PurposeThis technical paper aims to define the steps necessary to create an effective two‐dimensional image databases representing three‐dimensional museum objects for the purpose of instruction.Design/methodology/approachThe participating institutions reviewed six key types of services: finding content, collecting content, accessing content, documentation, accessibility, and access control. The project created, converted, described and transferred digitized images and data records from each partner to the web where they became universally accessible through a single common search interface.FindingsThe paper finds that collaboration between different institutions creates rich collections, and relationships that benefit the community.Research limitations/implicationsCapturing elements of three‐dimensional objects in a traditionally two‐dimensional medium provides unique challenges for web delivery.Practical implicationsProvides learning materials and access to objects that were once locked in storage and rarely exhibited, especially fragile and delicate objects. Also provides an environment for students to learn how to work professionally they would not acquire in the classroom.Originality/valueNew techniques in digitization were used and experimented with that are not widely used with these type of collections.

Continuous parenteral hydromorphone is used to treat pain in palliative care. Case reports have suggested that neuroexcitatory symptoms, such as agitation, myoclonic activity, and even seizures may occur during administration. However, little information exists on the incidence of these side effects or their relationship to the dose or duration of parenteral hydromorphone. A retrospective chart review was performed on 48 terminally ill hospice patients who received continuous parenteral hydromorphone for pain control. Chart reviews were conducted searching for three neuroexcitatory symptoms: agitation, myoclonus, and seizures; the incidence and relationship of these symptoms were statistically compared to the maximal dose and number of days on continuous parenteral hydromorphone. We found that agitation, myoclonus, and seizures were not associated with the patients gender, age, or diagnosis but found that agitation was associated (p < 0.01) in patients with known metastatic disease. Agitation, myoclonus, and seizures were independently associated with the maximal dose (p < 0.05, p < 0.001, and p < 0.05) and with the duration (p < 0.01, p < 0.05, and p < 0.01) of continuous parenteral hydromorphone A possible mechanism for these findings is hydromorphone-3-glucoronide, a metabolic product of hydromorphone, which has been implicated in neuroexcitatory symptoms in laboratory investigations.

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A lthough an essential communication skill, listening does not receive the same attention as speaking. As an often-required class, project or professional event, public speaking takes center stage. A person can experience a range of emotions associated with telling their story including shame, anxiety, and frustration but, depending on how they're being listened to, they may also experience validation, understanding, and empathy. The experience of being listened to and, more to the point, feeling heard can help reduce conflict, decrease physical pain, and foster emotional healing. At times, assuming the posture of listener can feel strenuous. Listening requires conscious effort and focused attention. However, listening serves as a powerful means of learning and connecting emotionally with others. Professionals in the healthcare industry would do well to recognize the positive impact that their nonjudgmental listening presence can provide. Through listening, a group may heal, learn, evolve, and achieve. 1 For the individual, research confirms that ''the lived experience of being listened to [is] fundamental to quality of life and health.'' 2 And physician listening serves as ''a healing and therapeutic agent'' for patients. 3 One's own narrative material serves as the initial source of the idea of self. However, the idea of self more fully emerges as a socially constructed concept created and recreated in the art of communication with the other. 4 This occurs within the second person space, or the space between the storyteller, or self, and story listener, or other. 5 In the second person space, the story listener's role becomes more significant, for strengthening the power of the story, alternatively aiding the teller in releasing, rearranging, replacing, or reframing a new one, 6 and recognizing the learning that may emerge from the story.

BackgroundUnnecessary testing is a problem-facing healthcare systems around the world striving to achieve sustainable care. Despite knowing this problem exists, clinicians continue to order tests that do not contribute to patient care. Using behavioural and implementation science can help address this problem. Locally, audit and feedback are used to provide information to clinicians about their performance on relevant metrics. However, this is often done without evidence-based methods to optimise uptake. Our objective was to improve the appropriate use of laboratory tests in the ED using evidence-based audit and feedback and behaviour change techniques.MethodsUsing the behaviour change wheel, we implemented an audit and feedback tool that provided information to ED physicians about their use of laboratory tests; specifically, we focused on education and review of the appropriate use of urine drug screen tests. The report was designed in collaboration with end users to help maximise engagement. Following development of the report, audit and feedback sessions were delivered over an 18-month period.ResultsData on urine drug screen testing were collected continually throughout the intervention period and showed a sustained decrease among ED physicians. Test use dropped from a monthly departmental average of 26 urine drug screen tests per 1000 patient visits to only eight tests per 1000 patient visits following the initiation of the audit and feedback intervention.ConclusionAudit and feedback reduced unnecessary urine drug screen testing in the ED. Regular feedback sessions continuously engaged physicians in the audit and feedback intervention and allowed the implementation team to react to changing priorities and feedback from the clinical group. It was important to include the end users in the design of audit and feedback tools to maximise physician engagement. Inclusion in this process can help ensure physicians adopt a sense of ownership regarding which metrics to review and provides a key component for the motivation aspect of behaviour change. Departmental leadership is also critical to the process of implementing a successful audit and feedback initiative and achieving sustained behaviour change.