The relevance of team characteristics and team directed strategies in the implementation of nursing innovations: A literature review

BackgroundImplementation of innovations is a complex and intensive procedure in which different strategies can be successful. In nursing, strategies often focus on intrinsic motivation, competencies and attitudes of individual nurses while ignoring the social context. Since nurses often work in teams, identifying relevant team characteristics and successful team directed strategies may contribute to the implementation of innovations. The literature was searched for evidence.MethodsA literature review was performed including key words related to nursing teams, innovations, team characteristics and team-directed strategies. On-line databases were searched (MEDLINE, CINAHL, PsycINFO, ERIC database and Cochrane reviews CENTRAL). The journal Quality and Safety in Healthcare (QSHC) was hand searched. Methodological quality was assessed.ResultsInitially, 323 titles were found. Screening of titles and abstracts and full texts resulted in nine articles meeting the inclusion criteria. The methodological quality of the studies was generally low. The innovations included different types of practices. Fifteen different team characteristics were labeled according to six features of successful teams.Twenty-one different team-directed strategies were identified and inductively categorized.ConclusionFew studies and little evidence were found for the relevance of team characteristics and team directed strategies in the implementation of nursing innovations. Feedback was most frequently used as a strategy. Leadership could be labeled as a team characteristic as well as a team directed strategy. Further research should be of good methodological quality and focusing on patient outcomes and time and costs invested in strategy delivery. This increases scientific knowledge on nursing implementation strategies focusing on leadership.     

Magnetic resonance imaging in size assessment of invasive breast carcinoma with an extensive intraductal component

Background  

Breast-conserving treatment of invasive breast carcinoma with an extensive intraductal component (EIC) is associated with DCIS-involved surgical margins and therefore it has an increased recurrence rate. EIC is a non-palpable lesion of which the size is frequently underestimated on mammography. This study was undertaken to evaluate the accuracy of MRI in size assessment of breast cancer with EIC.     

Residual susceptibility to measles among young adults in Victoria,Australia following a national targeted measles-mumps-rubella vaccination campaign

Background  

Past measles immunisation policies in Australia have resulted in a cohort of young adults who have been inadequately vaccinated, but who also have low levels of naturally acquired immunity because immunisation programs have decreased the circulation of wild virus. A measles-mumps-rubella (MMR) immunisation campaign aimed at addressing this susceptibility to measles among young adults was conducted in Australia in 2001–2. By estimating age-specific immunity, we aimed to evaluate the success of this campaign in the state of Victoria.     

In situ analysis of transforming growth factor-{beta}s (TGF-{beta}1, TGF-{beta}2, TGF-{beta}3and TGF-3 type II receptor expression in malignant melanoma

We have analysed, by in situ hybridization, mRNA expressionof TGF-ß1, TGF-ß2, TGF-ß3, andof TGF-ß type II receptor in benign melanocytic naevi,primary melanomas, and in skin metastases of malignant melanomas.Our results show that melanoma progression correlates with overexpressionof TGF-ß. All skin metastases and most primary melanomasinvasive to Clark's level IV-V revealed specific TGF-ß2mRNA and protein expression. However, expression of this cytokinewas not observed in benign melanocytic lesions and was detectedonly in one of five early primary melanomas investigated. Someprimary melanomas and skin metastases also revealed specificTGF-ß1 mRNA signals although expression of this isoformwas not found in benign naevi. TGF-ß3 expression,which was only barely detectable in benign melanocytic lesions,was enhanced in some skin metastases. Interestingly, the epidermisoverlaying melanomas revealed lower levels of TGF-ß3mRNA expression than epidermis of healthy skin or epidermisadjacent to benign naevi, thereby suggesting that paracrinemechanisms between tumour cells and keratinocytes may influencemelanoma development. In primary melanomas TGF-ß typeII receptor mRNA signals were much more heterogeneously distributedwhen compared to benign melanocytic naevi, suggesting variabledegrees of TGF-ß resistance among melanoma cells withinindividual lesions. However, melanoma progression appeared notto be correlated with a complete loss of TGF-ß typeII receptor gene expression, since all skin metastases revealedclearly detectable although heterogeneous levels of TGF-ßtype II receptor mRNA expression.     

MOTOR RESPONSE PROCESSING IN CLUMSY CHILDREN

Twelve clumsy children and 12 controls executed a four choice reaction time task in two compatibility conditions and three precue conditions. The experimental results indicated that the cognitive decision process of response selection contributed to the slow but not to the inaccurate performance of clumsy children. Clumsy children, compared with controls, had more problems with the translation of the stimulus code (s) to the response code (r) when this translation required more transformations. Response selection is a cognitive process that is likely to be important for deficits in perceptual-motor skills.     

Optical low coherence reflectometry for noncontact measurements of flap thickness during laser in situ keratomileusis

OBJECTIVE: There is growing evidence that iatrogenic keratectasia after laser in situ keratomileusis (LASIK) for high corrections occurs more frequently than initially assumed, and that it may result from larger variation in flap thickness. DESIGN: Consecutive noncomparative case series PARTICIPANTS: Thirty-four patients who underwent LASIK for myopia and astigmatism (first treatment group) and 10 patients who received re-LASIK (retreatment group). METHODS: Central corneal thickness and thickness of the lamella during LASIK were determined by optical low coherence reflectometry (OLCR) and contact ultrasound pachymetry. MAIN OUTCOME MEASURES: Thickness of the flap and its standard deviation, as well as its correlation with age, sphere, cylinder, corneal thickness, intraocular pressure, and corneal refractive power (K-readings). RESULTS: The mean flap thickness of the first treatment group determined by OLCR was 130 +/- 29 microm; the 95 percentile was 169 microm and the 5 percentile was 86 microm. The flap thickness was not correlated with any of the investigated demographic or refractive parameters. The mean flap thickness of the retreatment group was 152 +/- 14 microm; the 95 percentile was 175 microm and the 5 percentile was 137 microm. Thus, the flap thickness of the retreatment group was significantly thicker compared with the first treatment group (P < 0.001). CONCLUSIONS: Optical low coherence reflectometry (OLCR) was shown to be an appropriate alternative to ultrasonic preoperative and intraoperative corneal pachymetry in laser assisted in situ keratomileusis. The lack of correlation between achieved flap thickness and preoperative clinical data, such as corneal thickness, corneal curvature, intraocular pressure, and refraction, emphasizes the importance of measuring flap thickness and corneal bed thickness during surgery.