Introduction：There are large Pacific island communities in western and south-western Sydney, New South Wales, Australia. In 2011 and 2012, measles outbreaks disproportionally affected children and youth within these communities. The objectives of this study were to explore barriers to immunization in a Pacific island community from the perspectives of community members and health professionals and to conduct a pilot programme whereby immunization catch-up clinics were held in a Samoan church in western Sydney.Methods：Interviews were conducted with Pacific island community members (n = 12) and health professionals connected with the Pacific island community (n = 7) in 2013. A partnership with a local Samoan church was established to provide an accessible venue for immunization catch-up clinics.Results：Among the community members there were high levels of belief in the importance of immunization and a positive view regarding the protection offered by immunization. A key barrier reported by community members was being busy and therefore having limited time to get children immunized. The important role of the church within the community was emphasized in the interviews, and as a result, two immunization catch-up clinics were held in a Samoan church in western Sydney. The age range of attendees was 7–33 years. A total of 31 measles, mumps and rubella doses and 19 meningococcal C doses were given during the two clinics.Discussion：The outcomes of the interviews and the subsequent clinics highlighted the potential of churches as a venue for providing public health interventions such as catch-up immunization.

BACKGROUND: Most characteristics and common signs and symptoms of hyperthyroidism are the effects of thyroid  hormones  on  the heart and cardiovascular system. With the advent of echocardiography, characterizing the effects of  hyperthyroidism on the heart has been described mainly for overt hyperthyroidism. Data on subclinical hyperthyroidism  are still conflicting.
OBJECTIVE: To describe and compare the cardiac morphology and function of Filipino patients with uncontrolled overt and subclinical hyperthyroidism through echocardiogram, admitted at De La Salle University Medical Center (DLSUMC) for a period  of  five years and six months. 
METHODOLOGY: This is a retrospective descriptive study that utilized review of medical records. Seventy-five  hyperthyroid patients were included; 56%  with overt hyperthyroidism and 44% with subclinical hyperthyroidism. Cardiac morphology and systolic and diastolic functions were determined in the population and compared  between overt and subclinical hyperthyroidism using 2-dimensional echocardiogram.  
RESULTS: Cardiac morphology was slightly  compromised due to slight thickening of interventricular septum (IVSTd) and left ventricular posterior wall thickness at diastole (LVPWTd). There was also an increase in left ventricular mass (LVM), more pronounced in overt hyperthyroidism. Systolic function parameters such as fractional shortening (FS) and ejection fraction (EF) were normal. Impaired left ventricular myocardial relaxation manifested as low early mitral peak flow velocity, low E/A ratio and prolonged isovolumetricrelaxation time (IVRT) was observed in most patients, particularly in overt hyperthyroidism.
CONCLUSION: Abnormalities noted were comparable between the two groups of hyperthyroidism. With cardiac  parameters affected even in subclinical hyperthyroidism, treatment might be indicated regardless if hyperthyroidism is  overt or subclinical.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Middle Aged ; Adult ; Young Adult ; Academic Medical Centers ; Diastole ; Echocardiography ; Heart ; Hyperthyroidism ; Medical Records ; Retrospective Studies ; Systole

Workplace violence (WPV) is an increasing cause of concern around the globe, and healthcare organizations are no exception. Nurses may be subject to all kinds of workplace violence due to their frontline position in healthcare settings. The purpose of this systematic review is to identify and consider different interventions that aim to decrease the magnitude/prevalence of workplace violence against nurses. The standard method by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2009) has been used to collect data and assess methodological quality. Altogether, twenty-six studies are included in the review. The intervention procedures they report on can be grouped into three categories: stand-alone trainings designed to educate nurses; more structured education programs, which are broader in scope and often include opportunities to practice skills learned during the program; multicomponent interventions, which often include organizational changes, such as the introduction of workplace violence reporting systems, in addition to workplace violence training for nurses. By comparing the findings, a clear picture emerges; while standalone training and structured education programs can have a positive impact, the impact is unfortunately limited. In order to effectively combat workplace violence against nurses, healthcare organizations must implement multicomponent interventions, ideally involving all stakeholders.

Workplace violence (WPV) is an increasing cause of concern around the globe, and healthcare organizations are no exception. Nurses may be subject to all kinds of workplace violence due to their frontline position in healthcare settings. The purpose of this systematic review is to identify and consider different interventions that aim to decrease the magnitude/prevalence of workplace violence against nurses. The standard method by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA, 2009) has been used to collect data and assess methodological quality. Altogether, twenty-six studies are included in the review. The intervention procedures they report on can be grouped into three categories: stand-alone trainings designed to educate nurses; more structured education programs, which are broader in scope and often include opportunities to practice skills learned during the program; multicomponent interventions, which often include organizational changes, such as the introduction of workplace violence reporting systems, in addition to workplace violence training for nurses. By comparing the findings, a clear picture emerges; while standalone training and structured education programs can have a positive impact, the impact is unfortunately limited. In order to effectively combat workplace violence against nurses, healthcare organizations must implement multicomponent interventions, ideally involving all stakeholders.

Purpose: The aim of this study was to provide the perceptions of nurses, nursing supervisors, and nursing administrators about factors contributing to increased workplace violence (WPV) against nurses within the healthcare settings in Pakistan during the first wave of the COVID-19 pandemic. Methods: This study used a Descriptive Qualitative design, with a purposive sampling technique. From September to December 2021, In-depth interviews of 45 to 60 minutes, using a semistructured interview guide, we collected data from a private and a public healthcare setting in Pakistan. Given the travel restrictions during the COVID-19 pandemic, these interviews were conducted online, using Zoom audio features. Bedside nurses, nursing supervisors, and nursing administrators with at least six months of work experience participated in this study. Results: The qualitative data analysis steps suggested by Braun and Clarke (2013) were used for thematic analysis. The overarching theme emerging from the data was “Factors perceived by nurses that contributed to increased WPV in their work settings during the first wave of COVID-19, in a lower middle-income country” The subthemes from the participants' narrations were (a) highly stressed patients, attendants, and healthcare workers; (b) the financial burden on patients and their families; (c) lack of resources and shortage of staff; (d) restricted visiting policy and a weak security system; (e) lack of awareness about the seriousness of COVID-19; (f) misconceptions about COVID-19 vaccines and nurses' role in disseminating awareness. Conclusions The current pandemic increased the intensity of WPV against nurses in healthcare settings in Pakistan. Despite any supposed reasons for WPV, exposure to violence should never be an acceptable part of nursing. The healthcare system in Pakistan needs to pay equal attention to funding, resource provision, and ensuring a safe working environment for healthcare workers.

PURPOSE: The aim of this study was to measure the effect of an iPad-based asynchronous curriculum on emergency medicine resident performance on the in-training exam (ITE). We hypothesized that the implementation of an asynchronous curriculum (replacing 1 hour of weekly didactic time) would result in non-inferior ITE scores compared to the historical scores of residents who had participated in the traditional 5-hour weekly didactic curriculum. METHODS: The study was a retrospective, non-inferiority study. conducted at the University of California, Irvine Emergency Medicine Residency Program. We compared ITE scores from 2012 and 2013, when there were 5 weekly hours of didactic content, with scores from 2014 and 2015, when 1 hour of conference was replaced with asynchro-nous content. Examination results were compared using a non-inferiority data analysis with a 10% margin of difference. RESULTS: Using a non-inferiority test with a 95% confidence interval, there was no difference between the 2 groups (before and after implementation of asynchronous learning), as the confidence interval for the change of the ITE was −3.5 to 2.3 points, whereas the 10% non-inferiority margin was 7.8 points. CONCLUSION: Replacing 1 hour of didactic conference with asynchronous learning showed no negative impact on resident ITE scores.
California ; Curriculum* ; Education* ; Education, Medical, Graduate ; Emergencies* ; Emergency Medicine* ; Internship and Residency ; Learning ; Retrospective Studies ; Statistics as Topic ; United States*

INTRODUCTIONThis study aimed to ascertain whether nonopacified kidney on excretory urography (also known as intravenous urography [IVU]) indicates nonsalvageability.

METHODSWe retrospectively reviewed 45 adult patients with chronic unilateral urinary tract obstruction, in whom IVU revealed nonopacified kidney on one side but normal excretion on the contralateral side. Affected kidneys with split glomerular filtration rate (GFR) < 10 mL/min/1.73 m2 on 99mTc-diethylenetriaminepentaacetic acid diuretic renal scintigraphy were considered nonsalvageable. Non-function was defined based on cutoff points (< 15% and < 20%) to determine the sensitivity and specificity of differential renal function. Differences in IVU and renal scintigraphy findings, with respect to the duration of delayed filming on IVU, were analysed for significance.

RESULTSThe results of IVU and renal scintigraphy findings for 34 (75.6%) nonopacified kidneys matched, representing nonsalvageable kidneys. Sensitivity and specificity of differential renal function were 76% and 100%, respectively, when the cutoff point for non-function was set at < 15%. Sensitivity and specificity were 97% and 82%, respectively, when the cutoff point was < 20%. There was no significant difference between renal scintigraphy findings and IVU with 2-hour and > 2-hour delayed films (p = 0.96).

CONCLUSIONAlthough most nonopacified kidneys on IVU were nonsalvageable, a quarter of them were found to be salvageable on renal scintigraphy. Besides split GFR, differential function at cutoff point < 15% could be used to determine non-function of a chronic obstructed kidney when the contralateral kidney is normal. Delayed filming beyond two hours appears unnecessary in ensuring non-excretion on IVU.

Adult ; Aged ; Aged, 80 and over ; Chronic Disease ; Female ; Glomerular Filtration Rate ; Humans ; Kidney ; diagnostic imaging ; Kidney Diseases ; diagnostic imaging ; therapy ; Kidney Function Tests ; Male ; Middle Aged ; Pentetic Acid ; Radioisotope Renography ; methods ; Reproducibility of Results ; Retrospective Studies ; Sensitivity and Specificity ; Technetium ; Treatment Outcome ; Ureteral Obstruction ; diagnostic imaging ; therapy ; Urography ; methods

Purpose: Technological advances are changing how students approach learning. The traditional note-taking methods of longhand writing have been supplemented and replaced by tablets, smartphones, and laptop note-taking. It has been theorized that writing notes by hand requires more complex cognitive processes and may lead to better retention. However, few studies have investigated the use of tablet-based note-taking, which allows the incorporation of typing, drawing, highlights, and media. We therefore sought to confirm the hypothesis that tablet-based note-taking would lead to equivalent or better recall as compared to written note-taking. Methods: We allocated 68 students into longhand, laptop, or tablet note-taking groups, and they watched and took notes on a presentation on which they were assessed for factual and conceptual recall. A second short distractor video was shown, followed by a 30-minute assessment at the University of California, Irvine campus, over a single day period in August 2018. Notes were analyzed for content, supplemental drawings, and other media sources. Results: No significant difference was found in the factual or conceptual recall scores for tablet, laptop, and handwritten note-taking (P=0.61). The median word count was 131.5 for tablets, 121.0 for handwriting, and 297.0 for laptops (P=0.01). The tablet group had the highest presence of drawing, highlighting, and other media/tools. Conclusion In light of conflicting research regarding the best note-taking method, our study showed that longhand note-taking is not superior to tablet or laptop note-taking. This suggests students should be encouraged to pick the note-taking method that appeals most to them. In the future, traditional note-taking may be replaced or supplemented with digital technologies that provide similar efficacy with more convenience.

Objective: Although evidence implicates striatal cholinergic impairment as a mechanism underlying tardive dyskinesia, trials of nonspecific cholinergic agents have been inconclusive. As a partial agonist at specific nicotinic receptor subtypes, varenicline reduces drug-induced dyskinesias in animal models suggesting promise as a treatment for tardive dyskinesia. Methods: Three schizophrenia patients with tardive dyskinesia who were smokers underwent an open trial of varenicline. After a 2-week baseline, subjects received varenicline 1 mg twice daily. Changes from baseline on the Abnormal Involuntary Movement Scale were measured after a 4-week varenicline stabilization period, and 6 weeks after the smoking quit date in one patient. Results: Varenicline had no effect on mean Abnormal Involuntary Movement Scale scores after 4 weeks. Although smoking decreased after 4 weeks on varenicline and diminished further in one patient after 10 weeks, this also appeared to have no effect on ratings of tardive dyskinesia. Conclusion In contrast to animal models, no significant change in tardive dyskinesia occurred in response to varenicline replacement in three schizophrenia patients. Further investigations of cholinergic mechanisms in tardive dyskinesia are worthwhile as agents for specific cholinergic targets become available for treatment. In addition, treatment trials of tardive dyskinesia should control for smoking status, while patients on antipsychotics receiving nicotine replacement therapies for smoking should be studied further for changes in movement.

Objective: Although evidence implicates striatal cholinergic impairment as a mechanism underlying tardive dyskinesia, trials of nonspecific cholinergic agents have been inconclusive. As a partial agonist at specific nicotinic receptor subtypes, varenicline reduces drug-induced dyskinesias in animal models suggesting promise as a treatment for tardive dyskinesia. Methods: Three schizophrenia patients with tardive dyskinesia who were smokers underwent an open trial of varenicline. After a 2-week baseline, subjects received varenicline 1 mg twice daily. Changes from baseline on the Abnormal Involuntary Movement Scale were measured after a 4-week varenicline stabilization period, and 6 weeks after the smoking quit date in one patient. Results: Varenicline had no effect on mean Abnormal Involuntary Movement Scale scores after 4 weeks. Although smoking decreased after 4 weeks on varenicline and diminished further in one patient after 10 weeks, this also appeared to have no effect on ratings of tardive dyskinesia. Conclusion In contrast to animal models, no significant change in tardive dyskinesia occurred in response to varenicline replacement in three schizophrenia patients. Further investigations of cholinergic mechanisms in tardive dyskinesia are worthwhile as agents for specific cholinergic targets become available for treatment. In addition, treatment trials of tardive dyskinesia should control for smoking status, while patients on antipsychotics receiving nicotine replacement therapies for smoking should be studied further for changes in movement.