Pharmacist involvement in the emergency department (ED) and early in a patient’s hospital stay improves clinical outcomes and reduces medication errors. Because EDs are high-pressure settings with limited pharmacist staffing, pharmacists cannot review every patient. Instead, they must focus on identifying and prioritising patients who may be at risk of potential medication-related harm. To establish and prioritise consensus-based medication management criteria to identify patients with potential medication-related harm within the ED setting for early pharmacist review. We used Nominal Group Technique (NGT) methodology to rank the most important criteria for identifying whether a patient’s presentation may be due to medication-related harm or whether they may be at risk of developing medication-related harm in the ED. Participants were purposively recruited ED clinicians including pharmacists, doctors and nurses who worked at the ED of either the Gold Coast University Hospital or Robina Hospital on the Gold Coast, Queensland, Australia, during May–June 2025. A total of 14 participants comprising six pharmacists, five nurses and three doctors participated in two 1-h NGT workshops. Participants ranked 12 criteria from a list of 34 during NGT Round 1. They subsequently ranked six criteria from the list of 12 during NGT Round 2. The weighted rankings of the criteria across both groups were combined to determine the top six criteria which were, in order from 1 to 6 (1 = most relevant): (1) medication-related admission or thinks medicine responsible for admission; (2) bleeding and falls; (3) poor historian (unable to provide reliable history)/suspected non-adherence or poor compliance; (4) carbidopa/levodopa (entacapone), co-beneldopa; (5) unverified medicines; and (6) medicines requiring therapeutic drug monitoring/medicines with narrow therapeutic index. The first four criteria were ranked within the top six in both NGT workshops. This study has provided a concise list of six medication-related criteria that expert consensus agreed were the most important for prioritising patients with potential medication-related harm. This forms the basis for the development of information gathering strategies to be incorporated into clinicians’ workflows early in patients’ ED journey.

BACKGROUND The use of complementary and alternative medicines (CAM) among people with cancer is prevalent both globally and in Australia. CAMs are medications, medical products and practices that are not part of conventional medical treatment. Some CAMs exert physiological or pharmacological effects, which may pose risks. This study focuses on pharmacologically active CAMs due to their greater potential for harm. AIM This pilot study evaluated an evidence-based complementary and alternative medicine (CAM) education program delivered digitally. The objectives were to conduct a preliminary assessment of the clarity and usability of the educational content, the feasibility of the digital delivery platform, and the suitability of the associated questionnaires, with the aim of informing future refinement and development of the program. METHOD The CAM education was piloted in two stages (n1=7, n2=7), each stage assessing differing aspects, with purposefully sampled aged and/or educationally matched participants. Participants completed the education module as well as a demographic, pre-and-post education questionnaires, the EORTC-QLQ-C30 survey, pre-and-post education CAM knowledge test and a pilot-study questionnaire. RESULTS & CONCLUSION Most stage one participants (57%) and all stage two participants (100%), who had access to the added functionality, indicated that the educational content and questionnaires were clear and easy to understand. Functionality issues with the mobile application were identified and will be addressed in the refinement. Lastly, Improvements on the participant post-education CAM knowledge test scores as well as positive feedback on the usefulness of the education offer preliminary evidence of engagement. The preliminary findings from this study will guide the refinement of the educational program and its delivery platform for future studies, however, are limited in generalisability due to the small sample size.

Background. The SARS-CoV-2 pandemic and accompanying public health measures disrupted the normal transmission of respiratory viral pathogens. Less is known about the effects on bacterial pathogens. Aims. To assess the impact of public health restrictions on common respiratory pathogens (influenza viruses, respiratory syncytial virus (RSV) and the following bacterial pathogens: Streptococcus pneumoniae (S. pneumoniae), Klebsiella pneumoniae (K. pneumoniae), Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus). Methods. This statewide cohort study used respiratory specimen result data from 237 health facilities in Queensland, Australia, collected between January 2018 and June 2021. Trends and weekly positive rates per 100 tests/cultures for weeks 11-27 (with 95% confidence intervals) were compared between pre-pandemic (2018/2019), early pandemic restrictions (2020), and easing of restrictions (2021) periods. Results. Over 260,000 viral PCRs and 180,000 cultures were analyzed. Decreases in influenza and RSV were observed in 2020 from 10.8 to 1.1 and 9.5 to 2.5 per 100 tests, respectively; S. pneumoniae decreased from 1.7 to 1.1 per 100 cultures. Influenza levels remained low until the end of the study period. There was no change in the detection of S. aureus or P. aeruginosa per 100 cultures, but cultures positive for K. pneumoniae increased from 1.2 in 2018/2019 to 1.8 in 2020 and 1.6 in 2021. After restrictions eased, RSV rates increased to levels higher than before the pandemic. Conclusions. Transmission of droplet-spread pathogens decreased after the introduction of public health restrictions due to the COVID-19 pandemic . The increase in K. pneumoniae, often associated with nosocomial infections, warrants further investigation. Crown Copyright (c) 2024 Published by Elsevier Inc. on behalf of Instituto Mexicano del Seguro Social (IMSS). This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)

BACKGROUND:Existing evidence underscores inappropriate antimicrobial prescribing and use in the community setting. Increased and inappropriate antimicrobial use are major factors contributing to the emergence and transmission of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programmes are critical for mitigating AMR, enhancing patient outcomes, and reducing healthcare costs. Despite the existing Australian National Action Plan on AMR, optimisation of antimicrobial use in the community setting remains inadequately investigated. This study explored health professionals' perspectives on community AMS practices and systems, identifying challenges and areas for improvement. METHODS:This qualitative study utilised semi-structured interviews to explore the perspectives of 17 different health professionals from diverse community practice settings in South-East Queensland, Australia. Interviews were audio-recorded, anonymised, and transcribed verbatim. Data were thematically analysed, with NVivo 12 utilised for organisation and analysis. Data were then mapped and examined using the Elements of Medicines Stewardship (EMS), which aligns with United States Centers for Disease Control and Prevention- Core Elements of Antibiotic Stewardship. This was reported following the consolidated criteria for reporting qualitative research checklist. RESULTS:Four main themes described the health professionals' insights on community AMS practices and systems. Thematic analysis from these findings reveals a state of ambiguity and fragmentation in the community AMS practices and systems. In comparison to the hospital-based AMS system, the Australian community AMS system appears to be in its nascent stages of development. Applying the EMS is essential for developing and implementing community AMS strategies to enhance practices and systems. CONCLUSION:The study identified key health system factors that impact the implementation of community AMS programmes and highlighted the need for developing community-specific governance and frameworks that integrate multidisciplinary strategies to support effective implementation and enhance patient outcomes. This research will inform community AMS intervention strategies, influencing policy and practice to advance sustainable healthcare and address antimicrobial resistance.

OBJECTIVES:To investigate the effects of acute coffeeberry extract ingestion on soccer-specific technical skill performance, sprint performance, high-intensity running capacity, and subjective perceptions of fatigue, energy, and alertness during a soccer match simulation in academy soccer players. DESIGN:Double-blind, randomised, placebo-controlled, crossover trial. METHODS:Twenty trained male soccer players completed two experimental trials (coffeeberry extract [300 mg] and placebo [flavour and colour matched] beverages), separated by 7-14 days. Each trial, conducted 1 h after ingestion of the test beverages, included a 45-min half soccer match simulation incorporating dribbling, sprinting, and passing tasks, followed 5 min later by a high-intensity running-to-fatigue protocol. Subjective measures (fatigue, mental/physical energy), physiological data (glucose, lactate), technical skills and running outcomes were assessed. Blood samples were analysed for chlorogenic acid and caffeine concentrations. RESULTS:Coffeeberry ingestion resulted in greater maintenance of passing speed (p < 0.01) and accuracy (p < 0.01) compared to placebo, most evident on short passes. No meaningful significant differences were observed in sprint performance, dribbling or running capacity. Subjective fatigue increased, and energy scores declined, similarly across trials. No difference was observed in blood glucose or lactate responses. No chlorogenic acid or caffeine was detected at quantifiable concentrations in plasma samples post-ingestion. CONCLUSIONS:Acute ingestion of coffeeberry extract improved select aspects of soccer skill performance, particularly short-passing speed/accuracy, in academy soccer players. These findings suggest a potential cognitive or neuromuscular mechanism, independent of metabolic effects. Further research is warranted to explore the time course of chlorogenic acid absorption and its potential mechanistic role in skill performance.

Internationally, hospital pharmacy support staff, assistants, and technicians can become credentialled for extended roles, yet opportunities are limited in Australia. Increasing need for training more responsive to the hospital pharmacy setting could be addressed via flexible, portable courses and micro‐credentials to promote rapid skill development without compromising productivity. This study aimed to explore the feasibility of collaborative co‐production of a micro‐credential for an extended support staff role. Hospital clinicians and university researchers collaborated to identify training priorities and then co‐developed and piloted a micro‐credential with key stakeholders, including support staff as end‐users. A working group and semi‐structured stakeholder interviews identified prescription accuracy checking, history taking, and counselling of selected medicines as training priorities. Prescription accuracy checking was nominated for initial development as a micro‐credential. The Nominal Group Technique (NGT) was employed with three groups (working group, pharmacists, and support staff) to generate and prioritise ideas for content and assessment. A total of 108 individual ideas were generated from the NGT (working group [ n = 44], pharmacists [ n = 39], and support staff [ n = 25]). Technical knowledge, workflow processes, competency assessment, risk management, and mentorship were prioritised. A micro‐credential comprising five topics, assessment, and supervised staff checking was piloted from January–February 2024. Participating support staff engaged well with checking inpatient, outpatient, and discharge prescriptions, reporting translation of greater vigilance in their checking process to routine dispensing, and expressed optimism about a structured career pathway. Pharmacists were confident in staff checking accuracy and receptive to extended roles for support staff. Collaborative micro‐credential co‐production was considered feasible, providing a template for future credentialling to meet emerging workforce needs. Ethical approval was granted by the Metro South Health Human Research Ethics Committee (Reference no: HREC2021/QMS/73248) and the Griffith University Human Research Ethics Committee (Reference no: 2021/574) and the study conforms with the Australian National statement on ethical conduct in human research . Informed consent was obtained from all participants via distribution of a project information sheet and completion of a written consent form (paper or electronic). Participation was voluntary with an option for participants to withdraw at any stage without any explanation or penalty. Participants were given an option to participant in one or all the intervention arms (i.e. working group, NGT, interviews). Prior to the interviews or NGT, participants were briefed to ensure that they understood the project information sheet and consent form and asked if they wished to proceed. Participants were provided with incentives (AUD $30 grocery vouchers) for participating in interviews and focus groups outside of their usual work hours or if they were external to the health service.

Purpose. Healthcare students may lack the knowledge and confidence to apply research. This study evaluated the impact of immersion in student-academic co-creation and evaluation of a gamified resource on healthcare students’ research knowledge, and confidence. Method. A qualitative descriptive design was utilised. Student partners contributed to all aspects of design, implementation, and evaluation of the game. Students’ perceptions of this process were evaluated via a group interview and thematic analysis. Results. Six undergraduate students from five healthcare disciplines participated. Two overarching themes were identified. The first related to impacts of the immersion process on students’ own research knowledge and confidence, and the other to students’ perceptions of the collaborative process. The student-academic partnership provided rich learning opportunities that broadened students’ research knowledge, created value for their clinical practice and improved their confidence to undertake research. Partnership facilitators were clear communication, the student-led aspect, and access to academic expertise. Barriers included the time commitment, changing timelines and managing competing priorities. Conclusion. Students from multiple disciplines working in partnership with academics to co-create, implement, and evaluate a gamified resource to improve healthcare students’ research confidence, reported increased research knowledge facilitated by their multidisciplinary interactions. While this was an interesting outcome, the project relied on student volunteers, and participation did not contribute to course credit. Finding ways to provide outcomes for a greater number of students is a future focus

Many university students report anxiety and low confidence when undertaking research courses. In the field, healthcare professionals have further identified that new graduates lack basic research skills. The research aims were to (1) ascertain what research concepts were deemed challenging to inform the development of a gamified resource (named OGRE) and (2) to determine if the resource influenced students’ research attitudes, confidence, and knowledge. Adopting a mixed-method approach, four student group interviews were conducted and pre- and post-course surveys were embedded in two large research courses as measures. Additionally, the qualitative component of student evaluations from six courses served as secondary data. Descriptive statistical analysis and thematic analysis techniques were applied. Whilst students understood the relevance of research to practice, only a minority expressed enthusiasm for the topic. The game did not significantly impact on confidence to undertake research, nor could the increase in student knowledge be attributed to the game alone. Gamified resources can be helpful for visual learners and can assist students with ‘real-life’ applications to practice problems, but are not essential to achieve a course’s learning outcomes. Further multidisciplinary team scenarios could be incorporated in OGRE to enhance practice preparedness.

Medication-related harm (is a challenge globally and contributes to emergency department (ED) presentations. Accurate medication histories are essential to identify whether medication-related harm contributed to an ED presentation. The aim of this study was to explore the perspectives of ED clinicians on prioritising ED patients admitted due to potential medication-related harm. We conducted semi-structured qualitative interviews with purposively selected ED doctors, pharmacists, and nurses from a hospital and health service in Southeast Queensland, which includes both a tertiary and secondary ED. Participants were interviewed face-to-face May–July 2023. Interviews were guided by a piloted interview guide with seven open-ended questions focusing on clinicians’ views of medication management and prioritisation in suspected medication-related harm cases. Fifteen clinicians with varying ED experience levels were interviewed: five doctors, five pharmacists, five nurses. Average interview time was 19 min (9–44 min). Thematic analysis of the interview data identified two key themes and six subthemes related to the prioritisation of patients with suspected medication-related harm and the role of ED clinicians in medication management. ED clinicians used varied and inconsistent processes to identify and flag patients who were either admitted with or suffered potential medication-related harm during admission and identified a need for a strategic structured process. The value of ED pharmacists was highlighted by all non-pharmacist participants. Findings indicate that, in the absence of standardised prioritisation processes, ED clinicians rely heavily on individual clinical judgement. This underscores the need for the development of a tool specifically designed for the ED context to guide patient prioritisation.

AIM:COVID-19 has brought unprecedented challenges to the healthcare system. The rapid spread of the virus, laboratory burn-out, exhausted staff, diagnostic uncertainty and lack of guidelines cumulatively disrupted hospital antimicrobial stewardship (AMS) programs. This scoping review evaluated how the COVID-19 pandemic has impacted the implementation of AMS, particularly within the context of clinical audits. METHODS:An initial trend analysis was performed using a database search from 2000 to 2022. This review was developed following PRISMA-Scr guidelines. Databases such as Medline, Embase, Cochrane Library and CINAHL were searched using Medical Subject Headings and free text for 'Children', 'antimicrobial stewardship' and 'COVID-19'. Primary studies that reported data on antimicrobial use among hospitalised children during COVID-19 from December 2019 to December 2022 were considered. RESULTS:Paediatric AMS-related research output changed annually by -4.94% in 2022 compared to 14.44% in 2019. Of 677 articles, 15 were included, with 3 added through snowballing technique. All the studies were observational and from countries of all income levels. A quantitative measure of antibiotic use was the commonly assessed sub-category of AMS, while three studies performed the audit for a reason for antibiotic use, microbiological cultures, and surgical prophylaxis. Most studies reported antimicrobial use as prevalence, while two reported the days of therapy, and two used the AWaRe classification and the antibiotic spectrum index (ASI). CONCLUSIONS:Paediatric AMS activities were disrupted during the COVID-19 pandemic. A basic quantitative measure of antibiotic use was the only measure of assessment, with other AMS components unreported. A robust paediatric-focused AMS resilient to future pandemics and evidence-informed stewardship approach is needed.

BACKGROUND:Antimicrobial resistance (AMR) is a global health warning that increases mortality, morbidity, and medical expenses. Effective AMR surveillance is essential to guide interventions and maintain treatment efficacy. While AMR surveillance is studied in various healthcare settings, data sources in primary care settings need to be evaluated. AIM:To identify the value of utilizing AMR surveillance data in primary care settings to inform community antimicrobial stewardship (AMS) practices. METHODS:Eligibility criteria included primary studies, randomized and nonrandomised controlled trials, observational studies, surveys, qualitative studies, mixed-method studies, and grey literature in primary care published worldwide from 2001 to 2024. RESULTS:Our review of 21 included studies emphasized the significance of utilizing AMR surveillance data to enhance clinical care. Clinicians need to better understand the local AMR pattern when prescribing primary care antibiotics. Despite limitations, educational interventions can change prescribing behaviour. AMR increased because local susceptibility data frequently did not inform empirical antibiotic treatment. Digital and geospatial platforms could enhance surveillance with institutional support and standardized data integration. CONCLUSION:This analysis highlights the need for user-friendly, real-time, and easily accessible data visualization platforms to improve AMR surveillance and AMS in primary care. Addressing data accessibility and providing training and education are crucial elements. Standardising data and utilizing digital technologies can improve decision-making and antibiotic prescribing. These elements must be incorporated into a consistent and adaptive plan for effective AMS interventions and public health outcomes.

This chapter explores the use of eXtended reality (XR) technologies in the context of learning and teaching, focusing on how these technologies can be used to create immersive and meaningful educational experiences. Using specific projects, including virtual and augmented reality in pharmacy education, layered augmented reality for participant learning and bespoke environments for simulation, we demonstrate the potential of XR to enhance learning and promote deeper understanding and engagement with complex tasks and nuanced concepts. Whilst discussing these projects we also introduce a broader philosophical exploration of the 'Metaverse', examining the ways in which XR technologies are contributing to the emergence of new digital realities that are interwoven with physical experiences, transforming the way we interact with virtual and physical spaces, with avatars, and with information deployed in augmented, virtual, and mixed reality experiences. We argue that by exploring a multiplicitous notion of the metaverse, pedagogical design has the potential to benefit the way we learn and teach. The projects discussed in this chapter demonstrate how technological affordance can support design research methodology in the creation and deployment of XR experiences, for immersive, engaging, and effective educational experiences for academic purpose, and for the lifelong learning of a general audience.

Background Antimicrobial resistance is emerging as one of the most potentially disastrous threats of the 21st century. Pseudomonas aeruginosa (P. aeruginosa) is a leading resistant pathogen and is clinically significant due to its limited available treatment using antibiotics. Rising resistance of P. aeruginosa is of increasing concern and it is currently listed as one of the top three critically resistant pathogens by the World Health Organization. It is currently known that resistance in P. aeruginosa is significantly linked with the consumption of all antibiotics, making usage surveillance of particular concern. Aim The aim of the current study was to model current and future antibiotic usage using available prescription data for antipseudomonal antibiotics. Method A time-series analysis was performed on Pharmaceutical Benefits Scheme/Repatriation Pharmaceutical Benefits Scheme data from January 2000-June 2020 using Facebook Prophet time-series methods in Python 3.9.14 to analyse and forecast trends to 2025. Ethical approval was not required for this research article as it used publicly available data and did not involve human subjects. Results The usage of antipseudomonal antibiotics decreased by 14.3% from 2014 to 2020 (95% confidence interval [CI] -30.4% to 2.3%) and is projected to further decrease by 11.7% by 2025 (95% CI -30.6% to 7.3%). Conclusion The current study showed a decline in the use of certain antipseudomonal antibiotics in Australia since 2015 and projects that their use will continue to decline. This is likely due to an increased judicious use of these antibiotics.

Depression is a complex neurological disease that holds many theories on its aetiology and pathophysiology. The monoamine strategy of treating depression with medications to increase levels of monoamines in the (extra)synapse, primarily through the inhibition of monoamine transporters, does not always work, as seen in patients that lack a response to multiple anti-depressant exposures, as well as a lack of depressive symptoms in healthy volunteers exposed to monoamine reduction. Depression is increasingly being understood not as a single condition, but as a complex interplay of adaptations in various systems, including inflammatory responses and neurotransmission pathways in the brain. This understanding has led to the development of the neurodegenerative hypothesis of depression. This hypothesis, which is gaining widespread acceptance posits that both oxidative stress and inflammation play significant roles in the pathophysiology of depression. This article is a review of the literature focused on neuroinflammation in depression, as well as summarised studies of anti-inflammatory and antioxidant effects of antidepressants.

Plants of the genus Terminalia are used in multiple traditional medicine systems globally, including in southern Africa. Whilst scientific studies have confirmed the therapeutic properties of some Terminalia species, other species remain relatively overlooked. This study examines the antibacterial properties of Terminalia phanerophlebia Engl. & Diels (TP) and Terminalia sambesiaca Engl. & Diels (TS) leaf extracts, and their ability to potentiate selected conventional antibiotics against antibiotic-sensitive and antibiotic-resistant pathogens. The antibacterial activities of the extracts and reference antibiotics were screened using disc diffusion assays and quantified using liquid microdilution MIC assays. The methanolic and aqueous TP and TS leaf extracts inhibited the growth of S. aureus, E. coli and K. pneumoniae, including MRSA and ESBL antibiotic-resistant strains, producing zones of inhibition on agar of 13-15 mm, and minimum inhibitory concentration values of 182-1500 mu g/mL in most cases. Notably, the extracts inhibited MRSA growth with a similar efficacy to that observed against the susceptible S. aureus strain (133-265 mu g/mL). Combining the extracts with tetracycline and chloramphenicol had substantially greater antibacterial activity than for either component alone, indicating that extract components block bacterial resistance mechanisms. In contrast, the extracts antagonised the activity of ciprofloxacin against some of the bacterial species. Extract toxicities were assessed using Artemia nauplii toxicity bioassays and were all found to be nontoxic. Additionally, Orbitrap LC-MS was used to identify and highlight noteworthy compounds in the extracts. Non-targeted LC-MS analysis revealed the presence of several noteworthy compounds, including tannins and flavonoids. Our findings suggest that the TP and TS extracts show promise for antibacterial drug development. Further study is warranted to elucidate their antibacterial and potentiating mechanisms. (c) 2024 The Author(s). Published by Elsevier B.V. on behalf of SAAB. This is an open access article under the CCBY license (http://creativecommons.org/licenses/by/4.0/)

Background This scoping review examined the concept and scope of appropriateness of antimicrobial prescribing in the community setting and how it has been measured.Methods Utilizing the Joanna Briggs Institute's methodology, we appraised peer-reviewed articles and unpublished studies, focusing on the US, UK, Canada, and Australia, with no limit to date.Results Four basic components of antimicrobial prescribing to be evaluated during assessment of antimicrobial appropriateness in the community setting were identified: diagnosis for infection or indication for antimicrobial therapy, choice of antimicrobial therapy, dosing, and duration of therapy. The benchmark for definition of appropriateness is crucial in assessing antimicrobial prescribing appropriateness. The use of recommended guidelines as a benchmark is the standard for appropriate antimicrobial therapy, and when necessary, susceptibility testing should be explored.Conclusions Studies evaluating the appropriateness of antimicrobial prescribing should assess these components of antimicrobial prescribing, and this should be clearly stated in the aim and objectives of the study.

Pulmonary drug delivery does not only provide non-invasive therapy for local lung diseases but also remarkably enhances systemic absorption of therapeutics owing to the tremendous surface area of the lung and fast transport of active molecules across the respiratory epithelia. In comparison to traditional delivery systems, electrohydrodynamic atomisation (EHDA) is superior in terms of size and production rate control but the high surface charges of resulting particles prohibit its use in drug delivery. To overcome this challenge, we developed an in-flight electro-neutralisation electrospray (IFENE) method which enables the generation of mists of particles in respirable size range with little to no charge. Our approach uses low-frequency alternating current (AC) to produce charge-neutralised sprays with initial velocity due to oppositely charged droplets combination. Experiments and simulations with pure liquid as the working solution were conducted to reveal the underlying mechanism. The applied frequency is found to be the main factor that influences spray stability and formation. Poly (vinylidene fluoride) (PVDF) and PVDF with curcumin solution were electrosprayed via IFENE, producing sprays of organic particles with controlled sizes and neutralised charges. The capability of coupling particle generation in the respirable size range (below 5 μm) and charge reduction (under 400 femtoamperes), along with its simple setup makes IFENE a promising platform technology in inhalation drug delivery.

Abstract The SARS-Coronavirus-2 pandemic disrupted normal transmission of many viral respiratory pathogens. We analysed a state-wide dataset of microbiological results from public hospitals in Queensland, Australia. Following declaration of the pandemic and subsequent non-pharmaceutical interventions (NPIs), we observed decreases in influenza and respiratory syncytial virus (RSV) consistent with other studies. However, upon easing intrastate border and crowd gathering restrictions, RSV levels surged to unseasonally high levels; influenza levels did not. Among bacterial pathogens, we observed a decrease in detection of S. pneumoniae of 35% (95% confidence interval: 22% to 47%). No change in detection of S. aureus or P. aeruginosa per 100 cultures was evident, but cultures positive for K. pneumoniae increased from 1.21 (1.10-1.32) per 100 cultures pre-pandemic to 1.80 (1.58-2.02) in 2020 and 2021. We suggest that early NPIs limited transmission of all droplet-spread pathogens. However, later less-restrictive NPIs allowed RSV, (with a reproductive number greater than influenza or the Delta strain of SARS-CoV-2 but lower than the Omicron strain), to re-emerge. The increase in K. pneumoniae, commonly implicated in hospital-acquired infections, requires further investigation.

Background: During the 2020 iteration of a Bachelor of Nursing Clinical Health Assessment skills course delivered in Singapore, the sudden cancellation of all face-to-face classes due to the pandemic resulted in innovative strategies being quickly created to enable students to successfully complete Objective Structured Clinical Examinations online. However, the realism of the experience was rudimentary. After exploration of a range of technologies, a mixed reality (interactive virtual patient) application was developed within the Microsoft Power Apps platform, implemented and evaluated for the 2022 iteration of the Clinical Health Assessment course.Methods: A mixed methods exploratory design was used with quantitative and qualitative data collected regarding student performance and user experiences.Results: The data suggested positive user experiences, with 60% feeling the application involved them and 80% reporting consistency with real-world experiences. Students’ assessment item results from the 2022 iteration were also compared to previous iterations of the course and showed comparative alignment across the ranges of marks.Conclusion: The mixed reality (interactive virtual patient) application provided a realistic and interactive user experience as well as an effective means of online clinical skills assessment.