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Background and Aim: The present study was conducted to develop a situation analysis model for Iran's hospitals' emergency departments (EDs). Methods: The current research was a descriptive cross‐sectional applied study in three stages. The studies were reviewed in various library resources and valid sites in the first stage. In the second stage, the analysis model of the ED in Iran was presented. In the third stage, the model was validated based on the Delphi technique, and the final model was presented. Results: The final situation analysis model of ED in Iran was approved in four main aspects, including goals, internal factors, external factors, and organizations and institutions participating in the situation analysis, and its implementation schedule was approved by 90% of experts. Conclusion: Considering the importance of situation analysis in developing a strategic plan and improving the quality of health services in the ED of hospitals, implementing a coherent situation analysis model that includes all aspects leading to improving the ED quality and analyzing the internal and external factors is vital. [ABSTRACT FROM AUTHOR]

Intracellular decay of N6‐methyladenine (m6A)‐containing RNA potentially induces aberrant N6‐methyl‐2′‐adenine (6mdA) misincorporation into DNA. Biophysically, misincorporated 6mdA may destabilize the DNA duplex in a manner similar to bona fide methylated 6mdA DNA, thereby affecting DNA replication and transcription. Utilizing heavy stable isotope labeling and ultrasensitive UHPLC–MS/MS assay, we demonstrate that intracellular m6A‐RNA decay does not generate free 6mdA species, nor lead to any misincorporated DNA 6mdA in most mammalian cell lines tested, unveiling the existence of a sanitation mechanism that prevents 6mdA misincorporation. Depletion of deaminase ADAL increases the levels of free 6mdA species, concomitant with the presence of DNA‐misincorporated 6mdA resulting from intracellular RNA m6A decay, suggesting that ADAL catabolizes 6mdAMP in vivo. Furthermore, we show that the overexpression of adenylate kinase 1 (AK1) promotes 6mdA misincorporation, while AK1 knockdown diminishes 6mdA incorporation, in ADAL‐deficient cells. We conclude that ADAL together with other factors (such as MTH1) contributes to 2′‐deoxynucleotide pool sanitation in most cells but compromised sanitation (e.g., in NIH3T3 cells) and increased AK1 expression may facilitate aberrant 6mdA incorporation. This sanitation mechanism may provide a framework for the maintenance of the epigenetic 6mdA landscape. Synopsis: Intracellular decay of m6A‐containing RNA may induce aberrant N6‐methyl‐2′‐adenine (6mdA) incorporation into DNA, affecting its replication and transcription. This study unveils a 2′‐deoxynucleotide pool sanitation mechanism acting to suppress potential DNA 6mdA misincorporation.Intracellular m6A‐RNA decay does not induce any free 6mdA species, nor lead to any misincorporated DNA 6mdA in most mammalian cell lines tested.An active sanitation mechanism blocks 6mdA misincorporation.ADAL deaminase and other regulatory factors, such as MTH1, contribute to the sanitation.Compromised sanitation and increased adenylate kinase AK1 expression facilitate aberrant 6mdA incorporation. [ABSTRACT FROM AUTHOR]

N6‐methyldeoxyadenosine (6mA) is a chemical alteration of DNA, observed across all realms of life. Although the functions of 6mA are well understood in bacteria and protists, its roles in animal genomes have been controversial. We show that 6mA randomly accumulates in early embryos of the cnidarian Hydractinia symbiolongicarpus, with a peak at the 16‐cell stage followed by clearance to background levels two cell cycles later, at the 64‐cell stage—the embryonic stage at which zygotic genome activation occurs in this animal. Knocking down Alkbh1, a putative initiator of animal 6mA clearance, resulted in higher levels of 6mA at the 64‐cell stage and a delay in the initiation of zygotic transcription. Our data are consistent with 6mA originating from recycled nucleotides of degraded m6A‐marked maternal RNA postfertilization. Therefore, while 6mA does not function as an epigenetic mark in Hydractinia, its random incorporation into the early embryonic genome inhibits transcription. In turn, Alkbh1 functions as a genomic 6mA "cleaner," facilitating timely zygotic genome activation. Given the random nature of genomic 6mA accumulation and its ability to interfere with gene expression, defects in 6mA clearance may represent a hitherto unknown cause of various pathologies. Synopsis: The presence and functions of N6‐methylation of deoxyadenosine (6mA) in animal genomes are disputed. This study shows that N6‐methyladenosine (m6A)‐decorated maternal RNA is the source of 6mA in cnidarian embryonic genomes, from which it has to be removed for initiation of zygotic transcription.Rapid degradation of m6A‐marked maternal RNAs generates a nucleotide pool containing m6A.After NTP‐to‐dNTP conversion by a ribonucleotide reductase, 6mA is randomly incorporated into the embryonic genome.Genomic 6mA interferes with embryonic transcription.Removal of 6mA by the 6mA dioxygenase Alkbh1 facilitates timely zygotic genome activation. [ABSTRACT FROM AUTHOR]

Investigating a reactive chemical system with automated reaction network exploration algorithms provides a more detailed picture of its chemical mechanism than what would be accessible by manual investigation. In general, exploration algorithms cannot uncover reaction networks exhaustively for feasibility reasons. They should therefore decide which part of a network is kinetically relevant under some external conditions given. Here, we propose an automated algorithm that identifies and explores kinetically accessible regions of a reaction network on the fly by explicit modeling of concentration fluxes through an (incomplete) reaction network that is emerging during automated first‐principles exploration. Key compounds are automatically identified and selected for the continuation of the exploration. As an example, we explore the reaction network of the multi‐component proline‐catalyzed Michael addition of propanal and nitropropene. Our algorithm provides a mechanistic picture of the Michael addition in unprecedented detail. [ABSTRACT FROM AUTHOR]

DNA methylation constitutes one of the pillars of epigenetics, relying on covalent bonds for addition and/or removal of chemically distinct marks within the major groove of the double helix. DNA methyltransferases, enzymes which introduce methyl marks, initially evolved in prokaryotes as components of restriction‐modification systems protecting host genomes from bacteriophages and other invading foreign DNA. In early eukaryotic evolution, DNA methyltransferases were horizontally transferred from bacteria into eukaryotes several times and independently co‐opted into epigenetic regulatory systems, primarily via establishing connections with the chromatin environment. While C5‐methylcytosine is the cornerstone of plant and animal epigenetics and has been investigated in much detail, the epigenetic role of other methylated bases is less clear. The recent addition of N4‐methylcytosine of bacterial origin as a metazoan DNA modification highlights the prerequisites for foreign gene co‐option into the host regulatory networks, and challenges the existing paradigms concerning the origin and evolution of eukaryotic regulatory systems. [ABSTRACT FROM AUTHOR]

Quantum mechanics/molecular mechanics (QM/MM) hybrid models allow one to address chemical phenomena in complex molecular environments. Whereas this modeling approach can cope with a large system size at moderate computational costs, the models are often tedious to construct and require manual preprocessing and expertise. As a result, transferability to new application areas can be limited and the many parameters are not easy to adjust to reference data that are typically scarce. Therefore, it is desirable to devise automated procedures of controllable accuracy, which enables such modeling in a standardized and black‐box‐type manner. Although diverse best‐practice protocols have been set up for the construction of individual components of a QM/MM model (e.g., the MM potential, the type of embedding, the choice of the QM region), automated procedures that reconcile all steps of the QM/MM model construction are still rare. Here, we review the state of the art of QM/MM modeling with a focus on automation. We elaborate on MM model parametrization, on atom‐economical physically‐motivated QM region selection, and on embedding schemes that incorporate mutual polarization as critical components of the QM/MM model. In view of the broad scope of the field, we mostly restrict the discussion to methodologies that build de novo models based on first‐principles data, on uncertainty quantification, and on error mitigation with a high potential for automation. Ultimately, it is desirable to be able to set up reliable QM/MM models in a fast and efficient automated way without being constrained by specific chemical or technical limitations. This article is categorized under:Electronic Structure Theory > Combined QM/MM Methods [ABSTRACT FROM AUTHOR]

Background: Diffuse large B‐cell lymphoma (DLBCL) harboring Epstein–Barr virus (EBV) primarily occurs in patients who have underlying immunodeficiency or in elderly patients but is also reported in young, immunocompetent patients. The authors investigated the pathologic differences in EBV‐positive DLBCL in these three groups of patients. Methods: In total, 57 patients with EBV‐positive DLBCL were included in the study; of these, 16 patients had associated immunodeficiency, 10 were young (younger than 50 years), and 31 were elderly (aged 50 years or older). Immunostaining for CD8, CD68, PD‐L1, and EBV nuclear antigen 2, and panel‐based next‐generation sequencing was performed on formalin‐fixed, paraffin‐embedded blocks. Results: Immunohistochemistry revealed EBV nuclear antigen 2 positivity in 21 of the 49 patients. The degree of CD8‐positive and CD68‐positive immune cell infiltration and PD‐L1 expression did not differ significantly in each group. Extranodal site involvement was more common in young patients (p =.021). In mutational analysis, the genes with the highest mutation frequency were PCLO (n = 14), TET2 (n = 10), and LILRB1 (n = 10). For the TET2 gene, all 10 mutations were found in elderly patients (p =.007). Compared with a validation cohort, both TET2 and LILRB1 showed a higher mutation frequency in EBV‐positive patients than in EBV‐negative patients. Conclusions: EBV‐positive DLBCL occurring in three different age and immune status groups showed similar pathologic characteristics. Notably, a high frequency of TET2 and LILRB1 mutations was characteristic of this disease in elderly patients. Further studies are needed to determine the role of TET2 and LILRB1 mutations in the development of EBV‐positive DLBCL along with immune senescence. Plain Language Summary: Epstein–Barr virus‐positive diffuse large B‐cell lymphoma occurring in three different groups (immunodeficiency‐associated, young, and elderly) showed similar pathologic characteristics.The frequency of TET2 and LILRB1 mutations was high in elderly patients with Epstein–Barr virus‐positive diffuse large B‐cell lymphoma. Epstein–Barr virus‐positive diffuse large B‐cell lymphoma occurring in three different age and immune status groups showed similar pathologic characteristics. Notably, the high frequency of TET2 and LILRB1 mutations was characteristic of this disease in elderly patients. [ABSTRACT FROM AUTHOR]

SERENITY [J Comput Chem. 2018;39:788–798] is an open‐source quantum chemistry software that provides an extensive development platform focused on quantum‐mechanical multilevel and embedding approaches. In this study, we give an overview over the developments done in Serenity since its original publication in 2018. This includes efficient electronic‐structure methods for ground states such as multilevel domain‐based local pair natural orbital coupled cluster and Møller–Plesset perturbation theory as well as the multistate frozen‐density embedding quasi‐diabatization method. For the description of excited states, SERENITY features various subsystem‐based methods such as embedding variants of coupled time‐dependent density‐functional theory, approximate second‐order coupled cluster theory and the second‐order algebraic diagrammatic construction technique as well as GW/Bethe–Salpeter equation approaches. SERENITY's modular structure allows combining these methods with density‐functional theory (DFT)‐based embedding through various practical realizations and variants of subsystem DFT including frozen‐density embedding, potential‐reconstruction techniques and projection‐based embedding. This article is categorized under:Electronic Structure Theory > Density Functional TheoryElectronic Structure Theory > Ab Initio Electronic Structure MethodsSoftware > Quantum Chemistry [ABSTRACT FROM AUTHOR]

We present a de novo discovery of an efficient catalyst of the Morita–Baylis–Hillman (MBH) reaction by searching chemical space for molecules that lower the estimated barrier of the rate‐determining step using a genetic algorithm (GA) starting from randomly selected tertiary amines. We identify 435 candidates, virtually all of which contain an azetidine N as the catalytically active site, which is discovered by the GA. Two molecules are selected for further study based on their predicted synthetic accessibility and have predicted rate‐determining barriers that are lower than that of a known catalyst. Azetidines have not been used as catalysts for the MBH reaction. One suggested azetidine is successfully synthesized and showed an eightfold increase in activity over a commonly used catalyst. We believe this is the first experimentally verified de novo discovery of an efficient catalyst using a generative model. [ABSTRACT FROM AUTHOR]

We present a de novo discovery of an efficient catalyst of the Morita–Baylis–Hillman (MBH) reaction by searching chemical space for molecules that lower the estimated barrier of the rate‐determining step using a genetic algorithm (GA) starting from randomly selected tertiary amines. We identify 435 candidates, virtually all of which contain an azetidine N as the catalytically active site, which is discovered by the GA. Two molecules are selected for further study based on their predicted synthetic accessibility and have predicted rate‐determining barriers that are lower than that of a known catalyst. Azetidines have not been used as catalysts for the MBH reaction. One suggested azetidine is successfully synthesized and showed an eightfold increase in activity over a commonly used catalyst. We believe this is the first experimentally verified de novo discovery of an efficient catalyst using a generative model. [ABSTRACT FROM AUTHOR]

COVID‐19 has disrupted social and spatial life. In this work, I argue that such disruption provides an opportunity for all tiers of government to reassess collective priorities and reorient societal goals to work towards better health outcomes for all. I offer a systems thinking perspective to show how societal goals such as economic growth are supported by "system rules" created by governments—the same rules largely responsible for prevailing inequities and preventable chronic, noncommunicable diseases and conditions. The work is significant because it shows how the disruption caused by COVID‐19 changed deep system leverage points, highlighting places inside governmental systems susceptible and acceptable to change and revealing how systems can be reoriented. It draws on empirical data from one subnational jurisdiction of Australia. Specifically, in late 2020, 81 Tasmanian local government personnel shared views on diverse governmental changes made in response to the pandemic. Most participants wanted those changes to continue because of their net benefits to health and social, economic, and environmental outcomes more broadly. They expressed overwhelming support for actions to improve the social determinants of health and communicable and noncommunicable disease prevention and management. I conclude that unless such efforts for change continue, poor health outcomes and health inequities are likely to be exacerbated and argue that a shared systems goal to create a wellbeing economy could reorient systems to achieve better health outcomes for all. [ABSTRACT FROM AUTHOR]

N6‐methyladenosine (m6A), the sixth N methylation of adenylate (A) in RNA, is the most abundant transcriptome modification in eukaryotic messenger RNA (mRNAs). m6A modification exists in both coding mRNA and noncoding RNAs, and its functions are controlled by methyltransferase, demethylase, and m6A reading proteins. Methylation modification of m6A can regulate RNA cleavage, transport, stability, and expression. This review summarizes the enzymes involved in RNA m6A methylation and the commonly used detection methods. The role of m6A modification in physiological processes is described, and its impact on tumorigenesis, viral infection, and diabetes is further highlighted. Moreover, up‐to‐date knowledge of the implications of RNA m6A modification in ocular diseases such as uveal melanoma and diabetic retinopathy is introduced. Clarifying the mechanism of RNA m6A methylation will help elucidate the pathogenesis of various diseases, providing options for subsequent treatment. [ABSTRACT FROM AUTHOR]

Issue addressed: Governments across the world use guidelines and policy to support improving the quality and nutrition in school canteens, yet little is known about what makes for success in supporting school canteens. This study aimed to investigate the factors influencing the implementation of a healthy school canteen policy. Methods: A qualitative descriptive approach using interviews with a purposive sample of Victorian schools that had successfully implemented a healthy school canteen was conducted. Twelve interviews were conducted with principals (n = 4), assistant principal (n = 1), canteen managers (n = 5), food services manager (n = 1) and canteen staff members (n = 3) across six Victorian schools. Data were analysed using a content analysis approach. Results: Three key themes explained the adoption of policy: Values – emphasising service over profit; Knowledge – understanding of nutrition and the policy; and Support – from within and external to the school. Conclusions: Implementation of school canteen policy is more likely to be achieved when a school can focus on the service and educative component of the policy and where there is a shared priority for healthy eating across the entire school community. So what?: Creating a culture of service and community engagement with a healthy school canteen may increase policy implementation and should be the focus of future health promotion efforts. [ABSTRACT FROM AUTHOR]

Trichomonas vaginalis is an extracellular parasite that colonizes the human urogenital tract, causing a highly prevalent sexually transmitted infection. The parasite must change its transcriptional profile in order to establish and maintain infection. However, few core regulatory elements and transcription factors have been identified to date and little is known about other mechanisms that may control these rapid changes in gene expression during parasite infection. In the last years, epigenetic mechanisms involved in the regulation of gene expression have been gaining major attention in this parasite. In this review, we summarize and discuss the major advances of the last few years with regard to epigenetics (DNA methylation, post‐translational histone modifications, and histone variants) in the parasite T. vaginalis. These studies can shed light into our current understanding of this parasite's biology with far‐reaching implications for the prognosis and treatment of trichomoniasis. [ABSTRACT FROM AUTHOR]

6‐methyladenine (6mA) is fairly abundant in nuclear DNA of basal fungi, ciliates and green algae. In these organisms, 6mA is maintained near transcription start sites in ApT context by a parental‐strand instruction dependent maintenance methyltransferase and is positively associated with transcription. In animals and plants, 6mA levels are high only in organellar DNA. The 6mA levels in nuclear DNA are very low. They are attributable to nucleotide salvage and the activity of otherwise mitochondrial METTL4, and may be considered as a price that cells pay for adenine methylation in RNA and/or organellar DNA. Cells minimize this price by sanitizing dNTP pools to limit 6mA incorporation, and by converting 6mA that has been incorporated into DNA back to adenine. Hence, 6mA in nuclear DNA should be described as an epigenetic mark only in basal fungi, ciliates and green algae, but not in animals and plants. [ABSTRACT FROM AUTHOR]

Orofacial clefts (OFCs) have multiple etiologies and likely result from an interplay between genetic and environmental factors. Within the last decade, studies have implicated specific epigenetic modifications and noncoding RNAs as additional facets of OFC etiology. Altered gene expression through DNA methylation and histone modification offer novel insights into how specific genes contribute to distinct OFC subtypes. Epigenetics research has also provided further evidence that cleft lip only (CLO) is a cleft subtype with distinct etiology. Polymorphisms or misexpression of genes encoding microRNAs, as well as their targets, contribute to OFC risk. The ability to experimentally manipulate epigenetic changes and noncoding RNAs in animal models, such as zebrafish, Xenopus, mice, and rats, has offered novel insights into the mechanisms of various OFC subtypes. Although much remains to be understood, recent advancements in our understanding of OFC etiology may advise future strategies of research and preventive care. [ABSTRACT FROM AUTHOR]

Issue Addressed: Healthy Together Victoria (HTV) was a large-scale intervention that adopted a systems approach to prevention. It established the capability of an inexperienced workforce by cultivating their understanding of systems theories, tools and practice. This paper explores how this capacity was developed and what helped and hindered the process.Methods: This qualitative research included 31 primary semi-structured interviews that focused on participants' understanding of systems thinking. Deductive thematic analysis was undertaken. A workforce development framework informed the coding that was used to create a causal loop diagram.Results: The findings display the multiple influencers on capacity-building. Practice change was enabled with training-although it lacked coordination and participation was limited. Yet, the systems approach was strengthened with governance arrangements, policies, funding, team support and leadership that empowered practitioners to trial systems methods. Capacity-building was hindered by HTV's unspecified theory that made it harder for novice practitioners to grasp. Funding cuts due to political changes reduced the initiative's duration and prompted resignations, causing the newfound experience to exit the workforce.Conclusion: Capacity-building for systems practice requires a holistic approach of simultaneous, complimentary actions that address the individual and environmental influences of workforce development, especially the drivers of organisational culture that facilitate new practice. SO WHAT?: Effective training methods should specifically teach skills and knowledge that help practitioners to implement systems thinking. The workforce development requirements of other contributors also need to be considered, in addition to the policies, opportunities and resources that embed practice change. [ABSTRACT FROM AUTHOR]

Ovarian cancer (OVCA) is the deadliest of all gynecological cancers which is attributed to late presentation, persistence, and development of chemoresistance. The objectives were to evaluate the association between OVCA paclitaxel-resistance and epithelialto- mesenchymal transition (EMT) and to determine the capability of luteolin to chemosensitize OVCA cells. X10 and X22 cells were 11.8-25.3-fold and 7.8-8.6-fold resistant to paclitaxel than 1AP cells. X10 and X22 cells exhibited a mesenchymal phenotype, while 1AP has an epithelial characteristics. Furthermore, the expression of the epithelial marker E-cadherin was downregulated, while mesenchymal markers Vimentin and N-cadherin were upregulated in X10 and X22 cells when compared to 1AP cells. Transcription factors Snail, Slug, and Twist1 were upregulated in X10 cells, while Twist1 was highly expressed in X22 cells. Luteolin treatment caused cytotoxicity being most potent to X10 OVCA cells. Treatment of non-cytotoxic dose of luteolin at 15.625 mM chemosensitized X10 and X22 OVCA cells to paclitaxel as evidenced by reduced ED50 values from 11.8 to 0.2 mM and 8.6 to 3.6 mM for X10 and X22 cells, respectively. Moreover, luteolin treatment led to a more epithelial phenotype of X10 and X22 cells and modification of EMT markers indicating reversal of EMT. The mechanism involved is through reduction of phosphorylation of FAK and ERK leading to reduced nuclear translocation of p65. Our results highlight the significance of EMT in OVCA resistance to paclitaxel and warrant the investigation of luteolin as a potential therapeutic agent in chemoresistant OVCA. [ABSTRACT FROM AUTHOR]

Issue addressed Primary healthcare settings are important providers of health promotion approaches. However, organisational challenges can affect their capacity to deliver these approaches. This review identified the common enablers and barriers health organisations faced and it aimed to explore the experiences health organisations, in particular Aboriginal organisations, had when increasing their health promotion capacity. Methods A systematic search of peer-reviewed literature was conducted. Articles published between 1990-2014 that focused on a health care-settings approach and discussed factors that facilitated or hindered an organisation's ability to increase health promotion capacity were included. Results Twenty-five articles met the inclusion criteria. Qualitative (n=18) and quantitative (n=7) study designs were included. Only one article described the experiences of an Aboriginal health organisation. Enablers included: management support, skilled staff, provision of external support to the organisation, committed staffing and financial resources, leadership and the availability of external partners to work with. Barriers included: lack of management support, lack of dedicated health promotion staff, staff lacking skills or confidence, competing priorities and a lack of time and resources allocated to health promotion activities. Conclusions While the literature highlighted the importance of health promotion work, barriers can limit the delivery of health promotion approaches within primary healthcare organisations. A gap in the literature exists about how Aboriginal health organisations face these challenges. So what? Primary healthcare organisations wanting to increase their health promotion capacity can pre-empt the common barriers and strengthen identified enablers through the shared learnings outlined in this review. [ABSTRACT FROM AUTHOR]

Employees in EDs report increasing role overload because of critical staff shortages, budgetary cuts and increased patient numbers and acuity. Such overload could compromise staff satisfaction with their working environment. This integrative review identifies, synthesises and evaluates current research around staff perceptions of the working conditions in EDs. A systematic search of relevant databases, using MeSH descriptors ED/EDs, Emergency room/s, ER/s, or A&E coupled with (and) working environment, working condition/s, staff perception/s, as well as reference chaining was conducted. We identified 31 key studies that were evaluated using the mixed methods assessment tool (MMAT). These comprised 24 quantitative-descriptive studies, four mixed descriptive/comparative (non-randomised controlled trial) studies and three qualitative studies. Studies included varied widely in quality with MMAT scores ranging from 0% to 100%. A key finding was that perceptions of working environment varied across clinical staff and study location, but that high levels of autonomy and teamwork offset stress around high pressure and high volume workloads. The large range of tools used to assess staff perception of working environment limits the comparability of the studies. A dearth of intervention studies around enhancing working environments in EDs limits the capacity to recommend evidence-based interventions to improve staff morale. © 2016 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine [ABSTRACT FROM AUTHOR]

Objective: To understand the attitudes of consultant emergency medicine physicians and advanced trainees and the perceived barriers to public health interventions in Australasian EDs. Methods: This was a voluntary cross-sectional, mixed-methods online survey of consultant emergency physicians and advanced trainees of the ACEM, conducted between December 2011 and March 2012. Results: Eight hundred and fifty-six ACEM members responded to the survey - a response rate of 33%. A similar number of consultants (70%) and trainees (75%) believed public health initiatives should be provided in the ED. Barriers identified by a similar majority of consultants and trainees to the implementation of public health interventions in EDs included dedicated time available for staff to be involved; available public health resources; available funding; clinical staff skills and expertise in public health; and the availability of staff training. Conclusions: Public health and health promotion are perceived by the majority of emergency medicine physicians as important in emergency medicine; however, substantial barriers exists to their implementation. Development of an evidence-based approach to public health interventions, which are effective and feasible in the ED environment, will facilitate a more comprehensive approach to public health initiatives in emergency medicine. [ABSTRACT FROM AUTHOR]

ACADEMIC EMERGENCY MEDICINE 2012; 19:313-317 © 2012 by the Society for Academic Emergency Medicine Abstract Objectives: The objective was to introduce a public health promotion specialist (PHPS) into the hospital emergency department (ED) to provide a brief health promotion intervention to patients and to determine the effect of the initiative on patient satisfaction. Methods: Patients in the intervention group were offered and received a 5- to 10-minute presentation about exercise, heart health, healthy eating on a budget, or weight control by a trained PHPS. Patients in the control group received usual ED care. Both groups completed the patient satisfaction instrument. Ordinal logistic regression models were used to compare the two groups on patient satisfaction questions and to identify predictors of the likelihood of patients referring others to the ED. Results: Subjects in the intervention group were more likely to rate the services as great in areas of patient satisfaction such as provider listening, staff being friendly and helpful, comfort and safety, and privacy. Those in the intervention group were three times more likely than those in the control group to state that they would refer others to the ED. Conclusions: Health promotion and disease prevention interventions carried out by PHPS in the ED can improve patient satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: Hypertension is a highly prevalent risk factor for cardiovascular disease, and its early identification and management results in reductions in morbidity and mortality. Our objectives were to: (1) determine the extent to which the emergency department (ED) has been used to screen patients for undiagnosed hypertension; (2) estimate the incidence of undiagnosed hypertension in the ED population; (3) identify and describe the programs for ED hypertension screening; and (4) determine the feasibility of ED-based hypertension screening programs and the requirements for further study. Data sources: An online search of databases (i.e., OVID Search, CINAHL, Scopus, Web of Science), unpublished sources (i.e., ProQuest Dissertation & Theses and Papers First), and grey literature (i.e., OpenSIGLE and the New York Academy of Grey Literature) was conducted. A manual search of the reference lists of relevant studies was also completed. Conclusion: Hypertension screening in the ED is feasible. Individuals with elevated blood pressure (BP) in the ED should be referred for follow-up. Further study is needed to develop an ED screening tool that is predictive of persistently elevated BP in undiagnosed individuals. Implications for practice: Nurse practitioners in the ED should identify patients with elevated BP, provide hypertension education, and ensure appropriate intervention and referral. [ABSTRACT FROM AUTHOR]

Background: Many agencies over the last few decades have called for the explicit inclusion and application of health promotion in all aspects of nursing practice. This article reviews the body of empirical (research-based) and theoretical (conceptual) literature addressing health promotion in nursing clinical practice, to uncover its nature, intention, and impact. Approach: The aim of this review was to identify from the nursing literature what is reported on in relation to health promotion activity, both theoretical and clinical in the practice setting. An extensive review identified that literature pertaining to these issues clustered around the categories of: theorising and conceptualising the meaning and purpose of health promotion in nursing practice, the development and testing of tools and models for practice, and the exploration of attitudes, behaviours, roles and functions of nurses and health professionals in practice. Findings: Against more recent trends in health promotion, the literature shows that broader and wide-ranging health promotion reform has yet to have universal impact, whereas conventional health education activities remain the mainstay for the majority of “health promotion” activities in nursing practice. Where nurses purport to be conducting “health promotion” they are often conducting behavioural, lifestyle, and risk-orientated health education. The findings of this review therefore support the notion that much of nursing-related health practice is firmly located in reactive ill health and disease risk-specific preventive locations, instead of incorporating and instilling broader societal, economic, ecological, and political dimensions of health promotion. Recommendations for wider reform, developed from personal opinion and supported by the literature, are presented. Conclusions: It is argued that nursing bodies, as well as individual nurses themselves, should seek current health promotion locations in nursing practice, and find effective ways to implement health promotion strategies and, subsequently, equip practitioners with the necessary resources and skills to engage with other health promotion agencies. Future research should be aimed at implementing and evaluating broad health promotion processes. [ABSTRACT FROM AUTHOR]

BACKGROUND: In 1986, the World Health Organisation's (WHO) Ottawa Charter for Health Promotion sought to create a framework that conveyed the notion of capacity building, related to specific settings, and a structured process for health promotion action. It provided the platform from which the health promoting hospital movement was later launched. Nearly two decades on, the health promoting hospital (HPH) movement has grown considerably and continues to expand, against the backdrop of having to adapt to the changing needs and demands of clients and the evolving social context of their communities. Many nurses, it is argued here, are often unaware of health promoting hospitals concepts or, when they are, do little to contribute to them. METHOD: A critical review of the available health promoting hospital and related literature has been conducted for discussion. FINDINGS: The literature revealed that hospitals are being urged to reject practices based purely on health-limiting and limited biomedical frameworks, in favour of moving towards models based on health promoting hospitals and public health-orientated hospitals. This requires radical reform that focuses on the social and health policy context of organizations, the socio-political empowerment of its employers and clients, and the personal/collective positive health and welfare of its employers and clients. Many health service agencies are beginning to emphasize population health within communities as part of a concerted move away from an original primary focus on acute inpatient hospital-based service provision. CONCLUSION: Hospitals need to adapt and expand their efforts to focus on health promotion activities, in collaboration with the ever-widening community networks of health and social agencies. This requires the commitment of all health care professional groups. Nurses who practice in the hospital setting should be aiming to initiate and promote radical health promotion reform as set out in the health promoting hospital movement. This paper argues that nursing per se could be making much larger inroads and efforts to affect and implement wide-ranging health promotion activities in hospital organizations. Nurses should view the HPH movement as another opportunity truly to embrace evolving broad-based health promotion concepts, as a means to forge and own their own health agenda, and also as a means to move beyond the traditional reliance of a limited health education role. RELEVANCE TO CLINICAL PRACTICE: Hospitals and their employees must be seen to advocate, support and implement wide-reaching social and community-based reform, as part of a necessary commitment to 'seamless' health care provision. The health promoting hospital movement represents a collective vehicle for enabling such activities. If nurses wish to be at the forefront of current health service strategies they must be seen to embrace the radical health promotion reforms that are emerging from the current literature and put forward in this article. [ABSTRACT FROM AUTHOR]

• A recognized ‘paradigm war’ exists between the two distinct approaches of health education and health promotion practice. This tension is both unhealthy and unhelpful and is known to have a profound effect on nursing activity. • Leading health promotionalists have begun to acknowledge the futility of the stated paradigm tension, realizing that health education and health promotion interventions are not that dissimilar in their origins and intentions. Progressive health education and health promotion programmes acknowledge the interrelatedness of both approaches and seek to incorporate favourable aspects of the two. • The aim of this article is to present arguments and stances that help to diffuse/avoid the stated paradigm conflict, as a basis for health education and health promotion reform in nursing. It also seeks to clarify the nature of both health education and health promotion practice so as to avoid contextual confusion. In doing so, this article draws significantly from the author's previous work. • This article concludes that the constructive review of any intended health education/health promotion programme lies in the consideration of each approach according to its own relative merits, what is required of the programme, and the nature of the setting in which the intervention takes place. [ABSTRACT FROM AUTHOR]

To ascertain the level of security arrangements in Australian EDs. A postal survey to the directors of all Australasian College for Emergency Medicine (ACEM) accredited EDs in Australia. A score based on the ACEM design guidelines for EDs was given. A maximum score of 12 correlated with compliance with the 12 specific ACEM recommendations. Questions regarding satisfaction with security and occurrence of a major incident within the prior five years were included. There was an 88% response rate to the questionnaire. Of the respondents, 63% were unhappy with the level of security in their ED and 81% reported the occurrence of a major incident within five years. The average score out of 12 was 8.39 (SD 2.4). A total of 7% scored 12/12 and 21% scored 6 or less. There was no difference in scores when the ED were grouped by age, locality or annual attendances. The vast majority of Australian EDs do not comply with all ACEM recommendations on security and most department directors are unhappy with the existing level of security in their departments. This is of concern in light of the negative impact of violence on the well-being of ED staff. [ABSTRACT FROM AUTHOR]

Abstract Objective: To demonstrate a comprehensive workplace health survey is able to identify indicators that contribute to staff workplace welfare. Methods: Analysis of a VicHealth workplace health survey distributed to seven suburban emergency departments. Respondents rated multiple workplace health indicators in terms of perceived importance and perceived performance. A satisfaction rating and performance gap for each indicator was calculated. Results: There was a 64% response rate to 500 surveys. Staff rated a safe environment, professional standards, and staff morale the most important factors for workplace health. They were most satisfied with the flexibility of work arrangements (85.6%) and leadership (79.9%), and were least satisfied with the performance management of staff (68.5%) and job satisfaction and morale (67.2%). The largest gaps between perceived importance and performance were in the provision of safe well-lit parking, staff morale, and the use of reward and recognition systems. Conclusion: The VicHealth survey was an effective tool in identifying indicators that contribute to staff workplace health. Quantifiable findings allowed interdepartmental comparison and may be useful in focusing on improvements in organizational structure. [ABSTRACT FROM AUTHOR]

Reviews several articles about emergency medicine. 'Health Promotion - Who Us?,' by M. Bensberg and M. Kennedy; 'Emergency Department Anaphylaxis: A Review of 142 Patients in a Single Year,' by A.F.T. Brown, D. McKinnon and K. Chu; 'Quality Management and the Emergency Services Enhancement Program,' by C. Cobelas, C. Cooper, M. Ell, G. Hawthorne, M. Kennedy and D. Leach.

The author comments on the works of Dunnion ME & Kelly B. He argues for overall departmental and organizational reforms to measure unlined services between hospital and community-based services. Depicting discharge planning as an important and fractional component of the process, the author highlights action research for the health service reforms.

Lists the authors of articles published in the periodical 'Emergency Medicine' as of December 2002. G. Allen; N.A. Edwards; C.M. Hurn; T. Jackson; D.S. Leach; A.V. Maclean; J. Nicholl; D.L. O'Brien.