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Introduction: Radiotherapy is the main treatment modality in cancer. There is sparse knowledge on how patients with cancer experience their radiotherapy trajectory, and which factors might be associated with patients' experiences. Objectives: The aim of the present study was to explore how adults with cancer receiving radiotherapy evaluate the quality of their care, utilizing a patient-reported experience measure, and how patient- and service-related characteristics are associated with their evaluation. Methods: An explorative cross-sectional study using a self-completed questionnaire to assess patients' radiotherapy experiences was performed. Participants were recruited consecutively, within their last week of treatment, from two different hospitals in Norway from January 2021 to January 2022. Four hundred and eighty paper questionnaires were distributed to recruited patients, 240 at each hospital. Questionnaires were self-completed at home and returned by mail. The instrument person-centered coordinated care experience questionnaire (P3CEQ) was used. In addition to this, participants completed the European Organization of Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30) and The Sense of Coherence 13 scale (SOC-13). Data were analyzed using descriptive statistics, parametric tests, and unadjusted/adjusted linear regression models were estimated. Results: The study included 373 patients. Patients evaluated quality of care in terms of P3CEQ scores, with a mean score of 19.5 (standard deviation = 5.4). Lowest scores were identified in areas concerning person-centeredness and service coordination. There were no significant differences in P3CEQ scores between the younger and older groups. Having a partner and better SOC-13 scores were independently associated with the overall patient-reported experience score, whereas age was not. Conclusion: Patient-reported experience scores indicate that improvements are needed in some areas, such as informing and involving patients in the planning and coordination of their care. Findings suggest paying special attention to patients without a partner to offer patients the best possible care. [ABSTRACT FROM AUTHOR]

Objectives: To demonstrate the benefits of applying meta ethnography to the synthesis of qualitative research, by means of a worked example. Methods: Four papers about lay meanings of medicines were arbitrarily chosen. Noblit and Hare's seven-step process for conducting a meta ethnography was employed: getting started; deciding what is relevant to the initial interest; reading the studies; determining how the studies are related; translating the studies into one another; synthesising translations; and expressing the synthesis. Results: Six key concepts were identified: adherence/compliance; self-regulation; aversion; alternative coping strategies; sanctions; and selective disclosure. Four second-order interpretations (derived from the chosen papers) were identified, on the basis of which four third-order interpretations (based on the key concepts and second-order interpretations) were constructed. These were all linked together in a line of argument that accounts for patients' medicine-taking behaviour and communication with health professionals in different settings. Third-order interpretations were developed which were not only consistent with the original results but also extended beyond them. Conclusions: It is possible to use meta ethnography to synthesise the results of qualitative research. The worked example has produced middle-range theories in the form of hypotheses that could be tested by other researchers. [ABSTRACT FROM AUTHOR]

Background: Empirical studies suggest that gratitude positively influence the quality of life of palliative patients and relatives. However, the literature is marked by a lack of conceptual clarity about what gratitude is and whether it can bring about individual and social benefits. Aim: This paper explores how palliative care patients and relatives understand gratitude, how discursive representations of gratitude may affect their positions, perceptions and relations, and how to conceptualise gratitude in the palliative context. Design: We examine 33 gratitude letters written by patients and relatives and 25 semi-structured interviews conducted as part of a pilot gratitude intervention study. We use a qualitative approach, thematic analysis, within a conceptual framework of discourse analysis. Settings/participants: Data were collected from 23 patients and 13 relatives recruited through three hospital palliative care services in French-speaking Switzerland. Results: Participants articulate gratitude in five ways: (1) appreciating others; (2) love; (3) need to reciprocate; (4) appreciating the little things; (5) solace amid serious illness. While some of these representations are sources of positive emotions and outlook, wellbeing and hope, others may confirm self-perceptions of powerlessness and burden. These results support a tridimensional conceptualisation of gratitude in palliative care as source of individual benefits, valuing closest relationships and moral obligation. Conclusion: Our study suggests that gratitude is a key to a good (end of) life, whilst highlighting potential negative effects. It could help healthcare professionals to better understand what gratitude means to patients and relatives, which may facilitate awareness and fostering of gratitude in palliative care. [ABSTRACT FROM AUTHOR]

Purpose: Historically, clinical reasoning has largely been considered from an empirical, biomedical standpoint. This epistemology, rooted in imperial rule, is influential in how healthcare practitioners practice. An empirical approach to healthcare often oversimplifies the complex nature of clinical reasoning by obscuring the influence of imperial ideologies on decision-making. This can perpetuate inequitable approaches to healthcare delivery which deepen social, political and economic divides globally. This paper aims to explore and challenge this standpoint by exploring how power, imperialism and performativity influences healthcare provision and decision-making amongst healthcare practitioners in dysphagia rehabilitation. Methods: Qualitative exploratory interviews were undertaken with seven South African trained SLPs with experience working in dysphagia. To allow for participation and collaboration from participants, three data collection tools were employed within the interviews: oral histories, cognitive mapping and arts-based tasks. An initial modified thematic analysis followed by a further ideological analysis were undertaken to analyse the data collected. Results: The results suggest that the participants felt influenced by several manifestations of power within healthcare. We argue that this demonstrates that imperial practices can influence knowledge, interaction and context and therefore affect how healthcare practitioners make decisions. Conclusion: By acknowledging the impact of imperialism and power dynamics on healthcare provision and clinical reasoning we can potentially begin to transform the epistemology from which we approach healthcare provision in favour of one which is better suited to the current realities of healthcare to allow for equitable service provision. [ABSTRACT FROM AUTHOR]

The use of vignettes in research and education is well documented. Documentation of how vignettes are developed and content validity is established, however, are rare. The purpose of this paper is to describe a method for development and establishing content validity of vignettes that can be used to assess student performance and research participant outcomes. This three-phase method was designed to validate seven vignettes for a future research project. Content validity index survey and expert panel interviews were used to inform improvements in validity. Findings showed that clinical vignettes were improved with respect to content relevance (from 0.93 to 0.96) and importance (from 0.68 to 0.93). Developing validated vignettes is essential when used to measure outcomes in education and in research. This three-phase method of vignette development and validation is feasible and effective in improving content validity of vignettes and can be used in other education and research projects. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity has emerged as a major challenge facing health services globally, which will place a substantial burden on health systems going forward. This paper seeks to estimate the association between multimorbidity and direct healthcare costs among older people in Ireland from a healthcare system perspective. Methods: Cross-sectional analysis of data on 8,447 community-dwelling adults aged 50 and over collected between 2009 and 2011 as part of the Irish Longitudinal Study on Ageing. Multivariable generalised linear model regression, employing a log-link and Poisson family distribution, is used to assess the association between self-reported multimorbidity status and direct healthcare costs. Results: For the full sample, 21.20% reported having no chronic conditions, 27.39% had one chronic condition, and 51.40% had multimorbidity. After controlling for a range of socio-demographic and health status variables, we found that relative to those reporting no chronic conditions, one chronic condition was associated with additional average annual costs of €513 (95% CIs: 245, 781), increasing to €1277 (95% CIs: 942, 1612) for those with 6 or more chronic conditions. Relative to those reporting 2 chronic conditions, 4 chronic conditions were associated with additional costs of €411 (95% CIs: 106, 716), 5 chronic conditions with €591 (95% CIs: 214, 969), and 6 or more chronic conditions with additional average costs of €1006 (95% CIs: 641, 1371). Conclusion: This study finds positive and significant associations between the number of chronic conditions and direct healthcare costs and further highlights the potential economic benefits from preventing the onset and progression of multimorbidity. [ABSTRACT FROM AUTHOR]

The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers’ ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care’s ‘culture of documentation’. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers’ burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures. [ABSTRACT FROM AUTHOR]

Participation by people of color in research studies is important for generalizability and to mitigate health disparities. Barriers to recruitment are well documented, but less well known is how to succeed. This paper describes successful strategies for recruitment and retention of pregnant Black women for a multisite study of preterm birth. Recruiters provided input on strategies. Participant level strategies include: commitment to being respectful, friendly, and reliable; addressing concerns regarding confidentiality; acknowledging competing priorities; and when possible, matching recruiters by gender and race. Clinical level strategies include: the formation of a good working relationship with the clinical staff; prioritizing clinical care above research activities; and obtaining access to the electronic medical record systems. Protocol level strategies include: a wide enrollment window; coordinating biospecimen collection with the clinical laboratory tests; collecting survey data on an electronic tablet; text messaging; and providing compensation for the time needed to complete study activities. [ABSTRACT FROM AUTHOR]

Summary: The social work profession emphasises the development of the personal qualities of social workers in addition to requiring them to possess the necessary professional values, knowledge, theories and practice skills. Until now, we have tended to rely on the perspective of social work professional bodies, educators and employers to assess the personal qualities of social workers. We have seldom inquired about the views of service users on the qualities of social workers, thus disregarding their perspective. This article focuses on identifying the important qualities of social workers from the perspective of service users. Findings: This paper reports on qualitative research on the personal qualities of social workers that service users value in Hong Kong. It draws on a diverse range of service users with direct experiences of the services provided by social workers. A total of 47 service users from 7 core social welfare service settings and 32 service units participated in an in-depth qualitative interview. Six significant personal qualities of social workers from the service users' perspective are identified and discussed. Applications: The findings have several implications for examining directions for development of the social work profession, the relationship between service users and social workers, effective ways to develop the personal qualities of students in social work education and ways to resolve the dilemma between service users' expectations and the existing mode of social work service delivery. Issues of particular relevance to Hong Kong are highlighted in discussing these implications. [ABSTRACT FROM AUTHOR]

Background: Clinical pharmacy services started in 2009 at the National Center for Cancer Care and Research, Qatar. Clinical pharmacy services was established to provide comprehensive prescription of drug management and support, and consulting services to build clinically efficient and cost-effective pharmacy program. Aim: To determine perceptions and expectations of healthcare providers toward the clinical pharmacy services at the National Center for Cancer Care and Research. Methods: A cross-sectional survey of healthcare providers was conducted from January to May 2018. A self-administered electronic/paper survey containing four domains assessing healthcare providers' perceptions and expectations towards clinical pharmacy services, perceived barriers to clinical pharmacist role and suggested area for improvement was sent to 375 healthcare providers including physicians, operational pharmacists, nurses and dietitians. Results: The response rate was 112/375. Most of the healthcare providers (74%) perceived the increasing interest in clinical pharmacy services. Also, they expected (1) providing consultations regarding appropriate medication choices (82%); (2) providing information about medication availability and shortages (82%); (3) assisting in the prescribing of cost-effective drugs by providing pharmacogenomics information routinely (75%) and (4) Participating actively in research activities (74%). Overall, healthcare providers have a high level of trust in the clinical pharmacists' abilities (P < 0.01). Nurses were less appreciative (P < 0.002) of the positive role of clinical pharmacists in direct patient care as compared to both physicians and pharmacists (64.2%, 90% and 95.7%, respectively). Conclusion: This study revealed a positive attitude towards the role of clinical pharmacists by healthcare providers at National Center for Cancer Care and Research. However, there is an area of improvement by empowering with privilege and staffing, elevating the awareness and expansion in the ambulatory care settings. [ABSTRACT FROM AUTHOR]

The article discusses several research on health services and social policy. The paper by John Lavis and colleagues emphasizes the importance of a established personal relationships between researchers and policy makers. Ray Pawson and colleagues outlines a realist method which introduces another way of pulling together evidence and casts yet a broader net on what could be included in a possible synthesis.

Austerity measures have become a contentious topic, shaping the landscape of health care systems around the world. As governments grapple with economic challenges, the impact of austerity on health care has emerged as a critical concern. This study focuses on the consequences of austerity actions adopted by the Zimbabwean government under the Transitional Stabilization Program (TSP) from August 2018 to December 2025. This research examines the impact of austerity measures on Zimbabwe's health care sector, exploring its connections with health infrastructure and resources, accessibility and affordability of health care, health funding, health care inequalities, and the health care workforce. Using a quantitative approach and data from 970 participants, including the general populace, health care providers, and government officials, significant positive correlations between austerity measures and these health care variables were identified. The findings indicated a noteworthy positive correlation between the independent variable "austerity measures" and five dependent variables: health care accessibility and affordability, health care inequalities, infrastructure and resources, health care funding, and health care workforce. The t -statistics values exceeded the threshold of 1.96, with values of 5.085, 3.120, 6.459, 8.517, and 3.830, respectively. These findings highlight the importance of considering the effects of austerity on health care access, health funding, health care inequalities, health workforce, health infrastructure and resources development. Policymakers should prioritize equitable resource allocation and targeted investments to strengthen the resilience of the health care system during economic challenges. Understanding these associations is crucial for evidence-based policy decisions and fostering a more equitable and resilient health care system in Zimbabwe. [ABSTRACT FROM AUTHOR]

Background: Public health midwives (PHMs) play a frontline role in the Sri Lankan public healthcare system, ensuring the health of children and women at the community level. However, cultural differences in diverse social contexts necessitate PHMs for customised interventions to ensure optimum child and maternal health, particularly in most vulnerable communities. Purpose: The objective of the present study is to explore how PHMs have adapted their roles as community change agents to facilitate community mobilisation before implementing healthcare interventions for children and mothers in the estate sector (a marginalised and vulnerable community) of Sri Lanka. Research Design and methods: Using an exploratory qualitative research design, data were collected through in-depth interviews with 16 participants. The thematic analysis revealed two main themes that describe how PHMs engage in community mobilisation in addition to their designated role as healthcare officials in the estate sector of Sri Lanka. Results: The first theme highlights PHMs' involvement in community mobilisation through context-relevant advocacy for effective service implementation. The second theme illustrates how PHMs' role has been reshaped as advocates to intervene in making the family a supportive institution for child and maternal health. PHMs who work in the estate sector in the country are morally committed to engaging in community mobilisation and advocacy. However, this obligation can be neglected due to the lack of formal arrangements and training in sociocultural determinants of health and working with vulnerable communities. Conclusions: The role of a PHM in the estate sector differs significantly from that in the urban and rural sectors, given the significance of their interventions in family health. Also, community mobilisation is a prerequisite for implementing health policies for child and maternal health in vulnerable communities. Both community-level and family-level advocacy interventions and mobilisation efforts are equally important to establishing a supportive environment, without which any child and maternal healthcare interventions are difficult to implement. [ABSTRACT FROM AUTHOR]

To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit, with state concurrence, extended take-home methadone doses. The modification allowed for up to 28 days of take-home methadone for stable patients and 14 days for those less stable. Using both interrupted time series and difference-in-differences methods, this study examined the association between the policy change and fatal methadone overdoses, comparing states that permitted the expansion of take-home doses with states that did not. The findings suggest the pandemic emergency take-home policy did not increase methadone-involved mortality. [ABSTRACT FROM AUTHOR]

Sexual violence and sexual harassment (SVSH) are prevalent among college and university students; however, the experiences of ethnic minority students, especially Asians, are understudied. This study aimed to reduce this gap by exploring Asian students' perceptions of SVSH on three public university campuses in Southern California. We examined their perceptions about the campus environment related to SVSH, attitudes, and behaviors toward help seeking, and utilization of on-campus resources. A total of 23 in-depth interviews were conducted with Asian students enrolled at the three University of California campuses. Thematic coding was conducted to generate main themes and subthemes. Five main themes emerged: (a) SVSH is considered a "taboo" topic in Asian culture and family systems, and Asian student survivors are often reluctant to disclose incidents or seek support services. (b) Students did not feel their campus environments were tailored to understand or meet the sociocultural realities and needs of Asian student survivors. (c) Campus SVSH services and reporting processes were seen as non-transparent. (d) Peers were the major source of support and SVSH information, as opposed to official campus-based resources and training. (e) Survivors often conduct an internal cost–benefit analysis evaluating their decision about whether to report. This study highlights the lack of conversation surrounding SVSH in Asian families, and how the cultural stigma of sex and sexual violence prevented Asian students from receiving knowledge and resources about these topics in their families. Instead of relying on formal campus resources (e.g., Title IX and confidential advocacy services, mental health services), many students turn to their peers for support. Thus, facilitating peer support groups, training university students to support each other through SVSH incidents, and tailoring campus services to the diverse cultural backgrounds of students are key considerations to foster a safe campus environment and prevent SVSH. [ABSTRACT FROM AUTHOR]

Data on rates, percentages, or proportions arise frequently in many different applied disciplines like medical biology, health care, psychology, and several others. In this paper, we develop a robust inference procedure for the beta regression model, which is used to describe such response variables taking values in (0, 1) through some related explanatory variables. In relation to the beta regression model, the issue of robustness has been largely ignored in the literature so far. The existing maximum likelihood-based inference has serious lack of robustness against outliers in data and generate drastically different (erroneous) inference in the presence of data contamination. Here, we develop the robust minimum density power divergence estimator and a class of robust Wald-type tests for the beta regression model along with several applications. We derive their asymptotic properties and describe their robustness theoretically through the influence function analyses. Finite sample performances of the proposed estimators and tests are examined through suitable simulation studies and real data applications in the context of health care and psychology. Although we primarily focus on the beta regression models with a fixed dispersion parameter, some indications are also provided for extension to the variable dispersion beta regression models with an application. [ABSTRACT FROM AUTHOR]

Using a statewide survey, this exploratory, cross-sectional study examined 78 domestic violence (DV) service organizations' service delivery practices and perceived challenges to serving Latinx survivors in the context of rurality. Findings showed that DV organizations in rural areas perceived more challenges to delivering culturally appropriate services for Latinx survivors compared to those in other geographic settings even after accounting for client characteristics, service provision characteristics, and community resources. The study finding offers critical insights to ensure and enhance the provision of linguistically and culturally accessible services for rural Latinx survivors of intimate partner violence. [ABSTRACT FROM AUTHOR]

Introduction: Parent/carers of disabled children want timely and personalized support. Research suggests that technology may address some limitations associated with traditional methods of communication with therapists (e.g. letter, telephone). This exploratory study examined United Kingdom (UK) parents and carers views on the use of digital technology (i.e. computers/phones) in supporting their child and the potential for its greater use in the care of children with complex needs. Methods: An online survey was distributed via special schools and support forums/networks. Questions explored use of and attitudes to digital technology in the care of children with complex needs. Descriptive statistical analyses and content analyses were undertaken on the data. Results: Respondents were 43 parents/carers whose children used rehabilitation services prior to the COVID-19 pandemic. The majority used digital technology frequently to support their child and saw the potential for greater use in rehabilitation services – provided this was not at the expense of in-person therapist contact. Conclusion: Parents and carers held positive views of digital technology as a tool to support their child and enhance rehabilitation services. Recommendations include regular service consultation on parental/child attitudes to digital service delivery and longitudinal studies to assess related health outcomes. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to explore the expectations of and experiences with the public healthcare system of domestic partners of people with Parkinson's disease (PD) in Denmark and Norway. Methods: A qualitative exploratory design was applied. The sample consisted of 14 people from Denmark (n = 9) and Norway (n = 5) living with a partner with PD. Semi-structured individual interviews were conducted between June and September 2020, digitally recorded, transcribed verbatim and analysed using a reflexive thematic analysis approach combining inductive and deductive approaches. Results: The main themes were 'negotiating systems of support' and 'balancing being both a partner and a family carer'. Partners take responsibility for the people with whom they live and attempt to fill gaps in the public healthcare system. The most frequently described needs were more information, service coordination as the illness progressed and acknowledgement of the complex role. Discussion: A recommendation for practice is recognition of the complex roles of partners to people with PD and reaching out to both regularly to determine needs. This may enhance the collaboration between partner carers, people with PD and healthcare providers, ensure sustainability of the system and optimise living with PD in the family. [ABSTRACT FROM AUTHOR]

This overview aims to stimulate conceptual and practical discussions to help unlock the full potential of realist evaluation in health systems research. Based on a structured literature search, this review maps how the concepts of realist evaluation are applied in health systems research and which methodological problems are encountered. We found a great diversity in the depth of application of the philosophical concepts, use of terminology and scope of application in the research process. Terms of theory-driven evaluation, theories of change and realist evaluation are often used interchangeably. Diverging views exist regarding the nature of ‘mechanism’ and the difference between mechanism and essential context condition. A lack of methodological guidance was highlighted by many authors. Realist evaluation is slowly gaining traction in health systems research, but more clarity is needed concerning the definitions of mechanisms and context and how the configuration of context, mechanism and intervention can be described and assessed. [ABSTRACT FROM PUBLISHER]

It seems safe to conclude that nearly 150 years ago, "the lady with the lamp," Florence Nightingale, set a course that practice-based healthcare researchers continue to follow today. In her book, Notes on Nursing (1860), Nightingale identified light, ventilation, noise, and sanitation as elements of the environment that affected the well-being of soldiers in her care. Today, we attempt to study these same relationships: those that exist between the built environment of healthcare settings, and the health and well-being of the users of these spaces. The goal of this paper is to describe how research is conceptualized, integrated, and utilized in healthcare design decision making and to address the challenges and opportunities that exist when moving a research agenda forward. Numerous examples of design practitioners and healthcare facilities that have committed themselves to integrating research into healthcare design are provided. [ABSTRACT FROM AUTHOR]

Objective: To identify barriers and facilitators to international implementation of a prospective system for standardized outcomes measurement in cleft care. Design: Cleft teams that have implemented the International Consortium for Health Outcomes Measurement Standard Set for cleft care were invited to participate in this 2-part qualitative study: (1) an exploratory survey among clinicians, health information technology professionals, and project coordinators, and (2) semistructured interviews of project leads. Thematic content analysis was performed, with organization of themes according to the dimensions of the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework: reach, effectiveness, adoption, implementation, and maintenance. Results: Four cleft teams in Europe and North America participated in this study. Thirteen participants completed exploratory questionnaires and 5 interviewees participated in follow-up interviews. Survey responses and thematic content analysis revealed common facilitators and barriers to implementation at all sites. Teams reach patients either via email or during the clinic visit to capture patient-reported outcomes. Adopting routine data collection is enhanced by aligning priorities at the organizational and cleft team level. Streamlining workflows and developing an efficient data collection platform are necessary early on, followed by pilot testing or stepwise implementation. Regular meetings and financial resources are crucial for implementing, sustaining, analyzing collected data, and providing feedback to health care professionals and patients. Fostering patient-centered care was articulated as a positive outcome, whereas time presented challenges across all RE-AIM dimensions. Conclusions: Identified themes can inform ongoing implementation efforts. Intentionally investing time to lay a sound foundation early on will benefit every phase of implementation and help overcome barriers such as lack of support or motivation. [ABSTRACT FROM AUTHOR]

Public health projects carried out by non-government organisations (NGOs) are considered a critical contributor in the provision of health services to rural population in India. But there is clear lack of documented evidence that describes the capacity and competency of the NGO project managers to successfully design and implement a new project. This article presents findings of an exploratory case study using outreach model of family planning service delivery as an example to understand the steps and actions taken by senior managers throughout the project's life cycle and competencies required by them to execute the project. Focus group discussion followed by paper-based survey using sections of Management Competency Assessment Tool was conducted with senior managers of the chosen NGO. The results indicate that the strategies developed by the NGO managers are consistent with the existing literature on project management. However, not all managers have the same level of confidence in demonstrating the competencies of (a) knowledge of healthcare environment; (b) evidence informed decision making; and (c) interpersonal, communication qualities and relationship management. The organisation needs to invest in human resource development using mixed approach of providing training, team building activities, mentoring, and support. [ABSTRACT FROM AUTHOR]

The contention that retirement may have an adverse effect on health has become increasingly popular with the recent categorization of this phenomenon as a stressful "life event." The small number of empirical studies examining the health outcomes of retirement, however, appear neither to support nor to refute this hypothesis. Moreover, the serious methodological problems inherent in most of these studies caution against the generalization of findings. o This paper examines the existing research on the health and retirement relationship within the theoretical context of Atchley's process approach to retirement. Recent refinements in the study of life events (e.g., a focus on the timing of the event and the degree of control experienced) are seen as offering important potential contributions both to our understanding of retirement and to the development of more incisive and conceptually sound research in this area. At the same time, the inadequacy of existing life-events scales when applied to an older age group, and the genera/failure to view life changes within a broad sociostructural context are emphasized as weaknesses of the life-events approach that should be taken into account in future research on the complex retirement and health relationship. [ABSTRACT FROM AUTHOR]

Background: Limited evidence exists on how people living with dementia and their family/unpaid carers navigate care and support in India. Aim: This study used case vignettes to illustrate likely pathways to care for dementia, from receiving a diagnosis to long-term support, in India and to highlight gaps and challenges associated with current care provision for persons living with dementia. Methods: As part of the Strengthening Responses to Dementia in Developing Countries (STRiDE) project, and to contribute to an analysis of dementia care policies and systems in India, case vignettes were used to illustrate the diverse situations that people with dementia and their families may experience when seeking care in the Indian context. Eight hypothetical, but realistic cases of people with dementia were created by a multi-disciplinary team with experience in dementia care in India, to map out the likely care journeys of each case. Results: Investigating eight diverse care trajectories of people living with dementia highlighted important patterns relevant to the Indian context. We identified delays in dementia diagnosis to be attributed to low awareness of dementia among the general public and medical professionals in addition to a critical shortage of specialist services involved in facilitating dementia diagnosis. Post-diagnosis, support was recognized as limited and associated with considerable out-of-pocket (OOP) costs. Families primarily provide long-term care for people with dementia till end of life. Conclusions and Recommendations: Several steps need to be taken in order to improve dementia care in India. Increasing dementia awareness among both medical professionals and general public is essential. Shortages in dementia specialists can be addressed in part through appropriate task shifting. Lastly, more research is needed to develop evidence-based community interventions to support informal care provision for persons with dementia in India. [ABSTRACT FROM AUTHOR]

This study aims to estimate direct health-related costs for victims of intimate partner violence (IPV) using nationwide linked data based on police reports and two healthcare registers in Finland from 2015 to 2020 (N = 21,073). We used a unique register dataset to identify IPV victims from the data based on police reports and estimated the attributable costs by applying econometric models to individual-level data. We used exact matching to create a reference group who had not been exposed to IPV. The mean, unadjusted, attributable healthcare cost for victims of IPV was €6,910 per individual over the 5-year period after being first identified as a victim. When adjusting for gender, age, education, occupation, and mental-health- and pregnancy-related diagnoses, the mean attributable health-related cost for the 5 years was €3,280. The annual attributable costs of the victims were consistently higher than those for nonvictims during the entire study period. Thus, our results suggest that the adverse health consequences of IPV persist and are associated with excess health service use for 5 years after exposure to IPV. Most victims of IPV were women, but men were also exposed to IPV, although the estimates were statistically significant only for female victims. Victims of IPV were over-represented among individuals outside the labor force and lower among those who were educated. The total healthcare costs of victims of IPV varied according to the socioeconomic factors. This study highlights the need for using linked register data to understand the characteristics of IPV and to assess its healthcare costs. The study results suggest that there is a significant socioeconomic gradient in victimization, which could also be useful to address future IPV prevention and resource allocation. [ABSTRACT FROM AUTHOR]

The author comments on some research on social policy. He accepts that health care managers are low users of research evidence and have little tradition of using the library in finding the answer. He emphasized that researchers have a different perception of what constitutes good or useful research.

The Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit is a key component of Medicaid policy intended to define an essential set of services provided to patients younger than age 21. Given increasing attention to social determinants of health in pediatric health care, this qualitative review examines the extent to which EPSDT might be used to implement structured screening to identify environmental and social factors affecting children's health. Themes derived from semistructured interviews conducted in 2017 were triangulated with a review of the recent literature to describe how states currently consider the EPSDT benefit with respect to social determinants of health screening. Our findings suggest that, with sufficient stakeholder advocacy given the evidence supporting social determinants of health screening as "medically necessary," EPSDT benefits could be considered as a funding source to incentivize the incorporation of social determinants of health screening into the basic package of well-child care. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Annually, HPV infections result in $775 million in direct medical costs and approximately 46 000 new cases of HPV-associated cancers. Safe and highly effective vaccines have been available to prevent HPV for children/adolescents since 2006. Vaccination rates remain low, especially in rural areas. Parental attitudes and beliefs affect HPV vaccination rates. Methods: We developed, tested, and administered a survey that asked how parents and healthcare providers interacted about the HPV vaccine following a healthcare visit with an age-eligible child, as part of a multicomponent randomized controlled trial designed to improve HPV vaccination rates in rural Oregon. The 21-item survey assessed parents' information-seeking behavior, knowledge about HPV cancer risk reduction, the HPV vaccine series, and their vaccine confidence. Results: Forty-three participants (59.7%) were in the intervention group; 29 (40.3%) were controls. Over 90% of healthcare visits were illness, injury, sports physical, or well-child visits (n = 67 or 93.1%), and 6.9% of visits were vaccine-specific. No statistically significant differences were found between study groups for healthcare visits. Over half the parents reported having discussions about HPV and the HPV vaccine (54.5%) with their care providers, 31.3% had recently learned about HPV, HPV risks, and the HPV vaccine prior to the visit, 83.1% were knowledgeable about cancers associated with HPV, and 79.2% were considering vaccinating their child(ren), which did not differ between study groups. Conclusions: Knowledge about HPV-related cancers and consideration for vaccinating children was higher than expected, but not associated with the intervention tested. [ABSTRACT FROM AUTHOR]

The focus of this paper is the experiences and needs of family carers of people with end-stage dementia. The project involved in-depth, qualitative interviews with 15 carers. The major themes emerging from the accounts of participants’ experiences were: getting support; having to trust others with care; managing the loneliness of being a carer; witnessing a loved one fade away; anticipating and experiencing death; and re-establishing life after the funeral. Carers expressed a range of instrumental and psychosocial needs. The study has provided a more personal account of the caring experience than much of the related literature. It has emphasized the need of carers for genuine understanding and connection — from family and friends as well as healthcare staff. The study highlights the amount of support carers can provide to each other through support groups and associated friendships, and stresses the importance of healthcare staff acknowledging and respecting this capacity of carers. [ABSTRACT FROM PUBLISHER]

This paper explores the history of evidence-based medicine (EBM) in comparison to the relatively short history of evidence-based design (EBD), Throughout its development, EBM has encountered a number of challenges, including dealing with initial objections to the concept, creating safeguards to ensure rigor in research, supporting practitioners in their efforts to stay current with a growing body of research data, applying the literature to real-life situations, making decisions when literature to inform decision making is absent, and educating students and professionals to became EBM practitioners. The ways in which the field of EBM has handled these challenges provides a number of lessons for the relatively young field of EBD. [ABSTRACT FROM AUTHOR]

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Although there is increasing demand for syntheses of qualitative research, little is known about papers that aim to report such syntheses. We searched for published reports of attempts to conduct syntheses of qualitative research in health and healthcare. Papers were included if they were published between 1988 and 2004, in the English language, and in a peer-reviewed journal. We identified a modest body of literature (42 papers) reporting syntheses of qualitative research in health and healthcare. We extracted data on the topic of the paper and on reported methods for searching, appraisal, and synthesis. Some papers reported purposive attempts to innovate with, and to adapt, methods for synthesis. Many papers lack explicitness about methods for searching, appraisal, and synthesis, and there is little evidence of emerging consensus on many issues. There was also some evidence of possibly inappropriate use of some techniques. We conclude that continued methodological progress and improved reporting are required. [ABSTRACT FROM AUTHOR]

▪ AIMS During the last 10 years researchers in the field of substance abuse treatment have found most of the treatment organisations quite research and innovation resistant according to adopting the concept of evidence-based practice. It is the aim of this paper to show that the treatment services are not resistant to research and innovation, but they are organized around some organizational principles that are hardly compatible to the principles embedded in evidence-based practice. ▪ METHODS & DATA This study includes a mapping of the service structure and the treatment method's (evidence-based and not-evidence-based) in 21 outpatient treatment services for adolescent with substance abuse problems. ▪ RESULTS The treatment services showed not to be occupied by implementing evidence-based practice, but were at the same time open for adoption of innovations in treatment structure and method's, which indicates that they are not resistant to innovations. ▪ CONCLUSIONS In this paper the self-organization of the treatment centres is analysed through a new institutional theory approach, and it is described how the institutional orientation of the treatment centres exclude an adoption of the concept of evidence-based practice. It is suggested that the researchers should shift focus from the inability of the treatment organizations to develop evidence-based practice, and instead focus on how to build up an evidence-based infrastructure in which the producers of evidence-based knowledge and the treatment organizations can obtain knowledge of each others work. [ABSTRACT FROM AUTHOR]

The article underlines the use of case studies in clinical ethics. It is posed that case studies seem to serve two main goals in clinical ethics. They are essential for teaching and learning, as well as they can be helpful illustrations for research papers. Relative to clinical ethics, the usual practice for sharing, disclosing or publishing patient information is first to gain the consent of the person or persons involved.

Policy-makers and managers have always used a wide range of sources of evidence in making decisions about policy and the organization of services. However, they are under increasing pressure to adopt a more systematic approach to the utilization of the complex evidence base. Decision-makers must address complicated questions about the nature and significance of the problem to be addressed; the nature of proposed interventions; their differential impact; cost-effectiveness; acceptability and so on. This means that Cochrane-style reviews alone are not sufficient. Rather, they require access to syntheses of high-quality evidence that include research and non-research sources, and both qualitative and quantitative research findings. There is no single, agreed framework for synthesizing such diverse forms of evidence and many of the approaches potentially applicable to such an endeavour were devised for either qualitative or quantitative synthesis and/or for analysing primary data. This paper describes the key stages in reviewing and synthesizing qualitative and quantitative evidence for decision-making and looks at various strategies that could offer a way forward. We identify four basic approaches: narrative (including traditional 'literature reviews' and more methodologically explicit approaches such as 'thematic analysis', 'narrative synthesis', 'realist synthesis' and 'meta-narrative mapping'), qualitative (which convert all available evidence into qualitative form using techniques such as 'meta-ethnography' and 'qualitative cross-case analysis'), quantitative (which convert all evidence into quantitative form using techniques such as 'quantitative case survey' or 'content analysis') and Bayesian meta-analysis and decision analysis (which can convert qualitative evidence such as preferences about different outcomes into quantitative form or 'weights' to use in quantitative synthesis). The choice of approach will be contingent on the aim of the review and nature of the available evidence, and often more than one approach will be required. [ABSTRACT FROM AUTHOR]

Evidence-based policy is a dominant theme in contemporary public services but the practical realities and challenges involved in using evidence in policy-making are formidable. Part of the problem is one of complexity. In health services and other public services, we are dealing with complex social interventions which act on complex social systems – things like league tables, performance measures, regulation and inspection, or funding reforms. These are not 'magic bullets' which will always hit their target, but programmes whose effects are crucially dependent on context and implementation. Traditional methods of review focus on measuring and reporting on programme effectiveness, often find that the evidence is mixed or conflicting, and provide little or no clue as to why the intervention worked or did not work when applied in different contexts or circumstances, deployed by different stakeholders, or used for different purposes. This paper offers a model of research synthesis which is designed to work with complex social interventions or programmes, and which is based on the emerging 'realist' approach to evaluation. It provides an explanatory analysis aimed at discerning what works for whom, in what circumstances, in what respects and how. The first step is to make explicit the programme theory (or theories) – the underlying assumptions about how an intervention is meant to work and what impacts it is expected to have. We then look for empirical evidence to populate this theoretical framework, supporting, contradicting or modifying the programme theories as it goes. The results of the review combine theoretical understanding and empirical evidence, and focus on explaining the relationship between the context in which the intervention is applied, the mechanisms by which it works and the outcomes which are produced. The aim is to enable decision-makers to reach a deeper understanding of the intervention and how it can be made to work most effectively. Realist review does not provide simple answers to complex questions. It will not tell policy-makers or managers whether something works or not, but will provide the policy and practice community with the kind of rich, detailed and highly practical understanding of complex social interventions which is likely to be of much more use to them when planning and implementing programmes at a national, regional or local level. [ABSTRACT FROM AUTHOR]

In this paper, we report the development of a theoretical model for health care administration programs at the graduate level. Our model development was prompted by recently-expressed concerns that the training available to managers and executives in health care fields is encountering a number of problems: it is typically lengthy and expensive, and involves too many prerequisites. In terms of content, the training available may be too narrowly focused on performing functions, such as accounting, rather than managing the functions. We begin development by conducting a content analysis of several highly-regarded programs with commonly identified features. We next describe how those features can be incorporated into a fast-track, 33 hour program without prerequisites which is consistent with accreditation guidelines. Implications for executive education and research are discussed. [ABSTRACT FROM AUTHOR]

This paper provides an empirical check of some assumptions used to define the quality of care in the health services literature. Specifically, we test (i) whether service intensity is the only important determinant of a provider's quality and (ii) whether higher service intensity always causes higher quality. Using a panel of hospitals from Washington State, we find evidence that rejects both of these assumptions. As a result, further work is needed to postulate a more general definition that does not rely on these assumptions. [ABSTRACT FROM AUTHOR]

Objectives: The objectives of this audit were to document the current status of health services research (HSR) in Australia in terms of inputs and outputs. Inputs were defined as the number of organised centres or groups undertaking HSR, the extent to which HSR was being developed and the funding available for HSR. Outputs were measured as the number of peer-reviewed papers. Methods: Centres or groups were identified via the membership of the HSRAANZ and a web-based search. Information from annual reports and/or other published sources was used to determine the extent of capacity building and available funding. The tables of contents of 21 journals published over a 10-year period were searched for articles reporting Australian HSR. Results: Eighteen groups were identified that undertook HSR as their predominant activity, while twelve were involved in HSR as a collaborative activity. No HSR-specific training (in terms of under- or postgraduate degrees) was identified, although more than 400 postgraduate students were being supervised in the university departments where HSR groups were situated. Between 1998 and 2001, more than AU$13 million was awarded for HSR, most of it by the National Health and Medical Research Council (NHMRC). Over the past 10 years, 482 articles about Australian health services have been published in the peer-reviewed journals audited. Conclusions: Although HSR is widespread in Australia, no specific training appears to be available to build capacity. Overall, HSR is not well-funded especially by organisations outside the NHMRC or Australian Research Council. Thus, it is not surprising that the output of Australian HSR, in terms of peer-reviewed articles, is slight. [ABSTRACT FROM AUTHOR]

The prevalence of fluctuating demand is increasingly seen as a serious and ongoing issue facing the health services industry. Volume flexibility in a health care setting represents a means to improve service delivery and it allows organizations to leverage their scarce resources for optimal utilization in response to fluctuations in patient demand. This paper develops a research framework that describes four volume flexible strategies based on literature reviews and structured field interviews of health care administrators at a Carnegie I research and teaching hospital. This prescriptive framework and the propositions that are developed create a foundation to help guide future research on the important relationships between demand uncertainty, volume flexible strategies, and organizational performance. [ABSTRACT FROM AUTHOR]

Objective: To describe the introduction of an ongoing professional development programme for clinicians in a rural area mental health service. The programme involved a series of workshops delivered by clinical psychologists. The training component of each workshop focused on discrete cognitive behavioural strategies, targeted at the amelioration of anxiety and mood symptoms.Conclusions: The paper emphasizes contextual aspects of the programme: its setting, the modality of delivery, resourcing issues and maximizing engagement by the participants. Preliminary evaluation data are reviewed, and it is argued that programmes that focus on local capacity building in rural settings are an important component of redressing the urban-rural imbalance in the availability of evidence-based psychological treatments. [ABSTRACT FROM AUTHOR]

Background: Major depression makes an important contribution to disease burden in Canada. In principle, the burden of major depression can be reduced by the provision of treatment within the health care system. In a previous data analysis, the National Population Health Survey (NPHS) reported an increase in antidepressant (AD) use between 1994 and 1998. In this paper, the analysis is extended to 2000, and additional aspects of health care utilization are described.Methods: The NPHS provides a unique source of longitudinal data concerning major depression and its treatment in Canada. In this survey, probable cases of major depression were identified using a brief predictive instrument; health care utilization was evaluated using additional survey items; and the latest data release from Statistics Canada (that is, 2000) was used to make weighted estimates of the frequency of health care utilization in relation to major depression status.Results: The use of ADs has continued to escalate. These increases have been largest in men and in persons aged under 35 years. There has been an increase in polypharmacy: in 2000, almost 9% of persons taking an AD reported taking more than 1 AD medication-a tripling since 1994. The frequency of consultations with alternative practitioners has also grown. Although the overall proportion of persons with major depression who report consulting with health professionals about their mental health has not increased, the number of persons with major depressive disorder reporting 6 or more visits to nurses, social workers, and psychologists may have.Conclusion: The provision of AD treatment continues to expand in Canada. This probably represents a changing pattern of practice, because the frequency of professional consultation has not increased. More detailed data are required to evaluate the extent to which treatment needs are being met. [ABSTRACT FROM AUTHOR]

The author comments on several research on social policy and health services. He noted that the iterative nature of the realist methodology would add significantly to the overall level of confidence in the product. He believes that an extremely powerful tool could be created through the synthesis of the three papers into one overall strategy.

Objective: This paper examines the relation between coronary artery disease (CAD) and panic disorder (PD), discusses the implications of this relation to the general medical system, and suggests future assessment and intervention strategies for emergency departments.Method: We reviewed the literature on CAD and PD using Medline and PsycINFO.Results: PD is more expensive to our nonpsychiatric, general medical system than any other psychiatric condition. The main reason for PD patients' continued use of general medicine for their psychological symptoms is that their PD remains undiagnosed. In the emergency room (ER), PD patients with chest pain have their PD go undiagnosed about 98% of the time. By having ERs implement specific assessment and intervention strategies for patients presenting with chest pain, the savings to the general medical system could be substantial.Conclusions: By improving recognition of PD in the ER, there is the potential to generate large savings in general medical care. With the availability of empirically supported or effective psychological and pharmacologic treatments for PD, appropriately diagnosing and subsequently treating patients with PD may prevent them from experiencing many years of disability and higher rates of fatal coronary events. [ABSTRACT FROM AUTHOR]

In the era of advanced Open artificial intelligence (AI) technology, the large language model tool known as chat generative pre-training transformer (ChatGPT) is gaining an increasing number of users in various fields such as healthcare, medical education, agriculture, and customer support due to its features like information retrieval, generating human-like conversations, and natural language processing. The purpose of this narrative review is to present the perspectives of ChatGPT in Pharmacology and Medical Education. And highlight the limitations of ChatGPT in these areas and draw the attention of policymakers in healthcare to implement such technologies while taking into consideration ethical issues. To collect information regarding the perspectives of ChatGPT in pharmacology and medical education. And highlight the limitations of ChatGPT in these areas. In health care, it helps in the drug discovery and development process, diagnosis, treatment, counseling, assisting in surgical procedures, pharmacovigilance, pharmacy, and so on. In medical education, this tool plays a crucial role in online tutoring, personalized assistance, grading, improvement in grammar, and so on. Despite the limitations, ChatGPT is helpful in healthcare, medical education, and scientific writing. To overcome such limitations of ChatGPT, like ethical issues, emotionlessness, providing information before 2021, the risk of biases, uncontrollability, lack of transparency, academic dishonesty, and so on, alternatives have been developed, but they also fail to entirely resolve the associated limitations. Looking at the current scenarios, there is an urgent need for comprehensive guidelines to address these limitations and provide a framework for appropriately utilizing AI tools in healthcare domains. This framework should also focus on maintaining a balance between human involvement and technological advancements. [ABSTRACT FROM AUTHOR]

While health services are expected to have public involvement in service (re)design, there is a dearth of evaluation of outcomes to inform policy and practice. There are major gaps in understanding why outcome evaluation is under-utilised. The aims of this interpretive descriptive study were to explore researcher participants' experiences of and/or attitudes towards evaluating health service outcomes from public involvement in health service design in high-income countries. Additionally, the aims were to explore barriers and enablers of evaluation, and reasons for the use of evaluation tools or frameworks. Semi-structured interviews (n = 13) were conducted with researchers of published studies where the public was involved in designing health services. Using framework analysis, four themes were developed that captured participants' experiences: Public involvement is hard – evaluation is harder; power, a diversity of agendas, and the invisible public; practical and methodological challenges; and genuineness and authenticity matter. Evaluation is driven by stakeholder requirements, including decision-makers, funding bodies, researchers, and academics, and evaluation tools are rarely used. The public is largely absent from the outcome evaluation agenda. There is a lack of commitment and clarity of purpose of public involvement and its evaluation. Outcome evaluation must be multi-layered and localised and reflect the purpose of public involvement, what constitutes success (and to whom), and use the most appropriate methods. Multi-level supports should include increased resources, such as funding, time, and expertise. Without improved evaluation, outcomes of investment in public involvement in health service design/redesign remain unknown. [ABSTRACT FROM AUTHOR]

People with intellectual and developmental disabilities (IDD) experience elevated risk for poor health and social outcomes in adulthood and are at risk for experiencing homelessness and housing instability. Although the exact prevalence of IDD among homeless populations is unknown, a small body of literature related to the intersection of IDD and homelessness suggests differential health needs and service use patterns, with a need for targeted health and social services. In this study, we explore the perceptions and experiences of 18 homeless or disability service providers about (a) their clients at the intersection of IDD and homelessness and (b) their role and the services provided at the intersection of IDD and homelessness. Participants struggled to provide appropriate, accessible services for this population, owing to lack of training and awareness of specific needs, fragmented systems, and inadequately funded healthcare and housing support. Our findings also reveal that clients at this intersection have high contact with public systems, which places them at risk for losing their right to self-determination. Recommendations center on systems transformation to facilitate the ability of providers to collaborate and to make data-driven decisions to deliver person-centered care. [ABSTRACT FROM AUTHOR]

As the number of elderly people in society increases, the use of technology to support the care system is being examined. However, there is no agreed model of a technology-based health-care system that fully integrates the technical and social aspects to meet the needs of both clients and care providers. This paper examines a possible model from the perspective of both the client and the service provider, and estimates the costs, and hence the potential savings, associated with the introduction of a health-care system based on this model. Cost data are presented in the context of an installation as might be anticipated within a city such as Birmingham, UK. Installation costs of an advanced telecare system would be higher than the set-up costs of conventional systems. Expected savings in control centre costs and emergency services costs would be small. However, a reduction in the average annual length of hospital stay by one day and a reduction in the proportion of elderly people being treated in hospital from 32.4% to 32.0%, directly as a result of the use of advanced telecare, would produce significant savings. A financing scheme with a 5-year or 10-year repayment period would then be financially viable for a 10,000-home advanced telecare system. [ABSTRACT FROM AUTHOR]

The aim of this paper is to highlight the role for decision analysis in assessing outcomes of medical interventions at a population level. The basic steps of decision analysis are introduced and an illustrative hypothetical preventive intervention is examined. Specific modelling challenges that arise when estimating the population impact of an intervention are described and each is accompanied by an example. Decision analysis can provide useful information for health policy decision makers by identifying the intervention(s) with the largest beneficial impact on health over a wide range of assumptions. In addition, by focusing attention on the parameters with the greatest influence on projected outcomes, decision analysis can aid in identifying critical areas for future research. [ABSTRACT FROM AUTHOR]