Conectar
by Claire L. Chan, Saskia Eddy, Jennie Hejdenberg, Ben Morgan, Heather M. Morgan, Gillian Lancaster, Clare Robinson, Sandra M. Eldridge
BackgroundThe National Institute for Health and Care Research accepts applications for pilot and feasibility studies to their Research for Patient Benefit (RfPB) programme. There has been limited work describing the design practices of these applications and funding status. Knowing some of the qualities which may contribute towards a pilot or feasibility study application successfully gaining funding could help researchers improve the quality of their applications. Therefore, this study describes the protocol for a review looking at the characteristics of funded and non-funded external pilot trial applications. In particular, the primary objective is to describe the planned sample size and sample size justifications.
MethodsThe study will be conducted on 100 applications from Competition 31–37 with a randomised feasibility design, identified and given access to us by RfPB where the lead applicant has consented. We will screen these applications to identify the external pilot trials, first looking through the titles and then the full text. Following this, we will extract data on information such as medical area, study design, objective(s), sample size, sample size justification, and funding outcome stage one and two. Validation will be performed on 20% of the data extracted; discrepancies will be resolved by discussion or a third reviewer will decide if there is no consensus. We will use descriptive statistics to summarise quantitative data, and will analyse qualitative data using thematic analysis. Findings will be summarised through discussion with the project contributors to produce a reader-friendly guidance document.
DiscussionThis work will provide a more complete picture of RfPB external randomised pilot and feasibility trials. The findings will assist researchers when planning their pilot trials, and could help improve the quality of submitted applications.
Protocol RegistrationOpen Science Framework protocol registration DOI: https://doi.org/10.17605/OSF.IO/PYKVG.
by Wenting Yan, Carmel L. Montgomery, Liz Dennett, Stephanie A. Chamberlain
BackgroundThe demographic landscape of Western countries has shifted to a more diverse one. Along with the trend of an aging population, a new problem has emerged, which is the increased linguistic diversity in the aging population in these countries. As people age and their care needs increase, they may not receive optimal care if they don’t speak the same language as their caregivers in long-term care facilities. Culturally and linguistically responsive long-term care services are important to ensure the best care for an aging population, but there is limited evidence in the literature on the scope and practice of these services. The objective of this scoping review is to map out the types of CLR programs in LTC settings and examine their core components and target populations.
MethodsThe Arksey and O’Malley framework, further developed by Levac and colleagues, will be employed in this scoping review. The research question was framed using the PCC framework. A comprehensive systematic search was developed with an experienced librarian and will be conducted in Scopus, CINAHL, Embase, Medline, PsycINFO, and Academic Search Complete. All primary study designs, including quantitative, qualitative, and mixed methods, will be included. Studies must focus on culturally and linguistically responsive care programs used or implemented in long-term care services. There will be no date or language limitations. Findings will be thematically synthesized to answer the research question.
ConclusionThis review protocol provides a transparent process for how it will be conducted. We aim to contribute to a better understanding of what culturally and linguistically responsive care programs exist, how cultural and linguistic responsiveness is currently addressed across diverse care environments, and what gaps remain in long-term care.
Acute pain following pulmonary surgery can affect the recovery process of patients. The use of intrathecal morphine (ITM) injections offers a long-lasting analgesic effect, but its clinical application remains controversial. This study aims to investigate the impact of combining bupivacaine with ITM injections on the quality of postoperative recovery in patients who have undergone pulmonary surgery.
This multicentre, randomised, double-blind, controlled trial will enrol 254 patients undergoing elective lung surgery, who will be randomly assigned in a 1:1 ratio to either group IT (receiving an intrathecal injection of 3 mg bupivacaine and 0.25 mg morphine before general anaesthesia induction) or the control group (C group). The primary outcome includes postoperative recovery quality on day 1 (quality of recovery, QoR-15), with secondary outcomes encompassing postoperative recovery quality on days 2 and 3 (QoR-15), pain scores within 72 hours postoperatively, analgesic rescue, intraoperative haemodynamic parameters, opioid consumption, postoperative adverse reactions, recovery metrics, complications, chronic pain incidence and sleep quality.
The results will be disseminated through peer-reviewed publications. This study protocol (V.2.0, 30 October 2024) involves human participants and has been approved by the Ethics Committee of Affiliated Hospital of Yangzhou University (number 2024-08-02-2), Taicang Hospital Affiliated to Soochow University (number 2025 SR-041) and Yichang Central People’s Hospital (number 2024-513-02). Each individual who agrees to participate in the research will provide written informed consent after the objectives and procedures of this study are explained to them.
ChiCTR2400092935. Registered on 26 November 2024.
Hospital falls and associated injuries are a global issue associated with harm and significant costs to individuals and society, especially for older adults. Hospital standards specify the minimum level of care required to optimise patient safety, quality and outcomes. Standards are often used during hospital accreditation. This investigation analysed the content and quality of hospital falls standards across the globe.
Hospital standards were located by searching online databases (PubMed, CINAHL, Google Scholar, MEDLINE), ChatGPT, the grey literature via internet search engines, and websites of accreditation agencies, government agencies, and other relevant organisations. We searched for standards from the 60 largest countries by population plus the 60 countries with the highest gross domestic product (n = 82 after accounting for duplicates). For inclusion, hospital standards had to mention ‘fall/s’. Data were analysed using a deductive framework synthesis and content analysis to identify emergent themes.
Forty-one standards used by at least 72 countries were identified from our search. Sixteen were excluded from detailed analysis because they did not mention falls and 3 could not be retrieved. A total of 22 standards were included in the final detailed analysis. Included standards showed wide variations in content and quality. Seven were assessed as high quality, 12 medium quality, and 3 were deemed to be of low quality. Some lacked details on hospital falls screening, assessment, prevention, and management. Consumer engagement in development, implementation, or evaluation was not mentioned in all standards. Procedures for falls data collection and reporting were seldom documented. Hospital standards infrequently referred readers to contemporary research or clinical practice guidelines.
There are variations in the quality and content of standards on hospital falls. International collaboration is recommended to increase the consistency and validity of hospital falls standards across nations, in order to optimise healthcare outcomes.
The findings of this global analysis of hospital falls standards have the potential to impact falls rates and fall-related injuries in hospital patients by providing data to inform the content, evidence base and use of hospital standards to optimise the safety and quality of care delivery. The findings inform the review, design and implementation of hospital accreditation procedures to improve patient outcomes, patient experiences, and service quality.
by Renata dos Santos Guarnieri, Guilherme Sá de Oliveira, Kaylaine Marques Ferreira, Aline Penna-de-Carvalho, Vanessa Souza-Mello, Sandra Barbosa-da-Silva
High-intensity interval training (HIIT) is an effective intervention for improving metabolic health and mitigating metabolic dysfunction-associated steatotic liver disease (MASLD). Nonetheless, the stability of these benefits throughout detraining periods and upon weight regain remains inadequately characterized. This study aimed to evaluate whether hepatic improvements induced by HIIT are sustained during detraining, even after body weight regain. Eighty male C57BL/6 mice were fed either a control (10% fat) or a high-fat (HF) diet (50% fat) for 12 weeks. Following this period, the animals were allocated to groups subjected to continuous HIIT or intermittent training cycles (each lasting 3 weeks). The outcomes assessed included body mass (BM), glucose tolerance, lipid profiles, liver enzyme levels (aspartate aminotransferase and alanine aminotransferase), hepatic steatosis, and the expression profiles of genes associated with lipogenesis (Srebf1, Mlxpl, and Fas), β-oxidation (Ppara and Cpt1a), and endoplasmic reticulum (ER) stress (Atf4, Ddit3, and Gadd45). Compared with the sedentary HF-NT condition, continuous HIIT reduced BM and improved glucose tolerance. Intermittent training (HF-TNT, HF-NTN) preserved metabolic benefits and reduced triglyceride and cholesterol levels. Notably, hepatic steatosis was significantly alleviated in all training groups but persisted even after detraining. Additionally, HIIT downregulated the expression of lipogenic genes and upregulated the expression of genes involved in β-oxidation. The levels of markers indicating ER stress were attenuated by HIIT, with a sustained reduction during periods of detraining. HIIT-induced metabolic and hepatic improvements persist partially during detraining, despite weight regain. These findings underscore the therapeutic value of continued or periodically repeated physical training in mitigating the adverse effects of an HF diet and preventing the progression of metabolic disorders such as MASLD.
We conducted a feasibility study to evaluate the feasibility of recruiting patients to examine the effect of near vision glasses in young infants at risk of cerebral visual impairment.
A three-arm, parallel-group, open-label randomised feasibility trial.
Tertiary neonatal intensive care in London, UK.
We included babies born before 29 weeks of gestation or at full term with hypoxic ischaemic encephalopathy. Babies who needed ongoing inpatient care, with established eye anomalies or with very high refractive errors at baseline (±8.00D) were not included. Infants with retinopathy of prematurity were not excluded.
At 8 weeks corrected age, we allocated 18 infants to wear glasses (+3.00D over full cycloplegic refraction) immediately (intervention 1), 18 to wear the same glasses at 16 weeks (intervention 2) and 19 infants were allocated to standard treatment (no glasses).
Recruitment and retention of study participants (primary), compliance wearing glasses, preferential-looking visual acuity (with glasses) and visual function as determined using A Test Battery of Child Development for Examining Functional Vision at 3-month and 6-month age post-term.
Of 70 eligible families, 55 consented and 34 attended baseline assessments, and 28 completed the study. Non-attendance was due mainly to prolonged inpatient stay, infant health and scheduling conflicts. Glasses were worn for similar periods in each group (Intervention 1: median 2 hours/day (95% CI 1 hour to 4 hours); Intervention 2: median 2 hours/day (95% CI 1.5 hours to 3 hours)). Visual acuity improved from baseline to 6 months. Mean (SE) LogMAR (Minimum Angle of Resolution) improvements were standard care: 0.47 (0.45); intervention 1: 0.66 (0.44); intervention 2: 0.37 (0.36). Among the 29 very preterm infants, there were similar findings: standard care: 0.35 (0.35); Intervention 1: 0.67 (0.47); Intervention 2: 0.34 (0.40). As a functional measure, object permanence was present at the following rates by randomised arm: standard care: 29%; whereas intervention 1: 56%; and intervention 2: 44% (OR intervention 1 vs standard care: 3.13 (95% CI 0.38 to 25.57), ie, not statistically significant).
We demonstrate feasibility for a definitive RCT (randomized controlled trial) with good recruitment and retention and observed potential benefits for vision and development following the dispensing of glasses at 8 weeks post-term age compared with untreated controls. We identified methodological modifications to further improve recruitment processes for a future larger study.
To study the factors that influence physicians’ and patients’ use of, and willingness to use, economic information in clinical decision-making, and examine physicians’ views on whether clinical practice guidelines can support its use.
Semistructured focus group discussions with an inductive content analysis.
Finnish health centre general practitioners (GPs) and adult patient representatives, five groups of each.
22 GPs and 15 patient representatives.
In the GP groups, five factors involved in using economic information in clinical decisions were raised: the issue of who pays, knowledge about cost information, the cost-benefit ratio of treatments, care planning and health economic understanding. Concerning the inclusion of economic information in clinical guidelines, GPs raised themes including the content and means of presentation of economic information, and advantages and challenges related to the integration of economic information into clinical guidelines. In the patient groups, the identified themes related to seeing the costs of treatments, the organisation of healthcare services, inclusion of cost information in clinical guidelines, patient information and support, and cost containment in healthcare.
The study suggests that GPs and patients are willing to use economic information in clinical decision making. It also implies a need for easily accessible and understandable economic information, and that clinical guidelines may be a good way to support this. In addition, the study highlights the need for education on the economic aspects of healthcare for physicians.
To explore how the legalisation of medical assistance in dying (MAiD) has shaped the discourse of MAiD and its relationship with hospice palliative care (HPC) in Canada.
There is perceived tension in the discourse between the goals of MAiD and HPC, but little literature examines this relationship and the effect it has on healthcare providers such as nurses.
Integrative review following Whittemore and Knafl's and Toronto and Remington's methodology.
A search was conducted to identify literature discussing MAiD and HPC in Canada. Articles were critically appraised for methodological quality. Data from each article were abstracted, thematically analysed, and synthesised.
Initial searches were conducted in CINAHL, PubMed, and professional association and government websites in September 2018 and updated in May 2023.
A total of 457 records were screened for inclusion, and 83 articles were included. Articles included healthcare provider, patient, public, and institutional perspectives. Three themes identified from the data were the relationship between MAiD and HPC, suffering in the context of MAiD, and moral distress and moral uncertainty in providing or not providing MAiD.
The discourse around the relationship between MAiD and HPC is complex and contextual. Personal and professional understandings of end-of-life care differ and influence perspectives on how and whether MAiD and hospice palliative care can be reconciled. More exploration of this topic is recommended, given the changing legislation and beliefs around MAiD.
Findings consider how the concepts of end of life, MAiD, HPC, suffering, and moral distress influence and are influenced by the discourse of dying. This review provides direction for healthcare professionals working in end-of-life care and future ethical and moral areas for consideration.
No patient or public contribution was necessary for this literature review.
To comprehensively understand the meaning of person inclusive care and the care expectations of transgender individuals from health care professionals.
An integrative review was conducted.
Literature was searched in four databases (CINAHL, PubMed, Web of Science and Scopus) and 25 qualitative, quantitative and mixed methods studies published during January 2019–October 2024 were included.
All articles were critically appraised using validated critical appraisal tools. Deductive and constant comparative analyses were used to develop themes and sub-themes.
Person inclusive care was described as: (a) recognition and respect of identity, (b) holistic and individualised care and (c) creating safe and affirming healthcare environments. Care expectations included: (a) empowerment through shared decision-making, (b) person-centred communication, (c) advocacy as a supportive gesture and (d) intersectionality-informed care.
This review highlights the critical importance of person-inclusive care for transgender individuals, emphasising the need for healthcare practices that respect and affirm their identities, provide holistic care, and foster safe and supportive environments.
Transgender individuals experience persistent stigma and discrimination in healthcare settings and beyond. Understanding how to provide person-inclusive care and their care expectations from healthcare professionals is crucial to improving the delivery of quality care. The current body of evidence underscores significant disparities in healthcare for transgender individuals. While advancements in inclusive practices and affirming care models are evident in specific settings, these practices are not universally adopted. Inclusive care equips healthcare professionals with the necessary competencies to deliver high-quality, sensitive care that meets the unique needs of transgender individuals, ultimately fostering trust and equitable health outcomes. Nurses must ensure the delivery of person-inclusive care by demonstrating respect, advocacy, holistic assessment and care and genuine involvement of transgender individuals in decision-making for their care.
No direct patient or public contribution.
by Dinesh Dadarwal, Kira Crooks, Patricia Lainetti, Ryan Dickinson, Khawaja Ashfaque Ahmed, Colin Palmer
This study aimed to evaluate the effects of a single postpartum administration of pegbovigrastim, a recombinant bovine granulocyte colony-stimulating factor (rG-CSF), on peripheral leukocyte profiles, granulocyte function, and uterine cytology in healthy Holstein dairy cows. We hypothesized that rG-CSF would enhance leukocyte counts and granulocyte function without adversely affecting uterine immune cell composition. Twenty-three cows between 19–23 days in milk were randomly assigned to receive either rG-CSF (n = 12) or saline (n = 11). Blood samples were collected on the day of injection and on Days 3, 6, 10, and 21 post-treatment to assess total and differential leukocyte counts. Granulocyte phagocytosis of fluorescein isothiocyanate (FITC)-labeled Staphylococcus aureus and oxidative burst capacity following PMA stimulation were evaluated using flow cytometry. Vaginoscopy and transrectal ultrasound examinations were conducted at each time point, and uterine cytobrush samples were collected from a subset of cows for cytological analysis. Compared to controls, rG-CSF-treated cows exhibited a significant (2–3 fold) increase in total leukocytes and neutrophils (P P P = 0.04) and phagocytic activity as well as capacity (P = 0.01) that peaked on Days 3 and 6 post-treatment, respectively, following rG-CSF treatment. Furthermore, uterine samples from treated cows showed higher proportions of neutrophils (Days 6, 10, and 21) and macrophages (Day 10) compared to controls (P
by Huda Kutrani, Jim Briggs, David Prytherch, Claire Spice
BackgroundHospital Frailty Risk Score (HFRS) is commonly used to identify frailty risk and predict poor outcomes. Frailty and sepsis are associated with poor outcomes. This study aimed to evaluate the association between HFRS, risk of sepsis and poor health outcomes across all adult ages.
MethodsA retrospective cohort study analysed data from Queen Alexandra Hospital, a major acute hospital in the UK, covering the period from January 1, 2010, to December 31, 2019. It included patients aged 16 and older. The Hospital Frailty Risk Score (HFRS) was used to identify patients at risk of frailty. The Suspicion of Sepsis (SOS) codes and the National Early Warning Score (NEWS) were used to identify patients at risk of sepsis. Logistic Regression with interaction models were developed to examine the associations between HFRS, risk of sepsis and poor outcomes (length of stay and in-hospital mortality) across all adult ages.
ResultsPatients with higher frailty risk and sepsis-risk-positive groups had longer length of stay and higher risk of in-hospital mortality compared to the sepsis-risk-negative groups. Interaction between intermediate or high frailty risk and sepsis-risk-positive (SOS codes present, NEWS≥7, and SOS codes present with NEWS≥7 groups) was significant for all periods of length of stay and all periods of in-hospital mortality (P Conclusion
This study concluded that there is a strong association between risk of frailty (identified with HFRS), risk of sepsis, and poor outcomes in urgently hospitalised adults of all ages.
Pressure injuries present significant challenges in clinical care, leading to severe complications such as infection, pain and delayed wound healing. They are a common chronic wound that contribute to increased morbidity, prolonged hospital stays and substantial healthcare costs. Despite national efforts to enhance chronic wound management, development of optimal treatment strategies remains a priority. The Pressure Injury Treatment Advisory (PITA) Quick Guide was developed to provide an evidence-based guide to support clinicians in pressure injury management. A survey was conducted to evaluate clinician perspectives on the usability and practicality of the Guide in acute care, residential aged care and community settings. A post-test survey was conducted on a convenience sample of healthcare professionals from three healthcare settings across metropolitan, regional and rural Australia. The survey included 5-point Likert-scale items assessing ease of use, effectiveness and integration with workflows. Three hundred and two responses were received (66.7% response rate). Clinicians expressed overwhelmingly positive perceptions, with over 95% agreeing or strongly agreeing on the guide's utility and effectiveness. No respondents strongly disagreed with any item. Residential aged care and rural clinicians rated the tool slightly higher than acute care and medical clinicians. The PITA Quick Guide was well-received across all settings, demonstrating strong potential to enhance evidence-based pressure injury management.
Low physical functioning and frailty are prevalent in non-geriatric vulnerable populations such as people experiencing homelessness, addiction and mental health challenges. The objective of this study was to explore the feasibility and impact of a targeted exercise intervention with protein supplementation for women experiencing homelessness, addiction and mental health challenges.
Mixed-methods feasibility study.
A women’s-only day service for people with homelessness and addiction issues, in Dublin, Ireland.
Women experiencing homelessness, addiction and mental health challenges.
The intervention was a 10-week low-threshold exercise and protein supplementation pre-post programme (LEAP-W). Qualitative interviews were conducted following the intervention with programme participants and key stakeholders.
The primary outcome was feasibility measured by recruitment, retention, adherence, safety and acceptability, and secondary outcomes measured pre-post intervention change in physical function, pain, nutritional and frailty status, and overall health status.
Overall, 33 participants were recruited. Data generated demonstrated that LEAP-W was feasible by its safety, acceptability and high retention in certain subgroups, and high adherence to the exercise and protein supplement; its impact was demonstrated by pre-post intervention improvement in multiple domains (strength (chair stand test), balance (the single leg stance test), pain and quality of life/mental health (mental component summary of the Short Form-12; 95% CI, p
Targeted exercise interventions with trauma-sensitive, flexible design can be successfully delivered and yield impact in women with complex needs who experience homelessness, addiction and mental health challenges. Service design should be considered when delivering interventions to this population. Further higher-powered longitudinal studies are warranted.
Mobile health (mHealth) technologies have become increasingly popular for monitoring mental health symptoms and lifestyle behaviours, and are largely reported to be feasible and acceptable to users. However, to date, the efficacy of such technologies to improve perinatal mental health outcomes has been mixed. Within the perinatal context, much of this work has been done in the context of postpartum depression, stemming from electronic health records as well as cohort studies. There is, however, a dearth of studies focusing on depression in pregnancy, and machine learning-based clinical decision support systems remain underexplored. The HappyMums application has been developed to meet this need, and its use across Europe will be tested in this study.
A total of 1000 pregnant people currently suffering from, or at risk of, antenatal depression will be recruited across six countries. All participants will be between 13 and 28 weeks’ gestation and will be given access to the new purposefully developed HappyMums mobile application, to use from enrolment until 2 months postpartum. The application leverages passively collected data from smartphone sensors relating to physical activity and behaviour, as well as requiring active engagement from the user to complete mental health questionnaires and ‘game-like’ activities. Digital data types will be combined with traditional mental health measurement methods, such as standardised questionnaires and interviews, to develop novel predictive models capable of identifying mental health trajectories in women at risk of developing antenatal depression and to test the app’s utility for use as personalised risk prediction and depression identification tool. The primary outcome of this study is to determine what proportion of users will continue to use the mobile application and engage with its tasks and activities at least weekly, while secondary exploratory outcomes include assessing usability of the app and testing the predictive ability of a novel machine learning-based model. These outcomes will, for the first time, be assessed by integrating active as well as passive data.
Ethical approval has been granted by local research ethics committees in each recruiting centre. At King’s College London (leading the clinical study), the study was reviewed by the East of England—Essex Research Ethics Committee and granted favourable opinion (REC reference 24/EE/0129). All other sites collecting participant data have the study approved for local delivery. Findings relating to the primary and secondary outcomes will be submitted for publication in open access, peer-reviewed journals, as well as presentations at conferences as symposia or posters. Findings will be made available to a non-specialist audience through open access digital mental health magazines and promotion on social media.
Prior research, mostly from North America, suggests improved clinical outcomes for female patients treated by female physicians. Whether these findings apply in European healthcare systems and how underlying processes of care vary by sex remains unclear. This study aimed to assess whether in-hospital outcomes and processes of care differ by patient sex, physician sex or their interaction, in a European setting.
Retrospective cohort study.
General internal medicine division of a Swiss tertiary teaching hospital.
Adult inpatients (≥18 years) hospitalised between 2014 and 2024 and their primarily responsible physicians, classified by administrative sex (male vs female). The cohort included 20 094 hospitalisations (44.6% female patients) and 216 physicians (48.1% female).
Outcomes included in-hospital mortality, 30-day mortality and 30-day readmission, as well as processes of care (resource use, advance care planning and cardiovascular low-value care). Multilevel mixed-effects regression models adjusted for patient and physician characteristics.
Female patients had lower in-hospital mortality (OR 0.72, 95% CI 0.59 to 0.89) and 30-day mortality (OR 0.75, 95% CI 0.65 to 0.87), lower hospitalisation costs (–4.26%, 95% CI –6.08% to –2.41%), fewer diagnostic and therapeutic procedures (–6.44%, 95% CI –9.76% to –3.01%), fewer blood tests (–8.95%, 95% CI –12.98% to –4.73%) and were less likely to have resuscitation orders (OR 0.64, 95% CI 0.58 to 0.71) or intensive care unit transfer orders (OR 0.64, 95% CI 0.55 to 0.73). They were, however, more likely to receive non-indicated antihypertensive treatment (OR 1.86, 95% CI 1.38 to 2.51). No significant differences were observed by physician sex or patient–physician sex interaction.
In a European tertiary teaching hospital with universal healthcare coverage, in-hospital outcomes and processes of care did not differ by physician sex or patient–physician sex interaction. Nevertheless, disparities by patient sex persisted, underscoring the need for sex-disaggregated quality monitoring and sex-sensitive medical training.
To describe diagnostic categories and comorbidities associated with increased risk of readmission within 28 days among older adults.
Retrospective observational study of all hospital admissions following ED attendance by patients aged ≥ 60 years between July 2020 and June 2023. Index and subsequent 28-day readmission were identified using ED data and hospital discharge records. ED diagnosis, Australian Refined Diagnosis-Related Group (AR-DRG) discharge codes, and ICD-10-AM comorbidities were extracted. Multivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations with 28-day readmission. The study and findings have been reported against the STROBE-RECORD guideline.
Of the 28,730 initial patient visits, 7.9% re-presented within 28 days. The most common ED diagnoses at initial and readmission were chest pain (5.4% vs. 4.6%), falls (5.2% vs. 4.1%), dyspnoea (3.5% vs. 3.1%), abdominal pain (3.1% vs. 3.3%) and cerebrovascular accident (1.7% vs. 1.7%). The most frequent AR-DRGs were respiratory infections/inflammations, kidney and urinary signs/symptoms, and other digestive system disorders. Key ICD-10-AM codes associated with a higher likelihood of readmission within 28 days were obstructive/reflux uropathy (OR 2.66, 95% CI 1.78–3.96), urinary retention (OR 1.84, 95% CI 1.38–2.46), chronic ischaemic heart disease (OR 1.57, 95% CI 1.10–2.25), delirium (OR 1.35, 95% CI 1.07–1.71) and disorders of fluid, electrolyte, and acid–base balance (OR 1.29, 95% CI 1.09–1.54).
Nearly 8% of older adults are readmitted within 28 days. Our described approach offers a potential framework to identify at-risk groups and intervene to reduce avoidable representations and/or admissions.
The results reported here create the opportunity for clinicians to identify areas for improvement in clinical practice, care coordination, and service delivery. Our approach and methodology can be replicated in other health services.
No patient or public contribution.
by Mylaine Breton, Catherine Lamoureux-Lamarche, Véronique Deslauriers, Djamal Berbiche, Maude Laberge, Annie Talbot, Aude Motulsky, Marie-Pascale Pomey, Isabelle Gaboury
BackgroundAccess to primary care is an important component of health systems. Given the barriers experienced by unattached patients to accessing primary care in Quebec (Canada), the Ministry of Health mandated the province-wide implementation of Primary care access points for unattached patients (Guichet d’accès première ligne; GAP), an organizational innovation designed to orient patients to the most appropriate professional or service. This study aims to 1) document the factors associated with unmet healthcare needs after receiving GAP services and 2) assess whether those factors vary by GAP orientation.
MethodsThis cross-sectional study builds on data collected between April and July 2024 using an online patient questionnaire. All patients with a valid email address registered on the centralized waiting list for unattached patients in three local health territories (LHTs) received an email invitation to participate in the survey. The total sample included 20,282 participants who responded to the questionnaire and used the GAP.
ResultsThe findings showed that younger age, self-reporting poor/fair physical and mental health, receiving services in LHT 3 and reporting an emergency room visit were associated with increased likelihood of reporting unmet needs. Stratified analyses suggested that some characteristics (age, use of emergency room) were associated with unmet needs across orientations, while others (self-reported physical and mental health) were associated with specific orientations.
ConclusionThis study serves as a first step in deepening our understanding from a patient perspective of how to better plan primary care services and improve unattached patients’ experiences using the GAP. The findings showed that patients oriented to other professionals than a medical appointment with a family physician had the highest percentage of unmet needs. The next step involves an in-depth exploration of the reasons for patients’ unmet needs, enabling the development of more precise and effective strategies to address them.
Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder worldwide. Although not life-threatening, its chronic and recurrent nature greatly impacts patients’ quality of life. There is strong evidence that gut-directed psychotherapies (GDPs) help improve IBS symptoms. With technological advances, digital GDP is increasingly used as an alternative to traditional face-to-face GDP. This study will compare the clinical effectiveness of digital versus face-to-face GDP for IBS through network meta-analysis.
We will search English databases (PubMed, Cochrane Library, EMBASE and Web of Science) and Chinese databases (China National Knowledge Infrastructure, Wanfang, VIP and Chinese Biomedical Database) for randomised controlled trials (RCTs) of digital or face-to-face GDP for IBS. The search will cover the period from database inception to May 2025. We will perform multivariate network meta-analyses within a frequentist framework, using the mvmeta command in STATA V.16 software, and traditional pairwise meta-analysis using the DerSimonian-Laird random-effects model. The Cochrane Risk of Bias (RoB) tool (V.2) will be used to assess the RoB of each RCT, and the Confidence in Network Meta-Analysis (CINeMA) tool will be used to evaluate the certainty of the evidence.
Ethical approval is not required for this systematic review, as it involves the collection and synthesis of data from previously published primary studies.
Open Science Framework (OSF) registration: DOI 10.17605/OSF.IO/87463.
The optimal strategy for induction of labour (IOL) in cases of prelabour rupture of membranes (PROM) with an unfavourable cervix is elusive. No study conducted in nulliparous women has shown any one induction method to be superior to any other. In this project, we seek to determine whether IOL with balloon catheter and oxytocin can (1) increase rate of delivery
We are conducting a multicentre, randomised, controlled, open-label therapeutic trial with two parallel arms on nulliparous women with unfavourable cervix showing PROM at term without spontaneous labour.
After 12 hours of PROM, women are randomly assigned to one of two study groups. One group is treated with a balloon catheter for 12 hours, with oxytocin administered after 6 hours. If the balloon is expelled earlier than 6 hours after insertion and the cervix is still unfavourable, another balloon is placed. The other group (control) is treated with 25 µg oral PGE1 every 2 hours until labour starts. After a maximum of eight administrations and a timelapse of 4 hours, if there are no effective uterine contractions, the induction is continued with oxytocin infusion and epidural analgesia if the patient requests it. A total of 520 women will be recruited in five university hospitals in France and randomised at a 1:1 ratio with stratification by study centre.
Main inclusion criteria are nulliparous women with gestational age ≥37 weeks, PROM without labour beyond 12 hours, unfavourable cervix (Bishop score
The hierarchical primary endpoints are: (1) Proportion of patients vaginally delivered
The RUBAPRO2 trial was approved by the French national agency for drug safety and committee for protection of persons involved in biomedical research on 15 September 2022. Informed written consent will be obtained from all participants.
To investigate international evidence on home visits and parenting interventions delivered by nurses and midwives and to identify core components, such as intervention content, programme characteristics, contextual factors and implementation elements shared by effective interventions.
Scoping Review.
Nine academic databases and grey literature were searched between June and August 2024 for studies published between 2020 and 2024.
Screening and data extraction were independently conducted by two reviewers using covidence. The intervention characteristics were described using the TIDieR framework, and the content was analysed thematically.
Of the 3217 screened studies, 23 met the inclusion criteria. The studies employed various designs, including RCTs, quasi-experimental, cohort, cross-sectional, register-based and single-case experimental studies. Interventions were typically guided by theories of human ecology, attachment and self-efficacy. Most used structured materials and were delivered via face-to-face home visits by trained nurses, starting during pregnancy and continuing for up to 2 years. Visits ranged from weekly to monthly, mainly to family homes. Interventions were often tailored to family needs and cultural contexts. Five core themes emerged: (1) parenting education, (2) maternal and infant health, (3) mental health and psychosocial support, (4) community connections and (5) cultural sensitivity.
Effective interventions should be early, structured and tailored. Integrating parenting education, health, mental well-being and cultural sensitivity improves outcomes and scalable family care practices.
Findings highlight the need for structured training and support for nurses and midwives. Integrating these interventions into routine services, with attention paid to equity and proportionate universalism, can enhance family outcomes.
This review addressed the lack of clarity regarding what makes nurse- or midwife-led interventions effective. It identified key components that support child and family well-being and offers guidance for designing scalable, evidence-based interventions in maternal and child health services.
The EQUATOR guidelines for PRISMA were met.
No patient or public contributions.
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