Relationship between motivational style and glycemic control in Jordanian patients with type 2 diabetes mellitus.

BACKGROUND: Although, there is increased recognition of the importance of blood glucose control and diabetes education in type 2 diabetes mellitus (T2DM), the relationship between motivation and long term outcomes, glycemic control, are lacking. The primary aims of the present study were to: (i) describe the motivational style of Jordanian patients with T2DM regarding self-care management, taking medications, and self-monitoring of blood glucose (SMBG), as well as following therapeutic dietary instructions and exercising regularly; and b) examine the significance of these factors in predicting glycemic control. METHODS: A package including a treatment self-regulation questionnaire concerning diabetes, was administered to a convenience sample of 110 patients with T2DM. In addition, the most recent HbA1c results were extracted from the patients' medical records. RESULTS: Fifty-eight patients (52.7 %) reported being intrinsically motivated with regard to taking medication and regular SMBG, whereas half the participants (50 %) were intrinsically motivated to follow therapeutic dietary instructions and regular exercise. Patients who were intrinsically motivated were 8.3-fold more likely (95 % confidence interval [CI] 1.44-47.86) to have glycemic control than those reporting extrinsic motivation. In addition, those who were intrinsically motivated to follow therapeutic dietary instructions and exercise regularly were 10.50-fold more likely (95 % CI 2.50-48.78) times more likely to report glycemic control than those reporting extrinsic motivation. CONCLUSION: Interventional strategies should focus on promoting intrinsic motivation in order to enhance glycemic control.

Perceptions of reporting practices and barriers to reporting incidents among registered nurses and physicians in accredited and nonaccredited Jordanian hospitals.

AIMS AND OBJECTIVES: To explore the awareness of the incident reporting system, incident reporting practices and barriers to reporting incidents among Jordanian staff nurses and physicians in accredited and nonaccredited hospitals. BACKGROUND: Reporting medical incidents is an important element of patient safety enhancement and quality of care improvement and it should be an integral part of the organisational culture. DESIGN: A descriptive exploratory survey was used for the present study. METHODS: A modified version of the Incident Reporting Questionnaire was used to collect data from 307 nurses and 144 physicians at seven hospitals (four accredited and three not accredited) in Jordan. The response rate was 28·8% for nurses and 58·8% for physicians. RESULTS: Nurses were more aware of the incident reporting system than physicians. Physicians were less likely to report any incident on 50% or more of occasions. The major three barriers to reporting incidents were believing that there was no point in reporting near misses, lack of feedback and fear of disciplinary actions. CONCLUSION: The study showed significant differences between nurses in accredited and nonaccredited hospitals regarding barriers to reporting incidents and reporting practices. RELEVANCE TO CLINICAL PRACTICE: Nurse administrators should modify existing systems for reporting incidents to overcome the barriers as shown in the present study.

Perception of Jordanian mothers to nursing support during their children hospitalisation.

AIMS AND OBJECTIVES: To describe Jordanian mothers' perceptions of nursing support provided during hospitalisation of their children and identify socio-demographic characteristic of mothers and children associated with mothers' perceptions of nursing support. BACKGROUND: Nursing support is crucial to mothers to ease and relieve pain and stress experience during hospitalisation of their children. DESIGN: A cross-sectional design. METHOD: A total of 235 mothers who stayed with their children during their hospitalisations for medical or surgical health problems were recruited for the purpose of the study. Mothers of children of one month to two years old from two governmental hospitals in Amman-Jordan were interviewed over a period of two months. Data were collected using Nursing Parent Support Tool and demographic data questionnaire. RESULTS: This study showed that the perception of Jordanian mothers to nursing support was moderate (M = 3·23, SD = 0·95). Stepwise multiple regression analysis showed that mothers' satisfaction to nursing support and mothers' education explained (0·332) of the variance in the mother's perception of nursing support. CONCLUSION: Satisfaction with nursing care and level of education are important factors in Jordanian mothers' perception of nursing support. Nurses need to understand the importance of these factors when providing support and holistic care. RELEVANCE TO CLINICAL PRACTICE: To enhance high level of satisfaction of nursing care, paediatric nurses in the practice settings should establish parent support groups and provide educational materials that are beneficial for educated and uneducated parents.

Influence of bleeding on haemorheology and haemostasis in surgery.

Changes in haemorheology and haemostasis may contribute to bleeding or thrombosis, which is of concern particularly in surgery. Blood loss itself has a major influence on both parameters being closely involved in the clinical outcome. In order to analyze the underlying interrelations, a prospective study with 122 patients (64 females, 58 males) aged between 18 and 83 years (mean: 51.8 years) was conducted. All patients were electively submitted to orthopaedic surgery. Haemorheological parameters included measurements of plasma viscosity, red body cell (RBC) and platelet aggregation index preoperatively, as well as by day 1 and day 7 after surgery. Additionally hematological and haemostaseological parameters including leukocyte and platelet counts, haematocrit and fibrinogen were investigated. Bleeding was defined as high (>500 ml) or low blood loss (≤500 ml) according to the drainage volume. High but not low blood loss was associated with an increase of RBC aggregation by day 1 and 7 after surgery. Plasma viscosity decreased significantly by day 1, returning to normal 7 days after surgery. Platelet count decreased significantly, concurrent with the haematocrit, by day 1 postoperatively, whereas by day 7 a significant increase was observed, being more distinct in high blood loss. Platelet aggregation index did not change under the influence of blood loss. Plasma fibrinogen, clearly corresponding to the extend of blood loss, showed a continuous postoperative increase, which was significantly higher at day 7. Leukocytes increased moderately but significantly in particular in high blood loss. In conclusion, the postoperative decrease of plasma viscosity and of platelet counts, concurrent with the haematocrit, provides evidence of being clearly dependent on blood loss which is regarded as a dilution effect corresponding with the haemorrhagic risk. The increase of RBC aggregation at the early postoperative stage is solely observed in high blood loss and is esteemed as a result of volume therapy. The marked increase of platelet counts and plasma fibrinogen at the late postoperative stage, being more pronounced in high blood loss, might contribute to an elevated prothrombotic risk and is ascribed to an inflammatory response to surgery. In summary, it is concluded, that bleeding tendency corresponding with haemorheologic parameters is enhanced in the early, whereas the prothrombotic risk, well correlating with haemostaseologic parameters, is elevated in the later stage after surgery.

The use of antithrombotic agents in microvascular surgery.

Despite increasing advances in microvascular free tissue transfer, flap failures, most commonly resulting from thrombosis at the anastomotic vascular site, remain a significant concern. Although several experimental and clinical studies have been carried out, no consensus has been reached so far on the efficacy, dosage and timing of anticoagulant agents available for the prevention and treatment of thrombosis in microvascular surgery. Inhibition of fibrin formation and platelet function or the use of thrombolytic agents is a common approach in the antithrombotic management. However, some agents exhibit serious side effects and all of them carry the risk of bleedings. The current literature on the use of antithrombotic agents, targeting at clinical trials in microvascular surgery, is therefore reviewed, to provide an informative basis for recommendations for an appropriate pharmacological approach.

The intrinsic organization of the nucleus lentiformis mesencephali magnocellularis: a light- and electron-microscopic examination.

The nucleus lentiformis mesencephali magnocellularis (nLMmc) is an essential part of the accessory optic nuclei and is responsible for stabilization of the horizontal eye movement. The morphology of this nucleus and its intrinsic structural connectivity were studied with Golgi, biotinylated dextran amine anterograde immunotracer and GABA immunostaining methods by light and electron microscopy. In the Golgi preparations neurons of large, medium-large, medium and small sizes were distinguished. The small neurons are GABA-immunopositive local circuit neurons, the others are proposed to be partly projection, partly local circuit neurons. The large and medium-large projection neurons are located in a tight topographical relationship observed in the Golgi preparations. The dendrites of the large and medium-large cells are also observed to be in close proximity with each other, and also with retinal fibre terminals. The morphological arrangement suggests that the retinal fibres make synaptic contacts with dendrites from both types of cell, and this is confirmed by the examination of retinal fibre terminals using electron microscopy. The optic fibre terminals establish synaptic contacts with small dendritic branches, dendritic processes and dendritic spines of large and medium-large neurons in the nLMmc. This arrangement allows the two types of nLMmc neuron access to very similar, if not identical, inputs, which may facilitate some of the different aspects of visual processing. Optic transmission by these cells may be modulated by the GABA-immunopositive terminals from various local circuit neurons, and very probably from GABAergic myelinated fibres as well, which may originate from the contralateral nLMmc and/or the visual Wulst.