Care Council Research Articles

Voices from the frontline: a review of EMS first responders' experience of COVID-19 in Ireland

PurposeThis study explored the experiences of Irish emergency medical services (EMS) first responders during the first nationwide restrictions to curb the spread of COVID-19.Design/methodology/approachA systematic literature review (SLR) of research into healthcare workers' and first responders' experiences during the COVID-19 and 2003 SARS pandemics was performed. The SLR informed the content of an online questionnaire distributed via the Irish Pre-Hospital Emergency Care Council to 2,092 first responders on its live register. Data analysis used both descriptive and content analysis.FindingsEMS first responders faced many challenges including PPE quality, training on its use, issues with decontamination facilities, and organisational effectiveness. Emotional challenges included the anxiety experienced, the impact on families, and ethical dilemmas confronted related to patient care. Positive findings also emerged, such as first responders' dedication to working through the pandemic, collegiality, and the community goodwill displayed.Originality/valueWhile investigations of the impact of the COVID-19 pandemic on healthcare workers have been undertaken globally, studies focussing exclusively on the experiences of EMS first responders have been rare. This study addressed this knowledge gap, providing an insight into the challenges and successes experienced by first responders and identifying opportunities for learning that can be applied to future public health emergencies.

Research Before Policy: Identifying Gaps in Salmonid Welfare Research That Require Further Study to Inform Evidence-Based Aquaculture Guidelines in Canada.

Aquaculture is a growing industry worldwide and Canadian finfish culture is dominated by marine salmonid farming. In part due to increasing public and stakeholder concerns around fish welfare protection, the first-ever Canadian Code of Practice for the Care and Handling of Farmed Salmonids was recently completed, following the National Farm Animal Care Council's (NFACC) rigorous Code development process. During this process, both the Scientific (responsible for reviewing existing literature and producing a peer-reviewed report that informs the Code) and Code Development (a diverse group of stakeholders including aquaculture producers, fish transporters, aquaculture veterinarians, animal welfare advocates, food retailers, government, and researchers) Committees identified research gaps in tandem, as they worked through the literature on salmonid physiology, health, husbandry, and welfare. When those lists are combined with the results of a public “top-of-mind” survey conducted by NFACC, they reveal several overlapping areas of scientific, stakeholder, and public concern where scientific evidence is currently lacking: (1) biodensity; (2) health monitoring and management, with a focus on sea lice infection prevention and management; (3) feed quality and management, particularly whether feed restriction or deprivation has consequences for welfare; (4) enclosure design, especially focused on environmental enrichment provision and lighting design; and (5) slaughter and euthanasia. For each of these five research areas, we provide a brief overview of current research on the topic and outline the specific research gaps present. The final section of this review identifies future research avenues that will help address these research gaps, including using existing paradigms developed by terrestrial animal welfare researchers, developing novel methods for assessing fish welfare, and the validation of new salmonid welfare indices. We conclude that there is no dearth of relevant research to be done in the realm of farmed salmonid welfare that can support crucial evidence-based fish welfare policy development.

Changing Policy Landscape: How a Hospital-Based Opioid Treatment Program Adapted Care for Patients With Opioid Use Disorder During the COVID-19 Pandemic.

National Committee for Quality Assurance, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland (Ms Niles); and Johns Hopkins University School of Medicine, Johns Hopkins Medicine, Baltimore, Maryland (Dr Stoller). Correspondence: Lauren Niles, MPH, National Committee for Quality Assurance, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205 ([email protected]). Dr Stoller serves on the board of the American Association for the Treatment of Opioid Dependence, on The Joint Commission Behavioral Health Care and Human Services Accreditation Advisory Council, and the US HHS/SAMHSA Center for Substance Abuse Treatment National Advisory Council. The authors declare no conflicts of interest.

Interview With Launette Woolforde, EdD, DNP, RN, NEA-BC, NPD-BC, FAAN

Interview With Launette Woolforde, EdD, DNP, RN, NEA-BC, NPD-BC, FAAN

Disentangling post-vaccination symptoms from early COVID-19.

BackgroundIdentifying and testing individuals likely to have SARS-CoV-2 is critical for infection control, including post-vaccination. Vaccination is a major public health strategy to reduce SARS-CoV-2 infection globally. Some individuals experience systemic symptoms post-vaccination, which overlap with COVID-19 symptoms. This study compared early post-vaccination symptoms in individuals who subsequently tested positive or negative for SARS-CoV-2, using data from the COVID Symptom Study (CSS) app.MethodsWe conducted a prospective observational study in 1,072,313 UK CSS participants who were asymptomatic when vaccinated with Pfizer-BioNTech mRNA vaccine (BNT162b2) or Oxford-AstraZeneca adenovirus-vectored vaccine (ChAdOx1 nCoV-19) between 8 December 2020 and 17 May 2021, who subsequently reported symptoms within seven days (N=362,770) (other than local symptoms at injection site) and were tested for SARS-CoV-2 (N=14,842), aiming to differentiate vaccination side-effects per se from superimposed SARS-CoV-2 infection. The post-vaccination symptoms and SARS-CoV-2 test results were contemporaneously logged by participants. Demographic and clinical information (including comorbidities) were recorded. Symptom profiles in individuals testing positive were compared with a 1:1 matched population testing negative, including using machine learning and multiple models considering UK testing criteria.FindingsDifferentiating post-vaccination side-effects alone from early COVID-19 was challenging, with a sensitivity in identification of individuals testing positive of 0.6 at best. Most of these individuals did not have fever, persistent cough, or anosmia/dysosmia, requisite symptoms for accessing UK testing; and many only had systemic symptoms commonly seen post-vaccination in individuals negative for SARS-CoV-2 (headache, myalgia, and fatigue).InterpretationPost-vaccination symptoms per se cannot be differentiated from COVID-19 with clinical robustness, either using symptom profiles or machine-derived models. Individuals presenting with systemic symptoms post-vaccination should be tested for SARS-CoV-2 or quarantining, to prevent community spread.FundingUK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK National Institute for Health Research, UK Medical Research Council and British Heart Foundation, Chronic Disease Research Foundation, Zoe Limited.

Illness duration and symptom profile in symptomatic UK school-aged children tested for SARS-CoV-2

SummaryBackgroundIn children, SARS-CoV-2 infection is usually asymptomatic or causes a mild illness of short duration. Persistent illness has been reported; however, its prevalence and characteristics are unclear. We aimed to determine illness duration and characteristics in symptomatic UK school-aged children tested for SARS-CoV-2 using data from the COVID Symptom Study, one of the largest UK citizen participatory epidemiological studies to date.MethodsIn this prospective cohort study, data from UK school-aged children (age 5–17 years) were reported by an adult proxy. Participants were voluntary, and used a mobile application (app) launched jointly by Zoe Limited and King's College London. Illness duration and symptom prevalence, duration, and burden were analysed for children testing positive for SARS-CoV-2 for whom illness duration could be determined, and were assessed overall and for younger (age 5–11 years) and older (age 12–17 years) groups. Children with longer than 1 week between symptomatic reports on the app were excluded from analysis. Data from symptomatic children testing negative for SARS-CoV-2, matched 1:1 for age, gender, and week of testing, were also assessed.Findings258 790 children aged 5–17 years were reported by an adult proxy between March 24, 2020, and Feb 22, 2021, of whom 75 529 had valid test results for SARS-CoV-2. 1734 children (588 younger and 1146 older children) had a positive SARS-CoV-2 test result and calculable illness duration within the study timeframe (illness onset between Sept 1, 2020, and Jan 24, 2021). The most common symptoms were headache (1079 [62·2%] of 1734 children), and fatigue (954 [55·0%] of 1734 children). Median illness duration was 6 days (IQR 3–11) versus 3 days (2–7) in children testing negative, and was positively associated with age (Spearman's rank-order rs 0·19, p<0·0001). Median illness duration was longer for older children (7 days, IQR 3–12) than younger children (5 days, 2–9). 77 (4·4%) of 1734 children had illness duration of at least 28 days, more commonly in older than younger children (59 [5·1%] of 1146 older children vs 18 [3·1%] of 588 younger children; p=0·046). The commonest symptoms experienced by these children during the first 4 weeks of illness were fatigue (65 [84·4%] of 77), headache (60 [77·9%] of 77), and anosmia (60 [77·9%] of 77); however, after day 28 the symptom burden was low (median 2 symptoms, IQR 1–4) compared with the first week of illness (median 6 symptoms, 4–8). Only 25 (1·8%) of 1379 children experienced symptoms for at least 56 days. Few children (15 children, 0·9%) in the negatively tested cohort had symptoms for at least 28 days; however, these children experienced greater symptom burden throughout their illness (9 symptoms, IQR 7·7–11·0 vs 8, 6–9) and after day 28 (5 symptoms, IQR 1·5–6·5 vs 2, 1–4) than did children who tested positive for SARS-CoV-2.InterpretationAlthough COVID-19 in children is usually of short duration with low symptom burden, some children with COVID-19 experience prolonged illness duration. Reassuringly, symptom burden in these children did not increase with time, and most recovered by day 56. Some children who tested negative for SARS-CoV-2 also had persistent and burdensome illness. A holistic approach for all children with persistent illness during the pandemic is appropriate.FundingZoe Limited, UK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging and Artificial Intelligence Centre for Value Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation, and Alzheimer's Society.

A Study on the Perceptions of Networkings in Elementary Care Services Institutions of Community Child Centers Workers -Focusing on Community Child Center Worker in Gyeongsangnam-do

본 연구는 지역아동센터 종사자들을 대상으로 초등돌봄서비스기관 간 연계관련 인식을 살펴보고 이들의 연계필요성 인식에 영향을 미치는 요인을 파악하고자 하였으며, 이를 위해 경상남도 내 지역아동센터 종사자 118명의 자료를 분석하였다. 연구결과 초등돌봄서비스기관 간 연계의 필요성은 인식하고 있었으나 실제 연계는 원활히 이루어지지 않는 것으로 조사되었다. 바람직한 연계방안으로는 컨트롤타워 기관이 아동관리를 담당하고 돌봄협의체가 프로그램, 전문인력을 관리하는 연계인프라를 구축하며 초등돌봄서비스기관 간 기능이나 서비스 내용으로 역할분담하는 것을 선호하였다. 연계필요성 인식에 영향을 미치는 요인은 연령, 직원 수, 업무자율성, 자원필요성 인식, 연계 후 성공경험 등으로 조사되었다. 따라서 컨트롤타워 기관이 아동정보를 통합관리하여 적절한 초등돌봄서비스기관에 배치하고 돌봄협의체 중심으로 권역별 네트워크를 구축하여 초등돌봄서비스기관 간 상호교류의 기회 및 연계서비스를 제공하고 이에 대한 성공경험을 갖도록 하는 것이 필요할 것이다.The purpose of this study was to examine the Community Child Center worker’s perceptions on network among elementary care service institutions and to identify the factors that influence their necessity for networking. Structured questionnaires were mailed to 118 workers in community child centers in the Kyungnam area. As a result of the study, although the necessity of networking was recognized, the actual networking frequency was relatively low. The desirable networking plan looks like the control tower institution in charge of child management, the care council establishing a networking infrastructure that manages programs and professional manpower, and that roles divided into functions or service contents among elementary care service institutions. Factors influencing the recognition of need for networking were summed up to age, number of employees, autonomy of work, recognition of need for resources, and success experience after networking. Therefore, the control tower institution can integrate and manage child information and place it in appropriate elementary care service institutions, and establish a regional network centered on the care council to provide opportunities for mutual exchange and networking services between elementary care service institutions, and to have success experiences.

286 Where Is On-farm Animal Welfare in the United States Headed? A Canadian Perspective

Abstract Both the United States and Canada are major exporters of pork, with market forces and consumer demand playing a more important role than legislation in defining production standards. Canadian welfare standards can be seen as intermediate between those in America and Europe, with the province of Quebec leading the way in Canada’s production of “high welfare” pork. In many other respects- such as farm size, diets, genetics and management, pig farms in Canada and the United States are very similar. What can U.S. producers learn from Canada’s experience in implementation of new welfare standards? This talk discusses Canada’s 2014 implementation of the Code of Practice for the Care and Handling of Pigs. The Code included multiple new requirements, including the transition to group housing for gestating sows, use of analgesics at castration and tail docking, space allowances and the provision of enrichment. Code development is overseen by the National Farm Animal Care Council (NFACC) in cooperation with the Canadian Pork Council (CPC) and with participation of government, industry and public partners. In 2020, the Pig Code underwent a 5-year review, which resulted in eight major recommendations. Five of those recommendations will require amendments to the code and are yet to be approved. Each change illustrates a balance between economics and welfare in a highly competitive and changing industry. For example, the 2014 Code promoted adoption of group housing for sows by July 1, 2024. While integrated production systems committed to, and invested heavily in, implementation of group gestation, the cost of barn conversion and poor pork returns have been major deterrents on many farms. The CPC estimates that in 2021, 44% of Canada’s sow herd will be managed in groups. The Code review recognized that not all producers will be able to transition by 2024, and that forcing producers to convert on a strict timeline would result in a worsening of the animal’s welfare. The review recommended changing the date for implementation of group housing from 2024 to 2029. This more gradual transition will allow renovations to be part of a scheduled rebuild of an existing facility or new construction, with better long-term outcomes for producers and sow wellbeing.

What role do vaccines play in primary cardiovascular disease prevention?

President of the British Association for Nursing in Cardiovascular Care council Liz Butterfield and council member Jasmine Day discuss evidence for the role of vaccinations in preventing morbidity and mortality from cardiovascular disease.

Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit.

Preventing Hospital-Acquired Pressure Injuries by Using a Tiered Protocol in Children Receiving ECMO in the Pediatric Intensive Care Unit.

Assessing Cultural, Linguistic, and Indigenous Competencies: The Case of Early Childhood Care and Development Teachers in the Philippines

As a country with highly diverse local languages, cultures and indigenous groups, the Philippines’ Early Childhood Care and Development Council (ECCD) developed a manual for teachers that prescribes specific cultural, linguistic and indigenous competency standards. To determine the ECCD teachers’ levels in these competencies, this study utilizes self-assessment and supervisors’ assessment surveys. With the involvement of 274 teachers (locally known either as Child Development Workers or Teachers) in 12 areas all over the country, we reveal that their levels range from beginner to performer, with no skilled ratings. We conclude that although teachers are aware of the children’s cultural differences and respect their languages, and they somewhat provide a culturally-supportive environment, there seems to be a need for more training on designing an inclusive curriculum as evidenced by low ratings in planning and implementation. To improve the levels of competencies in the future, we recommend interventions such as the development of policies and frameworks on integration of indigenous cultures in early childhood education, training and revisiting of qualification standards in hiring, and the integration of professional learning communities with the Philippine commissions handling arts, language, and indigenous cultures.

Detecting COVID-19 infection hotspots in England using large-scale self-reported data from a mobile application: a prospective, observational study

BackgroundAs many countries seek to slow the spread of COVID-19 without reimposing national restrictions, it has become important to track the disease at a local level to identify areas in need of targeted intervention.MethodsIn this prospective, observational study, we did modelling using longitudinal, self-reported data from users of the COVID Symptom Study app in England between March 24, and Sept 29, 2020. Beginning on April 28, in England, the Department of Health and Social Care allocated RT-PCR tests for COVID-19 to app users who logged themselves as healthy at least once in 9 days and then reported any symptom. We calculated incidence of COVID-19 using the invited swab (RT-PCR) tests reported in the app, and we estimated prevalence using a symptom-based method (using logistic regression) and a method based on both symptoms and swab test results. We used incidence rates to estimate the effective reproduction number, R(t), modelling the system as a Poisson process and using Markov Chain Monte-Carlo. We used three datasets to validate our models: the Office for National Statistics (ONS) Community Infection Survey, the Real-time Assessment of Community Transmission (REACT-1) study, and UK Government testing data. We used geographically granular estimates to highlight regions with rapidly increasing case numbers, or hotspots.FindingsFrom March 24 to Sept 29, 2020, a total of 2 873 726 users living in England signed up to use the app, of whom 2 842 732 (98·9%) provided valid age information and daily assessments. These users provided a total of 120 192 306 daily reports of their symptoms, and recorded the results of 169 682 invited swab tests. On a national level, our estimates of incidence and prevalence showed a similar sensitivity to changes to those reported in the ONS and REACT-1 studies. On Sept 28, 2020, we estimated an incidence of 15 841 (95% CI 14 023–17 885) daily cases, a prevalence of 0·53% (0·45–0·60), and R(t) of 1·17 (1·15–1·19) in England. On a geographically granular level, on Sept 28, 2020, we detected 15 (75%) of the 20 regions with highest incidence according to government test data.InterpretationOur method could help to detect rapid case increases in regions where government testing provision is lower. Self-reported data from mobile applications can provide an agile resource to inform policy makers during a quickly moving pandemic, serving as a complementary resource to more traditional instruments for disease surveillance.FundingZoe Global, UK Government Department of Health and Social Care, Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK National Institute for Health Research, UK Medical Research Council and British Heart Foundation, Alzheimer's Society, Chronic Disease Research Foundation.

A policy analysis of the chronic care policies in Belgium

Abstract Introduction Chronic diseases form the largest burden of disease in European countries. Redesign of health systems towards chronic integrated care is needed, with more collaboration between first and second line, between medical and social services and support to prevention and self-management. What are the levers for change in such health systems? This study addresses this knowledge gap, through a policy analysis of barriers and facilitators for change towards chronic integrated care. Methods 26 central level stakeholders were selected, based upon their influence in regulation and policy, financing, health care provision and community representation. Semi-structured face-to-face interviews were held covering assessment of past and current policies and implementation, barriers and opportunities for change. Results Reforms have taken place, such as the stimulation of local initiatives for chronic integrated care projects and the set-up of local care councils. Most stakeholders assessed the current Belgium's implementation of integrated care as low, despite a growing awareness for the need for change. A context factor often mentioned to constrain implementation was a state reform which led to a partial decentralization, fragmentation of decision power and a division of healthcare competences between federal and federated levels. Other barriers were the current financing system, the lack of investments in new models of care and the vested interests of providers. Discussion This analysis shows that chronic care reform in Belgium is constrained by partial decentralization of primary health care, and by the financing system and vested interests. It points to the need for coordination of health policy making and implementation. Disentangling the levels of decision-making and the financial leverage at these levels gives insights for change and change management, for the Belgium health system and other countries with a strong decentralized system. Key messages The current Belgium’s implementation of integrated care was assessed as low, due to different contexts factors such as division of health care competencies between different governmental levels. In a country as Belgium with a strong decentralized health care system coordination of health policy making and implementation is key in order to scale up integrated care for chronic diseases.

Evaluating the Impact of an Innovative Educational Program for Skin Care Champions Using the Pieper-Zulkowski Pressure Ulcer Knowledge Test.

To assess pressure injury knowledge of Skin Care Council nursing members using the Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT), to design an educational intervention informed by the results of the baseline assessment, and to evaluate the effect of the intervention. This was a single-group pretest-posttest project conducted in an urban, academic, tertiary medical center from January to August 2017. Participants were measured on the pretest, received the intervention, and then were reevaluated on the posttest 3 months later. Pretest results informed the design of the intervention, which was a 1-day interactive, targeted educational program referred to as the "Skin Care Council Boot Camp." Paired-samples t tests were conducted to examine differences between pretest and posttest scores on the PZ-PUKT overall and in each test section. Seventy-seven participants enrolled in the project and completed the pretest. Of those, 58 (75.3%) were retained through the intervention and the posttest evaluation. Participants had a mean pretest score of 78.9 and a mean posttest score of 85.3. There were significant mean differences among pretest and posttest PZ-PUKT scores: 6.4 (t = 9.419, P < .001) overall; 4.6 (t = 5.356, P < .001) in the Prevention/Risk category; 4.1 (t = 3.668, P < .001) in the Staging category; and 10.5 (t = 7.938, P < .001) in the Wound Description category. By testing pressure injury knowledge before developing a program, investigators created a tailored, education program that addressed knowledge gaps. Posttest results provided insight into the program's success and opportunities for future improvement.

Hemispheric Surgery Outcome Prediction Scale: Development and Validation of a Seizure Freedom Prediction Tool

Background: A subset of pediatric epilepsy patients suffer from epilepsy syndromes related to multi-lobar or hemispheric epileptogenic networks and diseases. Most of these patients are refractory to anti-seizure drug treatment, resulting in persistent disabling seizures, neurocognitive delay and impaired quality of life. In well-selected patients, hemispheric surgery is associated with excellent seizure freedom rates and relatively low complication rates. Nevertheless, 30% of patients develop seizure recurrence after cerebral hemispheric surgery. The purpose of this study was to develop and validate a model to predict seizure freedom in children undergoing cerebral hemispheric surgery for the treatment of drug-resistant epilepsy. Methods: We analyzed 1237 hemispheric surgeries performed in pediatric patients across 31 centers and 12 countries to identify predictors of seizure freedom at 12 months after surgery. A multivariate logistic regression model was developed based on the entire dataset and its performance was evaluated based on cross-validation. Missing data was handled using multiple imputation techniques. Findings: Overall, 817/1237 (66%) hemispheric surgeries led to seizure freedom (median follow-up of 24 months), and 1050/1237 (85%) were seizure free at 12 months after surgery. The regression model containing age at seizure onset, presence of generalized seizure semiology, presence of contralateral 18-fluoro-2-deoxyglucose–positron emission tomography hypometabolism, etiologic substrate and previous non-hemispheric resective surgery were predictive of seizure freedom (AUC 0·72). A practical Hemispheric Surgery Outcome Prediction Scale (HOPS) score was devised based on these results that can be used to predict seizure freedom. Interpretation: Children most likely to benefit from hemispheric surgery can be selected and counselled through the implementation of a scale derived from a multiple regression model. Importantly, children who are unlikely to experience seizure control can be spared from the complications and deficits associated with this surgery. The HOPS score is likely to help physicians in clinical decision-making. Funding Statement: The authors stated: None. Declaration of Interests: None of the authors has any conflict of interest to disclose. None of the authors have financial relationships relevant to this article. Gary W Mathern MD is partly supported by the Davies/Crandall Endowed Chair for epilepsy Research at UCLA. Dr. Phillip Pearl receives research support from the NIH, NSF, and Boston Healthcare Associates; royalty payments from Elsevier, Springer Pubs, and UpToDate; has served as a consultant for Agilis Biotherapeutics and GLG Health Care Council; and is Associate Editor for the Journal of Child Neurology and on the editorial boards of Annals Neurology, Epilepsia, Future Neurology, Music and Medicine, and Neurology. Dr. Jeffrey Ojemann is a shareholder of Therma Neurosciences, a grant recipient of the NIH/NSF, and serves on the advisory board for the Epilepsy Foundation of the Northwest. The views expressed in this article are not the official positions of any authors’ affiliated institutions. Ethics Approval Statement: The organizing center received IRB approval for this study and each contributing center obtained research ethics approval locally.

&lt;p&gt;The Effectiveness of a New Topical Formulation Containing GSH-C4 and Hyaluronic Acid in Seborrheic Dermatitis: Preliminary Results of an Exploratory Pilot Study&lt;/p&gt;

IntroductionSeborrheic dermatitis is a common skin disease with clinical aspects similar to those of psoriasis, eczema or allergic reactions, appearing on the sebum-rich areas of the scalp, face, and trunk. Yeast like Malassezia species, immunologic abnormalities and activation of complement are recognized as a crucial pathogen for the onset of seborrheic dermatitis. Intermittent and active phases are characterized by burning, scaling and itching, then followed by inactive periods. The disease is sometimes severe up to the erythrodermia; thus, it has a great influence on the patient’s quality of life. In vitro and vivo studies have shown that the exogenous intake of glutathione-GSH-C4 and tocopherol inhibits lipid peroxidation and effectively fights and reduces oxidative stress in inflammatory disorders.MethodsWe have carried out a study enrolling 20 patients affected by SD to evaluate the effectiveness and tolerability of a new topical formulation in cream (hereinafter SEB) containing GSH-C4 0.4% in hyaluronic acid 0.25% – a new synthetic glutathione derivate called INCI (butyroyl glutathione)-assigned by the Personal Care Council. Investigator Global Assessment score and Patient Global Assessment of Treatment scales were used to test the efficacy of this new formulation.ResultsAll patients showed a good clinical response to the treatment with topical SEB demonstrated by the gradual reduction in inflammatory skin lesions.DiscussionThe results of our pilot study confirm the efficacy and tolerability of this new topical formulation in a real-life assessment and patients showed strong adherence to therapy. These promising results – still to be confirmed on a larger number of patients – emphasize the potential SEB has in controlling the chronic inflammation of seborrheic dermatitis.

'You've come to children that are in care and given us the opportunity to get our voices heard': The journey of looked after children and researchers in developing a Patient and Public Involvement group.

BackgroundLooked after children and care leavers (denoted as LAC) are often described as a ‘hard to reach' group of young people, and their voices are rarely sought to inform academic research.MethodsThis paper reports on experiences and reflections of a group of children and young people and academic researchers who developed a Patient and Public Involvement (PPI) group that was set up in the context of an ongoing health service intervention trial with LAC.Setting and participantsEighteen qualitative semi‐structured interviews were conducted with seven LAC, the participation officer within a North East Children in Care Council and the four researchers involved in developing and facilitating the PPI group. PPI sessions (n = 9) each approximately 1 hour in length were conducted over an 18‐month period.AnalysisThe qualitative interviews were transcribed verbatim. Thematic analysis was used to analyse the data, and direct quotes are used within the paper.Main outcomesThe LAC used the PPI group to produce a 5‐minute video to highlight why they think young people should be involved in research. Overall findings suggested that it was feasible to develop a research‐related PPI group with LAC. Findings from the research were used to co‐develop ‘top tips' of working with vulnerable young people such as looked after children.ConclusionThis paper has shown that PPI with LAC can be done if a co‐production approach to research is taken. It also suggests that assumptions regarding the capabilities of young people as researchers need to be re‐evaluated.

“That’s the Way We’ve Always Done It”: A Social Practice Analysis of Farm Animal Welfare in Alberta

Although beef and dairy production in Alberta, Canada, enjoys strong public support, there are enduring public concerns, including farm animal welfare. Evolving codes of practice and animal care councils prescribe changes and improvements to many areas of farm management, and may be seen by farmers as an appropriate response to public animal welfare concerns. However, codes of practice do not address every animal welfare concern, and new concerns can arise over time. Drawing on social practice theory and in-depth field research with 36 cattle and dairy farmers, this paper explores the materials, competencies, and meanings of four animal husbandry practices: branding, dehorning, weaning, and on-farm handling and moving. Findings show that branding and dehorning are evolving slowly with attention to pain management, but remain firmly rooted in ranching tradition and communities of practice. Weaning and animal handling practices are evolving more quickly with attention to changing materials, attitudes, and values that are more prevalent within producer communities.

A Review of Swine Transportation Research on Priority Welfare Issues: A Canadian Perspective.

The purpose of this review is to present the best available scientific knowledge on key animal welfare issues during swine transport, such as transport duration and distance, time off feed and water, rest intervals, environmental conditions, loading density, and transport of young animals, based on their impact on stress, injury, fatigue, dehydration, body temperature, mortality, and carcass and meat quality. The review was limited to this set of priority welfare issues which were identified by the National Farm Animal Care Council (NFACC) Scientific Committee to help with the development of the livestock transportation Codes of Practice. This review focuses primarily on research related to the transport of market pigs (100–135 kg) which is a reflection of the current literature available on pig transportation. This information presented here can be used to support other animal welfare codes, guidelines, standards or legislations regulating the welfare of pigs during transport. Based on the available literature, clear conclusions can be drawn on the impact of vehicle design, pre-transport fasting, control of environmental conditions and loading density on the welfare of pigs during transport and on pork quality. However, the effects of journey duration are still unclear and a recommendation on the maximum transport time cannot be provided. Further studies investigating the impact of factors, such as ambient conditions within the transport vehicle, loading density at extreme ambient conditions, travel distances, maximum travel duration, rest/stop duration, and management of pigs during rest stops are required. More specifically, further research in relation to the welfare of market weight, newly weaned and breeding pigs, and cull sows and boars during transport is needed.

Council of Europe Resolution CM/Res(2016)2: a major contribution to patient safety from reconstituted injectable medicines?

This article focuses on the reconstitution of parenteral medicines and the work that has been carried out at the European level to improve patient safety. Reconstitution may occur in a...