Perceptions of nurses on inter-shift handover: A descriptive study in Hospital Kuala Lumpur, Malaysia.

INTRODUCTION: The quality of information and efficiency in the practice and care environments are important aspects of nursing care. The use of a reliable and valid scale can monitor the quality of handover and provide information for continuous improvement of practice. This study aims to describe the perception of nurses, on the domains of quality of information, efficiency, interaction and support and patient involvement. METHOD: A cross-sectional descriptive study was conducted among 450 nurses from 37 wards in Hospital Kuala Lumpur. Nurses on shift duty were recruited by convenience sampling from the Medical, Surgery, Obstetrics & Gynaecology, Orthopaedic and Paediatric wards. Using a validated questionnaire (Handover Evaluation Scale), nurses self-rated their perceptions using a 7-point scale and provided open-ended responses to the strengths and challenges that they faced. Descriptive and inferential analyses were done while open-ended questions were summarised based on key themes. RESULTS: A total of 414 nurses completed the survey (92.0% response rate). Nurses had an overall mean (SD) perception score of 5.01 (SD 0.56). They perceived good interaction and support during handover and on the quality of information that they received, with mean scores of 5.54 (SD 0.79) and 5.19 (SD 0.69), respectively. There was an association between the departments where the nurses worked and their overall perceptions on nursing handover (p<0.001). Interruptions being the most common theme emerged from the open-ended section. CONCLUSION: Despite having substantial interaction and support amongst nurses, opportunities for improvements were noted. Improvements in the quality of handover information and reducing interruptions should be the main emphases as these were perceived to be essential in the current handover practices by nurses.

Effects of moderate exercise on VLDL1 and Intralipid kinetics in overweight/obese middle-aged men.

Prior moderate exercise reduces plasma triglyceride (TG)-rich lipoprotein concentrations, mainly in the large very low-density lipoprotein (VLDL1) fraction, but the mechanism responsible is unclear. We investigated the effects of brisk walking on TG-rich lipoprotein kinetics using a novel method. Twelve overweight/obese middle-aged men underwent two kinetic studies, involving infusion of Intralipid to block VLDL1 catabolism, in random order. On the afternoon prior to infusion, subjects either walked on a treadmill for 2 h at ∼50% maximal oxygen uptake or performed no exercise. Multiple blood samples were taken during and after infusion for separation of Intralipid (S(f) 400) and VLDL1 (S(f) 60-400). VLDL1-TG and -apoB production rates were calculated from their linear rises during infusion; fractional catabolic rates (FCR) were calculated by dividing linear rises by fasting concentrations. Intralipid-TG FCR was determined from the postinfusion exponential decay. Exercise reduced fasting VLDL1-TG concentration by 30% (P = 0.007) and increased TG enrichment of VLDL1 particles [30% decrease in cholesteryl ester (CE)/TG ratio (P = 0.007); 26% increase in TG/apoB ratio (P = 0.059)]. Exercise also increased VLDL1-TG, VLDL1-apoB, and Intralipid-TG FCRs by 82, 146, and 43%, respectively (all P < 0.05), but had no significant effect on VLDL1-TG or -apoB production rates. The exercise-induced increase in VLDL1-apoB FCR correlated strongly with the exercise-induced changes in VLDL1 CE/TG (r = -0.659, r = 0.020) and TG/apoB (r = 0.785, P = 0.002) ratios. Thus, exercise-induced reductions in VLDL1 concentrations are mediated by increased catabolism, rather than reduced production, which may be facilitated by compositional changes to VLDL1 particles that increase their affinity for clearance from the circulation.

Development of a novel method to determine very low density lipoprotein kinetics.

Isotopic tracer methods of determining triglyceride-rich lipoprotein (TRL) kinetics are costly, time-consuming, and labor-intensive. This study aimed to develop a simpler and cost-effective method of obtaining TRL kinetic data, based on the fact that chylomicrons compete with large VLDL (VLDL(1); S(f) = 60-400) for the same catalytic pathway. Ten healthy subjects [seven men; fasting triglyceride (TG), 44.3-407.6 mg/dl; body mass index, 21-35 kg/m(2)] were given an intravenous infusion of a chylomicron-like TG emulsion (Intralipid; 0.1 g/kg bolus followed by 0.1 g/kg/h infusion) for 75-120 min to prevent the clearance of VLDL(1) by lipoprotein lipase. Multiple blood samples were taken during and after infusion for separation of Intralipid, VLDL(1), and VLDL(2) by ultracentrifugation. VLDL(1)-apolipoprotein B (apoB) and TG production rates were calculated from their linear increases in the VLDL(1) fraction during the infusion. Intralipid-TG clearance rate was determined from its exponential decay after infusion. The production rates of VLDL(1)-apoB and VLDL(1)-TG were (mean +/- SEM) 25.4 +/- 3.9 and 1,076.7 +/- 224.7 mg/h, respectively, and the Intralipid-TG clearance rate was 66.9 +/- 11.7 pools/day. Kinetic data obtained from this method agree with values obtained from stable isotope methods and show the expected relationships with indices of body fatness and insulin resistance (all P < 0.05). The protocol is relatively quick, inexpensive, and transferable to nonspecialist laboratories.

Obesity indices and major components of metabolic syndrome in young adult Arab subjects.

BACKGROUND: The major components of metabolic syndrome are atherogenic dyslipidaemia (AD) and insulin resistance (IR), and both predict risk for atherosclerotic cardiovascular disease even in healthy individuals. AIMS: To assess if, in a group of healthy young adult Arab subjects, a simple classification in high and normal scores on waist-hip ratio (WHR), body mass index (BMI) and waist circumference (WC) scales could predict atherogenic parameters for metabolic syndrome (AD, IR). SUBJECTS AND METHODS: The subjects [n = 177 (72 M, 105 F), aged 29.7 +/- 8.4 (SD) years], underwent physical evaluation, BP measurement and anthropometry [height (m), weight (kg), waist (WC) and hip circumference (HC, cm)]. The cut-off points for normal/high scores on the indices were: (1) BMI: 30 kg/m(2) (M and F); (2) WHR: 0.80 F, 0.95 M, and (3) WC: 90 cm F, 100 cm M). The biochemical indices measured on fasting serum were: (1) AD: total cholesterol (TC), triglycerides (TG), HDL, LDL, apo B, HDL/TC ratio, and (2) IR: insulin, urate, insulin/glucose ratio (IGR). RESULTS AND DISCUSSION: In the whole group of subjects, and in women separately considered, those with high indices (BMI, WHR, WC) had significantly increased levels of glucose, LDL, apo B, urate, mean BP, TG, insulin and IGR and lower values for HDL/TC ratio (all p < 0.05). In men, only urate, insulin and IGR levels were increased (p < 0.01) in the high-score groups. None of the indices showed any special superiority in describing the risk of AD or IR. CONCLUSION: In women, BMI, WHR and WC appeared equally good in identifying individuals at high risk of AD and IR while in men, these indices satisfactorily described the risk of IR but not of AD. It is important to re-emphasise the need to indicate gender distinctions in using anthropometry for CHD risk assessment.