Burnout and its correlates among nursing staff: questionnaire survey

AIM: This paper is a report of a study to determine the burnout level and its correlates in nurses. BACKGROUND: Healthcare providers and especially nurses are generally considered a high risk group regarding work stress and burnout and this syndrome has been a major concern in the field of occupational health. METHOD: The study was carried out at a university hospital in Turkey during May-June 2005. A total of 418 nurses from the 474 working at the hospital at the time (88.2%) answered a self-administered questionnaire including the Maslach Burnout Inventory. FINDINGS: All the nurses were female, with a mean age of 30.6 (5.4) and a median age of 29 years. The mean score was 17.99(6.35) for the Emotional Exhaustion subscale, 5.72 (3.87) for the Depersonalization subscale and 19.83 (4.66) for the Personal Accomplishment subscale. Emotional Exhaustion decreased with increasing age (P < 0.05). Total time in the job, weekly working hours, shift-working and the unit where employed influenced burnout scores (P < 0.05). Not being happy with relations with superiors, not finding the job suitable, feeling anxious about the future, perceived poor health, problems with personal life and financial difficulties were also factors influencing burnout scale scores (P < 0.05). CONCLUSION: It is necessary to consider nurses having the characteristics shown as the correlates of burnout in this study as a target group, to screen periodically the burnout status and improve their working conditions, especially relationships with colleagues.     

Leader-member exchange, organizational identification and the mediating role of job involvement for nurses

Title. Leader‐member exchange, organizational identification and the mediating role of job involvement for nurses. Aim. This paper is a report of a study to explore the relationship between leader–member exchange quality and organizational identification and the mediating role of job involvement in this relationship. Background. As a result of the fast‐changing structures and increasing competition, healthcare organizations increasingly demand highly qualified nurses who also have positive work attitudes towards the job and the organization. Among these positive work attitudes, organizational identification affects nurses’ job performance and, in turn, the quality of care and patient satisfaction. The quality of the relationship between nurse supervisors and nurses, which is examined in the leader–member exchange context, can be an important determinant for organizational identification. This relationship is also affected by nurses’ job involvement. Method. The sample consisted of 148 nurses working in a private general hospital. Questionnaires, which included measures for organizational identification, level of leader–member exchange quality, job involvement and questions about the demographic characteristics of the sample, were distributed in 2007. The response rate was 87%. Results. A statistically significant and positive relationship was found between leader–member exchange quality and organizational identification. The results also reveal that job involvement mediates the positive effects of leader–member exchange quality on organizational identification. Conclusion. If nurse supervisors increase their awareness of the effects of their behaviours towards their nurses, they can increase the nurses’ performance and achieve desired results through increasing job involvement and organizational identification.     

Novel quantitative techniques for assessing regional and global function and structure based on modern imaging modalities: implications for normal variation, aging and diseased states

In this review, we describe the current approaches used for quantitative assessment of regional and global function with positron emission tomography (PET) imaging (combined with structural imaging modalities) with emphasis on both research and clinical applications of this powerful approach. We particularly refer to the impact of such measurements in assessing physiological processes such as aging and measuring response to treatment in serious disorders such as cancer. Although a multitude of methods has been described in literature, the optimal approaches that are both accurate and practical in clinical settings need to be defined and refined. Standardized uptake value (SUV) continues to be the most widely used index in the current practice. Calculating SUV at a single time point and assigning standard regions of interest are inadequate and suboptimal for the purposes adopted by the medical community. The concepts of partial volume correction for measured values in small lesions, dual-time point and delayed PET imaging, and global metabolic activity for assessment of various stages of disease may overcome deficiencies that are associated with the current quantitative (ie, SUV) techniques. Serious consideration of these concepts will enhance the role and reliability of these quantitative techniques, and therefore compliment the World Health Organization or the Response Evaluation Criteria in Solid Tumors (RECIST) criteria for managing patients with cancer and other disorders, including physiological states such as aging and serious diseases such as atherosclerosis and neurological diseases. We also introduce the concepts that allow for segmentation of various structural components of organs like the brain for accurate measurement of functional parameters. We also describe complicated kinetic modeling and methodologies that have been used frequently for assessing metabolic and pharmacological parameters in the brain and other organs. Simplified quantitative techniques based on these concepts are described, but should be validated against the kinetic models to test their role as practical tools.     

Determination of age-related changes in structure and function of skin, adipose tissue, and skeletal muscle with computed tomography, magnetic resonance imaging, and positron emission tomography

In this article, we report quantitative preliminary data obtained from retrospective analysis of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) and combined PET-computed tomography (PET/CT) examinations in subjects ages 3 to 84 years pertaining to changes in the metabolism of skin, subcutaneous adipose tissue, visceral adipose tissue, and skeletal muscle with age, as well as age-related changes in skeletal muscle attenuation. We also propose a new method for identifying hypermetabolic brown fat on FDG-PET. Finally, we present a review of the literature regarding reported age-related structural and functional changes that occur in skin, fat, and skeletal muscle. Using FDG-PET, We evaluated 213 subjects for changes in the metabolism of skin, adipose tissue, and skeletal muscle with aging. Thirty-two separate subjects were chosen to measure maximum standardized uptake value (SUV) of hypermetabolic brown fat on dual-time point PET imaging. Finally, 15 subjects evaluated by PET/CT were selected to measure changes in metabolism and attenuation of skeletal muscle, and changes in metabolism of adipose tissue with aging. We found that skin, fat, and skeletal muscle all demonstrate significant (P < 0.05) increases in SUV with increasing age on PET imaging. Dual-time point PET imaging demonstrates increasing FDG uptake of hypermetabolic brown fat in various regions studied. Finally, our PET/CT studies revealed statistically insignificant (P > 0.05) decreases in SUV of adipose tissue with aging and the opposite trend in skeletal muscles (P > 0.05). Skeletal muscle attenuation in the various regions studied was found to significantly decrease with age (P < 0.05). Our study shows notable trends in metabolism and attenuation of skeletal muscle and metabolism of skin and adipose tissue that occur with normal aging. We hope that the methodologies and data we present here will serve as a useful starting point for those interested in conducting future prospective research on age-related changes in these structures.     

彭玉教授活血通络法在小儿肺炎喘嗽中的应用

本文从肺炎喘嗽发生瘀血的理论基础、肺络气血瘀阻等方面总结彭玉教授治疗小儿肺炎喘嗽临床诊治经验,即以活血通络法辨治肺炎喘嗽,灵活把"活血通络"法运用其中.文章通过对彭玉教授经验理论的整理,对以"活血通络"法治疗小儿肺炎喘嗽验案的举隅,为临床上治疗小儿肺炎喘嗽提供有效的理论临床方法.     

The relationship of carotid intima-media thickness with anthropometric and metabolic parameters in patients with classic congenital adrenal hyperplasia

Background/aimWe aimed to determine the presence of subclinical atherosclerosis using carotid intima-media thickness (CIMT) and biochemical parameters in children and adolescents with congenital adrenal hyperplasia (CAH).Materials and methods Thirty-four patients with classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency on regular glucocorticoid treatment for ≥3 years and 31 healthy subjects were included in the study. The patients were divided into two groups according to the degree of control of the clinic, laboratory, and radiological parameters as a) “uncontrolled” [n= 22; with increased height velocity (HV) standard deviation score (SDS) (≥2 SDS), advanced bone age, serum 17-OH progesterone <2.0 and ≥10.0 ng/mL or androstenedione <0.3 and ≥ 3.0 ng/mL] or b) “controlled” [n= 12; with HV SDS < 2, bone age (BA)/ chronologic age (CA) ratio < 1.2, serum 17-OH progesterone between 2 and 10 ng/mL and androstenedione between 0.3 and 3.0 ng/mL]. Ultrasonographic examination of carotid artery was performed by the same radiologist using a B-mode ultrasound system.Results There was no significant difference between the CAH and control groups in terms of median (IQR) CIMT values [0.47 (0.05) mm and 0.47 (0.07) mm, respectively; p > 0.05]. When subgroup comparisons were done in terms of median (IQR) CIMT values, there was no significant difference among the controlled, uncontrolled, and healthy control groups [0.45 (0.03) mm, 0.47 (0.04) mm, 0.47 (0.07) mm, respectively; p> 0.05]. In addition, CIMT levels were similar according to sex and disease control status.Conclusion In this study, the CIMT values of CAH cases were similar to those of healthy subjects.     

The relationship between breast milk intake and speech in children with cerebral palsy

Background/aimCerebral palsy (CP) is a nonprogressive neurodevelopmental disorder that cause damage to the developing brain (0–3 years) for various reasons. Children with CP commonly have speech disorders due to impairment in neuromuscular control of oro-motor coordination. We focused on the relationship between breast milk intake and speech functions in children with CP.Materials and methodsThe gross motor function classification system (GMFCS) was used to categorize the gross motor function. The viking speech scale (VSS) was used to classify the speech in children with cerebral palsy. Children were subdivided into two groups as term and preterm based on gestational age. The duration of exclusive breast milk intake was defined as the period when the infant received breast milk alone. We used Spearman’s correlation coefficient to evaluate the relationship between the duration of breast milk intake, GMFCS, and VSS.Results The median level of viking speech scale was 2 in preterm-born children and 4 in term-born children. There was no correlation between age and VSS levels.We observed a statistically significant difference in terms of preterm- or term-born status among children with different VSS levels. There was a weak positive correlation between birth weight and VSS level, indicating better speech function in children with lower birth weight. There was a moderate negative correlation between the duration of exclusive breast milk intake, the total duration of breast milk intake, and the corrected age of weaning completion with VSS level.Conclusion The duration of breast milk intake may reflect the oromotor function and predict speech performance in children with cerebral palsy. We wanted to emphasize that speech language therapy is as important as motor rehabilitation.