The relationship between workplace, job stress and nurses' tobacco use: A review of the literature

The aim of this study was to provide a summary of the existing published knowledge on the possible relationship between the workplace as a stressor factor and nurses' tobacco use. A systematic review of the literature from 1995 to 2009, using the MEDLINE database took place. Studies, that referred to nurses' smoking habit exclusively or as a part of the study, were included in the review. 491 studies were retrieved and their titles/abstracts were examined systematically. Twenty one studies were retrieved for further consideration by a comprehensive literature review. Ten studies fulfilled the eligibility criteria and they were examined further. There is a conflict on the possible relationship between workplace as a stressor factor and nurses' smoking habits, because there is no evidence on if the nurses' work environment causes smoking initiation. © 2010 by the authors

Predictors of childhood exposure to parental secondhand smoke in the house and family Car

Childhood exposure to secondhand smoke (SHS) is a serious threat to public health and can be influenced by parental lifestyle habits and beliefs. Taking the above into account we aimed at locating predictors of parental induced exposure to SHS in the house and family car among 614 children who visited the emergency department of two large pediatric hospitals in Athens, Greece. The multivariate analysis revealed that the factors found to mediate household exposure to paternal SHS were the number of cigarettes smoked per day (O.R 1.13, p<0.001) while, having a non-smoking spouse had a protective effect (O.R 0.44, p=0.026). Maternally induced household SHS exposure was related to cigarette consumption. For both parents, child exposure to SHS in the family car was related to higher numbers of cigarettes smoked (p<0.001), and for fathers was also more often found in larger families. Additionally, lower educated fathers were more likely to have a spouse that exposes their children to SHS inside the family car (O.R 1.38 95%C.I: 1.04-1.84, p=0.026). Conclusively, efforts must be made to educate parents on the effects of home and household car exposure to SHS, where smoke free legislation may be difficult to apply

Barriers to ESC guideline implementation: results of a survey from the European Council on Cardiovascular Nursing and Allied Professions (CCNAP)

First Published May 12, 2017Background: The European Society of Cardiology (ESC) has a comprehensive clinical guideline development programme, relevant for all clinicians. However, implementation of guidelines is not always optimal. Aim: The aim of this study was to determine nurses’ and allied professionals’ awareness and barriers regarding clinical guideline implementation. Methods: A cross-sectional survey was administrated online and in print at EuroHeartCare 2015. A questionnaire was developed which examined awareness and barriers to implementation of ESC guidelines on cardiovascular disease prevention in clinical practice (2012) and ESC guidelines in general. Results: Of the 298 respondents, 12% reported that the prevention guidelines were used in their practice area. Respondents identified, in order of magnitude, that lack of leadership, workload, time, resources and a perception that they were unable to influence current practice were barriers to the use of the prevention guidelines. When asked to rank barriers to use of any ESC guidelines, time (22%) and leadership (23%) were ranked highest. Conclusions: Implementation of ESC guidelines by nurses, the majority responders in this survey, is a serious problem, requiring urgent improvement to ensure patients receive optimal evidence based care. Issues of leadership, workload, time and resources are significant barriers to guideline implementation. It is of concern that these professionals perceive both that they have little influence on implementation decisions and lack of leadership regarding guideline implementation. Educational and organisational strategies to improve leadership skills are imperative. These will build self-efficacy and empower nurses and allied professionals to advocate for evidence-based care in the clinical environment.Gabrielle McKee, Mary Kerins, Glenys Hamilton, Tina Hansen, Jeroen Hendriks, Eleni Kletsiou, Ekaterini Lambrinou, Catriona Jennings and Donna Fitzsimon

Suppressed neuropeptide levels and association with disease severity and pain levels in patients with multiple organ dysfunction syndrome (MODS)

INTRODUCTION. Phenytoin (PTN) is a highly protein bound anticonvulsant agent commonly employed in intensive care. Given the high morbidity associated with uncontrolled seizures in this setting, rapid attainment of therapeutic concentrations is mandated. OBJECTIVES. To define the population pharmacokinetics (PK) of phenytoin in the critically ill, in addition to risk factors for sub-therapeutic dosing. METHODS. Free and total PTN concentrations were measured in serum by means of high performance liquid chromatography following microfiltration, two to three times in the first 24 h after a loading dose. Population PK modelling, including intra and interindividual variability, were determined using NONMEM(R). RESULTS. Fifty three patients (total of 153 plasma samples) where included in the study. Demographic and pharmacokinetic data are presented in table 1. A one compartment linear model adequately described the pharmacokinetics of loading doses of PTN. The mean clearance and volume of distribution for PTN were 0.024 L kg/h and 1.08 L/kg respectively. The loading dose was within recommended guidelines (10–20 mg/kg) for the majority of cases. Protein binding was consistently * 90% when albumin levels were [25 mmol/L and hypoalbuminaemia was associated with higher unbound (free) PTN levels. The percentage of free and total trough levels that were therapeutic were 49% and 38% respectively. CONCLUSIONS. This study has developed a population PK model of PTN loading in critically ill patients. Hypoalbuminaemia was shown to be a critical factor in dosing requirements. In approximately 50% of patients, the trough PTN level was below the therapeutic range, suggesting that higher dosing may be required

Stress neuropeptide levels in adults with chest pain due to coronary artery disease: potential implications for clinical assessment

: Substance P (SP) and neuropeptide Y (NPY) are neuropeptides involved in nociception. The study of biochemical markers of pain in communicating critically ill coronary patients may provide insight for pain assessment and management in critical care. Purpose of the study was to to explore potential associations between plasma neuropeptide levels and reported pain intensity in coronary critical care adults, in order to test the reliability of SP measurements for objective pain assessment in critical care