“Too tired to care” – the experiences of doctors involved in car accidents after working extended shifts

BackgroundCOVID-19 became a global pandemic within weeks, as every country including small states and islands experienced a surge in cases. Small islands are known to face several challenges in the quest to curb the viral spread, but with the absence of land boarders and small population size, these factors should have played to their advantage to minimize the spread. The aim of this article was to compare and contrast the COVID-19 situation, restrictions, preparedness, management and the healthcare systems between the small population island states of Cyprus, Iceland and Malta.MethodsData were obtained from Ministry of Health websites and COVID dashboards of the three respective Island states in Europe. Comparisons were made between the reported cases, deaths, excess deaths, years of life lost, swabbing rates, restrictive measures, vaccination roll-out and healthcare system structures.ResultsCyprus and Malta contained the COVID-19 spread better than Iceland during the first wave. However, a significantly higher viral spread and mortality rates were observed in Malta during the second waves. Similar healthcare preparedness and services, restrictions and relaxation measures were implemented across the three islands with some exceptions. Covid-19 vaccination has initiated across all Islands with Malta leading the vaccination roll-out.ConclusionThe small population size and island status proved to be an asset during the first wave of COVID-19, but different governance approaches led to a different COVID-19 outcomes, including high mortality rates during the transition phases and the subsequent waves.

Background: Reflexive thematic analysis is widely used in qualitative research published in Palliative Medicine, and in the broader field of health research. However, this approach is often not used well. Common problems in published reflexive thematic analysis in general include assuming thematic analysis is a singular approach, rather than a family of methods, confusing themes and topics, and treating and reporting reflexive thematic analysis as if it is atheoretical. Purpose: We reviewed 20 papers published in Palliative Medicine between 2014 and 2022 that cited Braun and Clarke, identified using the search term ‘thematic analysis’ and the default ‘relevance’ setting on the journal webpage. The aim of the review was to identify common problems and instances of good practice. Problems centred around a lack of methodological coherence, and a lack of reflexive openness, clarity and detail in reporting. We considered contributors to these common problems, including the use of reporting checklists that are not coherent with the values of reflexive thematic analysis. To support qualitative researchers in producing coherent and reflexively open reports of reflexive thematic analysis we have developed the Reflexive Thematic Analysis Reporting Guidelines (the RTARG; in Supplemental Materials) informed by this review, other reviews we have done and our values and experience as qualitative researchers. The RTARG is also intended for use by peer reviewers to encourage methodologically coherent reviewing. Key learning points: Methodological incoherence and a lack of transparency are common problems in reflexive thematic analysis research published in Palliative Medicine. Coherence can be facilitated by researchers and reviewers striving to be knowing – thoughtful, deliberative, reflexive and theoretically aware – practitioners and appraisers of reflexive thematic analysis and developing an understanding of the diversity within the thematic analysis family of methods.

The following work is licensed under a Creative Commons: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License.

Background and aimsThere is growing recognition among practitioners worldwide of the benefits of practising emergency medicine in different countries and healthcare settings. A recent survey by the Royal College of...

Motorcycle operators who drive under the influence of psychoactive substances are at high risk for road traffic violations and accidents. Despite the high level of morbidity associated with psychoactive substance use, it is not a well-researched area in Northwestern Nigeria. The aim of the study was to determine the relationship between psychoactive substance use and road traffic violations and accidents among motorcycle operators in Kano, Northwestern Nigeria. It was a descriptive cross-sectional study. Instrument used for data collection included socio-demographic questionnaire and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Data analysis was done using Statistical Package for Social Sciences (SPSS) 17th edition. Three hundred and ninety-four subjects participated in the study. Their age ranged between 22 to 60 years, with mean age of 32.7 years ± 6.6. Motorcycle operators who used substances were more likely to violate traffic laws (P < 0.001; O.R = 1.6 (0.8 – 3.1) and to have road traffic accidents (P = 0.004; O.R = 2.6 (1.4 – 4.7) compared to those who did not use substances. Positive correlation was found between road traffic violations, road traffic accidents and substance use status at 99% confidence interval. There was also significant relationship between specific substance use, road traffic violations and accidents. Psychoactive substance use increases the risk of road traffic violations and road traffic accidents among motorcycle operators. Public health measures should be instituted to reduce the rate of substance use among motorcycle operators and cut down its associated morbidity. Key words: Psycho-active substance, road traffic accidents, road traffic violations, motorcycle operators, Schedule for Clinical Assessment in Neuropsychiatry (SCAN), Nigeria

A transparent analytical process contributes to the methodological rigor of reflexive thematic analysis. To enhance such transparency in reflexive thematic analysis, novice researchers need to document and present the analytical processes of theme development. In this article, we showcase how qualitative comparative analysis can be integrated into reflexive thematic analysis as a strategy for novice researchers. We demonstrate how novice researchers can develop codes and categories, use qualitative comparative analysis to facilitate the exploration of the complex causal relationships between categories, and construct candidate themes based on these analyses. We then show how novice researchers can continue developing these themes by creating relationships between codes and categories on the basis of qualitative data and existing literature. Such integration of methods not only facilitates theme development, but also assists researchers in justifying the decisions made in a reflexive thematic analysis process. The analytical procedures presented in this article may thus help novice researchers engaged in reflexive thematic analysis to enhance the transparency of their analytical process.

Despite its importance, recruiting a sufficient sample size for randomised controlled trials (RCTs) can pose a significant challenge, which has real-world impact on reliability of evidence, trial completion and ultimately, patient care. Technology has potential to enhance the recruitment process, but there is a lack of evidence regarding its current use and effectiveness. Consistent with findings from the PRioRiTy I study, the current research aims to explore the advantages and disadvantages to using technology during the recruitment process for RCTs. Semi-structured interviews (n=7) were conducted with researchers involved in RCT recruitment in Ireland. Subsequently, a Public & Patient Involvement (PPI) panel focus group (n=3) was conducted to add further depth to these findings. The data were qualitatively analysed through 'Reflexive Thematic Analysis' to extract prominent themes. A superordinate theme arose: 'Tech is just a medium so that you can reach more people', along with two themes, which were corroborated by the PPI focus group: 'Technology is used if and when the benefits outweigh the costs' and 'Success of recruitment through technology depends on the nature of the study.' This study provided a deeper understanding of the factors which influence researchers to employ technology in recruitment for RCTs. Implications suggest that future researchers should aim to adapt their recruitment approaches to meet digital tool preferences of their target cohort; and engage with patient groups in the community to allow networking opportunities for future studies. This research may contribute towards maximising efficiency in RCT recruitment.

The paradox of care: Navigating emotional demands in Faroese nursing practice.

Evidence suggests that digital peer support can be valuable for individuals struggling with their wellbeing, particularly those who do not feel able to or do not want to engage with other services. The current study explores the experience of young adults engaging with a digital peer support smartphone app. Interviews were conducted with 11 young adults aged 18-25. Reflexive thematic analysis was used and five themes were developed from the data: 1) Finding comfort in familiar and friendly digital spaces; 2) Developing coping and support skills through digital peer support; 3) The value of shared experiences; 4) Needing to 'pull your weight' but being scared of causing harm; 5) The limits of digital peer support. We found that participants valued the sense of community and feelings of relief and validation elicited from sharing relatable experiences with peers. They also believed they had developed skills in supporting themselves and others both within and external to the app. However, it was mainly perceived as a space for venting and may not succeed in delivering benefits beyond this, such as in reducing symptoms of poor mental health or helping people get to the root of issues. Moreover, participants reported a pressure to respond and anxieties around exacerbating someone's difficult feelings. Providing training and supervision to peers to help them feel confident and safe when supporting others may help to further the benefits of peer support, and a greater emphasis on boundaries within digital peer support may alleviate some anxieties and pressure.

Study objectivesIn this nationwide study, we investigate the risk and severity of all road traffic accidents in patients with obstructive sleep apnea (OSA). MethodsWe used the unique Danish registries to identify all Danish citizens receiving a diagnosis of OSA between 1995 and 2015. As a reference cohort, we randomly selected 10 sex- and age-matched citizens for each patient. We used Poisson regression to calculate the incidens rate ratio (IRR) for all road traffic accidents (motor vehicle, bicycle, and pedestrian) in both groups, and Cox proportional regression analysis to compare risk of first motor vehicle accident. Lastly, we used Fischers’ Exact test to compare severity of motor vehicle accident between the two groups- ResultsWe identified 48,168 patients with OSA, covering up to 24 years of follow-up. Patients with OSA had an increased risk of road traffic accidents when compared with the reference cohort (hazard ratio, 1.15; 95% CI, 1.10–1.20; IRR: 1.19; 95% CI, 1.14–1.29), especially motor vehicle accidents (hazard ratio, 1.29; 95% CI, 1.18–1.39; IRR 1.30; 95% CI, 1.20–1.42). The risk of accidents as pedestrian or bicyclist were not increased. Further, patients with OSA had a tendency to be involved in more severe motor vehicle accidents. ConclusionsThis is the first nationwide study to estimate the risk of all road traffic accidents in patients with OSA. Our estimates show that patients with OSA have an increased risk of motor vehicle accidents, and greater severity of accidents, when compared with a large reference cohort.

Reviewed by: European Small States and the Role of Consuls in the Age of Empire by Aryo Makko Heather Streets-Salter European Small States and the Role of Consuls in the Age of Empire By Aryo Makko. Leiden and Boston: Brill Nijhoff, 2020. In European Small States and the Role of Consuls in the Age of Empire, Aryo Makko explores the role of the consular service in the foreign policy of Sweden-Norway, and how the institution was critical to understanding the way the state participated in the global system of imperialism between 1875 and 1914. Makko argues that although small European states like Sweden-Norway did not have the military and economic capacity of the great European powers, they nevertheless shared their exploitative worldview and were anxious to benefit from the spoils of empire. According to Makko, small states “employed their own strategies of imperialism and colonialism” by extending their shipping-related commercial interests to the rapidly-growing territories of the European empires (2). In this enterprise, consuls—whose job it was to facilitate and regulate these interests—played a central role. The book is divided into four chapters plus an introduction and conclusion. Its structure is both chronological and geographical: the first chapter begins in about 1815 and the last ends in 1914, while chapters 2–4 each cover what was happening with the consular service in Africa, Eastern and Southern Asia and the West Indies respectively between 1875 and 1914. Chapter one is based mainly on secondary sources and functions to outline the history of the consular service in Sweden-Norway until about 1870. But it is also here where Makko argues that—given the fact that the merchant fleet of Sweden-Norway was the world’s fifth largest in the late nineteenth century—government officials were hopeful that the European expansion of empire would enhance the prestige of the state via the power of economics. As part of this aspiration for prestige, by the end of the century, Sweden-Norway maintained a network of 100 consulates and 800 consular officials worldwide. Chapters two and three provide the meat of the argument and reflect extensive work in the state consular archives. In chapter two, which explores the years 1875–84, Makko argues that state officials in Sweden-Norway were sympathetic to the assumptions and expansionist actions of imperialist states, and sought to adapt to the new reality by expanding both its trade networks and its consular network into newly-colonized regions. These efforts were hampered, however, by the inefficiencies of the consular service: chiefly, that most consuls for Sweden-Norway were neither Swedish nor Norwegian, and that most knew very little about the state or its shipping and business interests. In this Sweden-Norway was not alone: many other European states also suffered from a lack of professionalism in their consular services at this time, and many sought reforms in the last half of the nineteenth century. Officials in Sweden-Norway followed this trend, and set up a committee to reform the consular service in 1875. However, in part because of complications arising from the relationship between the two kingdoms of Sweden and Norway, it took a full decade—until 1885—for the committee to produce new regulations for a reformed consular service. This did not stop the consular service of Sweden-Norway from expanding into new territories as European empires grew, but it did mean that the system did not function very well. Chapter three covers the period between 1884–1905, when Makko argues that the consular service of Sweden-Norway reached “the height of its political and diplomatic function” (188). It also marked the high-water of Sweden-Norway’s involvement with the European imperial system. Indeed, Sweden-Norway ratified the General Act in the Berlin Conference of 1884–85, which divided sub-Saharan Africa between European powers, in the hopes that participation would translate into a more powerful voice in European politics. In the years that followed, consuls representing Sweden-Norway generally supported imperial endeavors. At the same time, the state tried to implement the new consular regulations that had finally been approved in 1885, but professionalization proved elusive when budgetary constraints meant there...

Objective: To address health disparities in the perinatal period (i.e., during pregnancy and through one year after birth) by exploring the intersectional experiences of perinatal Black, Indigenous, and other People of Color (BIPOC) women during the COVID-19 pandemic. In this study, participants were asked if and how COVID-19 had impacted their experiences of receiving healthcare, whether they had faced any challenges during this time, how they had navigated these challenges, and what recommendations they had for improving perinatal healthcare. Methods: Between November 2021 and March 2022 our team conducted eight virtual focus groups comprising perinatal BIPOC women. A semi-structured interview protocol was used, and interviews were voice recorded and transcribed verbatim. The data were analyzed using reflexive thematic analysis. Results: Three major themes common in BIPOC perinatal healthcare experiences during COVID-19 were generated through engaging in reflexive thematic analysis: (1) an overwhelming lack of support from providers, (2) experiences of blame and shame, and (3) difficulties navigating institutional policies that were unclear or ever-changing during the COVID-19 pandemic. Recommendations from participants included greater empathic communication from providers in the face of uncertainty during COVID-19, greater access to information and guidance for caring for themselves and their babies, and an overall request for greater compassion while navigating an exciting and busy time. Relevance: These findings have implications for trauma-informed and inclusive perinatal care that can reduce the impacts of systemic inequalities for perinatal BIPOC women. This study offers a discussion of implications for future training for maternal health providers and implications for community-based programs.

The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state’s health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta.

BackgroundUniversal health coverage (UHC) is critical to global poverty alleviation and equity of health systems. Many low-income and middle-income countries, including small island states in the Pacific, have committed to...

The COVID-19 pandemic has affected countries at different times and to varying degrees, placing significant pressure on healthcare systems and challenging the delivery of end-of-life care. Palliative care professionals faced unprecedented circumstances, requiring rapid adaptation to maintain the quality of care for vulnerable populations. Thus, the aim of this study was to explore the experiences, challenges, and perspectives of healthcare professionals providing palliative care in Brazil and England during the COVID-19 pandemic. This qualitative multicenter study was conducted with 36 healthcare professionals (18 occupational therapists and 18 nurses) from various palliative care services in Brazil and England. Data were collected remotely through semi-structured interviews and analysed using reflexive thematic analysis. Findings revealed that professionals experienced intense emotional distress and ethical challenges, particularly related to providing care in isolation and managing silent mourning processes. The study also highlighted the rapid adaptation of palliative care services in response to pandemic constraints, such as the implementation of telehealth and restructured workflows. Despite challenges, professionals demonstrated creativity and resilience, with innovations emerging from crisis situations to ensure continuity of care. The COVID-19 pandemic profoundly disrupted palliative care delivery, prompting teams to develop new strategies to support patients, families, and colleagues. The experience fostered reflection on care practices and emphasised the critical role of palliative care in public health emergencies. These findings provide valuable insights for future preparedness and underline the need for stronger integration of palliative care in healthcare systems during pandemics.