BACKGROUND & AIMS: :While the nephrology nursing shortage persists despite the continued growth of the population of individuals with Stage 5 chronic kidney disease, there is a paucity of empirical data regarding nephrology nurses' perceptions of their work environments. Moreover, there are no studies that have examined the relationship of work environment attributes to patient and nurse outcomes in dialysis settings. The purpose of this study was to examine the relationships between staff nurses' perceptions of dialysis work environments, nurses' intentions to leave their current jobs, nurse turnover, patient satisfaction, and patient hospitalization rates. A descriptive, correlational design was used. Nurse level and facility level data were obtained. The sample for nurse-level data consisted of 199 registered nurses in staff nurse roles in 56 dialysis facilities of a national dialysis company. The sample for facility-level analysis consisted of 46 dialysis facilities, and nurse-level data were aggregated for facility-level analysis. The Practice Environment Scale-Nursing Work Index (PES-NWI) was used to measure nurses' perceptions of the dialysis work environment. Nurses' intention to leave their jobs and facility-level turnover rates were the nurse outcomes examined in this study. Facility-level patient satisfaction and hospitalization rates were the patient outcomes examined. Correlation coefficients were computed to measure the relationships between study variables, and independent t-tests were performed to examine subgroup differences in work environment perceptions. Overall, nurses rated the work environment somewhat favorably. Nurses who expressed intention to leave their jobs rated the work environment more negatively compared to nurses who intended to stay. Significant correlations were found between nurses' perceptions of the dialysis work environment, nurses' intention to leave their jobs, nurse turnover rates, and patient hospitalizations. Study findings suggest that nurses' perceptions of the dialysis work environment are important for nurse and patient outcomes in dialysis settings. Further research is needed to explore the predictive ability of the work environment for nurse and patient outcomes in hemodialysis units.

背景与目标： ：尽管尽管患有5期慢性肾脏病的人数持续增长，但肾科护理人员短缺仍然存在，但是关于肾科护士对其工作环境的看法的经验数据很少。此外，尚无研究检查透析环境中工作环境属性与患者和护士结局之间的关系。这项研究的目的是检验护士对透析工作环境的看法，护士离职的意图，护士离职率，患者满意度和患者住院率之间的关系。使用了描述性的相关设计。获得了护士级别和设施级别的数据。护士级数据的样本由199家在一家国家透析公司的透析设施中担任护士职位的注册护士组成。用于设施级分析的样本由46个透析设施组成，并且汇总了护士级数据以进行设施级分析。实践环境量表-护理工作指数（PES-NWI）用于衡量护士对透析工作环境的看法。护士离开工作的意图和机构级别的离职率是本研究中检查的护士结局。设施水平的患者满意度和住院率是检查的患者结局。计算相关系数以衡量研究变量之间的关系，并进行独立的t检验以检验工作环境感知中的亚组差异。总体而言，护士对工作环境的评价较高。与打算留下来的护士相比，打算离开工作的护士对工作环境的评价更为负面。在护士对透析工作环境的看法，护士离开工作的意愿，护士离职率和患者住院之间，发现了显着的相关性。研究结果表明，护士对透析工作环境的理解对于透析环境中的护士和患者结局非常重要。需要进一步的研究来探索工作环境对血液透析部门护士和患者结果的预测能力。

BACKGROUND & AIMS: OBJECTIVES:To test an educational intervention designed to improve lactation knowledge, attitudes, and beliefs of NICU nurses and to improve their intentions to provide mothers with lactation support. DESIGN:Quasi-experimental, time-series pretest/posttest. SETTING:NICU of a Midwestern, free-standing, tertiary-care children's hospital. PARTICIPANTS:Convenience sample of 64 NICU nurses and 2 separate convenience samples of mothers of infants hospitalized in the NICU (n=19 and 13, respectively). METHODS:Nurses were measured on study outcomes at multiple time points, beginning with 2 weeks before and ending at 3 months after attendance to a 4-hour educational program. Mothers were sampled before and 3 months after the intervention. MAIN OUTCOME MEASURE(S):Nurses' lactation knowledge, attitudes, beliefs, and intentions to support lactation and mothers' perceptions of lactation support in the NICU. RESULTS:Findings suggest that this educational intervention was effective for improving NICU nurses' lactation knowledge and attitudes, and that these improvements were maintained over time. Further, the supportive atmosphere for lactation in this NICU significantly improved following the implementation of the educational intervention for nurses. CONCLUSION:Intermittent, short educational programs which include practical how-to's and motivational encouragement for staff may provide the empowerment nurses need in order to be supportive of lactation.

背景与目标： 目的：测试旨在提高NICU护士的哺乳知识，态度和信念并改善其为母亲提供哺乳支持的意图的教育干预措施。
设计：准实验性，时间序列的前测/后测。
地点：中西部独立式三级儿童医院的NICU。
参与者：64位新生儿重症监护病房护士的便利性样本和在新生儿重症监护病房住院的婴儿母亲的2个单独的便利性样本（分别为n = 19和13）。
方法：从多个时间点（从参加4小时教育计划的前2周开始到结束3个月后）对学习结局进行测量。在干预前和干预后三个月对母亲进行了采样。
主要观察指标：护士对哺乳的知识，态度，信念和意图，以及母亲对新生儿重症监护病房的哺乳支持的看法。
结果：研究结果表明，这种教育干预措施可有效改善重症监护病房护士的哺乳知识和态度，并且随着时间的流逝，这些改善措施得以保持。此外，在实施护士教育干预后，该新生儿重症监护室（NICU）的哺乳支持气氛得到了显着改善。
结论：间歇性，短期的教育计划包括实用的操作方法和对员工的激励性鼓励，可以为护士提供支持哺乳所需的能力。

BACKGROUND & AIMS: BACKGROUND:Screening, brief intervention, and referral to treatment (SBIRT) for substance use has an impact on morbidity and mortality and health care cost. LOCAL PROBLEM:Nurses in ambulatory care settings may lack knowledge about evidence-based substance use SBIRT. METHODS:A comparison of pre- and postintervention data was performed to determine whether knowledge improved and to identify facilitators and barriers to SBIRT implementation. INTERVENTIONS:Nurses completed an online self-paced program focusing on alcohol and drug use screening, motivational interviewing used in a brief intervention, and referral to specialty treatment. RESULTS:Postintervention knowledge scores increased (P < .001). Facilitator and barrier themes included time, education, resources, receptivity, and interprofessional collaboration. CONCLUSIONS:The implementation of the SBIRT online program was feasible for nurses to complete during work hours and resulted in increased SBIRT-related knowledge.

背景与目标： 背景：筛查，短暂干预和转介治疗（SBIRT）以使用药物会影响发病率，死亡率和医疗保健成本。
本地问题：非卧床护理环境中的护士可能缺乏基于证据的药物使用SBIRT的知识。
方法：比较干预前和干预后的数据，以确定知识是否有所改善，并确定实施SBIRT的促进因素和障碍。
干预措施：护士完成了一个在线自定进度的计划，重点是酒精和药物使用筛查，简短干预中使用的动机访谈以及转诊至专科治疗。
结果：干预后知识得分增加（P <.001）。促进者和障碍的主题包括时间，教育，资源，接受能力和专业间的合作。
结论：实施SBIRT在线计划对于护士在工作时间内完成工作是可行的，并增加了与SBIRT相关的知识。

BACKGROUND & AIMS: :Health care systems are changing at an unprecedented rate, but few are making the changes in a system affecting nearly 200,000 staff in over 1,100 different sites of service delivery originating from 171 medical centers nationwide, as is the Veterans Health Administration. The issues of change, quality of care, morale and opportunities involved in being a nurse today in a system undergoing this magnitude of change is presented within the framework of the quality of care initiatives that have been launched by VA. The new organization design of VA, emphasizing local decision-making, a description of the multiple quality programs recently introduced and integrative strategies that have been used by the Nursing Strategic Healthcare Group, the VA corporate level policy and nursing programs information center for the country, to support the change process are discussed.

背景与目标： ：医疗保健系统正在以前所未有的速度变化，但很少有系统在变化，这种变化影响了来自171个医疗中心的1,200多个服务站点中近200,000名员工，而退伍军人健康管理局也是如此。在弗吉尼亚州发起的护理质量计划的框架内，提出了在当今经历如此巨大变化的系统中，成为一名护士所涉及的变革，护理质量，士气和机会等问题。弗吉尼亚州的新组织设计，着重于地方决策，描述了最近引入的多项质量计划以及护理战略医疗保健集团，该州弗吉尼亚州公司级政策和护理计划信息中心所采用的综合策略，支持变更过程的讨论。

BACKGROUND & AIMS: BACKGROUND:It is important to clarify nurses' perceptions of conditions for patient education in daily work as research findings are ambiguous. There is a gap between societal regulations on nurses' competence in accomplishment/achievement of patient education and research findings. AIM:The aim was to describe nurses' perceptions of conditions for patient education, focusing on aspects of competence. The aim was also to describe differences in conditions for nurses working in primary, municipal and hospital care. METHODS:The study is a cross-sectional survey and is part of a project about nurses' patient-education. A randomized selection of nurses (842) received a questionnaire comprising 47 items concerning factual experience and attitudes to patient education and 13 background items. Questionnaires were returned by 83% of participants. Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. RESULTS:Nurses' perceptions of conditions for patient education differ between health-care settings. Primary care nurses are at an advantage in following research in patient education, perception of their own competence (prioritizing and knowing their mandate in patient teaching), pedagogical education and post graduate specializations. CONCLUSIONS:Nurses' patient education must be more visualized and appropriate conditions created at each workplace. In this change process, managers' support is considered vital.

背景与目标： 背景：由于研究结果含糊不清，因此必须弄清护士对患者在日常工作中所受教育条件的看法。关于护士在完成/实现患者教育和研究结果方面的能力的社会法规之间存在差距。
目的：旨在描述护士对患者教育条件的看法，重点放在能力方面。目的还在于描述初级，市政和医院护理工作护士的条件差异。
方法：这项研究是一项横断面调查，是有关护士患者教育项目的一部分。随机选择的护士（842）收到了一份调查表，包括47项与事实经验和对患者教育的态度有关的调查表，以及13项背景调查表。 83％的参与者返回了问卷。使用了开放性项目的描述性统计，非参数测试和内容分析。
结果：在医疗机构之间，护士对患者教育条件的看法有所不同。初级保健护士在以下方面具有优势：在患者教育方面的研究，对自身能力的感知（优先考虑和了解患者在教学中的职责），教育学教育和研究生专业。
结论：护士的患者教育必须更加形象化，并在每个工作场所创造适当的条件。在这种变革过程中，经理的支持被认为是至关重要的。

BACKGROUND & AIMS: :Oncology nurses encounter increasingly complex ethical challenges in clinical practice. This ethnographic study explored 30 oncology nurses' descriptions of ethical situations and 12 key informants' perspectives on factors that influence the development of ethically difficult situations. Nurses described the goals of preventing patient suffering and injury, being honest with patients, and contributing meaningfully to patient improvement and stated goals. Nurses experienced six primary challenges in meeting their goals: being the eyes and arms of patient suffering, experiencing the precariousness of competing obligations, navigating the intricacies of hope and honesty, managing the urgency caused by waiting, straining to find time, and weighing risks of speaking up in hierarchal structures. Nurse actions included addressing concerns, creating other avenues, murmuring to one another, staying silent, and looking away. Several factors influenced nurses' responses to ethical challenges. Results imply a contextual model of moral action that reveals a need for altering practice environments in addition to improving nurses' ethics skills. Nurses are very aware of their moral responsibilities in ethically difficult situations and need work environments conducive to interprofessional collaboration and open dialogue.

背景与目标： ：肿瘤科护士在临床实践中面临越来越复杂的伦理挑战。这项人种学研究探讨了30位肿瘤科护士对道德状况的描述，以及12位主要信息提供者对影响道德困难状况发展的因素的观点。护士描述了预防患者遭受痛苦和伤害，对患者诚实并为患者改善做出有意义的贡献的目标，并阐明了目标。护士在实现其目标方面遇到了六个主要挑战：成为患者痛苦的眼睛和手臂，经历竞争义务的pre可危，克服希望和诚实的错综复杂，管理因等待而造成的紧迫性，费力地寻找时间，以及权衡风险在层级结构中发言。护士的行动包括解决疑虑，开辟其他渠道，互相抱怨，保持沉默以及将目光移开。几个因素影响了护士对道德挑战的反应。结果暗示道德行动的情境模型表明，除了提高护士的道德技能外，还需要改变实践环境。护士非常意识到自己在道德困难的情况下应承担的道德责任，因此需要有利于专业间合作和公开对话的工作环境。

BACKGROUND & AIMS: :As nurses move into more nontraditional, expanded roles, they sometimes lack a social and professional support group within the work setting. Feeling isolated and lacking support, several clinical nurse specialists (CNSs) at a large county institution began the Specialty Nursing Council. The Specialty Nursing Council provides a means of networking and support for nurses in specialty roles in a three institution health care campus. Monthly meetings are conducted to bring members together and for continuing education programs. The keys to success in forming this type of council are: 1) a dedicated group that plans, organizes, and distributes informational material; 2) common goals and objectives; 3) direct benefits to members.

背景与目标： ：随着护士担任非传统的，扩展的角色，他们有时在工作环境中缺乏社会和专业支持小组。感到孤立无援且缺乏支持，一家大型县级机构的几名临床护士专家（CNS）成立了专业护理委员会。专业护理委员会为三机构医疗保健园区中担任专业角色的护士提供了一种联网和支持的手段。每月举行一次会议，以使成员聚集在一起并参加继续教育计划。成立这种类型的理事会的成功关键在于：1）一个专门小组，负责计划，组织和分发信息材料； 2）共同的目标； 3）直接给会员带来的好处。

BACKGROUND & AIMS: :Little is known about the current training and barriers in resuscitation skills among practicing ward nurses. A convenience sample of 459 ward nurses, recruited from 11 academic teaching hospitals in Korea, were surveyed to assess current training and barriers to optimal resuscitation performance on the wards. The Perceived Barriers scale was developed, refined, and its psychometric properties were assessed. Approximately 36% of nurses had received simulation-based resuscitation skills training. Exploratory factor analysis identified four barriers accounting for 58.4% of the variance: insufficient training (37.7%), lack of competence (9.8%), lack of self-confidence (5.9%), and workload and tension (5.1%). Strategic planning and resuscitation skills training should be incorporated into staff development programs to reduce barriers to optimal resuscitation performance and cope with work demands for ward nurses.

背景与目标： ：关于执业病房护士当前对复苏技能的培训和障碍知之甚少。从韩国11家学术教学医院招募的459名病房护士的便利样本进行了调查，以评估病房当前的培训和最佳复苏性能的障碍。感知障碍量表得到了发展，完善，并评估了其心理测量特性。大约36％的护士接受了基于模拟的复苏技能培训。探索性因素分析确定了四个障碍，占差异的58.4％：培训不足（37.7％），缺乏能力（9.8％），缺乏自信（5.9％），工作量和紧张程度（5.1％）。应将战略规划和复苏技术培训纳入员工发展计划中，以减少实现最佳复苏绩效的障碍并应对病房护士的工作需求。

BACKGROUND & AIMS: :The purpose of this study was to determine school nurses' knowledge of state and school district policies, their experience regarding the administration of rectal diazepam gel in the school, and the perceived benefits and barriers of providing this treatment. Four hundred nineteen nurses responded to a survey conducted during the National Association of School Nurses Annual Meeting. Seventy-one (18%) nurses surveyed had administered rectal diazepam gel in a school setting, while 54 (13%) nurses reported that either their state practice act or school district prohibited them from giving rectal medications in the school. Medication administration benefits, such as early intervention for treatment of acute seizure emergencies, were noted. Barriers were also identified, with lack of privacy as the most frequently listed. Scope of practice as it pertains to administering medication in the school and the extent to which delegation of duties can be used in the situation of administering rectal medication in a seizure emergency remain issues for school nurses.

背景与目标： ：这项研究的目的是确定学校护士对州和学区政策的了解，他们在学校中使用直肠地西epa凝胶管理的经验以及提供这种治疗方法的感知收益和障碍。 419名护士回应了全国学校护士协会年会期间进行的一项调查。接受调查的71名（18％）护士在学校环境中使用了直肠地西epa凝胶，而54名（13％）护士报告说，他们的州执业法令或学区禁止他们在学校中使用直肠药物。指出了药物管理的好处，例如对急性癫痫急症的早期干预。还列出了最常见的障碍，其中缺乏隐私。与学校管理药物有关的业务范围以及在癫痫发作紧急情况下管理直肠药物的情况下可以行使职责的程度仍然是学校护士的问题。

BACKGROUND & AIMS: :Results from several research studies combined with increasing public tensions surrounding physician-assisted suicide have fueled a growing awareness of the inadequacies of end-of-life care. Investigators also suggest that intensive care unit nurses have a limited role in end-of-life decision making and care planning. This article explores cultural issues influencing end-of-life care in intensive care units, explores factors surrounding the limited involvement of critical care nurses in end-of-life decision making and care planning, and offers recommendations for changing nursing practice. Because improving end-of-life care will require cultural changes, an understanding of the cultural issues involved is needed. Recommendations for changing nursing practice include a model of end-of-life care that incorporates the goals of both cure and comfort care, as well as a shared decision-making process. Nurses are essential to improving end-of-life care in today's intensive care units.

背景与目标： ：几项研究的结果，加上围绕医生协助自杀的日益紧张的公众气氛，加剧了人们对临终关怀不足的认识。研究人员还建议，重症监护室护士在临终决策和护理计划中的作用有限。本文探讨了重症监护病房中影响临终护理的文化问题，探讨了重症监护护士在临终决策和护理计划中参与有限的因素，并提出了改变护理实践的建议。由于改善报废医疗将需要文化上的改变，因此需要对所涉及的文化问题有一个了解。改变护理习惯的建议包括一个结合了治愈和舒适护理目标以及共同决策过程的临终护理模型。在当今的重症监护病房中，护士对于改善临终护理至关重要。

BACKGROUND & AIMS: RATIONALE:The professional identity and experiences of nurses have been focused upon in different studies AIM:This is a longitudinal study whose aim was to understand how nurses experience the meaning of their identity as nurses, when they are students and nurses 2 years after graduation. DESIGN:Data were collected through interviews once a year during education and two years after graduation, and were analysed using a phenomenological hermeneutic method, inspired by the philosophy of Paul Ricoeur. FINDINGS:The analyses of the narratives resulted in four perspectives: 'Having the patient in focus', 'Being a team leader', 'Preceptorship' and 'Task orientation'. The nurses did not change perspectives but the perspective showed a transition over time. CONCLUSION:The nurses' not changing perspective over time is understood as being a life paradigm, remaining throughout the years.

背景与目标： 理由：在不同的研究中，护士的专业身份和经验已得到关注
目的：这是一项纵向研究，目的是了解毕业后两年的护士和学生时，护士如何体会其作为护士的身份的含义。
设计：在教育期间和毕业两年后，通过每年一次的访谈收集数据，并采用一种现象学的诠释学方法对这一数据进行分析，该方法的灵感来自于保罗·里科（Paul Ricoeur）的哲学。
结果：对叙述的分析产生了四个视角：“使患者成为焦点”，“成为团队负责人”，“领导能力”和“任务导向”。护士们没有改变观点，但是观点显示了随着时间的推移。
结论：随着时间的流逝，护士的观点没有改变，这被认为是一种生活范式，并且一直存在。

BACKGROUND & AIMS: OBJECTIVES:The study investigated whether nurses' different working schedules are associated with different levels of job-related strain, health symptoms and behavior. No reports have been accessible in the relevant literature on the possible association between shift work and job-related strain in nurses. MATERIALS AND METHODS:This was a cross-sectional study conducted at a large university hospital in North-East Italy, involving 806 nurses working in selected departments. A multilevel logistic regression was applied to assess the association between work shift conditions and selected outcomes. RESULTS:Night shifts were associated not only with higher odds of having a high Job Demand, but also with lower odds of having a high Decision Authority and consequently with a stronger likelihood of having higher levels of Job Strain (high Job Demand score ≥ 38 and Low Decision Authority). The night shift was associated with various symptoms, particularly exhaustion (p = 0.039) and gastric pain (p = 0.020). Nurses' working schedules did not affect their job satisfaction scores. CONCLUSIONS:It has been confirmed that night shifts are a risk factor for nurses' health perception and working night shifts carries a considerable degree of strain. This is a condition that hospital nursing managements need to consider carefully to avoid burnout in nursing personnel and prevent an excessive turnover in this profession, which is a recurring problem for health care organizations.

背景与目标： 目的：该研究调查了护士的不同工作时间表是否与不同水平的工作相关的压力，健康症状和行为有关。在相关文献中，没有关于护士轮班工作与工作相关压力之间可能相关性的报道。
材料与方法：这是在意大利东北部的一家大型大学医院进行的一项横断面研究，涉及选定部门的806名护士。应用多级逻辑回归来评估轮班条件与选定结果之间的关联。
结果：夜班不仅与较高的工作需求机会相关，而且与具有较高决策权限的可能性较低有关，因此与较高的工作压力（较高的工作需求得分≥38并且低决策机构）。夜班与各种症状有关，尤其是精疲力竭（p = 0.039）和胃痛（p = 0.020）。护士的工作时间表不会影响他们的工作满意度得分。
结论：已经证实，夜班是护士健康感知的危险因素，而夜班工作会带来相当大的压力。这是医院护理管理人员需要仔细考虑的一种情况，以避免护理人员的倦怠并防止该行业的人员更替，这是医疗保健组织经常遇到的问题。

BACKGROUND & AIMS: :Reactive oxygen species (ROS), normally generated through biologic processes, may damage DNA, lipids, and proteins. ROS are balanced through enzymatic mechanisms and exogenous antioxidants; imbalance results in oxidative stress. Limited data suggest an association between oxidative stress and breast cancer. We evaluated pre-diagnostic plasma fluorescent oxidation products (FlOP), a global biomarker of oxidative stress, and breast cancer risk in a nested case-control study in the Nurses' Health Study. Participants provided two blood samples (1989-1990 and 2000-2002) (N = 18,743). 377 women developed breast cancer between the second collection and June 1, 2006. Cases were matched to 377 controls. Relative fluorescent intensity at three different excitation/emission wavelengths (FlOP_360, FlOP_320, FlOP_400) were quantified in both samples, providing distant (≥10 years before diagnosis) and proximate (≤6 years before diagnosis) measures of oxidative stress. We observed no association between FlOP and breast cancer risk in proximate or distant samples (e.g., proximate extreme quartiles: FlOP_360, RR 0.8, 95 % CI 0.5-1.3, p trend = 0.49; FlOP_320, RR 1.1, 95 % CI 0.7-1.7, p trend = 0.53; FlOP_400, RR 1.3, 95 % CI 0.8-2.0, p trend = 0.80). In general no association was observed when cross-classifying or averaging proximate and distant exposure (e.g., extreme quartile of averages: FlOP_360, OR 0.9, 95 % CI 0.6-1.4, p trend = 0.82; FlOP_400, OR 0.9, 95 % CI 0.6-1.4, p trend = 0.55), with the exception of a significant trend for average FlOP_320 (extreme quartiles, OR 1.6, 95 % CI 1.0-2.4, p trend = 0.02). We did not observe important associations between FlOP and breast cancer risk in this large prospective study, though our data suggest women with consistently high FlOP_320 may be at increased risk.

背景与目标： ：通常通过生物过程产生的活性氧（ROS）可能会损坏DNA，脂质和蛋白质。 ROS通过酶促机制和外源性抗氧化剂来平衡。不平衡会导致氧化应激。有限的数据表明氧化应激与乳腺癌之间存在关联。在“护士健康研究”中的嵌套病例对照研究中，我们评估了诊断前的血浆荧光氧化产物（FlOP），氧化应激的全球生物标志物和乳腺癌的风险。参与者提供了两个血液样本（1989-1990年和2000-2002年）（N = 18,743）。在第二批收集到2006年6月1日之间，有377名妇女患了乳腺癌。病例与377名对照者匹配。在两个样品中都对三个不同激发/发射波长（FlOP_360，FlOP_320，FlOP_400）的相对荧光强度进行了定量，从而提供了远距离（诊断前≥10年）和接近（诊断前≤6年）的氧化应激指标。我们观察到在近或远样本中FlOP与乳腺癌风险之间没有关联（例如，近四分位数：FlOP_360，RR 0.8，95％CI 0.5-1.3，p趋势= 0.49; FlOP_320，RR 1.1，95％CI 0.7-1.7 ，p趋势＝ 0.53； FlOP_400，RR 1.3，95％CI 0.8-2.0，p趋势＝ 0.80）。通常，对近距离和远距离暴露进行交叉分类或取平均值时，未观察到关联（例如，平均值的极四分位数：FlOP_360，或0.9，95％CI 0.6-1.4，p趋势= 0.82； FlOP_400，或0.9，95％CI 0.6 -1.4，p趋势= 0.55），平均FlOP_320的显着趋势除外（极四分位数，或1.6，95％CI 1.0-2.4，p趋势= 0.02）。在这项大型的前瞻性研究中，我们并未观察到FlOP与乳腺癌风险之间的重要关联，尽管我们的数据表明，持续高FlOP_320的女性可能处于增加的风险中。

BACKGROUND & AIMS: :Hereditary nonpolyposis colorectal cancer (HNPCC), also referred to as Lynch syndrome, is the most common form of hereditary colorectal cancer and is responsible for 2% to 4% of all colorectal cancers in the Western hemisphere. Generally characterized by early-onset colorectal carcinoma with a mean age of presentation of 40 to 45 years, it can also manifest with extracolonic adenocarcinomas and cancers of the endometrium, ovaries, stomach, pancreas, small intestine, hepatobiliary tract, upper uroepithelial tract, brain, and skin. HNPCC is autosomal dominant and carries an 80% lifetime risk of cancer development. This review addresses the molecular underpinnings of HNPCC while providing a concise approach to clinical detection, diagnosis, and management of patients who may or may not test positive for an HNPCC-causing mutation. Although applicable to any patient-care setting in which cancer may be observed, this review specifically addresses the role of nurses in detecting, diagnosing, and clinically managing HNPCC.

背景与目标： 遗传性非息肉性结直肠癌（HNPCC），也称为Lynch综合征，是遗传性结直肠癌的最常见形式，占西半球所有结直肠癌的2％至4％。一般以早发性大肠癌为特征，平均发病年龄为40至45岁，也可表现为结肠外腺癌和子宫内膜癌，卵巢癌，胃癌，胰腺癌，小肠癌，肝胆道癌，尿道上皮道癌，脑癌和皮肤。 HNPCC是常染色体显性基因，终生罹患癌症的风险为80％。这项审查解决了HNPCC的分子基础，同时为临床检测，诊断和管理可能会或可能不会导致HNPCC突变的患者提供了简洁的方法。尽管适用于可能观察到癌症的任何患者护理环境，但本次审查特别针对护士在检测，诊断和临床管理HNPCC中的作用。

BACKGROUND & AIMS: INTRODUCTION:Unrelieved acute musculoskeletal pain continues to be a reality of major clinical importance, despite advancements in pain management. Accurate pain assessment by nurses is crucial for effective pain management. Yet inaccurate pain assessment is a consistent finding worldwide in various clinical settings, including the emergency department. In this study, pain assessments between nurses and patients with acute musculoskeletal pain after extremity injury will be compared to assess discrepancies. A second aim is to identify patients at high risk for underassessment by emergency nurses. METHODS:The prospective PROTACT study included 539 adult patients who were admitted to the emergency department with musculoskeletal pain. Data on pain assessment and characteristics of patients including demographics, pain, and injury, psychosocial, and clinical factors were collected using questionnaires and hospital registry. RESULTS:Nurses significantly underestimated patients' pain with a mean difference of 2.4 and a 95% confidence interval of 2.2-2.6 on an 11-points numerical rating scale. Agreement between nurses' documented and patients' self-reported pain was only 27%, and 63% of the pain was underassessed. Pain was particularly underassessed in women, in persons with a lower educational level, in patients who used prehospital analgesics, in smokers, in patients with injury to the lower extremities, in anxious patients, and in patients with a lower urgency level. DISCUSSION:Underassessment of pain by emergency nurses is still a major problem and might result in undertreatment of pain if the emergency nurses rely on their assessment to provide further pain treatment. Strategies that focus on awareness among nurses of which patients are at high risk of underassessment of pain are needed.

背景与目标： 简介：尽管疼痛管理有所进步，但无法缓解的急性肌肉骨骼疼痛仍然是重要的临床现实。护士进行准确的疼痛评估对于有效的疼痛管理至关重要。然而，不准确的疼痛评估在包括急诊科在内的各种临床环境中都是全球一致的发现。在这项研究中，将比较四肢受伤后护士与急性肌肉骨骼疼痛患者之间的疼痛评估，以评估差异。第二个目标是确定急诊护士评估不足的高风险患者。
方法：前瞻性PROTACT研究包括539名成年患者，他们因肌肉骨骼疼痛而被送往急诊科。使用问卷和医院注册中心收集有关疼痛评估和患者特征的数据，包括人口统计学，疼痛和伤害，社会心理和临床因素。
结果：在11分的数字评分量表上，护士明显低估了患者的疼痛，平均差异为2.4，95％的置信区间为2.2-2.6。护士记录的疼痛与患者自我报告的疼痛之间的一致性仅为27％，而对疼痛的63％评估不足。妇女，教育程度较低的人，使用院前镇痛药的患者，吸烟者，下肢受伤的患者，焦虑的患者和尿急程度较低的患者对疼痛的评估尤其不足。
讨论：急诊护士对疼痛的低估仍然是一个主要问题，如果急诊护士依靠他们的评估来提供进一步的疼痛治疗，可能会导致疼痛的治疗不足。需要采取针对护士的意识的策略，即哪些患者极有可能无法充分评估疼痛。