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Advancing the description and conceptualisation of interventions in complex systems is necessary to support spread, evaluation, attribution and reproducibility. Improvement teams can provide unique insight into how interventions are operationalised in practice. Capturing this 'insider knowledge' has the potential to enhance intervention descriptions.

This exploratory study investigated the spread of a comprehensive medication review (CMR) intervention to (1) describe the work required from the improvement team perspective, (2) identify what stays the same and what changes between the different sites and why, and (3) critically appraise the 'hard core' and 'soft periphery' (HC/SP) construct as a way of conceptualising interventions.

A prospective case study of a CMR initiative across five sites. Data collection included observations, document analysis and semistructured interviews. A facilitated workshop triangulated findings and measured perceived effort invested in activities. A qualitative database waffort.
This study advances the conceptualisation of interventions by explicitly considering how evidence-based practices are operationalised in complex systems. Trometamol We propose a new conceptualisation of 'interventions-in-systems' which describes intervention components in relation to their proximity to the evidence base; component interdependence; component function; component adaptation and effort.During the coronavirus disease 2019 (COVID-19) pandemic, many hospitals have added COVID-19-specific visitor restrictions to their routine visitor restrictions. These additional visitor restrictions are designed to reduce viral transmission, protect patients and staff, and conserve personal protective equipment. They typically exempt patients with disabilities and those who are dying. Consistent application of these policies may, however, be inequitable. We present the case of a single mother seeking an individual exemption to both a routine and a COVID-19 specific visitor restriction. One commentator focuses on the importance of clear and transparent processes for considering requests for exceptions. The other argues that disproportionate burdens may be mitigated in other ways and the policy maintained.
To estimate the association between fluoroquinolone use and tendon injury in adolescents.

We conducted an active-comparator, new-user cohort study using population-based claims data from 2000 to 2018. We included adolescents (aged 12-18 years) with an outpatient prescription fill for an oral fluoroquinolone or comparator broad-spectrum antibiotic. The primary outcome was Achilles, quadricep, patellar, or tibial tendon rupture identified by diagnosis and procedure codes. Tendinitis was a secondary outcome. We used weighting to adjust for measured confounding and a negative control outcome to assess residual confounding.

The cohort included 4.4 million adolescents with 7.6 million fills for fluoroquinolone (275 767 fills) or comparator (7 365 684) antibiotics. In the 90 days after the index antibiotic prescription, there were 842 tendon ruptures and 16 750 tendinitis diagnoses (crude rates 0.47 and 9.34 per 1000 person-years, respectively). The weighted 90-day tendon rupture risks were 13.6 per 100 000 fld these events were rare. The excess risk of tendinitis associated with fluoroquinolone treatment was also small. Other more common potential adverse drug effects may be more important to consider for treatment decision-making, particularly in adolescents without other risk factors for tendon injury.Nature underpins human well-being in critical ways, especially in health. Nature provides pollination of nutritious crops, purification of drinking water, protection from floods, and climate security, among other well-studied health benefits. A crucial, yet challenging, research frontier is clarifying how nature promotes physical activity for its many mental and physical health benefits, particularly in densely populated cities with scarce and dwindling access to nature. Here we frame this frontier by conceptually developing a spatial decision-support tool that shows where, how, and for whom urban nature promotes physical activity, to inform urban greening efforts and broader health assessments. We synthesize what is known, present a model framework, and detail the model steps and data needs that can yield generalizable spatial models and an effective tool for assessing the urban nature-physical activity relationship. Current knowledge supports an initial model that can distinguish broad trends and enrich urban planning, spatial policy, and public health decisions. New, iterative research and application will reveal the importance of different types of urban nature, the different subpopulations who will benefit from it, and nature's potential contribution to creating more equitable, green, livable cities with active inhabitants.Florence Nightingale formally documented much of the early history of the nursing profession, a goal that remains important today to guide our practice. Many nurse scholars have published detailed accounts of historical research. Story-based narratives can be especially effective to describe the contributions of individual nurses in a way that resonates with nurses and lay readers. Two nurses, Terri Arthur and Jeanne Bryner, have successfully disseminated stories of nurses through creative writing. This article describes their journeys to capture nursing history using historical narrative, poetry, and reflective prose.Individuals who are incarcerated are disproportionately affected by chronic disease, mental health concerns, and substance use, compared to the general population. Despite the need to improve health in individuals who are incarcerated, the delivery of quality health care, including health education, often meets with challenges. Quality health education lays a foundation for improved health, and is one strategy nurses can use to improve the health of incarcerated individuals. To address this pressing health need, students in a community health nursing course at the University of Illinois at Chicago provided health education to men finishing their prison sentences at an adult transition center. Verbal and written statements from the men and the students indicate that the educational offering was a positive experience. One man's attendance at a health education class had a life-changing impact on another man at the center.
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