搜索结果：International emergency nursing

Yemen's prolonged conflict has severely strained the healthcare infrastructure, creating resource shortages and staffing deficits that compromise nursing practice and patient safety. The Joint Commission International (JCI) provides globally recognized patient-centered standards for quality improvement; however, their implementation and association with self-reported nursing performance remain underexplored in fragile, resource-constrained settings such as Yemen. This cross-sectional study was conducted between August and October 2024 at six hospitals in Sana'a, Yemen. A simple random sample of 526 nurses from emergency, inpatient, intensive care, and neonatal units completed a validated 66-item questionnaire assessing six JCI domains-international patient safety goals (IPSGs), access to care and continuity (ACC), patient-centered care (PCC), assessment of patients (AOP), care of patients (COP), and medication management and use (MMU)-and self-reported nursing performance. Analyses included confirmatory factor analysis (CFA) with multigroup measurement invariance testing across hospital types, multiple regression (variance inflation factor [VIF]&#x2009;=&#x2009;3.07-5.69; Durbin-Watson&#x2009;=&#x2009;1.84), relative weights analysis to address multicollinearity, the marker-variable technique to assess common method bias (CMB), and extensive sensitivity analyses. JCI implementation was moderately high, with the highest mean score for ACC (mean&#x2009;=&#x2009;4.95&#x2009;&#xb1;&#x2009;1.38) and the lowest for IPSGs (mean&#x2009;=&#x2009;4.46&#x2009;&#xb1;&#x2009;1.48). Self-reported nursing performance was moderate (mean&#x2009;=&#x2009;4.64&#x2009;&#xb1;&#x2009;1.39). The standards explained 67.2% of the variance in self-reported performance (R2&#x2009;=&#x2009;0.672, p&#x2009;<&#x2009;0.001), with MMU (&#x3b2;&#x2009;=&#x2009;0.277), IPSGs (&#x3b2;&#x2009;=&#x2009;0.208), and PCC (&#x3b2;&#x2009;=&#x2009;0.137) emerging as the strongest correlates of self-reported nursing performance, although the cross-sectional same-source design precludes causal inference. ACC, AOP, and COP did not reach statistical significance. Measurement invariance testing achieved full scalar invariance (&#x394;CFI&#x2009;=&#x2009;0.008), validating direct mean comparisons across hospital types. Nurses in private hospitals reported significantly higher levels of JCI standard implementation than nurses in public hospitals across all six domains (p&#x2009;<&#x2009;0.001; Cohen's d&#x2009;=&#x2009;-0.60 to -0.89). The common method variance (CMV)-adjusted R2 was 0.59. JCI patient-centered standards showed significant positive associations with self-reported nursing performance in Yemen. Given the cross-sectional, same-source self-report design, these findings should be interpreted as correlational rather than causal, even after common-method-bias adjustment (CMV-adjusted R2&#x2009;=&#x2009;0.59). Targeted training in medication safety and patient safety protocols, coupled with equitable resource allocation and systemic investment in public hospitals, is recommended to close quality gaps and improve outcomes for vulnerable Yemeni populations. Nurse leaders should treat medication safety, IPSG-anchored supervision, and patient-centered communication as priority levers for quality improvement. They should also advocate for equitable resourcing and structural support of public-sector nursing to close the implementation gap with private hospitals.

Critical care, emergency, and urgent care nursing is practiced within a highly specialised clinical setting that requires advanced competencies extending beyond generalist nursing education and that are not currently formally delineated through a state-recognized residency-based specialty within the nursing specialties of the Spanish National Health System. The national regulatory framework allows for the justification of new specialties based on healthcare needs, clinical complexity, and the existence of clearly differentiated professional competencies. To identify the specific competencies of nurses in critical care, emergency, and urgent care, by analysing their differences in relation to existing nursing specialties, as a basis for justifying their establishment as a distinct specialty. A sequential mixed-methods, descriptive and comparative study was conducted in three phases: 1) a competency questionnaire based on the Nursing Interventions Classification, the Therapeutic Intervention Scoring System-28, and the National Aeronautics and Space Administration-Task Load Index; 2) an eDelphi consensus process; and 3) an association analysis between nursing interventions and NANDA-I diagnoses. Data were analysed using descriptive statistics and concordance measures, yielding high levels of reliability. The first phase of the study was completed by 3476 nurses, and 302 experts participated in the second phase. In the third phase, 72.72% of the interventions reached a high frequency level (4-5), with a predominance of generalist activities such as nutrition, mobility, hygiene, safety, and comfort. In contrast, specific interventions; including oxygenation, advanced therapies, diagnostics, and critical communication; showed a high frequency exclusively in intensive care units, post-anesthesia care units, in-hospital and out-of-hospital emergency services, and advanced life support and nurse-led advanced life support teams (85.6%). Concordance in nursing interventions was 67.10%, and the intervention-nursing diagnosis association reached 53.65%, with only 31.46% shared with existing nursing specialties. The findings identify an advanced and homogeneous competency core in critical care, emergency, and urgent care nursing, clearly differentiated from generalist practice and aligned with international advanced practice frameworks. Establishing a dedicated specialty would standardise training and competencies, leading to improvements in patient safety, quality of care, and healthcare system efficiency.

To explore the association between an optimised emergency procedure combined with structured health education and anxiety, depression and treatment outcomes in patients with acute ischaemic stroke (AIS). We conducted a retrospective cohort study of 114 AIS patients admitted to our stroke centre between January and December 2023. On the basis of the admission timeframe, patients were divided into a conventional care group (n = 57, January to June 2023, routine care) and a comprehensive nursing group (n = 57, July to December 2023, optimised integrated care). Emergency nursing outcomes were assessed after stabilisation and before ward transfer. Neurological recovery was assessed with the European Stroke Scale (ESS); anxiety and depression were assessed with the Generalized Anxiety Disorder-7 (GAD7) and Patient Health Questionnaire-9 (PHQ-9) as primary psychological indicators. Process times and nursing satisfaction were also evaluated. Data analysis was conducted using SPSS 27.0. Normality was verified using the Shapiro-Wilk test. Normally distributed data were expressed as mean &#xb1; standard deviation and analysed using an independent samples t-test, whereas non-normal data were expressed as median (interquartile range) and analysed using the Mann-Whitney U test. Categorical data were analysed using chi-square test. Multivariate linear and logistic regression were used to analyse indicators such as neurological function and nursing satisfaction, adjusting for confounding factors. A p-value < 0.05 was considered statistically significant. Compared with the conventional care group, the waiting time, diagnosis time, emergency room waiting time and recanalisation time of patients in the comprehensive nursing group were significantly shortened (p < 0.05). The degree of improvement in ESS (&#x2206;ESS) in the comprehensive nursing group was significantly higher, and the reductions in GAD-7 and PHQ-9 scores were also significantly greater (p < 0.05). Patient and family satisfaction in the comprehensive nursing group were significantly higher than those in the conventional care group (p < 0.05). Through multivariate linear regression analysis, with baseline National Institutes of Health Stroke Scale (NIHSS) score, time from onset to visit, hypertension and diabetes as adjustment factors, allocation to the comprehensive nursing group was still significantly correlated with &#x2206;ESS (&#x3b2; [95% confidence interval (CI)] = 8.15 [5.72 to 10.58], p < 0.001), &#x2206;GAD-7 (&#x3b2; [95% CI] = -2.18 [-2.92 to -1.44], p < 0.001), and &#x2206;PHQ-9 (&#x3b2; [95% CI] = -2.65 [-3.32 to -1.98], p < 0.001). The results of multivariate logistic regression analysis showed that, after adjusting for the above confounding factors, inclusion in the comprehensive nursing group was independently associated with a significantly higher likelihood of obtaining a satisfactory nursing evaluation (adjusted OR = 8.915, 95% CI: 2.453 to 32.468, p = 0.001). The integrated model is associated with shorter treatment times, better neurological recovery, reduced anxiety and depression and higher satisfaction in AIS patients, providing preliminary evidence for a patientcentred comprehensive emergency care model.

Prehospital emergency care systems are expanding in scope and complexity, yet research agendas remain disjointed and often nationally focused. An internationally informed set of research priorities is needed to guide strategic investment and evidence generation across emergency medical services (EMS) and paramedicine contexts, while recognizing that local funding environments and needs will continue to shape national research decisions. The objective of this study was to identify and validate internationally informed research priorities for paramedicine and prehospital EMS using a multi-phase, stakeholder-informed consensus and analytic approach. An observational, three-phase mixed-methods study was conducted. Phase 1 involved an open-ended Delphi survey of international prehospital stakeholders to generate research priorities. Phase 2 asked participants to rate the importance of each priority using a 10-point scale; exploratory factor analysis (EFA) was performed to identify underlying factors. Phase 3 used confirmatory factor analysis (CFA) to test the factor structure. Participants included clinicians, educators, researchers, managers, students, and policy stakeholders from multiple countries to maximize breadth of stakeholder input. Across the three phases, responses were obtained from 1,299, 717, and 954 participants, respectively, with 703 complete cases included in the final CFA. The final model comprised nine interrelated factors encompassing 40 research priorities. Factors reflected key areas of contemporary prehospital practice, including operations, clinical governance, evidence-based practice, health and well-being, special care (community paramedicine), culture, education and training, trauma care, and clinical care. Confirmatory factor analysis demonstrated acceptable model fit, supporting the robustness of the identified structure. This study presents an internationally informed framework of research priorities for prehospital emergency care. The findings provide a practical foundation for researchers, funders, EMS organizations, and policy stakeholders to align future research efforts, reduce duplication, and address high-impact gaps across diverse prehospital systems, while remaining responsive to local context.

Hypovolemic shock is a life-threatening condition frequently encountered in emergency care, resulting from significant blood or fluid loss that impairs oxygen delivery to vital organs. Common causes include trauma, surgery, gastrointestinal bleeding, and ruptured ectopic pregnancy. Prompt fluid resuscitation is critical, with nurses playing a central role in early recognition, timely intervention, and continuous monitoring. To synthesise the best evidence for fluid resuscitation practices in hypovolemic shock and assess nursing knowledge and practice in emergency settings. This systematic review was conducted using preferred reporting items for systematic reviews and metaanalyses (PRISMA) guidelines and evaluated through the grading of recommendations assessment, development, and evaluation (GRADE) system. Databases including PubMed, EMBASE, and Cochrane Library were searched for studies published between 2015 and 2024. The isotonic crystalloids are the preferred first-line therapy, with early goal-directed fluid administration and close patient monitoring improving outcomes. Nurse-led assessment and reassessment were key to guiding resuscitation and reducing complications. However, gaps in protocol adherence, documentation, and practice variation were identified. Knowledge deficits among nurses were also evident, highlighting the need for targeted training. This review supports the development of a structured nursing guideline for managing hypovolemic shock, emphasising evidence-based fluid strategies and continuous clinical evaluation. Strengthening nursing competencies through education and standardised protocols can enhance emergency care delivery and patient survival.

This study aims to explore the mediating role of psychological capital and work passion in the relationship between emergency head nurses' leadership and the emergency nurses' capacity in emergency public health events. A cross-sectional and correlational study. 330 emergency nurses from 4 hospitals conveniently selected from Zhejiang province in China. The survey utilized the General Information Questionnaire, the Head Nurse Leadership Scale, the Emergency Nurses' Capacity to Public Health Events Questionnaire and the Psychological Capital of Nurses Scale. Data analyses were performed using independent sample t-tests, Pearson correlation analysis, one-way analysis of variance, structural equation modeling (SEM) analysis. Four variables in this study were significantly correlated (r = 0.80-0.86, p < 0.01). The direct effect of the head nurses' leadership on the emergency nurses' capacity was significant (78.2%), the psychological capital and work passion of nurses had a chain mediating effect (3.6%). Emergency head nurses' leadership is a core driver for enhancing nurses' capacity, psychological capital partially mediates the relationship between leadership and emergency response competence, and the work passion plays a limited role. Future research should explore strategies to optimize leadership behaviors and psychological interventions to enhance emergency capacity among emergency nurses.

Workplace violence (WPV) represents a major occupational hazard in emergency care, yet validated instruments specifically designed for the prehospital emergency care context remain lacking. This study aimed to adapt and conduct a preliminary psychometric evaluation of the Questionnaire for the National Survey on Violence against Emergency Department Nurses (QuIN16VIPs) for use in prehospital emergency care (QuIN16VIPs-ET). A prospective pilot study was conducted among 33 prehospital emergency nurses working in an Italian prehospital emergency care service. The adaptation process included expert panel assessment of item clarity and contextual relevance, followed by pilot administration with test-retest evaluation after 7&#xa0;days. Feasibility outcomes included recruitment, questionnaire completion, missing data, survey usability, and temporal stability. Internal consistency was assessed using Cronbach's alpha and McDonald's omega, while test-retest reliability was evaluated using intraclass correlation coefficients (ICC). The questionnaire demonstrated excellent feasibility, with a 100% completion and retention rate and no missing data across administrations. No operational or technical difficulties were reported during questionnaire administration. Internal consistency was high (Cronbach's &#x3b1;&#xa0;=&#xa0;0.903; McDonald's &#x3c9;&#xa0;=&#xa0;0.905), and test-retest reliability demonstrated excellent temporal stability (ICC range: 0.87-0.94). The QuIN16VIPs-ET demonstrated satisfactory feasibility, internal consistency, and temporal stability, supporting its potential applicability in future multicenter psychometric and epidemiological investigations on workplace violence in prehospital emergency care.

Background/Objectives: The rapid expansion of telemedicine has reshaped healthcare delivery, positioning telenursing as essential for continuity of care and patient management. This scoping review maps current evidence on telecare nursing practices, examining organizational models, professional roles, and key clinical and organizational outcomes. Methods: The review was conducted across five international databases, following the methodological framework proposed by Arksey and O'Malley, the interpretive extension by Levac et al., and the Joanna Briggs Institute guidelines, with reporting aligned to PRISMA-ScR recommendations. The search identified 1760 records, of which 1219 remained after duplicate removal. After title and abstract screening and full-text evaluation, 25 studies met the inclusion criteria. Results: Telenursing was implemented across diverse clinical contexts, particularly in chronic disease management, oncology, postoperative care, and emergency settings. Evidence indicates improvements in symptom management, therapeutic adherence, quality of life, and complication reduction, suggesting positive clinical and organizational impacts. The literature highlights the need for advanced digital, communication, and relational competencies, emphasizing the importance of targeted professional training. Cross-cutting trends include enhanced continuity of care, greater patient autonomy, improved integration between hospital and community services, and reduced healthcare costs. Conclusions: This review provides an updated overview of telenursing applications, highlighting their adaptability across clinical settings and the expanding strategic role of nurses in digital care. The findings indicate a rapidly evolving field and emphasize the need for further research to strengthen organizational frameworks, define advanced competencies, and support the sustainable integration of telenursing into healthcare systems.

暂无摘要（点击查看详情）

To assess the prevalence of workplace violence (WPV) against clinical nursing students during internships and quantify the prevalence of different types of violence, such as physical, verbal and sexual. Systematic review and meta-analysis. Eligible cross-sectional studies that reported WPV prevalence among clinical nursing students were included. Two researchers independently screened literature and extracted data. The Joanna Briggs Institute tool was used to evaluate bias risk. Pooled prevalence rates, heterogeneity and publication bias were examined. A comprehensive search was conducted across eight databases, from the inception of each database to 31 March 2025. A total of 16 cross-sectional studies from eight countries involving 8037 nursing students were included in the analysis, with 11 studies (n&#x2009;=&#x2009;5550) contributing to the overall pooled estimate. Using a random-effects model, the pooled prevalence of WPV of any type was found to be 40%, with substantial heterogeneity. Verbal violence emerged as the most prevalent subtype (47%), followed by sexual violence (12%) and physical violence (10%). Significant publication bias was detected for both physical and sexual violence, indicating a potential underestimation of the true prevalence. This systematic review indicated that WPV is a significant occupational hazard encountered by clinical nursing students across diverse international contexts represented during internships. These findings highlight the urgent need for educational and healthcare institutions and policymakers to implement coordinated measures, such as enhanced preventive training, comprehensive reporting and support systems and a zero tolerance safety culture to protect the future nursing workforce. This systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. This study did not include patient or public involvement in its design, conduct or reporting. The research protocol was registered with PROSPERO (CRD420251027354).

Spinal motion restriction (SMR) remains a fundamental component of trauma care, yet its routine application has been increasingly questioned. Evidence supporting selective SMR has grown; however, limited data exist on the knowledge, attitudes, and practices of emergency healthcare providers (HCP) across the prehospital and hospital settings, particularly in low- and middle-income settings. This study aimed to examine knowledge, attitudes, and practices (KAP) towards spinal motion restriction (SMR) among prehospital and in-hospital emergency HCPs in Jordan. This is a cross-sectional study using a purpose-built questionnaire. The questionnaire assessed demographics, knowledge, attitudes, and practices regarding SMR. KAP scores were calculated using validated scales with established internal consistency. A total of 363 participants completed the questionnaire. The median age was 30&#xa0;years (IQR 27-33) and most participants were male (85.1%). Approximately three-fifths (59.8%) were working in hospital settings, and only 36.4% reported receiving prior trauma courses. Overall knowledge related to SMR was low to moderate, with limited awareness of validated selective SMR tools; fewer than one-third of participants reported awareness of the Canadian C-Spine Rule (CCR) or NEXUS criteria. Knowledge scores did not differ significantly between trauma-trained and untrained participants but were higher among prehospital HCPs. Attitudes towards SMR were generally neutral and were not significantly associated with training status or work setting. Self-reported practice scores were relatively high, with no significant differences between prehospital and hospital HCPs or trained and untrained HCPS. Despite widespread trauma exposure and training, important gaps persist in SMR-related knowledge and decision-rule awareness among emergency HCPs. Neutral attitudes and high self-reported practice scores may mask inconsistent evidence-based decision-making. These findings highlight the need for targeted, competency-based SMR education and system-level alignment across the emergency healthcare setting, with relevance to emergency care systems in the Middle East and North Africa Region (MENA) and other resource-constrained settings.

Mis-triage represents a global concern, with reported rates ranging from 15% to 33%. Understanding its causes and contributing factors is essential for ensuring patient safety. Currently, available studies have mainly focused on evaluating triage systems rather than investigating the human factors affecting triage performance. A major limitation in triage evaluation studies is the lack of standardized criteria to assess patient acuity and the absence of a clear consensus on how to measure triage accuracy. Most studies rely on retrospective data, which often fail to capture real-life clinical complexity. Therefore, the underlying causes and consequences of mis-triage remain partially understood. This study aims to improve triage by defining the optimal triage evaluation process and identifying clinician-, patient-, and system-level factors that compromise its accuracy and safety. Reducing Mis-Triage in Emergency Departments (RemEDy) will be a 4-phase, mixed methods project conducted across 7 Swiss emergency departments. The first phase will focus on developing a standardized triage evaluation instrument, combining evidence from a scoping review of triage evaluation processes, workshops with triage clinicians using design thinking methodology, and a modified Research and Development-University of California Delphi involving international experts and patient representatives. The second phase will prospectively implement this instrument in real time within a multicenter observational cohort study to evaluate triage performance; quantify mis-triage; and identify predictors at the patient level (eg, demographics), clinician level (eg, training), and system level (eg, crowding and length of stay). The third phase will focus on designing and validating an artificial intelligence-based decision support tool, applying multimodal models that integrate real-time triage data to enhance acuity prediction and minimize human error. The fourth phase will develop and evaluate a targeted training program, guided by the Capability, Opportunity, Motivation, and Behavior model, to strengthen triage accuracy and mitigate cognitive biases. The project was funded by the Swiss National Science Foundation in March 2025 (grant 10004535). At submission, the scoping review is ongoing and expected to be completed in early 2026. Development and piloting of the triage evaluation instrument will take place in 2026. A multicenter cohort study is planned between October 2026 and June 2027. The intervention study is scheduled between October 2027 and December 2028. Final results are expected in 2029. The RemEDy project addresses key limitations of current triage research, including the lack of standardized evaluation methods. By combining expert and clinician consensus; real-time assessment; and multilevel analysis of patient-, clinician-, and emergency department-level factors, RemEDy is expected to provide a more comprehensive understanding of mis-triage and its causes. RemEDy will establish a novel framework for real-time triage evaluation and inform the development of targeted training programs with the potential to improve triage accuracy, safety, and equity. PRR1-10.2196/92264.

To evaluate an in-house newly fabricated patient-specific pediatric head CT phantom developed for trauma-oriented emergency imaging, with emphasis on multiplanar visual realism, cross-platform interpretability, and expert-reader assessment of diagnostic acceptability. A heterogeneous phantom was generated from an anonymized retrospective head CT dataset of a 5-year-old child and designed to preserve emergency-relevant osseous, aerated, orbital, and intracranial anatomy. A complex orbito-nasal midface trauma was incorporated as a trauma-mimicking feature. CT was performed on two clinical multidetector systems from different vendors: a 64-row GE Discovery CT750 HD and an 80-row Canon Aquilion RXL, each using routine pediatric head CT protocols. Ten radiologists independently reviewed axial, coronal, and sagittal reformations in bone and soft-tissue windows using a structured 20-item, 4-domain scoring framework. Representative multiplanar images showed preserved calvarial contour, skull-base and orbital anatomy, aerated sinonasal spaces, intracranial contour, falcine/midline anatomy, ventricular depiction, posterior fossa appearance, and visualization of the complex orbito-nasal midface trauma. Expert ratings were favorable on both scanners, with higher scores on Canon across all domains. Domain means on Canon versus GE were 4.38 versus 4.02 for osseous realism, 4.32 versus 4.00 for soft-tissue realism, 4.36 versus 4.18 for multiplanar interpretability, and 4.57 versus 4.10 for clinical utility. Overall composite scores were 4.38 on Canon and 4.07 on GE, paired domain-level differences showed higher mean scores for the Canon dataset in all domains, with the largest difference in clinical utility (+&#x2009;0.47). The phantom provided clinically recognizable, trauma-relevant pediatric emergency head CT appearances across multiplanar bone and soft-tissue review and was rated as realistic and diagnostically acceptable by expert readers, supporting its use in protocol evaluation, training, and observer-based emergency radiology research.

Bibliometrics tends to analyze the scientific research items published on a specific field or topic. This study aimed to analyze Iranian researchers' production in the field of emergency medicine (EM). This bibliometric visualization study was conducted using a descriptive-analytical approach and based on data from the Scopus database. All scientific output of Iranian researchers in the field of EM by the end of 2024 was collected and analyzed using VOSviewer 1.6.20 software. Iran's scientific output in the field of EM has grown significantly. The Archives of Academic Emergency Medicine is the top journal and Tehran University of Medical Sciences is the top institution publishing the scientific productions of Iranian researchers in the field. The United States, United Kingdom, Canada, and Australia are Iran's largest scientific collaborating partners. Iran is the second-ranked leading country in the Middle East, publishing 20.38% of the Middle Eastern scientific publications in the field. Out of 17 countries in the Middle East, only two countries, Turkey and Iran, are in the top 20 countries in the world. The co-occurrence map of keywords showed the five thematic clusters, including risk factors and clinical outcomes, clinical symptoms and laboratory indicators, emergency and psychiatric services, medical diagnostic and imaging tools, and vital signs and clinical monitoring. As the second-ranked country in the Middle East and the 16th-ranked in the world, Iran has a prominent position and a high capacity for scientific development and research diplomacy in EM. The trend of scientific productions of EM in Iran is also growing. Promoting this status and maintaining this trend requires special attention from officials and policy makers to research, expanding international cooperation, increasing the quality of research and focusing on interdisciplinary and problem-oriented research.

Following the 2021 first International Consensus on Severe Lung Cancer, global attention to patients with PS 2-4 has grown significantly. Recent advances in novel therapies, interventional techniques, and supportive care, along with emerging real world data, have expanded treatment opportunities for this population. To incorporate these advances, we have updated the consensus. A multidisciplinary panel comprising experts from oncology, radiation oncology, thoracic surgery, radiology, interventional medicine, respiratory medicine, critical care medicine, and nursing. After being presented with a comprehensive review of the current evidence pertaining to severe lung cancer and thorough discussions, the panel reached a consensus on 11 recommendations, each with over 70% expert agreement. The 11 consensus points focused on definition and causes (n=2), assessment and general strategies (n=4), and specific treatment modalities (n=5) were updated or newly developed. This updated consensus emphasizes dynamic and precise detection, robust life support, flexible application of novel therapies, and MDT guided treatment adjustment based on PS dynamics. Early rehabilitation and comprehensive supportive care are integral to disease management. This consensus updates the definition, diagnostic evaluation, and treatment strategies, providing a practical framework for clinicians based on current evidence and multidisciplinary expert consensus. Prospective trials focusing specifically on patients with severe lung cancer are urgently needed.

Background/Objectives: Maternal mortality remains disproportionately high in low- and middle-income countries, where ineffective referral systems and a lack of infrastructure contribute to delays in emergency obstetric care. In sub-Saharan Africa, referrals are largely conducted via paper, often resulting in lost documents and limited follow-up. Mobile health (mHealth) offers a promising solution by enabling real-time, bidirectional communication. This study aimed to examine how the Mobile Obstetric Referral Emergency System (MORES), a WhatsApp-based referral platform piloted in 20 rural health facilities and two district hospitals in Bong County, Libera, influences healthcare providers' communication, collaboration, and relationships. Methods: A mixed-methods design was used. Ninety one (N = 91) providers completed demographic and Trust and Teamwork surveys. Of the 91 providers, 35 providers from rural health facilities and 56 providers from district hospitals participated in a 10-question survey and individual interviews. Results: Survey results indicated high levels of mutual respect, confidence, and teamwork perceived by both the rural health facility and district hospital providers. Qualitative data further expanded on the quantitative results showing the MORES intervention enhanced the timeliness and accuracy of referrals, supported problem-solving between facilities, and fostered shared goals, mutual respect, and knowledge exchange. Conclusions: Providers perceived the MORES to be associated with increased collaboration and continuity of care, as well as a feasible, low-cost, and sustainable intervention to improve obstetric referral systems in low-resource settings.

Emergency department (ED) care is critical for managing acute bleeding events in people with bleeding disorders. Despite international guidelines recommending haemostatic treatment within 30-60&#xa0;min, delays and deviations from best practices are common and associated with poorer outcomes. Identify barriers to guideline-concordant ED management of bleeding disorders, evaluate interventions, assess clinical impact, and highlight knowledge gaps to inform future research. Five databases (MEDLINE, Embase, Scopus, Web of Science, Cochrane Library) were searched from inception to 21 March 2025, following established scoping review guidelines and a pre-registered protocol. Eligible studies examined barriers or interventions for improving ED care. Data were independently screened and extracted by two reviewers, then synthesized using descriptive statistics and narrative synthesis. Seventeen studies out of 3541 met inclusion criteria. Common barriers included electronic medical record (EMR) limitations, absence of standardized protocols, limited healthcare professional education, and inadequate communication with haematology. Delayed time to therapy (n&#xa0;=&#xa0;8, range 1.4-5.6&#xa0;h) was frequently reported; additional impacts included failure to administer haemostatic therapy for confirmed/suspected bleeding, non-indicated diagnostic testing, and patient mortality. Most interventions combined EMR enhancements with education. All interventions were associated with improved outcomes, including reduced time to therapy (n&#xa0;=&#xa0;4, range 0.4-2.5&#xa0;h). Perspectives of people with bleeding disorders and caregivers were infrequently incorporated. This review provides the first comprehensive synthesis of barriers and interventions in ED care for people with bleeding disorders, identifying critical gaps in timely treatment, interdisciplinary coordination, and stakeholder engagement. These findings provide a foundation for future quality improvement research.

Human trafficking is currently an international crime and one of the most urgent human rights issues. Understanding stakeholders' experiences is critical to developing a care pathway that improves recognition and response. Globally limited qualitative research exists on stakeholders' experiences of human trafficking in the Emergency Department. This study aims to explore and describe the experiences of stakeholders in recognizing and responding to victims of human trafficking. Descriptive qualitative study reported using COREQ. Three online focus groups (29-40 min) were audio-recorded, transcribed, and thematically analyzed following Braun and Clarke. The research team identified six codes: care pathways and policies for guidance, interprofessional collaboration, healthcare professionals' responses, screening and triage, training and education, and a trauma-informed approach. These codes were then synthesized into three main themes: the need for clear guidance, including policies and procedural frameworks; education, covering screening, triage, recognition of red flags, and awareness; and interprofessional and multisectoral collaboration with coordinated referrals. Contextually appropriate, standardized care pathways for identifying and managing human trafficking victims are recommended for South African and broader African healthcare settings. These should be co-designed with healthcare professionals and survivors and aligned with existing systems to promote integrated care. Ongoing training and strengthened multisectoral collaboration are essential to ensure trauma-informed, coordinated, and effective responses.

Disseminated intravascular coagulopathy (DIC) in pregnancy is a severe maternal morbidity that is associated with short- and long-term complications. However, information regarding the causes of DIC treatments and outcomes in pregnancy is based on local reports. To address this gap, two Scientific and Standardization Committees, the Women's Health Issues in Thrombosis and Hemostasis and Disseminated intravascular coagulation of the International Society on Thrombosis and Hemostasis, joined to establish an international global registry. This registry was developed to examine the current definitions, clinical presentations, and current practices around laboratory diagnosis and management of DIC worldwide. We collected data between 2018 and 2024; there were 148 data entries to the registry (13 countries), 104 of them included patients' clinical and laboratory information. Placental abruption is the leading cause for ante and intrapartum DIC, especially when associated with stillbirth. The leading etiology for postpartum DIC was uterine atony, especially following/during caesarean sections. The contribution of abnormally implanted placenta (i.e., placenta accreta and/or previa) to the development of DIC is increasing. The leading pregnancy complications associated with DIC were placental abruption in HIC and preeclampsia in LMIC. Hemostatic parameters differed between women who had a positive pregnancy-specific DIC score and those who did not meet that criterion. Women with placental-mediated pregnancy complications had a lower median pregnancy-specific DIC score than those without such complications at diagnosis of DIC and following recovery, suggesting a different mechanism of disease in the two groups.