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The incidence of head and neck cancer (HNC) is rising globally, with patients undergoing extensive surgical resection for advanced disease frequently requiring prophylactic tracheostomy to secure the airway in the early postoperative period. Specialised HNC nurses undertake extended scope tracheostomy procedures, including tube changes and decannulations, yet practice varies widely between institutions and no standardised training framework exists.
To benchmark the roles and responsibilities of specialised HNC nurses in tracheostomy management across Australia, and to explore the facilitators, barriers and enablers of nurse-led extended practice.
National mixed-methods study.
An online REDCap questionnaire was distributed to nurses with inpatient HNC tracheostomy experience within the past 5 years (n = 22). A subset participated in semi-structured interviews (n = 11), analysed using inductive thematic analysis.
Most participants were senior metropolitan-based nurses with over 12 years of HNC experience. Nine (41%) performed tracheostomy tube changes and 14 (64%) conducted decannulations. Thematic analysis identified six themes: the central role of the multidisciplinary team; education and patient support; training and skill acquisition; extended scope of practice; challenges to nurse-led management; and benefits of nurse-led management. Skill acquisition was facilitated by mentoring and high-volume exposure; barriers included collegial resistance, equipment access and workload pressures.
Specialised HNC nurses report undertaking extended scope tracheostomy procedures across a range of Australian centres, with mentoring, high-volume clinical exposure and multidisciplinary collaboration described as key enablers. Standardised competency frameworks may help to reduce inter-institutional variation; however, the safety, efficiency and patient-level outcomes of these models were not directly evaluated in this study and warrant formal investigation in future research.
This study provides the first national descriptive data on the role of nurses in tracheostomy management for patients with HNC in Australia and offers a foundation for the development of standardised training pathways. The potential impact of such pathways on efficiency, length of stay and nursing workforce capacity warrants formal evaluation in future studies.
To quantify the clinical burden and healthcare resource use (HCRU) associated with difficult-to-treat (D2T) rheumatoid arthritis (RA) compared with non-D2T RA and evaluate clinical characteristics and factors associated with D2T RA as well as treatment patterns in Japan.
Longitudinal, retrospective observational study using electronic medical record data from 1992 to 2024 and a physician survey administered between November 2022 and November 2025.
A single academic medical centre real-world clinical practice setting in Japan.
A total of 1581 patients with RA were included.
The primary outcome measures were the comparisons of clinical burden and HCRU in the D2T RA group compared with the non-D2T RA group. D2T RA status was defined according to the European Alliance of Associations for Rheumatology definition. Clinical burden included disease activity, physical function, patient-reported outcomes, serological markers and renal function. HCRU included outpatient visits and hospitalisations evaluated over 12-month, 24-month and 36 month windows pre-index using overlap weighting and regression models. Factors associated with D2T RA status were evaluated using logistic regression. Treatment patterns were reconstructed longitudinally as lines of therapy across biologic and targeted synthetic disease-modifying antirheumatic drugs.
Among 1581 patients with RA, 102 (6.5%) met the D2T criteria. Treatment trajectories showed earlier escalation and frequent switching across biologic and targeted synthetic disease-modifying antirheumatic drugs in the D2T RA group. The D2T RA group had modestly elevated outpatient visit rates (rate ratio 1.08–1.09) and were more likely to be hospitalised (OR 4.35–6.12) than the non-D2T RA group. Factors associated with D2T RA included RA onset at age
In this real-world Japanese cohort, D2T RA was associated with higher disease burden and HCRU, particularly hospital-based care. Earlier identification and targeted management of D2T RA may help reduce the overall clinical and healthcare burden in RA.
The relationship between clomiphene citrate (CC) dosing regimens and adverse reproductive outcomes has not been fully elucidated, both with and without use of in vitro fertilisation (IVF). We aimed to study the association between cumulative CC dose and perinatal outcomes among fresh autologous IVF cycles.
Retrospective cohort study.
We included all fresh autologous IVF embryo transfer cycles performed in the US fertility clinics during 2004–2021 using CC for ovulation induction. We used robust Poisson regression models to estimate adjusted risk ratios (aRRs) and 95% CIs for associations between four categories of CC dose (
21 004 fresh autologous embryo transfer cycles using CC.
The primary outcome measures included biochemical pregnancy, clinical pregnancy, spontaneous abortion, stillbirth, live birth, multiple birth and preterm delivery.
Among fresh autologous embryo transfer cycles using CC, 21.3% used
Our findings extend previous findings on the association between CC exposure and adverse perinatal outcomes by demonstrating a dose-dependent relationship.
To evaluate adult palliative and end-of-life care provision in England by community health nursing services using a national dataset (2013–2024) to report patterns in service provision over time and a regional dataset (2022/23, 2023/24 and 2024/25) to describe palliative and end-of-life care activities.
Secondary analyses of existing national and regional datasets.
We used national data to evaluate the populations served; workforce; referrals; unique service users seen annually; contacts; time on caseload; care delivered/care locations; support to other teams/processes; and deferred care. Regional data was used to examine palliative and end-of-life care activities in the context of all nursing care delivered.
Nationally, referrals to community health nursing services increased steadily from ~4,000 to ~6,000 per 100,000 weighted population between 2013 and 2024, while unique service users remained stable (around 2,600–2,800). Median average time on caseload reduced markedly from over 150 days to around 50 days, despite stable contact frequency (median 23 total contacts per service user) and duration (median 28 min for face-to-face contacts). Regional data showed that palliative and end-of-life care consistently accounted for 9.6% of all community nursing clinical time (30–32 h per 1,000 population annually) across 3 years, even as total care hours declined. A disproportionate amount of palliative and end-of-life care occurred out-of-hours.
Increasing referrals and shorter time on caseloads indicate a system under pressure. Time spent on palliative and end-of-life care by community health nursing teams has remained stable over time, despite growing population need. Workforce capacity, skill mix and out-of-hours provision need to align to support high-quality, person-centred care in the community.
This evidence informs better planning to ensure sufficient provision and workforce in community health nursing.
Patients, family carers and public members contributed to interpreting findings and implications for practice.
Rising demand for emergency care in England is a continuing challenge driven by population ageing and increasing multimorbidity. Ambulatory emergency care (AEC) refers to the provision of same-day acute care for patients who might otherwise require admission. However, the contribution of AEC conditions to demand remains unclear. This study aimed to examine the proportion and nature of patients attending emergency departments (ED) with AEC-related conditions and to describe variation between hospitals in attendances and emergency admissions for AEC conditions.
A retrospective study of routine data from 21 acute hospitals in England, including adult ED attendances and emergency admissions between 1 November 2021 and 31 October 2022. We used a federated approach to ensure data security, applying established AEC definitions to explore variation by age, socioeconomic status and length of stay.
Primary: Proportion of (i) ED attendances and (ii) emergency admissions for AEC conditions. Secondary: (i) Proportion of patients presenting at ED with an AEC condition who were admitted; (ii) proportion of emergency admissions with an AEC condition with a length of stay
We analysed 1 513 480 attendances (median per hospital: 73 125) and 660 105 admissions (median per hospital: 30 425). AEC accounted for 29.6% of attendances and 40.8% of admissions, with substantial inter-hospital variability. Patients aged ≥65 were more likely to present with an AEC, while patients from deprived areas had lower rates. Among AEC-related admissions, 49.3% had a stay of less than 2 days.
Nearly one-third of attendances and two-fifths of admissions were for conditions potentially manageable in AEC or community settings. Variation between hospitals suggests local factors, including service configuration and primary care access, may influence avoidable acute care use. These findings suggest a need for a more nuanced understanding of the drivers behind AEC, or SDEC Services, to better understand their impact on reducing hospital admissions. Analysing these patterns may inform interventions to reduce avoidable hospital utilisation. Further research is needed to identify drivers of variation and to develop scalable strategies for prevention.
To evaluate diagnostic equity, feasibility and acceptability of a remote photoplethysmography-based blood pressure screening application among adults with darker skin tones in Nigeria.
Prospective observational multisite field evaluation.
Three hospitals in Kebbi State, Nigeria.
Adults with Fitzpatrick skin types V–VI.
Feasibility, agreement, diagnostic accuracy, acceptability, and equity relevant factors including facial tribal markings and internet bandwidth, using automated cuff measurements as the reference standard and a 140 over 90 mm Hg hypertension threshold.
Among 306 enrolled participants, 249 (81.4%) produced usable readings. Agreement was poor (systolic mean absolute error (MAE) 15.4 mm Hg, root mean square error (RMSE) 19.9; diastolic MAE 10.9 mm Hg, RMSE 13.6). Sensitivity for threshold-based systolic and diastolic blood pressure classification was very low (systolic 0.04; diastolic 0.10), with systolic sensitivity 0.00 in Fitzpatrick type VI. Specificity was high (systolic 0.99; diastolic 0.89). Lower internet bandwidth correlated with reading failure (r = –0.69 to –0.51). While 70% of patients and over 90% of staff rated the tool favourably, technical limitations created a clear perception–performance gap. In an exploratory interaction analysis, Fitzpatrick type VI was associated with higher odds of measurement failure (OR 5.08, 95% CI 2.41 to 10.72), but there was no clear evidence that facial tribal markings modified this association (interaction OR 0.66, 95% CI 0.16 to 2.73; p=0.564).
Remote photoplethysmography (rPPG)-based blood pressure screening was feasible but showed inadequate performance in this darker-skinned field cohort, with critically low sensitivity. Without algorithmic recalibration for skin tone diversity and improved offline functionality, cloud-dependent rPPG systems deployed without spectrum-balanced validation may risk exacerbating diagnostic inequities in similar settings.
The Mental health care: Adverse Sequelae of COVID-19 study aimed to (1) compare the consequences of the COVID-19 pandemic for mental health services and people with pre-existing mental health conditions (MHCs) in six low- and middle-income countries and (2) identify good practice to mitigate these impacts.
An observational study, using a mixed-methods convergent design triangulating data from (1) semistructured interviews or focus groups and/or a self-completed survey, (2) routine service utilisation data, (3) local grey literature and (4) expert consultation.
The study was conducted in Chile, Ethiopia, Georgia, Nigeria, South Africa and Sri Lanka.
121 key informants.
We found clear evidence in all sites that the pandemic exacerbated pre-existing disadvantages experienced by people with MHCs and led to a deterioration in the availability and quality of care, especially psychosocial care. Alongside increased vulnerability to COVID-19, people with MHCs faced additional barriers to accessing prevention and treatment interventions compared with the general population. To varying extents, sites showed accelerated implementation of digital technologies, but with evidence of worsening inequities in access. In sites where primary care-based mental healthcare was more developed or prioritised, systems seemed more resilient and adaptive.
Our findings have the following implications. First, these mental health service reductions are clear examples of ‘structural stigma’, namely policy level decisions in healthcare which place a low priority upon services for people with MHCs. Second, integration of mental healthcare into all general healthcare settings is key to ensuring accessibility and parity of physical and mental healthcare. Third, digital innovations should be designed to strengthen and not fragment health systems. We discuss these findings in terms of anticipating such challenges for future pandemics and preparing layers of resilience.
Diabetic foot ulceration (DFU) contributes significantly to diabetes-related morbidity and amputation. In Barbados, where amputation rates are among the highest globally, the influence of socioeconomic factors on ulceration outcomes remains underexplored. Educational attainment, a social determinant of health, may influence health behaviours, engagement with healthcare services, and ultimately clinical outcomes. This study examines whether educational attainment is associated with diabetic foot ulcer severity, as measured by the SINBAD scoring system, and six-week healing outcomes among inpatients with DFU. A prospective observational study was conducted over 6 months at Barbados' sole public hospital. A total of 176 participants admitted with a diagnosis of DFU were recruited. Baseline demographics, comorbidities, and ulcer characteristics were collected, and SINBAD scores were determined. Random forest modelling was employed to evaluate predictors of complete healing at 6 weeks and to assess ulcer severity stratified by educational attainment. Of the cohort, 17.5% reported primary education as their highest attainment level, compared with 2.9% of the general adult population. The mean SINBAD score was 2.45 among those with primary education and 2.51 among those with secondary education (p > 0.05). No statistically significant association was found between educational attainment and healing outcomes at 6 weeks. Educational attainment in this inpatient DFU cohort was lower than that of the general Barbadian population; however, it was not significantly associated with ulcer severity or six-week healing outcomes. In a universal healthcare setting, equitable access to care may attenuate the effect of educational attainment on clinical outcomes. These null findings highlight the need for future adequately powered studies incorporating health literacy assessment and key clinical confounders. Nonetheless, the observed disparity in educational attainment among DFU inpatients suggests that foot health education initiatives should be designed to be accessible to individuals across all educational levels.
FreshRSS 