Development of an Audit Tool to Evaluate End of Life Care in the Emergency Department: A Face and Content Validity Study

Objectives:Emergency Departments (ED) are increasingly caring for patients with acute, chronic and terminal conditions requiring End of Life Care (EOLC). There is no published and validated tool available to evaluate EOLC delivery of patients dying in the ED. This study describes the face and content validity testing process to develop, refine and test a new and unique audit tool to evaluate EOLC in the ED.Methods: The face and content validation process used a three-round modified-Delphi technique. We consulted 11 experts to assess the proposed 89 items. Face validity explored the overall question of appropriateness and relevance; and content validity examined relevance ratings using the Content Validity Index (CVI) 4-point Likert scale in two rounds. Iterative assessment of ratings led to inclusion (CVI > 0.78), revision (CVI 0.65 to < 0.78) or exclusion (CVI < 0.65) of items from the tool.Results: Of the initial 89 items, 66 were included (CVI > 0.78), 16 items revised (scores 0.65 to < 0.78), seven were removed (scores < 0.65) and two new items suggested. Items covered the constructs patient characteristics, circumstances of death, ED performance, communication and care planning, recognition of dying, care delivery, and needs of families and carers. Scale CVI achieved 0.90. The consolidated list of 81 items achieved acceptable face validity and excellent content validity.Conclusion:Face and content validity of the ED EOLC audit tool achieved acceptable item-CVI scores and an excellent scale-CVI score. We recommend external validation of its components in real-life settings to monitor and set locally relevant clinical practice benchmarks

A Comparison of the Right to Protest and its Constitutional Protection: COVID and Beyond

This article considers the right to protest, and the way in which it is currently regulated by some Australian states. The legislation confers great discretion on decision makers in terms of whether to grant permission for a proposed protest. The article makes the argument that the discretion is so broad so that its exercise is, on one view, effectively unreviewable. The High Court has struck down provisions as constitutionally invalid where decisions made pursuant to it purport to be effectively unreviewable. It is also argued that legislation cast in such broad terms is contrary to the rule of law

RE: Invasive cervical cancer incidence following bivalent human papillomavirus vaccination: A population-based observational study of age at immunization, dose, and deprivation

In this article, Palmer and colleagues1 made certain claims regarding the impact of HPV vaccination in Scotland that on reanalysis of their data we find to contain inaccuracies. These inaccurate claims were reported widely in the media

SPIRIT 2025 explanation and elaboration: updated guideline for protocols of randomised trials

High quality protocols facilitate proper planning, conduct, reporting, and external review of randomised trials, yet their completeness varies and key elements are often not considered. To strengthen good reporting of trial protocols, the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 statement has been updated to incorporate new evidence and emerging perspectives. This SPIRIT 2025 explanation and elaboration document provides users with exemplars of reporting in contemporary trial protocols, contextual elaboration, more detailed guidance on reporting, references to key empirical studies, an expanded checklist, and a link to a website for further information. The document is intended to be used in conjunction with the SPIRIT 2025 statement and serves as a resource for researchers planning a trial and for others interested in trial protocols

Effectiveness of coronary heart disease peer support interventions: a systematic review and meta-analysis

Aims: To investigate the effect of peer support interventions on psychosocial outcomes, self-management behaviours and readmissions among people with coronary heart disease (CHD). The second aim was to characterise the peer support strategies being tested including the intervention initiation, method, dose, timing, format and content, and the characteristics and training of the peers providing the intervention.Methods and Results: Systematic review and meta-analysis (MEDLINE, Embase, PsycINFO, CINAHL, Scopus, PubMed [non-MEDLINE], Web of Science, and Cochrane Central Register) and risk of bias appraisal was conducted on the above outcomes according to the PRISMA checklist and Cochrane Collaboration guidelines. Meta-analysis was undertaken in RevMan5.4 using the inverse variance method and random effects model. Intervention components and outcomes unsuitable for meta-analysis were narratively synthesised. Sixteen randomised controlled trials (n=2013) were included. Peer support had no effect on anxiety (SMD -0.73, 95%CI -1.57,0.10), depression (SMD -0.09, 95%CI -0.25,0.06), health-related quality of life (SMD -0.38, 95%CI -1.84,1.08), or perceived social support (SMD -0.05, 95%CI -0.31,0.21). However, peer support interventions significantly improved self-management behaviours (SMD 1.49, 95%CI 0.66,2.32) and self-efficacy up to 6 months (SMD 0.57, 95%CI 0.37,0.77), and reduced readmissions (RR 0.25, 95%CI 0.10,0.60). Self-efficacy remained higher in those receiving peer support at 6-12 months post-intervention (SMD 0.67, 95%CI 0.29,1.05). Peer support interventions varied widely, but common strategies included in person (56%), group based (31%) experience sharing (44%). Although subgroup analysis was not possible, narrative synthesis indicated that in-person strategies and peer support that was commenced during admission were the most effective for improving outcomes.Conclusion: Peer support interventions for people with CHD may be used to improve self-management and self-efficacy, and reduce readmission risk, but anxiety, depression, HRQoL and social support did not reach statistical significance when meta-analysed. In-person, group based and experience sharing were the most common peer support categories, and strategies that were in-person and initiated during admission demonstrated the most consistent improvements across outcomes. REGISTRATION: PROSPERO [CRD42024514564]

Patient outcomes and surgical strategies in revision cervical arthroplasty following M6-C™ disc-related osteolysis

PURPOSE: Periprosthetic osteolysis from the M6-C™ Artificial Cervical Disc (Orthofix, Lewisville, Texas) has become a significant issue, sometimes requiring revision spine surgery (RSS). This study evaluates patient-reported outcome measures (PROMs) and revision strategies for managing device-related wear and osteolysis.METHODS: PROMs, including the Visual Analogue Scale (VAS) for neck/arm pain and the Neck Disability Index (NDI), were analyzed at pre-index surgery (T1), pre-RSS (T2), and final follow-up (T3). Osteolysis severity was graded radiographically. A control group who underwent primary M6-C cervical total disc replacement (CTDR) without RSS was included for comparison.RESULTS:Of 53 patients with M6-C CTDR, 19 (35.9%) required RSS due to osteolysis. Osteolysis grades included Grade 1 (4 patients), Grade 2 (7 patients), Grade 3 (3 patients), and Grade 4 (5 patients). Revision strategies included removal and anterior fusion, requiring vertebrectomy for Grade 4 cases; revisions to a different CTDR prosthesis were reserved for Grades 1-3. The RSS group showed significant VAS neck pain improvement at T3 (mean = 36.2 points, p < 0.001), exceeding the minimum clinically important difference (MCID). However, VAS arm pain and NDI did not meet MCID thresholds. The control group showed clinically significant improvements across all PROMs. At T2, the RSS group had a higher disability (NDI, p = 0.027) than the controls.CONCLUSION: Revision surgery for M6-C osteolysis improves neck pain, not arm pain or disability. Early detection and tailored revision strategies are crucial to optimize patient outcomes and mitigate osteolysis-related disability

Crisis planning intentions among hotel managers: what have we learned from the COVID-19 pandemic?

This study investigates the motivational factors which influence future crisis planning intentions, by utilising the Theory of Planned Behaviour (TPB) as the underlying theoretical framework. This research focuses on understanding the attitudes, subjective norms, and perceived behavioural control of hotel managers’ intentions regarding future crisis planning. To enhance the TPB model, the study incorporates two additional variables: perceived risk and past behaviour, thereby addressing previous calls to extend the TPB model. Employing a qualitative methodology, semi-structured interviews (n = 21) were conducted with hotel managers who worked at government-appointed quarantine hotels in Australia during the COVID-19 pandemic. Thematic analysis was conducted using Leximancer, an artificial intelligence (AI) data text mining software to explore the verbatim content via text mining, thematic analysis. This research provides critical insights into the determinants of crisis planning intentions among hotel managers, contributing to the theoretical and practical understanding of crisis preparedness in the hospitality industry

Business model innovation and its impact on the diffusion of innovation in construction business organizations

The evolving business landscape, driven by digitalization and environmental, social, and governance (ESG) considerations, requires a systems approach to construction business. The discussion around digitalization as a key driver of innovation and a catalyst for change has been crucial, prompting construction organizations to adapt their business models. Due to the dynamic nature of the construction industry, construction organizations often encounter challenges in embracing new technologies and updating their business models to meet changing market demands. Consequently, business model innovation often takes a backseat. This chapter delves into how innovation, particularly driven by public sector clients, can influence business model innovations in construction organizations, drawing insights from an extensive literature review and the Hong Kong Housing Authority case. The findings suggest that construction organizations may be more inclined to adopt new technologies, implement systems, and explore business model innovations when public policies are in place to support such initiatives

30 Years of contribution and future directions in tourism, hospitality, and events research: A Quo Vadis perspective from the Journal of Hospitality and Tourism Management

The Journal of Hospitality and Tourism Management (JHTM) recently celebrated its 30th anniversary, a significant milestone reflecting its enduring contribution to research in tourism, hospitality, and events. As part of the celebrations, the senior editorial board of JHTM has prepared this perspective paper, one of several initiatives marking this occasion. The paper critically examines research published in JHTM, focusing on seven key topics: Events & Festivals; Experience Design and Management; Destination Marketing & Management; Service Management; Information & Communication Technologies (ICT); Sociocultural Impacts of Tourism; and Climate Change & Environmental Concerns