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Observational studies in critical care medicine offer a popular and practical approach to questions of treatment effectiveness. Although observational research is widely understood to be susceptible to design and interpretation challenges, one well-described source of bias-immortal time bias (ITB)-is frequently present yet often overlooked. ITB may be introduced by study design oversights or mishandled during data analysis. When present, ITB can create inappropriate estimates of the benefit or harm of an exposure or intervention. Studies examining treatments in critically ill patients may be particularly susceptible to ITB, with consequences for clinical adoption and design and initiation of randomized trials. In this Critical Care Perspective, we illustrate the persistent problem of ITB in observational research using recent studies of hydrocortisone, ascorbic acid, and thiamine therapy in patients with sepsis and septic shock. Of the eight studies examined, none contained enough design or reporting elements to rule out the presence of ITB. To mitigate the influence of ITB in future observational studies, we present a novel checklist to help readers assess the features of study design, analysis, and reporting that introduce ITB or obscure its presence. We recommend that commonly used tools designed to evaluate observational research studies should include an ITB assessment.

Care transitions (CT) are critical junctures in the healthcare delivery process. Effective transitions reduce the need for subsequent transfers between healthcare settings, including nursing homes. Understanding social services (SS) involvement in these processes in nursing homes is important from a quality and holistic care perspective. Using logistic regression, this study examines structural and relational factors identified with higher involvement of SS in care transitions and admissions. SS directors from 924 nursing homes were evaluated in relation to SS involvement in care transitions and admissions processes. Results suggest the level of SS involvement in care transitions and admissions are associated with structural factors such as size of facility, geographical location, ratio of FTE's to beds, ownership status, and standalone SS departments, as well as relational factors, including perceptions and utilization of SS staff by facility leadership, coworkers, and family. Additionally, SS staff with higher levels of expertise and with social work degrees are less involved in admissions tasks.

This article, understanding populism as an essentially undemocratic ideology, argues that the pro‐social theatre education approach of ensemble pedagogy can offer a model of educational practice which counters these anti‐democratic rhetorics by creating a shared space for the enactment of empathetic discourse. Via an ethnography of the UK Shakespeare Schools Foundation festival project, the notion of the theatre education ensemble ‘family’ as a model of civic caring is offered as an alternative, feminist ‘care perspective’ on civic and political rhetorics, in contrast to the patriarchal ‘justice perspectives’ which facilitate the reductive anti‐democratic rhetorics of populism. Thus, this article concludes that ensemble approaches to theatre education, viewed through this feminist pedagogy lens, hold rich potential for developing learners’ capacity to resist populism and act in socially hopeful ways.

The terms parent-teacher relationship and partnership are used frequently throughout the literature in early childhood education and special education. Their prevalence may imply that we know more ...

In response to the estimated potential impact of coronavirus disease (COVID-19) on New York City hospitals, our institution prepared for an influx of critically ill patients. Multiple areas of surge planning progressed, simultaneously focused on infection control, clinical operational challenges, ICU surge capacity, staffing, ethics, and maintenance of staff wellness. The protocols developed focused on clinical decisions regarding intubation, the use of high-flow oxygen, engagement with infectious disease consultants, and cardiac arrest. Mechanisms to increase bed capacity and increase efficiency in ICUs by outsourcing procedures were implemented. Novel uses of technology to minimize staff exposure to COVID-19 as well as to facilitate family engagement and end-of-life discussions were encouraged. Education and communication remained key in our attempts to standardize care, stay apprised on emerging data, and review seminal literature on respiratory failure. Challenges were encountered and overcome through interdisciplinary collaboration and iterative surge planning as ICU admissions rose. Support was provided for both clinical and nonclinical staff affected by the profound impact COVID-19 had on our city. We describe in granular detail the procedures and processes that were developed during a 1-month period while surge planning was ongoing and the need for ICU capacity rose exponentially. The approaches described here provide a potential roadmap for centers that must rapidly adapt to the tremendous challenge posed by this and potential future pandemics.

This article aims to increase knowledge of cardiac assessment. Anatomy and physiology of the heart are briefly reviewed and reference is made to pathology that can cause cardiac dysfunction. The main features to look for when taking a cardiac history are discussed, with suggestions for questions to elicit this information, and the signs to look for when undertaking a cardiac examination. There is also an introduction to the main investigations to aid differential diagnosis and clinical reasoning. A follow-up article will look in more detail at some common cardiac conditions presenting to emergency care, with an emphasis on critical thinking and diagnostic reasoning. These articles are written from an emergency care perspective, and therefore do not focus in great detail on invasive investigation of cardiology conditions, but more so on picking up these possibilities in undifferentiated patients presenting to emergency care.

Issues of disclosure and privacy management are important to the development and maintenance of interpersonal relationships. We discuss communication privacy management (CPM) theory as a framework for understanding how people make choices to disclose information to others or protect it from access. CPM theory is a rules- and systems-based theory about disclosure and privacy management. After presenting CPM, we highlight recent trends in interpersonal communication using the theoretical framework, including examinations of CPM and interpersonal health issues, the use of social media, and family communication. The chapter concludes with discussion of directions for future research and evaluation of the CPM theoretical framework.

Australia is rapidly moving towards 'living with COVID-19', with relaxation of some public health measures. The number of severe cases of COVID-19 may be mitigated by vaccination, but 'living with COVID-19' will be associated with higher number of patients seeking emergency care. This impending impact on the emergency care system requires recognition, monitoring and co-ordinated management. Current challenges include a lack of emergency care monitoring systems, staff shortages and patient flow processes that are quickly overwhelmed by large numbers, particularly in a system already operating at capacity. Effective monitoring systems are required for health systems to proactively detect and respond to stresses. Additional solutions include public health messaging and clinical innovation to facilitate care of the right patient in the right place at the right time. Optimising staff numbers and morale, and efficient patient flow, are integral steps to increasing capacity within the emergency care system.

The emergence of skeletal prosthetic attachments leaves governmental organizations facing the challenge of implementing equitable policies that support the provision of bone-anchored prostheses (BAPs). In 2013, the Queensland Artificial Limb Service (QALS) started a five-year research project focusing on health service delivery and economic evaluation of BAPs. This paper reflects on the QALS experience, particularly the lessons learned. QALS’ jurisdiction and drivers are presented first, followed by the impact of outcomes, barriers, and facilitators, as well as future developments of this work. The 21 publications produced during this project (e.g., reimbursement policy, role of prosthetists, continuous improvement procedure, quality of life, preliminary cost-utilities) were summarized. Literature on past, current, and upcoming developments of BAP was reviewed to discuss the practical implications of this work. A primary outcome of this project was a policy developed by QALS supporting up to 22 h of labor for the provision of BAP care. The indicative incremental cost-utility ratio for transfemoral and transtibial BAPs was approximately AUD$17,000 and AUD$12,000, respectively, per quality-adjusted life-year compared to socket prostheses. This project was challenged by 17 barriers (e.g., limited resources, inconsistency of care pathways, design of preliminary cost-utility analyses) but eased by 18 facilitators (e.g., action research plan, customized database, use of free repositories). In conclusion, we concluded that lower limb BAP might be an acceptable alternative to socket prostheses from an Australian government prosthetic care perspective. Hopefully, this work will inform promoters of prosthetic innovations committed to making bionic solutions widely accessible to a growing population of individuals suffering from limb loss worldwide. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/36210/28330 How To Cite: Berg D, Frossard L. Health service delivery and economic evaluation of limb lower bone-anchored prostheses: A summary of the Queensland artificial limb service’s experience. Canadian Prosthetics & Orthotics Journal. 2021; Volume 4, Issue 2, No.12. https://doi.org/10.33137/cpoj.v4i2.36210 Corresponding Author: Laurent Frossard, PhD, Professor of BionicsYourResearchProject Pty Ltd, Brisbane, Australia.E-Mail: laurentfrossard@outlook.comORCID number: https://orcid.org/0000-0002-0248-9589

This study examines the tensions between the western concept of professional independence and accountants’ commitment to significant others under the care perspective of guanxi. The principle of professional independence is founded on arm’s-length transactions to avoid undue influence on professional and ethical judgement. However, in the relational society of China, social interactions based on Confucianism elicit a duty of care and concern towards significant others in important relationships. For a professional accountant, the commitment to persons with whom they have guanxi is potentially at odds with their commitment to professional independence. Data collected from interviews with Chinese accounting professionals, accounting academics and expatriate accountants working in China provide insight on how Chinese accounting professionals discharge their obligations under guanxi. Notions of guanxi and the rules of exchange identified in Hwang’s (Knowledge and action: A social psychological interpretation of Chinese cultural traditions, Sin-Li, Taipei, 1995) model of “Confucian ethics for ordinary people” provide the lens to explain the ethical dilemmas facing Chinese accountants. The findings suggest that accounting professionals prioritise the interests of their superiors and clients over the users of financial reports. Despite accountants’ moral obligation to protect the public interest, personal and professional obligations in China struggle to extend beyond client or employer interests mostly because of the absence of a formal relationship or connection with the public. This contrasts sharply with the notion of professional independence practised in western societies, where accounting professionals must be independent of their clients and superiors and commit to a duty to protect the public interest. The outcome of this study demonstrates the impediments to transplanting western concepts to different cultures.

Co-creation is seen as imperative in healthcare however existing frameworks are in need for adapting to specific settings from a person-centred care perspective such as shared decision-maki...

This paper presents the experiences of formal carers working in technology-enriched supported accommodation for people living with dementia, examining their care-giving role from a person-centred care perspective. Within a qualitative study, 21 semi-structured interviews were conducted with formal carers and data were analysed following a thematic approach. Four main themes were identified that mapped to the attributes of the person-centred practice framework (PCPF): promoting choice and autonomy, staffing model, using assistive technology and feeling that ‘you're doing a good job’. Central to person-centred practice in these settings was the promotion of choice, autonomy and independence. The dichotomy between safety and independence was evident, curtailing the opportunities within the environmental enablers and associated embedded assistive technologies. Formal carers reported considerable job satisfaction working in these settings. The small-scale, home-like facilities seemed to have a positive effect on job satisfaction. These findings are relevant to policy makers, commissioners and service providers, highlighting the facilitators of person-centred care in community dwellings for people living with dementia and the role of formal carers in promoting this approach.

In 1973, analysis of the mummified remains of a young boy dated to 700AD and from the Late Nasca period (Peru) identified (i) chronic Pott’s disease, leading to loss of lower body mobility, and (ii) acute miliary tuberculosis, affecting most organs and the immediate cause of death ( Allison et al., 1973 ). This report was the first to establish, beyond dispute, the presence of tuberculosis in the Americas before the arrival of Europeans. Here, we revisit the ‘Nasca Boy’ from a bioarchaeology of care perspective. Contextualising the original study’s results within what is known of contemporary lifeways, we apply the bioarchaeology of care methodology in considering the Nasca Boy’s experience of living with tuberculosis; the type of care he required and how this may have evolved over a period of deteriorating health; and what such caregiving may suggest both about social organisation within his community and some of the more everyday aspects of Nasca existence. Up to now, the bioarchaeology of care approach has been employed almost exclusively with skeletal evidence; in this analysis of the Nasca Boy’s remains, and in the accompanying wider-ranging discussion, we illustrate the potential of preserved soft tissue evidence to contribute to research into disability and care in the past. Although this report functions as a stand-alone case study, to obtain maximum benefit it should be read in conjunction with the Introduction to the special International Journal of Paleopathology issue on ‘mummy studies and the bioarchaeology of care’ ( Nystrom and Tilley, 2018 ).

Objective The aim of this study was to develop an instrument that measures all healthcare staff's perceptions of a culture of caring. Background Healthcare organizations have increased their focus on cultures of caring within their staff to improve staff satisfaction and patient satisfaction. Nurses and physicians traditionally have been the focus in understanding caring cultures excluding non-direct care staff who do impact organizational culture. Methods An exploratory and partial confirmatory factor analysis was completed on 2 instruments that measure the perception of a caring culture in both direct care and non-direct care staff. Results Results demonstrate that both the direct and non-direct care instruments are valid and reliable measures for assessing a caring culture. Conclusions The new 14-item clinical and new 10-item nonclinical staff caring assessment instruments will provide healthcare and nursing leaders with the ability to assess their culture through a direct and non-direct care perspective.

Background and rationale Ageism in nursing, particularly regarding oldest-old adults (age ≥80 years), adversely affects patient safety and care quality. Nurse education can reduce ageist attitudes. Swedish and Austrian nursing students' attitudes towards adults age ≥80 years have not been assessed. Aims To analyse attitudes towards adults age ≥80 years among nursing students from universities in Sweden and Austria. Design A prospective cross-sectional survey including the four-factor, 26-item validated Ageing Semantic Differential scale and demographic questions. Methods A pen-and-paper survey was administered to nursing students at the Medical University of Graz, Austria (May-June 2019); an online survey was conducted at the University of Gothenburg, Sweden (January-June 2020). Demographic data were analysed descriptively; means and individual item ratings were calculated for each country. Multiple logistic regression was performed for each factor of the instrument: (1) Instrumentality, (2) Autonomy, (3) Acceptability and (4) Integrity. Six independent variables were included in the regression analysis. Results In total, 136 Austrian and 222 Swedish students responded (88% women). Compared with Austrian students, Swedish students were older and had more positive attitudes about oldest-old adults. Swedish students' median factor ratings (7-point scale) were 3.62 (Factor 1), 3.50 (Factor 2), 2.71 (Factor 3) and 3.80 (Factor 4). Austrian students' median ratings were 4.25 (Factor 1), 3.83 (Factor 2), 3.28 (Factor 3) and 4.00 (Factor 4). Regression analyses showed that the variables country, older family member/acquaintance, and age were associated with the different factors. Discussion Compared with Austrian students, Swedish students' attitudes towards oldest-old adults were more favourable. We discussed the findings at individual, interpersonal/intergroup and societal/cultural levels and present implications for education and research. Conclusions Nurse education should address ageism as a multilevel phenomenon, and include the person-centred care perspective. Further research comparing nursing students' attitudes from different cultures is needed.

Wild animals are falling increasingly under threat as their habitats are being disrupted by human activities and global warming. At the same time, we see wild animals such as wolves actually settling in human landscapes. This forces us to rethink how we can live together with other living beings, with whom we share one earth. The contributions in this book section can be seen as attempts to do just that. However, these developments also challenge the traditional ethical approach towards wild animals, concisely worded as “Let them be”. That falls short in the current era, in which semi-wild, contact zone, and liminal animals are recognized. Animals, whether living in natural or human landscapes, all make opportunistic use of all sorts of resources – including human ones. If circumstances change, either due to natural or human-made causes, they will enter into new interactions with their environment to survive. They are nodes in a dynamic, heterogeneous network of dependency relationships that increasingly includes humans. In this chapter a framework is proposed to indicate the presence of wild animals in the human landscape based on the species’ adaptability and their degree of dependence on humans. The framework shows that species strongly differ in their vulnerability and that a diversity of measures is required in a world in which human and animal domains increasingly merge. Recognizing that we do not have exclusive rights to the earth implies an impersonal care perspective for wild animals as fellow-earthlings. It requires the reconsideration of our ethics, philosophies, culture and politics.

Objectives: to know the meaning of contemporary nursing from the experience of intensive care nurses. Methods: qualitative research based on the theoretical framework of Symbolic Interactionism and the methodological framework of Interpretive Interactionism. The setting was a general hospital in Bahia, being carried out with 12 nurses working in intensive care for at least one year, through semi-structured interviews and drawing-text-theme technique, whose data were organized according to Miles and Huberman and analyzed upon the referential. Results: the sense of being a nurse was evidenced; a being for care, resulting from the experience in intensive care, capable of promoting the development of professional self-image, by causing, in nurses, other skills - besides the scientific ones, such as empathy, creativity, spirituality and compassion. Final Considerations: the sense of being a nurse, currently, expresses developments inherited from the Nightingalean proposal, but transcends the technical-managerial emphasis of this to a humanistic care perspective converging with our contemporary professional identity: a being for care. RESUMEN Objetivos: conocer el significado de la enfermería contemporánea partiendo de la experiencia de enfermeros de Terapia Intensiva Métodos: investigación cualitativa fundamentada en el referencial teórico del Interaccionismo Simbólico y en el Referencial Metodológico del Interaccionismo Interpretativo. Realizado en un Hospital General de la Bahía, con 12 enfermeros que actúan en la terapia Intensiva hace un año, sometidos a entrevista semiestructurada y al diseño-texto-tema cuyos datos fueron organizados según Miles y Huberman, analizados usando el referencial. Resultados: manifiesta el sentido de ser enfermero, un ser para el cuidado, formado a partir de la experiencia en terapia intensiva, que promueve la elaboración de la autoimagen profesional, al estimular en los enfermeros, otras habilidades además de las científicas, como: empatía, creatividad, espiritualidad y compasión. Conclusiones: el ser enfermero actualmente expresa, desdoblamientos heredados de la iniciativa nightingaliana, que va desde un énfasis técnico-gerencial, a una perspectiva humanística asistencial convergente con nuestra identidad profesional contemporánea: un ser para el cuidado. RESUMO Objetivos: conhecer o significado da enfermagem contemporânea a partir da experiência de enfermeiros da Terapia Intensiva. Métodos: pesquisa qualitativa sob o referencial teórico do Interacionismo Simbólico e referencial metodológico do Interacionismo Interpretativo, desenvolvida em um hospital geral da Bahia, com 12 enfermeiros da terapia intensiva. Foram realizadas entrevistas semiestruturadas e aplicada a técnica desenho-texto-tema, cujos dados foram organizados segundo Miles e Huberman e analisados mediante o referencial. Resultados: evidenciou-se o sentido de ser enfermeiro; um ser para o cuidado, tecido no decorrer da experiência na terapia intensiva, capaz de promover a elaboração da autoimagem profissional ao mobilizar, nos enfermeiros, outras habilidades para além das científicas, tais como empatia, criatividade, espiritualidade e compaixão. Considerações Finais: o sentido atual de ser enfermeiro expressa desdobramentos herdados da iniciativa nightingaliana, mas transcende a ênfase técnico-gerencial desta para uma perspectiva humanística assistencial convergente com a nossa contemporânea identidade profissional: um ser para o cuidado.

As the internet is increasingly embedded in the everyday things in our homes, we notice a need for greater focus on the role care plays in those relationships—and therefore an opportunity to realize un- seen potential in reimagining home Internet of Things (IoT). In this paper we report on our inquiry of home dwellers’ relationships to caring for their everyday things and homes (referred to as thing- care). Findings from our design ethnography reveal four thematic qualities of their relationships to thingcare: Care Spectacle, Care Liminality, Ontological Binding, and Care Condition. Using these themes as touchstones, we co-speculated to produce four specula- tive IoT concepts to explore what care as a design ethic might look like for IoT and reflect on nascent opportunities and challenges for domestic IoT design. We conclude by considering structures of power and privilege embedded within care practices that critically open new design imaginaries for IoT.

Context In Sweden, 34% of herds in official statistics 2021 (77% of the cows) have an automatic milking system (AMS) and keep 19% of the dairy cows. Objective This study should be considered in relation to the rapid increase of digitalisation in agriculture. It aimed at investigating Swedish farmers’ experiences and reflections in dairy farming concerning AMS use from a care perspective, based on two research questions: 1) What kinds of success factors and management challenges do farmers experience with AMS usage? and 2) How do farmers view their work environment in this kind of system? Methods A mixed method approach was performed, using method triangulation through a questionnaire, interviews, and field visits. The Activity Theory (AT) was used as a theoretical lens to consider care practice in the dairy farming as a learning system. Results and conclusions Participating dairy farmers were found to be in a continuous learning process on different levels in their system, from detailed problems with an individual cow or the herd to the whole dairy system. Implementation of AMS required learning in order to manage, and thus care for, a system comprising of animals, technology, and humans, to increase business viability. In successful AMS use, willingness to learn, adapt to the local situation, and continually improve practice, or care as a patterning of activities, appeared to be the most important factors. With more people involved, differentiations were possible, which in turn accentuated the need for more trained staff who can perform more complicated tasks. The findings indicated high importance of experience and a ‘stockperson's eye’, in combination with tool-mediated seeing using data from the robot, in developing enhanced professional vision and good care. A good stockperson had broad competence combining a stockperson's eye with experience with robot data. One of the greatest challenges for dairy farms was finding a good stockperson as staff or advisor. Increased flexibility in work and better physical health were important driving forces for implementing AMS, while handling alarms was mentally stressful and gave different perspectives on AMS vulnerability. Overall, the analysis of the collected data showed that AMS had brought major, primarily positive, changes in daily work and increased work satisfaction for most farmers, with a clear majority of the respondents feeling good in their work situation and enjoying their work. Significance Application of AT in studying AMS from a care perspective, represents a shift from traditional research that normally addresses technological inventions, to studying farmers’ socio-technical system. The AT lens revealed the work practices in performing care, as a patterning of activities accomplished by a tinkering learning process, in the rich and messy matrix of humans, cows, and technology. CC BY 4.0Available online 1 October 2021Corresponding author: christina.lundstrom@slu.se (C. Lundström)

A Smart Mirror is another one of those smart devices which have been developed to improve our normal lives by making the things that we use on an everyday basis ‘SMART’. It is a mirror with programmable functions and features adjoining a user personalized data feed and a mirror, hence, saving loads of time. The Mirror built in the Proposed system is more focused on the Healthcare Perspective. The aim of keeping the user fit and healthy. In addition to displaying the existing widgets based on the choice of a particular user, it also displays health and fitness related quotes, thereby constantly reminding the user or anybody who looks at the mirror, how important is it to keep your body healthy and fit. The main reason of building a Smart Mirror is to have everything that you need in a rush at the same place. For example, while leaving for work in the morning or going to school in the morning or going out in the evening, you may want to know if you have any to-do tasks or medicine reminders or doctor appointments scheduled for the day. You may want to check how much more water should you drink to complete your daily goal, or what your current BMI is and has it increased or decreased since last week or last month and you can do all that just by looking in a mirror. So, all that the Smart Mirror does is make our life simpler by helping us to do multi-tasking and increasing our efficiency in the rush hours. It has a lot of scope for improvement in the future and the potential to be one of the best-selling products in the market.

The future of work has become a pressing matter of concern: Researchers, business consultancies, and industrial companies are intensively studying how new work models could be best implemented to increase workplace flexibility and creativity. In particular, the agile model has become one of the “must-have” elements for re-organizing work practices, especially for technology development work. However, the implementation of agile work often comes together with strong presumptions: it is regarded as an inevitable tool that can be universally integrated into different workplaces while having the same outcome of flexibility, transparency, and flattened hierarchies everywhere. This paper challenges such essentializing assumptions by turning agile work into a “matter of care.” We argue that care work occurs in contexts other than feminized reproductive work, namely, technology development. Drawing on concepts from feminist Science and Technology Studies and ethnographic research at agile technology development workplaces in Germany and Kenya, we examine what work it takes to actually keep up with the imperative of agile work. The analysis brings the often invisibilized care practices of human and nonhuman actors to the fore that are necessary to enact and stabilize the agile promises of flexibilization, co-working, and rapid prototyping. Revealing the caring sociotechnical relationships that are vital for working agile, we discuss the emergence of power asymmetries characterized by hierarchies of skills that are differently acknowledged in the daily work of technology development. The paper ends by speculating on the emancipatory potential of a care perspective, by which we seek to inspire careful Emancipatory Technology Studies.

Despite the increasing need for neonatal palliative care, it is not adequately implemented in practice. This analysis aimed to clarify the dimension of the neonatal palliative care concept to increase understanding of the concept to give more insight into clinical practice. Using dimensional analysis methodology, 46 English language papers from 2001-2018 were analyzed. The coding of the literature for the perspective, context, conditions, process, and consequences of the concept was completed. Five dimensions informed the conceptualization of this concept and interrelationships among their themes/sub-themes were presented in the matrix named, "improving quality of life and death". Within the family-centered care perspective and under different conditions/contexts through the processes of neonate's comfort and providing holistic care, the consequences of this care were improving quality of life/a good death. Family-centered care was the fundamental dimension and essential to achieving the consequences. The other dimensions of context, conditions, and processes were also affected by the family's needs, preferences, culture, and expectations. This analysis reinforces that neonatal palliative care is a multidimensional concept. To provide the standard of neonatal palliative care an integrated plan to get together many stakeholders including community, parents, clinical staff, policymakers, insurance authorities, health care systems, and education system is required. All NICUs should have neonatal palliative care-trained nurses and protocols with a family-centered care approach to focus on the quality of life of neonates with life-threatening conditions from diagnosis of disease to death. Regular training and educational courses on neonatal palliative care and family-centered care principles can make nurses more sensitive to their advocacy role.

COVID-19 is a new highly infectious disease with an incompletely described clinical course, which has caused a pandemic, with Europe being identified as the third epicentre. COVID-19 has placed unprecedented pressure on critical care services which is likely to stretch resources beyond capacity. The situation is exacerbated by increased staff absence from self-isolation and illness, increased referral of patients with suspected or confirmed COVID-19 who develop respiratory failure, and limited availability of Extra Corporeal Membrane Oxygenation (ECMO) services. In addition, there is the ongoing challenge of patients being transferred between departments and hospitals for ongoing care. In consequence, as current needs continue to rise, innovative approaches are needed to redress shortages and support the continuance of services. This article provides an overview of severe COVID-19 infection, outlining treatment strategies and nursing processes that will need to develop and extend in response to this evolving situation.

The COVID-19 pandemic has had a significant impact on the economy and health system of most countries in the world and this is also true of Australia. Australia has not seen the huge surge of COVID-19 positive cases and subsequent hospitalisations and deaths experienced in other parts of the world. However there have been important social and health strategies to "flatten" the curve, to reduce infections and to manage those infected. These have included closure of international and interstate borders, local lockdown measures, physical distancing, shift to work from home, closure of non-essential businesses and full or partial closure of all schools and tertiary education facilities. From the diabetes care perspective, there was a significant and concerted diversion of hospital resources and staff to COVID-19 specific activities. Reduced access to primary care, diagnostic and hospital services for diabetes, combined with fear of exposure to the virus in these settings, led to a significant drop in access to usual diabetes care. Provision of outpatient and private sector diabetes services via telehealth was encouraged and supported by expanded and new government subsidies. Importantly, for the first time, there was government funded subsidy for care delivered via the telephone and inclusion of credentialled diabetes educators in funded telephone/telehealth support. The Australian health professional and consumer organisations worked cooperatively producing guidelines, position statements and other educational resources specific for the COVID-19 setting. Once the COVID-19 pandemic is over, review of all the changes will be important, determining which should be permanently implemented. The learnings from COVID-19 should help prepare Australia for future pandemics or other major health crises.

What is the value of an early (presymptomatic) diagnosis of dementia in the absence of effective treatment? There has been a lively scholarly debate over this question, but until now (future) patients have not played a large role in it. Our study supplements biomedical research into innovative diagnostics with an exlporation of its meanings and values according to (future) patients. Based on seven focusgroups with (future) patients and their care-givers, we conclude that stakeholders evaluate early diagnostics with respect to whether and how they expect it to empower their capacity to (self-) care. They value it, for instance, with respect to whether it (a) explains experienced complaints, (b) allows to start a process of psychological acceptance and social adaptation to the expected degeneration, (c) contributes to dealing with anxieties (with respect to inheritable versions of dementia), (d) informs adequately about when to start preparing for the end of life, (d) informs the planning of a request for euthanasia, or (e) allows society to deal with a growing amount of dementia patients. Our study suggests that information about disease is considered 'harmful' or 'premature' when recipients feel unable to act on that information in their (self-) care. The results of this research offers input to further ethical research. It invites to adopt a care perspective in evaluation and to seek ways to prevent the 'harm' that such diagnostic methods can bring about.

We were pleased to read ‘Requested withdrawal of mechanical ventilation in six patients with motor neuron disease’,1 and congratulate the authors. We wish to add to this discussion, including both neurology and palliative medicine perspectives from our clinical practice within the State-wide Progressive Neurological Disease Service (SPNDS). The SPNDS provides multidisciplinary care for approximately 350 patients with motor neuron disease (MND) across Victoria, Australia. It combines specialist neurology, palliative medicine, psychiatry and allied health clinicians and works closely with the Victorian Respiratory Support Service, Austin Health and local community palliative care services. Approximately 5–10 patients with MND who attend the SPNDS request elective withdrawal of ventilation annually. Some deteriorate abruptly due to intercurrent illness and elect a palliative approach. They or their medical decision-maker may discuss elective withdrawal to avoid prolonging this phase. Guidance from advance care directives is particularly helpful. Others, a smaller number in our experience, make an informed decision to electively withdraw ventilation when they perceive it has become burdensome rather than beneficial. Most of our experience has been withdrawal of non-invasive ventilation (NIV) in the community and hospice setting. The authors identified the importance of a …

No abstract available.

Health systems are increasingly investing in efforts to prevent disease and promote health for populations. By and large, these prevention-related interventions have not been inclusive of critical care and the intensive care unit (ICU). However, we suggest that there is value—to patients, families, health systems, and society at large—in extending this continuum into the ICU setting and including the ICU in disease prevention and health promotion efforts. Including the ICU in this continuum allows the critical care perspective to inform (I) advocacy for prevention; (II) efforts to improve disparities in health and health care; (III) mitigation of the negative effects of critical illness and injury as well as ICU exposure; and (IV) promotion of health and well-being in the community. As disease prevention and health promotion rise as priorities within health systems, critical care can and should join, even help lead, the effort.

This paper links Criterion A of the Diagnostic and Statistical Manual of Mental Disorders-5th Edition Alternative Model for Personality Disorders with the contemporary interpersonal model of personality pathology. Advances in interpersonal theory and assessment are outlined to demonstrate that Criterion A's self (identity, self-direction) and interpersonal (empathy, intimacy) impairments are related to the interpersonal meta-constructs and agency and communion and are operationalized by perceptual, behavioral, and affective mechanisms of the interpersonal situation framework. Research informed by the interpersonal situation examining interpersonal functioning in personality disorders is reviewed. Specifically, studies employing experience sampling with event-contingent designs examine social functioning in daily life and studies employing continuous assessment of interpersonal dynamics examine the moment-to-moment unfolding of interpersonal behavior in dyadic interactions.

In principle, lower limb bone-anchored prostheses could alleviate expenditure associated with typical socket manufacturing and residuum treatments due to socket-suspended prostheses.This study reports (a) the incremental costs and (b) heath gain as well as (c) cost-effectiveness of bone-anchored prostheses compared to socket-suspended prostheses.Retrospective individual case-controlled observations and systematic review.Actual costs were extracted from financial records and completed by typical costs when needed over 6-year time horizon for a cohort of 16 individuals. Health gains corresponding to quality-adjusted life-year were calculated using health-related quality-of-life data presented in the literature.The provision of bone-anchored prostheses costed 21% ± 41% more but increased quality-adjusted life-years by 17% ± 5% compared to socket-suspended prostheses. The incremental cost-effectiveness ratio ranged between -$25,700 per quality-adjusted life-year and $53,500 per quality-adjusted life-year with indicative incremental cost-effectiveness ratio of approximately $17,000 per quality-adjusted life-year. Bone-anchored prosthesis was cost-saving and cost-effective for 19% and 88% of the participants, respectively.This study indicated that bone-anchored prostheses might be an acceptable alternative to socket-suspended prostheses at least from a prosthetic care perspective in Australian context. Altogether, this initial evidence-based economic evaluation provided a working approach for decision makers responsible for policies around care of individuals with lower limb amputation worldwide. Clinical relevance For the first time, this study provided evidence-based health economic benefits of lower limb bone-anchored prostheses compared to typical socket-suspended prostheses from a prosthetic care perspective that is essential to clinicians and decision makers responsible for policies.

Background In Neonatal Intensive Care Units (NICUs), parent satisfaction and their experiences are fundamental to assess clinical practice and improve the quality of care delivered to infants and parents. Recently, a specific instrument, the EMpowerment of PArents in THe Intensive Care-Neonatology (EMPATHIC-N), has been developed in the Netherlands. This instrument investigated different domains of care in NICUs from a family-centered care perspective. In Italy, no rigorous instruments are available to evaluate parent satisfaction and experiences in NICU with family-centered care. The aim of this study was to translate and validate the EMPATHIC-N instrument into Italian language measuring parent satisfaction. Methods A psychometric study was conducted in nine Italian NICUs. The hospitals were allocated across Italy: four in the North, four in Central region, one in the South. Parents whose infants were discharged from the Units were enrolled. Parents whose infants died were excluded. Results Back-forward translation was conducted. Twelve parents reviewed the instrument to assess the cultural adaptation; none of the items fell below the cut-off of 80% agreement. A total of 186 parents of infants who were discharged from nine NICUs were invited to participate and 162 parents responded and returned the questionnaire (87%). The mean scores of the individual items varied between 4.3 and 5.9. Confirmatory factor analysis was performed and all factor loadings were statistically significant with the exception of item ‘Our cultural background was taken into account’. The items related to overall satisfaction showed a higher trend with mean values of 5.8 and 5.9. The Cronbach’s alpha’s (at domain level 0.73-0.92) and corrected item-total scale correlations revealed high reliability estimates. Conclusions The Italian EMPATHIC-N showed to be a valid and reliable instrument measuring parent satisfaction in NICUs from a family-centered care perspective. Indeed, it had good psychometric properties, validity, and reliability. Furthermore, this instrument is fundamental for further research and internationally benchmarking. Electronic supplementary material The online version of this article (10.1186/s13052-017-0439-8) contains supplementary material, which is available to authorized users.

The following inquiry aims at exploring the beliefs of caregivers from the Public Crèche Network in Warsaw, the biggest network of this type in Poland, on the importance of fostering different developmental and educational goals in the youngest children. The participating caregivers (N = 449) completed a structured, Internet-based questionnaire on the significance of supporting the development of social, cognitive, physical, emotional and personal goals of 0–3-year-olds in early childhood settings. Also, information on practitioners’ educational background and work experience was collected to investigate whether their beliefs differed depending on these background characteristics. The results revealed no associations between the caregivers’ beliefs and their formal pre-service training (higher education diploma vs none or vocational training) or their work experience (5 years or less experience of work in early childhood settings vs over 5 years of work in the ECEC sector). The findings of the study are discussed with regard to the Polish legal context and potential practical implications. Celem badania jest eksploracja poglądów wychowawców z Zespołu Żłobków m.st. Warszawy, największej tego typu sieci w Polsce, na temat ważności wspierania różnych celów rozwojowych i edukacyjnych w pracy z najmłodszymi dziećmi. Wychowawcy (n = 449) wypełnili internetowy, ustrukturyzowany kwestionariusz ankiety na temat wspierania rozwoju społecznych, poznawczych, fizycznych, emocjonalnych i osobistych umiejętności dzieci do 3 lat, podczas ich pobytu w żłobku. Ponadto w badaniu uwzględnione zostały informacje dotyczące wykształcenia praktyków i stażu ich pracy. Wyniki sugerują, że nie ma związku między poglądami wychowawców i ich formalnym przygotowaniem do wykonywania zawodu opiekuna dziecięcego (dyplom uczelni wyższej vs brak wykształcenia lub wykształcenie zawodowe w obszarze wczesnej opieki, wychowania i edukacji) oraz długości stażu pracy (5 lub mniej lat pracy w sektorze vs więcej niż 5 lat pracy w sektorze). Rezultaty badania omówione są w odniesieniu do regulacji prawnych sektora wczesnej opieki, wychowania i edukacji dzieci w Polsce oraz potencjalnych implikacji praktycznych. Grant from the European Union’s Seventh Framework Programme for Research, Technological Development and Demonstration under grant agreement No. 613318 and the national funds for science in the years 2014–2016 for the co-financing of international project

This research note explores conflict-handling styles from the Islamic perspective. According to Quran and the prophetic remarks, Islam prohibits dominating style and encourages obliging style, while it considers compromising, integrating and avoiding styles as acceptable for resolving interpersonal conflict. Managers can use the knowledge of Islamic instructions in their training, mentoring and counselling to handle conflicting parties within the organization and reduce the level of dysfunctional conflicts. In the end, the note offers indications for future studies where the level of religiosity (Islamic) may be a befitting mediating variable. Also, there may be studies on the influence of Islamic values in specific areas of human interactions within the workplace.

This article suggests ways health psychology instructors can challenge the prevailing discourse of the “obesity epidemic” as a major risk factor for chronic illness. Textbooks generally support mes...

This article critically considers the concept of vulnerability and its interaction with care practice, particularly care of the self. Underpinned by a feminist ethics of care perspective the relational aspects of vulnerability that can facilitate and realise ambivalent and unknown potential outcomes for individuals are emphasised. Original ethnographic research considering the offer and receipt of free meals within one community cafe in the city of Newcastle in northeast England explores how ‘vulnerability’ is experienced and negotiated by individuals visiting the cafe. The article finds that in recognising and being open to their own vulnerability and agency enabled people's management of care relations and interactions within the cafe. The article highlights the need to critically reflect on the self-careful actions inherent in an individual's response to their own particular vulnerability, and to challenge the constructs of passivity and dependency associated with care and vulnerability and the...

Over the past decade, there has been substantial growth in empirical evidence supporting that proper assessment and treatment of trauma using evidence-based practices can effectively reduce a wide range of symptoms in both children and adults. Given the complex nature of trauma treatment, trauma-based educational programming in social work is most commonly found at the graduate level. Yet, to date, there has been little discussion calling for the inclusion of trauma content in BSW education. In this paper, we examine the current state of trauma-content inclusion in social work education, and offer a guiding framework for integrating core trauma content into the BSW curriculum that is based on the core principles of trauma-informed care.

An updated version of a chapter originally appearing in A Century of Transformation: Studies in Honor of the 100th Anniversary of the Eastern Communication Association, this piece examines the history and continued development of interpersonal communication. We begin by examining the progression of interpersonal communication from the 1920s through the 1980s. We then explore contemporary trends in interpersonal communication since the 1990s. Finally, we consider the challenges and future trajectories of interpersonal communication as it continues to develop and transform. We identify major aspects of research and how they are informed by identity and raise critical challenges to studying interpersonal communication. We end by exploring how transformations in technology are inexorably connected to our understanding and valuing interaction with others, and identify emerging areas of inquiry.