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BackgroundTwo general practices close every week in the UK. Given the pressure on UK general practices, such closures are likely to persist. Yet little is known about the consequences. Closure refers to when a practice ceases to exist, merges, or is taken over.AimTo explore whether practice funding, list size, workforce composition, and quality change in surviving practices when surrounding general practices close.Design and settingA cross-sectional study of English general practices was undertaken, using data from 2016–2020.MethodThe exposure to closure for all practices existing on 31 March 2020 was estimated. This is the estimation proportion of a practice’s patient list that had been through a closure in the preceding 3 years, between 1 April 2016 and 3 March 2019. The interaction between the exposure to closure estimate and the outcome variables (list size, funding, workforce, and quality) was analysed through multiple linear regression, while controlling for confounders (age profile, deprivation, ethnic group, and rurality).ResultsA total of 694 (8.41%) practices closed. A 10% increase in exposure to closure resulted in 1925.6 (95% confidence interval [CI] = 1675.8 to 2175.4) more patients in the practice with £2.37 (95% CI = £4.22 to £0.51) less funding per patient. While numbers of all staff types increased, there were 86.9 (95% CI = 50.5 to 123.3), 4.3%, more patients per GP. Increases for other staff types were proportionate to increases in patients. Patient satisfaction with services declined across all domains. No significant difference in Quality and Outcomes Framework (QOF) scores was identified.ConclusionHigher exposure to closure led to larger practice sizes in remaining practices. Closure of practices changes workforce composition and reduces patient satisfaction with services.

[...]a successful public health movement in the United States must make eliminating systemic racism a top priority. Had the federal government more closely monitored the deceptive advertising campaigns of Purdue Pharma, it could have countered the company's false messages to doctors, preventing tens of thousands of opioid deaths.11 In addition, continuingto allow industry sectors to use developments in science and technology-from digital data collection and precision agriculture to autonomous vehicles-without public accountability enables them to use this knowledge to benefit their bottom lines at the expense of public well-being, a likely cause for health crises of the next decade. [...]our nation needs to strengthen its democracy. According to the American Public Health Association, public health champions the health of all people and communities.

Aim: To generate and understand the process of change in the empowerment of women from 60 to 80 years old through a Participatory Action Research. Specific aim: To analyse the women participants' experiences concerning empowerment and self-care. Design: We use the Participatory Action Research approach (in its critical option) in the Socio-critical Paradigm and applying the Kemmis and McTaggart Model. Methods: A group of 10 women participants from 60 to 80 years old was created and developed the Participatory Action Research from June 2019 to May 2020. This group was involved in 22 group sessions, individual interviews, reflective diaries and triangulation with quantitative data. Results: Findings were interpreted based on the Gestalt Self Theory. Women generated changes in their empowerment based on three characteristics (self-determination, self-esteem and self-confidence) and, consequently, in their self-care. They did so according to two distinct patterns of behaviour: Leader women and follower women. The former took the lead in transforming their realities and the latter observed them and evolved in a slower and more reflective manner. These changes had an impact on the most individual level (inner world) and went beyond that barrier, modifying in turn their immediate surroundings and the social level (outer world). Conclusions: The group of older women began to consider their needs and consider themselves as important once they worked on their self-determination, self-esteem and self-confidence; we show these are key aspects to work on their empowerment and promote their self-care. Impact: The patterns of behaviour and dimensions of empowerment detected may help in future research designs and emancipatory community interventions in this population group. Sí

Objectives Low medication adherence is considered a cause of exacerbated diseases and greater economic losses. Hence, information strategies that improve patients’ willingness to take medications have received considerable attention. Newer information strategies that utilise the ‘peak-end rule’ proposed in behavioural economics were investigated in this study to advance strategy development. Methods An online scenario survey was conducted among adults aged 20–79 years in Japan. One of four medication counselling videos on a hypothetical hypertension drug narrated by a pharmacist was viewed by the respondents and their willingness to take the medication was evaluated. The four scenarios differed according to the presence or absence of risk probability and the order in which risk and benefit were provided. Key findings The responses of 383 participants were analysed and the results revealed that providing risk probability increased their willingness to take medication (3%), whereas the estimated risk probability by the participants was 28.7% on an average when no numerical probability was provided. Moreover, when risk probability was provided in a benefit/risk order, the willingness to take medication increased than in the risk/benefit order. Conclusions The participants’ willingness to take medication improved when the pharmacists provided risk probability; this helped participants comprehend that the risk probability was lesser than their assumptions. Moreover, the participants’ attention to the numeric information in medication counselling can be elicited by the peak-end rule. The findings from the hypothetical scenarios employed in this study merit further testing in real-life situations for clinical application., Research Papers

Cancer research is a crucial pillar for countries to deliver more affordable, higher quality, and more equitable cancer care. Patients treated in research-active hospitals have better outcomes than patients who are not treated in these settings. However, cancer in Europe is at a crossroads. Cancer was already a leading cause of premature death before the COVID-19 pandemic, and the disastrous effects of the pandemic on early diagnosis and treatment will probably set back cancer outcomes in Europe by almost a decade. Recognising the pivotal importance of research not just to mitigate the pandemic today, but to build better European cancer services and systems for patients tomorrow, the Lancet Oncology European Groundshot Commission on cancer research brings together a wide range of experts, together with detailed new data on cancer research activity across Europe during the past 12 years. We have deployed this knowledge to help inform Europe's Beating Cancer Plan and the EU Cancer Mission, and to set out an evidence-driven, patient-centred cancer research roadmap for Europe. The high-resolution cancer research data we have generated show current activities, captured through different metrics, including by region, disease burden, research domain, and effect on outcomes. We have also included granular data on research collaboration, gender of researchers, and research funding. The inclusion of granular data has facilitated the identification of areas that are perhaps overemphasised in current cancer research in Europe, while also highlighting domains that are underserved. Our detailed data emphasise the need for more information-driven and data-driven cancer research strategies and planning going forward. A particular focus must be on central and eastern Europe, because our findings emphasise the widening gap in cancer research activity, and capacity and outcomes, compared with the rest of Europe. Citizens and patients, no matter where they are, must benefit from advances in cancer research. This Commission also highlights that the narrow focus on discovery science and biopharmaceutical research in Europe needs to be widened to include such areas as prevention and early diagnosis; treatment modalities such as radiotherapy and surgery; and a larger concentration on developing a research and innovation strategy for the 20 million Europeans living beyond a cancer diagnosis. Our data highlight the important role of comprehensive cancer centres in driving the European cancer research agenda. Crucial to a functioning cancer research strategy and its translation into patient benefit is the need for a greater emphasis on health policy and systems research, including implementation science, so that the innovative technological outputs from cancer research have a clear pathway to delivery. This European cancer research Commission has identified 12 key recommendations within a call to action to reimagine cancer research and its implementation in Europe. We hope this call to action will help to achieve our ambitious 70:35 target: 70% average 10-year survival for all European cancer patients by 2035.

Fracture liaison services (FLS) are considered to be the most effective organizational approach for secondary fracture prevention. In this study, we evaluated whether FLS care was associated with reduced subsequent fracture and mortality risk over 3 years of follow-up. In total, 8682 consecutive patients aged 50-90 years with a recent fracture were included. Before FLS introduction, regular fracture treatment procedures were followed (pre-FLS). After FLS introduction, patients were invited to the FLS and FLS attenders were assessed for osteoporosis, prevalent vertebral fractures, metabolic bone disorders, medication use, and fall risk, and treatment for fracture prevention was initiated according to Dutch guidelines. All fractures were radiographically confirmed and categorized into major/hip (pelvis, proximal humerus or tibia, vertebral, multiple rib, distal femur) and non-major/non-hip (all other fractures). Mortality risk was examined using age and sex adjusted Cox proportional hazard models. For subsequent fracture risk, Cox proportional hazard models were adjusted for age, sex, and competing mortality risk (subdistribution hazard [SHR] approach). The pre-FLS group consisted of 2530 patients (72% women), of whom 1188 (46.9%) had major/hip index fractures, the post-FLS group consisted of 6152 patients (69% women), of whom 2973 (48.3%) had major/hip index fractures. In patients with a non-major/non-hip fracture there was no difference in subsequent non-major/non-hip fracture risk or mortality between pre-FLS and post-FLS. In patients with a major/hip index fracture, mortality risk was lower post-FLS (hazard ratio [HR] 0.84; 95% confidence interval [CI], 0.73-0.96) and subsequent major/hip fracture risk was lower in the first 360 days after index fracture post-FLS compared to pre-FLS (SHR 0.67; 95% CI, 0.52-0.87). In conclusion, FLS care was associated with a lower mortality risk in the first 3 years and a lower subsequent major/hip fracture risk in the first year in patients with a major/hip index fracture but not in patients with a non-major/non-hip fracture. (c) 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR). This study was funded by the research foundation of VieCuri Medical Center Noord-Limburg, The Netherlands and Stichting de Wijerhorst.

Although it is widely accepted that patients do better when evidence-based health care practices are used, there is less acknowledgment of the positive outcomes associated with evidence-based policy making. To address the need for high-quality evidence to inform mental health policies, Psychiatric Services has recently launched a new article format: the Policy Review. This review type defines a specific policy-relevant issue affecting behavioral health systems, describes current knowledge and limitations, and discusses policy implications. Reviews can focus on mental health policies or examine how other health or social policies affect people with mental illness or substance use disorders. This brief overview of the need for a policy review article type describes differences between evidence-based policy making and practices and looks at research approaches focused on evidence-based policy making, as well as legislative and other efforts to support it. Broad guidelines for potential submissions are also provided.

The Pediatric Emergency Medicine (PEM) Point-of-care Ultrasound (POCUS) Network (P2Network) was established in 2014 to provide a platform for international collaboration among experts, including multicenter research. The objective of this study was to use expert consensus to identify and prioritize PEM POCUS topics, to inform future collaborative multicenter research.Online surveys were administered in a two-stage, modified Delphi study. A steering committee of 16 PEM POCUS experts was identified within the P2Network, with representation from the United States, Canada, Italy, and Australia. We solicited the participation of international PEM POCUS experts through professional society mailing lists, research networks, social media, and "word of mouth." After each round, responses were refined by the steering committee before being reissued to participants to determine the ranking of all the research questions based on means and to identify the high-level consensus topics. The final stage was a modified Hanlon process of prioritization round (HPP), which emphasized relevance, impact, and feasibility.Fifty-four eligible participants (16.6%) provided 191 items to Survey 1 (Round 1). These were refined and consolidated into 52 research questions by the steering committee. These were issued for rating in Survey 2 (Round 2), which had 45 participants. At the completion of Round 2, all questions were ranked with six research questions reaching high-level consensus. Thirty-one research questions with mean ratings above neutral were selected for the HPP round. Highly ranked topics included clinical applications of POCUS to evaluate and manage children with shock, cardiac arrest, thoracoabdominal trauma, suspected cardiac failure, atraumatic limp, and intussusception.This consensus study has established a research agenda to inform future international multicenter PEM POCUS trials. This study has highlighted the ongoing need for high-quality evidence for PEM POCUS applications to guide clinical practice.

BackgroundThere are inequalities in the geographical distribution of the primary care workforce in England. Primary Care Networks (PCNs), and the associated Additional Roles Reimbursement Scheme (ARRS) funding, has stimulated employment of new healthcare roles. However, it is not clear whether this will impact inequalities. AimTo examine whether the ARRS impacted inequality in the distribution of primary care workforce.Design and SettingA retrospective before-and-after study of English PCNs in 2019 and 2022MethodsWe combined workforce, population and deprivation data at network-level for March 2019 and March 2022. We estimated the change between 2019 and 2022 in the Slope Index of Inequality (SII) across deprivation of full-time equivalent general practitioners (total doctors, qualified GPs and doctors-in-training), nurses, other direct patient care (ARRS and non-ARRS staff), administrative, and total staff per 10,000 patients.Results1255 networks were included. Nurses and qualified GPs decreased in number whilst all other staff roles increased, with ARRS staff having the greatest increase. There was a pro-rich change in the SII for administrative staff (-0.482 (95% CI: -0.841, -0.122)) and a pro-poor change for doctors-in-training (0.161 (0.049, 0.274)). Changes in distribution of all other staff types were not statistically significant. ConclusionThe distribution of administrative staff became less pro-poor and of doctors-in-training became pro-poor between 2019 and 2022. The changes in inequality in all other staff groups were mixed. The introduction of PCNs has not substantially changed the longstanding inequalities in the geographical distribution of primary care workforce.

Objective: To report and discuss the experience of the Circle of Culture in a school space, with attention to the social identity of adolescents. Method: Action research, conducted under the assumptions of the Circle of Culture, from August to December 2019. Participants were 16 adolescents, enrolled in Elementary School, in a state public school, in the rural district of a city of São Paulo. Data collection took place through photographic records, participant observation and field diary. Results: The relations of friendship were the central agenda of the Circles of Culture when dialogues about their structuring and influence on the identity construction were developed. Conclusion: Circles of Culture mediated by health professionals in the school setting have the power to problematize the reality of each adolescent’s life and, simultaneously, dialogue about the common, an aspect that empowers identity projects. RESUMEN Objetivo: Relatar y discutir la experiencia del Círculo de Cultura en un espacio escolar, con atención a la identidad social de los adolescentes. Método: Investigación-acción, realizada bajo los supuestos del Círculo de Cultura, de agosto a diciembre de 2019. Participaron 16 adolescentes, matriculados en la Enseñanza Fundamental, en una escuela pública, en el distrito rural de una ciudad de São Paulo. La recolección de datos se realizó a través de registros fotográficos, observación participante y diario de campo. Resultados: Las relaciones de amistad fueron catalogadas como la agenda de los Círculos de Cultura, cuando los diálogos de su estructuración e influencia en la construcción identitaria fueron ofrecidos. Conclusión: Los Círculos de Cultura mediados por profesionales de la salud en el ámbito escolar tienen el poder de problematizar la realidad particular de la vida de cada adolescente y, simultáneamente, dialogar sobre lo común, aspecto que potencia para proyectos identitarios. RESUMO Objetivo: Relatar e discutir a experiência do Círculo de Cultura em espaço escolar, com atenção a identidade social de adolescentes. Método: Pesquisa-ação, realizada sob pressupostos do Círculo de Cultura, no período de agosto a dezembro de 2019. Participaram 16 adolescentes, matriculados no Ensino Fundamental, em escola pública estadual, do distrito rural de uma cidade do interior paulista. A coleta dos dados deu-se por registros fotográficos, observação participante e diário de campo. Resultados: As relações de amizade foram elencadas como pauta dos Círculos de Cultura, quando foi oportunizado diálogos de seus estruturantes e influência na construção identitária. Conclusão: Círculos de Cultura mediado por profissionais de saúde no cenário escolar tem potência para problematizar a realidade particular da vida de cada adolescente e, simultaneamente dialogar sobre o comum, aspecto que empodera para projetos identitários.

Introduction: Stakeholder engagement remains scarce in basic brain research. However, it can greatly improve the relevance of investigations and accelerate the translation of study findings to policy. The Lifebrain consortium investigated risk and protective factors influencing brain health using cognition, lifestyle and imaging data from European cohorts. Stakeholder activities of Lifebrain—organized in a separate work package—included organizing stakeholder events, investigating public perceptions of brain health and dissemination. Here, we describe the experiences of researchers and stakeholders regarding stakeholder engagement in the Lifebrain project. Methods: Stakeholder engagement in Lifebrain was evaluated through surveys among researchers and stakeholders and stakeholders' feedback at stakeholder events through evaluation forms. Survey data were analysed using a simple content analysis approach, and results from evaluation forms were summarized after reviewing the frequency of responses. Results: Consortium researchers and stakeholders experienced the engagement activities as meaningful and relevant. Researchers highlighted that it made the research and research processes more visible and contributed to new networks, optimized data collection on brain health perceptions and the production of papers and provided insights into stakeholder views. Stakeholders found research activities conducted in the stakeholder engagement work package to be within their field of interest and research results relevant to their work. Researchers identified barriers to stakeholder engagement, including lack of time, difficulties in identifying relevant stakeholders, and challenges in communicating complex scientific issues in lay language and maintaining relationships with stakeholders over time. Stakeholders identified barriers such as lack of budget, limited resources in their organization, time constraints and insufficient communication between researchers and stakeholders. Conclusion: Stakeholder engagement in basic brain research can greatly benefit researchers and stakeholders alike. Its success is conditional on dedicated human and financial resources, clear communication, transparent mutual expectations and clear roles and responsibilities. Public Contribution: Patient organizations, research networks, policymakers and members of the general public were involved in engagement and research activities throughout the project duration.

Background: Oral health during pregnancy is of high importance because of the impacts physiological alterations have on oral health and because adverse pregnancy outcomes can result from oral and dental conditions. Previous studies demonstrated a high dental visit avoidance among pregnant women due to barriers such as cost and misbeliefs. Objectives: The main objective of this thesis was to investigate the unmet dental and oral needs during pregnancy, and associated factors, through two complementary studies. Methods: A systematic literature review was conducted regarding misbeliefs about oral health and dental visits during pregnancy. A survey-based study was conducted on a clinic-based sample of pregnant women in London, Ontario. Results: The most common misbeliefs discussed in the 45 studies included in our Systematic Review were related to the safety of dental care services utilization and treatments, and the supposed impacts of pregnancy on oral health. The pilot study recruited 67 of 76 eligible subjects, of whom 76.1% reported having good to excellent oral health and 82.1% had visited a dentist within the last two years. Of 51 who had no dental visit during pregnancy, 12 believed it was not necessary, while cost was a barrier for 18 individuals. Age (p=0.001), education (p=0.003), and dental flossing frequency (p=0.035) were significantly associated with self-reported oral health. Women with dental insurance (p=0.022) and good to excellent oral health status (p=0.029) were more likely to have visited a dentist within the last two years. Oral health status and dental visit patterns of the study sample were poorer than the Canadian general population, and may reflect the clinic which was a disadvantaged population. Conclusion: Educational interventions regarding oral health awareness and policies improving access to dental insurance may improve the unmet oral and dental needs and access to dental care services. Further analyses of more diverse populations and larger samples are required to provide a better understanding of the unmet oral needs and dental visit patterns during pregnancy.

Sequential socioeconomic shocks, including the COVID-19 pandemic, economic recession, or energy and refugee crises in the face of violent conflicts, have led to the failure of healthcare systems in Europe. Against this background, the aim of this study was to evaluate the resilience of regional gynecological and obstetric inpatient care using the example of a regional core medical provider in central Germany. Base data were retrieved from Marburg University Hospital and underwent standardized calculation and descriptive statistical assessment pursuant to the aG-DRG catalog. The data illustrate a decline in the average length of patient stays and average case complexity in combination with increasing patient turnover for the six-year observation period of 2017–2022. Core profitability of the departments of gynecology and obstetrics deteriorated in the year of 2022. The results suggest weakened resilience of gynecological and obstetrics inpatient care in the setting of a regional core medical provider in central Germany and indicate how it may have failed in core economic profitability. This is consistent with predictions about the lack of resilience of health systems and the critical economic situation of German hospitals in the face of ongoing socioeconomic shocks that collaterally endanger women’s health care.

Background: The participation of health professionals in designing interventions is considered vital to effective implementation, yet in areas such as clinical coordination is rarely promoted and evaluated. This study, part of Equity-LA II, aims to analyse the design process of interventions to improve clinical coordination, taking a participatory-action-research (PAR) approach, in healthcare networks of Argentina, Brazil, Chile, Colombia, Mexico and Uruguay. This participatory process was planned in four phases, led by a local steering committee (LSC): (1) dissemination of problem analysis results and creation of professionals' platform, (2) selection of problems and intervention (3) intervention design and planning (4) adjustments after evaluation of first implementation stage.Methods: A descriptive qualitative study based on documentary analysis, using a topic guide, was conducted in each intervention network. Documents produced regarding the intervention design process were selected. Thematic content analysis was conducted, generating mixed categories taken from the topic guide and identified from data. Main categories were LSC characteristics, type of design process (phases, participants' roles, methods) and associated difficulties, coordination problems and interventions selected.Results: LSCs of similar composition (managers, professionals and researchers) were established, with increasing membership in Chile and high turnover in Argentina, Colombia and Mexico. Following results dissemination and selection of problems and interventions (more participatory in Chile and Colombia: 200–479 participants), the interventions were designed and planned, resulting in three different types of processes: (1) short initial design with adjustments after first implementation stage, in Colombia, Brazil and Mexico; (2) longer, more participatory process, with multiple cycles of action/reflection and pilot tests, in Chile; (3) open-ended design for ongoing adaptation, in Argentina and Uruguay. Professionals' time and the political cycle were the main barriers to participation. The clinical coordination problem selected was limited communication between primary and secondary care doctors. To address it, through discussions guided by context and feasibility criteria, interventions based on mutual feedback were selected.Conclusions: As expected in a flexible PAR process, its rollout differed across countries in participation and PAR cycles. Results show that PAR can help to design interventions adapted to context and offers lessons that can be applied in other contexts.

Background Physical activity (PA) literature is dominated by individual-level descriptive studies, which are known to have limited impact on population PA levels. Leveraging systems science methods offers opportunities to approach PA in a manner which embraces its inherent complexity. This study describes how participatory systems mapping and social network analysis (SNA) were used to understand the work of local and national level walking systems in Ireland. Methods Two adapted participatory action research workshops with multisectoral stakeholders were used to develop a systems map for walking in Cork, Ireland. The Global Action Plan for Physical Activity 2018–2030 (GAPPA) map was used as a framework to categorize workshop outcomes. Secondly, SNA methods were used to analyse the communication network between partners of Get Ireland Walking, a national walking promotion initiative, as defined within their strategic plan and the actual communication network as experienced by the partners. Results The systems mapping process allowed stakeholders to identify 19 suggested actions for the Cork walking system. The SNA found that there were considerably fewer communication ties between partners in the actual communication network than in the strategy defined network. Conclusion The systems mapping process was a useful catalyst for engaging stakeholders in cross-sectoral communication and the GAPPA was a practical way to organize workshop outcomes. Social network analysis methods highlighted that the communication network of a national level walking promotion partnership is not working as planned. Overall, the use of systems science methods can provide practical insights for local and national level walking systems.

This article contains the largest analysis of pRBC transfusion and renal angiogram in inpatient pediatric patients. We provide accurate estimates of rates of pRBC transfusion and renal angiography after kidney biopsy in inpatient pediatric patients.

Provider- and claims-focused administrative databases are powerful tools for conducting health services research, and these studies often have good generalizability owing to diversity of hospitals from which samples are derived. In this research methods article, we describe administrative data and how available provider- and claims-focused administrative databases can be used to conduct health services research. We describe common observational study designs using administrative data and provide real-world examples. We highlight the strengths and weaknesses of studies conducted using administrative data and describe methodological considerations to reduce bias and improve the rigor of observational studies using administrative data. Finally, we provide guidance on the types of study questions suitable for observational study designs using administrative data.

Clinical relevance Physical activity is an essential part of childhood physical and mental development. Recent research identified visual problems associated with a sedentary lifestyle in children in Ireland. Background This study explored the association between visual function in children and their engagement with physical activities outside school. Methods Participants were 1,626 schoolchildren (728 aged 6–7 years, 898 old 12–13 years) in randomly selected schools in Ireland. Before data collection, parents/legal guardians of participants completed a standardised questionnaire reporting physical activity as no activity (mostly on screens), light activity (occasional walking/cycling), moderate activity (/week engaged in sports), or regular activity (>3hrs/week been involved in sports). Measurements included logMAR monocular visual acuities (with spectacles and pinhole), in the distance (3 m) and near (40 cm), stereoacuity (TNO stereo-test), cover test, and cycloplegic autorefraction (1% cyclopentolate). Results Controlling for confounders (socioeconomic disadvantage and non-White ethnicity), linear regression analysis revealed presenting distance visual acuity, near visual acuity, and stereoacuity were significantly better amongst participants who reported regular physical activity rather than moderate light or no activity in both 6–7-year-old and 12–13-year-old participants. Absence of clinically-significant refractive error (>−0.50D

Purpose This discursive paper presents a lived experience leadership model as developed as part of the Activating Lived Experience Leadership (ALEL) project to increase the recognition and understanding of lived experience leadership in mental health and social sectors. The model of lived experience leadership was formulated through a collaboration between the South Australian Lived Experience Leadership & Advocacy Network and the Mental Health and Suicide Prevention Research and Education Group. Design/methodology/approach As one of the outcomes of the ALEL research project, this model incorporates findings from a two-year research project in South Australia using participatory action research methodology and cocreation methodology. Focus groups with lived experience leaders, interviews with sector leaders and a national survey of lived experience leaders provided the basis of qualitative data, which was interpreted via an iterative and shared analysis. This work identified intersecting lived experience values, actions, qualities and skills as characteristics of effective lived experience leadership and was visioned and led by lived experience leaders. Findings The resulting model frames lived experience leadership as a social movement for recognition, inclusion and justice and is composed of six leadership actions: centres lived experience; stands up and speaks out; champions justice; nurtures connected and collective spaces; mobilises strategically; and leads change. Leadership is also guided by the values of integrity, authenticity, mutuality and intersectionality, and the key positionings of staying peer and sharing power. Originality/value This model is based on innovative primary research, which has been developed to encourage understanding across mental health and social sectors on the work of lived experience leaders in seeking change and the value that they offer for systems transformation. It also offers unique insights to guide reflective learning for the lived experience and consumer movement, workers, clinicians, policymakers and communities.

BackgroundNetwork meta-analysis (NMA) is increasingly used in guideline development and other aspects of evidence-based decision-making. We aimed to develop a risk of bias (RoB) tool to assess NMAs (RoB NMA tool). An international steering committee recommended that the RoB NMA tool to be used in combination with the Risk of Bias in Systematic reviews (ROBIS) tool (i.e. because it was designed to assess biases only) or other similar quality appraisal tools (eg, A MeaSurement Tool to Assess systematic Reviews 2 [AMSTAR 2]) to assess quality of systematic reviews. The RoB NMA tool will assess NMA biases and limitations regarding how the analysis was planned, data were analysed and results were presented, including the way in which the evidence was assembled and interpreted.ObjectivesConduct (a) a Delphi process to determine expert opinion on an item’s inclusion and (b) a knowledge user survey to widen its impact.DesignCross-sectional survey and Delphi process.MethodsDelphi panellists were asked to rate whether items should be included. All agreed-upon item were included in a second round of the survey (defined as 70% agreement). We surveyed knowledge users’ views and preferences about the importance, utility and willingness to use the RoB NMA tool to evaluate evidence in practice and in policymaking. We included 12 closed and 10 open-ended questions, and we followed a knowledge translation plan to disseminate the survey through social media and professional networks.Results22 items were entered into a Delphi survey of which 28 respondents completed round 1, and 22 completed round 2. Seven items did not reach consensus in round 2. A total of 298 knowledge users participated in the survey (14% respondent rate). 75% indicated that their organisation produced NMAs, and 78% showed high interest in the tool, especially if they had received adequate training (84%). Most knowledge users and Delphi panellists preferred a tool to assessbothbias in individual NMA resultsandauthors’ conclusions. Response bias in our sample is a major limitation as knowledge users working in high-income countries were more represented. One of the limitations of the Delphi process is that it depends on the purposive selection of experts and their availability, thus limiting the variability in perspectives and scientific disciplines.ConclusionsThis Delphi process and knowledge user survey informs the development of the RoB NMA tool.

OBJECTIVE: Children with complex health needs (CCHN) have both medical (e.g., chronic conditions) and health-related social needs (e.g., potentially adverse social determinants of health) that require ongoing healthcare and support from multiple community service providers. National standards developed for populations defined by health needs (CYSHCN) provide a framework for stakeholders to plan system-level improvements in care delivery for CCHN, but improvement efforts should reflect the priorities of their families and providers. This article describes a process of prioritizing system-level efforts to improve the health and well-being of CCHN and families in North Carolina (NC), using systematic stakeholder engagement and modified Delphi expert ratings. METHODS: We surveyed stakeholders with experience caring for CCHN using an open-ended, 3-item instrument to identify opportunities to improve systems of care. Using directed qualitative content analysis, we synthesized responses into a master list of potential improvement topics. Using a modified Delphi approach, a 16-member advisory committee rated all topics for importance and urgency, on 9-point Likert scales over two rounds; then ratings for each topic were ranked (low, medium, high) to establish relative priority. RESULTS: 47 individuals from 31 counties around NC provided survey responses, yielding 59 improvement topics in 10 domains. Through the modified Delphi method process, 21 topics (36%) received the highest rankings, largely representing access to community- and home-based services, equity, and enhancement of the pediatric workforce. CONCLUSIONS: Priorities identified by stakeholders will inform advocacy, policy, and improvement efforts. Next steps for the coalition include developing improvement projects to implement stakeholder-recommended actions for the highest-priority topics.

Studies have highlighted common challenges and barriers to patient engagement in research, but most were based on patient partners' or academic researchers' experiences. A better understanding of how both groups differentially experience their partnership could help identify strategies to improve collaboration in patient engagement research.This study aimed to describe and compare patient partners' and academic researchers' experiences in patient engagement research.Based on a participatory approach, a descriptive qualitative study was conducted with patient partners and academic researchers who are involved in the PriCARE research programme in primary health care to examine their experience of patient engagement. Individual semi-structured interviews with patient partners (n = 7) and academic researchers (n = 15) were conducted. Academic researchers' interview verbatims, deidentified patient partners' summaries of their interviews and summaries of meetings with patient partners were analysed using inductive thematic analysis in collaboration with patient partners.Patient partners and academic researchers' experiences with patient engagement are captured within four themes: (1) evolving relationships; (2) creating an environment that fosters patient engagement; (3) striking a balance; and (4) impact and value of patient engagement. Evolving relationships refers to how partnerships grew and improved over time with an acceptance of tensions and willingness to move beyond them, two-way communication and leadership of key team members. Creating an environment that fosters patient engagement requires appropriate structural support, such as clear descriptions of patient partner roles; adequate training for all team members; institutional guidance on patient engagement; regular and appropriate translation services; and financial assistance. For patient partners and academic researchers, striking a balance referred to the challenge of reconciling patient partners' interests and established research practices. Finally, both groups recognized the value and positive impact of patient engagement in the programme in terms of improving the relevance of research and the applicability of results. While patient partners and academic researchers identified similar challenges and strategies, their experiences of patient engagement differed according to their own backgrounds, motives and expectations.Both patient partners and academic researchers highlighted the importance of finding a balance between providing structure or guidelines for patient engagement, while allowing for flexibility along the way.Patient partners from the PriCARE research programme were involved in the following aspects of the current study: (1) development of the research objectives; (2) planning of the research design; (3) development and validation of data collection tools (i.e., interview guides); (4) production of data (i.e., acted as interviewees); (5) validation of data analysis tools (code book); (6) analysis of qualitative data; and (7) drafting of the manuscript and contributing to other knowledge translation activities, such as conference presentations and the creation of a short animated video.

Objectives: We assessed if using a biographical method, social biography, alongside photovoice, and the Five Whys could facilitate critical dialogue in a youth participatory action research (YPAR) context. Method: In a YPAR program, we added social biography to photovoice and the Five Whys during the problem definition phase. We coded ethnographic fieldnotes to examine the quality of critical discourse. Participants were six 10-11 year old Latinx children, some from mixed-status families. Results: Social biography enlivened critical dialogue when children defined the problem for their project: the accountability of la migra, or Immigration and Customs Enforcement (ICE). Conclusions: Social biography is a valuable tool for democratizing knowledge production with children through a liberatory framework. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

OBJECTIVES In recent years, increased anti-immigrant hostility has trickled into school settings creating toxic climates for immigrant-origin (I-O) students (Rogers, School and society in the age of trump, 2019, UCLA's Institute for Democracy, Education, and Access). Through youth participatory action research (yPAR), this study qualitatively examined how a class of Emerging Bilingual (EB) students aimed to promote more inclusive learning environments by designing, implementing, and evaluating a school-wide program. Here, we consider how the students experienced growth in their civic development as well as how they contended with resistances encountered during the project. METHODS The current study took place at a majority I-O, northeastern high school and was led by an EB class (n = 20) and its teacher. Participants were as follows: on average 16.5 years; 60% female; and 65% Latinx, 30% Black, and 5% mixed-race (Black-Latino). Multiple data sources documenting the students' experiences were collected (including weekly student reflections and ethnographic field notes) and then thematically analyzed using open coding. RESULTS Participating students demonstrated civic development as evidenced through: growing confidence that the program could generate positive change; enhanced sense of connection toward their classmates; and increased commitment to future civic engagement. Nonetheless, some participants demonstrated initial trepidation in both disclosing their migration stories as well as the potential efficacy of engaging in the project. Furthermore, others were disappointed by the disinterest displayed by some of their peers and teachers. CONCLUSIONS Collaborative research can support I-O youths' civic development, though, the resistances encountered and engendered illuminate possible challenges to ensure its benefits. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BACKGROUND: The Ending the HIV Epidemic (EHE) initiative set a goal to virtually eliminate new HIV infections in the US by 2030. The plan is predicated on the fact that tools exist for diagnosis, prevention, and treatment and the current scientific challenge is how to implement them effectively and with equity. Implementation research (IR) can help identify strategies that support effective implementation of HIV services. SETTING: NIH funded the Implementation Science Coordination Initiative (ISCI) to support rigorous and actionable IR by providing technical assistance to NIH-funded projects and supporting local implementation knowledge becoming generalizable knowledge. METHODS: We describe the formation of ISCI, the services it provided to the HIV field, and data it collected from 147 NIH-funded studies. We also provide an overview of this supplement issue as a dissemination strategy for HIV IR. CONCLUSION: Our ability to reach EHE 2030 goals is strengthened by the knowledge compiled in this supplement, the services of ISCI and connected hubs, and a myriad of investigators and implementation partners collaborating to better understand what is needed to effectively implement the many evidence-based HIV interventions at our disposal.

There has been an increasing emphasis on placing patients at the center of clinical care and health care research and, in particular, assessing outcomes and experiences from the patient's perspective. One of the most widely used patient-reported outcome instruments is the Veterans RAND 12-item Health Survey (VR-12). This article reviews the VR-12 development and its applications over the last 2 decades, including research and potential uses in clinical care.

The context of child prosthetics is a complex and important area for research and innovation. Yet, like many areas of paediatric medical technology development, there are several barriers to innovating specifically for the unique needs of children (i.e., a relatively small patient population or 'market'). As such, much child prosthetics technology is developed from the downsizing of adult prosthetics, leading to suboptimal outcomes for children and young people. Since 2016, the Starworks Child Prosthetics Research Network has been exploring this space, bringing children and their families together with key opinion leaders from the NHS, clinical Academia and leading National Research Centres with capabilities in child prosthetics with the aim of increasing research across the system. Above all else, Starworks is centred on the needs of children and their families, ensuring they have an equal voice in driving the ongoing research agenda. This article will share key learnings from the creation and development of the Starworks Network that may be applicable and/or adaptable across a wider paediatric medical technology research and innovation landscape. In particular it will discuss how it addressed three key aims of; (1) Addressing child-specific issues; (2) Building a sustainable network; and (3) Fostering impactful innovation.

IntroductionCivil–military cooperation (CMC) in infectious disease outbreak responses has become more common, and has its own cooperation dynamics. These collaborations fit WHO’s call for multisectoral cooperation in managing health emergencies according to the emergency management cycle (EMC). However, the literature on CMC on this topic is fragmented. The core aim of this review is to understand the breadth and dynamics of this cooperation by using the EMC as a framework and by identifying challenges and opportunities in the management of outbreaks.MethodsA scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline was conducted. A systematic search for peer-reviewed journals was performed in PubMed, Embase, Web of Science and Scopus. Eligible papers addressed substantive contributions to the understanding of CMC. Papers were categorised by EMC phase and relevant information on study characteristics and areas of cooperation were extracted from the data. Recurring themes on challenges and opportunities in cooperation were identified by means of qualitative interpretation analysis.ResultsThe search resulted in 8360 papers; 54 were included for analysis. Most papers provided a review of activities or expert opinions. CMC was described in all EMC phases, with the fewest references in the recovery phase (n=1). In total, eight areas of CMC were explored. Regarding the better understanding of cooperative dynamics, the qualitative analysis of the papers yielded five recurring themes covering challenges and opportunities in CMC: managing relations, framework conditions, integrating collective activities, governance and civil–military differences.ConclusionGuided by these five themes, successful CMC requires sustainable relations, binding agreements, transparency, a clear operational perspective and acknowledgement of organisational cultural differences. Early and continuous engagement proves crucial to avoid distrust and tension among stakeholders, frequently caused by differences in strategical goals. Original research on this topic is limited.

Introduction Civil-military cooperation (CMC) in infectious disease outbreak responses has become more common, and has its own cooperation dynamics. These collaborations fit WHO's call for multisectoral cooperation in managing health emergencies according to the emergency management cycle (EMC). However, the literature on CMC on this topic is fragmented. The core aim of this review is to understand the breadth and dynamics of this cooperation by using the EMC as a framework and by identifying challenges and opportunities in the management of outbreaks. Methods A scoping review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guideline was conducted. A systematic search for peer-reviewed journals was performed in PubMed, Embase, Web of Science and Scopus. Eligible papers addressed substantive contributions to the understanding of CMC. Papers were categorised by EMC phase and relevant information on study characteristics and areas of cooperation were extracted from the data. Recurring themes on challenges and opportunities in cooperation were identified by means of qualitative interpretation analysis. Results The search resulted in 8360 papers; 54 were included for analysis. Most papers provided a review of activities or expert opinions. CMC was described in all EMC phases, with the fewest references in the recovery phase (n=1). In total, eight areas of CMC were explored. Regarding the better understanding of cooperative dynamics, the qualitative analysis of the papers yielded five recurring themes covering challenges and opportunities in CMC: managing relations, framework conditions, integrating collective activities, governance and civil-military differences. Conclusion Guided by these five themes, successful CMC requires sustainable relations, binding agreements, transparency, a clear operational perspective and acknowledgement of organisational cultural differences. Early and continuous engagement proves crucial to avoid distrust and tension among stakeholders, frequently caused by differences in strategical goals. Original research on this topic is limited.

Objective Participation in healthcare research shapes health policy and practice; however, low trust is a barrier to participation. We evaluated whether returning health information (information transparency) and disclosing intent of data use (intent transparency) impacts trust in research. Materials and Methods We conducted an online survey with a representative sample of 502 US adults. We assessed baseline trust and change in trust using 6 use cases representing the Social-Ecological Model. We assessed descriptive statistics and associations between trust and sociodemographic variables using logistic and multinomial regression. Results Most participants (84%) want their health research information returned. Black/African American participants were more likely to increase trust in research with individual information transparency (odds ratio (OR) 2.06 [95% confidence interval (CI): 1.06–4.34]) and with intent transparency when sharing with chosen friends and family (3.66 [1.98–6.77]), doctors and nurses (1.96 [1.10–3.65]), or health tech companies (1.87 [1.02–3.40]). Asian, Native American or Alaska Native, Native Hawaiian or Pacific Islander, Multirace, and individuals with a race not listed, were more likely to increase trust when sharing with health policy makers (1.88 [1.09–3.30]). Women were less likely to increase trust when sharing with friends and family (0.55 [0.35–0.87]) or health tech companies (0.46 [0.31–0.70]). Discussion Participants wanted their health information returned and would increase their trust in research with transparency when sharing health information. Conclusion Trust in research is influenced by interrelated factors. Future research should recruit diverse samples with lower baseline trust levels to explore changes in trust, with variation on the type of information shared.

In questo rapporto nazionale, presentiamo i risultati descrittivi del sondaggio SPOTnat (Spitex Coordinazione e Qualità - uno studio nazionale), condotto da gennaio 2021 e settembre 2021 presso 88 organizzazioni di Spitex (cura a domicilio) in Svizzera. Hanno risposto al questionario, 3223 dipendenti Spitex, 1509 clienti e 1165 parenti. L’obiettivo di questa indagine è stato quello di analizzare il coordinamento e la qualità dell’assistenza, la qualità dell’ambiente lavorativo e i risultati legati al personale come, ad esempio, la soddisfazione sul lavoro o la propensione alle dimissioni. English: In in this national report, we present the descriptive results of the SPOTnat survey (home care coordination and quality - a national study), which was conducted from January 2021 to September 2021 in 88 home care organizations in Switzerland. 3.223 home care employees, 1.509 clients and 1.165 relatives were surveyed. The focus of this survey was on coordination and quality of care, the quality of the work environment and personnel outcomes, e.g., job satisfaction or the intention to quit., This report is available in German, French and Italian.

ObjectivesTo compare success of applicants to specialty training posts in the UK by gender, ethnicity and disability status.DesignCross-sectional observational study.SettingNational Health Service, UK.ParticipantsAll specialty training post applications to Health Education England, UK, during the 2021–2022 recruitment cycle.InterventionNil.Primary and secondary outcome measuresComparison of success at application to specialty training posts by gender, ethnicity, country of qualification (UK vs non-UK) and disability. The influence of ethnicity on success was investigated using a logistic regression model, where country of qualification was included as a covariate.Results12 419/37 971 (32.7%) of applicants to specialty training posts were successful, representing 58 specialties. The difference in percentage of successful females (6480/17 523, 37.0%) and males (5625/19 340, 29.1%) was 7.9% (95% CI 6.93% to 8.86%), in favour of females. Segregation of applications to specialties by gender was observed; surgical specialties had the highest proportion of male applicants, while obstetrics and gynaecology had the highest proportion of female applicants. The proportion of successful recruits to specialties largely reflected the number of applications. 11/15 minority ethnic groups (excluding ‘not stated’) had significantly lower adjusted ORs for success compared with white-British applicants. ‘Mixed white and black African’ (OR 0.52, 95% CI 0.44 to 0.61, p≤0.001) were the least successful minority group in our study, while non-UK graduates had an adjusted ORs for success of 0.43 (95% CI 0.41 to 0.46, p≤0.001) compared with UK graduates. The difference in percentage of success by disabled applicants (179/464, 38.6%) and non-disabled applicants (11 940/36 418, 32.8%) was 5.79% (95% CI 1.23% to 10.4%), in favour of disabled applicants. No disabled applicants were accepted to 21/58 (36.2%) of specialties.ConclusionsDespite greater success by female applicants overall, there is an attraction issue to specialties by gender. Further, most ethnic minority groups are less successful at application when compared with white-British applicants. This requires continuous monitoring and evaluation of the reasons behind observed differences.Trial RegistrationNot applicable.

Health services research increasingly uses commercial databases that capture provider practice characteristics. Little is known about how these data sets compare along other dimensions with publicly available data. We assess the quality of one of the most commonly used commercial databases, SK&A’s office-based physician database, for capturing oncologists who bill the Medicare fee-for-service program. Using 2017 data, we find that nearly 74% of the oncologists in Medicare claims can be found in the SK&A data. Weighted by patients, service volume, or spending, match rates increase to 77%, 96%, and 92%, respectively. Matched oncologists have a high concordance (above 95%) on subspecialty as well as contact information other than street address. Oncologists who appear only in Medicare tend to have low service volumes and spending relative to those who are matched while over half of oncologists who appear only in SK&A have a pediatric subspecialty.

ObjectiveDigital symptom-checkers (SCs) have potential to improve rheumatology triage and reduce diagnostic delays. In addition to being accurate, SCs should be user friendly and meet patient’s needs. Here, we examined usability and acceptance ofRheumatic?—a new and freely available online SC (currently with >44 000 users)—in a real-world setting.MethodsStudy participants were recruited from an ongoing prospective study, and included people ≥18 years with musculoskeletal complaints completingRheumatic?online. The user experience survey comprised five usability and acceptability questions (11-point rating scale), and an open-ended question regarding improvement ofRheumatic?Data were analysed in R using t-test or Wilcoxon rank test (group comparisons), or linear regression (continuous variables).ResultsA total of 12 712 people completed the user experience survey. The study population had a normal age distribution, with a peak at 50–59 years, and 78% women. A majority foundRheumatic?useful (78%), thought the questionnaire gave them an opportunity to describe their complaints well (76%), and would recommendRheumatic?to friends and other patients (74%). Main shortcoming was that 36% thought there were too many questions. Still, 39% suggested more detailed questions, and only 2% suggested a reduction of questions.ConclusionBased on real-world data from the largest user evaluation study of a digital SC in rheumatology, we conclude thatRheumatic?is well accepted by women and men with rheumatic complaints, in all investigated age groups. Wide-scale adoption ofRheumatic?, therefore, seems feasible, with promising scientific and clinical implications on the horizon.

BACKGROUND: Although home care workers (HCWs) are increasingly caring for adults with heart failure (HF), many feel unprepared and lack HF training. To serve as the foundation for a future educational intervention, we aimed to elicit HCWs’ HF educational needs. METHODS: We partnered with the largest healthcare union in the US to recruit 41 HCWs employed by 17 home care agencies. Using the nominal group technique, we asked HCWs to respond to 3 questions: When caring for a HF patient: (1) What information do you want? (2) What symptoms worry you? (3) What situations do you struggle with? Participants ranked their responses by priority. Data were consolidated by question. RESULTS: For question 1, participants ranked HF signs and symptoms most highly, followed by HF treatment and medications. For question 2, chest pain was most worrisome, followed by neurologic changes and shortness of breath. For question 3, participants struggled with encouraging patients to follow a heart-specific diet. CONCLUSIONS: HCWs expressed a need to learn more about signs and symptoms of HF and ways to assist patients with HF self-care. These findings can inform the development of a HF training program for HCWs that specifically addresses their expressed needs.

Background Evidence on the health impacts of social conditions has led US healthcare systems to consider identifying and addressing social adversity—e.g. food, housing, and transportation insecurity—in care delivery settings. Social screening is one strategy being used to gather patient information about social circumstances at the point of care. While several recent studies describe the rapid proliferation of social screening activities, little work has explored either why or how to implement social screening in clinical settings. Our study objectives were to assess diverse healthcare stakeholder perspectives on both the rationale for social screening and evidence needed to inform practice and policy-relevant implementation decisions. Methods We convened five focus groups with US experts representing different stakeholder groups: patient advocates, community-based organizations, healthcare professionals, payers, and policymakers. In total, 39 experts participated in approximately 90-minute long focus groups conducted between January-March 2021. A inductive thematic analysis approach was used to analyze discussions. Results Three themes emerged from focus groups, each reflecting the tension between the national enthusiasm for screening and existing evidence on the effectiveness and implementation of screening in clinical settings: (1) ambiguity about the rationale for social screening; (2) concerns about the relavence of screening tools and approaches, particularly for historically marginalized populations; (3) lack of clarity around the resources needed for implementation and scaling. Conclusion While participants across groups described potential benefits of social screening, they also highlighted knowledge gaps that interfered with realizing these benefits. Efforts to minimize and ideally resolve these knowledge gaps will advance future social screening practice and policy.

Adolescents in the United States are increasingly seeking treatment for mental health crises in emergency departments and general medical hospitals. Medical needs are often addressed quickly, yet youth remain hospitalized because further psychiatric treatment is not immediately available. We sought to better understand the experiences of caregivers whose children are “boarding” in a medical hospital while awaiting inpatient psychiatric treatment. We conducted semi-structured interviews with caregivers who were recruited, enrolled, and interviewed during their child’s hospital stay. Interviews were audio-recorded, transcribed verbatim, and thematic analysis was facilitated by NVivo 12. Fourteen caregivers enrolled in the study. Themes that emerged included positive hospital and provider experiences; frustration with the medical and mental health care systems; information needs; fears about inpatient psychiatric units; practical challenges and emotional needs; difficulties with caregiver–child communication; difficulties with clinician–caregiver communication; and need for self-care and support. While many caregivers felt positively about the overall experience at the hospital, they also wished for more information about their child’s treatment plan and future, as well as social support, emotional comfort for themselves, and self-care skills and resources. Their experiences illuminate ways in which clinical practice can ameliorate concerns and alleviate stress of caregivers related to their child’s mental health crisis.

Background: The evidence base for understanding hospice use among persons with dementia is almost exclusively based on individuals with a primary terminal diagnosis of dementia. Little is known about whether comorbid dementia influences hospice use patterns. Objective: To estimate the prevalence of comorbid dementia among hospice enrollees and its association with hospice use patterns. Design: Pooled cross-sectional analysis of the nationally representative Health and Retirement Study (HRS) linked to Medicare claims. Subjects: Fee-for-service Medicare beneficiaries in the United States who enrolled with hospice and died between 2004 and 2016. Measurements: Dementia was assessed using a validated survey-based algorithm. Hospice use patterns were enrollment less than or equal to three days, enrollment greater than six months, hospice disenrollment, and hospice disenrollment after six months. Results: Of 3123 decedents, 465 (14.9%) had a primary hospice diagnosis of dementia and 943 (30.2%) had comorbid dementia and died of another illness. In fully adjusted models, comorbid dementia was associated with increased odds of hospice enrollment greater than six months (adjusted odds ratio [AOR] = 1.52, 95% confidence interval [CI]: 1.11-2.09) and hospice disenrollment following six months of hospice (AOR = 2.55, 95% CI: 1.43-4.553). Having a primary diagnosis of dementia was associated with increased odds of hospice enrollment greater than six months (AOR = 2.62, 95% CI: 1.86-3.68), hospice disenrollment (AOR = 1.82, 95% CI: 1.32-2.51), and hospice disenrollment following six months of hospice (AOR = 4.31, 95% CI: 2.37-7.82). Conclusion: Approximately 45% of the hospice population has primary or comorbid dementia and are at increased risk for long hospice enrollment periods and hospice disenrollment. Consideration of the high prevalence of comorbid dementia should be inherent in hospice staff training, quality metrics, and Medicare Hospice Benefit policies.

Information sharing, a component of patient and family engagement (PFE), is an important process that may contribute to intensive care unit (ICU) quality of care. Yet, virtually no studies explore how the process of information sharing unfolds in the ICU from the interprofessional team and family member perspectives. To better understand the process of information sharing, we conducted ethnographic fieldwork in a 20-bed medical ICU, focusing on behaviors and interactions of the interprofessional team and family members (May 2016 - October 2016). We completed 17.5 observation hours, 6 shadowing sessions, and 12 semi-structured interviews with 17 total participants. We used thematic content analysis and iterative inductive coding to identify three themes about the information sharing process: 1) family factors (health literacy and past experience with the ICU environment) influence information sharing; 2) clinicians strategies can support engagement in the process of information sharing (assessing families' need for information, understanding a families' hope, using rounds as an opportunity for information sharing); 3) the process of information sharing allows for trust building between families and the ICU team. Our findings suggest that information sharing is a crucial process that may serve as a catalyst for effective patient and family engagement in the ICU.

IntroductionThe Indian Health Service (IHS) and Tribal health programs provide clinical pharmacy services to improve health outcomes among American Indian and Alaska Native (AI/AN) adults with cardiovascular disease (CVD).ObjectivesThe study's primary objective was to describe characteristics, including social determinants of health (SDOH), associated with clinical pharmacy utilization by AI/ANs with CVD who accessed IHS/Tribal services. A secondary objective assessed changes in systolic blood pressure (SBP) associated with such utilization.MethodsAnalysis included IHS data for 9844 adults aged 18 and older with CVD who lived in 5 locations. Multivariable logistic regression was used to examine patient characteristics (eg, age, sex, health status, SDOH) associated with clinical pharmacy utilization in fiscal year (FY) 2012. A propensity score model was employed to estimate the association of elevated SBP in FY2013 with FY2012 clinical pharmacy utilization.ResultsNearly 15% of adults with CVD used clinical pharmacy services. Among adults with CVD, the odds of clinical pharmacy use were higher among adults diagnosed with congestive heart failure (adjusted odds ratio [OR]=1.22; 95% CI:1.01-1.47), other types of heart disease not including ischemia (OR=1.40; 95% CI: 1.18-1.65), and vascular disease (OR=1.23; 95% CI: 1.04-1.46), compared to adults without these conditions. Diabetes (OR=4.05, 95% CI: 3.29-5.00) and anticoagulation medication use (OR=20.88, 95% CI: 16.76-20.61) were associated with substantially higher odds of clinical pharmacy utilization. Medicaid coverage (OR=0.72; 95% CI: 0.56-0.93) and longer travel times to services (OR=0.87; 95% CI: 0.83-0.92) were each associated with lower odds. FY2012 clinical pharmacy users had lower odds of elevated SBP (OR=0.71 95% CI: 0.58-0.87) in FY2013 than nonusers.ConclusionIn addition to health status, SDOH (eg, Medicaid coverage, longer travel times) influenced clinical pharmacy utilization. Understanding characteristics associated with clinical pharmacy utilization may assist IHS/Tribal health programs in efforts to support optimization of these services.

Homelessness results from an interaction of structural determinants and individual vulnerabilities, creating various pathways into homelessness and having multilevel impacts. Understanding and addressing homelessness requires research that not only takes an ecological perspective but also can be translated into action. Despite research demonstrating differing needs and experience among various subpopulations, particularly marginalized groups, homeless service systems often take a one-size-fits-all approach. Additionally, homeless service systems' prioritization of the most vulnerable and chronically homeless for permanent housing programs results in a service system that operates in a state of triage, with minimal attention to prevention efforts. This special issue highlights actionable research focused on preventing homelessness and addressing disparities among marginalized groups. Included articles target homelessness at multiple levels using a combination of qualitative, quantitative, and mixed-methods approaches. Embedded in community psychology values, this study focuses on prevention, leverages participatory methods, relies on diverse lived experiences, and explores community-based solutions.

Objectives (i) to create a shortened version of the Action Research Arm Test scale, (ii) to investigate its psychometric properties compared to the original scale and (iii) to externally validate it within an independent cohort. Design Prospective longitudinal cohort study. Settings Two University Hospitals (France, Switzerland). Participants 47 patients with poststroke motor deficits of the upper limb coming from two different sites were included and divided into two cohorts (n = 22 for the construction cohort; n = 25 for the validation cohort). Main Measures We used the first cohort to build the Mini-ARAT by shortening the Action Research Arm Test scale on the basis of ceiling/floor effects and collinearity of the subscales. We studied its reliability, validity, and responsiveness and performed an external validation with the second cohort. Results The Mini-ARAT consisted of 2 subscales from the original Action Research Arm Test scale (Grip and Pinch). Internal consistency (α = 87) and inter-rater reliability (0.99, 95% CI: 0.98–0.99, p Conclusion The Mini-ARAT is a time-effective tool able to capture the dynamics of motor deficits with high reliability and consistency, providing excellent information about residual motor functions, which is critically important for clinical and research purposes.

Resumen Antecedentes y objetivo: No existen datos actualizados sobre los recursos asistenciales ni la actividad medico-quirurgica de los servicios de dermatologia espanoles. El objetivo de esta investigacion es conocer la situacion y actividad de dichos servicios durante el ano 2019. Material y metodos: Estudio transversal mediante cuestionario online distribuido a los jefes de servicio de dermatologia de hospitales publicos espanoles. Resultados: De los 162 jefes de servicio encuestados, se obtuvo una participacion del 36,4% (59/162). Se observo un deficit de personal generalizado, especialmente de dermatologos en hospitales de complejidad media-baja. La principal causa del deficit de dermatologos fue la ausencia de profesionales interesados. Las infraestructuras y equipamiento disponibles fueron superiores en los grandes complejos hospitalarios. La atencion mixta presencial-telematica estuvo presente en mas de la mitad de los centros. En el ambito de las consultas monograficas, la de psoriasis fue la mas implementada. Aproximadamente el 75% de los centros contaron con quirofanos con anestesista. Procedimientos quirurgicos de mayor complejidad como la biopsia selectiva de ganglio centinela o la cirugia de Mohs se realizaban con mayor frecuencia en los grandes complejos hospitalarios. La hospitalizacion de pacientes y la presencia de dermatologos residentes de guardia fue igualmente mas habitual en estos hospitales. La actividad docente e investigadora tambien se relaciono con la complejidad del hospital. Conclusiones: Nuestros resultados describen la situacion de los servicios de dermatologia espanoles justo antes de la pandemia por COVID-19, y pueden ser utiles para la gestion clinica y para definir lineas de trabajo y areas de mejora.

BACKGROUND: Positive deviance as a methodology is increasing in application yet there is high variability in how this approach is applied in health services research. METHODS: We conducted a scoping review of the literature for positive deviance applied to health outcomes informed by PRISMA-ScR. We searched the literature from 1945 to 2020, including articles on positive deviance or positive outliers, and restricted to examining individual rather than organizational outcomes. We analyzed the methodology applied including the process of identifying deviants, the use of control groups, and the degree of community engagement. RESULTS: Our initial search identified 1140 manuscripts; we included 104 papers describing 98 studies, 11 topical and one miscellaneous category. Most studies used objective measures of health or survey-based responses to identify deviants from a sub-set of the population at risk. The use of controls was less common in some topics (hospital infections), whereas controls were universally applied in other topics (malnutrition). The degree of community engagement varied widely. CONCLUSIONS: Positive deviance would benefit from improvements in reporting and standardized approaches to defining deviance. Studies could be improved through clarified definitions of deviance/risk, explicit descriptions of community engagement, and more consistent use of controls.

Purpose: This article describes the first four steps of the intervention mapping framework used to design a programme aimed at increasing adherence to prescribed exercise by people with persistent musculoskeletal pain. Method: In Step 1, a systematic review and qualitative study was completed to inform Step 2 and the identification of the Health Action Process Approach as an appropriate theoretical framework for establishing two programme objectives: enhancing self-management and providing tailored and accessible exercise instructions. Step 3 encompassed the selection of the programme methods, and the programme is described in Step 4. The resulting programme provides virtually delivered motivational interviewing and an app-based exercise programme to support individuals’ adherence to exercise. Results: The resulting intervention was assessed in a proof-of-concept feasibility and acceptability study and was shown to be feasible and acceptable. Refinements to the programme included additional tailoring of the exercise app and modifying the motivational interviewing schedule. Conclusions: Using the intervention mapping approach enabled us to successfully develop an intervention aimed at supporting the development of self-management behaviours and addressing maladaptive beliefs as a means of enhancing individuals’ adherence to exercise. Evaluation and implementation of the intervention should now be carried out.\ud \ud Objectif : décrire les quatre premières étapes du cadre de modélisation d’une intervention, utilisé pour concevoir un programme visant à accroître l’adhésion à une prescription d’exercices chez les personnes souffrant de douleurs musculosquelettiques persistantes. Méthodologie : à la première étape, les chercheurs ont effectué une analyse systématique et une étude qualitative pour étayer la deuxième étape et déterminer le processus d’action en santé dans un cadre théorique approprié qui permettrait de formuler les deux objectifs du programme : améliorer l’autogestion et fournir des directives d’exercices adaptées et accessibles. L’étape trois englobait le choix de la méthodologie du programme, décrite à l’étape quatre. Le programme qui en découle comprend des entrevues motivationnelles virtuelles et un programme d’exercices fondé sur une application pour renforcer l’adhésion à l’exercice. Résultats : l’intervention obtenue, évaluée dans une étude de validation de la faisabilité et de l’acceptabilité, s’est révélée faisable et acceptable. Les améliorations au programme ont inclus de nouvelles adaptations à l’application d’exercices et des modifications au calendrier d’entrevues motivationnelles. Conclusion : grâce à la démarche de modélisation de l’intervention, il a été possible d’élaborer une intervention visant à promouvoir l’acquisition de comportements d’autogestion et à corriger des convictions mésadaptées pour accroître l’adhésion à l’exercice. Il reste maintenant à évaluer et à mettre en œuvre l’intervention.

The Canadian Institutes of Health Research - Institute of Health Services and Policy Research (IHSPR) has published its Strategic Plan 2021-2026 (CIHR IHSPR 2021) and, as members of the Expert Advisory Group for a Pan-Canadian Health Data Strategy, we are providing commentary on the second strategic priority of IHSPR's Strategy related to health data and digital health. Systemic barriers have prevented the timely and effective collection, sharing and use of health data in Canada. Many of these systemic barriers relate to the fragmented health data foundation, lack of coordinated data governance and a risk-averse culture. As IHSPR mobilizes its strategic plan, it will be important to consider and address these factors head-on to contribute to a stronger health data foundation that would help achieve both IHSPR's strategic objectives and meaningfully contribute to elevating Canada's health data ecosystem.

The Canadian Institutes of Health Research - Institute of Health Services and Policy Research's (IHSPR) Strategic Plan 2021-2026 (CIHR IHSPR 2021) aims to accelerate healthcare system transformation to achieve the Quadruple Aim and health equity through research. This special issue features a collection of commentaries from academic and health system leaders who were invited to respond to IHSPR's strategic plan and share insights regarding the opportunities the plan presents and areas where more attention may be needed. The present paper features a response from the IHSPR team and outlines the next steps regarding implementation. IHSPR is deeply grateful to the commentary authors for their insight, advice and recommendations, which will help to inform the implementation of the plan.

Much of health services and policy research is applied. We offer four provocations to stimulate thinking about the relationship between research and the "systems" it aims to influence. We conclude that a focus on partnership implies that researchers need to be empathetic to the timelines and needs of policy makers, while true relationships are bidirectional. Focusing on the priorities of "systems" will emphasize short-term issues. This leads to researchers often conducting post-implementation evaluation, where they have had little involvement in policy or intervention design. Finally, a focus on single-project return of investment will tend to undervalue riskier - but also potentially more rewarding - research.

In its Strategic Plan 2021-2026, the Canadian Institutes of Health Research - Institute of Health Services and Policy Research (IHSPR) convincingly expresses its desire to expand capacity for applied health services and policy research (HSPR) and better mobilize research results for health system transformation geared toward the Quadruple Aim and health equity for all (CIHR IHSPR 2021). These strategic priorities echo views widely shared within the HSPR community, and we commend IHSPR for its leadership and vision. Recognizing the systemic challenges ahead of us, this commentary considers the HSPR community's capacity to achieve the promise of learning health systems, given the obstacles likely to hinder their rapid scale-up over the next five years. Next, we consider the spread of virtual care during the pandemic to illustrate the embedded and negotiated nature of innovation in health systems and the need for vigilance as to the social distribution of their benefits and costs. Finally, a critical review of the strategic plan provides insights into how research is governed in the HSPR field. Based on this analysis, it appears essential to reconsider health system transformation as social system transformation and strengthen interdisciplinary and comparative research. Looking forward, developing a science of science to better understand the conditions associated with high-impact research should be a cross-cutting priority for Canada's HSPR community.

British Pakistani women have exceptionally high rates of obesity and yet are seldom heard in a research priority setting concerning weight management. The objectives of this study were (i) to ascertain what multisectoral professionals perceive to be the most pressing unmet obesity needs or topic areas that need more research in relation to Pakistani women living in deprived areas of Bradford and (ii) to determine the top 10 obesity health priorities for this group to develop an obesity research agenda.A two-step process was adopted using the following: (i) a survey of a wide range of multisectoral professional stakeholders (n = 159) and (ii) a ranking exercise involving Pakistani women living in deprived areas of Bradford (n = 32) to select and prioritize their top 10 obesity health concerns and unmet needs from a list of 31 statements identified in the survey and previous research. Survey data were analysed using inductive content analysis and themes were identified. Themes were translated into statements to be ranked by Pakistani women. The ranking exercise was conducted by telephone either via voice or video call. Data were analysed using a reverse scoring system.Survey responses were grouped into statements reflecting the following three categories: education needs; healthy behaviour barriers and mental well-being. The highest rankings were given by Pakistani women to statements on mental health and the need for education. The top 10 prioritized statements were developed with members of the public into an obesity research agenda that reflected the target population.Actively engaging British Pakistani women in setting research priorities provided a unique opportunity to understand the key areas they think are important for future research. The culminating research agenda can be used by researchers to advance the field of obesity research in Pakistani communities, thus producing research outputs that are relevant to and have impact in this population.Participants in the ranking exercise collected data. Public contributors were involved in developing the prioritized statements into a research agenda.