Leadership in the nursing unit: relationships with nurses' well-being

The head nurse occupies an important position in the nursing unit Concerning leadership style, a distinction is traditionally made between consideration and initiating structure Sometimes a third style is distinguished as well, namely 'production-orientated' leadership In a study of 561 nurses from 16 general hospitals in The Netherlands, the influence of two leadership styles upon the reactions of nurses (job satisfaction, experienced meaningfulness, health complaints and absenteeism) to their work situations was examined, namely the styles of social (i e consideration) and instrumental leadership (a combination of the styles initiating structure and production-onentated) The separate effects of the two styles were studied, as well as the connection between combinations of leadership styles and reactions The results indicate that social leadership contributes positively to nurses' reactions to their job Instrumental leadership, on the other hand, leads to health complaints From the analyses of combinations of leadership styles it appears that nurses are most satisfied if the head nurse pays much attention to both dimensions of leadership For health complaints, a tendency in this directions is also found Finally, it becomes clear that nurses with a great need for autonomy prefer a different type of leadership from nurses with little need for autonomy     

Virus Inactivation of Fresh Frozen Plasma by a Solvent Detergent Procedure: Biological Results

In order to increase the safety of blood products, we have developed a procedure for the virus inactivation of fresh frozen plasma. Several batches have been prepared and with the first 10 batches, each of them composed of 60 litres of plasma, we have determined a set of biological parameters. Virus inactivation was realised using TnBP (1%) and Octoxynol 9 (1%). After their elimination with castor oil using chromatography on insolubilized C18 resin, glycine was added and the pH of the plasma was adjusted to 7.4. Plastic bags were aseptically filled with a mean volume of 200 ml of plasma. The mean levels of coagulation factors were all over 0.7 U/ml and their recovery from initial plasma was nearly the same as total protein except for factor VIII:C. The net loss in factor VIII:C was 16%, when including the dilution of plasma. In vivo and in vitro tests demonstrated that in the final product there were no activated factors. As in fresh frozen plasma, the protein concentration was over 50 g/l and the potassium level lower than 5 mmol/l. According to these results, virus-inactivated plasma has the same qualities of fresh frozen plasma and could now replace it.     

Haemophilus influenzae meningitis in Manitoba and the Keewatin District, NWT: potential for mass vaccination.

A community-based surveillance study of all central nervous system infections was carried out in Manitoba and the Keewatin District, NWT, between Apr. 1, 1981, and Mar. 31, 1984. There were 201 cases of bacterial meningitis in Manitoba over the study period, 81 (40%) caused by Haemophilus influenzae; all but one isolate tested were type b (Hib). There were nine cases of H. influenzae meningitis in the Keewatin District. The overall annual incidence rate of H. influenzae meningitis in Manitoba was 2.5/100,000; for children under 5 years the rate was 32.1/100,000. For the Keewatin District the corresponding rates were 69.6/100,000 and 530/100,000. A total of 85% and 100% of the cases of H. influenzae meningitis occurred by 24 months of age in Manitoba and the Keewatin District respectively. The age at onset was earlier in native Indian children (22 cases) and Inuit children (9 cases) than in non-native children (59 cases) (p less than 0.005); thus, vaccine prevention of Hib meningitis will likely be more difficult in native Indian and Métis children. Without evaluating the increased potential of H. influenzae vaccines to prevent nonmeningitic forms of disease, we concluded that mass childhood vaccination with polyribosylribitolphosphate (PRP) vaccine is not warranted in Manitoba or the Keewatin District. Immunogenicity studies suggest that administration of conjugated Hib vaccines such as PRP-D in infancy may prevent approximately one-third to two-thirds of cases of H. influenzae meningitis; these vaccines warrant consideration for use in mass childhood vaccination programs.     

Remission of Lambert-Eaton syndrome over a 10-year period. Recurrence without evidence of tumor at autopsy

A case of Lambert-Eaton's syndrome with onset 18 months prior to detection of an epidermoid cancer of the larynx is reported. Regression of the syndrome, and its total remission over 10 years without treatment following excision of the tumor, suggested a possible relationship as a paraneoplastic disorder. However, doubt was cast on any possible link by recurrence of the Lambert-Eaton's syndrome after 10 years remission, and the satisfactory course without treatment over the next 6 years combined with failure to detect any tumor recurrence or metastases, even at autopsy. The question raised is whether this is indeed a true paraneoplastic affection or a fortuitous association of an idiopathic form of Lambert-Eaton's syndrome and an infrequent cancer which, in addition, has never been reported at the origin of the Lambert-Eaton syndrome.     

Asymptomatic bacteriuria: review and discussion of the IDSA guidelines

Asymptomatic bacteriuria is a common finding, but is usually benign. Screening and treatment of asymptomatic bacteriuria is only recommended for pregnant women, or for patients prior to selected invasive genitourinary procedures. Healthy women identified with asymptomatic bacteriuria on population screening subsequently experience more frequent episodes of symptomatic infection, but antimicrobial treatment of asymptomatic bacteriuria does not decrease the occurrence of these episodes. Clinical trials in spinal-cord injury patients, diabetic women, patients with indwelling urethral catheters, and elderly nursing home residents have consistently found no benefits with treatment of asymptomatic bacteriuria. Negative outcomes with antimicrobial treatment do occur, including adverse drug effects and re-infection with organisms of increasing resistance. Optimal management of asymptomatic bacteriuria requires appropriate implementation of screening strategies to promote timely identification of the selected patients for whom treatment is beneficial, and avoidance of antimicrobial therapy where no benefit has been shown.     

Neurological disorders and perhexiline maleate therapy. Clinical study of 10 cases. Neuropathological, pharmacocinetic and biochemical studies (author's transl)]

Ten new cases of perhexiline induced peripheral neuropathies are reported. The authors emphasize the possible association of other neurological disorders: cerebellar symptoms in one case, complex tremor in two other cases, marked decrease of photomotor reflexes in one case and disgeusia in another one. The pharmacocinetic study of 4 cases revealed the presence of a low metabolism of the drug in one of them. Polymorphous inclusions have been seen in Schwann cell and endothelial cell cytoplasm in the three patients with electron microscopic study of the nerves. The pathological study of one case showed the demyelination of spinal cord posterior columns. In another case, who died from hepatic coma, the biochemical study of cerebral lipids revealed the low values of cerebrosides and sulfatides in cerebellum and cerebral white matter.     

Susceptibility of clinical isolates of Staphylococcus saprophyticus to fifteen commonly used antimicrobial agents.

Susceptibility of 34 recent clinical isolates of Staphylococcus saprophyticus to 16 commonly used antimicrobial agents was studied. Strains were uniformly resistant to nalidixic acid but tended to be sensitive to other agents, with occasional resistance noted to penicillin (3%), tetracycline (6%), sulfamethoxazole (6%), and erythromycin (15%).