A survey of work engagement and psychological capital levels.

AIM: To evaluate the relationship between work engagement and psychological capital (PsyCap) levels reported by registered nurses. BACKGROUND: PsyCap is a developable human resource. Research on PsyCap as an antecedent to work engagement in nurses is needed. METHODS: A convenience sample of 137 registered nurses participated in this quantitative cross-sectional survey. Questionnaires measured self-reported levels of work engagement and psychological capital. Descriptive and inferential statistics were used for data analysis. RESULTS: There was a statistically significant correlation between work engagement and PsyCap scores (r=0.633, p<0.01). Nurses working at band 5 level reported statistically significantly lower PsyCap scores compared with nurses working at band 6 and 7 levels. CONCLUSION: Nurses reporting high levels of work engagement also reported high levels of PsyCap. Band 5 nurses might benefit most from interventions to increase their PsyCap. This study supports PsyCap as an antecedent to work engagement.

Anticoagulated patient's perception of their illness, their beliefs about the anticoagulant therapy prescribed and the relationship with adherence: impact of novel oral anticoagulant therapy - study protocol for The Switching Study: a prospective cohort study.

BACKGROUND: Anticoagulant therapy is prescribed for millions of patients worldwide for the prevention and treatment of both arterial and venous thrombosis. Historically, only vitamin K antagonists have been available for clinicians to prescribe. The anticoagulation landscape is changing. The recent availability of the novel oral anticoagulants overcome many of the disadvantages associated with vitamin K antagonists. However the lack of formal monitoring and clinic follow-up is a concern for clinicians, as medication adherence is being assumed, which is known to decline in patients prescribed medications for chronic conditions. The switching study is a programme of work investigating the association between medication adherence and patient's beliefs about anticoagulation therapy (warfarin and subsequently novel oral anticoagulants), together with beliefs about their illness and anticoagulation related quality of life. METHODS/DESIGN: The anticoagulation database at King's College Hospital will be interrogated and two groups of patients will be identified; those with a time in therapeutic range on warfarin of ≥75 % and those <50 %. These groups of patients will have their illness perceptions, anticoagulation specific quality of life and beliefs about medications compared. Those patients in the time in therapeutic range <50 % group, will be then be invited to switch to a novel oral anticoagulant, as per local guidance. Those patients, who do switch, will then be followed longitudinally and have their adherence, illness perceptions, anticoagulation specific quality of life and beliefs about medications, re-evaluated on the novel agent. The results from these sub-studies, will inform a clinical pathway to support patients on these novel agents, which will be evaluated in an independent group of patients. DISCUSSION: The results from the switching study will be used to develop a clinical pathway to support patient's prescribed novel oral anticoagulant therapy long-term.

Relationship between development of post-thrombotic syndrome and serial ultrasound, D-dimer, and factor VIII activity after a first deep venous thrombosis.

OBJECTIVE: The aim of this study was to evaluate the relationship of post-thrombotic syndrome (PTS) with residual vein thrombosis, deep venous reflux (DVT), D-dimer, and factor VIII (FVIII) after a first deep venous thrombosis (DVT). METHODS: There were 133 participants with objectively confirmed DVT, of whom 114 were observed for 6 months after completion of anticoagulation. Ultrasound, D-dimer, and FVIII evaluations were undertaken at 6 weeks after completion of anticoagulation and at the end of follow-up. PTS was considered present in those with a score of ≥5 on the Villalta scale at either assessment. RESULTS: The cumulative incidence of PTS was 51.8%, with median duration of follow-up of 11 months. Median D-dimer and FVIII in those with PTS were significantly higher at both time points compared with those without. Similarly, residual vein thrombosis and deep venous reflux were more prevalent in those with PTS at both study assessments. On multivariable analysis, only FVIII at end of study remained significantly associated with PTS with an odds ratio of 2.83 (95% confidence interval, 1.09-7.42; P = .034). Ultrasound markers and D-dimer were not significantly associated with PTS after adjustment for age, body mass index, Charlson Index ≥1, and proximal extent of DVT. CONCLUSIONS: FVIII activity at end of follow-up was independently associated with PTS, suggesting underlying activation of coagulation.

Deep vein thrombosis: diagnosis and treatment.

This article aims to give nurses an insight into proximal deep vein thrombosis (DVT). DVT is relatively common and is associated with significant morbidity and mortality. Complications such as post-thrombotic syndrome, venous leg ulcers, recurrent venous thromboembolism (VTE) - pulmonary embolism (PE) or DVT - and pulmonary hypertension can develop following DVT diagnosis. There is also a risk that a large PE could prove fatal. While VTE prevention is a clinical priority, nurses should also have appropriate skills and knowledge to care for patients with suspected DVT. Nurses need to be aware of the signs and symptoms of DVT, common diagnostic tests, pharmacological and mechanical treatments, and the follow-up investigations patients should be offered.

Comprehensive VTE prevention program incorporating mandatory risk assessment reduces the incidence of hospital-associated thrombosis.

BACKGROUND: VTE is a common complication of hospitalization and is associated with significant morbidity and mortality. The use of appropriate thromboprophylaxis can significantly reduce the risk of VTE but remains underutilized. In England, a comprehensive approach to VTE prevention was launched in 2010. This study aimed to evaluate the impact of the implementation of the national program in a single center. METHODS: A prospective quality improvement program was established at King's College Hospital NHS Foundation Trust in 2010. The multidisciplinary thrombosis team launched mandatory documented VTE risk assessment and updated thromboprophylaxis guidance. Root cause analysis of hospital-associated thrombosis (HAT) was implemented to identify system failures, enable outcome measurement, and facilitate learning to improve VTE prevention practice. The key outcomes were the incidence of HAT and the proportion of events preventable with appropriate thromboprophylaxis. RESULTS: Documented VTE risk assessment improved from <40% to > 90% in the first 9 months. Four hundred twenty-five episodes of HAT were identified over 2 years. A significant reduction in the incidence of HAT was observed following sustained achievement of 90% risk assessment (risk ratio, 0.88; 95% CI, 0.74-0.98; P = .014). The proportion of HAT attributable to inadequate thromboprophylaxis fell significantly from 37.5% to 22.4% (P = .005). CONCLUSIONS: Mandatory VTE risk assessment can significantly reduce preventable HAT and thereby improve patient safety.

Presenting D-dimer and early symptom severity are independent predictors for post-thrombotic syndrome following a first deep vein thrombosis.

Post-thrombotic syndrome (PTS) is the most common complication of deep vein thrombosis (DVT). Current preventative strategies are limited to the daily wear of graduated compression stockings (GCS). The aim of this study was to evaluate early predictors of PTS. One hundred and twenty-two consecutive patients with a first DVT were prospectively recruited from diagnosis and followed for up to 6 months post-end of anticoagulation. D-dimer was measured in 107 participants at presentation and Villalta scale was evaluated in 70 participants at a median of 2 weeks following diagnosis. PTS developed in 51·6% of participants. GCS were obtained by 78·1% of participants, with 33·7% reporting daily wear at the end of follow-up. Mean early Villalta scale was significantly higher in those with PTS (8·1 ± 3·7) compared to those without (2·6 ± 2·7, P < 0·001). Median D-dimer was significantly higher in those with PTS [3260 ng/ml, interquartile range (IQR) 820-8000 ng/ml] compared to those without (1540 ng/ml, IQR 810-2520 ng/ml, P < 0·001). The adjusted odds ratio for every one point increase in early Villalta scale was 1·78 [95% confidence interval (CI), 1·19-2·64; P = 0·005] and for D-dimer >1910 ng/ml it was 2·71 (95% CI, 1·05-7·03; P = 0·04). These markers could enable targeted counselling regarding GCS for those at high risk of PTS.

African-Caribbean ethnicity is associated with a hypercoagulable state as measured by thrombin generation.

African-Caribbean ethnicity is associated with an increased risk of both first and recurrent venous thromboembolism (VTE). The aim of this study was to evaluate thrombin generation in African-Caribbeans compared with whites in patients with deep vein thrombosis (DVT) and healthy volunteers. Thrombin generation was measured in a case-control study of 80 patients who had completed anticoagulation therapy for a first DVT (50 white and 30 African-Caribbean) and 66 controls. Peak thrombin with and without thrombomodulin was significantly higher in African-Caribbeans with DVT compared with whites with DVT (P < 0.001 for both comparisons) and African-Caribbean controls (P < 0.001, 0.003, respectively). Endogenous thrombin potential (ETP) with and without thrombomodulin was significantly higher in African-Caribbeans with DVT than whites with DVT (P ≤ 0.001 for both comparisons). Maximum velocity and ETP ratio were increased in African-Caribbeans with DVT compared with whites with DVT (P < 0.001 and 0.030, respectively) and African-Caribbean controls (P < 0.001 and 0.019, respectively). Within the control group, peak thrombin was significantly increased in African-Caribbeans compared with whites (P = 0.017). ETP, peak thrombin with thrombomodulin and maximum velocity were also increased in African-Caribbeans compared with white controls (P = 0.045 for all comparisons). African-Caribbeans with DVT had significantly higher factor VIII levels compared with whites with DVT and controls. African-Caribbean ethnicity confers a hypercoagulable state as measured by thrombin generation. This supports epidemiological findings of increased risk of first and recurrent VTE. Thrombin generation requires adjustment for ethnicity in studies undertaken in ethnically diverse populations.

Collaborative working to reduce VTE.

The thrombosis team at King's College Hospital used innovative methods to bring about a change in the trust's VTE prevention practice. The team took a structured approach with a focus on positive aspects of practice. The aim was to involve clinical staff by forming partnerships rather than using a dictatorial approach. The creation of a nurse and midwife link network and valuing the individuality of clinical areas were fundamental to successful change.

Preventing venous thromboembolism through risk assessment approaches.

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in hospitalized patients. Recent guidelines from the Department of Health and the National Institute for Health and Clinical Excellence recommend mandatory, universal VTE risk assessment for hospitalized patients and the provision of appropriate prevention measures (thromboprophylaxis). Careful selection of a suitable VTE risk assessment approach is required to improve the chance of its successful implementation in hospital. At-risk patients need to be identified, counselled and the most appropriate thromboprophylaxis selected, prescribed and delivered. Nurses are ideally placed to play a central role in the implementation of this change in clinical practice through leadership and education. Extended pharmacological thromboprophylaxis has been recommended in certain high-risk groups. New oral anticoagulants are being evaluated, which could change the way thromboprophylaxis is administered in future, benefiting both patients and nurses.

UV-B is required for normal development of oil glands in Ocimum basilicum L. (sweet basil).

Plants of Ocimum basilicum L. grown under glass were exposed to short treatments with supplementary UV-B. The effect of UV-B on volatile essential oil content was analysed and compared with morphological effects on the peltate and capitate glandular trichomes. In the absence of UV-B, both peltate and capitate glands were incompletely developed in both mature and developing leaves, the oil sacs being wrinkled and only partially filled. UV-B was found to have two main effects on the glandular trichomes. During the first 4 d of treatment, both peltate and capitate glands filled and their morphology reflected their 'normal' mature development as reported in the literature. During the following days there was a large increase in the number of broken oil sacs among the peltate glands as the mature glands broke open, releasing volatiles. Neither the number of glands nor the qualitative or quantitative composition of the volatiles was affected by UV-B. There seems to be a requirement for UV-B for the filling of the glandular trichomes of basil.

Anther dehiscence in Lycopersicon esculentum: II. Water relations.

Water tracers have been used to demonstrate the continued functioning of the anther filament during dehiscence in Lycopersicon esculentum Mill. Since Lycopersicon possesses neither nectar nor nectaries dehiscence cannot be related to sugar secretion, as has been demonstrated for other plants. The anthers seem structurally adapted for water conservation and the only transpirational loss of the flower appears to be through the petals. Transpiration from the anthers themselves thus appears not to be involved in regulating dehiscence. Anther opening is preceded by dehydration of the locule and circumstantial evidence indicates it to be an active process, with water being exported through the filaments to the petals along an osmotic gradient generated by starch/sugar interconversion. Measurement of water potential differentials between the petals and anthers points to the mechanism driving this export of water from the anthers. Interestingly, turgor pressure is maintained in the majority of the anther tissues until senescence, remaining remarkably constant against a background of dramatic changes in osmotic potential. These data, combined with the observation that the hydration level of the anthers falls only to 70% at senescence, indicates that dehiscence cannot primarily be a desiccatory process. Some domains within the anther do desiccate, but these are strictly localized. Thus, while hydration levels of living tissues remain independent of the environment, those observed to undergo protoplast degeneration and wall collapse exhibit environmentally-linked hygroscopic absorption. Dehiscence thus emerges as an orchestrated programme of structural and physiological events leading to the desiccation of specific domains of the anthers. These findings are discussed in terms of current models for anther dehiscence in flowering plants.