Rates above the median declined substantially during the study period. Although 67% of hospitals reported comparably low rates of seclusion (≤0.09 hours per 1,000 patient-hours) and restraint (≤0.15 hours per 1,000 patient-hours), 10% of hospitals reported rates at least five to 10 times higher. Conclusions Despite some progress, many hospitals continue to report very high rates of seclusion and restraint. It is unlikely that this variability can be fully accounted for by patient-level factors. Centers for Medicare and Medicaid Services data reporting should be expanded to include frequency of seclusion and restraint use and duration of episodes.Interventions that integrate care for mental illness or substance use disorders into general medical care settings have been shown to improve patient outcomes in clinical trials, but efficacious models are complex and difficult to scale up in real-world practice settings. Existing payment policies have proven inadequate to facilitate adoption of effective integrated care models. This article provides an overview of evidence-based models of integrated care, discusses the key elements of such models, considers how existing policies have fallen short, and outlines future policy strategies. Priorities include payment policies that adequately support structural elements of integrated care and incentivize multidisciplinary team formation and accountability for patient outcomes, as well as policies to expand the specialty mental health and addiction treatment workforce and address the social determinants of health that disproportionately influence health and well-being among people with mental illness or substance use disorders.Telemedicine could be a key to control the world-wide disruptive and spreading novel coronavirus disease (COVID-19) pandemic. The COVID-19 virus directly targets the lungs, leading to pneumonia-like symptoms and shortness of breath with life-threatening consequences. Despite the fact that self-quarantine and social distancing are indispensable during the pandemic, the procedure for testing COVID-19 contraction is conventionally available through nasal swabs, saliva test kits, and blood work at healthcare settings. Therefore, devising personalized self-testing kits for COVID-19 virus and other similar viruses is heavily admired. Many e-health initiatives have been made possible by the advent of smartphones with embedded software, hardware, high-performance computing, and connectivity capabilities. A careful review of breathing sounds and their implications in identifying breathing complications suggests that the breathing sounds of COVID-19 contracted users may reveal certain acoustic signal patterns, which is worth investigating. To this end, acquiring respiratory data solely from breathing sounds fed to the smartphone’s microphone strikes as a very appealing resolution. The acquired breathing sounds can be analyzed using advanced signal processing and analysis in tandem with new deep/machine learning and pattern recognition techniques to separate the breathing phases, estimate the lung volume, oxygenation, and to further classify the breathing data input into healthy or unhealthy cases. The ideas presented have the potential to be deployed as self-test breathing monitoring apps for the ongoing global COVID-19 pandemic, where users can check their breathing sound pattern frequently through the app.Objective This study aims to assess the educational needs and professional competencies of community pharmacists in Qatar to inform the development of relevant continuing professional development (CPD) programs. Methods A mixed-methods cross-sectional exploratory study targeting community pharmacists was conducted using a questionnaire and an event diary. Descriptive and inferential analyses were utilized to analyze the data using the Statistical Package for Social Sciences (SPSS®) version 21 software. For the event diary, thematic content analysis was used for data analysis. Results Drug information skills and pharmaceutical care process were the most identified topics for inclusion in CPD programs. None of the pharmacists thought that they were competent in core areas of pharmacy practice. Community pharmacists who filled an event diary highlighted the need for development in areas such as communication skills and medication safety. Conclusion The identified needs shall help in developing a CPD program that addresses what community pharmacists perceive as educational and professional training needs.The objective of this study was to explore the exact nature, extent, and cognitive correlates of prospective memory deficits in mild cognitive impairment (MCI) by using the Ecological Test of Prospective Memory (TEMP). Twenty-five MCI participants and 25 healthy older adults (HOA) performed the TEMP, the Envelope Task, the Comprehensive Assessment of Prospective Memory (CAPM), and a neuropsychological test battery. Results showed that, during the TEMP, MCI participants had difficulty detecting the moment to perform the intentions in the time-based condition (prospective component) and retrieving the associated actions in the event- and time-based conditions (retrospective component). The prospective component of the event-based condition was correlated with retrospective memory, whereas the prospective component of the time-based condition was correlated with executive functions. Finally, the TEMP yielded good sensitivity and specificity for discriminating between MCI and HOA, contrary to the Envelope Task and the CAPM.Mother-to-child transmission of HIV (MTCT) accounts for a significant proportion of new HIV infections in Peru. The purpose of this case-control study was to examine maternal and infant factors associated with MTCT in Peru from 2015 to 2016. For each biologically confirmed case infant, we randomly selected four birth year- and birth hospital-matched controls from five hospitals in Lima-Callao. Maternal and infant information were gathered from medical records. Simple conditional logistic regression was utilized to examine possible maternal and infant characteristics associated with MTCT. The rate of MTCT was 6.9% in 2015 and 2.7% in 2016. A total of 63 matched controls were identified for 18 cases. Protective factors included higher number of prenatal visits (odds ratio [OR] 0.72; 95% confidence interval [CI] 0.55-0.94, p = 0.012) and having more children (OR 0.10, 95% CI 0.01-0.79, p = 0.029). Risk factors included later maternal diagnosis (OR 1.19; 95% CI 1.06-1.34; p = 0.001) and greater viral load at the time of maternal diagnosis (OR 1.05; 95% CI 1.01-1.10; p = 0.022). Our study highlights the importance of targeting early and continued prenatal care as specific areas to target to prevent gaps in the HIV treatment cascade for pregnant HIV-infected women. These strategies can ensure early screening and initiation of antiretroviral therapy to reduce MTCT rates.Most of the information on clinical factors related to HIV infection is focused on key populations and young people. Therefore, there is little information on clinical factors related to HIV infection in older persons (>45 years old). In this study, data on CD4 lymphocyte counts were analyzed on adults who are linked to care and have their first CD4 cell count done from different regions of the Republic of Panama from 2012 to 2017. Samples were grouped according to late presentation status, region of origin in the country, year, gender, and age groups. Factors associated with late presentation to care and advanced HIV were assessed on each group by multivariable logistic regression. Late presentation to care was observed in 71.6% of the evaluated subjects, and advanced HIV in 54.5%. Late presentation was associated with males (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI]=1.1-1.6, p = 0.03), age greater than 45 years old (AOR = 2.3 CI= 1.8-2.9, p less then 0.001), and being from regions where antiretroviral clinics are not well instituted (AOR = 2.1, CI = 1.6-2.7, p less then 0.001). Despite an increase in subjects linked to care with a CD4 test performed over the years, late presentation remained constant. Therefore, prevention policies must be reformulated. Promotion of routine HIV testing, accessibility among all population groups, installation of antiretroviral clinics, and implementation of programs as rapid initiation of antiretroviral therapy should be rolled out nationally.The primary aim of the current study was to test the effect of the presentation design of a test alert system on healthcare workers’ (HCWs’) decision-making regarding blood-borne virus (BBV) testing. The secondary aim was to determine HCWs’ acceptance of the system. An online survey used a within-subjects research design with four design factors as independent variables. The dependent variable was clinical decision. Ten realistic descriptions of hypothetical patients were presented to participants who were asked to decide whether to request BBV testing. The effect of a pre-set course of action to request BBV testing was significant when additional information (cost-effectiveness, date of last BBV test or risk assessment) was not presented, with a 16% increase from 30 to 46% accept decisions. When risk assessment information was presented without a pre-set course of action, the effects of cost-effectiveness (27% increase) and last test date (23% decrease) were significant. The main reason for declining to test was insufficient risk. HCWs’ acceptance of the test alert system was high and resistance was low. We make recommendations from the results for the design of a subsequent real-world trial of the test alert system.Objectives We sought to explore the sociodemographics and primary care service utilization among people who died from opioid overdose and to assess the possibility of using this information to identify those at high risk of opioid overdose using routine linked data. Methods Data related to decedents of opioid overdose between January 1, 2012 and December 31, 2015 were linked with general practitioner (GP) records over a period of 36 months prior to death. Results Of n = 312 decedents of opioid overdose, 73% were male (n = 228). Average age at death was 40.72 (SD 11.92) years. A total of 63.8% of the decedents were living in the 2 most deprived quintiles according to the Welsh Index of Multiple Deprivation. Over 80% (n = 258) of the decedents were recorded as having at least 1 GP episode during the 36-month observation period prior to death. The median number of episodes per decedent was 75 [38-118]. Overall, 31.8% (n = 82) of decedents with at least 1 GP episode received a prescription for a proton pump inhibitor and 31% (n = 80) were prescribed a broad-spectrum antibiotic. According to their GP records, less than 10% were referred to or receiving specialist drug treatment (n = 24, 9.3%); or were known to be drug dependent (n = 21, 8.14%), or a drug user (n = 5, 1.94%). In all, 81% were recorded as smokers (n = 209) and 10.5% as ex-smokers (n = 27). Conclusions The majority of decedents of opioid overdose were in contact with GP services prior to death. GPs are either often unaware of high-risk opioid use, or rarely record details of opioid use in patient notes. It is possible that GP awareness of high-risk opioid use could be increased. For example, awareness of the risks associated with opioid use, and the relationship between the sociodemographic and clinical characteristics of opioid overdose decedents could be raised using educational materials prominently displayed in waiting areas. Clinicians in primary care may be in an excellent position to intervene in problematic opioid use.