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Aim: This study aimed to explore the association between medication literacy and blood pressure control among hypertensive patients. Background: Blood pressure control is a challenge for global health systems. Medication literacy is essential for medication self‐management in hypertensive patients and a basis for managers to develop comprehensive intervention strategies for hypertension medication use. Design: A cross‐sectional observational study was conducted. Methods: A total of 378 hypertensive patients was selected by convenience sampling from two tertiary hospitals and four community health service centres from December 2021 to January 2022 in Changsha, China. Associations between medication literacy and blood pressure control were identified with chi‐square, independent samples t‐tests and logistic regression analyses. Results: The average medication literacy score of the hypertensive patients investigated was low. Over a third of patients had uncontrolled blood pressure. Logistic regression analysis showed that medication literacy was an influencing factor for blood pressure control rate in hypertensive patients. Conclusions: Medication literacy and blood pressure control among hypertensive patients was poor. Medication literacy was a facilitator of blood pressure control so improving medication literacy may be of value to improve blood pressure control in hypertensive patients. Summary statement: What is already known about this topic? Medication literacy is essential for medication self‐management in hypertensive patientsThe association between medication literacy and blood pressure control in hypertensive patients is unclear. What this paper adds? Medication literacy and blood pressure control rates among hypertensive patients were poor and in need of urgent improvement.Medication literacy was a facilitator of blood pressure control in hypertensive patients. The implications of this paper: Clinical nurses may enhance hypertension management by improving medication literacy.Findings provide a base for implementing medication literacy intervention strategies and promoting blood pressure management. [ABSTRACT FROM AUTHOR]

This paper follows an earlier report of young children's object play activities investigated in a cross-sectional sample of 289 typically developing children. Thirty-minute videotaped observations were taken of children at 8, 12, 18, 24, 30, 36, 42, 48, 54, and 60 months of age in their homes. Forty-nine percent were boys. Children were identified as White (70%); mixed racial/cultural backgrounds (14%); Asian (7%); Black (6%); and Latinx (3%). This study reports patterns of cognitive development based on mastery scores derived from frequency and variety of activities in the 27 categories identified in the earlier study. Mastery scores afforded evaluation of the robustness of certain play categories, and the retention and reduction of others, yielding a final set of 14 to describe and assess developments in play. Discussion centers on the value of differentiated categories along with scores that yield a standard for an assessment of children's play. [ABSTRACT FROM AUTHOR]

Background: Oral fluid intake decreases in advanced cancer in the dying phase of illness. There is inadequate evidence to support the assessment, and management, of hydration in the dying. Bioelectrical impedance analysis (BIA) is a body composition assessment tool. BIA has the potential to inform clinal management in advanced cancer, by examining the relationships between hydration status and clinical variables. Aim: BIA was used to determine the association between hydration status, symptoms, clinical signs, quality-of-life and survival in advanced cancer, including those who are dying (i.e. in the last week of life). Materials and methods: We conducted a prospective observational study of people with advanced cancer in three centres. Advance consent methodology was used to conduct hydration assessments in the dying. Total body water was estimated using the BIA Impedance index (Height – H (m)2 /Resistance – R (Ohms)). Backward regression was used to identify factors (physical signs, symptoms, quality of life) that predicted H2/R. Participants in the last 7 days of life were further assessed with BIA to assess hydration changes, and its relationship with clinical outcomes. Results: One hundred and twenty-five people participated (males n = 74 (59.2%), females, n = 51 (40.8%)). We used backward regression analysis to describe a statistical model to predict hydration status in advanced cancer. The model demonstrated that 'less hydration' (lower H2/R) was associated with female sex (Beta = -0.39, p < 0.001), increased appetite (Beta = -0.12, p = 0.09), increased dehydration assessment scale score (dry mouth, dry axilla, sunken eyes - Beta = -0.19, p = 0.006), and increased breathlessness (Beta = -0.15, p = 0.03). 'More hydration' (higher H2/R) was associated with oedema (Beta = 0.49, p < 0.001). In dying participants (n = 18, 14.4%), hydration status (H2/R) was not significantly different compared to their baseline measurements (n = 18, M = 49.6, SD = 16.0 vs. M = 51.0, SD = 12.1; t(17) = 0.64, p = 0.53) and was not significantly associated with agitation (rs = -0.85, p = 0.74), pain (rs = 0.31, p = 0.23) or respiratory tract secretions (rs = -0.34, p = 0.19). Conclusions: This is the first study to use bioimpedance to report a model (using clinical factors) to predict hydration status in advanced cancer. Our data demonstrates the feasibility of using an advance consent method to conduct research in dying people. This method can potentially improve the evidence base (and hence, quality of care) for the dying. Future BIA research can involve hydration assessment of cancers (according to type and stage) and associated variables (e.g., stage of illness, ethnicity and gender). Further work can use BIA to identify clinically relevant outcomes for hydration studies and establish a core outcome set to evaluate how hydration affects symptoms and quality-of-life in cancer. Key message: What is already known about this topic? - Oral fluid intake decreases in people with advanced cancer, especially when they approach the dying phase of their illness. - There is inadequate evidence to support hydration assessment and decision making in the dying phase of illness. - It is important to understand which clinical factors are associated with hydration status in advanced cancer, to enable healthcare professionals, to evaluate hydration status and support clinical decision making. - Bioimpedance is a non-invasive technology, which has potential to identify clinically relevant variables for cancer hydration assessment. What this paper adds. - This is the first study to use bioimpedance to report a model (using clinical factors) to predict hydration status in advanced cancer. - The variables with combined significance for predicting hydration status were biological sex, appetite, dry mouth, dry axilla, sunken eyes, breathlessness and oedema. In the dying phase, hydration status did not significantly change compared to baseline, and hydration status was not significantly associated with survival. Implications for practice, theory or policy. - Further work can use bioimpedance to identify clinically relevant outcomes for hydration studies, to establish a core outcome set to evaluate how hydration affects symptoms and quality-of-life in cancer. [ABSTRACT FROM AUTHOR]

Intersectoral collaborations are recommended as effective strategies to reduce health inequalities. People most affected by health inequalities, as are people living in poverty, remain generally absent from such intersectoral collaborations. Community-based participatory research (CBPR) projects can be leveraged to better understand how to involve people with lived experience to support both individual and community empowerment. In this paper, we offer a critical reflection on a CBPR project conducted in public housing in Québec, Canada, that aimed to develop intersectoral collaboration between tenants and senior executives from four sectors (housing, health, city and community organizations). This single qualitative case study design consisted of fieldwork documents, observations and semi-structured interviews. Using the Emancipatory Power Framework (EPF) and the Limiting Power Framework (LPF), we describe examples of types of power and resistance shown by the tenants, the intersectoral partners and the research team. The discussion presents lessons learned through the study, including the importance for research teams to reflect on their own power, especially when aiming to reduce health inequalities. The paper concludes by describing the limitations of the analyses conducted through the EPF–LPF frameworks and suggestions to increase the transformative power of future studies. [ABSTRACT FROM AUTHOR]

Hospital to home transfers for older people require effective communication, coordination and collaboration across multiple service settings. Rural Nursing Theory and the Beyond Periphery model explain why this is particularly difficult in rural areas, but there are few examples of how rural services respond. This paper presents a case study of the district of Tärnaby in the inland north of Sweden. Data are drawn from interviews with health and care staff in Tärnaby, observations, and experiences of the researchers. Data were analyzed thematically, with four main themes emerging – role clarity, communication, geography, and understanding of the rural context. Responses to challenges included increasing opportunities for communication between service providers and improving documentation. The paper concludes that informal "workarounds" run the risk of further disconnecting rural service settings from "the city". Rather, the aim needs to be to improve contextual understanding through formally incorporating "the rural" in service design. [ABSTRACT FROM AUTHOR]

Nurses are at high risk of burnout and subsequent mental health concerns due to problems with overstaffing, immense workload volume, and personal health risks associated with the job. Effective mental health treatments are available but potential barriers to receiving care may prevent nurses from benefiting. The Emotional Health and Well-Being Clinic (EHWC) at Houston Methodist is an outpatient mental health clinic offering therapy and medication management services for employees and employee dependents of our institution. The EHWC is uniquely positioned to observe how nurses utilize mental health services and to address barriers to effective care for this vital group of healthcare professionals. This paper provides descriptive data on the utilization of mental health services by nurses in the EHWC and a discussion of possible challenges faced by this group when seeking care. Based on these data, we propose potential solutions to ensure that nurses can achieve maximum benefit from outpatient mental health services. [ABSTRACT FROM AUTHOR]

Engaging in 'reflexive practice' throughout the research process (Benson and O'Reilly, 2022) and a 'reflexivity of discomfort' (Hamdan, 2009) through an intersectional lens, this article presents a reflective account of accessing and conducting observations and interviews at a South Asian women's organisation, in North England, to explore Pakistani and Bangladeshi Muslim (PBM) lone motherhood. It critically explores how researchers' own subjectivities and intersecting identities – in this case, my intersecting identities and positionalities as a young British Pakistani Muslim women, researcher and volunteer – impact interactions in different circumstances with different groups of participants and the importance of having continuous critical self-awareness. Moving beyond simplistic insider–outsider debates, the paper contributes towards further developing reflexivity debates taking an 'intersectional reflexivity' approach. It argues for thinking about the research process and engagements in the field as socially constructed, changing, adapting and negotiated overtime and to utilise intersectionality to unpick broader categories. Finally, it encourages researchers to adopt reflexivity in their research practices. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Seclusion is a harmful and traumatising intervention for people accessing mental health services.People who are subject to seclusion in inpatient mental health services often first experience this within the first 24 h following admission.There is limited research examining how recent contact with services impacts the likelihood of seclusion when people are admitted to inpatient services. What the paper adds to existing knowledge?: Males, Māori and Pasifika experience higher rates of seclusion within the first 24 h following inpatient admission.People perceived by clinicians as overactive, aggressive, disruptive or agitated are seven times more likely to be secluded within the first 24 h.People referred from police or justice services are three times more likely to be secluded within the first 24 h.People who had frequent contact with community mental health services prior to inpatient admission were less likely to be secluded. What are the implications for practice?: The first 24 h of inpatient admission is a critical focus for eliminating the use of seclusion. Initial interactions with people recently admitted should focus on nurturing relationships and reducing distress.Mental health staff should consider the person's cultural needs, referral pathway, recent service contact and baseline ratings on the Health of the Nation Outcomes Scales (HoNOS) when working proactively to prevent the use of seclusion in the first 24 h following admission.Strengthening the focus on nurturing relationships, cultural understanding and non‐coercive de‐escalation approaches requires leadership support and strategic workforce development. Introduction: People who experience seclusion in inpatient mental health services often do so within the first 24 h following admission. There is limited research examining the potential contributing factors, particularly recent contact with services. Aim/Question: To identify factors associated with seclusion within the first 24 h following admission into acute inpatient mental health services. Method: A retrospective analysis was undertaken using routinely collected data from Aotearoa New Zealand mental health services. Results: A higher likelihood of seclusion within the first 24 h following admission was associated with: males, Māori, Pasifika, referrals from police/justice services, inpatient transfers, recent contact with crisis assessment teams and clinician perceptions of aggression, problematic substance use, cognitive problems and hallucinations or delusions. Recent contact with community mental health services was associated with a lower likelihood. Discussion: People's cultural needs, referral pathway, recent service contact and HoNOS scores should be considered when working to prevent the use of seclusion in the first 24 h following admission. Implications for Practice: The first 24 h following inpatient admission is a critical period for preventing the use of seclusion. Nurturing relationships, cultural understanding and use of non‐coercive de‐escalation approaches can support better outcomes for people recently admitted. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Nurses' observation of patients in seclusion is essential to ensure patient safety.Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy.Direct observation and video monitoring are widely used in observing patients in seclusion.Coercive practices may cause distress to patient‐staff relations. What the paper adds to existing knowledge?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients.Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness.Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized.Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion.Pixellating the video camera would give a sense of privacy and dignity. What are the implications for practice?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs.A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision.Viewing panels (small window on the seclusion door) are important in establishing two‐way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients.Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness.More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations.Patient education is paramount. Providing prior information to patients using a co‐produced information leaflet might reduce their anxiety and make them feel safe in the room.When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. Introduction: A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim: The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method: A retrospective phenomenological approach, using semi‐structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results: Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion: The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice: Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion. [ABSTRACT FROM AUTHOR]

The effects of preterm birth, neonatal morbidities and environmental influences on infant sleep development is an important yet under-researched topic, with little known about normative sleep for infants born sick or preterm. The aim of this prospective, observational longitudinal study was to evaluate maternal perceptions and degree of bother with infant sleep behaviours and feeding outcomes across the first 9 months after discharge for sick/preterm infants cared for in the neonatal intensive care unit (NICU) and for healthy term-born infants. This paper reports outcomes for the sick/preterm cohort (I = 94) that were recruited from two NICUs in Perth, Western Australia. Total bother scores were on average 20.2% higher at 9 months than at two weeks post-discharge (p < 0.001). Increased night waking frequency, evening settling duration and crying duration were all positively associated with total bother scores. Maternal confidence scores were negatively associated with maternal bother scores; with each unit increase in confidence, maternal bother decreased by 8.5% (p < 0.001). Covariates such as birth gestation, breastfeeding status and multiple births were not associated with maternal bother. Families may benefit from additional support when experiencing increased night waking frequency and crying and settling durations in the first 9 months after discharge from NICU. [ABSTRACT FROM AUTHOR]

Background: Writing is an important and complex skill, which could be enhanced by teaching students effective writing strategies such as outlining. Electronic outlining ‐ integrated feature in Microsoft® Word – has been shown to enhance students' writing performance. However, little is known about the optimal didactic approach for electronic outlining. Objective: This study examined the effects of learning to use electronic outlining either via observational learning or via learning‐by‐doing on students' argumentative writing performance. Methods: Students (N = 129, 10th‐grade) were assigned with their complete class to one of three conditions: a control (traditional pen and paper outlines via learning‐by‐doing), outline (electronic outlines via learning‐by‐doing) or observation (electronic outlines via observational learning) condition. Students followed an argumentative writing lesson‐series that differed across conditions in terms of planning strategies and didactic approaches used. To examine the influence of the different conditions on students' writing, argumentative texts were used as pre‐ and post‐tests, and the quality was evaluated with an analytic assessment protocol. In addition, data regarding students' perceived mental effort and the organisation of the writing process were collected. Finally, students' attitudes towards electronic outlining were assessed. Results and Conclusion: Although the overall text structure had improved after the lesson series, no significant differences were found between conditions. Electronic outlining increased the total amount of time dedicated to the texts as well as the revision ratio. Students in the observation condition showed a higher pause ratio and a lower fluency on the post‐test as compared to students who learned by doing (both control and outline conditions). With regard to perceived mental effort, students in the outline and control conditions perceived significant decreases over tasks, as opposed to those in the observation condition. In conclusion, the self‐reports indicate that students in the outline condition appropriated electronic outlining significantly better than those in the observation condition, suggesting that practice enhanced students' appropriation of electronic outlining. Lay Description: What is already known about this topic: Planning as a writing strategy helps students organise their writing and reduce mental effort.Electronic outlining is an effective and efficient tool to support a planning strategy.Observational learning is an effective didactic approach in writing education. What this paper adds: Traditional planning and electronic outlining via either observational learning or learning‐by‐doing affect writing products equally.Tool appropriation is greater for students who learned‐by‐doing. Implications for practice: Importance of elaborated and explicit (strategy) instruction.Advantage of video‐based modelling for teacher efficiency. [ABSTRACT FROM AUTHOR]

Aims: This is the second of two papers conceptualizing emotional labour in the emergency department (ED). This paper aims to understand the environmental 'moderators' of ED nurses' emotional labour. Design: Ethnography, through an interpretivist philosophy, enabled immersion in the ED setting, gathering the lived experiences and narratives of the ED nurses. Methods: Observation and semi‐structured interviews over a 6‐month period. Two hospital sites (one district general and one major trauma centre based in the United Kingdom. Results: Over 200 h of observation plus 18 formal/semi‐structured interviews were completed. Environmental, institutional and organizational dynamics of the emergency department instrumented the emotional labour undertaken by the nursing team. Time and space were found to be 'moderators' of ED nurses' emotional labour. This paper focusses on the relevance of space and in particular, 'excessive visibility' with little respite for the nurses from their intense emotional performance. Conclusion: Emotional labour is critical to staff well‐being and the way in which healthcare spaces are designed has an impact on emotional labour. Understanding how emotional labour is moderated in different clinical settings can inform organizational, environmental and workforce‐related decision‐making. [ABSTRACT FROM AUTHOR]

Purpose: Effectively engaging parents under stress is a key component of skilful child welfare practice. This paper aims to investigate how social workers practice with parents with either high or normal levels of stress. Design/methodology/approach: The study used a mixed methods design including observations and audio recordings of meetings between families and social workers, interviews with parents/carers and questionnaires with social workers. Validated instruments, including the general health questionnaire (GHQ) for stress levels and the working alliance inventory (WAI), were used to explore how levels of stress influence practice. Findings: Data from 366 families found twice as many parents had clinically elevated GHQ scores compared to the general population (40% to about 20%). Stressed parents reported significantly less good working relationships with social workers [WAI, for the less stressed parents/carers, M = 65.3 vs highly stressed M = 60.6, t(324) = 2.407, p = 0.017, d = 0.28]. When quality of practice was directly measured, workers showed higher level of relationship skills with the less stressed group [t(291) = 1.71, p = 0.44, d = 0.205]. Originality/value: This study explored the interaction between practitioner skills and family factors influencing engagement, such as stress and anxiety. Engagement with stressed families may be particularly challenging, making it all the more important to understand how social workers engage such families to provide effective help and support. A better understanding of the parent-worker relationship under stress can lead to the development of training and practice strategies aimed at overcoming barriers in family engagement. This study also highlights the need for practice to re-focus on the relational elements and the emotional well-being of families. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to describe the perceptions that older people in Argentina have about the use of cell phones and to analyze their influence on user behavior. At the same time, it was intended to analyze whether sociodemographic factors influence these perceptions. Design/methodology/approach: The authors conducted a study with a non-experimental, cross-sectional and cross-correlational design; a non-probabilistic sample of 138 intentionally selected older people was chosen. Findings: The frequency and years of cell phone use, as well as the applications used, are influenced by the perceptions that older people have about cell phone use. In addition, it was found that age, gender and socio-educational level determine the perceptions that older people have about cell phone use. Originality/value: This research has implications for interventions aimed at improving older people's functional health. Understanding the perceptions of older people in relation to technology will enable the enhancement of its utility to foster an autonomous lifestyle and social integration in old age. [ABSTRACT FROM AUTHOR]

Background: Accurate estimation of the specialized pediatric palliative care (PPC) burden and the definition of the extent and quality of PPC service in Italy represent urgent needs to enable the proper allocation of PPC resources and the definition of prevention and educational plans. The PalliPed project aimed to provide the first comprehensive assessment of the characteristics of Italian patients requiring PPC, the quality and extent of regional PPC networks/facilities, and the number of dedicated resources. In this paper, we present the results of the second part of the project, regarding the implementation and quality of PPC services in Italy. Methods: The PalliPed study had an observational cross-sectional design. All Italian specialized PPC centers/facilities were invited to participate in the project and complete a survey on the characteristics of PPC centers/facilities in different care settings, reporting data as of 24 October 2022. Data were collected online. Results: 19 PPC specialized centers/facilities from 12 Italian regions and two autonomous provinces responded to the survey. Among them, 11 are regional referral centers. Seven Italian regions out of 20 reported no PPC centers/facilities, mainly in central-southern Italy. Less than half (45%) of the regional referral centers cover the entire regional territory, and three offer 24/7 service. Ten centers have a dedicated team. Half of the eight non-referral centers offer 24/7 service and have a dedicated team. A total of 1,092 patients were reported by 18 centers as of 24 October 2022. Over the years, an increasing number of patients has been reported, rising from 1,202 (2019) to 1,544 (2021). The dedicated staff is inadequate, and most healthcare providers are not recognized at an institutional level. A shortage of 'young' staff and a lack of specific training was reported, particularly among nurses (77% had no training in PPC). Conclusions: The results obtained show how training, information, and research interventions are still necessary for the reorganization of the available resources and definition of proper strategies to respond dynamically to the new emerging needs of these populations. At the same time, our study represents a first step in defining a national registry of PPC models, useful for monitoring evolutions, and critical issues and planning any new or corrective strategy. [ABSTRACT FROM AUTHOR]

Background: COVID‐19 necessitated emergency telepractice for student‐led speech‐language therapy clinical practicals in training institutions, with limited preparation and evidence‐based guidelines. Beyond the pandemic, practitioners and university training sites are likely to continue to offer telepractice necessitating thorough preparation for telepractice services underpinned by a comprehensive understanding of the complexities involved in online therapy. Aims: Adopting realist evaluation principles, our aim in this paper was to explore broadly what works and does not work in a set of student‐led telepractice sessions in a diverse, resource‐limited context. The broader goal of this project was to provide evidence‐based support to enhance the efficiency and success of telepractice sessions in student clinical training contexts. Methods & Procedures: We used qualitative observational methods with reflexive thematic analysis to analyse 28 video recordings and 61 observation notes of student‐led paediatric telepractice sessions from a South African university clinic as part of a pilot study. Outcomes & Results: We identified four overarching considerations for student‐led telepractice: (1) additional, specific preparation is required, (2) with greater management of technology and adaptation of tasks, especially during times of poor connectivity; (3) telepractice relies heavily on caregiver input and collaboration; and (4) promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical skills that are complicated by the lack of face‐to‐face contact. Conclusions & Implications: Our findings indicate that telepractice pedagogy needs to be explicitly taught and students require practical assistance as they learn how to use this service delivery approach effectively. There are some aspects peculiar to telepractice that require unique consideration and planning, especially in contexts where service providers and users may be unfamiliar with this form of service provision. The findings of this pilot study can be used by clinical educators and student clinicians to enhance clinical training opportunities involving telepractice. WHAT THIS PAPER ADDS: What is already known on this subject: Many speech‐language therapy (SLT) student clinicians had to transition quickly to telepractice service provision during COVID‐19 with limited existing guidelines and support, especially in contexts where teletherapy is typically non‐existent or difficult to access. Although there is some literature available on experiences of telepractice, there is very little evidence‐based research which explores the mechanics of such sessions in real‐time and which offers practical support to student clinicians and clinical educators engaging in this mode of service delivery. What this study adds: This pilot study examined video‐recorded, student‐led, paediatric, speech‐language teletherapy sessions to understand challenges and considerations involved in using telepractice as a clinical training tool. Findings show that additional preparation for telepractice sessions is required, particularly in contexts of poor digital literacy; students must learn to manage technology, especially when connectivity poses a challenge, and adapt therapy tasks for online work with clients; telepractice relies heavily on caregiver input and collaboration, more so than in in‐person consultations, and this relationship requires careful management; and promoting engagement online, holding a client's attention, building rapport and offering reinforcement are critical yet challenging skills in telepractice. What are the potential or actual clinical implications of this work?: Our findings highlight a need to teach telepractice pedagogy explicitly and support students practically in learning how to provide therapy effectively via this mode of service delivery. Observational methods for studying practices in recorded telepractice sessions can be used as part of a reflective approach to clinical training. Using already available data allowed us to unpack the 'messy reality' of clinical training using telepractice. [ABSTRACT FROM AUTHOR]

This paper examines changes in the completeness of documentation in clinical practice before and during the implementation of the Safer Births Bundle of Care (SBBC) project. This observational study enrolled parturient women with a gestation age of at least 28 weeks at the onset of labour. Data collectors extracted information from facility registers and then a central data manager summarised and reported weekly statistics. Variables of clinical significance for CQI were selected, and the proportion of non-documentation was analysed over time. A Pearson chi-square test was used to test for significant differences in non-documentation between the periods. Between 1 March 2021 and 31 July 2022, a total of 138,442 deliveries were recorded. Overall, 75% of all patient cases had at least one missing variable among the selected variables across both periods. A lack of variable documentation occurred more frequently at the district hospital level (81% of patient cases) and health centres (74%) than at regional referral hospitals (56%) (p < 0.001). Non-documentation decreased significantly from 79% to 70% after the introduction of the SBBC (p < 0.001). A tendency towards negative correlations was noted for most variables. We noted an increased attention to data quality and use which may have a positive impact on the completeness of documentation. However, halfway through the project's implementation, the completeness of documentation was still low. Our findings support the recommendation to establish short-spaced feedback loops of locally collected data using one data platform. [ABSTRACT FROM AUTHOR]

Purpose: The shift in policy discourse towards individualism is affecting service provision and access, which has become increasingly conditioned on individual agency and the "deservingness" of the recipient. Gendered and intersectional experiences of homelessness and excluded populations less likely to be living on the streets remain overlooked and unaddressed. This study thus aims to uncover what drives "invisibility" in services for women experiencing multiple disadvantage and the gendered constraints the women are facing when exiting and navigating multiple disadvantage. Design/methodology/approach: The paper draws on in-depth interviews with women who face severe and multiple disadvantage and their support staff. Data is also gathered through survey data and observations with a wide range of frontline service providers, as well as support notes and numerical progress data recorded by one of the service providers. Findings: Contradicting the common assumption that people act as rational actors in their interaction with services, the author found that women's decisions to (dis)engage may be blinded by forces of multiple disadvantage and mistrust. These are often developed as a result of systemic and gendered constraints that limit women's capabilities and exercise of choice. Barriers in service access often amplified the personal barriers they were facing and reinforced women's decisions to not engage with services. Research limitations/implications: The author hopes that this paper sheds light on the particular set of barriers women with multiple disadvantage face, which will be vital to reach women who face severe disadvantage and provide more effective policies, care and support. Originality/value: This study gives voice to a particular hidden population: women with multiple disadvantage. It contributes to existing frameworks on agency and choice by understanding gendered barriers behind service engagement and how services themselves may be contributing to women's invisibility. [ABSTRACT FROM AUTHOR]

Purpose: Communicative participation poses a challenge in meetings between healthcare professionals (HCPs) and people with aphasia (PwA). How communication is affected by aphasia in group meetings, where several healthcare professionals participate together with the patient, is largely unexplored. The aim of this study was to investigate self‐rated communicative participation during goal‐setting meetings among PwA compared to patients without aphasia and to investigate whether communicative participation among PwA was associated with self‐rated knowledge about aphasia among HCPs. A further aim was to investigate if there was a difference in the use of communication strategies among HCPs in the respective situations. Methods: Nine PwA and nine control patients without aphasia rated their experience of communication during a goal‐setting meeting. Thirty‐eight HCPs rated their knowledge about aphasia and communication, and their use of communication strategies during goal‐setting meetings. Results: The PwA reported being listened to by the HCPs as well as being able to comprehend the meeting. PwA with more severe language impairment did not report a lower level of communicative participation compared to PwA with milder impairment. Half of the patients from both groups indicated some difficulty asking questions during the meeting. Patients' ratings of communication were not correlated to HCPs' knowledge of communication strategies. There was a significant difference in self‐rated use of communication strategies among HCPs for the two conditions, although the individual variation was large. Conclusion: Results from both PwA and controls imply that patients may need more support to be able to ask questions in meetings with HCPs. Although self‐ratings increase the ecological validity of the study of participation, further studies could benefit from using video observations in combination with self‐reported experience, since awareness might influence results. What this paper ads: What is already known on this subject: Aphasia is an acquired language disorder that affects patient–provider communication. In stroke rehabilitation, person‐centred goal setting is a key component. If healthcare professionals (HCPs) are not able to use adequate communication strategies, a lack of accessible communication can become a barrier to person‐centredness. There are evidence‐based communication strategies which can be used to overcome this barrier. What this paper adds to existing knowledge: This study aimed to investigate communicative participation during goal‐setting meetings from the perspective of patients with aphasia and HCPs. To our knowledge, this is the first study where persons with aphasia are asked to rate communicative participation in goal‐setting meetings. To broaden the perspective on communication and goal setting, ratings of patients with aphasia are compared to ratings by patients with stroke but no aphasia. The results of this study indicate that there is room for improvement regarding communication during goal‐setting meetings. However, asking direct questions on communicative participation to persons with severe aphasia may not be feasible. What are the potential or actual clinical implications of this work?: The results of this study imply that both patients with and without aphasia may need more support to be able to express themselves during goal‐setting meetings. There also seems to be a need for further education on aphasia and communication strategies among rehabilitation professionals. [ABSTRACT FROM AUTHOR]

Background: The Successful Aging after Elective Surgery (SAGES) II Study was designed to examine the relationship between delirium and Alzheimer's disease and related dementias (AD/ADRD), by capturing novel fluid biomarkers, neuroimaging markers, and neurophysiological measurements. The goal of this paper is to provide the first complete description of the enrolled cohort, which details the baseline characteristics and data completion. We also describe the study modifications necessitated by the COVID‐19 pandemic, and lay the foundation for future work using this cohort. Methods: SAGES II is a prospective observational cohort study of community‐dwelling adults age 65 and older undergoing major non‐cardiac surgery. Participants were assessed preoperatively, throughout hospitalization, and at 1, 2, 6, 12, and 18 months following discharge to assess cognitive and physical functioning. Since participants were enrolled throughout the COVID‐19 pandemic, procedural modifications were designed to reduce missing data and allow for high data quality. Results: About 420 participants were enrolled with a mean (standard deviation) age of 73.4 (5.6) years, including 14% minority participants. Eighty‐eight percent of participants had either total knee or hip replacements; the most common surgery was total knee replacement with 210 participants (50%). Despite the challenges posed by the COVID‐19 pandemic, which required the use of novel procedures such as video assessments, there were minimal missing interviews during hospitalization and up to 1‐month follow‐up; nearly 90% of enrolled participants completed interviews through 6‐month follow‐up. Conclusion: While there are many longitudinal studies of older adults, this study is unique in measuring health outcomes following surgery, along with risk factors for delirium through the application of novel biomarkers—including fluid (plasma and cerebrospinal fluid), imaging, and electrophysiological markers. This paper is the first to describe the characteristics of this unique cohort and the data collected, enabling future work using this novel and important resource. [ABSTRACT FROM AUTHOR]

Aim: This study examined the feasibility of integrating actigraphy devices into orthopaedic surgical settings to assess the concurrent validity between objective actigraphy data and PROMIS measures. Additionally, the association between changes in actigraphy data and longitudinal changes in PROMIS measures was examined. Methods: Data were collected from 17 participants using actigraphy devices the week prior to and after orthopaedic surgery from 02/2019 to 03/2020. Participants completed PROMIS measures (Physical Function, Sleep Disturbance, Pain Interference) preoperatively and up to 6 months postoperatively. Nonparametric correlations (rs) assessed for concurrent validity. Linear mixed‐effects models examined the association between changes in actigraphy data and PROMIS measures. Results: Prolonged wake after sleep onset was associated with increased sleep disturbances (rs = 0.49; p = 0.045) and pain interference (rs = 0.51; p = 0.04). Changes in pain interference were correlated with increased awakenings (rs = 0.54; p = 0.03). Increased wake after sleep onset was associated with worsening sleep disturbance (β = 0.12; p = 0.01) and pain interference scores over the postoperative period (β = 0.12; p = 0.02). Conclusions: This study is among the first to examine changes in objective actigraphy data and longitudinal PROMIS measures following orthopaedic surgery and illustrates the feasibility of incorporating actigraphy into surgical settings to evaluate postoperative recovery. Summary statement: What is already known about this topic? Actigraphy activity and sleep monitoring, paired with robust patient‐reported outcomes, may provide a means by which providers can better understand the patient experience and barriers to recovery after surgery.Often postoperative recovery is only assessed using patient‐reported outcomes (e.g. PROMIS measures), despite consensus groups recommending pairing assessments with objective assessments to better estimate risks for poor postoperative outcomes.Previous studies integrating actigraphy and PROMIS measures together have predominately been limited to paediatric populations or over shorter postoperative periods.What this paper adds? Participants were found to return to preoperative levels of sleep, evident by concurrent changes in both actigraphy and patient outcomes, by 1 week postoperatively.PROMIS Sleep Disturbance and Pain Interference demonstrated concurrent validity with sleep data collected from wrist worn actigraphy devices prior to and after surgery.Prolonged wake after sleep onset was associated with increased PROMIS Sleep Disturbance and Pain Interference scores, while increasing awakenings during sleep were linked to increased PROMIS Pain Interference scores.The implications of this paper: This longitudinal study not only builds upon earlier cross‐sectional investigations with comparable sample sizes that examined the validity of PROMIS measures with actigraphy sleep related data but also uniquely examines how changes in the immediate postoperative period are associated with longitudinal postoperative outcomes.Pairing patient‐reported outcomes with objective actigraphy measures can help improve data collection for nurse scientists and improve nurses' postoperative assessments to help in estimating patient's risks for poor postoperative recovery. [ABSTRACT FROM AUTHOR]

Objectives: High variation in clinical practice may indicate uncertainty and potentially low-value care. Methods to identify low value care are often not well defined or transparent and can be time intensive. In this paper we explore the usefulness of variation analysis of routinely-collected data about surgical procedures in England to identify potentially low-value surgical care. Methods: This is a national ecological study using Hospital Episode Statistics linked to mid-year population estimates and indices of multiple deprivation in England, 2014/15-2018/19. We identified the top 5% of surgical procedures in terms of growth in standardised procedure rates for 2014/15 to 2018/19 and variation in procedure rates between clinical commissioning groups as measured by the systematic component of variance (SCV). A targeted literature review was conducted to explore the evidence for each of the identified techniques. Procedures without evidence of cost-effectiveness were viewed as of potentially low value. Results: We identified six surgical procedures that had a high growth rate of 37% or more over 5 years, and four with higher geographical variation (SCV >1.6). There was evidence for two of the 10 procedures that surgery was more cost-effective than non-surgical treatment albeit with uncertainty around optimal surgical technique. The evidence base for eight procedures was less clear cut, with uncertainty around clinical- and/or cost-effectiveness. These were: deep brain stimulation; removing the prostate; surgical spine procedures; a procedure to alleviate pain in the spine; surgery for dislocated joints due to trauma and associated surgery for traumatic fractures; hip joint replacement with cemented pelvic component or cemented femoral component; and shoulder joint replacement. Conclusions: This study demonstrates that variation analysis could be regularly used to identify potentially low-value procedures. This can provide important insights into optimising services and the potential de-adoption of costly interventions and treatments that do not benefit patients and the health system more widely. Early identification of potentially low value care can inform prioritisation of clinical trials to generate evidence on effectiveness and cost-effectiveness before treatments become established in clinical practice. [ABSTRACT FROM AUTHOR]

Objectives: Saccharin test (ST) is a convenient method to assess the efficiency of mucociliary clearance, the primary defense mechanism of the upper airways' tract. The study objectives are to: (1) substantiate its short- (3 days) and long-term (30 days) repeatability; (2) assess its tolerability; (3) conduct a systematic literature review and to compare our results with the existing evidence. Methods: Twenty-nine healthy subjects were enrolled in an observational prospective study to perform an ST on three separate visits (at baseline; at follow-up visits at day 3 and at day 30). Transit times were recorded and self-reported nasal and general symptoms noted. A systematic review of the literature was conducted to compare our results with the existing literature. Results: The mean values (±SD) of ST transit time (STTT) were 7.085 (±2.19), 7.788 (±2.11), and 7.790 (±2.06) minutes at baseline, day 3, and day 30, respectively. Significant linear regression analysis was observed between day 3 and baseline (r =.193; P =.019) and day 30 and baseline (r =.182 P =.024). Significant agreement for the intrasession repeatability was observed with an ICC =.354 (P =.001). Outcomes' comparisons between baseline vs day 3 (P =.197) and baseline vs day 30 (P =.173) were not statistically significant. ST was well tolerated. Concordance with existing literature's data and high level of STTT repeatability were confirmed by the qualitative analysis. Conclusion: STTT reproducibility was good both in the short- and long-term. ST tolerability was very good. Our study data are consistent with the existing literature, indicating ST as a sound methodology for detection of early respiratory health changes and for specific regulatory application in respiratory research. [ABSTRACT FROM AUTHOR]

Aims Heart failure nurse practitioners (HF NPs) are an emerging component of the heart failure (HF) specialist workforce but their impact in an inpatient setting is untested. The aim of this paper is to explore the impact of an inpatient HF NP service on 12- month all-cause rehospitalizations, emergency department (ED) presentations, and mortality in patients hospitalized with HF compared with usual hospital care. Methods and results Retrospective, two-group comparative design involving patients (n= 408) admitted via ED with acute HF to a metropolitan quaternary hospital between January 2013 and August 2017. Doubly robust estimation with augmented inverse probability weighting (DR-AIPW) was used to account for the non-random allocation of patients to usual hospital care or the HF NP service in addition to usual in-hospital care. Among 408 patients (186 usual care and 222 HF NP service) admitted with acute HF, the mean age was 76.5 [standard deviation (SD) 12.0] years and 56.4% (n=230) were male. After IPW adjustment, patients seen by the HF NP service had a lower risk of 12-month rehospitalization (61.3 vs. 78.3% usual care; difference -16.9%, 95% CI: -26.4%, -6.6%) and ED presentations (12.6 vs. 22.0%; difference -9.4%, 95% CI: -17.3%, -1.4%) with no difference in 6- or 12-month mortality. The HF NP service improved referrals to a home visiting programme that was available to HF patients (64.4 vs. 45.4%; difference 19%, 95% CI: 8.8%, 28.8%). Conclusion Additional support by an inpatient HF NP service has the potential to significantly reduce rehospitalizations and ED presentations over 12 months. Further evidence from a multicentre randomized control trial is warranted. [ABSTRACT FROM AUTHOR]

In a medical setting, observational studies commonly involve patients who initiate a particular treatment (e.g., medication therapy) and others who do not, and the goal is to draw causal inferences about the effect of treatment on a time-to-event outcome. A difficulty with such studies is that the notion of a treatment initiation time is not well-defined for the control group. In this paper, we propose a Bayesian approach to estimate treatment effects in longitudinal observational studies where treatment is given by indication and thereby the exact timing of treatment is only observed for treated units. We present a framework for conceptualizing an underlying randomized experiment in this setting based on separating the time of indication for treatment, which we model using a latent state-space process, from the mechanism that determines assignment to treatment versus control. Next, we develop a two-step inferential approach that uses Markov Chain Monte Carlo (MCMC) posterior sampling to (1) infer the unobserved indication times for units in the control group, and (2) estimate treatment effects based on inferential conclusions from Step 1. This approach allows us to incorporate uncertainty about the unobserved indication times which induces uncertainty in both the selection of the control group and the measurement of time-to-event outcomes for these controls. We demonstrate our approach to study the effects on mortality of inappropriately prescribing phosphodiesterase type 5 inhibitors (PDE5Is), a medication contraindicated for certain types of pulmonary hypertension, using data from the Veterans Affairs (VA) health care system. [ABSTRACT FROM AUTHOR]

Background: Early identification of subtle cognitive decline in community-dwelling older adults is critical, as mild cognitive impairment contributes to disability and can be a precursor to dementia. The clock drawing test (CDT) is a widely adopted cognitive screening measure for dementia, however, the reliability and validity of paper-and-pencil CDT scoring scales for mild cognitive impairment in community samples of older adults is less well established. We examined the reliability, sensitivity and specificity, and construct validity of two free-drawn clock drawing test scales-the Rouleau System and the Clock Drawing Interpretation Scale (CDIS)-for subtle cognitive decline in community-dwelling older adults. Methods: We analyzed Rouleau and CDIS scores of 310 community-dwelling older adults who had MoCA scores of 20 or above. For each scale we computed Cronbach's alpha, receiver operating characteristic curves (ROC) for sensitivity and specificity using the MoCA as the index measure, and item response theory models for difficulty level. Results: Our sample was 75% female and 85% Caucasian with a mean education of 16 years. The Rouleau scale had excellent interrater reliability (94%), poor internal consistency [0.37 (0.48)], low sensitivity (0.59) and moderate specificity (0.71) at a score of 9. The CDIS scale had good interrater reliability (88%), moderate internal consistency [0.66 (0.09)], moderate sensitivity (0.78) and low specificity (0.45) at a score of 19. In the item response models, both scales' total scores gave the most information at lower cognitive levels. Conclusion: In our community-dwelling sample, the CDIS's psychometric properties were better in most respects than the Rouleau for use as a screening instrument. Both scales provide valuable information to clinicians screening older adults for cognitive change, but should be interpreted in the setting of a global cognitive battery and notas stand-alone instruments. [ABSTRACT FROM AUTHOR]

Executive functions have both direct and indirect effects on reading comprehension. Previous studies have shown that people with hearing loss (HL) perform poorly on executive functions and reading comprehension tasks. This scoping review explored the current state of the literature relating executive function and reading comprehension in children and adolescents with cochlear implants. Searches were carried out in five databases to identify empirical studies related to executive functions, reading comprehension, and children and/or adolescents with cochlear implants. All results were analysed by peer-reviewers. A systematic search only found four studies in the field. We carried out our narrative review of these papers, with a focus on the mediating role of oral language on the relationship between executive functions and reading comprehension. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify factors associated with an emergency department (ED) length of stay ≥4 hours (h) and hospital admission for people with a mental health problem brought in by police. Methods: We undertook a retrospective, observational cohort study of state-wide adult ED mental health presentations brought in by police from 1 January 2012 to 31 December 2017. We used multivariable logistic regression to determine factors associated with an ED length of stay ≥4 h and hospital admission. Results: In total, 9325 ED presentations with a mental health problem brought in by police to Queensland EDs were included. Factors most strongly associated with an ED length of stay ≥4 h included an Australasian Triage Score (ATS) of 1, an age of 85 years or older, night shift arrival and subsequent hospital admission. For hospital admission, an ATS of 1, an age of 85 years or older and an ED length of stay ≥4 h were the strongest factors. Conclusion: Findings indicate opportunities for targeted mental health models of care to better support people brought in by police to an ED. Such models should involve ED, pre-hospital providers (police and ambulance) and mental health services to support early intervention and potentially reduce the likelihood of a long ED length of stay and subsequent hospital admission. What is known about the topic? Some people with mental health problems are brought in by police to an emergency department (ED). People brought in by police are recognised as having poorer health profiles compared to other arrival modes. What does this paper add? Several patient and clinical factors influence ED length of stay and hospital admission for people with a mental health problem brought in by police, indicating a need for targeted health care that addresses these factors. What are the implications for practitioners? This study justifies the need to develop specialised pre-hospital models of care and embed early assessment processes in an ED for people with mental health problems brought in by police. [ABSTRACT FROM AUTHOR]

Background: Chinese American immigrants have been underrepresented in health research partly due to challenges in recruitment. Objectives: This study aims to describe recruitment and retention strategies and report adherence in a 7-day observational physical activity study of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Methods: Foreign-born Chinese women aged 18--45 years, with a gestational diabetes index pregnancy of 0.5--5 years, who were not pregnant and had no current diabetes diagnosis were recruited. They wore an accelerometer for 7 consecutive days and completed an online survey. Multiple recruitment strategies were used: (a) culturally and linguistically tailored flyers, (b) social media platforms (e.g., WeChat [a popular Chinese platform] and Facebook), (c) near-peer recruitment and snowball sampling, and (d) a study website. Retention strategies included flexible scheduling and accommodation, rapid communications, and incentives. Adherence strategies included a paper diary and/or automated daily text reminders with a daily log for device wearing, daily email reminders for the online survey, close monitoring, and timely problem-solving. Results: Participants were recruited from 17 states; 108 were enrolled from August 2020 to August 2021. There were 2,479 visits to the study webpage, 194 screening entries, and 149 inquiries about the study. Their mean age was 34.3 years, and the mean length of U.S. stay was 9.2 years. Despite community outreach, participants weremainly recruited fromsocialmedia (e.g., WeChat). The majority were recruited via near-peer recruitment and snowball sampling. The retention rate was 96.3%; about 99% had valid actigraphy data, and 81.7% wore the device for 7 days. The majority of devices were successfully returned, and the majority completed the online survey on time. Discussion: We demonstrated the feasibility of recruiting and retaining a geographically diverse sample of Chinese American immigrants with prior gestational diabetes during the COVID-19 pandemic. Recruiting Chinese immigrants via social media (e.g., WeChat) is a viable approach. Nonetheless, more inclusive recruitment strategies are needed to ensure broad representation from diverse socioeconomic groups of immigrants. [ABSTRACT FROM AUTHOR]

Introduction: Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered. Methods: Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents' care plans and speech and language therapist recommendations. Results: Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision. Conclusion: Care homes need to be supported to establish a safe swallowing culture to improve residents' safety and care experience. WHAT THIS PAPER ADDS: What is already known on this subject?: Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents.There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia.Care for nursing home residents at mealtimes is often task‐centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia. What this study adds?: Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification.Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas.Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported. What are the clinical implications of this work?: Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission.Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia.The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines.Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely.Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety. [ABSTRACT FROM AUTHOR]

This paper aims to examine the spatial attributes in the hospital ward environment and their impact on medical students' learning and experience of the clinical workplace. An ethnographic study was conducted in a Scottish teaching hospital, combining observations and interviews over a period of 10 months. Two teaching wards served as the field-sites where approximately 120 h of non-participant observations took place sequentially. In addition, 34 individual interviews were conducted with identified key informants that included medical students, junior doctors, postgraduate trainees, consultant supervisors, ward nurses and hospital pharmacist. A combination of Actor-network Theory (ANT) and Social cognitive theory (SCT) was applied to analyse data pertaining to spatial attributes and their relevance to clinical teaching and learning. Analysis of the observational and interview data led to generation of the following themes: spatial attributes in the clinical workplace can enable or constrain teaching and learning opportunities, inadequate spaces impact students' and junior doctors' sense of value, short clinical rotations influence a sense of ownership of doctors' spaces, and contested nature of space in the clinical environment. Several illustrations of the field-sites help to contextualise the themes and aid in understanding the participants' experiences and perceptions. Our findings suggest a complex entanglement of space with medical students learning and wellbeing in the clinical workplace. Provision of suitable spaces needs to be a core consideration to realise the full potential of work-based learning in medicine. [ABSTRACT FROM AUTHOR]

Since the onset of the coronavirus disease, COVID-19 pandemic, concern arose for those who might be at higher risk of a worse COVID-19 prognosis, such as those with cystic fibrosis (CF). In this context, we evaluated the features of hospitalized patients with CF due to severe acute respiratory infection (SARI) in Brazil and we also performed a systematic review including all the studies published from the beginning of the first case of COVID-19 (17 November 2019) to the date of this search (23 May 2022) which included, concomitantly, patients with CF and COVID-19 in the worldwide population. In our Brazilian data, we evaluated the period from December 2019 to March 2022, and we included 33 demographical and clinical patients' features. We classified the patients into groups: (G1) SARI due to another viral infection than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (23; 5.4%), (G2) SARI due to an unknown etiological agent (286; 67.1%), and (G3) SARI due to SARS-CoV-2 infection (117; 27.5%). The individuals in G3 tended to be older, especially over 50 years old, and presented a higher prevalence of dyspnea, peripheral capillary oxygen saturation (SpO2) <95%, and cardiopathy. The highest prevalence for intensive care unit (ICU) treatment (52; 44.4%) and invasive mechanical ventilation (29; 24.8%) was for patients in G3. Almost half of the patients in G3 died (51; 43.6%); in contrast, none in G1 died. However, we observed 43 (15.0%) deaths in G2. In addition, 12 (4.2%) and one (0.9%) death not associated with SARI occurred, respectively, in the G2 and G3. The patients who died due to SARS-CoV-2 infection had a higher frequency of SpO2 <95% (46; 90.2%), ICU treatment (34; 66.7%), and invasive mechanical ventilation (27; 52.9%) when compared to those who recovered. The systematic review comprised a total of 31 papers published as observational studies. These studies comprised 661,386 patients in total, including children, adults, and elderly age groups. However, only 19,150 (2.9%) patients were diagnosed with CF and, from these patients, 2523 (0.4%) were diagnosed with both CF and COVID-19. It was observed that the most common outcome was the need for hospitalization (n = 322 patients with CF), and the need for oxygen support (n = 139 patients with CF). One hundred patients with CF needed intensive care units, fifty patients needed non-invasive mechanical ventilation support, and only three patients were described as receiving invasive mechanical ventilation support. Deaths were described in 38 patients with CF. Importantly, lung-transplanted patients with CF represented an increased risk of death in one publication; in accordance, another study described that lung transplantation and moderate to severe lung disease were independent risk factors for severe outcomes after SARS-CoV-2 infection. In contrast with the literature, in conclusion, Brazilian patients in G3 presented a severe phenotype, even though most of the other studies did not observe worse outcomes in patients with CF and COVID-19. [ABSTRACT FROM AUTHOR]

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(1) Background: This paper aims to assess temporal trends (2016–2020) in incidence, patient's characteristics, complications, length of hospital stay (LOHS) and in-hospital mortality (IHM) among patients with and without idiopathic pulmonary fibrosis (IPF) undergoing lung transplantation (LTx). We also analyse the effect of the COVID-19 pandemic on LTx in these populations. (2) Methods: A retrospective, population-based observational study was conducted using the Spanish National Hospital Discharge Database. Multivariable adjustment was conducted with logistic regression to analyse the IHM. (3) Results: We identified 1777 admissions for LTx during the study period, of which 573 (32.2%) were performed in patients with IPF. The number of hospital admissions for LTx rose from 2016 to 2020, both in patients with and without IPF, but a marked reduction was observed from year 2019 to year 2020. Over time, the proportion of single LTx decreased and bilateral LTx increased significantly in both groups. The incidence of LTx complications increased significantly over time along with the increase in the incidence of IPF. No significant differences in the incidence of complications or in the IHM between patients with and without IPF were found. Suffering any complication of the LTx and pulmonary hypertension were conditions positively associated with IHM in patients with and without IPF. The IHM remained stable from 2016 to 2020 in both study populations and was not affected by the COVID pandemic. (4) Conclusions: Patients with IPF account for almost a third of all lung transplants. The number of LTx increased over time in patients with and without IPF, but a marked reduction was observed from 2019 to 2020. Although the proportion of LTx complications increased significantly over time in both groups, the IHM did not change. IPF was not associated with increased complications or IHM after LTx. [ABSTRACT FROM AUTHOR]

The forced expiratory volume in one second (FEV1) is regularly used for the follow-up of patients with non-cystic fibrosis bronchiectasis (nCF-BE). The lung clearance index (LCI), measured by the multiple breath washout test, has been recently proposed as a lung function measure and a potential tool more sensitive than the FEV1 measured by spirometry in assessing airway changes seen on imaging. While several data have been endorsed as a useful endpoint in clinical trials of patients with early or mild CF lung disease and as the main outcome measure in clinical trials with CFTR modulators in children and adolescents with CF, few data are available in the context of non-CF bronchiectasis. The aim of this pilot study was to compare the LCI with the FEV1 as well as the forced vital capacity (FVC), the forced expiratory flow at 25–75% of the FVC (FEF 25–75%), and chest imaging based on the modified Reiff score in patients with primary ciliary dyskinesia (PCD) and non-CF, non-PCD bronchiectasis (PCD-BE and nCFnPCD-BE). Additionally, we compared each test's duration and the preferred technique. Twenty children were included; nine had PCD-BE and eleven had nCFnPCD-BE. The median age was twelve years (ages ranging between five and eighteen years). The median LCI was seven while the median z-scores of the FEV1, FVC, and FEF 25–75% were −0.6, 0, and −0.9, respectively. No significant associations or correlations were observed between LCI, spirometric parameters, or the modified Reiff score. However, nearly half of the population (n = 9) had an abnormal LCI, while only 10% had an abnormal FEV1. A total of 75% of children preferred MBW, despite it lasting five times longer than spirometry. In this paper, the authors suggest that LCI might be useful in a cohort of pediatric patients with PCD-BE and nCFnPCD-BE for detecting early lung function changes during their follow-up. Additionally, MBW seems to be preferred by patients. These data may encourage further studies on this topic. [ABSTRACT FROM AUTHOR]

The concept of dignity is core to community district nursing practice, yet it is profoundly complex with multiple meanings and interpretations. Dignity does not exist absolutely, but, rather, becomes socially (de)constructed through and within social interactions between nurses and older adult patients in relational aspects of care. It is a concept, however, which has, to date, received little attention in the context of the community nursing care of older adults. Previous research into dignity in health care has often focused on care within institutional environments, very little, however, explores the variety of ways in which dignity is operationalised in community settings where district nursing care is conducted 'behind closed doors', largely free from the external gaze. This means dignity (or the lack of it) may go unobserved in community settings. Drawing on observational and interview data, this paper highlights the significance of dignity for older adults receiving nursing care in their own homes. We will demonstrate, in particular, how dignity manifests within the relational aspects of district nursing care delivery and how tasks involving bodywork can be critical to the ways in which dignity is both promoted and undermined. We will further highlight how micro-articulations in caring relationships fundamentally shape the 'dignity encounter' through a consideration of the routine and, arguably, mundane aspects of community district nursing care in the home. [ABSTRACT FROM AUTHOR]

Social work is often described as a helping profession. Yet in the context of child protection services, the kind of 'help' on offer is not always welcome. Relatively few parents or children request the assistance of child protection services, and child protection investigations are often highly stressful. Workers and family members may have different ideas about the nature of the family's problems, and the type of support they need. So, how do child protection social workers think they are helping children and their families? In this paper, we report an analysis of audio-recordings of supervision case discussions, through which we explore what social workers talk about when they talk about helping families. In some cases, workers did not know how they were helping, or even if they were. Other times, workers said they were helping by developing positive relationships, addressing parental behaviour change, coordinating with other services, and fulfilling their statutory duties. We reflect on these findings in relation to the nature of 'help' in child protection services, practice epistemologies and Hasenfeld's typologies of power. [ABSTRACT FROM AUTHOR]

Simple Summary: Systemic inflammation and changes in the inflammatory status are frequent features of lung cancer. There is a close interconnection between cancer development and the clinical, general, and inflammatory status of patients. In this paper, we evaluate a large panel of inflammatory indexes in patients who underwent lung resection for NSCLC lung cancer; we show that pre-operative inflammatory status strongly influences long-term prognosis in patients affected by NSCLC and undergoing surgery. Background (1): Our goal was to investigate if and how pre-operative inflammatory status can influence the long-term prognosis of patients undergoing lung surgery for cancer. Materials and Methods (2): This prospective observational study includes the agreement of all operable patients to the study, who were referred to our department between 1 January 2017 and 30 December 2018. The inflammatory pre-operative status of the patients was investigated by calculating albumin, CPR (c-protein reactive), complete blood count (neutrophils, lymphocytes, platelets, hemoglobin), and some other indexes referring to inflammatory status, namely the HALP amalgamated index, platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocytes ratio (NLR), systemic immune-inflammation index (SII), and advanced lung cancer inflammation Index (ALI). The follow-up ended in November 2021. Patient overall survival was assessed using the Kaplan–Meier method. The log-rank test was used to compare survival rates. Variables significantly associated with survival at univariate analysis were entered int Cox multivariate analysis (stepwise mode) to assess their independent character. Hazard ratios and their 95% confidence intervals were calculated. Variables associated with p < 0.05 were considered significative. Results (3): We enrolled 257 patients in our study. The overall survival of the cohort was as follows: 1 year, 96.1%; 3 year, 81.3%; and 4 year, 74.2%. Univariate analysis showed risk factors for overall survival as follows: Thoracoscore ≥ 2 (p = 0.002); histology (p = 0.002); HALP < 32.2 (p = 0.0002); SII ≥ 808.9 (p = 0.0004); ALI < 34.86 (p = 0.0005); NLr ≥ 2.29 (p = 0.01); hemoglobin < 13 g/dl (p = 0.01); PLR ≥ 196.1 (p = 0.005); pN+ (p < 0.0001); pleural invasion (p = 0.0002); and presence of vascular or lymphatic tumor emboli (p = 0.0002). Multivariate Cox analysis (stepwise model) identified Thoracoscore ≥ 2 (p = 0.02); histology, HALP < 32.2 (p = 0.004), and pN (p < 0.0001) as independent predictors of death. Conclusion (4): Pre-operative inflammatory status strongly influences long-term prognosis in patients affected by NSCLC and undergoing surgery. [ABSTRACT FROM AUTHOR]

Background: Artificial Intelligence (AI) literacy is a crucial part of digital literacy that all individuals should possess in today's technologically advanced world. Despite the potential benefits that AI education offers, little research has been done on how to teach AI literacy to children. Objectives: This study aimed to fill that gap by investigating how children were engaged in AI literacy activities that are supported by intelligent agents. These activities were implemented in a Hong Kong kindergarten with a class of six 5‐year‐olds (Mage = 62.83 months, SD = 2.91) over a 6‐week period. Methods: The study gathered data from multiple sources, including classroom observations, teacher interviews, and documents/artefacts. Results and Conclusions: The results showed that children could learn about AI through interaction with intelligent agents in embodied learning contexts. The findings of this study have implications for the broader field of digital technology education, particularly in the context of early childhood education. Lay Description: What is already known about this topic: Artificial Intelligence (AI) literacy is essential in today's world.Little research exists on engaging young children in learning AI literacy. What this paper adds: Technology‐enhanced embodied learning approach affords multimodality in enabling young children's learning with AI‐related agents.Project‐based learning and real‐life examples can enhance children's learning. Implications for practice and/or policy: Early exposure to AI can help children navigate the increasingly digital world.Practical approaches, such as embodied and multimodal learning, seem to be effective.Teachers can enhance children's digital learning by using pedagogical strategies like project‐based learning and real‐life examples. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking is an independent and modifiable risk factor for the onset and development of psoriasis; however, evidence on the association between tobacco smoking and psoriasis treatment efficacy is limited. This study aimed to explore the influence of smoking on treatment efficacy in a cohort of patients with psoriasis in Shanghai, China. METHODS Patients with psoriasis were recruited from the Shanghai Skin Disease Hospital between 2021 and 2022. The treatment for patients with psoriasis includes acitretin, methotrexate, narrow-band ultraviolet/benvitimod, and biologics. Data were collected using a structured questionnaire, physical examination, and disease severity estimation at baseline, week four, and week eight. The achievement of a ≥75% reduction in psoriasis area and severity index (PASI75) score from baseline to week 8 was set as the primary outcome for treatment efficacy estimation. Data were analyzed using SAS 9.4. RESULTS A total of 560 patients with psoriasis were enrolled in this study, who were predominantly males (72.9%). The average age of patients was 48.4 years, and 38.8% of them were current smokers, 5.0% of them were former smokers. The median score of PASI among patients changed from 11.1 (interquartile range, IQR: 7.9-16.6) at baseline to 6.2 at week 4 and 3.1 at week 8, and 13.8% and 47.3% of patients with psoriasis achieved PASI75 at weeks 4 and 8, respectively. Logistic regression indicated that patients without tobacco smoking had a higher proportion of PASI75 achievement at week 8. The adjusted odds ratio (AOR) was 11.43 (95% CI: 6.91-18.89), 14.14 (95% CI: 8.27-24.20), and 3.05 (95% CI: 1.20-7.76) for non-smokers compared with smokers, current smokers, and former smokers, respectively. Moreover, former smokers had higher PASI75 achievement than current smokers (AOR=3.37), and patients with younger smoking initiation age, longer smoking duration, and higher smoking intensity had lower PASI75 achievement. CONCLUSIONS Tobacco smoking was negatively associated with PASI75 achievement both in current and former smokers, and former smokers had higher PASI75 achievement than current smokers. The implementation of tobacco control measures is beneficial for improving treatment responses. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to systematically and critically appraise the available scientific evidence concerning the prevalence of edentulism among diabetic patients compared to non‐diabetic people. Methods: MEDLINE‐PubMed and Cochrane‐CENTRAL databases were comprehensively searched up to April 2023 to identify appropriate studies. The inclusion criteria were observational studies conducted in human subjects ≥18 years of age with the primary aim of investigating the prevalence of edentulism among diabetic patients. Based on the extracted data, a meta‐analysis was performed. Recommendations based on the body of evidence were formulated using the GRADE approach. Results: Independent screening of 2085 unique titles and abstracts revealed seven publications that met the eligibility criteria. Study size ranged from 293 to 15,943 participants. Data from all seven studies were suitable for meta‐analysis. Overall, 8.3% of the studied population was edentulous. The weighted mean prevalence of edentulism among diabetic and non‐diabetics was 14.0% and 7.1%, respectively. The overall odds ratio for diabetic patients to be edentulous as compared to non‐diabetics was 2.39 (95% CI [1.73, 3.28], p < 0.00001). Conclusion: There appears to be moderate certainty that the risk of being edentulous for diabetic patients compared to non‐diabetic people is significant, but the odds ratio is estimated to be small. [ABSTRACT FROM AUTHOR]

Background: Research has shown that routinely assessed, patient-reported outcome measures (PROMs) have positive effects in patients with advanced oncologic diseases. However, the transferability of these results to specialist palliative care is uncertain because patients are more impaired and staff doubt the feasibility and benefits. The aim of this study is to evaluate the feasibility of patient self-assessment of PROMs, their use by staff and the benefits in palliative care wards. Method: A multicentre observational study was conducted in the context of the implementation of the Integrated Patient Outcome Scale (IPOS) in three specialist palliative care wards at university hospitals in Germany. All admitted patients who screened positive regarding their ability to complete questionnaires were asked to participate and complete the IPOS on paper weekly, with assistance if necessary. Feasibility of questionnaire completion (e.g. proportion of patients able to complete them), use (e.g. involvement of different professional groups) and benefit (e.g. unexpected information in IPOS as rated by treating physicians) were assessed. Staff members' opinion was obtained in a written, anonymous evaluation survey, patients' opinion in a short written evaluation. Results: A total of 557 patients were screened for eligibility, 235 were assessed as able to complete the IPOS (42.2%) and 137 participated in the study (24.6%). A majority needed support in completing the IPOS; 40 staff members and 73 patients completed the evaluation. Unexpected information was marked by physicians in 95 of the 137 patient questionnaires (69.3%). The staff differed in their opinions on the question of whether this also improved treatment. A majority of 32 staff members (80.0%) were in favour of continuing the use of IPOS (4 against continuation, 4 no answer); 43 (58.9%) patients rated their overall experience of IPOS use as 'positive', 29 (39.7%) as 'neutral' and 1 (1.4%) as 'negative'. Conclusions: While most staff wished to continue using IPOS, it was a challenge to integrate the effort to support the completion of IPOS into daily practice. Digital implementation was not successful, despite various attempts. To explore the effects on care and patient outcomes, multicentre cluster-randomised trials could be employed. Trial registration: German Clinical Trials Register DRKS-ID: DRKS00016681 (24/04/2019). [ABSTRACT FROM AUTHOR]

This study examines the access to healthcare for children and adolescents with three common chronic diseases (type-1 diabetes (T1D), obesity, or juvenile idiopathic arthritis (JIA)) within the 4th (Delta), 5th (Omicron), and beginning of the 6th (Omicron) wave (June 2021 until July 2022) of the COVID-19 pandemic in Germany in a cross-sectional study using three national patient registries. A paper-and-pencil questionnaire was given to parents of pediatric patients (<21 years) during the routine check-ups. The questionnaire contains self-constructed items assessing the frequency of healthcare appointments and cancellations, remote healthcare, and satisfaction with healthcare. In total, 905 parents participated in the T1D-sample, 175 in the obesity-sample, and 786 in the JIA-sample. In general, satisfaction with healthcare (scale: 0–10; 10 reflecting the highest satisfaction) was quite high (median values: T1D 10, JIA 10, obesity 8.5). The proportion of children and adolescents with canceled appointments was relatively small (T1D 14.1%, JIA 11.1%, obesity 20%), with a median of 1 missed appointment, respectively. Only a few parents (T1D 8.6%; obesity 13.1%; JIA 5%) reported obstacles regarding health services during the pandemic. To conclude, it seems that access to healthcare was largely preserved for children and adolescents with chronic health conditions during the COVID-19 pandemic in Germany. [ABSTRACT FROM AUTHOR]

Objective: The harmful use of alcohol is a global issue. This study aimed to describe and compare the profiles, emergency department (ED) clinical characteristics, and outcomes of alcohol-related ED presentations (ARPs) and non-alcohol-related ED presentations (NARPs). Methods: A multi-site observational study of all presentations to four EDs between 4 April 2016 and 31 August 2017, was conducted. Routinely collected ED clinical, administrative and costings data were used. Classification of ARPs were prospectively recorded by clinicians. Analysis was performed at the presentation, rather than person level. Univariate tests were undertaken to compare demographics, ED clinical characteristics and outcomes between ARPs and NARPs. Results: A total of 418 051 ED presentations occurred within the 17-month study period; 5% (n = 19 875) were ARPs. Presentations made by people classified as ARPs were younger, more likely to be male, present on weekends or at night, and arrive by ambulance or police compared to NARPs. Compared with NARPs, ARPs had a longer median ED length of stay of over 20 min (95% CI 18–22, median 196 min vs 177 min, P < 0.001), a 5.5% (95% CI 4.9–5.3) lower admission rate (36% vs 42%, P < 0.001), and a AUD69 (95% CI 64–75) more expensive ED episode-of-care (AUD689 vs AUD622, P < 0.001). Conclusion: Clinically meaningful differences were noted between alcohol-related and non-alcohol-related ED presentations. The higher cost of care for ARPs likely reflects their longer time in the ED. The healthcare and economic implications of incidents of alcohol-related harm extend beyond the ED, with ARPs having higher rates of ambulance and police use than NARPs. What is known about the topic? The harmful use of alcohol is a major health issue globally contributing to morbidity and mortality. What does this paper add? The demographic profile, clinical characteristics, and outcomes of people presenting to emergency departments with alcohol-related harm differ to people arriving for other reasons. What are the implications for practitioners? Indicating alcohol as a cause of an ED presentation, as standard practice, may foster quality assurance/improvement activities. [ABSTRACT FROM AUTHOR]

Aims: To examine the differences in decisional conflict, decision regret, self‐stigma and quality of life among breast cancer survivors who chose different surgeries, as well as the effects of decisional conflict, decision regret and self‐stigma on quality of life. Design: Observational study. Methods: Paper and online surveys were used to collect data from March to September 2020. The Chinese version of the Decisional Conflict Scale, Decision Regret Scale, Self‐Stigma Form and Functional Assessment of Cancer Treatment‐B were used to measure the corresponding health outcomes for breast cancer survivors who chose different surgeries from three university‐affiliated hospitals. One‐way analysis of variance, Pearson's correlation coefficient and hierarchical multiple regression analysis were used for data analysis. Results: Among the 448 participants, only 21% chose breast conservative surgery, while 79% chose mastectomy with or without reconstruction. Women who chose mastectomy with reconstruction reported higher decisional conflict (p =.028) and more decision regret (p =.013) than women who chose breast conservative surgery; women who chose mastectomy without reconstruction indicated higher decisional conflict (p =.015), more decision regret (p <.001), and higher self‐stigma (p =.034) than women who chose breast conservative surgery. Decisional conflict (r = −.430), decision regret (r = −.495), and self‐stigma (r = −.561) were negatively correlated with quality of life. After controlling for sociodemographic and clinical variables, decisional conflict and decision regret explained 19.7% and self‐stigma explained 12.9% of the variance in quality of life. Conclusion: Decisional conflict, decision regret and self‐stigma vary according to different breast surgeries and are greatly associated with the quality of life of breast cancer survivors. Impact Future studies are warranted to investigate the decision‐making process and the underlying reasons for surgical choices. Decision support strategies pre‐surgery are needed to inform women about the risks and benefits of surgery options. Moreover, psychosocial support post‐surgery is warranted to relieve women's self‐stigma, thus improving their quality of life. [ABSTRACT FROM AUTHOR]

Introduction: Child Safeguarding Services intervene in situations where a child is at risk of serious emotional or physical harm. The response will vary according to the level of risk, but in serious cases, a child may need to be removed from danger and cared for by foster parents either temporarily or permanently. The number of children being taken into care has increased markedly in recent years in the United Kingdom. Oxford shire County Council (OCC) is implementing a new approach to the welfare of children (Family Solutions Plus; FSP) in which the focus is to support the whole family and ideally reduce the need for foster care. In this paper, we describe a proposed programme of evaluation to examine the impact of FSP on the time children are in contact with services, the nature of the support provided, experience of children and families, the experience of staff, and longer term outcomes for children, particularly whether they remain within the family or need to be cared for outside the home. Methods and analysis: A mixed methods approach will be taken in an observational retrospective study of children’s social care services. Quantitative research will include descriptive analysis on data routinely collected by OCC, examining the effect on time spent in services, outcomes for children and how these outcomes are mediated by family characteristics and circumstances. Qualitative research will be carried out using individual interviews and focus groups with children, families and staff in the teams providing family safeguarding services to capture their experiences with the new model. Ethics and dissemination: This project has been registered with the OCC as a service evaluation. The qualitative studies will seek ethical approval from Oxford University Ethics Committee. A local data sharing agreement will govern the transfer of quantitative data. Results will be disseminated through newsletters, community forums, professional publications and conference presentations to national and international audiences. [ABSTRACT FROM AUTHOR]

Introduction: Network platforms are interesting for integrated care governance as they seek solutions for the problem of competition and tensions between networks. In this paper, we analyse how a network platform functions for the actors involved, and how it is used in their work. Methods: We employed a case study in a Dutch urbanised hospital region, and conducted 17 interviews with hospital physicians, directors, and supporting staff who are involved in a network platform called “BeterKeten” (BK). Results: Actors assign different functions and purposes to BK: facilitating and legitimising professional (learning) communities; adapting to a changing policy context; enlarging professionals’ and the networks’ circle of influence; and extending governing possibilities. Network platform’ dynamics and frictions entail changing professional and managerial practices; embedding a BK network in a partner network; and alignment of (conflicting) network platforms. Discussion: Network platforms are a promising strategy to govern, facilitate, and nurture network-building actions to enhance integrated care, offering new ways of working to cope with its multi-level nature. Conclusion: BK is a dynamic actor with steering capacities that enables the coexistence of multiple purposes. Further research could pay attention to how network platforms are able to develop modalities of integrated care governance that suit healthcare system’s networked character. [ABSTRACT FROM AUTHOR]

A technique called arch-clamping was used at our institute to ensure perfusion of the lower body and brain during total arch replacement with frozen elephant trunk (TAR and FET). The aortic arch clamp is inserted between the left common carotid artery and the left subclavian artery after inserting the stented elephant trunk into the true lumen of the descending aorta during the procedure, and then clamps the aorta and graft together as the distal anastomotic edge of the aorta. After the arch clamp was in place, lower body perfusion was resumed through the femoral artery was resumed and time to circulatory arrest was reduced to approximately 4 min. Cardiopulmonary bypass (CPB) flow was gradually restored to full rate. Thereafter, the left carotid artery anastomosis was completed and rewarming began. Finally, during the rewarming period, other branches of the aortic arch and ascending aorta were reconstructed. In this paper, we describe the perfusion management strategy, discuss intraoperative monitoring parameters, and examine the feasibility of the technique from a perfusion perspective. [ABSTRACT FROM AUTHOR]

Objectives: To characterize pregnant women admitted to Irene Neto Maternity Hospital, Lubango city, Huíla province, and their pregnancy outcomes. Methods: We conducted a descriptive cross-sectional facility-based survey between October 2016 and September 2017, involving 500 pregnant women, followed from admission in labor until the end of delivery. Mean (SD) was computed for quantitative variables, while relative and absolute frequencies were determined for categorical variables. Additionally, confidence intervals were estimated. Results: Among pregnant women 18.3% were adolescents (≤ 19 years) and 14.5% had advanced maternal age (≥ 35 years). Illiteracy was reported by 8.2%. One in three (33.6%) had a short stature (< 1.55 m). Malaria was the most frequent infection during pregnancy (16.3%). Upon admission, 18.1% were anemic (Hb < 11 g/dl) and 36.0% had hypertension (SBP ≥ 140 mmHg and/or DBP ≥ 90 mmHg), contrasting with the few cases reported of chronic hypertension and pregnancy-induced hypertension. There were 15 twin pregnancies. Cesarean section was performed in 25.2% of the women, although there was no medical indication for 23.0% of women having cesareans. Two maternal deaths occurred in our sample. Among live births from singleton pregnancies (97.1%), birth asphyxia (Apgar < 7 at 5 min) was observed in 22.7% and 10.3% had low birth weight (< 2.5 kg). Conclusions: There are very few studies reporting pregnancy outcomes in Angola. This analysis presents data from Huíla province, the second most populous province. We identified characteristics for higher risk of adverse pregnancy outcomes: adolescence, illiteracy, and short stature. Among newborn outcomes, birth asphyxia and low birth weight demand special attention. Further research is needed to explore the non-medical indications for cesarean section and to better understand the twinning rate in Lubango. Significance: The significance of this paper is that it is one of the very few reports contributing for the knowledge of detailed maternal, obstetric and newborn outcomes in Angolan women. Although our study only addresses the outcomes descriptively, it can be used as a first step in monitoring and improving outcomes of Angolan women. Maternal and child health is a key issue to address sustainable development in Angola. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to investigate the effect of different probe placements on the ventral and dorsal sides of the same finger using pulse oxygen saturation monitoring. Methods: This clinical trial used a convenience sampling method in patients admitted to the Second Hospital of Hebei Medical University. We enrolled 1330 patients from March to July 2018, including patients who were hospitalized in the intensive care unit (n = 258) and in the general ward (n = 1072). Pulse oxygen saturation measurements obtained from the ventral and dorsal sides of the same finger were compared. This work adhered to the STROBE checklist requirements. Results: We found that pulse oxygen saturation measurements between the dorsal and ventral sides of a finger were not affected by different fingers, disease types, the application of a ventilator, vasoactive drugs, the conscious state of the patient or the instrument model. Conclusion: Our findings suggested no significant difference in saturation measurements with variation in the placement of the pulse oxygen saturation measurement instrument between the dorsal and ventral sides of a finger, regardless of illness severity. We believe that these results could simplify the monitoring procedures performed by nurses and eliminate worries concerning the inaccuracy of data because of varied probe positions. SUMMARY STATEMENT: What is already known about this topic? Early application of digital pulse oxygen measurement in patients with early hypoxia can continuously display their blood oxygen status and can promptly detect hypoxaemia development.Some details may have an impact on clinical comprehension of pulse oximetry values, such as the signal averaging time, data sampling rates and sensor position.In clinical practice, although various medical units adopt different pulse oximeter monitoring instruments, the use of different brands of pulse oximeters requires the placement of the fingernail bed and probe on the same side during finger insertion. What is already known about this topic? In our study, we investigated whether the oxygen saturation measurements obtained from the ventral and dorsal sides of the same fingers in either hand were credible.Factors that affected the perfusion status of the fingertip (i.e. ventilator use, vasoactive drugs and coma) had no effect on the consistency of the oxygen saturation measurements obtained from the ventral and dorsal sides of the same fingers of either hand.Even when monitoring patients in, for example, fixed position, with fingers absent and with a range of different disease states, there is no difference between oxygen saturation measurements on the ventral and dorsal sides of fingers of either hand. The oxygen saturation measurements were found to be reliable. The implications of this paper: Placement of the probe on the dorsal or ventral sides of the fingers does not affect the pulse oxygen saturation measurement in patients with a range of different disease states.In clinical practice, the oxygen saturation measurement results from the ventral and dorsal sides of the same finger from either hand are credible. This finding would simplify daily nursing work. [ABSTRACT FROM AUTHOR]