https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(13)62631-8.pdf

Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study

Objective To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33 659 nurses and 11 318 patients in Europe; 27 509 nurses and more than 120 000 patients in the US. Main outcome measures Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). Results The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Conclusions Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction.

/pdf/patient-safety-satisfaction-and-quality-of-hospital-care-569u8f4bow.pdf

Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States.

ContextIn observational studies, individuals with elevated levels of plasma
homocysteine tend to have moderately increased risk of coronary heart disease
(CHD). The MTHFR 677C→T polymorphism is a genetic
alteration in an enzyme involved in folate metabolism that causes elevated
homocysteine concentrations, but its relevance to risk of CHD is uncertain.ObjectiveTo assess the relation of MTHFR 677C→T
polymorphism and risk of CHD by conducting a meta-analysis of individual participant
data from all case-control observational studies with data on this polymorphism
and risk of CHD.Data SourcesStudies were identified by searches of the electronic literature (MEDLINE
and Current Contents) for relevant reports published before June 2001 (using
the search terms MTHFR and coronary
heart disease), hand searches of reference lists of original studies
and review articles (including meta-analyses) on this topic, and contact with
investigators in the field.Study SelectionStudies were included if they had data on the MTHFR 677C→T genotype and a case-control design (retrospective or nested
case-control) and involved CHD as an end point. Data were obtained from 40
(34 published and 6 unpublished) observational studies involving a total of
11 162 cases and 12 758 controls.Data ExtractionData were collected on MTHFR 677C→T genotype,
case-control status, and plasma levels of homocysteine, folate, and other
cardiovascular risk factors. Data were checked for consistency with the published
article or with information provided by the investigators and converted into
a standard format for incorporation into a central database. Combined odds
ratios (ORs) for the association between the MTHFR 677C→T
polymorphism and CHD were assessed by logistic regression.Data SynthesisIndividuals with the MTHFR 677 TT genotype
had a 16% (OR, 1.16; 95% confidence interval [CI], 1.05-1.28) higher odds
of CHD compared with individuals with the CC genotype. There was significant
heterogeneity between the results obtained in European populations (OR, 1.14;
95% CI, 1.01-1.28) compared with North American populations (OR, 0.87; 95%
CI, 0.73-1.05), which might largely be explained by interaction between the MTHFR 677C→T polymorphism and folate status.ConclusionsIndividuals with the MTHFR 677 TT genotype
had a significantly higher risk of CHD, particularly in the setting of low
folate status. These results support the hypothesis that impaired folate metabolism,
resulting in high homocysteine levels, is causally related to increased risk
of CHD.

MTHFR 677C-->T polymorphism and risk of coronary heart disease: a meta-analysis.

The extent to which member states transpose EU directives in a timely fashion is often argued to be strongly associated with the general effectiveness of national bureaucracies. But what kind of institutional solutions ensure better performance? This paper examines the patterns and effects of departmental oversight across 28 ministries in Estonia, Hungary, Poland and Slovenia. In mapping the strength of oversight, it relies on around 90 structured interviews regarding the rules-in-use on transposition planning, legal review and monitoring of deadlines. The analysis of the impact of departmental oversight is based on an original dataset of over 300 directives with transposition deadlines between January 2005 and December 2008.

On the european union

Five subscales were derived from the Nursing Work Index (NWI) to measure the hospital nursing practice environment, using 1985-1986 nurse data from 16 magnet hospitals. The NWI comprises organizational characteristics of the original magnet hospitals. The psychometric properties of the subscales and a composite measure were established. All measures were highly reliable at the nurse and hospital levels. Construct validity was supported by higher scores of nurses in magnet versus nonmagnet hospitals. Confirmatory analyses of contemporary data from 11,636 Pennsylvania nurses supported the subscales. The soundness of the new measures is supported by their theoretical and empirical foundations, conceptual integrity, psychometric strength, and generalizability. The measures could be used to study how the practice environment influences nurse and patient outcomes.

Practice Environment Scale of the Nursing Work Index

Thrombolytic therapy salvages jeopardized myocardium and preserves left ventricular function. Therefore, a beneficial effect on exercise tolerance and haemodynamic adaptation to exercise can be anticipated. In the present study the results of bicycle exercise tests, performed at 10 to 14 days and at more than 1 year after infarction, were compared between patients randomized double blindly to recombinant tissue plasminogen activator (rt-PA) or placebo. At 2 weeks, the maximal heart rate (140 vs 130 beats. min−1 P=0.017), systolic blood pressure (169 vs 161 mmHg, P=0.018) and pressure-rate product (22907 vs 20865 beats. min-1mmHg, P=0.0025) were higher in rt-PA treated patients (n=145) than in controls (n=142). At a mean follow-up of 16 months, rt-PA patients (n=126) performed a higher total and peak work load (733 vs 600 Watts. min, P=0.027 and 133 vs 100 Watts, P=-0.036, respectively) than control patients (n=122). During both exercise tests the incidence of clinical or electrocardiographic signs of ischaemia was similar. Multiple regression analysis indicated that age and end-systolic volume were predictors of peak pressure-rate product at 2 weeks (R2=0.11, P=0.0001). Age, sex and left ventricular ejection fraction at discharge were independent predictors of peak work load at 2 weeks (R2=0.32, P=0.0001) and the square root of peak work load at 16 months (R2=0.39, P=0.001). These findings suggest that an improved left ventricular function in the thrombolysis group plays a role in the better exercise capacity observed in rt-PA treated patients.

Early and late exercise capacity after acute myocardial infarction treated with recombinant tissue-plasminogen activator

Aim: To assess the clinical efficacy and safety profile of opicapone (25 and 50 mg once daily) versus placebo. Patients: Levodopa-treated adults with Parkinson's disease. Material & methods: A systematic review and meta-analysis were conducted. Results: Opicapone provided a greater reduction in the absolute OFF-time, increased the chances of ≥1-h reduction in the OFF-time and ≥1-h increase in the ON-time compared with placebo. Receiving opicapone more often facilitated levodopa dose reduction versus placebo. There were no differences in the occurrence of adverse events (severe and leading to drug discontinuation), but receiving opicapone increased the frequency of dyskinesia. Conclusion: Opicapone demonstrated superior clinical efficacy to placebo, with a comparable general safety profile.

Opicapone as an add-on to levodopa for reducing end-of-dose motor fluctuations in Parkinson's disease: a systematic review and meta-analysis.

Forecasting nursing. Planning human resources in nursing, organisation and scope of the RN4CAST study in Poland

	The study was conducted as part of European RN4CAST project, with participation of 16 countries, including 12

Organizacja i zakres badań RN4CAST (Registered Nurse Forecasting) dotyczących planowania zatrudnienia w pielęgniarstwie w Polsce

Treatment of primary pulmonary hypertension with hydralazine

Despite many prophylactic activities, coronary heart disease (CHD) remains the main health problem in Poland and the most common cause of death among men. Risk factors related to life style are the target for the modification of prophylaxis. The main task of health education is to develop the skills and knowledge affecting the future behavior and habits of healthy lifestyle. The aim of this project was to assess the influence of health education on the occurrence of CHD risk factors among healthy young men. Sixty four men (31 submitted to education and physical training group and 33 to the control group) up to 50 years of age, without recognized cardiovascular diseases were selected for the study. At the beginning the presence of risk factors was recorded in each participant. The education (6 weeks) and training program (25 weeks) was conducted and it was finally evaluated after six months by comparing experimental versus control groups. The background data showed that 95% of men had at least one risk factor, the mean number of risk factors in average participant was 8.8, minimum 2 and maximum 17, there was no difference between the experimental and control groups. The educational program limited amount of risk factors in the experimental group (p<0.0001). Positive changes concerned physical activities (p=2E-09), knowledge (p=0.01) and stress management (p<0.05).

Tomasz Brzostek

Papers

Early and late exercise capacity after acute myocardial infarction treated with recombinant tissue-plasminogen activator

Opicapone as an add-on to levodopa for reducing end-of-dose motor fluctuations in Parkinson's disease: a systematic review and meta-analysis.

Organizacja i zakres badań RN4CAST (Registered Nurse Forecasting) dotyczących planowania zatrudnienia w pielęgniarstwie w Polsce

Treatment of primary pulmonary hypertension with hydralazine

Influence of health education on the occurrence of risk factors for coronary heart disease