Educating for leadership: a programme designed to build a responsive health care culture

paterson k., henderson a. & trivella a. (2010) Journal of Nursing Management 18 , 78–83
Educating for leadership: a programme designed to build a responsive health care culture
Aim  To describe a leadership programme that progressively builds nurses capacity from the commencement of their employment to assist with the development of 'others'. Such an approach ultimately contributes to the creation of a team responsive to changing health care needs.
Background  The literature supports the relationship between positive leadership attributes, good nursing care and patient outcomes. Despite this, nurses are not routinely encultured into effective leadership practices early in their career, but rather they are 'added on' at a later stage according to organizational need.
Key issues  The effective education of leadership practices in this programme is largely dependent on an inclusive and embedded approach to learning. This is achieved through targeting staff early, enhancing their responses to clinical interactions in a structured and supported approach, and challenging their beliefs about capacity to influence through leadership.
Conclusions  Clinical leadership education needs to directly link with clinical areas to engage staff at the commencement of employment, and support them through their career trajectory, so that a systematic pathway of professional development is fostered.
Implications for nursing management  Clearly delineated progressive pathways for leadership development are essential to encourage lifelong reflection and learning that directly impacts on health care quality.     

Accountability: a core concept for primary nursing

Summary

• ? The aim of this paper is to explore how the theoretical definitions of accountability might be put into practice within a structure of primary nursing.
• ? Bergman's preconditions leading to accountability (1981) are discussed with respect to traditional ward organization and contrasted with primary nursing. The size of the case-load is identified as a significant factor in the way and the depth with which the concept is operationalized.
• ? Adaptations to nursing roles are necessary in order to facilitate accountability in action. The primary nurse is given authority as both case manager and line manager. The ward manager role changes to focus on resource management and developmental need.
• ? Changes of this nature lead to accountability being viewed in a positive light and an abstract concept becoming grounded in reality.

     

Heart Rate Turbulence in Chagas Disease

RIBEIRO, A.L.P., et al. : Heart Rate Turbulence in Chagas Disease. Heart rate turbulence (HRT) quantifies the biphasic response of the sinus node to ventricular premature complexes (VPCs) and is a powerful electrocardiogram related risk predictor. VPCs are frequent in Chagas disease, a potentially lethal illness, and can hamper the analysis by conventional methods of autonomic heart control. The aim of the study was to examine HRT in patients with Chagas disease. Chagas disease patients and healthy controls (group   0, n = 11   ) without other diseases were submitted to a standardized protocol, including electrocardiogram, echocardiography, and 24-hour Holter monitoring. Chagas disease patients were divided according to their left ventricular systolic function: normal (group   1, n = 103   ) and reduced ejection fraction (group   2, n = 23   ). Two HRT indices, turbulence onset (TO) and turbulence slope (TS), were calculated and compared among groups after adjustment for covariates like the prevalence of VPCs and the mean heart rate. Chagas disease patients had significantly altered TO (group 1: −0.0186, group 2: −0.0126) and TS (group 1: 10.844, group 2: 7.870) values in comparison with controls (TO − 0.0256, TS 19.829);   P < 0.001   for both comparisons. In conclusion, HRT data may be useful in the electrocardiographic analysis of autonomic heart control in Chagas disease. Its prognostic value remains to be determined. (PACE 2003; 26[Pt. II]:406–410)     

Serological reactivity to heat shock protein 70 in patients with hydatid disease

Heat shock protein 70 (hsp70) was chosen as a model antigen with which to investigate autoantibody production in humans with cystic hydatid disease. Levels of specific serum antibody were assessed in the sera of patients with surgically confirmed infection with E. granulosus and sera from non-infected controls. Antigens used were human hsp70, obtained from K562 cells grown in culture, and E. granulosus hsp70 obtained by expression of the full length protein in Escherichia coli following cloning of the associated mRNA. Antibody reactivity to human hsp70 was detected in the sera of only a small proportion of hydatid patients (10%) as well as a similar proportion of sera from age matched controls. Specific antibodies reactive with E. granulosus hsp70 were detected in 60% of hydatid patients, although some samples (21%) from healthy controls also reacted with E. granulosus hsp70, the level of reactivity was significantly higher in hydatid patients. This report identifies E. granulosus hsp70 as an immunogen during human hydatid infection but, despite its having a predicted 81% protein sequence homology with human hsp70, it does not appear to induce autoimmune reactivity against the homologous human protein.     

Multiple Intracoronary Stenting in Native Coronary Arteries and Saphenous Vein Grafts: A Single Center Experience

Objective: To determine the early and late clinical outcomes following multiple stent deployment during a single percutaneous transluminal coronary angioplasty (PTCA) procedure. Methods: All patients who received two or more stents during a single PTCA were reviewed. An analysis was made of 114 patients (mean age = 61.2 years). A total of 268 stents were deployed, range 2–6 stents per PTCA (mean = 2.4). Stenting was performed as a primary procedure in 38 patients, for arterial dissection in 44, and for threatened closure in 32. At least two stents were deployed in the same vessel in 101 (88.6%) patients. Before discharge from hospital, there were 4 (3.6%) deaths, 6 (5.2%) patients required emergency coronary artery bypass grafting (CABG), and 2 (1.8%) patients required repeat PTCA. Three (2.6%) patients sustained acute myocardial infarction (AMI). The mean follow-up period was 10.6 months. After leaving hospital, there were no deaths, 5 (4.4%) patients required CABG, and 5 (4.4%) had a further PTCA. There was one (0.9%) AMI. The total event rate was 19.2%, which compares well with single stent trials in which event rates of 20.1% and 19.5% were reached. In addition, 19 (16.7%) patients had a recurrence of symptoms. Conclusion: It is possible to deploy multiple stents at a single intervention in the same or different vessels safely and with clinical outcomes that are similar to those in studies of single coronary stenting.     

DIFFERENTIAL INHIBITION OF POLYMORPHONUCLEAR LEUCOCYTE FUNCTIONS BY CLORICROMENE

Leucocytes play an essential role in the pathogenesis of ischaemia and reperfusion injury and inhibition of their adhesion and of mediator release can reduce vascular and tissue damage. Previous studies have shown that cloricromene modifies several granulocyte as well as monocyte/macrophage functions and it has been shown that cloricromene administration exerts a clear protective action in several experimental models of ischaemia. The present work describes new data on polymorphonuclear leukocyte (PMN) inhibition exerted by cloricromene and compares these observations with earlier ones. Human washed PMN and human whole blood (HWB) were studied in vitro upon stimulation with f-MLP in the presence of cytochalasin B, with opsonized zymosan and with a phorbol ester (PMA). Amongst free radicals, superoxide anions were chosen as index of oxidative burst. Phagocytosis and beta-glucuronidase, as lysosomal release indicators, were measured to characterize PMN function: cloricromene inhibited concentration-dependently all the parameters upon stimulation by each activator tested. Experiments performed in rabbit whole blood (RWB) showed that cloricromene inhibited free radical generation with IC50 values similar to those obtained in human whole blood. Comparing the action of cloricromene on human cells in different tests, we found that some parameters were more sensitive than others, even when the same stimulus was used. In particular, free radical generation was inhibited by cloricromene with IC50 values below 36 microM, while other functions, like lysosomal release and phagocytosis were inhibited with IC50 values over 100 microM. These data confirm that cloricromene exerts a notable inhibitory effect on PMN and may explain the activity of the compound, observed in vivo in several experimental models of ischaemia-reperfusion and shock.     

Evaluation of online training for the provision of opioid substitution treatment by community pharmacists in New Zealand

Introduction and Aims. The role of community pharmacists in the provision of opioid substitution treatment (OST) is pivotal and integral to addiction treatment. An online training program for pharmacists in OST management was piloted in New Zealand in 2010, following recognition of the difficulty in recruitment and retention of community pharmacists to provide OST services. Our aim was to evaluate the OST online training that was made available for any community pharmacist in New Zealand and to establish the feasibility and acceptability of this format of training for community pharmacists. The evaluation explored participants' attitudes, skills and knowledge both pre‐ and post‐training in OST. Design and Methods. All pharmacists registering to participate in the training program were asked to complete an evaluation questionnaire immediately before (pre) and immediately after (post) completing the training. Participants were also invited to participate in a brief 10 min structured telephone interview about their training experience. Results. In the first 4 months 190 pharmacists commenced the training; 101 completed both evaluations. Improvements in the confidence and skills of pharmacists were demonstrated through both the quantitative and qualitative analyses. Statistically significant changes in attitudes were also demonstrated. Overall the OST training was well received and the online format was feasible and highly acceptable. Discussion and Conclusion. Online training is an appropriate and economical method of improving pharmacists' clinical skills with respect to this client group, and has the potential to reach a wider audience of pharmacists. Further research is required to investigate OST client experiences in community pharmacy.[Walters C, Raymont A, Galea S, Wheeler A. Evaluation of online training for the provision of opioid substitution treatment by community pharmacists in New Zealand. Drug Alcohol Rev 2012;31:903–910]     

Increasing Intention to Comply with Pharmaceutical Product Instructions: An Exploratory Study Investigating the Rolesof Frame and Plain Language

ABSTRACT

Purpose: The purpose of this study was to describe the coverage and portrayal of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) risk factors as framed in newspapers targeting Aboriginal (First Nations, Métis, and Inuit) peoples in Canada.

Methods: From a sample of 31 Aboriginal newspapers published in English from 1996 to 2000, 14 newspapers were randomly selected. Of the 167 articles published on HIV/AIDS during this time period, all anecdotal (n = 34) and an approximate 25% random sample of scientific (n = 32) articles were analyzed using both quantitative (coding reliability and frequencies) and qualitative (in-depth content analysis) analyses.

Results: Individual risk factors for HIV/AIDS were described in 74% (49/66) of the articles and included unprotected sexual intercourse (20/49 or 41%), sharing of needles for injection drug use (IDU; 16/49 or 33%), infected blood transfusions (3/49 or 6%), and vertical transmission from mother to baby (10/49 or 20%). Additional risk factors of alcohol use and poverty were mentioned in 29% and 25% of the articles. In addition to the well-recognized HIV/AIDS risk groups of prostitutes and homosexual men, sexual abuse victims, prisoners, and women were identified in Aboriginal newspapers as being at risk. Although Aboriginal women were identified as being at high risk, the newspaper coverage also emphasized their lack of knowledge regarding HIV/AIDS. Heterosexual men were not mentioned as being at risk for HIV/AIDS in the newspaper articles.

Background: The prevalence of HIV/AIDS is higher among Canadian Aboriginals than in the general population. Local and community newspapers are an important channel for the dissemination of health information for isolated, rural, and Aboriginal communities.

Interpretation: The findings show that Aboriginal media identify high-risk groups and individualistic risk factors for HIV/AIDS, within a public health perspective. The articles also emphasize, however, Aboriginal people's lack of knowledge about disease transmission and the full spectrum of who is at risk.     

Fertility and pregnancy after operation for a prolactinoma

Summary. Pituitary exploration was performed in 40 women with hyperprolactinaemic infertility and a prolactinoma was found in 37. After operation 26 (65%) of the 40 patients had a normal serum prolactin concentration; 31 women have so far had 49 pregnancies; in seven of these patients bromocriptine therapy was used after surgery. Eight of the remaining nine women were shown to be ovulating, but four of these subsequently decided not to attempt a pregnancy. The course and outcome of the 49 pregnancies were similar to those in normal women and no visual or endocrine complications occurred. Surgical removal of a prolactinoma often restores fertility, and may secure a safer pregnancy.     

Syntheses,opioid binding affinities,and potencies of dynorphin A analogues substituted in positions 1, 6, 7, 8 and 10

Structural, stereochemical, stereoelectronic and conformational requirements for biological activity of dynorphin A_1–11-NH₂ analogues at opioid receptors were explored by substitution of Tyr¹, Arg⁶, Arg⁷, Ile⁸ and Pro¹⁰ with other amino acid residues. Interestingly, substitution of Tyr¹ with N^α-Ac-Tyr^l, D-Tyr¹, Phe¹ or p-BrPhe¹ led to analogues that were quite potent at κ opioid receptors, and additional substitution of Ile⁸with D-Ala⁸ and/or Pro¹⁰ with D-Pro¹⁰ retained high potency in brain binding assay: [N^α-Ac-Tyr¹]- (1), [D-Tyr¹]- (2) [Phe¹]- (3), [Phe¹. D-Ala⁸]- (5), [p-BrPhe¹, D-Ala^s]- (6), [Phe¹, D-Pro¹⁰]- (7) and [Phe¹, D-Ala⁸, D-Pro¹⁰]-Dyn A_1–11-NH₂ (8) had IC₅₀(nM) binding affinities of 13.2, 18.6, 1.64, 1.26, 1.84, 2.44 and 1.62 nM, respectively. The D-Phe¹ analogue 4, however, was only weakly active (610 nM). All of the analogues except 4 were modestly selective for κ vs. μ guinea pig brain opioid receptor (11- to 88–fold) and quite selective for κ vs. δ receptors (65–576). However, all of the analogues appeared to have very low or essentially no activity in the guinea pig ileum and mouse vas deference functional bioassays, and one analogue, 5, appeared to have weak antagonist activities. On the other hand, if constrained amino acids such as β-methylphenylalanine or 1,2,3,4-tetrahydroisoquinoline carboxylic acid, and hydroxyproline were placed in the 1 position, inactive analogues or analogues with greatly reduced potency and biological activity were obtained (compounds 12–14). It had previously been suggested that the Arg⁶ and Arg⁷ residues were critical for biological activity. However, when we replace either one of these residues, [Nle⁶]Dyn A_1–11 (9) and [Nle⁷]Dyn A_1–11-NH₂ (10) were both highly potent binders in κ receptor binding studies (IC₅₀= 0.95 and 0.43 nM, respectively), and interestingly also were potent in μ and δ binding studies. Furthermore, both of the analogues were modestly potent in the GPI and MVD assays (94, 65 nM; 31, 81 nM, respectively). These results demonstrate that basic residues at positions 6 and 7 in dynorphin are not very important for binding to κ opioid receptors. Finally, many of the compounds reported here showed high selectivity for central vs. peripheral κ opioid receptors, with compound 4 being the most selective (63 000-fold).