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Person-centred care (PCC) is an essential component of high-quality healthcare across professions and care settings. While research is emerging in subacute nutrition services more broadly, there is limited literature exploring the person-centredness of nutrition care in rehabilitation. This study aimed to explore person-centred nutrition care (PCNC) in rehabilitation units, as described and actioned by patients, support persons and staff. Key factors influencing PCNC were also explored. An ethnographic study was undertaken across three rehabilitation units. Fifty-eight hours of field work were completed with 165 unique participants to explore PCNC. Field work consisted of observations and interviews with patients, support persons and staff. Data were analysed through the approach of reflexive thematic analysis, informed by PCC theory. Themes generated were: (1) tensions between patient and staff goals; (2) disconnected moments of PCNC; (3) the necessity of interprofessional communication for PCNC; and (4) the opportunity for PCNC to enable the achievement of rehabilitation goals. PCNC was deemed important to different stakeholders but was at times hindered by a focus on profession-specific objectives. Opportunities exist to enhance interprofessional practice to support PCNC in rehabilitation. Future research should consider the system-level factors influencing PCNC in rehabilitation settings. Understanding what matters to patients in rehabilitation was reported as essential in person-centred nutrition care (PCNC), however varying degrees of this were observed in practice, with tensions exposed between the priorities of patients and staff. Collaborative goal setting is needed to enact PCNC, placing the patient at the centre of the process, rather than focusing on pre-determined, profession-specific agendas. However, reorientating this process must coincide with consideration of influencing systems, service priorities and cultures. Nutrition and mealtime-related goals of patients should be communicated not only within clinical teams, but also with dietetic support staff to better inform interprofessional practice and PCNC. Opportunities exist to better connect nutrition and dietetic services with the broader goals and objectives of rehabilitation. [ABSTRACT FROM AUTHOR]

Aim: One definition of research co-production is a collaboration between researchers and healthcare professionals throughout a research process to facilitate knowledge translation and improve the clinical impact of research findings. In this paper, we present a case study of clinical research co-production and reflect on how the process was facilitated between researchers and healthcare professionals. Type of program or service: Development of a novel transdisciplinary assessment for implementation in an acute stroke unit (ASU). Methods: Researchers and healthcare professionals integrated perspectives and co-produced a novel transdisciplinary assessment. Team-based activities were guided by a logic model, including task analysis and simulation testing. A logframe matrix was used to plan implementation strategies to mitigate potential risks. Results: Research co-production was fundamental to integrating multiple perspectives to develop an effective, novel transdisciplinary assessment for patients with stroke. Preliminary data demonstrated that the transdisciplinary approach could save up to 103 minutes per patient in assessment time. Lessons Learnt: As the project evolved, the three most important factors for research co-production were 1) the right people to integrate critical disciplinary and pragmatic perspectives; 2) a project leader who was inclusive of perspectives held by researchers and healthcare professionals, and 3) structured and non-biased team discussions using a theoretical tool. We recommend these three factors be considered in future research co-production in healthcare settings. [ABSTRACT FROM AUTHOR]

One strategy to meet increasing consumer demand for healthcare services in the pandemic era has been to reorganize the healthcare workforce. This can be achieved by reorganizing healthcare teams, which are associated with improved workforce productivity and better patient outcomes. However, healthcare teams are described using numerous terminologies and labels, which has led to conceptual confusion for researchers and research users. In this paper, we explore the disparate nature of healthcare team terminology, ramifications of conceptual confusion, and we propose standardized terminology with synthesized definitions focused on characteristics of clinically based healthcare teams including unidisciplinary, multidisciplinary, interprofessional, and transdisciplinary teams. [ABSTRACT FROM AUTHOR]

Background: Patient centred care (PCC) positively influences individual and organisational outcomes. It is important that dietitians working in rehabilitation units are supported to deliver PCC because effective rehabilitation is a collaborative and patient centred process. The objective of this scoping review was to explore the literature available regarding the delivery of dietetic PCC, with patients undergoing rehabilitation in subacute inpatient units. Methods: PubMed, MEDLINE, CINAHL, Embase and Scopus were searched for relevant published literature. Searches for grey and unpublished literature were also completed. Studies were eligible for inclusion and data extraction if they demonstrated the delivery of PCC by qualified dietitians, through individual consultations with adult patients undertaking subacute rehabilitation. Results: Overall, 675 studies were identified and six were included in the review. From the literature available, documentation was lacking regarding conceptualisation and delivery of patient centred nutrition care, with only one study providing quality indicators for patient centred dietetic services. Elements of PCC cited were mostly limited to phrases such as, 'individualised care', 'tailored advice', 'follow‐up' and 'team collaboration'. Conclusions: This scoping review identified a considerable gap in the literature regarding the delivery of dietetic PCC in subacute rehabilitation units. Contemporary descriptions of PCC show that the delivery of care which is truly patient centred is far more comprehensive than individualising interventions or organising ongoing services. This raises the question: is the delivery of nutrition care in subacute rehabilitation unit's patient centred? [ABSTRACT FROM AUTHOR]

Background and Purpose: The modified Rankin Scale (mRS) is the most widely used primary outcome measure in acute stroke trials. However, substantial interobserver variability impairs outcome assessment as well as reduces power of clinical trials. Guided by the International Classification of Functioning, Disability and Health, we developed a comprehensive, hierarchical assessment tool (miFUNCTION) to address the shortcomings of the modified Rankin Scale and deliver a more thorough understanding of disability following stroke. Methods: The initial construct validity of miFUNCTION was established in a pilot study of patients at an outpatient stroke prevention clinic that had been diagnosed with stroke within 60 days. To further assess criterion validity, miFUNCTION was compared against the modified Rankin Scale and other outcome measures within the Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE) trial. Logistic regression analysis with miFUNCTION as an outcome was used to demonstrate the beneficial effect of endovascular treatment. Results: The pilot study showed moderate inter-observer agreement (k = 0.585, p < 0.005) but near perfect correlation between miFUNCTION and modified Rankin Scale (ρ = 0.821, p < 0.05). The correlation of miFUNCTION and modified Rankin Scale was near perfect again in the ESCAPE trial (ρ = 0.944). Effect size of the multivariable models using modified Rankin Scale (adjusted odds ratio: 3.45, 95% confidence interval: 2.05–5.78) and miFUNCTION (adjusted odds ratio: 3.32, 95% confidence interval: 1.99–5.55) as an outcome measure for the ESCAPE trial patients was similar. Conclusions: miFUNCTION is strongly associated with the degree of disability following stroke both in an outpatient setting and a clinical trial. Further work remains to assess sensitivity to change and to improve the inter-observer reliability of the scale. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions Digital health transformation may enhance or impede person‐centred care and interprofessional practice, and thus the provision of high‐quality rehabilitation and nutrition services. We aimed to understand how different elements and factors within existing digital nutrition and health systems in subacute rehabilitation units influence person‐centred and/or interprofessional nutrition and mealtime care practices through the lens of complexity science.Our ethnographic study was completed through an interpretivist paradigm. Data were collected from observation and interviews with patients, support persons and staff. Overall, 58 h of ethnographic field work led to observing 125 participants and interviewing 77 participants, totalling 165 unique participants. We used reflexive thematic analysis to analyse the data with consideration of complexity science.We developed four themes: (1) the interplay of local context and technology use in nutrition care systems; (2) digitalisation affects staff participation in nutrition and mealtime care; (3) embracing technology to support nutrition and food service flexibility; and (4) the (in)visibility of digitally enabled nutrition care systems.While digital systems enhance the visibility and flexibility of nutrition care systems in some instances, they may also reduce the ability to customise nutrition and mealtime care and lead to siloing of nutrition‐related activities. Our findings highlight that the introduction of digital systems alone may be insufficient to enable interprofessional practice and person‐centred care within nutrition and mealtime care and thus should be accompanied by local processes and workflows to maximise digital potential. [ABSTRACT FROM AUTHOR]

Background: South Asians experience higher rates of cardiovascular disease than any other ethnic group. South Asians may be less adherent with a cardiac medication regimen than Caucasians. The factors contributing to adherence are important to discover to assist South Asians to optimize their cardiac health. Data sources: CINAHL, Medline (Ovid), PsychINFO, EMB Reviews-(Cochrane), and EMBASE were accessed using the key words: ‘South Asian’, ‘Asia’, ‘East India’, ‘India’, ‘Pakistan’, ‘Bangladesh’, ‘Sri Lanka’, ‘medication compliance’, ‘medication noncompliance’ and ‘medication adherence’. English language papers published from January 1980 to January 2013 were eligible for inclusion. Review methods: Abstracts were reviewed for redundancy and eligibility by the primary author. Manuscripts were then retrieved and reviewed for eligibility and validity by the first and last authors. Content analysis strategies were used for the synthesis. Results: Thirteen papers were in the final data set; most were conducted in India and Pakistan. Medication side-effects, cost, forgetfulness and higher frequency of dosing contributed to non-adherence. South Asian immigrants also faced language barriers, which contributed to non-adherence. Knowledge regarding the medications prescribed was a factor that increased adherence. Conclusion: South Asians’ non-adherence to cardiac medications is multifaceted. How South Asians who newly immigrate to Western countries make decisions regarding their cardiac medication adherence ought to be explored in greater detail. [ABSTRACT FROM AUTHOR]

Purpose: Demand for stroke services is increasing. To save time and costs, stroke care could be reorganised using a transdisciplinary assessment model embracing overlapping allied health professional skills. The study compares transdisciplinary assessment to discipline-specific allied health assessment on an acute stroke unit, by evaluating assessment time, quality of care, and cost implications., Method: The pre-/post- clinical study used non-randomised groups and 3-month follow-up after hospital admission. Patients with confirmed/suspected stroke received usual discipline-specific allied health assessment (pre-implementation phase) or the novel transdisciplinary assessment (post-implementation phase). Staff/student assessment times (primary outcome) and medical record data (secondary outcomes) were collected. Time differences were estimated using multivariable linear regression controlling for confounding factors. Cost minimisation and sensitivity analyses estimated change in hospital resource use., Findings: When the transdisciplinary assessment was used ( N  = 116), compared to usual assessment ( N  = 63), the average time saving was 37.6 min (95% CI -47.5, -27.7; p  < 0.001) for staff and 62.2 min (95% CI -74.1, -50.3; p  < 0.001) for students. The median number of allied health occasions of service reduced from 8 (interquartile range 4-23) to 5 (interquartile range 3-10; p  = 0.011). There were no statistically significant or clinically important changes in patient safety, outcomes or stroke guideline adherence. Improved efficiency was associated with an estimated cost saving of $379.45 per patient (probabilistic 95% CI -487.15, -271.48)., Discussion and Conclusion: Transdisciplinary stroke assessment has potential for reorganising allied health services to save assessment time and reduce healthcare costs. The transdisciplinary stroke assessment could be considered for implementation in other stroke services., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: In the emergency department, portable point-of-care testing (POCT) coagulation devices may facilitate stroke patient care by providing rapid International Normalized Ratio (INR) measurement. The objective of this study was to evaluate the reliability, validity, and impact on clinical decision-making of a POCT device for INR testing in the setting of acute ischemic stroke (AIS)., Methods: A total of 150 patients (50 healthy volunteers, 51 anticoagulated patients, 49 AIS patients) were assessed in a tertiary care facility. The INR's were measured using the Roche Coaguchek S and the standard laboratory technique., Results: The interclass correlation coefficient and 95% confidence interval between overall POCT device and standard laboratory value INRs was high (0.932 (0.69 - 0.78). In the AIS group alone, the correlation coefficient and 95% CI was also high 0.937 (0.59 - 0.74) and diagnostic accuracy of the POCT device was 94%., Conclusions: When used by a trained health professional in the emergency department to assess INR in acute ischemic stroke patients, the CoaguChek S is reliable and provides rapid results. However, as concordance with laboratory INR values decreases with higher INR values, it is recommended that with CoaguChek S INRs in the > 1.5 range, a standard laboratory measurement be used to confirm the results.

This position paper will: 1. Provide an update on relevant current developments in the education, training and positioning of clinician nurse scientists; 2. Provide and promote a rational argument for the development of the clinician nurse scientist role; and 3. Discuss issues related to capacity building in clinical research in neuroscience nursing, with specific reference to and support for the cerebrovascular (stroke) specialty nursing area.