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Background. Changing demographics has led to healthcare systems reorientating healthcare delivery towards the community setting and implementing integrated models of care worldwide. This systematic review examines the effectiveness of community‐based multidisciplinary integrated care strategies with general practitioner (GP) participation for community‐dwelling older adults and describes the level of care integration in each study. Methods. PubMed, Embase, CINAHL, Central Register of Controlled Trials in the Cochrane Library, and MEDLINE were systematically searched in February 2024. Randomised controlled trials (RCTs) or cluster RCTs that focused on interventions for community‐dwelling older adults delivered by health and social care professionals with GPs were included. Two reviewers independently conducted the risk of bias assessment, applied the GRADE tool to quantify the certainty of evidence, and used the rainbow model of integrated care taxonomy to describe the elements of integrated care. Outcomes included functional status, healthcare utilisation, participant satisfaction with care, health‐related quality of life, mortality, nursing home admission, and adverse outcomes. Meta‐analyses were performed using Review Manager 5.4. Results. Twelve trials recruiting 8069 participants across 8 countries were included. Community‐based multidisciplinary team (MDT) integrated care demonstrated significant improvements in functional status (standardised mean difference (SMD): 0.21; 95% confidence interval (CI): 0.05–0.37; low certainty evidence), hospitalisation (risk ratio (RR): 0.77; 95% CI: 0.63–0.95; very low certainty evidence), and participant satisfaction with care (SMD: 0.46; 95% CI: 0.15–0.76; low certainty evidence) from 12 to 36 months. No statistically significant effects favouring community‐based MDT interventions for functional status at 6‐month follow‐up, emergency department presentation, mortality, health‐related quality of life, or nursing home admission were established. Conclusion. Community‐based MDT integrated care with GP participation improves functional status, reduces hospitalisations, and increases patient satisfaction among community‐dwelling older adults in the long term. Future research should focus on models of integrated care that respond to the needs and preferences of older adults. This trial is registered with CRD42022309744. [ABSTRACT FROM AUTHOR]

Objectives: There is conflicting evidence regarding the outcomes of acute stroke patients who present to hospital within normal working hours ('in-hours') compared with the 'out-of-hours' period. This study aimed to assess the effect of time of stroke presentation on outcomes within the Irish context, to inform national stroke service delivery. Materials and methods: A secondary analysis of data from the Irish National Audit of Stroke (INAS) from Jan 2016 to Dec 2019 was carried out. Patient and process outcomes were assessed for patients presenting 'in-hours' (8:00–17:00 Monday-Friday) compared with 'out-of-hours' (all other times). Results: Data on arrival time were available for 13,996 patients (male 56.2%; mean age 72.5 years), of which 55.7% presented 'out-of-hours'. In hospital mortality was significantly lower among those admitted 'in-hours' (11.3%, n = 534) compared with 'out-of-hours' (12.8%, n = 749); (adjusted Odds Ratio (OR) 0.82; 95% Confidence Interval CI [95% CI] 0.72–0.89). Poor functional outcome at discharge (Modified Rankin Scale ≥ 3) was also significantly lower in those presenting 'in-hours' (adjusted OR 0.79; 95% CI 0.68–0.91). In patients receiving thrombolysis, mean door to needle time was shorter for 'in-hours' presentation at 55.8 mins (n = 562; SD 35.43 mins), compared with 'out-of-hours' presentation at 80.5 mins (n = 736; SD 38.55 mins, p <.001). Conclusion: More than half of stroke patients in Ireland present 'out-of-hours' and these presentations are associated with a higher mortality and a lower odds of functional independence at discharge. It is imperative that stroke pathways consider the 24 hour period to ensure the delivery of effective stroke care, and modification of 'out-of-hours' stroke care is required to improve overall outcomes. [ABSTRACT FROM AUTHOR]

Background: Traditional models of palliative care have been tested by the challenges of caring for increasing numbers of people at the end stages of a chronic non-malignant illness. The COVID-19 pandemic and consequent reliance on telehealth services, has enabled the development of creative models of care. Aims: To improve home-based palliative care for people with chronic illness using telehealth, and this was demonstrated using quality-of-life measures. Methods: A total of 35 non-cancer referrals to a community palliative care service were recommended for the pilot project, with one specialist palliative care nurse as their contact. All were offered a telehealth service with a specially designed app to self-monitor their symptoms, a session on advance care directives, and self-rated quality-of-life measures using the RAND 36-Item Health Survey (Version 1.0), consisting of 36 items that cover nine domains. Statistical analysis was performed using SPSS software. Findings: Over the 21 months of the pilot study, 13 people chose to participate in the pilot. For participants, telehealth meant more control over their symptoms, fewer emergency presentations and appointment travel time was alleviated. Quality-of-life surveys highlighted physical impairments, which did not change over time. Conclusion: This pilot programme demonstrated an innovative approach to addressing the demands of people dying of chronic illness, with further work required to explore the place of telehealth consultations in the overall healthcare system. [ABSTRACT FROM AUTHOR]

Objectives: This pilot project replicated a self-compassion program to support health-care professionals in palliative care settings. We anticipated that undertaking this program would enhance participants' psychological well-being. Methods: Participants were recruited by convenience sampling from palliative care services in an area of Melbourne, Australia. Because of the COVID-19 pandemic, the program was offered online and comprised six once-weekly gatherings. Three survey rounds with identical questions were conducted prior to, immediately after, and 3 months after the training. The surveys consisted of 6 scales: the Self-Compassion Scale, the Santa Clara Brief Compassion Scale, the Cognitive and Affective Mindfulness Scale, the Depression Anxiety Stress Scale, the Professional Quality of Life Scale, and the Interpersonal Reactivity Index Scale. Paired-sample t-test and repeated measures analysis of variance analyses were used to compare participant responses. Results: Nine participants working in palliative care completed the training and 3 surveys and included qualitative responses. The experience was overwhelmingly positive. Self-compassion (F  = 14.44; p  < 0.05) and mindfulness (F  = 18.44; p  < 0.05) scores significantly increased post-training, were picked up in a short time and endured. The emotional state improved by compassion satisfaction, showing a positive improvement 3 months post-training, along with there being no changes in compassion satisfaction, burnout, and dispositional empathy. Significance of results: Participants all worked in a supportive environment, which encouraged self-care. Even against the pandemic difficulties, a short online program was effective, assisting participants to cultivate their inner resources in mindfulness and self-compassion. While a small sample size, expansion of the training may benefit the wider palliative care workforce. [ABSTRACT FROM AUTHOR]

This article describes how a diverse, interdisciplinary team of faculty formed a topic-based faculty learning community. Following an introduction to faculty learning communities and a brief discussion of their benefit to faculty engaged in the process of adopting new technology, we explain how our team, through a competitive mini-grant application process and intensive training workshop, complemented by a series of follow-up training sessions, formed a faculty learning community that collectively adopted a web-based rubric model for performance evaluation, began implementing it, and, in doing so, developed a culture of assessment. We describe the web-based rubric software we adopted and provide short reports authored by seven members of the faculty learning community to exemplify how the implementation of web-based rubrics can enhance student performance, augment instructor evaluation of student performance, and facilitate outcomes assessment. The article includes a "lessons learned" section which synthesizes what we learned from the endeavor and emphasizes what we considered critical to the group's success. (Contains 10 figures.)

This article reviews how the presence of a bespoke assessment system can enable the measurement of what was previously 'unmeasurable' in a constructive and positive way. It highlights how tracking the small-step progress of pupils with a diagnosis of special educational needs can support the identification of targets which not only support pupil progress but also increase understanding by professionals of how effective assessments can enable them to develop skills in planning and setting individual targets. This article shows how one school community has responded to the reforms implemented by central government by using them as an opportunity to draw on the strengths of the school, the experience they have in supporting SEND pupils and a deep commitment to providing all the pupils with the best possible education. The article reflects on the development of this system and its impact on teaching and learning across the whole school, using an illustrative case study.

Meeting the end-of-life care needs of particular groups in Australia remains challenging, especially those people who are culturally and/or religiously diverse. One such group is those adherents to Islam, whose communities come from many parts of the world. to develop connections with the Islamic community, to understand their end-of-life care needs. over 12 months palliative care staff and members of the Islamic community met to prepare for and deliver a seminar to assist understandings between the Islamic community and palliative care services. A seminar, attended by 79 participants, addressed issues like palliative care and Islam; how palliative care works; advance care planning; care coordination; and bereavement. Many commonalities emerged, to provide a foundation for further activities; and the process demonstrated the importance of working together, and highlighted opportunities for shared collaborative work. [ABSTRACT FROM AUTHOR]