To explore why there is variation in implementation of multifactorial falls prevention practices that are recommended to reduce falls risks for older patients in hospital.

Mixed method, realist evaluation.

Three older persons and three orthopaedic wards in acute hospitals in England.

Healthcare professionals, including nurses, therapists and doctors (n=40), and patients aged 65 and over, and carers (n=31).

We examined mechanisms hypothesised to underpin the implementation of multifactorial falls risk assessment and multidomain, personalised prevention plans.

We developed an explanation detailing that how contextual factors supported or constrained implementation of recommended falls prevention practices.

Nurses led delivery of falls risk assessment and prevention planning using their organisation’s electronic health records (EHR) to guide and document these practices. Implementation of recommended practices was influenced by (1) organisational EHR systems that differed in falls risk assessment items they included, (2) competing priorities on nurse time that could reduce falls risk assessment to a tick box exercise, encourage ‘blanket’ rather than tailored interventions and that constrained nurse time with patients to personalise prevention plans and (3) established but not recommended falls prevention practices, such as risk screening, that focused multidisciplinary communication on patients screened as at high risk of falls and that emphasised nursing, rather than Multidisciplinary Team (MDT), responsibility for preventing falls through constant patient supervision.

To promote consistent delivery of multifactorial falls prevention practices, and to help ease the nursing burden, organisations should consider how electronic systems and established ward-based practices can be reconfigured to support greater multidisciplinary staff and patient and carer involvement in modification of individual falls risks.

The sustainable employability of healthcare workers is associated with quality of care and vice versa, but how both interact remains largely unknown. This study aims to better understand the underlying mechanisms that explain the interconnectedness between healthcare workers’ sustainable employability and quality of care by examining organisational practices in two hospital teams that work on improving specific clinical processes.

A qualitative study was conducted, where team leaders, department managers and healthcare teams were observed and interviewed about their experiences with, and perspectives on, the (organisation of the) respective clinical process and daily (quality improvement) work. Transcripts and field notes were analysed in accordance with reflexive thematic analysis.

The emergency room and operating room of a recently merged Dutch hospital.

A total of 49 hours of observations and 10 interviews were conducted with team leaders, department managers, (scrub) nurses, physicians and other allied health professionals. Interviewees were purposively recruited when they were involved in, or considered knowledgeable about, the clinical processes.

This study identified three mechanisms as a result of different organisational practices that affected healthcare workers’ sustainable employability and quality of care separately and set in motion their interconnectedness: routinely overburdened staff, prolonged perceived distance between staff and regular disregard of raised concerns by staff. Over time, as these mechanisms remained unaddressed, undertows of slumbering sentiments—discontent, distrust and inertia—emerged. These sentiments proved hard to bring to the surface and to resolve and, in turn, may further compromise sustainable employability of healthcare workers and quality of care.

In this study, we show how the relationship between the sustainable employability of healthcare workers and quality of care is set in motion by seemingly unrelated organisational practices. To benefit both healthcare workers and patients, leadership and healthcare teams are urged to prevent (undertows of) slumbering sentiments by recognising sentiments as important signals of dysfunctional circumstances and by effectively organising participatory practices that enable healthcare workers’ voice and input.

Persistent somatic symptoms and functional disorders are conditions requiring a biopsychosocial approach to care, often from multiple professionals. The fragmentation of care common in most health systems results in unsatisfactory and challenging care experiences. Collaborative care networks form an important route towards improving outcomes and the overall experience of care for patients and professionals. While we have a good idea of what such collaborative care networks can look like, we lack knowledge on the practicalities of implementing change in such networks.

The core objective of this study is to implement change in a collaborative care network for persistent somatic symptoms and functional disorders care. Our questions were twofold: first, what are examples of realistic action processes to improve such collaborative care networks? Second, what are, in our experience, conditions for an effective change process in such a collaborative care network?

Participatory action research approach embedded within an active regional network between May 2023 and May 2024. The process was led by an action group who selected objectives and related actions with the aim of improving the network, leading to better care for people with persistent somatic symptoms and functional disorders as well as improving satisfaction among professionals.

ALK Netwerk Salland, a regional network of professionals and experts-by-experience, focused on care of persistent somatic symptoms. This network is based in the Salland region in the east of the Netherlands, centred around the city of Deventer.

The action group was made up of local stakeholders including experts-by-experience and health and social care professionals, facilitated by a researcher-in-residence. Other participants included members of the regional network who provided input towards the different objectives.

Over the course of a year, three objectives were selected and enacted, including assessing the resources of the network, improving knowledge of treatment options and improving the shared vision of care. The process faced some challenges, such as changes in action group members and a lack of resources and time to enact changes. However, by having a trusted and engaged team, working with an active network, we were able to enact significant changes to the network, which may be sustained and built on through the ongoing action group.

Future participatory action research studies would benefit from a trusted and embedded researcher-in-residence, meaningful involvement early in the process of experts-by-experience, and serious consideration of realistic outcome measures to monitor for evaluation of changes made.

Unfinished care—also referred to as care left undone, missed care or implicit rationing—has been widely studied in nursing but remains poorly defined and underexplored in the medical profession. Physicians play a central role in diagnosis, treatment and coordination of care, yet little is known about the extent, determinants and consequences of unfinished care in their daily work.

To systematically map and synthesise existing evidence on how unfinished care among physicians in acute care hospitals has been conceptualised, measured and empirically studied.

Original, peer-reviewed studies on physicians working in acute care hospital settings that explicitly addressed unfinished care, care left undone, missed care, suboptimal care or closely related constructs at the microlevel of clinical work. Exclusions: primary care, allied professions, adherence to guidelines, underuse at the population level, explicit macrolevel rationing, non-original reports, non-English, no full text available.

Five bibliographical databases PubMed, EMBASE, Web of Science, SCOPUS and CINAHL were searched in June 2024 to identify relevant studies.

Two reviewers independently screened titles/abstracts and full texts against prespecified criteria defined following the population, concept, context framework, with consensus resolution. Data were charted on study characteristics, terminology/definitions, measurement approach and findings. Methodological quality was appraised by the authors and an external independent expert using the Mixed Methods Appraisal Tool. Qualitative and quantitative findings were charted, then synthesised via a descriptive and thematic analysis.

Using predefined inclusion and exclusion criteria, 1971 potentially relevant titles and abstracts were identified and subsequently screened. Eight studies met the inclusion criteria, comprising three quantitative, three qualitative, one mixed methods and one quantitative non-randomised study. Only one study explicitly defined and measured ‘care left undone’, reporting that 78.3% of surveyed physicians had omitted at least one necessary care activity during their most recent shift. The terminology and clarity of concepts varied significantly across the studies (eg, ‘shortcuts’, ‘missed opportunities’, ‘suboptimal care’). Identified drivers emerged at both organisational (eg, high workload, poor communication) and individual (eg, burnout, fatigue) levels. While two studies connected care left undone to adverse patient outcomes (eg, readmissions) and worse physician well-being, the overall evidence on its prevalence and consequences remains limited. Overall methodological quality of the included studies was moderate, but conceptual and theoretical development remained limited.

This scoping review reveals major conceptual and empirical gaps in the study of unfinished care among physicians. Terminology is inconsistent, theoretical grounding is weak, and validated measurement tools are lacking. Evidence on prevalence, determinants and consequences remains scarce and largely descriptive. To advance the field, future research must establish conceptual clarity, achieve terminological consensus and develop robust, validated instruments to capture how unfinished care manifests within complex clinical systems.

To synthesise the perspectives of healthcare professionals and patients/residents of hospitals/nursing homes about determinants of inappropriate indwelling urinary catheter (IUC) use and strategies for reduction.

Qualitative evidence synthesis.

We searched MEDLINE, Scopus and CINAHL for studies published between 1 January 2000 and 23 May 2025.

Studies were eligible if they used qualitative methods to explore the perceptions and experiences of healthcare professionals and patients/residents of hospitals/nursing homes or their family members regarding the determinants of IUC use and reduction. Included studies focused on behavioural drivers or strategies to reduce inappropriate IUC use.

Two independent authors reviewed the search results, extracted and coded data, and assessed methodological strengths and limitations of studies. We used a thematic synthesis approach following the Cochrane–Campbell Handbook for Qualitative Evidence Synthesis and applied the Grading of Recommendations Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research approach to assess confidence in the findings.

We synthesised 24 studies. Perceived determinants of inappropriate IUC use included non-adherence to guidelines due to vague indications for initial IUC insertion, differing perspectives on benefits and risks, low priority given to the topic, limited accessibility or perceived unsuitability of alternatives, high nurse workload and staff shortages (moderate confidence). Ineffective nurse–physician communication, documentation difficulties and lack of training were also assumed to be linked to inappropriate IUC use (low confidence). Mentioned strategies for the reduction of inappropriate IUC use included additional training for healthcare professionals, clinician reminders to review or remove catheters, improved electronic documentation systems, increased staffing and greater use of IUC alternatives.

Key drivers of inappropriate IUC use are vague indications and routine decisions, lack of suitable and available alternatives, staff shortages and perceived lack of importance of the topic. Addressing these barriers is important for deimplementing inappropriate IUC use, and multifaceted strategies appear to be the most promising approach to address the multiple factors that drive current IUC misuse.

CRD42024531522.

The home-based primary care cohort was set up to identify the characteristics of Home-Based Primary Care (HBPC) users across three domains: health-related information, utility of healthcare service and care-related information.

A total of 407 patients enrolled in five HBPC centres were recruited between January 2023 and March 2024. The baseline survey was conducted among 332 participants who provided informed consent for both study participation and home visits. The second wave of data collection is scheduled to take place 6 months after enrolment, while the third wave will be conducted 12 months post-enrolment. During each home visit, trained interviewers administered structured survey questionnaires. On completion of the 12-month follow-up period, the dataset will include survey data, intervention records from the five participating HBPC centres, home mortality status and institutionalisation risk linked to each participant.

This study examines HBPC in Korea, integrating the Widely Integrated Services in Home model with the long-term care insurance system. Among participants, 30.1% lived alone, and 74.1% were homebound, showing similarities to findings from a US HBPC study. Analysing cohort data, this study evaluates the impact of HBPC on healthcare utilisation, aligning with international findings on reduced hospitalisations and costs. As the first HBPC effectiveness study in Korea, it highlights its role in enhancing care for homebound older adults and shaping national health policies.

Data on the number of interventions by profession, institutionalisation and hospitalisation status and duration, and death at home occurrence are being separately collected from five HBPC centres and will be included in the analysis. The analysis will examine associations between these variables to identify risk factors influencing institutionalisation. Additionally, this study plans to link the dataset with the National Health Insurance Service-Senior (NHIS-Senior) customised cohort for further analysis.

Acute kidney injury (AKI) is a complex, devastating condition characterised by a sudden reduction in renal function, leading to increased mortality and healthcare costs globally. Outcomes of AKI are worsened by factors such as limited access to healthcare, delayed hospital presentation and underlying comorbidities, which severely affect patients in sub-Saharan Africa. The renal resistive index (RRI) has come into view as an encouraging non-invasive imaging approach for the early prediction of AKI. However, the use of the RRI for AKI prediction in sub-Saharan Africa is poorly documented. This research aims to map and describe the evidence for using the RRI for the early detection of AKI in sub-Saharan Africa.

The Joanna Briggs Institute methodology for scoping reviews will be used for this study. It will include a comprehensive search of electronic databases, grey literature (including academic proceedings), as well as an extensive literature review of relevant journals. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews will also be used as a guide. Discrepancies will be handled by consensus or by consulting a third reviewer. This evidence synthesis will explore the usefulness and accuracy of the RRI for early prediction of AKI in sub-Saharan Africa, where the patients are generally younger and have different AKI risk predictors and cardiovascular profiles compared with patients in high-income countries. Evidence of implementation and associated challenges will also be explored. These challenges may include limited access to specialised ultrasound equipment and a lack of trained healthcare providers proficient in RRI measurement and interpretation. The findings will inform future studies and be useful for healthcare providers, policymakers and patient advocates seeking sustainable strategies for preventing AKI.

Ethical approval is not required for this scoping review. The findings of this review will be published in a peer-reviewed journal and presented to decision-makers, health system administrators and healthcare providers at national and international academic conferences.

There is limited evidence regarding the outcomes and impacts of Patient and public involvement (PPI) in research, mainly based on narrative studies. Existing frameworks for supporting and evaluating PPI often require adaptation to specific contexts, and comprehensive instruments are needed. From an international perspective, strengthening the scientific foundation that underpins PPI is crucial to generate stronger evidence to understand which approaches work best, in which contexts, and with what effects.

To promote PPI implementation in German health research, this project aims to (1) Establish an evaluation framework, (2) Develop a modular evaluation tool in the form of a questionnaire and (3) Pilot and psychometrically validate the tool.

A three-phase mixed methods approach will be employed, integrating qualitative and quantitative data. First, we will explore with researchers, research partners and other stakeholders in health services research what contributes to meaningful and successful PPI through a web-based survey and focus groups. Findings are discussed in a codesign workshop in which participants agree on an evaluation framework based on a LOGIC model. Second, items from international instruments that evaluate PPI are deductively assigned to the evaluation framework. Further items are developed based on the focus groups from phase 1. Cognitive pretests and qualitative review will be conducted with researchers and patients in order to refine the item pool and develop the evaluation tool. Third, the evaluation tool with modules for researchers and patients will be piloted in a web-based survey. Data analysis will include thematic analysis for qualitative data and descriptive and psychometric analyses for quantitative data. A participatory research team will provide ongoing support throughout all project phases.

Ethical approval has been obtained from the Local Ethics Committee of the Centre for Psychosocial Medicine, University Medical Centre Hamburg-Eppendorf (LPEK-0889). The study will follow the principles of the Helsinki Declaration and good scientific practice. Results will be disseminated at national and international conferences, public symposiums and in peer-reviewed journals, contributing to the internationally developing field of PPI in research and addressing relevant research gaps.

The Core Outcome Measures for Improving Dementia Care (COM-IC) project aims to develop a core outcome set for measuring the quality of care provided to people living with dementia in routine care settings. In a previous stage of the project, 17 core outcomes were identified. This study is the next step, aiming to review the literature to identify existing or recommended, validated scales for measuring the identified core outcomes.

A rapid review

Six electronic databases (PubMed, Embase (Elsevier), CINAHL Complete (EBSCOhost), APA PsycINFO (EBSCOhost), Web of Science (Clarivate) and Scopus (Elsevier) were searched. Searches were completed on 12 July 2024.

Peer-reviewed systematic reviews or original validation studies of scales measuring dignity; engagement in advance care planning; pain; quality of life; feeling safe and secure; emotional well-being; diagnosis of dementia; behavioural and psychological symptoms of dementia; the importance of relationships; meaningful activities; hygiene and comfort; resource utilisation and safety incidents for people living with dementia were included. Peer-reviewed systematic reviews or original validation studies of the scales to measure informal carers’ quality of life, their educational opportunities, formal carers’ morale and dementia-specific qualifications were also included. All studies were required to have been conducted among people living with dementia or carers, as appropriate, and to have full texts available in English.

Data on the scale’s name, the number of subscales, subscales’ names, the number of items, response options, scoring, estimated time to complete the scale, recommended frequency of data collection and the setting where the scale was first validated were extracted. Findings are presented in figures, tables and narrative texts.

A total of 88 validated scales were identified. No scales measuring dignity, engagement in advance care planning, feeling safe and secure, hygiene or safety incidents were validated for people living with dementia. No scale was identified to measure the importance of relationships for people living with dementia, the formal carers’ dementia-specific qualifications or the educational opportunities for informal carers. The review also describes the 50 recommended or validated scales.

Several validated or recommended scales exist to measure core outcomes identified as important for assessing the quality of care provided to people living with dementia in routine care settings. This review offers COM-IC stakeholders and other potential users with information on the validated/recommended scales to measure these core outcomes.

Hospital length of stay (LOS) is a key indicator of hospital efficiency and quality of care, but a reliable metric for benchmarking LOS remains problematic. This report describes a time-to-event methodology to generate a hospital standardised LOS ratio (HSLR).

Retrospective observational analysis of LOS from a jurisdictional administrative dataset using a time-to-event (hazard of discharge) analytic approach to generate risk-adjusted LOS (predicted LOS—pLOS), and the HSLR (= (sum observed LOS)/(sum total pLOS)).

219 (public and private) acute-care hospitals in the State of Victoria, Australia, adult population 5.28 million.

2.73 million adult multiday separations and 15.53 million bed-days from July 2019 to June 2024.

Nil.

Descriptive statistics for annual mean LOS (aLOS), pLOS and HSLR at the hospital level with model fit assessed for calibration (Cox-Snell residuals), classification (aLOS and HSLR results for hospital-years compared to benchmark), variance (intraclass correlation coefficient (ICC) at provider level) and model dispersion (value () and random effect SD ()) characteristics.

Observed LOS was markedly right skewed and autocorrelated (p3 SD of benchmark); whereas 936 (99.5%) HSLR values were inliers (

aLOS is a simple descriptor but poor comparator. Time-to-event survival analytic models furnish risk-adjusted pLOS and HSLR metrics which indicate that the majority of LOS variation is due to patient-related, not hospital, factors.

To develop survey items for a national patient registry on Long COVID using a modified Delphi process.

This study was based on a modified Delphi process involving three rounds of anonymous, online surveys to develop consensus on and prioritise survey elements to be included in a minimum dataset for use in a national patient registry in Canada. Initial Long COVID items were identified through an environmental scan of the literature.

This study focused on healthcare systems in Canada and was conducted online.

A panel of 52 experts (patients, caregivers, clinicians and researchers) participated in all three rounds of the online survey. These participants were recruited through the Long COVID Web network and word of mouth.

In total, 243 survey elements related to care, quality of life and symptoms were included in round 1 of the survey. 200 reached consensus and moved to round 2 with two additional elements being developed based on open-ended responses. In round 2, participants ranked these survey elements and 34 advanced. In round 3, 33 survey elements met the threshold of consensus with one added a priori. The 33 survey elements were then used to develop a Long COVID minimum dataset, which consists of 48 items.

The findings affirm broad consensus for collecting data related to fatigue, post-exertional malaise, cardiovascular issues, respiratory problems and cognitive issues. This highlighted the desire for quality-of-life indicators and information related to care utilisation, quality and access.

Low back pain (LBP) is the leading contributor to disability globally. It has a substantial impact on the lives of those who experience it, and places considerable economic burden on healthcare systems. Despite these impacts, and the consistency of guideline recommendations, many individuals do not receive recommended LBP management. Structural barriers to accessing timely, evidence-based care, as well as public uncertainty about where to seek appropriate management, can influence the care individuals receive. Telephone and digitally based helplines assist to overcome many traditional barriers to accessing care and offer a scalable platform to improve the delivery of guideline recommended management for LBP. However, uptake of such services can be limited without targeted promotion and patient-centred design. This project aims to codesign, implement and evaluate an upgraded component of an existing Australian helpline service, tailored for people with back pain and supported by a media awareness campaign. This protocol outlines the codesign process, implementation and planned evaluation of the helpline.

This protocol uses three complementary frameworks—an iterative codesign process, the Practical Robust Implementation Sustainability Model, and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework—to guide the codesign and development, implementation and evaluation of an upgraded helpline for people with LBP. The codesign process involves key stakeholders, including consumers and clinicians, to inform the development and implementation of both the upgraded helpline service and the media campaign to raise awareness and uptake of the helpline. Data sources will include a pre–post cohort of helpline service users, routinely collected service data (eg, monthly call rate) and health system data to evaluate the broader population level impact (eg, rates of emergency department presentations for LBP in the Australian region targeted by the media campaign). Implementation evaluation will include Reach, Effectiveness, Adoption, Implementation and Maintenance as well as internal and external environmental factors that influence the success of these outcome measures.

The project was approved by the University of Sydney’s Human Research Ethics Committee (HE001081). This project involves collaboration with consumers, clinicians and other stakeholders to interpret, translate and disseminate research findings to relevant audiences.

Acute respiratory infection (ARI) is one of the leading causes of childhood morbidity and mortality. In Mauritania, very few children who experience ARI receive medical treatment. Additionally, inequalities in the care-seeking behaviour for ARI have not been assessed in the country.

To examine inequalities in care-seeking behaviour for childhood ARI in Mauritania and assess the extent to which they have changed between 2000–2001 and 2019–2021.

A population-based cross-sectional study using the WHO health equity assessment toolkit.

Mauritania.

Under-five children.

We utilised inequality measures, including Difference (D), Ratio (R), Population Attributable Fraction (PAF) and Population Attributable Risk (PAR). The results were disaggregated based on five dimensions of inequality. We calculated these measures separately for each of the two surveys and then compared their estimates.

The proportion of care-seeking behaviour for ARI rose slightly from 45.2% in 2000–2001 to 46.4% in 2019–2021, reflecting an increase of only 1.2%. Rural-urban inequalities showed the largest decline between 2000–2001 (D=30.0; R=2.0; PAF=33.5, PAR=15.2) and 2019–2021 (D=12.0; R=1.3; PAF=17.4, PAR=8.1). Disparities based on wealth (2000–2001: D=40.3; R=3.0; PAF=34.6, PAR=15.6; 2019–2021: D=30.5; R=2.1; PAF=25.1, PAR=11.6) and maternal education (2000–2001: D=25.1; R=1.6; PAF=49.8, PAR=22.5; 2019–2021: D=19.1; R=1.4; PAF=34.1, PAR=15.8) were also reduced. Inequalities related to the sex of the child were minimal. However, discrepancies across subnational regions were evident in both survey rounds.

Care-seeking behaviour for ARI in Mauritania has shown slow progress over the past 20 years. Large inequalities persist, particularly by place of residence, wealth and maternal education. Efforts to strengthen equitable health service access should prioritise reducing geographic and socioeconomic disparities by targeting children from poor households, with less educated mothers, and living in rural areas to ensure all children benefit equally from healthcare services.

To evaluate the psychometric properties of the Hospital Survey on Patient Safety Culture (HSoPSC) version 2.0 in Ethiopian public hospitals.

A cross-sectional study.

Five public hospitals in Eastern Ethiopia.

Healthcare professionals (N=582).

An adapted and contextualised version of HSoPSC 2.0 was used to conduct structural validity using exploratory and confirmatory factor analyses (EFA and CFA). Convergent and discriminant validity were evaluated through item loadings and interfactor correlations, respectively. Reliability was measured using McDonald’s omega and Cronbach’s alpha.

CFA indicated a poor model fit for the original 10-factor, 32-item HSoPSC 2.0 across all statistical indices: relative chi-square (²/df=7.71), root mean square error of approximation (RMSEA=0.108), standardised root mean square residual (SRMR=0.088), comparative fit index (CFI=0.814) and Tucker-Lewis’s index (TLI=0.780). Consequently, a comprehensive EFA was conducted, which identified a revised model comprising 5-factor, 21-item. This model accounted for 62.8% of the total variance and demonstrated strong construct validity, with excellent fit indices (²/df=3.67, RMSEA=0.068, SRMR=0.034, CFI=0.969, TLI=0.945). Internal consistency, assessed via McDonald’s omega and Cronbach’s alpha, exceeded the acceptable threshold of 0.70 across all dimensions, except for Response to Error (0.66). The convergent and discriminant validity of the new model was confirmed, ensuring an accurate representation of the underlying constructs.

The original HSoPSC 2.0 with 10-factor, 32-item failed to demonstrate structural validity in the Ethiopian healthcare context. In contrast, a revised 5-factor, 21-item model showed strong validity and acceptable reliability. This adapted version provides a culturally and contextually relevant tool for assessing patient safety culture in Ethiopian healthcare settings.

To identify the core attributes of quality care that supports well-being from the perspectives of those who access and provide stroke services.

Qualitative Interpretive Description study design involving in-depth semistructured individual and group interviews and analysis using journey mapping and conventional content analysis.

24 people with stroke, 13 family/whānau members and 34 healthcare professionals located throughout New Zealand.

Participants were recruited through health services, stroke support organisations and professional networks. Interviews were completed in person at people’s homes or workplaces or on an online videoconference.

Analysis generated a quality framework of domains. High-quality care that supports well-being after stroke in Aotearoa: supports people through uncertainty; fosters a sense of belonging; prioritises relationships and connecting ‘as people’; attends to the emotional aspects of stroke; centres people’s preferences and supports people to have choice and control; honours Māori knowledges and practices; responds to the strengths and needs of friends and whānau; and attends to people’s holistic long-term well-being.

This study offers a framework for considering holistic stroke care that supports areas of need not consistently addressed in stroke services. This framework can help structure practice and policy and can underpin future research in well-being.

Essential care partners (ECPs), also known as family caregivers, play a critical role in the Canadian healthcare system across the continuum of care, particularly in managing complex conditions like stroke. With the rising number of stroke incidents occurring in Canada each year, there is an increased need for caregiver assistance to help manage the care needs of stroke survivors as they transition to home and community services. Although existing research has highlighted the practical and psychosocial needs of stroke ECPs, these challenges have been mainly overlooked. The lack of integrated intersectoral care services across stroke care pathways places additional significant burdens on caregivers, leading to increased stress, social isolation and a decreased quality of life. Nelson and colleagues’ novel Discharge Assistance and Supports at Home model uses community-based interventions mobilised through intersectoral partnerships and volunteers as human resources to facilitate grassroots solutions to the discharge and transition challenges often faced by stroke survivors. As an extension of this work, this rapid review will investigate and detail community-involved or community-led interventions that have been proven effective in addressing the unmet needs of stroke ECPs during critical care transitions. The findings of this review will identify what works, for whom and in what context regarding community-involved caregiver-centred transition interventions to inform the creation of an actionable Research Agenda—DASH-Caregiver.

This rapid review will be conducted using the updated guidance on methods used in Cochrane rapid reviews of effectiveness. The search strategy will be refined by the study team with assistance from an information specialist and applied to six databases: Medline, Cochrane, Embase, CINAHL and PubMed. Grey literature will be searched using Google search engines, targeted websites and consultation with knowledge holders. Two research team members will conduct a two-stage screening process to determine study eligibility. Data from eligible studies will be extracted using a piloted charting form and synthesised narratively.

This review protocol does not require ethics approval, as no data have been collected or analysed. The results will be shared with key knowledge holders through publications and presentations and incorporated into the team’s future research.

Worldwide, there are 15 established trauma databases collecting data to better understand the patterns of injury and effectiveness of interventions, but interpreting the information is hampered by the varied approaches. The aim of this study was to determine the impact, practices, evolution in design and methods of analysis that are standardised and comparable within registries.

A thematic analysis using a narrative synthesis was used to develop threads for future study and identify the limitations in current practice.

PubMed, Ovid, Scopus and EMBASE were searched on the 2 October 2025. At the same time, ChatGPT (Open artificial intelligence) identified the most cited articles in orthopaedic trauma registries, cross-referencing lists as a form of triangulation to aid in snowballing references.

The review included 174 papers from trials and observational studies that analyse data from established trauma orthopaedic registries published in English.

Two independent reviewers used standardised methods to search, screen and code included studies assessing the papers using the Strengthening the Reporting of Observational Studies in Epidemiology checklist to assess the observational and cohort studies and the Downs and Black Quality Criteria for the remaining papers.

Outcome measures other than mortality are poorly collected, undermining the value of registries. Trauma patients reported considerable impairment 6 and 12 months after injury. Association between level of trauma care and mortality is evident for major trauma populations, but does not hold for general trauma populations. Level I trauma centres produce improved survival in severely injured, but this association could not be proven for non-fatal outcomes in general populations. There is a disparity between resources allocated to save and salvage cases within major trauma units, and hence, routine cases often have lower priority and delayed care.

There is a need to develop a standardised and reproducible method to evaluate data quality in trauma registries. National performance guidelines and trauma centre audits are integral steps towards optimum results. Routine collection of postinjury outcome measures beyond mortality will enable the development of quality improvement metrics that better reflect patient outcomes.

Lack of familiarity and limited digital literacy frequently limit the ability and willingness of older adults to use digital health tools. This study aimed to investigate the factors influencing the intention to use digital health information and services (DHIAS) and their actual use among indigenous Taiwanese older adults, based on the theory of planned behaviour (TPB) and digital health literacy.

Cross-sectional quantitative study using a structured questionnaire.

Community-based settings at the primary care level; 11 cultural health stations located in Eastern Taiwan.

A total of 170 Indigenous elders aged ≥55 years were recruited. Inclusion criteria included: Indigenous descent, aged ≥55 years, cognitively intact and able to communicate in Mandarin. All participants completed the interview-based survey.

The primary outcomes were the intention to use DHIAS and its actual use. Predictors included digital health literacy and TPB constructs. All variables were measured using validated or adapted items within the questionnaire.

The mean score for intention to use DHIAS was 1.50 (SD=0.90) and the mean score for actual behaviour was 1.68 (SD=1.14). Hierarchical regression analyses indicated that subjective norms (β=0.270, p

Digital health literacy and TPB constructs critically influence digital health engagement among older populations. Interventions aimed at improving digital health engagement among older populations should focus on enhancing digital skills and creating socially supportive environments. Future studies should explore culturally tailored strategies to reduce digital disparities in communities with limited healthcare access.

Value-based healthcare (VBHC) strives to improve the healthcare system by focusing on value of care, that is, patient relevant outcomes relative to the costs for achieving these outcomes. Within VBHC, patient participation is crucial to identify patient relevant outcomes and value improvement potential. However, patient participation in VBHC initiatives remains limited. Therefore, we aimed to improve patient participation within VBHC teams with the ultimate aim to develop a practical guide for patient participation in VBHC.

An action research study.

This study was conducted in seven collaborating Dutch hospitals from March 2023 to November 2024.

Seven VBHC teams were selected to participate in the cyclical action research steps, that is, orientation, planning, implementation, and evaluation, in which patient participation was implemented or improved. These included the following patient groups: prostate cancer, vulnerable elderly, breast cancer, diabetes, maternity care, colorectal cancer and chronic kidney disease.

Both qualitative and quantitative data were collected. Qualitative data included observations and minutes of meetings with the intervention teams. Quantitative data included responses to the Public and Patient Engagement Evaluation Tool (PPEET) by multiple members of the intervention (n=7) and control teams (n=94) at three time points (T1=6 months, T2=12 months, T3=end of study). Qualitative data were thematically analysed and quantitative data were analysed descriptively. Finally, the data were triangulated to create an overview of lessons learnt in improving patient participation.

Patient participation goals varied across teams, leading to diverse actions, such as establishing a diabetes patient panel and distributing questionnaires to patients with colorectal cancer. PPEET results show that 71% of intervention team members reported that patient participation had an impact on the team’s outcomes compared with 44% in control teams (T3). Furthermore, 80% of the intervention team members initially wanted training in patient participation (T1), which dropped to 29% at T3. Overall, 22 lessons in improving patient participation in multidisciplinary project teams were identified and compiled into a practical guide.

The action research process improved the process and impact of patient participation in the intervention teams. Furthermore, the results indicate that the action research process enhanced the team members’ knowledge and skills on patient participation. The practical guide developed in this study can be used to support implementation of patient participation in VBHC.

Racial disparities in critical illness outcomes are well-described, with social determinants of health as likely contributors. We sought to identify inequalities in readmissions and mortality between black and white patients among survivors of critical illness with sepsis and assess whether these disparities were explained by neighbourhood characteristics, health insurance and hospital quality.

Retrospective cohort study examining 90-day and 9-month readmissions and survival as coprimary outcomes. Models included age, sex, race and area deprivation index (ADI), Medicaid status or hospital Centers for Medicare & Medicaid Star rating. Accelerated failure time and Cox proportional hazards models with subgroup analyses by age and surgical status were employed.

14 community and tertiary hospitals in Western Pennsylvania.

48 027 survivors of sepsis with critical illness; 20 952 (50.4%) male; 6489 (13.5%) identified as black.

Black patients were younger (mean age 59.0 years vs 65.8 years), more likely to have higher ADI, Medicaid insurance and receive care at lower-quality hospitals. Black patients had higher readmission risk: (90-day subdistribution HR (SDHR) 1.13 (95% CI 1.04 to 1.23); p=0.003); 9-month SDHR: 1.11 (95% CI 1.03 to 1.20); p=0.005). Adjusting for age and sex, we found no difference in 90-day and 9-month mortality (90-day acceleration factor (AF): 1.04 (95% CI 0.91 to 1.19); p=0.556; 9-month: 1.08 (95% CI 0.96 to 1.22); p=0.196), which remained consistent when including ADI, Medicaid status or hospital quality. Mortality among black patients was increased relative to white patients among patients ≥60 years (9-month AF 1.23 (95% CI 1.07 to 1.42; p=0.004)) and among surgical patients (90-day AF: 1.23 (95% CI 1.01 to 1.50; p=0.04); 9-month AF: 1.28 (95% CI 1.07 to 1.53; p=0.006)). Medicaid status, but not ADI or hospital quality, attenuated racial differences in subgroup mortality.

In a retrospective analysis of intensive care unit (ICU) survivors with sepsis, black patients had higher readmission rates but comparable mortality to white patients, except among older and surgical subgroups. Medicaid status influenced racial inequalities in mortality, highlighting a need for targeted post-ICU interventions.