Impacts of nurses' circadian rhythm sleep disorders, fatigue, and depression on medication administration errors

The safety and quality of the administration of medications by nurses raise the opportunity to study risk factors such as circadian rhythm sleep disorders, fatigue, and depression. This study was conducted to explore the extent of nurses' circadian rhythm sleep disorders, fatigue, and depression and their impact on medication administration errors. Both approval from the hospital ethics committee and formal patient consent were obtained. A descriptive cross sectional study was conducted using a demographic data sheet, a depression scale [CES-D], a modified fatigue severity scale, a medication errors observation sheet and an AASM two week sleep diary. The average number of medication errors per nurse per shift was 1.40 +/- 2. [Wrong time [and] wrong rate] were the most frequent medication errors [23.1% each]. About half [51.9%] of the nurses reported deficient sleep hours. Medication errors were negatively correlated with average working hours and positively correlated with depression score; errors peaked with irregular shift work patterns and irregular night sleep patterns in nurses with more than 4 night shifts in the preceding 2 weeks. Fatigue was significantly correlated with total depression score and significantly associated with deficient sleep hours. Additionally, the depression score was significantly affected by irregular sleep patterns. There were significant relationships between sleep medication intake and medication errors, depression, and fatigue. Linear regression analysis demonstrated that the independent predictors of medication errors were the number of patients under the nurses' direct care and the depression score of the nurses. Medication administration errors, fatigue and depression were all significantly affected by circadian sleep disorders. An administration's control of work flow to provide convenient sleep hours will help in improving sleep circadian rhythms and consequently minimize these problems

Association between HCV induced mixed cryoglobulinemia and pulmonary affection: the role of TNF-alpha in the pathogenesis of pulmonary changes

Chronic hepatitis C virus [HCV] infection is associated with both pulmonary involvement and cryoglobulinemia. Therefore, this study was designed to investigate the relationship between pulmonary involvement and mixed cryoglobulinemia in chronic HCV infected patients and to investigate the role of TNF-alpha in the pathogenesis of pulmonary changes. After hospital ethics committee approval and formal patient consent were obtained, 100 patients with compensated hepatitis C virus infection as confirmed by PCR were recruited in this cross sectional study. Their demographic and laboratory data, abdominal ultrasound findings, pulmonary function tests [spirometry], arterial blood gas [ABG] parameters, TNF-alpha levels, and data from high-resolution chest CT were collected and analyzed using SPSS version 16, and a serum cryoglobulin assay was performed in all of the studied patients The prevalence of mixed cryoglobulinemia was 61.7% in the studied HCV patients. Pulmonary symptoms were observed in more than half of these patients. The most common complaint among the symptomatic patients was dyspnea [51.7%], followed by cough [43.3%]. Oxygen saturation [Spo[2] and Sao[2]%], and FEVi and FVC levels, were significantly decreased in the cryoglob-ulin positive patients compared to the cryoglobulin negative patients. A statistically significant correlation was found between the presence of cryoglobulins and FEV level, FVC level, serum albumin level, viremia level, thrombocytopenia and arterial blood gas parameters. No correlation was found between cryoglobulinemia and TNF-alpha level. The results of this study suggest that pulmonary involvement is common in patients with chronic HCV infection and mixed cryoglobulinemia. Cryoglobulinemia may lead to pulmonary involvement through vascular and interstitial deposition of cryoglobulins, which results in impaired gas exchange and airway affection