The role of teamwork in the implicit rationing of nursing care: A systematic mixed-methods review.

AIM: To systematically evaluate the role of teamwork in implicit rationing care and how to improve teamwork. BACKGROUND: The implicit rationing of nursing leads to adverse effects for both patients and nurses. Therefore, how to reduce it has attracted increasing research attention. How teamwork may be an important factor in reducing implicit rationing care has become a focus of research. METHODS: Data between May 2000 and May 2020 were collected from five databases. The study was guided by the framework of a mixed studies review. RESULTS: Seventeen studies were chosen for review regarding efficient teamwork to reduce implicit rationing care. The following seven subthemes with positive effects that improve teamwork and reduce implicit rationing care were formed: (a) improving knowledge and skills; (b) promoting effective communication; (c) building mutual trust; (d) reducing turnover intention; (e) reasonable staffing; (f) division of responsibilities; and (g) cultivating team consciousness. CONCLUSIONS: Teamwork can decrease implicit care and is influenced by many factors, but the intervention is singular. In the future, teamwork can be further improved to reduce implicit care. IMPLICATIONS FOR NURSING MANAGEMENT: With more intervention research in the future, leadership and team-oriented roles can be used to complete all the care needed.

Cost effectiveness of immune checkpoint inhibitors for treatment of non-small cell lung cancer: A systematic review.

BACKGROUND: Immune checkpoint inhibitors (ICIs) for treatment of non-small cell lung cancer (NSCLC) have been rapidly evolving. ICIs are likely to be more effective but also lead to escalating healthcare costs. OBJECTIVES: The aim of this study was to evaluate the cost effectiveness of immune checkpoint inhibitors (ICIs) for treatment of non-small cell lung cancer (NSCLC). METHODS: We searched the PubMed, Web of Science, and Cochrane Library for studies comparing the cost effectiveness of ICIs for NSCLC. Potential studies identified were independently checked for eligibility by two authors, with disagreement resolved by a third reviewer. Quality of the included studies was evaluated using Consolidated Health Economic Evaluation Reporting Standards checklists. RESULTS: A total of 22 economic studies were included. Overall reporting of the identified studies largely met CHEERS recommendations. In the first-line setting, for advanced or metastatic NSCLC patients with PD-L1 ≥ 50%, pembrolizumab appeared cost-effective compared with platinum-based chemotherapy in the US and Hong Kong (China), but not in the UK and China. The cost-effectiveness of pembrolizumab versus chemotherapy for first-line treatment of NSCLC in PD-L1 ≥ 1% patients remained obscure. Regardless of PD-L1 expression status, pembrolizumab in combination with chemotherapy could be a cost-effective first-line therapy in the US. On the contrary, addition of atezolizumab to the combination of bevacizumab and chemotherapy was not cost-effective for patients with metastatic non-squamous NSCLC from the US payer perspective. In the second-line setting compared with docetaxel, pembrolizumab was cost-effective; though nivolumab was not cost-effective in the base case, it could be by increased PD-L1 threshold. Results of the cost-effectiveness of atezolizumab second-line treatment remained inconsistent. In addition, the adoption of durvalumab consolidation therapy after chemoradiotherapy could be cost-effective versus no consolidation therapy for patients with stage III NSCLC. CONCLUSIONS: Immunotherapy can be a cost-effective option for treatment of NSCLC in several scenarios. A discount of the agents or the use of PD-L1 expression as a biomarker improves the cost-effectiveness of immunotherapy.

Associations between work environment and implicit rationing of nursing care: A systematic review.

AIM: To systematically evaluate the effect of working environment on implicit rationing of nursing care. BACKGROUND: Research has established direct and indirect associations between work environment and adverse patient outcomes. However, the causal nature of this relationship is uncertain, and implicit rationing has been proposed as a mediating factor between the work environment and patient outcomes. METHOD: Eight databases were searched for articles published between May 2000 and May 2019. RESULTS: The reviewed articles provided evidence for the negative correlation between working environment and implicit rationing in 15 studies, and one of the studies showed that the correlation was not strong. There were differences in the levels of implicit rationing in different hospitals, units and shifts. CONCLUSION: The degree of influence of various factors in the working environment on implicit rationing is different. In addition, the working environment is only one of the factors that affects implicit rationing. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers initiatives to improve nurses' work environments should include improve nurses' perception of the adequacy of staffing and resources and improving teamwork to decrease nursing care left undone, so as to improve nurse outcomes and quality of care.

Theory-Based Interventions to Promote Fluid Intake Adherence Among Dialysis Patients: A Systematic Review.

BACKGROUND AND PURPOSE: Dialysis involves a complex regimen including diet, fluid, medication, and treatment. Therapeutic regimen adherence determines the therapeutic success, quality of life, and survival of patients on dialysis. Complying with fluid management is the most difficult among the therapeutic regimen. Several theory-based interventions have been designed to promote fluid intake compliance in patients receiving dialysis. This review has two aims. One is to explore the effectiveness of theory-based interventions. The other is to examine the extent of the combination of theory and interventions in improving adherence to fluid intake among dialysis patients. METHODS: A literature review was performed using PubMed, PsycINFO, Embase, Web of Science, and the Cochrane Library to acquire associated studies. Data were extracted independently by two researchers. The degree of theory application was accessed using a theory coding scheme (TCS). RESULTS: Eight studies were identified as eligible for inclusion, and five theories were cited as basis (health belief model, social cognitive theory, self-regulation model, transtheoretical model). According to the TCS, adherence outcomes and the extent of theory use were not optimal. IMPLICATIONS FOR PRACTICE: Combining theory with patient health education might be beneficial in improving fluid intake adherence of dialysis patients. The framework and TCS could be considered to guide theory utilization and promote nursing education in improving the quality of renal nursing care.

Pharmacokinetic/Pharmacodynamic Analysis of Isavuconazole Against Aspergillus spp. and Candida spp. in Healthy Subjects and Patients With Hepatic or Renal Impairment by Monte Carlo Simulation.

The aim of this pharmacokinetic/pharmacodynamic (PK/PD) study is to evaluate the efficacy of various isavuconazole dosing regimens for healthy individuals and patients with hepatic or renal impairment against Aspergillus spp. and Candida spp. Monte Carlo simulations were conducted using pharmacokinetic (PK) parameters and pharmacodynamics (PD) data to determine the probabilities of target attainment and cumulative fractions of response in terms of area under the concentration curve/minimum inhibition concentration (AUC/MIC) targets of isavuconazole. A clinically recommended dosage regimen of isavuconazole (200 mg qd) obtained high cumulative fraction of response values of > 90% for all subjects against A. fumigatus, A. flavus, A. nidulans, A. terreus, A. versicolor, C. parapsilosis and C. tropicalis. For patients with mild or moderate hepatic impairment, the dosage should be halved only when treating invasive fungal infections caused by C. albicans, C. parapsilosis or C. tropicalis. However, dose adjustment is unlikely to be required in mild to severe renal impairment patients because all cumulative fraction of response values were similar to those of comparing with healthy subjects. Notably, all isavuconazole dosing regimens were not effective against C. glabrata and C. krusei in all subjects. These PK/PD-based simulations rationalize and optimize the dosage regimens of isavuconazole for healthy individuals and patients with hepatic or renal impairment against Aspergillus spp. and Candida spp.

Drug-loadable Mesoporous Bioactive Glass Nanospheres: Biodistribution, Clearance, BRL Cellular Location and Systemic Risk Assessment via (45)Ca Labelling and Histological Analysis.

Mesoporous bioactive glass (MBG) nanospheres with excellent drug loading property have attracted significant attention in the field of nano-medicine. However, systemic metabolism and biosafety of MBG nanospheres which are crucial issues for clinical application are yet to be fully understood. Isotope quantitative tracing combined with biochemical parameters and histopatological changes were used to analyze biodistribution, excretion path and the effect on metabolism and major organs, and then we focused on the hepatocellular location and damaging effect of MBG. The results indicated MBG possessed a longer residence time in blood. After being cleared from circulation, nanospheres were mainly distributed in the liver and were slightly internalized in the form of exogenous phagosome by hepatocyte, whereby more than 96% of nanospheres were located in the cytoplasm (nearly no nuclear involvement). A little MBG was transferred into the mitochondria, but did not cause ROS reaction. Furthermore, no abnormal metabolism and histopathological changes was observed. The accumulation of MBG nanospheres in various organs were excreted mainly through feces. This study revealed comprehensively the systemic metabolism of drug-loadable MBG nanospheres and showed nanospheres have no obvious biological risk, which provides a scientific basis for developing MBG nanospheres as a new drug delivery in clinical application.

Association between socioeconomic status and metabolic control and diabetes complications: a cross-sectional nationwide study in Chinese adults with type 2 diabetes mellitus.

BACKGROUND: Low socioeconomic status (SES) is associated with adverse cardiovascular risk factor patterns and poor outcomes in patients with diabetes. The aim of this study was to determine whether SES is associated with the control of blood glucose, blood pressure, blood cholesterol (3Bs), and diabetic complications in Chinese adults with type 2 diabetes. METHODS: Data regarding patients' demographics, social economics, diabetes complications, and cardiovascular risk profiles were analyzed for 25,454 patients. The outcomes of interest were the proportions of patients with HbA1c <7.0 %, blood pressure <140/80 mmHg, total serum cholesterol <4.5 mmol/L, and diabetes complications. Multivariable logistic regression was used for analysis. RESULTS: Of the 25,454 patients, the least educated patients (1695, 6.7 %) had the highest chances of developing cardiovascular diseases (p = 0.048), cerebrovascular diseases (p < 0.001), and retinopathy (p < 0.001). The patients with lowest household income (10,039, 40.8 %) had the highest prevalence of retinopathy (p < 0.001) and neuropathy (p < 0.001). The most educated patients were more likely than the least educated patients to achieve HbA1c <7.0 % [adjusted odds ratio (OR) 1.38; 95 % confidence interval (95 % CI) 1.22-1.56] and 3B goals (adjusted OR 1.30; 95 % CI 1.11-1.53). The patients with highest household income were more likely to achieve BP < 140/80 mmHg (adjusted OR 1.16; 95 % CI 1.07-1.27), but less likely to reach HbA1c < 7.0 % (adjusted OR 0.90; 95 % CI 0.83-0.98) than those lowest income patients. CONCLUSIONS: Low SES was associated with poor metabolic control and more diabetes complications in adult patients in China. Individual diabetes management based on the SES of patients is encouraged.

Lookback Option Pricing with Fixed Proportional Transaction Costs under Fractional Brownian Motion.

The pricing problem of lookback option with a fixed proportion of transaction costs is investigated when the underlying asset price follows a fractional Brownian motion process. Firstly, using Leland's hedging method a partial differential equation satisfied by the value of the lookback option is derived. Then we obtain its numerical solution by constructing a Crank-Nicolson format. Finally, the effectiveness of the proposed form is verified through a numerical example. Meanwhile, the impact of transaction cost rate and volatility on lookback option value is discussed.

[The current situation of older hospitalized patients in a cadre ward in Jilin, China].

OBJECTIVE: The proportion of elderly people and the nation's medical expenditures are rapidly increasing in China. The existence of cadre wards, where retired members of the cadre of the Communist Party of China are hospitalized and receive careful treatment, helps in providing care for the elderly. Elderly retired cadre patients are thought to be more frequently hospitalized and to stay in the hospital longer than elderly non-cadre patients on general hospital wards, and therefore might be expected make an important contribution to the increase in the nation's medical expenditures. However the current situation is not well characterized. The aim of this study was to provide a basis for possible solutions related to the cadre patient burden by determining the circumstances and background of these patients with long hospital stays and investigating their needs. METHODS: We analyzed the medical records of hospital discharges from a cadre ward from 2000 to 2004, and from general wards in 2004 at a large university-affiliated hospital in Jilin, China. Additionally, a questionnaire survey including an interview concerning needs was carried out in August 2005 for 100 elderly patients on the cadre ward (91% of the total patients on this ward) of the same hospital at that time. RESULTS: The mean length of hospital stays of patients on the cadre ward decreased by half during the study period, but remained longer than that of patients on general hospital wards. Regression analysis showed that of all the variables measured, the type of ward (cadre vs. general) was the most influential on the mean length of hospital stay. Moreover, patients who were hospitalized more often, males and older individuals showed longer hospital stays. The questionnaire survey showed that there are many patients who could be discharged from the hospital based on their health condition but are not discharged because outside care or welfare services are insufficient, or because there is little information available on social resources. CONCLUSIONS: Although medical policy, by which elderly retired cadre patients receive careful treatment, may contribute to the longer length of the hospital stay of the patients on the cadre ward, it was thought to be important to construct appropriate discharge plans and a support system after discharge to the community. The results provide important information for solution of medical problems related to elderly retired cadre patients in China.

[An exploratory discussion on biological evaluation and risks for medical devices].

Biological evaluation of medical devices before clinical usage has become one of the necessary procedure. But many of medical devices which have already passed a series of biological safety evaluation do not mean that they are absolutely safe and harmless. And there are still application risks in these medical devices, because of the deficient knowledge about the interaction of biomedical materials and human tissue, limitation of the existent technology level, the indefiniteness of the evaluation system, the imperfections of present standards and so on. This essay is trying to analyze the relationship between the biological evaluation of medical devices and their application risks, and to discuss how to make a risk analysis related to biological evaluation in order to acquire a better and exact understanding of biological evaluation for medical devices.