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Background Increased self-management is a suggested solution to the burden on health-care services of long-term conditions (LTCs). This requires effective sharing of knowledge between health-care professionals and patients, and is an underexplored area. Objective To understand how patients and health-care professionals (HCPs) share and utilize knowledge in the social context of health-care interactions within long-term condition management. Methods Thematic analysis of 93 hours of observations of health-care interactions and 33 semi-structured interviews involving patients, carers and HCPs. Results 3 themes were identified: normative social roles, differing professional roles and the value of knowledge. Knowledge sharing was a complex process heavily influenced by social and cultural norms within the health-care context. Not all knowledge was easily shared within routine health-care interactions. Discussion The social context in which health-care is practised influences what knowledge is shared and how this is achieved. It favours sharing of clinical knowledge from HCPs to patients and disadvantages patients in their ability to share their unique knowledge based on lived experience of illness. The opportunities for patients to be supported in their knowledge, skills and confidence within routine health-care interactions are limited. Conclusion Both patients and HCPs need support to recognize the characteristics of the social context of health care and their understandings of their roles within this in order for them to move beyond accepted behaviours to develop more effective partnership working. Patient or public contribution Patients were involved in initial design of the study, particularly ethics of ethnographic observation.

Background In recent decades, many self‐report instruments have been developed to assess the extent to which patients want to be informed and involved in decisions about their health as part of the concept of person‐centred care (PCC). The main objective of this research was to translate, adapt and validate the Patient‐Practitioner Orientation Scale (PPOS) using a sample of primary care health‐care professionals in Spain. Methods Baseline analysis of PPOS scores for 321 primary care professionals (general practitioners and nurses) from 63 centres and 3 Spanish regions participating in a randomized controlled trial. We analysed missing values, distributions and descriptive statistics, item‐to‐scale correlations and internal consistency. Performed were confirmatory factor analysis (CFA) of the 2‐factor model (sharing and caring dimensions), scale depuration and principal component analysis (PCA). Results Low inter‐item correlations were observed, and the CFA 2‐factor model only obtained a good fit to the data after excluding 8 items. Internal consistency of the 10‐item PPOS was acceptable (0.77), but low for individual subscales (0.70 and 0.55). PCA results suggest a possible 3‐factor structure. Participants showed a patient‐oriented style (mean = 4.46, SD = 0.73), with higher scores for caring than sharing. Conclusion Although the 2‐factor model obtained empirical support, measurement indicators of the PPOS (caring dimension) could be improved. Spanish primary care health‐care professionals overall show a patient‐oriented attitude, although less marked in issues such as patients’ need for and management of medical information.

Purpose: To explore the factors influencing adherence to home-based exercises among communitydwelling stroke survivors using Intervention Mapping (IM) approach. Material and methods: Qualitative interviews were conducted with ten stroke survivors living in semi-urban regions of India. The data were analysed using Atlas.Ti8 software and categorised using the Social Ecological Model. Results: The mean age of the stroke participants was 61 ± 11 years. Key factors such as lack of awareness about stroke recovery and exercises, poor perceived recovery, hopelessness and lack of emphasis on exercises by healthcare professionals led to non-adherence while commitment, continued supervision, supportive family and society facilitated adherence. Some cultural specific factors such as opting for folk medicine over rehabilitation and social stigma were also identified. Conclusions: The factors which influenced adherence to home-based exercises in stroke are existent at the individual, interpersonal, organisational and community level. This study can lead to the development of effective interventions for promoting exercise adherence among stroke survivors in low and middle income countries (LMICs).

Intracranial hemorrhage (ICH) is the most feared complication of anticoagulation with a high mortality and morbidity. Before registration of a specific reversal agent for factor Xa inhibitors (FXa-I), international guidelines recommended prothrombin complex concentrate (PCC), which also is the specific reversal agent for vitamin K antagonists (VKA). In two contemporary cohorts, we compared clinical outcomes between patients with FXa-I and VKA related ICH treated with PCC between 2014 and 2018. Primary outcome was effective hemostasis after 24 h, according to the International Society of Thrombosis and Hemostasis definition. Safety outcomes were defined as venous and arterial thromboembolic complications and death within 30 days. Thirty-six patients with FXa-I-ICH and 39 patients with VKA-ICH were available for analysis. Baseline characteristics were comparable between both groups, except for time from start of symptoms to presentation at the hospital. In the FXa-I-ICH cohort, 24 (73%) patients achieved effective hemostasis compared to 23 (62%) patients in the VKA-ICH cohort (crude odds ratio [OR] 1.62 [95%CI 0.59-4.48], adjusted OR 1.45 [95%CI 0.44-4.83]). Eight (24%) patients with FXa-I-ICH deceased compared to 17 (45%) patients with VKA-ICH (crude OR 0.38 [95%CI 0.14-1.24], adjusted OR 0.41 [95%CI 0.12-1.24]). In this observational cohort study, the outcome of ICH managed with PCC was similar in patients with FXa-I-ICH and in patients with VKA-ICH.

Differences in cardiac and aortic structure and function are associated with cardiovascular diseases and a wide range of other types of disease. Here we analyzed cardiovascular magnetic resonance images from a population-based study, the UK Biobank, using an automated machine-learning-based analysis pipeline. We report a comprehensive range of structural and functional phenotypes for the heart and aorta across 26,893 participants, and explore how these phenotypes vary according to sex, age and major cardiovascular risk factors. We extended this analysis with a phenome-wide association study, in which we tested for correlations of a wide range of non-imaging phenotypes of the participants with imaging phenotypes. We further explored the associations of imaging phenotypes with early-life factors, mental health and cognitive function using both observational analysis and Mendelian randomization. Our study illustrates how population-based cardiac and aortic imaging phenotypes can be used to better define cardiovascular disease risks as well as heart-brain health interactions, highlighting new opportunities for studying disease mechanisms and developing image-based biomarkers.

Physical activity has increasingly gained attention within palliative care. This article aims to explore how the idea of physical activity influences patients with advanced cancer and health-care professionals’ interactions. The empirical material was gathered as part of an anthropological field study about palliative care needs among 16 patients with advanced cancer, consisting of observations and interviews with patients, relatives, and professionals. Two of the patient cases were analyzed, inspired by Goffman’s theory, showing how patients and health-care professionals interact in relation to physical activity. The findings show that patients played roles either embracing physical activity or distancing it by postponement. Professionals played expert roles of duty and attachment, stressing the importance of physical activity. Thus, they accepted a minimum of physical activity when patients were close to death. Professionals regarded patients’ absence of physical activity as a lack of desire to live; patients regard it as a way to live.

Objective To report on the findings of a systematic review which examined the experiences and views of older people aged 65 years and over on health professionals’ recognition of sexuality and sexual health and whether these aspects of the person are incorporated into care. Review methods The review followed the methods laid out by the Joanna Briggs Institute. Eleven electronic databases were searched using the terms sexual*, aged, ageing/aging, attitudes and care in any health-care setting. Only quantitative and qualitative research and opinion papers written in English and offering unique commentary published between January 2004 and January 2015 were eligible. Results A total of 999 papers were initially identified and of these, 148 were assessed by two reviewers. Eighteen studies – seven quantitative, eight qualitative and three opinion papers – met the inclusion criteria and were appraised. The importance of sexuality to well-being, language used, expressing sexuality, discomfort discussing sexuality, inadequate sexuality health education and treatment and deficient communication with health-care professionals were all identified as significant issues in a range of settings. Fourteen categories and five syntheses summarize the 43 findings. Conclusions Sexuality remains important for many older people; however, embarrassment, dissatisfaction with treatment, negative attitudes and seeming disinterest by health professionals can all inhibit discussions. Professionals and health-care services need to adopt strategies and demonstrate characteristics which create environments that are more supportive of sexuality. Issues related to sexuality and sexual health should be able to be discussed without anxiety or discomfort so that older people receive optimal care and treatment.

Background: Incorporation of information technology (IT) advancements in health care has gained wide acceptance in the last two decades. Developed countries have successfully incorporated this in their health-care system, thus improving health care. However, only a limited application of IT is seen in developing countries. Aim: The aim of the study was to assess the knowledge and utilization of computers among health-care professionals in Mumbai, India. Methodology: A cross-sectional questionnaire study was conducted among dental, medical, Ayurveda, and homeopathy practitioners. A total of 1000 respondents (250/group) were included in the study. The first section of the questionnaire sought sociodemographic information of respondents, and the second section sought information on the level to which health-care practitioners apply computers to tasks at their places of work, accessibility of the Internet, views regarding the cost of a computer, and the problems associated with the medical recording system at their places of work. Data were entered into Microsoft Excel and analyzed using SPSS version 17. P ≤ 0.05 was considered statistically significant. Results: Two hundred and fifty participants in each profession were included in the study. The age ranged between 23 and 65 years. Majority (>80%) of the participants had knowledge about word processing program and slide preparation for presentation. On comparison, knowledge was more in medical and dental professionals (P = 0.04). Almost 80% were in the opinion that electronic system for records is better than paper-based recording system, but majority of them reported lack of such facility at their workplace. Knowledge and utilization was higher among the doctors having postgraduate qualification compared to undergraduates (P = 0.002). Conclusion: The study showed average knowledge but lack of utilization of computers by health-care professionals in routine practice. More research should be done into the factors that play an important role in computer use among health-care professionals in developing societies.

Many publications have delineated strategies for mental health care to respond to psychological concerns and ramifications related to coronavirus disease 2019 (COVID-19). The current review aims to encapsulate existing guidelines and recommendations of psychological management for mental health care for the general population, health-care professionals, children, and elderly populations, applied to a pandemic in particular reference to COVID-19. The literature on psychological care of such repercussions of COVID-19 was retrieved via a search in PubMed and Google database. Of 91 retrieved initial articles, only 18 were selected for final analysis, which was divided into two categories: (a) guidelines by government/public health bodies (n = 11) and (b) publications in peer-reviewed journals (n = 7). The recommendations can be summed but not limited to psychoeducation from a reliable source, normalization of stress, behavioral activation, scheduling of activities with a bespoke blending of recreational and daily chores, supportive care, staying digitally connected, relaxation techniques, ensuring rest, rotating shifts and short breaks during working hours, curtailing media consumption, fostering community resilience, seeking and sharing support from colleagues/supervisors, avoidance of abusing psychoactive substances, online consultation of mental health professionals on need, and participatory communication in a developmentally appropriate way with children. In the absence of observational and controlled studies on psychological management during pandemic times, we recommend such research soon.

Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring followed by oral anticoagulation (OAC) treatment have been proposed to prevent recurrent cardioembolic strokes. This white paper by experts from the AF-SCREEN International Collaboration summarizes existing evidence and knowledge gaps on searching for AF after a stroke by using ECG monitoring. New AF can be detected by routine plus intensive ECG monitoring in approximately one-quarter of patients with ischemic stroke. It may be causal, a bystander, or neurogenically induced by the stroke. AF after a stroke is a risk factor for thromboembolism and a strong marker for atrial myopathy. After acute ischemic stroke, patients should undergo 72 hours of electrocardiographic monitoring to detect AF. The diagnosis requires an ECG of sufficient quality for confirmation by a health professional with ECG rhythm expertise. AF detection rate is a function of monitoring duration and quality of analysis, AF episode definition, interval from stroke to monitoring commencement, and patient characteristics including old age, certain ECG alterations, and stroke type. Markers of atrial myopathy (eg, imaging, atrial ectopy, natriuretic peptides) may increase AF yield from monitoring and could be used to guide patient selection for more intensive/prolonged poststroke ECG monitoring. Atrial myopathy without detected AF is not currently sufficient to initiate OAC. The concept of embolic stroke of unknown source is not proven to identify patients who have had a stroke benefitting from empiric OAC treatment. However, some embolic stroke of unknown source subgroups (eg, advanced age, atrial enlargement) might benefit more from non–vitamin K-dependent OAC therapy than aspirin. Fulfilling embolic stroke of unknown source criteria is an indication neither for empiric non–vitamin K-dependent OAC treatment nor for withholding prolonged ECG monitoring for AF. Clinically diagnosed AF after a stroke or a transient ischemic attack is associated with significantly increased risk of recurrent stroke or systemic embolism, in particular, with additional stroke risk factors, and requires OAC rather than antiplatelet therapy. The minimum subclinical AF duration required on ECG monitoring poststroke/transient ischemic attack to recommend OAC therapy is debated.

Infective endocarditis (IE) is a complex disease with cardiac involvement and multiorgan complications. Its prognosis depends on prompt diagnosis that leads to an aggressive therapeutic management combining antibiotic therapy and early cardiac surgery when indicated. However, IE diagnosis always poses a challenge, and echocardiography remains diagnostically imperfect in cases of prosthetic valve IE or cardiac implantable electronic device infection. In recent years, other imaging modalities (computed tomography, magnetic resonance imaging, nuclear imaging) have experienced significant technical improvements, and their application to the detection of cardiac and extracardiac IE-related lesions seems to be a strategic way forward in the management of patients with suspected IE. However, the scientific evidence in the literature remains limited; current guidelines address the use of the multimodality imaging in the field of IE with caution; the incremental value of each technique and their combinations is debated; and their use varies across countries. Despite these limitations, healthcare providers and surgeons should be aware of the possibilities offered by the multimodal imaging approach when appropriate. Here, we emphasize the value of a multidisciplinary heart valve team, the endocarditis team, underlining the importance of cardiac and extracardiac imaging experts in playing a key role in informing the diagnosis and management of patients with IE. Illustrative cases, critical appraisal of contemporary data, and conceptual and practical suggestions for clinicians that may help to improve the prognosis of patients with IE are provided in this review article.

AIMS: Penumbral selection is best-evidence practice for thrombectomy in the 6-24 hour window. Moreover, it helps to identify the best responders to thrombolysis. Multimodal computed tomography (mCT) at the primary centre-including noncontrast CT, CT perfusion, and CT angiography-may enhance reperfusion therapy decision-making. We developed a network with five spoke primary stroke sites and assessed safety, feasibility, and influence of mCT in rural hospitals on decision-making for thrombolysis. METHODS: Consecutive patients assessed via telemedicine from April 2013 to June 2018. Clinical outcomes were measured, and decision-making compared using theoretical models for reperfusion therapy applied without mCT guidance. Symptomatic intracranial hemorrhage (sICH) was assessed according to Safe Implementation of Treatments in Stroke Thrombolysis Registry criteria. RESULTS: A total of 334 patients were assessed, 240 received mCT, 58 were thrombolysed (24.2%). The mean age of thrombolysed patients was 70 years, median baseline National Institutes of Health Stroke Scale was 10 (IQR 7-18) and 23 (39.7%) had a large vessel occlusion. 1.7% had sICH and 3.5% parenchymal hematoma. Three months poststroke, 55% were independent, compared with 70% in the non-thrombolysed group. CONCLUSION: Implementation of CTP in rural centers was feasible and led to high thrombolysis rates with low rates of sICH. ispartof: CNS NEUROSCIENCE & THERAPEUTICS vol:26 issue:3 pages:367-373 ispartof: location:England status: published

Background: Trust in providers is key to positive health outcomes. However, perceptions of trust in health-care professionals can vary by population. Factors beyond the immediate behaviors of health-care professionals such as group association may influence perceptions of trust. Objective: To examine the possible association of in-group membership and levels of trust in health-care professionals in Kazakhstan. Method: We used an online survey including the General Trust in Physicians scale along with demographic questions and a question regarding family members as health-care professionals. Bivariate analysis was used to compare the mean differences between general levels of trust and sociodemographic characteristics. Then multivariate analysis was conducted to examine the association between having a family member who is a health-care professional and general level of trust in health-care professionals among Kazakhstani citizens. Statistical tests were 2-sided. Results: A total of 497 Kazakhstani participants completed the survey. In adjusted multivariate regression, participants with family members as health-care professionals scored significantly higher on the trust scale ( P < .001), and other factors such as language ( P < .001) and interaction term of language and education ( P< .05) were also shown to be influential in the general level of trust. Conclusion: Further examinations of how group membership influences reported trust levels in health-care professionals in Kazakhstan are warranted. Such studies would be beneficial if trust in health-care professionals is to be understood and improved in order to achieve more desirable health outcomes.

BackgroundRandomised controlled trials with perfusion selection have shown benefit of endovascular treatment (EVT) for ischaemic stroke between 6 and 24 hours after symptom onset or time last seen well. However, outcomes after EVT in these late window patients without perfusion imaging are largely unknown. We assessed their characteristics and outcomes in routine clinical practice.MethodsThe Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands Registry, a prospective, multicentre study in the Netherlands, included patients with an anterior circulation occlusion who underwent EVT between 2014 and 2017. CT perfusion was no standard imaging modality. We used adjusted ordinal logistic regression analysis to compare patients treated within versus beyond 6.5 hours after propensity score matching on age, prestroke modified Rankin Scale (mRS), National Institutes of Health Stroke Scale, Alberta Stroke Programme Early CT Score (ASPECTS), collateral status, location of occlusion and treatment with intravenous thrombolysis. Outcomes included 3-month mRS score, functional independence (defined as mRS 0–2), and death.ResultsOf 3264 patients who underwent EVT, 106 (3.2%) were treated beyond 6.5 hours (median 8.5, IQR 6.9–10.6), of whom 93 (87.7%) had unknown time of stroke onset. CT perfusion was not performed in 87/106 (80.2%) late window patients. Late window patients were younger (mean 67 vs 70 years, pConclusionsWithout the use of CT perfusion selection criteria, EVT in the 6.5–24-hour time window was not associated with poorer outcome in selected patients with favourable clinical and CT/CT angiography characteristics. randomised controlled trials with lenient inclusion criteria are needed to identify more patients who can benefit from EVT in the late window.

Background Consistent with the ‘Making Every Contact Count’ UK public health policy, general practitioners (GPs) are expected to provide patients with behaviour change interventions opportunistically. However, there is a belief widely held among GPs that patients neither want or need such interventions. We aimed to understand the following: (a) the characteristics of people attending GP appointments, (b) patients' needs for health behaviour change, (c) perceptions of appropriateness and helpfulness of interventions, and (d) factors associated with recall of receipt of interventions. Methods Cross‐sectional nationally representative online survey of UK adults who had attended GP clinics in the preceding four weeks (n = 3028). Data were analysed using descriptive statistics and binary logistic regression. Results 94.5% (n = 2862) of patients breached at least one health behaviour guideline, and 55.1% reported never having had a conversation with their GP about health behaviours. The majority of patients perceived intervention as appropriate (range 84.2%‐87.4% across behaviours) and helpful (range 82.8%‐85.9% across behaviours). Being male (OR = 1.412, 95% CI 1.217, 1.639), having a long‐term condition (OR = 1.514, 95% CI 1.287, 1.782) and a higher number of repeat GP visits (OR = 1.016, 95% CI 1.010, 1.023) were among factors associated with recall of receipt of interventions. Conclusions Patients perceived behaviour change intervention during routine GP consultations as appropriate and helpful, yet there are variations in the likelihood of receiving interventions according to sociodemographic factors. GPs could adopt a more proactive approach to behaviour change in patient consultations with the broad approval of patients. Patient or public contribution The questionnaire was piloted among a convenience sample prior to distribution.

Background and purpose The global COVID‐19 pandemic led many stroke centres worldwide to shift from in‐person to telemedicine consultations to assess patients with transient ischaemic attacks (TIAs). We aimed to investigate the impact of telemedicine during the COVID‐19 pandemic on the management and outcome of the patients with TIA. Methods We retrospectively analysed data from a registry of consecutive TIA patients assessed at the Stroke Department, Imperial College Health Care Trust, London, during the national lockdown period (between March 23 2020 and 30 June 2020). As controls, we evaluated the clinical reports and stroke quality metrics of patients presenting to the TIA clinic in the same period of 2019. Results Between 23 March 2020 and 30 June 2020, 136 patients were assessed using the telemedicine TIA clinic, compared to 180 patients evaluated with face‐to‐face consultation in the same period in 2019. Patients’ characteristics were similar in both groups. At 3 months after the TIA, there were no significant differences in the proportion of patients admitted to the hospital for recurrent TIA/stroke or any other cardiovascular cause from the 2020 period compared to the same period in 2019. Conclusions Our analysis showed that during the pandemic, our telemedicine consultations of TIA patients were not associated with an increased 3‐month rate of recurrent TIA/stroke or cardiovascular hospital admissions. More robust studies looking at this model of care will be needed to assess its long‐term effects on patients and health care systems.

Heyam F Dalky,1,2 Nariman Ghader,3 Muna Al Kuwari,4 Malek Alnajar,5 Samantha Ismaile,5 Mona Almalik,5,6 Raed Shudifat,5 Sarah Sanad,5 Nezam Al-Nsair,7 Fatima Al Matrooshi8 1Psychiatric Mental Health, Faculty of Health Sciences/Nursing Department, Higher Colleges of Technology, Sharjah, United Arab Emirates; 2Psychiatric Mental Health, Faculty of Nursing, Jordan University of Science & Technology, Irbid 22110, Jordan; 3Specialized Care Department, Strategic Planning and Institutional Performance, Ministry of Health and Prevention-HQ, Dubai, United Arab Emirates; 4Specialized Care Department, Specialized Care Management, Hospitals Sector, Ministry of Health and Prevention-HQ, Dubai, United Arab Emirates; 5Faculty of Health Science/Nursing Department, Higher Colleges of Technology, Sharjah, United Arab Emirates; 6Maternal and Child Health Nursing Department, Faculty of Nursing, University of Mutah, Mu’tah, Jordan; 7Higher Colleges of Technology, Faculty of Health Sciences, Sharjah, United Arab Emirates; 8Specialized Care Department, Hospitals Sector, Ministry of Health and Prevention-HQ, Dubai, United Arab EmiratesCorrespondence: Heyam F DalkyPsychiatric Mental Health, Faculty of Health Sciences/Nursing Department, Higher Colleges of Technology, PO Box 9747, Sharjah, United Arab EmiratesEmail hdalky@hct.ac.aeBackground: Since COVID-19 surfaced in December 2019, health-care organizations across the globe have struggled to maintain the safety and well-being of health-care professionals (HCPs).Purpose: This study investigates the HCPs’ general understanding of the health risks of COVID-19 and to what extent they are equipped with the knowledge to protect themselves and others against this contagion.Methods: This cross-sectional study used a web-based structured questionnaire posted on the UAE government electronic survey portal. A collection of 941 HCPs from diverse general and specialty hospitals in the UAE responded to an electronic participation invite.Results: Our analysis showed that the majority of HCPs (97.6%) had updated information about COVID-19 modes of transmission, risks of contamination, high-risk groups, and the potential consequences of testing positive. Furthermore, the results of the chi-squared testing revealed that the HCPs’ confidence and vigilance of the COVID-19 threats were significantly increased (p< 0.01) by being experienced, having had infection control training, or/and having undergone COVID-19 education.Conclusion: We conclude that HCPs have an evidence-based understanding of the ways their own health is at risk while they are performing their duties in hospital setups. Further, the study found that HCPs who undergo special infection control training and who are kept posted on the official updates on COVID-19 are more likely to remain vigilant at all times to minimize the risks to themselves and their patients. Although the generalizability of the study findings should be considered with caution, the results could be generalizable to health-care professionals who received similar COVID-19 related training in the UAE or other regional countries.Keywords: vigilance, pandemic, attitude, COVID-19, infection control, health-care professionals

Background During the outbreak of SARS-CoV-2 in Italy, infection among health-care professionals and in the context of welfare and health-care facilities was a significant concern. It is known that the elderly or those with concomitant pathologies are at greater risk of a serious evolution of the disease if affected by COVID-19 and that health workers are a category with greater exposure to SARS-CoV-2 infection. Until now, there has been little information on the epidemiological features and transmission dynamics of the COVID-19 outbreak which did not involve health-care professionals or social and health-care facilities. For this reason, this paper aims to describe the epidemiological characteristics of SARS-CoV-2 infection in the general population outside these semi-closed communities. Methods The study was designed by analyzing the data of the 1371 SARS-CoV-2 positive subjects observed in Sardinia up to 9 July, 2020 and whose data were available in the public health department. Statistical analysis and graphic representation were performed using STATA and Adobe Illustrator, respectively. Results Of the positive cases analyzed, 323 (23.5%) are health-care workers and 563 (41.1%) reside in social or health-care facilities. The number of positive cases among the general population (subjects who do not belong to these semi-closed communities), is 399 (29.1%), 208 females and 191 males. The estimated Case Fatality Rate stands at 5.0%, which is almost half the rate reported for all the SARS-CoV-2 positive cases (9.8%). The geographical distribution of positive cases differs considerably from the distribution of the totality of cases in Sardinia. Conclusions This review provides an insight into the COVID-19 situation in the general community, ie not involving health-care professionals or social and health-care facilities. Understanding the evolving epidemiology and transmission dynamics of the outbreak outside of these semi-closed communities would provide appropriate information to guide intervention policy. The COVID-19 pandemic has exacerbated the vulnerability of our health-care system. Severe disruptions in care, medicine shortages and unequal access to health-care are but a few examples of the challenges faced by people living in Italy and Europe, highlighting the importance of evidence-based approaches in supporting the development of prevention and response strategies for future pandemics.

Introduction: Worldwide, COVID-19 pandemic caused millions of infected people and thousands of deaths Due to enormous pressure on health-care systems and its inadequate preparedness, utter collapse is expected In the current epidemic response, healthcare workers´ (HCWs) knowledge and practice are crucial, while the impact on their mental health is still unknown Methods: The cross-sectional study was conducted among HCWs redeployed to COVID points in the Public Institution Health Centre of Sarajevo Canton According to guidelines and information provided by the World Health Organization and Ministries of Health, a questionnaire was developed In addition, General Anxiety Disorder-7 as a screening tool for anxiety disorders was used Results: Of 180 respondents, 26 (14 4%) were in direct contact with the sick patient In total, 79 (43 9%) respondents consider their personal protective equipment is in accordance with the guidelines of the world health authorities A total of 72 (39 7%) of respondents used the same mask for several days In general, the danger from new coronavirus was considered minimal by 59 (32,6%) HCWs Based on the achieved score for assessing the anxiety disorder, in 63 (35%) subjects, the presence of severe symptoms was detected Conclusion: This study found that most HCWs do not have enough knowledge about the COVID-19 pandemic We identified that there are differences in the sources of information and gap in perceptions of the native origin of the virus Considering the frequency of anxiety symptoms among HCWs, interventions are necessary in order to preserve their mental health © 2020 Daniel Maestro, et al ;licensee University of Sarajevo - Faculty of Health Studies This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons org/licenses/by/4 0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

The coronavirus disease 2019 (COVID-19) pandemic, first reported in late December 2019, is regarded as the most significant public health emergency of the century. According to the World Health Organization (WHO), the current outbreak of COVID-19 has affected millions of people and killed hundreds of thousands in more than 200 countries, including Pakistan. Health-care professionals (HCPs) cannot minimize human interactions or isolate themselves from patients due to their jobs and moral duties. Hence, the outbreak needed HCPs to work in adverse and challenging conditions with possible mental health problems. In light of the stated background, this study aims to explore and understand the factors that impede HCPs to effectively treat COVID-19 patients in Karachi, Pakistan. Based on qualitative methods, a phenomenological approach was considered to record the true experiences of HCPs. Twelve doctors and nurses were recruited from five COVID-19 designated hospitals in Karachi, Sindh Province, using purposive and snowball sampling. Semi-structured in-depth telephone interviews were conducted from April 6 to 14, 2020, and analyzed through thematic analysis. The findings suggest that there were two types of constraints, institutional and personal, which were impeding HCPs to treat COVID-19 patients effectively. Institutional constraints include the poor condition of isolation wards, inadequate availability of personal protective equipment (PPE), excessive and uneven workload, and absence of emotional and psychological support in hospitals. Besides, personal constraints include nervousness due to the novel virus, a constant fear of becoming infected, fear of taking virus to family, extreme isolation and loneliness, and feeling of powerlessness. The study found that HCPs in Pakistan have been dealing with a high risk of infection, causing mental health problems such as stress, anxiety, and depressive symptoms. These mental health problems not only affect attention, understanding, and decision-making capacity of HCPs, which could hinder the fight against COVID-19, but they could also have a continuous effect on their overall well-being on a long-term basis. Therefore, the present study outlines important clinical and policy strategies that are needed to support HCPs as the pandemic continues.

Background Cranial radiotherapy may damage the cerebral vasculature. The aim of this study was to understand the prevalence and risk factors of cerebrovascular disease (CVD) and white matter hyperintensities (WMHs) in childhood brain tumors (CBT) survivors treated with radiotherapy. Methods Seventy CBT survivors who received radiotherapy were enrolled in a cross-sectional study at a median 20 years after radiotherapy cessation. The prevalence of and risk factors for CVD were investigated using MRI, MRA, and laboratory testing. Tumors, their treatment, and stroke-related data were retrieved from patients’ files. Results Forty-four individuals (63%) had CVD at a median age of 27 years (range, 16-43 years). The prevalence rates at 20 years for CVD, small-vessel disease, and large-vessel disease were 52%, 38%, and 16%, respectively. Ischemic infarcts were diagnosed in 6 survivors, and cerebral hemorrhage in 2. Lacunar infarcts were present in 7, periventricular or deep WMHs in 34 (49%), and mineralizing microangiopathy in 21 (30%) survivors. Multiple pathologies were detected in 44% of the participants, and most lesions were located in a high-dose radiation area. Higher blood pressure was associated with CVD and a presence of WMHs. Higher cholesterol levels increased the risk of ischemic infarcts and WMHs, and lower levels of high-density lipoprotein and higher waist circumference increased the risk of lacunar infarcts. Conclusions Treating CBTs with radiotherapy increases the risk of early CVD and WMHs in young adult survivors. These results suggest an urgent need for investigating CVD prevention in CBT patients.

Aims and objectives Overall, this study aimed to describe nursing care for patients with dementia in acute hospitals, with the objectives of describing the provided nursing care (a), nurses' attitudes and perceptions in caring for patients with dementia (b), and exploring how nurses deal with challenging behaviour (c). Additionally, we determined background variables associated with caring for people with dementia. Background Due to comorbidities, people with dementia are frequently admitted to acute care hospitals. Here, they are at high risk of complications. Nurses strive for good care but regularly experience insufficient knowledge and skills regarding caring for people with dementia. Design A cross-sectional survey study design. Methods Data were collected in seven Dutch acute hospitals and through social media. In total, 229 hospital nurses completed the questionnaire. We used the Geriatric In-Hospital Nursing Care Questionnaire and two subscales of Hynninen on managing challenging behaviour. This report followed the STROBE checklist. Results Nurses express that they often apply general preventive interventions not explicitly related to dementia care. In general, nurses have mixed feelings about the nursing care provided in their department. For challenging behaviour, a variety of approaches, including restrictive measures and medication, is applied. The nurses' attitudes and perceptions are influenced by the type of hospital where the nurses work, the level of education, the number of hours nurses work, and if the nurses completed a course on dementia in the last year. Conclusions Despite a positive attitude, nurses do not have the specific knowledge and skills needed to provide proper care. Nurses who recently completed a course on dementia had more positive attitudes and perceptions towards caring for patients with dementia. Relevance to clinical practice The results of this research can be used to improve the quality of nursing care for patients with dementia in acute hospitals.

Sedentary behaviour is any waking behaviour in sitting, lying or reclining postures with low energy expenditure. High sedentary behaviour levels, common after stroke, are associated with poor health and higher levels of mobility disability. The aim of this study was to undertake a behavioural diagnosis of sedentary behaviour in the early phase after stroke to inform interventions that may reduce sedentary behaviour and associated disability. Independently mobile stroke survivors were interviewed three months after stroke. The topic guide was informed by the central layer of the Behaviour Change Wheel to explore three components: capability, opportunity and motivation. This model recognises that behaviour is the consequence of an interacting system of these components. Interviews were transcribed verbatim and analysed using The Framework Method. Thirty one people were interviewed (66.7 years; 16 male). The perception of diminished capability to reduce sedentary behaviour due to physical tiredness/fatigue, and pain/discomfort acting as both a motivator and inhibitor to movement, were discussed. Environmental barriers and the importance of social interaction were highlighted. Perceived motivation to reduce sedentary behaviour was influenced by enjoyment of sedentary behaviours, fear of falling and habitual nature of sedentary behaviours. This information will inform evidence-based sedentary behaviour interventions after stroke.Implications for rehabilitationHigher levels of sedentary behaviours are associated with poor health and stroke survivors are highly sedentary.Stroke survivors have complex reasons for spending time in sedentary behaviours including fatigue, pain, fear of falling and environmental barriers.Future interventions should educate stroke survivors on the health consequences of sedentary behaviours and encourage an increased awareness of time spent sedentary.Supporting stroke survivors to identify enjoyable and achievable activities that involve standing and movement, and ideally social interaction, is recommended. Higher levels of sedentary behaviours are associated with poor health and stroke survivors are highly sedentary. Stroke survivors have complex reasons for spending time in sedentary behaviours including fatigue, pain, fear of falling and environmental barriers. Future interventions should educate stroke survivors on the health consequences of sedentary behaviours and encourage an increased awareness of time spent sedentary. Supporting stroke survivors to identify enjoyable and achievable activities that involve standing and movement, and ideally social interaction, is recommended.

Objective: Health-care professionals (HCPs) are the frontline warriors in the time of this uncertain and unpredictable crisis of COVID. They face many challenges while caring for these patients, yet they are expected to cope with it and deliver their duties for the betterment of humankind. Our primary aim was to identify and assess the concerns of HCPs working in COVID area in a tertiary institutional isolation center. Methodology: An online Google-based questionnaire survey was distributed through various social media platforms after approval of the institutional review board to a total of 100 HCPs who were treating and managing COVID-positive patients. Results: Of 100 responses, 72% were concerned about the risk of infection to self and family, while 46% reported disruption of their daily activities at a personal level. At the institutional level, 17% were concerned about inadequate personal protective equipment-related challenges. 20% had inadequate knowledge and training about COVID. 16% of participants were anxious all the time, 11% feared all the time, and 12% had stress all the time while treating COVID patients. Connectedness and communication with family and friends, word of appreciation, music, and TV were few strategies to cope up with these challenges. Conclusion: There is a need to identify and address the concerns and challenges faced by HCPs and to develop a comprehensive strategy and guideline to provide a holistic care and to ensure their security in the workplace.

There have been concerns about high rates of thus far undiagnosed SARS-CoV-2 infections in the health-care system. The COVID-19 Contact (CoCo) Study follows 217 frontline health-care professionals at a university hospital with weekly SARS-CoV-2-specific serology (IgA/IgG). Study participants estimated their personal likelihood of having had a SARS-CoV-2 infection with a mean of 21% [median 15%, interquartile range (IQR) 5–30%]. In contrast, anti-SARS-CoV-2 IgG prevalence was about 1–2% at baseline. Regular anti-SARS-CoV-2 IgG testing of health-care professionals may aid in directing resources for protective measures and care of COVID-19 patients in the long run.

Aim: The need for pharmacogenomic education is becoming more and more urgent. Our aim was to evaluate the progress in pharmacogenomics education since then, and to put forward further recommendations. Methods: A survey was sent to 248 schools of medicine, pharmacy, nursing and health professions around the world. Results: The majority of the study programs (87%) include pharmacogenomics education, which is generally taught as part of the pharmacology curriculum. On average, educators and teachers have selected appropriate and highly relevant pharmacogenomics biomarkers to include in their teaching programs. Conclusions: Based on the results, we can conclude that the state of pharmacogenomics education at the surveyed universities has improved substantially since 2005. ispartof: PHARMACOGENOMICS vol:20 issue:9 pages:643-657 ispartof: location:England status: published

Background: Workplace bulling is a pervasive phenomenon with negative consequences for the health of victims and the productivity of organizations. The aim of this study was to measure the prevalence and forms of workplace bullying among employees working at the public health-care sector of Cyprus using the Greek version of Leymann Inventory of Psychological Terror (LIPT) instrument. Methods: A translation process was followed from the French to the Greek version of LIPT questionnaire. Test–retest reliability expressed by Pearson's correlation coefficient was 0.98 indicating excellent reproducibility. Internal consistency reliability assessed by Cronbach α coefficient was 0.87 suggesting high reliability. LIPT instrument was distributed among 403 employees working at the primary health-care setting and at the largest public hospital of Cyprus with response rate of 73.4%. Results: Women comprised the majority of participants (71.4%). Mean age was 43.3 years. Prevalence of workplace bulling according to Leymann's definition was 5.9%. Most common forms of bullying were “Being continuously interrupted” (17.2%) and “continuously being given new work assignments” (13.5%). Women were significantly more often exposed to at least one mobbing behavior than men within the previous year (49% vs. 35.7%, p = 0.038), whereas nurses were significantly exposed to at least one mobbing behavior as compared to physicians (53.3% vs. 31.4%, p = 0.004). Conclusion: This was the first study that examined the prevalence of workplace bullying in the public health-care sector by elaborating the Greek version of LIPT instrument. Results showed that workplace bullying is a common and complex phenomenon among health-care organizations. Keywords: Health-care professionals, Leymann Inventory of Psychological Terror questionnaire, Workplace bullying

Fatimah Alshakhs, Turki Alanzi Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia Purpose: The objective of this study is to evaluate the perception of health-care professionals in Saudi Arabia toward the usages of social media in health-care delivery.Methods: In this cross-sectional study, an online-based questionnaire was distributed among the health-care professionals residing in the eastern region of Saudi Arabia. Their perception toward the uses of social media in health-care service delivery was evaluated by analyzing their attitude toward its benefits and risks involved.Results: The sample size was 120 participants, and 80% of them agreed with the benefits of using social networks in health-care services and considered that the use of these technologies in the provision of health services improves their professional knowledge and is a suitable tool for patient education and public health awareness. However, some respondents (20%) believed that there are several risks associated with the use of social media, such as ethical or legal challenges, the risk to the patient’s health status, or the breaching of the privacy and confidentiality of the patient.Conclusion: The results of this research indicate that social media can be a useful tool by which physicians may promote their services and publish general health information. However, there are potential problems in the use of social networks that can have negative consequences for patients and HCPs. This implies that precautions must be taken to avoid ruptures of patient privacy and other risks that can result in legal action against health professionals damaging their image and professional status. The study also found that the participants are willing to use social media for professional purposes. Keywords: social media, health-care professionals, HCPs, Saudi Arabia

Background The aim of this article is to give more insight into what ethical challenges clinicians in mental healthcare experience and discuss with a Clinical Ethics Committee in psychiatry in the Region of Southern Denmark. Ethical considerations are an important part of the daily decision-making processes and thereby for the quality of care in mental healthcare. However, such ethical challenges have been given little systematic attention – both in research and in practices. Methods A qualitative content analysis of 55 written case-reports from the Clinical Ethics Committee. The Committee offers clinicians in mental healthcare structured ethical analyses of ethical challenges and makes a thorough written case-report. Results The ethical challenges are grouped into three overarching topics: 1. Clinicians and their relation to patients and relatives. 2. Clinicians and institutional aspects of mental healthcare 3. Clinicians and mental healthcare in a wider social context. Through presentation of illustrative examples the complexity of daily clinical life in mental healthcare becomes evident, as well as typical interests, values and arguments. Conclusions This qualitative study indicates that difficult ethical challenges are an inherent part of mental healthcare that requires time, space and competence to be dealt with adequately.

Introduction: Health-care professionals are trained health-care providers who occupy a potential vanguard position in human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) prevention programs and the management of AIDS patients. This study was performed to assess HIV/AIDS-related knowledge, attitude, and practice (KAP) and perceptions among health-care professionals at a tertiary health-care institution in Uttarakhand, India, and to identify the target group where more education on HIV is needed. Materials And Methods: A cross-sectional KAP survey was conducted among five groups comprising consultants, residents, medical students, laboratory technicians, and nurses. Probability proportional to size sampling was used for generating random samples. Data analysis was performed using charts and tables in Microsoft Excel 2016, and statistical analysis was performed using the Statistical Package for the Social Science software version 20.0. Results: Most participants had incomplete knowledge regarding the various aspects of HIV/AIDS. Attitude in all the study groups was receptive toward people living with HIV/AIDS. Practical application of knowledge was best observed in the clinicians as well as medical students. Poor performance by technicians and nurses was observed in prevention and prophylaxis. All groups were well informed about the National AIDS Control Policy except technicians. Conclusion: Poor knowledge about HIV infection, particularly among the young medical students and paramedics, is evidence of the lacunae in the teaching system, which must be kept in mind while formulating teaching programs. As suggested by the respondents, Information Education Communication activities should be improvised making use of print, electronic, and social media along with interactive awareness sessions, regular continuing medical educations, and seminars to ensure good quality of safe modern medical care.

In a new prescribing qualification course for specialist oncology nurses, we thought that it is important to emphasize pharmacovigilance and adverse drug reaction (ADR) reporting. We aimed to develop and evaluate an ADR reporting assignment for specialist oncology nurses. The quality of report documentation was assessed with the “Clinical Documentation tool to assess Individual Case Safety Reports” (ClinDoc). The relevance of the reports was evaluated in terms of ADR seriousness, the listing for additional monitoring of the drug by European Medicines Agency (EMA), and lack of labelling information about the ADR. Nurses’ opinions of the assignment were evaluated using an E-survey. Thirty-three ADRs were reported, 32 (97%) of which were well documented according to ClinDoc. Thirteen ADRs (39%) were “serious” according to CIOMS criteria. In five cases (15%), the suspect drugs were listed for additional monitoring by EMA and in seven cases (21%), the ADR was not mentioned in the Summary of Product Characteristics. Twenty-five (78.1%) of the 32 enrolled nurses completed the E-survey. Most were > 45 years of age (68%), female (92%) and had extensive clinical experience (6–33 years). All agreed or completely agreed that the reporting assignment was useful, that it fitted in daily practice and that it increased their attention for medication/patient safety. A large majority (84.0%) agreed the assignment changed how they dealt with ADRs. Specialist oncology nurses are capable of reporting ADRs, and they considered the assignment useful. The assignment yielded valuable, relevant, and well-documented ADR reports for pharmacovigilance practice. Electronic supplementary material The online version of this article (10.1007/s00210-017-1430-z) contains supplementary material, which is available to authorized users.

Introduction Pharmaceutical risk minimization programs involve interventions designed to support safe and appropriate use of medicines. Currently, information regarding the evaluation of these programs is not publicly reported in a standardized and transparent manner. To address this gap, we developed and piloted a quality reporting checklist entitled the Reporting recommendations Intended for pharmaceutical risk Minimization Evaluation Studies (RIMES). Methods Checklist development was guided by three sources: (1) a theoretical framework derived from program theory and process evaluation; (2) public health intervention design and evaluation principles; and (3) a review of existing quality reporting checklists. Two raters independently reviewed 10 recently published (2012–2016) risk minimization program evaluation studies using the proposed checklist. Inter-rater reliability of the checklist was assessed using Cohen’s Kappa and Gwet’s AC1. Results A 43-item checklist was generated. Results indicated substantial inter-rater reliability overall (κ = 0.65, AC1 = 0.65) and for three (key information, design and evaluation) of the four subscales (κ ≥ 0.64, AC1 ≥ 0.64). The fourth subscale (implementation) showed low reliability based on Cohen’s Kappa, but substantial reliability based on the AC1 (κ = 0.17, AC1 = 0.61). Conclusions The RIMES statement augments relevant elements from existing quality reporting guidelines with items that address aspects of intervention design, implementation and evaluation specific to pharmaceutical risk minimization programs. Our results show that the RIMES statement reliably measures key dimensions of reporting quality. This tailored checklist is an important first step in improving the reporting quality of risk minimization evaluation studies and may ultimately help to improve the quality of these interventions themselves.

Background and Purpose— High blood pressure (BP) is associated with poor outcome and the occurrence of symptomatic intracranial hemorrhage in acute ischemic stroke. Whether BP influences the benefit or safety of intra-arterial treatment (IAT) is not known. We aimed to assess the relation of BP with functional outcome, occurrence of symptomatic intracranial hemorrhage and effect of IAT. Methods— This is a post hoc analysis of the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment of Acute Ischemic Stroke in the Netherlands). BP was measured at baseline, before IAT or stroke unit admission. We estimated the association of baseline BP with the score on the modified Rankin Scale at 90 days and safety parameters with ordinal and logistic regression analysis. Effect of BP on the effect of IAT was tested with multiplicative interaction terms. Results— Systolic BP (SBP) had the best correlation with functional outcome. This correlation was U-shaped; both low and high baseline SBP were associated with poor functional outcome. Higher SBP was associated with symptomatic intracranial hemorrhage (adjusted odds ratio, 1.25 for every 10 mm Hg higher SBP [95% confidence interval, 1.09–1.44]). Between SBP and IAT, there was no interaction for functional outcome, symptomatic intracranial hemorrhage, or other safety parameters; the absolute benefit of IAT was evident for the whole SBP range. The same was found for diastolic BP. Conclusions— BP does not affect the benefit or safety of IAT in patients with acute ischemic stroke caused by proximal intracranial vessel occlusion. Our data provide no arguments to withhold or delay IAT based on BP. Clinical Trial Registration— URL: http://www.isrctn.com . Unique identifier: ISRCTN10888758.

There is growing awareness in the hospital setting toward pain management to decrease patients' suffering, improve postsurgical outcomes and to decrease cost.The aim of this study was to get an overview of the knowledge and attitude among health-care professionals toward pain management in the King Fahd Hospital of the University, and the need for an educational plan to improve pain service in hospitals.We conducted a survey over a 3-month period based on a 30-question questionnaire to test pain knowledge and attitude among nurses and physicians of different specialties, the level of education and years of experience.The results of the data showed that knowledge and attitude of pain were deficient and unsatisfactory.We concluded that efforts to spread knowledge and education of proper pain management among health-care professionals are required. Further surveys involving more hospitals are warranted.ملخص البحث: ازداد الوعي مؤخرا في المستشفيات عن أهمية علاج الألم لتخفيف معاناة المرضى ولتحسين نتائج العمليات الجراحية وتقليل التكلفة. تهدف هذه الدراسة إلى معرفة ومواقف توجهات العاملين بمستشفى جامعي عن علاج الألم ومدى الاحتياج لخطة تدريبية لتحسين الخدمات المرضية لهذا الغرض في المستشفيات الأخرى. وضحت هذه الدراسة المبنية على الاستبيان أن معلومات وتوجهات العاملين عن الألم وعلاجه كانت ناقصة وغير مرضية. وأوصت بتكثيف الجهود لنشر المعلومات والتدريب الملائم لعلاج الألم. كما كان من توصيات الدراسة إجراء المزيد من الدراسة عن هذا الموضوع في المستشفيات الأخرى.

Background: Disparities in health care among lesbian, gay, bisexual, or transgender (LGBT) communities have been researched in primary care, but few have examined these phenomena among LGBT inpatients. Methods: Descriptive correlational study. A questionnaire was emailed to an LGBT population for a total of 508 participants. Questionnaires addressed level of satisfaction with hospital employees and whether this was related to their sexual orientation or gender identity (SOGI). Descriptive statistics describe participants and hospitals. χ2 was used to examine satisfaction and belief based on SOGI, recommendation to LGBT friends, and the relationship between location and likelihood of recommendation. Results: Those reporting dissatisfaction were likely to indicate it was related to their SOGI. They were less likely to recommend the hospital to LGBT friends or family. Analysis between location and recommendation identified rural hospitals as less likely to be recommended. Discussion: Lesbian, gay, bisexual, or transgender patients perceived lack of courtesy by hospital employees to be related to their SOGI.

Background:\ud Since development of the Utstein style recommendations for the uniform reporting of cardiac arrest, increasing numbers of national and regional out-of-hospital cardiac arrest (OHCA) registries have been established worldwide. The International Liaison Committee on Resuscitation (ILCOR) created the Research and Registries Working Group and aimed to systematically report data collected from these registries.\ud \ud Methods:\ud We conducted two surveys of voluntarily participating national and regional registries. The first survey aimed to identify which core elements of the current Utstein style for OHCA were collected by each registry. The second survey collected descriptive summary data from each registry. We chose the data collected for the second survey based on the availability of core elements identified by the first survey.\ud \ud Results:\ud Seven national and four regional registries were included in the first survey and nine national and seven regional registries in the second survey. The estimated annual incidence of emergency medical services (EMS)-treated OHCA was 30.0 to 97.1 individuals per 100,000 population. The combined data showed the median age varied from 64 to 79 years and more than half were male in all 16 registries. The provision of bystander cardiopulmonary resuscitation (CPR) and bystander automated external defibrillator (AED) use was 19.1% to 79.0% in all registries and 2.0% to 37.4% among 11 registries, respectively. Survival to hospital discharge or 30-day survival after EMS-treated OHCA was 3.1% to 20.4% across all registries. Favourable neurological outcome at hospital discharge or 30 days after EMS-treated OHCA was 2.8% to 18.2%. Survival to hospital discharge or 30-day survival after bystander witnessed shockable OHCA ranged from 11.7% to 47.4% and favourable neurological outcome from 9.9% to 33.3%.\ud \ud Conclusion:\ud This report from ILCOR describes data on systems of care and outcomes following OHCA from nine national and seven regional registries across the world. We found variation in reported survival outcomes and other core elements of the current Utstein style recommendations for OHCA across nations and regions.

Objective Seizure at onset (SaO) has been considered a relative contraindication for intravenous thrombolysis (IVT) in patients with acute ischemic stroke, although this appraisal is not evidence based. Here, we investigated the prognostic significance of SaO in patients treated with IVT for suspected ischemic stroke. Methods In this multicenter, IVT-registry-based study we assessed the association between SaO and symptomatic intracranial hemorrhage (sICH, European Cooperative Acute Stroke Study II definition), 3-month mortality, and 3-month functional outcome on the modified Rankin Scale (mRS) using unadjusted and adjusted logistic regression, coarsened exact matching, and inverse probability weighted analyses. Results Among 10,074 IVT-treated patients, 146 (1.5%) had SaO. SaO patients had significantly higher National Institutes of Health Stroke Scale score and glucose on admission, and more often female sex, prior stroke, and prior functional dependence than non-SaO patients. In unadjusted analysis, they had generally less favorable outcomes. After controlling for confounders in adjusted, matched, and weighted analyses, all associations between SaO and any of the outcomes disappeared, including sICH (odds ratio [OR]unadjusted = 1.53 [95% confidence interval (CI) = 0.74-3.14], ORadjusted = 0.52 [95% CI = 0.13-2.16], ORmatched = 0.68 [95% CI = 0.15-3.03], ORweighted = 0.95 [95% CI = 0.39-2.32]), mortality (ORunadjusted = 1.49 [95% CI = 1.00-2.24], ORadjusted = 0.98 [95% CI = 0.5-1.92], ORmatched = 1.13 [95% CI = 0.55-2.33], ORweighted = 1.17 [95% CI = 0.73-1.88]), and functional outcome (mRS ≥ 3/ordinal mRS: ORunadjusted = 1.33 [95% CI = 0.96-1.84]/1.35 [95% CI = 1.01-1.81], ORadjusted = 0.78 [95% CI = 0.45-1.32]/0.78 [95% CI = 0.52-1.16], ORmatched = 0.75 [95% CI = 0.43-1.32]/0.45 [95% CI = 0.10-2.06], ORweighted = 0.87 [95% CI = 0.57-1.34]/1.00 [95% CI = 0.66-1.52]). These results were consistent regardless of whether patients had an eventual diagnosis of ischemic stroke (89/146) or stroke mimic (57/146 SaO patients). Interpretation SaO was not an independent predictor of poor prognosis. Withholding IVT from patients with assumed ischemic stroke presenting with SaO seems unjustified. ANN NEUROL 2019;86:770-779.

Objective To synthesize the literature on the views and experiences of patients/family members and health‐care professionals (HCPs) on the disclosure of adverse events. Methods Systematic review of qualitative studies. Searches were conducted in MEDLINE, Embase, PubMed, CINAHL and PsycINFO. Study quality was evaluated using the Critical Appraisal Skills Programme tool. Qualitative data were analysed using a meta‐ethnographic approach, comprising reciprocal syntheses of ‘patient’ and ‘health‐care professional’ studies, combined to form a lines‐of‐argument synthesis embodying both perspectives. Results Fifteen studies were included in the final syntheses. The results highlighted that there is a difference in attitudes and expectations between patients and HCPs regarding the disclosure conversation. Patients/family members expressed a need for information, the importance of sincere regret and a promise of improvement. However, HCPs faced several barriers, which hindered appropriate disclosure practices. These included difficulty of disclosure in a blame culture, avoidance of litigation, lack of skills on how to conduct disclosure and inconsistent guidance. A lines‐of‐argument synthesis is presented that identified both the key elements of an ideal disclosure desired by patients and the facilitators for HCPs, which can increase the likelihood of this taking place. Conclusions Although patients/family members and HCPs both advocate disclosure, several barriers prevent HCPs from conducting disclosure effectively. Both groups have different needs for disclosure. To meet patients’ requirements, training on disclosure for HCPs and the development of an open, transparent culture within organizations are potential areas for intervention.

Background. Practice nurses in general practice sub-optimally adhere to evidence-based smoking cessation treatment guidelines, but factors explaining their adherence have not yet been investigated. Understanding such factors is important to develop interventions improving practice nurses' smoking cessation guideline adherence and patients' subsequent cessation success. This study explored the association between different socio-cognitive and predisposing factors, and practice nurses' adherence to the Dutch smoking cessation guideline in general (i.e. overall adherence) and to each guideline step individually (i.e. step-based adherence).Methods. A cross-sectional study was conducted among practice nurses (N = 157) in January-March 2015 via web-based questionnaires, assessing constructs from the Integrated Change Model. Spearman's correlations and linear regression analysis were used to identify potential determinants of overall guideline adherence; Mann-Whitney U-tests and logistic regression analyses were used to identify potential determinants of step-based adherence.Results. On average five out of nine steps were completely adhered to by practice nurses; and step-based adherence ranged from 34% to 75%. Overall guideline adherence was associated with high levels of self-efficacy to use a guideline (beta = 0.32, P = 0.00), and step-based adherence was additionally associated with spending more time on counselling. Regression results showed positive associations between self-efficacy (8/9 steps) and perceived advantages (7/9 steps) with step-based adherence.Conclusion. This study quantitatively confirmed practice nurses' sub-optimal guideline adherence and found associations between socio-cognitive (self-efficacy and perceived advantages) and predisposing factors (time spent on counselling), and guideline adherence. Detailed insights in these factors offer preliminary directions for intervention development to improve practice nurses' adherence to evidence-based smoking cessation guidelines.

Background: Communication between parents and their children about parental life-limiting illness is stressful. Parents want support from health-care professionals; however, the extent of this support is not known. Awareness of family’s needs would help ensure appropriate support. Aim: To find the current literature exploring (1) how parents with a life-limiting illness, who have dependent children, perceive health-care professionals’ communication with them about the illness, diagnosis and treatments, including how social, practical and emotional support is offered to them and (2) how this contributes to the parents’ feelings of supporting their children. Design: A systematic literature review and narrative synthesis. Data sources: Embase, MEDLINE, PsycINFO, CINAHL and ASSIA ProQuest were searched in November 2015 for studies assessing communication between health-care professionals and parents about how to talk with their children about the parent’s illness. Results: There were 1342 records identified, five qualitative studies met the inclusion criteria (55 ill parents, 11 spouses/carers, 26 children and 16 health-care professionals). Parents wanted information from health-care professionals about how to talk to their children about the illness; this was not routinely offered. Children also want to talk with a health-care professional about their parents’ illness. Health-care professionals are concerned that conversations with parents and their children will be too difficult and time-consuming. Conclusion: Parents with a life-limiting illness want support from their health-care professionals about how to communicate with their children about the illness. Their children look to health-care professionals for information about their parent’s illness. Health-care professionals, have an important role but appear reluctant to address these concerns because of fears of insufficient time and expertise.

Introduction. All over the world people on organ transplant waiting lists die due to shortage of donor organs. The success of organ donation program needs education of the population regarding organ donation for which healthcare professionals are most suitable. The present study was taken up to assess the knowledge and attitude of 1st, 2nd and 3rd year medical students about organ donation. Methods. A specially designed self-administered questionnaire was distributed amongst all willing 1st, 2nd and 3rd year medical students at our Medical College and later analyzed statistically. Results. A total of 157, 145 and 92 students from each year of medical education respectively gave their consent for participation in the study. Awareness regarding organ donation was found to be 98.7-100%, 69.4% claimed television as their source of information regarding organ donation and 46.7% stated that it is possible for patient to recover from brain death. The awareness regarding eye, liver, heart and kidney donations was found to be 92.4%, 87%, 87% and 97.8%, respectively. 87% of medical students were aware of need for legal supervision, and awareness regarding the existing laws was found to be 57.6%. Conclusion. Medical students had a high level of awareness and a positive attitude towards organ donation. However, knowledge regarding “brain-death”, organs and tissues donated, legislation and ethical issues was poor. A teaching intervention designed to specifically address these issues could help increase the confidence of the health-care professionals and may result finally in increased organ procurement rates.

BackgroundAlthough Female Genital Mutilation/Cutting (FGM/C) is internationally considered a harmful practice, it is increasingly being medicalized allegedly to reduce its negative health effects, and is thus suggested as a harm reduction strategy in response to these perceived health risks. In many countries where FGM/C is traditionally practiced, the prevalence rates of medicalization are increasing, and in countries of migration, such as the United Kingdom, the United States of America or Sweden, court cases or the repeated issuing of statements in favor of presumed minimal forms of FGM/C to replace more invasive forms, has raised the debate between the medical harm reduction arguments and the human rights approach.Main bodyThe purpose of this paper is to discuss the arguments associated with the medicalization of FGM/C, a trend that could undermine the achievement of Sustainable Development Goal 5.3. The paper uses four country case studies, Egypt, Indonesia, Kenya and UK, to discuss the reasons for engaging in medicalized forms of FGM/C, or not, and explores the ongoing public discourse in those countries concerning harm reduction versus human rights, and the contradiction between medical ethics, national criminal justice systems and international conventions. The discussion is structured around four key hotly contested ethical dilemmas. Firstly, that the WHO definition of medicalized FGM/C is too narrow allowing medicalized FGM to be justified by many healthcare professionals as a form of harm reduction which contradicts the medical oath of do no harm. Secondly, that medicalized FGM/C is a human rights abuse with lifelong consequences, no matter who performs it. Thirdly, that health care professionals who perform medicalized FGM/C are sustaining cultural norms that they themselves support and are also gaining financially. Fourthly, the contradiction between protecting traditional cultural rights in legal constitutions versus human rights legislation, which criminalizes FGM/C.ConclusionMore research needs to be done in order to understand the complexities that are facilitating the medicalization of FGM/C as well as how policy strategies can be strengthened to have a greater de-medicalization impact. Tackling medicalization of FGM/C will accelerate the achievement of the Sustainable Development Goal of ending FGM by 2030.

Objectives Successful, non-pharmacological research interventions are challenging to implement in clinical practice. The aim of the study was to understand the experiences of rheumatology nurses and occupational therapists (tutors) delivering a novel fatigue intervention in a trial setting, and their views on requirements for clinical implementation. After training, tutors delivered courses of a manualized group cognitive-behavioural intervention to patients with RA in a seven-centre randomized controlled trial [Reducing Arthritis Fatigue by clinical Teams using cognitive-behavioural approaches (RAFT)], which demonstrated reduced fatigue impact at 2 years. Methods Fourteen tutors participated in interviews, and eight tutors also participated in a focus group. Data were audio-recorded, transcribed and analysed using inductive thematic analysis. Results The following five main themes were identified: ‘exciting but daunting’ reflected the mixture of excitement and anxiety in intervention training and delivery; ‘skills practice and demonstrations were essential’ captured the value of learning and practising together, even though the process could be uncomfortable; ‘an individual approach to a standardized intervention’ showed how tutors negotiated adherence to the manual with delivery using their own words; ‘becoming a better practitioner’ described how participation enhanced tutors’ wider clinical practice; and ‘pragmatic and flexible’ highlighted practical adaptations to facilitate training and intervention roll out. Conclusion These insights inform strategies for clinical implementation of an evidence-based intervention that addresses a patient priority, with implications for other successful research interventions. Tutors believed that the skills acquired during RAFT enhanced their wider clinical practice, which highlights the benefits of upskilling members of clinical teams to provide self-management support to patients.

A body of work emerging in the last few years has expanded the focus of youth sexual health to include problems in sexual functioning. Recent surveys show that rates of youth sexual functioning problems are similar to those of adults. Physicians' lack of awareness about problems of sexual functioning has been identified as a major obstacle in treatment. Yet little is known about health-care provider (HCP) perspectives on youth sexual functioning. We conducted a descriptive qualitative study with HCPs to learn about their perceptions of adolescent sexual problems and HCP roles in managing these issues including sexual functioning. Nineteen HCPs: Family physicians, nurse practitioners, and public health nurses working primarily with youth in universities, schools, or sexual health clinics were recruited to draw on their expert knowledge and experience. All completed in-depth individual interviews. Data were analyzed using directed qualitative content analysis. Our findings illuminate inconsistent views. Some HCPs, particularly those in youth-focused services, adopt a holistic role in promoting healthy sexual functioning, and others, commonly those in general practice, attend only to biomedical issues related to sexual dysfunction. All HCPs in our study were challenged by a paucity of sexual health preparation in their formal education. HCP interest in youth sexual health affected their efforts to acquire new information and training and, along with the structure of their practice setting, influenced whether they framed their role in youth sexual health holistically within a context of social determination or constrained their role to a medical model. These findings draw attention to the need for new approaches for strengthening knowledge, training, and resources to foster HCP promotion of healthy sexual functioning and prevention of lifelong sexual health problems.

BackgroundRecruitment to randomised controlled trials (RCTs) is challenging. Pre-trial qualitative research provides insights into the feasibility and acceptability of proposed trial designs and delivery; however, this is rarely conducted. This paper reports on work undertaken in advance of the Prepare for Kidney Care trial (formerly PrepareME), which compares preparing for dialysis with preparing for conservative care for patients with chronic kidney disease. The paper describes how the findings refined plans for the forthcoming trial.MethodsSemi-structured interviews were undertaken with health-care professionals involved in delivering or recruiting to the trial. Interview findings were considered in relation to observations of a patient advisory group workshop and introductory site visits, which were set up to present the trial to professionals involved in the internal pilot phase of the RCT. The use of findings and input from multiple sources was intended to support suggested refinements to the forthcoming trial. The findings were fed back to the trial management group and other expert stakeholders.ResultsSixteen health-care professionals were interviewed, and one patient advisory group workshop and six introductory visits to sites involved in the internal pilot were observed. The professionals interviewed included renal consultants, nurses and renal social workers. Key themes identified from the interviews, supported by the observations, were concerns around the eligibility criteria, the feasibility of the trial intervention, imbalances in the presentation of the trial arms, and anticipated recruitment issues arising from patients’ and clinicians’ preferences for one arm or the other. Changes to the design were made in response, including to the content of the intervention, the presentation of the trial arms and the name of the RCT.ConclusionsThis study highlights the value of carrying out pre-trial work with health-care professionals to identify issues with delivering the proposed trial. This work can be particularly valuable in trials of new interventions, for which the barriers to their integration into routine care are unknown. This work has important implications for facilitating the identification of further obstacles in the main RCT. We suggest that pre-trial qualitative work is undertaken to address design issues early on, in addition to ongoing qualitative research to monitor the emergence of obstacles affecting recruitment.

BACKGROUND: Patient safety incident reporting systems (PSRS) have been established for over a decade, but uncertainty remains regarding the role that they can and ought to play in quantifying healthcare-related harm and improving care.OBJECTIVE: To establish international, expert consensus on the purpose of PSRS regarding monitoring and learning from incidents and developing recommendations for their future role.METHODS: After a scoping review of the literature, semi-structured interviews with experts in PSRS were conducted. Based on these findings, a survey-based questionnaire was developed and subsequently completed by a larger expert panel. Using a Delphi approach, consensus was reached regarding the ideal role of PSRSs. Recommendations for best practice were devised.RESULTS: Forty recommendations emerged from the Delphi procedure on the role and use of PSRS. Experts agreed reporting system should not be used as an epidemiological tool to monitor the rate of harm over time or to appraise the relative safety of hospitals. They agreed reporting is a valuable mechanism for identifying organisational safety needs. The benefit of a national system was clear with respect to medication error, device failures, hospital-acquired infections and never events as these problems often require solutions at a national level. Experts recommended training for senior healthcare professionals in incident investigation. Consensus recommendation was for hospitals to take responsibility for creating safety solutions locally that could be shared nationally.CONCLUSIONS: We obtained reasonable consensus among experts on aims and specifications of PSRS. This information can be used to reflect on existing and future PSRS, and their role within the wider patient safety landscape. The role of PSRS as instruments for learning needs to be elaborated and developed further internationally.

The complexity of drug therapies has increased the need to evaluate the drug information scientifically. In this regard, the aim of drug information centers (DICs) is to promote rational use of drugs in a health-care setting. DI pharmacists play a vital role in providing the necessary and reliable information on drugs to promote the concept of rational drug use, eventually leading to a better patient outcome. The objective of the present study was to assess the drug-related queries received by the DIC at the King Saud Medical City (KSMC) from health-care professionals working in a large tertiary care setting. Methods: A retrospective analysis was conducted from February 2016 to January 2017. Data were collected using the DI request form, available in both printed and electronic formats for use by the health-care professionals. Descriptive statistics were used to calculate frequencies and percentages. Data analysis was performed using the Statistical Package of the Social Sciences software, version 16.0. Results: The current study received a total of 139 queries that were answered by the DIC pharmacists over a period of 1 year. The majority of queries were asked by pharmacists (61.2%), followed by physicians (23.7%) and nurses (10.10%). About half of the queries were related to the dosage and administration of the drugs. Lexicomp® acted as the common resource of information. Conclusion: DIC has been instrumental in the dissemination of drug-related information to health-care professionals since its inception in February 2016, resulting in the provision of quality health care to the patients. However, based on yearly queries, there still exists a need to increase the awareness of health-care professionals about the DIC at KSMC, which will urge them to take drug consultation from DIC pharmacists and promote patient safety., published version, peerReviewed

Objectives: Patients value health-care professionals’ attention to their spiritual needs. However, this is undervalued in health-care professionals’ education. Additional training is essential for implementation of a national multidisciplinary guideline on spiritual care (SC) in palliative care (PC). Aim of this study is to measure effects of a training program on SC in PC based on the guideline. Methods: A pragmatic multicenter trial using a quasi-experimental pretest–posttest design as part of an action research study. Eight multidisciplinary teams in regular wards and 1 team of PC consultants, in 8 Dutch teaching hospitals, received questionnaires before training about perceived barriers for SC, spiritual attitudes and involvement, and SC competencies. The effect on the barriers on SC and SC competencies were measured both 1 and 6 months after the training. Results: For nurses (n = 214), 7 of 8 barriers to SC were decreased after 1 month, but only 2 were still after 6 months. For physicians (n = 41), the training had no effect on the barriers to SC. Nurses improved in 4 of 6 competencies after both 1 and 6 months. Physicians improved in 3 of 6 competencies after 1 month but in only 1 competency after 6 months. Significance of Results: Concise SC training programs for clinical teams can effect quality of care, by improving hospital staff competencies and decreasing the barriers they perceive. Differences in the effects of the SC training on nurses and physicians show the need for further research on physicians’ educational needs on SC.

Background and purpose: Until now, stroke and transient ischemic attack (TIA) have been clinically based terms which describe the presence and duration of characteristic neurological deficits attributable to intrinsic disorders of particular arteries supplying the brain, retina, or (sometimes) the spinal cord. Further, infarction has been pathologically defined as death of neural tissue due to reduced blood supply. Recently, it has been proposed we shift to definitions of stroke and TIA determined by neuroimaging results alone and that neuroimaging findings be equated with infarction. Methods: We examined the scientific validity and clinical implications of these proposals using the existing published literature and our own experience in research and clinical practice. Results: We found that the proposals to change to imaging-dominant definitions, as published, are ambiguous and inconsistent. Therefore, they cannot provide the standardization required in research or its application in clinical practice. Further, we found that the proposals are scientifically incorrect because neuroimaging findings do not always correlate with the clinical status or the presence of infarction. In addition, we found that attempts to use the proposals are disrupting research, are otherwise clinically unhelpful and do not solve the problems they were proposed to solve. Conclusion: We advise that the proposals must not be accepted. In particular, we explain why the clinical focus of the definitions of stroke and TIA should be retained with continued sub-classification of these syndromes depending neuroimaging results (with or without other information) and that infarction should remain a pathological term. We outline ways the established clinically based definitions of stroke and TIA, and use of them, may be improved to encourage better patient outcomes in the modern era.

This pilot study explored the effects of a mindfulness meditation intervention on nurses’ perceived stress and compassion. A quasi-experimental pre-test/post-test design was used. Nurses ( n = 90) working at three university teaching hospitals completed the Perceived Stress Scale and Compassion Scale at the beginning of the training and 64 completed the scales at the end of the training. The 64 matched data sets were analysed using the t -test, chi-square test and analysis of variance. The findings indicated that the nurses’ perceived stress was significantly reduced after the intervention. Notably, compassion scores were increased after the intervention, and this finding was significant for nurses working at one of the hospitals. There were no significant differences between results from a 6-week and an 8-week mindfulness intervention. The results suggest that mindfulness meditation training can impact positively on nurses’ perceived stress and also enhance nurses’ compassion. Mindfulness may well be a suitable self-care, stress-management intervention that can effectively teach nurses coping skills to assist them in managing the daily stressors inherent in their home and work life.