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Perceptions of determinants for the provision and uptake of maternal influenza vaccination from the perspective of healthcare providers in Kuwait: a qualitative study

Por: Alhendyani · F. · Lindsey · L. · Hayes · L. · McNally · R.
Objectives

To explore the current context in which maternal influenza vaccination (MIV) is delivered in Kuwait and to identify determinants influencing its provision and uptake from the perspectives of preventive medicine professionals (PMPs), including policymakers.

Design

Qualitative semistructured interviews were conducted with purposely selected PMPs including policymakers. Interview questions were obtained from the Tailoring Immunization Programme for improving MIV in Europe.

Setting

PMPs from six governmental regions of Kuwait, including hospitals and associated polyclinics. Data collection was conducted between March and June 2022.

Participants

A total of 10 participants reflected diverse professional and population contexts, including Kuwaiti and non-Kuwaiti professionals working in rural and urban settings. Cell sampling was used to ensure representation across key roles involved in MIV delivery, including policymakers, vaccination campaign managers and campaign implementers.

Results

Thematic analysis identified four overarching themes: barriers, facilitators, influences on MIV uptake and suggested interventions. Key barriers included limited knowledge among pregnant women and healthcare providers (HCPs), lack of prioritisation of pregnant women within vaccination programmes, shortage of vaccine supply and the COVID-19 pandemic. Facilitators and influential factors included the presence of vaccination champions, targeted health promotion activities and the availability of a Ministry of Health (MoH) hotline for addressing concerns and system-level accessibility and digital facilitation of MIV uptake. Suggested interventions emphasised strengthening HCP education through continuous training aligned with clear national policies and guidelines.

Conclusion

This study highlights the need for clear national policies and clinical guidelines to support consistent MIV provision, alongside ongoing education for HCPs in Kuwait to strengthen MIV recommendation. Future research should include obstetricians, given their central role in antenatal care, to ensure MIV strategies are clinically grounded and integrated into routine maternity services.

Realist review of informal carer involvement in the transition of medicines-related care for patients moving from hospital to home

Por: Richardson · C. L. · Cooper · M. · Atkinson · O. · Black · D. · Lindsey · L. · Cooper · C. · Nazar · H. · Wong · G. · Hughes · C.
Objective

The aim of this work was to understand carer involvement in transitions of care from hospital to home in relation to medicines management. Specifically, via a realist review, to describe how carers provide support, to what extent do they support patients and under what circumstances are carers able to provide support towards patient care in relation to medicines management.

Design

A realist review was conducted in line with a published protocol and as registered via PROSPERO (CRD42021262827). An initial programme theory (PT) was developed before searches of three databases, PubMed, CINHAL and EMBASE, were conducted in accordance with eligibility criteria. Data were extracted from eligible studies and synthesised into realist causal explanations in the form of Context-Mechanism-Outcome-Configurations (CMOCs) and the PT was refined. Throughout the review, a patient and PPIE group (n≥5) was involved, meeting five times, to inform the research focus and develop CMOCs and the PT by providing feedback and ensuring they capture the carer experience.

Results

Following title and abstract screening of 4835 papers, the final number of included articles was 208. The evidence synthesis identified 31 CMOCs which were categorised into three themes: (1) continuum of support; (2) understanding the carers’ priorities, role and responsibilities through shared decision-making (SDM) and (3) access to appropriate materials, resources and support information. These themes were formed into an updated PT with accompanying narrative that explained the transition from hospital to home involving carers in medicines management and identified possible areas for future intervention development.

Conclusion

This review provides insights and recommendations on how carers can be better supported when managing medicines when patients are discharged from hospital. Carers need a continuum of support throughout and following the transition. Healthcare professionals can support this by understanding the carer’s priorities, role and responsibilities through SDM during the hospital stay. Consequently, carers can then be offered access to appropriate materials, resources and support information which allows them to provide better care relating to medicines in the long term.

PharmacoGENEtics in Youth Depression (GENE-YD) Study protocol: a pilot triple-blinded randomised controlled trial using pharmacogenetics to tailor antidepressant treatment in young Australians

Por: Roberts · B. · Cooper · Z. · Miljevic · A. · Stanley · S. H. · Majda · B. T. · Collins · K. R. L. · Baltic · S. · Lindsey-Temple · S. E. · Akkari · P. A. · Hood · S. D. · Rodger · J.
Background

The prevalence of depression and mood disorders has been steadily rising in Australian youth, with a concomitant increase in antidepressant pharmacotherapy prescription rates. Yet, the tolerability and efficacy of antidepressant drugs in youth remain poor. Pharmacogenetic (PGx) testing, or the personalised and guided treatment of medication based on genetic data, has been suggested to improve the effectiveness and tolerability of antidepressants. However, limited studies have evaluated the utility of antidepressant PGx-guided treatment in adolescent and young adult populations. Thus, this pilot randomised controlled trial (RCT), the GENE-YD Study, will evaluate the feasibility for a large-scale RCT assessing the effect of PGx-guided antidepressant prescription vs treatment as usual in youth with major depressive disorder (MDD).

Methods and analysis

Eighty young people between 16 and 24 years of age and in the early stages of pharmacotherapy treatment for MDD will be recruited. Following initial screening, participants will be randomised on a 1:1 ratio to either the intervention or control study group. Participants in the intervention condition will have their treatment tailored based on their PGx profile. Participants randomised into the control group will have their prescription based on current best practice recommendations, or treatment as usual. Individuals will be assessed at drug prescription baseline and again 6 and 12 weeks following drug prescription. The primary outcome of the study will be to evaluate the feasibility and acceptability of the GENE-YD protocol. Specifically, this study will explore participation recruitment strategies and attrition to the study protocols to guide the recruitment processes of a large-scale RCT, along with participating satisfaction in overall study protocols. Secondary outcomes will inform the utility and variability of specific measures (eg, depression rating scales, quality of life measures and medication adherence scales) that may be scaled up for use in a future full-scale trial.

Ethics and dissemination

Ethics approval was granted by the Department of Health, Western Australia’s Human Research Ethics Committee (RGS0000006822) and recognised by the University of Western Australia’s Human Research Ethics Committee (2024/ET000685). All participants will be required to provide written informed consent. Results will be published in international peer-reviewed journals.

Trial registration number

ACTRN12624000760572.

Agency Nurse Usage of Infusion Interoperability: Identifying Barriers and Improving Workflows

imageOver the past several years, hospitals have utilized agency staffing to combat staffing shortages. Increased use of agency staffing presented an opportunity for implementation of an education project related to the potential variance in practice of permanent staffing, specifically with the use of infusion interoperability in the inpatient setting at the University of Pittsburgh Medical Center St Margaret hospital. Discussion around variables causing agency nurse setbacks with utilizing infusion interoperability while trying to meet the required standard laid the groundwork for this project. Improving agency workflows allowed for process improvement including enhanced quality, documentation, and adherence. Early data analysis revealed variance in adherence between agency and permanent staffing prompting further analysis. Investigational methods included assessment of agency nurse infusion interoperability usage through interviews and observations, review of adherence reports, review of education and onboarding, and interviewing of nurse leaders. Findings suggested lack of experience, inability to troubleshoot, and underutilized resources contributed to lower adherence with agency compared with permanent staff. These findings lead the informaticists to make changes to the curriculum for new hire onboarding, increase rounding and interactions with agency staff, and increase access to resources. These interventions resulted in increased adherence scores and verbalized satisfaction by the agency nurses.
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