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Aims and ObjectivesThis paper explores patients' perspectives on infection prevention and control.BackgroundHealthcare‐associated infections are the most frequent adverse event experienced by patients. Reduction strategies have predominantly addressed front‐line clinicians' practices; patients' roles have been less explored.DesignVideo‐reflexive ethnography.MethodsFieldwork undertaken at a large metropolitan hospital in Australia involved 300 hours of ethnographic observations, including 11 hours of video footage. This paper focuses on eight occasions, where video footage was shown back to patients in one‐on‐one reflexive sessions.FindingsViewing and discussing video footage of clinical care enabled patients to become articulate about infection risks, and to identify their own roles in reducing transmission. Barriers to detailed understandings of preventative practices and their roles included lack of conversation between patients and clinicians about infection prevention and control, and being ignored or contradicted when challenging perceived suboptimal practice. It became evident that to compensate for clinicians' lack of engagement around infection control, participants had developed a range of strategies, of variable effectiveness, to protect themselves and others. Finally, the reflexive process engendered closer scrutiny and a more critical attitude to infection control that increased patients' sense of agency.ConclusionThis study found that patients actively contribute to their own safety. Their success, however, depends on the quality of patient–provider relationships and conversations. Rather than treating patients as passive recipients of infection control practices, clinicians can support and engage with patients' contributions towards achieving safer care.Relevance to clinical practiceThis study suggests that if clinicians seek to reduce infection rates, they must start to consider patients as active contributors to infection control. Clinicians can engage patients in conversations about practices and pay attention to patient feedback about infection risk. This will broaden clinicians' understandings of infection control risks and behaviours, and assist them to support appropriate patient self‐care behaviour.

Calf muscles and Achilles tendon play important roles in functional activities. However, it is not clear how biomechanical properties of the uniarticular soleus (SOL) and biarticular gastrocnemius muscle and Achilles tendon, including the fascicle length, pennation angle, and stiffness, change concurrently post stroke. Biomechanical properties of the medial gastrocnemius (GM) and soleus muscles were evaluated bilaterally in 10 hemiparetic stroke survivors using combined ultrasonography-biomechanical measurements. Biomechanical properties of the Achilles tendon including the length, cross-sectional area (CSA), stiffness, and Young's modulus were evaluated, together with calf muscle biomechanical properties. Gastrocnemius and SOL contributions were separated using flexed and extended knee positions. The impaired side showed decreased fascicle length (GM: 6%, P = 0.002 and SOL: 9%, P = 0.03, at full knee extension and 0° ankle dorsiflexion) and increased fascicular stiffness (GM: 64%, P = 0.005 and SOL: 19%, P = 0.012, at a common 50 N force level). In contrast, Achilles tendon on the impaired side showed changes in the opposite direction as the muscle fascicles with increased tendon length (5%, P < 0.001), decreased tendon CSA (5%, P = 0.04), decreased tendon stiffness (42%, P < 0.001) and Young's modulus (30%, P < 0.001) compared with the unimpaired side. The fascicle and tendon stiffness changes were correlated negatively to the corresponding fascicle and tendon length changes, and decrease in Achilles tendon stiffness was correlated to the increases of SOL and GM fascicular stiffness ( P < 0.05). Characterizations of calf muscle fascicles and Achilles tendon biomechanical properties help us better understand concurrent changes of fascicles and tendon as part of the calf muscle-tendon unit and facilitate development of more effective treatments.

AbstractRationale, aims and objectivesHypertension (HT) is prevalent in Turkey and even with pharmacological interventions HT control rates do not meet guideline recommendations. We aimed to estimate the proportion of hypertensive patients who achieved target blood pressure (BP) and seek to determine the predictors responsible for failure of to reach goals.MethodsWe conducted a retrospective cohort study involving patients with HT. A total of 437 patients were identified with a current diagnosis of HT at baseline. All available predictors for BP improvements were included in the multivariate linear regression model.ResultsFollow‐up data on HT goal achievements was available for 276 (63.1%) participants. Only 18.1% of the patients at the baseline visit, and 48.6% at the follow‐up visit achieved the overall SBP/DBP targets specified by the JNC‐8 guideline. Significant differences were determined by baseline and 1st visit measurements of mean SBP/DBP levels (P < 0.001, P < 0.001, respectively). DM and baseline SBP were positively associated with SBP improvement (β = 8.410, P = 0.003; β = 0.692, P < 0.001, respectively), whereas being prescribing more HT medications and being older were negatively associated with improvement (β = −7.968, P = 0.005; β = −5.707, P = 0.037; respectively). DM, baseline DBP and HT duration were positively associated with DBP improvement (β = 4.539, P = 0.012; β = 0.702, P < 0.001; β = 0.023, P = 0.012; respectively), whereas additional HT medications and GFR values were negatively associated with improvement (β = −5.682, P = 0.002; β = −0.098, P = 0.005; respectively).ConclusionsAlthough the progress in achieving in BP targets was encouraging, only half of patients had reached the HT goals. Adequate pharmacological approaches and comprehensive management strategies should be implemented in hypertensive patients.

AbstractBackgroundVoriconazole is a commonly used antifungal medication in allogeneic hematopoietic stem cell transplantation (allo‐HSCT) patients. In solid organ transplantation, voriconazole use has been associated with the development of cutaneous squamous cell carcinoma (SCC). We sought to determine if voriconazole use was associated with SCC in patients undergoing allo‐HSCT.MethodsWe retrospectively reviewed consecutive adult patients who underwent allo‐HSCT at Mayo Clinic from January 2007 through July 2012. Multivariable Cox models were created to assess the relationship of SCC with two time‐dependent voriconazole exposure variables: (i) history of voriconazole exposure (yes/no), and (ii) cumulative days of voriconazole use.ResultsIn our cohort of 381 allo‐HSCT patients, SCC developed in 26 of 312 patients exposed to voriconazole (25 post‐voriconazole) and in 1 of 69 patients who received alternative antifungal agent(s). Cumulative incidence of SCC was estimated to be 19% at 5 years post allo‐transplant. Cumulative days of voriconazole use was found to be a risk factor for SCC, and this relationship persisted in a multivariable model using previously identified risk factors as covariates (hazard ratio 1.859 for each 180 days of use, P < 0.001).ConclusionThis is the first study, to our knowledge, to identify cumulative days of voriconazole use as a risk factor for SCC development following allo‐HSCT, and may help guide appropriate antifungal use in this patient population.