搜索结果：International journal of integrated care

To evaluate nursing students' attitudes towards end-of-life care and assess the impact of an elective educational course on shaping these attitudes. A cross-sectional observational study with a post-test-only design was conducted at the University of Padua in northern Italy. The study involved 475 third-year nursing students, with 228 participants (48%) completing an online survey. The validated Frommelt Attitude Toward Care of the Dying Scale, Form B, Italian Version (FATCOD Form B-I) was used, and data were analysed through descriptive statistics, t-tests and correlation analyses. Participants demonstrated overall positive attitudes towards end-of-life care, with a mean FATCOD Form B-I score of 118.65 (SD&#x2009;=&#x2009;9.63). Female students scored significantly higher in communication (p&#x2009;<&#x2009;0.001) and family care (p&#x2009;=&#x2009;0.002) than males. However, no significant differences were found between students who completed the elective palliative care course and those who did not. Fear and discomfort with death negatively influenced relationship building with patients, while communication and active care were strongly correlated (r&#x2009;=&#x2009;0.45, p&#x2009;<&#x2009;0.001). Although nursing students exhibited generally positive attitudes, the elective course alone was insufficient to significantly enhance preparedness for end-of-life care. A comprehensive, integrated palliative care education programme is necessary to address emotional barriers and improve relational competencies, ensuring students are equipped for compassionate and competent end-of-life care. Although nursing students exhibited generally positive attitudes towards end-of-life care, theoretical instruction alone proved insufficient to significantly enhance their preparedness for palliative care practice. These findings have direct implications for nursing education and clinical care quality: integrating comprehensive, experiential palliative care education throughout nursing curricula, rather than relying on optional standalone courses, may better equip future nurses to deliver compassionate and competent end-of-life care. Despite international recommendations, many nursing students feel unprepared for end-of-life care. This study examined whether an elective palliative care course produces meaningful attitudinal change among final-year nursing students. Students showed generally positive attitudes, with the highest scores in Family care and Communication. No significant difference emerged between students who attended the elective course and those who did not. The findings impact nursing educators and curriculum designers, ultimately benefiting future nurses and the terminally ill patients and families they will care for. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for observational studies. No patient or public contribution.

The Interprofessional Learning and Innovation Network (IP-LIN), comprising nursing and social care professionals, students, and teachers, was established to enhance integrated care competences, specifically attention to health and wellbeing for older adults living in the community. This case study with ten interprofessional case discussions and two focus groups was completed with nursing and social work professionals, students and teachers. Thematic analysis regarding five interprofessional competences of the Zuyd Interprofessional Building Blocks model was conducted. Key recurring themes included responsibility, available time, mutual understanding of professional language, reflection on attitudes, and optimising client autonomy. Identified barriers were the absence of a joint care plan, incomplete application of the methodical circle, and insufficient consultation among professionals involved with the client. Participants recognised that interprofessional learning fosters improved collaboration between nursing and social work domains; however, the absence of a joint care plan remains a significant obstacle to fully integrated care. The IP-LIN facilitated opportunities for professionals, students, and teachers to understand each other's roles, responsibilities, and perspectives, thereby increasing confidence in interprofessional and team competencies. Successful IP-LIN implementation requires sustained commitment from both care and social work sectors to overcome existing barriers and promote integrated care.

Implementation of integrated care into the training of our health and social care workforce is lacking or inconsistent. This study engaged discipline leads across Australian higher education providers to ascertain whether a validated International Competency Framework for High-Quality Workforce Development in Integrated Care (the Framework) could be used to guide the implementation of integrated care into curriculum. Twelve curriculum leads participated in individual interviews across different disciplines. Interviews focused on participants' understanding of integrated care and the potential utility of the Framework in their work. We used reflexive thematic analysis to identify the key themes across the data set. We identified barriers to implementing the Framework including a lack of understanding of what integrated care is and how the Framework can be used. Three main areas were identified in which the Framework could be implemented. These were: national workforce reform, curriculum transformation and leadership and culture. Our findings show training in integrated care needs to be mandated and incorporated into the training of health and social care professionals. Our Framework serves as a national standard for guiding this training.

Frailty among older adults is an escalating public health challenge, often associated with poorer quality of life (QoL) and increased pressure on healthcare systems. Integrated care is proposed as a strategy to meet the complex needs of this population, though evidence of its effectiveness remains inconclusive. To determine the impact of integrated care on the quality of life of frail, community-dwelling older adults. Systematic review and mixed-methods synthesis, including meta-analysis and narrative synthesis. Community-based healthcare systems across six international studies. A total of 5498 frail, community-dwelling older adults across six studies: four randomised controlled trials and two quasi-experimental designs. Integrated care interventions tailored to frailty, including person-centred, multidisciplinary, and value-based models. Quality of Life was the primary outcome. Secondary outcomes included social functioning and healthcare costs. Standardised tools such as SF-12, SF-36, ICECAP-O, and EQ-5D were used across studies. The meta-analysis showed a small, non-significant improvement in QoL (SMD = 0.13, 95 % CI: -0.09 to 0.35, p = 0.24) with high heterogeneity (I&#xb2; = 91 %). Tailored, multidimensional models showed greater effects, particularly in preserving social functioning. Findings on cost-effectiveness were inconsistent; some studies reported reduced hospital use, while others found increased primary care visits without cost savings. . Integrated care may support social functioning but does not demonstrate a consistent improvement in overall QoL. Future trials should standardise QoL measurement, report intervention components clearly, include economic evaluations, and assess longer-term outcomes.

Hyperglycaemia is common in intensive care unit (ICU) patients and blood glucose management practices likely vary, but there are limited contemporary data on ICU doctors' and nurses' preferences. We conducted an international online survey of ICU doctors and nurses. The 16-question survey covered respondent characteristics, glucose management practices, perceived challenges with intermittent point of care (iPOC) glucose monitoring and continuous glucose monitoring (CGM), and preferences for a future trial on CGM versus usual care. Data were reported descriptively for all respondents and stratified by profession. We received 1424 responses from 12 countries, of which 63% were from nurses. The overall response rate was 36% and the highest proportion of missing data for any question was 9%. Most respondents (92%) reported that their ICU had a glucose management protocol. The median reported insulin initiation threshold was blood glucose of 10&#x2009;mmol/L. Long-acting insulin was reported to be used occasionally by 68% of respondents. As needed pro re nata insulin was reported as most often given subcutaneously (43%) or intravenously (25%). Overall, 61% of ICU nurses reported concerns related to iPOC use versus 53% among ICU doctors (concerns among nurses versus doctors included risk of hypoglycaemia in 41% vs. 28%; risk of hyperglycaemia in 28% vs. 16%; patient discomfort in 26% vs. 27%). Overall, 75% of respondents never used CGM and 18% of ICU nurses reported concerns related to CGM use versus 22% of ICU doctors (accuracy and reliability in 14% vs. 18%; calibration and maintenance in 9% versus 16%; patient discomfort in 5% vs. 6%, respectively). Most respondents (89%) supported a randomised trial on CGM versus usual care in ICU and 68% preferred an intervention arm with a specific CGM-treatment protocol. Glucose management preferences varied among ICU staff, particularly in the administration of as needed doses and long-acting insulin. ICU nurses appeared more concerned about iPOC use than ICU doctors. The concerns about use of CGM appeared less common than concerns about iPOC. Most nurses and doctors would support a randomised trial on CGM versus usual care for glucose management in ICU and reported a preference for CGM to be used with a specific treatment protocol. This international survey highlights substantial professional differences and heterogeneity in ICU glucose management practices, particularly regarding as-needed and long-acting insulin use. Nurses expressed greater concern than doctors about intermittentpoint point-of-care glucose monitoring, especially the risks of hypoglycaemia and hyperglycaemia. Although continuous glucose monitoring was rarely used, it was viewed favourably overall, with broad support for a future protocolised randomised CGM trial.

For youth living with neurodisabilities and rare conditions, transitioning from pediatric to adult care results in significant loss of services and supports. This article examines transition-related health systems, policies and provider roles in the context of Duchenne muscular dystrophy (DMD). DMD is a multi-systemic X-linked disorder mainly characterized by progressive muscle degeneration, with about 30% of patients presenting with neurodevelopmental comorbidities. Due to advances in respiratory and cardiac care, life expectancy has increased significantly, creating a new population of adults living with DMD. This demographic shift has exposed critical gaps in the transition from pediatric to adult health care. To date, there is no systematic review covering existing transition policies and programs. This article utilizes integrated care and continuity of care frameworks to examine transition-related health systems, policies, and provider roles. We conducted a PRISMA-compliant systematic review searching OVID Medline, Embase, PsycINFO, CINAHL, Web of Science, and SCOPUS from January 1, 2000, to August 31, 2025. Studies were included if they reported on health systems, programs, policies or health care providers' roles in DMD. For synthesizing evidence, we utilized Popay's Narrative Synthesis framework to analyze health systems, policies, and provider roles across included studies, allowing for an aggregation of a body of heterogenous data (quantitative, qualitative and mixed-methods). This methodological approach ensured that the review moved beyond a simple aggregation of findings to generate new insights into the structural gaps. 42 studies met the inclusion criteria. The programs described in these studies varied from residential life-skills training to respiratory-focused transition protocols. A significant disconnect was identified between international care guidelines and implementation; most initiatives are project-based rather than policy-driven. While neurology is central in pediatric care, respiratory and sleep medicine often become the de facto "medical home" for adults. Crucially, support for patients with neurodiverse development was only discussed in 4 of the 42 studies. This review underlines a lack of comprehensive care models for DMD transition, specifically within the high-resource settings that dominate the literature. Future policies must bridge the gap between project-based funding and sustainable health systems, specifically addressing neurodiversity and caregiver burden.

Addressing the impact of chronic conditions on work participation requires an integrated care model that embeds work-related goals from diagnosis onward. The Work-oriented Care Model (WoCM) adopts a biopsychosocial, patient-centered approach and incorporates key elements of the Capability Approach (CA) and the International Classification of Functioning (ICF), aligning functional performance with individual goals and contextual factors. A case study illustrates the need for continuous work-oriented assessment involving healthcare and occupational professionals. Implementation challenges underscore the importance of structural integration and improved coordination across healthcare and occupational systems.

The "Six-Bed Integration" model in Kangjian Subdistrict, Shanghai, represents an innovative approach to integrated eldercare, combining three healthcare beds (family medical beds, rehabilitation/palliative care beds, and hospital beds) with three eldercare beds (home care, day care, and institutional care). This study explores the implementation challenges and systemic tensions within this model. Using purposive sampling, professionals (N = 15) involved in the Kangjian integrated care system were interviewed through semi-structured interviews. Data were analyzed via Colaizzi's phenomenological approach to identify key themes. The study identified three key challenges in the integrated care model: (1) Structural barriers including Medicare restrictions, bed shortages, and unclear admission criteria hindered service integration; (2) Ineffective outreach to homebound seniors and digital disparities limited service accessibility and understanding; (3) Unclear stakeholder responsibilities caused referral disputes, with nursing homes rejecting high-risk cases and discharge-bed availability mismatches worsening conflicts. These findings reveal systemic gaps in resource allocation, communication, and coordination within the integrated care system. The "Six-Bed Integration" model demonstrates potential in bridging medical and social care but faces challenges in resource allocation, communication, and inter-institutional accountability. The study implies that optimizing integrated care delivery requires not only frontline training in coordination skills but also policy support to create synergistic mechanisms for resource sharing and accountability. Policy interventions must address Medicare constraints, standardize referral protocols, and enhance cross-sector collaboration to optimize integrated eldercare delivery.

Tuberculosis (TB) and diabetes mellitus (DM) represent a growing syndemic in low- and middle-income countries (LMICs), particularly across South Asia. The bidirectional relationship between these diseases exacerbates health outcomes and increases system burdens. Although the World Health Organization has advocated for integrated management of TB and DM, implementation remains inconsistent across the SAARC region. This systematic review aims to identify and analyse implementation determinants of integrated TB and DM care in SAARC countries. We conducted a systematic review following PRISMA 2020 guidelines. searching MEDLINE (via Ovid), EMBASE, Web of Science, Cochrane CENTRAL, and CINAHL for peer-reviewed studies. Grey literature was sourced from Google Scholar and citation search. Four reviewers independently screened title, abstract and full text using Rayyan. Using a structured Excel form, two reviewers extracted data. Quality assessment was conducted by using Mixed Methods Appraisal Tool (MMAT). A narrative synthesis was conducted in line with SWiM guidelines to categorize implementation determinants as barriers or facilitators. Ten studies met the inclusion criteria and were conducted across five SAARC countries: India (n = 7), Pakistan (n = 1), Bangladesh (n = 1), and Sri Lanka (n = 1). Identified facilitators included political commitment, use of digital tools, and training of healthcare workers. Barriers encompassed inadequate infrastructure and finances, workforce shortages, lack of standardized guidelines and fragmented vertical health systems. Integrated TB-DM care in the SAARC region remains at an early developmental stage, with most efforts limited to pilot projects or small-scale screenings. Despite political and institutional recognition of the dual burden, scale-up is constrained by systemic barriers, resource gaps, and lack of evidence-informed implementation strategies. Future efforts should prioritize system-wide integration guided by implementation frameworks, standardized protocols, and investment in workforce and infrastructure to achieve sustainable impact. PROSPERO registration number: CRD42025644263.

Convalescent plasma (CP) may reduce mortality in people with viral respiratory diseases, and is being investigated as a potential therapy for coronavirus disease 2019 (COVID-19). A thorough understanding of the current body of evidence regarding the benefits and risks of this intervention is required. To assess the effectiveness and safety of convalescent plasma transfusion in the treatment of people with COVID-19. To identify completed and ongoing studies, we searched CENTRAL, MEDLINE, Embase, the Epistemonikos COVID-19 L*OVE Platform, and clinical trial registries to October 2024. We included randomised controlled trials (RCTs) evaluating convalescent plasma for people with COVID-19, irrespective of disease severity, age, gender, or ethnicity. We excluded studies investigating other coronavirus diseases or standard immunoglobulin. We used the GRADE approach to rate the certainty of evidence for the following outcomes: all-cause mortality (up to day 28), worsening and improvement of clinical status (for individuals with moderate to severe disease), hospital admission or death, COVID-19 symptoms resolution (for individuals with mild disease), quality of life (QoL), grade 3/4 adverse events, and serious adverse events. We used RoB 2 to assess bias in included studies. We followed standard Cochrane methodology. We included 48 RCTs (24,518 participants), 15 of which were added in this update. We also identified 36 new ongoing studies and 33 completed studies awaiting classification. Individuals with a confirmed diagnosis of COVID-19 and moderate to severe disease Forty-two RCTs investigated the use of CP for 21,393 participants with moderate to severe disease. Of these, 36 RCTs (20,798 participants) compared CP to placebo or standard care, five (604 participants) to standard plasma, and one (190 participants) to human immunoglobulin. In the full review, we performed subgroup analyses by antibody detection, time since symptom onset, country income level, and key comorbidities. Convalescent plasma versus placebo or standard care alone CP does not reduce all-cause mortality at up to day 28 (risk ratio (RR) 0.96, 95% confidence interval (CI) 0.90 to 1.03; 31 RCTs, 20,798 participants; high-certainty evidence). It has little to no impact on the need for invasive mechanical ventilation, or death (RR 1.03, 95% CI 0.98 to 1.08; 8 RCTs, 15,189 participants; high-certainty evidence) and has no impact on whether participants are discharged from hospital (RR 1.00, 95% CI 0.97 to 1.02; 9 RCTs, 13,930 participants; high-certainty evidence). CP may have little to no impact on QoL (MD 1.00, 95% CI -2.14 to 4.14; 1 RCT, 483 participants; low-certainty evidence). CP may have little to no impact on the risk of grade 3/4 adverse events (RR 1.17, 95% CI 0.96 to 1.42; 6 RCTs, 2392 participants; low-certainty evidence). It probably has little to no effect on the risk of serious adverse events (RR 1.19, 95% CI 1.02 to 1.38; 11 studies, 5298 participants; moderate-certainty evidence). Convalescent plasma versus standard plasma The evidence is uncertain about whether CP reduces all-cause mortality at up to day 28 (RR 0.77, 95% CI 0.53 to 1.10; 5 RCTs, 604 participants; very low-certainty evidence) and whether it increases the need for invasive mechanical ventilation, or death (RR 5.59, 95% CI 0.29 to 108.38; 1 study, 34 participants; very low-certainty evidence). The evidence is uncertain about whether convalescent plasma reduces or increases the risk of grade 3/4 adverse events (1 RCT, 248 participants). The evidence is also uncertain about whether CP reduces the risk of serious adverse events (RR 0.82, 95% CI 0.57 to 1.17; 4 RCTs, 447 participants; very low-certainty evidence). No studies in this comparison reported clinical improvement or QoL. Individuals with a confirmed diagnosis of SARS-CoV-2 infection and mild disease Six RCTs investigated the use of CP for 2761 participants with mild disease. Four RCTs (1164 participants) compared CP to placebo or standard care alone, and two (1597 participants) to standard plasma. Convalescent plasma versus placebo or standard care alone The evidence is uncertain about whether CP reduces all-cause mortality at up to day 28 (odds ratio (OR) 1.24, 95% CI 0.33 to 4.60; 3 RCTs, 1004 participants; very low-certainty evidence) and admission to hospital or death within 28 days (RR 0.45, 95% CI 0.04 to 4.81; 2 RCTs, 493 participants; very low-certainty evidence). It may have little to no impact on time to COVID-19 symptom resolution (hazard ratio (HR) 1.05, 95% CI 0.85 to 1.30; 1 RCT, 376 participants) and on the risk of grade 3/4 adverse events (RR 1.29, 95% CI 0.75 to 2.19; 1 RCT, 376 participants), both with low-certainty evidence. The evidence is uncertain about whether CP has an impact on the risk of serious adverse events (RR 0.84, 95% CI 0.56 to 1.26; 2 RCTs, 494 participants; very low-certainty evidence). No studies in this comparison reported other critical outcomes. Convalescent plasma versus standard plasma The evidence is uncertain about whether CP reduces all-cause mortality at up to day 28 (RR 0.41, 95% CI 0.05 to 3.06; 2 RCTs, 1597 participants; very low-certainty evidence). It probably reduces admission to hospital or death within 28 days (RR 0.50, 95% CI 0.32 to 0.78; 2 RCTs, 1597 participants; moderate-certainty evidence). CP may have little to no effect on initial symptom resolution at up to day 28 (RR 1.12, 95% CI 0.82 to 1.54; 1 RCT, 416 participants; low-certainty evidence). Neither study in this comparison reported other critical outcomes. Compared with placebo or standard care, high-certainty evidence shows that CP does not reduce mortality in individuals with moderate to severe disease and has little to no effect on clinical improvement or worsening. CP probably has little to no effect on serious adverse events. Publication of ongoing studies might resolve some of the uncertainties around CP therapy for people with asymptomatic or mild disease. This review was previously a living systematic review, from the first version published in 2020 until our last search in October 2024. The research question is no longer a priority for decision-making, new studies are less frequently published, and research that might impact the conclusions of the review is no longer emerging. The European Commission, Belgium SUPorting high quality evaluation of COVID-19 convalescent plasma thrOughouT Europe (SUPPORT-E, grant number 101015756) supported this review. Protocol registered with the Center for Open Science on 17 April 2020 (DOI: 10.17605/OSF.IO/DWF53). Access the 2023 version of this review here: DOI: 10.1002/14651858.CD013600.pub6.

ObjectivePediatric head trauma is common, but computed tomography exposes children to ionizing radiation. This systematic review and meta-analysis evaluated the diagnostic accuracy of point-of-care ultrasound for pediatric skull fractures and clarified its role as an adjunct to clinical assessment rather than a replacement for computed tomography when intracranial injury is suspected.MethodsWe conducted a systematic review and bivariate random-effects diagnostic test meta-analysis guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement and registered in the International Prospective Register of Systematic Reviews (Registration Number: CRD420251139217). PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception through 3 September 2025. Two reviewers independently screened studies, extracted 2&#x2009;&#xd7;&#x2009;2 diagnostic data, and assessed risk of bias using the Quality Assessment of Diagnostic Accuracy Studies-2 tool.ResultsNine studies conducted in emergency department settings met the inclusion criteria. Point-of-care ultrasound demonstrated a pooled sensitivity of 0.90 (95% confidence interval: 0.84-0.94), specificity of 0.98 (95% confidence interval: 0.94-0.99), and an area under the summary receiver operating characteristic curve of 0.96 (95% confidence interval: 0.94-0.97). The summary positive likelihood ratio was 41.73 (95% confidence interval: 15.85-109.87), and the negative likelihood ratio was 0.10 (95% confidence interval: 0.07-0.17). Deeks' funnel plot showed no evidence of small-study effects (P&#x2009;=&#x2009;0.80).ConclusionsPoint-of-care ultrasound shows high diagnostic accuracy for detecting pediatric skull fractures and may support bedside risk stratification in selected children with low- or intermediate-risk mild head trauma. However, most isolated linear skull fractures are managed conservatively, and point-of-care ultrasound does not evaluate intracranial injury. Computed tomography decisions should therefore remain anchored in neurological status, injury mechanism, validated pediatric head injury decision rules, and clinician judgment.

Children and families from priority populations (e.g. culturally and linguistically diverse and regional/rural communities) often experience significant psychosocial challenges and barriers to accessing health and social care. These inequities were further exacerbated during the COVID-19 pandemic. Integrating social care with health services has been proposed as an approach to improve service access and address unmet needs. A two-site parallel randomised controlled trial was conducted in Australia between August 2021 and 2023. Parents/carers of children from priority populations were recruited through Child and Family Health services (n = 288) and randomised to the Watch Me Grow-Electronic (WMG-E) intervention (n = 145) or care as usual (n = 143). The WMG-E program comprised digital developmental screening and community navigation to relevant health and social services via a service navigator. The primary outcome was change in unmet social needs measured using the WE CARE instrument. Intention-to-treat generalised linear mixed-effects models adjusted for child developmental concerns, parental mental health, and sociodemographic factors. Unmet social needs decreased over time across both groups (&#x3b2; = -0.23, SE = 0.11, p = 0.036). At 12 months, the intervention group showed greater reductions in unmet needs than the control group (&#x3b2; = -0.35, SE = 0.17, p = 0.046), although the time &#xd7; group interaction was not significant. The WMG-E platform demonstrated feasibility as a digital developmental screening and navigation tool supporting families from priority populations. WMG-E shows promise in improving access to health and social care and reducing unmet social needs; however, further research is needed to assess sustained impacts across diverse settings. The study (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st 2021, and the trial results are being reported according to recommendations in the CONSORT Statement. What is already known on this topic Significant inequities exist in the access to healthcare for priority population families with preschool children and this results in children missing opportunities for early identification and intervention for health and developmental problems.While addressing heath care inequities is critical for providing children a healthy start to life, there are no effective and systematic ways to reach such families as they do not engage with services early, and often experience significant barriers due to social care needs.Addressing health inequities by tackling social determinants of health alongside healthcare is critical to supporting families in priority population groups, aligning with the Sustainable Development Goals (SDGs) of the World Health Organization (WHO). What this study adds This study is one of the first Australian randomised controlled trials evaluating the effectiveness of a digital developmental screening program coupled with service navigation for improving unmet social care needs in multicultural and rural/regional communities.Significant reductions in unmet need scores were observed over time in both intervention and control groups, with a greater reduction in the intervention group, though no significant interaction between time and group was found.The Watch Me Grow Electronic (WMG-E) platform was shown to be a feasible and effective tool for developmental screening and navigation to address unmet social needs in diverse, priority population families.

Professional and organisational collaboration of integrated services, like Flexible Assertive Community Treatment (FACT), plays a pivotal role in ensuring continuous and coordinated care for persons with complex mental health needs. While some research reflect team members' view of FACT or program fidelity, no research has explored the social practice of FACT and how collaboration evolve and sustain. The aim is to explore the process of collaboration for the making of the integrated service of FACT. A constructivist grounded theory design helped to collect and analyse empirical evidence of 28 interviews with multiprofessional FACT team members and managers, in 2021 (n = 14) and 2022/2023 (n = 14) in Sweden. Building care in the heart of the moment was constructed as the core category reflecting the timely process of FACT, while the sub-categories of 1) Embracing empathy and holistic view with users' best interest at heart, 2) Openness, curiosity and genuine interest for each other, 3) Borders across disciplines and services get erased yet sharpened, and 4) Orchestration of the team and leadership underpins sustainable collaboration reflected critical ingredients and passages of collaboration. Sustainable collaboration required organisations to support team members' transition from individual or entrapped social niches into an enabling niche, supportive team environment. Cultivating a social learning space may reduce uncertainty and enables timely, skillful action through which relationships, expertise, and performance develop.

Person centred care planning and models of care coordination across levels of care reduce fragmentation and unnecessary resource use. Our objectives were to assess the impact of implementing a coordinated care model between intermediate care and primary care, as determined by the identification of complex patients, and recording their individualized care plans in the shared medical record and to assess its effectiveness in relation to the use of health resources. A pre-post quasi-experimental study of 160 complex patients with dementia who were discharged from intermediate care between April 2022 and July 2024. A 31.4% (from 63 to 106 patients) increase in the identification of complex patients with dementia and a 23.6% (from 19 to 44 patients) increase in the development of care plans were found at 3 months of discharge. Of the patients who had visited emergency department in the six months preceding hospitalisation, 54.4% (n = 31) did not visit it in the six months post-discharge (p = 0.026). Our coordinated care model may have contributed to improved identification of patients with dementia and complex conditions, the development of individualized care plans, and reduced emergency department use. La planificaci&#xf3; de l&#x2019;atenci&#xf3; centrada en la persona i els models de coordinaci&#xf3; assistencial entre nivells assistencials redueixen la fragmentaci&#xf3; i l&#x2019;&#xfa;s innecessari de recursos. El nostre objectiu va ser avaluar l&#x2019;impacte de la implementaci&#xf3; d&#x2019;un model d&#x2019;atenci&#xf3; coordinada entre l&#x2019;atenci&#xf3; interm&#xe8;dia i l&#x2019;atenci&#xf3; prim&#xe0;ria, determinat per la identificaci&#xf3; de pacients complexos i el registre dels seus plans d&#x2019;atenci&#xf3; individualitzats a la hist&#xf2;ria cl&#xed;nica compartida, aix&#xed; com avaluar-ne l&#x2019;efectivitat en relaci&#xf3; amb l&#x2019;&#xfa;s de recursos sanitaris. Estudi quasi experimental pre-post de 160 pacients amb complexitat i dem&#xe8;ncia donats d&#x2019;alta de l&#x2019;atenci&#xf3; interm&#xe8;dia entre abril de 2022 i juliol de 2024. Es va observar un augment del 31,4% (de 63 a 106 pacients) en la identificaci&#xf3; de pacients complexos amb dem&#xe8;ncia i un increment del 23,6% (de 19 a 44 pacients) en l&#x2019;elaboraci&#xf3; de plans d&#x2019;atenci&#xf3; als 3 mesos de l&#x2019;alta. Dels pacients que havien visitat el servei d&#x2019;urg&#xe8;ncies en els sis mesos previs a l&#x2019;hospitalitzaci&#xf3;, el 54,4% (n = 31) no el van visitar en els sis mesos posteriors a l&#x2019;alta (p = 0,026). El nostre model d&#x2019;atenci&#xf3; coordinada pot haver contribu&#xef;t a millorar la identificaci&#xf3; de pacients amb dem&#xe8;ncia i condicions complexes, el desenvolupament de plans d&#x2019;atenci&#xf3; individualitzats i a reduir l&#x2019;&#xfa;s dels serveis d&#x2019;urg&#xe8;ncies.

Globally, chronic wounds resulting from diverse etiologies impose a significant physical, psychosocial, and economic burden and have remained a highly neglected public health challenge. Yet, people in rural Ethiopia have limited access to quality and comprehensive wound care. There is a marked paucity for an integrated, holistic care model in the primary healthcare settings. Hence, this study aimed to develop a context-tailored, integrated, holistic, chronic wound care package in Ethiopia. A multi-method approach was applied, including a scoping review, formative assessments, Theory of Change workshops and a qualitative validation study. Purposive sampling was employed to recruit participants. Collected data were transcribed, coded, and thematically analysed to generate insights for refining the intervention package. A total of 49 stakeholders participated in the Theory of Change (ToC) workshops, while 36 participants were included in the qualitative study. The intervention package is structured around six core thematic components: awareness-raising and stigma reduction, capacity-building, active case detection and follow-up, program and supply chain management, Institutional and community-based rehabilitation, monitoring, and evaluation. Implementation and scale-up of these components are designed to cascade across three levels of the existing primary healthcare system, specifically the health organization, the health facility level, and the community level. This study introduced a context-driven, integrated, and holistic wound care package aimed at managing chronic wounds alongside their associated mental health and psychosocial challenges. The package encompasses interventions that address the physical, psychological, and social impacts of chronic wounds in individuals affected by neglected tropical diseases of the skin and related conditions. It employs multilevel implementation strategies targeting individuals, communities, and the health system to reduce morbidity, disability, and the economic and psychosocial burdens linked to chronic wounds. This standardized, scalable, and sustainable care model provides a promising approach for Ethiopia and other low- and middle-income countries.

ObjectiveTo evaluate the association between a prehospital-to-in-hospital integrated transfusion workflow and transfusion timeliness, coagulation-related indices, and short-term clinical outcomes in patients with severe trauma requiring emergency transfusion.MethodsThis single-center observational before-and-after study included 120 consecutive patients with severe trauma requiring emergency transfusion (60 per group). The conventional workflow group included patients treated between January 2022 and August 2023, and the integrated workflow group included patients treated between January 2024 and March 2025. The integrated workflow comprised prehospital assessment, real-time pre-arrival communication, early activation of emergency and transfusion resources, electronic transfusion ordering, and dedicated blood product delivery. The primary outcome was time to first transfusion, interpreted as a process-efficiency measure. Secondary outcomes included coagulation-related indices before transfusion and at 24&#x2005;h, 24-h blood product utilization, intensive care unit length of stay, and in-hospital mortality. Univariable and multivariable analyses were performed to evaluate the association between workflow group and key outcomes.ResultsBaseline demographic, clinical, and pretransfusion laboratory characteristics were generally comparable between groups. The integrated workflow group had a shorter time to first transfusion than the conventional workflow group (25.1&#x2009;&#xb1;&#x2009;6.4 vs. 56.3&#x2009;&#xb1;&#x2009;8.2&#x2005;min, p&#x2009;<&#x2009;0.001). Fresh frozen plasma transfused within 24&#x2005;h was higher in the integrated workflow group (1776&#x2009;&#xb1;&#x2009;348 vs. 1395&#x2009;&#xb1;&#x2009;317&#x2005;mL, p&#x2009;<&#x2009;0.001), whereas 24-h packed red blood cell use was similar (14.2&#x2009;&#xb1;&#x2009;5.4 vs. 14.7&#x2009;&#xb1;&#x2009;5.7 U, p&#x2009;=&#x2009;0.645). At 24&#x2005;h after transfusion, international normalized ratio and activated partial thromboplastin time were lower in the integrated workflow group (1.24&#x2009;&#xb1;&#x2009;0.29 vs. 1.37&#x2009;&#xb1;&#x2009;0.33, p&#x2009;=&#x2009;0.022; 35.1&#x2009;&#xb1;&#x2009;6.6 vs. 42.1&#x2009;&#xb1;&#x2009;8.1&#x2005;s, p&#x2009;<&#x2009;0.001). Intensive care unit length of stay was shorter (7.3&#x2009;&#xb1;&#x2009;2.3 vs. 8.7&#x2009;&#xb1;&#x2009;3.8 days, p&#x2009;=&#x2009;0.013). In-hospital mortality was numerically lower but did not differ significantly between groups (13.3% vs. 21.7%, p&#x2009;=&#x2009;0.337).ConclusionsIn this single-center observational before-and-after study, a prehospital-to-in-hospital integrated transfusion workflow was associated with shorter time to first transfusion, greater early plasma administration, more favorable coagulation-related indices at 24&#x2005;h, and shorter intensive care unit length of stay in patients with severe trauma requiring emergency transfusion. These findings should be interpreted primarily as evidence of improved workflow efficiency and hypothesis-generating associations with intermediate physiologic and short-term clinical outcomes. Further multicenter studies using standardized workflow timestamps, protocol-adherence assessment, and more rigorous adjustment for confounding are needed to determine whether this approach improves patient-centered outcomes across different trauma systems.

To co-develop a stakeholder-informed oral healthcare model for dependent older adults that can be integrated into Thailand's existing Community-Based Long-Term Care (CBLTC) system using an Experience-Based Co-Design (EBCD) approach. A Participatory Action Research (PAR) approach was employed using Experience-Based Co-Design (EBCD). The process involved five iterative steps: baseline assessment, in-depth interviews, stakeholder-specific focus group discussions, a joint co-design session, and validation of the model. Participants included dependent older adults, formal and informal caregivers, family care teams, local authorities, and private-sector actors (N = 22). Data were collected through qualitative methods and analysed using inductive content analysis to derive the model components and assess stakeholder consensus. The findings revealed a critical gap in oral healthcare within the current CBLTC framework, despite existing coordination across medical and social care. Participants identified barriers such as a lack of trained personnel, inadequate referral systems, and insufficient caregiver capacity. Through a structured co-design process, a community-specific oral healthcare model was developed. The model defines stakeholder roles, referral pathways, and action plans for implementation. The co-designed model offers a practical, equity-driven solution to a long-standing gap in Thailand's long-term care landscape. By embedding oral healthcare into the existing CBLTC infrastructure, the model elevates oral health as a critical component of holistic ageing care. Although further implementation and evaluation are required, this framework sets a precedent for inclusive, community-informed innovation that may inspire broader policy adoption and system-wide integration.

Patients presenting to the emergency department (ED) with transient ischemic attack (TIA) or stroke, as well as admitted patients who develop stroke symptoms in acute nonstroke units, are commonly transferred to stroke units, where trained interdisciplinary teams provide comprehensive assessments and discharge planning. However, the lack of integrated interdisciplinary stroke assessments in the ED and acute nonstroke unit care settings has contributed to inefficient patient flow and capacity pressure, prolonged hospital length of stay (LOS), and delayed discharge. Prior models have emphasized rapid outpatient TIA or stroke prevention clinics and ED observation pathways; these approaches have largely focused on expedited medical diagnosis and treatment, with limited attention to coordinated interdisciplinary functional assessment and discharge planning to facilitate early discharge, especially from the ED and nonstroke units, reduce readmissions, and support rehabilitation. This protocol outlines the implementation and prospective evaluation of the MOTIVE (Mobile Transient Ischemic Attack and Stroke With Adaptive Workflow) team, an interdisciplinary mobile service operational within the ED and inpatient nonstroke units at Health Sciences North, a regional stroke center in Northeastern Ontario. The service aims to deliver prompt medical and functional assessments to facilitate early decision-making and discharge planning. The objectives are to (1) reduce avoidable ED admissions for patients with TIA and minor stroke, (2) decrease hospital LOS, (3) maintain patient safety as measured by 30-day readmission rates, and (4) enhance patient and caregiver experience. This single-center, prospective, uncontrolled, before-and-after quality improvement study will use control charts to evaluate temporal changes in outcomes. The MOTIVE project will follow the Institute for Healthcare Improvement Model for Improvement and will be reported in accordance with the SQUIRE (Standards for Quality Improvement Reporting Excellence) 2.0 guidelines. The preimplementation period (fiscal year 2022) will serve as the baseline period. The postimplementation evaluation will cover 12 months following the full implementation of the MOTIVE team, with iterative refinement guided by Plan-Do-Study-Act cycles. This is a study protocol; therefore, the results are not yet available. Planned analyses will include run charts and control charts to evaluate temporal trends, alongside preimplementation and postimplementation comparisons. Outcomes will comprise primary measures (ED-to-inpatient admission rate, acute LOS, and avoided bed-day costs), process measures (time to interdisciplinary assessment, magnetic resonance imaging wait time, and proportion of patients triaged within 24 h), and balancing measures (30-day readmission, outpatient therapy services wait time, stroke prevention clinic referral volume and wait time, and patient and caregiver experience). This innovative MOTIVE model is anticipated to improve stroke care efficiency, patient outcomes, and patient and caregiver experience through timely interdisciplinary assessments and support earlier discharge for select patients. The findings of this study will inform the feasibility and scalability of this model in similar health care contexts. OSF Registries osf.io/2jybu; https://osf.io/2jybu. DERR1-10.2196/93315.

Integrated Care Systems (ICSs) in England seek ever-closer collaborative relationships between health and social care providers, local authorities, and the Voluntary, Community, Faith and Social Enterprise (VCFSE) sector to deliver public services in place. However, ICSs present significant challenges for VCFSEs. In-depth qualitative case study of VCFSEs in an ICS contiguous with a Unitary Authority in England. i) the role of the 'microbiome' of smallest VCFSE in the ICS is unclear; ii) current commissioning models work against the effective participation of VCFSEs in ICSs; iii) short-term and under-funded contracts threaten VCFSEs; iv) substitution and appropriation represent tangible threats to VCFSEs through increased demand and bureaucratisation; v) the degree to which ICS support a vibrant, heterogeneous, and sustainable VCFSE sector depends on 'system maturity'. Integration is a process, not an event. The evolving landscape of service design presents both opportunities and challenges for VCFSEs, requiring careful management to harness strategic advantages while addressing operational risks.