omega-3 PUFA and omega-6 PUFA), saturated fatty acids and cholesterol], and dietary carbohydrates. The literature revealed that many of these antioxidants and nutrients exert a protective role by functioning synergistically. Specifically, the use of dietary supplements with targeted actions can provide minimal benefits on the onset or progression of AMD; however, this does not appear to be particularly beneficial in healthy people. Furthermore, some supplements or nutrients have demonstrated discordant effects on AMD in some studies. Since intake of dietary supplements, as well as exposure to damaging environmental factors, is largely dependent on population habits (including dietary practices) and geographical localization, an overall healthy diet appears to be the best strategy in reducing the risk of developing AMD. As of now, the precise mechanism of action of certain nutrients in AMD prevention remains unclear. Thus, future studies are required to examine the effects that nutrients have on AMD and to determine which factors are most strongly correlated with reducing the risk of AMD or preventing its progression

Nursing workload and staff allocation in an Italian hospital: a quality improvement initiative based on nursing care score

Aim: To develop, implement, and evaluate a Nursing Care Score (NCS) system, built into the electronic health record, to optimize nursing workload and staff allocation. Design: A quality improvement (QI) initiative with a pre- and post-implementation design was conducted by an interprofessional team in the 33-bed cardio-thoracic unit of a 72-bed hospital in Palermo, Italy. Methods: A seven-phase process was used to develop, implement, and evaluate the NCS, which lists 53 nursing work tasks, each assigned a score from 1.5 to 5.0. The nurse-to-patient ratio on all shifts was determined by the NCS. Nurse satisfaction with both the existing system and the NCS workload system was assessed. Descriptive statistics and McNemar's test were used to analyze the data. Results: At pre-implementation, 92.5% of nurses reported that the existing system was not effective, 87.5% reported it did not enable them to provide adequate nursing care, and 20.0% believed that workload was fairly distributed. At post-implementation, 75.0% of nurses reported that the NCS system was effective (p = 0.0348), 85.0% reported that the NCS system enabled them to provide adequate care, and 85.0% believed that workload was fairly distributed. An NCS score of 65 ± 5 was found to distribute workload most fairly. Conclusion: An automatic electronic operating system to generate a daily workload report based on the NCS was successfully implemented and evaluated. The NCS provided relevant information to guide nurse managers in defining nurse-to-patient ratio and determining staff allocation. Nurses were satisfied with the NCS system. The steps used to develop, implement, and evaluate the NCS system may be transferable to other units and other hospitals

Fate of Escherichia coli artificially inoculated in Tenebrio molitor L. larvae rearing chain for human consumption

The edible insect food chain represents a relatively novel food-producing system; hence, associated biological risks still need to be exhaustively evaluated. In the present study, the dynamics of Escherichia coli during the whole living period of Tenebrio molitor larvae (from eggs to pupae) were studied. To this end, a rearing substrate consisting of organic wheat middlings was spiked with E. coli cells at two initial contamination levels: 1 log cfu g-1 (low) and 6 log cfu g-1 (high). Microbial viability counting coupled with metataxonomic analyses was used to assess i) the persistence and growth of E. coli in the rearing substrate (wheat middlings); ii) the colonization and growth of E. coli in the insect larvae; and iii) the occurrence and load of E. coli in the frass (excrement from larvae mixed with substrate residues). The results highlighted a very limited persistence of the pathogen in all analyzed samples. In more detail, the results suggested that when E. coli was present at very low levels in the eggs of the insect, the pathogen was not able to reach concerning levels in the larvae. Moreover, when E. coli was present in the wheat middlings used for rearing, the environmental conditions of the substrate (low aw values) were not favorable for its survival and multiplication, irrespective of the presence of the larvae and their frass. Surprisingly, under the conditions applied in the present study, the larvae fed wheat middlings contaminated with E. coli seemed to be inhospitable or even hostile environments for microbial survival or multiplication. To explain the low levels of E. coli cells in the larvae reared in the present study, many factors can be considered, including the immune response of the host, microbial composition and interactions established in the gut of larvae, and insect species. Of note, part of the major fraction of the microbiota of larvae at the end of rearing was represented by Lactococcus, thus suggesting a possible effect of this lactic acid bacterium on E. coli decay. Further research is needed to better clarify the interactions between E. coli and the insect gut, as well as the interactions established among the target microorganism and those naturally harbored by the insect gut

Staphylococcus aureus artificially inoculated in mealworm larvae rearing chain for human consumption: Long-term investigation into survival and toxin production

The present research reports the results of a long-term study (70 days) of the dynamics of Staphylococcus aureus artificially inoculated in a Tenebrio molitor rearing chain for human consumption. To this end, a rearing substrate consisting of organic wheat middlings was spiked with S. aureus to obtain three initial contamination levels, namely 1 (low level), 5 (medium level) and 7 (high level) Log colony forming unit per gram. Microbial viable counting coupled with metataxonomic analysis were performed to evaluate: i) the persistence and growth of S. aureus in the rearing substrate; ii) the colonization and growth of S. aureus in the insect larvae; iii) the occurrence and load of S. aureus in the frass (excrement from larvae mixed with substrate residues); iv) the presence of S. aureus enterotoxins in the rearing substrate, frass, and larvae. The results of the present study highlighted that wheat middlings contaminated with S. aureus do not represent a suitable environment for the multiplication of the pathogen, irrespective of the initial contamination level. Of note, frass originated from the larvae reared on contaminated wheat middlings might potentially represent a source of S. aureus, with cell loads depending on the initial contamination level. A complex resident microbiota was revealed by metataxonomic analysis. Interestingly, co-occurrence/co-exclusions analysis did not reveal associations between the target microorganism and the microbiota of wheat middlings, larvae, or frass. Considering safety aspects of larvae, the results overall collected suggested that, under the applied conditions, T. molitor represents an inhospitable or even hostile environment for S. aureus, with this latter showing counts below the detection limit in the larvae at the end of the 70-day rearing trial, irrespective of the initial contamination level. The results also suggested that a combination of bactericidal factors, including unfavorable environmental conditions (such as low aw of wheat middlings and frass), might have established in the rearing chain. Finally, the absence of staphylococcal toxins suggests that, even when S. aureus is present at high contamination levels, it is not able to produce toxins in wheat middlings, larvae, or frass