Endemic Methicillin-Resistant Staphylococcus Aureus: Nurses' Risk Perceptions and Attitudes

Dissemination of methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult challenges for prevention, control, and treatment of health care-associated infections. A survey and interviews were conducted on nurses from a hospital center. We found that most nurses' perceived risk of acquiring MRSA related to themselves (72%), other nurses (88.5%), and patients (97.8%). This perception influences attitudes, leading to compliance with the existing recommendations.

Acute Kidney Injury after Pediatric Cardiac Surgery: Risk Factors and Outcomes. Proposal for a Predictive Model

Objectives: To characterize the epidemiology and risk factors for acute kidney injury (AKI) after pediatric cardiac surgery in our center, to determine its association with poor short-term outcomes, and to develop a logistic regression model that will predict the risk of AKI for the study population. Methods: This single-center, retrospective study included consecutive pediatric patients with congenital heart disease who underwent cardiac surgery between January 2010 and December 2012. Exclusion criteria were a history of renal disease, dialysis or renal transplantation. Results: Of the 325 patients included, median age three years (1 day---18 years), AKI occurred in 40 (12.3%) on the first postoperative day. Overall mortality was 13 (4%), nine of whom were in the AKI group. AKI was significantly associated with length of intensive care unit stay, length of mechanical ventilation and in-hospital death (p<0.01). Patients’ age and postoperative serum creatinine, blood urea nitrogen and lactate levels were included in the logistic regression model as predictor variables. The model accurately predicted AKI in this population, with a maximum combined sensitivity of 82.1% and specificity of 75.4%. Conclusions: AKI is common and is associated with poor short-term outcomes in this setting. Younger age and higher postoperative serum creatinine, blood urea nitrogen and lactate levels were powerful predictors of renal injury in this population. The proposed model could be a useful tool for risk stratification of these patients.

Analyzing the impact of HRM Systems on the organizational climate, culture and outcomes: The mediating role of HMR Strength, organizational climate and culture

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

The characteristics, clinical manifestations and outcomes of pandemic influenza A (H1N1) 2009 in the elderly

IntroductionThe objetctive of this study was to evaluate the 2009 Pandemic Influenza A (H1N1) in the elderly and identify the clinical characteristics, mortality and prognostic factors of the infection in these patients.MethodsThis was an observational, retrospective study. Data were collected from the National Notifiable Diseases (SINAN), from the Brazilian Ministry of Health. Only patients 60 years old or more that had laboratory confirmed infections were included. The socio-demographic and clinical variables and outcomes were evaluated to compare mortality rates in the presence or absence of these factors.ResultsWe included 93 patients in the study, 16.1% of whom died. The symptoms of cough and dyspnea, the use of the antiviral oseltamivir, influenza vaccine and comorbidities influenced the outcomes of cure or death. Chest radiography can aid in diagnosis.ConclusionsAlthough relatively few elderly people were infected, this population presented high lethality that can be justified by the sum of clinical, physical and immunological factors in this population. Treatment with oseltamivir and vaccination against seasonal influenza have significantly reduced rates of hospitalization and mortality.

Career barriers influencing career success: A focus on academics’ perceptions and experiences

Purpose – Few research has addressed the factors that undermine people’s subjective perceptions of career success. Hence, the purpose of this paper is to further illuminate the issue of career barriers in perceptions of career success for a specific group of professionals: academics. Design/methodology/approach – This study adopts an interpretative-social constructionist methodology. Complementarily, it was employed a phenomenological method in data gathering and analysis – with the use of in-depth interviews and a theme analysis. The research was undertaken with a group of 87 Portuguese academics of both sexes and in different stages of their academic careers. Findings – The findings pinpoint the existence of multi-level barriers encountered by the academics when trying to succeed in their careers. The interviewees mentioned particularly the organizational-professional career barriers pertaining to three general themes: poor collegiality and workplace relationships; the lack of organizational support and employment precariousness; and the career progression standards and expectations. At the individual life cycle level the interviewees referred to the theme of finding balance; at the same time, the gender structure was also a theme mentioned as an important career barrier in career success, particularly by the women interviewed. Research limitations/implications – One of the limitations of this research is related to the impossibility of generalizability of its findings for the general population. Nevertheless, the researcher provides enough detail that grants the reader with the ability to judge of its similarity to other research contexts. Practical implications – This research highlights the role played by distinct career barriers for a specific professional group: academics. This has implications for higher education policy-makers and for human resources managers in higher education institutions. Originality/value – The current study extends the literature on career success by offering detailed anecdotal evidence on how negative work experiences might hinder career success. This research shows that to understand career barriers to success it is useful to consider multi-level factors: organizational-level factors (e.g. poor collegiality and workplace relationships); individual-level factors (e.g. life-cycle factors such as age/career stage); and structural-level factors (e.g. gender).

Impact of cerebral cardiopulmonary resuscitation maneuvers in a general hospital: prognostic factors and outcomes

OBJECTIVE: To assess survival of patients undergoing cerebral cardiopulmonary resuscitation maneuvers and to identify prognostic factors for short-term survival. METHODS: Prospective study with patients undergoing cardiopulmonary resuscitation maneuvers. RESULTS: The study included 150 patients. Spontaneous circulation was re-established in 88 (58%) patients, and 42 (28%) were discharged from the hospital. The necessary number of patients treated to save 1 life in 12 months was 3.4. The presence of ventricular fibrillation or tachycardia (VF/VT) as the initial rhythm, shorter times of cardiopulmonary resuscitation maneuvers and cardiopulmonary arrest, and greater values of mean blood pressure (BP) prior to cardiopulmonary arrest were independent variables for re-establishment of spontaneous circulation and hospital discharge. The odds ratios for hospital discharge were as follows: 6.1 (95% confidence interval [CI] = 2.7-13.6), when the initial rhythm was VF/VT; 9.4 (95% CI = 4.1-21.3), when the time of cerebral cardiopulmonary resuscitation was < 15 min; 9.2 (95% CI = 3.9-21.3), when the time of cardiopulmonary arrest was < 20 min; and 5.7 (95% CI = 2.4-13.7), when BP was > 70 mmHg. CONCLUSION: The presence of VF/VT as the initial rhythm, shorter times of cerebral cardiopulmonary resuscitation and of cardiopulmonary arrest, and a greater value of BP prior to cardiopulmonary arrest were independent variables of better prognosis.

IPH response to NICE consultation on new indicators for Quality and Outcomes Framework (QOF)

IPH responded to the consultation on potential new indicators for the 2013/14 Quality and Outcomes Framework (QOF) in the UK. The 20 potential new indicators relate to chronic obstructive pulmonary disease (COPD), heart failure, coronary heart disease, diabetes, depression, hypertension, rheumatoid arthritis, asthma and cancer. The consultation asked people to consider whether there were any barriers to the implementation of the care described by any of the indicators; whether there were potential unintended consequences to the implementation of any of the indicators; whether there was potential for differential impact (in respect of age, disability, gender reassignment, pregnancy and maternity, race, religion or belief, sex and sexual orientation); and whether the indicators may have an adverse impact in different groups in the community.”

Spinal cord ischemia : clinical and imaging patterns, pathogenesis, and outcomes in 27 patients

RÉSUMÉ Introduction: l'histoire naturelle et la physiopathologie des infarctus de la moelle épinière restent largement inconnues. En effet, la plupart des études cliniques portent sur des patients qui ont souffert d'infarctus médullaire secondaire à des chirurgies aortiques ou des hypotensions prolongées. Méthode: ce travail analyse les données cliniques, le laboratoire, l'imagerie (IRM) et l'évolution de 27 patients souffrant d'infarctus de la moelle épinière admis dans le service de Neurologie du CHUV. Parmi ces patients, il y avait 11 hommes et 16 femmes (âge moyen de 56 ans, tranche d'âge de 19 à 80 ans). Résultats: dix patients (37%) souffraient d'infarctus de l'artère spinale antérieure, 4 (15%) d'infarctus unilatéraux antérieurs, 4 (15%) unilatéraux postérieurs, 3 (11%) d'infarctus centraux, 2 (7%) d'infarctus des artères spinales postérieures, 2 (7%) d'infarctus transverse tandis que 2 patients présentaient des tableaux cliniques inclassables. Vingt patients (74%) n'avaient pas d'étiologie identifiable. Les patients avec infarctus centraux ou transverses présentaient fréquemment (40%) des artériopathies périphériques et tous les infarctus transverses survenaient à la suite d'hypotensions artérielles prolongées. Le début de tous les autres types d'infarctus était associé à des facteurs mécaniques (p=0.02} et ces patients avaient fréquemment des pathologies du rachis (p=0.003) au niveau de la lésion médullaire. Dans ces cas, les données cliniques suggèrent une lésion d'une racine nerveuse au niveau de l'infarctus médullaire compromettant mécaniquement le flux de son artère radiculaire. L'évolution clinique était généralement favorable, seuls 13 patients (48%) présentaient une atteinte significative de la marche à la sortie de l'hôpital. Conclusion: ce travail montre qu'il existe 2 types principaux d'infarctus de la moelle épinière : d'une part les infarctus dans le territoire d'une artère radiculaire (infarctus de l'artère spinale antérieure, des artères spinales postérieures et infarctus unilatéraux) et d'autre part les hypoperfusions régionales globales de la moelle épinière (infarctus centraux et transverses). Chacune de ces 2 catégories d'infarctus ont des caractéristiques cliniques, radiologiques, physiopathologiques et pronostiques distinctes.

Referral patterns and outcomes in noncritically ill patients with hospital-acquired acute kidney injury.

Background and objectives Despite modern treatment, the case fatality rate of hospital-acquired acute kidney injury (HA-AKI) is still high. We retrospectively described the prevalence and the outcome of HA-AKI without nephrology referral (nrHA-AKI) and late referred HA-AKI patients to nephrologists (lrHA-AKI) compared with early referral patients (erHA-AKI) with respect to renal function recovery, renal replacement therapy (RRT) requirement, and in-hospital mortality of HA-AKI. Design, setting, participants, & measurements Noncritically ill patients admitted to the tertiary care academic center of Lausanne, Switzerland, between 2004 and 2008 in the medical and surgical services were included. Acute kidney injury was defined using the Acute Kidney Injury Network (AKIN) classification. Results During 5 years, 4296 patients (4.12% of admissions) experienced 4727 episodes of HA-AKI during their hospital stay. The mean ± SD age of the patients was 61 ± 15 years with a 55% male predominance. There were 958 patients with nrHA-AKI (22.3%) and 2504 patients with lrHA-AKI (58.3%). RRT was required in 31% of the patients with lrHA-AKI compared with 24% of the patients with erHA-AKI. In the multiple risk factor analysis, compared with erHA-AKI, nrHA-AKI and lrHA-AKI were significantly associated with worse renal outcome and higher in-hospital mortality. Conclusions These data suggest that HA-AKI is frequent and the patients with nrHA-AKI or lrHA-AKI are at increased risk for in-hospital morbidity and mortality.

Does Warfare Matter? Severity, Duration, and Outcomes of Civil Wars

Importa si una guerra civil es combat com un conflicte irregular, convencional o simètric no convencional? En altres paraules, tenen les “tecnologies de la rebel·lió” un impacte sobre la gravetat d’una guerra, la seva durada o el seu resultat? Aquest treball mostra que els conflictes irregulars duren més que els altres tipus de conflicte, mentre els convencionals tendeixen a ser més greus en termes de letalitat al camp de batalla. D’altra banda, els conflictes irregulars tendeixen a ser guanyats pels governs, mentre els altres són més propensos a acabar en empat. Substancialment, aquests resultats ens ajuden a donar sentit a l’evolució de les guerres civils, les quals tendeixen a ser més curtes, més intenses i més difícils per als governs. Teòricament, aquests resultats donen suport a la importància de la tecnologia de rebel·lió a l’estudiar la gravetat, la durada i els resultats de les guerres civils; a més, contribueixen a una millor comprensió de la contribució històrica de la guerra irregular a la construcció de l’Estat i al canvi social.

Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study.

BACKGROUND: Treatment strategies for acute basilar artery occlusion (BAO) are based on case series and data that have been extrapolated from stroke intervention trials in other cerebrovascular territories, and information on the efficacy of different treatments in unselected patients with BAO is scarce. We therefore assessed outcomes and differences in treatment response after BAO. METHODS: The Basilar Artery International Cooperation Study (BASICS) is a prospective, observational registry of consecutive patients who presented with an acute symptomatic and radiologically confirmed BAO between November 1, 2002, and October 1, 2007. Stroke severity at time of treatment was dichotomised as severe (coma, locked-in state, or tetraplegia) or mild to moderate (any deficit that was less than severe). Outcome was assessed at 1 month. Poor outcome was defined as a modified Rankin scale score of 4 or 5, or death. Patients were divided into three groups according to the treatment they received: antithrombotic treatment only (AT), which comprised antiplatelet drugs or systemic anticoagulation; primary intravenous thrombolysis (IVT), including subsequent intra-arterial thrombolysis; or intra-arterial therapy (IAT), which comprised thrombolysis, mechanical thrombectomy, stenting, or a combination of these approaches. Risk ratios (RR) for treatment effects were adjusted for age, the severity of neurological deficits at the time of treatment, time to treatment, prodromal minor stroke, location of the occlusion, and diabetes. FINDINGS: 619 patients were entered in the registry. 27 patients were excluded from the analyses because they did not receive AT, IVT, or IAT, and all had a poor outcome. Of the 592 patients who were analysed, 183 were treated with only AT, 121 with IVT, and 288 with IAT. Overall, 402 (68%) of the analysed patients had a poor outcome. No statistically significant superiority was found for any treatment strategy. Compared with outcome after AT, patients with a mild-to-moderate deficit (n=245) had about the same risk of poor outcome after IVT (adjusted RR 0.94, 95% CI 0.60-1.45) or after IAT (adjusted RR 1.29, 0.97-1.72) but had a worse outcome after IAT compared with IVT (adjusted RR 1.49, 1.00-2.23). Compared with AT, patients with a severe deficit (n=347) had a lower risk of poor outcome after IVT (adjusted RR 0.88, 0.76-1.01) or IAT (adjusted RR 0.94, 0.86-1.02), whereas outcomes were similar after treatment with IAT or IVT (adjusted RR 1.06, 0.91-1.22). INTERPRETATION: Most patients in the BASICS registry received IAT. Our results do not support unequivocal superiority of IAT over IVT, and the efficacy of IAT versus IVT in patients with an acute BAO needs to be assessed in a randomised controlled trial. FUNDING: Department of Neurology, University Medical Center Utrecht.

The Lausanne cohort Lc65+: a population-based prospective study of the manifestations, determinants and outcomes of frailty

BACKGROUND: Frailty is a relatively new geriatric concept referring to an increased vulnerability to stressors. Various definitions have been proposed, as well as a range of multidimensional instruments for its measurement. More recently, a frailty phenotype that predicts a range of adverse outcomes has been described. Understanding frailty is a particular challenge both from a clinical and a public health perspective because it may be a reversible precursor of functional dependence. The Lausanne cohort Lc65+ is a longitudinal study specifically designed to investigate the manifestations of frailty from its first signs in the youngest old, identify medical and psychosocial determinants, and describe its evolution and related outcomes. METHODS/DESIGN: The Lc65+ cohort was launched in 2004 with the random selection of 3054 eligible individuals aged 65 to 70 (birth year 1934-1938) in the non-institutionalized population of Lausanne (Switzerland). The baseline data collection was completed among 1422 participants in 2004-2005 through questionnaires, examination and performance tests. It comprised a wide range of medical and psychosocial dimensions, including a life course history of adverse events. Outcomes measures comprise subjective health, limitations in activities of daily living, mobility impairments, development of medical conditions or chronic health problems, falls, institutionalization, health services utilization, and death. Two additional random samples of 65-70 years old subjects will be surveyed in 2009 (birth year 1939-1943) and in 2014 (birth year 1944-1948). DISCUSSION: The Lc65+ study focuses on the sequence "Determinants --> Components --> Consequences" of frailty. It currently provides information on health in the youngest old and will allow comparisons to be made between the profiles of aging individuals born before, during and at the end of the Second World War.

Incidence and outcomes of respiratory viral infections in lung transplant recipients: a prospective study.

BACKGROUND: The incidence and outcomes of respiratory viral infections in lung transplant recipients (LTR) are not well defined. The objective of this prospective study conducted from June 2008 to March 2011 was to characterise the incidence and outcomes of viral respiratory infections in LTR. METHODS: Patients were seen in three contexts: study-specific screenings covering all seasons; routine post-transplantation follow-up; and emergency visits. Nasopharyngeal specimens were collected systematically and bronchoalveolar lavage (BAL) was performed when clinically indicated. All specimens underwent testing with a wide panel of molecular assays targeting respiratory viruses. RESULTS: One hundred and twelve LTR had 903 encounters: 570 (63%) were screening visits, 124 (14%) were routine post-transplantation follow-up and 209 (23%) were emergency visits. Respiratory viruses were identified in 174 encounters, 34 of these via BAL. The incidence of infection was 0.83 per patient-year (95% CI 0.45 to 1.52). The viral infection rates upon screening, routine and emergency visits were 14%, 15% and 34%, respectively (p<0.001). Picornavirus was identified most frequently in nasopharyngeal (85/140; 60.7%) and BAL specimens (20/34; 59%). Asymptomatic viral carriage, mainly of picornaviruses, was found at 10% of screening visits. Infections were associated with transient lung function loss and high calcineurin inhibitor blood levels. The hospitalisation rate was 50% (95% CI 30% to 70.9%) for influenza and parainfluenza and 16.9% (95% CI 11.2% to 23.9%) for other viruses. Acute rejection was not associated with viral infection (OR 0.4, 95% CI 0.1 to 1.3). CONCLUSIONS: There is a high incidence of viral infection in LTR; asymptomatic carriage is rare. Viral infections contribute significantly to this population's respiratory symptomatology. No temporal association was observed between infection and acute rejection.

Nursing diagnoses and outcomes related to the circulatory-system terms (ICNP®) represented in an ontology

The aim of the present study was to develop titles of Nursing Diagnoses and Outcomes (ND/NO) through the relationship between the terms of the Focus axis, limited to the Circulatory System Process, and the terms of other ICNP® axes and to integrate these terms into an ontology. Titles were developed linking 17 terms of the focus axis, which were evaluated by expert nurses in five Brazilian cities. Titles whose use concordance was above 0.80 were included in the ontology. In total, 89 titles for ND/NO were supported in the literature, and 19 were not supported; 37 were assessed as eligible for use in healthcare practice and were included in the ontology. The construction of ND/NO titles based on the ICNP® and using a formal representation of knowledge is a task that requires deepening concepts used for nursing and adequate classification revisions. The elaborated titles will facilitate the composition of diagnostics that are more consistent with practice.