The effectiveness of oral bovine lactoferrin compared to iron supplementation in patients with a low hemoglobin profile: A systematic review and meta-analysis of randomized clinical trials.

BACKGROUND: Patients with a low serum blood hemoglobin concentration suffer from a pathologic state that contributes significantly to morbidity and mortality figures worldwide. Oral iron supplementation, the most common method of treatment, is reported to have poor patient adherence, due to its unwanted side effects. Lactoferrin is a globular glycoprotein of the transferrin family that has shown promising results in patients with a low hemoglobin profile. This systematic review and meta-analysis of randomized clinical trials explore its effect on blood hemoglobin compared to conventional iron preparations. METHODS: We followed the PRISMA Guidelines for reporting systematic reviews and meta-analyses. A systematic search was conducted in electronic databases (PubMed, CINAHL, Scopus, and Cochrane) from inception to June 2022. Meta-analysis was performed on studies where the primary outcome was the mean Hb concentration, comparing lactoferrin to ferrous sulfate subgroups. We assessed the methodological quality of the trials using the Jadad scoring scale. RESULTS: Nineteen trials published between 2006 and 2022 met the eligibility criteria. It has been found that the levels of Hb concentration in different populations with varying health conditions undergo a moderate to significant change after treatment with all types of trialed interventions, including both iron and lactoferrin treatment, in both the intervention group and the comparison group. Most of the studies report that LF showed a statistically significant increase in Hb concentration levels, compared to those in the iron group. The meta-analysis included seven trials comparing the effectiveness of lactoferrin to ferrous sulfate for patients with low Hb concentration. The analysis showed a statistically significant increase in Hb levels in the oral bovine lactoferrin group compared to ferrous sulfate (SMD -0.81, 95% CI: -1.21, -0.42, p < 0.0001, I2 = 95.8%, P heterogeneity < 0.001). CONCLUSIONS: Lactoferrin is an effective intervention at doses of 100-250 ng/day, for patients with a low Hb concentration. As a safer option and with high compliance evidence, lactoferrin can serve as an iron replacement treatment for patients who may be experiencing adverse side effects due to iron intake.

Leadership and Intention to Leave Among Public Health Sector Physicians in Cyprus: A National Cross-Sectional Study.

Physician shortage is a major concern in many health care systems globally, while healthcare leadership constitutes one of the most vital factors within human resource management. Our study examined the relationship between managers' leadership styles and physicians' intent to leave their current position. In this cross-sectional national survey, questionnaires were distributed to all physicians working in the public health sector of Cyprus. Most demographic characteristics evaluated by chi-square or Mann-Whitney test, were statistically significantly different between those who intended to leave their job and those who did not. The results of our study demonstrated that transformational leadership has a positive influence on retention of physicians in public hospitals, while non leadership infers a negative influence. Developing leadership skills in physician supervisors is of a great importance for organizations to make a large impact on health professionals' retention and overall performance.

Organisational commitment, job satisfaction and intention to leave among physicians in the public health sector of Cyprus: a cross-sectional survey.

OBJECTIVES: Organisational commitment, job satisfaction and intention to leave constitute important characteristics of health professionals' employment status. Our study aimed at investigating the level of organisational commitment, job satisfaction in association with intention to leave among physicians. DESIGN: A cross-sectional study. SETTING: A survey was conducted using self-administered questionnaires (the Organizational Commitment Questionnaire and the Job Satisfaction Survey) among all physicians working in the public health sector of Cyprus (October 2016-January 2017). PARTICIPANTS: Out of 690 physicians working in the public health sector who received an invitation to participate, 511 completed the survey and 9 were excluded. Therefore, 502 physicians were included in the final analysis (response rate 73%). A total of 188 cases were excluded because they were undetermined with respect to their intention to leave and a total of 75 cases were excluded from the regression analysis due to missing values on at least one variable or due to having values considered as outliers. Therefore, a total of 239 physicians (120 men and 119 women) were included in the current analysis. PRIMARY AND SECONDARY OUTCOME MEASURES: Physicians' intention to leave. RESULTS: A considerably large percentage of physicians (72.8%) working in the public hospitals and healthcare centres of Cyprus reported their intention to leave their job. Moreover, the majority of employees in public hospitals (78.4%) intended to leave their job, while only 21.6% of employees in health centres reported an intention to leave (p<0.001). The study also confirmed that organisational commitment and job satisfaction were negatively correlated with intention to leave. In addition, the results of this study demonstrate that certain demographics also influence physicians' intention to leave including age, gender and medical specialisation. CONCLUSIONS: Certain physicians' demographics, organisational commitment and job satisfaction constitute important parameters influencing physicians' intention to leave their job.

Investigating nurses' knowledge and attitudes about delirium in older persons: a cross-sectional study.

INTRODUCTION: Delirium is the most common emergency for older hospitalized patients that demands urgent treatment, otherwise it can lead to more severe health conditions. Nurses play a crucial part in diagnosing delirium and their competencies facilitate the appropriate treatment and management of the condition. AIM: This study aims to enhance the understanding of delirium care by exploring both knowledge and attitudes of nurses toward patients in acute care hospital wards and the possible association between these two variables. METHOD: The Nurses Knowledge of Delirium Questionnaire (NKD) and the Attitude Tool of Delirium (ATOD) that were created for the said inquiry, were disseminated to 835 nurses in the four largest Public Hospitals of the Republic. These tools focused particularly on departments with increased frequency of delirium (response rate = 67%). RESULTS: Overall nurses have limited knowledge of acute confusion/delirium. The average of correct answers was 42.2%. Only 38% of the participants reported a correct definition of delirium, 41.6 correctly reported the tools to identify delirium and 42.5 answered correctly on the factors leading to delirium development. The results of the attitudes' questionnaire confirmed that attitudes towards patients with delirium may not be supportive enough. A correlation between the level of nurses' knowledge and their attitude was also found. The main factors influencing the level of knowledge and attitudes were gender, education, and workplace. CONCLUSION: The findings of this study are useful for the international audience since they can be used to develop and modify educational programmes in order to rectify the knowledge deficits and uninformed attitudes towards patients with delirium. The development of a valid and reliable instrument for the evaluation of attitudes will help to further assess nurses' attitudes. Furthermore, the results are even more important and useful on a national level since there is no prior data on the subject area, making this study the first of its kind.

A pilot randomized controlled study of the effects of an educational training program on skin reactions induced by chemotherapy, Epidermal Growth Factor Inhibitor (EGFRI) treatments, and immunotherapy.

PURPOSE: To evaluate the effectiveness of an educational program for cancer patients who developed pruritus, rash or photosensitivity induced by chemotherapy, epidermal growth factor inhibitor (EGFRI) treatments, or immunotherapy. METHOD: This study is a pilot randomized controlled study. The patients in the experimental pool were assigned to attend the educational program once weekly, for 4 weeks. For the patients in the control group the usual information was provided to them, as with any cancer patient who initiates treatment. Each participant's induction day to the program (symptoms initiation) was considered part of week 0. For the Primary endpoint repeated measurements were taken weekly regarding the grade of skin reaction. For the Secondary endpoint the 36-Item Short Form Survey questionnaire (SF-36) (since week 0) and the Dermatology Life Quality Index (DLQI) questionnaire (since week 1) were recorded. RESULTS: The study was conducted between January 2019 and December 2020 and included 40 patients. The grades of skin reactions, showed a statistically significant improvement in the intervention group compared to the control (Walds X2 = 19,25, p = 0.004). The results from the SF-36 questionnaire, showed that patients in the intervention group presented higher functional health and wellbeing status, although the results did not indicate a significant interaction between Group and Time, for all the questionnaire parameters. The effect size difference between control and intervention groups was higher at week 3 (d = 0.44) according to the results of DLQI questionnaire. CONCLUSIONS: Further validation of the effectiveness of the educational program over longer periods of time will be required.

Exploring Nurses' Perceptions of Medication Error Risk Factors: Findings From a Sequential Qualitative Study.

A focus group study was conducted to explore nurses' perceptions of medication administration error associated factors in two medical wards of a tertiary hospital. Nurses were invited to participate in focus group discussions. Thematic analysis was employed and identified four themes: professional practice environment related factors, person-related factors, drug-related factors, and processes and procedures. Staffing, interruptions, system failures, insufficient leadership, and patient acuity were perceived as risk factors for medication errors. The findings of this study complement the findings of an observational study which investigated medication administration errors in the same setting. Although some findings were similar, important risk factors were identified only through focus group discussions with nurses. Nurses' perceptions of factors influencing medication administration errors provide important considerations in addressing factors that contribute to errors and for improving patient safety.

Observational Evidence of the Prevalence and Association of Polypharmacy and Drug Administration Errors in Hospitalized Adult Patients.

Objective To describe the prevalence of polypharmacy and medication administration errors (MAEs) in adult inpatients and explore the association between polypharmacy and MAEs. Polypharmacy and MAEs are common phenomena in hospital settings. Different MAE contributing factors have been suggested by previous studies. Polypharmacy, however, is not always assessed by studies exploring medication error risk factors, and it may deserve further attention. Methods This was a descriptive observational study. The medication administration process in two adult medical wards of a tertiary hospital was recorded by two observers, with parallel review of patients' medication records. Any deviation from prescriber's order, manufacturers' administration instructions, or relevant institutional policies were recorded as errors. Chi square and regression analysis were used to explore associations between polypharmacy and MAEs. Results Six hundred sixty-five medication administrations were observed. The mean number of drugs prescribed per patient was 8.7. Most inpatients were prescribed more than 5 drugs (92.6%). Almost half of the inpatients were prescribed more than 9 drugs (45.1%) and some more than 12 drugs (22.6%). In total, 2,371 errors were detected, and the mean number of errors per administration was 3.5. When patients received more than 9 (the odds ratio is 1.57, [95%] CI 1.08-2.27; P = 0.02) or more than 12 (the odds ratio is 1.53, [95%] CI 1.04-2.30; P = 0.04) drugs, the occurrence of a higher number of errors per administration was significantly increased. Conclusion Polypharmacy is common in adult medical wards and can be associated with the occurrence of a higher number of MAEs. Future interventions aiming for the prevention of MAEs should consider addressing polypharmacy by improving prescribing practices and optimizing pharmacotherapy.

Empowerment and turnover of nurse managers before and after a major health care reform in Cyprus: A cross sectional study.

AIM: This study aimed to investigate the perceived empowerment and turnover intention of middle nurse managers before and after the implementation of a major reform of the health care system in Cyprus, which also includes the transition of public hospitals towards administrative and financial autonomy. BACKGROUND: The empowerment of nurse managers is important since previous studies have shown that it is associated with performance at work and may have an impact on their turnover intention. METHODS: A repeated cross-sectional study was conducted in March 2019 (first phase) and was repeated in March 2020 (second phase), after the introduction of major changes. The target population was all nurse managers of the public hospitals. The final sample consisted of 175 (RR 94%) participants in the first phase and 178 (RR 95.6%) in the second. RESULTS: Measurements at both time points revealed moderate levels of perceived empowerment among Cyprus nurse managers. Empowerment score (17.95) appeared slightly lower at the repeat measurement compared to the first empowerment score (18), but the observed difference was not statistically significant (p = 0.184). Among the categories of empowerment opportunities was presenting statistically significant differences between the two phases. At the second phase, mean scores of empowerment were consistently lower among those who stated YES compared to those who stated NO in relation to (a) the intention to change department, (b) the intention to change profession and (c) the intention to change organization/hospital. CONCLUSIONS: This study demonstrated lower levels of empowerment among nurse managers with turnover intentions. It is therefore needed to be investigated further whether lower empowerment levels are the main reason for turnover intentions. It also suggests the need for senior management to create opportunities and to develop and implement interventions which aim to maintain and further improve the empowerment of the nurse managers and assess their effectiveness in terms of turnover intention in the organization. IMPLICATIONS FOR NURSING POLICY: The senior management of the hospitals needs to adopt retention strategies by establishing an empowered positive working environment for nurse managers. Nurse managers need to collaborate with the senior management and seek more access to opportunities, information, support and resources which will enable them to perform their duties with efficiency and be more effective.

Omissions and Deviations From Safe Drug Administration Guidelines in 2 Medical Wards and Risk Factors: Findings From an Observational Study.

OBJECTIVES: This study aimed to record the type and frequency of errors, with an emphasis on omissions, during administration of medicines to inpatients and to investigate associated factors. METHODS: This was a descriptive observational study. The medication process in 2 medical wards was observed by 2 observers using a structured observation form. χ2 Test, Kruskal-Wallis test, and regression analysis were used to explore associations between factors and errors. RESULTS: From the 665 administrations observed, a total of 2371 errors were detected from which 81.2% were omissions and 18.8% were errors of commission. Omissions in the infection prevention guidelines (46.6%) and in the 5 rights of medication safety principles (35.8%) were a predominant finding. In particular, omitting to hand wash before administering a drug (98.4%), omitting to disinfect the site of injection (37.7%), and omitting to confirm the patient's name (74.4%) were the 3 most frequently observed omissions. Documentation errors (13.1%) and administration method errors (4.5%) were also detected. Regression analysis has shown that the therapeutic class of the drug administered and the number of medicines taken per patient were the 2 factors with a statistical significance that increased the risk of a higher number of errors being detected. CONCLUSIONS: Errors during drug administration are still common in clinical practice, with omissions being the most common type of error. In particular, omissions in the basic infection and safety regulations seem to be a very common problem. The risk of a higher number of errors being made is increased when a cardiovascular drug is administered and when the number of medicines administered per patient is increased.

Correlation Between Teamwork and Patient Safety in a Tertiary Hospital in Cyprus.

Background Over time, the multidimensional nature of the safety culture in the healthcare field has led to great efforts to improve quality and create tools aiming at enhancing safety. In particular, emphasis has been placed on teamwork and the safety climate. There is a strong relationship between these two complex elements, which interact to improve the safety climate and reduce patient-safety issues. In this study, "teamwork" includes the perceptions of the health professionals collaborating within a health team to provide safe patient care, and "safety climate" refers to the professional commitment to patient safety. Objective This article assesses health professionals' perceptions of both patient-safety issues and teamwork in their hospital work environment after the development and implementation of a comprehensive quality-assurance system. Methods This descriptive correlation study is based on anonymous and self-completed questionnaires obtained after the development and implementation of a comprehensive quality assurance system in the wards and departments of Nicosia General Hospital. The research sample consisted of the health professionals who participated in the working groups that implemented the quality assurance system. We used the questionnaire's sociodemographic data and the Safety Attitudes Questionnaire (SAQ) developed in the Deepening our Understanding of Quality Improvement in Europe program, focusing on two factors: Teamwork and the safety climate. Results While teamwork received a positive score (>75%), the same did not occur for the safety climate (68.60%). Women typically rated the safety climate more positively than men, who mostly gave negative ratings (p = 0.005). There was a statistically significant difference (p = 0.011) in the scores between participants aged 24-44 and those aged 45-54, with the latter reporting higher teamwork scores. The participants' educational levels also played important roles in their responses, with university graduates (BSc) providing more positive teamwork scores than those with a master's degree (p = 0.018). Conclusions Our research revealed that the health professionals of Nicosia General Hospital perceived the teamwork climate as positive, in contrast to the safety climate. The results highlight the need not only to intervene in all the areas covered by the SAQ to improve the safety climate but also to keep encouraging teamwork to obtain better results.

A pretest-posttest pilot study for the development and preliminary validation of a tool for the clinical assessment of radioiodine induced sialadenitis.

OBJECTIVES: The clinical assessment of radioiodine-induced sialadenitis is relied on the observer-defined toxicity grading model. However, this model has significant limitations, the major one being the lack of systematic assessment based on objective criteria. The main aim of this study was the development and testing of an assessment tool which could examine the severity of post-irradiation sialadenitis. METHODS: The development of the Sialadenitis Assessment Tool proceeded through three phases. The first and second phases included a literature review and the development of the tool which derived from the review, respectively. The third phase involved a pilot testing of the Assessment Tool to a sample of 34 patients undergoing I131 therapy. The assessment was carried out by two independent healthcare professionals, pre- and post-radioiodine therapy. The results of the assessment tool were compared with other scales, including the DIRIX and EORTC H&N35. RESULTS: According to the Cohen's kappa test, the Sialadenitis Assessment Tool is a reliable tool for the assessment of sialadenitis (Cohen's κ = 1). The concurrent and internal validity tests showed a tendency of association with most variables (p < 0.001) in the DIRIX and EORTC QLQ-HN35 scales. CONCLUSION: Preliminary evidence show that Sialadenitis Assessment Tool is a valid and reliable tool to assess radioiodine-induced sialadenitis in patients undergoing I131 therapy post-thyroidectomy.

The knowledge about patient safety among undergraduate nurse students in Cyprus and Greece: a comparative study.

BACKGROUND: The Patient safety movement contributed to the reduction of preventable adverse events associated with health care. Although patient safety issues have received the attention of educators in the health care studies, there is evidence that in nursing education and the associated curricula it is not well-incorporated. This may not allow students to acquire scientific knowledge and develop strong competencies to assure patient safety throughout their professional life. The aim of the study was the exploration of the undergraduate nursing student perspectives regarding knowledge received during their training about patient safety-related issues. METHODS: A descriptive comparative study was conducted with three and four-year undergraduate nursing students from the Cyprus Republic (n = 243) and Greece (n = 367). All students were surveyed using the Health Professional Education Patient Safety Survey (H-PEPSS) to describe students' knowledge in the classroom and clinical setting. RESULTS: Students' Knowledge about patient safety was expressed significantly higher (p < 0.001) in the classroom (mean = 4.0) than the clinical setting (3.7) (1-5 scale). The knowledge in the dimension "clinical aspects" received the highest score and "working in teams" received the lowest. Also, differences were recorded between countries with Cypriot students reporting higher level of knowledge than the Greek students in most of the dimensions. CONCLUSiON: The findings revealed the gap between theory and practice and the need for collaboration between the two settings. Also, students reported relatively higher knowledge with regards to the technical aspects of patient safety. Still, they were less knowledgable about the sociocultural aspects of the patient, such as working in teams.

Missed Nursing Care Among Patients With Dementia During Hospitalization: An Observation Study.

Patients with dementia (PwD) are characterized as a vulnerable group as they are unable to communicate their needs, putting them at risk for care omissions. The current study aimed to explore care toward PwD and detect if any aspects of care are omitted. An observation study was conducted in three medical-surgical adult wards of an acute general hospital. Data were collected by an observer, through field notes, and were analyzed with content analysis. A face scale was used to assess PwD's mood. Thirteen PwD were observed for 90 hours. Four thematic areas were identified: (a) Unmet Fundamental Patient Needs, (b) Human Right to Dignity and Respect, (c) Communication Deficiencies, and (d) Implementation of Nursing Interventions. Nurse-patient contact lasted from 5 to 7 minutes and numerous care omissions were noted. The face scale assessment revealed that most PwD looked very sad after nursing care. This study enriches insight for the care of PwD during hospitalization and emphasizes the need for health care workers' education and support. [Research in Gerontological Nursing, 14(3), 150-159.].

Contribution of Healthcare Professionals in Issues that Relate to Quality Management.

BACKGROUND: The health sector should adopt integrated quality systems because of the need to survive and develop in a highly competitive environment. Inefficiency of mechanistic procedures, along with inadequate administrative infrastructure, impose innovative appoaches to improve operations and increase revenues by reducing quality feilures. OBJECTIVE: A health system that relies on quality healthcare services can directly benefit the entire society, may reduce mortality, disease severity, and increase life expectancy. The following literature review constitutes an attempt to assess the contribution of healthcare professionals in issues that relate to quality management over the course of recent years. METHODS: This systematic review took place between May 2019 and June 2020 in the databases PubMed, Cochrane Library, Wiley Online Library, Web of Science, Google Scholar and Scopus search engine databases. Study Selection and Data Extraction: This review includes articles written in English language, which contain quantitative and qualitative analysis of healthcare professionals' involvement in quality activities. Correspondingly, the exclusion criteria were: languages other than English, secondary surveys (general and systematic reviews or post-analyses), letters to the publisher, and editorials or articles that did not illuminate the subject under study. After an extensive literature review, a standardised Excel spreadsheet was developed for data extraction from the included studies. The main characteristics of the studies were recorded (author's name, place and time of work, the article under study and the methodology) so that all research articles corresponding to the review could be included. 31 articles were included. RESULTS: Healthcare professionals are engaged in quality improvement activities and there is high association between quality management strategies and clinical processes. A systematic approach on healthcare activities based on the input of healthcare professionals can help increase business performance, reduce errors, improve patient safety, and contribute to a more proactive care. CONCLUSION: Health professionals' contribution in the strategic planning of healthcare organisations that address quality activities can lead to better output, both in patient satisfaction and safety.

Medication adherence, self-efficacy and health literacy among patients with glaucoma: a mixed-methods study protocol.

INTRODUCTION: As the world population ages, glaucoma is becoming an increasingly significant cause of blindness. A key component in the management of glaucoma is the use of prescribed medications and the adherence to treatment. However, there is evidence of low adherence to prescribed medication in chronic diseases, such as glaucoma. This study aims to explore the level of medication adherence, self-efficacy, social support and health literacy among the patients with glaucoma and to determine if there are any correlations between them. The ultimate aim is to use the information to develop an educational programme for patients with glaucoma at a later stage. METHODS AND ANALYSIS: This is a mixed-methods study which includes two stages: a descriptive study (stage 1) and focus group discussions (stage 2). SAMPLE: Patients with glaucoma or ocular hypertension, using at least one kind of drops, from two ophthalmology clinics. Selected measures include: The Glaucoma Treatment Compliance Assessment Tool, The European Health Literacy Survey Questionnaire, The Glaucoma Medication Self-Efficacy Questionnaire and The Multidimensional Scale of Perceived Social Support. Two focus groups will be used for the collection of qualitative data, aiming to enrich the study with the patients' experiences. The data will be analysed with SPSS, using descriptive and inferential statistics for stage 1 whereas content analysis will be used for the data from the focus group discussions (stage 2). ETHICS AND DISSEMINATION: Permission to conduct the study was received from the National Bioethics Committee and the board of management of the two ophthalmology clinics. All participants will be informed fully on the purpose and methods of the study. Consent forms will be signed and at any time participants will have the right to withdraw. Confidentiality and the protection of data will be respected at all times.

Self-efficacy, empowerment and power of middle nurse managers in Cyprus: A correlational study.

AIM: To investigate the perceived self-efficacy, structural empowerment and power of middle nurse managers before the implementation of a major reform of public hospitals in Cyprus. BACKGROUND: Nurse managers' self-efficacy is important as it makes a difference in nurses' motivation and the way they feel, think and behave. Empowerment promotes workers' engagement at work, leading to positive performance outcomes. METHODS: This is a descriptive correlational study with a sample of 175 nurse managers. It was conducted during March-April 2019. RESULTS: The results showed that nurse managers perceived relatively high scores of self-efficacy, moderate levels of empowerment and moderate levels of both formal and informal power. Access to resources has been recorded as low. Statistically significant correlations have been found between self-efficacy, age and work experience. Nurse managers with a bachelor's degree had a higher informal power than those with a master's degree. CONCLUSIONS: The present study provides recommendations for maintaining and enhancing the self-efficacy, empowerment and power of nurse managers in the evolving conditions of health care reforms. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to improve their access to empowerment structures and be involved in policy decision-making, future planning, organisation and control, aiming for the improvement of services and care that they provide.

The extent to which the last decade has yielded additional treatment options for EGFR-associated rash besides classic treatment with antibiotics and corticosteroids - A systematic review.

PURPOSE: To investigate the effectiveness of different interventions for the prevention and treatment of EGFRI treatment-induced rash (EGFRIr) that appeared in the last decade, excluding antibiotics and steroids products alone. METHOD: A systematic review was performed in 2019 and was updated in 2020. The search strategy was limited to studies published within the last 10 years on the Medline database accessed via Pubmed and the Cochrane database. The search was performed using keywords combined with AND, OR. RESULTS: The search yielded thirteen studies. The studies were divided into two categories, based on the intervention method used: four studies used creams containing vitamin K1 or vitamin K3 (henceforth classified as "Category A″) and nine studies ("Category B″) focused on different intervention methods such as laser treatment, Polydatin (PD) cream treatment, treatment with sunscreen, Adapalene gel treatment, topical aloe vera treatment, topical hydration treatment, the impact of a pre-emptive skin treatment and, finally, epidermal growth factor (EGF) ointment treatment. From "Category A″, the results vary as two studies found no benefit from cream use, while two studies indicated a possible improvement on skin reactions from cream use. In "Category B″, a benefit due to laser treatment was indicated, Polydatin-containing moisturizer showed a reduction in the incidence of rash grade ≥ II in patients treated with afatinib, while treatment with sunscreen demonstrated no benefit for the prevention of EGFRIr. Additionally, Adapalene gel use is not recommended as prophylaxis for EGFRIr, topical aloe vera may be used in the management for EGFRIr due to cetuximab, topical hydration resolved the EFGRIr, the pre-emptive skin treatment routine was well tolerated and the epidermal growth factor ointment improved all the symptoms due to EGFRI. CONCLUSIONS: The results from the studies vary, although this study focuses on reviewing treatment interventions that can be utilized, apart from antibiotics and steroids, in order to alleviate the problems of the patients suffering from EGFRIr. More specifically, the authors of this review cannot draw a conclusion from "Category A″, as the efficacy of vitamin K for the management of EGFRIr is controversial. From "Category B″, some of the suggested treatments show encouraging results, while others may prove ineffective and rather harmful for the patients.

Nursing quality indicators for adult intensive care: A consensus study.

BACKGROUND: The selection of quality indicators demonstrating the efficiency and relevance of nursing practice in patient outcomes in the intensive care unit remains a challenge. AIM: The aim of this study was to develop a set of potential quality indicators to quantify nursing care provided to critically ill patients through a consensus method. DESIGN: This was a three-phase study including a European survey of intensive care unit (ICU) nurses (phase one) followed by a two-phase face-to-face consensus meeting of experts from Cyprus. METHOD: Two distinct panels of experts were asked to rate each quality indicator using a 4-point Likert scale in phases one and two. The level of consensus was set at 60%. In phase three, scores of the content validity index for items and scales were considered for the final selection of quality indicators. RESULTS: The phase one survey included 139 ICU nurses from 13 European countries, and phases two and three included seven ICU experts from Cyprus. "Consensus in" was achieved for 12 items at the end of phase two. Three of the quality indicators were significantly different by country: (a) falls (P = .006), (b) accidental removal of nasogastric tube (P < .001), and (c) accidental removal of intravascular catheters (P < .001). Only falls was significantly correlated with higher academic qualifications of the participants (P = .002). CONCLUSIONS: Fifteen items have been identified as potential indicators for adult ICU nursing quality. These need to be prospectively studied to determine the extent to which they can accurately capture nursing care quality in this setting. RELEVANCE TO CLINICAL PRACTICE: The study provides a set of relevant quality indicators. A nursing set for the ICU may serve as the basis for nursing management and facilitate the strategy dedicated to the vision of health care quality assurance.

The effectiveness of systematic pain assessment on critically ill patient outcomes: A randomised controlled trial.

BACKGROUND: Evidence suggests that critically ill patients' pain may still be underestimated. Systematic approaches to pain assessment are of paramount importance for improving patients' outcomes. OBJECTIVES: To investigate the effectiveness of a systematic approach to pain assessment on the incidence and intensity of pain and related clinical outcomes in critically ill patients. METHODS: Randomized controlled study with consecutive critically ill patients allocated to either a standard care only or a systematic pain assessment group. The Behavioral Pain Scale (BPS) and the Critical Pain Observation Tool (C-POT) were completed twice daily for all participants. In the intervention group, clinicians were notified of pain scores. Linear Mixed Models (LMM) for the longitudinal effect of the intervention were employed. RESULTS: A total of 117 patients were included (control: n=61; intervention: n2=56). The incidence of pain (C-POT >2) in the intervention group was significantly lower compared to the control group (p < .001). The intervention had a statistically significant effect on pain intensity (BPS, p = 0.01). The average total morphine equivalent dose in the intervention group was higher than in the control group (p = 0.045), as well as the average total dose of propofol (p = 0.027). There were no statistically significant differences in ICU mortality (23.4% vs 19.3%, p=0.38, odds ratio 0.82 [0.337-1.997]) and length of ICU stay (13.5, SD 11.1 vs 13.9, SD 9.5 days, p= 0.47). CONCLUSION: Systematic pain assessment may be associated with a decrease in the intensity and incidence of pain and influence the pharmacological management of pain and sedation of critically ill patients.

Development of a Tool for the Assessment of Nurses' Attitudes Toward Delirium.

BACKGROUND AND PURPOSE: The prevalence of delirium during hospitalization is high in older patients and there is evidence of staff regarding them as unpopular or a burden. This study aims to develop an instrument examining nurses' attitudes toward patients with delirium. METHODS: Stages included (a) content identification, (b) content development, (c) content critique, (e) pilot study with a test-retest reliability, (f) field study consisting of psychometric testing of the internal consistency and construct validity. RESULTS: The Cronbach's alpha was 0.89 and the stability reliability was acceptable. The factor analysis resulted in three factors explaining a total of 56.5% of the variance. hese factors are "beliefs," "behavior," and "emotions," explaining 37.025%, 12.792%, and 5.652% of variance. CONCLUSIONS: The Attitude Tool of Delirium (ATOD) is a reliable and valid instrument for the assessment of attitudes toward delirium.