HRT: Decide Based on the Evidence

The effectiveness and safety of hormone replacement therapy (HRT) have been studied since the 1980s. However, much of the available evidence was contradictory, and practitioners were uncertain how to counsel peri- and postmenopausal patients. In this article, recent evidence, both for and against use of HRT in peri- and postmenopausal patients, is compared to past studies with recommendations for practice

Classifying nursing organization in wards in Norwegian hospitals: self-identification versus observation

<p>Abstract</p> <p>Background</p> <p>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).</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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 leader-dominated 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.</p> <p>Conclusions</p> <p>A meaningful classification of wards was achieved through an empirical cluster solution; this was, however, only moderately consistent with the self-identification. This empirical classification is an objective approach to variable construction and can be generally applied across Norwegian hospitals. The classification procedure used in the study could be developed into a standardized method for classifying hospital wards across health systems and over time.</p

Assessing attitudes toward elderly among nurses working in the city of Ilam

Objective: Several factors affect the quality of care in the elderly, such as nurses' attitudes. This study aimed to assess nurses' attitude toward elderly in the city of Ilam. Method: This cross-sectional study was conducted among 230 nurses working at public hospitals in the city of Ilam. Participants were selected using simple random sampling from the list of staff. The Kogan's attitude questionnaire was used to measure nurses' attitudes toward the elderly. Results: The mean age of respondents in this study was 32.65 (SD = 7.67), and the score of attitudes toward the elderly was 144.96 (SD = 51.75) in average. More than half (54.3) of the nurses had negative attitudes toward the elderly. The results of ANOVA analysis showed significant differences (P < 0.05) were observed in the attitudes toward the elderly among the nurses as their ages, marital status, work experiences, and ward types differed. Conclusion: In conclusion, nurses in this study have marginally negative attitudes toward the elderly. Therefore, promoting nurses' attitudes toward the elderly is important to provide high-quality care. (C) 2017 Chinese Nursing Association. Production and hosting by Elsevier B.V

Assessing dopamine concentrations: an evidence-based approach

BACKGROUND: Both overmedication and undermedication can be potentially life threatening. If the actual volume of a 100-mL intravenous bag used to mix dopamine solutions is greater than the labeled volume, overdilution of medication can occur, resulting in an ineffective hemodynamic response in patients and thus an unintended adverse drug event. OBJECTIVES: To determine the actual fluid volumes of 100-mL intravenous bags, compare the actual volumes of 100-mL bags from the 3 major manufacturers of intravenous bags, and determine if the excess volume is sufficient to cause a clinically significant overdilution of dopamine. METHODS: A comparative descriptive design was used. The volumes of 162 intravenous bags of 100 mL of 5% dextrose in water (32 lot numbers with various expiration dates) were measured. Visual volume was confirmed by using a 250-mL graduated cylinder. Volume by weight was determined with a calibrated laboratory-quality electronic scale. On the basis of a mathematical model, any overfill greater than 110 mL was considered clinically significant. RESULTS: The difference between actual and labeled volumes was statistically and clinically significant. Mean visual volume was 110.20 mL (range, 107-114 mL). Mean weighed volume was 109.26 mL (range, 106.15-112.09 mL). The fluid volumes among bags from the 3 major IV companies differed significantly (P &amp;lt; .001). CONCLUSIONS: The overfill in sufficient numbers of 100-mL intravenous bags was enough to cause clinically significant overdilution of dopamine. When dopamine or other vasoactive medications are mixed, either an in-line buret or premixed bags of the drugs should be used to prevent an unintended adverse drug event.</jats:p