Conectar
To compare attitudes and perceptions towards opioid use disorder among people with opioid use disorder and emergency providers, describe interactions between the two groups, and identify barriers to providing and receiving care.
Mixed methods observational study.
Participants were recruited from an academic, tertiary care hospital and a community-based harm reduction agency in New England. Emergency healthcare providers (nurses, physicians, and paramedics) and adult people with opioid use disorder were enrolled. Electronic surveys were administered to providers, and semi-structured interviews were conducted with people with opioid use disorder and a subset of providers. Descriptive statistics were calculated for surveys, and directed content analysis was used to analyse semi-structured interviews.
Sixty-eight providers completed the survey, 11 of whom also completed a semi-structured interview. Twenty-two people with opioid use disorder completed the semi-structured interview. Both providers and people with opioid use disorder agreed that addiction is a disease; however, opinions differed on the extent to which personal choice played a role in the onset of opioid use disorder. Participants described how factors such as experiencing homelessness, alongside other personal or familial challenges, contributed to ongoing substance use and presented barriers to accessing healthcare. There was discordance in priorities between providers and people with opioid use disorder, which often drove conflict and perceived stigma. Both groups described physical and emotional trauma from prior interactions, which shaped expectations of future interactions and biases towards each other.
Educational initiatives should arm providers not only with clinical knowledge about opioid use disorder but with skills to recognize implicit biases, navigate unique barriers related to social determinants of health, and effectively deploy shared decision-making techniques. Healthcare organizations should provide support for trauma that emergency care providers are exposed to in caring for people with opioid use disorder.
Consolidated criteria for reporting qualitative studies (COREQ)–32 item checklist.
This study did not include patient or public involvement in its design, conduct, or reporting.
by Elham Ahmadi, Sophia Baierl, Stephan Voss, Ida Asenkerschbaumer, Ursula Berndt, Leonie Bernhard, Anita Hennig, Anna-Lena Würfele, Michaela Coenen
Urban soundscapes, particularly those experienced in green spaces, have been increasingly recognized as factors that influence human mental health. This scoping review explores the existing literature on soundscapes within urban green spaces and their associated mental health outcomes. It aims to classify the methodologies used in this domain, identify mental health outcomes related to urban green space soundscapes, and examine specific soundscape elements and their correlations with mental health. A systematic search of peer-reviewed studies was conducted. After screening titles, abstracts, and full texts, 22 studies met the inclusion criteria. Diverse methodological approaches were identified, with an emphasis on quantitative multi-method designs. Commonly studied mental health outcomes include stress reduction, mood enhancement, perceived restorativeness, and cognitive restoration. Standardized psychometric tools, such as the Perceived Stress Scale (PSS-14), Positive and Negative Affect Schedule (PANAS) and Perceived Restorativeness Soundscape Scale (PRSS) are frequently used as outcome measures. Natural soundscape elements such as birdsong, water sounds, and rustling leaves had a positive association with relaxation and perceived mental restoration throughout all studies, while mechanical sounds, such as traffic noise were linked to adverse mental health outcomes. These findings highlight that natural soundscapes in urban green spaces have a potential positive relationship with mental health by reducing stress and enhancing mood. However, the cross-sectional design and methodological heterogeneity of the included studies limit causal interpretation. Future research should explore multi-sensory experiences and examine soundscapes in diverse urban contexts to provide more robust insights into their relationship with mental health. The practical implications suggest that urban planners should prioritize integrating natural sound elements into urban areas to improve mental health. The study protocol of this scoping review had been registered at OSF (osf.io/4r7gd).by Wenting Yan, Carmel L. Montgomery, Liz Dennett, Stephanie A. Chamberlain
BackgroundThe demographic landscape of Western countries has shifted to a more diverse one. Along with the trend of an aging population, a new problem has emerged, which is the increased linguistic diversity in the aging population in these countries. As people age and their care needs increase, they may not receive optimal care if they don’t speak the same language as their caregivers in long-term care facilities. Culturally and linguistically responsive long-term care services are important to ensure the best care for an aging population, but there is limited evidence in the literature on the scope and practice of these services. The objective of this scoping review is to map out the types of CLR programs in LTC settings and examine their core components and target populations.
MethodsThe Arksey and O’Malley framework, further developed by Levac and colleagues, will be employed in this scoping review. The research question was framed using the PCC framework. A comprehensive systematic search was developed with an experienced librarian and will be conducted in Scopus, CINAHL, Embase, Medline, PsycINFO, and Academic Search Complete. All primary study designs, including quantitative, qualitative, and mixed methods, will be included. Studies must focus on culturally and linguistically responsive care programs used or implemented in long-term care services. There will be no date or language limitations. Findings will be thematically synthesized to answer the research question.
ConclusionThis review protocol provides a transparent process for how it will be conducted. We aim to contribute to a better understanding of what culturally and linguistically responsive care programs exist, how cultural and linguistic responsiveness is currently addressed across diverse care environments, and what gaps remain in long-term care.
by Mireille Jasmin, Geneviève Piché, Aude Villatte, Andrea Reupert, Marie-Ève Clément, Anne Dorothee Müller, Marianne Fournier-Marceau, Darryl Maybery, Marie-Hélène Morin, Stéphane Richard-Devantoy
BackgroundParenting responsibilities can be particularly challenging for patients receiving mental health services, often resulting in a range of negative impacts on children. Incorporating a family-focused approach into the usual care of parents with mental illness has been recommended to promote patient recovery while supporting the well-being of children and the entire family unit. This study aimed to document the family-focused practices undertaken by psychiatrists working with parents who have a mental illness and to explore potential facilitators and barriers to these practices.
MethodsA sequential explanatory mixed-method design was used, combining an online survey and individual interviews. Family-focused practices were reported by 27 psychiatrists through the French version of the Family-Focused Mental Health Practice Questionnaire. Follow-up qualitative individual interviews were conducted with 5 psychiatrists. Item-by-item analysis of the quantitative data was performed, followed by a thematic analysis of the qualitative data, integrating findings from both sources.
ResultsAlthough psychiatrists acknowledge their patients’ parenting role, most are reluctant to provide further support. Key barriers to family-focused practice include the predominantly individual-focused nature of psychiatric care, stigma, consent issues, and limited collaboration between adult and child services. Facilitators include psychiatrists’ professional autonomy, personal experience, and confidence in conducting family meetings.
ConclusionPsychiatrists can play a pivotal role in identifying, acknowledging, and providing appropriate support to parents with mental illness and their families, including children. Developing comprehensive guidelines and targeted training is essential to equip psychiatrists with effective strategies for addressing parenting challenges in patients with complex mental health issues. Additionally, psychoeducational resources for children should be incorporated. Implementing these initiatives may lead to more compassionate, targeted care and improved outcomes for parents and their families.
by Ratikorn Chaisiwamongkol, Rattapon Uppala, Phanthila Sitthikarnkha, Leelawadee Techasatian, Suchaorn Saengnipanthkul, Pope Kosalaraksa, Kaewjai Thepsuthammarat, Sirapoom Niamsanit
Background and aimsDiabetic ketoacidosis (DKA) remains a major cause of pediatric morbidity and death. This study examined national trends in DKA hospitalizations and factors associated with in-hospital mortality among Thai children.
Materials and methodsA nationwide, retrospective cohort study was conducted using data from the National Health Security Office (NHSO) during 2015–2023. Children aged 1 month to under 18 years hospitalized with DKA were identified using International Classification of Diseases, 10th Revision, Thai Modification (ICD-10-TM) codes. Prevalence and mortality were described by year and region. Factors associated with death were assessed with multivariable logistic regression; model discrimination used area under the curve (AUC).
ResultsAmong 10,669 admissions, national DKA prevalence increased from 4.5 to 11.8 per 10,000 pediatric hospitalizations, with Bangkok showing the highest rates. The overall intubation rate was 10.2%, peaking in infants and older adolescents. Although national mortality declined from 2.2% to 0.6%, regional and age-specific fluctuations persisted. Independent associations with mortality included malignancy (Adjusted odds ratio [AOR] 5.25, 95% CI: 1.63-16.92; p=0.005), septic shock (AOR 2.93, 95% CI: 1.71-5.03; p Conclusion
DKA hospitalizations are increasing in Thailand, with regional variation and persistent mortality risk, particularly among patients with critical complications and vulnerable groups. Although declining mortality trends and lower mortality in recurrent cases suggests improved protocol-based treatment, targeted prevention strategies remain essential for high-risk populations.
To quantify medication discrepancies between an outpatient psychiatric service and general practitioners in northern France, and investigate general practitioner identification in psychiatric records.
Quantitative, exploratory, retrospective, descriptive, monocentric study.
Study conducted in 2022 on 112 patients, comparing medication lists between the medical and psychological center and general practitioners through medication reconciliation.
Among the 33 patients (29.5%) with complete data allowing medication reconciliation, 84.8% had at least one discrepancy between medication regimens known to the outpatient psychiatric service versus those known to general practitioners. Discrepancies affected both psychiatric (85.7%) and nonpsychiatric medications (78.6%). 18.8% of the 112 patients did not have an identified general practitioner in the outpatient psychiatric records.
Medication reconciliation in outpatient psychiatry can improve treatment safety and create an opportunity for communication between care providers.
This study highlights opportunities for advanced practice nurses to improve medication safety and interprofessional communication in outpatient psychiatric care through medication reconciliation, which appears to be a reliable indicator for quantitatively assessing communication while actively creating opportunities for dialogue between outpatient psychiatric care facilities and primary care structures. The implementation of these practices could be supported by the advanced practice nurses recently introduced in France, by raising awareness among healthcare professionals, by contributing to the therapeutic education of patients and by supporting the use of digital health tools.
Compliance with EQUATOR RECORDS guidelines, extended from STROBE statements.
This study did not include patient or public participation in its design, conduct, or reporting.
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).
by Viet Anh Nguyen, Viet Hoang, Thi Quynh Trang Vuong, Thi Nga Phung, Nghi Phan Bich Hoang
ObjectivesChairside bonding of auxiliaries directly to aligners can avoid remanufacturing trays, but optimal protocols may be substrate-specific across modern thermoformed and 3D-printed materials. This study aimed to compare bond strength and failure mode across six representative aligner materials using a universal primer-orthodontic adhesive combination and a one-step aligner adhesive, with and without sandblasting.
Materials and methodsPolyethylene terephthalate glycol-modified (PETG), thermoplastic polyurethane (TPU), and glycol-modified polycyclohexylenedimethylene terephthalate (PCTG), together with three 3D-printed resins (TA-28, TC-85DAC, DCA), were prepared as 0.76-mm plates (n = 64). Specimens received alumina sandblasting or no treatment, then were bonded with either of two bonding strategies (n = 16). After thermocycling, bond strength was tested, and failures were scored by ARI. Two- and three-way ANOVA and proportional-odds modeling assessed effects (α = 0.05).
ResultsBond strength showed significant main effects of material and sandblasting, with significant material–sandblasting and material–primer interactions. The primer main effect was not significant. Post hoc tests confirmed substrate-specific rankings. PETG with Bond Aligner (non-sandblasted) reached 26.71 MPa, while DCA with universal primer (sandblasted) reached 22.36 MPa. Sandblasting generally increased bond strength, with some exceptions. Failure mode was material-dependent and not completely parallel with bond strength.
ConclusionsBonding efficacy depends on the aligner substrate. For thermoformed trays, a one-step aligner adhesive is preferable, with sandblasting contraindicated for PETG but advantageous for more elastic TPU and PCTG. For 3D-printed trays, a universal primer-orthodontic adhesive combination performs more consistently, with sandblasting benefiting DCA and TA-28, whereas TC-85DAC performs slightly better without it.
To verify the efficacy of virtual reality compared to tablet games for pain and anxiety management in children undergoing percutaneous bone pin and/or suture removal procedures.
Randomised clinical trial using two parallel groups: (1) virtual reality or (2) tablet game.
Three-center, randomised pragmatic clinical trial, using a parallel design with two groups (experimental group: immersive virtual reality; active comparator: tablet games). Children aged 6–17 requiring percutaneous pins and/or sutures were recruited between 2020 and 2022 from three outpatient orthopaedic clinics in paediatric hospitals. Pain was measured with the Numerical Rating Scale and anxiety with the Child Fear Scale before and immediately after the procedure.
A total of 188 participants were assigned to either the virtual reality group (96 participants) or the tablet group (92 participants). At the first assessment, there was no noticeable difference between the two groups in terms of pain or anxiety levels. However, further analysis revealed that participants aged 13 and older in the virtual reality group experienced significantly lower anxiety.
Virtual reality was not more efficacious than games on a tablet for pain and anxiety of children undergoing removal of bone pins or sutures. However, virtual reality demonstrated a benefit in reducing anxiety for teenagers, particularly those aged 13-older.
Virtual reality games provide an immersive, non-pharmacological alternative of for anxiety management of teenagers during pins and/or sutures removal.
This study showed that a virtual reality game may help reduce anxiety during pins and/or sutures removal procedures in patients aged 13 years and older.
We adhered to the CONSORT checklist for reporting results.
A patient partner reviewed the study design, methods and final manuscript.
NCT03680625
by Thanh Luan Nguyen, Thanh Khoi Tu, Thien-Vy Phan, Chanh M. Nguyen, Khoa D. Nguyen, Minh Quan Pham, Hai Ha Pham Thi
Cyperus amuricus (Cyperaceae) has exhibited potential anticancer activity against hepatocellular carcinoma (HCC), yet its molecular mechanisms and phytoconstituent interactions with oncogenic pathways remain underexplored. This study integrates in vitro cytotoxicity assays and molecular docking to evaluate the effects of C. amuricus fractionated extracts on HCC, focusing on PI3K/AKT/mTOR signaling axis. The ethyl acetate (EA) fraction selectively inhibited HepG2 cell proliferation (IC50 = 159.76 µg/mL) with minimal toxicity to normal fibroblasts. Apoptotic features—cell shrinkage, membrane blebbing, nuclear condensation, and DNA fragmentation—were confirmed through DAPI staining and gel electrophoresis. Western blot analysis revealed dose-dependent suppression of phosphorylated Akt and p70S6K, indicating pathway inhibition. Molecular docking identified strong binding affinities between Cyperaceae-derived compounds and PI3K/AKT/mTOR targets, with luteolin 7-O-β-D-glucuronopyranoside-6″-methyl ester blocked PI3K activation, vitexin bound AKT’s allosteric site, and digitoxin targeted mTOR’s ATP-binding pocket, showing comparable binding energies to reference ligands. These findings suggest C. amuricus as a promising candidate for natural product-based HCC therapy.Implementation of low-intensity, evidence-based psychological interventions can help meet the mental health and psychosocial needs of people with cancer, especially in low-resource settings where there is a dearth of mental health specialists. In this study, we will conduct a feasibility randomised controlled trial (RCT) of the stress management intervention Self-Help Plus, which has been translated and adapted to Vietnamese, vSH+, among people newly diagnosed with breast or gynaecological cancer in Viet Nam.
At six participating hospitals, individuals diagnosed with breast or gynaecologic cancer within the past year will be recruited, consented and randomised into either enhanced usual care (EUC) or EUC plus the vSH+ intervention, which consists of four sessions each lasting approximately 75 min. Quantitative surveys will be administered at three time points: enrolment/baseline (T0), after 6 weeks (T1) and after 4 months (T2). A qualitative evaluation component, which will include in-depth interviews with patients, implementers and healthcare staff and managers, as well as focus group discussions with caregivers, will assess the acceptability and feasibility of the vSH+ intervention.
Ethical reviews for the study were obtained from Boston University, Hanoi University of Public Health (HUPH) and all the participating hospital sites. On completion of data collection and analyses, the research team will prepare and submit abstracts to scientific conferences as well as manuscripts to peer-reviewed journals. We will also conduct dissemination events to report the trial results to relevant stakeholders.
To explore the optimal timing of patient-reported outcome assessment, defined as the collection and use of patient-reported outcomes at clinically meaningful points such as before or during encounters, treatment initiation and follow-up, and to identify the facilitators and barriers to timely use.
A qualitative analysis of semi-structured interviews with healthcare professionals across diverse US health systems.
Thematic analysis was used to identify key themes related to the timing and implementation of patient-reported outcomes assessments. Interviews were analysed iteratively to develop a coding framework and synthesise overarching themes.
Fourteen healthcare professionals, including nurse practitioners, cardiologists and health informatics experts across seven U.S. health systems from academic and community hospitals, were interviewed in February 2024. Three major themes emerged: (1) value proposition of timely patient-reported outcome data collection (2) key facilitators for timely implementation and (3) multilevel barriers. The value proposition focused on the use of patient-reported outcomes for prevention and active disease management. Critical facilitators for the timely implementation of patient-reported outcomes included the involvement of research and clinical coordinators, strategies for pre-visit and on-site patient-reported outcome collection, the use of standardised templates within EHRs and the alignment of patient-reported outcome collection with patients' long-term treatment goals. Finally, multilevel barriers included time constraints, patient-level challenges (e.g., fatigue, literacy, language) and systemic issues (e.g., technical limitations, lack of reimbursement and unclear guidelines).
Timely collection and use of patient-reported outcomes is critical for improving symptom monitoring and supporting patient-centered clinical decision-making. However, multilevel barriers hinder consistent implementation across health care settings.
Integrating patient-reported outcomes into clinical workflows can improve the patient-centeredness of patient-healthcare professional interactions, and provide a more holistic picture of a patient's health status. Addressing barriers to patient-reported outcome implementation, including lack of time, poor health literacy and workflow integration barriers, is crucial for improving clinical outcomes.
This study adhered to the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist, in accordance with EQUATOR Network guidelines.
No patient or public involvement: This study did not include patient or public involvement in its design, conduct or reporting.
by Tu Ngoc Tran, Nguyen Phan Thu Hang
This paper aims to explore the effect of User-Generated Content (UGC) on the purchasing behavior of environmentally friendly products at Hospitality and Food Service Industry in Vietnam, particularly in Ho Chi Minh City. A conceptual model has been developed based on literature reviews and empirical studies. Furthermore, the Partial Least Squares Structural Equation Modeling (PLS-SEM) method was employed to investigate the impact of UGC on the purchasing behavior of environmentally friendly products at Hospitality and Food Service Industry in Vietnam. The results confirm that environmental concerns, attitudes, and the intention to purchase green products are all positively and significantly influenced by UGC. Especially, the results validate that brand reputation plays a moderating role in the connections between UGC and environmental concern, UGC and environmental attitude, as well as the relationship between the intention to purchase environmentally friendly products and actual purchasing behavior.To describe a sample of healthcare professionals' responses to the valid and reliable Climate and Health Tool and compare participant characteristics relating to Climate and Health Tool subscales.
Observational, cross-sectional, multi-site study.
An electronic survey containing the Climate and Health Tool was administered to healthcare professionals across a large, multi-state health system in the Western United States with a committed effort to reducing carbon emissions.
One thousand three hundred and sixty-three participants reported moderately elevated levels of awareness and concern around climate impacts on health and motivation to participate in climate protective actions. Respondents reported moderate levels of climate-protecting behaviours at home and low levels at work. Females were more concerned and motivated. Medical staff and respondents reporting familiarity with system environmental initiatives reported more awareness and behaviours at home to preserve climate health.
Healthcare professionals are concerned and motivated to decrease climate impacts on health yet take little action at work to preserve the climate. Because of the intersection of climate change, health, and healthcare, healthcare organizations should prioritize and support meaningful action for healthcare professionals to meet community climate health needs.
Healthcare organizations committed to contributing to climate solutions can use this research to increase healthcare professionals' education, engagement, and impact to preserve the climate and health of communities.
Healthcare is a major contributor to carbon emissions, yet healthcare professionals' awareness, motivation, concern, and behaviours related to climate change and health were not clear. Our research showed healthcare professionals are aware and concerned about climate impacts on health but reported low levels of workplace behaviours to protect the climate. The findings of our research will impact healthcare professionals and healthcare organizations to focus efforts on climate-preserving behaviours.
This manuscript followed the STROBE guidelines.
None.
by Véronique Gille, Flore Gubert, Camille Saint-Macary, Stéphanie Dos Santos, Franck Houffoué, Hugues Kouadio, Epiphane Marahoua, Petanki Soro, Alexander van Geen
Lead (Pb) exposure is a major global health concern, particularly for young children, yet awareness of the risks is low. Pb-based paint remains a significant source of exposure in many low- and middle-income countries, despite existing regulations. We investigate whether personalized information on lead in paint can increase awareness and encourage preventive behaviors. As part of a pilot study in Abidjan, Ivory Coast, painted surfaces in pregnant women’s homes were tested using a low-cost Pb detection kit, followed by confirmatory testing with an X-ray fluorescence (XRF) device. Among the final sample of 153 women, those living in homes that tested positive for Pb were 33-35 percentage points more likely to acknowledge their exposure risk. This increased awareness led to self-reported behavioral changes among mothers of young children, including a higher likelihood of preventing children from ingesting paint chips and washing their hands more frequently. We find no impact on self-reported home-cleaning or renovation behaviors. Our findings highlight the potential of personalized information to drive behavioral change in environmental health.The aim of this study was to determine the prevalence of groin rash among Thai military personnel and to identify associated risk factors, clinical features and patient perceptions. We also evaluated care-seeking behaviour and treatment practices.
Cross-sectional, questionnaire-based study.
Conducted among Thai military personnel in a tropical environment.
A total of 500 male military personnel were recruited between August 2022 and September 2023. Of these, 475 participants were included in the analysis, while 25 were excluded due to non-participation in field training. Eligibility was restricted to those actively engaged in field exercises at the time of study.
Not applicable.
Primary outcome was the prevalence of groin rash, defined by self-report aided by standardised clinical images. Secondary outcomes included risk factors, rash morphology, symptom severity, treatment practices and healthcare-seeking behaviour. Associations were analysed using multivariable logistic regression adjusted for age, body mass index (BMI) and other covariates.
Lifetime prevalence of groin rash was 22.3% (106/475), and the point prevalence was 3.8% (18/475). Among those with rash, 39.6% were classified as probable fungal infections. Independent risk factors included reusing underwear (aOR 2.25; 95% CI 1.27 to 3.99; p=0.005) restricted bathing time (aOR 1.73; 95% CI 1.06 to 2.83; p=0.030) and higher BMI (aOR 1.10; 95% CI 1.02 to 1.42; p=0.030). Most affected participants (54.7%) reported minimal impact on daily life, and only 18.9% sought professional care. Self-medication was common, with 50% using topical over-the-counter antifungals alone, while 16% used a combination of oral and topical drugs. Relapse occurred in 36.1% of cases.
Groin rash is relatively common among young Thai military personnel and is associated with modifiable hygiene-related factors. Only a small proportion of affected individuals appear to present for medical evaluation. Educational interventions emphasising regular laundering and adequate bathing during training may assist in reducing its prevalence.
To describe telephone-triage nurses' perceptions of their well-being and the system factors that influenced their well-being while conducting telephone-triage for COVID-19 during the pandemic.
This descriptive, qualitative study applied both inductive and deductive analysis to generate themes.
We interviewed a convenience sample of 27 nurses from two health systems about their perceptions of well-being when triaging patient calls about COVID-19 and reasons for those perceptions. Data collection occurred between November 2020 and June 2021. Themes were organised using the National Academies of Science, Engineering and Medicine framework.
Telephone-triage nurses' well-being was significantly impacted by COVID-19. Uncertainty regarding evolving COVID-19 guidance, increased call volumes and difficult patient responses were some of the key work system challenges that impacted nurses' well-being.
Our findings suggest the need to revisit work system factors that impact the well-being of telephone-triage nurses and develop organisational interventions to support nurses to provide optimal care during crisis situations.
Organisational information infrastructure should be bolstered for future pandemic responses to minimise impacts on nurses' well-being. Additionally, leaders need to realign tasks, workflows and workload of telephone triage during pandemic surges to prevent excessive demands on nurses.
This work contributes to understanding telephone-triage nurses' well-being during COVID-19. The increased demands they faced and impact on their well-being point to opportunities for organisational well-being interventions and development of crisis standards for tele-triaging to support nurses during high-stress, crisis situations.
The authors have adhered to COREQ guidelines for reporting.
No patient or public contribution.
To evaluate whether implementing the Comprehensive Assessment and Risk Evaluation (CARE) record, developed to operationalise Standard 5: Comprehensive Care of the Australian National Safety and Quality Health Service Standards was associated with improvements in patient safety and quality of care. A secondary objective was to explore staff and patient experiences of implementation.
Mixed-methods pre–post evaluation combining quantitative analysis of routinely collected hospital data with staff surveys and patient interviews.
A metropolitan hospital network in Melbourne, Victoria, Australia
Quantitative analysis included 88 041 admissions pre-implementation and 23 765 post implementation. Staff surveys were completed by 117 staff (84% nurses, 60% with >5 years at the service). Structured interviews were conducted with 39 patients (mean age 65.6 years, 64% male).
The CARE record was a structured record embedding validated risk assessments (STRATIFY, Braden Scale, Malnutrition Screening Tool, Confusion Assessment Method/4 ‘A’s Test, Broset Violence Checklist, Columbia-Suicide Severity Rating Scale) and care planning into routine workflows, to meet requirements of Standard 5.
Primary outcomes were the incidence of falls and pressure injuries. Secondary outcomes were completion of the CARE record, staff and patient experiences, and documentation of other hospital-acquired complications (HACs) (delirium, malnutrition, violence and aggression, suicide and self-harm). Data were compared for two time periods: 1 January 2016 to 28 February 2019 (before CARE record implementation) and 1 March 2019 to 30 March 2020 (after CARE record implementation but before COVID-19).
Post implementation, overall falls decreased (OR 0.85; 95% CI 0.78 to 0.93), though severe falls increased (OR 1.89; 95% CI 1.17 to 3.07). Pressure injuries decreased in coded data (OR 0.41; 95% CI 0.23 to 0.73) and incident reports (OR 0.79; 95% CI 0.68 to 0.92). Documentation of delirium (OR 2.02), malnutrition (OR 2.03), aggression/violence (OR 2.09) and suicide/self-harm (OR 1.92) increased. Half of the staff (50.4%) felt they knew more about patients, but 61.2% reported more time to admit patients. Communication between nursing and allied health improved (65.8%). Patients were generally satisfied, though 50% repeated information frequently and 20% felt unprepared for discharge.
CARE record implementation, mandated by the Australian Commission on Safety and Quality in Health Care’s Standard 5, was associated with fewer pressure injuries and overall falls (though there was an increase in falls resulting in serious injury), and greater documentation of other complications. Staff and patient experiences highlighted some benefits but also documentation time challenges. Findings provide lessons for the national implementation of Standard 5 and the need to balance structured processes with clinical judgement.
To increase Chlamydia trachomatis screening in adolescents 15–19 years of age from 7.8% to 15% following a 6-week implementation of universal chlamydia screening at three paediatric primary care (PPC) sites.
Pre-implementation (1 January 2022–19 October 2022) and post-implementation (20 October 2022–1 June 2023) screening rates were tracked through run charts and compared via Chi-square testing. Universal opt-out chlamydia screening with universal urine collection for 15- to 19-year-old was implemented at well visits, along with patient and staff education, and sexually transmitted infection treatment protocols.
Chlamydia trachomatis screening increased from 7.8% to 34.1% with implementation of universal opt-out chlamydia screening. Proportions of patients screened increased significantly among White individuals, males and privately insured individuals.
A universal C. trachomatis screening project can be feasibly implemented in pediatric primary care and successfully increase adolescent chlamydia screening rates.
Implementing a universal opt-out C. trachomatis screening project is feasible in PPC and can help achieve the public health goal of chlamydia identification and treatment.
These findings will be impactful for both paediatric primary care and adolescent patients. The universal, opt-out C. trachomatis screening approach facilitated screening increases, improved equity in screening and led to increased case detection and treatment which has vast significance for those patients.
This manuscript is submitted using the SQUIRE 2.0 guidelines for quality improvement reporting.
Patient contribution included de-identified data collection of chlamydia screening rates of eligible adolescents 15–19 years old who attended routine well visits at the three PPC locations. The data were reviewed on a dashboard, then stratified by race, ethnicity, payor and sex assigned at birth.
FreshRSS 