bluuebunny/crossref_metadata_2025_split huggingface dataset:
Decision-making under pressure: ethical considerations in COVID-19 policy making in Switzerland
Authors: Brall C 
Published: October 2024

Abstract

Background
Policy making and science were deeply intertwined during the COVID-19 pandemic, particularly in justifying health policy measures with ethical considerations being at the core of decision-making trade-offs. However, not much is known about the actual ethical challenges encountered by policy makers and scientists involved in policy advice. This study aims to explore the ethical challenges in COVID-19-related political decision-making as perceived by Swiss policy makers and scientists involved in policy making, the role of ethics advice, and what can be learned for future public health crises.

Methods
Thirteen qualitative expert interviews were conducted with policy makers and scientists involved in COVID-19 policy decisions in Switzerland at regional and national levels. We used inductive thematic content analysis to analyse the interviews.

Results
Key ethical challenges included making trade-offs between common vs. individual good and economic welfare vs. health of the population, proportionality of policy measures, and public capacity to handle uncertainty. Opinions varied on the sufficiency of ethical considerations on the policy level. Constraints included a lack of time in the fast-paced dynamic of the pandemic, ethics as a complex subject area, its overlap with law, too much focus on few topics such as vaccination-related questions, and individual character traits, such as the dominance of medical professionals over ethicists. While ethics support was deemed adequately present in the decision-making process, there were calls for more ethics training, involvement of the public in the discourse, and for accompanying communication to build trust among the population for the future.

Conclusions
The study offers empirical insights into the ethical considerations of COVID-19 policy making in practice in Switzerland, providing a basis to enhance ethics support for future crises also in other countries.

Key messages
• This study uncovers the key ethical considerations in Swiss COVID-19 policy making, emphasizing constraints to sufficient ethical discussions.
• Enhanced ethics training and greater public engagement is needed in future health crises to build trust and improve decision-making in future health crises.
Does staffing impact health and work conditions of staff in long-term care homes?: a scoping review
Authors: Miller M , Hopwood P , Haghighi P , Littler E , Davis A , Al Momani Y , MacEachen E 
Published: October 2024

Abstract

Background
Long-Term Care (LTC) homes are highly regulated and task oriented, with demanding work and insufficient resources. Chronic underfunding of the sector, coupled with increased complexity of care, has deteriorated working conditions, resulting in precarious employment, intensified and stressful work, and decreased job satisfaction. These work conditions have contributed to severe staffing shortages of healthcare workers globally. To meet increased labour demands, OECD countries on average will need to increase the proportion of overall employment dedicated to LTC by 32% over the next decade. While reviews of literature have examined the association between staffing and care outcomes for residents in LTC, they have not examined how staffing structures affect the healthcare staff themselves. This scoping review asks: How does staffing impact the health of staff and working conditions in LTC?

Methods
A scoping review of empirical peer reviewed and grey literature was conducted to examine the association between LTC staffing practices and how they impact working conditions and the health and well-being of staff. PubMed, CINHAL, and Scopus databases were searched for relevant articles published within the past 10 years.

Results
Searches yielded 3994 unique articles, which were independently screened by pairs of reviewers. Preliminary results highlight that staffing levels are not optimized for healthy, sustainable work conditions. The level of staff, their skill mix, and ratios all impact the ability to provide care. In circumstances where there is inadequate staffing, care workers are more likely to experience stress, burnout, job dissatisfaction, and increased injury and illness.

Conclusions
Staffing practices shape working conditions which impact healthcare workers own health outcomes. To facilitate a strong LTC workforce, working conditions and occupational health need to be a priority in improvement initiatives.

Key messages
• With extreme staffing shortages challenging the healthcare sector, this review highlights the need for heightened attention to the impact of staffing practices on the healthcare workforce.
• Improving working conditions and attuning to the needs of the workforce, ultimately improves quality of care.
Ready or not? The state of emergency preparedness among Italian Public Health medical residents
Authors: Zotti N , Guicciardi S , Di Serafino F , Mimmo R , Sanna A , Granvillano G , Iagnemma A , Rizzo C , Tafuri S ,   WG
Published: October 2024

Abstract

Background
Italy frequently experiences major events like earthquakes, floods, and migrant shipwrecks, reflecting global concerns that also include climate change, pandemics, and wars. This study aims to assess the role of public health experts and the current state of Italian post-degree Public Health schools in addressing these challenges.

Methods
In June 2023, a cross-sectional online survey was administered to all Italian Public Health residents enrolled in the Italian Society of Hygiene, Preventive Medicine, and Public Health (SItI). The survey investigated the availability and frequency of training and updates related to emergencies, measured the interest and perceived importance of these topics among residents, examined the impact of the COVID-19 pandemic on their awareness, and identified their primary sources of information in the subject.

Results
Out of 289 respondents, a significant majority (86.2%) acknowledging the importance of being trained in emergency management and 74.4% expressed interest in topic (p &lt; 0.001). A 90.1% of residents indicated a lack of dedicated courses and 93.1% reported an absence of specialized master’s programs (p &lt; 0.001). There was a strong correlation between recognizing the importance of the topic and the desire to attend specialized conferences (p &lt; 0.001). The COVID-19 pandemic had a noticeable impact: 24.6% recognized the importance of the topic pre-pandemic, while 50.9% raised awareness during (p &lt; 0.001).

Conclusions
The findings highlight a critical gap in the training of public health professionals in Italy, particularly in the domain of emergency preparedness and management. There is a pressing need to establish enhanced, uniform training programs across different public health training networks in Italy. Implementing such programs would ensure a more robust and effective response to future emergencies, thereby safeguarding public health and improving outcomes during crises.

Key messages
• Significant gap in specialized training and awareness among health professionals.
• Urgent need for emergency preparedness training in public health.
Strengthening the quality of primary healthcare services and interdisciplinary collaboration
Authors: Lyhne C 
Published: October 2024

Abstract

Background
Political organisations stress the need for preventive strategies to reduce the amount of avoidable hospital admissions, i.e. admissions that could have been avoided given timely and adequate care in the primary healthcare setting. Interdisciplinary collaboration has been suggested as a means to prevent hospitalizations, but effective implementation remains a challenge. Thus, there is a need for evidence-based strategies to prevent avoidable admissions and support interdisciplinary collaboration. The aim was to develop an evidence-based framework for preventive and coordinated interventions strengthening the quality of primary healthcare services and supporting interdisciplinary collaboration.

Methods
The project consists of three sub-studies: 1) a mixed methods systematic review following the JBI methodology; 2) a focus group study with primary healthcare providers in the Central Denmark Region, including general practitioners, physiotherapists, occupational therapists, home care providers, registered nurses and nurse specialists; and 3) a study using participatory design, where a framework for coordinated interventions were developed based on the results from study 1 and 2, supported by all stakeholders.

Results
Findings suggest that some hospitalizations can be prevented by intervening on mental factors, e.g., through trustful relations, and social factors, e.g., living situation. Also, a strong collaboration between healthcare providers from different disciplines and healthcare services is needed to improve the care pathway and prevent hospitalization. The collaboration may be strengthened if the health providers share a common language regarding the citizens’ health status.

Conclusions
Stakeholders at all levels should be informed about the relevance of considering mental, social and physical factors to improve the quality and responsiveness of primary healthcare services and to develop initiatives to support interdisciplinary collaboration.

Key messages
• By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately to prevent some admissions.
• Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration.
Future proof competencies for nurses working in primary care; a mixed methods study
Authors: Wit R F , de Groot K , de Bruijn EHML , Batenburg R S , Francke A L 
Published: October 2024

Abstract

Background
Healthcare services, also those provided by nurses, are challenged by the increasing care demands of an ageing population and people with chronic conditions. To improve care efficiency and quality, now and in the future, nurses must have competencies regarding self-management support of patients, electronic communication, preventive care, and engaging relatives in care. This study aimed to assess primary care registered nurses’ (RNs) time allocation to these competencies and their perceived needs for further development of these competencies.

Methods
A mixed methods design was used, involving a nationwide survey (n = 303) and focus groups (12 participants), both with RNs working in community care services or general practitioners (GPs) practices. Survey data were analysed descriptively, and focus group transcripts underwent qualitative thematic analysis.

Results
The majority of RNs invest significant time in client self-management support (90%), preventive care (82%), and involving relatives in care (74%). RNs also recognized an increasing demand for these competencies in the future and the need to motivate patients and relatives to self-manage their health. Furthermore, RNs reported that competencies regarding electronic communication skills will become extra important in the future, yet currently only 37% dedicate substantial time to this. RNs face challenges in effectively utilizing electronic communication with patients and thus need opportunities to improve digital skills. Additionally, RNs desire enhanced collaboration with other healthcare professionals, such as GPs and medical specialists.

Conclusions
RNs’ limited time allocation and perceived inadequacy in electronic patient communication, underscore the importance of targeted training in this area, and prioritizing this by healthcare organizations. In addition, fostering collaboration between nursing staff and other healthcare professionals could support future proof nursing in primary care.

Key messages
• Nurses demonstrate resilience in addressing healthcare challenges, emphasizing client care, prevention and family engagement.
• Training nurses in competencies for electronic communication with patients is essential to meet the anticipated increase in demand for this aspect in their practice.
How common is emergency department as a death place in Portugal and who is more likely to die there?
Authors: Sanguedo B , Gomes B , Lopes S 
Published: October 2024

Abstract

Background
Most people would prefer to die at home but most die in hospitals or other healthcare settings. Some of the latter deaths may have taken place in Emergency Departments (EDs), as EDs are a major hospital gateway. However, EDs have not been consistently categorised as a place of death (PoD) across countries. Portugal is an exception. This study aimed to examine trends in deaths at EDs in Portugal from 2015 to 2021, identifying who is more likely to die at the ED.

Methods
We obtained national death certificate data on PoD for 2015 to 2021 from the the Portuguese General-Directorate for Health. We analysed the percentage of deaths taking place at the ED by sex, age group (0-17y, 18-49y, 50-69y, 70-79y, ≥80y), underlying cause of death (cancer, dementia, and other causes) and year of death.

Results
804.971 people died in Portugal from 2015-2021 (50.1% male; 0.4% aged 0-17y, 58.0% aged ≥80y; 23.3% died from cancer, 5.6% from dementia, and 71.1% from other causes). Of these, 13.2% died at the ED. The percentage of ED deaths was higher in female (13.7% vs. 12.8% in male), in adults (13.3% vs. 9.0% in children), in those dying from dementia (15.7% compared to 9.6% in cancer and 14.3% in other causes). The percentage of ED deaths rose from 10.6% in 2015 to 14.3% in 2021, increasing steadily over time (average 0.6 percentual points per year, representing 1069 additional deaths per year).

Conclusions
One in every ten deaths in Portugal happens at ED and this is increasing. Patients with non-cancer conditions are more likely to die at the ED, in particular those dying from dementia. To understand if this reality compares with other countries, we are developing a pioneering international classification of place of death which includes the ED. Funding: European Research Council (agreement nr. 948609).

Key messages
• Emergency department (ED) is a significant PoD in Portugal and has increased from 10.6% to 14.3% (2015-2021). Non-cancer patients, especially those with dementia, more likely to die at ED.
• This study highlights the need for an international place of death classification to compare emergency department death trends across countries.
Performance and trend of core measures among oral cancer patients: A population-based cohort study
Authors: Wang Z C , Chen Y Y 
Published: October 2024

Abstract

Objectives
This study explores the performance and trend of core measures, which were established as evidence-based indicators to assess and improve the quality of care for oral cancer patients.

Methods
This retrospective cohort study uses the National Health Insurance Research Database (NHIRD), Taiwan Cancer Registry, and Cause of Death Statistics, provided by the Health and Welfare Data Science Center (HWDC), Ministry of Health and Welfare (MOHW). The study population was adult patients hospitalized for oral cancer surgery with stage I-IV between 2014 and 2021. The trend tests and the generalized linear mixed model (GLMM) were applied.

Results
A total of 23392 oral cancer patients were enrolled. The core measure set used in this study included five indicators (two process-related and three outcome-related indicators). Process indicators’ mean achievement rates significantly increased from 82.6% to 85.7% (p = 0.018, trend test). On the other hand, most patients demonstrated good achievement rates to the outcome indicators (98.9% to 99.3%) (p = 0.218, trend test). Overall indicators’ 100% achievement rate increased over time from 62.9% in 2014 to 66.2% in 2021 (p &lt; 0.001, trend test). Subgroup analyses were performed by age, stage, and comorbidity score. The analysis of the GLMM revealed that the 100% achievement to overall indicators was positively associated with age&lt;45, not-low socioeconomic status, body mass index ≥ 24, squamous cell carcinoma, recent treatment year, treated with surgery only, negative surgical margins, and receiving care in a high-volume hospital (all p &lt; 0.01).

Conclusions
The results highlight a significant measurable improvement in the quality of oral cancer care. However, there is still room for enhancement in process indicator performance.

Key messages
• The results highlight a significant measurable improvement in the quality of oral cancer care.
• There is still room for enhancement in process indicator performance.
Impact of bundled payments on healthcare use and costs for cardiovascular diseases in the Netherlands
Authors: Dros J T , van Dijk C E , Verheij R A , Bos I , Meijboom B R 
Published: October 2024

Abstract

Background
Bundled payments for patients with cardiovascular diseases (CVD) aim to enhance primary care utilization in the Netherlands. This study assesses changes in healthcare utilization patterns and costs for CVD between 2015 and 2019, while investigating the potential association with bundled payment adoption.

Methods
We studied patients at very high risk for CVD using routinely recorded nationwide healthcare data. Multilevel logistic- and gamma regressions were conducted to assess healthcare utilizations patterns between 2015 and 2019, and the impact of bundled payments on the likelihood of receiving medical specialist care and the height of associated costs.

Results
The odds of medical specialist involvement declined over time for the 148,876 patients included in our study. This decline was significantly associated with practices’ use of bundled payments. Medical specialist costs did also significantly decrease between 2015 and 2019, and patients in practices with the highest level of bundled payments had significantly lower medical specialist costs. When general practice costs were included however, healthcare costs per patient stayed the same, both over time and stratified by use of bundled payments.

Conclusions
Our findings suggest an association between bundled payments and specialized healthcare use, potentially facilitating the transition to primary care. While we found no evidence for costs savings, our findings do support a reduction in spending growth.

Key messages
• We evaluated the impact of bundled payments as a means to facilitate integrated care, and found that bundled payments were associated with lower uptake of specialized medical care.
• We found no cost savings were found, but findings do support reduced spending growth.
Pharmacist care for hypertension management among patients with diabetes: a systematic review
Authors: Gastens V , Tancredi S , Bonnan D , Kiszio B , Del Giovane C , Tsuyuki R T , Paradis G , Chiolero A , Guénette L , Santschi V 
Published: October 2024

Abstract

Background
Improving blood pressure (BP) control is of major importance among patients with diabetes, due to their high risk of micro- and macrovascular complications. Community-based models of care with the involvement of pharmacists and other nonphysician healthcare providers can help manage hypertension. We aimed to estimate the effectiveness of pharmacist interventions, alone or in collaboration, on BP among outpatients with diabetes and hypertension.

Methods
We conducted systematic searches of randomized controlled trials assessing the effect of pharmacist interventions on BP among outpatients with hypertension and diabetes compared to usual care. The outcome was the systolic and diastolic BP change or BP control. We performed a meta-analysis with random effects models and results are presented by mean difference along with relative 95% CI.We will perform subgroup analyses for the types and intensity (duration, frequeny) of pharmacist interventions, patients’ characteristics, and healthcare settings. The protocol was registered in PROSPERO (CRD42021279751) and published in an open-access peer-reviewed journal.

Results
Out of 2048 study records identified by electronic database searching, we included 9 studies, with 5067 participants, published between 2008 and 2022. These studies were conducted mainly in North America (n = 5; other regions: n = 4). The intervention was led by the pharmacist in 78% of the studies and in collaboration with other healthcare providers in 22%. Pharmacist intervention included patient education in 67%, healthcare providers education in 11% of studies and feedback to healthcare providers in 44% of the studies. Systolic and diastolic BP were reduced after pharmacist intervention by -5.6 mmHg (95% CI: -10.6 to -0.6) and -4.1 mmHg (95% CI: -7.1 to -1.2) respectively. Additional analyses will be presented at the congress.

Conclusions
Pharmacist interventions improve blood pressure control in hypertensive diabetic outpatients.

Key messages
• Recent hypertension guidelines recommend pharmacist involvement in hypertension care management.
• This systematic review provide updated evidence on the effect of pharmacist interventions on hypertension management of patients with diabetes.
Effectiveness of pictorial-warning intervention to reduce consumption of sugar-sweetened-beverages
Authors: Afreen A , Patnaik S 
Published: October 2024

Abstract

Background & Aims
Limited research have looked at pictorial-health-warnings (PHW) for sugar- sweetened beverages (SSB), despite the potential for behaviour change that pictorial warnings on tobacco products hold. This study aimed to examine how visual warnings impacted parents’ decisions to buy SSB for their children.

Materials and methods
All residents dwelling in the communities and local vendors available were subjected to a ten-week multi-strategy intervention by randomized stepped-wedge controlled trial to support the introduction of PHW labels. Stepped implementation of a two-week PHW intervention was delivered in a randomly selected order at one-week intervals. Follow-up data were collected for all three sectors two weeks following the completion of the PHW intervention in the third sector. The trial outcome was determined by comparing the overall perception change towards SSB among parents between the baseline and follow-up periods for three sectors combined. Secondary outcomes included reactions to the trial labels, attitudes toward SSB, and intentions to serve their child SSB.

Results
PHW led to a 30 % (-37.12%, -22.37%) reduction in purchases of SSB, along with lower intentions to serve SSB to children, higher thoughtfulness about the harms of SSB, more perceived control of healthy eating decisions, stronger negative emotional reactions, lower perceived healthfulness of SSB for their child, and greater injunctive norms to limit SSB for their child (all p &lt; 0.05). No differences by sector or within sector were found between pre and post-intervention in the appeal of SSB or perceived tastiness of SSB (all p &gt; 0.05). Nearly 53% of participants reported being more in control of making healthy eating decisions.

Conclusions
Warnings on SSB are a promising policy approach to reduce sugary drink purchasing. This evidence will support the health service adoption of implementation strategies to support PHW labels across the entire country.

Key messages
• Warnings on SSB are a promising policy approach to reduce sugary drink purchasing.
• Support the health service adoption of implementation strategies to support PHW labels across the entire country.