L. Lee Glenn

Visitor and nurse satisfaction with a visitation policy change in critical care units.

Studies have addressed the visitation needs of visitors and patients and the impact of visitation policies on nurses, but few studies compare the level of satisfaction between visitors and nurses when visitation policies change. The objectives of this study were to investigate whether a more liberal intensive care unit visitation policy satisfactorily met the needs and expectations of visitors and nurses.

Comparison of Masculine and Feminine Traits in a National Sample of Male and Female Nursing Students

The stereotype that male nurses are less masculine has existed for generations and spans all age groups. Several studies have investigated masculinity and femininity in nurses using the Bem Sex-Role Inventory, but the results are conflicting and inconclusive. Therefore, a nationwide survey was conducted across the United States that examined the sex-role identity of individuals who chose nursing as a career path. Twenty-eight males and 81 females from 37 states completed the survey. The males and females in the study both had higher mean scores on masculinity and femininity scales when compared with previous studies. The greatest percentage of participants were classified as androgynous, as opposed to masculine, feminine, or undifferentiated, with half of the males and nearly half of the females falling into this category.

Miglustat effects on the basal nasal potential differences in cystic fibrosis

A recent study by Leonard, Lebecque, Dingemanse, and Leal [1] tested the effect of Miglustat, an alpha inhibitor on the cystic fibrosis conductance regulator gene using total chloride secretion in the nasal epithelium as the key variable estimated from basal nasal potential differences. The conclusion was drawn that “There was no evidence of a treatment effect on any nasal potential difference variable.” This conclusion may not be correct because of a slight misinterpretation of their statistical results. There also is a question of whether longer exposure periods than 8 days would have produced a more pronounced effect. The p and n values in Table 2 of the above study were converted to standardized effect sizes (r) by the methods described in Trikalinos et al. [2]. The primary clinical endpoint of total chloride secretion had an effect size of 19% (r=0 .191). This is not a large effect size, but it is far from zero. That is, it would need closer to zero before one could conclude that no evidence of a treatment effect was found. The fact that this effect was not statistically significant does not mean that there was absence of evidence of an effect, which was the conclusion of the above study. If this pilot study hadmore than 11 participants, it is possible that this effect would have been statistically significant, and consequently, some effectiveness cannot be ruled out. Another possibility that confounds the conclusion concerns the duration of exposure to Miglustat. The duration of exposure was 8 days, and this was justified by the finding that plasma concentrations of Miglustat reached a steady-state within four days. However, this duration could have been too short to see long term outcomes from a chronic disease such as cystic fibrosis. A classic example of the dissociation between plasma levels and clinical effects is the lack of correlation between the time to steady the state of plasma levels for amitriptyline and the antidepressant effects [3]. The above study had many strengths, including the criteria for selecting the participant, the disclosure of the study limitations,

Risk Factors for Heart Disease in Rural Appalachia

The objectives of the study were to identify which risk factors for heart disease were most prevalent in a poor, underserved, rural Appalachian county. A random sample of medical records was selected (n=292) of adult men and women who participated in a countywide health care project. Data were obtained from a health risk appraisal questionnaire and other physical and demographic information and were analyzed using univariate and bivariate statistical procedures. The findings indicated that these rural Appalachian subjects had a significant number of heart disease risk factors: excessive smoking, lack of exercise, high fat diets, and abnormal serum lipid levels.

A linear method for the curve fitting of multiexponentials

Two single-pass methods for fitting multiexponentials to experimental data are described. These methods rely on the construction of a matrix whose characteristic polynomial is used to determine the rates of decay. In the first method, which we call the multiple-delay method, the matrix is constructed using time delays of the experimental data. This method is fast and highly accurate even if the experimental signal contains exponential components with similar rates of decay. In the second method, which we call the successive-integral method, the matrix is constructed using integrals of the experimental data. This procedure yields good results for noisy signals and is a generalization of the method of Martin et al. ((1993) J. Neurosci. Methods, 51: 135-146). In addition, a particular instability of the multiexponential curve fitting problem is identified and a method for overcoming this instability is given.

Effect of ambient temperature and cardiac stability on two methods of cardiac output measurement.

The dependence of cardiac output measurement precision on ambient temperature and cardiac output stability was assessed by concurrent continuous and bolus thermodilution methods in postoperative cardiac surgery patients. The degree of agreement between the two methods was depended on room temperature (0.1 L/min for each degree below 25 degrees C). The agreement was also closer in trials where cardiac output was stable (< 10% variation). The continuous thermodilution method shows sufficient agreement with the bolus method for use in critical care; however, improved precision of cardiac output thermodilution measurements can be achieved by use of correction factors for cardiac instability and for ambient temperature.

Measurement of workplace violence reporting

The recent study by Arnetz et al. (2015) concluded that hospital employees underreported incidents of workplace violence mainly because non-victims (witnesses) tended to report incidents far less often than victims. However, this conclusion is not well supported by the data in their study because of unclear definitions of violence, insufficient separation of the participants into the two groups of victims of violence and witnesses of violence, and plausible alternative explanations for the findings, as explained below. Of the 446 hospital workers surveyed, a flowchart in Figure 1 in the above study indicates that 62% of them (n = 275) answered “Yes, I was a target of violence within the last year.” Of these 275 respondents, the same flowchart shows that 212 of them answered that “I did not report the violence” in the survey. However, when asked about reasons for not reporting incidents of violence (Table 3), 30% of the 212 respondents answered that they were neither a target nor witnesses to violence. The contradicting answers indicate a low reliability for the participants’ determination of whether they were a target of workplace violence. This problem can be addressed by giving the participants of the survey an option to indicate the nature of the violence experienced and their role (e.g., target, witness). The low reliability regarding workplace violence may have been due to an unclear definition of violence. Although the flowchart in Figure 1 documents whether a participant had been a target of violence, the authors state in the “Methods” section that the question was whether the participant had been a target of either violence or aggression with no definition provided for aggression. The two forms of this question would be expected to produce different responses. Furthermore, the “Results” section reported that the question was whether the participant had experienced a violent incident, presumably including the witnessing of an incident without being a target. The confusing definitions of violence could explain the low reliability of the responses, but this is not the only possible explanation for the low reliability of the responses to the same question at two different places in the survey. Another possible explanation is faulty recall due to the lengthy recall period of 1 year. Recall periods for injuries or similar events, such as hospital stays, have been shown to be unreliable if more than 3 months prior (Moshiro, Heuch, Astrøm, Setel, & Kvåle, 2005; Overpeck et al., 1994). The study reported that 88% of hospital workers who experienced workplace violence failed to report the incident using the official electronic system, and thus concluded that this finding indicated a need to take action. The estimate of 88% is likely exaggerated for the following reasons. First, one incident could have been witnessed by multiple employees but reported only once by one person in the electronic reporting system. If an employee knows that someone else reported it, they may decide that this is sufficient. This explanation is supported by the study conclusion that employees tended not to report incidents if they were not the victims of violence themselves. By the methods used in the study, this explanation would inflate the numbers of employees who failed to report an incident. Second, the study hospital system only encouraged workers to report via the electronic system, but does not require it. If it is only encouraged, workers cannot be expected to report anything or everything. It is probably unreasonable to conclude that a failure-to-report problem exits when reporting is not mandated. This explanation also would be expected to inflate the failure-to-report percentage. The study by Arnetz et al. has many strengths including an adequate sample size, use of multiple sites within a hospital system, appropriate statistical analysis, clear discussion of workplace violence literature, and a focus on a critical occupational health and safety problem. Despite these strengths, due to the low response reliability of the key questions and evidence of alternative explanations for the findings, the study conclusion, that hospital employees drastically underreport workplace violence, is not well supported. Instead, an alternative conclusion, that workplace violence reporting may be acceptable, but the value of the electronic reporting system is low among hospital employees, particularly nurses, is proposed.

Variability of FEV1 and Criterion for Acute Pulmonary Exacerbation

Morgan et al. (1) concluded that cystic fibrosis (CF) in children and adolescents with a high baseline forced expiratory volume (FEV1) were less likely to have a therapeutic intervention or slower rate of FEV1 decline after a single acute decline in FEV1 of 10%. This conclusion is not well supported due to the arbitrary criteria used for defining a pulmonary exacerbation, as explained below. First, only a single low FEV1 value defined an exacerbation. However, FEV1 measurements are notoriously variable from test-to-test; Taylor-Robinson et al. (2) showed that the baseline fluctuations have a wide range of about 60%. FEV1 tests are sensitive to time of day, health status, mood, tiredness, lack of sleep, medical instruction, nutritional status, acute comorbidities, and other factors Cystic Fibrosis Foundation (3). Given that a single FEV1 assessment was used, rather than the average of repeated measurements on different days, evidence that the assessment values were technically accurate. Second, an exacerbation was defined as a single 10% decline in FEV1 in the above study without any explanation as to why 10% was chosen nor why a range of declines were not evaluated to determine the sensitivity and specificity of different criteria (by testing several criterion values such as 5, 15, 20, and 25%). A threshold of 10% is nearly within the noise level of the FEV1 measurements (2, 4). This leaves open the possibility that the findings in the study would not hold if a slightly greater (or smaller) value was used, such as 8 or 12%. Furthermore, regarding the use of the cutoff of 10%, there is no agreement on the optimal cutoff for separating pulmonary exacerbations from the large natural technical variations in FEV1 from test-to-test, a variation that has been found to be higher in CF without evidence of concomitant changes in the severity of the condition (4, 5). National treatment guidelines (5) for acute pulmonary exacerbations in CF was based on the work of Fuchs et al. (6), a clinical trial of DNAase that only incidentally mentioned 10% as a criterion if 4 of 12 other signs or symptoms were present in a population of adults and children. In a more comprehensive study on children under six years of age, Rabin et al. (7) and Regelmann et al. (8) defined exacerbations operationally by whether or not pulmonologists decided to intensify treatment using antibiotics. These authors found the average FEV1 decline to be 20% in children under 6 years of age, these investigators proposed a refinement of the criterion to 15% or higher, rather than 10% suggested by Fuchs et al. (6), under the condition that a 15% decline would only be considered an exacerbation if two other clinical signs were concurrent, such as increased cough frequency, new crackles, or hemoptysis. Evidence on the best cutoff value is consequently nearly absent and remains to be determined. The most logical path follow would be to first test the full range of pulmonary decline criterion, perhaps from 0 to 30%, to determine the optimal criterion, and then to conduct a focused study on this value. The findings from such a range analysis could be of great value in helping further refine the criterion for an exacerbation based on FEV1 decline, rather than assuming a single value at this early stage. The study has many prominent strength including well-defined hypotheses, very large sample size, analysis by age group, excellent statistical analysis, clearly presented findings, excellent flow of logic, and others. However, due to the shortcomings described above, we suggest further study of the above critical questions before the findings are implemented in practice.

Accuracy of the spanish emotional labour scale

The recent study by Picardo et al. (2013) thatwaspublished inNurse Education Today concluded that their Spanish version of the Emotional Labour Scale has “an acceptable congruence” (Picardo et al., 2013) with the English version of Brotheridge and Lee (2003). However, that conclusion is not supported by the findings in the study because the translated version of the ELS is not shown, key information on the congruence of eigenvalue structure is missing, and last, the outcomes differ between the two versions, as explained below. The fact that the English version was presented but not the Spanish version that is being tested prevents the reader from independently assessing the translated version. The value of presenting the Spanish version is indicated by signs of discrepancies in the translation version. While discussing the instrument, the authors state that, “The Duration subscale consists in an open-ended question directed to know how many times the professional dedicate to one emotional interaction with the client” (Picardo et al., 2013). In the original article, Brotheridge and Lee describe this subset as a question of howmuch timeworkers devote to client interactions (Brotheridge and Lee, 2003). The difference in wording by Picardo et al. significantly changes the meaning of the phrase and would be expected to affect the findings. A key criterion of whether or not the original and translation are equivalent is the nature of the eigenvalues. Brotheridge and Lee (2003) found that the first four eigenvalues were greater than one, where one is a conventional cutoff point in selecting the number of eigenvalues to use, and hence the number of factors. If the translated version also had four eigenvalues greater than one, or perhaps even three or five, then this would argue for the equivalence of the original and translated version. However, no information about the eigenvalue series is provided in the Picardo et al. (2013) study. Four eigenvalue terms are used

Measurement validity of childbirth perceptions

The research by Bertucci et al. (2012) that was published in Midwifery concluded that ‘the current research evidenced that the Italian first adaptation of the CPQ, the Childbirth Experience Perception Scale, may be a valid and reliable measure of childbirth experience perception for use in different women’s health clinical outcome and studies’ (Bertucci et al., 2012). However, that conclusion is not supported by their study due to insignificant pvalues, small effect sizes, and weak evidence of measurement validity, as explained below. First, the statement is made that statistically significant discriminant validity was found in a correlation between scores on the CPQ and whether the birth was vaginal or caesarean. To check this, we recalculated the discriminant validity by converting the means and S.D.s presented in the above study into standardized effect sizes (r). The effect sizes turn out to be small with p-values that were not all statistically significant. The effect size for c-section vs. vaginal delivery was 18.6%, vaginal vs. vaginal with analgesia was 20.9%, c-section vs. vaginal with analgesia was 0.8%. The p values were 0.026., 0.018, and 0.93 respectively. Although the two comparisons that involved vaginal births are statistically significant, the effect sizes were very low, arguing against adequate discriminant validity. Second, the weak validity of the CPQ, which was originally developed by Padawer et al. (1988) was known before it was adapted to the Italian language. Touliatos et al. (2001) reviewed the instrument and noted that, ‘The CPQ was developed largely on the basis of clinical intuition and does not appear to have been substantially psychometrically evaluated. The scale may have utility, but not in its current form’. The findings in the study by Bertucci et al. (2012) can be interpreted as confirming the review by Touliatos et al. (2001). The low levels of measurement validity found are not characteristic of this particular field of research. Dencker et al. (2010) found that a similar scale, Childbirth Experience Perception Scale, had good effect sizes for discriminant validity. The effect sizes ranged from 34% to 72% for operative delivery vs. vaginal delivery across four subscales: Own capacity, professional support, perceived safety, and participation. These values are many times larger than those of the Childbirth Experience Perception Scale. We should point out that the groups in Decker’s and Bertucci’s studies were not exactly the same. The groups tested in Dencker’s study were an operative group, which included c-sections and forceps-used deliveries, and a vaginal birth group, which included deliveries with and without analgesia. Bertucci divided groups into c-section only, vaginal deliveries without analgesic only, and vaginal deliveries with analgesics only groups. Nevertheless, there is enough equivalence between the two studies to illustrate the low discriminant validity of both the English and Italian versions of the CPQ.