Predictors of nurse absenteeism in hospitals: a systematic review

Aim  This study aimed to identify and examine predictors of short-term absences of staff nurses working in hospital settings reported in the research literature.
Background  Front-line staff nurse absenteeism contributes to discontinuity of patient care, decreased staff morale and is costly to healthcare.
Evaluation  A systematic review of studies from 1986 to 2006, obtained through electronic searches of 10 online databases led to inclusion of 16 peer-reviewed research articles. Seventy potential predictors of absenteeism were examined and analysed using content analysis.
Key issue  Our findings showed that individual 'nurses' prior attendance records', 'work attitudes' (job satisfaction, organizational commitment and work/job involvement) and 'retention factors' reduced nurse absenteeism, whereas 'burnout' and 'job stress' increased absenteeism. Remaining factors examined in the literature did not significantly predict nurse absenteeism.
Conclusions  Reasons underlying absenteeism among staff nurses are still poorly understood. Lack of robust theory about nursing absenteeism may underlie the inconsistent results found in this review. Further theory development and research is required to explore the determinants of short-term absenteeism of nurses in acute care hospitals.
Implications for nursing management  Work environment factors that increase nurses' job satisfaction, and reduce burnout and job stress need to be considered in managing staff nurse absenteeism.     

大豆蛋白体外酶解物中血管紧张素转化酶抑制剂活性肽研究

目的:体外模仿部分胃肠道消化酶解过程,考察大豆蛋白酶解消化能否产生血管紧张素转化酶抑制剂(ACEI)活性肽及其活性状况,以揭示大豆蛋白体内消化酶解与ACEI的活性关系。方法:模拟人体胃肠道消化过程,以胃蛋白酶结合胰蛋白酶,相继酶解大豆分离蛋白(SPI),经色谱分离,动态检测不同阶段ACEI肽片段及其活性大小。结果:胃蛋白酶酶解过程前20min内,酶解液ACEI活性达到最高点,随后在胰蛋白酶酶解阶段其抑制活性下降。180min后的酶解产物,其半抑制活性浓度IC50值为0.28±0.06 mg/ml。同时,未经酶解的SPI液在0.73mg/ml时无ACEI活性。SPI酶解液经各种色谱分离后的组分,其IC50值从0.13±0.03到0.93±0.08 mg/ml。低分子量和伴有疏水性基团的肽类最具ACE抑制活性。结论:体外模仿胃肠消化过程使用胃蛋白酶和胰蛋白酶酶解SPI可产生不同ACEI活性的肽片段,说明人体正常摄食消化大豆蛋白可产生血管紧张素转化酶抑制剂活性肽。     

Palpable lymph nodes of the neck in Swedish schoolchildren

We studied 3592 Swedish schoolchildren, 8 or 9 years old, examined for palpable submandibular, cervical and supraclavicular lymph nodes. All children were skin tested with 2 TU PPD RT23 and with 0.1 μ g of Mycobacterium avium sensitin or 0.1 μ g of M. scrofulaceum sensitin. A total of 991 children had palpable lymph nodes in any of the three locations. Among them, 811 had lymph nodes in one location, 162 in two locations and 18 in three. In 312 children, the lymph nodes were ± 5 mm in size in any location. The most common location was submandibular. Boys had a significantly higher prevalence of palpable lymph nodes than girls. There was also seasonal variation. Children infected by atypical mycobacteria (sensitin reaction ±6 mm) did not have a higher prevalence of palpable lymph nodes than those not infected.     

Relationship between age and clinical characteristics of patients with gastric cancer

The relationship between the prognosis and age of patients with gastric cancer is controversial. To evaluate whether there is a biological characteristic specific to the age of patients, we examined the clinical characteristics of patients with gastric cancer with special reference to their age. Based on a prospective database, a retrospective study of 419 patients who underwent radical gastrectomy for cure in the past 6 years was conducted. Clinical characteristics including gender, gross appearance of the tumour (Borrmann's classification, tumour location), histopathology (depth of tumour invasion, lymph node status, Lauren's classification and degree of tumour cell differentiation) and TNM tumour stage were analysed in six different age groups (< 39, 40–49, 50–59, 60–69, 70–79, > 80 years). The mean age of the 419 patients was 64.6 years (range from 26–91) and the peak age incidence of gastric cancer (46.3%) was in the 60–69 year old age group. The male: female ratio was 4.6: 1 on the whole and male gender predominated at ages > 60. The proportion of diffuse type tumours (68.4%) by Lauren's criteria in the young age group (< 39 yrs) decreased with age (25% in the > 80 years group; P<0.001). Similarly, the proportion of poorly-differentiated tumours (89.5%) in the young age group (< 39 yrs) decreased with advancing age (P<0.001). These findings suggest that both diffuse type and poorly-differentiated tumours predominate in younger patients and, without considering the factor of delay in diagnosis, may explain the poorer prognosis demonstrated in younger patients.     

An evaluation of freestanding alcoholism treatment for Medicare recipients

The Health Care Financing Administration (HCFA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) conducted a demonstration between 1982 and 1985 to test the feasibility of providing payments for alcoholism treatment services to Medicare and Medicaid recipients in specially selected freestanding facilities. This study of the Medicare part of the demonstration answers two questions: do freestanding facilities save money for Medicare and do their patients have lower health care utilization following imitation of treatment than patients treated in hospital-bated facilities? The statistical methodology is a logit and cluster approach. The analysis begins with a logistic regression model to predict the probability of patients seeking alcoholism treatment in either the demonstration (freestanding facility) or hospital-based cohort. The statistically significant variables from logit analysis are then used to form clusters. The health expenditure of freestanding and hospital patients are compared within homogeneous clusters. This study shows that the number of admissions, the average length of stay, and the average monthly health expenditures following the start of treatment are lower for the group treated in the freestanding facilities. The conclusion is that for some persons with alcohol problems, treatment in freestanding facilities is less costly and leads to lower subsequent health care utilization than treatment in hospitals.     

From open to laparoscopic adrenalectomy:a review of 16-year experience

Ｄｉｓｅａｓｅｓｏｆａｄｒｅｎａｌｇｌａｎｄａｒｅａｒｅｌａｔｉｖｅｌｙｒａｒｅｃｏｎｄｉｔｉｏｎｒｅｑｕｉｒｉｎｇｓｕｒｇｅｏｎｓ’ｋｎｏｗｌｅｄｇｅｏｆｅｎｄｏｃｒｉｎｅｐｈｙｓｉｏｌｏｇｙａｎｄｓｕｒｇｉｃａｌａｎａｔｏｍｙＯｖｅｒａｌｌ,ｍｏｒｂｉｄｉｔｙａｓｓｏｃｉａｔｅｄｗｉｔｈａｄｒｅｎａｌｅｃｔｏｍｙｃａｎｂｅａｓｈｉｇｈａｓ40%ａｎｄｍｏｒｔａｌｉｔｙ,ａｐｐｒｏｘｉｍａｔｅｌｙ2%ｔｏ4%1　Ｏｖｅｒｔｈｅｐａｓｔｆｅｗｄｅｃａｄｅｓ,ａｂｅｔｔｅｒｕｎｄｅｒｓｔａｎｄｉｎｇｏｆｔｈ…     

英国药学教育制度对我国药学教育发展的启示

目的:探讨英国药学教育制度对我国药学教育发展的启示。方法:分析英国药学教育制度的成功之处及其缺点,提出对我国药学教育未来发展的建议。结果与结论:英国药学教育以培训药学硕士为主,其教学内容需遵从英国药物政务局的全国统一指示性药学教学大纲,教学及考试方式以案例教学法和临床能力测验为主,有效地规范了全国的药学教育,使课程的质量和学生能力达到较高水平。这些制度对我国药学教育有正面的参考价值,也有实施的可能性。     

Fine structure of nuclei and cytoplasm of osteoclasts in Paget's disease of bone

To investigate the fine structural features of nuclei and cytoplasm in osteoclasts from patients with Paget's disease of bone, eight bone biopsies were examined. Unusual paracrystalline filamentous formations were found within the nuclei of both actively resorbing and degenerating osteoclasts. These formations were made up of parallel arranged filaments which, in most cases, clustered together regularly. The filaments were slightly argyrophilic and this helped to differentiate them from the surrounding nuclear matrix, even when they were not aggregated in clusters. Argyrophilic filaments were also found loosely aggregated inside the cytoplasm of osteoclasts. In three biopsies two additional and unusual cytoplasmic inclusions were found. The first consisted of irregularly branching, highly argyrophilic membranous strands which were located inside membrane-bound vacuoles. The second consisted of spindle-shaped structures enclosed by two membranes and containing three or more tubules. It is suggested that these results stand as further morphological evidence in favour of the view that a virus, possibly of the paramyxovirus class, has a pathogenetic role in Paget's disease of bone.     

Snake skin pattern gastropathy in cirrhotic patients

Gastric mucosal lesions are common in patients with cirrhosis. Among them, snake skin pattern gastropathy (SSPG) is the most distinguishing one. A prospective study was conducted to investigate the incidence of SSPG in cirrhotic patients, the relationship between the degree of portal pressure and SSPG, and the possible association of SSPG with serum levels of gastrin and pepsinogen I. SSPG was found to be significantly more common in 100 cirrhotic patients than in 100 age- and sex-matched healthy controls (41% vs 0%, P less than 0.0001). Hepatic venous pressure gradient and serum gastrin and pepsinogen I levels were measured in 21 cirrhotic patients with SSPG and 25 cirrhotics without SSPG. There was no significant difference in hepatic venous pressure gradient (16.1 +/- 4.4 mmHg vs 16.1 +/- 4.9 mmHg, P greater than 0.05), serum gastrin level (78.0 +/- 26.7 pg/mL vs 80.1 +/- 32.5 pg/mL, P greater than 0.05) and serum pepsinogen I level (69.5 +/- 26.6 ng/mL vs 65.2 +/- 26.1 ng/mL, P greater than 0.05) in cirrhotic patients with or without SSPG. In conclusion, SSPG is common in cirrhotic patients. Portal pressure per se may not be the only factor causing SSPG--other aggressive factors may be needed together to cause the gastropathy. There is no evidence of correlation between serum gastrin or pepsinogen I level and SSPG.