Conectar
Pressure injuries present significant challenges in clinical care, leading to severe complications such as infection, pain and delayed wound healing. They are a common chronic wound that contribute to increased morbidity, prolonged hospital stays and substantial healthcare costs. Despite national efforts to enhance chronic wound management, development of optimal treatment strategies remains a priority. The Pressure Injury Treatment Advisory (PITA) Quick Guide was developed to provide an evidence-based guide to support clinicians in pressure injury management. A survey was conducted to evaluate clinician perspectives on the usability and practicality of the Guide in acute care, residential aged care and community settings. A post-test survey was conducted on a convenience sample of healthcare professionals from three healthcare settings across metropolitan, regional and rural Australia. The survey included 5-point Likert-scale items assessing ease of use, effectiveness and integration with workflows. Three hundred and two responses were received (66.7% response rate). Clinicians expressed overwhelmingly positive perceptions, with over 95% agreeing or strongly agreeing on the guide's utility and effectiveness. No respondents strongly disagreed with any item. Residential aged care and rural clinicians rated the tool slightly higher than acute care and medical clinicians. The PITA Quick Guide was well-received across all settings, demonstrating strong potential to enhance evidence-based pressure injury management.
This systematic review and meta-analysis aims to provide an overview of the effectiveness of digital physiotherapy interventions on pain, physical functions and quality of life for patients with knee osteoarthritis.
Systematic review and meta-analysis using the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach.
A systematic search of electronic databases, including MEDLINE, EMBASE, Web of Science, PsycInfo, CINAHL, Scopus and Cochrane Library, was conducted on 19 February 2025.
We included randomised controlled trials which compared digital physiotherapy interventions to standard physiotherapy care for patients with knee osteoarthritis. Main outcomes included pain, physical functions and quality of life.
25 studies met the inclusion criteria, and 18 studies were eligible for meta-analysis. The primary author conducted the initial search, selected articles and extracted data from eligible studies, which were independently checked by a second reviewer. Risk of bias (ROB) was assessed by Cochrane ROB-2 tool. Quality of evidence was evaluated by the GRADE approach.
Overall, digital physiotherapy was associated with a small but statistically significant improvement in physical function (SMD=0.24, 95% CI 0.13 to 0.35); an overall meta-analysis was not performed for pain and quality of life due to considerable heterogeneity. Subgroup analyses revealed both video-conferencing and app- or web-based physiotherapy significantly reduced pain (SMD=–0.53, 95% CI –1.06 to –0.01 and SMD=–0.47, 95% CI –0.70 to –0.25, respectively) and physical function (SMD=0.32, 95% CI 0.10 to 0.54 and SMD=0.30, 95% CI 0.09 to 0.50 respectively). Digital physiotherapy interventions with individualised exercise components also reduced pain (SMD=–0.43, 95% CI –0.66 to –0.21) and improved physical function (SMD=0.30, 95% CI 0.17 to 0.43), when compared with non-exercise interventions.
There was moderate-quality evidence to support the use of digital physiotherapy interventions in improving pain and function in patients with knee osteoarthritis. Subgroup analyses revealed low-to-moderate quality evidence in using video-conferencing and app-/web-based physiotherapy and interventions with exercise components to treat patients with knee osteoarthritis. Overall, there were limited high-quality trials in drawing a robust conclusion. High ROB and huge heterogeneity were observed across studies. Further research should minimise the ROB and investigate the effect of different digital modalities, intervention components and length of follow-up.
To develop and validate a polycystic ovary syndrome (PCOS) case definition using administrative health data sources.
A validation study.
Secondary care centre outpatient gynaecology clinic in Calgary, Alberta, Canada.
3951 electronic health records of women aged 18–45 years who presented to a gynaecology clinic in Calgary, Canada, between January 2014 and December 2019 were reviewed. We identified 180 patients with PCOS using the Rotterdam criteria. Participants were excluded if they were biologically male, pregnant at the time of the consultation, did not meet the date criteria or if their consultation note was missing. The chart data were connected to the Practitioner Claims and the Discharge Abstract Database by personal health number.
Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 68 case definitions for PCOS were estimated. Case definition performance was graded.
Of the 68 case definitions tested, none had high validity. The best performing case definitions were: (1) ≥3 instances of International Classification of Diseases-9 code 256.4 (polycystic ovaries) with exclusion codes (sensitivity 23.89%, specificity 99.59%, PPV 74.14%, NPV 96.35%) and (2) 626.X (irregular menstruation), 704.1 (hirsutism) and ≥3 instances of code 256.4 with exclusion codes (sensitivity 2.78%, specificity 99.97%, PPV 83.33%, NPV 95.40%).
We identified several case definitions for PCOS of moderate validity with high PPV (>70%) for case ascertainment in PCOS research in jurisdictions with similar administrative health data. These case definitions are limited by low sensitivity, which should be considered when interpreting research findings.
Australian First Nations children bear 8.5 times greater burden of early and recurrent ear and nasopharyngeal infections compared with non-Indigenous children. These disparities are compounded by structural inequities in access to healthcare. To better understand these patterns, we analysed the state-wide epidemiology of childhood myringotomy procedures in South Australia and conducted spatial analysis for its main metropolitan region—Adelaide—to examine the associations with socioeconomic status and distance to healthcare facilities.
A cross-sectional, population-wide study.
All persons who had myringotomy procedures performed between 2007 and 2022.
Annual, age and sex-specific incidence was calculated at the local scale (Statistical Area level 2, SA2). We used admitted patient care data from SA Health, providing comprehensive coverage of otitis media procedures across the population, including First Nations. We applied negative binomial regression to assess associations with socioeconomic status and distance to healthcare facilities, accounting for count-based data and overdispersion.
Myringotomy incidence among First Nations children ranged from 2.2 to 6.1 per 1000 child-years across SA2 regions, compared with 2.4 to 3.7 among non-indigenous children. For the whole population, overall annual incidence ranged from 2.7 to 4.2 for males and 2.0 to 2.9 for females, with higher incidence observed in several suburban areas of Adelaide. Myringotomy procedures were associated with socioeconomic status, with increased socioeconomic advantage associated with a 17% reduction in cases (relative risk 0.83, 95% CI 0.76 to 0.92) among First Nations children. Distance to healthcare facilities was associated with myringotomy for non-indigenous children but not for First Nations children.
This study found a higher incidence of myringotomy procedures among First Nations children, particularly in later childhood. Socioeconomic disadvantage was a driver, while geographic proximity to healthcare had limited influence. Future initiatives may benefit by prioritising culturally informed, community-led strategies focused on early intervention, prevention and equitable service delivery.
Investing in advanced nursing roles (AN) in social care is a strategic priority to address workforce challenges, create new career pathways, improve outcomes and future-proof the sector. However, there is limited understanding of these roles globally. This systematic scoping review maps the international presence and impact of post-qualification advanced practice roles for registered nurses (RNs) working in care homes and charitable organisations.
This review was conducted following the methodology established by the JBI and adhered to the PRISMA extension for scoping reviews checklist.
Studies were included if (1) they included RNs working in care homes, charities or not-for-profit health centres, (2) the RN was in a specialist, enhanced or advanced practice role and (3) if role details were provided. Studies were limited to those published in the English language between 2014 and 2024. Evidence was gathered from a comprehensive search of electronic databases (CINAHL, MEDLINE, Scopus, PubMed and Web of Science), grey literature, relevant webpages, and reference lists. Expert consultations were also conducted. Eligible full texts were reviewed in Covidence software by two independent researchers.
The search yielded 575 records, and 89 were taken forward for full-text screening. A total of 20 met the inclusion criteria: 19 were concerned with AN roles in care homes, and one focused on a charitable organisation. The majority of these studies (n = 12) were conducted in North America.
The literature on AN roles in care homes and charitable organisations is notably sparse. Despite this, the available evidence highlights substantial benefits, including improved care quality, enhanced resident outcomes and positive impacts on team dynamics. This review identifies four key themes: scope of practice, positive impacts, influencing factors and barriers, which provide a framework for policymakers, healthcare leaders and educators to optimise the contributions of this group within the evolving global social care sector.
Not undertaken because of the nature of scoping reviews.
This review highlights the crucial role of advanced nurses in enhancing care quality, resident outcomes, and workforce sustainability in care homes and charitable organisations. The findings provide direction for policymakers and health and social care leaders to further develop the role of nursing in social care settings globally.
Advancing equity, diversity and inclusion in health research trials is essential for improving health outcomes among priority populations. While evidence increasingly highlights the importance of cultural diversity in research trial leadership and participation, evidence-based strategies for enhancing this remain limited. This article outlines approaches to strengthen Aboriginal and Torres Strait Islander involvement in health research trials, drawing on insights from community engagement at the Darwin (Northern Territory) trial site of the Australian Fans in Training (Aussie-FIT) project.
Community engagement at this site aimed to (1) build mutually beneficial relationships with community leaders, specifically Aboriginal and Torres Strait Islander men; (2) codesign engagement standards to enhance the quality of engagement with these leaders and more broadly with local community members and stakeholders. A culturally diverse community advisory group was established, which codesigned engagement standards tailored to community needs and preferences.
While the codesigned standards supported Aboriginal and Torres Strait Islander trial leadership and participation during the trial, the extensive consultation needed to build cross-cultural relationships and develop the standards meant they were finalised only after trial recruitment had ceased. As a result, researchers were unable to fully implement them in the early stages of the trial.
This paper shared and critically discussed approaches used in the early stages of the Aussie-FIT trial to foster more equitable and inclusive practices in research trials. Implementation of these approaches and community-informed recommendations has the potential to enhance research quality, build trust with priority populations and address participation inequities, thus supporting effective trial design and improved health outcomes.
This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12623000437662).
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