Trauma rehabilitation in a teaching hospital in Antananarivo, Madagascar: current provision and patients’ perspectives

In 2020 a series of stakeholder workshops on palliative care and end of life identified dementia as a priority for the Central Coast area of New South Wales Australia. These workshops resulted in the commissioning of a rapid review of existing models of dementia and palliative care, and a research project exploring end-of-life care experiences of Central Coast residents with advanced dementia. It was intended that findings of the research would support development of an improved model of care for people with advanced dementia living on the Central Coast. On completion of the research in 2022, representatives of the Central Coast Research Institute, HammondCare, and the Central Coast Local Health District initiated the idea to take forward a co-design process across key stakeholders focusing on integrated models of care that improve care experiences, outcomes and effectiveness of services delivered with and for people living with dementia at the end-of-life. The stakeholder group involved managers, researchers, clinicians (including nurses, private geriatricians, allied health professionals, and a general practitioner), aged care providers, and representatives from peak bodies. The group also included four patient and carer representatives. Funding was secured to reimburse representatives for their time. More than 100 stakeholders have engaged throughout the process. The group had an initial meeting to get to know one another and discuss the need for a dementia specific palliative care model on the Central Coast. A follow-up meeting held to establish a shared mission and purpose, and the group agreed to participate in a series of five co-design workshops. In the first workshop, the group identified their top priorities, which were to increase information and education on dementia and palliative care and improve coordination of care and communication across all systems. The remaining workshops were focussed on designing, refining, and testing a logic model. The logic model included inputs and activities such as education delivery, a care coordinator, and multidisciplinary case conferences. These inputs and activities were shown in the logic model to result in short, medium, and long-term outcomes, including reduced healthcare resource use and increased quality of life for people with dementia at the end of life. An accompanying document was created to define elements of the model, explain referral processes, and plans for implementation and evaluation. The next steps for the working group in 2024 are to plan for the education delivery, engage further with primary care, and secure funding to implement and monitor the initiative. The stakeholder group participated in an evaluation survey (n=18). The results of the survey were that 83% were satisfied with the model of care; 89% said there were opportunities for networking and making new connections; and 88% said they ‘always’ felt heard in the workshops. 39% of stakeholders said their awareness of dementia and palliative care services and supports increased. Key learnings for international audiences include the importance of asking the question of ‘whose voices are missing’ from the design of integrated care, and the time it takes to build trusting, collaborative working relationships.

Traumatic injuries, defined as injuries resulting from a traumatic event such as a motor vehicle accident, fall, or violence, represent a significant global health burden. Traumatic injuries encompass a wide range of severities, ranging from minor wounds to life-threatening incidents, and can have profound consequences for the affected individuals and society.They not only result in immediate physical pain and disability but also have long-term consequences that can significantly impact the quality of life for survivors. On top of that, the economic burden of trauma is high, and traumatic injuries rank among the five most costly medical conditions worldwide. Also, these costs are expected to increase during the upcoming decades due to the aging population. The effectiveness of trauma care systems has been extensively researched over the past years. Due to decreased trauma-related mortality, the focus has shifted towards improving trauma survivors’ quality of life and long-term functional outcomes. Amongst others, this is done by aiming to improve the organization of trauma rehabilitation and streamlining care between primary and secondary care. The Transmural Trauma Care Model (TTCM) was developed at Amsterdam UMC, the Netherlands, to bridge this gap between these two care sectors. The TTCM is a multidisciplinary and patient‐centered transmural rehabilitation care model, consisting of 1) joint consultations by a multidisciplinary team at the outpatient clinic for trauma patients; 2) coordination and individual goal setting; 3) a network of specialized network physiotherapists (NPs) and 4) secured email traffic between hospital‐based physiotherapists and NPs. The primary aim of this thesis was to assess the (cost-)effectiveness of the TTCM compared with usual care. Secondary aims included the investigation of the barriers and facilitators of the upscaling and financing of the TTCM, exploring the association of fracture- and treatmentrelated factors and disease-specific HR-QOL, functional outcome, and societal costs in trauma patients, and assessing the measurement properties of the Lower Extremity Functional Scale (i.e., a functional outcome scale, used for patients with lower extremity fractures).

India needs shift in thinking to improve road safety

The influence of the built environment in enacting a household model of residential aged care for people living with a mental health condition: A qualitative post-occupancy evaluation

This case study describes the development and implementation of an innovative integrated primary-secondary model of care for people with complex diabetes. The aim of the paper is to present the experiences of clinicians and researchers involved in implementing the 'Beacon' model by providing a discussion of the contextual factors, including lessons learned, challenges and solutions. Beacon-type models of community care for people with chronic disease are well placed to deliver on Australia's health care reform agenda, and this commentary provides rich contextual information relevant to the translation of such models into policy and practice.

Approximately one in five Australians who undergo total knee replacement (TKR) experience persistent postoperative pain. There are currently no known effective and cost-effective multidisciplinary models of care in Australia to address this. We are developing the 'Early Pain Intervention after Knee Replacement' (EPIK) model of care, adapted from 'Support and Treatment After Replacement' (STAR) care pathway. STAR was developed in the United Kingdom (UK) and shown to be effective and cost-effective in the UK context. Extensive consumer and clinician engagement informed the development of the EPIK model of care, tailored to the Australian health system and geographical context to address this critical gap. To co-design the 'Early Pain Intervention after Knee replacement' (EPIK) model of care for people with persistent pain after TKR. We used Experience-Based Co-Design (EBCD) methodology to co-design EPIK, a telehealth model of care providing remote care coordination for people with persistent pain after TKR. Three online Zoom workshops were conducted with key stakeholders, including consumers with lived experience, clinicians (orthopaedic surgeons, physiotherapists, general practitioners, psychologists and a rehabilitation physician), and EPIK investigators. Workshop 1 explored consumer perspectives on the EPIK model of care assessment and follow-up. Workshop 2 determined the feasibility and roles of clinicians in the EPIK model of care delivery. Workshop 3 brought together consumers, clinicians, and researchers to refine and finalise the EPIK model of care. Using EBCD methodology and inductive framework analysis, themes were derived iteratively. Across consumer and clinician workshops, consensus was reached through facilitated discussions where stakeholders actively contributed to prioritisation activities and iterative refinement of model components. Twenty-one individuals participated in the workshops, comprising nine consumers and 12 clinicians from the Australian Capital Territory, New South Wales, Tasmania, and Western Australia, alongside five EPIK Investigators. Workshop 1 with consumers highlighted the need for clearer definition of communication processes, patient education and coaching strategies, and the role of the EPIK care coordinator to ensure consistent information and coordinated support throughout the model of care delivery. Workshop 2 with clinicians focused on telehealth assessments, escalation of clinical pathways, referrals, and psychological support. The final workshop reached consensus on its components and delivery, emphasising the importance of patient advocacy, reassurance and continuity of personalised care. Through meaningful end-user involvement, co-design informed the development of the EPIK model of care. The effectiveness, cost-effectiveness and safety of EPIK will be evaluated in a randomised controlled trial. Two consumer co-authors (T.G. and B.L.) guided the development of the preliminary model of care and trial protocol. Consumers with lived experience of persistent pain after TKR participated throughout the co-design process. ACTRN12625001029482p (Australian and New Zealand Clinical Trials Registry). Registered on 17 September 2025.

Objective: To collaboratively develop a model of nurse-led care, within a multidisciplinary team and support continuity of care at the primary-secondary interface for people with multimorbidity. Background: Existing models of care are frequently based on a medical model, designed to manage a single disease condition, and thus pose a significant challenge to provide healthcare for people with multimorbidity. Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated, however, these have not been applied to the development of a nurse-led model of care for people with multimorbidity. Study design and methods: This paper, the first in a series of two, is part of a broader action research study and reports on the development of a model which will subsequently be assessed in terms of feasibility to provide a nurse-led care coordination service for people with multi-morbidity. This paper reports on the first action research cycle and methodology including a literature search, stakeholder engagement forums, validation workshop, team meetings, and professional engagement and validation. Results: Data from two stakeholder forums were sorted into 257 ‘structure, process and outcome’ statements and 86 goal related statements. These were cross referenced with design elements on models of care from the literature and finally aggregated into themes. The aggregated themes were then integrated into a model of care for a nurse–led care coordination service. The model consists of an overarching component, 4 domains and 6 operational areas with underpinning criteria. Conclusion: Through stakeholder consultation, consideration of the strengths of previous models and building blocks, a new nurse-led model of care that provides a pathway for transitional healthcare management at the primary -secondary interface has been developed. Inclusion of governance and culture within the model’s domains enables the approach to be pragmatic and adaptable, contributing to the potential for successful change management and model implementation in the clinical workplace. Further evaluation and refinement of the model is planned and will be reported on, in part 2 of this two-part series. Implications for research, policy, and practice: These findings provide direction for model implementation and further research required regarding nurse-led models of care. The supporting documents, systems, and processes reported, positions the model to support change and guide clinical practitioners and nursing management working at the primary-secondary healthcare interface. The future success of model implementation could provide evidence for health workforce policy and coordinated healthcare management. What is already known about this topic: Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated. Interventions delivered at the primary-secondary care interface, particularly stepped care and models of shared care are effective for the management of depression. Established model design elements and interventions to improve continuity of care at the primary-secondary interface have not been applied to nurse- led models of care for chronic conditions and still require development within research settings. What this paper adds: A new person-centred nurse-led model of care coordination, with healthcare management activities intended to support and enable development of the person’s agency in their healthcare optimisation. A model with specific domains and criteria with the potential for application to nurse-led services across primary and secondary settings, for a range of patients. Inclusion of governance and culture as domains within the model, to enable the best possibility for change, model implementation and continuity of care between the primary-secondary healthcare interface.

Accessible summary We wanted to know what people with learning disabilities know about dementia. We asked service users what the word meant to them, if they knew anyone with dementia, and what it was like to share a house with someone who has dementia. We learnt that: • Service users can know a lot about dementia. • Living with someone with dementia can be really hard – and staff do not always have enough time for everyone else. • Services should think more about how dementia affects everyone – not just the person who has the dementia. Summary This paper reports on research that illuminates how people with a learning disability understand dementia and indicates the implications of these understandings for developing appropriate models of care. As this new policy and practice area struggles to provide appropriate and effective models of care for people with a learning disability and dementia, an awareness of service users’ understandings of dementia leads to a number of important insights. The wider research programme from which this paper is drawn aims to identify best practice in supporting people with learning disabilities to stay in their own homes as they grow older and develop dementia. A combination of focus groups, ethnography and individual interviews were conducted at eight sites across England. Participants were people with a learning disability who had dementia, and those who have lived with someone with dementia. The findings have the potential to improve support to this population as they grow older.

Core elements and principles of nutrition models of care for people with cancer: A scoping review.

Background: Access to palliative care in the community enables people to live in their preferred place of care, which is often home. Community palliative care services struggle to provide timely 24-h services to patients and family. This has resulted in calls for ‘accessible and flexible’ models of care that are ‘responsive’ to peoples’ changing palliative care needs. Digital health technologies provide opportunities to meet these requirements 24-h a day. Aim: To identify digital health technologies that have been evaluated for supporting timely assessment and management of people living at home with palliative care needs and/or their carer(s), and the evidence-base for each. Design: A systematic review of systematic reviews (‘meta-review’). Systematic reviews evaluating evidence for virtual models of palliative or end-of-life care using one or more digital health technologies were included. Systematic reviews were evaluated using the Risk of Bias Tool for Systematic Reviews. A narrative approach was used to synthesise results. Data sources: Medline, Embase, Web of Science, CINAHL and Cochrane Database of systematic reviews were searched for English-language reviews published between 2015 and 2020. Results: The search yielded 2266 articles, of which 12 systematic reviews met criteria. Sixteen reviews were included in total, after four reviews were found via handsearching. Other than scheduled telehealth, video-conferencing, or after-hours telephone support, little evidence was found for digital health technologies used to deliver virtual models of palliative care. Conclusions: There are opportunities to test new models of virtual care, beyond telehealth and/or video conferencing, such as 24-h command centres, and rapid response teams. Systematic review registration number: Prospero CRD42020200266

Inflicted Childhood Neurotrauma: New Insight into The Detection, Pathobiology, Prevention, and Treatment of Our Youngest Patients with Traumatic Brain Injury

BackgroundCurrent models of care for people with advanced chronic obstructive pulmonary disease (COPD) have been demonstrated to be inadequate, particularly in areas such as advance care planning, symptom control and psychosocial and spiritual care.AimThis paper aims to explore how a model of patient-centred care can incorporate a palliative approach to form a practical and useful framework for care that meets the needs of people with advanced COPD.DiscussionThere is increasing recognition of the need to provide active disease management at the same time as supportive care for people with chronic disease. A palliative approach can incorporate these two care imperatives but a number of barriers often make implementation problematic. A patient-centred care approach can help to address these barriers and is increasingly being seen as an appropriate framework for all healthcare service provision. Significant changes are required to health systems and service provision for this model of care to be implemented; specialist palliative care services can take a leading role in change management.ConclusionPatient-centred care provides an appropriate framework for the development of a model of care for advanced COPD. It allows for a need-based approach to service provision, rather than the current prognosis-based system and brings patient and carer needs and concerns to the forefront of care.

Introduction: The Shoalhaven in regional Australia has an aging population with a high prevalence of dementia and insufficient geriatricians to provide a timely service to this group of patients. General Practitioners had limited experience in managing patients living with dementia with high numbers referred for recurrent review in hospital clinics. These clinic settings have different funding sources in the Australian context. Practice Change: Practices were invited to enrol in the Geriatrician in the Practice (GIP) Program. A dementia clinical nurse consultant (CNC) and geriatrician attended the general practice and ran a joint comprehensive geriatric consultation with the general practitioner and practice nurse. Eight Practices were recruited and training was provided to 15 practice nurses on cognitive assessment and to 32 General Practitioners on dementia diagnosis and management. Aim and Theory of Change: The aims of the program were to provide patients with dementia timely assessment in a familiar location, to improve the skills in primary care for the diagnosis and management of dementia and build improved relationships between the primary health and hospital sectors. It was proposed that these changes would improve the confidence of primary health practitioners to manage patients with dementia, provide improved patient satisfaction with their care experience, reduce the need for specialist review and reduce outpatient waiting times at hospital clinics. Timeline: The Program was funded in July 2015 with the first clinics commencing in November 2015. The program has been expanding with new practices included every 6 months. Highlights: The level of patient satisfaction is very high and the program has identified groups of patients who were not attending hospital clinics. The practice nurses and General Practitioners have improved confidence in the management of people living with dementia and the number of people requiring subsequent review by a geriatrician has significantly reduced. The ability of the General Practice to prioritise patients seen at the clinics has led to a more timely assessment of patients in need. Sustainability: The practice nurses have shown sufficient knowledge acquisition to not necessitate the continued regular involvement of the CNC. The Geriatrician involvement has been demonstrated to be sustainable within current funding models Transferability. There is currently consideration to expand the model to other chronic disease models of care. Conclusions: The GIP model of care has successfully lead to knowledge transfer from hospital specialist clinics to primary care. It has provided more timely assessment and greater patient satisfaction and increased available specialist time for new assessments. Discussion: The GIP model of care required initial intensive input but through knowledge transfer has provided a sustainable model of care for people living with dementia and primary care providers with a high level of patient acceptability and improved access to specialist services. It is anticipated that a hybrid model of GIP clinics and hospital based clinics will be provided in the future to accommodate patient and practitioner preferences. Lessons learned: The GIP program demonstrated that it feasible to have improved outcomes by reviewing models of care. There needs to be development of guidelines including responsibilities and roles prior to commencing such a program. A review of information technology links across the services is also recommended

To identify the care models and the impact of the use of these in the care of people with chronic diseases reported in the literature in the years 2000 to 2014. Integrative literature review in which the following guiding question was adopted: Which care models are used in the care of patients with chronic diseases and what impacts can be verified through their application? We consulted the bibliographic databases Virtual Health Library, LILACS, MEDLINE, Spanish Bibliographic Index of Health Sciences and the Database of Nursing. The sample consisted of 17 articles on the topic of interest. Three categories emerged from the analysis: health care costs, model-based care experience, and patient autonomy. The articles addressed self-management, case management and care model for people with chronic diseases. The major impacts on the use of the models were: a better relationship between the patient and the health professional, an increase in the autonomy of the person with chronic illness, and a reduction in personal and health care expenditure. The use of care models for people with chronic diseases presents benefits to the patient and to the health system. Nurses must actively participate in the application of these care models of people with this type of illness.

BackgroundMany people diagnosed with schizophrenia, bipolar or other psychoses in England receive the majority of their healthcare from primary care. Primary care practitioners may not be well equipped to meet their needs and there is often poor communication with secondary care. Collaborative care is a promising alternative model but has not been trialled specifically with this service user group in England. Collaborative care for other mental health conditions has not been widely implemented despite evidence of its effectiveness. We carried out a formative evaluation of the PARTNERS model of collaborative care, with the aim of establishing barriers and facilitators to delivery, identifying implementation support requirements and testing the initial programme theory.MethodsThe PARTNERS intervention was delivered on a small scale in three sites. Qualitative data was collected from primary and secondary care practitioners, service users and family carers, using semi-structured interviews, session recordings and tape-assisted recall. Deductive and inductive thematic analysis was carried out; themes were compared to the programme theory and used to inform an implementation support strategy.ResultsKey components of the intervention that were not consistently delivered as intended were: interaction with primary care teams, the use of coaching, and supervision. Barriers and facilitators identified were related to service commitment, care partner skills, supervisor understanding and service user motivation. An implementation support strategy was developed, with researcher facilitation of communication and supervision and additional training for practitioners. Some components of the intervention were not experienced as intended; this appeared to reflect difficulties with operationalising the intervention. Analysis of data relating to the intended outcomes of the intervention indicated that the mechanisms proposed in the programme theory had operated as expected.ConclusionsAdditional implementation support is likely to be required for the PARTNERS model to be delivered; the effectiveness of such support may be affected by practitioner and service user readiness to change. There is also a need to test the programme theory more fully. These issues will be addressed in the process evaluation of our full trial.Trial registrationISRCTN95702682, 26 October 2017.