Leadership: the key to quality outcomes

Nurse executives are charged with creating a workforce that provides quality care in a creative and cost-effective manner. Style of leadership determines how nurse executives relate to their professional nurses and ultimately how successful their health care institutions will be. The practice-based theory of nursing leadership called the Integrated Leadership Practice Model can be practiced by nurse executives to promote employee satisfaction, assure that quality care is provided based on standards and competencies, and promote an organizational culture committed to quality. This article proposes the application of integrated leadership to the practice of nurse executives and demonstrates how they can foster and support this model for nursing leadership within their nurse managers.     

Correlation between gingival crevicular fluid dipeptidyl peptidase II and IV activity and periodontal attachment loss. A 2–year longitudinal study in chronic periodontitis patients

OBJECTIVE: The aim of this study is to determine whether gingival crevicular fluid (GCF) dipeptidyl peptidase (DPP) II or IV levels, total activity (TA) and concentration (EC), predict progressive attachment loss (AL). SUBJECTS AND METHODS: Seventy five patients with moderate periodontitis were recruited. GCF was first collected from 16 molar and premolar mesiobuccal sites and then probing attachment level (PAL) and probing pocket depth (PPD) were measured with an electronic probe. Finally, gingival index, gingival bleeding and plaque indices were scored. Patients were given basic periodontal treatment prior to baseline after which the above procedures were repeated. Patients were seen 3 monthly for 2 years and the procedures were repeated. Carefully localised radiographs were taken of the test teeth annually. RESULTS: One hundred and twenty AL sites, 88 rapid AL (RAL) and 32 gradual AL (GrAL), in 48 patients were detected. DPP It and IV levels (TA and EC) at RAL sites were significantly higher (P ≤ 0.0001) than paired control sites at the attachment loss time (ALT) and prediction time (PT). Mean levels over the study period of both proteases (TA and EC) at GrAL sites were significantly higher (P≤ 0.0001) than paired control sites. The GCF levels of DPP IV were always slightly higher than those of DPP II. Critical values (CV) of 5 μU per 30 s (TA) and 25 μU μPI^-1 (EC) for both proteases showed high sensitivity and specificity values for TA and EC and these were the same at both ALT and PT. The positive predictive values were slightly higher for DPP II. Mean site DPP II and IV levels (TA and EC) in intra-patient comparisons were significantly higher (P ≤ 0.0001) at RAL and GrAL sites than non-attachment loss (NAL) sites in AL patients and mean patient levels were significantly higher (P ≤ 0.0001) in AL patients than NAL patients in inter-patient comparisons. CONCLUSIONS: These results indicate that both GCF DPP II and IV may be predictors of periodontal attachment loss.     

Initial Experience with a New Technique of Binding Pancreaticogastrostomy: A Prospective Study

Aim

To study postoperative complications in patients undergoing binding pancreaticogastrostomy (PG) following pancreaticoduodenectomy (PD) in a tertiary hospital in India.

Methods

A prospective study was conducted of patients undergoing binding PG following PD over a 2-year period. The demographic and preoperative laboratory data of the patients, the type of procedure, complications, hospital mortality, duration of hospital stay, and postoperative interventional procedures or reoperations were recorded and examined for associations. Statistical analysis was performed using Stata 9.0 (College Station, Texas, USA).

Results

Over 2 years, 47 patients, 29 men and 18 women, mean age 55.4 ± 11.6 years, who underwent binding PG following PD were included in the study. Postoperative complications were recorded in 23 patients and there were 2 deaths in the first 30 days following surgery. The most frequent complication was delayed gastric emptying (DGE), observed in 11 patients (23%), with a mean duration of 13.5 ± 2.6 days. Post-operative pancreatic leak, which was detected in 3 patients (6%), did not appear to be influenced by the pancreatic duct diameter or the softness of the pancreas, which are known independent factors responsible for pancreatic leak.

Conclusion

The technique of binding PG is simple, safe, easy to perform, and less traumatic to the pancreatic stump, with fewer complications, and it can be performed without significant adverse outcome, irrespective of pancreatic stump texture or pancreatic duct diameter.

     

In Vivo Ethanol Experience Increases D2 Autoinhibition in the Ventral Tegmental Area

Alcoholism is characterized by compulsive alcohol intake after a history of chronic consumption. A reduction in mesolimbic dopaminergic transmission observed during abstinence may contribute to the negative affective state that drives compulsive intake. Although previous in vivo recording studies in rodents have demonstrated profound decreases in the firing activity of ventral tegmental area (VTA) dopamine neurons after withdrawal from long-term ethanol exposure, the cellular mechanisms underlying this reduced activity are not well understood. Somatodendritic dopamine release within the VTA exerts powerful feedback inhibition of dopamine neuron activity via stimulation of D₂ autoreceptors and subsequent activation of G protein-gated inwardly rectifying K⁺ (GIRK) channels. Here, by performing patch-clamp recordings from putative dopamine neurons in the VTA of mouse brain slices, we show that D₂ receptor/GIRK-mediated inhibition becomes more potent and exhibits less desensitization after withdrawal from repeated in vivo ethanol exposure (2 g/kg, i.p., three times daily for 7 days). In contrast, GABA_B receptor/GIRK-mediated inhibition and its desensitization are not affected. Chelating cytosolic Ca²⁺ with BAPTA augments D₂ inhibition and suppresses its desensitization in control mice, while these effects of BAPTA are occluded in ethanol-treated mice. Furthermore, inositol 1,4,5-trisphosphate (IP₃)-induced intracellular Ca²⁺ release and Ca²⁺/calmodulin-dependent protein kinase II are selectively involved in the desensitization of D₂, but not GABA_B, receptor signaling. Consistent with this, activation of metabotropic glutamate receptors that are coupled to IP₃ generation leads to cross-desensitization of D₂/GIRK-mediated responses. We propose that enhancement of D₂ receptor-mediated autoinhibition via attenuation of a Ca²⁺-dependent desensitization mechanism may contribute to the hypodopaminergic state during ethanol withdrawal.     

Variation of Cadmium Concentration in Swedish Wheat and Barley

In order to evaluate whether or not an increase in daily cadmium intake may be taking place, 75 wheat samples (spring wheat and fall wheat) harvested from the same “nonpolluted” farm fields between the years 1916 and 1972 were analyzed.

The individual scatter was large but a significant (P<.05) tendency toward increasing concentration with time was evident for fall wheat. A similar tendency was found for spring wheat, though not a statistical significance. This increase may be explained by general air contamination or the cumulative effect of fertilizers.

There was a clear covariation in cadmium concentrations of different genotypes of wheat and barley harvested in the same year despite yearly variations in average concentration.     

Swords to ploughshares — improving the world's Health

Unemployment and war are the greatest threats to world health. Arms conversion industries and alternative technology developments create socially‐useful products using skills and ingenuity which are otherwise wasted by unemployment or in armaments industries. Arms conversion decreases our capacity for destruction, provides worthwhile employment and produces goods for which there is a real social need.