Nurses are assigned a key role in pandemic response, with work engagement considered to be pivotal. The job demands-resources theory assumes that work engagement depends on job resources and job ...demands. Key job resources and demands have already been proposed for nurses. However, there is no evidence on their importance under pandemic conditions. Hence, the aim of this study was to investigate their relevance to nurses' work engagement during the second wave of the COVID-19 pandemic.
The study was carried out in a cross-sectional design and addressed nurses in direct health care settings in Germany. Data was collected administering a quantitative online survey using valid and reliable measures during the second wave of the pandemic. A convenience sample was obtained, including the use of social media, randomly selected health care facilities, and all universities with nursing-related programs in Germany. The dataset for analyses comprised a total of 1,027 cases. The sample included nurses of various educational levels and from different sectors. Multiple linear regression analysis after multiple imputation was used to examine the relevance of key resources and demands for work engagement.
Key resources and demands explained 36% of the variance in nurses' work engagement during the COVID-19 pandemic. Positive associations were found between the key resources of autonomy (β¯
=0.072, 95% CI 0.011; 0.133), professional resources (β¯
=0.204, 95% CI 0.124; 0.285), and interpersonal relationships (β¯
=0.178, 95% CI 0.117; 0.240) and nurses' work engagement. On the demands side, lack of formal rewards negatively (β¯
=-0.312, 95% CI -0.380; -0.245) affected work engagement, whereas work overload (β¯
=0.063, 95% CI 0.001; 0.126) was positively associated with work engagement.
The job demands-resources theory is suitable for explaining nurses' work engagement even in times of crisis. Taken together, key resources and demands have a significant influence on nurses' work engagement under pandemic conditions. However, not all so-called key resources and demands actually have a key status in a pandemic.
Any lack of formal rewards should be countered, professional resources should be sustainably secured, and the autonomy of nurses and their interpersonal relationships should be strengthened. Nursing management decisions should be made not only with the current pandemic but also the post-pandemic period in mind.
Improved characterization of the microstructural brain changes occurring in the early stages of Alzheimer's disease may permit more timely disease detection. This study examined how longitudinal ...change in brain microstructure relates to cognitive decline in aging and prodromal Alzheimer's disease. At baseline and two-year follow-up, 29 healthy controls and 21 individuals with mild cognitive impairment or mild Alzheimer's disease underwent neuropsychological evaluation and restriction spectrum imaging (RSI). Microstructural change in the hippocampus, entorhinal cortex, and white matter tracts previously shown to be vulnerable to Alzheimer's disease, was compared between healthy controls and impaired participants. Partial correlations and stepwise linear regressions examined whether baseline RSI metrics predicted subsequent cognitive decline, or change in RSI metrics correlated with cognitive change. In medial temporal gray and white matter, restricted isotropic diffusion and crossing fibers were lower, and free water diffusion was higher, in impaired participants. Restricted isotropic diffusion in the hippocampus declined more rapidly for cognitively impaired participants. Baseline hippocampal restricted isotropic diffusion predicted cognitive decline, and change in hippocampal and entorhinal restricted isotropic diffusion correlated with cognitive decline. Within controls, changes in white matter restricted oriented diffusion and crossing fibers correlated with memory decline. In contrast, there were no correlations between rates of cortical atrophy and cognitive decline in the full sample or within controls. Changes in medial temporal lobe microarchitecture were associated with cognitive decline in prodromal Alzheimer's disease, and these changes were distinct from microstructural changes in normal cognitive aging. RSI metrics of brain microstructure may hold value for predicting cognitive decline in aging and for monitoring the course of Alzheimer's disease.
•Longitudinal diffusion MRI was conducted in individuals with MCI/AD and controls.•Mean restricted diffusion in hippocampus declined more rapidly in MCI/AD.•Baseline hippocampal restricted diffusion predicted cognitive decline.•Change in medial temporal restricted diffusion correlated with cognitive decline.•In healthy controls, white matter microstructure correlated with memory decline.
Diffusion imaging has demonstrated sensitivity to structural brain changes in Alzheimer's disease (AD). However, there remains a need for a more complete characterization of microstructural ...alterations occurring at the earliest disease stages, and how these changes relate to underlying neuropathology. This study evaluated the sensitivity of restriction spectrum imaging (RSI), an advanced diffusion magnetic resonance imaging (MRI) technique, to microstructural brain changes in mild cognitive impairment (MCI) and AD.
MRI and neuropsychological test data were acquired from 31 healthy controls, 12 individuals with MCI, and 13 individuals with mild AD, aged 63-93 years. Cerebrospinal fluid amyloid-β levels were measured in a subset (n = 38) of participants. RSI measures of neurite density (ND) and isotropic free water (IF) were computed in fiber tracts and in hippocampal and entorhinal cortex gray matter, respectively. Analyses evaluated whether these measures predicted memory performance, correlated with amyloid-β levels, and distinguished impaired individuals from controls. For comparison, analyses were repeated with standard diffusion tensor imaging (DTI) metrics of fractional anisotropy (FA) and mean diffusivity.
Both RSI and DTI measures correlated with episodic memory and disease severity. RSI, but not DTI, measures correlated with amyloid-β42 levels. ND and FA in the arcuate fasciculus and entorhinal cortex IF most strongly predicted recall performance. RSI measures of arcuate fasciculus ND and entorhinal cortex IF best discriminated memory impaired participants from healthy participants.
RSI is highly sensitive to microstructural changes in the early stages of AD, and is associated with biochemical markers of AD pathology. Reduced ND in cortical association fibers and increased medial temporal lobe free-water diffusion predicted episodic memory, distinguished cognitively impaired from healthy individuals, and correlated with amyloid-β. Although further research is needed to assess the sensitivity of RSI to preclinical AD and disease progression, these results suggest that RSI may be a promising tool to better understand neuroanatomical changes in AD and their association with neuropathology.
Dem Arbeitsengagement Pflegender wird in der Pandemiebewältigung ein essenzieller Stellenwert zugeschrieben. Die job demands-resources theory nimmt an, dass das Arbeitsengagement von ...Arbeitsressourcen und Arbeitsanforderungen abhängt. Für Pflegende wurden bereits berufsspezifische Schlüsselressourcen und -anforderungen identifiziert. Für deren Bedeutung unter Pandemiebedingungen gibt es jedoch keine Evidenz. Ziel dieser Studie war es daher, ihre Relevanz für das Arbeitsengagement von Pflegenden während der zweiten Welle der COVID-19-Pandemie zu untersuchen.
Die Studie wurde im Querschnittdesign realisiert und adressierte Pflegende in der direkten Gesundheitsversorgung in Deutschland. Die Daten wurden per Online-Fragebogen in der zweiten Welle der Pandemie mit Messinstrumenten erhoben, die sich in früheren Studien als valide und reliabel erwiesen haben. Die Stichprobe wurde als Gelegenheitsstichprobe, u.a. über soziale Medien, zufällig ausgewählte Gesundheitseinrichtungen und die Hochschulen mit pflegebezogenen Studiengängen gewonnen. Es konnten 1027 Fälle ausgewertet werden. Die Stichprobe umfasste Pflegende unterschiedlicher Ausbildungsgrade und Einsatzorte. Die Relevanz von Schlüsselressourcen und -anforderungen für das Arbeitsengagement wurde mit einer multiplen linearen Regressionsanalyse nach Multipler Imputation untersucht.
Die Schlüsselressourcen und -anforderungen erklärten 36% der Varianz des Arbeitsengagements der Pflegenden während der COVID-19-Pandemie. Es zeigten sich positive Zusammenhänge zwischen den Schlüsselressourcen Autonomie (β¯SP= 0,072, 95%-KI 0,011; 0,133), professionelle Ressourcen (β¯SP= 0,204, 95%-KI 0,124; 0,285) und zwischenmenschliche Beziehungen (β¯SP= 0,178, 95%-KI 0,117; 0,240) und dem Arbeitsengagement der Pflegenden. Bei den Anforderungen wirkten sich mangelnde formale Belohnungen negativ (β¯SP= -0,312, 95%-KI -0,380; -0,245) auf das Arbeitsengagement aus, Arbeitsüberlastung (β¯SP= 0,063, 95%-KI 0,001; 0,126) hingegen war positiv mit dem Arbeitsengagement assoziiert.
Die job demands-resources theory ist geeignet, das Arbeitsengagement auch in Krisenzeiten zu erklären. Die Schlüsselressourcen und -anforderungen haben insgesamt einen erheblichen Einfluss auf das Arbeitsengagement der Pflegenden unter Pandemiebedingungen. Allerdings kommt während der Pandemie nicht allen Schlüsselressourcen und -anforderungen tatsächlich ein Schlüsselstatus zu.
Mangelnden formalen Belohnungen sollte entgegengesteuert, professionelle Ressourcen sollten nachhaltig gesichert und die Autonomie von Pflegenden sowie deren zwischenmenschliche Beziehungen sollten gestärkt werden. Entscheidungen sollten dabei so getroffen werden, dass sie nicht nur pandemiegerecht, sondern nachhaltig tragfähig sind und damit verstetigt werden können.
Nurses are assigned a key role in pandemic response, with work engagement considered to be pivotal. The job demands-resources theory assumes that work engagement depends on job resources and job demands. Key job resources and demands have already been proposed for nurses. However, there is no evidence on their importance under pandemic conditions. Hence, the aim of this study was to investigate their relevance to nurses’ work engagement during the second wave of the COVID-19 pandemic.
The study was carried out in a cross-sectional design and addressed nurses in direct health care settings in Germany. Data was collected administering a quantitative online survey using valid and reliable measures during the second wave of the pandemic. A convenience sample was obtained, including the use of social media, randomly selected health care facilities, and all universities with nursing-related programs in Germany. The dataset for analyses comprised a total of 1,027 cases. The sample included nurses of various educational levels and from different sectors. Multiple linear regression analysis after multiple imputation was used to examine the relevance of key resources and demands for work engagement.
Key resources and demands explained 36% of the variance in nurses’ work engagement during the COVID-19 pandemic. Positive associations were found between the key resources of autonomy (β¯SP=0.072, 95% CI 0.011; 0.133), professional resources (β¯SP=0.204, 95% CI 0.124; 0.285), and interpersonal relationships (β¯SP=0.178, 95% CI 0.117; 0.240) and nurses’ work engagement. On the demands side, lack of formal rewards negatively (β¯SP=–0.312, 95% CI –0.380; –0.245) affected work engagement, whereas work overload (β¯SP=0.063, 95% CI 0.001; 0.126) was positively associated with work engagement.
The job demands-resources theory is suitable for explaining nurses’ work engagement even in times of crisis. Taken together, key resources and demands have a significant influence on nurses’ work engagement under pandemic conditions. However, not all so-called key resources and demands actually have a key status in a pandemic.
Any lack of formal rewards should be countered, professional resources should be sustainably secured, and the autonomy of nurses and their interpersonal relationships should be strengthened. Nursing management decisions should be made not only with the current pandemic but also the post-pandemic period in mind.
Demands, resources, and work engagement of nurses during the second wave of the COVID-19 pandemic - A cross-sectional study
Nurses are assigned a key role in managing the COVID-19 pandemic. Of ...particular importance is their work engagement, depending on job demands and resources. So far, there have only been scattered and first-wave related indications of nurses' job demands, resources and work engagement in Germany during the pandemic.
To systematically assess key job demands, key job resources and work engagement of nursing staff for the second wave of the COVID-19 pandemic, also differentiating between various groups of nurses.
The study was realized in a cross-sectional design and included nurses in direct health care settings in Germany. Data was collected with an online questionnaire using valid and reliable measures during the second wave of the pandemic. The dataset for analyses comprised 1027 cases in total.
Regarding demands, work overload was even higher than before the pandemic, but work-life interferences were less pronounced. Nurses' resource architecture was not fundamentally changed by the pandemic, but interpersonal relationships and autonomy were rated more positively. Domiciliary care workers assessed demands and resources more positively than nurses in nursing homes or hospitals, whereas nurses caring for COVID-19 patients evaluated demands and resources more critically. Nurses' work engagement was higher during the second pandemic wave than in the first wave, but still low overall.
Due to the importance of work engagement for nurses' health and performance and thus the quality of care, demands and resources must be further improved. Starting points are, e. g., fostering team cohesion, strengthening autonomy, and managing workload.
This ENETS guidance paper aims to provide practical advice to clinicians for the diagnosis, treatment and follow‐up of functioning syndromes in pancreatic neuroendocrine tumours (NET). A ...NET‐associated functioning syndrome is defined by the presence of a clinical syndrome combined with biochemical evidence of inappropriately elevated hormonal levels. Different hormonal syndromes can be encountered in pancreatic NET patients, including insulinoma, gastrinoma as well as the rare glucagonoma, VIPoma, ACTHoma, PTHrPoma, carcinoid syndrome, calcitoninoma, GHRHoma and somatostatinoma. The recommendations provided in this paper focus on the biochemical, genetic and imaging work‐up as well as therapeutic management of the individual hormonal syndromes in well‐differentiated, grade 1‐3, functioning NET with the primary tumour originating in the pancreas, and for specific subtypes also in the duodenum.
Stem cell therapy may be useful in chronic myocardial infarction (MI); this is conceivable, but not yet demonstrated in humans.
After acute MI, bone marrow-derived cells improve cardiac function.
We ...treated 18 consecutive patients with chronic MI (5 months to 8.5 years old) by the intracoronary transplantation of autologous bone marrow mononuclear cells and compared them with a representative control group without cell therapy.
After three months, in the transplantation group, infarct size was reduced by 30% and global left ventricular ejection fraction (+15%) and infarction wall movement velocity (+57%) increased significantly, whereas in the control group no significant changes were observed in infarct size, left ventricular ejection fraction, or wall movement velocity of infarcted area. Percutaneous transluminal coronary angioplasty alone had no effect on left ventricular function. After bone marrow cell transplantation, there was an improvement of maximum oxygen uptake (VO2max, +11%) and of regional 18F-fluor-desoxy-glucose uptake into infarct tissue (+15%).
These results demonstrate that functional and metabolic regeneration of infarcted and chronically avital tissue can be realized in humans by bone marrow mononuclear cell transplantation.
The value of surgical resection in the management of pancreatic neuroendocrine tumors (PNET) with liver metastases (LM) is still debated. The aim of this study was to evaluate the outcomes of surgery ...of PNET with LM.
Patients with PNET with synchronous LM between 2000 and 2011 from 4 high-volume institutions were included. The patients were divided into 3 groups: curative resection, palliative resection, and no resection.
Overall, 166 patients were included. Eighteen patients (11%) underwent curative resection, 73 patients (43%) underwent palliative resection, and 75 patients (46%) underwent conservative treatment. The median overall survival (OS) from the time of diagnosis was 73 months. Patients who underwent curative resection had a significantly better median OS from the initial diagnosis compared with those who underwent palliative resection and those who were conservatively treated (97 vs. 89 vs. 36 months, p = 0.0001). The median OS from the time of diagnosis in those patients who underwent radical or palliative resection was 97 months, with a 5-year survival rate of 76%. On multivariate analysis, factors associated with OS from the time of diagnosis were the presence of bilobar metastases, tumor grading, and curative resection in a first model. On a second model, curative or palliative surgery was an independent predictor of OS. Among 91 patients who underwent surgery, the presence of pancreatic neuroendocrine carcinoma G3 was the only factor independently associated with a poorer survival after surgery (median OS: 35 vs. 97 months, p < 0.0001).
Patients with LM from PNET benefit from surgical resection, although surgery should be reserved to well- or moderately differentiated forms.
The study of Hox clusters and genes provides insights into the evolution of genomic regulation of development. Derived ray-finned fishes (Actinopterygii, Teleostei) such as zebrafish and pufferfish ...possess duplicated Hox clusters that have undergone considerable sequence evolution. Whether these changes are associated with the duplication(s) that produced extra Hox clusters is unresolved because comparison with basal lineages is unavailable. We sequenced and analyzed the HoxA cluster of the bichir (Polypterus senegalus), a phylogenetically basal actinopterygian. Independent lines of evidence indicate that bichir has one HoxA cluster that is mosaic in its patterns of noncoding sequence conservation and gene retention relative to the HoxA clusters of human and shark, and the HoxAalpha and HoxAbeta clusters of zebrafish, pufferfish, and striped bass. HoxA cluster noncoding sequences conserved between bichir and euteleosts indicate that novel cis-sequences were acquired in the stem actinopterygians and maintained after cluster duplication. Hence, in the earliest actinopterygians, evolution of the single HoxA cluster was already more dynamic than in human and shark. This tendency peaked among teleosts after HoxA cluster duplication.
PDF
