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Humankind’s main defence against the virus that cuases COVID-19 (SARS-CoV-2), besides vaccine development, was co-ordinated behaviour change. In many countries, co-ordination was assisted by tracking surveys designed to measure self-reported behaviour and attitudes. This paper describes an alternative, complementary approach, which was undertaken in close collaboration with officials in the Department of the Taoiseach (Irish Prime Minister). We adapted the Day Reconstruction Method (DRM) to develop the ‘Social Activity Measure’ (SAM). The study was conducted fortnightly for 18 months, with findings delivered directly to the Department. This paper describes the method and shows how SAM generated a detailed picture of where and why transmission risk occurred. By using the DRM, we built aggregate measures from narrative accounts of how individuals spent their previous day. SAM recorded the amount, location and type of social activity, including the incidence of close contact and mask-wearing, as well as compliance with public health restrictions by shops and businesses. The method also permitted a detailed analysis of how public perceptions and comprehension are related to behaviour. The results informed government communications and strategies for lifting public health restrictions. The method could be applied to other future situations that might require co-ordinated public behaviour over an extended period.

Background: Even though antithrombotic therapy has probably little or even negative effects on the well-being of people with cancer during their last year of life, deprescribing antithrombotic therapy at the end of life is rare in practice. It is often continued until death, possibly resulting in excess bleeding, an increased disease burden and higher healthcare costs. Methods: The SERENITY consortium comprises researchers and clinicians from eight European countries with specialties in different clinical fields, epidemiology and psychology. SERENITY will use a comprehensive approach combining a realist review, flash mob research, epidemiological studies, and qualitative interviews. The results of these studies will be used in a Delphi process to reach a consensus on the optimal design of the shared decision support tool. Next, the shared decision support tool will be tested in a randomised controlled trial. A targeted implementation and dissemination plan will be developed to enable the use of the SERENITY tool across Europe, as well as its incorporation in clinical guidelines and policies. The entire project is funded by Horizon Europe. Results: SERENITY will develop an information-driven shared decision support tool that will facilitate treatment decisions regarding the appropriate use of antithrombotic therapy in people with cancer at the end of life. Conclusions: We aim to develop an intervention that guides the appropriate use of antithrombotic therapy, prevents bleeding complications, and saves healthcare costs. Hopefully, usage of the tool leads to enhanced empowerment and improved quality of life and treatment satisfaction of people with advanced cancer and their care givers.

BACKGROUND: Cardiovascular disease is the most common cause of death and disability in indigenous communities but limited prospective data exist about stroke. AIMS: To estimate the difference in stroke recognition, risk factors, treatment rates and outcomes between indigenous and non-indigenous peoples admitted to the Wagga Wagga Rural Referral Hospital (WWRRH) over a 5-year period with a suspected acute stroke. METHODS: All suspected strokes presenting to the 33 peripheral hospitals within the Murrumbidgee Local Health District (MLHD) were transferred to the WWRRH and prospectively assessed over a 5-year period from 1 January 2012 to 31 December 2017. Actions at stroke onset, risks factors, stroke type, treatment and outcomes were analysed. RESULTS: A total of 1843 patients were included. Of these, 45 (2.5%) patients were indigenous. Only 26.6% of indigenous and 34% of non-indigenous patients knew of the face, arm, speech, time (FAST) acronym. Indigenous patients were younger (mean age 62.0 years vs 74.4 years) and more likely to have diabetes (risk difference (RD) 22.3% (95% CI: 3%, 41.7%)), dyslipidaemia (RD 19.4% (95% CI: 21.%, 36.7%)), and be ever smokers (RD 24.9% (95% CI: 9.5%, 40.3%)). Stroke types were similar except lacunar infarcts were more common (19.2% vs 8.4%). Treatment rates and outcomes were similar between the two groups. CONCLUSIONS: Indigenous Australians with stroke are a decade younger and have a higher prevalence of important, modifiable stroke-risk factors. Delayed presentation to hospital is more common, due in part to stroke symptoms being underrecognised. When admitted to a specialised stroke unit, treatment rates and outcomes are comparable.

Objective: Vaccination campaigns against COVID-19 will only be successful if enough people want to take the vaccine. We tested a government communications intervention to encourage uptake. Design: A pre-registered randomised controlled trial. Methods: A large, nationally representative sample were randomly assigned to see one of eight posters. The posters varied by image (general practitioner or two hospital doctors) and message (control with public health guidance not related to vaccination, endorsement of the vaccine from the pictured doctor, endorsement with information about COVID-19 risk, endorsement with information about risk and appeal to get vaccinated to protect friends and family). The posters were presented as part of a larger study. The main outcomes were intention to be vaccinated and how soon people would be willing to be vaccinated. Results: The posters induced different reactions indicating that participants had engaged with them. The hospital image was generally preferred to the GP image. Perhaps critically, all intervention messages were trusted less than a control message which did not mention the vaccine (Control Poster Mean = 5.65, SE = 0.09 vs. Poster M Mean = 5.18, SE = 0.09, p <.001; vs. Poster M + R Mean = 5.11, SE = 0.09, p <.001; vs. Poster M + R + F Mean = 5.33, SE = 0.09, p =.01). There were no effects of poster type on intention to take the vaccine or how soon people were willing to take it. Conclusion: Although the intervention messages were based on the strongest correlates of vaccine hesitancy identified by contemporaneous surveys, none was effective. More recent research suggests that focusing on the risk of COVID-19 may be less effective than focusing on the benefits of vaccination. Null findings can be as important as positive findings for designing public health campaigns. This study informed government communications about the COVID-19 vaccine.

Background: Intravenous thrombolytic therapy (IVT) with tissue plasminogen activator for acute ischemic stroke is underutilized in many parts of the world. Randomized trials to test the effectiveness of thrombolysis implementation strategies are limited. Methods and Results: This study aimed to test the effectiveness of a multicomponent, multidisciplinary tissue plasminogen activator implementation package in increasing the proportion of thrombolyzed cases while maintaining accepted benchmarks for low rates of intracranial hemorrhage and high rates of functional outcomes at 3 months. A cluster randomized controlled trial of 20 hospitals in the early stages of thrombolysis implementation across 3 Australian states was undertaken. Monitoring of IVT rates during the baseline period allowed hospitals (the unit of randomization) to be grouped into 3 baseline IVT strata—very low rates (0% to ≤4.0%); low rates (>4.0% to ≤10.0%); and moderate rates (>10.0%). Hospitals were randomized to an implementation package (experimental group) or usual care (control group) using a 1:1 ratio. The 16-month intervention was based on behavioral theory and analysis of the steps, roles, and barriers to rapid assessment for thrombolysis eligibility and involved comprehensive strategies addressing individual and system-level change. The primary outcome was the difference in tissue plasminogen activator proportions between the 2 groups postintervention. The absolute difference in postintervention IVT rates between intervention and control hospitals adjusted for baseline IVT rate and stratum was not significant (primary outcome rate difference=1.1% (95% CI −1.5% to 3.7%; P=0.38). Rates of intracranial hemorrhage remained below international benchmarks. Conclusions: The implementation package resulted in no significant change in tissue plasminogen activator implementation, suggesting that ongoing support is needed to sustain initial modifications in behavior. Clinical Trial Registration: URL: ww