Multicentre study of validity and interrater reliability of the modified Nursing Care Recording System (NCR11) for assessment of workload in the ICU

BACKGROUND: Reliable assessment of nursing workload is necessary for the quantitative approach to staffing of intensive care units. The Nursing Care Recording System (NCR11) scores both the nursing contribution to patient care and those related to medical procedures. The purpose of the present work was to compare NCR11 scoring with the Therapeutic Intervention Scoring System (TISS) and Nine Equivalents of Nurse Manpower use Score (NEMS) and to examine the interrater reliability of NCR11 scoring. METHODS: Bias and precision of workload scores (NCR11 vs. TISS or NEMS) were assessed for 6126 consecutive admissions (23910 ICU-days) at three intensive care units. Inter-rater reliability was analyzed by having nurses at nine ICUs score workload using NCR11 for three dummy intensive care patient cases presented over a 3-year period. Variability in scoring was analyzed using the coefficient of variation. RESULTS: Agreement between NCR11 and TISS or NEMS was poor and limits of agreement were wide. Linear relationships between NCR11 and TISS or NEMS scores differed between units. Variability in NCR11 scoring decreased significantly from 10.4% to 5.9% between dummy cases 1 and 2 and remained low for patient case 3. CONCLUSION: The NCR11 does not measure the same elements of workload in the ICU as do TISS and NEMS. Inter-rater reliability with NCR11 is good, showing little variation in scoring between nurses.     

Racial differences of lens transparency properties with aging and prevalence of age-related cataract applying a WHO classification system

PURPOSE: To investigate racial differences of lens transparency properties and the prevalence of lens opacification by age. METHODS: Lenses of randomly selected Asian (1,038 Japanese and 517 Singaporeans) and Caucasian (1,045 Icelanders) subjects were evaluated for their lens transparency property (LTP). The prevalence of lens opacification was determined with a newly proposed WHO cataract classification system. RESULTS: LTP increased with aging for all nationalities. Light scattering intensity was significantly higher in the Singaporeans followed by the Icelandic subjects. The prevalence of cortical opacification in Singaporeans was significantly higher than those of the other nationalities up to the age of 60, and the prevalence in Asians was significantly higher than that in Caucasians aged 60-69. Cortical opacification was more prevalent than the other types for both Japanese and Icelanders in their 50s, 60s and 70s. Regarding the central optical zone, the prevalence in the Singaporeans was significantly higher than in the other two groups in their 50s and 60s. The prevalence of nuclear opacification in Singaporeans was markedly higher than those of the two other groups for all ages. Subcapsular cataract was the least prevalent type for all age groups and nationalities; however, the highest prevalence was observed in Singaporeans. CONCLUSIONS: Lens transparency decreased with age in the Singaporeans more markedly than in the other two groups. The high prevalence of nuclear opacification in Singaporeans is considered to be due to environmental rather than race-specific factors.     

Classification,identification and subtyping of bacteria based on pyrosequencing and signature matching of 16S rDNA fragments

The rapid identification of the etiological agent of microbial infections can bring about both clinical and financial benefits. Thus, fast and generally applicable classification methods are needed that will enable us to rapidly distinguish pathogenic bacteria from commensals or saprophytic bacteria found in the same habitat. We here show that provisional classification of bacterial isolates can be performed on a large scale based on 16S rRNA sequence comparisons using Pyrosequencing, a recently described real-time DNA sequence analysis technique, and the concept of signature matching. The probes we have developed, together with the new technology, will enable early diagnosis of specific pathogens, which is critical for the rational use of antimicrobial therapy in clinical medicine.     

Squamous carcinoma of the prostate

A primary squamous cell carcinoma occurring in the prostate of 84 year-old man is described. The patient died of local progression six months after diagnosis. Review of the literature suggests that such a cancer of the prostate is rare, highly aggressive, and responds poorly to any mode of therapy.     

Cortical lens opacification in Iceland. Risk factor analysis -- Reykjavik Eye Study

PURPOSE: Cortical lens opacification has been associated with outdoor exposure and UV radiation more than other types of lens opacification. We studied risk factors for cortical lens opacification only, the most common as well as the earliest age related change we observe in the lens. METHODS: 1,045 persons, 583 females and 462 males, 50 years and older, underwent a detailed eye examination and answered a questionnaire. Participants with cortical lens opacification grade I, totalling 374 persons, were assigned to case-control study I, and to case-control study II those with cortical lens opacification grades II and III, totalling 82 subjects. 378 age and sex matched persons served as controls. RESULTS: Those who spent more than 4 hours/day outside on weekdays, in their 20's--30's and 40's--50's respectively, were found to have increased risk of moderate to severe cortical lens opacification. Thus the relative risk for grades II & III, was 2.80 (95% CI 1.01--7.80) and 2.91 (95% CI 1.13--9.62) respectively. Ageing and systemic cortical steroids use were also found to be risk factors. CONCLUSION: Outdoor exposure appears to be associated with increased risk of moderate to severe cortical lens opacification. Ageing is, however, the main risk factor.     

The need for an adapted initiation nomogram during Fiix prothrombin time monitoring of warfarin

Journal of Thrombosis and Thrombolysis - The new Fiix prothrombin time (Fiix-PT) and its derived Fiix-normalized ratio (Fiix-NR) is affected only by reductions in coagulation factors (F) II and X,...     

Small steps of improvement in small-cell lung cancer (SCLC) within two decades: A comprehensive analysis of 484 patients

Background

It is not clear whether or not the fate of patients suffering from small-cell lung cancer (SCLC) has improved. To better understand the course of disease, we aimed at documenting disease features at initial diagnosis, sequences of therapy modalities and outcome in consecutive patients over two decades. We postulated that SCLC patients might have benefitted from refined diagnosis and treatment options during the last decade.

Methods

All SCLC cases diagnosed at the Innsbruck University Hospital and associated institutions between 1991 and 2011 have been documented in detail in accordance with a prespecified protocol.

Results

A total of 484 patients diagnosed with SCLC were followed. The most important symptoms at initial diagnosis were cough, dyspnea and tumor pain in 55%, 51% and 44%, respectively. Patients who were operated during early stage of disease (n = 26) had a favorable 5-year, relapse-free survival (74%). A total of 112 patients with locally advanced disease were treated by radiochemotherapy in curative intent (RCT), and achievement of CR offered a chance of long term overall survival (OS), reaching 44% after 10-years. In the palliative setting (median OS in 304 evaluable patients, 9.7 months), a therapeutic progress in the more recent decade could not be observed. Parameters independently associated with favorable OS were: response to therapy and prophylactic brain irradiation in patients with RCT; and response, age <70 years and absence of LDH elevation in the palliative setting.

Conclusions

In this comprehensive view on SCLC, the findings on symptomatology, comorbidity, and spectrum of treatments may help to better understand individual courses of the disease. Overall, modern medicine failed to translate into substantial benefit of SCLC patients, except in patients in locally advanced disease receiving multimodal therapy.