Conectar
Falls in hospital are a common patient safety incident after stroke. Despite the reprevalence of communication disability following stroke, there is little guidance for health professionals to provide effective falls prevention strategies for this population.
To provide a synthesis of findings across a selected set of related studies on falls in hospital patients with communication disabilities following stroke and guidance for health professionals to enhance falls prevention strategies for this group.
A qualitative meta-synthesis of six integrated studies using a content thematic analysis.
Communication disability often lacks visibility in falls research, hospital policies, and clinical management. Whilst the relationship of communication disability as a risk factor for falls is unclear, communication disability contributes to falls and is a barrier to falls prevention and management. Suggestions for falls prevention include involving family members, tailored falls and stroke education programmes, and improved documentation of the functional impacts of communication disability.
In recognising the complexities of falls in patients with communication disability, health professionals could provide more targeted, patient-specific falls prevention plans. Further research, inclusive of patients with communication disability following stroke, could provide important insights into their falls and falls management. Research examining the effectiveness of falls prevention strategies for this group is indicated.
Insights from this review could enhance falls prevention programmes for patients with communication disabilities after stroke.
This meta-synthesis combined a set of integrated studies to provide guidance for the management and prevention of falls in hospital patients with communication disabilities after stroke. Three interconnected content themes were identified: (a) An invisible problem: communication disability is invisible, and consideration of this in research and falls management has been lacking; (b) Painting the falls picture: the nature of communication disability and falls; and (c) A complex problem: the multiple impacts of communication disability on falls management. Falls prevention themes identified in the individual studies that specifically target the needs of patients with communication disability after stroke are presented as 'The Way Forward: Potential Falls Prevention Strategies to Improve Care for Hospital Patients with Communication Disability Following Stroke'. The integration of these findings into clinical practice should mean that (a) healthcare professionals provide more patient-specific falls prevention plans that include considerations of communication disability, and (b) hospital managers should take steps towards improving falls prevention and management policies to include patients with communication disability following stroke.
This review is reported according to the Standards for Reporting Qualitative Research.
No patient or public contribution.
People in prison experience disproportionate health burdens compared with community-based populations, including elevated rates of infectious and non-communicable diseases, mental illness and substance use disorders. Previous studies have consistently shown increased rates of mortality following release from incarceration, particularly from external (unnatural) causes such as suicide and violence. However, evidence on mortality incidence during imprisonment is scarce, and many deaths may be preventable through targeted health and prevention interventions. This study aims to synthesise worldwide evidence on all-cause mortality incidence in prisons.
We will conduct a worldwide registry study combined with a systematic literature review and meta-regression analysis. Eligible sources will report deaths among incarcerated people between 2005 and 2025 at the national or, where more appropriate, the subnational jurisdictional level. Mortality data will be retrieved from official reports of prison administrations and direct contact with prison authorities. Also, data from international databases and the scientific literature will be reviewed. Incidence rates of all-cause mortality per 100 000 person-years will be calculated and reported for each jurisdiction, alongside standardised mortality ratios comparing imprisoned populations with general population estimates.
Since the study relies on anonymised routine data registries available from different sources, an exemption certificate was granted by the Ethics Committee of Diego Portales University (UDP) in Santiago, Chile. Findings will be submitted for publication in a peer-reviewed academic journal.
Adenotonsillectomy is the primary treatment for type 1 obstructive sleep apnoea (OSA1). Although polysomnography (PSG) remains the gold standard for measuring Apnoea-Hypopnoea Index, it is a labour-intensive procedure and does not correlate with improvements in quality of life postadenotonsillectomy. Mouth breathing is associated with poorer quality of life in children. Mandibular movement (MM), which measures mouth opening, is a validated measure of respiratory effort that can be easily and safely assessed in children using the JAWAC technology. This study aims to evaluate the relationship between changes in quality of life and changes in mouth opening in children with OSA1 after undergoing adenotonsillectomy. Secondary objectives include evaluating changes in quality of life, clinical symptoms and other MM and PSG metrics in the same population.
This exploratory, non-randomised, monocentric, prospective cohort study with a non-blinded single arm will include 50 children aged 3–7 years, undergoing adenotonsillectomy at the Clinique Saint Jean, Montpellier, France. Quality of life will be measured using the parent version of the Paediatric Quality of Life Inventory and MM metrics will be measured during PSG using the JAWAC system during the inclusion visit and 3 months after adenotonsillectomy. The primary outcome will be the correlation between the changes in quality of life and mouth opening (1/10 mm) postadenotonsillectomy. Secondary analyses will evaluate changes in clinical symptoms, PSG measures and other MM metrics including respiratory effort, as well as the associations between these measures.
This study was approved by an independent ethics committee (Comité de Protection des Personnes Est) on 24 March 2025 (2024-A02761-46) and will be conducted in accordance with French law, good clinical practice and the guidelines of the Declaration of Helsinki. Study findings will be disseminated through international peer-reviewed journal articles as well as public, academic presentations at national and international conferences.
Taking multiple medicines can be appropriate but has the potential to be problematic. The Implementing Stimulating Innovation in the Management of Polypharmacy and Adherence THrough the Years (iSIMPATHY) project used the 7-Steps person-centred approach for medication reviews, supporting patients and clinicians to define and achieve realistic goals for drug treatment, and helping enable patients to lead healthy and active lives.
To assess the impact of pharmacist-led comprehensive person-centred medication reviews using the 7-Steps methodology.
iSIMPATHY sought to transform the approach to optimisation of medicinces through the delivery of person-centred medication reviews for people taking multiple medicines in primary care, hospital and outpatient clinics. The reviews were conducted by embedding a single approach for polypharmacy management, building on key recommendations from SIMPATHY.
Interventions made were graded, with 82% being classified as clinically significant and 4% potentially preventing major organ failure, adverse drug reactions or incidents of similar clinical importance. The average number of medications reduced from 12 to 11, with 92% of the reviews resulting in more appropriate medication use, thereby decreasing the likelihood of medication-related harm. Inappropriate medicines were stopped, reduced or altered to improve appropriateness. There were significant healthcare resource utilisation benefits as indicated by a positive return on investment for both medication and healthcare costs with a quality-adjusted life year gain of 7.4 per 100 patients.
Pharmacist-led, person-centred medication review using the 7-Steps approach was delivered across jurisdictions and healthcare settings, with positive impacts on the number and appropriateness of medicines, clinical interventions and cost savings outweighing expenditure on the service. The approach is scalable by means of the tools and resources developed over the duration of the project.
Patients with acute psychiatric symptoms are often referred to the emergency department (ED) for medical evaluation to exclude medical causes before psychiatric admission. The absence of a prospectively validated medical screening tool leads to wide practice variation. This study aims to develop a new, evidence-based and consensus-based medical screening tool through a collaborative, interdisciplinary, international Delphi approach.
This modified Delphi study will include representatives from emergency medicine and psychiatry societies across four continents, as well as patient representatives with prior experience of medical screening in the ED. A minimum sample size of 24 participants is planned to account for potential dropouts. The Delphi procedure consists of four rounds. Round 1 will present current evidence and identify key items for the new medical screening tool. Round 2 will evaluate and refine statements from Round 1. Round 3 will seek consensus on the variables to be included in a medical screening tool. In Round 4, hypothetical clinical vignettes will be used to assess the agreement on the recommendations of the newly developed medical screening tool in order to test for content and construct validity. Surveys will be conducted via Research Electronic Data Capture (REDCap), with participants rating statements on a 6-point Likert scale. Response stability will be evaluated using the intraclass correlation coefficient, and consensus defined as ≥80% agreement. Results will be reported according to the ACcurate COnsensus Reporting Document guidelines and the Guidance for Reporting Involvement of Patients and the Public 2 short form.
The Ethics Committee of Northwestern and Central Switzerland exempted the project from committee approval under the Human Research Act on 11 September 2024. Written consent will be obtained from all participants. Results of this study will be summarised as a medical screening tool which will be validated in a prospective, multicentre study in a second step.
by Anshu Parajulee, Abdo Souraya, Nancy Humber, Sean Ebert, Kim Williams, Tom Skinner, Jude Kornelsen
ObjectiveTo identify contextually relevant indicators to measure the quality of surgical and obstetrical care in low-volume rural hospitals using a consensus-based methodology.
MethodsA modified Delphi process was implemented in which participants were asked to rate the priority of proposed evaluation metrics over two rounds. Two Delphi surveys were electronically administered in 2019, approximately one month apart. Fifty-one health care professionals from across Canada, including rural proceduralists and quality improvement experts, were invited to participate. All quality measures in the first round were proposed by the study team. The second round included measures that did not reach consensus in the first round and measures suggested by respondents during the first round.
ResultsThirty individuals participated in Round 1 (59% response rate). Of the 30 respondents from Round 1, 23 participated in Round 2 (77% response rate). 115 of 177 proposed measures (65%) reached positive consensus in Round 1 or 2. Expert participants agreed that these measures should be prioritized/included when evaluating surgical and/or obstetrical quality in rural hospitals. No measure reached negative consensus in either round. Open-text comments offered practical guidance on how to interpret and use surgical and obstetrical quality data within a rural context. Many respondents believed that rare adverse outcomes have low relevance at rural hospitals where volumes are low, procedures are almost all lower complexity day cases (Cesarean section being the major exception), and patients are typically healthy.
ConclusionThe modified Delphi process resulted in the identification of surgical and obstetrical quality indicators that are contextually embedded in the realities of rural practice. The methodology allowed for the consideration of factors often overlooked by normative urban-based approaches, including team-based care characteristic of rural hospitals and limited access to specialist care and imaging services.
To explore long-term care recipients' perceptions of high-quality care and how person-centred approaches are applied in the services.
A descriptive explorative qualitative design.
Data were collected through individual interviews with 19 care recipients and 197 h of participant observation at 10 nursing homes and home care units in three Norwegian municipalities. The data were analysed using qualitative content analysis.
The analysis revealed a main theme—to be seen and cared for as an individual—describing the core of the recipients' perceptions of high-quality care. This main theme encompassed two sub-themes. The first—individually adapted care—showed that the recipients valued whether their healthcare workers understood them and their individual care needs and preferences. The second theme—interpersonal encounters—captured the recipients' appreciation of their healthcare workers' presence and ability to create moments where they were seen and treated as human beings.
From the perspective of care recipients, high-quality care services depend on how they are treated as individuals and how the care they receive is adapted to their individual needs and preferences. These recipients' perceptions of individualised care delivered by healthcare workers are consistent with the goal of person-centred care. These results highlight the value of and need for non-standard approaches to providing high-quality care.
Despite the long-term care services' extensive caregiving tasks and time pressure, they should enable healthcare workers to be present in the moment with care recipients.
Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines are used for this study (Tong, Sainsbury, and Craig 2007).
Long-term care recipients and the units where they received care contributed to this study. The recipients' perceptions of the care and the units' arrangements facilitating participant observation played significant roles in this research.
FreshRSS 