Abstract Background Adults with hematological malignancies who develop febrile neutropenia (FN) face elevated risks of sepsis, intensive care admission, and treatment interruptions. Early sepsis detection is challenging, as classical clinical signs are often attenuated or delayed in this population. Current risk stratification tools demonstrate limitations when applied to adults with FN. A tailored, nurse-led scoring system integrating clinical, laboratory, and physiological predictors may enhance early sepsis identification. Objective This 2-phase study aims to develop and internally validate a nurse-led sepsis risk score for adults with FN in phase I and to temporally validate its performance in phase II. The new score will be compared to the MASCC risk index, CISNE, NEWS2_ and qSOFA at FN onset . The secondary objectives include evaluating associations between risk groups and remote patient monitoring alerts within 24 hours of FN onset, interrater agreement, and bedside feasibility. Methods The study is being conducted in the hematology and bone marrow transplantation department of a tertiary care hospital in Bengaluru, India. Phase I uses a nested matched case-control design within a retrospective cohort of approximately 140 patients with FN. We will analyze clinical, laboratory, and physiological predictors measured at FN onset using multivariable conditional logistic regression, with internal validation via bootstrapping. In Phase II, which utilizes a prospective temporal validation cohort, bedside nurses will calculate the proposed score at FN onset alongside the MASCC, CISNE, NEWS2, and qSOFA scores A substudy will include additional nurses scoring independently to assess interrater agreement and feasibility. Two blinded reviewers will adjudicate phase I outcomes within 14 days of FN onset, while assessors blinded to all scores will adjudicate phase II outcomes within the same time frame. The primary outcome is sepsis within 14 days of FN onset. Phase II evaluates discrimination, calibration, and comparative diagnostic performance. Results We obtained ethics approval in April 2025, and the study was registered in June 2025 (CTRI/2025/06/088290). The initial phase I derivation was completed in November 2025, using sepsis within 14 days of FN onset as the primary outcome. A protocol amendment in September 2026 harmonized the outcome window to 14 days, prompting rederivation of the model and superseding the initial analysis. Phase II commenced in December 2025. As of September 2026, enrollment and data collection were ongoing, with study completion anticipated in December 2026. Main results are expected in 2027. Conclusions This protocol evaluates an FN-specific, nurse-led sepsis score integrating clinical and laboratory predictors with contactless physiological measurements. We will examine remote patient monitoring alerts as secondary markers of clinical instability. Validation findings will establish the score’s predictive performance and inform future implementation studies.
Abstract Background In Australian residential aged care, infection prevention and control (IPC) Lead nurses (IPC Leads) are a key part of the IPC program. IPC Leads are often the main IPC contacts and provide support to staff to improve IPC and resident outcomes. To enhance their competence and self-efficacy, IPC Leads need to engage in ongoing role development. Connecting with other IPC Leads, learning together, and sharing ideas and resources could also be beneficial. Communities of practice (CoPs) have been shown to improve self-efficacy and job satisfaction by fostering belonging, peer learning, and problem-solving. Drawing on social learning theory, CoPs encourage learning with and from one another to explore and iteratively develop practice. This study draws on the CoP literature and builds on our previous pilot of a CoP for IPC Leads in 1 state of Australia, which found promising impacts on confidence and practice change. Objective This study will evaluate CoPs for IPC Leads working in Australian residential aged care. Primarily, the study will assess changes in IPC Leads’ self-efficacy. It will also explore job satisfaction and IPC practice improvement and assess the acceptability and feasibility of CoPs. Methods We are conducting a before-and-after study using multimethods. We will recruit IPC Leads from across Australia to participate in the CoPs. The CoPs will be implemented over 12 months, with online sessions held monthly for 30 to 60 minutes each. Baseline and 12-month follow-up surveys of IPC Leads’ self-efficacy and job satisfaction and audits of IPC practice will be conducted. At the 12-month follow-up, surveys and interviews with IPC Leads will be used to assess the acceptability and feasibility of the CoPs and to explore case examples of IPC Leads facilitating practice change. Researcher notes and costing data collected will be used to further evaluate the feasibility and fidelity of the CoPs. Quantitative data will be summarized descriptively, and an ordinal mixed-effects model with a logit link will be used to assess change in self-efficacy. Interview data will be analyzed using an inductive approach, followed by a deductive approach, based on the Framework Method. Results This project was funded in October 2024 and commenced in February 2025. As of April 30, 2026, 97 potential participants had registered their interest in participating, but no participants had been enrolled (ie, consented to participate). Recruitment of IPC Leads began in March 2026. The CoPs are expected to commence in June to July 2026. Data collection will commence in May 2026, and data analysis is expected to be completed by January 2028. Study results are expected to be published in 2028. Conclusions The findings will create new research knowledge in the field of CoPs and knowledge translation in the aged care sector and inform the sustainability and potential for future scale-up of this collaborative social learning approach.
Abstract Background Restrictive practices, including restraint and seclusion, are used across aged care, mental health, and disability support settings to manage behaviors of concern. These practices are associated with substantial ethical, psychological, and physical harms. Digital health technologies, including real-time monitoring systems and AI-enabled predictive analytics, are increasingly used to detect early behavioral escalation. However, detection or prediction alone does not reduce restrictive practices. It remains unclear how these technologies are translated into care actions, decision-making, and measurable outcomes in real-world settings. Objective This scoping review aims to identify and map evidence on real-time monitoring, predictive analytics, and related digital technologies used to prevent or reduce restrictive practices in health and social care. The review will examine the technologies and contexts studied; how technology outputs are translated into care responses and workflows; and the implementation, outcomes, governance, and ethical considerations reported. Methods The review will be conducted in accordance with Joanna Briggs Institute methodology and will be reported using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Librarian-assisted searches were conducted in MEDLINE, CINAHL Ultimate, PsycINFO, Scopus, and IEEE Xplore on March 11, 2026. The executed database search strategies were not modified after Open Science Framework registration. Reference lists of included studies and relevant reviews will be screened using citation chasing. Eligible English-language sources will be those that examine digital technologies linked to care responses intended to reduce restrictive practices or to reported restrictive-practice outcomes. Two reviewers will independently screen records and chart all included sources. Standard scoping-review mapping categories will be used to describe the evidence landscape. The Implementation Research Logic Model will inform analysis of explicitly reported implementation determinants, strategies, mechanisms, and outcomes. Results Electronic database searches were completed on March 11, 2026. Protocol version 5.0 was registered with the Open Science Framework on March 22, 2026. Title and abstract screening had not commenced at the time of registration. The review is expected to be completed by July 2027. Conclusions By clarifying how digital detection and prediction technologies are translated into care actions, and the conditions under which restrictive practice–related outcomes are reported, this review will support safer, more ethical, and more implementable digital health approaches.
Abstract Background Elder orphans have been described as a growing vulnerable population of isolated older adults with limited social and caregiving support. There is a lack of consistency in the terminology and definitions of elder orphans. This lack of consistency impedes research and implementation of services for elder orphans, who are predisposed to isolation, loneliness, unmet care needs, and a decline in health outcomes. It is imperative for elder orphans to plan for their health and well-being as they age in the community. Objective The objectives of the scoping review are (1) to document the definitions and settings surrounding terms used to describe elder orphans, (2) to explore the determinants of isolation and loneliness in elder orphans, and (3) to understand the barriers to and facilitators of planning to age well in elder orphans. Methods This review follows the JBI methodology for scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The search strategy was first developed and piloted in the Scopus database on October 16, 2025, to identify initial articles on the topic. The following databases were searched: Scopus, MEDLINE ALL (Ovid), CINAHL Complete (EBSCOhost), APA PsycINFO (EBSCOhost), Social Work Abstracts (EBSCOhost), Web of Science (Clarivate), Sociological Abstracts (ProQuest), Sociology Database (ProQuest), and Applied Social Sciences Index & Abstracts (ASSIA; ProQuest). Gray literature was searched using Google (incognito) and ClinicalTrials.gov. Only literature in English was considered due to staff constraints. Two reviewers will screen and extract data independently using piloted screening and data extraction tools. Descriptive analysis will include narrative summaries, tables, and charts and deductive thematic analysis using appropriate frameworks. Results This protocol has been registered on the Open Science Framework. As of October 2026, the final search and abstract citation screening has been completed. We expect screening, data extraction, and synthesis to be completed by February 2027, with the manuscript of the scoping review submitted thereafter. Conclusions This review explores both peer-reviewed and gray literature using rigorous and reproducible methods. It will support researchers in streamlining future work on elder orphans and will identify directions for future research and services for elder orphans.
Abstract Background The Otago Exercise Program (OEP), traditionally delivered at home by a physical therapist, is an evidence-based intervention proven to reduce falls and fall-related injuries in older adults. Despite its effectiveness, widespread adoption has been limited by the personnel and resource demands required for program delivery. Exploring alternative delivery methods, including remote platforms and community-based programs, may help overcome implementation barriers and expand access to this program. Objective This study aims to evaluate (1) the effectiveness of 2 delivery modes of the OEP, a remotely delivered, smartphone-based program, and an in-person, community-based program, and (2) participant experiences, feasibility, and acceptability across both delivery formats. Methods Thirty-six adults aged 55 years or older, classified as being at intermediate or high risk for falls according to the World Falls Guidelines, will be enrolled in this study. Eligible participants will be randomly assigned to one of two intervention groups: (1) a remotely delivered, smartphone-based OEP, or (2) an in-person, community-based OEP. Participants in the community-based group will attend sessions at a senior center, whereas those in the smartphone-based group will complete the program at home via the Improve (Vipul Lugade) smartphone app. Both groups will receive individualized 60-minute training sessions twice a week for 8 weeks, delivered by certified trainers under the supervision of physical therapists. The 16-session program will include progressive balance, mobility, and strengthening exercises consistent with the OEP. The primary outcome is self-selected gait speed. Secondary outcomes include injurious falls, fall risk assessed using the Physiological Profile Assessment, Timed Up and Go, 30-Second Chair Stand, 4-Stage Balance Test, and 4-Square Step Test, as well as measures of feasibility, acceptability, usability, and health-related quality of life. Outcomes will be assessed at baseline and postintervention by investigators blinded to group allocation. In addition, gait speed will be assessed weekly throughout the 8-week intervention using the Improve app to monitor changes over time. Trainers will be blinded to outcome data, including baseline and interim assessment results. Results The study received funding in February 2026, and enrollment began in the same month. As of May 2026, 16 participants have been enrolled. Data collection is expected to be completed in December 2026, with findings anticipated for dissemination by the middle of 2027. Conclusions This is the first study to use a smartphone to deliver OEP and to directly compare remote- and community-based delivery platforms. Findings may support broader adoption and implementation of this evidence-based fall prevention program by reducing participation barriers and expanding access for older adults, particularly in remote and underserved areas.
