Namsos Hospital

Aim: With an international shortage of experienced critical care nurses, there is an increasing focus on improving staff retention. This study examined the subjective nursing workload in Norwegian intensive care units (ICUs) and its relationship with the Nursing Activities Score (NAS) and nurses' demographics. Method: A prospective cross-sectional study utilized the National Aeronautics and Space Administration Load Index (NASA-TLX) to measure six demands of subjective nursing workload (mental, physical, temporal, effort, performance, and frustration), the NAS and nurses' demographic data. Relationships were analyzed using mixed effect Beta regression. Results: A total of 3,476 questionnaires from 12 ICUs (81.3% response rate) were analyzed. Most critical care nurses were over 46 years of age (52.3%) with most registered nurses younger than 46 years (71.6%). The mean (SD) NASA-TLX score was 48.8 (17.5). The mean (SD) NAS per shift per nurse varied from 56.4% (42.8) to 139.5% (20.7). Higher NAS scores were associated with higher NASA-TLX scores (p < 0.001) in areas of mental (p < 0.001), physical (p = <0.001), temporal (p = <0.001), and effort (p = >0.001), frustration (p = <0.001) but not with performance (p = 0.35). Age, educational level, experience and shifts were associated with all the NASA-TLX six demands, although less so with performance and frustration. Conclusion: High subjective workload was consistently associated with higher NAS scores. These findings highlight the importance of integration of subjective and objective measures of workload. A multifaceted understanding of workload is essential to protect nurses' wellbeing, support a healthy work-life balance, and address workforce challenges. Proactively monitoring both areas of workload enables management to identify areas of improvement, address staffing issues, and implement targeted interventions to promote nursing retention. Implication for clinical practice: This study underscores the value of workload assessments as an effective tool for identifying staffing challenges in ICUs. Managers can implement targeted strategies, such as focusing on the needs of specific groups. In optimizing workload management, the unit can retain nursing staff.

Abstract Background Lipedema is a chronic female disease characterized by a painful accumulation of adipose tissue in the limbs. Plasma fatty acid (FA) composition has been proposed as a potential modulator of pain. However, the pathophysiology behind lipedema pain remains uncertain. The primary objective of this secondary analysis was to compare changes in plasma concentrations of FAs between low-energy diets either low in carbohydrates or low in fat, in females with lipedema and obesity. A secondary objective was to investigate potential associations between changes in pain and changes in the concentration of several FAs. Methods Females with lipedema and obesity (BMI 30–45 kg/m2) were randomized to isocaloric low-energy diets, either low-carbohydrate diet (LCD) or low-fat diet for 8 weeks. Plasma concentrations of FAs were quantified using gas chromatography and subjective pain using the Brief Pain Inventory, before and after the intervention. Results 70 females were included in the analyses, with a mean BMI of 37 ± 5 kg/m2 and mean age of 47 ± 11 years. Significant decreases in the concentration of the saturated FAs (SFAs) myristic, stearic, and behenic acids, and the polyunsaturated FAs (PUFA) gamma-linolenic (GLA), dihomo-gamma-linolenic (DGLA), alpha-linolenic (ALA), eicosapentaenoic (EPA), and docosapentaenoic acids (DPA) were seen in both groups. A reduction in the SFA arachidic acid, and the monounsaturated FAs (MUFA) palmitoleic and oleic acids was seen in the LCD group only, while an increase in the SFA lignoceric acid and a decrease in the PUFA linoleic acid was seen only the low-fat diet group. Changes in myristic and palmitic acids (SFAs) were positively associated with changes in pain. Conclusion A reduction in most FAs was found after energy restricted LCD and low-fat diets in females with lipedema and obesity. Notably, reductions in SFAs seem to be associated with the reduction in pain seen in the LCD group, especially myristic acid. These findings suggest that FA composition may play a role in pain reduction in females with lipedema. Trial registration NCT04632810, Effect of Ketosis on Pain and Quality of Life in Patients With Lipedema (Lipodiet).

IntroductionLow-carbohydrate diets (LCDs) have been suggested as a potential treatment option for females with lipedema, due to their superiority in reducing pain, possibly through improvements in insulin dynamics.ObjectivesThe objective of this secondary analysis was to compare changes in markers of glucose and insulin dynamics after a low-carbohydrate versus low-fat low-energy diets in females with lipedema and obesity. A secondary objective was to investigate potential associations between changes in glucose and insulin dynamics and changes in pain.MethodsFemales with obesity and lipedema were randomized to either an LCD or a low-fat low-energy diets (1200 kcal/day for both; 75 vs. 180 g carbohydrates/day) for 8 weeks. Basal and postprandial (total and incremental area under the curve (tAUC and iAUC)) concentrations of glucose, insulin, glucose-dependent insulinotropic polypeptide (GIP), and C-peptide were measured before and after the intervention, and HOMA-IR, Matsuda index and insulin clearance calculated.ResultsA total of 70 females (35 in each group, age 47 ± 11 years, BMI 37 ± 5 kg/m2) were included in the analysis. Both groups lost body weight, but with a significantly greater weight loss in the LCD group. Both groups showed ed a reduction in basal glucose, C-peptide, and insulin concentrations, with a greater reduction in glucose on the LCD. A significant increase in glucose iAUC, C-peptide iAUC, insulin clearance, and Matsuda index was observed in the LCD group only. Both groups experienced an increase in GIP tAUC, as well as a reduction in HOMA-IR, with no significant differences between groups. No associations were seen between changes in glucose and insulin measures and changes in pain.ConclusionBoth diets improved insulin dynamics in females with lipedema and obesity, despite additional benefits in the LCD group. However, changes in the measured indices of insulin dynamics were not associated with pain reduction, suggesting that the effects of the LCD on pain and systemic metabolic regulation may involve other pathways.

This study addresses the need for an examination of the criterion validity of a highly popular self-report instrument which is used to gain a quick first impression of personality dysfunction: the Level of Personality Functioning Scale-Brief Form 2.0 (LPFS-BF 2.0). To this end, the relationship between LPFS-BF 2.0 scores and SCID-5-AMPD-I scores rated by trained clinicians was investigated in a clinical Norwegian sample (N = 155). Moreover, we investigated the relationship between the Norwegian version of the LPFS-BF 2.0 and other self-report instruments (the WSAS, GAD-7, and PHQ-9). Correlations, a linear regression model, as well as sensitivity and specificity for cut-off values proposed in the literature, were estimated. The results of the linear regression analysis with SCID-5-AMPD-I scores as the dependent variable, showed a strong and significant relationship between LPFS-BF 2.0 scores and SCID-5-AMPD-I scores, also when controlling for other variables. The LPFS-BF 2.0 showed moderate to high correlations with all other instruments. The sensitivity values for cut-off scores suggested in the literature for the LPFS-BF 2.0 were too low. In sum, we found support for the concurrent and criterion validity of the LPFS-BF 2.0. Additionally, we tentatively suggest that the cut-off values currently in use may need to be lowered.