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Blastomycosis is a fungal disease caused by inhalation of Blastomyces spores from the environment that can result in severe pulmonary illness and high hospitalization rates. In early March 2023, Public Health Delta and Menominee Counties (Michigan) reported a cluster of blastomycosis cases among paper mill workers to the Michigan Department of Health and Human Services (MDHHS). MDHHS subsequently notified CDC. On March 17, paper mill management requested a health hazard evaluation (HHE) from CDC's National Institute for Occupational Safety and Health (NIOSH) to investigate potential workplace exposures to Blastomyces and recommend prevention and control measures at the mill. The workplace epidemiologic investigation combined a NIOSH HHE medical survey consisting of a questionnaire on work and health with Blastomyces urine antigen testing of specimens obtained from workers to assist in case finding, with additional case information from MDHHS blastomycosis surveillance data. Assessment of 645 mill workers identified 162 cases of blastomycosis with illness onset during November 1, 2022--May 15, 2023, with the weekly case count peaking at 21 cases in early March 2023. HHE environmental sampling in and around the mill did not identify the source of workers' Blastomyces exposure in the mill. This outbreak was the largest documented blastomycosis outbreak in the United States, and the first associated with a paper mill or an industrial setting. A coordinated public health response facilitated swift prevention measures with recommendations focused on reducing workers' exposure to Blastomyces, including hazard communication, respiratory protection, mill cleaning, and ventilation system improvements. [ABSTRACT FROM AUTHOR]

The Bündnis Junger Ärztinnen und Ärzte (BJÄ, Alliance of Young Physicians in Germany) has presented a position paper (PP) on Postgraduate Medical Education (PGME) against the background of an unfolding hospital reform in Germany, and they describe existing deficits of PGME in Germany. Based on this, demands were made of legislators, employers and medical associations which could result in a sweeping reformation of PGME. Hospital reforms can only be accomplished with well trained and motivated physicians. In this respect the BJÄ regards the reform of hospitals and the health-care system as a chance for a reform of PGME, which is long overdue. Legislative competence for PGME lies with the States of the Federal Republic of Germany and this warrants an adjustment of state medical association laws to accommodate the demands of the BJÄ. Generally PGME must be taken into consideration in all health-care legislation, in analogy to the meanwhile globally adopted principle of "Health in all Politics (HiAP)". The BJÄ has made every endeavour to produce this PP. The responsible stakeholders and actors in the health-care system would be well-advised to take the position paper seriously with a dwindling physician work force in hospitals and serious quality deficits in PGME. Hence, the BJÄ must be comprehensively supported. They need congenial partners to define the scientific foundation of all their demands, to test their application under real life conditions in hospital and outpatient care, to pursue research on the impact on patient care and on the intended transformation of the health-care system. This might best be accomplished by partnering with a scientific Association for Postgraduate Medical Education as has been the case in many countries for decades. [ABSTRACT FROM AUTHOR]

Patient value in hospital care has become increasingly important over the last decade. This paper argues that patient value could be ameliorated by investing in patient agility. Patient agility constitutes the capabilities that enable hospitals to sense the health service needs of their patients and respond to the changing health service demands of these patients. This paper further posits that hospitals’ current sensing and responding capabilities are inherently reactive as they detect, act upon and pursue occurrences and patterns in the needs and demands of patients after these have already manifested themselves. Hence, we assert that this reactive nature thwarts hospitals in preventing negative trends or capitalizing on positive trends necessitating a shift to sensing and responding capabilities that are more predictive. We postulate that this necessary organizational shift can be facilitated by implementing and utilizing the power of predictive analytics and that this particular issue has not yet been adequately addressed by existing scientific literature. Based on this argument, an initial research proposal is established centering around the role of predictive analytics in fostering patient agility and patient value in hospitals. The initial research proposal sets out to examine this topic in an inclusive, integrated and comprehensive manner as it outlines a coherent conceptual model, incorporates a multi-stakeholder perspective and integrates biomedical as well as health service needs and demands. The initial proposal is meant to serve as a conceptual framework for future research as well as an initial point of departure for further refinement, improvement, elaboration, and discussion.

Background: This study has two primary objectives. Firstly, it aims to measure the time savings achieved through the digitization of paper forms filled out by nurses in the inpatient care process. Secondly, it seeks to reveal the financial savings resulting from reduced paper consumption due to the digitalization. The Health Information Management System Society (HIMSS)--Electronic Medical Record Adaption Model (EMRAM), which makes stage-based (0--7) evaluations, serves as a tool to measure the rate of technology utilization in public hospitals in Turkey. The study is based on the HIMSS EMRAM criteria for 2018. Bahçelievler State Hospital, a public hospital in Turkey, was chosen as the research facility. In 2017, it was accredited as Stage 6 with HIMSS EMRAM. However, not all its wards have been digitalized. Initially, pilot selected wards were digitized. Therefore, digital and non-digital wards serve together. In this context, 4 wards were randomly selected and time, paper and toner savings before and after digitalization were measured. Method: A table was created in Microsoft Excel,listing the forms used by nurses in inpatient care and the time required to fill them out.The time spent for filling paper-based forms and digital-based forms was measured in randomly selected wards. Result: The analysis showed that digital forms saved more time, paper and toner. For example, filling out the patient history form took 45 min when using paper, compared to 12 min in digital environment. Approximately 27% time savings are achieved only for the patient history form. The total time savings delivered by digitalization for 1,153 inpatients during the year were found as 117 care days, and the savings on total paper consumption was 41.289 pages. For 1,153 inpatients throughout the year, the total time savings from digitalization was 117 care days and the total paper consumption savings was 41,289 pages. In addition, in 4 wards with a total bed capacity of 25, annual paper savings of $1,705.86 and toner savings of $283,736 were achieved. Discussion: This study reveals the benefits of digitalisation in hospitals for nurses. It saves the time that nurses allocate for filling out paper forms with digitalised forms. Thus, it is a good practice example in terms of using the time allocated for form filling for patient care.When we extend this study to Turkey in general, it can be considered that the time savings achieved by nurses by digitizing inpatient forms varies between 10.8% and 13%. The number of nurses working in public hospitals in Turkey is approximately 160,000. Assuming that 60% of the nurses work in the inpatient ward, it is understood that the annual savings achieved by digitizing the forms corresponds to a range of 398--559 nursing hours. [ABSTRACT FROM AUTHOR]

The Centers for Medicare & Medicaid Services (CMS) introduced the Severe Sepsis/Septic Shock Management Bundle (SEP-1) as a pay-for-reporting measure in 2015 and is now planning to make it a pay-for-performance measure by incorporating it into the Hospital Value-Based Purchasing Program. This joint IDSA/ACEP/PIDS/SHEA/SHM/SIPD position paper highlights concerns with this change. Multiple studies indicate that SEP-1 implementation was associated with increased broad-spectrum antibiotic use, lactate measurements, and aggressive fluid resuscitation for patients with suspected sepsis but not with decreased mortality rates. Increased focus on SEP-1 risks further diverting attention and resources from more effective measures and comprehensive sepsis care. We recommend retiring SEP-1 rather than using it in a payment model and shifting instead to new sepsis metrics that focus on patient outcomes. CMS is developing a community-onset sepsis 30-day mortality electronic clinical quality measure (eCQM) that is an important step in this direction. The eCQM preliminarily identifies sepsis using systemic inflammatory response syndrome (SIRS) criteria, antibiotic administrations or diagnosis codes for infection or sepsis, and clinical indicators of acute organ dysfunction. We support the eCQM but recommend removing SIRS criteria and diagnosis codes to streamline implementation, decrease variability between hospitals, maintain vigilance for patients with sepsis but without SIRS, and avoid promoting antibiotic use in uninfected patients with SIRS. We further advocate for CMS to harmonize the eCQM with the Centers for Disease Control and Prevention's (CDC) Adult Sepsis Event surveillance metric to promote unity in federal measures, decrease reporting burden for hospitals, and facilitate shared prevention initiatives. These steps will result in a more robust measure that will encourage hospitals to pay more attention to the full breadth of sepsis care, stimulate new innovations in diagnosis and treatment, and ultimately bring us closer to our shared goal of improving outcomes for patients. [ABSTRACT FROM AUTHOR]

COVID-19 pandemic has raised concerns for a number of strategical social interactions. From quarantines and social distancing to vaccination and geopolitics, the cooperation or even the coordination of efforts has been challenging, as governments, economic sector, institutions, and individuals, often have conflicting interests. Game theory, which is a mathematical tool extensively used in order to determine the outcomes of strategical interactions, has been applied to a number of issues arising from the pandemic. In this paper, 60 publications are analyzed to identify the key contributions of game theory to addressing COVID-19. First, 10 keywords-topic are chosen and each publication is examined to consider if it deals with these topics. Then R package "igraph" and cluster Louvain are used in order to group the papers to 3 clusters. The results indicate that there is a temporal variation in the topics examined. In the beginning the main concern has been coupling the modelling of the transmission of the virus with social distancing responses from the public and quarantining policy. Then the economic implications of the pandemic drew the attention and finally the application of the vaccination campaigns and the cooperation of the individuals with vaccination guidelines. The paper targets on bridging the gap between game theorists and epidemiologists, illustrating how modelling agents interactions can improve responses. The clusters created can help researchers identify groups of problems that can be addressed jointly, using similar approaches. The analysis indicates that game theory can reveal social aspects that can improve the responses to future emergencies. [ABSTRACT FROM AUTHOR]

Background: The main task of the emergency medical system is to provide primary care and transfer the patients to hospital. Studies have been conducted to investigate the outcome of air and ground ambulance patients, but they show different results. These different results may be due to the type of study, statistical methods, differences in prehospital emergency systems, and insufficient control of confounding variables. Thus, it is difficult to compare and generalize the results. This study aimed to investigate the outcomes of injured people transported by air and ground ambulance in road traffic accidents in Qom Province, Iran, during 2015-2019. Materials and Methods: In this retrospective analytical descriptive study, we used the numerical method and examined all road traffic accident patients transferred through ground or air to Qom Shahid Beheshti Hospital by the prehospital emergency from 2015 to 2019. The collected information included the type of transfer, age, sex, type of trauma, distance from the accident site to the hospital, initial vital signs, duration of the mission, and day of the accident. To control the confounding factors, we used propensity score matching. Outcomes studied included length of hospital stay, length of stay in the intensive care unit, duration of mechanical ventilation, and the need for immediate surgery. Logistic regression was used to analyze the need for immediate surgery and a generalized linear model for other consequences. Results: After matching, the number of patients in each group transferred by ground ambulances and helicopter was 566. Trauma to the head (P=0.028) and back (P=0.002) were more common in helicopter-transported patients. The patients transported by helicopter had a longer time to reach the scene (7.70 ±5.18 min) (P<0.001), a shorter duration of presence on the scene (12.17±8.33 min) (P=0.041), and a shorter duration of transfer (13.12±4.75 min) (P<0.001) than the ground ambulance. There was no significant difference between the patients who transferred by ground and helicopter ambulance regarding the length of hospital stay in the intensive care unit (P=0.718), mechanical ventilation (P=0.507), and hospitalization (P=0.089). The need for immediate surgery in helicopter-transported patients was 84.8% higher than ground ambulance patients (95%CI: 0.086-0.267; P<0.001). Conclusion: The patients transported by helicopter were not significantly different from ground ambulances transported patients regarding staying in the intensive care unit, mechanical ventilation, and hospitalization, but they more needed immediate surgery. If the patients are triaged adequately according to the type of injury and the level of consciousness at the scene and transferred to the appropriate hospital by ground or air, they can enjoy the benefits of the type of transfer. [ABSTRACT FROM AUTHOR]

Background: Preventing cancer is better than treating or curing it. Cancer prevention ensures reduced physical, emotional, financial burden to the individual. Methods: The focus of the preventive oncology unit at Healthcare Global (HCG) Enterprise Limited, Bangalore, India, is to increase the understanding of how lifestyle and risk of cancer are related. It also focusses on screening of normal individuals for estimating their risk of developing cancer, which in-turn can lead to earlier detection, improved treatment and outcomes. This unique endeavor started one year back, provides counseling and vaccination services for HPV (Human Papilloma Virus) and HBV (Hepatitis B Virus). Our outreach initiatives in collaboration with the State and City health Departments include screening camps, and awareness sessions focusing on HPV and HBV vaccination. Results: The focus of research is in the areas of cancer epidemiology, prevention, screening, and control. Such research involves a multidisciplinary approach involving the fields of epidemiology, biostatistics, behavioral science, nutrition, and basic science. Conclusion: This novel endeavor at a tertiary cancer hospital in a Developing Country is aimed at preventing the development or progression of the malignant cancer process. [ABSTRACT FROM AUTHOR]

With more than 23 million infections and more than 814,000 deaths worldwide, the coronavirus disease-2019 (COVID-19) pandemic is still far from over. Several classes of drugs including antivirals, antiretrovirals, anti-inflammatory, immunomodulatory, and antibiotics have been tried with varying levels of success. Still, there is lack of any specific therapy to deal with this infection. Although less than 30% of these patients require intensive care unit admission, morbidity and mortality in this subgroup of patients remain high. Hence, it becomes imperative to have general principles to guide intensivists managing these patients. However, as the literature emerges, these recommendations may change and hence, frequent updates may be required. [ABSTRACT FROM AUTHOR]

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]

Copyright of Revista Eletrônica de Enfermagem is the property of Revista Eletronica de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mobility can be defined as the ability to move or be moved freely and easily. In older adults, mobility impairments are common and associated with risk for additional loss of function. Mobility loss is particularly common in these individuals during acute illness and hospitalization, and it is associated with poor outcomes, including loss of muscle mass and strength, long hospital stays, falls, declines in activities of daily living, decline in community mobility and social participation, and nursing home placement. Thus, mobility loss can have a large effect on an older adult's health, independence, and quality of life. Nevertheless, despite its importance, loss of mobility is not a widely recognized outcome of hospital care, and few hospitals routinely assess mobility and intervene to improve mobility during hospital stays. The Quality and Performance Measurement Committee of the American Geriatrics Society has developed a white paper supporting greater focus on mobility as an outcome for hospitalized older adults. The executive summary presented here focuses on assessing and preventing mobility loss in older adults in the hospital and summarizes the recommendations from that white paper. The full version of the white paper is available as Text S1. J Am Geriatr Soc 67:11–16, 2019. [ABSTRACT FROM AUTHOR]

The article highlights a report on people with dyspnea following COVID-19 hospitalisation; and mentions that additional telerehabilitation is more effective at improving exercise capacity, muscle strength and the physical component of quality of life than education alone.

Introduction: One of the most challenging decisions is to assess the preterm infant's transition from tube feeding to oral feeding. Thus, we require a reliable tool for determining the time to start oral feeding. This study aimed to measure the interrater and intrarater reliability of the Preterm Infant Oral Feeding Readiness Assessment scale (PIOFRA). Materials and Methods: This study was an observational, cross-sectional study. The study participants were preterm infants who had been hospitalized in the Neonatal Intensive Care Unit of Shariati Hospital affiliated to Tehran University of Medical Sciences, between December 2017 and February 2018. The inclusion criteria were absence of neurological and gastrointestinal disorders or major congenital anomalies, Apgar score 3 or more in the first 1 minute, and 5 or more in the first 5 minutes. The exclusion criteria included family's unwillingness to participate in the study, infant's death, or a sudden change that affects neonates' nutritional status, like cerebral hemorrhage or intestinal problems. Results: The interrater and intrarater reliability of the total PIOFRA scale was good Intraclass Correlation Coefficients (ICC˃0.75). The interrater and intrarater reliability of most items were good and excellent, with weighted kappa more than 0.50, with the exception of lip posture and especially stress sign, with weighted kappa less than 0.40. Conclusion: Generally, most items of the PIOFRA scale had acceptable interrater and intrarater reliability. Also, the interrater and intrarater reliabilities of the total POFRAs score was good. [ABSTRACT FROM AUTHOR]

Aims This paper discusses the application of transformational leadership to the teaching and learning of safe medication management. Background The prevalence of adverse drug events ( ADEs) and medication-related hospitalisations (one hundred thousand each year in the USA) are of concern. Evaluation This discussion is based on a narrative literature review and scrutiny of international nursing research to synthesise pedagogical strategies for the application of transformational leadership to teaching medication safety. Key issues The four elements relating transformational leadership to medication safety education are: 'Idealised influence' or role modelling, both actual and exemplary, 'Inspirational motivation' providing students with commitment to medication safety, 'Intellectual stimulation' encouraging students to value improvement and change, and 'Individualised consideration' of individual students' educational goals, practice development and patient outcomes. The model lends itself to experiential learning and a case-study approach to teaching, offering an opportunity to reduce nursing's theory-practice gap. Conclusion Transformational leadership for medication safety education is characterised by a focus on the role of nurse educators and mentors in the development of students' abilities, creation of a supportive culture, and enhancement of students' creativity, motivation and ethical behaviour. This will prepare nursing graduates with the competencies necessary to be diligent about medication safety and the prevention of errors. Implications for nursing management Teaching medication safety through transformational leadership requires the close collaboration of educators, managers and policy makers. Investigation of strategies to reduced medication errors and consequent patient harm should include exploration of the application of transformational leadership to education and its impact on the number and severity of medication errors. [ABSTRACT FROM AUTHOR]

John Sung (1901–1944) was a prominent Chinese Christian evangelist whose enduring influence is still recognized through China and Southeast Asia. His reputation has long been based primarily on his autobiography and excerpts from his diaries that his daughter Levi Sung selected and published. The correspondence, writings, and extensive diaries of Sung recently acquired by the Yale Divinity Library shed new light on his life and work. This article gives a detailed account of provenance, content, and format of all the materials included in the Sung papers. They are invaluable to the study and rediscovery of Sung's life, thought, and ministry as well as the history and development of indigenous Christianity and churches in China and Southeast Asia. This article also examines Sung's English diaries from the period of his hospitalization in a psychiatric facility to reveal complexities in Sung that have been less evident in published biographies and writings. Five additional original diary entries will be compared to their published versions to reveal alterations, deletions, and inaccuracies in the published extracts. The comparative study demonstrates that the diary extracts compiled by Levi, which are the most commonly-cited source on Sung, are in some cases problematic. [ABSTRACT FROM AUTHOR]

Acute heart failure is a fatal syndrome. Emergency physicians, cardiologists, intensivists, nurses and other health care providers have to cooperate to provide optimal benefit. However, many treatment decisions are opinion-based and few are evidenced-based. This consensus paper provides guidance to practicing physicians and nurses to manage acute heart failure in the pre-hospital and hospital setting. Criteria of hospitalization and of discharge are described. Gaps in knowledge and perspectives in the management of acute heart failure are also detailed. This consensus paper on acute heart failure might help enable contiguous practice. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper analyzes the work of nursing technicians in Brazil, in primary health care and hospital emergency. 48 interviews were analyzed; their scripts sought to understand who these workers are, how they build the relationships between training and labor insertion, and how they perceive social relations at work. From the analyzes emerged three thematic categories: the (un)predictable trajectories of nursing technicians and the search for a more socially recognized work; times of precariousness of the ways of being a worker and the sufferings of the work of the nursing technicians; only dissatisfaction or multiple possibilities of implication with the work? A tendency for the training of super-qualified technicians is configured, who keep on, to a great extent, performing the same activities, with little freedom of choice in their professional trajectories. The results show overload and difficult working conditions, which coexist with the presence of feelings of satisfaction associated with the affinity with the production of care, the resolubility of care and learning. [ABSTRACT FROM AUTHOR]

Introduction: Aspiration pneumonia (AP) is an infection of the lungs caused by inhalation of material. The reported incidences vary across literature and clinical populations and is associated with high morbidity and mortality. Management of AP is best carried out by a multidisciplinary team. Methods: This aim of this review was to collate and describe the available evidence on AP to develop a greater understanding of the concept of AP as it is represented in the nursing literature. As a collaborative team, we undertook the six stages of a systematic mapping review. We searched for the term aspiration pneumonia in 200 peer reviewed nursing journals across 10 databases, over a ten-year period (2013-2023). Results: In this review, 293 papers were coded. Dysphagia, oral health and tube feeding emerged as the most frequent risk factors for AP, and the most reported factors for preventing this condition. Mortality was the most commonly described consequence of AP, followed by hospitalisations and morbidity. Multiple management approaches were reported including dysphagia assessment, risk evaluation, oral care and texture modification of food and fluids. The role of nurses and interprofessional collaborations were described. Discussion: Despite limited evidence related to the topic of AP in the nursing literature, the complexity of the causes, prevention, management and consequences of AP emerged. Certain factors, such as dysphagia, oral health, and tube feeding, were described under prevention, cause and management of AP. The importance of multidisciplinary approach in the management and prevention of AP was presented. [ABSTRACT FROM AUTHOR]

The article offers information on people with chronic obstructive pulmonary disease, initiation of nocturnal non-invasive ventilation at home is non-inferior to initiation during a hospital admission.

The article reflects on standard management for children with symptomatic joint hypermobility for improving pain. Topics include The non-pharmacological trials often consist of multi-component interventions; active ingredients are sometimes difficult to isolate and the final intervention may substantially differ from the planned intervention; and recommend explicitly describing the components, including whether it was standardized and the adherence rates to the protocol and to the intervention.

A quiz concerning the Chronic Obstructive Pulmonary Disease is presented.

Background: The aim of this research was to study the epidemiology, microbiology, prophylaxis, and antibiotic therapy of surgical site infections (SSIs), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), and identify the risk factors for these infections. In Italy SSIs occur in about 5 % of all surgical procedures. They are predominantly caused by staphylococci, and 30 % of them are diagnosed after discharge. In every surgical specialty there are specific procedures more associated with SSIs. Methods: The authors conducted a systematic review of the literature on SSIs, especially MRSA infections, and used the Delphi method to identify risk factors for these resistant infections. Results: Risk factors associated with MRSA SSIs identified by the Delphi method were: patients from long-term care facilities, recent hospitalization (within the preceding 30 days), Charlson score > 5 points, chronic obstructive pulmonary disease and thoracic surgery, antibiotic therapy with beta-lactams (especially cephalosporins and carbapenem) and/or quinolones in the preceding 30 days, age 75 years or older, current duration of hospitalization >16 days, and surgery with prothesis implantation. Protective factors were adequate antibiotic prophylaxis, laparoscopic surgery and the presence of an active, in-hospital surveillance program for the control of infections. MRSA therapy, especially with agents that enable the patient's rapid discharge from hospital is described. Conclusion: The prevention, identification and treatment of SSIs, especially those caused by MRSA, should be implemented in surgical units in order to improve clinical and economic outcomes. [ABSTRACT FROM AUTHOR]

The article presents abstracts on several papers related to geriatrics. On of papers examined nursing home facility characteristics associated with DNR orders among NH residents with severe cognitive impairment. Facility rate of DNR orders has been associated with feeding tube use and hospitalizations. Another paper provides information about Mild cognitive impairment (MCI), which is a transitional state between cognitive changes of normal aging and very early Alzheimer's disease .Treatments for MCI are not yet available.

Abstract This paper will explore whether hospital occupancy influences quality of care. It discusses the ‘systems’ theory of error causation in the context of adverse medical outcomes. It then relates how high occupancy rates may cause problems in hospital systems. The evidence relating to quality of care and occupancy is reviewed. Finally, a new method of studying this relationship using time series analysis is proposed. We conclude that the relationship requires further exploration since revealing ‘system’ problems may compel clinicians to expose problems medical errors. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Involuntary detention is a legislative power that allows people to be taken against their will for a mandatory mental health assessment and is known to be a restrictive and traumatizing process for patients.While there is some literature examining police/ambulance and mental health worker co‐response models, the conclusions are mixed as to whether they reduce rates of involuntary detentions in mentally ill people.The Police, Ambulance, Clinician Early Response (PACER) model is an example of a tri‐response mental health crisis response team whose role is to respond and assess people thought to be experiencing a mental health crisis.There is little literature to determine whether PACER tri‐response model reduces incidents of involuntary detention when compared with standard police and/or ambulance responses. What this paper adds to existing knowledge?: This paper describes the outcomes of patients assessed by a PACER team, compared with patients who were assessed by police or ambulance.It demonstrates that PACER may reduce unnecessary involuntary detentions through expert mental health assessment for patients coming to emergency services for assistance. It is one of only two published studies examining a tri‐response model. What are the implications for practice?: The results of this study may support health and policing policymakers to implement PACER models as a means of reducing involuntary detentions, reducing demand for emergency departments, reducing time spent by emergency services responding to people experiencing mental health crisis and improving outcomes for people with mental illness. Background: Involuntary detention is a common method of enforcing mental health assessment and treatment; however, it is associated with poor patient outcomes and high emergency service and hospital demand. Aim: To examine the association between (1) Police, Ambulance, Clinician, Early Response (PACER) model, (2) police or (3) ambulance response and rates of involuntary detention of mentally ill people. Methods: A retrospective observational study using routine administrative data in an Australian City, over a 12‐month period (2019–2020). Results: Over a 12‐month period, 8577 people received crisis mental health intervention in the study setting. We observed an 18% increase in the relative risk of being involuntarily detained by police, and a 640% increase in the relative risk of being detained by ambulance. The PACER team detained 10% of their total presentations, as compared with 12% by police and 74% by ambulance. Involuntary detentions enacted by PACER were more likely to convert to a post‐detention hospitalization (72%), when compared with police (27%) and ambulance (17%). Discussion: PACER was associated with lower rates of involuntary detention and higher rates of post‐detention hospitalization when compared to police and ambulance response. Implications for Practice: PACER cohort experience more positive outcomes than with police or ambulance cohorts. [ABSTRACT FROM AUTHOR]

Introduction: Existing research has established that some people struggle with prescription charges. This paper reports on the experiences of a sub-sample of people who participated in the FreeMeds study (a randomised controlled trial of prescription charges) about their problems paying for medicines. Aim: The aim of this study was to explore participants' previous experiences with paying for medicines, and the impact of receiving free medicines through the Free Meds study. Method: Semi-structured interviews were carried out with 23 people (21 were available for analysis), purposefully selected from the 1061 participants in the FreeMeds trial. Trial participants had to live in an area of high socio-economic deprivation (NZDep 7–10), either take medicines for diabetes and/or take anti-psychotics and/or have chronic obstructive pulmonary disease. Transcripts were analysed thematically. Results: Prior to being enrolled in the study, prescription charges were an important issue for many of the participants, who faced multiple health challenges. Some reported having to go without medicines until they could afford them, and many reported having to make hard choices, such as choosing which of their medicines to pick up, or choosing between medicines and other expenses like food. Echoing the quantitative results from the trial, some participants reported previous hospitalisations because of their inability to pay for and hence take, their medicines. Few participants had discussed the affordability of medicines with their doctor. Participants reported that being exempted (through the FreeMeds trial) had reduced their stress and allowed them to afford medicines they would normally have gone without. Discussion: The study supports the government's decision to eliminate prescription charges, to remove one barrier to health and wellbeing for people facing significant disadvantages. What is known about the topic: Even small prescription charges can prevent people from accessing medicines they need, leading to increased use of other health services. The FreeMeds randomised controlled trial found that eliminating $5 prescription charges led to a reduction in hospital use. What this research adds: This paper provides some of the human stories of participants in the FreeMeds study. Many reported having to make changes to how they took their medicines or making choices between obtaining their medicines or other essentials. Some reported hospitalisations due to inability to afford medicines. Few participants had discussed their inability to afford medicines with their general practitioners. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to examine the effectiveness of a web application on health literacy and self‐efficacy in managing arm oedema symptoms among patients with breast cancer. Methods: The research was carried out in four phases as follows: Phase 1, using a qualitative approach to explore problems and information needs in educating breast cancer patients through in‐depth interviews with 10 professional nurses who had experiences in caring for breast cancer patients and 20 breast cancer patients. Data were analysed by content analysis; Phase 2, designing and developing a web application and confirming its quality by five experts with experience caring for breast cancer patients; Phase 3, testing the web application with five breast cancer patients; and Phase 4, examining the effectiveness of a web application in breast cancer patients using a quasiexperimental research method. Patients were divided into 15 persons in control and 15 in intervention groups, a total of 30 persons. The tools used in the study consisted of (1) a web application on practices for reducing risk for arm oedema after breast cancer treatment, (2) a health literacy assessment tool, (3) a self‐efficacy for managing symptoms questionnaire and (4) a web application satisfaction questionnaire. Data were analysed using descriptive statistics, chi‐square and t test. Results: Qualitative findings: The web application should cover patients' and nurses' views on arm oedema causes, assessment, prevention and self‐care for managing swelling after breast cancer treatment. Characteristics of a web application required: large text, bright colours, clear visibility, accompanying pictures or videos, using simple language without official terminology, easy to access, convenient to use, concise, interesting content and shareable to others. Quantitative findings: The intervention group had significantly higher health literacy and self‐efficacy in managing symptom scores than before the trial (p < 0.001). Sample groups were satisfied with the developed web application at a high level. When considering each item, it was found that all items were rated at high levels. Two items with the same highest score were ease of use and the attractiveness of the presentation style. Conclusion: This web application, aimed at reducing the risk of arm oedema after breast cancer treatment, is an effective tool for educating all hospitalized patients. In addition, further research should be conducted to monitor the sustainability of long‐term and clinical outcomes. Summary statement: What is already known about this topic? Some patients with breast cancer experience arm oedema either immediately after treatment or over extended periods.Web applications have become a valuable tool for educating patients with breast cancer. However, the features of the web applications designed to reduce the risk of breast cancer‐related lymphedema and their effectiveness remain unclear. What this paper adds? An effective web application for preventing breast cancer‐related lymphedema should cover causes, assessment, prevention strategies and self‐management guidelines. Key features should include large text, user‐friendly design, attractiveness and clarity.Web applications can help patients with breast cancer improve health literacy and self‐efficacy in managing symptoms. The implications of this paper: The web application should be used to educate breast cancer patients. [ABSTRACT FROM AUTHOR]

Aim: This study was conducted to determine the effects of music therapy on non‐stress test results and anxiety levels in high‐risk pregnant women. Methods: This randomized controlled study was conducted in pregnant women who were hospitalized in the High‐Risk Pregnancy Service of Meram Medical Faculty Hospital, Konya, Turkey, between April 1 and July 31, 2021. In the intervention group (n = 58), a 20‐min music therapy with ney sounds was performed, while in the control group (n = 58), routine care practices were applied. Hüseyni maqam of ney was selected, a melodic mode used by Turks for music therapy. Data were collected using the Descriptive Information Form, the Non‐Stress Test Evaluation Form, and the State–Trait Anxiety Inventory. Results: After music therapy, the intervention group experienced increased mean acceleration (p = 0.010) and foetal movement rates (p < 0.001) while no such difference was observed in the control group. The state anxiety levels of pregnant women differed significantly between the intervention and control groups (p < 0.001). Regression analysis showed that music therapy reduced state anxiety levels in pregnant women by a factor of 4.6 (p < 0.001). Conclusion: Based on the findings, music therapy was found to enhance acceleration and foetal heart rate in high‐risk pregnant women while reducing state anxiety levels. Summary statement: What is already known about this topic? Music therapy is a non‐invasive easy application that is frequently used in the treatment of psychological disorders. What this paper adds? Music therapy reduces the state anxiety levels of high‐risk pregnant women.Music therapy can lead to increase in the number of accelerations in high‐risk pregnant women.Music therapy can lead to increase in the number of foetal movements in high‐risk pregnant women. The implications of this paper: Nurses and other healthcare professionals may routinely apply music therapy during the non‐stress test procedure in high‐risk pregnancy services. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has led to preventive measures worldwide. With the decline of infection rates, less stringent restrictions for sports and exercise are being implemented. COVID-19 is associated with significant cardiovascular complications; however there are limited data on cardiovascular complications and long-term outcomes in both competitive (elite) athletes and highly active individuals. Based on different categories of disease severity (asymptomatic, regional/systemic symptoms, hospitalisation, myocardial damage, and/or myocarditis), in this point-of-view article we offer the (sports) cardiologist or sports physician in the Netherlands a practical guide to pre-participation screening, and diagnostic and management strategies in all athletes >16 years of age after COVID-19 infection. [ABSTRACT FROM AUTHOR]

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