Conectar
Chronic dyspnoea is a prevalent symptom, and primary care is ideally placed to identify and manage it. However, chronic dyspnoea is under-reported by patients and can be a diagnostic dilemma for practitioners. A fully automated system of patient screening, coupled with a clinical decision support system (CDSS) that uses a validated and evidence-based dyspnoea algorithm, may improve detection, diagnosis and management of the condition. There is currently no CDSS validated for chronic dyspnoea diagnosis and management in primary care in Australia. The objectives of this study are to assess the clinical impact of a CDSS for chronic dyspnoea in primary care. We hypothesise that the use of the CDSS will lead to a clinically significant improvement in patient-reported dyspnoea scores, reduced time to diagnosis and healthcare costs at 12 months compared with standard care.
The BREATHE study is an open-label, cluster-randomised controlled trial of standard of care compared with a CDSS. General practices (n=40) in metropolitan, regional/rural and rural/remote settings will be recruited and randomised equally to pre-screening for chronic dyspnoea and usual standard-of-care management or pre-screening and CDSS-guided management. The CDSS includes an algorithm derived from a robust data and clinical knowledge model and incorporates evidence-based recommendations for the assessment and management of chronic dyspnoea. It is integrated into general practice medical software systems, fitting in the workflow of general practitioners (GPs). Eligible patients will be ≥18 years old and will have previously consented to receive SMS communication from their practice. In-scope patients will receive an automated text message prior to their GP appointment and will be screened for chronic dyspnoea (≥4 weeks). Patients identified with chronic dyspnoea will be invited to participate in the BREATHE study and followed up for 12 months. The primary outcome is improvement in the Dyspnoea-12 (D-12) score from baseline to 12 months, measured by the Dyspnoea-12 (D-12) questionnaire. Secondary outcomes include disease-specific questionnaires to assess changes in clinical outcomes, time to final diagnosis, quality of life, healthcare utilisation and costs incurred to patients.
The trial is registered at ANZCTR (ACTRN12624001451594). ANZCTR is a primary registry that meets the requirements of the ICMJE and is listed on the ICTRP Registry Network.
The study protocol has been approved by the University of New South Wales Human Research Ethics Committee (HREC) (iRECS6645) and complies with the National Health and Medical Research Council ethical guidelines. Participating practices and each GP will provide written, informed consent. All patients being screened will provide electronic informed consent. Results of the study will be disseminated through various forums, including peer-reviewed publications and presentation at national and international conferences. Following the study, participating practices will be provided with a summary of the findings of the study, together with a full copy of any publications and a plain language statement for participants, which will be made available in the practice reception area.
To explore the published literature on nurse/midwife and peer worker collaborations in healthcare services.
Scoping review and narrative synthesis.
The framework proposed by Levac et al. was used. PubMed, CINAHL, MEDLINE, Scopus, and Embase databases were systematically searched, and results uploaded to Covidence for screening against inclusion criteria. A critical narrative synthesis of included studies was conducted, guided by Popay et al.
Sixteen studies from five countries met the inclusion criteria. They examined peer worker and nurse/midwife collaboration across diverse settings including cancer, HIV, mental health, and community services. Findings indicated that nurse/midwives and peer workers valued the distinct forms of expertise they contributed, which enhanced care. Tensions in collaboration related to clinical dominance and control in hierarchical structures, challenges navigating scope and role boundaries, and mistaken notions of what constitutes ‘successful’ peer work. Peer workers and nurses/midwives could be ‘close strangers’ with little opportunity to build genuine rapport.
Successful collaboration requires attention to power dynamics within healthcare cultures and opportunities to connect and understand each other's disciplinary expertise. Identifying strategies to optimise partnership and mobilise collective strengths has the potential to further enhance care.
Peer worker or ‘lived experience’ roles within healthcare services have rapidly expanded. Our study highlights the benefits of peer worker and nurse/midwife collaborations and areas that require attention, including recognition of peer worker and nurse/midwife roles and responsibilities in the healthcare setting and effective integration of peer workers into existing healthcare teams. Importantly, strategies should be developed to address disparate power dynamics between nursing/midwifery staff and peer workers as these impact workforce relations and capability. Addressing these key areas will strengthen collaboration between nurses/midwives and peer workers, improve healthcare provision, and ultimately benefit service users.
This study highlights the tensions arising when nurses/midwives and peer workers carry out duties alongside each other, as well as factors that can promote effective collaboration. Successful collaboration in healthcare necessitates addressing power differentials, fostering mutual understanding, and providing the tools, training, and inclusive environments needed for nurses/midwives and peer workers to work together effectively.
This scoping review adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) extension for scoping reviews.
Our authorship team includes experts with experience in peer work and supervision of peer workers, and designing and implementing peer-led interventions within health and community service settings.
There is a pressing need for effective interventions that can support healthcare workers and caregivers in the challenging yet crucial task of disclosing the HIV status to infected children and adolescents. Previously, we developed and tested a successful disclosure intervention called Sankofa in Ghana. In an ongoing 5-year follow-up study, Sankofa 2, we aim to build on the successful Sankofa trial by testing the intervention on a larger scale.
This study is a pragmatic, stepped-wedge cluster randomised trial.
It is being conducted in 12 HIV paediatric clinics in Ghana to examine the effectiveness, health benefits, cost and implementation of the Sankofa intervention. Caregiver–child dyads (n=700) will be enrolled. Evaluation of effectiveness, health benefits, cost and implementation of the Paediatric HIV disclosure intervention, Sankofa 2, is posed to offer valuable insights for scale-up and sustainability.
Ethical clearance has been obtained from the Ghana Health Service Ethics Review Committee, the University of Ghana Ethical and Protocol Review Committee, the Committee on Human Research Publication and Ethics of the Kwame Nkrumah University of Science and Technology, the Johns Hopkins Medicine Institutional Review Board and the Yale School of Medicine Human Investigation Committee. The clinical trial was registered on ClinicalTrials.gov on 5 March 2021. All caregiver participants are required to provide written informed consent and the children assent before enrolment. If either the child or caregiver says no to the study, the dyad is not eligible for the study. No study-related procedures are performed until consent is obtained. The results of the trial will be added on ClinicalTrials.gov, published in peer-reviewed journals and presented at international conferences.
This study aimed to explore adverse childhood experiences (ACEs) and their association with common mental disorders (CMD) among college students in Ethiopia.
Cross-sectional study.
Addis Ababa University, College of Health Sciences.
A total of 345 participants completed the whole questionnaire.
The study used a stratified random sampling technique. Data were gathered through self-administered questionnaires. The instruments used included adapted sociodemographic questions, the ACEs International Questionnaire, the Patient Health Questionnaire, the Generalized Anxiety Disorder Scale and a brief tool for assessing substance use. To examine the relationship between ACEs and various independent variables, both binary and multivariate logistic regression analyses were employed.
In the total sample (n=345), the participant’s mean age was 22.2 (± 2.03), with the majority being females (58%). About 16% of the participants reported depression symptoms and 14.2% had anxiety. The majority of the participants (80%) had at least one ACE and one quarter (25.2%) of the participants had experienced four or more ACEs. The most prevalent type of ACE was community violence (35.4%). One fifth (20%) of the participants had reported having experienced childhood sexual abuse. After controlling for confounding variables, those with four or more ACEs were 6.17 times (adjusted OR (aOR) 6.17; 2.51, 15.18) and 6.0 times (aOR 6.0; 2.25, 16.02) more likely to have depression and anxiety, respectively.
There was a dose-response relationship between ACEs and both anxiety and depression. Identifying and preventing ACEs at an early stage could contribute to reduce depression and anxiety among young people. Efforts to prevent ACEs should target not only individuals but also extend to households and communities.
This study aimed to (1) assess Lumos data quality, a New South Wales (NSW) statewide linked health data asset; and (2) determine sociodemographic variation in health service utilisation of general practice, emergency department and admitted services.
A retrospective cohort study using Lumos, a linked health data asset.
A representative statewide sample population of NSW, Australia.
People residing within NSW with an electronic health record at a Lumos participating general practice between January 2010 and June 2023.
Data quality indicators of Lumos including completeness, representativeness against NSW population data, consistency and timeliness. Furthermore, variation in general practice visits, emergency department presentations and hospital admission rates stratified by age, sex, rurality and Index of Relative Socio-economic Disadvantage (IRSD)—a measure of socioeconomic status used in Australia, where lower values represent greater relative disadvantage across a range of metrics such as education and income.
At the time of analysis, Lumos included records from 5.2 million unique patients, representing half (49.7%) of the NSW resident population. Limiting data to 2022, the Lumos population distribution broadly aligned with the 2021 Census except for IRSD quintile four and five which were under-represented (15.0% vs 20.4% (standardised difference –0.14)), and over-represented (29.7% vs 19.9% (standardised difference 0.23)), respectively. Age and greater relative disadvantage were associated with higher rates of general practice visits and hospital admissions. Greater relative disadvantage was also associated with higher rates of emergency department presentations.
Lumos’s ability to overcome historical limitations of separately managed health data in Australia and its demonstrated data quality present an opportunity to enhance health system policy and planning in NSW. The variation in service utilisation across primary and tertiary care by population and geography apparent in Lumos reinforces the need for tailored service planning.
FreshRSS 