The outcome of a rapid training program on nurses’ attitudes regarding the prevention of aggression in emergency departments: A multi-site evaluation

Background

Patient aggression is a common source of occupational violence in emergency departments. Staff attitudes regarding the causes for aggression influence the way they manage it. The Management of Clinical Aggression – Rapid Emergency Department Intervention is a 45 min educational program that aims to promote the use of de-escalation techniques and effective communication skills to prevent patient aggression.

Objective

We sought to evaluate the impact of the program on staff attitudes regarding the prevention and early management of patient aggression.

Design

A mixed methods approach was used including a pre-test post-test survey of training participants and individual interviews with key stakeholders.

Setting and sample

The setting was public sector hospital emergency departments located in metropolitan and regional Victoria, Australia. A convenience sample of eighteen emergency departments was recruited via the Victorian Department of Health.

Participants

Survey participants were nurses and midwives who were employed at the study sites. Interview participants were a purposive sample of nurse unit managers and trainers.

Methods

The Management of Aggression and Violence Attitude Scale was administered to training participants immediately before and 6–8 weeks after training. Semi-structured telephone interviews with trainers and managers occurred 8–10 weeks after the intervention.

Results

Four hundred and seventy one participants completed the pre-test and post-test. Statistically significant shifts were observed in 5/23 items (Wilcoxon Signed Ranks Test: p ≤ 0.01). Despite training, participants were undecided if it was possible to prevent patient aggression, and continued to be unsure about the use of physical restraint. Twenty-eight (82.3%) of managers’ and trainers’ eligible to be interviewed provided their perceptions of the impact of the program. Overall, these perceptions were consistent with the significant shifts observed in the survey items.

Conclusion

There was limited evidence to demonstrate that the program significantly modified staff attitudes towards the prevention of patient aggression using the Management of Aggression and Violence Attitude Scale. Additional survey items that specifically measure staff attitudes about the use of restraint in emergency settings are needed to better understand decision making about restraining practices. Further work is indicated to quantify the impact of training in practice.     

Shigella sonnei bacteremia. Unusual antibody response from immunosuppressive therapy following renal transplantation

Shigella sonnei bacteremia developed in a patient who had undergone renal transplantation and immunosuppressive therapy; following treatment with chloramphenicol and lincomycin, the patient recovered from the infection. Possibly because of the concurrent immunosuppressive therapy, the patient had only a modest antibody response against the infecting microorganism but, unexpectedly, produced antibodies in high titer against a recently recognized antigen shared by enteric bacteria.     

Copper and zinc tolerance of two tropical microalgae after copper acclimation

Current toxicity tests with microalgae are often criticized as being overly sensitive to metals because algae are cultured in metal-deficient media. If such bioassays overestimate copper toxicity in surface waters, the relevance of water quality guidelines derived from these tests is questionable. In this study, the effect of acclimation to copper at environmentally relevant concentrations, on the sensitivity of the marine diatom Nitzschia closterium and the freshwater green alga Chlorella sp. to copper and zinc was examined. N. closterium was acclimated in culture medium containing 5 or 25 microg Cu L(-1) for 200 days, while Chlorella sp. was acclimated in medium containing 2 microg Cu L(-1) for 100 days. Changes in algal growth rates and copper and zinc tolerance were monitored using standard growth inhibition toxicity tests in minimal medium over 72 h. Neither of the two acclimated N. closterium cultures had increased zinc or copper tolerance compared with that of the nonacclimated algae, nor were there any changes in control growth rates. Similarly, no changes in copper tolerance or control growth rates were observed for the acclimated Chlorella sp. culture. This was supported by measurements of intracellular and extracellular copper which confirmed that there were no differences in copper accumulation in either acclimated or nonacclimated algae. These results suggest that these algae grown in standard culture media are generally no more sensitive than algae grown in a metal-enriched medium. This supports the continued use of current laboratory bioassays with microalgae, as part of a suite of tests for assessing metal bioavailability, for use in ecological risk assessments and for providing data for the derivation of water quality guidelines.     

Serum Lipids and Apolipoproteins and Their Relationship with Macrovascular Disease in Type 1 Diabetes

In order to examine the relationship between serum lipids and apolipoproteins and macrovascular disease in patients with Type 1 diabetes mellitus, 50 patients with Type 1 diabetes mellitus attending the diabetic clinics at St Mary's and St Charles' Hospitals, London were recruited into a cross-sectional study. B-mode ultrasound was used to measure intima-media thickness and define an arterial ultrasound score for each patient as a non-invasive indicator of atherosclerotic change. Intima-medial (i-m) thickness was significantly higher in those subjects with clinical evidence of macrovascular disease compared to those without macrovascular disease (0.865 ± 0.191 vs 0.695 ± 0.162 mm, p = 0.0038). In the study group there were significant correlations between i-m thickness and age (r = 0.65, p < 0.01), total serum cholesterol (r = 0.32, p < 0.01), and serum fibrinogen (r = 0.43, p < 0.01) but no other lipid or apolipoprotein variable. When i-m thickness was corrected for age there were significant correlations with total cholesterol (r = 0.43, p < 0.01) and LDL-cholesterol (r = 0.42, p < 0.01). Whereas total and LDL-cholesterol and serum fibrinogen concentrations were related to the extent of atherosclerotic disease by ultrasound techniques, there was no relationship with high density lipoprotein (HDL) or subfraction cholesterol concentrations. HDL-cholesterol may not be a useful marker for cardiovascular disease in Type 1 diabetes.     

PTPRG suppresses tumor growth and invasion via inhibition of Akt signaling in nasopharyngeal carcinoma

Protein Tyrosine Phosphatase, Receptor Type G (PTPRG) was identified as a candidate tumor suppressor gene in nasopharyngeal carcinoma (NPC). PTPRG induces significant in vivo tumor suppression in NPC. We identified EGFR as a PTPRG potential interacting partner and examined this interaction. Dephosphorylation of EGFR at EGFR-Y1068 and -Y1086 sites inactivated the PI3K/Akt signaling cascade and subsequent down-regulation of downstream pro-angiogenic and -invasive proteins (VEGF, IL6, and IL8) and suppressed tumor cell proliferation, angiogenesis, and invasion. The effect of Akt inhibition in NPC cells was further validated by Akt knockdown experiments in the PTPRG-down-regulated NPC cell lines. Our results suggested that inhibition of Akt in NPC cells induces tumor suppression at both the in vitro and in vivo levels, and also importantly, in vivo metastasis. In conclusion, we confirmed the vital role of PTPRG in inhibiting Akt signaling with the resultant suppression of in vivo tumorigenesis and metastasis.     

Average reference EEG lateralization in schizophrenic patients.

The authors transformed 9 channels of electroencephalogram (EEG) to 10 channels of average reference data and compared EEG asymmetry between medication-free (for 2 weeks) schizophrenic male patients (n = 14), male patients with affective disorder (n = 9), and normal males (n = 13). Multivariate analyses failed to find lateralized differences between groups in resting and task EEG. Neuroleptic treatment (n = 11) was associated with asymmetrical changes in beta power rather than in alpha and theta, as previously reported. There were no relationships between clinical ratings (based on the Brief Psychiatric Rating Scale and subscales) and alpha asymmetry. The authors discuss conflicts with previous findings and the advantages of minimizing reference bias when studying EEG topography.     

Hemangiopericytoma of the urinary bladder: A case report and review of the literature

A case of hemangiopericytoma arising in the urinary bladder is presented. Initial symptoms included hematuria and frequency of urination. Hemangiopericytoma is a vascular tumor of pericyte origin which occurs primarily in several organs and can be benign or malignant. Reports in the literature of genitourinary system involvement are reviewed. It is concluded that genitourinary tumors of this type should be considered malignant and treated aggressively.     

The Surgical Management of Multiple Lung Metastases

From 1970 to June, 1976, 56 patients who had multiple metastatic tumors of the lung were treated by lung resection. Most of the bilateral lung lesions were removed through a median sternotomy so as to avoid staged bilateral thoracotomy. The surgical mortality was 1.8%. A total of 26 patients are alive at 7 to 69 months (estimated median survival, 20.7 months).Patients with tumor doubling time of less than 40 days had lower survival results (median, 9.5 months), compared to patients with tumor doubling time of more than 40 days (median not yet reached).The type of primary tumor, tumor-free interval, number of lesions removed, and presence of unilateral as opposed to bilateral lung metastases did not seem to affect the therapeutic results.     

Evaluation of lymphangiography for clinical staging of bladder tumors.

Preoperative lymphangiography was done on 18 patients with bladder cancer and the results were correlated with the surgicopathological findings at the time of radical cystectomy and pelvic lymph node dissection. Correlation between radiological and pathological findings showed no falsely negative results. One patient had a falsely positive interpretation of lymphangiography. The accuracy of the study was 94 per cent. Accurate interpretation of lymphography is related to the experience of the reader. Routine use of lymphangiography in clinical staging of bladder cancer is recommended.     

Carcinoma of prostate. Long-term survival after bilateral adrenalectomy

A patient with stage D carcinoma of the prostate with metastases to the perineal skin and bladder involvement is clinically tumor-free four years after bilateral adrenalectomy. Previous orchiectomy, estrogen therapy, and pelvic radiotherapy failed to induce an objective remission. The patient had an abnormally high ratio of 11-deoxy to 11-oxy 17-ketosteroids prior to adrenalectomy. These measurements became normal after bilateral adrenalectomy.