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To explore the prescribing practices and behaviours of Advanced Practice Nurses (APN) and pharmacist prescribers in Singapore, assess their confidence in key prescribing competencies, examine their use of information sources, and understand their views on the consequences of prescribing errors.
Cross-sectional national survey.
A census survey of all registered APN and pharmacist prescribers in Singapore was conducted from February to May 2024 using a validated 96-item instrument. The survey assessed prescribing practices, confidence in prescribing competencies, use of information sources, and prescribing safety. Descriptive statistics were used for analysis.
Ninety-one prescribers (54 APNs, 37 pharmacists) responded (32% response rate), most of whom worked in public medical/surgical settings. Prescribing comprised a median of 75% of their practice. Most time was spent prescribing continued medications, with less on initiating new medicines. Participants reported high confidence in communication, therapeutic partnerships, and working within professional standards. Greatest confidence was seen in educating patients, legal prescribing, and monitoring treatment response. Lower confidence was noted in complementary medicine-related tasks. Professional literature and colleagues were the most valued information sources. Most participants acknowledged the serious consequences of prescribing errors, though many believed such errors would likely be intercepted.
APNs and pharmacists demonstrate strong competencies in safe, holistic prescribing. However, cultural factors may limit patient engagement, highlighting the need to strengthen shared decision-making and collaborative practice.
Refining governance structures, adopting tiered prescriber autonomy, and enhancing training in complex prescribing are essential. Standardising deprescribing, improving access to decision-support tools, and promoting interprofessional collaboration and patient involvement can strengthen care quality and team-based delivery.
This study offers the first national insight into Singapore's Collaborative Prescribing Framework and informs training, policy, and workforce development for non-physician prescribers locally and in similar international contexts.
STROBE checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
To evaluate the effectiveness of multidisciplinary transitional care interventions on functional status, quality of life and readmission rates of stroke patients.
Quantitative systematic review and meta-analysis.
Studies with interventions to ease the hospital-to-home transition of stroke patients that were delivered by multidisciplinary teams consisting of registered healthcare professionals from at least two disciplines were included. Cochrane Risk of Bias tool was used for quality appraisal.
Seven electronic databases (PubMed, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Scopus and Web of Science) were searched for randomised controlled trials delivering transitional care interventions to hospitalised stroke patients.
Thirty-one randomised controlled trials were included in the final review. The studies featured multidisciplinary teams of two to nine professionals, most commonly nurses, physicians and physiotherapists. Although multidisciplinary care improved functional status and quality of life scores, the impact on readmission rates was inconclusive. Meta-analysis revealed significant improvements in functional status when care involved physicians, care coordinators (often nurses) or had teams of more than two healthcare professionals. Significant improvement in quality of life was also reported when care involved physicians or in teams with more than two healthcare professionals.
Multidisciplinary transitional care interventions show promise in improving functional status and quality of life after stroke. Their effectiveness depends on team composition and coordination, particularly the inclusion of physicians and care coordinators. Future research should address reporting gaps and evaluate broader strategies to reduce hospital readmissions.
Impact (Addressing)
What problem did the study address? ○
The effectiveness of multidisciplinary transitional care interventions for stroke patients.
○Evaluated the role of various healthcare professionals within these teams.
What were the main findings? ○
Multidisciplinary transitional care interventions significantly enhance stroke patients' functional status, especially within the first 3 months.
○Teams with care coordinators (often nurses) and supportive physicians improve functional outcomes, with effective communication being crucial despite underreporting of specific practices.
○Teams comprising of more than two health professionals can significantly improve stroke patients' functional status.
Where and on whom will the research have an impact? ○
Healthcare institutions and providers: The findings can guide healthcare institutions in developing and implementing effective transitional care services for stroke patients.
○Stroke patients: Patients receiving multidisciplinary transitional care are likely to experience enhanced functional recovery and improved ability to perform daily activities.
○Policymakers and researchers: The study highlights the need for more detailed reporting and research on communication practices within multidisciplinary teams and the importance of evaluating underreported outcomes like readmission rates.
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) checklist.
No Patient or Public Contribution.
To collate the common caregiving experience of Young Onset Dementia informal caregivers.
Qualitative systematic review.
Qualitative grey literature and peer-reviewed journals published between 2013 and 2023 that addressed Young Onset Dementia informal caregivers' experiences were included without context limitation. Only English language publications were included because of limitations in translation. Study selection was conducted with two independent reviewers. Critical appraisal using Joanna Brigg Institutes Qualitative Appraisal Instrument, data extraction of participant's quote verbatim and data synthesis through categorisation of extracted verbatim were conducted without an independent reviewer.
PubMed on 16 October 2023, Cochrane and MEDLINE on 17 October 2023, EMBASE, CINAHL, PsycINFO, ProQuest, Scopus, Web of Science and Google Scholar on 18 October 2023.
A total of 37 studies included in this review represented the experiences of 566 informal caregivers. A total of 354 extracted findings were synthesised into 25 categories and four themes through meta-aggregation which addressed informal caregivers' diagnosis challenges, challenges with complex care, experience with various support services and coping strategies.
Young Onset Dementia informal caregivers experience unique caregiving challenges. These informal caregivers required age-appropriate support services to meet their unique needs.
Gaps in available appropriate support services for Young Onset Dementia informal caregivers existed. Therefore, these informal caregivers experienced unique challenges such as loss of employment that informal caregivers of other diseases do not experience.
Policymakers and healthcare professionals need to understand the unique experience of these informal caregivers to provide appropriate support services that could improve their caregiving experience.
PRISMA 2020 Statement.
No Patient or Public Contribution.
This review highlighted the various unique challenges encountered by informal caregivers.
PROSPERO Database (CRD42023467541). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023467541
To describe and compare the Evidence-Based HealthCare (EBHC) competence of Advanced Practice Nurses (APNs), and the factors associated with it in Finland and Singapore.
A descriptive and analytical cross-sectional study.
Data were collected from APNs working in healthcare in Finland (n = 157) or Singapore (n = 99) between May 2023 and October 2023 using a self-assessment instrument to measure EBHC competence (EBHC-Comp-APN) and an EBHC knowledge test. The data were analysed using descriptive statistics, analysis of variance, K-mean cluster and multivariate analyses.
The self-assessments of APNs working in Finland and Singapore regarding their EBHC competence level varied and three distinct profiles of APNs' EBHC competence were identified in both countries. The strongest EBHC competence was in ‘The Knowledge Needs Related to Global Health’, while the weakest in ‘Evidence Synthesis and Transfer’. The country-specific differences were identified in factors associated with EBHC competence.
The EBHC competencies of APNs vary widely and require planned and needs-driven development. In connection with the development of EBHC competence, the factors related to competence should be considered country-by-country.
The APN's EBHC competence should be systematically developed considering the factors associated with and the current level of EBHC competence.
The level of EBHC competence of APNs and associated factors should be identified when developing their competence and role in collaboration with APNs, leaders of healthcare and education organisations and policy makers. In addition, research into APNs' EBHC competence should continue.
The STROBE checklist was used in the reporting of the study.
No patient or public contribution.
Diabetic ulcers are chronic wounds that are notoriously difficult to treat, leading to significant physical and psychological distress and increased healthcare costs. Their multifactorial aetiology necessitates long-term interdisciplinary collaboration and various complementary treatment measures. While numerous studies suggest that electrical stimulation (ES) positively impacts diabetic ulcer healing, the robustness and consistency of these findings require further evaluation to optimize clinical application. We searched databases including PubMed, the Cochrane Library, Embase, Web of Science and the China National Knowledge Infrastructure (CNKI). Only randomized clinical trials (RCTs) comparing ES treatment to placebo or conventional treatment were included. Extracted information included objective healing measures and data for assessing effect sizes. Ten RCTs involving 451 patients met inclusion criteria. ES improved ulcer healing rate compared to control or placebo (MD 20.37, 95% CI: 16.89–23.85, p <0.001) and increased the number of healed ulcers (RR 1.45, 95% CI: 1.18–1.78, p <0.001), with both results being statistically significant. The observed benefits are likely due to the positive effects of ES on the vascular and neurological functions of the lower limbs in patients with diabetic ulcers. Both low-frequency, moderate-intensity alternating current and low-intensity or high-voltage direct current have demonstrated efficacy in promoting ulcer healing. The results suggest ES may be a promising approach of managing diabetic ulcers. However, the optimal method of ES application remains undetermined; therefore, high-quality and large-scale studies are essential.
To undertake a systematic review of the practice patterns and roles of advanced practice nurses (APNs) in inpatient and outpatient stroke-care services; and to evaluate the impact of APN-led inpatient and outpatient stroke-care services on clinical and patient-reported outcomes.
A mixed-methods systematic review.
A systematic search was conducted across six electronic databases for primary studies. Data were synthesised using a convergent integrated approach.
A systematic search was conducted across PubMed, CINAHL, Cochrane Library, Embase, PsycInfo and ProQuest Dissertations & Theses Global, for primary studies published between the inception of the databases and 3 November 2022.
Findings based on the 18 included primary studies indicate that the APNs' roles have been implemented across the continuum of stroke care, including pre-intervention care, inpatient care and post-discharge care. Practicing at an advanced level, the APNs engaged in clinical, operational and educational undertakings across services and disciplines. Positive clinical and patient-reported outcomes have been attributed to their practice.
The review highlights the critical role of APNs in improving stroke care, especially in the pre-intervention phase. Their clinical expertise, patient-centered approach and collaboration can transform stroke care. Integrating APNs into stroke care teams is essential for better management and outcomes in light of the increasing stroke burden.
Healthcare institutions should integrate APNs to enhance pre-intervention stroke care, improve diagnostic accuracy and expedite treatment. APNs can prioritise patient-centric care, including assessments, coordination and education. Medication reconciliation, timely rehabilitation referrals and lifestyle modifications for secondary stroke prevention are crucial. Implementing advanced practice nursing frameworks ensures successful APN integration, leading to improved stroke care and better patient outcomes in response to the growing stroke burden.
What problem did the study address? Poor clarity of the role of advanced practice nurses among patients, physicians, healthcare professionals, health policymakers and nurses.
What were the main findings? Advanced practice nurses practise across the continuum of stroke care, mainly in pre-intervention care which takes place before initiating treatment, inpatient care and post-discharge care. The implementation of the advanced practice nurse role in stroke care has contributed positively to clinical and patient-reported outcomes.
Where and on whom will the research have an impact? Insights from the review are envisioned to inform healthcare policymakers and leaders in the implementation and evaluation of the APN role in stroke care.
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines.
No Patient or Public Contribution.
https://figshare.com/ndownloader/files/41606781; Registered on Open Science Framework osf.io/dav8j.
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