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Genomic diagnostics have accelerated therapeutic and preventative breakthroughs in oncology and cancer genetics. Despite increased access, the implementation of genomics-based care faces serious fragmentation and scalability issues due to a lack of system support. The Precision Care Initiative aims to develop a novel and scalable Precision Care Clinic (PCC). It is designed to coordinate precision medicine in oncology and streamline decision support for referring oncologists and geneticists. The PCC will enhance quality of care through multifaceted, patient-centred communication. It will also improve translational capacity by integrating team expertise in precision oncology, implementation science, clinical informatics, cancer genetics, health economics and patient-reported measures.
This programme uses a type I and type II hybrid effectiveness-implementation trial design sequentially. The complex clinical intervention is precision oncology—matching the targeted treatment or risk management strategy to the right patient, based on their genomic, cancer staging, environmental, lifestyle and biological characteristics, etc. The service intervention is the PCC, providing centralised multidisciplinary review to facilitate shared decision-making with clinicians for the provision of optimal precision oncology care for their patients. The implementation intervention is the co-designed implementation platform—applying evidence-based implementation approaches and Learning Health System principles to enhance feasibility and sustainability. All adult patients across Australia referred to the PCC (n=est. 100–150/year), and healthcare professional interest holders involved in the delivery of precision oncology services, are eligible to participate. Over the study course, phase I involves using a mixed-methods approach to inform iterative co-design and pilot testing of the first PCC with an accompanying implementation platform, and a suite of outcome measures to assess effectiveness; phase II (hybrid type I) includes the implementation of the PCC and evaluation of the outcome measures designed in phase I; phase III (hybrid type II) involves a co-design of local adaptations and testing the effectiveness of the PCC model nationally.
The study received ethical approval from the St Vincent’s Hospital Human Research Ethics Committee (2023/ETH00373). Study results will be presented at relevant conferences and published in peer-reviewed journals.
To assess the impact of opening a large community-based asynchronous review ophthalmic clinic on attendance delays among patients with stable chronic eye disease attending a London teaching eye hospital network.
Interrupted time-series analysis of routine electronic health records of appointment attendances.
A large eye hospital network with facilities across London, UK, between June 2018 and April 2023.
We analysed 69 257 attendances from 39 357 patients, with glaucoma and medical retina accounting for 62% (n=42 982) and 38% (n=26 275) of visits, respectively. Patients over 65 made up 54% (n=37 824) of attendances, while 53% (n=37 014) were from the more deprived half of the population, and 51% (n=35 048) were males.
An asynchronous review clinic opened in a shopping centre in London, in autumn 2021, following the COVID-19 lockdown in spring 2020.
Average attendance delays (days), calculated as the difference between follow-up attendance date and the latest clinically appropriate date determined at the preceding attendance.
Pre-COVID-19, attendance delays for chronic eye disease monitoring were increasing by 0.9 days per week (95% CI, 0.8 to 0.9) on average, worsening to 2.0 days per week (95% CI, 2.0 to 2.0) after the first COVID-19 national lockdown, mid-March 2020. Opening the asynchronous review clinic increased appointment capacity, with delays decreasing on average by 8.1 days per week (95% CI, 8.1 to 8.2) shortly after opening. The rate of decrease slowed to 0.3 days per week (95% CI, 0.3 to 0.3) after 5 months. We found no significant differences in average attendance delays by age, gender or level of deprivation.
The asynchronous review clinic significantly reduced attendance delays across the hospital network, addressing pre-existing backlog for stable chronic eye diseases. The reduction appeared to be maintained after the initial backlog had been cleared.
To examine the evidence from systematic reviews on the development, implementation, and/or sustainability of age-friendly cities and communities programmes.
This review was informed by the Joanna Briggs Institute umbrella review methodology.
Critical appraisal, data extraction, and synthesis were carried out according to the Joanna Briggs protocol for undertaking umbrella reviews.
An extensive CINAHL, MEDLINE, PsychINFO, PubMed and Scopus search was conducted for literature published from January 2007 to July 2024. Finalised search terms included ‘age-friendly’, ‘age-friendly cities and communities’ ‘systematic review’, meta-analysis', ‘integrative review’, ‘narrative review’, ‘scoping review’, ‘rapid review’ and ‘scientometric review’ in combination with index terms were utilised to locate relevant literature.
Ten reviews were included comprising 4 scoping reviews, 1 interpretive review, 1 integrative review, 2 systematic reviews, 1 rapid review and 1 structured literature review. Synthesised findings were presented under the categories of ‘Development’; ‘Implementation’; and ‘Sustainability’.
The findings are relevant to policy, practice and research. Longitudinal and evaluation research is needed to determine the long-term sustainability of AFCC programmes. More evidence is required on the success of programmes in marginalised communities and low to middle-income countries. Designing appropriate environments for ageing in place has far-reaching implications for the health and well-being of communities, especially our oldest citizens. This is particularly salient in this time of unprecedented population ageing. Nurses must have an in-depth understanding of the broader determinants of health, including ensuring environments are fit for purpose and meet the needs of older communities.
Understanding the importance of ensuring our cities and communities are age-friendly will positively influence the health and social care provided by nurses to older adults.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyse checklist were used to report the screening process.
There was no patient or public contribution to this umbrella review.
The PROSPERO registration number: CRD42023413096 (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=413096)
To identify and synthesise evidence related to ageism in older regulated nurses' practice settings.
A systematic review following Joanna Briggs Institute methodology.
The review included empirical studies that involved older nurses as the primary study population and studies that focused on ageism in older nurses' work environments, including strategies or interventions to address ageism within the workplace. Following the initial screening, all relevant studies were critically appraised by two reviewers to ensure they were appropriate to include in the review. A synthesis without meta-analysis reporting (SWiM) guideline was employed in the review.
Medical Literature Analysis and Retrieval Systems Online, Scopus, Psychological Information Database and Cumulative Index to Nursing and Allied Health Literature and Google Scholar were searched to identify empirical studies and a range of academic institutional websites were accessed for master's and doctoral dissertations and theses. The search covered the period from January 2022 to May 2022, and only publications in English from 2000 onwards were considered.
Nineteen studies were included, ten qualitative studies, seven quantitative studies and two mixed methods secondary analyses. Our results revealed that negative perceptions and beliefs about older nurses' competencies and skills prevail in their practice settings, which influences older nurses' health and well-being as well as their continuation of practice. Further, older nurses' continuation of practice can be facilitated by having a positive personal outlook on ageing, meaningful relationships in their practice settings and working in an environment that is age-inclusive.
To combat ageism in older nurses' practice settings and support their continuation of practice, effective interventions should be organisational-led. The interventions should focus on fostering meaningful relationships between older nurses and their colleagues and managers. Further, healthcare institutions should implement initiatives to promote an age-inclusive work environment that supports an age-diverse nursing workforce.
The review findings offer insights for healthcare managers, policymakers and researchers, emphasising the need for anti-ageism policies in healthcare organisations. According to WHO (2021), educational activities such as role-playing and simulation during in-service training may also be effective interventions. Additionally, incorporating anti-ageism initiatives into staff meetings and mandating anti-ageism training could support the continuation of practice for older nurses while fostering a more age-diverse nursing workforce.
We found evidence on the presence of ageism in older nurses' workplace and the detrimental effects of ageism on older nurses' well-being and continuation of practice. Importantly, we identified a lack of organisational initiatives to address ageism and support older nurses. These findings should encourage healthcare organisations to address ageism in older nurses' practice settings and prompt policymakers to develop age-inclusive policies that support older nurses' continuation of practice.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Synthesis Without Meta-analysis checklists were used to report the screening process.
The PROSPERO registration number for the review was CRD42022320214 (https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022320214).
No Patient or Public Contribution.
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