Writing Committee for the REMAP-CAP Investigators IMPORTANCE The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive.OBJECTIVE To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. DESIGN, SETTING, AND PARTICIPANTSThe ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) enrolled and randomized 4763 adults with suspected or confirmed COVID-19 between March 9, 2020, and January 18, 2021, within at least 1 domain; 2011 critically ill adults were randomized to open-label interventions in the immunoglobulin domain at 129 sites in 4 countries. Follow-up ended on April 19, 2021. INTERVENTIONSThe immunoglobulin domain randomized participants to receive 2 units of high-titer, ABO-compatible convalescent plasma (total volume of 550 mL ± 150 mL) within 48 hours of randomization (n = 1084) or no convalescent plasma (n = 916). MAIN OUTCOMES AND MEASURESThe primary ordinal end point was organ support-free days (days alive and free of intensive care unit-based organ support) up to day 21 (range, −1 to 21 days; patients who died were assigned -1 day). The primary analysis was an adjusted bayesian cumulative logistic model. Superiority was defined as the posterior probability of an odds ratio (OR) greater than 1 (threshold for trial conclusion of superiority >99%). Futility was defined as the posterior probability of an OR less than 1.2 (threshold for trial conclusion of futility >95%). An OR greater than 1 represented improved survival, more organ support-free days, or both. The prespecified secondary outcomes included in-hospital survival; 28-day survival; 90-day survival; respiratory support-free days; cardiovascular support-free days; progression to invasive mechanical ventilation, extracorporeal mechanical oxygenation, or death; intensive care unit length of stay; hospital length of stay; World Health Organization ordinal scale score at day 14; venous thromboembolic events at 90 days; and serious adverse events. RESULTS Among the 2011 participants who were randomized (median age, 61 [IQR, 52 to 70] years and 645/1998 [32.3%] women), 1990 (99%) completed the trial. The convalescent plasma intervention was stopped after the prespecified criterion for futility was met. The median number of organ support-free days was 0 (IQR, -1 to 16) in the convalescent plasma group and 3 (IQR, -1 to 16) in the no convalescent plasma group. The in-hospital mortality rate was 37.3% (401/1075) for the convalescent plasma group and 38.4% (347/904) for the no convalescent plasma group and the median number of days alive and free of organ support was 14 (IQR, 3 to 18) and 14 (IQR, 7 to 18), respectively. The median-adjusted OR was 0.97 (95% credible interval, 0.83 to 1.15) and the posterior probability of futility (OR <1.2) was 99.4% for the convalescent plasma group compared with the no convalescent plasma group. The treatment effects were consistent across the primary outcome and the 11...

Forensic nurses are faced with unique challenges in their attempt to deliver nursing care in a custodial environment. * The impact of such challenges on the cultural dynamic of forensic nursing and consequently on healthcare delivery is largely unknown. * The aim of this ethnographic study was to explore the nursing culture within an Australian prison hospital and the migration of the culture over a 12-month period. * At the end of the study, the nursing culture was found to be one of hope, although with no clearly articulated vision of nurse-hood or patient-hood and model within which to practice nursing. * The ability to articulate practice is central to the development of mental health nursing in any context. Abstract Forensic nurses are faced with unique challenges in their attempt to deliver nursing care in a custodial environment. The impact of such challenges on the cultural dynamic of forensic nursing and consequently on healthcare delivery is largely unknown. The aim of this ethnographic study was to explore the nursing culture within an Australian prison hospital and the migration of the culture over a 12-month period. At the end of the study the nursing culture was found to be one of hope, although with no clearly articulated vision of nurse-hood or patient-hood and model within which to practice nursing.

No abstract

The constant structural changes to the NHS in England have created instability and lack of job security within the public health workforce in the U.K. Since posts are linked to structures which keep changing, recent years have seen constant changes in titles, responsibilities and expectations. Effective public health practice involves teamwork across sectors and strong relationships with local communities, and this constant change has posed professional challenges. The changes in 2002 offered the Faculty of Public Health the opportunity to work with the Department of Health to consult with specialists, the main objective being to reach agreement on future roles and ways of working. The lessons learnt from this exercise are described here as they remain relevant as the structural changes continue. Key messages are that if the many opportunities of the current policy agenda are to be realized, the public health profession needs to be supported to play its full role in the three domains of practice: health improvement, health protection and developing better health services. This challenge needs professional bodies to be clear on expected competence of their members; employers to be clear on the potential contribution of public health specialists not only in promoting and protecting health in communities but also within the acute sector; organizational arrangements to be in place to sustain the capacity of the workforce whatever the structural changes occurring. This lesson has yet to be learnt.

By focusing on the Masters of Public Health course, this study took a pragmatic approach to exploring the interface between public health education and public health practice. The commonly utilized 'three domains of practice' framework could provide a robust and explicit link between educational provision and practice for public health. This model provides the workforce, the university, the students and the potential funders of the course with an easily comprehensible framework for understanding how the modules of an MSc can support the development of competency within the context of practice.