Fathers report experiencing negative feelings and psychological difficulties during the perinatal period

The perinatal period is the time from the start of pregnancy to 1 year after the child has been born.1 During the perinatal period, an estimated 5%–10% of fathers will develop above-threshold symptoms of paternal depression.2 During this period, fathers can experience a high level of stress which can have negative effects on themselves and their families.3 This review aims to explore the needs and experiences associated with the mental health of fathers during this perinatal period.

The effectiveness of continuous quality improvement for developing professional practice and improving health care outcomes: a systematic review

Efforts to improve the quality, safety, and efficiency of health care provision have often focused on changing approaches to the way services are organized and delivered. Continuous quality improvement (CQI), an approach used extensively in industrial and manufacturing sectors, has been used in the health sector. Despite the attention given to CQI, uncertainties remain as to its effectiveness given the complex and diverse nature of health systems. This review assesses the effectiveness of CQI across different health care settings, investigating the importance of different components of the approach. We searched 11 electronic databases: MEDLINE, CINAHL, EMBASE, AMED, Academic Search Complete, HMIC, Web of Science, PsycINFO, Cochrane Central Register of Controlled Trials, LISTA, and NHS EED to February 2019. Also, we searched reference lists of included studies and systematic reviews, as well as checking published protocols for linked papers. We selected randomized controlled trials (RCTs) within health care settings involving teams of health professionals, evaluating the effectiveness of CQI. Comparators included current usual practice or different strategies to manage organizational change. Outcomes were health care professional performance or patient outcomes. Studies were published in English. Twenty-eight RCTs assessed the effectiveness of different approaches to CQI with a non-CQI comparator in various settings, with interventions differing in terms of the approaches used, their duration, meetings held, people involved, and training provided. All RCTs were considered at risk of bias, undermining their results. Findings suggested that the benefits of CQI compared to a non-CQI comparator on clinical process, patient, and other outcomes were limited, with less than half of RCTs showing any effect. Where benefits were evident, it was usually on clinical process measures, with the model used (i.e., Plan-Do-Study-Act, Model of Improvement), the meeting type (i.e., involving leaders discussing implementation) and their frequency (i.e., weekly) having an effect. None considered socio-economic health inequalities. Current evidence suggests the benefits of CQI in improving health care are uncertain, reflecting both the poor quality of evaluations and the complexities of health services themselves. Further mixed-methods evaluations are needed to understand how the health service can use this proven approach. Protocol registered on PROSPERO (CRD42018088309)

Effectiveness of zinc therapy for the treatment of pressure ulcers

Pressure ulcers are a significant burden in healthcare settings, impacting patients’ lives and incurring substantial costs. Nutrition, including the micronutrient zinc, plays a role in wound healing. However, controversy exists regarding zinc supplementation for pressure ulcer management. Further research is needed to determine the efficacy, optimal dosages, and safety of oral zinc supplementation. This commentary provides a critical appraisal of the systematic review conducted by Song et al (2020), which evaluates the efficacy of zinc therapy in the treatment of pressure sores, focusing on the implementation of the nutritional recommendations in context to practice

Diagnostic accuracy of early warning system scores in the prehospital setting

The use of prehospital early warning scores in ambulance services is widely endorsed to promptly identify patients at risk of clinical deterioration. Early warning scores enable clinicians to estimate risk based on clinical observations and vital signs, with higher scores indicating an elevated risk of adverse outcomes. Local healthcare systems establish threshold values for these scores to guide clinical decision-making, triage, and response, necessitating a careful balance between identifying critically unwell patients and managing the challenge of prioritisation. Given the limited evidence for optimal early warning scores in emergency department and prehospital care settings, a systematic review was carried out by Guan et al (2022) to assess the diagnostic accuracy of early warning scores for predicting in-hospital deterioration when applied in the emergency department or prehospital setting. This commentary aims to critically appraise the methods used within the review by Guan et al (2022) and expand upon the findings in the context of clinical practice

Is a lower socio-economic position associated with poorer outcomes for end-of-life care?

Individuals living in the most deprived areas are more likely to access acute hospital services in the last three months of life and die in hospital rather than at home, compared to those living in the least deprived areas. Individuals living in a high area of deprivation or with a lower level of education are less likely to receive specialist palliative care. Further research should aim to improve access to appropriate end-of-life care for those identified within a lower socio-economic position