Introduction Healthcare incident reporting and learning systems (HIRLs) are central to patient safety and quality improvement. While there is much attention paid to the design and content architecture, there is less attention paid to the underpinning rationale of why a HIRL is needed and how it will be used in practice. The aim of this scoping review (ScR) is to identify and synthesise the theoretical frameworks that inform the design, implementation, and evaluation of HIRLs in order to develop a comprehensive map of the theoretical underpinnings currently in use and to consider how these may shape future practice. Methods and analysis This study adopts a scoping review design. It will be conducted following the Arksey and O’Malley framework, guided by the methods manual published by the Joanna Briggs Institute (JBI). Reporting will be in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Search strategies will be constructed using the ECLIPSE mnemonic (Expectation; Client group; Location; Impact; Professionals; Service). Electronic databases (OvidMEDLINE, Embase, CINAHL, PsycINFO) will be searched from January 2009 until December 2024, grey literature sources, citation tracking, and expert consultation will be utilised. Studies will be included if they discuss the development, implementation, or evaluation of HIRLs in healthcare settings and make explicit use of a theoretical or conceptual framework. Screening will be conducted by two researchers and disagreements agreed by consensus, involving a third researcher if required. Data extraction will include study characteristics, the focus of the HIRL, the theoretical framework(s) used and how they are used. A descriptive analysis will be conducted. Ethics and dissemination Ethical approval is not required. Findings will be disseminated through publication in a peer-reviewed journal and conference proceedings. Registration details This protocol was registered prospectively with the Open Science Framework (OSF). The DOI is https://doi.org/10.17605/OSF.IO/5UQPE .
Background Survivors of adolescent and young adult (AYA) cancer are at increased risk of cardiovascular disease (CVD) including ischemic heart disease, stroke, and heart failure. While numerous risk prediction models (RPM) have been developed or validated for CVD in pediatric or older adult cancer populations, it is unclear whether they can be applied to survivors of AYA cancer. Methods We plan to undertake a systematic review of cardiovascular RPM development/ validation studies in survivors of cancer diagnosed at any age. We will search MEDLINE, EMBASE, and Web of Science with additional hand searching. Two reviewers will screen abstracts and full texts; we will include full-text English studies that used real-life patient data to predict outcomes ≥1 year from diagnosis and after completing therapy. We will use the CHARMS checklist to guide data extraction and further extract data on participant demographics, outcomes, and predictors used in the models grouped by cardiovascular outcome; these data will be described with frequencies, means/medians, and other relevant descriptive statistics dictated by the data. We will apply the PROBAST tool to assess risk of bias (RoB) and applicability to AYA cancer survivors. Results and Use We will report all steps of the screening process, and identify number of models developed or validated for each of the following outcomes: heart failure, ischemic heart disease, stroke, death, arrhythmia, or composite CVD outcome. We will report RoB and applicability to AYA cancer survivors. With our results, we will identify those models most clinically applicable to AYA cancer survivors which will help guide whether additional models need to be developed or validated in this population. Results will be disseminated in conference presentations, manuscript form, and PhD dissertation (L.Guolla); ethical approval is not required given public availability of data. Registration PROSPERO - CRD42023458516 (Updated August, 2025)
Background Breast cancer is a global health issue, being the most common malignancy and a leading cause of cancer-related deaths among women, particularly in Ethiopia. Despite this high burden, survival rates and predictors of mortality remain undetermined. This study aimed to assess the pooled incidence of breast cancer and identify factors influencing mortality in Ethiopia. Methods A comprehensive search was conducted using several databases, including PubMed, EMBASE, Google Scholar, Google, and Web of Science. Articles were evaluated according to predefined inclusion and exclusion criteria. Relevant data were extracted and analyzed using R version 4.2.3 and Stata version 17.0. Results Eight studies were included in this analysis. The pooled incidence of mortality among patients with breast cancer was 25% (95% CI: 17–33%). The results showed that late-stage at diagnosis (AOR=4.79, 95% CI: 1.76–7.81) and chemotherapy treatment (AOR=0.51, 95% CI: 0.06–0.96) were significant predictors of mortality. Conclusions This systematic review and meta-analysis estimated the pooled incidence of mortality among patients with breast cancer in Ethiopia to be 25%. These findings indicate that individuals diagnosed at late stages of breast cancer have a five-fold increased risk of dying compared to those whose cases were diagnosed early. Furthermore, the study indicated that the likelihood of death for patients receiving chemotherapy was 51% less than for those not receiving chemotherapy. These insights highlight the importance of early detection and effective treatment options for improving survival outcomes in breast cancer patients in Ethiopia.
Introduction With the recognition of the need for palliative care for people with non-malignant conditions, there is an increasing emphasis on interdisciplinary working between geriatric and palliative care teams. This interdisciplinary work has evolved organically; more needs to be known about current working practices. This is of policy and clinical interest as the older patient population continues to grow. Methods A case study based on qualitative interviews was undertaken of end-of-life care for older in-patients in a large London NHS Trust. 30 semi-structured qualitative interviews were conducted with staff from palliative care and geriatric medical and nursing teams, two with patients and five with carers. Questions covered: examples and perceptions of collaboration and patient/carer perceptions of clarity as to who was providing care. Interviews were transcribed and thematically analysed focusing on: examples of successful collaboration; areas of tension, duplication or confusion about responsibilities; and suggestions for future practice. Results Participants were positive about collaboration. Examples of what works well include: the referral process to the palliative care team; inter-team communication and use of face-to-face handovers; unity between the teams when communicating with patients and families. Areas for potential development include: embedding palliative care within ward multidisciplinary team meetings; continual on-ward education given rotation of staff; and improving collaboration between palliative care, physiotherapy and occupational therapy. It is unclear whether patients’ and carers’ lack of awareness of the different teams has a detrimental effect on their care or needs. Conclusions There is evidence of strong collaborative working between the teams; however, this study highlights potential areas for improvement. An exploration of these relationships in other settings is required to determine if the same themes arise with a view to inform national guidelines and policy to improve care towards the end of life.
Introduction With the recognition of the need for palliative care for people with non-malignant conditions, there is an increasing emphasis on interdisciplinary working between geriatric and palliative care teams. This interdisciplinary work has evolved organically; more needs to be known about current working practices. This is of policy and clinical interest as the older patient population continues to grow. Methods A case study based on qualitative interviews was undertaken of end-of-life care for older in-patients in a large London NHS Trust. 30 semi-structured qualitative interviews were conducted with staff from palliative care and geriatric medical and nursing teams, two with patients and five with carers. Questions covered: examples and perceptions of collaboration and patient/carer perceptions of clarity as to who was providing care. Interviews were transcribed and thematically analysed focusing on: examples of successful collaboration; areas of tension, duplication or confusion about responsibilities; and suggestions for future practice. Results Participants were positive about collaboration. Examples of what works well include: the referral process to the palliative care team; inter-team communication and use of face-to-face handovers; unity between the teams when communicating with patients and families. Areas for potential development include: embedding palliative care within ward multidisciplinary team meetings; continual on-ward education given rotation of staff; and improving collaboration between palliative care, physiotherapy and occupational therapy. It is unclear whether patients’ and carers’ lack of awareness of the different teams has a detrimental effect on their care or needs. Conclusions There is evidence of strong collaborative working between the teams; however, this study highlights potential areas for improvement. An exploration of these relationships in other settings is required to determine if the same themes arise with a view to inform national guidelines and policy to improve care towards the end of life.
Background It is important to develop an adequate evidence base regarding the resources needed to meet the complex care needs of patients dying at home, and how care might best be resourced and coordinated. Currently, however, there is little information about the nature, extent and adequacy of local and national provision, particularly of out-of-hours care. The wide variation in service models in the UK makes it hard to establish their outcomes and effectiveness. Methods This paper presents qualitative findings from a mixed methods study of a Hospice Night Support Service (HNS) that was established to extend the support provided to and by Hospice at Home and other out-of-hours services, including District Nurses and GPs, where there was previously very little provision for home care at night. It reports staff perspectives and experience of working for the HNS, and its role and value in the provision of out-of-hours hospice services. Results Participants’ accounts indicate the great potential for further development of rapid response services such as the HNS through effective integration between local hospice, health and social care services to provide a more substantial, clearly defined and essential resource for patients and family members. Conclusion Greater clarity is needed regarding the remit of Hospice at Home services such as the HNS, their best fit within local networks of palliative care, whether they are intended specifically for dying patients or more generally for those who are frail and vulnerable, and the extent and sustainability of long- term family care for severely ill patients dying at home.
Background Remote cognitive assessments are increasingly used with the rising popularity of teleneuropsychology. Here, we evaluated the performance of the remotely administered Oxford Cognitive Screen (Tele-OCS) compared to in-person administration in adult stroke survivors. Methods 40 stroke survivors (M age = 69.30, SD = 10.44; sex = 30% female) completed in-person and remote versions of the OCS on average 30 days apart, with different trained examiners. The order of administration was counterbalanced. Cohen’s d estimates were used to compare performance between modalities. Results We found that the proportion of OCS subtasks impaired did not differ across modalities (d <.001). With regards to raw subtask scores, only the picture naming subtask and executive score from the trail making subtask were found to be statistically different across modalities, though raw differences were minimal (<1 point difference on average). These statistical differences did not affect impairment classifications. Conclusions The Tele-OCS classified cognitive impairments in a comparable way to the in-person version. The validation of the Tele-OCS allows for remote assessment to increase accessibility and pragmatically aid in addressing the clinical need for stroke-specific cognitive screening in a wider population.
Background The pathophysiology and medical management between ischaemic stroke and intracerebral haemorrhage differ as do their functional independence and mortality outcomes. This paper aims to establish whether their respective upper limb motor impairment and recovery differ. This information could inform discussions with patients about their recovery prognosis as well as identify appropriate rehabilitation settings. Methods A PROSPERO registered systematic search of three databases (MEDLINE, CINAHL, Embase) identified studies that measured upper limb motor function (Fugl-Meyer assessment scale for upper extremity) in participants with first stroke (ischaemic stroke or intracerebral haemorrhage) within 31 days post-stroke and at least one follow-up assessment. Risk of bias was assessed using the Critical Appraisal Skills Programme. Results The search identified 1108 studies of which three met inclusion criteria, with a total of 258 participants (200 ischaemic stroke, 58 intracerebral haemorrhage). All studies had low to moderate risk of bias. At baseline, participants with intracerebral haemorrhage had greater upper limb motor impairment on the Fugl-Meyer assessment scale, but at six months post-stroke, the stroke subtypes reached similar upper limb motor function. Improvements were greatest early after stroke. Conclusions Despite greater severity at baseline, intracerebral haemorrhage survivors appeared to reach the same level of arm function at six months post stroke. However, these findings need to be interpreted with caution due to limited studies and small number of participants included in this review and warrant further research. PROSPERO registration CRD42020159110 (19/02/2020).
Background The pathophysiology and medical management between ischaemic stroke and intracerebral haemorrhage differ as do their functional independence and mortality outcomes. This paper aims to establish whether their respective upper limb motor impairment and recovery differ. This information could inform discussions with patients about their recovery prognosis as well as identify appropriate rehabilitation settings. Methods A PROSPERO registered systematic search of three databases (MEDLINE, CINAHL, Embase) identified studies that measured upper limb motor function (Fugl-Meyer assessment scale for upper extremity) in participants with first stroke (ischaemic stroke or intracerebral haemorrhage) within 31 days post-stroke and at least one follow-up assessment. Risk of bias was assessed using the Critical Appraisal Skills Programme. Results The search identified 1108 studies of which three met inclusion criteria, with a total of 258 participants (200 ischaemic stroke, 58 intracerebral haemorrhage). All studies had low to moderate risk of bias. At baseline, participants with intracerebral haemorrhage had greater upper limb motor impairment on the Fugl-Meyer assessment scale, but at six months post-stroke, the stroke subtypes reached similar upper limb motor function. Improvements were greatest early after stroke. Conclusions Despite greater severity at baseline, intracerebral haemorrhage survivors appeared to reach the same level of arm function at six months post stroke. However, these findings need to be interpreted with caution due to limited studies and small number of participants included in this review and warrant further research. PROSPERO registration CRD42020159110 (19/02/2020).
This May, the World Health Assembly (WHA) will vote on re-establishing a mandate for the World Health Organization (WHO) to address the health consequences of nuclear weapons and war [1]. Health professionals and their associations should urge their governments to support such a mandate and support the new United Nations (UN) comprehensive study on the effects of nuclear war.
As the global population ages, and rates of modifiable risk factors for cancer change, cancer incidence and mortality continue to increase. While we understand many modifiable risk factors related to diet, nutrition, bodyweight, and physical activity in adulthood that influence cancer risk, how exposure during childhood, adolescence, and young adulthood impacts cancer risk is less clear. This is partly because the timeline from initial mutation to cancer development and diagnosis can span several decades. This long latency period creates methodological, ethical, and financial issues; as well as resource and feasibility challenges in the design, implementation, and data analysis of lifecourse studies. As such, the large majority of lifecourse studies are observational, often using recall data which has inherent bias issues. Concurrently, a new research era has begun, with mature birth cohort studies that are phenotyped/genotyped and can support studies on adult cancer risk. Several studies and consortia contain information spanning the lifecourse. These resources can support association, mechanistic and epigenetic investigations into the influences of multi-disciplinary (e.g. genetic, behavioural, environmental) factors, across the lifecourse and critical time periods. Ultimately, we will be able to produce high-quality evidence and identify how/when early life risk factors impact cancer development and survival.
As the global population ages, and rates of modifiable risk factors for cancer change, cancer incidence and mortality continue to increase. While we understand many modifiable risk factors related to diet, nutrition, bodyweight, and physical activity in adulthood that influence cancer risk, how exposure during childhood, adolescence, and young adulthood impacts cancer risk is less clear. This is partly because the timeline from initial mutation to cancer development and diagnosis can span several decades. This long latency period creates methodological, ethical, and financial issues; as well as resource and feasibility challenges in the design, implementation, and data analysis of lifecourse studies. As such, the large majority of lifecourse studies are observational, often using recall data which has inherent bias issues. Concurrently, a new research era has begun, with mature birth cohort studies that are phenotyped/genotyped and can support studies on adult cancer risk. Several studies and consortia contain information spanning the lifecourse. These resources can support association, mechanistic and epigenetic investigations into the influences of multi-disciplinary (e.g. genetic, behavioural, environmental) factors, across the lifecourse and critical time periods. Ultimately, we will be able to produce high-quality evidence and identify how/when early life risk factors impact cancer development and survival.
Background Remote cognitive assessments are increasingly used with the rising popularity of teleneuropsychology. Here, we evaluated the performance of the remotely administered Oxford Cognitive Screen (Tele-OCS) compared to in-person administration in adult stroke survivors. Methods 40 stroke survivors (M age = 69.30, SD = 10.44; sex = 30% female) completed in-person and remote versions of the OCS on average 30 days apart, with different trained examiners. The order of administration was counterbalanced. Cohen’s d estimates were used to compare performance between modalities. Results We found that the proportion of OCS subtasks impaired did not differ across modalities (d <.001). With regards to raw subtask scores, only the picture naming subtask and executive score from the trail making subtask were found to be statistically different across modalities, though raw differences were minimal (<1 point difference on average). These statistical differences did not affect impairment classifications. Conclusions The Tele-OCS classified cognitive impairments in a comparable way to the in-person version. The validation of the Tele-OCS allows for remote assessment to increase accessibility and pragmatically aid in addressing the clinical need for stroke-specific cognitive screening in a wider population.
Aging populations have increased demand for hospice palliative care and support for dying persons. More broadly, community support is also becoming an increasingly important aspect of public health intervention. Compassionate communities advocate active bottom-up community participation to strengthen communities’ assets around death and dying. However, these rapidly growing initiatives face a challenge in putting values such as cultural diversity, relationship, and love into practice and in making a social impact through “meaningful participation” at the community level. Reflecting on our experiences in a recent study of dying at home in Canada, we consider potential challenges for compassionate communities more broadly. We argue that risks related to gendered inequity, neo-liberal discourses around caring work, and an over-emphasis of community resilience need to be deliberated in compassionate community policy and service development. To mitigate these risks, we argue that the eight components of the International Standards for Community Development Practice or ISCDP (from the International Association for Community Development or IACD) provide important direction about putting values into practice, for instance by advocating for service and policy improvement while engaging in practice and research on compassionate communities. We discuss how the international standards can inform compassionate community development in Canada.
Background Post-traumatic stress disorder (PTSD) remains a significant concern among military personnel, with combat experiences posing a heightened risk. Methods A mixed methods approach was employed to investigate PTSD's diverse nature, utilizing both quantitative surveys and qualitative inquiry. The study involved thirty participants, predominantly male and Caucasian, with varying military service backgrounds. Results Quantitative analysis revealed a high prevalence of traumatic experiences prompting mental health care seeking, alongside dissatisfaction with available military-connected mental health care options. Qualitative analysis uncovered coping strategies ranging from therapeutic counseling to medication. Conclusions Despite interest in mental health care services, satisfaction levels were suboptimal, indicating a need for improved support structures. The findings underscore the ongoing emotional toll of traumatic events, with implications for substance abuse and relationship challenges. Future research should aim for greater diversity in participant demographics and explore partnerships with veteran organizations for enhanced outreach and support initiatives.
Background Our aim was to determine the impact of the COVID-19 pandemic on the publication productivity of neurosurgeons in the United Kingdom and Republic of Ireland. Methods Using bibliometric data we quantified and analysed the academic output of neurosurgeons in England, Scotland, Northern Ireland, Wales, and the Republic of Ireland, between two time periods i.e., January 2017 to December 2019 and January 2020 to March 2022, as a representative capture of the academic climate before and after the start of the COVID-19 pandemic. The consultant neurosurgeons were grouped according to their departments, title, sex, subspecialities and additional research qualifications. Using data charts on Scopus author directory, the total number of publications, citations and h-indices of each neurosurgeon were obtained over the two time periods. The median and mean of these 3 parameters were computed and the median values were analysed and tested for significance using a Mann Whitney-U test according to the groups. Results Our analysis conveyed a statistically significant increase (2440 publications and between January 2020 and March 2022 there were 2548 publications p<0.05) in the total number of publications after the start of the COVID-19 pandemic compared to before. There was a statistically significant decrease in the mean number of citations (mean 55.24 vs 57.01, p<0.05), after the start of the COVID-19 pandemic. This trend was observed in both sexes, in authors without an additional MD/PhD and in authors who sub-specialized in neuro-oncology. Overall, there was a significant decrease in H-index after the start of the pandemic compared to before (median h-index:1.00 and 2.00; mean h-index:1.8 and 3.4 respectively). Conclusions There appears to be an apparent increase in total number of publications after the start of the COVID-19 pandemic, most authors have registered a reduction in citations and h-indices, suggesting a lower impact and unequal distribution of the abovementioned increase.
Background The importance of quality of life needs to be reviewed critically as the number of elderly people's life expectancy increases with the advances in science. Retirees in developing countries like Nigeria experience dwindling resources, increasing their vulnerability, and decreasing their quality of life. These problems range from reduced monthly pension payout, residential homes, the deteriorating economy of the country, as well as deteriorated health conditions due to ageing. The study aimed to explore retirees’ quality of life as influenced by socio-economic factors, in Southwestern Nigeria. Methods An Interpretative Phenomenological Analysis (IPA) design was used. The study population consisted of healthcare retirees from three purposefully selected states of Southwestern Nigeria. After gaining consent, data was collected through in-depth interviews and focused group discussions (FGDs). Both were audio recorded, transcribed verbatim, and analyzed using the IPA procedures. This was then imported into NVivo Version 12. Results Respondents identified factors like social life adjustments and financial illiteracy as the main problem. Social status changes coupled with the inevitable ageing process only need adaptation. Government non-support of the senior citizens in the form of discounted food and medicine exacerbates the problem. The theme of “government support” and subthemes like “housing”, “socio-economic status”, “family responsibility”, and “health status” emerged. Conclusions Retirees cherish social relationships although their participation was limited by financial scarcity and ill-health. Encouraging social activities requires government support, networking, and family participation to improve the quality of life for the elderly.
Aging populations have increased demand for hospice palliative care and support for dying persons. More broadly, community support is also becoming an increasingly important aspect of public health intervention. Compassionate communities advocate active bottom-up community participation to strengthen communities’ assets around death and dying. However, these rapidly growing initiatives face a challenge in putting values such as cultural diversity, relationship, and love into practice and in making a social impact through “meaningful participation” at the community level. Reflecting on our experiences in a recent study of dying at home in Canada, we consider potential challenges for compassionate communities more broadly. We argue that risks related to gendered inequity, neo-liberal discourses around caring work, and an over-emphasis of community resilience need to be deliberated in compassionate community policy and service development. To mitigate these risks, we argue that the eight components of the International Standards for Community Development Practice or ISCDP (from the International Association for Community Development or IACD) provide important direction about putting values into practice, for instance by advocating for service and policy improvement while engaging in practice and research on compassionate communities. We discuss how the international standards can inform compassionate community development in Canada.
Background The aim of this study was to explore whether sail training using a VSail® simulator would allow people with spinal cord injuries (SCI) to learn to sail in a safe controlled environment and then sail competently on the water in wind of moderate strength (12 knots). A battery of physical tests and questionnaires was used to evaluate possible improvements in health and well-being as a consequence of participation in the trial. Methods Twenty participants were recruited with the assistance of their physicians from The International Center for Spinal Cord Injury, Kennedy Krieger Institute. Inclusion criteria were SCI >6 months previously, medically stable, with no recent (1 month or less) inpatient admission for acute medical or surgical issues. All neurological SCI levels (C1-S1) were eligible. All subjects followed a programme of instruction leading to mastery of basic sailing techniques (steering predetermined courses, sail trimming, tacking, gybing and mark rounding). Results Not all participants completed the study for various reasons. Those that did were seven males and six females, six with tetraplegia and seven with paraplegia. The mean age was 45 years (23 to 63) and the average time since injury was 14.7 years (2 to 38 years). At the end of the course subjects were able to perform the sailing maneuvers and navigate a triangular racecourse on the simulator’s display in 12 knots of wind within a pre-set time. At 6 weeks post completion of training most subjects showed a decrease in depression, physical and social limitations, and an improvement in physical tests. These improvements were maintained or increased in most participants by 12 weeks, but not others. Conclusions The primary objective of the trial was achieved as all participants who completed the VSail® training were able to sail on the water at the Downtown Sailing Center in Baltimore.
