Jianqiao Zheng, Li Du, Xiaoqian Deng, Lu Zhang, Jia Wang, Guo Chen
Efficacy of virtual reality techniques in cardiopulmonary resuscitation training: protocol for a meta-analysis of randomised controlled trials and trial sequential analysis
BMJ open
adults rare autoimmune rheumatic diseases face unique challenges struggles navigate healthcare systems designed manage common conditions evidence inform optimal service framework care scarce using systemic vasculitis exemplar aimed identify explain key service components underpinning effective care rare diseases mixedmethods study data collected part survey vasculitis service providers across uk ireland interviews patients organisational case studies identify key service components enable good care association components patient outcomes eg serious infections mortality provider outcomes eg emergency hospital admissions examined populationbased data linkage study using routine healthcare data obtained patients antineutrophil cytoplasmic antibody ancaassociated vasculitis national health datasets scotland univariable multivariable analyses using bayesian poisson negative binomial regression estimate incident rate ratios irrs cox proportional hazards models estimate hazard ratios hrs people lived experiences involved research writing process good care characterised service components supported timely access services integrated care expertise 1420 patients ancaassociated vasculitis identified national health datasets servicereported average waiting times new patients less 1 week associated fewer serious infections irr 070 95 credibility interval 055088 fewer emergency hospital admissions 078 068092 nurseled advice lines associated fewer serious infections 076 058093 fewer emergency hospital admissions 085 074096 average waiting times new patients less 1 week also associated reduced mortality hr 059 95 credibility interval 037093 cohorted clinics nurseled clinics specialist vasculitis multidisciplinary team meetings associated fewer serious infections irr 075 059096 cohorted clinics 065 039084 nurseled clinics 072 057090 specialist vasculitis multidisciplinary team meetings emergency hospital admissions 081 071091 075 065094 086 075096 key components characterised ability overcome professional tensions specialties key service components associated important health outcomes underpinning factors identified inform initiatives improve design delivery effectiveness healthcare models rare autoimmune rheumatic diseases versus arthritis