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A stochastic model motivated by the Lagrangian transported probability density function method for turbulent reacting flows and the cellular automata approach for forest fires was put together to simulate propagation of fires in terrains with inhomogeneous composition. In contrast to the usual cellular automata models for fires where the probability of ignition is prescribed, here the ignition of cells is determined by a random walk that mimics turbulent convection and diffusion of the hot gases and firebrands from upwind and neighbouring fire fronts. Radiation is also included. The model is aimed at speed of computation while approximating the key physics through only a few terrain-related inputs and tunable parameters representing fire intensity, hot gas and ember decay timescales, cell ignition delay and local turbulence. These parameters were calibrated against controlled fire experiments and the model was then used to give reasonable predictions for fires of increasing complexity. The presented framework allows improvements for more accurate representation of the flammable material characteristics, fire-induced flow modifications, and most other phenomena present in fires, hence providing an extendable and simple yet physically-realistic novel modelling approach.

Bottom-up proteomics analyses have been proved over the last years to be a powerful tool in the characterization of the proteome and are crucial for understanding cellular and organism behaviour. Through differential proteomic analysis researchers can shed light on groups of proteins or individual proteins that play key roles in certain, normal or pathological conditions. However, several tools for the analysis of such complex datasets are powerful, but hard-to-use with steep learning curves. In addition, some other tools are easy to use, but are weak in terms of analytical power. Previously, we have introduced ProteoSign, a powerful, yet user-friendly open-source online platform for protein differential expression/abundance analysis designed with the end-proteomics user in mind. Part of Proteosign's power stems from the utilization of the well-established Linear Models For Microarray Data (LIMMA) methodology. Here, we present a substantial upgrade of this computational resource, called ProteoSign v2, where we introduce major improvements, also based on user feedback. The new version offers more plot options, supports additional experimental designs, analyzes updated input datasets and performs a gene enrichment analysis of the differentially expressed proteins. We also introduce the deployment of the Docker technology and significantly increase the speed of a full analysis. ProteoSign v2 is available at http://bioinformatics.med.uoc.gr/ProteoSign., Graphical Abstract Graphical AbstractProteoSign v2: a faster and evolved user-friendly online tool for statistical analyses of differential proteomics.

In the present study, we report a case of a female infant with a de novo unbalanced t(14;15) translocation resulting in a 14-Mb deletion of the 15q11.1q14 region. The deletion includes the 15q11.2q13 Prader-Willi syndrome (PWS) critical region, while no known deleted genes are found in the 14qter region. According to literature review, patients with similar or larger deletions in the 15q region exhibit an expanded phenotype of PWS with case-specific atypical features such as severe retardation, absence of speech, microcephaly, retrognathia, bifid uvula, ear malformations, and heart defects in addition to typical features of PWS. Our proband exhibited increased deep tendon reflexes, an atypical feature which is not reported in the reviewed literature. The severity of the phenotype is not directly associated with the size of the deletion; however, using a combination of methods, the identification of breakpoints and the deleted genes can be helpful for the prognostication in patients with atypical PWS deletions.

RANCARE brought together a large number of researchers, early career investigators, policy makers, academicians, clinical nurses, and PhD students, to talk about and study on an international nursing phenomenon: missed nursing care. As COST actions rely on exchange of ideas, RANCARE made good use of every opportunity that would allow an in-depth study of its objectives. During the life span of RANCARE, a great number of visits, research collaborations, and project submissions for funding took place. Inevitably, these synergies significantly contributed to the success of the action in addition to further expanding the role of nursing as a health science.

Missed Nursing Care is widely recognized as affecting patient safety and healthcare outcomes. Theoretical frameworks, antecedents and consequences have been extensively studied while interventions aimed at preventing the Missed Nursing Care remain little investigated to date. Nurse Managers and Nurse Directors play a main role in promoting interventions at the unit, hospital and at the policy levels. However, few evidences are available to date, thus limiting an evidence-based approach. The aim of this study was to emerge interventions used on a daily basis by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care.A qualitative descriptive study design based upon a positive deviance approach was adopted. Twelve Nurse Managers and Nurse Directors were purposefully selected, working at Hospital, Healthcare Trust or Nursing Home levels, in Italy. Participants were interviewed in two focus group sessions. A thematic analysis of the audio-recorded interviews was performed by two researchers.The following interventions have been reported as effective in preventing and/or minimizing the Missed Nursing Care: (a) Expanding the nursing care capacity; (b) Ensuring the standard of care and an early detection of failures; (c) Monitoring the processes of care; (d) Promoting a shared decision-making; (e) Redesigning the layout of the hospital systems; (f) Promoting a culture towards the Missed Nursing Care prevention, and (g) Realigning the nurse management to the care of patients.Several interventions based mainly on process dimension and with preventive intents are daily enacted by Nurse Managers and Directors to prevent and/or minimize Missed Nursing Care. Measuring the effect of these interventions through rigorous studies could help in expanding the evidence available to contrast a phenomenon that threatens patient safety.

BACKGROUND: Oral health is considered essential for individuals’ well-being. Poor oral health has a negative impact on overall human health while contributing and predisposing to other diseases. It has been internationally documented that nurses delay or omit oral care of hospitalized patients and as a result of this, the risk of adverse events is increased. METHODS: Four focus groups were organized (n=30) to elicit the issue under study. Nurse managers and nurses working in medical and surgical departments in 3 acute care hospitals participated in June 2019. The discussions were coordinated by an independent moderator, using a semi-structured interview guide. Recordings of the conversations were transcribed and thematic analysis was performed according to Krueger and Casey guidelines. RESULTS The findings confirm that oral care of hospitalized patients is often omitted and is not acknowledged as an important patient need. The barriers and facilitators that affected oral health care positively or negatively were divided into three themes and included patient’ characteristics, nurses’ knowledge and skills and recourses as well as the working environment . CONCLUSIONS: Oral care is not considered as priority and there are many factors that contribute negatively or positively to its implementation. Nurse managers and nurses can play a crucial role for the adoption of universal oral care practices in hospitalized patients.

Aim To identify strategies to prevent Missed Nursing Care (MNC) that can be implemented by nurse managers/directors on a daily basis. Background Only few recommendations have been established to date aiming at supporting nurse managers/ directors in preventing MNC. However, several strategies are implemented on a daily basis, suggesting that a body of tacit, practical, and wise knowledge is already in place. Method(s) An international qualitative descriptive study based on the positive deviance approach conducted in 2019-2020 and reported according to The Consolidated Criteria for Reporting Qualitative Research. A purposeful sample of 35 nurse managers/directors working in hospitals in Cyprus, Italy, Germany and Switzerland was involved. Codes were extracted from each country and a thematic analysis was performed at the transnational level to identify strategies and interventions preformed to prevent MNC. Results Eight strategies and 22 interventions, mainly with preventive intent and designed at the hospital level, affecting both the processes and the structural dimensions, have been reported as effective in preventing MNC. Conclusion Nurse leaders are involved daily in implementing strategies to minimize MNC at the nursing and at the hospital system levels, integrated with each other. Implications for nursing management Preventing MNC should be a core value of the entire hospital, and not merely a nursing issue: therefore, complex interventions at the system level are required.

Objective The purpose of this study was to adapt and validate the Revised Practice Environment Scale of the Nursing Work Index, to be utilized among the Cyprus nurses’ population. Validated research scales are valuable tools in the hands of researchers in their attempt to recommend alterations within health care systems, especially during reform periods. Results Internal consistency reliability of the scale was satisfactory (alpha = 0.94). Exploratory factor analysis produced a five-factor structure solution. Experts in the field provided further guidance. The findings demonstrated that the Cyprus version of the Revised Practice Environment Scale of the Nursing Work Index is a reliable and valid research instrument, however differences with previous studies on the factor structure were observed, mainly due to cultural reasons. As a valid and reliable scale, it can capture the views of nurses concerning their work environment. The Cyprus version of the Revised Practice Environment Scale of the Nursing Work Index can be used by nurse managers and policy makers to introduce changes that may improve the quality of nursing care provided and enhance the patients’ satisfaction from the health system as a whole.

People are often reluctant to seek psychological help, mainly because they perceive help-seeking as a potential threat to their self-esteem. There is a need for cross-culturally valid instruments to assess attitudes, public- and self- stigma, which seem to play a critical role in seeking mental health treatment. We examined the factor structure, internal consistency, test-retest reliability, as well as the construct, criterion and discriminant validity of the Greek version of three questionnaires – the Attitudes towards Seeking Professional Psychological Help Scale-Short Form (ATSPPH-SF; Fischer and Farina 1995); the Stigma Scale for Receiving Psychological Help (SSRPH; Komiya et al. 2000); and the Self stigma of Seeking Help Scale (SSOSH; Vogel et al. 2006) – in accordance with the original studies. EFA was used to explore the factor structure of the questionnaires in a sample of 1381 Greek University students. The resulting models were subjected to CFA to further test the latent structures. The data showed acceptable model fit for all three questionnaires. The internal consistency of the ATSPPH-SF was α = .76 and the 1-month test-retest reliability was .89 (N = 35). The internal consistency of the SSOSH and the SSRPH were α = .77 and α = .69, respectively. The discriminant and criterion validity of the SSOSH were satisfactory. Men reported higher SSRPH, SSOSH and ATSPPH scores than women. These differences remained significant after controlling for age. This study offers evidence to suggest that the Greek versions of the three questionnaires have acceptable psychometric properties. The data support the suitability and usefulness of the Greek versions of the three scales for assessing self-stigma, public-stigma and attitudes towards seeking psychological help. Compared with men, women perceived less public-stigma and self-stigma, and more favorable attitudes to seeking psychological help.

The process of translating, adapting and validating research instruments or scales is crucial for international research projects, as it will facilitate safe comparisons. Versions of research instruments or scales in different languages need to be reliable and valid but also have semantic equivalence between them. This is very important since diversity among people worldwide exists. It is particularly important for nursing research due to the different definitions widely given for the same concept. This chapter focusses on the most common methodological approaches that can be used by researchers who want to translate, adapt and validate a research instrument or scale into a different language.

The World Health’s Organization’s safety surgical checklist has been described as a means for increasing patient safety during surgical procedures. However, its full implementation has not yet been achieved worldwide. The aim of this study, via a focus group study among nurses, was to explore the factors that serve as barriers and facilitators for the list’s implementation. Findings reveal that the use of the checklist can be compromised by many factors but also supported by others.

Nowadays, due to the technological advances of high-throughput techniques, Systems Biology has seen a tremendous growth of data generation. With network analysis, looking at biological systems at a higher level in order to better understand a system, its topology and the relationships between its components is of a great importance. Gene expression, signal transduction, protein/chemical interactions, biomedical literature co-occurrences, are few of the examples captured in biological network representations where nodes represent certain bioentities and edges represent the connections between them. Today, many tools for network visualization and analysis are available. Nevertheless, most of them are standalone applications that often (i) burden users with computing and calculation time depending on the network’s size and (ii) focus on handling, editing and exploring a network interactively. While such functionality is of great importance, limited efforts have been made towards the comparison of the topological analysis of multiple networks. Network Analysis Provider (NAP) is a comprehensive web tool to automate network profiling and intra/inter-network topology comparison. It is designed to bridge the gap between network analysis, statistics, graph theory and partially visualization in a user-friendly way. It is freely available and aims to become a very appealing tool for the broader community. It hosts a great plethora of topological analysis methods such as node and edge rankings. Few of its powerful characteristics are: its ability to enable easy profile comparisons across multiple networks, find their intersection and provide users with simplified, high quality plots of any of the offered topological characteristics against any other within the same network. It is written in R and Shiny, it is based on the igraph library and it is able to handle medium-scale weighted/unweighted, directed/undirected and bipartite graphs. NAP is available at http://bioinformatics.med.uoc.gr/NAP .

Background: Respecting patients’ dignity has been described as a fundamental part of nursing care. Many studies have focused on exploring the concept of patients’ dignity from the patient and nurse perspective, but knowledge is limited regarding students’ nursing perceptions and experiences. Objective: To explore the issue of patients’ dignity from the perspective of nursing students. Research design: A qualitative study was employed with the formation of four focus groups and the participation of nursing students. Data were analysed via a thematic content analysis of the discussions. Participants and research context: Thirty-four nursing students of a Cyprus University participated in the four focus groups. Each group was homogenous in terms of the year of study and heterogeneous in terms of clinical practice in various wards. Ethical consideration: The study’s protocol was reviewed and approved by the Cyprus National Bioethics Committee. Ethical standards were followed throughout the study. Findings: Several factors that maintain or compromise patients’ dignity emerged. These factors were grouped into five themes: (a) patients’ preferences, verbal abuse and regarding a patient as a unique person; (b) privacy and confidentiality; (c) loss of autonomy and need for help; (d) discrimination and (e) attribution and reciprocity. Discussion: Different understandings of the perceived concept of dignity and the factors that maintain or compromise patient’s dignity were expressed through the eyes and the feelings of nursing students. Students highlighted the importance of promoting patient dignity as an important component of nursing care. Conclusion: Nurse educators can use the findings of this study in order to tailor nursing programmes to emphasise the importance of respecting patients’ dignity. In addition, nurse ward managers can use the findings as means for persuading nurses to change current behaviour.

Background Research evidence supports that the role of the professional practice environment is crucial for the delivery of quality care as it is significantly correlated with patient and nurse outcomes. However, in countries sharing similar cultural and ethnic backgrounds, like Cyprus and Greece, as well as the increased mobility of patients and healthcare workers, there is a lack of information regarding this issue. The aim of this study is to explore and compare Cypriot and Greek nurses' perceptions of their professional practice environment. Methods A descriptive comparative survey was employed using a sample of nurses in Cyprus (N = 150) and Greece (N = 147). Information was collected with the Revised Professional Practice Environment Scale (RPPE). Results The results revealed significant differences between the two countries in three out of eight factors of the RPPE, with Greece's mean value being higher than Cyprus's: Handling Disagreements and Conflicts, Leadership and Autonomy in Clinical Practice, and Teamwork. Conclusions The findings generate additional knowledge about the organizational context of care delivery that might help nursing leaders to understand how nurses perceive their work environment and how this influences their work, and consequently the care provided. The results can be utilized by nurse ward managers to improve the quality of nursing care provided. Further research is needed using different approaches to explore nurses' experience in more depth. Implications for nursing or health policy Measuring nurses' perceptions of their professional practice environment may assist managers and policymakers in introducing interventions that contribute to a better practice environment and consequently to improved nursing, as well as patient, outcomes.

Bedside rationing in nursing care refers to withholding or failure to carry out certain aspects of care because of limited resources such as time, staffing or skill mix. The absence of previous systematic reviews on nursing care rationing leads to a gap of synthesized knowledge on the factors and processes related to rationing and the potential negative consequences on both patients and nurses. The aim of this study was to gain an in-depth understanding of the factors and processes related to nursing care rationing. Selected papers were methodologically assessed based on their design, sampling, measurement and statistical analysis. Seventeen quantitative studies were reviewed, and findings were categorized into four themes: elements of nursing care being rationed, causes of rationing, nurse outcomes and patient outcomes. Results revealed that communication with patients and families, patient ambulation, and mouth care were common elements of rationed care. Nurse-patient workload and communication barriers were reported as potential causes of rationing. Patient-related outcomes included patient falls, nosocomial infections and low patient satisfaction levels. Nurse-related outcomes included low job and occupational satisfaction. In addition, rationing appears to be an important organizational variable linked with patient safety and quality of care. This review increases understanding of what is actually occurring at the point of care delivery so that managers will be able to improve processes that lead to high quality of care and better patient and nurse outcomes.

Background: Occupational exposure to pathogens forms a major concern among nurses, the largest team among healthcare professionals. Unfortunately, international literature marks high rates of occupational exposure to pathogens among nurses. Data from these studies allow to the implementation of prevention programs to avoid such incidences.Aim:To assess the prevalence of Cypriot nurses’ occupational exposure to pathogens as well as their reporting behaviour following such incidences.Methodology: A cross sectional survey has been conducted among a convenience sample of 577 nurses, during March and May 2010.Results: Our analysis demonstrated that almost half of Cypriot nurses (48.4%) had at least one incidence of occupational exposure to pathogens, with more than 20% of the exposed nurses having been exposed via more than one mode. The majority of them have made a report of the incident, according to the policy of their hospital. Main reasons for not reporting such a critical incident included being too busy and forgetfulness.Conclusions: The results indicate that exposure to pathogens among Cypriot nurses is high, a fact that puts them into danger for acquiring an infection. A risk management program should be implemented to reduce such incidents.

Here we demonstrate quantitation of stimuli-induced proteome dynamics in primary cells by combining the power of bio-orthogonal noncanonical amino acid tagging (BONCAT) and stable-isotope labeling of amino acids in cell culture (SILAC). In conjunction with nanoscale liquid chromatography-tandem mass spectrometry (nanoLC-MS/MS), quantitative noncanonical amino acid tagging (QuaNCAT) allowed us to monitor the early expression changes of >600 proteins in primary resting T cells subjected to activation stimuli. © 2013 Nature America, Inc. All rights reserved.

The Ministry of Health of Cyprus (approval no: Y.Y. 5.14.02.4(2)) and the Cyprus National Bioethics Committee (approval no: EEBK/EΠ/2008/1) reviewed and approved the research protocol as Cyprus was the coordinating country for the research study. Abstract BACKGROUND: Patients' decisional control over care is the ability or power for patients to decide what their involvement will be in healthcare decisions. There is evidence of limited agreement between the perceptions of patients and the perceptions of nurses and/or caregivers with regard to the degree of patient involvement in the planning and performance of their care. AIM: To analyse and compare patients' and nurses' perceptions of patients' decisional control over their own care. METHOD: A multisite cross-sectional comparative survey design was employed. Data were collected from hospitalised surgical inpatients (n = 1315) and their caregivers (n = 960 nurses) in five European countries. The Individualised Care Scale part B was used for collecting data from both the patients and nurses. Ethical standards were followed throughout the study. RESULTS: Significant between-country differences were found between patients and nurses. In all countries, both patients and nurses regarded that decisional control over care had been actualised (ICS-B: M = 3.75-4.47 and 3.48-4.33, respectively), but there were significant differences in their perceptions regarding four of the six items of the decisional control factor of the ICS-B. CONCLUSIONS: The results show that there are disparities between patients' and nurses' perceptions of patient involvement in care, probably due to cultural issues that need further exploration. CLINICAL RELEVANCE: The disparities between patients' and nurses' perceptions on patients' decisional control over their care should be taken into consideration as a potential cause of patient dissatisfaction with nursing care. The study was funded by the Cyprus University of Technology (EX 11/2008).

Aim: The aim of this study was to explore the association between nurses’ characteristics (educational level, country, work title, gender, type of work, age, and length of working experience) and t ...

The functional design and application of a data-independent LC-MS precursor and product ion repository for protein identification, quantification, and validation is conceptually described. The ion repository was constructed from the sequence search results of a broad range of discovery experiments investigating various tissue types of two closely related mammalian species. The relative high degree of similarity in protein complement, ion detection, and peptide and protein identification allows for the analysis of normalized precursor and product ion intensity values, as well as standardized retention times, creating a multidimensional/orthogonal queryable, qualitative, and quantitative space. Peptide ion map selection for identification and quantification is primarily based on replication and limited variation. The information is stored in a relational database and is used to create peptide- and protein-specific fragment ion maps that can be queried in a targeted fashion against the raw or time aligned ion detections. These queries can be conducted either individually or as groups, where the latter affords pathway and molecular machinery analysis of the protein complement. The presented results also suggest that peptide ionization and fragmentation efficiencies are highly conserved between experiments and practically independent of the analyzed biological sample when using similar instrumentation. Moreover, the data illustrate only minor variation in ionization efficiency with amino acid sequence substitutions occurring between species. Finally, the data and the presented results illustrate how LC-MS performance metrics can be extracted and utilized to ensure optimal performance of the employed analytical workflows.

Scand J Caring Sci; 2012; 26; 372–380 Patient satisfaction as an outcome of individualised nursing care Background: The association between individualised nursing care and patient satisfaction has been previously found. However, there is a lack of studies examining this association between individualised care and patient satisfaction in a cross-cultural study. Aims: This study examines the association between individualised care and patient satisfaction in a sample of general surgical patients from five European countries. Methods: A cross-sectional design and survey method were used to collect data from general surgical patients (N = 1315, response rate 78%) in 72 inpatient wards in 26 general acute hospitals’ in 2009 using self-completed questionnaires the Individualised Care Scale and the Patient Satisfaction Scale. Data were analysed using descriptive statistics, Pearson correlation coefficients and multiple stepwise regression analyses. Results: Surgical patients reported that the care they received was only moderately individualised overall, but individuality was taken into account well in patients’ clinical situation and decisional control over care. Patients were satisfied with their care, mostly with the technical aspects of care and least with the information given. There were between-country differences in patients’ perceptions of individuality in care and patient satisfaction. A positive correlation between the level of individualised care received and patient satisfaction was found, confirming that individualised nursing care delivery influences patients’ satisfaction with care and demonstrating that this quality of care indicator might be able to be used as a predictor of patient satisfaction, one outcome of care. Conclusion: The findings of this study strengthen previous results and further reporting the existence of a relationship and the positive correlation between individualised care and patient satisfaction. The results can inform administrative decisions and policy on introducing nursing approaches to care that would increase patient satisfaction.

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D. & Suhonen R. (2012) Journal of Nursing Management20, 236–248 A seven country comparison of nurses’ perceptions of their professional practice environment Aims To describe and compare nurses’ perceptions of their professional practice environment in seven countries. Background There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses’ ability to perform and are linked to differing nurse and patient outcomes. Methods A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions Although between-country differences in nurses’ professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management The results support investment to improve nurse’s work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

Aim. The aim of this study was to compare patients’ and nurses’ perceptions of individualised care in five European countries, the Czech Republic, Cyprus, Finland, Greece and Hungary. Background. Individualised nursing care has been studied from both patients’ and nurses’ perspectives, but to date, there are no studies comparing these perspectives internationally. Methods. A cross-sectional comparative survey design was used. Data were collected from nurses (n = 960; response rate, 79%) and patients (n = 1315; response rate, 78%) in 71 surgical units from 26 acute hospitals in 2009. Data were collected using two Individualised Care Scales (ICS-Nurse and ICS-Patient) and analysed statistically using descriptive and inferential statistics. Results. Differences in patients’ and nurses’ assessments of individualised nursing care were found between each country. Nurses, compared with patients, assessed that they supported patient individuality more often. The Meannurses ranged from 3·61 (SD 0·90, Greece)–4·31 (SD 0·53, Hungary), and the Meanpatients ranged from 3·05 (SD 1·09, Greece)–3·79 (SD 1·00, Cyprus). To a large extent, the care provided was individualised as defined by the Meannurses 3·75 (SD 0·92, Greece)–4·36 (SD 0·49, Hungary) and the Meanpatients 3·41 (SD 0·95, Greece)–4·18 (SD 0·79, Cyprus). In Cyprus and Finland, patients’ assessments of the individuality in their care corresponded well with nurses’ assessments. Clear between-country differences in both patients’ and nurses’ assessments were found in both subscales of the ICS. Conclusions. An in-depth analysis of the European between-country differences is required to define the causes of differences that may be due to the differing content of education, the organisation of nursing work, ideology and values assigned to individualised care and health care systems and processes in each country. Relevance to clinical practice. Obtaining both patients’ and nurses’ assessments of individualised care may facilitate the further development of individualised nursing care and be used to help to harmonise European health care processes and nursing care.

papastavrou e., efstathiou g., tsangari h., suhonen r., leino-kilpi h., patiraki e., karlou c., balogh z., palese a., tomietto m., jarosova d. & merkouris a. (2011) A cross-cultural study of the concept of caring through behaviours: patients’ and nurses’ perspectives in six different EU countries. Journal of Advanced Nursing 68(5), 1026–1037. Abstract Aim. This paper is a report of an international study of patients’ and nurses’ perceptions of nurse caring behaviours. Background. Current economic constraints on healthcare systems, demand to increase the quality of care and the incorporation of the consumers’ perspective into care, have created a need to develop a clear understanding of nursing behaviours which convey caring. Patients in different areas of the world report different expectations of nurses’ caring actions when compared to nurses’ views. Method. A descriptive comparative survey design was used to analyse a sample of surgical patients (n = 1659) and their nurses (n = 1195) in 88 wards of 34 hospitals in Cyprus, the Czech Republic, Finland, Greece, Hungary and Italy. Data were collected in autumn 2009 using the Caring Behaviours Inventory-24. Nurses’ and patients’ responses were compared using both inferential and descriptive statistics. Results. Independent samples t-tests showed important differences between nurses’ and patients’ views. Although both groups perceived knowledge and skill as being the most important sub-scale, the nurses’ responses were higher compared to patients (P

Objectives: Caring for a family member with Alzheimer's disease is associated with increased burden and depression. Effective coping with the hardships and demands of caring may help to sustain the caregiver and lessen the effect of the stressors. The objective of this study was to examine caregivers’ coping styles and the relationship with reported levels of burden and depression. Method: A cross-sectional correlation study was employed. One hundred and seventy-two caregivers of patients suffering from Alzheimer's type dementia participated in the study. All patients were recruited from neurology clinics. The Greek versions of four measuring instruments used were: the Memory and Behaviour Problem Checklist, the Burden Interview, the Centre for Epidemiological studies-Depression scale and the Ways of Coping Questionnaire. Results: Positive coping is negatively correlated with burden (r = −0.20) and wishful thinking strategies were related positively (r = 0.16). The relation between depression and positive coping strategies is highly significant (p

Aim. This paper is a report of a study of internationally-based differences in nurses' perceptions of individualized care in orthopaedic surgical in-patient wards. Background. Individualized care is valued in healthcare policy, practice and ethical statements as an indicator of care quality. However, nurses' assessments of individualized care are limited and comparative cross-cultural studies on individualized nursing care are lacking. Methods. A descriptive comparative survey was used to sample orthopaedic surgical nurses (n = 1163) working in 91 inpatient wards in 34 acute hospitals in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and the United States of America. Data were collected between March and November 2009 using the Individualized Care Scale-Nurse and analysed using descriptive and inferential statistics. Results. Nurses in different countries perceived that they supported patients' individuality generally and provided individualized care during nursing activities. Although the highest scores were in support of patients' individuality in the clinical situation both through nursing provision and nurses' perceptions of individuality, there were between-country differences within these scores. Generally, the Greek and American nurses gave the highest scores and the Turkish, Cypriot and Portuguese nurses the lowest. Conclusions. Between-country differences found may be attributed to differing roles of nurses, care processes, healthcare systems and/or the ways nursing care is defined and organized. As this was the first time the Individualized Care Scale-Nurse was used in an international context, the results are formative and indicate the need to continue studies in this area.

Standard Precautions have been introduced as a means to protect health professionals from exposure to pathogens. This study examines the extent of Cypriot nurses' compliance with the main aspects of Standard Precautions and explores the possible associations with the nurses' characteristics. Self-completed questionnaires that examined the frequency of the implementation of Standard Precautions were distributed to a convenience sample of 668 nurses.The response rate was 89.37%.The results showed inadequate compliance with Standard Precautions. Full compliance with all the main aspects of Standard Precautions was reported by only 9.1% of the participants. Male nurses and those who had not been exposed previously to pathogens reported better compliance, in comparison to female nurses and those who had been exposed previously. Nurses who had participated previously in an educational program about Standard Precautions reported a higher frequency of implementing them than those who had not participated. The nurses' age and frequency of the implementation of Standard Precautions were found to be significantly and positively correlated. The results can be used to enhance nurses' safety by focusing on areas of non-compliance.

papastavrou e., efstathiou g. & charalambous a. (2011) Nurses’ and patients’ perceptions of caring behaviours: quantitative systematic review of comparative studies. Journal of Advanced Nursing67(6), 1191–1205. Abstract Aim. This paper is a report of a systematic review conducted to test the hypothesis that nurses and patients perceive the concept of caring in nursing differently. Background. Caring is viewed as the central focus of nursing. However, despite its fundamental place in clinical practice, researchers and scholars have failed in reaching a common definition. This failure has led to eliciting for nebulous interpretations of the concept often leading to perplexity and opposing views between patients and nurses. Data sources. Extensive search was conducted using MEDLINE, CINAHL and EMBASE between March and May 2009 with no publishing time limit and the keywords ‘care’, ‘caring’, ‘nurse’, ‘nursing’, ‘behavio(u)rs’, ‘patient’, ‘perception’, ‘quantitative’ and ‘comparative’. Review methods. This quantitative systematic review of comparative studies followed the guidance of the Centre for Reviews and Dissemination. A seven-item ‘yes’ or ‘no’ checklist was developed and used for appraising the quality status of the selected literature. Narrative summary technique was used to report outcomes. Results. Evidence of incongruence of perceptions between patients and nurses is mainly supported by the literature. Few studies, however, report aspects of congruence. Conclusion. There is considerable evidence of the assertion that there is no congruence of perceptions between patients and nurses as regards to which behaviours are considered caring and intended caring is not always perceived as such by the patient. Further research is needed, however, to generate more knowledge on the relationship between caring behaviours, patient outcomes and health or nursing costs.

Rationale Translation, adaptation and cross-cultural validation of instruments or scale to measure concepts of interest among different populations can facilitate sharing of knowledge and advance cross-cultural research globally, especially in countries with diverse populations. Aims and objectives This is a two-phase study aiming to: (1) translate, adapt and cross-validate the 24-item English version of Caring Behaviors Inventory into Greek; and (2) evaluate the psychometric properties of the Greek version (CBI-GR). Methods A descriptive correlational design was used to conduct the study. The procedure involved professional translators, committee approach, and a sample of nurses and patients. The psychometric evaluation of the CBI-GR used a sample of 245 Greek and Cypriot medical-surgical nurses. Data analyses comprised internal consistency reliability (Cronbach's alpha coefficient), stability (test–retest) reliability, item analysis and confirmatory factor analysis. Results The Cronbach's alpha for the overall CBI-GR was 0.92 and ranged from 0.76 to 0.87 for the subscales. Correlation coefficients between test and retest for the overall CBI-GR was r = 0.83 and ranged from r = 0.69 to 0.78 for its subscales. Confirmatory factor analysis of the scale supports its four-factor structure and the model indexes were adequate: X2 (239) = 515.54, P

Introduction An Amyand’s hernia is a rare occurrence of an inguinal hernia, with an estimated prevalence of 1%. The major complications of an Amyand’s hernia include necrotizing fasciitis of the anterior abdominal wall and secondary intestinal perforation. Though the incidence of this type of hernia is low, the appendix may easily become initially incarcerated, possibly leading to strangulation and perforation. Case presentation A 92-year-old female patient presented to our emergency department with clinical signs of an incarcerated right inguinal hernia, accompanied by fever. A clinical examination revealed localized abdominal pain, reflecting to the right side of her groin. Laboratory tests showed leukocytosis (13,200/μL), while an abdominal X-ray showed colon distension with evidence of intestinal obstruction. Ultrasonography was performed and confirmed the presence of an inflamed tubular structure inside her right inguinal canal. Our patient underwent emergency surgery. We started with a right inguinal incision, which revealed an incarcerated right inguinal hernia, containing her ruptured appendix and showing macroscopic evidence of malignancy. A specimen biopsy was immediately performed and the results showed a ruptured cecal adenocarcinoma. The incision was slightly extended upwards, and a right hemicolectomy performed. Conclusions Diagnosis of an Amyand’s hernia occurs primarily as an incidental finding during surgery and the optimal therapeutic approach must be considered individually for each case. Owing to the rarity of Amyand’s hernia and the wide variance of its clinical characteristics, every case provides useful information toward the treatment of this type of hernia.

The purpose of this European survey was to examine the relationship of surgical patients' and nurses' personal characteristics with their perceptions of caring behaviors. Caring Behaviors Inventory (CBI) was completed by convenience samples of 1,659 patients and 1,195 nurses from six countries of Europe. The results showed that the older the patients, the more positive were their evaluations of CBI. Those with planned admission and good/very good health conditions gave higher ratings compared to those with an emergency and poor health conditions. Type of admission, age, and health conditions explained 5.2% of CBI variance. Nurses with more work experience and experience in the unit gave significantly higher ratings compared to nurses with less experience. Nurses' total experience and gender explained 2.3% of the variance of perceived care. Therefore, in a multinational surgical environment, caring behaviors may be influenced by other variables, better captured by using different research methods. This study was funded by the Cyprus University of Technology.

Caring is a key concept in nursing. A nursing practice based on caring behaviors can improve quality outcomes in health care services, such as patient satisfaction, and can also improve organizational outcomes, such as turnover rates and workers wellbeing. A widely used instrument to measure caring behaviors perceptions of both patients and nurses is the Caring Behaviors Inventory (CBI). The aim of this study is to validate the Italian translation of the 24 items version of the CBI on both patients and nurses samples. Content validity of the scale was obtained with forward-backward translation process. The scale was filled by 213 patients (response rate 88%) and 178 nurses (response rate 95%) in surgical settings and showed high reliability (Cronbach a respectively 0.94 and 0.92). The CFA showed acceptable fit indexes for the 4-factors model in the nurses sample. Moreover high response rates indicates a good level of acceptability of the scale by both patients and nurses and this result could enable a wide use of this tool for a systematic evaluation of care in clinical settings and to deepening predictors of turnover and wellbeing in nurses.

This study is an exploration of nursing students' experiences within the clinical learning environment (CLE) and supervision provided in hospital settings. A total of 357 second-year nurse students from all universities in Cyprus participated in the study. Data were collected using the Clinical Learning Environment, Supervision and Nurse Teacher instrument. The dimension "supervisory relationship (mentor)", as well as the frequency of individualized supervision meetings, were found to be important variables in the students' clinical learning. However, no statistically-significant connection was established between successful mentor relationship and team supervision. The majority of students valued their mentor's supervision more highly than a nurse teacher's supervision toward the fulfillment of learning outcomes. The dimensions "premises of nursing care" and "premises of learning" were highly correlated, indicating that a key component of a quality clinical learning environment is the quality of care delivered. The results suggest the need to modify educational strategies that foster desirable learning for students in response to workplace demands.

Ethical approval: University of Turku Ethics Committee, 1/2009, 14.1.2009. Abstract BACKGROUND: Previous research studies have found that the better the quality of practice environments in hospitals, the better the outcomes for nurses and patients. Practice environment may influence nurses' ability to individualize care but the detailed relationship between individualized care and the professional practice environment has not been investigated widely. Some evidence exists about the association of practice environments with the level of individualization of nursing care, but this evidence is based on single national studies. OBJECTIVES: The aim of this study was to determine whether nurses' views of their professional practice environment associate with their views of the level of care individualization in seven countries. DESIGN: This study had an international, multisite, prospective, cross-sectional, exploratory survey design. SETTINGS: The study involved acute orthopedic and trauma surgical inpatient wards (n=91) in acute care hospitals (n=34) in seven countries, Cyprus, Finland, Greece, the State of Kansas, USA, Portugal, Sweden, and Turkey. PARTICIPANTS: Nurses (n=1163), registered or licensed practical, working in direct patient care, in orthopedic and trauma inpatient units in acute care hospitals in seven countries participated in the study. METHODS: Self-administered questionnaires, including two instruments, the Revised Professional Practice Environment and the Individualized Care Scale-Nurse (Individualized Care Scale-Nurse A and B) were used for data collection. Data were analyzed statistically using descriptive statistics, simultaneous multiple regression analysis, and generalized linear model. RESULTS: Two regression models were applied to assess the predictive validity of the Revised Professional Practice Environment on the Individualized Care Scale-Nurse-A and B. The results showed that elements of the professional practice environment were associated with care individualization. Internal work motivation, cultural sensitivity, control over practice, teamwork, and staff relationship with physicians were predictors of support (Individualized Care Scale-A) for and the delivery (Individualized Care Scale-B) of individualized care. CONCLUSIONS: The results of this study provide evidence that environment aspect could explain variations in care individualization. These findings support the assertion that individualized care needs to be understood in a broader context than the immediate nurse-patient relationship and that careful development of the care environment may be an effective way to improve care quality and outcomes.

WOS: 000317372100014, PubMed: 23458605, Researchers have found that the stigma associated with seeking therapy particularly self-stigma can inhibit the use of psychological services. Yet, most of the research on self-stigma has been conducted in the United States. This is a considerable limitation, as the role of self-stigma in the help-seeking process may vary across cultural groups. However, to examine cross-cultural variations, researchers must first develop culturally valid scales. Therefore, this study examined scale validity and reliability of the widely used Self-Stigma of Seeking Help scale (SSOSH; Vogel, Wade, & Haake, 2006) across samples from 6 different countries (England, Greece, Israel, Taiwan, Turkey, and the United States). Specifically, we used a confirmatory factor analysis framework to conduct measurement invariance analysis and latent mean comparisons of the SSOSH across the 6 sampled countries. Overall, the results suggested that the SSOSH has a similar univariate structure across countries and is sufficiently invariant across countries to be used to explore cultural differences in the way that self-stigma relates to help-seeking behavior.

Signaling through the T cell receptor (TCR) initiates adaptive immunity and its perturbation may results in autoimmunity. The plasma membrane scaffolding protein LAT acts as a central organizer of the TCR signaling machinery to activate many functional pathways. LAT-deficient mice develop an autoimmune syndrome but the mechanism of this pathology is unknown. In this work we have compared global dynamics of TCR signaling by MS-based quantitative phosphoproteomics in LAT-sufficient and LAT-defective Jurkat T cells. Surprisingly, we found that many TCR-induced phosphorylation events persist in the absence of LAT, despite ERK and PLCγ1 phosphorylation being repressed. Most importantly, the absence of LAT resulted in augmented and persistent tyrosine phosphorylation of CD3ζ and ZAP70. This indicates that LAT signaling hub is also implicated in negative feedback signals to modulate upstream phosphorylation events. Phosphorylation kinetics data resulting from this investigation is documented in a database (phosphoTCR) accessible online. The MS data have been deposited to the ProteomeXchange with identifier PXD000341.

The aim of this study was to explore the association between nurses' characteristics (educational level, country, work title, gender, type of work, age, and length of working experience) and their assessments of individualized care.A cross-sectional comparative survey using questionnaires was employed to sample nurses from seven countries.Data were collected from orthopedic and trauma nurses from Cyprus, Finland, Greece, Portugal, Sweden, Turkey, and the United States (N= 1,163, response rate 70%) using the Individualized Care Scale-Nurse (ICS-Nurse) and a sociodemographic questionnaire in 2008. Data were analyzed using descriptive statistics and general linear models.When compared with practical nurses, registered nurses, length of working experience, and the country of the nurses were associated with assessments of the support of patient individuality in specific nursing activities (ICS-A-Nurse) and country assessments of individuality in the care provided (ICS-B-Nurse). The background and experience within nursing teams together with the country affect the delivery of individualized care.Overall, our findings suggest that nurses' personal attributes have important effects on their assessments of individualized nursing care that will be useful when making context-dependent recruitment decisions.The characteristics of nurses contribute to the care delivered in healthcare organizations. Recognition of these nurse-related factors may help nurse leaders in the development and management of clinical practice.

Bedside rationing in nursing care refers to withholding or failure to carry out certain aspects of care because of limited resources such as time, staffing or skill mix. The absence of previous systematic reviews on nursing care rationing leads to a gap of synthesized knowledge on the factors and processes related to rationing and the potential negative consequences on both patients and nurses. The aim of this study was to gain an in-depth understanding of the factors and processes related to nursing care rationing. Selected papers were methodologically assessed based on their design, sampling, measurement and statistical analysis. Seventeen quantitative studies were reviewed, and findings were categorized into four themes: elements of nursing care being rationed, causes of rationing, nurse outcomes and patient outcomes. Results revealed that communication with patients and families, patient ambulation, and mouth care were common elements of rationed care. Nurse-patient workload and communication barriers were reported as potential causes of rationing. Patient-related outcomes included patient falls, nosocomial infections and low patient satisfaction levels. Nurse-related outcomes included low job and occupational satisfaction. In addition, rationing appears to be an important organizational variable linked with patient safety and quality of care. This review increases understanding of what is actually occurring at the point of care delivery so that managers will be able to improve processes that lead to high quality of care and better patient and nurse outcomes.

Although respect and human presence are frequently reported in nursing literature, these are poorly defined within a nursing context. The aim of this study was to examine the differences, if any, in the perceived frequency of respect and human presence in the clinical care, between nurses and patients. A convenience sample of 1537 patients and 1148 nurses from six European countries (Cyprus, Czech Republic, Finland, Greece, Hungary and Italy) participated in this study during autumn 2009. The six-point Likert-type Caring Behaviours Inventory-24 questionnaire was used for gathering appropriate data. The findings showed statistically significant differences of nurses’ and patients’ perception of frequency on respect and human presence. These findings provide a better understanding of caring behaviours that convey respect and assurance of human presence to persons behind the patients and may contribute to close gaps in knowledge regarding patients’ expectations.

The association between individualised nursing care and patient satisfaction has been previously found. However, there is a lack of studies examining this association between individualised care and patient satisfaction in a cross-cultural study.This study examines the association between individualised care and patient satisfaction in a sample of general surgical patients from five European countries.A cross-sectional design and survey method were used to collect data from general surgical patients (N = 1315, response rate 78%) in 72 inpatient wards in 26 general acute hospitals' in 2009 using self-completed questionnaires the Individualised Care Scale and the Patient Satisfaction Scale. Data were analysed using descriptive statistics, Pearson correlation coefficients and multiple stepwise regression analyses.Surgical patients reported that the care they received was only moderately individualised overall, but individuality was taken into account well in patients' clinical situation and decisional control over care. Patients were satisfied with their care, mostly with the technical aspects of care and least with the information given. There were between-country differences in patients' perceptions of individuality in care and patient satisfaction. A positive correlation between the level of individualised care received and patient satisfaction was found, confirming that individualised nursing care delivery influences patients' satisfaction with care and demonstrating that this quality of care indicator might be able to be used as a predictor of patient satisfaction, one outcome of care.The findings of this study strengthen previous results and further reporting the existence of a relationship and the positive correlation between individualised care and patient satisfaction. The results can inform administrative decisions and policy on introducing nursing approaches to care that would increase patient satisfaction.

Papastavrou E., Efstathiou G., Acaroglu R., da Luz M.D.A., Berg A., Idvall E., Kalafati M., Kanan N., Katajisto J., Leino-Kilpi H., Lemonidou C., Sendir M., Sousa V.D.Suhonen R. (2011) Journal of Nursing Management A seven country comparison of nurses' perceptions of their professional practice environment Aims To describe and compare nurses' perceptions of their professional practice environment in seven countries. Background There is evidence of variation in the nursing professional practice environments internationally. These different work environments affect nurses' ability to perform and are linked to differing nurse and patient outcomes. Methods A descriptive, comparative survey was used to collect data from orthopaedic and trauma nurses (n = 1156) in Finland, Cyprus, Greece, Portugal, Sweden, Turkey and Kansas, USA using the 39-item Revised Professional Practice Environment instrument. Results Differences were found between participants from the northern countries of Europe, Kansas, USA, and the Mediterranean countries regarding perceptions about control over practice. No between-country differences were reported in the internal work motivation among the nurses from any of the participating countries. Conclusions Although between-country differences in nurses' professional practice environment were found, difficulties related to demographic, cultural and health system differences and the way in which nursing is defined in each country need to be considered in the interpretation of the results. Implications for Nursing Management The results support investment to improve nurse's work environment, which is important for improving the quality of patient care, optimizing patient outcomes and developing the nursing workforce.

Purpose: Theoretically, patient satisfaction is correlated with nursing care, but there is not sufficient evidence to support it. The aim of this study was to address three research questions: (a) What is the correlation between caring as perceived by patients and patient satisfaction? (b) Are there differences across various countries on the correlation on caring as perceived by patients and patient satisfaction? (c) Do caring behaviors affect patient satisfaction? Design: A multicenter correlational design was adopted involving surgical patients from six European countries: Cyprus, Czech Republic, Greece, Finland, Hungary, and Italy. Methods: A convenience sample of 1,565 patients was recruited in autumn 2009. The short version of the Caring Behaviours Inventory (CBI; 24 items) and Patient Satisfaction Scale (PSS; 11 items) were used. Data analysis included descriptive statistics, as well as correlation analysis and stepwise multiple regression, to examine relations between caring behaviors and patient satisfaction. Findings: According to the patients involved, nurses performed caring behaviors between very frequently (score = 5) and always (score = 6). Patient satisfaction with nursing care was also high, between satisfied (score = 3) and very satisfied (score = 4). A positive correlation emerged between CBI and PPS (r= 0.66, p < .01) ranging between countries from 0.27 to 0.85 (Czech Republic r= 0.27, Cyprus r= 0.76, Finland r= 0.71, Greece r= 0.85, Hungary r= 0.63, and Italy r= 0.45 [p < .01]). Among the CBI dimensions, “connectedness” mainly explains patient satisfaction (R2= 0.404, p < .001), followed by “assurance” (R2= 0.032, p < .001) and “respectful” (R2= 0.005, p < .001). Conclusions: Caring behaviors enacted by nurses determine a consistent proportion of patient satisfaction. This association between them suggests several implications for nursing education, practice, and management. Clinical Relevance: The results may be utilized by policymakers, nurse ward managers, nurse educators, and clinical nurses as a background for taking appropriate measures to improve nursing care provided, thereby enhancing patient satisfaction.