Conectar
by Anas Ismail, Moatasem Salah, Mads Gilbert, Yousef H. Abu Alreesh, Craig Jones
BackgroundGaza has faced numerous military attacks that resulted in mass casualty incidents (MCIs). The ongoing genocide in Gaza has destroyed much of the health system, including killing and injuring of hundreds of health care workers (HCWs). Current thinking on the health system reconstruction lacks empirical data and local HCWs’ perspectives. The study analyses locally driven innovations and lessons learned by HCWs who responded to MCIs between 2018 and 2021 to guide current and future planning of the reconstruction of the health system in Gaza.
MethodsThis was a qualitative study using online and face-to-face interviews with HCWs who responded to the Great March of Return and the 2021 Israeli military attacks. Transcripts and extensive notes from the interviews were recorded and analyzed on NVivo using thematic content analysis. We used the health system building blocks as themes for deductive analysis with a seventh place-based theme (Gaza-specific) to account for the context of Gaza and the MCIs.
ResultsProblems faced by HCWs mostly related to the nature and complexity of traumatic injuries, shortages in HCWs, particularly specialist doctors, poor coordination among actors, duplication of services, and shortages of supplies and equipment. Locally driven innovations and solutions included establishing new services centers, opening and expanding training programs, starting new coordination bodies, and task shifting of staff and facilities. Lessons learned included strengthening training and employment opportunities for staff, enhancing emergency preparedness and capacities, maintaining coordination bodies, enhancing community engagement and strengthening the governance of the Ministry of Health.
ConclusionReconstruction of Gaza’s health system needs to be grounded in its political context and in the experiences of HCWs who have worked in and managed the system. Locally driven solutions and lessons learned can ensure that reconstruction serves as a vehicle for self-determination and sovereignty, rather than entrenching dependency.
To develop and psychometrically test a comprehensive Cancer Nurse Self-Assessment Tool (CaN-SAT).
Modified Delphi to assess content validity and cross-sectional survey to assess reliability and validity.
Phase 1: An expert group developed the tool structure and item content. Phase 2: Through a modified Delphi, cancer nursing experts rated the importance of each element of practice and assessed the relevance and clarity of each item. Content Validation Indexes (CVI) were calculated, and a CVI of ≥ 0.78 was required for items to be included. Phase 3: Cancer nurses participated in a survey to test internal consistency (using Cronbach's alpha coefficients) and known-group validity (through Mann–Whitney U tests). This study was reported using the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) checklist.
The CaN-SAT underwent two rounds of Delphi with 24 then 15 cancer nursing experts. All elements of practice were rated as important. Only three items achieved a CVI < 0.78 after round one; however, based on open-ended comments, 26 items were revised and one new item added. After round two, all items received a CVI above 0.78. The final tool consisted of 93 items across 15 elements of practice. Cronbach's alpha coefficients were between 0.92 and 0.98 indicating good reliability. Mann–Whitney U tests demonstrated significant differences between clinical nurses and advanced practice nurses across 13 out of 15 elements of practice.
The CaN-SAT is a comprehensive, valid and reliable tool that can be used for cancer nurses to self-assess current skill levels, identify their learning needs and inform decisions about educational opportunities to optimise cancer care provision.
The research team included three patient advocates from Cancer Voices NSW, who were actively involved in all aspects of the study and are listed as authors.
by Olatundun Gafari, Ashleigh Craig, Khuthala Mabetha, Duncan Hornby, Craig Hutton, Mary Barker, Shane A. Norris
ObjectiveTo assess the associations between food insecurity, coping strategies, socio-economic status and anxiety, depression and multimorbidity in South Africa.
MethodsData from a nationally representative cross-sectional survey conducted in April 2024 (n = 3171; weighted to 20,955,234 adults aged > 18 years) were used. Food insecurity was measured using the Community Childhood Hunger Identification Project (CCHIP) tool, a validated household-level measure commonly used in South Africa. Coping strategy, anxiety and depression were measured using the coping strategies index, Generalised Anxiety Disorder–7 scale and Patient Health Questionnaire–9, respectively. Multimorbidity was self-reported as ≥2 of 14 known chronic conditions. Multivariable logistic regression was used to test associations, and a generalised structural equation model examined the roles of socio-economic status and coping strategies.
ResultsBeing from a food-insecure household more than doubled the odds of experiencing multimorbidity (OR=2.17, 95% CI 2.17, 2.19), depression (OR=2.96, 95% CI 2.95, 2.97) and anxiety (OR=2.82, 95% CI 2.81, 2.83). Food insecurity accounted for approximately 60% of the total association between socio-economic status and depression, and about 88% of the association between socio-economic status and multimorbidity.
ConclusionsFood insecurity is significantly associated with adverse physical and mental health outcomes. Interventions to improve food security, especially in low socio-economic populations, should be prioritised given their associations with multimorbidity, anxiety and depression. Potential intervention effects will require longitudinal or experimental evaluation.
To understand the regulatory landscape in the UK and globally before the introduction of the Medicines and Healthcare Products Regulatory Agency’s (MHRA) International Recognition Procedure (IRP). This paper aims to inform on the IRP’s potential impact on access to innovative medicines, by comparing medicines approval in the UK with other international regulatory agencies.
A retrospective analysis of 154 technologies (medicine(s) + studied indication(s)) was conducted based on the National Institute for Health and Care Research Innovation Observatory technology briefings submitted to the National Institute for Health and Care Excellence (NICE) in 2020. These briefings serve as the trigger for the NICE Technology Assessment process. Data on the medicines’ submission and approval dates were extracted across five IRP reference regulators, which are the regulators from the US (Food and Drug Administration (FDA)), European Union (EU) (European Medicines Agency (EMA)), Japan (Pharmaceuticals and Medical Devices Agency (PMDA)), Australia (Therapeutic Goods Administration (TGA)) and Singapore (Health Science Authority (HSA)). The dates were compared with data from the UK (MHRA).
95 (62%) medicines were approved by at least one regulatory agency, while 59 (38%) medicines were not approved by any regulatory agency. The number of medicines approved by the following regulatory agencies is FDA (n=84, 55%), EMA (n=80, 52%), MHRA (n=71, 46%), TGA (n=51, 33%), HSA (n=41, 27%) and PMDA (n=38, 25%). The first submissions were primarily to the FDA (n=64) or the EMA (n=24). The FDA had the highest number of first approvals (n=70), followed by the EMA (n=17), PMDA (n=5) and the MHRA (n=1). The FDA used more expedited pathways than other regulators (n=61). Compared with the MHRA, FDA approvals were on average 360 days faster and EMA approvals 86 days faster.
There were significant differences in market access timelines across the five reference regulators, with the FDA and EMA having the highest number of approved medicines, first submissions and first approvals. IRP applications with the FDA or EMA as reference regulators may expedite access to innovative medicines in the UK by reducing the approval dates gap between the FDA/EMA and the MHRA. This understanding of the regulatory landscape will help inform future planning to accommodate the disruption that the IRP may cause.
Acute intracerebral haemorrhage (ICH) is devastating with a 1 month mortality rate of ~40%. Cerebral oedema can complicate acute ICH and is associated with poor outcome. In patients with large ICH, the accompanying swelling increases mass effect and causes brain herniation. Mannitol, an osmotic diuretic, is used to treat cerebral oedema after traumatic brain injury, but its safety and efficacy in ICH is unclear. We aim to assess the feasibility of a phase II randomised, controlled trial of mannitol in patients with ICH with, or at risk of, cerebral oedema to inform a definitive trial.
The mannitol for cerebral oedema after acute intracerebral haemorrhage trial (MACE-ICH) aims to include 45 ICH participants from 10 UK sites with estimated largest diameter of haematoma volume >2 cm, presenting within 72 hours of onset with, or at risk of, cerebral oedema (limited Glasgow Coma Scale (GCS)8) with or without mass effect. Participants will be randomised (1:1:1) to 1 g/kg 10% single-dose intravenous mannitol, 1 g/kg 10% mannitol followed by a second dose at 24 hours, or standard care alone. Outcome assessors will be masked to treatment allocation. Feasibility outcomes include proportion of patients approached being randomised, participants receiving allocated treatment, recruitment rate, treatment adherence and follow-up. Secondary outcomes include serum electrolytes and osmolality at days 1–2; change in ICH and oedema volume at day 5; number of participants who developed urinary tract infection, GCS and National Institutes of Health Stroke Scale at day 5±2; length of hospital stay, discharge destination and death up to day 28; death and death or dependency by day 180 and disability (Barthel Index), quality of life (EuroQol, 5-D) and cognition (telephone mini-mental state examination) at day 180.
MACE-ICH received ethics approval from the East Midlands-Leicester Central research ethics committee (22/EM/0242). The trial is funded by a National Institute for Health and Care Research RfPB grant (203080). The results will be published in an academic journal and disseminated through academic conferences and patient support groups. Reporting will be in line with Consolidated Standards of Reporting Trials recommendations.
ISRCTN15383301; EUDRACT 2022-000283-22.
The experimental EuroQol Toddler and Infant Populations (EQ-TIPS) instrument is currently under development as a health-related quality of life (HRQoL) measure for toddlers and infants aged 0–36 months. Using this protocol, researchers can conduct surveys with discrete choice experiments (DCEs) that examine the key properties of HRQoL instruments, specifically whether severity aligns with preferences across each attribute and the extent to which attributes influence choices. To demonstrate this protocol, we will conduct two waves of DCE surveys using different choice tasks and a common scenario (a 1-month health episode for a 1-year-old child).
In the first wave (a general population sample of 400 Australian adults; 14 kaizen tasks each), respondents will view a single EQ-TIPS-five-level (v3.0) profile for each task and be asked to make a series of choices that sequentially alleviate the child’s health problems. Using this exploratory evidence, we will assess whether EQ-TIPS severity aligns with preferences and the extent to which each attribute level influences choices (ie, main effects). In the second wave (1000 Australian adults; 28 paired comparisons), respondents will see two EQ-TIPS profiles for each task and be asked to choose between them. Using this confirmatory evidence, we will compare the main effects and their uncertainty by wave. For each DCE, we will estimate a main-effects conditional logit model and test for differences in effects using cluster bootstrap techniques. As sensitivity analyses, we will evaluate the effects of task sequence, attribute order and sample size on uncertainty in each wave.
The independent review board at Includovate evaluated the application for ethical clearance and approved the study on 19 February 2025. To disseminate our findings, we will prepare multiple manuscripts for publication in peer-reviewed journals and present highlights at scientific meetings, such as the EuroQol Plenary Meeting and the International Academy of Health Preference Research.
FreshRSS 