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This study aimed to evalúate the palatability, nutrient digestibility, metabolisable energy (ME) and faecal characteristics of diets in dogs fed increasing levels of herbal phosphatidylcholine (herbal mix)versusan unsupplemented diet (with only 377 mg choline provided by 1 kg food) or choline chloride(2000 mg choline/kg food) in 40 adult dogs. In experiment 1, a palatability test was conducted to make two pairwise comparisons: 0 versus 200; and 0 versus 400 mg/kg herbal mix. In experiment 2, a digestibility test was performed to evaluate herbal mix at 0, 200, 400 and 800 mg/kg and 2000 mg choline provided by choline chloride. Results from experiment 1 indicated that the dogs preferred diets containing herbal mix to the unsupplemented diet (P

Background The COVID-19 pandemic has disrupted the typical delivery of nursing education. Multifactorial issues related to the pandemic and clinical placements have forced nurse educators to employ innovative strategies for content delivery. Methods This article is an accounting of a simulation team response to the move to all remote or virtual simulated learning experiences over a two-week period and lessons learned on how to move forward with simulated learning contingency plans. Results Learning outcomes were achieved via the delivery of online commercial and faculty made experiences to simulate clinical practice. Simple and easy to use guides assisted both students and faculty for a positive experience. Conclusion Creating a detailed formal contingency plan for emergencies is essential for nursing programs. Additionally, the pandemic highlighted the importance of continuing faculty development and education in online, virtual, and simulation pedagogy. Finally, it is recommended that schools of nursing implement formal policies for replacement of clinical hours with simulation.

Choline chloride is used to provide choline in dog foods; however, in other domestic species, it has been replaced with a polyherbal containing phosphatidylcholine. A polyherbal containing Achyrantes aspera, Trachyspermum ammi, Citrullus colocynthis, Andrographis paniculata, and Azadirachta indica was evaluated in adult dogs through body weight changes, subcutaneous fat thickness, blood metabolites, and gene expression. Forty dogs (4.6 ± 1.6 years old) who were individually housed in concrete kennels were randomly assigned to the following treatments: unsupplemented diet (377 mg choline/kg), choline chloride (3850 mg/kg equivalent to 2000 mg choline/kg diet), and polyherbal (200, 400, and 800 mg/kg) for 60 days. Blood samples were collected on day 59 for biochemistry, biometry, and gene expression analysis through microarray assays. Intake, final body weight, and weight changes were similar for the two choline sources. Feed intake variation among dogs (p = 0.01) and dorsal fat (p = 0.03) showed a quadratic response to herbal choline. Dogs that received the polyherbal diet had reduced blood cholesterol levels (Quadratic, p = 0.02). The gene ontology analysis indicated that 15 biological processes were modified (p ≤ 0.05) with implications for preventing cardiovascular and metabolic diseases, cancer prevention, inflammatory and immune response, and behavior and cognitive process. According to these results that were observed in a 60 day trial, the polyherbal form could replace choline chloride in dog diets at a concentration of 400 mg/kg.

The objective of this study was to evaluate the productive performance, apparent digestibility, and carcass and longissimus dorsi muscle characteristics of lambs fed diets supplemented with four levels of Saccharomyces cerevisiae. Thirty-two male Hampshire lambs (25.82±1.95 kg body weight) were distributed in four treatments: basal diet (20:80, forage:concentrate), and the inclusion of 0, 3, 5, and 10 g animal−1 d−1Saccharomyces cerevisiae. The variables evaluated were dry matter intake, daily weight gain, feed conversion, apparent digestibility, dorsal fat thickness, longissimus dorsi muscle area, and physicochemical characteristics of carcass and muscle. We used a completely randomized design and orthogonal polynomials to test the linear and quadratic effects of the inclusion levels of the yeast. Saccharomyces cerevisiae showed a quadratic effect on lamb performance. Dry matter intake decreased with yeast in response to a better feed conversion and body weight gain; however, at the highest Saccharomyces cerevisiae dose, daily weight gain and final weight were lower than with the basal diet treatment. Saccharomyces cerevisiae did not affect apparent digestibility or carcass and muscle physicochemical characteristics. Supplementation with 3 and 5 g d−1 Saccharomyces cerevisiae improves productive performance of lambs fed high concentrate diets without affecting the physicochemical characteristics of the carcass or muscle.

To assess the potential impact of predominant circulating SARS-CoV-2 variants on neutralizing activity of infected and/or vaccinated individuals, we analyzed neutralization of pseudoviruses expressing the spike of the original Wuhan strain, the D614G and B.1.1.7 variants. Our data show that parameters of natural infection (time from infection and infecting variant) determined cross-neutralization. Importantly, upon vaccination, previously infected individuals developed equivalent B.1.1.7 and Wuhan neutralizing responses. In contrast, uninfected vaccinees showed reduced neutralization against B.1.1.7.FundingThis study was funded by Grifols, the Departament de Salut of the Generalitat de Catalunya, the Spanish Health Institute Carlos III, CERCA Programme/Generalitat de Catalunya, and the crowdfunding initiatives #joemcorono, BonPreu/Esclat and Correos.

Altres ajuts: This work was partially funded by Grifols, the Departament de Salut of the Generalitat de Catalunya (grant SLD016 to J.B. and Grant SLD015 to J.C.), and the crowdfunding initiatives #joemcorono, BonPreu/Esclat and Correos. With the spread of new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there is a need to assess the protection conferred by both previous infections and current vaccination. Here we tested the neutralizing activity of infected and/or vaccinated individuals against pseudoviruses expressing the spike of the original SARS-CoV-2 isolate Wuhan-Hu-1 (WH1), the D614G mutant and the B.1.1.7 variant. Our data show that parameters of natural infection (time from infection and nature of the infecting variant) determined cross-neutralization. Uninfected vaccinees showed a small reduction in neutralization against the B.1.1.7 variant compared to both the WH1 strain and the D614G mutant. Interestingly, upon vaccination, previously infected individuals developed more robust neutralizing responses against B.1.1.7, suggesting that vaccines can boost the neutralization breadth conferred by natural infection.

A polyherbal feed mixture containing (Achyrantes aspera, Trachyspermum ammi, Citrullus colocynthis, Andrographis paniculata, and Azadirachta indica) was evaluated in growing calves through blood chemistry, blood biometry, and gene expression during the pre-ruminant to weaning period. Forty Holstein calves (initial BW 45.6 ± 3.2 kg; 22.8 ± 0.9 days post birth) from a dairy farm were randomly assigned to the following treatments: 0, 3, 4, and 5 g/d of a polyherbal mixture, dosed in colloid gels with gelatin. Calves were housed in individual outdoor boxes with ad libitum access to a 21.5% CP calf starter and water and fed individually with a mixture of milk and a non-medicated milk replacer (22% CP). Blood samples were collected on day 59 for blood chemistry, blood biometry, and gene expression analysis in leukocyte through microarray assays. Immunoglobulins were quantified by enzyme-linked immunosorbent assay. The animals treated with the polyherbal mixture showed a quadratic effect on final body weight, daily weight gain, final hip height, and final thoracic girth. The best performance results were obtained with a treatment dose of 4 g/d. The serum IgG increased linearly with the treatment doses. Gene set enrichment analysis of upregulated genes revealed that the three biological processes with higher fold change were tight junction, mucin type O-Glycan biosynthesis, and intestinal immune network for IgA production. Also, these upregulated genes influenced arachidonic acid metabolism, and pantothenate and CoA biosynthesis. Gene ontology enrichment analysis indicated that the pathways enriched were PELP1 estrogen receptor interacting protein pathways, nuclear receptors in lipid metabolism and toxicity, tight junction, ECM-receptor interaction, thyroid hormone signaling pathways, vascular smooth muscle contraction, ribosome function, glutamatergic synapse pathway, focal adhesion, Hippo, calcium, and MAPK signaling pathways.

Introduction Electronic health records have become a standard documentation platform to house patient information in most US hospitals. To improve documentation, providers suggest establishing electronic health record user education at the classroom level so students can interact with patient data early. The purpose of this study was to assess student nurses' clinical documentation and critical thinking skills using virtual patients and a simulated electronic health record system. Methods Eighty-four undergraduate nursing students completed assessments on four assigned virtual patients and entered their findings into a simulated electronic health record system. Benner's five stage novice to expert theory was used to evaluate performance of six assessment items. Results Significant differences (p = 0.046) were seen in median scores between the first and second assignments, and between the second and fourth assignments (p = 0.021) with minimal improvements from one assignment to the next. Discussion Data entered in the electronic health record showed that students started at an advance beginner's level and moved to be proficient in documenting basic patient information using critical thinking skills by the end of the first semester. Conclusion It is important to expose students to electronic health record systems before entering the workforce or while training in a hospital setting to enhance readiness for clinical practice with electronic documentation and critical thinking skills.

An experiment was carried out to evaluate the effect of an herbal choline feed plant additive on the productive parameters and blood metabolites of finishing lambs. Forty male Hampshire × Suffolk lambs (initial body weight of 30.36±3.75 kg) were assigned according to a completely randomized design. Treatments consisted of dietary inclusion of the herbal additive BioCholine at 0, 3, 6, and 9 g/kg dry matter for 56 days. A linear response for herbal choline dose was observed for daily gain, final body weight, feed conversion, blood glucose, and blood phosphatidylcholine as herbal choline level was increased in the diet. Total protein, globulins, and low-density lipoproteins showed a quadratic effect, and there were no effects on intake, Longissimus dorsi area, back fat, blood cholesterol, triglycerides, high-density lipoproteins, or albumins. The inclusion of the herbal choline feed plant additive improved daily gain and feed efficiency of finishing lambs. The choline feed plant additive is a source that can be used to meet choline requirements in small ruminants, as demonstrated by blood phosphatidylcholine and lamb performance.

Coccidiosis negatively impacts health and productive performance in broilers. Anticoccidial resistance has prompted alternatives to prevent and control this disease. Therefore, the objective of this study was to evaluate a plant feed additive consisting of Acacia concinna containing saponins (Peptasan®) and compare its effectiveness with salinomycin in terms of performance of broilers challenged with Eimeria. In the first experiment, 300 Ross chicks (1 day old) were randomly distributed into a negative (uninfected and untreated), and positive control group (infected and untreated), and three levels of dietary Peptasan® (500, 750 and 1000 ppm). In the second experiment, the same number of chicks were distributed in two control groups (negative and positive), two levels of Peptasan® (500 and 750 ppm) and one level of salinomycin (550 ppm). In both experiments chicks were challenged at day 21 of age with 100,000 oocysts of Eimeria acervulina, 50,000 oocysts of Eimeria maxima and 50,000 oocysts of Eimeria tenella. Dietary Peptasan® improved productive performance, reduced mortality and the number of oocysts in feces, as well as increased yellow pigmentation of the skin of challenged chickens. The plant feed additive Peptasan® containing Acacia concinna can be effectively used for preventing coccidiosis in broilers.

Producción Científica, Classification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thresholds (Ct) were independently associated with poor outcome CDI. Our objective was to perform a multicentre external validation of a PCR-toxin B Ct as a marker of poor outcome CDI. We carried out a multicentre study (14 hospitals) in which the characteristics and outcome of patients with CDI were evaluated. A subanalysis of the results of the amplification curve of real-time PCR gene toxin B (XpertTM C. difficile) was performed. A total of 223 patients were included. The median age was 73.0 years, 50.2% were female, and the median Charlson index was 3.0. The comparison of poor outcome and non–poor outcome CDI episodes revealed, respectively, the following results: median age (years), 77.0 vs 72.0 (p = 0.009); patients from nursing homes, 24.4% vs 10.8% (p = 0.039); median leukocytes (cells/μl), 10,740.0 vs 8795.0 (p = 0.026); and median PCR-toxin B Ct, 23.3 vs 25.4 (p = 0.004). Multivariate analysis showed that a PCR-toxin B Ct cut-off

The objective of this study was to evaluate the economic impact of supplementing dairy cows with mixtures of polyherbal products supplying conjugates of choline (BioCholine, BC), lysine (OptiLysine, L) and methionine (OptiMethionine, M), considering the costs of veterinary treatments, the nutraceutical effects of the mixtures, the partial cost and returns of milk production. Eighty postpartum Holstein cows were randomly assigned to individually receive. The pellets no containing (Control, 20 cows) and containing polyherbal products (g/d) (BC20, 19 cows; BC40, 17 cows; BC20+L40+M20, 12 cows, and BC40+L80+M40, 12 cows) were offered to cows during the milking through automatic feeders in the course of 90 days in a commercial farm. Treatment costs were grouped in terms of antibiotics, healing, anti-inflammatories, glucogenics, hormonal, intra-mammary treatments, restorative and vitamins. Milk production was not affected (P>0.05) by polyherbal additives but there were numerical differences in the number of treatments and costs; animal health cost per cow showed a high variation coefficient (average 347%). Cows receiving BC40 and BC20+L40+M20 had reduced animal health cost per cow but only the treatment BC40 showed residual effects post experiment with an economic improvement of 2.1% over the control group, showing benefits associated to a reduction in the number of doses with antibiotics and doses of immune-stimulants. Cows receiving BC40 had the best milk yield numerically in combination with the lower number of animal health costs which resulted in the highest income.

Objective This experiment was designed to evaluate the effects of Agave tequilana inulin and Lactobacillus casei (L. casei) on growth performace, hematological variables, serum metabolites, and total coliforms in nursing lambs. Methods The experimental design was completely randomized; treatments were T1, control (pre-starter concentrate, PC), T2: T1+2% inulin, and T3: T1+2% inulin+L. casei; treatments were compared with Tukey test (p≤0.05); and 45 new born Kathadin×Dorset lambs (4.8±0.8 kg birth weight) were the experimental units (15 per treatment). The variables were daily weight gain (DWG), dry matter intake and diarrheas incidence (%) during 56 d. Twenty-four hours after birth and at the end of the experiment, blood samples were collected to evaluate hematological variables and serum metabolites. Besides, the populations of total coliforms and lactobacilli were estimated in fecal samples. Results Addition of agave inulin and L. casei increased (p≤0.05) DWG 356, 384, and 415 g/d, weaning weight 24.92, 26.18, and 28.07 kg, as well as lactobacilli population 5.79, 6.32, and 6.48 Log10 cfu/g, for T1, T2, and T3, respectively. Lambs fed L. casei had decreased (p≤0.05) populations of total coliforms (T1 = 6.18, T2 = 5.77, and T3 = 5.07 Log10 cfu/g), diarrheas incidence (T1 = 11.67%, T2 = 8.33%, and T3 = 5.0%), and serum cholesterol concentration (11% in T2 and 13% in T3, compared to control). Conclusion The combination of Agave tequilana inulin and L. casei increases weight gain and improves intestinal health by reducing coliforms and diarrheas incidence in Katahdin× Dorset lambs during the pre-weaning period.

Type 2 diabetes is a major health burden in the United States, and population trends suggest this burden will increase. High interest in, and increased availability of, testing for genetic risk of type 2 diabetes presents a new opportunity for reducing type 2 diabetes risk for many patients; however, to date, there is little evidence that genetic testing positively affects type 2 diabetes prevention. Genetic information may not fit patients' illness representations, which may reduce the chances of risk-reducing behavior changes. The present study aimed to examine illness representations in a clinical sample who are at risk for type 2 diabetes and interested in genetic testing. The authors used the Common Sense Model to analyze survey responses of 409 patients with type 2 diabetes risk factors. Patients were interested in genetic testing for type 2 diabetes risk and believed in its importance. Most patients believed that genetic factors are important to developing type 2 diabetes (67%), that diet and exercise are effective in preventing type 2 diabetes (95%), and that lifestyle changes are more effective than drugs (86%). Belief in genetic causality was not related to poorer self-reported health behaviors. These results suggest that patients' interest in genetic testing for type 2 diabetes might produce a teachable moment that clinicians can use to counsel behavior change.

Summary Background Most available information on carbapenemase-producing Enterobacteriaceae (CPE) is usually associated with specific types of infection or patient or with descriptions of outbreaks. The aim of this study was to comprehensively analyse the clinical epidemiology, clinical features and outcomes of colonisation and infections due to CPE in Spain. Methods A multicentre prospective cohort study was carried out in 34 Spanish hospitals from February to May 2013. All new patients testing positive for CPE in clinical samples were included. Logistic regression was used to identify predictors of mortality. Results Overall, 245 cases were included. The most frequent organism was Klebsiella pneumoniae (74%) and the carbapenemases belonged to the OXA-48 (74%), metallo-β-lactamase (MBL) (24%) and KPC (2%) groups. Acquisition was nosocomial in 145 cases (60%) and healthcare-associated (HCA) in 91 (37%); 42% of the latter were nursing home residents, in whom OXA-48-producing K. pneumoniae ST405 predominated. MBLs and OXA-48 predominated in ICU and medical patients, respectively. Overall, 67% of patients had infections. The most frequent infections identified in this study were urinary tract (43%) and skin structure (21%) infections, and 10% of infections were bacteraemic. Crude mortality was 20%. Inappropriate antibiotic therapy was independently associated with an increased risk of death (OR = 3.30; 95% CI: 1.34–8.11). Conclusions We found some differences in the epidemiology of CPE depending on the type of carbapenemase produced. Although a low proportion of CPE infections were bacteraemic, active antibiotic therapy was a protective factor for reducing mortality.

Con el fin de comprobar cientificamente el método de esterilización por calor seco empleando en forma empírica, se decide veríficar la eficancia del "Horno Casero" para dicho proceso.Para esta investigación se utilizan hornos con cámaras de diferente capacidad y esporas de Bacillus Subtilis variedad Niger (control biológico) alternando las variables tiempo y temperatura hasta llegar al binomio ideal.Se comprueba la esterilización en los diferentes tipos de hornos y materiales para ver la eficacia del método y dar normas sobre el manejo de hornos, tipos de materiales que pueden esterilizarse y forma de empacado de la carga.

Objectives To describe the molecular and population-level characterization of a selected group of OXA-48-like-producing Klebsiella pneumoniae isolates collected in Spain between January 2011 and May 2012. Methods During the study period, 151 OXA-48-like-producing K. pneumoniae isolates were collected from 10 hospitals in six different Spanish regions. From these, a representative sample of 21 isolates that caused hospital outbreaks and single infections was selected for further in-depth analysis. Molecular epidemiology was investigated using PFGE and multilocus sequence typing (MLST). Resistance genes were characterized by PCR and sequencing. Plasmids carrying bla(OXA-48-like) were studied by PFGE with S1 nuclease digestion. Results All 21 isolates had ertapenem MICs ≥ 1 mg/L, but 47.6% remained susceptible to imipenem and meropenem; bla(OXA-48) was identified in 19 isolates (90.5%) and the novel bla(OXA-244) and bla(OXA-245) genes were detected in 1 isolate each. With one exception, all isolates that contained bla(OXA-48-like) also contained bla(CTX-M-15). PFGE typing revealed six clusters comprising isolates that belonged to MLST types ST11, ST16, ST392, ST405, ST437 and ST663, respectively. Two main clusters were identified: PFGE cluster 1 (12 isolates, belonging either to ST405 or ST663, from seven hospitals), and PFGE cluster 2 (4 ST16 isolates from two hospitals). Six of seven donor isolates conjugated successfully; bla(OXA-48-like) (but not bla(CTX-M-15)) was carried on ≈ 60 kb Inc L/M plasmids. Conclusions Multidrug-resistant K. pneumoniae producing OXA-48-like carbapenemase are emerging as important pathogens in Spain due to intra- and inter-hospital, clonal and non-clonal dissemination.

Los altos niveles de ácidos grasos saturados en la carne de rumiantes representan un punto crítico en la alimentación humana por su relación con enfermedades cardiovasculares. La levadura Saccharomyces cerevisiae (Sc) es rica en ácido oleico y representa una alternativa para modificar el perfil de ácidos grasos de la carne, al incrementar la proporción de ácidos grasos insaturados. Por lo anterior, se realizó un experimento con corderos en crecimiento (20± 0.9 kg PV), utilizando una dieta a base de concentrado y tres niveles (tratamientos, T) de Sc (0, 3 y 5 g animal-1 d-1, T1, T2 y T3, respectivamente), con el objetivo de determinar el comportamiento animal, caracterizar la fermentación ruminal, los niveles plasmáticos de colesterol y los ácidos grasos depositados en la canal. Los datos se analizaron con un diseño completamente al azar, con tres tratamientos y diez repeticiones. La adición de 3 g animal-1 d-1 (T2) de Sc disminuyó (P < 0.05) los niveles de consumo de MS en el segundo y cuarto periodo de evaluación. Sin embargo, no afectó (P > 0.05) la ganancia diaria de peso, ni la conversión alimenticia. En los componentes del alimento solamente se afectó (P > 0.05) la digestibilidad de la FDA, disminuyendo en 8.6 % con la adición de 5 g animal-1 d-1 de Sc (T3). No hubo efecto (P < 0.05) de Sc en las variables ruminales: pH, ácidos grasos volátiles y nitrógeno amoniacal; tampoco afectó (P < 0.05) el área del musculo Longissimus dorsi, espesor de grasa y colesterol total en sangre. Los niveles del ácido mirístico y esteárico en la canal no cambiaron (P>0.05) en los tratamientos evaluados; sin embargo, el cultivo de levadura disminuyó (P 0.05) daily gain and feed conversion, so it decreased the digestibility of ADF. Sc did not affect (P> 0.05) ruminal parameters as VFA, N – NH3 and ruminal pH, also did not affect (P> 0.05) Longissimus dorsi muscle area, back fat thickness and total blood cholesterol. As Sc dose increased, decreased (P

Background Type 2 diabetes is a prevalent chronic condition globally that results in extensive morbidity, decreased quality of life, and increased health services utilization. Lifestyle changes can prevent the development of diabetes, but require patient engagement. Genetic risk testing might represent a new tool to increase patients' motivation for lifestyle changes. Here we describe the rationale, development, and design of a randomized controlled trial (RCT) assessing the clinical and personal utility of incorporating type 2 diabetes genetic risk testing into comprehensive diabetes risk assessments performed in a primary care setting. Methods/Design Patients are recruited in the laboratory waiting areas of two primary care clinics and enrolled into one of three study arms. Those interested in genetic risk testing are randomized to receive either a standard risk assessment (SRA) for type 2 diabetes incorporating conventional risk factors plus upfront disclosure of the results of genetic risk testing ("SRA+G" arm), or the SRA alone ("SRA" arm). Participants not interested in genetic risk testing will not receive the test, but will receive SRA (forming a third, "no-test" arm). Risk counseling is provided by clinic staff (not study staff external to the clinic). Fasting plasma glucose, insulin levels, body mass index (BMI), and waist circumference are measured at baseline and 12 months, as are patients' self-reported behavioral and emotional responses to diabetes risk information. Primary outcomes are changes in insulin resistance and BMI after 12 months; secondary outcomes include changes in diet patterns, physical activity, waist circumference, and perceived risk of developing diabetes. Discussion The utility, feasibility, and efficacy of providing patients with genetic risk information for common chronic diseases in primary care remain unknown. The study described here will help to establish whether providing type 2 diabetes genetic risk information in a primary care setting can help improve patients' clinical outcomes, risk perceptions, and/or their engagement in healthy behavior change. In addition, study design features such as the use of existing clinic personnel for risk counseling could inform the future development and implementation of care models for the use of individual genetic risk information in primary care. Trial Registration ClinicalTrials.gov: NCT00849563

Background: Quality specifications for indicators of the key analytic processes have been defined by international consensus. However, only preliminary specifications for laboratory-related strategic and support processes have been developed. The present study attempts to increase the robustness of the preliminary proposed specifications. Methods: Recovering records and incidences occurred over a 4-year follow-up period, for 12 indicators, used in all laboratories from this group regarding strategic and support processes. Results and conclusions: The results obtained indicate that it is better to establish an interval rather than a fixed value for the majority of indicators. Longer studies are needed to properly assess some quality specifications, and data recording system must be standardized in others. Additional, multicenter studies are needed to establish more robust specifications and determine the state of the art of laboratories in other settings. Clin Chem Lab Med 2010;48:1015–9.

Background Cardiovascular disease (CVD) and diabetes account for over one third of the mortality difference between African Americans and white patients. The increased CVD risk in African Americans is due in large part to the clustering of multiple CVD risk factors. Objectives The current study is aimed at improving CVD outcomes in African-American adults with diabetes by addressing the modifiable risk factors of systolic blood pressure , glycosolated hemoglobin, and low-density lipoprotein cholesterol. Methods A sample of African American patients with diabetes (N = 400) will receive written education material at baseline and be randomized to one of 2 arms: (1) usual primary care or (2) nurse-administered disease-management intervention combining patient self-management support and provider medication management. The nurse administered intervention is delivered monthly over the telephone. The nurses also interacts with the primary care providers at 3, 6, and 9 months to provide concise patient updates and facilitate changes in medical management. All patients are followed for 12 months after enrollment. The primary outcomes are change in glycosolated hemoglobin, systolic blood pressure, and low-density lipoprotein cholesterol over 12-months. Secondary outcomes include change in overall cardiovascular risk, aspirin use, and health behaviors. Conclusion Given the continued racial disparities in CVD, the proposed study could result in significant contributions to cardiovascular risk reduction in African-American patients.

Background This work is the second part of a study regarding indicators and quality specifications for the non-analytical processes in laboratory medicine. Five primary care and five hospital laboratories agreed on the indicators for two strategic processes (quality planning and project development) and various support processes (client relationships, instrument and infrastructure maintenance, safety and risk prevention, purchases and storage, personnel training). Methods In the majority of cases, the median values recorded over 1 year is considered to be the state-of-the-art in our setting and proposed as the quality specification for the indicators stated. Values have been stratified according to primary care and hospital laboratory for referred tests and group of personnel for training. In some cases, the specifications have been set equal to zero events, such as serious incidents in the infrastructure maintenance process and number of work accidents in the safety and risk prevention process. Results and conclusions In light of this study, an effort is needed to optimize decisions regarding corrective actions and to move from a subjective individual criterion to systematic and comparative management. This preliminary study provides a comprehensive vision of a subject that could motivate further research and advances in the quality of laboratory services.

Background The aim of this study was to identify process indicators for the three phases of laboratory activity and their corresponding quality specifications in our setting (primary care centers, and second- and third-level hospitals that provide public healthcare services in Catalonia). Methods Every 2 months, working group members met to present data obtained for quality indicators for the current processes in their laboratories. The results collected were for indicators recorded monthly from 2005 and for indicators recorded less frequently from 2004. The medians of the results obtained in all laboratories were calculated and the values obtained were established as the current specifications for the corresponding indicators. Results The laboratories participating in this working group use 12 indicators for the key processes (three for preanalytical steps, four for analytical steps and five for postanalytical steps). The preanalytical indicators are erroneous request, erroneous sample, and samples not taken, with specifications of 4.1%, 5.0% and 1.7%, respectively. A new indicator for the analytical step is the percentage of external controls exceeding the specification (0.8%); specifications for the other three well-recognized indicators (imprecision, bias and total error) are not the subject of this study. For the postanalytical phase, the indicators (and specifications) include duplicate hard copies of reports sent to centers or clinical units (1.6%), failure in critical value reporting (0.5%), reports exceeding delivery time (0.7%), reports from referred tests that exceed delivery time (8.9%), and incidents related to the data processing network between centers (25 events per year). Conclusions The process indicators reflect the state-of-the-art of the laboratories comprising our working group. Current performance for the analytical phase is satisfactory because it is entirely in the hands of the laboratory, while the main problems in extra-analytical phases reside in activities performed outside the laboratory (sample collection and transport, as well as non-electronic report delivery).

ObjectivesNurses are under increased pressure to provide care to patients which is both safe and effective (Durham & Alden, 2008). Schools of nursing feel the pressure to incorporate more patient safety education into already full courses of study to prepare graduates for the pressures of healthcare

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