Supporting breastfeeding for women with low education levels, psychosocial problems, and/or socioeconomic constraints: a scoping review protocol.

OBJECTIVE: This scoping review aims to identify and map interventions and/or strategies used to support the initiation and continuation of breastfeeding for women at risk of delaying initiation, early cessation, or not breastfeeding due to low levels of education, psychosocial problems, and/or socioeconomic challenges in high-income countries. INTRODUCTION: While breastfeeding has lifelong beneficial health effects for women and infants, there is a risk of delaying initiation, early cessation, or not initiating breastfeeding at all due to factors related to health inequalities, such as low levels of education, psychosocial problems, and/or socioeconomic constraints. INCLUSION CRITERIA: This review will include eligible quantitative, qualitative, and mixed methods studies, as well as systematic reviews and gray literature. We will encompass studies conducted in high-income countries, focusing on interventions and/or strategies to support women with low levels of education, psychosocial problems, and/or socioeconomic constraints in the initiation and continuation of breastfeeding for up to 6 months postpartum. METHODS: This review will follow the JBI methodology for scoping reviews, using the Participants, Concept, and Context framework. The primary search will be performed in the following databases: MEDLINE (PubMed), PsycINFO (EBSCOhost), Embase (Ovid), and CINAHL (EBSCOhost). We will include publications in English, Swedish, Norwegian, Danish, German, Bulgarian, Arabic, and Spanish, published from 1991 until the present. A data charting form will be developed and applied to all the included articles. REVIEW REGISTRATION: The study is registered in Open Science Framework, DOI 10.17605/OSF.IO/TMP4V.

Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL.

BACKGROUND: Frail elderly patients are exposed to suffering strokes if they do not receive timely anticoagulation to prevent stroke associated to atrial fibrillation (AF). Evaluation in the cardiological ambulatory can be cumbersome as it often requires repeated visits. AIM: To develop and implement CardioShare, a shared-care model where primary care leads patient management, using a compact Holter monitor device with asynchronous remote support from cardiologists. METHODS: CardioShare was developed in a feasibility phase, tested in a pragmatic cluster randomization trial (primary care clinics as clusters), and its implementation potential was evaluated with an escalation test. Mixed methods were used to evaluate the impact of this complex intervention, comprising quantitative observations, semi-structured interviews, and workshops. RESULTS: Between February 2020 and December 2021, 314 patients (30% frail) were included, of whom 75% had AF diagnosed/not found within 13 days; 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In an escalation test, 58 primary-care doctors evaluated 93 patients over three months, with remote support from four hospitals in the Capital Region of Denmark. CONCLUSIONS: CardioShare was successfully implemented for AF evaluation in primary care.

The Feasibility of the Adverse Childhood Experiences Questionnaire among Women in Danish Antenatal Care: A Mixed-Methods Study.

A traumatic upbringing increases the risks of antenatal health problems, unfavourable pregnancy outcomes, and mental disorders. Such childhood experiences may affect women's pa-renting skills and the social-emotional functioning of their children. Research on screening for adverse childhood experiences in antenatal care is limited. The objective of this study was to explore pregnant women's attitudes towards and experiences of an adverse childhood experiences questionnaire, and to assess the relevance of the questionnaire among a population of pregnant women referred to antenatal care levels one and two, targeting women who are generally not perceived to be vulnerable. Data were collected at three maternity wards and consisted of quantitative data on 1352 women's adverse childhood experience scores, structured observations of 18 midwifery visits, and in-depth interviews with 15 pregnant women. Quantitative data were analysed by descriptive statistics, and qualitative data were analysed using systematic text condensation. The qualitative analysis revealed two main categories: "Being screened for childhood adversities" and "Having adverse childhood experiences". In the study population, the prevalence of adverse childhood experiences was high. The women assessed the adverse childhood experiences questionnaire to be a relevant and acceptable screening method. Furthermore, women's perceptions of their relationship with their midwife greatly impacted their attitudes towards and experiences of the questionnaire.

The Feasibility and Acceptability of the Adverse Childhood Experiences Questionnaire in Danish Antenatal Care-A Qualitative Study of Midwives' Implementation Experiences.

Adverse childhood experiences have a potential lifelong impact on health. A traumatic upbringing may increase antenatal health risks in mothers-to-be and impact child development in their offspring. Yet, little is known about the identification of adverse childhood experiences in antenatal care. The objective of this study was to explore the feasibility and acceptability of the adverse childhood experiences questionnaire among midwives and factors affecting its implementation. Three Danish maternity wards participated in the study. The data consisted of observations of midwifery visits and informal conversations with midwives, as well as mini group interviews and dialogue meetings with midwives. The data were analysed using systematic text condensation. Analysis of the data revealed three main categories; "Relevance of the adverse childhood experiences questionnaire", "Challenges related to use of the adverse childhood experiences questionnaire" and "Apprehensions, emotional strain, and professional support". The findings showed that the adverse childhood experiences questionnaire was feasible to implement in Danish antenatal care. Midwives' acceptability of the questionnaire was high. Training courses and dialogue meetings motivated the midwives to work with the questionnaire in practice. The main factors affecting the implementation process were time restrictions, worries of overstepping women's boundaries, and a lack of a specific intervention for women affected by their traumatic upbringing circumstances.

Reaching Frail Elderly Patients to Optimize Diagnosis and Management of Atrial Fibrillation (REAFEL): A Feasibility Study of a Cross-Sectoral Shared-Care Model.

Introduction: Atrial fibrillation (AF) management in primary care often requires a referral to cardiology clinics, which can be strenuous for frail patients. We developed "cardio-share" (CS), a new cross-sector collaboration model, to ease this process. General practitioners (GPs) can use a compact Holter monitor (C3 from Cortrium) to receive remote advice from the cardiologist. Objective: To test the feasibility and acceptability of the CS model to manage suspected AF in frail elderly patients. Methods: We used a mixed methods design, including the preparation of qualitative semistructured interviews of GPs and nurses. Results: Between MAR-2019 and FEB-2020, 54 patients were consulted through the CS model, of whom 35 underwent C3 Holter monitoring. The time from referral to a final Holter report was shortened from a mean (SD) of 117 (45) days in usual care to 30 days (13) with the CS model. Furthermore, 90% of the patients did not need to attend visits at the cardiology clinic. The GPs and nurses highlighted the ease of using the C3 monitor. Their perception was that patients were confident in the GPs' collaboration with cardiologists. Conclusions: The CS model using a C3 monitor for AF is both feasible and seems acceptable to GPs. The elapsed time from referral to the Holter report performed for the diagnosis was significantly reduced.

Intersectoral Ward Rounds on Patients Admitted to Temporary Twenty-Four-Hour Accommodations in Denmark: Case Study.

INTRODUCTION: Temporary twenty-four-hour accommodations (TTAs) are municipal beds for elderly patients discharged from the hospital with acute treatment, care and/or rehabilitation needs that cannot be met in their own homes. TTAs are staffed by nurses and nursing assistants who are not authorized to prescribe or modify medications. At North Zealand Hospital one third of the many readmissions from a TTA within eight days after discharge have been assessed as preventable. DESCRIPTION: A hospital-based team rounded on 268 patients at TTAs from May 2017 to October 2019 to promote integrated care. This study aimed to assess the efficacy of the rounding by auditing patient cases. A physician, a nurse, and a pharmacist from the hospital; a general practitioner; and one or two TTA nurses audited 17 cases. DISCUSSION: Obtaining access to all electronic patient records and reconstructing information shared across sectors were not feasible in all cases. CONCLUSION: An overview of the course of treatment was provided in most casesThe patient's health was enhanced in most cases and to a considerable or determining degree in half of casesMedication was optimized in most casesThe succeeding course of treatment was enhanced in more than half of the casesReadmission was prevented in some cases.

Protocol for a cluster-randomized non-inferiority trial of the effect of direct access to publicly subsidized physiotherapy for adults with musculoskeletal pain.

BACKGROUND: In the Danish healthcare system, direct access to physiotherapy is an option, but public subsidy for treatment requires referral from a general practitioner. To relieve general practice of unnecessary consultations and provide patients with easier access to relevant treatment, direct access to publicly subsidized physiotherapy has been suggested. METHODS: Direct access to subsidized physiotherapy will be evaluated in a controlled design and has a duration of one year. Physiotherapy clinics invite eligible patients to participate in the evaluation. Participants complete questionnaires at baseline and six weeks and six months after baseline. Physical health status (ShortForm-12v2) is the primary outcome. In addition, the evaluation will assess the use of services in general practice, physiotherapy, specialists in private practice and hospitals and referrals to diagnostic imaging. A process evaluation will assess the attitude to and implementation of direct access to subsidized physiotherapy through the experiences and attitudes of local general practitioners, secretaries and physiotherapists in participating clinics. DISCUSSION: This intervention may affect the point of entry to health care services. For the intervention group the physiotherapists assume responsibility in symptom assessment. During recruitment registration of red flags in physiotherapy is closely monitored. The results of the study may be used to assess if direct access to subsidized physiotherapy is a way to relieve the workload in general practice while maintaining or improving patient level outcomes. TRIAL REGISTRATION: The project was reported to The Committee on Health Research Ethics of the Capital Region of Denmark with protocol number J.nr.: H-19074802. The Committee assessed the project as not registrable and therefore can be implemented without further permission. This trial has been registered at the Danish Data Protection Agency (J.nr.: P-2019-672). The trial has been registered at ClinicalTrials.gov (identifiers: NCT04900480).

The PATH project in eight European countries: an evaluation.

PURPOSE: This paper's aim is to evaluate the perceived impact and the enabling factors and barriers experienced by hospital staff participating in an international hospital performance measurement project focused on internal quality improvement. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews involving international hospital performance measurement project coordinators, including 140 hospitals from eight European countries (Belgium, Estonia, France, Germany, Hungary, Poland, Slovakia and Slovenia). Inductively analyzing the interview transcripts was carried out using the grounded theory approach. FINDINGS: Even when public reporting is absent, the project was perceived as having stimulated performance measurement and quality improvement initiatives in participating hospitals. Attention should be paid to leadership/ownership, context, content (project intrinsic features) and processes supporting elements. RESEARCH LIMITATIONS/IMPLICATIONS: Generalizing the findings is limited by the study's small sample size. Possible implications for the WHO European Regional Office and for participating hospitals would be to assess hospital preparedness to participate in the PATH project, depending on context, process and structural elements; and enhance performance and practice benchmarking through suggested approaches. ORIGINALITY/VALUE: This research gathered rich and unique material related to an international performance measurement project. It derived actionable findings.

[International comparisons of health systems]. / Internationale sammenligninger af sundhedssystemer.

International comparisons of health systems are widely used as a method for cross country learning, strategy development at the national level, and to demonstrate accountability. Comparisons may comprise entire health systems or subsystems within these, and may include many or few health systems. This paper describes strengths and weaknesses of different types of comparisons and methodological challenges involved in comparing different health systems. Finally, the paper emphasizes that caution must be exercised when transferring ideas from one system to another.