Conectar
In the context of declining total fertility rates, many governments are seeking the optimal blend of policy interventions to encourage childbirth. Scholars have mapped how pronatal policy agendas are shaping social policies, yet there has been less attention on how such agendas shape health policies. This review will map and synthesize the evidence on how pronatal policies affect sexual and reproductive healthcare.
A scoping review will be conducted using two searches. One search will identify relevant peer-reviewed papers in Medline, EMBASE, social policy and practice, global health and Web of Science databases. A second search will identify relevant grey literature from Overton and Policy Commons databases. Sources will be managed using Rayaan software and studies selected based on specified inclusion criteria. Data will be extracted using a customised extraction form, mapped and subsequently synthesised using narrative approach.
This review will be disseminated through a peer-reviewed manuscript and conference presentations. Ethics and patient engagement are not required for a scoping review.
CRD420251156155.
This study aimed to co-design a model of brilliant care for older people that provides clear, actionable principles to guide how brilliant care for older people can be realised.
As the demand for and international importance of care for older people grows, so too does the negative discourse about care for older people. This ongoing focus on deficiencies can have implications for patients, carers, clinicians, health services, and policymakers, overshadowing opportunities for innovation and positive change.
Experience-based co-design informed this study, grounded in the lived experiences of key stakeholders.
Three scaffolded co-design workshops were facilitated, involving lived experience experts, managers, professionals, clinicians, and an academic (n= 13). The data collected during these workshops were analysed using a qualitative descriptive method and documented according to COREQ guidelines to optimise rigour and transparency.
The participants co-designed a model of brilliant care for older people, comprising principles to promote connection and innovation. To promote connection, the model includes protecting staff member time to deliver meaningful care and demonstrating that everyone matters. To promote innovation, it encourages role flexibility, curiosity, small improvements, and the recognition of brilliant practices.
This article presents a co-designed model of brilliant care for older people, incorporating principles of connection and innovation that can be enacted through simple, resource-efficient practices.
For those who manage and deliver care for older people, the model encompasses simple, accessible, and cost-effective principles to: positively deviate from norms within the sector, offering care to older people; and to deliver brilliant care for older people. Furthermore, given that the model was co-designed with lived experience experts, managers, professionals, and clinicians, its principles are imbued with their experiential insights, which served to bring particular priorities to the fore.
The co-designers, who included lived experience experts, were invited to participate in workshops to co-design a model of brilliant care for older people, during which they discussed and critiqued the findings constructed from the data and co-designed the model.
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.
Venous thromboembolism (VTE) is a common complication of traumatic brain injury (TBI) and is associated with increased morbidity and mortality. Low molecular weight heparin (LMWH) is recommended for prophylaxis against VTE after trauma but may increase the risk of progression of intracranial bleeding. Limited evidence exists to guide clinicians regarding the optimal timing of VTE prophylaxis in patients with acute TBI. This randomised controlled trial (RCT) will directly compare the safety and effectiveness of early versus delayed initiation of LMWH in patients with moderate to severe TBI.
The study design is a Bayesian adaptive RCT comparing early (within three calendar days of injury) versus delayed (after study Day 7) VTE prophylaxis with the LMWH, dalteparin. All patients receive sequential compression devices until study Day 8. The co-primary effectiveness outcome is the development of clinically important VTE at study Day 8. The co-primary safety outcome is the development of clinically important intracranial bleeding at study Day 8. Secondary outcomes are mortality and functional outcomes (Glasgow Outcome Scale Extended and EQ-5D) measured at study Days 30 and 180; clinically diagnosed VTE to Day 30 and progression of intracranial bleeding to Day 8.
This study has been approved through Clinical Trials Ontario’s streamlined ethics review process (board of record, Sunnybrook Health Sciences Centre) and all participating centres. It is conducted in accordance with the Declaration of Helsinki, Good Clinical Practice guidelines and Health Canada regulatory requirements. We anticipate that the trial will achieve wide dissemination through publication in a peer-reviewed medical journal and presentation at international conferences targeting the fields of critical care, trauma and neurosurgery. The results of this trial will help guide clinicians aiming to balance the risks and benefits of early anticoagulant prophylaxis after TBI and will inform guideline development.
Past studies show a mixed relationship between the Global Health Security (GHS) Index and COVID-19 pandemic health outcomes. Some recent work that suggested higher GHS Index scores are associated with better mortality outcomes has been criticised on methodological grounds. There remains scope for improved analyses of these relationships, including of island nations and macroeconomic pandemic outcomes. We aimed to determine the relationship between GHS Index scores and COVID-19 pandemic excess mortality 2020–2021 and macroeconomic pandemic outcomes.
Cross-sectional, multivariable regression design (controlling for per capita gross domestic product (GDP) and political corruption), comparing island and non-island jurisdictions.
194 jurisdictions with 2019 GHS Index scores.
Age-standardised cumulative excess mortality 2020–2021, GDP per capita growth 2019–2020 and 2020–2021.
The GHS Index predicted better health outcomes in terms of age-standardised excess mortality through 2020–2021 in non-island jurisdictions (β=–0.046, p=0.00068, adj R2=0.48), but not in island jurisdictions (β=0.012, p=0.734). For a starting age-standardised excess mortality of 100 per 100 000, a +10-point rise in overall GHS Index score predicts a 26.7 per 100 000 reduction in age-standardised mortality. We found no robust evidence that a higher GHS Index predicted higher year-on-year GDP per capita growth through 2019–2020 or 2020–2021.
The GHS Index demonstrated clear associations with favourable health outcomes of non-island jurisdictions through the COVID-19 pandemic, supporting its use to guide pandemic preparedness investments. Contrasting findings for islands suggest the need to enhance how the Index measures border biosecurity capacities and capabilities, including the ability to support the exclusion/elimination strategies that successfully protected islands during the COVID-19 pandemic.
The aim of this study was to identify nurses' responses to psychological trauma and strategies to support nurses' healing and resilience during COVID-19 and generate creative integrated understandings of nurses' responses to psychological trauma and strategies supporting nurses' healing and resilience during COVID-19.
COVID-19 exacerbated trauma already experienced by some nurses. Nursing leadership called for action to improve nurses' mental health and resilience. However, policy changes have been rudimentary and insufficiently funded. Negative impacts manifesting as mental health disorders may significantly disrupt care quality, deepen nursing shortages and de-stabilize healthcare systems. Building nurses' capacity to respond with resilience is widely indicated for countering harmful effects of psychological trauma and enabling professional longevity.
Integrative review design was used to support discovery of emergent knowledge, as phenomena of interest lacked a traditional empirical evidence base.
Cumulative Index to Nursing and Allied Health, ProQuest Nursing & Allied Health, and PubMed databases were searched for nursing publications, January–October 2020. Search words included nurs*, COVID-19, Coronavirus, pandemic, post-traumatic stress disorder, trauma, mental health, resilience. PRISMA Checklist standards guided reporting. Joanna Briggs Institute tools facilitated quality measurement. Inclusion criteria were English language and nursing focus on trauma, healing or resilience strategies. Thirty-five articles met inclusion criteria. Elo and Kyngäs' qualitative content analysis method guided thematic analysis.
Findings suggest dysfunctional responses for some nurses to COVID-19 trauma, or living fearful, uncertain and unstable. Findings also reveal numerous potential regenerative healing and resilience strategies for nurses, or living whole, optimistic and supported. Individual actions of self-care, adjustment, social connection and finding meaning, coupled with workplace changes, hold potential to improve nurses' future.
Risks to nurses' mental health from COVID-19's extraordinary intensity and duration of trauma warrant timely research.
Nurses' responses to COVID-19 trauma are complex, but strategies for professional resilience are abundant.
To explore the key factors influencing nurses' capability, opportunity and motivation to offer the choice for self-collection for cervical screening within rural primary care services, following a national policy change in Australia.
A qualitative study informed by implementation and behavioural change frameworks.
Primary health nurses working in Victoria were invited to participate in semi-structured interviews via video or telephone between December 2022 and March 2023. Eighteen nurses from 18 clinics participated. Interview data were analysed following a Framework analysis approach, and themes were mapped to the COM-B model.
Nurses were highly motivated to offer the choice for self-collection due to perceived advantages for their patients and potential opportunities for reaching people hesitant to screen. There was variation in how nurses offered this choice, and to whom. Some nurses were concerned about lost opportunities to visualise the vulval area or cervix, or to have broader health and wellbeing conversations with patients. Views were mixed about how self-collection would impact nurse roles, and several external factors were impacting their opportunities as cervical screening providers.
Appropriately trained nurses have the capability and motivation to incorporate the choice for self-collection within their screening practice; however, their opportunity to maximise equity and increase participation is impacted by funding models and structures that limit their autonomy.
People living outside major cities experience greater healthcare inequities. Australia introduced access to the choice for self-collection for all eligible individuals in 2022, in part to achieve greater equity in the national screening program. Nurses can play a key role in program delivery. Understanding how they incorporate self-collection into their practice, and the key factors influencing implementation in rural primary care settings, can inform future program implementation and improve outcomes for patients.
We have adhered to COREQ reporting guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
Inherited retinal diseases (IRDs) are a broad range of diseases associated with abnormalities/degeneration of retinal cells. We aimed to identify the top 10 Australian research priorities for IRDs to ultimately facilitate more meaningful and potentially cost-effective research.
We conducted a James Lind Alliance priority setting partnership that involved two Australian-wide surveys and online workshops.
Australia-wide.
Individuals aged 16 years or older were eligible to participate if they had an IRD, were caregivers of an individual with an IRD or were health professionals providing care to this community.
In Survey 1, we gathered participants’ unanswered questions about IRDs. We grouped these into summary questions and undertook a literature review to verify if they were truly unanswered (ie, evidence uncertainties). In Survey 2, participants voted for the uncertainties that they considered a priority. Top-ranked uncertainties progressed for discussion and final prioritisation in two workshops.
In Survey 1, we collected 223 questions from 69 participants. We grouped these into 42 summary questions and confirmed 41 as evidence uncertainties. In Survey 2, 151 participants voted, with the 16 uncertainties progressing to final prioritisation. The top 10 priorities, set by the 24 workshop participants, represented (1) treatment/cure; (2) symptoms and disease progression; (3) psychosocial well-being and (4) health service delivery. The #1 priority was for treatment to prevent, slow down or stop vision loss, followed by the #2 priority to address the psychological impact of having an IRD.
The top 10 research priorities highlight the need for IRD research that takes a whole-person, systems approach. Collaborations to progress priorities will accelerate the translation of research into real-world benefits.
Public involvement in mental health research enhances research quality. The use of citizen science methods in mental health research has been described as a conclusion of a movement towards increased public involvement; however, this field is in its early stages of development. Our objective was to create a theory of change (ToC) for how citizen science can be used to enhance mental health research quality.
Iterative consultation with the stakeholders of an existing citizen mental health science study, that is, change for citizen science to achieve co-production at scale (C-STACS: https://www.researchintorecovery.com/research/c-stacs/)
We co-developed a ToC through an iterative consultation with C-STACS stakeholders who were (a) representatives of mental health community organisations (n=10), individuals with public involvement experience (n=2) and researchers (n=5). In keeping with established ToC practice, entities were identified, including long-term impacts, outcomes needed to create an impact, stakeholder assumptions and indicators for tracking progress.
A desired primary long-term impact of greater co-production of research was identified between researchers and members of the public, which would create a secondary impact of enhancing public capacity to engage in citizen mental health science. We proposed long-term outcomes needed to enable this impact: (1) greater co-production of research objectives and pathways between researcher and the public, (2) greater embedment of citizen mental health science into funder processes (eg, the creation of specific funding calls for citizen mental health science proposals, (3) greater clarity on the boundaries between citizen science and other participatory approaches (eg, so that there is not loss of impact due to conceptual confusion between these, (4) increased knowledge around effective frameworks to enable mass public participation and (5) greater availability of technology platforms, enabling safe and accessible engagement with citizen mental health science projects.
The proposed ToC is grounded in the C-STACS project, but intended to be broadly applicable. It allows the continued formation of a community of practice around citizen mental health science and should be reviewed, as greater knowledge is developed on how citizen mental health science creates change.
Thanks to the introduction of recent national guidelines for treating herpes simplex virus (HSV) encephalitis, health outcomes have improved. This paper evaluates the health system costs and the health-related quality of life implications of these guidelines.
A sub-analysis of data from a prospective, multi-centre, observational cohort ENCEPH-UK study conducted across 29 hospitals in the UK from 2012 to 2015.
Data for patients aged ≥16 years with a confirmed HSV encephalitis diagnosis admitted for treatment with aciclovir were collected at discharge, 3 and 12 months.
Patient health outcomes were measured by the Glasgow outcome score (GOS), modified ranking score (mRS) and the EuroQoL; healthcare costs were estimated per patient at discharge from hospital and at 12 months follow-up. In addition, Quality Adjusted Life Years (QALYs) were calculated from the EQ-5D utility scores. Cost–utility analysis was performed using the NHS and Social Care perspective.
A total of 49 patients were included; 35 were treated within 48 hours, ‘early’ (median (IQR) 8.25 [3.7–20.5]) and 14 were treated after 48 hours ‘delayed’ (median (IQR) 93.9 [66.7–100.1]). At discharge, 30 (86%) in the early treatment group had a good mRS outcome score (0–3) compared with 4 (29%) in the delayed group. According to GOS, 10 (29%) had a good recovery in the early treatment group, but only 1 (7%) in the delayed group. EQ-5D-3L utility value at discharge was significantly higher for early treatment (0.609 vs 0.221, p
This study suggests that early treatment may be associated with better health outcomes and reduced patient healthcare costs, with a potential for savings to the NHS with faster treatment.
FreshRSS 