A single-blind,randomized controlled trial to evaluate the effectiveness of transcutaneous tibial nerve stimulation (TTNS) in Overactive Bladder symptoms in women responders to percutaneous tibial nerve stimulation (PTNS)

ObjectivesTo evaluate the effectiveness of transcutaneous tibial nerve stimulation (TTNS) compared to percutaneous tibial nerve stimulation (PTNS) in sustaining symptom improvement over a 6-month period in women with idiopathic Overactive Bladder (OAB) who had responded to an initial 12-week course of PTNS.DesignRandomized, active-controlled trial.ParticipantsTwenty-four women diagnosed with idiopathic OAB successfully treated with PTNS were included in this study.InterventionsTwelve subjects were allocated to receive monthly sessions of PTNS for six months, and twelve subjects followed a flexible home-based TTNS regime after instruction on the use of a TENS device for the same follow-up time.OutcomesParticipants were assessed at six weeks, three months and six months after completing the initial course of PTNS. Primary outcomes were changes from baseline in urinary frequency, number of episodes of urgency and number of episodes of urge urinary incontinence (UUI). Subjectively reported severity of symptoms and quality of life (QoL) were assessed using the validated OAB questionnaire (OAB-q).ResultsUrinary frequency, episodes of urinary urgency and episodes of UUI did not change significantly between baseline and six months in either group. Similarly, OAB-q scores for severity of symptoms and QoL were maintained within both arms for the duration of the study. There were no statistically significant differences between the groups in any of the outcome measures at any of the study points.ConclusionTTNS is effective in the maintenance of symptom improvement in women with OAB who had positively responded to a course of 12 weekly PTNS sessions.
The trial was registered in the Clinicaltrials.gov PRS database (Identifier: NCT02377765).     

Are falls in people with multiple sclerosis related to the severity of urinary disorders?

BackgroundLower urinary tract symptoms (LUTSs), especially overactive bladder, are frequent in people with multiple sclerosis (PwMS). Urinary urgency and urge urinary incontinence could lead to precipitation and thus could increase the risk of falling in these individuals.ObjectiveWe aimed to assess the association between severity of LUTSs and risk of falling in PwMS.MethodsPwMS with LUTSs were recruited in a neuro-urology department. Participants were asked about the number of falls in the past 3 months and their circumstances. Severity of LUTSs was assessed by the Urinary Symptoms Profile (USP) score, and individuals were classified as with or without urinary incontinence.ResultsThis cross-sectional study included 154 patients (69% women); the mean (SD) age was 50.1 (11.5) years and median EDSS was 5 (interquartile range 3–6). Overall, 20 (13%) patients reported one fall during the past 3 months, and 43 (28%) reported at least 2 falls. Only 9 (6%) patients reported a fall on the way to the toilet, 6 during a urinary urgency. No link was found between falls and urinary incontinence (P = 0.71), type or severity of urinary symptoms (overactivity, voiding dysfunction or stress incontinence, P > 0.05). Falls on the way to the bathroom was associated with high USP score related to overactive bladder (P = 0.03) and severe nocturia (> 2 nocturnal micturitions) (P < 0.01). Falling at night was also associated with severe nocturia (P < 0.001).ConclusionsThe severity of LUTSs and presence of urinary incontinence do not appear related to the risk of falling in PwMS and urinary disorders but rather to the specific risk of falling on the way to the bathroom. Severe nocturia increases the risk of falling at night. Further studies are needed to assess the impact of LUTS treatment on the risk of falling. ClinicalTrials.gov (NCT04338646).     

Families' Perceptions of Veterans' Distress Due to Post-Traumatic Stress Disorder-Related Symptoms at the End of Life

ObjectivesTo define the frequency of post-traumatic stress disorder (PTSD)-related symptoms among veterans who are near the end of life and to describe the impact that these symptoms have on patients and their families.MethodsPatients had received inpatient or outpatient care from a participating VA facility in the last month of life, and one family member per patient was selected using predefined eligibility criteria. Family members then completed a telephone survey, The Family Assessment of Treatment at End-of-Life, which assessed their perceptions of the quality of the care that the patients and they themselves received during the patients' last month of life.ResultsSeventeen percent of patients (89 of 524) were reported to have had PTSD-related symptoms in the last month of life. PTSD-related symptoms caused discomfort less often than pain did (mean frequency score 1.79 vs. 1.93; Wilcoxon sign rank test, P < 0.001) but more often than dyspnea did (mean severity score 1.79 vs. 1.73; Wilcoxon sign rank test, P < 0.001). Family members of patients with PTSD-related symptoms reported less satisfaction overall with the care the patient received (mean score 48 vs. 62; rank sum test, P < 0.001). Patients who received a palliative care consult (n = 49) had lower ratings of discomfort attributed to PTSD-related symptoms (mean 1.55 vs. 2.07; rank sum test, P = 0.007).ConclusionPTSD-related symptoms may be common and severe among veterans near the end of life and may have a negative effect on families' perceptions of the quality of care that the veteran received.     

Effect of low-impact aerobic exercise combined with music therapy on patients with fibromyalgia. A pilot study

ObjectiveFibromyalgia is a pathological entity characterized by chronic widespread musculoskeletal pain and the presence of “tender points”. It constitutes a significant health problem because of its prevalence and economic impact. The aim of the present study was to determine the therapeutic benefits of low impact aerobic exercise alone or in combination with music therapy in patients with fibromyalgia.MethodsA single-blind randomized controlled pilot trial was performed. Thirty-five individuals with fibromyalgia were divided into three groups: (G1) therapeutic aerobic exercise with music therapy (n = 13); (G2) therapeutic aerobic exercise at any rhythm (n = 13) and (CG) control (n = 9). The intervention period lasted eight weeks. Depression, quality of life, general discomfort and balance were assessed before and after intervention.ResultsAt post-intervention, group G1 improved in all variables (depression (p = 0.002), quality of life (p = 0.017), general discomfort (p = 0.001), and balance (p = 0.000)), while group G2 improved in general discomfort (p = 0.002). The change observed in balance was statistically different between groups (p = 0.01).ConclusionTherapeutic aerobic exercise is effective in improving depression and general discomfort in individuals with fibromyalgia. However, effectiveness is higher when combined with music therapy, which brings about further improvements in quality of life and balance.     

Transcutaneous electrical nerve stimulation for the control of pain during rehabilitation after total knee arthroplasty: A randomized,blinded, placebo-controlled trial

This study evaluated the efficacy of transcutaneous electrical nerve stimulation (TENS) in reducing pain and hyperalgesia and increasing function after total knee arthroplasty (TKA). We hypothesized that participants using TENS during rehabilitation exercises would report significantly lower pain during range-of-motion (ROM) activity and fast walking but not at rest, would have less hyperalgesia, and would have better function than participants receiving placebo-TENS or standard care. We also hypothesized that change in ROM pain would differ based on psychological characteristics (trait anxiety, pain catastrophizing, and depression) and treatment group. This prospective, randomized study used intent-to-treat analyses in 317 participants after primary, unilateral TKA. Assessors, blinded to treatment allocation, measured pain, function (ROM and gait speed), and hyperalgesia (quantitative sensory tests) postoperatively and 6 weeks after surgery. Analgesic intake, anxiety, depression, and pain catastrophizing were also assessed. TENS participants used it 1 to 2 times per day at 42 mA (on average) and had less pain postoperatively during active knee extension (P = .019) and fast walking (P = .006) than standard care participants. TENS and placebo-TENS were not significantly different. TENS participants who scored low on anxiety and pain catastrophizing had a greater reduction in ROM pain at 6 weeks than those who scored high on these factors (P = .002 and P = .03). Both TENS and placebo-TENS participants had less postoperative mechanical hyperalgesia (P = .03–.01) than standard care participants. Supplementing pharmacologic analgesia with TENS during rehabilitation exercises reduces movement pain postoperatively, but a placebo influence exists and the effect is gone by 6 weeks. Patients with low anxiety and pain catastrophizing may benefit most from TENS.     

The effects of a sensory stimulation intervention on psychosocial and clinical outcomes of critically ill patients and their families: A randomised controlled trial

ObjectivesTo explore the effectiveness of a sensory stimulation intervention on intensive care unit patients' psychosocial, clinical, and family outcomes.DesignA prospective, assessor-blind, parallel-group randomised controlled trial.SettingA surgical intensive care unit of one tertiary hospital in Guangzhou, mainland China.InterventionParticipants in the intervention group received a daily 30-minute auditory and visual stimulation session starting from recruitment and for a maximum of seven days while in the intensive care unit.Measurement and main resultsOne hundred fifty-two patients and family caregiver dyads were recruited. Patients in the intervention group showed lower total scores of post-traumatic stress disorder (21.92 ± 6.34 vs 27.62 ± 10.35, p = 0.001), depressive symptoms (3.76 ± 3.99 vs 6.78 ± 4.75, p = 0.001) and delusional memories (0.47 ± 0.92 vs 0.82 ± 1.23, p = 0.001) collected immediately post-intervention than those in the control group, while not on depressive symptoms at one-month post-intervention (3.32 ± 4.03 vs 3.28 ± 3.77, p = 0.800). Sensory stimulation did not significantly impact patients' unit length of stay and 30-day mortality (all p > 0.05). For family outcomes, family caregivers in the intervention group had greater satisfaction with care (127.12 ± 14.14 vs 114.38 ± 21.97, p = 0.001) and a lower level of anxiety (28.49 ± 6.48 vs 34.64 ± 7.68, p = 0.001) than family caregivers in the control group.ConclusionsSensory stimulation may benefit patients' and family caregivers' psychological well-being, and further well-designed multi-centre clustered randomized controlled trials could be considered to strengthen the evidence.     

Concurrent validity of handheld dynamometer measurements for scapular protraction strength

BackgroundHandheld dynamometers (HHD) provide quick and low-cost assessments of muscle strength and their use has been increasing in clinical practice. There is no available data related to the validity of HHD for this measurement.ObjectiveTo verify the concurrent validity of scapular protraction measurements using an HHD.MethodsIndividuals with traumatic anterior glenohumeral instability were allocated in Instability Group (n = 20), healthy swimmers were allocated in Athletes Group (n = 19) and healthy subjects were allocated in Sedentary Group (n = 21). Concurrent validity was verified by the Pearson correlation test between HHD and isokinetic measurements. The agreement between instruments was verified by Bland–Altman plots, for each of the two HHD positions.ResultsA moderate correlation was observed between seated (r = 0.59) and lying supine HHD (r = 0.54) and isokinetic dynamometer measurements for the all groups. Separated group analysis exhibited a strong correlation between seated HHD and isokinetic dynamometer measurements in the Instability Group (r = 0.80), Sedentary Group (r = 0.79) and Athletes Group (r = 0.76). The Bland–Altman plot showed greater agreement in the seated position than the lying supine position when comparing measurements with the HHD and isokinetic in both the general sample and separated groups.ConclusionThe HHD may be considered a valid tool for assessing scapular protraction muscle strength among healthy athletes, non-athletes and subjects with shoulder instability. We recommend to assess subjects in the seated position and to be aware that the HHD tends to overestimate the peak force, compared with the gold-standard isokinetic dynamometer.     

Time to be Ready to Void: A new tool to assess the time needed to perform micturition for patients with multiple sclerosis

BackgroundUrgency urinary incontinence is one of the major disabling urinary symptoms in people with multiple sclerosis (PwMS). The warning time (time from first sensation of urgency to voiding or incontinence) only partially reflects the possibility of continence. Other factors such as mobility, difficulties in transfer or undressing can influence this time.ObjectivesThe aim was to create a specific test for PwMS to assess the global time required to be ready to perform micturition and to assess its reliability.MethodsThe Time to be Ready to Void (TRV) was based on 2 timed steps: “mobility” stage, including standing up and walking 6 m to the toilet, and the “settled” stage, starting as soon as the individual opens the toilet door until readiness for micturition. All participants performed the TRV twice. Reliability were assessed by the intraclass correlation coefficient (ICC) and convergent validity by Spearman correlation coefficient.ResultsWe included 71 PwMS (mean [SD] age 54.4 [11.7] years). Inter-rater reliability was excellent for the TRV mobility stage (ICC: 0.97), settled stage (ICC: 0.99) and total test (ICC: 0.99). Test–retest reliability was good for the mobility stage (ICC: 0.88) and total test (ICC: 0.81) and moderate for the settled stage (ICC: 0.67). Test–retest reliability assessed by a Likert-type scale was good for each stage (κ 0.75 and 0.88). The mobility stage was correlated with the scores for the Timed Up and Go test, 10-Meter Walk Test, and Tinetti Mobility Test (ρ = 0.89; ρ = 0.88; ρ = −0.67, respectively; P < 0.0001) and the settled stage with scores for the Tinetti Mobility Test, Functional Independence Measure and Nine Hold Peg test (right) (ρ = −0.48; ρ = −0.36; ρ = 0.31, respectively; P < 0.01). Comprehension, acceptance and relevance were rated good by most participants (97%, 95% and 90%, respectively).ConclusionThe TRV is a new tool to measure the global time needed to be ready to achieve micturition in PwMS. It seems useful in clinical practice for overactive bladder in addition to the classical warning time because it takes into account all the time needed to accomplish micturition (mobility, undressing, installation).     

Nursing students' knowledge and attitudes toward urinary incontinence: A cross-sectional survey

BackgroundNurses must have adequate knowledge to manage the complexities of urinary incontinence. Nursing students are the nurses of the future, yet little is known about urinary incontinence education in undergraduate nursing programs.ObjectivesThe aim of this study was (a) to assess the knowledge and attitudes of urinary incontinence held by undergraduate nursing students in China and (b) to explore the relationship between knowledge, attitudes and socio-demographic characteristics.DesignA cross-sectional survey using cluster random sampling.SettingsUndergraduate departments of Nursing within the Faculty of Health Sciences at six Universities, located in different areas of China.ParticipantsA random selection of 6 faculties with a total of 1313 full time undergraduate nursing students completed the survey.MethodsSelf-reported data were collected using two validated questionnaires, the Urinary Incontinence Knowledge Scale and the Urinary Incontinence Attitude Scale, to access students' knowledge and attitudes toward urinary incontinence.ResultsOverall urinary incontinence knowledge was poor (49.9%, 15.0/30) and attitudes about urinary incontinence were generally positive (71.7%, 43.0/60). A high level of interest in learning more about urinary incontinence was found. There was a weak correlation between urinary incontinence knowledge and attitudes (r = 0.135, p < 0.01). There was also a significant positive correlation between urinary incontinence knowledge and attitudes and nursing students' year of study, urinary incontinence education and training, and formal clinical practicum experience in urology (p < 0.05).ConclusionsChinese nursing students showed poor urinary incontinence knowledge but generally positive attitudes toward urinary incontinence. This study suggests there is a need to examine urinary incontinence content throughout undergraduate nursing curricula in China.     

Beneficial effects of biofeedback-assisted pelvic floor muscle training in patients with urinary incontinence after radical prostatectomy: A systematic review and metaanalysis

ObjectivesThis systematic review and metaanalysis compared the effects of biofeedback-assisted pelvic floor muscle training with those of pelvic floor muscle training alone in patients with urinary incontinence after radical prostetactomy.DesignA review and metaanalysis study design.Data sourcesThe metaanalysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A systematic search of PubMed/Medline OVID, the Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, BioMed Central, Web of Science, Chinese Electronic Periodical Services, Chinese Journal and Thesis Database, and China National Knowledge Infrastructure was performed for retrieving records.Review methodsFor determining the effects of training type on urinary incontinence, randomized controlled trials on biofeedback-assisted pelvic floor muscle training with or without electrical stimulation were compared with those on pelvic floor muscle training with or without electrical stimulation, respectively, in the metaanalysis. The Cochrane Collaboration tool in the Cochrane Handbook for Systematic Review of Interventions 5.1.0 was used to assess the methodological quality of the included trials. Subjective and objective measurement of urinary incontinence improvement and the quality of life were the primary and secondary outcome measures, respectively. Data were analyzed using Comprehensive Meta-Analysis software 2.0. In addition, subgroup analyses and metaregression were performed to explore the possible sources of heterogeneity.ResultsThirteen randomized controlled trials involving 1108 patients with prostatectomy incontinence were included. The immediate-, intermediate-, and long-term effects of objectively measured biofeedback-assisted pelvic floor muscle training on urinary incontinence were significant (mean effect size = −0.316, −0.335, and −0.294; 95% CI: −0.589 to −0.043, −0.552 to −0.118 and −0.535 to −0.053; p = 0.023, 0.002, and 0.017, respectively) when compared with those of pelvic floor muscle training alone. However, when urinary incontinence was measured subjectively, only the intermediate and long-term effects of biofeedback were found (p = 0.034 and 0.005, respectively). Small-to-moderate immediate- and intermediate-term effects on the quality of life were observed when biofeedback-assisted pelvic floor muscle training was compared with pelvic floor muscle training alone. No publication bias was observed among studies.ConclusionsBiofeedback can be an adjunct treatment to pelvic floor muscle training for reducing urinary incontinence in patients who have undergone radical prostatectomy.     

Effectiveness of a role-play simulation program involving the sbar technique: A quasi-experimental study

BackgroundAccurate, skilled communication in handover is of high priority in maintaining patients' safety. Nursing students have few chances to practice nurse-to-doctor handover in clinical training, and some have little knowledge of what constitutes effective handover or lack confidence in conveying information.ObjectivesThis study aimed to develop a role-play simulation program involving the Situation, Background, Assessment, Recommendation technique for nurse-to-doctor handover; implement the program; and analyze its effects on situation, background, assessment, recommendation communication, communication clarity, handover confidence, and education satisfaction in nursing students.DesignNon-equivalent control-group pretest-posttest quasi-experimental.ParticipantsA convenience sample of 62 senior nursing students from two Korean universities.MethodThe differences in SBAR communication, communication clarity, handover confidence, and education satisfaction between the control and intervention groups were measured before and after program participation.ResultsThe intervention group showed higher Situation, Background, Assessment, Recommendation communication scores (t = − 3.05, p = 0.003); communication clarity scores in doctor notification scenarios (t = − 5.50, p < 0.001); and Situation, Background, Assessment, Recommendation education satisfaction scores (t = − 4.94, p < 0.001) relative to those of the control group. There was no significant difference in handover confidence between groups (t = − 1.97, p = 0.054).ConclusionsThe role-play simulation program developed in this study could be used to promote communication skills in nurse-to-doctor handover and cultivate communicative competence in nursing students.     

The effect of obesity on testicular function by insulin-like factor 3, inhibin B,and leptin concentrations in obese adolescents according to pubertal stages

ObjectivesThe aim of the present study is to investigate the effect of obesity on testicular function by evaluating reproductive hormones, inhibinB, insulin-like 3(INSL3), and leptin, in obese and non-obese adolescents according to pubertal Tanner stages.Design and methodsEighty adolescent boys were grouped (n = 20) as; Group1: obese-Tanner2, Group2: non-obese-Tanner2, Group3: obese-Tanner4, Group4: non-obese-Tanner4. Serum INSL3, luteinizing hormone, follicle-stimulating hormone, total testosterone, free testosterone, estradiol, sex hormone binding globulin, inhibin B and leptin levels were assessed in all groups.ResultsINSL3 levels were significantly lower in obese adolescents compared to non-obese boys (p = 0.003, Tanner2) and (p = 0.031, Tanner4). There was a negative correlation between INSL3 and leptin (r = ?0.468, p = 0.001). The negative correlation between INSL3 and BMISDS indicates that pubertal obesity leads to Leydig cell impairment.ConclusionsThis study demonstrated for the first time in the literature that obesity effects testicular Leydig cell function starting from Tanner stage 2.     

The effect of quality circles on job satisfaction and quality of work-life of staff in emergency medical services

IntroductionQuality circles, as a participatory management technique, offer one alternative for dealing with frustration and discontent of today’s workers. This study was conducted to investigate the effect of implementation of quality circles on nurses’ quality of work-life and job satisfaction.Materials and methodsIn this study, two emergency medical services (EMS) of Hamedan province were selected and randomly assigned as the experimental and control groups. After the experimental group was trained and quality circles were established in this group, the levels of quality of work-life and job satisfaction were measured in the two groups. Then, the statistical analyses were performed using t-test.ResultsAfter the intervention, the results showed significant differences between the scores of motivational factors (p = 0.001), the total scores of job satisfaction (p = 0.003), and the scores of some quality of work life (QWL) conceptual categories including the use and development of capacities (p = 0.008), the total space of life (p = 0.003), and the total scores of QWL (p = 0.031) in the experimental group compared to those in the control group.ConclusionThis study confirms the effectiveness of quality circles in improving quality of work-life and job satisfaction of nurses working in EMS, and offers their application as a management method that can be used by EMS managers.     

Plasma and synovial fluid sclerostin are inversely associated with radiographic severity of knee osteoarthritis

ObjectiveThe purpose of this study was to analyze sclerostin in plasma and synovial fluid of knee osteoarthritis (OA) patients and to investigate the association between sclerostin levels and radiographic severity.Design and methodsA total of 190 subjects (95 knee OA patients and 95 healthy controls) were recruited in the present study. Sclerostin levels in plasma and synovial fluid were assessed using an enzyme-linked immunosorbent assay. OA grading was performed using the Kellgren–Lawrence classification.ResultsPlasma sclerostin levels were significantly lower in OA patients than in healthy controls (P = 0.004). Additionally, sclerostin levels in plasma were significantly higher with respect to paired synovial fluid (P < 0.001). Moreover, sclerostin levels in plasma and synovial fluid demonstrated a significant inverse correlation with the radiographic severity of knee OA (r = − 0.464, P < 0.001 and r = − 0.592, P < 0.001, respectively). Subsequent analysis revealed that there was a positive correlation between plasma and synovial sclerostin levels (r = 0.657, P < 0.001).ConclusionsSclerostin was significantly lower in OA plasma samples when compared with healthy controls. Plasma and synovial fluid sclerostin levels were inversely associated with the radiographic severity of knee OA. Therefore, sclerostin may be utilized as a biochemical marker for reflecting disease severity in primary knee OA.     

The association of eating performance and environmental stimulation among older adults with dementia in nursing homes: A secondary analysis

BackgroundNursing home residents with dementia experience increased risk for compromised eating performance due to intrapersonal, interpersonal, and environmental factors. Environmental stimulation is physical, social, and/or sensory stimulation present in the environment that can potentially trigger individuals’ emotion or motivate physical reactions. Beyond the personal factors, there is a lack of evidence on how environmental stimulation influences individuals’ eating performance at mealtimes.ObjectivesThis study examined the association between environmental stimulation and eating performance among nursing home residents with dementia.DesignThis study was a secondary analysis using baseline videos selected from a communication intervention study, where videos were recorded to capture staff-resident interactions during care activities for nursing home residents with dementia. Videos were included in this study only if residents demonstrated eating activities at mealtimes.Sample and settingA total of 36 videos were selected (mean length = 4 min). The sample included 15 residents with dementia (mean age = 86), and 19 certified nursing assistants (mean age = 36) in 8 nursing homes.MethodsThe dependent variable was eating performance as measured by the Level of Eating Independence scale (range: 15–36, with higher scores indicating better eating performance). The independent variables were characteristics of environmental stimulation measured by the Person-Environment Apathy Rating-Environment subscale (stimulation clarity, stimulation strength, stimulation specificity, interaction involvement, physical accessibility, and environmental feedback). Each characteristic was rated on a 1–4 scale with higher scores indicating more desirable environmental stimulation. Multilevel models were used to examine the association between eating performance and environmental stimulation, adjusting for resident characteristics (i.e., age, gender, dementia stage, function, comorbidity, psychoactive medication use) and nesting effects of residents and staff.ResultsResident participants demonstrated moderate levels of eating performance (M = 27.08, SD = 5.16). Eating performance was significantly lower among older residents, those with more advanced dementia, and higher comorbidity. After controlling for resident characteristics, eating performance was significantly associated with stimulation specificity (how the stimulation is delivered and tailored to the resident), and was not associated with other environmental stimulation characteristics. For each 1 point increase in stimulation specificity, eating performance increased by 8.78 points (95% CI=0.59, 16.97).ConclusionsEnvironmental stimulation that is personally tailored to a resident’ needs and preferences and directly offered to a resident contributed to better eating performance among residents with dementia. The findings will direct future development and implementation of person-directed mealtime care programs and dining environment arrangements for residents with dementia in nursing homes.     

Job satisfaction as a mediator between structural empowerment and intent-to-leave: A study of critical care nurses

BackgroundNurse turnover is an issue that impacts a hospital’s financial resources and the quality of patient care. There is a need to discover what actions can be taken to improve nurse retention.ObjectiveNurses’ job satisfaction has been shown to improve organizational outcomes, such as nurses’ retention. The objective of this study is to examines the relationship between intent to leave, job satisfaction and structural empowerment (SE), providing a theoretical basis for further research.MethodsA convenience sample of 83 critical care nurses, recruited from two Facebook groups and the AACN website. The nurses completed a survey that used three tools; Conditions of Work Effectiveness II (CWEQ II), Job Satisfaction Survey (JSS), and Turnover Intention (TIS-6) to address 4 hypotheses to determine the relationship of the three constructs.ResultsFindings indicated that SE was not significantly related to intent-to-leave; SE was positively related to job satisfaction (β = 0.760, p < 0.01) , and job satisfaction was negatively related to Intent-to-leave (β = −0.610, p < 0.01).ConclusionThe research provided a theoretical framework for further research on SE and its importance in improving job satisfaction and reducing turnover in critical nurse.     

Online intravenous pump emulator: As effective as face-to-face simulation for training nursing students

BackgroundThe expansion of online education for nursing students has created the challenge of finding innovative ways to teach clinical skills. An online intravenous pump emulator (IVPE) modelled on actual IV pumps used in clinical healthcare settings was developed to facilitate online education delivery.ObjectivesThe objectives of the study were to implement the online IVPE and evaluate student learning outcomes and perceptions of device use.DesignA mixed method, quasi-experimental design was used.SettingThe study was conducted in the School of Nursing and Midwifery at a regional university in Queensland, Australia.ParticipantsParticipants were 179 first year nursing students enrolled in a medications course, ranging in age from 18 to 44 years, of whom 150 were female.MethodsParticipants were assigned to one of three groups and trained in the use of IV infusion pumps. Group 1 (n = 57) were trained online using the IVPE (ONL); Group 2 (n = 73) were trained on-campus using an actual IV pump (ONC); Group 3 (n = 49) were trained both on-campus using the actual IV pump and online using the IVPE (ONL + ONC). Competence in using the actual IV pump was assessed for all participants at the conclusion of the training period.ResultsNo significant differences in learning outcomes, measured by assessment scores out of 80 points, were found between the ONL (M = 65.5 ± 9.2) and ONC (M = 62.0 ± 14.8; p > .05) groups. Significantly better learning outcomes were evident for the ONL + ONC group (M = 68.7 ± 4.9) compared to the ONC group (p < .01).ConclusionsThis study highlights that the nursing students became more competent in the skill of preparing and administrating IV infusions when face-to-face and online learning were combined.     

Parenting and childhood atopic dermatitis: A cross-sectional study of relationships between parenting behaviour,skin care management,and disease severity in young children

BackgroundThe development of child behaviour and parenting difficulties is understood to undermine treatment outcomes for children with atopic dermatitis. Past research has reported on correlates of child behaviour difficulties. However, few research studies have sought to examine parenting confidence and practices in this clinical group.ObjectivesTo examine relationships between child, parent, and family variables, parent-reported and directly-observed child and parent behaviour, parents’ self-efficacy with managing difficult child behaviour, self-reported parenting strategies, and disease severity.DesignCross-sectional study design.ParticipantsParent-child dyads (N = 64) were recruited from the dermatology clinic of a paediatric tertiary referral hospital in Brisbane, Australia. Children had a diagnosis of atopic dermatitis of ≥3 months and no other chronic health conditions except asthma, allergic rhinitis, or allergy.MethodsParents completed self-report measures assessing child behaviour; parent depression, anxiety, and stress; parenting conflict and relationship satisfaction; self-efficacy with managing difficult child behaviour, and use of ineffective parenting strategies; and self-efficacy for managing atopic dermatitis, and performance of atopic dermatitis management tasks. The Scoring Atopic Dermatitis index was used to assess disease severity. Routine at-home treatment sessions were coded for parent and child behaviour.ResultsPearson’s and Spearman’s correlations identified relationships (p < 0.05) between self-efficacy with managing difficult child behaviour and child behaviour problems, parent depression and stress, parenting conflict and relationship satisfaction, and household income. There were also relationships between each of these variables and use of ineffective parenting strategies. Greater use of ineffective parenting strategies was associated with more severe atopic dermatitis. Using multiple linear regressions, child behaviour and household income explained unique variance in self-efficacy for managing difficult child behaviour; household income alone explained unique variance in use of ineffective parenting strategies. Self-efficacy for managing difficult child behaviour and self-efficacy for managing atopic dermatitis were positively correlated (rho = 0.48, p < 0.001), and more successful self-reported performance of atopic dermatitis management tasks correlated with less permissive (r = 0.35, p = 0.005) and less authoritarian (r = 0.41, p = 0.001) parenting. Directly observed aversive child behaviour was associated with more severe atopic dermatitis, parent stress, and parent-reported child behaviour problems.ConclusionThis study revealed relationships between parents’ self-efficacy and parenting practices across the domains of child behaviour management and atopic dermatitis management. Parents of children with more severe atopic dermatitis may have difficulty responding to child behaviour difficulties appropriately, potentially impacting on illness management. Incorporating parent and parenting support within treatment plans may improve not only child and family wellbeing, but also treatment outcomes.     

Association between myeloperoxidase polymorphisms and its plasma levels with severity of coronary artery disease

ObjectivesMyeloperoxidase (MPO) polymorphism ?463 has been related to higher cardiovascular risk. This study was conducted to test whether the MPO promoter polymorphism ?463A/G and MPO plasma levels are associated with coronary artery disease (CAD) severity.Design and methodsPatients submitted to elective coronariography were enrolled, CAD severity was assessed and blood samples collected to identify the MPO polymorphism and its plasma levels.ResultsGenotypes were determined in 118 patients. Among these patients, 12 (10%) were homozygous for AA, 69 (58%) for GG and 37 (32%) were heterozygous. Mean MPO plasma levels were 8.6 ± 4.7 ng/mL for AA, 8.6 ± 7.0 ng/mL for AG and 9.4 ± 5.6 ng/mL for GG genotypes. The CAD severity was not associated with MPO genotypes (p = 0.43), however, patients with higher CAD score presented higher MPO levels (p = 0.02).ConclusionWe found no association between MPO polymorphism and CAD severity, although a relation was observed for MPO plasma levels and extension of CAD.