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Persons living with human immunodeficiency virus (HIV) and others receiving antiretrovirals are at risk for medication errors during hospitalization and at transitions of care. These errors may result in adverse effects or viral resistance, limiting future treatment options. A range of interventions is described in the literature to decrease the occurrence or duration of medication errors, including review of electronic health records, clinical checklists at care transitions, and daily review of medication lists. To reduce the risk of medication-related errors, antiretroviral stewardship programs (ARVSPs) are needed to enhance patient safety. This call to action, endorsed by the Infectious Diseases Society of America, the HIV Medicine Association, and the American Academy of HIV Medicine, is modeled upon the success of antimicrobial stewardship programs now mandated by the Joint Commission. Herein, we propose definitions of ARVSPs, suggest resources for ARVSP leadership, and provide a summary of published, successful strategies for ARVSP that healthcare facilities may use to develop locally appropriate programs. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper examines the approaches accounting researchers adopt to draw causal inferences using observational (or nonexperimental) data. The vast majority of accounting research papers draw causal inferences notwithstanding the well-known difficulties in doing so. While some recent papers seek to use quasi-experimental methods to improve causal inferences, these methods also make strong assumptions that are not always fully appreciated. We believe that accounting research would benefit from more in-depth descriptive research, including a greater focus on the study of causal mechanisms (or causal pathways) and increased emphasis on the structural modeling of the phenomena of interest. We argue these changes offer a practical path forward for rigorous accounting research. [ABSTRACT FROM AUTHOR]

The purpose of this essay is to describe how to prepare a qualitative research paper. The essay discusses the crucial components for preparing a qualitative paper. The topics that are addressed are: sample size, sampling procedure, data collection procedure, reliability and trustworthiness, data quality, and integrity of qualitative findings. [ABSTRACT FROM AUTHOR]

The present study is a single-site quality improvement project within pediatric primary care involving the implementation of a digital version of the Modified Checklist for Autism in Toddlers–Revised. We evaluated the impact of the digital screener on the likelihood of physician referral for a developmental evaluation or autism diagnosis, and the age of the patients at the time of the event. Patients were children 16–30 months old seen for 18 and 24 months' well-child visits (1279 encounters), who screened positive for risk for autism spectrum disorder on the Modified Checklist for Autism in Toddlers–Revised without a previously documented autism spectrum disorder diagnosis. Comparisons were made between a cohort of children screened with the paper and pencil version of the Modified Checklist for Autism in Toddlers–Revised before the digital version was implemented and a cohort of children screened during the intervention period. Patients were followed until 48 months and referrals were obtained from electronic health records. Patients screened with the digital Modified Checklist for Autism in Toddlers–Revised were five times more likely to be referred for a developmental evaluation. The automatic scoring, risk assessment, and referral decision support features helped to improve screening outcomes. In this clinic, process change to a digital screening method with automatic guidance for next steps improved adherence to evidence-based clinical care. This was a project in primary care for young children (1–2 years old). We tested a parent questionnaire on a tablet. This tablet questionnaire asked questions to see whether the child may have autism. We compared the paper and pencil version of the questionnaire to the tablet questionnaire. We read the medical charts for the children until they were 4 years old to see whether they ended up having autism. We found that doctors were more likely to recommend an autism evaluation when a parent used the tablet questionnaire. We think that the tablet's automatic scoring feature helped the doctors. We also think that the doctors benefited from the advice the tablet gave them. [ABSTRACT FROM AUTHOR]

Background: The accessibility and fairness of the floating population's access to basic public health services have an important impact on improving the health level of the whole population. Existing studies have shown that medical insurance and social integration have an impact on basic public health services, but there are few studies on the specific influence path between the three. Therefore, the research purpose of this paper is to explore the effects of medical insurance for urban and rural residents and basic medical insurance for urban employees on the utilization of basic public health services, and to analyze the mediating effect of social integration. Methods: The data in this paper are derived from the 2017 China Mobile Population Dynamic Monitoring Survey data, which collects information on 31 provinces (regions, cities) and Xinjiang Production and Construction Corps mobile population 169,989 people, all of whom come from China's relatively concentrated mobile population inflow areas (NHC FPSCo. 2021. Floating Population Service Center of NHC). After deleting part of the missing data and replacing the mean value, 154,586 people were finally included in the analysis. The proportion is 90.9%. Based on the data of China's floating population dynamic survey in 2017,we used Logistic regression method to analyze the effects of basic medical insurance for urban and rural residents, basic medical insurance for urban employees and social integration on the utilization of basic public health services. Then we used the Bootstrap method of structural equation model to analyze the mediating effect of social integration. Results: Medical insurance for urban and rural residents (β = 0.236;95%CI:1.195 ~ 1.342) has positive impact on health education, it (β = 0,190;95%CI:1.150 ~ 1.272) also has positive impact on the establishment of residents' health records. Social integration (including political participation (β = 0.312;95%CI:1.324 ~ 1.410),activity participation (β = 0.724;95%CI:2.009 ~ 2.119), identity (β = 0.421; 95%CI:1.387 ~ 1.675))has positive impact on health education, it ((β = 0.312;95%CI:1.324 ~ 1.410), (β = 0.404;95%CI:1.463 ~ 1.534), (β = 0.282;95%CI:1.191 ~ 1.477)) also has positive impact on the establishment of residents' health records. In addition, BMIUE (β = 0.169;95%CI:1.150 ~ 1.219) has an impact on the establishment of residents' health records. The direct effect of medical insurance on the utilization of public health services was 0.092 (95%CI: 0.093 ~ 0.103), social integration was a partial mediator, the mediating effect was 0.127 (95%CI: 0.108 ~ 0.127), and the mediating effect size was 57.73%. Conclusions: Medical insurance can directly promote the floating population to use basic public health services, and can indirectly promote the improvement of public health service utilization level through social integration. [ABSTRACT FROM AUTHOR]

What is known and objective: Australian hospitals have undergone a transformation with both a review and expansion of traditional roles of healthcare professionals and the implementation of an ieMR. The implementation of an ieMR brings large scale organizational change within the health system especially for staff with direct patient contact. This is changing the future of healthcare and the roles of healthcare professionals. There is minimal research on the impact of these electronic systems on the people and processes required to realise the improvements in patient care such as therapeutic drug monitoring (TDM) and the role of the pharmacist within the TDM process. The literature has discussed the use of computerised programs to assist with the interpretation of results and calculating of doses but the impact of an ieMR on the TDM process has not been discussed. This study undertook a retrospective analysis at an Australian tertiary hospital to investigate the impact of a digital hospital system on TDM within the facility. Methods: A 2‐year retrospective audit was conducted on TDM at an Australian Tertiary Hospital. The periods were 2016 (a paper‐based hospital) and 2018 (ieMR). Patients were identified using the pathology database. Patients were excluded if under the age of 18, in an outpatient setting or the emergency department. Progress notes, medication charts, ieMR and other relevant pathology were reviewed. They were assessed for appropriateness of the timing of collection, compliance to recommended TDM guidelines, and pharmacist documentation. Results and Discussion: A total of 2926 observations were included in the analysis. There was as similar percentage of appropriately collected samples between the paper‐based system (2016) and the digital hospital system (2018) with 59% and 58% respectively. Results of logistic regression analysis models show the effect of year was not significant with regards to TDM for either a sample being appropriate or the dose adjustment being appropriate. Samples for TDM were more likely to be appropriate if the pharmacist had documented advice but less likely with regards to appropriate dose adjustment. This study considered the effect of introducing a hospital wide digital system on TDM processes. Overall, the results indicate no difference between the paper‐based system and ieMR for appropriate samples and doses adjustments. What is new and conclusion: To our knowledge, this is the first study of this kind looking at the impact of a digital hospital system on TDM. The introduction of a digital hospital system does not appear to have made improvement on the effective use of TDM. Inappropriate sampling as seen in this study can lead to ineffective clinical management of patients, inefficient use of time, and waste of financial resources. Further work is required to incorporate specific guidance and recommendations within the digital system to optimize TDM. [ABSTRACT FROM AUTHOR]

BACKGROUND: While the health and economic impact of COVID-19 is becoming better known among the general population, little is known about the impact of the pandemic and recession on employees with intellectual and developmental disability (IDD). PURPOSE: The purpose of this paper is to examine the impact of the COVID-19 pandemic and subsequent recession on individuals with IDD. METHODS: The present paper described the impact of COVID-19 pandemic and recession on the employment status, hours worked, and hourly wage of 156 individuals with IDD who work in competitive integrated employment for February to July 2020. These findings are compared with a similar group receiving services from the same agency in February to July 2019. RESULTS: Findings indicate that these employees were not able to work from home and experienced furlough or lay off instead. Further, the number of hours worked monthly was also significantly affected. Wages were not affected by the pandemic and recession. Employees in some industries, notably health care and distribution and supplies, were less affected than employees in other industries like food service, retail, and entertainment. Finally, and surprisingly, black, indigenous, and other people of color worked more hours monthly than their white peers in both 2019 and 2020. CONCLUSION: Implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Purpose: The available research on specialized interventions for youth experiencing commercial sexual exploitation almost exclusively focuses on the impact and efficacy related to cisgender girls, despite the inclusion of youth who identify as transgender in these programs. This paper aims to present a case study on the experience of a transgender adolescent girl who experienced commercial sexual exploitation and provides a narrative of the multifarious challenges she faced while involved in institutional systems of care. Design/methodology/approach: This paper conducted an in-depth case review of all records on "Jade," a white adolescent transgender girl who experienced commercial sexual exploitation, from a specialty court program in the juvenile justice system between 2012 and 2016. Her experiences throughout childhood exemplify many of the unique challenges that transgender girls and young women with histories of exploitation or trafficking may encounter within service delivery and socioecological systems. This paper applied concepts adapted from the gender minority stress theoretical model to understand how minority gender identity can shape the experiences and outcomes of the youth impacted by commercial sexual exploitation. Findings: Jade's narrative underscores the interplay of gender-based sexual violence, heteronormative structural barriers, transphobia and their intersectional impact on her experience while receiving specialized care. The intersectional hardships she experienced likely contributed to adverse biopsychosocial outcomes, including high rates of medical and behavioral health diagnoses and expectations of further rejection. Originality/value: This paper highlights the extraordinary challenges and barriers faced by an often under-recognized and overlooked subset of the youth impacted by commercial sexual exploitation, who may receive services that do not account for their unique needs related to gender expression and identity. This paper exemplifies how internalized stigma along with expectations of further rejection and victimization have implications for clinical and multidisciplinary intervention settings. Jade's case underscores the need for improved access to supportive services for youth with minority gender identities, including peer community-building opportunities. Finally, this paper identifies a critical gap in US legislation and social policy. This gap contributes to the structural harms faced by transgender and gender-nonconforming youth receiving services during or following experiences of commercial sexual exploitation. [ABSTRACT FROM AUTHOR]

Short Message Service ( SMS) is one of the most widely used data services worldwide. This paper examines the assumption that the 160-character limit would force brief and thus comparatively uninformative responses in psychological research compared to other data collection modes. In laboratory classes, 463 psychology undergraduate students were randomly assigned to complete a 2-item questionnaire by SMS, e-mail, online survey, or paper survey. 2 weeks later, participants completed a multiple-choice self-report risk taking questionnaire on paper. While SMS response lengths were statistically significantly shorter than those yielded in other modes, they did not contain less information. [ABSTRACT FROM AUTHOR]

Aim: We aimed to identify the risk factors for delayed discharge in a day surgery centre in west China. Background: Delayed discharge affected by various factors is a key indicator for healthcare quality of day surgery. However, few studies have focused on this issue in developing countries where the day surgery started much later. Design A retrospective case–control design. Method: A random sample of 169 delayed discharge cases and 514 normal discharge cases was randomly selected from 38,021 day surgery cases from May 2011 to May 2019 in a tertiary teaching hospital in west China. Socio‐demographic and clinical characteristics of patients were collected through the hospital electronic database and a chart review. A multivariate logistic regression was conducted to identify the risk factors for delayed discharge. Results: The urban employee basic medical insurance, comorbidity, general anaesthesia, pain, fever, bleeding and metabolic disorder were identified as the risk factors for delayed discharge. Living in the city where the hospital located was a protective factor for delayed discharge. Conclusion: Post‐operative complications including fever, pain, bleeding and metabolic disorder were the most important risk factors for delayed discharge. The pre‐operative prevention, careful monitoring and rapid reactions to post‐operative complications may reduce delayed discharge. Summary statement: What is already known about this topic? Day surgery is conducted worldwide due to its time‐saving, cost‐effectiveness and low risk for post‐operative infection.Delayed discharge is considered as one of the most important indicators for healthcare quality of a day surgery centre.Most of the identified risk factors for delayed discharge are from the developed countries' experience of day surgery and remain controversial. What this paper adds? The insurance reimbursement rate influenced patients' willingness for discharge.Living in the same city where the hospital is located was a protective factor for delayed discharge.Post‐operative metabolic disorder was a risk factor for delayed discharge. The implications of this paper: Reducing the insurance reimbursement rate of patients who meet discharge criteria but ask for longer hospital stays may be helpful to reduce delayed discharge.Careful monitoring and rapid response to post‐operative complications may be simple but useful measures to reduce the risk of delayed discharge. [ABSTRACT FROM AUTHOR]

Background: While implementation studies in aphasia management have shown promising improvements to clinical practice, it is currently unknown if aphasia implementation outcomes are sustained and what factors may influence clinical sustainability. Aims: To evaluate the sustainment (i.e., sustained improvement of aphasia management practices and domains influencing clinicians' practice) and sustainability (i.e., factors influencing sustainability) outcomes of the Acute Aphasia IMplementation Study (AAIMS). Methods & Procedures: A convergent interactive mixed‐methods sustainability evaluation was conducted on two previously delivered implementation interventions (AAIMS). The AAIMS interventions were targeted at improving either written aphasia‐friendly information provision (Intervention A) or collaborative goal‐setting (Intervention B). Outcomes were collected 2 and 3 years post‐implementation, addressing the research questions of sustainment (e.g., medical record audits and behavioural constructs questionnaires) and sustainability (e.g., post‐study focus groups and organizational readiness surveys). Quantitative sustainability data were compared with post‐implementation data, allowing for sustainment to be determined. Clinicians' perspectives on sustainability outcomes and challenges were analysed using framework analysis and integrated with the quantitative findings. Outcomes & Results: A total of 35 speech–language therapists (SLTs) from four hospitals participated. The medical records of 79 patients were audited in the sustainability period compared with the 107 medical records audited during AAIMS. Overall, there was variable sustainment of the target behaviours; implementation for Intervention A was not sustained at either sustainability time point (2018 = 47.8% decrease; 2019 = 22.78% decrease), but implementation for Intervention B was sustained at both time points (2018 = 7.78% increase; 2019 = 18.1% increase). There was a pattern of sustained change in the behaviour change domains targeted by the implementation interventions, where scores of the targeted domains increased over time (0.13, 95% confidence interval (CI) = −0.05 to 0.30) and scores of the non‐targeted domains declined (−0.03, 95% CI = −0.11 to 0.04). Factors influencing sustainability were mainly related to 'processes', 'the inner context' and 'SLT characteristics', and these interacted dynamically to account for variation between teams. Conclusions & Implications: Implementation outcomes (i.e., practice changes) were not sustained to the same level for three of the four participating SLT teams, with variable or partial sustainment most common. While the factors influencing sustainability differed depending on the context and individuals involved, the most important factor influencing outcomes seemed to be the level to which behaviour‐change processes and strategies were embedded within the SLT department. Future implementation studies should incorporate sustainability measures from the onset and include follow‐ups and monitoring systems to help support sustained change in the long term. What this paper adds: What is already known on the subject: In post‐stroke aphasia management, there are few examples of long‐term sustainability of implementation outcomes. It is therefore unknown what factors are potentially important to sustain implementation of best‐practice recommendations in aphasia services. What this paper adds to existing knowledge: There is potential for implementation outcomes to be sustained long term, but sustainment is impacted by a range of factors. Ongoing facilitation or follow‐up after initial implementation may to useful to promote sustainment, but is not essential if processes are sufficiently embedded. Gradual implementation into practice may lead to better sustainment than rapid change that is quickly forgotten. What are the potential or actual clinical implications of this work?: Future implementation efforts should incorporate sustainability measures from the onset. Applying a sustainability framework was useful to guide evaluations and explore factors influencing the sustainment outcomes and is recommended for those interested in sustainability. Results from our evaluation can be used to guide refinement and support future development of sustainable implementation interventions. [ABSTRACT FROM AUTHOR]

Dysphagia (impaired swallowing) is known to contribute to decreased quality of life, and increased length of hospital stay and mortality post‐stroke. Despite the advancements in stroke treatment with the introduction of thrombolysis and endovascular clot retrieval (ECR), patients continue to present with high rates of dysphagia. Speech and language therapists and stroke teams should consider the presence of haemorrhagic transformation, success of reperfusion and presence of communication deficits as risk factors for dysphagia post‐ECR and/or thrombolysis. Purpose: To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. Method: A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. Results: Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech‐language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. Conclusion: This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence‐base for SLPs and the wider medical team and to inform clinical practice guidelines. What this paper adds: What is already known on the subject: Stroke is one of the leading causes of disability and death internationally. Dysphagia (impaired swallowing), a common sequalae of stroke, is known to contribute to decreased quality of life, increased length of hospital stay and mortality. With advancements in technology, treatments for acute ischaemic stroke (endovascular clot retrieval and thrombolysis) are increasing in popularity. However, limited research exists exploring the impact of these therapies on dysphagia. What this paper adds: Despite the advancements in stroke treatment, patients continue to present with high rates of dysphagia. Dysphagia following thrombolysis and/or ECR was found to be significantly correlated to the presence of aphasia, haemorrhagic transformation, and the success of reperfusion (regardless of treatment type). Additionally, increased rates of enteral feeding were found amongst this patient population compared to figures reported in the literature for patients following traditional stroke management. Clinical implications of this study: Speech‐language pathologists and the wider medical team should consider dysphagia as an ongoing consequence of stroke following reperfusion therapies, with consideration for success of reperfusion and adverse outcomes i.e., haemorrhagic transformation. Further research is required to provide an evidence‐base and specific guidelines for the management of dysphagia post reperfusion therapies, including use of enteral feeding. [ABSTRACT FROM AUTHOR]

Background: Incorrect surgical counts are closely related to retained surgical items, which pose a threat to patients. However, the risk factors for incorrect surgical counts have not been identified yet. Aim: To identify the risk factors associated with incorrect surgical counts during surgery in a tertiary hospital. Design An observational case–control study. Methods: Seventy cases of incorrect surgical counts were reviewed in this study. Data were collected from January 1, 2014, to April 4, 2019. For each case, we included four randomly selected control cases involving the same surgical procedures by the same surgeon within a 6‐month period for comparison. The medical data of these cases were extracted for further statistical analysis. Results: A higher incidence of incorrect surgical counts was observed among surgical counts performed between 8:00 a.m. to 12:00 a.m., emergency operations, prolonged procedures, and/or after addition of surgical items. Conclusion: Prolonged surgical procedures, emergency operations, time of occurrence, and addition of surgical items were the risk factors related to incorrect surgical counts during surgery. Summary statement: What is already known about the topic? Incorrect surgical count is a perplexing problem during operation.Incorrect surgical count is closely associated with retained surgical items which can cause patient injury.The underlaying risk factors of incorrect surgical count were still unknown. What this paper adds? This was the first case–control study for incorrect surgical counts in China.The present research demonstrated that several risk factors were significantly associated with the occurrence of incorrect surgical counts, including the time period, the type of surgery, and the duration of the procedure.Vigilance should be maintained during an emergency operation or a long procedure to reduce the incidence of incorrect surgical counts. The implications of this paper: It is important for nurses to be aware of the factors that can interfere with correct surgical counts, thereby ensuring vigilance during emergency operations or long procedures.By identifying these risk factors, a more comprehensive safety policy in the operation room can be implemented to reduce incorrect surgical counts.Novel technological adjuncts should be promoted in the operating room gradually to improve overall patient safety. [ABSTRACT FROM AUTHOR]

Context: Gender bias has been observed in the authorship and editorship of academic literature in varied medical specialties. This is important as peer‐reviewed publications, and participation on editorial boards, are closely related to academic productivity and advancement. The aim of this paper was to examine whether gender‐based disparities in authorship and editorship exist in leading medical education journals. Methods: A retrospective bibliometric review was conducted of articles published at eight different time‐points across a 49‐year time period (specifically: 1970, 1980, 1990, 2000, 2005, 2010, 2015 and 2019) in four leading medical education journals (Academic Medicine, BMC Medical Education, Medical Education and Medical Teacher). First and last (as a proxy for senior) author gender was determined for each article, along with the gender of the 2019 editorial board members of each journal. Chi‐square tests for trend were conducted to examine variations in author gender distributions over time, and binomial tests of proportions were conducted to examine gender distributions in authorship and editorship in 2019. Logistic regression analyses were carried out to determine factors that predicted the odds of authorship by women. Results: A total of 5749 articles were included. A significant trend of increased women as first and last authors was observed across all journals. The percentage of women first authors increased from 6.6% in 1970 to 53.7% in 2019 (P <.001), and women last authors increased from 9.5% in 1970 to 46% in 2019 (P <.001). Overall, the distributions of women first authors, last authors and editorial board members in 2019 indicated greater gender parity than many other fields of medicine. Conclusions: Positive progress towards gender parity has been made in medical education scholarship. However, future research and efforts are needed to ensure the continued participation, and highlighting, of women in medical education scholarship and to address other factors which may hinder academic advancement for women in this field. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate the validity and reliability of the modified Chronic Kidney Disease Self‐Management instrument in an English‐speaking population. Background: There is growing evidence that self‐management behaviours can improve outcomes for people with chronic kidney disease. However, there are few suitable instruments available. Design The study was cross sectional, with a test–retest protocol. Method: Adults with chronic kidney disease attending a primary health care between June and December 2015 completed the Chronic Kidney Disease Self‐Management instrument. Construct validity was determined using exploratory factor analysis, internal consistency and test–retest reliability using Cronbach's α and intraclass correlation. For convergent validity, the relationships between knowledge, self‐efficacy and self‐management were investigated. Results: The Australian version of the Chronic Kidney Disease Self‐Management instrument has 17 items grouped into four factors: self‐integration, seeking social support, adherence to lifestyle modification and problem solving. The instrument demonstrated good reliability. Self‐efficacy was positively correlated with self‐management scores, although there was no correlation between chronic kidney disease knowledge and self‐management. Conclusions: The Australian version of the Chronic Kidney Disease Self‐Management instrument was found to be a valid and reliable patient‐reported outcome measure. It can be used in clinical practice to support self‐management, as well as future research. SUMMARY STATEMENT: What is already known about this topic? The burden of chronic kidney disease is rising mostly due to the increasing prevalence of diabetes and hypertension.Chronic kidney disease progression can be slowed with effective self‐management behaviours.Patient‐reported outcome measures need testing in target populations prior to implementation in clinical settings and research. What this paper adds? The Australian version of the Chronic Kidney Disease Self‐Management instrument demonstrated good validity and reliability in the target population.The instrument is suitable to use in research testing interventions to improve self‐management of chronic kidney disease. The implications of this paper: Clinicians can use this patient‐reported outcome measure to assess for changes in CKD self‐management behaviours following patient education.The instrument can be used to identify individuals in need of support for self‐management skills. [ABSTRACT FROM AUTHOR]

Background: Our hospice caters to referrals from the wide areas in the northern Indian territory. A descriptive analysis of hospice admissions can bring to light, the status of palliative care in the region overall. Aim: The aim was to assess the clinical and demographic profile of hospice admissions in New Delhi during the time period 2016–2017. Methods: Hospice admission records from the calendar year 2016 were digitized from paper charts, and statistical analysis was carried out using SPSS v21. Patient and caregiver demographic profile and dominant referral and utilization patterns were retrospectively assessed. Results: One hundred and fifty-four admissions (mean age 51.8 ± 15 years; 60% females) were recorded. Up to one-third of the patients (48, 31%) were single at the time of admission. Majority of the patients had below 10th grade literacy level (116, 75.3%) and belonged to low socioeconomic status. Two large tertiary care centers were the most common referrers (54.6%). The top three diagnoses were head-and-neck cancers (56, 36.4%), gastrointestinal cancers (27, 17.5%), and metastatic breast cancer (23, 14.9%). Major patient-reported debilities were pain (73%), dysphagia (51%), and incontinence (45%). The mean duration from diagnosis to hospice referral was 2.7 ± 0.7 years. Majority of the patients (76%) reported to have undergone some form of oncologic treatment. Up to two-thirds of the patients received opioids with or without additional supportive care. Conclusion: Pain, dysphagia, and incontinence were the most common reasons for hospice referral, with incontinence being significantly correlated with the divorced status. There were no differences in the prevalence of other symptoms with relation to the marital status. Data on hospice utilization patterns in India are limited to pilot experiences. More data are needed to drive national-level policies. [ABSTRACT FROM AUTHOR]

Background: Although previous research studies have defined several prognostic factors that affect cognitive‐communication performance in patients with all traumatic brain injury (TBI) severity, little is known about what variables are associated with cognitive‐communication impairment in complicated mild TBI (mTBI) specifically. Aims: To determine which demographic and trauma‐related factors are associated with cognitive‐communication performance in the early recovery phase of acute care following a complicated mTBI. Methods & Procedures: Demographic and accident‐related data as well as the scores on cognitive‐communication skill measures in the areas of auditory comprehension (complex ideational material subtest of the Boston Diagnostic Aphasia Examination), verbal reasoning (verbal absurdities subtest of the Detroit Test of Learning Aptitude), confrontation naming (short form of the Boston Naming Test), verbal fluency (semantic category and letter category naming), and conversational discourse (conversational checklist of the Protocole Montréal d'évaluation de la communication) were retrospectively collected from the medical records of 128 patients with complicated mTBI admitted to a tertiary care trauma hospital. Multiple linear regressions analyses were carried out on the variables sex, age, education level, Glasgow Coma Scale (GCS) score, lesion site and bilingualism. Outcomes & Results: Females performed better than males on letter‐category naming, while those more advanced in age performed worse on most cognitive‐communication measures. Patients with higher education achieved better confrontation and letter‐category naming, whereas reading comprehension results were worse with a lower GCS score. Bilingual individuals presented more difficulty in conversational discourse skills than those who spoke only one language. In terms of site of lesion, the presence of a right frontal injury was associated with worse auditory and reading comprehension and an occipital lesion was related to worse confrontation naming. Conclusions & Implications: Cognitive‐communication skills should be evaluated early in all patients with complicated mTBI, but especially in those who are advanced in age, those with fewer years of education and those who present with lower GCS scores, in order to determine rehabilitation needs. The findings of this study will allow acute care clinicians to better understand how various demographic and injury‐related factors affect cognitive‐communication skills after complicated mTBI and to better nuance the interpretation of their evaluation results in order to improve clinical care. Further study is required regarding the influence of lesion location, sex and bilingualism following complicated mTBI. What this paper addsWhat is already known on the subjectIn early acute recovery studies including all severity of TBI, cognitive‐communication performance was poorer in individuals with more advanced age, those with fewer years of education and with more severe TBI. It is not yet known which demographic and injury‐related variables predict cognitive‐communication performance after a complicated mTBI specifically.What this paper adds to existing knowledgeWe confirmed that age, level of education and TBI severity, as measured with the GCS score, were associated with some areas of cognitive‐communication performance for a group of patients in the acute stage of recovery from a complicated mTBI. We also identified that sex, bilingualism and site of lesion were new variables that show an influence on aspects of cognitive‐communication skills in this group of patients.What are the potential or actual clinical implications of this work?The findings of this study on prognostic factors in the case of complicated mTBI will help acute care clinicians to better understand evaluation results knowing the variables that can influence cognitive‐communication performance and to nuance the interpretation of these results with the goal of determining rehabilitation needs and enhancing clinical care. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the frequency and type of emergency department (ED) presentations involving drugs and/or alcohol (DA) among young people. Methods: A retrospective chart review was conducted of patients aged 14–25 years who presented to the ED at a tertiary hospital between 7 October and 25 November 2013. Data were collected on standardised data sheets, including whether DA was a factor in the patient's presentation. Results: In all, 713 ED presentations of patients aged 14–25 years were included in this review (mean age 20 years). Of these, 94 (13%) presentations involved DA (median blood alcohol level 0.12%; range 0.01–0.39%); among patients aged 14–17 years, 13 (8%) presentations involved DA. Patient presentations involving DA were more likely to occur overnight and at weekends, had higher Australasian Triage Scale scores and had longer ED lengths of stay. These patients were also more likely to present with aggression, because of an assault, or with mental health disorders. Conclusion: DA are involved in a substantial number of presentations of young people to the ED and are associated with an increased risk of assault and aggression. Public health strategies should target the links between DA use and mental health in young people. What is known about the topic already?: It is known that the use of alcohol and drugs in young people is an ongoing public health concern. Research suggests this cohort of the population is more likely to present to an ED with an injury than the comparative age group not intoxicated by drugs or alcohol, and is more likely to be reviewed after hours. Alcohol is the predominant drug that had been used by young people at the time of the present study. What does this paper add?: This paper reviews the number and types of presentations to a tertiary ED. In so doing, many more areas were researched (rather than simply link to injury) and, as a result, it was found that young people present to the ED with an increased risk of mental health issues and an increased risk of aggression. The study also found that young people intoxicated with DA most commonly presented for different reasons than the same sober cohort. What are the implications for practitioners?: We know that young people intoxicated with DA represent a different public health issue than the sample group, and, as a result, public health initiatives must concentrate on the confounding factors of the presenting complaint, notably education surrounding the risk of mental health disturbance and increased aggression rates. Furthermore, the study should benefit practitioners, showing that more mental health services should be available after hours for this cohort presenting with issues related to DA. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to evaluate incidences of inappropriate initial urinary catheter placements within an older inpatient cohort. Methods: A total of 200 inpatients that received urinary catheterizations within 24 hours of admission were recruited for this observational study. The key demographic and clinical factors were recorded. Adverse outcomes were assessed by examining incidences of catheter‐associated urinary tract infection (CAUTI) during hospitalization, after transfer to skilled nursing facilities, second, duration of hospital stay and by scoring changes on the Katz Index of Independence in Activities of Daily Living. Correlative relationships between demographic data and clinical factors with adverse outcomes were analyzed. Results: Inappropriate initial urinary catheterization in our cohort was approximately 39%. This was associated with elevated Charlson comorbidity index scores and increased dependency, with correlations to medical diagnosis. We also observed that the primary rationale for the procedure (inappropriate catheterization) was for neurogenic bladder (where intermittent catheterization was indicated) and in 'convenience‐of‐care' catheterizations. Inappropriate catheter placement was ultimately associated with an elevated CAUTI at point of discharge, with transfers to skilled nursing facilities and also with an increased duration of hospital stay. Conclusions: Inappropriate catheter placement was prevalence in southwestern China and associated with adverse outcomes. SUMMARY STATEMENT: What is already known about this topic? Urinary catheterization is a common procedure for geriatric in‐patients, yet up to half of such placements are inappropriately performed.Reducing inappropriate urinary catheter use is key to minimizing adverse outcomes such as urinary tract infection and genitourinary trauma.Although guidelines for in‐patient catheterization have been developed, there are no uniform standardized national guidelines in China that could advise physicians on the placement of inpatient urinary catheters.What this paper adds? High incidences of inappropriate initial urinary catheterizations in mainland China have been reported (as represented by a hospital in southwestern China).This study finds that inappropriate catheter placements are associated with catheter‐associated UTIs at the point of discharge, with transfers to skilled nursing facilities, and an increased duration of stay.We also find that inappropriate catheter placements occur when catheterization is indicated for neurogenic bladder (with intermittent catheterization), and for 'convenience‐of‐care' purposes.The implications of this paper: The study identifies situations where older in‐patients have an elevated risk of receiving inappropriate initial urinary catheterization which should receive special attention.The findings of this study highlight the need to develop effective uniform strategies to reduce inappropriate catheterization for older Chinese patients.The factors associated with inappropriate catheterization based on our findings could be useful in establishing the proactive strategies. [ABSTRACT FROM AUTHOR]

Background: The presence of corruption in State institutions and broader society presents a significant obstacle to the right to the enjoyment of the highest attainable standard of health. The Universal Periodic Review, a Member State-led peer review system administered by the Human Rights Council, is a core tool of human rights, including the right to health accountability. This paper builds on existing research to examine processes that support State engagement on the issue of corruption. We identify opportunities for States to use the Universal Periodic Review to support anti-corruption, transparency and accountability to control corruption in the health-care sector. Objectives: This paper focuses on health sector how human rights mechanisms, and particularly the Universal Periodic Review, can be a tool for greater accountability for the right to health for corruption in the health sector. Methods: The research team applied qualitative content analysis methods to analyze all 135 Universal Periodic Review documents produced during 2018 in order to analyze how human rights mechanisms address the impact of corruption on the realization of the right to health. Results: Although health rights violations are often addressed within human rights mechanisms such as the UPR, corruption remains under-addressed, suggesting that there are gaps in understanding how corruption can seriously undermine the right to health. Conclusion: Human rights mechanisms should drive greater attention to the importance of addressing corruption in health. In order to make the UPR more effective, this paper suggests that there is a need to generate more awareness of corruption-based violations of the right to health in order to promote greater health accountabilityPractical tools such as strategic litigation and social audits can also contribute to creating greater transparency and accountability in dealing with corruption. [ABSTRACT FROM AUTHOR]

Purpose: The adverse effects of the COVID-19 pandemic have opened the door to investigations of the leadership practices needed to guarantee positive work-related outcomes among employees in organizations. Therefore, building on the norm of reciprocity, this research aims to propose a model to examine servant leadership's role in stimulating task performance and risk-taking behaviors during crisis times. In this model, safety climate was hypothesized to serve as a mediating variable between servant leadership, task performance and risk-taking behavior. Design/methodology/approach: Data were collected from 237 staff (medial and administrative staff) working in Palestinian hospitals. Partial least squares structural equation modeling was used to analyze the data. Common method bias remedies were presented. Findings: This study demonstrates that servant leadership is effective in fostering task performance and risk-taking behaviors in times of crisis through the mediation of safety climate. According to the results, safety climate demonstrated to fully mediate relationship between servant leadership and task performance (ß = 0.225, p-value = 0.000), and the relationship between servant leadership and risk-taking behavior (ß = 0.248, p-value = 0.000). Moreover, the results demonstrated that employees with higher experience tend to be more willing to engage in risk-taking behavior. Practical implications: The findings may be useful for hospital managers on the role servant leadership can play in generating positive work-related outcomes during crisis times. Originality/value: The paper is among the few empirical endeavors which examine the consequences of servant leadership in times of crisis, taking into account the intervening role of safety climate. [ABSTRACT FROM AUTHOR]

Objective: Neuropathic orofacial pain disorders are frequently managed with topical or systemic medications that carry a risk of dangerous side effects such as drowsiness, disorientation, and/or physical addiction. The aim of this paper is to report the use of neurosensory oral appliances as a safe means of providing symptomatic relief for neuropathic orofacial pain. Study design: This is a retrospective chart review of patients with diagnoses of persistent idiopathic facial pain (PIFP), painful post‐traumatic trigeminal neuropathy (PTTN), or an oral dysesthesia, who utilized neurosensory appliances with or without the use of topical anesthetic gel. Results: Eleven patients were identified. Eight patients (62.5%) found benefit with the neurosensory appliance alone, and three patients (37.5%) found relief with the addition of lidocaine 2% gel. All patients reported >50% resolution of their symptoms, with three (37.5%) reporting complete resolution. Seven patients maintained follow‐up ≥3 months, with efficacy lasting for a range of at least 3–8 months. Conclusion: Oral neurosensory appliances, whether used alone as a physical barrier or as a vehicle to deliver topical anesthetic, represent a safe and effective modality for the management of neuropathic orofacial pain disorders. Additional studies are needed to assess long‐term efficacy. [ABSTRACT FROM AUTHOR]

Biomedical named entity recognition (BioNER) from clinical texts is a fundamental task for clinical data analysis due to the availability of large volume of electronic medical record data, which are mostly in free text format, in real-world clinical settings. Clinical text data incorporates significant phenotypic medical entities (e.g., symptoms, diseases, and laboratory indexes), which could be used for profiling the clinical characteristics of patients in specific disease conditions (e.g., Coronavirus Disease 2019 (COVID-19)). However, general BioNER approaches mostly rely on coarse-grained annotations of phenotypic entities in benchmark text dataset. Owing to the numerous negation expressions of phenotypic entities (e.g., "no fever," "no cough," and "no hypertension") in clinical texts, this could not feed the subsequent data analysis process with well-prepared structured clinical data. In this paper, we developed Human-machine Cooperative Phenotypic Spectrum Annotation System (http://www.tcmai.org/login, HCPSAS) and constructed a fine-grained Chinese clinical corpus. Thereafter, we proposed a phenotypic named entity recognizer: Phenonizer, which utilized BERT to capture character-level global contextual representation, extracted local contextual features combined with bidirectional long short-term memory, and finally obtained the optimal label sequences through conditional random field. The results on COVID-19 dataset show that Phenonizer outperforms those methods based on Word2Vec with an F1-score of 0.896. By comparing character embeddings from different data, it is found that character embeddings trained by clinical corpora can improve F -score by 0.0103. In addition, we evaluated Phenonizer on two kinds of granular datasets and proved that fine-grained dataset can boost methods' F1-score slightly by about 0.005. Furthermore, the fine-grained dataset enables methods to distinguish between negated symptoms and presented symptoms. Finally, we tested the generalization performance of Phenonizer, achieving a superior F1-score of 0.8389. In summary, together with fine-grained annotated benchmark dataset, Phenonizer proposes a feasible approach to effectively extract symptom information from Chinese clinical texts with acceptable performance. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to compare robotic versus laparoscopic colorectal operations for clinical outcomes, safety and cost. Methods: A retrospective cohort study was performed of 213 elective colorectal operations (59 robotic, 154 laparoscopic), matched by surgeon and operation type. Results: No differences in age, body mass index, median American Society of Anesthesiologists score or presence of cancer were observed between the laparoscopic or robotic surgery groups. However, patients undergoing robotic colorectal surgery were more frequently male (P = 0.004) with earlier T stage tumours (P = 0.02) if cancer present. Procedures took longer in cases of robotic surgery (302 vs 130 min; P < 0.001), and patients in this group were more frequently admitted to intensive care units (P < 0.001). Overall length of stay was longer (7 vs 5 days; P = 0.03) and consumable cost was A$2728 higher per patient in the robotic surgery group. Conclusion: Robotic colorectal surgery appears to be safe compared with current laparoscopic techniques, albeit with longer procedure times and overall length of stay, more frequent intensive care admissions and higher consumables cost. What is known about the topic?: Robotic surgery is an emerging alternative to traditional laparoscopic approaches in colorectal surgery. International trials suggest the two techniques are equivalent in safety. What does this paper add?: This is an original cohort study examining clinical outcomes in Australian colorectal robotic surgery. The data suggest it may be safe, but this paper demonstrates key issues in the implementation and audit of novel surgical technologies in relatively low-volume centres. What are implications for practitioners?: In our study, patients undergoing robotic colorectal surgery at a single centre in Australia had equivalent measured clinical outcomes to those undergoing laparoscopic surgery. However, practitioners may counsel patients that robotic procedures are typically longer and more expensive, with a longer overall hospital admission and a higher likelihood of intensive care admission. [ABSTRACT FROM AUTHOR]

Objective: The aims of the present study were to establish rates of resuscitation order documentation of patients aged ≥65 years from both psychogeriatric and general medical units and to compare patients on predictors of resuscitation status, particularly examining the effect of depression. Methods: A retrospective case note audit of psychogeriatric (n = 162) and general medical (n = 135) unit admissions within a tertiary teaching hospital was performed. Multivariate logistic regression was used to determine significant clinical and demographic predictors of resuscitation status. Results: Resuscitation orders were documented in more psychogeriatric (94.4%) than general medical (48.1%) files. Depression did not significantly predict resuscitation status in either group. Having undergone competency assessment significantly predicted resuscitation status for the total sample and separately for psychogeriatric and medical patients. Older age (overall sample), poorer prognosis (overall sample), living in residential care (overall sample and medical group) and self-consenting to resuscitation status (overall sample and medical group) significantly predicted resuscitation status. Conclusions: Resuscitation orders were more frequently documented on the psychogeriatric unit. Further prospective analysis is needed of how resuscitation orders are made before depression is discounted as a predictor of end-of-life decision-making. What is known about the topic?: Despite increased community, media and research attention to end-of-life decision-making, resuscitation preferences of older patients are often poorly documented. Existing research into patient clinical and demographic factors that influence end-of-life decision-making have largely focused on general medical rather than psychogeriatric settings. There is a need to investigate rates of resuscitation documentation in psychogeriatric and general medical units and specific factors associated with having a 'do not attempt resuscitation' order in place, particularly the effect of current depression on decision-making. What does this paper add?: Resuscitation orders were more frequently documented on the psychogeriatric than medical unit. Depression was not a significant predictor of resuscitation status in either group of patients. Although having undergone a competency assessment, older age and poorer prognosis predicted not being for resuscitation for the total sample, living in residential care and self-consenting to resuscitation status predicted not being for resuscitation for the overall sample and the medical group specifically. What are the implications for practitioners?: This paper suggests that the need for clinicians to ensure documentation of preferences is a focus of day-to-day work with older patients. Clinicians should consider patient competency in end-of-life decision-making and how factors associated with depression, such as helplessness, may be more closely related to resuscitation decision-making in older patients. [ABSTRACT FROM AUTHOR]

Summary: The paper focuses on the identification of atypical fractures (AFFs). This paper examines the concordance between objective classification and expert subjective review. We believe the paper adds critical information about how to apply the American Society of Bone and Mineral Research (ASBMR) criteria to diagnose AFFs and is of high interest to the field. Introduction: Assess American Society of Bone and Mineral Research (ASBMR) criteria for identifying atypical femoral fractures (AFFs). Methods: Two orthopedic surgeons independently evaluated radiographs of 372 fractures, applying ASBMR criteria. We assessed ease of applying ASBMR criteria and whether criteria-based assessment matched qualitative expert assessment. Results: There was up to 27% uncertainty about how to classify specific features. 84% of films were classified similarly for the presence of AFF according to ASBMR criteria; agreement increased to 94% after consensus meeting. Of 37 fractures categorized as AFFs based on ASBMR criteria, 23 (62.2%) were considered AFFs according to expert assessment (not relying on criteria). Only one (0.5%) femoral shaft fracture that did not meet ASBMR criteria was considered an AFF per expert assessment. The number of major ASBMR features present (four vs five) and whether there was periosteal or endosteal thickening ("beaking" or "flaring") played major roles in the discrepancies between ASBMR criteria-based and expert-based determinations. Conclusions: ASBMR AFF criteria were useful for reviewers but several features were difficult to interpret. Expert assessments did not agree with the ASBMR classification in almost one-third of cases, but rarely identified an AFF when a femoral shaft fracture did not meet ASBMR AFF criteria. Experts identified lateral cortical transverse fracture line and associated new-bone formation along with no or minimal comminution as crucial features necessary for the definition of atypical femoral fractures. [ABSTRACT FROM AUTHOR]

Introduction: In this paper, we introduce geographical information systems (GIS) as a tool to study trends in disease spread in time and space. Based on data gathered by the integrated disease surveillance programme (IDSP), we can see where outbreaks of Chickenpox have occurred. Objective: The aim of this study is to assess the trends in chickenpox diseases in India between January 2015 and April 2021 using GIS maps. Methods: For the collection of secondary data relating to chickenpox, a free app called collect 5 was used for collecting data weekly from the IDSP website and then storing them in an online server. In this project, variables that needed to be processed with QGIS were combined with table attributes of many shapefiles of India and presented as maps. Results: Between Jan 2015 and May 2021, 1269 chickenpox outbreaks (27,257 cases) have been recorded. Thirty-one deaths have been confirmed, with most occurring in Bihar and Uttar Pradesh. Nineteen states did not report any deaths. According to the seasonally adjusted trend, the number of cases was highest during the months of January and March. Conclusion: In summary, geographic information systems have become an invaluable tool for mapping the hotspots of acute epidemics and planning public health interventions to prevent the spread of these diseases. [ABSTRACT FROM AUTHOR]

Background: Studies on the application of developmental care initiatives in Italian NICUs are rather scarce. We aimed to assess parental access to the NICUs and facilities offered to the family members and to test "the state of art" regarding kangaroo mother care (KMC) and breastfeeding policies in level III Italian NICUs. Methods: A questionnaire both in paper and in electronic format was sent to all 106 Italian level III NICUs; 86 NICUs (i.e., 80% of NICUs) were completed and returned. The collected data were analysed. In addition, a comparison between the 2017 survey results and those of two previous surveys conducted from 2001 to 2006 was performed. Results: In total, 53 NICUs (62%) reported 24-h open access for both parents (vs. 35% in 2001 and 32% in 2006). Parents were requested to temporarily leave the unit during shift changes, emergencies and medical rounds in 55 NICUs (64%). Some parental amenities, such as an armchair next to the crib (81 units (94%)), a room for pumping milk and a waiting room, were common, but others, such as family rooms (19 units (22%)) and adjoining accommodation (30 units (35%)), were not. KMC was practised in 81 (94%) units, but in 72 (62%), i.e., the majority of units, KMC was limited to specific times. In 11 (13%) NICUs, KMC was not offered to the father. The average duration of a KMC session, based on unit staff estimation, was longer in 24-h access NICUs than in limited-access NICUs. KMC documentation in medical records was reported in only 59% of questionnaires. Breastfeeding was successful in a small proportion of preterm infants staying in the NICU. Conclusion: The number of 24-h access NICUs doubled over a period of 13 years. Some basic family facilities, such as a dedicated kitchen, rooms with dedicated beds and showers for the parents, remain uncommon. KMC and breastfeeding have become routine practices; however, the frequency and duration of KMC sessions reported by NICU professionals still do not meet the WHO recommendations. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on this subject?: The physical health of people with serious mental illness (SMI) is an issue of growing concern in New Zealand and internationally.Metabolic syndrome is prevalent among people with severe mental illness and increases the likelihood of developing cardiovascular disease and diabetes.No previous international research has investigated rates of metabolic monitoring in specialist mental health services and in primary care. What this paper adds to existing knowledge?: Rates of metabolic monitoring are low in this specialist mental health service and in primary care.Primary care nurses are positive in their views of their role in providing care for people with mental illness, and would value further education in this area. What are the implications for practice?: Services need to consider ways in which nurses can be supported to improve rates of metabolic monitoring.Guidelines may have a role to play in improved monitoring but need service‐level support in order to be effective. Introduction: People with serious mental illness experience significant disparities in their physical health compared with the general population. One indicator of health impairment is metabolic syndrome, which increases the likelihood of developing cardiovascular disease and diabetes. No international studies have reported both primary care and mental health nurses' rates of metabolic monitoring among people with serious mental illness, and no New Zealand studies have investigated rates of metabolic monitoring. Aim: To evaluate metabolic monitoring practices within one of New Zealand's 20 district health board regions. Method: An audit of clinical records in primary care (n = 46) and secondary care (n = 47) settings and a survey of practice nurses were conducted. A survey was sent to 127 practice nurses with a response rate of 19% (n = 24). Data were analysed using descriptive statistics. Results: Rates of metabolic monitoring were low in both services. Survey participants expressed positive views towards physical health monitoring and confidence in relating to mental health consumers. Rates of treatment of metabolic abnormalities were low, and communication between primary and secondary services was limited. Conclusion: Despite existence of guidelines and protocols, metabolic monitoring rates in both primary and secondary health services are low. Incorporating metabolic monitoring systems into service delivery, supported by appropriate tools and resourcing, is essential to achieve better clinical outcomes for people experiencing mental illness. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic anterior hip dislocations are subdivided to obturator (inferior) and pubic (superior) dislocations by Epstein's descriptive classification. This rare injury is thought to have favourable clinical outcomes. The incidence of associated femoral head and acetabular injuries has been low in past case series. We sought to revisit this injury and classification in the era of advanced imaging and contemporary surgical techniques. Materials and methods: A retrospective study of 15 patients treated for anterior hip dislocation was performed. Medical records were reviewed for demographic and surgical data. Imaging studies were revisited to determine direction of dislocation and associated fractures. Patients were assessed for pain, hip function using the modified Harris Hip Score (mHHS), hip range of motion and radiographic changes. Mean follow-up time was 3 years. Results: Anterior dislocation occurred in an obturator (inferior), pubic (superior) or central direction. 9 patients had concomitant femoral head impaction and 7 patients suffered from acetabular fractures. 8 patients with an anterior hip dislocation underwent surgical treatment. This therapy, along with early range of motion and weight bearing, produced favourable clinical outcomes with 9 patients reporting no pain and an average mHHS of 83.8. 6 patients had heterotopic ossification at latest follow-up. Conclusions: Traumatic anterior hip dislocation is commonly associated with femoral head impaction and acetabular injuries which should be addressed operatively when appropriate to produce favourable results. In this paper, we propose a revision to the commonly used descriptive classification system. [ABSTRACT FROM AUTHOR]

Objectives: Suicide Awareness for Veterans Exiting Community Living Centers (SAVE-CLC) is a brief intervention to standardize suicide-risk screening and clinical follow-up after VA nursing home discharge. This paper examines the outcomes of SAVE-CLC compared to care as usual. Methods: A quasi-experimental evaluation was conducted (N = 124) with SAVE-CLC patients (n = 62) matched 1:1 to a pre-implementation comparison group. Data were obtained through VA Corporate Data Warehouse resources and chart reviews. Outcomes examined (within 30/90 days of discharge) included mortality rates, frequency of outpatient mental health visits, emergency department visits, rehospitalizations, depression screens (PHQ-2), and the latency period for outpatient mental health care. Results: A greater portion of SAVE-CLC patients received a depression screen after discharge, n = 42, 67.7% versus n = 8, 12.9%, OR = 14.2 (5.7, 35.3), p <.001. The number of days between discharge and first mental health visit was also substantially shorter for SAVE-CLC patients, M = 8.9, SD = 8.2 versus M = 17.6, SD = 9.1; t = 2.47 (122), p =.02. Significant differences were not observed in emergency department visits, hospitalizations, or mortality. Conclusions: SAVE-CLC is a time-limited intervention for detecting risk and speeding engagement in mental health care in the immediate high-risk post-discharge period. Clinical Implications: Care transitions present an important opportunity for addressing older adults' suicide risk; brief telephone-based interventions like SAVE-CLC may provide needed support to individuals returning home. [ABSTRACT FROM AUTHOR]

Background: Low birthweight (LBW) (< 2500 g) is a significant determinant of infant morbidity and mortality worldwide. In low-income settings, the quality of birthweight data suffers from measurement and recording errors, inconsistent data reporting systems, and missing data from non-facility births. This paper describes birthweight data quality and the prevalence of LBW before and after implementation of a birthweight quality improvement (QI) initiative in Amhara region, Ethiopia. Methods: A comparative pre-post study was performed in selected rural health facilities located in West Gojjam and South Gondar zones. At baseline, a retrospective review of delivery records from February to May 2018 was performed in 14 health centers to collect birthweight data. A birthweight QI initiative was introduced in August 2019, which included provision of high-quality digital infant weight scales (precision 5 g), routine calibration, training in birth weighing and data recording, and routine field supervision. After the QI implementation, birthweight data were prospectively collected from late August to early September 2019, and December 2019 to June 2020. Data quality, as measured by heaping (weights at exact multiples of 500 g) and rounding to the nearest 100 g, and the prevalence of LBW were calculated before and after QI implementation. Results: We retrospectively reviewed 1383 delivery records before the QI implementation and prospectively measured 1371 newborn weights after QI implementation. Heaping was most frequently observed at 3000 g and declined from 26% pre-initiative to 6.7% post-initiative. Heaping at 2500 g decreased from 5.4% pre-QI to 2.2% post-QI. The percentage of rounding to the nearest 100 g was reduced from 100% pre-initiative to 36.5% post-initiative. Before the QI initiative, the prevalence of recognized LBW was 2.2% (95% confidence interval [CI]: 1.5–3.1) and after the QI initiative increased to 11.7% (95% CI: 10.1–13.5). Conclusions: A QI intervention can improve the quality of birthweight measurements, and data measurement quality may substantially affect estimates of LBW prevalence. [ABSTRACT FROM AUTHOR]

Background: Efforts to improve antenatal care have been heightened to reduce global maternal deaths. In resource-limited settings, community-based interventions play a pivotal role in improving antenatal care services. However, effective implementation of community-based interventions is influenced by prevailing community-related factors. Drawing from the community-based interventions implemented in Iringa Region in Tanzania, this paper underscores how community factors influence implementation and ultimate improvement of antenatal care services. Methods: A qualitative case study design was employed using in-depth interviews, focus group discussions and document reviews. Data was collected in Kilolo and Mufindi districts in Iringa Region where community-based interventions were implemented. A total of one hundred and forty-six (146) participants were involved in the study. Eighty-six (86) participants were interviewed and sixty (n = 60) participated in focus group discussions. Data were analysed thematically and manually by categorizing and coding emerging issues to facilitate analysis and interpretation. Results: Key factors that influenced the implementation of the community-based interventions were the community readiness to adopt the interventions and effective local administrative systems. Stakeholders' engagement and local health system support were also pivotal for improving antenatal care services. However, the physical environment, bullying of implementers of interventions and family-related challenges constrained the implementation of the interventions. Conclusion: This study has shown that the performance of community-based interventions is highly influenced by community-related factors. More specifically, inadequate community engagement may lead to community members' reluctance to adopt implemented interventions. Therefore, in-depth understanding and adequate management of community engagement are important during the planning, development and implementation of community-based interventions. Plain English Summary: Increasing uptake of antenatal care services is crucial for improving maternal and child health. One of the strategies that has been found to be relevant for improving uptake of antenatal care services in resource constrained countries especially in rural communities is implementation of community based initiatives. This study focused on the project that was implemented in Iringa region, Tanzania under the Innovating for Maternal and Child Health in Africa (IMCHA) program, which was implemented through community based initiatives. In order to understand community contextual factors that facilitated or constrained implementation of the IMCHA project, a participatory approach was applied to seek views from women groups as key project implementers and other stakeholders such as community leaders, male champions' religious leaders, health care providers and health facility governing committees. A total of one hundred forty six people were engaged in interviews and focused group discussions. Community readiness to adopt the interventions emerged as a determining factor for success of the project. Stakeholder engagement also enabled participatory implementation. The major constraining factors were the physical environment that made navigation through the villages difficult as well as negative feedback from family members. This study concludes that community readiness and participatory approaches can be enhanced by various aspects integrated in the initial designing of project activities. This strengthens the project support system critical for sustainability. [ABSTRACT FROM AUTHOR]

Objective: The effect of hearing aid use on the evolution of presbycusis has not been well described in the literature, with only a handful of publications addressing this topic. This paper aims to evaluate the long-term use of amplification and its effect on pure-tone thresholds and word recognition scores. Method: Monaurally fitted patients were followed with serial audiograms. Data was collected from hearing aid centers. Seventy-seven patients with presbycusis met the inclusion criteria and participated in the present study. The progression of hearing loss in both pure tone thresholds and word recognition scores were compared between the hearing aid ears (HA), and the non-hearing aid ears (NHA). Pure tone thresholds were analyzed by comparing the pure tone average at the initial and last audiograms. Word Recognition Scores (WRS) were analyzed using the model of Thornton and Raffin (1978), and by comparing the change in the absolute values of WRS from the initial to the last audiogram between the HA ear and the NHA ear. Results: No significant difference in pure-tone thresholds between the HA ear and NHA ear was found at the last audiogram (P =.696), even after dividing the patients into groups based on the duration of amplification. Both methods of analysis of patients' WRS showed a statistically significant worsening in NHA (P <.05). Conclusion: The present study supports the previously defined auditory deprivation effect on non-fitted ears, which showed worsening of word recognition over time and no effect on pure tone average. It provides an additional argument for the counseling of patients with presbycusis considering amplification, and highlights the importance of bilateral amplification in preserving the residual hearing of hearing impaired patients. [ABSTRACT FROM AUTHOR]

Objective: To explore end-of-life care in the ward and intensive care unit (ICU) environment in nine Australian hospitals in a retrospective observational study. Methods: In total, 1693 in-hospital deaths, 356 in ICU, were reviewed, including patient demographics, advance care plans, life-sustaining treatments, recognition of dying by clinicians and evidence of the palliative approach to patient care. Results: Most patients (n = 1430, 84%) were aged ≥60 years, with a low percentage (n = 208, 12%) having an end-of-life care plan on admission. Following admission, 82% (n = 1391) of patients were recognised as dying, but the time between recognition of dying to death was short (ICU (staying 4–48 h) median 0.34 days (first quartile (Q1), third quartile (Q3): 0.16, 0.72); Ward (staying more than 48 h) median 2.1 days (Q1, Q3: 0.96, 4.3)). Although 41% (n = 621) patients were referred for specialist palliative care, most referrals were within the last few days of life (2.3 days (0.88, 5.9)) and 62% of patients (n = 1047) experienced active intervention in their final 48 h. Conclusions: Late recognition of dying can expose patients to active interventions and minimises timely palliative care. To attain alignment to the National Consensus Statement to improve experiences of end-of-life care, a nationally coordinated approach is needed. What is known about the topic?: The majority of Australian patient deaths occur in hospitals whose care needs to align to the Australian Commission on Safety and Quality in Health Care's National Consensus Statement, essential elements of safe and high - quality end - of - life care. What does this paper add?: The largest Australian study of hospital deaths reveals only 12% of patients have existing advance care plans, recognition of death is predominantly within the last 48 h of life, with 60% receiving investigations and interventions during this time with late symptom relief. What are the implications for practitioners?: Given the poor alignment with the National Consensus Statement, a nationally coordinated approach would improve the patient experience of end-of-life care. [ABSTRACT FROM AUTHOR]

Rationale, aim and objective: The physiotherapy profession did not escape the effects of racially based segregatory practises. While numerous strategies and initiatives have been employed to redress the inequities of the past, the extent of demographic transformation within the physiotherapy profession in South Africa remains uncertain. Transformation is defined in this article as an intentional change aimed at addressing inequalities and the ultimate goal is for population group and gender profiles of higher education graduates to be representative of the national epidemiological profile. This paper describes the demographic patterns of Health Professions Council of South Africa (HPCSA) registered physiotherapists from 1938 to 2018. Method: A retrospective record review of the HPCSA database from 1938 until 2018 was performed. De‐identified data were extracted, coded and analyzed for descriptive purposes. Z‐tests were used for analysis of proportion differences, along with P‐values and 95% confidence intervals for interpretation. Results: In 2018, 7663 physiotherapists (6350 women and 1313 men) were registered with the HPCSA. Most registered physiotherapists (55.6%) were classified as white, followed by black (17.3%), coloured (10.3%) and Indian (9.8%). A progressive increase was found in the number of new registrations over time (1949‐2018) by black (0.00%‐24.38% of total new registrations), coloured (0.00%‐15.47%) and Indian individuals (0.00%‐10.03%), with a statistically significant increase in newly registered black therapists in the decade prior to 2018 (P =.005). Gender transformation appears to be occurring at a slower pace as the profession remains female‐dominated (82.9% of registered physiotherapists in 2018). Conclusion: There has been a steady transformation of the South African physiotherapy graduates composition regarding population categories and gender. However, it is clear that much more than selection criteria is needed to transform the profession in a way that is nationally representative, remain actively accountable for transformation and apt for local context. [ABSTRACT FROM AUTHOR]

Orthotic management is frequently part of the rehabilitation of various neurological conditions in adults such as stroke, peripheral neuropathies, spinal cord injuries and multiple sclerosis. Despite this, there are limited data available on the implementation of orthotic care in practice. The primary aim of this study is to establish the proportion of inpatients in a mixed neurorehabilitation cohort which receive orthotic assessment and treatment. The secondary aim was to document the overall care pathway. Existing data were reviewed retrospectively. Data gathered included patient demographics such as age, gender and diagnosis, type of orthoses prescribed, number of orthotic treatment sessions required and outcome measures used. The paper was prepared in accordance with the STROBE statement for observational studies. During a 6 month period, 54 patients were admitted as inpatients. Of these, 25 (46%) were referred to the orthotic service for assessment, with 23 (43%) receiving a lower limb orthosis and 19 (35%) subsequently being discharged using either an ankle-foot orthosis or knee-ankle-foot orthosis. The conditions most commonly seen were stroke (40%), incomplete spinal cord injuries (28%) and peripheral neuropathies (16%). Significant improvements were recorded at discharge using the Functional Independence Measure (FIM) and Functional Assessment Measure (FAM). Various aspects of the orthotic care process are described. This study suggests that orthotic treatment is needed with high frequency in a mixed inpatient neurorehabilitation cohort. In terms of service planning, these data support existing the recommendation that neurological rehabilitation centres should have good access to orthotic services. Custom orthoses such as AFOs and KAFOs are frequently needed by neurological rehabilitation inpatients. Orthoses may facilitate standing and walking at an earlier stage during rehabilitation. Those responsible for neurological rehabilitation services should ensure appropriate access to orthotic services. [ABSTRACT FROM AUTHOR]

Background: Access to high-quality primary care has been identified as a pressing need for adults with intellectual and developmental disabilities (IDD). Adults with IDD live with complex physical and mental health conditions, use health services differently than the general population and continue to face challenges when accessing health services. Interprofessional primary care teams offer comprehensive and coordinated approaches to primary care delivery and are well-positioned to address the needs of adults with IDD and other vulnerable populations. Although interprofessional primary care teams are recommended, there is currently limited understanding of how interprofessional care is delivered and how access to a team of providers improves the health of this population. The aim of this paper is to describe the organizational attributes of interprofessional primary care for adults with IDD within and across models of team-based care in one local health service context. Methods: A multiple case study was conducted with five interprofessional primary care teams in Ontario, Canada. Multiple methods were used to generate data including: a survey, document review, electronic medical record report and qualitative interviews. Pattern matching was the primary analytic approach for the within and across case analysis. Results: Adults with IDD were found to be a small part of the patient population served and this group was poorly identified in three of five teams. Key organizational attributes that support the delivery of interprofessional primary care for adults with IDD were identified. Two examples of targeted programs of care for this group were also found. Despite the presence of interprofessional health providers in all teams, there were limited organizational processes to engage a wide-range of interprofessional services in the care of this group. There was no consistent reporting of outcomes or processes in place to measure the impact of interprofessional services for this population. Conclusions: This study provides important insights into the current state of interprofessional primary care for adults with IDD in Ontario and highlight a critical need for further work in the field to develop organizational structures and processes to engage in team-based care and demonstrate the value of the approach for this population. [ABSTRACT FROM AUTHOR]

Purpose: Brazil's street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service availability. Recently, an influx of multi-ethnic migrants within an urban drug scene in Sao Paulo was associated with heroin use, a drug normatively absent from Brazil. The purpose of this paper is to characterize and compare heroin use-related characteristics and outcomes for an attending sub-sample of clients from a large community-based treatment centre ("CRATOD") serving Sao Paulo's local urban drug scene. Design/methodology/approach: All non-Brazilian patients (n = 109) receiving services at CRATOD for 2013–2016 were identified from patient files, divided into heroin users (n = 40) and non-heroin users (n = 69). Based on chart reviews, select socio-demographic, drug use and health status (including blood-borne-virus and other infections per rapid test methods) were examined and bi-variately compared. Multi-variate analyses examined factors independently associated with heroin use. Findings: Most participants were male and middle-aged, poly-drug users and socio-economically marginalized. While heroin users primarily originated from Africa, they reported significantly more criminal histories, drug (e.g. injection) and sex-risk behaviors and elevated rates of BBV (e.g. Hepatitis C Virus and HIV). A minority of heroin users attending the clinic was provided methadone treatment, mostly for detoxification. Originality/value: This study documented information on a distinct sample of mostly migration-based heroin users in Sao Paulo, Brazil. Based on the local experience, global migration dynamics can bring changes to established drug use cultures and services, including new challenges for drug use-related related behaviors and therapeutic interventions that require effective understanding and addressing. [ABSTRACT FROM AUTHOR]

Objectives: In this paper, we explore and compare types and longitudinal trends of hospital adverse events in Norway and Sweden in the years 2013–2018 with special reference to AEs that contributed to death. Design: Acute care hospitals in both countries performed medical record reviews on randomly selected medical records from all eligible admissions. Analysis: Comparison between Norway and Sweden of linear trends from 2013–2018, and percentage rates of admissions with at least one AE according to types and severities. Setting: Norway and Sweden have similar socio-economic and demographic characteristics, which constitutes a relevant context for cooperation, comparison and mutual learning. This setting has promoted the use of GTT to monitor national rates of AEs in hospital care in the two countries. Participants: 53 367 medical records in Norway and 88 637 medical records in Sweden were reviewed. Results: 13.2% of hospital admissions in Norway and 13.1% in Sweden were associated with an AE of all severities (E-I). 0.23% of hospital admissions in Norway and 0.26% in Sweden were associated with an AE that contributed to death (I). The differences between the two countries were not statistically significant. Conclusions: There were no significant differences in overall rates (E-I) of AEs in Norway and Sweden, nor in rates of AEs that contributed to death (I). There was no significant change in AEs or fatal AEs in either country over the six-year time period. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic warrants an immediate response. Persons with disabilities (PWDs) are one of the most vulnerable populations susceptible to marginalization. While there are existing guidelines in the Philippines that aim to assist their basic needs, a call for inclusivity in policymaking for the COVID-19 response is highly advocated. This paper aims to analyze existing policy guidelines concerning the welfare of PWDs in the country based on several policy domains. Methods: Relevant documents were acquired through extensive search of government and nongovernment websites and news agencies. Literature included memorandums, circulars, and news bulletins in the period between January 2020 to May 2021. This study conducted a framework analysis on policies enacted by the Philippine government during the COVID-19 pandemic concerning PWDs. The framework was divided into eight areas: access to (1) information, (2) healthcare, (3) education, and (4) financial support, (5) protection from infection in residential settings, (6) reasonable accommodation, (7) consideration for disabled people facing multiple exclusions, and (8) inclusion to decision-making process. Results: Fifteen PWD related COVID-19 response documents from the Philippines were reviewed and analyzed. Most policies corresponded to themes related to financial support and reasonable accommodations. Most documents were limited to proposals and suggestions with only a few documents including specific details on how the program will be implemented and monitored. Conclusion: The state has proven its cognizance for PWDs; however, implementation and its impact remain to be seen. The government needs to evaluate these efforts to identify gaps and barriers. A comprehensive national database should be implemented to centralize registration of PWDs, and efforts should be made to inform and educate PWDs of their rights and of existing programs. Most importantly, PWDs should be included in the discourse and decision-making process to ensure programs are acceptable and accessible. [ABSTRACT FROM AUTHOR]

Background The term failure to cope (FTC) is often used to dismissively describe hospitalized older adults. The purpose of this study was to identify the factors associated with receiving a label of FTC. Methods Age-matched, case-control study with electronic and paper chart review identifying patient characteristics and admission details. Results One hundred eighty-five patients 70 years of age or older admitted to a general medicine team over two years: 99 patients with the label of FTC and 86 controls. No patients labelled with FTC came from long-term care. Characteristics associated with a label of FTC included living alone (aOR 3.8, 95% CI 1.9-7.8), falls (aOR 3.8, 95% CI 1.9-7.8), rehospitalization (aOR 3.6, 95% CI 1.7-8.0), and living in an independent dwelling (aOR 2.4, 95% CI 1.0-5.5). A higher number of chronic medications was associated with a lower likelihood of being labelled with FTC (aOR 0.9, 95% CI 0.8-1.0). Conclusions The results suggest that FTC is a label based predominantly on social factors and has no role in a medical assessment. The patient's home setting was the key factor in being labelled with FTC, most medical factors did not play a significant role, and a pervasive language of blame was present. [ABSTRACT FROM AUTHOR]

Objective: To investigate differences in presenting patient characteristics, investigation, management and related outcomes between culturally and linguistically diverse (CALD) and non‐CALD chest pain (CP) patients presenting to the ED. Methods: A cohort study of 258 patients was enrolled on presentation to Liverpool Hospital ED with a complaint of CP over a 2‐week period. Main outcomes included frequency and timeliness of diagnostic and radiological investigations, medication administered and ED length of stay. Administrative and clinical data were extracted and linked from Cerner EMR FirstNet®, PowerChart® and paper records. Results: There were 155 (60%) CALD and 103 (40%) non‐CALD patients. CALD patients were older by 10 years (95% CI 4, 15; P < 0.0001). There were no significant differences in the number of pathology and imaging investigations carried out in each group, and similarly there were no significant differences in the number of patients administered analgesia or cardiac‐specific medications. Neither group differed in their ED length of stay (median 280 vs 259.5 min; P = 0.79) or hospital admission rate (median 56% vs 55%, P = 0.8). Conclusion: Both CALD and non‐CALD ED CP patients had similar test ordering, medication administration and clinical outcomes, but this was in the context of CALD patients being 10 years older together with a small study sample size. A larger cohort, matched for age, would provide further insights into potentially important differences. [ABSTRACT FROM AUTHOR]

Glaucoma is a serious eye disease characterized by dysfunction and loss of retinal ganglion cells (RGCs) which can eventually lead to loss of vision. Robust mass screening may help to extend the symptom-free life for the affected patients. The retinal optic nerve fiber layer can be assessed using optical coherence tomography, scanning laser polarimetry (SLP), and Heidelberg Retina Tomography (HRT) scanning methods which, unfortunately, are expensive methods and hence, a novel automated glaucoma diagnosis system is needed. This paper proposes a new model for mass screening that aims to decrease the false negative rate (FNR). The model is based on applying nine different machine learning techniques in a majority voting model. The top five techniques that provide the highest accuracy will be used to build a consensus ensemble to make the final decision. The results from applying both models on a dataset with 499 records show a decrease in the accuracy rate from 90% to 83% and a decrease in false negative rate (FNR) from 8% to 0% for majority voting and consensus model, respectively. These results indicate that the proposed model can reduce FNR dramatically while maintaining a reasonable overall accuracy which makes it suitable for mass screening. [ABSTRACT FROM AUTHOR]

(1) Background: Overweight and obesity in children have increased worldwide and tend to persist into adolescence and adulthood. The Child Health Service (CHS) has an important role in providing health-promotive interventions, and such interventions are required to be documented in a child's health record. The aim of the study was to investigate Child Health Care (CHC) nurses' documentation of weight-related, health-promotive interventions in the Child Health Care Record (CHCR) regarding lifestyle habits in connection to the four-year visit. (2) Methods: A record review of 485 CHCRs using a review template was accomplished. Of the included CHS units, four used electronic records and two used paper records. Chi-square tests and Spearman's rank-order correlations were used to analyse data. (3) Results: The results showed that CHC nurses document interventions regarding lifestyle habits to a low extent, although children with overweight/obesity seemed to undergo more interventions. There was also a difference between electronic and paper records. (4) Conclusions: The consequences of not documenting the interventions in the CHCR make it difficult to follow up and demonstrate the quality of the CHC nurse's work. There is a need for more research to gain a deeper understanding of the reasons that the work of CHC nurses is not visible in children's health records. [ABSTRACT FROM AUTHOR]

Background: Malaysia recorded its first COVID-19 case on 24 January 2020. One of the district with the highest caseloads in Malaysia was recorded in Hulu Langat. Following the rapid spread of the disease, a nationwide lockdown termed Movement Control Order (MCO) was declared on 18 March 2020. This paper aimed to assess if MCO contributed to reduction of cases and close contacts in Hulu Langat district. Materials and Methods: A cross-sectional study was conducted from 2 March to 22 April 2020. Data of COVID-19 cases and close contacts were collected from case investigation reports and official databases. Data were divided into pre-MCO and post-MCO. Descriptive analyses and Mann-Whitney U test were used to measure differences in number of cases and close contacts pre- and post-MCO. Result: There were 456 cases recorded, with median age of 30.00 years (IQR 31.00) pre-MCO and 28.00 (IQR 23.75) in post-MCO. Majority were male and Malaysians in both periods. Most were locally transmitted (89.2%) and symptomatic (61.5%). Pre-MCO, 277 (60.7%) were diagnosed and 179 (39.3%) in post-MCO, showing significant reduction (p-value<0.05). Number of close contacts reduced significantly from 4111 (77.9%) pre-MCO to 1162 (22.1%) post-MCO. Conclusion: There were significant reductions in number of cases and contacts between pre and post-MCO, suggesting that MCO with the public health measures taken were effective in controlling COVID-19 spread in the district. [ABSTRACT FROM AUTHOR]

Published evidence confirms poor access to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians from the Northern Territory. This study aimed to identify the practical causes and recommend improvement. Pathways to wait-listing for a kidney transplant were reviewed to identify potential barriers. Processes were mapped to identify potential problem areas, provide comparison of the actual versus the ideal, identify where data needed collecting and provide clear presentation of the processes. Staff involved in the work-up of patients going for wait-listing were asked to list the barriers. Data were collected for patients from the transplant database between 1 January 2017 to 31 August 2018. Quality improvement statistical processes and charts were used to analyse and present the results. There were 102 patients in the transplant work-up process; 81.4% were Aboriginal and Torres Strait Islander, 71.6% were progressing with the work-up, 28.4% were on-hold. Of the 29 patients on hold, 92.9% were Aboriginal and Torres Strait Islander. Causes of delays to wait-listing included: failure to attend appointments due to competing priorities and communication barriers, access and navigating complex pathways to specialist services, transport, co-morbidities requiring multiple tests and multiple specialty services, and pressures on dialysis and hospital bed capacity. In conclusion, barriers to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians are complex and can be addressed by redesigning healthcare provision, including increasing the Aboriginal and Torres Strait Islander workforce to provide education and patient navigation of the healthcare system and improve communication, streamlining investigations and coordinating specialist services. What is known about the topic?: Access to wait-listing for kidney transplantation for Aboriginal and Torres Strait Islander Australians from the Northern Territory is poor. Barriers to wait-listing for kidney transplantation can occur anywhere along the pathway of care from a patient's first contact with the renal service to wait-listing. What does this paper add?: Identified barriers to wait-listing for kidney transplantation include health service workforce and resources shortages, patient and health service barriers such as patients' competing priorities, poor communication between the health service and patients, transport and accommodation for patients from remote communities, complex comorbidities, and access to specialist services. What are the implications for practitioners?: Recruitment and retention of Aboriginal and Torres Strait Islander mentors, healthcare workers and patient navigators should be prioritised to provide an effective culturally appropriate service. Effective communication strategies with patients and improved access to streamlined appropriate investigations and collaboration among specialist services will invariably improve access to wait-listing for kidney transplantation. [ABSTRACT FROM AUTHOR]

Can the careful implementation of global health research reduce the stigmatization of involved human subjects? This study analyses stigma in an Ebola vaccine clinical trial in West Africa that deployed complex community engagement strategies including a sensitization component. Qualitative research found that stigma against trial subjects manifested in various forms beyond the reach of these anti-stigma interventions. Drawing on and advancing Hacking's notion of 'looping effects', this paper argues that stigma was a product of a wider socio-historical context beyond the control of community-based interventions. This case prompts global health practitioners to think through the limitations of community-based interventions in practice. [ABSTRACT FROM AUTHOR]