ABSTRACT
Background: Safe and effective nurse staffing is widely recognised as an important issue to ensure quality patient care and reduce mortality. There are many nurse dependency tools described in the literature but no gold standard tool that can be used in all specialities. In burn care there are even fewer burn specific tools and none reported for use in the UK to date. The international Burn Injury Database contains routinely collected information about burn injuries, including nurse dependency data which so far has not been reported in the literature. Objective: This study aimed to confirm whether the international Burn Injury Database nurse dependency tool can be used to measure nurse dependency in burn services. Methods: Over a two week period, nurses in three burn services scored the nurse dependency of their burn injured patients daily using the international Burn Injury Database Nurse Dependency Tool and the Safer Nursing Care Tool. Additionally all the participating nurses were asked to score three fictional case studies using the same two tools to assess inter-rater reliability. Results: There was a statistically significant positive correlation between the international Burn Injury Database Nurse Dependency Tool and the Safer Nursing Care Tool scores (ρ = 0.87, 95% CI = 0.82-0.90). The case study scores showed a similar correlation pattern as the daily comparison recordings. The inter-rater reliability between the participants was comparable for both the international Burn Injury Database Nurse Dependency Tool (α =0.74, CI = 0.71-0.77) and the Safer Nursing Care Tool (α =0.79, CI = 0.76-0.81). Psychological support variable had the weakest correlation with the nurse dependency tools and the lowest agreement between nurses. Conclusion: This is the first report in the literature of the international Burn Injury Database Nurse Dependency Tool, the results of which suggest that it does measure aspects of nurse dependency and thus could be a valuable tool in the battle to ensure safe staffing. The good inter-rater reliability between the nurses, regardless of the nurse dependency tool used, should give confidence to nurses and managers using the dependency data to influence staffing.
ABSTRACT
OBJECTIVE: Human endogenous retrovirus (HERV)-K10 has been implicated in the etiology and pathogenesis of rheumatoid arthritis (RA). A secondary immune response to this virus might suggest an antigen-driven response in patients. The Gag region of HERV-K10 could provide a key epitope important for immunological reactivity. We investigated the presence of IgG antibodies to this region and assessed its significance in RA. METHODS: We determined an antigenic peptide on the matrix segment of HERV-K10 and developed an ELISA system to detect IgG antibodies in patients with RA and controls. The presence of antibodies to the matrix peptide (denoted as MAG1: RIGKELKQAGRKGNI) was correlated with patient details. RESULTS: On screening patients' serum, we found a significantly higher mean IgG antibody response to MAG1 in 30 patients with RA as compared to 23 patients with inflammatory bowel disease (p = 0.003), 29 patients with osteoarthritis (p = 0.001), and 43 healthy individuals (p = 0.002). Reactivity was not observed to a control peptide possessing a nonhomologous amino acid sequence. On evaluating clinical details with serological activity, no correlation with disease duration (p = 0.128), sex (p = 0.768), or rheumatoid factor status (p = 0.576) was found. CONCLUSION: A significantly elevated IgG antibody response to an HERV-K10 Gag matrix peptide was observed in patients with RA, suggesting that the exposure of HERV-K10 may cause a secondary, antigenic driven immune response in RA.
