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Issue Addressed Methods Results Conclusion So What? Intersectoral action is integral in promoting population health and health equity. In South Australia, public health partnership authorities (PHPAs) are one mechanism to promote intersectoral collaboration for addressing complex public health issues. This case study examined contemporary evidence on the critical elements of successful partnerships, explored the role of formalisation in success, and examined how identified critical elements were operationalised over time in an existing PHPA.In the first phase, a scoping review was conducted. The second phase was a retrospective longitudinal case study of a government‐academic PHPA agreement, involving partnership document review and key informant interviews. Data triangulation and iterative thematic analysis were performed.The critical elements of successful partnership, triangulated through multiple data sources, are mutuality, governance, communication, resources, leadership, and interactions and relationships. These elements have a high degree of interdependence. Trust supports and is reinforced by these elements, particularly during times of change or crisis. Formalisation of a partnership supports success in many ways but is insufficient on its own.Operating in dynamic environments, a partnership requires dedicated time and effort to be successful. Attention to the strength and interconnectedness of the critical elements over the course of a partnership is crucial.This case study describes how the elements of successful partnership can be applied to progress beyond transactional relationships towards authentic collaboration and overcome cross‐border and cross‐boundary public health challenges to promote population health and well‐being. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was the multicentric assessment of the virtual prosthetic case planning environment (VCPE), which relocates patient planning into the virtual space in dental education. Materials and Methods: The VCPE is separated into two rooms: a virtual entry area where the user can choose between 10 different prosthetic case plans of ascending complexity, and a virtual patient case planning room. In spring term 2022, the use of virtual case planning was voluntarily assessed in four different German dental schools (DSs) from the perspective of both lecturers and students. The assessment was performed afterwards using a questionnaire. Data were analysed using Kolmogorov–Smirnov test, exploratory data analysis, Fisher–Freeman–Halton test, and exact Fisher test. Reliability was assessed with Cronbach Alpha test (α < 0.05). Results: A total of 59 lecturers and 63 students were included. There were 38.5% male, 60.7% female, and 0.8% diverse participants. The mean age of the lecturers was 36.2 ± 9.0 years and of the students 24.3 ± 3.0 years. The VCPE was assessed as good, yet the evaluations between either the DSs or between the lecturers and students were significantly different. Conclusions: Even though for some assessment criteria significantly different results between the four DS were observed, the majority of participants evaluated the VCPE positively and recommended them for teaching. The virtual reality as a teaching method for teaching prosthetic case planning for the further preparation of the students for the later professional life can be considered as helpful. [ABSTRACT FROM AUTHOR]

Analytical and therapeutic innovations led to a continuous but variable extension of newborn screening (NBS) programmes worldwide. Every extension requires a careful evaluation of feasibility, diagnostic (process) quality and possible health benefits to balance benefits and limitations. The aim of this study was to evaluate the suitability of 18 candidate diseases for inclusion in NBS programmes. Utilising tandem mass spectrometry as well as establishing specific diagnostic pathways with second‐tier analyses, three German NBS centres designed and conducted an evaluation study for 18 candidate diseases, all of them inherited metabolic diseases. In total, 1 777 264 NBS samples were analysed. Overall, 441 positive NBS results were reported resulting in 68 confirmed diagnoses, 373 false‐positive cases and an estimated cumulative prevalence of approximately 1 in 26 000 newborns. The positive predictive value ranged from 0.07 (carnitine transporter defect) to 0.67 (HMG‐CoA lyase deficiency). Three individuals were missed and 14 individuals (21%) developed symptoms before the positive NBS results were reported. The majority of tested candidate diseases were found to be suitable for inclusion in NBS programmes, while multiple acyl‐CoA dehydrogenase deficiency, isolated methylmalonic acidurias, propionic acidemia and malonyl‐CoA decarboxylase deficiency showed some and carnitine transporter defect significant limitations. Evaluation studies are an important tool to assess the potential benefits and limitations of expanding NBS programmes to new diseases. [ABSTRACT FROM AUTHOR]

Early Check is a voluntary, large‐scale expanded newborn screening study in North Carolina that uses a self‐directed web‐based portal for return of normal individual research results (IRR). Little is known about participant perspectives in using web‐based portals to receive IRR. This study explored user attitudes and behaviors within the Early Check portal using three methods: (1) a feedback survey available to the consenting parent of participating infants (typically mothers), (2) semi‐structured interviews conducted with a subset of parents, and (3) Google Analytics. During an approximate 3‐year period, 17 936 newborns received normal IRR and there were 27 812 visits to the portal. Most surveyed parents reported viewing their baby's results (86%, 1410/1639). Parents largely found the portal easy to use to get results, and helpful in understanding the results. However, 10% of parents said it was difficult to find enough information to understand their baby's results. In Early Check, providing normal IRR via the portal made a large‐scale study practical, and was highly rated by most users. Return of normal IRR may be particularly amenable to web‐based portals, as the consequences to participants from not viewing results are modest, and the interpretation of a normal result is relatively straightforward. [ABSTRACT FROM AUTHOR]

Rationale, Aims and Objectives: Women with previous gestational diabetes mellitus (GDM) are more than eight times more likely to develop type 2 diabetes (T2DM) compared to women without GDM. Annual follow‐up T2DM‐screening is recommended, but participation rates decrease rapidly after the first year. In the North Denmark Region, an electronic reminder has been tested with the aim of improving follow‐up care for women with prior GDM. The aim of this study was to explore women's perspectives on receiving an electronic reminder, and the role of reminders in both women's decision‐making and informed choice regarding participation in follow‐up screening. Methods: A qualitative process evaluation informed by a critical realistic perspective. Data consisted of 20 semi‐structured interviews with women previously diagnosed with GDM who had received the reminder. Interviews were analyzed using reflexive thematic analysis. Results: The reminder affected women's decision‐making and informed choices through a range of mechanisms. Its personalized design prompted feelings of co‐responsibility and care from the healthcare system, supported continuity in women's care pathways, and helped women bridge the gap between healthcare sectors. Women's perception of diabetes risk and the importance of follow‐up influenced their decision‐making. Participation in follow‐up screening was influenced by several contextual factors, as women's everyday life impeded their prioritizing follow‐up screening. Women who experienced being met by their general practitioner (GP) with acknowledgement rather than stigmatization and received supportive information tailored to their life situation were more motivated to participate in future follow‐up screenings. Conclusion: The reminder indicated both concern and co‐responsibility for women's follow‐up care after GDM and was well received by the women. It supported participation in follow‐up screening through an emphasis on shared decision‐making and informed choice. Women's interaction with their GP played a significant role. [ABSTRACT FROM AUTHOR]

Background: The principles of palliative care were developed in hospices and specialised palliative care units and have not been sufficiently adapted to and evaluated in nursing homes. Therefore, an educational intervention from an interprofessional education perspective was performed within the project Implementation of Knowledge‐Based Palliative Care in Nursing Homes. The aim of this study was to evaluate professionals' experience of palliative care delivery before and after the educational intervention. Methods: The educational intervention for nursing home professionals consisted of five 2‐h seminars over 6 months at 20 nursing homes. The intervention and control groups consisted of 129 and 160 professionals from 30 nursing homes respectively. The questionnaire 'Your experience of palliative care' was completed 1 month before (baseline) and after (follow‐up) the intervention. Descriptive and inferential statistics were calculated. Results: The positive effects at follow‐up concerned the use of a valid scale for grading symptoms, attendance to the needs of next of kin (including bereavement support), documentation of older persons' wishes regarding place to die and conversations about their transition to palliative care and about how they were treated. Conclusions: This study demonstrates a promising interprofessional educational model. However, the paucity of improvements brought to light at follow‐up indicates a need for research directed towards a revision of this model. Supervision of professionals during palliative care delivery is one suggestion for change. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate The Little Things training program, designed to assist personal care assistants (PCAs) from culturally and linguistically diverse (CALD) backgrounds to communicate more effectively with aged care residents. Methods: This project included PCAs from residential aged care facilities (RACFs) and Certificate III students from registered training organisations (RTOs) in Melbourne, Australia. A control group (n = 18) was also included. Measures included the following: pre‐ and posttraining confidence to communicate and rankings of task importance; posttraining perceived change in confidence; and posttraining impacts on practice. Results: Altogether, 75 PCAs and 30 RTO students participated in Intake I of the training and 31 PCAs and 34 RTO students in Intake 2. Confidence increased in The Little Things participants relative to those in the control group (β = 0.11, T = 1.99, p = 0.05). Change did not vary by Intake or whether someone was in the RACF or RTO group, F (2, 147) = 0.58, p = 0.5; nor by sociodemographic characteristics. Most training participants (84%) thought their ability to communicate with older people would 'improve a lot' as a result of the training. Training participants also ranked the importance of duties such as 'Speaking in a friendly and informal way to older people' more highly after than before the training (p = 0.01), while little change was observed in the control group. Conclusions: The Little Things program increased training participants' confidence to communicate and shifted perceived priorities towards interacting with residents in a way that enhanced resident well‐being. [ABSTRACT FROM AUTHOR]

Objectives: To: 1. Develop a CE‐marked smartphone App to support doctors' concordance with transfusion guidelines in non‐bleeding adult patients, emphasising informed consent and anaemia management. 2. Test App accuracy and potential to improve user decisions. Background: Studies have shown inappropriate use of blood components and that most junior doctors own smartphones with medical apps. Methods: A multidisciplinary team developed App screens and logic through an iterative process based on national guidelines. Thirty medical or surgical transfusion scenarios were developed based on national guidelines and each sent to Consultant Haematologist experts in Transfusion Medicine. To obtain a clinical consensus and exclude ambiguous scenarios, their independent decisions and associated certainty were compared. The consensus clinical decision was then compared with guidance from the App. To explore potential App impact on simulated user decisions, 26 junior doctors responded to five transfusion scenarios before and after access to the App. Results: The Blood Choices App agreed with 91% (95% CI: 72%–99%) of expert decisions with a sensitivity of 100% (69% to 100%) and specificity of 85% (55%–98%). Excluding one malfunction scenario, the App had the potential to increase correct decisions by junior doctors from 83% (73%–90%) pre‐App use to 96% (88%–99%) post (p‐value 0.013), with 90% (67%–99%) saying they would use it in practice. Conclusions: Transfusion guidelines can be converted into an App with potential to improve guideline concordance. However, evaluating such Apps is essential to understand their limitations, detect malfunctions and prevent harm. [ABSTRACT FROM AUTHOR]

Introduction: Several automated coagulation analyzers are available for laboratory use. In a university hospital central laboratory, we compared four different instruments. The results for global coagulation assays are presented here. Methods: ACL TOP 750 CTS (Instrumentation Laboratory), Atellica COAG 360 (COAG 360), BCS XP (both Siemens Healthineers), and cobas t 711 (Roche Diagnostics) were compared. For inter‐instrument comparison, five basic coagulation parameters were analyzed in 476 patient plasma samples. Additional assessments included precision testing using commercial control samples and plasma pools, analysis time for a defined set of samples, sample capacity testing, minimum required sample volumes, and detection quality for hemolytic, icteric, or lipemic (HIL) interferences. Results: Good concordance between different instruments was evident from Bland–Altman plots and comparison of data from each instrument with the overall median (τ≥0.8). Shortest analysis times were found for BCS XP and COAG 360, COAG 360 revealed highest sample capacity. Observed required sample volumes were broadly in line with manufacturer specifications and varied according to instrument configurations. HIL detection differed between instruments and was best with ACL TOP 750 CTS. Conclusion: The four analyzers showed similarly high levels of concordance, although some variations were apparent. The most significant differences between the instruments were found in analysis times and sample capacity. Analyzer capabilities must be considered when selecting laboratory equipment and defining algorithms for clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers. Data Sources/Study Setting: Costs for a heart failure health care program based in a safety‐net hospital were reported by program staff for the program year May 2018–April 2019. Additional data sources included hospital records, invoices, and staff survey. Study Design: We conducted a retrospective, cross‐sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities. Data Collection: Program cost data were collected using a activity‐based, micro‐costing approach. In addition, we conducted a survey that was completed by key staff to understand time allocation. Principal Findings: Program costs were approximately $1.33 million, and the annual per patient cost was $1455. Thirty percent of the program costs was for social needs activities: 18% for 30‐day supply of medications and addressing socioeconomic barriers to medication adherence, 18% for mobile health services (outpatient home visits), 53% for navigating services through a financial counselor and community health worker, and 12% for transportation to visits and addressing transportation barriers. Most of the program costs were for personnel: 92% of the health care program fixed, 95% of the health care program variable, and 78% of social needs activities. Discussion: Historically, social and health care services are funded by different systems and have not been integrated. We estimate the cost of implementing social needs activities into a health care program. This work can inform implementation for hospitals attempting to address social determinants of health and social needs in their patient population. [ABSTRACT FROM AUTHOR]

Research shows that top‐down‐designed parenting programmes do not always meet the needs of postmigration parents. Bottom‐up programmes by migrant organizations hold a promise to fill this gap; however, research about these programmes and appropriate evaluation methodologies is scarce. Drawing upon Wenger's () "communities of practice," this paper explores an alternative perspective on parenting programme evaluation. Findings are presented from a study looking into social learning processes of postmigration parents who participated in a bottom‐up programme about raising teenagers in urban areas. Using an ethnographically inspired method combined with a preprogramme and postprogramme design, 115 Moroccan‐Dutch mothers and fathers from 15 programme groups participated. Results show that the programme provided a social learning space in which parents used themselves as resources to learn collectively about parenting. Moreover, parents consciously engaged in learning interactions across learning spaces stretched into their social networks. These analyses showed how parents' development of "learning citizenship" (Wenger,) provides us with insight in collective learning dimensions present in a bottom‐up parenting programme, which is often not included in evaluation studies. Implications for practitioners as facilitators of parents' collective learning are presented. [ABSTRACT FROM AUTHOR]

ABSTRACT In this paper, we propose a method to achieve effective facial emotional expressivity for embodied conversational agents by considering two types of asymmetry when exploiting the valence-arousal-dominance representation of emotions. Indeed, the asymmetry of facial expressions helps to convey complex emotional feelings such as conflicting and/or hidden emotions due to social conventions. To achieve such a higher degree of facial expression in a generic way, we propose a new model for mapping the valence-arousal-dominance emotion model onto a set of 12 scalar facial part actions built mostly by combining pairs of antagonist action units from the Facial Action Coding System. The proposed linear model can automatically drive a large number of autonomous virtual humans or support the interactive design of complex facial expressions over time. By design, our approach produces symmetric facial expressions, as expected for most of the emotional spectrum. However, more complex ambivalent feelings can be produced when differing emotions are applied on the left and right sides of the face. We conducted an experiment on static images produced by our approach to compare the expressive power of symmetric and asymmetric facial expressions for a set of eight basic and complex emotions. Results confirm both the pertinence of our general mapping for expressing basic emotions and the significant improvement brought by asymmetry for expressing ambivalent feelings. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Influenza is a major cause of morbidity and mortality. In 2011, influenza vaccination was provided free for people at greatest risk of severe disease: people aged 65 years and over, Aboriginal Australians 15 years and older, pregnant women, and individuals aged 6 months and over who suffered chronic medical conditions. Aims To evaluate the Western Sydney and Nepean Blue Mountains Local Health District Influenza Prevention Program and to identify some of the enablers and barriers to vaccination in the hospital outpatient setting. Methods Western Sydney and Nepean Blue Mountains local health districts' influenza prevention programme provided influenza vaccine in hospital outpatient settings between 21 March 2011 and 30 June 2011. Accredited nurse immunisers vaccinated 2824 individuals and recorded their primary reason for vaccination. Nurse immunisers were interviewed to identify barriers and enablers to influenza immunisation uptake. Results Two thousand, eight hundred and twenty-four doses of influenza vaccine were administered to people at high risk of influenza in four hospitals in the region: two tertiary facilities and two district hospitals. The primary indication for vaccination was chronic disease in 50% and pregnancy in 37%. Estimated direct cost of the programme was $19 per dose. Conclusions: A hospital-based influenza vaccination programme can be an effective way to improve influenza vaccination rates among specific population groups at high risk of severe disease with influenza, particularly pregnant women and those younger than 65 years with a chronic medical condition. [ABSTRACT FROM AUTHOR]

ABSTRACT Identifying citation classics in the field is one of the key methodologies used to conduct a systematic evaluation of research performance. The objective of this study was to determine the most frequently cited articles published in journals that are placed under the 'respiratory system' subject category (Institute for Scientific Information (ISI) Journal Citation Reports) and to compare them with the most frequently cited respiratory-related articles published in any journal, regardless of subject category. The authors utilized the ISI Journal Citation Reports: Science Edition 2010 database in April 2012 to determine the most frequently cited articles by respiratory system subject category and by respiratory-related keywords. The top 50 most-cited articles were identified in each category and evaluated according to various characteristics. The majority of these papers originated from the United States. The median numbers of citations for the top 50 cited articles stratified by respiratory system subject category and respiratory-related keywords were 841.5 and 2701, respectively. Half of the top 50 cited articles identified by respiratory-related keywords were published in general medical or basic science journals, whereas only three out of these were published in journals under the respiratory system subject category in ISI Journal Citation Reports. In summary, respiratory-related articles published in general medical or science journals attracted more citations than those published in the specific respiratory journals. [ABSTRACT FROM AUTHOR]

Background Patients with type 2 diabetes have an increased risk of developing microvascular and macrovascular complications. In routine diabetes care an adequate reduction of risk factors for these complications is often not achieved. Objective The aim of the study was to evaluate the effects of structured diabetes care on clinical outcomes of patients with type 2 diabetes in primary care. Methods We performed a quasi-experimental study on the effects of structured care consisting of organizational and educational components ( n = 581) compared with care-as-usual ( n = 152). We assessed clinical outcomes of HbA1c, blood pressure, cholesterol, creatinine and body mass index, at baseline and after 1 year. The long-term effects in the structured care group were determined after another 2 years. Results Structured care led to improvement in HbA1c and long-term improvements in blood pressure and cholesterol compared with care-as-usual. After 1 year, the percentage of patients who did not deteriorate was higher in the structured care group, again for HbA1c, diastolic blood pressure, low-density lipoprotein cholesterol and body mass index. Conclusions Structured diabetes care consisting of multiple components has a positive effect on clinical outcomes compared with care-as-usual. Our findings support its further implementation in order to reduce complications in type 2 diabetes patients. [ABSTRACT FROM AUTHOR]

OBJECTIVE • To evaluate the impact of urisheaths vs absorbent products (APs) on quality of life (QoL) in men with moderate to severe urinary incontinence (UI). PATIENTS AND METHODS • A randomized, controlled, crossover trial in 61 outpatient adult men with stable, moderate to severe UI, with no concomitant faecal incontinence, was conducted from June 2007 to February 2009 in 14 urology centres. • Participants tested Conveen Optima urisheaths (Coloplast, Humlebaek, Denmark) with collecting bags and their usual AP in random order for 2 weeks each. • The impact of each on QoL was measured using the King’s Health Questionnaire (KHQ) and the short form-12 acute questionnaire, and each patient’s preference was recorded. • A 10-item patient questionnaire was also used to assess the product main advantages on an 11 point scale (0: worst; 10: best). A 72-h leakage diary was used to record the number and severity of leaks and daily product consumption. Safety was measured as the number of local adverse events. RESULTS • All dimensions of the KHQ were scored lower with urisheaths, indicating an improvement in QoL. The greatest mean score reductions were in Limitations of Daily Activities ( − 10.24, P= 0.01) and Incontinence Impact ( −7.05, P = 0.045). • The majority (69%) of patients preferred Conveen Optima urisheaths to their usual AP ( P = 0.002). • Urisheaths scored significantly higher for all categories in the patient questionnaire (efficacy, self-image, odour management, discretion, skinintegrity) except ease of use. • Safety was considered to be good. CONCLUSIONS • Conveen Optima urisheaths showed apositive impact on QoL (according to the KHQ results) in moderate to severe incontinent men, who were long-term usersof APs, and participants largely preferred urisheaths. • Conveen Optima urisheaths should be recommended to incontinent men in preference to APs. [ABSTRACT FROM AUTHOR]

Objectives: Victoria's new trauma care system has been followed by reductions in preventable and potentially preventable deaths and in deficiencies contributing to death. This improvement has followed triaging more patients to expanded major trauma services where mortality was already lower rather than to improved results within the major trauma services, metropolitan or rural trauma services or ambulance services, Victoria. The objective of the present study was to identify continuing inadequacies within the individual trauma services and in association with representatives of these services to develop appropriate countermeasures. Methods: Initially, presentations were made to each trauma service of their fatalities evaluated after introduction of the new trauma system. At separate working party meetings with each service consensus recommendations were finalized and these disseminated to stakeholders. Results: Recommendations related to the need for Trauma Director/Coordinator appointments at all designated hospitals receiving major trauma, improved facilities and equipment, the trauma team, referral, communications, protocols, a prompting system, education, audit and feedback, infrastructure, staffing, documentation and inter-hospital patient transfer. Conclusion: Interaction between the Consultative Committee on Road Traffic Fatalities and Victorian trauma services identified continuing deficiencies in the new trauma care system and developed consensus recommendations to target these problems. These require implementation through the State Trauma Committee. [ABSTRACT FROM AUTHOR]

The article reports on the study which evaluated several measures to determine the changes in health-related quality of life in children with Hodgkin disease. It indicates that all measures for children in all stages of Hodgkin disease from Canada were able to detect the change in diverse grouping. It implies that the Pediatric Quality of Life Inventory (PedsQL) and the EuroQol EQ-5D visual analogue scale indicated its highest sensitivity to change.

The present study evaluated two primary care parenting interventions. First, we evaluated the most widely used Dutch practices for primary care parenting support. Second, we assessed the applicability of the Primary Care Triple P approach, which is now being utilized in a wide variety of primary care settings. Both interventions target parents of children with mild to moderate behavioural and/or emotional problems, with the aim of improving parenting skills and thereby decreasing child problems. We examined the interventions in pre-, post- and follow-up assessment, and compared the results. Both interventions produced significant reductions in reported child emotional and behaviour problems, that also remained after 3 months. For both groups, parenting styles were also found to have improved at both post-test and follow-up measurement. When compared with the regular Dutch parenting consultation practices, however, the Primary Care Triple P approach produced greater reductions in parental laxness and total parenting dysfunction, and greater improvement in total parenting competence at both post-test and follow-up. Primary Care Triple P may even—in light of the greater improvements in parenting skills and total parental competences in the Triple P group than in the regular Dutch parenting consultation group—produce better results in the long run concerning child behaviour and emotional problems. Copyright © 2009 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Purpose: The objective of the present study was to identify and report on the key challenges confronted by emergency doctors following the introduction of Computerised Provider Order Entry system in a major metropolitan hospital in Sydney. Basic procedures: A qualitative study was undertaken during the period May 2006 to December 2006. The study included a series of eight interviews with three senior doctors and one focus group involving six registrars. Participants were chosen on the basis of their experience of planning for, or working with the new electronic ordering system. The study also incorporated five observation sessions and document analysis. Data were analysed iteratively, which led to the identification and elaboration of issues relevant to the research question. Findings: Three major issues emerged from the findings: (i) the implementation of the new system was accompanied by major shifts in ED work responsibilities and tasks; (ii) the appearance of dysfunctional consequences of the new system related to the excess time it took to electronically order and the usability of some features of the new system; and (iii) doctors' concerns that their views and opinions about the design and implementation of the new system had not been adequately addressed. Conclusion: The implementation of electronic ordering has important implications for ED functioning and the delivery of patient care. The complexity of the ED makes it vulnerable to disruption caused by inadequate system design and ineffective channels of communication across the hospital. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the perfusion characteristics of rabbit liver tumours before and after Ar-He (argon–helium) cryoablation using functional CT and to evaluate the therapeutic effect of Ar-He cryoablation. VX-2 tumour was implanted into the livers of 30 New Zealand white rabbits. Two weeks after tumour implantation, Ar-He cryoablation was performed on these rabbits. Functional CT was performed on the rabbits before and after treatment on days 1, 5, 14, 21 and 35. In the meantime, five rabbits were killed, and the livers were removed for histopathological examination at each of the time points mentioned above. Perfusion characteristics of the tumour and hot spot, such as blood flow (BF), blood volume (BV) and permeability, were analysed based on multislice CT. Histopathological studies corresponding to functional CT were observed, and the therapeutic effects (whether the tumour disappeared completely or still remained) were judged. The two-tailed student’s t-test was used to compare the differences between the effect of pre- and post-Ar-He cryoablation treatment on tumour perfusion parameters. After cryoablation treatment, the number of tumours exhibiting complete necrosis was 13 (52%), and their perfusion parameters, such as BF, BV and permeability values, were significantly lower than those before treatment ( P < 0.05, P < 0.01 and P < 0.05, respectively). After treatment, the number of incomplete necrotic tumours was 12 (48%). In the earlier stage (within 14 days of treatment), the whole tumour perfusion parameters of BF, BV and permeability were significantly lower than those before treatment ( P < 0.05). In the late stage (more than 14 days of treatment), the whole tumour perfusion parameters of BF, BV and permeability were not significantly different compared with the pretreatment results ( P > 0.05). The hot spot perfusion parameters of incomplete necrotic tumours, such as BF, BV and permeability values, showed no significant differences compared with pretreatment ( P > 0.05). Functional CT can measure the perfusion characteristics of hepatic tumours and is consistent with histopathological changes in the tumour after Ar-He cryoablation. Functional CT might also be accurate in judging the therapeutic effect of Ar-He cryoablation. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of a streaming model, previously validated in metropolitan EDs, on selected performance indicators in a regional ED. Method: Multiple linear regression models were applied to monthly time series data from 43 months prior to the intervention and 15 months following the intervention to measure the impact of the streaming model on the following performance indicators: (i) percentage of emergency patients admitted to an inpatient bed within 8 h; (ii) percentage of non-admitted emergency patients with a length of stay of less than 4 h; and (iii) percentage of emergency patients who left without being seen by a doctor or nurse practitioner. Setting: Bendigo Health ED in regional Victoria. Results: Prior to the introduction of streaming, there was a downward trend in both the percentage of emergency patients admitted to an inpatient bed within 8 h, and the percentage of non-admitted emergency patients with a length of stay of less than 4 h. After the introduction of streaming, these trends were reversed ( P = 0.008 and P = 0.004, respectively). There was no statistically significant change in the trend associated with the percentage of emergency patients who left without being seen ( P = 0.904). Conclusions: The implementation of the streaming model had an impact on the two performance indicators associated with length of stay in this regional ED, but did not have a significant impact (positive or negative) on the percentage of patients who did not wait to be seen. These results might interest other EDs in regional hospitals. [ABSTRACT FROM AUTHOR]

Aim: To determine current practice of general paediatricians in New Zealand in the investigation and management of a first unprovoked seizure in childhood. Methods: A self-administered questionnaire was emailed to 109 general paediatricians in New Zealand. The questionnaire presented the participant with three hypothetical case scenarios representing a generalised tonic clonic seizure, a complex partial seizure and an episode of non-specific collapse. The participant was asked to indicate what investigations and course of management was required. Results: Forty-seven questionnaires were returned. Primary investigations included an electroencephalogram (EEG) in 47% of cases after a first generalised tonic clonic seizure increasing to 89% after a second. Ninety-one per cent of paediatricians were likely to request an EEG after a complex partial seizure. No paediatrician would request neuroimaging following a first generalised tonic clonic seizure. Neuroimaging was requested by 10% of paediatricians following a second generalised tonic clonic seizure and by 47% following a complex partial seizure. No paediatrician elected to initiate antiepileptic drugs after a first generalised tonic clonic seizure, but 49% would initiate treatment after a second generalised tonic clonic seizure. Eleven per cent of paediatricians would start treatment after a single complex partial seizure. Conclusion: Less than 50% of general paediatricians would request an EEG after a first unprovoked seizure. This is an unexpectedly low rate that may reflect accessibility. New Zealand paediatricians had an appropriately low rate of requesting neuroimaging. As currently recommended no general paediatricians began antiepileptic drugs in the scenario of a single uncomplicated seizure in the absence of other risk factors. [ABSTRACT FROM AUTHOR]

Medical students' final clinical grades in internal medicine are based on the results of multiple assessments that reflect not only the students' knowledge, but also their skills and attitudes.To examine the sources of validity evidence for internal medicine final assessment results comprising scores from 3 evaluations and 2 examinations.The final assessment scores of 8 cohorts of Year 4 medical students in a 6-year undergraduate programme were analysed. The final assessment scores consisted of scores in ward evaluations (WEs), preceptor evaluations (PREs), outpatient clinic evaluations (OPCs), general knowledge and problem-solving multiple-choice questions (MCQs), and objective structured clinical examinations (OSCEs). Sources of validity evidence examined were content, response process, internal structure, relationship to other variables, and consequences.The median generalisability coefficient of the OSCEs was 0.62. The internal consistency reliability of the MCQs was 0.84. Scores for OSCEs correlated well with WE, PRE and MCQ scores with observed (disattenuated) correlation of 0.36 (0.77), 0.33 (0.71) and 0.48 (0.69), respectively. Scores for WEs and PREs correlated better with OSCE than MCQ scores. Sources of validity evidence including content, response process, internal structure and relationship to other variables were shown for most components.There is sufficient validity evidence to support the utilisation of various types of assessment scores for final clinical grades at the end of an internal medicine rotation. Validity evidence should be examined for any final student evaluation system in order to establish the meaningfulness of the student assessment scores. [ABSTRACT FROM AUTHOR]

Many states have introduced home visitation programs to improve the health of mothers and newborn infants. In South Carolina, the Postpartum/Infant Home Visit (P/IHV) program seeks to provide all Medicaid-eligible mothers and infants with at least one home visit by a nurse or other qualified health professional. In the summer 2002, the authors conducted a cost-benefit analysis of the P/IHV program using both qualitative and quantitative methods. This article describes the qualitative methods and findings from the larger study. Focus groups were held with nurses who provide P/IHV visits to gain insight into the structure and functioning of the P/IHV program, to hear firsthand the nurses' experiences with the program, and to provide guidance in developing the empiric model for measuring cost-benefit. Analysis of the focus-group data suggests that what actually occurs during a home visit is fairly standardized. Nurses indicated that they were knowledgeable about community resources and services available to the families they serve. Referral processes were identified as an important factor in determining whether a mother receives a home visit. Overall, the nurses felt that the home visit program has had a positive impact on the health and well-being of the mothers and infants served. [ABSTRACT FROM AUTHOR]

Objective To evaluate the full range of self-adhesive continence sheaths for men available in the UK and thus provide clinicians and consumers with a basis for product selection. Subjects and methods Fifty-eight volunteers (aged 30–89 years) tested each of six different self-adhesive sheaths available in the UK in September 1998 for 1 week each. Thirty subjects applied the sheaths themselves and 28 subjects relied on a carer to do so. During each week subjects completed a diary recording sheath changes and the result of skin inspection, to note any unscheduled sheath changes (because of sheath detachment) and any skin problems. At the end of each week an 11-item questionnaire was completed using a three-point rating scale (‘good’, ‘acceptable’, ‘unacceptable’) to assess the key aspects of product performance. Results A significantly higher proportion of subjects scored the ‘Aquadry Clear Advantage’ sheath as ‘good’ than four of the other sheaths (P < 0.01) and a significantly higher proportion found the ‘Incare’ sheath to be ‘unacceptable’ than all of the other sheaths (P < 0.001) for the ‘overall opinion’ question. Sheath detachments (sheath falling off or blowing off) for the ‘Incare’ were significantly more common than for four of the other products (P < 0.01). Sheath detachments for the ‘Aquadry Clear Advantage’ were significantly less common than for two of the other products (P < 0.01). A significantly higher proportion of subjects found sheaths with an applicator to be ‘unacceptable’ than sheaths with no applicator (P < 0.001) for the ‘ease of putting on’ and ‘overall opinion’ questions (when adjusted for previous product use and person applying the sheath). Conclusions There were substantial differences between products in their general performance and ergonomics, and... [ABSTRACT FROM AUTHOR]

ObjectTo develop and evaluate the effect of having a personal learning log on Senior House Officers knowledge and confidence. MethodsA multiple choice paper and a confidence checklist for two hospital specialties were developed to assess knowledge and confidence. These were administered to a control group and to an intervention group who had the learning log. Both groups completed an evaluation at the end of the post. SettingThe study took place in Accident & Emergency and Obstetric & Gynaecology posts in Greater Glasgow and Lanarkshire. Subjects79 Senior House Officers in Accident & Emergency and 78 Senior House Officers in Obstetrics & Gynaecology. ResultsThe mean scores in the MCQ and the mode in the confidence checklist increased significantly in both specialties during the post, but there was no significant difference between the control and intervention groups. Forty two learning logs were returned at the end of the study and analysis of these revealed that there was great scope for learning but few documented the specific learning achieved. Evaluation of the posts revealed that some improvements had taken place in teaching and assessment frequency, however, there was scope for further improvement. ConclusionWhile the problems of hospital training are well documented, an attempt to improve the situation using a learning log did not have a statistically significant impact on SHO knowledge or confidence. A six-month hospital post appears to present many opportunities for learning but these are not exploited. It is suggested that three things are needed. Firstly, active participation by and personalized feedback from a senior member of staff, with training where needed. Secondly, protected time for tutorials with a planned system of formative assessment, and thirdly, a more positive approach to learning by both SHOs and consultants. Once this occurs, a learning log may have a more significant impact on training. [ABSTRACT FROM AUTHOR]

Psychogeriatric patients are a very vulnerable group among the elderly. A relative large proportion is institutionalized. In addition, many studies point to the heavy burden on the informal carets of psychogeriatric patients, frequently leading to depression. Geriatric expertise in primary care, however, is limited. To complement this expertise, an experiment was conducted involving a geriatric assessment unit in a nursing home. An evaluation study was carried out including 96 patients, 89 of whom were looked after by informal carers. Data were collected from the unit and two ‘external controls’, both the GP and the informal carer, were interviewed before and 3 months after the intervention. The results show that, in a majority of cases, a new psychiatric or somatic diagnosis could be arrived at. Advice was given on drugs and physiotherapy and the monitoring of behaviour. The impact of the behavioural problems of patients was diminished after the intervention according to the informal carers. Moreover, the sense of competence of the informal eaters was enhanced. The health status of the informal carets and the social support they received remained the same. Furthermore, comparison with other datasets supported the assumption of early detection. [ABSTRACT FROM AUTHOR]