Individuals with neurodisabilities require comprehensive support to improve outcomes in multiple areas related to their primary condition, such as continence, mobility, and psychological wellbeing. Insufficient management of neurodisabilities can negatively impact an individual’s quality of life, and the resulting economic burden can be significant. One way to ensure quality of care in an economically viable way is through community-based service provision, allowing individuals to seek healthcare locally. This systematic literature review identifies, collates, and summarises empirical evidence on economic evaluations and their corresponding methods used to investigate the economic impact of community-based healthcare interventions for neurodisability management. A systematic search of the literature was conducted across six databases, with study selection guided by a Population, Intervention, Comparison, Outcomes and Study (PICOS) framework. Studies published after January 1990 assessing minimally to non-invasive community-based interventions for continence, mobility and psychological wellbeing were considered. Of the 1,216 studies identified, 94 were selected for a full-text examination, of which 14 met the inclusion criteria. Full economic evaluations were performed in eight studies, while six were partial economic evaluations. Just five studies describe interventions explicitly delivered in the community; the remainder describe clinical-based interventions which could be implemented at the community level or interventions provided in both community and clinical settings. Most studies were performed from the narrower healthcare provider perspective, suggesting that costs may be underestimated. Studies that measured health-related quality of life outcomes used either generic preference-based measures alone or in combination with a non-preference-based or disease-specific measure. Overall, economic evidence regarding the use of community-based interventions for neurodisability management is scarce, reflecting both a limited number of such interventions and a lack of formal economic evaluations assessing them. Moreover, the methodology used to determine cost effectiveness is heterogenous. Choice of intervention, population, perspective, and time horizon was possibly restricted by the trial-based data available. Future studies could consider using decision analytical modelling to overcome some of these barriers.

Background: Emergency departments are experiencing crowding and delays in care, which are associated with poorer patient outcomes. Nurse staffing is a key determinant of patient throughput and outcomes, but much of the existing research relies on indicators such as average nurse-to-patient ratios that do not account for daily variation in patient acuity. Acuity-adjusted measures of staffing that reflect the balance between available nursing hours and patient care requirements may provide a more accurate understanding of how nurse staffing affects emergency department performance.Objective: To examine the association between nurse staffing, adjusted for daily case-mix acuity, and patient processes and outcomes. Design: Retrospective longitudinal study.Setting: Emergency department of a university hospital. Participants: Administrative data from 67,010 patients corresponding to 115,078 adult visits over 787 consecutive days.Methods: Routinely collected emergency department data from January 2018 to February 2020 were analysed, with each 24-hour period as the unit of analysis. Actual nursing hours were taken from rosters. Required nursing hours were estimated by linking each patient’s Manchester Triage System category to a pre-determined nursing care time. A staffing deficit was defined as actual minus required hours. Process measures were time to triage, and wait to be seen; outcome measures were patient experience time, and leaving without being seen. Models were run unadjusted and adjusted for potential confounders.Results: On average, 85% of visits were triaged as urgent or very urgent. On 88% of days, actual nursing hours were below the estimated requirement. Median times were 21 minutes to triage, 2.1 hours to be seen, and a median of 7.0 hours total patient experience time. Staffing deficits were associated with poorer patient processes and outcomes (p < 0.001). Each 5-hour deficit (versus no deficit) in nurse staffing was associated with a 21% increase in time to triage (RGM 1.21; 95% CI 1.19 to 1.23), a 12% increase in wait to be seen (RGM 1.12; 95% CI 1.09 to 1.14), a 7% increase in patient experience time (RGM 1.07; 95% CI 1.05 to 1.09), and 16% higher odds of a patient leaving without being seen (OR 1.16; 95% CI 1.11 to 1.22). Conclusions: Lower nurse staffing relative to patient acuity was associated with delays across all stages of care and more patients leaving without being seen. An acuity-adjusted staffing metric provides a more accurate relationship between staffing and patient need than simple nurse-to-patient ratios supporting its use in determining safe emergency department staffing.

Objectives Namaste Care, a non-pharmaceutical daily multicomponent palliative care intervention, offers care for people with dementia, aiming to improve quality of life of those living with dementia as well as their family and caregivers. This systematic review explores the Namaste Care intervention and its clinical and economic effects in multiple care settings. The aim of this review is to consolidate existing evidence on Namaste Care’s clinical and economic outcomes and examine the tools used for data collection. Design A systematic literature search was conducted (PubMed, Scopus and Web of Science) to identify peer-reviewed studies on Namaste Care’s impact on quality of life, costs, health, economic outcomes and benefits up to 22 February 2026. Methodological quality was assessed using the Mixed Methods Appraisal Tool, while the completeness of reporting of economic evaluation studies was evaluated according to the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS). Results 31 studies reported the clinical and/or economic outcomes of Namaste Care. The results for quality of life and quality of dying were mixed, while 5 of 11 studies evaluating quality of life reported significant improvements. The various quality-of-life instruments used include the Quality of Life in Late-Stage Dementia (QUALID), EQ-5D-3L and EQ-5D-5L instruments, ICEpop CAPability Measure for Older People (ICECAP-O), ICECAP Supportive Care Measure (ICECAP-SCM), Quality of Life for People with Dementia (QUALIDEM) and Carers-DEMentia Quality of Life (C-DEMQOL). The clinical outcomes considered included pain, behavioural symptoms and quality of end-of-life care. The Medication Quantification Scale and Minimum Data Set indicated reductions in antidepressant and antianxiety medication use. Seven studies reported significant improvements in well-being, and two studies reported reduced stress among family members following Namaste Care sessions. A subset of five studies reported a range of economic outcomes. Conclusion The findings suggest that Namaste Care improves well-being, reduces caregiver stress and lowers the use of antidepressant and antianxiety medications at a moderate cost. The current literature is characterised by small, non-random, heterogeneous studies. Randomised controlled trials, which include economic evaluations, help to improve evidence-based research to support funding and implementation decisions on Namaste Care. PROSPERO registration number CRD42024560056.

PURPOSE:Those living beyond a cancer diagnosis experience unmet supportive care needs due to fragmented post-treatment pathways and limited integration of digital health tools. The Linking You to Support and Advice (LYSA) trial assessed the feasibility of a complex-intervention which incorporated a nurse- and dietitian-led multidisciplinary clinic and a digital platform for capturing and responding to electronic Patient-Reported Outcome (ePRO) data for women with early-stage breast and gynecologic cancer less than 12 months post-primary curative therapy. METHODS:The LYSA trial was an unblinded, randomized, controlled, feasibility trial co-designed with public and patient involvement, conducted across two cancer centers in Ireland. Participants were randomized to the experimental arm, receiving bi-monthly ePRO assessments and trigger-initiated responses to ePROs for 12 months; or the active comparator arm, receiving usual care. Primary feasibility outcomes included participant enrolment, ePRO survey completion, and healthcare professional engagement triggered by ePRO assessments. Secondary outcomes focused on symptom scores, health-related quality of life (HRQOL), and patient satisfaction. A process evaluation explored factors affecting implementation. RESULTS:The trial met its three predefined feasibility outcomes: 200 participants were enrolled (84% breast, 16% gynecologic), >85% of baseline and endpoint surveys were completed, and >70% of participants in the experimental arm engaged in nurse and dietetic consultations following ePRO symptom triggers. The experimental arm demonstrated significant improvements in fatigue (p = 0.018), anxiety (p = 0.012), depression (p < 0.001) and HRQOL (p = 0.031) scores. The process evaluation indicated high levels of satisfaction with the intervention, with positive feedback on the multidisciplinary approach and responsive symptom management. CONCLUSIONS:LYSA demonstrates the feasibility and acceptability of an ePRO-led survivorship approach, with potential HRQOL and symptom benefits, warranting a powered efficacy trial.

BACKGROUND:Testicular cancer (TC) is the most common malignancy amongst adolescents and young adults (AYAs) aged 15-39 years assigned male at birth. Survivors often experience late effects of treatment and report unmet supportive care needs. OBJECTIVES:To present the protocol for the TRANSCEND-XR project (TesticulaR cANcer late effects and unmet Supportive CarE NeeDs of AYA survivors using eXtended Reality). MATERIALS AND METHODS:TRANSCEND-XR aims to ethically co-create, test, and scale up in a clinical setting an innovative digital intervention to increase AYA TC survivors' knowledge of the late effects of TC treatment and address their unmet supportive care needs using XR. Delivered by a consortium of 15 partners across 12 European countries, guided by the Medical Research Council's framework for complex interventions, and funded by the European Union, TRANSCEND-XR is structured into three phases: co-creation and validation (Phase 1); implementation and evaluation (Phase 2); and impact, guideline development, policy, dissemination, and exploitation (Phase 3). RESULTS:Phase 1 involves a cross-sectional survey of 500 AYA TC survivors to assess late effects and care needs as well as participatory World Café sessions with healthcare professionals, survivors, and care partners (n = 200) to co-design the TRANSCEND-XR intervention. Phase 2 includes a multicentre, single-arm phase 2 pilot trial (n = 15) across three clinical sites in three countries evaluating intervention feasibility, and a multicentre pragmatic randomised controlled phase 3 trial (n = 230) across eight clinical sites in seven countries, evaluating improvements in knowledge of late effects, cost-effectiveness, implementation, and ethical considerations. Phase 3 focuses on guideline development, policy influence, and strategic dissemination to ensure long-term sustainability and integration into European healthcare systems. DISCUSSION:TRANSCEND-XR aims to transform survivorship care for AYA TC survivors through a co-created, scalable XR intervention. Its interdisciplinary approach promotes scientific rigour, stakeholder engagement, and policy relevance to improve long-term outcomes and quality of life. CONCLUSION:TRANSCEND-XR has the potential to advance survivorship care standards for AYAs with TC whilst providing a model for future digital health interventions in oncology.

This qualitative study explores the economic impacts of bereavement from the perspectives of bereaved individuals and professionals supporting them in Ireland. Data from interviews with bereaved individuals and focus groups with professionals supporting them are analysed using inductive thematic content analysis. Results show there are identifiable groups, with pre-existing vulnerabilities, who are most likely to be severely economically impacted by bereavements. The economic hardship may be owing to direct loss of income arising from the deceased no longer financially contributing to the household, increased expenses associated with the funeral, and indirectly arising from the adverse impacts of grief. This hardship can reduce household incomes and create a complex and challenging financial situation, with long-term implications for workforce participation. While some support is available, it is often insufficient, which in turn contributes to household debt and financial strain. Future policies must mitigate the impacts and minimize inequalities.

INTRODUCTION:Job satisfaction and intention to leave have been consistently linked to the working environment. However, there are few studies of interventions for improving the environment or staff outcomes. AIM:To determine the impact of implementing a framework for safe nurse staffing on the environment and staff outcomes. This involved an assessment of required nursing hours per patient day, supernumerary nurse in charge and minimum 80:20 skill-mix, with intentional changes in staffing if required. DESIGN:A pre-post observational design. METHODS:This was a prospective observational study in six medical and/or surgical wards across three acute hospitals in Ireland. The outcomes were measured pre- and post-implementation, and included the environment, using the Practice Environment Scale of the Nursing Work Index; and job satisfaction and intention to leave using a dichotomised 4-point scale. OUTCOMES:Changes in staffing levels, adjustments to skill-mix and the supervisory role of the ward leader were seen following the implementation. A multilevel model found significant increases over time on three of the five Nursing Work Index subscales: Staffing and Resource Adequacy, Collegial Nurse-Physician Relations, and Nurse Participation in Hospital Affairs. Job satisfaction increased and intention to leave decreased, although the differences were not statistically significant. Increased job satisfaction was significantly associated with Staffing and Resource Adequacy, Collegial Nurse Physician Relations and Nurse Manager, Leadership and Support. A decreased odds of intention to leave was associated with increased job satisfaction. CONCLUSION:There were significant improvements in the environment following the implementation of the Framework. Three of the practice environment subscales were significantly associated with job satisfaction, while job satisfaction is a predictor of intention to stay. This study indicates that intentional changes to staffing can result in improvements to working environments which may in turn have an impact on job satisfaction and furthermore, on intention to stay. IMPACT:This study investigated intentional changes to nurse staffing in medical and surgical wards, examining the impact pre- and post-implementation. This study underlined that when staffing is based on a systematic approach, based on a Framework for Safe Nurse Staffing, a subsequent improvement can be seen in staff's perceptions of the work environment, along with improvements in staff outcomes. This research will impact on staff working in acute settings as a means of determining staffing and improving outcomes using a Framework for Safe Nurse Staffing. REPORTING METHOD:STROBE checklist. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

Retinal disease is one of the leading causes of blindness and vision impairment worldwide, including Europe. With the advent of gene therapy, the treatment landscape for retinal disease is changing and clinical trials are underway investigating the therapeutic potential of gene therapy in both acquired and inherited retinal diseases. Given the high price of innovative medicines, it is essential to consider the current costs associated with retinal diseases to inform economic evaluations early in the life cycle of these forthcoming treatments. These could inform future reimbursement decisions, health budgets and service delivery plans. This systematic literature review sought to examine the economic burden of retinal diseases, for which gene therapy is emerging for patients in Europe. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guideline, a systematic search was performed using the Medline, CINAHL, EconLit and Embase databases. The searches were restricted to English language articles published after 1st January 2000. Following article selection, data were extracted in a tabular form and a narrative synthesis was performed. A total of 28 research studies were identified and included in the review that varied in terms of disease of interest, size, country setting, methodology, as well as how costs were reported and valued. While many retinal diseases were considered, almost half of the articles related to the costs of neovascular age-related macular degeneration (nAMD). Significant cost variations were observed across the studies as costs ranged from 45 USD to almost 30,000 USD per patient per annum, across all conditions combined. This systematic literature review evidences the heterogeneity among studies analysing the economics of retinal diseases underlying vision impairment. The paucity in the literature, signals the need for further research investigating the costs associated with retinal diseases, for which innovative therapies are expected to enter the market and will be subject to evaluation by decision-makers, whose decisions will have a significant impact on the delivery of these technologies to patients.

Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

AIM:To examine burnout levels, nurse perceptions of the work environment, job satisfaction, intention to stay and quality of care for nurses working in emergency departments before and following a planned change to nurse staffing levels. DESIGN:A pre-post observational design. METHODS:A systematic approach (Nursing Hours per Patient Presentation) was introduced to determine nurse staffing levels based on patient presentations resulting in adjustments to nurse staffing. Data on burnout, the work environment, intention to stay, job satisfaction and quality of care were collected from three emergency departments prior to and following the adjustments to nurse staffing. RESULTS:An adjustment to nurse staffing levels was made to all three emergency departments. Mean emotional exhaustion scores were significantly lower, and quality of work environment scores and levels of job satisfaction were significantly higher for nurses following staffing adjustments. There was an increase to the proportion of nurses who perceived an improvement in quality of care delivered. In general, the results indicated improvements in outcomes following adjustments to nurse staffing levels. CONCLUSION:A more holistic organisational approach is required to address staffing in emergency departments. Initiatives that involve frontline nurses in resource planning facilitating a bottom-up approach to allow for improved work environments would be beneficial. IMPACT:This study addressed a planned change to nurse staffing levels in emergency departments and staff outcomes pre and post changes to staffing levels. This study highlighted that staffing an emergency department, based on nursing hours per patient presentation, was associated with improvements in staff outcomes. The research will impact on nurses working in emergency departments as outcomes from this research were used to develop a Framework for Safe Nurse Staffing and Skill Mix in Emergency Care Settings. REPORTING METHOD:STROBE and SQUIRE checklist. PATIENT OR PUBLIC CONTRIBUTION:No Patient or Public Contribution.

As dementia is a life-limiting illness, it is now widely accepted that people with dementia benefit from palliative care. The core components of palliative care for people with dementia have been suggested, however little is known about what an effective dementia palliative care service looks like in practice. While some services exist, a lack of description and scant detail on how and why they work makes it difficult for others to learn from existing successful models and impedes replication. Accordingly, we set out to describe an effective dementia palliative care service using programme theory, and to visually represent it in a logic model. This was mixed-methods study. An exemplary dementia palliative care service, which cares for people with advanced dementia in their own home in the last year of life, had been identified from a previous survey. The development of the programme logic model was informed by interviews with staff (n = 6), staff surveys (n = 1), service user surveys (n = 10) and the analysis of secondary data sources including routinely collected service data. The logic model and summary results explain in detail how this dementia palliative care service undertook activities relating to person-centred care, carer support, end-of-life care, accessible care, timely care, and integrated care. It maps each activity to specific outputs and outcomes, showing that dementia palliative care, when provided appropriately, can greatly improve the quality of care received by people living and dying with advanced dementia, and their families, in the community. The logic model presented may support those developing dementia palliative care services, or guide others running existing services in how to systematically present their service activities to others, and demonstrates how clinicians, policy-makers, and others involved in service planning can utilise logic models to design new services and improve existing services.

Virtual reality (VR) is potentially effective in raising awareness of testicular diseases, promoting self-examination and early help-seeking among men. This paper presents an early economic evaluation exploring the potential cost-effectiveness of Enhancing Men’s Awareness of Testicular diseases (E-MAT)VR, a VR interactive experience compared with E-MATE, electronic information, among male athletes Results from this economic evaluation will inform and support the design of a future randomized controlled trial (RCT). Results from an Irish feasibility trial (ClinicalTrials.gov identifier: NCT05146466) with 74 participants conducted in 2022 were employed. Benefits were measured in monetary units whereby the contingent valuation method was used to elicit participants’ preferences through willingness-to-pay measures. A micro-cost analysis estimated the costs of the intervention and comparator and subsequent resource use. The costs and benefits of E-MATVR and E-MATE were compared to determine the net benefit. Sensitivity analyses were also conducted. Base case analysis suggests participants were willing to pay €21.88 for E-MATVR and €11.16 for E-MATE. The total cost of E-MATVR was €104.09 and of E-MATE was €22.75 per participant. These estimates include capital and delivery costs, of which delivery costs were €25.02 and €22.40 for E-MATVR and E-MATE, respectively. A negative net benefit indicates E-MATVR was not cost-beneficial as delivered in the feasibility trial. Scenario analyses demonstrated reducing costs via delivery modifications increased the probability of E-MATVR being considered cost-effective. The cost–benefit analysis was feasible, response rates were acceptable, and willingness-to-pay estimates were stable. Economic evaluations alongside feasibility trials enable early economic evaluations, informing the design and conduct of a future RCT. E-MATVR had higher expected benefits (WTP) and costs than E-MATE, yielding a negative net benefit. Given the high cost of digital health interventions, investigating their cost-effectiveness early is important to inform and optimize resource allocation decisions. We present a series of scenarios to demonstrate how delivery modifications to reduce costs could improve the likelihood of E-MATVR being considered cost-effective.

1505 Background: Expert consensus supports a multidisciplinary strategy in cancer survivorship care to enhance patient outcomes and quality of life. We hypothesized that introducing a women’s survivorship clinic into routine follow up care would be feasible, and associated with improved symptom management and quality of life (QOL). Methods: LYSA was a multisite randomized controlled trial with parallel arms (experimental and active comparator), co-designed with public and patient involvement. Eligibility: early-stage hormone receptor-positive breast or gynaecologic cancer (GYN) within 12 months of completing primary therapy, and internet access (NCT05035173). Experimental arm attended a nurse-led clinic targeting symptom management, and dietetic consultation. Electronic patient-reported outcome (ePRO) assessments were undertaken at baseline, and bimonthly to 12 months. An online trigger alert system facilitated symptom management. Active comparator arm attended the nurse-led clinic at baseline and end of study. Primary endpoint (feasibility): Proportions of participants completing baseline and follow up ePRO surveys, and engaging in healthcare consultations after ePRO triggers. Pilot efficacy endpoints: changes in cancer-related symptom (PROMIS, PRO-CTCAE, Fear of Cancer Recurrence), health-related QOL Questionnaires (EORTC-QLQ, EQ5D5L) . Sample size target (n=200) facilitated feasibility outcomes. Between arm differences were estimated using generalized linear model, adjusted for baseline outcome. Results: 200 women were randomized, March 2021-August 2022 across two sites; 84% breast and 16% GYN. Consent was obtained in clinic (51%), video call (33%) or phone (16%). Median age was 54 (range 23-78). Of the 173 participants completing the study (n = 90 experimental, 83 comparator), all completed both baseline and end of study surveys. Following symptom triggers (experimental arm), there were 322 study nurse visits across 86 participants, and 243 dietician visits across 73 participants. Engagement with healthcare and other supportive resources was approximately twice more than comparator arm, due to referral. There were no notable between-arm differences with respect to EQ5D5L items at study end. However, experimental arm participants had better EORTC Total scores at study end relative to comparator (difference in means -3.87 95%CI -6.58 to -1.16, p=0.005). There were also significant (p < 0.05) differences observed between the arms for 8/12 symptom items reflecting less fatigue, anxiety and depression in experimental arm at study end. Conclusions: The LYSA trial met its primary feasibility endpoint, with high rates of ePRO completion. Secondary endpoint analysis is ongoing including an economic analysis and future studies. Clinical trial information: NCT05035173 .

BackgroundThe relationship between nurse staffing, skill-mix and quality of care has been well-established in medical and surgical settings, however, there is relatively limited evidence of this relationship in emergency departments. Those that have been published identified that lower nurse staffing levels in emergency departments are generally associated with worse outcomes with the conclusion that the evidence in emergency settings was, at best, weak.MethodsWe searched thirteen electronic databases for potentially eligible papers published in English up to December 2023. Studies were included if they reported on patient outcomes associated with nurse staffing within emergency departments. Observational, cross-sectional, prospective, retrospective, interrupted time-series designs, difference-in-difference, randomised control trials or quasi-experimental studies and controlled before and after studies study designs were considered for inclusion. Team members independently screened titles and abstracts. Data was synthesised using a narrative approach.ResultsWe identified 16 papers for inclusion; the majority of the studies (n = 10/16) were observational. The evidence reviewed identified that poorer staffing levels within emergency departments are associated with increased patient wait times, a higher proportion of patients who leave without being seen and an increased length of stay. Lower levels of nurse staffing are also associated with an increase in time to medications and therapeutic interventions, and increased risk of cardiac arrest within the emergency department.ConclusionOverall, there remains limited high-quality empirical evidence addressing the association between emergency department nurse staffing and patient outcomes. However, it is evident that lower levels of nurse staffing are associated with adverse events that can result in delays to the provision of care and serious outcomes for patients. There is a need for longitudinal studies coupled with research that considers the relationship with skill-mix, other staffing grades and patient outcomes as well as a wider range of geographical settings.Tweetable abstractLower levels of nurse staffing in emergency departments are associated with delays in patients receiving treatments and poor quality care including an increase in leaving without being seen, delay in accessing treatments and medications and cardiac arrest.

Background Eight out of ten adults use social media, yet its efficacy in recruitment in clinical trials remains under-explored. The purpose of this SWAT was to determine which recruitment method, X, Facebook or QR code via posters, was more efficient and cost effective for recruiting participants to the host trial. Methods A cluster randomised cross-over design evaluated three recruitment strategies, X, Facebook and QR code. Seven Gaelic Athletic Association (GAA) clubs were randomised to receive either X, Facebook, or QR code. The seven clubs were re-randomised twice more, two weeks apart. There were two primary outcomes: 1. proportion of participants who consent to participate, relative to the number of players contacted; and 2. proportion of participants who consent to participate, relative to the number of players who clicked the link to register their interest. Results Fifty participants were randomised to three recruitment methods, and 47 were retained in the host trial. Participants mainly heard about the study through friends, with some engagement via social media platforms Facebook and X, and little to no engagement with the QR code. Primary outcomes were hindered by the inability to disaggregate data by GAA club. Economic outcomes revealed QR code as the costliest strategy, and while X was cheaper than Facebook in terms of the number of clicks, Facebook demonstrated better recruitment and retention and thus reduced the costs per participant. Conclusions While the inability to disaggregate data by club was a limitation, the study revealed that Facebook outperformed X and QR codes in terms of recruitment and participant retention and was thus considered to be more cost effective. The findings emphasise the importance of considering engagement patterns and cost-effectiveness in designing recruitment strategies for clinical trials, especially within the dynamic landscape of social media use.

Background In areas of social disadvantage up to 40–50% of children enter preschool with speech and language skills significantly poorer than would be expected for their age. The Happy Talk trial tests if a community embedded, targeted selective speech and language programme that simultaneously engages with parents and early childhood educators, (1) improves language outcomes in children aged between 2 years 10 months and 6 years and (2) is cost effective for the health care system. Method The Happy Talk trial is a large scale cluster randomised trial of a 12-week manualised intervention delivered in pre/school settings serving socially disadvantaged communities, in Ireland. Seventy-two clusters will receive the intervention (12 participants per cluster). Parents and pre/school staff engage in group training and coaching in the form of 12 1-hour sessions for parents and four staff workshops, over the course of the pre/school year. Training/coaching includes core interaction skills (modelling, expanding, balancing questions and comments), early literacy and phonological awareness. Blinded assessments pre- and immediately post-intervention and at 6 months follow up, will measure the primary outcomes of children’s receptive and expressive language and functional impact, and secondary outcomes of quality of life. Parental responsiveness and educator-child interactions will also be evaluated. Discussion This robust study evaluates a public health approach to the delivery of speech language and communication intervention in the ‘real world’ in the community, which focuses on prevention and equity of access. Pilot work indicates that the programme is feasible, acceptable to parents and staff, cost effective, and suitable for implementation at scale. The trial includes a process evaluation, a well-developed economic evaluation and the outcomes are directly relevant to children, families and educators. This work has the potential to improve the long-term outcomes and life chances of people living in social disadvantage. Trial registration clinicaltrials.gov NCT06460090 Trial Management There is a formal governance structure to oversee the conduct and running of the trial, consisting of a trial management group and a steering committee. More details on the composition, roles and responsibilities of each committee can be found in the supplemental material.

Purpose COVID-19 disrupted cancer care services in Ireland, from screening and diagnostics to treatments, possibly impacting physical health outcomes owing to delayed diagnosis and treatment changes. This study explores how cancer care and patients in Ireland were affected by COVID-19 from the perspective of Irish policy, clinical and patient stakeholders using a qualitative approach. The findings could inform future strategic and implementation plans for the current challenges faced and lessons learned will be identified. Methods A thematic analysis of a multi-stakeholder online workshop representing policy and clinical and patient stakeholders was completed. Results The pandemic exasperated prior challenges including under-resourced services, access barriers, staff shortages and lack of interoperability in information technology (IT) systems. Overall, the measures implemented protected cancer patients from COVID-19; however, some groups were more vulnerable, with apparent demographic and socio-economic inequalities. Many hard-fought gains from the previous decade, in terms of cancer screening, diagnosis and survivorship, were eroded. As we transition to the peri-COVID-19 period, staff burnout, poor IT infrastructure and lack of good quality data must be addressed to minimise further disruptions and restore and enhance cancer services. Conclusions Overall, innovations and measures adopted during the pandemic protected cancer patients; however, some groups were particularly vulnerable, and inequalities may have widened further. Only proven effective and efficient innovations introduced during the pandemic should be retained and enhanced. Good quality data is needed to inform such decisions when choosing amongst them.