Best Practices for Promoting Safe Patient Care Delivery by Hospital-Based Traveling Clinical Staff: An Integrative Review

BACKGROUND

Hospitals use traveling clinical staff (TCS) to fill personnel shortages. Although this approach may help improve staffing ratios, it is not without risk.

PURPOSE

The interdisciplinary team conducted an integrative literature review to determine best practices for promoting safe patient care delivery by TCS.

METHODS

Using the Johns Hopkins Evidence-Based Practice model, the authors performed an integrative literature review, including appraisal of quality, synthesis of themes, and best-evidence recommendations.

RESULTS

The final synthesis included 16 articles. Evidence demonstrated the importance of preemployment screening, standardized onboarding and orientation, and optimizing the integration of TCS into the work environment.

CONCLUSION

Hospitals should use these recommendations when incorporating TCS into their teams.

N-acetylcysteine supplementation may affect somatic cell count in goat milk (short communication)

Abstract. The aim of this study was to estimate an influence of supplementation of exogenous N-acetylcysteine (NAC) on the somatic cell count (SCC, quantified as cells per ml) and chemical composition of goat milk. The study was carried out on 15 goats, in the last part of lactation (220-250 days). The animals were divided into 3 groups according to SCC in their milk: 1st – up to 2×106, 2nd – from 2 to 4×106 and 3rd – above 4×106. The animals were clinically healthy. They were given NAC in the amount of 12 mg/ kg of live body weight per os for 7 days, once a day, during evening milking. Milk yield, as well as fat, protein and lactose contents and SCC were studied three times: 1st – just before starting the experiment, 2nd – after 7 days of NAC application and 3rd – a week after the end of NAC application. The analysis of variance with General Linear Model (GLM) procedure of SAS® package was used. There was observed the significant decrease of SCC after one-week supplementation of NAC and stagnation of SCC after next week in all three groups. The changes of chemical composition of milk were not significant. The significant decrease of SCC may indicate improvement of health of mammary gland. The oxidation processes might be decreased and probably the increase of immune defence of organism took place. One can suggest that the supplementation of NAC may lead to improvement of goat udder health.

The polymorphism in the beta4-defensin gene and its association with production and somatic cell count in Holstein-Friesian cows

The aim of this study was to find a polymorphism of the bovine beta4-defensin gene and search for its association with milk yield and composition and with the somatic cell count in milk. The data were from the years 1999 to 2004 on 212 Holstein-Friesian (HF) dairy cows, descended from 70 sires. Based on the sequence of the bovine beta4-defensin gene (GenBank no. AF008307) the primers were designed for the amplification of the 924-bp or 393-bp long fragments. The 924-bp long fragment was sequenced and the sequence was compared with that available in the GenBank. Ten putative nucleotide sequence polymorphisms were found in the intron of the bovine beta4-defensin gene. One of them, a C-->T transition at position 2239, that creates a new NlaIII (Hin1II) restriction site, was genotyped with polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) in a cohort of 212 HF cows. The CC genotype was the most common (72%). The heterozygous CT genotype was found in 26% of the genotyped cows and four cows (2%) were TT homozygotes. In order to determine the relationship between the polymorphism of the beta4-defensin gene and milk production traits a multi-trait repeatability test-day animal model was used. The Derivative-free Multivariate analysis program was used for computation. The differences between estimates for genotypes were checked using Student's t-test. The model included the animal genotype, year-season of calving and parity as fixed effects and the animal additive genetic effect and permanent environmental effect of individual cows as well as dates of the tests as random effects. Significant associations were found between the RFLP-NlaIII and milk fat, protein and lactose contents. Also, a significant effect was shown of the defensin genotype on the somatic cell count in the milk.