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Supplemental digital content is available in the text., Objectives Patients are unintentionally, yet frequently, harmed in situations that are deemed preventable. Incident reporting systems help prevent harm, yet there is considerable variability in how patient safety incidents are reported. This may lead to inconsistent or unnecessary patterns of incident reporting and failures to identify serious patient safety incidents. This systematic review aims to describe international approaches in relation to defining serious reportable patient safety incidents. Methods Multiple electronic and gray literature databases were searched for articles published between 2009 and 2019. Empirical studies, reviews, national reports, and policies were included. A narrative synthesis was conducted because of study heterogeneity. Results A total of 50 articles were included. There was wide variation in the terminology used to represent serious reportable patient safety incidents. Several countries defined a specific subset of incidents, which are considered sufficiently serious, yet preventable if appropriate safety measures are taken. Terms such as “never events,” “serious reportable events,” or “always review and report” were used. The following dimensions were identified to define a serious reportable patient safety incident: (1) incidents being largely preventable; (2) having the potential for significant learning; (3) causing serious harm or have the potential to cause serious harm; (4) being identifiable, measurable, and feasible for inclusion in an incident reporting system; and (5) running the risk of recurrence. Conclusions Variations in terminology and reporting systems between countries might contribute to missed opportunities for learning. International standardized definitions and blame-free reporting systems would enable comparison and international learning to enhance patient safety.

Funding: This research is part of the Data and Connectivity National Core Study, led by Health Data Research UK in partnership with the Office for National Statistics and funded by UK Research and Innovation (HDRUK2020.146). EAVE II is funded by the Medical Research Council (MC_PC_19075) and supported by the Scottish Government. This work is supported by BREATHE - The Health Data Research Hub for Respiratory Health (MC_PC_19004). BREATHE is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. ConCOV is supported by the Medical Research Council (MR/V028367/1); Health Data Research UK (HDR-9006) which receives its funding from the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF) and the Wellcome Trust; and Administrative Data Research UK which is funded by the Economic and Social Research Council (grant ES/S007393/1). Introduction : The novel coronavirus SARS-CoV-2, which emerged in December 2019, has caused millions of deaths and severe illness worldwide. Numerous vaccines are currently under development of which a few have now been authorised for population-level administration by several countries. As of 20 September 2021, over 48 million people have received their first vaccine dose and over 44 million people have received their second vaccine dose across the UK. We aim to assess the uptake rates, effectiveness, and safety of all currently approved COVID-19 vaccines in the UK. Methods and analysis : We will use prospective cohort study designs to assess vaccine uptake, effectiveness and safety against clinical outcomes and deaths. Test-negative case–control study design will be used to assess vaccine effectiveness (VE) against laboratory confirmed SARS-CoV-2 infection. Self-controlled case series and retrospective cohort study designs will be carried out to assess vaccine safety against mild-to-moderate and severe adverse events, respectively. Individual-level pseudonymised data from primary care, secondary care, laboratory test and death records will be linked and analysed in secure research environments in each UK nation. Univariate and multivariate logistic regression models will be carried out to estimate vaccine uptake levels in relation to various population characteristics. VE estimates against laboratory confirmed SARS-CoV-2 infection will be generated using a generalised additive logistic model. Time-dependent Cox models will be used to estimate the VE against clinical outcomes and deaths. The safety of the vaccines will be assessed using logistic regression models with an offset for the length of the risk period. Where possible, data will be meta-analysed across the UK nations. Ethics and dissemination : We obtained approvals from the National Research Ethics Service Committee, Southeast Scotland 02 (12/SS/0201), the Secure Anonymised Information Linkage independent Information Governance Review Panel project number 0911. Concerning English data, University of Oxford is compliant with the General Data Protection Regulation and the National Health Service (NHS) Digital Data Security and Protection Policy. This is an approved study (Integrated Research Application ID 301740, Health Research Authority (HRA) Research Ethics Committee 21/HRA/2786). The Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub meets NHS Digital’s Data Security and Protection Toolkit requirements. In Northern Ireland, the project was approved by the Honest Broker Governance Board, project number 0064. Findings will be made available to national policy-makers, presented at conferences and published in peer-reviewed journals. Publisher PDF

This study examined the association between interpersonal violence and a range of psychiatric and physical health outcomes and assessed whether these associations changed when controlling for a stress-related diagnosis. An observational case–control study was conducted on a sample of 4,059 victims of violence. Using propensity score matching a number of risk factors (assessed five years prior assault) were used. Controls were matched 10:1 using the Danish Central Registry System. Outcomes were ICD-10 diagnoses of a range of psychiatric and physical health outcomes in the 15 years post-injury. Statistically significant associations were found for all psychiatric conditions and a diagnosis of a drug or substance misuse disorder. These findings remained even after controlling for a diagnosis of a stress-related disorder. Large scale case–control studies using the Danish nationwide registers enables a powerful way of assessing the relative impact of exposure to interpersonal violence on the development of psychiatric and physical health problems.

Background/aim Psychological violence is estimated to be the most common form of intimate partner violence (IPV). Despite this, research on the independent effect of psychological violence on mental health is scarce. Moreover, the lack of a clear and consistent definition of psychological violence has made results difficult to compare. The present study therefore aims to consolidate knowledge on psychological violence by conducting a systematic review and random-effects meta-analysis on the association between psychological violence and mental health problems, when controlling for other types of violence (e.g. physical and sexual) and taking into account severity, frequency, and duration of psychological violence. Method The present study is registered in the International Prospective Register for Systematic Reviews (PROSPERO; #CRD42018116026) and the study design follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA; Additional file 1). A dual search will be conducted in the electronic databases PsycINFO, PubMed, EMBASE, and Web of Science. Data will be extracted using Endnote and Covidence and a meta-analysis will be conducted using Metafor-package in the programming language R. The Quality Assessment Tool for Quantitative Studies developed by the Effective Public Health Practice Project will be used to assess the quality of the included studies (i.e. weak, moderate and strong). Results and discussion The present review will help consolidate knowledge on psychological violence by evaluating whether frequency, severity or actual “type” of psychological violence produces the most harm. A thorough quality assessment will help overcome potential limitations regarding expected variations in terminology and assessment of psychological violence. Systematic review registration PROSPERO CRD42018116026. Electronic supplementary material The online version of this article (10.1186/s13643-019-1118-1) contains supplementary material, which is available to authorized users.

The aim of this study was to develop an observational metric that could be used to assess the performance of a practitioner in completing an acute surgical wound‐dressing procedure using aseptic non‐touch technique (ANTT). A team of clinicians, academics, and researchers came together to develop an observational metric using an iterative six‐stage process, culminating in a Delphi panel meeting. A scoping review of the literature provided a background empirical perspective relating to wound‐dressing procedure performance. Video recordings of acute surgical wound‐dressing procedures performed by nurses in clinical (n = 11) and simulated (n = 3) settings were viewed repeatedly and were iteratively deconstructed by the metric development group. This facilitated the identification of the discrete component steps, potential errors, and sentinel (serious) errors, which characterise a wound dressing procedure and formed part of the observational metric. The ANTT wound‐dressing observational metric was stress tested for clarity, the ability to be scored, and interrater reliability, calculated during a further phase of video analysis. The metric was then subjected to a process of cyclical evaluation by a Delphi panel (n = 21) to obtain face and content validity of the metric. The Delphi panel deliberation verified the face and content validity of the metric. The final metric has three phases, 31 individual steps, 18 errors, and 27 sentinel errors. The metric is a tool that identifies the standard to be attained in the performance of acute surgical wound dressings. It can be used as both an adjunct to an educational programme and as a tool to assess a practitioner's performance of a wound‐dressing procedure in both simulated and clinical practice contexts.

Background: Psychological trauma has only recently been considered a traumatic event. Therefore, research on Posttraumatic Stress Disorder (PTSD) and Complex-PTSD following exposure to psychological violence, is less studied compared with physical and sexual violence. Objectives: This study aimed to establish the prevalence of PTSD and C-PTSD of among female victims of partner violence (IPV) and examine the unique association between different subtypes of IPV (i.e. physical, psychological and sexual IPV) and the traumatic response. Methods: The study includes a shelter-based sample of female victims of IPV (N = 147). Validated measures were used to estimate IPV exposure and mental health outcomes. Partial Correlation and Hierarchical Regression was used to examine the association between IPV and PTSD and C-PTSD, respectively. Results: The study found a high prevalence of both PTSD (56.5%) and C-PTSD (21.1%) in the sample. Overall, when controlling for the other types of violence, psychological violence correlated with PTSD, C-PTSD, negative affect and somatization. When controlling for psychological violence, neither physical nor sexual violence correlated with any of the mental health outcomes. Hierarchical regression models helped explain 23.5% and 29.7% of the variance in symptoms of PTSD and C-PTSD, respectively. Conclusion: A relatively large subgroup of the women had symptoms of C-PTSD, which demonstrate a potentially unmet need for trauma-informed treatment services in Danish Women Shelters. Psychological violence was found to be the strongest risk factor for all mental health outcomes and thus, it is important to acknowledge the severity of this IPV subtype., HIGHLIGHTS • New research suggests that psychological IPV is the strongest risk factor for Complex Posttraumatic Stress Disorder, compared to physical and sexual IPV. This emphasizes the need to acknowledge the severity of psychological violence in both research and clinical practice.

This study aimed to examine the effects of different types of maltreatment on psychiatric outcomes. The second aim was to examine patterns of comorbidity among different types of child maltreatment. Participants were randomly selected from the total birth cohort of all children born in Denmark in 1984. Data were then linked to information drawn from the Danish health and social registries. Four distinct subgroups of child maltreatment were used: no abuse; sexual abuse; emotional abuse; and co-occurring abuse. Multivariate analysis demonstrated that all types of maltreatment were associated with psychiatric outcomes independent of other forms of adversity and parental history of psychiatric conditions. The strength of these associations was consistent for some, but not all conditions. Findings are consistent with emerging transdiagnostic models of psychopathology, which demonstrate that the risk for psychopathology appears to operate at the broad dimension level, rather than the level of specific diagnoses. Key Practitioner Messages: This study found that maltreatment in childhood was associated with a number of psychiatric conditions and high levels of comorbidity independent of other forms of adversity and parental history of psychiatric conditions. Findings point to the importance of early intervention for maltreated children using an individual and developmentally appropriate approach that may offset the risk trajectory for co-occurring psychiatric conditions. Interventions targeting difficulties in attachment, emotional regulation and promoting adaptive coping strategies have been useful in treating a range of conditions.

Identifying methods that enable prediction of psychopathology that results from military service is crucial for individual and mission readiness, and for postdeployment mental health. In the present study, we investigate the relationship between sensation seeking (SS) and posttraumatic stress disorder (PTSD) and between SS and depression. Data from 743 Danish soldiers deployed to Afghanistan in 2009 were collected 6 times: before deployment, during deployment, 1–3 weeks after homecoming, 2 months after homecoming, 7 months after homecoming, and 2.5 years after homecoming. In this study, we did not find a relationship between SS and PTSD, or between SS and depression. The present study does not support previous findings that link SS with psychopathology. The structural environment in the military setting, the extent of exposure and type of stressful situations may play a moderating role. More extreme environments, such as imprisonment and torture, may favor different expressions of SS. Further research should include other factors such as context and the extent and type of traumatic exposure in relation to SS.

Objective The current prospective study assessed the temporal relations between dissociation and posttraumatic stress (PTS) in a sample of treatment-seeking female survivors of childhood sexual abuse. PTS refers to symptoms associated with posttraumatic stress disorder (PTSD) in the absence of a clinical diagnosis of PTSD. Method Initial assessment was on average 23 years after the onset of abuse (N = 405), and participants were followed-up after 6 months (N = 245) and 12 months (N = 119). Results Findings indicated that dissociative experiences and PTS were highly correlated within each wave of data collection. Cross-lagged panel analysis revealed that at each assessment period dissociative symptoms and PTS levels, respectively, were primarily explained by scores on the same variable at the previous assessment period. Although further reciprocal relations between dissociation and PTS were evident, these associations were relatively weak in magnitude. Conclusion Current results provide important insights into the temporal relations between dissociative symptoms and PTS. The high correlations between dissociative experiences and PTS several years after trauma exposure have important clinical implications that may affect their treatment and trauma recovery.

ObjectiveTo explore patient involvement in the implementation of infection prevention and control (IPC) guidelines and associated interventions.DesignScoping review.MethodsA methodological framework was followed to identify recent publications on patient involvement in the implementation of IPC guidelines and interventions. Initially, relevant databases were searched to identify pertinent publications (published 2013–2018). Reflecting the scarcity of included studies from these databases, a bidirectional citation chasing approach was used as a second search step. The reference list and citations of all identified papers from databases were searched to generate a full list of relevant references. A grey literature search of Google Scholar was also conducted.ResultsFrom an identified 2078 papers, 14 papers were included in this review. Our findings provide insights into the need for a fundamental change to IPC, from being solely the healthcare professionals (HCPs) responsibility to one that involves a collaborative relationship between HCPs and patients. This change should be underpinned by a clear understanding of patient roles, potential levels of patient involvement in IPC and strategies to overcome barriers to patient involvement focusing ontheprofessional–patient relationship (eg, patient encouragement through multimodal educational strategies and efforts to disperse professional’s power).ConclusionsThere is limited evidence regarding the best strategies to promote patient involvement in the implementation of IPC interventions and guidelines. The findings of this review endorse the need for targeted strategies to overcome the lack of role clarity of patients in IPC and the power imbalances between patients and HCPs.

Background: Interpersonal violence is a pervasive global public health problem associated with myriad health, social and economic consequences. In recent years the rates of interpersonal violence have decreased, however, high numbers of individuals continue to present to emergency departments for non-fatal violence-related injuries.Objective: This study aimed to examine a range of risk factors associated with violence-related injuries in an emergency department in Denmark.Method: A case-control study was conducted on a sample of 3,940 victims of violence collected by the Accident Analysis Center for Aarhus County Municipality. Using the Danish Civil Registry System, controls were matched 10:1 on age, gender and municipality. Risk factors were rendered from Danish health and social registers five years prior to the violent assault. These included marital status, educational qualification, employment status, national origin, involvement with child protective services (CPS), prior convictions, and a diagnosis of adjustment disorder and alcohol and/or substance use disorders.Results: Multivariate logistic regression identified that being male, divorced, unmarried, non-Danish origin, attending compulsory education, being outside the labour force, students, involvement with CPS, prior criminal conviction and a diagnosis of alcohol and/or substance use disorders were associated with an increased likelihood of being exposed to violence. The dominant risk factors were alcohol and/or substance use disorders (OR = 3.62) and prior criminal conviction (OR = 3.54). Attainment of tertiary education was associated with a reduced likelihood of being a victim of violence.Conclusion: These findings highlight that research into effective interventions offered in emergency departments may help the public health effort to reduce the health, social and economic burden of interpersonal violence.

Background : Childhood sexual abuse (CSA) is a common occurrence and a robust, yet non-specific, predictor of adult psychopathology. While many demographic and abuse factors have been shown to impact this relationship, their common and specific effects remain poorly understood. Objective : This study sought to assess the prevalence of Axis I disorders in a large sample of help-seeking victims of sexual trauma, and to examine the common and specific effects of demographic and abuse characteristics across these different diagnoses. Method : The participants were attendees at four treatment centres in Denmark that provide psychological therapy for victims of CSA ( N =434). Axis I disorders were assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Multivariate logistic regression analysis was used to examine the associations between CSA characteristics (age of onset, duration, number of abusers, number of abusive acts) and 10 adult clinical syndromes. Results : There was significant variation in the prevalence of disorders and the abuse characteristics were differentially associated with the outcome variables. Having experienced sexual abuse from more than one perpetrator was the strongest predictor of psychopathology. Conclusions : The relationship between CSA and adult psychopathology is complex. Abuse characteristics have both unique and shared effects across different diagnoses. Keywords: Childhood sexual abuse; Axis I disorders; help-seeking sample; sexual trauma; incest; multivariate analysis; multiple perpetrators; adult psychopathology (Published: 8 April 2016) Responsible Editor: Marylene Cloitre, National Center for PTSD in Palo Alto, CA, USA. For the abstract or full text in other languages, please see Supplementary files in the column to the right (under ‘Article Tools’). Citation: European Journal of Psychotraumatology 2016, 7 : 30686 - http://dx.doi.org/10.3402/ejpt.v7.30686

Adult attachment theory is increasingly being conceptualized within a traumatic framework, however, few studies have examined temporal relationships between the insecure attachment orientations (attachment anxiety and attachment avoidance) and symptoms of posttraumatic stress (PTS). PTS refers to symptoms associated with posttraumatic stress disorder (PTSD) in the absence of a clinical diagnosis of PTSD. This prospective study assesses the temporal relations between the 2 attachment dimensions of anxiety and avoidance and PTS among a treatment-seeking sample of female survivors of childhood sexual abuse (CSA). Cross-lagged panel analysis was employed to assess the temporal relations between insecure attachment orientations and PTS using the Revised Adult Attachment Scale (RAAS) and the Harvard Trauma Questionnaire (HTQ). Initial assessment was on average 23 years after the onset of abuse (N = 405), and participants were followed-up after 6 months (N = 245) and 12 months (N = 119). PTS levels and insecure attachment declined over the 12-month period. Cross lagged panel analyses indicated that over the longer-term course of PTS, insecure attachment orientations are significantly related to PTS. While these associations were relatively weak in magnitude, temporal relations nevertheless remain. Specifically attachment avoidance appears to be the more relevant orientation in PTS across the 3 time points in the study. Current results provide insight into the temporal relations between insecure attachment orientations and symptoms of PTS. The findings are discussed in terms of the existing trauma literature.

Objective The present study investigated the relationship between different types of childhood maltreatment (emotional abuse, sexual abuse, multiple abuse types, and no abuse) and the occurrence of later traumatic events during later adolescence and young adulthood. Method Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4718 young adults who were 24 years old was randomly selected using the total birth cohort of children born in 1984. A structured interview was conducted during which participants were asked about a range of traumatic and abusive experiences. Results A response rate of 63% was achieved for a total sample size of 2980. Chi-squared analyses revealed significant relationships between all child maltreatment groups and direct exposure to 10 of the 13 traumatic events; there were also significant relationships between all child maltreatment groups and indirect exposure to 12 of the 13 traumatic events. Conclusions The results showed that childhood maltreatment was associated with increased risk of exposure to traumatic events, both directly and indirectly, during adolescence and young adulthood. The findings of this study suggest there is an increased risk of being exposed to both direct and indirect traumas during later adolescence and young adulthood after any form of child maltreatment.

Aim: The purpose of this literature review is to identify and explore the definition of modified compression and its application using compression garments to prevent reoccurrence of chronic wounds in the population of people with the comorbidities of peripheral arterial disease and diabetes. Background: Compression is considered the best practice treatment in wound care and prevention, but does this apply to vulnerable people who have comorbidities? Evidence demonstrates wound healing is compromised in the presence of comorbidities. Clinical experience and literature show that compression is not utilised with patients experiencing comorbidities. Therefore, they do not receive best practice. The provision of best practice treatment, including the use of modified compression, is vital for wound prevention. Research highlights the fact that this population is already at risk of delayed wound healing and higher risk of re-occurrence of wounds 1. Although consensus documents exist, the definition of modified compression is neither clear nor consistent and methods of application are not prescribed within these documents. Clearer guidelines regarding the use of compression with these vulnerable people are needed. The lack of clarity with the definitions and application, further add to the concerns by health practitioners regarding injuring this population and are cited as the most common factors inhibiting the application of compression for this population 1, 2. Method: An electronic database search was conducted using medical subject headings followed by a keyword search strategy. The following databases were searched: MEDLINE, CINAHL, Scopus and Wiley. Key search terms included, reduced compression/modified compression; wound/ulcer; leg/lower limb. Exclusion criteria included, surgery, pneumatic, dressing, vacuum, thrombosis/DVT. Results/Discussion: Initial analysis shows inconsistencies in the definition and application techniques of modified compression in the literature. Working definitions from the research range from less than 40mmHg to greater than 10 mmHg. It is noted, that the literature is consistent with the concept of less than standard compression. Concerning application techniques, the literature is very limited in the area of modified compression application using garments, with only two articles clearly related to this topic. The concept of using compression garments to prevent reoccurrence is consistent and well documented in the literature, however, specific application methods of the modified compression is inconsistent. Using a wider search term of compression provided a range of application techniques, from bandages short stretch/long stretch to inelastic Velcro garments. Conclusion: More research is needed to assist with clearer definitions and application methods regarding the use of compression with vulnerable people. Clarifying the definition and application of modified compression will contribute to standardising the language used in guidelines, protocols and procedures, thus enabling clinicians to implement best practice treatment for all people. References: 1- Woo KY, Sears K. Knowledge, Attitude, and Practice in the Management of Mixed Arteriovenous Leg Ulcers. International Journal of Lower Extremity Wounds. 2016;151:52-7 2- Bianchi J, Zamiri M, Loney M, McIntosh H, Dawe RS, Douglas WS. Pulse oximetry index: a simple arterial assessment for patients with venous disease [corrected] [published erratum appears in J WOUND CARE 2008 Jul;177:327]. Journal of Wound Care. 2008;176:253

Intimate partner violence (IPV) is a global public health concern with profound psychological consequences. Perpetrators often have a history of childhood trauma and a range of co-occurring psychiatric problems, which may have implications for treatment. This study examines the prevalence of psychiatric and personality disorders (PD) among perpetrators and the association between a range of demographic, childhood trauma, and adult criminality variables for the most prominent disorders. Data were collected from IPV perpetrators ( n = 529) engaging in a treatment program, ‘ Dialogue Against Violence’. High rates of childhood trauma were observed. There was significant variation in the prevalence of clinical disorders and PDs, with Antisocial PD and Anxiety Disorder being the most common. A clinical disorder was the strongest predictor of PDs, likewise a PD was the strongest predictor of clinical disorders. Findings demonstrated that IPV perpetrators have a number of personality and clinical disorders and traumatic histories that need to be considered within a treatment perspective.

OBJECTIVE: Evidence has suggested there are sex differences in posttraumatic stress disorder (PTSD) symptom expression; however, few studies have assessed whether these differences are due to measurement invariance. This study aimed to examine sex differences in PTSD symptoms based on the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) using differential item functioning (DIF).METHOD: Confirmatory factor analysis was conducted on the DSM-5 model of PTSD, followed by a multiple indicators multiple causes (MIMIC) model to examine possible DIF using the PTSD Checklist for DSM-5. Data were analyzed from a Malaysian adolescent sample (n = 481) of which 61.7% were female, with a mean age of 17.03 years.RESULTS: The results indicated the presence of DIF for 2 of 20 PTSD criteria. Females scored significantly higher on emotional cue reactivity (B4), and males reported significantly higher rates of reckless or self-destructive behavior (E2) while statistically controlling for the latent variables in the model. However, the magnitude of these item-level differences was small.CONCLUSION: These findings indicate that despite the presence of DIF for 2 DSM-5 symptoms, this does not provide firm support for nonequivalence across sex. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated with evidence supporting the recently proposed seven-factor Hybrid model. However, despite myriad studies examining PTSD symptom structure few have assessed the diagnostic implications of these proposed models. This study aimed to generate PTSD prevalence estimates derived from the 7 alternative factor models and assess whether pre-established risk factors associated with PTSD (e.g., transportation accidents and sexual victimisation) produce consistent risk estimates. Seven alternative models were estimated within a confirmatory factor analytic framework using the PTSD Checklist for DSM-5 (PCL-5). Data were analysed from a Malaysian adolescent community sample (n = 481) of which 61.7% were female, with a mean age of 17.03 years. The results indicated that all models provided satisfactory model fit with statistical superiority for the Externalising Behaviours and seven-factor Hybrid models. The PTSD prevalence estimates varied substantially ranging from 21.8% for the DSM-5 model to 10.0% for the Hybrid model. Estimates of risk associated with PTSD were inconsistent across the alternative models, with substantial variation emerging for sexual victimisation. These findings have important implications for research and practice and highlight that more research attention is needed to examine the diagnostic implications emerging from the alternative models of PTSD.

With the publication of the International Statistical Classification of Diseases and Related Health Problems, 11th edition (ICD-11) due for release in 2018, a number of studies have assessed the factorial validity of the proposed post-traumatic stress disorder (PTSD) and complex (CPTSD) diagnostic criteria and whether the disorders are correlated but distinct constructs. As the specific nature of CPTSD symptoms has yet to be firmly established, this study aimed to examine the dimension of affect dysregulation as two separate constructs representing hyper-activation and hypo-activation. Seven alternative models were estimated within a confirmatory factor analytic framework using the International Trauma Questionnaire (ITQ). Data were analysed from a young adult sample from northern Uganda (n = 314), of which 51% were female and aged 18–25 years. Forty per cent of the participants were former child soldiers (n = 124) while the remainder were civilians (n = 190). The prevalence of CPTSD was 20.8% and PTSD was 13.1%. The results indicated that all models that estimated affective dysregulation as distinct but correlated constructs (i.e. hyper-activation and hypo-activation) provided satisfactory model fit, with statistical superiority for a seven-factor first-order correlated model. Furthermore, individuals who met the criteria for CPTSD reported higher levels of war experiences, symptoms of anxiety and depression, and somatic problems than those with PTSD only and no diagnosis. There was also a much larger proportion of former child soldiers that met the criteria for a CPTSD diagnosis. In conclusion, these results partly support the factorial validity of the ICD-11 proposals for PTSD and CPTSD in a non-Western culture exposed to mass violence. These findings highlight that more research is required across different cultural backgrounds before firm conclusions can be made regarding the factor structure of CPTSD using the ITQ.

Previous research has identified strong associations between war experiences and posttraumatic stress disorder (PTSD). Few studies, however, have explored the underlying mechanisms of these associations in an integrated model. This study explored whether feelings of anger, shame, and guilt mediated the effects of war experiences and PTSD and if this association is heightened in former child soldiers from Northern Uganda. Nearly 40% of the sample were former child soldiers (N = 122), and 189 were civilians. A total of 35.5% met the proposed ICD-11 criteria for PTSD. Findings indicated previous war experiences were directly associated with PTSD. Anger and guilt were significant mediators of this effect, child soldier status did not moderate the mediated effects. This study provides an alternative framework of assessing the association between trauma and PTSD using a sample of young adults exposed to mass conflict.

Background The DARE2-patient safety rubric was developed for the performance evaluation of final year nursing students. The rubric contains four domains of competency: systematic patient assessment, clinical response, clinical-psychomotor skills, and communication proficiency. The aim of this research was to investigate the inter-rater reliability of data from the DARE2. Method A nonexperimental quantitative exploratory design was employed. Archived recorded performances of students (n = 34) were independently evaluated by nurse lecturers who teach and examine in the simulation centre (n = 4). Results Intraclass correlation coefficients (ICC) were greater than 0.70 for three of the four domains of practice and 0.58 for the fourth (clinical-psychomotor skills). An ICC of 0.75 for the overall rubric score is indicative of excellent reliability. Percentage agreement for the overall rubric was 59%. Conclusion These results support the inter-rater reliability of data from the DARE - patient safety rubric and highlights the difference between consensus and consistency estimates of inter-rater reliability.

The association between childhood adversity and posttraumatic stress disorder (PTSD) symptomatology has been argued to be both directly and indirectly explained through a number of psychological mechanisms. This study builds on recent findings from an analysis of childhood adversity co-occurrence that revealed 4 groups: emotional abuse, sexual abuse, and multiple (overall) abuse and a no-abuse group to investigate the relationship between PTSD experiences. Data was analyzed using a Danish stratified probability survey that included 2980 interviews of 24-year-olds. A multiple mediator model was conducted to assess the role of self-esteem, social support, and being bullied at school on the abuse types and PTSD experiences. Results indicated that the 3 mediating variables were all statistically significant with low social support exerting the strongest influence in the association between childhood adversity and PTSD experiences. Low self-esteem, however, was only associated with sexual abuse. The current study supports that there are direct and indirect effects between childhood adversity and PTSD experiences but suggests there may be additional mechanisms underlying this relationship. Further exploration into underlying mechanisms will promote and inform intervention and treatment programs.

Background Patients at increased risk of sexually transmitted infections (STIs)/HIV acquisition are advised to reattend for retesting. A previous study showed that ‘generic’ text reminders did not improve reattendance. Aim To assess if a personalised text message with increased contact information would increase reattendance rates of at-risk patients. Methods Patients who are at risk of future STIs, defined by having a current acute STI, attending for emergency contraception, commercial sex workers (CSWs) or men who have sex with men (MSM), were sent a text reminder to reattend for retesting 6 weeks after initial visit. Reattendance rates were measured for September to December 2012 (control group who received a generic text message) and February to May 2014 (intervention ‘personalised message’ group who received a text message containing their first name and ways to contact the clinic). Reattendance was counted within 4 months of the end of the initial episode of care. Results The reattendance rate was significantly higher for the intervention group: 149/266 (56%) than the control group: 90/273 (33%) (p=0.0001) and was also significantly higher in the intervention group than the control group in patients with the following risks: recent chlamydia (64/123 (52%) vs 43/121 (36%)) (p=0.03), recent gonorrhoea (41/64 (64%) vs 4/21 (19%)) (p=0.0003) and MSM (26/45 (58%) vs 3/18 (16%)) (p=0.006). New STI rates in the reattending intervention group and controls were 26/ 149 (17%) and 13/90 (14%) (n.s), respectively. Conclusions Sending a personalised text message with increased contact information as a reminder for retesting increased reattendance rates by 23% in patients who are at higher risk of STIs.

Objectives The study aimed to assess the feasibility and acceptability of third-trimester antenatal HIV testing within our service after two cases of HIV seroconversion in pregnancy were noted in 2008. North American Guidelines recommend universal third-trimester HIV testing in areas with an HIV prevalence of more than 1 per 1000. The HIV prevalence rate in our area is 3.01 per 1000. Methods Pregnant women prior to 28 weeks of gestation were recruited at booking between 1 September 2008 and 31 August 2009 and offered an additional third-trimester HIV test. Consent was obtained and testing was performed by hospital and community midwives. Information was entered into a modified existing electronic maternity database. A qualitative e-mail survey of midwives investigated barriers to participation in the study. Results A total of 4134 women delivered; three (

This study aimed to explore a broad range of psychological reactions to trauma in a sample of bereaved parents in order to assess whether the traumatic framework is adequate for describing the entire range of emotional reactions to infant death. A sample of bereaved parents (N = 455) who lost their child through perinatal or postnatal loss were compared to a control group of parents (N = 110) who gave birth to a healthy child. Multivariate regression analysis clearly demonstrated that bereaved parents scored significantly higher on the Depression, Anxiety, Dissociation, Sleep Disturbances, Somatization, Interpersonal Sensitivity, and Aggression subscales of the Trauma Symptom Checklist. Consistent with previous studies, the results showed that for up to 5 years postloss bereaved parents expressed elevated levels of trauma-specific and psychological outcomes, in particular interpersonal sensitivity and aggression.

‘Did not attend’ and cancellation rates were compared for two 12-month periods before (2009) and after (2012/2013) the introduction of routine short message service text reminders being sent to patients who have pre-booked appointments. After the introduction of short message service text appointment reminders, the overall ‘did not attend’ rates fell by 4% from 28% to 24% ( p

Objective Previous research has identified an association between loneliness and psychiatric morbidity, but many of the studies have been based on small convenience samples and have not always used standardized measures. Aims and Methods This study aimed to assess the association between standardized measures of loneliness and psychiatric morbidity using data from a large sample of adolescents from Northern Ireland (Young Life and Times Survey, 2011). A total of 1,434 participants completed the survey. Results The prevalence of loneliness and psychiatric morbidity was 15.6% and 28.4% respectively. A multivariate binary logistic regression was used to identify the significant correlates of psychiatric morbidity. Demographic and loneliness variables were entered as covariates and female gender and perceptions of familial poverty were significantly associated with GHQ caseness. Loneliness increased the likelihood of GHQ caseness by more than five times. Conclusions Adolescent loneliness is significantly associated with psychiatric morbidity for Northern Irish adolescents. School-based screening and interventions to reduce loneliness may reduce the prevalence of loneliness. Practitioner Points Adolescent loneliness is a possible indirect indicator for mental health problems. Standardized measures of loneliness, with population norms, are widely available. There is no clear profile of a ‘lonely adolescent’ based on demographic variables.

Background : The International Classification of Diseases (ICD-11) is currently under development with proposed changes recommended for the posttraumatic stress disorder (PTSD) diagnosis and the inclusion of a separate complex PTSD (CPTSD) disorder. Empirical studies support the distinction between PTSD and CPTSD; however, less research has focused on non-western populations. Objective : The aim of this study was to investigate whether distinct PTSD and CPTSD symptom classes emerged and to identify potential risk factors and the severity of impairment associated with resultant classes. Methods : A latent class analysis (LCA) and related analyses were conducted on 314 young adults from Northern Uganda. Fifty-one percent were female and participants were aged between 18 and 25 years. Forty percent of the participants were former child soldiers ( n =124) while the remaining participants were civilians ( n =190). Results : The LCA revealed three classes: a CPTSD class (40.2%), a PTSD class (43.8%), and a low symptom class (16%). Child soldier status was a significant predictor of both CPTSD and PTSD classes (OR=5.96 and 2.82, respectively). Classes differed significantly on measures of anxiety/depression, conduct problems, somatic complaints, and war experiences. Conclusions : To conclude, this study provides preliminary support for the proposed distinction between PTSD and CPTSD in a young adult sample from Northern Uganda. However, future studies are needed using larger samples to test alternative models before firm conclusions can be made. Keywords: ICD-11; PTSD; complex PTSD; latent class analysis; Northern Uganda (Published: 8 September 2016) Responsible Editor: Chris Brewin, University College London, UK. Citation: European Journal of Psychotraumatology 2016, 7 : 32678 - http://dx.doi.org/10.3402/ejpt.v7.32678

Background This study examined the relationship between alcohol misuse and different types of childhood maltreatment in a sample of young adults while controlling for posttraumatic stress disorder (PTSD) symptoms and current mental disorders. This study further examined if these associations were different for males and females. Methods Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4718 young adults (24 years of age) was randomly selected using the total birth cohort of children born in 1984. Structured interviews were conducted with a response rate of 63%, equating to a total sample size of 2980 participants. Results Three types of child maltreatment were assessed; emotional abuse (N =263), sexual abuse (N=59), and multiple abuse (N=64) alongside a non-abused (N=2595) control group. Findings indicated the three maltreatment groups were all related to alcohol misuse. Maltreated women in particular had a 16-to-25-fold increased risk of alcohol misuse. For males these associations were attenuated with odds ratios (OR) ranging between 3 and 5 for emotional and multiple abuse groups. PTSD symptoms were associated with alcohol misuse for both genders, whilst current mental health disorder was non-significant for both males and females. Conclusion A significant relationship was found between the child maltreatment and alcohol misuse. This relationship was significantly stronger for maltreated women, which identifies a gap in the literature. High associations between maltreatment and alcohol misuse in females may suggest alcohol is used as a coping strategy following childhood maltreatment.

Objective The present study investigated the relationship between different types of childhood maltreatment (emotional, sexual, overall abuse, and no abuse) and the symptoms of attention deficit hyperactivity disorder (ADHD) in young adulthood. Method Data were collected from a Danish national study conducted by The Danish National Centre for Social Research in 2008 and 2009. A sample of 4,718 young adults (24 years of age) were randomly selected using the total birth cohort of children born in 1984. Structured interviews were conducted with a response rate of 63%, equating to a total sample size of 2,980 participants. Results Chi-square analyses revealed significant relationships between child maltreatment groups and a probable diagnosis of ADHD using the Adult ADHD Self-Report Scale (ASRS). Binary logistic regression analysis showed that the overall abuse class was more strongly associated with probable ADHD (OR=5.08), followed by emotional abuse (OR=3.09) and sexual abuse (OR=2.07). Conclusions The results showed that childhood maltreatment was associated with increased risk of ADHD symptoms in young adulthood. The findings of this study are discussed within the existing literature and suggestions for future research are outlined in order to replicate these findings in other adult populations. Highlights of the article Child maltreatment is associated with higher levels of ADHD symptoms in a nationally representative sample of young Danish adults. Co-occurring (multiple) types of maltreatment display stronger associations with ADHD symptoms with attenuated effects for sexual abuse. Males confer stronger associations with ADHD symptoms than females. Findings underscore the importance of exploring the role of childhood trauma in young adults with ADHD symptoms.

Aim. To determine whether the provision of an information booklet on mobilisation improves early mobility postsurgical repair of hip fracture. Background. Hip fracture among older people can have long-lasting consequences with the majority of patients failing to achieve their prefracture functional status. Early postoperative mobility may have a positive effect on long-term recovery. The importance of providing postoperative information on mobility has been highlighted. It is suggested that patients remain passive in their recovery when they do not understand the importance of mobilisation. Design. The study used a pretest–post-test design of two treatments and a usual care control group. Methods. Eighty-three adults postsurgical repair of hip fracture, aged 65 years and older, were recruited to the study. Participants were assigned to one of three groups, a usual care group, treatment group 1 (T1) usual care plus basic information booklet or treatment group 2 (T2) usual care plus detailed information booklet. Data collection three days postsurgery and prior to discharge included the Mini-Mental State Examination, a Demographic Questionnaire, the Elderly Mobility Scale and a Numerical Pain Scale. Results. Greatest improvements in Elderly Mobility Scale scores occurred in T1, with least changes observed in T2. Changes did not reach significance level (p = 0·105). Conclusion. The results of the study suggest that the provision of basic information is preferable and highlights a deficiency of education in usual care. Relevance to clinical practice. Hip fracture patients should be provided with an educational booklet containing basic information on mobility to promote optimal recovery.

Current curriculum models rely heavily on conventional teacher-centered approaches to student learning. Recent literature challenges educators to implement student-centered learning ap- proaches. Health care complexities that confront the future of nursing education, combined with the demands of technologically literate students, challenge educators to be responsive and proactive to ad- vance student-centered learning. Undertaking a scholarly approach to teaching and learning is in keep- ing with the concept of integrative learning. This article discusses the merger of two active-learning strategies, problem-based learning and simulation, on the basis of a review of recent literature, as well as the scholarly approach undertaken to develop an innovative teachingelearning strategy. Last, it rec- ommends potential pedagogical advantages of combining these strategies in nurse education. This dis- cussion article presents the rationale for merging two well-known teaching strategies for a baccalaureate nursing program at University College Cork, Ireland.

hartigan i., murphy s. & hickey m. (2011) Older adults’ knowledge of pressure ulcer prevention: a prospective quasi-experimental study. International Journal of Older People Nursing7, 208–218 doi: 10.1111/j.1748-3743.2011.00274.x Aim. To test an evidence base patient education leaflet to evaluate older adults’ knowledge of pressure ulcers and prevention strategies. Background. The increasing population of older adults living in the community managing chronic health conditions are at risk of pressure ulcer development. Education leaflets are a useful adjunct to reinforce healthcare professional’s verbal information to promote healthy lifestyles choices. However, little is known of the effectives of pressure ulcer prevention educational leaflets for older adults. Methods. A quasi-experimental uncontrolled pre-test, post-test study of participants’ knowledge of pressure ulcer and preventative strategies was conducted. Community dwelling older adults (n = 75) were recruited to this study. Older adult’s knowledge was measured pre- and postdistribution of an education intervention. A risk assessment scale was recorded to identify whether this cohort of older adults were actually at risk of developing pressure ulcers. Conclusion. The results indicate that an education leaflet enhanced patients’ knowledge relating to pressure ulceration. Printed education materials increase knowledge and understanding which may lend to older adults adopting healthy behaviours. Implications for practice. An education leaflet can help older adults and their carers to be more empowered as active participants in reducing the incidence of pressure ulceration.

On successful completion of nurse education programmes new graduate nurses are expected to meet the requirements for registration as a professional practitioner. Nurse educators need to collaborate with clinical colleagues to be responsive to changes in health care. Identifying challenging acute nursing episodes (CANE) that nurses' encounter in clinical practice and the aspect of competence that new graduate nurses require to manage these episodes effectively can inform undergraduate nursing curricula. Thus a qualitative, descriptive design was employed when undertaking a study to identify challenging acute nursing episodes which new graduates will encounter in clinical practice. Six focus groups were conducted in three university teaching hospitals in Ireland where a total of 28 registered nurses were recruited. Thematic analysis was used to extract themes from the focus group data. The results of this study identified 41 challenging acute nursing episodes and 4 key aspects of competence namely; patient assessment, technical/clinical skills; interactions and communications and clinical decision making. Findings of this study identify both the episodes which challenge new graduates and aspects of competence required by new graduates. These findings provide evidence for nurse educators to develop and deliver curricular content which is congruent with the realities of current day nursing practice.

mccarthy b. & murphy s. (2010) Journal of Nursing Management 18, 234–244 Preceptors’ experiences of clinically educating and assessing undergraduate nursing students: an Irish context Aim To explore preceptors’ views and experiences of preceptoring undergraduate nursing students. Background Undertaking a preceptoring role is acknowledged internationally as complex and challenging. With the introduction of the undergraduate degree programme in Ireland (2002), preceptors were assigned a more formal role in the teaching and assessing of students. As this was a new programme for students and an additional responsibility for preceptors, it was important to investigate how preceptors found this new experience. Methods Data were collected using a mixed methods descriptive approach. Results Many preceptors wanted to become a preceptor and enjoyed the role. The majority of preceptors found the role stressful and burdensome and did not feel adequately supported by their clinical managers. Preceptors expressed the need for protected time, support, feedback and recognition from management for undertaking this role. Conclusion Findings validate problems experienced with preceptoring in other English-speaking countries and contribute further to building a case for vital change in this component of nursing education and nursing practice. Implications for nursing management Managers should focus on the challenges expressed by preceptors in this study and identify appropriate strategies to carefully select, monitor and support preceptors in this complex role.

Summary Pneumatic tourniquets are used world wide to provide a bloodless surgical field for a variety of extremity surgeries. However, their use is not without potential for complications such as superficial skin injury and deep tissue injury. This national study of orthopaedic nurses in Ireland aimed to determine orthopaedic nurse's actual practices in caring for patients following surgical procedures where pneumatic tourniquets were used. A quantitative descriptive exploratory study of 69 experienced orthopaedic nurses reported finding skin insults beneath tourniquet cuff sites as well as extremity pain, stiffness and swelling. This study concludes that orthopaedic nurses have a key role in the detection and reporting of potential pneumatic tourniquet complications and makes recommendations for practice.

Summary Serious injuries to the musculoskeletal system can result in increased morbidity, long-term functional impairment, pain and deformity [Handoll, H., Madhok, R., 2003. Conservative interventions for treating distal radial fractures in adults. Cochrane. Database of Systematic Reviews: CD000314]. The clinical presentation of compartment syndrome is often indefinite and confusing leading to delays with diagnosis despite the presence of signs and symptoms [Schoen, D., 2000. Adult Orthopaedic Nursing. Philadelphia, Lippincott]. Thus, it follows the orthopaedic nurse is in a key position to conduct a comprehensive neurovascular assessment and to reduce the risk of neurovascular compromise [Schoen, D., 2000. Adult Orthopaedic Nursing. Philadelphia, Lippincott; Lucas, B., Davis, P., 2005. Why restricting movement is important. In: Kneale, J., Davis, P., (Eds.) Orthopaedic and Trauma Nursing, second ed. Edinburgh, Churchill Livingston]. An issue of concern was raised by clinicians in relation to difficulties encountered in accurately recording the neurovascular status of patients in a large urban university hospital in Southern Ireland. Consequently, a collaborative working group formed to develop upper and lower limb assessment tools combining academic and clinical practice perspectives. The evidence-based tools developed have been approved for clinical use with orthopaedic and plastic surgical patients. By sharing the experiences of this endeavour the group fulfill an appeal made in the literature which encourages nurse researchers who undertake scholarly activities, to share experiences of the practicalities involved in doing so [Mc Lafferty, I. 2004. Focus group interviews as a data collecting strategy. Journal of Advanced Nursing 48 (2), 187–194]. In this paper the experiences of a group of several grades of nurses engaged in a practice development project are outlined as well as the opportunities which arose as a result of collaborative working.

Health care organisations such as the World Health Organisation (WHO) and An Bord Altranais (ABA, The Irish Nursing Registration Board) demand higher standards of new graduate nurses than heretofore. This is in conjunction with the implementation of degree programmes for undergraduate nurse education. These organisations stipulate that graduates must be well-educated, accountable, and can demonstrate the skills of a safe, caring and competent decision-making practitioner. The Bachelor of Science (BSc) four-year degree programme for undergraduate nurse education was introduced in Ireland in 2002, and is provided in universities and colleges of higher education throughout The Republic of Ireland. During the implementation process, each university and college of higher education developed a range of assessment strategies to clinically assess students. Preceptor nurses were subsequently assigned the responsibility of clinically assessing students, a remit previously undertaken by Clinical Ward/Unit Nurse Managers. Preceptors are qualified nurses, working in clinical units who are specially prepared to support BSc students during clinical placements. The purpose of this study was to explore to what extent preceptor nurses use the devised assessment strategies to clinically assess BSc students in one university in The Republic of Ireland. Data were collected by using a questionnaire distributed to all known preceptors in General, Psychiatric and Intellectual Disability nursing, during year four of the first cycle of the BSc programme. Findings from this descriptive study revealed that many preceptors were inexperienced, did not fully comprehend the assessment process and were not applying all of the recommended assessment strategies when assessing students in clinical practice. In light of these findings suggestions are made in the context of further research, management and education.

Summary Pneumatic tourniquets are used in over 1 million surgical cases annually in North America [McEwen, J., 2005. Retrieved 2.10.2006 "Complications and preventative measures". ]. There is a paucity of nursing literature about the complications and preventative measures in relation to pneumatic tourniquet use. Pneumatic tourniquets may be used in surgical and nonsurgical settings to establish a bloodless field for extremity surgery and anaesthetic procedures. Nevertheless, their use may induce injuries that are commonly transient and even unnoticeable but some are permanent. Injuries vary depending on the inflated pressure, the duration of inflation and the physical status of the patient. Current evidence based research has predominantly come from medical research. This article outlines the historical background, relevant physiological changes induced by tourniquet during surgery and issues of nursing management relevant to orthopaedic nursing to prevent and reduce tourniquet injury.

This study sought to investigate the psychometric properties of the Posttraumatic Cognitions Inventory (PTCI; Foa et al., 1999, Psychol. Assess., 11, 303) among a cohort of older adolescents and to determine the relationship between post-traumatic cognitions and a variety of psychological outcomes including depression, anxiety, stress, and loneliness.The PTCI was investigated among a large sample (N = 785) of Northern Irish adolescents. Confirmatory factor analysis and composite reliability analysis were conducted to assess the psychometric properties of the scale.The familiar three-factor solution of negative cognitions of self, negative cognitions of the world and others, and self-blame was supported; however, it was necessary to remove eight items from the original 33-item scale. The three-factor structure was subsequently demonstrated to be factorially invariant across gender and to possess satisfactory internal reliability. The three PTCI factors were found to correlate with depression, anxiety, stress, and three dimensions of loneliness.These results provide the first piece of evidence that older adolescents cognitively respond to trauma in a similar manner to adults, that the PTCI is factorially invariant between genders, and that trauma cognitions are correlated with feelings of loneliness. The contextual dependent nature of the structure of the PTCI factors is discussed in relation to future research efforts.The PTCI is a valid and reliable measure of trauma-related cognitions among adolescents and works equally well for male adolescents and female adolescents. Trauma cognitions are associated with a range of mental health problems beyond post-traumatic stress disorder including depression, anxiety, stress, and various aspects of loneliness. Reductions in trauma cognitions in survivors of trauma will have wide-scale clinical benefits to patient well-being. The exact structure and make-up of items in the PTCI may well be dependent on culture, context, and the nature of the trauma. The study is limited due to the fact that the authors could not assess the severity of the trauma experienced by the adolescent sample.