The association of withholding or continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers on acute kidney injury after non-cardiac surgery.

BACKGROUND: Withholding or continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers peri-operatively in non-cardiac surgery remains controversial as they may result in intra-operative hypotension and postoperative organ damage. METHODS: We included patients prescribed angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers who underwent surgical procedures > 1 h duration under general or spinal anaesthesia from January 2012 to June 2022 in a single centre. We categorised patients by whether these drugs were withheld for 24 h before surgery. We evaluated the association of withholding these drugs before non-cardiac surgery with creatinine concentrations that increased ≥ 26.4 µmol.l-1 in the first 48 postoperative hours (acute kidney injury). We also analysed changes in creatinine concentrations and estimated glomerular filtration rates. RESULTS: Angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers were withheld in 24,285 of 32,933 (74%) patients and continued in 8648 (26%) patients. We used propensity scores for drug discontinuation to match 8631 patient pairs who did or did not continue these drugs: acute kidney injury was recorded for 1791 (21%) patients who continued these drugs vs. 1587 (18%) who did not (OR (95%CI) 1.16 (1.08-1.25), p < 0.001). Intra-operative hypotension was recorded for 3892 (45%) patients who continued drugs vs. 3373 (39%) patients who did not (OR (95%CI) 1.28 (1.21-1.36), p < 0.001). Continuing drugs was independently associated with a mean increase in creatinine of 2.2 µmol.l-1 (p < 0.001) and a mean decrease in estimated glomerular filtration rate of 1.4 ml.min.1.73 m-2 (p < 0.001). CONCLUSIONS: Continuing angiotensin-converting enzyme inhibitors or angiotensin 2 receptor blockers 24 h before non-cardiac surgery was associated with intra-operative hypotension and postoperative acute kidney injury.

Effect of continuing angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers on the day of surgery on myocardial injury after non-cardiac surgery: A retrospective cohort study.

STUDY OBJECTIVE: To evaluate the effect of continuing of angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) prescriptions 24 h before surgery on postoperative myocardial injury and blood pressure in patients undergoing non-cardiac surgery. DESIGN: A single-center, retrospective study. SETTING: Operating room and perioperative care area. PATIENTS: 42,432 patients who had been taking chronic ACEI/ARB underwent non-cardiac surgery from January 2012 to June 2022. INTERVENTIONS: Patients who discontinued ACEI/ARB 24 h before surgery (withheld group, n=31,055) and those who continued ACEI/ARB 24 h before surgery (continued group, n=11,377). MEASUREMENTS: Primary outcome was myocardial injury after non-cardiac surgery (MINS) within 7 days postoperatively. MINS was defined as an elevated postoperative cardiac troponin measurement above the 99th percentile of the upper reference limit with a rise/fall pattern. Perioperative blood pressure and clinical outcomes were secondary outcomes. MAIN RESULTS: Among 42,432 patients, MINS occurred in 2848 patients (6.7%) and was the all-cause of death within 30 days in 122 patients (0.3%). Incidence of MINS was significantly higher in the continued group than the withheld group (847/11,377 [7.4%] vs. 2001/31,055 [6.4%]; OR [95% CI] 1.17 [1.07-1.27]; P<0.001). After 1:1 propensity score matching, 11,373 patients were included in each group. There was still a significant difference for the occurrence of MINS between two groups in matched cohort (7.4% vs. 6.6%, OR [95% CI] 1.14 [1.03-1.26]; P=0.015). Time-average weight of mean arterial pressure <65 mmHg during surgery was significantly higher in the continued group (mean 0.11 vs. 0.09 [95% CI of mean difference] [0.01-0.03]; P<0.001). However, there was no significant difference in other clinical outcomes and mortality. CONCLUSIONS: Withholding ACEI/ARB before surgery was associated with a reduced risk of intraoperative hypotension and postoperative myocardial injury, but it did not affect overall clinical outcomes in patients undergoing non-cardiac surgery.

Integral leadership in nursing: Development and psychometric validation of a Korean version of the Integral Nursing Leadership Scale.

BACKGROUND: With the importance of nursing leadership roles, there is a need for a more integrated approach to nursing leadership that can adapt quickly to many challenges in today's healthcare environments. In recent years, integral leadership that can apply a more holistic and inclusive approach to leadership has gained growing attention in other disciplines. However, research on integral leadership in nursing is sparse since no instrument specifically measuring integral leadership in nursing contexts is available. OBJECTIVE: The study aimed to develop an integral nursing leadership scale and evaluate its psychometric properties. METHODS: The scale was developed in two phases. In the first phase, items were generated to reflect the attributes of integral leadership in the nursing context. These attributes were identified through a conceptualization process using a literature review and semi-structured interviews. The process was based on the four dimensions of the integral leadership framework, adopting Wilber's four quadrants of integral theory. Then, the psychometric properties of the scale, including content validity, structural validity, and internal consistency reliability, were evaluated. Data were collected from a convenience sample of 806 Korean nurses and were analyzed using both exploratory factor analysis and second-order confirmatory factor analysis, using two separate random halves of the sample. RESULTS: The newly developed scale consisted of 30 items across four dimensions: individual leadership qualities, individual performance, influencing organizational culture, and organizational excellence. Content validity for the 30 items was calculated to be 0.84 for item-level content validity and 0.96 for the scale's content validity averaging method, indicating adequate content validity. The four-factor structure of integral nursing leadership was cross-validated by exploratory factor analysis and second-order confirmatory factor analysis. The internal consistency reliability was also found to be acceptable, as indicated by a Cronbach's alpha of 0.97 and a McDonald's ω estimate of 0.98. CONCLUSION: Findings demonstrate that the Integral Nursing Leadership Scale has acceptable content validity, structural validity, and reliability in measuring integral leadership, specifically in the context of nursing. More research is needed to further refine and establish strong validity of the scale.

Identifying patterns of lifestyle behaviours linked to sociodemographic characteristics and health conditions among young adults in South Korea.

AIMS: To identify specific patterns of lifestyle behaviours among young adults and examine the relationships of the patterns to sociodemographic characteristics and health conditions (hypertension, diabetes and obesity). DESIGN: Descriptive, correlational study. METHODS: Data from a nationally representative sample of 4562 young adults aged 19-39, who participated in the 2016-2018 Korea National Health and Nutrition Examination Survey, were analysed. Latent class analysis was used to identify the patterns of lifestyle behaviours, including smoking, alcohol use, physical activity and vaccination. Generalized linear regression analysis was used to examine the relationships among lifestyle behaviour patterns, sociodemographic characteristics and health conditions. RESULTS: Three patterns of lifestyle behaviours were identified: physically active (6.9%), high risk (21.5%) and passive (71.6%). The membership of these three patterns was significantly associated with sociodemographic characteristics (age, sex, education level, occupation and living arrangement). Among the three groups, young adults in the high-risk group were found to be significantly associated with all three health conditions (hypertension, diabetes and obesity) while controlling for sociodemographic characteristics. CONCLUSION: These results indicate that young adults are likely to engage in unhealthy lifestyle behaviours that are related to individual socioeconomic conditions, which could negatively affect their health conditions. IMPACT: This study provides insights into the lifestyle behaviours among young adults who have been recognized to be socially disadvantaged. This could help develop education and prevention programmes tailored to specific patterns of lifestyle behaviours for improving health while considering their socioeconomic contexts. NO PATIENT OR PUBLIC CONTRIBUTION: This applies to this research as the focus was on young adults in South Korea only.

The impact of pulmonary function tests on early postoperative complications in open lung resection surgery: an observational cohort study.

We investigated whether pulmonary function tests (PFTs) can predict pulmonary complications and if they are, to find new cutoff values in current open lung resection surgery. In this observational study, patients underwent open lung resection surgery at a tertiary hospital were analyzed (n = 1544). Various PFTs were tested by area under the receiver-operating characteristic curve (AUCROC) to predict pulmonary complications until 30 days postoperatively. In results, PFTs were generally not effective to predict pulmonary complications (AUCROC: 0.58-0.66). Therefore, we could not determine new cutoff values, and used previously reported cutoffs for post-hoc analysis [predicted postoperative forced expiratory volume in one second (ppoFEV1) < 40%, predicted postoperative diffusing capacity for carbon monoxide (ppoDLCO) < 40%]. In multivariable analysis, old age, male sex, current smoker, intraoperative transfusion and use of inotropes were independent risk factors for pulmonary complications (model 1: AUCROC 0.737). Addition of ppoFEV1 or ppoDLCO < 40% to model 1 did not significantly increase predictive capability (model 2: AUCROC 0.751, P = 0.065). In propensity score-matched subgroups, patients with ppoFEV1 or ppoDLCO < 40% showed higher rates of pulmonary complications [13% (21/160) vs. 24% (38/160), P = 0.014], but no difference in in-hospital mortality [3% (8/241) vs. 6% (14/241), P = 0.210] or mean survival duration [61 (95% CI 57-66) vs. 65 (95% CI 60-70) months, P = 0.830] compared to patients with both > 40%. In conclusion, PFTs themselves were not effective predictors of pulmonary complications. Decision to proceed with surgical resection of lung cancer should be made on an individual basis considering other risk factors and the patient's goals.

A robust and practical CRISPR/crRNA screening system for soybean cultivar editing using LbCpf1 ribonucleoproteins.

KEY MESSAGE: Calli protoplasts isolated from three soybean cultivars are useful tools to evaluate guide RNAs for clustered regularly interspaced short palindromic repeats (CRISPR)-based precise gene editing. A type V CRISPR effector, LbCpf1(Cas12a) from Lachnospiraceae bacterium ND 2006, has been used for precision editing of the plant genome. We report that callus-derived protoplasts from three soybeans, including Glycine Max var. Williams 82 and two Korean cultivars (Kwangan and Daewon) represent efficient systems for the screening of active crRNA for CRISPR/LbCpf1. CRISPR/LbCpf1 ribonucleoproteins (RNPs) were delivered as complexes of purified endonucleases mixed with designed crRNA to simultaneously edit target genes of GlymaFAD2-1A and GlymaFAD2-1B transfected into three soybean protoplasts including genome-sequenced Williams 82 with cultivars, Kwangan and Daewon. Previously, we reported that nine crRNAs designed for LbCpf1 exhibited varying degrees of editing efficacy for two FAD2 genes. Among the nine crRNAs, the LbCpf1-crRNA3 complexes showed the highest efficiency in soybean cotyledon protoplasts. The new screening systems of callus protoplasts from three soybeans have been successfully used to transfect GFP-tagged markers and CRISPR/LbCpf1 RNPs. The callus protoplasts confirm that the LbCpf1-crRNA3 complex is an active crRNA for LbCpf1 to edit two FAD2 genes similar to cotyledon protoplasts. These results demonstrate that soybean callus protoplast-based CRISPR/crRNA selection is a new and practical tool to screen the efficacy of crRNAs and a prerequisite for progressive regeneration of the edited soybean.

Prediction of Pleural Adhesions by Lung Ultrasonography: An Observational Study.

OBJECTIVE: Pleural adhesion makes video-assisted thoracoscopic surgery (VATS) an arduous procedure and can increase postoperative pain from accompanying adhesiolysis. For the present study, the feasibility of lung ultrasonography for the prediction of pleural adhesions and postoperative pain in VATS was investigated. DESIGN: Blinded, prospective, observational study. SETTING: Tertiary teaching hospital, Seoul, South Korea. PARTICIPANTS: Sixty patients (American Society of Anesthesiologists physical status I to III) scheduled to undergo VATS were assessed for eligibility. After exclusions, 53 patients were enrolled and followed-up. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated with lung ultrasonography during deep spontaneous respiration before induction of anesthesia, and surgeons confirmed the presence of pleural adhesions during the surgery. Pain was evaluated using a numeric rating scale and by the amount of opioid consumption until 24 hours postoperatively. Lung ultrasonography showed acceptable predictability of pleural adhesions, with the area under the receiver operating characteristic curve (0.75, 95% confidence interval [CI] 0.67-0.83) and high specificity (0.97, 95% CI 0.91-0.99) but low sensitivity (0.53, 95% CI 0.38-0.68). The pain score was not different between sonographic adhesion (+) and (-) groups; however, the sonographic adhesion (+) group consumed more opioids until 24 hours postoperatively (fentanyl 675 [558-805] µg v 420 [356-476] µg; p < 0.001). CONCLUSIONS: Lung ultrasonography may help with planning postoperative pain management in VATS; however, it was a better tool for ruling out rather than detecting pleural adhesions.

Person-Centered Care Environment Associated With Care Staff Outcomes in Long-Term Care Facilities.

BACKGROUND: Although a general implementation of person-centered care in Korean long-term care delivery systems would be challenging, person-centered care has the potential to improve resident and staff outcomes through changes in current care services. However, little empirical evidence currently supports a positive relationship between person-centered care environments and staff outcomes. PURPOSE: This study was designed to examine the relationship between person-centered care environments and staff outcomes, including job satisfaction and turnover intention, among care staff in Korean long-term care facilities. METHODS: This descriptive, correlational study used data from 235 care staff (94 nursing staff and 141 personal care workers) in 13 long-term care facilities in Korea. Data were collected using structured survey questionnaires, including items related to the person-centered care environment, job satisfaction, and turnover intention. Multilevel linear and logistic regression analyses were performed using Mplus Version 7.0. RESULTS: After controlling for individual (age, education, monthly income, position, shift work, and job tenure) and organizational (type of facility, location, ownership, bed size, and staffing levels) characteristics, a significant relationship was found between the person-centered care environment and job satisfaction and turnover intention among staff in Korean long-term care facilities. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: The study findings indicate that working in a person-centered care environment is key to higher job satisfaction, which is a significant predictor of turnover intention among staff in long-term care facilities. To recruit and retain qualified staff to provide high-quality person-centered care in long-term care facilities, a supportive work environment is crucial. Fostering a person-centered care environment will ultimately improve quality of care for residents.

A stable DNA-free screening system for CRISPR/RNPs-mediated gene editing in hot and sweet cultivars of Capsicum annuum.

BACKGROUND: DNA-free, clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein (Cas) ribonucleoprotein (RNP)-based genome editing is a simple, convincing, and promising tool for precision crop breeding. The efficacy of designed CRISPR-based genome editing tools is a critical prerequisite for successful precision gene editing in crops. RESULTS: This study demonstrates that soil-grown leaf- or callus-derived pepper protoplasts are a useful system for screening of efficient guide RNAs for CRISPR/Cas9 or CRISPR/Cas12a (Cpf1). CRISPR/Cas9 or Cpf1 were delivered as CRISPR/RNP complexes of purified endonucleases mixed with the designed single guide RNA, which can edit the target gene, CaMLO2 in two pepper cultivars with whole genome sequenced, Capsicum annuum 'CM334' and C. annuum 'Dempsey'. The designed guide RNAs (sgRNAs for Cas9 or crRNAs for Cpf1) are conserved for CaMLO2 in both CM334 and Dempsey and cleave CaMLO2 in vitro. CRISPR/Cas9- or /Cpf1-RNP complexes were transfected into purely isolated protoplasts of the hot pepper CM334 and sweet pepper Dempsey by PEG-mediated delivery. Targeted deep sequencing analysis indicated that the targeted CaMLO2 gene was differentially edited in both cultivars, depending on the applied CRISPR/RNPs. CONCLUSIONS: Pepper protoplast-based CRISPR guide-RNA selection is a robust method to check the efficacy of designed CRISPR tools and is a prerequisite for regenerating edited plants, which is a critical time-limiting procedure. The rapid and convincing selection of guide RNA against a target genome reduces the laborious efforts for tissue culture and facilitates effective gene editing for pepper improvement.

Attributes associated with person-centered care competence among undergraduate nursing students.

Person-centered care is widely recognized as a promising practice to improve patient care quality. However, little is known about the competencies of nursing students who are essential to providing high-quality person-centered care. In this study, relevant attributes, including professional nursing competence, empathy, and self-awareness, were examined in relation to person-centered care competence among South Korean nursing students while controlling for individual characteristics, including age, gender, religion, and academic performance. Data were collected from 213 senior students enrolled in four nursing schools in South Korea from November 15 to 30, 2017. The mean age of the nursing students in the sample was 23 years. Data were analyzed using multiple regression analyses while accounting for the students nested in their schools. Professional nursing competence and empathy were strongly associated with person-centered care competence among nursing students. Of the five aspects of professional nursing competence, human understanding and communication skills were the most likely to be associated with person-centered care competence. Moreover, there were few variations across nursing schools in the levels of professional nursing competence. Our findings corroborate the importance of developing better communication skills and empathy to improve and maintain person-centered care competence among nursing students who belong to a new generation.

Restrictive intraoperative fluid management was associated with higher incidence of composite complications compared to less restrictive strategies in open thoracotomy: A retrospective cohort study.

Restrictive fluid management has been recommended for thoracic surgery. However, specific guidelines are lacking, and there is always concern regarding impairment of renal perfusion with a restrictive policy. The objective of this study was to find the net intraoperative fluid infusion rate which shows the lowest incidence of composite complications (either pulmonary complications or acute kidney injury) in open thoracotomy. We hypothesized that a certain range of infusion rate would decrease the composite complications within postoperative 30 days. All patients (n = 1,031) who underwent open thoracotomy at a tertiary care university hospital were included in this retrospective study. The time frame of fluid monitoring was from the start of operation to postoperative 24 hours. The cutoff value of the intraoperative net fluid amount was 4-5 ml.kg-1.h-1 according to the minimum p-value method, thus, patients were divided into Low (≤3 ml.kg-1.h-1), Cutoff (4-5 ml.kg-1.h-1) and High (≥6 ml.kg-1.h-1) groups. The Cutoff group showed the lowest composite complication rate (19%, 12%, and 13% in the Low, Cutoff, and High groups, respectively, P = 0.0283; Low vs. Cutoff, P = 0.0324, Bonferroni correction). Acute respiratory distress syndrome occurred least frequently in the Cutoff group (7%, 3%, and 6% for the Low, Cutoff, and High groups, respectively, P = 0.0467; Low vs. Cutoff, P = 0.0432, Bonferroni correction). In multivariable analysis, intraoperative net fluid infusion rate was associated with composite complications, and the Cutoff group decreased risk (odds ratio 0.54, 95% confidence interval: 0.35-0.81, P = 0.0035). In conclusion, maintaining intraoperative net fluid infusion at 4-5 ml.kg-1.h-1 was associated with better results in open thoracotomy, in terms of composite complications, compared to more restrictive fluid management.

Person-centered rehabilitation care and outcomes: A systematic literature review.

BACKGROUND: Despite growing recognition of person-centered care as an essential component of quality care, little is known about how person-centered care can be implemented in the provision of care services and how it is empirically related to outcomes in the rehabilitation settings. OBJECTIVES: To investigate the extent of implementation of the person-centered care in rehabilitation practices, as well as its effects on relevant outcomes. DESIGN: Systematic literature review. DATA SOURCES: Six electronic databases (PubMed, Web of Science, CINAHL, Scopus, PsycARTICLES, and Cochrane library) were searched for articles published between January 2000 and January 2018. METHODS: Based on the inclusion criteria, quantitative studies that examined person-centered rehabilitation interventions and relevant outcomes were included. Study quality assessment, data extraction, and synthesis were performed. RESULTS: For this systematic review, 17 eligible studies were included and most studies were rated as low-quality. The selected studies were varied concerning the use of the term person-centered care, research design, target population, sample size, setting, intervention, and outcome measures. The most examined interventions in this review were focused on goal setting and shared-decision making processes based on the client-centered approach. The implementation of those interventions varied considerably. Results showed mixed relationships between person-centered care and the outcomes examined in the studies although there was strong evidence regarding the positive effects of person-centered care on occupational performance and rehabilitation satisfaction. CONCLUSIONS: Person-centered care has been increasingly advocated in rehabilitation settings. However, we found that true person-centered care was not fully implemented in rehabilitation practices. Moreover, it appears that person-centered care could positively affect rehabilitation outcomes, such as significant improvements in functional performance and quality of life, however, evidence about these positive effects of person-centered care is not sufficient. More research with rigorous designs is needed.

Proportional subcellular localization of Arabidopsis thaliana RabA1a.

Subcellular localization of trafficking proteins in a single cell affects the assembly of trafficking machinery between organelles and vesicles throughout the targeting pathway. RabGTPase is one of the regulators to direct specific targeting of cargo molecules depending on GDP/GTP bound status. We have recently determined the crystal structures of GDP-bound inactive and both GTP- and GppNHp-bound active forms of Arabidopsis RabA1a. It is notable that the switch regions of RabA1a exhibit conformational changes derived by GDP or GTP binding. However, it was not clear that where the GDP- or GTP-bound RabA1a is localized at the subcellular level in a cell. Here we demonstrate that the distinct proportion of subcellular localization of RabA1a depends on its site-specific mutation as the GDP- or GTP-bound form. RabA1a proteins located at the plasma membrane, endosomes, and cytosol. While the GDP-bound form of RabA1aS27N located more at endosomes than the plasma membrane compared to the proportions of RabA1a wild-type, and the GTP-bound RabA1aQ72L located mainly at the plasma membrane in comparison to RabA1a wild-type and RabA1aS27N. These distinct proportional localizations of RabA1a enable a cognate interaction between inactive/active RabA1 and effector molecules to direct specific targeting of its cargo molecules.

A Concept Analysis of Traditional Korean (Hanbang) Nursing.

PURPOSE: The purpose of this concept analysis was to clarify the meaning and the attributes of traditional Korean (Hanbang) nursing. DATA SOURCE: Data sources include Academic Search Complete, Allied and Complementary Medicine Database, EBSCOhost, PubMed, MEDLINE, and Research Information Sharing Service. DATA SYNTHESIS: We used Walker and Avant's method to analyze the concept of Hanbang nursing. CONCLUSIONS: By exploring its common use in the literature, a comprehensive definition of the concept of Hanbang nursing was developed. IMPLICATIONS FOR NURSING PRACTICE: The results of analyzing the current concept of Hanbang nursing will help provide a better understanding of it and contribute to expanding nursing knowledge and developing of a valid and reliable measurement.

Patient Safety Culture Associated With Patient Safety Competencies Among Registered Nurses.

PURPOSE: To investigate the relationships between registered nurses' (RNs') perceptions of the culture of patient safety in their workplace and their patient safety competency-attitudes, skills, and knowledge. DESIGN: A cross-sectional study design was used. Data were collected by using a self-reported survey from 343 RNs working in a university hospital in Seoul, South Korea. METHODS: Patient safety culture was measured using the Korean version of the Agency for Healthcare Research and Quality's Hospital Survey on Patient Safety Culture (Hospital SOPSTM). Patient safety competency was measured using the Patient Safety Competency Self-Evaluation tool. Multiple regression analysis was performed using Stata version 14 to examine the relationships between patient safety culture and RNs' patient safety competency, while adjusting for the RNs nested in their units. FINDINGS: Of the 10 specific aspects of patient safety culture, only teamwork within units was significantly related to overall safety competency. In relation to each of the three patient safety competencies, teamwork within and across units and supervisor or manager expectations were significantly related to attitudes, while teamwork within units and learning were significantly related to skills. Only organizational learning was significantly related to knowledge. CONCLUSIONS: Although teamwork, leadership, and continuous learning in the nursing unit were major factors influencing RNs' safety competency, the relationships of these factors to patient safety attitudes, skills, and knowledge among RNs were varied. CLINICAL RELEVANCE: Creating a unit-specific patient safety culture that is tailored to the competencies of the unit's RNs in patient safety practice would be essential to enhance and maintain high levels of patient safety attitudes, skills, and knowledge among the unit's RNs, which would ultimately affect patient safety.

Registered Nurse Perception of Patient Assignment Linking to Working Conditions and Outcomes.

PURPOSE: To examine nurse working conditions and outcomes (job satisfaction, intent to stay, and RN-rated quality of care) among registered nurses (RNs) with different perceptions of patient assignments. DESIGN AND METHODS: A descriptive study was conducted using data from 106,439 RNs in 751 acute care hospitals that participated in the National Database of Nursing Quality Indicators® (NDNQI® ) RN Survey. To compare the nurse working conditions and three outcomes by the two RN groups on perceptions of patient assignment, chi-square and t tests were performed with Stata version 14. FINDINGS: All comparisons of nurse working conditions and outcomes examined in this study were significantly different between the two RN groups on perceptions of patient assignment. RNs who rated their patient assignments to be appropriate were significantly more likely to report positive working conditions (e.g., fewer assigned patients and appropriate meal break) than those who rated their patient assignments to be inappropriate. RNs who rated their patient assignments as appropriate also reported higher job satisfaction, intent to stay in current positions, and quality of care compared with their counterparts of patient assignment perception. CONCLUSIONS: Positive perceptions of patient assignments among RNs were significantly related to better nurse working conditions as well as positive outcomes. CLINICAL RELEVANCE: To create nursing work environments that significantly affect nurse and patient outcomes, nursing administrators or managers should pay attention to ensure not only adequate nurse staffing levels, but also optimal nurse-to-patient assignments.

[Identifying Latent Classes of Risk Factors for Coronary Artery Disease].

PURPOSE: This study aimed to identify latent classes based on major modifiable risk factors for coronary artery disease. METHODS: This was a secondary analysis using data from the electronic medical records of 2,022 patients, who were newly diagnosed with coronary artery disease at a university medical center, from January 2010 to December 2015. Data were analyzed using SPSS version 20.0 for descriptive analysis and Mplus version 7.4 for latent class analysis. RESULTS: Four latent classes of risk factors for coronary artery disease were identified in the final model: 'smoking-drinking', 'high-risk for dyslipidemia', 'high-risk for metabolic syndrome', and 'high-risk for diabetes and malnutrition'. The likelihood of these latent classes varied significantly based on socio-demographic characteristics, including age, gender, educational level, and occupation. CONCLUSION: The results showed significant heterogeneity in the pattern of risk factors for coronary artery disease. These findings provide helpful data to develop intervention strategies for the effective prevention of coronary artery disease. Specific characteristics depending on the subpopulation should be considered during the development of interventions.

Reports From RNs on Safe Patient Handling and Mobility Programs in Acute Care Hospital Units.

OBJECTIVE: The aim of this study was to investigate the perceptions of RNs on the implementation of safe patient handling and mobility (SPHM) programs in states with and without SPHM legislation. BACKGROUND: Despite numerous strategies developed to reduce caregiver injuries, nurses are still experiencing work-related musculoskeletal injuries. A comprehensive SPHM program has been found to be effective in reducing patient handling injuries among nurses. METHODS: By using data from 143 480 RNs working in 321 acute care hospitals in 44 US states, RNs' perceptions on 6 key aspects of SPHM programs were compared between states with and without SPHM legislation and among 11 unit types. RESULTS: Registered nurses in states with SPHM legislation are more likely to report the implementation of SPHM programs in contrast with those in comparison states. This finding was found for each of the 11 unit types. CONCLUSIONS: This study provides evidence to support the positive effect of state-based efforts for legislative actions on the development and implementation of SPHM programs.

An unusual case of fistula formation and thrombosis between arteriovenous graft and a native vein.

Arteriovenous graft for hemodialysis vascular access is a widely used technique with many advantages. However, it has crucial complications with graft thrombosis and infection. We recently experienced an unusual case of arteriovenous graft complication involving graft thrombosis related to fistula formation between the graft and the natural vein with infection. We diagnosed this condition using Doppler ultrasound and computed tomography angiography. Successful surgical treatment including partial graft excision and creation of a secondary arteriovenous fistula using an inadvertently dilated cephalic vein was performed. The dialysis unit staff should keep this condition in mind and try to prevent this complication.

Comparability of nurse staffing measures in examining the relationship between RN staffing and unit-acquired pressure ulcers: a unit-level descriptive, correlational study.

BACKGROUND: Various staffing measures have been used in examining the relationship between nurse staffing and patient outcomes. Little research has been conducted to compare these measures based on their explanatory power as predictors of nursing-sensitive outcomes. In this study, both administrative and nurse-reported measures were examined. Administrative measures included registered nurse (RN) skill mix and three versions of nursing hours per patient day (HPPD); nurse-reported measures included RN-reported number of assigned patients and RN-perceived staffing adequacy. OBJECTIVES: To examine correlations among six nurse staffing measures and to compare their explanatory power in relation to unit-acquired pressure ulcers (UAPUs). DESIGN: Descriptive, correlational study. SETTINGS: 2397 nursing units in 409 U.S. acute care hospitals. METHODS: Random-intercept logistic regression analyses were performed using 2011 data from a national database. Relationships between nurse staffing measures and UAPU occurrences were examined in eight models, each with one or more staffing measures as predictors. Characteristics of nursing units (RN workgroup education level and RN workgroup unit tenure) and hospitals (size, teaching status, and Magnet status) were included as control variables. RESULTS: Two versions of HPPD (total nursing HPPD and RN HPPD) and RN skill mix were significantly correlated with RN-reported number of assigned patients (r range=-0.87 to -0.75). These staffing measures had weaker correlations with RN-perceived staffing adequacy (r range=0.16 to 0.23). Of the six staffing variables, only RN-perceived staffing adequacy and RN skill mix were significantly associated with UAPU odds, the former being the better predictor. CONCLUSIONS: Although RN-perceived staffing adequacy was not highly correlated with administrative measures of HPPD and RN skill mix, it was the strongest predictor of UAPU occurrences. RN-perceived staffing adequacy can serve as a more appropriate measure of staffing for nursing-sensitive outcomes research than administrative measures, as it reflects relevant aspects of staffing and involves an implicit adjustment for patient acuity.