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Respiratory Syncytial Virus (RSV) is a common seasonal respiratory virus and an important cause of illness among infants, but the burden of RSV disease is not well described among the older population. The objective of this study was to estimate the age-specific incidence of hospital admission among over 65s due to respiratory illnesses attributable to RSV in England to inform optimal vaccine and therapeutic interventions. We used linear multiple regression to examine the effect of changes in weekly counts of respiratory pathogens on the weekly counts of respiratory hospital admissions. The study population was all patients aged 65 years or over admitted to English hospitals between 2nd August 2010 and 30th July 2017. RSV was estimated to account for a seasonal annual average of 71 (95% CI 52-90) respiratory admissions per 100,000 in adults age 65-74 and 251 (95% CI 186-316) admissions per 100,000 adults age 75+. Pneumococcus was the pathogen responsible for highest annual average respiratory admission with 448 (95% CI 310-587) admissions per 100,000 adults age 65-74 and 1010 (95%CI 527-1493) admissions per 100,000 adults aged 75+. This study shows that RSV continues to exert a significant burden of disease among older adults in England. These findings will support development of policy for the use of RSV therapeutics and vaccines in this age group.

Mifepristone (brand name Mifeprex) is a prescription drug that has been safely used in the United States for twenty years to end early pregnancies and, more recently, to treat early miscarriages. Although the U.S. Food and Drug Administration (FDA) acknowledges that mifepristone's safety and efficacy are “well-established by both research and experience” [1] , it imposes a Risk Evaluation and Mitigation Strategy (“REMS”) that severely restricts where, how, and from whom this medication can be obtained. Most notably, FDA requires that mifepristone be dispensed at a hospital, clinic, or medical office—not by mail or through a retail or mail-order pharmacy—even though patients can receive all evaluation and counseling via telemedicine and can self-administer the mifepristone tablet, unsupervised, at the location of their choice. Of more than 20,000 FDA-approved drugs [2] , mifepristone is the only one FDA requires patients to pick up in a clinical setting even though they do not have to take it under clinical supervision [3] . FDA's singular restrictions on mifepristone are not only clinically unjustified, but unlawful. On behalf of leading medical associations, individual physicians, and reproductive justice advocates, our organization, the American Civil Liberties Union, has taken FDA to court—twice—because the agency's restrictions on mifepristone do not satisfy the strict constraints Congress established for REMS programs and erect profound and unnecessary barriers to care in violation of the U.S. Constitution.

We recently showed that eumenorrheic, ovulatory women with obesity experience suppressed antral follicle dynamics, as evidenced by fewer recruitment events, selectable follicles and dominant follicles. Ovulatory follicles were selected for preferential growth at smaller diameters and lower luteal progesterone production was also observed. Weight loss is posited to improve reproductive function in women with obesity. However, the mechanisms underlying these improvements are unclear. The objective of this study was to contrast ovarian follicular growth and endocrine dynamics in eumenorrheic women with obesity, before and after a weight-loss intervention. | Twelve reproductive age females with obesity (total percent body fat ≥35%) and regular menstrual cycles (21-35 days) were evaluated by serial ovarian transvaginal ultrasonography and venipuncture every-other-day for one complete inter-ovulatory interval (IOI) (pre-intervention) and after a 6-month hypocaloric dietary intervention (post-intervention). The number and diameters of all follicles ≥2mm at each visit were documented offline using the Grid Method. Growth profiles of individual follicles which grew to >7mm were recorded using the Identity Method to document antral follicle recruitment events, selection, and ovulation. Clinical, morphologic, and endocrine features were compared pre- and post-intervention using paired t-tests and mixed models. | Participants lost an average of 9.5±3.8% total body weight (IQR: 7.7-12.6%). Antral follicle counts (AFC) across the IOI were lower post-intervention versus pre-intervention (PINTERVENTION=0. 002), driven by fewer 2-5mm follicles (PINTERVENTION=0. 001). Participants tended to exhibit more recruitment events (Pre: 1. 0±0.7 vs. Post: 2. 0±0.9, P=0. 09) and more selectable (6-9mm) follicles before and after weight loss (4±3 vs. 6±4 respectively, P=0. 07). A greater number of selectable follicles achieved a diameter of >10mm across the IOI post-intervention (PINTERVENTION=0. 001). Ovulatory follicles were also selected at larger diameters after the intervention (Pre: 7.3±2.9mm vs. Post: 10.9±2.6, P=0. 01). Dominant and ovulatory follicle growth kinetics were similar before and after the intervention (All, P>0. 05). Luteal progesterone concentrations were higher in women after the intervention (Pre: 5.3±3.7 vs. Post: 6.3±4.7ng/mL, P Presentation: Monday, June 13, 2022 12:30 p.m. - 2:30 p.m.

Current national estimates of respiratory syncytial virus (RSV)-associated hospital admissions are insufficiently detailed to determine optimal vaccination strategies for RSV. We employ novel methodology to estimate the burden of RSV-associated hospital admissions in infants in England, with detailed stratification by patient and clinical characteristics.We used linked, routinely collected laboratory and hospital data to identify laboratory-confirmed RSV-positive and RSV-negative respiratory hospital admissions in infants in England, then generate a predictive logistic regression model for RSV-associated admissions. We applied this model to all respiratory hospital admissions in infants in England, to estimate the national burden of RSV-associated admissions by calendar week, age in weeks and months, clinical risk group and birth month.We estimated an annual average of 20,359 (95% CI 19,236-22,028) RSV-associated admissions in infants in England from mid-2010 to mid-2012. These admissions accounted for 57,907 (95% CI 55,391-61,637) annual bed days. 55% of RSV-associated bed days and 45% of RSV-associated admissions were in infants3 months old. RSV-associated admissions peaked in infants aged 6 weeks, and those born September to November.We employed novel methodology using linked datasets to produce detailed estimates of RSV-associated admissions in infants. Our results provide essential baseline epidemiological data to inform future vaccine policy.

Objective: The present review aimed to examine the relationship between attachment styles and posttraumatic growth in adults exposed to traumatizing events. Method: A systematic literature search resulted in the inclusion of 14 studies in the review. Four correlational meta‐analyses of the relationship between the attachment styles of secure, dismissive, preoccupied, and fearful, and posttraumatic growth, were conducted. Results: These revealed a significant small positive relationship between secure attachment and posttraumatic growth (r = 0.21, p < 0.001); a significant small negative relationship between dismissive attachment and posttraumatic growth (r = −0.12, p < 0.001), and a weak relationship between preoccupied attachment and posttraumatic growth (r = −0.04, p = 0.235), and fearful attachment and posttraumatic growth (r = 0.08, p = 0.248). Conclusions: The relationship between attachment styles and posttraumatic growth is modest and may be better explained by other variables. Nonetheless, findings provide useful information for clinicians regarding the potential small impact of attachment style following traumatizing exposure. Implications for future research are highlighted with respect to methodological rigor and the role of other potentially influential variables.

Public speaking anxiety (PSA) is a prevalent condition with disabling occupational, educational, and social consequences. Exposure therapy is a commonly utilized approach for treating PSA. Traditionally, this intervention has been delivered as in vivo exposure therapy (IVET). Limitations inherent to in vivo as a mode of delivery have been identified and studies have increasingly explored the use of Virtual Reality Exposure Therapy (VRET) as an alternative. Understanding the efficacy of both VRET and IVET as psychological interventions for PSA is important. A systematic search identified 11 studies with 508 participants. Meta-analysis yielded a large significant effect wherein VRET resulted in significant reductions in PSA versus control of −1.39 ( Z = 3.96, p

Public speaking anxiety (PSA) is a prevalent condition which is highly interrelated with social anxiety. PSA can be effectively treated with exposure therapy. Virtual reality exposure therapy (VRET) is increasingly being explored as a novel and cost-effective mode of treatment. No previous randomized controlled trial has examined whether stand-alone 360° video VRET is an effective intervention for treating PSA and interrelated disorder relevant fears. Further, studies have not explored whether 360° video content influences VRET outcomes. Participants with high PSA (n = 51) were randomly allocated to: 360° video VRET incorporating stimuli of audiences (360°Audience) (n = 17), 360° video VRET incorporating stimuli of empty rooms (360°Empty) (n = 16) and no treatment control (n = 18). Outcomes were measured over five time-points. Mixed ANOVA revealed a significant interaction between time and intervention group for PSA, social anxiety and fear of negative evaluation (FNE). Within-group analysis demonstrated there was a significant pre-intervention to post-intervention reduction across measures for both 360° video VRET groups: PSA 360°Audience (ηp2 = .90, p

SummaryBackground The unregulated social network YouTubeTM has become an increasingly popular source of information on health topics such as vaccine safety. With a reach of over one billion users per month, the potential for misinformation is significant. Methods Using the keywords ‘vaccine safety’ and ‘vaccines and children’, 87 of the most widely viewed YouTubeTM videos were identified and analyzed for content, author status and view count. Results The range of view counts was 25 532 to 6 229 835, with a median of 62 075 views per video. Most videos (n = 74, 85.1%) were devoted exclusively to the topic of vaccination. The three most common sources of these YouTubeTM videos were consumers (27.6%), TV-based or Internet-based news (26.4%) and individual health professionals (25.3%). Top topics covered were autism causality (47.1% of videos), undisclosed or poorly understood risks (42.5%), adverse reactions (40.2%) and thimerosol or mercury in vaccines (36.8%). The majority of videos (65.5%) discouraged the use of vaccines. Conclusion Health professionals should be aware of the widely disseminated vaccination information available on the Internet and should appreciate its possible effect on the public.

SUMMARYThe epidemiology of laboratory-confirmed respiratory syncytial virus (RSV) infections in young children has not recently been described in England, and is an essential step in identifying optimal target groups for future licensed RSV vaccines. We used two laboratory surveillance systems to examine the total number and number of positive RSV tests in children aged

This paper traces the historic development of flood risk and the antecedent conditions that contributed to the catastrophic consequences in central South Carolina as the result of the 2015 ...

Individuals often search the Internet for information about their medical conditions, such as generalized anxiety disorder (GAD), a common mental health disorder.To describe the content of the most popular videos on YouTube™ related to GAD.Videos with at least 50,000 views in October 2016 were coded for information regarding symptoms, treatments and causes for GAD. Associations of content with factors such as popularity and focus on a personal experience were examined.The search returned 95 videos, which had been collectively viewed 37,044,555 times. Most (65%) were uploaded by consumers and 56% were about a personal experience. The most common symptoms mentioned were worry or panic (72%) and social anxiety (46%). Many videos (63%) mentioned at least one treatment, but only 26% mentioned any cause of anxiety. Videos that focused on a personal experience were significantly less likely to mention other phobias ( p = .036), panic disorder ( p = .033) and sleep issues ( p = .016).The majority of the most popular videos on YouTube ™ related to GAD were produced by consumers. Improved understanding about what information is available and popular online can assist mental health professionals in aiding their patients and in producing media that is likely to be viewed.

Background: Violence is a pervasive problem in the United States. Toys, far from trivial playthings, are a reflection of society, including its beliefs and values. The purpose of this study was to describe the extent to which violent toys are marketed in online weekly flyers of popular retailers, how the violence is manifested, and whether violent toys are marketed differentially to boys and girls. Methods: For this cross-sectional observational study, online circulars from 5 major retailers were downloaded and examined each week for 14 weeks during the fall of 2014. For each retailer, the total number of toys, as well as the total number of violent and non-violent toys, was recorded. In addition, each violent toy was categorized into one of five groups: picturing a figure with a weapon, a figure with intent to strike (with fists drawn or an angry face), a toy with a violent name, a toy that was a weapon itself, or a set of toys that included two or more of these criteria. Results: A total number of 3,459 toys were observed, of which 1,053 (30%) were deemed violent. Of the violent toys, 95% were marketed to boys (n=1,003) versus 5% to girls (n=50). The most prevalent violent category was a figure with a weapon such as a sword, knife or gun (29%), followed by figures with fists out and aggressive faces (26%). Conclusion: Parents should be mindful of toy retailer’s marketing of violent toys, especially toward boys, and the potential for those toys to de-sensitize their children to violence.

Purpose – The purpose of this paper is to establish the effectiveness of self-management training as an intervention for people using secondary mental health services. Design/methodology/approach – A self-management and peer support intervention was developed and delivered by secondary mental health service users to 262 people with psychiatric diagnoses living in the community. Data on wellbeing and health-promoting behaviour were collected at three time points (baseline, six, and 12 months). Findings – Participants reported significant improvements in wellbeing and health-promoting lifestyle six and 12 months after self-management training. Peer-led self-management shows potential to improve long-term health outcomes for people with psychiatric diagnoses. Research limitations/implications – Due to the lack of a control group, the positive changes cannot definitively be attributed to the intervention. Other limitations were reliance on self-report measures, and the varying numbers of completers at three time points. These issues will be addressed in future studies. Practical implications – The evaluation demonstrated the effectiveness of self-management training for people with psychiatric diagnoses, suggesting self-management training may bring significant wellbeing gains for this group. Social implications – This study represents a first step in the implementation of self-management approaches into mental health services. It demonstrates the feasibility of people with psychiatric diagnoses developing and delivering an effective intervention that complements existing services. Originality/value – This is the first study to investigate the effectiveness of a self-management training programme developed and delivered by mental health service users in the UK.

ObjectivesThis study aims to describe the burden of respiratory syncytial virus (RSV) in children

Objective To investigate whether affective and relational components of nurses’ experience of work have a significant impact on their intentions to leave either the job or the nursing profession in models that control forother factors (sociodemographic, work conditions, perceptions of quality of care) that are known to affect career decisions. Method An exploratory, cross-sectional postal survey of 2880 nurses in grades A-I in 20 National Health Service (NHS) Hospital Trusts, 11 in inner London and nine in outer London, was carried out between January and July 2002, looking at nurses’ intention to leave their current job or the nursing profession. The data were analysed using logistic regression with robust standard errors. Results In models that controlled for known sources of job dissatisfaction, relationships with supervisors and managers were found to have a significant effect on respondents’ career intentions. Feeling valued by the Trust and by society was very important. Nurses seemed to distinguish between local problems that are the responsibility of the Trust and those, such as levels of pay, that could only be solved at the national level. Conclusion Nurses’ career intentions are complex and multifactorial. Feelings of being valued and listened to play a role, as well as the individual and job-related characteristics. The study highlights the role of supervisors and managers in retaining staff and suggests that investment in robust systems of communication, conflict resolution and security could slow nurse turnover. The NHS as an employer may be most interested in the role of pay in nurse retention, and the general public in how societal attitudes and verbal abuse shape nurses’ career decisions.

Background: The purpose of this cross-sectional study was to enumerate and describe violent and risky behaviors as well as other general health behaviors exhibited in the advertisements during the National Football League (NFL) Super Bowl 2015. Methods: Commercials during the NFL Super Bowl 2015 were assessed for violent and risky behaviors. Additional health behaviors were indicated such as the advertisement of unhealthy food, promotion of physical activity, and sexual content. Results: A total of 110 commercials were documented, accounting for 64 minutes of broadcast time. Commercials promoting automobiles, television shows, food, and movies were the most prevalent, representing just over half (53.7%) of all of the advertisements featured. Depictions of unsafe driving were found in 10.9% (n = 12) of the commercials. All 12 commercials contained some sort of risky or wild driving behavior, and speeding was observed in 11 of the 12 commercials. A total of 32 (29.1%) of the commercials were coded as including violent content.Physical activity behavior was present in 3 (2.7%) of the commercials. Conversely, substance use was observed in 3 (2.7%) of the commercials, none of which included health promotion messaging. Of the 110 commercials aired during the 2015 Super Bowl, 12.7% (n = 14) included sexual content. Conclusion: Parents should consider the possibility that their children may observe acts of violence or conflicting safety messages during commercial breaks.

Objectives: To assess current attitudes towards the national patient survey programme in England, establish the extent to which survey results are used and identify barriers and incentives for using them. \ud \ud Design: Qualitative interviews with hospital staff responsible for implementing the patient surveys (survey leads). \ud \ud Setting: National Health Service (NHS) hospital organisations (trusts) in England. \ud \ud Participants: Twenty-four patient survey leads for NHS trusts. \ud \ud Results: Perceptions of the patient surveys were mainly positive and were reported to be improving. Interviewees welcomed the surveys’ regular repetition and thought the questionnaires, survey methods and reporting of results, particularly inter-organisational benchmark charts, were of a good standard. The survey results were widely used in action planning and were thought to support organisational patient-centredness. There was variation in the extent to which trusts disseminated survey findings to patients, the public, staff and their board members. The most common barrier to using results was difficulty engaging clinicians because survey findings were not sufficiently specific to specialties, departments or wards. Limited statistical expertise and concerns that the surveys only covered a short time frame also contributed to some scepticism. Other perceived barriers included a lack of knowledge of effective interventions, and limited time and resources. Actual and potential incentives for using survey findings included giving the results higher weightings in the performance management system, financial targets, Payment by Results (PbR), Patient Choice, a patient-centred culture, leadership by senior members of the organisation, and boosting staff morale by disseminating positive survey findings. \ud \ud Conclusion: The national patient surveys are viewed positively, their repetition being an important factor in their success. The results could be used more effectively if they were more specific to smaller units.

Objective: To determine the extent of correlation between stroke patients’ experiences of hospital care with the quality of services assessed in a national audit. Methods: Patients’ assessments of their care derived from survey data were linked to data obtained in the National Sentinel Stroke Audit 2004 for 670 patients in 51 English NHS trusts. A measure of patients’ experience of hospital stroke care was derived by summing responses to 31 survey items and grouping these into three broad concept domains: quality of care; information; and relationships with staff. Audit data were extracted from hospital admissions data and management information to assess the organisation of services, and obtained retrospectively from patient records to evaluate the delivery of care. Patient survey responses were compared with audit measures of organisation of care and compliance with clinical process standards. Results: Patient experience scores were positively correlated with clinicians’ assessment of the organisational quality of stroke care, but were largely unrelated to clinical process standards. Responses to individual questions regarding communication about diagnosis revealed a discrepancy between clinicians’ and patients’ reports. Conclusions: Better organised stroke care is associated with more positive patient experiences. Examining areas of disparity between patients’ and clinicians’ reports is important for understanding the complex nature of healthcare and for identifying areas for quality improvement. Future evaluations of the quality of stroke services should include a validated patient experience survey in addition to audit of clinical records.

BackgroundMinority ethnic groups in the UK are reported to have a poor experience of mental health services, but comparative information is scarce.AimsTo examine ethnic differences in patients' experience of community mental health services.MethodTrusts providing mental health services in England conducted surveys in 2004 and 2005 of users of community mental health services. Multiple regression was used to examine ethnic differences in responses.ResultsAbout 27 000 patients responded to each of the surveys, of whom 10% were of minority ethnic origin. In the 2004 survey, age, living alone, detention and hospital admissions were stronger predictors of patient experience than ethnicity Self-reported mental health status had the strongest explanatory effect. In the 2005 survey, the main negative differences relative to the White British were for Asians.ConclusionsEthnicity had a smaller effect on patient experience than other variables. Relative to the White British, the Black group did not report negative experiences whereas the Asian group were most likely to respond negatively. However, there is a need for improvements in services for minority ethnic groups, including access to talking therapies and better recording of ethnicity.

Objectives Adult inpatient surveys generate approximately 70,000 responses per year about patients’ experiences of National Health Service hospital care in England. We examine historical data to assess change between 2002 and 2013 and consider the factors that may have stimulated any change. Methods Archived national data from National Health Service Inpatient Surveys between 2002 and 2013 (comprising 840,077 patient responders) were obtained. Questions were selected for inter-year analysis if they had been replicated for at least seven years. The percentage of responses in the most positive category was compared for each question’s earliest and most recent year. The statistical significance of differences was tested using chi-square. Also, since such large sample sizes mean that even 1% differences are statistically significant, effect sizes were used to assess the practical significance of those differences. Results There were statistically significant ( p 0.1) and one ‘small’ decline, but differences were not meaningful for 42 questions. The greatest improvements were for patients receiving copies of doctors’ letters; single sex ward areas; clinicians’ hand washing; ward cleanliness and planned admission waiting times. The greatest decline was that fewer responders said their call bells were usually answered within 2 min. Conclusions More aspects of care have improved than have deteriorated. This study highlights the need for a consistent repeated survey programme to detect changes over the long term, since year-to-year changes tend to be small. The greatest improvements are in areas that can be influenced by organisation-wide interventions and many are associated with top–down government policies, targets or media campaigns. Patients’ evaluations of many aspects of their interactions with clinicians are unchanged or have declined. Further research could test whether ward-specific facilitated communication of survey results to clinicians could drive improvements in clinician–patient interactions.

BackgroundEarly detection and treatment influence the mortality risk of skin cancer. ObjectiveThe objective of this study was to analyze the content of the most viewed professional and consumer videos uploaded to YouTube related to skin cancer. MethodsA total of 140 professional and consumer videos uploaded between 2007 and 2014 were identified and coded. Coding involved identifying and sorting followed by gathering descriptive information, including length of the video, number of views, and year uploaded. A dichotomous coding scheme (ie, yes or no) was used in coding specific aspects of video content, including provision of information, type of skin cancer, age group, family history, risk reduction, risk factors, fear, and home remedies for skin cancer treatment. ResultsThe majority of videos provided information related to screening. Many consumer videos conveyed information related to the use of a black salve as a home remedy for skin cancer, despite the fact that there is no evidence that it is an effective treatment. ConclusionsResearch is needed to identify characteristics of videos that are most likely to be viewed to inform the development of credible communications.

Background: It generally is accepted that cataract surgery during the first 6 weeks of life is associated with the best visual outcomes for children with dense unilateral congenital cataracts. The latent period for children with dense bilateral congenital cataracts has not been clearly defined. Methods: The best-corrected visual acuity (BCVA) at 4 to 6 years of age was collected retrospectively on a series of 43 children with dense bilateral congenital cataracts from 4 institutions. All of the children underwent a lensectomy, posterior capsulotomy, and anterior vitrectomy at 36 weeks of age or younger. Results: Cataract surgery was performed at a mean age of 11.5 weeks for the better-seeing eye. BCVA was assessed when the children were a mean of 5.3 years of age. The visual acuities of 26 (60%) were 20/40 or better, 12 (28%) were 20/50 to 20/80, and 5 (12%) were 20/100 or worse. There was a trend for worse BCVA with increasing age at the time of surgery (r = 0.28, P = 0.07). We noted that a BCVA of 20/100 or worse occurred only among eyes undergoing surgery when infants were older than 10 weeks (≤10 weeks: 0/21 = 0% vs. >10 weeks: 5/22 = 23%, P = 0.049). Children with preoperative nystagmus had worse visual outcomes; only 38% of children with preoperative nystagmus achieved a BCVA of 20/40 or better compared with 74% of children without preoperative nystagmus (P = 0.03). Conclusion: Previous reports have proposed that cataract surgery during the first 5 to 8 weeks of life is associated with better visual outcomes in children with dense bilateral congenital cataracts. Our results would suggest that good visual outcomes can be achieved beyond this age, but the incidence of poor visual outcomes increases if cataract surgery is delayed beyond 10 weeks of age. The absence of preoperative nystagmus is a better predictor of a good visual outcome than the age at surgery.

With a monthly total of more than one billion unique visitors, YouTube

Aims and objectives. To investigate whether nurses experience barriers to delivering high quality care in areas that are of particular concern to patients and to describe which aspects of care are most affected when nurses lack the required resources, such as time, tools and training to do their job. Background. Patient surveys conducted in the National Health Service of the United Kingdom tend to show there is variation in the extent to which they are satisfied with care in a number of important areas, such as physical comfort, emotional support and the coordination of care. Design. A sample of nurses working in 20 acute London hospitals was asked to complete a postal questionnaire based on a prototype employee survey developed in the United States and adapted by the authors for use in the United Kingdom. Method. Staff in the human resources departments of participating hospitals mailed the questionnaires to nurses’ home addresses. After two reminders, 2880 (out of 6160) useable responses were returned, giving a response rate of 47%. Results. Nurses are aware that there are deficits in standards of care in areas that are particularly important to patients. The majority feel overworked (64%) and report that they do not have enough time to perform essential nursing tasks, such as addressing patients’ anxieties, fears and concerns and giving patients and relatives information. Their work is often made more difficult by the lack of staff, space, equipment and cleanliness. They are often unable to control noise and temperature in clinical areas. Nurses in acute London hospitals are subject to high levels of aggressive behaviour, mainly from patients and their relatives, but also from other members of staff. More positively, high proportions of the nurses in our survey expressed the desire for further training, particularly in social and interpersonal aspects of care. Relevance to clinical practice. This paper goes beyond reporting problems with the quality and safety of care to try to understand why patients do not always receive optimum care in areas that are important to them. In many cases nurses lack the time, tools and training to deliver high quality care in acute London hospitals. We suggest a number of low-cost interventions that might remove some of the barriers to patient-centred care. The questionnaire we have developed could be a useful tool for improving quality locally.

Objectives Previous research on nurse retention has focused mainly on its relationship with employment conditions. This study aimed to include an examination of the impact of nurses’ perceived barriers to delivering high-quality patient-centred care on their intentions to leave their current employers. Methods An American employee questionnaire was adapted for use with British nurses. The questionnaire was mailed to 6160 nurses directly employed by 20 London hospitals. Up to two reminders were sent to non-responders. The questionnaire asked nurses to report on experiences in their working lives and to state their intentions to leave or stay with their current employer. Demographic and employment history information was also elicited. Results Responses were received from 2880 (47%). Nurses report that the care they are able to provide often falls short of recognised standards. Factor analysis combined 82 questions on nurses’ experiences into four patient-centred and four nurse-centred dimensions. Nurses who report more problems in both nurse-centred and patient-centred dimensions are more likely to intend to leave their current employers. Satisfaction with pay and the cleanliness of work areas are also important factors. Conclusions Standards of care are often perceived by nurses to be unacceptably poor. Furthermore, their experience of barriers to care has a demonstrable impact on their decision to leave or stay with their current employer. Nurse managers need to address the perceived barriers to providing high-quality care when considering nurse retention strategies.

AIM: To examine YouTube™ videos about bowel preparation procedure to better understand the quality of this information on the Internet. METHODS: YouTube™ videos related to colonoscopy preparation were identified during the winter of 2014; only those with ≥ 5000 views were selected for analysis (n = 280). Creator of the video, length, date posted, whether the video was based upon personal experience, and theme was recorded. Bivariate analysis was conducted to examine differences between consumers vs healthcare professionals-created videos. RESULTS: Most videos were based on personal experience. Half were created by consumers and 34% were ≥ 4.5 min long. Healthcare professional videos were viewed more often (> 19400, 59.4% vs 40.8%, P = 0.037, for healthcare professional and consumer, respectively) and more often focused on the purgative type and completing the preparation. Consumer videos received more comments (> 10 comments, 62.2% vs 42.7%, P = 0.001) and more often emphasized the palatability of the purgative, disgust, and hunger during the procedure. Content of colonoscopy bowel preparation YouTube™ videos is influenced by who creates the video and may affect views on colon cancer screening. CONCLUSION: The impact of perspectives on the quality of health-related information found on the Internet requires further examination.

SummaryEvidence suggests that there is a greater prevalence of pain, particularly chronic pain, in the older than in the younger population. This review looks at how dementia affects older people's ability to report pain, and indicates that pain is poorly assessed and managed in people living with dementia, in particular in care and acute settings. The review also reports findings from two recent studies looking at ways of improving the assessment and management of pain in acute settings. Multi-dimensional, patient-centred approaches to assessing and managing pain in those living with dementia are required, and future research should focus on innovative and practical approaches that can be applied in care home and acute settings.

Background Respiratory syncytial virus (RSV) is a major cause of hospital admission for lower respiratory tract infections in young children. Since virological testing is carried out in only a minority of admitted children, previous estimates of the hospital burden of RSV have relied on time-series modelling techniques. In this study we use a unique linked laboratory surveillance and hospital admission database to estimate the secondary care burden of RSV in children younger than 5 years in England. Methods National laboratory surveillance data was probabilistically linked to the Hospital Episode Statistics database for children younger than 5 years in England from Aug 1, 2010, to July 31, 2012, using National Health Service number, date of birth, post code, and sex. We used the linked data to estimate the probability of a respiratory hospital admission being RSV-related based on diagnostic coding and calendar week. Using these probabilities, we estimated the number of RSV-associated admissions by age and sex, and calculated admission rates using Office for National Statistics mid-year population estimates. Findings We analysed 4530 RSV-positive linked admissions and 7910 RSV-negative linked admissions. 4257 (94%) of 4530 RSV-positive admissions occurred between Nov 1 and March 31 each year. 3656 (81%) of 4530 RSV-positive admissions were in children younger than 1 year. 3139 (79%) of 4530 RSV-positive admissions had a primary diagnosis of bronchiolitis. Linked admissions had a longer length of stay than did unlinked admissions (median 3 days vs 1). We will present results on the total estimated number of RSV-associated admissions stratified by age, calendar week, and primary diagnosis. Preliminary analysis estimates a total annual average of about 33 500 RSV-associated admissions in children younger than 5 years, with nearly half of these admissions in children younger than 6 months. Interpretation Our study is the first, to our knowledge, to link laboratory and hospital data for RSV in England. Our results point to a likely testing bias towards younger children who are in hospital for longer. Our approach of estimating the national secondary care burden using probability weights from smaller, linked samples could be applied to other seasonal infections. With several RSV vaccines in clinical trials, our results can be used to populate cost-effectiveness models of alternative vaccination strategies. Funding RMR is funded by a Farr Institute of Health Informatics Research PhD studentship.

The applicability of several theories of leisure motivation to a range of 36 activities typically undertaken by younger people has been investigated. The theories were Csikzentmihalyi's theory of flow (theory 1), Bandura's theory of self-efficacy (theory 2), Apter's theory of telic and paratelic activity (theory 3) and a general theory of social motivation (theory 4). Participants were 183 young men and women in secondary and tertiary education who completed self-report questionnaires containing scales for the frequency, enjoyment, purpose, social satisfaction, skill, ability and challenge which they associated with activities they had personally experienced. The balance between skill and challenge implied by theory 1 was found to be characteristic of all activities, whether or not they could be expected to generate flow. The data collected in the study provided little support for theory 2. It was possible to distinguish telic and paratelic activities according to theory 3 and to show that the latter were more enjoyable and less purposive. Although theory 4 was not relevant to solitary activities, it was still the most generally applicable and even appeared to account for most of the enjoyment derived from highly purposive activities, which were not otherwise greatly enjoyed.

Objective To compare the use of contact lenses and intraocular lenses (IOLs) for the optical correction of unilateral aphakia during infancy. Methods In a randomized, multicenter (12 sites) clinical trial, 114 infants with unilateral congenital cataracts were assigned to undergo cataract surgery with or without IOL implantation. Children randomized to IOL treatment had their residual refractive error corrected with spectacles. Children randomized to no IOL treatment had their aphakia treated with a contact lens. Main outcome measures Grating acuity at 12 months of age and HOTV visual acuity at 4 1/2 years of age. Application to clinical practice This study should determine whether either treatment for an infant with a visually significant unilateral congenital cataract results in a better visual outcome. Results Enrollment began December 23, 2004, and was completed January 16, 2009. The median age at the time of cataract surgery was 1.8 months. Fifty patients were 4 to 6 weeks of age at the time of enrollment; 32, 7 weeks to 3 months of age; and the remaining 32, more than 3 to less than 7 months of age. Fifty-seven children were randomized to each treatment group. Eyes with cataracts had shorter axial lengths and steeper corneas on average than the fellow eyes. Conclusions The optimal optical treatment of aphakia in infants is unknown. However, the Infant Aphakia Treatment Study was designed to provide empirical evidence of whether optical treatment with an IOL or a contact lens after unilateral cataract surgery during infancy is associated with a better visual outcome.

The effectiveness of a central bank's monetary policymaking is determined by the merit of its policy actions and their perceived credibility. Since the 1990s central banks have placed more emphasis on clear communications and transparency as additional levers to help achieve their goals. In this paper we examine how UK financial markets react to Bank of England communication. We might expect interest rate expectations, and potentially other asset prices, to react to official communication if such communication helps inform market participants. We find evidence that the publication of the Minutes of the Monetary Policy Committee meetings and the Inflation Report significantly affect near-term interest rate expectations, an effect particularly visible in intraday data. Speeches and parliamentary committee hearings appear to have less of an impact. Our results for the UK are arguably less strong than Kohn and Sack's (2003) findings for US Federal Reserve communication. Although differences in institutional frameworks between the UK and US mean communications are not directly comparable, our results might also reflect the different mandates of the FOMC and the MPC, with the Federal Reserve having greater freedom to interpret its objectives.

BACKGROUND: The purpose of this study was to compare the performance of the 15-item Picker Patient Experience questionnaire (PPE-15) when embedded in a short form instrument as compared with a longer form measure. METHODS: A postal questionnaire survey of patients recently discharged from two hospital trusts was carried out. Patients were randomized to receive the PPE-15 in either a four-page or a 12-page survey instrument. RESULTS: A total of 1445 questionnaires were mailed to patients in either four- or 12-page formats. A total of 949 (65.67 per cent) forms were returned. No difference in response rate was found between the two versions of the questionnaire. Item completion and psychometric properties of the PPE-15 were not found to differ significantly between the two arms of the trial. CONCLUSION: In this survey the length of questionnaire in which the PPE-15 was embedded had no impact in terms of response rate or data quality. Consequently, the results suggest that length of questionnaire, up to the 108 items included in the 12-page survey, is unlikely to adversely affect results on the PPE-15.