Conectar
by Melissa M. Baker, Lyonel Nerolin Doffou Assalé, David Doledec, Romance Dissieka, Ahmenan Claude Liliane Konan, Agnes Helen Epse Assagou Mobio, Koffi Landry Kouadio, Oka René Kouamé, Ama Emilienne Yao, Hubert Zirimwabagabo
BackgroundWhile recent data on vitamin A deficiency (VAD) prevalence is lacking, the 2004 Côte d’Ivoire Nutrition and Mortality Survey reported that 26.7% of children aged 6–59 months were affected by VAD, and approximately 60% were at risk. Since 2016, the government has transitioned from mass campaigns to routine vitamin A supplementation (VAS) delivery integrated into health services. However, evidence on the cost-effectiveness of the routine distribution approaches is limited. This study evaluated the cost, coverage, and cost-effectiveness of three routine VAS delivery strategies across two health districts in northern Côte d’Ivoire.
MethodsA mixed-methods study evaluated three routine VAS delivery strategies – routine-fixed, advanced community-based, and catch-up – across two health districts, Ferkessédougou and Niakaramadougou, in northern Côte d’Ivoire. The quantitative cost data were collected via a structured tool covering six cost categories: planning, procurement, training, social mobilization, distribution, and supervision. VAS coverage was assessed through a post-event coverage survey (PECS) via a two-stage cluster sampling methodology. A cost-effectiveness analysis determined the cost per child supplemented, the cost per DALY averted, and a sensitivity analysis tested the robustness of the findings under different cost scenarios.
ResultsThe total program cost for July-December 2023 was 25.5 million FCFA, with personnel costs comprising over 70% of expenditures. In Ferkessédougou, the routine advanced community-based strategy was the most cost-effective, at 458 FCFA per child in rural areas (versus 596 FCFA for the routine-fixed facility-based approach in the same area). In Niakaramadougou, the December catch-up was more cost-effective in rural areas (606 FCFA per child) than the routine-fixed approach (714 FCFA). Across both districts combined, the routine-fixed strategy averaged roughly 651 FCFA per child supplemented, and the cost per DALY averted ranged from 30,093 FCFA (advanced strategy in Ferkessédougou) to 89,550 FCFA (catch-up Jul 2023 in Niakaramadougou) – all below Côte d’Ivoire’s cost-effectiveness threshold (0.5 x GDP per capita; approximately USD 1,265).
ConclusionAll three strategies were cost-effective, though the advanced community-based strategy achieved the best balance of reach and efficiency. Scaling advanced strategies within health system constraints may enhance sustainability and coverage in low-resource settings.
To develop a context-specific health technology assessment (HTA) framework tailored to the healthcare needs and system of Iran, to improve evidence-based decision-making, optimise resource allocation and support progress towards universal health coverage.
A mixed-methods Delphi consensus study conducted using a three-phase, sequential approach: document review, qualitative focus group discussions and Delphi consensus rounds. The study reporting follows the Accurate Consensus Reporting Document guideline to ensure transparent reporting of consensus methods.
A national-level study conducted in Iran’s healthcare system between January 2023 and March 2024, including perspectives from public and academic institutions, policy bodies and patient organisations.
The study involved 18 purposively selected stakeholders in three focus group discussions, including policymakers, healthcare professionals, researchers and patient representatives. Subsequently, 20 HTA experts participated in three iterative Delphi rounds to refine and reach consensus on the framework components.
Identification of core components and operational steps required to develop and implement a comprehensive HTA framework in Iran.
The final HTA framework includes nine core components: (1) establishing a national HTA body; (2) engaging stakeholders; (3) building capacity through training and research; (4) developing standard HTA methodologies; (5) implementing prioritisation and evaluation processes; (6) ensuring sustainable funding; (7) enhancing transparency and accountability; (8) promoting continuous improvement and (9) fostering innovation. Detailed operational steps and micro-activities were developed for each component. The framework achieved an 84% consensus among Delphi panellists, indicating strong agreement on its content and applicability.
This tailored HTA framework provides a structured roadmap to institutionalise evidence-based decision-making in Iran’s healthcare system. Its implementation can strengthen the efficiency, equity and sustainability of healthcare planning and policy. Pilot testing is recommended to assess feasibility and scalability, with potential to serve as a model for other low-income and middle-income countries.
An abnormal composition of gut bacteria along with alterations in microbial metabolites and reduced gut barrier integrity has been associated with the pathogenesis of chronic autoimmune and inflammatory rheumatic diseases (AIRDs). The aim of the systematic review, for which this protocol is presented, is to evaluate the clinical benefits and potential harms of therapies targeting the intestinal microbiota and/or gut barrier function in AIRDs to inform clinical practice and future research.
This protocol used the reporting guidelines from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol. We will search Embase (Ovid), Medline (Ovid) and the Cochrane Library (Central) for reports of randomised controlled trials of patients diagnosed with an AIRD. Eligible interventions are therapies targeting the intestinal microbiota and/or gut barrier function including probiotics, synbiotics, faecal microbiota transplantation, live biotherapeutic products and antibiotics with the intent to modify disease activity in AIRDs. The primary outcome of the evidence synthesis will be based on the primary endpoint of each trial. Secondary efficacy outcomes will be evaluated and selected from the existing core domain sets of the individual diseases and include the following domains: disease control, patient global assessment, physician global assessment, health-related quality of life, fatigue, pain and inflammation. Harms will include the total number of withdrawals, withdrawals due to adverse events, number of patients with serious adverse events, disease flares and deaths. A meta-analysis will be performed for each outcome domain separately. Depending on the type of outcome, the quantitative synthesis will encompass both ORs and standardised mean differences with corresponding 95% CIs.
No ethics approval will be needed for this systematic review. We will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to disseminate the study results through a peer-reviewed publication.
CRD42025644244.
Frontotemporal dementia (FTD) remains challenging to diagnose owing to the marked clinical heterogeneity associated with the disease. This heterogeneity stems from the complex interplay of various clinical phenotypes, genetic mutations and underlying neuropathologies, such as TDP-43 and tau proteinopathies. Currently, there is no single confirmed biomarker that can reliably diagnose disease, specifically disease stage, disease subtype and underlying neuropathology. Recent research has indicated that neuroimaging techniques hold the most promise for the discovery of FTD biomarkers. We propose a protocol for a systematic review and meta-analysis to identify MRI and fluorodeoxyglucose positron emission tomography (FDG-PET) biomarkers associated with clinical, genetic and pathological subtypes of FTD. We aim to address the following research questions: can regional MRI volumetry and FDG-PET hypometabolism differentiate (1) FTD patients from healthy controls; (2) sporadic cases of FTD from healthy controls; (3) genetic cases of FTD (MAPT, GRN, and C9orf72 mutations); and (4) underlying neuropathology, specifically discriminating between tau- and TDP-43-based FTD?
Literature searches will be performed across three databases: Ovid Medline, Ovid Embase and Web of Science. Publications that have fewer than five participants, are non-human-based, not written in the English language or contain unpublished data will be excluded. Two independent investigators will screen and subsequently evaluate which publications to include. Should any disagreements arise, a third investigator will settle the discrepancy. After the random-effects meta-analysis has been used to extract and pool the data, I2 analysis will be used to quantify heterogeneity.
Ethics approval will not be required for this research. On completion, the systematic review and meta-analysis will be published in a peer-reviewed journal.
CRD42024545302.
Group-format, peer-led parenting interventions may be valuable for parents with significant emotional and interpersonal difficulties in improving child behaviour, parenting and parent mental health. This article presents the results of a feasibility pilot randomised controlled trial (RCT) of a novel peer-led group intervention, Being a Parent (BaP)-Enjoying Family Life.
Two-arm, parallel group superiority feasibility RCT, with pre–post intervention (postintervention) and 6-month follow-up (6-month follow-up).
Community recruitment across four South London boroughs.
Main inclusion criteria were (1) primary parental caregivers, (2) aged 18–65 years and (3) significant emotional and interpersonal difficulties (score ≥3 on Standardised Assessment of Personality–Abbreviated Scale screening tool) and had a child (a) aged 2–11 years, (b) living with parent participant and (c) with caregiver-reported behavioural difficulties.
Intervention arm: BaP-Enjoying Family Life, a 10-session, peer-led, group intervention for parents with significant emotional and interpersonal difficulties. Control arm: BaP-Standard, a nine-session, peer-led group parenting intervention.
Primary feasibility criteria were rates of recruitment, retention, intervention acceptability and fidelity. Initial estimates of intervention effect were measured using the Eyberg Child Behaviour Inventory (primary outcome), and the Concerns about my Child scale, Arnold O’Leary Parenting Scale, Parental Reflective Function Questionnaire, Kansas Parent Satisfaction Scale, Brief Parent Self Efficacy Scale, Brief Adjustment Scale-6 and Home Observation Measurement of the Environment (secondary outcomes). Data collection was conducted with the researcher masked to intervention allocation.
Predefined thresholds were met for three of five feasibility indices and partially met for the remaining two. Eligibility criteria were met by 70% (n=77) of 110 interested parents, and 85% (n=66) of those eligible completed baseline data collection and were randomised. Data were collected at postintervention for 91% (n=60) of parents. 75% (n=49) of participants attended at least one session and 50% (n=33) completed 5 or more sessions (intervention completers). The intervention was found to be acceptable by 60.71% of participants in BaP-Enjoying Family Life and 62.50% of participants in BaP-Standard arm, increasing to 93.33% and 88.24%, respectively, among intervention completers. Fidelity was reached for three of five groups in each arm, with missing data and group cancellation contributing to lack of observed fidelity in the remaining two groups. We aimed to obtain estimates of intervention effect and, while underpowered, estimates of effect on the primary outcome (child behaviour) were moderate within each arm (BaP-Enjoying Family Life d=0.73 (95% CI 0.30 to 1.15), BaP-Standard d=0.73 (95% CI 0.34 to 1.12)) from baseline to postintervention. Improvements were maintained at 6-month follow-up. Moderate and large pre–post effects were observed on most secondary outcomes. Effect sizes also indicated no between-arm effect of intervention BaP-Enjoying Family Life and BaP-Standard on most primary and secondary outcomes.
Findings indicate that both interventions show promise in supporting parents with significant emotional and interpersonal difficulties with limited differential effects. Further refinements which increase intervention completion, acceptability and fidelity should be conducted prior to progression to a full-scale RCT.
Past studies show a mixed relationship between the Global Health Security (GHS) Index and COVID-19 pandemic health outcomes. Some recent work that suggested higher GHS Index scores are associated with better mortality outcomes has been criticised on methodological grounds. There remains scope for improved analyses of these relationships, including of island nations and macroeconomic pandemic outcomes. We aimed to determine the relationship between GHS Index scores and COVID-19 pandemic excess mortality 2020–2021 and macroeconomic pandemic outcomes.
Cross-sectional, multivariable regression design (controlling for per capita gross domestic product (GDP) and political corruption), comparing island and non-island jurisdictions.
194 jurisdictions with 2019 GHS Index scores.
Age-standardised cumulative excess mortality 2020–2021, GDP per capita growth 2019–2020 and 2020–2021.
The GHS Index predicted better health outcomes in terms of age-standardised excess mortality through 2020–2021 in non-island jurisdictions (β=–0.046, p=0.00068, adj R2=0.48), but not in island jurisdictions (β=0.012, p=0.734). For a starting age-standardised excess mortality of 100 per 100 000, a +10-point rise in overall GHS Index score predicts a 26.7 per 100 000 reduction in age-standardised mortality. We found no robust evidence that a higher GHS Index predicted higher year-on-year GDP per capita growth through 2019–2020 or 2020–2021.
The GHS Index demonstrated clear associations with favourable health outcomes of non-island jurisdictions through the COVID-19 pandemic, supporting its use to guide pandemic preparedness investments. Contrasting findings for islands suggest the need to enhance how the Index measures border biosecurity capacities and capabilities, including the ability to support the exclusion/elimination strategies that successfully protected islands during the COVID-19 pandemic.
To estimate the sociodemographic and geographical variation in prescribing selective serotonin reuptake inhibitors (SSRIs) and medications for attention-deficit/hyperactivity disorder (ADHD) to children and young people (CYP) in North West London, UK.
Cross-sectional population-based study.
General practices in North West London, UK, with data for the period 2020–2022 obtained from the Discover Now platform, which covers approximately 95% of the local population.
762 390 CYP aged 5–24 years in the year 2022.
Primary outcome: Prescription rates of SSRIs and ADHD medications. Secondary outcomes: Associations between prescription rates and sociodemographic factors, including age, gender, geographical area (local authority), ethnicity and socioeconomic deprivation (measured using the Index of Multiple Deprivation).
The total sample comprised 762 390 CYP. 2.20% of the sample were prescribed an SSRI (95% CI 2.17% to 2.24%) and 0.50% an ADHD medication (95% CI 0.49% to 0.52%) in years 2020–2022. High deprivation was associated with the highest rates of an SSRI prescription (2.5%). In contrast, low deprivation was associated with the highest rates of an ADHD medication prescription (0.70%). This divergent pattern was evident in some London boroughs and not in others. The relationship between level of area deprivation and prescription rates also differed by borough. Overall, the sociodemographic factors could not explain most of the variation in prescription rates (Pseudo R2 0.18 for SSRI and 0.06 for an ADHD medication).
Prescriptions for common mental disorders and ADHD for CYP from North West London varied by sociodemographic characteristics and London borough of residence, potentially exacerbating mental health inequalities. To monitor and address these inequalities, more extensive use of linked electronic health records should be undertaken; for example, data on mental health diagnosis and service utilisation are needed to investigate the relationship between diagnosis and treatment over time.
by Mohamadreza Hatefi, Seyedeh Feriyal Mahdavi, Amirreza Abbasi, Farideh Babakhani
BackgroundUpper extremity (UE) dominance is often defined by self-reported hand preference; however, this may not accurately reflect true functional or strength-based dominance. This study examined the relationship between writing hand, throwing hand, and maximal grip strength to assess how these measures align.
MethodsThirty-four healthy, recreationally active college-aged individuals reported their preferred writing and throwing hands and completed standardized grip strength testing. Associations among the variables were analyzed using Phi coefficients and chi-square tests.
ResultsA moderate, significant relationship was found between writing and throwing hand preference (φ = 0.456; p = 0.008), indicating general consistency across these subjective measures. However, no significant association emerged between grip strength dominance and either writing (φ = 0.027; p = 0.876) or throwing hand (φ = 0.096; p = 0.574).
ConclusionThese results suggest that grip strength dominance may not correlate with commonly used indicators of hand preference, highlighting the need for task-specific definitions of dominance in clinical and athletic contexts. Consequently, employing such task-specific definitions allows for more accurate assessments and enhances the translational relevance of research findings in practical settings.
This study investigates cortical reorganisation and hemodynamic responses in individuals with lower extremity amputation and replantation using functional near-infrared spectroscopy (fNIRS). A total of 15 healthy controls, four left lower limb amputees and one replantation patient were included. Oxyhemoglobin (oxy-Hb) activations were measured during 10 unilateral lower limb motor tasks (toe, ankle, knee and hip movements). Non-parametric analyses revealed significant differences in cortical activation between amputees and controls, particularly during knee flexion and extension. Three-dimensional contrast maps demonstrated that oxy-Hb activity in amputees extended from the M1-leg area into somatosensory regions, reflecting neuroplastic remapping. In contrast, the replantation patient exhibited activation patterns closer to the control group, especially in knee and hip tasks. These findings indicate that fNIRS can sensitively capture hemispheric dynamics during unilateral lower limb movements and highlight neuroplastic adaptations following amputation and replantation. Such insights may guide future neuroprosthetic design and rehabilitation strategies.
To explore how parents of children with de novo retinoblastoma (RB) experience the diagnostic process and acute treatment phase, and to identify factors that may support parental coping and adaptation.
A qualitative interview study using reflexive thematic analysis.
National Retinoblastoma Unit at Aarhus University Hospital, Denmark.
Thirty-one parents (21 mothers, 10 fathers) of 21 children diagnosed with de novo RB were recruited via hospital follow-up clinics and a support group day.
For most parents, the diagnostic process was short. In cases of diagnostic delay, parents described frustration and guilt due to missed symptoms. Receiving the RB diagnosis was described as a surreal experience, accompanied by feelings of shock, grief and loss of control. Parents faced challenges in adapting to rapid medical decisions and the unfamiliar demands of hospital protocols. However, meeting the clinical experts was a relief, as parents felt they were in capable hands, experiencing empathetic communication and a clearly framed treatment plan. Parents emphasised the importance of support systems, including family, healthcare professionals and the child’s resilience, as crucial for coping with and managing the diagnosis.
Parents faced a sudden and disruptive transition from symptom recognition to life-altering diagnosis and treatment. While professional care and communication were experienced as supportive, they did not eliminate the emotional impact. Clinical pathways should prioritise early validation of parental concerns and provide transparent communication, both prior to referral and throughout treatment. Future research should examine longer-term parental adjustment and identify interventions that support emotional resilience beyond the acute phase.
To evaluate the effectiveness of the recommendation improvement matrix (RIM) methodology for improving the quality of recommendations resulting from sentinel event analysis, where we hypothesise that the use of the RIM methodology leads to better quality recommendations.
A before-and-after analysis of the quality of the formulated recommendations after sentinel event analysis.
The study was carried out during the 2023 Saudi Patient Safety Centre International Patient Safety Conference.
36 conference participants, including nurses, medical doctors, pharmacists, dentists, general practitioners and quality officers.
RIM methodology training during a structured 3-hour workshop.
The primary outcome was the proportion of recommendations that using the 2 test, passed the RIM filter criteria before and after training. Secondary outcomes included changes in recommendation categorisation within the matrix and participant ratings of feasibility and usability on a five-point Likert scale using a t-test for comparison.
Prior to training, 49 recommendations were generated, of which 63.3% met the filter criteria. Post-training, the proportion of recommendations passing the filter increased significantly to 83% (p=0.00543). Adjustments to recommendations primarily improved alignment with the filter criteria, though limited improvements were observed in matrix categorisation. Participants rated the methodology’s feasibility and usability highly, with average scores of 4.39/5 and 4.43/5, respectively. However, 46% expressed a need for additional training, particularly on the matrix application.
The RIM methodology significantly improves the quality of recommendations following sentinel event analyses. To enhance its impact, further training focusing on matrix application is necessary. Incorporating the methodology into healthcare education and professional development could strengthen patient safety practices.
To examine how nurse managers perceive and respond to conflicting priorities between patients' needs, employees' well-being and organisational objectives in decisions regarding work scheduling.
An embedded case study of nurse managers' decisions about new work scheduling in community healthcare in a Norwegian municipality.
We accessed internal and national policy documents outlining the potential benefits of increasing full-time positions in healthcare and conducted 24 semi-structured interviews in January and February 2019. During the thematic data analysis, institutional logics emerged as a theoretical lens to understand nurse managers' conflicting priorities and responses.
We found that nurse managers handled conflicting priorities by prioritising an employee logic in a way that allowed them to combine this with elements of managerial and professional logics within the institutional context.
The institutional logics perspective extends our understanding of how nurse managers interpret the values, norms and practices underlying their priorities.
Nurse managers should (1) recognise that multiple institutional logics may be available to guide their responses to conflicting priorities and (2) carefully consider how to combine employee involvement with managerial and organizational responsibilities.
We studied how nurse managers perceive and respond to conflicting priorities in work scheduling decisions. Nurse managers are embedded in institutional contexts with co-existing logics and their decisions can be understood through an employee logic, but also in combination with managerial and professional logics. Nurse managers should carefully consider their work scheduling decisions from the perspectives of different logics, ensuring that the decisions benefit employees, patients and their employer.
The study is reported according to COREQ guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
by Mahsa Pourshaban, Atefeh Allahbakhshian, Hadi Hasankhani
PurposeProviding holistic and high-quality nursing care to oncology patients necessitates integrating care across physical, psychological, spiritual, and emotional domains. This study explored the meaning of oncology nurses’ experiences of missed nursing care during the COVID-19 pandemic.
MethodsThis study employed a qualitative design based on Heidegger’s hermeneutic phenomenological approach as the foundational philosophical approach because of its focus on real-life experiences. The sample comprised fourteen nurses employed at various oncology departments in Iran. Data was collected from February 2023 to March 2025 with institutional permission and ethics committee approval (IR.TBZMED.REC.1401.1032). Data were collected through in-depth, semi-structured interviews. Data analysis was conducted concurrently with data collection following the approach outlined by Diekelmann et al. (1989). Standards for Reporting Qualitative Research (SRQR) were used.
ResultsFading connections between oncology nurses and patients, nursing managers, physicians, and the care environment have affected the quality of care and communication during the pandemic. Three subthemes include (1) care behaviors, (2) isolation in duty, and (3) disruption of care canvas and twelve meaning units were obtained. The most care deficits were primarily related to emotional and psychological support.
ConclusionWhen human and professional relationships are compromised, the essence of nursing care is lost, and it risks being reduced to a mechanical, task-focused practice. The experiences of oncology nurses during the COVID-19 pandemic reveal significant gaps in nursing care that stem from professional, relational, and systemic challenges. Addressing these issues is crucial for improving nurse well-being and patient outcomes in future healthcare crises.
To describe the lessons learnt during the promotion of a new approach to the care of critically ill patients in TanzaniaEssential Emergency and Critical Care (EECC).
A descriptive qualitative study using thematic analysis of structured interviews.
The study was conducted in Tanzania, involving 11 policymakers, researchers and senior clinicians who participated in the promotion of EECC in the country.
Five inter-related themes emerged from the promotion of EECC in Tanzania: (1) early and close collaboration with the government and stakeholders; (2) conduct research and use evidence; (3) prioritise advocacy and address misconceptions about EECC; (4) leverage events and embed activities in other health system interventions; and (5) employ a multifaceted implementation strategy. The themes map to the normalisation process theory domains of coherence, cognitive participation, collective action and reflexive monitoring.
The integration of EECC into Tanzania’s health policy is a result of a multidisciplinary collaboration including government and partners that has used evidence, advocacy and context and included multifaceted implementation strategies. The lessons from Tanzania’s experience provide guidance for adoption in similar settings to improve critical care systems, foster access to care and optimal outcomes for all critically ill patients.
Delivering nursing care to patients' fundamental needs in neurological settings is challenging due to complex needs such as long-term care, physical disability and cognitive or communicative impairment.
To examine how registered nurses and nurse assistants perceive their capability, opportunity and motivation to deliver fundamental nursing care and use this insight to inform implementation strategies based on the Fundamentals of Care framework.
Cross-sectional survey.
The questionnaire, grounded in the Capability–Opportunity–Motivation (COM-B) model and the Fundamentals of Care framework, was distributed to all nursing staff (n = 404) in four neurological departments at a university hospital in Denmark. Level of agreement was calculated as the proportion of responses in the top two Likert categories (‘to some extent agree’ and ‘completely agree’) and categorised as low (< 60%), medium (60%–85%) or high (> 85%). Quantitative results were analysed descriptively and inferentially; open-text answers were examined using deductive content analysis.
The response rate was 63%. Agreement was high for capability (90.6%), motivation (89.2%) and addressing physical needs (85.2%), while opportunity (75.3%) and relational care (69.1%) were lower. The relational domain scored notably high for taking time to listen (95.8%) and low for evaluating the nurse–patient relationship (43.5%). Nurse assistants showed significantly higher agreement in the physical care domain than registered nurses. Variation across departments highlighted higher agreement in spinal cord injury and neurology compared to anaesthesia, pain, respiratory and traumatic brain injury units.
Nursing staff show strong internal drive and perceived competence—particularly in physical care—but face structural barriers in relational nursing and continuity. Implementation strategies should leverage high motivation, strengthen leadership engagement, ensure resource allocation and systematically integrate relational care into practice.
No patient or public contribution.
Danish Data Protection Agency (P20231246)
Delirium, a common, serious and often preventable complication in older hospitalised adults, contributes to significant health and social care costs. Carers are uniquely positioned to identify early signs and support delirium prevention. The Prevention & Early Delirium Identification Carer Toolkit (PREDICT), a novel model of care designed to educate carers about delirium management and prevention strategies, enables them to actively participate in the care and recovery of their person. Developed through a comprehensive literature review, a co-designed eDelphi and pilot study, PREDICT demonstrated acceptability and feasibility.
To evaluate the effectiveness, implementation and cost-benefit of a PREDICT in hospital settings.
A stepped-wedge cluster randomised controlled trial (SW-cRCT), consisting of a cohort study, healthcare service evaluation, and process evaluation. The study will assess carer and staff knowledge of delirium, carer care giving stress, health service outcomes (e.g., incidence, length of stay, readmissions) and cost-benefit.
PREDICT is a scalable, person-centred approach that supports both patients and carers, with the potential to embed best-practice delirium management into routine healthcare.
This study was developed in consultation with older adults, carers and healthcare staff. Two consumer representatives joined the project steering committee and contributed to shaping the research question, refining the study protocol and selecting outcome measures relevant to families and healthcare staff. Carers were involved in reviewing participant information sheets and the PREDICT website, providing feedback to ensure clarity and accessibility. Results will be shared with participants and the wider community through plain-language summaries and public presentations.
Australian and New Zealand Clinical trial: ACTRN12625000705482 registered on the 3rd of July 2025
As global health education becomes more embedded in university curricula, the availability of experiential learning opportunities in this field has expanded as well. These programmes offer students valuable exposure to diverse cultural perspectives and help develop essential competencies in global health. However, concerns have arisen regarding the persistence of colonial-era dynamics, power imbalances and the potential negative impacts on host organisations in low- and middle-income countries. Much of the existing literature on this topic centres on short-term medical student experiences and is focused on the perspectives of the sending organisations. This study aims to fill this gap by examining a semester-long undergraduate global health experiential learning programme through the perspectives of host organisation staff.
This qualitative case study draws on interviews with 18 key informants from host organisations across seven countries. The research design, data collection and analysis were developed using an analytical framework based on recommendations made by previous studies.
Host organisations across seven countries participated in the study. Interviews were conducted remotely via Zoom. The interviews were audio-recorded, transcribed, coded in Dedoose software and analysed for emerging patterns and themes.
Eighteen key informants from host organisations were interviewed, representing seven countries — Tanzania, Ghana, Mexico, India, Bangladesh, Australia and the Philippines — and a range of institutions including research institutes, government agencies and UN bodies.
Participants generally viewed their engagement in experiential learning courses positively. They emphasised the importance of their role in mentoring American and other foreign global health students, building their research skills and cultural competency, and providing valuable insights into power dynamics, local health systems and the wider context in which global health operates. Beyond financial remuneration, participants emphasised multiple non-financial benefits for host organisations. The study identified three key themes in developing strong programmes: partnership, communication and cultural competence. These findings reinforce the value of longer-term programmes and offer actionable recommendations for their continued evolution in global health education.
To explore how coaching can facilitate the development of an Evidence-Based Quality Improvement (EBQI) learning culture within nursing teams in hospital and community care settings. This study also explores the specific contextual factors that influence effective outcomes.
Action research.
Nine teams, including 254 nurses were selected from four hospitals and two community care organisations to participate in the development of an EBQI-learning culture under the guidance of internal and external coaches. Data were gathered from 27 focus groups with 56 unique participants (of whom 31 participated multiple times) and six individual interviews with three external coaches. Transcripts of all interviews were subjected to abductive thematic analysis.
To promote an EBQI learning culture in nursing teams, it is essential that internal coaches effectively guide their team members. The internal coaches in this study focused on enhancing readiness for EBQI by providing support, encouraging involvement and motivating team members. They deepened innovation competencies including assessing daily care, implementing well-structured changes in care practices and embedding small steps in the change process in daily routines. It was found that barriers and facilitators within the team's context can influence the development of EBQI-learning culture and therefore need to be considered when seeking to make changes. The presence of external coaches served as a valuable resource and a motivator in supporting internal coaches to apply and improve their coaching skills.
To stimulate the development of an EBQI-learning culture, internal coaches need to focus on team readiness to work with EBQI. Priority needs to be given to enhancing the care change competencies of team members. Barriers to change must also be addressed. Internal coaches require external support and motivation to continually develop coaching skills.
The Standards for Reporting Qualitative Research.
No patient or public contribution.
To co-identify adaptations with key stakeholders needed to optimise elements of a video-based intervention (i.e., PREEMIE PROGRESS [PP]), which trains parents in evidence-based family management skills to care for their very preterm infant in the neonatal intensive care unit (NICU).
Descriptive qualitative study oriented with a pragmatic philosophy, informed by the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework and the framework for reporting adaptations and modifications-expanded (FRAME).
Semistructured interviews to identify potential adaptations with key stakeholders: family management researchers (n = 5), clinicians (n = 9), technology experts (n = 5) and parents of preterm infants (n = 17). Weekly design team meetings to select and implement high-priority adaptations necessary for the next research phase. Monthly NICU parent partnership meetings to review adaptations and make recommendations for potential adaptations with conflicting data.
Stakeholders (N = 36) suggested 98 potential adaptations: 32 (33.0%) were completed, 8 (8.2%) were abandoned, 5 (5.2%) have work that is ongoing and 52 (53.6%) were tabled for future research phases. Content adaptations (70, 71.4%) were the most frequently suggested adaptation type. Potential adaptations mostly addressed RE-AIM dimensions of effectiveness (43, 43.9%), and implementation (46, 46.9%) and were directed at the parent (i.e., intervention recipient) level (79, 81.4%).
Use of the RE-AIM framework ensured we systematically identified needed adaptations with key stakeholders across a range of dimensions that would improve PP for parents now and in future phases of this research.
Co-identifying potential adaptations with key stakeholders, paired with FRAME documentation, can help nurses prioritise adaptations most appropriate for each phase of implementation.
Our paper highlights for nurse clinicians and researchers how FRAME documentation of potential adaptations can support stakeholder engagement and a systematic approach to incorporating adaptations throughout all phases of the research process, thereby shortening the evidence to practice gap.
COREQ guidelines for qualitative reporting.
The research team was supported by members of the NICU's Parent Partnership Council (PPC), whose mission is to promote family-centred care improvement projects and research within the NICU. This committee is comprised of nursing, physician, allied health leadership and parents of infants previously hospitalised in the NICU. The NICU PPC met monthly to review conflicting data on potential adaptations and provide recommendations on adaptation decisions.
Geographical isolation compounds limited access to healthcare services and skilled workforce for the provision of rural aged care. Residents have complex chronic disease management and end-of-life care needs. An undersupply of general medical practitioners due to retirement, attrition or unfilled training places in Australia has impacted recruitment to rural areas. Nurse practitioners have been identified as a potential solution.
To describe and explore the inner (local and organisational) and outer (wider health system) contexts of healthcare, from the perspective of care staff and residents' families. This, in turn, aims to inform the planned implementation of a nurse practitioner model, in several aged care facilities, operating within rural and remote settings, in Queensland Australia.
A convergent mixed methods design.
Qualitative data were collected, in 2022–2023, using semistructured interviews with staff focusing on role, knowledge development, workplace culture and care relationships with local community. Resident's family's perspectives were obtained as a secondary analysis of organisational feedback data. Quantitative data were collected from direct care workers using the Alberta Context Tool for Long-Term Care. Data were analysed according to type and integrated.
Relational care for residents and families is highly valued but provision of quality is challenging where time-poor staff are perceived to be doing the best they can. Scarce local healthcare services make it difficult to meet resident healthcare needs. Despite the supportive organisational culture, evolving policy requirements have impacted already difficult staff recruitment in rural settings.
Identifying contextual needs of organisations in readiness for change highlights geographical and sectoral nuances influencing any future implementation. As government policy changes to improve the older adult care sector, rural and remote facilities are forced to increasingly adapt.
Context-specific needs extend far beyond a nurse practitioner providing additional expertise in care provision.
What problem did the study address? Nurse practitioners have been successfully implemented into residential aged care facilities in metropolitan and major regional centres but translating this role into rural and remote Australia requires being cognisant of the needs, unique challenges and context of this setting.
What were the main findings? In an organisational culture of support, the importance of staff providing relational care and having connection with older adult residents and families was a central driver. It was challenging for staff to meet complex care requirements in the absence of local healthcare options and support. Time pressures, from inadequate staffing and changing structural aged care sector, force the prioritising of care requirements.
Where and on whom will the research have an impact? Older adults, policy makers and aged care providers will benefit from understanding the context of rural and remote settings, particularly in identifying potential solutions when there are gaps in primary and secondary healthcare.
The GRAMMS checklist was followed in reporting of this study.
Two lived experience consumers were involved as research team members. One was involved during the development and submission of the funding application and another during project activities including data collection and analysis and the development of publications.
FreshRSS 