Witney Community Hospital

In a comprehensive literature review, the author examines partnership in care between nurses and patients. The article describes the constraints on the relationship, assessing how theory relates to current practice and highlighting the stresses nurses are under as patient attitudes and expectations change.

INTRODUCTION: Our goal was to describe the structure, process, platforms, and piloting period activities of the International Emergency Medicine (iEM) Education Project, which is a Free Open Access Medical Education (FOAM) initiative designed for medical students. METHODS: This was a descriptive study. We analyzed the activity data of iEM Education Project platforms (website and image, video, audio archives) in the piloting period (June 1, 2018-August 31, 2018). Studied variables included the total and monthly views, views by country and continents, the official languages of the countries where platforms were played, and their income levels. RESULTS: Platforms were viewed or played 38,517 times by users from 123 countries. The total views and plays were 8,185, 11,896, and 18,436 in June, July, and August, respectively. We observed a monthly increasing trend in all platforms. Image archive and website were viewed the most. All platforms were dominantly viewed from Asia and North America, high- and upper-middle-income countries, and non-English speaking countries. However, there were no statistically significant differences between continents, income levels, or language in platforms, except for the website, the project's main hub, which showed a strong trend for difference between income levels (Kruskal-Wallis, P = 0.05). Website views were higher in high-income countries compared with low- and lower-middle income countries (Mann Whitney U test, P = 0.038 and P = 0.021, respectively). CONCLUSION: The iEM Education Project was successfully established. Our encouraging initial results support the international expansion and increased collaboration of this project. Despite targeting developing countries with limited resources in this project, their engagement was suboptimal. Solutions to reach medical students in these countries should be investigated.

<bold>Background:</bold> Multiple early hospital cohorts of coronavirus disease 2019 (COVID-19) showed that patients with chronic respiratory disease were significantly under-represented. We hypothesised that the widespread use of inhaled glucocorticoids was responsible for this finding and tested if inhaled glucorticoids would be an effective treatment for early COVID-19 illness. <bold>Methods:</bold> We conducted a randomised, open label trial of inhaled budesonide, compared to usual care, in adults within 7 days of the onset of mild Covid-19 symptoms. The primary end point was COVID-19-related urgent care visit, emergency department assessment or hospitalisation. The trial was stopped early after independent statistical review concluded that study outcome would not change with further participant enrolment. <bold>Results:</bold> 146 patients underwent randomisation. For the per protocol population (n=139), the primary outcome occurred in 10 participants and 1 participant in the usual care and budesonide arms respectively (difference in proportion 0.131, p=0.004). The number needed to treat with inhaled budesonide to reduce COVID-19 deterioration was 8. Clinical recovery was 1 day shorter in the budesonide arm compared to the usual care arm (median of 7 days versus 8 days respectively, logrank test p=0.007). Proportion of days with a fever and proportion of participants with at least 1 day of fever was lower in the budesonide arm. Fewer participants randomised to budesonide had persistent symptoms at day 14 and day 28 compared to participants receiving usual care. <bold>Conclusion:</bold> Early administration of inhaled budesonide reduced the likelihood of needing urgent medical care and reduced time to recovery following early COVID-19 infection.

Abstract Background and Aims Retroactive jealousy is an unhealthy interest in a partner's romantic/sexual history that has a detrimental effect on sufferers and relationships. Significant numbers of people seek therapeutic help for retroactive jealousy each year, but no research has used their lived experiences to identify potential therapeutic interventions. That was the aim of this research. Methods Seven adults (21–43 years) who had sought help for retroactive jealousy were interviewed about their experiences. Participants' accounts were analysed with reflexive thematic analysis, and findings were used to identify potential therapeutic interventions. Findings Three main themes represented participants' experiences. Fears threaten hope and security involved negative self‐comparisons with past rivals, a sense of one's partner and the relationship losing value and of feeling wronged. Feeling compelled to know about the past involved one's mind as a creative generator of distress and feeling compelled to seek reassurance but making things worse. Feeling split and out of control involved feeling like a devil was on one's shoulder and having retroactive jealousy as a constant background to relational life. Implications Therapeutic guidance for change and growth can be directed at participants' desires to forge a special romantic relationship, to achieve a more stable sense of self, and to act consistently with their underlying values and not in response to their visceral fears. We offer suggestions for psychoeducation regarding characteristics of healthy relationships, for working to move from insecure to secure responses, and for integrating cognitive defusion and implementation intentions to enhance agency.

I learned a great deal from this article. I knew the main symptoms of heart failure were breathlessness, effort intolerance and fluid retention but now know there is a scale to classify the severity of these symptoms. I found it very interesting to learn how the heart compensates for deficiencies, eventually causing the body harm. I learned that this is now seen as a multi-system disorder, which seems logical as the whole body is ultimately affected.

In March this year, while on a trip to America and Canada, I was fortunate enough to be able to arrange a visit to the Baycrest Centre for elderly care in Toronto. This is perceived as a ‘centre of excellence’, and is at the forefront of services for older people in Canada.

It was good to read that Tory MP Paul Marland (News October 16) was able to gain greater insight and understanding about the work of nurses. I lowever, it was sad that after a seven-and-a-half- hour shift he left with the illusion that washing, feeding and making patients comfortable was housework, implying that this was not the work of nurses.

This systematic review examined whether neural responses to visual food cues measured by functional magnetic resonance imaging (fMRI) are influenced by habitual physical activity and structured exercise. PubMed, Scopus, SPORT Discus, PsycINFO, PsycArticles, The Cochrane Library, and ClinicalTrials.gov were searched for human studies published from inception to February 2023. These studies assessed visual food cue reactivity using fMRI in conjunction with an assessment of habitual physical activity or structured exercise exposure.

This repeat measures study assessed the progress of 45 children in a therapeutic residential school in terms of attachment, trauma/loss, affect regulation and educational attainment. The aim was to build a profile of complex trauma in severely maltreated children and estimate any changes over a two year period. Attachment, trauma and affect regulation were assessed using the Child Attachment and Play Assessment (CAPA), based on Crittenden's Dynamic Maturational Model of attachment (DMM). Based on a matrix combining attachment risk, unresolved loss or trauma and observed high or low states of physiological arousal, 51% of children improved and 33% showed deterioration. There was a general improvement in education scores but no significant gains made by children whose stories were assessed with unresolved trauma. While insecure attachment can act as a buffer against severe maltreatment, unresolved trauma or loss is pernicious and continues to affect children's development. Specific Adverse Childhood Experiences (ACEs), rather than ACE accumulation, influenced improvement compared with deterioration. In particular perinatal neglect may have had a particularly potent impact on change. DMM Type A+ attachment was more susceptible to loss of regulation than Type C+ and the two attachment patterns require different approaches. The CAPA offers a more finely calibrated analysis than that obtained by the more usual questionnaire assessment of complex trauma and is useful in devising treatment plans for individual children.

Urinary tract infection (UTI) is the commonest infection in women, affecting up to 50% of women at some point in their lives. Although generally uncommon in men, it is more common among older people and can lead to serious complications if untreated. This article discusses the presentation and diagnosis of UTI, and prevention and treatment from the perspective of the nurse prescriber.