IntroductionMaking decisions about the appropriate level of care is a significant challenge for healthcare professionals, especially when older patients present with diffuse symptoms. Collaboration between ambulance services and primary care may promote a comprehensive understanding of patient needs. However, such collaboration remains limited, potentially leading to lower care quality and higher costs. There is a need to understand how collaboration can be effectively implemented. This scoping review aims to explore existing models of collaboration between ambulance services and primary care, identifying their characteristics, outcomes and current research gaps.

Methods and analysisThis scoping review will follow the methodological framework proposed by Arksey and O’Malley, supplemented with recommendations from the Joanna Briggs Institute Handbook for Scoping Reviews. A comprehensive literature search will be conducted in PubMed, CINAHL, Web of Science and Scopus. In addition, Google Scholar, Overton, SwePub and the Swedish national library database Libris will be searched for relevant grey literature. The review will include studies published from January 2014 to the present. Data will be analysed descriptively, with findings categorised by collaboration models and patterns identified through inductive analysis to address the research questions. The review will apply the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews to present the results.

Ethics and dissemination This review is the first stage of an overarching research study to develop a model for extended collaboration between ambulance services and primary care (the ECAP project). Results will be disseminated through peer-reviewed publications, conference presentations and sharing with ambulance services and primary care stakeholders to inform practice and policy. This scoping review protocol has been registered on the Open Science Framework (https://osf.io/nrkm5/). No participants will be involved at this stage, and the selected literature is publicly available, so no ethical approval will be required for this scoping review.

Background As we age, staying physically active and reducing sedentary behavior becomes crucial. To understand how to achieve this, factors related to daily physical function such as five-time sit-to-stand (STS) time should be explored. This study aimed to investigate the associations between STS time, self-rated physical activity, physical function, health-related quality of life, physical and mental health in community-dwelling older adults aged >= 60 years. Method Cross-sectional design with self-reported and objectively measured data from adults aged >= 60 years (n = 819), acquired from the Swedish National Study on Aging and Care. Data was analyzed through multiple linear regression. Results The model (R-2 = 0.268) showed that STS time was predicted by grip strength (beta' = -0.204, p < 0.05), age (beta' = 0.202, p < 0.05), health-related quality of life (beta' = -0.192, p < 0.05), having fallen within the preceding twelve months (beta' = -0.127, p < 0.05), physical activities of perceived light to moderate intensity (beta' = -0.121, p < 0.05), one-leg stand (beta' = -0.099, p < 0.05), and education level (beta' = -0.092, p < 0.05). For STS time, health-related quality of life (beta = -0.354, confidence interval [CI] (-0.509)-(-0.199)), having fallen within the preceding twelve months (beta = -0.222, CI (-0.365)-(-0.078)), and physical activities of perceived light to moderate intensity (beta = -0.166, CI (-0.278)-(-0.053)) were the most prominent predictors. Conclusion The model highlights the importance of grip strength and health-related quality of life in predicting STS time in older adults. Clinicians can use these insights to develop interventions that maintain physical function by regularly assessing and monitoring these factors. Future research should explore the relationship between fall history, faster STS time, and the impact of grip strength and health-related quality of life on sedentary behavior among older adults.

Purpose: The aim of the study was to describe how the care relationship in primary healthcare has contributed to the recovery of persons with stress-related disorders.

Methods: This study was based on the phenomenological approach, Reflective Lifeworld Research (RLR). Fifteen persons who had recovered from stress-related disorders and who had experience of being cared for in primary healthcare were included. Lifeworld interviews were conducted, and the data were analysed according to the RLR principles of openness, flexibility and bridling.

Results: The participants experienced that the care relationship in primary healthcare contributed to their recovery from stress-related disorder by enabling them to land and be embraced in a safe relationship. This opened up a space for rest and growth that included time, being listened to and a permitting space for existential reflection based on one’s life story. The results also showed that a sense of disharmony in the care encounter constitutes a threat to recovery and reinforces vulnerability.

Conclusions: Sensing security and hope is a crucial element in the care relationship in primary healthcare when recovering from stress-related disorders. This includes the importance of being treated with respect, being given space to tell one’s story, being listened to and being supported in an existential reflection of one’s life situation

Background

Cancer-related fatigue (CRF) is still undertreated in most patients, as evidence for pharmacologicaltreatments is limited and conflicting. Also, the efficacy of the pharmacological agents relative to each other is stillunclear. Therefore, medications that may potentially contribute to improving CRF will be investigated in this head-toheadtrial. Our main objective is to compare the efficacy of methylphenidate vs. bupropion vs. ginseng vs. amantadinevs. placebo in patients with advanced cancer.

Methods

The 5-EPIFAT study is a 5-arm, randomized, multi-blind, placebo-controlled, multicenter trial that will usea parallel-group design with an equal allocation ratio comparing the efficacy and safety of four medications (Methylphenidatevs. Bupropion vs. Ginseng vs. Amantadine) versus placebo for management of CRF. We will recruit 255adult patients with advanced cancer who experience fatigue intensity ≥ 4 based on a 0–10 scale. The study periodincludes a 4-week intervention and a 4-week follow-up with repeated measurements over time. The primary outcomeis the cancer-related fatigue level over time, which will be measured by the functional assessment of chronic illnesstherapy-fatigue (FACIT-F) scale. To evaluate safety, the secondary outcome is the symptomatic adverse events, whichwill be assessed using the Patient-Reported Outcomes version of the Common Terminology Criteria for AdverseEvents in cancer clinical trials (PRO-CTCAE). Also, a subgroup analysis based on a decision tree-based machine learningalgorithm will be employed for the clinical prediction of different agents in homogeneous subgroups.

Discussion

The findings of the 5-EPIFAT trial could be helpful to guide clinical decision-making, personalization treatmentapproach, design of future trials, as well as the development of CRF management guidelines.

Trial registration IRCT.ir IRCT20150302021307N6. Registered on 13 May 2023.

Background Venous leg ulcers take time to heal. It is advocated that physical activity plays a role in healing, and so does the patient’s nutritional status. Additionally, malnutrition influences the inflammatory processes, which extends the healing time. Therefore, the staff’s advising role is important for patient outcomes. Thus, this study aimed to investigate the associations between given self-care advice and healing time in patients with venous leg ulcers while controlling for demographic and ulcer-related factors.

Methods The sample consisted of patients registered in the Registry of Ulcer Treatment (RUT) which includes patient and ulcer-related and healing variables. The data was analyzed with descriptive statistics. Logistic regression models were performed to investigate the influence of self-care advice on healing time.

Results No associations between shorter healing time (less than 70 days) and the staff´s self-care advice on physical activity was identified, whilst pain (OR 1.90, CI 1.32–2.42, p < 0.001) and giving of nutrition advice (OR 1.55, CI 1.12–2.15, p = 0.009) showed an association with longer healing time.

Conclusions Neither self-care advice on nutrition and/or physical activity indicated to have a positive association with shorter healing time. However, information and counseling might not be enough. We emphasize the importance of continuously and systematically following up given advice throughout ulcer management, not only when having complicated ulcers.

Background: Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs.

Objective: This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home.

Methods: This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework.

Results: Theidentifiedinfluencingfactorsguidingthecontentsandformatdevelopmentof2newself-careexerciseswerethat pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, “Breathing exercises” and “Picking up from the floor,” revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested.

Conclusions: This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support.

Background

Aging has a significant impact on health, underlining the importance of maintaining physical function and reducing time spent sitting among older adults. To understand how to reduce prolonged sitting or increase physical activity, factors related to the daily living and observed daily activity patterns should be explored. This study aimed to investigate the association between daily steps, self-rated health, physical activity, sedentary behavior, motivation to exercise and fear of falling among older adults receiving initial support.

Method

Cross-sectional design with total population questionnaire data from adults aged ≥ 60 years (n = 917), living at home with initial support from municipal care in southern Sweden. The older adults were offered to participate in a follow-up study measuring daily activity patterns with accelerometers (n = 72). Linear regression was used to analyze associations between daily steps and possible predictors.

Results

The linear model (

0.478) showed that sitting in unbroken bouts of > 60 min (β = -0.313, p < 0.05), walking independently outdoors (β = 0.301, p < 0.05), intending to increase physical activity (β = -0.294, p < 0.05), sex (β = 0.279, p < 0.05), relative autonomy index (β = 0.258, p < 0.05), fear of falling (β = -0.238, p < 0.05), and self-rated health (β = 0.213, p < 0.05) predicted daily steps.

Conclusion

The model of predictors brings new understanding regarding daily steps among community-dwelling older adults. The association between sitting in bouts of > 60 min and daily steps is interesting as 35% of participants had a number of sitting bouts that on average, showed 30% less steps taken. Minimizing long sitting bouts and maintaining physical functioning to promote independence when walking outdoors can be tools for clinical practitioners devising interventions to break prolonged sitting among community-dwelling older adults. Future research should prioritize studying older adults’ outdoor walking independence, including its relation to walking with or without assistive devices and its impact on physical activity and sedentary behavior.

PurposeThe impact of a sedentary lifestyle on health and well-being is well recognized. However, there is limited understanding of how a lifetime of physical activity and sedentary behaviour influences an active lifestyle in older adults. The aim of this study was to describe how lived experience of physical activity and sedentary behaviour impacts daily activities among older adults, from a life course perspective.MethodsQualitative content analysis was used; individual telephone interviews were conducted with fourteen older adults aged 71 to 92 years. The participants received initial support from community care and lived in ordinary housing in southern Sweden.ResultsThe interviews yielded one theme, “Navigating with an embodied activity compass,” and two sub-themes: “Being guided by the past” and “Unveiling pathways through body awareness.”ConclusionsOur study highlights how older adults’ lived experiences of physical activity, with their connections to body awareness and acceptance, impact daily physical activity. These findings offer new knowledge for clinical practitioners balancing recommendations of sedentary behaviour and physical activity, to promote healthy daily physical activity among older adults. Future research and policies should consider the lived experiences of older adults when addressing public health matters related to sedentary behaviour and physical activity.

BackgroundContinuity of care is viewed as a hallmark of high-quality care in the primary care context. Measures to evaluate the quality of provider performance are scarce, and it is unclear how the assessments correlate with patients' experiences of care as coherent and interconnected over time, consistent with their preferences and care needs.AimTo develop and evaluate a patient-reported experience measure of continuity of care in primary care for patients with complex care needs.MethodThe study was conducted in two stages: (1) development of the instrument based on theory and empirical studies and reviewed for content validity (16 patients with complex care needs and 8 experts) and (2) psychometric evaluation regarding factor structure, test-retest reliability, internal consistency reliability, and convergent validity. In all, 324 patients participated in the psychometric evaluation.ResultsThe Patient Experienced Continuity of care Questionnaire (PECQ) contains 20 items clustered in four dimensions of continuity of care measuring Information (four items), Relation (six items), Management (five items), and Knowledge (five items). Overall, the hypothesized factor structure was indicated. The PECQ also showed satisfactory convergent validity, internal consistency, and stability.Conclusion/ImplicationsThe PECQ is a multidimensional patient experience instrument that can provide information on various dimensions useful for driving quality improvement strategies in the primary care context for patients with complex care needs.Patient or Public ContributionPatients have participated in the content validation of the items.

Background: Patient involvement in the interdisciplinary bedside round (IBR) increases care quality and safety but is influenced and perceived differently by different round participants. Nursing and medical students are still not structurally embedded in the healthcare system, and they participate in interdisciplinary bedside rounds for educational purposes. Thus, the students may give a valuable perspective on patient involvement from the 'outside view'.

Aim: This study aimed to describe nursing and medical students' perceptions of patient involvement in IBRs.

Methods: This study has a qualitative design with individual interviews. Eighteen informants were recruited with the help of gatekeepers from two sites in Sweden: a university training health clinic and a county hospital. They participated in one-to-one semi-structured interviews, which were analysed with an inductive qualitative content analysis approach.

Ethical Issues and Approval: The study has been approved by the Swedish Ethical Review Authority. Informed consent was received from all participants.

Results: The results yielded five categories. Two sub-themes and one theme of meaning emerged as a 'red thread' across the categories. The theme of meaning was: 'In hospital rounds, the patient is a respected guest, but with a disadvantaged "alien status" due to the hosts' difficult medical language and unclear routines'. Students perceive patients are not fully involved in IBRs, and the healthcare team controls this involvement due to patients' lack of knowledge and vulnerability, the hectic hospital environment, and complicated medical language. Doctors lead IBRs and encourage or discourage patient involvement and nurses act as patient advocates, supporting their involvement.

Conclusions: According to nursing and medical students, patients are seldom involved in IBRs due to multiple interaction barriers and despite communicational facilitators. Their involvement depends on healthcare professionals. Further research should investigate other IBRs stakeholders' perspectives on patient involvement in IBRs to facilitate it.