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Background: Implementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care. Aim: To evaluate the behaviour-change-informed HIRAID® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability). Methods: An effectiveness-implementation hybrid design including a step–wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID® implementation emergency nurse survey, (ii) HIRAID® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the 'how' and 'why' of quantitative results. Results: HIRAID® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID® documentation templates) at 6 months and 100% setting sustainability at 3 years. Conclusion: The behaviour-change informed strategy for the emergency nursing framework HIRAID® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts. Trial registration: ANZCTR, ACTRN12621001456842. Registered 25 October 2021. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your awareness and understanding of the Columbia-Suicide Severity Risk Scale • To learn about a project to improve suicide risk screening in three emergency departments in the US • To acknowledge the need to provide nurses with adequate training and tools on suicide risk assessment. Suicide is a significant and increasing public health concern. Research has shown that screening for suicide risk is inconsistent in acute care settings and that a variety of different tools are used for that purpose. The Columbia-Suicide Severity Risk Scale (C-SSRS) has emerged as a validated and recognised suicide risk screening tool. This article describes a quality improvement project designed to improve the screening of patients for suicide risk in a large hospital system in the Midwestern US. As part of the project, 97% of nurses working in the organisation’s emergency departments self-completed a 30-minute interactive learning module on the background, relevance and application of the C-SSRS. The C-SSRS enables nurses to classify the severity of suicide risk, which helps to provide interventions commensurate with patients’ level of risk. Following completion of the module, there was a significant increase in the percentage of patients screened for suicide risk. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhea, or menstrual pain, is a subjective experience, and can only be assessed by patient‐reported outcomes. These instruments should be reliable, valid and responsive. Aim: To identify and critically appraise the available evidence for the measurement properties of specific patient‐reported outcome measures used for dysmenorrhea. Methods: The PRISMA statement was used to report this systematic review. Databases searched were PubMed, SCOPUS, CINAHL, Web of Science, ScienceDirect and Google Scholar (April 2021; updated on February 2023). Original studies with primary data collection, with no restriction on language and publication date that reported psychometric properties of one or more dysmenorrhea‐related patient‐reported outcome measure. The literature searches, selection of studies, data extraction and assessment of the risk of bias were performed independently by two reviewers and followed the COSMIN guidelines. Results: Thirty studies were analysed in this review, and 19 patient‐reported outcome measures were evaluated. The instruments varied in relation to the measured construct and measurement properties (validity, reliability and responsiveness). The methodological quality of the studies and the quality of evidence of the patient‐reported outcome measures were variable. Among the 13 studies that reported the development of patient‐reported outcome measures, most had inadequate methodological quality, and the overall rating was insufficient or inconsistent. Conclusions: The Dysmenorrhea Symptom Interference (DSI) scale was the only identified patient‐reported outcome measure that has the potential to be recommended because of its sufficient rating combined with moderate quality of evidence for content validity. Future studies should further evaluate the measurement properties of the existing patient‐reported outcome measures, or develop new patient‐reported outcome measures following the COSMIN methodology. Patient or public contribution: Not applicable as this is a systematic review. Trial registration: PROSPERO protocol: CRD42021244410. Registration on April 22, 2021. [ABSTRACT FROM AUTHOR]

Background: Electronic Patient-Reported Outcome Measures (ePROMs) have emerged as valuable tools in cancer care, facilitating the comprehensive assessment of patients' physical, psychological, and social well-being. This study synthesizes literature on the utilization of ePROMs in oncology, highlighting the diverse array of measurement instruments and questionnaires employed in cancer patient assessments. By comprehensively analyzing existing research, this study provides insights into the landscape of ePROMs, informs future research directions, and aims to optimize patient-centred oncology care through the strategic integration of ePROMs into clinical practice. Methods: A systematic review was conducted by searching peer-reviewed articles published in academic journals without time limitations up to 2024. The search was performed across multiple electronic databases, including PubMed, Scopus, and Web of Science, using predefined search terms related to cancer, measurement instruments, and patient assessment. The selected articles underwent a rigorous quality assessment using the Mixed Methods Appraisal Tool (MMAT). Results: The review of 85 studies revealed a diverse range of measurement instruments and questionnaires utilized in cancer patient assessments. Prominent instruments such as the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Patient Reported Outcome-Common Terminology Criteria for Adverse Events (PROCTCAE) were frequently referenced across multiple studies. Additionally, other instruments identified included generic health-related quality of life measures and disease-specific assessments tailored to particular cancer types. The findings indicated the importance of utilizing a variety of measurement tools to comprehensively assess the multifaceted needs and experiences of cancer patients. Conclusion: Our systematic review provides a comprehensive examination of the varied tools and ePROMs employed in cancer care, accentuating the perpetual requirement for development and validation. Prominent instruments like the EORTC QLQ-C30 and PRO-CTCAE are underscored, emphasizing the necessity for a thorough assessment to meet the multifaceted needs of patients. Looking ahead, scholarly endeavours should prioritize the enhancement of existing tools and the creation of novel measures to adeptly address the evolving demands of cancer patients across heterogeneous settings and populations. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the complexities of assessing pain in older people with normal, mildly impaired or severely impaired cognition • To recognise the benefits and limitations of different tools for assessing pain in older people with normal, mildly impaired or severely impaired cognition • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Pain is a relatively common experience among older people, but unrelieved pain has significant functional, cognitive and emotional consequences for this population. A comprehensive and accurate pain assessment is essential for effective pain management. Self-report tools are suitable to assess pain in older people with normal or mildly impaired cognition, while observational tools are suitable for use with those with significant cognitive impairment or communication difficulties. However, pain assessment in older people can be challenging. The use of one tool on its own is rarely sufficient and it is crucial to involve family carers in assessment of pain in older people with severe cognitive impairment. This article discusses different tools and strategies, including the benefits and limitations, for assessing pain in older people. [ABSTRACT FROM AUTHOR]

The Bee Cosmetic Surgery Scale (BCSS) is a novel clinical tool designed to assess the psychopathological, psychosocial, and decision-making factors involved in accepting cosmetic procedures. This prospective, multicenter study aimed to propose and validate the BCSS, which considers aesthetic aspects, personal pathological history, and psychopathological implications leading to the acceptance of invasive or non-invasive aesthetic interventions. The study included 281 participants aged 18–66 years, divided into three groups: non-invasive cosmetic surgery (NICS), invasive and non-invasive cosmetic surgery (INICS), and individuals who had not undergone cosmetic surgery (NCS). Participants were randomly selected from patients visiting plastic surgery services and various medical services in Oradea, Romania, between October 2022 and March 2024. The BCSS comprises 20 items with Likert-type responses, ranging from one to five. The Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure perceived social support. The BCSS aims to elucidate the patient's desire for aesthetic procedures, whether it stems from an impulsive act, warrants a longer decision-making period, or necessitates addressing psychological or psychiatric conditions before scheduling the procedure. The scale enables cosmetic surgeons to assess whether the patient has been adequately informed and understands the risks and complications associated with the cosmetic surgical procedure. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Methods Results Conclusions Impact Reporting Method Patient or Public Contribution Trial Registration To develop an evidence‐driven, behaviour change focused strategy to maximise implementation and uptake of HIRAID (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication and reassessment) in 30 Australian rural, regional and metropolitan emergency departments.An embedded, mixed‐methods study.This study is the first phase of a step‐wedge cluster randomised control trial of HIRAID involving over 1300 emergency nurses. Concurrent quantitative and qualitative data were collected via an electronic survey sent to all nurses to identify preliminary barriers and enablers to HIRAID implementation. The survey was informed by the Theoretical Domains Framework, which is a synthesis of behavioural change theories that applies the science of intervention implementation in health care to effect change. Quantitative data were analysed using descriptive statistics and qualitative data with inductive content analysis. Data were then integrated to generate barriers and enablers to HIRAID implementation which were mapped to the Theoretical Domains Framework. Corresponding intervention functions and Behaviour Change techniques were selected and an overarching implementation strategy was developed through stakeholder consultation and application of the APEASE criteria (Affordability, Practicability, Effectiveness and cost‐effectiveness, Acceptability, Side‐effects/safety and Equity).Six barriers to HIRAID implementation were identified by 670 respondents (response rate ~58%) representing all 30 sites: (i) lack of knowledge about HIRAID; (ii) high workload, (iii) lack of belief anything would change; (iv) not suitable for workplace; (v), uncertainty about what to do and (vi) lack of support or time for education. The three enablers were as follows: (i) willingness to learn and adopt something new; (ii) recognition of the need for something new and (iii) wanting to do what is best for patient care. The 10 corresponding domains were mapped to seven intervention functions, 21 behaviour change techniques and 45 mechanisms. The major components of the implementation strategy were a scaffolded education programme, clinical support and environmental modifications.A systematic process guided by the behaviour change wheel resulted in the generation of a multifaceted implementation strategy to implement HIRAID across rural, regional and metropolitan emergency departments. Implementation fidelity, reach and impact now require evaluation. HIRAID emergency nursing assessment framework reduced clinical deterioration relating to emergency care and improved self‐confidence and documentation in emergency departments in pilot studies. Successful implementation of any intervention in the emergency department is notoriously difficult due to workload unpredictability, the undifferentiated nature of patients and high staff turnover. Key barriers and enablers were identified, and a successful implementation strategy was developed. This study uses theoretical frameworks to identify barriers and enablers to develop a data‐driven, behavioural‐focused implementation strategy to optimise the uptake of HIRAID in geographically diverse emergency departments which can be used to inform future implementation efforts involving emergency nurses. The CROSS reporting method (Supporting Information S3) was used to adhere to EQUATOR guidelines.No Patient or Public Contribution.Australian New Zealand; Clinical Trials Registry (ANZCTR) number: ACTRN12621001456842, registered 25/10/2021 [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of the aims of and processes involved in triage • To enhance your understanding of the strategies you can use to make triage as safe and effective as possible for patients and staff • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Triage is the first stage of a patient’s journey through the emergency department and is used to determine patient acuity. There is no single quantifiable metric for determining acuity, which amalgamates different factors that are more or less relevant depending on the patient’s presentation. This article explains the aim and process of triage and how nurses can ensure the process is effective and safe. The author discusses strategies nurses can use to mitigate uncertainty and to make their acuity assessments rapid, targeted and comprehensive. The author also highlights triage safety considerations, including infection prevention and control and the physical and emotional safety of patients and staff. [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]

Emergency Department (ED) care is provided for a diverse range of patients, clinical acuity and conditions. This diversity often calls for different vital signs monitoring requirements. Requirements often change depending on the circumstances that patients experience during episodes of ED care. To describe expert consensus on vital signs monitoring during ED care in the Australasian setting to inform the content of a joint Australasian College for Emergency Medicine (ACEM) and College of Emergency Nursing Australasia (CENA) position statement on vital signs monitoring in the ED. A 4-hour online nominal group technique workshop with follow up surveys. Twelve expert ED nurses and doctors from adult, paediatric and mixed metropolitan and regional ED and research facilities spanning four Australian states participated in the workshop and follow up surveys. Consensus building generated 14 statements about vital signs monitoring in ED. Good consensus was reached on whether vital signs should be assessed for 15 of 19 circumstances that patients may experience. This study informed the creation of a joint position statement on vital signs monitoring in the Australasian ED setting, endorsed by CENA and ACEM. Empirical evidence is needed for optimal, safe and achievable policy on this fundamental practice. [ABSTRACT FROM AUTHOR]

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Abstract Background Emergency medical services (EMS) personnel must rapidly assess and transport patients with time-sensitive conditions to optimise patient outcomes. Serum lactate, a valuable in-hospital biomarker, has become more accessible in EMS settings through point-of-care (POC) testing. Although POC lactate levels are valuable in specific patient groups, its broader application in EMS remains unclear. This study assessed the additional predictive value of POC lactate levels in a general adult EMS population. Methods This prospective observational study (March 2018 to September 2019) involved two EMS organisations in Västra Götaland, Sweden. Patients were triaged using the Rapid Triage and Treatment System (RETTS). POC lactate levels were measured using StatStrip Xpress devices. Non-consecutive patients who received EMS and were aged 18 years and above were available for inclusion if triaged into RETTS levels: red, orange, yellow, or green if respiratory rate of ≥ 22 breaths/min. Outcomes were adverse outcomes, including a time-sensitive diagnosis, sequential organ failure assessment (SOFA) score ≥ 2, and 30-day mortality. Statistical analyses included descriptive statistics, imputation, and regression models to assess the impact of the addition of POC lactate levels to a base model (comprising patient age, sex, presence of past medical conditions, vital signs, pain, EMS response time, assessed triage condition, and triage level) and a RETTS triage model. Results Of 4,546 patients (median age 75 [57, 84] years; 49% male), 32.4% had time-sensitive conditions, 12.5% met the SOFA criteria, and 7.4% experienced 30-day mortality. The median POC lactate level was 1.7 (1.2, 2.5) mmol/L. Patients with time-sensitive conditions had higher lactate levels (1.9 mmol/L) than those with non-time-sensitive conditions (1.6 mmol/L). The probability of a time-sensitive condition increased with increasing lactate level. The addition of POC lactate marginally enhanced the predictive models, with a 1.5% and 4% increase for the base and RETTS triage models, respectively. POC lactate level as a sole predictor showed chance-only level predictive performance. Conclusions Prehospital POC lactate assessment provided limited additional predictive value in a general adult EMS population. However, it may be beneficial in specific patient subgroups, emphasizing the need for its judicious use in prehospital settings.

Abstract Background Implementing evidence that changes practice in emergency departments (EDs) is notoriously difficult due to well-established barriers including high levels of uncertainty arising from undifferentiated nature of ED patients, resource shortages, workload unpredictability, high staff turnover, and a constantly changing environment. We developed and implemented a behaviour-change informed strategy to mitigate these barriers for a clinical trial to implement the evidence-based emergency nursing framework HIRAID® (History including Infection risk, Red flags, Assessment, Interventions, Diagnostics, communication, and reassessment) to reduce clinical variation, and increase safety and quality of emergency nursing care. Aim To evaluate the behaviour-change-informed HIRAID® implementation strategy on reach, effectiveness, adoption, quality (dose, fidelity) and maintenance (sustainability). Methods An effectiveness-implementation hybrid design including a step–wedge cluster randomised control trial (SW-cRCT) was used to implement HIRAID® with 1300 + emergency nurses across 29 Australian rural, regional, and metropolitan EDs. Evaluation of our behaviour-change informed strategy was informed by the RE-AIM Scoring Instrument and measured using data from (i) a post HIRAID® implementation emergency nurse survey, (ii) HIRAID® Instructor surveys, and (iii) twelve-week and 6-month documentation audits. Quantitative data were analysed using descriptive statistics to determine the level of each component of RE-AIM achieved. Qualitative data were analysed using content analysis and used to understand the ‘how’ and ‘why’ of quantitative results. Results HIRAID® was implemented in all 29 EDs, with 145 nurses undertaking instructor training and 1123 (82%) completing all four components of provider training at 12 weeks post-implementation. Modifications to the behaviour-change informed strategy were minimal. The strategy was largely used as intended with 100% dose and very high fidelity. We achieved extremely high individual sustainability (95% use of HIRAID® documentation templates) at 6 months and 100% setting sustainability at 3 years. Conclusion The behaviour-change informed strategy for the emergency nursing framework HIRAID® in rural, regional, and metropolitan Australia was highly successful with extremely high reach and adoption, dose, fidelity, individual and setting sustainability across substantially variable clinical contexts. Trial registration ANZCTR, ACTRN12621001456842 . Registered 25 October 2021.

Background: Emergency medical services (EMS) personnel must rapidly assess and transport patients with time-sensitive conditions to optimise patient outcomes. Serum lactate, a valuable in-hospital biomarker, has become more accessible in EMS settings through point-of-care (POC) testing. Although POC lactate levels are valuable in specific patient groups, its broader application in EMS remains unclear. This study assessed the additional predictive value of POC lactate levels in a general adult EMS population. Methods: This prospective observational study (March 2018 to September 2019) involved two EMS organisations in Västra Götaland, Sweden. Patients were triaged using the Rapid Triage and Treatment System (RETTS). POC lactate levels were measured using StatStrip Xpress devices. Non-consecutive patients who received EMS and were aged 18 years and above were available for inclusion if triaged into RETTS levels: red, orange, yellow, or green if respiratory rate of ≥ 22 breaths/min. Outcomes were adverse outcomes, including a time-sensitive diagnosis, sequential organ failure assessment (SOFA) score ≥ 2, and 30-day mortality. Statistical analyses included descriptive statistics, imputation, and regression models to assess the impact of the addition of POC lactate levels to a base model (comprising patient age, sex, presence of past medical conditions, vital signs, pain, EMS response time, assessed triage condition, and triage level) and a RETTS triage model. Results: Of 4,546 patients (median age 75 [57, 84] years; 49% male), 32.4% had time-sensitive conditions, 12.5% met the SOFA criteria, and 7.4% experienced 30-day mortality. The median POC lactate level was 1.7 (1.2, 2.5) mmol/L. Patients with time-sensitive conditions had higher lactate levels (1.9 mmol/L) than those with non-time-sensitive conditions (1.6 mmol/L). The probability of a time-sensitive condition increased with increasing lactate level. The addition of POC lactate marginally enhanced the predictive models, with a 1.5% and 4% increase for the base and RETTS triage models, respectively. POC lactate level as a sole predictor showed chance-only level predictive performance. Conclusions: Prehospital POC lactate assessment provided limited additional predictive value in a general adult EMS population. However, it may be beneficial in specific patient subgroups, emphasizing the need for its judicious use in prehospital settings. [ABSTRACT FROM AUTHOR]

Rationale and key points: Why you should read this article: • To increase your awareness of the challenges of diagnosing constipation in people with learning disabilities • To understand the potential consequences, for people with learning disabilities, of untreated constipation • To revisit the assessments required to diagnose constipation in a person with a learning disability accurately. Constipation is a common health condition that, if not recognised and treated, can have major adverse effects on people’s health and well-being. People with learning disabilities have been shown to have a shorter life expectancy than the general population. Leading causes of premature death in this population group are respiratory disease, cardiovascular disease and gastrointestinal disorders including constipation. Yet, with timely assessments and appropriate interventions, constipation can be prevented or treated. • Consequences of constipation include increased laxative use, frequent hospital admissions and readmissions, suboptimal health outcomes and premature death. • The signs and symptoms of constipation can be challenging to ascertain in people with learning disabilities due notably to communication difficulties and diagnostic overshadowing. • Accurately diagnosing constipation in a person with a learning disability who shows behaviour of concern involves comprehensive and thorough assessments of their physical and mental health, behaviour, medicines and environment. Reflective activity: ‘How to’ articles can help you to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when supporting the accurate diagnosis of constipation in a person with a learning disability who shows behaviour of concern. • How you could use this information to educate nursing students or colleagues to support the accurate diagnosis of constipation in a person with a learning disability who shows behaviour of concern. [ABSTRACT FROM AUTHOR]

Given the important role of patient-ventilator assessments in ensuring the safety and efficacy of mechanical ventilation, a team of respiratory therapists and a librarian used Grading of Recommendations, Assessment, Development, and Evaluation methodology to make the following recommendations: (1) We recommend assessment of plateau pressure to ensure lung-protective ventilator settings (strong recommendation, high certainty); (2) We recommend an assessment of tidal volume (VT) to ensure lung-protective ventilation (4-8 mL/kg/predicted body weight) (strong recommendation, high certainty); (3) We recommend documenting VT as mL/kg predicted body weight (strong recommendation, high certainty); (4) We recommend an assessment of PEEP and auto-PEEP (strong recommendation, high certainty); (5) We suggest assessing driving pressure to prevent ventilator-induced injury (conditional recommendation, low certainty); (6) We suggest assessing FIO2 to ensure normoxemia (conditional recommendation, very low certainty); (7) We suggest telemonitoring to supplement direct bedside assessment in settings with limited resources (conditional recommendation, low certainty); (8) We suggest direct bedside assessment rather than telemonitoring when resources are adequate (conditional recommendation, low certainty); (9) We suggest assessing adequate humidification for patients receiving noninvasive ventilation (NIV) and invasive mechanical ventilation (conditional recommendation, very low certainty); (10) We suggest assessing the appropriateness of the humidification device during NIV and invasive mechanical ventilation (conditional recommendation, low certainty); (11) We recommend that the skin surrounding artificial airways and NIV interfaces be assessed (strong recommendation, high certainty); (12) We suggest assessing the dressing used for tracheostomy tubes and NIV interfaces (conditional recommendation, low certainty); (13) We recommend assessing the pressure inside the cuff of artificial airways using a manometer (strong recommendation, high certainty); (14) We recommend that continuous cuff pressure assessment should not be implemented to decrease the risk of ventilator-associated pneumonia (strong recommendation, high certainty); and (15) We suggest assessing the proper placement and securement of artificial airways (conditional recommendation, very low certainty). [ABSTRACT FROM AUTHOR]

Background: Foundation doctors and nurses are the clinicians most closely involved in fluid assessment, intravenous (IV) fluid prescription and administration. However, both groups report challenges regarding IV fluids. At a large NHS trust in England, adherence to the National Institute for Health and Care Excellence (NICE) guideline CG174, regarding IV fluids, was largely unknown. Aims: To assess the baseline adherence, within the hospitals, to CG174 and identify areas for improvement. Methods: A set of 12 audit standards were developed and used to collect data across 29 clinical areas between September 2022 and May 2023, with 255 patients receiving IV fluids at any time during their inpatient stay included. Findings: For two standards target adherence of 95% was achieved, with an adherence less than 50% in most. Areas of particularly poor adherence included assessing and meeting fluid and electrolyte requirements, patient reassessment and developing IV fluid management plans. Conclusion: Trust baseline adherence to NICE CG174 requires improvement, particularly regarding patient assessment and reassessment, and meeting electrolyte requirements. [ABSTRACT FROM AUTHOR]

Rationale and key points: Why you should read this article: • To understand the necessary preparation required before triaging a patient • To familiarise yourself with the steps required when triaging a patient in the emergency department • To learn about the scales and algorithms used by nurses when triaging patients. Triaging patients can be a complicated process, with multiple modes of assessment taking place simultaneously, and nurses need to be confident and competent in their assessment skills. This article explains the necessary preparation for triage and outlines the steps that nurses need to take when triaging a patient in the emergency department. • Triage requires a targeted patient assessment, using both clinical judgement and triage tools to determine appropriate acuity categories. • Different scales and algorithms are used in triage, so it is essential to clearly communicate the acuity categories assigned to patients. • A structured approach to patient assessment can guide decision-making and identify issues. • Various diagnostic tests can be used to facilitate the triage process, but care needs to be taken to ensure the process is not prolonged by their use. Reflective activity: ‘How to’ articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when assessing the acuity of patients in triage. • How you could use this information to educate nursing students or your colleagues on the appropriate technique and evidence base regarding the triaging of patients in the emergency department. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that accurate, reliable and regular weight measurement is an important intervention to prevent and manage malnutrition in people aged over 65 years • To read about a project in an emergency assessment unit that improved the recording of older patients’ actual weight and the completion of Malnutrition Universal Screening Tool scores • To identify the need to involve nursing staff at the outset of quality improvement projects if they are to be meaningful and sustainable. Malnutrition can have significant negative effects on older people’s health, as well as a cost burden for health and social care services. Accurate, reliable and regular measurement of a patient’s weight is important for prompt identification and management of malnutrition. This article discusses a quality improvement project that was undertaken in an emergency assessment unit for patients aged over 74 years in Northern Ireland. The aim of the project was to improve completion of Malnutrition Universal Screening Tool (MUST) scores for patients attending the unit by nursing staff recording actual weight rather than recalled weight. A simple intervention of relocating weighing scales in the unit’s triage bay resulted in an increase in completed MUST scores from 60% (n=18) to 97% (n=29) in the six months following the intervention. Feedback from members of the multidisciplinary team indicated that the intervention had a positive effect on the care they provided to patients and on their working relationships with colleagues. [ABSTRACT FROM AUTHOR]

Patients with rheumatoid arthritis (RA) have an increased risk of developing cardiovascular disease (CVD). Identification of at-risk patients is paramount to initiate preventive care and tailor treatments accordingly. Despite international guidelines recommending all patients with RA undergo CVD risk assessment, rates remain suboptimal. The objectives of this review were to map the strategies used to conduct CVD risk assessments in patients with RA in routine care, determine who delivers CVD risk assessments, and identify what composite measures are used. The Joanna Briggs Institute methodological guidelines were used. A literature search was conducted in electronic and grey literature databases, trial registries, medical clearing houses, and professional rheumatology organisations. Findings were synthesised narratively. A total of 12 studies were included. Strategies reported in this review used various system-based interventions to support delivery of CVD risk assessments in patients with RA, operationalised in different ways, adopting two approaches: (a) multidisciplinary collaboration, and (b) education. Various composite measures were cited in use, with and without adjustment for RA. Results from this review demonstrate that although several strategies to support CVD risk assessments in patients with RA are cited in the literature, there is limited evidence to suggest a standardised model has been applied to routine care. Furthermore, extensive evidence to map how health care professionals conduct CVD risk assessments in practice is lacking. Research needs to be undertaken to establish the extent to which healthcare professionals are CVD risk assessing their patients with RA in routine care. Key Points • A limited number of system-based interventions are in use to support the delivery of CVD risk assessments in patients with RA. • Multidisciplinary team collaboration, and education are used to operationalise interventions to support Health Care Professionals in conducting CVD risk assessments in practice. • The extent to which Health Care Professionals are CVD risk assessing their patients with RA needs to be established. [ABSTRACT FROM AUTHOR]

Objectives: There has been limited investigation into nursing students' experiences of carrying out comprehensive assessments. Consequently, there is a need to explore the most effective and efficient assessment approach for students conducting palliative assessments for patients. This study aimed to investigate nursing students' experiences of performing palliative assessments while on clinical placement in a hospital. Materials and Methods: This research was conducted in West Kalimantan, Indonesia. Eight nursing students participated in semi-structured interviews utilising open-ended questions, generating 10 audio recordings. This qualitative study applied interpretative phenomenology analysis, with data analysed thematically. Results: The study identified eight substantial themes that illustrate the experiences of nursing students in palliative care assessment: Upgrading assessment skills, Contributing influences in the assessment process, The way the patient responds to the assessment, Replenishment of data, The importance of family involvement, Emerging issues in the assessment process, Approaches to assessment and Refining the assessment process. The study enhances comprehension of how students surmount assessment challenges. Conclusion: The findings present a potential guide for future research on assessing the effectiveness of palliative care instruments employed by nurses to enhance comprehensive holistic assessments for patients. [ABSTRACT FROM AUTHOR]

A female patient, known to have hypermobile Ehlers-Danlos syndrome (hEDS), underwent several elective gastroscopies under sedation in different hospitals. Except for a single incident of mild laryngospasm during emergence, all procedures were uneventful. On that occasion, following the procedure in the postanesthesia care unit, the patient suffered severe airway obstruction, and standard airway rescue techniques exacerbated adequate ventilation. After the removal of all stimuli and maintaining only an indirect oxygen supply via a mask in front of her face, her airway improved, and the patient fully recovered after 17 minutes. After the gastroscopy, physical examination revealed that the patient had an extremely flexible trachea that could be completely moved outside the midline to the extreme right and left. For the subsequent procedures, an airway plan was developed in conjunction with the patient and resulted in uncomplicated perianesthetic care. This case report serves to alert readers to the risk of adverse airway events in patients with EDS and suggests an alternative approach to avoid such complications. When patients receive care in different hospitals, adequate documentation is essential and adequate preoperative assessment is crucial. This case study demonstrates the value of patient-coproduction care plans. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To appreciate that the gradual and uncertain trajectory in frailty can be a barrier to advance care planning • To recognise the importance of the early recognition of frailty in prompting conversations on end of life care • To acknowledge the need for all healthcare professionals to receive better education on frailty and its effects. Background: Older people with frailty are susceptible to sudden and rapid deterioration, so discussing their wishes and preferences for care at the end of life should be a priority. However, frailty is often not considered or recognised, which impedes patient-centred decision-making. Aim: To explore the views and perceptions of senior healthcare professionals regarding the usefulness of the Clinical Frailty Scale (CFS) in identifying frailty; whether a CFS score of severe frailty leads senior healthcare professionals to recognise that the person is likely to be approaching the end of life; and whether a CFS score of severe frailty prompts senior healthcare professionals to have conversations about advance care planning and end of life care with patients. Method: Semi-structured individual interviews were undertaken with seven senior healthcare professionals at one hospital in England. Data were analysed using thematic analysis. Findings: Frailty appeared to be complex, multifaceted and at times difficult to identify. A diagnosis of severe frailty did not necessarily prompt advance care planning and end of life care conversations. Such conversations were more likely to happen if the person had comorbidities, for example cancer. Prognostication appeared to be challenging, partly due to the gradual and uncertain trajectory in frailty and a lack of understanding, on the part of healthcare professionals, of the condition and its effects. Conclusion: People with severe frailty may be disadvantaged in terms of receiving appropriate end of life care. Better education on frailty for all healthcare professionals would facilitate conversations about advance care planning and end of life care with patients diagnosed with severe frailty. [ABSTRACT FROM AUTHOR]

Acne scarring is common and can occur even with effective acne management. In addition, patients with acne scarring suffer from significant psychosocial morbidity, including depression and suicidality. Despite the availability and advancement of therapeutic modalities, treatment for acne scarring is not always optimized and often overlooked in patients with acne encounters. Using acne scarring assessment tools and identifying specific acne scar subtypes allows for a tailored therapeutic approach. Part I of this continuing medical education series covers the pathophysiology and morphology of textural and pigmented acne scars, scarring assessment tools, and medical treatment options. The principles reviewed will aid in approaching and initiating acne scar treatment in the outpatient setting. [ABSTRACT FROM AUTHOR]

BackgroundElectronic Patient-Reported Outcome Measures (ePROMs) have emerged as valuable tools in cancer care, facilitating the comprehensive assessment of patients’ physical, psychological, and social well-being. This study synthesizes literature on the utilization of ePROMs in oncology, highlighting the diverse array of measurement instruments and questionnaires employed in cancer patient assessments. By comprehensively analyzing existing research, this study provides insights into the landscape of ePROMs, informs future research directions, and aims to optimize patient-centred oncology care through the strategic integration of ePROMs into clinical practice.MethodsA systematic review was conducted by searching peer-reviewed articles published in academic journals without time limitations up to 2024. The search was performed across multiple electronic databases, including PubMed, Scopus, and Web of Science, using predefined search terms related to cancer, measurement instruments, and patient assessment. The selected articles underwent a rigorous quality assessment using the Mixed Methods Appraisal Tool (MMAT).ResultsThe review of 85 studies revealed a diverse range of measurement instruments and questionnaires utilized in cancer patient assessments. Prominent instruments such as the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and the Patient Reported Outcome-Common Terminology Criteria for Adverse Events (PRO-CTCAE) were frequently referenced across multiple studies. Additionally, other instruments identified included generic health-related quality of life measures and disease-specific assessments tailored to particular cancer types. The findings indicated the importance of utilizing a variety of measurement tools to comprehensively assess the multifaceted needs and experiences of cancer patients.ConclusionOur systematic review provides a comprehensive examination of the varied tools and ePROMs employed in cancer care, accentuating the perpetual requirement for development and validation. Prominent instruments like the EORTC QLQ-C30 and PRO-CTCAE are underscored, emphasizing the necessity for a thorough assessment to meet the multifaceted needs of patients. Looking ahead, scholarly endeavours should prioritize the enhancement of existing tools and the creation of novel measures to adeptly address the evolving demands of cancer patients across heterogeneous settings and populations.

Why you should read this article: • To enhance your knowledge of blunt mechanism chest wall injury • To understand the acute care priorities for patients with blunt mechanism chest wall injury following initial assessment • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Blunt mechanism chest wall injury (CWI) is commonly seen in the emergency department (ED), since it is present in around 15% of trauma patients. The thoracic cage protects the heart, lungs and trachea, thereby supporting respiration and circulation, so injury to the thorax can induce potentially life-threatening complications. Systematic care pathways have been shown to improve outcomes for patients presenting with blunt mechanism CWI, but care is not consistent across the UK. Emergency nurses have a crucial role in assessing and treating patients who present to the ED with blunt mechanism CWI. This article discusses the initial assessment and acute care priorities for this patient group. It also presents a prognostic model for predicting the probability of in-hospital complications following blunt mechanism CWI. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To refresh your knowledge of holistic needs assessments (HNAs) • To consider how HNAs can be effectively delivered to patients with cancer as and when required • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Holistic needs assessments (HNAs) are interventions used by clinical nurse specialists (CNSs) and other members of the cancer team to deliver personalised care to people living with cancer. HNAs have been used since the launch of the National Cancer Survivorship Initiative in 2007, with many cancer services embedding them in routine patient care. However, shortcomings in HNA delivery remain, notably in terms of the number of people who receive them. This article prompts nurses to reflect on how HNAs can be effectively delivered to all patients with cancer as and when they need them. The author discusses the principles of personalised cancer care, the benefits of HNAs and when, where, how and by whom HNAs should be carried out. Recommendations to support nurses in cancer settings to increase and improve HNA delivery include CNSs, cancer support workers and allied health professionals joining forces and collaboration between secondary and primary care teams. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the importance of exercise in older people in preventing falls • To enhance your confidence in promoting exercise programmes suitable for older people • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Older people who sustain a fall may experience a range of adverse outcomes, such as distress, injury and loss of independence. Falls increase the risk of frailty and frailty increases the risk of falls. Regular exercise is a pillar of falls prevention and can have extensive benefits for older people’s health, well-being and ability to undertake activities they enjoy. As part of the multidisciplinary team, nurses have a pivotal role in implementing exercise-based falls prevention strategies for older people and in encouraging their patients to exercise. This article discusses exercise as a falls prevention strategy in hospital and in the community and supports nurses to develop their knowledge and confidence in promoting exercise in older people. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise the challenges that may be involved in undertaking mental health assessments of people with learning disabilities • To identify appropriate communication skills, strategies and approaches that can be used when conducting mental health assessments of people with learning disabilities • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Mental health issues are not only more prevalent in people with learning disabilities compared with the general population, but they are also more challenging to assess and diagnose. Reasons for this may include the communication issues and cognitive impairments often experienced by people with learning disabilities. This article describes some of the challenges that nurses and other healthcare professionals may encounter when assessing mental health issues in people with learning disabilities. It provides practical advice on how to conduct an effective mental health assessment and outlines a range of communication strategies that can be used to overcome any issues that occur. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To increase your awareness of the importance of identifying and assessing older people living with frailty • To understand the concept of frailty as a clinical syndrome • To familiarise yourself with frailty assessment tools such as the Clinical Frailty Scale, the most commonly used in the emergency department. An ageing population is leading to an increase in patients attending emergency departments (EDs) with comorbidities and age-related syndromes such as frailty. Frailty is a clinical syndrome defined as an increased vulnerability to age-related or disease-related insults in older adults due to diminishing physiological reserves. It also places increased demands on staff and hospital services. Screening for frailty early in the care pathway ensures goal-directed and timely care. This article provides an overview of frailty and its assessment in older people presenting to the ED. It discusses the most commonly used frailty assessment tool in the ED, the Clinical Frailty Scale, and identifies that the results of frailty assessment should be used to initiate appropriate individualised care in older patients. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the elements of neurological assessments in children • To improve your understanding of when to perform neurological observations and when to escalate them • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). Neurological observations are a vital part of the assessment of infants, children and young people with a suspected or confirmed acquired brain injury (ABI). They are designed to identify neurological deterioration and inform the management of ABIs. Children’s nurses may perform many of these neurological observations, including by using tools such as the AVPU scale, the Glasgow Coma Scale, pupillary response and limb assessment. This is the second of two articles that aim to encourage accuracy and consistency when performing neurological observations in infants, children and young people with a suspected or confirmed ABI to optimise their care. The article explains how to undertake various elements of a neurological assessment, how often to perform neurological observations, when to escalate concerns and why it is important to use family-centred care. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your understanding of the risk of skeletal-related events in patients with bone metastases • To increase your awareness of the need to inform at-risk patients about metastatic spinal cord compression • To identify the potential benefits of monitoring, educating and supporting at-risk patients. Patients with bone metastases are at significant risk of skeletal-related events such as metastatic spinal cord compression (MSCC), pathological fractures and hypercalcaemia. There is increasing evidence to support the early recognition of, and intervention for, skeletal-related events resulting from bone metastases. To enable early diagnosis and treatment, patients and families need to know what signs and symptoms to look out for and be aware that they must promptly report them if they appear. This is particularly the case of MSCC, which is an oncological and palliative care emergency. This article outlines the development of a multidisciplinary palliative care bone metastases review service in England which provides monitoring, education and support to patients with bone metastases. The service has not yet been formally audited but initial achievements and feedback are promising. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate physicians' knowledge of the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach components. Methods: A cross-sectional study was conducted in 2023 using an online questionnaire in order to collect data about the knowledge of the ABCDE approach's components among physicians in different specialties in Riyadh, Saudi Arabia. Results: The number of participants were 165 in total and the median knowledge score for all participants was 15.0, with an associated interquartile range (IQR) of 10.0 to 20.0. Intensive Care Medicine had the highest median knowledge score of 19.0 (IQR: 12.0– 21.0), followed by Internal Medicine at 17.0 (IQR: 13.0– 20.0). Conversely, Cardiology and Anesthesiology showed lower scores, with medians of 8.0 (IQR: 4.0– 10.0) and 7.5 (IQR: 4.0– 13.5), respectively (p = 0.011). Senior Registrars demonstrated the highest median knowledge score of 20.0 (IQR: 14.0– 22.0), while Fellows had the lowest at 8.5 (IQR: 7.0– 13.0) (p < 0.001). Practicing for 10 to 15 years and more than 15 years having medians of 20.0 (IQR: 16.0– 23.0) and 19.0 (IQR: 17.0– 22.0), respectively. However, participants with less experience, working for less than 5 years, had a median score of 12.0 (IQR: 8.5– 16.5) (p < 0.001). Conclusion: Knowledge scores of physicians representing various medical specialties found diverse levels regarding the ABCDE approach. Knowledge scores were significantly influenced by the primary area of practice, level of experience, and duration worked in the profession, highlighting the need for tailored training and education across different specialties and career stages. On the other hand, future studies should concentrate on finding new factors that influence practice adherence to the ABCDE approach and tying theoretical knowledge to clinical practice. [ABSTRACT FROM AUTHOR]

ObjectiveTo describe how a partnered evaluation of the Whole Health (WH) system of care-comprised of the WH pathway, clinical care, and well-being programs-produced patient outcomes findings, which informed Veterans Health Administration (VA) policy and system change.Data sourcesElectronic health records (EHR)-based cohort of 1,368,413 patients and a longitudinal survey of Veterans receiving care at 18 WH pilot medical centers.Study designIn partnership with VA operations, we focused the evaluation on the impact of WH services utilization on Veterans' (1) use of opioids and (2) care experiences, care engagement, and well-being. Outcomes were compared between Veterans who did and did not use WH services identified from the EHR.Data collectionPharmacy records and WH service data were obtained from the VA EHR, including WH coaching, peer-led groups, personal health planning, and complementary, integrative health therapies. We surveyed veterans at baseline and 6 months to measure patient-reported outcomes.Principal findingsOpioid use decreased 23% (31.5-6.5) to 38% (60.3-14.4) among WH users depending on level of WH use compared to a secular 11% (12.0-9.9) decrease among Veterans using Conventional Care. Compared to Conventional Care users, WH users reported greater improvements in perceptions of care (SMD = 0.138), engagement in health care (SMD = 0.118) and self-care (SMD = 0.1), life meaning and purpose (SMD = 0.152), pain (SMD = 0.025), and perceived stress (SMD = 0.191).ConclusionsEvidence developed through this partnership yielded key VA policy changes to increase Veteran access to WH services. Findings formed the foundation of a congressionally mandated report in response to the Comprehensive Addiction and Recovery Act, highlighting the value of WH and complementary, integrative health and well-being programs for Veterans with pain. Findings subsequently informed issuance of an Executive Decision Memo mandating the integration of WH into mental health and primary care across VA, now one lane of modernization for VA.

Why you should read this article: • To understand why exacerbations of chronic obstructive pulmonary disease occur • To familiarise yourself with the year-round patient management of chronic obstructive pulmonary disease • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). In winter, exacerbations of chronic obstructive pulmonary disease (COPD) are frequent. These exacerbations are associated with increased hospital admissions, morbidity and mortality. Reducing the risk of winter exacerbations of COPD is crucial for alleviating pressures on health services and can be achieved by providing optimal year-round patient management. Identifying, reviewing and assessing patients at risk of COPD exacerbations well ahead of the winter season helps put in place preventive interventions such as checking inhaler technique, educating patients to recognise exacerbations and promoting self-management. This article highlights risk factors for COPD exacerbations, describes how to undertake a comprehensive review of a patient with COPD, and discusses interventions that community and primary care nurses can deliver to reduce the risk of winter exacerbations. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To read the results of a study that evaluated two psychometric properties of the online version of the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q) • To recognise that the online CAIDS-Q could offer a way of supporting identification of learning disability in autistic people that is accessible to professionals and families • To be aware that the online CAIDS-Q may offer primary care staff a quick and accurate way of identifying people who need to join the learning disability register. Background: It is crucial that children and young people and adults with a learning disability are identified in a timely manner so that they can access appropriate support and interventions. However, it is often challenging to identify learning disability in autistic people, although it is common among this population. Aim: To examine the sensitivity (accuracy) and test-retest reliability of the online version of the Child and Adolescent Intellectual Disability Screening Questionnaire (CAIDS-Q) in identifying learning disability in people who are autistic and in those who are not autistic. Method: Anonymous CAIDS-Q data were used from 1,203 people who had completed the tool about a child or young person. Of these children and young people, 396 were reported to be autistic and 807 were not reported to be autistic. To determine the tool's sensitivity, the outcome based on the CAIDS-Q was compared with whether or not the person was reported to have a learning disability by the user of the tool. To determine the tool's test-retest reliability, data were analysed from a subsample of 139 people who had completed the screening tool about the same child or young person on two occasions within one week. Results: This study found that the online version of the CAIDS-Q accurately identified those with reported learning disability in 92% of those who were autistic and in 83% of those who were not autistic. The study also found that the CAIDS-Q scores were stable over a short period of time. Conclusion: The results suggest that the online CAIDS-Q can be used to help identify learning disability in people who are autistic and in those who are not autistic, indicating that the tool could be used in clinical practice to recognise those who may benefit from additional assessment, interventions and support. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the importance of the early recognition of health issues in people with learning disabilities • To enhance your knowledge of the range of communication skills nurses may use to engage service users in a systematic health assessment • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers). An important element of the role of the learning disability nurse is to support service users to maintain their health, particularly in relation to the early detection of health issues and timely access to appropriate treatments. One way of achieving this is by undertaking a systematic health assessment, of which effective communication is a central component in terms of identifying the person's communication needs and using appropriate communication methods to meet those needs. Effective communication can engage the person in the assessment process as well as identifying their own experience of their health. This article explains the importance of using a systematic approach to health assessment and describes various elements of communication involved in this process. The authors include a fictional case study to outline how a systematic health assessment works in practice and the range of communication skills nurses may use to engage service users in the process. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the different types and causes of acquired brain injuries (ABIs) in infants, children and young people • To increase your understanding of the pathophysiology of ABIs and associated complications • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Caring for infants, children and young people with an acquired brain injury (ABI) can be challenging due to their developing brain and reliance on parents and caregivers. It is essential that children's nurses are able to perform effective neurological observations, because these can identify deterioration and inform the management of patients with an ABI. This is the first of two articles that aim to encourage accuracy and consistency when undertaking neurological observations in infants, children and young people with an ABI to optimise their care. This first article details the pathophysiology, types and causes of ABIs and explains the potential complications that can occur following such injuries. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To read about the development of a nurse-led homeless health service in a general practice • To learn about how a nurse-led homeless health service functions • To recognise the benefits of a nurse-led health service for people experiencing homelessness People experiencing homelessness have a significantly higher mortality rate than the general population. Easy and flexible access to healthcare services is paramount in reducing morbidity and mortality in this patient population. In Caerphilly County Borough, where 309 residents were known to experience homelessness in 2023, two nurses have created a nurse-led homeless health service at a general practice. In the first two years of its existence, the service has conducted 140 assessments. Most people seen at the service had not engaged with primary care services since starting to experience homelessness. This article describes how the nurse-led homeless health service was developed, how it works and what is has achieved. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the similarities between the early symptoms of dementia and those of other healthcare conditions • To recognise some of the challenges in making an accurate and timely diagnosis of dementia • To learn why receiving a timely diagnosis can enhance access to treatment for people with dementia Receiving a timely and accurate diagnosis of dementia is essential to enable people to access vital treatment and support, reduce the risk of premature deterioration, and empower families to live well and plan. However, there are several challenges associated with obtaining a timely diagnosis, which have been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. This article outlines some of these challenges, describes the similarities between early symptoms of dementia and other health conditions and details the dementia diagnosis pathway in primary care. The authors use a case study to demonstrate this pathway. [ABSTRACT FROM AUTHOR]

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The HBV (hepatitis B virus) infection is intended for elimination, but evaluating patients is both costly and insufficiently applied in several countries. An expensive analysis in Romania is HBV-DNA quantification, with a limited prognostic potential. Our study intended to find new predictors for high viremia in HBV patients, using molecules involved in the multiple assessment of various HBV complications, such as microRNAs. A total of 61 subjects (48 patients with chronic HBV infection and 13 healthy subjects) were generally evaluated. Using a RT-PCR method, with a 2−ΔΔCT algorithm, we detected the expressions of miR-122 and miR-146a in 33 subjects. MiR-21 was the internal control. The results were analyzed with the R 4.2.2. software. Kruskal–Wallis's comparisons, Spearman correlations, and several logistic regression methods were applied. The median age of the patients was over 40 years. Without microRNAs, we could not obtain a good prediction formula. The combination of miR-122 and age proved to be the best prediction method for high viremia, with an AUC of 0.827, and a sensitivity of 89.5%. This is the first study which included age and miR-122 as independent predictors for high viremia in Romanian HBV-positive patients. MiR-122 is a new potential biomarker in the evaluation of Romanian patients. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To enhance your knowledge of the risks associated with pelvic fractures caused by high-energy trauma • To recognise the importance of conducting a primary survey adapted to patients with severe pelvic fractures • To identify the management priorities for patients who have sustained high-energy trauma to the pelvis Pelvic fractures caused by high-energy trauma such as falling from a height or road traffic collisions have a high mortality rate and patients are also at high risk of life-changing injuries. High-energy trauma to the pelvis is associated with major haemorrhage and injuries to the internal pelvic organs. Emergency nurses have a fundamental role in the initial assessment and management of patients, as well as in their ongoing care once the fracture has been stabilised and bleeding is controlled. This article describes the anatomy of the pelvis, discusses the initial assessment and management of patients who have sustained high-energy pelvic trauma, details the complications of pelvic fractures and explains patients' ongoing care in the emergency department. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To explore the causes and consequences of cortical visual impairment in people with learning disabilities • To understand better how to recognise visual perception issues in people with learning disabilities • To contribute towards revalidation as part of your 35 hours of CPD (UK readers) • To contribute towards your professional development and local registration renewal requirements (non-UK readers) Sight issues, which can be eye-related or brain-related, are common among people with learning disabilities. Premature birth or subsequent developmental delays can cause damage to the areas of the brain that process vision, leading to cortical visual impairment. Eye-related and brain-related sight issues can manifest as impaired visual perception causing, for example, difficulties with light perception, colour perception, object perception or movement perception. People with learning disabilities may display behaviours indicative of visual perception issues, but such behaviours are often ignored or misinterpreted. This article explains the causes and consequences of cortical visual impairment, describes visual perception issues that commonly arise from ocular/retinal or cortical causes, and outlines how learning disability nurses can detect the presence of visual perception issues in service users. [ABSTRACT FROM AUTHOR]

Aim(s): To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration. Design: This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses' vital sign measurement and escalation of care for deteriorating patients. Methods: The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24‐h periods within the same week were audited at three time points: pre‐intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post‐intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi‐square test. Results: A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre‐Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre‐Medical Emergency Team (n = 2403) or Medical Emergency Team triggers (n = 273). One or more nursing interventions were documented in 29.5% of audits with pre‐Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers. Conclusion: When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. Relevance to Clinical Practice: Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under‐recognised element of the organisational response to deteriorating patients. Implications for the profession and/or patient care: Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date. Impact: This study addresses the gap in the literature regarding nurses' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings.When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration.The results of this research are relevant to nurses working on medical and surgical wards. Reporting Method: The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement. Patient or Public Contribution: No Patient or Public Contribution. [ABSTRACT FROM AUTHOR]