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Introduction: Small‐cell lung cancer (SCLC) may be associated with neuronal autoantibodies and paraneoplastic neurological syndromes. It has been suggested that neuronal autoantibodies, especially antineuronal nuclear antibody type 1 (Hu) autoantibodies, are associated with longer survival of patients with SCLC. The objective of this study was to determine the frequency and distribution of neuronal autoantibodies at the time of diagnosis of SCLC patients and assess survival rates in relation to autoimmunity. Methods: In this retrospective study, serum from 40 patients with biopsy‐proven SCLC at the time of diagnosis was studied prior to treatment. The sera originated from a cancer registry at the Oncology Department, Vejle Hospital from 2007 to 2010. The sera were analyzed blindly to clinical status for the presence of neuronal autoantibodies. Medical records were reviewed for neurological symptoms. Results: Neuronal autoantibodies were detected in 22/40 (55%) of the SCLC patients. A broad range of neurological symptoms was recorded in 28/40 (70%) patients, of which 14/28 (50%) were positive for neuronal autoantibodies. The most frequently detected autoantibodies were Hu (7/40, 17.5%) followed by GAD65 (6/22, 15.0%). Striational and P/Q‐ or N‐type voltage‐gated calcium channel antibodies were less common, with each found in five patients (12.5%). Eight patients (20%) had coexisting autoantibodies. Autoantibody‐positivity was not associated with survival. Conclusion: Neuronal autoantibodies were at time of diagnosis found in approximately half of the treatment‐naïve SCLC patients. Neither autoantibody positivity at diagnosis nor neurological manifestations correlated with survival and their clinical importance requires further studies in larger, prospective cohorts. [ABSTRACT FROM AUTHOR]

Purpose: Persistent microvascular obstruction (MVO) after successful percutaneous coronary intervention (PCI) in acute ST segment elevation myocardial infarction (STEMI) has been well‐described. MVO predicts lack of recovery of left ventricular function and increased mortality. Sonothrombolysis utilizing diagnostic ultrasound induced cavitation of commercially available microbubble contrast has been effective at reducing infarct size and improving left ventricular ejection fraction (LVEF) when performed both pre‐ and post‐PCI. However, the effectiveness of post‐PCI sonothrombolysis alone after successful PCI has not been demonstrated. Methods: A prospective randomized controlled trial was performed in 50 consecutive consenting patients with anterior STEMI who underwent a continuous microbubble infusion immediately following successful PCI. Intermittent high mechanical index (MI) impulses were applied only in the sonthrombolysis group. Delayed enhancement magnetic resonance imaging (MRI) was performed at 48 h and again at 6–8 weeks to assess for differences in infarct size, LVEF, and MVO. Results: There were no differences between groups in age, gender, and cardiovascular risk factors. Significant (> 2 segments) MVO following successful PCI was observed in 66% of patients. Although sonothrombolysis reduced the extent of MVO acutely, there were no differences in infarct size, LVEF, or extent of MVO by MRI at 48 h. Twenty‐eight patients returned for a follow up MRI at 6–8 weeks. LVEF improved only in the sonothrombolysis group (∆LVEF 7.81 ± 4.57% with sonothrombolysis vs. 1.77 ± 7.02% for low MI only, p =.011). Conclusion: Post‐PCI sonothrombolysis had minimal effect on reducing myocardial infarct size but improved left ventricular systolic function in patients with acute anterior wall STEMI. [ABSTRACT FROM AUTHOR]

Adherence to continuous positive airway pressure (CPAP) in patients with obstructive sleep apnea (OSA) post-stroke is often problematic, despite potential benefits. This study aimed to evaluate CPAP adherence in patients with OSA post-stroke based on the Andersen behavioral model of health services utilization. A total of 227 eligible participants were recruited from a Chinese hospital. After baseline assessment, participants were followed for 6 months to determine short-term CPAP adherence. Those with good short-term adherence were followed for an additional 6 months to explore long-term adherence and influencing factors. Short-term CPAP adherence rate was 33%. Being married or living with a partner, having an associate degree or baccalaureate degree or higher, and stronger health beliefs independently predicted short-term CPAP adherence. Only 25% of participants from the adherent group showed good long-term adherence. The factor associated with long-term CPAP adherence was participants not using alcohol. Adherence to CPAP is suboptimal among patients having OSA post-stroke. Addressing unfavorable predisposing factors and modifying health beliefs are suggested. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effect of fluid management, symptom control, and quality of life on education based on the Roy Adaptation Model. This randomized controlled study was conducted with the participation of 107 patients (53 intervention, 54 control). Data were collected using the "Patient Data Collection Form," "Fluid Control in Hemodialysis Patients Scale," "Dialysis Symptom Index," and "Nottingham Health Profile." The forms were filled out through face-to-face interviews with the patients in the intervention and control groups at the 0th (onset), 1st, and 3rd months. The patients in the intervention group were trained with an education booklet based on the Roy Adaptation Model. The results revealed that the education given according to the Roy Adaptation Model improved the compliance with fluid control, quality of life, and symptom control of hemodialysis patients. It is recommended that education based on the Roy Adaptation Model be systematically used by hemodialysis nurses. The results are limited to the population included in the study, and further research on hemodialysis populations is needed. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have demonstrated a high degree of atrioventricular (AV) synchrony with a new leadless pacemaker called Micra AV. Our group previously reported a new and unique sensing method. We believe that this novel sensing method, "Simplified A3 method," might facilitate better AV synchrony than a conventional sensing method in almost all cases with Micra AV implantation. Methods: We conducted a non‐randomized retrospective study comparing the two pacing methods at two centers. From December 1, 2021 to October 31, 2022, Micra AV was implanted for 32 patients at the two centers. Twenty of the 32 patients with sinus rhythm and complete AV block were included in this study. In Group 1, the conventional setting was programmed as follows: auto A3 threshold, auto A3 window‐end (WE), and auto A4 threshold turned on during hospitalization. In Group 2, the "Simplified A3 method" was programmed as follows: auto A3 threshold and auto A3WE turned off. Instead, an intentionally prolonged A3WE (850–1000 ms) and low A3 threshold (A3 signal amplitude + 0.5–1.0 m/s2) were programmed. Results: Twenty patients were analyzed. In Group 2, AV synchrony (%AMVp) was significantly higher at the first outpatient clinic (63.0 ± 5.7% vs 81.0 ± 4.2%, p =.03). A3 threshold was significantly lower in Group 2 (5.9 ± 0.7 m/s2, p <.05 vs 2.3 ± 0.5 m/s2, p <.05). Conclusion: Our novel sensing method might be a more feasible sensing method for obtaining higher AV synchrony than the conventional algorithm. [ABSTRACT FROM AUTHOR]

Introduction: Bicuspid aortic valves (BAV) are the most common congenital heart defects and the extent of ventricular arrhythmias (VA) in patients with BAV is unclear. The objective of this study is to describe VAs and late gadolinium enhancement cardiac magnetic resonance imaging (LGE‐CMR) in patients with BAV. Methods: A total of 19 patients with BAV (18 males, age: 58 ± 13 years) were referred for VA ablation procedures. Ten patients had BAVs at the time of ablation, nine patients had prior aortic valve replacement for a BAV. All but one patient had LGE‐CMR and all patients underwent programmed ventricular stimulation at the time of the ablation. Results: Frequent PVCs were the targeted VAs in 17/19 patients and VT in 2/19 patients. Monomorphic ventricular tachycardia (VT) was inducible in 6 patients. A total of 15 VTs were inducible (2.5 ± 1.0 VTs per patient with a mean cycle length of 322 ± 83 msec). LGE was present in 13 patients. Patients with inducible VT had larger borderzone and core scar compared to non‐inducible patients (7.8 ± 2.1 cm3 vs. 2.5 ± 3.1 cm3 and 5.1 ± 2.6 cm3 vs. 1.9 ± 3.0 cm3, p‐value <.05 for both). PVCs and VTs were mapped to the periaortic valve area in 12 patients and 4 patients, respectively. The PVC burden was reduced from 27 ± 13 to 3 ± 6 (p <.001) and the ejection fraction improved from 49 ± 13% to 55 ± 9% (p =.005). Conclusions: VAs in patients with BAV often originate from the perivalvular area and patients often have LGE and inducible VT. LGE may be due to ventricular remodeling secondary to the presence of BAV and harbors the arrhythmogenic substrate for VT. [ABSTRACT FROM AUTHOR]

Introduction: Dolutegravir + rilpivirine (DTG + RPV) is an effective antiretroviral therapy regimen approved in clinical guidelines as a switch therapy for virologically suppressed people with HIV. Our study aimed to compare the effectiveness and tolerability of DTG + RPV in women and men in real‐world clinical practice. Methods: This was a retrospective analysis of treatment‐experienced people with HIV from a large HIV unit who switched to DTG + RPV. We analysed treatment effectiveness, rates of adverse events and discontinuation, and metabolic changes after 48 weeks of treatment. HIV‐RNA levels <50 copies/mL were analysed at 48 weeks using both intention‐to treat analysis (where missing data were interpreted as failures) and per‐protocol analysis (excluding those with missing data or changes due to reasons other than virological failure). Outcomes were compared between women and men based on sex at birth. Results: A total of 307 patients were selected (71 women and 236 men). No transgender people were included. At baseline, women had lived with HIV infection and received antiretroviral therapy for longer than men (23.2 vs 17.4 years and 18.9 vs 14.2 years, respectively). In the intention‐to‐treat analysis, 74.6% (95% confidence interval [CI] 63.4–83.3%) of women and 83.5% (95% CI 78.2–87.7) of men had HIV‐RNA <50 copies/mL. In the per‐protocol analysis, 96.4% (95% CI 87.7–99) of women and 99% (95% CI 98.9–99.7) of men had HIV‐RNA levels <50 copies/mL. Two women and two men had HIV‐RNA >50 copies/mL at 48 weeks. Discontinuation due to adverse events was more frequent in women than in men: 12.7% vs 7.2% (p < 0.02). Neuropsychiatric and gastrointestinal events were the most frequently reported. A median (interquartile range) weight gain of 1.9 kg (0–4.2) in women and 1.2 kg (−1–3.1) in men was reported (median of differences between baseline visit and week 48); the remaining changes in metabolic parameters were neutral. Conclusions: DTG + RPV exhibited good and similar virological effectiveness in women and men in real‐world settings. However, poorer tolerability and more treatment interruptions were observed in women. [ABSTRACT FROM AUTHOR]

Background: Various cutoffs have been used to diagnose computed tomography (CT)‐defined low skeletal muscle mass; however, the impact of this variability on predicting physical functional limitations (PFL) remains unclear. In the present study we aimed to evaluate the diagnostic test metrics for predicting PFLs using a fixed cutoff value from previous reports and sought to create a prediction score that incorporated the skeletal muscle index (SMI) and other clinical factors. Methods: In this cross‐sectional study including 237 patients with lung cancer, the SMI was assessed using CT‐determined skeletal muscle area at the third lumbar vertebra. Physical function was assessed using the short physical performance battery (SPPB) test, with PFL defined as an SPPB score ≤9. We analyzed the diagnostic metrics of the five previous cutoffs for CT‐defined low skeletal muscle mass in predicting PFL. Results: The mean age of participants was 66.0 ± 10.4 years. Out of 237 patients, 158 (66.7%) had PFLs. A significant difference was observed in SMI between individuals with and without PFLs (35.7 cm2/m2 ± 7.8 vs. 39.5 cm2/m2 ± 8.4, p < 0.001). Diagnostic metrics of previous cutoffs in predicting PFL showed suboptimal sensitivity (63.29%–91.77%), specificity (11.39%–50.63%), and area under the receiver operating characteristic curve (AUC) values (0.516–0.592). Age and the SMI were significant predictors of PFL; therefore, a score for predicting PFL (age – SMI + 21) was constructed, which achieved an AUC value of 0.748. Conclusion: Fixed cutoffs for CT‐defined low skeletal muscle mass may inadequately predict PFLs, potentially overlooking declining physical functions in patients with lung cancer. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to validate the Delirium Observation Screening Scale (DOSS) in a population of long‐term care facility (LTCF) residents in Flanders. Currently there is no validated screening tool for delirium available for the population in this setting in Flanders. Methods: A multisite, cross‐sectional study was conducted in six LTCFs. A total of 338 residents aged 65 years and older were included. Sociodemographic and clinical data, including data from the Montreal Cognitive Assessment (MoCA), Confusion Assessment Method (CAM) and DOSS, were obtained by three trained nurse researchers. For the DOSS, internal consistency was determined, and inter‐rater reliability was calculated. To validate the DOSS, the sensitivity, specificity, and positive and negative predictive value of the DOSS relative to the CAM were determined through receiver operating characteristic analysis. This article adheres to the Strengthening the Reporting of Observational Studies (STROBE) checklist for observational research. Results: For 338 residents, delirium assessments were completed during an early or late shift. The prevalence of delirium was 14.2% as measured with the DOSS. The reliability (α) for the CAM and DOSS was assessed, as was the inter‐rater reliability (κ) and the area under the curve. The sensitivity and specificity for a cut‐off value of 3 on the DOSS by Youden's index were very high, as was the negative predictive value. The positive predictive value was good. Conclusions: This study showed that the DOSS is a reliable and valid instrument to screen for delirium in LTCF residents in Flanders. Geriatr Gerontol Int 2024; 24: 619–625. [ABSTRACT FROM AUTHOR]

Background: Given students' lack of self‐directed learning skills and the growing concern about implementing massive online open courses (MOOCs) in K12 education, learning strategies are needed to facilitate MOOC learning. Many studies have provided different strategies for effective learning in MOOCs. However, there is still limited research to confirm whether these strategies effectively support MOOC learning when deployed by secondary schools, which are not MOOC developers. Objectives: This mixed‐method study examines the provision of different learning strategies, including a learning guide, an academic mentoring programme, a training workshop, and a reimbursement scheme, and investigates the impact of these strategies on student learning in MOOCs. Methods: The study uses two data sources: (1) surveys with 40 participants and (2) semi‐structured interviews with 12 participants. The quantitative data were analysed with descriptive statistics and Fisher's exact test, and the qualitative data were analysed with thematic analysis. Results and Conclusion: The findings indicate that MOOC learners had positive attitudes towards the overall school support, with mentoring enjoying great popularity amongst the students. In terms of the effectiveness of the school support, the mentoring programme and reimbursement scheme were more effective than the university training and learning guide. The paper discusses the implications for researchers and educators. Lay Description: What is already known about this topic: There are a large number of K12 MOOC implementations, which are (i) STEM‐related and computer science courses, and (ii) from Europe and the USA.Limited studies provided different learning strategies for MOOC learning from the perspective of K12 schools, which are not MOOC developers.There is a need to explore MOOC initiatives encompassing a wide variety of subjects, including computer science MOOCs and non‐computer science MOOCs, in regions beyond Europe and the USA.There is also a need for further scrutiny of the effectiveness of learning strategies provided by the K12 school. What this paper adds: Our study launched the first MOOC implementation in K12, encompassing several subject areas beyond computer science in the region of Asia.Our study provided different learning strategies adopted by the K12 school, and the analysis revealed that MOOC learners took positive attitudes towards overall school support with mentoring enjoying great popularity with these students.Our study examined the effectiveness of school support and identified that mentoring and reimbursement are more effective than university training and the learning guide. Implications for practitioners: The insights gained from the study enable other K12 schools and educators to implement MOOC into existing school infrastructures successfully.These strategies provided in the MOOC implementation program can be helpful in many different online learning contexts. [ABSTRACT FROM AUTHOR]

Context: The Covid‐19 pandemic has added a new chapter to discussions about the professional duty to care. To understand how Covid‐19 may have changed medical students' ethical attitudes towards this duty, we analysed policies written before and during the pandemic by first‐year students completing a yearly educational exercise focused on work requirement expectations for healthcare professionals during a hypothetical epidemic. Methods: Within a repeated cross‐sectional design, consensus coding was performed on policies written over 5 years (2017–2021) using a codebook based on eight questions from the educational exercise for summative content analysis. Frequencies provided summative results and comparisons across years used Fisher's exact test. Results: We analysed 142 written policies from 2017 to 2021 representing 884 first‐year students working in small groups. Students' commitment to the duty to care remained stable during the Covid‐19 pandemic, but during the pandemic, students were more likely to support exceptions to the duty to care (e.g. for healthcare professionals with medical conditions or concern for household members' health) and more likely to expect institutions to provide safe working conditions. Ethical values supporting students' policies were largely consistent before and during the pandemic, the most common being beneficence, justice, duty to care, non‐maleficence and utility. Conclusions: Our results suggest that students' support for the duty to care remained strong during the Covid‐19 pandemic. We also found that students supported exceptions to this duty to reflect the needs of healthcare professionals and their families and that they expected institutions to provide safe working conditions. These findings can help inform ethics education and future pandemic preparedness. While students' support for the duty to care remained strong during the Covid‐19 pandemic, Kaldjian et al. explain their need for safe working conditions and concerns about the health of clinicians and their families." [ABSTRACT FROM AUTHOR]

Introduction: Stroke poses challenges to the physiological, psychosocial and spiritual well‐being of affected individuals. As the impacts of stroke might not be reversible, a shift in focus to providing care is desirable. Visual art interventions using visual and symbolic art can help participants to express their feelings, give them a sense of choice and the feeling that they are retaining a sense of control, promote insights, restructure their sense of cognition and instil hope. There have been few studies on visual art interventions involving older people with stroke and none in residential care homes (RCHs). Theoretical support and rigorous research designs on the subject are lacking. Thus, this study seeks to address this research gap by examining the feasibility of a visual art intervention for older people in RCHs and exploring the impacts on their holistic well‐being. Methods: This was a single‐blinded, two‐arm, randomised controlled feasibility study grounded on Watson's Caring Theory. The Holistic Well‐Being Scale and Caring Factor Survey were used in the study, with three assessment time‐points: before the intervention (T1), at the mid‐point of the intervention (T2) and immediately after the intervention (T3). Results: Sixty‐one older people with stroke were recruited from 14 RCHs and randomised into the intervention and control groups. The recruitment rate was 44.53%, and the retention rate for the intervention group was 93.55%. Implementing the programme was affordable (at approximately US$126/head), the duration was acceptable (721 min) and the feedback from participants and staff of the RCHs was positive. Conclusions: The visual art intervention programme proved to be clinically feasible. This study adds new insights to the development of visual art interventions and to the caring sciences. The efficacy of the programme on holistic well‐being has yet to be confirmed. [ABSTRACT FROM AUTHOR]

Aim: To describe the expectations, acceptability, and challenges identified by nurses and key healthcare stakeholders regarding the implementation of advanced practice nursing in Gabon. Background: Advanced practice nursing presents an opportunity to address the epidemiological transition and the shortage of healthcare professionals in Africa. In anticipation of establishing a master's degree program in advanced practice nursing and its subsequent implementation, it is important to understand Gabon's specific needs and characteristics. Design: This study used a multicenter cross‐sectional mixed‐method design. Methods: From April to May 2022, a total of 187 healthcare professionals were included from two hospitals and two universities in Gabon. Data were collected through questionnaires and complemented by focus group discussions, guided by the existing literature, the PEPPA framework, and Hamric's model. Results: The implementation of advanced practice nursing was generally well accepted. Factors influencing acceptability included being female, awareness of advanced practice nursing, and supporting the role of advanced practice nurses in diagnosing chronic diseases. Barriers to implementation included the absence of a legal framework for the profession and a lack of recognition of nursing skills by both nurses and doctors. Facilitators included the establishment of a master's degree program, formalization of a legal framework, raising awareness, providing training to medical doctors and other healthcare professionals about advanced practice nursing, and the development of nursing leadership. Implications for nursing: Advanced practice nursing can play a crucial role in addressing healthcare resource shortages and the dual burden of chronic and infectious diseases in Gabon, as well as in other African countries. Implications for nursing policy: To successfully implement advanced practice nursing in Gabon and French‐speaking Africa, it is essential to regulate the nursing and advanced nursing professions by creating a legal framework and establishing nursing councils. An effective implementation strategy for advanced practice nurses should be based on the specific needs of the country. Guidelines: COREQ, STROBE [ABSTRACT FROM AUTHOR]

Background: Students with intellectual and developmental disabilities (IDD) were disproportionately impacted by the COVID‐19 pandemic. This study's goal was to assess the effectiveness of 2 messaging strategies on participation in SARS‐CoV‐2 weekly testing. Methods: Cluster randomized trials were conducted at 2 school systems, the special school district (SSD) and Kennedy Krieger Institute (Kennedy) to assess messaging strategies, general versus enhanced, to increase weekly screening for SARS‐CoV‐2. Testing was offered to staff and students from November 23, 2020 to May 26, 2022. The primary outcomes were percentage of students and staff consented weekly and percentage of study participants who had a test performed weekly. Generalized estimating equation models were utilized to evaluate the primary outcomes. Results: Increases in enrollment and testing occurred during study start up, the beginning of school years, and following surges in both systems. No statistical difference was observed in the primary outcomes between schools receiving standard versus enhanced messaging. Implications for School Health Policy, Practice, and Equity: Frequent and consistent communication is vital for families and staff. Weekly screening testing within schools is possible and highlighted the importance of utilizing equitable protocols to provide important testing to students with IDD. Conclusion: Enhanced messaging strategies did not increase the number of participants enrolled or the percentage of enrolled participants being tested on a weekly basis. [ABSTRACT FROM AUTHOR]

Advanced practice nurses constitute a new professional group within the French health care system. Advanced practice nurses specialise in one of five disciplines including Psychiatry/Mental‐Health. This specific discipline is strongly marked by stigmatising representations by healthcare users and other health professionals (including other advanced practice nurses), whose consequences have a deleterious effect. The aim was to highlight all advanced practice nurses representation of Psychiatry/Mental‐Health advanced practice nurses. An observational descriptive survey, based on an anonymous online questionnaire was conducted in April 2022 among qualified and student advanced practice nurses from the five specialist disciplines. Overall, 356 advanced practice nurses completed the survey questionnaire. No significant difference in stigmatising representations of Psychiatry/Mental‐Health advanced practice nurses versus other advanced practice nurses was observed. Only 3.3% of other advanced practice nurses thought that Psychiatry/Mental‐Health advanced practice nurses are often 'strange'. Psychiatry/Mental‐Health advanced practice nurses and other advanced practice nurses appeared to have similar representations of the professional roles of advanced practice nurses in general and of advanced practice nurses APN specifically. Unlike other professionals in the psychiatric field (e.g. medical interns, nurses), very little stigmatisation of Psychiatry/Mental‐Health advanced practice nurses by their colleagues (i.e. other advanced practice nurses) was observed. This could be partly due to the fact that advanced practice nurses professional identity appeared to be built collectively around the concept of advanced practice. Advanced practice nurses constitute a professional group that is fully involved in contemporary transformations in care and organisational innovation. The very low level of stigmatisation of Psychiatry/Mental‐Health advanced practice nurses by other advanced practice nurses in our study suggests that these new healthcare actors could play a crucial role in the improvement of professional health practices, particularly in terms of improved coordination between psychiatric‐care and physical‐care. [ABSTRACT FROM AUTHOR]

Background: Dietitians are central members of the multidisciplinary long‐term care (LTC) healthcare team. The overall aim of this current investigation is to gain a better understanding of dietitian involvement in LTC resident's end‐of‐life care via referrals. Methods: Retrospective chart reviews for 164 deceased residents (mean age = 88.3 ± 7.3; 61% female) in 18 LTC homes in Ontario, Canada, identified dietitian referrals and documented eating challenges recorded over 2‐week periods at four time points (i.e., 6 months, 3 months, 1 month and 2 weeks) prior to death. Nutrition care plans at the beginning of these time points were also noted. Logistic mixed effects regression models identified time‐varying predictors of dietitian referrals. Bivariate tests identified associations between nutrition orders and dietitian referrals that occurred in the last month of life. Results: Nearly three‐quarters (73%) of participants had at least one dietitian referral across the four observations. Referrals increased significantly with proximity to death; 45% of residents had a referral documented in the last 2 weeks of life. Dietitian referrals were associated with the number of eating challenges (odds ratio [OR] = 1.42, 95% confidence interval [CI] = 1.27, 1.58). Comfort‐focused nutrition care orders were significantly more common when a dietitian was referred (25%) compared with when a dietitian was not referred (12%) in the final month of life (p = 0.04). Conclusions: Our findings suggest that dietitians are involved in end‐of‐life and comfort‐focused nutrition care initiatives, yet they are not engaged consistently for this purpose. This presents a significant opportunity for dietitians to upskill and champion palliative approaches to nutrition care within the multidisciplinary LTC team. Key points: Dietitian referrals increased in prevalence in the last 2 weeks of life for residents living in Ontario long‐term care homes.Residents experienced a variety of complex eating challenges that required additional support from a dietitian.Dietitian referrals were associated with the initiation of comfort‐focused nutrition care orders.With earlier engagement, dietitians would be well positioned to champion and manage a palliative approach to care among multidisciplinary long‐term care teams. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy and safety of ketamine alone with those of ketamine‐dexmedetomidine combination for sedation during brain CT in paediatric patients with head injuries. Methods: We retrospectively analysed the data of paediatric patients who underwent sedation for brain CT at the ED. We included patients aged 6 months to 6 years with American Society of Anesthesiologists physical status I or II. The sedative protocol involved the administration of intramuscular (IM) ketamine 3 mg/kg (K), ketamine 2 mg/kg with dexmedetomidine 1.5 μg/kg (KD) or ketamine 1.5 mg/kg with dexmedetomidine 1.5 μg/kg (low‐KD). The primary and secondary outcomes were sedation failure and adverse events, respectively. Results: We included 77 patients; among them, 28, 23 and 26 were in the K, KD and low‐KD groups, respectively. In multivariable analysis, the combination groups (KD and low‐KD groups) were significantly associated with a lower possibility of sedation failure compared to the K group (adjusted odds ratio, 0.12; 95% confidence interval, 0.02–0.56). Moreover, there were no significant differences in adverse events between the groups, and the sedation‐related time variables also did not significantly differ among the three groups. Conclusions: Our findings indicated that a combination of IM ketamine‐dexmedetomidine provides effective sedation for paediatric patients undergoing brain CT without significant adverse events. Further research is needed to investigate the potential benefits of using lower doses of ketamine in combination. [ABSTRACT FROM AUTHOR]

Most studies on nursing students' awareness and knowledge of child abuse and neglect (CAN) report insufficient knowledge. However, there are limited studies evaluating the effectiveness of educational interventions. This study aimed to examine the effect of the Child Abuse and Neglect Awareness Program (CANAP) on nursing students on their CAN knowledge and awareness levels. A randomized controlled study was conducted between 21 May and 29 June 29, with 75 students, 40 in the experimental group and 35 in the control group, studying nursing at a foundation university in Turkey. While CANAP was applied to the participants in the experimental group, no intervention was applied to those in the control group. The data were collected in three stages (before the intervention, immediately after the intervention and 1 month after the intervention) using the Personal Information Form, Diagnosis Scale of the Risks and Symptoms of Child Abuse and Neglect (DSRSCAN) and Child Abuse and Neglect Awareness Scale (CANA‐S). Data were analysed using Chi‐square and Fisher exact tests, independent samples t test and repeated measures analysis of variance (ANOVA) test. The groups were homogeneous regarding the students' sociodemographic characteristics (p > 0.05). In the study, the mean DSRSCAN and CANA‐S scores of the groups were similar in the pre‐test before CANAP but increased significantly in the post‐test and re‐test (p < 0.05). All CANA‐S re‐test sub‐dimension mean scores of the experimental group were significantly higher than the control group (p < 0.05). The mean scores of the experimental group in the DSRSCAN physical symptoms of abuse on the child, characteristics of parents prone to abuse and neglect, characteristics of children at risk of abuse and neglect and familial characteristics in child abuse and neglect sub‐dimensions were significantly higher than the control group (p < 0.05). CANAP effectively increases nursing students' CAN knowledge and awareness levels. It was observed that the experimental group students maintained their increased knowledge and awareness 1 month after the intervention. [ABSTRACT FROM AUTHOR]

Introduction: Artificial intelligence (AI) ECG arrhythmia mapping provides arrhythmia source localization using 12‐lead ECG data; whether this information impacts procedural efficiency is unknown. We performed a retrospective, case‐control study to evaluate the hypothesis that AI ECG mapping may reduce time to ablation, procedural duration, and fluoroscopy. Materials and Methods: Cases in which system output was used were retrospectively enrolled according to IRB‐approved protocols at each site. Matched control cases were enrolled in reverse chronological order beginning on the last day for which the technology was unavailable. Controls were matched based upon physician, institution, arrhythmia, and a predetermined complexity rating. Procedural metrics, fluoroscopy data, and clinical outcomes were assessed from time‐stamped medical records. Results: The study group consisted of 28 patients (age 65 ± 11 years, 46% female, left atrial dimension 4.1 ± 0.9 cm, LVEF 50 ± 18%) and was similar to 28 controls. The most common arrhythmia types were atrial fibrillation (n = 10), premature ventricular complexes (n = 8), and ventricular tachycardia (n = 6). Use of the system was associated with a 19.0% reduction in time to ablation (133 ± 48 vs. 165 ± 49 min, p = 0.02), a 22.6% reduction in procedure duration (233 ± 51 vs. 301 ± 83 min, p < 0.001), and a 43.7% reduction in fluoroscopy (18.7 ± 13.3 vs.33.2 ± 18.0 min, p < 0.001) versus controls. At 6 months follow‐up, arrhythmia‐ free survival was 73.5% in the study group and 63.3% in the control group (p = 0.56). Conclusion: Use of forward‐solution AI ECG mapping is associated with reductions in time to first ablation, procedure duration, and fluoroscopy without an adverse impact on procedure outcomes or complications. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this cross‐sectional study was to explore the structural validity and internal consistency reliability of General Anxiety Disorder‐7, Patient Health Questionnaire‐8, 15 and Jaw Functional Limitation Scale‐20 in patients with chronic pain of temporomandibular disorders. Materials and Methods: Validity and reliability were assessed in 129 patients diagnosed according to the diagnostic criteria for temporomandibular disorders. Structural validity was explored using factor analysis, and internal consistency by calculating Cronbach α. Results: Confirmatory factor analysis revealed a suitable 2‐factor model for Patient Health Questionnaire‐8, with Cronbach α of 0.89, and 0.86. One and 2‐factor models were suitable for General Anxiety Disorder‐7, with overall Cronbach α of 0.93 for the 1‐factor model, and 0.91 and 0.84 for both factors in a 2‐factor model. A 4‐factor solution was appropriate for Patient Health Questionnaire‐15, with Cronbach α of 0.72, 0.57, 0.71 and 0.73 for each factor separately. Exploratory factor analysis was conducted to explore the factor structure of Jaw Functional Limitation Scale 20, and a 3‐factor solution was appropriate. Conclusions: This study provides positive evidence of structural validity and internal consistency of these questionnaires in patients with pain of temporomandibular disorders. However, additional testing is required to explore further psychometric properties. [ABSTRACT FROM AUTHOR]

Objective: To map oral health‐related standard of care in the context of head and neck cancer (HNC) treatment across the European Union (EU). Materials and Methods: Six hundred and ninety centers across the European Union were contacted. The questionnaire contained questions focusing on the team/department structure, HNC treatment planning routines, and assessment and handling of dental treatment needs prior to cancer treatment. Results: Eighty‐seven centers across the EU responded. Department structure and number of HNC patients treated per year varied widely and dental professionals are included as part of the team in about 25% of the centers. Standard of care, in terms of dental assessment and preventive dentistry routines, such as recording an orthopantomogram, offering dental treatment, and providing a radiation protection splint and splint for fluoride application, differed significantly among the European regions. Independent of the region, these aspects are positively affected if dental professionals are part of the interdisciplinary treatment team and if dental treatment is offered within the center. Conclusion: Dental professionals are still only to a very limited extent included in interdisciplinary treatment planning teams of HNC patients. However, their inclusion and/or offering dental treatment within the same hospital/center appears to improve oral health‐related standard of care. Clinical Relevance: Inclusion of dental professionals in treatment planning teams of HNC patients appears to improve oral health‐related standard of care within HNC treatment. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to compare the levels of gingival crevicular fluid (GCF), salivary, and serum matrix metalloproteinase‐9, interleukin (IL)‐17, IL‐36γ, and IL‐38 in individuals with healthy periodontium, gingivitis, and periodontitis and to evaluate their correlations with clinical periodontal parameters. Materials and Methods: Ninety systemically healthy and nonsmoking volunteers divided into a healthy (H) group (n = 30), a gingivitis (G) group (n = 30), and a periodontitis (P) group (n = 30) were included in this study. Clinical periodontal parameters of volunteers were recorded, and GCF, unstimulated saliva, and serum samples were collected. Data analysis was done with enzyme‐linked immunosorbent assays. The Kruskal–Wallis test and Bonferroni correction were used for multiple comparisons and post hoc statistical analyses. Results: The group H had significantly lower clinical parameters than the group P (p < 0.001). GCF and salivary IL‐36γ and IL‐38 levels were significantly higher in the group P than in the H and G groups (p < 0.05). Positive correlations between biochemical findings and clinical periodontal parameters were observed. Conclusions: IL‐36γ and IL‐38 levels in GCF, saliva, and serum correlate with clinical periodontal parameters and may play a role in determining the activity of periodontitis. [ABSTRACT FROM AUTHOR]

Objective: Chemotherapy and radiotherapy, used to treat childhood hematological malignancies (acute lymphocytic leukemia [ALL] and acute myelocytic leukemia [AML]) can negatively affect oral tissues and organs. This study aimed to evaluate the oral health‐related quality of life in children with ALL/AML. Materials and Methods: A total of 99 children, including 49 undergoing ALL/AML (41 with ALL and eight with AML) and 50 healthy volunteers, were included in this cross‐sectional study. The mean age of the entire study group was 78.63 ± 34.41 months. The mean age of the ALL/AML and control groups was 87.12 ± 35.04 and 70.95 ± 34.85 months, respectively. The Simplified Oral Hygiene Index (SOHI), the Decayed, Missing, and Filled Teeth (DMFT/dmft) index, and the Turkish version of the Early Childhood Oral Health Impact Scale (ECOHIS‐T) were administered to all children. The data were analyzed using SPSS software (version 22.0). The Pearson chi‐square and Fisher's exact tests were used to compare demographic data. Results: The age and gender distributions of the two groups were similar. According to ECOHIS‐T, the children in the ALL/AML group had significantly more loss of function (eating, drinking, sleeping, etc.) than those in the control group. Conclusions: Oral health and self‐care were negatively affected by childhood ALL/AML and its treatment. [ABSTRACT FROM AUTHOR]

Objective: The present study aimed to compare the estimated prevalence, sociodemographic features and impacts of Bulimia Nervosa (BN), Binge Eating Disorder (BED) and Other Specified Feeding or Eating Disorder (OSFED; BN or BED of low frequency and/or limited duration) when comparing the DSM‐5 with the broader ICD‐11 diagnostic criteria for size and specifiers of binge‐eating episodes in a general population epidemiological sample. Methods: 2977 individuals (1524 women and 1453 men) aged ≥15 years from randomly selected households in South Australia were interviewed in person. Participants were asked questions relating to sociodemographic features, symptoms of eating disorder pathology, physical and mental health‐related quality of life (HRQoL; SF‐12) and role impairment. Results: The estimated prevalence of only one diagnosis, namely BED, was lower when applying DSM‐5 criteria than when applying ICD‐11 criteria, largely due to the Criterion B binge‐eating specifiers of the DSM‐5. There were no significant differences in participants' demographic features, HRQoL, or role impairment between the comparable diagnosis of either scheme. Conclusions: There were few differences in distribution and similar levels of health impacts when applying either diagnostic scheme in this epidemiological study. However, cases of BED may be missed when using the stricter criteria of DSM‐5 in epidemiological surveys. Further studies are needed to assess the clinical utility of the DSM‐5 and ICD‐11 diagnostic specifiers of binge‐eating. Highlights: In a representative sample of the Australian general population the estimated prevalence of BED was significantly lower when applying DSM‐5 criteria than when applying ICD‐11 criteria.The estimated prevalence of BN or OSFED did not differ when applying DSM‐5 criteria or when applying ICD‐11 criteria.Participants with a BN, BED or OSFED diagnosis experienced similar levels of health impacts when either DSM or ICD criteria were applied. [ABSTRACT FROM AUTHOR]

Background: Nurses have a key role in the recognition, reporting, and channelization of child abuse and neglect. Nurses should have sufficient knowledge about the presentation of child abuse and neglect. They also need to understand their role in reporting any instance where they detect cases of abuse and neglect. Purpose: The aim of this study is to determine the effect of a structured Child Neglect and Abuse Educational Program (CNaA‐EP) on the level of knowledge and awareness of nursing students about child neglect and abuse. Methods: This study conducted with nursing students used a pretest−post‐test quasi‐experimental design. The third‐year nursing students were divided into two groups: experimental (n = 25) and control groups (n = 30). The intervention group received CNaA‐EP. In both groups, pretests were performed using the "Child Abuse and Neglect Awareness Scale," and "Child Abuse and Neglect Knowledge Test" The posttest was conducted 1 week after the 14‐week CNaA‐EP course was completed. Numbers, percentages, chi‐square test, t‐test, Kolmogorov–Smirnov test, Fisher's exact test were conducted using SPSS 22.00 software. Results: The education group's scores of child abuse/neglect awareness (t = −2.768 p < 0.05) and child abuse/neglect knowledge (t = −12.416 p < 0.01) were significantly higher than those of the control group. After the education program, a significant difference was found between the education and control groups on the core measures. Conclusion: A child neglect and abuse education program was an effective method of educating nursing students on knowledge and awareness of child abuse and neglect. For this reason, education programs should be planned and implemented to increase awareness about abuse and neglect problems that threaten children's health and development. [ABSTRACT FROM AUTHOR]

Background: Adverse drug events (ADEs) during hospitalization are a serious, yet preventable concern for older adults. Our institution designed a Geriatric Prescribing Context (GPC) to adjust doses for the older adult population but its impact on ADEs was unknown. The goal of this study was to assess any differences in rates of ADEs before and after its implementation in July 2017. Methods: We used relevant ICD‐10 codes followed by confirmatory chart review to identify dose‐related ADEs from 10 commonly used medications at our institution. We assessed differences in the number of admissions with an ADE before and after the GPC implementation using a test of binomial proportions. The pre‐period was from July 2016 through June 2017 and the post‐period was from August 2017 through July 2018. We compared the rate of ADEs per 1000 patient days between periods with a Poisson rate test and further examined any differences in harm categories using a Fisher's exact test. Results: The proportion of admissions with any dose‐related ADEs significantly decreased from 0.0082 to 0.0037 after the GPC (p = 0.04). The rate of dose‐related ADEs also declined from 2.5 per 1000 patient days to 1.1 per 1000 patient days (p = 0.001). Harm categories did not change significantly between time points (p = 0.30). Conclusions: Based on our list of relevant ICD‐10 codes, the GPC was associated with lower dose‐related ADEs for our selected medications among hospitalized older adults. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to identify peripheral and salivary gland (SG) biomarkers of response/resistance to B cell depletion based on the novel concise Composite of Relevant Endpoints for Sjögren Syndrome (cCRESS) and candidate Sjögren Tool for Assessing Response (STAR) composite endpoints. Methods: Longitudinal analysis of peripheral blood and SG biopsies was performed pre‐ and post‐treatment from the Trial of Anti–B Cell Therapy in Patients With Primary Sjögren Syndrome (TRACTISS) combining flow cytometry immunophenotyping, serum cytokines, and SG bulk RNA sequencing. Results: Rituximab treatment prevented the worsening of SG inflammation observed in the placebo arm, by inhibiting the accumulation of class‐switched memory B cells within the SG. Furthermore, rituximab significantly down‐regulated genes involved in immune‐cell recruitment, lymphoid organization alongside antigen presentation, and T cell co‐stimulatory pathways. In the peripheral compartment, rituximab down‐regulated immunoglobulins and auto‐antibodies together with pro‐inflammatory cytokines and chemokines. Interestingly, patients classified as responders according to STAR displayed significantly higher baseline levels of C‐X‐C motif chemokine ligand‐13 (CXCL13), interleukin (IL)‐22, IL‐17A, IL‐17F, and tumor necrosis factor‐α (TNF‐α), whereas a longitudinal analysis of serum T cell–related cytokines showed a selective reduction in both STAR and cCRESS responder patients. Conversely, cCRESS response was better associated with biomarkers of SG immunopathology, with cCRESS‐responders showing a significant decrease in SG B cell infiltration and reduced expression of transcriptional gene modules related to T cell costimulation, complement activation, and Fcγ‐receptor engagement. Finally, cCRESS and STAR response were associated with a significant improvement in SG exocrine function linked to transcriptional evidence of SG epithelial and metabolic restoration. Conclusion: Rituximab modulates both peripheral and SG inflammation, preventing the deterioration of exocrine function with functional and metabolic restoration of the glandular epithelium. Response assessed by newly developed cCRESS and STAR criteria was associated with differential modulation of peripheral and SG biomarkers, emerging as novel tools for patient stratification. [ABSTRACT FROM AUTHOR]

Objectives: Adolescents and young adults are the main target population for human papillomavirus (HPV). The study aimed to investigate school students' HPV vaccination intentions and explore the contributing factors from a socio‐ecological perspective. Design: A questionnaire survey was conducted in three secondary schools and three colleges in China. Sample: A total of 1756 students aged 14–22 years participated in this study. Among the 1756 participants, 182 students have received the HPV vaccine. For the remaining 1574 students, we analyzed their HPV vaccination intentions and the influencing factors. Measurements: Survey items for sociodemographics, knowledge and awareness of HPV, sexual intercourse and sexual knowledge, subjective socioeconomic status, self‐efficacy, eHealth literacy, perceived social support from family, and the availability of HPV vaccine information were measured. Results: Only 182 (10.4%) had received the HPV vaccine among the 1756 participants. Among the remaining 1574 students, the majority of the students (1403, 89.1%) were willing to receive the HPV vaccine. Binary logistic regression analysis showed that students who were female, had lower self‐efficacy, scored higher on sexual knowledge, believed vaccination preventing related diseases, worried about side effects after vaccination, thought oneself at risk of contracting HPV, had higher family support, knew the availability of the HPV vaccine in Mainland China from healthcare institutions, and with family residence in rural areas were more willing to receive the HPV vaccine. Conclusions: Students had high HPV vaccination intentions while had low vaccination rate. Intrapersonal, interpersonal and institutional or community factors predicted HPV vaccination intention. Public health nurses in communities and schools could target the modifiable factors to promote students' HPV vaccine uptake. [ABSTRACT FROM AUTHOR]

Objectives: To examine the effectiveness of a media literacy‐based smoking prevention program based on Ajzen's theory of planned behavior in female adolescents. Methods: This quasi‐experimental study was conducted with female high school students aged 16–17 years in Seoul, Republic of Korea. The program provided eight sessions over 4 weeks. Quantitative data were collected before and after online surveys in an intervention (n = 21) and control (n = 21) groups, and analyzed using mixed analysis of variance. Qualitative data on participation experiences was collected by requesting the participants to answer open‐ended questions once a week during the intervention and performing co‐occurrence analysis of specific terms in the responses was conducted through text mining. Results: Although the program decreased smoking intention and increased smoking media literacy in the intervention group, there were no significant differences between the groups. Qualitative results obtained from the intervention group showed cognitive and behavioral changes in the perception of the harmfulness of e‐cigarettes in the media and the expression of a willingness to overcome the temptation to smoke. Conclusions: Our findings show that the enhancement of smoking media literacy, specifically by correcting misconceptions regarding e‐cigarettes promoted by the new media, contributes smoking prevention in female adolescents. It supports calls for an expanded role of public health professionals in health education at the school level. [ABSTRACT FROM AUTHOR]

Background: Studies on early abstinence suggest that cognitive function is significantly reduced in the first year of abstinence, which raises the question of whether it is relevant to early relapse in patients with substance use disorders. This study investigates the extent to which impairments in executive function and memory predict alcohol relapse in patients with alcohol use disorder (AUD). Understanding these relationships is crucial for improving therapeutic approaches to prevent relapse in patients with AUD. Methods: We selected 116 adult patients (79 male and 37 female) diagnosed with AUD based on DSM‐5 criteria, all of whom were undergoing alcohol detoxification treatment. A comprehensive array of neuropsychological tests was administered to assess global cognition, memory, and executive functions. Patients' alcohol use was monitored monthly during a 6‐month follow‐up period. Logistic regression and Cox regression were used to explore the relationship between cognitive function and the likelihood of alcohol relapse. Results: Impairments in global cognition, semantic and phonemic fluency, cognitive flexibility, and learning ability during detoxification were significant predictors of relapse in AUD patients, showing similar predictive values at both 3 and 6 months post‐treatment. An abnormal Montreal Cognitive Assessment (MoCA) score increased the risk of relapse by 123% (HR: 2.227), and impairments in both semantic and phonemic fluency each increased the risk by 142% (HR: 2.423). Additionally, abnormal performance on the MoCA, Trail Making Test Part B (TMT‐B), and California Verbal Learning Test (CVLT) was associated with a higher number of drinking days at 3 months (IRR: 3.764; IRR: 2.237; IRR: 2.738, respectively) and abnormal MoCA and TMT‐B scores at 6 months (IRR: 2.451; IRR: 1.859, respectively). Conclusions: The MoCA test is a valuable tool for predicting relapse risk in AUD patients undergoing detoxification treatment, with similar predictive value for relapse at 3 or 6 months. Learning ability needs to be assessed and their impairments considered in the treatment of AUD patients. Future research should explore strategies for managing patients with impairments in memory and learning ability to enhance treatment effectiveness and prevent relapse. [ABSTRACT FROM AUTHOR]

Introudction: There is increased risk of skin cancer in patients with gloermular disease or those with renal transplant. Objectives: To compare the risk of skin cancer between kidney recipients (KTRs) and patients with glomerular disease (GD). Design: The cohort comprised patients with KTRs (n = 61) and GD (n = 51) in Central and Central West Queensland, Australia. A quantitative cohort study was undertaken to study the risk of skin cancer in rural communities between two subgroups of patients with kidney diseases in relationship to immunosuppression. Statistical analyses of the differences in incidence of skin cancers between the two groups were done by chi‐square test, Fisher's exact test, independent t‐test and McNemar's test. Findings: KTRs with non‐melanoma skin carcinoma (NMSC) increased significantly after treatment with immunosuppressants (pre‐transplantation, n = 11 [18.0%], post‐transplantation, n = 28 [45.9%]; p < 0.001). There were no differences in number of patients with NMSC observed in the GD group (pre‐diagnosis, n = 6 [11.8%], post‐diagnosis, n = 7 [13.7%]; p = 1.000). Compared to the risks at 1 year post‐immunosuppressants, the incidence of NMSC of KTRs increased significantly at 3 years (20.3% vs. 35.4%, p < 0.001) and 5 years (20.3% vs. 62.2%, p < 0.001) post‐immunosuppressants, whereas the increased incidence of NMSC was observed only at 5 years (2.1% vs. 11.8%, p = 0.012) in the GD cohort. The mean cumulative number of NMSC in KTRs increased significantly at 3 years (p = 0.011), and 5 years (p = 0.001) post‐immunosuppressants, compared to the risks at 1 year post‐immunosuppressants, however, no differences were noted in the GD cohort. Discussion: Immunosuppressants increased the risk of NMSC in KTRs. The increased risk is likely dependent on the intensity and duration of immunosuppressants. Conclusion: In patients with a high risk of NMSC, reducing skin cancer risk should be considered in conjunction with the optimisation of treatment. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to investigate bone metastasis induced by Notch signalling pathway dysregulation and to demonstrate that SPARC is a potential therapeutic target in adenoid cystic carcinoma (AdCC) with Notch dysregulation. Materials and Methods: This retrospective study enrolled 144 AdCC patients. RNA‐sequencing and enrichment analyses were performed using 32 AdCC samples. Osteonectin/SPARC and the Notch activation indicator Notch intracellular domain (NICD) were detected using immunohistochemistry. Cell proliferation and migration assays were conducted using stably NICD over‐expressing cells. The effect of SPARC on osteoclast differentiation in NICD cells was investigated using western blotting, quantitative reverse transcription PCR, tartrate‐resistant acid phosphatase staining and resorption assays. Results: RNA‐sequencing analysis showed that genes down‐regulated in Notch‐mutant AdCCs, such as SPARC, were enriched in ossification and osteoblast differentiation. Most (75/110, 68.2%) Notch1‐wild‐type AdCCs showed SPARC over‐expression, whereas 30 out of 34 (88.2%) Notch1‐mutant tumours showed low SPARC expression. SPARC over‐expression was then found negatively to be correlated with NICD expression in 144 AdCCs. NICD over‐expression promoted cell growth, migration and osteoclast differentiation, which could be partly reversed by exogenous SPARC. Conclusions: Notch activation in AdCC contributes to bone metastasis through SPARC inhibition. The study results suggest that SPARC may represent a prognostic biomarker and potential therapeutic target. [ABSTRACT FROM AUTHOR]

Aims: The aim of the study was to analyze objective and subjective olfactory/gustatory function in post‐COVID‐19 infection (PCI). Materials and Methods: Patients with past PCR‐confirmed COVID‐19 infection and persistent olfactory/gustatory complaints were investigated. Olfactory threshold and identification, gustatory detection, identification, and magnitude scaling were tested. Results: A total of 42 PCI subjects were compared to 41 age‐ and gender‐matched controls with no COVID‐19 history. All PCI tested had mild COVID‐19 disease. Mean interval between COVID‐19 confirmations to testing was 7.4 ± 3.1 months. PCI subjects complained of combined dysfunction in 85.7%, isolated olfactory or gustatory dysfunction in 7.1% each. Combined complaints were significantly higher in PCI (p < 0.001). Objective testing showed significantly higher prevalence of dysfunction in PCI versus controls for hyposmia (73.8%, 12.2%), anosmia (11.9%, 0%), odor identification (68.5%, 83.0%), hypogeusia (23% and 2.4%, respectively), and impaired magnitude scaling, (p < 0.05). All PCI subjects with hypogeusia had abnormal gustatory magnitude scaling. Conclusions: While most PCI subjects complained of combined gustatory and olfactory dysfunction, objective testing showed in the majority an isolated single sense dysfunction, with a low level of agreement between subjective and objective findings. Abnormal objective results for all olfactory and gustatory functions tested may suggest a central rather than peripheral mechanism, although concomitant mechanisms cannot be excluded. [ABSTRACT FROM AUTHOR]

Objectives: To analyze and summarize the clinicopathological features, risk factors for cervical nodal metastasis, and prognostic factors of malignant sublingual gland tumors (MSLGT). Methods: Patients diagnosed with MSLGT were retrospectively reviewed from January 2005 to December 2017 at Shanghai Ninth Hospital. The clinicopathological features were summarized, and the correlations between clinicopathological parameters, cervical nodal metastasis, and local–regional recurrence were evaluated using the Chi‐square test. Kaplan–Meier method and Cox regression analysis were performed to assess the survival and independent prognostic factors. Results: Seventy‐nine patients were included, and the 5‐year overall survival and disease‐free survival rates was 85.7% and 71.7%, respectively. Gender and clinical tumor stage were risk factors for cervical nodal metastasis. Tumor size and pathological lymph node (LN) stage were independent prognostic factors for adenoid cystic carcinoma (ACC) of the sublingual gland; while age, pathological LN stage, and distant metastasis were prognostic factors for patients with non‐ACC of the sublingual gland. Patients with higher clinical stage were more likely to undergo tumor recurrence. Conclusions: Malignant sublingual gland tumors are rare, and neck dissection should be performed in male MSLGT patients with higher clinical stage. Among patients with both ACC and non‐ACC MSLGT patients, pN+ indicate a poor prognosis. [ABSTRACT FROM AUTHOR]

Background: Head and neck dermatofibrosarcoma protuberans (HNDFSP) is extremely rare and not entirely understood. Objective: To investigate the clinicopathological features of HNDFSP and identify the expression of its clinically relevant indicators, with the expectation of improving the existing treatment strategies. Methods: A long‐term follow‐up of patients with HNDFSP who received treatment between 2000 and 2021 at Shanghai Ninth People's Hospital was conducted. The clinical, histological, and immunohistochemical data of the patients were retrieved and analyzed. The endpoint of the study was the incidence of significant disease‐related clinical events (recurrences or metastasis). Results: A total of 49 patients with HNDFSP were included in the study, with males (92.7%) predominating than females (7.3%). Eighteen patients developed recurrent disease (36.8%) after surgery, and the median time of recurrence was 48 months (interquartile, 20–74 months). Metastasis occurred in two cases (4.1%). Two patients died during follow‐up, both with local recurrence, and one of them with intestinal metastasis. Post‐operation radiotherapy was administered to eight patients (16.3%) and the effect in local control was remarkable. Age, tumor size, and negative margins with sufficient safety width were the main independent factors affecting the disease‐free survival. Several potential targeted therapeutic indicators, including EZH2 (80.0%), EGFR (91.4%), PDGF (97.1%), PD‐L1 (77.1%), and VEGF (77.1%), were positively expressed in most tumor samples. Conclusion: HNDFSP is rare, significantly challenging to control locally, and has a worse prognosis with current treatment strategies. Wide local excision and long‐term follow‐up are needed. Radiotherapy could improve the prognosis of patients with HNDFSP. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis, a syndrome of organ dysfunction caused by an unregulated host response to infection. This study aimed to develop a novel sepsis diagnostic model of hematological parameters and evaluate its effectiveness in the early identification and prognosis of sepsis in emergency departments. Methods: A retrospective study was conducted in Emergency Department. Cell population data parameters related to monocytes and neutrophils were obtained using the Mindary BC‐6800 plus hematology analyzer. Receiver operating characteristic (ROC) curve analysis, logistic regression analysis was performed to assess the performance of the parameters and establish a diagnostic and prognostic model of sepsis, which was then verified with a validation cohort. Results: Mon_XW exhibited the best diagnostic performance (area under the ROC curve [AUC] = 0.848, 95% confidence interval [CI]: 0.810–0.885, p < 0.001), followed by Neu_Y and Neu_YW (AUC = 0.777 95% CI: 0.730–0.824, p < 0.001). Logistic regression analysis identified Mon_XW and Neu_Y as independent predictors, which were used to establish a diagnostic model named hematological parameter for sepsis (HPS). HPS demonstrated the best diagnostic performance with an AUC of 0.862 (95% CI: 0.826–0.898, p < 0.001), sensitivity of 70.0%, and specificity of 87.1%, compared to C‐reactive protein (CRP) and procalcitonin (PCT). The validation cohort also found that the positive predictive value of HPS was 70.4% and the negative predictive value was 92.2%. Conclusion: The developed HPS model showed promising diagnostic efficacy for sepsis in the emergency department, which outperformed CRP and PCT in terms of sensitivity and specificity. By enabling early identification and prognosis of sepsis, that contributes to reducing sepsis‐related mortality. [ABSTRACT FROM AUTHOR]

Moderate acute malnutrition (MAM) is a persistent public health problem in Tanzania. The current approach for its management is nutrition counselling. However, there has been no commercial production of ready‐to‐use supplementary foods for the management of MAM in the country but rather imported from companies outside the country. The objective of the study was to determine the ability of a ready‐to‐use food supplementation versus corn soya blend (CSB+) to manage MAM. The randomised controlled trial employed three parallel arm approach. The first arm received CSB+ and infant and young child feeding (IYCF) counselling, the second arm received ready‐to‐use food (RUF) and IYCF counselling and the third arm, a control group, received IYCF as standard care for three consecutive months. Results indicated that the overall proportion of children who recovered from MAM was 65.6%. There was a significant difference (p < 0.001) in the proportion of children who recovered from MAM between the three arms (CSB+, RUF and standard care). Results revealed further a high recovery rate of 83.7% in the RUF arm, followed by 71.9% in the CSB+ arm and 41% in the standard care arm. The risk differences for RUF compared with CSB+ and standard care were 11.8% and 42.7%, respectively. RUFs can be used as an alternative supplement to conventional CSB+ for the management of MAM in children and, thus, has the potential to scale up its use to address the problem of MAM among 6 to 59 months' children. Key messages: Moderate acute malnutrition can progress to the severe form, which is a life‐threatening condition if not well managed.Chronic undernutrition, in turn, can have an impact on the nutritional status of future generations, tending to result in 'intergenerational growth failure', a cycle of poor diet that continues throughout generations with lifelong implications.Supplementary foods can be formulated from locally available ingredients that are accessible, cheap and can deliver the required amounts of nutrients essential for the effective recovery of children with MAM.Supplementation of RUFs is more effective in treating MAM when compared to other conventional supplementation methods. [ABSTRACT FROM AUTHOR]

The STOMP (stopping over‐medication of people with a learning disability, autism or both with psychotropic medicines) initiative and NICE guidelines regarding the management of challenging behaviour in adults with intellectual disability (ID) promote the use of non‐pharmacological approaches ahead of medication, with an emphasis also on reducing dosage or stopping medication where appropriate. Here the authors report on the findings of a service evaluation looking at how often a community intellectual disability psychiatry clinic initiates non‐pharmacological approaches in cases referred for challenging behaviour, and importantly whether this impacts the dosages of medication subsequently prescribed. [ABSTRACT FROM AUTHOR]

Aim: We aimed to investigate the level of undergraduate nursing students' professional identity (PI) during the COVID‐19 pandemic and its potential influences. Methods: This cross‐sectional study included 742 undergraduate nursing students from Chengdu Medical College. Basic demographics, personal characteristics and PI score were collected. Chi‐squared test, one‐way analysis of variance, and multivariable logistic regression analysis were used to analyze the data. Results: In the classes of 2019, 2020, and 2021, the PI score was 96.85 ± 18.26, 105.37 ± 17.46, 106.67 ± 22.08 (P <.001). PI score was the independent predictive factor for both "want to be a nurse" and "willingness to serve during COVID‐19 or other pandemics". Conclusions: PI contributes greatly to nursing students' willingness to be a nurse and overcome pandemics. The challenge of culturing PI during COVID‐19 pandemic revealed the necessity of developing individual management strategies for nursing education. [ABSTRACT FROM AUTHOR]

Objective: Decisional conflict is used increasingly as an outcome measure in advance care planning (ACP) studies. When the Decisional Conflict Scale (DCS) is used in anticipatory decision‐making contexts, the scale is typically tethered to hypothetical scenarios. This study reports preliminary validation data for hypothetical scenarios relating to life‐sustaining treatments and care utilisation to inform their broader use in ACP studies. Methods: Three hypothetical scenarios were developed by a panel of multidisciplinary researchers, clinicians and community representatives. A convenience sample of 262 older adults were surveyed. Analyses investigated comprehensibility, missing data properties, sample norms, structural, convergent and discriminant validity. Results: Response characteristics suggested that two of the scenarios had adequate comprehensibility and response spread. Missing response rates were unrelated to demographic characteristics. Predicted associations between DCS scores and anxiety (r's =.31–.37, p <.001), and ACP engagement (r's = −.41 to −.37, p <.001) indicated convergent validity. Conclusion: A substantial proportion of older adults reported clinically significant levels of decisional conflict when responding to a range of hypothetical scenarios about care or treatment. Two scenarios showed acceptable comprehensibility and response characteristics. A third scenario may be suitable following further refinement. Patient or Public Contribution: The scenarios tested here were designed in collaboration with a community representative and were further piloted with two groups of community members with relevant lived experiences; four people with life‐limiting conditions and five current or former care partners. [ABSTRACT FROM AUTHOR]

Background: Although lung expansion therapy with positive end‐expiratory pressure (PEEP) following heart surgery is associated with positive clinical outcomes, whether such therapy can improve oxygenation and diminish the occurrence of lung complications when performed during heart surgery with extracorporeal circulation (ECC) is not yet clear. Objective: Analyze the impact of lung expansion therapy with PEEP at 20 cmH2O for 60 s during elective heart surgery. Methods: A randomized clinical trial was conducted. The experimental group (EG) (n = 27) received PEEP at 20 cmH2O for 60 s during heart surgery at the moment in which ECC was ended. No intraoperative maneuver was performed in the control group (CG) (n = 15). Results: The incidence of atelectasis upon hospitalization and the pre‐maneuver oxygenation index (PaO2/FiO2) were similar between the groups. A lower incidence of atelectasis in the immediate postoperative period (7.4%, p = 0.03) and shorter time on noninvasive mechanical ventilation (TNIMV) (5.78 ± 2.54, p = 0.01) were found in the EG compared with the CG. Conclusions: The application of PEEP at 20 cmH2O for 60 s during heart surgery reduces the incidence of atelectasis in the immediate postoperative period and shortens the TNIMV. This maneuver proved to be safe, with no adverse events. [ABSTRACT FROM AUTHOR]

The article discusses research which aimed to evaluate older adult cost savings from student pharmacist-assisted Medicare Part D plan comparisons. Cited are the method used to recruit subjects as well as the characteristics of study participants, the potential of lower cost medications to improve medication adherence and health outcomes, and the ability of plan comparisons to enhance the pharmacy students' geriatric pharmacotherapy education and skills.

Background: A better understanding of the effects of lower levels of prenatal alcohol exposure (PAE), as a common exposure, is needed. The goal of this study was to examine the effects of mild-moderate PAE and episodic binge drinking on perinatal outcomes. Methods: The data were obtained from three prospective cohorts with a combined sample of 281 participants: 125 with PAE and 156 without PAE. Alcohol-related measures included the Alcohol Use Disorders Identification Test, timeline follow-back questionnaires (covering the periconceptional period, mid-gestation, and late gestation), and biomarkers. Absolute alcohol per day (AAD) and per drinking day (AADD), number of binge episodes, and maximum number of drinks in a 24-h period were estimated. Perinatal outcomes included gestational age and anthropometric measures. Data were analyzed using correlation and multivariable regression analysis. Results: Among women with PAE, average alcohol consumption across the periconceptional period and pregnancy was 0.37 oz ± 0.74 AA/day (~5 drinks/week). After adjusting for tobacco co-exposure and sociodemographic characteristics, significant associations between all alcohol measures and gestational age at delivery were observed, including cumulative measures of AAD (β = -0.58; 95% CI: -0.98; -0.17) and AADD (β = -0.58; 95% CI: -0.90; -0.26) during pregnancy and the periconceptional period. A significant association between the maximum number of drinks in a 24-h period and birth length percentile (β = -0.70; 95% CI: -1.36; -0.04) was observed in the final model. PAE was associated with lower birth weight percentile in univariate analyses only. Conclusions: Results of this study demonstrate a negative association between mild-moderate PAE and episodic binge drinking with gestational age at delivery and birth length percentile after controlling for other factors. Robust negative effects of PAE, including in the periconceptional period before pregnancy recognition, on duration of gestation highlight the need for primary prevention efforts aimed at PAE in persons of reproductive age. [ABSTRACT FROM AUTHOR]

Background: Alcohol use disorders (AUDs) are widespread, devastating and complex. About 20% of people who consume alcohol develop problem use, accounting for over 5% of worldwide deaths. While numerous animal models have facilitated understanding of the consequences of excessive drinking, translational models allow for experimental manipulation of factors thought to contribute to AUD liability. Methods: We employ a single-exposure conditioned place preference assay (SE-CPP) to investigate the influence of age, sex and the opioid peptide β-endorphin (bE) on the initial rewarding effects of ethanol, a strong predictor of AUDs. Adolescent (PND28-35) and adult (PND70-90) male and female, control C57BL/6J and bE-deficient mice were tested following a single injection of 1.5 g/kg of ethanol. Following the SE-CPP test, animals were deeply anesthetized, sacrificed, and perfused, and the brains were subsequently sectioned at 40 microns and processed for immunohistochemical localization of c-fos. One-sample, two-tailed t-tests were used to assess drug preference or aversion and the locomotor effects of alcohol. Results: In general, adults were more sensitive to the effects of alcohol than adolescents, and outcomes depended on sex and bE. For example, among females, adolescents were stimulated by the drug, but insensitive to locomotor effects as adults, while among males, adolescents were insensitive and adults sedated. Wild-type adolescents of both sexes failed to evince initial subjective reward from the drug, but bE-deficient adolescents, and all adult subjects, preferred a context once associated with ethanol over one that had been paired with saline. c-fos immunoreactivity in multiple brain regions was attenuated in bE-deficient animals, though influences of both sex and bE grew stronger with age. Conclusions: This study demonstrates the utility of the SE-CPP paradigm for elucidating factors that contribute to the liability for AUDs, and supports the growing body of research that shows that sensitivity to the rewarding effects of alcohol changes during the course of development. Our results also suggest that developmental contributions are sex-dependent, and may also depend on the influence of endogenous opioid signaling. [ABSTRACT FROM AUTHOR]

Introduction: Luminal esophageal temperature (LET) monitoring during atrial fibrillation (AF) ablation is widely used to reduce the incidence of endoscopically detected esophageal lesion (EDEL). We sought to assess whether specific patterns of LET variation are associated with EDEL. Methods: A high‐fidelity multisensor probe was used to record LET in AF patients undergoing radiofrequency ablation (RFA) or cryoballoon ablation (CBA). Explainable machine learning and SHapley Additive exPlanations (SHAP) analysis were used to predict EDEL and assess feature importance. Results: A total of 94 patients (38.3% persistent AF, 71.3% male, 72 RFA, and 22 CBA) were included. EDEL was detected in 11 patients (10 RFA and one CBA). In the RFA group, the highest LET recorded was similar between patients with and without EDEL (40.6 [40.1–41]°C vs. 40.2 [39.1–40.9]°C; p =.313), however, the rate of LET rise for the highest recorded peak was higher (0.08 [0.03–0.12]°C/s vs. 0.02 [0.01–0.05]°C/s; p =.033), and the area under the curve (AUC) for the highest peak was smaller (412.5 [206.8–634.1] vs. 588.6 [380.4–861.1]; p =.047) in patients who had EDEL. In case of CBA, the patient with EDEL had a faster LET decline (0.12 vs. 0.07 [0.02–0.14]°C/s), and a smaller AUC for the lowest trough (2491.3 vs. 2629.3 [1712.6–5283.2]). SHAP analysis revealed that a rate of LET change higher than 0.05°C/s and an AUC less than 600 were more predictive of EDEL in RFA. Conclusion: The rate of LET change and AUC for the recorded temperature predicted EDEL, whereas absolute peak temperatures did not. [ABSTRACT FROM AUTHOR]

Introduction: Successful return to pre‐injury occupational performance following distal radius fracture (DRF) may be influenced by person and environment factors such as pain, age, social support, and socioeconomic status. The primary aim of this study was to explore Australian hand therapists' current clinical practice and determine whether they consider these factors during the management of DRF. Methods: A mixed methods online survey was distributed to members of the Australian Hand Therapy Association. Descriptive statistics were used to examine the quantitative data, and the qualitative data were analysed by content analysis. Results: Of the 120 members who completed the survey, 68% were occupational therapists and 32% were physiotherapists with 74% in the private and 26% in the public health‐care setting. Most factors perceived to influence recovery were consistent with person factors and a biomechanical approach. Other factors related to occupational performance, such as social and leisure skills, environment and culture were reported less often. When asked about defining occupational performance, the key categories identified through qualitative open responses were 'performing meaningful activities/occupations', 'performing work/employment', and 'completing activities/function'. Conclusion: The data suggest that hand therapists in Australia primarily identify person factors as key to recovery after DRF. Context and environmental factors that influence occupational performance did not appear to be considered as often during treatment or when defining occupational performance. Further research is needed to explore the contextual and environmental factors that influence hand therapy intervention and determine whether they play a role in the successful return to pre‐injury occupational performance following DRF. Consumer and community involvement: The survey was conceptualised by the research team, which included two experienced hand therapists and piloted with 10 consumers. Hand therapists (consumers) of various years of experience and discipline (i.e., occupational therapy and physiotherapy) provided feedback to improve the survey in terms of content, comprehensibility, and length. No clients/patients of hand therapists were involved in the development of the survey or the study, and the consumers of the study were considered hand therapists. [ABSTRACT FROM AUTHOR]

Purpose: The coronavirus disease 2019 (COVID‐19) generates long‐term sequelae, but studies investigating patients with chronic pain syndrome (CPS) are limited. This study aimed to establish the etiological factors of CPS in patients with post‐COVID‐19 conditions. Methods: This was a case–control retrospective study. The predictor variables were sex, diabetes mellitus, obesity (predisposing factors), unfavorable socioeconomic conditions, impaired rehabilitation (disabling factors), repeated exposure to COVID‐19 (precipitating factor), home isolation, stress overload, fear of dying, admission to intensive care unit, prone positioning, and use of medications (reinforcing factors). The outcome variable was the presence of CPS. Findings: This study included 120 individuals. Prolonged days of isolation (p = 0.005), fear (p < 0.001), stress overload (p < 0.001), and impaired rehabilitation (p = 0.003) were significantly associated with CPS. Conclusions: A significant relationship was found between prolonged days of isolation, fear, stress overload, impaired rehabilitation, and CPS. Implications for nursing practice: The study findings can assist nurses by promoting their knowledge of the causes of CPS and supporting the care planning needs of patients with post‐COVID‐19 conditions, in addition to promoting the use of the NANDA‐International taxonomy. [ABSTRACT FROM AUTHOR]

Objective: Anorexia nervosa is associated with low bone mineral density (BMD) and deficits in bone microarchitecture and strength. Low BMD is common in atypical anorexia nervosa, in which criteria for anorexia nervosa are met except for low weight. We investigated whether women with atypical anorexia nervosa have deficits in bone microarchitecture and estimated strength at the peripheral skeleton. Method: Measures of BMD and microarchitecture were obtained in 28 women with atypical anorexia nervosa and 27 controls, aged 21–46 years. Results: Mean tibial volumetric BMD, cortical thickness, and failure load were lower, and radial trabecular number and separation impaired, in atypical anorexia nervosa versus controls (p <.05). Adjusting for weight, deficits in tibial cortical bone variables persisted (p <.05). Women with atypical anorexia nervosa and amenorrhea had lower volumetric BMD and deficits in microarchitecture and failure load versus those with eumenorrhea and controls. Those with a history of overweight/obesity or fracture had deficits in bone microarchitecture versus controls. Tibial deficits were particularly marked. Less lean mass and longer disease duration were associated with deficits in high‐resolution peripheral quantitative computed tomography (HR‐pQCT) variables in atypical anorexia nervosa. Discussion: Women with atypical anorexia nervosa have lower volumetric BMD and deficits in bone microarchitecture and strength at the peripheral skeleton versus controls, independent of weight, and particularly at the tibia. Women with atypical anorexia nervosa and amenorrhea, less lean mass, longer disease duration, history of overweight/obesity, or fracture history may be at higher risk. This is salient as deficits in HR‐pQCT variables are associated with increased fracture risk. Public Significance: Atypical anorexia nervosa is a psychiatric disorder in which psychological criteria for anorexia nervosa are met despite weight being in the normal range. We demonstrate that despite weight in the normal range, women with atypical anorexia nervosa have impaired bone density, structure, and strength compared to healthy controls. Whether this translates to an increased risk of incident fracture in this population requires further investigation. [ABSTRACT FROM AUTHOR]

Malnutrition and disability are major global public health problems. Poor diets, inadequate access to nutrition/health services (NaHS), and poor water, sanitation and hygiene (WASH) all increase the risk of malnutrition and infection. This leads to poor health outcomes, including disability. To better understand the relationship between these factors, we explored access to NaHS and household WASH and dietary adequacy among households with and without children with disabilities in Uganda. We used cross‐sectional secondary data from 2021. Adjusted logistic regression was used to explore associations between disabilities, access to NaHS, WASH and dietary adequacy. Of the 6924 households, 4019 (57.9%) reported having access to necessary NaHS, with deworming and vaccination reported as both the most important and most difficult to access services. Access to services was lower for households with children with disabilities compared to those without, after adjusting for likely confounding factors (Odds ratio = 0.70; 95% CI 0.55–0.89, p = 0.003). There is evidence of an interaction between disability and WASH adequacy, with improved WASH adequacy associated with improved access to services, including for children with disabilities (interaction odds ratio = 1.12, 95% CI: 1.02–1.22, p = 0.012). The proportion of malnourished children was higher among households with children with disabilities than households without it (6.3% vs. 2.4% p < 0.001). There are concerning gaps in access to NaHS services in Uganda, with households with children with disabilities reporting worse access, particularly for those with low WASH adequacy. Improved and inclusive access to NaHS and WASH needs to be urgently prioritized, especially for children with disabilities. Key messages: There is low access to essential nutrition and health services for households in Uganda: access barriers need to be examined and minimized.Children with disabilities have particularly poor access to key nutrition and health services. Clean water, sanitation and good hygiene for children with disabilities are associated with improved access to nutrition and health services. [ABSTRACT FROM AUTHOR]

Summary: Background and Objective: The aim was assessing a short training for healthcare providers on patient‐focused counselling to treat childhood obesity in primary care, along with dietitian‐led workshops and educational materials. Methods: Randomized clustered trial conducted with paediatrician‐nurse pairs (Basic Care Units [BCU]) in primary care centres from Tarragona (Spain). BCUs were randomized to intervention (MI) (motivational interview, dietitian‐led education, and educational materials) or control group (SC, standard care). Participants were 8–14‐year‐old children with obesity, undergoing 1–11 monthly treatment visits during 1 year at primary care centres. The primary outcome was BMI z‐score reduction. Results: The study included 44 clusters (23 MI). Out of 303 allocated children, 201 (n = 106 MI) completed baseline, final visits, and at least one treatment visit and were included in the analysis. BMI z‐score reduction was −0.27 (±0.31) in SC, versus −0.36 (±0.35) in MI (p = 0.036). Mixed models with centres as random effects showed greater reductions in BMI in MI than SC; differences were B = −0.11 (95% CI: −0.20, −0.01, p = 0.025) for BMI z‐score, and B = −2.06 (95% CI: −3.89, −0.23, p = 0.028) for BMI %. No severe adverse events related to the study were notified. Conclusion: Training primary care professionals on motivational interviewing supported by dietitians and educational materials, enhanced the efficacy of childhood obesity therapy. [ABSTRACT FROM AUTHOR]