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In Norway around 25% of personnel working in the municipal health and care services lack a relevant health-related education (i.e. are unskilled), while at the same time the care need of patients in the community is increasing. We know little about how this affects the quality of services and the safety of patients. In addition, we know little about the consequences of changes in skill mix, e.g. when higher qualified personnel are replaced with personnel with lower qualifications. With skill mix we mean the composition of the various categories of nursing staff providing direct patient care. With the aim to summarise the evidence in the field in a systematic review, we searched for studies that evaluate the effects on quality of care and patient safety of a high proportion of unskilled personnel working directly with patients and the effects of changes in skill mix.1. We found no studies that evaluated the impact on quality of care and patient safety of a high proportion of unskilled personnel working in direct patient care.2. Nor did we find any eligible studies that evaluated the impact on quality of care and patient safety of a change in skill mix. This review highlights the lack of high quality evidence from studies with robust study designs, on this important and current research topic.

Medical personnel --- Quality of Health Care.

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Motivational interviewing. --- Labor

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Systematic reviews (Medical research)

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Motivational interviewing. --- Labor

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Liverpool Care Pathway (LCP) has been promoted as a holistic approach for the care of dying patients and their families at the end of life. We conducted this rapid review to evaluate the effectiveness of LCP on the quality of palliative care. We included two recently published controlled studies that compared the effectiveness of LCP with standard palliative care. The results show that: 1. LCP may lead to little or no difference in overall quality of care provided to dying patients and their families. 2. LCP may give better symptom control in dying patients with regard to breathlessness. 3. LCP may lead to a desired change in use of medications: 1.1. higher use of one out of six possibly appropriate medications (pulmonary secretions).1.2. lower use of one out of ten possibly inappropriate medications (vasodilator drugs).1.3. increase in subcutaneous delivery of medications. 4. It is uncertain if there is a difference between LCP and standard palliative care with regard to the dying patient's physical symptoms and symptom burden at the end of life. Available evidence regarding the effectiveness of LCP is of low to very low quality. There is a lack of high quality evidence that provides clinical documentation in favor of LCP.

Palliative treatment. --- Hospice care.