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ObjectivePlay is a non-invasive, safe and inexpensive intervention that can help paediatric patients and their families manage difficult aspects of being ill or hospitalised. Although play has existed in hospitals for decades, research on hospital play interventions is scarce. This review aimed to categorise and synthesise the last 20 years of research on hospital play interventions.DesignScoping review.Data sourcesPubMed, CINAHL, CENTRAL, ERIC and PsycINFO (1 January 2000– 9 September 2020).Study selection and data extractionWe systematically searched for original peer-reviewed articles, written in English, on hospital play interventions in paediatric patients (0–18 years) in non-psychiatric settings. Two reviewers independently screened titles and abstracts, reviewed full text of relevant articles and extracted data. We thematically synthesised the data from the included studies, and a descriptive analysis, based on a developed framework, is presented.ResultsOf the 297 included articles, 78% came from high-income countries and 56% were published within the last 5 years. Play interventions were carried out across all ages by various healthcare professionals. Play interventions served different roles within four clinical contexts: A) procedures and diagnostic tests, B) patient education, C) treatment and recovery and D) adaptation. Across these contexts, play interventions were generally facilitated and purpose-oriented and had positive reported effects on pain, stress, and anxiety.ConclusionsPlay in hospitals is an emerging interdisciplinary research area with a significant potential benefit for child and family health. Future research should further describe principles for play in hospitals. High-quality studies investigating short-term and long-term effects are needed to guide when and how to best integrate play in hospitals.

Young children often get sick, and although they usually do not need treatment, it can be distressing for parents and lead to a high rate of urgent health care use. As the demand for out-of-hours services grows, understanding parents' concerns and needs when caring for an ill child is crucial for designing interventions that support informed health-seeking decisions. This study aimed to investigate why parents contacted a Medical Helpline, their expectations regarding the call, and how their situation changed following telephone triage. Parents who contacted an out-of-hours Medical Helpline in Denmark participated in semistructured interviews that were analyzed using Braun and Clarke's 6-step approach to thematic analysis. A total of 39 interviews were conducted. Our analysis led to three key themes: (1) parental uncertainty in decision-making: caring for an ill child was associated with stress and uncertainty. Parents lacked the tools to differentiate between acceptable symptoms and signs of severe illness, resulting in catastrophic thinking; (2) validation: parents contacted the medical helpline to validate their assessment and share responsibility with a health care professional; they experienced a conflict between responsible health care usage and the need for reassurance; and (3) feeling safe at home: when the health care professional demonstrated competence, recognized parents' emotions, and dedicated time to explain the symptoms, parents felt empowered to manage their child at home through telephone consultation. Uncertainty in assessing a sick child's symptoms can lead parents to seek reassurance and validation by contacting a medical helpline. Telephone consultations often enable parents to manage their children at home. Interventions that help parents distinguish between mild and severe symptoms, and accept frequent illnesses as a normal part of childhood, could reduce stress and reliance on health care services.

We performed a systematic review and meta-analysis of observational studies assessing quality of life in adolescents and young adults born with CHD compared with age-matched controls. We carried out a systematic search of the literature published in Medline, Embase, PsychINFO, and the Cochrane Library's Database (1990-2013); two authors independently extracted data from the included studies. We used the Newcastle-Ottawa scale for quality assessment of studies. A random effects meta-analysis model was used. Heterogeneity was assessed using the I2-test. We included 18 studies with 1786 patients. The studies were of acceptable-to-good quality. The meta-analysis of six studies on quality of life showed no significant difference - mean difference: -1.31; 95% confidence intervals: -6.51 to +3.89, I2=90.9% - between adolescents and young adults with CHD and controls. Similar results were found in 10 studies not eligible for the meta-analysis. In subdomains, it seems that patients had reduced physical quality of life; however, social functioning was comparable or better compared with controls. For the first time in a meta-analysis, we have shown that quality of life in adolescents and young adults with CHD is not reduced when compared with age-matched controls.

Importance Young children often fall ill, leading to concern among their caregivers and urgent contact with health care services. Objective To assess the effectiveness and safety of video tutorials to empower caregivers in caring for acutely ill children. Design, Setting, and Participants Caregivers calling the out-of-hours Medical Helpline 1813 (MH1813), Emergency Medical Services Capital Region, Denmark, and their children aged 0.5 to 11.9 years were randomized to video tutorials (intervention) or telephone triage by a nurse or physician (control) from October 2020 to December 2021 and followed up for 72 hours blinded to the intervention. Data were analyzed from March to July 2022. Intervention The intervention group had the call disconnected before telephone triage and received video tutorials on managing common symptoms in acutely ill children and when to seek medical help. Caregivers could subsequently call MH1813 for telephone triage. Main outcomes and measures The primary outcome was caregivers’ self-efficacy, reported in an electronic survey the following day. Secondary outcomes were satisfaction, child status, assessment by a general practitioner or physician at the hospital, telephone triage, and adverse events during the 72-hour follow-up period. Results In total, 4686 caregivers and children were randomized to intervention (2307 participants) or control (2379 participants), with a median (IQR) child age of 2.3 (1.3-5.1) years and 53% male distribution in both groups (2493 participants). Significantly more caregivers in the intervention group reported high self-efficacy (80% vs 76%; crude odds ratio [OR], 1.30; 95% CI, 1.01-1.67;P = .04). The intervention group received fewer telephone triages during follow-up (887 vs 2374 in the control group). Intention-to-treat analysis showed no difference in secondary outcomes, but per-protocol subanalysis showed fewer hospital assessments when caregivers watched video tutorials (27% vs 35%; adjusted OR, 0.67; 95% CI, 0.55-0.82). Randomization to video tutorials did not increase adverse outcomes. Conclusions and relevance In this randomized clinical trial, offering caregivers video tutorials significantly and safely increased self-efficacy and reduced use of telephone triage. Children had fewer hospital assessments when caregivers watched videos. This suggests a future potential of health care information to empower caregivers and reduce health care utilization. Trial Registration ClinicalTrials.gov Identifier:NCT04301206

Revision knee arthroplasty is assumed to be even more painful than primary knee arthroplasty and predominantly performed in chronic pain patients, which challenges postoperative pain treatment. We hypothesized that the adductor canal block, effective for pain relief after primary total knee arthroplasty, may reduce pain during knee flexion (primary endpoint: at 4 h) compared with placebo after revision total knee arthroplasty. Secondary endpoints were pain at rest, morphine consumption and morphine-related side effects. We included patients scheduled for revision knee arthroplasty in general anesthesia into this blinded, placebo-controlled, randomized trial. Patients were allocated to an adductor canal block via a catheter with either ropivacaine or placebo; bolus of 0.75% ropivacaine/saline, followed by infusion of 0.2% ropivacaine/saline. Clinicaltrials.gov ID: NCT01191593. We enrolled 36 patients, of which 30 were analyzed. Mean pain scores during knee flexion at 4 h (primary endpoint) were: 52 ± 22 versus 71 ± 25 mm (mean difference 19, 95% CI: 1 to 37, P = 0.04), ropivacaine and placebo group respectively. When calculated as area under the curve (1-8 h/7 h) pain scores were 55 ± 21 versus 69 ± 21 mm during knee flexion (P = 0.11) and 39 ± 18 versus 45 ± 23 mm at rest (P = 0.43), ropivacaine and placebo group respectively. Groups were similar regarding morphine consumption and morphine-related side effects (P > 0.05). The only statistically significant difference found between groups was in the primary endpoint: pain during knee flexion at 4 h. However, due to a larger than anticipated dropout rate and heterogeneous study population, the study was underpowered. Clinicaltrials.gov NCT01191593.

This study investigates asymmetric beam shapes to introduce keyhole oscillation and reduce porosity. Three different beam shapes were tested: Gaussian (benchmark), pre-post heating shape, and asymmetric shape, with varying power levels and welding velocities. CT scans revealed a reduction in porosity with the asymmetric beam shape. Thermal imaging showed oscillations in the keyhole area, with frequencies around 8 Hz and 10 Hz depending on the laser power, welding speed and beam shape. The findings suggest that quasi-static beam shaping can decrease porosity though keyhole wobbling induced by beam shaping, and it is assumed that these results can be generalized to static beam shapes as well. However, further experiments are needed to validate these findings and confirm the tendency for keyhole oscillation.

Background Antisocial personality disorder often co-exists with drug and alcohol use disorders. Methods This trial examined the effectiveness of offering psycho-education for antisocial personality disorder in community substance use disorder treatment centers in Denmark. A total of 176 patients were randomly allocated to treatment as usual (TAU, n  = 80) or TAU plus a psycho-educative program, Impulsive Lifestyle Counselling (ILC, n  = 96) delivered by site clinicians ( n  = 39). Using follow-up interviews 3 and 9 months after randomization, we examined changes in drug and alcohol use (Addiction Severity Index Composite Scores), percent days abstinent (PDA) within last month, and aggression as measured with the Buss-Perry Aggression Questionnaire-Short Form and the Self-Report of Aggression and Social Behavior Measure. Results Overall engagement in psychological interventions was modest: 71 (76 %) of participants randomized to psycho-education attended at least one counselling session, and 21 (23 %) attended all six sessions. The Median number of sessions was 2. All patients reduced drug and alcohol problems at 9 months with small within-group effect sizes. Intention-to-treat analyses indicated significant differences between ILC and TAU in mean drugs composite score ( p  = .018) and in PDA ( p  = .041) at 3 months. Aggression declined in both groups, but no differences between ILC and TAU were observed in terms of alcohol problems or aggression at any follow-up. Conclusions Moderate short-term improvements in substance use were associated with randomization to Impulsive Lifestyle Counselling. The findings support the usefulness of providing psycho-education to outpatients with antisocial personality disorder. Trial registration ISRCTN registry, ISRCTN67266318 , 17/7/2012

Background People in treatment for substance use disorder commonly have comorbid personality disorders, including antisocial personality disorder. Little is known about treatments that specifically address comorbid antisocial personality disorder. Methods Self-rated help received for antisocial personality disorder was assessed during follow-ups at 3, 9 and 15 months post-randomization of a randomized trial of psychoeducation for people with comorbid substance use and antisocial personality disorder ( n  = 175). Results Randomization to psychoeducation was associated with increased perceived help for antisocial personality disorder. Perceived help for antisocial personality disorder was in turn associated with more days abstinent and higher treatment satisfaction at the 3-month follow-up, and reduced risk of dropping out of treatment after the 3-month follow-up, and perceived help mediated the effects of random assignment on days abstinent at 3-month.follow-up. Conclusions Brief psychoeducation for antisocial personality disorder increased patients’ self-rated help for antisocial personality disorder in substance abuse treatment, and reporting having received help for antisocial personality disorder was in turn associated with better short-term outcomes, e.g., days abstinent, dropout from treatment and treatment satisfaction. Trial registration ISRCTN registry, ISRCTN67266318 , retrospectively registered 17/7/2012.

Unspecific peroxygenases (UPOs) are versatile enzymes capable of oxidizing a broad range of substrates, using hydrogen peroxide as the sole co-substrate. In this study, UPOs were evaluated for their potential in the selective oxyfunctionalization of the phenolic lignin monomer 4-propylguaiacol (4-PG) to generate versatile scaffolds for the synthesis of high-value compounds. In addition to the desired peroxygenase reaction, the phenolic group of 4-PG is susceptible to undesirable one-electron oxidation (peroxidase activity). Assessment of the activity of 19 UPOs from phylogenetically diverse clades toward 4-PG revealed that several UPOs could serve as potential biocatalysts for the functionalization of 4-PG, with some enzymes showing both promising conversion yields (>50%) and regioselectivity for the peroxygenase reaction. Pronounced differences in peroxygenase:peroxidase activity ratios and regioselectivity were observed. Comparative analysis—supported by experimental activity profiles and structural data—suggest that a more constrained active-site topology contributes to the peroxygenase activity. UPOs from a clade within the Ascomycota phylum with high peroxygenase activity possess a unique aliphatic pocket in their catalytic centers. Our study provides valuable insights into the structure–function relationships underpinning enhanced peroxygenase activity of UPOs and provides a functional mapping of a broad UPO-sequence space for 4-PG, highlighting these enzymes as promising catalysts for the selective oxyfunctionalization of a phenolic lignin monomer.

Background Decision-making and problem-solving processes are powerful activities occurring daily across all healthcare settings. Their empowering potential is seldom fully exploited, and they may even be perceived as disempowering. We developed the EMPOWER-UP questionnaire to enable assessment of healthcare users’ perception of empowerment across health conditions, healthcare settings, and healthcare providers’ professional backgrounds. This article reports the initial development of EMPOWER-UP, including face and content validation. Methods Four grounded theories explaining barriers and enablers to empowerment in relational decision-making and problem-solving were reviewed to generate a preliminary item pool, which was subsequently reduced using constant comparison. Preliminary items were evaluated for face and content validity using an expert panel of seven researchers and cognitive interviews in Danish and English with 29 adults diagnosed with diabetes, cancer, or schizophrenia. Results A preliminary pool of 139 items was reduced to 46. Independent feedback from expert panel members resulted in further item reduction and modifications supporting content validity and strengthening the potential for generic use. Forty-one preliminary items were evaluated through 29 cognitive interviews, resulting in a 36-item draft questionnaire deemed to have good face and content validity and generic potential. Conclusions Face and content validation using an expert panel and cognitive interviews resulted in a 36-item draft questionnaire with a potential for evaluating empowerment in user-provider interactions regardless of health conditions, healthcare settings, and healthcare providers’ professional backgrounds. Plain Language Summary Users of healthcare services living with long-term health conditions may need empowerment-based support from healthcare providers to discover and develop their inherent capacity to be responsible for their own life. This ensures that healthcare users develop the skills needed to manage the many decisions and problems they face. Yet many healthcare users still experience lack of involvement and support in decision-making and problem-solving. Therefore, we developed the EMPOWER-UP questionnaire to allow healthcare users to evaluate the empowering qualities of their interactions with healthcare providers regardless of their diagnosis, where the interactions take place, and with whom. The aim of this article was to describe the development of EMPOWER-UP and to present the results of early evaluations of its content. The questionnaire was developed in Danish based on thorough qualitative research explaining distinct, complex patterns in user-provider interactions and translated to English during the evaluation process. We used individual feedback from a panel of expert researchers and interviews conducted with healthcare users diagnosed with diabetes, cancer, or schizophrenia to evaluate EMPOWER-UP’s content. Interviews were conducted while the participants answered preliminary versions of the questionnaire. As a result of these evaluations, several items in the questionnaire were adjusted, some were deleted, and some new items were developed. We believe that EMPOWER-UP can be an important tool to help evaluate the effectiveness of interventions aimed at ensuring empowering support from healthcare providers. Thus, EMPOWER-UP may help to identify the most effective interventions for specific healthcare contexts.