Clinical nursing leaders', team members' and service managers' experiences of implementing evidence at a local level

kitson a., silverston h., wiechula r., zeitz k., marcoionni d. & page t. (2011) Journal of Nursing Management 19 , 542–555
Clinical nursing leaders’, team members’ and service managers’ experiences of implementing evidence at a local level Aim To describe the experiences of 14 clinical nursing leaders introducing a knowledge translation (KT) project into one metropolitan acute care hospital in South Australia. The study also explored team members’ and service managers’ experiences. Background KT strategies assume that local (nursing) clinical leaders have the capacity and capability to champion innovation combining positional leadership roles (ward leader) with a project lead role. There is limited evidence to support these assumptions. Method Semi-structured interviews of clinical nursing leaders and managers were undertaken at month 4 and 12 of the project. Data were also collected from the interdisciplinary team members (n = 28). Results Clinical nursing leaders identified risks and anxieties associated with taking on an additional leadership role, whereas managers acknowledged the multiple pressures on the system and the need for local level innovation. Team members generally reported positive experiences. Conclusions With support, clinical nursing leaders can effectively embrace KT project leadership roles that complement their positional leadership roles. Clinical nursing leaders’ experiences differed from nursing and medical managers’ experiences. Implications for nursing management Managers need to be more attuned to the personal risks local leaders experience, providing support for leaders to experiment and innovate. Managers need to integrate local priorities with broader system wide agendas.     

In vitro assessment of macrophage attachment and phenotype on polymerized phospholipid bilayers

Phosphatidyl choline (PC)-based materials have been found to be resistant to nonspecific protein adhesion in vitro. In this study, a PC-based planar supported phospholipid bilayer composed of 1,2-bis[10-(2',4'-hexadienoyloxy)decanoyl]-sn-glycero-3-phosphocholine (bis-SorbPC or BSPC) was generated on piranha-treated silicon wafers by vesicle deposition. The bilayer was polymerized with redox initiation forming a stable 4-nm thick coating. Polymerized lipid bilayers (PLBs) were characterized and tested for uniformity, with ellipsometry and contact angle. Cellular adhesion and morphological changes in RAW 264.7 macrophages were investigated in vitro on PLBs and compared to bare silicon controls. Fluorescent and scanning electron microscopy were used to observe changes in cellular morphology. The PLBs showed much lower cellular adhesion than bare silicon controls. Of the cells that attached to the PLBs, a very low percentage showed the same morphological expressions seen on the controls. It is hypothesized that proteins adsorb to the defects in the PLBs, caused by incomplete polymerization, and this mediates the observed minimal cellular attachment and morphological changes. ? 2011 Wiley Periodicals, Inc. J Biomed Mater Res Part A: , 2011.     

Neck motion patterns in whiplash-associated disorders: Quantifying variability and spontaneity of movement

Background

Whiplash-associated disorders have usually been explored by analyzing changes in the cervical motor system function by means of static variables such as the range of motion, whereas other behavioural features such as speed, variability or smoothness of movement have aroused less interest.

Methods

Whiplash patients (n = 30), control subjects (n = 29) and a group of people faking the symptoms of whiplash-associated-disorders (Simulators, n = 30) performed a cyclical flexion–extension movement. This movement was recorded by means of video-photogrammetry. The computed variables were: range of motion, maxima angular velocity and acceleration, and two additional variables that quantify the repeatability of a motion and its spontaneity. Two comparisons were made: Control vs. Patients and Patients vs. Simulators. At each comparison we used ANOVA to detect differences between groups and discriminant analysis to evaluate the ability of these variables to classify individuals.

Findings

Comparison between Controls and Patients showed significant reductions in the range of motion, and both the maximum of angular velocity and acceleration in the Patients. The most efficient discriminant model only included the range of motion and maximum angular velocity. Comparison between Patients and Simulators showed a significant reduction in all measured variables in the Simulators. The best classification model was obtained with maximum angular velocity, spontaneity and repeatability of motion.

Interpretation

Our results suggest that the pathological patterns differ from those of Controls in amplitude and speed of motion, but not in repeatability or spontaneity of movement. These variables are especially useful for detecting abnormal movement patterns.     

Pain sensitivity and pain reactivity in osteoarthritis

Objective

To assess experimental pain sensitivity and compare the inflammatory response to pain in 26 osteoarthritis (OA) patients and 33 age‐ and sex‐matched controls from the general population in order to examine the nature of the association between pain and inflammation in OA.

Methods

The participants underwent psychophysical pain testing to assess pain sensitivity in response to heat, cold, and mechanical stimuli. Blood samples were taken at baseline and at 4 time points after testing to determine the effect of acute pain on C‐reactive protein (CRP), interleukin‐6 (IL‐6), IL‐1β, and tumor necrosis factor α levels.

Results

OA patients had lower pressure pain thresholds (P ≤ 0.003) and higher heat pain ratings (P ≤ 0.04) than controls across multiple body sites. OA patients had higher CRP levels than controls (P = 0.007). CRP levels did not change in response to pain testing. Although not statistically significant, OA patients tended to have higher IL‐6 levels than controls (P = 0.12). IL‐6 levels increased after pain testing in OA patients and controls (P < 0.0001), but the amount of increase was not different between the 2 groups. Among OA patients, heightened pain sensitivity was associated with elevated CRP and IL‐6 levels (P ≤ 0.05).

Conclusion

Compared with controls, OA patients are more sensitive to experimental pain at multiple body sites. IL‐6 levels in OA patients and controls exhibited reactivity to acute painful stimuli, increasing at similar rates after psychophysical pain testing.     

Developmental outcomes in Malawian children with retinopathy-positive cerebral malaria

Objective To assess children with retinopathy‐positive cerebral malaria (CM) for neurocognitive sequelae. Methods Participants were selected from an ongoing exposure–control study. Eighty‐three Malawian children averaging 4.4 years of age and diagnosed with retinopathy‐positive CM were compared to 95 controls. Each child was classified as delayed or not using age‐based norms for the Malawi Developmental Assessment Tool (MDAT) for developmental delay on the total scale and for the domains of gross motor, fine motor, language and social skills. Groups were also compared on the Achenbach Child Behaviour Checklist (CBCL) (1.5–5 years). Results Children with retinopathy‐positive CM were delayed, relative to the comparison group, on MDAT total development (P = 0.028; odds ratio or OR = 2.13), with the greatest effects on language development (P = 0.003; OR = 4.93). The two groups did not differ significantly on the Achenbach CBCL internalizing and externalizing symptoms total scores. Stepwise regression demonstrated that coma duration, seizures while in hospital, platelet count and lactate level on admission were predictive of assessment outcomes for the children with retinopathy‐positive CM. Conclusions Children who suffer retinopathy‐positive CM at preschool age are at greater risk of developmental delay, particularly with respect to language development. This confirms previous retrospective study findings with school‐age children evaluated years after acute illness. The MDAT and the Achenbach CBCL proved sensitive to clinical indicators of severity of malarial illness.