Factors critical for the successful delivery of telehealth to rural populations: a descriptive qualitative study.

BACKGROUND: The use of telehealth has proliferated to the point of being a common and accepted method of healthcare service delivery. Due to the rapidity of telehealth implementation, the evidence underpinning this approach to healthcare delivery is lagging, particularly when considering the uniqueness of some service users, such as those in rural areas. This research aimed to address the current gap in knowledge related to the factors critical for the successful delivery of telehealth to rural populations. METHODS: This research used a qualitative descriptive design to explore telehealth service provision in rural areas from the perspective of clinicians and describe factors critical to the effective delivery of telehealth in rural contexts. Semi-structured interviews were conducted with clinicians from allied health and nursing backgrounds working in child and family nursing, allied health services, and mental health services. A manifest content analysis was undertaken using the Framework approach. RESULTS: Sixteen health professionals from nursing, clinical psychology, and social work were interviewed. Participants mostly identified as female (88%) and ranged in age from 26 to 65 years with a mean age of 47 years. Three overarching themes were identified: (1) Navigating the role of telehealth to support rural healthcare; (2) Preparing clinicians to engage in telehealth service delivery; and (3) Appreciating the complexities of telehealth implementation across services and environments. CONCLUSIONS: This research suggests that successful delivery of telehealth to rural populations requires consideration of the context in which telehealth services are being delivered, particularly in rural and remote communities where there are challenges with resourcing and training to support health professionals. Rural populations, like all communities, need choice in healthcare service delivery and models to increase accessibility. Preparation and specific, intentional training for health professionals on how to transition to and maintain telehealth services is a critical factor for delivery of telehealth to rural populations. Future research should further investigate the training and supports required for telehealth service provision, including who, when and what training will equip health professionals with the appropriate skill set to deliver rural telehealth services.

Experiences of caregivers of children with autism during the COVID-19 pandemic: A scoping review.

BACKGROUND:  The coronavirus disease 2019 (COVID-19) outbreak has had a profoundly negative impact on people all over the world, particularly those with disabilities such as autism. However, there are gaps in research understanding the impact of COVID-19 on this population and the support required. AIM:  To explore the evidence available on the impact of the COVID-19 pandemic on caregivers of children with autism. METHOD:  A scoping review methodology using the Arksey and O'Malley framework was employed. Five electronic databases from March 2020 to December 2022 were reviewed. Two thousand two hundred and six articles were retrieved with primary search terms: caregivers (population), autism (diagnosis) and COVID-19 (context). Following the screening of titles, abstracts and articles, 36 articles were included in the final review. Thematic and content qualitative analysis was completed. RESULTS:  Preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guided the reporting of the findings. Three main themes were identified: (1) caregiver's mental health and wellbeing, (2) response to remote health care and support and (3) caregiver resilience. CONCLUSION:  The pandemic affected children with autism and their families regarding changes in routine, difficulties with support and emotional states. However, little research has been conducted on the impact in upper-middle-income countries such as South Africa.Contribution: The findings from this review carry practical implications that extend beyond the pandemic, such as political instability or natural disasters that may present similar stressors for children with autism and their families.

How effective are digital/e-health interventions for supporting prisoners with mental ill-health? An integrative review.

PURPOSE: There has been a move towards the implementation of digital/e-health interventions for some time. Digital/e-health interventions have demonstrable efficacy in increasing individual empowerment, providing timely access to psychological interventions for those experiencing mental ill-health and improving outcomes for those using them. This study aims to determine the efficacy of digital/e-health interventions for individuals detained in prison who experience mental ill-health. DESIGN/METHODOLOGY/APPROACH: A systematic search of five academic databases - CINAHL, ASSIA, PsycINFO, Embase and Medline - was completed in December 2020 and updated in February 2022. The review was guided by the Whittemore and Knafl (2005) framework for integrative reviews. A total of 6,255 studies were returned and screened by title and abstract. A full-text screening of nine (n = 9) studies was conducted. FINDINGS: No study met the inclusion criteria for the clinical efficacy of digital/e-health interventions in a prison setting. Subsequently, a review of the literature that made it to the full-text review stage was conducted, and gaps in the literature were identified to inform policy, practice and future research. ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first integrative review conducted on the efficacy of digital/e-health interventions for mental ill-health in prison settings.

Exploring the care coordination experiences of professionals and caregivers of youth with acquired brain injuries in rural areas.

PURPOSE: Acquired brain injuries (ABIs) can have devastating effects on children and their families. Families living in rural communities experience unique barriers to receiving and coordinating care for complex medical needs, but little research has examined those barriers for rural youth with ABIs. MATERIALS AND METHODS: This qualitative study explored the experiences of rural adults caring for children with ABIs through interviews with six caregivers, three school staff members, and three medical professionals who had treated at least one child with an ABI. RESULTS: Themes in their accounts include difficulty navigating complex situations, support from small communities, isolation and loneliness, the need for more professional education about ABI, and feelings of hope. Barriers to quality care coordination include navigating complex situations, access to transportation, and a lack of communication and education from healthcare agencies. Facilitators of rural care coordination include support from small communities and interagency communication. CONCLUSIONS: The results support the need for more comprehensive coordination among rural agencies involved in ABI care. Suggestions for care improvement include providing flexibility due to transportation barriers, capitalizing on the benefits of a small and caring community, and providing healthcare and education professionals with more education about ABI interventions.

Practitioners should implement tailored support systems that include initiatives to facilitate direct communication between rural medical agencies and schools.Expanding the role of care coordinators to bridge gaps across healthcare, education, and community services could enhance care coordination for children with acquired brain injuries in rural areas.Schools in rural areas should develop formal reintegration programs tailored to the needs of children with mild acquired brain injuries, leveraging existing sports protocols for non-sports-related injuries.Collaborative efforts between schools, medical teams, and community agencies can provide comprehensive education programs tailored to the rural context.The development of online options for follow-up appointments would be particularly beneficial in rural areas, where transportation barriers are more pronounced.

Elucidating managerial, staff and client perspectives on the Speech and Language Therapy service in Malta.

BACKGROUND: Speech and language therapy (SLT) services are fundamental for communication, academic and social development. Evidence shows that demand for services is increasing, and this can adversely affect the quality of care. There are limited published studies in relation to the demand and quality of speech and language services in Malta. AIMS: To elucidate the perspectives of speech-language pathologists (SLPs), service managers and parents of clients about the impact of factors pertaining to human resource development (HRD), human resource management (HRM) and the environment on the quality of the children's SLT service in western Malta. Also, to outline the beneficial strategies or recommendations to improve the quality of the service provided. METHODS & PROCEDURES: A mixed-method study was used. Quantitative data provided by the Speech and Language Center (SLC) were analysed to determine demand over time using descriptive statistics. Qualitative data from one-to-one interviews using a bespoke questionnaire with managers, SLPs and parents were transcribed and analysed. Common and distinct themes in relation to the quality of services were then formulated and evaluated. OUTCOME & RESULTS: Quantitative results highlighted that clients were not receiving the required number of the therapeutic sessions. In total, nine themes in relation to the quality of the SLT service were identified by parents, SLPs and managers. The factors affecting the service quality were outlined and subdivided under three branches: HRD, HRM and the environment. All factors within these subgroups are expected to enhance the quality of the service provided if they are enhanced and improved upon. Additionally, the results showed that a discrepancy between the perceived and offered SLT services was felt from the managers' and SLPs' perspectives; however, this was not felt by parents. For parents, the main concern was the availability and frequency of the therapeutic sessions provided. CONCLUSION & IMPLICATIONS: Insights from SLPs, managers and parents of clients highlighted the barriers and enablers of quality of service in SLT services for children. These findings can be used to improve services in Malta and other countries with similar contexts, mainly by altering time management, reducing demands and improving availability. WHAT THIS PAPER ADDS: What is already known on the subject SLT is proven to enhance a child's communication skills. Increasing demands for therapy can affect the quality of the service provided, ultimately affecting the child's progress. There is a gap in the evidence base regarding the quality of speech and language services for children in Malta and the factors which affect the quality of the service. What this study adds to the existing knowledge This is the first study of its kind in Malta. It seeks to identify the quality of SLT services for children from three different perspectives: service managers, SLPs and parents. In addition, this study investigated what affects the quality of SLT services positively or negatively. Through this study, the impeding factors were divided into three domains; HRD factors, HRM factors and environmental factors. These domains were mentioned by all three groups of participants because they affected the service negatively or positively. The main negative aspects included bad time management, high demands, and reduced availabilities and accessibilities, whilst positive aspects included improved support, relationships and the environment. What are the practical and clinical implications of this work? This study suggests reducing the managerial and administrational demands on SLPs and improving session frequency would enhance the quality of service. In relation to the three domains, the HRD factors that would enhance the quality of service are: SLPs' and parental competencies, enhancing SLPs' positive characteristics, positive attitudes and cooperation from all personas; for HRM resources the factors important for quality are strategic and risk management, workforce and recruitment; and for the environmental factors the physical environment and resources are important as they affect the service depending on their condition, that is, improved resources result in improved service. Such alterations would reduce the SLPs' demotivation and burnout due to reduced responsibilities, whilst improving accessibility and availability, ultimately enhancing the quality of the service provided.

An evaluation of outpatient service provision in the National Health Service in Great Britain: A freedom of information request.

RATIONALE: The National Health Service (NHS) Long Term Plan was published in January 2019. One of its objectives was restructuring outpatient services, as part of an Outpatient Transformation initiative. Monitoring of trusts' adherence to the objectives of the Long Term Plan is therefore required to benchmark progress against national objectives. AIMS AND OBJECTIVES: We aimed to explore whether outpatient transformation initiatives and phlebotomy services that are managed by outpatients are appropriately staffed and to evaluate trusts' adherence to the objectives outlined in the Long Term Plan. METHOD: A freedom of information (FOI) request was sent in January 2023 to 153 trusts across Great Britain (time span: 1 January 2022-31 December 2022). Parameters requested included number of outpatients seen/discharged, phlebotomy episodes, number of sites/wards covered by phlebotomy, target/actual did not attend (DNA) rates, time since inception of the outpatient transformation project (OTP), advice and refer (A&R) and patient-initiated follow-up (PIFU), phlebotomy and outpatient managerial establishment and use of electronic notes and patient portals. RESULTS: A total of 117 trusts (76.5%) provided responses to the FOI request. The mean number of new outpatients seen face-to-face was 185,810. Of 73 trusts reporting both actual and target DNA rates, 62 (84.9%) did not meet their DNA targets. The actual DNA rate was significantly greater than the target DNA rate across trusts (p < 0.001, mean: 8.8% vs. 6.5%, respectively). A total of 58 different electronic systems and 29 patient portals were utilised across trusts. Thirty-six trusts (30.3%) did not have an outpatient transformation project manager and 16 trusts (13.7%) did not initiate an OTP. With phlebotomy provision, the mean number of outpatient phlebotomy episodes was lower than inpatient episodes (83,383 vs. 91,020, respectively). CONCLUSION: There are deficiencies in current outpatient establishments that may hinder the achievement of objectives set in the NHS Long Term Plan. Changes at all levels of healthcare are required, with increased reliance on technologies and investment in support for transformation management.

A Multilevel Analysis of Individual and Community Factors Associated With Case Dispositions Following Child Maltreatment Investigations.

Understanding service disposition pathways is critical to provide deeper insight into why certain subgroups of the population are at risk for recurrent Child Protective Services (CPS) involvement and may highlight disparities across groups or geographic areas. Using the Decision-Making Ecology Framework as a lens, the present study examines whether service disposition pathways are influenced by risk assessment, safety concerns, child age, maltreatment type, previous CPS involvement, and/or county-level structural vulnerability. We linked administrative data from New Mexico's Department of Children, Youth and Families (DCYF) to data from the American Community Survey. Multilevel models examining associations between case (N = 12,960) and county (N = 33) characteristics revealed that both case (age, maltreatment type, risk/safety assessments, previous CPS involvement) and county-level factors (transportation and housing) were associated with service disposition. Additionally, we observed considerable variation at the county level in both the provision of services and the relationship between risk assessment and service provision. By linking different factors of the decision-making process in child welfare cases to intervention strategies, the analysis reveals that the perception of risk can vary based on geographical context resulting in different outcomes for families who have similar risks but different county-level vulnerabilities.

Who gets an annual review for coeliac disease? Patients with lower health literacy and lower dietary adherence consider them important.

BACKGROUND: A lifelong gluten-free (GF) diet to manage coeliac disease is recognised to be challenging. This paper comprises two studies: study one aimed to report the opinions of adults with coeliac disease on review provision and explore factors influencing dietary adherence. Study two aimed to report dietetic provision for adults with coeliac disease. METHODS: A cross-sectional online survey was completed by 722 adults with coeliac disease, including validated dietary adherence, health literacy and quality-of-life questionnaires. An online and paper survey designed to capture the provision of dietetic services to adults with coeliac disease was completed by 88 dietetic departments within the United Kingdom. RESULTS: Only 26% of adults with coeliac disease were offered annual reviews. In contrast, 85% considered reviews important, with 62% preferring dietetic provision. Those who considered reviews important had lower health literacy, greater dietary burden, poorer GF dietary adherence and lower GF food knowledge (all p < 0.05) compared with those who did not consider reviews important. GF dietary adherence was associated with health literacy, self-regulatory behaviours, dietary burden and GF food knowledge; 53% agreed with the 'cost of GF food restricts what I eat'; they had poorer GF dietary adherence compared with those who disagreed (p < 0.001). More than 72% of dietetic coeliac review provision provided content on improving access to GF foods and eating out of the home. CONCLUSIONS: A subpopulation of adults with coeliac disease have a greater need for support and guidance, which supports the viewpoint that limited resources should be targeted towards patients with the most need for support to enable successful disease management.

Identifying co-morbidities and risk in people with epilepsy: The Maltese experience.

BACKGROUND: People with epilepsy are at increased risk of multiple co-morbidities that may influence risk of adverse outcomes including impact on quality of life and premature mortality. These risk factors include potentially modifiable clinical characteristics associated with sudden unexpected death in epilepsy (SUDEP). For services to tackle risk, the clinical complexity of the target epilepsy population needs to be defined. While this has been comprehensively studied in large, economically developed countries little knowledge of these issues exist in small economically developed countries, like Malta (population: 500,000). METHODS: This was a single centre study focused exclusively on patients attending Gozo General Hospital (GGH) Malta. STROBE guidance for reporting cross sectional studies was used to design and report the study. This was a retrospective review of standard care and SUDEP and seizure risks provided to all adults (over 18 years) with epilepsy attending GGH (2018-2021). RESULTS: The review identified 68 people and 92% were compliant with their anti-seizure medication. A fifth (21%) had an intellectual disability. Despite only one patient having a psychotic illness, 19% were on antipsychotic medication. Only 18% of patients had a specific epilepsy care plan, 6% nocturnal surveillance and none had received advice on SUDEP. DISCUSSION: Patient outcomes may be improved with increasing rates of personalized epilepsy care plans, appropriate nocturnal surveillance and reducing the prescription of antipsychotic medication as it is associated with greater risk of mortality. Issues such as stigma and shame appear to play a significant role in small communities and their access to care.

Roles and Dynamics within Community Mental Health Systems During the COVID-19 Pandemic: A Qualitative Systematic Review and Meta-Ethnography.

Globally, COVID-19 had an immense impact on mental health systems, but research on how community mental health (CMH) systems and services contributed to the pandemic mental health response is limited. We conducted a systematic review and meta-ethnography to understand the roles of CMH services, determinants of the quality of CMH care, and dynamics within CMH systems during COVID-19. We searched and screened across five databases and appraised study quality using the CASP tool, which yielded 27 qualitative studies. Our meta-ethnographic process used Noblit and Hare's approach for synthesizing findings and applying interpretive analysis to original research. This identified several key themes. Firstly, CMH systems played the valuable pandemic role of safety nets and networks for the broader mental health ecosystem, while CMH service providers offered a continuous relationship of trust to service users amidst pandemic disruptions. Secondly, we found that the determinants of quality CMH care during COVID-19 included resourcing and capacity, connections across service providers, customized care options, ease of access, and human connection. Finally, we observed that power dynamics across the CMH landscape disproportionately excluded marginalized groups from mainstream CMH systems and services. Our findings suggest that while the pandemic role of CMH was clear, effectiveness was driven by the efforts of individual service providers to meet demand and service users' needs. To reprise its pandemic role in the future, a concerted effort is needed to make CMH systems a valuable part of countries' disaster mental health response and to invest in quality care, particularly for marginalized groups.

Prevalence, Disclosure, and Help Seeking in Black and Asian Male Survivors of Sexual Violence in the United Kingdom: A Rapid Review.

Sexual violence against men has been significantly overlooked, and under-researched, with minimal attention paid to the influence of culture and ethnicity on survivors' experiences of abuse. This rapid review examines prevalence, disclosure, help-seeking, and criminal justice experiences of Black and Asian male survivors in the United Kingdom. Eight empirical studies published since 2003 involving Black and Asian sexual violence survivors were included through comprehensive database searches, including gray literature and reference lists. Findings suggest prevalence data underestimate the true extent of victimization in ethnic minority groups in the United Kingdom. Barriers to disclosure and help-seeking were associated with specific cultural factors unique to Black and Asian male experiences, as revealed by three qualitative studies. However, accessing and reporting to the criminal justice system remains largely unexplored for Black and Asian male survivors. Methodological limitations within existing studies emphasize the urgent need for substantial, high-quality research that addresses issues with inconsistent definitions, measurements, and lack of ethnic-specific approaches across prevalence, disclosure, help-seeking, and criminal justice experiences. Culturally informed professional training emerges as a critical requirement to sensitively address the unique challenges faced by ethnic minority male survivors. Additionally, targeted outreach initiatives hold the potential to engage minority male survivors more effectively. A collaborative, system-wide approach is vital to bring to the forefront the overlooked experiences of ethnic minority males, thereby promoting an environment of support, understanding, and recovery.

Support or justice: a triangulated multi-focal view of sexual assault victim support in a UK sexual assault referral centre (SARC).

BACKGROUND: Despite vast levels of underreporting, sexual assault remains an issue at scale in the UK, necessitating the presence of statutory and voluntary organisations in the support of victims. Understanding the experiences of all parties within this context is important for the resilience of support that can be provided at a systems level. This study examines the barriers faced by service providers when working with victims of sexual assault. METHODS: Semi-structured interviews took place with eleven professionals working in or in conjunction with a Sexual Assault Referral Centre (SARC) in Southeast England, which were subsequently analysed using inductive thematic analysis. RESULTS: Five themes were identified exploring SARC staff's experiences with (i) communication breakdowns with external services; (ii) delivering support in an underfunded system; (iii) tailoring support to survivors' needs; (iv) the Criminal Justice System fails victims of sexual assault; and (v) reckoning with burnouts and vicarious trauma. CONCLUSION: Significant gaps in UK service provision for sexual assault victims are identified, particularly within the criminal justice system, where legal and investigative processes are cited as retraumatizing. The results emphasize the urgency of enhanced training, coordination, resources, and trauma-informed practices across organizations to better serve victims and support overwhelmed providers. Prioritizing systemic improvements is crucial to address the complex needs of both victims and service professionals.

Digital economy and institutional dynamics: striving for equitable public service in a digitally transformed era.

Background: The rapid emergence of China's digital economy has sparked profound interest in the complex interplay between digitalization and the provision of public services. This study aims to delve deeper into how the development of the digital economy impacts the level of equalization in public service delivery and evaluates whether institutional factors can moderate this transformation. Against the backdrop of pursuing "common prosperity," this research provides valuable guidance for policymaking and strategic planning. It ensures that the ascent of the digital economy not only elevates the standards of public services but also fosters their equitable distribution, thereby advancing the cause of social equity. Methodology: The study utilized the System Generalized Method of Moments (GMM) model along with longitudinal trend data spanning from 2009 to 2018. This approach facilitated an in-depth analysis of the relationship between the digital economy and the level of equalization in public service delivery. The application of this model provided deeper insights into the impact of the digital economy on public service equalization and the identification of underlying mechanisms. Findings: This study reveals a complex paradox that the digital economy is exacerbating regional disparities in the provision of basic public services. Furthermore, the research underscores the pivotal role of institutional environments in mitigating the adverse effects of the digital economy on public service provision. By examining the interplay between digital economy growth and institutional frameworks, the study suggests that adaptable and robust institutions are essential for harnessing the digital economy's benefits while minimizing its potential drawbacks. Conclusion: In conclusion, the findings from this study offer substantial insights into the dual impact of the digital economy on public service provision, enriching the ongoing discourse on digital transformation and social equity. The research underscores the significance of strategic policy reforms and institutional adjustments to harness the transformative power of the digital economy, promoting equitable access to public services and advancing the goal of "common prosperity" in the digital age.

Health Facilities Readiness and Determinants to Manage Cardiovascular Disease in Afghanistan, Bangladesh, and Nepal: Evidence from the National Service Provision Assessment Survey.

Background: In South Asia, cardiovascular diseases (CVDs) are an increasing public health concern. One strategy for dealing with the growing CVDs epidemic is to make health facilities more ready to provide CVDs services. The study's objectives were to: (1) assess healthcare facilities' readiness to offer CVDs services; and (2) identify the variables that influence such readiness. Methods: This study employed data from the Afghanistan Service Provision Assessment Survey 2018-2019, Bangladesh Health Facility Survey 2017, and Nepal Health Facility Survey 2021 that were cross-sectional and nationally representative. In Afghanistan, Bangladesh, and Nepal, 117, 368, and 1,381 health facilities, respectively, were examined. A total of 10 items/indicators were used to measure a health facility's readiness to provide CVDs services across three domains. Results: The mean readiness scores of managing CVDs were 6.7, 5.6, and 4.6 in Afghanistan, Bangladesh, and Nepal, respectively. Availability of trained staff for CVD services are not commonly accessible in Afghanistan (21.5%), Bangladesh (15.3%), or Nepal (12.9%), except from supplies and equipment. Afghanistan has the highest levels of medicine and other commodity availability. Among the common factors linked with readiness scores, we ought to expect a 0.02 unit rise in readiness scores for three nations for every unit increase in number of CVDs care providers. In Afghanistan, Bangladesh, and Nepal, availability of both diagnosis and treatment facilities was associated with increases in readiness scores of 27%, 9%, and 17%, respectively. Additionally, an association was observed between nation-specific facility types and the readiness scores. Conclusions: Country-specific factors as well as universal factors present in all three nations must be addressed to improve a health facility's readiness to provide CVDs care. To create focused and efficient country-specific plans to raise the standard of CVD care in South Asia, more investigation is necessary to ascertain the reasons behind country-level variations in the availability of tracer items.

Intention to Use an Electronic Community Health Information System Among Health Extension Workers in Rural Northwest Ethiopia: Cross-Sectional Study Using the Unified Theory of Acceptance and Use of Technology 2 Model.

BACKGROUND: IT has brought remarkable change in bridging the digital gap in resource-constrained regions and advancing the health care system worldwide. Community-based information systems and mobile apps have been extensively developed and deployed to quantify and support health services delivered by community health workers. The success and failure of a digital health information system depends on whether and how it is used. Ethiopia is scaling up its electronic community health information system (eCHIS) to support the work of health extension workers (HEWs). For successful implementation, more evidence was required about the factors that may affect the willingness of HEWs to use the eCHIS. OBJECTIVE: This study aimed to assess HEWs' intentions to use the eCHIS for health data management and service provision. METHODS: A cross-sectional study design was conducted among 456 HEWs in 6 pilot districts of the Central Gondar zone, Northwest Ethiopia. A Unified Theory of Acceptance and Use of Technology model was used to investigate HEWs' intention to use the eCHIS. Data were cleaned, entered into Epi-data (version 4.02; EpiData Association), and exported to SPSS (version 26; IBM Corp) for analysis using the AMOS 23 Structural Equation Model. The statistical significance of dependent and independent variables in the model was reported using a 95% CI with a corresponding P value of <.05. RESULTS: A total of 456 HEWs participated in the study, with a response rate of 99%. The mean age of the study participants was 28 (SD 4.8) years. Our study revealed that about 179 (39.3%; 95% CI 34.7%-43.9%) participants intended to use the eCHIS for community health data generation, use, and service provision. Effort expectancy (ß=0.256; P=.007), self-expectancy (ß=0.096; P=.04), social influence (ß=0.203; P=.02), and hedonic motivation (ß=0.217; P=.03) were significantly associated with HEWs' intention to use the eCHIS. CONCLUSIONS: HEWs need to be computer literate and understand their role with the eCHIS. Ensuring that the system is easy and enjoyable for them to use is important for implementation and effective health data management.

Guidelines for assistive technology service provision - A scoping review.

PURPOSE: Despite the high unmet need for effective AT provision, multiple service delivery models across different countries, and a shortage of personnel trained in this field, no widely useable and accepted Assistive Technology (AT) service provision guidelines currently exist. This review aims to provide an overview of the literature regarding AT service provision guidelines to inform the development of globally useable AT provision guidance, aligned with contemporary global initiatives to improve access to AT. MATERIALS AND METHODS: The rapid scoping review method used a two-tiered approach to identifying relevant publications: (1) systematic search of academic databases (Medline, CINAHL, SCOPUS, and Google Scholar); (2) consultation with international AT organisations and experts. The search was conducted in March 2023 with no date limitations. Analysis was guided by the TIDE-funded HEART research on quality AT provision and service delivery processes in Europe, as well as the WHO-GATE 5 P framework for strengthening access to AT. RESULTS: 35 publications were identified from various countries, and directed at differing assistive products, personnel, and provision contexts. No established guidelines for AT service provision currently exist. However, despite the variety in contexts, the range of assistive products and the range of stakeholders to whom guidelines are directed, several key service delivery steps were identified that may form part of such guidelines. CONCLUSIONS: This review offers a strong starting point for developing guidance for AT provision to meet global needs. Careful consideration of vocabulary, process, and application to the diversity of assistive products is recommended in systematizing globally applicable guidance.

Guidelines offer accepted benchmarks for clinical practice.Evidence-based guidelines ensure consistent and appropriate interventions, including assistive technology provision.The evidence suggests global guidance is required, and a substantial evidence base can be drawn upon to formulate such guidelines.

Serving IPV Survivors in Culturally Diverse Communities: Perspectives From Current Service Providers.

This qualitative study examines current IPV service providers' perspectives on service delivery methods that best reach and serve IPV survivors from culturally diverse communities. Semi-structured interviews were conducted with 11 service providers, and transcripts were analyzed for themes related to service providers' experiences. Five themes emerged from the data that suggest best practices for reaching and serving survivors from culturally diverse backgrounds, including understanding survivors' backgrounds, promoting trust and inclusivity, building community relationships, providing culturally responsive education on IPV, and supporting current and future staff with training. Study findings provide implications for the education and training of future service providers.

Impact of the COVID-19 pandemic on the use of an inpatient and community palliative care service.

BACKGROUND: The COVID-19 pandemic disrupted the usual provision of healthcare, changing models of care, clinical loads, service provision and patient behaviour. AIMS: This study assesses the impact of COVID-19 on community and inpatient palliative care service provision. METHODS: A retrospective audit and comparison of service use conducted over two defined periods, before and during the COVID-19 pandemic, 2019-2020. FINDINGS: The community palliative care service had a 9% increase in referrals, with a lower proportion of referrals (2.4%) from subacute/palliative care hospitals during the COVID-19 pandemic. Provision of care during the pandemic included less face-to-face contact with patients (24.1% versus 30.2% before), and markedly more contact with patients via videoconference (2.1% versus 0.1% before the pandemic). CONCLUSION: The community specialist palliative care service was busier during the pandemic period, and experienced a shift in mode of care delivery, while the inpatient unit experienced no difference in service use.

Sustained Increase in Pediatric Inflammatory Bowel Disease Incidence Across the South West United Kingdom Over the Last 10 Years.

BACKGROUND: Pediatric inflammatory bowel disease (pIBD) incidence has increased over the last 25 years. We aim to report contemporaneous trends across the South West United Kingdom. METHODS: Data were provided from centers covering the South West United Kingdom (Bristol, Oxford, Cardiff, Exeter, and Southampton), with a total area at-risk population (<18 years of age) of 2 947 534. Cases were retrieved from 2013 to 2022. Incident rates were reported per 100 000 at-risk population, with temporal trends analyzed through correlation. Subgroup analysis was undertaken for age groups (0-6, 6-11, and 12-17 years of age), sex, and disease subtype. Choropleth maps were created for local districts. RESULTS: In total, 2497 pIBD cases were diagnosed between 2013 and 2022, with a mean age of 12.6 years (38.7% female). Diagnosis numbers increased from 187 to 376, with corresponding incidence rates of 6.0 per 100 000 population per year (2013) to 12.4 per 100 000 population per year (2022) (b = 0.918, P < .01). Female rates increased from 5.1 per 100 000 population per year in 2013 to 11.0 per 100 000 population per year in 2022 (b = 0.865, P = .01). Male rates increased from 5.7 per 100 000 population per year to 14.4 per 100 000 population per year (b = 0.832, P = .03). Crohn's disease incidence increased from 3.1 per 100 000 population per year to 6.3 per 100 000 population per year (b = 0.897, P < .01). Ulcerative colitis increased from 2.3 per 100 000 population per year to 4.3 per 100 000 population per year (b = 0.813, P = .04). Inflammatory bowel disease unclassified also increased, from 0.6 per 100 000 population per year to 1.8 per 100 000 population per year (b = 0.851, P = .02). Statistically significant increases were seen in those ≥12 to 17 years of age, from 11.2 per 100 000 population per year to 24.6 per 100 000 population per year (b = 0.912, P < .01), and the 7- to 11-year-old age group, with incidence rising from 4.4 per 100 000 population per year to 7.6 per 100 000 population per year (b = 0.878, P = .01). There was no statistically significant increase in very early onset inflammatory bowel disease (≤6 years of age) (b = 0.417, P = .231). CONCLUSIONS: We demonstrate significant increases in pIBD incidence across a large geographical area including multiple referral centers. Increasing incidence has implications for service provision for services managing pIBD.

Incidence of inflammatory bowel disease continues to increase in childhood, particularly in older children. This is demonstrated in a contemporary dataset collected over a 10-year period, and covering an at-risk population of nearly 3 000 000. These data have significant implications for service provision.