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To explore whether routine electronic healthcare records can be used to identify triggers for initiating advance care planning (ACP) and the optimal time window to initiate ACP. We aimed to assess the prevalence of triggers for initiating ACP as defined for use in routine data, whether their presence is associated with death, and what their position is relative to a previously identified ‘optimal time window for ACP’.
Nested case-control study within a large dynamic population cohort dataset.
Primary care population-based, anonymised data extracted from GP centres in the South Holland province, The Netherlands.
We selected records of individuals aged ≥65 registered with their general practice from 1 Jan 2014 to 1 Jan 2017. Cases were individuals who died between 1 Jan 2017 and 1 Jan 2020. Controls were individuals who remained alive. Cases were matched by age to controls in a 1:4 ratio.
Outcomes include prevalence of triggers for ACP in the records of deceased and living individuals; association of the triggers’ presence with death; timing of the identified triggers in deceased individuals relative to the ‘optimal time window for ACP’.
We included 17098 records, 4139 from deceased individuals (mean age 81) and 12959 from living individuals (mean age 79). Triggers most strongly associated with death were consultations concerning malignancy (OR 8.35, 95% CI 7.42 to 9.41), hospital admissions (OR 7.32, 95% CI 6.75 to 7.94), emergency department referrals (OR 7.11, 95% CI 6.52 to 7.75), registered home visits (OR 5.97, 95% CI 5.51 to 6.47), consultations concerning heart failure (OR 5.25, 95% CI 4.59 to 5.99), dementia (OR 4.75, 95% CI 3.99 to 6.56), opioid prescriptions (OR 4.58 (4.25–4.93), consultations concerning general decline/feeling old (OR 4.15, 95% CI 3.72 to 4.64) and skin ulcers/pressure sores (OR 4.04, 95% CI 3.55 to 4.61). Those closest to the median of the optimal time window for ACP were consultations regarding dyspnoea, general decline/feeling old, heart failure, skin ulcers/pressure sores and fever, opioid prescriptions, emergency department referrals, registered home visits and hospital admissions.
Clinical triggers for initiating ACP in general practice can be recognised within the routine electronic health records and they align well with the ‘window of opportunity’ to initiate ACP.
Physical activity is crucial for young children’s health and development. Many young children do not meet the recommended 3 hours of daily physical activity, including 60 min of energetic play. Early childhood education and care (ECEC/childcare) is a key setting to intervene to improve children’s physical activity. The Play Active programme is a scalable evidence-informed ECEC-specific physical activity policy intervention with implementation support strategies to improve educators’ physical activity-related practices.
This hybrid type III effectiveness-implementation trial will use a quasi-experimental repeated measures design to assess the real-world effectiveness of Play Active’s scalable implementation support strategies in helping ECEC services adopt the practices included in the Play Active policy. Secondary aims will examine changes in educator-reported and device-measured children’s physical activity; assess the sustainability of the programme; identify effective dissemination strategies; assess cost-effectiveness; and involve comprehensive process evaluation. All ECEC services in Western Australia (n=776), Queensland (n=1744) and South Australia (n=445) will be invited to participate. Data will be collected at baseline, 6, 12, 18, 24 and 30 months.
Ethics approval has been provided by The University of Western Australia Human Research Ethics Committee (HREC) (2023/ET000187), the University of Queensland HREC (2024/HE000076) and the University of South Australia HREC (206023). This real-world trial of Play Active is vital for understanding its implementation in practice and to generate evidence for further scale-up and roll-out nationally. Key findings will be disseminated to stakeholders, collaborators, policy-makers as well as families and practitioners in the ECEC sector.
ACTRN12624000406505.
Stroke represents the second leading cause of death worldwide after cardiovascular disease and the first cause of disability in adults. Only 25% of stroke survivors fully recover, 75% survive with some form of disability, and half of them lose self-sufficiency, negatively impacting their quality of life. This study aims to understand the experiences of stroke survivors and caregivers of training needs and support during the transitional care phase from hospital to home; it also investigates the experience of health care professionals (HCPs) of providing support and training to the dyad during this phase.
Meta-synthesis was conducted following a critical-interpretative approach. The SPIDER method was used for sample selection, and the PRISMA research question was adopted for article selection. The search for studies on CINAHL, Pubmed, Scopus, ERIC, PsycInfo and OVID was conducted until August 2024.
Of the 1123 articles found, 32 met the inclusion criteria and were included in the meta-synthesis. Text analysis revealed two main thematic areas: (1) the training need is a new awareness in the transition of care from hospital to home and (2) moulding oneself to new life. The first theme had six subthemes: need for information and training, uncertainty, involvement, evaluation of training needs, individual discharge planning and physical-psychological problems. The second theme included three subthemes: different role perception, support after discharge and adaptation to change.
Knowing the training and support needs in the stroke survivor caregiver dyad guides HCPs to structure tailored discharge plans. Multi-method and multidisciplinary training and support interventions such as health coaching, weekend passes and early supported discharge are satisfactory outcomes for the triad involved in the transition of care, as continuous feedback on the needs of the new reality at home fortifies the relationship between the dyad and HCPs. A transitional care pathway based on the dynamic needs of the triad can improve the quality of care in the community.
FreshRSS 