Key Stakeholder Organizations Research Articles

Improving hospital care for people who use drugs: deliberative process development of a clinical guideline for opioid withdrawal management

Abstract Background Management of opioid withdrawal in hospital settings is crucial to improve treatment completion and health outcomes among patients who use opioids, such as heroin. Evidence-based clinical guidelines can support responsive provision of opioid substitution therapy (OST). In England there is no standardised application of guidance for substance dependence management across National Health Service (NHS) Hospitals. A recent review of NHS hospital policies identified varying approaches to managing opioid withdrawal and procedural barriers to timely medication. Objective To develop a clinical guideline for opioid withdrawal management in acute NHS hospital trusts to be tested and evaluated as part of the iHOST (Improving Hospital Opioid Substitution Therapy) research intervention. Methods We undertook a deliberative guideline development process. The University London College Hospital (UCLH) substance dependence guideline was used as a template, with key points of revision informed by evidence review, consultations with hospital staff and people with opioid dependence. A multidisciplinary working group deliberated evidence statements to develop recommendations. These were reviewed by an oversight committee comprising representatives from key stakeholder organisations. The team authored the guideline with iterative review by the oversight committee, key stakeholders and UCLH clinical governance committees. Results Deliberation focused on three key domains: (1) identifying opioid dependence and promptly continuing existing OST prescriptions; (2) initiating or re-titrating OST; (3) ensuring safety and continuity of care at discharge. Changes to the UCLH guideline included removal of mandatory urine drug testing prior to OST; increasing initial methadone titration dose; and provision for a higher day-one titration dose when specific safety criteria are met. A new titration schedule for sublingual buprenorphine was incorporated. Discharge planning to ensure continuity of community care and reduce risk of opioid overdose was emphasised, with allowance for bridging prescriptions of OST and naloxone provision on hospital discharge. Conclusion The iHOST clinical guideline aims to remove procedural barriers to opioid withdrawal management for hospital inpatients. It is intended to be implemented by other NHS hospitals, which could improve access to OST and reduce discrepancies in treatment access and completion. Study registration ISRCTN47320412 https://doi.org/10.1186/ISRCTN47320412.

Conceptualising trust and collaboration among stakeholders in MaaS ecosystems

Understanding the factors that facilitate trust and collaboration in Mobility as a Service (MaaS) ecosystems is crucial to the effective delivery of a MaaS scheme given the involvement of both public and private stakeholders. This paper presents the findings of a study investigating the factors that build trust and collaboration among the stakeholders in a MaaS ecosystem and provides insights into the role of regulatory authorities in enabling MaaS developments. The research approach employed the Constructivist Grounded Theory Method (CGTM) using the distinct cases of Whim in Helsinki, Finland and The Sydney MaaS trial in Sydney, Australia. Semi-structured in-depth interviews were conducted with the representatives of key stakeholder organizations in the two MaaS ecosystems. A conceptual framework of trust and collaboration was developed for each case study to illustrate the process of forming and consolidating trust and collaboration in each MaaS ecosystem. The findings suggest that trust acts as the antecedent and catalyst for building collaborative space within a MaaS ecosystem. Possessing a good understanding of partners’ expectations is a prerequisite for collaboration given the inherent conflicts between interests and goals of the public and private sector. The capability of the partners, prior relationships and open negotiations emerged as the key constructs which form trust in a MaaS ecosystem. It was evident that appropriate policies and legislation developed with the consultation of stakeholders are critical in the development of trust and collaboration in the MaaS ecosystem.

Abstract WP54: Design and Preliminary Results on an Educational Intervention to Foster Stroke Coordinator Engagement, Knowledge, and Job Satisfaction

Background: Stroke Coordinators (SC) are instrumental in overseeing the development, evaluation, and sustainability of processes that drive the Stroke Care System. However, there are many practice barriers that impact the SC role including time management, mentorship, education, and training. The aim of this study s to train SC throughout Alabama’s six EMS regions and evaluate whether training in certification in Stroke Nursing increases overall job satisfaction. Methods: This part of StrokeSTAT, a larger observational trial designed to evaluate the implementation of severity-based stroke triage across Alabama’s six EMS regions. Key elements of the intervention include partnerships with the Alabama Department of Public Health and the State’s professional multi-disciplinary association of health care professionals involved in the care of stroke patients (Alabama Stroke Alliance of Professionals, ASAP), bringing stroke symposia to each EMS region; providing SCs with a Stroke Certified Registered Nurse (SCRN) review course to encourage and inspire nurses caring for patients with acute stroke to sit for the exam; and reimbursement for successful certification. Results: At present, two regional courses have been offered with 27 Registered Nurses in attendance from 33 Stroke Centers. Evaluations (n=20) indicated that before the course, SCs were “slightly comfortable” (5%), “somewhat comfortable” (20%), “for the most part comfortable” (75%) with exam content. In the post-course evaluation, 100% of attendees responded, “the information in this activity will help me do my job.” Conclusions: Stroke care continues to rapidly evolve, and SC are often untrained for the role. The partnership with key stakeholder organizations, bringing the symposia to each region, and focusing on improving knowledge and preparation to sit for the SCRN exam were highly effective in engaging the Alabama SCs in the two EMS regions thus far. The symposia provided specialized knowledge for the practice of Stroke Nursing, and uniformly increased participant’s perception of their ability to perform their duties. Evaluation of impact of the different elements of this complex health intervention on stroke coordinator perception is ongoing.

Regulation of the bioeconomy: Barriers, drivers and potential for innovation in the case of Ireland

The bioeconomy is generally understood as an economy in which sustainably-sourced renewable bio-based resources are used for the production of food, energy and other products and services. Expectations are high for its potential to support the transition away from a fossil fuel-based economy and help to address complex issues such as climate change and biodiversity depletion. However, given its cross-sectoral nature and key focus on innovation, tensions can emerge between bioeconomy goals and the need for regulation of bioeconomy activities. In particular, there is a recognition of the need for regulation to (a) support sustainability and resource efficiency, (b) manage competing interests and (c) provide coherence and innovation support. To identify how regulation may be acting as a barrier and / or driver of the bioeconomy in Ireland, interviews were conducted with a range of key stakeholder organisations. Analysis revealed four key barriers, relating to the need for financial support tools such as feedin tariffs, more flexible approaches to regulating the use of waste materials, closing the gap between regulation and innovation activity and addressing planning issues. The two drivers identified highlight a positive role for regulation in supporting and enabling bioeconomy development, especially in terms of using more flexible and innovative approaches. Associated challenges include the need to support genuine public participation and the provision of resources to support policy-makers in the design and implementation of an effective bioeconomy regulatory framework.

Development of Scholarship Core Competencies for Pediatric Hospital Medicine Fellowship Programs.

The Pediatric Hospital Medicine (PHM) Fellowship Directors, recent fellowship graduates, and senior leaders in PHM have long identified training in scholarly activities as a key educational priority for fellowship training programs. We led a 2-day conference funded by the Agency for Healthcare Research and Quality to develop scholarship core competencies for PHM fellows. Participants included fellowship directors, national experts in PHM research, and representatives from key stakeholder organizations. Through engagement in large group presentations and small group iterative feedback and editing, participants created and refined a set of scholarship core competencies. After the conference, goals and objectives were edited and harmonized by conference leaders incorporating feedback from conference participants. Core competency development included 7 domains: (1) study design and execution, (2) data management, (3) principles of analytics, (4) critical appraisal of the medical literature, (5) ethics and responsible conduct of research, (6) peer review, dissemination, and funding, and (7) professionalism and leadership. Specific objectives for each goal were further organized into 3 levels to indicate core skills for all fellowship trainees (level 1), specialized and specific skills determined by fellow scholarly focus (level 2), and advanced skills for fellows interested in a clinical investigator career path (level 3). These newly developed scholarship core competencies provide a foundation for curricular development and implementation to ensure that the field continues to expand academically, given the 2-year training period and variable infrastructure across programs.

"We don't want to run before we walk": the attitudes of Australian stakeholders towards using psychedelics for mental health conditions.

This study was aimed at understanding the attitudes and positions of key Australian organisational and political stakeholders towards using psychedelic agents in medically supervised environments to treat mental health conditions. Specifically, this research was designed to identify some of the issues that might impede the clinical implementation of psychedelics. Semi-structured interviews were conducted with four Australian politicians and nine representatives of key stakeholder organisations between September 2022 and January 2023. Data analyses were completed using pattern-based inductive thematic analysis. Participants were cautiously optimistic about using psychedelics to treat mental health conditions, with hesitancy emerging due to the perceived inadequacy of research into the efficacy and feasibility of these treatments. Politicians consistently mentioned that negative stigma prevented them and their peers from supporting the use of psychedelics in Australia. Effective, evidence-based, clear messaging that refutes misconceptions, uses persuasive messaging and provides clear information to inform implementation is needed to improve knowledge and challenge attitudes, biases and emotions that can influence the debate around psychedelics. Stakeholder representatives and politicians agree that insufficient evidence exists to support the widespread clinical implementation of psychedelics in Australia. Politicians also perceive the stigma associated with psychedelics might negatively influence progressive legislation. Additional research and a clear presentation of this research are needed before the clinical use of psychedelics can be supported.

Australia needs to implement a national health strategy for doctors.

Australia needs to implement a national health strategy for doctors.

Representation and diversity in the sign language translation and interpreting profession in the United Kingdom

This article reports the findings of a nationwide sign language translator and interpreter (SLTI) census to establish a baseline description of the United Kingdom’s SLTI workforce that was commissioned by the Association of Sign Language Interpreters UK. Complete responses were received from 690 practitioners from across the United Kingdom (43% of the potential sample). The survey responses were analysed using the SPSS statistical software, specifically to look at various intersectional characteristics concerning gender, age, sexuality, race, and ethnicity. This article provides an overview of the findings with respect to two key themes: representation and diversity in the profession, along with discussion of the profile of the SLTI profession in the United Kingdom, and recommendations for actions for key stakeholder organisations. As a first snapshot, this census functions as a baseline for future comparisons, and can be modified and improved through open dialogue with professional and community groups. This snapshot helps us to identify gaps in representation. Finally, it can also inform the planning and forecasting of recruitment needs for the workforce and highlight any education and training needs.

A global study to identify a potential basis for policy options when integrating animal welfare into the UN Sustainable Development Goals

A previously developed methodology to rate the strength of the impact of improving animal welfare on achieving each of the 17 SDGs and the impact of achieving each SDG on animal welfare was used at the third Animal Welfare Global Forum of the World Organisation for Animal Health. Data from 95 participants from key stakeholder categories and organisations involved in animal welfare were analysed. The resulting ‘map’ of the relative strengths of these associations confirmed the expected co-benefits of improving animal welfare and achieving the SDGs. Differences at regional level and according to the economic classification of the country were also identified. This paper focuses on using this ‘map’ as a potential guide for how organisations interested in improving animal welfare could identify potential new allies for strategic partnerships to facilitate the implementation of different policy options. For example, a strategy can be to collaborate with those organisations where the impact is of similar mutual benefit, e.g. between improving animal welfare and achieving SDG 3 (Good health and well-being). Organisations in these two areas are already aligning themselves in the ‘One Health’ movement. Another strategy can be to align with organisations for whom achievement of their goal has the greatest impact on animal welfare, even if the impact is not mutual e.g. by collaborating with organisations working to achieve SDG 16 (Peace justice and strong institutions) and SDG 4 (Quality education). Achieving these goals was considered to have a large impact on improving animal welfare, equivalent to that of achieving SDG 3. In summary, this study can help organisations working in the area of animal welfare identify previously untapped areas of potential support, so tailoring their efforts efficiently, while at the same time themselves supporting movement towards the Agenda 2030. Simply put, the co-benefits make collaboration worthwhile, potentially opening up opportunities that would be unavailable when organisations are working independently towards their own respective goals.

Making everyone count: it is time to improve the visibility of people with disability in primary care.

Making everyone count: it is time to improve the visibility of people with disability in primary care.

Dying at work. Work-related suicide – how does the UK regulatory context measure up?

PurposeThe purpose of this paper is to examine how work-related suicides are monitored, investigated and regulated in the UK, examining a small selection of cases and drawing on international comparison with other countries. Effective data collection and regulation are the cornerstone of suicide prevention, and this paper aims to consider whether the UK’s current regulatory framework provides an effective basis for preventing work-related suicides.Design/methodology/approachThis study draws on qualitative sociological methods and is based on an in-depth analysis of 12 suicide cases occurring between 2015 and 2020. In each case, work-related causal factors had been previously identified by at least one official source (police enquiry, coroner or employer’s investigation). This study analysed multiple sources of documentation and undertook interviews with individuals close to each suicide case. The aim of this study was to consider the organisational response of three stakeholder organisations to the suicides: the Health and Safety Executive (HSE), the coroner and the employer.FindingsThe study points to serious shortcomings in the UK’s regulatory response to work-related suicides. Suicides are currently not recorded, investigated or regulated. Whereas the fracture of an arm or leg in the workplace needs to be reported to the HSE for further investigation, a suicide occurring in the workplace or that is work-related does not need to be reported to any public agency. Employers are not required to investigate an employee suicide or make any changes to workplace policies and practices in the aftermath of a suicide. The work-related factors that may have caused one suicide may, therefore, continue to pose health and safety risks to other employees.Originality/valueWhereas some recent studies have examined work-related suicides within specific occupations in the UK, to the best of the authors’ knowledge, this is the first study to analyse the UK’s regulatory framework for work-related suicides. The study on which the paper is based produced a set of recommendations that were targeted at key stakeholder organisations.

Efficacy and cost-effectiveness of an online mindfulness program (MindOnLine) to reduce fear of recurrence among people with cancer: study protocol for a randomised controlled trial

IntroductionFear of cancer recurrence (FCR) is a common condition among cancer survivors that can lead to significant levels of distress, anxiety and depression. Online mindfulness programmes may provide the mechanism...

Lessons from the development and delivery of a rural suicide prevention program.

AimsSuicide prevention remains a priority in rural and remote Australia, where suicide rates continue to be higher than those in urban communities. This commentary describes the Good SPACE suicide prevention program, and the lessons learned from delivering this program over a 14‐year period.ContextThe Good SPACE program has been operating in rural New South Wales since 2007. The program focuses on educating rural community members to recognise the signs of suicide vulnerability, and how to take appropriate action if they encounter someone considering suicide.ApproachCommunities are selected to receive Good SPACE training in consultation with key stakeholder organisations, or by request from communities. Across the life of the program, key challenges in its administration have included short‐term funding arrangements and staff turnover. Strengths have included the ability to adapt content to meet the needs of rural communities (eg from an initial focus on helping farmers during periods of drought, to a broader focus on all rural residents and a wider range of adversities). As the program moves forward, emphasis will be placed on harder‐to‐reach populations, including males and those with lower mental health literacy.ConclusionThe Good SPACE program has ongoing funding to adapt its content and continue administration through the Rural Adversity Mental Health Program (https://www.ramhp.com.au/). The lessons learned throughout the life of the program might be of use to other organisations aiming to provide community‐based education programs in rural and remote communities.

In this October issue

Intubation is arguably the most important intervention done in an ED. We publish papers that discuss it in some detail. (a) A group from Melbourne conclude that structured and targeted debriefing after intubating children in the ED is feasible and contributes to measurable and qualitative improvements in patient safety. (b) A group from NSW describe current airway management practices after a failed intubation attempt in Australian and NZ EDs as well as factors associated with second attempt success. (c) A group from Queensland report that implementation of an evidence-based care bundle and audit of practice has created a safe environment for trainees to learn the core critical care skill of rapid sequence intubation in the ED. In an editorial linked to the above paper from Melbourne, Victoria Brazil and her colleagues highlight the importance of hot debriefing in the ED. Staff are enthusiastic about team conversations after clinical encounters – to defuse high emotion, promote learning and reflect on ways to improve future care. They argue that clinical event debriefing should be a cornerstone of healthcare team reflexivity but can only result in change if embedded within a larger ‘improvement ecosystem’ that synthesises, analyses and reacts to the data from the coal face. The topic of debriefing is also discussed in detail in the Trainee Focus section. Every year 25 000 Australians experience a cardiac arrest in the community, but only 12% survive. The faster CPR and defibrillation starts, the greater the chance of survival. Currently, only half of Australian adults are trained in Basic Life Support (BLS). The Australian Resuscitation Council and key stakeholder organisations believe the best way to ensure all Australians know how to save a life is by mandating BLS education and training in schools. We publish an ‘Aussie KIDS SAVE LIVES’ Position Statement outlining a strategy to help facilitate the introduction of a programme of regular BLS training into the Australian school curriculum. The August issue profiled this paper on its front cover. In doing so we inadvertently used an acronym for Aboriginal and Torres Strait Islander peoples that is disrespectful and does not embrace cultural diversity. Once we realised the problem, the acronym was changed immediately online; unfortunately, it was too late to change the cover of the print edition. No disrespect or offence was intended. We apologise unreservedly. A group from South Australia give us a retrospective analysis assessing whether the introduction of point of care Rotational Thromboelastometry (ROTEM) influenced blood product transfusion and coagulation management in an Australian level 1 trauma centre. The authors conclude that ROTEM introduced in the ED, altered blood product transfusion practices for major trauma patients with an ISS >12, leading to a potentially safer transfusion strategy and cost savings for key blood products. Another paper from South Australia reports the incidence of Acute Traumatic Coagulopathy (ATC) in trauma patients presenting to the Royal Adelaide Hospital. The conclusion is that prehospital blood transfusions are given to the most severely injured trauma patients and the incidence of ATC in this group is more than 80%. There is an association with prehospital blood transfusion and increased ATC in part related to patient selection and severity of trauma, with the contribution of red cell transfusions to ATC unclear. This association should allow earlier identification of patients at increased risk of ATC to ensure rapid correction of coagulopathy to decrease the morbidity and mortality of trauma. Since 2018, the Australasian College for Emergency Medicine has collaborated with Swinburne University of Technology on a research project to understand and enhance the leadership capacity of emergency physicians, beginning with Australasian Directors of Emergency Medicine (DEMs). This research has revealed the complexity of leadership in emergency medicine, illuminating the strengths and limitations of extant research and suggesting promising new directions for emergency medicine leadership and leadership development research. This program has also shed new light on the knowledge, skills and abilities that DEMs need to develop to catalyse change in the systems where they work. The authors argue that an approach to leadership development that reflects the complexity of leadership in emergency medicine will go a long way to enhancing the sophistication, effectiveness and impact of leadership in emergency medicine.

Aussie KIDS SAVE LIVES: A position statement from the Australian Resuscitation Council and supported by stakeholders.

Every year 25 000 Australians experience a cardiac arrest in our community, but only 12% survive. The faster cardiopulmonary resuscitation and defibrillation, known as basic life support (BLS), is commenced, the greater the chance of survival. Currently, only half of the Australian adults are trained in BLS. The Australian Resuscitation Council and key stakeholder organisations believe that the best way to ensure all Australians know how to save a life is by mandating BLS education and training in our schools. This ‘Aussie KIDS SAVE LIVES’ position statement outlines our strategy to help facilitate the introduction of a programme of regular BLS training into the Australian school curriculum.

Key stakeholder perspectives on the development and real-world implementation of a home-based physical activity program for mothers at risk of postnatal depression: a qualitative study

BackgroundPhysical activity (PA) is a modifiable risk factor for postnatal depression (PND) and programs are needed to enhance PA amongst women at risk of PND. Key stakeholder involvement in informing development and implementation of such programs is vital. However, little research demonstrates key stakeholder insights to inform the design and delivery of PA programs for improving PND. The aim of this study was to explore key stakeholder perspectives on the design and delivery of a home-based PA program for mothers with PND symptoms to inform future real-world implementation and scale-up.MethodsA descriptive qualitative study was undertaken whereby semi-structured interviews were conducted with representatives from various key stakeholder organisations involved in postnatal PA and/or mental health, public health and policy in Australia (n = 11). Interviews were conducted between September to November 2019 and explored stakeholder perceptions on the design and delivery of a home-based PA program for mothers with PND symptoms. The interview schedule was informed by both the Consolidated Framework for Implementation Research (CFIR) and the PRACTical planning for Implementation and Scale-up (PRACTIS) guide. Data were analysed thematically using both deductive and inductive coding.ResultsThe relative priority of PND and PA was high for most organisations involved, although none implemented PA programs supporting women at risk of PND. Most stakeholders perceived the program as appealing due to addressing barriers to postnatal PA, although identified some feasibility issues regarding funding and delivery mechanisms. Suggestions for program adaptations included an equity focus (e.g. providing socioeconomically disadvantaged women with a greater program dose; translating web-app based content into various languages). Planned components of the program were suggested to align (i.e. relative advantage) with existing initiatives (e.g. equipment hire for nurseries scheme) and screening systems for PND (timing of referral). Perceived barriers to scale-up included logistics/cost of equipment, organisational capacity demands and safety risks/liability. Perceived enablers to scale-up included linking the program with ‘adjunct’ programs and services.ConclusionsWhile the program was appealing and most organisations could see a role in endorsing and/or referring to the program, funding and delivery mechanisms still need to be identified.

Review of Australian initiatives to reduce stigma towards people with complex mental illness: what exists and what works?

BackgroundAustralian national mental health policy outlines the need for a nationally coordinated strategy to address stigma and discrimination, particularly towards people with complex mental illness that is poorly understood in the community. To inform implementation of this policy, this review aimed to identify and examine the effectiveness of existing Australian programs or initiatives that aim to reduce stigma and discrimination.MethodPrograms were identified via a search of academic databases and grey literature, and an online survey of key stakeholder organisations. Eligible programs aimed to reduce stigma towards people with complex mental illness, defined as schizophrenia, psychosis, personality disorder, or bipolar disorder; or they focused on nonspecific ‘mental illness’ but were conducted in settings relevant to individuals with the above diagnoses, or they included the above diagnoses in program content. Key relevant data from programs identified from the literature search and survey were extracted and synthesized descriptively.ResultsWe identified 61 programs or initiatives currently available in Australia. These included face-to-face programs (n = 29), online resources (n = 19), awareness campaigns (n = 8), and advocacy work (n = 5). The primary target audiences for these initiatives were professionals (health or emergency), people with mental illness, family or carers of people with mental illness, and members of the general population. Most commonly, programs tended to focus on stigma towards people with non-specific mental illness rather than on particular diagnostic labels. Evidence for effectiveness was generally lacking. Face-to-face programs were the most well-evaluated, but only two used a randomised controlled trial design.ConclusionsThis study identified areas of strength and weakness in current Australian practice for the reduction of stigma towards people with complex mental illness. Most programs have significant input from people with lived experience, and programs involving education and contact with a person with mental illness are a particular strength. Nevertheless, best-practice programs are not widely implemented, and we identified few programs targeting stigma for people with mental illness and their families, or for culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander communities and LGBTIQ people. These can inform stakeholder consultations on effective options for a national stigma and discrimination reduction strategy.

An overview of assistive technology products and services provided in Malawi

Background Assistive technology is the products and services used by individuals with functional limitations to enable participation in society and realisation of rights afforded by the United Nations Convention on the Rights of Persons with Disabilities. The Assistive Product List is a comprehensive list of products identified as essential for access through universal health coverage. Key stakeholders, including organisations of persons with disabilities, civil service organisations, academic organisations and government ministries are collaborating to integrate assistive technology into policy and develop a priority assistive products list for Malawi. Objective To understand the organisational characteristics of, and assistive products provided by, key stakeholders working in AT in Malawi. Study Design Online survey of representatives from key stakeholder organisations. Methods We surveyed representatives of key stakeholder organisations to gather information regarding assistive technology product and service provision in Malawi. Responses were analysed using counts for closed-ended questions, and conventional content analysis for open-ended questions. Results A total of 36 of the 50 APL products were provided by eight organisations. Related services were provided for 36 of the 50 APL products by twelve organisations. Five organisations reported providing both products and services. Products and services are largely funded by donation and provided free to those who require them. Conclusion A range of organisations in Malawi play a role in assistive product delivery and related services. Coordinated AP delivery and service provision is required at a national level which is sustainable and inclusive, and is based on identified needs of the Malawian population. Implications for rehabilitation Policies supporting assistive product and service provision must acknowledge the contextual needs of the communities where they are implemented. Coordination is required for assistive product and service provision at the national and subnational level. Existing and potential gaps in service provision must be addressed when implementing a national assistive products list.

Feasibility of eLearning Nutrition Education and Supplemental Locally-Grown Produce Dissemination Model: Perspectives from Key Stakeholders

ABSTRACT Adults with low-income often lack access to nutrition education and experience food insecurity, which compromises nutrition-related chronic disease management. Through qualitative interviews, we examined the feasibility of a safety-net clinic based, eLearning nutrition education and supplemental produce program from the perspectives of community-based stakeholders (n = 8). Findings suggest the importance of building collective capacity among existing community resources, balancing resource utilization and workload among the key stakeholder organizations, and considering participant’s motivation to engage in the program. Stakeholder interviewees suggested the program is feasible and could serve as a community-based solution to improve the health and food security of limited-income adults.

Top 10 research priorities for human milk banking and use of donor human milk: A partnership between parents and clinicians.

This study sought to establish research priorities in human milk banking and use of pasteurised donor human milk. It aimed to (i) collaborate with national stakeholders, including parents of preterm infants, human milk donors and health-care professionals, to identify evidence uncertainties and (ii) agree by consensus on a consolidated prioritised list of research questions. A consensus approach modelled on the James Lind Alliance was used. A steering group was formed, and key stakeholder organisations identified. Evidence uncertainties were gathered through an online survey and literature search. An iterative process was used to consolidate and rank questions. A final workshop was held to identify the top 10 research priorities. A total of 391 evidence uncertainties were gathered from 202 respondents (38% parents of preterm infants/milk donors, 50% health-care professionals, 12% who identified as both a parent of preterm and health professional) and a further 15 were identified from literature. The steering group consolidated these to 39 evidence uncertainties, which were ranked via another survey. The top 24 questions were workshopped by 13 participants (four parents and nine clinicians) to determine the top 10 research priorities. These included the risks and benefits of using donor milk, optimum techniques for processing and the effects of these on the properties of milk, the nutrient profile of the milk and clinical criteria for prioritising receipt of milk. The top 10 research priorities in human milk banking and use of donor milk were identified and can be used to guide researchers.