Background Adverse events and serious errors are common in critical care. Although factors in the work environment are important predictors of adverse outcomes for patients, communication between nurses and physicians may be the most significant factor associated with excess hospital mortality in critical care settings. Objectives To examine the relationships between nurses’ perceptions of their practice environment, nurse-physician communication, and selected patients’ outcomes. Methods A nonexperimental, descriptive design was used, and all nurses (N=866) working in 25 intensive care units in southeastern Michigan were surveyed. The Conditions for Work Effectiveness Questionnaire-II and the Practice Environment Scale of the Nursing Work Index were used to measure characteristics of the work environment; the ICU Nurse-Physician Questionnaire was used to measure nurse-physician communication. Nurses self-rated the frequency of ventilator-associated pneumonia, catheter-related sepsis, and medication errors in patients under their care. Results A total of 462 nurses (53%) responded. According to multilevel modeling, both practice environment scales accounted for 47% of the variance in nurse-physician communication scores (P=.001). Nurse-physician communication was predictive of nurse-assessed medication errors only (R2=0.11). Neither environment scale was predictive of any of the patient outcomes. Conclusions Healthy work environments are important for nurse-physician communication. In intensive care units, characteristics of the work environment did not vary enough to be significantly predictive of outcomes, suggesting that even in various types of critical care units, characteristics of the work environment may be more similar than different.

Purpose In an attempt to more thoroughly describe aggressive behavior in nursing home residents with dementia, we examined background and proximal factors as guided by the Need-Driven Dementia-Compromised Behavior model. Design and Methods We used a multivariate cross-sectional survey with repeated measures; participants resided in nine randomly selected nursing homes within four midwestern counties. The Minimum Data Set (with verification by caregivers) identified participants. We used a disproportionate probability sample of 107 participants (51% with a history of aggressive behavior) to ensure variability. Videotaped care events included four of direct care (shower baths, meals, dressing, and undressing) and two of nondirect care (two randomly selected 20-minute time periods in the afternoon and evening). The majority of participants (75%) received three shower baths, for a total of 282 videotaped baths. Results Because the shower bath was the only care event significantly related to aggressive behavior (F = 6.9, p < .001), only those data are presented. Multilevel statistical modeling identified background factors (gender, mental status score, and lifelong history of less agreeableness) and a proximal factor (amount of nighttime sleep) as significant predictors (p < .05) of aggressive behavior during the shower bath. We found significant correlations between aggressive behavior and negative subject affect (r = .27) during the bath, and aggressive behavior and lifetime agreeableness level (r = − .192). We also found significant correlations between mental status and the amount of education (r = .212), and between negative caregiver affect and negative participant affect (r = .321). Implications We identified three background and one proximal factor as significant risk factors for aggressive behavior in dementia. Data identify not only those persons most at risk for aggressive behavior during care, but also the care event most associated with aggressive behavior. Together these data inform both caregiving for persons with dementia as well as the design of intervention studies for aggressive behavior in dementia.

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Background: Limited recent data exists regarding discospondylitis in dogs.Hypothesis/Objectives: (i) Describe the signalment, clinical and imaging findings, etiologic agents, treatment, and outcome of dogs with discospondylitis, (ii) determine diagnostic agreement between radiographs, CT, and MRI with regard to the presence of discospondylitis and its location, and (iii) determine risk factors for relapse and progressive neurological deterioration.Animals: Three hundred eighty-six dogs.Methods: Multi-institutional retrospective study. Data extracted from medical records were: signalment, clinical and examination findings, diagnostic results, treatments, complications, and outcome. Potential risk factors were recorded. Breed distribution was compared to a control group. Agreement between imaging modalities was assessed via Cohen's kappa statistic. Other analyses were performed on categorical data, using cross tabulations with chi-squared and Fisher's exact tests.Results: Male dogs were overrepresented (236/386 dogs). L7-S1 (97/386 dogs) was the most common site. Staphylococcus species (23/38 positive blood cultures) were prevalent. There was a fair agreement (κ = 0.22) between radiographs and CT, but a poor agreement (κ = 0.05) between radiographs and MRI with regard to evidence of discospondylitis. There was good agreement between imaging modalities regarding location of disease. Trauma was associated with an increased risk of relapse (P = .01, OR: 9.0, 95% CI: 2.2-37.0). Prior steroid therapy was associated with an increased risk of progressive neurological dysfunction (P = .04, OR: 4.7, 95% CI: 1.2-18.6).