Predicting emotional exhaustion among haemodialysis nurses

Background Understanding the organisational predictors of burnout (emotional exhaustion) in haemodialysis nurses is critical for staff retention and improving nurse and patient outcomes. Previous research has demonstrated high levels of emotional exhaustion among haemodialysis nurses; yet the relationships among nurses’ work environment, job satisfaction, stress and emotional exhaustion are poorly understood. Aim To test an explanatory model of the relationships among the nursing work environment, job satisfaction, job stress and emotional exhaustion for haemodialysis nurses, drawing on Kanter’s Structural Theory of Organisational Empowerment. Methods Using a cross-sectional design 417 haemodialysis nurses completed an online survey between October 2011 and April 2012 using validated instruments to measure the work environment, and levels of job satisfaction, job stress and emotional exhaustion. Results Overall, the explanatory model demonstrated adequate fit and we found partial support for the hypothesised relationships. Haemodialysis nurses’ work environment had a direct positive effect on job satisfaction, explaining 88% of the variance. Greater job satisfaction, in turn, predicted lower job stress, explaining 82% of the variance. Job satisfaction also had an indirect effect on emotional exhaustion by mitigating job stress. However, job satisfaction did not have a direct effect on emotional exhaustion. Conclusion The work environment of haemodialysis nurses is pivotal to the development of job satisfaction. Nurses’ job satisfaction also affects the levels of job stress and emotional exhaustion. Our findings suggest nurse managers can improve staff retention by creating empowering work environments that promote job satisfaction in haemodialysis nurses.

Why are haemodialysis nurses satisfied also experiencing burnout?

Background Haemodialysis nurses work in a technological environment caring for patients over a prolonged period of time leading to the development of unique nurse-patient relationships. In order to improve retention of nurses in this specialised area of nursing it is important to know the factors that affect job satisfaction, stress and burnout and understand how these experiences are conceptualised by haemodialysis nurses. Aim To explore the factors contributing to satisfaction with the work environment, job satisfaction, job stress and burnout in haemodialysis nurses in Australia and New Zealand. Method A quantitative dominant sequential explanatory mixed method design was used. Quantitative data was collected using an on-line questionnaire containing demographic questions and pre-existing instruments examining job satisfaction, stress, burnout and satisfaction with the work environment. The qualitative phase involved semi-structured interviews. Results 417 nurses completed the questionnaire. Overall, nurses were satisfied with their work environment and the job that they performed but there were stressors in the haemodialysis setting that led to high levels of burnout. Key themes emerged from the qualitative data related to the physical environment, intensity of nurse-patient relationships, workloads, and coping with death and dying. The qualitative findings also provide possible explanations for the high level of burnout identified in the quantitative findings. Conclusion Explanation of areas where specific nurse and patient outcomes were affected will support the development of appropriate interventions to sustain a work environment conducive to job satisfaction that also alleviates stress and burnout in these nurses.

Nursing and medical perceptions of a hospital rapid response system: New process but same old game?

Perhaps no other patient safety intervention depends so acutely on effective interprofessional teamwork for patient survival than the hospital rapid response system (RRS). Yet little is known about nurse-physician relationships when rescuing at-risk patients. This study compared nursing and medical staff perceptions of a mature RRS at a large tertiary hospital. Findings indicate the RRS may be failing to address a hierarchical culture and systems-level barriers to early recognition and response to patient deterioration.

Field and Service Robotics: Results of the 9th International Conference

The Field and Service Robotics (FSR) conference is a single track conference with a specific focus on field and service applications of robotics technology. The goal of FSR is to report and encourage the development of field and service robotics. These are non-factory robots, typically mobile, that must operate in complex and dynamic environments. Typical field robotics applications include mining, agriculture, building and construction, forestry, cargo handling and so on. Field robots may operate on the ground (of Earth or planets), under the ground, underwater, in the air or in space. Service robots are those that work closely with humans, importantly the elderly and sick, to help them with their lives. The first FSR conference was held in Canberra, Australia, in 1997. Since then the meeting has been held every 2 years in Asia, America, Europe and Australia. It has been held in Canberra, Australia (1997), Pittsburgh, USA (1999), Helsinki, Finland (2001), Mount Fuji, Japan (2003), Port Douglas, Australia (2005), Chamonix, France (2007), Cambridge, USA (2009), Sendai, Japan (2012) and most recently in Brisbane, Australia (2013). This year we had 54 submissions of which 36 were selected for oral presentation. The organisers would like to thank the international committee for their invaluable contribution in the review process ensuring the overall quality of contributions. The organising committee would also like to thank Ben Upcroft, Felipe Gonzalez and Aaron McFadyen for helping with the organisation and proceedings. and proceedings. The conference was sponsored by the Australian Robotics and Automation Association (ARAA), CSIRO, Queensland University of Technology (QUT), Defence Science and Technology Organisation Australia (DSTO) and the Rio Tinto Centre for Mine Automation, University of Sydney.

A meta-analysis of 87,040 individuals identifies 23 new susceptibility loci for prostate cancer

Genome-wide association studies (GWAS) have identified 76 variants associated with prostate cancer risk predominantly in populations of European ancestry. To identify additional susceptibility loci for this common cancer, we conducted a meta-analysis of > 10 million SNPs in 43,303 prostate cancer cases and 43,737 controls from studies in populations of European, African, Japanese and Latino ancestry. Twenty-three new susceptibility loci were identified at association P < 5 × 10(-8); 15 variants were identified among men of European ancestry, 7 were identified in multi-ancestry analyses and 1 was associated with early-onset prostate cancer. These 23 variants, in combination with known prostate cancer risk variants, explain 33% of the familial risk for this disease in European-ancestry populations. These findings provide new regions for investigation into the pathogenesis of prostate cancer and demonstrate the usefulness of combining ancestrally diverse populations to discover risk loci for disease.

How does symptom burden differ in people with advanced CKD who are non-dialysis or currently receiving dialysis?

Background Chronic kidney disease (CKD) leads to a range of symptoms which are often under-recognised. Little is known about the full range of symptoms, particularly in who are pre-dialysis. Understanding symptom prevalence, distress, severity and frequency will help prioritise symptom management. Aims To examine symptom burden in advanced CKD (stages 4 and 5) and compare the symptom experience between those receiving dialysis or those who are pre-dialysis. Methods Using a cross-sectional design, a convenience sample of 436 people from three hospitals completed the Modified Dialysis Symptom Index (MDSI). Demographic and renal history data was also collected. Based on the 32 symptoms, we compared the prevalence, severity, distress and frequency of each symptom by treatment modality. Results Mean age was 48 years (range 18-87 years) and 53% were male. 75.5% (haemodialysis = 287; peritoneal dialysis = 42) were receiving dialysis and 24.5% (n = 107) were pre-dialysis. Overall, the mean symptom prevalence was 12.6 ± 7.9 and the most prevalent symptoms were fatigue (77%), bone or joint pain (60.3%) and itching (59.6%) across all CKD groups. The distress, severity and frequency of the symptoms were higher in the dialysis group. However, a higher frequency of psychological symptoms (worrying, feeling nervous and depression) were reported in the pre-dialysis group. Implication for clinical practice Patients with advanced CKD have a high symptom burden with those who are pre-dialysis needing greater psychological support. The MDSI could be used in nursing practice to screen patients for symptoms which could lead to timely and appropriate interventions.

Someone else's boom but always our bust: Australia as a derivative economy, implications for regions

This paper examines the socio-economic impact of mineral and agricultural resource extraction on local communities and explores policy options for addressing them. An emphasis on the marketisation of services together with tight fiscal control has reinforced decline in many country communities in Australia and elsewhere. However, the introduction by the European Union of Regional Policy which emphasises ‘smart specialisation’ can enhance greatly the capacity of local people to generate decent livelihoods. For this to have real effect, the innovative state has to enable partnerships between communities, researchers and industry. For countries like Australia, this would be a substantive policy shift.

Gamifying collective intelligence for the common good

The rise of the mobile internet enables the creation of applications that provide new and easier ways for people to organise themselves, raise issues, take action and interact with their city. At the same time, society faces new problems that can only be solved when citizens work together. Nevertheless, a lack of motivation or knowledge often prevents many citizens from regularly contributing to the common good. In this position paper, we present DoGood – a mobile app – as a socio-technological system that aims at supporting the collective intelligence of citizens in their pursuit of civic engagement and civic collaboratories. Our study asks to what extent gamification can motivate users to “do good” deeds. The DoGood app uses gamified elements to encourage citizens to submit and promote their civic activities as well as to join the activities of others. Gamification is sometimes criticised for simply adding a limited number of game elements, such as leaderboards, on top of an existing experience with the hope of increasing motivation. However, in the case of the DoGood app, the process of game design was an integral part of the development, and the gamified elements target the user’s intrinsic motivations instead of providing them with an external reward. In this paper, we present design elements of the app and discuss their potential to support collective intelligence for the common good.

Anti-tumour effects of antibodies targeting the extracellular cysteine-rich region of the receptor tyrosine kinase EphB4

EphB4 is a membrane-bound receptor tyrosine kinase (RTK) commonly over-produced by many epithelial cancers but with low to no expression in most normal adult tissues. EphB4 over-production promotes ligand-independent signaling pathways that increase cancer cell viability and stimulate migration and invasion. Several studies have shown that normal ligand-dependent signaling is tumour suppressive and therefore novel therapeutics which block the tumour promoting ligand-independent signaling and/or stimulate tumour suppressive ligand-dependent signaling will find application in the treatment of cancer. An EphB4-specific polyclonal antibody, targeting a region of 200 amino acids in the extracellular portion of EphB4, showed potent in vitro anti-cancer effects measured by an increase in apoptosis and a decrease in anchorage independent growth. Peptide exclusion was used to identify the epitope targeted by this antibody within the cysteine-rich region of the EphB4 protein, a sequence defined as a potential ligand interacting interface. Addition of antibody to cancer cells resulted in phosphorylation and subsequent degradation of the EphB4 protein, suggesting a mechanism that is ligand mimetic and tumour suppressive. A monoclonal antibody which specifically targets this identified extracellular epitope of EphB4 significantly reduced breast cancer xenograft growth in vivo confirming that EphB4 is a useful target for ligand-mimicking antibody-based anti-cancer therapies.

“They are like family”: The emotional cost experienced by nurses when caring for haemodialysis patients

Background Haemodialysis (HD) nursing is characterised by frequent, intense interactions with patients over long periods of time resulting in a unique nurse-patient relationship. Due to the life-limiting nature of end-stage renal failure, nurses are likely to have repeated exposures to the death of patients with whom they have formed relationships. Repeated exposure to patient death translates into frequent grief experiences. There is scant literature on the psychological impact of patient death for nurses working in the HD setting. Aims To explore HD nurses experiences of patient death and coping mechanisms used. Methods A sequential mixed method study investigating job satisfaction, stress and burnout found that HD nurses had high levels of stress and burnout. These results were explored in more detail during 8 semi-structured interviews with HD nurses. Interviews were audio-recorded, transcribed verbatim and subjected to thematic analysis. Results Three themes were identified that highlight the stress experienced by nurses when a haemodialysis patient dies. The first theme, “quazi-family” describes the close relationship which forms between nurses and patients. The “complicated grief” theme outlines the impact of death on HD nurses, and the final theme, “remembrance” explains some of the coping mechanisms used in the grieving process. Conclusion Nurses develop individual coping mechanisms to accommodate the grief and loss experienced when a “close” patient dies. The grieving process caused by the death of patient’s needs to be recognised by nurses and nurse managers as causing psychological stress and strain.

Capnography monitoring during procedural sedation and analgesia: A systematic review protocol

Background An important potential clinical benefit of using capnography monitoring during procedural sedation and analgesia (PSA) is that this technology could improve patient safety by reducing serious sedation-related adverse events, such as death or permanent neurological disability, which are caused by inadequate oxygenation. The hypothesis is that earlier identification of respiratory depression using capnography leads to a change in clinical management that prevents hypoxaemia. As inadequate oxygenation/ventilation is the most common reason for injury associated with PSA, reducing episodes of hypoxaemia would indicate that using capnography would be safer than relying on standard monitoring alone. Methods/design The primary objective of this review is to determine whether using capnography during PSA in the hospital setting improves patient safety by reducing the risk of hypoxaemia (defined as an arterial partial pressure of oxygen below 60 mmHg or percentage of haemoglobin that is saturated with oxygen [SpO2] less than 90 %). A secondary objective of this review is to determine whether changes in the clinical management of sedated patients are the mediating factor for any observed impact of capnography monitoring on the rate of hypoxaemia. The potential adverse effect of capnography monitoring that will be examined in this review is the rate of inadequate sedation. Electronic databases will be searched for parallel, crossover and cluster randomised controlled trials comparing the use of capnography with standard monitoring alone during PSA that is administered in the hospital setting. Studies that included patients who received general or regional anaesthesia will be excluded from the review. Non-randomised studies will be excluded. Screening, study selection and data extraction will be performed by two reviewers. The Cochrane risk of bias tool will be used to assign a judgment about the degree of risk. Meta-analyses will be performed if suitable. Discussion This review will synthesise the evidence on an important potential clinical benefit of capnography monitoring during PSA within hospital settings. Systematic review registration: PROSPERO CRD42015023740

Modelling ciphersuite and version negotiation in the TLS protocol

Real-world cryptographic protocols such as the widely used Transport Layer Security (TLS) protocol support many different combinations of cryptographic algorithms (called ciphersuites) and simultaneously support different versions. Recent advances in provable security have shown that most modern TLS ciphersuites are secure authenticated and confidential channel establishment (ACCE) protocols, but these analyses generally focus on single ciphersuites in isolation. In this paper we extend the ACCE model to cover protocols with many different sub-protocols, capturing both multiple ciphersuites and multiple versions, and define a security notion for secure negotiation of the optimal sub-protocol. We give a generic theorem that shows how secure negotiation follows, with some additional conditions, from the authentication property of secure ACCE protocols. Using this framework, we analyse the security of ciphersuite and three variants of version negotiation in TLS, including a recently proposed mechanism for detecting fallback attacks.

Post-quantum key exchange for the TLS protocol from the ring learning with errors problem

Lattice-based cryptographic primitives are believed to offer resilience against attacks by quantum computers. We demonstrate the practicality of post-quantum key exchange by constructing cipher suites for the Transport Layer Security (TLS) protocol that provide key exchange based on the ring learning with errors (R-LWE) problem, we accompany these cipher suites with a rigorous proof of security. Our approach ties lattice-based key exchange together with traditional authentication using RSA or elliptic curve digital signatures: the post-quantum key exchange provides forward secrecy against future quantum attackers, while authentication can be provided using RSA keys that are issued by today's commercial certificate authorities, smoothing the path to adoption. Our cryptographically secure implementation, aimed at the 128-bit security level, reveals that the performance price when switching from non-quantum-safe key exchange is not too high. With our R-LWE cipher suites integrated into the Open SSL library and using the Apache web server on a 2-core desktop computer, we could serve 506 RLWE-ECDSA-AES128-GCM-SHA256 HTTPS connections per second for a 10 KiB payload. Compared to elliptic curve Diffie-Hellman, this means an 8 KiB increased handshake size and a reduction in throughput of only 21%. This demonstrates that provably secure post-quantum key-exchange can already be considered practical.

Supporting staff to identify residents in pain: A controlled pretest-posttest study in residential aged care

Practical strategies are needed to improve pain awareness among aged care staff and promote a systematic approach to pain identification using evidence-based tools. The purpose of this study was to evaluate a pain identification tool for use by nursing and non-professional staff in residential aged care facilities (RACFs). A controlled pretest-posttest intervention design was conducted in two RACFs in Brisbane, Australia. Completed surveys were returned by 216 staff and 74 residents at baseline and 218 staff and 94 residents at 3-month follow-up. Chart audits were conducted on 308 residents at baseline and 328 at follow-up. Groups were compared on: (1) staff knowledge and attitudes regarding pain, perceived confidence and skills for pain assessment, and perceived quality of pain management, (2) frequency of pain assessments and use of pain interventions, and (3) residents’ perceptions of the quality of pain management. Both groups had high knowledge scores and reported high levels of confidence, skills and perceived quality of pain management at baseline and follow-up. The intervention group showed significant improvement in routine pain assessment and use of non-drug pain interventions. However, due to unexpected changes in control group conditions, both groups increased episodic pain assessment. Overall, staff believed the intervention was clinically useful and fostered a team approach to pain assessment. We found the introduction of pain identification resources with implementation strategies to support frontline staff was partially effective in improving staff and resident outcomes. Nonetheless, our findings confirm the need for change and importance of translational pain research in RACFs.