Organizational Factors Associated With Nurses’ Competence in Averting Failure to Rescue in Acute Care Settings

Background: Organizational characteristics are the main concerns of nursing practice in acute care settings. The present study aimed to assess the organizational factors associated with nurses’ competence in averting Failure to Rescue (FTR) in acute care settings. Methods: This was a descriptive and correlational study. A purposive sampling technique was used to collect the necessary data from the study respondents. In total, 173 of the 204 eligible registered nurses providing sudden, urgent, and emergency direct care to patients in the identified acute care settings of Olabisi Onabanjo University Teaching Hospital in Sagamu City, Nigeria participated in this study. A self-structured 38-item questionnaire, including 4 parts (demographic characteristics, knowledge on FTR, competence in averting FTR, & organizational factors) was employed for data collection. The obtained data were analyzed in SPSS V. 22 using descriptive statistics (i.e. frequency, percentages, mean, standard deviation, & tables) as well as Spearman’s Rho correlation to test the hypotheses based on the assumptions that the variables were measured on an ordinal scale at P<0.05. Results: Most nurses presented a high level of knowledge regarding FTR with a mean score of 5.91. Besides, they were moderately competent in averting FTR with a mean score of 29.3. A significant correlation was also detected between organizational characteristics and the studied nurses’ level of competence in averting FTR (P=0.026). Conclusion: The present study data revealed that FTR could be reduced in acute care settings by the modification of organizational factors.

Reevaluation of the role of LIP-1 as an ERK/MPK-1 dual specificity phosphatase in the C. elegans germline

The fidelity of a signaling pathway depends on its tight regulation in space and time. Extracellular signal-regulated kinase (ERK) controls wide-ranging cellular processes to promote organismal development and tissue homeostasis. ERK activation depends on a reversible dual phosphorylation on the TEY motif in its active site by ERK kinase (MEK) and dephosphorylation by DUSPs (dual specificity phosphatases). LIP-1, a DUSP6/7 homolog, was proposed to function as an ERK (MPK-1) DUSP in the Caenorhabditis elegans germline primarily because of its phenotype, which morphologically mimics that of a RAS/let-60 gain-of-function mutant (i.e., small oocyte phenotype). Our investigations, however, reveal that loss of lip-1 does not lead to an increase in MPK-1 activity in vivo. Instead, we show that loss of lip-1 leads to 1) a decrease in MPK-1 phosphorylation, 2) lower MPK-1 substrate phosphorylation, 3) phenocopy of mpk-1 reduction-of-function (rather than gain-of-function) allele, and 4) a failure to rescue mpk-1–dependent germline or fertility defects. Moreover, using diverse genetic mutants, we show that the small oocyte phenotype does not correlate with increased ectopic MPK-1 activity and that ectopic increase in MPK-1 phosphorylation does not necessarily result in a small oocyte phenotype. Together, these data demonstrate that LIP-1 does not function as an MPK-1 DUSP in the C. elegans germline. Our results caution against overinterpretation of the mechanistic underpinnings of orthologous phenotypes, since they may be a result of independent mechanisms, and provide a framework for characterizing the distinct molecular targets through which LIP-1 may mediate its several germline functions.

Prediction of Postoperative Mortality in Patients With Organ Failure Following Pancreaticoduodenectomy

Background Failure to rescue (FTR) patients with postoperative complications contribute to a significant proportion of postoperative mortality. Our main objective was to determine the risk factors for FTR among patients undergoing pancreaticoduodenectomy who suffered a life-threatening complication requiring intensive care unit (ICU) management. Materials and Methods Consecutive patients undergoing pancreaticoduodenectomy from 2011 to 2020 were reviewed retrospectively. Causes of organ failure were described as the one that most commonly contributed to patient’s transfer to ICU or death. Two groups were created based on whether patients had FTR and risk factors for FTR were compared. The impact of baseline characteristics, operative characteristics, and risk scoring on FTR was analyzed using multiple logistic regression. Results There were 19/58 (33%) FTR patients. Baseline, operative characteristics, postoperative complications, and length of hospital and ICU stay were similar between groups. However, a higher proportion of FTR patients experienced a postoperative pancreatic fistula (POPF) (16% vs 2.6%, P = .062). Among patients who experienced a POPF, the FTR group had a trend in delayed time from diagnosis to treatment (7 vs 23 hours, P=.131). Renal complications (OR 6.12, 95% CI, 1.23 to 38.43, P = .035) and time from POPF diagnosis to treatment (OR 1.05, 95% CI, 1.00 to 1.11, P = .036) were independent predictors of FTR by multivariable analysis. Conclusion The occurrence of certain postoperative complications such as renal complications as well as delayed timing of the management of POPF is predictive of FTR following pancreaticoduodenectomy, especially as delayed timing to treatment is a risk factor for FTR.

Evaluation of a Theory-Informed Pediatric Rapid Response Training Program Using the Logic Model

BACKGROUND AND OBJECTIVES The activators of rapid-response (RR) events tasked with recognition of clinical decompensation, initial management, and response activation seldom receive RR training. RR activators often experience negative emotions of “failure to rescue” that can compromise team performance during RRs. We used the logic model framework for development and evaluation of an educational program grounded in self-determination theory for pediatric RR activators. METHODS The program unfolded in a large quaternary pediatric hospital to impart knowledge and skills; foster autonomy, competence, and relatedness; and improve participants’ satisfaction with performance in RRs. Logic model–guided inputs-activities-outputs-outcomes-context for program evaluation. Preintervention-postintervention follow-up surveys and interviews generated data to determine outcomes and impact of the program. The evaluation instruments were tested for validity and internal consistency. RESULTS Over 4 years, 207 multidisciplinary RR activators were trained. Iterative modifications yielded a workshop that incorporated multiple learning modalities, a standardized learner-centered case bank, formalized evaluation tools, and a database to track participation. Significant improvements in RR-related knowledge, self-efficacy, and self- determination were noted. Workshop evaluation yielded a mean score of 4.85 (0.27) on a 5-point scale. At 6-months follow-up survey and interviews, participants reported application of the knowledge and increased confidence with participation in real-life RR events. The workshop gained traction across the hospital, was associated with improved RR clinical outcomes, and contributed to professional advancement of the educators. CONCLUSIONS We successfully implemented a self-determination theory–informed RR training program for pediatric RR activators, and the logic model framework was used to facilitate comprehensive evaluation.

Improving Outcomes for Elderly Patients Following Emergency Surgery: a Cutting-edge Review

Purpose of Review The aim of this review is to explore the consequence of emergency general surgery in the elderly, and to summarise recent developments in the pre-, peri- and postoperative management of these patients, in order to improve outcomes. Recent Findings Preoperatively, accurate risk assessment is vital to ensure the right patients undergo emergency surgery. Perioperatively, there are multiple interventions specific to elderly patients that have been shown to improve outcomes. Postoperatively, elderly patients must be cared more in an appropriate setting in order to avoid failure to rescue and promote return to function. Summary This review of contemporary evidence identifies multiple pre-, peri- and postoperative interventions that can improve outcomes for elderly patients after emergency general surgery. These evidence-based recommendations should help direct care of elderly patients undergoing emergency surgery and foster further quality improvement measures and research investigations.