Conectar
Establishing comparability between measured outcomes in clinical trials poses a significant obstacle for systematic reviewers. Core outcome sets (COSs) were developed to address this issue. The macular degeneration (MD) COS is designed to standardise outcome measurement across clinical trials for MD. This study investigates the uptake of the MD COS in standardising outcome measurement across clinical trials.
Cross-sectional analysis
We conducted a search on ClinicalTrials.gov to locate MD clinical trials that were registered 5 years prior to COS publication through the search date of 26 June 2023 and obtained a pool of 2152 registered studies. After applying various inclusion and exclusion criteria, we analysed 159 trials. We then analysed the COS uptake using an interrupted time series analysis (ITSA) and performed performed analyses of variance (ANOVAs) and Pearson correlations to evaluate associations between trial characteristics and outcome measurement.
ITSA showed no significant change in uptake following the MD COS (2016): mean percentage of completion of the COS increased by 0.24% per month before publication (p=0.27) and by 0.07% per month after publication (p=0.62), indicating no meaningful post-publication slope change in COS use. For context, visual acuity was most commonly measured, while several patient-reported and disutility domains were infrequently captured.
No discernible patterns in COS usage for MD trials were observed. We recommend further collaboration between regulators and COS developers to help with COS uptake. Additionally, we suggest that further studies analyse adherence to COSs in respect to regulatory recommendations.
The aim of this integrative review was to explore registered nurses' understandings of organisational culture and cultures of care in aged care.
Integrative literature review.
A literature search was conducted of Medline (OVID), CINAHL Plus with Full Text, Scopus, Proquest Nursing and Allied Health, and Informit databases in June 2024. In October 2024, a search for grey literature was conducted focusing on Google Scholar, the Analysis and Policy Observatory (Australia), Australian Government websites, European Union Institutions and Bodies, and usa.gov. The inclusion criteria were Australian and international literature published in English between 2004 and 2024. The inclusion criteria were amended to focus on literature published from 2014 to 2024.
Seventeen research studies met the inclusion criteria for the review. Four primary themes were identified: competing hierarchies of power; the multifaceted role of nurses in long-term care settings; standing still is not an option; and implications for culture change strategies in practice.
Registered nurses in aged care are pivotal to evolving clinical and administrative practice and creating organisational cultures that affirm the rights of older people, including providing a supportive workplace for those who care for them, in an environment focussed on developing and sustaining quality care. Viewing the complex relationships at different organisational levels through the prism of Foucault's ideas on disciplinary power generates new insights into the role of registered nurses in aged care settings. This review also underscores that research on organisational culture in aged care is at a formative stage. There is potential for future research that fosters a robust evidence base to support the development of organisational cultures that nurture a person-centred environment ultimately leading to improved care and staff experience.
Registered nurses in aged care settings are advocating for a transformative shift in organisational cultures that prioritises inclusivity, compassion and person-centred care. Empowering nurses through clinical and administrative leadership roles is crucial for cultivating person-centred organisational cultures in aged care settings. It is essential that policymakers invest in the development of registered nurses who can excel in clinical and operational roles at management and executive levels. Policy changes that promote frameworks that facilitate nursing leadership are essential for establishing and maintaining person-centred workplace cultures.
Prisma extension for scoping reviews (PRISMA—ScR).
This study did not include patient or public involvement in its design, conduct, or reporting.
The postnatal period is critical for preventing maternal and neonatal morbidity and mortality. Globally, a significant proportion of maternal and neonatal deaths occur within the first 6 weeks after delivery. Timely and adequate postnatal care (PNC) can detect and manage life-threatening complications; however, service utilisation remains alarmingly low in many low- and middle-income countries, including Saudi Arabia. Addressing the behavioural and perceptual factors that influence service use is essential for improving health outcomes.
This study aimed to assess mothers’ utilisation of PNC services and examine how their health beliefs and sociodemographic characteristics influence this behaviour.
A cross-sectional study guided by the Health Belief Model (HBM) was conducted to explore predictors of PNC utilisation.
Eight primary healthcare (PHC) centres were randomly selected from 179 PHC centres distributed in the different governorates of the Jazan region of Saudi Arabia.
A total of 464 mothers were surveyed between October and December 2023 using an interviewer-administered questionnaire.
The primary outcome was PNC utilisation, defined by the number of postnatal visits. The independent variables included sociodemographic characteristics and HBM constructs (perceived susceptibility, benefits, barriers and cues to action).
In terms of PNC utilisation, 80.0% of participants had two or fewer postnatal visits, whereas 20.0% had three or more postnatal visits. Perceived barriers had the strongest influence (mean score 2.51±0.87), followed by cues to action (2.43±0.89), susceptibility (1.92±0.72) and benefits (1.86±0.64). In the multivariate analysis, perceived barriers, cues to action and perceived susceptibility were significantly associated with PNC utilisation, with adjusted ORs of 1.679 (95% CI: 1.007 to 2.799), 0.470 (95% CI: 0.256 to 0.863) and 0.405 (95% CI: 0.197 to 0.832), respectively.
PNC utilisation in the Jazan region remains suboptimal. Perceptual factors, particularly barriers and cues to action, play a central role in service use. Health interventions targeting these beliefs and improving follow-up mechanisms may help increase PNC engagement and improve maternal and infant health outcomes in Saudi Arabia.
Our objectives were (1) to characterise the age-sex-standardised prevalence of comorbidities among people living with HIV (PLWH) and people not living with HIV (PnLWH) between 2001 and 2019 and (2) to examine the effect of comorbidities on direct healthcare costs among PLWH and PnLWH.
This was a retrospective, matched cohort study conducted with the Comparative Outcomes and Service Utilisation Trends (COAST) cohort, which contained all known PLWH in British Columbia (BC), Canada and a general population sample.
BC, Canada.
A total of 9554 PLWH and 47 770 PnLWH from the COAST cohort were followed between 2001 and 2019. Participants were at least 19 years old and 82% male in both groups.
The primary outcomes were the age-sex-standardised prevalence of 16 comorbidities, calculated annually, among PLWH and PnLWH. Secondary outcomes included direct healthcare costs associated with each comorbidity among PLWH and PnLWH. Outcomes were ascertained from administrative health databases.
PLWH exhibited a higher age-sex-standardised prevalence of most comorbidities compared with PnLWH over the study period. Relative disparities in liver and kidney diseases markedly decreased since 2008. Disparities in the prevalence of mental health disorders and substance use disorder (SUD) were consistently large throughout the study period. Comorbidities were associated with high healthcare costs, especially among PLWH.
This study underscores the persistent and evolving burden of non-AIDS-defining comorbidities among PLWH, even in the context of improved HIV management. The high prevalence of mental health disorders and SUD, coupled with the substantial healthcare costs associated with these conditions, emphasises the need for holistic and integrated care models that address the full spectrum of health challenges faced by PLWH.
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