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Background A crisis in pain management persists, as does the epidemic of opioid overdose deaths, addiction, and diversion. Pain medicine is meeting these challenges by returning to its origins: the Bonica model of multidisciplinary pain care. The 2018 Academic Consortium White Paper detailed the historical context and magnitude of the pain crisis and the evidence base for nonpharmacologic strategies. More than 50% of chronic opioid use begins in the acute pain care setting. Acupuncture may be able to reduce this risk. Objective This article updates the evidence base for acupuncture therapy for acute pain with a review of systematic reviews and meta-analyses on postsurgical/perioperative pain with opioid sparing and acute nonsurgical/trauma pain, including acute pain in the emergency department. Methods To update reviews cited in the 2018 White Paper, electronic searches were conducted in PubMed, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials for "acupuncture" and "acupuncture therapy" and "acute pain," "surgery," "peri-operative," "trauma," "emergency department," "urgent care," "review(s) ," "systematic review," "meta-analysis," with additional manual review of titles, links, and reference lists. Results There are 22 systematic reviews, 17 with meta-analyses of acupuncture in acute pain settings, and a review for acute pain in the intensive care unit. There are additional studies of acupuncture in acute pain settings. Conclusion The majority of reviews found acupuncture therapy to be an efficacious strategy for acute pain, with potential to avoid or reduce opioid reliance. Future multicenter trials are needed to clarify the dosage and generalizability of acupuncture for acute pain in the emergency department. With an extremely low risk profile, acupuncture therapy is an important strategy in comprehensive acute pain care. [ABSTRACT FROM AUTHOR]

COVID 19 struck us all like a bolt of lightning and for the past 10 months, it has tested our resilience, agility, creativity, and adaptability in all aspects of our lives and work. Simulation centers and simulation-based educational programs have not been spared. Rather than wait for the pandemic to be over before commencing operations and training, we have been actively looking at programs, reviewing alternative methods such as e-learning, use of virtual learning platforms, decentralization of training using in situ simulation (ISS) modeling, partnerships with relevant clinical departments, cross-training of staff to attain useful secondary skills, and many other alternatives and substitutes. It has been an eye-opening journey as we maximize our staff's talent and potential in new adoptions and stretching our goals beyond what we deemed was possible. This paper shares perspectives from simulation centers; The SingHealth Duke NUS Institute of Medical Simulation which is integrated with an Academic Medical Center in Singapore, The Robert and Dorothy Rector Clinical Skills and Simulation Center, which is integrated with Thomas Jefferson University, Oakhill Emergency Department, Florida State University Emergency Medicine Program, Florida, USA and The Wellington Regional Simulation and skills center. It describes the experiences from the time when COVID 19 first struck countries around the world to the current state whereby the simulation centers have stWWarting functioning in their "new norm." These centers were representative examples of those in countries which had extremely heavy (USA), moderate (Singapore) as well as light (New Zealand) load of COVID 19 cases in the nation. Whichever categories these centers were in, they all faced disruption and had to make the necessary adjustments, aligning with national policies and advisories. As there is no existing tried and tested model for the running of a simulation center during an infectious disease pandemic, this can serve as a landmark reference paper, as we continue to fine-tune and prepare for the next new, emerging infectious disease or crisis. [ABSTRACT FROM AUTHOR]

System barriers to effective healthcare engagement and navigation contribute to healthcare disparities among Latino children with immigrant parents in the US. We evaluated a nine-minute educational video supporting healthcare navigation and engagement skills of Spanish-speaking Latino parents of infants. Participants viewed the video at their child's 2-month well-visit, completed a pre-and post-video knowledge evaluation, and answered open-ended questions on video style. A paired t test was used to examine differences in knowledge and open-ended responses were coded using an iterative, consensus-based process. Of the 79 participants, 63.3% had an education level below high school diploma/GED and 84.8% were at risk for limited health literacy. There was a significant gain in healthcare navigation and engagement knowledge after watching the video (p < 0.001). Parents expressed that the video was interesting and provided useful information. Parents valued the knowledge gained and preferred videos over written materials for receiving culturally and linguistically tailored health education. [ABSTRACT FROM AUTHOR]

Purpose UNC Medical Center converted to an electronic health record (EHR) in 2014. This conversion allowed for the transition of paper chemotherapy orders to be managed electronically. This article describes the process for converting inpatient paper chemotherapy orders into the new EHR in a safe and effective manner. Summary A collaborative interdisciplinary approach to the EHR transition enabled our organization to move from using paper chemotherapy orders to fully electronic chemotherapy treatment plans in both ambulatory and acute care areas. Active chemotherapy orders for acute care inpatients were reviewed and transcribed by two oncology pharmacists in the cancer hospital prior to being signed by an attending physician. The newly input orders were independently verified by two pharmacists in the cancer hospital inpatient pharmacy. Nurse review of the signed and verified treatment plans, along with reconciliation of the medication administration record ensured a safe transition to the new EHR workflow. Providers benefit from the ability to review treatment plans remotely, track changes, and include supportive medications in one consolidated location. The coordinated team effort allowed for a smooth transition with minimal interruptions to patient care. Conclusion The pharmacist-led, multidisciplinary conversion to electronic chemotherapy orders was safe, accurate, and occurred ahead of schedule for the EHR go-live. Advance communication and planning around scheduled inpatient admissions helped to minimize the impact of the transition from paper to electronic treatment plans. Both pharmacist and physician engagement were necessary to ensure a smooth transition for active inpatient treatment plans. [ABSTRACT FROM AUTHOR]

Aim: The present study aims at teaching the right citation models in scientific publications by top authors from Iranian universities of medical sciences in 2017, considering the relationship between moral development and self-control variables and model of "citation to multi-authored papers" in these articles. Background: Multi-authorship increases the amount of self-citation and also increases the likelihood of being cited by others. Methods: This study is of the applied scientometrics and correlation (model presentation) studies type. The research population in the first part of this study includes all the authors who had an H-index of 10 or more in the scientific databases of 2017. The sample size at this stage was 110, selected by systematic random sampling. The collected data were analyzed using SPSS 16.0. Results: The results of regression analysis based on the concurrent method indicated that the regression model is significant. The coefficient of determination is 0.096 and the F ratio is 5.650, which are significant at the level of p <0.001. In this regression model, the variables of the level of moral development (β = -5.801, p <0.001) and self-control (p < 0.001, β = -0.253) have significant predictive power and can be considered as predictors of behavioral modeling in citing "multi-authored papers". Conclusion: Based on the results, teaching how to avoid blindly citing the "multi-authored papers", which is regarded as a kind of "citation deviation", can, to some extent, lead to strengthening citation indexes. [ABSTRACT FROM AUTHOR]

PURPOSE: To evaluate the effect of electronic and paper-based standardized nursing care plans (SNCPs) use on quality of nurses’ documentation. METHODS: Using quasi-experimental design, two wards were grouped into electronic and paper-based wards. Nurses were trained to use electronic- and paperbased SNCPs for care-planning and documentation. Data was collected before, 3, and 6 months postintervention and analyzed with SPSS version 20. FINDINGS: There was improvement in documentation quality in the two wards after introducing SNCPs with higher quality scores in the electronic ward postintervention. CONCLUSION: Providing SNCPs in electronic and paper formats is critical to improving nursing documentation. IMPLICATION FOR NURSING PRACTICE: Adequate training and support for nurses are needed for successful implementation of SNCPs in electronic health records (EHRs) in developing nations. [ABSTRACT FROM AUTHOR]

Unlike mammals, adult zebrafish are capable of regenerating their hearts without scarring after injury -- a process that has great therapeutic potential. A new paper in Development investigates the role of Prxx1b, a transcription factor that is expressed in epicardial heart tissue after injury, to understand its role in the scar-free regeneration of the adult zebrafish heart. To hear more about the study, we caught up with joint first authors, Dennis De Bakker and Mara Bouwman, and the corresponding author, Jeroen Bakkers, the group leader at the Hubrecht Institute and professor of Molecular Cardiogenetics at the University Medical Center in Utrecht, The Netherlands. [ABSTRACT FROM AUTHOR]

Coaching has become increasingly popular as a mechanism to support learning across the health professions education (HPE) continuum. While there is a growing body of literature in this area, there is minimal guidance related to the design and implementation of academic coaching in health professional courses. This paper seeks to contribute to this literature by presenting guidance for academic developers who are considering introducing academic coaching into a health professional course. The 12 tips are based on the authors' collective experiences of designing and implementing academic coaching in university medical courses in Australia and the UK. Although focused on medical education, this paper is intended to have applicability across the health professions, and potentially across university and postgraduate training contexts. Together, the tips offer a strategic and operational framework to guide the design and implementation of academic coaching initiatives in health professions education. [ABSTRACT FROM AUTHOR]

Objectives: To explore the rate of NUPs and associated factors in the PED of the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain) using Andersen's Behavioural Model. Methods: We conducted a descriptive cross‐sectional study using Andersen's Behavioural Model in parents visiting the PED with their children at the 'Hospital Universitario y Politécnico La Fe' in Valencia (Spain). Results: The study involved a total of 530 participants, of whom 419 (79%) had made an NUP. The predisposing factors identified were: (I) paediatric patients brought in by their fathers (OR = 0.460; p = 0.005), (II) lower educational attainment (OR = 3.841; p = 0.000), (III) first‐time parenthood (OR = 2.335; p = 0.000) and (IV) higher parental stress (OR = 1.974; p = 0.023). The enabling factors included: (I) responsibility for a significant part of the childcare shared with others (OR = 0.348; p = 0.041) and (II) the perception that PEDs provide better care than primary care (PC) services (OR = 1.628; p = 0.005). The need factors were: (I) existing chronic illness in the child seeking care (OR = 0.343; p = 0.000) and (II) the perceived severity of the urgency (OR = 0.440; p = 0.031). Conclusions: The NUP rates found in this study are similar to those found internationally. In accordance with Andersen's Behavioural Model, we identify predisposing, enabling and need factors to explain the multifactorial nature of NUPs in PEDs. Implications for Practice: Identifying the factors associated with NUPs enables interventions to be targeted at those groups most likely to engage in NUPs, thereby optimising the functioning of the PED and improving the well‐being of children and families. These interventions should focus on improving parental health literacy, providing education on making appropriate decisions about accessing health services and recognising severe symptoms in children, as well as improving access to high‐quality PC services. Providing support to parents during the transition to parenthood would also be beneficial. Reporting Method: This paper adheres to the STROBE initiative guidelines. Contribution from patients or members of the public: Participants, who voluntarily agreed to take part, contributed to the study by completing a paper‐based questionnaire containing all the study variables as prepared by the research team. [ABSTRACT FROM AUTHOR]

Background: Changing the food environment is an important public health lever for encouraging sustainable food choices. Targeting the availability of vegetarian main meals served in cafeterias substantially affects food choice, but acceptability has never been assessed. We examined the effects of an availability intervention at a French university cafeteria on students' main meal choices, meal offer satisfaction and liking. Methods: A four-week controlled trial was conducted in a university cafeteria in Dijon, France. During the two-week control period, vegetarian main meals constituted 24% of the offer. In the subsequent two-week intervention period, this proportion increased to 48%, while all the other menu items remained unchanged. Students were not informed of the change. Student choices were tracked using production data, and daily paper ballots were used to assess student satisfaction with the meal offer and liking of the main meal they chose (score range [1;5]). Nutritional quality, environmental impact, and cost of production of meal choices were calculated for each lunchtime. Food waste was measured over 4 lunchtimes during control and intervention periods. An online questionnaire collected student feedback at the end of the study. Results: Doubling availability of vegetarian main meals significantly increased the likelihood of choosing vegetarian options (OR = 2.57, 95% CI = [2.41; 2.74]). Responses of the paper ballots (n = 18,342) indicated slight improvements in meal offer satisfaction from 4.05 ± 0.92 to 4.07 ± 0.93 (p = 0.028) and in liking from 4.09 ± 0.90 to 4.13 ± 0.92 (p < 0.001) during control and intervention periods, respectively. The end-of-study questionnaire (n = 510) revealed that only 6% of students noticed a change the availability of vegetarian main meals. The intervention led to a decrease in the environmental impact of the main meals chosen, a slight decrease in nutritional quality, a slight increase in meal costs and no change in food waste. Conclusions: Doubling availability of vegetarian main meals in a university cafeteria resulted in a twofold increase in their selection, with students reporting being more satisfied and liking the main meals more during the intervention period. These results suggest that serving an equal proportion of vegetarian and nonvegetarian main meals could be considered in French university cafeterias to tackle environmental issues. Trial registration: Study protocol and analysis plan were pre-registered on the Open Science Framework (https://osf.io/pf3x7/). [ABSTRACT FROM AUTHOR]

Background: The Pontifical Academy for Life (PAV) is an academic institution of the Holy See (Vatican), which aims to develop and promote Catholic teachings on questions of biomedical ethics. Palliative care (PC) experts from around the world professing different faiths were invited by the PAV to develop strategic recommendations for the global development of PC ("PAL-LIFE group"). Design: Thirteen experts in PC advocacy participated in an online Delphi process. In four iterative rounds, participants were asked to identify the most significant stakeholder groups and then propose for each, strategic recommendations to advance PC. Each round incorporated the feedback from previous rounds until consensus was achieved on the most important recommendations. In a last step, the ad hoc group was asked to rank the stakeholders' groups by order of importance on a 13-point scale and to propose suggestions for implementation. A cluster analysis provided a classification of the stakeholders in different levels of importance for PC development. Results: Thirteen stakeholder groups and 43 recommendations resulted from the first round, and, of those, 13 recommendations were chosen as the most important (1 for each stakeholder group). Five groups had higher scores. The recommendation chosen for these top 5 groups were as follows: (1) Policy makers: Ensure universal access to PC; (2) Academia: Offer mandatory PC courses to undergraduates; (3) Healthcare workers: PC professionals should receive adequate certification; (4) Hospitals and healthcare centers: Every healthcare center should ensure access to PC medicines; and (5) PC associations: National Associations should be effective advocates and work with their governments in the process of implementing international policy framework. A recommendation for each of the remaining eight groups is also presented. Discussion: This white paper represents a position statement of the PAV developed through a consensus process in regard to advocacy strategies for the advancement of PC in the world. [ABSTRACT FROM AUTHOR]

Purpose It has been estimated that medication errors (ME) are responsible for 7000 deaths each year. Some studies show that electronic prescribing systems have achieved health benefits and patient safety, resulting in a saving of resources. Other studies suggest that they may increase adverse events. Objective The objective of this study was to compare medication errors between electronic and paper-based prescription detected during pharmacovigilance. Methods This was an observational, cross-sectional comparative study of 600 randomized medical records that were systematically reviewed by a pharmacovigilance team, with a deliberate search for ME. Each error was classified according to its severity, National Coordinating Council for Medication Error and Prevention taxonomy and high-risk medications. The number of errors was calculated per 100 prescribed medications, number of errors per record and number of records with an error as a quality indicator. Results A total of 229 ME were found with a mean per record of 0.38 (SD = 0.7), of which 155 corresponded to the paper-based method (1.04, SD = 1.67) and 74 to the electronic-based method (0.29, SD = 0.57) P = <0.001. The use of the electronic method was associated with an OR of 0.59 (95% CI 0.41-0.85) for the recording of at least one ME ( P = 0.005), but to a greater severity of ME (<0.001). Conclusion The use of the electronic system was associated with a reduction in ME, compared with the paper-based method. Despite this, it was associated with more severe ME. [ABSTRACT FROM AUTHOR]

Context.--In 2018 the College of American Pathologists Diagnostic Immunology and Flow Cytometry Committee designed and implemented a new plasma cell neoplasia flow cytometry proficiency testing program--PCNEO--to allow clinical flow cytometry laboratories to monitor and assess their performance compared with a peer group. Objective.--To report the results from the first 4 years of the PCNEO program. Design.--Program participants were sent 2 sets of challenges per year, each including 1 wet challenge and 2 dry challenges, with associated clinical and laboratory findings. The wet challenges were composed of myeloma cell line specimens (with or without dilution in preserved whole blood) for flow cytometric analysis. The dry (paper) challenges were composed of clinical case summaries and images of flow cytometric test results from various flow cytometry laboratories of committee members. Results.--A total of 116 to 145 laboratories from 17 countries enrolled in the proficiency testing program. For the wet challenges, almost all participants (97%--100%; cumulative, 98.2%) correctly identified the presence of neoplastic plasma cell populations based on flow cytometric analysis of undiluted myeloma cell lines. Slightly fewer participants (89.0%--97.4%; cumulative, 95.2%) correctly identified the presence of neoplastic plasma cell populations based on flow cytometric analysis of diluted myeloma cell lines (10% or 50% dilutions into peripheral blood) intended to better represent a typical clinical sample. There was generally agreement among 80% or more of participants for positive or negative staining for CD38, CD138, CD19, CD20, and surface and cytoplasmic K and λ light chains. Similarly, 84% to 100% of participants were able to correctly identify the presence of neoplastic plasma cell populations in paper challenges, including the presence of small, neoplastic plasma cell populations (0.01%--5.0% clonal plasma cells) and the presence of nonneoplastic plasma cell populations (correctly identified by 91%--96% of participants). Conclusions.--Participant performance in the new proficiency testing program was excellent overall, with the vast majority of participants able to perform flow cytometric analysis and identify neoplastic plasma cell populations and to identify small plasma cell clones or expanded populations of reactive plasma cells in dry challenge flow cytometry results. This program will allow laboratories to verify the accuracy of their testing program and test interpretations for the assessment of patients suspected of having a plasma cell neoplasm. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study is to analyse the risk factors for unplanned readmissions within 1 month after hospital discharge to develop a seamless support system from discharge to home care. Background: With shorter hospital stay lengths, understanding the characteristics of patients with multiple risk factors is important to prevent rehospitalization. Design: This is a single‐centre retrospective descriptive study. Methods: Logistic regression and decision tree analyses were performed using eight items from the records of 3117 patients discharged from a university hospital between April–September 2017 as risk factors. Results: Unplanned readmission risk was significantly associated with emergency hospitalization (odds ratio [OR]: 3.12, 95% confidence interval [CI]: 2.04–4.77), malignancy (OR: 2.16, 95% CI: 1.44–3.24), non‐surgical admission (OR: 1.76, 95% CI: 1.07–2.88), hospital stay of ≥ 15 days (OR: 1.66, 95% CI: 1.14–2.43) and decline in activities of daily living owing to hospitalization (OR: 1.68, 95% CI: 1.06–2.64). The highest risk combinations for rehospitalization were as follows: emergency hospitalization and malignancy; emergency admission, non‐malignancy and a hospital stay of ≥15 days; and scheduled hospitalization, no surgery and a hospital stay of ≥15 days. Conclusions: Patients with multiple risks for unplanned readmission should be accurately screened and provided with optimal home care. Summary statement: What is already known about this topic? Although the characteristics of patients at high risk of rehospitalization include malignancy, heart failure, conditions such as chronic obstructive pulmonary disease and other diseases prone to recurrence, old age, reduced activities of daily living and emergency hospitalization, few studies have reported on cases with multiple risks. What this paper adds? The most frequent risk types for unplanned readmissions within a month were emergency admissions for malignant tumours, emergency admissions for non‐malignant tumours with a hospital stay of 2 weeks or more and scheduled admissions for non‐surgical purposes with a length of stay of 2 weeks or more. The implications of this paper: The risk of unplanned readmission within 1 month of discharge increased due to a combination of multiple risks.This study helps us identify patients who are at high risk for readmission early in the hospitalization process and in providing nursing support for transition to their homes. [ABSTRACT FROM AUTHOR]

Institutional ethnography (IE), a term coined by sociologist Dorothy Smith, explores the nuances of institutions and their complex relationships in sociology. IE is an approach to studying and analysing social organization, and it provides a more holistic understanding of 'invisible' relationships that govern institutions and how those relationships interact with each other. Health sciences researchers in patient care, patient experience, and allied health professionals have recently become more interested in the use of this methodology and how to incorporate it into their research. However, in health professions education (HPE) there is little use of IE. We hypothesize this may be because of limited practical knowledge of this methodology. This paper serves as an introduction to the use of IE in HPE, describing the differences between IE and traditional ethnographies, recognizing the common pitfalls when utilising IE, and incorporating texts into IE. While ethnographies may be daunting to researchers less familiar with these approaches, the tips in this paper will provide an introduction and help educators and researchers successfully navigate the use of IE in health profession scholarship and education. [ABSTRACT FROM AUTHOR]

Aims: Psychological insulin resistance is a common barrier to initiation and persistence with insulin therapy that affects approximately 42.7% of people living with type II diabetes mellitus, which may negatively impact self‐management. This study aimed to assess patients' levels of psychological insulin resistance and to identify factors associated with self‐management in patients with type II diabetes mellitus treated with insulin therapy. Methods: We adopted a cross‐sectional design. Subjects from the metabolism and endocrinology outpatient departments of a regional teaching hospital in central Taiwan were recruited by consecutive sampling. Patients were assessed for psychological insulin resistance and self‐management using the barriers to insulin treatment questionnaire and the partners in health scale. Results: A total of 222 patients with type II diabetes mellitus were recruited. Patients had an average psychological insulin resistance score of 3.14 (maximum of 8). Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age. Conclusion: Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy. Insulin therapy education should be offered to improve patients' beliefs about insulin therapy and enhance patients' ability to perform self‐management. Summary statement: What is already known about this topic? Psychological insulin resistance is a common psychological barrier to initiation and persistence with insulin therapy.Psychological insulin resistance causes poor glycaemic control and diabetes‐related complications.Psychological insulin resistance may negatively impact self‐management in patients with type II diabetes mellitus. What is the contribution of this paper? Positive self‐management was associated with insulin therapy injection by patient, fewer expectations regarding positive insulin‐related outcomes, no diabetes‐related complications, less fear of injection and self‐testing, no hypoglycaemia within the previous year, and younger age.Insulin therapy injection by patient and no diabetes‐related complications were the most common factors associated with overall self‐management and with each domain of self‐management in patients with type II diabetes mellitus treated with insulin therapy.Patients with poor self‐management had statistically significantly higher levels of overall psychological insulin resistance, fear of injections and self‐testing, expectations regarding positive insulin‐related outcomes, and stigmatization by insulin injections, compared to those with appropriate self‐management. What are the implications of this paper? Knowing in advance the factors associated with diabetes self‐management will allow healthcare professionals prevent psychological insulin resistance in patients with type II diabetes mellitus treated with insulin therapy.Healthcare professionals can design and provide patient‐centred diabetes education based on education level to enhance self‐management. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate disparities in urine drug testing (UDT) during perinatal care at a single academic medical center. This retrospective cohort study included patients who had a live birth and received prenatal care at our institution between 10/1/2015 and 9/30/2020. The primary outcomes were maternal UDT during pregnancy (UDTPN) and UDT only at delivery (UDTDEL). Secondary outcomes included the number of UDTs (UDTNUM) and the association between a positive UDT test result and race/ethnicity. Mixed model logistic regression and negative binomial regression with clustering based on prenatal care locations were used to control for confounders. Of 6,240 live births, 2,265 (36.3%) and 167 (2.7%) received UDTPN and UDTDEL, respectively. Black (OR 2.09, 95% CI 1.54–2.84) and individuals of Other races (OR 1.64, 95% CI 1.03–2.64) had greater odds of UDTPN compared to non-Hispanic White individuals. Black (beta = 1.12, p < 0.001) and Hispanic individuals (beta = 0.78, p < 0.001) also had a positive relationship with UDTNUM. Compared to individuals with non-Medicaid insurance, those insured by Medicaid had greater odds of UDTPN (OR 1.66, 95% CI 1.11–2.49) and had a positive relationship with UDTNUM (beta = 0.89, p < 0.001). No significant associations were found for UDTDEL and race/ethnicity. Despite receiving more UDT, Black individuals were not more likely to have a positive test result compared to non-Hispanic White individuals (OR 0.95, 95% CI 0.72–1.25). Our findings demonstrate persistent disparities in substance use testing during the perinatal period. Significance: What is already known on this subject?: Prior literature has shown evidence of racial disparities in urine drug testing during pregnancy-related hospital admissions and at delivery. What this study adds?: This paper found that disparities in urine drug testing also exist during the prenatal care period at an urban academic institution. We also found a positive relationship between the number of tests received and being of Black or Hispanic race/ethnicity. Future research should investigate health care system-related interventions to mitigate disparities in urine drug testing. [ABSTRACT FROM AUTHOR]

Background: Perceptual measures such as speech intelligibility are known to be biased, variant and subjective, to which an automatic approach has been seen as a more reliable alternative. On the other hand, automatic approaches tend to lack explainability, an aspect that can prevent the widespread usage of these technologies clinically. Aims: In the present work, we aim to study the relationship between four perceptual parameters and speech intelligibility by automatically modelling the behaviour of six perceptual judges, in the context of head and neck cancer. From this evaluation we want to assess the different levels of relevance of each parameter as well as the different judge profiles that arise, both perceptually and automatically. Methods and Procedures: Based on a passage reading task from the Carcinologic Speech Severity Index (C2SI) corpus, six expert listeners assessed the voice quality, resonance, prosody and phonemic distortions, as well as the speech intelligibility of patients treated for oral or oropharyngeal cancer. A statistical analysis and an ensemble of automatic systems, one per judge, were devised, where speech intelligibility is predicted as a function of the four aforementioned perceptual parameters of voice quality, resonance, prosody and phonemic distortions. Outcomes and Results: The results suggest that we can automatically predict speech intelligibility as a function of the four aforementioned perceptual parameters, achieving a high correlation of 0.775 (Spearman's ρ). Furthermore, different judge profiles were found perceptually that were successfully modelled automatically. Conclusions and Implications: The four investigated perceptual parameters influence the global rating of speech intelligibility, showing that different judge profiles emerge. The proposed automatic approach displayed a more uniform profile across all judges, displaying a more reliable, unbiased and objective prediction. The system also adds an extra layer of interpretability, since speech intelligibility is regressed as a direct function of the individual prediction of the four perceptual parameters, an improvement over more black box approaches. WHAT THIS PAPER ADDS: What is already known on this subject: Speech intelligibility is a clinical measure typically used in the post‐treatment assessment of speech affecting disorders, such as head and neck cancer. Their perceptual assessment is currently the main method of evaluation; however, it is known to be quite subjective since intelligibility can be seen as a combination of other perceptual parameters (voice quality, resonance, etc.). Given this, automatic approaches have been seen as a more viable alternative to the traditionally used perceptual assessments. What this study adds to existing knowledge: The present work introduces a study based on the relationship between four perceptual parameters (voice quality, resonance, prosody and phonemic distortions) and speech intelligibility, by automatically modelling the behaviour of six perceptual judges. The results suggest that different judge profiles arise, both in the perceptual case as well as in the automatic models. These different profiles found showcase the different schools of thought that perceptual judges have, in comparison to the automatic judges, that display more uniform levels of relevance across all the four perceptual parameters. This aspect shows that an automatic approach promotes unbiased, reliable and more objective predictions. What are the clinical implications of this work?: The automatic prediction of speech intelligibility, using a combination of four perceptual parameters, show that these approaches can achieve high correlations with the reference scores while maintaining a certain degree of explainability. The more uniform judge profiles found on the automatic case also display less biased results towards the four perceptual parameters. This aspect facilitates the clinical implementation of this class of systems, as opposed to the more subjective and harder to reproduce perceptual assessments. [ABSTRACT FROM AUTHOR]

Background: Aphasia, a common consequence of stroke, which affects both communication and social functioning, and in turn, quality of life, is on the rise due to increases in stroke prevalence and survival rate. The rehabilitation of post‐stroke aphasia primarily falls within the purview of speech‐language pathology and research supports the effectiveness of such services. However, provision of aphasia rehabilitation services in sub‐Saharan Africa is associated with challenges. Aims: This study aimed to examine rehabilitation services for individuals with post‐stroke aphasia in Ghana by exploring the roles of the stakeholder groups involved in the assessment and treatment of post‐stroke aphasia in Ghana, as well as the challenges they encounter in providing or identifying services. The stakeholder groups included educational institutions, interdisciplinary healthcare professionals, and family caregivers of individuals with post‐stroke aphasia. Methods & Procedures: A qualitative case study approach was used to collect and integrate from multiple sources data such as demographic information, interview responses and program syllabi to develop a holistic image. Fifteen respondents from the stroke and speech therapy units at Komfo Anokye and Korle‐Bu Teaching Hospitals, University of Ghana, and University of Health and Allied Sciences, Ghana were purposively sampled. Interview questions were developed and centred on aphasia education and training, knowledge of speech‐language pathology services, speech‐language pathology service delivery, access to speech‐language pathology services, challenges in both delivery and access to speech‐language pathology services and suggestions for improving speech‐language pathology services. In‐person and virtual interviews were conducted after demographic information was collected. Interviews were analysed thematically, and demographic information and program syllabi were triangulated with the interview data collected. Outcomes & Results: All stakeholder groups identified concerns with current aphasia services in Ghana. Issues raised included the insufficient number of speech‐language pathologists, lack of awareness of speech‐language pathology services for post‐stroke aphasia (among healthcare professionals and the public), absence of aphasia management information and clinical training in educational programming, lack of interest in speech‐language pathology training programs, financial challenges, spiritual and traditional beliefs and geographic barriers (i.e., speech‐language pathology services are currently available in only a few cities). Conclusions & Implications: These findings emphasised the need to improve post‐stroke aphasia rehabilitation in Ghana. The process of data collection itself educated respondents on the importance of post‐stroke aphasia rehabilitation, and by identifying barriers, strategies to improving services, such as designing standardised aphasia assessments for the Ghanaian context, can now be initiated. WHAT THIS PAPER ADDS: What is already known on the subject: To address post‐stroke aphasia, evidence‐based speech‐language pathology services are provided. However, there is a paucity of studies on post‐stroke aphasia services in Ghana, preventing an accurate report of services and practices in the country. What this study adds: This study provides an overview of the existing rehabilitation services for post‐stroke aphasia in Ghana. It highlights challenges facing the existing services and suggested strategies to improve post‐stroke aphasia services. What are the clinical implications of this work?: The study created awareness among healthcare professionals and general public (study participants) about the importance of rehabilitation services for post‐stroke aphasia. Based on the study findings, appropriate stakeholders such as policy makers, researchers, and healthcare professionals can further design assessments and interventions to improve rehabilitation, including speech‐language pathology services, for post‐stroke aphasia in Ghana. [ABSTRACT FROM AUTHOR]

Aim: To analyse the risk factors and incidence of falls in geriatric outpatients in a university hospital ward in Hangzhou, China. Methods: From May 2020 to August 2022, 1712 geriatric outpatients in a university hospital ward in Hangzhou, China, were screened using a socio‐demographic questionnaire (e.g. gender, age, living arrangement, etc.) and assessment scales. The correlation between each factor and falls was preliminarily analysed by chi‐squared tests. Finally, binary logistic regression analysis was conducted to further analyse the risk factors of falls. The STROBE checklist was used in reporting this study. Results: Of the 1712 geriatric outpatients recruited, 1626 participants (60–79 and ≥ 80 years old) with complete questionnaire and assessment data were included. The occurrence of falls for those in the 60–79 age group was 8.4%, and for those in the ≥80 age group it was 13.4%. Age (p =.007), use of a walking assistance device (p <.001), the Stay Independent Brochure Questionnaire (SIB) (OR = 7.751, 95% CI = 5.089–11.806, p <.001), living arrangement (p =.004), timed up and go test (TUGT) (p =.007) and three diseases or above (OR = 2.496, 95% CI = 1.358–11.4.586, p =.003) reached statistical significance. Conclusions: Older people have a high incidence of falls. In this study, age, disease history, SIB scores (≥4 points), living arrangement, TUGT and walking assistance device increased the probability of falls in older Chinese adults. Personalised interventions should be carried out according to the specific situation of older people to effectively reduce their incidence of falls and improve their quality of life. Relevance to Clinical Practice: The basic characteristics and fall risk factors of the older can help nurses identify fall risk, and early intervention by caregivers can reduce fall‐related injuries, which has practical significance for promoting healthy aging. Patient or Public Contribution: The subjects of this study were older patients ≥60 years old, and the demographic characteristics and fall‐related information of patients were obtained by questionnaire. The team worked closely with a team of experts in the field of health care. Some researchers collect data and rewrite them, while other researchers analyse the information and write a paper. All authors read and approved the final manuscript. [ABSTRACT FROM AUTHOR]

This White Paper summarizes the state of readiness of combat surgeons and provides action recommendations that address the problems of how to train, sustain, and retain them for future armed conflicts. As the basis for the 2014 Scudder Oration, I explored how to secure an improved partnership between military and civilian surgery, which would optimize learning platforms and embed military trauma personnel at America's academic medical universities for trauma combat casualty care (TCCC). To craft and validate these recommendations, I conducted an integrative and iterative process of literature reviews, interviews of military and civilian leaders, and a survey of military-affiliated surgeons. The recommended action points advance the training of combat surgeons and their trauma teams by creating an expanded network of TCCC training sites and sourcing the cadre of combat-seasoned surgeons currently populating our civilian and military teaching hospitals and universities. The recommendation for the establishment of a TCCC readiness center or command within the Medical Health System of the Department of Defense includes a military and civilian advisory board, with the reformation of a think tank of content experts to address high-level solutions for military medicine, readiness, and TCCC. [ABSTRACT FROM AUTHOR]

The 8th biennial national conference of the Association of Psychologists in Academic Health Centers (APAHC) was held in Detroit, MI, March 9-11, 2017. All speakers were invited to contribute manuscripts based on their conference presentations to this special issue of the Journal of Clinical Psychology in Medical Settings, and five presenters did so. All manuscripts were peer reviewed by experts in the field. The Conference Co-Chairs, Drs. Amy M. Williams and John A. Yozwiak, serve as Guest Editors for the special issue with Associate Editorial support from Dr. Elizabeth D. Cash. This article provides a brief overview of the rationale for the choice of the conference theme and the speakers, and a brief introduction to the articles in this special issue. [ABSTRACT FROM AUTHOR]

Objective. To evaluate the validity, in terms of the patients’ acceptance, preference, feasibility and reliability of an innovative, interactive computerized system for collection of patient-reported outcome (PRO) data on axial SpA against the paper-and-pencil version.Methods. Fifty-five patients with axial SpA completed both the touch screen and the paper-and-pencil set of questionnaires. A computerized touch-screen system, SPEAMonitor, was developed to capture PRO data. Variables recorded included demographic data, patient’s assessment of general health status, BASDAI, BASFI, BASMI and acute-phase reactant levels. In order to assess the patient’s acceptance of, preference for and feasibility of computer-based questionnaires, the participants filled in an additional questionnaire. The time taken to complete both formats was measured. In a further test–retest study, 25 patients were re-evaluated.Results. The agreement between the paper-administered and computer touch-screen format of the BASFI, BASDAI questionnaires and the Ankylosing Spondylitis Disease Activity Scores was excellent. Intraclass correlation coefficients (ICCs) between data ranged from 0.90 to 0.96. Additionally the test–retest study showed a very good agreement between the scores for the two administrations (ICC &geq; 0.90). Age, computer experience and education level had no significant impact on the results. The computerized questionnaires were reported to be easier to use. The mean time spent completing the questionnaires on a touch screen was 5.1 min and on paper 7.9 min.Conclusion. Our newly developed computer-assisted touch-screen questionnaires for PRO in axial SpA were well accepted by patients, with good data quality, reliability and score agreement. [ABSTRACT FROM PUBLISHER]

Background: The etiology of anorexia nervosa is still unknown. Multiple and distributed brain regions have been implicated in its pathophysiology, implying a dysfunction of connected neural circuits. Despite these findings, the role of white matter in anorexia nervosa has been rarely assessed. In this study, we used diffusion tensor imaging (DTI) to characterize alterations of white matter microstructure in a clinically homogeneous sample of patients with anorexia nervosa. Methods: Women with anorexia nervosa (restricting subtype) and healthy controls underwent brain DTI. We used tract-based spatial statistics to compare fractional anisotropy (FA) and mean diffusivity (MD) maps between the groups. Furthermore, axial (AD) and radial diffusivity (RD) measures were extracted from regions showing group differences in either FA or MD. Results: We enrolled 19 women with anorexia nervosa and 19 healthy controls in our study. Patients with anorexia nervosa showed significant FA decreases in the parietal part of the left superior longitudinal fasciculus (SLF; pFWE < 0.05), with increased MD and RD but no differences in AD. Patients with anorexia nervosa also showed significantly increased MD in the fornix (pFWE < 0.05), accompanied by decreased FA and increased RD and AD. Limitations: Limitations include our modest sample size and cross-sectional design. Conclusion: Our findings support the presence of white matter pathology in patients with anorexia nervosa. Alterations in the SLF and fornix might be relevant to key symptoms of anorexia nervosa, such as body image distortion or impairments in body-energy-balance and reward processes. The differences found in both areas replicate those found in previous DTI studies and support a role for white matter pathology of specific neural circuits in individuals with anorexia nervosa. [ABSTRACT FROM AUTHOR]

Background: Evidence-based medicine (EBM) is a term that has acquired different definitions in different settings and is considered as an ambiguous concept. However, it represents an empiricist mode of thinking in medicine. EBM is a patient-centered approach in medicine and bases clinical knowledge on evidence as well as having a huge impact on clinical practice during the past few decades. Aim: The study aimed to evaluate medical resident trainees’ attitude, knowledge, and practice of EBM and encountered barriers in clinical settings to determine the relationship between trainees at different levels and departments and implications on patient care. Methods: A cross sectional survey conducted between June 2022 till December 2022, utilizing face-to-face and online questionnaire. Our questionnaire consisted of 37 questions which include characteristics of the sample in addition to attitudes related to EBM and perceptions of barriers related to it. Inclusion criteria were residents working at Jordan University Hospital with a total of 175 residents who agreed to participate in this study, and exclusion criteria were other medical assistant members and fellows. Results: A survey was distributed to 175 residents, who completed it and provided information on their sociodemographic. Approximately 72.6 percent of the participants were females (n = 127), and the median age was 27 years and an interquartile range of 2 years. The majority of participants (n = 171, 97.7%) stated that they had heard the term "evidence-based medicine" before. When asked about the residents' knowledge of various research-related terms, their answers showed a positive trend, with the majority indicating that they had some understanding of the term. The remaining findings are covered below. Conclusion: Despite having received no formal training in this area during their years of training, JUH residents demonstrated positive views regarding EBM, supporting it, and believing in its conclusions. They also generally had good terminology knowledge. More than 85% utilize medical websites, more than 50% have papers published, and more than 50% endorse EBM. [ABSTRACT FROM AUTHOR]

Aims: To elicit experiences of patients, family caregivers, and healthcare professionals in intermediate care units (IMCUs) in an academic medical centre in Baltimore, MD related to the challenges and intricacies of multimorbidity management to inform development of a multimorbidity symptom management toolkit. Design: Experience‐based co‐design. Methods: Between July and October 2021, patients aged 55 years and older with multimorbidity admitted to IMCUs at an academic medical centre in Baltimore, Maryland, USA were recruited and interviewed in person. Interdisciplinary healthcare professionals working in the IMCU were interviewed virtually. Participants were asked questions about their role in recognizing and treating symptoms, factors affecting the quality of life, symptom burden and trajectory over time, and strategies that have and have not worked for managing symptoms. An inductive thematic analysis approach was used for analysis. Results: Twenty‐three interviews were conducted: 9 patients, 2 family caregivers, and 12 healthcare professionals. Patients' mean age was 67.5 (±6.5) years, over half (n = 5) were Black or Hispanic, and the average number of comorbidities was 3.67. Five major themes that affect symptom management emerged: (1) the patient–provider relationship; (2) open and honest communication; (3) accessibility of resources during hospitalization and at discharge; (4) caregiver support, training, and education; and (5) care coordination and follow‐up care. Conclusion: Patients, caregivers, and healthcare professionals often have similar goals but different priorities for multimorbidity management. It is imperative to identify shared priorities and target holistic interventions that consider patient and caregiver experiences to improve outcomes. Implications for the Profession and/or Patient Care and Impact: This paper addresses the paucity of research related to the shared experience of disease trajectory and symptom management for people living with multimorbidity. We found that patients, caregivers, and healthcare professionals often have similar goals but different care and communication priorities. Understanding differing priorities will help better design interventions to support symptom management so people with multimorbidity can have the best possible quality of life. Reporting Method: We have adhered to the Consolidated Criteria for Reporting Qualitative Studies (COREQ) guidelines in our reporting. Patient or Public Contribution: This study has been designed and implemented with patient and public involvement throughout the process, including community advisory board engagement in the project proposal phase and interview guide development, and member checking in the data collection and analysis phases. The method we chose, experience‐based co‐design, emphasizes the importance of engaging members of a community to act as experts in their own life challenges. In the coming phases of the study, the public will be involved in developing and testing a new intervention, informed by these qualitative interviews and co‐design events, to support symptom management for people with multimorbidity. [ABSTRACT FROM AUTHOR]

Aim: To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing. Background: Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high‐quality care. Introduction: In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles. Methods: We conducted a cross‐sectional‐study using a paper‐and‐pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist. Results: Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance. Discussion: In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications. Conclusion and implications for nursing and/or health policy: In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration). [ABSTRACT FROM AUTHOR]

Collaborative quantitative scientists, including biostatisticians, epidemiologists, bioinformaticists, and data‐related professionals, play vital roles in research, from study design to data analysis and dissemination. It is imperative that academic health care centers (AHCs) establish an environment that provides opportunities for the quantitative scientists who are hired as staff to develop and advance their careers. With the rapid growth of clinical and translational research, AHCs are charged with establishing organizational methods, training tools, best practices, and guidelines to accelerate and support hiring, training, and retaining this staff workforce. This paper describes three essential elements for building and maintaining a successful unit of collaborative staff quantitative scientists in academic health care centers: (1) organizational infrastructure and management, (2) recruitment, and (3) career development and retention. Specific strategies are provided as examples of how AHCs can excel in these areas. [ABSTRACT FROM AUTHOR]

Aim: The risk of Type 2 Diabetes is 10 times higher after a pregnancy with Gestational Diabetes. Physical activity can independently reduce this risk, yet engagement with physical activity remains low after Gestational Diabetes. Therefore, the present study aimed to explore the barriers and facilitators to the uptake of physical activity after Gestational Diabetes in the United Kingdom, using a socio‐ecological approach. Methods: The paper was written following the Standards for Reporting Qualitative Research. Patient and Public Involvement contributed to the study's conceptualisation and design. Participants were recruited through an audit of Gestational Diabetes cases at a local Teaching Hospital in 2020. Twelve participants took part in semi‐structured one‐to‐one interviews. Reflexive thematic analysis was used to generate themes in iterative rounds of refinement. The final themes were then organised using the socio‐ecological model. Results: Participants were all over 31 years old, predominantly self‐identified as White British and were all in employment but were evenly spread across UK‐based deprivation deciles. Ten themes were generated and organised according to the four levels of the socio‐ecological model: intrapersonal (beliefs about activity, recovering from birth), social (health care professionals, family and partner, role as a mother), organisational (access and cost, environment, childcare and work) and community (connecting women with recent Gestational Diabetes). Conclusions: Many of the amenable barriers and facilitators to physical activity were beyond the intrapersonal level, based on higher levels of the socio‐ecological model (social, organisational and community). Multi‐level interventions are needed to effectively address all barriers. [ABSTRACT FROM AUTHOR]

An algorithm for the two-stage robust optimization surgery-to-operating room allocation problem is presented. The second-stage problem is an integer linear program whose convex hull is approximated using three types of specialized valid inequalities and Chvátal-Gomory cuts. The resulting linear relaxation of the second-stage problem is then dualized and integrated into the first-stage problem. The resulting mixed integer linear program, which is an approximation of the original problem, is then solved using a commercial solver. If the solution of this model is not optimal for the second-stage problem, valid inequalities for the second-stage problem are generated, yielding a type of column-generation based approach that we refer to as the sequential follower refinement (SFR) algorithm. Data from an academic medical center are used to compare the computational performance of SFR with the constraint and column generation (C&CG) algorithm, which is the only exact approach that has been specifically applied for this problem in the literature. An extensive numerical study of SFR and its computational characteristics is presented that shows that SFR yields better-quality solutions compared with C&CG, even as the termination criterion of SFR is met much sooner, especially for problems involving higher number of surgeries. History: Accepted by Paul Brooks, Area Editor for Applications in Biology, Medicine, & Healthcare. Supplemental Material: The software that supports the findings of this study is available within the paper and its Supplemental Information (https://pubsonline.informs.org/doi/suppl/10.1287/ijoc.2022.0191) as well as from the IJOC GitHub software repository (https://github.com/INFORMSJoC/2022.0191). The complete IJOC Software and Data Repository is available at https://informsjoc.github.io/. [ABSTRACT FROM AUTHOR]

This paper aims to examine the spatial attributes in the hospital ward environment and their impact on medical students' learning and experience of the clinical workplace. An ethnographic study was conducted in a Scottish teaching hospital, combining observations and interviews over a period of 10 months. Two teaching wards served as the field-sites where approximately 120 h of non-participant observations took place sequentially. In addition, 34 individual interviews were conducted with identified key informants that included medical students, junior doctors, postgraduate trainees, consultant supervisors, ward nurses and hospital pharmacist. A combination of Actor-network Theory (ANT) and Social cognitive theory (SCT) was applied to analyse data pertaining to spatial attributes and their relevance to clinical teaching and learning. Analysis of the observational and interview data led to generation of the following themes: spatial attributes in the clinical workplace can enable or constrain teaching and learning opportunities, inadequate spaces impact students' and junior doctors' sense of value, short clinical rotations influence a sense of ownership of doctors' spaces, and contested nature of space in the clinical environment. Several illustrations of the field-sites help to contextualise the themes and aid in understanding the participants' experiences and perceptions. Our findings suggest a complex entanglement of space with medical students learning and wellbeing in the clinical workplace. Provision of suitable spaces needs to be a core consideration to realise the full potential of work-based learning in medicine. [ABSTRACT FROM AUTHOR]

Chronic pain is a common feature of hypermobile Ehlers–Danlos Syndrome (hEDS), yet how patients assess and communicate their pain remains poorly understood. The objective of the present study was to explore the use of numeric pain assessment in individuals with hEDS, from a patient-centered perspective. Our analysis is based on in-depth qualitative interviews. The interviews were conducted over the phone. Our participants were patients living with hEDS (N = 35). Interviews were recorded, transcribed, and analyzed to identify factors related to their use of these pain assessment instruments. Three primary themes emerged from these data, namely, (1) confusion around the quantification of multidimensional pain, (2) the subjectivity of pain experience, and (3) a strategic use of assessments for practical purposes beyond the accurate representation of pain. These results demonstrate the need for caution in relying exclusively on numeric pain assessment instruments. We conclude with a brief proposal for a clinical communication strategy that may help to address the limitations of numeric pain assessment that were identified in our interviews. Chronic pain is a common feature of hypermobile Ehlers–Danlos Syndrome (hEDS), yet how patients assess and communicate their pain remains poorly understood. Clinicians should be aware that patients have difficulties with the Numeric Rating Scale (NRS) for at least three reasons: (1) confusion around the quantification of multidimensional pain, (2) the subjectivity of pain experience, and (3) a strategic use of assessments for practical purposes beyond the accurate representation of pain. Clinicians should use caution in relying exclusively on NRS instruments. Clinicians may benefit from using clinical communication strategies outlined in our paper, which may help to address the limitations of the NRS that were identified in our interviews. [ABSTRACT FROM AUTHOR]

Background: The clitoris has long been ignored in medical literature and teaching, with the first paper describing its anatomy only published in 1993. It is essential that those working in women's health understand the anatomy of this important female sexual organ. Aims: The aim of this study was to assess the level of knowledge of the anatomy of the clitoris across five cohorts in a busy teaching maternity hospital in Ireland. Materials and Methods: A questionnaire was devised, asking ten consultants, ten non‐consultant hospital doctors (NCHDs), ten midwives, ten midwifery students and ten medical students to name the anatomical parts of a 3D model of the clitoris. Results: None of the 50 respondents could name all five labelled parts of the clitoris, and 38 of respondents could not correctly name one anatomical part. Conclusions: It is evident that there is a lack of knowledge of the anatomical parts of the clitoris among the medical staff included in this study. This reflects a lack of adequate teaching in this area in both past and recent years. Despite this, we acknowledge that women's health and sexual health awareness is improving all of the time, and we hope that this study can highlight the need for reformed teaching in this area. [ABSTRACT FROM AUTHOR]

Aim: To develop and explore the validity of a Patient Reported Experience Measure (PREM) for adult inpatient diabetes care. Method: 27 in‐depth interviews were conducted to inform the development of the 42‐item PREM which was cognitively tested with 10 people. A refined 38‐item PREM was piloted with 228 respondents completing a paper (n = 198) or online (n = 30) version. The performance of the PREM was evaluated by exploring (i) uptake/number of responses and (ii) survey validity by investigating whether the PREM data were of adequate quality and delivered useful information. Results: The PREM had low drop‐out or missing data rates suggesting it was appropriately constructed. Analysis of item frequencies and variances, and problem score calculations concluded that questions provided sufficient score differentiation. Conclusions: This new PREM allows for experiences of inpatient diabetes care to be measured, understood and reported on to help identify priority areas for improving care quality. [ABSTRACT FROM AUTHOR]

Background: Digital texts are progressively becoming the medium of learning for students, but research has indicated that students tend to process information more superficially while reading on screen. It is therefore relevant to examine what strategies can support digital text comprehension. Objectives: This study aimed to investigate the effects of highlighting—both learner generated and experimenter provided—when reading digitally. Methods: University students (N = 170) were randomly assigned to the condition of learner‐generated highlighting, experimenter‐provided highlighting, or control. Reading outcomes were measured as literal and inferential text comprehension, transfer of knowledge, and metacognitive calibration of comprehension performance at immediate and delayed post‐tests. Individual differences in prior knowledge, cognitive reflection, and reading self‐efficacy were taken into account. The quality of the information highlighted by students in the condition of active highlighting was also measured. Results: From linear mixed‐effects models, the main effect of condition did not emerge for any of the outcomes. However, an interactive effect of condition and cognitive reflection emerged for literal text comprehension that favoured readers in the condition of experimenter‐provided highlighting with higher ability to resist automatic thinking. Inferential text comprehension, transfer of knowledge, and calibration of performance were only predicted by cognitive reflection or reading self‐efficacy. Finally, the quality of information highlighted significantly contributed to students' literal text comprehension and transfer of knowledge in the learner‐generated highlighting condition. Takeaways: Active highlighting is not effective per se during digital reading. The "amplification" effect of already highlighted text and higher cognitive reflection suggests that readers who are more able to resist automatic thinking may also invest more effort in the task, taking more advantage of the provided support. Even if active highlighting may not be effective per se compared to other reading conditions, what students highlight contributes to literal text comprehension and their learning from text. Lay Description: What is already known about this topic: Reading on a screen to learn new content for academic assignments is a typical learning activity for todays' students.For digital reading students tend to adopt a more superficial approach compared to traditional reading.Reading strategies can help readers to comprehend complex digital texts.Highlighting is a technically simple strategy to use for digital reading, which can at least support the selection of relevant information for text comprehension. What this paper adds: When considering digital reading neither learner‐generated highlighting nor experimenter‐provided highlighting is effective by itself.Experimenter‐provided highlighting is more effective for literal text comprehension than learner‐generated highlighting when combined with readers' ability to cognitively reflect and resist more automatic responses.The individual differences of cognitive reflection and reading self‐efficacy predicted inferential text comprehension and transfer of knowledge.Reading self‐efficacy also predicted readers' metacognitive calibration of comprehension performance (accuracy of self‐judgements of comprehension performance). The implications of study findings for practitioners: The effective use of highlighting for text comprehension probably requires some explicit instruction and practice in learning devices.The potential benefits of either learner‐generated highlighting or experimenter‐provided highlighting should be considered in relation to cognitive and motivational individual differences.It is important to create or refine readers' awareness that the quality of the information they highlight matters as it is associated with their text literal text comprehension and transfer of knowledge. [ABSTRACT FROM AUTHOR]

In recent years, Hunza has seen a surge of suicide cases among youth. This paper attempts to decipher the multiple layers of meanings entailed in suicide cases. The dominant perception among the natives is the attribution of influence to supernatural beings. This paper attempts to provide insights into the supernatural cosmology and its relationship to youth suicide among the Burushaski speakers of Hunza. Using qualitative research methodology, this paper describes the local perception of supernatural beings, and their classifications as well as the role of local shamans, known in Burushaski as bitan. In this scenario, suicide is not seen as a self-destruction, but is rather a punishment by the supernatural beings owing to the violation of the sacred supernatural social order imposed by the spirits connected to the supernatural world. For the natives, both the terrestrial and supernatural spheres share common habitats and mountain ecology; however, the latter is perceived to have more powers than the former. Therefore, breach of this order is highly discouraged and bears dire consequences. What appears as mere supernatural and human conflict actually carries deeper references to social and ecological disruptions. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to bring awareness to clinicians that are interested in pursuing a teaching career in schools of nursing in higher academic institutions. The paper aims to discuss the need-to know information to be successful in the academy. The target audience for this paper includes registered nurses, advanced practice registered nurses (APRNs), and newly hired instructors and/or assistant professors aspiring for an academic appointment in a university setting. [ABSTRACT FROM AUTHOR]

Aims: The study aimed to develop and evaluate the effects of a self‐determination theory‐based, nurse‐led, physical activity programme for postmenopausal women with rheumatoid arthritis. Methods: Between December 2019 and April 2020, this randomized controlled trial recruited 62 postmenopausal women with rheumatoid arthritis from a university‐affiliated hospital in South Korea. The intervention group participated in a self‐determination theory‐based, nurse‐led, physical activity programme that consisted of Tai Chi‐based physical activity, a supportive psychosocial strategy, and interactive counselling for 16 weeks, and the control group continued to undergo their usual care. Results: There were statistically significant group‐by‐time interactions in physical activity and perceived sarcopenia, which favoured the intervention group. Additionally, the intervention group showed significant improvements in the perceived therapeutic efficacy of physical activity, grip strength, walking speed, disease activity score, and health‐related quality of life. Conclusions: The programme developed in this study can be an effective and feasible approach for postmenopausal women with rheumatoid arthritis in improving physical activity, selected osteosarcopenic outcomes, and health‐related quality of life. Further research is required to investigate the long‐term effects of this theory‐based programme for postmenopausal women in diverse settings. Summary statement: What is already known about this topic? Tai Chi‐based physical activity has been known to be a component of self‐management for rheumatoid arthritis. What this paper adds? It highlights the efficacy of a theory‐based, nurse‐led, physical activity programme to improve the quality of life of postmenopausal women with rheumatoid arthritis.The evidenced‐based programme could be transferred to postmenopausal women with rheumatoid arthritis in clinical settings. The implications of this paper: The self‐determination theory‐based, nurse‐led, physical activity programme can improve physical and psychosocial outcomes in postmenopausal women with rheumatoid arthritis.Importantly, this nurse‐led and theory‐based programme is expected to be applicable to postmenopausal women with rheumatoid arthritis in clinical settings, including both hospitals and communities. [ABSTRACT FROM AUTHOR]

Background: Pain and anxiety management in patients undergoing medical and surgical procedures is an important competence area for nurses. Aim: This study aimed to determine and compare the effects of virtual reality and acupressure interventions on pain, anxiety, vital signs and comfort levels in the process of femoral catheter extraction for patients undergoing coronary angiography. Methods: The study was a single‐blind, three‐group, randomized controlled trial conducted in the cardiology clinics of a university hospital in 2021. A total of 153 patients (51 virtual reality, 51 acupressure, 51 control) participated in the study. Data were collected using a Visual Analogue Scale, the State–Trait Anxiety Inventory, a vital signs follow‐up form and the Perianesthesia Comfort Scale. Results: Both intervention groups had significantly lower pain and anxiety scores, as well as higher comfort scores, compared to the control group (p < 0.001). The virtual reality group had lower systolic blood pressure, respiratory rate and pulse rate than the control group (p < 0.05). The acupressure group had lower systolic and diastolic blood pressure and respiratory rate than the control group (p < 0.05). Conclusions: While neither intervention group was found to be superior to the other, both interventions improved vital signs and comfort levels by reducing pain and anxiety. Summary statement: What is already known about this topic? Uncontrolled pain and anxiety during medical and surgical procedures may increase the risk of complications and have negative effects on the pulmonary and cardiovascular systems, leading to changes in vital signs and compromising patients' hemodynamics.Virtual reality has demonstrated its potential to restore cognitive attention capacities, enabling patients to remain engaged and mentally focused during procedures, and thus reducing pain and anxiety.Acupressure, as a non‐pharmacological intervention, involves applying pressure to specific points on the body to alleviate pain and anxiety. It constitutes a safe, side‐effect‐free and cost‐effective option for improving patient outcomes.What this paper adds? This paper contributes to the knowledge of virtual reality and acupressure interventions as non‐pharmacological approaches that nurses can safely incorporate within their independent professional roles.The study evaluates the effects of traditional acupressure and technological virtual reality interventions on patients, comparing the two interventions for the first time to the best of our knowledge. Furthermore, to the best of our knowledge, these procedures were applied for the first time in femoral catheter extraction after coronary angiography.The implications of this paper: This study emphasizes the positive impacts of virtual reality and acupressure interventions administered by nurses for patients undergoing medical procedures.Overall, the findings suggest that non‐pharmacological techniques such as virtual reality and acupressure can contribute to a similar degree in improving patient outcomes during medical procedures. [ABSTRACT FROM AUTHOR]

Background: According to the legal definition healthcare systems and their components (e.g., hospitals) are part of the critical infrastructure of modern industrial nations. During the last few years hospitals increasingly became targets of cyber attacks causing severe impairment of their operability for weeks or even months. According to the German federal strategy for protection of critical infrastructures (KRITIS strategy), hospitals are obligated to take precautions against potential cyber attacks or other IT incidents. Objective: This article describes the process of planning, execution and results of an advanced table-top exercise which took place in a university hospital in Germany and simulated the first 3 days after a cyber attack causing a total failure of highly critical IT systems. Material and methods: During a first stage lasting about 8 months IT-dependent processes within the clinical routine were identified and analyzed. Then paper-based and off-line back-up processes and workarounds were developed and department-specific emergency plans were defined. Finally, selected central facilities such as pharmacy, laboratory, radiology, IT and the hospitals crisis management team took part in the actual disaster exercise. Afterwards the participants were asked to evaluate the exercise and the hospitals cyber security using a questionnaire. On this basis the authors visualized the hospitalʼs resilience against cyber incidents and defined short-term, medium-term and long-term needs for action. Results: Of the participants 85% assessed the exercise as beneficial, 97% indicated that they received adequate support during the preparations and 75% had received sufficient information; however, only 34% had the opinion that the hospitalʼs and their own preparedness against critical IT failures were sufficient. Before the exercise took place, IT-specific emergency plans were present only in 1.7% of the hospital facilities but after the exercise in 86.7% of the clinical and technical departments. The highest resilience against cyber attacks was not surprisingly reported by facilities that still work routinely with paper-based or off-line processes, the IT department showed the lowest resilience as it would come to a complete shutdown in cases of a total IT failure. Conclusion: The authors concluded that the planning phase is the most important stage of developing the whole exercise, giving the best opportunity for working out fallback levels and workarounds and through this strengthen the hospitals resilience against cyber attacks and comparable incidents. A meticulous preparedness can minimize the severe effects a total IT failure can cause on patient care, staff and the hospital as a whole. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID‐19) has adversely affected intensive care nurses; for instance, they have fought against an unknown disease, and their workload has increased. In addition, the COVID‐19 pandemic has led intensive care nurses to work in new settings and with new teams. Objective: The aim of this study was to explore and describe the caregiving experiences of nurses who were working in a new COVID‐19 intensive care unit in Turkey and providing care for patients infected with SARS‐CoV‐2. Method: In this descriptive qualitative study, semi‐structured interviews were held from 22 July to 31 August 2020 and were recorded and analysed based on thematic analysis. The researchers followed the COREQ checklist in reporting the study. Findings: From interviews held with 11 nurses, four main themes (uncertainty and challenges in the 'danger zone', emotional and psychosocial changes, professional effects of the pandemic and being ready for a future pandemic) were derived from 11 sub‐themes. Conclusions: The new setting and the ever‐changing team make caring for the COVID‐19 patient even more difficult. A good organization, an experienced permanent team, a known setting and good working conditions are essential to be prepared for possible pandemics in the future. Summary statement: What is already known about this topic? Pandemics are emergencies that can lead the health system to collapse.Patient care quality is associated with nurses' knowledge and experience.The COVID‐19 pandemic has led intensive care nurses to work in new settings and with new teams. What this paper adds? Nurses described challenges such as the fear, stress and stigma they experienced in the ICU during the first wave of the pandemic, which negatively affected patient care.The new setting and the ever‐changing team make caring for the COVID‐19 patient even more difficult. The implications of this paper: A good organization and an experienced permanent team should be established in order to ensure patient safety and high‐quality care in ICU settings for COVID‐19 patients.Working conditions of nurses should be improved without changing their setting during the pandemic. [ABSTRACT FROM AUTHOR]

Background: Medical workplace learning consists largely of individual activities, since workplace settings do not lend themselves readily to group learning. An electronic Learning Management with System Computer-Supported Collaborative Learning (CSCL) could enable learners at different workplace locations to discuss personal clinical experiences at a distance to enhance learning. Aim: To explore whether CSCL-enabled structured asynchronous discussions on an authentic task has additional value for learning in the medical workplace. Methods: Between January 2008 and June 2010, we conducted an exploratory evaluation study among senior medical students that were engaged in clinical electives. Students wrote a Critical Appraisal of a Topic paper about a clinical problem they had encountered and discussed it in discipline homogeneous subgroups on an asynchronous forum in a CSCL environment. A mixed method design was used to explore students'' perceptions of the CSCL arrangement with respect to their preparation and participation, the design and knowledge gains. We analysed the messages recorded during the discussions to investigate which types of interactions occurred. Results: Students perceived knowledge improvement of their papers. The discussions were mostly task-focused. The students considered an instruction session and a manual necessary to prepare for CSCL. A high amount of sent messages and a high activity in discussion seem to influence scores on perceptions: ''participation'' and ''knowledge gain'' positively. Conclusion: CSCL appears to offer a suitable environment for peers to provide formative feedback on a Critical Appraisal of a Topic paper during workplace learning. The CSCL environment enabled students to collaborate in asynchronous discussions, which positively influenced their learning. [ABSTRACT FROM AUTHOR]

Patient-reported outcomes are an important tool in clinical research. In the setting of cancer treatments, benefit of therapy is essentially characterised by improvement of survival as well as quality of life ( QoL). A standardised instrument to assess QoL is the standardised QoL questionnaire of the European Organisation for Research and Treatment ( EORTC QLQ- C30 questionnaire). QoL instruments provide data on different aspects (domains) of the framework of QoL. Using these questionnaires in studies provides data on how a treatment affects QoL in a group of patients. The goal of our concept is to individualise QoL and to use validated instruments in order to integrate patients' perspectives and aims into treatment assessment, planning and control. We propose to use the domains of the EORTC QLQ- C30 and to ask the patient to determine which objectives besides survival are relevant for him and should be achieved by treatment. These individual goals can be used in a process of shared decision-making to choose and monitor treatment. In clinical studies, this approach would allow to recruit more patients who would most probably benefit from the therapy. In addition, supportive data could be gathered in correlation to treatment goals and actual benefits. [ABSTRACT FROM AUTHOR]

Presents the position paper of The Network: Towards Unity for Health (TUFH), an initiative of the World Health Organization (WHO) and the Network, on primary care. Developments in primary care; Best evidence regarding health benefit of primary care; Primary care goals of the initiative; Attributes of primary-care oriented Academic Health Centers (AHC); Primary care innovations of the initiative.

Background: Acute and late toxicities in patients treated with (chemo)radiotherapy for head and neck cancer (HNC) is common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. Aims: Since Dutch performance status scales for the HNC population are lacking, we conducted this study to translate the Performance Status Scale for Head and Neck Cancer Patients (PSS‐HN) into Dutch (D‐PSS‐HN) and to validate this version. Methods & Procedures: The D‐PSS‐HN was translated into Dutch according to the internationally described cross‐cultural adaptation process. It was administered to HNC patients and together with the Functional Oral Intake Scale completed by a speech and language pathologist at five different time points during the first 5 weeks of (chemo)radiotherapy. Patients were asked each time to complete the Functional Assessment of Cancer Therapy and the Swallowing Quality of Life Questionnaire. Pearson correlation coefficients were used to calculate convergent and discriminant validity and the evolution of D‐PSS‐HN scores was assessed by means of linear mixed models. Outcomes & Results: A total of 35 patients were recruited and > 98% of the clinician‐rated scales were completed. Convergent and discriminant validity were demonstrated, with all correlations rs between 0.467 and 0.819, and between 0.132 and 0.256, respectively. The subscales of the D‐PSS‐HN are sensitive to detect changes through time. Conclusion & Implications: The D‐PSS‐HN is a valid and reliable instrument to assess performance status in patients with HNC treated with (chemo)radiotherapy. It is a useful tool to measure HNC patients' current diet level and functional abilities to perform daily life activities. WHAT THIS PAPER ADDS: What is already known on the subject: Acute and late toxicities in patients treated with (chemo)radiotherapy for HNC are common and can negatively impact quality of life and performance. Performance status instruments measure the functional ability to perform daily life activities and are important tools in the oncologic population. However, Dutch performance status scales for the HNC population are lacking. Therefore, we translated the Performance Status Scale for Head and Neck Cancer Patients (PSS‐HN) into Dutch (D‐PSS‐HN) and validated this version. What this paper adds to existing knowledge: We translated the PSS‐HN and demonstrated its convergent and discriminant validity. The subscales of the D‐PSS‐HN are sensitive to detect changes through time. What are the potential or actual clinical implications of this work?: The D‐PSS‐HN is a useful tool to measure HNC patients' functional abilities to perform daily life activities. The tool can easily be used in clinical settings: since data collection duration is very short, this facilitates clinical (and research‐related) implementation of the scale. Patients' individual needs could be identified by using the D‐PSS‐HN, resulting in more appropriate approaches and (early) referrals if needed. Interdisciplinary communication could be facilitated. [ABSTRACT FROM AUTHOR]

Background: At the beginning of the 21st century, international adoptions of children with cleft lip and/or palate increased dramatically in Sweden. Many children arrived partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. To date, the speech development of internationally adopted (IA) children has been described up to age 7–8 years, but later development remains unstudied. Aims: To investigate speech development between ages 5 and 10 years in children born with cleft lip and palate (CLP) adopted from China and to compare them with non‐adopted (NA) children with CLP. A secondary aim was to compare the frequencies of secondary palatal surgery and number of visits to a speech and language pathologist (SLP) between the groups. Methods & Procedures: In a longitudinal study, 23 IA children from China were included and matched with 23 NA children born in Sweden. Experienced SLPs blindly reassessed audio recordings from routine follow‐ups at ages 5 and 10 years. Velopharyngeal function (VPF) was assessed with the composite score for velopharyngeal competence (VPC‐Sum) for single words and rated on a three‐point scale (VPC‐Rate) in sentence repetition. Target sounds in words and sentences were phonetically transcribed. Per cent correct consonants (PCC) were calculated at word and sentence levels. For in‐depth analyses, articulation errors were divided into cleft speech characteristics (CSCs), developmental speech characteristics (DSCs) and s‐errors. Information on secondary palatal surgery and number of visits to an SLP was collected. Outcomes & Results: VPF differed significantly between the groups at both ages when assessed with VPC‐Sum, but not with VPC‐Rate. Regardless of the method for assessing VPF, a similar proportion in both groups had incompetent VPF but fewer IA than NA children had competent VPF at both ages. IA children had lower PCC at both ages at both word and sentence levels. More IA children had CSCs, DSCs and s‐errors at age 5 years, and CSCs and s‐errors at age 10. The development of PCC was significant in both groups between ages 5 and 10 years. The proportion of children receiving secondary palatal surgery did not differ significantly between the groups, nor did number of SLP visits. Conclusions & Implications: CSCs were more persistent in IA children than in NA children at age 10 years. Interventions should target both cleft and DSCs, be comprehensive and continue past the pre‐school years. WHAT THIS PAPER ADDS: What is already known on this subject: At the beginning of the 21st century, IA children with cleft lip and/or palate arrived in Sweden partially or totally unoperated, despite being at an age when palatoplasty has usually been performed. Studies up to age 7–8 years show that adopted children, compared with NA peers, have poorer articulation skills, demonstrate both cleft‐related and developmental articulation errors, and are more likely to have velopharyngeal incompetence. Several studies also report that adopted children more often require secondary palatal surgery due to fistulas, dehiscence or velopharyngeal incompetence compared with NA peers. What this paper adds to existing knowledge: This longitudinal study provides additional knowledge based on longer follow‐ups than previous studies. It shows that the proportion of children assessed to have incompetent VPF was similar among IA and NA children. It was no significant difference between the groups regarding the proportion that received secondary palatal surgery. However, fewer IA children were assessed to have a competent VPF. Developmental articulation errors have ceased in most IA and all NA children at age 10 years, but significantly more adopted children than NA children still have cleft‐related articulation errors. What are the potential or actual clinical implications of this work?: Speech and language therapy should target both cleft‐related and developmental articulation errors. When needed, treatment must be initiated early, comprehensive, and continued past the pre‐school years, not least for adopted children. [ABSTRACT FROM AUTHOR]

Introduction: A National Cancer Information System is planned for phased implementation in Irish cancer centres to enable electronic prescribing (ePrescribing) of systemic anti-cancer therapy. This study aimed to capture the opinions of healthcare professionals in a hospital setting relating to the current paper-based workflow for systemic anti-cancer therapy prescribing and their attitudes and expectations of the new ePrescribing system to develop recommendations, which assist in the planning and implementation of future ePrescribing systems. Methods: A mixed methods study of concurrent design was conducted. Interviews with healthcare professionals primarily aimed to evaluate processes and identify areas requiring improvement within the current paper-based workflow for systemic anti-cancer therapy prescribing. An online questionnaire adapted from the Information Systems Expectations and Experiences tool primarily aimed to capture expectations of the new ePrescribing system and attitudes towards the transition. Results: Twelve healthcare professionals were interviewed, and 50 healthcare professionals responded to the online questionnaire (response rate: 33.3%). Eight major themes emerged from interview transcripts relating to opinions on the paper-based workflow. Questionnaire respondents reported positive attitudes towards ePrescribing implementation and had high expectations for workflow improvements and functionalities of the new system. Seven recommendations for ePrescribing implementation were developed: (1) prioritise specific processes; (2) plan for changes in communication; (3) repeat research in the post-implementation setting; (4) ensure good information technology infrastructure and system support; (5) ensure optimum training; (6) outline limitations of clinical decision support; (7) provide clear instructions on local configurability. Conclusion: This study identifies potential challenges in transitioning to ePrescribing and provides recommendations, which assist stakeholders in ensuring safe and effective transitions, thus informing future ePrescribing systems' implementation in haematology/oncology settings. [ABSTRACT FROM AUTHOR]

Objectives: Integrated respiratory and palliative care services for people with advanced lung disease provide disease-orientated care until the end of life, alongside symptom management and discussions about future care. This study aimed to explore patient, caregiver and general practitioner perspectives of an integrated respiratory and palliative care service, to understand which components of the service were considered valued and effective. Methods: We approached patients, caregivers and general practitioners, to participate in semi-structured phone interviews. A grounded theory approach guided data collection and qualitative analysis. Results: Between July and December 2019, 10 patients, eight caregivers and five general practitioners completed interviews. The overarching theme was that of valuing integrated care – the provision of disease-orientated care along with palliative care. Four other major themes emerged: Valuing communication and engagement between patient, caregiver and healthcare professionals – who spoke of 'growing this plan together'; the delivery of person-centred care – where physicians 'actually listen and you are not treated like a number'; the reality of action plan use in serious illness – while many found plans 'certainly' do help, others described when they were simply 'too ill to do the action plan'; and finally, divergent preferences for discussions about future care – while some patients felt this subject was 'better left alone', caregivers consistently reported their preference was to 'make a plan.' Conclusion: Consumer perspectives highlight the service was valued for delivering personalised care with high communication standards. Similar services should appreciate the usefulness and limitations of action plan use in advanced lung disease, and be sensitive to potential diverging preferences of the patient and caregiver when discussing future care. What is known about the topic? Integrated respiratory and palliative care services for people with advanced lung disease may improve quality of life and decrease acute healthcare utilisation and cost. What does this paper add? This paper adds to our understanding of patients', caregivers' and general practitioners' perspectives of this integrated care model. Participants highly valued this integrated service for providing person-centred care. Participants outlined both the effectiveness and limitations of action plan use in advanced lung disease, and of diverging preferences between patients and caregivers for discussions about future care. What are the implications for practitioners? The integration of disease-orientated care along with the provision of palliative care is highly valued from a consumer perspective. [ABSTRACT FROM AUTHOR]

Objectives: To explore general practitioners' perspectives on the discharge summaries they receive about their patients who have been discharged from hospital. Methods: A survey of general practitioners in the catchment of a major metropolitan South Australian health service consisting of three teaching hospitals was undertaken. Surveys were disseminated electronically and via hardcopy mailout to general practitioners. The 36-question survey focused on five constructs of discharge summaries: accessibility, length and clarity, format, transparency, and medicines content. Results: A total of 150 general practitioners responded (response rate, 27.6%). Respondents were vocationally registered (96%), predominately from metropolitan practices (90.2%), and 65.8% were female. Overwhelmingly, 86.7% of general practitioners stated that the optimal time for receipt of discharge summaries was <48 h post-discharge, and 96.6% considered that late arrival of discharge summaries adversely impacts patient care. The ideal length of discharge summaries was reported as <4 pages by 64% of respondents. A large proportion of respondents (84.6%) would like to be notified when their patients are admitted and discharged from hospital, and 82.7% were supportive of patients receiving their own copy of the discharge summary. A total of 76.7% general practitioners reported that they had detected omissions or discrepancies in the discharge summaries. Provision of rationale for medication changes was viewed as important by 86.7%, however, only 29.3% reported that it is always or often communicated. Conclusions: General practitioners supported timely receipt, concise length of discharge summary and format refinement to improve the utility and communication of this important clinical handover from hospital to community care. What is known about the topic? Discharge summaries are an important handover document when transitioning care from hospital to general practice. Delays, omissions and inaccuracies in discharge summaries can contribute to adverse patient outcomes. What does this paper add? This paper provides contemporary perspectives of general practitioners about discharge summaries and scope for improvements. What are the implications for practitioners? General practitioners value receiving discharge summaries that are timely, follow a format, provide clear details for ongoing care, and are an appropriate length. [ABSTRACT FROM AUTHOR]