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Treatment adherence is one of the milestones in the care of hypertensive patients, with new information and communication technologies as potential educational tools. This study aimed to evaluate the add-on effect of a digital cartoon educative video on the therapeutic observance of patients followed up in the General Hospital Yaoundé compared to standard of care. We conducted a randomized simple blind clinical trial at the cardiology unit of the Yaoundé General Hospital over a 6-month period from 1st March to 30th August 2022. We enrolled 110 patients and randomized them in blocs of 4 creating two groups of 57 and 53, respectively, without (group 1) and with (group 2) intervention. Preintervention treatment adherence was assessed using the Morisky Medication Adherence Scale (MMAS). In the standard group (G1), we provided standard paper-based clinical counselling, including oral advice, and in the intervention group (G2), we did the same and added a digital cartoon video containing exactly the same message as images and audio. The primary outcome was medication adherence after three months. The mean age was 56.65 ± 10.98 years in group 1 (paper) and 56.42 ± 10.46 years in group 2 (paper + video), without any significant difference. The two groups were similar regarding the proportion of females (36.8% in G1 and 49.3% in G2) and educational levels. According to the Morisky medication adherence scale, before the intervention, the proportions of patients with good, medium and low treatment adherence in groups 1 and 2 were 7%, 25.6%, 67.4%, and 5.1%, 43.6%, 51.3%, respectively, without any significant difference. After interventions, the proportion of patients presenting a good observance moved from 7 to 11% in group 1 (paper) and 5.1 to 20% in group 2 (paper + video). The intragroup variation in treatment adherence in the intervention group (before-after) tended to be significant, with a p-value = 0.0572, while this p-value was 0.712 in the standard group. Our results provide insight into how digital cartoon videos can help to have an add-on effect on the treatment adherence of hypertensive patients, with clinical significance.

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.)

Objectives: To describe and reflect on the consumer engagement approaches used in five living guidelines from the perspectives of consumers (i.e., patients, carers, the public, and their representatives) and guideline developers., Study Design and Setting: In a descriptive report, we used a template to capture engagement approaches and the experiences of consumers and guideline developers in living guidelines in Australia and the United Kingdom. Responses were summarized using descriptive synthesis., Results: One guideline used a Consumer Panel, three included two to three consumers in the guideline development group, and one did both. Much of our experience was common to all guidelines (e.g., consumers felt welcomed but that their role initially lacked clarity). We identified six challenges and opportunities specific to living guidelines: managing the flow of work; managing engagement in online environments; managing membership of the panel; facilitating more flexibility, variety and depth in engagement; recruiting for specific skills-although these can be built over time; developing living processes to improve; and adapting consumer engagement together., Conclusion: Consumer engagement in living guidelines should follow established principles of consumer engagement in guidelines. Conceiving the engagement as living, underpinned by a living process evaluation, allows the approach to be developed with consumers over time., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The COVID-19 pandemic and the UK government's subsequent coronavirus action plan have fundamentally impacted on every aspect of healthcare. One area that is severely affected is ear, nose and throat (ENT)/laryngology where speech and language therapists (SLTs) engage in a diverse range of practice with patients with a range of conditions, including voice disorders, airway problems, and head and neck cancers (HNCs). A large majority of these patients are in high-risk categories, and many specialized clinical practices are vulnerable. In addition, workforce and research issues are challenged in both the immediate context and the future. Aims: To discuss the threats and opportunities from the COVID-19 pandemic for SLTs in ENT/laryngology with specific reference to clinical practice, workforce and research leadership. Methods & Procedures: The relevant sections of the World Health Organisation's (WHO) health systems building blocks framework (2007) were used to structure the study. Expert agreement was determined by an iterative process of multiple-group discussions, the use of all recent relevant policy documentation, and other literature and shared documentation/writing. The final paper was verified and agreed by all authors. Main Contribution: The main threats to ENT/laryngology SLT clinical services include increased patient complexity related to COVID-19 voice and airway problems, delayed HNC diagnosis, reduced access to instrumental procedures and inequitable care provision. The main clinical opportunities include the potential for new modes of service delivery and collaborations, and harnessing SLT expertise in non-instrumental assessment. There are several workforce issues, including redeployment (and impact on current services), training implications and psychological impact on staff. Workforce opportunities exist for service innovation and potential extended ENT/SLT practice roles. Research is threatened by a reduction in immediate funding calls and high competition. Current research is affected by very limited access to participants and the ability to conduct face-to-face and instrumental assessments. However, research opportunities may result in greater collaboration, and changes in service delivery necessitate robust investigation and evaluation. A new national set of research priorities is likely to emerge. Conclusions & Implications: The immediate impact of the pandemic has resulted in major disruption to all aspects of clinical delivery, workforce and research for ENT/laryngology SLT. It is unclear when any of these areas will resume operations and whether permanent changes to clinical practice, professional remits and research priorities will follow. However, significant opportunity exists in the post-COVID era to re-evaluate current practice, embrace opportunities and evaluate new ways of working.

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]

Under the rapid advances of digital technology, traditional paper-based forms of reading and writing are steadily giving way to digital-based literacies, in theory as well as in application. Drawing on a study of literacy in a medical workplace context, this article examines critically the shift toward computer-mediated textual practices. While a considerable body of research has investigated benefits and issues associated with digital literacy tools in medicine, we consider the affordances of paper-based practices. Our analysis of verbal interaction and textual artifacts drawn from a qualitative study of oncology visits indicates that the uses of pen and paper are advantageous for both doctor and patient. Specifically, they allow doctors to process and package information in ways that are favorable to their personal modus operandi, and they enable patients to participate in the medical visit and take an active role in managing their medical treatment. Understanding the affordances of paper-based literacy provides insights for refining digital tools as well as for motivating the design of possible hybrid forms and digital-analog intersections that can best support medical practices.

This commentary discusses 4 issues relevant to interpretation of A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) article: (a) Self-reported compliance in medical settings has generally been substantially higher than verified compliance, suggesting that this is not a rare phenomenon; (b) none of the studies reported in Green et al. explicitly verified paper diary compliance; (c) the impact of participant motivation on diary compliance is unknown, and it may be difficult for researchers to accurately assess it in their own studies; and (d) without objective verification of diary compliance, analysis of the effects of noncompliance on data quality is difficult to interpret. The authors conclude that compliance in paper diaries and the effects of noncompliance on data quality are still unsettled issues.

The authors applaud A. S. Green, E. Rafaeli, N. Bolger, P. E. Shrout, and H. T. Reis's (2006) response to one-sided comparisons of paper versus electronic (plastic) diary methods and hope that it will stimulate more balanced considerations of the issues involved. The authors begin by highlighting areas of agreement and disagreement with Green et al. The authors review briefly the broader literature that has compared paper and plastic diaries, noting how recent comparisons have relied on study designs and methods that favor investigators' allegiances. The authors note some sorely needed data for the evaluation of the implications of paper versus plastic for the internal and external validity of research. To facilitate evaluation of the existing literature and assist in the design of future studies, the authors offer a balanced comparison of paper and electronic diary methods across a range of applications. Finally, the authors propose 2 study designs that offer fair comparisons of paper and plastic diary methods.

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.

Background: Socially marginalised people are at a substantially increased risk of diseases and typically have several contacts with the healthcare system. Health professionals at hospitals often lack the knowledge, skills, confidence, and time to provide relevant care for socially marginalised patients. Danish hospitals have implemented a social nursing initiative consisting of social nurses with specialised knowledge about marginalisation to support socially marginalised patients. Limited research into patients' perceptions of social nursing has been undertaken., Objective: To explore patients' experiences with the in-hospital social nursing initiative., Design: A qualitative study was conducted using a phenomenological hermeneutical approach., Setting: Odense University Hospital, Denmark., Participants: Patients aged 18 years and older who had been in contact with a social nurse during hospital admission were purposely sampled. Data saturation was reached when 15 participants were recruited., Methods: In-depth patient interviews were conducted from November 2021 to April 2022 using a semi-structured interview guide. The interviews were transcribed verbatim and analysed using systematic text condensation. NVivo 12 software was employed for the analysis. Patient representatives were involved to validate the analysis and interpretations., Results: Three themes were identified: (1) an equal and trusting relationship, (2) receiving person-centred care, and (3) coherence in the patient trajectory. The results show that when patients have established a relationship with a social nurse, they are willing to let her into their lives and share personal information. Patients also experience person-centred care and coherence in their trajectory when a social nurse participated in their treatment and care., Conclusion: The findings indicate that the social nursing initiative bridges the gap between socially marginalised patients and healthcare services., (© 2023 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

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)

Objectives: To explore the feasibility and value of using real patients as trigger material in problem-based learning (PBL)., Design: A questionnaire was given to all students participating in a PBL module including a question about 'the added value of using real, as opposed to paper cases', in problem-based learning. Resources used by students and assessment of feasibility were recorded by the course tutors., Setting: A 7-week student-selected problem-based module in general practice in the fourth-year undergraduate medical curriculum, University of Newcastle upon Tyne., Subjects: 69 students participating in the module over 2 years., Results: All students valued the use of real patients. A total of 10 categories were identified, all congruent with accepted educational principles for effective adult learning. Real patients stimulated the use of a very wide range of resources and imaginative presentation of what had been learned., Conclusion: Real patients are potent trigger stimuli in problem-based learning. The use of real patients in this general practice-based module presented no organizational or ethical difficulties. Their use should be considered more widely.

Point-of-care sonography is a precondition in acute and emergency medicine for the diagnosis and initiation of therapy for critically ill and injured patients. While emergency sonography is a mandatory part of the training for clinical acute and emergency medicine, it is not everywhere required for prehospital emergency medicine. Although some medical societies in Germany have already established their own learning concepts for emergency ultrasound, a uniform national training concept for the use of emergency sonography in the out-of-hospital setting is still lacking. Experts of several professional medical societies have therefore joined forces and developed a structured training concept for emergency sonography in the prehospital setting. The consensus paper serves as quality assurance in prehospital emergency sonography. [ABSTRACT FROM AUTHOR]

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).)

Patient selection and appliance design are important factors in the development of intra-oral models. Adults, rather than children, are recommended as panelists due to their similarity to children in response to fluoride for caries prevention, greater likelihood of compliance with all study requirements, and greater availability for appointments. It may be desirable for additional factors--including the presence of cariogenic micro-organisms and the characteristics of their saliva with regard to remineralization--to be used in the selection of panelists. Cross-over test designs may be desirable to minimize the impact of these variables as well as of dietary differences. Appliances should be designed to approximate the normal oral conditions to the maximum extent possible. Intra-oral models should be capable not only of detecting the effects of clinically-proven fluoride treatments but also of detecting fluoride dosage responses.

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.

Purpose: This paper aims to focus on the involvement of mental healthcare professionals in a co-design process of a digital healthcare platform. Many people with severe mental disorders need constant support and monitoring, and with long waiting lists and scarce resources in mental healthcare, there is a dire need for innovative digital solutions to counteract those issues. This paper elaborates on a co-design process of a digital platform and mobile app designed for people with mental disorders. The platform primarily considers two perspectives: (i) the patients and (ii) the healthcare professionals. Design/methodology/approach: This paper is based on canonical action research, where the co-design involvement with 13 healthcare professionals is analyzed and their interactions with three primary scenarios are focused. Findings: The main contribution of this paper is three co-design principles: (i) clarity and information accessibility regarding the patient's side, (ii) efficiency and flexibility when it comes to the healthcare professional's side and (iii) a notification function in the mobile application. Originality/value: The theoretical contribution is the conceptualization of the three co-design principles that others can use when designing digital platforms in healthcare in general and psychiatric care in particular. The practical contributions are firstly outlined through the co-design process itself, where scenarios to guide the work are used, and secondly, the improvements made in the digital platform derived from the results of the co-design process.

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.

Discusses these changes in mental health care: patient needs and service utilization; purchasers of care; changing attitudes toward health care; relief or palliation of symptoms; performing life tasks and meeting role requirements; security, protection, and sustenance; and personal potential, satisfaction, and happiness. Concludes changes will result in a multitiered system with controlled access to services. (ABL)

Aims and Objectives: To explore organisation‐wide experiences of person‐centred care and risk assessment practices using existing healthcare organisation documentation. Background: There is increasing emphasis on multidimensional risk assessments during hospital admission. However, little is known about how nurses use multidimensional assessment documentation in clinical practice to address preventable harms and optimise person‐centred care. Design: A qualitative descriptive study reported according to COREQ. Methods: Metropolitan tertiary hospital and rehabilitation hospital servicing a population of 550,000. A sample of 111 participants (12 patients, 4 family members/carers, 94 nurses and 1 allied health professional) from a range of wards/clinical locations. Semi‐structured interviews and focus groups were conducted at two time points. The audio recording was transcribed, and an inductive thematic analysis was used to provide insight from multiple perspectives. Results: Three main themes emerged: (1) 'What works well in practice' included: efficiency in the structure of the documentation; the Introduction, Situation, Background Assessment, Recommendation (ISBAR) framework and prompting for clinical decision‐making were valued by nurses; and direct patient care is always prioritised. (2) 'What does not work well in practice': obtaining the patient's signature on daily care plans; multidisciplinary (MDT) involvement; duplication of paperwork and person‐centred goals are not well‐captured in care plan documentation. (3) 'Experience of care'; satisfaction of person‐centred care; communication in the MDT was important, but sometimes insufficient; patients had variable involvement in their daily care plan; and inadequate integration of care between MDT team which negatively impacted patients. Conclusions: Efficient and streamlined documentation systems should herald feedback from nurses to address their clinical workflow needs and can support, and capture, their decision‐making that enables partnership with patients to improve the individualisation of care provision. Relevance to clinical practice: The integration of effective MDT involvement in clinical documentation was problematic and resulted in unmet supportive care from the patient's perspective. [ABSTRACT FROM AUTHOR]

COVID‐19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID‐19 pandemic (April 2020), the U. S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear‐ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (a) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturisers; (b) Frequent PPE offloading to relieve pressure and shear applied to skin; (c) treat visible skin injuries immediately caused by PPE to minimise future infection; (d) non‐porous dressings may provide additional skin protection, but lack evidence; (e) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence‐based recommendations on prevention of device‐related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long‐term effects (e.g. scarring). These simple steps to minimise the risk of skin injury and reduce the risk of coronavirus infection from PPE can help. [ABSTRACT FROM AUTHOR]

Objective: The medical record is critical for documentation and communication between healthcare professionals. This study compared the completeness of orthopaedic documentation between the electronic medical record (EMR) and paper medical record (PMR). Methods: A review was undertaken of 400 medical records (200 EMR, 200 PMR) of patients with operatively managed traumatic lower limb injury. The operative report, discharge summary and first and second out-patient reviews were evaluated using criteria designed by a senior orthopaedic surgeon and senior physiotherapist. The criteria included information deemed critical to the post-operative care of the patient in the first 6 weeks post-surgery. Results: In all cases, an operative report was completed by a senior surgeon. Notable findings included inferior documentation of patient weight-bearing status on the operative report in the EMR than PMR group (P = 0.018). There was a significant improvement in the completion of discharge summaries in the EMR compared with PMR cohort (100% vs 82.5% respectively; P < 0.001). In the PMR group, 70.0% of discharge summaries were completed and adequately documented, compared with 91.5% of those in the EMR group (P < 0.001). At out-patient review, there was an improvement in documentation of weight-bearing instructions in the EMR compared with PMR group (81.1% vs 76.2% respectively; P = 0.032). Conclusion: The EMR is associated with an improvement in the standard of orthopaedic medical record documentation, but deficiencies remain in key components of the medical record. What is known about the topic?: Medical records are an essential tool in modern medical practice and have significant implications for patient care and management, communication and medicolegal issues. Despite the importance of comprehensive documentation, numerous examples of poor documentation continue to be demonstrated. Recently, significant changes to the medical record in Australia have been implemented with the conversion of some hospitals to an EMR and the implementation of the My Health Record. What does this paper add?: Standards of patient care should be monitored continuously and deficiencies identified in order to implement measures for improvement and to close the quality loop. This study has highlighted that although there has been improvement in medical record keeping with the implementation of an EMR, the standard of orthopaedic medical record keeping continues to be below what is expected, and several key areas of documentation require improvement. What are the implications for practitioners?: The implications of these findings for practitioners are to highlight current deficiencies in documentation and promote change in current practice to improve the quality of medical record documentation among medical staff. Although the EMR has improved documentation, there remain areas for further improvement, and hospital administrators will find these observations useful in implementing ongoing change. [ABSTRACT FROM AUTHOR]

Objectives: A national electronic health record is being procured for Health Service Executive hospitals in Ireland. A number of hospitals have implemented an electronic document management system. This study aimed to investigate the efficiency and safety of the electronic document management system in our centre. Methods: A retrospective audit was performed of patients operated on at Galway University Hospital. The availability and location of patients' admission data on the electronic document management system were recorded. These data were analysed using Microsoft Excel software, version 16.45. Results: The records of 100 patients were analysed. The main findings were: 5 per cent of operation notes were missing, 80 per cent were in the incorrect section, while 15 per cent were in the correct 'procedure' section on the electronic document management system. Conclusion: This study shows there is potential for error with 'paper-light' solutions, whereby delayed scanning, misfiling of scanned records and missing records may lead to significant delays in treatment and potential patient safety issues. [ABSTRACT FROM AUTHOR]

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).

Background: Health system responsiveness (HSR)-the ability of a health system to meet the non-medical legitimate expectations of patients-is a key to patient-centred health systems. Although responsiveness is essential to provide equitable and accountable health care, little is known about patient-side drivers of HSR. This study aims to narrow this gap., Methods: A survey among 20,000 Germans with substitutive private health insurance included questions on HSR and patient characteristics such as health literacy (HL), experienced discrimination, and sociodemographic information. Survey data were linked to patient-level claims data. Logistic regression was applied to assess the association between HSR and patient characteristics., Results: The sample (age 54.0 ± 16.1; 60.5% male) contains 2951 respondents with outpatient physician care in the past year. Of the nine HSR items, eight are rated as (very) good (74.4%-94.3%), except for coordination between providers (60.2%). Patient characteristics highly influence HSR: patients with high HL, for instance, are more likely to assess responsiveness as (very) good (e.g., clear explanations from physicians: OR 4.17). Poor assessment of responsiveness is seen among users who experienced discrimination., Conclusion: This study revealed new associations between HSR and patient characteristics. Incorporating this knowledge in practice would help strengthen patient-centred health services by considering patient experiences and expectations. This highlights that HSR can be used as a tool to evaluate and promote patient-centred health services. Future research should investigate additional drivers of HSR, both on the patient and the provider sides., (© 2022 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.)

As early as 1687, Gerard Langbaine noted the tendency of the most prolific Restoration playwrights to borrow from a plurality of sources for a single play. While Langbaine's identifications of playwrights' source materials, or "thefts," have been widely expanded upon in recent decades, the precise nature (and implications) of such borrowings have been underexplored. This essay will demonstrate how close comparison between a Restoration play and its paper stage sources contributes to an understanding of what might be at issue in such "thefts." This essay's focus is on two plays by Aphra Behn: The Rover (1677) and Sir Patient Fancy (1678). [ABSTRACT FROM AUTHOR]

Medical training has become a global phenomenon, and the Physician's Charter (PC), as a missionary document, is key to training those outside the Global North. Undergraduate and postgraduate students in the medical profession are sometimes trained in contexts foreign to their social and ontological backgrounds. This might lead to confusion and blunders, creating an impression of what might look and feel unprofessional to those unfamiliar with the local context. Understanding the cultural backgrounds of the trainees is crucial, and the reverse is also as important. It is essential for clinicians and trainees to understand the cultural backgrounds of their patients to avoid miscommunication. In this phenomenological study, we recruited participants in 2020 who were in their first to fourth year of study of medical training during the #FeesMustFall protests. We used data from this extensive study looking at students' experiences during their training amidst protest and social upheavals in a South African tertiary institution. For this paper, we examined what professionalism means to the student participants using an African Ubuntu lens. Ubuntu and the Collective Finger theory were used to investigate what professionalism means to participants. The Ubuntu philosophy was compared to the PC. In the findings, the clinical space is hierarchical, silencing and the opposite of what Ubuntu means. In comparison to the PC, respect is overarching while compassion and responsibility are the most comparable to the Charter. This study adds an African voice to the professionalism discourse while showing African elements that could be aligned to the PC to challenge the current global discourses.

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]