The objective of this scoping review is to identify and describe factors that affect access to post-sepsis care. Considering the burden faced by sepsis survivors, it is important to understand the facilitators and barriers to accessing post-sepsis care to facilitate the design and implementation of patient-centred and equitable pathways to care.

This scoping review will include studies that consider individuals who have experienced sepsis and any factors that may affect access to care, including comorbidities, discharge setting and social determinants of health. A comprehensive search of MEDLINE, Embase, Emcare, HealthSTAR and Scopus will be conducted. The extracted data will be summarised and presented thematically.

Approval from a research ethics board is not required for this review as it is a synthesis of information from studies where the primary investigators have already received approval from their respective ethics boards. Once complete, the review will be submitted for publication in a peer-reviewed journal, and the findings will be shared to local and national forums.

This review has been uploaded and registered under Open Science Framework. https://doi.org/10.17605/OSF.IO/JMFW2

Patient-reported experience measures (PREMs) are measures of patients’ perceptions of care they receive. PREMs are critical in developing and evaluating programmes that aim to improve patient healthcare experiences and quality of care (QoC) according to patient-defined needs. This review aims to map key domains of PREMs across distinct healthcare technical areas and life stages from globally available literature.

A scoping review adapting Arksey and O’Malley’s framework and Joanna Briggs Institute’s guidelines for the conduct of scoping reviews.

Google Scholar, PubMed, WHO, US Academy of Medicine and USAID Momentum.

PREMs literature from electronic repositories of grey and peer-reviewed publications, published in English historically up to September 2023.

Two lead reviewers with support from the technical working group co-created a review framework of healthcare technical areas, life stages and PREMs domains. We screened eligible articles, prioritising reviews except for technical areas with no reviews, where we then selected individual studies. We charted, analysed and synthesised data from 52 eligible articles.

PREMs literature has recently increased, especially in low-income and middle-income countries (LMICs), although studies in high-income countries (HICs) dominate in proportion (n=38; 73.1%). Out of 52 eligible articles, technical areas with most publications were sexual and reproductive health (n=21; 40.4%) and general outpatient care (n=11; 21.2%). Studies in adulthood (n=24; 46.2%) and from pregnancy and birth to postnatal (n=16; 30.8%) were most represented. PREMs studies reported mostly on communication and rapport (n=33; 63.5%) and respect and dignity (n=42; 80.8%) domains. Nearly a quarter (n=12; 23.1%) of the articles included only validated tools; the rest included a combination of validated and unvalidated measures. Of the tools relating to life stages of babies, younger children and older adults, the majority (n=17; 94.4%) included patient proxies.

PREMs, as an important component of QoC measurement, are increasing across several healthcare technical areas and life stages with commonalities and notable distinctions in measurement domains and tools. Evidence on PREMs largely comes from HICs. Evidence on critical, yet sometimes overlooked domains, highlights key QoC implementation gaps. The adaptation and utilisation of PREMs in programmes, especially in LMICs and under-represented technical areas, present opportunities to close the QoC disparities in those settings. Strategic, concerted efforts towards the harmonisation of PREMs tools across multiple life course stages and technical areas are critically needed in high-level quality improvement efforts.

South Asian populations in the UK experience increased health risks related to long-term conditions, exacerbated by underdiagnosis, cultural differences in help-seeking behaviours, language barriers, low health literacy and a lack of culturally sensitive services. We know that group interventions that include education and rehabilitation, such as cardiac and pulmonary rehabilitation, are highly effective, but people from diverse communities often face barriers to access and engage with them. This review aims to synthesise evidence on the barriers and facilitators to education and rehabilitation interventions experienced by South Asian people living with long-term conditions.

A systematic review of qualitative studies using meta-ethnography as the analytical approach to synthesis was conducted, following Noblit and Hare’s approach, eMERGe Reporting Guidance for Meta-Ethnography, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Systematic searches were performed across MEDLINE, PsycINFO, CINAHL, CENTRAL, EMBASE and Applied Social Sciences Index and Abstracts from database inception through March 2024 (updated April 2025).

MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost platform), CENTRAL (Cochrane Library), EMBASE (Ovid), Applied Social Sciences Index and Abstracts (ProQuest platform) were searched from inception to March 2024 (updated April 2025).

We included qualitative research exploring the attitudes, views and experiences of South Asian adults (outside of South Asia) with diabetes, cardiovascular disease or chronic obstructive pulmonary disease (COPD) regarding group treatments for these conditions.

Two independent reviewers searched, screened and coded studies, while remaining authors peer-reviewed. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research. Data extraction and synthesis followed eMERGe and PRISMA reporting guidance, with findings synthesised qualitatively.

Of 8348 identified citations, 17 studies met inclusion criteria, providing data from South Asian people living with cardiovascular disease and diabetes mellitus. No studies including people with COPD met the inclusion criteria. Synthesis revealed four overarching themes, each incorporating both barriers and facilitators: faith, culture, communication, and safe space and professional relationship.

Findings indicate that current group education and rehabilitation interventions are not fully inclusive of South Asian needs, often lacking cultural sensitivity, which impedes engagement. Special attention is required for South Asian women, who can face additional cultural and societal barriers. Addressing these challenges through culturally sensitive care, such as flexible intervention scheduling around religious practices, gender-sensitive adaptations and culturally tailored communication strategies, has potential to improve engagement in education and rehabilitation interventions, and therefore long-term condition outcomes.

CRD42024493644.

Musculoskeletal pain is a global issue affecting millions of individuals. Healthcare provider gender bias (HCP-GB) in pain management or treatment may have implications. This study aimed to systematically (1) identify and map the scientific and grey literature as it relates to HCP-GB in the assessment, diagnosis and management of musculoskeletal pain, and (2) identify current gaps that necessitate further research.

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

The following databases were searched: PubMed (National Library of Medicine), Embase (Elsevier), Scopus (Elsevier), CINAHL Complete (Ovid), Academic Search Complete (EBSCOhost), Pre-Prints Database (National Library of Medicine) and Rehabilitation Reference Center from inception to August 2022 and updated in May 2025. Relevant grey literature was identified.

All screening was performed by two reviewers during title/abstract screening and full-text screening stages. Articles published in English, Spanish and German were included if they involved participants with musculoskeletal pain and examined HCP-GB as the dependent variable.

Two reviewers independently extracted data from the bibliometric, study characteristics and pain science variables. Results were descriptively mapped, and the frequency of concepts, population and characteristics was narratively reported.

21 full-text articles were included. All articles were published in North America and Europe. A total of 3694 healthcare providers from various specialty areas were examined. A majority of studies (57.1%; n=12) measured HCP-GB using written case vignettes, 33.3% (n=7) used case vignettes plus virtual human pictures/videos, and 9.5% (n=2) used real patients. The influence of patients’ sex in HCP pain assessment was reported in 28.5% (n=6) of the articles, while 42.9% (n=9) reported gender bias regarding HCP non-pharmacological treatment recommendations. Male patients were more likely to receive exercise recommendations for back pain and laboratory testing, whereas female patients received more psychological treatment recommendations and counselling from their HCP.

While there appears to be inconsistent use of the terms sex and gender, the literature informing this review suggests an existence of gender bias in the management of patients with musculoskeletal pain. Future research should be more purposeful in the use of sex/gender-related terms and consider exploring the impact of implicit bias training to rectify potential gender biases present in HCP.

To examine demographic and occupational attributes associated with work-life balance (WLB) satisfaction among physician assistants/associates (PAs) using a national dataset.

This is a cross-sectional study using 2023 national data.

USA.

The study included 149 909 board certified PAs who updated, confirmed or verified their profile questions.

Descriptive and bivariate statistics, followed by multivariate logistic regression, were conducted to identify factors associated with WLB satisfaction among PAs. The primary outcome was a binary variable derived from a 7-point scale assessing PAs’ satisfaction with WLB. Responses of ‘Somewhat’, ‘Mostly’ and ‘Completely’ satisfied were coded as ‘Satisfied’, while ‘Neither/Nor’, ‘Somewhat’, ‘Mostly’ and ‘Completely’ dissatisfied were coded as ‘Not satisfied’. Our analytical sample comprised 86,000 PAs who responded to a question inquiring about their satisfaction with WLB.

Over two-thirds (71.7%) of PAs indicated satisfaction with WLB. The multivariate logistic regression revealed that the types of specialties that PAs practised were among the strongest factors associated with WLB satisfaction. Compared with PAs in primary care, those practising in dermatology (adjusted OR (aOR)=1.83; 95% CI 1.66 to 2.02), general surgery (aOR=1.64; 95% CI 1.48 to 1.83), pain medicine (aOR=1.63; 95% CI 1.41 to 1.89) and hospital medicine (aOR=1.52; 95% CI 1.37 to 1.68) had higher odds of being satisfied with WLB (all p

Our findings revealed that PAs practising in non-primary care specialties had the highest odds of reporting satisfaction with WLB. Identifying factors strongly associated with PA work-life balance can aid in developing targeted interventions. However, further research is needed to understand the intrinsic and extrinsic factors influencing PAs’ WLB.

To explore the role of senior and mid-level managers as barriers or enablers to change in tackling the discriminatory challenges experienced by Black and Minority Ethnic (BME) employees working in the National Health Service (NHS).

A multi-level, multi-sourced qualitative study of five NHS Trusts in England.

26 qualitative interviews with senior leaders and BME network chairs (27 participants) and five focus groups (37 participants) with BME employees, across five NHS Trusts in England.

Our findings revealed that discrimination, racial harassment, incivilities, lack of progression and exclusion experienced by BME employees appear to be deeply ingrained in the culture of the NHS. Despite numerous national and local initiatives aimed at promoting inclusivity and addressing discriminatory behaviours, our findings also revealed a notable disparity between what senior leaders thought was effective in addressing discriminatory behaviours and the actual lived experiences of BME employees. Finally, a key finding was the pivotal role middle managers played in setting the tone for whether discriminatory behaviours are challenged or allowed to persist, which directly impacts on the overall experiences of BME employees within the NHS.

Our results provide evidence that not only does racial discrimination continue to be experienced by NHS BME employees, but that middle managers are key to addressing and improving this situation. Despite there being national policies and initiatives addressing racial discrimination, our study found that positive change, whether at an individual or organisational level, is dependent on the actions and commitment of middle managers.

To describe well-care visit attendance among children of adolescent mothers living with HIV and HIV-negative adolescent mothers and identify factors associated with optimal retention in the well-care visit schedule up to 18 months.

Cross-sectional data were used from a community-based observational cohort study of adolescent mothers (10–19 years; n=481) and their children (≥19 months old; n=502) in the Eastern Cape, South Africa.

Optimal well-care visit retention up to 18 months was defined as attending visits within 4 weeks of the recommended child age, attending the 18-month visit and missing no more than one scheduled visit.

Attendance was highest at the 6-week visit (88.4%; 95% confidence interval (CI) 85.6% to 91.3%) and lowest at the 18-month visit (58.0%, 95% CI 53.6% to 62.3%). About one-third (36.1%; 95% CI 31.8% to 40.3%) of children were retained to 18 months. Retention was highest among children living in rural vs urban areas (adjusted odds ratio (aOR)=2.01, 95% CI 1.32 to 3.06), those born to mothers whose highest education at pregnancy was secondary versus primary school (aOR=2.73, 95% CI 1.60 to 4.65), born via caesarean section vs vaginal birth (aOR=1.65, 95% CI 1.05 to 2.60) and living closer to the clinic (aOR=0.52, 95% CI 0.28 to 0.96 for long vs short distance). There was weak evidence that retention was lower among children of mothers living with HIV (aOR=0.64, 95% CI 0.40 to 1.02) and higher among food-secure children (aOR=2.18, 95% CI 0.96 to 4.96) and those receiving the child support grant (aOR=1.71, 95% CI 0.92 to 3.16).

Universal interventions are needed for retention beyond the neonatal period for children of adolescent mothers living with HIV and HIV-negative adolescent mothers. Interventions must address structural barriers, especially for adolescent mothers with primary education and in urban areas. Future research should examine the underlying mechanisms linking mode of delivery with well-care retention.

Malnutrition among under-5 children is a major challenge in low-income and middle-income countries, contributing to poor growth and development. Growth monitoring and promotion (GMP) is recommended by WHO for early detection, yet its implementation remains weak due to limited resources and health system gaps. While many studies focus on utilisation, little is known about facility readiness, especially from multicountry analyses. This study aimed to assess the readiness of health facilities to provide growth monitoring (GM) service and associated factors using nationally representative data.

Secondary analysis of existing cross-sectional survey data.

Secondary data from service provision assessment surveys of Afghanistan, Bangladesh, Ethiopia, Haiti, Nepal and Tanzania was used.

We included 6595 health facilities, which have complete information. Health facilities’ readiness score was constructed as a counting score with regard to the availability of essential indicators required to provide GM services by using WHO service availability and readiness assessment.

Among 6595 health facilities, 28.5% (95% CI 27.4% to 29.6%) of the facilities reported at least 75% of the relevant items for GM service provision. The factors associated with health facilities’ readiness to provide GM service were quality assurance activities (incident rate ratio (IRR): 1.15; 95% CI 1.07 to 1.24), separate user fees (IRR: 1.10; 95% CI 1.00 to 1.20), fixed user fees (IRR: 1.20; 95% CI 1.10 to 1.31) and presence of trained health provider at facility 24 hours (IRR: 1.09; 95% CI 1.02 to 1.17).

Health facilities in six countries showed low readiness for GMP services. Strengthening facility capacity, staffing, equipment and quality assurance is essential to improve readiness.

The COVID-19 pandemic accelerated telehealth adoption, offering remote consultations via phone and video. Allied health services are one part of the healthcare system where telehealth, in specific teleconsultations, has been applied and has shown promising results in improving healthcare access by breaking down financial, logistical and geographic barriers. However, more insight is needed into the consumer’s perspective. A consumer is anyone who has used, currently uses or will use telehealth for allied health services. Therefore, this study explores consumer experiences and preferences, identifying barriers and facilitators to telehealth for allied health services.

This qualitative study used focus group discussions to evaluate consumers’ experiences with telehealth for allied health services. Allied health was defined as healthcare professionals distinct from medical, dental and nursing fields. Eight focus groups with 57 participants were conducted. The participants were recruited from the general public as well as seldom represented communities such as a support service focused on improving and maintaining members’ mental health, the deaf and hard-of-hearing community, young disabled people and the Pacific Islander community. An inductive thematic analysis was used to analyse the data.

Five main themes were identified. First, the consumer with their individual characteristics and context played a major role in the suitability of telehealth. Second, the allied health practitioner and their skills influenced the quality and therefore the success of remote consultations. Further, the relationship between consumer and practitioner contributed to the success of telehealth. The appointment itself was equally often discussed. While telehealth improved access to care, remote appointments were seen as more suitable for questions and verbal exchanges. Lastly, the technology was an important factor with the availability of necessary technology and the accessibility of it playing a central role.

The findings reinforce existing research while highlighting new insights from often under-represented groups, emphasising the importance of telehealth choice, accessible technology and quality standards.

The WHO Safe Childbirth Checklist (SCC) has been implemented in diverse settings to improve the quality and safety of intrapartum care, but implementation strategies and their relationship with adoption and fidelity remain heterogeneous and incompletely described.

To describe the landscape of SCC implementation, map the implementation strategies used and explore how these strategies were reported in relation to adoption and fidelity.

We included primary studies reporting SCC implementation in healthcare settings that described at least one implementation strategy, with no restrictions on country or language. Studies that did not report implementation strategies or did not involve SCC use in real-world care settings were excluded.

We searched PubMed, Embase, CINAHL, Global Health and Global Index Medicus (June 2024), screened reference lists and consulted grey literature for the period 2009–2024.

This scoping review followed JBI methodology (Peters et al) and was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. We extracted study characteristics and implementation findings, coded strategies using the Expert Recommendations for Implementing Change (ERIC) taxonomy and grouped them by clusters. Adoption (initial uptake) and fidelity (adherence to core components) were categorised following Proctor’s implementation outcomes. We created a descriptive implementation intensity score and conducted exploratory analyses (tertiles, boxplot).

34 studies described 19 SCC implementation projects across 16 countries. We identified 24 distinct ERIC strategies, with most projects using 5–11 strategies. Frequently reported strategies included educational meetings, audit and feedback, supervision, contextual adaptation and leadership or champions. Exploratory analyses did not show consistent associations between implementation intensity and adoption or fidelity. ‘Change infrastructure’ strategies (such as record system or equipment changes) were variably defined and warrant cautious interpretation. Adaptations (eg, translation and alignment with national guidelines) were common and aimed at improving local fit, but heterogeneous reporting limited cross-study comparability.

SCC implementation has relied on diverse, multicomponent strategies, yet reporting—especially of strategy content and adaptations—remains insufficient, constraining comparison and synthesis across settings. As a pragmatic bundle, implementers may prioritise brief team training, unit-level champions and leadership signals, point-of-care audit and feedback, light-touch SCC adaptation that preserves core content and structured supervision or peer coaching, combined with systematic inclusion of women and families through codesign and companion-mediated prompting. Using theory-informed frameworks (such as Exploration, Preparation, Implementation, and Sustainment and Consolidated Framework for Implementation Research [CFIR]) and standardised reporting tools (eg, Proctor’s outcomes; Template for Intervention Description and Replication / Standards for Reporting Implementation Studies [TIDieR/StaRI]) can make SCC implementation strategies more transparent, comparable and scalable.

Open Science Framework: https://doi.org/10.17605/OSF.IO/RWY27.

Patient safety is a central pillar of healthcare quality. However, with repeated examples of failure emerging across healthcare, there is an ongoing need to better understand how the safety of care can be improved for patients. Evidence suggests that some population groups are more likely to inequitably experience healthcare harm. This review will look at what evidence exists on understanding patient safety harm and its causes and impact on different population groups and particularly those from marginalised backgrounds. It will also focus on what actions can be taken to address patient safety disparities and service improvements, including with patient and public involvement.

A scoping review of empirical and grey literature will be conducted following the Joanna Briggs Institute guidance. Medical databases such as Medline, EMBASE, PsycINFO will be searched for peer-reviewed articles and grey literature sources such as BASE, institutional and government repositories will be searched for reports, independent reviews, confidential enquiries, etc. These will be searched from 2001 to present for publications in English. Title and abstract and full text screening will be undertaken by one or more people acting as first reviewers and validated by a second reviewer. A data extraction form will be used to extract data including equity considerations following the PRO EDI framework. Data will be grouped thematically and analysed using a narrative approach.

Ethics approval is not required for this work as the information used is publicly available. The findings of the review will be disseminated through stakeholder meetings, a peer-reviewed publication and conference presentations.

osf.io/4mfus.

This study aimed to examine adverse event occurrences in outpatient care settings and healthcare utilisation after discharge and to identify the characteristics of patients at high risk of safety issues during the care transition from the hospital to their homes. In addition, the performance of outpatient triggers for the detection of adverse events was explored.

A retrospective cohort study using hospital medical record reviews over 6 months postdischarge.

A tertiary teaching hospital in South Korea.

A total of 746 adult patient medical records mainly including patients potentially at high risk of adverse events were analysed, comprising 5439 outpatient visits.

Occurrence of adverse events.

Approximately 14.2% of patients experienced at least one adverse event within 6 months postdischarge. Medication-related (84.2%) and surgical/procedural (13.2%) events were common. Most events were mild in severity and assessed as unpreventable. Patients who experienced adverse events had significantly more all-cause re-hospitalisations, emergency room visits and outpatient clinic visits. No difference was found in mortality. Controlling for other variables, multiple logistic regression analysis showed that patients who are overweight (OR=0.48, 95% CI 0.25 to 0.90), with circulatory system diseases (OR=0.38, 95% CI 0.15 to 0.96) and with a National Early Warning Score 2 (NEWS2) ≥2 at discharge (OR=0.26, 95% CI 0.12 to 0.54) were less likely to experience adverse events. Those with admissions via emergency rooms or day-surgery centres (OR=1.98, 95% CI 1.18 to 3.32), in medical departments (OR=1.93, 95% CI 1.15 to 3.23), with a diagnosis of cancer (OR=2.03, 95% CI 1.14 to 3.62) and longer hospital stays (OR=1.07, 95% CI 1.02 to 1.11) were more likely to experience adverse events postdischarge. Outpatient triggers with relatively high performance included ‘constipation with narcotics/calcium channel blockers’, ‘abrupt medication discontinuation’, ‘rash’ and ‘white blood cell count 3’.

Approximately 14% of patients, mainly comprising high-risk patients, experienced adverse events postdischarge, with more emergency room visits and all-cause re-hospitalisations. Patients experiencing adverse events were characterised by body mass index, type of admission route, clinical department, medical diagnosis, length of hospital stay and NEWS2. Patient and caregiver participation in the monitoring and reporting of adverse events should be encouraged to improve postdischarge patient safety. The use of triggers to detect potential patient safety problems is recommended.

The global population of older adults has grown at an unprecedented rate, and projections indicate that the number of older adults will continue to increase considerably in the coming decades. The clinical complexity of older adults living in retirement homes, also known as assisted living settings, is also increasing, and the regulations to ensure quality and safety standards in retirement homes are highly variable. The purpose of this scoping review is to map and summarise the methods used to monitor and measure the safety of older adults living in retirement homes, providing an overview of existing approaches and areas requiring further investigation.

This scoping review will follow the five stages of the Arksey and O’Malley scoping review process. We will report this review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews. A comprehensive search of four electronic databases (MEDLINE (Ovid), EMBASE (Ovid), CINAHL (EBSCO) and Web of Science Core Collection) will be performed, and reference lists of included articles will be searched. We will conduct a two-step screening process, data extraction and analysis of the included studies. We will include all primary study designs that report on safety measurement and monitoring of any type of harms. Relevant grey literature will also be identified. We will exclude studies that only report results from facilities providing 24-hour skilled nursing care or specialised care services, and those not published in English or French. This protocol is registered on the Open Science Framework (osf.io/8rheq).

No ethical approval is needed for the review, and we plan to present the results at research conferences and in a peer-reviewed article. Our findings may inform future research studies that seek to support and improve safety practices in retirement homes.

To explore the perceived importance of essential Value-Based Healthcare (VBHC) and patient-centred care elements within operational military healthcare among wounded service members (WSM), military surgeons (MS) and medical commanders, and to identify preconditions that enable the delivery of patient-centred care and relevant medical outcomes during military operations.

A two-round Delphi study was conducted following the Accurate Consensus Reporting Document guideline. An initial list of 17 preconditions was developed through a narrative-style literature review and expert-panel discussion. Preconditions were rated on a four-point Likert scale (‘not important’ to ‘very important’) to reach consensus on ‘military-oriented’ preconditions for patient-centred trauma care.

An in-person expert-panel meeting and subsequent online Delphi surveys conducted between March 2020 and September 2022.

The expert panel consisted of Dutch military healthcare leaders and clinical specialists. A total of 30 participants completed both Delphi rounds, including 17 MS and commanding officers (Group 1) and 13 WSM (Group 2) with deployment experience in Uruzgan, Afghanistan, ensuring balanced representation of care providers, facilitators and recipients.

Primary outcome: identification of military-oriented preconditions essential for patient-centred and value-based trauma care. Secondary outcome: conceptual contribution to the future development of patient-centred outcome measures for military trauma populations.

Consensus was reached on 10 preconditions perceived as important or very important. While Group 1 prioritised operational readiness and procedural efficiency, Group 2 emphasised communication, shared decision-making and family involvement. Both groups rated informed consent, timely treatment registration and patient safety as the most critical elements, demonstrating convergence between logistic-oriented and patient-oriented perspectives.

Integrating VBHC principles into military medical doctrine can reconcile operational readiness with patient-centred care. The consensus-based preconditions identified in this study provide a foundation for developing measurable outcomes that reflect value for both patients and the military health system and can guide future VBHC implementation in trauma-related operational care.

This study investigated district-level variations in the impact of COVID-19 on maternal, neonatal and child healthcare (MNCH) service utilisation, delivery and health outcomes in Gauteng, one of the hardest-hit provinces in South Africa.

A cross-sectional quantitative study.

We collected District Health Information System data for MNCH services from all 493 public healthcare facilities across all five districts in Gauteng province. We applied simple linear regression to assess key performance indicators before (March 2019 to February 2020) and during (March 2020 to February 2021) the COVID-19 pandemic. A pooled multiple linear regression model compared the impact of the pandemic in each district with that of the Johannesburg reference district. The regression models followed the bootstrap approach. Analyses were performed in Stata V.17.0.

Regarding service utilisation, primary headcount under 5 years (n) significantly decreased in all five districts during COVID-19. The effect was greater in Johannesburg (–20 954.5, 95% CI –28 913.3 to –12 995.7; p

In Gauteng province, the COVID-19 pandemic caused a heterogeneous adverse impact on MNCH service utilisation, delivery and health outcomes across the districts. Recognising the geographical differences in the effects of outbreaks and pandemics is critically important for informed decision-making to support healthcare services recovery in affected areas and for planning against future crises.

To evaluate the impact of public–private mix (PPM) models for tuberculosis (TB) on health, process and system outcomes, adopting the WHO’s definition of PPM, which is a strategic partnership between national TB programmes and healthcare providers, both public and private, to deliver high-quality TB diagnosis and treatment.

Systematic review without meta-analysis using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines.

EMBASE, MEDLINE, Health Management Information Consortium, Social Sciences Citation Index, Science Citation Index, Emerging Sources Citation Index, CENTRAL, Database of Disability and Inclusion Information Resources, WHO Library Database and 3ie.

We included all primary studies examining PPM models delivering TB services in urban health sectors in least-developed, low-income and lower–middle-income countries and territories.

17 reviewers were involved in data extraction in COVIDENCE using a prepiloted template. All extractions were completed by a single reviewer and checked by a second reviewer. Quality appraisal was carried out using the mixed-methods appraisal tool, covering mixed-methods, qualitative and quantitative study designs. Narrative synthesis was carried out by tabulating and summarising studies according to PPM models and reported in line with the synthesis without meta-analysis guidelines.

Of the 57 included studies, covering quantitative (n=41), qualitative (n=6) and mixed-method (n=10) designs, the majority were from Southeast Asia (n=37). PPM models had overall positive results on TB treatment outcomes, access and coverage and value for money. They are linked with improved TB health workers’ skills and service delivery. Most outcomes tended to favour interface models, although with considerable heterogeneity. Inconsistent implementation of national TB guidelines, uncoordinated referrals and lack of trust among partners were identified as areas of improvement. Evidence was lacking on the involvement of informal providers within PPM models.

PPM models can be effective and cost-effective for TB care in urban low- and middle-income countries contexts, particularly when levels of mistrust between public and private sectors are addressed through principles of equal partnership. The evidence indicates that this may be more achievable when an interface organisation manages the partnership.

CRD42021289509.

To assess the feasibility and preliminary effectiveness of ‘Partners for Patient Safety’ (P4PS) programme for strengthening competencies and patient engagement at the organisational level.

Prospective study with three measurement points (baseline, interim and follow-up) and an explanatory sequential mixed methods approach for formative and process evaluation.

Oncology-focused patient and family advisory councils (PFACs) integrated into healthcare organisations and networks in five German federal states.

Initially, 36 stakeholders of six PFACs were recruited. At follow-up, 27 participated in all intervention modules and completed all surveys. From those, 14 participated in follow-up interviews.

The P4PS programme consists of two sequentially implemented modules: (1) an e-learning module and (2) a 4-hour on-site workshop. The programme focuses on the following topics: patient safety (PS), communication strategies and PFAC engagement in respective care organisations.

Primary outcome measures were feasibility domains, assessed via standardised (acceptability, appropriateness, feasibility) and self-developed measures (relevance, acceptability and social validity, complexity and practicability, demand and implementation, and adaptability). Secondary outcome measure was preliminary effectiveness, measured via changes in self-assessed competencies in PS, communication and engagement.

Feasibility ratings were high across standardised and self-developed measures (median range: 4–5 of 5). Qualitative data showed P4PS programme’s practical relevance, need for organisational support and its adaptability across PFAC contexts. Effectiveness analyses showed significant improvements in PS competencies (adjusted pV) and selected domains of PFAC engagement (adjusted pd=–0.77 to –1.37). Participants expressed strong expectations for future improvements in competencies regarding PS, communication and PFAC engagement.

This P4PS programme showed high feasibility and effectiveness, it increased key competencies, clarified roles and promoted active PFAC engagement in PS. Future work needs to address organisational support and sustainable implementation with application to context as well as long-term evaluation across different care settings.

DRKS00034733; German Clinical Trials Register.

Occupational gender segregation is a contributing factor to gender pay inequity in medicine but has not been thoroughly characterised. We assessed the historical relationship between surgeon sex, type of work and value of procedural payments. We hypothesised that female surgeons perform lower-paying procedures as a group, and that this could be seen both with broad historical overview and with focused analysis of major operative procedures in a specific year.

We conducted repeated cross-sectional studies using public payment data from the Canadian Institute for Health Information. We calculated average payment per service by sex and service category and used linear regression to assess the association between proportion of female surgeons performing a procedure and payment value per procedure for 41 major procedures in 2019–2020.

Surgeons in 10 Canadian jurisdictions from 1996 to 1997 (5459) to 2019–2020 (8069).

The proportion of female surgeons increased over the study period from 10.5% (n=575) in 1996–1997 to 28.7% (n=2314) in 2019–2020. The sex gap in the average payment per service narrowed but persisted. A greater proportion of women’s earnings came from non-procedural work in consultation and visits (43% for women vs 36% for men in 2019–2020) while a greater proportion of men’s earnings was from procedural work in major surgery (23% for women vs 38% for men in 2019–2020). There was an inverse relationship between proportion of women performing a procedure and payment value such that for one percent increase in female proportion, the procedural payment was CAD$1.77 lower.

Our findings suggest that women receive fewer procedural payments than men and tend to perform lower paying procedures. Reforms to referral systems and billing codes can help address root causes for the gender pay gap in surgery.

This study investigates how lean management (LM) practices align with and contribute to strategic objectives in healthcare using the congruence model as a conceptual framework.

This study employed a qualitative research design, integrating both inductive and deductive approaches. Data were collected from multiple hospital departments using primary and secondary sources. Primary data included semi-structured interviews, guided by a standardised interview protocol. Secondary data consisted of reports on courses of action, annual reports, policy documents and findings from exploratory meetings. The analysis involved iterative cycles of open coding, axial coding and selective coding to systematically identify and refine themes, supporting thematic analysis.

Six departments: Kidney and vascular surgery, Care core movement, Clinical department, Systemic diseases, Oncology, Care core Hepato-Pancreato-Biliary disease (HPB), which were part of one business unit within a tertiary care institution, a University Medical Centre in the Netherlands.

22 respondents aged 18 years or older were purposefully selected based on their organisational roles and LM experience. Respondents had to be involved in LM practices, which meant they had to understand LM and have passed at least one LM training programme, or they should be enrolled in a training course during the research.

Interviewees identified several barriers to LM implementation, including insufficient management support for a culture of continuous improvement, limited time for LM projects, inadequate recognition from management and poor communication of strategic objectives. Despite positive individual experiences with LM projects, their contribution to strategic objectives was deemed limited due to these barriers. Specific challenges included an experienced lack of leadership commitment, inadequate follow-up on projects, insufficient resource allocation, limited access to training and leaders failing to acknowledge employee value. Facilitators of success were fostering a culture of continuous improvement, committed managers and providing training.

LM practices have the potential to contribute to strategic objectives in healthcare organisations by reducing waste, improving patient care quality and optimising processes. However, their impact is constrained by organisational barriers and misalignments. Challenges such as insufficient resources, poor project follow-up, lack of management support and the absence of a continuous improvement culture minimise LM’s effectiveness.

The Veterans Health Administration (VA) integrated mental and physical health services to better detect and treat depression. Primary care nurses conduct screening annually. Clinicians, including Primary Care Mental Health Integration (PCMHI) specialists, follow-up as needed for treatment. Depression detection and management processes are complex, involve multilevel stakeholders, and are subject to significant disruption from COVID-19 and from the resulting expansion of telehealth, aiming to preserve care access. This study aimed to examine whether the COVID-19 pandemic worsened depression-related care quality and/or patient outcomes (eg, suicide).

Given hypothesised care disruption (lowered care quality) during COVID-19, we will first assess the VA population’s trajectory from a new positive depression (and suicide risk) screen to appropriate treatment (ie, medication, therapy) in the Fiscal Year 2019–2323. We will also examine the changing mix of virtual and in-person depression care delivered. Second, we will use interrupted time series analyses to explore the extent to which psychiatric emergency visits and hospitalisations may be mitigated by clinician detection of depression. As well as compare mental health-related mortality rates between patients detected and not detected to have depression. Subanalyses will reveal where (eg, clinics with low PCMHI access) and for whom (eg, minorities) detection does not systematically occur, and downstream negative sequelae, to guide future intervention. Finally, we will interview 40 veterans, half of whom were detected and half not detected to have depression and 40 VA primary care and PCMHI providers about changes brought on by the pandemic and the expansion of virtual care across three VA facilities. In addition to contextualising disrupted care findings, qualitative data will help identify best practices on patient-to-provider and provider-to-provider interactions in hybrid in-person/telehealth depression care models.

Ethics approval was granted by the VA Greater Los Angeles Healthcare System Institutional Review Board. Alongside journal publications, dissemination activities include briefings to our policy and operational partners, and presentations to clinical, research and policy-oriented audiences.