Key organizational commitment antecedents for nurses, paramedical professionals and non-clinical staff.

PURPOSE: The purpose of this paper is to develop a causal model that explains the antecedents and mediating factors predicting the organizational commitment of healthcare employees in different work roles. DESIGN/METHODOLOGY/APPROACH: This study tests an integrative causal model that consists of a number of direct and indirect relationships for antecedents of organizational commitment. It is proposed that the relationship between job satisfaction and organizational commitment is best understood by focusing on the three interrelated facets of job satisfaction, i.e. satisfaction with career advancement, satisfaction with supervisor, and satisfaction with co-workers. However, the model also advances that these job satisfaction facets have different mediating effects for other antecedents of organizational commitment. FINDINGS: The Structural Equation Modeling (SEM) path analysis showed that the job satisfaction facets of career advancement and satisfaction with supervisor had a direct impact on organizational commitment. Employee empowerment, job-motivating potential, effective leadership, acceptance by co-workers, role ambiguity and role conflict were also important determinants of organizational commitment. Interestingly, post hoc analyses showed that satisfaction with co-workers only had an indirect impact on organizational commitment. ORIGINALITY/VALUE: While there has been extensive research on organizational commitment and its antecedents in healthcare organizations, most previous studies have been limited either to a single employee group or to a single time frame. This study proposes a practical causal model of antecedents of organizational commitment that tests relationships across time and across different healthcare employee groups.

Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit.

BACKGROUND: In critically ill patients who are receiving mechanical ventilation, the factors associated with physicians' decisions to withdraw ventilation in anticipation of death are unclear. The objective of this study was to examine the clinical determinants that were associated with the withdrawal of mechanical ventilation. METHODS: We studied adults who were receiving mechanical ventilation in 15 intensive care units, recording base-line physiological characteristics, daily Multiple Organ Dysfunction Scores, the patient's decision-making ability, the type of life support administered, the use of do-not-resuscitate orders, the physician's prediction of the patient's status, and the physician's perceptions of the patient's preferences about the use of life support. We examined the relation between these factors and withdrawal of mechanical ventilation, using Cox proportional-hazards regression analysis. RESULTS: Of 851 patients who were receiving mechanical ventilation, 539 (63.3 percent) were successfully weaned, 146 (17.2 percent) died while receiving mechanical ventilation, and 166 (19.5 percent) had mechanical ventilation withdrawn. The need for inotropes or vasopressors was associated with withdrawal of the ventilator (hazard ratio, 1.78; 95 percent confidence interval, 1.20 to 2.66; P=0.004), as were the physician's prediction that the patient's likelihood of survival in the intensive care unit was less than 10 percent (hazard ratio, 3.49; 95 percent confidence interval, 1.39 to 8.79; P=0.002), the physician's prediction that future cognitive function would be severely impaired (hazard ratio, 2.51; 95 percent confidence interval, 1.28 to 4.94; P=0.04), and the physician's perception that the patient did not want life support used (hazard ratio, 4.19; 95 percent confidence interval, 2.57 to 6.81; P<0.001). CONCLUSIONS: Rather than age or the severity of the illness and organ dysfunction, the strongest determinants of the withdrawal of ventilation in critically ill patients were the physician's perception that the patient preferred not to use life support, the physician's predictions of a low likelihood of survival in the intensive care unit and a high likelihood of poor cognitive function, and the use of inotropes or vasopressors.

Evaluating Atlantic bottlenose dolphin (Tursiops truncatus) leukocyte differential counts comparing the CellaVision DM96 and the manual method.

BACKGROUND: The leukocyte differential count is an excellent diagnostic tool; however, the manual differential count has several drawbacks, especially for nontraditional species. Automated cell analyzers commonly used in veterinary practices require species-specific validation for use in nondomestic species other than dogs and cats. OBJECTIVES: The purpose of this study was to examine the potential of the CellaVision DM96 (DM96), an automated image analysis system, as a rapid and accurate method for providing a WBC differential count in comparison to the manual WBC differential count in bottlenose dolphins. METHODS: Ten fresh, EDTA anticoagulated blood samples were collected, blood smears were made and stained, and the differential WBC counts were performed on the DM96 and compared with manual differential WBC counts. Agreement, means, and errors were compared between the methods. RESULTS: There was good agreement between the DM96 and manual differential WBC counts for neutrophils; however, there was significant variation when comparing lymphocyte, monocyte, and eosinophil counts. No basophils were seen by any method. CONCLUSIONS: Despite a small sample size, the DM96 appeared to provide a viable alternative for automated neutrophil counting in blood of bottlenose dolphins. Whether the counts are comparable in animals with highly pathologic differential counts must be addressed in follow-up studies, preferably with more study animals.

Preadmission antithrombotic treatment and stroke severity in patients with atrial fibrillation and acute ischaemic stroke: an observational study.

BACKGROUND: Vitamin K antagonists (eg, warfarin) substantially reduce the risk of ischaemic stroke in patients with atrial fibrillation. Additionally, therapeutic anticoagulation at time of acute stroke admission might reduce in-hospital mortality and disability. We assessed the association between preadmission antithrombotic treatment and initial stroke severity, neurological deterioration, major vascular events during hospital stay, and death or disability at discharge in patients with acute ischaemic stroke and atrial fibrillation. METHODS: We identified consecutive patients with acute ischaemic stroke and atrial fibrillation, admitted to 11 hospitals in Ontario, Canada, from the Registry of the Canadian Stroke Network (2003-05). Logistic regression was used to assess the association between antiplatelet treatment, subtherapeutic warfarin treatment (admission international normalised ratio [INR] < 2), therapeutic warfarin treatment (admission INR > or = 2), and clinical outcome. Stroke severity was measured using the Canadian neurological scale (CNS) and was categorised into mild (CNS > 7) and severe stroke (CNS < or = 7). Disability was measured with the modified-Rankin scale (mRS) and was categorised into strokes associated with no or mild-moderate dependency (mRS 0-3) and with severe dependency or death (mRS 4-6). RESULTS: Of 948 patients, 306 (32%) were not on antithrombotic treatment, 292 (31%) were receiving antiplatelet treatment, 238 (25%) were receiving warfarin with a subtherapeutic INR, and 112 (12%) were receiving warfarin with a therapeutic INR on admission. Compared with those not receiving antithrombotic therapy, antiplatelet therapy (odds ratio 0.7; 95% CI 0.5-0.995) and therapeutic warfarin (0.4; 0.2-0.6) were associated with a reduction in severe stroke at admission. Therapeutic warfarin was also associated with a reduction in the odds of severe disability or death at discharge (0.5; 0.3-0.9). INTERPRETATION: Therapeutic warfarin is associated with reduced severity of ischaemic stroke at presentation and reduced disability or death at discharge in patients with atrial fibrillation. Antiplatelet treatment is associated with a more modest reduction than warfarin in baseline stroke severity.

The prevalence and impact of child maltreatment and other types of victimization in the UK: findings from a population survey of caregivers, children and young people and young adults.

OBJECTIVES: To measure the prevalence of maltreatment and other types of victimization among children, young people, and young adults in the UK; to explore the risks of other types of victimization among maltreated children and young people at different ages; using standardized scores from self-report measures, to assess the emotional wellbeing of maltreated children, young people, and young adults taking into account other types of childhood victimization, different perpetrators, non-victimization adversities and variables known to influence mental health. METHODS: A random UK representative sample of 2,160 parents and caregivers, 2,275 children and young people, and 1,761 young adults completed computer-assisted self-interviews. Interviews included assessment of a wide range of childhood victimization experiences and measures of impact on mental health. RESULTS: 2.5% of children aged under 11 years and 6% of young people aged 11-17 years had 1 or more experiences of physical, sexual, or emotional abuse, or neglect by a parent or caregiver in the past year, and 8.9% of children under 11 years, 21.9% of young people aged 11-17 years, and 24.5% of young adults had experienced this at least once during childhood. High rates of sexual victimization were also found; 7.2% of females aged 11-17 and 18.6% of females aged 18-24 reported childhood experiences of sexual victimization by any adult or peer that involved physical contact (from sexual touching to rape). Victimization experiences accumulated with age and overlapped. Children who experienced maltreatment from a parent or caregiver were more likely than those not maltreated to be exposed to other forms of victimization, to experience non-victimization adversity, a high level of polyvictimization, and to have higher levels of trauma symptoms. CONCLUSIONS: The past year maltreatment rates for children under age 18 were 7-17 times greater than official rates of substantiated child maltreatment in the UK. Professionals working with children and young people in all settings should be alert to the overlapping and age-related differences in experiences of childhood victimization to better identify child maltreatment and prevent the accumulative impact of different victimizations upon children's mental health.

The effect of clinical academic service contracts on surgeon satisfaction.

OBJECTIVE: The purpose of this study was to determine the satisfaction of members of an academic department who are funded by a Clinical Academic Service Contract (CASC), compared with those who are not. METHODS: We mailed a satisfaction questionnaire designed to examine surgeons' perceived effect of CASCs on their participation in their division or department and on professional activities (research, teaching, clinical) to members of the surgery department who perform operative interventions. We analyzed responses from CASC and non-CASC members, using t tests for continuous variables and chi-square tests for categorical variables. RESULTS: Four of 9 operative divisions (cardiac, thoracic, neurosurgery, pediatric surgery) are CASC-funded, and 5 are not (general, plastic, otolaryngology, urology, vascular). The response rate after 3 mailings was 59%. CASC responders agreed on the need for the following: improved focus and resolution of issues (p < 0.001, p < 0.02); focus on developmental and future planning (p < 0.001); flexibility to change the level of participation in research, teaching and clinical activities (p < 0.001); recognition for academic and administrative activities (p < 0.002); opportunities to achieve career path goals (p < 0.002); more autonomy in research (p < 0.04); compensation for professional activities (p < 0.001); and increased leisure time (p < 0.004). Responders disagreed that morale was low (p < 0.001). They were satisfied with the following: professional activities (p < 0.019), increased research activities (p < 0.001), quality of research (p < 0.001), more presentations (p < 0.025), increased teaching time (p < 0.004) and ability to care for their patients (p < 0.001). CONCLUSION: CASC responders were significantly more satisfied with their professional activities and more optimistic in their divisional roles than were non-CASC responders. Based on these results, all departmental members who perform operative interventions should consider being on a CASC.

The impact of a blended learning approach on instructor and learner satisfaction with preceptor education.

To further enhance satisfaction and effectiveness, six pediatric hospitals created a blended learning approach to preceptor role preparation. In this blended approach, foundational content was delivered via online learning, allowing the classroom instructors to focus more on experiential learning activities. Both preceptor-learners and classroom instructors were asked to complete an evaluation of their experiences. This article describes the results and implications.