Outcomes of medically retrieved infants with bronchiolitis in high-income countries: A scoping review.

INTRODUCTION: Bronchiolitis is the most common respiratory infection and reason for hospitalisation in infancy; however, outcomes of infants with bronchiolitis who require interhospital transfer by specialist medical retrieval services are poorly understood. OBJECTIVES: The objective of this study was to summarise current evidence of the rate, therapy, and outcomes of infants with bronchiolitis who required medical retrieval for ongoing management. REVIEW METHOD: A scoping literature review informed by the Joanna Briggs Institute methodology was used including published studies in any language covering the period 1996 to December 2022 and grey literature sources comprised of reports from retrieval services in high-income countries with comparable healthcare systems. DATA SOURCES: Medline, CINAHL, and the Cochrane Database of Systematic Reviews electronic databases were the sources for published studies. Grey literature sources were retrieval service web pages/social media sites from Australia, Canada, New Zealand, the United Kingdom, and the United States of America. RESULTS: Searching identified 12 677 records, with 12 069 ineligible records and 286 duplicates excluded at screening. Of the 72 papers included for title and abstract review, 16 were selected for full-text review. Six papers fulfilled inclusion criteria. Infants with bronchiolitis were the primary focus of three studies. Transfer rate was reported in four studies, ranging from 4.3% to 18.5%. Use of respiratory therapy was variably reported and was associated with prematurity. Outcomes following retrieval such as respiratory therapies, days on therapies, length of stay in the intensive care unit, and hospital length of stay were only reported in two studies. Of 103 identified medical retrieval services and data registries, no reports were found that included information on the number of transfers or outcomes for infants with bronchiolitis. CONCLUSIONS: Up to one in five infants with bronchiolitis require medical retrieval. Only two published studies and no reports reported on the number and outcomes of infants. Given the frequency and severity of bronchiolitis, understanding indications for medical retrieval and outcomes of those infants may help to better target care and interventions for this common illness. Benefits could include diminishing the costly burden to families and the healthcare system of avoidable medical retrieval and interhospital transfer.

Associations between socioeconomic status and place of residence with survival after aneurysmal subarachnoid haemorrhage.

BACKGROUND/AIM: This study aims to understand early (<24 h post ictus) and late (up to 12 months) survival post aneurysmal subarachnoid haemorrhage (aSAH), with a focus on rurality and socioeconomic status. METHODS: A statewide population-based cohort of aSAH cases in Tasmania, Australia, was established from 2010 to 2014 using multiple overlapping sources. Clinical data were collected from medical records and the Tasmanian Death Registry, with area-level rurality and socioeconomic status geocoded to participants' residential address. RESULTS: From a cohort of 237 (70% women, 36% disadvantaged, 38% rural) individuals over a 5-year period, 12-month mortality was 52.3% with 54.0% of these deaths occurring within 24 h post ictus. In univariable analysis of 12-month survival, outcome was not influenced by socioeconomic status, but rural geographical location was associated with a non-significant increase in death (hazard ratio (HR) 1.22; 95% confidence interval (CI) 0.85-1.75) along with hypertension (HR 1.78; 95% CI 1.07-2.98) and hypercholesterolaemia (HR 1.70; 95% CI 0.99-2.91). Multivariable analysis demonstrated a statistically significant increase in death to 12 months after aSAH for both hypertension (HR 1.81; 95% CI 1.08-3.03) and hypercholesterolaemia (HR 1.71; 95% CI 1.00-2.94) but not socioeconomic status or geographic location. CONCLUSION: We found high early death in this population-based aSAH Australian population. Survival to 12 months after aSAH was not related to either geographical location or socioeconomic status but modifiable risk factors increased the risk of death.

Time and predictors of time to treatment for aneurysmal subarachnoid haemorrhage (aSAH): a systematic review.

BACKGROUND: Aneurysmal subarachnoid haemorrhage (aSAH) is a serious form of stroke, for which rapid access to specialist neurocritical care is associated with better outcomes. Delays in the treatment of aSAH appear to be common and may contribute to poor outcomes. We have a limited understanding of the extent and causes of these delays, which hinders the development of interventions to reduce delays and improve outcomes. The aim of this systematic review was to quantify and identify factors associated with time to treatment in aSAH. METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines and was registered in PROSPERO (Reg. No. CRD42019132748). We searched four electronic databases (MEDLINE, EMBASE, Web of Science and Google Scholar) for manuscripts published from January 1998 using pre-designated search terms and search strategy. Main outcomes were duration of delays of time intervals from onset of aSAH to definitive treatment and/or factors related to time to treatment. RESULTS: A total of 64 studies with 16 different time intervals in the pathway of aSAH patients were identified. Measures of time to treatment varied between studies (e.g. cut-off timepoints or absolute mean/median duration). Factors associated with time to treatment fell into two categories-individual (n = 9 factors, e.g. age, sex and clinical characteristics) and health system (n = 8 factors, e.g. pre-hospital delay or presentation out-of-hours). Demographic factors were not associated with time to treatment. More severe aSAH reduced treatment delay in most studies. Pre-hospital delays (patients delay, late referral, late arrival of ambulance, being transferred between hospitals or arriving at the hospital outside of office hours) were associated with treatment delay. In-hospital factors (patients with complications, procedure before definitive treatment, slow work-up and type of treatment) were less associated with treatment delay. CONCLUSIONS: The pathway from onset to definitive treatment of patients with aSAH consists of multiple stages with multiple influencing factors. This review provides the first comprehensive understanding of extent and factors associated with time to treatment of aSAH. There is an opportunity to target modifiable factors to reduce time to treatment, but further research considering more factors are needed.

Sex differences in aneurysmal subarachnoid haemorrhage (aSAH): aneurysm characteristics, neurological complications, and outcome.

BACKGROUND: Women are over-represented in aSAH cohorts, but whether their outcomes differ to men remains unclear. We examined if sex differences in neurological complications and aneurysm characteristics contributed to aSAH outcomes. METHODS: In a retrospective cohort (2010-2016) of all aSAH cases across two hospital networks in Australia, information on severity, aneurysm characteristics and neurological complications (rebleed before/after treatment, postoperative stroke < 48 h, neurological infections, hydrocephalus, seizures, delayed cerebral ischemia [DCI], cerebral infarction) were extracted. We estimated sex differences in (1) complications and aneurysm characteristics using chi square/t-tests and (2) outcome at discharge (home, rehabilitation or death) using multinomial regression with and without propensity score matching on prestroke confounders. RESULTS: Among 577 cases (69% women, 84% treated) aneurysm size was greater in men than women and DCI more common in women than men. In unadjusted log multinomial regression, women had marginally greater discharge to rehabilitation (RRR 1.15 95% CI 0.90-1.48) and similar likelihood of in-hospital death (RRR 1.02 95% CI 0.76-1.36) versus discharge home. Prestroke confounders (age, hypertension, smoking status) explained greater risk of death in women (rehabilitation RRR 1.13 95% CI 0.87-1.48; death RRR 0.75 95% CI 0.51-1.10). Neurological complications (DCI and hydrocephalus) were covariates explaining some of the greater risk for poor outcomes in women (rehabilitation RRR 0.87 95% CI 0.69-1.11; death RRR 0.80 95% CI 0.52-1.23). Results were consistent in propensity score matched models. CONCLUSION: The marginally poorer outcome in women at discharge was partially attributable to prestroke confounders and complications. Improvements in managing complications could improve outcomes.

Mothers' views of health problems in the 12 months after childbirth: A concept mapping study.

AIMS: To identify the health problems that women feel require help and subsequent help-seeking behaviour during the 12 months period after childbirth. BACKGROUND: Many women experience physical and mental health problems after childbirth, but there is a gap in understanding how they perceive their health after childbirth. Studies suggested they are inhibited in expressing their needs and so seek informal rather than professional help for their health problems. DESIGN: A mixed method concept mapping study. METHOD: Two groups of Australian women were recruited by an online platform and purposive sampling (N = 81) in 2017-2018, based on an established concept mapping methodology. A first group created 83 brainstorm statements about post-childbirth health problems and help-seeking and a second group sorted and rated the statements based on their perception of the prevalence of the issues and the help-seeking advice they would offer to others. Bradshaw`s Taxonomy of Needs was used to theoretically underpins the explanation of the results of women's felt need after childbirth. RESULTS: Multidimensional scaling resulted in six clusters of issues which were categorized into three domains: 'health issues and care', 'support' and 'fitness'. Despite being directly asked, about two-thirds of the women did not report experiencing any health problems. CONCLUSION: Our findings showed women had a broader perception of healthcare needs which included support and fitness. There is a potential gap in services for women who do not have good social support. IMPACT: Family and friends were a key source of help-seeking. Post-childbirth routine care was focused on infant care and limited to the first 6 weeks after childbirth. The content of current post-childbirth care must be reviewed.

Socioeconomic Disadvantage Is Associated with a Higher Incidence of Aneurysmal Subarachnoid Hemorrhage.

BACKGROUND AND PURPOSE: Aneurysmal subarachnoid hemorrhage (aSAH) incidence is not well studied. Varied definitions of "subarachnoid hemorrhage" have led to a lack of clarity regarding aSAH incidence. The impact of area-level socioeconomic disadvantage and geographical location on the incidence of aSAH also remains unclear. Using a population-based statewide study, we examined the incidence of aSAH in relation to socioeconomic disadvantage and geographical location. METHODS: A retrospective cohort study of nontraumatic subarachnoid hemorrhages from 2010 to 2014 was undertaken. Researchers manually collected data from multiple overlapping sources including statewide administrative databases, individual digital medical records, and death registers. Age-standardized rates (ASRs) per 100,000 person years were calculated using the 2001 Australian population. Differences in incidence rate ratios were calculated by age, sex, area-level socioeconomic status, and geographical location using Poisson regression. RESULTS: The cohort of 237 cases (mean age, 61.0 years) with a female predominance of 166 (70.04%) included 159 confirmed aSAH, 52 community-based deaths, and 26 probable cases. The ASR for aSAH was 9.99 (95% confidence interval [CI], 8.69-11.29). A significant association between area-level socioeconomic disadvantage and incidence was observed, with the rate of aSAH in disadvantaged geographical areas being 1.40 times higher than that in advantaged areas (95% CI, 1.11-1.82; P = .012). CONCLUSION: This study uses a comprehensive search of multiple data sources to define a new baseline of aSAH within an Australian population. This study presents a higher incidence rate of aSAH with socioeconomic variations. As a key risk factor that may explain this paradox, addressing socioeconomic inequalities is important for effective prevention and management interventions.

We are not all coping: a cross-sectional investigation of resilience in the dementia care workforce.

BACKGROUND: Research on workforce development for high-quality dementia care more often focuses on enhancing employee knowledge and skill and less on managing employee stress and coping at work. OBJECTIVE: To review employee stress and coping in response to high job demands in community-based dementia care organizations in Tasmania, Australia. METHODS: Stress and coping in response to job roles of 25 community-based dementia care workers were reviewed using self-report questionnaire data. Data were analysed for descriptive results and at an individual case level. Individual participant scores were reviewed for clinically significant stress and coping factors to create worker profiles of adjustment. RESULTS: Two adjustment profiles were found. The 'global resilience' profile, where workers showed positive adjustment and resilience indicating they found their jobs highly rewarding, were very confident in their abilities at work and had a strong match between their personal and organizational values. The second 'isolated distress' profile was only found in a minority and included poor opportunities for job advancement, a missmatch in personal and work values or clinically high levels of psychological distress. CONCLUSION: Aged care workplaces that advocate employee well-being and support employees to cope with their work roles may be more likely to retain motivated and committed staff. Future research should consider employee stress and coping at the workforce level, and how this can influence high-quality care delivery by applying the measures identified for this study. Comparative research across different care settings using meta-analytic studies may then be possible.

Community paramedicine model of care: an observational, ethnographic case study.

BACKGROUND: Community paramedicine programs have emerged throughout North America and beyond in response to demographic changes and health system reform. Our aim was to identify and analyse how community paramedics create and maintain new role boundaries and identities in terms of flexibility and permeability and through this develop and frame a coherent community paramedicine model of care that distinguish the model from other innovations in paramedic service delivery. METHODS: Using an observational ethnographic case study approach, we collected data through interviews, focus groups and field observations. We then applied a combination of thematic analysis techniques and boundary theory to develop a community paramedicine model of care. RESULTS: A model of care that distinguishes community paramedicine from other paramedic service innovations emerged that follows the mnemonic RESPIGHT: Response to emergencies; Engaging with communities; Situated practice; Primary health care; Integration with health, aged care and social services; Governance and leadership; Higher education; Treatment and transport options. CONCLUSIONS: Community engagement and situated practice distinguish community paramedicine models of care from other paramedicine and out-of-hospital health care models. Successful community paramedicine programs are integrated with health, aged care and social services and benefit from strong governance and paramedic leadership.

Caring for the carer: a systematic review of pure technology-based cognitive behavioral therapy (TB-CBT) interventions for dementia carers.

BACKGROUND: Face-to-face delivery of CBT is not always optimal or practical for informal dementia carers (DCs). Technology-based formats of CBT delivery (TB-CBT) have been developed with the aim to improve client engagement and accessibility, and lower delivery costs, and offers potential benefits for DCs. However, research of TB-CBT for DCs has maintained heavy reliance on therapist involvement. The efficacy of pure TB-CBT interventions for DCs is not currently established Methods: A systematic review of trials of pure TB-CBT intervention for DCs from 1995 was conducted. PsycINFO, Cochrane Reviews, Scopus and MedLine databases were searched using key terms related to CBT, carers and dementia. Four hundred and forty two articles were identified, and inclusion/exclusion criteria were applied; studies were only retained if quantitative data was available, and there was no active therapist contact. Four articles were retained; two randomized and two waitlist control trials. Methodological and reporting quality was assessed. Meta-analyses were conducted for the outcome measures of caregiver depression. RESULTS: Meta-analysis revealed small significant post-intervention effects of pure TB-CBT interventions for depression; equivalent to face-to-face interventions. However, there is no evidence regarding long-term efficacy of pure TB-CBT for DCs. The systematic review further identified critical methodological and reporting shortcomings pertaining to these trials Conclusions: Pure TB-CBT interventions may offer a convenient, economical method for delivering psychological interventions to DCs. Future research needs to investigate their long-term efficacy, and consider potential moderating and mediating factors underpinning the mechanisms of effect of these programs. This will help to provide more targeted interventions to this underserviced population.

The nurse practitioner-client therapeutic encounter: an integrative review of interaction in aged and primary care settings.

AIMS: To review the key features of the nurse practitioner-client interaction in the thera-peutic encounter to inform the development of nurse practitioner-led memory clinics. BACKGROUND: Nurse practitioners spend significant time interacting with clients and their families/caregivers yet there is limited research on this interaction during therapeutic encounters in aged and primary care contexts. DESIGN: Integrative review. DATA SOURCES: Electronic search of CINAHL, Embase, Medline, PsychINFO, PubMed, Scopus, Web of Science 2004-2013; hand search of the Journal of Advanced Nursing, Journal of the American Academy of Nurse Practitioners and Journal of Clinical Nursing. REVIEW METHODS: Integrative literature review using Whittemore and Knafl's methodology. RESULTS: Ten published studies were included, representing over 900 nurse practitioners and their clients. Three key factors of nurse practitioner-client interaction were identified: nurse practitioner expertise and the influence of the therapeutic encounter context; affirming exchange as a bedrock of communication; and high levels of client engagement. In aged and primary care settings, where the therapeutic encounter requires and allows longer consultations, such as nurse practitioner-led memory clinics, patient-centred approaches can engage clients in consultations using a biopsychosocial framework, resulting in improved client satisfaction and, potentially, increased adherence to treatment plans. Nurse practitioners who are open and respectful, who encourage patients to provide more information about their lives and condition and are perceived by the client to be empathetic, are providing affirmation to the client. CONCLUSION: Affirming interactions are a key feature of successful therapeutic encounters when time and context do not allow or warrant the full repertoire of patient-centred communication.

Open referral policy within a nurse-led memory clinic: patient demographics, assessment scores, and diagnostic profiles.

BACKGROUND: Memory clinics, typically led by multidisciplinary teams and requiring health professional referral, are one means of providing diagnosis and care coordination for dementia. Nurse-led clinics may provide an effective and alternative means to dementia diagnosis, and open referral policies may minimize existing barriers to accessing a diagnosis, but evidence is needed. METHODS: Patients attending a one-day per week nurse-led memory clinic over a 25-month period during 2011-2013 (n = 106) completed comprehensive cognitive assessments and were diagnosed by an aged care nurse practitioner. Descriptive statistics detail the demographics, assessment scores, and diagnostic profiles of patients. Comparable data from published literature was identified, and the differences were analyzed qualitatively. RESULTS: One hundred and six patients were assessed with the key differences from other data sets being history of falls more common, higher mean Mini-Mental State Examination scores, and fewer dementia diagnoses. Sixty-four patients (60%) were self-referred to the nurse-led memory clinic, of which 19 (30%) were diagnosed with mild cognitive impairment (MCI) or dementia. Overall, forty-eight patients (45%) received diagnoses of MCI or dementia. CONCLUSIONS: An open referral policy led to a high proportion of patients being self-referred, and nearly a third of these were diagnosed with cognitive impairment or dementia. Open referral policies and nurse-led services may overcome some of the barriers to early diagnosis that are currently experienced. Considering an aging population worldwide and the associated increases in cognitive impairment, which benefits from early identification and intervention, this paper provides an alternative model of nurse-led assessment.

An investigation of factors that impact patients' subjective experience of nurse-led clinics: a qualitative systematic review.

AIMS AND OBJECTIVES: To systematically review the qualitative evidence on factors that affect the experience of patients attending nurse-led clinics and compare with key elements of person-centred care. BACKGROUND: As the number of nurse-led clinics increases in response to health system needs, evaluation has focused on clinical outcomes and cost. Patient experiences are less researched and yet, they are an important influence on clinical outcomes and an indicator of person-centred care. A detailed review of existing research in this area is needed. DESIGN: A systematic review of primary, qualitative literature was conducted using the Joanna Briggs Institute methodology of meta-aggregation. METHODS: Published research from 1990-2012 was located using CINAHL, PubMed, Medline and PsycINFO. Reference lists were searched and analysed. Two reviewers assessed the papers for methodological quality using instruments from the Joanna Briggs Institute to critically appraise, extract data and meta-aggregate findings. RESULTS: Eleven studies met all inclusion criteria. Three meta-synthesis statements were derived from 46 findings aggregated to nine categories. The key themes relating to establishment of a therapeutic relationship, effective communication, and clinical skills and collaboration mapped closely to the person-centred care framework. CONCLUSION: Concepts central to person-centred care proved to be factors impacting patients' subjective experience. Further research is warranted to meet the challenge to transform the key concepts of the person-centred care model into everyday nursing practice. RELEVANCE TO CLINICAL PRACTICE: Knowledge of patients' feelings and the importance of person-centred, individualised care may contribute to development of future training and re-training programs in basic nursing skills. This is significant in that it contributes to future positive patient experience.

A tool to support meaningful person-centred activity for clients with dementia - a Delphi study.

BACKGROUND: This paper reports on a study to validate the concept of the 'Activity Support Tool' that aimed to assist dementia service workers to identify and act upon the support needs of people with dementia living alone, in line with the person-centred ideal. METHODS: The tool was part of a two-stage exploratory qualitative study, which used interview and observational data from seven people with dementia living alone. Findings highlighted that people with dementia use objects and spaces within their homes to maintain or re-enact identities from the past. Thematic results from interviews were translated into a tool, with construct validation using the Delphi technique. Eighteen expert health professionals received round one of the questionnaire and six participants completed round three. The first round directed our focus towards operationalizing the person-centred ideal of dementia care. RESULTS: The tool was considered by almost all advisory panel members to be a potentially valuable resource for helping to address impediments to integrated, effective and person-centred dementia care. Specific strengths identified were simplicity, person-centeredness and applicability across service settings. Issues of concern included practicability, risk management, gender stereotyping and terminology. The results support the findings of previous research into the intuitive and ethical appeal, but problematic applicability, of person-centred dementia services. CONCLUSION: Health professionals with a range of service-related expertise found the concept of person-centred care compelling, but required tangible, enduring structures to translate the ideal into practical action. The tool now requires further research to test its usefulness in practice.

Why carers use adult day respite: a mixed method case study.

BACKGROUND: We need to improve our understanding of the complex interactions between family carers' emotional relationships with care-recipients and carers use of support services. This study assessed carer's expectations and perceptions of adult day respite services and their commitment to using services. METHODS: A mixed-method case study approach was used with psychological contract providing a conceptual framework. Data collection was situated within an organisational case study, and the total population of carers from the organisation's day respite service were approached. Fifty respondents provided quantitative and qualitative data through an interview survey. The conceptual framework was expanded to include Maslow's hierarchy of needs during analysis. RESULTS: Carers prioritised benefits for and experiences of care-recipients when making day respite decisions. Respondents had high levels of trust in the service and perceived that the major benefits for care-recipients were around social interaction and meaningful activity with resultant improved well-being. Carers wanted day respite experiences to include all levels of Maslow's hierarchy of needs from the provision of physiological care and safety through to the higher levels of belongingness, love and esteem. CONCLUSION: The study suggests carers need to trust that care-recipients will have quality experiences at day respite. This study was intended as a preliminary stage for further research and while not generalizable it does highlight key considerations in carers' use of day respite services.

Who knows, who cares? Dementia knowledge among nurses, care workers, and family members of people living with dementia.

The number of people with dementia is increasing rapidly worldwide. Commensurate with population ageing, the use of nursing homes in Australia (known as residential aged care facilities) for individuals with dementia is growing. As a terminal condition, dementia is best managed by instituting a palliative approach to care. A good knowledge of dementia, including its progression and management, among staff and families of people living with dementia is essential for clear decision making and the provision of appropriate care. Yet there is limited information regarding relative levels of dementia knowledge. This paper reports the results of a study that assessed dementia knowledge among these two cohorts using the Dementia Knowledge Assessment Tool; the study surveyed 279 staff members and 164 family members of residents with dementia. Dementia knowledge deficits were evident in both cohorts across a range of areas. It is critical that dementia knowledge deficits are identified and addressed in order to support evidence-based dementia care.

A tool to aid talking about dementia and dying--development and evaluation.

BACKGROUND: Health professionals often avoid talking about death and dying with patients and relatives, and this avoidance is compounded in cases of dementia by lack of knowledge of trajectory and prognosis. Unfortunately, this impacts on care, with many terminally ill dementia clients receiving inadequate palliation and excessive intervention at end-of-life. This study developed and evaluated a tool to facilitate conversations about death and dying in aged care facilities. METHODS: This study utilised available best-practice evidence, feedback from aged care facility nursing and care staff and specialist input to develop the 'discussion tool', which was subsequently trialled and qualitatively evaluated, via thematic analysis of data from family interviews and staff diaries. The study was part of a larger mixed method study, not yet reported. The tool provided knowledge and also skills-based 'how to' information and specific examples of 'what to say'. RESULTS: The tool facilitated a more open dialogue between dementia palliation resource nurses (a role specifically developed during this project) and family members. Both resource nurses and family members gained confidence in discussing the death of their relative with dementia, and in relevant cases discussed specific decisions around future care. Family members and nurses reported satisfaction with these discussions. CONCLUSION: Providing specific skills-based support, such as the 'discussion tool' can help staff to gain confidence and change practice in situations where unfamiliar and uncomfortable practices might normally be avoided. As our populations age, health professionals will increasingly need to be able to openly discuss care options towards end-of-life.

Perspectives of the community-based dementia care workforce: "occupational communion" a key finding from the Work 4 Dementia Project.

BACKGROUND: Community care workers' experience of delivering support to people with dementia is less researched than that of residential workers. The purpose of the study is to explore community-based dementia care workers' perspectives about their roles and the contextual variables that impact upon their work experiences. METHOD: A qualitative design was employed. Twenty-five community dementia care workers (average age 53 years, majority female and employed casually) participated in standardized semi-structured interviews about their job roles, training, employer agenda, organizational support, and intention to stay. A deductive approach to Interpretive Phenomenological Analysis was adopted to identify key themes. RESULTS: Three themes highlighted workers' experiences. Occupational communion described strong attachment to clients and a desire for greater connection with colleagues. Job demands described the challenges of work, which varied with intensity. Job resources ranged from positive (strong organizational commitment) to negative (poor pay and conditions). Occupational communion was identified as a concept that exists at the interface between social and organization psychology that was perceived to be essential for adaptive coping. Identifying themes informed a conceptual model for designing intervention components aimed at improving workers' skills, capabilities, and employer supportive functions. CONCLUSION: Occupational communion may be particularly relevant for women's caring careers and future research is needed to explore the relevance of this concept for men. To determine reliable change associated with interventions that target occupational communion, further investigation is required in relation to measurement approaches.

Delivering patient decision aids on the Internet: definitions, theories, current evidence, and emerging research areas.

BACKGROUND: In 2005, the International Patient Decision Aids Standards Collaboration identified twelve quality dimensions to guide assessment of patient decision aids. One dimension-the delivery of patient decision aids on the Internet-is relevant when the Internet is used to provide some or all components of a patient decision aid. Building on the original background chapter, this paper provides an updated definition for this dimension, outlines a theoretical rationale, describes current evidence, and discusses emerging research areas. METHODS: An international, multidisciplinary panel of authors examined the relevant theoretical literature and empirical evidence through 2012. RESULTS: The updated definition distinguishes Internet-delivery of patient decision aids from online health information and clinical practice guidelines. Theories in cognitive psychology, decision psychology, communication, and education support the value of Internet features for providing interactive information and deliberative support. Dissemination and implementation theories support Internet-delivery for providing the right information (rapidly updated), to the right person (tailored), at the right time (the appropriate point in the decision making process). Additional efforts are needed to integrate the theoretical rationale and empirical evidence from health technology perspectives, such as consumer health informatics, user experience design, and human-computer interaction. CONCLUSIONS: As of 2012, the updated theoretical rationale and emerging evidence suggest potential benefits to delivering patient decision aids on the Internet. However, additional research is needed to identify best practices and quality metrics for Internet-based development, evaluation, and dissemination, particularly in the areas of interactivity, multimedia components, socially-generated information, and implementation strategies.

The implementation and impacts of national standards for comprehensive care in acute care hospitals: An integrative review.

Objectives: To synthesise current evidence addressing implementation approaches, challenges and facilitators, and impacts of national standards for comprehensive care in acute care hospitals. Methods: Using Whittemore & Knafl's five-step method, a systematic search was conducted across five databases, including Medline (EBSCO), CINAHL (EBSCO), Cochrane Library, Web of Science, and Scopus, to identify primary studies and reviews. In addition, grey literature (i.e., government reports and webpages) was also searched via Google and international government/organisation websites. All searches were limited to January 1, 2000 to January 31, 2023. Articles relevant to the implementation or impacts of national standards for comprehensive care in acute care hospitals were included. Included articles underwent a Joanna Briggs Institute quality review, followed by qualitative content analysis of the extracted data adhering to PRISMA reporting guidelines. Results: A total of 16 articles were included in the review (5 primary studies, 5 government reports, and 6 government webpages). Three countries (Australia, Norway, and the United Kingdom [UK]) were identified as having a national standard for comprehensive care. The Australian standard contains a unique component of minimising patient harm. Norway does not have a defined implementation framework for the standard, whereas Australia and the UK do. Limited research suggests that challenges in implementing a national standard for comprehensive care in acute care hospitals include difficulties in implementing governance processes, end-of-life care actions, minimising harms actions, and developing comprehensive care plans with multidisciplinary teams, the absence of standardised care plans and patient-centred goals in documentation, and excessive paperwork. Implementation facilitators include a new care plan template using the Identify, Situation, Background, Assessment and Recommendation framework for handover, promoting efficient documentation, clinical decision-making and direct patient care, and proactivity among patients and care professionals with collaboration skills. Limited research suggests introducing the Australian standard demonstrated some positive effects on patient outcomes. Conclusion: The components and implementation approaches of the national standards for comprehensive care in Australia, Norway and the UK were slightly different. The scarcity of studies found during the review highlights the need for further research to evaluate the implementation challenges and facilitators, and impacts of national standards for comprehensive care in acute care hospitals.