Based on the results of this meta-analysis, there is no evidence to prefer CSS more than OSS.

This is the first study to quantify the effect of ICU environment on family and patient satisfaction. Family and patient satisfaction with ICU experience increased by 6 % in the new ICU environment with noise-reduced, single rooms with daylight, adapted colouring and improved family facilities.

Objectives: It is unclear how nurses adjust the double check during injectable medication administration andguarantee patient safety. We used the Functional Resonance Analysis Method (FRAM) to determine the fit betweenthe double check according to the protocol (work-as-imagined) and clinical practice (work-as-done). Weaimed to learn about process variation in order to optimize safety during injectable medication administration. Methods: A qualitative study (February-July 2018) with semi-structured group interviews. An internal medicineand a surgery ward of two Dutch hospitals participated (four wards total). We interviewed nurses about injectable medication administration practices, based on prior observations. A work-as-done model was constructedfor each hospital. The work-as-imagined model was based on the Dutch protocol for safe injectablemedication administration. Results: A total of 27 nurses were interviewed. In both hospitals, nurses split the double check into a digital andphysical check to improve workflow. The digital check was routinely conducted. For the physical check, nursesmade their own risk-impact analysis and assessed staffing, familiarity with the medication, severity of sideeffects, type of 

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Aims To examine hospital nurses’ perception of their actual and potential contribution to shared decision‐making about life‐prolonging treatment and their perception of the pre‐conditions for such a contribution. Design A qualitative interview study. Methods Semi‐structured face‐to‐face interviews were conducted with 18 hospital nurses who were involved in care for patients with life‐threatening illnesses. Data were collected from October 2018‐January 2019. The interviews were recorded, transcribed verbatim and analysed using thematic analysis by two researchers. Results Nurses experienced varying degrees of influence on decision‐making about life‐prolonging treatment. Besides, we identified different points of contact in the treatment trajectory at which nurses could be involved in treatment decision‐making. Nurses’ descriptions of behaviours that potentially contribute to shared decision‐making were classified into three roles as follows: checking the quality of a decision, complementing shared decision‐making and facilitating shared decision‐making. Pre‐conditions for fulfilling the roles identified in this study were: (a) the transfer of information among nurses and between nurses and other healthcare professionals; (b) a culture where there is a positive attitude to nurses' involvement in decision‐making; (c) a good relationship with physicians; (d) knowledge and skills; (e) sufficient time; and (f) a good relationship with patients. Conclusion Nurses described behaviour that reflected a supporting role in shared decision‐making about patients’ life‐prolonging treatment, although not all nurses experienced this involvement as such. Nurses can enhance the shared decision‐making process by checking the decision quality and by complementing and facilitating shared decision‐making. Impact Nurses are increasingly considered instrumental in the shared decision‐making process. To facilitate their contribution, future research should focus on the possible impact of nurses’ involvement in treatment decision‐making and on evidence‐based training to raise awareness and offer guidance for nurses on how to adopt this role.

ObjectiveTo determine whether highly prevalent P. aeruginosa sequence types (ST) in Dutch cystic fibrosis (CF) patients are specifically linked to CF patients we investigated the population structure of P. aeruginosa from different clinical backgrounds. We first selected the optimal genotyping method by comparing pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and multilocus variable number tandem-repeat analysis (MLVA).MethodsSelected P. aeruginosa isolates (n = 60) were genotyped with PFGE, MLST and MLVA to determine the diversity index (DI) and congruence (adjusted Rand and Wallace coefficients). Subsequently, isolates from patients admitted to two different ICUs (n = 205), from CF patients (n = 100) and from non-ICU, non-CF patients (n = 58, of which 19 were community acquired) were genotyped with MLVA to determine distribution of genotypes and genetic diversity.ResultsCongruence between the typing methods was >79% and DIs were similar and all >0.963. Based on costs, ease, speed and possibilities to compare results between labs an adapted MLVA scheme called MLVA9-Utrecht was selected as the preferred typing method. In 363 clinical isolates 252 different MLVA types (MTs) were identified, indicating a highly diverse population (DI  = 0.995; CI  = 0.993–0.997). DI levels were similarly high in the diverse clinical sources (all >0.981) and only eight genotypes were shared. MTs were highly specific (>80%) for the different patient populations, even for similar patient groups (ICU patients) in two distinct geographic regions, with only three of 142 ICU genotypes detected in both ICUs. The two major CF clones were unique to CF patients.ConclusionThe population structure of P. aeruginosa isolates is highly diverse and population specific without evidence for a core lineage in which major CF, hospital or community clones co-cluster. The two genotypes highly prevalent among Dutch CF patients appeared unique to CF patients, suggesting specific adaptation of these clones to the CF lung.

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Meropenem exposure is associated with the highest risk of resistance development in P. aeruginosa. Increasing carbapenem use attributable to emergence of Gram-negative bacteria producing extended-spectrum β-lactamases will enhance antibiotic resistance in P. aeruginosa.