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Generative Artificial Intelligence is set to revolutionize healthcare delivery by transforming traditional patient care into a more personalized, efficient, and proactive process. Chatbots, serving as interactive conversational models, will probably drive this patient-centered transformation in healthcare. Through the provision of various services, including diagnosis, personalized lifestyle recommendations, dynamic scheduling of follow-ups, and mental health support, the objective is to substantially augment patient health outcomes, all the while mitigating the workload burden on healthcare providers. The life-critical nature of healthcare applications necessitates establishing a unified and comprehensive set of evaluation metrics for conversational models. Existing evaluation metrics proposed for various generic large language models (LLMs) demonstrate a lack of comprehension regarding medical and health concepts and their significance in promoting patients’ well-being. Moreover, these metrics neglect pivotal user-centered aspects, including trust-building, ethics, personalization, empathy, user comprehension, and emotional support. The purpose of this paper is to explore state-of-the-art LLM-based evaluation metrics that are specifically applicable to the assessment of interactive conversational models in healthcare. Subsequently, we present a comprehensive set of evaluation metrics designed to thoroughly assess the performance of healthcare chatbots from an end-user perspective. These metrics encompass an evaluation of language processing abilities, impact on real-world clinical tasks, and effectiveness in user-interactive conversations. Finally, we engage in a discussion concerning the challenges associated with defining and implementing these metrics, with particular emphasis on confounding factors such as the target audience, evaluation methods, and prompt techniques involved in the evaluation process.

Objective: Patients taking antiresorptive medications in dental clinics are at risk of medication-related osteonecrosis of the jaw (MRONJ), which poses daily challenges for their clinicians. This paper aimed to summarize and revisit the three most recognized practice guidelines for the management and prevention of MRONJ, which were proposed by the American Association of Oral and Maxillofacial Surgeons (AAOMS), and presented by the Journal of Bone and Mineral Research (JBMR) and the Journal of Clinical Oncology (JCO). Results and case studies: The AAOMS position paper focused on risk stratification by different medications, management decision trees, risk factors, pathophysiology, and disease staging. The JBMR international consensus presented eight focused questions, which were addressed by systematic reviews. The JCO clinical practice guideline presented six clinical questions, and each concluded with practical recommendations. Practical information was summarized and converted into an adoptable patient care workflow for clinicians to follow and apply in daily practice. Three case studies presented were treated following these guidelines. Each patient underwent advanced surgeries including alveoloplasty, tooth extraction, implant placement, and particulate bone grafting. Some of the considerations not fully informed were discussed and illustrated in each step of the patient care workflow, which included specifics for risk communication, updates on the use of antibiotics, biomarkers, and drug holidays. Conclusion and practical implications: Structured risk communication with official informed consent documentation should be considered before initiating invasive treatments. Disease control phase with home care therapy should be provided prior to staged reconstructive therapy. Drug holidays and antibiotics coverage can be customized based on individual conditions and related procedures with interprofessional coordination. [ABSTRACT FROM AUTHOR]

Despite explicit expectations and accreditation requirements for integrated curriculum, there needs to be more clarity around an accepted common definition, best practices for implementation, and criteria for successful curriculum integration. To address the lack of consensus surrounding integration, we reviewed the literature and herein propose a definition for curriculum integration for the medical education audience. We further believe that medical education is ready to move beyond “horizontal” (1-dimensional) and “vertical” (2-dimensional) integration and propose a model of “6 degrees of curriculum integration” to expand the 2-dimensional concept for future designs of medical education programs and best prepare learners to meet the needs of patients. These 6 degrees include: interdisciplinary, timing and sequencing, instruction and assessment, incorporation of basic and clinical sciences, knowledge and skills-based competency progression, and graduated responsibilities in patient care. We encourage medical educators to look beyond 2-dimensional integration to this holistic and interconnected representation of curriculum integration.

INTRODUCTION: Ethics consultations are often needed at difficult junctures of medical care. However, data on the nature of how patient characteristics, including race/ethnicity, language, and diagnosis, affect ethics consult outcomes are lacking. METHODS: We performed a retrospective cohort study of all patients who were seen by the Ethics Consult Service between 2017 and 2021 at a large tertiary academic center with the aim of determining whether patient demographic and clinical factors were associated with the timing of ethics consult requests and recommendations of the ethics team. RESULTS: We found that patients admitted for COVID-19 had significantly longer median times to consult from admission compared with other primary diagnoses (19 vs 8 days respectively, p = 0.015). Spanish-speaking patients had longer median times to consult from admission compared to English speaking patients (20 vs 7 days respectively, p = 0.008), indicating that language barriers may play a role in the timing of ethics consultation. CONCLUSIONS: This study demonstrates the need to consider clinical and demographic features when planning and prioritizing ethics consultations at large institutions to enhance consult efficiency, resource utilization, and patient experience and autonomy.

Background: Craniotomy to remove brain tumors is an intricate procedure with multiple postoperative symptoms. However, there has been limited research on the symptom networks of these patients. To this end, this study aims to explore these symptom networks, revealing their interplay to inform better symptom control, hasten the discovery of postoperative issues, and tailor Enhanced Recovery After Surgery (ERAS) protocols, all to enhance recovery and enhance patient care. Methods: From September 2023 to March 2024, 211 patients with primary brain tumors who underwent craniotomy at Shanghai Tongji Hospital were recruited. Their symptoms were assessed using the MDASI-BT (M.D. Anderson Symptom Inventory Brain Tumor Module) one day post-craniotomy. The symptom network of 22 symptoms was visualized using R, with central and bridge symptoms identified. Results: Sadness (rs=2.482) and difficulty in understanding (rs=1.138) have the highest strength of all symptoms, indicating they are the central symptoms. Sadness (rb=2.155) and loss of appetite (rb=1.828) have the highest value of betweenness, indicating they are the bridge symptoms. Strong correlations were found between difficulty in understanding and difficulty in speaking (r = 0.701), distress and sadness (r = 0.666), fatigue and lethargy (r = 0.632), and nausea and vomiting (r = 0.601). Subgroup analysis revealed that noninvasive tumor patients exhibited similar symptom networks to the overall cohort, whereas invasive tumor patients showed weak symptom connections, resulting in no discernible network. Conclusion: This study underscores the importance of understanding symptom networks in brain tumor patients post-craniotomy, highlighting key symptom interrelationships. These insights can guide more effective symptom management, early complication detection, and optimization of ERAS protocols, ultimately enhancing recovery and patient care. [ABSTRACT FROM AUTHOR]

Specialist stoma care nurses (SSCNs) are highly educated professionals who play a critical role in the care of people living with a stoma. However, they experience some unique challenges. Currently in the UK, stoma care has no national standards, targets or best practice pathway, resulting in significant variation and an undervalued service. As members of an evidence-based profession, SSCNs need to demonstrate their value. Specialist nurses in cancer care and inflammatory bowel disease are supported by nationally, with pathways, targets and standards of care, as well as career and education frameworks. This system could be used for SSCNs. A national approach is needed to develop an evidence-based best-practice pathway, commissioned and implemented across the UK for all stoma patients and with SSCNs at its heart. SSCNs need to demonstrate their value through data and evidence. Working with Getting it Right First Time, a taskforce aims to review the evidence and establish minimum standards of care for all stoma patients. SSCNs should be co-ordinators and drivers of change at the highest level of national innovation, policy and decision-making. The work of SSCNs should be is recognised and valued because what they do matters. [ABSTRACT FROM AUTHOR]

Colostomy irrigation is a procedure that allows patients to achieve a certain degree of bowel control, and a period free of stoma effluent. It has the potential to improve quality of life, body image and confidence, and reduce patient anxiety. It may also help reduce odour and flatus, prevent/address peristomal skin irritation and alleviate constipation. Because it can reduce or eliminate the need for a colostomy bag, it may also cut expenditure on stoma appliances. However, colostomy irrigation is not offered to patients as standard. A protocol was drawn up to ensure colostomy irrigation was routinely offered to suitable patients and to provide them with a structured follow-up to ensure they were well supported throughout the first year of carrying out the procedure. Quality of life and the efficacy of colostomy irrigation can be monitored using questionnaires on these two issues. Two case studies demonstrate how patients' quality of life can improve when using colostomy irrigation as part of their stoma care routine. [ABSTRACT FROM AUTHOR]

Postoperative stoma education is an essential aspect of care for all types of stoma formation because having a stoma impacts on every aspect of a person's life. This critical review of the literature explores stoma patients' needs and wants; postoperative education care guidelines; the role of ward link nurses; and care pathways. The findings from this review demonstrate that there is no national standard postoperative stoma care pathway, yet such pathways are a cost-effective means to improve patient outcomes and care. The review also identified that structured care pathways are not a new concept, but there is a lack of formal research to determine best practice in postoperative stoma education. In the UK, there is wide variation in practice and outcomes, which means that effectiveness cannot be accurately measured. The author has developed and implemented a multidisciplinary postoperative education pathway in line with a national need to further refine postoperative stoma care services to meet stoma patients' needs. [ABSTRACT FROM AUTHOR]

Events such as the COVID-19 pandemic and the war in Ukraine have increased people's awareness of mental health issues. Psychological trauma impacts patients in the acute care setting through physical and mental health presentations. Trauma is a public health issue crossing all socioeconomic groups and is related to social determinants of health. Trauma-informed care (TIC) is an evidence-based approach to providing care. TIC is within the scope of nursing practice and improves outcomes for patients. However, there is a lack of standard terms or practices within healthcare. Additionally, there is superficial acknowledgment of the need for TIC at the local or national level regarding policy. Nurses need to adopt TIC into practice and advocate for policy change to improve the health and lives of those seeking care. [ABSTRACT FROM AUTHOR]

Mycetoma is a debilitating neglected tropical disease that affects individuals worldwide, particularly in regions where there is poverty and limited health care access. The Mycetoma Research Center (MRC), based in Khartoum, Sudan, provides a sustainable, holistic approach to patient care as the only World Health Organization collaborating center for mycetoma. We describe MRC activities that align with the United Nations' Sustainable Development Goals to control mycetoma in Sudan and globally. [ABSTRACT FROM AUTHOR]

Multiple myeloma, a complex hematologic malignancy, has devastating consequences for patients, including dramatic bone loss, severe bone pain, and pathological fractures that markedly decrease the quality of life and impact the survival of affected patients. This necessitates a refined understanding of biomarkers for accurate diagnosis and prognosis of such severe malignancy. Therefore, this article comprehensively covers current research, elucidating the diverse spectrum of biomarkers employed in clinical settings. From traditional serum markers to advanced molecular profiling techniques, the review provides a thorough examination of their utility and limitations. Through this scoping review, emphasis is placed on the evolving landscape of personalized medicine, where biomarkers play a pivotal role in tailoring therapeutic strategies. The integration of genomic, proteomic, next generation sequencing and flow cytometric data further enriches the discussion, unravelling the molecular intricacies underlying disease progression. The updated criteria allow for the treatment of people who clearly would benefit from therapy and might live longer if treated before significant organ damage occurs. Navigating through the evolving diagnostic and prognostic paradigms in multiple myeloma, this article equips clinicians and researchers with crucial insights for optimizing patient care and advancing future therapeutic approaches. [ABSTRACT FROM AUTHOR]

Assessment of pressure ulcer (PU) risk remains a challenge in clinical practice. The first part of this article (Martin and Holloway, 2024) discussed the evidence base underpinning the development of clinical guidelines for PUs alongside the creation of the bundle approach regarding PU prevention. This article, part two, presents the results of a clinical audit that explores compliance against a PU prevention bundle (the aSSKINg framework) in an adult community nursing setting in the south-east of England. The clinical audit was conducted between July-December 2021 and included records of 150 patients. Overall, compliance against the aSSKINg framework was poor, with only two criterion being met: equipment provision for chair and referral to the tissue viability team. Short-term recommendations are that mandatory PU training for staff in the management of PUs should be implemented, and the tissue viability nurse network should be increased. The long-term recommendation was the introduction of the aSSKINg framework as a template into the electronic patient record. [ABSTRACT FROM AUTHOR]

The diagnosis of mycobacterial infections, including both the Mycobacterium tuberculosis complex (MTBC) and non-tuberculous mycobacteria (NTM), poses a significant global medical challenge. This study proposes a novel approach using immunochromatographic (IC) strip tests for the simultaneous detection of MTBC and NTM. Traditional methods for identifying mycobacteria, such as culture techniques, are hindered by delays in distinguishing between MTBC and NTM, which can affect patient care and disease control. Molecular methods, while sensitive, are resource-intensive and unable to differentiate between live and dead bacteria. In this research, we developed unique monoclonal antibodies (mAbs) against Ag85B, a mycobacterial secretory protein, and successfully implemented IC strip tests named 8B and 9B. These strips demonstrated high concordance rates with conventional methods for detecting MTBC, with positivity rates of 93.9% and 85.9%, respectively. For NTM detection, the IC strip tests achieved a 63.2% detection rate compared to culture methods, considering variations in growth rates among different NTM species. Furthermore, this study highlights a significant finding regarding the potential of MPT64 and Ag85B proteins as markers for MTBC detection. In conclusion, our breakthrough method enables rapid and accurate detection of both MTBC and NTM bacteria within the BACTEC MGIT system. This approach represents a valuable tool in clinical settings for distinguishing between MTBC and NTM infections, thereby enhancing the management and control of mycobacterial diseases. Key points: • Panel of mAbs for differentiating MTB versus NTM • IC strips for diagnosing MTBC and NTM after the BACTEC MGIT • Combined detection of MTP64 and Ag85B enhances diagnostic accuracy [ABSTRACT FROM AUTHOR]

This literature review examines the impact of orthopaedic trauma on patient mental health. It focuses on patient outcomes, available resources, and healthcare provider knowledge and education. Orthopaedic trauma represents a significant physical and psychological burden for patients, often resulting in long-term disability, pain, and functional limitations. Understanding the impact of orthopaedic trauma on patient mental health is crucial for improving patient care, and optimizing recovery and rehabilitation outcomes. In this review, we synthesize the findings of empirical studies over the past decade to explore the current understanding of mental health outcomes in patients with orthopaedic trauma. Through this analysis, we identify gaps in existing research, as well as potential avenues for improving patient care and mental health support for patients with severe orthopaedic injuries. Our review reveals the pressing need for collaboration between healthcare providers, mental health professionals, and social support systems to ensure comprehensive mental care for patients with traumatic orthopaedic injuries. [ABSTRACT FROM AUTHOR]

BACKGROUND Botulinum toxin (BoNT) has evolved as a popular treatment for various medical and aesthetic conditions since the 1980s. The emergence of new liquid formulation BoNT products in the industry highlights the need to evaluate the value and advantages of these modern formulations. OBJECTIVE The aim of this review was to assess and compare the expected difference in practice between liquid and powder formulation BoNT products. PAITENTS AND METHODS/MATERIALS This article involves a review of pertinent guidelines, product information from manufacturers, available database for safety reports, and survey results. RESULTS Guidelines and safety reports have pointed out potential risks in the reconstitution process, while medication preparation steps are simplified in liquid formulation. CONCLUSION The shift toward ready-to-use liquid products can mitigate risks related with reconstitution errors and potentially enhancing patient care by saving time and cost associated with medication preparation. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusion Impact Reporting Method Patient or Public Contribution To examine the organisational (i.e., perceived organisational support and psychologically safe environment) and individual (i.e., value, belief and norm) antecedents that strengthen healthcare workers' speaking‐up behaviour in a developing economy.The study uses a cross‐sectional design to gather the same data from healthcare workers within the Ashanti Region of Ghana.The data collection happened between 15 June and 30 August 2023. A sample of 380 healthcare workers was selected from 20 facilities in the Ashanti Region of Ghana. A configurational approach, a fussy‐set qualitative comparative analysis, was used to identify the configurations that caused high and low speaking‐up behaviour among the study sample.The study results reveal that whereas four configurations generate high speaking‐up behaviour, three configurations, by contrast, produce low speaking‐up behaviour among healthcare workers.Results suggest that in so far as organisational support systems which take the form of a psychologically safe environment and perceived organisational support are vital in relaxing the hierarchical boundaries in a healthcare setting to improve healthcare workers' speaking‐up behaviour, the individual value‐based factors that take the form of values, beliefs and norms are indispensable as it provides the healthcare workers with the necessary inner drive to regard speaking‐up behaviour on patient safety and care as a moral duty.Healthcare workers' speaking‐up behaviour is better achieved when organisational support systems complement the individual norms, values and beliefs of the individual.Adhered to Strengthening Reporting of Observational Studies in Epidemiology guidelines.No patient or public contribution. [ABSTRACT FROM AUTHOR]

Purpose Manipulation of tablet medications to produce a customized dose is common practice, and splitting tablets may reduce the acquisition cost of the medication. However, cost savings may be diminished by the cost of the increased labor and repackaging materials needed when splitting tablets. Splitting tablets may also result in safety concerns if the final products are under (eg, reduced benefit) or over (eg, toxicity) the desired dosage. The purpose of this quality improvement project was to evaluate and recommend changes for all half- and quarter-tablet medications prepared and distributed from the inpatient pharmacy at University of Utah Health (U of U Health). Summary The evaluation included all half- and quarter-tablet medications prepared by pharmacy technicians for administration to patients admitted to U of U Health hospitals. A final list of 173 half- and quarter-tablet dosages was evaluated for opportunities to decrease the total number. On the basis of the developed criteria, 93 half- and quarter-tablet dosages (54%) were recommended to be removed from routine stock in the inpatient pharmacy. Systems remain in place to create customized half and quarter tablets if required for patient care. Conclusion Reducing the number of medications for which half and quarter tablets are used may allow pharmacy technicians to prioritize other patient care tasks and potentially decrease waste. [ABSTRACT FROM AUTHOR]

'Ramping' is a commonly used term in contemporary Australian healthcare. It is also a part of the public and political zeitgeist. However, its precise definition varies among sources. In the published literature, there are distinctions between related terms, such as 'entry overload' and 'Patient Off Stretcher Time Delay'. How ramping is defined and how it came to be defined have significance for policies and procedures relating to the described phenomenon. Through examination of the history of the term, insights are obtained into the underlying issues contributing to ramping and, accordingly, associated possible solutions. [ABSTRACT FROM AUTHOR]

Background: Stillbirth is a devastating event for families as well as hospital staff. Hospital practices around internal and external staff communication, debriefing, and training are unknown. Methods: We systematically sampled U.S. hospitals that provide obstetrical care. Staff knowledgeable of bereavement care on labor and delivery were invited to participate in an anonymous survey linked to hospital descriptors. We evaluated stillbirth communication, debriefing, and training for staff. Results: We received 289 usable surveys from 429 eligible staff (67% response). Most (94%) noted hospitals' marked rooms housing bereaved families, but only a third (37%) reported a marker on the paper or electronic medical record. Half of the hospitals had no standard debriefings post-loss, and 38% reported no perinatal loss training for labor and delivery nurses. Conclusions: Hospitals have significant variations and gaps in staff communication, support, and training, which are key aspects of respectful stillbirth care. [ABSTRACT FROM AUTHOR]

BACKGROUND: Interventions aimed to standardize care may impact racial and ethnic disparities. We evaluated the association of race and ethnicity with adherence to recommendations from the American Academy of Pediatrics' clinical practice guideline for febrile infants after a quality improvement (QI) intervention. METHODS: We conducted a cross-sectional study of infants aged 8 to 60 days enrolled in a QI collaborative of 99 hospitals. Data were collected across 2 periods: baseline (November 2020-October 2021) and intervention (November 2021-October 2022). We assessed guideline-concordance through adherence to project measures by infant race and ethnicity using proportion differences compared with the overall proportion. RESULTS: Our study included 16 961 infants. At baseline, there were no differences in primary measures. During the intervention period, a higher proportion of non-Hispanic white infants had appropriate inflammatory markers obtained (2% difference in proportions [95% confidence interval (CI) 0.7 to 3.3]) and documentation of follow-up from the emergency department (2.5%, 95% CI 0.3 to 4.8). A lower proportion of non-Hispanic Black infants (-12.5%, 95% CI -23.1 to -1.9) and Hispanic/Latino infants (-6.9%, 95% CI -13.8 to -0.03) had documented shared decision-making for obtaining cerebrospinal fluid. A lower proportion of Hispanic/Latino infants had appropriate inflammatory markers obtained (-2.3%, 95% CI -4.0 to -0.6) and appropriate follow-up from the emergency department (-3.6%, 95% CI -6.4 to -0.8). CONCLUSIONS: After an intervention designed to standardize care, disparities in quality metrics emerged. Future guideline implementation should integrate best practices for equity-focused QI to ensure equitable delivery of evidence-based care. [ABSTRACT FROM AUTHOR]

This article reviews the design of a recently published randomized controlled trial (RCT) on immediate vs delayed access to genderaffirming hormones for transgender and gender-diverse (TGD) people and outlines key learning points that clinicians should know about how RCTs can and cannot contribute to advancing health equity for TGD people. [ABSTRACT FROM AUTHOR]

The Myeloproliferative Neoplasm Symptom Assessment Total Symptom Score (MPN-SAF TSS) is a surrogate marker for symptom evaluation in chronic myeloproliferative neoplasms (MPNs). However, insufficient data are available regarding the relationship among the MPN-SAF TSS, JAK2 mutation allele burden, and thrombosis. In this retrospective analysis, we aimed to determine the genetic burdens, clinical features, and relationships with MPN-SAF TSS in MPN patients. One hundred thirty JAK2V617F-positive patients with MPNs were included in our study. We calculated the MPN-SAF TSS for all patients and compared it with their clinical characteristics. Patients with higher JAK2V617F mutation allele burden had higher MPN-SAF TSS values (p=0.008). Patients with thrombosis had higher MPN-SAF TSS than patients without thrombosis (p=0.003). The mean MPN-SAF TSS was higher in patients with primary myelofibrosis compared to those with polycythemia vera and essential thrombocythemia. Thrombosis was associated with increased symptom severity in several domains, including fatigue, abdominal discomfort, inactivity, night sweats, pruritus, weight loss, and early satiety. Additionally, an increase in JAK2 allele burden was observed with higher symptom scores. The MPNSAF TSS proved to be a reliable tool for assessing symptom burden in Turkish MPN patients. Furthermore, the significant association between thrombosis occurrence and symptom severity suggests that thrombotic events may contribute to symptom development. Notably, increasing JAK2 allele burden was correlated with more severe symptoms, highlighting its potential role in predicting disease burden. This study emphasizes the importance of symptom assessment in MPN patients and supports the incorporation of the MPN-SAF TSS in routine clinical practice to enhance patient care and management. [ABSTRACT FROM AUTHOR]

Purpose: Professional Identity Formation (PIF) is crucial for high-quality patient care and physician well-being. Few empirical studies examined PIF in residency from the perspective of supervisors. In GP residency, residents are supervised with an 'end in mind' that remains unexplored. To encourage supervisors to reflect on their teaching behaviours, this study investigated GP clinical supervisors' perceptions of PIF outcomes in GP residency. Methods: Applying qualitative description, focus group interviews were conducted between spring and autumn 2019. Using a semi-structured interview guide, supervisors' perceptions of PIF outcomes were explored. In an iterative coding process applying constant comparison, a thematic analysis was performed of focus group transcripts. Results: We conducted eight focus groups with 55 supervisors at four training institutes across the Netherlands. Half of the supervisors were female. GP supervisors tend to address the 'poor GP' when prompted to address the 'good GP'. PIF outcomes in GP residency should revolve around taking ownership in patient care, self-care and the persistence of GP as a profession. Conclusion: PIF can be challenged by a lack of positive language. Supervisors' strong beliefs regarding ideals of the profession potentially compromise PIF when they do not resonate with residents' beliefs, resulting in poor educational alliance. [ABSTRACT FROM AUTHOR]

Background: Individuals with intellectual disabilities experience barriers to quality healthcare. To reduce this disparity, equipping medical trainees with the knowledge and skills required for treating this patient population is critical. Our aim is to describe the breadth of instructional interventions and identify gaps in intellectual disability medical education curricula. Method: Using scoping review methods, the intellectual disability programmes described in 27 articles were evaluated and their coverage of the six core competencies on disability for health care education was examined. Results: The most frequently represented core competencies were disability conceptual frameworks, professionalism and communication, and clinical assessment, which were, in most programmes, fulfilled by activities involving individuals with intellectual disabilities. Uneven competency coverage warrants consideration. Conclusions: Considerable variabilities exist in medical school curricula on intellectual disabilities. Using core competencies on disability for health care education for curricular design and evaluation would provide a coherent training experience in this important area. [ABSTRACT FROM AUTHOR]

Only a few physicians are willing to comprehensively concern themselves with how a legally watertight treatment documentation should be structured, in addition to their practical activities; however, the importance of the documentation cannot be emphasized enough, not only for a potential case of liability but also for the medical (further) treatment. This article therefore illustrates the legal foundations of the mandatory documentation and the most important questions associated with it for the practice, in particular on the content of the documentation, the timing of the documentation, the preservation of treatment documents and on the conduct in cases of an impending incident. [ABSTRACT FROM AUTHOR]

The affordances of social media, have significantly transformed how patients seek and process health information online, including those with chronic diseases like irritable bowel disease (IBD). Few studies have explored how information processing may impact symptom management. Guided by social cognitive theory, this study investigates how Chinese and U.S. patients (N = 838) process health information in a cross-cultural setting and the impact on symptom management. It finds that efficient information processing improves treatment understanding and symptom management for IBD patients, regardless of their cultural backgrounds. It also reveals a U-shaped quadratic relationship between IBD severity and emotional and peer support, indicating varying support needs at different IBD stages. These findings provide valuable insights for healthcare professionals, patients, and caregivers in designing interventions for chronic diseases. The study underscores the importance of recognizing the dynamics of health information processing and the need for a more nuanced approach to patient support and care. [ABSTRACT FROM AUTHOR]

Introduction: Inpatient and outpatient evaluation is important for management of temporal bone trauma due to the possible otologic complications that can result. However, there is limited literature on follow up rates following temporal bone fracture. This study aimed to determine the proportion of patients lost to follow up after sustaining temporal bone fractures and identify factors associated with loss to follow up. Methods: Retrospective review of adult patients who sustained temporal bone fractures at a level I trauma center from January 1, 2019 to January 1, 2024 was completed (IRB H-44161). The primary outcome included prevalence of patient loss to follow up. Secondary variables included initial radiographic and exam findings, otologic complications, and demographic characteristics. Patients who were seen in follow up and lost to follow up were compared, and odds of loss to follow up was calculated. Results: Sixty-nine patients met inclusion criteria for this study, of which 30 patients (43.5%) were lost to follow up. Patients who were White had a significantly lower odds of loss to follow up than those who were not White (OR = 0.2506 (95% CI: 0.0706, 0.8067, P =.0024). While need for acute management was not significantly different between the groups, a significantly lower proportion of patients who were intubated on presentation (P =.0091), had abnormal otoscopic exam (P =.0211), and had otologic complications (P =.0056) were lost to follow up. Conclusion: Almost half of patients who sustained temporal bone fractures, including a significantly higher odds of minority race/ethnicity patients, were lost to follow up. [ABSTRACT FROM AUTHOR]

Background: The use of genetic testing in pediatric patients with chronic kidney diseases (CKD) has increased exponentially in the past few years, particularly with the emergence of novel sequencing techniques. However, the genetic yield remains unexpectedly low in nephrology, with an impact on diagnosis, prognosis and treatment. Moreover, the increasing diversity of genetic testing possibilities can be seen as an obstacle by clinicians, in the absence of a strong background in genetics. Here, we propose a step-by-step, multidisciplinary strategy for the diagnostic evaluation of pediatric patients with CKD, and appropriate genetic test selection to maximize the yield of genetic testing. Methods: A total of 126 pediatric patients were enrolled in a retrospective file analysis. Genetic testing techniques used included phenotype-associated next-generation panel sequencing (N = 41), Sanger and SNaPshot sequencing (N = 3) and/or whole exome sequencing (N = 2). Results: Overall genetic yield reached 63% and genetic testing significantly impacted patient management in 70%. The distribution of kidney diseases among patients was balanced and matched previously described pediatric cohorts in terms of glomerulopathies, tubulopathies and ciliopathies. Genetic analyses led to significant treatment modifications, kidney biopsy sparing and personalized nephroprotection, as well as tailored genetic counseling. Of note, the evaluation of Human Phenotype Ontology term accuracy in the cohort showed that causal mutations were precisely identified in 85% of the patients at most. Conclusion: Here we suggest a step-by-step, multidisciplinary strategy to maximize the yield of genetic testing in pediatric patients with CKD. This approach optimizes patient care while avoiding unnecessary treatments or procedures. [ABSTRACT FROM AUTHOR]

Artificial intelligence (AI) is increasingly being used in health care. Without an ethically supportable, standard approach to knowing when patients should be informed about AI, hospital systems and clinicians run the risk of fostering mistrust among their patients and the public. Therefore, hospital leaders need guidance on when to tell patients about the use of AI in their care. In this article, we provide such guidance. To determine which AI technologies fall into each of the identified categories (no notification or no informed consent [IC], notification only, and formal IC), we propose that AI use-cases should be evaluated using the following criteria: (1) AI model autonomy, (2) departure from standards of practice, (3) whether the AI model is patient facing, (4) clinical risk introduced by the model, and (5) administrative burdens. We take each of these in turn, using a case example of AI in health care to illustrate our proposed framework. As AI becomes more commonplace in health care, our proposal may serve as a starting point for creating consensus on standards for notification and IC for the use of AI in patient care. [ABSTRACT FROM AUTHOR]

Task Force on 'Clinical Algorithms for Fracture Risk' commissioned by the American Society for Bone and Mineral Research (ASBMR) Professional Practice Committee has recommended that FRAX® models in the US do not include adjustment for race and ethnicity. This position paper finds that an agnostic model would unfairly discriminate against the Black, Asian and Hispanic communities and recommends the retention of ethnic and race-specific FRAX models for the US, preferably with updated data on fracture and death hazards. In contrast, the use of intervention thresholds based on a fixed bone mineral density unfairly discriminates against the Black, Asian and Hispanic communities in the US. This position of the Working Group on Epidemiology and Quality of Life of the International Osteoporosis Foundation (IOF) is endorsed both by the IOF and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). [ABSTRACT FROM AUTHOR]

Purpose: The triticeal cartilage, situated within the lateral thyrohyoid membrane, remains elusive in function yet crucial in clinical contexts. Composed of hyaline cartilage, it is prone to ossification, potentially leading to diagnostic challenges such as misidentification with atherosclerosis or fractures. Methods: This study, aiming to establish its prevalence and highlight clinical relevance, conducted a systematic review across several electronic databases such as Medline, PUBMED, Scopus, Google Scholar, Web of Science, SpringerLink and Sciencedirect using keywords "triticeal cartilage", "triticeous cartilage" or "cartilago triticea". An assurance tool for anatomical investigations was used to assess the quality of the methodology (AQUA). A random effects model was utilized to determine the pooled prevalence. Results: The true prevalence of triticeal cartilage was found to be variable, with an overall pooled proportion of 43% while crude prevalence were 50.6%. Its crude prevalence was notably higher in women compared to men, in contrary true prevalence was higher in men, posing sex-related disparities. It was mostly seen bilaterally. When the morphologic characteristics of the cartilage were evaluated, classification differences were observed in terms of shape, with a mean length of 5.48 mm, a mean width of 3.04 mm and a mean weight of 62.32 mg. The vertebral level at which the TC was located was mostly C4. The degree of calcification of the cartilage was most commonly mild. Conclusion: In conclusion, triticeal cartilage holds significant clinical importance, necessitating vigilance during diagnostic evaluations and surgical approaches. Further studies are imperative to elucidate its function comprehensively and refine diagnostic strategies, ensuring optimal patient care in neck-related pathologies. [ABSTRACT FROM AUTHOR]

Purpose: Since the COVID-19 pandemic, psycho-oncological care has increasingly been provided virtually and/or telephonically. We examined whether patients' therapeutic alliance (TA) – an essential processual outcome – differs due to altered modes of care delivery (MOCD) and assessed, if MOCD impacts patients' care satisfaction and patient reported outcomes. Methods: Survey and documentation data from newly diagnosed cancer patients that were cared for in the new form of care 'isPO' in Germany, were analyzed. Patients were surveyed after completing the one-year psycho-oncological care program. MOCD was operationalized by the ratio of patients' face-to-face, telephonic or video-based consultations to all their consultations. Regression analyzes were conducted to determine a possible relationship between MOCD and TA, between MOCD and patients' care satisfaction ('subjective effectiveness' and 'satisfaction and needs-orientation') and patient reported outcomes (anxiety and depression, sense of coherence, global health status). Findings: MOCD does not significantly influence TA. Regression models on the possible effect on subjective effectiveness and satisfaction and needs-orientation do not show statistical significance with only MOCD as the predictor. MOCD does not predict any of the patient reported outcomes. Conclusions: During the pandemic, neither TA, care satisfaction nor patient reported outcomes were affected by the MOCD in the new form of care 'isPO'. Therefore, the MOCD didn't negatively affect quality of care, which indicates that telephone or video consultations seem to be useful alternatives for psycho-oncological care in Germany. [ABSTRACT FROM AUTHOR]

In some countries, pharmacists have obtained prescribing rights to improve quality and accessibility of care and reduce physician workload. This case study explored pharmacists' current roles in and potential for prescribing in primary care in the Netherlands, where prescribing rights for pharmacists do not exist. Participatory observations of pharmacists working in either general practice or community pharmacy were conducted, as were semi-structured interviews about current and potential practice. The latter were extended to patients and other healthcare professionals, mainly general practitioners, resulting in 34 interviews in total. Thematic analyses revealed that pharmacists, in all cases, wrote prescriptions that were then authorized by a physician before dispensing. General practice-based pharmacists often prescribed medications during patient consultations. Community pharmacists mainly influenced prescribing through (a) medication reviews where the physician and/or practice nurse often were consulted to make treatment decisions, and (b) collaborative agreements with physicians to start or substitute medications in specific situations. These findings imply that the pharmacists' current roles in prescribing in the Netherlands resemble collaborative prescribing practices in other countries. We also identified several issues that should be addressed before formally introducing pharmacist prescribing, such as definitions of tasks and responsibilities and prescribing-specific training for pharmacists. [ABSTRACT FROM AUTHOR]

In the rapidly evolving field of artificial intelligence (AI) for radiology, with a plethora of vendor options and use-cases and evidence claims to sift through, the pressing question is how to effectively implement the right tool for enhanced patient care? This article presents a structured approach to AI deployment, drawing from a comprehensive case study in South West London. We underscore the necessity of forming a dedicated AI team with a clear vision and assertive leadership to navigate such complexities. Central to our discussion is the significance of crafting an AI implementation plan, with an overarching aim to augment patient care, promote operational efficiency, and lay down standardized protocols for seamless AI adoption. By presenting a blueprint for AI implementation within the National Health Service (NHS), we intend to demystify the process for radiology departments across the UK, enabling them to make informed decisions and empowering their staff to embrace and leverage AI responsibly ensuring that patient welfare remains at the heart of innovation. Thus, having a framework to follow when implementing an AI solution that addresses a vision for scalable adoption, core team members with diversity of skillset, staff engagement and education, plan for vendor selection, and change management is crucial for success. • A vision and roadmap for widespread artificial intelligence (AI) adoption is vital for implementation. • Change needs to happen at a human as well as technical level. • An 'AI implementation team' helps engage members and foster project ownership. • Monitoring the change and celebrating successes keeps team motivation. [ABSTRACT FROM AUTHOR]

The article focuses on the increasing involvement of mental health issues in ethics consultations. Topics include addressing combative behaviors and refusal of care by patients, handling privacy and confidentiality concerns in group therapy, and determining appropriate care settings for patients with severe mental illness.

Background: The goal of health care systems is to ensure high quality of medical services provided, including patient safety. The intensive care unit (ICU) is an environment conducive to the occurrence of adverse events and medical errors because of the complexity of the care provided, the severity of the conditions of patients treated in these units and work often performed under stressful conditions. Aim: Assessment of attitudes of nurses working in ICUs towards patient safety. Study Design: A cross‐sectional, descriptive study was conducted in a group of 214 nurses employed in ICUs in hospitals located in the southern part of Poland. The study used the Polish version of the Attitudes towards safety: (SAQ‐SF PL) questionnaire and an original questionnaire consisting of questions on socio‐demographic and professional data. Results: The overall SAQ score for the whole group was 61.89, 57.29 for adult ICU nurses and 68.20 for children's ICU. The surveyed nurses in general obtained the highest average results in terms of teamwork climate (TC)—66.92, while the lowest scores were given to the management—hospital management (PM)—45.08 and working conditions (WC)—57.56. job satisfaction (JS) positively correlated with the assessment of the TC, the assessment of the safety climate (SC), the assessment of the management staff (Head of Department) (PM), the assessment of the management staff (hospital management) (PM) and the assessment of work conditions (WC). A statistically significant, negative correlation was found between the assessment of JS and the assessment of stress recognition (SR) (r = −.20; p <.01). Conclusions: In the surveyed ICU branches, there is a low SC, and it is related, among others, to the perception of WC and the role of the management staff. The level of JS among nursing staff mainly depends on the SC, the TC, WC and the support of the management staff. Relevance to Clinical Practice: The results of the research presented here provide valuable assistance in identifying areas related to patient safety in ICUs. Managers' awareness of the importance of coping with occupational stress, WC or effective teamwork can help to improve staff attitudes and attitudes towards patient safety. When shaping a safe culture in a health care organization, it is important to remember that ensuring safe patient care is not only about programmes, standards or procedures, but safety is primarily about human resources—the staff involved in the treatment process—doctors, nurses, paramedics and physiotherapists. High awareness of safety at work, cooperation in an interdisciplinary team, assessment of safety culture at work and analysis and drawing conclusions may result in a real increase in quality and safety, and the patient will feel safer in 'XX' hospitals. [ABSTRACT FROM AUTHOR]

Laboratory practitioners working in oncology are increasingly involved in implementing genomic medicine, operating at the intersection of the laboratory and the clinic. This includes molecular diagnostic work and molecular testing to direct entry into molecular-based clinical trials and treatment decision-making based on molecular profiling. In this article, we draw on qualitative interviews with laboratory practitioners in the United Kingdom to explore the role of laboratory work in genomic cancer medicine, focusing on the handling of patient tissue and making of potentiality to guide patients' present and future care. With an increase in molecular testing to inform standard care and clinical trial participation, we show how practitioners "potentialized" the tissue by carefully negotiating what to test, how to test, and when. This included maximizing and managing small amounts of tissue in anticipation of possible future patient care. Tissue archives also took on new meaning, and potentiality, which practitioners negotiated alongside patient care. Potentiality was key to generating the "big" future of genomic medicine and also involved care work where the tissue emerged as an extension of the patient, as a form of "material patienthood," to secure present and future care for patients through their involvement in genomic medicine. [ABSTRACT FROM AUTHOR]

Objective: To analyse the influence of the COVID‐19 pandemic and the perception of self‐efficacy on the health professionals of the Spanish out‐of‐hospital emergency services. Design: Observational, cross‐sectional and descriptive with a survey methodology of 1710 participants from Spain (1 February–30 April, 2021). Methods: The mental health of healthcare workers was assesed in terms of stress, anxiety and depression, as well as their self‐efficacy. Linear and logistic regression models were fitted to predict these variables. A moderation analysis was conducted to determine the effect of self‐efficacy on mental health. Results: The means of the sample for stress, anxiety, depression and self‐efficacy were 20.60, 15.74, 13.07 and 70.87, respectively. In the regression models, being a woman was the most significant factor for severe mental health impairment. Female gender was also a relevant factor for self‐efficacy. Self‐efficacy had a direct effect on the mental health for working in patient care. Conclusions: Healthcare workers showed moderate stress, severe anxiety, mild depression and good self‐efficacy. Direct patient care was associated with more stress and severe anxiety. Age, female gender, job changes and job adjustment were associated with levels of stress, anxiety and depression. Self‐efficacy is a determining factor of mental health in the direct care modality. Implications: The mental health of healthcare workers has been of great importance in the aftermath of the pandemic, but out‐of‐hospital emergency workers have been neglected in research. The levels of stress, anxiety and depression during the pandemic justify the creation of prevention and early diagnosis programmes, as they are essential in a health disaster. Surprisingly, their high level of perceived self‐efficacy directly impact on the mental health of patient helthcare workers, so improving it will reduce the psychological risk. Reporting Method: We have followed the STROBE guidelines. It has been partially funded by the Asistencia Sanitanitaria Interprovincial de Seguros ‐ ASISA Foundation (Spain). Patient or Public Contribution: 'No patient or public involvement'. [ABSTRACT FROM AUTHOR]

Aim: To describe the implementation of a trauma‐informed model of care in the Post COVID Respiratory Clinic of a large tertiary referral centre in NSW. Design: Discussion paper. Data Sources: Evidence gathered from a literature search (2008–2022) was used to develop a framework for management of patients presenting to this Post COVID Respiratory Clinic. This paper outlines the personal reflections of the clinic staff as they developed and implemented this framework. Ethical approval was obtained to report the data collected from patient reviews. Discussion: The literature highlights the high prevalence of trauma in patients following COVID‐19 infection, as well as the larger population both during and after the pandemic. This experience of trauma was observed in patients seen within the clinic, indicating a need for specialized care. In response, a trauma‐informed model of care was implemented. Conclusion: Reconceptualizing COVID‐19 as a 'collective trauma' can help healthcare workers understand the needs of post‐COVID patients and enable them to respond empathetically. A trauma‐informed model is complementary to this cohort as it specifically addresses vulnerable populations, many of whom have been further marginalized by the pandemic. Implications for Nursing and Patient Care: Frontline healthcare workers, particularly nurses, are well positioned to implement trauma‐informed care due to their high‐level of patient contact. Adequate allocation of resources and investment in staff is essential to ensure such care can be provided. Impact: The COVID‐19 pandemic has led to adverse physical and mental health outcomes for many.Trauma‐informed care is a way to promote reengagement with the healthcare system in this group.Post COVID patients globally may benefit from this approach, as it aims to build trust and independence. Patient or Public Contribution: Feedback was sought from a patient representative to ensure this paper adequately reflected the experience of the post‐COVID patient. [ABSTRACT FROM AUTHOR]

Aim: This study provides an overview of the literature to identify and map the types of available evidence on self‐supporting mobile applications used by nurses in wound care regarding their development, evaluation and outcomes for patients, nurses and the healthcare system. Design: Scoping review. Review Method: Joanna Briggs Institute scoping review methodology was used. Data Sources: A search was performed using MEDLINE, Embase, CINAHL (via EBSCO), Web of Science, LiSSa (Littérature Scientifique en Santé), Cochrane Wounds, Érudit and grey literature, between April and October 2022, updated in April 2023, to identify literature published in English and French. Results: Eleven studies from 14 publications met the inclusion criteria. Mostly descriptive, the included studies presented mobile applications that nurses used, among other things, to assess wounds and support clinical decision‐making. The results described how nurses were iteratively involved in the process of developing and evaluating mobile applications using various methods such as pilot tests. The three outcomes most frequently reported by nurses were as follows: facilitating care, documentation on file and access to evidence‐based data. Conclusion: The potential of mobile applications in wound care is within reach. Nurses are an indispensable player in the successful development of these tools. Implications for the Profession and Patient Care: If properly developed and evaluated, mobile applications for wound care could enhance nursing practices and improve patient care. The development of ethical digital competence must be ensured during initial training and continued throughout the professional journey. Impact: We identified a dearth of studies investigating applications that work without Internet access. More research is needed on the development of mobile applications in wound care and their possible impact on nursing practice in rural areas and the next generation of nurses. Reporting Method: The Preferred Reporting Items for Systematic Reviews and Meta‐analysis Extension for Scoping Review guidelines were used. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Introduction: A comprehensive patient assessment is essential for safe patient care. Patient assessment frameworks for nurses are generally restricted to patients who already have altered vital signs and are at risk of deterioration, or to specific risks or body systems such as falls, pressure injury and the Glasgow Coma Score. Comprehensive and structured evidence‐based nursing assessment frameworks that consider the whole patient and extend beyond vital signs, specific risks and single systems are not routinely used in inpatient settings but are important to establish early risks for patient deterioration. Aim: The aim of this review was to identify nursing assessment tools or frameworks used to holistically assess hospitalized patients and to identify the impact of these tools on patient and health service outcomes. Methods: A scoping literature review was conducted. Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest Dissertations and Thesis, Embase and Scopus were databases used in the search. The initial search was conducted in August 2021 and repeated in November 2022. No date parameters were set. The Participants, Concept, Context (PCC) framework was used to guide the development of the research question and consolidate inclusion and exclusion criteria. The PRISMA‐ScR Checklist Item was followed to ensure a methodologically sound checklist was used. Results: Ten primary research studies evaluating six nursing assessment frameworks were included. Of the five nursing assessment frameworks, none were explicitly designed for general ward nursing, but rather the emergency department or specific patient cohorts, such as oncology. Four studies reported on reliability and/or validity; two reported on patient outcomes and four on staff satisfaction. Conclusion: Evidence‐based nursing patient assessment frameworks for use in general inpatient wards are lacking. Existing assessment tools are largely designed for specific patient cohorts, specific body systems or the already deteriorating patient. Implications for the Profession and Patient Care: A framework to enable a structured approach to patient assessment in this environment is needed for patient safety, consistency in assessment, nursing staff enablement and confidence to escalate care. Routine systematic nursing assessment could also aid timely patient escalation. Impact: What problem did the study address? This study addresses the lack of evidence‐based nursing assessment frameworks for use in hospitalized patients. The impact of this is that it highlights the need for an evidence‐based, whole of patient assessment framework for use by nurses for patients admitted to a ward environment. What were the main findings? This review identified limited comprehensive, patient assessment frameworks for use in general ward inpatient areas. Those identified were not validated for this patient cohort and are aimed at patients already deteriorating. Where and on whom will the research have an impact? This review has the potential to impact future research and patient care. It highlights that most research is focussed on processes to detect and escalate care for the already deteriorating patient. There is a need for an evidence‐based routine nursing assessment framework for patients admitted to a ward environment to promote positive patient outcomes and prevent deterioration. Patient and Public Contribution: This review contributes to existing knowledge of nursing patient assessment frameworks, yet it also highlights several gaps. Currently, there are no known, validated, holistic, structured nursing patient assessment frameworks for use in general ward inpatient settings. However, areas that do use such assessment frameworks (e.g. the emergency department) have shown positive patient outcomes and staff usability. Hospitalized ward patients would benefit from routine, structured nursing assessments targeting positive patient outcomes prior to the onset of deterioration. [ABSTRACT FROM AUTHOR]

Modern demographic changes, which lead to increased migration and population diversity, impose the need for culturally sensitive care in health care, which requires training and education of nurses. Research highlights the importance of cultural competence and the development of skills to effectively interact with patients from diverse cultural backgrounds, which can improve the quality of care and reduce potential racial stereotyping and conflict. The aim of the research is to explore the role of the nurse in caring for patients from different cultural backgrounds. A direct, individual, anonymous survey was prepared and conducted through the Google Forms platform. The results of the study highlight the importance of cultural competence in nursing, with almost all participants acknowledging the need to understand the cultural characteristics of patients. Language barriers, different beliefs and stereotypes are major challenges for nurses in caring for culturally diverse patients. Most participants expressed a lack of confidence in their abilities and a desire for training in cultural competence, emphasizing the need for better training in this area. Nurses play a key role in caring for culturally diverse patients and must be trained and empathetic to provide the best care and treatment for each patient, regardless of their cultural background. [ABSTRACT FROM AUTHOR]

Purpose In high-acuity situations such as cardiac arrest, clinicians rely on prepared medications stocked in code carts to provide timely and accurate pharmacotherapy. We examined shortage trends for medications commonly used in code carts. Methods Drug shortage data from 2001 to 2022 were retrieved from the University of Utah Drug Information Service (UUDIS) to characterize shortages reported for commonly used code cart medications. Data extracted included the number of shortages, shortage duration, drug characteristics, and reason for the shortage. Results From 2001 to 2022, 71 drug shortages for code cart medications were reported. The number of new shortages peaked in 2010, and the number of total shortages peaked in 2010. At the end of the study period, 61 (84.7%) shortages had been resolved. For resolved shortages, the mean shortage duration was 18.2 months. The drug with the greatest number of reported shortages was dextrose (10 total), the drug with the longest resolved shortage was calcium chloride injection (116 months), and the drug with the longest active shortage was atropine injection (165 months at the end of the study period). Throughout the entire study period, only 2 suppliers provided commercially available prefilled syringes of dextrose for stocking on code carts. The most common reason for shortages, when reported, was manufacturing delays. Conclusion Medications commonly used in code carts were frequently impacted by drug shortages, which have the potential to impact patient care. Institutional protocols for mitigation and larger efforts to promote a more resilient drug supply chain are critical to ensure patient safety and quality care. [ABSTRACT FROM AUTHOR]

This article explores how practitioners of creative bibliotherapy utilise diverse approaches and understand the therapeutic possibilities of their practice. Creative bibliotherapy involves the therapeutic use of literature by a non-clinical facilitator working with groups or individuals. It is distinct from clinical bibliotherapy as a therapeutic approach, which generally works with non-fiction self-help texts in clinical contexts. While clinical bibliotherapy has been well-studied, there is a paucity of research on creative bibliotherapy, which only gained momentum in Australia in the 2010s. Based on in-depth qualitative interviews with bibliotherapists in Australia we explore differences in the practitioners' methods, approaches and backgrounds as well as the ideas of literature and wellbeing underpinning the practice. An inductive thematic analysis identified three key areas of difference: the therapeutic intentions of the practitioners, the diversity of the people they work with and their understanding of the role of literature in the bibliotherapeutic process. [ABSTRACT FROM AUTHOR]

In this review, we will discuss the risks of COVID-19 on maternal, obstetric, and neonatal outcomes. We will also review the safety of COVID-19 vaccination in pregnancy, as well as review the management of COVID-19 in pregnancy. [ABSTRACT FROM AUTHOR]

Background: Oncology nurses constantly provide emotional support to patients and are confronted with their suffering, which represents chronic stress leading to the development of burnout syndrome. Aim: This study aimed to evaluate the prevalence of burnout and identify associated factors in a sample of oncology nurses. Methods: We conducted a descriptive cross‐sectional study with 70 oncology nurses at the Salah Azaiez Institute of Oncology in Tunisia. Burnout was assessed using the Maslach Burnout Inventory Human Service Survey. This study follows the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) Guidelines. Results: Burnout affected 60 nurses (85.7%), with a high level in 20% of cases. High scores of emotional exhaustion, depersonalisation, and low personal accomplishment were recorded in 65.7%, 50% and 25.7% respectively. Emotional exhaustion was associated with higher age, marital status, having 2 or 3 or more dependent children, number of patients under care exceeding 15, professional experience and history of psychiatric problems. Depersonalisation was correlated with age, marital status, professional grade and history of psychiatric problems. Low levels of personal accomplishment increased with the number of patients under care, history of psychiatric problems and the regret of professional choice. Conclusion: Burn‐out is a reality in oncology hospital with an alarming rate. Interventions including rationalisation of workload, support groups, training in emotion and stress management would improve the mental health of these nurses and increase their performance. The screening for burnout should be included as a regular practice in health promotion programmes for oncology health professionals, particularly for a vulnerable subgroup that possesses the risk mentioned above factors. [ABSTRACT FROM AUTHOR]

Background: Previous evidence underscores the need to assess potential clinical outcomes resulting from pharmaceutical care interventions and to monitor patient's progress to evaluate their clinical evolution, which is crucial for bolstering the relevance of implementing pharmaceutical care in healthcare services. Aims: To conduct an in‐depth analysis of pharmaceutical care practices in a geriatric ward and monitor the clinical outcomes of older people served. Methods: This interventionist study was conducted in the geriatrics ward of a Brazilian university hospital. The research intervention occurred between January and May 2022, with a follow‐up conducted for up to 90 days after patients' hospital discharge. Older patients in the geriatrics ward received pharmaceutical care, including medication reconciliation, medication review, and pharmacotherapeutic follow‐up, aimed at identifying and resolving drug‐related problems (DRPs). The clinical relevance of DRPs and pharmaceutical recommendations was evaluated. Additionally, analyses were conducted on mortality and rehospitalization outcomes in older patients at 30, 60, and 90 days following initial hospital discharge. Results: Of the patients evaluated, a significant 88.3% exhibited at least one DRP (with an average of 2.6 ± 1.9 DRPs per patient), with the majority classified as need/indication problems (38.9%). The acceptance rate of pharmaceutical recommendations was 80.9%, with the majority categorized as very significant relevance (60.4%). DRPs were predominantly of serious clinical relevance (50.9%). In patients whose clinical indicators could be monitored, 95.5% showed some clinical response (in vital signs, laboratory tests and/or clinical status evolution) potentially related to resolved DRPs. Association analysis revealed that a higher number of medications in use before hospitalization correlated with a greater identification of DRPs during hospitalization (p = 0.03). At hospital discharge, 23.6% of patients were no longer using polypharmacy. In total, 16 patients (26.7%) died during the study period. Among patients who did not die during hospitalization (n = 54), 20 patients (37%) experienced rehospitalizations within 90 days following discharge. Conclusion: This study facilitated the consolidation of pharmaceutical care implementation in a geriatric ward. We conducted identification, evaluation, and proposed evidence‐based solutions, as well as monitored cases for outcome analysis. It is anticipated that this methodology will inspire future research and the implementation of pharmaceutical care‐related services. [ABSTRACT FROM AUTHOR]