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Background: Ankle-brachial index (ABI) is a simple method for diagnosing peripheral artery disease (PAD) but has limited reliability in patients with diabetes mellitus (DM) because of medial artery calcification. Our study aims to investigate whether the toe brachial index (TBI) or the cardio-ankle vascular index (CAVI) has a better detection over the ABI for diagnosing PAD in diabetic kidney disease (DKD). Materials and Methods: A cohort of 368 patients (mean age 68.59 ± 13.14 years, 190 males and 178 females) with type 2 DM underwent ABI, TBI, and CAVI measurements at our outpatient clinic. Results: Of all enrolled patients, the TBI is significant in evaluating PAD, especially in patients whose chronic kidney disease (CKD) stage 3a with adjusted odds ratio (AOR) = 6.50, 95% confidence interval (CI) 1.63–25.97, p = 0.0080, stage 3b AOR = 7.47, 95% CI 1.52–36.81, p = 0.0135, and stage 4–5 AOR = 20.13, 95% CI 1.34–94.24, p = 0.0116. CAVI is also significant in CKD stage 1 with AOR = 0.16, 95% CI 0.03–0.77, p = 0.0223, stage 2 with AOR = 0.18, 95% CI 0.04–0.74, p = 0.0180, and stage 3a AOR = 0.31, 95% CI 0.10–0.93, p = 0.0375. Conclusion: TBI has a better yield of detection of PAD compared to ABI among Taiwanese patients with DKD. CAVI may play a role in the early stage of DKD. [ABSTRACT FROM AUTHOR]

Background & Problems: While the central line catheter is a common device used in intensive medical care, it is a frequent source of nosocomial infection. The central line associated bloodstream infection (CLABSI) rate at our medical ICU had increased steadily, with an average rate between January and May 2011 of .47%. We used a cross-team approach to implement bundle care as a strategy to reduce the CLABSI rate., Purpose: We designed a project to reduce the CLABSI rate below .3% in our ICU., Resolution: This project was conducted between June 2011 and May 2012. Our strategy included providing a sterile towel, implementing maximal barrier precautions (head to toe), designing an illustration explaining how to use 2% CHG, establishing a procedures and care checklist, implementing quality assurance for procedures and care, and providing education on bundle care., Results: The CLABSI rate reduced to .24% after project implementation. This result was below the target of .30%., Conclusions: We want to share this experience to help other hospitals and units improve critical care quality and to continue working to achieve a zero-tolerance infection rate.

Background: Central venous catheter-related bloodstream infection (CRBSI) is an important indicator of care quality. The average CRBSI rate in our unit was 1.027% in 2009. Causes of infection included inadequate CRBSI prevention practices and outdated standard procedures., Purpose: We designed a project to reduce the CRBSI rate below 0.5% in our intensive care unit., Resolution: Improvement plans included providing in-service education, establishing a central venous catheter (CVC) care checklist, and updating CRBSI clinical management standards., Results: The CRBSI rate fell to 1.43‰ after implementation. This was significantly below the reduction target of 0.5%., Conclusions: This project effectively reduced CRBSI. We want to share this experience to help other hospitals and units improve critical care quality and reduce healthcare costs.

High nurse turnover rates and the related rise in patient-to-nurse ratios correlate with the integrity and maturity of nursing organizations and patient safety issues. Previous studies indicate bullying among nurses to be significantly related to high turnover rates and to impact negatively on the physical and mental health of nurses. The situation has been severe enough to lead to nurse suicides (Yildirim & Yildirim, 2007). In light of such, the International Council of Nurses (ICN) reviewed the literature about nursing workplace bullying and proclaimed the importance of fostering a positive work environment in 2007. Most studies on nursing workplace bullying have focused on western societies. In order to clarify the state of nursing bullying in Taiwan, this paper worked to summarize observations in the literature regarding the causes of and management strategies for nursing workplace bullying in order to increase the attention of nursing managers and staff toward this issue. The authors hope that this article may help raise awareness and both prevent nursing workplace bullying and reduce currently high turnover rates.