Care Organizations Research Articles

Prospective evaluation of patient-reported anxiety and experiences with adaptive radiation therapy on an MR-linac

PurposeAn integrated magnetic resonance scanner and linear accelerator (MR-linac) was implemented with daily online adaptive radiation therapy (ART). This study evaluated patient-reported experiences with their overall hospital care as well as treatment in the MR-linac environment. MethodsPatients pre-screened for MR eligibility and claustrophobia were referred to simulation on a 1.5 T MR-linac. Patient-reported experience measures were captured using two validated surveys. The 15-item MR-anxiety questionnaire (MR-AQ) was administered immediately after the first treatment to rate MR-related anxiety and relaxation. The 40-item satisfaction with cancer care questionnaire rating doctors, radiation therapists, the services and care organization and their outpatient experience was administered immediately after the last treatment using five-point Likert responses. Results were analyzed using descriptive statistics. Results205 patients were included in this analysis. Multiple sites were treated across the pelvis and abdomen with a median treatment time per fraction of 46 and 66 min respectively. Patients rated MR-related anxiety as “not at all” (87%), “somewhat” (11%), “moderately” (1%) and “very much so” (1%). Positive satisfaction responses ranged from 78 to 100% (median 93%) across all items. All radiation therapist-specific items were rated positively as 96–100%. The five lowest rated items (range 78–85%) were related to general provision of information, coordination, and communication. Overall hospital care was rated positively at 99%. ConclusionIn this large, single-institution prospective cohort, all patients had low MR-related anxiety and completed treatment as planned despite lengthy ART treatments with the MR-linac. Patients overall were highly satisfied with their cancer care involving ART using an MR-linac.

Mortalité maternelle, adéquation des soins et évitabilité, France 2016–2018

ObjectiveTo describe, for the 2016–2018 period, the adequacy of care provided to women who died of maternal death in France, as well as the possible preventability of these deaths. MethodNational data from the Enquête Nationale Confidentielle sur les Morts Maternelles for 2016–2018. For each maternal death identified, the National Expert Committee on Maternal Mortality (CNEMM) assesses the adequacy of the care provided and whether the death was probably, possibly or not preventable. ResultsFor 2016–2018, 272 maternal deaths (considered up to 1 year after the end of pregnancy) occurred in France. Of these, 265 had sufficient information collected by the confidential survey and could be assessed by the CNEMM. In total, care was judged to be “sub-optimal” for 66% of deaths assessed for all causes, a proportion similar to that for previous periods. In addition to the obstetric and anaesthetic care provided at the time of the acute complication, which was judged to be sub-optimal for 45% (obstetric care) and 38% (anaesthetic care) of maternal deaths, this report highlights the scope for improvement in other types of care, more related to prevention and screening: “sub-optimal” preconception care for 51% of the women who died for whom it was justified, particularly notable for deaths linked to a preexisting condition (52%) and for suicides (67%); prenatal surveillance judged to be “sub-optimal” in 30% of cases, a sub-optimality also more frequent among deaths linked to a preexisting condition (35%) and suicides (34%). In all, 59.7% of maternal deaths assessed were judged to be “probably” (17%) or “possibly” (42.7%) preventable, a profile that remained stable. Suicide and other psychiatric causes, the leading cause of maternal death, were considered to be potentially preventable in 79% of cases. Deaths from haemorrhage remained largely preventable (95%, the highest proportion by cause). The factor most often implicated was inadequate care, and preventability linked to this factor was identified in 53% of deaths, all causes combined. Gap in organization of care was a preventability factor identified in 24% of deaths, and poor interaction between the woman and the healthcare system in 22% of deaths. ConclusionThis proportion of more than half of potentially preventable maternal deaths shows that a reduction in maternal mortality in France is still possible and must be achieved, the objective being to prevent all preventable deaths. Analysis of the factors involved, overall and by cause of death, suggests areas for improvement.

Mortalité maternelle par suicide et autres causes psychiatriques en France 2016–2018

This report, covering the period 2016–2018, confirms that psychiatric causes (largely dominated by suicides) are the leading cause of maternal mortality up to 1year after childbirth, a finding already made in the previous 2013–2015 report. There were 47 deaths from psychiatric causes in 3years, including 45 maternal suicides, giving a maternal mortality ratio (MMR) of 2.1 per 100,000 live births (NV) (95% CI: 1.4–2.6). The median time to suicide was 138days postpartum. This group represents 17.3% (16.5% for suicides) of all maternal deaths for the period. Maternal suicide is linked to an interaction of several risk factors, including a history of personal and family psychiatric disorders not always known to the obstetric team (53% of women), socioeconomic disparities (29% present social vulnerability, and 14% domestic violence), stressful events, and inadequate access to healthcare services. Psychiatric causes are among those in which the proportion of sub-optimal care and preventable deaths, i.e. 79% of cases, are the highest. An analysis of all the women who died in France of psychiatric causes during pregnancy reveals a number of recurring elements that point to the need for improvement, both in terms of the quality and organization of care, and in terms of women's interaction with the healthcare system. Screening for a history of psychiatric disorders and ongoing psychiatric pathologies must be carried out systematically at all stages of pregnancy and postpartum by all those involved, with communication with future parents on the not inconsiderable risk of perinatal depression. Finally, it is important to develop an adapted and graduated response across the country, according to resources, and to strengthen city–hospital collaboration and training for all those involved.

Enquête Nationale Confidentielle sur les Morts Maternelles en France, un système de surveillance améliorée depuis 25 ans, indispensable pour la caractérisation fiable des décès maternels

Although maternal mortality is rare in wealthy countries, it remains a fundamental indicator of maternal health. It is considered to be a “sentinel event”, the occurrence of which indicates dysfunctions, often cumulative, in the healthcare system. In addition to the classic epidemiological surveillance findings – number of deaths, maternal mortality ratio, distribution of medical causes, sub-groups of women at risk – its study, through a precise analysis of the history of each woman who died, enables to highlight areas for improvement in the content or organisation of care, the correction of which will make it possible to prevent not only deaths but also upstream morbid events involving the same mechanisms. To achieve this dual epidemiological and clinical audit objective, an ad hoc “enhanced” system is needed. France has had such a system since 1996, the Enquête Nationale Confidentielle sur la Mortalité Maternelle (ENCMM), under the joint supervision of Santé Publique France and Inserm. The ENCMM method aims to identify maternal deaths exhaustively and reliably up to 1 year after the end of pregnancy, and to document each death as fully as possible. The 1st step is the multi-source identification (direct declaration, death certificates, linkage with birth certificates, hospital stay database) of women who died during pregnancy or in the year following its end. The 2nd step is the collection of detailed information for each death by a pair of clinical assessors. The 3rd step is the review of these anonymised documents by the National Expert Committee on Maternal Mortality, which establishes the maternal nature of the death (causal link with pregnancy) and, with a stated aim of improvement rather than judgement, assesses the adequacy of care and the preventability of the death. The summary of the information gathered for maternal deaths in the 2016–2018 period is presented in the other articles of this special issue.

TEMPORARY REMOVAL: Mortalité maternelle par hémorragie obstétricale en France 2016–2018

Between 2016 and 2018, 20 maternal deaths were related to obstetric haemorrhage, excluding haemorrhage in the first trimester of pregnancy, representing a mortality ratio of 0.87 per 100,000 live births (95% CI 0.5 -1.3). Obstetric haemorrhage is the cause of 7.4% of all maternal deaths up to 1 year, 10% of maternal deaths within 42 days, and 21% of deaths directly related to pregnancy (direct causes). Between 2001 and 2018, maternal mortality from obstetric haemorrhage has been considerably reduced, from 2.2 deaths per 100,000 live births in 2001-2003 to 0.87 in the period presented here. Nevertheless, obstetric haemorrhage is still one of the main direct causes of maternal death, and remains the cause with the highest proportion of deaths considered probably (53%) or possibly (42%) preventable according to the CNEMM's collegial assessment (see chapter 3). The preventable factors reported are related to inadequate content of care in 94% of cases and/or organisation of care in 44% of cases. In this triennium, maternal death due to haemorrhage occurred mainly in the context of caesarean delivery (65% of cases, i.e. 13/20), and mostly in the context of emergency care (12/13). The main causes of obstetric haemorrhage were uterine rupture (6/20) in unscarred uterus or in association with placenta accreta, and surgical injury during the caesarean delivery (5/20). Every maternity hospital, whatever its resources and/or technical facilities, must be able to plan any obstetric haemorrhage situation that threatens the mother's vital prognosis. Intraperitoneal occult haemorrhage following caesarean section and uterine rupture require immediate surgery with the help of skilled surgeon resources with early and appropriate administration of blood products.

Influence of the work environment of nurses on the 30-day mortality of patients hospitalized in Polish hospitals. cross-sectional studies

BackgroundAn optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital’s employees and a reduction in hospital mortality rates.AimTo understand the relationships between the work environment as perceived by nurses on the 30-day mortality of patients treated in Polish hospitals.BackgroundAn optimal work environment for nurses is characterized primarily by appropriate staffing, good team relations, and support from the management staff. These factors are consistently associated with a positive assessment of patient safety by a hospital’s employees and a reduction in hospital mortality rates.Material and methodsThe analysis used discharge data from 108,284 patients hospitalized in internal medicine and surgery departments in 21 hospitals (with 24/7 operations) in Poland. Administrative data included coded data to estimate 30-day mortality. A Nurses’ satisfaction questionnaire, including the PES-NWI scale and the SAQ questionnaire, was used to assess the work environment of nurses (n = 1,929). Correlations between variables were assessed using the Pearson coefficient. The analysis used a Poisson regression model, which belongs to the class of generalized linear models.ResultsA lower 30-day mortality rate amongst patients was found among those treated in hospitals where the personnel feel that they may question the decisions or actions of their superiors regarding the care provided (r = − 0.50); nurses are informed about changes introduced on the basis of reports about negligence and mistakes (r = − 0.50); the ward nurse is a good manager (r = − 0.41); nurses receive timely information from the head of the department that may have an impact on their work (r = − 0.41).ConclusionsFactors related to care during hospital stay such as the organization of care at the ward level, analysis of care errors, the number of staff providing direct patient care, informing nurses about mistakes without punishment, and the possibility of nurses challenging the decisions or actions of superiors, which concerns care providing, affect the 30-day mortality of patients after the end of hospitalization in Polish hospitals.

Being used for the greater good while fighting on the frontline: care staff’s experiences of working with older people during the COVID-19 pandemic in Sweden

BakgroundWorldwide, older people were more severely affected during the COVID-19 pandemic than others. In Sweden, those living in residential care facilities had the highest mortality rate, followed by those receiving home care services. The Swedish and international literature on the working environment for assistant nurses and care aides during the pandemic shows an increase in stress, anxiety, depression and post-traumatic stress syndromes. Care organisations were badly prepared to prevent the virus from spreading and to protect the staff from stress. In order to be better prepared for possible future pandemics, the health and well-being of the staff, the care of older people and the experiences of the staff both during and after a pandemic are important aspects to take into account. Therefore, this study aims to describe the experiences of assistant nurses and care aides working in the care of older people during the COVID-19 pandemic in Sweden, their working conditions and the impact all this had on their lives. MethodologyThe study has a qualitative, descriptive design. The data was collected in four focus group interviews with 21 participants and analysed using qualitative content analysis.ResultsThe results revealed the theme, Being used for the greater good while fighting on the frontline, which was then divided into three categories: portrayed as a risk for older people, not being valued and being burnt out. The worsening working conditions that the pandemic contributed to resulted in a high degree of stress and risk of burnout, with staff members both wanting to and actually leaving their employment. After the pandemic they felt forgotten again and left to cope in an even worse situation than before.ConclusionsThe pandemic had a major effect on assistant nurses and care aides in terms of their working environment and their private lives. To be better prepared for future pandemics or disasters, organisations with responsibility for the care of older people will need to ensure that their staff have the necessary competencies and that there is adequate staffing in place. This also means that adequate government funding and multiple interventions will be needed.

How general practitioners used job crafting strategies during the COVID-19 pandemic in Sweden

Objective General practitioners (GPs) played a crucial role in limiting the impact of the COVID-19 pandemic, and many GPs experienced they did not have the prerequisites to provide adequate care. However, GPs developed approaches that helped them to provide care to patients through various job crafting strategies. The aim of this study is to identify how job crafting strategies were deployed by GPs at the beginning of the COVID-19 pandemic in Sweden and the significance of the strategies on their work situation. Design A qualitative design with semi-structured interviews. The data was analysed using qualitative content analysis with job crafting as the conceptual framework for the analysis process. Setting Primary healthcare in five healthcare regions in Sweden. Subjects Fourteen GPs participated in individual interviews. Results In their endeavours to organise and provide care, GPs shaped the task, relational and cognitive boundaries of their work. GPs felt proud about finding new ways of working when given room to manoeuvre. Intensified collaboration between healthcare professionals made GPs more confident in their clinical work. GPs expressed that they consequently felt stronger in their professional role through what they accomplished in the organisation of care. Conclusions/Implications The results suggest that the job crafting strategies GPs used were meaningful to them in clinical practice. Knowledge about how GPs’ job crafting strategies were deployed might be useful for healthcare organisations in preparing for future health crises. Taking advantage of GPs’ experiences and strategies is considered important for promoting sustainable working conditions for GPs in the future.

Factors Determining in The Selection of Pediatrics Health Care Service in Chennai, India

Background: Parents can choose their children's healthcare center; however, the healthcare business struggles to meet the growing health demands of vulnerable groups. Pediatricians now prioritize parental interests to improve their services and healthcare. This study also determined the association of sociodemographic variables with factors influencing the parent's decision. Materials and Methods: A cross-sectional study was undertaken among 146 parents of children aged 0 to 13 years who sought-patient services at a paediatrics department of a tertiary care center in Chennai between July 2023 to October 2023. The Validated semi structured questionnaire was administered. Results: In the present study, mean age group of the study population is 29±4, among them 69% were female and 31% were male. Sociodemographic variables, namely younger age, female gender, middle monthly income, and higher educational status, are influential in the parent's decision-making process for selecting a health care center. Conclusion: Although parents may lack the ability to assess all facets of care and treatment, their perspectives contribute immensely to the interpersonal aspect of care, communication, information, and care organization. The present study has yielded significant results that enhance the knowledge base of practitioners, managers, and other professionals tasked with delivering pediatrics general practice services.

Results of an international survey on the current organization of care for pregnant women with cancer.

The global incidence of cancer is increasing, including its incidence in women of reproductive age. Still, physicians encounter this situation rarely, which could lead to substandard care. This research sought to explore opportunities to improve future care for pregnant women with cancer, by describing the outcomes of a survey distributed to physicians all over the world focusing on clinical experience with pregnant women with cancer, the organization of care and current gaps in knowledge. We included 249 responses from physicians working across 36 countries. Responses demonstrate a wide variation in the organization of care - generally lacking centralization, and the physicians' acknowledgement of insufficient knowledge on the management of pregnant women with cancer. There is a need for improvement through national centralization and/or establishing advisory boards for cancer in pregnancy. Seeing the paucity of cancer in pregnancy experience, the importance of global multidisciplinary collaboration is emphasized.

Caring, law, and solidarity—on the need for reorientation

Abstract What significance does care have in law? How is solidarity understood in the relationship between individuals, society, and the state, and what needs to be changed? How should the welfare state promote care and caring relationships by granting solidary forms of support and enabling beyond the already existing but insufficient rights and services? These questions guide the analysis; German law and EU law are important points of reference, but the general argument transcends national borders and jurisdictions. It results that solidarities are ambivalent, the recognition of care-related rights and provision of care services and infrastructures is insufficient. There is a need for care policies based on solidarity. Although there are numerous fragmented regulations in family, labour and social law with regard to care and care needs, these are often inadequate. Coherent and solidarity-based care policies, such as those developed by some countries and international organizations, can serve as a stimulus and inspiration for social and legal policies in Germany and elsewhere. Although the contents of solidarity as a legal principle is rather indeterminate and open to the discretion of the state, solidarity can be an important part of the argument, because the social support and organization of care is in the interest of society and of all those who need or provide care and contribute to the public good.

Value-Based Healthcare Delivery: A Scoping Review.

Healthcare systems are transforming from the traditional volume-based model of healthcare to a value-based model of healthcare. Value generation in healthcare is about emphasising the health outcomes achieved by patients and organisations while maintaining an optimal relationship with costs. This scoping review aimed to identify the key elements and outcomes of implementing value-based healthcare (VBHC). The review process included studies published from 2013 to 2023 in four different databases (SpringerLink, PubMed, ProQuest and Scopus). Of the 2801 articles retrieved from the searches, 12 met the study's inclusion criteria. A total of 11 studies referred to value as the relationship between the outcomes achieved by patients and the costs of achieving those outcomes. Most of the studies highlighted the presence of leadership, the organisation of care into integrated care units, the identification and standardisation of outcome measures that generate value for the patient, and the inclusion of the patient perspective as the most prominent key elements for optimal VBHC implementation. Furthermore, some benefits were identified from VBHC implementation, which could shed light for future implementation actions. Therefore, the VBHC model is a promising approach that may contribute to an improvement in the efficiency and sustainability of healthcare.

Experiences Among Patients With Cystic Fibrosis in the MucoExocet Study of Using Connected Devices for the Management of Pulmonary Exacerbations: Grounded Theory Qualitative Research.

Early detection of pulmonary exacerbations (PEx) in patients with cystic fibrosis is important to quickly trigger treatment and reduce respiratory damage. An intervention was designed in the frame of the MucoExocet research study providing patients with cystic fibrosis with connected devices and educating them to detect and react to their early signs of PEx. This study aims to identify the contributions and conditions of home monitoring in relation to their care teams from the users' point of view to detect PEx early and treat it. This study focused on the patients' experiences as the first and main users of home monitoring. A qualitative study was conducted to explore patients' and professionals' experiences with the intervention. We interviewed patients who completed the 2-year study using semistructured guides and conducted focus groups with the care teams. All the interviews were recorded and transcribed verbatim. Their educational material was collected. A grounded analysis was conducted by 2 researchers. A total of 20 patients completed the study. Three main categories emerged from the patients' verbatim transcripts and were also found in those of the professionals: (1) task technology fit, reflecting reliability, ease of use, accuracy of data, and support of the technology; (2) patient empowerment through technology, grouping patients' learnings, validation of their perception of exacerbation, assessment of treatment efficacy, awareness of healthy behaviors, and ability to react to PEx signs in relation to their care team; (3) use, reflecting a continuous or intermittent use, the perceived usefulness balanced with cumbersome measurements, routinization and personalization of the measurement process, and the way data are shared with the care team. Furthermore, 3 relationships were highlighted between the categories that reflect the necessary conditions for patient empowerment through the use of technology. We discuss a theorization of the process of patient empowerment through the use of connected devices and call for further research to verify or amend it in the context of other technologies, illnesses, and care organizations. ClinicalTrials.gov NCT03304028; https://clinicaltrials.gov/ct2/show/results/NCT03304028.

Turning Loss Into Legacy: Opportunities for Tissue and Eye Donation in Community Hospice/Palliative Care.

Organ, tissue, and eye donations provide opportunities to leave a legacy by saving and/or enhancing the quality of life of others. There has been little published related to tissue or eye donation in hospice/palliative care and few initiatives to facilitate donation among hospice patients/families. Donation myths, gaps in knowledge, and, most significantly, lack of donation referral processes result in missed opportunities for patient/families to consider donation. One donor has the potential to impact 75 lives or more through tissue donation and 2 lives through eye donation. Hospice/palliative care providers can play key roles related to education, advocacy, and collaboration. The support of hospice/palliative care organizations and the local Organ Procurement Organization/Tissue and Eye Recovery Agency are essential for facilitating donation opportunities. This article summarizes current literature, examines legislation and regulations related to donation, presents a case that illustrates an opportunity for hospice community based donation, and shares practices that support donation in hospice/palliative care organizations together with the local Organ Procurement Organization/Tissue and Eye Recovery Agency. This article will hopefully provide the impetus for further study and the development of practices to optimize donation in hospice/palliative care, thus providing more patients and families the opportunity to turn loss into legacy.

Clinical Impact of the Implementation Strategies Used to Apply the 2013 Pain, Agitation/Sedation, Delirium or 2018 Pain, Agitation/Sedation, Delirium, Immobility, Sleep Disruption Guideline Recommendations: A Systematic Review and Meta-Analysis.

To summarize the effectiveness of implementation strategies for ICU execution of recommendations from the 2013 Pain, Agitation/Sedation, Delirium (PAD) or 2018 PAD, Immobility, Sleep Disruption (PADIS) guidelines. PubMed, CINAHL, Scopus, and Web of Science were searched from January 2012 to August 2023. The protocol was registered with PROSPERO (CRD42020175268). Articles were included if: 1) design was randomized or cohort, 2) adult population evaluated, 3) employed recommendations from greater than or equal to two PAD/PADIS domains, and 4) evaluated greater than or equal to 1 of the following outcome(s): short-term mortality, delirium occurrence, mechanical ventilation (MV) duration, or ICU length of stay (LOS). Two authors independently reviewed articles for eligibility, number of PAD/PADIS domains, quality according to National Heart, Lung, and Blood Institute assessment tools, implementation strategy use (including Assess, prevent, and manage pain; Both SAT and SBT; Choice of analgesia and sedation; Delirium: assess, prevent, and manage; Early mobility and exercise; Family engagement and empowerment [ABCDEF] bundle) by Cochrane Effective Practice and Organization of Care (EPOC) category, and clinical outcomes. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation. Among the 25 of 243 (10.3%) full-text articles included ( n = 23,215 patients), risk of bias was high in 13 (52%). Most studies were cohort ( n = 22, 88%). A median of 5 (interquartile range [IQR] 4-7) EPOC strategies were used to implement recommendations from two (IQR 2-3) PAD/PADIS domains. Cohort and randomized studies were pooled separately. In the cohort studies, use of EPOC strategies was not associated with a change in mortality (risk ratio [RR] 1.01; 95% CI, 0.9-1.12), or delirium (RR 0.92; 95% CI, 0.82-1.03), but was associated with a reduction in MV duration (weighted mean difference [WMD] -0.84 d; 95% CI, -1.25 to -0.43) and ICU LOS (WMD -0.77 d; 95% CI, -1.51 to 0.04). For randomized studies, EPOC strategy use was associated with reduced mortality and MV duration but not delirium or ICU LOS. Using multiple implementation strategies to adopt PAD/PADIS guideline recommendations may reduce mortality, duration of MV, and ICU LOS. Further prospective, controlled studies are needed to identify the most effective strategies to implement PAD/PADIS recommendations.

Opportunities and challenges of promoting integrated care through digitalisation–Learning lessons from large-scale national programmes in England

There is a growing global interest in integrating health and care through digitalisation. However, many ambitious digitalisation initiatives in the healthcare sector fail to achieve their intended outcomes. One contributing factor is the failure to apply lessons learned from past endeavours. We here leverage the experiences gained from large-scale digitalisation efforts within the National Health Service (NHS) in England to distil valuable insights for strategic decision-makers who are embarking on the development and implementation of initiatives aimed at integrating health and social care through digitalisation. While not exhaustive, our compilation of eight key lessons serves as a foundational resource to inform such initiatives, seeking ultimately to contribute to realising maximum benefits for health and care organisations and service users.

The implementation of smart continence care for people with disabilities: A qualitative study of key stakeholders' first-hand experiences.

Innovative technological applications like smart continence care (SCC) offer potential benefits in healthcare delivery, particularly for individuals with profound intellectual and multiple disabilities (PIMD). SCC aims to prompt caregivers to change continence materials, potentially improving clients' quality of life and reducing caregivers' workload. Although the use of SCC in PIMD care is promising, research is needed to improve its use in these complex settings. The aim of this study was to reflect on the SCC implementation process in care organizations for people with PIMD. Fifteen semi-structured interviews were conducted with key stakeholders, caregivers, and SCC project leaders, across four care organizations. Interviews utilized an integrated framework drawing from the centre for eHealth research roadmap and the nonadoption, abandonment, scale-up, spread, and sustainability framework, both addressing eHealth implementation. Thematic analysis and open coding were employed to identify key themes and sub-themes in the implementation process. Four main themes emerged as crucial for successful SCC implementation: creating support, communication between stakeholders, problem-solving, and willingness to adopt SCC. The first three themes were perceived as contributors to the success of SCC implementation, whereas the last theme showed factors impacting willingness to adopt SCC. Early involvement of key stakeholders and clear communication about expectations of their roles was perceived as crucial and created clarity. Adequate problem-solving was identified as influential in SCC utilization and willingness to adopt person-centred continence care. Implementation of SCC requires changes in the work routines of those involved, and key stakeholders' early involvement appears to improve support for these changes. Fostering communication between key stakeholders and adequate problem-solving contributes to positive experiences and the perceived success of sustainable implementation. This study offered a rich understanding of day-to-day practices around implementing SCC in disability care organizations. The findings may also be relevant for the implementation of technologies in other care settings.

Saúde mental perinatal e cuidado. Interseções e reconfigurações no contexto da pandemia de Covid-19, na Argentina

Perinatal mental health refers to the psychosocial processes that occur during pregnancy, childbirth and the postpartum period. A study was carried out with a quantitative-qualitative design, with quota sampling, with pregnant and postpartum women from three hospitals in two Argentine provinces during the Covid-19 pandemic. An in-person survey was conducted with 300 women. The results indicate a slight increase in care time and a decrease in time dedicated to paid work. A great concern was found among women about changes in health care, the care and health of their children, and the daily management of care. A high incidence of anxiety in pregnant women and postpartum depression was recorded. Studying maternal mental health and the organization of care from a gender perspective allows for a more comprehensive understanding of the suffering of women mothers understood as social subjects.

Digital health interventions for improving access to primary care in India: A scoping review.

Access to quality healthcare remains a challenge in low-and middle-income countries. Vulnerable populations with unmet needs face the greatest challenge in accessing primary care for appropriate and timely healthcare. The use of digital technologies can not only strengthen health systems but also improve access to health care, particularly for the vulnerable. This scoping review aims to assess the various digital health technologies and interventions available for improving access to primary care for the vulnerable in India. This scoping review employed the Joanna Brigg Institute's (JBI) guidelines and Arksey and O'Malley's methodological framework. The literature search was conducted in Medline/PubMed, Embase, Web of Science-Core Collection, Scopus, AgeLine, PsycINFO, CINAHL, ERIC, Cochrane CENTRAL, and Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register databases, using the keywords, such as 'Access', 'Healthcare', 'Assistive technology', 'Digital health' 'Vulnerable', 'India' and 'Healthcare technology'. A two-staged screening of titles and abstracts, followed by full-text was conducted independently by two reviewers, using the Rayyan software. Subsequently, the data was extracted from selected studies using a pre-designed and approved extraction form. The data was then synthesised and analysed narratively. The protocol for this review has been registered with open science forum (OSF) registries (https://osf.io/63pjw/). The search yielded about 3840 records, 3544 records were eligible for screening of titles and abstracts. We included seven studies after a two-round screening and identified seven different technological innovations developed to bridge gaps in access to primary care. The commonly used digital health interventions for improving access to primary care were virtual tele-health systems and mHealth applications in-built within an android smartphone or a tablet. Digital health interventions was either used as a standalone tele-health aid or a collaborative system for community workers, primary care physicians as well as the health service users. The purpose of these innovations was to increase awareness and knowledge to access support for specific aspects of healthcare. Virtual primary health care with the specialist in the hub supporting general physicians at the primary health centres in blocks and districts was another such model used for improving access to primary care. Digital health interventions was also used for mass community screening of disabilities, such as persons with hearing disability. To re-imagine a digitally empowered health systems in India, also inclusive of the vulnerable, it is important to inclusively conceptualise, systematically develop and rigorously evaluate any public health interventions including those that are enabled by digital health interventions to bridge the gaps in access to primary care in India. Such a strategy could address the paucity of evidence in public health interventions and provide sustainable strategies to strengthen health systems in India. Trial registration: Open Science Framework-Registration Link: https://osf.io/63pjw/.

Building a caring network of formal and informal help (offline and online) in a super-diverse neighbourhood

Several organisations (i-mens, Steunpunt Mantelzorg, Hoplr, city of Aalst, sickness funds, Eerstelijnszone regio Aalst, informal carers organisations...) came together for the project ‘Neighbourhood Building Blocks’ to create a caring neighbourhood in a super-diverse area in Aalst, a city close to Brussels, Belgium. It is an area with an older ‘Belgian’ population and a younger population with a migration background. People in this neighbourhood are generally less wealthy, less healthy and more socially isolated than in other areas in Flanders.
 The goal of the project is to ensure that people only must ask help once to get the appropriate answer or support at the right time. To achieve this, we are creating a virtual and physical network of informal and formal support in the neighbourhood, putting together several existing building blocks: capacities of neighbours, professional care, volunteers, support for informal carers, a digital platform of neighbours (Hoplr) and the building complex of i-mens – a care organisation, with an office building for their home care services, a day care and service flats. The underlying assumption is that everyone has something to contribute and something to gain from the network.
 We have 3 intervention axes: 1. Neighbourly help network 2. Empowerment of informal carers 3. Connecting the professional care network with the informal network. We have a neighbourhood concierge and connector. She connects the 3 axes of the project, and ensures that the project is driven by and embedded in the neighbourhood, together with the key partners.
 
 We start from the capacities of neighbours (ABCD-model) to create neighbourly help networks, both offline and online. We match people based on their capacities and needs, and track this through a dashboard (people matched – help provided – after care). To find capacities and needs we organise activities and informal contact at the gathering room of the service flats and the meeting rooms of i-mens. All activities have 3 functions: information in group on rights and possible support, conversation and encounters in group (social contact), and one-on-one questions and support with individual cases.
 Learning from the experience of previous caring neighbourhoods, we give specific attention to informal carers. We know that they find it more difficult to rely on help from neighbours and professional caregivers. Empowering and informing informal carers through specific interventions ensures their involvement and support from the network.
 We connect professional actors (care organisations, local traders, …) with each other and with the informal actors, tailored to the needs and capacities of the neighbourhood. We aim to make professional support and care more accessible to people in the neighbourhood. At the back-office side, we are developing a decision-making tree so we know which question for help can be resolved by which formal or informal actor. The dashboard to match neighbourly help will be expanded in order to track matches with formal actors.
 
 We will present the first results of the project, and share experiences of neigbhours, informal carers and profesionnal actors.