Search

Cardiac arrhythmias occur at all ages. Cardiac mapping and ablation are established methods for curing arrhythmia substrates; however, complications may occur. We report a patient with transient Wenckebach heart block during radiofrequency ablation in the setting of Wolff Parkinson White syndrome despite the ablation catheter being well away from the atrioventricular node, and we speculate on the potential mechanism.

The success of the Australian COVID-19 vaccination strategy rested on access to primary healthcare. People experiencing or at risk of homelessness are less likely to access primary healthcare services. Therefore, leaders in homeless health service delivery in Sydney identified the need to develop a vaccine hub specifically for this vulnerable population. The aim of this study was to develop an evidenced based model of care to underpin the Vaccine Hub and optimize access to vaccination for people experiencing or at risk of homelessness. A mixed methods study was conducted that included interviews with key stakeholders involved in establishing and delivering the Inner City COVID-19 Vaccine Hub, and a survey with people receiving COVID-19 vaccination. Over the 6-month period of this study, 4305 COVID-19 vaccinations were administered. Participants receiving vaccination reported feeling safe in the Vaccine Hub and would recommend it to others. Stakeholders paid tribute to the collective teamwork of the Vaccine Hub, the collaboration between services, the ‘no wrong door’ approach to increasing access and the joy of being able to support such a vulnerable population in challenging times. The study findings have been populated into a Vaccination Hub Blueprint document that can be used as a template for others to improve access to vaccinations for vulnerable populations.

Background Links among homelessness, poor health and frequent hospitalisation are familiar to health services worldwide. Despite this, limited research has explored hospital-based Registered Nurses’ perspectives of homelessness healthcare. Aim This study explored the perspectives of hospital-based Registered Nurses, regarding provision of person-centred care for people who are homeless. Methods Interviews were conducted with twelve Registered Nurses working in a tertiary metropolitan hospital. Interview transcripts were analysed using a deductive thematic approach guided by Deci and Ryan’s self-determination theory (SDT). Findings Five themes emerged regarding provision of person-centred care for people who are homeless. First, people who are homeless frequently access the hospital as a safe place. Second, nurses often perceive homeless health problems as multifaceted and difficult to manage. Third, stigma creates a barrier to the delivery of hospital-based homelessness healthcare. Fourth, it is important to provide people who are homeless with a sense of choice. Fifth, there is a lack of suitable discharge options and connection between the hospital and community services. Discussion If care pathways within a hospital are not designed to adequately address the complex needs of people who are homeless, they are vulnerable to frequent re-admissions and extended lengths of stay. A non-judgmental attitude and providing a sense of choice are important approaches for hospital-based Registered Nurses when working with people who are homeless. Conclusion Hospital-based homelessness healthcare presents many challenges. The perceptions of Registered Nurses provide insight into the daily experience of caring for people experiencing homelessness within a hospital setting.

Objective: Coronavirus disease 2019 (COVID-19) spread globally, including across Europe, resulting in different morbidity and mortality outcomes. The aim of this study was to explore the progression of the COVID-19 pandemic over 18 mo in relation to the effect of COVID-19 vaccination at a population level across 35 nations in Europe, while evaluating the data for cross-border epidemiological trends to identify any pertinent lessons that can be implemented in the future. Methods: Epidemiological data were obtained from European Centre for Disease Prevention and Control and Our World in Data databases while Ministry of Health websites of each respective country and local newspapers were used for COVID-19-related vaccination strategies. Case, mortality, and vaccination incidence comparative analyses were made across neighboring countries. Results: Similar morbidity and mortality outcomes were evident across neighboring countries over 18 mo, with a bidirectional relationship evident between cumulative fully vaccinated population and case fatality rates. Conclusion: Countries’ COVID-19 outcome is related on national mitigative measures, vaccination rollouts, and neighboring countries’ actions and COVID-19 situations. Mass population vaccination appeared to be effective in reducing COVID-19 case severity and mortality rates. Vaccination equity and pan-European commitment for cross-border governance appear to be the way forward to ensure populations’ return to “normality.”

ObjectivesIn this paper, we report the development of the Homeless Health Access to Care Tool. This tool aims to improve the gap in assessing health need and capacity to access healthcare of people experiencing homelessness. Tools exist that prioritise people experiencing homelessness for housing, but none specifically designed to prioritise for healthcare, or that are succinct enough to be easily implemented to emergency department or primary healthcare settings.Design and settingThe Homeless Health Access to Care Tool has been adapted from an existing tool, the Vulnerability Index Service Prioritisation Decision Assistance Tool through a five-step process: (1) domain identification, (2) literature review, (3) analysis of hospital admission data, (4) expert judges, and (5) Delphi study.ParticipantsThe tool was adapted and developed by homeless health clinicians, academics and people with lived experience of homelessness. The Delphi study (n=9) comprised emergency department and homeless health clinicians.ResultsConsensus was gained on all but one item, five new items were added, and wording changes were made to six items based on expert feedback. Participants perceived the tool would take between 5 to 11 min to complete, the number of items were appropriate, and the majority agreed it would facilitate the assessment of health needs and capacity to access healthcare.ConclusionRobust development of the Homeless Health Access to Care Tool through the Delphi is the first phase of its development. The Homeless Health Access to Care Tool offers an opportunity to assess both health need and capacity to access healthcare with the aim to improve access to healthcare for people experiencing homelessness. This tool will facilitate standardised data collection to inform service design and data linkage regarding access to healthcare of people experiencing homelessness. The next stages of testing include construct validity, feasibility, usability and inter-rater reliability, and pilot implementation.

People experiencing homelessness find it challenging to access the healthcare they so desperately need. To address this, we have developed the Homeless Health Access to Care Tool, which assesses health related vulnerability (burden of injury and/or illness and ability to access healthcare) and can be used to prioritize people for access to healthcare. Here, we report the initial psychometrics of the Homeless Health Access to Care Tool. To assess interrater reliability, clinician participants were invited to instinctually rate the health-related vulnerability of 18-fictional case studies and then apply the Homeless Health Access to Care Tool to these same case studies. To assess convergent validity, the Homeless Health Access to Care Tool and the tool it was adapted from, the Australian Vulnerability Index Service Prioritization Decision Assistance Tool were administered to people experiencing homelessness. Feedback was sought from the participants receiving these two tools and from those administering them. The Homeless Health Access to Care Tool demonstrated a high interrater reliability and internal consistency. Participants using and receiving the Homeless Health Access to Care Tool reported it as straightforward, unintrusive and clear. Median time of administration was 7 min 29 s (SD 118.03 s). Convergent validity was established for the Homeless Health Access to Care Tool with a moderate correlation (r = 0.567) with the total score of the Australian Vulnerability Index Service Prioritization Decision Assistance Tool. Findings suggest that the Homeless Health Access to Care Tool is feasible and reliable. Larger samples are required to report construct validity.

Problem Throughout the world people who are homeless experience high rates of hospitalisation. Nurses who work in hospitals have the potential to improve outcomes for this group. To date, a review of qualitative literature pertaining to hospital-based nursing for people who are homeless has been lacking. Aim To synthesize findings of contemporary qualitative studies related to hospital-based nursing care for people who are homeless in Organisation for Economic Cooperation and Development (OECD) nations. Design A systematic database search was conducted in mid-2017 using search terms: homeless*, hospital* and nurs*, combined by the Boolean operator ‘AND’. Inclusion and exclusion criteria that mandated publication year, language, method, quality, participants, and setting were applied. 341 abstracts were screened for relevancy resulting in the final inclusion of 8 qualitative and 2 mixed method studies. Findings Three overarching themes emerged; (1) Homelessness challenges rigid approaches to hospital-based care (2) Stigma impedes healthcare for people who are homeless (3) Hospitals can provide a platform to address homelessness. Discussion Delivering flexible, non-stigmatising nursing in a way that empowers people experiencing homelessness challenges hospitals around the globe. Research is needed to explore local approaches and subgroups within the homeless population. Conclusion Experiences of homelessness vary across nations and between cities necessitating local solutions. Within hospitals, if nurses can provide flexible, non-stigmatising care, they have potential to make a huge difference both the lives of individuals who are homeless and in the wellbeing of society as a whole.

Background The objectives of this scoping review are to investigate the characteristics assessed by existing vulnerability indices and the health outcomes achieved by applying them to people experiencing homelessness. This review forms part of the development and implementation of a novel tool to prioritise people experiencing homelessness for healthcare based on their need and capacity to access healthcare. Methods Included papers were primary research, published in the English language, participants were experiencing homelessness and aged over 18 years at the time of the study, a vulnerability index was used in the study, sample size was greater than 30, and the study had a health focus. Databases searched were MEDLINE, Embase, CINAHL, Scopus, PubMed and Web of Science, between January-April 2020. The Joanna Briggs Appraisal criteria were used to quality appraise the included studies. Results were synthesised narratively. Results Six papers were included, a total of 27,509 participants. The reported use of the indices varied; they included screening and profiling homeless populations, comparing homeless populations, and two studies evaluated the predictive capacity, reliability and validity of the indices. One vulnerability index focused on screening for human immunodeficiency virus, one used a 50-item index and four used a nine-item index. No direct health outcomes were reported from applying the vulnerability indices. The studies identified limitations of using vulnerability indices, including the potential bias of relying on self-reported data and two studies highlighted the need for further psychometric testing to ensure validity and reliability of the indices. Discussion The sample of included studies was small. Vulnerability indices are reportedly a useful and easily accessible method of gaining valuable data on the health status and health needs of people experiencing homelessness. The variety of characteristics included in the vulnerability indices suggests the importance of tailoring vulnerability indices to the needs of the population to which it is to be applied. Conducting appropriate psychometric testing is critical so that an index can be used to accurately inform decision making and accurately prioritise people experiencing homelessness who are most at risk of mortality and morbidity. A specific tool that prioritises people experiencing homelessness for access to health care is not yet available. The review was funded by a St Vincent’s Network Inclusive Health grant.

In the absence of an effective vaccine and/or treatment, COVID-19 remains pandemic. It is only public health measures, such as social distancing (and these included school closures), that have prevented millions of infections and deaths. School closures followed a precautionary principle in that many previous epidemics (e.g. influenza) were mainly transmitted by children. This is supported by few studies and yet, these closures have significantly impacted parents and children. We are now in September 2020, with public health restrictions being lifted in an attempt to attenuate the negative economic impact of the pandemic. The easing of restrictions has led to a resurgence of COVID-19 in a second wave of infections. In the meantime, summer school holidays are coming to an end in the northern hemisphere and it is salutary to review the effects on viral surges due to school openings thus far. This review shows that as schools open, outbreaks that affect both pupils and staff occur probably due to failure to adhere to public health principles: hand washing, distancing etc. Reopenings should clearly be done slowly and cautiously so as to control potential COVID-19 outbreaks before they get out of hand. Reopenings may also require targeted closure of other establishments/facilities (such as restaurants and shops) so as to keep the locality's COVID-19 reproduction rate below 1.

Doctors in Star Trek are vital and central characters, often crucial in helping their captains to reach command decisions. They are also interdisciplinarians, performing not only medical tasks but also any form of work related to all fields of biology. Furthermore, these doctors also carry out any required research that pertains to the biological sciences. It is perhaps this unique blend of skills, combined with a fundamental orientation towards humanism and compassion, that leads to their default position, de facto, if not de jure, as the crew's ethics officers, a role that they embrace with as much dedication and zeal as the former Soviet communist political officers/commissars (the Zampolit) did theirs. This paper will show that from the very inception of Star Trek, doctors strictly adhered to deontological tenets which lead them to actively influence command decisions that pertain not only to health, but also to any ethical decisions that may have to be taken by Starfleet officers. This portrayal of future doctors signals the wishes of contemporary audiences: that future doctors remain humane, compassionate and ethical guardian angels, and not only superb medics.