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Chiu et al. report in their paper “Health Promotion and Disease Prevention Interventions for the Elderly: A Scoping Review from 2015–2019” [1] that the amount of literature promoting health for the elderly has increased, particularly that addressing health promotion, screening, primary prevention, and social support. Page 7, line 16: “Health promotion” is not a “research method” for “health promotion, screening primary prevention and social support”. The paper could have some merits. [...]these clarifications are of interest as only a “rigorous peer-review process together with strict ethical policies and standards” can “ensure the addition of high-quality scientific studies to the field of scholarly publication”, as mentioned on the homepage of this journal [2,3].

This empirical study examines the experiences of academics and professional service staff in a large UK university during first weeks of the transition to online teaching and working from home during the Covid-19 pandemic. The method draws on the work by Gourlay and Oliver (2018) to explore engagement with the digital university in everyday practice. Using data from 412 survey responses and 32 interviews, the study traces varying ways staff characterised themselves during the first months of lockdown in the UK (from March to July, 2020). The findings highlight that university support services underwent a metamorphosis to support the transition to online teaching. However, insufficient attention was paid to the 'identity crisis' and threats perceived by academics who were used to teaching students on campus. Academics tended to focus on transferring traditional teaching practices to the online environment, rather than on changing teaching practice, leaving face-to-face teaching as the default point of reference. These cultural barriers are a persistent obstacle to a more productive engagement with digitalisation. Transitioning to online teaching involves continuing existing work while also learning new practices. Such efforts were challenging for teaching staff who did not have dedicated space at home to work and those with caring responsibilities. This, combined with gendered patterns around caring and the extra support needed by students during the crisis, added emotional labour to already-full workloads. We recommend that intersecting forms of disadvantage be acknowledged, supported and rewarded for universities to create sustainable and just futures.

Background: High-intensity smoking cessation programs generally lead to more continuous abstinence, however, lower rates of success have been reported among heavy smokers. The aim was to evaluate continuous abstinence among heavy smokers during the intensive 6-week Gold Standard Program (GSP) and to identify modifiable factors associated with continuous abstinence. Methods: In this nationwide clinical study based on 36,550 smokers attending an intensive cessation program in Denmark. Heavy smoking was defined as ≥7 points in the Fagerström Nicotine Dependency Test, smoking ≥20 cigarettes daily or ≥20 pack-years. Results: Overall, 28% had a Fagerström score ≥7 points, 58% smoked ≥20 cigarettes daily and 68% smoked ≥20 pack-years. Continuous abstinence was 33% in responders (6-months response rate: 78%); however, abstinence was approximately 1–6% lower in the heavy smokers than the overall population. Attending GSP with an individual format (vs. group/other, OR 1.23–1.44); in a hospital setting (vs. pharmacy/municipality services, OR 1.05–1.11); and being compliant (attending the planned meetings OR 4.36–4.89) were associated with abstinence. Abstinence decreased in a dose-dependent manner with increasing smoking severity. Conclusions: Abstinence after GSP was 1–6% lower in the heavy smokers than in the overall study population. Modifiable factors may be used for small improvements in continued abstinence. However attempts to improve compliance seemed especially promising.

Background A peripheral venous catheter (PVC) is the most widely used device for obtaining vascular access, allowing the administration of fluids and medication. Up to 25% of adult patients, and 50% of pediatric patients experience a first-attempt cannulation failure. In addition to patient and clinician characteristics, device features might affect the handling and success rates. The objective of the study was to compare the first-attempt cannulation success rate between PVCs with wings and a port access (Vasofix® Safety, B. Braun, abbreviated hereon in as VS) with those without (Introcan® Safety, B. Braun, abbreviated hereon in as IS) in an anesthesiological cohort. Methods An open label, multi-center, randomized trial was performed. First-attempt cannulation success rates were examined, along with relevant patient, clinician, and device characteristics with univariate and multivariate analyses. Information on handling and adherence to use instructions was gathered, and available catheters were assessed for damage. Results Two thousand three hundred four patients were included in the intention to treat analysis. First-attempt success rate was significantly higher with winged and ported catheters (VS) than with the non-winged, non-ported design (IS) (87.5% with VS vs. 78.2% with IS; P Chi  < .001). Operators rated the handling of VS as superior (rating of “good” or “very good: 86.1% VS vs. 20.8% IS, P Chi  < .001). Reinsertion of the needle into the catheter after partial withdrawal—prior or during the catheterization attempt—was associated with an increased risk of cannulation failure (7.909, CI 5.989–10.443, P  < .001 and 23.023, CI 10.372–51.105, P  < .001, respectively) and a twofold risk of catheter damage (OR 1.999, CI 1.347–2.967, P  = .001). Conclusions First-attempt cannulation success of peripheral, ported, winged catheters was higher compared to non-ported, non-winged devices. The handling of the winged and ported design was better rated by the clinicians. Needle reinsertions are related to an increase in rates of catheter damage and cannulation failure. Trial registration ClinicalTrials.gov, Identifier: NCT02213965 , Date: 12/08/2014.

This prospective observational study investigated whether self-reported psychological distress and alcohol use problems of surgical patients change between preoperative baseline assessment and postoperative 6-month follow-up examination. Patients with preoperative interest in psychotherapy were compared with patients without interest in psychotherapy. A total of 1,157 consecutive patients from various surgical fields completed a set of psychiatric questionnaires preoperatively and at 6 months postoperatively, including Patient Health Questionnaire-4 (PHQ-4), Brief Symptom Inventory (BSI), Center for Epidemiologic Studies Depression Scale (CES-D), World Health Organization 5-item Well-Being Index (WHO-5), and Alcohol Use Disorder Identification Test (AUDIT). Additionally, patients were asked for their interest in psychotherapy. Repeated measure ANCOVA was used for primary data analysis. 16.7% of the patients were interested in psychotherapy. Compared to uninterested patients, they showed consistently higher distress at both baseline and month 6 regarding all of the assessed psychological measures (p's between <0.001 and 0.003). At 6-month follow-up, neither substantial changes over time nor large time x group interactions were found. Results of ANCOVA's controlling for demographic variables were confirmed by analyses of frequencies of clinically significant distress. In surgical patients with interest in psychotherapy, there is a remarkable persistence of elevated self-reported general psychological distress, depression, anxiety, and alcohol use disorder symptoms over 6 months. This suggests high and chronic psychiatric comorbidity and a clear need for psychotherapeutic and psychiatric treatment rather than transient worries posed by facing surgery.

Objectives To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates. Design Observational prospective cohort study. Setting GSPs in pharmacies, hospitals and communities in Denmark, reporting to the national Smoking Cessation Database. Participants Disadvantaged patients, defined as patients with a lower level of education and those receiving unemployment benefits. Interventions 6-week manualised GSP smoking cessation interventions performed by certified staff. Main outcome measures 6 months of continuous abstinence, response rate: 80%. Results Continuous abstinence of the 16 377 responders was 34% (of all 20 588 smokers: 27%). Continuous abstinence was lower in 5738 smokers with a lower educational level (30% of responders and 23% of all) and in 840 unemployed (27% of responders and 19% of all). In respect to modifiable factors, continuous abstinence was found more often after programmes in one-on-one formats (vs group formats) among patients with a lower educational level, 34% (vs 25%, p=0.037), or among unemployed, 35% (vs 24%, p=0.099). The variable ‘format’ stayed in the final model of multivariable analyses in patients with a lower educational level, OR=1.31 (95% CI 1.05 to 1.63). Conclusions Although continuous abstinence was lower among disadvantaged smokers, the absolute difference was small. If the programme had been as effective in disadvantaged as in non-disadvantaged groups, there would have been an extra 46 or 8 quitters annually, respectively. Promoting individual interventions among those with a low education may increase the effectiveness of GSP.

Objectives To evaluate the real-life effect of an evidence-based Gold Standard Programme (GSP) for smoking cessation interventions in disadvantaged patients and to identify modifiable factors that consistently produce the highest abstinence rates. Design Observational prospective cohort study. Setting GSPs in pharmacies, hospitals and communities in Denmark, reporting to the national Smoking Cessation Database. Participants Disadvantaged patients, defined as patients with a lower level of education and those receiving unemployment benefits. Interventions 6-week manualised GSP smoking cessation interventions performed by certified staff. Main outcome measures 6 months of continuous abstinence, response rate: 80%. Results Continuous abstinence of the 16 377 responders was 34% (of all 20588 smokers: 27%). Continuous abstinence was lower in 5738 smokers with a lower educational level (30% of responders and 23% of all) and in 840 unemployed (27% of responders and 19% of all). In respect to modifiable factors, continuous abstinence was found more often after programmes in one-on-one formats (vs group formats) among patients with a lower educational level, 34% (vs 25%, p=0.037), or among unemployed, 35% (vs 24%, p=0.099). The variable 'format' stayed in the final model of multivariable analyses in patients with a lower educational level, OR=1.31 (95% CI 1.05 to 1.63). Conclusions Although continuous abstinence was lower among disadvantaged smokers, the absolute difference was small. If the programme had been as effective in disadvantaged as in non-disadvantaged groups, there would have been an extra 46 or 8 quitters annually, respectively. Promoting individual interventions among those with a low education may increase the effectiveness of GSP.

ZusammenfassungHintergrundDie Sicherstellung der zukünftigen urologischen Versorgung über die Schnittstelle ambulant-stationär hinweg stellt durch die demografische Entwicklung mit zunehmendem Anteil an urologischen Krankheitsbildern bei gleichzeitig drohendem Ärzt*innenmangel sowie zunehmender Ambulantisierung auch komplexer urologischer Krankheitsbilder eine Herausforderung dar.Ziel der ArbeitDas im Folgenden dargestellte sektorenverbindende Kooperationsmodell zwischen universitärem Maximalversorger und Belegarztwesen kann hier als ideales Bindeglied der ambulant-stationären Patientenversorgung fungieren.Material und MethodenSeit 2016 besteht eine enge Kooperation zwischen der urologischen Berufsausübungsgemeinschaft (BAG) in Winsen/Buchholz sowie dem Universitätsklinikum Hamburg-Eppendorf (UKE). Neben direktem Patiententransfer, engmaschiger Vor- und Nachbehandlung von Patienten rotieren zudem jährlich zwei Assistenzärzt*innen des UKE in die BAG.ErgebnisseDie BAG profitiert hierbei durch Planungssicherheit und Entlastung im Alltag. Das UKE durch Patiententransfer und operative sowie „basisurologische“ Ausbildung der Assistent*innen. Durch Vermeidung von Doppeluntersuchungen und frühere Entlassung der Patienten in die ambulante Nachbehandlung werden Ressourcen geschont; eine sinnvolle Patientenvorselektion ermöglicht kleinere Eingriffe heimatnah über die BAG, wohingegen komplexe Fälle an einem Zentrum mit großer Expertise erfolgen.DiskussionDie Zusammenarbeit wird von allen Parteien ausnahmslos positiv und v. a. als ein Gewinn für das Patientenwohl gesehen, da aufgrund der guten Vernetzung eine reibungslose Versorgung gewährleistet werden kann. Eine solche Rotation urologischer Assistenzärzt*innen sollte als möglicher Baustein in die Weiterbildungsordnung der urologischen Facharztausbildung integriert werden.

To examine the effect of bolus vs. continuous infusion adjustment on severity and duration of alcohol withdrawal syndrome (AWS), the medication requirements for AWS treatment, and the effect on ICU stay in surgical intensive care unit (ICU) patients. Prospective randomized, double-blind controlled trial in a surgical ICU. 44 patients who developed AWS after admission to the ICU. Patients were randomized to either (a). a continuous infusion course of intravenous flunitrazepam (agitation), intravenous clonidine (sympathetic hyperactivity), and intravenous haloperidol (productive psychotic symptoms) if needed (infusion-titrated group), or (b). the same medication (flunitrazepam, clonidine, or haloperidol) bolus adjusted in response to the development of the signs and symptoms of AWS (bolus-titrated group). The administration of \"as-needed\" medication was determined using a validated measure of the severity of AWS (Clinical Institute of Withdrawal Assessment). Although the severity of AWS did not differ between groups initially, it significantly worsened over time in the infusion-titrated group. This required a higher amount of flunitrazepam, clonidine, and haloperidol. ICU treatment was significantly shorter in the bolus-titrated group (median difference 6 days) due to a lower incidence of pneumonia (26% vs. 43%). We conclude that symptom-orientated bolus-titrated therapy decreases the severity and duration of AWS and of medication requirements, with clinically relevant benefits such as fewer days of ventilation, lower incidence of pneumonia, and shorter ICU stay.

The patients’ history and conventional laboratory markers are often not sensitive or specific enough to detect chronic alcohol misuse, preoperatively. We investigated whether carbohydrate-deficient transferrin (CDT), determined with a new commercially available kit, is a more sensitive and specific marker to detect chronic alcohol misuse in these patients and we compared it to a CDT research kit and to other conventional laboratory markers. 153 patients with oral, pharyngeal, laryngeal or esophageal carcinomas were evaluated regarding their drinking habits. Chronic alcohol misuse was diagnosed if the daily ethanol intake was ≧60 g and the patient met the DSM-III-R criteria for chronic alcohol abuse or dependence. CDTs and the conventional laboratory markers were sampled on admission of the patients, preoperatively, postoperatively following admission to the ICU and on day 2, 4 and 7 in the ICU. CDT was determined by microanion exchange chromatography and turbidimetry (research kit) and microanion exchange chromatography and radioimmunoassay (commercially available CDT kit), respectively. The investigators were blinded to the CDT results. For all patients admitted to the hospital the sensitivity of the CDT research kit was 74% and for the commercially available CDT kit 77%. Specificity was 100% for the CDT research kit and 97% for the commercially available CDT kit. Both CDT kits were more accurate in detecting chronic alcohol misuse than any other conventional laboratory marker over a range of cutoffs evaluated by receiver operating characteristic curves. Since the CDT values on admission were significantly correlated with the length of ICU stay (CDT research kit: rs = 0.56; p = 0.000; commercially available CDT: rs = 0.39; p = 0.009) and since investigated chronic alcoholics developed more complications in the ICU and had a prolonged ICU stay, it seems reasonable to determine serum CDT, the most sensitive and specific marker of chronic alcohol misuse. Patients with pathologically elevated CDT values should be further evaluated and managed accordingly.