Conectar
To examine the reasons for and methods of using remote video monitoring to prevent falls across hospital and residential aged care, and explore how staff, patients, residents and families perceive its use and benefits.
Scoping Review.
Following JBI methodology, eight databases were searched in July 2025 with no date restrictions. Two reviewers independently screened studies using predefined criteria, and one reviewer extracted data. Narrative and thematic syntheses described how video monitoring is implemented for falls prevention and explored stakeholders' attitudes.
Thirty-five studies were included, with 77% conducted in hospitals and 86% focusing on staff perspectives, highlighting a critical underrepresentation of patients/residents and families. Perceived effectiveness was shaped by underlying motivations—falls prevention, workforce optimisation, or cost reduction. Attitudes were influenced by workload impacts, video monitoring knowledge, ethical and liability concerns. Three remote video monitoring models were identified: technician-based, automated alerts, and nurse-observed without alerts. Technician-based systems were only in hospitals, with no equivalent in aged care.
Research on remote video monitoring for falls prevention is heavily weighted towards hospitals and staff perspectives. Nurses generally viewed video monitoring as effective but still preferred in-person observers. Although there is interest in innovative monitoring systems in aged care that balance safety with a homelike environment, empirical research is lacking. Patient, resident, and family experiences remain underrepresented and require further research.
Remote video monitoring has emerged as an alternative to mobilisation alarms, given their uncertain effectiveness and negative consequences for patients and nurses. Much U.S. hospital research reflects a cost-reduction paradigm aimed at replacing in-person observers, a trend not seen internationally or in aged care. This research is relevant to decision-makers considering technological options for falls prevention and to nurse leaders seeking insight into the appeal and apprehension surrounding video monitoring.
PRISMA-ScR.
None.
Anomia is a primary feature of aphasia that negatively impacts quality of life. Although current anomia treatments improve word retrieval, long-term retention and generalisation of trained words to discourse-level communication are rarely measured. Treatment that produces lasting naming gains and generalises to real-world use is one of the top priorities of people living with aphasia. Here, we report the protocol for a randomised clinical trial that investigates individualised anomia treatment through adaptive naming deadlines to achieve ‘desirable difficulty’ to promote learning retention and generalisation.
We implement a within-subject sequential, crossover design in which 30 participants with chronic post-stroke aphasia will complete three anomia treatment conditions in randomised order: (1) an adaptive condition where the naming deadline (ie, amount of time the participant is given to name the item) dynamically adjusts between 1.5 and 10 s based on ongoing participant performance and (2) a static Effort-Maximised condition where there is a fixed 10-second naming deadline for all treatment sessions and (3) a static Accuracy-Maximised condition where items are presented immediately in auditory and orthographic form and are repeated by the participant. In each condition, participants are treated on 40 unique non-overlapping words across eight treatment sessions. Before and after each condition, participants complete naming probes and discourse probes. Treatment outcomes from the adaptive treatment will be tested against the two static conditions using linear mixed-effects modelling. Our primary outcome is performance on noun picture naming at 3 months post-treatment. We evaluate production of treated words in discourse probes as a secondary analysis. We predict that our novel, adaptive naming treatment will produce more successful outcomes compared with the static treatment conditions.
The Institutional Review Board of the University of Pittsburgh approved the trial protocol (Study 21120130). Following study completion, results will be disseminated in peer-reviewed journals. If hypothesised results are observed, the adaptive treatment will be a novel, empirically based intervention for long-term retention of anomia treatment gains, positively impacting the lives and recovery of individuals living with aphasia.
Environmental enteropathy (EE) is a syndrome affecting the gut characterised by villus blunting, reduced nutrient absorption and microbial translocation in children and adults experiencing a high burden of enteric infection due to inadequate access to clean water and sanitation.
We will conduct coordinated randomised controlled trials in six countries to determine if supplementation with indispensable amino acids (IAAs) can improve intestinal barrier dysfunction in six geographically diverse populations of 18–36 months old children with stunting or severe stunting. All trials will measure the same primary outcomes while secondary outcomes will be measured on a per-trial basis using standardised protocols across the project. The primary endpoint will be change in gut permeability as assessed by the lactulose/rhamnose ratio. Secondary endpoints include changes in amino acid and carbohydrate absorption using novel, isotope tracer tests. Other prespecified outcome measures include changes in EE biomarkers and child weight. IAA supplementation will be given daily for 28 days and evaluation of the major endpoints will be at baseline and after 28 days of supplementation.
Ethical approval will be obtained from the Research Ethics Committee at each participating site. Caregivers will provide written informed consent for each participant. Findings will be disseminated through peer-reviewed journals, conference presentations and face-to-face meetings with participant caregivers.
CTRI: CTRI/2024/06/069187 (India); ClinicalTrials.gov (NCT06617130, Malawi;
Scar outcomes are traditionally evaluated at 12 months post-surgery, yet early prediction of long-term scar characteristics may facilitate timely interventions, enhance treatment strategies, shorten clinical trial durations, and improve patient outcomes. This study evaluates whether 3-month scar assessments reliably predict 12-month outcomes using validated scar assessment scales and interrater reliability measures. Two surgeons evaluated a prospective cohort of 40 surgical patients using standardised scar assessment tools. Logistic regression assessed the predictive value of 3-month classifications for 12-month binary outcomes (‘good’ vs. ‘poor’ scar quality), while linear regression evaluated continuous scar scores. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values quantified predictive accuracy. Scars classified as ‘good’ at 3 months were significantly more likely to remain ‘good’ at 12 months (p < 0.001), with strong predictive performance (AUC = 0.763). Linear regression demonstrated significant predictive accuracy for width, height, and overall opinion. However, vascularity predictions were weak, and depth was not significantly associated with long-term outcomes. Interrater reliability was moderate to good across measures, with intraclass correlation coefficients values ranging from 0.215 (depth) to 0.714 (width), and Cohen's Kappa for binary scar classifications of 0.505 (p < 0.001). Early 3-month scar assessments reliably predict 12-month outcomes for width, height, and overall opinion, while vascularity and depth remain less predictable. Scars rated as ‘good’ at 3 months are unlikely to worsen, while ‘poor’ scars rarely improve without intervention. These findings highlight the utility of early scar evaluations in guiding postoperative management and patient counselling.
Patient decision aids (PtDAs) are effective interventions to support patient involvement in health decisions and have the potential to impact favourably on health inequities by reducing gender bias in clinical practice. The aim was to explore sex and gender reporting and differences in randomised controlled trials (RCTs) evaluating PtDAs for adults making treatment or screening decisions.
Secondary analysis of the Cochrane review of PtDAs of RCTs that reported sex and/or gender. The original review searched MEDLINE, Embase, PsychINFO and EBSCO from journal inception to March 2022. Two team members independently screened citations, extracted data and assessed risk of bias. For this secondary analysis, we only included primary outcomes from the original review. We assessed appropriate use of terminology for sex (biological attribute) and gender (social construct). When terms were used interchangeably, it was considered inaccurate. Findings were synthesised descriptively, and we used meta-analysis when two or more RCTs were conducted with females/women or males/men using similar outcome measures.
Informed values-choice congruence and the quality of the decision-making process (eg, knowledge, accurate risk perceptions, feeling informed, clear values, participation in decision making, undecided) and adverse events (eg, decision regret, emotional distress) by sex and gender.
Of 209 RCTs in the original review, 206 reported sex and/or gender, with 35 (17%) using accurate terminology. Of 206 RCTs, 70 were with females/women only, 27 males/men only, 12 analysed by sex/gender and 97 RCTs did not disaggregate findings by sex or gender. Meta-analysis comparing RCTs for females/women to usual care and RCTs for males/men only compared with usual care showed similar mean differences in knowledge scores (10.84 vs 9.38 out of 100; p=0.44). Males/men had significantly higher self-reported participation in decision making compared with females/women (RR 3.16 vs 0.95; p
In PtDA RCTs, sex and gender terms are used interchangeably and 6% analysed outcomes by sex or gender. Meta-analysis of males/men only given PtDAs showed higher self-reported decision making participation in clinical practice compared to usual care versus females/women only compared with usual care. Researchers must improve reporting sex and gender in PtDA RCTs to assess how it influences health inequities.
To: (i) examine Stroke Coordinators' perspectives of factors influencing sustained adherence to evidence-based protocols to manage Fever, Sugar (hyperglycaemia) and Swallow (FeSS) and (ii) compare findings between hospitals with consistently high FeSS Protocol adherence versus those with consistently low or variable adherence.
Qualitative descriptive process evaluation using in-depth, individual semi-structured interviews.
Hospitals that participated in ≥ 3 national stroke audit cycles were ranked by mean adherence to FeSS Protocols and stratified by consistently high, low and variable adherence. Three hospitals from each adherence strata were purposefully selected after further stratification by (i) previous participation in a FeSS Intervention study; and (ii) location (state, remoteness). Inductive thematic analysis was undertaken, with themes mapped to factors from the framework to compare findings by adherence level and contextualise the findings in relation to sustainability.
Analysis of 14 interviews identified two themes [and sub-themes]: (1) Stroke Coordinator as sustainability champions and boundary spanners [maintenance of implementation strategies; fostering working relationships, communication and influence] mapped to Workforce factors, organisational and Innovation-specific factors; and (2) Hospital executive and middle management respect of stroke specialty [designated area for stroke care; recognition of stroke specialist nursing skills; previous FeSS Intervention study participation] mapped to Workforce and Political factors. Key differences by adherence groupings related to the Stroke Coordinator model, workplace configuration, and the impact of interdepartmental relationships and competing organisational directives.
The Stroke Coordinator role was pivotal for sustained use of evidence-based FeSS Protocols for acute stroke care, driving multidisciplinary collaboration.
Internationally, many patients do not receive evidence-based acute stroke care. Despite the proven benefits of the FeSS Protocols, consistent implementation remains a challenge. This study recognises the critical importance of a dedicated Stroke Coordinator for all acute stroke hospitals. Their advocacy for the use of evidence-based interventions is key to improving stroke outcomes.
This study did not include patient or public involvement in its design, conduct, or reporting as it focused solely on the professional experiences of stroke care providers.
ACTRN 12623000445673. Registered 1 May 2023
This study aims to describe current nurse prescribing practices in the absence of a legal framework, evaluate healthcare providers' preferred prescribing models, and their perceptions of the impact of nurse prescribing in Belgian hospitals.
Multicentre quantitative, cross-sectional survey.
Between December 2022 and April 2023, healthcare providers from seven Flemish hospitals completed an online survey after being presented with a short explanatory video on independent and supplementary nurse prescribing. The survey assessed demographics, current practices, expected impact and preferred prescribing models.
Of the 303 respondents, 86% were nurses, 10% were medical doctors and 4% were pharmacists.
Independent nurse prescribing or deprescribing of medications was reported by 75% in their current work context. Nurse prescribing was observed weekly or daily by 48%, primarily for initiating new medications. Overall, 44% preferred independent nurse prescribing over no prescribing.
Despite the absence of a legal framework, nurses in Belgian hospitals regularly prescribe medications. Most healthcare providers positively perceive the expected impact of nurse prescribing.
There is an urgent need for legal and institutional frameworks that acknowledge existing practices, define responsibilities and support safe and effective care. Structured policies could improve interprofessional collaboration, clarify clinical accountability and ensure consistent training for nurse prescribers.
This study addressed the widespread but informal practice of nurse prescribing in the absence of legal regulation in Belgium. It found that a majority of healthcare providers observed nurse prescribing in clinical practice and preferred formalised prescribing models. These insights can support health authorities, healthcare decision-makers and educators in designing regulations, implementation strategies and curricula aligned with clinical practice.
The authors adhered to the STROBE reporting checklist for cross-sectional studies.
This study did not include patient or public involvement in its design, conduct, analysis or reporting.
To explore why and how staff use alarms for falls prevention in hospital and their alignment to person-centred practice.
Qualitative interpretive design.
One hundred focus groups and 25 interviews across 10 health services were completed between October 2022 and September 2024. Participants included nurses (n = 451), allied health (n = 82), and fall prevention managers (n = 18). The Framework Method guided initial data familiarisation and analysis and led to the Person-Centred Practice Framework being identified as a useful framework.
Themes generated: (1) Understaffed, under-resourced, under pressure, (2) Alarm impact on stress and workload, (3) Negotiating patient safety and patient preference, (4) Engaging family as a resource, (5) Sharing responsibility for alarms and falls prevention, and (6) Navigating ambiguity and fearing consequences.
Staff feel compelled to use alarms despite problems associated with their use and challenges to person-centred practice. Drivers of alarm use were feeling under-resourced and fearing liability if patients fell. Staff want clearer organisational guidance in alarm use but also want the freedom to use their own clinical reasoning.
Hospitals worldwide are working to identify effective strategies for preventing falls. However, research has yet to adequately explore the perspectives of frontline nurses and allied health staff regarding the use of mobilisation alarms—a critical gap when evaluating their impact and effectiveness. This study's six key themes provide insights into why alarms are so widely used despite the limited evidence supporting their effectiveness.
Consolidated Criteria for Reporting Qualitative Research.
This study did not include patient or public involvement in its design, conduct, or reporting.
Australian New Zealand Clinical Trials Registry ACTRN12621000823875.
To analyse, critique, and synthesise available research to create a unique framework of the impacts of COVID-19 on acute care nurses.
Whittemore and Knafl's framework was used to organise this review. The Mixed Methods Appraisal Tool was used for quality analysis.
CINAHL, MEDLINE, Web of Science, Scopus and the National Institute of Health COVID-19 database were searched.
Twenty-five articles were included. Impacts on acute care nurses came from changes, access to resources, interrupted relationships, and the virus itself. The outcomes from nurses were categorised as positive, physical, emotional responses, leaving and mental disorders. These outcomes were mediated by making connections, coping, learning and experience, and finding meaning.
Nurses working in acute care during COVID-19 were faced with immense stressors in a tumultuous and dangerous time. The vastly negative outcomes were less surprising than the fact nurses were left to find mitigating factors on their own. Given the large attrition from nursing that occurred and is still occurring, health systems that can both lessen the impacts and strengthen the buffering effects of mediating factors may fare better when the next pandemic comes.
Lessons learned can be used to prepare for future pandemics. Nurses should be at the forefront of all planning whether through education, policy, or research. Having a framework allows for a more comprehensive understanding and provides an underpinning for future action.
The possibility for impact spans nurses across the globe who have worked, and who may work, during a pandemic. This framework provides a basis for changes related to pandemic planning throughout nursing domains.
The researcher has adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.
No Patient or Public Contribution.
Understanding the patient perspective is crucial for enhancing healthcare delivery and outcomes for chronic conditions like diabetic foot ulcers. This qualitative study examined the perspectives of patients with diabetic foot ulcers to inform clinical strategies for both physicians and current patients to enhance care and prevent lower extremity amputations. Fifteen patients with a history of diabetes and diabetic foot ulcers and/or amputations participated in semi-structured interviews which explored their lived experiences and advice for both physicians and fellow patients to improve diabetic foot ulcer related care. Interview transcriptions were analysed to identify recurring themes. Advice for physicians emphasised increasing patient education, initiating preventive foot care at the time of diabetes diagnosis, providing instructions for managing diabetic ulcers early and demonstrating empathetic bedside manner. Advice for fellow patients focused on adopting healthy lifestyle practices, regular foot self-examinations, consistent blood glucose monitoring, medication adherence and seeking prompt medical attention for new or worsening foot lesions. Participants also stressed the importance of routine check-ups with providers to support prevention and management efforts. This qualitative study highlights the value of incorporating patient perspectives to improve our understanding of diabetic foot ulcer onset, care and outcomes and thereby reduce the risk of lower extremity complications.
Community support for individuals with mental health problems is a global public health issue. Poor mental health literacy and high levels of stigmatising attitudes among the general population can hinder both help-seeking behaviours and limit the capacity of community members to provide support to people experiencing mental health challenges. The Mental Health First Aid (MHFA) training course was created to educate community members to provide initial help towards a person developing a mental health problem. MHFA training has spread to high-income countries, but there is relatively little research on cultural adaptation to lower-resource settings. This study aims to fill that gap and is the first cluster randomised controlled trial (cRCT) assessing the effectiveness of MHFA training in Chile and Argentina.
The study involves a two-arm wait-list cRCT with 240 participants (120 in each country). The study will be conducted in three settings in each of Chile and Argentina (eg, universities, health services and workplaces). Two clusters per setting in each country will be paired and randomly allocated to the intervention (the MHFA training for Chile and Argentina) or the wait-list control group. Participants in the intervention arm will be asked to complete questionnaires at baseline (T1), after training completion (T2) and 6 months after completion (T3), with control arm participants completing data collection at corresponding time points. The primary outcome will be intended support towards someone experiencing a mental health problem or experiencing a mental health crisis. Secondary outcome measures will include the ability to recognise depression and psychosis in vignettes; beliefs about the helpfulness of different types of interventions and helping actions, confidence in providing MHFA and stigmatising attitudes towards a person with depression or psychosis. Findings will demonstrate whether the culturally adapted MHFA training for Chile and Argentina can effectively enhance intended support, knowledge, attitudes and supportive actions towards other individuals within the community.
Ethics approval has been granted by the Human Research Ethics Committee at the University of Melbourne (Australia), Proyecto Suma (Argentina) and the University of Chile (Chile). Dissemination will be via academic publications and conference presentations. These will also be made available to participants and other interested parties on request.
Breast screening uptake remains low in parts of the UK, partly due to barriers including limited transport access. Offering free transport to screening appointments may help address this and improve uptake. This general practitioner (GP) cluster-randomised feasibility trial will assess whether offering free door-to-door transport alongside routine screening invitations increases attendance.
Eight general practices in Yorkshire will be randomised to either the intervention (routine invitation plus information about booking free door-to-door transport) or control (routine invitation only) group. Around 8000 women due for routine breast screening will be included. Primary feasibility outcomes include GP recruitment and randomisation, intervention fidelity, proportion of women from the 10% most deprived areas, acceptability and data transfer processes. Secondary outcomes include understanding travel behaviour, cost-effectiveness and screening uptake. Data will be collected from routine National Health Service (NHS) screening records, data linkage with NHS England, travel surveys and qualitative interviews exploring experiences and acceptability. Patient and public involvement is embedded throughout with members contributing to advisory and oversight roles.
The trial has received ethical approval from the London–Harrow Research Ethics Committee, Section 251 approval from the Confidentiality Advisory Group and other relevant regulatory bodies. The University of Hull is the study sponsor. Results will be disseminated through peer-reviewed journal publications, conference presentations and plain English summaries for participants and the public. Findings will inform the feasibility and design of a potential larger trial to improve breast screening uptake via transport support.
Identify and describe patient engagement interventions used to improve medication management in older adults during transitions of care.
A mixed-methods systematic review.
A comprehensive search of all study designs was conducted. Studies were categorised using the ladder of patient and family engagement, a framework that positions engagement from low (passive) to high (active partnership) patient engagement.
Six databases were searched from inception to April 2024.
The search yielded 29 reports, with 25 classified as studies. Most interventions (n = 19, 76%) were low-level interventions that comprised informing patients in a passive manner. Interventions that facilitated high-level engagement (n = 6, 24%) where patients were integrated in the decision-making process were associated with consistently improved patient and healthcare long-term outcomes.
While low and high-level engagement interventions were associated with significantly decreased hospital readmission rates, high-level interventions consistently demonstrated positive patient outcomes. Interventions supporting older adults beyond discharge achieved meaningful and lasting patient and healthcare outcomes for older adults.
Findings provide clinical reference for designing engagement interventions, highlighting long-term benefits of partnership-based approaches and continuity beyond discharge.
Engagement in medication management during transitions of care varied significantly. High-level engagement was consistently linked to improved patient and healthcare outcomes but was often resource intensive. This review identifies the need to design balanced interventions that align with the preferences of older adults and real-world contextual healthcare settings.
PRISMA guidelines.
No patient or public contribution.
PROSPERO (registration number CRD42024557385).
Understanding the epidemiological shifts of respiratory syncytial virus (RSV) is essential to inform public health interventions, particularly given its increased burden on healthcare systems post-COVID-19 pandemic. This study aimed to examine age-specific trends and seasonal variations in RSV incidence, considering the recent introduction of a newborn RSV immunisation programme in Ireland.
A surveillance time series study analysing routinely collected RSV notification data.
National-level weekly RSV notifications collected by the Health Service Executive-Health Protection Surveillance Centre in Ireland from 2012 to 2024.
Infants (
Annual trends in RSV epidemiology with special reference to the pre- and post-COVID-19 winter surges, and the time lag in age-related transmission to peak incidence among the various age groups. Data were analysed to evaluate incidence rates, peak timing, age-related transmission trends and lag times before and after the COVID-19 pandemic.
The study examined the increasing incidence of RSV post-COVID-19 and a significant shift toward earlier RSV peaks in recent years (2021/2022, 2022/2023 and 2023/2024 seasons) in Ireland, with the onset and peak of the season nearly 2 months earlier than in pre-COVID-19 pandemic seasons (p
This analysis highlights an early seasonal onset and intensified RSV burden among infants in recent winters (2021/2022, 2022/2023 and 2023/2024 seasons). Quantifying the time lag for the community-level RSV transmission from infants and young children to older adults will offer insights to optimise RSV intervention strategies as a ‘life-course approach’ to alleviate healthcare system pressures during peak seasons.
While health services leaders rely heavily on information gathered via environmental scans (ESs) to guide strategic decision-making, formal guidance on how to conduct these scans is notably absent. The purpose of this study was to determine the level of agreement on essential components of a definition and a methodological framework for ESs. The goals were to (1) advance our working definition to a concept definition for ESs and (2) develop a methodological framework to guide health service researchers conducting ESs.
We used a real-time, modified Delphi survey in a virtual platform setting to seek perspectives on statements related to ESs from individuals who were recruited based on having verifiable experience designing or conducting ESs in health services delivery research. Surveylet, an online software, was used to facilitate asynchronous data collection and to determine the level of agreement on the statements with an a priori threshold of 75% set for agreement on each statement.
21 panellists provided opinions on 59 statements related to a proposed ES definition and on 69 statements specific to components of a methodological framework for ESs.
Panellists from four countries participated in the survey representing 2 to ≥11 years of experience with ESs and having completed 1 to ≥7 ESs. Agreement was achieved in 28 of the 59 statements related to the ES definition and for 51 of 69 statements related to a methodological framework.
The agreement on many elements deemed essential for a definition of ES support development of a proposed concept definition of ES in health service delivery research. As well, the agreement on components deemed necessary for a methodological framework will help in future development of such a framework to guide stakeholders in the planning and implementation of ESs. These results provide a starting point for a common understanding of ESs in the field of health services delivery research.
by Ian C. Murphy, Kelly Bryan, Muriel Burk, Rong Jiang, Francesca Cunningham, Sarah Providence, Elizabeth Rightnour, Sarah Zavala, Kathleen Morneau, Trisha Exline, Stacey Rice, Travis Schmitt, Kelly Drumright, Jennifer Lee, BreAnna Davids, Tram Guilbeault, Brooke Klenosky, Ann-Marie Sutherland, Abbie Rosen, Lauren Ratliff, Kenneth Bukowski, Margaret A. Pisani, Andrew Franck, Mark Wong, Preston Witcher, Kathleen M. Akgün
OBJECTIVESEarly data suggested higher sedative requirements for ventilated COVID+ patients, deviating from established guidelines. We assessed the relationship between sedative use and outcomes in mechanically ventilated Veterans during the COVID-19 pandemic.
DesignRetrospective Medication Use Evaluation
SettingNational Sample of 13 Distinct VA Medical Center Intensive Care Units
PatientsCritically ill Veteran patients requiring mechanically ventilation for ≥2 days
InterventionsNone.
Measurements and main resultsThe proportion of patients receiving fentanyl, midazolam and propofol was higher during COVID years. Compared with pre-COVID, median fentanyl dose was higher during Years 1 and 2 (1575mcg [(IQR) 1000–1650] vs. 1900 [1250–3000] vs. 1910 [1150–3500]). Adjuvant antipsychotics use was relatively low but tended to increase over time (pre = 10.5% vs. Year 1 = 12.3% vs. Year 2 = 14.1%). Most patients started on antipsychotics in the ICU were continued on the drug after extubation. Mortality was higher during COVID years (pre = 26.9% vs. 1 = 36.8% and 2 = 35.9%). In stratified analyses by COVID status years 1–2 (n = 79, 27%), a higher proportion of COVID+ patients received fentanyl (96% vs. 84%) and propofol (90% vs. 77%) and at higher doses (fentanyl = 1650mcg vs. 2688mcg median cumulative dose; propofol maximum infusion rate = 30 mc/kg/min (20–50) vs. 40 (25–50)). Sedative doses were similar to pre-COVID among non-COVID patients. Anti-psychotics were more frequently continued post extubation among COVID+ (34.6% vs. non-COVID+=14.9%). COVID+ patients were also less likely to have awakening and breathing trials at 48 hours after intubation (18% vs. 46%).
ConclusionsSedative use and dosing increased during the first two years of COVID compared to pre-COVID, especially for COVID+ patients. The sustained elevated levels of fentanyl use in Year 2 suggests possible ‘therapeutic creep’ away from guideline-concordant practices for COVID+ patients. Antipsychotic prescription during intubation and following extubation was also more common among COVID + . These findings could inform development and implementation of safer sedation practices across VA ICUs during respiratory pandemics.
Adults with intellectual and/or developmental disabilities (IDD) experience higher rates of age-related health concerns, including dementia, than adults without disabilities. Despite this, current efforts to support brain health in ageing have often excluded this population. To address this gap, we will codesign, codeliver and evaluate a national virtual brain health education programme, Brain Health-IDD, for ageing individuals with IDD, family caregivers and health and social care providers.
This study will evaluate the Brain Health-IDD Program, an interactive virtual psychoeducation course codesigned and coled by an interdisciplinary team of clinicians and people with lived experience. Three participant groups will be recruited from across Canada: adults with IDD, aged 40 years and older; family caregivers who have a family member with IDD aged 40 years and older or who are themselves aged 60 years and older; and health or social service providers who support adults with IDD aged 40 years and older. Outcomes will be measured at baseline, postcourse and 3-month follow-up. Data will be collected through structured surveys, including both closed and open-ended questions, and focus group interviews.
Primary outcomes are participation, satisfaction and changes in knowledge and self-efficacy related to brain health among the three participant groups. Secondary outcomes for both adults with IDD and family caregivers include changes in health-related behaviours (social connections, sleep hygiene and physical activity), physical health, mental wellbeing, resilience and whether cognitive screening is initiated for adults with IDD and for caregivers. For health and social service providers, secondary outcomes include changes in brain health promotion practices and whether cognitive screening for older adults with IDD is initiated.
Analysis of open-text survey responses and qualitative data from focus group interviews will explore the experiences of participants with the Brain Health-IDD Program.
Institutional ethics approval was obtained from the Centre for Addiction and Mental Health Research Ethics Board. Programme findings and resources will be shared with advocacy groups, disability agencies, family caregiver organisations, clinicians and policymakers in the fields of disability, health and ageing at the provincial, national and international levels.
Explore state school nurse consultants' pivotal position during the COVID-19 pandemic to shape school policy and support frontline school nurses.
An inductive qualitative study.
Members of the National Association of State School Nurse Consultants in the United States participated in focus groups and a written survey from January to April 2023. Standard content analysis was used to identify patterns and themes. COREQ guidelines were followed.
Data from 14 participants revealed 5 themes and 29 subthemes: State School Nurse Consultants walk in two worlds, bridging health and education. They built collaboration and trust and functioned as interpreters and gatekeepers. State consultants were resources, advocates and supports for school nurses. They witnessed and experienced trauma. State consultants defined lessons learned and described how their national organisation supported them. Few sources describe state consultants' role from 2000 to 2022; therefore, this study fills a gap.
State consultants advocated for school nurses, students and school staff, whose needs were not well understood by public health or education leaders.
School nurses' workload increases exponentially in the absence of state consultants who provide resources to deliver effective and efficient school health services.
Policy leaders should recognise state school nurse consultants' intersectionality which strengthens the public health infrastructure, critical to meeting current and emerging public health challenges.
System-wide leadership at regional, state and national levels provides consistency in policy and programmes, reduces duplication of effort and potential error and ensures school nurses benefit from shared resources, problem-solving and support.
National Association of State School Nurse Consultants leaders instigated the study and approved the design and open-ended questions. Preliminary findings were shared with members at a national online meeting and feedback affirmed that the results resonated with their experiences.
FreshRSS 