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Selected AbstractsDevelopment, implementation and benefits of a rheumatology-specific electronic medical record application with automated display of outcome measuresINTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 4 2010Anand N. MALAVIYA Abstract Objectives:, To make a rheumatology-specific electronic medical record (EMR) application for easy clinical data entry, automated display of outcome measures in real-time that generates well laid-out print-outs; and provides an easily retrievable database for clinical analysis and research. Methods:, Highly labour-intensive ,MS-WORD®' template used earlier provided the basic framework for developing rheumatology-EMR applications. The authors, a rheumatologist and a soft tissue surgeon with expertise in developing medical software, successfully created a rheumatology-EMR application over a period of 2½ years using the same basic flow of work as used in the old ,MS-WORD®' template. Results:, The resulting EMR application form has a standard medical record documenting demographic data, complete diagnosis, appropriate dates, visit number, disease status, history, physical examination, investigations, follow-up and prescription page (with automatic updates wherever applicable). Mathematical calculations required for outcome measures (DAS, DAS28, CDAI, SDAI, AS-DAS, BASDAI, BASFI, BASMI, SLE-DAI and others) are embedded in the software, with automated updating as the examination of the musculoskeletal system proceeds in real time. Following implementation of this EMR application, more patients are being seen, patient waiting lists have been reduced; more time is available for academic and teaching work, without compromising the quality of notes, and print-outs for patients. Data retrieval has simplified clinical research with increased numbers of abstracts being presented and research papers being published. Conclusion:, Healthcare workers with understanding of the basic principles of computers and softwares should interact with software engineers who are either themselves medical doctors or are familiar with the workflow and clinical evaluation processes to create an efficient speciality-specific EMR application. [source] An evaluation of the hand and nasal flora of Turkish nursing students after clinical practiceJOURNAL OF CLINICAL NURSING, Issue 3 2009Reva Balc Aim., The purpose of this study was to evaluate and compare the hand and nasal flora of nursing students before and after the clinical practice. Background., Hospitals are places where infective agents abound. Healthcare workers, relatives of patients and students practising in the hospital medium are often exposed to these infective agents. Although the role of the hand and nasal flora of healthcare workers in the development of nosocomial infections has been emphasised by earlier studies, there are a limited number of studies which investigate the hand and nasal flora of nursing students. Design., Descriptive. Methods., This descriptive study involved 66 volunteer nursing students. Two samples of flora from both hands and nose of each student were obtained. The inoculated samples were then evaluated through routine bacteriological study methods. Chi-square and percentage calculations were used in comparisons. Results., None of the students had methicillin-resistant Staphylococcus aureus or methicillin-resistant coagulase-negative Staphylococcus colonisation in the hand samples before clinical practice, 6·1% of the students had methicillin-resistant Staphylococcus aureus and 4·5% had methicillin-resistant coagulase-negative Staphylococcus colonisation after the practice. Although the differences between the rates of contamination with pathogen micro-organisms in the hand and nasal flora of the student nurses before and after clinical practice were not significant, the rate of colonisation after clinical practice was higher. Conclusions., In this study, the rate of colonisation after clinical practice was higher. These findings indicate that students might have been contaminated with bacteria during clinical practice. Relevance to clinical practice., The results of this study have practical importance in clinical practice. The role of the hand and nasal flora of nursing students in the development of nosocomial infections is significant. For this reason, some precautions, such as using gloves and handwashing with special solutions when needed, should be taken to prevent nosocomial infections and protect students against associated risks. [source] Healthcare workers and influenza vaccination Commentary on Canning HS, Phillips J & Allsup S (2005) Healthcare workers beliefs about influenza vaccine and the reasons for non-vaccination , a cross-sectional survey.JOURNAL OF CLINICAL NURSING, Issue 6 2007Journal of Clinical Nursing 1 [source] Adolescent Homosexuality and Culturally Competent NursingNURSING FORUM, Issue 3 2000Leslie G. Dootson Nursing is striving for cultural competency. Cultural competency includes the ability to deliver care to disenfranchised and marginalized people. The adolescent gay, lesbian, or bisexual person is at risk for violence, disease, harassment, and problems with identity development. Ethnic/minority youth who are also gay, lesbian, and bisexual suffer from prejudice and disenfranchisement within their ethnic community as well as in the dominant white culture. Healthcare workers exhibit homophobia and heterosexism in the delivery of care to patients. Nursing needs to evaluate its own values and prejudices and incorporate sexual orientation into culturally valid tools of assessment to provide competent care. [source] A Survey of Workplace Violence Across 65 U.S. Emergency DepartmentsACADEMIC EMERGENCY MEDICINE, Issue 12 2008Susan M. Kansagra MD Abstract Objectives:, Workplace violence is a concerning issue. Healthcare workers represent a significant portion of the victims, especially those who work in the emergency department (ED). The objective of this study was to examine ED workplace violence and staff perceptions of physical safety. Methods:, Data were obtained from the National Emergency Department Safety Study (NEDSS), which surveyed staff across 69 U.S. EDs including physicians, residents, nurses, nurse practitioners, and physician assistants. The authors also conducted surveys of key informants (one from each site) including ED chairs, medical directors, nurse managers, and administrators. The main outcome measures included physical attacks against staff, frequency of guns or knives in the ED, and staff perceptions of physical safety. Results:, A total of 5,695 staff surveys were distributed, and 3,518 surveys from 65 sites were included in the final analysis. One-fourth of surveyed ED staff reported feeling safe sometimes, rarely, or never. Key informants at the sampled EDs reported a total of 3,461 physical attacks (median of 11 attacks per ED) over the 5-year period. Key informants at 20% of EDs reported that guns or knives were brought to the ED on a daily or weekly basis. In multivariate analysis, nurses were less likely to feel safe "most of the time" or "always" when compared to other surveyed staff. Conclusions:, This study showed that violence and weapons in the ED are common, and nurses were less likely to feel safe than other ED staff. [source] Prevalence of Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Carriage in Three PopulationsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010S. Kottler Background: A higher prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization is reported in healthcare workers compared with nonhealthcare workers. Hypothesis: The prevalence of MRSA colonization differed in people and pets in households with healthcare workers as compared with households without healthcare workers. Subjects: A person and 1 dog or cat from 586 households defined as either a nonhealthcare (n = 213), veterinary healthcare (n = 211), or human healthcare (n = 162) worker household. Methods: Prospective cross-sectional study. Samples from humans and pets were cultured in vitro. Staphylococcus aureus was identified as methicillin sensitive (MSSA) or MRSA with mecA polymerase chain reaction. Pulsed-field gel electrophoresis and spa -typing were used to characterize relatedness of S. aureus and MRSA and assign USA types. Results: The prevalence of MSSA and MRSA in humans was 21.5% (126/586) and 5.63% (33/586), respectively, and 7.85% (46/586) and 3.41% (20/586), respectively, in pets. There were no differences in prevalences of either MSSA or MRSA between household types. The proportion of MRSA among all S. aureus isolates in humans and pets was 20.8% (33/159) and 30.3% (20/66), respectively. In <1.0% (4/586) of households, the same strain of MRSA was found in both a person and a pet. Conclusions and Clinical Importance: There were no differences in the prevalences of MSSA or MRSA between healthcare worker and nonhealthcare worker households. Pets and people colonized with S. aureus were as likely to be colonized with MRSA. Colonization of a person and their pet with the same strain of MRSA was rare. [source] ORIGINAL ARTICLE: A survey of the management of needlestick injuries from incapacitated patients in intensive care units,ANAESTHESIA, Issue 9 2010L. A. Burrows Summary The Human Tissue Act 2004 and Mental Capacity Act 2005 resulted in a change in the management of needlestick injuries sustained from incapacitated patients. It appears unlawful to test for blood-borne viruses without a patient's consent for the sole benefit of the healthcare worker. This survey of intensive care units within England, Wales and Northern Ireland investigated how needlestick injuries from incapacitated patients had been managed within the previous year. Of the 225 intensive care units surveyed, 99 (44%) responded. Sixty-two (62.6%) reported a needlestick injury to a healthcare worker from an incapacitated patient. Thirty-six (64.3%) patients were tested for blood-borne viruses without consent. Sixteen (25.8%) patients tested positive for blood-borne viruses. Only 19 (30.6%) healthcare workers took post-exposure prophylaxis following the injury. These results show that needlestick injuries from incapacitated patients are common and that the majority of patients were tested for blood-borne viruses without consent. [source] ,Like a friend going round': reducing the stigma attached to mental healthcare in rural communitiesHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2002P. Crawford RMN DPSN BA (Hons) PhD Abstract Traditionally, stigma is seen as something that is the fault of the mental health system, and that involves an individual suffering social disapprobation and reduced life chances as a result of having been given a diagnostic label and an identity as a patient as a result of their contact with psychiatric institutions. The present study, based on focus group discussions conducted with users and mental healthcare workers in a rural setting, suggests that this classic conception of stigma does not readily apply to care in the community. First, workers described themselves as actively trying to challenge stigma at an institutional level, as well as being apt to change their own practice to reduce the stigmatizing effect of mental healthcare on their clients and make their presence less conspicuous. The ideal was to be ,like a friend going round'. However, this view included a somewhat passive notion of clients. By contrast, the present investigation showed that clients described themselves in much more active terms as being aware of possible sources of stigma and being inclined to challenge negative attitudes themselves. Future mental healthcare practice could draw upon professionals' stock of knowledge as to how their practice could lead to less stigma and could build upon clients' own strengths to achieve stigma reduction. [source] Adult hepatitis B vaccination using a novel triple antigen recombinant vaccineHEPATOLOGY, Issue 2 2001Michael D. Young Present hepatitis B vaccines use multidose prolonged regimens, which even healthcare workers at risk do not always complete. Moreover, when vaccination is completed there remain some who fail to achieve adequate protection. The protection of adults at risk could be improved if there were a more potent vaccine and/or a shorter vaccination regimen available. Vaccine-naive adults were randomized to vaccination with either Engerix-B (SmithKline Biologicals, Rixensart, Belgium) or a novel triple antigen (S, pre-S1, and pre-S2) recombinant vaccine (Hepacare; Medeva Pharma Plc, Speke, UK). The primary efficacy parameter was the degree of seroprotection 6 or 7 months (26 ± 2 weeks) after beginning vaccination. A total of 304 adults entered the study. Of these, 16 failed to complete the study (9 on Hepacare and 7 on Engerix-B). With the Engerix-B standard (0, 1, 6) regimen, 88% of subjects were protected by month 7, whereas with the triple antigen vaccine a 2-dose regimen (0, 1) provided equivalent protection (91%) within 6 months and a 3-dose (0, 1, 6) regimen was significantly superior (98% seroprotected by 7 months after starting vaccination P < .001). With adults at risk for a suboptimal response (i.e., older adults, the obese, men, and smokers) the triple antigen vaccine produced a greater degree of protection. The vaccines had similar safety profiles. Both vaccines were well tolerated. In healthy normal adults, a triple antigen hepatitis B vaccine containing S and pre-S antigens produced an enhanced immunologic response and was as effective as a 2- and 3-dose regimen. [source] Stop female genital mutilation: appeal to the international dermatologic communityINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2002Aldo Morrone MD Female genital mutilation (FGM) is a traditional cultural practice, but also a form of violence against girls, which affects their lives as adult women. FGM comprises a wide range of procedures: the excision of the prepuce; the partial or total excision of the clitoris (clitoridectomy) and labia; or the stitching and narrowing of the vaginal orifice (infibulation). The number of girls and women who have been subjected to FGM is estimated at around 137 million worldwide and 2 million girls per year are considered at risk. Most females who have undergone mutilation live in 28 African countries. Globalization and international migration have brought an increased presence of circumcised women in Europe and developed countries. Healthcare specialists need to be made aware and trained in the physical, psychosexual, and cultural aspects and effects of FGM and in the response to the needs of genitally mutilated women. Health education programs targeted at immigrant communities should include information on sexuality, FGM, and reproduction. Moreover, healthcare workers should both discourage women from performing FGM on their daughters and receive information on codes of conduct and existing laws. The aim is the total eradication of all forms of FGM. [source] Mothering in Public: A Meta-Synthesis of Homeless Women With Children Living in SheltersJOURNAL FOR SPECIALISTS IN PEDIATRIC NURSING, Issue 4 2003MPHArticle first published online: 24 AUG 200, Mikki Meadows-Oliver MSN ISSUES AND PURPOSE The purpose of this paper is to synthesize the current qualitative literature on homeless women with children living in shelters. METHODS Eighteen qualitative studies on homeless women with children living in shelters were included in the synthesis. The meta-synthesis was conducted using the meta-ethnographic approach of Noblit and Hare (1988). RESULTS Six reciprocal translations (themes) of homeless mothers caring for their children in shelters emerged: On becoming homeless, protective mothering, loss, stressed and depressed, survival strategies, and strategies for resolution. PRACTICE IMPLICATIONS The results may be used by healthcare workers as a framework for developing intervention strategies directed toward helping mothers find new solutions to dealing with shelter living and innovative ways to resolve their homelessness. [source] Burnout and physical and mental health among Swedish healthcare workersJOURNAL OF ADVANCED NURSING, Issue 1 2008Ulla Peterson Abstract Title.,Burnout and physical and mental health among Swedish healthcare workers Aim., This paper is a report of a study to investigate how burnout relates to self-reported physical and mental health, sleep disturbance, memory and lifestyle factors. Background., Previous research on the possible relationship between lifestyle factors and burnout has yielded somewhat inconsistent results. Most of the previous research on possible health implications of burnout has focused on its negative impact on mental health. Exhaustion appears to be the most obvious manifestation of burnout, which also correlates positively with workload and with other stress-related outcomes. Method., A cross-sectional study was conducted, using questionnaires sent to all employees in a Swedish County Council (N = 6118) in 2002. The overall response rate was 65% (n = 3719). A linear discriminant analysis was used to look for different patterns of health indicators and lifestyle factors in four burnout groups (non-burnout, disengaged, exhausted and burnout). Results., Self-reported depression, anxiety, sleep disturbance, memory impairment and neck- and back pain most clearly discriminated burnout and exhausted groups from disengaged and non-burnout groups. Self-reported physical exercise and alcohol consumption played a minor role in discriminating between burnout and non-burnout groups, while physical exercise discriminated the exhausted from the disengaged group. Conclusion., Employees with burnout had most symptoms, compared with those who experienced only exhaustion, disengagement from work or no burnout, and the result underlines the importance of actions taken to prevent and combat burnout. [source] Beliefs on Mandatory Influenza Vaccination of Health Care Workers in Nursing Homes: A Questionnaire Study from the NetherlandsJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 12 2009Ingrid Looijmans-van den Akker MD OBJECTIVES: To assess whether nursing homes (NHs) made organizational improvements to increase influenza vaccination rates in healthcare workers (HCWs) and to quantify the beliefs of NH administrators on the arguments used in favor of implementation of mandatory influenza vaccination of HCWs. DESIGN: Anonymous questionnaire study. SETTING: Dutch NHs. PARTICIPANTS: Dutch NH administrators. MEASUREMENTS: Influenza vaccination rates in NH residents and NH HCWs, organizational aspects of influenza vaccination of HCWs, and agreement of respondents with arguments in favor of implementation of mandatory influenza vaccination in HCWs. RESULTS: Of the 310 distributed questionnaires, 185 were returned (response rate 59.7%). The average vaccination rate in NH HCWs was 18.8% and in NH residents was 91.6%. In all, 126 (68.1%) NHs had a written policy, 161 (87.0%) actively requested that their employees be immunized, and 161 (87.0%) offered information to HCWs in any way. Despite the fact that the majority of NH administrators (>69%) agreed with all arguments in favor of implementation of mandatory influenza vaccination, only a minority (24.3%) agreed that mandatory vaccination should be implemented if voluntary vaccination fails to reach sufficient vaccination rates. CONCLUSION: Despite the low vaccination rate of NH HCWs, most NH administrators did not support mandatory influenza vaccination of NH HCWs. [source] An evaluation of the hand and nasal flora of Turkish nursing students after clinical practiceJOURNAL OF CLINICAL NURSING, Issue 3 2009Reva Balc Aim., The purpose of this study was to evaluate and compare the hand and nasal flora of nursing students before and after the clinical practice. Background., Hospitals are places where infective agents abound. Healthcare workers, relatives of patients and students practising in the hospital medium are often exposed to these infective agents. Although the role of the hand and nasal flora of healthcare workers in the development of nosocomial infections has been emphasised by earlier studies, there are a limited number of studies which investigate the hand and nasal flora of nursing students. Design., Descriptive. Methods., This descriptive study involved 66 volunteer nursing students. Two samples of flora from both hands and nose of each student were obtained. The inoculated samples were then evaluated through routine bacteriological study methods. Chi-square and percentage calculations were used in comparisons. Results., None of the students had methicillin-resistant Staphylococcus aureus or methicillin-resistant coagulase-negative Staphylococcus colonisation in the hand samples before clinical practice, 6·1% of the students had methicillin-resistant Staphylococcus aureus and 4·5% had methicillin-resistant coagulase-negative Staphylococcus colonisation after the practice. Although the differences between the rates of contamination with pathogen micro-organisms in the hand and nasal flora of the student nurses before and after clinical practice were not significant, the rate of colonisation after clinical practice was higher. Conclusions., In this study, the rate of colonisation after clinical practice was higher. These findings indicate that students might have been contaminated with bacteria during clinical practice. Relevance to clinical practice., The results of this study have practical importance in clinical practice. The role of the hand and nasal flora of nursing students in the development of nosocomial infections is significant. For this reason, some precautions, such as using gloves and handwashing with special solutions when needed, should be taken to prevent nosocomial infections and protect students against associated risks. [source] Hand hygiene among nurses in Turkey: opinions and practicesJOURNAL OF CLINICAL NURSING, Issue 3 2007Asiye D. Akyol RN Aims and objectives., This study aims to identify nurses' practices and opinions of handwashing during routine patient care. Background., Transmission of microorganisms from the hands of healthcare workers is the main source of cross-infection in hospitals and can be prevented by handwashing. Design and methods., A questionnaire survey was used for this study. A total of 129 clinical nurses at University of Ege Faculty of Medicine Application and Investigation Hospital at Internal Medicine Clinics was surveyed with a response rate of 100%. Data analysis was carried out using SPSS version 10. Results., The study revealed that nurses have a poor level of knowledge concerning quality of hand washing. All nursing actions related to ,clean' and ,dirty' activities were evaluated using the Fulkerson scale. The majority of nurses reported that they always wash hands after contact with contaminated and non-contaminated patients, equipment and environment. It was found that they did need to wash their hands often but that they were not able to do this because of dense working conditions, insufficiency of necessary materials and drying and sore of hands after frequent washing. Conclusion., To improve hand hygiene and quality of handwashing compliance, additional factors must be considered. These factors include improving healthcare workers , especially nurses', skin conditions, hand hygiene techniques and disinfections substantially. Relevance to clinical practice., Hospitals need to develop and implement innovative educational and motivational programmes tailored to specific groups of health personnel. [source] Nitrous oxide as an adjunct in tumescent liposuctionJOURNAL OF COSMETIC DERMATOLOGY, Issue 4 2005Garrett Bird Summary Background, Nitrous oxide (N2O) has been used as an anesthetic for over 300 years. It is safe, easy to use, and effective. In this article we will document N2O use as an adjunct to tumescent liposuction. The history, mechanism of action, use, and safety in ambulatory surgery of N2O are reviewed. Objective, The authors intend to review the history of both tumescent liposuction and N2O in surgery, discuss the possible adverse reactions, and present guidelines for the use of N2O during tumescent liposuction. Methods, A Medline review of articles, 1966,2004, related to N2O was performed, using the search terms nitrous, oxide, safety, toxicity, mechanism, anesthetic, surgery, risks, and delivery. Articles that were cited by the authors of this subset of original articles were also used when appropriate. Articles were rated and included based on date of publication, level of evidence, and applicability to tumescent liposuction. Results and conclusions, Nitrous oxide is safe, easily administered, inexpensive, and is an effective adjunct to tumescent liposuction. It provides a high level of pain control, and is patient controlled, while not putting the patient at risk of full anesthesia. When used correctly, with proper equipment, it poses little risk to either patients or healthcare workers. [source] Do pathways lead to better organized care processes?JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 5 2009Kris Vanhaecht RN MSc PhD Abstract Aim, Clinical pathways are used worldwide to (re)organize care processes. They are used by multidisciplinary teams in their search towards excellence. The goal of this study is (1) to assess differences in the perception of health professionals in their evaluation of care processes; (2) to assess whether care processes supported by clinical pathways perform better than those not supported by clinical pathways; and (3) to assess the sensitivity and specificity of clinical pathways in predicting well-organized care processes. Methods, A cross-sectional, multi-centre study was performed comprising 309 healthcare workers, 103 care processes and 49 hospitals. The Care Process Self Evaluation Tool (CPSET) was used to score care processes according to their organization. Processes were also scored according to the level of pathway implementation. Results, (1) Significant differences between healthcare professionals were found on two of five CPSET subscales. No significant differences were found among the overall CPSET scores. (2) Care processes supported by pathways had the highest CPSET scores. Nonetheless, continuous follow-up is necessary. (3) Clinical pathways have significant impact on the coordination of care (odds ratio: 8.92), follow-up (odds ratio: 6.65) and overall CPSET score (odds ratio: 4.26). Clinical pathways have a positive impact on the organization of care processes. Not all pathways have high CPSET scores, and care processes without pathways can also be well organized. Continuous evaluation is essential. This is the first study to analyse how healthcare teams perceive the organization of care processes with respect to clinical pathways. Our findings are important for other quality improvement methods. [source] Director of nursing and midwifery leadership: informed through the lens of critical social scienceJOURNAL OF NURSING MANAGEMENT, Issue 4 2010ANNETTE SOLMAN RN, Dip HSN, Masters NR solman a. (2010) Journal of Nursing Management18, 472,476 Director of nursing and midwifery leadership: informed through the lens of critical social science Aims, Highlight the use of critical social science theories, practice development principles and a situational leadership framework within transformational leadership to inform Directors of Nursing and Midwifery (DoNM) practices as leaders. Background, Healthcare is constantly changing, unpredictable, strives for quality service and cost containment, which can result in stress and crisis for healthcare workers. DoNM leadership is critical to supporting and leading staff through these complex times within healthcare. Key issues, Understanding theories, frameworks and their application to real-world practice can assist in supporting individuals and teams to navigate through the changing healthcare environment. Conclusion, Blending critical social science theories with practice development principles and the situational leadership framework can assist the DoNM to enact transformational leadership to support the development of individuals and teams to meet the complex healthcare needs of patients within the clinical setting. Implications for nurse management, This article contributes through the practical application of critical social science theories, practice development principles and situational leadership framework within transformational leadership as an approach for enacting DoNM leadership. To further understand and develop in the role of the contemporary DoNM in leadership, these directors are encouraged to publish their work. [source] The mediating effect of burnout on the relationship between structural empowerment and organizational citizenship behavioursJOURNAL OF NURSING MANAGEMENT, Issue 3 2010STEPHANIE GILBERT MSc gilbert s., laschinger h.k.s. &leiter m (2010) Journal of Nursing Management18, 339,348 The mediating effect of burnout on the relationship between structural empowerment and organizational citizenship behaviours Aim, We used Kanter's (1977) structural empowerment theory to examine the influence of structural empowerment and emotional exhaustion on healthcare professionals' use of organizational citizenship behaviours directed at the organization (OCBO) and peers (OCBI). Background, Organizational citizenship behaviours (OCB) are discretionary behaviours that are not rewarded directly by the organization but have been linked to positive outcomes, such as increased job satisfaction and lower turnover intentions. Promoting OCB can help employees and organizations flourish despite current challenges in the healthcare system. Structural empowerment may influence the frequency and type of OCB by reducing burnout. Method, We conducted multiple mediated regression analyses to test two hypothesized models about relationships between empowerment, emotional exhaustion and two types of OCB (OCBI and OCBO) in a sample of 897 healthcare professionals in five Canadian hospitals. Results, Emotional exhaustion was found to be a significant mediator of the relationship between empowerment and OCBO. The predicted mediation of the empowerment/OCBI relationship by emotional exhaustion was not supported. Conclusions, Exhaustion was an important mediator of empowering working conditions and OCBO, but was not significantly related to OCBI. Empowerment was significantly related to both OCBO and OCBI. Implications for nursing management, Promoting empowerment among healthcare workers may decrease burnout and promote OCB. Specific managerial strategies are discussed in the present study. [source] Prevalence of Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Carriage in Three PopulationsJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2010S. Kottler Background: A higher prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization is reported in healthcare workers compared with nonhealthcare workers. Hypothesis: The prevalence of MRSA colonization differed in people and pets in households with healthcare workers as compared with households without healthcare workers. Subjects: A person and 1 dog or cat from 586 households defined as either a nonhealthcare (n = 213), veterinary healthcare (n = 211), or human healthcare (n = 162) worker household. Methods: Prospective cross-sectional study. Samples from humans and pets were cultured in vitro. Staphylococcus aureus was identified as methicillin sensitive (MSSA) or MRSA with mecA polymerase chain reaction. Pulsed-field gel electrophoresis and spa -typing were used to characterize relatedness of S. aureus and MRSA and assign USA types. Results: The prevalence of MSSA and MRSA in humans was 21.5% (126/586) and 5.63% (33/586), respectively, and 7.85% (46/586) and 3.41% (20/586), respectively, in pets. There were no differences in prevalences of either MSSA or MRSA between household types. The proportion of MRSA among all S. aureus isolates in humans and pets was 20.8% (33/159) and 30.3% (20/66), respectively. In <1.0% (4/586) of households, the same strain of MRSA was found in both a person and a pet. Conclusions and Clinical Importance: There were no differences in the prevalences of MSSA or MRSA between healthcare worker and nonhealthcare worker households. Pets and people colonized with S. aureus were as likely to be colonized with MRSA. Colonization of a person and their pet with the same strain of MRSA was rare. [source] IgE reactivity to latex allergens among sensitized healthcare workers before and after immunotherapy with latexALLERGY, Issue 2 2006J. Sastre Background:, New IgE sensitizations to proteins in allergen extracts have been shown to occur during allergen-specific immunotherapy (IT). Methods:, Twenty-four healthcare workers (HCWs) , patients included in a latex IT study , were analysed, 16 in active treatment and eight in placebo. Sera were obtained at baseline and after 6 months of IT and analysed with immunoblotting and CAP System with eight single recombinant latex allergens (rHev b 1, 3, 5, 6.01, 8, 9, 10, 11, and a mix of rHev b1, 5, 6.01 and 8). Results:, After IT with latex, three patients in the active treatment group had new IgE sensitizations, one to Hev b 5, one to Hev b 11 and another to Hev b 6.01. No other significant variation in mean of specific IgE to latex or recombinant allergens were observed in patients who received placebo or active treatment. A significant (P = 0.012) negative correlation (,0.72) was observed between maximal tolerated dose and specific IgE to Hev b 6.01 at baseline. After IT, immunoblot analysis demonstrated a significant increase in IgE binding in a band of approximately 22 kDa (P = 0.032) that may correspond to Hev b 6.01. New or more intense bands appeared in seven patients of the active group, while in three subjects a reduction was observed. Conclusions:, Hev b 6.01 seems to be the most relevant latex allergen in HCWs. New or more intense IgE binding to latex allergenic components occurs during latex immunotherapy. However, the levels of specific IgE against these new components are low and do not seem to have clinical relevance. [source] Killing for the state: the darkest side of American nursingNURSING INQUIRY, Issue 1 2003Dave Holmes The aim of this article is to bring to the attention of the international nursing community the discrepancy between a pervasive ,caring' nursing discourse and a most unethical nursing practice in the United States. In this article, we present a duality: the conflict in American prisons between nursing ethics and the killing machinery. The US penal system is a setting in which trained healthcare personnel practice the extermination of life. We look upon the sanitization of deathwork as an application of healthcare professionals' skills and knowledge and their appropriation by the state to serve its ends. A review of the states' death penalty statutes shows that healthcare workers are involved in the capital punishment process and shielded by American laws (and to a certain extent by professional boards through their inaction). We also argue that the law's language often masks that involvement; and explain how states further that duplicity behind legal formalisms. In considering the important role healthcare providers, namely nurses and physicians, play in administering death to the condemned, we assert that nurses and physicians are part of the states' penal machinery in America. Nurses and physicians (as carriers of scientific knowledge, and also as agents of care) are intrinsic to the American killing enterprise. Healthcare professionals who take part in execution protocols are state functionaries who approach the condemned body as angels of death: they constitute an extension of the state which exercises its sovereign power over captive prisoners. [source] Challenges and strategies of increasing the production and use of Cochrane reviews: the Argentinean experiencePAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 2008Agustín Ciapponi Summary The Cochrane Collaboration (CC), established in 1993, is an internationally renowned initiative dedicated to improving health care for the world's population. In the late 1990s, the Iberoamerican Cochrane Centre (IbCC) was created to promote the CC in Latin America. Because the production and use of Cochrane reviews were still low in 2002, Argentina implemented specific strategies and a model to expand the IbCC. The objective of this article was to describe strategies to increase the production and use of Cochrane reviews in Argentina. Methods used included surveys delivered to primary health care workers to provide data about their knowledge and use of the CC, and about the production of titles, protocols, and systematic reviews published in the Cochrane Library. Our survey showed that only 51% of a selected population of primary healthcare workers knew about the CC and only 23% knew about the Argentine Cochrane centre. In the previous year, 60% had never used the CC. To overcome these challenges, we used seven types of complementary strategies: (1) networking, (2) dissemination, (3) training, (4) support to Cochrane members, (5) strategic alliances, (6) research, and (7) fund-raising. An improvement in the production and use of Cochrane reviews was seen in Argentina, and the set of aforementioned strategies could be partly responsible for this increase. Multi-level networking, training and an appropriate centre's mother institution could be the most important interventions. More research is needed to explore this hypothesis. Lessons learned on this first evaluation will help us to continue with the development of the CC in Argentina. [source] Comparison of military and civilian reporting rates for smallpox vaccine adverse events,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2007A. W. McMahon MD Abstract Introduction US smallpox vaccination (SMA) started most recently in December 2002. Military and civilian personnel report adverse events (AEs) to the Vaccine Adverse Event Reporting System (VAERS), a surveillance system that relies on spontaneous reports. Although reported rates of probable myo/pericarditis after SMA in the literature are similar between military personnel and civilian healthcare workers, some civilian AE reporting rates after SMA appeared higher than those in the military. Objective Determine if SMA-associated reporting rates are different in civilians than in the military, considering age, sex, seriousness, and expectedness of the AE, as well as self-reporting. Methods Numerators were SMA reports in VAERS from 12/12/02 to 3/1/04. Limitations of VAERS include underreporting and lack of diagnostic confirmation. Denominators were number of military and civilian vaccinees. Results Reporting rates stratified by age and sex of serious and non-serious AEs were significantly higher in civilian than military personnel ages <55 years (rate ratios 4,27). These rate ratios decreased with increasing age. Conclusions Reporting rates in VAERS differed significantly and substantially in civilians compared to military personnel <55 years of age. Differences in stimulated passive surveillance systems, and AE reporting practices, including the ,threshold' for reporting most likely explain these findings. These results suggest that in the case of smallpox vaccine AEs, there may be systematic differences in reporting completeness between the civilian and military sectors, and that passive surveillance data should be interpreted with caution. Copyright © 2006 John Wiley & Sons, Ltd. [source] Risk assessment of drugs, biologics and therapeutic devices: present and future issues,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 8 2003B. L. Strom Abstract Purpose The current US system for detecting adverse effects of therapeutics (drugs, devices and biological products) is suboptimal. This report presents the results of an expert workshop on assessing therapeutic risks. This is the second of five workshops coordinated by the Centers for Education and Research on Therapeutics (CERTs) to address the management of therapeutic risks relative to potential benefits. Methods The workshop included academic, industry, government and constituency-based leaders. The focus was on the postapproval phase and procedures in the US, but relevant international issues and attendees were included. Results Substantial deficiencies in the current US system for risk assessment were delineated. Improving the system will involve research into methods to improve risk assessment, enhancement and consolidation of data-handling systems, education of healthcare workers, allocation of financial resources and building of constituencies. Conclusions We need leadership on multiple levels for global coordination of risk assessment. We can then begin to fill gaps and produce benefits for industry, health authorities, government agencies, healthcare providers, and most important, the public. Copyright © 2003 John Wiley & Sons, Ltd. [source] Prevalence of asthma by industry and occupation in the U.S. working populationAMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 5 2010Michelle K. McHugh MS Abstract Background Workers are potentially exposed to asthmagens daily. Our study was conducted to estimate the prevalence of asthma among working adults in the U.S. by industry and occupation. Methods Using data from the National Health and Nutrition Examination Survey (2001,2004), multiple logistic regression was used to investigate associations between industry and occupation and current asthma as defined by positive responses to "Has a doctor or other health professional ever told you that you have asthma?" and "Do you still have asthma?" Results Workers in mining (17.0%), health-related industries (12.5%), teaching (13.1%), or in health-related occupations (12.6%) had the highest prevalence of asthma. As compared to construction industry workers, workers in mining (aOR,=,5.2, 95% CI: 1.1,24.2) or health-related (aOR,=,2.3, 95% CI: 1.1,4.8) industries had significantly higher odds of asthma. Conclusion Our study adds to the increasing evidence that miners, healthcare workers and teachers remain high-risk working populations and appropriate evaluation and control measures are needed to protect these workers. Am. J. Ind. Med. 53:463,475, 2010. © 2010 Wiley-Liss, Inc. [source] Occupation and leukemia: A population-based case,control study in Iowa and Minnesota,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 1 2001A. Blair PhD Abstract Background Studies have suggested that risk of leukemia may be associated with occupational or industrial exposures and risk may vary by the histological type of the disease. Methods A population-based case,control study was conducted in Iowa and Minnesota to evaluate the association between various occupations, industries, and occupational exposures and leukemia risk. A total of 513 cases and 1,087 controls was included in the study. A lifetime occupational history and other risk factor information were collected through in-person interviews, and a job-exposure matrix was used to assess possible risks associated with specific exposures. Results A significantly increased risk of leukemia was observed among agricultural service industries and among nursing and healthcare workers. Janitors, cleaners, and light truck drivers also experienced increased risk. Those employed in plumbing, heating and air conditioning industries, and sales of nondurable goods (such as paints and varnishes) had an increased risk. Printers, painters, and workers in the food and metal industries had a nonsignificantly increased risk of leukemia. Analyses by specific exposures and histology of leukemia showed that risk of leukemia associated with occupational or industrial exposures may vary by histological type of the disease. Conclusions An increased risk of leukemia among workers employed in agricultural industries, nursing and healthcare workers, and in a few occupations with possible exposure to solvents is consistent with earlier studies. Associations of risk with occupations not observed previously deserve further assessment. Am. J. Ind. Med. 40:3,14, 2001. Published 2001 Wiley-Liss, Inc. [source] An evaluation of an aggression management training program to cope with workplace violence in the healthcare sectorRESEARCH IN NURSING & HEALTH, Issue 4 2008Janneke K. Oostrom Abstract Workplace violence is a major occupational hazard for healthcare workers, generating a need for effective intervention programs. The purpose of this study was to evaluate the effectiveness of an aggression management training program. The evaluation design was based on the internal referencing strategy, an unobtrusive and applicable evaluation method that rules out some major threats to internal validity without the need for a control group. On three occasions, training participants completed a questionnaire containing experimental and control variables. As hypothesized, there was a significant improvement in the experimental variables that was larger than the non-significant change in the control variable. We conclude that aggression management training may be an effective instrument in the fight against workplace violence. © 2008 Wiley Periodicals, Inc. Res Nurs Health 31:320,328, 2008 [source] ORIGINAL ARTICLE: A survey of the management of needlestick injuries from incapacitated patients in intensive care units,ANAESTHESIA, Issue 9 2010L. A. Burrows Summary The Human Tissue Act 2004 and Mental Capacity Act 2005 resulted in a change in the management of needlestick injuries sustained from incapacitated patients. It appears unlawful to test for blood-borne viruses without a patient's consent for the sole benefit of the healthcare worker. This survey of intensive care units within England, Wales and Northern Ireland investigated how needlestick injuries from incapacitated patients had been managed within the previous year. Of the 225 intensive care units surveyed, 99 (44%) responded. Sixty-two (62.6%) reported a needlestick injury to a healthcare worker from an incapacitated patient. Thirty-six (64.3%) patients were tested for blood-borne viruses without consent. Sixteen (25.8%) patients tested positive for blood-borne viruses. Only 19 (30.6%) healthcare workers took post-exposure prophylaxis following the injury. These results show that needlestick injuries from incapacitated patients are common and that the majority of patients were tested for blood-borne viruses without consent. [source] Systemic capillary leak syndrome resulting in compartment syndrome and the requirement for a surgical airwayANAESTHESIA, Issue 6 2009J. Perry Summary We report on a case of systemic capillary leak syndrome associated with a monoclonal band on plasma electrophoresis. In our patient hospital admission was precipitated by ischaemic pain in the left lower limb, associated with polycythaemia, renal failure and hypovolaemic shock. Fluid resuscitation, venesection and renal replacement therapy were instituted but a compartment syndrome developed necessitating surgery. Failure of tracheal intubation resulted in the requirement for a surgical airway. Despite surgical and resuscitative efforts the outcome was fatal from hypovolaemia and hyperkalaemia. We aim to highlight the difficulties in managing this condition and to remind healthcare workers to include it in the differential diagnoses for patients presenting with polycythaemia; in particular polycythaemic patients with a monoclonal band on plasma electrophoresis. [source] | ||||||||||||||||||||||||||||