Analytical Unreliability of 25 Hydroxy Vitamin D Measurements in Pre-Term Neonates.

BACKGROUND: Vitamin D supplementation is common practice for neonates and infants due to limited stores of vitamin D at birth. Although not commonly encountered, vitamin D toxicity can occur due to over-supplementation. However, toxic concentrations are often not included in method validation experiments, and assays often are not validated in the neonatal population. METHODS: We compared serial 25 hydroxy vitamin D [25(OH)D] measurements in pre-term neonates receiving 25(OH)D supplementation and identified 12 patients wherein concentrations of 25(OH)D were above 50 ng/mL (125 nM) that required additional investigations as the 25(OH)D results did not match the clinical picture. Available samples were compared across 4 immunoassay platforms (LIAISON XL, Roche Cobas e602, Abbott Alinity i, and Siemens Centaur XP) and LC-MS/MS. RESULTS: Concentrations of 25(OH)D observed on one individual immunoassay platform (LIAISON XL) fluctuated substantially between subsequent blood draws in select neonates with elevated concentrations. Serum samples from these patients showed variable agreement between LC-MS/MS and other immunoassay platforms. These fluctuations were not explained by the presence of 3-epimer-25(OH)D or 24,25(OH)2D. CONCLUSIONS: Although we were unable to identify a cause for the variable elevated results, our findings suggest that neonatal 25(OH)D measurements alone should not be used for assessment of nutritional monitoring, and that clinical correlation and other laboratory parameters including ionized calcium should be considered.

A comprehensive systematic review of evidence on determining the impact of Magnet designation on nursing and patient outcomes: is the investment worth it?

OBJECTIVE: The overall objective is to examine the current evidence of the impact of Magnet designation on patient and nurse outcomes. INCLUSION CRITERIA: This review considered any quantitative or qualitative study comparing organizational, nurse, patient or economic outcomes in Magnet designated hospitals with a comparison to a non-Magnet facility. Studies which used case-controlled, descriptive comparative, descriptive correlational and qualitative designs were considered due to the nature of the question. Participants included nurses in four hospital types: ANCC Magnet, Reputational Magnet, Magnet-Aspiring, and non-Magnet. Interventions included: Magnet hospitals (ANCC), Reputational Magnet; Magnet-Aspiring hospitals and non-Magnet hospitals. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies and papers, limited to the English language. An initial search of the Joanna Briggs Institute for Evidence Based Nursing and Midwifery and Cochrane Library databases was conducted. A three-step search strategy was then used. A first-stage, limited search of MEDLINE and CINAHL using preliminary key words was done. In consultation with an information scientist experienced in database searching, a comprehensive search strategy incorporating the key words from the preliminary search was undertaken. The third approach was to review the reference lists from all retrieved papers meeting the inclusion criteria to identify any further research not identified in the first two stages. METHODOLOGICAL QUALITY: Each paper was assessed by two independent reviewers for methodological quality prior to inclusion using the appropriate critical appraisal instrument from the Joanna Briggs Institute. RESULTS: A total of 17 papers were included in the review. All were descriptive comparative studies with the majority using a cross sectional survey approach comparing outcomes across either two or three categories of Magnet designation. Comparison across studies using the same instrument was limited as survey instruments were not used in the same manner and studies had different Magnet designation comparison groups. Majority of studies investigated professional nurse practice environment, nurse burnout, nurse satisfaction, perception of quality care, and intent to leave. Limited studies found related to patient outcomes, and no studies met criteria for inclusion for economic review. CONCLUSION: The investment is worth it. There is evidence to support the positive effect of Magnet designation on the professional nurse practice environment (PNPE). Stronger PNPE and Magnet status are associated with lower levels of nurse burnout, higher levels of nursing satisfaction, higher perceptions of quality of care, and decreased intent to leave. There is a need to further investigate the linkage between PNPE and/or Magnet designation with patient outcomes. Understanding the economic implications of a PNPE requires further study.