Views of general practice staff on sharing general practice data for research: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to understand the range and types of evidence in relation to the views of general practitioner and other general practice staff on sharing general practice data for research purposes. INTRODUCTION: The use of general practice data for research has the potential to drive transformative improvements in health care. The vast amount of patient data collected in general practice is valuable and provides researchers with data to conduct large-scale studies and generate evidence that can inform policy decisions, support the development of personalized medicine, and enhance patient outcomes. However, despite there being clear benefits to using general practice data for research, there are also potential harms, such as data misuse, loss of trust between the general practitioner and patient, and data breaches. INCLUSION CRITERIA: This scoping review will focus on the views of general practice staff, including general practitioners, practice nurses, and practice managers, about sharing general practice data for the purposes of research. This scoping review will exclude sources of evidence that are conducted outside of the general practice setting, and papers that report on public, patient, or community views on data sharing. METHODS: This scoping review will be conducted in accordance with JBI methodology for scoping reviews. A 3-step search strategy will be used to acquire both published and unpublished sources of evidence. Two independent reviewers will select sources of evidence in line with the inclusion and exclusion criteria. No limits on the date of the search or language will be applied. Data will be extracted and the results will be summarized descriptively and presented in a tabular format. REVIEW REGISTRATION: Open Science Framework https://osf.io/49yw5.

Political economy analysis of health: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to identify and map the literature on concepts, definitions, frameworks, outcomes, and applications of political economic analysis of health. INTRODUCTION: The political economy of health approach seeks to understand how political and economic domains interact and shape individual and population health outcomes. A political economic analysis can provide insights into health problems and inequalities; however, there needs to be more clarity on how the political economy framework is defined and the methods adopted for conducting political economy analysis concerning health. INCLUSION CRITERIA: Studies focusing on the political economy analysis addressing specific health problems will be included. The study population is not limited to any sociodemographic characteristics, and there will be no restrictions on language or the source of evidence (primary studies or secondary data studies). Both qualitative and quantitative methodologies will included, but narrative and systematic reviews will be excluded, as will conference abstracts and editorials. Studies involving sector- or country-level analysis will be included. METHODS: The review will follow the JBI methodology for scoping reviews. Databases to be searched include MEDLINE, Scopus, Web of Science, Cochrane CENTRAL, CINAHL, Embase, ProQuest, DynaMed, and gray literature via Google Scholar and OAIster. Two reviewers will perform study screening and data extraction using a customized data extraction form. The concepts, definitions, frameworks, outcomes, and applications of the political economy of health will be summarized and discussed. The health problems addressed using political economy analysis will be enumerated. Stakeholder engagement will guide all steps of the study. Results will be presented in tabular and graphical formats accompanied by a narrative summary. REVIEW REGISTRATION: Open Science Framework https://osf.io/4qaxr/.

Implementation and evaluation of the Supportive and Palliative Care Indicators Tool (SPICT™) in acute care.

OBJECTIVES: The Supportive and Palliative Care Indicators Tool (SPICT™) has been used to identify patients at risk of deteriorating and dying within 1 year. Early identification and integration of advance care planning (ACP) provides the opportunity for a better quality of life for patients. The aims of this study were to identify the number of patients who were SPICT™ positive; their mortality rates at 6 and 12 months of the SPICT™ assessment; and level of adherence to ACP documentation. METHODS: A retrospective audit of the Supportive and Palliative Care database was conducted at an acute aged care precinct in a major metropolitan tertiary referral hospital in New South Wales, Australia. Data comprising demographics, clinical conditions, SPICT™ positivity and compliance with ACP documentation were collected. SPICT™-positive patients and mortality were tracked at 6 and 12 months, respectively. RESULTS: Data from 153 patients were collected. The mean age of the patients was 84.1 (±7.8) years, and the length of hospital stay was 10 (±24.7) (range 1-269) days. Approximately 37% were from residential care, and 80% had family deciding on their care. About 15% died during hospitalisation, and 48% were discharged to a care facility. The ACP documentation showed various levels of completion. Mortality rates at 6 and 12 months were 36% and 39%, respectively. Most patients (99%) were SPICT™-positive, with indicators correlating with higher mortality rates at both follow-ups. CONCLUSIONS: The study emphasises the critical need for addressing ACP and palliative care among older patients with life-limiting conditions. It underscores the importance of timely discussions, documentation, and cessation of futile interventions.

"We are not invited": Australian focus group results on how to improve ethnic diversity in trials.

OBJECTIVES: Lack of ethnic diversity in trials may contribute to health disparities and to inequity in health outcomes. The primary objective was to investigate the experiences and perspectives of ethnically diverse populations about how to improve ethnic diversity in trials. STUDY DESIGN AND SETTING: Qualitative data were collected via 16 focus groups with participants from 21 ethnically diverse communities in Australia. Data collection took place between August and September 2022 in community-based settings in six capital cities: Sydney, Melbourne, Perth, Adelaide, Brisbane, and Darwin, and one rural town: Bordertown (South Australia). RESULTS: One hundred and fifty-eight purposively sampled adults (aged 18-85, 49% women) participated in groups speaking Tamil, Greek, Punjabi, Italian, Mandarin, Cantonese, Karin, Vietnamese, Nepalese, and Arabic; or English-language groups (comprising Fijian, Filipino, African, and two multicultural groups). Only 10 participants had previously taken part in medical research including three in trials. There was support for medical research, including trials; however, most participants had never been invited to participate. To increase ethnic diversity in trial populations, participants recommended recruitment via partnering with communities, translating trial materials and making them culturally accessible using audiovisual ways, promoting retention by minimizing participant burden, establishing trust and rapport between participants and researchers, and sharing individual results. Participants were reluctant to join studies on taboo topics in their communities (eg, sexual health) or in which physical specimens (eg, blood) were needed. Participants said these barriers could be mitigated by communicating about the topic in more culturally cognizant and safe ways, explaining how data would be securely stored, and reinforcing the benefit of medical research to humanity. CONCLUSION: Participants recognized the principal benefits of trials and other medical research, were prepared to take part, and offered suggestions on recruitment, consent, data collection mechanisms, and retention to enable this to occur. Researchers should consider these community insights when designing and conducting trials; and government, regulators, funders, and publishers should allow for greater innovation and flexibility in their processes to enable ethnic diversity in trials to improve.

Ethical issues when conducting health research with military personnel: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to understand the scope and nature of evidence in relation to the ethical issues that arise when conducting health research with military personnel. INTRODUCTION: Ethical obligations in human research have been debated for centuries. Historically, research conducted with military personnel has led to ethical controversies regarding autonomy, harm, and informed consent. In particular, the power dynamics, hierarchical nature, and culture that are inherent in military structures may compromise the voluntary nature of research participation. INCLUSION CRITERIA: This scoping review will include all sources of evidence that identify ethical issues, such as autonomy, beneficence, non-maleficence, and justice, within health research with military personnel, including reservists. This review will exclude sources of evidence on health research conducted during combat or on new technologies for fighting in wars. METHODS: This scoping review will be conducted in accordance with the JBI methodology for scoping reviews. A 3-step search strategy will be used to obtain both published and unpublished sources of evidence. Two independent reviewers will screen sources of evidence against the inclusion and exclusion criteria. No limits on language will be applied; we will use Google Translate to translate sources of evidence in languages other than English. Sources of evidence published since 1964 will be included. Data will be extracted using a purpose-designed spreadsheet and the results will be summarized descriptively and presented in tabular format. REVIEW REGISTRATION: Open Science Framework https://osf.io/db85p.

Effectiveness of Telehealth Cardiac Rehabilitation Programs on Health Outcomes of Patients With Coronary Heart Diseases: An Umbrella Review.

PURPOSE: The aim of this study was to conduct an umbrella review summarizing the evidence from existing systematic reviews of telehealth cardiac rehabilitation (CR) on health outcomes of patients with coronary heart disease (CHD). REVIEW METHODS: An umbrella review of systematic reviews was undertaken in accordance with the PRISMA and JBI guidelines. A systematic search was conducted in Medline, APA PsycINFO, Embase, CINAHL, Web of Science, Cochrane database of systematic reviews, JBI evidence synthesis, Epistemonikos, and PROSPERO, searching for systematic reviews published from 1990 to current and was limited to the language source of English and Chinese. Outcomes of interest were health behaviors and modifiable CHD risk factors, psychosocial outcomes, and other secondary outcomes. Study quality was appraised using the JBI checklist for systematic reviews. A narrative analysis was conducted, and meta-analysis results were synthesized. SUMMARY: From 1301 identified reviews, 13 systematic reviews (10 meta-analyses) comprised 132 primary studies conducted in 28 countries. All the included reviews have high quality, with scores ranging 73-100%. Findings to the health outcomes remained inconclusive, except solid evidence was found in the significant improvement in physical activity (PA) levels and behaviors from telehealth interventions, exercise capacity from mobile health (m-health) only and web-based only interventions, and medication adherence from m-health interventions. Telehealth CR programs, work adjunct or in addition to traditional CR and standard care, are effective in improving health behaviors and modifiable CHD risk factors, particularly in PA. In addition, it does not increase the incidence in terms of mortality, adverse events, hospital readmission, and revascularization.

Older persons' perceptions and experiences of community palliative care: a systematic review of qualitative evidence.

OBJECTIVE: The objective of this review was to critically appraise and synthesize qualitative evidence of older persons' perceptions and experiences of community palliative care. INTRODUCTION: Palliative care focuses on the relief of symptoms and suffering at the end of life and is needed by approximately 56.8 million people globally each year. An increase in aging populations coupled with the desire to die at home highlights the growing demand for community palliative care. This review provides an understanding of the unique experiences and perceptions of older adults receiving community palliative care. INCLUSION CRITERIA: This review appraised qualitative studies examining the perceptions and experiences of older adults (65 years or older) receiving community palliative care. Eligible research designs included, but were not limited to, ethnography, grounded theory, and phenomenology. METHODS: A search of the literature across CINAHL (EBSCOhost), MEDLINE (Ovid), Embase (Ovid SP), Web of Science Core Collection, and Scopus databases was undertaken in July 2021 and updated November 1, 2022. Included studies were published in English between 2000 and 2022. The search for unpublished studies included ProQuest Dissertations and Theses. Study selection, quality appraisal, and data extraction were performed by 2 independent reviewers. Findings from the included studies were pooled using the JBI meta-aggregation method. RESULTS: Nine qualitative studies involving 98 participants were included in this review. A total of 100 findings were extracted and grouped into 14 categories. Four synthesized findings evolved from these categories: i) Older persons receiving palliative care in the community recognize that their life is changed and come to terms with their situation, redefining what is normal, appreciating life lived, and celebrating the life they still have by living one day at a time; ii) Older persons receiving palliative care in the community experience isolation and loneliness exacerbated by their detachment and withdrawal from and by others; iii) Older persons receiving palliative care in the community face major challenges managing prevailing symptoms, medication management difficulties, and costs of medical care and equipment; and iv) Older persons want to receive palliative care and to die at home; however, this requires both informal and formal supports, including continuity of care, good communication, and positive relationships with health care providers. CONCLUSIONS: Experiences and perceptions of community palliative care vary among older adults. These are influenced by the individual's expectations and needs, available services, and cost. Older adults' input into decision-making about their care is fundamental to their needs being met and is contingent on effective communication between the patient, family, and staff across services. Policy that advocates for trained palliative care staff to provide care is necessary to optimize care outcomes, while collaboration between staff and services is critical to enabling holistic care, managing symptoms, and providing compassionate care and support.

Exploring the perspectives of selectors and collecters of trial outcome data: an international qualitative study.

INTRODUCTION: Selecting and collecting data to support appropriate primary and secondary outcomes is a critical step in designing trials that can change clinical practice. In this study, we aimed to investigate who contributes to the process of selecting and collecting trial outcomes, and how these people are involved. This work serves two main purposes: (1) it provides the trials community with evidence to demonstrate how outcomes are currently selected and collected, and (2) it allows people involved in trial design and conduct to pick apart these processes to consider how efficiencies and improvements can be made. METHODS: One-with-one semi-structured interviews, supported by a topic guide to ensure coverage of key content. The Framework approach was used for thematic analysis of data, and themes were linked through constant comparison of data both within and across participant groups. Interviews took place between July 2020 and January 2021. Participants were twenty-nine international trialists from various contributor groups, working primarily on designing and/or delivering phase III pragmatic effectiveness trials. Their experience spanned various funders, trial settings, clinical specialties, intervention types, and participant populations. RESULTS: We identified three descriptive themes encompassing the process of primary and secondary outcome selection, collection, and the publication of outcome data. Within these themes, participants raised issues around the following: 1) Outcome selection: clarity of the research question; confidence in selecting trial outcomes and how confidence decreases with increased experience; interplay between different interested parties; how patients and the public are involved in outcome selection; perceived impact of poor outcome selection including poor recruitment and/or retention; and use of core outcome sets. 2) Outcome collection: disconnect between decisions made by outcome selectors and the practical work done by outcome collectors; potential impact of outcome measures on trial participants; potential impact on trial staff workload; and use of routinely collected data. 3) Publication of outcome data: difficulties in finding time to write and revise manuscripts for publication due to time and funding constraints. Participants overwhelmingly focused on the process of outcome selection, a topic they talked about unprompted. When prompted, participants do discuss outcome collection, but poor communication between selectors and collectors at the trial design stage means that outcome selection is rarely linked with the data collection workload it generates. DISCUSSION: People involved in the design and conduct of trials fail to connect decisions around outcome selection with data collection workload. Publication of outcome data and effective dissemination of trial results are hindered due to the project-based culture of some academic clinical trial research.

A protocol for a systematic review of randomised evaluations of strategies to improve recruitment of rural participants to randomised controlled trials.

INTRODUCTION: People living rurally face health inequities fuelled by social exclusion, access to and awareness of health services, and poor transport links. In order to improve the acceptability, accessibility and applicability of health and care interventions, it is important that clinical trial participant populations include people living rurally. Identifying strategies that improve recruitment of rural participants to trials will support trialists, reduce research waste and contribute to alleviating health inequalities experienced by rural patients. The objective of the review is to quantify the effects of randomised evaluations of strategies to recruit rural participants to randomised controlled trials. METHODS: The following databases will be searched for relevant studies: Ovid MEDLINE, Embase, Cochrane Library, Web of Science All, EBSCO CINAHL, Proquest, ERIC, IngentaConnect, Web of Science SSCI and AHCI, and Scopus. Any randomised evaluation of a recruitment intervention aiming to improve recruitment of rural participants to a randomised trial will be included. We will not apply any restriction on publication date, language or journal. The primary, and only, outcome of our review will be the proportion of participants recruited to a randomised controlled trial. Two reviewers will independently screen abstracts and titles for eligible studies, and then full texts of relevant records will be reviewed by the same two reviewers. Where disagreements cannot be resolved through discussion, a third reviewer will adjudicate. RESULTS: We will assess the methodological quality of individual studies using the Cochrane risk of bias tool, and the GRADE approach will be applied to determine the certainty of the evidence within each comparison. CONCLUSION: This systematic review will quantify the effects of randomised evaluations of strategies to recruit rural participants to trials. Our findings will contribute to the evidence base to support trial teams to recruit a participant population that represents society as a whole, informing future research and playing a part to alleviate health inequalities between rural and urban populations.

Widening participation - recruitment methods in mental health randomised controlled trials: a qualitative study.

BACKGROUND: Barriers to mental health research participation are well documented including distrust of services and research; and stigma surrounding mental health. They can contribute to a lack of diversity amongst participants in mental health research, which threatens the generalisability of knowledge. Given the recent widespread use of the internet in medical research, this study aimed to explore the perspectives of key partners on the use of online (e.g. social media) and offline (e.g. in-person) recruitment as an approach to improving diversity in mental health randomised controlled trials (RCTs). METHODS: Face-to-face and online interviews/focus groups with researchers working in mental health and Patient and Public Involvement partners in the United Kingdom. Recordings were transcribed and analysed using a combination of inductive and deductive thematic analysis. RESULTS: Three focus groups and three interviews were conducted with a total N = 23 participants. Four overarching themes were identified: (1) recruitment reach; (2) Demographic factors that affect selection of recruitment method; (3) safety of technology, and; (4) practical challenges. Five main factors were identified that affect the choice of recruitment method: age, complexity of mental health problem and stigma, cultural and ethnicity differences and digital divide. The use of online methods was considered more accessible to people who may feel stigmatised by their mental health condition and with a benefit of reaching a wider population. However, a common view amongst participants was that online methods require closer data monitoring for quality of responders, are not fully secure and less trustworthy compared to offline methods that enable participants to build relationships with health providers. Funding, staff time and experience, organisational support, and technical issues such as spam or phishing emails were highlighted as practical challenges facing online recruitment. All participants agreed that using a hybrid approach tailored to the population under study is paramount. CONCLUSIONS: This study highlighted the importance of offering a flexible and multifaceted recruitment approach by integrating online with offline methods to support inclusivity and widening participation in mental health research. The findings will be used to develop considerations for researchers designing RCTs to improve recruitment in mental health research.

Empathy and ethical sensitivity among intensive and critical care nurses: A path analysis.

BACKGROUND: Intensive and critical care nurses need to demonstrate ethical sensitivity especially in recognizing and dealing with ethical dilemmas particularly as they often care for patients living with life-threatening conditions. Theories suggest that there is a convergence between nurses' empathy and ethical sensitivity. Evidence in the literature indicates that nurses' emotional, demographic, and work characteristics are associated with their level of empathy and ethical sensitivity. AIM: To investigate the relationship between nurses' empathy and ethical sensitivity, considering their emotional states (depression, anxiety, and stress), demographic and work characteristics, and test an empirical model describing potential predictors of empathy (as a mediator) and ethical sensitivity using path analysis. RESEARCH DESIGN: Using a cross-sectional design, the philosophical theory of care ethics and empathy was extended and adopted as a conceptual framework for this study and tested by path analysis. PARTICIPANTS AND RESEARCH CONTEXT: Data were collected from 347 intensive care nurses recruited by ten educational-medical hospitals in Iran using a questionnaire between February and March 2021. ETHICAL CONSIDERATIONS: The study was reviewed by the Ethical Advisory Board in Iran and conducted according to the Declaration of Helsinki. FINDINGS: Study participants demonstrated a mild level of stress, anxiety, and depression, alongside a relatively high level of empathy and ethical sensitivity. Nurses with good socioeconomic status had higher empathetic behavior with patients than those with weak status. Nurses aged over 40 who had received ethics training and had higher work experience were associated with higher ethical sensitivity compared to nurses under 20 years of age. Empathy directly affected ethical sensitivity; however, anxiety had an indirect effect on ethical sensitivity through empathy. Among demographic factors, age had a positive direct effect on ethical sensitivity. CONCLUSIONS: Less anxiety and a high level of empathy contribute to higher levels of ethical sensitivity among intensive and critical care nurses.

Prevalence and Impact of Poststroke Fatigue on Patient Outcomes in the First 6 Months After Stroke: A Systematic Review and Meta-analysis.

ABSTRACT: BACKGROUND: Post-stroke fatigue (PSF) is one of the most pervasive and debilitating symptoms after stroke and has a negative impact on activities of daily living (ADLs) and health-related quality of life (HRQoL) of stroke survivors. However, to date, no study has systematically reviewed the prevalence of PSF at different points in time after stroke. OBJECTIVE: The aim of this study was to investigate the prevalence of PSF and its impact on ADLs and HRQoL in the first 6 months post stroke. METHOD: CINAHL, MEDLINE, Scopus, Google Scholar, and Index to Theses were searched from 1983 to August 2022 for studies published in English. Studies were included if they were conducted on adults 18 years and older, and were observational, correlational, and quantitative components of mixed methods reporting on PSF, ADLs, and HRQoL post stroke. RESULTS: Thirty studies were included in this review, and all had a high methodological quality. The pooled prevalence of PSF at 1 to 6 weeks was 49.5%; at 3 months, it was 41.9%; and at 6 months, it was 43.4%. A negative correlation between PSF and ADLs was observed at 1, 2, and 4 to 6 weeks, and at 3 and 6 months post stroke. A significant negative correlation between PSF and HRQoL was observed within the first week ( r = -0.40, P < .05) and at 3 and 6 months post stroke. The results at 3 and 6 months post stroke were inclusive. CONCLUSION : The prevalence of PSF in the first 6 weeks, particularly in the first 2 weeks after stroke, is high and has a significant negative impact on stroke survivors' ADLs and HRQoL. Only a limited number of studies assessed PSF within the first 2 weeks after stroke.

"I just wanted money for food": a qualitative study of the experiences of Australians during the COVID-19 pandemic.

Aim: The social and economic impacts that have occurred during the COVID-19 pandemic can disproportionally affect those already experiencing poverty or at risk of poverty. Therefore, this study sought to explore the relationship between well-being and social determinants of health among Australian adults during the pandemic. Subject and Methods: Semi-structured interviews were undertaken with 20 participants, aged 21-65 years, from various socioeconomic areas. Results: Three main themes emerged from the analysis of the data: food security; housing outcomes; and psychological and emotional impact. Participants in low socioeconomic areas struggled with food security, having to access food banks, which was precipitated by employment loss during the pandemic. Some female participants experienced worsening inequalities and lack of financial and housing stability, affecting their overall well-being. Conclusion: This study identified that there was a clear social divide between adults living in low socioeconomic areas compared with those living in high socioeconomic areas, with participants in low socioeconomic areas faring worse in terms of exacerbated social determinants of health and consequent impacts on well-being.

The efficiency of a continuous versus an intermittent apheresis method for collection of hematopoietic progenitor stem cells: A systematic review.

Peripheral blood hematopoietic progenitor stem cells (HPSCs) are the most common source of stem cells for autologous and allogenic transplantation. Currently, systematic reviews comparing the collection efficiency of a continuous to an intermittent method are lacking despite the existence of primary studies. Therefore, the objective of this review was to synthesize the best available evidence to compare the efficiency of the continuous vs the intermittent method for the collection of hematopoietic progenitor stem cells required for HPC transplantation. A search using MEDLINE, CINAHL, EMBASE, Google scholar, and MedNar for both published and unpublished studies was conducted in December 2021. The systematic review was conducted in accordance with JBI methodology. A critical appraisal of the studies was undertaken by two independent reviewers using the JBI quasi-experimental critical appraisal checklist. A total of six studies were included in the review. The findings of this review demonstrated that there was no statistically significant difference in the collection efficiency, length of procedure time, and total blood volume processed between the continuous and intermittent programs. The evidence suggests that the continuous method is as safe and effective as the intermittent method to collect HPSCs. Until further evidence becomes available clinicians should be guided by the policies of their individual hospitals.

Prevalence and Predictors of Knowledge and Attitudes Toward Eye Donation Among the General Population: A Systematic Review.

PURPOSE: The purpose of this systematic review was to investigate knowledge and attitudes toward eye donation and sources of eye donation information among the general population. METHODS: A search was conducted using MEDLINE through Ovid and Scopus; CINAHL through EBSCOhost and ProQuest; and Embase through Ovid database entries from January 2010 to March 2021. Quantitative studies were selected if they included participants aged 16 years or older from the general population (nonhealthcare) and had a sample size of >200. Studies were included if they measured knowledge and attitudes toward eye donation and sources of eye donation information. Methodological quality was assessed using JBI criteria, and the data were analyzed using SUMARI software. RESULTS: A total of 25 studies were included in this review. Pooled data from 6 studies demonstrated that 30.8% of participants [95% confidence interval (CI) = 11.0-55.4] had some knowledge of eye donation. Seventeen studies reported that 40.6% (95% CI = 39.8-41.3) were willing to donate their eyes, and 5 of these studies found that 7.3% (95% CI = 6.5-8.3) had already pledged their eyes. Eleven studies reported on the source of eye donation information, indicating 50.9% of participants (95% CI = 49.8-52.1) received information from mass media. CONCLUSIONS: The results of this review indicate that understanding eye donation knowledge and attitudes is crucial for developing interventions or tools to increase eye donation rates. Further studies in different populations are required.

Predicting behavioural intentions towards medication safety among student and new graduate nurses across four countries.

AIMS AND OBJECTIVES: To identify final-year undergraduate students and new graduate nurses' behavioural intentions towards medication safety across four countries. BACKGROUND: Medication errors are a common and avoidable occurrence, being costly for not only patients but also for health systems and society. DESIGN: A multi-site cross-sectional study. METHODS: A self-administered survey was distributed to students and new graduate nurses in South Africa, India, Turkey and Australia. Descriptive statistics were calculated for all survey items. Multiple linear regressions were performed to predict behavioural intentions using the three Theory of Planned Behaviour constructs: attitudes, behavioural control and subjective norms. This study adheres to the STROBE guidelines. RESULTS: Data were analysed for 432 students and 576 new graduate nurses. Across all countries, new graduate nurses reported significantly higher scores on all the TPB variables compared with student nurses. Attitudes towards medication management were found significantly and positively related to intention to practice safe medication management for both student and new graduate nurses. Total perceived behavioural control was significantly and negatively related to intention to practice safe medication management for students. CONCLUSION: Student and new graduate nurses showed favourable attitude, subjective norm, perceived behaviour control and intention in practising medication safety. However, differences in countries require further exploration on the factors influencing attitudes towards medication safety among student nurses and new nurse graduates. RELEVANCE TO CLINICAL PRACTICE: Understanding student and new graduate nurses' medication administration practices is important to inform strategies aimed at improving patient safety. The findings of this study highlight the need for an internationally coordinated approach to ensure safe medication administration by student and new graduate nurses.

Adaption of the Cancer Information Overload Scale for pandemics and assessment of infodemic levels among nurses and midwives.

AIM: This study was conducted in three phases. Phase 1 aimed to adapt the Cancer Information Overload Scale and conduct content validity testing. Phase 2 aimed to conduct factorial validity testing of the scale. Phase 3 aimed to assess information overload and the sources of information used by nurses and midwives to keep up-to-date about COVID-19. DESIGN: A cross-sectional survey of nurses and midwives working in a metropolitan Local Health District in Sydney, Australia, was conducted from May to June 2020. METHODS: Adaptation of the Cancer Information Overload Scale and content validity of the modified scale (as the Pandemic Information Overload Scale) was undertaken by an expert panel comprising of senior nurses and researchers. Factorial validity and reliability of the Pandemic Information Overload Scale were evaluated using exploratory factor analyses using one subsample of the data. Using the second subsample of the data, information overload and sources of information used by nurses and midwives to keep up-to-date about COVID-19 were examined. RESULTS: The Pandemic Information Overload Scale is a reliable and valid instrument for measuring information overload among nurses during a pandemic. Its internal consistency was high (α = 0.81, M = 3.84). CONCLUSION: The 8-item PIO scale is a brief, reliable and psychometrically sound instrument for measuring nurses' and midwives' perceptions of information overload during COVID-19. Mean scores across this study indicated that participants were experiencing above average information overload. Implementing strategies to reduce this overload would optimize clinical decision making and promote patient safety.

Exploring the perceived sociocultural factors in the initiation of smokeless tobacco among adolescents: a qualitative systematic review protocol.

OBJECTIVE: The objective of the review is to identify and explore the perceived sociocultural factors leading to smokeless tobacco initiation among the adolescent population. INTRODUCTION: Smokeless tobacco use is associated with oral cancer and premalignant lesions. The initiation of smokeless tobacco often occurs in adolescence, with multiple sociocultural factors facilitating the commencement of this habit. An in-depth understanding of the factors influencing smokeless tobacco uptake can assist policymakers and tobacco-control units in establishing global policies and implementing control strategies to prevent adolescents' taking up smokeless tobacco. INCLUSION CRITERIA: This review will consider qualitative studies conducted within the last 20 years on adolescent smokeless tobacco users, focusing on sociocultural factors influencing smokeless tobacco initiation. Studies involving cigarette smoking, other alternative forms of smoking, and any form of tobacco cessation intervention will be excluded. METHODS: A systematic search will be conducted in MEDLINE, Scopus, CINAHL, Embase, PsycINFO, and the Cochrane CENTRAL databases, using a 3-step search process. ProQuest Dissertations and Theses, OAIster, and Google will be searched for unpublished studies. Only studies published from January 2002 until the present and in English will be considered. Study screening, extraction, and critical appraisal will be performed by 2 independent reviewers using the standardized JBI qualitative appraisal and data extraction tools. Data synthesis will involve aggregation of the review findings to generate a set of statements based on similarity of meaning. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021240588.

Social capital and wellbeing among Australian adults' during the COVID-19 pandemic: a qualitative study.

BACKGROUND: COVID-19 has created global disruption, with governments across the world taking rapid action to limit the spread of the virus. Physical distancing and lockdowns abruptly changed living conditions for many, posing specific challenges of social isolation and lack of connectedness due to being physically and socially isolated from family and friends. Social capital is the bonding of individuals within a society that facilitates and shapes social interactions. The aim of this study was to qualitatively explore the impact that existing social capital has on Australians' experience of lockdowns during the COVID-19 pandemic and the effect this has had on their wellbeing and quality of life. METHODS: Participants from various socioeconomic areas within Australia were purposively selected to participate in semi-structured interviews conducted via videoconferencing or telephone. Inductive thematic analysis of the data was undertaken. RESULTS: A total of 20 participants were interviewed ranging in age from 21 to 65 years, including 50% (n = 10) females, 40% (n = 8) males, 5% (n = 1) non-binary and 5% (n = 1) transgender. Three main themes emerged from the analysis of the data: No person is an island; Social engagement; and Loneliness and isolation. Individuals who resided in low socioeconomic areas, those who lived alone and had reduced social support expressed feelings of poorer wellbeing. CONCLUSIONS: This study describes the lived-experiences of the influence of the COVID-19 pandemic on Australians' social capital and wellbeing. The findings highlight the need for interventions to increase social support, social cohesion, and social connectedness, especially among Australians from low socioeconomic areas, to enhance their overall wellbeing.

Water for wound cleansing.

BACKGROUND: Although various solutions have been recommended for cleansing wounds, normal saline is favoured as it is an isotonic solution and is not thought to interfere with the normal healing process. Tap water is commonly used in community settings for cleansing wounds because it is easily accessible, efficient and cost-effective; however, there is an unresolved debate about its use. OBJECTIVES: To assess the effects of water for wound cleansing. SEARCH METHODS: For this fifth update, in May 2021 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included all randomised controlled trials (RCTs) that assessed wound cleansing using different types of water (e.g. tap water, distilled, boiled) compared with no cleansing or with other solutions (e.g. normal saline). For this update, we excluded quasi-RCTs, thereby removing some studies which had been included in the previous version of the review. DATA COLLECTION AND ANALYSIS: Two review authors independently carried out trial selection, data extraction and GRADE assessment of the certainty of evidence. MAIN RESULTS: We included 13 trials in this update including a total of 2504 participants ranging in age from two to 95 years. Participants in the trials experienced open fractures, surgical wounds, traumatic wounds, anal fissures and chronic wounds. The trials were conducted in six different countries with the majority conducted in India and the USA. Three trials involving 148 participants compared cleansing with tap water with no cleansing. Eight trials involving 2204 participants assessed cleansing with tap water compared with cleansing with normal saline. Two trials involving 152 participants assessed cleansing with distilled water compared with cleansing with normal saline.  One trial involving 51 participants also assessed cleansing with cooled boiled water compared with cleansing with normal saline, and cleansing with distilled water compared with cleansing with cooled boiled water. Wound infection: no trials reported on wound infection for the comparison cleansing with tap water versus no cleansing. For all wounds, eight trials found the effect of cleansing with tap water compared with normal saline is uncertain (risk ratio (RR) 0.84, 95% confidence interval (CI) 0.59 to 1.19); very low-certainty evidence. Two trials comparing the use of distilled water with normal saline for cleansing open fractures found that the effect on the number of fractures that were infected is uncertain (RR 0.70, 95% CI 0.45 to 1.09); very low-certainty evidence. One trial compared the use of cooled boiled water with normal saline for cleansing open fractures and found that the effect on the number of fractures infected is uncertain (RR 0.83, 95% CI 0.37 to 1.87); very low-certainty evidence. This trial also compared the use of distilled water with cooled boiled water and found that the effect on the number of fractures infected is uncertain (RR 0.59, 95% CI 0.24 to 1.47); very low-certainty evidence. Wound healing: results from three trials comparing the use of tap water with no wound cleansing demonstrated there may be little or no difference in the number of wounds that did not heal between the groups (RR 1.04, 95% CI 0.95 to 1.14); low-certainty evidence. The effect of tap water compared with normal saline is uncertain; two trials were pooled (RR 0.57, 95% CI 0.30 to 1.07) but the certainty of the evidence is very low. Results from one study comparing the use of distilled water with normal saline for cleansing open fractures found that there may be little or no difference in the number of fractures that healed (RR could not be estimated, all wounds healed); the certainty of the evidence is low. Reduction in wound size: the effect of cleansing with tap water compared with normal saline on wound size reduction is uncertain (RR 0.97, 95% CI 0.56 to 1.68); the certainty of the evidence is very low. Rate of wound healing: the effect of cleansing with tap water compared with normal saline on wound healing rate is uncertain (mean difference (MD) -3.06, 95% CI -6.70 to 0.58); the certainty of the evidence is very low. COSTS: two trials reported cost analyses but the cost-effectiveness of tap water compared with the use of normal saline is uncertain; the certainty of the evidence is very low. Pain: results from one study comparing the use of tap water with no cleansing for acute and chronic wounds showed that there may be little or no difference in pain scores. The certainty of the evidence is low. Patient satisfaction: results from one study comparing the use of tap water with no cleansing for acute and chronic wounds showed that there may be little or no difference in patient satisfaction. The certainty of evidence is low. The effect of cleansing with tap water compared with normal saline is uncertain as the certainty of the evidence is very low. AUTHORS' CONCLUSIONS: All the evidence identified in the review was low or very low certainty. Cleansing with tap water may make little or no difference to wound healing compared with no cleansing; there are no data relating to the impact on wound infection. The effects of cleansing with tap water, cooled boiled water or distilled water compared with cleansing with saline are uncertain, as is the effect of distilled water compared with cooled boiled water. Data for other outcomes are limited across all the comparisons considered and are either uncertain or suggest that there may be little or no difference in the outcome.