Active Support Measure: a multilevel exploratory factor analysis

BACKGROUND

Active Support is a person-centred practice that enables people with intellectual disabilities (IDs) to engage in meaningful activities and social interactions. The Active Support Measure (ASM) is an observational tool designed to measure the quality of support that people with IDs living in supported accommodation services receive from staff. The aim of the study was to explore the underlying constructs of the ASM.

METHODS

Multilevel exploratory factor analysis was conducted on ASM data (n = 884 people with IDs across 236 accommodation services) collected during a longitudinal study of Active Support in Australian accommodation services.

RESULTS

Multilevel exploratory factor analysis indicated that 12 of the ASM's 15 items loaded on two factors, named Supporting Engagement in Activities and Interacting with the Person.

CONCLUSIONS

The 12-item ASM measures two dimensions of the quality of staff support. Both technical and interpersonal skills comprise good Active Support.

Effect of Human Activity and Presence on the Behavior of Long-Tailed Macaques (Macaca fascicularis) in an Urban Tourism Site in Kuala Selangor, Malaysia

The increasing overlap of resources between human and long-tailed macaque (Macaca fascicularis) (LTM) populations have escalated human-primate conflict. In Malaysia, LTMs are labeled as a 'pest' species due to the macaques' opportunistic nature. This study investigates the activity budget of LTMs in an urban tourism site and how human activities influence it. Observational data were collected from LTMs daily for a period of four months. The observed behaviors were compared across differing levels of human interaction, between different times of day, and between high, medium, and low human traffic zones. LTMs exhibited varying ecological behavior patterns when observed across zones of differing human traffic, e.g., higher inactivity when human presence is high. More concerning is the impact on these animals' welfare and group dynamics as the increase in interactions with humans takes place; we noted increased inactivity and reduced intra-group interaction. This study highlights the connection that LTMs make between human activity and sources of anthropogenic food. Only through understanding LTM interaction can the cause for human-primate conflict be better understood, and thus, more sustainable mitigation strategies can be generated.

Using Qualitative Methods to Understand the Interconnections Between Cities and Health: A Methodological Review

Objective: Using different perspectives and methods to investigate the links between the urban phenomenon and health is critical in an urbanizing world. This review discusses qualitative methods in the context of urban health research. Methods: We conducted a narrative review following these steps: We identified the qualitative data collection, analysis and sampling methods that could be more relevant for the problems researched in the urban health field. We conducted searches for methodological articles and other documents about those methods. We included some influential materials and examples of empirical urban health studies using those methods. Results: We included 88 studies and identified several qualitative data gathering, analysis and sampling methods relevant for urban health researchers. We present those methods, focusing their strengths and limitations, and providing examples of their use in the field of urban health. These methods are flexible and allow in-depth analysis of small samples by collecting and analyzing rich and nuanced data. Conclusion: This article should contribute to a better understanding of how, and when, qualitative methods may improve our knowledge on urban health.

[The DoC-feeling scale, a paramedical assessment tool improving the diagnostic accuracy of the state of consciousness of non-communicative patients]

The Neurological Intensive Care Unit (ICU) at Pitié-Salpêtrière Hospital cares for patients with severe brain injuries, which can lead to acute or chronic disorders of consciousness. To assess the patient's state of consciousness, the team relies on precise clinical examination. This article presents the assessment tools used to establish the patient's prognosis.

Pragmatism and Experimental Bioethics

Pragmatism gained considerable attention in bioethical discussions in the early 21st century. However, some dimensions and contributions of pragmatism to bioethics remain underexplored in both research and practice. It is argued that pragmatism can make a distinctive contribution to bioethics through its concept, developed by Charles S. Peirce and John Dewey, that ethical issues can be resolved through experimental inquiry. Dewey's proposal that policies can be confirmed or disconfirmed through experimentation is developed by comparing it to the confirmation of scientific hypotheses, with a focus on the objection that the consequences of following a moral view or policy do not provide guidance on choosing among competing ethical perspectives. As confirmation of scientific hypotheses typically relies on evidence gathered from observation, the possibility of ethically relevant observation is then explored based on Peirce's views on feelings as emotional interpretants. Finally, the connection between Dewey's experimental ethics and democracy is outlined and compared to unfettered ethical progressivism.

Nothing less than a creative triumph: a study of children admitted to hospital for serious somatic illness or injury and their experience of art therapy

Background

Hospitalization can be an extremely distressing experience for seriously ill and injured children. Art therapy has a well-established clinical history, and recent research has begun to demonstrate its effectiveness in somatic pediatric wards. Descriptive and statistical research indicates that art therapy can alleviate anxiety and fear, improve mood, and enhance communication among children, parents, and healthcare professionals. This study aims to enhance our understanding of the specific elements of art therapy that facilitate a connection with the healthier aspects of the self.

Method

A total of 12 hospitalized children, aged 4-12, participated in an art therapy session led by a certified art therapist. Verbalizations during the sessions were recorded, and subsequent observations were synchronized with verbatim transcriptions of audio recordings. A reflexive thematic analysis was conducted to identify relevant patterns of meaning.

Findings

The study identified four significant dimensions of the children's experiences during art therapy: (1) The child feels safe, (2) The child becomes a competent artist, bursting with creativity, (3) The healthy child emerges, and (4) The child achieves something beyond its limits - a triumph.

Discussion

The active ingredients contributing to effective art therapy include the stimulation of creativity, guided art-making with scaffolding support, task variation, granting children control over the artistic process, encouragement of free expression, and the display of positive regard. This study also delves into the therapeutic alliance, emphasizing its role in facilitating children's learning, self-expression, concentration, and the creation of work they take pride in. Additionally, certain psychotherapy-like interactions, such as control-mastery dynamics, were observed. Nevertheless, more extensive research with larger sample sizes is required to draw broader conclusions.

Thinking strategies used by registered nurses during drug administration in nursing homes-An observational study

AIM

To explore registered nurses' thinking strategies during the drug administration process in nursing homes.

DESIGN

An exploratory qualitative design.

METHODS

Eight registered nurses, one male and seven female, in five nursing home wards in Mid-Norway were observed during 15 drug dispensing rounds (175 drug dispensing episodes). Think Aloud sessions with follow-up individual interviews were conducted. The Think Aloud data were analysed using deductive qualitative content analysis based on Marsha Fonteyn's description of 17 thinking strategies. Interview data were used to clarify missing information and validate the content of Think Aloud data.

RESULTS

The registered nurses used all 17 thinking strategies described by Fonteyn, including several variants of each strategy. The three most frequent were 'providing explanations', 'setting priorities' and 'drawing conclusions'. In addition, we found two novel thinking strategies that did not fit into Fonteyn's template, which were labelled 'controlling' and 'interacting'. Among all strategies, 'controlling' was by far the most used, serving as a means for the registered nurses to stay on track and navigate through various interruptions, while also minimising errors during drug dispensing.

CONCLUSION

The study highlights the diverse thinking strategies employed by registered nurses in nursing homes during medication administration. The findings emphasise the multifaceted nature of medication administration and underscore the importance of skilled personnel in ensuring medication safety. Recognising the significance of these findings is crucial for maintaining patient well-being and upholding medication safety standards in healthcare settings.

RELEVANCE TO CLINICAL PRACTICE

Understanding the thinking strategies employed by registered nurses can inform training programmes and enhance the clinical judgements of health care professionals involved in medication administration, ultimately leading to improved patient outcomes and reduced medication errors in practice.

PATIENT OR PUBLIC CONTRIBUTION

Patients were involved in this study as recipients of drugs which the nurses distributed during the observations. The patients were involved as a third party and consent to the observations was either given by the patients themselves or relatives in cases where the patient was not competent to consent. No personal information was collected about the patients.

REPORTING METHOD

The reporting of this study adhered to the COREQ checklist.

Neck management in metastatic cutaneous squamous cell carcinoma of the head and neck

Objective

Optimal neck management remains unclear in head and neck cutaneous squamous cell carcinoma (HNcSCC) with parotid metastasis. Our goal was to compare the impact of different cervical treatments on HNcSCC with parotid metastasis.

Methods

Patients were retrospectively included. The primary outcome variables were regional control (RC) and disease-specific survival (DSS). The impacts of observation, elective neck irradiation (ENI), and elective neck dissection (END) were analyzed using the Cox model and presented as hazard ratios (HRs) and 95% confidence intervals (CIs).

Results

In total, 268 patients were enrolled. In the Cox model for RC, compared with ENI, observation was associated with a significantly higher risk of regional recurrence (p = 0.001, HR = 2.50, 95%CI = 1.45-4.30). However, END showed a comparable influence on regional recurrence (p = 0.246, HR = 0.70, 95%CI = 0.38-1.28). In the Cox model for DSS, END demonstrated a similar HR of 0.62 (95%CI = 0.30-1.26) compared to ENI (p = 0.184). However, patients who underwent observation were associated with an additional nearly twofold risk of cancer-related mortality (HR = 2.85, 95%CI = 1.55-5.23). Subgroup analysis showed that ENI predicted comparable RC (p = 0.389) and DSS (p = 0.346) in patients with one or two metastatic parotid lymph nodes, but worse RC (p = 0.007) and DSS (p = 0.024) in patients with more than three positive lymph nodes.

Conclusion

In HNcSCC with parotid metastasis, elective treatment of neck lymph nodes with END or ENI should always be performed.

Neck management in cutaneous squamous cell carcinoma with parotid metastasis

OBJECTIVE

Our objective is to assess the oncologic outcomes of observation, elective neck dissection (END), and elective neck irradiation (ENI) in the neck management of head and neck cutaneous squamous cell carcinoma (HNcSCC) with parotid metastasis (P+) and to evaluate the quality of life (QoL) of patients who received END or ENI.

METHODS

Patients with P+ HNcSCC were retrospectively enrolled. The impact of observation, END, and ENI on regional control (RC) and overall survival (OS) was analyzed using Cox proportional hazards model with presentation via hazard ratio (HR) with a 95% confidence interval (CI). QoL was evaluated using the University of Washington Quality of Life questionnaire.

RESULTS

A total of 134 patients were included in our analysis. In the Cox model for RC, both END and ENI had decreased HRs of 0.27 (95% CI: 0.15-0.69) and 0.34 (95% CI: 0.18-0.86), respectively, in comparison with observation. In the Cox model for OS, both END (p = 0.001, HR: 0.22, 95% CI: 0.10-0.72) and ENI (p = 0.006, HR: 0.30, 95% CI: 0.17-0.83) were superior to observation. In patients with three or more positive parotid lymph nodes, END resulted in significantly better RC (p < 0.001) and OS (p = 0.001) compared with ENI. The two groups were found to be comparable in all 12 domains of the University of Washington Quality of Life questionnaire.

CONCLUSION

In the neck management of P+ HNcSCC, observation is not recommended. END is the preferred option, but ENI is an alternative method without compromise to survival or QoL, except in cases with three or more metastatic parotid lymph nodes.

Gender differences in perceiving the portion size of meat when being observed

Previous research has shown that being observed can influence people's behaviors, including their eating habits. In this study, we predicted that men and women would exhibit different reactions to the perception of portion size of meat when being observed. By utilizing a camera to create a sense of being observed during the act of eating meat, we revealed that men in the observed condition reported perceiving the portion size of the meat they ate to be smaller and the eating amount to be less than was reported by those in the non-observed condition. However, women did not show any differences in their perceptions of the portion size of the meat they ate. These findings demonstrate that gender identity plays a role in how people perceive the meat they eat when they are aware of being observed. The discussion highlights the effect of being observed on meat consumption and illustrates the influence of masculine identity.

Occupational therapists' assessment and reporting of functional cognition in stroke care

PURPOSE

To investigate how functional cognition of people post-stroke is evaluated and reported by occupational therapists in Ireland. Functional cognition refers to the use and integration of cognitive skills for daily function.

METHODS

This study used a qualitative design. Six focus groups and one individual interview were conducted with 20 occupational therapists purposively sampled for variation across different clinical grades. Data were analysed according to the Braun and Clark thematic analysis framework.

RESULTS

Participants felt that assessment of functional cognition was an integral feature of occupational therapy assessment in stroke care but acknowledged that terminology used by occupational therapists for functional cognition was inconsistent. Non-standardised observational assessment was routinely used by participants. Challenges were reported with respect to written documentation of non-standardised observations. Participants reported that use of standardised cognitive assessments required considered clinical reasoning before administration. Standardised performance-based assessments were not widely implemented by participants.

CONCLUSION

Occupational therapists in Ireland reported a multi-component assessment process to evaluate functional cognition post-stroke. Establishing practice guidelines for the assessment of functional cognition may be of benefit to occupational therapists working in stroke care. Further research is needed to quantify procedures in this assessment process to account for variation in practice.

Extent of smoking at a Danish hospital with a smoke-free policy

AIM

One-fifth of the Danish population smoke and exposure to second-hand smoke has well-documented adverse health effects. The smoking policy at hospital level prohibits hospital staff from smoking on the hospital grounds while patients and visitors may smoke in outdoor smoking cabins. This study aimed to quantify smoking at a Danish hospital and document any policy breaches.

METHODS

In April 2020, we collected cigarette butts and observed smokers at the outdoor grounds to document smoking behaviour.

RESULTS

In total, 7152 cigarette butts were collected during one week and 368 people were observed smoking at the outdoor grounds during four observation days. Of all collected cigarette butts, 55% were collected outside the smoking cabins and 62% of all smokers were observed smoking outside the smoking cabins. In addition, 31 staff were observed smoking.

CONCLUSIONS

This study documents that smoking is prevalent at a smoke-free hospital and that the smoking policy is frequently violated. The frequency of smoking outside the cabins may at least partly be influenced by the COVID-19 pandemic. Smoking at a hospital can expose patients, visitors and staff to second-hand smoke with subsequent adverse health effects. Hospitals could play an exemplary role towards a smoke-free society (and not the exception), but the opportunity is not always seized.

Pressure injury prevalence in critical care settings: An observational pre-post intervention study

AIM

To explore pressure injury prevention practices and evaluate the impact of an educational intervention on PI prevalence before and after an educational intervention.

DESIGN

A multi-centre observational study.

METHOD

Data were collected at two time points in May 2021 and April 2022 using a Qualtrics® online form. Two Registered Nurses at each site collected observational data at each time point by diagnosing and staging any identified pressure injuries as part of a prevalence study. Patients admitted to participating units were included.

RESULTS

A total of 181 patients in critical care units were included at the two-time points. Pressure injury prevalence was 60.9% at the outset, with 52.9% hospital-acquired, 37.9% unit-acquired and 23.0% medical device-related. Post-intervention prevalence decreased significantly to 28.7%, including 21.3% hospital-acquired, 14.9% unit-acquired, and 8.5% medical device-related. Pressure injuries were prominent in the sacral region, head area, and heels. Stages I and II pressure injuries were the most common. Increased age and longer ICU stays are linked to a heightened risk of pressure injury development in critically ill patients, whereas higher haemoglobin levels show an inverse relationship with the development of both pressure injury and severe stages in the univariate analysis. The predictive models revealed that increased age and longer ICU stays are predictors for both pressure injury development and progression to severe stages, while Braden scores predict the likelihood of developing severe stages of pressure injuries.

CONCLUSIONS

This study has identified a benchmark for pressure injury prevalence in critical care units in Saudi Arabia. The results demonstrate that pressure injuries can be prevented in critically ill patients when evidence-based education strategies are implemented.

PATIENT CARE IMPACT

Pressure injuries are an important issue for critically ill patients and can be prevented with proper investments. Strategies to prevent pressure injuries from admission will result in fewer pressure injuries.

REPORTING METHOD

Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines and the Template for Intervention Description and Replication (TIDieR) checklist.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

COVID-19 Personal Protective Behaviors during Large Social Events: The Value of Behavioral Observations

Within the context of reopening society in the summer of 2021, as the UK moved away from 'lockdowns', the Government of Wales piloted the return of organized 'mass gatherings' of people at a number of test events. The current study reports behavioral observations that were made at two of the test events to inform this process. The researchers were particularly interested in four key factors: how (1) context within a venue, (2) environmental design, (3) staffing and social norms, and (4) time across an event, affected the personal protective behaviors of social distancing and face-covering use. Data collection was undertaken by trained observers. Adherence to protective behaviors was generally high, but there is clear evidence that these behaviors were shaped in a systematic way by the environment, situational cues, and the passage of time during the events. Some instances of large-scale non-adherence to personal protective behaviors were documented. An analysis within a dual-process framework suggests ways to understand and respond to supporting target health behaviors in groups of people where intervention is deemed valuable, such as in complex or ambiguous contexts. This is one of the first studies to include a 'true' behavioral measure in understanding human responses to COVID-19. It demonstrates that behavioral observations can add precision and granularity to understanding human behavior in complex real-world contexts. Given the significant physical and mental health burden created acutely and chronically by COVID-19, this work has implications for how governments and organizations support target populations in other complex challenges facing us today, such as in sustainability, and healthy lifestyle behaviors. An individual's intentions are not always matched by their actions, and so the findings support a balanced liberal paternalistic approach where system-level changes support appropriate individual-level decisions to engender collective responsibility and action.

Sport officials' use of observational learning

Introduction

Observational learning is a key tool for improving skilled performances. Sport officials (e.g., referees, umpires, and judges) might glean particular benefits from using observation, as most officials do not engage in traditional practice. Unfortunately, little is known about how observational learning can be of benefit to sport officials. Thus, the purpose of this study was to take an exploratory approach to learn more about sport officials' use of observation.

Methods

Participants included 206 sport officials (170 male, 35 female, 1 not specified) from 17 sports (mainly ice hockey, soccer, lacrosse, and volleyball). Sport officials completed a 50-question online survey regarding their use of observational learning. Survey questions revolved around the reasons for using observation (e.g., to learn about positioning or rule application), along with when and how participants used observation (e.g., before versus after competitions; watching an unskilled versus skilled model).

Results

Participants used observation most frequently to learn knowledge and application of rules, personality and game management, and fitness and positioning/mechanics. Results revealed that participants preferred to use observation after their competitions, while watching other sport officials in-person, and while observing a skilled model who was correctly executing their tasks.

Discussion

In the discussion, we expand on the results, connecting it to previous research in sport officiating or observational learning. Lastly, we offer suggestions for future researchers that should help build our understanding of sport officials' use of observation.

Wait-and-scan management in sporadic Koos grade 4 vestibular schwannomas: A longitudinal volumetric study

Background

Volumetric natural history studies specifically on large vestibular schwannomas (VSs), commonly classified as Koos grade 4, are lacking. The aim of the current study is to present the volumetric tumor evolution in sporadic Koos grade 4 VSs and possible predictors for tumor growth.

Methods

Volumetric tumor measurements and tumor evolution patterns from serial MRI studies were analyzed from selected consecutive patients with Koos grade 4 VS undergoing initial wait-and-scan management between January 2001 and July 2020. The significant volumetric threshold was defined as a change in volume of ≥10%.

Results

Among 215 tumors with a median size (IQR) of 2.7 cm3 (1.8-4.2), 147 tumors (68%) demonstrated growth and 75 tumors (35%) demonstrated shrinkage during follow-up. Growth-free survival rates (95% CI) at 1, 2, 5, and 10 years were 55% (48-61), 36% (29-42), 29% (23-36), and 28% (21-34), respectively and did not significantly differ in tumors> 20 mm (Chi-square = .40; P-value = .53). Four tumor evolution patterns (% of total) were observed: continued growth (60); initial growth then shrinkage (7); continued shrinkage (27); and stability (5). Good hearing (adjusted HR 2.21, 95% CI 1.48-3.30; P < .001) and peritumoral edema (adjusted HR 2.22, 95% CI 1.18-4.13; P = .01) at diagnosis were significantly associated with an increased likelihood of growth.

Conclusions

Koos grade 4 VSs show a wide variety in size and growth. Due to variable growth patterns, an initial wait-and-scan strategy with short scan intervals may be an acceptable option in selected tumors, if no significant clinical symptoms of mass effect that warrant treatment are present.

A group concept mapping and ethnographic study of intensive care rehabilitation culture

BACKGROUND

Early physical activity and physical rehabilitation are advocated in the critical care unit for patients recovering from critical illness. Despite this, there are still many factors associated with implementation of early physical rehabilitation into routine critical care and practice. One such factor that has been consistently identified is unit culture, yet there is little understanding of how or why the culture of a critical care unit impacts on implementation of early rehabilitation.

AIM

To develop a detailed understanding of the cultural barriers and enablers to the promotion and implementation of physical activity and early mobilization in National Health Service (NHS) critical care units in the United Kingdom (UK).

STUDY DESIGN

A mixed-methods, two-phase study incorporating online group concept mapping (GCM) and ethnography. GCM will be conducted to provide a multistakeholder co-authored conceptual framework of rehabilitation culture. Ethnographic observations and interviews will be conducted of culture and behaviours in relation to the implementation and promotion of early physical activity and rehabilitation in two NHS critical care units in the North East of England.

RESULTS

The results of the Group Concept Mapping and ethnographic observations and interviews will be triangulated to develop a contextual framework of rehabilitation culture in critical care.

RELEVANCE TO CLINICAL PRACTICE

This study will provide a detailed understanding of barriers and facilitators in relation to providing a positive rehabilitation culture in the critical care unit.

Exploring techniques for encoding spoken instructions in working memory: a comparison of verbal rehearsal, motor imagery, self-enactment and action observation

Encoding and recalling spoken instructions is subject to working memory capacity limits. Previous research suggests action-based encoding facilitates instruction recall, but has not directly compared benefits across different types of action-based techniques. The current study addressed this in two experiments with young adults. In Experiment 1, participants listened to instructional sequences containing four action-object pairs, and encoded these instructions using either a motor imagery or verbal rehearsal technique, followed by recall via oral repetition or enactment. Memory for instructions was better when participants used a motor imagery technique during encoding, and when recalling the instructions by enactment. The advantage of using a motor imagery technique was present in both verbal and enacted recall. In Experiment 2, participants encoded spoken instructions whilst implementing one of four techniques (verbal rehearsal, motor imagery, observation of others' actions or self-enactment), and then recalled the instructions by oral repetition or enactment. For both verbal and enacted recall, memory for instructions was least accurate in the rehearsal condition, while the other encoding conditions did not differ from each other. These novel findings indicate similar benefits of imagining, observation and execution of actions in encoding spoken instructions, and enrich current understanding of action-based benefits in working memory.

["The Nidcap gave me the impression of having a fairer and more objective perception of the child"]

Certified Neonatal Individualized Developmental Care and Assessment Program (Nidcap) childcare worker, Fabienne Grillère first experimented with this practice in the neonatology department before doing so in maternal and child care. Indeed, the principle of Nidcap care can be applied in different professional sectors since they refer to the premature or sick newborn and its observation. Its use brings an undeniable advantage in the support offered to the child and his family.

[Nidcap behavioral observation]

Who says Neonatal Individualized Developmental Care and Assessment Program (Nidcap) says observation of the baby's behavior. But what is a Nidcap observation? Who are the professionals who can use this method and what are their objectives? How does an observation of this type take place? How do professionals approach their analyzes with parents? Which babies benefit from it? What does this practice bring to the caregiver who uses it? So many questions that are important to address to better understand the Nidcap observation.

Alongside: Exploring the Meaningfulness of Significant Moments in Others' Lives Through Observation and Interview

How do we explore the meaningfulness of others' experiences? What means do we have to access their experiencing of the world? How do we express our understandings of others' experiences of body and place without reducing them to objectification? In this methodological paper, we reflect on how we can gain valuable insights into the lived experiences of others through research activities that are conducted 'alongside' participants. Phenomenological concepts of intentionality and embodiment are considered as we draw on an empirical example of exploring the experiences of hospitalized patients with neurological diseases through observations and interviews. The aim is to unfold alongside as an epistemological stance to explore the meaning of another's lifeworld. We strive to show that personal presence and engagement within this approach contains relational, existential, and aesthetic dimensions worth considering.

Should oral care be about more than a gut feeling? A qualitative study investigating patients' and healthcare professionals' experiences

AIM

To explore patients' and healthcare professionals' (HCPs) experiences of oral care during hospitalisation to identify needs and challenges.

BACKGROUND

Daily oral care is important to patients' health and well-being, to prevent diseases in the oral cavity, systemic infections and increased morbidity, which subsequently can lead to prolonged hospitalisation and, at worst, increased mortality. Despite this knowledge, oral care is a neglected part of nursing practice. Studies do not clearly identify barriers regarding oral care, as the existing knowledge is inadequate.

DESIGN

A qualitative study exploring participants' experiences to gain new in-depth knowledge of oral care among hospitalised patients.

METHODS

A phenomenological-hermeneutic approach was applied. Participant observations were conducted on five hospital wards, combined with individual semi-structured interviews with 16 patients and 15 HCP. Data analysis was based on Ricoeur's theory of narrative and interpretation.

RESULTS

Four themes describing the challenges regarding oral care emerged: Oral care as a gut feeling; oral care fades into the background; even self-reliant patients need help with oral care; and the mouth reflects the life lived.

CONCLUSIONS

The identified challenges show there is a need for improvement in the health professional approach to oral care in nursing practice. Focus on increasing HCPs' knowledge, skills and competences can increase their nursing agency and support patients' self-care capacity.

IMPACT

Investigation of oral care during hospitalisation revealed four main challenges concerning both patients' and HCPs' lack of knowledge and awareness of oral care. Thus, patients and HCPs should be included in developing solutions to improve oral care in nursing practice.

REPORTING METHODS

The COREQ criteria for reporting qualitative research were adhered to.

PATIENT CONTRIBUTION

A patient representative was involved in the discussion of the proposal, conduct and results of the study.

The development and reliability testing of the Functional Lower-Limb Amputee Gait Assessment

OBJECTIVE

The study purpose was three-fold: (a) to describe the development of the Functional Lower-Limb Amputee Gait Assessment, (b) to determine its reliability with two groups of raters, physical therapists, and certified prosthetists, and (c) to determine the agreement on its results between the two groups.

DESIGN

A reliability study.

SETTING

Institution for higher education.

PARTICIPANTS

Five physical therapists and five certified prosthetists.

INTERVENTION

Not applicable.

MAIN MEASURE

The gait of people with unilateral lower limb amputation was evaluated using the Functional Lower-Limb Amputee Gait Assessment. Kappa statistic was used to analyze reliability.

RESULTS

The intra-rater reliability of nine gait deviations in the physical therapists' group and eight in the certified prosthetists' group was between moderate and almost perfect agreement (kappa = .41-1). In the physical therapists' group, the inter-rater reliability of four gait deviations was moderate (kappa = .41-.6). In the certified prosthetists' group, the inter-rater reliability of six gait deviations was moderate to substantial (kappa = .41-.8). Three gait deviations achieved moderate agreement in both groups of clinicians (kappa = .41-.6).

CONCLUSIONS

Most gait deviations included in the Functional Lower-Limb Amputee Gait Assessment appear stable over time when used by the same clinician. Six gait deviations in the certified prosthetists' group and four in the physical therapists' group may be used by multiple clinicians, and three gait deviations may be used across both professions to assist in communication and collaboration on the best course of treatment for a patient with a unilateral lower limb amputation.

Examining Learner-Controlled Role-Switching in Dyad Practice for the Learning of a Speed Cup-Stacking Task

Dyad practice has proven to be an efficient, and in some cases, a more effective method of promoting motor learning compared to individual practice. Further, providing individuals control over their own or another learner's practice environment has also been shown to be superior for skill learning relative to individuals without control. The purpose of the experiment was to assess learner-controlled role-switching in dyad practice conditions. In dyads, partners either alternated actor and observer roles on a trial-to-trial basis, or under novel learner-controlled conditions wherein either the actor or the observer was given control over when the partners should switch roles. Participants practiced a speed cup-stacking task and learning was assessed in 24-h retention and transfer tests. Although there were no learning differences between dyad conditions, paired learners effectively chose when to switch roles with their partner, without undermining learning. The results also highlight the dynamic nature of dyad practice as the observers chose to switch roles more frequently than the actors, yet both dyad groups adopted comparable switching strategies by alternating roles following relatively 'good' and 'bad' trials. This experiment provides further support for dyad practice as an efficient and effective method of skill learning.

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study

WHAT IS KNOWN ON THE SUBJECT?: Nurses' observation of patients in seclusion is essential to ensure patient safety. Patient observation in seclusion assists nurses in adhering to the requirements of mental health legislation and hospital policy. Direct observation and video monitoring are widely used in observing patients in seclusion. Coercive practices may cause distress to patient-staff relations. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We add detailed information on specific observation methods in seclusion and compare them from the perspective of patients. Nurses communicating with patients ensures relational contact and that quality care is provided to patients even in the most distressed phase of their illness. Providing prior information to patients on observation methods in seclusion and the need for engaging patients in meaningful activities, while in seclusion are emphasized. Observation via camera and nurses' presence near the seclusion room made patients feel safe and gave a sense of being cared for in seclusion. Pixellating the video camera would give a sense of privacy and dignity. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The overarching goal is to prevent seclusion. However, when seclusion is used as a last resort to manage risk to others, it should be done in ways that recognize the human rights of the patient, in ways that are least harmful, and in ways that recognize and cater to patients' unique needs. A consistent approach to relational contact and communication is essential. A care plan must include patient's preferred approach for interacting while in seclusion to support individualized care provision. Viewing panels (small window on the seclusion door) are important in establishing two-way communication with the patient. Educating nurses to utilize them correctly helps stimulate relational contact and communication during seclusion to benefit patients. Engaging patients in meaningful activities when in seclusion is essential to keep them connected to the outside world. Depending on the patient's presentation in the seclusion room and their preferences for interactions, reading newspapers, poems, stories, or a book chapter aloud to patients, via the viewing panel could help ensure such connectedness. More focus should be placed on providing communication training to nurses to strengthen their communication skills in caring for individuals in challenging care situations. Patient education is paramount. Providing prior information to patients using a co-produced information leaflet might reduce their anxiety and make them feel safe in the room. When using cameras in the seclusion room, these should be pixelated to maintain patients' privacy. ABSTRACT: Introduction A lack of research investigating the specific role that various observational techniques may have in shaping the therapeutic relations in mental health care during seclusion warranted this study. Aim The aim of the study was to explore patients' experience of different methods of observation used while the patient was in seclusion. Method A retrospective phenomenological approach, using semi-structured interviews, ten patients' experiences of being observed in the seclusion room was investigated. Colaizzi's descriptive phenomenological method was followed to analyse the data. Results Communicating and engaging patients in meaningful activities can be achieved via the viewing panel. The camera was considered essential in monitoring behaviour and promoting a sense of safety. Pixelating the camera may transform patient view on privacy in seclusion. Discussion The mental health services must strive to prevent seclusion and every effort should be made to recognise the human rights of the patient. The study reveals numerous advantages when nurses actively engage in patient communication during the process of observation. Implications for Practice Different observation methods yield different benefits; therefore, staff education in using these methods is paramount. Empowering the patient with prior information on seclusion, engaging them in meaningful activities and proper documentation on patient engagement, supports the provision of individualised care in seclusion.

Couple Conflict Behavior: Disentangling Associations With Relationship Dissatisfaction and Intimate Partner Violence

This study investigates associations between (a) relationship satisfaction and intimate partner violence (IPV: psychological, physical, and sexual) and (b) observed couples communication behavior. Mixed-sex couples (N=291) were recruited via random digit dialing. Partners completed the Quality of Marriage Index (Norton, 1983), the Revised Conflict Tactics Scale (Straus et al., 1996), and one female-initiated and one male-initiated 10-min conflict conversations. Discussions were coded with Rapid Marital Interaction Coding System, 2nd Generation (Heyman et al., 2015). As hypothesized, lower satisfaction was associated with more hostility (p =.018) and less positivity (p < 0.001); more extensive IPV was associated with more hostility (p < 0.001). For negative reciprocity, there was a dissatisfaction × IPV extent × conversation-initiator interaction (p < 0.006). Results showed that conflict behaviors of mixed-sex couples are related to the interplay among gender, satisfaction, and the severity of couple-level IPV. Theoretical and clinical implications are discussed.

Understanding the workflow of nurses in acute and subacute medical wards: A time and motion study

AIMS AND OBJECTIVES

The aim of this study was to determine how much time nurses spend on direct and indirect patient care in acute and subacute hospital settings.

BACKGROUND

Quantifying direct and indirect nursing care provided during inpatient stay is vital to optimise the quality of care and manage resources.

DESIGN

Time and motion cross-sectional observational study and reported the study according to the STROBE guideline.

METHODS

Nurses working in an acute or subacute medical wards of a single health service participated. Nurses were observed twice for 2 h on the same day with an observer break in between sessions. Real-time task-related data were digitally recorded using the Work Observation Method By Activity Timing (WOMBAT) tool by a single research assistant. Frequency and time spent on pre-determined tasks were recorded and included direct care, indirect care, documentation, medication-related tasks, communication (professional) and other tasks. Task interruptions and multitasking were also recorded.

RESULTS

Twenty-one nurses (acute n = 12, subacute n = 9) were observed during shifts between 7 AM and 9 PM in May-July 2021. A total of 7240 tasks were recorded. Nurses spent a third of their time on direct patient care (27% direct care and 3% medication administration). A total of 556 task interruptions occurred, mostly during documentation, and medication-related tasks. A further 1385 tasks were performed in parallel with other tasks, that is multitasking.

CONCLUSIONS

Time spent on tasks was similar regardless of the setting and was consistent with previous research. We found differences in the distribution of tasks throughout the day between settings, which could have implications for workforce planning and needs to be investigated further. Interruptions occurred during documentation, direct care and medication-related tasks. Local-level strategies should be in place and regularly revised to reduce interruptions and prevent errors. Relevance to clinical practice The association between interruption and increased risk of error is well-established and should be an ongoing area of attention including observations and education provided in local settings.

Talking about cancer: Patient responses to raising awareness of oral cancer in primary dental care

OBJECTIVES

Dentists and other members of the dental team could raise awareness by talking about oral cancer during routine dental check-ups. A communication guide has been developed to facilitate this. However, it has been suggested that discussions about oral cancer may raise patients' anxiety and this has been documented by dentists as a barrier to having these conversations. The current research aimed to investigate implementation of the communication guide and its impact on the dental patient.

METHODS

A consecutive-case sample of adult dental patients attending primary dental care for a routine NHS check-up at one dental practice were invited to take part in the study via letter prior to their appointment. Consultations of participating patients (n = 77) were audio-recorded. Before and after their appointment, patients were asked to rate their current anxiety via the six-item version of Spielberger's State-Trait Anxiety Inventory. Audio recordings of each consultation were reviewed by two raters to determine the extent to which the dentist covered the topics recommended in the communication guide.

RESULTS

The dentist informed all patients that they were being checked for oral cancer, spoke about signs and symptoms, and discussed risk factors. However, they rarely recommended where help should be sought or addressed barriers to seeking help. Discussions took an average of 95 s. The extent to which oral cancer was discussed did not correlate with patients' post-appointment anxiety. Patients made positive or neutral responses to the discussions. The few questions that were asked were easily addressed.

CONCLUSIONS

As findings are based on one dentist working at one practice, generalization of these results should be cautious. The study indicated that using an evidence-based guide to talk about oral cancer did not appear to raise patients' anxiety in this practice population. This could help to increase awareness of oral cancer in the endeavour to facilitate early cancer diagnosis.

'It must be right, I saw it on TV!': An observational study of third stage birth practices in popular television programmes

Objectives

To examine modern media depictions of the third stage of birth in a selection of UK television representations.

Design

Observational study of a sample of televised fictional and real births, audited against current National Institute of Health and Social Care Excellence (NICE) guidance.

Setting

UK television channels BBC (Call The Midwife and This Is Going To Hurt) and Channel 4 (One Born Every Minute).

Participants

87 births from 48 episodes, sampled from the three shows.

Main outcome measures

The primary outcome was the number of births where the cord was clamped at more than 1 min after birth. Secondary outcomes included place and type of birth, measures of dignity and paternal involvement.

Results

Overall, the timing of cord clamping was clearly shown in 25/87 (29%) of births, of which only 4/25 (16%) occurred at more than 1 min in screen time. The place of birth and caesarean section (CS) rate changed according to the series perspective and era; graphic explicit images were shown, but these related to CS detail.

Conclusions

UK television shows have accurately depicted changes in place, culture and type of birth over the last century. They provide the public with a view of new rituals but an inaccurate picture of good quality care. Early cord clamping was shown in most births, even those set after 2014. No programme informed viewers about the safety aspects. When showing outdated practices, broadcasters have a public health duty to inform viewers that this is no longer recommended.

Development of individual competencies and team performance in interprofessional ward rounds: results of a study with multimodal observations at the Heidelberg Interprofessional Training Ward

Introduction

Interprofessional training wards (IPTW) aim to improve undergraduates' interprofessional collaborative practice of care. Little is known about the effects of the different team tasks on IPTW as measured by external assessment. In Heidelberg, Germany, four nursing and four medical undergraduates (= one cohort) care for up to six patients undergoing general surgery during a four-week placement. They learn both professionally and interprofessionally, working largely on their own responsibility under the supervision of the medical and nursing learning facilitators. Interprofessional ward rounds are a central component of developing individual competencies and team performance. The aim of this study was to evaluate individual competencies and team performance shown in ward rounds.

Methods

Observations took place in four cohorts of four nursing and four medical undergraduates each. Undergraduates in one cohort were divided into two teams, which rotated in morning and afternoon shifts. Team 1 was on morning shift during the first (t0) and third (t1) weeks of the IPTW placement, and Team 2 was on morning shift during the second (t0) and fourth (t1) weeks. Within each team, a tandem of one nursing and one medical undergraduate cared for a patient room with three patients. Ward round observations took place with each team and tandem at t0 and t1 using the IP-VITA instrument for individual competencies (16 items) and team performance (11 items). Four hypotheses were formulated for statistical testing with linear mixed models and correlations.

Results

A total of 16 nursing and medical undergraduates each were included. There were significant changes in mean values between t0 and t1 in individual competencies (Hypothesis 1). They were statistically significant for all three sum scores: "Roles and Responsibilities", Patient-Centeredness", and "Leadership". In terms of team performance (Hypothesis 2), there was a statistically significant change in mean values in the sum score "Roles and Responsibilities" and positive trends in the sum scores "Patient-Centeredness" and "Decision-Making/Collaborative Clinical Reasoning". Analysis of differences in the development of individual competencies in the groups of nursing and medical undergraduates (Hypothesis 3) showed more significant differences in the mean values of the two groups in t0 than in t1. There were significant correlations between individual competencies and team performance at both t0 and t1 (Hypothesis 4).

Discussion

The study has limitations due to the small sample and some sources of bias related to the external assessment by means of observation. Nevertheless, this study offers insights into interprofessional tasks on the IPTW from an external assessment. Results from quantitative and qualitative analysis of learners self-assessment are confirmed in terms of roles and responsibilities and patient-centeredness. It has been observed that medical undergraduates acquired and applied skills in collaborative clinic reasoning and decision-making, whereas nursing undergraduates acquired leadership skills. Within the study sample, only a small group of tandems remained constant over time. In team performance, the group of constant tandems tended to perform better than the group of random tandems. The aim of IPTW should be to prepare healthcare team members for the challenge of changing teams. Therefore, implications for IPTW implementation could be to develop learning support approaches that allow medical and nursing undergraduates to bring interprofessional competencies to team performance, independent of the tandem partner or team.

Distinctive Roles of Medial Prefrontal Cortex Subregions in Strategic Conformity to Social Hierarchy

People often align their behaviors and decisions with others' expectations, especially those of higher social positions, when they are being observed. However, little attention has been paid to the neural mechanisms underlying increased conformity to the social hierarchy under social observation. Using a preference rating task, we investigated whether and how individual preferences for novel stimuli were influenced by others' preferences by manipulating others' social hierarchy and observational context. The behavioral results showed that human participants of both sexes were more likely to change their preferences to match those of a superior partner in a public than in a private context. fMRI data revealed distinct contributions of the subregions of the medial prefrontal cortex (mPFC) to increased conformity to social hierarchy under observation. Specifically, the ventral mPFC showed increased activity when participants' preferences aligned with those of superior partners, regardless of behavioral manifestation. The rostral mPFC showed increased activity when conforming to a superior partner and nonconforming to an inferior one, indicating goal-dependent valuation. The dorsal mPFC showed increased activity in private conditions with a superior partner but only in those with a higher tendency to conform. These findings support the hierarchical allostatic regulation model of the mPFC function for social valuation and suggest strategic conformity as a way to minimize metabolic costs.SIGNIFICANCE STATEMENT This study revealed distinct roles of subregions of the mPFC in increased conformity to individuals of different social ranks under observation. Specifically, the ventral mPFC showed increased activity when participants' preferences aligned with those of higher-ranking partners, whereas the rostral mPFC showed increased activity when conforming to a superior partner and nonconforming to an inferior partner, indicating goal-dependent valuation. The dorsal mPFC was more active in private conditions with a superior partner but only in those with a higher tendency to conform. These findings support the hierarchical allostatic regulation model of the mPFC function for social valuation and suggest strategic conformity as a way to minimize metabolic costs.

An exercise in scientific problem-solving: Illustrating the utility of the principles of the Sydney Declaration

In forensic science, scientific problem-solving is characterized by the recognition of traces as part of iterative reasoning processes to assign meaning to those traces in order to interpret and reconstruct events. Through a set of fundamental principles, the Sydney Declaration presents a foundation of forensic science through the lens of a scientist. The distinction between a scientist and a technician may require clarification-where a prototypical technician follows a prescribed set of 'standard operating procedures' and may be limited in the interpretation of the resultant data, the scientist utilizes knowledge, skills, experience and imagination to identify the issue at hand and develop lines of inquiry for testing and interpretation. This case report draws on the Sydney Declaration in order to highlight the importance of learning about events from careful consideration of both obvious and less obvious traces. A case involving the assault of a police officer is examined to illustrate the use of the Principles: the problem originally defined by investigators at the scene and later by prosecutors resulted in incorrect analysis and interpretation of traces, hampering efforts at an accurate reconstruction of events. This exercise serves to demonstrate that in order to engage in scientific problem-solving, it is necessary to apply observation and reasoning in forensic investigations in order to yield an outcome that can be clearly articulated. The overarching goal is to support the drive to improve forensic science practice, education, and research through a case illustrating the value of the principles of the Sydney Declaration.

Observing and interpreting clinical process: Methods and findings from 'Layered analysis' of parent-infant psychotherapy

This paper describes a method for investigating clinical process, Layered Analysis, which combines therapist countertransference reports and multi-faceted microanalytic research approaches. Findings from the application of Layered Analysis to video-recorded micro-events of rupture and repair in four psychoanalytic parent-infant psychotherapy sessions are presented. Layered analysis showed that countertransference and observation are complementary perspectives, which enable concomitant study of interactive events, conscious internal experiences, as well as nonconscious and unconscious elements of therapeutic interaction. Interactional rupture and repair were found to constitute co-constructed micro-events that occurred fleetingly and often implicitly, and differed in the structure, coherence and flow of interactions and in the relationship between verbal and nonverbal communication. Furthermore, interactional ruptures were found to sometimes 'get into' the therapist and transiently disrupt their self-organization, such that the therapist became a locus of disruption for the patient(s), actively contributing to the rupture, which thus became embedded in the therapeutic system. Interactive repair was found to be most often initiated by the therapist and to be underpinned by the therapist re-establishing self-regulation, through metabolizing embodied and verbal aspects of the rupture. Studying such processes can enhance our understanding of clinical process, inform therapist training and clinical supervision, and contribute to clinical outcomes.

The Course of Hearing Loss in Patients With a Progressive Vestibular Schwannoma

OBJECTIVE

This study evaluates the natural course of hearing loss (HL) prior to treatment in patients with progressive tumors and an indication for active intervention. Evaluating this patient group specifically can put hearing outcomes after vestibular schwannoma therapy into an adequate context.

STUDY DESIGN

Retrospective cohort study.

SETTING

Tertiary referral center.

METHODS

Inclusion criteria comprised unilateral vestibular schwannomas prior to active treatment, with ≥2 mm extracanalicular (EC) tumor growth and ≥2 audiograms. We performed a comprehensive assessment of hearing using multiple outcome parameters including (the annual decrease in) pure-tone averages (PTAs; an average of 0.5, 1, 2, and 3 kHz). Predictors for HL were evaluated (patient age, tumor size/progression, follow-up duration, baseline hearing).

RESULTS

At presentation, 86% of patients suffered from sensorineural HL on the affected side (≥20 dB PTA) with a median of 39 dB (interquartile rate [IQR]: 27-51 dB). The median follow-up duration was 21 months (IQR: 13-34 months), after which 58% (187/322) of patients experienced progressive HL (≥10 dB), with a median increase of 6.4 dB/year. At the last follow-up, the median PTA was 56 dB (IQR: 37-73). Median speech discrimination scores deteriorated from 90% (IQR: 70%-100%) to 65% (IQR: 35%-100%). Tumor progression (maximal EC diameter) was significantly correlated to the progression of sensorineural HL, corrected for follow-up (F(2,228) = 10.4, p < .001, R2  = 8%).

CONCLUSION

The majority of patients (58%) with radiologically confirmed progressive vestibular schwannomas experience progressive sensorineural HL during observation. Tumor progression rate, EC tumor extension, and longer follow-up are factors associated with more sensorineural HL.

Art at the Start: A controlled trial and close observation of parent-infant art therapy intervention

This two-part study seeks to evidence art therapy intervention for parent-infant attachment relationships, looking at improvements to wellbeing and relationships. Study one was a controlled trial with 105 participating parent/caregivers and their infants (0-3-years), identified due to concerns about their relationship. They were quasi-randomized to attend a 12-week art therapy group or treatment as usual. Measures focused on parents' wellbeing and their perceptions of their relationship with their infant. In study 2 we analyzed video footage from the first and penultimate sessions of a sample of 37 dyads, looking for observable changes in the different channels of communication upon which attachments are predicated. The controlled trial showed intervention participants had significantly improved parental wellbeing, significant increases in attachment warmth and significant decreases in intrusion. This contrasted with the control sample who showed a significant decrease in wellbeing, stable warmth, and significant increases in intrusion. The observation study showed that there was a significant increase in the communicative behaviors from the parents to the infant which would support attachments between the first and penultimate sessions. We conclude that these results make a robust case for the inclusion of art therapy within the range of interventions available for at risk early relationships.

Clinical profiles and outcomes in patients with ulcerative colitis receiving standard and higher-than-standard doses of vedolizumab: findings from a real-world study in Europe

OBJECTIVE

Vedolizumab is an antibody targeting α4β7 integrin used in the treatment of ulcerative colitis (UC). Patients are commonly prescribed higher-than-standard doses if treatment response is inadequate, but little is known about the drivers and impact of increased dosing. Our objective was to use real-world data to describe vedolizumab dosages in current clinical practice, patient characteristics, physicians' reasons for prescribing vedolizumab, and physician treatment satisfaction.

METHODS

Data were derived from the Adelphi Real World UC vedolizumab Chart Review, a cross-sectional survey of gastroenterologists and their UC patients, conducted in France, Germany, Italy, Spain, and the United Kingdom between December 2022 and March 2023. Gastroenterologists provided data on patient demographics, clinical characteristics, treatment and vedolizumab dosage history, reasons for dose choice, and treatment satisfaction.

RESULTS

Data were returned on 448 patients by 112 gastroenterologists. Overall, 83.5% of patients were on a standard vedolizumab dose and 10.3% were on a higher-than-standard dose. The worsening of symptoms was the most cited reason for higher doses. Most reported symptoms at survey were fatigue, abdominal distention or pain, diarrhea, and bowel urgency, with the latter particularly in higher-than-standard dose patients. Patients on higher-than-standard dose had high rates of mild (37.0%) or moderate (26.1%) disease, and low rates of remission (33.8%). Physicians were dissatisfied with treatment control for 2.7% of standard and 26.1% of higher-than-standard dose patients.

CONCLUSIONS

Over 10% of patients were receiving a higher-than-standard dose of vedolizumab, but despite this were found to have suboptimal clinical outcomes and low physician satisfaction.

An Individualized Training Program for PE Teachers Based on Self-Determination Theory as a Way to Improve Students' Psychosocial Health: A Study Protocol

The interactions that take place in physical education (PE) between teachers and students have received large attention from the scientific community. However, despite the existence of different studies aiming to promote motivation among students through school interventions, there seem to be no interventions based on motivational strategies in which interventions are personalized to better fit teachers' own characteristics on the basis of theoretical contents grounded in self-determination theory. This study aims to present a protocol intervention in the PE context based on SDT to improve teaching behaviours through an individualized and lifelong training program. This protocol is a convenience study in which PE teachers will design and implement motivational strategies to increase students' motivation in class. The training program will take place along the intervention to allow teachers to personalize their implementation of motivational strategies according to their specific context. Data collection will be conducted before, during and after the intervention using recorded sessions (observational methodology), interviews (qualitative approach), and questionnaires (quantitative approach). The measures will assess teachers' and students' perceived teaching styles. This intervention program is expected to change and improve the quality of teaching behaviours, which could foster students' psychosocial health.

Differences in participant characteristics and observed child restraint use between population-based and restraint fitting service samples

OBJECTIVE

To compare characteristics and restraint use between a population-based and fitting service sample of child restraint users.

METHOD

Characteristics of the two samples were compared using chi-squared tests. Differences in errors in restraint use observed in the two samples were modeled using logistic regression.

RESULTS

There were significant differences in child age (p < 0.001), and restraint types (p < 0.001) between the two samples, with more younger children in the fitting service sample. Controlling for differences in restraint type, the odds that adult participants were female were 61% less in the fitting service sample than in the population-based sample (OR 0.39, 95%CI 0.21-0.71). The odds that adult participants perceived a large risk associated with restraint misuse (OR 3.62, 95%CI 1.33-9.84), had a household income in the highest bracket (OR 3.89, 95%CI 1.20-12.62) and were living in areas of highest socioeconomic advantage (OR 2.72, 95%CI 1.22-6.06) were approximately three times higher in the fitting service sample. Overall, more participants had errors in restraint use in the population-based sample (p = 0.021). However, after controlling for restraint type, securing errors were three times more likely (OR 3.34, 95%CI 1.12-10.2), and serious installation errors were almost twice as likely (OR 1.91, 95% CI 1.09-3.39) in the fitting service sample.

CONCLUSIONS

While less resource intensive, convenience and/or fitting service samples may be less representative than population-based samples. Given the need for efficiency, methods that combine randomized population-based invitations to participate in restraint fitting check day events across geographically representative areas may be useful for ongoing surveillance of child restraint use.

The Road to Developing Standard Time for Efficient Nursing Care: A Time and Motion Analysis

(1) Background: The amount of time nurses spend with their patients is essential to improving the quality of patient care. Studies have shown that nurses spend a considerable amount of time on a variety of activities--which are often not taken into account while estimating nurse-to-patient care time allocation--that could potentially be eliminated, combined or delegated with greater productivity. The current study aimed to calculate standard time for each activity category by quantifying the amount of time required by nurses to complete an activity category and determine the adjustment time that can be given during work, as well as determine factors that can be altered to improve the efficiency of nursing care on inpatient general wards of a governmental hospital. (2) Method: A time and motion study was conducted over two weeks using 1-to-1 continuous observations of nurses as they performed their duties on inpatient general wards, while observers recorded each single activity, and specifically the time and movements required to complete those activities. (3) Result: There was 5100 min of observations over 10 working days. Nurses spent 69% (330 min) of time during their 8 h morning shift on direct patient care, (19.4%) ward/room activities (18%), documentation (14%), indirect patient care (12%) and professional communication (5%). Around 94 min of activities seem to be wasted and can be potentially detrimental to nurses' overall productivity and threaten patient care quality. The standard number of hours that represents the best estimate of a general ward nurse regarding the optimal speed at which the staff nurse can provide care related activities was computed and proposed. (4) Conclusions: The findings obtained from time-motion studies can help in developing more efficient and productive nursing work for more optimal care of patients.

Can Hot Weather Cause Non-ST Elevation Myocardial Infarction in Young Athletic Male Runners?

Athletes are a group of people who have good activity, regular muscular exercise, an almost standard lifestyle, and should be in good condition with low rates of medical, particularly cardiovascular, complications. However, cardiac attacks, sudden cardiac deaths, and fatal arrhythmogenic syndromes have been reported in athletes with low incidences. We can determine external and internal factors that lead to cardiac attacks in athletes. The former include abnormal cardiac structures and genetics, while the latter include environmental conditions like extreme temperatures, smoking, and drug abuse. Here, we report a case of a cardiac attack with non-ST elevation myocardial infarction (NSTEMI) in a young athlete who was a non-smoker, did not have any abnormal heart structures or a history of drug abuse, and did not have a family history of cardiac disease or arrest. High humidity levels and temperatures were the main causes of the cardiac attack, which occurred during a sports exercise at high temperatures with high humidity levels. We hope to prevent the recurrence of such a case. We need to understand when and where sports exercises can be performed without the risk of medical complications.

Unruptured Anterior Communicating Artery Aneurysms: Management Strategy and Results of a Single-Center Experience

Although anterior communicating artery (AComA) unruptured intracranial aneurysms (UIAs) comprise one of the largest aneurysm subgroups, their complex adjacent neurovasculature and increased risk of rupture impede optimal management. In the present study, we analyzed the results of our diverse strategy in AComA UIAs with the additional goal of assessing the risk of treatment and the incidence of hemorrhage. We analyzed 131 patients, of which each was assessed by a multidisciplinary neurovascular team and assigned to observation (45.8%), endovascular treatment (34.4%) or microsurgery (19.8%). Median aneurysm sizes were 3, 7.2 and 7.75 mm, respectively. In the observation group, four (7.1%) aneurysms (initially <5 mm) grew over a median time of 63.5 months and were treated endovascularly. We found that fewer patients in the observation group were smokers (p = 0.021). The aneurysm size ratio was different between the combined treatment versus the observation group (p < 0.0001). Noteworthily, there were no hemorrhages in the observational group. Mortality for all patients with available follow-up was 2.4% (3/124) and permanent morbidity was 1.6% (2/124) over a mean follow-up of 64.2 months. These compelling rates refer to a high-risk group with potentially devastating consequences in which we have decreased the annual risk of hemorrhage to 0.14%.

Management of Epidural Hematomas in Pediatric and Adult Population: A hospital-based

AIM

We retrospectively reviewed and evaluated our treatment protocols in EDH (Epidural Hematoma) cases to compare surgical versus nonsurgical treatment subsections with their trauma mechanism, injury type, clinical pattern, radiological details, functional outcome, and mortality rates.

MATERIALS AND METHODS

This study included 350 patients (142 females and 208 males) treated for epidural hematoma between 2010 and 2018. Two hundred seven operated and 143 observed patients for EDH were compared for demography, injury type, treatment, and outcome scores retrospectively. Glasgow Coma Scale (GCS) and Glasgow Outcome Scale (GOS) were used to standardizing the clinical findings. Marshall and Rotterdam classifications classified radiological abnormalities. The Infinity PACS system measured hematoma volume, and volume parameters were evaluated differently in pediatric and adult groups.

RESULTS

Radiological parameters showed that the observation was more favorable when the EDH volume was <30 ml in the adult and <20 ml in the pediatric group. However, close clinical follow-up with repeated CT scans suggested that when the hematoma increase in volume in the first 24 hours, it should be treated surgically. Headache, vomiting, and paresis were significant clinical symptoms in this period. Only 11% of conservatively followed cases required delayed surgical intervention. When we analyzed the findings of the two groups of the patient, pediatric and adult, we noticed that rebleeding after the first surgery was more common in the adult group than the pediatric group, whereas surgery due to a growing hematoma was less common in the pediatric group.

CONCLUSION

Age, trauma severity, initial neurological statuses, and accompanying co-morbidities can affect the functional outcome in acute EDH. We found that urgent surgical intervention and conservative treatment may lead to excellent results in most cases. Thus, EDH can be managed both conservatively and surgically in certain conditions. We made a comparison between pediatric and adult age groups according to treatment modalities. Both rebleeding and mortality rates are relatively lower in the pediatric operated group than in the adult operated group. In the adult observation group, rates of delayed surgery because of growing hematoma seem relatively higher than in the pediatric observation group. During radiological follow-up, we found that the progression rate of EDH in the adult observed group according to time is faster than in the pediatric observed group (p<0.05).

Health profession students' outlooks on the medical profession during the COVID-19 pandemic: a global perspective

BACKGROUND

This article summarizes a global study of the effect of the COVID-19 pandemic on junior health professions students' outlook on medicine. The pandemic has significantly affected health professions education. There is limited understanding of how students' pandemic experiences will affect them, and what impact these events may have on their career paths or the future of the professions. This information is important as it impacts the future of medicine.

METHODS

In the Fall 2020 semester, 219 health professions students at 14 medical universities worldwide responded to the question: 'Has this experience (with COVID-19) changed your outlook on medicine as a profession?'. Short essay responses were semantically coded and organized into themes and subthemes using an inductive approach to thematic analysis.

RESULTS

145 responses were submitted. Themes were identified: (1) students reflected on the interaction between politics and healthcare; (2) reported becoming more aware of the societal expectations placed on healthcare professionals, including undertaking high risks and the sacrifices that healthcare professionals must make; (3) found reassurance from the recognized importance of healthcare professionals and expressed pride to be entering the profession; and (4) reflected on the current state of healthcare, including its limitations and future.

CONCLUSION

Most students, independent of the extent of the pandemic in their respective countries, noted a change in their outlook regarding medicine. An overall positive outlook was noted in most junior students. Educators need to work on nurturing these sentiments and attitudes to help young students maintain a healthy relationship towards their chosen profession.

Resource- and Neighbor-Aware Observation Transmission Scheme in Satellite Networks

The observation satellite can exploit its own storage and computational resources to reduce the transmission delay. However, too excessive usage of these resources can have negative effects on the queuing delay at the relay satellite and/or on conducting other tasks at each observation satellite. In this paper, we proposed a new resource- and neighbor-aware observation transmission scheme (RNA-OTS). In RNA-OTS, each observation satellite decides whether to use its resources and the resources of the relay satellite at each time epoch by considering its resource utilization and transmission policies of neighbor observation satellites. For the optimal decision of each observation satellite in a distributed manner, the operation of observation satellites is modeled by means of a constrained stochastic game, and a best-response-dynamics-based algorithm is devised to find the Nash equilibrium. The evaluation results demonstrate that RNA-OTS can decrease the delay to deliver the observation to the destination by up to 87% compared to a relay-satellite-based scheme while guaranteeing a sufficiently low average utilization of the resources of the observation satellite.

Dolichoectatic vertebrobasilar aneurysms: a systematic review and meta-analysis of management strategies and outcomes

OBJECTIVE

The aim of this study was to describe the efficacy, clinical outcomes, and complications of open cerebrovascular surgery, endovascular surgery, and conservative management of dolichoectatic vertebrobasilar aneurysms (DVBAs).

METHODS

Relevant articles were retrieved from PubMed, Scopus, Web of Science, and Cochrane databases according to PRISMA guidelines. A meta-analysis was conducted for clinical presentation, treatment protocols, and clinical outcomes-good (improved or stable clinical status) or poor (deteriorated clinical status or death)-and mortality rates.

RESULTS

The 9 identified articles described 41 cases (27.5%) of open cerebrovascular surgery, 61 endovascular procedures (40.9%), and 47 cases (31.5%) of conservative management for DVBAs. The total cohort had a good outcome rate of 51.9% (95% CI 28.3%-74.6%), a poor outcome rate of 45.5% (95% CI 23.0%-70.1%), and a mortality rate of 22.3% (95% CI 11.8%-38.0%). The treatment groups had comparable good clinical outcome rates (open cerebrovascular surgery group: 24.7% [95% CI 2.9%-78.2%]; endovascular surgery group: 69.0% [95% CI 28.7%-92.5%]; conservative management group: 57.7% [95% CI 13.0%-92.5%]; p = 0.19) and poor outcome rates (open vascular surgery group: 75.3% [95% CI 21.8%-97.1%]; endovascular surgery group: 27.2% [95% CI 5.6%-0.70.2%]; conservative management group: 39.9% [95% CI 9.1%-81.6%]; p = 0.15). The treatment groups also had comparable mortality rates (open vascular surgery group: 39.5% [95% CI 11.4%-76.8%]; endovascular surgery group: 15.8% [95% CI 4.4%-43.0%]; conservative management group: 19.2% [95% CI 6.8%-43.5%]; p = 0.23).

CONCLUSIONS

The current study of DVBAs illustrated poor outcomes and high mortality rates regardless of the treatment modality. The subgroup analysis showed heterogeneity among the subgroups and advice for personalized management.

Validation of a form for assessing the professional performance of residents in cardiology by nurses

BACKGROUND

There is a strong need for transformation in our assessment systems from one that evaluates performance based on levels of training to another that focuses on professional competence to meet the expected requirements for the practice of the profession. The aim of this study is to validate for the first time a Spanish version of a new tool for assessing the professional performance of residents by nurses newly developed in the Ottawa Hospital (O-RON).

MATERIALS AND METHODS

After the author's written authorization, the original O-RON form was translated and cross-culturally adapted. Then we conducted a prospective observational study in two cardiology centers in the city of Buenos Aires. The validity of the tools was evaluated by the ability of the instrument to discriminate the level of experience of the residents according to their post-graduate year level. Data is expressed as percentages and frequencies of the qualifications obtained in the different questions. The chi-square test was used to assess the significance of the differences obtained. A generalizability test was used to evaluate reliability. Feasibility was defined as a minimum of 4 assessments per resident per evaluation round. Satisfaction of evaluators was assessed using a survey with a 10-point scale designed by the authors.

RESULTS

A total of 838 evaluations were performed. Regarding validity, the 15-item form could significantly discriminate the experience of the residents according to their postgraduate year level (P < 0,005). Thirty evaluations per resident are required to obtain reliable results. The tool is feasible to implement and an average of 4.55 assessment per resident per evaluation round were achieved throughout the entire experience. This value remained stable during the 8 rounds (1st: 4.65; 2nd: 4.34; 3^rd: 4.47; 4^th: 6.17; 5^th: 4.56; 6^th: 4.08; 7^th: 4.36; 8^th: 3.91). The levels of satisfaction among the evaluators were acceptable.

CONCLUSION

The Spanish version of the O-RON form can provide residents with a valuable source of feedback from the eyes of nurses on important aspects of their professional training. This tool, positively assessed by the raters, significantly discriminates residents' experience. Its implementation is feasible in our environment, and it is user-friendly, though it requires a considerable number of assessments to achieve high reliability.

Factors associated with loss to follow-up before and after treatment initiation among patients with tuberculosis: A 5-year observation in China

Background

Loss to follow-up (LTFU) is a significant barrier to the completion of anti-tuberculosis (TB) treatment and a major predictor of TB-associated deaths. Currently, research on LTFU-related factors in China is both scarce and inconsistent.

Methods

We collected information from the TB observation database of the National Clinical Research Center for Infectious Diseases. The data of all patients who were documented as LTFU were assessed retrospectively and compared with those of patients who were not LTFU. Descriptive epidemiology and multivariable logistic regression analyses were conducted to identify the factors associated with LTFU.

Results

A total of 24,265 TB patients were included in the analysis. Of them, 3,046 were categorized as LTFU, including 678 who were lost before treatment initiation and 2,368 who were lost afterwards. The previous history of TB was independently associated with LTFU before treatment initiation. Having medical insurance, chronic hepatitis or cirrhosis, and providing an alternative contact were independent predictive factors for LTFU after treatment initiation.

Conclusion

Loss to follow-up is frequent in the management of patients with TB and can be predicted using patients' treatment history, clinical characteristics, and socioeconomic factors. Our research illustrates the importance of early assessment and intervention after diagnosis. Targeted measures can improve patient engagement and ultimately treatment adherence, leading to better health outcomes and disease control.

The No-Cloning Life: Uniqueness and Complementarity in Quantum and Quantum-like Theories

This article considers a rarely discussed aspect, the no-cloning principle or postulate, recast as the uniqueness postulate, of the mathematical modeling known as quantum-like, Q-L, modeling (vs. classical-like, C-L, modeling, based in the mathematics adopted from classical physics) and the corresponding Q-L theories beyond physics. The principle is a transfer of the no-cloning principle (arising from the no-cloning theorem) in quantum mechanics (QM) to Q-L theories. My interest in this principle, to be related to several other key features of QM and Q-L theories, such as the irreducible role of observation, complementarity, and probabilistic causality, is connected to a more general question: What are the ontological and epistemological reasons for using Q-L models vs. C-L ones? I shall argue that adopting the uniqueness postulate is justified in Q-L theories and adds an important new motivation for doing so and a new venue for considering this question. In order to properly ground this argument, the article also offers a discussion along similar lines of QM, providing a new angle on Bohr's concept of complementarity via the uniqueness postulate.