Conectar
Developmental regression is when children lose one or more skills they have established. Families caring for these children need timely recognition to assist diagnosis and tailored interventions. Families also need support to develop practical skills for caregiving and strategies to promote family well-being and community participation. Given the high caring demands, flexibly delivered approaches are needed to accommodate family routines. Online delivery of health-related interventions that provide coaching, information, or both has been found to be a feasible and effective option for families. Family Focus is a new family-centred online programme, co-designed with parents and family advocates, clinicians, and researchers to support and empower primary carers.
This study is a prospective, pragmatic randomised controlled trial comparing the effectiveness of online parent coaching plus Family Focus (Coaching+FF) to Family Focus alone (FF) for primary carers of children experiencing developmental regression. A sample of 56 families will be randomised in a 1:1 ratio. Outcomes are assessed at baseline, post-intervention and 12-month post-randomisation. The primary outcome is parental stress symptoms at post-intervention. Secondary outcomes include parental depressive and anxiety symptoms, parental engagement in health-promoting activities, family empowerment, family quality of life and child global health outcomes. The study will also examine the uptake and acceptability of specific coaching and FF components and explore the facilitators and barriers to their delivery and implementation.
Ethics approvals were obtained from the participating organisations (Monash Health HREC/107806). Informed consent is obtained from parents/guardians of children prior to study enrolment. Study findings will be disseminated through peer-reviewed publications, conference presentations and lived experience agencies.
To explore healthcare professionals’ perceptions and experiences with point-of-care testing (PoCT) implementation within Australia’s healthcare system and identify potential strategies for effective governance and improvements to regulation and guidelines that facilitate coordinated integration of quality PoCT into healthcare systems.
A descriptive qualitative study with thematic analysis with codes derived inductively from the transcriptions and a structured framework analysis using the six building blocks of the WHO Health Systems Framework exploring barriers and enablers to PoCT implementation.
Healthcare settings in Australia.
Healthcare workers with patient care responsibilities and healthcare administrators with oversight or regulatory responsibility for a service. 18 participants were interviewed with four from hospitals, four from primary care, three from community care, three from pathology laboratories, two from emergency care and two from pharmacy settings.
Healthcare professionals’ perspectives on PoCT implementation were grouped into three main themes: (1) community-centric pathology testing, (2) connectivity and continuity of care and (3) quality and governance. Participants identified insufficient health system financing and health information systems as significant barriers to PoCT implementation. Improved practical guidance for workforce training and health service delivery to interpret the current regulation outside of laboratory settings was viewed as a potential enabler to establishing PoCT within healthcare services.
Participants reflected that Australia has several examples of successful PoCT programmes providing patient-centred pathology to improve healthcare equity. However, the lack of information systems, funding, workforce training and diagnostic strategies prohibits the implementation of PoCT at-scale. It was recommended that adequately financing PoCT to encompass costs for testing, quality management and workforce training would incentivise services to obtain accreditation and ensure quality healthcare delivery. Despite the potential of PoCT to improve equitable healthcare access and patient outcomes, health system strengthening is required to integrate PoCT effectively across Australian healthcare services.
People with severe mental illness (SMI) engage in less physical activity (PA) and more sedentary behaviour (SB) than the general population, contributing to poorer physical health outcomes in this population. Therefore, the aim of this study was to evaluate the feasibility of a multi-component behaviour change intervention called Walking fOR Health (WORtH), delivered by community mental health teams, aimed at increasing PA and reducing SB compared with a one-off education session in people with SMI.
Feasibility randomised controlled trial (RCT).
Study recruitment and intervention delivery took place within four community mental health teams in the UK and Ireland.
Eligible participants had a diagnosis of a SMI and no contraindications to participating in physical activity. Fifty-four participants (25 male, 29 female; mean age 51.6 years) were recruited.
Participants were randomised to the 13-week WORtH intervention, comprising education, activity tracking and health coaching or an education-only control.
Feasibility outcomes included recruitment, retention, adherence and acceptability. Clinical outcomes included device-measured (Axivity AX3) and self-reported PA and SB, body anthropometry, physical function and mental well-being.
This feasibility study met 90% target recruitment and 94% of participants provided follow-up data. Adherence to allocated intervention and engagement with all core intervention components was >80%. Qualitative feedback indicated high levels of satisfaction. Valid device-measured moderate-vigorous PA (MVPA), the intended primary outcome for a definitive trial, was obtained from 90% of participants at baseline and 75% of participants at post-intervention. Point estimates indicated a mean increase of 8.6 min/day of MVPA in the intervention group (baseline 54.7 min/day (95% CI 39.5 to 70.0); follow-up 63.3 min/day (95% CI 50.1 to 76.4)) and of 1.0 min/day in the control group (baseline 42.1 min/day (95% CI 24.6 to 59.6); follow-up 43.1 min/day (95% CI 29.6 to 56.5)).
The results of this study support the feasibility of the WORtH intervention in adults with SMI, and findings will be used to optimise the design of a definitive RCT.
In 2017, Lifeline Nehemiah Projects in Sierra Leone launched 2YoungLives, a mentoring initiative for vulnerable pregnant adolescents, including those living with disabilities. Drawing from the social model of disability, we aimed to investigate the exacerbated disabling barriers which prevent these girls and their babies from accessing available healthcare and develop comprehensive solutions to improve their access.
Qualitative methods were used in this study.
Participants were invited to participate in face-to-face interviews in one district in Sierra Leone.
Six pregnant or postnatal adolescents living with disability, alongside four caregivers and five stakeholders from various organisations participated in semi-structured interviews employing thematic analysis.
We identified four key themes: (1) discrimination and financial barriers within the healthcare system, despite laws ensuring free healthcare for persons living with disabilities, (2) societal stigma manifested through abandonment by families and inadequate support, (3) lack of understanding of disability issues, particularly of those with intellectual impairments, leading to stigmatisation and exclusion, and (4) infrastructural limitations which hinder accessibility to essential services, with many facilities remaining non-compliant with disability regulations.
Adolescent girls living with disability during pregnancy and after birth in Sierra Leone face barriers to accessing healthcare, including caregiver ignorance, lack of autonomy, disabling services, social stigma and ineffective policy implementation, despite existing supportive laws. These findings keep those women who are arguably the most vulnerable, adolescent and living with a disability, from accessing perinatal healthcare, exacerbating their risk and that of their babies. Solutions include the need to enforce disability-inclusive policies and infrastructure adaptations, awareness and training for healthcare providers and community advocacy to break down social stigma.
Chronic diabetic foot ulcers and venous leg ulcers remain difficult to treat due to delayed healing and high complication rates. Biologic skin allografts derived from living or amniotic tissue provide extracellular matrix components, cytokines, growth factors and viable cells that facilitate tissue repair. This investigation systematically reviewed randomised controlled trials comparing Apligraf, Theraskin, Amnioband, Amnioexcel, EpiCord and Epifix for chronic lower extremity wounds. Searches were conducted in PubMed, Embase and Cochrane databases. Primary outcomes included complete wound closure at 12 weeks, time to healing and percent area reduction. Secondary outcomes included infection, amputation and recurrence rates. Nineteen trials with a total of 1303 participants met inclusion criteria. Analysis demonstrated statistical significance in 12-week wound closure (p = 0.0394), with Theraskin achieving the highest mean closure (84.7%) and Amnioexcel the lowest (37.5%). Epifix and Amnioband showed faster healing trends and greater closure advantages compared with standard care. Reported complications were uncommon and inconsistently defined. While no single graft demonstrated statistically superior outcomes, descriptive trends suggest Theraskin, Epifix and Amnioband may offer greater clinical benefit. These findings provide comparative insight to guide clinical selection of skin substitutes and highlight the need for large-scale head-to-head trials to establish relative efficacy.
Gynaecological cancer nurses are crucial to the delivery of quality, specialised care to meet the needs of people with these cancers. The extent of evidence-based guidance to support nursing care is unknown.
To identify and describe existing international guidance for specialised gynaecological cancer nursing care.
Scoping review.
This scoping review utilised the participants, concept, context framework with narrative synthesis.
Databases including MEDLINE (Ovid), CINAHL Ultimate (EBSCO), Proquest Central (Alumni) and Google Scholar were searched on 4 April 2025 along with relevant websites and reference lists of included sources. Included sources referred to the nurse's role and provided clinical guidelines, practice recommendations or equivalent guidance on how nurses provide specialised care. Sources were limited to those published in English from 2009 to present.
Of 1905 sources identified, 12 met the inclusion criteria. Sources were published by authors in seven countries between 2014 and 2024. Most sources related to one specific gynaecological cancer type and/or one aspect or time point of care. Sources varied in the volume of nurse relevant content. No individual source provided comprehensive nursing guidance across all gynaecological cancer types.
Internationally published guidance for specialised gynaecological cancer nursing presents gaps in available evidence for care. We recommend comprehensive guidance resource development to meet clinical nurses' needs and improve translation of evidence-based nursing practice.
The current lack of comprehensive published guidance for specialised gynaecological cancer nursing does not meet reported needs of nurses working in clinical practice and may be contributing to variation in nursing care delivery.
Trial Registration: https://osf.io/ntdzj; registered 24 March 2025; Open Science Framework
Spinal cord injury (SCI) impairs autonomic functions, which are ranked among the highest priorities for recovery. The loss of autonomic control, including bowel, bladder, sexual and cardiovascular functions, interferes with rehabilitation and decreases health-related quality of life (HRQoL). Preliminary evidence indicates that non-invasive transcutaneous spinal cord stimulation (TCSCS) has the potential to improve autonomic stability in people with SCI. However, the optimal stimulation site for improving autonomic responses remains to be determined. This pilot randomised clinical trial aims to explore the efficacy of non-invasive mid-thoracic and lumbosacral TCSCS (proof-of-concept) for blood pressure stability (orthostatic hypotension and autonomic dysreflexia burden) alongside end-organ autonomic functions (lower urinary tract, bowel and sexual function) and HRQoL.
30 participants with chronic (>1 year) motor-complete SCI (American Spinal Injuries Association Impairment Scale A and B) at or above T6 will be enrolled in this open-label, two-arm randomised pilot clinical trial. Participants will be block randomised into either the mid-thoracic or lumbosacral TCSCS group. Participants will then undergo 8 weeks of TCSCS (3 times per week for 60 min; 24 sessions total) while in a seated position. Post-treatment effects will be recorded following the 8-week intervention and follow-up effects will be recorded 8 weeks after the end of the intervention. Primary and secondary outcomes will assess resting blood pressure, autonomic dysreflexia, orthostatic hypotension and lower urinary tract, bowel and sexual functions as well as HRQoL.
This study is approved by The University of British Columbia’s Clinical Research Ethics Board (UBC CREB H22-00365), and by Health Canada for Investigational Testing Authorisations (ITA) for Class II medical devices used in this trial (ITA#346875 TESCoN; ITA#381 154 SCONE). The findings will be disseminated through peer-reviewed publications, conferences, seminars and SCI community outreach.
Ankle fracture fixation surgery may be performed with or without the use of a tourniquet. Surgeons who use a tourniquet report reduced intraoperative bleeding, which improves the visualisation of anatomical structures. This may facilitate more accurate fracture fixation and restoration of the anatomical configuration of the ankle joint, potentially leading to improved functional outcomes. An additional proposed benefit of tourniquet use is reduced operative time. In contrast, surgeons who choose not to use a tourniquet report concerns that it may exacerbate postoperative pain and increase the risk of venous thromboembolism, surgical site infection and other complications. However, existing clinical trials are limited by small sample sizes and high risk of bias, preventing the ability to draw robust conclusions. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) to evaluate the potential benefits and risks of tourniquet use in ankle fracture fixation surgery.
This study comprises a two-centre, participant-blinded and surgeon-blinded parallel-arm RCT and an integrated qualitative interview study. A computer-generated randomisation service will allocate up to 50 patients to undergo ankle fracture fixation surgery either with or without the use of a tourniquet. Participants will be followed up for 3 months postoperatively. Primary outcomes include recruitment and retention rates, data completeness, success of blinding and adherence to allocated intervention. Secondary outcomes include postoperative pain, quality of the surgical field, intraoperative blood loss, blood transfusions, procedure duration, skin assessment, awareness of tourniquet use, health-related quality of life (EuroQol-5D-5L), Olerud-Molander Ankle Score and intraoperative and postoperative complications. The integrated qualitative study will consist of semistructured interviews with up to 12 patients and 12 trauma and orthopaedic surgeons (~24 interviews). Interviews will explore perspectives on the feasibility trial, identify factors associated with unblinding and examine barriers and potential solutions to the design and delivery of a future definitive trial. Interviews will be analysed using inductive thematic analysis.
National Research Ethics Committee (East of England-Essex) approved this study on the 8 May 2025 (REC 25/EE/0051). The results will be disseminated via peer-reviewed publication.
Respiratory syncytial virus (RSV) is a significant cause of respiratory infections in young children. Since 2021, RSV has been a notifiable disease in Australia. However, current surveillance systems focus on hospitalised RSV, with limited surveillance at a community level through primary care clinics. This approach only captures RSV requiring hospitalisation. Less severe illnesses, while not captured, may have significant social and economic impacts including the associated cost of care and absenteeism. The aim of this study is to establish an understanding of the broader burden of RSV in young children in a community setting.
The PATROL (Parents Actively Tracking RSV in Little Ones) project is a prospective longitudinal observational study of RSV and other respiratory viruses in children
Incidence rates of RSV illness and asymptomatic carriage will be calculated and compared with the incidence rate ratios of other respiratory viruses.
The Government of Western Australia Child and Adolescent Health Service Human Research Ethics Committee approved all study materials. Results and findings will be disseminated through manuscripts, conference abstracts and presentations, participant newsletters and appropriate general news media items.
Pilonidal sinus disease (PSD) is associated with substantial morbidity because of wound complications and recurrence after surgery. Adjunct laser hair removal (LHR) has been incorporated into postoperative management in some settings, but real-world outcomes in cohorts treated uniformly with LHR remain incompletely described. This study aimed to characterize postoperative outcomes after PSD surgery in a large integrated healthcare system in which adjunctive LHR was standard practice and to compare outcomes by surgical approach. We performed a retrospective descriptive cohort study of patients aged 14–89 years who underwent operative treatment of PSD with adjunctive LHR at Kaiser Permanente Northern California between 2012 and 2024. Outcomes included repeat procedures, 30-day surgical site infection (SSI), and unplanned clinic visits. Outcomes were summarized as proportions overall and by surgical approach. Exploratory bivariable logistic regression examined associations between sex or body mass index (BMI) and outcomes. Multivariable modeling was not performed because of low event counts and sparse covariate distributions, which resulted in unstable models. Among 168 patients, the overall repeat procedure rate was 16.7%, the 30-day SSI rate was 14.4%, and 39.3% had at least one unplanned clinic visit. Patients treated with Bascom flap closure had fewer repeat procedures (10.4% vs. 20.8%) and fewer unplanned visits (33.8% vs. 43.6%) than those undergoing pilocystectomy, with similar SSI rates (14.9% vs. 14.0%). In exploratory analyses, sex and BMI were not significantly associated with outcomes in either surgical group. In this real-world cohort managed uniformly with adjunctive LHR, postoperative outcomes appeared to vary more by surgical approach than by sex or BMI. These findings are descriptive and do not estimate the independent effect of LHR. Controlled comparative studies are needed to determine the contribution of LHR to PSD outcomes.
The objective of this study was to investigate the utility of the days alive and out of hospital (DAOH) metric within a cohort of patients undergoing burr-hole drainage of a chronic subdural haematoma (CSDH). We evaluate the validity of the DAOH metric in a national CSDH cohort and examine how the DAOH metric compares to its constituent outcomes (mortality and hospital bed days) at an organisational level.
Retrospective cohort study using Hospital Episode Statistics data linked to the national death registry to identify patients who underwent burr-hole drainage of CSDH in English National Health Service neurosurgical units between 1 April 2013 and 31 March 2020. Construct validity was assessed by measuring the patterns of DAOH across categories of known perioperative risk factors. Variation between units in the risk-adjusted values for DAOH, postoperative mortality and days in hospital was explored using funnel plots. Linear regression and logistic regression were used to derive the risk-adjusted rates.
Overall, 16 450 patients who underwent at least one burr-hole drainage of CSDH were identified during the time period. The median 30-day DAOH was 16 (IQR, 0–24); the median for the 90-day DAOH was 74 (42–84), and was better at measuring the complete stay associated with the index admission. Worse 90-day DAOH values were associated with older age, increasing comorbidities and greater frailty. Risk-adjusted 90-day DAOH values for neurosurgical units varied more markedly than for its constituent outcomes.
The 90-day DAOH looks to be a valid outcome metric for patients undergoing burr-hole drainage for CSDH that is feasible to derive using national hospital data. Future work should explore how to estimate a minimally important clinical difference for DAOH and evaluate its utility as an outcome measure.
To advocate for the systematic review as a rigorous, competency-aligned option for the Doctor of Nursing Practice (DNP) project.
A descriptive and conceptual analysis was used, drawing on existing literature, historical context, and a case study of a three-semester curriculum integrating systematic review methodology. Data sources included peer-reviewed research, professional guidelines, and faculty experience in teaching and mentoring DNP students.
Integrating systematic reviews as DNP projects equips students with competencies in evidence synthesis, critical appraisal, knowledge translation, and project management. A three-semester scaffolded approach to conducting a systematic review has the potential to foster strong student engagement, build essential skills, and prepare graduates to lead evidence-based practice change.
Systematic reviews meet DNP project criteria when paired with practice-focused implementation and evaluation components. This approach offers an alternative where site access, time, or feasibility limits primary data collection, while ensuring methodological rigor and professional relevance.
Adopting systematic reviews as DNP projects can reduce clinical site burden, expand project opportunities, and strengthen evidence-based practice capacity in nursing. Broader acceptance and standardization of this model could enhance practice-based doctoral education globally.
No Patient or Public Contribution.
To design and develop a novel co-produced intervention tool aimed at facilitating discussions that lung cancer nurses have with lung cancer patients about clinical trial opportunities; and promote trial recruitment.
A multi-phase qualitative focus group (phase 1) and co-production (phase 2) study.
The rigorous design and content of the intervention tool was informed by qualitative data from seven focus groups with lung cancer healthcare professionals (n = 38) and patients and their carers (n = 22) to establish barriers and facilitators to clinical trial participation. Data collection took place across England and Scotland between October and December 2023. Findings from a previously published systematic review were also incorporated to inform intervention tool design. The tool was developed through an extended co-production workshop comprising lung cancer nurses (n = 7), lung cancer patients (n = 2) and health researchers (n = 4). The COM-B model of behavioural change underpinned both phases of the project to guide tool development.
Phase 1 focus groups identified the need for a tool to provide basic trial information to patients, and to support lung cancer nurses in discussing trials with patients, thus improving nurses' knowledge, confidence, and awareness of trials. The phase 2 coproduction workshop identified that the tool should consist of two elements: a patient-facing information pamphlet and a large poster for nurses to assist them in discussing trial opportunities.
The study results demonstrate how nurses can be supported to discuss clinical trial opportunities with patients, with the potential to increase long-term recruitment to clinical trials.
Lung cancer nurses often lack confidence to support patients to make informed choices about trial enrolment. By addressing this issue, participation in lung cancer clinical trials can be significantly improved to benefit patient outcomes and trial participation rates.
The tool has the potential to be used across a range of different cancer settings and sites to increase recruitment to clinical trials.
The COREQ checklist was utilised to ensure that robust processes were followed and reported on.
Patients and members of the public were involved in all study processes and contributed to the study design, interpretation of the data, and intervention design. Their contributions included reviewing focus group topic guides, reviewing data analysis, the co-production of the intervention tool, and co-authoring this paper, ensuring the research addressed the needs and priorities of lung cancer patients when making an informed choice about clinical trial participation.
To develop and validate the End-of-Life Care Assessment Tool for Dementia (EoLC-ATD).
A methodological study with multiple phases.
Five sub-studies comprising: a review of 90 validated dementia measures to compile an item bank of advanced dementia symptoms; focus groups with registered nurses on advanced dementia symptom identification and relevance of item bank inclusions; Delphi surveys with dementia experts seeking consensus on the EoLC-ATD constructs and items; pilot testing of the EoLC-ATD; and field testing of the EoLC-ATD in persons with dementia.
The item-bank included 180 symptoms, most of which focus group nurses (n = 17) identified as occurring in advanced dementia. Delphi surveys with dementia experts (n = 31) achieved 70% consensus for 25 of 26 EoLC-ATD items. Pilot testing of the EoLC-ATD by two nurses in eight persons with dementia showed good agreement for six constructs (Cohen's Kappa 0.856–0.927) and 26 items (Cronbach's alpha 77.0). An ‘other sympto’ item was included following RN recommendation. The 27-item EoLC-ATD field tested by 17 nurses in persons with dementia (n = 113) accurately identified advanced dementia symptoms (Cronbach's alpha 77.0, p < 0.001). Mortality at 180 days after baseline EoLC-ATD was significant (p < 0.001, area under the ROC curve p = 0.769).
The EoLC-ATD accurately and reliably identified symptoms of advanced dementia.
The EoLC-ATD provides registered nurses with a single measure of advanced dementia symptoms that will help in identifying symptom-responsive palliative care requirements.
The EoLC-ATD will address the current lack of a validated dementia symptom measure for use by aged care home registered nurses to identify unique palliative and end-of-life care needs according to presenting symptoms in persons living with advanced dementia.
STROBE Statement for cohort and mixed methods studies.
An eight-member Expert Advisory Group, which provided guidance and advice throughout the study, was composed of three carers of persons living with dementia, two dementia care clinicians, a dementia care clinical educator, and two dementia clinician researchers.
To develop and validate a model to predict cognitive decline within 12 months for home care clients without a diagnosis of dementia.
We included all adults aged ≥ 18 years who had at least two interRAI Home Care assessments within 12 months, no diagnosis of dementia and a baseline Cognitive Performance Scale score ≤ 1. The sample was randomly split into a derivation cohort (75%) and a validation cohort (25%). Significant cognitive decline was defined as an increase (deterioration) in Cognitive Performance Scale scores from ‘0’ or ‘1’ at baseline to a score of ≥ 2 at the follow-up assessment.
Using the derivation cohort, a multivariable logistic regression model was used to predict cognitive decline within 12 months. Covariates included demographics, disease diagnoses, sensory and communication impairments, health conditions, physical and social functioning, service utilisation, informal caregiver status and eight interRAI-derived health index scales. The predicted probability of cognitive decline was calculated for each person in the validation cohort. The c-statistic was used to assess the model's discriminative ability. This study followed the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD) reporting guidelines.
A total of 6796 individuals (median age: 82; female: 60.4%) were split into a derivation cohort (n = 5098) and a validation cohort (n = 1698). Logistic regression models using the derivation cohort resulted in a c-statistic of 0.70 (95% CI 0.70, 0.73). The final regression model (including 21 main effects and 8 significant interaction terms) was applied to the validation cohort, resulting in a c-statistic of 0.69 (95% CI 0.66, 0.72).
interRAI data can be used to develop a model for identifying individuals at risk of cognitive decline. Identifying this group enables proactive clinical interventions and care planning, potentially improving their outcomes. While these results are promising, the model's moderate discriminative ability highlights opportunities for improvement.
To explore multidisciplinary clinical, academic, policy and governance stakeholders' perceptions of enablers and barriers to implementing designated registered nurse prescribing in Australia, using a systems-thinking approach.
A two-phase explorative study using a systems-thinking lens to investigate complex health-system interdependencies.
Fifty-three participants were recruited from all Australian states and territories, including registered nurses, nurse practitioners, pharmacists, medical practitioners and health-service planners. Phase 1 involved interviews and focus groups conducted between February 2024 and April 2024 (n = 45), analysed using deductive content analysis, guided by the Sustainability of Innovation Framework. Phase 2 was a face-to-face workshop conducted in August 2024 (n = 28), with data from participant discussions and observer field notes analysed inductively and refined through reflexive dialogue. Reflexive analysis of the findings allowed the construction of recommendations for implementation in various healthcare contexts.
In Phase 1, participants representing all Australian jurisdictions and healthcare contexts identified that successful adoption of designated registered nurse prescribing is contingent upon several interrelated system components. These interconnected factors influence each other within the broader healthcare system and serve as the focus for Phase 2.
In Phase 2, participants reported context-specific service models, stakeholder engagement, financial support, clear messaging and workforce/organisational readiness for new models of care and service delivery were recognised as dynamic interrelated elements. Three overarching themes for successful implementation were generated: The Standard—just one piece of the puzzle. Harnessing collective capability. Shared wisdom for success.
National implementation of registered nurse prescribing requires consistent but context-responsive reforms. A systems-thinking approach underscores the need for whole-of-system strategies, acknowledging interdependencies and avoiding rapid, unplanned implementation. This study highlights that sustainable adoption of registered nurse prescribing in Australia depends on recognising system interdependencies and their dynamic nature.
Designated registered nurse prescribing has the potential to improve timely access to medicines and enhance patient-centred care when implemented with whole-of-system support.
This study provides key systems-level recommendations to guide policymakers and healthcare services to successfully implement designated registered nurse prescribing across various settings.
This study highlights key stakeholders' perspectives, providing valuable insights on the essential elements required for the successful adoption of this expanded practice.
Broad systems-level recommendations are offered to guide policymakers and healthcare services to successfully implement designated prescribing across various settings, taking into account the complexity of the healthcare system.
Consolidated criteria for reporting qualitative research guidelines.
This study did not include patient or public involvement in its design, conduct or reporting.
Not registered.
To examine the impact of delays in intensive care unit (ICU) admission on patient outcomes, specifically clinical deterioration and mortality among patients transferred from the emergency department (ED) or general wards following acute deterioration in an Australian public hospital.
This prospective cohort study was conducted over a 12-month period (15 April 2022–14 April 2023) in a 209-bed regional hospital. It included adult patients (aged ≥ 18 years) admitted to the ICU from ED or general wards following acute deterioration. Primary outcomes measured were duration of delay in ICU admission, ICU and hospital mortality and changes in Sequential Organ Failure Assessment (SOFA) scores over time to assess organ dysfunction and progression.
A total of 403 patients were included. Of these, 276 (68.5%) experienced delays in ICU admission, ranging from 25 min to 347.25 h (median: 7.13 h). Delayed ICU admission was associated with increased mortality. Each one-point increase in the highest recorded SOFA score was linked to a 7.5% rise in mortality odds, while each one-point increase in the initial or 24-h SOFA score corresponded to a 6.8% increase.
Delayed ICU admission was significantly associated with increased mortality, particularly in patients with elevated SOFA scores, indicating worsening organ dysfunction and clinical instability.
These findings highlight the urgent need for improved triage systems, early warning protocols and streamlined escalation pathways to expedite ICU transfers for deteriorating patients. Timely intervention is essential to reduce harm and improve outcomes.
This study reinforces the clinical risks of delayed ICU admission and supports timely escalation of care in emergency and ward settings across Australian public hospitals.
Conducted in accordance with STROBE guidelines.
No direct patient or public involvement. The study used routinely collected clinical data to evaluate systemic and clinical outcomes.
To map the scope of nursing work and models of service delivery in Australian primary and secondary schools for children aged 3–18 years.
Scoping Review.
A search of CINAHL, Medline, PsycINFO, ERIC, Informit and Google was conducted in August 2024 for peer reviewed, non-peer reviewed and grey literature giving insight into nursing work in primary and secondary Australian schools in urban, regional and remote areas of all Australian states and territories.
The review employed Johanna Briggs Institute methodology for scoping reviews and reported the findings in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.
One hundred and forty-two sources were included. Findings indicate that nurses working in Australian schools conduct a wide range of activities which vary by jurisdiction, education sector, employer and school type. Models of nursing service delivery are similarly varied and range from full-time school-based nurses to nurses who visit schools on an occasional basis.
The varied scope of nursing work and models of service delivery provide evidence that the nursing workforce in schools is adaptable and flexible, but unequal access to nursing services raises important questions about equity. There is an urgent need for a national approach to nursing work in Australian schools.
This is the first review to map the scope of nursing work and models of service delivery in Australian primary and secondary schools.
FreshRSS 