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Background: Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery., Aim: Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality., Method: Data from the RN4CAST study (2009-2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses' staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation., Results: Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse's workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031-1.106) and 16% (OR 1.159 95% CI 1.039-1.294) increase in the odds of a patient dying within 30days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality., Conclusion: Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an 'early warning' indicator of higher risk for poor patient outcomes., (Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The Poisons Information Centre receives many inquiries about acute exposures to chemical products. Our aim was to characterise the frequency and severity of such exposures and to raise awareness of chemicals that rarely cause poisoning, but may lead to serious systemic toxicity even in small amounts., Material and Methods: Data were collected from inquiries to the Poisons Information Centre in the period 2004-2006 and from the Product Register on the use of selected chemicals., Results: In 2004-2006, the Poisons Information Centre received 35,802 inquiries regarding acute exposures to chemicals or chemical products. Most of the exposures (72%) were assessed as non-toxic or involving risk of minor poisoning, while only 7.8% were assessed as involving risk of severe poisoning. The substances most frequently involved were cleaning agents, cosmetics/personal care products and hydrocarbon fuels, whereas risk of severe poisoning is related to alkali and hydrocarbon exposures. Poisonings with hydrofluoric acid and glycols/glycol ethers are rare, but the outcome is often severe. As many as 84% of the hydrofluoric acid exposures and 36% of the ingestions of ethylene glycol by children were assessed as involving risk of moderate or severe poisoning., Interpretation: Exposure to chemicals or chemical products is frequent, but rarely leads to severe poisonings. Data from inquiries to the Poisons Information Centre are representative of the chemical exposure conditions. It is important to have detailed product information readily available to assure correct treatment after exposure incidents.