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A sedentary lifestyle and being overweight or obese are well-established cardiovascular risk factors and contribute substantially to the global burden of disease. Changing such behavior is complex and requires support. Social media interventions show promise in supporting health behavior change, but their impact is unclear. Moreover, previous reviews have reported contradictory evidence regarding the relationship between engagement with social media interventions and the efficacy of these interventions. This review aimed to critically synthesize available evidence regarding the impact of social media interventions on physical activity and weight among healthy adults. In addition, this review examined the effect of engagement with social media interventions on their efficacy. CINAHL and MEDLINE were searched for relevant randomized trials that were conducted to investigate the impact of social media interventions on weight and physical activity and were published between 2011 and 2021 in the English language. Studies were included if the intervention used social media tools that provided explicit interactions between the participants. Studies were excluded if the intervention was passively delivered through an app website or if the participants had a known chronic disease. Eligible studies were appraised for quality and synthesized using narrative synthesis. A total of 17 papers reporting 16 studies from 4 countries, with 7372 participants, were identified. Overall, 56% (9/16) of studies explored the effect of social media interventions on physical activity; 38% (6/16) of studies investigated weight reduction; and 6% (1/16) of studies assessed the effect on both physical activity and weight reduction. Evidence of the effects of social media interventions on physical activity and weight loss was mixed across the included studies. There were no standard metrics for measuring engagement with social media, and the relationship between participant engagement with the intervention and subsequent behavior change was also mixed. Although 35% (6/16) of studies reported that engagement was not a predictor of behavior change, engagement with social media interventions was found to be related to behavior change in 29% (5/16) of studies. Despite the promise of social media interventions, evidence regarding their effectiveness is mixed. Further robust studies are needed to elucidate the components of social media interventions that lead to successful behavior change. Furthermore, the effect of engagement with social media interventions on behavior change needs to be clearly understood. PROSPERO International Prospective Register of Systematic Reviews CRD42022311430; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=311430.

Background Cardiovascular disease (CVD) and stroke disproportionately affect culturally and linguistically diverse (CALD) communities, where access to prevention programmes is often limited by cultural, language, and systemic barriers. Understanding the experiences of healthcare professionals and nongovernment organisations in delivering and providing education to these communities is essential for developing effective, culturally tailored strategies that support equitable cardiovascular outcomes. Objectives To explore (i) healthcare professionals', key health networks' and non‐government organisations' experiences of delivering CVD or stroke prevention education; (ii) the context i.e., barriers and enablers to delivering education; and (iii) and identify core components and ideal approach to deliver a CVD and stroke prevention education and behaviour change programme for CALD communities. Design A qualitative exploratory study using semi‐structured interviews. Deductive thematic analysis was completed using NVivo 15. Setting and Participants Fourteen participants were recruited and interviewed via Zoom; seven cardiovascular and stroke healthcare professionals and seven representatives from a range of federal‐ and state‐level cardiovascular and stroke nongovernment organisations and multicultural health networks. Results Two key themes were identified: (1) challenges when providing and delivering culturally and linguistically tailored education and (2) components of an ideal education programme. Challenges in delivering CVD and stroke prevention education include the need to navigate diverse cultural health beliefs and worldviews, limited access to qualified interpreters and a lack of culturally relevant and translated resources. An ideal education programme was considered one that is simple, evidence‐based, culturally appropriate, and delivered in accessible, preferred formats. Key to sustained behaviour change beyond the programme are family and community engagement, the use of codesign approach to foster ownership and relevance from the inception, trust‐building, and ongoing reinforcement of educational content through reminders. Discussion and Conclusion While systemic barriers such as interpreter shortages and limited funding persist, engaging families, empowering individuals, tailoring delivery methods, and embracing community‐specific strategies offer clear pathways for improving engagement and reach of CVD and stroke prevention education. Incorporating these components, particularly through codesign, will be essential in ensuring equitable cardiovascular outcomes for people from CALD communities. Patient or Public Contribution Adults with lived experience of cardiovascular disease and stroke were engaged during the conceptualisation of this study through informal discussions. Clinicians and representatives from end‐user organisations were involved as participants in the study.

Objectives The objectives of this study were to determine the prevalence of frailty in the context of atrial fibrillation (AF); to identify the most commonly used frailty instruments in AF; and to describe the effect of frailty on non‐vitamin K oral anticoagulant (NOAC) prescription for stroke prevention in adults with AF. Methods A systematic search of databases, including Medline, Embase, Web of Science, Cochrane Library, Scopus, and CINAHL, was conducted using search terms including “atrial fibrillation,” “frailty,” and “anticoagulation.” A narrative synthesis was undertaken. Results A total of 92 articles were screened, and 12 articles were included. The mean age of the participants (n = 212,111) was 82 years (range = 77–85 years) with 56% of participants identified as frail and 44% identified non‐frail. A total of five different frailty instruments were identified: the Frailty Phenotype (FP; n = 5, 42%), the Clinical Frailty Scale (CFS; n = 4, 33%), Cumulative Deficit Model of Frailty (CDM; n = 1, 8%), Edmonton Frail Scale (n = 1, 8%) and the Resident Assessment Instrument – Minimum Data Set (RAI‐MDS 2.0; n = 1, 8%). Frailty was identified as an important barrier to anticoagulant therapy with 52% of the frail population anticoagulated vs 67% non‐frail. Conclusion Frailty is an important consideration in anticoagulation decision making for stroke prevention in patients with AF. There is scope to improve frailty screening and treatment. Frailty status is an important risk marker and should be considered when evaluating stroke risk alongside congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke, transient ischemic attack, or thromboembolism, vascular disease, age 65–74 years, sex category (CHA2DS2‐VASc) and Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile, Elderly, and Drugs (HAS‐BLED) scores. Frailty is an important consideration in anticoagulation decision making for stroke prevention in patients with AF. There is scope to improve frailty screening and treatment in patients with AF. Frailty status is an important risk marker that should be considered when evaluating stroke risk alongside tools such as the CHA2DS2VASc and HAS‐BLED.

This is an exploratory qualitative study of cardiovascular clinicians, people living with heart failure (HF), and their caregivers. The aim was to understand the unmet educational needs in self-management for adults living with HF. Four focus groups were conducted face-to-face or via videoconference, recorded, and transcribed verbatim for thematic analysis. A total of 23 participants were recruited and included in analyses (clinicians n = 13; adults with HF n = 7; caregivers n = 3). The focus groups were on average 81 (range 73 to 91) minutes in duration. Seven key themes were identified which were: (i) Understanding and reinforcing the signs and symptoms, self-management, medications, and prognosis and severity of HF; (ii) Providing concise and timely education; (iii) Building trust and relationships; (iv) Accessibility of education to support patient needs; (v) Engaging family members and informal caregivers; (vi) Tailoring education to patients diverse needs; and (vii) Navigating the health system and dealing with continuity of care. There were several unmet educational needs for people living with heart failure and their caregivers. Providing patient-centred education is critical to developing understanding and reinforcing the signs and symptoms, prognosis, and severity of heart failure, to underpin self-management and optimise medication adherence. Clinicians, patients, and their caregivers provided several suggestions for improvement, such as the importance of providing concise and timely education and building trust and relationships between clinicians and patients. Priorities for education improvement were also provided, including regional and rural considerations; engaging informal family caregivers; tailoring to culturally and linguistically diverse and indigenous peoples, navigating the health system and ensuring continuity of care.

Background Transitioning from hospital to home is a critical and fragmented process for acutely ill older adults and their carers. Despite widespread recognition of its importance, persistent gaps leave older adults vulnerable, highlighting the urgent need for safer transitions in care. Qualitative exploration into end‐user experiences of this transition can help to identify gaps in care and inform the development of targeted, person‐centred interventions. Aim To explore the experiences of hospitalised older adults and their carers when they transition from hospital to home. Methods Participants were purposively sampled during their contact with the rehabilitation and aged care service of a metropolitan hospital. Patients who had transitioned or were in the process of transitioning from hospital to home and informal carers to such patients were eligible. Verbatim transcripts were uploaded into NVivo and analysed using thematic analysis. Results A total of 19 separate interviews were conducted, 12 patient and 7 carer interviews. The patients' mean age was 79 years (range 70–88 years), and carers' mean age was 74 years (range 58–85 years). Qualitative analysis developed three main themes during the transition from hospital to home, including (1) Impacting identity and the journey home: independence, frailty and functional ability; (2) Navigating inpatient care, communication and a harmonised transition; and (3) Pillars of support and the reality of social isolation. Conclusion Complex challenges were highlighted for hospitalised older adults and their carers during transitions from hospital to home, reinforcing the urgent need for holistic, patient‐centred care. This study highlighted the compounding need to tailor discharge processes to individuals and calls for health services to embed patient‐centred discharge communication into service provision. These are essential steps towards enhancing the quality and safety of transitional care. Patient or Public Contribution Patients and carers contributed to the design of this qualitative study through consultation with a consumer advisory group, where potential transitional care interventions were discussed. These discussions highlighted a need to further explore transitional care unmet needs, informing the development of this interview study with patients and carers. Participants' perspectives were central to the analysis and interpretation of findings. Participants received a simple one‐page summary of the findings, along with contact details for the research team to enable further comment or feedback.

Objectives To examine baseline frailty and its association with rehospitalisation and mortality within 12 months among older adults enrolled in the Western Sydney Clinical Frailty Registry. Design Prospective observational cohort study. Setting and participants 592 adults admitted to an acute geriatric medicine service in NSW, Australia, were included in this study. Methods The Western Sydney Clinical Frailty Registry is a study of adults admitted to acute geriatric wards in a 570-bed two-site district general hospital in Western Sydney, NSW, Australia. Recruitment began in April 2020 and is ongoing. Each participant is recruited while an inpatient and followed up for 12 months, including baseline visits and three-, six- and 12-month follow-ups via telephone interviews. The primary outcome of this study was rehospitalisation and/or mortality at 12 months. Results Median age 82 years; half the cohort were classified as mild-moderately frail, and 21% were classified as severely frail. A total of 134 participants died (22.6%) within the 12-month follow-up period. Increased cumulative incidence of first rehospitalisation and/or death during the first 12 months post-discharge was significantly associated with higher modified Charlson comorbidity (p < 0.001) and Clinical Frailty Scale (CFS) scores (p < 0.001). Compared to the ‘non-frail’ group (CFS 1–4), those who were severely frail (CFS 7–9) had an 85% increased risk of rehospitalisation and/or death (95% CI 1.36–2.52), and those who were mild-moderately frail (CFS 5–6) had a 52% increased risk after adjusting for effects of the other variables (95% CI 1.18–1.94). Conclusions Frailty is very common in older adults admitted to acute geriatric services. Assessing frailty using the CFS is feasible and is independently predictive of rehospitalisation and mortality. Our findings suggest that integrating frailty assessment into clinical practice goes beyond simple risk stratification, offering valuable insights for tailored clinical management strategies.

Background A clinical quality registry (CQR) is a structured database that systematically collects data to monitor clinical quality and improve healthcare outcomes. The aims of CQRs are to improve treatment plans, assist in decision-making, increase healthcare value, enhance care quality, and reduce healthcare costs by providing feedback to healthcare providers. Feedback to clinicians is used as a quality improvement tool. It provides data to clinicians about their performance, which may contribute to improvement in healthcare outcomes. To the best of our knowledge, previous research on CQRs has primarily focused on factors affecting their use and their impact on healthcare outcomes. In this study, a scoping review is conducted to understand the barriers to and facilitators of using feedback systems from clinical quality registries in acute healthcare settings. Methods For this review, Arksey and O’Malley’s framework for scoping reviews will be applied. The following electronic databases (MEDLINE via Ovid, CINAHL, and Scopus) and grey literature (Google Scholar) will be systematically searched for qualitative and mixed-method studies (only including qualitative findings) published after 2000 in the English language. Two reviewers will independently screen the articles and extract the data which, subsequently, will be mapped against the COM-B model. Discussion This review is conducted with the aim of providing valuable insights into the factors that influence the utilisation of feedback from Clinical Quality Registries by healthcare providers, which, in the context of quality improvement, may have significant implications for clinical research, registry science, health policy, and clinical practice. Scoping review registration This protocol has been registered prospectively with the Open Science Framework (OSF) ( https://osf.io/fhm4n/ ).

Chronic lung disease is a common and complex condition. Pulmonary rehabilitation programmes-either hospital-based or in the community are recommended in evidence-based clinical practice guidelines. To explore the experience of older people with chronic lung disease involved in a peer support community-based exercise maintenance programme. Participants were a part of the Lungs in Action programme run in a local community leisure centre through Lung Foundation Australia. All the programme participants (n = 25) were invited by an independent person through email and/or letter to participate in the study and provided with a participant information and consent form. Participants who returned consent forms were scheduled for group interviews. Participants were recruited over a 2-week period between 30 August and 13 September 2022. We conducted qualitative group interviews using a semi-structured interview guide to explore the experiences of older people living with chronic lung disease. Data were analysed using reflexive thematic analysis. A total of 14 participants (eight female and six male) aged between 64 and 86 years were interviewed. Three themes emerged from the data: motivation, authentic social engagement, and sustainable achievement. Motivation stemmed from the participants' perceived health benefits, and from the trainers' motivation and encouragement. Participants discussed how sharing experiences created an environment of trust and understanding, fun and friendship. Social engagement and creating authentic relationships were key aspects raised by participants. Feeling more confident in themselves and being able to accomplish physical tasks, making activities of daily living more manageable featured highly in participants' responses. Community-based peer support exercise groups enable environments for people with chronic lung disease to maintain physical fitness, and to connect with others to form friendships and have fun.

Modifications to lifestyle risk factors for stroke may help prevent stroke events. This systematic review aimed to identify and summarise the evidence of acupuncture interventions for those people with lifestyle risk factors for stroke, including alcohol-dependence, smoking-dependence, hypertension, and obesity. MEDLINE, CINAHL/EBSCO, SCOPUS, and Cochrane Database were searched from January 1996 to December 2016. Only randomised controlled trials (RCTs) with empirical research findings were included. PRISMA guidelines were followed and risk of bias was assessed via the Cochrane Collaboration risk of bias assessment tool. The systematic review reported in this paper has been registered on the PROSPERO (#CRD42017060490). A total of 59 RCTs (5,650 participants) examining the use of acupuncture in treating lifestyle risk factors for stroke met the inclusion criteria. The seven RCTs focusing on alcohol-dependence showed substantial heterogeneity regarding intervention details. No evidence from meta-analysis has been found regarding post-intervention or long-term effect on blood pressure control for acupuncture compared to sham intervention. Relative to sham acupuncture, individuals receiving auricular acupressure for smoking-dependence reported lower numbers of consumed cigarettes per day (two RCTs, mean difference (MD) = -2.75 cigarettes/day; 95% confidence interval (CI) = -5.33, -0.17; p = 0.04). Compared to sham acupuncture those receiving acupuncture for obesity reported lower waist circumference (five RCTs, MD = -2.79 cm; 95% CI: -4.13, -1.46; p<0.001). Overall, only few trials were considered of low risk of bias for smoking-dependence and obesity, and as such none of the significant effects in favour of acupuncture interventions were robust against potential selection, performance, and detection bias. This review found no convincing evidence for effects of acupuncture interventions for improving lifestyle risk factors for stroke.

Background StrokeLine is a stroke‐specific helpline used by stroke survivors and their families in Australia to access professional support. There has been little research exploring stroke survivors' experiences of using helplines and their perceived impact on their stroke recovery. Aim The aim of this study is to explore the reasons prompting stroke survivors to call StrokeLine and their experiences and to describe the perceived impact of calling StrokeLine on their recovery. Methods An exploratory descriptive qualitative study was undertaken using thematic analysis of data collected through semi‐structured interviews of stroke survivors between December 2020 and May 2022. Participants were recruited using purposive sampling. Interviews were conducted via audio‐recorded Zoom conference calling and transcribed verbatim for thematic analysis. Results A total of eight callers (four men and women women) participated, with the time since stroke ranging from 3.5 months to 5 years. Four major themes were identified, including 17 sub‐themes. Key themes included (1) factors prompting use of StrokeLine; (2) experience of using StrokeLine; (3) perceived impact of using StrokeLine; and (4) conceptualising StrokeLine service provision. Conclusions Participants perceived their experience of contacting StrokeLine as having a positive impact on their stroke recovery, leaving them feeling empowered and motivated to self‐manage their condition. Patient or Public Contribution Stroke survivors with lived experience influenced the conceptualisation of this study through conversations with consumers and the Stroke Foundation. Eight stroke survivors were involved as participants in the research study.