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Background: This study aimed to identify patterns of overall, team, and individual sport participation and examine the prospective associations between these patterns and loneliness in young people. Methods: We analyzed data from 4241 young people, from waves 3 (8–9 y) to 9 (20–21 y) of the Longitudinal Study of Australian Children. We conducted latent class analyses to identify overall and team versus individual sport participation trajectories and used adjusted log-Poisson regression models to examine the associations between these trajectories and loneliness at wave 9. Results: Latent class analyses identified 4 distinct overall sport participation classes which were labeled: nonparticipants (24%), dropouts (42%), initiators (7%), and consistent participants (27%). Compared with nonparticipants, consistent participants had a lower risk of loneliness (risk ratios = 0.69; 95% CIs, 0.59–0.81). Latent class analyses also identified 4 distinct team versus individual sport participation classes: team and individual sport nonparticipants (38%), individual sport participants (14%), moderate team sport participants (14%), and high team sport participants (34%). Compared with the team and individual sport nonparticipants, the high team sports participants had a lower risk of loneliness (risk ratios = 0.70; 95% CIs, 0.53–0.92). Conclusions: Young people who continued participating in sport in general, and particularly in team sport, had a reduced risk of loneliness. Continued participation in sports should be promoted to improve a range of physical, mental, and social health benefits. Furthermore, team-based sport can provide additional health and well-being benefits, including reduced loneliness due to the group nature of participation. [ABSTRACT FROM AUTHOR]

Context: Anterior cruciate ligament (ACL) injuries, prevalent in athletic contexts have profound physical and psychological impacts. Despite extensive research on the physiological aspects of ACL recovery, the psychological dimensions of this process have gained increased attention. This scoping review delves into the intricate landscape of psychological factors influencing ACL rehabilitation. Design: Scoping review. Methods: A literature search across multiple databases was conducted to identify relevant published studies that provide insight into the psychological aspects of ACL recovery. This search spanned various study designs, enabling a nuanced understanding of the psychological intricacies surrounding ACL recovery. Overall, a total of 1830 unique articles were screened, of which 66 were included in this review. Our findings are further contextualized through alignment with insights from prior reviews on similar themes. Through a comprehensive analysis of diverse literature, we explore 3 key themes: psychological challenges, current rehabilitation programs, and the integration of psychological support. Results: Psychological challenges emerged as a pervasive aspect of ACL rehabilitation, encompassing fear, anxiety, motivation, and depression. The nuanced emotional responses, particularly the fear of reinjury, impact treatment adherence and overall well-being. Contemporary rehabilitation programs revealed inconsistencies in incorporating psychological support, emphasizing the need for standardized, multidisciplinary approaches. The alignment with prior reviews in the literature reinforced the importance of psychological traits, such as knee self-efficacy, in predicting positive outcomes. Conclusion: This scoping review provides a comprehensive overview of psychological factors within ACL rehabilitation, highlighting the importance of tailored interventions and standardized approaches. The integration of multidisciplinary expertise emerges as crucial for optimizing patient outcomes. Our findings not only contribute to a nuanced understanding of psychological nuances in ACL rehabilitation but also offer valuable implications for clinical practice and policy development. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to provide a comprehensive case analysis from a single center, with the objective of clarifying the optimal timing and recommendations for a preferred treatment strategy customized to the specific presentation of each type of supernumerary tooth identified in the research. Method and materials: A retrospective study was conducted on patients who presented with a supernumerary tooth and were treated interdisciplinarily at the clinic. Results: In total, 55 patients with 81 supernumerary teeth of the permanent dentition were analyzed, 30 males and 25 females. The dentition status of the patients was as follows: 31 patients with mixed dentition, no patients with primary dentition, and 24 patients with permanent dentition. The diagnosis of supernumerary tooth was primarily made by general or pediatric dental practitioners and/or orthodontists. Patients were then referred to maxillofacial surgeons for treatment decision. The timing of treatment was mainly determined by the oral surgeon, based on the recommendations of the other specialists involved. Cases involving maleruption or malalignment of permanent teeth required both surgical and orthodontic treatment. Patients over 9 years old were treated either under local anesthesia or sedation, whereas those under 9 years old were treated under deep sedation or general anesthesia. A comprehensive investigation of cases involved the utilization of CBCT at the supernumerary tooth site to facilitate treatment planning. There was a significant correlation between younger age and the preference for treatment under sedation or general anesthesia (P = .01, t test). Similarly, a strong association was found between younger age and the need for additional orthodontic treatment (P = .016, t test). Cases of surgical removal of a supernumerary tooth at a young age typically did not require orthodontic traction of the permanent tooth, in contrast to cases of late surgical intervention (patients over 11 years old), which often did necessitate such traction. There was a strong tendency for treating supernumerary teeth in the maxilla. The proximity of supernumerary teeth to vital anatomical landmarks significantly influenced treatment decisions. Patients with supernumerary teeth near the mental foramen or the inferior dental canal in the premolar area were exclusively placed under follow-up care (P = .002, Pearson chi-square test). However, in the maxilla, the proximity of supernumerary teeth to vital structures such as the floor of the nose and the incisive nerve did not affect the treatment approach, and those supernumerary teeth were mostly removed. Conclusions: A team approach for managing supernumerary teeth is recommended. The timing of treatment should carefully consider the advantages and disadvantages of early versus late intervention. Early surgical treatment in cases where eruption is disturbed might result in spontaneous eruption, eliminating the need for orthodontic traction of the permanent teeth. [ABSTRACT FROM AUTHOR]

Objective: An altered sensation during endodontic treatment can occur due to the extrusion of endodontic materials. This study aims to discuss intentional replantation to address paresthesia resulting from an endodontic file penetrating the inferior alveolar nerve canal and provide a protocol for managing nerve injuries in such incidents. Case presentation: A 12-year-old girl developed paresthesia when an endodontic file separated and was inadvertently pushed through the apical foramen into the inferior alveolar nerve canal during root canal treatment of the mandibular left first molar. A CBCT scan revealed the file penetrating the canal towards the inferior border of the mandible. After considering the treatment options, intentional replantation was deemed suitable. The tooth was atraumatically extracted and preserved in sterile saline. The surgeon then carefully cleaned and irrigated the socket. The radiographic assessment confirmed successful file removal from the socket. The root ends were resected, and retrograde preparation and obturation were conducted using ultrasonic tips and mineral trioxide aggregate. The tooth was then replanted into the socket. Successful replantation was confirmed by tooth stability and an audible click. The patient was prescribed antibiotics and steroids. After completion of the endodontic treatment, a stainless steel crown was cemented. The successful intentional replantation procedure resulted in rapid improvement in the patient's condition. The normal sensation had been restored, indicating nerve recovery. At the 15-month follow-up, periapical bone healing and the eruption of the adjacent second molar were observed, affirming the treatment protocol's overall success. Conclusion: Prompt intervention and immediate intentional replantation facilitated direct inspection of the separated file within the socket. Collaboration between an oral maxillofacial surgeon and an endodontist ensures expedited and targeted treatment, leading to favorable outcomes. [ABSTRACT FROM AUTHOR]

Dental implants are commonly used to replace missing single teeth. However, esthetic rehabilitation of an adjacent tooth may also be required due to diastemas, crowding, or existing large direct restorations to improve the final esthetic outcome. With the advancements in ceramics and bonding techniques, minimally invasive esthetic approaches have become viable for compromised spacing issues. This case report describes a dental technique for the esthetic rehabilitation of compromised anterior spacing with a customized zirconia implant abutment at a maxillary central incisor site and a partial ceramic veneer bonded to the adjacent central incisor. [ABSTRACT FROM AUTHOR]

Background: Relative energy deficiency in sport (REDs) is a condition that is associated with negative health and performance outcomes in athletes. Insufficient energy intake relative to exercise energy expenditure, resulting in low energy availability, is the underlying cause, which triggers numerous adverse physiological consequences including several associated with musculoskeletal (MSK) health and neuromuscular performance. Purpose: This commentary aims to (1) discuss the health and performance implications of REDs on the skeletal and neuromuscular systems and (2) examine the role that MSK training (ie, strength and plyometric training) during treatment and return to performance following REDs might have on health and performance in athletes, with practical guidelines provided. Conclusions: REDs is associated with decreases in markers of bone health, lean body mass, maximal and explosive strength, and muscle work capacity. Restoration of optimal energy availability, mainly through an increase in energy intake, is the primary goal during the initial treatment of REDs with a return to performance managed by a multidisciplinary team of specialists. MSK training is an effective nonpharmacological component of treatment for REDs, which offers multiple long-term health and performance benefits, assuming the energy needs of athletes are met as part of their recovery. Supervised, prescribed, and gradually progressive MSK training should include a combination of resistance training and high-impact plyometric-based exercise to promote MSK adaptations, with an initial focus on achieving movement competency. Progressing MSK training exercises to higher intensities will have the greatest effects on bone health and strength performance in the long term. [ABSTRACT FROM AUTHOR]

This clinical case outlines a comprehensive digital workflow for a minimally invasive multidisciplinary treatment. The process utilizes one open-source software for digital wax-up and one low-cost software to address esthetic concerns related to teeth misalignment. The patient's function was stabilized with a digitally made occlusal splint. The application of the described digital workflow technique, incorporating open-source, lowcost, and closed software, played a pivotal role in attaining a straightforward and predictable outcome with minimally invasive treatment. Furthermore, the continual evolution of technology contributes to the growing precision of dental procedures. The presented digital workflow helped formulate a predictable treatment plan, replicate a diagnostic digital wax-up, and achieve precise teeth alignment. This approach satisfactorily addressed the patient's esthetic concerns, providing an outstanding approximation of the definitive result. [ABSTRACT FROM AUTHOR]

Bariatric dentistry is the branch of dental medicine focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing US and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy, it is necessary that proper accommodations are made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. The aim of the present case report was to bring awareness and start professional discussions on the importance of dental practitioners in the community and dental academic programs working together to assure access for primary oral health for bariatric patients. [ABSTRACT FROM AUTHOR]

Urinary incontinence, encompassing stress, urge, and overflow types, significantly impacts patients' physical, psychological, and social wellbeing. This article provides an overview of each type, exploring their pathophysiology, risk factors, and clinical presentations. It emphasises the crucial role of nursing and discusses evidence-based management strategies, including behavioural therapies, pharmacological treatments and patient education. The article also addresses the impact of incontinence on quality of life and future directions for research and practice, advocating a multidisciplinary approach to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Purpose Postpartum hypertension (PPHTN) poses increased risks, including of stroke. Timely assessment and management by clinicians is imperative but challenging. Team-based care involving pharmacists has shown promise in improving blood pressure control, yet its application in PPHTN management remains unexplored. The objective of this study was to determine the impact and feasibility of an interprofessional model for PPHTN management. Summary This initiative implemented a novel interprofessional model at a safety-net hospital to address previous workflow limitations. Ambulatory care pharmacists collaborated with an obstetric nurse (OBRN) and a maternal fetal medicine specialist to manage high-risk patients with PPHTN utilizing electronic consults (e-consults). Data collection and symptom assessment were completed by an OBRN via telemedicine appointments. Pharmacists employed a collaborative practice agreement based on a preestablished algorithm to initiate medications. Data on patient demographics, consult volume, prescriptions, and pharmacist comfort were collected during the first quarter of full integration. Pharmacists completed 55 e-consults and generated 54 prescriptions. The average time spent per chart review was 12.5 minutes, and the average time to completion of e-consults was 54 minutes. Forty-five unique patients received care, who were primarily non–English-speaking and non-Hispanic Black patients. Pharmacists reported moderate to high comfort levels in managing PPHTN based on the algorithm and provided feedback leading to workflow adjustments. Conclusion Integration of pharmacists into PPHTN care enables prompt medication initiation and titration. This innovative model, involving remote blood pressure monitoring, telemedicine visits with an OBRN, and e-consults completed by pharmacists, ensures delivery of timely and equitable care and improved access across a diverse population. [ABSTRACT FROM AUTHOR]

The article discusses the Quality Enhancement Research Initiative (QUERI) process used by the Department of Veterans Affairs (VA) to identify research priorities for chronic pain and opioid use disorder (OUD). The process involves steps such as identifying research gaps, gathering input from various stakeholders, finalizing priorities through an expert consensus panel, and integrating priorities into funding mechanisms. The application of the QUERI process helps align research efforts with clinical and organizational needs, ensuring that research supports health system needs in a timely manner. The process involves integrating knowledge from within the organization with external evidence and gathering feedback from multilevel partners and end users, including Veterans, to ensure that priorities are Veteran-centered. [Extracted from the article]

objective: At our large, university-affiliated primary care clinic, we aimed to enhance the quality of well-child checkups (WCCs) to align with Bright Futures/ American Academy of Pediatrics recommendations. Our primary goal was to increase the rate of complete WCCs from 45.6% to 80% by April 2024. Our secondary aims were to ensure WCC improvement for all language groups and to increase referrals to 2 community partners. methods: A multidisciplinary team initiated a quality improvement project primarily focused on transitioning from paper-based to electronic questionnaires for patient screenings. Clinic processes were developed to assist families in completing questionnaires. The percentage of complete WCCs was the primary outcome measure. We defined complete WCCs as those that included note documentation of all required patient-reported elements. Our primary outcome measure was analyzed by using statistical process control charts to identify special cause variation. results: We reviewed 51809 WCCs from July 2022 to April 2024, and the rate of complete WCCs improved from 45.6% to 84.7%. We significantly improved the rates for all measured aspects of WCCs as follows: 7 different common pedi-atric questionnaires and 7 routine WCC assessments. Referrals to 2 community nutrition and literacy resources increased. Despite large improvements across all language groups, disparities remained for patients who spoke languages other than English. conclusions: Transitioning to electronic questionnaires and revised clinic procedures led to more comprehensive WCCs and connected more families with community resources. Although progress was made across all language groups, we note ongoing challenges in eliminating disparities. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: Clinical pathways translate best evidence into the local context of a care setting through structured, multidisciplinary care plans. Little is known about clinical pathway programs in pediatric settings. The purpose of this study was to determine the prevalence of clinical pathway programs and describe similarities and differences. METHODS: We performed a cross-sectional web survey to assess the existence of a clinical pathway program, number, type, and creation or revision of clinical pathways, and its characteristics in the 111 hospitals of the Pediatric Research in Inpatient Settings network. RESULTS: Eighty-one hospitals responded to the survey (73% response rate). Most hospitals had a clinical pathway program (63%, n = 50 of 80) that was hospital-wide (70%, n = 35 of 50). Freestanding children's (48%, n = 39 of 81), academic (60%, n = 43 of 72), teaching hospitals (96%, n = 78 of 81) made up the largest proportion of survey respondents. There was no funding for nearly half of the programs (n = 21 of 46, 46%). Over a quarter of survey respondents reported no data collected to assess pathway utilization and/or care outcomes (n = 19 of 71, 27%). CONCLUSIONS: Greater than half of respondents confirmed existence of a program. Freestanding, academic teaching hospitals accounted for the most responses. However, nearly half of surveyed programs were unfunded, and many are unable to measure their pathway outcomes or demonstrate improvement in care. Survey respondents were enthusiastic about participating in a national collaborative on pediatric clinical pathways. [ABSTRACT FROM AUTHOR]

Background: Perinatal palliative care can offer compassionate support to families following diagnosis of a life-limiting illness, to enable them to make valued choices and the most of the time that they have with their newborn. However, home birth is usually only offered in low-risk pregnancies. Case: A couple who received an antenatal diagnosis of hypoplastic left heart syndrome and who had made a plan to provide palliative care to their baby after birth requested the option of a home birth. Possible courses of action: Recommend birth at hospital or explore the possibility of a home birth with perinatal palliative care support. Formulation of a plan: Multidisciplinary discussion and collaboration enabled a plan for home birth to be made which anticipated potential complications. Outcome: The baby was born at home and died on day 5 of life receiving outreach nursing, paediatric and palliative care support and buccal and oral opioids for symptom management. We include reflections from the family on the importance of this experience. Lessons: We provide a list of potential criteria for considering home birth in the setting of perinatal palliative care. View: Facilitating a home birth in the setting of perinatal palliative care is an option that can be hugely valued by families, but this service may be practically difficult to deliver in many contexts. Further research is needed to understand the preferences of women and families receiving perinatal palliative care. [ABSTRACT FROM AUTHOR]

Introduction: Autistic children commonly receive simultaneous services from various health‐care and other professionals, including occupational therapy, throughout their journey of diagnosis and consequent therapeutic support. Current best practice guidelines for supporting autistic youth emphasise the importance of interprofessional collaboration. Despite this, collaboration among health‐care professionals does not always occur, and little is understood about clinicians' experiences of collaborative care. The aim of this study was to explore Australian paediatric occupational therapists' experiences of interprofessional collaboration and their perception of factors influencing collaboration when supporting autistic children. Methods: This study employed an exploratory qualitative descriptive design. Semi‐structured interviews were conducted with 13 Australian paediatric occupational therapists involved in service provision to autistic children. Questions explored clinicians' experiences and perceptions of interprofessional collaboration. Reflexive thematic analysis was used to inductively analyse data. Consumer and Community Consultation: This study was conceptualised and conducted by a team of researchers with a range of personal and professional experiences with the autistic community. The research design was strongly informed by the Autism CRC'S research guidelines. Findings: Three themes were generated highlighting factors that influence collaboration between occupational therapists and other professionals. The first emphasised that 'clinicians' capacity to collaborate' at both organisational and individual levels was understood to be greatly influenced by funding structures. The second emphasised that 'relationships are key to collaboration' with these often established through shared workplaces or clients. The third, 'shared perceptions make collaboration easier' described how shared perceptions of collaboration, the occupational therapy role, and autism‐related frames of reference were perceived to influence interprofessional collaboration. Conclusion: Findings indicate that, while occupational therapists perceive interprofessional collaboration as valuable in the support of autistic children, there are barriers to effective collaboration, particularly in the context of a marketised service delivery model. PLAIN LANGUAGE SUMMARY: This study looked at how Australian occupational therapists work with other professionals to support autistic children. Even though it is recommended that professionals work together to support autistic children and their families, this does not always happen. In this study, researchers interviewed 13 occupational therapists and asked what it is like working with other professionals, what is helpful, and what makes working together difficult. From these interviews, it was found that many things affect how well occupational therapists can work with other health professionals and teachers to support autistic children. Factors like funding and workplace rules affect how professionals work together. Having someone take on the role of leader and having good relationships between professionals made it easier to work together. It was also helpful when occupational therapists and other professionals shared similar ideas on how to support autistic children. The study could be improved if it had gathered more information about the occupational therapists' education and what they have learnt about working with other professionals. Overall, the therapists in this study believed that working together to support autistic children and their families was important, but that there are many challenges to making this happen. More research on this topic would be helpful. [ABSTRACT FROM AUTHOR]

The authors discuss the meeting by Childhood Sjöogren's Disease (cSjD) Workgroup during the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Annual Scientific Meeting to review the current state of cSjD and identify opportunities to prioritize this rare and understudied disease. Topics include domains identified by the core members of the workgroup prior to the meeting and key themes and research questions that emerged from the domains.

Purpose: Stroke survivors must complete large amounts of practice to achieve functional improvements but spend many hours inactive during their rehabilitation. We conducted a mixed methods process evaluation exploring factors affecting the success of a 6-month behaviour change intervention to increase use of ward-based practice books. Methods: Audits of the presence, quality and use of ward based-practice books were conducted, alongside focus groups with staff (n = 19), and interviews with stroke survivors (n = 3) and family members (n = 4). Quantitative data were analysed descriptively. Focus group and interview transcripts were analysed using qualitative analysis. Results: Personal (patient-related) factors (including severe weakness, cognitive and communication deficits of stroke survivors), staff coaching skills, understanding and beliefs about their role, affected practice book use. Staff turnover, nursing shift work and a lack of action planning reduced success of the behaviour change intervention. Conclusions: Staff with the necessary skills and understanding of their role in implementing ward practice overcame personal (patient-related) factors and assisted stroke survivors to successfully practice on the ward. To improve success of the intervention, repeated training of new staff is required. In addition to audit and feedback, team action planning is needed around the presence, quality, and use of ward practice books. IMPLICATIONS FOR REHABILITATION: Ward-based practice books are one evidence-based strategy that can be used by rehabilitation teams to increase the amount of practice completed by stroke survivors during inpatient rehabilitation. Stroke survivors' personal factors (including severe weakness, cognitive and communication deficits), staff beliefs about their role and coaching skills, affected stroke survivors ability to practice on the ward using practice books. Staff with the necessary skills, understanding and belief about their role in implementing ward practice can overcome personal (patient related) factors (such as severe weakness) and assist stroke survivors to successfully practice on the ward. To increase the success of ward practice, repeated booster training of staff is required along with audit and feedback and team action planning on the presence, quality, and use of ward practice books. [ABSTRACT FROM AUTHOR]

Pediatric neurocritical care teams care for patients and families facing the potential for significant neurologic impairment and high mortality. Such admissions are often marked by significant prognostic uncertainty, high levels of parental emotional overload, and multiple potentially life-altering decision points. In addition to clinical acumen, families desire clear and consistent communication, supported decision-making, a multidisciplinary approach to psychosocial supports throughout an admission, and comprehensive bereavement support after a death. Distinct from their adult counterparts, pediatric providers care for a broader set of rare diagnoses with limited prognostic information. Decision-making requires its own ethical framework, with substitutive judgment giving way to the best interest standard as well as "good parent" narratives. When a child dies, bereavement support is often needed for the broader community. There will always be a role for specialist palliative care consultation in the pediatric neurocritical care unit, but the care of every patient and family will be well served by improving these primary palliative care skills. [ABSTRACT FROM AUTHOR]

Background: To meet the population's needs, community care should be customized and continuous, adequately equipped, and monitored. Introduction: Considering their fragmented and heterogeneous nature, a summary of community healthcare services described in European literature is needed. The aim of this study was to summarize their organizational models, outcomes, nursing contribution to care, and nursing‐related determinants of outcomes. Methods: A systematic review was performed by searching PubMed, CINAHL, Scopus, and Embase in October 2022 and October 2023 (for updated results). Quantitative studies investigating the effects of community care, including nursing contribution, on patient outcomes were included and summarized. Reporting followed the PRISMA checklist. The review protocol was registered on PROSPERO (CRD42022383856). Results: Twenty‐three studies describing six types of community care services were included, which are heterogeneous in terms of target population, country, interventions, organizational characteristics, and investigated outcomes. Heterogeneous services' effects were observed for access to emergency services, satisfaction, and compliance with treatment. Services revealed a potential to reduce rehospitalizations of people with long‐term conditions, frail or older persons, children, and heart failure patients. Models are mainly multidisciplinary and, although staffing and workload may also have an impact on provided care, this was not enough investigated. Discussion: Community health services described in European literature in the last decade are in line with population needs and suggest different suitable models and settings according to different care needs. Community care should be strengthened in health systems, although the influence of staffing, workload, and work environment on nursing care should be investigated by developing new management models. Conclusions and implications for health policy: Community care models are heterogeneous across Europe, and the optimum organizational structure is not clear yet. Future policies should consider the impact of community care on both health and economic outcomes and enhance nursing contributions to care. [ABSTRACT FROM AUTHOR]

Physical and mental health are intricated, however, there is a paucity of studies investigating the association between self-reported global functioning and handgrip strength and functional capacity in people with mental disorders. This study investigated the association between functioning, handgrip strength, and functional capacity in outpatients with a range of mental disorders. This was a two-center, cross-sectional study. Functioning was assessed with the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Handgrip strength was assessed with a hand dynamometer, and functional exercise capacity through the 2-min walk test (2 MW T). Multiple linear regression analysis was used to identify the association between WHODAS 2.0, handgrip strength, and functional capacity, adjusted for study site, age, educational level, and severity of psychiatric symptoms. A total of 91 outpatients (mean age = 40.16 ± 13.49, 63.7% females) participated in the study. The mean functioning score was 26.77 (±8.74) out of 60 points, while the mean distance walked was 142.20 ± 34.40 m and the mean handgrip strength was 30.62 ± 11.17 kgf. The adjusted multiple linear regression analysis revealed that only handgrip strength (p = 0.008, 95%CI = −0.327 to −0.050) was associated with functioning. Thus, our results revealed that muscular strength is associated with functioning in patients with mental disorders. This study suggests the importance of incorporating physical health assessment into mental health care for a comprehensive assessment of functioning levels, which is usually restricted to mental symptoms. • Handgrip strength is associated with functioning in patients with mental disorders. • Muscular strength can reflect functioning in patients with mental disorders. • It is important to incorporate physical health care into mental health care. [ABSTRACT FROM AUTHOR]

Objective: This case report describes the physiotherapy treatment of a soldier who suffered a severe combat blast injury. Methods: A 38-year-old Ukrainian man sustained blast injuries while driving over a mine during his service in the Ukrainian army. After receiving acute treatments, he was transferred to an academic hospital in the Netherlands. There, the man presented with severe soft tissue injuries on his back, as well as injuries to multiple organs, including the sciatic nerve and sacrum. Due to these injuries, the man could only lie in a prone position. His treatment goal was to be able to walk again. Results: The patient started physiotherapy, focussing on range of motion, strengthening the leg muscles, and functional transfers. Four months after the injury, he was able to achieve a standing position using a tilt table. Subsequent exercises were conducted to enable independent walking with a scale walker and, eventually, crutches. Seven months after the injury, the patient was transferred to a military rehabilitation centre. Rehabilitation efforts continued to increase joint mobility, improve muscle strength, build stamina with hydrotherapy, and enhance independence. Thirteen months after the blast injury, the man was independent in daily activities and could walk two kilometres without walking aids. Conclusion: This case report presents the challenging yet successful physiotherapeutic treatment of a soldier who suffered a blast injury. A dedicated multidisciplinary treatment team, progressive mobilisation with walking aids, targeted exercises, and the creative use of supportive materials contributed to the patient's recovery to independent daily functioning. [ABSTRACT FROM AUTHOR]

Inequality in health persists in childbearing families in socially or mentally vulnerable positions. The FACAM project was developed as an intervention aiming to enhance health outcomes for childbearing families. Purpose: The aim of this study was to gain a deeper understanding of the experiences and perspectives of care professionals in multidisciplinary and cross-sectorial collaboration, and their experiences of interactions with childbearing families within the context of the FACAM project. Methods: Eight focus groups were conducted with 32 multidisciplinary care professionals working with childbearing families in vulnerable positions. A thematic analysis was conducted, with positioning theory as the theoretical framework focusing on storylines, positioning and speech-acts. Results: Two overall themes were constructed. Theme one: Cross-sectorial collaboration and the influence on the care provided. Theme two: Interaction with and assessment of women and families' care needs and their influence on the care provided, with three subthemes; a) Establishment of a trustful relationship, b) Assessments of vulnerable positions in relation to function in everyday life, c) Interactions with the woman or family depending on their needs. Conclusion: Care professionals found needs-adapted and tailored care meaningful. Well-functioning multidisciplinary and cross-sectorial collaboration was important to support the families. [ABSTRACT FROM AUTHOR]

Purpose: The prevalence of Type 2 diabetes is rapidly increasing, with 537 million people estimated to have diabetes in 2021. The literature suggests that nurses can deliver effective person-centred diabetes care and that families can be essential in supporting patients. Thus, a Nurse-led Family-based (NLFB) approach may be particularly effective. This study aims to explore the perceptions of nurses, adults with type 2 diabetes, and family members regarding the NLFB intervention. Methods: Guided by the UK Medical Research Council Framework, this seminal study adopted a qualitative, descriptive approach with content analysis. Data were obtained through 16 semi-structured, in-depth interviews. Themes emerged based on an inductive process using constant comparison (Graneheim and Lundman 2004). The COREQ checklist was used in ensuring rigour. Results: Three main themes emerged includes: (1) nurses' experiences with current diabetes care practices, (2) stakeholders' views on the development of a NLFB approach, and (3) merging the nurse-led family aspects into the diabetes care. The key challenges are the dominant medical model, lack of specialist nurses, and time. The key facilitators are knowledge and social support. Conclusion: The study recommends stakeholders embrace nursing empowerment strategies and involve families to enhance the nurses' advanced roles and family inclusion in healthcare. [ABSTRACT FROM AUTHOR]

Purpose: The use of narration in healthcare has been accentuated as a response to the requested shift towards person-centred care. The notion of narrative relations refers to a process of involving several people in mutual and ongoing narrative exchange. This study aimed to explore how and where narrative relations may be adopted and enacted in everyday healthcare practice. Methods: The study has a qualitative, explorative design. Seven interprofessional focus group discussions with healthcare staff were prompted by vignettes. A multidisciplinary team of healthcare staff (n = 31) were recruited on a geriatric ward. Data were analysed using a constant comparative method. Results: A core theme shows how narrative relations are adopted and enacted both as part of an approved practice—the work procedures commonly approved as part of healthcare, and as a disregarded practice where covert but important narrative relations take place to support fundamental qualities of healthcare. Moreover, the findings consider arenas of healthcare practice where approved or disregarded practices are enacted in the clinic frontstage and the clinic backstage. Conclusions: Narrative relations may take place in different arenas of healthcare practice yet simultaneously become a cohesive force interconnecting those arenas and uphold continuity. Impeded narrative relations in one arena may have unintended consequences in another. [ABSTRACT FROM AUTHOR]

This study aims to create a vision of the future hospital to help healthcare leaders understand how changes in society and the healthcare system, compounded by climate change, could affect future hospital estate. The study is part of a larger project based on participatory backcasting aimed at providing integrated strategies for transitioning to a zero-carbon future and adapting to existing climate change through improved asset management. The data presented in this paper were collected during a full-day workshop to construct the vision of the future hospital in 2050. A multidisciplinary team of 19 participants participated in the discussions. A six-phase thematic analysis was applied to the data to develop the narrative vision and graphic recording. The healthcare system is undergoing transformative changes due to evolving healthcare delivery, patient expectations, emerging technologies, climate change, and sustainability. However, current hospital strategies often fail to consider the interrelationship between the hospital estate and its socio-environmental context. Policymakers, healthcare system leaders, and hospital leaders need a clear vision of the hospital of the future to implement transformational strategies. Healthcare transformations require shifting from traditional centralised hospitals to a more flexible, distributed model. Healthcare leaders need to proactively assess how hospitals respond to current and future hazards and consider the impacts within the context of integrated and dispersed healthcare delivery. To address this, a systematic approach to modelling hazards and evaluating design or upgrading options is essential to mitigate the transfer of climate-related risks within healthcare systems. [ABSTRACT FROM AUTHOR]

Background: With the recent Food & Drug Administration (FDA) approval of cellular therapy that requires product manipulation prior to administration in combination with a short stability window, the need was identified for local dose preparation within the pharmacy rather than the off-site stem cell processing laboratory. This approval gave rise to assessment of regulatory standards surrounding cellular therapy, evaluation and revision of current standard operating procedures and policies with formal process validation, assessment of occupational exposure mitigation and safety considerations, and development of staff training and education. Objective: To describe and provide insight into the stepwise process of FACT validation and onboarding of commercially available cellular therapy products that require sterile compounding manipulation within a pharmacy prior to administration. Discussion: A multidisciplinary effort is required to attain FACT certification and implement pharmacist compounding of cellular therapy products. 1 Local preparation within a pharmacy facilitates a sound operational workflow and provides a pathway to perform aseptic manipulations of cellular therapy products safely and efficiently. Conclusion: Safe and successful administration of cellular therapies handled and compounded by pharmacy department staff along with program validation requires a preemptive review utilizing a multidisciplinary approach for process development. This manuscript will provide a foundation based on consistency and transparency in effective cellular therapy sterile compounding and aseptic manipulation, proper handling and disposal procedures, increased communication through creation and optimization of treatment plans and order-sets, standardized medical center staff education, and development of policies and standard operating procedures for the entire health care team. [ABSTRACT FROM AUTHOR]

Background: Encounters of moral distress have long-term consequences on healthcare workers' physical and mental health, leading to job dissatisfaction, reduced patient care, and high levels of burnout, exhaustion, and intentions to quit. Yet, research on approaches to ameliorate moral distress across the health workforce is limited. Research Objective: The aim of our study was to qualitatively explore multi-professional perspectives of healthcare social workers, chaplains, and patient liaisons on ways to reduce moral distress and heighten well-being at a southern U.S. academic medical center. Participants & Research Context: Purposive sampling and chain-referral methods assisted with recruitment through hospital listservs, staff meetings, and newsletters. Interested participants contacted the principal investigator and all interviews were conducted in-person. Consent was attained prior to interviews. All interviews were recorded and transcribed verbatim. Research Design: Directed content analysis was used to deductively organize codes and to develop themes in conjunction with the National Academy of Medicine's National Plan for Health Workforce Well-Being. Rigor was attained through peer-debriefing, data triangulation methods, and frequent research team meetings. Ethical Considerations: Ethics approval was obtained from the university and medical center institutional review boards. Findings: Themes demonstrate that rather than offering interventions in the aftermath of moral distress, multilevel daily practices ought to be considered that pre-emptively identify and reduce morally distressing encounters through (1) the care team, (2) management and leadership, and (3) the health care industry. Strategies include interdisciplinary decision-making, trusting managerial relationships, and organizational policies and practices that explicitly invest in mental health promotion and diverse leadership opportunities. Conclusion: Moral distress interventions ought to target short-term stress reactions while also addressing the long-term impacts of moral residue. Health systems must financially commit to an ethical workplace culture that explicitly values mental health and well-being. [ABSTRACT FROM AUTHOR]

Purpose Secondary to the risk of antipsychotic-induced acute dystonia, prophylactic use of benztropine is occasionally warranted but is recommended for no longer than 7 days after initiating an antipsychotic, correlating to the period of highest dystonia risk. Despite the associated increased anticholinergic burden, many clinicians continue to order benztropine for periods exceeding the recommended prophylactic duration. We investigated the reduction of benztropine use duration subsequent to implementation of truncated electronic entry orders to improve benztropine prescribing within an acute psychiatric facility. Methods Data were collected for psychiatric inpatients admitted between January and June 2020 who were prescribed scheduled benztropine. In a quality improvement initiative implemented in April 2022, electronic orders for benztropine were modified from a 180-day to a 7-day duration, with subsequent postintervention data collection. The primary outcomes included a change in the duration of benztropine use for any indication in the hospital, and a change in the percentage of patients meeting predetermined "unnecessary use" criteria. Secondary analyses included the percentage of patients with discharge prescriptions for scheduled benztropine (either for prophylaxis or for other indications) in the pre- and postintervention periods. Results 73 pre- and 77 postintervention individual patients/encounters were included. Following the intervention, in-hospital duration of benztropine use for any indication decreased from a median of 14 days to a median of 7.5 days (P < 0.05), and appropriate use increased by 92.9%. The percentage of patients with prescriptions for scheduled benztropine decreased from 67.1% in the preintervention group to 29.9% in the postintervention group. Conclusion Decreased benztropine use duration, by means of truncated order entry sentences, during inpatient psychiatric admissions, appears feasible regardless of dual antipsychotic or first-generation antipsychotic use, and may reduce the rates of benztropine prescriptions written for discharge. [ABSTRACT FROM AUTHOR]

Aim: To explore registered nurses' beliefs regarding pain assessment in people living with dementia. Design: A descriptive exploratory qualitative study informed by the Theory of Planned Behaviour. Methods: Online semi‐structured in‐depth interviews were conducted from January to April 2023 with a purposive sample of 15 registered nurses caring for people with dementia. Following transcription, data were analysed using direct content analysis. Findings: Registered nurses believe pain assessment improves the well‐being of people with dementia and informs and evaluates practice. However, there is a possibility of misdiagnosing pain as agitation or behavioural problems, leading to inaccurate pain management. Interpersonal factors, such as registered nurses' knowledge and experience, beliefs and motivation to improve care provision, were the primary facilitators of pain assessment. Physical and behavioural dimensions of the pain of the dementia syndrome were the most reported barriers to pain assessment. Registered nurses reported that multidisciplinary team members expect them to do pain assessments. Most did not experience disapproval when performing pain assessments. Conclusion: Registered nurses hold beliefs about pain assessment benefits, consequences, enablers, barriers, approvals and disapprovals regarding dementia. The findings could inform interventions to enhance pain assessment practices. Implications for the Profession and/or Patient Care: Policymakers should provide education opportunities for registered nurses to improve their knowledge, skills and beliefs about pain assessment in dementia. Future research should develop and implement multidisciplinary, multifaceted pain assessment protocols to enhance the accuracy of pain assessment practices. Impact: Pain is underassessed in dementia, and this could stem from registered nurses' beliefs about pain assessment in dementia. The findings could inform interventions to enhance pain assessment beliefs and practices. Reporting Method: This study adhered to the COREQ criteria. Patient or Public Contribution: Registered nurses caring for people living with dementia participated as interview respondents. [ABSTRACT FROM AUTHOR]

Objective: Understanding biopsychosocial contributions to a sensitised pain system is a key target of many pain management programs. The 'Protectometer' is a freely available educational tool that guides people with chronic pain to explore their personal threats and reassurances, identifying them as 'DIMs' (danger in me) or 'SIMs' (safety in me), to guide personalised pain management. This study aimed to explore common types of DIMs and SIMs, and examine differences between adults and young people. Materials and Methods: A retrospective qualitative study was conducted. Written DIMs (n = 504) and SIMs (n = 711) were collected from 96 participants with chronic pain (77 adults aged 18–85 years; 19 young people aged 9–17 years) across 15 multidisciplinary pain management groups. DIMs and SIMs were transcribed and analysed using deductive content analysis. Results: Four overarching themes were identified: 'Engaging with the environment', 'In my body', 'My emotional health', and 'Activities and behaviours'. Similarities in SIMs were found, with the greatest proportion of SIMs in the social domain (49% adults; 47% young people). While adult DIMs were fairly evenly spread across the biological (37%), psychological (27%) and social domains (36%), young people's DIMs were predominantly in the psychological (44%) and social (43%) domains. Discussion: These findings provide insights into common threats and reassurances people in pain perceive, and revealed age-related differences in biopsychosocial contributions to pain and pain relief. Findings also highlight the importance of social-based interventions as part of pain management therapies for both adults and young people. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to explore how care managers in team conferences jointly solve problems related to difficult cases involving clients with cognitive decline, focusing specifically on their professional roles and judgements. Team conferences in a Swedish social work setting mean that social workers assess and interpret previously collected information and discuss how to proceed with cases. We use conversation analysis to study two case sequences from 137 audio-recorded cases, focussing on professional judgements and accomplishing agreement. We show how care managers make use of different conversational practices, such as hypothetical talk and shared authority as a 'we' when conveying institutional routines, as well as when providing support to care managers. We also show how the care managers make use of expanding techniques that challenge their manager's advice. This paper offers new perspectives on how organisational norms are reproduced and how shared professional judgements are accomplished. [ABSTRACT FROM AUTHOR]

Debridement, a mainstay of nursing clinical practice, refers to the removal of dead or unhealthy tissue from a wound to facilitate healing. Debridement is one component of the concept of wound bed preparation that has long guided the approach to wound management. The ability of a wound to heal must be determined prior to the initiation of any method of debridement. In areas where high-quality, comparative studies on the relative benefits of different debridement modalities are lacking, nurses should adopt an evidence-informed approach to care. To do this, nurses must understand the importance of following a comprehensive, holistic approach when treating chronic wounds. Nurses should have knowledge of inflammation and infection control and of the fundamentals of moisture management, recognize the need for debridement in healable wounds, and be familiar with different debridement options. This article provides nurses with a wound management framework, an overview of wound debridement options based on the potential for wound healing, and scope of practice considerations for developing a plan of care. A composite case is presented to illustrate the critical considerations in wound care. This article provides nurses with a wound management framework, an overview of wound debridement options based on the potential for wound healing, and scope of practice considerations for developing a plan of care. [ABSTRACT FROM AUTHOR]

This paper attempts to identify and to describe the implicit understanding of mind and mental life at work across an adolescent inpatient eating disorder ward, where the author worked as a healthcare assistant for 12 weeks. It does so by providing an account of 'prompts' employed by hospital staff during mealtimes on the ward. The vision of mental illness implied by these 'prompts' is described as supporting a paradigm of mental life consistent with the assumptions of cognitive behavioural therapy (CBT). An account of supervising mealtimes while employing language consistent with a psychodynamic model of mind is briefly offered as an alternative, before some of the benefits and drawbacks of both paradigms are outlined. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the feasibility of the Swiss complex interprofessional intervention, NEODOL© (NEOnato DOLore), for improving the management of procedural pain in neonates in the Finnish context. Background: Interprofessional collaboration is important for all professionals involved in the care of neonates and for neonates' parents, to understand the appropriate use of non‐pharmacological and/or pharmacological methods for each pain situation and how to assess pain in real‐life situations. Appropriate methods of pain relief for neonates should be preferred as they protect the development of the neonate's brain. Design: A descriptive qualitative design. Method: Data were collected through semi‐structured focus group discussions following the Medical Research Council's framework for evaluation of complex interventions, in this case NEODOL© which aims to improve the procedural pain management of neonates. A purposive sample (n = 13) included eleven professionals representing various professions within Finnish Neonatal Intensive Care Units and two parents of infants who have received care in a Neonatal Intensive Care Unit. Data were analysed using inductive content analysis, and the results were reported in accordance with the COREQ guidelines. Results: Professionals' and parents' evaluations suggest that NEODOL© is feasible, because it is consistent and addresses a current need. They assessed its overall content to be relevant and accessible, and its components to be internally coherent. However, they emphasise the need for further evaluation and refinement of the intervention to achieve the desired outcomes and cost‐effectiveness. Conclusions: While NEODOL© is considered feasible, it requires further evaluation and refinement in the local context of each hospital before implementation. [ABSTRACT FROM AUTHOR]

Background: Since 1990, childhood overweight and obesity have been rising on every continent and have almost doubled worldwide. The deleterious consequences include hypertension, type 2 diabetes mellitus, and dyslipidemia leading to metabolic syndrome in childhood and myocardial infarction, stroke, cancer and other disabling conditions in adulthood. Purpose: In Southern Europe, including Greece, Italy, and Spain, 10 to 15% of children are obese. Obesity in Eastern European countries is somewhat lower, but the rates of rise are very steep and will approach those in Southern Europe during the next few years. Worldwide, Asia accounts for nearly half of all overweight children under the age of 5, while Africa is home to one quarter of overweight children under 5. In Latin America, about 20% of children under 20 are overweight. Further, children living in poverty can suffer simultaneous overweight and obesity as well as malnutrition. In the US, the risk of being overweight in adolescence is several times higher when a younger child has a body mass index (BMI) in the 50th or greater percentile. Findings: If the clinical, non-clinical and public health communities ignore these challenges, such inaction will surely portend an unprecedented future pandemic of overweight and obesity in children and adolescents leading to future premature morbidity and mortality. All clinical, non-clinical and public health professionals should exert concerted efforts concerning their individual patients, their families, communities, and policymakers. Conclusions: Such coordinated interdisciplinary efforts may curb these alarming trends and secure healthier futures for children and their families throughout the world. Significance: Pediatric overweight and obesity are emerging as a pandemic and cause hypertension, type 2 diabetes mellitus, and dyslipidemia leading to metabolic syndrome. In adults, these conditions markedly increase risks of myocardial infarction and stroke as well as liver disease, obstructive sleep apnea, arthritis, and certain cancers, all of which are increasing at younger ages. This commentary contains challenges and potential solutions to clinical, non-clinical and public health professionals to increase efforts with their individual patients, families, communities, and policymakers. Exerting concerted interdisciplinary efforts may curb these alarming trends and secure healthier futures for children and their families throughout the world. [ABSTRACT FROM AUTHOR]

Rationale: The Knowledge Translation (KT) Programme of a pan‐Canadian strategic patient‐oriented research network focused on brain‐based developmental disabilities aimed to mobilize knowledge relevant to the network members. The programme also promotes and studies integrated Knowledge Translation (iKT) approaches involving different interested parties, such as researchers, patient‐partners and decision‐makers, in all parts of the knowledge creation process. Aims and Objectives: The objective of this study is to advance research programme evaluation methods through a realist evaluation of the process of implementing iKT activities. Methods: Realist process evaluation included: (1) development of initial programme theories (using the partnership synergy theory); (2) data collection and analysis; (3) synthesis and refinement of theories through engagement with literature; and (4) presentation of findings in context‐mechanism‐outcome (C‐M‐O) configurations. A range of project documentation records were reviewed for analysis, and three co‐leads, a programme coordinator, and a senior research associate were consulted to contextualize the implementation process of relevant KT activities. Results: Based on the developed C‐M‐O configurations, we identified five key mechanisms of generating synergy in the iKT processes: (1) Visible shared leadership that embodies what iKT looks like; (2) Researchers' readiness for iKT; (3) Adaptation and flexible allocation of resources to emerging needs; (4) Power sharing to create practical and creative knowledge; and (5) Collective voice for potential transformative impacts at the policy level. Conclusions: The current realist evaluation demonstrated how partnerships between researchers, patient‐partners and other interested parties can synergistically generate new ways of thinking among all interested parties, actionable strategies to integrate users in research, and solutions to disseminate knowledge. In particular, we identified a pivotal role for patient‐partners to act as equal decision‐maker helps building and maintaining partnerships and consolidating KT strategies. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between prestroke frailty and nonhome discharge, prolonged length of stay as well as functional outcomes. Design: Prospective observational study. Setting: Single urban teaching hospital in Guangzhou, China. Participants: Consecutive sample of 271 older patients admitted with acute stroke. Intervention: N/A. Main measures: A five-item FRAIL scale (0∼5 points) and the stroke severity at onset were measured. The primary outcome of interest was nonhome discharge, with secondary outcomes including prolonged length of stay and worse short-term prognosis. Multivariable logistic regression adjusting for confounding factors was used to determine the association between patient-reported frailty and nonhome discharge, prolonged length of stay, worse short-term prognosis. Results: The population had a median age of 68 [interquartile range (IQR), 64∼74)]years, with 50 individuals (18.5%) identified as frail. After adjusting for age, sex, Barthel index, National Institutes of Health Stroke Scale, and Mini-Mental Status Exam score at admission, patients with self-reported frailty were significantly likely to experience nonhome discharge (Odds Ratio [ OR ] = 4.788; 95% confidence interval [CI] = 1.272∼18.017; p =.021), prolonged length of stay (OR = 4.76; 95% CI = 1.80∼12.56; p =.002), mRS scores at 30 days (OR = 6.72;95% CI = 1.79∼25.20; p =.005) and three months postdischarge and three-month (OR = 8.94; 95% CI = 2.10∼38.08; p =.003). Conclusions: In older adults with stroke, frailty is associated with nonhome discharge, prolonged length of stay, and worse short-term prognosis, regardless of the stroke severity, cognition, and Barthel index score at admission. FRAIL scale can be used as a practical screening tool in acute care setting by multidisciplinary team in supporting discharge process. [ABSTRACT FROM AUTHOR]

Research in palliative care is regarded as ethically challenging although there is increasing recognition that such research is important. Young adults with life-shortening conditions were not expected to reach adulthood but this population is growing and there is limited research that focuses on their lives or their experiences of engaging in research. The study explored the unintended consequences of pandemic control measures on the lives of young adults living with life-shortening conditions in the United Kingdom. This paper focuses on some of the methodological issues arising from this study, drawing on data that explores participants' experiences of taking part. This is an interpretivist and inclusive qualitative study co-produced with three experts by experience using constructivist Grounded Theory method conducted during the first wave of the Coronavirus pandemic. In-depth interviews using a topic guide were transcribed verbatim and analysed iteratively until the point of data saturation. Twenty-six young adults aged 22–40 (17 female; 9 male), reporting a wide range of life-limiting and/or life-threatening conditions including rare and undiagnosed conditions and co-morbidities. Through analysis we identify four key themes focusing on participants' experiences of taking part in the research: helping others and influencing change; reciprocity and support; therapeutic value; and (in)visibility and legacy. This paper offers methodological reflections on research in palliative care drawing on qualitative co-produced research involving young adults with life-shortening conditions. Our findings indicate that although participating in research can feel uncomfortable, this is outweighed by the perceived benefits of contributing to research. [ABSTRACT FROM AUTHOR]

Delirium has been recognized, documented, and examined for centuries. In 500 BC Hippocrates described hyper- and hypoactive forms of delirium. As medicine, surgery, and critical care have accelerated over the last century, so too has our understanding of delirium and its profound risks to patients, families, and health care teams. It has also been increasingly understood that it is the accumulation of risk factors that ultimately precipitates delirium and nonpharmacological interventions to reduce these risks remain the cornerstone of delirium prevention and management. However, over the last three decades, these nonpharmacological strategies have moved from a single-component approach to a multicomponent approach, targeting multiple risk factors. Additionally, our understanding of what constitutes a risk factor for delirium has evolved, and in particular, it has been recognized that delirium can sometimes be a byproduct of our interventions and health care systems. In the surgical setting, for example, optimization of risk factors prior to surgery, when possible, is now seen as a key way to prevent postoperative delirium. Similarly, critical care medicine now operates with the appreciation of the profound risk to patients of prolonged mechanical ventilation, sedation, and immobilization and seeks to minimize each to reduce the risk of delirium, among other negative effects. The future of delirium prevention and management lies in both better implementation of best practices that have been defined over the last three decades as well as taking more of a whole patient view. This includes harnessing the electronic medical record, artificial intelligence, and so on to risk assess and individualize care for each patient; restructuring care to reduce deliriogenic practices and care environments; redefining what usual care looks like (e.g., utilizing music and involving loved ones, etc.); policy changes to change systematic priorities. In this paper, we will explore the past, present, and future of nonpharmacological prevention and management of delirium across care settings. [ABSTRACT FROM AUTHOR]

The article discusses the importance of positionality in qualitative research, emphasizing the need to understand how researchers' identities and experiences shape their work. Positionality involves recognizing one's social identity, lived experiences, and assumptions, and how these factors influence research outcomes. By reflecting on positionality throughout the research process, researchers can produce more ethical, coherent, and rigorous work. The article provides practical questions and tools to guide researchers in exploring their positionality and engaging in reflexive practice to enhance the quality of their research. [Extracted from the article]

Background: Experience-based knowing in general practice includes advanced interpretation of subjective, complex and particular phenomena in a social context. Enabling different metapositions for reflexivity may provide the accountability needed for such knowing to be recognized as evidence-based practice. Objective: To demonstrate and discuss the potential of substantive theories to enhance interpretation of complex challenges in clinical knowing in general practice. Methods: We present a fictional case to demonstrate how interdisciplinary substantive theories, with a relevant and specific match to concrete questions, can situate the clinical interaction at an accountable platform. A female patient with Parkinson's disease consults her GP complaining that the disease is restraining her life and threatening her future. The GP has some new ideas from Bandura's theory of self-efficacy and introduces the patient to strategies for further action. Findings: The case presents an example of how a relevant substantive theory may offer the GP: 1) a sharper focus for achievement: recognising the issues of fear and identity in chronic, progressive illness, 2) a subsequent position for individualized understanding of adequate strategies: encouraging physical and social activity in a well-known context, and 3) an invitation to consider further possibilities: finding ways to alleviate the burden of fear and progressive decline; engaging in joyful living. Implications: General practice knowledge embraces a diversity of sources with different evidence power. The transparency mediated to clinical practice when supported by relevant substantive theories may contribute to recognition of experience-based knowing as evidence-based practice. KEY POINTS: Experience-based knowing is an important capacity for interpretation of complex phenomena in general practice, but support for elaboration and analysis of such strategies is limited Interdisciplinary substantive theories can enable reflexivity and enhance clinical practice Substantive theories may offer sharper focus, individualised understanding and recognition of additional possibilities A connection to specific theoretical ideas may augment the transparency of experience-based knowing, thus advancing attitudes for evidence-based practice [ABSTRACT FROM AUTHOR]

Background: Inadvertent intra-arterial injection of sclerosants is an uncommon adverse event of both ultrasound-guided and direct vision sclerotherapy. This complication can result in significant tissue or limb loss and significant long-term morbidity. Objectives: To provide recommendations for diagnosis and immediate management of an unintentional intra-arterial injection of sclerosing agents. Methods: An international and multidisciplinary expert panel representing the endorsing societies and relevant specialities reviewed the published biomedical, scientific and legal literature and developed the consensus-based recommendations. Results: Actual and suspected cases of an intra-arterial sclerosant injection should be immediately transferred to a facility with a vascular/interventional unit. Digital Subtraction Angiography (DSA) is the key investigation to confirm the diagnosis and help select the appropriate intra-arterial therapy for tissue ischaemia. Emergency endovascular intervention will be required to manage the risk of major limb ischaemia. This includes intra-arterial administration of vasodilators to reduce vasospasm, and anticoagulants and thrombolytic agents to mitigate thrombosis. Mechanical thrombectomy, other endovascular interventions and even open surgery may be required. Lumbar sympathetic block may be considered but has a high risk of bleeding. Systemic anti-inflammatory agents, anticoagulants, and platelet inhibitors and modifiers would complement the intra-arterial endovascular procedures. For risk of minor ischaemia, systemic oral anti-inflammatory agents, anticoagulants, vasodilators and antiplatelet treatments are recommended. Conclusion: Inadvertent intra-arterial injection is an adverse event of both ultrasound-guided and direct vision sclerotherapy. Medical practitioners performing sclerotherapy must ensure completion of a course of formal training (specialty or subspecialty training, or equivalent recognition) in the management of venous and lymphatic disorders (phlebology), and be personally proficient in the use of duplex ultrasound in vascular (both arterial and venous) applications, to diagnose and provide image guidance to venous procedure. Expertise in diagnosis and immediate management of an intra-arterial injection is essential for all practitioners performing sclerotherapy. [ABSTRACT FROM AUTHOR]

Jason, a 15‐year‐old adolescent, was recently adjudicated and placed at the Rhode Island Training School (RITS), the state's only secure carceral facility for detained and adjudicated youth. Like many of the youth entering the facility, Jason arrived at the RITS with a complex history of trauma, substance use, and behavioral issues. As a child, his father was incarcerated and his mother struggled with substance use, leaving Jason without a consistent caregiver. His early life was marked by frequent moves between foster homes, unstable housing, and exposure to violence. This instability in his childhood led to feelings of anger and frustration, which often manifested in school through defiant behavior, truancy, and eventually, physical altercations that led to his involvement with the juvenile legal system. [ABSTRACT FROM AUTHOR]

Aims: Multiple system atrophy (MSA) is a progressive neurodegenerative disorder with poor prognosis. This case report presents the first interdisciplinary rehabilitation program for a patient with the Parkinsonian subtype of MSA (MSA-P). Methods: A 68-year-old male who was diagnosed with clinically probable MSA-P was transferred to a Canadian-based rehabilitation center. He participated in an intensive interdisciplinary program over 36 days, with goal-directed rehabilitation from a physiotherapist, occupational therapist, and speech language pathologist, including remediation, compensation and education. Results: From admission to discharge, he made substantial improvements in Berg Balance Scale (BBS) score (14/56 to 30/56), Functional Independence Measure (FIM) score (61 to 75), dominant hand dexterity, communication, and development of safe swallowing strategies. Conclusion: This case supports a short-term, intensive-based interdisciplinary approach for the MSA-P population to provide educational value to patients and their caregivers, to develop compensation strategies, and to achieve functional improvement which translates to community living. [ABSTRACT FROM AUTHOR]

In Switzerland and other high-income countries, one out of 3000 to 5000 term and late preterm neonates develops early onset sepsis (EOS) associated with a mortality of around 3%, while incidence and mortality of EOS in very preterm infants are substantially higher. Exposure to antibiotics for suspected EOS is disproportionally high compared to the incidence of EOS with consequences for future health and antimicrobial resistance (AMR). A safe reduction of unnecessary antibiotic treatment has to be a major goal of new management strategies and guidelines. Antibiotics should be administered immediately in situations with clinical signs of septic shock. Group B streptococcus (GBS) and Escherichia coli (E. coli) are the leading pathogens of EOS. Amoxicillin combined with an aminoglycoside remains the first choice for empirical treatment. Serial physical examinations are recommended for all neonates with risk factors for EOS. Neonates without any clinical signs suggestive of EOS should not be treated with antibiotics. In Switzerland, we do not recommend the use of the EOS calculator, a risk stratification tool, due to its unclear impact in a population with an observed antibiotic exposure below 3%. Not all neonates with respiratory distress should be empirically treated with antibiotics. Isolated tachypnea or respiratory distress starting immediately after delivery by elective caesarean section or a clearly assessed alternative explanation than EOS for clinical signs may point towards a low probability of sepsis. On the other hand, unexplained prematurity with risk factors has an inherent higher risk of EOS. Before the start of antibiotic therapy, blood cultures should be drawn with a minimum volume of 1 ml in a single aerobic blood culture bottle. This standard procedure allows antibiotics to be stopped after 24 to 36 h if no pathogen is detected in blood cultures. Current data do not support the use of PCR-based pathogen detection in blood as a standard method. Lumbar puncture is recommended in blood culture–proven EOS, critical illness, or in the presence of neurological symptoms such as seizures or altered consciousness. The accuracy of a single biomarker measurement to distinguish inflammation from infection is low in neonates. Therefore, biomarker guidance is not a standard part of decision-making regarding the start or stop of antibiotic therapy but may be used as part of an algorithm and after appropriate education of health care teams. Every newborn started on antibiotics should be assessed for organ dysfunction with prompt initiation of respiratory and hemodynamic support if needed. An elevated lactate may be a sign of poor perfusion and requires a comprehensive assessment of the clinical condition. Interventions to restore perfusion include fluid boli with crystalloids and catecholamines. Neonates in critical condition should be cared for in a specialized unit. In situations with a low probability of EOS, antibiotics should be stopped as early as possible within the first 24 h after the start of therapy. In cases with microbiologically proven EOS, reassessment and streamlining of antibiotic therapy in neonates is an important step to minimize AMR. Conclusion: This guideline, developed through a critical review of the literature, facilitates a probability-based approach to the management of neonates at risk of early onset sepsis. What is Known: • Neonatal exposure to antibiotics is disproportionally high compared with the incidence of early onset sepsis with implications for future health and antimicrobial resistance. What is New: • A probability-based approach may facilitate a more balanced management of neonatal sepsis and antibiotic stewardship. [ABSTRACT FROM AUTHOR]

Introduction: Shortage of ear, nose, and throat specialists in public hospitals can result in delays in the detection and management of otitis media. This study introduced a new hospital-based telehealth service, named the Ear Portal, and investigated its role in improving access to specialist care. Methods: The study included 87 children (aged 6 months to 6 years) referred to a tertiary children's hospital due to otitis media-related concerns. A specialist multidisciplinary team met fortnightly to review pre-recorded data and provide care plans. Results: The service resulted in a median waiting time of 28 days to receive a diagnosis and care plan by the multidisciplinary team, compared to a mean waiting time of 450 days for a reference group receiving standard healthcare services. Most children (90.3%) received bilateral ear diagnosis. Normal findings were found in 43.9%. However, the majority required further ear, nose, and throat with or without audiology face-to-face follow-up due to a diagnosis of middle-ear disease, unknown hearing status, or concerns not related to ears. The mean time required for clinical assessments completion by research assistants and multidisciplinary team review was 37.6 and 5.1 min per participant, respectively. Discussion: Children in the Ear Portal service received a diagnosis and care plan in a median of 28 days, which is within the clinically recommended timeframes. With sufficient clinical information, this service can provide faster access to specialist care than the standard healthcare pathway. The service can reduce the time required by the specialist to provide a diagnosis and care plan which may help increase the specialists' capacity. [ABSTRACT FROM AUTHOR]

Objective: This review aims to emphasize the role of pharmacists for optimization of evidence-based outcomes of finerenone in multidisciplinary kidney care teams during the early detection process of CKD patients. Data Sources: A PubMed literature search was performed using keywords pharmacists, chronic kidney disease (CKD), type 2 diabetes (T2D), and finerenone. Study Selection and Data Extraction: All English-language studies on the role of pharmacists in managing CKD patients or finerenone prescriptions were evaluated. Data Synthesis: CKD is a major health problem affecting millions worldwide, especially those with T2D. In recent years, new drugs have been added to the treatment options for patients with T2D and CKD, which have been shown to reduce the risk of cardiovascular and renal complications in large clinical trials. Conclusions: Pharmacists can help detect and treat CKD in patients with T2D. They may use indicators to identify potential candidates for appropriate finerenone therapy, such as stage of CKD, albuminuria level, serum potassium concentration, and use of RAAS inhibitors. Pharmacists can provide education on the benefits and usage of finerenone, monitor response to therapy, adjust the medications and doses, prevent drug interactions, help with adherence and tolerability issues, and coordinate with other healthcare providers. [ABSTRACT FROM AUTHOR]

Background: Point-of-care ultrasound (POCUS) in the neonatal intensive care unit (NICU) is becoming increasingly utilized, with the focus of training aimed at physicians. However, the role of neonatal nurse practitioners (NNPs) in the development of POCUS programs is not well described. Purpose: To describe the NNP role in the implementation of a NICU POCUS program and exemplify the potential to expand the professional scope and educational advancement of NNPs. Methods: In 2018, a multidisciplinary team assembled to develop a POCUS program in the NICU at Lucile Packard Children's Hospital (LPCH). Three NNPs received formal POCUS training in order to provide onsite training, perform and supervise POCUS imaging, and participate in quality assurance sessions. NNPs also assisted with the development of a REDCap database and imaging protocols. Results: The LPCH POCUS NNP providers contributed to the advancement of the profession by practicing to the full scope of their role, providing leadership in program development, research, and education. Incorporating NNPs into the programmatic structure of a POCUS program can be a model for others. With advancing skill set, NNPs can be positioned to be national leaders and educators. Implications for practice and research: NICUs developing POCUS programs can benefit from the integration of NNPs to serve as consistent content experts to expand the number of trained providers while assuring the quality of image capture. POCUS is becoming increasingly essential to the care of newborns. NNPs can play a central role in performing POCUS, participating in quality improvement and research, and educating other NICU providers. [ABSTRACT FROM AUTHOR]

This collaborative study by The Australasian College of Paramedicine's Clinical Practice Guidelines (CPG) Working Group aimed to examine CPG development practices in Australian and New Zealand ambulance services. Employing a qualitative descriptive design, the research utilised thematic analysis to extract insights from interviews with eleven experts actively involved in CPG development. The study embraced a nominalist and constructivist approach, recognising the intricate connection between individual experiences and the realities of CPG development in the paramedic field. Key findings revealed significant heterogeneity in CPG development practices, emphasising a lack of formal training and a substantial reliance on existing guidelines. The study highlighted challenges in project management flexibility, limited research capacity, and inconsistencies in external consultations and resource utilisation. The study recommends adopting project management frameworks, investing in training, and utilising evidence evaluation methodologies like GRADE. It emphasises the need for multidisciplinary teams and formal expertise in evidence synthesis, advocating for targeted training programs. Funding challenges highlight the importance of dedicated budgets and collaborative efforts for resource allocation. Knowledge translation and implementation issues underscore the significance of training programs for evidence evaluation and knowledge translation in overcoming these challenges. [ABSTRACT FROM AUTHOR]

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