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Background: People in receipt of community palliative care usually receive care from a range of services and require access to care 24/7. However, care outside of normal working hours varies, with little understanding of which models of care are optimal. Aim: To identify and characterise current models of out-of-hours community palliative care in the UK and explore healthcare professionals' views on the barriers and facilitators to providing high quality community out-of-hours care. Design: Exploratory qualitative study using semi-structured interviews, analysed using reflexive thematic analysis. Setting and participants: We recruited 39 healthcare professionals from 20 geographic areas. Participants were service leads from community palliative care, district/community nursing and primary care providers. Results: Four overarching models of out-of-hours palliative care identified, characterised by levels of integration between services, balance between generalist and specialist providers, availability of care and type of care provided (hands-on clinical care/ advisory care). Analysis of barriers and facilitators generated three themes: (1) 'It's never one service': challenges of coordination of care across multiple services, (2) Need for timely skilled management of distressing symptoms, (3) 'We're just plugging gaps': prioritising patient care within limited resources. Patterns within the themes varied across the four models. Conclusion: This study identifies key characteristics of four common models of out-of-hours palliative care, from the perspectives of professionals. Facilitators of high quality out-of-hours care include: a palliative care specific single point of access for patients; formal structures to integrate generalist/specialist services; and timely/skilled management of symptoms. We provide recommendations for a potential model incorporating these factors. [ABSTRACT FROM AUTHOR]

Background: Providing safety-netting advice (SNA) in out-of-hours (OOH) primary care is a recognised standard of safe care, but it is not known how frequently this occurs in practice. Aim: Assess the frequency and type of SNA documented in OOH primary care and explore factors associated with its presence. Design and setting: This was a retrospective cohort study using the Birmingham Out-of-hours general practice Research Database. Method: A stratified sample of 30 adult consultation records per month from July 2013 to February 2020 were assessed using a safety-netting coding tool. Associations were tested using linear and logistic regression. Results: The overall frequency of SNA per consultation was 78.0% (1472/1886), increasing from 75.7% (224/296) in 2014 to 81.5% (220/270) in 2019. The proportion of specific SNA and the average number of symptoms patients were told to look out for increased with time. The most common symptom to look out for was if the patients' condition worsened followed by if their symptoms persisted, but only one in five consultations included a timeframe to reconsult for persistent symptoms. SNA was more frequently documented in face-to-face treatment-centre encounters compared with telephone consultations (odds ratio [OR] 1.77, 95% confidence interval [CI] = 1.09 to 2.85, P = 0.02), for possible infections (OR 1.53, 95% CI = 1.13 to 2.07, P = 0.006), and less frequently for mental (versus physical) health consultations (OR 0.33, 95% CI = 0.17 to 0.66, P = 0.002) and where follow-up was planned (OR 0.34, 95% CI = 0.25 to 0.46, P<0.001). Conclusion: The frequency of SNA documented in OOH primary care was higher than previously reported during in-hours care. Over time, the frequency of SNA and proportion that contained specific advice increased, however, this study highlights potential consultations where SNA could be improved, such as mental health and telephone consultations. [ABSTRACT FROM AUTHOR]

Background/Objectives: The rapid spread of antimicrobial resistance (AMR) presents a critical threat to global health. Primary care plays a significant role in this crisis, with oral antibacterial drugs among the most prescribed medications. Antibacterial prescribing rates are often high and complicated in out-of-hours (OOH) services, including weekdays outside regular hours, weekends, and holidays, potentially exacerbating AMR. This review aims to identify the existing literature on oral antibacterial drug prescribing within primary care OOH services. Methods: This review followed established frameworks, adhered to PRISMA-ScR guidelines, and the protocol was registered on Open Science Framework. Seven databases were searched from 2017 to May 2022. Data were summarised, tabulated, and presented narratively to explore themes and patterns that aligned with the review objectives. Results: The search identified 28 studies from nine high-income countries, mainly the UK (n = 6) and Belgium (n = 5). Most were quantitative studies (n = 23). Key areas identified included common oral antibacterial prescriptions, prescribing trends, presentations and conditions managed in OOH services, factors and predictors associated with prescribing, prescribing appropriateness, the impact of interventions on prescribing, prescribing in the context of COVID-19, patient satisfaction and expectations, and the challenges encountered, such as factors influencing prescribing behaviour and decision making, safety netting, and communication. Conclusions: This review highlights key areas around oral antibacterial prescribing in primary care OOH services. Despite the numerous articles identified covering various areas within OOH services, the variability in OOH services approaches across countries and studies complicates the comparison of practice. Further research is needed to better understand practices in these settings. [ABSTRACT FROM AUTHOR]

Background/Objectives: The rapid spread of antimicrobial resistance (AMR) presents a critical threat to global health. Primary care plays a significant role in this crisis, with oral antibacterial drugs among the most prescribed medications. Antibacterial prescribing rates are often high and complicated in out-of-hours (OOH) services, including weekdays outside regular hours, weekends, and holidays, potentially exacerbating AMR. This review aims to identify the existing literature on oral antibacterial drug prescribing within primary care OOH services. Methods: This review followed established frameworks, adhered to PRISMA-ScR guidelines, and the protocol was registered on Open Science Framework. Seven databases were searched from 2017 to May 2022. Data were summarised, tabulated, and presented narratively to explore themes and patterns that aligned with the review objectives. Results: The search identified 28 studies from nine high-income countries, mainly the UK (n = 6) and Belgium (n = 5). Most were quantitative studies (n = 23). Key areas identified included common oral antibacterial prescriptions, prescribing trends, presentations and conditions managed in OOH services, factors and predictors associated with prescribing, prescribing appropriateness, the impact of interventions on prescribing, prescribing in the context of COVID-19, patient satisfaction and expectations, and the challenges encountered, such as factors influencing prescribing behaviour and decision making, safety netting, and communication. Conclusions: This review highlights key areas around oral antibacterial prescribing in primary care OOH services. Despite the numerous articles identified covering various areas within OOH services, the variability in OOH services approaches across countries and studies complicates the comparison of practice. Further research is needed to better understand practices in these settings.

Background: Patients contacting out-of-hours primary care (OHS-PC) with shortness of breath (SOB) are often concerned. Sometimes, they also have an uncanny feeling; existential anxiety that something is wrong in their body. How concerns and uncanny feeling are related to critical medical conditions that cause SOB is unknown. We therefore explored the relation between expressed concerns and researcher's judged uncanny feeling among patients who contact OHS-PC for SOB with potential life-threatening events (LTEs) as the outcome., Methods: This is an explorative cross-sectional study. We analysed telephone triage conversations from patients with SOB who contacted Dutch OHS-PC between September 2020 and August 2021. We recorded whether patients expressed concerns and we judged whether patients had an uncanny feeling. We calculated odds ratios (ORs) for the association between (i) expressed concerns and (ii) uncanny feeling with the outcome potential LTEs., Results: Of the 1,843 patients with SOB, 43.6% patients expressed concerns and 33.0% had an uncanny feeling. Potential LTEs were similarly present among those who did and did not express concerns (OR: 1.07; 95% CI 0.84-1.37, mOR: 1.07; 95% CI 0.83-1.36), whereas potential LTEs were more often present among those with an uncanny feeling compared to those without such feeling (OR: 1.36; 95% CI 1.06-1.75, mOR: 1.35; 95% CI 1.05-1.74)., Conclusions: Among patients who contacted OHS-PC with SOB, a perceived uncanny feeling of the patient was associated with a higher odd of potential LTEs, while patient's expressed concerns were not. Critical reflective interpretation is needed as uncanny feelings are difficult to judge. Nevertheless, our results implicate that further research into uncanny feelings in telephone triage could further improve the understanding of the relation with potential LTEs. Furthermore, this could be used to investigate how triage nurses may become more sensitive to what the patient is feeling but not explicitly saying such as by paying special attention to paralanguage., Trial Registration: The Netherlands Trial Register, number: NL9682, registration date: 20-08-2021., Competing Interests: Declarations. Ethics approval and consent to participate: The Medical Research Ethics Committee (MREC) Utrecht (reference number 21/361) has reviewed our study protocol. The MREC concluded that this study is not within the scope of the WMO and granted an exemption for this study. Personal data and research data was de-identified according to the European General Data Protection Regulation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The primary cause of antimicrobial resistance is excessive and non-indicated antibiotic use., Aim: To evaluate the impact of a multifaceted intervention aimed at various healthcare professionals (HCPs) on antibiotic prescribing and dispensing for common infections., Design and Setting: Before-and-after study set in general practice, out-of-hours services, nursing homes, and community pharmacies in France, Greece, Lithuania, Poland, and Spain., Methods: Following the Audit Project Odense method, HCPs from these four settings self-registered encounters with patients related to antibiotic prescribing and dispensing before and after an intervention (February-April 2022 and February-April 2023). Prior to the second registration, the HCPs undertook a multifaceted intervention, which included reviewing and discussing feedback on the first registration's results, enhancing communication skills, and providing communication tools. Indicators to identify potentially unnecessary prescriptions and non-first-line antibiotic choices were developed, and the results of the two registrations were compared., Results: A total of 345 HCPs registered 10 744 infections in the first registration period and 10 207 infections in the second period. In general practice, participants showed a significant 9.8% reduction in unnecessary antibiotic prescriptions in the second period, whereas limited or no effect was observed in out-of-hours services and nursing homes (0.8% reduction and 4.5% increase, respectively). Pharmacies demonstrated an 18% increase in safety checks, and correct advice in pharmacies rose by 17%., Conclusion: External factors like COVID-19, antibiotic shortages, and a streptococcal epidemic impacted the intervention's benefits. Despite this, the intervention successfully improved antibiotic use in both settings., (© The Author(s) 2024. Published by Oxford University Press.)

Background: The "weekend effect" on hospital admissions has been extensively studied, showing increased risks for patients admitted on weekends than those admitted on weekdays. We aimed to assess the "weekend effect" on in-hospital outcomes in patients undergoing transcatheter aortic valve replacement (TAVR)., Methods: A nationwide cohort study was conducted using the National Inpatient Sample Database. We identified 82,094 eligible patients aged ≥ 18 years admitted for TAVR between 2013 and 2021. Patients were grouped into weekend or weekday cohorts based on day of admission. Propensity score matching (PSM) and multivariate regression models were employed to evaluate outcomes. After PSM, 2,688 weekend admissions and 13,440 weekday admissions were included in the analyses., Results: Multivariable regression, adjusted for propensity score, revealed that weekend admission was associated with 45% higher odds of in-hospital mortality (adjusted odds ratio: 1.45; 95% confidence interval: 1.13-1.85). Significant heterogeneity in mortality was observed based on admission urgency, with a 3.27 times higher increased risk of death observed for elective admissions on weekends than on weekdays (P for interaction = 0.001). Moreover, weekend admissions had significantly higher adjusted odds for cardiogenic shock, permanent pacemaker implantation, endocarditis, acute kidney injury, acute ischemic stroke, and blood transfusion. There was a trend of higher in-hospital mortality for weekend over weekday admissions throughout the study period., Conclusions: Weekend admissions for TAVR had higher mortality, complications, and resource utilization, particularly in elective cases. Our findings suggest that patients admitted for TAVR during weekends are at high risk and warrant special attention., Competing Interests: Declarations. Ethics approval and consent to participate: Given the public accessibility of the NIS database ( www.hcup-us.ahrq.gov ) and the absence of individually identifiable information, the local institutional review board deemed informed consent unnecessary under the Health Insurance Portability and Accountability Act. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Clinical trial number: Not applicable., (© 2025. The Author(s).)

Objectives: To analyze the 24-hour on-call experience and factors influencing the treatment decisions of a dental resident for dental emergencies, particularly pulpitis, during on-call hours., Methods: This retrospective study was conducted at a public stomatology hospital from January 1 to December 30, 2023. Each consultation was documented, recording the date and time, patient age and gender, diagnosis, and any emergent interventions. Statistical analyses were conducted using univariate analysis to explore the association between various factors and the incidence of dental interventions for pulpitis, with significance set at p < 0.05., Results: Over 1 year, 81 residents from seven specialties managed 2,717 consultations during 365 instances of 24-h call duty. The busiest months were October ( n = 297). Most consultations occurred during extended hours (1,856 consultations) compared to normal hours (8:00-17:00) (861 consultations). The busiest consultation periods were between 20:00 and 22:00. Pulpitis was the most frequently diagnosed condition ( n = 988). Univariate analysis showed no significant impact of patient gender ( p = 0.896) or age ( p = 0.632) on the likelihood of receiving a dental intervention. However, consultations during extended hours were twice as likely (OR = 2.028, 95% CI [1.510-2.723]) to result in no intervention compared to normal hours. Endodontics and pediatric dentistry residents were more likely to perform interventions compared to other specialties, with postgraduate year (PGY) six residents being less likely to perform interventions compared to PGY4 residents., Conclusion: Residents exhibit lower willingness to perform dental interventions during extended working hours and in higher grade levels, with significant variability across different specialties. Enhanced training and fatigue risk management for residents may help to ensure effective patient care during on-call hours., Competing Interests: The authors declare that they have no competing interests., (© 2025 Zheng et al.)