[The creation of an advanced practice department within a GHT]. / La création d'un département de pratique avancée au sein d'un GHT.

In order to meet the health needs of the population, the joint management of three establishments in the Yvelines Nord territorial hospital group has chosen to deploy advanced nursing practice. To facilitate the implementation of these professionals, an innovative organization has been designed, resulting in the creation of a specific department. The advanced practice nurse is part of a coordinated care pathway where his or her pivotal role in patient care leads him or her to develop numerous partnerships.

Mindfulness buffers the deleterious effects of workaholism for work-family conflict.

RATIONALE: Workaholism logically corresponds to the experience of work-family conflict (WFC) which is associated with a wide variety of negative employee outcomes. Finding ways to mitigate the occurrence of workaholism and/or lessen its deleterious effects on the work-family interface is practically important. Mindfulness research may hold some promise in this regard. OBJECTIVE: We explore the potential that mindfulness - through its association with accuracy and salience of present moment experience and disengagement from automatic thoughts and debilitating behavior - may buffer the effects of workaholic tendencies on the experience of WFC. METHODS: We use a two-study design (total n = 1022) to examine the role of dispositional mindfulness and mindfulness practice on the workaholism-WFC relationship. RESULTS: Results suggest that (1) trait mindfulness buffers the workaholism-WFC relationship (Study 1; n = 307), and that (2) mindfulness practice and mindfulness training similarly buffer this relationship (Study 2; n = 715). CONCLUSION: Mindfulness effectively serves as a buffer in the relationship between workaholism and WFC.

Prophylactic isopropyl alcohol inhalation and intravenous ondansetron versus ondansetron alone in the prevention of postoperative nausea and vomiting in high-risk patients.

Patients identified as high risk for postoperative nausea and vomiting (PONV) are often treated prophylactically with intravenous (IV) ondansetron and an additional agent. Limited options exist for a second agent with no adverse effects. The purpose of this investigation was to determine if combining the prophylactic inhalation of isopropyl alcohol (IPA) vapors, an agent with no adverse effects, with IV ondansetron would be more effective than IV ondansetron alone in the prevention of PONV in high-risk patients. A total of 76 patients at high risk for PONV were randomized into control (n = 38) and experimental (n = 38) groups. All patients received IV ondansetron before emergence from general anesthesia. In addition, the experimental group inhaled IPA vapors before induction. Severity of PONV was measured using a 0 to 10 verbal numeric rating scale. Other measured variables included time to onset and incidence of PONV, 24-hour composite nausea score, and satisfaction with nausea control. No significant differences in demographics, surgical or anesthesia time, number of risk factors, severity or incidence of PONV, or satisfaction scores were noted. Prophylactic inhalation of IPA vapors in combination with IV ondansetron was no more efficacious than IV ondansetron alone in the prevention of PONV in a high-risk population.

Biphasic dosing regimen of meclizine for prevention of postoperative nausea and vomiting in a high-risk population.

The purpose of this study was to determine if giving 50 mg of meclizine the night before and on the day of surgery would effectively reduce postoperative nausea and vomiting (PONV) for the entire 24 hours after surgery in patients identified as being at high risk for PONV Subjects were randomly assigned to receive either 50 mg of oral meclizine (experimental group) or a placebo (control group) the night before and the day of surgery. All subjects were intravenously administered 4 mg of ondansetron before the conclusion of surgery. Seventy subjects (35 control; 35 experimental) were included in analysis. postoperaIn the placebo group we noted higher verbal numeric rating scale scores for nausea, a higher incidence oftive nausea and vomiting (PONV) continues to be a common complication after general anesthesia, with the incidence ranging from 17% to 87%.15 It has been reported that PONV increased antiemetic requirements, and lower overall anesthesia satisfaction scores at all time intervals measured, compared with the experimental group, but the differences were not statistically significant until analyzed by postoperative setting. No difference in sedation or side effects was noted between groups. Based on these results, we recommend that the administration of 50 mg of oral meclizine the night before and on the day of surgery be considered effective antiemetic prophylaxis in patients identified as having a high risk for PONV.