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Millions of Australians use the private health system every year. They should receive safe, high-quality, value-based care. However, poor policy and inadequate regulation of medical technology is driving low-value care at great expense to consumers and the broader health system. Key drivers include the Prescribed List of Medical Devices and Human Tissue, gaps in quality and safety controls for devices being used, and marketing and conflicts of interest. All of these should be addressed to reduce low-value care in Australia's private health system, so consumers are protected from harm and limited health budgets are used effectively. What is known about the topic? With health expenditure rising unsustainably, there is a growing focus on ways to reduce low-value care to improve health outcomes and eliminate unnecessary costs. What does this paper add? This paper details drivers of low-value care in Australia's private health system and recommendations to overcome them. Drivers include the Prescribed List of Medical Devices, gaps in safety and quality controls, and conflicts of interest and marketing. What are the implications for practitioners? These insights are relevant to clinicians, researchers, policymakers, consumers and health business leaders with an interest in low-value care. This article belongs to the Special Issue: Value-based Healthcare. [ABSTRACT FROM AUTHOR]

Vaporised hydrogen peroxide sterilization (VH2O2) can be used to sterilize medical devices. Sterilization processes can be monitored using physical, biological and chemical indicators (CIs). An acceptable Sterility Assurance Level is achieved by exposure to specified parameters of each process variable eg 134oC for 3min in steam sterilization. Alternatively, a prescribed dose, an integration of intensity of sterilizing agent and time, is applied; an approach used in radiation sterilization. In steam sterilization Fo is also used to express an equivalent heating time at 121.1oC. Fo is a measure of the “dose” applied, temperature being an expression of “intensity” of the sterilizing agent, moist heat. In VH2O2 sterilization the area beneath the H2O2 concentration curve is integrated and expressed as a dose with dimensions mg∙s/L, concentration representing the “intensity” of the microbicidal agent. [ABSTRACT FROM AUTHOR]

The recent clearance by the United States Food and Drug Administration of Tidepool Loop sets an important precedent within the medical device landscape. For the first time, an automated insulin delivery mobile application—based on an algorithm initially designed and developed by users —has been recognised as safe and effective by a regulatory body. The aim of this paper is twofold: firstly, we map out the regulatory pathways and processes that were navigated by Tidepool, the non‐profit behind Tidepool Loop, in order to make this landmark moment possible. Secondly, we set out potential approvals processes in the European Union and United Kingdom with a view to examining the challenges to obtaining regulatory clearance for Tidepool Loop in these jurisdictions. In so doing, we highlight the significant differences, not only between the United States and European systems but also between the European Union and Great Britain systems. We conclude by arguing that the complexity encountered when seeking to introduce an innovative solution in different regulatory systems has the potential to act as a disincentive to open source developers from seeking regulatory approvals for such technologies in the future. [ABSTRACT FROM AUTHOR]

Background: In today's society, a growing body of literature attests to the importance of young children's early digital literacy skills in their home environments and how acquisition of these digital literacy skills relates to their future learning and digital literacy. Objectives: Research on young children's digital literacy practices at home was reviewed to explore the positive and negative influences on early learning. This is important due to the children's rapid uptake of online digital technologies over the past decade. Methods: Peer‐reviewed research articles on home digital literacy practices of children (aged 0–8 years old) published between 2010 and 2021 from four education databases were carefully selected based upon pre‐determined criteria and examined using content analysis. Results and Conclusion: A high proportion of studies (29 of the 31; 93.5%) demonstrated significant benefits of young children gaining a range of skills, including digital operational, early literacy and language, socio‐emotional, and STEM, through the use of digital technologies at home. Five of the 31 (16.12%) studies reported negative effects of digital technologies in the home context, including distraction, aggressive behaviour, and false self‐confidence. Tablets and smartphone use gained greater momentum in the home context, especially between 2015 and 2021, and there was a positive shift in parental mediation, family involvement, and the children's home digital literacy practices. Implications: By leveraging children's acquisition of digital literacy skills in the home and taking into account the sociocultural context, we can enhance young children's preparation for the future and provide opportunities for skill development across various learning domains. Lay Description: What is already known about this topic: The literature shows use of tablets in the home by children have gained momentum.Parents have different attitudes towards using digital technologies in the home context.Parents have used different mediation strategies to control, supervise and support their children's home digital literacy practices. What this paper adds: Within the past decade, parents have extended their mediation strategies to support their children's home digital literacy practices.Young children move from early digital literacy to proficient digital literacy within the home.Home digital literacy practices can foster important skills in young children such as language and literacy, operational, socio‐emotional, and STEM.Artificial intelligence devices such as smart robots are extending children's home digital literacy practices. Implications for practice and/or policy: Understanding the sociocultural differences of young children can help parents, teachers, and policymakers to facilitate digital literacy skill acquisition.Fostering young children's basic language literacy, operational, socio‐emotional, and STEM skills through technology use in the home before formal education is essential.Extending young children's home digital literacy practices to other contexts such as the classroom is necessary. [ABSTRACT FROM AUTHOR]

Activity reporting of Pastoral Care Coordinators (PCCs) is often inadequate within care settings because of suboptimal analog data collection methods. This study aims to render pastoral care activity reporting more efficient through digitizing data collection in pastoral care settings. A one-year feasibility (pilot) study of a digital tool, the "Pastoral Care Activity Tracker" (PCAT) was conducted between June 1, 2020 and May 31, 2021 at HammondCare, an Australian nonprofit healthcare organization. Feasibility was measured using electronic activity logs collected by the tool and user feedback surveys by PCCs. Of the 43 PCCs working in the organization, 42 (97.7%) used the PCAT tool to complete the logging of 66,298 pastoral care activities (M [SD] = 1,578.5 [827.8] activities per PCC). Most activities were logged successfully (98.3%) and took less than one minute (89.5%). Survey responses (n = 20, 46.6%) indicated many PCCs found the PCAT more convenient (n = 15, 75.0%) and easier to use (n = 10, 50.0%) than paper-based method. PCCs found the PCAT to be feasible, favorable, and easier to use for report generation compared to paper-based methods. The feasibility of the PCAT improved pastoral care activity data capture, as perceived by PCCs. [ABSTRACT FROM AUTHOR]

Every year, the Food and Drug Administration (FDA) clears approximately 3,000 medical devices for marketing via the 510(k) pathway. These constitute 99% of all devices approved for human use and includes the premarket review of many devices incorporating newer technology such as artificial intelligence (AI), machine learning (ML), and other software. As the complexity of these novel technologies and the number of applications is expected to increase in the coming years, statutory changes such as the 2016 21st Century Cures Act, regulations, and guidance documents have increased both the volume and complexity of device review. Thus, the ability to streamline the review of less complex, low-to-moderate risk devices through the 510(k) pathway will maximize the FDA's capability to address other important, future-oriented regulatory questions. For over twenty five years, third party review organizations have served a defined function to assist with the review of 510(k) applications for a set of enumerated device classes. This paper reviews the history of FDA device regulation, the evolution of the 510(k) review pathway, and the recent history of the 510(k) third party review program. Finally, the paper addresses policy concerns from all stakeholders – including the FDA – along with policy suggestions to improve the third party review program and FDA device regulation writ large. [ABSTRACT FROM AUTHOR]

Aims: We aimed to develop and test the psychometric properties of a Medical Device‐related Pressure Injuries Knowledge and Practice Assessment Tool. Background: Assessment of nurses' knowledge and practices is critical in the prevention of Medical Device‐related Pressure Injuries. Design: This was an instrument development and testing study. Methods: The sample of the study consisted of nurses (n = 189). The study was conducted in three phases between January and February 2021. In the first phase, multiple‐choice items contained within Aetiology/Risk Factors, Prevention Interventions, and Staging domains were created. In the second phase, content validity and criterion validity were evaluated, and the tool was pre‐tested. The third phase examined item difficulty, discrimination index and distractor quality. The test–retest method was used for reliability. Results: The Content Validity Index was found to be 0.75, 0.86 and 0.96 for the domains of Aetiology/Risk Factors, Prevention and Staging, respectively. The item difficulty values of the items were between 0.18 and 0.96. A positive, strong and significant relationship was found between the results and a positive, moderate and significant relationship between the tools administered for the proof of scale validity. The Cronbach's alpha reliability coefficient was found to be 0.54. Conclusions: The tool is a suitable measurement instrument for use in nursing education, research and clinical settings. Summary statement: What is already known about this topic? Medical Device‐related Pressure Injuries (MDRPIs) are a common and preventable issue in healthcare settings.Nurses' knowledge and practices are important in the prevention and management of MDRPIs.It is crucial to measure nurses' knowledge levels and practices on MDRPIs by using valid and reliable measurement tools. What this paper adds? The study developed and psychometrically tested a Medical Device‐related Pressure Injuries Knowledge and Practice Assessment Tool.The Medical Device‐related Pressure Injuries Knowledge and Practice Assessment Tool (MDPI‐ASSET) was shown to be a valid and reliable tool that can be used to evaluate knowledge and practices. The implications of this paper: The tool developed in this study can be adapted to different languages.The tool can be used in nursing practice, education and research to identify knowledge and practice gaps and focus areas on optimizing strategies to improve care quality. [ABSTRACT FROM AUTHOR]

This paper aims to highlight how to reduce medication errors through the implementation of human factors science to the design features of medication containers. Despite efforts to employ automation for increased safety and decreased workload, medication administration in hospital wards is still heavily dependent on human operators (pharmacists, nurses, physicians, etc.). Improving this multi-step process requires its being studied and designed as an interface in a complex socio-technical system. Human factors engineering, also known as ergonomics, involves designing socio-technical systems to improve overall system performance, and reduces the risk of system, and in particular, operator, failures. The incorporation of human factors principles into the design of the work environment and tools that are in use during medication administration could improve this process. During periods of high workload, the cognitive effort necessary to work through a very demanding process may overwhelm even expert operators. In such conditions, the entire system should facilitate the human operator's high level of performance. Regarding medications, clinicians should be provided with as many perceptual cues as possible to facilitate medication identification. Neglecting the shape of the container as one of the features that differentiates between classes of medications is a lost opportunity to use a helpful characteristic, and medication administration failures that happen in the absence of such intentional design arise from "designer error" rather than "user error". Guidelines that define a container's shape for each class of medication would compel pharmaceutical manufacturers to be compatible and would eliminate the confusion that arises when a hospital changes the supplier of a given medication. [ABSTRACT FROM AUTHOR]

As mechanical efficiency has great relevance in the alternative engine performance, the authors research in the development of testing facilities to characterize the sources of engine mechanical losses. The present paper deals with the realization of a hardware platform to conduct experimental studies in small combustion engines to experimentally characterize the mechanical losses of a singlecylinder internal combustion engine by means of the indicated diagram and motoring methods. The system was completed by means of an electrical motor-generator coupled to a single-cylinder air-cooled spark ignition engine, a self-developed electronic hardware control, and a PC-based instrumentation and data acquisition system. Specifications of load-motoring-starting system, including the description of the proprietary electronic load regulation system, are detailed. Also, the instrumentation system of in-cylinder and intake pressures; Temperatures of intake air, exhaust gases, lubricant oil, and engine block; effective torque and crankshaft position are described, including the signal acquisition system. The methodologies for indicated diagram and motoring method are described, mentioning the required measurements to apply each method and the engine load-temperature considerations when an engine is tested in fired or motored conditions. The platform was used to study the mechanical losses of the engine under motored and fired conditions under a wide range of rotational speeds and throttle openings, allowing to draw conclusions about the operating features of the developed test bench in itself, and also about the mechanical losses of the engine tested. Initially, samples of cylinder pressure, torque, intake pressure as function of crank angle and indicate diagram were obtained, showing similar waveforms present in related literature. Then, variations of the aforementioned temperatures against rotation speed and throttle opening and results for the mechanical losses determined by indicated diagram and motoring methods are shown. Finally, two empirical correlations are proposed to estimate the mechanical losses. In the future the hardware platform will be utilized to investigate in-cylinder engine parameters, detailed thermal and mechanical engine performance. [ABSTRACT FROM AUTHOR]

The manual user-operated Arise Standing Wheelchair (SWC) is the end-result of multiple design iterations based on comments from user trials. The Arise SWC provides standing functionality, outdoor mobility, affordability, and customizability. This paper describes a user experience study of the Arise SWC's pre-commercial version. Thirty participants (N = 30, 25 Male, 5 Female) were recruited for the study. All the participants were people with spinal cord injury. The study was conducted over a period of six weeks (five participants per week) within the hospital premises under the supervision of clinical personnel. A 30 min interactive training session involved thirteen activities. During the trial period, the participants were trained to perform twenty-two activities to familiarize themselves with the SWC. The participants were also trained to perform four functional usage activities with the SWC. At the end of the study, participant responses to ten outcome measures were captured using a smiley-based Likert-scale questionnaire. A majority of the participants (93.3%) felt happy when they stood in the SWC. The majority participants (83.3%) preferred the Arise SWC over their current wheelchair. Also, 80% participants anticipated that they could get more work done at home using the standing function of the wheelchair. A one-time fitting and training ensured optimal effort for the SWC operation, correct posture, and comfortable user experience. With proper dissemination and awareness, it is believed that the Arise SWC will benefit eligible users and improve their quality of life. The Arise wheelchair provides standing functionality, outdoor mobility, affordability, and customizability. Study confirms that incorporating standing functionality can improve the quality of life for wheelchair users. The majority of users were happy, felt safe and expected to do more with the standing functionality. Study results support further testing in real world conditions beyond the hospital setting. [ABSTRACT FROM AUTHOR]

Deficits in social verbal communication in individuals with Social Communication Disorder (SCD) is of concern and SCD in the human community is prevalent in large population throughout the globe. Deficits in verbal social communication are prevalent in a large population. This paper aimed to propose internet connected multi-system architecture which is capable to support verbal communication in a social environment for individuals with social communication deficits. Implementation methodology was included with corpus collection for specific communication, deep learning based machine training for intelligent communication, and implementation of the trained algorithm on internet connected electronic multiple social communication devices. The implemented system is smart enough to initiate and maintain two types of communication; the first type includes communication between multiple individuals on the remote location and the second type includes communication with the individual present in the physical listening range. The system was investigated in terms of its algorithmic parameters and found 97% to 100% in terms of training and testing accuracy with negligible mean squared error. Vocal-Friend analysed results based on audio-bot simulative conditions provide more than 91% accuracy, interaction rate and fallback rate. On the basis of the satisfaction analysis, above average results were noticed. In terms of technical implementations and satisfaction analysis, results found acceptable with above average score. Proposed framework is easy to use by caregivers with even having little knowledge. Support individual with deficit to learn social verbal communication skill to survive in society. Aiding parents, caregivers and professionals to understand the communication needs of individuals with communication deficits. Since technology is also grooming in the domain of rehabilitation, so this system could be used in various future applications such as social robots, social virtual assistants etc. [ABSTRACT FROM AUTHOR]

Background: Current evidence shows that medical device‐related pressure injury (MDRPI) has a high prevalence (10%) and incidence (12%), and much research has been done to prevent MDRPI in recent years. However, to our knowledge, there is limited systematic review available on interventions and strategies to prevent MDRPI. Aim: To synthesise research evidence on interventions and strategies used to prevent MDRPI. Methods: This systematic review adhered to the PRISMA Guidelines. We searched six databases including Medline, CINAHL, EMBASE, Cochrane library, Web of Science and ProQuest with no restriction to year of publication. Data were extracted and checked by two authors independently. A narrative summary technique was used to describe the findings. Implementation strategies were grouped into six classifications: dissemination/implementation process/integration/capacity building/sustainability/scale‐up strategies. Results: Twenty‐four peer‐reviewed papers met the inclusion criteria, which comprised of 11 quality improvement projects and 13 original research. Types of devices included respiratory devices (non‐invasive ventilation mask, CPAP/BiPAP mask, endotracheal tube), gastrointestinal/urinary devices and other devices. Interventions used included the use of dressing, hyperoxygenated fatty acids, full‐face mask, training, and/or multidisciplinary education, use of special securement devices or tube holder, repositioning, application of stockinette, early removal and foam ring use. Common implementation strategies included ongoing staff education, audit and standardising documentation or guideline development. Conclusion: Much work on MDRPI prevention strategies has been undertaken. There were a variety of devices reported, however, it is evident that higher quality research is needed. Relevance to clinical practice: Current evidence shows that interventions including use of dressing or special securement device, repositioning, and training/multidisciplinary education can be beneficial for MDRPI prevention. High‐quality research, such as randomised controlled trials are needed to test the effectiveness of the interventions and their implementation strategies. No patient or public contribution. [ABSTRACT FROM AUTHOR]

Objectives: The World Health Organization has adopted two main strategies to improve the quality of maternal health: increasing the number of deliveries by skilled birth attendants and increasing access to emergency obstetric care. Despite increased access to care, there continue to be high rates of maternal morbidity and mortality in part due to quality of care. This study aims to identify and summarize existing frameworks for measuring quality of maternal care at a facility-level. Methods: PubMed, Health Systems Evidence, Embase, Global Health, OVID Healthstar, OVID Medline, PsycINFO, and Web of Science were searched for frameworks, tools, theories, or components of frameworks relevant to maternal quality of care in facility-level settings. Title/abstract and full-text screening were completed by two independent reviewers and conflicts resolved through consensus or a third reviewer. Results: An initial search resulted in 3182 studies. Fifty-four studies were included in the qualitative analysis. A best fit framework analysis was done using the updated Hulton framework as the conceptual framework. A facility-based maternal quality of care framework is proposed including the following components, separated into provision and experience of care: (1) human resources; (2) infrastructure; (3) equipment, supplies and medicine; (4) evidence and information; (5) referral and networks of care; (6) cultural competence; (7) clinical practice; (8) financing; (9) leadership and governance; (10) cognition; and 11) respect, dignity, equity, and emotional support. Significance: Despite increased institutional access to care, there continue to be high rates of maternal morbidity and mortality in some low- and middle-income countries. This is in part due to the quality of maternal care once care has been accessed. Several frameworks have been proposed for understanding the complexities surrounding quality of care in maternal health but there has not been a single framework consistently used in the literature for facility-based quality of maternal care. This paper identifies and summarizes existing frameworks and tools, and uses a best fit framework analysis to propose a comprehensive framework for assessing facility-based maternal quality of care. [ABSTRACT FROM AUTHOR]

With advances in technology, there are an increasing number of direct-reading instruments available to occupational health and safety professionals to evaluate occupational aerosol exposures. Despite the wide array of direct-reading instruments available to professionals, the adoption of direct-reading technology to monitor workplace exposures has been limited, partly due to a lack of knowledge on how the instruments operate, how to select an appropriate instrument, and challenges in data analysis techniques. This paper presents a review of direct-reading aerosol instruments available to occupational health and safety professionals, describes the principles of operation, guides instrument selection based on the workplace and exposure, and discusses data analysis techniques to overcome these barriers to adoption. This paper does not cover all direct-reading instruments for aerosols but only those that an occupational health and safety professional could use in a workplace to evaluate exposures. Therefore, this paper focuses on instruments that have the most potential for workplace use due to their robustness, past workplace use, and price with regard to return on investment. The instruments covered in this paper include those that measure aerosol number concentration, mass concentration, and aerosol size distributions. [ABSTRACT FROM AUTHOR]

District nursing services are relentless in adapting to change and continuously seek different methods to improve the care they offer to service users. One of the relatively new changes where adaptation has been necessary is the use of digital devices to record assessments and work in real time. As documented in The NHS Long Term Plan (NHS) (2019), the NHS is being required to grow into the new digital age and, subsequently, district nurses (DNs) have needed to embrace the use of a paper-lite system. Although beneficial overall, the use of technology is a threat to the person-centred nursing approach used in assessment, which is the highest fundamental value in nursing. This article will seek to conceptualise the importance of a person-centred initial assessment with a service user who has either a long-term and/or a lifelong condition whilst considering the use of digital devices, benefits, and drawbacks of their use. It will emphasise the role of the DN, encompassing the multidisciplinary services throughout, whilst also considering any recommendations for further development. [ABSTRACT FROM AUTHOR]

As we review health governance during the COVID-19 pandemic, we have an opportunity to reflect on these processes and ensure that future challenges might be managed in a more collaborative and whole of system response. This 'Perspective' reviews COVID-19 responses in Australia, reflects on a number of potential solutions that have been developed by organisations over the past two decades and proffers a governance framework for a Communicable Disease and Pandemic Management Authority that might assist health responses to future challenges. What is known about the topic? Responses to the COVID-19 pandemic were at best disorganised with multiple failures at almost every level. Reflecting on these responses is essential if we are to perform better in future health and societal crises, which will inevitably occur. What does this paper add? This paper summarises a number of organisational 'structures' and discussion documents that have been developed over the past decades which might be useful starting points for development of a structure(s) that would leave Australia in a better position when the next 'wave' hits. What are the implications for practitioners? Good governance is fundamental to how we do business and the complexities of the health and welfare system(s) only compound these challenges. [ABSTRACT FROM AUTHOR]

Purpose. Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive surgical procedure that reduces patient trauma, infection probability, and rehabilitation time. This paper reviews the progress made in the control-actuation robotic systems for gastrointestinal NOTES development. Material and Methods. A survey on both existing and state-of-the-art control-actuation robotic systems for gastrointestinal NOTES was conducted in December 2021. Results. Nine control-actuation robotic systems for gastrointestinal NOTES were identified. The structures and specifications of these robotic systems were reported. The technical parameters were also discussed. Special attention was directed to systems using a control-actuation structure and tendon-driven mechanism. The control-actuation robotic systems typically deploy a control-actuation structure and tendon-driven mechanism. Control-actuation robotic systems for gastrointestinal NOTES show great ability to improve operational accuracy and flexibility and flatten the learning curve of procedures. These characteristics suggest that the use of control-actuation robotic systems is worth exploring in future development. [ABSTRACT FROM AUTHOR]

The purpose of the paper is to contribute to the knowledge in the field of marketing of medical devices in the public sector. The research problem is based on verifying the correlations between the elements of the 4P marketing mix, after-sales activities and their influence on the preparation of tender documentation in the marketing of medical devices to social welfare institutions. In the process of marketing products through public procurement, the same attention is devoted to the after-sales activities as marketing mix elements (4P). We created a marketing mix model for the marketing of medical devices through public procurement. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise some of the factors that can make it challenging for nurses to access training and maintain competence in using medical devices • To learn about development of an electronic medical device training passport that aims to better identify nurses' training needs • To understand the benefits of an electronic medical device training passport for nurses, nurse managers and clinical leaders Background: All nurses, particularly those working in critical care settings, are required to use medical devices when providing patient care. However, inconsistent practice and variations in documentation can make it challenging for nurses and nurse managers to identify what medical device training is required and when. Aim: To develop and evaluate the use of an electronic medical device training passport to identify the training needs of nurses in intensive care units (ICUs). Method: A pilot study was conducted in a multi-unit critical care department in London, England, to determine if the passport could make it easier to identify ICU nurses' medical device training needs compared with existing practice. Nine participants were first asked to identify their needs using existing spreadsheets or paper records, then asked to identify them using the passport. The participants were also interviewed to identify their training requirements before and after using the passport. The data were analysed quantitatively and qualitatively. Findings: The electronic passport significantly improved identification of medical device training needs compared with paperwork or spreadsheets for all device groups, except for medical devices used on high dependency units (P≤0.005). However, there may be issues related to nurses' behaviours and expectations, particularly that staff do not always recognise their need for training. Conclusion: The findings of this pilot study suggest that the use of an electronic medical device training passport has many benefits and could make it easier to identify ICU nurses' training needs in clinical practice. [ABSTRACT FROM AUTHOR]

This paper reports the design of a powered stapler for gastrointestinal anastomosis and evaluates its performance. The proposed stapling instrument is intended to simplify and optimize the current procedure of mechanical stapling, while providing controllable operation for the powered stapling procedure, such as conditioning the tissue to the right stage before firing of the stapler. The feasibility and efficacy of the prototype were assessed by ex vivo experiments with porcine small intestine segments, where the tissue conditioning operation, burst pressure of the stapled intestine samples, and staple malformation rate were examined. The functionality of the developed powered stapler was validated, where the theoretical, numerical, and experimental results agree well with each other. The preliminary results indicated that the proposed tissue conditioning operation could lower the clamping pressure with a maximum level of 1.35 g/mm2. The average burst pressure of the stapled segments (16 samples) is 6.37 kPa, and the maximum malformation rate of the tested groups (five groups, each group with 90 staplers) was 5.56%. The developed novel tissue conditioning procedure could reduce the pressure response of the intestine tissue samples. The proposed powered stapler proves effective for performing gastrointestinal anastomosis procedures. [ABSTRACT FROM AUTHOR]

Background: Preschool‐age children in hospitals are at a high risk of unexpected incidents. Safety incidents in hospitals can cause serious damage to the children. Objective: To determine the effectiveness of the mobile‐type mHealth Safe Kids Hospital (SKH) application (app) for the prevention of hospitalized child safety incidents. Design: This study used a three‐group, randomized controlled trial pre‐post design. Setting(s): This study was conducted in the pediatric ward of three general hospitals in Korea. Participants: A total of 124 eligible hospitalized children and their caregivers were enrolled in the study from June to December 2018. Of these, 116 finally participated in the study, and 8 were excluded because they were discharged before the intervention. Methods: Hospitalized preschool‐age children and their caregivers were randomly allocated into three groups: experimental group I (n = 39), experimental group II (n = 39), and the control group (n = 38). Experimental group I received the SKH app intervention, the experimental group II received a paper‐based intervention, whereas the control group received the usual intervention. Participants' outcomes of awareness, knowledge, and behavior related to hospital safety, were assessed at two time points: baseline and 24 h after the intervention. Results: Hospital safety awareness had a higher increase after intervention in experimental groups I and II than in the control group. Among the four subdomains of hospital safety awareness, there was a significant increase in the scores of experimental group I on three subdomains after the intervention: falls (F = 8.19, p < 0.001), burns (F = 6.73, p = 0.002), and medical devices (F = 6.81, p = 0.002). In hospital safety knowledge and safety behavior, experimental group I had the highest average score after the intervention compared with experimental group II and the control group; however, there was no statistically significant difference in the average score of the three groups. Conclusions: Using the SKH app is easy to attract the interest of preschool‐age children and is also easy for nurses to use in clinical trials; thus, it is considered to be a useful educational intervention to prevent safety incidents in clinical fields in future. Clinical Relevance: It is thought to contribute to the prevention of preschool‐age children's safety incidents in pediatric wards. [ABSTRACT FROM AUTHOR]

Intensive care units are considered life-saving medical services and a vital component of healthcare systems. These specialized hospital wards contain the life support machines and technical expertise to sustain seriously ill and injured bodies. However, as the COVID-19 pandemic has demonstrated, intensive care is an expensive, finite resource which is not necessarily available to all citizens, and which may be unjustly rationed. As a result, the intensive care unit may contribute more towards biopolitical narratives of investment in lifesaving than measurable improvements in population health. Drawing from ethnographic fieldwork and a decade of involvement in clinical research, this paper examines everyday activities of lifesaving in the intensive care unit and interrogates epistemological assumptions upon which they are organized. A closer look at how healthcare professionals, medical devices, patients, and families accept, refuse, and modify imposed boundaries of bodily finitude reveals how activities of lifesaving often lead to uncertainty and may even impose harm when they deny possibilities for desired death. Refiguring death as a personal ethical threshold, rather than inherently tragic ending, challenges the power of the logic of lifesaving and instead insists on greater attention towards improving conditions for living. • A logic of lifesaving permeates the clinical activity of the intensive care unit. • Underlying this logic are legal, material/technical, and cultural aspects. • These aspects combine to deny death even in contexts when it is desired. • Reimagining death as subjective ethical limit challenges the logic of lifesaving. [ABSTRACT FROM AUTHOR]

Vaccination against pertussis in pregnancy is the main strategy to prevent the disease in the first trimester of life of new-borns. Effective communication is essential to successfully engage pregnant women. The use of digital devices within the outpatient setting may be helpful to engage patients before and during the consultation. The aim of this study was to develop and test an e-health tool to assess vaccine hesitancy and to deliver tailored information and education interventions to raise awareness and promote vaccine acceptance. Methods: One-hundred-and-five participants were recruited in 4 ob-gyn clinics. Participants were invited to complete a self-administered psychometric questionnaire to assess vaccine hesitancy, disease beliefs and self-efficacy perception on health behaviours on a tablet. Participants were randomly allocated to three communication-format types providing equivalent content: 1)a single video simulating a patient-doctor conversation on the topic; 2)an interactive platform with five infographics videos; 3)a paper leaflet followed by a brief consultation with the physician. The intention to get vaccinated during pregnancy was assessed through a specific question before and after the intervention. Results: In the pre-intervention phase there was no difference observed between groups in terms of the variable "intention" to get vaccinated. After the intervention, participants of groups 1 and 3 showed a higher intention to get vaccinated than group 2 at the Kruskal-Wallis test (H(2)=6.008, p < 0.05). Post-intervention intention to vaccinate correlated with Individual SelfEfficacy (rs(105)=0.30, p < 0.001) and was inversely associated with vaccine hesitancy (rs(105)=0.34, p < 0.001). Conclusions: We implemented and assessed the impact of different communication strategies to promote vaccine uptake among pregnant women. Our results suggest comparable effect may be obtained using simulated versus live patient-physician communication. Key messages: The use of digital devices allows an effective and manageable communication about vaccination to pregnant women. In the present study, the implementation of digital forms of communication allowed a comparison with standard procedures of information towards vaccination, demonstrating their equivalence. [ABSTRACT FROM AUTHOR]