BackgroundPneumothorax is a condition where air leaks into the space between the visceral and parietal pleura. Community acquired pneumonia is a rare cause of pneumothorax in children. Pneumothorax can sometimes develop as a complication of pneumonia when infection erodes the distal airway into the pleural cavity causing air leak. If the air leak persists for more than 7 days, then it is termed a persistent air leak.Case SummaryA 6‐year‐old South Asian girl presented with right upper and middle lobe pneumonia with empyema, for which a chest tube drain was inserted, which progressed to a persistent pulmonary air leak. Despite initial hospital management, the air leak persisted, necessitating home‐based care with meticulous follow‐up. Later on, after home‐based care, the child improved and the chest tube could be removed without complications. The management of persistent air leak complicated by pneumonia necessitates a multidisciplinary approach.ConclusionThis case highlights an innovative approach to managing complex pediatric respiratory conditions outside the hospital setting. The incorporation of domiciliary care introduces a novel dimension. This requires meticulous training of the parents with no medical exposure before monitoring and guiding them via online video and ensuring they adhere to treatment protocols. This report highlights the possibility of conservative domiciliary management for persistent air leak before going into definitive surgery.

Introduction Oral surgery services within England have a set referral to treatment target of 18 weeks, which varies significantly. Nationally only 50.4% of these referrals were seen within the 18-week target in April 2025. We propose a model to bypass the long waiting times for vulnerable special care patients.Model The concern was raised about the long waiting times for vulnerable patients. Piloting a model The Hertfordshire Model. This was piloted for 12 months successfully and formalised and integrated into the regional care pathway. The oral surgery referrals are referred internally and seen within the service by a consultant oral surgeon. This allowed for these patients to be seen within an average of 4.86 weeks. The average completion time was 7.35 weeks.Discussion Vulnerable patients benefit from continuity of care and familiarity. This model allows for this, with close communication with the initial referring clinician. The service is already equipped with specialised facilities, offering local anaesthetic, inhalation sedation, intravenous sedation, general anaesthetic and domiciliary care to provide treatment. This model also benefits National Health Service services financially.Conclusion Aligning with the ten-year plan for England to move towards a primary care model, this model demonstrates this ahead of time. This approach reflects national priorities to decentralise services, alleviate pressure on secondary care, reduce waiting lists, and deliver more personalised, locally accessible care.

This study aims to identify and map innovative care models for LGBTQ+ older adults and characterise the supporting evidence base. Older LGBTQ+ adults face persistent inequalities in health and social care, including discrimination, invisibility and barriers to appropriate support. As the population of openly LGBTQ+ older people grows, ensuring equitable and affirming provision has become increasingly urgent in the UK and beyond. In response, care models that may be considered innovative (whether newly developed, adapted for LGBTQ+ communities or applied in novel ways) have begun to emerge. However, no review has yet systematically mapped what is currently known about innovations in LGBTQ+ care and the evidence supporting them. This scoping review therefore aims to identify and map innovative care models for LGBTQ+ older adults and to characterise the supporting evidence base. This scoping review will be conducted in accordance with Arksey and O'Malley's framework and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. Evidence will be included where a care model or initiative is described or evaluated along with its implications for LGBTQ+ older people. For this review, care models are defined as organised approaches to care-that is, services, policies, practices (including training), initiatives or interventions-implemented in formal or informal care settings-such as residential care homes, housing with care schemes (eg, supported accommodation, retirement communities), domiciliary care, communities or informal long-term care arrangements. Use of the term 'innovation' will not be required for inclusion and will instead be coded by reviewers during charting. English-language sources of any design published between 2015 and 2025 will be included; sources without LGBTQ+ relevance, purely theoretical pieces, protocol papers and conference abstracts without full reports will be excluded. Searches will be conducted in Scopus, Social Science Premium Collection, CINAHL and PsycINFO, with grey literature identified through Overton. Additional searching of SCIE, Google Scholar, relevant third-sector resources and reference lists will be undertaken following source selection. After de-duplication, two reviewers will independently screen titles/abstracts and full texts, with disagreements resolved through discussion or consultation with a third reviewer. Data will be charted on author and year, country, source type, participants or source focus, intended beneficiary population, intervention/model/practice described, study design or document design, context/setting, methods, type of evidence, innovation basis, innovation level/domain, reviewer rationale for innovation coding, outcome or implementation indicators reported, main findings relevant to the review question and limitations of the study or evidence. Findings will be presented in tables and through narrative synthesis to map the models of care, their innovative features and the nature of the evidence base, and to identify implications for UK policy, practice and research. As this review will use data from publicly available sources, ethical approval is not required. Findings will be disseminated through peer-reviewed publication, presentations and accessible outputs for relevant stakeholders, including community-facing materials where appropriate.

Community staff are central to preventing the spread of infection among older adults in community settings, such as care homes, domiciliary care, supported living and primary care. Early detection of infection in older adults is challenging because of atypical presentations and high vulnerability. Community nurses and adult social care workers are often the first to notice subtle changes in health status that can signal infection. Swift reporting through established escalation pathways enables rapid action to contain risk and prevent outbreaks. Despite national guidance emphasising infection prevention and control competence, workforce pressures, limited specialist capacity and barriers such as infectious presenteeism impede early detection and reporting. This article integrates local system learning from Northumberland and North Tyneside and discusses infectious presenteeism in private care homes. The article also illustrates clearly how community and adult social care staff from a variety of settings contribute to infection prevention and control and outlines structures that support timely action. Essential components include continuous training tailored to community settings, clearly defined reporting pathways with supportive leadership, and collaborative partnerships that integrate community staff observations into public health action. Building capability, opportunity and motivation among the community workforce is central to sustainable infection prevention and control practice. The article concludes with recommendations for nursing practice and service leaders to strengthen early detection, reporting mechanisms and organisational cultures that support proactive infection control.

Contrasting predominant assumptions of women who live with age-related care needs as passive, unagentic, and helpless, this article explores agency exercised in everyday lives permeated by formal home care services. Using a narrative thematic analysis of interviews, diaries, and observations of three Swedish women in later life using home care services, this study examines their diverse ways of navigating and managing a care system that can be described as complex and fragmented. As users of domiciliary care, they lead, instruct, and educate staff; they prepare for and assist in carrying out service provision, coordinate service agents, and engage empathetically with staff to reduce stress levels. At times, they also protest, resist and criticise, or express contentment in spite of questionable service quality. The analysis conceptualises such manifestations of agency as a regime-dependent, situationally embedded striving to influence everyday life, encompassing not only overt, goal-directed actions but also seemingly passive or contradictory orientations such as withdrawal, acceptance, refusal, or even self-harming practices. The findings demonstrate how the participants – Betty, Ofelia, and Gunnel – each enact distinctive approaches: Betty pragmatically seeks to tailor services to her preferences, Ofelia critically challenges and attempts to influence the system, and Gunnel strives to maintain harmony through collaboration. Their extensive engagement contests assumptions that women in the so-called ‘fourth age’ have lost their agency. Instead, the study shows that, in becoming operatrices of the care system, they paradoxically uphold or even intensify their agency, which calls for recognising care users’ influence over the services they rely on.

Background: NHS England East of England led a working group to develop the 'My Mouth Matters' programme, aimed at developing a sustainable model for a Dental Care Professional (DCP) led service improvement pilot to improve mouth care and the oral health of adults in care homes. Objectives: Develop a Primary Care model, to support implementation of NICE NG48 guidance and quality standards, with the potential to upscale. Support the reduction of oral health inequalities and improve oral health and oral health related quality of life as an integral part of general health. Method: Primary Care dental practices in the East of England were commissioned to deliver My Mouth Matters. DCPs were upskilled and liaised with a nominated Oral Health Champion in each care home to provide oral health training, aid oral health policy development, and act as a direct link to a primary dental service provider. A pathway was developed to refer residents for oral health care. Results: The programme engaged with 34 care homes and 1674 residents. 280 resident care plans were evaluated: 54% of residents did not have a regular dentist, 29% required domiciliary care and 48% had additional access needs, 54% of residents did not know if they paid for their dental treatment. 71% of residents with dentures had a denture pot, 14% had their dentures marked, 38% of residents required some support and 24% required full support for oral health care, 10% of residents were prescribed high fluoride toothpaste. Conclusion: The My Mouth Matters programme demonstrated positive steps in developing a Primary Care model to improve oral health for care home residents. Further work to support models of engagement and training were highlighted as the main areas requiring development.

Due to the deteriorating care quality in the United Kingdom’s (UK’s) social care sector, we link managerial emotional intelligence, psychological contract, and care quality in the UK’s domiciliary care sector. Based on in-depth semi-structured interviews with 44 migrant domiciliary care workers in London, we utilized a combination of interpretative phenomenological analysis and hermeneutic phenomenology to investigate our participants lived experiences through the lens of the psychological contract literature. We found that participants faced personal challenges, poor relationships with their managers, and workplace challenges including communication, other, time management, work-life-imbalance, and safety and well-being concerns, which combine to influence their psychological contracts. Unfortunately, participants were erroneously treated as a homogeneous group who require a standardized approach to managing and staffing, despite their heterogeneity. Based on the reciprocity in psychological contracts, we conclude that, for improved care quality, employers/managers must first fulfil their obligations in the psychological contract with individual employees. This is one of the pioneering efforts to examine the relationships between managerial emotional intelligence, trust, dignity, psychological contract, employees lived experiences, and care quality of the UK’s migrant domiciliary care workers.

Care work and status subjugation: An exploration of the relationship between care work organisation and training, and the recruitment crisis in adult long-term care.

Abstract Introduction Frail older adults are often discharged from hospital with complex needs into community care services. Without senior clinical oversight, many experience fragmented care, delayed reviews, inappropriate care planning, and avoidable readmissions. This project evaluated the impact of introducing clinical leadership into a care provider pathway designed to deliver short-term, post-discharge domiciliary care. Methods Over 11 weeks, 51 patients were supported, 43 of whom were on the care provider pathway. Using the Plan-Do-Study-Act (PDSA) framework, the project identified inefficiencies and tested solutions. Interventions included senior clinician-led home visits, MDT support, care plan reviews, and collaboration with community therapy and social care teams. Data was collected on care package changes, hospital length of stay, and therapy involvement. Results Key issues included: lack of formal policy for the pathway, no senior clinical oversight, unregistered care staff making key decisions, and poor end-of-life planning. Outcomes from clinical leadership interventions included: 12% of patients had reduced care packages prior to discharge; 24% had reduced care needs once home. Estimated 476 care hours released per week. Approximate cost saving of £7000 per week. Senior clinician home visits proved the most impactful, enabling timely assessments, realistic care decisions, reduced dependence on social care, and improved patient experience. MDT engagement and end-of-life care planning also improved significantly. Conclusions Introducing senior clinical leadership to the care provider pathway significantly improved patient flow, care quality, and resource use. A 12-month Band 7/8 leadership role is recommended, jointly funded by acute, community, and social care partners, to oversee and define this pathway. This approach offers a sustainable model to manage complex discharges for frail patients while reducing system strain and supporting better outcomes.

The perceived impact of a Student-Led domiciliary midwifery care on Patient-Centered Care: A mixed methods Inquiry into postnatal Mothers’ experiences

Objectives: With the rapid aging of the global population, maintaining oral health in older adults with frailty has become a major public health priority.Domiciliary dental care, which provides dental services directly at home or in long-term care facilities, has emerged as a promising approach for overcoming barriers to mobility, access, and equity.However, evidence of its structure, effectiveness, and sustainability remains fragmented across countries.This scoping review aimed to map and synthesize international models of domiciliary dental care, focusing on their organizational structures, delivery processes, reported outcomes, limitations, and policy implications.We also sought to identify gaps in evidence and propose future research directions.Methods: Following the PRISMA-ScR framework, we conducted a structured review of the literature on domiciliary dental care systems in Japan, Hong Kong, Taiwan, Germany, the United Kingdom, Canada, and Australia.The data were charted on program design; service coverage; financing; workforce organization; and outcomes related to oral health, patient experience, and systemic challenges.Results: Domiciliary dental care improved access for frail or homebound older adults, facilitated early detection and prevention, enhanced oral health maintenance, and increased patient and caregiver satisfaction across countries.Education components for caregivers and facility staff further contributed to sustained oral hygiene practices.Nevertheless, most services were limited to preventive and basic restorative care, constrained by a lack of portable equipment, inadequate workforce capacity, low reimbursement levels, administrative burden, and legal liability concerns.Evidence from low-and middle-income countries was extremely limited, and few longitudinal and experimental studies were available to assess the cost-effectiveness or long-term outcomes.Conclusions: This scoping review highlights domiciliary dental care as a valuable but underdeveloped public health strategy for aging societies.To achieve sustainability and a broader impact, future efforts must address streamlined administration, standardized guidelines, adequate financing, professional training, and legal safeguards supported by stronger evidence, including economic evaluations and long-term outcome studies.

Malnutrition and frailty frequently affect older adults receiving domiciliary care services, increasing their vulnerability to adverse events such as delirium. Despite this, the role of malnutrition as a risk factor for delirium in this population remains under-researched. The aim of this study was to examine the relationship between nutritional status and the development of delirium over a 2-year period among older adults who received domiciliary care services. In this 2-year prospective cohort study, we included 210 participants aged 65years or older who received domiciliary care services at least once per week. Nutritional status was assessed using the Mini Nutritional Assessment at the time of inclusion, while delirium was assessed weekly, upon admission to hospital, and upon clinical indication according to DSM-5 criteria. Logistic regression analysis was used to examine the relationship between malnutrition and delirium. Of the sample, 116 (55.2%) were malnourished/at risk of malnutrition at the time of inclusion. Over a 2-year period, 42.4% developed delirium. The odds ratio for developing delirium was 2.00 (95% CI 1.08-3.72, P = 0.028), for the group with malnutrition/risk of malnutrition, adjusted for covariates. Malnutrition is an independent risk factor for delirium in older adults receiving domiciliary care services. These findings highlight the importance of regular nutritional assessments and interventions to potentially reduce the risk of delirium in this vulnerable population.

Co-production is important due to its effectiveness in creating relevant and meaningful outputs for use in social and healthcare practice, however, frontline staff such as homecare workers (also known as aides, personal assistants or domiciliary care workers providing paid care within the home) are a key group within the social care workforce who are under-represented in this approach. Here, we report our coproduction process engaging with this workforce to develop training resources for workers providing end-of-life homecare. To co-produce training resources with homecare workers and their managers to support and educate workers delivering end-of-life homecare using evidence from our larger qualitative interview study. We conducted a series of 12 co-production workshops with UK-based homecare workers and managers (partners) to design training resources and recommendations for homecare providers informed by research findings. We adopted the five key principles of co-production: Sharing of power; Including all perspectives and skills; Respecting and valuing knowledge; Reciprocity; and Building and maintaining relationships. A co-production advisory group of homecare workers as well as the workshop partners gave valuable oversight throughout the workshop series. 77 partners (31 homecare workers, 46 managers) participated in 12 workshops (one face-to-face; 11 online). Our approach enabled power-sharing, inclusivity, respect, collaboration and reciprocity, relationship-building, and identification of effective flexible approaches to co-production. Specific forms of training resources were co-created. Training recommendations (content, delivery formats, access during working hours, etc.) were also developed together. Challenges were non-attendance and lack of engagement by some partners during sessions. These workshops are the first, to our knowledge, to successfully co-produce end-of-life care training resources with homecare workers and managers, a poorly represented workforce in co-production. Challenges included inconsistent attendance and poor engagement by a minority of partners. The five key principles of co-production enabled true engagement with the process, thereby enriching the final outputs.

Despite the global shift in delegating greater responsibilities, including pressure ulcer (PU) prevention, to healthcare support workers (HCSWs), their experiences and perspectives are often under-represented in research. The aim of this study was to explore HCSWs' experiences and perspectives in PU prevention when delivering patient care. A generic qualitative research was used. Between March and June 2021, four focus groups were conducted via Zoom (Zoom Corp., US) with HCSWs working in different clinical settings. The focus groups explored HCSWs' experiences and perspectives into PU prevention, including their roles, challenges and areas requiring improvement. Data were analysed using thematic analysis. The research included 14 participants: three trainee nursing associates (acute n=2, community n=1) and one nursing associate from acute settings; and 10 healthcare assistants from acute (n=4), community (n=2), domiciliary care (n=3) and mental health (n=1). Participants demonstrated strong commitment to PU prevention, driven by their compassion and a genuine desire to alleviate patient suffering. Participants discussed challenges to effective PU prevention, including: lack of knowledge; skills; staff shortages; excessive workloads; and inconsistent practices. They stressed the critical role of teamwork and communication with patients and families for successful PU prevention. There was a strong call for structured training to enhance their knowledge and skills, advocating for mandatory, comprehensive and recurrent training for all involved in patient care. The findings highlighted the critical role of HCSWs in PU prevention within the current healthcare workforce model. They identified challenges and emphasised the need for structured training and support to fortify the contributions to effective PU prevention made by HCSWs.

Abstract Amid efforts to decarbonize society, the voices of socially disadvantaged community members, e.g. women low-paid workers, are often overlooked. Given the nature and growing significance of domiciliary care and the characteristics and size of its workforce, it represents a potentially valuable case study of involving communities in the co-design of solutions for a sector already undergoing significant transformation and now facing scrutiny as a major carbon emitter. This paper reports the preliminary findings of JUST-Systems, a UK-wide research initiative aimed at developing integrated systems approaches that position people at the center of efforts to accelerate action on decarbonization, local economies, and social justice. JUST-Systems seeks to identify bottlenecks and design better, more inclusive interventions by understanding the interactions between people, policies, and technologies. By adopting a systems approach, it may be possible to identify synergies and trade-offs between climate strategies and other priorities, such as jobs and social inclusion, focus on key obstacles and leverage points for change, and highlight what interventions can yield co-benefits. Welsh domiciliary care is one of the project’s test cases. This paper explores how systems thinking can aid in identifying synergies and trade-offs between climate strategies and the sector’s other policy priorities and challenges, emphasizing key barriers and leverage points for change. The paper reports on applying participatory action research methods and the Critical Systems Heuristics framework for reflective practice to reveal worker views around delivering domiciliary care through a decarbonization lens, identifying the opportunities and challenges in utilizing such techniques in facilitating worker voice.

Background: Oral pathology (e.g. caries, periodontal disease, edentulism) contributes to poor overall health and negatively impacts quality of life. Ageing increases susceptibility to oral diseases and poor oral health is common among older adults. In contrast, dental attendance is low among this group. This descriptive study aims to examine dental utilisation patterns among older adults in Flanders, Belgium. Methods: The study included all members from the two largest Belgian healthcare insurance funds aged 65 and older, residing in Flanders (Belgium). Descriptive and bivariate analyses were performed with dental utilisation patterns as main outcome and socio-demographic data, care dependency and oral status as covariates. Statistical analysis was performed using chi-square tests, with effect sizes calculated using Cramér's V. Results: Data from 911,159 older adults were analysed. Between 2020 and 2022, preventive care was regularly received by 36.8% of the participants, 37.0% had no contact with an oral health professional and 21.9% only received curative care. Lower utilisation of preventive care was observed in the following groups: the oldest-old (Cramér's V = 0.136), individuals having an increased reimbursement (Cramér's V = 0.171), residents of long-term care facilities (Cramér's V = 0.090), recipients of domiciliary nursing care (Cramér's V = 0.121), and edentulous older adults (Cramér's V = 0.362). Conclusion: A significant proportion of older adults did not attend a dentist or only received curative care. Further research is needed to investigate whether health promotion campaigns and enhanced collaboration among health professionals can motivate these older adults to engage in preventive oral care.

Domiciliary dental care coverage in Taiwan: An assessment of provider participation and geographic distribution using the universal health coverage framework

ABSTRACTBackground and AimsThis study evaluated the impact of major elective surgery on performance status, defined as functional and cognitive status, in older adults 3 months postoperatively. Secondary endpoints included assessing the need for domiciliary care, rehospitalization, or institutionalization, and evaluating associations with anesthesia type.MethodsIn this observational prospective cohort study, 169 patients aged ≥ 70 underwent major elective surgery between May 2020 and June 2023; 150 had complete information at 3‐months (T3). Decline in performance status, either functional or cognitive, was defined as a ≥ 10‐point worsening in the Barthel Index (BI) or death, or a ≥ 3‐point decline in Mini‐Mental State Examination (MMSE), all measured 3 months after surgery.ResultsMean (SD) age was 77 (5) years, with a mean (SD) Charlson Comorbidity Index (CCI) of 7 (2). Most surgeries (133, 79%) were performed for oncologic indications. Baseline median [IQR] BI was 100 [100‐100], and MMSE was 27 [25–28]. At T3, 44 (29%) patients showed a ≥ 10‐point BI decline (p < 0.001) and 7 died, while 14% exhibited a ≥ 3‐point MMSE decrease. Domiciliary care was required in 14 (9%) patients, while 26 (17%) were institutionalized. Fifty‐five (37%) patients reported health sequelae within 3 months post‐surgery. Multivariable regression analysis associated higher CCI and post‐discharge health issues with BI decline or death, but not with MMSE. Domiciliary care needs or rehospitalization was linked to elevated CCI and laparotomic approach.ConclusionMajor elective surgery may compromise functional status in nearly one‐third of older patients, especially those with high comorbidity and post‐discharge sequelae. Cognitive decline was less prevalent, and the need for domiciliary or institutional care was relatively low.Trial Registration: URL: https://register.clinicaltrials.gov/prs/beta/studies/S000CLIN00000033/recordSummary; Clinicaltrials.gov identifier: NCT05594277.

Challenging conventional provider-oriented perspectives on older adults' spatial realities, this study explores how community-dwelling care users in Sweden manage their home environments. It investigates how older adults use the welfare system and coordinate widely available but disparate material and social resources to achieve a spatially sustainable ageing-in-place. Research on domiciliary care for older adults has largely focused on the provider, overlooking the skills and strategies older care users themselves employ to make arrangements work; this study adopts a fresh lens by examining the active engagement of older adults in shaping their own home arrangements. The data comprised twelve qualitative interviews with older care users, along with walk-alongs in their homes, focusing on how different areas of the home were used in everyday life. The concepts of bricoleur, bricolage, and tinkering, were employed to analyse the activities and arrangements respondents implemented to utilise services in managing their daily lives. The findings revealed that participants had been prompted to develop sophisticated procedures and competencies, leveraging supportive networks and combining housing adaptations, assistive devices, and innovative uses of household items to make the services useful. The study highlights the importance of recognising the active coordination efforts of older care users and underscores the need to focus on their expertise and adaptive learning within supportive systems. An eldercare provision such as the one in Sweden, offering a variety of different services, can be perceived as fragmented and challenging to navigate, necessitating a user-centred approach to improve accessibility and effectiveness.

At present, the design of autism rehabilitation centers in China generally fails to meet the rehabilitation needs of patients, making it difficult to achieve the health and well-being goals of sustainable development. In this context, restorative environment theory, with its potential to improve spatial environments and enhance well-being, has gradually become a key driving force in the environmental design process. Therefore, this literature review employs a combined approach of macro-level quantitative and micro-level qualitative research methods based on the Web of Science (WOS) database. First, 5953 relevant literature sources were analyzed to reveal the research background, current status, hot topics, and future development trends of the theory of restorative environment and rehabilitation centers for children with autism. Through keyword network visualization, seven primary clusters were identified: #0 environmental design, #1 burnout, #2 Autism specturn disorder, #3 Attention deficit hyperactivity disorder, #4 caregiver, #5 domiciliary care, # 6 stroke. These clusters were further synthesized into four core design elements: lifecycle-spanning design, family collaboration and community engagement design, green sustainable environment design, and culturally inclusive and diverse physical and mental development design. Subsequently, a multi-level case analysis was conducted using 24 global autism-friendly design examples to validate the practical applicability of these core elements. Finally, based on the research findings, the discussion section proposes environmental design strategies for autism rehabilitation centers tailored to the Chinese context.These strategies aim to enhance the well-being of children with autism and contribute to the achievement of Sustainable Development Goal 3 (SDG3).