A Study to Evaluate the Need for Comminution in the Preparation of Food Materials for Testing of Listeria monocytogenes, Staphylococcus Species, and Generic Escherichia coli.

BACKGROUND: Comminution reduces the sampling error arising from distributional heterogeneity of the target contaminant/target analyte in the material, facilitating the selection of a more representative test portion. A laboratory sampling method incorporating comminution prior to selection of the test portion (Sampling Method B) was compared to current sampling methods that used no comminution step (Sampling Method A). OBJECTIVE: This required the development of an efficient process for comminution of food samples prior to removal of the test portion for the detection and isolation of Listeria monocytogenes and the enumeration of Staphylococcus species and Escherichia coli. METHOD: From December 2016 to December 2017, 2742 tests were conducted on 778 unique food samples. For all food samples, a test portion (TPA) was first removed using Sampling Method A, and then the remainder of the material was comminuted and a second test portion (TPB) was removed using Sampling Method B and tested alongside the first portion. RESULTS: Across all food matrices and microbial targets, 17 additional targets were detected using only Sampling Method B, and positive detections of target analytes increased by 77% using Sampling Method B from the test portions taken using Sampling Method A. CONCLUSION: Utilizing a sample preparation method that includes a comminution step resulted in an increased number of pathogen detections. HIGHLIGHTS: The introduction of a comminution step in the preparation of food samples for detection of three common microbial contaminants resulted in an increase in the rate of detection of natural contaminates in a variety of ready to eat foods. An efficient aseptic process for commutation that can be adapted to a wide range of laboratory settings was identified.

Communities of practice in Alberta Health Services: advancing a learning organisation.

BACKGROUND: In 2009, Alberta Health Services (AHS) became Canada's first and largest fully integrated healthcare system, involving the amalgamation of nine regional health authorities and three provincial services. Within AHS, communities of practice (CoPs) meet regularly to learn from one another and to find ways to improve service quality. This qualitative study examined CoPs as an applied practice of a learning organisation along with their potential influence in a healthcare system by exploring the perspectives of CoP participants. METHODS: A collective case study method was used to enable the examination of a cross-section of cases in the study organisation. Semi-structured interviews were conducted with 31 participants representing 28 distinct CoPs. Using Senge's framework of a learning organisation, CoP influences associated with team learning and organisational change were explored. RESULTS: CoPs in AHS were described as diverse in practice domains, focus, membership boundaries, attendance and sphere of influence. Using small-scale resource investments, CoPs provided members with opportunities for meaningful interactions, the capacity to build information pathways, and enhanced abilities to address needs at the point of care and service delivery. Overall, CoPs delivered a sophisticated array of engagement and knowledge-sharing activities perceived as supportive of organisational change, systems thinking, and the team learning practice critical to a learning organisation. CONCLUSION: CoPs enable the diverse wealth of knowledge embedded in people, local conditions and special circumstances to flow from practice domain groups to programme and service areas, and into the larger system where it can effect organisational change. This research highlights the potential of CoPs to influence practice and broad-scale change more directly than previously understood or reported in the literature. As such, this study suggests that CoPs have the potential to influence and advance widespread systems change in Canadian healthcare.

Integration of Advance Care Planning Into Clinical Practice: A Quality Improvement Project for Leaders.

OBJECTIVE: This quality improvement initiative sought to develop a proactive integrated system approach to advance care planning (ACP) through leadership and colleague engagement. BACKGROUND: Nurse leaders have the capacity to influence the professional competencies of care teams in ACP. Nurse leaders were educated on the importance of ACP, national quality metrics, resources for staff education, and ways to integrate ACP into workflows based on a population management model. METHODS: The project design is a prospective, mixed method design. RESULTS: Nurse leader participants demonstrated a significant increase in knowledge of the importance of ACP and evidence-based models to increase staff engagement and competency. CONCLUSIONS: Study supports nurse leader interventions, promoted engagement of proactive ACP to honor patient choice, and aligns with the mission and vision of one of the largest national Catholic healthcare organizations of being a trusted partner for life.

The Impact of COVID-19 on HIV Treatment and Research: A Call to Action.

The impact of the COVID-19 pandemic is far reaching, with devastating effects on individuals, communities, and societies across the world. People with chronic health conditions may be at greater risk of contracting or experiencing complications from COVID-19. In addition to illness or death for those who contract the virus, the physical distancing required to flatten the curve of new cases is having a negative impact on the economy, the effects of which intersect with mental health and other existing health concerns, thus affecting marginalized communities. Given that HIV also has a disproportionate impact on marginalized communities, COVID-19 is affecting people with HIV (PWH) in unique ways and will continue to have an impact on HIV research and treatment after the COVID-19 crisis passes. Using the biopsychosocial framework to contextualize the impact of COVID-19 on PWH, the purpose of this review article is to: (1) outline the similarities and differences between the COVID-19 and HIV pandemics; (2) describe the current and future impact of COVID-19 on PWH; and (3) outline a call to action for scientists and practitioners to respond to the impact of COVID-19 on HIV prevention and treatment.

Transforming graduate nursing education in the context of complex adaptive systems: implications for master's and DNP curricula.

The purpose of this article is to describe the evolution and implementation of a graduate nursing program's curricular framework. A number of factors contributed to the realization that the curricular framework needed revision. These factors included the rapid changes occurring in the U.S. health care system, the publication of the 2011 edition of the Essentials of Master's Education in Nursing, and the publication of the Institute of Medicine's report entitled The Future of Nursing: Leading Change, Advancing Health (2010). A careful analysis of key guiding documents resulted in the development of three central, interrelated concepts to guide this revision, namely, relationship-based care, creative inquiry, and leadership.

Relationship of workplace incivility, stress, and burnout on nurses' turnover intentions and psychological empowerment.

This study explored the relationships among perceived workplace incivility, stress, burnout, perceived turnover intentions, and perceived level of psychological empowerment among acute care nurses (medical-surgical and critical care) in community and tertiary hospitals through the lens of complexity science. An exploratory study was conducted, and findings demonstrate significant relationships among workplace incivility, stress, burnout, turnover intentions, total years of nursing experience, and RN education levels. Creating targeted retention strategies and policies that will be sensitive to the needs and interests of nurses at high risk for leaving their organizations is imperative for nurse executives.

Identifying the barriers to use of standardized nursing language in the electronic health record by the ambulatory care nurse practitioner.

PURPOSE: This study identified the perceived user barriers to documentation of nursing practice utilizing standardized nursing language (SNL) in the electronic health record (EHR) by ambulatory care nurse practitioners (NPs). DATA SOURCES: A researcher-developed survey was sent to a randomized sample of ambulatory care NPs in the United States who belonged to the American Academy of Nurse Practitioners (n= 1997). CONCLUSIONS: Surveyed ambulatory care NPs placed a higher value on documenting medical care versus nursing care. Only 17% of respondents currently use SNL and 30% believe that SNL is not important or appropriate to document NP practice. Barriers to using SNL in EHRs included lack of reimbursement for nursing documentation, lack of time to document, and lack of availability of SNL in electronic records. IMPLICATIONS FOR PRACTICE: Respondents identified NP practice as a blend of medical as well as nursing care but NPs have not embraced the current SNLs as a vehicle to document the nursing component of their care, particularly in EHRs. Until these barriers are addressed and discreet data in the form of SNL are available and utilized in the EHR, the impact of the NPs care will be unidentifiable for outcomes reporting.

The impact of mindfulness meditation in promoting a culture of safety on an acute psychiatric unit.

PURPOSE: The purpose of this study was to examine the impact of the mindfulness-based stress reduction (MBSR) program on managing work stress and improving patient outcomes. DESIGN AND METHODS: A one-group pre-/post-test design was used to measure the impact of the MBSR program. The Mental Health Professionals Stress Scale, the Sense of Self Scale, the Toronto Mindfulness Scale, and the Maslach Burnout Inventory were used. FINDINGS: The MBSR class assisted staff in decreasing their stress levels and improve their self-care, which resulted in improved patient care. PRACTICE IMPLICATIONS: Increases in patient satisfaction and decreases in patient safety events were found.

Produce isolates of the Escherichia coli Ont:H52 serotype that carry both Shiga toxin 1 and stable toxin genes.

Produce isolates of the Escherichia coli Ont:H52 serotype carried Shiga toxin 1 and stable toxin genes but only expressed Stx1. These strains had pulsed-field gel electrophoresis profiles that were 90% homologous to clinical Ont:H52 strains that had identical phenotypes and genotypes. All Ont:H52 strains had identical single nucleotide polymorphism profiles that are suggestive of a unique clonal group.