The personality characteristics of emergency nurses

Background: There are ever increasing demands on the emergency nursing workforce so it is necessary to consider how to enhance the recruitment and retention of emergency nurses. Personality is known to influence occupational choice, yet there is a lack of research exploring how personality may influence the workforce decisions of emergency nurses. Aims: To establish the personality profile of a sample of emergency nurses, and to explore whether any relationship exists between their personality characteristics and time spent working within emergency nursing. Methods: A standardised personality assessment instrument, the NEO™-PI-3, was used along with a demographic survey. Data were collected from 72 emergency nurses in an Australian Emergency Department between July and October 2012. Descriptive statistics were used to report demographics and the personality assessment results were compared against general population norms in each of the five personality domains and their 30 associated facets using a one-sample t-test. A two-sided alpha level of .01 was determined to indicate statistical significance. Results: Emergency nurse participants scored higher than the population norms in the domains of extraversion, openness to experience and agreeableness, and in twelve facets, including excitement seeking, vulnerability and competence. Conclusion: The personality profile of this sample of emergency nurses is different from the established population norms. Further research is required to establish whether these study results are applicable to the wider emergency nurse workforce and to establish any link with personality and other nursing specialty choice, which may assist in improving nursing workforce retention and recruitment

Identifying risk factors for COPD and adult-onset asthma: an umbrella review

BACKGROUND: COPD and adult-onset asthma (AOA) are the most common noncommunicable respiratory diseases. To improve early identification and prevention, an overview of risk factors is needed. We therefore aimed to systematically summarise the nongenetic (exposome) risk factors for AOA and COPD. Additionally, we aimed to compare the risk factors for COPD and AOA. METHODS: In this umbrella review, we searched PubMed for articles from inception until 1 February 2023 and screened the references of relevant articles. We included systematic reviews and meta-analyses of observational epidemiological studies in humans that assessed a minimum of one lifestyle or environmental risk factor for AOA or COPD. RESULTS: In total, 75 reviews were included, of which 45 focused on risk factors for COPD, 28 on AOA and two examined both. For asthma, 43 different risk factors were identified while 45 were identified for COPD. For AOA, smoking, a high body mass index (BMI), wood dust exposure and residential chemical exposures, such as formaldehyde exposure or exposure to volatile organic compounds, were amongst the risk factors found. For COPD, smoking, ambient air pollution including nitrogen dioxide, a low BMI, indoor biomass burning, childhood asthma, occupational dust exposure and diet were amongst the risk factors found. CONCLUSIONS: Many different factors for COPD and asthma have been found, highlighting the differences and similarities. The results of this systematic review can be used to target and identify people at high risk for COPD or AOA

Phenotyping of asthma by multidimensional analysis : Focus on peripheral blood characteristics of severe asthma patients

In this thesis the activation state of blood eosinophils and neutrophils was discovered to contribute significantly to the diagnostic accuracy of a quick and low-invasive test for eosinophilia asthma. In patients with eosinophilic airway inflammation, blood eosinophils are more refractory to stimulation with fMLF. A multi-dimensional reduction approach based on Non-linear PCA reduced dimensions of cellular and clinical parameters, making use of the multivariate advantage. Subsequent Discriminant Analysis of PCA scores of the Utrecht asthma cohort lead to a prediction model that was validated by the independently measured Oxford cohort of asthma patients. In contrast to blood, sputum eosinophils and neutrophils were found to be overall highly activated, independent of the asthma phenotype being eosinophilic or non-eosinophilic. Hence, sputum eosinophil and neutrophil activation do not have diagnostic value for asthma phenotypes. In the subsequent two chapters, the MFC analysis method FLOOD was described. FLOOD identifies and describes subpopulations of cells that are changed or mobilized as a result of a stimulus. FLOOD showed its potential in the human LPS challenge study by clearly visualizing two subpopulations in an unsupervised fashion that were already known to be present but were not yet described in so much detail regarding specific receptor profile. FLOOD also identified exercise-associated neutrophils in elite rowers after intense anaerobic exercise. The exercise-associated neutrophils show similarities to banded cells appearing after LPS challenge. Additional functional assays (e.g. bacterial killing capacity) will be required to verify whether these neutrophils are in fact similar. DAMACY, a second multivariate MFC analysis method, proved helpful in diagnosing asthma in general and eosinophilic asthma specifically. Moreover, it identified an important unknown subset of CD3+CD8+CRTH2+ cells, known to be Tc2 cells. In the last chapter of this thesis Tc2 cells are found to be present in higher numbers in peripheral blood and airways of patients with severe eosinophilic asthma. In vitro assays show an activation response of Tc2 cells by PGD2 and LTE4, both lipid mediators that were measured in higher concentrations in the airways of patients with severe eosinophilic asthma. Therefore Tc2s might play an important role in severe eosinophilic asthma and could be a promising target of therapy. In summary, this thesis shows that a combination of detailed cellular measurements and improved multi-dimensional and unbiased analysis methods of MFC data lead to the development of promising diagnostic steps to further phenotype asthma with the ultimate goal to improve asthma care

Quality over quantity; eosinophil activation status will deepen the insight into eosinophilic diseases

Eosinophil associated diseases have gained much attention recently because of the introduction of specific eosinophil targeted therapies. These diseases range from acute parasitic infections to chronic inflammatory diseases such as eosinophilic asthma. In eosinophilic asthma an increased eosinophil cell count in peripheral blood is the gold standard for determination of the pheno-/endotype and severity of disease. Despite a broad consensus there is concern on validity of this simple measurement, because the eosinophil compartment is far from homogenous. Multiple tissues harbour non-activated cells under homeostatic conditions and other tissues, normally devoid of eosinophils, become infested with these cells under inflammatory conditions. It will, therefore, be clear that eosinophils become differentially (pre)-activated at different tissue sites in homeostatic and inflammatory conditions. This complexity should be investigated in detail as it is 1) far from clear what the long-term side effects are that are caused by application of eosinophil targeted therapies in a ?one size fits all? concept and 2) real-world data of eosinophil targeted therapies in asthma shows a broad variety in the treatment response. This review will focus on complex mechanisms of eosinophil activation in vivo to create a better view on the dynamics of the eosinophil compartment in health and disease both to prevent collateral damage caused by aberrant activation of eosinophils ?nd to improve effectiveness of eosinophil targeted treatments