Conectar
by Mylaine Breton, Catherine Lamoureux-Lamarche, Véronique Deslauriers, Djamal Berbiche, Maude Laberge, Annie Talbot, Aude Motulsky, Marie-Pascale Pomey, Isabelle Gaboury
BackgroundAccess to primary care is an important component of health systems. Given the barriers experienced by unattached patients to accessing primary care in Quebec (Canada), the Ministry of Health mandated the province-wide implementation of Primary care access points for unattached patients (Guichet d’accès première ligne; GAP), an organizational innovation designed to orient patients to the most appropriate professional or service. This study aims to 1) document the factors associated with unmet healthcare needs after receiving GAP services and 2) assess whether those factors vary by GAP orientation.
MethodsThis cross-sectional study builds on data collected between April and July 2024 using an online patient questionnaire. All patients with a valid email address registered on the centralized waiting list for unattached patients in three local health territories (LHTs) received an email invitation to participate in the survey. The total sample included 20,282 participants who responded to the questionnaire and used the GAP.
ResultsThe findings showed that younger age, self-reporting poor/fair physical and mental health, receiving services in LHT 3 and reporting an emergency room visit were associated with increased likelihood of reporting unmet needs. Stratified analyses suggested that some characteristics (age, use of emergency room) were associated with unmet needs across orientations, while others (self-reported physical and mental health) were associated with specific orientations.
ConclusionThis study serves as a first step in deepening our understanding from a patient perspective of how to better plan primary care services and improve unattached patients’ experiences using the GAP. The findings showed that patients oriented to other professionals than a medical appointment with a family physician had the highest percentage of unmet needs. The next step involves an in-depth exploration of the reasons for patients’ unmet needs, enabling the development of more precise and effective strategies to address them.
Effect size and event rate estimation is necessary for sample size calculation in randomised clinical trials. Overestimation of the effect size and event rate can lead to inadequately powered studies and increased probability of false negative results. This is common in trials involving critically ill patients. However, such overestimation has not been systematically evaluated in trials involving neurocritical care. We aimed to conduct a systematic review of published randomised clinical trials involving critically ill neurological patients, to determine the accuracy of effect size and event rate estimation.
We will review randomised clinical trials involving adult critically ill neurological patients that were published from 2015 onwards in selected clinically useful and high-impact journals. We will include randomised clinical trials reporting a binary or time to event outcome, using two study groups, and a superiority design testing the efficacy of diagnostic, monitoring, therapeutic or process interventions. All eligible studies must report an estimated event rate in the control group and estimated effect size. All relevant studies will be identified through database searches. All study selection and data extraction will be conducted by two independent reviewers. We will use a random-effects model for pooling data. This review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guidelines. Accuracy of effect size and event rate estimation will be evaluated by comparing the estimated and observed values. The association between the accuracy of the individual randomised clinical trial effect size and event rate estimation and rejection of the null hypothesis will be evaluated using logistic regression analysis. Multivariable linear regression analysis will be used to explore the factors associated with accuracy of effect size and event rate estimation. In addition, we will perform subgroup analysis by impact factor of the published journals, sample size of the studies and risk of bias.
As this systematic review will use data from previously published studies, it does not require ethics approval. Findings of this systematic review will be published in a peer-reviewed journal and will be presented at specialty-based conferences. The study will be included in the higher degree research thesis of the primary author.
CRD420251106394.
To estimate the association between maternal COVID-19 vaccination during pregnancy and adverse neonatal and maternal outcomes.
Population-based retrospective cohort study using a hospitalisation database linked with other health administrative databases.
Province of Quebec, Canada, from 1 May 2021 to 30 June 2023.
All singleton pregnancies resulting in a live birth or stillbirth at ≥20 weeks of gestation, excluding those with a conception date
We used robust Poisson regression models to estimate adjusted risk ratios (aRRs) for chorioamnionitis, postpartum haemorrhage, caesarean delivery, preterm birth, very preterm birth, small for gestational age (SGA), maternal and neonatal admission to intensive care unit (ICU, NICU) and severe neonatal morbidity. We used a Cox regression model with a time-varying exposure variable to estimate adjusted HRs (aHRs) for stillbirth. Propensity score weighting was used to adjust for potential confounding.
Among 140 073 singleton pregnancies resulting in live birth or stillbirth, 61 282 individuals (43.8%) received at least one dose of messenger RNA COVID-19 vaccine during pregnancy. Vaccination during pregnancy was not associated with an increased risk of chorioamnionitis (aRR 0.99, 95% CI 0.95 to 1.04), postpartum haemorrhage (aRR 1.03, 95% CI 0.99 to 1.06), very preterm birth (aRR 1.04, 95% CI 0.89 to 1.21) and stillbirth (aHR 1.14, 95% CI 0.94 to 1.39). Vaccination during pregnancy was significantly associated with a reduced risk of caesarean delivery (aRR 0.94, 95% CI 0.92 to 0.96), maternal ICU admission (aRR 0.80, 95% CI 0.65 to 0.98), SGA (aRR 0.94, 95% CI 0.91 to 0.98), NICU admission (aRR 0.91, 95% CI 0.85 to 0.96), preterm birth (aRR 0.94, 95% CI 0.90 to 0.99) and severe neonatal morbidity (aRR 0.91, 95% CI 0.85 to 0.98).
Our findings suggest that COVID-19 vaccination during pregnancy was not associated with an increased risk of adverse outcomes. Ongoing surveillance of the safety of maternal COVID-19 vaccination is essential as doses continue to be recommended for this group.
The aim of this systematic review was to assess and synthesize the global evidence on existing general dementia training and education for the social care workforce.
Mixed-methods systematic review.
Systematic searches on five databases (PubMed, APA PsychINFO, CINAHL Plus, Scopus, Web of Science) were conducted for articles published between 2010 and July 2024.
Each abstract and full text was screened by two research team members, with conflicts of inclusion dissolved by a third team member. Data were extracted and studies narratively synthesized by the group into comparisons of content, delivery mode, workforce and outcomes/impact.
Twenty-seven studies from 13 mainly high-income countries were included in this review. Most studies provided training to care home staff, with studies using remote, in-person and blended training delivery modes. While the focus was on generic dementia education, various interventions have been evidenced in the social care workforce, to different effects. Most changes in outcomes were reported for staff knowledge and confidence, while evidence on impacts on people with dementia is limited and mixed.
There are various types of in-person and remote dementia training available for the social care workforce, with overall positive impacts on knowledge and change in care delivery. Evidenced interventions need to be implemented across countries and have the potential to improve dementia knowledge, particularly in lower- and middle-income countries where evidence and the social care workforce are limited.
Findings provide clear recommendations on the value and benefit of diverse dementia training on the social care workforce, care delivery and limited but emerging evidence on service user outcomes. Nurses are key parts of the staff working in social care settings, including care homes and would thus benefit from the identified dementia training.
Two former unpaid carers and three voluntary sector staff helped interpret the findings and reviewed drafts of the manuscript. They are co-authors.
No abstract available 
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