BIOSTATISTICS : PS1

(Health Study Designs and Managing Data)
ABSTRACT 1

Classifying nursing organization in wards in Norwegian hospitals: self-identification versus observation
Background The organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification). Methods In a cross-sectional postal survey, 93 ward nurse managers in Norwegian hospitals responded to questions about nursing organization in their wards, and what they called their organizational models. K-means cluster analysis was used to classify the wards according to the pattern of activities attributed to the different nursing roles and discriminant analysis was used to interpret the solutions. Cross-tabulation was used to validate the solutions and to compare the classification obtained from the cluster analysis with that obtained by self-identification. The bootstrapping technique was used to assess the generalizability of the cluster solution. Results The cluster analyses produced two alternative solutions using two and three clusters, respectively. The three-cluster solution was considered to be the best representation of the organizational models: 32 team leaderdominated wards, 23 primary nurse-dominated wards and 38 wards with a hybrid or mixed organization. There was moderate correspondence between the three-cluster solution and the models obtained by self-identification. Cross-tabulation supported the empirical classification as being representative for variations in nursing service organization. Ninety-four per cent of the bootstrap replications showed the same pattern as the cluster solution in the study sample.

Background . . only moderately consistent with the selfidentification. 3 Clust er grp.Nonrandomized .Conclusions A meaningful classification of wards was achieved through an empirical cluster solution. This empirical classification is an objective approach to variable construction and can be generally applied across Norwegian hospitals. 32 team leader – dominated wards. however. 1 93 subje cts Nonrandomized Clust er grp. 23 primary nurse dominated wards and 38 wards with a hybrid or mixed org.Cross –sectional .Concurrent Components of the Study .2 I N T E R V E N T I O N S E L F I D E N T I F I C A T I O N Cross Tabular (Observation ) Postal Survey ABSTRACT 2 Burnout in health-care professionals during reorganizations and downsizing.Subjects : 93 ward nurse manager. this was. A cohort study in nurses. Type of Research : Experimental study . The classification procedure used in the study could be developed into a standardized method for classifying hospital wards across health systems and over time.Method Used: Postal Survey Flowchart/Diagram Clust er grp.

r square 0. Burnout was associated with low SOC (p<0.Burnout is a psychological reaction triggered by interaction between personal characteristics and stress factors.5 pr year (p<0. burnout was assessed in nurses with long work experience in three surveys during a 30 months' period with two comprehensive reorganizations and downsizing of a hospital unit with mostly seriously ill patients with cancer. Answer: Type of Research: Quasi-experimental Retrospective Cohort Study Length/Duration of Study: 30 months’ period Method Used: .001.“Sense of Coherence” (SOC) with Antonovsky’s Questionnaire Components of Study: . This is a study of burnout in nurses during a period with two comprehensive reorganizations. The proportion of satisfied nurses at the first and last survey were 84% and 35% respectively. Results One man and 45 women aged 30 to 65 years were invited to the surveys.Bergen Burnout Indicator (BBI) . Methods In this quasi-experimental retrospective cohort study. Working with seriously ill patients with cancer has probably made the nurses exceptionally vulnerable to the stress and workload related to the reorganizations. Burnout was measured with Bergen Burnout Indicator (BBI) at each survey.Subject: One man and 45 women ages 30-65 y/o . and "Sense of Coherence" (SOC) with Antonovsky's questionnaire at the last survey. Burnout was associated with low SOC. the mean increase in BBI-score was 12.001). There was a significant increase in burnout during the study period. and the proportions with burnout were 0% and 29% respectively (p<0. Reorganizations and downsizing with increased workload imply stress for health-care professionals. Except for auxiliary nurses with experience from the medical department. Conclusions There was a significant development of burnout in a group of nurses during a period with two reorganizations and downsizing. all subgroups experienced a significant increase in BBI.001).33).

Flowchart/Diagram Population: One man. 45 women (Aged 30-65 y/o) Experimental: Burnout Nurses Control: Satisfied Nurses First data collected: 0% Period of Manipulation: 30 months Last data collected: 29% First data collected: 84% No Manipulation Last data collected: 35% Difference (%) during study: Burnout = 29% Satisfied = 19% .

sense of failure and frustration. only 4 of their partners were reported to be sad or anxious. In the semi-structured interviews. communicating.7%) and men (6%). providing emotional support by listening. The second phase was a semi-structured interview of 10 clients who got pregnant following treatment. feelings of devastation. The need for additional and continuous training for nurses employed in fertility settings in Kuwait is paramount. 65.9%). 14. . Methods Quantitative and qualitative methods were used. The interview explored their feelings and perception of the nurses' role.7% of the men were found to show more anxiety than women (6%).2% weak ejaculation and 7. Emotional reactions experienced were: anxiety in women (12. Conclusions This study illuminates the emotional reactions of infertile clients.ABSTRACT 3 Emotional reaction to diagnosis of infertility in Kuwait and successful clients' perception of nurses' role during treatmen Background The unfulfilled desire of millions of infertile couples worldwide to have their own biological children results in emotional distress. This study evaluated the emotional reactions of couples attending a combined infertility clinic in Kuwait and successful clients' perception of nurses. reassuring and being empathetic. Results The average duration of infertility was 4 years. Fertility nurses in Kuwait can provide emotional support through communication. between October 2002 and September 2007. Interviews were transcribed verbatim and analyzed.9% experienced premature ejaculation. 5.9% had impotence although 4. 12. powerlessness.1% of men suffered from primary infertility.7% of the women and 76.9% were transient. In the survey. educating about investigative and treatment procedures. depression in women (5. Although all the 10 women interviewed confirmed they were anxious.2%) and men (14. encouraging.9%) and reduced libido in women (6. Also in men. Data were collected from 268 couples attending the combined infertility clinic.7%) and men (29. Successful clients' perception of nurses' roles included nurses carrying out basic nursing procedures. The first phase was by structured interview using two standardized psychological scales: the 25-item Hopkins Symptom Checklist and Modified Fertility Adjustment Scale. the emotions expressed were similar and in addition to anger.

with the aim of longitudinally examining a wide variety of individual and work- . Semi.Type of Research: Experimental study .Method used : a.structured Interview Duration of the study: October 2002 – September 2007 Flowchart/Diagram With Outcome 25 item Hopkins (couples 268 Symptom Checklist and who got couple Modified Fertility pregnant) s Adjustment Scale Without Outcome With Outcome 10 couple s Result from previous(historical) study Semi.Subjects: 268 couples attending the combined infertility clinic . 25 item Hopkins Symptom Checklist and Modified Fertility Adjustment Scale b.Historical Cohort Components of the study .structured Interview Without Outcome Onset Intervention in subjects only Time ABSTRACT 4 Monitoring the newly qualified nurses in Sweden: the Longitudinal Analysis of Nursing Education (LANE) study Background The Longitudinal Analysis of Nursing Education (LANE) study was initiated in 2002.

In the cohort who graduated in 2002.related variables related to psychological and physical health. about 2% of the participants had left the nursing profession five years after graduating. Intention to leave the profession was more common among young nurses. About 10% of the cohorts who graduated in 2002 and 2004 intended to leave the profession one year after graduating. The most common reason for not working was due to maternity leave. to estimate representativeness and analyse response rates over time. 4316 consented to participate Timeline : 3years Professio nal retention 43 16 10% intended to have a profession one year after graduating . as well as rates of employee and occupational turnover. in this cohort. Results Sociodemographic data in the cohorts were found to be close to population data. nearly all participants had qualified as nurses and had later also held nursing positions. During the first year after graduation. nearly every fifth registered nurse continued to further higher educational training within the health professions. Methods Three Swedish national cohorts of nursing students on university degree programmes were recruited to constitute the cohorts. Of 6138 students who were eligible for participation. and among those who graduated in 2006 the figure was almost twice as high. The aim of this paper is to present the LANE study. Moreover. and also to describe common career pathways and life transitions during the first years of working life. as point estimates only differed by 0-3% from population values. The cohorts will be followed prospectively for at least three years of their working life. Type of Research : Cohort / Multiple Cohort design Components of the study : 6138 students eligible for participation. Response rates were found to decline somewhat across time. a total of 4316 consented to participate and responded at baseline (response rate 70%). and professional development among nursing students in the process of becoming registered nurses and entering working life. Conclusion Both high response rates and professional retention imply a potential for a thorough analysis of professional practice and occupational health. and this decrease was present in all analysed subgroups.

Conclusions . hand/wrist and legs. Low back pain was the most frequently reported symptom (27%). there are no data on these disorders among students of this healthcare profession. A questionnaire collected data concerning personal characteristics. shoulder (11%). Methods The students (n = 109) currently attending the 3-year X-ray technologist school at a large University in the Apulia region of Southern Italy were recruited for the study. low back. We have therefore estimated the prevalence of musculoskeletal complaints among a group of X-ray technology students. Results The prevalence of complaints in any body site over the previous 12 months was 37%. with a 100% participation rate. leg (8%) and hand/wrist (5%) pain. Although recent studies show musculoskeletal disorders are a common problem among X-ray technologists. followed by neck (16%). shoulders.Cessati on to work Maternity leave More common to young nurses Onset of study ABSTRACT 5 3 years Musculoskeletal complaints among Italian X-ray technology students: a cross-sectional questionnaire survey Background There is a high prevalence of musculoskeletal disorders among healthcare professional students. and the presence of musculoskeletal symptoms in the neck. Poor physical activity was associated with the complaints. physical exposure during training activities.

Our research also showed a significant association between poor physical activity and the presence of musculoskeletal disorders in young university students. A pilot study . representing about half of those found in Italian technologists.Our study showed prevalence rates of musculoskeletal complaints among X-ray technology students to be somewhat high.Cross-sectional Components of the study A. The most common musculoskeletal problem was low back pain. Type of Research: Experimental study . questionnaire Flowchart/Diagram With outcome: prevalence of musculoskeletal disorders is high among Xray students 109 students currently attending the technology 3-yr x-ray technologist school Without outcome duration ABSTRACT 6 An exploration of knowledge. attitudes and advice given by health professionals to parents in Ireland about the introduction of solid foods. Method used : c. Subjects: 109 students currently attending the 3-year X-ray technologist school B. which had also been found in research conducted among nursing students.

Questionnaires were then distributed in a postal survey to General Practitioners (GPs) (n 179). No global recommendations have been made for formula fed infants. commencing with a multidisciplinary focus group to guide and develop a questionnaire. However. 1. attitudes and advice practices about weaning. Practice Nurses (PNs) (n 121). CDs and PHNs acknowledged a clear role in providing weaning advice while demonstrating high confidence levels in providing this advice. Public Health Nurses (PHNs) (n 107) and Community Dieticians (CDs) (n 8). In Europe it is recommended that weaning foods should be introduced between 18 weeks and 26 weeks regardless of whether infants are breast or formula fed. 19% of PNs and 7% of GP respondents did not acknowledge that they have a role in providing weaning advice to parents. Results The results indicate varying levels of knowledge of official weaning recommendations and a variety of advice practices. this study aimed to explore their knowledge. Observational Study -Cross sectional . UK and local recommendations may be a source of confusion for parents and health care professional based in Ireland. Further research is needed. Emerging evidence suggests that babies in Ireland are given solid foods before the recommended age but there has been little investigation of the weaning advice provided by health professionals. even though Health Service Executive (HSE) written literature given to parents states that they should seek information from PNs and GPs. Conclusion Small pockets of misinformation about the introduction of solid foods persist amongst health professionals which may lead to inconsistent advice for parents. Since community health professionals have routine parent interactions in the pre-weaning and early-weaning period and hence are in a unique position to positively influence parental weaning decisions. In Ireland official guidelines recommend that breast fed infants should be introduced solids at 6 months of age while for formula fed infants the recommendation is for 4 months. European. Global recommendations by the World Health Organisation (WHO) recommend that all infants be exclusively breast-fed for the first six months of life.Background For the purposes of this paper "weaning is defined as the introduction of the first solid foods to infants". In the United Kingdom it is recommended that solids be introduced at around six-months for both breast and formula fed infants. Methods A mixed-methods approach was used for the research. The disparity between these global.

Tools: Questionnaires to assess their knowledge about child weaning 3. unit environment Introduction Environmental stimulus. and NL plus use of earplugs and eye masks (NLEE). baseline. Flow chart/ Diagram CDs and PHNs acknowledged a clear role in providing weaning advice while demonstrating high confidence levels in providing this advice. exposure to recorded ICU noise and light (NL). 107(PHN) & 8 (CD) B. Subject: 415 respondents which are professionals comprised of 179 (GP). is thought to disrupt sleep in patients in the intensive care unit (ICU). anxiety levels and perception of environmental stimuli. Methods Fourteen subjects underwent polysomnography under four conditions: adaptation. 121 (PN). especially noise and light. This study aimed to determine the physiological and psychological effects of ICU noise and light. 415 health professional s 19% of PNs and 7% of GP respondents did not acknowledge ABSTRACT 7 that they have a role in providing Effects of earplugs and eye masks on nocturnal sleep. Results .2. Urine was analyzed for melatonin and cortisol levels. Components: A. Subjects rated their perceived sleep quality. used in these conditions in healthy subjects. and of earplugs and eye masks. weaning advice melatonin and cortisol in a simulated intensive care to parents.

composed of 8 female & 6 male with ages 21-70 y/o B. less REM sleep when exposed to simulated ICU noise and light (P < 0.002). shorter REM latency. more light sleep.06). making their promotion in ICU patients reasonable. Nocturnal melatonin (P = 0.05).05) and elevated melatonin levels (P = 0. Subject: 14 Healthy volunteers. Conclusions Earplugs and eye masks promote sleep and hormone balance in healthy subjects exposed to simulated ICU noise and light.Randomized controlled Trial -Crossover Study Components: A. Control: ICU Noise & Light (NL) as sleep disruptor Flow chart/ Diagram ICU NL with ear plugs & eye masks ICU NL without ear plugs & eye masks 7 subject s Adaptation Baseline 14 subject s Randomizatio n 7 subject s ICU NL without ear plugs & eye masks ICU NL with ear plugs & eye masks . Experimental . Use of earplugs and eye masks resulted in more REM time. longer rapid eye movement (REM) latency. less arousal (P < 0.Subjects had poorer perceived sleep quality.004) differed significantly by condition but anxiety levels did not (P = 0. Experimental treatment: Ear plugs & Eye masks to help manage frequent sleep arousal from ICU NL C.007) and cortisol secretion levels (P = 0.

88%). 73%). scoring of GCS and FOUR score was performed by neurologists and ICU staff on 267 consecutive patients admitted to intensive care. 79%. Methods In this prospective observational study. P = 0. and an inconsistent inter-rater reliability. was recently proposed. The exact inter-rater agreement among neurologists was superior to that among ICU staff for the FOUR score (87% vs.04) but not for the GCS (73% vs. a new coma scale not reliant on verbal response. . the inter-rater agreement within a range of ± 1 score point for the GCS was 90%. Neurologists and ICU staff did not significantly differ in the interrater agreement within a range of ± 1 score point for both GCS (88% vs. Limitations of the GCS include the impossibility to assess the verbal score in intubated or aphasic patients.). A further aim was to compare the inter-rater reliability of neurologists with that of intensive care unit (ICU) staff. and for the FOUR score 92% (P = ns. 93%) and the FOUR score (91% vs. Results In a total of 437 pair wise ratings the exact inter-rater agreement for the GCS was 71%.0016).AB ABSTRACT 8 Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients: a prospective observational study Introduction The Glasgow Coma Scale (GCS) is the most widely used scoring system for comatose patients in intensive care. The aim of the present study was to compare the inter-rater reliability of the GCS and the FOUR score among unselected patients in general critical care. The FOUR (Full Outline of UnResponsiveness) score. and for the FOUR score 82% (P = 0.

) Materials: Glasgow Coma Scale and Full Outline of UnResponsiveness Score C.) Components of the Study: A.Conclusions The FOUR score performed better than the GCS for exact inter-rater agreement. a score with a long tradition in intensive care. but not for the clinically more relevant agreement within the range of ± 1 score point.) Flowchart: ABSTRACT 9 Effect of negative air ions on the potential for bacterial contamination of plastic medical equipment . Inter-rater reliability of the Full Outline of UnResponsiveness score and the Glasgow Coma Scale in critically ill patients 1.) Conductors/Evaluators: Neurologist and ICU staff 3.Cohort Study .The study took place between May 2006 – April 2007 2. Though neurologists outperformed ICU staff with regard to exact inter-rater agreement. The small advantage in inter-rater reliability of the FOUR score is most likely insufficient to replace the GCS.) Type of Research: Observational Study . Switzerland B.) Subjects: 328 critically ill patients who were admitted in the two subunits of the ICU in University Hospital of Basel. the inter-rater agreement of ICU staff within the clinically more relevant range of ± 1 score point equalled that of the neurologists.

Results The results of the study demonstrated that common items of equipment such as ventilator tubes rapidly developed a large negative charge (i. did however develop a positive charge in the presence of the ionizer. generally >-100V) in the presence of a negative air ionizer. . there is clinical evidence that air ions might play an important role in preventing the transmission of Acinetobacter infection. While most items of equipment tested behaved in a similar manner to this. a box from a urological collection and monitoring system (the only item made from styrene acrylonitrile). either in free space or in contact with a table surface. one item. airborne bacteria. However. and that this has the potential to cause any Acinetobacter-bearing particles in the air to be strongly repelled from some plastic surfaces and attracted to others. the physical action of air ions on bacterial dissemination and deposition has largely been ignored. the ionizers minimize electrostatic deposition on these items. and exposed to negative ions produced by an air ionizer. By negatively charging both particles in the air and items of plastic equipment. Although the reasons for this are unclear. this may prevent critical items of equipment from becoming contaminated with the bacterium. In so doing. rather than attract. By comparison. Methods A study was undertaken in a mechanically ventilated room under ambient conditions to accurately measure changes in surface potential exhibited by items of plastic medical equipment in the presence of negative air ions. In so doing they may help to interrupt the transmission of Acinetobacter infection in certain healthcare settings such as intensive care units. it is hypothesized that a physical effect may be responsible: the production of air ions may negatively charge items of plastic medical equipment so that they repel.e. Conclusion The findings of the study suggest that the action of negative air ionizers significantly alters the electrostatic landscape of the clinical environment. Plastic items were suspended on nylon threads.Background In recent years there has been renewed interest in the use of air ionizers to control the spread of infection in hospitals and a number of researchers have investigated the biocidal action of ions in both air and nitrogen. The charge build-up on the specimens was measured using an electric field mill while the ion concentration in the room air was recorded using a portable ion counter.

DIAGRAM .

Comparison of doses showed improved interpersonal problems in the medium and long course but not in the short course. coping style and interpersonal problems. 158 minutes) or long (17 sessions.) Type of Research: Experimental Study . 223 minutes) version. however.ABSTRACT 10 Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training Background Working in a hospital during an extraordinary infectious disease outbreak can cause significant stress and contribute to healthcare workers choosing to reduce patient contact.an interactive. Results 158 hospital workers took the course and were randomly assigned to the short (7 sessions. medium (12 sessions. computer-assisted training course designed to build resilience to the stresses of working during a pandemic. Comparing three "doses" of the course suggested that the medium course was optimal. This study tests the feasibility and effectiveness of a less expensive alternative . the course was associated with significant improvements in confidence in support and training. There was a trend towards higher drop-out rates with longer duration of training. Psychological training of healthcare workers prior to an influenza pandemic may reduce stress-related absenteeism. Participants who under-utilized coping via problem-solving or seeking support or over-utilized escape-avoidance experienced improved coping. median cumulative duration 111 minutes). pandemicrelated self-efficacy. pandemic self-efficacy and interpersonal problems. Methods A "dose-finding" study compared pre-post changes in three different durations of training.) Components of the Study: . Using an intention-to-treat analysis. established training methods that change behavior and attitudes are too resource-intensive for widespread use. We measured variables that are likely to mediate stress-responses in a pandemic before and after training: confidence in support and training.Randomized Uncontrolled Trial 2. Conclusions Computer-assisted resilience training in healthcare workers appears to be of significant benefit and merits further study under pandemic conditions. 1.

Canada B.) Flow Chart .) Materials/Instruments: Three computer assisted courses that will help healthcare workers to prepare for influenza pandemic.A. 3.) Subjects: 158 healthcare workers with consent to participate from Mount Sinai Hospital in Toronto.