Advancing the science of patient safety.

Despite a decade's worth of effort, patient safety has improved slowly, in part because of the limited evidence base for the development and widespread dissemination of successful patient safety practices. The Agency for Healthcare Research and Quality sponsored an international group of experts in patient safety and evaluation methods to develop criteria to improve the design, evaluation, and reporting of practice research in patient safety. This article reports the findings and recommendations of this group, which include greater use of theory and logic models, more detailed descriptions of interventions and their implementation, enhanced explanation of desired and unintended outcomes, and better description and measurement of context and of how context influences interventions.

Patient falls: Association with hospital Magnet status and nursing unit staffing.

The relationships between hospital Magnet® status, nursing unit staffing, and patient falls were examined in a cross-sectional study using 2004 National Database of Nursing Quality Indicators (NDNQI®) data from 5,388 units in 108 Magnet and 528 non-Magnet hospitals. In multivariate models, the fall rate was 5% lower in Magnet than non-Magnet hospitals. An additional registered nurse (RN) hour per patient day was associated with a 3% lower fall rate in ICUs.

Nursing care quality and adverse events in US hospitals.

Aim: To examine the association between nurses' reports of unmet nursing care needs and their reports of patients' receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals.

Background: Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes.

Design: Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US.

Understanding clinical expertise: nurse education, experience, and the hospital context.

Clinical nursing expertise is central to quality patient care. Research on factors that contribute to expertise has focused largely on individual nurse characteristics to the exclusion of contextual factors. To address this, we examined effects of hospital contextual factors and individual nurse education and experience on clinical nursing expertise in a cross-sectional analysis of data from 8,611 registered nurses.

Organizational determinants of work outcomes and quality care ratings among Army Medical Department registered nurses.

The Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and several single-item measures were administered to registered nurses (RNs) working within 23 U.S.-based Army Medical Department (AMEDD) hospitals.

Risk of deep vein thrombosis following a single negative whole-leg compression ultrasound: a systematic review and meta-analysis.

Context: In patients with suspected lower extremity deep vein thrombosis (DVT), compression ultrasound (CUS) is typically the initial test to confirm or exclude DVT. Patients with an initial negative CUS result often require repeat CUS after 5 to 7 days. Whole-leg CUS may exclude proximal and distal DVT in a single evaluation.

An unusual perineal swelling: a cyst between the sphincters.

Epidermal cysts are very common lesions. Here we present the unusual case of an epidermal cyst occurring between the anal sphincters, presenting as a lump in the perineum. This was successfully excised with careful dissection of the intersphincteric plane.

Solid-state NMR study of proteorhodopsin in the lipid environment: secondary structure and dynamics.

Proteorhodopsins are typical retinal-binding light-driven proton pumps of heptahelical architecture widely distributed in marine and freshwater bacteria. Recently, we have shown that green proteorhodopsin (GPR) can be prepared in a lipid-bound state that gives well-resolved magic angle spinning (MAS) NMR spectra in samples with different patterns of reverse labelling. Here, we present 3D and 4D sequential chemical shift assignments identified through experiments conducted on a uniformly (13)C,(15)N-labelled sample.

Variations in nursing care quality across hospitals.

Title: Variations in nursing care quality across hospitals.

Aims: The aim of the study was to describe Registered Nurses' reports of unmet nursing care needs and examine the variation of nursing care quality across hospitals.

Background: Large proportions of Registered Nurses have reported leaving necessary care activities undone because they lacked the time to complete the activities.

Effects of hospital care environment on patient mortality and nurse outcomes.

Objective: The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education.

Background: Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited.

Methods: Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed.

Effects of posting examinations and answer keys on students' study methods and test performance.

A rich database was assembled to test the validity of contradictory claims about the effects of policy regarding posting of code-protected individual student scores and keyed examination questions. Four second-year lecture courses, each in a specialty area and each testing using multiple-choice examinations at the end of quarters, were compared. Two of the courses follow the practice of regularly posting scores and keyed questions; one holds review sessions during subsequent quarters to discuss some questions, while the other allows students to review their tests in a proctored room without access to paper and pencil.

Development of the Hospital Nurse Surveillance Capacity Profile.

Better patient outcomes are often achieved through effective surveillance, a primary function of nurses. The purpose of this article is to define, operationalize, measure, and evaluate the nurse surveillance capacity of hospitals. Nurse surveillance capacity is defined as the organizational features that enhance or weaken nurse surveillance.

Increasing accuracy of antenatal ultrasound diagnosis of cleft lip with or without cleft palate, in cases referred to the North Thames London Region.

Objectives: To determine the accuracy of antenatal ultrasound diagnosis of cleft lip with or without cleft palate (CL +/- P) and isolated cleft palate (CP).

Methods: This was a retrospective review of 256 surviving cases referred in 2002-2003 for treatment of CL +/- P.

Results: We had referrals from 36 maternity units, 27 of which were in our local catchment area.

Effects of hospital care environment on patient mortality and nurse outcomes.

Objective: The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education.

Background: Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited.

Methods: Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed.

Hospital nurse practice environments and outcomes for surgical oncology patients.

Objective: To examine the effect of nursing practice environments on outcomes of hospitalized cancer patients undergoing surgery.

Data Sources: Secondary analysis of cancer registry, inpatient claims, administrative and nurse survey data collected in Pennsylvania for 1998-1999.

Study Design: Nurse staffing (patient to nurse ratio), educational preparation (proportion of nurses holding at least a bachelor's degree), and the practice environment (Practice Environment Scale of the Nursing Work Index) were calculated from a survey of nurses and aggregated to the hospital level.

The nursing practice environment: measurement and evidence.

Improvements in nurses' practice environments are essential to retain nurses and keep patients safe. The pace of improvements can accelerate if evidence is translated clearly for researchers, managers, and policymakers. This article evaluates the utility of published multidimensional instruments to measure the nursing practice environment.

Measuring nurses' practice environments with the revised nursing work index: evidence from registered nurses in the Veterans Health Administration.

The Revised Nursing Work Index (NWI-R) is a widely used instrument for evaluating registered nurses' (RNs) practice environments. The existence of multiple subscale sets from the NWI-R raises questions about its generalizability. We tested the validity of the one-, three-, and five-subscale sets from the NWI-R and derived a short-form subscale set using a sample of RNs from the Veterans Health Administration (VHA).

Are patient falls and pressure ulcers sensitive to nurse staffing?

Research has demonstrated an association between more nurses and more qualified nursing staff in hospitals and better patient outcomes. Patient falls and pressure ulcers have been advanced as nursing-sensitive outcomes. This article evaluates the state of the science linking nurse staffing to falls and pressure ulcers.

Variations in nursing practice environments: relation to staffing and hospital characteristics.

Background: While improvements in nursing practice environments are considered essential to address the nursing shortage, relatively little is known about the nursing practice environments in most hospitals.

Objectives: The objectives of this study are to describe variations in nursing practice environments across hospitals and to examine their associations to hospital bed size, community size, teaching intensity, and nurse staffing levels.

Methods: The research design was cross-sectional analyses of nurse survey and administrative data for 156 Pennsylvania hospitals from 1999.

Multilevel modeling of a clustered continuous outcome: nurses' work hours and burnout.

Background: Multilevel models were designed to analyze data generated from a nested structure (e.g., nurses within hospitals) because conventional linear regression models underestimate standard errors and, in turn, overestimate test statistics.

Assay variation confounds the diagnosis of hypovitaminosis D: a call for standardization.

Endemic hypovitaminosis D contributes to osteoporosis development. However, variation in 25-hydroxyvitamin D (25OHD) measurement is reported and confounds the diagnosis of vitamin D insufficiency/deficiency. This report emphasizes the marked variability observed in serum 25OHD measurements between laboratories.