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A clinical case is described of a patient diagnosed of prostate cancer under treatment with brachytherapy in the last three months. Due to this, the patient presents urinary retention and secondary acute renal failure. This case occurred during the COVID-19 confinament period. Appointments requested by the patient were by telephone and the family doctor, based on each case, decided and scheduled the in-person appointment. Considering this exceptional situation, we want to stress, first of all, the importance of a telephone interview as a filter to decide on the in-person care of the patient. On the other hand, the important role of the ultrasound as a tool to help in the primary care study, which, in the case of this patient, was fundamental to establish the diagnosis and send the patient without delay to the second care level

Introducción: la diabetes mellitus tipo 2 (DM2) es uno de los principales problemas epidemiológicos debido a la naturaleza compleja de la enfermedad. En el plano de atención individual, es necesario llevar a cabo intervenciones nutricionales y promover hábitos de alimentación saludables, utilizando herramientas que permitan una adecuada adherencia a dichas medidas. El objetivo de esta revisión es identificar, a través del análisis de la literatura, las estrategias dietéticas para el control de la DM2 y compararlas según su eficacia para lograr la adherencia del paciente. Métodos: se consultaron las bases de datos Pubmed, Scielo, Google Académico, Ovid y Web of Science con las palabras clave. Resultados: la educación a largo plazo provee conocimientos que el paciente puede utilizar como forma de empoderamiento para la toma de decisiones; sin embargo, estos estudios demostraron cómo la libertad de elegir los alimentos disminuye de manera considerable la adherencia nutricional. La intervención a través de menús establecidos o un control estricto genera buenos resultados a corto plazo, pero apenas logran la consciencia que permitirá al paciente ser responsable de la enfermedad. Este tipo de intervención parece hacer poco para ayudar al individuo a analizar la magnitud e importancia de modificar los hábitos dietéticos de forma saludable a largo plazo. Conclusión: la intervención constante a través de la educación en nutrición es efectiva en la tarea de crear adherencia de los pacientes con DM2 a tratamientos nutricionales a largo plazo. Palabras clave: intervenciones dietéticas, diabetes mellitus, adherencia, alimentos y educación en nutrición, evaluación, eficacia.

Understanding how patients can be engaged in safety-related activities at the direct care level is of current relevance given global efforts to reduce harm in hospitals. As part of a multiphase study, including a descriptive, exploratory qualitative study (Duhn & Medves, 2018), patients were asked to respond to a brief questionnaire to quantify how they viewed their patient-reported safety participation behaviours while in hospital. This paper is a summary of those responses. The 8-item questionnaire was, in part, used to help address a secondary research question of the larger qualitative study, specifically: What behaviours do patients report in promoting their safety while receiving care in hospital? Patients completed the questionnaire at the end of the face-to-face in-hospital interviews. Twenty-eight adult inpatients completed the questionnaire. Fifteen participants indicated that they ‘always’ or ‘usually’ checked their hospital medications; this was the second lowest rated activity. Most participants (n=20) believed they could rely on their knowledge and alertness to protect them from health-care error. Seventeen participants were in the high participation category. Given the prevalence of medication errors, patient involvement warrants further examination, including system supports to increase feasibility. Overall, a standardized, valid and reliable patient engagement in safety measure for the direct care level is required. Experience Framework This article is associated with the Policy & Measurement lens of The Beryl Institute Experience Framework. (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens.

espanolObjetivos. Tras los primeros meses de evolucion de la pandemia, los datos de infeccion de profesionales sanitarios en nuestro pais resultan dramaticos. Estos profesionales constituyen el colectivo con mas casos de covid-19; no se justifica la desproporcion de afectados de nuestro pais al compararla con la de los paises de nuestro entorno. En esta segunda encuesta, la SEMG se plantea el objetivo de conocer la situacion de los profesionales de atencion primaria (AP) en cuanto a la disponibilidad de recursos y acceso a pruebas para hacer frente la gestion de casos desde este nivel asistencial y, ademas, analizar la evolucion de ambos aspectos. Material y metodos. Se disena un estudio observacional, descriptivo, transversal, en formato de encuesta autocumplimentada, mediante un formulario online distribuido fundamentalmente por redes sociales, que alcanzo representacion en todo el territorio nacional. Respondieron a esta encuesta 1.210 profesionales entre los dias 24 de abril y 6 de mayo de 2020, momento del traspaso de la gestion de casos a la AP. Resultados. La disponibilidad de equipos de proteccion individual (EPI) por parte de los profesionales era insuficiente, ya que solo el 17,9 % disponia del equipo completo en la cantidad necesaria y un 30,5 % no disponian de ello. El 11,3 % de profesionales tenian acceso completo siempre que fuera necesario a peticion de PCR, el 6,9 % a la solicitud de test rapidos de anticuerpos, el 40,5 % a la peticion de analitica completa, el 61,8 % a la peticion de radiologia y el 16,9 % a la peticion de TAC. El nivel de proteccion que manifestaron sentir los profesionales en su puesto de trabajo presento una media de 5,42 y el nivel de preocupacion de 8,68, ambos sobre 10. Conclusiones. Es necesario adoptar medidas urgentes correctoras de esta situacion para poder seguir haciendo frente a esta pandemia y gestionar los casos de la misma en el nivel comunitario por parte de AP. EnglishObjectives. After the first months of evolution of the pandemic, the data of infections of the health care professionals in our country are dramatic. These professionals make up the group having the most cases of COVID-19. The disproportion of those affected in our country is not justified when it is compared with that of the countries of our setting. In this second survey, the SEMG contemplates the objective of knowing the situation of the primary health care (PC) professionals regarding availability of resources and access to tests to cope with the cases from this care level and, also, to analyze the evolution of both aspects. Material and methods. An observational, descriptive, cross-sectional study has been designed, using a self-completion survey format, with an online form basically distributed through social networks, which reached a representative distribution of the entire national territory. A total of 1210 professionals answered this survey between 24 April and 6 May 2020, moment in when the management of the cases was transferred to Primary Care. Results. The availability of individual protection equipments (IPE) by the professionals was insufficient, since only 17.9% had the necessary complete equipment and 30.5% did not have it. Of the professionals, 11.3% had complete access whenever necessary to request PCR, 6.9% to the request for rapid test of antibodies, 40.5% to request for complete analysis, 61.8% to request an X-ray and 16.9% to CT scan request. The level of protection that the professionals stated they felt in their work site was a mean of 5.42 and level of concern 8.68, both of which were on a ratio of 1 to 10. Conclusions. Urgent corrective measures of this situation must be adopted in order to be able to continue coping with this pandemic and to manage the cases on the community level by PC.

Body reactions to drugs can manifest as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). TEN is the most severe form of cutaneous reactions with an incidence rate of 1-2 per million cases per year. Despite TEN being a critical and life-threatening condition, there is little to no evidence of clear management protocol. We reported a 5-year-old male child who presented with lamotrigine-induced TEN and was successfully treated with intravenous immune globulin (IVIG) with a burn unit care level, while TEN treatment with IVIG is an appropriate approach with predictable good outcomes, burn unit care is also effective in creating highly favorable effects. Upon reviewing the literature, several studies indicate that TEN patients treated with the combination of IVIG and burn unit care lead to decreased levels of morbidity and mortality than when treated with IVIG or burn unit care alone. Therefore, treatment involving both IVIG and burn unit care should be considered for TEN patients.

Older adults undergoing emergency abdominal surgery have significantly poorer outcomes than younger adults. For those who survive, the level of care required on discharge from hospital is unknown and such information could guide decision-making. The ELF (Emergency Laparotomy and Frailty) study aimed to determine whether preoperative frailty in older adults was associated with increased dependence at the time of discharge.The ELF study was a UK-wide multicentre prospective cohort study of older patients (65 years or more) undergoing emergency laparotomy during March and June 2017. The objective was to establish whether preoperative frailty was associated with increased care level at discharge compared with preoperative care level. The analysis used a multilevel logistic regression adjusted for preadmission frailty, patient age, sex and care level.A total of 934 patients were included from 49 hospitals. Mean(s.d.) age was 76·2(6·8) years, with 57·6 per cent women; 20·2 per cent were frail. Some 37·4 per cent of older adults had an increased care level at discharge. Increasing frailty was associated with increased discharge care level, with greater predictive power than age. The adjusted odds ratio for an increase in care level was 4·48 (95 per cent c.i. 2·03 to 9·91) for apparently vulnerable patients (Clinical Frailty Score (CFS) 4), 5·94 (2·54 to 13·90) for those mildly frail (CFS 5) and 7·88 (2·97 to 20·79) for those moderately or severely frail (CFS 6 or 7), compared with patients who were fit.Over 37 per cent of older adults undergoing emergency laparotomy required increased care at discharge. Frailty scoring was a significant predictor, and should be integrated into all acute surgical units to aid shared decision-making and discharge planning.Los adultos mayores sometidos a cirugía abdominal de urgencia tienen resultados significativamente peores que los adultos jóvenes. Para aquellos pacientes que sobreviven, el nivel de atención que requieren tras el alta hospitalaria se desconoce y esta información podría servir de guía en la toma de decisiones. El estudio ELF (Emergency Laparotomy and Frailty) tenía como objetivo determinar si la fragilidad preoperatoria en adultos mayores se asociaba con un aumento de la dependencia en el momento del alta. MÉTODOS: El estudio ELF era un estudio multicéntrico extenso efectuado en el Reino Unido (n = 49) que incluyó una cohorte prospectiva de 934 pacientes mayores ( 65 años) sometidos a laparotomía de urgencia durante marzo-junio de 2017. El objetivo fue establecer si la fragilidad preoperatoria aumentaba el nivel de asistencia en el momento del alta en comparación con el nivel de asistencia preoperatorio. Para el análisis se utilizó una regresión logística multinivel ajustada a características previas al ingreso: fragilidad, edad del paciente, género, y nivel de asistencia.La edad media de los pacientes fue 76,2 años (DE = 6,83), con un 57% de mujeres, un 20,2% de pacientes frágiles y un 37,4% de adultos mayores que presentaron un aumento en el nivel de asistencia en el momento del alta. Un aumento de la fragilidad se asoció con un incremento en el nivel de asistencia en el momento del alta (y mayor poder predictivo que la edad). La razón de oportunidades (odds ratio, OR) ajustada por el aumento del nivel de asistencia fue 4,48 (i.c. del 95% 2,03-9,91) para pacientes aparentemente vulnerables (Clinical Frailty Scale, CFS 4); 5,94 (i.c. del 95% 2,54-13,90) para aquellos ligeramente frágiles (CFS 5); y 7,88 (i.c. del 95% 2,97-20,79) para aquellos con fragilidad moderada o grave (CFS 6 and 7) en comparación con pacientes en buenas condiciones. CONCLUSIÓN: Este es el primer estudio que documenta que más del 37% de adultos mayores sometidos a laparotomía de urgencia precisaron un aumento en el nivel de asistencia en el momento del alta. La evaluación de la fragilidad debería integrarse en todas las unidades quirúrgicas de agudos para ayudar a compartir la toma de decisiones y los planes de tratamiento.

This study aims to investigate the factors of care-level deterioration in older adults with mild and moderate disabilities using nationally standardized survey data for care-needs certification. We enrolled people aged 68 years or older, certified as support levels 1–2 (mild disability) or care levels 1–2 (moderate disability) with no cancer. The outcome was care-level deterioration after two years. The possible factors were physical and mental functions which were categorized as the following five dimensions according to the survey for care-needs certification: body function, daily life function, instrumental activities of daily living (IADL) function, cognitive function, and behavioral problems. A multivariate logistic regression analysis was conducted after stratifying the care level at baseline. A total of 2844 participants were included in our analysis. A low IADL function was significantly associated with a risk of care-level deterioration in all participants. In addition, low cognitive function was linked to care-level deterioration, except for those with support level 1 at baseline. Participants with more behavioral problems were more likely to experience care-level deterioration, except for those with care level 2 at baseline. Our study showed the potential utility of the care-needs certification survey for screening high-risk individuals with care-level deterioration.

Private rooms are widely preferred by residents in senior homes. However, having roommates may help them to maintain social networks, leading to promoted social cohesion and health. The differences in social cohesion among senior-home residents who reside in private or shared rooms need investigation. Focusing on social cohesion and room arrangement, on-site questionnaire surveys recruited 345 residents from eight senior homes in Beijing and Shanghai, China. Controlling for personal and facility factors, ANOVA tests were employed to investigate the differences in social cohesion among residents who resided in private or shared rooms. Room arrangement was found significant to social cohesion in assisted-living and nursing-care residents. At the assisted-living level, triple-room (room shared by three) residents had stronger social cohesion than private-room or double-room (room shared by two) residents (p ≤ 0.01). At the nursing-care level, residents with less roommates had stronger social cohesion (p ≤ 0.05). At the independent-living level, no factors significant to social cohesion was found. The influences of room arrangement on social cohesion vary by care level and facility. To promote social cohesion, triple rooms are suggested for assisted-living care whereas private rooms are more appropriate for nursing care. Senior-living rooms should be social-friendly through appropriate arrangement in cultural contexts.

Health care systems around the world are now facing unprecedented challenges due to various factors including the tsunami of ageing populations, unhealthy lifestyles and diets as well as the recurrent and new emergence of infectious diseases such as flu and COVID-19. Government’s health policies need to be revisited in an attempt to put extra efforts and resources in primary care and public health. Despite the Alma-Ata Declaration of the international primary health care (PHC) conference signed in 1978, PHC models nowadays need to shift the paradigm from ‘sick care’ to ‘health care’ with the innovative model of ‘Smart Health Communities' (SHC). SHC address various stakeholders involved in enhancing the health of the citizens in the localities or cities. This initiative is within the domain of ‘Smart Cities’ with the adoption of ‘Internet of Things’ to enhance the collection of essential health data about the health status of patients and citizens in the community. SHCs are especially important in primary and community care. By means of case studies of Hong Kong and Australia, the values and impacts of using digital health and networked technologies such as wearables, electronic health record systems to facilitate SHC are highlighted to address the factors for success and the difficulties encountered. These experiences gained from Asia-Pacific regions are deemed to be the learning points for other cities to reflect about their health care systems especially in community care level so as to innovate and to further shift their focus from sick care to health care.

Indonesia, as the country with the world’s largest Muslim population, has issued a regulation on halal product assurance (UU JPH) Act No. 33/2014. Furthermore, the consumers’ care on the halal food is another significant element in the implementation of this regulation. This study concerns on how the students of Islamic Senior High School (MA) in Surakarta care on the halal food products. This is a quantitative study in which data were collected using questioners. There are 430 selected students participated in this study. Data was analyzed using descriptive analysis by counting the mean score and classified into four categories namely; do not care, less care, quite care, and care. Findings of this research showed that most students are “quite care” for halal product, but they mostly did not ask to the merchants whether the product they bought to have “haram” ingredients or not. Moreover, the majority of students sometimes checked the halal label on the product, while others did not check them at all. Overall, the students’ care level toward halal product is categorized as at the “quite care”. This result indicated that it needs more concern from the related stakeholders on how the students can be more attentive toward halal food products.

Introdução: O suicídio é tido como um fenômeno complexo, multicausal, fruto da interação de fatores de ordem filosófica, biológica, antropológica, psicológica, e social, considerado nos dias de hoje um grave problema de saúde pública. Objetivo: realizar uma análise documental dos materiais lançados pelo SUS relacionados às medidas a serem adotadas em casos e tentativas de suicídio, bem como nos meios previni-las. Método: trata-se de um estudo descritivo, no qual foram verificadas as portarias e manuscritos do SUS relacionadas ao suicídio, tendo sido consultados oito documentos oficiais. Resultados: a primeira portaria a tratar especificamente do assunto, Portaria nº 1.876, foi lançada em 2006, e instituiu as Diretrizes Nacionais para Prevenção do Suicídio, norteando as estratégias do Ministério da Saúde para atuação e contenção do fenômeno. A partir dela, outros documentos foram instituídos, visando o aprimoramento do acesso, acolhimento, e tratamento aos indivíduos predispostos a desenvolverem depressão, ou que estão em situações de risco, além de garantir maiores esforços e investimentos para grupos específicos. Conclusões: as portarias estabelecidas garantem ao usuário do SUS acolhimento e acompanhamento, desde o nível de atenção básica até a atenção especializada.

The article discussesthe currentstate of the care level for fetuses, newborns and children with congenital abnormalities of the cardiovascular system. There are considered the features of prenatal diagnostics of heart defects and aspects of the management of pregnancy and childbirth of women with the specified pathology in the fetus. The authors made the analysis of the existing problems in the diagnosis and treatment of congenital heart defects and heart rhythm disorders in children. The article substantiates the introduction of the perinatal cardiology concept and formulates the main issues to be solved at this stage of development.

Wahrend soziookonomische Unterschiede in der Sterblichkeit im mittleren Lebensalter gut erforscht sind, ist uber deren Ausmas in der hochaltrigen Bevolkerung wenig bekannt. Surveys und Follow-up-Studien von Volkszahlungen sind in dieser Altersgruppe mit Zuverlassigkeits- und Gultigkeitsproblemen behaftet. Durch Verknupfung statistischer Informationen aus Registerdaten soll untersucht werden, in welchem Ausmas bei hochaltrigen Mannern in Osterreich Sterblichkeitsunterschiede nach soziookonomischen Variablen wie Bildung und Einkommen bestehen und inwieweit diese durch unterschiedliche Gesundheitszustande erklarbar sind. Die Datensatze zu den bei der osterreichischen Registerzahlung 2011 erfassten Mannern im Alter von 80 bis 99 Jahren werden um Informationen aus Steuer- und Sozialversicherungsdaten angereichert und mit den Sterbefallen im Zeitraum bis 5 Jahre nach der Zahlung verknupft. Relative Sterberisiken werden mittels Cox-Regression geschatzt. Der Gesundheitszustand wird durch die Pflegestufe operationalisiert. Auch bei hochaltrigen Mannern bestehen signifikante Mortalitatsunterschiede nach soziookonomischem Status: Bei der Bildung zeigt sich ein kontinuierlicher Effekt, beim Einkommen ein Armutseffekt. Kontrolliert man neben dem Alter zusatzlich die Pflegestufe, zeigen sich keine soziookonomischen Unterschiede mehr. Das hohere Sterblichkeitsniveau niedrig gebildeter bzw. einkommensschwacher hochaltriger Manner ist also Folge ihres schlechteren Gesundheitszustands. Im Alter uber 80 Jahren ist der Gesundheitszustand der relevante Einflussfaktor auf die Sterblichkeit. Masnahmen zur Verringerung soziookonomischer Mortalitatsunterschiede mussen also in fruheren Lebensphasen ansetzen, um das Ausmas der Pflegebedurftigkeit in sozial benachteiligten Gruppen zu verringern.

Background To evaluate the success of plaque reduction after external toothbrushing by instructed laypeople versus dental professionals using either a manual or powered toothbrush. Longitudinal, randomized, parallel-group intervention study in periodontitis patients with reduced oral hygiene quality undergoing anti-infective therapy. Patients were randomly and equally assigned to one of four groups: laypeople using a manual or powered toothbrush or dental professionals using a manual or powered toothbrush. Plaque reduction (Quigley–Hein-Index (QHI), Marginal Plaque Index (MPI)), gingivitis (papilla bleeding index), and cleaning time (seconds) were investigated. Results Thirty-nine patients participated in the study. Neither the choice of toothbrush (p = 0.399) nor the use of a dental professional (p = 0.790) had a significant influence on plaque levels achieved. However, multivariate modeling indicated statistically significant differences in the external cleaning time between brushing groups, with longer time required by laypeople (p = 0.002) and longer use of the powered toothbrush (p = 0.024). Conclusion When the ability to carry out personal oral hygiene is reduced, external brushing by dental professionals or instructed laypeople who meet previously defined criteria such as sufficient personal oral hygiene at home could help to fill the emerging dental care gap. A combination of oral hygiene approaches adapted to the individual needs of the patients in need of external help is necessary for optimum oral hygiene. Trial registration: German Clinical Trials register (https://www.germanctr.de; number DRKS00018779; date of registration 04/11/2019).

The aim of this study was to investigate the possible relations between sibling care level and the areas of interest in adolescents’ life purposes. Participants were 113 adolescents. The instruments were a record of socio-demographic data, the household tasks and Sibling Care Questionnaire, and a written testimony on life purpose. We identified 347 life projects, which were grouped into the following categories: career, family, possessions, happiness, and generosity. The results of the Pearson’s correlations indicated positive associations between sibling care and generosity and career. Thus, there is a tendency that adolescents who take care of their younger siblings have more life projects related to assisting the family of origin and to professional development. These results suggest that taking care of younger siblings may influence the areas of interest of adolescents’ life purposes.

Background Although the overall quality of high-risk neonatal care has improved recently, there is still concern about a difference in the quality of care when comparing off-hour births and regular-hour births. Moreover, there are no data in Korea regarding the impact of time of birth on mortality and morbidities in preterm infants. Methods A total of 3,220 infants weighing < 1,000 g and born at 23–34 weeks in 2013–2017 were analyzed based on the Korean Neonatal Network data. Mortality and major morbidities were analyzed using logistic regression according to time of birth during off-hours (nighttime, weekend, and holiday) and regular hours. The institutes were sub-grouped into hospital group I and hospital group II based on the neonatal intensive care unit (NICU) care level defined by the mortality rates of < 50% and ≥ 50%, respectively, in infants born at 23–24 weeks' gestation. Results The number of births during regular hours and off-hours was similar. In the total population and hospital group I, off-hour births were not associated with increased neonatal mortality and morbidities. However, in hospital group II, increased early mortality was found in the off-hour births when compared to regular-hour births. Conclusion Efforts to improve the overall quality of NICU are required to lower the early mortality rate in off-hour births. Also, other sensitive indexes for the evaluation of quality of NICU care should be further studied., Graphical Abstract

BackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment. The aim of this study was to test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients. MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (pConclusionsROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.

BackgroundHigh prevalence of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism as well as microembolization of vital organs may in these individuals be direct causes of death. The identification of patients at high risk of developing thrombosis may lead to targeted, more effective prophylactic treatment.ObjectivesTo test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in COVID-19 patients, and whether patients with severe disease have a more pronounced hypercoagulopathy compared with less severely ill patients.MethodsThe study was designed as a prospective observational study where COVID-19 patients over 18 years admitted to hospital were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken after admission and the data were compared with ROTEM in healthy controls.ResultsThe ROTEM variables Maximum Clot Firmness (EXTEM-/FIBTEM-MCF) were higher in COVID-19 patients compared with healthy controls (pConclusionROTEM variables were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease severity, suggesting that ROTEM-analysis may be useful to predict thromboembolic complications in these patients.

Background To improve harm prevention, patient engagement in safety at the direct care level is advocated. For patient safety to most effectively include patients, it is critical to reflect on existing evidence, to better position future research with implications for education and practice. Methods As part of a multi‐phase study, which included a qualitative descriptive study (Duhn & Medves, 2018), a scoping review about patient engagement in safety was conducted. The objective was to review papers about patients’ attitudes and behaviours concerning their involvement in ensuring their safe care. The databases searched included MEDLINE, CINAHL and EMBASE (year ending 2019). Results This review included 35 papers about “Patient Attitudes” and 125 papers about “Patient Behaviours”—indicative of growing global interest in this field. Several patterns emerged from the review, including that most investigators have focused on a particular dimension of harm prevention, such as asking about provider handwashing, and there is less known about patients’ opinions about their role in safety generally and how to actualize it in a way that is right for them. While patients may indicate favourable attitudes toward safety involvement generally, intention to act or actual behaviours may be quite different. Conclusion This review, given its multi‐focus across the continuum of care, is the first of its kind based on existing literature. It provides an important international “mapping” of the initiatives that are underway to engage patients in different elements of safety and their viewpoints, and identifies the gaps that remain.

The aim of this study was to evaluate the effect of an oral care intervention program on the incidence of pneumonia and fever as a surrogate endpoint. In addition, we tried to determine the oral care risk factors for the incidence of fever. We provided an oral care program for the elderly at one private nursing home in July 2013. The maximum capacity of the nursing home was 60 residents. The body temperatures of all residents were measured twice a day and were summarized as the incidence of fever over a one-month period, which was used as the dependent variable. The residents’ life conditions, number of teeth, and prescribed diet were used as independent variables. The factors that affected the incidence of fever were the number of remaining teeth, a prescribed diet of sliced food, the meal care level, and the oralCandidalevels. These risk factors affected the incidence of fever independently or interactively with oral care. Some risk factors for the incidence of fever were enhanced by the oral care program. It is important to evaluate and control these factors before the implementation of an oral care program.