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This article addresses the issue of patient sleep during hospitalization, which the Society of Anesthesia and Sleep Medicine believes merits wider consideration by health authorities than it has received to date. Adequate sleep is fundamental to health and well-being, and insufficiencies in its duration, quality, or timing have adverse effects that are acutely evident. These include cardiovascular dysfunction, impaired ventilatory function, cognitive impairment, increased pain perception, psychomotor disturbance (including increased fall risk), psychological disturbance (including anxiety and depression), metabolic dysfunction (including increased insulin resistance and catabolic propensity), and immune dysfunction and proinflammatory effects (increasing infection risk and pain generation). All these changes negatively impact health status and are counterproductive to recovery from illness and operation. Hospitalization challenges sleep in a variety of ways. These challenges include environmental factors such as noise, bright light, and overnight awakenings for observations, interventions, and transfers; physiological factors such as pain, dyspnea, bowel or urinary dysfunction, or discomfort from therapeutic devices; psychological factors such as stress and anxiety; care-related factors including medications or medication withdrawal; and preexisting sleep disorders that may not be recognized or adequately managed. Many of these challenges appear readily addressable. The key to doing so is to give sleep greater priority, with attention directed at ensuring that patients' sleep needs are recognized and met, both within the hospital and beyond. Requirements include staff education, creation of protocols to enhance the prospect of sleep needs being addressed, and improvement in hospital design to mitigate environmental disturbances. Hospitals and health care providers have a duty to provide, to the greatest extent possible, appropriate preconditions for healing. Accumulating evidence suggests that these preconditions include adequate patient sleep duration and quality. The Society of Anesthesia and Sleep Medicine calls for systematic changes in the approach of hospital leadership and staff to this issue. Measures required include incorporation of optimization of patient sleep into the objectives of perioperative and general patient care guidelines. These steps should be complemented by further research into the impact of hospitalization on sleep, the effects of poor sleep on health outcomes after hospitalization, and assessment of interventions to improve it., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 International Anesthesia Research Society.)

Aim: This paper highlights the difficulties and lacunae in the Mental Health Care Act 2017 that hinder its implementation and use for the care and treatment of persons with mental illness in India. Methods: An online nationwide survey, involving structured questions as well as open-ended questions, to elicit the level of implementation, experience in complying with the provisions of the Act, and level of satisfaction, of practicing psychiatrists was carried out. Responses were analyzed using appropriate statistics. Results: 600 respondents answered the online questionnaire. A majority of psychiatrists were senior practitioners with over 10 years of experience. 92.5% respondents were dissatisfied with the MHCA, wherein 73.3% wanted it amended, and 19.2% asked for repeal. Procedural issues were deterrent for 66.5% from taking medically necessary or helpful decisions for patients. Non-implementation of the Act was a major finding. Major dissatisfaction was expressed regarding judicial over reach in admission and discharge procedures, inclusion of general hospital psychiatry units in the definition of mental health establishment, non-applicability of provisions like advance directive and nominated representative in Indian setting, and that all treatment should be covered under insurance. Conclusion: The Act in its present form defies the spirit of its own objectives and is unimplementable. It needs major revisions. [ABSTRACT FROM AUTHOR]

Background: Electronic formats of patient-reported outcome (PRO) measures are now routinely used in clinical research studies. When changing from a validated paper and pen to electronic administration it is necessary to establish their equivalence. This study reports on the value of Rasch analysis in this process., Methods: Three groups of US pulmonary hypertension (PH) patients participated. The first completed an electronic version of the CAMPHOR Activity Limitation scale (e-sample) and this was compared with two pen and paper administrated samples (pp1 and pp2). The three databases were combined and analysed for fit to the Rasch model. Equivalence was evaluated by differential item functioning (DIF) analyses., Results: The three datasets were matched randomly in terms of sample size (n = 147). Mean age (years) and percentage of male respondents were as follows: e-sample (51.7, 16.0 %); pp1 (50.0, 14.0 %); pp2 (55.5, 40.4 %). The combined dataset achieved fit to the Rasch model. Two items showed evidence of borderline DIF. Further analyses showed the inclusion of these items had little impact on Rasch estimates indicating the DIF identified was unimportant., Conclusions: Differences between the performance of the electronic and pen and paper administrations of the CAMPHOR Activity Limitation scale were minor. The results were successful in showing how the Rasch model can be used to determine the equivalence of alternative formats of PRO measures.

A major problem in doing linguistic research from tape-recorded material is finding specific tape content for later, detailed analysis of data. A project on use of language in medicine being carried out at the Cornell University Medical College has developed a method of cataloguing taped material that eliminates the need for transcriptions and permits rapid locating of a specific tape segment. The project studies taped conversations between doctors and patients to observe how speakers hear and understand each other in natural conversation and to use findings to teach medical students the uses and functions of language in medicine. Contents of tapes are organized into eight categories: address, or time of utterance; speaker; main conversational division; specific speech act; lexical content; miscellaneous linguistic and non-linguistic information; attitude displayed by the speaker, and the conceptual category - an abstract interpretation of the subject discussed. Categories are explained here with examples, and an appendix furnishes a transcript of recorded conversation and its corresponding cataloguing sample. (CHK)

Retrieval-based Clinical Decision Support (ReCDS) can aid clinical workflow by providing relevant literature and similar patients for a given patient. However, the development of ReCDS systems has been severely obstructed by the lack of diverse patient collections and publicly available large-scale patient-level annotation datasets. In this paper, we collect a novel dataset of patient summaries and relations called PMC-Patients to benchmark two ReCDS tasks: Patient-to-Article Retrieval (ReCDS-PAR) and Patient-to-Patient Retrieval (ReCDS-PPR). Specifically, we extract patient summaries from PubMed Central articles using simple heuristics and utilize the PubMed citation graph to define patient-article relevance and patient-patient similarity. PMC-Patients contains 167k patient summaries with 3.1 M patient-article relevance annotations and 293k patient-patient similarity annotations, which is the largest-scale resource for ReCDS and also one of the largest patient collections. Human evaluation and analysis show that PMC-Patients is a diverse dataset with high-quality annotations. We also implement and evaluate several ReCDS systems on the PMC-Patients benchmarks to show its challenges and conduct several case studies to show the clinical utility of PMC-Patients., (© 2023. The Author(s).)

The U.S. healthcare system struggles to provide adequate language assistance to medical practitioners and patients. As a result, health providers and patients rely on ad hoc interpreters, including children, to communicate. Bilingual children who regularly interpret for others, whom we refer to as child language brokers, are important linguistic and cultural conduits for their communities and bridge language differences in vital contexts, such as health and medical settings. In this paper, we explore the experiences of 17 adolescent language brokers and consider the settings, tasks, and people they engage with when language brokering for health. Findings illustrate that child language brokering is a real and important component for immigrant family health, that child language brokering for health is not a uniform experience, and that language brokering for health can sometimes have severe ramifications.

The transition period from the hospital to the outpatient setting is a critical phase when managing heart failure. A well-structured transition is paramount and helps to ensure a tight follow-up schedule for the heart failure patient, thereby improving treatment outcomes. This article aims to provide guidance for the first three follow-up visits after hospital discharge, with a focus on monitoring heart failure patients and up-titrating their medication in primary care.

In caring professions, such as childcare and healthcare, empathy and narrative underpin important aspects of the emotional work of early childhood educators and nurses (Rogers, Jefferies & Ng, 2022). Unfortunately, they are not given much attention in scholarly articles, but it is important for practitioners to understand them (Barton & Garvis, 2019). This cross-disciplinary paper discusses the virtue of empathy from a philosophical stance, and its relationship to narrative when building shared understandings. There is a sense in which empathy and narrative are interdependent: storytelling helps to cultivate empathy in others, and empathy can be essential if we are to elicit and understand the stories that others have to tell. In fact, when it comes to eliciting and understanding the kinds of stories that are of particular interest for this paper (i.e., the personal stories to be told by young children participating in a research project, and those of patients in a healthcare setting), empathy tends to be especially important. As we argue, these examples drawn from early childhood education and care and healthcare serve to illustrate certain ways in which empathy, storytelling, and the development of shared understandings can be of deep significance; not only for researchers, educators and healthcare professionals, but also for senior administrative and public policy officials.

Developing transition planning for youth living with severe and persistent mental illness requires the creation, memorialization, and retrieval of appropriate and responsive treatment preferences to meet their needs, especially during a mental health crisis. Regrettably, transition-aged youth at the age of 18 can no longer rely on their support persons (typically family caregivers) to consent to care during a mental health crisis. Due to this, caregivers expressed challenges conveying information about their loved one's preferences for care (Lavoie, 2018) during a crisis. This lack of access to patient information exchange during a mental health crisis can effect treatment decisions. Caregivers report a range of negative outcomes including traumatic events resulting in distrust of the health care system (Lester et al., 2005). While misinformation is typically thought of as the deliberate falsification of information, we explore misinformation as both omission and lack of access to patient information, in this case health information. But what happens when a caregiver is distrustful of the health care system? What influence does distrust have on disclosure of health information? The purpose of this paper is to understand how caregivers trust of the healthcare system effects their decision regarding the sharing of health information on behalf of a person experiencing a mental health crisis. Using a mixed methods approach, this paper provides the results of Texas wide online survey regarding disclosure of healthcare information during a mental health crisis. This study expands the understanding of misinformation and the consequence of when information is withheld from individuals and healthcare systems, that can result in clinical decisions based on misinformation. The data provides preliminary evidence to suggest that the role of distrust of the medical system plays a part of the decision to not disclose health information. Open ended responses also suggest a relationship of how lack of information can lead to misinformed decisions. Practical recommendations call for applications in which capacitated persons living with serious mental illness and their caregivers collaborate on the sharing and memorialization using a psychiatric advance directive (PAD). A psychiatric advance directive (PAD) is not only a communication tool it is a medical-legal document that promotes patients' autonomy giving capacitated adults living with serious mental illnesses the ability to record their preferences for care during a mental health crisis (Table et al., 2020).

Contemporary design education seeks to prepare students for the workplace through studiobased learning that replicates real world practice. Design problems in the workplace have become increasingly complex and one example of this is within the area of design for healthcare, which requires multidisciplinary collaboration between various stakeholders to build knowledge in order to create new products, services systems and spaces. The complexity of these roles creates challenges for design educators in preparing students for the workplace. This paper presents a hybrid approach to address this challenge by presenting a real-world approach to design education. This entails a bottom-up approach to facilitate design research in a clinical setting to gather rich insights and needs of the clinical setting along with a top-down industry collaboration with sponsored briefs to guide students through the requirements of developing solutions in a heavily regulated field. The paper outlines examples of this process and how it was achieved in a blended model that was predominantly online in response to the changed environment caused by the COVID-19 pandemic. The advantages of this model are threefold, students gain deep knowledge and skills through collaborating with a variety of stakeholders within health care, they gain the opportunity to validate their designs through testing and feedback with these partners and lastly students develop the connections to create opportunities for further partnerships and employment.

Aim: To address the need for additional education in the management of mental illness in the critical care setting by providing a broad overview of the interrelationship between critical illness and mental illness. The paper also offers practical advice to support critical care staff in managing patients with mental illness in critical care by discussing two hypothetical case scenarios involving aggressive and disorganised behaviour. People living with mental illness are over‐represented among critically unwell patients and experience worse outcomes, contributing to a life expectancy up to 30 years shorter than their peers. Strategic documents call for these inequitable outcomes to be addressed. Staff working in intensive care units (ICUs) possess advanced knowledge and specialist skills in managing critical illness but have reported limited confidence in managing patients with comorbid mental illness. Design & Methods: A discursive paper, drawing on clinical experience and research of the authors and current literature. Results: Like all people, patients with mental illnesses draw on their cognitive, behavioural, social and spiritual resources to cope with their experiences during critical illness. However, they may have fewer resources available due to co‐morbid mental illness, a history of trauma and social disadvantage. By identifying and sensitively addressing patients' underlying needs in a trauma‐informed way, demonstrating respect and maximising patient autonomy, staff can reduce distress and disruptive behaviours and promote recovery. Caring for patients who are distressed and/or display challenging behaviours can evoke strong and unpleasant emotional responses. Self‐care is fundamental to maintaining a compassionate approach and effective clinical judgement. Staff should be enabled to accept and acknowledge emotional responses and access support—informally with peers and/or through formal mechanisms as needed. Organisational leadership and endorsement of the principles of equitable care are critical to creation of the environment needed to improve outcomes for staff and patients. Relevance to clinical practice: ICU nurses hold an important role in the care of patients with critical illnesses and are ideally placed to empower, advocate for and comfort those patients also living with mental illness. To perform these tasks optimally and sustainably, health services have a responsibility to provide nursing staff with adequate education and training in the management of mental illnesses, and sufficient formal and informal support to maintain their own well‐being while providing this care. Patient and public involvement: This paper is grounded in accounts of patients with mental illness and clinicians providing care to patients with mental illness in critical care settings but there was no direct patient or public contribution. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to investigate the practical aspects of training for parents and teachers of chronically ill children who are under long-term treatment in medical institutions. The paper identifies knowledge, attitudes and practices associated with both formal and non-formal education programs for teachers and parents of children undergoing long-term in-patient treatment. Innovative practices used in Moscow City University are presented, including educational techniques, methods and formats for training teachers and parents of children undergoing long-term treatment together with the results of parent surveys and interviews. The paper describes the benefits of a specially designed program of parent professional retraining to provide tutor support for children with long-term illnesses. Integrating the best informal training practices and formal training modules, this program allows for successful tutoring for children with long-term illnesses.

Background: Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. Method: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. Results: Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts' opinion. Conclusions: The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient. [ABSTRACT FROM AUTHOR]

Intensive Care Units (ICU) are units where vital support with advanced technology is given to critically ill patients and multidisciplinary approaches are frequently applied. As we all see during the pandemic, the ICU beds are limited in number; therefore, appropriate use of ICU beds is very important to give the necessary treatment to patients on time while allocating the resources rationally and efficiently. Practices to be implemented for this purpose may cause conflicts between the patients, relatives of the patients, the society and the healthcare team. It is crucial to prevent these conflicts and to ensure that they are resolved properly when they arise. This policy paper prepared by Turkish Society of Clinical Microbiology and Infection (Klimik), Turkish Society of Intensive Care and Turkish Bioethics Association brings suggestions to physicians and healthcare administrators regarding the rational use of intensive care units. We presume that it will be effective as supported by the professional organizations and medical associations operating in our country. [ABSTRACT FROM AUTHOR]

Many research institutions and funders have recently stated their commitment to actively support and promote 'Equality, Diversity and Inclusion' (EDI) in various aspects of health research including Patient and Public Involvement (PPI). However, translating this commitment into specific research projects presents significant challenges that existing approaches, practical guidelines and initiatives have not adequately addressed. In this paper, we explore how the lack of clear justifications for the EDI commitment in existing guidelines inadvertently complicates the work of those involved with PPI and we stress the need for conceptual clarity for any EDI effort to yield meaningful results. Our focus centres on the first principle of the EDI discourse, 'equality', particularly in the form of 'equality of opportunity' as outlined in current guidance provided by the National Institute of Health Research in the United Kingdom. We examine challenges related to justifying and implementing a general, unspecified commitment to equality of opportunity and explain that this reflects a lack of consensus regarding the moral value of PPI in research -- a profound problem that remains unaddressed. We then discuss how the presence of several opposing moral perspectives on PPI, makes determining the most appropriate way of addressing barriers to involvement complex and controversial, raising ethical implications for the work of health researchers, PPI specialists and coordinators. Finally we make suggestions on how future research can enrich the concept of 'equality of opportunity' in PPI and improve practice. While our primary focus is on the NIHR, a strong advocate of PPI in research, this analysis will point to normative and ethical considerations that may be relevant to other research institutions and funding organisations aiming to promote equality of opportunity in their public and patient involvement strategies.

Background: Temporomandibular disorders (TMD) are common and therefore managed by dentists on a daily basis. However, patients with TMD consistently go undetected and therefore untreated in dentistry. The reasons for these shortcomings have not been fully explored, specifically with regard to patients' perspectives. Therefore, this study aimed to explore patients' experiences of TMD and related treatment, with special focus on the experiences of having TMD, factors related to seeking care, and perspectives on received treatment., Methods: Purposive sampling was used to recruit adult patients at the Public Dental Health services (PDHS) in the Region of Västerbotten, Sweden, during 2019. Individual semi-structured interviews were conducted and analysed using Qualitative Content Analysis. Sixteen patients were interviewed (ten women and six men, 20-65 years). The interviews probed the patients' perspectives of having TMD, seeking care, and receiving treatment. All participants were also examined according to the Diagnostic Criteria for TMD (DC/TMD) and qualified for at least one DC/TMD diagnosis., Results: The data analysis led to the main theme Seeking care when the situation becomes untenable, but dental care fails to meet all needs. The patients expressed worry and social discomfort because of the symptoms but still strived to have an as normal daily life as possible. However, severe symptoms and associated consequences compelled them to seek professional help. Experiences of distrust together with challenges to access the PDHS were identified and related to the patients' unfulfilled expectations., Conclusions: Patients' reported experiences indicate that receiving timely and appropriate care is more of an unfulfilled expectation than the current state of management of patients with TMD in dentistry., (© 2023. BioMed Central Ltd., part of Springer Nature.)

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In this study, we apply theories about self-efficacy, empowerment and motivation to account for the phenomena that people with diabetes Mellitus type 1 express as being influential for people with diabetes' behaviour regarding self-regulation. They must make significant changes to their lifestyle, to keep the disease stabilized. The changes can be cumbersome and hard to implement why people with diabetes receive training in self-regulation. For many people it can be challenging to comply with the recommendations. We conducted field observations and surveys to understand how people with diabetes experience their perceived self-efficacy, and what motivates them to perform blood sugar measurements and physical activities. We found differences in people with diabetes' ability to follow the recommendation based on gender, motivation, and their level of self-efficacy. We also found indications on how a motivational dialog may affect both professionals and people with diabetes. Thus, we suggest that guidance of people with diabetes should be based on an emancipating motivational approach such enabling the possibility of strengthening the people with diabetes' motivation and thereby their self-efficacy. Through these processes, the people with diabetes may become able to achieve a higher level of health literacy such experiencing a better outcome of their self-regulation. With this paper we contribute to the contemporary overall knowledge about the diabetes field, such our investigation focus on people with diabetes ability to act upon information provided by healthcare professionals and how to best approach the issues people with diabetes experience as being essential for their general well-being and everyday lives.

For many instructional designers (ID), subject matter experts (SMEs) are viewed as a necessary evil. Depending upon their day job, SMEs can be challenging to work with due to their schedules and responsibilities outside the ID's project. They can be unaware of the eLearning process, learning models and theories, and expensive -- a SME can easily add thousands of dollars to an already stretched budget. However, if the ID does not have the "expert" knowledge of the content for students to achieve the learning outcomes successfully, it is improbable that the learning event will be meaningful. This paper explores students' learning outcomes in a case-based simulated learning event before and after the inclusion of a SME on an instructional design team.

Person-centered approaches to measurement are needed to more fully reach the goals of person-centered practice. Keyform maps, derived from Rasch analysis and principles of person-centered measurement, are thought to be an important tool for translating person-centered measurement into clinical practice. The purpose of this study was to understand the impact of keyform map use in a variety of learning activities embedded across multiple courses in an entry-level occupational therapy curriculum. This paper includes a description of 3 keyform map learning activities and corresponding results. The effects of keyform maps as a signature instructional strategy within entry-level occupational therapy education and implications for future studies are also discussed.

Objectives: Posterior tibial slope (PTS) is a known anatomical factor in the biomechanical function of the anterior cruciate ligament. However, when PTS is typically measured on a lateral radiograph, this does not consider potential differences between the lateral and medial tibial plateau. The difference between medial posterior tibial slope (MPTS) and lateral posterior tibial slope (LPTS) in a knee is largely unknown. Generally, computed tomography (CT) is the gold standard for 3-dimensional osseus imaging but very few studies to date have attempted to quantify the medial and lateral PTS in the same knee using CT. Clinically, it is debated whether an elevated MPTS or the LPTS is critical for anterior cruciate ligament injury and reinjury. The objective of this study was to quantify the variation in the difference between MPTS and LPTS using full tibial CT scans. Methods: At our institution, CT-assisted preoperative planning is frequently used for osteotomies. Ninety-seven patients with clinically acquired CT scans went through the preoperative planning process (Bodycad, Quebec City, Canada) from Jan 2016 to Nov 2022. This includes patients undergoing coronal, sagittal or biplanar high tibial and distal femoral osteotomies. This process is semi-automated meaning that the user can intervene with the measurements and adjust the initial landmarks and best-fit. Distally, the software will find the center of the tibiotalar joint to provide a point for the tibial axis. The user may adjust that landmark if needed. To measure the tibial slope, the software finds the best fit tibial plateau in 3D and determines the slope angle medially and laterally. The software measures the MPTS and LPTS independently. The slope measurements were compiled and quantitatively analyzed including mean, median, range as well as the difference between the MPTS and LPTS. Patients were defined to have undergone a sagittal or coronal correction if there was more than 2 degrees of change in the sagittal plane or more than 5% change in the coronal plane weight bearing line. Patients were defined as having a biplanar correction when both conditions were met. The slopes were analyzed with respect to sex and laterality. Additionally, patients undergoing an osteotomy in conjunction with an ACL reconstruction (either single or two-staged) were compared to the other patients. Results: There are differences in the MPTS and LPTS within the same knee. When analyzing the whole group, the average absolute difference is 2.76⁰ with a standard deviation of 2.49. As shown in Table 1, 40% of knees had greater than a 2.5⁰ difference in MPTS and LPTS, 19% of knees had greater than a 5⁰ difference in MPTS and LPTS, 5% of knees had greater than a 7.5⁰ difference in MPTS and LPTS and 2% of knees had greater than a 10⁰ difference in MPTS and LPTS. The magnitude of the LPTS is greater than the MPTS 52% of the time. There is no significant difference in the average, standard deviation, mean or the 10th, 25th, 75th and 90th percentiles of the MPTS and LPTS as shown in Table 2. One hundred percent of the sagittal corrections and 84% of the biplanar corrections also underwent an ACL reconstruction in addition to an osteotomy. Characteristics of these groups of patients are shown in table 3. The sagittal and coronal osteotomy patients have a higher MPTS and LPTS than the patients undergoing a coronal osteotomy. Conclusions: The most important finding in this study is that the medial and lateral PTS can be very different within the same knee. There can be up to 11.62-degree difference in this population. Sixteen out of 97 patients had a difference of more than 5⁰ with 2 patients having a difference of greater than 10⁰. The data presented here has uncovered a description of the medial and lateral posterior tibial slope anatomy that was not evident with conventional lateral knee x-rays previously. We do not know the clinical significance of a large difference in the medial and lateral PTS and it brings forth an interesting set of clinical questions. 1) Which posterior tibial slope, medial or lateral, is most important for knee biomechanics, specifically regarding ACL stresses and function? 2) When performing a slope correcting osteotomy, is it the medial, lateral or average slope that should be the target for correction? 3) Should an intercondylar correction which only modifies one slope be considered? Further clinical studies should focus on investigating the relationship of differential PTS to native knee biomechanics as well as its implication for corrective osteotomy procedures and ACL reconstruction. [ABSTRACT FROM AUTHOR]

Donor human milk (DHM) from a milk bank is the recommended feeding method for preterm infants when the mother's own milk (MOM) is not available. Despite this recommendation, information on the possible contamination of donor human milk and its impact on infant health outcomes is poorly characterised. The aim of this systematic review is to assess contaminants present in DHM samples that preterm and critically ill infants consume. The data sources used include PubMed, EMBASE, CINAHL and Web of Science. A search of the data sources targeting DHM and its potential contaminants yielded 426 publications. Two reviewers (S. T. and D. L.) conducted title/abstract screening through Covidence software, and predetermined inclusion/exclusion criteria yielded 26 manuscripts. Contaminant types (bacterial, chemical, fungal, viral) and study details (e.g., type of bacteria identified, study setting) were extracted from each included study during full‐text review. Primary contaminants in donor human milk included bacterial species and environmental pollutants. We found that bacterial contaminants were identified in 100% of the papers in which bacterial contamination was sought (16 papers) and 61.5% of the full data set (26 papers), with the most frequently identified genera being Staphylococcus (e.g., Staphylococcus aureus and coagulase‐negative Staphylococcus) and Bacillus (e.g., Bacillus cereus). Chemical pollutants were discovered in 100% of the papers in which chemical contamination was sought (eight papers) and 30.8% of the full data set (26 papers). The most frequently identified chemical pollutants included perfluoroalkyl substances (six papers), toxic metal (one paper) and caffeine (one paper). Viral and fungal contamination were identified in one paper each. Our results highlight the importance of establishing standardisation in assessing DHM contamination and future studies are needed to clarify the impact of DHM contaminants on health outcomes. Key messages: Research regarding chemical contamination in donor human milk (DHM) is limited and needs to be studied further to draw appropriate conclusions on reducing potential risks for infants.Parents/guardians should be educated on the availability of DHM as a supplemental feeding option and made aware of the current research in the field.DHM use requires further standardisation both within the United States and abroad. This standardisation should ensure that risks are not overemphasised and DHM is a cost‐effective, accessible resource as a short‐term intervention when used appropriately as part of optimal lactation and breastfeeding support. [ABSTRACT FROM AUTHOR]

Context: Athletic trainers provide care for a variety of patients with diverse backgrounds, including members of the lesbian, gay, bisexual, transgender, queer, intersex, other diverse sexualities, other gender identities, or other gender expressions (LGBTQIA+) community. Learners who gain experience with patients who identify as LBGTQIA+ should be better prepared clinicians. Objective: The purpose of this paper is to describe a standardized patient (SP) experience for a patient who is gay and concerned about a sexually transmitted infection after a conversation with a previous partner. Background: Patients who identify as LGBTQIA+ report substandard care and have poor health care experiences. Standardized patients are used in athletic training education as a method to teach and assess skills and can be used to improve the care that learners provide to patients who identify as gay. Educational Advantage: Education drives clinical practice, and incorporating SP cases in which learners must provide care for a patient who is gay will help the learners provide better inclusive patient-centered care as a clinician. Conclusions: Faculty may consider using a SP encounter to better prepare learners to provide care for a patient who is gay.

The application of big data, radiomics, machine learning, and artificial intelligence (AI) algorithms in radiology requires access to large data sets containing personal health information. Because machine learning projects often require collaboration between different sites or data transfer to a third party, precautions are required to safeguard patient privacy. Safety measures are required to prevent inadvertent access to and transfer of identifiable information. The Canadian Association of Radiologists (CAR) is the national voice of radiology committed to promoting the highest standards in patient-centered imaging, lifelong learning, and research. The CAR has created an AI Ethical and Legal standing committee with the mandate to guide the medical imaging community in terms of best practices in data management, access to health care data, de-identification, and accountability practices. Part 1 of this article will inform CAR members on principles of de-identification, pseudonymization, encryption, direct and indirect identifiers, k-anonymization, risks of reidentification, implementations, data set release models, and validation of AI algorithms, with a view to developing appropriate standards to safeguard patient information effectively. [ABSTRACT FROM AUTHOR]

Background: Low- and middle-income countries (LMICs), including South Africa, are currently experiencing multiple epidemics: HIV and the rising burden of non-communicable diseases (NCDs), leading to different patterns of multimorbidity (the occurrence of two or more chronic conditions) than experienced in high income settings. These adversely affect health outcomes, increase patients' perceived burden of treatment, and impact the workload of self-management. This paper outlines the methods used in a qualitative study exploring burden of treatment among people living with HIV/NCD multimorbidity in South Africa. Methods: We undertook a comparative qualitative study to examine the interaction between individuals' treatment burden (self-management workload) and their capacity to take on this workload, using the dual lenses of Burden of Treatment Theory (BoTT) and Cumulative Complexity Model (CuCoM) to aid conceptualisation of the data. We interviewed 30 people with multimorbidity and 16 carers in rural Eastern Cape and urban Cape Town between February-April 2021. Data was analysed through framework analysis. Findings: This paper discusses the methodological procedures considered when conducting qualitative research among people with multimorbidity in low-income settings in South Africa. We highlight the decisions made when developing the research design, recruiting participants, and selecting field-sites. We also explore data analysis processes and reflect on the positionality of the research project and researchers. Conclusion: This paper illustrates the decision-making processes conducting this qualitative research and may be helpful in informing future research aiming to qualitatively investigate treatment burden among patients in LMICs. [ABSTRACT FROM AUTHOR]

With more than 23 million infections and more than 814,000 deaths worldwide, the coronavirus disease-2019 (COVID-19) pandemic is still far from over. Several classes of drugs including antivirals, antiretrovirals, anti-inflammatory, immunomodulatory, and antibiotics have been tried with varying levels of success. Still, there is lack of any specific therapy to deal with this infection. Although less than 30% of these patients require intensive care unit admission, morbidity and mortality in this subgroup of patients remain high. Hence, it becomes imperative to have general principles to guide intensivists managing these patients. However, as the literature emerges, these recommendations may change and hence, frequent updates may be required. [ABSTRACT FROM AUTHOR]

In a resource-limited country like India, rationing of scarce critical care resources might be required to ensure appropriate delivery of care to the critically ill patients suffering from COVID-19 infection. Most of these patients require critical care support because of respiratory failure or presence of multiorgan dysfunction syndrome. As there is no pharmacological therapy available, respiratory support in the form of supplemental oxygen, noninvasive ventilation, and invasive mechanical ventilation remains mainstay of care in intensive care units. As there is still dearth of direct evidence, most of the data are extrapolated from the experience gained from the management of general critical care patients. [ABSTRACT FROM AUTHOR]

Mental health professionals can help patients understand exceptional and paranormal experiences, integrate them into day-to-day life, and cope with confusion and anxiety that sometimes accompany them. However, a broader clinical perspective and specialized training in clinical parapsychology is needed. In the first part of the paper I argue that psychiatry as currently practiced is limited because it embraces a strictly materialist paradigm, emphasizes treatment over prevention, and relies principally on pharmaceuticals that are often ineffective and/or unsafe. A paradigm shift in psychiatry is taking place that will soon lead to novel concepts of energy and innovations in therapeutic approaches. In the second part of the paper I review the ongoing debate over consciousness, implications of novel understandings of energy for psychiatry, and research findings in physics, neuroscience and parapsychology that are contributing to a postmaterialist paradigm in psychiatry. I comment on an important problem in the philosophy of science called Hempel's dilemma and argue that future scientific theories of consciousness will probably encounter similar conceptual limits to those faced by current theories. Following Beauregard, Trent and Schwartz (2018) I argue that different categories of theories may be needed to adequately explain the variety of human experiences and I propose an integral paradigm that acknowledges the validity of both conventional scientific explanations and postmaterialist theories of consciousness. Finally, I discuss implications of postmaterialism for research, education and training in psychiatry.

Purpose: The purpose of this study was to evaluate a computerized touch-screen version of the asthma-specffic quality-of-life (cA-QOL) questionnaire against the conventional paper-and-pencil version (pA-QOL) for equivalence, time for completion, user preference, and ease of use. Methods: A total of 261 patients were recruited. A randomized cross-over design was used. Patients in group A completed the cA-QOL first while waiting to see a physician, and completed the pA- QOL version after seeing the physician. Patients allocated in group B completed these questionnaires in the reverse order. The patients were asked questions about user preference and ease of use of the cA-QOL. The time taken to complete both versions of the questionnaire was measured. Results: Weighted kappa coefficients of all items showed almost per- fect agreement. The time required to complete the pA-QOL is faster than the time for cA-QOL. The patients who preferred the cA-QOL were 37.5%, while those who preferred the pA-QOL were 29.9%. Most patients reported that the cA-QOL was "easy" or "very easy" to complete. Conclusion: The cA-QOL is the computerized equivalent of the pA-QOL. The findings herein demonstrate that the cA-QOL can be helpful to nurses in busy practices for assessing, collecting, and evaluating their patients' health related quality of life. [ABSTRACT FROM AUTHOR]

Clinical education standards for speech-language pathology and nursing programs indicate the need for students to gain experience with interprofessional collaborative practice (ICP). However, colleges not affiliated with hospitals struggle to offer experiences between healthcare disciplines. The purpose of this paper is to present a case study as a model for interprofessional healthcare simulation that can be applied to schools that have limited access to a variety of professional programs and few complimentary medical specialties at their home institution. The partnership of a masters in speech-language pathology (MS-SLP) program at a public state sponsored institution and a bachelors of science in nursing (BSN) program at a private college provides insights on model effectiveness. A strong partnership between simulation facilitators allowed for agreement on learning objectives, mapping the experience from pre-brief to debrief, and maintenance of unique professional roles for greater authenticity. MS-SLP and BSN students reported high ratings of confidence, understanding of other professional roles, and a shared respect for the unique roles and responsibilities of each team member. Strengths and challenges of the approach are discussed.

Introduction: Position sense, one of the most accurate senses in the body, makes everyone aware of the state of the body in space. This sense is an essential ability in maintaining physical health and avoiding injury. Deficits in position sense cause balance impairments in people with mild Multiple Sclerosis (MS). Position sense requires instant and coordinated communication between the central nervous system and peripheral nervous system, while in patients with MS, communication between the brain and other parts of the body is disrupted. This study aims to compare the position sense of knee joint in people with MS and healthy subjects. Materials and Methods: Ten healthy subjects with the Mean±SD age of 27.6±3.71 years and 10 persons with MS disease and the Mean±SD age of 31.40±3.50 years participated in this study. For evaluating their position sense of knee joint, they flexed their knees (from 90 to 45 degrees) four times, and then a software calculated their repositioning errors. Results: No significant changes in repositioning errors (constant, variable, absolute) were observed in MS patients, and the control group (P˃0.05). Conclusion: The results indicate that mild MS disease cannot disturb the position sense of knee joint. [ABSTRACT FROM AUTHOR]

Introduction: Subclinical hypothyroidism is an endocrine disorder that can adversely affect cognitive performance. In this regard, patients with subclinical hypothyroidism may develop poor attention. However, the effects of this endocrine disorder on auditory attention is unclear. This study aims to evaluate the impact of subclinical hypothyroidism on auditory divided attention. Materials and Methods: This cross-sectional, case control study was performed on 30 adult patients, aged 20-40 years, who met the study inclusion criteria. Based on their Thyroid Stimulating Hormone (TSH) level, the subjects were divided into two case groups (each with 15 patients) with a TSH level of 5˂TSH≤10 and 10˂TSH≤15. A healthy control group was recruited with matched age, sex, and education with the case groups. The participants were evaluated by the Persian version of the Bergen dichotic listening test. Among different experimental situations that included non-forced attention, forced right, and forced left, we chose the non-forced attention. Statistical analysis was done in SPSS V. 25. Results: There was a significant difference between the subclinical hypothyroid (5˂TSH≤10 group) and controls in the scores of the right and left ear. However, there was no significant difference between scores of right and left ear in subclinical hypothyroid (10˂TSH≤15 group). No significant difference in scores of the right and left ear was found between men and women in three groups. Conclusion: Subclinical hypothyroidism had no effect on auditory divided attention. [ABSTRACT FROM AUTHOR]