Interlaboratory comparison study of immunosuppressant analysis using a fully automated LC-MS/MS system.

OBJECTIVES: All guidelines recommend LC-MS/MS as the analytical method of choice for the quantification of immunosuppressants in whole blood. Until now, the lack of harmonization of methods and the complexity of the analytical technique have prevented its widespread use in clinical laboratories. This can be seen in international proficiency schemes, where more than half of the participants used immunoassays. With the Cascadion SM Clinical analyzer (Thermo Fisher Scientific, Oy, Vantaa, FI) a fully automated LC-MS/MS system has been introduced, which enables the use of LC-MS/MS without being an expert in mass spectrometry. METHODS: To verify the interlaboratory comparison of the immunosuppressant assay on this type of instrument, three centers across Europe compared 1097 routine whole blood samples, each site sharing its own samples with the other two. In other experiments, the effects of freezing and thawing of whole blood samples was studied, and the use of secondary cups instead of primary tubes was assessed. RESULTS: In the Bland-Altman plot, the comparison of the results of tacrolimus in fresh and frozen samples had an average bias of only 0.36%. The respective data for the comparison between the primary and secondary tubes had an average bias of 1.14%. The correlation coefficients for patient samples with cyclosporine A (n=411), everolimus (n=139), sirolimus (n=114) and tacrolimus (n=433) were 0.993, 0.993, 0.993 and 0.990, respectively. CONCLUSIONS: The outcome of this study demonstrates a new level of result harmonization for LC-MS/MS based immunosuppressant analysis with a commercially available fully automated platform for routine clinical application.

Self-Caring Practices Among Nurses: Findings From an Online Survey.

Faith community nurses receive additional education in holistic health and intentional spiritual care, including self-caring. This study used an online survey to explore self-caring practices of faith community nurses and clinical nurses. Despite sample limitations, faith community nurses reported significantly higher levels of self-caring practices than clinical nurses.

The Relationship Between Staff Nurses' Perceptions of Nurse Manager Caring Behaviors and Patient Experience: A Correlational Study.

OBJECTIVE: The objective of this study was to explore the relationship between staff nurses' perceptions of nurse manager caring behaviors and patient experience. BACKGROUND: Despite numerous interventions aimed at changing the provision of patient care to improve care quality, patient experience scores have remained moderate. Little research has been conducted exploring how caring relationships in the professional practice environment might play a role in the patient experience of care. METHODS: A cross-sectional, correlational design was used to examine the relationship between staff nurses' perceptions of nurse manager caring behaviors as measured by the Caring Assessment Tool-Administration (CAT-Adm) and acute-care patient experience using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. RESULTS: There was a positive relationship between the staff nurses' perceptions of nurse manager caring behaviors and patients' HCAHPS overall hospital rating. There also was a positive relationship between the CAT-Adm scores and nurse manager visibility. CONCLUSION: Departments had higher HCAHPS overall hospital rating when the staff nurses perceived their unit manager as caring. In addition, the more staff nurses actually visualized their nurse manager during a shift, the more they perceived their nurse manager as caring.

Do caring behaviors in the quality caring model promote the human emotion of feeling cared for in hospitalized stroke patients and their families?

The aim of this study was to explore the discrete behaviors that comprise the human emotion of feeling cared for as described by hospitalized stroke patients and their families. Joanne Duffy's Quality Caring Model© (QCM) describes 8 caring behaviors supporting the experience of caring relationships exhibited during health care encounters. A secondary analysis of data from a guided interview was analyzed by 3 persons independently using general thematic content analysis and predetermined categories from the QCM, with final validation by the theorist. Percent agreement was 74.3% at first analysis, and 100% after secondary analysis. 82 of 100 phrases fit into at least one caring behavior, 17 phrases overlapped, and 18 phrases did not fit. Overlap between the caring behaviors is consistent with published quantitative reports. Patient experiences generating the emotion of "feeling cared for" may be formed from multiple caring behaviors enacted simultaneously by clinicians. Characteristics of clinicians, such as knowledge, may be as important as caring behaviors.

Description and Factors Associated With Missed Nursing Care in an Acute Care Community Hospital.

OBJECTIVE: The aims of this study are to describe and evaluate the factors associated with missed nursing care in an acute care community hospital. BACKGROUND: Despite RNs' accountability for high-quality patient care in hospitals, missed nursing care is widespread, jeopardizing patient safety and health system costs. Better understanding of the factors associated with missed nursing care may provide nurse leaders with opportunities for improvement. METHODS: Using a cross-sectional correlational study design, 138 RNs were randomly sampled during May-June 2017. RESULTS: The extent of missed nursing care is consistent with other studies, was greater on medical-surgical and telemetry units compared with specialty units, and was negatively associated with staffing/resources, satisfaction with current position, and collegial nurse-physician relationships. CONCLUSION: Findings suggest urgent nurse leader action and future research.

The impact of the Nurse Faculty Scholars program on schools of nursing.

BACKGROUND: The Robert Wood Johnson Foundation Nurse Faculty Scholars program was conceptualized as not only promoting the growth and development of early-career faculty but as enhancing the research infrastructure of scholars' schools of nursing. PURPOSE: At the completion of the scholars' three years of support, deans/directors were asked to provide feedback regarding the institutional impact of the scholars' participation in the program. METHODS: Phone interviews were conducted on the first five completed cohorts and a six-item questionnaire was developed to obtain some quantitative data. DISCUSSION: The program was viewed as having accelerated the scholars' leadership and scholarship, and their influence within the school/university and regionally/nationally. Deans/directors generally agreed that the scholars' experience helped build the school's research portfolio. CONCLUSION: Looking back on how the participating schools of nursing fared, one can say that the program's institutional expectations were achieved most of the time. The program helped scholars build their own reputations and that in turn had consequences for the school's standing as a whole. A number of components are described that can be replicated singly or in various combinations by schools/universities interested in adopting aspects of this program.

Nurses' Research Capacity, Use of Evidence, and Research Productivity in Acute Care: Year 1 Findings From a Partnership Study.

OBJECTIVE: The aim of this study was to compare baseline and year 1 findings from a research-focused academic-service partnership (ASP) designed to increase research capacity, evidence-based practice (EBP) use, and research productivity. BACKGROUND: Few combined individual and organizational best practices could be found that successfully sustain EBP. An ASP model, using structural and enabling processes, was evaluated. METHODS: Using a nonexperimental pretest-posttest design, 67 acute care nurses who participated at baseline were resurveyed, and year 1 focus groups were conducted. RESULTS: Knowledge increased from baseline to year 1, and nurses who participated on a committee with an embedded scientist were more knowledgeable at year 1 than those who did not. While EBP confidence and self-reported EBP use did not improve, research productivity increased 33%. Year 1 focus groups identified facilitators and barriers. CONCLUSION: Findings support some EBP benefits related to a research-focused ASP including research productivity; however, implementation barriers and contextual factors may have limited potential outcomes.

Nurses' research capacity and use of evidence in acute care: baseline findings from a partnership study.

OBJECTIVE: The aim of this study is to report baseline findings from a research-focused academic-service partnership. BACKGROUND: Despite widespread efforts, the research-practice gap remains considerable. A research-focused academic-service partnership may offer a strategy for decreasing this gap. METHODS: With the use of a shared model and a descriptive correlational design, 75 acute care nurses were sampled from July to October 2013. RESULTS: Attitudes toward evidence-based practice (EBP) were favorable, but knowledge of common research language was low and EBP confidence was reported as moderate. Evidence-based practice confidence had the strongest relationship to EBP use and was greatest in those who held professional certification and were more educated. CONCLUSION: Findings continue to demonstrate the need for new approaches to reduce the research-practice gap.

Age-specific Reference Intervals of Abbott Intact PTH-Potential Impacts on Clinical Care.

Background: PTH assays are not standardized; therefore, method-specific PTH reference intervals are required for interpretation of results. PTH increases with age in adults but age-related reference intervals for the Abbott intact PTH (iPTH) assay are not available. Methods: Deidentified serum PTH results from September 2015 to November 2022 were retrieved from the laboratory information system of a laboratory serving a cosmopolitan population in central-west England for individuals aged 18 years and older if the estimated glomerular filtration rate was ≥60 mL/min, serum 25-hydroxyvitamin D was >50 nmol/L, and serum albumin-adjusted calcium and serum phosphate were within reference intervals. Age-specific reference intervals for Abbott iPTH were derived by an indirect method using the refineR algorithm. Results: PTH increased with age and correlated with age when controlled for 25-hydroxyvitamin D, estimated glomerular filtration rate, and adjusted calcium (r = 0.093, P < .001). The iPTH age-specific reference intervals for 4 age partitions of 18 to 45 years, 46 to 60 years, 61 to 80 years, and 81 to 95 years were 1.6 to 8.6 pmol/L, 1.8 to 9.5 pmol/L, 2.0 to 11.3 pmol/L, and 2.3 to 12.3 pmol/L, respectively. PTH was higher in women compared with men (P < .001). Sex-specific age-related reference intervals could not be derived because of the limited sample size. Conclusion: Age-specific Abbott iPTH reference intervals were derived. Application of age-specific reference intervals will impact the diagnosis and management of normocalcemic hyperparathyroidism, based on current definitions, and secondary hyperparathyroidism. Additional studies are required to clarify the effect of sex and ethnicity on PTH.

Older adults' perceptions of feeling safe in urban and rural acute care.

OBJECTIVE: The purposes of this study were to identify factors that influenced hospitalized older adults' perceptions of feeling safe and to identify differences in perceptions between rural and urban contexts. BACKGROUND: Efforts are underway to ensure patient physical safety and improve care quality in acute-care environments. Perception of care is a unique and independent dimension of quality that includes patients' views of care and how these perceptions might affect responses to illness. METHOD: Grounded theory method was used to identify the basic social process of feeling safe in acute care. RESULTS: Older adults felt safe when nurses provided oversight, were predictable, provided personalized care, and were willing to advocate for them. CONCLUSIONS: Findings are consistent with professional models that center on the human relational components of care. Nurse leaders can facilitate practice environments where relational aspects of nurse work, including patients' perceptions of feeling safe, are the norm, thereby creating exceptional patient care delivery systems.

Assessing treatment adherence is crucial to determine adequacy of mineralocorticoid therapy.

Background: There is no consensus strategy for mineralocorticoid (MC) therapy titration in patients with primary adrenal insufficiency (PAI). We aim to measure serum fludrocortisone (sFC) and urine fludrocortisone (uFC) levels and to determine their utility, alongside clinical/biochemical variables and treatment adherence to guide MC replacement dose titration. Methods: Multi-centre, observational, cross-sectional study on 41 patients with PAI on MC replacement therapy. sFC and uFC levels (measured by liquid chromatography-tandem mass spectrometry), plasma renin concentration (PRC), electrolytes (Na+, K+), mean arterial blood pressure (MAP), total daily glucocorticoid (dGC) and MC (dMC) dose, and assessment of treatment adherence were incorporated into statistical models. Results: We observed a close relationship between sFC and uFC (r = 0.434, P = 0.005) and between sFC and the time from the last fludrocortisone dose (r = -0.355, P = 0.023). Total dMC dose was related to dGC dose (r = 0.556, P < 0.001), K+ (r = -0.388, P = 0.013) as well as sFC (r = 0.356, P = 0.022) and uFC (r = 0.531, P < 0.001). PRC was related to Na+ (r = 0.517, P < 0.001) and MAP (r = -0.427, P = 0.006), but not to MC dose, sFC or uFC. Regression analyses did not support a role for sFC, uFC or PRC measurements and confirmed K+ (B = -44.593, P = 0.005) as the most important variable to guide dMC titration. Of the patients, 32% were non-adherent with replacement therapy. When adherence was inserted into the regression model, it was the only factor affecting dMC. Conclusions: sFC and uFC levels are not helpful in guiding dMC titration. Treatment adherence impacts on clinical variables used to assess MC replacement and should be included as part of routine care in patients with PAI.

The first drug-related death associated with xylazine use in the UK and Europe.

BACKGROUND AND AIMS: On November 8th, 2022, the United States Food and Drug Administration (FDA) issued a statement alerting healthcare professionals to the increasing prevalence of xylazine in illicit drug overdoses in the country. Xylazine is a veterinary medicine with sedative, analgesic and muscle relaxant properties that is used as a heroin/fentanyl adulterant on the illicit drug market in North America. Here we report the first drug-related death associated with xylazine in the United Kingdom. METHODS: The National Programme on Substance Abuse Deaths (NPSAD) receives reports on drug-related deaths from coroners In England, Wales and Northern Ireland on a voluntary basis. The NPSAD was searched for cases with xylazine detections in cases received by December 31, 2022. RESULTS: One drug-related death associated with xylazine use was reported to NPSAD by December 31, 2022. The deceased was a 43-year-old male who was found dead at home with drug paraphernalia located at the property in May 2022. The post-mortem examination identified recent puncture wounds to the groin. Coronial documentation reports that the deceased had a history of illicit drug use. A number of drugs were detected by post-mortem toxicology and xylazine was implicated in death alongside heroin, fentanyl and cocaine. CONCLUSIONS: To the best of our knowledge, this is the first death associated with xylazine use reported in the UK, and even Europe, and indicates the entry of xylazine into the UK drug supply. This report highlights the importance of monitoring changes in illicit drug markets and the emergence of new drugs.

11ß-HSD1 inhibition in men mitigates prednisolone-induced adverse effects in a proof-of-concept randomised double-blind placebo-controlled trial.

Glucocorticoids prescribed to limit inflammation, have significant adverse effects. As 11ß-hydroxysteroid dehydrogenase type 1 (11ß-HSD1) regenerates active glucocorticoid, we investigated whether 11ß-HSD1 inhibition with AZD4017 could mitigate adverse glucocorticoid effects without compromising their anti-inflammatory actions. We conducted a proof-of-concept, randomized, double-blind, placebo-controlled study at Research Unit, Churchill Hospital, Oxford, UK (NCT03111810). 32 healthy male volunteers were randomized to AZD4017 or placebo, alongside prednisolone treatment. Although the primary endpoint of the study (change in glucose disposal during a two-step hyperinsulinemic, normoglycemic clamp) wasn't met, hepatic insulin sensitivity worsened in the placebo-treated but not in the AZD4017-treated group. Protective effects of AZD4017 on markers of lipid metabolism and bone turnover were observed. Night-time blood pressure was higher in the placebo-treated but not in the AZD4017-treated group. Urinary (5aTHF+THF)/THE ratio was lower in the AZD4017-treated but remained the same in the placebo-treated group. Most anti-inflammatory actions of prednisolone persisted with AZD4017 co-treatment. Four adverse events were reported with AZD4017 and no serious adverse events. Here we show that co-administration of AZD4017 with prednisolone in men is a potential strategy to limit adverse glucocorticoid effects.

Evaluating patient-centered care: feasibility of electronic data collection in hospitalized older adults.

Evaluating patient-centered care (PCC) is crucial to its improvement. This pilot study tested the feasibility of an electronic format to assess PCC during hospitalization. Using a validated indicator of PCC embedded on a mobile device, 86 older adults evaluated its delivery by registered nurses. Patients older than 85 years rated PCC poorer than those who were younger (r = -0.22; P = .04). The electronic format was appraised as feasible; it performed well and took on average 30 minutes to complete.

Vitamin D status: a U-shaped relationship for SARS-CoV-2 seropositivity in UK healthcare workers.

BACKGROUND: There is increasing evidence that vitamin D (VD) deficiency may increase individuals' risk of COVID-19 infection and susceptibility. We aimed to determine the relationship between VD deficiency and sufficiency and COVID-19 seropositivity within healthcare workers. METHODS: The study included an observational cohort of healthcare workers who isolated due to COVID-19 symptoms from 12 May to 22 May 2020, from the University Hospitals Birmingham National Health Service Foundation Trust. Data collected included SARS-CoV-2 seroconversion status, serum 25(OH)D3 levels, age, body mass index (BMI), sex, ethnicity, job role and comorbidities. Participants were grouped into four VD categories: (1) Severe VD deficiency (VD<30 nmol/L); (2) VD deficiency (30 nmol/L ≤VD<50 nmol/L); (3) VD insufficiency (50 nmol/L ≤VD<75 nmol/L); (4) VD sufficiency (VD≥75 nmol/L). RESULTS: When VD levels were compared against COVID-19 seropositivity rate, a U-shaped curve was identified. This trend repeated when participants were split into subgroups of age, sex, ethnicity, BMI and comorbidity status. Significant difference was identified in the COVID-19 seropositivity rate between VD groups in the total population and between groups of men and women; black, Asian and minority ethnic (BAME) group; BMI<30 (kg/m2); 0 and +1 comorbidities; the majority of which were differences when the severely VD deficient category were compared with the other groups. A larger proportion of those within the BAME group (vs white ethnicity) were severely VD deficient (p<0.00001). A larger proportion of the 0 comorbidity subgroup were VD deficient in comparison to the 1+ comorbidity subgroup (p=0.046). CONCLUSIONS: Our study has shown a U-shaped relationship for COVID-19 seropositivity in UK healthcare workers. Further investigation is required to determine whether high VD levels can have a detrimental effect on susceptibility to COVID-19 infection. Future randomised clinical trials of VD supplementation could potentially identify 'optimal' VD levels, allowing for targeted therapeutic treatment for those at risk.

Feasibility of a multi-institution collaborative to improve patient-nurse relationship quality.

OBJECTIVE: The objective of the study was to assess the feasibility of a multi-institution quality improvement collaborative to improve patient-nurse relationship quality. BACKGROUND: Patient-nurse relationships provide the foundation for nursing services and are linked to patient outcomes. Measuring the quality of these relationships is important for ongoing practice changes. METHODS: A prospective evaluation approach was used. Patients from 12 hospitals in 4 distinct areas of the United States comprised the sample. RESULTS: All 12 hospitals submitted patient data on a quarterly basis, yielding a reliable database for performance improvement. The Caring Assessment Tool (CAT) performed well, and individual hospitals used the results to improve their performance. Inconsistencies in labeling, differing sample sizes, and administrative burden limited the results. CONCLUSIONS: Adult patients were willing to provide feedback about their care during hospitalization and multiple institutions successfully participated in the project. An electronic version of the CAT with real-time analysis would decrease burden and provide more timely and accurate results for actionable practice changes.

Evidence-based nursing leadership: Evaluation of a Joint Academic-Service Journal Club.

This article describes the importance of evidence-based nursing leadership in the development and evaluation of a joint academic-service nursing leadership journal club. The use of scientific evidence and the embracing of an environment of continuous learning are essential to quality practice; however, nursing leadership has been slow to apply evidence-based practice to their own work. A noontime monthly meeting schedule, incentivized by lunch, was organized as a nursing leadership journal club. Articles were selected and reviewed monthly, and the process was formally evaluated using a written evaluation at the end of year 1. Eighteen articles were appraised by the group with 6 topics identified. Positive results included increased knowledge, competence of the leader, and attainment of goals. Recommendations include revision of goals, plans to share leadership of the group, development of a rigorous evaluation of outcomes, and dissemination of findings. The journal club was valuable in increasing awareness of nursing leadership research, promoting leadership development, and improving competence in the performance of research appraisals. Process improvement and further study are needed to increase understanding regarding the benefits of leadership journal clubs.

Advancing nursing education science: an analysis of the NLN's Grants Program 2008-2010.

The National League for Nursing has responded to the increasing need for nursing education research through its grant program. Significant growth in proposals has intensified competition for funds and challenged the Nursing Education Research Advisory Council's review process. The purpose of this article is to explore the NLN's nursing education research proposals from 2008 to 2010 in order to improve performance and provide guidance to future nursing education researchers. Beginning with the 2008 grant cycle, a database was developed to assist in performance improvement. A total of 113 proposals were submitted; of those, 24 were funded for a success rate of greater than 21 percent. Various designs and samples were employed and all geographic regions of the United States were represented. Inter-rater reliability among reviewers remained high and the scientific rigor of proposals steadily increased. Increased funding from other sources is urgently needed to build the science of nursing education.