Influence of Alcohol Consumption, Personality and Attention Deficit Hyperactivity Disorder on Traffic Offenders.

BACKGROUND: Despite the authorities' efforts to promote responsible driving, traffic accidents are a notable cause of death in many countries. Scientific research shows that variables such as alcohol abuse and personality dimensions can contribute to explaining this social phenomenon and the rising number of traffic offences. The present study aims to explore how alcohol abuse, personality disorders and Attention Deficit Hyperactivity Disorder (ADHD) are associated with risky driving behaviour. METHOD: The sample included 300 subjects: the study group (199 convicted of traffic offences) and the control group (101 subjects from the general driving population). The tools used were the International Personality Disorder Scale, the Alcohol Use Disorders Identification Test and the Adult ADHD Self-Report Scale (ASRS). RESULTS: A higher incidence of signs of paranoid, antisocial, impulsive, borderline and anxious personality traits was detected for the study group, as well as a higher prevalence of alcohol abuse. CONCLUSIONS: This research offers indications for the design of effective preventive and reinsertion interventions. It also highlights the importance of considering psychological dimensions to ensure road safety.

Efectos en la calidad de vida de pacientes con fibromialgia tras un tratamiento integrado de fisioterapia y atención plena: un estudio cuasiexperimental pre-postintervención / Effects on the quality of life of fibromyalgia patients after an integrated physiotherapy and mindfulness treatment: a quasi-experimental pre-post-intervention study

Introducción: El dolor físico es la característica por excelencia de la fibromialgia, pero tan importantes son en esta enfermedad los síntomas físicos como psicológicos, además ambos contribuyen a disminuir la calidad de vida de los pacientes; el dolor corporal no debería ser el único componente a estudiar ni a tratar. Objetivo: Analizar el impacto en la calidad de vida que se produce en una muestra de pacientes con fibromialgia antes y después de un tratamiento integrado de fisioterapia y atención plena. Materiales y métodos: Se ha realizado una evaluación de la calidad de vida y de dolor a 33 mujeres con fibromialgia, utilizando como instrumento de medida el Fibromyalgia Impact Questionnaire y la Escala Visual Analógica, antes y después de un tratamiento de 8 sesiones de ejercicios de fisioterapia integrada con atención plena. Resultados: Se han obtenido puntuaciones de mejora significativa después del tratamiento de fisioterapia integrada con atención plena. El dolor ha disminuido un punto y medio (p<0,01) y la función física, la sensación de bienestar, la ansiedad y la depresión, también han mejorado significativamente (p<0,01). Conclusión: La introducción de la atención plena al tratamiento fisioterápico consigue disminuir el impacto de la enfermedad, mejorando la salud física y psicológica, y en consecuencia, la calidad de vida.

Introduction: Physical pain is the characteristic par excellence of fibromyalgia, but the physical and psychological symptoms are just as important in this disease, and both can reduce the quality of life of these patients. Therefore bodily pain should not be the only component to study or treat. Objective: To analyse the impact on quality of life in a sample of patients with fibromyalgia before and after a physiotherapy treatment, integrated with mindfulness. Materials and methods: An evaluation of quality of life and pain was carried out in 33 women with fibromyalgia, using the Fibromyalgia Impact Questionnaire and the Visual Analogue Scale as a measurement instrument, before and after an integrated physiotherapy treatment with mindfulness. Results: Significant improvement scores were obtained after the mindfulness-integrated physical therapy treatment. Pain decreased by one and a half points (p<.01) and physical function, feeling of well-being, anxiety, and depression also improved significantly (p<.01). Conclusion: The introduction of mindfulness to physiotherapy treatment reduces the impact of the disease, improving physical and psychological health, and consequently, quality of life.

Role of carbonate burial in Blue Carbon budgets.

Calcium carbonates (CaCO3) often accumulate in mangrove and seagrass sediments. As CaCO3 production emits CO2, there is concern that this may partially offset the role of Blue Carbon ecosystems as CO2 sinks through the burial of organic carbon (Corg). A global collection of data on inorganic carbon burial rates (Cinorg, 12% of CaCO3 mass) revealed global rates of 0.8 TgCinorg yr-1 and 15-62 TgCinorg yr-1 in mangrove and seagrass ecosystems, respectively. In seagrass, CaCO3 burial may correspond to an offset of 30% of the net CO2 sequestration. However, a mass balance assessment highlights that the Cinorg burial is mainly supported by inputs from adjacent ecosystems rather than by local calcification, and that Blue Carbon ecosystems are sites of net CaCO3 dissolution. Hence, CaCO3 burial in Blue Carbon ecosystems contribute to seabed elevation and therefore buffers sea-level rise, without undermining their role as CO2 sinks.

Seagrass soil archives reveal centennial-scale metal smelter contamination while acting as natural filters.

The upper Spencer Gulf in South Australia hosts the world's largest single stream Pb-Zn smelter, which has caused environmental and health issues related to elevated metal concentrations in the surrounding environment. The area also has extensive seagrass meadows, occupying >4000 km2. We reconstructed the fluxes of heavy metals over the last ~3000 years through a multi-parameter study of the soil archives formed by the seagrass Posidonia australis. Pb, Zn and Cd concentrations increased up to 9-fold following the onset of smelter operations in the 1880s, and the stable Pb isotopic signatures confirmed the smelter has been the main source of lead pollution in the seagrass soils until present. Preliminary estimates suggest that over the past 15 years seagrass meadows within 70 km2 of the smelter accumulated ~7-15% of the smelter emissions in their soils. Here we demonstrate that seagrass meadows act as pollution filters and sinks while their soils provide a record of environmental conditions, allowing baseline conditions to be identified and revealing the time-course of environmental change.

The Posidonia oceanica marine sedimentary record: A Holocene archive of heavy metal pollution.

The study of a Posidonia oceanica mat (a peat-like marine sediment) core has provided a record of changes in heavy metal abundances (Fe, Mn, Ni, Cr, Cu, Pb, Cd, Zn, As and Al) since the Mid-Holocene (last 4470yr) in Portlligat Bay (NW Mediterranean). Metal contents were determined in P. oceanica. Both, the concentration records and the results of principal components analysis showed that metal pollution in the studied bay started ca. 2800yr BP and steadily increased until present. The increase in Fe, Cu, Pb, Cd, Zn and As concentrations since ca. 2800yr BP and in particular during Greek (ca. 2680-2465cal BP) and Roman (ca. 2150-1740cal BP) times shows an early anthropogenic pollution rise in the bay, which might be associated with large- and short-scale cultural and technological development. In the last ca. 1000yr the concentrations of heavy metals, mainly derived from anthropogenic activities, have significantly increased (e.g. from ~15 to 47µg g(-1) for Pb, ~23 to 95µg g(-1) for Zn and ~8 to 228µg g(-1) for As). Our study demonstrates for the first time the uniqueness of P. oceanica meadows as long-term archives of abundances, patterns, and trends of heavy metals during the Late Holocene in Mediterranean coastal ecosystems.

Determining indirect caregivers' contribution to patient care.

It is critical to measure contributions of staff who are not direct caregivers so that organizations can continually maximize resource. Understanding the consumer's perceptions is necessary to identify activities that contribute to the perception of an effective CNE. An awareness of the values placed by consumers on education services helps the educators to focus their efforts on those activities with the greatest perceived value. If educators put their efforts toward valued activities, their services would be frequently used and the staff would be more willing to accept the information, thereby benefiting from the educator's expertise. Learning how a role directly benefits patient care helps nurses in leadership positions meet institutional objectives. It allows nurse leaders to ensure that the role is, in fact, contributing to care, and it is doing so to the fullest extent. This builds institutional support and value for the role. The process of evaluating the benefit also allows the educators to gain support and credibility among consumers and other individuals within the institution. This perpetuates the increased utilization and benefit of the role. Results of this project can be used as a guide in evaluating various roles. Understanding activities that are valued by consumers enables staff in the roles that are being evaluated to determine how and where they should focus their efforts. This is especially critical as staff is being asked to do more work with less time and must establish priorities in their ongoing workload. Finally, it is vital to identify ways of turning the invisible work that indirect caregivers provide into visible work.

Using evidence-based practice in providing care.

Case managers are in prime positions that enable them to implement initiatives, which may lead to evidence-based practice. The possibilities abound regardless of the setting; case managers are charged with the delivery of patient care in the most efficient manner. When the best care is given to patients within the shortest time frame, everyone benefits--the patients and their families, case managers and other staff, and the entire organization. The various tools used to coordinate patient care--protocols and pathways--can be readily used to collect data in a standard way; this is a vital step in initiating evidence-based practice. Initiatives leading to evidence-based practice require several phases: obtaining evidence, monitoring the use of evidence, and evaluating the use of evidence in practice. This article will describe the use of evidence-based practice for case managers and demonstrate the steps to ensuring successful implementation in patient care activities.

When new employee orientation doesn't go as planned. "It is time for Plan B ... but, what is Plan B?".

Although organizations have standard orientation programs for newly hired registered nurses, there are times when orientees are unable to meet expectations. When this happens, it is important to implement a Plan B--a revised orientation program that includes individualized strategies and content--to meet the needs of the orientee who is not progressing. This article will identify factors that may predict the need for increased orientation time and strategies to assist the new employee to complete orientation successfully.

Detection of specific IgM antibody in the investigation of an outbreak of pneumonia due to Legionella pneumophila serogroup 1.

OBJECTIVE: Management of outbreaks of pneumonia due to Legionella pneumophila serogroup 1 (SG1) infection requires rapid and accurate diagnostic tests. Current serologic approaches, based on detection of seroconversion for total antibody, do not fulfil this requirement. METHODS: A diagnostic test based on detection of IgM antibody to L. pneumophila SG1 by indirect immunofluorescence was developed and used to evaluate serum samples from patients involved in a community outbreak of L. pneumophila SG1 pneumonia that occurred in Spain. RESULTS: Testing of samples from serologically proven, sporadic cases of pneumonia due to L. pneumophila SG1 (14), cases of atypical pneumonia due to other infectious agents (16) and healthy controls (100) supported the sensitivity and specificity of the assay. On samples from the outbreak, the IgM assay recognized five of six cases with isolation of L. pneumophila SG1 from respiratory secretions or lung tissue and more than 70% of cases with confirmed or presumptive diagnosis as determined by the current serologic criteria. In addition, the IgM assay was positive in 23-70% of patients who fulfilled the clinical and epidemiologic criteria of case definition but did not display diagnostically significant serologic results or who lacked a detectable antibody response in the routine assay. Among cases confirmed by the current criteria, detection of specific IgM was occasionally achieved before the conventional serology gave significant results. CONCLUSION: Incorporation of IgM antibody detection in the current diagnostic criteria for L. pneumophila SG1 infection may help to improve the management of outbreaks of pneumonia due to this agent.

Revitalizing a departmental committee.

Committees are vital and as such should be evaluated regularly for congruence with organizational mission and contribution to outcomes. The authors present an approach to revitalizing a committee, using the nursing education committee as an exemplar. Phases used in achieving this revitalization are: evaluating the congruence of the existing committee with the organizational strategic plan, addressing gaps between existing committee functions and the organizational plan, soliciting support for the new committee direction, and evaluating the new committee direction.

Morphological and immunohistochemical aspects of the biological seal in Klöckner's dental implants: study of 15 cases.

The morphological and immunohistochemical aspects of the peri-implanted pathological soft tissue of 21 Klöckner implants are assessed, corresponding to 15 patients and three gingival samples from three cadavers. For the collagen and vascular walls assessment, the Picro-Sirio technique is used with normal microscopy as well as with polarized light, evaluating the decrease of collagen fibers in relation to the grade of inflammation. In cases when there is a plasmocyte inflammatory prevalence, antibodies are used contrasted with Kappa and Lambda light chains, observing in all cases a polyclonal plasmocytosis (reactive). The Ag. Ki-67 is used to mark cell proliferation that shows a normal or enlarged activity that can reach the infiltrated cells of the lamina propria. Epitheliotropism or a lymphoepithelial lesion is analyzed in relation to the inflammation, observing the tendency to be larger in K-type implants with a completely-submerged technique. The lesion that is usually observed is the periimplanted mucositis of the chronic or mixed type. The regenerated epithelium has a slight thickness with congestive and dilated vessels. In one case (as anecdotal value), there is the presence of coilocytes compatible with infection by HPV (Human Papilloma Virus).

Designing measurements to assess case management outcomes.

Evaluating outcomes begins with determining the goals of case management. As the emphasis on the delivery of cost-effective patient care increases, comparing outcomes across settings is desirable and essential. A key component to comparing how an organization rates with similar institutions is to identify commonly used measures. Conducting a literature search, benchmarking, participating in initiatives of accrediting bodies, and establishing ways to collect and manage reliable and valid data are vital in laying the groundwork for an organization's ability to join evaluation projects across settings.

Making planned and unplanned role transitions.

Changes in organizations mean planned and unplanned role transitions for nurse administrators and managers. Keeping abreast of trends engaging in activities that promote professional growth, assessing work habits, maintaining job interviewing skills, and reviewing and updating resumes are essential to prepare for role changes. When unplanned changes occur because one is fired or a position is abolished, one has to organize personal needs, cope with the job loss, look for a job, and assume a new role. The authors discuss strategies that can be used personally or with others to facilitate job change.

Management skills in an era of shifting paradigms.

Managers have vital roles in balancing clinical practice and business-related outcomes. Skills in recruiting and retaining a diversified staff, along with a broad perspective of health care and political savvy, are essential in implementing changes, negotiating, collaborating, conducting meetings, and managing workloads. Demystifying the myths related to management is a crucial step when the paradigm shifts and requires changing roles.

Nursing management of enteral tube feedings.

OBJECTIVE: To describe the management practices of nurses when providing care to patients receiving enteral tube feedings. DESIGN: A descriptive study was conducted with use of questionnaires distributed to registered nurses (RNs). SETTING: A midwestern university medical center. SAMPLE: A total of 235 questionnaires were distributed to RNs. Two hundred nineteen were considered eligible and 180 were usable. This represents an 82% response. METHOD: A 43-item questionnaire with a return envelope was placed in the mailbox of RNs. DATA ANALYSIS: Descriptive statistics were used to analyze data. RESULTS: (1) Checking the flow rate of enteral feeding: Flow rates were checked between 1 to 4 hours by 70% of the nurses, whereas 16% checked every 8 hours, and the remaining 14% checked every 12 hours or longer. (2) Flushing the enteral tube: Ninety-four percent of respondents indicated they regularly flushed the enteral tube before each feeding (29%), after each feeding (43%), and every 4 hours (59%). The types of irrigants that were used for flushing included tap water, sterile water, and sterile normal saline solution. (3) Method of unclogging obstructed tubes: An irrigant solution is the primary intervention reported by nurses to unclog tubes (94%). The types of solutions reportedly used most frequently were carbonated beverage (81%), sterile water (49%), dissolved papain (46%), and tap water (42%). (4) Checking residuals: Most RNs (95%) reported that they check residuals every 4 hours; of these, 50% stated they discard residuals, and 49% stated that they readminister residuals. In regard to the volume of residual deemed to be excessive, 50% of the respondents stated that an amount greater than or equal to 100 ml is excessive. (5) Administering medications: Flushing the enteral tube with water is reported to be done before (47%) and after (95%) giving medicines. When multiple medicines are given, 38% report flushing the enteral tube between each medication. CONCLUSION: The findings of this self-report study suggest that practices regarding management of enteral feedings vary widely among nurses.

[Duodenal metastasis of renal cell adenocarcinoma]. / Metástasis duodenal de adenocarcinoma de células renales.

Duodenal metastases are a rare finding. Only 7% of these metastases are originated from a renal cell carcinoma and usually appear as a disseminated metastatic disease. The case of a patient with a duodenal metastasis from a renal cell carcinoma treated by duodenal resection, eight years after nephrectomy, is presented.

Roles and responsibilities of clinical nurse researchers.

A follow-up survey of 142 nurse researchers employed in clinical settings (NRECS) was conducted 10 years after the first one conducted by Knafl, Bevis, and Kirchhoff in which only 34 individuals qualified for inclusion. An 80-item questionnaire included items about the structure of the position, processes used, variables that may influence outcomes, and outside activities. When ineligible persons were excluded, the response rate was 75 per cent. Most commonly NRECS had positions in clinical settings only (55.7 per cent), offices (75.5 per cent), some staff (72.6 per cent), and secretarial support (52.8 per cent), and they usually reported to the chief nurse executives (71.7 per cent). Although the majority of NRECS reported responsibility for research activities, the average time spent on research is only 50 per cent. Most (82 per cent) have a nursing research committee, but NRECS also sit on other research-related committees in the department or hospital. Details about salary, responsibilities, and processes will be helpful to those preparing themselves or others for this role, for those who wish to start such a position for themselves or another, or for those in the role wanting to know how other NRECS perform.

Managing variances in case management.

Timely management of variances is vital for cost effective patient care. A multifaceted approach that involves the healthcare team, patient, and family facilitates the identification and management of variances as they occur. The critical path can be used to monitor variances that influence fiscal outcomes in select patient populations. Strategies are described that can be used to monitor and manage variances, including developing a mechanism for monitoring and managing variances, implementing that mechanism, and evaluating the process for usability. Monitoring variances includes choosing tools that will be used and staff who will assume primary responsibility, and initiating an outcome analysis program. Managing variances comprises organizing an interdisciplinary committee, establishing a communication plan, creating strategies, and using continuous quality improvement teams.

Productivity of nurse researchers employed in clinical settings.

With limited resources, there is increased scrutiny of the contributions of leadership staff, such as nurse researchers employed in the clinical setting (NRECS). The authors describe activities that pertain to research, presentations, publications, and procurement of funds for studies. Major obstacles that impede NRECS from achieving their goals, job performance evaluation and indices (staff, organization, and personal) that NRECS use to determine success in enacting their role also are presented.