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INTRODUCTION: The Italian Committee of medical residents in Hygiene, Preventive Medicine and Public Health is a member of the Italian Society of Hygiene, Preventive Medicine and Public Health with the aim of developing a network among Italian resident in public health and promoting the educational path improvement through comparisons and debates between postgraduate medical schools. In this perspective, during last years account has been taken of some essential topics concerning education of public health medical residents, which represent future health-care and public health experts. METHODS: Cross-sectional researches were conducted among Italian public health medical residents (PHMRs) through self-administered and web-based questionnaires. Each questionnaire was previously validated by pilot studies conducted during the 46th National Conference of the Italian Society of Hygiene, Preventive Medicine and Public Health. RESULTS: Seventy percent of Italian PHMRs considered the actual length of Public Health postgraduate medical school excessively long, with regard to predetermined educational goals. Confirming this statement, 90% of respondents were inclined to a reduction from 5 to 4 years of postgraduate medical school length, established by Law Decree 104/2013. Seventy seven percent of surveyed PHMRs stand up for a rearrangement on a national setting of the access contest to postgraduate medical schools. Moreover 1/3 of Italian schools performed less than 75%of learning and qualifying activities specified in Ministerial Decree of August 2005. In particular, data analysis showed considerable differences among Italian postgraduate schools. Finally, in 2015 only four Italian Universities (Napoli Federico II, Palermo, Pavia, Roma Tor Vergata) provide for the Second Level Master qualify for the functions of occupational doctor. This offer makes available 60 positions against a request of over 200 future Public Health medical doctors who have shown interest in the Master. CONCLUSIONS: In Italy, after the introduction of Ministerial Decree 285/2005, the educational course of PHMRs was significantly improved. The standardization of learning and qualifying activities allowed for the first time the attendance at medical directions or Local Health Units. Nevertheless, the excessive lenght of postgradute schools and the differences about training among Italian Universities are critical and actual issue. Moreover, the remarkable interest shown by PHMRs in the Master could suggest a poor job replacement prospect for young medical specialist in Hygiene, Preventive Medicine and Public Health.

This study investigates the number of articles published by Italian nursing journals by analyzing five Italian journals between 2003 and 2009. This is the third part of a study started in 1978, two articles were already published in 2005. The work is aimed at monitoring the number of nursing articles published. The articles were cataloged according to predefined criteria with the main aim to verify the status of the progress of research and theoretical development among Italian nurses. Results show that, although there is an increase in publications which apply research methods, these are still below the international trend and that, at national level, nurses prefer topics such as care plans, regulations and organization of work rather than research or scientific evidence. On the one hand there is a raise on Italian nurses of interest in wider topic in order to be closer to the international debate, on the other hand there is a lack of adequate tools to improve knowledge and specific investments in research. As result of this there is a strong limitation in the knowledge growth of Italian nurses together with a lack of participation among and for different generations of nurses. In addition to the above it has been enucleated a scarcity within the literature analyzed of development of theoretical models, theories and concepts. Conversely theoretical models, theories and concepts are important pillars of scientific knowledge and they have a strong role in professional development, moreover these are necessary in order to set and improve nursing and nurses image nowadays far from the exclusive applied science.

BACKGROUND AND AIMS: Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force. METHOD: a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff. RESULTS: Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems. CONCLUSIONS: a Case/Care Manager's profile has been drafted on the basis of the comparative analysis conducted. It has been noted how the Case/Care Manager's professional profile can really improve relationships and communications between medical staff and patients, promoting a major unity among the working team. According to the present research, the Case/Care Manager's profile has been proved helpful in positively influencing the team activity and to elicit major satisfaction both in patients and their family.

BACKGROUND AND AIM: The evaluation of nursing care is a topic of great interest and especially crucial in intensive care contexts. However, inside the Italian scientific scenario it is still difficult to measure NSO, or Nursing Sensitive Outcomes, due to the lack of indicators or scales shared by the nursing community. The aim of the present study was therefore to develop a Quality Nursing Care Scale for the Intensive Care (ICU-I-QNCS). METHOD: From the literature review of the Intensive Care Unit (ICU) quality standards, they were generated 63 items. Then 43 experts assessed them through the Content Validity Index (CVI). Items with a CVI score <0.90 were removed from the scale. RESULTS: All the 63 items have achieved an average score CVI equal or greater than 0.90. 5 item reached an optimal average CVI score (=1); 23 showed an average CVI score between 0.90-0.94 and last 35 were between 0.95-0.99. CONCLUSIONS: The ICU-I-QNCS has obtained an acceptable CVI level and it reflects the underlying theoretical model of Doran (2002).

Automatic airway segmentation from chest computed tomography (CT) scans plays an important role in pulmonary disease diagnosis and computer-assisted therapy. However, low contrast at peripheral branches and complex tree-like structures remain as two mainly challenges for airway segmentation. Recent research has illustrated that deep learning methods perform well in segmentation tasks. Motivated by these works, a coarse-to-fine segmentation framework is proposed to obtain a complete airway tree. Our framework segments the overall airway and small branches via the multi-information fusion convolution neural network (Mif-CNN) and the CNN-based region growing, respectively. In Mif-CNN, atrous spatial pyramid pooling (ASPP) is integrated into a u-shaped network, and it can expend the receptive field and capture multi-scale information. Meanwhile, boundary and location information are incorporated into semantic information. These information are fused to help Mif-CNN utilize additional context knowledge and useful features. To improve the performance of the segmentation result, the CNN-based region growing method is designed to focus on obtaining small branches. A voxel classification network (VCN), which can entirely capture the rich information around each voxel, is applied to classify the voxels into airway and non-airway. In addition, a shape reconstruction method is used to refine the airway tree.

L’interprofessionalità tra evidenze scientifiche e best practiceT.M. Attardo, L. Tesei, A. Montagnani L’impatto della collaborazione interprofessionale nell’organizzazione e nella qualità di curaF. Dentali, G. Catania La nutrizione nei pazienti terminali: quali migliori approcciP. Gnerre, G. Riggi, G. Filannino L’iperglicemia e l’ipoglicemia: come prevenirle, come gestirleT.M. Attardo, A. Morselli La sindrome ipocinetica: cosa non ha funzionato? La collaborazione interprofessionale può fare la differenza?M. Frualdo, S. Brovarone, M. Piasentin, S. Lenti L’impatto dell’interprofessionalità sull’incidenza delle infezioni correlate all’assistenzaI. Lo Burgio, A. Toccaceli, D. Dalla Gasperina La cirrosi epatica: quali strategie clinico-assistenziali per migliorare la qualità di vita dei pazientiP. Piccolo, N. Cosentino L’interprofessionalità come strumento per un corretto management del deliriumP. Gnerre, R. Rocchi, D. Clemente Il giro visita congiunto come strumento per una migliore cogestione dei pazientiF. Dentali, A. Vitiello La dimissione dall’ospedale: percorso di condivisione del teamO. Para, R. Rapetti, S. Di Bernardino Quando l’interprofessionalità coinvolge anche il paziente: come fare buona sanità oltre la curaL. Tesei, D. Manfellotto Pillole di interprofessionalità: decalogo FADOI/ANIMO: punti comuni e rilevanti per creare collaborazioni tra professionistiT.M. Attardo, L. Tesei

Objective: Aggression is one of the common social disorders in adolescence. Blindness is a disability, which can lead to immature and inappropriate behaviors in children, and increase aggression in teenagers. The present study was conducted to investigate the effect of music on aggressive behavior in visually impaired students. Methods: This research was an experimental pretest-posttest study with a control group and was conducted in 2012. The study population of this research was teenagers with visual impairments in Bojnord, northeast of Iran. For this purpose, Buss and Perry aggression questionnaire and Rutter behavior questionnaire for teachers were used. Twelve music therapy sessions were held, each lasting 90 minutes. T-tests and analysis of covariance (ANCOVA) were used for data analysis. Results: There were not significant differences between the two groups regarding age, socioeconomic status, and education level of parents, as ascertained prior to the pretest. In the intervention group, the declines of aggression scores were statistically significant. There were significant differences between the results of posttest in the intervention and control groups. Conclusion: Music therapy reduces aggression in teens with blindness and can be used as a non-pharmacological intervention to reduce emotional states in this group.

Executive summary<br/>“Oxygen delayed is life denied,” COVID-19 survivor, Kenya<br/><br/>Medical oxygen is an essential medicine that has been in clinical use for over 150 years. It is required at every level of the healthcare system for children and adults with a wide range of acute and chronic conditions, and for safe surgery and perioperative care, and must be available to all who need it. The COVID-19 pandemic shone a spotlight on the longstanding inequities in access to medical oxygen globally, and the importance of this lifesaving therapy to people of all ages and in every part of the world. It was against this backdrop that the Lancet Global Health Commission on Medical Oxygen Security was launched in 2022 – to synthesise available evidence and harness expertise into concrete and actionable recommendations for governments, industry, global health agencies, donors, healthcare workforce, and researchers.<br/><br/>Our work emphasises that oxygen is a service, not just a commodity, and achieving equitable oxygen access requires a systems approach, addressing multiple domains (production, storage, distribution, supply, clinical use, coordination, regulation, financing) across multiple sectors (health, education, energy, industry, transport). Previous efforts, including the major investments in response to the COVID-19 pandemic, largely focused on the delivery of equipment to produce more oxygen, neglecting the systems and people required to ensure equipment is distributed, maintained, and used safely and effectively. Key findings from this Commission show how future investment in strengthening oxygen systems could have huge impact, saving millions of lives, accelerating progress towards the Sustainable Development Goals (SDGs), and leaving the world much better prepared for future pandemics.<br/><br/>Key findings<br/>The global need for medical oxygen is high. Each year, 373 million newborns, children, and adults need medical oxygen, including 364 million patients with acute medical and surgical conditions, and 9 million patients with long-term oxygen needs due to chronic obstructive pulmonary disease (COPD). Eighty-two percent of patients needing oxygen live in low- and middle-income countries (LMICs), with 70% concentrated in South Asia, East Asia, and Sub-Saharan Africa. Patients with acute medical and surgical needs require a minimum 1.2 billion cubic metres (Nm3) of medical oxygen annually. This need is rising, driven by population growth, unmet surgery and long-term oxygen therapy needs. Efforts to prevent oxygen need are critical, through immunisation, smoking and malnutrition reduction, improved indoor and outdoor air pollution, and climate change mitigation. During emergencies the need for oxygen can increase exponentially, putting enormous pressure on health systems. In 2021, globally an additional 52 million patients needed 1.9 billion cubic meters of oxygen to treat COVID-19.Global access to oxygen is highly inequitable with huge gaps in many LMICs despite pandemic-related investments in recent years. We found over 5 billion people, 60% of the world’s population, do not currently have access to safe, quality, and affordable medical oxygen services. In LMICs, less than one in three (30%) people who need oxygen for acute medical or surgical conditions currently receives adequate oxygen therapy, with the greatest inequities in Sub-Saharan Africa. This equates to a 70% oxygen coverage gap, which far exceeds gaps for HIV/AIDS (24%) and tuberculosis (39%) medicines. Major contributors to the oxygen access gap include: people not reaching a health facility; facilities lacking basic oxygen service capacity; missed identification of oxygen need due to lack of pulse oximetry; interrupted, unsafe, or otherwise low quality oxygen care; and the high costs of oxygen services borne by patients. Pulse oximeters and oxygen are currently available in 54% and 58% of general and 83% and 86% of tertiary hospitals, with frequent shortages and equipment breakdown causing healthcare workers moral distress as they ration care. Pulse oximeters and oxygen are practically nonexistent in primary healthcare facilities.<br/><br/>Global costs to fill the oxygen gap are large but represent a highly cost-effective investment that will have wide reaching impacts. We estimate that closing the large acute medical and surgical oxygen access gap in LMICs requires an additional $US6.5 billion annually, equating to $US32.6 billion between 2025 and 2030. This does not include the substantial cost to meet the additional oxygen needed for pandemics ($US6.8 billion for COVID-19 in 2021) or costs for long-term oxygen therapy services. The case for investing in medical oxygen is strong - it is as cost-effective as routine childhood immunization, would enable governments to make progress on eight of the nine SDG 3 goals, and reduce deaths during future pandemics.<br/><br/>National Medical Oxygen Plans are essential to facilitate investment and effectively coordinate service delivery, as outlined in the 2023 World Health Organization (WHO) Increasing Access to Medical Oxygen Resolution. Less than 30 countries have developed National Oxygen Plans to date, and we encourage all governments to do so by 2030. Governments should bring together public and private sector partners with a stake in medical oxygen delivery - including health, education, industry, energy, transport, and other sectors - to design the system and institute a governance structure that keeps all parties connected in its management. Oxygen systems must be integrated into broader national health plans and pandemic preparedness and response strategies.<br/><br/>Pulse oximetry is the gateway to safe, quality, affordable oxygen care and needs to be integrated in clinical education, guidelines, and all levels of the healthcare system. Pulse oximetry measures an essential vital sign - the peripheral blood (haemoglobin) oxygen saturation (SpO2) - that should be routinely assessed in all patients at all levels of health care. However, healthcare workers are currently poorly equipped or supported to use pulse oximeters effectively and pulse oximetry and oxygen therapy are lacking from many clinical guidelines and health curricula. We found that pulse oximetry was performed for only 19% of patients presenting to general hospitals in LMICs and almost never performed for patients presenting to primary healthcare facilities, with the greatest inequities in small and rural government health facilities and across Sub-Saharan Africa. We recognise an urgent need to make high-quality, robust pulse oximeters more affordable and better used while also working to improve their accuracy for all populations, including those with darker skin pigmentation and infants and young children.<br/><br/>Oxygen systems must be designed to suit the context, include operational costs, and be affordable to all patients. There is no one-size-fits-all national medical oxygen system. Rather, governments should define priorities and optimise their systems to suit local conditions. Most health systems and health facilities will benefit from a mixed-source oxygen supply (i.e., liquid, oxygen plant, cylinder, and/or oxygen concentrator), including reliable back-up in case of failure and to meet surges during emergencies. Operational costs account for 50 to 80% of total system costs but have received relatively little investment to date, with catastrophic consequences for the functioning, sustainability, and effective use of oxygen equipment. We particularly highlight the importance of investing in the clinical and engineering workforce. Although there are many different models for managing a national oxygen system, from fully-government- to fully private sector-run, governments should ensure that whatever system they choose, costs are not shifted to the patients. Patient and caregiver testimonies repeatedly told of punishing out-of-pocket costs and we strongly urge governments to include pulse oximetry and oxygen services in Universal Health Coverage (UHC) schemes and to pursue other strategies to minimise user fees.<br/><br/>We call for closer collaboration between the medical oxygen industry, national governments, and global health agencies. The medical oxygen industry, like the pharmaceutical industry, is an essential part of the public health and pandemic preparedness and response architecture. Governments are responsible for ensuring that medical oxygen markets function safely, competitively, and with price transparency, and that national regulations defining medical oxygen quality and safety are aligned with the updated WHO International Pharmacopoeia. Companies should adopt specific oxygen access targets and publish progress while global health agencies should regularly assess oxygen industry progress as they currently do for the pharmaceutical industry. We call on global health agencies and donors to maintain oxygen access as a global health priority, including supporting the new Global Oxygen Alliance (GO2AL) and replenishing The Global Fund with a strong oxygen access mandate. Finally, access to medical oxygen and related tools and therapies must be fully integrated into global pandemic preparedness and response architecture.<br/><br/>Accurate and timely data on oxygen systems is essential for effective decision making and oxygen service access. We found huge gaps in oxygen access data, major deficiencies in the tools we use to monitor oxygen systems and service delivery, and estimates of cost-effectiveness for different oxygen solutions and patient populations. We present two new tools to help governments, health facilities, and global health agencies make progress. These include 10 Oxygen Coverage Indicators and a national Access to Medical Oxygen Scorecard (ATMO2S), which governments should use to both plan their national oxygen systems and report progress implementing the WHO Oxygen Resolution. We also offer

La storia lunga 30 anni di Assistenza Infermieristica&#13;\ne Ricerca, dei progetti di ricerca lanciati (6 studi epidemiologici&#13;\nsu larga scala ed una sperimentazione clinica randomizzata&#13;\ncontrollata) e delle reti attivate, è l’occasione per&#13;\nun bilancio dei risultati ottenuti e per definire le strategie future.&#13;\nLa Rivista ha avuto la capacità di attivare diversi progetti&#13;\nche si sono conclusi con successo (un ruolo unico nel&#13;\npanorama delle riviste, non solo nazionale). La maggior parte&#13;\ndei progetti erano studi collaborativi di sperimentazioni&#13;\ncliniche, ma sono stati prodotti e pubblicati anche studi epidemiologici&#13;\ne studi sperimentali indipendenti. L’aspetto più&#13;\ncritico è la capacità di tenere in vita le reti, in modo che continuino&#13;\na proporre e fare ricerca.

Peripheral intravenous catheters (PIVCs) are widely used in hospital settings but are associated with high failure rates and patient safety risks. Various dressing and securement methods have been implemented to mitigate these complications. This systematic review aimed to systematically review the effectiveness and safety of different dressing and securement methods for PIVCs in hospitalised adult and paediatric patients. Randomised controlled trials (RCTs) published between 1959 and 2024 were identified through searches of CENTRAL, CINAHL, Ovid EMBASE, and Ovid MEDLINE. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and certainty of evidence was evaluated using GRADE. Outcomes included PIVC failure, dislodgement, occlusion, infiltration, extravasation, phlebitis, and catheter-related bloodstream infection (CRBSI), analysed using risk ratios where meta-analysis was feasible. Dwell time was reported descriptively as mean or median values. Fifteen RCTs involving 5542 participants evaluated eight PIVC dressing and securement methods. In adult populations, tissue adhesive significantly reduced PIVC failure compared with transparent polyurethane dressing (risk ratio [RR] 0.83, 95% confidence interval [CI] 0.73-0.95), as well as dislodgement (RR 0.60, 95% CI 0.42-0.84) and occlusion (RR 0.73, 95% CI 0.57-0.94). Transparent polyurethane dressing was associated with lower dislodgement rates compared with gauze in adults. Other comparisons showed no statistically significant differences or were informed by single studies only, limiting the strength of conclusions. Evidence in paediatric populations was sparse and predominantly derived from individual trials. Tissue adhesive appears effective in reducing PIVC failure and mechanical complications in adults. Its effectiveness in pediatric patients remains uncertain, highlighting the need for further adequately powered trials.

OBJECTIVE: To develop and validate the Unfinished Community Nursing Care Reasons Survey (UCNC_RS) transnationally and compare Unfinished Nursing Care (UNC) reasons across countries. DESIGN: This development and validation study was conducted in Israel and Italy, following the COnsensus-based Standards for the selection of health Measurement Instruments guidelines. SAMPLE AND MEASUREMENT: Tool identification, adaptation, and development were followed by content and language validation; structural validation was then performed with 309 community nurses (156 in Israel and 153 in Italy) who agreed to participate. Exploratory Factor Analysis (EFA), Mokken analysis, and descriptive statistics were conducted. RESULTS: The UCNC_RS consists of 23 items. Israeli EFA identified three factors, while the Italian EFA identified two, with items loading on more than one factor in both countries. Mokken analysis indicated a good model fit. Reasons for UNC differed between countries, both in their order of importance and in their averages, indicating different patterns of perceived elements affecting UNC occurrence. CONCLUSION: Overall, the UCNC_RS may be used in daily practice to survey and proactively address factors that may increase the occurrence of UNC. Reasons for UNC are organized hierarchically, suggesting that actions should target different system levels to reduce its occurrence. In Israel, priority policies are needed at the macro-, exo-, and nurse-system levels, while in Italy, policies are needed at the macro-, meso-, and micro-levels. Moreover, the reasons for UNC differ across countries, both in their order of importance and in their scores, with only some common elements, indicating different patterns of perceived reasons.

BACKGROUND: Intensive care unit (ICU) experiences after cardiac surgery significantly influence patient outcomes, including psychological disorders, quality of life and overall comfort. The existing literature emphasises psychological impacts and transitions from ICU to general wards, but there is a paucity of qualitative research focussing specifically on post-cardiac surgery ICU experiences. AIM: This study aimed to explore the lived experiences of patients in the ICU following major cardiac surgery, providing a comprehensive understanding of their emotional and psychological challenges. STUDY DESIGN: Utilising Cohen's phenomenological approach, we conducted in-depth interviews with 20 patients from a cardiothoracic ICU in Southern Italy. Participants were chosen through purposive sampling. Data were analysed using thematic analysis to identify recurring themes. RESULTS: Five main themes emerged from the data: (1) 'Closing the eyes and not opening them', highlighting pervasive fear and anxiety; (2) 'Confusion upon awakening', marked by disoriented memories and the fear of not being able to breathe; (3) 'Time stood still', describing a distorted perception of time; (4) 'The closeness of my angels: the nurses', underscoring the critical role of nursing support; and (5) 'The other side: exclusion from care', reflecting feelings of marginalisation during the care process. CONCLUSIONS: The study underscores the complex experiences of ICU patients' post-cardiac surgery, emphasising the need for psychological support and inclusive communication strategies to enhance patient outcomes. Further research should focus on developing tailored interventions to support these patients through their recovery process. RELEVANCE TO CLINICAL PRACTICE: There is a clear need for enhanced psychological support for patients before, during and after the ICU stay. Preoperative education programmes that set realistic expectations and provide coping strategies can significantly reduce anxiety and improve patient outcomes. Additionally, enhancing the role of nurses in offering emotional support and involving patients in care decisions can lead to a more positive ICU experience. Psychological interventions can optimise preoperative expectations and reduce hospital stays, offering significant cost-benefit advantages for healthcare systems.

The 30th anniversary of Assistenza Infermieristica e Ricerca is the occasion for a reflection&#13;\non the past and future of a journal whose aim is to publish but, above&#13;\nall, to promote research in/on nursing care, stimulating confrontations, trying to&#13;\ndescribe and to find answers to unmet needs.

Nurses are required to decide on priorities; however, how they prioritize the interventions toward patients with delirium is still unclear. Therefore, expanding the knowledge on (a) how nurses prioritize interventions to manage episodes of delirium and (b) the underlying prioritization patterns were the aims of this study. The Q-methodology was applied in 2021. A systematic review to identify the recommended interventions for patients with delirium was performed, and a nominal group technique was used to select those interventions that are applicable in daily practice (35 out of 96 identified). Then, using a specific scenario, 56 clinical nurses working in hospital medical (n = 31), geriatric (n = 15), and postacute (n = 10) units were asked to order the 35 interventions (from -4 the lowest to +4 the highest priority) using a Q-sort table. Averages (confidence interval at 95%) were calculated at the group level, and a by-person factor analysis was applied to discover underlying patterns of prioritization at the overall and at the individual levels. At the group level, "Ensuring a safe environment (e.g., reducing bed height)" was ranked as the highest priority (2.29 out of four); at the individual level, three prioritization patterns accounting for a total variance of 50.21% have emerged: "Individual needs-oriented" (33.82% variance explained; 41 nurses); "Prevention-oriented" (8.47%; five nurses); and "Cognitive-oriented" (7.92%; six nurses). At the group level, nurses prioritize safety while caring for patients with delirium; however, at the individual level, they follow three different patterns of prioritization oriented toward diverse aspects, suggesting uncertainty in the actions to be taken-with potential implications for patients.

General practice nurses (GPNs) are essential members of multidisciplinary primary care teams. Understanding their demographics, career trajectories, and professional challenges is crucial for workforce sustainability. This study examines the demographic characteristics, professional experiences, and career intentions of GPNs in Australia, focusing on workforce sustainability, job satisfaction, and professional development. A cross-sectional survey was conducted among GPNs across Australia. Descriptive analysis, factor analysis, and logistic regression examined demographic trends and professional outcomes. The workforce is aging, with many nearing retirement and an underrepresentation of younger and culturally diverse nurses, including Aboriginal and Torres Strait Islanders. Job satisfaction was moderate, influenced by work-life balance, remuneration, and professional development. Barriers to continuing education included financial constraints and limited institutional support. Logistic regression identified employment status, pay, and professional development as key predictors of job satisfaction and retention. Sustaining the GPN workforce requires strategies to retain experienced nurses, attract younger and diverse entrants, and enhance professional development. Stable funding, an expanded scope of practice, and stronger continuing education support are essential for meeting Australia's evolving primary care needs.

BACKGROUND AND OBJECTIVE: Management of post operative pain in children undergoing hypospadiasis repair, accounts for optimized surgery outcomes and improved patients' satisfaction. Thus, various studies have widely investigated the best approaches for the pain management. In this study our aim was to determine the effect of dexamethasone in combination with penile nerve block on the postoperative pain and complications in the children undergoing hypospadias surgery. METHODS: In this randomized double-blind placebo controlled trial, after obtaining informed consent from parents or legal guardians, 42 children undergoing surgical treatment of hypospadias were randomized in two groups to receive either IV dexamethasone 0.5 mg/kg (n=23) or placebo (normal saline) (n=19) during the operation. Penile block was performed in both groups using Bupivacaine 0.5% (1mg/kg) at the end of the procedure. By the end of the operation, FLACC (Face, Leg, Activity, Cry, Consolability) pain score was assessed as the primary outcome of the study. Secondary outcomes includes timing and episodes of rescue medication consumption, post operative nausea \vomiting and bleeding. All the outcomes were assessed in the recovery room and after 2, 6, 12, and 24 hours. RESULTS: The median of FLACC pain scores at the recovery room and 2, 6, 12, and 24 hours post operation was 2, 1, 1, 1, and 2 for the dexamethasone group and 8, 8, 7, 7, and 8 for the placebo group respectively. This were significantly different (P<0.000). The median time of first rescue medication consumption was 8 hours post operation for the dexamethasone group and three hours for the placebo group which was significantly different (z= 4.57, p<0.000). The maximum episode of post operative rescue medication consumption in dexamethasone group was 4 episodes in only one patient and the minimum was one episode in 11 patients. In comparison numbers in placebo group were five episodes in seven patients and three episodes in four patients. The result indicated that there was statistically significant difference between two groups in terms of episodes of rescue medication consumption (Chi2= 31.4, p<0.000). CONCLUSION: Single dose of intravenous dexamethasone (0.5 mg/kg) in combination with penile block decreased the post operative pain measures, and total post operative analgesic requirement. It also increased the onset of the first analgesic requirement compared to penile block alone.

Introduction Nurses are continually faced with multiple demands to make decisions in their clinical practice. The Nursing Decision-Making Instrument (NDMI) assesses nurses’ decision-making styles during the several stages of this process. Objectives To adapt the NDMI into European Portuguese and evaluate the psychometric properties of the Portuguese version in a population of Portuguese nurses. Methods Descriptive study design was used to examine psychometric properties of NDMI. Nonprobability convenience sample of 339 Portuguese direct-care nurses. Data were collected using a questionnaire comprising sociodemographic and professional data and the NDMI–Portuguese version (NDMI-PT). An exploratory factor analysis (EFA; n = 125) and a confirmatory factor analysis (CFA; n = 214) were carried out using IBM SPSS (v. 24) and AMOS (v. 22). Results The EFA revealed a structure of four latent factors, which represent the reorganized stages of the decision-making process. The CFA found a good overall fit of the model (χ 2 /df = 2.13; comparative fit index [CFI] = 0.91; goodness of fit index [GFI] = 0.82; Tucker-Lewis Index [TLI] = 0.90; root mean square error of approximation [RMSEA] = 0.07; maximum-likelihood expected cross-validation index [MECVI] = 3.13). The psychometric analysis of the theoretical structure revealed that the four factors reflect the decision-making stages and have a better overall fit than the empirical structure (χ 2 /df = 1.82; CFI = 0.94; GFI = 0.86; TLI = 0.93; RMSEA = 0.06; MECVI = 2.55). The analysis of the construct reliability of the NDMI-PT revealed that the overall internal consistency was excellent ( α=0.96). Conclusions This study revealed that the empirical and theoretical structures were appropriate and valid for the sample under analysis. The NDMI-PT is a reliable and valid tool for assessing nurses’ decision-making styles. Studies should be conducted to gain further insight into the robustness of this validated tool.

This work presents the design and implementation of an IoT enabled Endotracheal Tube Cuff Pressure Controller Device. This device, a fusion of electronics, control, and software engineering, aims to automatically regulate the cuff pressure of an Endotracheal Tube placed in a patient’s trachea, ensuring that it remains within the optimal pressure range. The ideal pressure range, established to be between 20-30 cmH2O, can be adjusted to accommodate different patients’ needs. The device is designed as an IoT device and includes an emergency button for shutting down the system in case of an emergency. The total cost of the system, which amounts to approximately 70 USD, makes it a cost-effective solution compared to other commercially available options. In order to verify the device’s capability to accurately read and supply pressure, it is benchmarked against the gold standard (Fluke 729 300G FC) using quantitative tests including Pearson’s r test, the paired t-test, and Bland-Altman analysis. The results from these assessments confirmed that the performance characteristics of the device are notably comparable to the Fluke 729 300G FC, which will be further examined in this study. These outcomes, along with the device’s economic viability, validate it as a workable and reasonable alternative. The necessity for an automated and continuous monitoring system is further reinforced by the fact that manual cuff pressure measurement is prone to error and may even put the patient through discomfort.