Conectar
This study examined social determinants and structural barriers to lung cancer outcomes in Kern and Fresno counties, California, and co-developed a multilevel intervention strategy informed by community perspectives.
Engaging stakeholders through group model building (GMB) to elicit their knowledge to build a system dynamics (SD) simulation model for intervention strategy design.
We identified and trained four community members from two community-based organisations in Central Valley, California, to help recruit GMB participants. 14 community members representing patient advocacy organisations, cancer survivors, clinicians, caregivers, public health professionals, medical interpreters, housing, agriculture, sanitation, healthcare payer organisations and local policymaking sectors were recruited.
The GMB protocol consisted of two in-person and four virtual workshops from 22 August to 11 November 2024. The SD simulation model was built with iSee System’s Stella Architect SD modelling software (V.4.0).
The 181 variables suggested by the GMB workshop participants were categorised into 3 themes and 13 subthemes, which shaped the system boundary and model structure. 7 of the 16 intervention scenarios tested showed a cumulative reduction in the at-risk population and increases in screening, diagnoses, treatment and cancer-free survival. Participants selected a multilevel strategy focused on expanding public health and insurance education and advocating for air pollution-related screening within existing protocols.
Community engagement is essential for understanding lung cancer disparities and designing practical multilevel interventions. Scenario testing enables informed planning to improve long-term population health outcomes.
by Justin Clements, Jenna E. Stanek, Kylie Gallegos, Jessica Celmer, Jesse Berryhill, Andrew Thiros, Mark A. Peyton, Shannon M. Gaukler
Polychlorinated biphenyls (PCBs) are a group of industrial chemicals that were widely used in the United States before being banned by the Toxic Substances Control Act in 1976. Concerns regarding PCBs arose in the 1960s due to their toxicity, classification as a carcinogenic compound, and longevity in the environment. Although the production of PCBs in the United States is currently banned, PCBs can still be found in legacy equipment, and the environment and PCBs are still unintentionally produced in common building materials. To document the concentration of PCBs in biota predominantly found in northern New Mexico, biota (mammalian, avian, and reptilian) were opportunistically collected from 2009 to 2025. We grouped biota species into feeding guilds (carnivore, herbivore, and omnivore) to examine whether different feeding guilds had higher or lower proportions of total PCBs, PCB homologs, dioxin-like PCB congeners, and toxic equivalents. When we examined the concentrations of PCB homologs and total PCBs, we found the highest abundance of PCBs in the carnivore feeding guild compared with both herbivores and omnivores. We also observed differences of dioxin-like PCB congeners among feeding guilds, examined in this study. Toxic equivalents were also observed at higher values in carnivores. Furthermore, we demonstrate the biomagnification of PCBs across trophic levels, with higher concentrations observed in mountain lions relative to their primary ungulate prey (mule deer and elk). A comparison of biota revealed a significant difference in concentrations of PCBs found in samples (mule deer and elk) collected in developed areas when compared with rural locations, with the developed areas having higher concentrations. Our investigation provides significant insight into the distribution, composition, and biomagnification of PCB in terrestrial animals in New Mexico, including the biomagnification of PCBs within the carnivore feeding guild, which could be at a higher risk of adverse effects from PCB exposure.To evaluate greenhouse gas (GHG) emissions from procedure room NanoNeedle arthroscopy (NA) and its associated clinical pathway, compared with conventional arthroscopy (CA) delivered in an operating room, focusing on non-complex knee arthroscopy procedures.
Hybrid carbon footprint analysis using process-based life-cycle methods combined with economy-wide input-output data that include environmental impact factors for medical devices and components of patient care pathways. Three care pathways were evaluated: (1) CA in an OR with preoperative MRI, (2) NA in a procedure room with MRI and (3) NA in a procedure room without MRI. Emissions were calculated for all pathway components, including patient and staff travel, diagnostic imaging, medical devices, the procedure itself and postoperative care.
UK National Health Service-based care pathway model for non-complex knee arthroscopy procedures.
The primary outcome was GHG emissions (kgCO2e) per procedure pathway. Additional analyses assessed emissions by pathway component, adoption scenarios, conversion rates from NA to CA and sensitivity analyses for selected assumptions and input parameters.
The CA pathway generated 77.0 kgCO2e per procedure, whereas the NA with MRI produced 45.0 kgCO2e and NA without MRI 35.3 kgCO2e, representing reductions of 42% and 54% of kgCO2e, respectively. Major emission contributors for CA were patient travel, consumable items and general anaesthesia; for NA pathways, patient travel and the device itself were the leading contributors. Adoption modelling indicated that using NA without MRI for 5000–20 000 knee arthroscopy procedures could yield annual CO2e savings ranging from 208 tons to 834 tons.
Knee arthroscopy delivered via the NA procedure room pathway has the potential to substantially reduce environmental impact compared with conventional OR-based care. As healthcare providers and policymakers increasingly consider environmental sustainability, technologies that enable alternative care models, such as NA in a procedure room setting, may represent a promising approach for reducing the carbon footprint of selected procedures.
Children discharged after in-hospital treatment for severe anaemia or severe malaria in sub-Saharan Africa remain at high risk of readmission and death, particularly in malaria-endemic settings where recurrent infections are common. Post-discharge malaria chemoprevention (PDMC) has demonstrated substantial reductions in mortality and hospital readmissions and is now recommended by the WHO. However, optimal PDMC delivery strategies, via existing health systems, that optimise adherence remain unclear, particularly in West Africa where implementation and evidence of impact on clinical outcomes are limited. This trial aims to determine the effectiveness of different PDMC delivery strategies and adherence support mechanisms in optimising completion of PDMC courses. Secondary objectives include assessing clinical outcomes (readmissions, outpatient visits, mortality), evaluating health system linkage mechanisms and examining the acceptability and feasibility of the different delivery approaches.
A cluster-randomised implementation trial will be conducted in central and southern Benin across urban and rural settings. Clusters, defined as villages within the catchment areas of two referral hospitals, will be randomly allocated (1:1:1) to one of three arms: (A) facility-based drug distribution (all courses) at discharge with community health worker (CHW) home visit reminders; (B) monthly community-based drug delivery by CHWs combined with phone reminders; and (C) dispensing all courses to caregivers at discharge without adherence support (control). Eligible participants are children under 10 years hospitalised with severe anaemia or severe malaria and clinically stable at discharge. All participants should receive three courses of dihydroartemisinin–piperaquine at weeks 2, 6 and 10 post-discharge and will be followed for 14 weeks. The primary endpoint is incomplete adherence to the full PDMC regimen (3 courses/9 doses). Secondary endpoints include all-cause and malaria-specific readmissions, outpatient visits and mortality. Quantitative outcomes will be analysed using mixed-effects regression models under an intention-to-treat approach. Qualitative methods will assess acceptability and feasibility among caregivers, providers and policymakers.
Ethical approval was received from the institutional review boards of the Benin Institute of Applied Biomedical Sciences and Liverpool School of Tropical Medicine. Trial findings will be disseminated to national and international stakeholders through meetings, peer-reviewed publications and major conferences to inform PDMC policy, implementation guidelines and global malaria scale-up efforts, particularly through engagement with the World Health Organization and major malaria funding partners
This study evaluated district-wide implementation of a digital wound model of care combining an artificial intelligence–enabled application with a virtual command centre across four hospitals and five community health centres in Australia. A post-implementation multimethods evaluation (January 2024–January 2026) of patients (n = 94), frontline clinicians (n = 75), and senior wound nurses (n = 9) and a product manager (n = 1) using surveys, semi-structured interviews and analysis of governance meeting minutes. Patient satisfaction was high: 91% rated care as ‘excellent’ or ‘good’, 93% 'agreed' or 'strongly agreed' it was effective and 96% 'agreed' or 'strongly agreed' that they felt confident in the care they received from their wound care provider. Just over half (59%) felt they were meaningfully involved in decisions about their own care, an area identified for targeted improvement in future iterations of the model. The most cited virtual care benefits included improved condition understanding (63%), and reduced travel (49%). Among the 28 patient app users, 89% reported improved communication between them and the wound care provider and 79% self-management confidence. Senior wound nurses rated the app highly for ease of use and continuity of care (both 86%), but poor connectivity was a limitation. Frontline clinicians valued enhanced documentation consistency but reported barriers including time pressures and training burden. This multisite implementation demonstrates that digital wound care models are highly acceptable and deliver perceived clinical benefit, while identifying patient involvement in decision-making and clinician workflow integration as priority areas for future investment.
Salutogenic and health-promoting communication techniques – such as positive health, motivational interviewing, solution-focused approaches and health coaching – aim to strengthen patient empowerment, resource activation and self-management in primary care. Despite growing interest, the evidence on how these approaches are implemented in general practice is fragmented. Guided by the Consolidated Framework for Implementation Research (CFIR), this scoping review will map settings, strategies, determinants and outcomes related to the implementation of salutogenic and health-promoting communication techniques in primary care. This review aims to bridge the gap between theory and routine care by identifying context-sensitive strategies for integrating salutogenic and health-promoting dialogue into everyday general practice.
Following the Joanna Briggs Institute guidance for scoping reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P), we will search MEDLINE, CINAHL and Embase from database inception to the date of search (no date limits; English/German). Eligibility will be structured by the Population–Concept–Context framework. Two reviewers will independently screen studies via Rayyan and chart data with a piloted form that captures intervention components, implementation strategies and contextual determinants mapped to CFIR domains. We will present descriptive summaries and CFIR-based matrices of barriers/facilitators and strategies, alongside narrative synthesis.
Ethical approval is not required. We will disseminate findings via peer-reviewed publication, conference presentations and make all extraction matrices openly available via the Open Science Framework (OSF).
The protocol is registered on the OSF (https://osf.io/my7sh/overview).
Pregestational diabetes is one of the most frequent medical conditions in pregnancy. Nutrition insecurity is a non-medical, health-related social need and affects glycaemic management and pregnancy outcomes for women with both type 1 and type 2 pregestational diabetes. Collaborative healthcare-community partnerships to enhance food access, facilitate culinary medicine, diabetes self-management education and support (DSMES) and address unmet social needs for pregnant women with pregestational diabetes remain to be evaluated.
In a two-arm randomised controlled trial, we will examine the combined effects of a tripartite NOURISH intervention ((1) produce home delivery, (2) culinary medicine with DSMES and (3) community health worker-led social needs assessment and support) versus the current standard of diabetes and prenatal care. We will recruit and enrol 174 pregnant women (87 NOURISH, 87 standard care) ≤22+6 weeks of gestation with pregestational diabetes, inadequate glycaemic management (haemoglobin A1c≥6.5%) and self-reported risk of food insecurity from a diabetes and prenatal care programme at a tertiary care academic health system located in the USA. We will measure the primary outcome of glycaemic management by delivery (haemoglobin A1c
The Institutional Review Board at The Ohio State University approved this study (IRB: STUDY20260307; date: 23 April 2026). We plan to submit results of the trial for publication in peer-reviewed journals and presentations at international scientific meetings.
Targeted next-generation sequencing (tNGS) offers promise in the rapid detection of drug-resistant tuberculosis (DR-TB) directly from sputum. While pilot studies on tNGS are emerging, there is limited empirical qualitative evidence on tNGS implementation. This study, therefore, aimed to explore the experiences of tNGS programmatic implementation by clinicians, laboratory technicians and policymakers to identify perceived key operational barriers and enablers.
An exploratory qualitative study employing inductive thematic analysis. Data were collected via semi-structured interviews and focus group discussion. Analysis was guided by the theoretical framework of acceptance.
This study was conducted between March and October 2025 as part of a broader implementation study evaluating tNGS potential programmatic integration in West Java, Indonesia. Participants were recruited from a DR-TB reference laboratory and a tertiary care hospital.
A purposive sample of 18 tNGS users participated, including clinicians (n=7), laboratory technicians (n=9) and policymakers (n=2).
Analysis revealed a dual challenge for tNGS implementation: technical-operational complexity and unguided clinical utility. Technical barriers include laboratory workflow optimisation and the need for highly skilled technicians for routine operation. From a clinical point of view, lack of local tNGS guidelines for clinicians and absence of local evidence such as cost-effectiveness and diagnostic performance at the policy levels hampered clinical adoption. Several enablers for tNGS implementation were identified, namely technicians with prior sequencing experience, perceived clinical value for complicated cases and advocacy within professional networks.
Successful scale-up of tNGS for DR-TB in high-burden settings requires a coordinated multisectoral strategy. Generating local evidence on robust laboratory data for technical guidelines, clinical utility and cost-effectiveness are warranted to support tNGS adoption. This evidence can then be integrated into the national tNGS roll-out strategy to enable sustainable and nationwide adoption of tNGS.
High cancer mortality in Small Island Developing States (SIDS) is compounded by the insufficient evidence from local epidemiological studies. Stakeholder engagement is particularly important in SIDS to ultimately drive these studies and cancer control. We aimed to map cancer control stakeholders as part of the development of the CaSIDEC study.
The Cancer in Small Island Developing States of the Eastern Caribbean (CaSIDEC) study investigates the role of overseas travel on cancer survivorship in the six countries of the Organisation of Eastern Caribbean States (OECS). Stakeholders were identified during the study planning phases through professional networks, snowballing and public directories. Persons interested in research/cancer care or those capable of influencing it were included in the analysis. We assessed power and interest by attributing scores based on publicly available content and previous interactions. Based on scores, stakeholders were categorised into engagement typologies: promoters, latent, advocates or bystanders. Descriptive statistics were computed, and country-specific variations were examined.
Of 159 identified stakeholders, 96 were analysed. The stakeholder subgroups included supporters (36%), policymakers (32%), implementers (18%) and civil society leaders (14%). The overall mean scores for interest and power were low (4.5/10, SD=2.6 and 4.7/10, SD=2.5, respectively). 29% of stakeholders were classified as latent, 28% as bystanders, 23% as advocates and 20% as promoters. Of these promoters, the majority were implementers and policymakers (36% each). Antigua, Saint Vincent and Saint Kitts had more representation from policymakers but less from implementers compared with other islands.
We carried out the first analysis in the Caribbean, mapping stakeholders for an epidemiological study. Like other developing countries, interest in developing a large-scale epidemiological study was low among stakeholders. Cancer support groups and implementers were strong advocates for this research. Our findings will help guide efforts to increase the political will needed to generate new knowledge and policy.
Health literacy has become increasingly important in healthcare and education. The aim is to provide an overview of school nurses' activities to increase health literacy in schools, and to analyse their conceptual understanding of health literacy.
This mixed-methods study consists of an online survey (n = 65), two focus group interviews (n = 16) and non-participatory observations with school nurses in Germany (n = 5), and expert interviews with interest-holders (n = 10). School nurses' health literacy-related activities, conceptual health literacy understanding, and critical health literacy (measured by the Critical Health Competence Test) were assessed. Quantitative data were analysed descriptively, and the qualitative data by content analysis. Quantitative and qualitative findings were integrated and triangulated using a convergent design.
School nurses address health literacy among students and their relatives through counselling, teaching support, and acute care. Their services are primarily based on a functional health literacy understanding. Experts view schools as key settings for health literacy, led by school nurses.
School nurses use real-life oriented, low-threshold activities to address health literacy and empower students. School nurses' critical health literacy and evidence-based practice could be improved.
School nurses represent a valuable resource to address health literacy in German schools, in line with international approaches. These interventions should be expanded.
This study followed the criteria for Good Reporting of A Mixed Methods Study (GRAMMS), the consolidated criteria for reporting qualitative research (COREQ) and the Checklist for Reporting Results of Internet E-Surveys (CHERRIES).
No direct patient or public contribution.
To develop a care-bundle of non-pharmacological strategies with the potential to prevent constipation in people with dementia in Residential Aged Care (RAC).
Mixed-methods intervention development study using Modified Delphi and co-design, informed by evidence, current constipation prevention practices and stakeholder collaboration to define best practice.
The draft bundle was developed using evidence from a scoping review, consultations with aged care professionals and staff at two RAC homes and field observations. It was then refined through expert and lived-experience panels via an online Modified Delphi survey (rating relevance, acceptability and feasibility) and a face-to-face workshop to finalise items for the constipation prevention care-bundle.
Health data, interviews, observations, surveys and workshops.
The draft care-bundle comprised 24 items; 13 reached ≥ 78% agreement in the Modified Delphi, including dietitian consultation, adequate fibre, individualised hydration and toileting plans, beverage cart, constipation risk assessment, privacy during toileting, dementia-friendly signage, toileting positioning, contrasting toilet seat, electronic alerts, staff education and resident/family information.
An evidence-informed and co-designed care-bundle was co-developed with potential to prevent constipation in residents with dementia.
This research has implications for nursing practice by offering an alternative to reliance on pharmacological strategies for preventing constipation in people with dementia.
This co-designed and evidence-informed care-bundle has potential to reduce the incidence of constipation among the growing population with dementia. To ensure sustained use, it was co-designed with stakeholders to be fit-for-purpose.
There were no reporting guidelines for this co-design study identified.
End-users, including frontline staff and older people receiving care, as well as carers of people with dementia, were engaged in the co-design as equal partners in the constipation prevention care-bundle development process.
Very preterm infants (
Australasian multicentre, two-arm, parallel-group, prospective, randomised, open, blinded-endpoint superiority trial in 868 infants born less than 32 weeks’ gestation. Infants are randomised to cycled environmental light and noise or routine care in a non-cycled hospital environment from soon after birth until discharge home. The intervention comprises wearing eye-masks and ear plugs from 20:00 to 6:00, followed by removal of these devices and exposure to normal environmental noise and 300-600 lux light from 6:00 to 20:00. The primary outcome is composite cognitive score on Bayley-4 developmental assessment at 2 years corrected postnatal age.
The trial is approved by the Child and Adolescent Health Service Human Research Ethics Committee under the National Mutual Acceptance Scheme in Australia. Infants are randomised to intervention or control group after informed parental consent is obtained. Results of the CIRCA DIEM Study will be disseminated widely via presentations at local, national and international conferences, publication in international peer-reviewed journals and inclusion on the study website. Information about trial findings will also be communicated directly to the parents/guardians of trial participants through the regular study newsletter. The trial investigators will seek opportunities to communicate study results to the lay public through media and social media avenues.
ANZCTRN12618000371291.
Musculoskeletal (MSK) conditions affect over 20 million people in the UK and account for one in seven General Practitioner (GP) consultations. To address capacity challenges, First Contact Physiotherapists (FCPs) now manage MSK patients in primary care. However, FCPs working in isolation from physiotherapy teams exhibit broad variation in decision-making that could pose risks to care quality. PRimary Care Individual Social Norms MSK Data Dashboard (PRISM) is a clinician-facing behaviour change digital dashboard that provides individualised social norms feedback such as, ‘you are in the top 10% of those referring to secondary care’ or ‘in the bottom 10% of those referring to social prescribing’. It aims to nudge FCPs towards evidence-based norms, including more effective and cost-efficient treatments, thereby reducing unwarranted variation in care and improving patient outcomes. Social norms interventions have been shown to positively influence clinician behaviour, but their application in MSK services remains unexplored.
To determine the feasibility of evaluating PRISM’s effectiveness and cost-effectiveness in a future clinical trial.
A pragmatic feasibility cluster randomised controlled trial will be conducted across four UK primary care sites with FCP services. Sites will be allocated 1:1 to intervention (PRISM dashboard, guidebook and structured clinical supervision) or control (usual care). Data on clinical decision-making will be collected monthly and anonymised for dashboard generation and compared to an existing dataset of over a million FCP consultations. Patients seen by FCPs will be invited to provide patient-reported outcome measures and experience measures. Feasibility outcomes include recruitment and retention of sites, FCPs and patients; dashboard engagement and completeness of data collection.
The primary outcome is recruitment feasibility. Secondary outcomes include retention, dashboard usage, patient-rated outcome measure/experience measure (patient-rated outcome measures/patient-rated experience measures) completion and supervision engagement. Descriptive analyses will summarise feasibility metrics and missing data. Health economic and carbon reduction data collection will also be assessed for future trial planning.
IRAS number 361 359. REC reference: 25/EM/0256, Approved: 10 December 2025 based on PRISM Protocol V.9. Dated 25 November 2025.
Findings from the PRISM feasibility trial will be disseminated through peer-reviewed publications, conference presentations and stakeholder engagement. Results will also be shared with participating sites, patient and public involvement representatives and professional bodies such as the Chartered Society of Physiotherapy to inform clinical practice and policy. Additionally, lay summaries will be produced for patients and the public and digital channels will be used to maximise reach.
Advances in surgical techniques and neoadjuvant care for rectal cancer have increased sphincter preservation, allowing restoration of bowel continuity through low anterior resection (LAR). However, up to 75% of patients experience low anterior resection syndrome (LARS), which is bowel dysfunction characterised by faecal incontinence, frequency, urgency and clustering of bowel movements, significantly impairing quality of life (QoL). Current management is largely empirical, using lifestyle or pharmacological strategies with variable success. Transanal irrigation (TAI) is a non-surgical intervention that allows controlled colonic washouts, improving symptom control. Evidence supporting TAI for LARS is limited by small sample sizes and is primarily observational, highlighting the need for a rigorous randomised controlled trial (RCT). This study aims to compare TAI with conventional LARS care on QoL, bowel function, faecal incontinence and satisfaction in adults with LARS following LAR.
This is a pragmatic, multicentre, crossover RCT conducted at eight academic hospitals across Quebec, Ontario and British Columbia, Canada. Eligible participants are adults (≥18 years) with an LARS score >20, at least 6 months post-LAR and without an ostomy or active colorectal complications. Participants will be randomised to receive either 3 months of daily TAI or conventional LARS care, followed by a 1 month washout and crossover to the alternate intervention. The TAI intervention includes an irrigation system, access to a web-based educational platform and virtual training with a research team member. Primary outcome is difference in global QoL between interventions, assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Secondary outcomes include bowel function (LARS score), faecal incontinence (Cleveland Clinic Faecal Incontinence Score) and satisfaction. Sample size (n=66, accounting for 10% attrition) was determined using Monte Carlo simulations to detect a 6-point difference in QoL with 85.8% power. Data will be analysed using linear mixed-effects models accounting for period, treatment and sequence effects. All study data will be collected via Research Electronic Data Capture and maintained in secure, password-protected systems; participant confidentiality will be ensured throughout. Safety monitoring will include training on proper TAI technique and reporting of adverse events.
The study has received ethics approval from each participating site. The trial adheres to the Canadian Tri-Council Policy Statement on the use of human participants in research. Findings will be disseminated through peer-reviewed journals, conference presentations and scientific meetings, with authorship following the International Committee of Journal Editors guidelines.
To explore Practice Development interventions and associated contextual factors to understand their impact on patient and staff outcomes and experiences in healthcare settings.
Systematic review.
Preferred Reporting Items for Systematic Reviews and Meta-analysis informed design, conduct and management. A systematic approach was taken, utilising multiple reviewers and consensus methods. Mixed Methods Appraisal Tool informed quality appraisal. Qualitative findings were analysed using Reflexive Thematic Analysis. Quantitative results are presented as a narrative summary.
CINAHL; MEDLINE; PubMed; Scopus; ScienceDirect; Nursing and Allied Health; Cochrane Library; Internurse.com; The Kings Fund; GOV.UK and Trip Database were searched between 1st January 1980 to 5th January 2026.
Twenty-nine studies were included. Eighteen studies met all quality assessment criteria. Limited quantitative data was available, and inconsistent outcome measures constrained quantitative analysis. Qualitative analysis generated three themes: (1) Shaping Practice: the interplay of organisational context, culture, and structure, (2) Enablers and constraints in Practice Development, (3) Collective empowerment.
Across diverse study designs, the majority of studies indicate that PD contributes positively to staff working environments and the contexts in which patient care is delivered. However, current findings do not demonstrate consistent improvements in clinical outcomes or quality of life.
Practice Development may contribute to improvements in care environments for patients and staff, respectively. This review highlights knowledge gaps in the generalisability and transferability of Practice Development that would benefit from further exploration.
Practice Development may enhance healthcare environments, but further research is needed to determine if these benefits impact upon clinical outcomes.
Preferred Reporting Items for Systematic reviews and Meta-Analyses.
No patient or public contribution.
PROSPERO registration number: CRD42024557949
This study aimed to explore emergency medical dispatchers’ (EMDs’) experiences of prioritising patients and stewarding ambulance resources when system capacity was constrained.
Qualitative interview study using inductive qualitative content analysis.
Emergency medical communication centres (EMCCs) in Sweden, operated by the national emergency call provider and responsible for receiving 112 calls and dispatching ambulances.
13 purposively sampled EMDs with at least 1 year of professional experience.
Interviews were analysed inductively using qualitative content analysis (Elo and Kyngäs) through open coding, grouping into subcategories and abstraction into generic categories and one main category.
Dispatchers described prioritisation under scarcity as system work that simultaneously addressed individual patient acuity and population-level readiness. One main category captured this work: stewarding scarce response capacity. Three inter-related generic categories characterised stewardship: (1) prioritising by clinical urgency within geographic and operational constraints; (2) producing availability through anticipation, reassessment and queue governance in a ‘virtual waiting room’; and (3) coordinating response through information infrastructures and interprofessional collaboration. Across categories, dispatchers described redistributing risk across patients and time, managing moral strain when delays could harm patients and using experience, reassessment and teamwork to avoid both under-response to urgent need and over-allocation that would leave areas without coverage.
Dispatch under scarcity is best understood as active stewardship of a safety-critical dispatch queue. Strengthening patient safety therefore requires organisational support for reassessment and escalation during prolonged waits, explicit governance of queue dynamics and geographic coverage trade-offs, safeguards for contextual judgement when automation is used and support for dispatchers exposed to morally difficult scarcity decisions.
Commentary on: Meitern R, Gortfelder M, Puur A, et al. Mothers of twins had higher old-age survival than mothers of singletons in Estonian 19th-century birth cohorts. Hum Reprod. 2024 Sep 1;39(9):2124-2133. doi: 10.1093/humrep/deae166. PMID: 39067454.
Implications for practice and research While twin pregnancies may be associated with higher postpartum mortality, mothers to twins may experience higher survival odds after the age of 80. Future research should explore the lifespans of mothers with a history of twin pregnancy versus those with a history of singleton pregnancy in more diverse and modern populations.
Although twin pregnancies have been shown to increase postpartum maternal mortality, the evidence regarding the impact on long-term survival of mothers after twin pregnancies is limited.
FreshRSS 