Temporal and spatial refugia modify predation risk for non-native crabs in rocky intertidal habitats.

Populations of the non-native Asian shore crab, Hemigrapsus sanguineus, now dominate the rocky intertidal of southern New England, USA. High abundances suggest the recent invader may have experienced enhanced success as a result of enemy release. While larvae and juveniles may serve as a food source for ecologically important species, little is known about predation of mature H. sanguineus or the influence of habitat on predation pressure. To assess natural predation rates of adult H. sanguineus, crabs were tethered in the intertidal at Clarks Cove in New Bedford, MA. Crabs were left in situ for half of a tidal cycle then observed for signs of predation. Results of separate high and low tide trials showed that adult crabs were preyed upon at both high and low tide, though at a significantly higher rate during high tide during both daytime and nighttime, suggesting predation by aquatic species is greater than that by terrestrial species. To investigate the role of habitat as refuge from predation, a laboratory experiment manipulated the complexity of habitat provided to crabs in the presence of a native fish predator. Results indicate better refuge is provided by more complex shelter. Together, findings suggest that fish, crabs, and/or diving birds are important predators for H. sanguineus in the invaded range and that habitat refuge acts to reduce predation pressure.

Intertidal habitat complexity influences the density of the non-native crab Hemigrapsus sanguineus.

Habitat structural complexity can provide protection from predators, potentially affecting population density of native and non-native prey. The invasive Asian shore crab, Hemigrapsus sanguineus, occurs in variable densities in the rocky intertidal zone of eastern North America and northern Europe, often in densities greater than in its native range. The present study examined the influence of habitat complexity on the density of H. sanguineus. Artificial shelters of concrete pavers with stones arranged in increasing complexity were deployed in the intertidal zone along a rocky shore in southeastern Massachusetts, USA, for 21 consecutive weekly intervals in 2020. Crabs consistently reached the highest densities in the most complex shelters despite their lower internal surface area. In addition, crabs exhibited shelter selectivity based on body size, with large crabs occupying artificial shelters in greater numbers than adjacent natural substrate. In a subsequent lab study, crab activity over 1 h was observed in the presence of the same artificial shelters, under simulated tidal conditions. Shelter complexity had little influence on the number of crabs under the pavers although crabs were more active when submerged in water than exposed to air. These results show that crab density increases as habitat complexity increases, and complexity may serve as a predictor of H. sanguineus density but not short-term behavior.

Reflections on vital sign measurement in nursing practice.

Physiological observations or vital sign monitoring is a fundamental tenet of nursing care within an acute care setting. Surveillance of vital signs with algorithmic early warning frameworks aids the nurse in monitoring for early symptoms of clinical deterioration. The nurse must be cognizant of the factors that can influence the vital sign measurements because the framework score is only as reliable as the data inserted. Vital sign technology has made significant progress in its ability to objectify nursing subjective assessments. Early scientists have struggled with its relationship with subjectivity, claiming it has no relevance in true science. Quantitative measurements, regardless of how objectively they were created or obtained, need a subjective lens to interpret and act on the results. The skill of "making" the vital signs can be easily taught or done with technology, but it is the "taking" of the data for analysis of truth and action that requires a higher level of expertise. This paper will examine the truth of vital sign methodology and monitoring to explore the question, "Is true objectivity in the nursing practice of vital sign measurement possible?" The truth in vital sign recognition through a subjective lens will also be explored to challenge the philosophical scientific claims that objective data are the absolute truth.

Six Things You Can Do Today to Prevent Hospital-Onset C. difficile Tomorrow.

Some lesser-known advice on keeping patients safe.

Improving the culture of safety on a high-acuity inpatient child/adolescent psychiatric unit by mindfulness-based stress reduction training of staff.

PROBLEM: The purpose of this study was to reduce perceived levels of interprofessional staff stress and to improve patient and staff safety by implementing a brief mindfulness-based stress reduction (MBSR) training program on a highacuity psychiatric inpatient unit. METHODS: A one-group repeated measure design was utilized to measure the impact of the (MBSR) training program on staff stress and safety immediately posttraining and at 2 months. Two instruments were utilized in the study: the Toronto Mindfulness Scale and the Perceived Stress Scale. FINDINGS: The MBSR program reduced staff stress across the 2-month post-training period and increased staff mindfulness immediately following the brief training period of 8 days, and across the 2-month post-training period. A trend toward positive impact on patient and staff safety was also seen in a decreased number of staff call-ins, decreased need for 1:1 staffing episodes, and decreased restraint use 2 months following the training period. CONCLUSIONS: A brief MBSR training program offered to an interprofessional staff of a high-acuity inpatient adolescent psychiatric unit was effective in decreasing their stress, increasing their mindfulness, and improving staff and patient safety.

Abundance of non-native crabs in intertidal habitats of New England with natural and artificial structure.

Marine habitats containing complex physical structure (e.g., crevices) can provide shelter from predation for benthic invertebrates. To examine effects of natural and artificial structure on the abundance of intertidal juvenile crabs, 2 experiments were conducted in Kingston Bay, Massachusetts, USA, from July to September, 2012. In the first experiment, structure was manipulated in a two-factor design that was placed in the high intertidal for 3 one-week periods to test for both substrate type (sand vs. rock) and the presence or absence of artificial structure (mesh grow-out bags used in aquaculture, ∼0.5 m(2) with 62 mm(2) mesh openings). The Asian shore crab, Hemigrapsus sanguineus, and small individuals of the green crab, Carcinus maenas, were observed only in the treatments of rocks and mesh bag plus rocks. Most green crabs were small (<6 mm in carapace width) whereas H. sanguineus occurred in a wide range of sizes. In the second experiment, 3 levels of oyster-shell treatments were established using grow-out bags placed on a muddy sand substrate in the low intertidal zone: mesh grow-out bags without shells, grow-out bags with oyster shells, and grow-out bags containing live oysters. Replicate bags were deployed weekly for 7 weeks in a randomized complete block design. All crabs collected in the bags were juvenile C. maenas (1-15 mm carapace width), and numbers of crabs differed 6-fold among treatments, with most crabs present in bags with live oysters (29.5 ± 10.6 m(-2) [mean ± S.D.]) and fewest in bags without shells (4.9 ± 3.7 m(-2)). Both C. maenas and H. sanguineus occurred in habitats with natural structure (cobble rocks). The attraction of juvenile C. maenas to artificial structure consisting of plastic mesh bags containing both oyster shells and living oysters could potentially impact oyster aquaculture operations.

Improving the culture of safety on a high-acuity inpatient child/adolescent psychiatric unit by mindfulness-based stress reduction training of staff.

PROBLEM: The purpose of this study was to reduce perceived levels of interprofessional staff stress and to improve patient and staff safety by implementing a brief mindfulness-based stress reduction (MBSR) training program on a high-acuity psychiatric inpatient unit. METHODS: A one-group repeated measure design was utilized to measure the impact of the (MBSR) training program on staff stress and safety immediately post-training and at 2 months. Two instruments were utilized in the study: the Toronto Mindfulness Scale and the Perceived Stress Scale. FINDINGS: The MBSR program reduced staff stress across the 2-month post-training period and increased staff mindfulness immediately following the brief training period of 8 days, and across the 2-month post-training period. A trend toward positive impact on patient and staff safety was also seen in a decreased number of staff call-ins, decreased need for 1:1 staffing episodes, and decreased restraint use 2 months following the training period. CONCLUSIONS: A brief MBSR training program offered to an interprofessional staff of a high-acuity inpatient adolescent psychiatric unit was effective in decreasing their stress, increasing their mindfulness, and improving staff and patient safety.

Applying STAAR interventions in incremental bundles: improving post-CABG surgical patient care.

BACKGROUND: Rehospitalization within 30 days of discharge after coronary artery bypass surgery (CABG) is a contributing factor to higher-than-acceptable overall hospital readmission rates throughout the United States. CABG rehospitalizations are of such concern that they are specifically targeted for action in 2015 under the Patient Protection and Affordable Care Act (2010). The phenomenon of increasing readmission rates has prompted the Institute for Healthcare Improvement to devise the Triple Aim initiative and the STate Action on Avoidable Rehospitalizations (STAAR) initiative to reduce 30-day readmission rates nationally. AIMS: This study explored the impact of implementing STAAR interventions delivered as part of a quality improvement project in incremental bundles on 30-day readmission rates and the experience of care in CABG patients. Specifically, the use of the teach-back patient education method and the scheduling of follow-up cardiology appointments prior to discharge using existing staff were examined. METHODS: A quantitative comparative study was conducted with 189 post-CABG patients at a tertiary care facility in the United States over a 2-year period, comparing outcomes between the group of patients prior to implementation of the STAAR interventions and those who later received them. Outcome variables included 30-day readmission rate and patient perception of experience of care. RESULTS: The overall 30-day readmission rate for CABG patients in the postintervention group was decreased to 12.0%, compared to 25.8% in the preintervention group. Of the demographic and health characteristics explored, only chronic lung disease was significantly related to 30-day readmission rates, and only in the postintervention group. LINKING EVIDENCE TO ACTION: Thirty-day readmission rates among CABG patients can be reduced and the experience of care can be enhanced through the use of targeted interventions utilizing existing staff and resources. The deliberate incremental implementation of bundled initiatives is an effective strategy in reducing 30-day readmissions in post-CABG patients.

The impact of a nurse practitioner rapid response team on systemic inflammatory response syndrome outcomes.

BACKGROUND: Early recognition of systemic inflammatory response syndrome (SIRS) can significantly alter outcomes such as mortality, unplanned intensive care unit admissions, and cost. PURPOSE: Through utilization of a nurse practitioner rapid response team (NP-RRT) and a revised database query, earlier identification of SIRS patients and consistent implementation of early goal-directed therapy (EGDT) on the medical-surgical units would positively impact SIRS outcomes. METHOD: A database query that indicated when patients had 2 or more of the SIRS criteria and anion gap acidosis was initiated. The NP-RRT reviewed the triggered patients, and if blood cultures, lactic acid levels, volume resuscitation, or antibiotics were not in place, they were either ordered or recommended to the physicians. RESULTS: All 4 components of EGDT were more frequently discussed with physicians at a statistically significant level. Individual components of EGDT had high levels of implementation. Unplanned intensive care unit admissions were reduced by 3.25% after intervention with a cost savings of approximately $250 000. After initiation of the database query, patients seen by the NP-RRT were more acutely ill, with a statistically higher mean anion gap acidosis, and as a result, mortality was essentially unchanged. DISCUSSION: Improved detection of SIRS and successful implementation of EGDT led to a bridging of the evidence-to-practice gap. Future recommendations on earlier detection of lactic acidosis were rendered as a consequence of this study. The NP-RRT will continue to use the database query to identify SIRS patients in a timely manner and expedite EGDT.

Exploring early and future use of DNP prepared nurses within healthcare organizations.

A strategy to gather data on DNP utilization and impact was designed using Donabedian's conceptual model and was piloted by surveying chief nursing officers (CNOs) leading Michigan's public and teaching hospital systems. Few of the responding CNOs reported currently employing DNP-prepared nurses. The majority reported gaps in knowledge related to role expectations and projected outcomes from a DNP-prepared nurse. Nurse leaders should become familiar with the role competencies of the DNP in order to maximize the potential contribution of this new level of care provider to improving care quality and access.

An interprofessional process to improve early identification and treatment for sepsis.

The course of sepsis is rapid. Patient outcomes improve when sepsis is diagnosed and treated quickly. The clinical goals of the evidence-based bundled strategies from the International consortium Surviving Sepsis Campaign (SSC) include optimizing timeliness in the delivery of care and creating a continuum for sepsis management that runs from the emergency department (ED) to the acute and critical care settings. Successful implementation of processes that integrate sepsis bundles can improve patient mortality and hospital costs. Improving interprofessional education and collaboration are necessary to facilitate the effective use of bundled strategies. An intervention that included interprofessional education resulted in a statistically significant difference between the three phases studied. There was a statistically significant improvement between the phases for lactate completion X(2) = 16.908 (p < .01) after education. Frequency of blood cultures being obtained before antibiotic administration was nearing statistical significance (p < .054). There was an improvement in time to antibiotic administration between phase 2 (182.09 mean average minutes, SD = 234.06) and phase 3 (91.62 mean average minutes, SD = 167.99).

Relationship of workplace incivility, stress, and burnout on nurses' turnover intentions and psychological empowerment.

This study explored the relationships among perceived workplace incivility, stress, burnout, perceived turnover intentions, and perceived level of psychological empowerment among acute care nurses (medical-surgical and critical care) in community and tertiary hospitals through the lens of complexity science. An exploratory study was conducted, and findings demonstrate significant relationships among workplace incivility, stress, burnout, turnover intentions, total years of nursing experience, and RN education levels. Creating targeted retention strategies and policies that will be sensitive to the needs and interests of nurses at high risk for leaving their organizations is imperative for nurse executives.

The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit.

PURPOSE: The purpose of this study was to examine the impact of the mindfulness-based stress reduction (MBSR) program on managing work stress and improving patient outcomes. DESIGN AND METHODS: A one-group pre-/post-test design was used to measure the impact of the MBSR program. The Mental Health Professionals Stress Scale, the Sense of Self Scale, the Toronto Mindfulness Scale, and the Maslach Burnout Inventory were used. FINDINGS: The MBSR class assisted staff in decreasing their stress levels and improve their self-care, which resulted in improved patient care. PRACTICE IMPLICATIONS: Increases in patient satisfaction and decreases in patient safety events were found.

A school-based application of modified habit reversal for Tourette syndrome via a translator: a case study.

A school-based modified habit reversal intervention was utilized with an adolescent diagnosed with Tourette syndrome who recently immigrated from Mexico. Because the student possessed little proficiency of the English language, an interpreter was needed to help implement the procedure. The frequency of motor tics markedly decreased from baseline to intervention across classroom settings. Results of two follow-up phases revealed that motor tic levels remained below those observed in the baseline phase. Implications and limitations of these findings are noted.

HIV and hepatitis C virus testing and seropositivity rates in Canadian federal penitentiaries: A critical opportunity for care and prevention.

BACKGROUND: Incarcerated persons experience high rates of HIV and hepatitis C virus (HCV) infection, but little is known about the burden of these bloodborne viruses among federal penitentiary inmates in Canada. OBJECTIVE: The present study investigates rates of testing and seropositivity for HIV and HCV among inmates in all 53 Canadian federal penitentiaries. METHODS: A cross-sectional design using surveillance data on voluntary HIV and HCV antibody testing in 2002 were applied to estimate the rate of testing uptake and the rate of incident seropositive tests among new admissions to federal penitentiaries and resident inmates. Rates of testing and infection were further examined by sex and region. Seroprevalence of HIV and HCV was estimated from the number of cumulative positive tests to year-end. RESULTS: Of 7670 new admissions during 2002, 30% were tested for HIV and HCV. Test seropositivity rates in this group were 0.7% for HIV and 10% for HCV. Of the 12,426 resident inmates, 28% were tested for HIV and 27% for HCV. Seropositivity rates in this group were 0.3% for HIV and 7% for HCV. Seroprevalence rates at yearend for 2002 were 2.0% for HIV and 26% for HCV and were substantially higher among women offenders (HIV: 3.7% of women, 1.9% of men; HCV: 34% of women, 26% of men). Variations in testing uptake and test seropositivity were observed across regions. CONCLUSIONS: The present study underscores the value of continued monitoring and evaluation of trends in HIV and HCV infection, which remain prevalent in federal penitentiaries. Higher rates of testing are warranted for at-risk inmates to improve early detection of infection and provide infected inmates with timely care and treatment. For those who remain free of infection, testing can provide the additional benefits of exposing inmates to health counselling and for the reinforcement of prevention messages. The period of incarceration is also a critical opportunity to link inmates with outside resources in preparation for release to the community.

Cost-effectiveness of a transplantation strategy compared to melphalan and prednisone in younger patients with multiple myeloma.

High dose chemotherapy with autologous stem cell transplantation (ASCT) improves outcomes in patients 65 years of age or less with multiple myeloma. Survival and costs in a cohort of 16 patients who received melphalan and prednisone as part of a clinical trial were compared with those of 36 patients referred to our centre for consideration of ASCT. In the transplant group, survival and costs were extrapolated to match the period of observation in the melphalan and prednisone group. Patient-specific and average costs were calculated from the perspective of the Ontario Ministry of Health. Costs and survival were varied by 50% in the sensitivity analysis. Transplantation improved life expectancy by 19.3 months with a cost difference of 30,517 Canadian dollars. The incremental cost-effectiveness of transplantation compared with melphalan and prednisone was 25,710 Canadian dollars per life-year gained when additional pamidronate and follow-up costs were considered. Discounting costs and survival at 3 and 5% did not result in important differences. The sensitivity analysis resulted in best and worse case scenarios for transplantation compared with melphalan and prednisone of 13,049 dollars and 63,954 dollars per life-year gained respectively. In comparison with melphalan and prednisone, ASCT appears to be cost-effective in patients 65 years old or younger with myeloma.