A lethal association of congenital apnea with brainstem tegmental necrosis

Brainstem tegmental necrosis and olivary hypoplasia: raising awareness of a rare neuropathologic correlate of congenital apnea

This case study describes an instance of death in an early term female newborn with congenital apnea in the clinical setting of multiple congenital anomalies (retrognathia, posteriorly rotated ears, camptodactyly, and arthrogryposis) and prenatal history of polyhydramnios. Postmortem neuropathologic findings were significant for tegmental necrosis in the caudal pons and medulla characterized by a coalescence of microcalcifications accompanied by neuronal loss, axonal spheroids, gliosis, and a concomitant hypoplasia of the inferior olives. This report raises awareness of the rare lethal entity of brainstem tegmental necrosis and olivary hypoplasia and its nosological relationship to the Möbius syndrome in the context of differential diagnosis of congenital apnea owing to central respiratory dysfunction.

Burnout in relation to specific contributing factors and health outcomes among nurses: a systematic review

Nurses have been found to experience higher levels of stress-related burnout compared to other health care professionals. Despite studies showing that both job satisfaction and burnout are effects of exposure to stressful working environments, leading to poor health among nurses, little is known about the causal nature and direction of these relationships. The aim of this systematic review is to identify published research that has formally investigated relationships between these variables. Six databases (including CINAHL, COCHRANE, EMBASE, MEDLINE, PROQUEST and PsyINFO) were searched for combinations of keywords, a manual search was conducted and an independent reviewer was asked to cross validate all the electronically identified articles. Of the eighty five articles that were identified from these databases, twenty one articles were excluded based on exclusion criteria; hence, a total of seventy articles were included in the study sample. The majority of identified studies exploring two and three way relationships (n = 63) were conducted in developed countries. Existing research includes predominantly cross-sectional studies (n = 68) with only a few longitudinal studies (n = 2); hence, the evidence base for causality is still very limited. Despite minimal availability of research concerning the small number of studies to investigate the relationships between work-related stress, burnout, job satisfaction and the general health of nurses, this review has identified some contradictory evidence for the role of job satisfaction. This emphasizes the need for further research towards understanding causality.

Gastroschisis, destructive brain lesions, and placental infarction in the second trimester suggest a vascular pathogenesis

The cause and pathogenesis of gastroschisis are uncertain. We report the autopsy and placental pathology of a stillbirth at 20 gestational weeks, in which gastroschisis was accompanied by destructive lesions in the cerebral cortex and brainstem, as well as cardiac calcification, consistent with ischemic injury during the 2nd trimester. An important potential underlying mechanism explaining the fetal abnormalities is the presence of infarcts in the placenta, indicative at this gestational age of maternal vascular underperfusion. The association of gastroschisis with ischemic lesions in the brain, heart, and placenta in this case supports the concept that gastroschisis, at least in some instances, may result from vascular event(s) causing disruption of the fetal abdominal wall and resulting in the extrusion of the abdominal organs, as well as hypoxic-ischemic brain and cardiac injury.

Quality of care in accredited and nonaccredited hospitals: perceptions of nurses in the Eastern Province, Saudi Arabia

BACKGROUND

Although Saudi Arabia is one of the first countries in the Eastern Mediterranean Region to implement healthcare accreditation standards, little is known about its impact on nurse assessment of the provision of healthcare.

OBJECTIVE

The main objectives of this study were to determine the quality of healthcare services provided by accredited and nonaccredited hospitals on the basis of the views of nurses. In addition, this study aimed to explore the potential contributing factors affecting the quality of care.

METHODS

A cross-sectional study was carried out at one accredited and another nonaccredited hospital at Al-Khobar city, Saudi Arabia. A questionnaire was used to assess nurses' perceptions of the quality of healthcare provided in the target hospitals on a five-point Likert scale tool. A total of 164 nurses were surveyed.

MAIN OUTCOME MEASURES

Quality of healthcare services and the potential contributing factors affecting the quality of care.

RESULTS

The most highly rated scales by nurses were 'education & training' (mean=4.09), followed by 'quality management' (mean=3.96) at the accredited hospital compared with 'use of data' (mean=3.56) and 'strategic quality planning' (mean=3.56) at the nonaccredited hospital. For both hospitals, the lowest scores were assigned to the 'reward' (mean=2.78 and 3.06 by nurses at accredited and nonaccredited hospitals, respectively). Nurses' rating for all scales was higher in the accredited compared with the nonaccredited hospital, except for the reward scale. The difference was statistically significant for all scales, except human resource utilization (P≤0.02). In accredited hospitals and for different scales, nurses with 4-6 years of experience, Saudi nurses, and those aged 30-35 years had significantly higher agreement scores than their counterparts. For the accredited hospitals, the predictors of good-quality results were leadership, commitment and support (P=0.019), and strategic quality planning (P=0.007). For nonaccredited hospitals, predictors of good quality results were leadership, commitment, and support (P=0.001).

CONCLUSION

As perceived by nurses in study hospitals, accredited hospitals perform favorably compared with nonaccredited hospitals in almost all quality scales. Thus, accreditation can be considered a tool for improving hospital quality. The most important determinants of quality in healthcare were leadership, commitment and support, and strategic quality planning.

Job stress and job satisfaction of physicians, radiographers, nurses and physicists working in radiotherapy: a multicenter analysis by the DEGRO Quality of Life Work Group

BACKGROUND

Ongoing changes in cancer care cause an increase in the complexity of cases which is characterized by modern treatment techniques and a higher demand for patient information about the underlying disease and therapeutic options. At the same time, the restructuring of health services and reduced funding have led to the downsizing of hospital care services. These trends strongly influence the workplace environment and are a potential source of stress and burnout among professionals working in radiotherapy.

METHODS AND PATIENTS

A postal survey was sent to members of the workgroup "Quality of Life" which is part of DEGRO (German Society for Radiooncology). Thus far, 11 departments have answered the survey. 406 (76.1%) out of 534 cancer care workers (23% physicians, 35% radiographers, 31% nurses, 11% physicists) from 8 university hospitals and 3 general hospitals completed the FBAS form (Stress Questionnaire of Physicians and Nurses; 42 items, 7 scales), and a self-designed questionnaire regarding work situation and one question on global job satisfaction. Furthermore, the participants could make voluntary suggestions about how to improve their situation.

RESULTS

Nurses and physicians showed the highest level of job stress (total score 2.2 and 2.1). The greatest source of job stress (physicians, nurses and radiographers) stemmed from structural conditions (e.g. underpayment, ringing of the telephone) a "stress by compassion" (e.g. "long suffering of patients", "patients will be kept alive using all available resources against the conviction of staff"). In multivariate analyses professional group (p < 0.001), working night shifts (p = 0.001), age group (p = 0.012) and free time compensation (p = 0.024) gained significance for total FBAS score. Global job satisfaction was 4.1 on a 9-point scale (from 1 - very satisfied to 9 - not satisfied). Comparing the total stress scores of the hospitals and job groups we found significant differences in nurses (p = 0.005) and physicists (p = 0.042) and a borderline significance in physicians (p = 0.052).In multivariate analyses "professional group" (p = 0.006) and "vocational experience" (p = 0.036) were associated with job satisfaction (cancer care workers with < 2 years of vocational experience having a higher global job satisfaction). The total FBAS score correlated with job satisfaction (Spearman-Rho = 0.40; p < 0.001).

CONCLUSION

Current workplace environments have a negative impact on stress levels and the satisfaction of radiotherapy staff. Identification and removal of the above-mentioned critical points requires various changes which should lead to the reduction of stress.