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To determine age-specific and age-standardised incidence trends of acute rheumatic fever (ARF) or rheumatic heart disease (RHD) among Indigenous Western Australians aged less than 35 years of age.
A population-based retrospective cohort study with linked data analysis.
Western Australian hospital admissions (1996–2022) and RHD notifications to the state-based register (2011–2015).
Patients, both Indigenous and non-Indigenous aged
Of 1746 incident ARF/RHD cases, 1526 (87%) were Indigenous peoples, with the highest rates observed in patients aged 5–14 years, with an annual estimated increase of 4.3% (95% CI 3.2% to 5.2%). The 0–4 years age group experienced an annual increase in incidence rates of 4.8% (95% CI 1.4% to 8.2%). Overall, Indigenous patients experienced an annual increase of 1.9% (95% CI 1.3% to 2.6%) from 1996 to 2022. However, most cases (n=894) were identified after multiple significant policy developments (2011–2022) with an annual increase of 5.7% (95% CI 3.7% to 7.5%) for this period.
Increasing trends of incident ARF/RHD were observed in Indigenous patients aged under 15 years, with the greatest annual increments observed after policy implementation for disease reporting and awareness in the period from 2011 to 2022. Improvement in case ascertainment of ARF/RHD may be contributing towards increasing trends with improved reporting and monitoring of incident cases in very young Indigenous Australians more recently.
Black and Asian women experience significantly higher rates of mortality and morbidity perinatally compared with white women and are more likely to lose their babies. These groups are also under-represented in clinical research, resulting in evidence that may not be generalisable. Tools have been developed to facilitate the inclusion of ethnic minority groups, but it is unknown to what extent representation and inclusion are considered in maternity trials.
To provide an overview of how ethnically diverse recruitment is considered and reported in maternity trials in the UK.
A scoping review was conducted, undertaking a systematic search to identify published trial protocols and their subsequent results papers, conducted within the UK, recruiting women during pregnancy or within 6 weeks postnatally between 2004 and 2024.
Data was extracted from protocols on whether representation of participants was considered in the study design and if specific recruitment and retention strategies were planned for ethnic minority groups.
Data extracted from results papers identified whether representation of participants was discussed and if recruitment strategies were discussed; these were compared against the protocol.
A total of 96 published protocols met the inclusion criteria; 8 mentioned specific recruitment strategies and 5 mentioned specific retention strategies. Only two included both recruitment and retention strategies. The most common strategies included providing different types of language support and adapting interventions to be culturally appropriate. Strategies were not evaluated.
67 results papers were available. Ethnicity was reported in 57 papers, with heterogeneity of categories between papers. Only 32 papers discussed representativeness of participants.
Few maternity trials report considerations on how they ensure they are recruiting and retaining ethnically representative participants. Minimal discussion is undertaken around the extent to which trial participants reflect the population to which findings will be applied.
Further work is needed to support implementation and evaluation of inclusive research guidance. Failing to ensure those from ethnic minority groups are included in research can exacerbate inequalities.
To explore the optimal timing of patient-reported outcome assessment, defined as the collection and use of patient-reported outcomes at clinically meaningful points such as before or during encounters, treatment initiation and follow-up, and to identify the facilitators and barriers to timely use.
A qualitative analysis of semi-structured interviews with healthcare professionals across diverse US health systems.
Thematic analysis was used to identify key themes related to the timing and implementation of patient-reported outcomes assessments. Interviews were analysed iteratively to develop a coding framework and synthesise overarching themes.
Fourteen healthcare professionals, including nurse practitioners, cardiologists and health informatics experts across seven U.S. health systems from academic and community hospitals, were interviewed in February 2024. Three major themes emerged: (1) value proposition of timely patient-reported outcome data collection (2) key facilitators for timely implementation and (3) multilevel barriers. The value proposition focused on the use of patient-reported outcomes for prevention and active disease management. Critical facilitators for the timely implementation of patient-reported outcomes included the involvement of research and clinical coordinators, strategies for pre-visit and on-site patient-reported outcome collection, the use of standardised templates within EHRs and the alignment of patient-reported outcome collection with patients' long-term treatment goals. Finally, multilevel barriers included time constraints, patient-level challenges (e.g., fatigue, literacy, language) and systemic issues (e.g., technical limitations, lack of reimbursement and unclear guidelines).
Timely collection and use of patient-reported outcomes is critical for improving symptom monitoring and supporting patient-centered clinical decision-making. However, multilevel barriers hinder consistent implementation across health care settings.
Integrating patient-reported outcomes into clinical workflows can improve the patient-centeredness of patient-healthcare professional interactions, and provide a more holistic picture of a patient's health status. Addressing barriers to patient-reported outcome implementation, including lack of time, poor health literacy and workflow integration barriers, is crucial for improving clinical outcomes.
This study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist, in accordance with EQUATOR Network guidelines.
No patient or public involvement: This study did not include patient or public involvement in its design, conduct or reporting.
To explore parents' experiences of holding children for healthcare procedures in an Australian paediatric hospital setting.
A qualitative exploratory study was undertaken at a paediatric tertiary hospital in Melbourne, Australia.
Semi-structured interviews were conducted with parents of children who had undergone a procedure during their hospital admission. Interviews were audio recorded, transcribed and analysed using reflexive thematic analysis.
Eight parents were interviewed, with four themes becoming apparent from their experiences, representing the multiple roles parents undertook when holding their child for a procedure. Parent as a protector was identified as the overarching role, with all roles involving aspects of parents protecting their child. The remaining roles included comforter—where parents supported their child by providing reassurance and being present; helper—where parents actively sought a role or stepped up to assist during a procedure and enforcer—where at times parents had a belief that to facilitate some procedures holding was necessary. A sliding-scale schema illustrates that these roles are not static, but rather positioned along a continuum, with some parents moving between roles throughout a procedure.
This study provided valuable insight into the complexity of parents' involvement when supporting their child during a procedure. The varying roles suggest parents balance the desire for their child to feel safe (holding as a comforter) with wanting to get the procedure done (holding as an enforcer).
This research impacts clinicians, parents and children involved in healthcare procedures. Clinicians can use the sliding-scale schema that illustrates the distinct roles parents can take on, as a visual tool to promote parental involvement and help parents define their role during a procedure.
Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline was utilised when reporting findings.
No patient or public contribution.
Previous studies have shown the COVID-19 pandemic was associated with reductions in volume across a spectrum of non-SARS-CoV-2 hospitalizations. In the present study, we examine the impact of the pandemic on patient safety and quality of care.
This is a retrospective population-based study of discharge abstracts.
We applied a set of nationally validated indicators for measuring the quality of inpatient care to hospitalizations in Ontario, Canada between January 2010 and December 2022. We measured 90-day mortality after selected types of higher risk admissions (such as cancer surgery and cardiovascular emergency) and the rate of patient harm events (such as delirium, pressure injuries and hospital-acquired infections) occurring during the hospital stay.
A total 13,876,377 hospitalization episodes were captured. Compared with the pre-pandemic period, and independent of SARS-CoV-2 infection, the pandemic period was associated with higher rates of mortality after bladder cancer resection (adjusted risk ratio [aRR] 1.20 (1.07–1.34)) and open repair for abdominal aortic aneurysm (aRR 1.45 (1.06–1.99)). The pandemic was also associated with higher rates of delirium (adjusted odds ratio [aOR] 1.04 (1.02–1.06)), venous thromboembolism (aOR 1.10 (1.06–1.13)), pressure injuries (aOR 1.28 (1.24–1.33)), aspiration pneumonitis (aOR 1.15 (1.12–1.18)), urinary tract infections (aOR 1.02 (1.01–1.04)), Clostridiodes difficile infection (aOR 1.05 (1.02–1.09)), pneumothorax (aOR 1.08 (1.03–1.13)), and use of restraints (aOR 1.12 (1.10–1.14)), but was associated with lower rates of viral gastroenteritis (aOR 0.22 (0.18–0.28)). During the pandemic, SARS-CoV-2-positive admissions were associated with a higher likelihood of various harm events.
The COVID-19 pandemic was associated with higher rates of patient harm for a wide range of non-SARS-CoV-2 inpatient populations.
Understanding which quality measures are improving or deteriorating can help health systems prioritize quality improvement initiatives.
No patient or public contribution.
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