Introduction: Top-level managers in municipal social care administration play a central role in ensuring high-quality care through coordination within and between organisations. However, there is limited understanding of the specific tasks and responsibilities they undertake in this regard. Therefore, this study aimed to explore municipal top-level managers’ perspectives on fostering safe and integrated care for older adults with complex care needs living at home.

Methods: Thirteen top-level managers in municipal social care administration were interviewed. Interview data were analysed thematically.

Results: One theme ‘Leading through trust and empowerment, and encouraging collaborations within and between organisations to foster safe and integrated care’ and five subthemes were identified: ‘Creating conditions for seamless care by minimising cross-organisational barriers’, ‘Using the mandated role when navigating the bigger picture’, ‘Empowering middle managers and nursing staff’, ‘Fostering trust in working towards a common goal’ and ‘Leveraging successful partnerships across organisations’.

Conclusion: Top-level managers see themselves as parts of a larger system that requires them to collaborate with others. Empowering middle managers and nursing staff to thrive in their roles, through leadership based on trust, promotes a unified effort toward the common goal of safe and integrated care for older adults with complex care needs.

Introduction Making 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 analysis This 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.

Objective

The digital transformation of society has significant implications for healthcare. Despite a growing body of research on telemedicine implementation, studies specifically examining chat-based care assessments by primary care nurses remain limited. The aim of the present study was to explore nurses’ work experiences and training needs regarding chat-based care assessments in primary healthcare.

Method

This qualitative exploratory study employed semi-structured in-depth interviews with six nurses trained in telemedicine chat technique. Data were analysed inductively using reflexive thematic analysis.

Results

The findings indicated that chat-based care assessments could lead to prolonged assessment processes, and that nurses needed proficiency in chat techniques and effective communication skills to ensure clarity in conversations and accurate medical history acquisition. Training gaps were noted, particularly in fostering effective patient-professional relationships through brief text exchanges in the chat. The prolonged process had both advantages and disadvantages. Although it was more time-consuming, nurses got better opportunities to consider their responses and consult with colleagues, which was thought to improve the accuracy of medical assessments. Further benefits of chat-based assessments included access to chat history, the ability to share informational links, and opportunities for professional development. Nurses pointed to the need for system improvements, such as auto-anamnesis and auto-triage features, to better support their work in the future.

Conclusion

The study offers valuable insights for healthcare professionals, technology designers, and policymakers regarding the nuances of nurses’ chat-based interactions with patients in primary care settings. The results can inform the development of targeted training programs in chat techniques and communication skills, enhancing the effectiveness of digital consultations and fostering therapeutic relationships with patients. Chat-based assessments offer clear benefits within the care process but also come with challenges.

Background: Maintaining and motivating physical functioning among older adults has substantial health-related benefits, such as reducing the risk of falls and increasing the opportunities for independent living. Supporting preventive actions among older adults also has socioeconomic relevance. Previous studies have shown that digital tools involving video feedback can facilitate reflection and learning by encouraging active engagement.

Objective: This study aimed to explore health care professionals’ experiences of using a video-based tool as part of the rehabilitation to facilitate physical functioning among older adults (aged ≥65 years) living at home.

Methods: An experience-based co-design approach was used, involving 20 health care professionals. Nine iterative workshops were conducted, followed by 9 group interviews held between 2022 and 2023. The data were analyzed using reflexive thematic analysis.

Results: The results from this study captured the experiences of health care professionals using a video-based tool to facilitate physical functioning in older adults living at home. The participants described focusing on supporting patient commitment, creating a shared language to enhance collaboration in the rehabilitation process, and navigating barriers to adopting the video-based tool in practice.

Conclusions: From the perspective of health care professionals, video feedback has the potential to improve movement performance in daily activities and may play a crucial role in providing motivation and promoting sustainable physical functioning among older adults. Clinical recommendations include training health care professionals to introduce video feedback in a patient-centered manner and using it to foster shared communication that promotes professional development and patient engagement. Further research is needed to assess the impact of video feedback on older adults’ health outcomes and to identify strategies for implementation in complex rehabilitation needs.

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

Purpose: Prolonged stress leading to sick leave is a serious health problem, and it is crucial to find ways to support recovery. The aim of this review was to synthesize the results from qualitative research about what people with stress-related disorders experience as supportive for recovery. Methods: The systematic review was designed as a qualitative meta-synthesis following the recommendations by Walsh and Downe. Our search across PubMed, CINAHL, and PsycInfo identified 20 articles that met the inclusion criteria. These articles were subsequently assessed for quality and analysed. Results: Three themes were identified that describe what people with stress-related disorders experience as supportive for recovery: ´Engaging and authentic atmospheres—an essentiality for recovery`, ´Pursuing an empowered and hopeful self`, and ´Embracing the continuous demanding quest for personal growth`. Recovery from stress-related disorders can be supported by giving each person the opportunity to grow and pursue an empowered and hopeful self. This requires time and support in an engaging and authentic atmosphere. Having the possibility for existential reflection, learning and exploring through various activities is important. Conclusion: Our findings show the importance of formal support that patiently stimulates existential reflection and learning in a non-demanding environment. Implementing activities in clinical practice that stimulate such a process, and which can be adapted to each person’s needs and preferences could be beneficial.

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.