Analysis of Aortic Arch Hemodynamics With Simulated Bird's Beak Effects.

OBJECTIVE: The objective of this study was to investigate the flow effects in different degrees of thoracic aortic stent graft protrusion extension by creating bird beak effect simulations using accurate 3D geometry and a realistic, nonlinear, elastic biomechanical model using computer-aided software SolidWorks. METHODS: Segmentation in 3D of an aortic arch from a computed tomography (CT) scan of a real-life patient was performed using SolidWorks. A parametric analysis of three models was performed: (A) Aortic arch with no stent, (B) 3 mm bird-beak configuration, and (C) 6.5 mm bird-beak configuration. Flow velocity, pressure, vorticity, wall shear stress (WSS), and time average WSS were assessed. RESULTS: The flow velocity in Model A remained relatively constant and low in the area of the ostium of the brachiocephalic artery and doubled in the left subclavian artery. On the contrary, Models B and C showed a decrease in velocity of 52.3 % in the left subclavian artery. Furthermore, Model B showed a drop in velocity of 82.7% below the bird-beak area, whereas Model C showed a decline of 80.9% in this area. The pressure inside the supra-aortic branches was higher in Model B and C compared with Model A. In Model A, vorticity only appeared at the level of the descending aorta, with low to non-vorticity in the aortic arch. In contrast, Models B and C had an average vorticity of 241.4 Hz within the bird beak area. Regarding WSS, Model A, and Model B shared similar WSS in the peak systolic phase, in the aortic arch, and the bird beak area, whereas Model C had an increased WSS by 5 Pa on average at these zones. CONCLUSION: In the present simulations' lower velocities, higher pressures, vortices, and WSS were observed around the bird beak zone, the aortic arch, and the supra-aortic vessels.

Momentary skills use predicts decreased binge eating and purging early in day treatment: An ecological momentary assessment study.

OBJECTIVE: Emerging research indicates that skills acquisition may be important to behavior change in cognitive behavior therapy (CBT) for eating disorders. This study investigated whether skills use assessed in real time during the initial 4 weeks of CBT-based day treatment was associated with momentary eating disorder behavior change and rapid response to treatment. METHODS: Participants with DSM-5 bulimia nervosa or purging disorder (N = 58) completed ecological momentary assessments (EMA) several times daily for the first 28 days of treatment. EMA assessed skills use, the occurrence of binge eating and/or purging, and state negative affect. Rapid response was defined as abstinence from binge eating and/or purging in the first 4 weeks of treatment. RESULTS: Greater real-time skills use overall, and use of "planning ahead," "distraction," "social support," and "mechanical eating" skills in particular, were associated with a lower likelihood of engaging in binge eating or purging during the same period. After controlling for baseline group differences in overall difficulties with emotion regulation, rapid and non-rapid responders did not differ in overall skills use, or skills use at times of higher negative affect, during the EMA period. DISCUSSION: Momentary use of skills appears to play an important role in preventing binge eating and purging, and certain skills appear to be particularly helpful. These findings contribute to the literature elucidating the processes by which CBT treatments for eating disorders work by providing empirical evidence that skills use helps to prevent binge eating and purging behaviors. PUBLIC SIGNIFICANCE: Individuals with eating disorders learn new skills during treatment to help them improve their symptoms. This study shows that for people with eating disorders, using skills helps prevent eating disorder behaviors in the moment. Certain skills may be particularly helpful, including planning ahead, distracting activities, support from others, and focusing on eating meals and snacks regardless of how one is feeling. These findings help us better understand how treatments work.

Clinical characteristics, treatment course and outcome of adults treated for avoidant/restrictive food intake disorder (ARFID) at a tertiary care eating disorders program.

BACKGROUND: Avoidant/restrictive food intake disorder (ARFID) is now recognized as a feeding/eating disorder that affects individuals across the lifespan, but research on ARFID in general and particularly in adults remains limited. The purpose of this study was to describe the demographic and clinical characteristics of adults with ARFID seeking treatment at a tertiary care eating disorders program, and to describe the course and outcomes of treatment at three levels of care-inpatient, intensive outpatient, and outpatient individual therapy. METHOD: This retrospective chart review study examined the charts of 42 patients who received treatment for ARFID between April 2020 and March 2023. Following diagnostic assessment, patients were referred to either inpatient treatment, intensive outpatient treatment, or outpatient individual therapy. All three levels of care involved individual cognitive behaviour therapy. Inpatients typically transitioned to one of the outpatient treatments as part of a continuous care plan. We examined demographic and clinical characteristics, treatment length and completion, and changes in key indicators during treatment. RESULTS: Patients were diverse with respect to demographics (e.g., 62% cisgender women; 21% cisgender men; 17% transgender, non-binary, or other gender) and comorbid concerns (e.g., 43% had neurodevelopmental disorders; > 50% had mood and anxiety disorders; 40% had posttraumatic stress disorder [PTSD]; 35% had medical conditions impacting eating/digestion). Most patients presented with more than one ARFID maintaining mechanism (i.e., lack of appetite/interest, sensory sensitivities, and/or fear of aversive consequences of eating). Treatment completion rates and outcomes were good. On average, patients showed significant improvement in impairment related to their eating disorder, and those who were underweight significantly improved on BMI and were not underweight at end of treatment. DISCUSSION: These findings add to the literature by indicating that ARFID patients are commonly male or have diverse gender identities, and have high rates of neurodevelopmental, mood, anxiety, and gastrointestinal disorders. We also found high rates of PTSD. The findings show promise for treatment outcomes across the continuum of care. Next steps in ARFID treatment and research include incorporating ARFID-specific assessments into routine care, and ongoing research investigating the efficacy and effectiveness of treatments such as CBT-AR.

Avoidant/restrictive food intake disorder (ARFID) is now recognized as a feeding/eating disorder that affects individuals across the lifespan, but research on ARFID in general and particularly in adults remains limited. The purpose of this study was to describe the demographic and clinical characteristics of adults with ARFID seeking treatment at a tertiary care eating disorders program, and to describe the course and outcomes of treatment at three levels of care­inpatient, intensive outpatient, and outpatient individual therapy.

Phenomenographic Approaches in Research About Nursing.

We propose that phenomenography is well-suited to research about nursing, given its focus on identifying variation in individuals' experiences, and inclusion of diverse voices and perspectives. Phenomenography explores qualitatively different ways in which a group of people experience a phenomenon, often using semi-structured interviews. The use of phenomenography is especially relevant in research about nursing which provides accounts of the experiences of nurses and patients within complex practice settings. We consider the tenets of phenomenography and examine phenomenography's relationship to and differences from phenomenology. We review literature published about phenomenographic research in nursing and reflect on the potential benefits of phenomenographic research about nursing. This paper adds to knowledge about use of phenomenography in research about nursing.

'The solution is we need to have a centre': a study on diabetes in Liberia.

In Liberia, one of the poorest nations in sub-Saharan Africa, the burden of diabetes is a growing concern. The high mortality and morbidity associated with diabetes have significant implications for individuals, families and society at large. The aim of this critical hermeneutic study was to explore what it is like to live with diabetes in Liberia. We recruited 10 participants from Monrovia, Liberia to partake in this study. Photovoice, a well-established participatory data collection approach was used to gather images and stories that represented participants' everyday experiences of living with diabetes. Three major themes were uncovered, highlighting the strengths, challenges and solutions related to living with diabetes in Liberia: strengths-engagement in diabetes self-management practices, focused on participants' commitment to engage in diabetes self-management practices despite the socioeconomic challenges they experienced; challenges-lack of social and economic support, focused on limited access to food, diabetes medications and supplies and diabetes education; and solutions-centre for diabetes education, care and support, focused on participants' recommendations for a community-based diabetes centre, a single point of access for meeting the needs of people with diabetes. A strong commitment to prioritize diabetes on Liberia's national health agenda and increased resources for diabetes care is needed to address the challenges experienced by people living with this chronic disease in Liberia.

Postpartum experiences of women, birthing people, and their families during COVID-19: a qualitative systematic review protocol.

OBJECTIVE: The objective of the review is to explore and understand the postpartum experiences of birthing people and their families during COVID-19. INTRODUCTION: Positive postpartum experiences are formative for the long-term health and well-being of parents and babies. However, the COVID-19 pandemic has complicated the transition to parenthood and existing postpartum challenges through evolving policies and practices, including visiting limitations, masking requirements, and reduced accessibility of supports. Understanding the impact of COVID-19 on the postpartum experiences of women, birthing people (people who give birth but may not identify as women), and their families through the synthesis of qualitative evidence can help inform public health and government directives in comparable future contexts. INCLUSION CRITERIA: Studies including women, birthing people, and their families who experienced postpartum during the COVID-19 pandemic will be considered. This review will include studies published after January 2020 that explore postpartum experiences up to 1 year following birth. We will examine qualitative data, including, but not limited to, research designs such as phenomenology, ethnography, grounded theory, feminist research, and action research. METHODS: The following databases will be searched: MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), PsycINFO (Ovid), and LitCovid. PsyArXiv and Google Scholar will be searched for gray literature. Studies will be assessed and appraised independently by 2 reviewers and disagreements will be resolved through discussion or with a third reviewer. Data extraction will be completed by 2 reviewers. The JBI tools and resources will be used for assessing confidence and meta-aggregation, including the creation of categories and synthesized findings. REVIEW REGISTRATION: PROSPERO CRD42022364030.

Bridging Community Mental Health and Primary Care to Improve Medication Monitoring and Outcomes for Patients With Mental Illness Taking Second-Generation Antipsychotics-Phase 2: Quality Improvement Initiative Over 15 Months.

Objective: To evaluate the effectiveness of a quality improvement (QI) initiative to improve family medicine residents' metabolic monitoring of second-generation antipsychotics (SGAs) for patients comanaged across nonintegrated community mental health and family medicine clinics.Methods: Patients were aged ≥ 18 years seen by family medicine residents and prescribed at least 1 SGA (N = 175). Preparative and scheduled QI interventions were nonblinded and included collaboration across organizations, education, and monthly interprofessional care conferences. The QI outcome included evaluation of pre-post metabolic monitoring laboratory data over the 15-month study period. A subset of patients (n = 26) was reviewed at least once at monthly interprofessional care conferences. Patients were stratified by diagnosis of diabetes (n = 45) and no diabetes (n = 130) at baseline. Analyses of the QI intervention outcomes were framed by the time period of monthly care conferences (January 31, 2019-April 30, 2020) and compared to baseline (the historical time period) (October 31, 2017-January 29, 2019).Results: Improved adherence in glycated hemoglobin (HbA1c) (P = .042) and lipid (P < .001) monitoring per guidelines from baseline to follow-up was seen in the total patient population (N = 175). Patients without diabetes (n = 130) had significant improvement (P = .001) in HbA1c monitoring from baseline to follow-up. The subgroup of patient cases that were discussed at a care conference showed no significant improvement in HbA1c or lipid monitoring.Conclusion: Preparative and scheduled QI interventions provided family medicine residents powerful reminders of the SGA monitoring guidelines that improved the metabolic monitoring behaviors for all patients on SGAs.Prim Care Companion CNS Disord. 2023;25(3)22m03432. Author affiliations are listed at the end of this article.

Experiences of women who have planned unassisted home births in high-resource countries: a qualitative systematic review.

OBJECTIVE: The aim of this review was to identify, appraise, and synthesize the qualitative evidence about the experiences of women in high-resource countries who have planned unassisted home births. INTRODUCTION: Unassisted birth occurs when a woman chooses to give birth without the assistance of health care providers. These births are planned and usually occur in a woman's home. It is difficult to know the prevalence of unassisted birth because it occurs at the margins of health care systems, making data difficult to collect. Based on its lack of visibility in society, we assume that unassisted birth is not a common birth choice. Women who choose planned unassisted birth may face stigma for their decision and their experience of birth, which challenge accepted norms. Synthesizing qualitative evidence about women's experiences of planned unassisted birth can improve our understanding about women's birthing values and provide important clues about aspects of birthing care that may be missing in mainstream birthing services. INCLUSION CRITERIA: Studies that explored the experiences of women who had planned unassisted home births without the support of health care providers in high-resource countries were included. Unassisted home births were defined as those that were planned not to be assisted by health care professionals. Study designs that focused on qualitative data were eligible for inclusion. METHODS: MEDLINE (Ovid), Embase, CINAHL (EBSCO), Scopus, Web of Science, Sociological Abstracts (ProQuest), ProQuest Dissertations and Theses (ProQuest), and Nursing and Allied Health Database (ProQuest) were searched in 2022. Studies published in English since the databases' inception were considered for inclusion. A search of relevant websites for unpublished and gray literature was also undertaken in 2022. Two independent reviewers assessed the methodological quality of papers identified for inclusion. Qualitative research findings were extracted from papers that met the inclusion criteria and critical appraisal standard. Findings were extracted and categorized based on similarity of meaning. The categories were synthesized to create 2 synthesized findings, and the ConQul approach was used to grade the findings to establish confidence in the synthesized findings. RESULTS: Six studies were included in the review. All the studies used interviews for data collection; other methods included surveys, email correspondence, posts on internet discussion boards and forums, and websites. The total sample size for interviews was 103 participants. Total survey sample size for surveys was 87 participants. Total sample size for email correspondence was 5. Internet data sources included more than 100,000 individual and forum posts and 127 birth stories. A total of 17 findings were extracted and grouped into 4 categories. The 4 categories were then synthesized into 2 synthesized findings: i) navigating tensions within self, and between self and systems, and ii) integrating and transcending physical experiences of birth. CONCLUSIONS: More research is needed to better understand the experiences of women who have planned unassisted births. Improving understanding and increasing the awareness of planned unassisted birth are necessary steps for promoting inclusive, relational, and person-centered birthing experiences for everyone. Reflection about the differences between planned unassisted births and mainstream births may support needed reorientations of perinatal services. REVIEW REGISTRATION: PROSPERO CRD42019125242. SUPPLEMENTAL DIGITAL CONTENT: A French-language version of the abstract of this review is available [ http://links.lww.com/SRX/A9 ].

Postnatal experiences of South Asian immigrant women in Australia, Canada, the United Kingdom, and the United States: a qualitative systematic review protocol.

OBJECTIVE: The goal of this review is to gain an understanding of the postnatal experiences of South Asian immigrant women in 4 English-speaking countries: Australia, Canada, the United Kingdom, and the United States. INTRODUCTION: The postnatal period is an important time in the lives of women and their families. Major changes take place during this time as a woman's body gradually returns to its pre-pregnancy state. The postnatal period is also a time for women to adapt and transition into their new role as a mother. Immigrant women experience many challenges in accessing quality postnatal care in comparison to non-migrant populations. South Asian immigrant women, specifically, encounter unique postnatal experiences and face a myriad of hardships in accessing proper postnatal care. The presence of cultural factors and traditional norms largely influence postnatal experiences of South Asian immigrant women. Cultural factors include, but are not limited to, relationships with family and in-laws, gender-specific roles, newborn gender, mental health stigma, language barriers, acculturative stress, and expression of depression. INCLUSION CRITERIA: Qualitative studies in English reporting postnatal experiences of South Asian immigrant women published after January 2000 will be considered for this review. Research designs may include, but are not limited to, feminist research, exploratory descriptive design, or ethnography. Gray literature will be limited to theses and dissertations only. METHODS: MEDLINE, Embase, CINAHL, EthOS, and ProQuest Dissertations and Theses will be searched. Disagreement resolution, data extraction, and meta-aggregation will be completed through discussion between 2 reviewers. Studies will be critically appraised and assigned a level of credibility. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022354306.

Structural interventions that affect racial inequities and their impact on population health outcomes: a systematic review.

Structural racism is the historical and ongoing reinforcement of racism within society due to discriminatory systems and inequitable distribution of key resources. Racism, embedded within institutional structures, processes and values, perpetuates historical injustices and restricts access to structural factors that directly impact health, such as housing, education and employment. Due to the complex and pervasive nature of structural racism, interventions that act at the structural level, rather than the individual level, are necessary to improve racial health equity. This systematic review was conducted to evaluate the effects of structural-level interventions on determinants of health and health outcomes for racialized populations. A total of 29 articles are included in this review, analyzing interventions such as supplemental income programs, minimum wage policies, nutrition safeguard programs, immigration-related policies, and reproductive and family-based policies. Most studies were quasi-experimental or natural experiments. Findings of studies were largely mixed, although there were clear benefits to policies that improve socioeconomic status and opportunities, and demonstrable harms from policies that restrict access to abortion or immigration. Overall, research on the effects of structural-level interventions to address health inequities is lacking, and the evidence base would benefit from well-designed studies on upstream policy interventions that affect the structural determinants of health and health inequities and improve daily living conditions.

Integrating social determinants into pharmacotherapy courses: A case-based learning approach.

BACKGROUND: The recognition of social determinants as major drivers of health outcomes has important implications for health care providers, including pharmacists. It is therefore imperative that providers have the requisite knowledge, skills, and attitudes to adequately address the contributions of social determinants of health (SDOH) alongside the impact of medical care on health and treatment outcomes. Case-based learning is a common practice in pharmacy education. Patient cases used in pharmacotherapy courses typically highlight clinical parameters and quantitative indices, often to the exclusion of sociocultural contexts. In actual practice, pharmacists (and other health care providers) must consider both clinical information and the context of SDOH in order to deliver responsive and effective patient care. EDUCATIONAL ACTIVITY AND SETTING: The aim of the project was to build patient cases that reflect both aspects. The intent is to use these cases in the core pharmacy curriculum to teach students how to concurrently consider both clinical and social elements in patient care. Eleven pharmacists and educators participated in three work groups to develop 10 cases for pharmacotherapy courses in cardiovascular disease, diabetes management, and mental health. Two of the cases were facilitated with fourth year students on advanced pharmacy practice experiences. SUMMARY: Feedback from case developers and students highlights features of the cases that lend them to utility in the pharmacy curriculum. The integration of SDOH in patient cases provides opportunity for students to build the relevant competencies that will enable them to provide holistic patient care.

Health care providers' experiences caring for women living with obesity during pregnancy, birth, and postpartum: a qualitative systematic review protocol.

OBJECTIVE: This review will examine qualitative evidence about the experiences of health care providers who provide care to women living with obesity during the perinatal period to support evidence-informed approaches to care. INTRODUCTION: As the number of women living with obesity increases, health care providers are interacting more with this population during pregnancy, birth, and postpartum. Qualitative studies about this topic show that health care providers often face challenges that prevent the provision of quality care. A qualitative systematic review of the experiences of health care providers caring for women living with obesity throughout the perinatal period is important to identify and address current gaps in the delivery of perinatal health care services. INCLUSION CRITERIA: All studies with settings where licensed health care providers care for women living with obesity during pregnancy, birth, and postpartum will be considered. Studies published in English from 1995 onward will be included. The review will consider both mixed methods and qualitative studies such as phenomenology, grounded theory, and participatory action research. METHODS: The following databases will be searched: CINAHL, Embase, PsycINFO, MEDLINE, and Sociological Abstracts (ProQuest). The ProQuest Digital Dissertations database will be searched for unpublished studies. Two independent reviewers will assess each study. Conflicts will be resolved through discussion. Data will be extracted by 2 trained independent reviewers. JBI resources for meta-aggregation will be used and data will be categorized and synthesized accordingly.

Capability as a concept in advanced practice nursing and education: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map how the concept of capability in advanced practice nursing and education is described in the literature. INTRODUCTION: Advanced practice nursing and education is often described in terms of the achievement of competencies. The concept of capability has been proposed as a more accurate description of the attributes of advanced practice nursing. Definitions of capability in advanced practice nursing vary, but often focus on the integration of prior knowledge, skills, resources, judgment, and experience when solving unanticipated problems or working in new situations. INCLUSION CRITERIA: This review will consider studies addressing the concept of individual capability in any setting related to advanced practice nursing education and practice. The working definition of capability in this review is a combination of knowledge, skills, experience, and competencies that enables advanced practice nurses to provide appropriate care for patients in both familiar and unfamiliar clinical settings. Advanced practice nurses will include nurses with both graduate education and an expanded scope of practice. METHODS: Eight academic databases will be searched for qualitative, quantitative, and mixed methods study designs. The gray literature search will include policy and practice documents from nursing and health organization websites. Two reviewers will independently complete title and abstract screening prior to full-text review and data extraction. Articles published in English from 1975 to the present will be included. Other languages will be included if translations are available.

Experiences of birthing care during COVID-19: a systematic review protocol.

OBJECTIVE: The objective of this review is to explore and understand the birthing care experiences of midwives, nurses, women, and birthing people during COVID-19. INTRODUCTION: The COVID-19 pandemic has had implications for providing and receiving birthing care globally. In addition to navigating fears of contracting COVID-19, health care providers and families have had to adapt to changing policies and clinical practices in response to varying recommendations and evidence. These changes, including restrictive visitor policies and mandated mask-wearing, influenced the experience of birthing care. Synthesizing qualitative evidence about the birthing experiences of midwives, nurses, women, and birthing people (people who give birth but who do not identify as women) during COVID-19 can provide important information for policies and decision-making for future global pandemics. INCLUSION CRITERIA: Studies including licensed midwives, licensed nurses, women, and birthing people who provided or received birthing care during the COVID-19 pandemic will be considered. Studies published from January 2020 onward will be included. The review will consider all studies that present qualitative data, including, but not limited to, research designs such as phenomenology, ethnography, grounded theory, feminist research, and action research. METHODS: The following databases will be searched: MEDLINE, Embase, CINAHL, PsycINFO, and LitCovid. MedArchiv, PsyArXiv, and Google Scholar will be searched for gray literature. Studies will be assessed independently by two reviewers. Any disagreements will be resolved through discussion or with a third reviewer. Data extraction will be completed by two reviewers. The JBI tools and resources will be used for meta-aggregation, including the creation of categories and synthesized findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021292832.

Advanced practice nursing roles in Arab countries in the Eastern Mediterranean region: a scoping review.

OBJECTIVE: The objectives of this review were to map and summarize evidence regarding advanced practice nursing roles in Arab countries located in the Eastern Mediterranean region. INTRODUCTION: Many countries have reported an increase in the number and types of advanced practice nursing roles as research demonstrating their positive impact on patient and health system outcomes continues to accumulate. There is international evidence that the achievement of these outcomes depends on the effective implementation of advanced practice nursing roles at the organizational and country levels. A comprehensive review of the status of advanced practice nursing role implementation in Arab countries in the Eastern Mediterranean region has not been conducted. INCLUSION CRITERIA: Eligible studies included advanced practice nursing roles (including, but not limited to, nurse practitioners and clinical nurse specialists) in Arab countries in the Eastern Mediterranean region. Studies were considered if they focused on role development, titles, entry-level education, regulation and scope of practice, and facilitators and barriers to role implementation. METHODS: A comprehensive systematic search was completed for both published and non-published literature. The databases searched included CINAHL, PubMed, PsycINFO, Embase, Nursing and Allied Health Database, and Scopus. Gray literature was searched using websites such as Google Scholar, ProQuest Dissertations and Theses, International Council of Nurses, World Health Organization regional office for the Eastern Mediterranean region, and websites of nursing associations and Ministries of Health in Arab countries. The search included literature published in Arabic and English from the inception of the databases to August 2020. RESULTS: A total of 35 articles were included, the majority (n = 24) of which were published from 2010 onward. Ten of the included studies were empirical research papers that used qualitative and quantitative research designs. Advanced practice nursing role development is still in its infancy in most of the Arab countries in the Eastern Mediterranean region and can be described as slowly and steadily evolving. The main driving forces for the implementation of the roles in this region included a shortage of physicians both in number and specialties, the emergence of chronic diseases due to lifestyle changes, the desire to have more cost-effective primary care, and to advance nursing as a profession. Clinical nurse specialists and nurse practitioners are the most common titles for the advanced nursing roles practiced in the region. Some advanced practice nursing roles stipulated a master's degree as a minimum requirement, while others required a 12-month in-house training program. Oman is the only Arab country that authorizes nurse practitioners to prescribe pre-set medications. The common barriers to advanced practice nursing role implementation included a lack of recognition of roles at national levels, role ambiguity, lack of clear scope of practice, resistance from male physicians, low involvement of nurses in policy-making, and low status of nursing as a profession. CONCLUSION: The successful implementation and sustainment of advanced practice nursing roles in Arab countries in the Eastern Mediterranean region requires foundational work, including development of definitions, educational standards, regulations, and a clear scope of practice. SCOPING REVIEW REGISTRATION NUMBER: Open Science Framework: https://osf.io/wyj8a.

Maintenance treatment for eating disorders following inpatient or day treatment: outcomes of intensive outpatient group and individual CBT treatments.

Relapse is a substantial problem in eating disorders. Until recently, there have been few investigations into maintenance treatments aimed at helping patients maintain improvements made in treatment. This study compared the outcomes of group-based intensive outpatient versus individual cognitive behavioural therapy (CBT)-based maintenance treatments for eating disorders, following inpatient or day treatment. In this sequential cohort study, patients received the type of maintenance treatment (intensive outpatient group or individual CBT) available at the time. A total of 221 patients with eating disorders were included, and data were examined retrospectively. Cox regression was used to determine whether treatment type predicted rate of return to clinically significant symptoms over the 12 months following inpatient or day treatment. Intensive outpatient group versus individual CBT maintenance treatment did not predict differential rate or trajectory of return to clinically significant symptoms in diagnostic subgroups and the overall sample. Maintenance treatment type did not predict changes in weight/shape concerns between end-of-inpatient or day treatment) and 6- or 12-month follow-up (after controlling for diagnosis). Although the treatments appeared similarly effective in helping patients maintain gains made in intensive treatment, individual CBT may be a more time- and cost-efficient approach to delivering maintenance treatment.

Influence of organisational attributes on registered nurse contributions to well-child care: a scoping review protocol.

INTRODUCTION: Universal access to preventative healthcare is essential to children's health. Registered nurses (RN) are well positioned to deliver well-child care within primary care settings; however, RN role implementation varies widely in this sector and the scope of literature that examines the influence of organisational attributes on nursing contributions to well-child care is not well understood. The aim of this scoping review is to identify the scope and characteristics of the literature related to organisational attributes that act as barriers to, or facilitators for RN delivery of well-child care within the context of primary care in high-income countries. METHODS AND ANALYSIS: The Joanna Briggs Institute scoping review methodology will be used to conduct this review. Databases that will be accessed include Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE and Embase. Inclusion criteria includes articles with a focus on RNs who deliver well-child care in primary care settings. Literature that meets this inclusion criteria will be included in the study. Covidence software platform will be used to review citations and full-text articles. Titles, abstracts and full-text articles will be reviewed independently by two reviewers. Any disagreements that arise between the reviewers will be resolved through discussion, or with an additional reviewer. Data will be extracted and organised according to the dimensions outlined in the nursing care organisation conceptual framework (NCOF). Principles of the 'best fit' framework synthesis will guide the data analysis approach and the NCOF will act as the framework for data coding and analysis. ETHICS AND DISSEMINATION: This scoping review will undertake a secondary analysis of data already published and does not require ethical approval. Findings will be disseminated via peer-reviewed publications and conference presentations targeting stakeholders involved in nursing practice and the delivery of well-child care. TRIAL REGISTRATION DETAILS: Braithwaite, S., Tranmer, J., Lukewich, J., & Macdonald, D. (2021, March 31). Protocol for a Scoping Review of the Influence of Organisational Attributes on Registered Nurse Contributions to Well-child Care. https://doi.org/10.17605/OSF.IO/UZYX5.

Experiences of and visions for collaboration between midwives and nurses in Nova Scotia.

PROBLEM: In jurisdictions where midwifery and nursing are autonomous and separate health care professions, little is known about how they collaborate during the delivery of perinatal health care services. BACKGROUND: Midwifery became a regulated profession in the province of Nova Scotia, Canada in 2009. Since regulation, midwives and nurses have worked together at three models sites for the delivery of midwifery services and perinatal care. QUESTION: How do midwives and nurses collaborate during the provision of birthing care in Nova Scotia, Canada? METHODS: This was an instrumental case study guided by feminist poststructuralism. Individual interviews of 17 participants were audio-recorded and transcribed verbatim. Twenty-five documents were reviewed, and field notes were gathered. Feminist poststructuralist discourse analysis was used. FINDINGS: Midwives and nurses collaborated well together. Participants described how positive collaborative experiences could influence a new way for midwives and nurses to work together. In this paper we present the theme Moving forward: A Modern Model for Nurses and Midwives working together, and its sub-themes of 1)'The birthing culture has changed' and 2) 'Allies and advocates'. DISCUSSION: Within the global context of strengthening midwifery and nursing, this study illustrated the potential for developing formal, collaborative perinatal models of care led by midwife and nurse teams to address inequities in perinatal health care services. CONCLUSION: Midwives and nurses need more opportunities to collaborate and to build professional relationships. Establishing a midwife-led and nurse supported model of care may transform existing perinatal health care values, beliefs, and practices.

Women's experiences of living with obesity during pregnancy, birthing, and postpartum: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to explore and understand women's experiences of living with obesity during the perinatal period to support evidence-informed approaches to care. INTRODUCTION: The rising incidence of maternal obesity is a serious global health problem. Qualitative studies exploring the viewpoints of pregnant women living with obesity have shown that some women report negative experiences associated with pregnancy, with some instances of current care management practices being perceived as confronting, judgmental, and generally unhelpful. Synthesizing qualitative findings about the experiences of pregnant and postpartum women who live with obesity can provide important insights into the general needs of this population and current gaps in health care practice. INCLUSION CRITERIA: All settings in which women who live with obesity during their pregnancies and receive health care for pregnancy, birthing, and postpartum care will be considered. Studies published from 1995 onward will be included. The review will consider all studies that present qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, and feminist research. METHODS: The following databases will be searched for this review: CINAHL (EBSCO), Embase (Elsevier), PsycINFO (EBSCO), MEDLINE (Ovid), and Sociological Abstracts (ProQuest). ProQuest Dissertations and Theses will be searched for unpublished studies. Each study will be assessed by two independent reviewers. Any disagreements will be resolved through discussion. Data extraction will be conducted by two independent reviewers. The JBI resources for meta-aggregation will be used to create categories and synthesized findings. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020214762.

Impact of Interprofessional Care Conferences Across Primary Care and Mental Health Organizations on Family Medicine Resident Learning.

BACKGROUND AND OBJECTIVES: Patients with severe mental illness often lack care coordination between primary care and mental health providers which can negatively impact patient outcomes. Team-based care is integral in the effective management of patients with multiple comorbidities, with the family physician central in coordinating holistic care. Family medicine residency programs must provide models of effective interprofessional collaboration and mental health treatment to prepare residents to navigate an evolving health care landscape. The objective of this study was to evaluate family medicine residents' learning about providing holistic care with an interprofessional team and medication safety monitoring from the interprofessional cross-organizational care conference experience. METHODS: To bridge care and cultivate the necessary skills, a family medicine clinic and mental health clinic implemented monthly interprofessional care conferences to coordinate care for their shared patients during 2019. Residents who participated in the care conference each (n=11) completed a retrospective pre/postsurvey (11/11=100% response rate) to gather perceptions of what they learned from the interprofessional care conference experience. RESULTS: After participating in the care conference, all residents agreed they understood the elements that must be considered to provide holistic patient care, were confident conducting medication safety monitoring for their patients taking second-generation antipsychotics (eg, lipids, A1C, ECG), and agreed the care conference helped them develop a more comprehensive patient-centered care plan. Additionally, they all intend to work collaboratively across professions in the future. CONCLUSIONS: Interprofessional and cross-organizational care conferences create an authentic learning environment that enhances family medicine residents' understanding and confidence in providing collaborative and holistic care for patients with severe and persistent mental illness.