Objectives To establish the acceptability and feasibility of collecting daily patient-generated health data (PGHD) using smartphones and integrating PGHD into the electronic health record, using the example of RA. Methods The Remote Monitoring of RA smartphone app was co-designed with patients, clinicians and researchers using qualitative semi-structured interviews and focus groups, including selection of question sets for symptoms and disease impact. PGHD were integrated into the electronic health record of one hospital and available in graphical form during consultations. Acceptability and feasibility were assessed with 20 RA patients and two clinicians over 3 months. A qualitative evaluation included semi-structured interviews with patients and clinicians before and after using the app, and audio-recordings of consultations to explore impact on the consultation. PGHD completeness was summarized descriptively, and qualitative data were analysed thematically. Results Patients submitted data on a median of 91% days over 3 months. Qualitative analysis generated three themes: RA as an invisible disease; providing the bigger picture of RA; and enabling person-centred consultations. The themes demonstrated that the system helped render patients’ RA more visible by providing the ‘bigger picture’, identifying real-time changes in disease activity and capturing symptoms that would otherwise have been missed. Graphical summaries during consultations enabled a more person-centred approach whereby patients felt better able to participate in consultations and treatment plans. Conclusion Remote Monitoring of RA has uniquely integrated daily PGHD from smartphones into the electronic health record. It has delivered proof-of-concept that such integrated remote monitoring systems are feasible and can transform consultations for clinician and patient benefit.

Ideally, a measure of the security of a system should capture quantitatively the intuitive notion of 'the ability of the system to resist attack'. That is, it should be operational, reflecting the degree to which the system can be expected to remain free of security breaches under particular conditions of operation (including attack). Instead, current security levels at best merely reflect the extensiveness of safeguards introduced during the design and development of a system. Whilst we might expect a system developed to a higher level than another to exhibit 'more secure behaviour' in operation, this cannot be guaranteed; more particularly, we cannot infer what the actual security behaviour will be from knowledge of such a level. In the paper we discuss similarities between reliability and security with the intention of working towards measures of 'operational security' similar to those that we have for reliability of systems. Very informally, these measures could involve expressions such as the rate of occurrence of security breaches (cf rate of occurrence of failures in reliability), or the probability that a specified 'mission' can be accomplished without a security breach (cf reliability function). This new approach is based on the analogy between system failure and security breach. A number of other analogies to support this view are introduced. We examine this duality critically, and have identified a number of important open questions that need to be answered before this quantitative approach can be taken further. The work described here is therefore somewhat tentative, and one of our major intentions is to invite discussion about the plausibility and feasibility of this new approach.

New graduate registered nurses (NGRN's) have an expectation of clinical support as they make the transition from novice to advanced beginner. In this 2008-2009 study of three rural transition to practice programs we found that clinical support did not eventuate. Consequently, NGRN's reported feeling underprepared for practice, overwhelmed by responsibility and often abandoned. Against this background, many were concerned that their inexperience had implications for safe patient care. Graduate nurse transition programs need to have the physical and human resources necessary to deliver the clinical support as promised in their prospectus, to ensure patient safety. This grounded theory study identified three essential core elements - leadership support, clinical supervision, and effective interprofessional relationships. Recommendation is made to address these deficits by mandating their inclusion in all transition to professional practice programs.

BackgroundNursing students will graduate into stressful workplace environments and resilience is an essential acquired ability for surviving the workplace. Few studies have explored the relationship between resilience and the degree of innate dispositional mindfulness, compassion, compassion fatigue and burnout in nursing students, including those who find themselves in the position of needing to work in addition to their academic responsibilities.AimThis paper investigates the predictors of resilience, including dispositional mindfulness and employment status of third year nursing students from three Australian universities.DesignParticipants were 240 undergraduate, third year, nursing students. Participants completed a resilience measure (Connor–Davidson Resilience Scale, CD‐RISC), measures of dispositional mindfulness (Cognitive and Affective Mindfulness Scale Revised, CAMS‐R) and professional quality of life (The Professional Quality of Life Scale version 5, PROQOL5), such as compassion satisfaction, compassion fatigue and burnout.MethodAn observational quantitative successive independent samples survey design was employed. A stepwise linear regression was used to evaluate the extent to which predictive variables were related each to resilience.ResultsThe predictive model explained 57% of the variance in resilience. Dispositional mindfulness subset acceptance made the strongest contribution, followed by the expectation of a graduate nurse transition programme acceptance, with dispositional mindfulness total score and employment greater than 20 hours per week making the smallest contribution. This was a resilient group of nursing students who rated high with dispositional mindfulness and exhibited hopeful and positive aspirations for obtaining a position in a competitive graduate nurse transition programme after graduation.