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Evidence‐based medicine (EBM), one of the most important movements in health care, has been a lightning rod for controversy. Conflicts about the meaning and value of EBM are owing in part to lack of clarity about basic questions regarding its development, the importance of expertise and intuition, and the role of evidence in clinical decision making. These issues have persisted in part because of unclarity at the outset, but also because of how EBM evolved, why it was introduced when it was, and how it was modified following its introduction. This paper traces the evolution of EBM from clinical epidemiology (CE) and the internal dispute that precipitated the developers to establish EBM as a distinct approach to clinical practice. The paper proposes that health care industrialization also had a significant role in EBM's emergence and that industrialization influenced the decision to merge EBM with the method of normative decision making known as decision analysis (DA). The paper discusses the impact of this merger, in particular how it led to EBM's identification with managed care and has added momentum to the effort at forging a connection between a normative decision model and clinical judgement. This effort would turn clinical decision making into a conduit for bringing administrative rules and regulations into the consulting room and would result in expertise becoming a surplus skill. The paper closes by discussing a challenge yet unmet by EBM's advocates and critics—to chronicle the dangers that EBM in the framework of DA during the current era of industrialization poses to health and health care, and discover ways of unhinging the relationship between model and judgement. [ABSTRACT FROM AUTHOR]

The human body ECG signal was detected successfully with the polymer/AgNWs electrode, which is comparable to the signal obtained by the commercial electrode. International Conference on Display Technology 2020 (V olume 52, Issue S1) 39 Wearable and Printable Sensors for Human Healthcare Monitoring Junliang Yang*, Pei He, Xiaowen Xu School of Physics and Electronics, Central South University, Changsha 410083, Hunan, P. R. China. The graphene textile electrode was successfully used to record ECG signals, which showed comparable performance with conventional pre-gelled Ag/AgCl electrode. [Extracted from the article]

The article presents a list of the papers to be published including "Robustness and Separation in Multidimensional Screening," by Gabriel Carroll, "Insurer Competition in Health Care Markets," by Kate Ho and Robin S. Lee and "When Does Predation Dominate Collusion?," by Thomas Wiseman.

The article presents the author's outlook on failure of the national eHealth strategy to focus on needs of the community. Topics discussed include implementation strategy of national eHealth, funding of various core foundation eHealth technology services by the National Electronic Health Transition Authority (NEHTA) and adoption strategy to address the needs of the community healthcare sector at the provider and practice level.

Background: Dementia Care Navigators (DCNs) are professionals without clinical training, who provide individualised emotional and practical support to people living with dementia, working alongside clinical services. Navigator services have been implemented but the service offered vary without a consistent overview provided. The aim of this narrative systematic review was to describe and compare existing service formats, and to synthesise evidence regarding their implementation and impacts. Methods: The review was registered on PROSPERO [CRD42021292518]. Three electronic databases were searched and included studies reported on a DCN service, defined as a service in which non‐clinically trained workers provide personalised advice and support to people with dementia and/or carers in the community. Two independent reviewers screened abstracts and titles and read through full papers for inclusion. Risk of bias was assessed using the Standard Quality Assessment QualSyst. Results: We included 14 papers reporting on six studies. All services were US‐based and only varied by integration and training provided. Studies reported different degrees of impact on service utilisation and on symptoms and mental well‐being of people with dementia and their carers, with too little evidence to draw substantial/meaningful conclusions and studies employing different outcome measures. One study evidenced greater impacts on people with more advanced dementia compared to earlier stages. Conclusions: DCN services have the potential to effectively provide non‐clinical support to people with dementia and carers from the point of diagnosis. Further research from countries other than the USA, focusing on the impact on social care and social support service access and utilisation, and utilising similar established outcome measures are required. Key points: Evidence on the impact of Dementia Care Navigators (DCNs) is limited but shows promising benefits for people living with dementia and their carers.More research needs to be conducted in countries other than the US, where all evidence was reported, and with similar outcome measures to allow comparison.DCNs are a highly useful professional group without medical training, who can navigate people living with dementia and their carers to support and provide support themselves. [ABSTRACT FROM AUTHOR]

Background: We report on a study of a facilitated interactive group learning approach, through Collaborative Implementation Groups (CIGs), established to enhance capacity for equity‐sensitive evaluation of healthcare services to inform local decision‐making: (1) What was the experience of participants of the CIGs? (2) How was knowledge mobilisation achieved? (3) What are the key elements that enhance the process of coproducing equity‐sensitive evaluations? Methods: A thematic analysis of qualitative data obtained from focus group (FG) discussions and semistructured interviews exploring the experiences of participants. All FGs included representation of participants from different projects across the programme. Interviews were conducted with a member from each of the teams participating in the first cohort after their final workshop. Results: We identified four themes to illustrate how the approach to delivering intensive and facilitated training supported equity‐sensitive evaluations of local healthcare services: (1) Creating the setting for coproduction and knowledge mobilisation; (2) establishing a common purpose, meaning and language for reducing health inequalities; (3) making connections and brokering relationships and (4) challenging and transforming the role of evaluation. Conclusion: We report on the implementation of a practical example of engaged scholarship, where teams of healthcare staff were supported with resources, interactive training and methodological advice to evaluate their own services, enabling organisations to assemble timely practical and relevant evidence that could feed directly into local decision‐making. By encouraging mixed teams of practitioners, commissioners, patients, the public and researchers to work together to coproduce their evaluations, the programme also aimed to systematise health equity into service change. The findings of our study illustrate that the approach to delivering training gave participants the tools and confidence to address their organisation's stated aims of reducing health inequalities, coproduce evaluations of their local services and mobilise knowledge from a range of stakeholders. Patient or Public Contribution: The research question was developed collaboratively with researchers, partner organisations and public advisers (PAs). PAs were involved in meetings to agree on the focus of this research and to plan the analysis. N. T. is a PA and coauthor, contributing to the interpretation of findings and drafting of the paper. [ABSTRACT FROM AUTHOR]

The term value‐based healthcare (VBHC) describes an approach to the organization and delivery of care that emphasizes reducing the cost of care while improving outcomes. This involves increased investment earlier in the care pathway e.g., in the prevention, timely diagnosis, and screening for complications in order to maximize the overall impact of care. Key elements of VBHC include the collection and interpretation of relevant data to drive quality improvement and appropriateness of care, a focus on a continuum of care from prevention through to complications, an awareness of the financial drivers of the cost of care and a recognition that meaningful outcomes of care are those that are important to patients. Although VBHC has its origins in North America and has mostly been applied to private health systems, the principles can also be applied to national health services. In publicly funded health systems, where resources are finite, VBHC initiatives aim to eliminate ineffective care that has no beneficial impact or added value for patients and to optimize patient outcomes by delivering care that meets the changing healthcare needs of a population over time. The National Health Service in Wales has established a VBHC Office and has begun to realize the benefits of adopting VBHC approaches. The Irish Health Service Executive (HSE) can learn from the approaches used in Wales. In this paper we explore some of the principles of VBHC through case studies from Ireland and Wales highlighting how national health services are using VBHC to achieve improvement in outcomes for people living with diabetes. [ABSTRACT FROM AUTHOR]

Generalized pustular psoriasis (GPP) is a multisystem disease with potentially life‐threatening adverse effects. As patients increasingly seek health information online, and as the landscape for GPP changes, the quality of online health information (OHI) becomes progressively more important. This paper is the first of its kind to examine the quality, comprehensiveness and readability of online health information for GPP. Similar to pre‐existing studies evaluating OHI, this paper examines 5 key search terms for GPP‐ 3 medical and 2 laymen. For each search term, the results were evaluated based on HONcode accreditation, an enhanced DISCERN analysis and a number of readability indices. Of the 500 websites evaluated, 84 (16.8%) were HONcode‐accredited. Mean DISCERN scores of all websites were 74.9% and 38.6% for website reliability and treatment sections, respectively, demonstrating key gaps in comprehensiveness and reliability of GPP‐specific OHI. Additionally, only 4/100 websites (4%) analysed for readability were written at the NIH‐recommended sixth‐grade level. Academic websites were significantly more difficult to read than governmental websites. This further exacerbates the patient information gap, particularly for patients with low health literacy, who may already be at higher risk of not receiving timely medical care. [ABSTRACT FROM AUTHOR]

Aim: To identify the research on childhood disability service adaptations and their impact on children and young people with long‐term disability during the COVID‐19 pandemic. Method: A mapping review was undertaken. We searched the World Health Organization Global COVID‐19 database using the search terms 'children', 'chronic/disabling conditions', and 'services/therapies'. Eligible papers reported service changes for children (0–19 years) with long‐term disability in any geographical or clinical setting between 1st January 2020 and 26th January 2022. Papers were charted across the effective practice and organization of care taxonomy of health system interventions and were narratively synthesized; an interactive map was produced. Results: Reduction of face‐to‐face care and usual provision had a huge impact on children and families. Adoption of telehealth provided continuity for the care and management of some conditions. There was limited evidence of changes to mental health services, transitions of care, social care, or child‐reported satisfaction or acceptability of service changes. Interpretation: The long‐term impacts of service change during the pandemic need full evaluation. However, widespread disruption seems to have had a profound impact on child and carer health and well‐being. Service recovery needs to be specific to the individual needs of children with a disability and their families. This should be done through coproduction to ensure that service changes meet needs and are accessible and equitable. [ABSTRACT FROM AUTHOR]

This study examines performance of provincial health‐care system in China, using a dynamic network data envelopment analysis (DEA) approach. We focus on efficiency improvements both within provincial health‐care system and within two separate internal sub‐divisions. The administration division engages in financial management while the medical care division provides medical care services. Then there are two main results. First, the average overall efficiency score of provincial health‐care system is 0.9316 from 2010 to 2017. Second, the productivity progress in administration division is lower than that in medical care division, and the technical advances contribute most of the productivity progress. The research gap and the innovation of this paper lie in three aspects: First, this paper opens the black box of health production function and use the network DEA to analyze Chinese provincial health‐care system and its inner two constructs. Second, this paper discusses the efficiency scores as well as dynamic changes in one model. Finally, this paper tries to reveal the regional heterogeneity of static efficiency as well as the dynamic efficiency changes. [ABSTRACT FROM AUTHOR]

Many Australians are requiring mental health care, including families, leading to long wait times in order to access support. Walk‐in therapy reduces barriers to mental health support services by providing support at the time that families seek help. This paper presents a proof‐of‐concept study investigating the acceptability and short‐term effectiveness of an online walk‐in family therapy service, Walk‐in Together (WIT). Part 1 of the paper describes the experiences of 44 family members from 22 families who presented to a public family therapy clinic for a virtual walk‐in family therapy session. The session was conducted by a team of three experienced family therapists. Family members' experiences were sought pre‐session, post‐session, and at 6 weeks follow‐up via survey and interview. Part 2 of the paper explores therapist perceptions (n = 7) of the WIT approach, through thematic analysis of semi‐structured interview data. Post‐session feedback showed 85% of family members found WIT to be helpful and 50% were optimistic about their future as a family after their WIT session. Six weeks post‐session it was revealed that WIT supported planning for families in equipping them to move forward with 88% of family members reporting that they knew what to do after the session. All therapists uniformly experienced the model as offering a timely and beneficial service, suitable for diverse presentations and constellations of families. These preliminary results suggest the significant utility of this WIT intervention as a well‐received and helpful service for families, who valued the easy access and rapid therapeutic response afforded by the online, walk‐in delivery model. This proof‐of‐concept paper suggests the potential for further development and growth of WIT, as well as other mental health support services using a walk‐in, telehealth model to meet the rising demand for therapeutic support for families in distress. [ABSTRACT FROM AUTHOR]

Policy PointsHospital executives posit a number of rationales for system mergers which lack any basis in academic evidence. Decades of academic research question whether system combinations confer public benefits. Antitrust authorities need to continue to closely scrutinize these transactions.Recently, mergers of hospital systems that span different geographic markets are on the rise. Economists have alerted policymakers about the potential impacts such cross‐market mergers may have on hospital prices. We suggest there are other reasons for concern that scholars have not often confonted. Cross‐market mergers may be conducted for purely self‐serving reasons of organizational growth that increases executive compensation. Combinations of sellers should have clear advantages to consumers. System executives and their boards should bear the burden of proof.Federal regulators and state attorney generals should be cognizant that rationales for cross‐market systems advanced by merging parties are unlikely to be operative or dominant in merger decision making.Policymakers should be careful about passing legislation that encourages hospitals to consolidate. Context: There is a growing trend of combinations among hospital systems that operate in different geographic markets known as cross‐market mergers. Economists have analyzed these broader systems in terms of their anticompetitive behavior and pricing power over insurers. This paper evaluates the benefits advanced by these new hospital systems that speak to a different set of issues not usually studied: increased efficiencies, new capabilities, operating synergies, and addressing health inequities. The paper thus "looks under the hood" of these emerging, cross‐market systems to assess what value they might bestow and upon whom. Methods: The paper examines recently announced cross‐market mergers in terms of their supposed benefits, as expressed by the systems' executives as well as by industry consultants. These presumed benefits are then evaluated against existing evidence regarding hospital system outcomes. Findings: Advocates of cross‐market hospital mergers cite a host of benefits. Research suggests these benefits are nonexistent. Additional evidence suggests other motives may be at play in the formation of cross‐market mergers that have nothing to do with efficiencies, synergies, or community benefits. Instead these mergers may be self‐serving efforts by system chief executive officers (CEOs) to boost their compensation. Conclusions: Cross‐market hospital mergers may yield no benefits to the hospitals involved or the communities in which they operate. The boards of hospital systems that engage in these cross‐market mergers need to exercise greater diligence over the actions of their CEOs. [ABSTRACT FROM AUTHOR]

Aim: This paper discusses four main strategies for addressing nursing shortages that have been persistent, widespread and growing. Fallout from the COVID‐19 pandemic might offer valuable impetus to address this tenacious challenge. Background: Nursing shortages are common, widespread and have been persistent for most of a century. Many of the reasons behind these shortages are well known and are themselves enduring, as are the types of strategies put forward for addressing them. These strategies can generally be classified into four main categories: enhancing retention, improving recruitment, encouraging return to practice and drawing on international human resources. The COVID‐19 pandemic is the latest major threat to ensuring a sufficiently sized and skilled nursing workforce. Many nurses have succumbed to burnout as well the plethora of factors that predated the pandemic and have a negative impact on nurse wellbeing, turnover and intention to leave. Sources of evidence: This discussion paper draws on international sources of evidence. Discussion/conclusion: This paper highlights how many of the factors behind and strategies for addressing nursing shortages at the local, national and global levels are widely studied and known. A sustained combination of strategies that focus both within and beyond health and nursing, including on the broader social context, is necessary. While COVID‐19 has been extremely damaging, it might present an opportunity to make sustainable, effective reforms to address nursing shortages. Implications for policy: Knowledge users must recognise that a combination of approaches across the gamut of policies that influence nursing workforces is necessary to address nursing shortages. Attention must also focus on factors beyond nursing and healthcare if shortages are to be remedied. [ABSTRACT FROM AUTHOR]

People with Down syndrome have complex health care needs which are not always fully met. Health care improvements are required to better meet these needs. Quality indicators are an important tool for improving health care. However, quality indicators for health care for people with Down syndrome are scarce. Existing quality indicators focus on medical (physical) needs or the clinical setting, even though it is acknowledged that quality measures should reflect the total of quality aspects relevant to the population at stake, which may encompass aspects beyond the medical domain. These aspects beyond the medical domain are the focus of the current paper, which aims to provide insight into the way people with Down syndrome live their lives, how health care may fit in, and how this may impact the development of quality indicators. The paper is based on data originating from interviews with people with Down syndrome and their parents as well as focus groups with support staff members working in assisted living facilities for people with intellectual disability. The data revealed a lot of variation in how people with Down syndrome live their lives. Nevertheless, we were able to identify 11 topics, which we grouped into three overarching themes: (1) Being different yet living a normal life; (2) Down syndrome‐(un)friendly society and services; and (3) family perspective. The variation in our data stresses the importance of health care that takes a person's life into account beyond the medical domain, as exemplified by the identified topics. Our findings also show that a good life is not merely depending on good health care supported by well‐defined quality indicators, but on (support in) all life domains. [ABSTRACT FROM AUTHOR]

Dialectical Behaviour Therapy (DBT) programmes are often the only available treatment for people diagnosed with borderline personality disorder and were rapidly converted to online delivery during the COVID‐19 pandemic. Limited research exists surrounding how the major elements of DBT are delivered in an online environment. This scoping review considered the operationalization of online delivery of DBT and its effectiveness. EBSCO host databases were searched using free text. Of 127 papers, 11 studies from 2010 to 2021 investigating online DBT for any clinical population were included in the review. A narrative synthesis of papers selected was undertaken. Seven articles reported results from five clinical trials (n = 437). Most adaptations mirrored face‐to‐face programmes although there was considerable variation in how therapy was facilitated. Attendance was reported to be greater online with comparable clinical improvements to face‐to‐face for those who remained in therapy. Additional challenges included managing risk, therapist preparedness and technology difficulties. Online delivery of DBT programmes is feasible and may be more accessible, acceptable and as safe and effective as face‐to‐face delivery. However, mirroring face to face delivery in an online environment may not be the most effective and efficient way to adapt DBT to online provision. Research is needed to identify areas which require further adaptation. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal diseases that negatively affect the enjoyment of food and engagement in social and cultural gatherings. Such experiences may promote psychosocial challenges, an aspect of IBD often overlooked and under‐supported in clinical settings and research. Objectives: This study explored the psychosocial experiences that young adults with IBD have with food via a qualitative patient‐led research process. Methods: Trained patient researchers conducted this study by engaging peers via semi‐structured interviews and focus groups in a three‐step co‐design process. Participants (n = 9) identified the research topic (SET), explored the topic and identified emerging themes (COLLECT), refined themes and made recommendations for healthcare system change (REFLECT). Results: Themes that emerged included: 'Experimenting with Food', 'Evolution Over Time', 'Diet Changes are Emotional' and 'Role of Stigma'. Participants identified the significance and frustrations of repeated testing and experimenting with food compatibility, and noted nuances in food relationships as they gain knowledge and experience over time. They emphasized the importance of maintaining a sense of hope throughout and wished to impart this to newly diagnosed patients. Conclusion: Participants experience numerous psychosocial challenges as they strive to manage their diet, noting gaps in support available from IBD practitioners. Participants made practical recommendations for healthcare system change to improve patient outcomes, highlighting the importance of sharing stories and collaboratively including patients in the development of new services and protocols. Authors recommend further research in this area to build a body of knowledge and support that helps IBD patients maintain hope while navigating challenges with food. Patient or Public Contribution: The first four authors on this paper were the lead researchers in this study's design and analysis and identify as patients; they conducted the research with this identity at the forefront following a peer‐to‐peer research model. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process itself was co‐lead and directed by other patient participants and consultants. Results and recommendations coming from this paper came directly from patient participants. [ABSTRACT FROM AUTHOR]

Context: The involvement of lay people in health care decision‐making processes is now the norm in many countries. However, one important aspect of participation has not received sufficient attention in the past and remains underexplored: representation. Objective: This paper explores the question of how public participation efforts in collective health care decision‐making processes can attempt to aim for legitimate representation so that those individuals or groups not present can be taken into account in the decisions affecting them. This paper argues that to make decisions that effectively address those affected, representation needs to be seen as a relevant part of any participatory setting. To support this argument, the paper outlines the concepts of participation and representation and transfers them to health care contexts. Results: A conceptual reflection on responsiveness and the characteristics of representative actors in representative‐participatory settings is introduced, which could provide actors planning to conduct participatory health care projects with tools to reflect on the merits and possible flaws of participatory constellations. Patient or Public Contribution: The paper contributes to improving public participation in health care decision‐making. [ABSTRACT FROM AUTHOR]

Doctors are typically portrayed as active agents in their work lives. However, this paper argues that this construction of agency ignores the effects of the healthcare structures that constrain choice, which in turn affects population health outcomes. Medical training pathways, regional boundaries, and rationalisation all have a long‐lasting impact on the provision of healthcare. Using a mobilities lens to examine the movement of doctors, this paper examines how the expectation of movement built into training programmes perpetuates unequal access to healthcare. Long waiting times, poor care quality and lack of preventative care all perpetuate health inequalities; as one of the socio‐economic determinants, access to healthcare affects health outcomes. [ABSTRACT FROM AUTHOR]

Nowadays, cloud computing offers a digital infrastructure for smart city development. Cognitive cities are steadily automating daily urban processes. The ever expanding objective‐driven communities gather and share sensitive data that must be stored securely. Cloud computing offers a suitable platform that allows cognitive smart cities to access and re‐access data to learn from their past to adapt its current behaviour. However, the cloud is an untrusted entity that may expose data when decrypted for processing by systems. In this paper, we treat the issue of encrypted data processing. Often, the data is encrypted prior to transferring it to the cloud, where the cloud must have the data in clear to be able to make calculations which raises security and privacy threats if the cloud is considered untrusted. The scenario of asking users to make the calculations after decrypting the received cloud data and encrypting the obtained results before sending them back to the cloud is not a practical solution in distributed multi‐tenant architectures. Homomorphic encryption allows offers a solution for processing encrypted data. Many existing homomorphic encryption schemes suffer from limitations that hinder their usability. This paper presents an efficient fully homomorphic encryption scheme using twin key encryption and magic number fragmentation. The details of the scheme are presented along with cryptanalytic attacks to assess its effectiveness. The proposed scheme exhibits strong resilience against brute‐force attacks compared to its rivals from the literature. Finally, we illustrate the applicability of the proposed scheme using a cognitive smart city application. [ABSTRACT FROM AUTHOR]

What motivates people to enter health care occupations? What are the rewards of these jobs? What are the paths of mobility from low‐paid, low‐prestige, health care jobs to higher paid, more professional ones? This paper attends to these questions through interviews and ethnographic observations among West African immigrant nurses and disability support professionals in the US. I find that extrinsic motivations, (racial discrimination in other segments of the labor market), and the quest for extrinsic rewards, (wages, immigration status benefits), played a role in the decision‐making of West African immigrant health care workers. I show how West African immigrants were able to parlay low‐wage, entry level positions in the health care industry into more professional, highly paid, and secure ones. These workers also reaped material benefits, and developed intrinsic rewards (love/affection, job satisfaction), and the desire to help others after being immersed in their jobs. I posit an understanding of intrinsic and extrinsic rewards of care, as complex, layered, and intersecting. I prove that a mélange of motivations is in play, intrinsic and extrinsic rewards work in tandem, and one can enter health care for money and remain for money and for love. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives Complex and chronic disease is placing significant pressure on hospital outpatient departments. Novel ways of delivering care have been developed recently and are often described as 'triage' services. This paper reviews the literature pertaining to definitions and descriptions of orthopaedic/musculoskeletal triage processes, in order to provide information on 'best practice' to assist health care facilities. Method A comprehensive open-ended search was conducted using electronic databases to identify studies describing models of triage clinics for patients with a musculoskeletal/orthopaedic complaint, who have been referred to hospital outpatient clinics for a surgical consultation. Studies were critically appraised using the McMaster quality appraisal tool and ranked using the National Health and Medical Research Council hierarchy of evidence. A thematic analysis of the definitions, processes and procedures of triage described within the literature was undertaken. Results 1930 studies were identified and 45 were included in the review (including diagnostic and evaluative research). The hierarchy of evidence ranged from I to IV; however, the majority were at low levels of evidence and scored poorly on the critical appraisal tool. Three broad themes of triage were identified: presence of a referral, configuration of the triage (who, how and where) and the aim of triage. However, there were significant inconsistencies across these themes. Conclusions This systematic review highlighted the need for standardization of the definition of triage, the procedures of assessment and management and measures of outcome used in orthopaedic/musculoskeletal triage to ensure best-practice processes, procedures and outcomes for triage clinics. [ABSTRACT FROM AUTHOR]

Rigor has important ramifications for the entire qualitative research process. The aim of this study was to evaluate aspects of methodological congruence by focusing on four dimensions of rigor in qualitative nursing research related to the presence of patients’ family members in the intensive care unit. Eight research papers covering the years 1990–2004 were analyzed by means of one of Burns and Grove’s standards, methodological congruence, for critique and consistency. The results show that there are varying degrees of focus on procedural rigor, such as limitations and bias. Ethical rigor is described clearly in some papers, while others lack descriptions of confidentiality and the voluntary nature of participation. However, all papers contain descriptions of qualitative data analysis. In conclusion, there were strengths in procedural rigor and auditability, but also some limitations in the identification of theoretical development and the scientific tradition on which the article is based. [ABSTRACT FROM AUTHOR]

Aim. This paper presents an evaluation of the effectiveness of three search strategies to identify research for a qualitative synthesis of patient experiences of living with a leg ulcer. Background. Systematic reviews of research are increasingly the form of evidence used for evaluation of health care. There are well-established methods for conducting systematic reviews of effectiveness incorporating randomized controlled trials. Methods have been developed for the synthesis of qualitative research, but these are not widely used or evaluated. Searching for qualitative research is one of the least developed and tested areas in systematic reviewing of qualitative research. Method. The replication of three search strategies (free text, thesaurus and broadbased terms) developed for identification of qualitative research papers within electronic databases is described. Each strategy was run in seven electronic databases: MEDLINE, CINAHL, EMBASE, British Nursing Index, Social Science Citation Index, Applied Social Sciences Index and Abstracts, PsychInfo. The effectiveness of these strategies for identifying qualitative research for a synthesis of patients' experiences of living with a leg ulcer is discussed. Findings. Each of the three search strategies produced similar numbers of potentially and actually relevant papers from each of the seven databases. These results were most striking for CINAHL, when all of the papers ultimately included in the review were identified by each search strategy. No other database identified all included papers. Conclusion. A simple search strategy using broad-based terms was as effective as a complex one (free text) in locating qualitative research examining patients' experiences of living with a leg ulcer. For a question with a clear nursing focus, it may be sufficient to search only CINAHL in order to locate qualitative research. This result needs replicating with other nursing topics. [ABSTRACT FROM AUTHOR]

lindsay b. (2004) Journal of Advanced Nursing 45(1), 84–94 Randomized controlled trials of socially complex nursing interventions: creating bias and unreliability? The randomized controlled trial is viewed by many researchers as the ‘gold standard’ research design. It is used increasingly to evaluate the effectiveness of socially complex activities such as nursing interventions. This use is seen by many commentators as problematic, while others are concerned about the quality of many published trial reports. One area of concern is that of intervention bias: the impact that a sentient intervention, such as a nursing one, may have consciously or unconsciously on study outcomes. This paper reports on an analysis of intervention definitions and possible intervention bias in 47 reports of randomized controlled trials of nursing interventions published in 2000 or 2001. This study evaluates four characteristics of the included reports: intervention sample size, intervention definition, involvement of intervention nurses in other aspects of the trial, and the claimed generalizability of results. Reports of randomized controlled trials published in 2000 or 2001 were identified. Full-text versions of 47 papers were obtained and information about the four characteristics was extracted and analysed. Problems relating to possible intervention bias were identified in each of the papers. Inadequate intervention definition was the commonest problem, leading to difficulties in calculating the ‘intervention dose’ and in replicating or generalizing from the studies. None of the included studies met the requirements of the Consolidated Standards of Reporting Trials. Four types of intervention bias were identified, and their possible implications for the reporting of trials of nursing interventions are discussed. This was a small-scale study, limited by time and resources. Its results are suggestive of a major problem of intervention bias but larger-scale investigations are necessary to quantify its extent. Intervention bias is potentially a problem in randomized controlled trials. Lack of detail about interventions in published papers could be corrected by stricter adherence to guidelines such as the Consolidated Standards of Reporting Trials, but this will not correct the underlying problem of inadequate study design that appears to be widespread in randomized controlled trials of nursing interventions. [ABSTRACT FROM AUTHOR]

In a large community health organisation, following high‐profile cases of non‐recent (historical) child sexual abuse, there was an increase in such disclosures and in uncertainties voiced by clinicians, both medical and non‐medical, about the most appropriate response to them. Practitioners within the safeguarding children team realised that there was little clear practice guidance available on this subject. This paper explores the process of how guidance for responding to disclosure of non‐recent child sexual abuse was developed and how, in the face of initial considerable anxiety and concern from clinicians, successful implementation was ultimately achieved. 'This paper explores the process of how guidance for responding to disclosure of non‐recent child sexual abuse was developed' Key Practitioner Messages: Addressing non‐historic disclosure of sexual abuse: Is complex and requires flexibility of approach from professionals at the time of disclosure and subsequently.Should wherever possible include the wishes of the individual making the disclosure but may require additional professional decisions to prevent harm to others.Requires appreciation of the perspectives of professionals from different disciplines and agencies.Requires clear process and good senior, interagency working relationships if resolution of complex dilemmas is to be achieved. [ABSTRACT FROM AUTHOR]

The means by which patients acquire their medications differ between countries, and a knowledge of this is essential when conducting and interpreting pharmacoepidemiological studies. The aim of this paper is to provide an overview of how patients obtain medicines in Denmark, to relate these to nationwide registries available for research and to discuss the implications for research. Health services are predominantly tax‐funded in Denmark, with dentistry and some medicine bought at community pharmacies being exceptions, involving partial reimbursement of charges. The paper gives an overview of prescription medicines acquired from community pharmacies (including magistral preparations), over‐the‐counter medicines, vaccinations and in‐hospital medicine including so‐called "free medicine" (in Danish: "vederlagsfri medicin"). "Free medicine" is medicines for a defined list of diseases and indications that is provided free of charge to patients in outpatient clinics. The paper also describes the content of the various Danish data sources about medicine use, summarizes their strengths and limitations, and exemplifies the ways of evaluating their completeness. An example is provided of the regional variation in the means by which medicines are acquired. [ABSTRACT FROM AUTHOR]

Discusses the contents of the December 2003 issue special section of "Health Services Research." Appeal for the submission of research focusing on the management of chronic illness in managed care setting; Selection criteria for papers; Funding for the medical care quality research from the Agency for Healthcare Research and Quality.

One of the most significant developments in healthcare over the past 25 years has been the widespread deployment of information and communication technologies. These technologies have had a wide–ranging impact on the organisation of healthcare, on professional practice and on patients’ experience of illness and its management. In this paper we discuss the ways in which Sociology of Health and Illness has provided a forum for the analysis of these new technologies in healthcare. We review a range of relevant research published in the Journal; papers that address such issues as dehumanisation and emotional labour, professional practice and identity, and the social and institutional shaping of technology. Despite these important initiatives, we suggest that information and communication technologies in healthcare remain relatively under–explored within the Journal and, more generally, by the sociology of health and illness and point to developments in cognate areas which may have some bearing upon the analysis of technology in action. [ABSTRACT FROM AUTHOR]

Conference papers have highlighted the difficulty of conducting valid analyses of alcohol and drug abuse treatment services. Because of these difficulties, investigators, providers and policy makers could feel overwhelmed and be reluctant to initiate studies. The papers, however, also offer guidance and encourage researchers to apply these methods and improve their investigations. Common features of the papers are noted and the potential for making contributions to the state of the art is examined. Aspects of health services research that are not addressed in the papers are also discussed. Although alcohol services research is not easy and can be improved, the state of alcohol services research is where it belongs - in the middle of the personal, programmatic and policy level struggles to achieve stable recoveries from alcohol and drug dependence. [ABSTRACT FROM AUTHOR]

Background: There have been recent important advances in conceptualizing and operationalizing involvement in health research and health ‐ care service development. However, problems persist in the field that impact on the scope for meaningful involvement to become a routine – normalized – way of working in primary care. In this review, we focus on current practice to critically interrogate factors known to be relevant for normalization – definition, enrolment, enactment and appraisal. Method: Ours was a multidisciplinary, interagency team, with community representation. We searched EBSCO host for papers from 2007 to 2011 and engaged in an iterative, reflexive approach to sampling, appraising and analysing the literature following the principles of a critical interpretive synthesis approach and using Normalization Process Theory. Findings: Twenty ‐ six papers were chosen from 289 papers, as a purposeful sample of work that is reported as service user involvement in the field. Few papers provided a clear working definition of service user involvement. The dominant identified rationale for enrolling service users in primary care projects was linked with policy imperatives for co ‐ governance and emancipatory ideals. The majority of methodologies employed were standard health services research methods that do not qualify as research with service users. This indicates a lack of congruence between the stated aims and methods. Most studies only reported positive outcomes, raising questions about the balance or completeness of the published appraisals. Conclusion: To improve normalization of meaningful involvement in primary care, it is necessary to encourage explicit reporting of definitions, methodological innovation to enhance co ‐ governance and dissemination of research processes and findings. [ABSTRACT FROM AUTHOR]

The article emphasizes the need to consider the potential harm of testing and interventions. It presents two papers that challenge the traditional view that testing and interventions are always helpful. It is reported that the first paper shows that early aggressive intravenous hydration in patients with mild acute pancreatitis causes increased fluid overload while the second paper shows that prophylactic fluid bolus given during intubation of critically ill adults did not prevent hypotension.

The Covid‐19 pandemic is widely speculated to have disrupted the delivery of primary health care in low‐income countries. Yet, there is little rigorous empirical research identifying this effect. This paper estimates the impact of Covid‐19 on facility and skilled delivery and utilisation of antenatal care (ANC) services by comparing these outcomes for women who were pregnant/delivered before and during the Covid‐19 period. The results show that Covid‐19 led to 23% and 25% reductions, respectively, in the likelihood of facility delivery and four or more ANC visits during pregnancy. These findings highlight the need to build more resilient health systems in low‐income settings. [ABSTRACT FROM AUTHOR]

The explosive growth of information has rapidly ushered people into the era of big data. Due to the large volume, high variety, and rapid velocity characteristics of big data, most traditional data mining methods developed for a centralized data analysis process cannot be applied directly. AI leverages machine intelligence to provide insights, automation, and new methods to interact with data, thereby promoting data literacy throughout the organization. Based on the theory of Big Data Cycle, this paper discusses the relationship between big data and AI and how they interact and influence each other. It adopts the integrative review research method to screen latest literature and summarizes the role of AI in different phases of big data cycle. We also provide an insight into the applications of big data and AI in three different areas, that is, social network, health care, and finance. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has had an impact on all aspects of the health system. Little is known about how the activities and experiences of patient, family and caregiver partners, as a large group across a variety of settings within the health system, changed due to the substantial health system shifts catalysed by the pandemic. This paper reports on the results of a survey that included questions about this topic. Methods: Canadian patient, family and caregiver partners were invited to participate in an online anonymous survey in the Fall of 2020. A virtual snowballing approach to recruitment was used. Survey invitations were shared on social media and emailed to health system and governmental organizations with the request that they share the survey with patient partners. This paper focuses on responses to two questions related to patient partner experiences during the COVID‐19 pandemic. Results: The COVID‐19 questions were completed by 533 respondents. Over three quarters of respondents (77.9%, n = 415) indicated their patient engagement activities had been impacted by COVID‐19. The majority (62.5%, n = 230) experienced at least a temporary or partial reduction in their patient engagement activities. Some respondents did see increases in their patient engagement activities (11.4%, n = 42). Many respondents provided insights into their experience with virtual platforms for engagement (n = 194), most expressed negative or mixed experiences with this shift. Conclusions: This study provides a snapshot of Canadian patient, family and caregiver partners' perspectives on the impact of COVID‐19 on their engagement activities. Understanding how engagement unfolded during a crisis is critical for our future planning if patient engagement is to be fully integrated into the health system. Identifying how patient partners were engaged and not engaged during this time period, as well as the benefits and challenges of virtual engagement opportunities, offers instructive lessons for sustaining patient engagement, including the supports needed to engage with a more diverse set of patient, family and caregiver partners. Patient Contribution: Patient partners were important members of the Canadian Patient Partner Study research team. They were engaged from the outset, participating in all stages of the research project. Additional patient partners were engaged to develop and pilot test the survey, and all survey respondents were patient, family or caregiver partners. The manuscript is coauthored by two patient partners. [ABSTRACT FROM AUTHOR]

The mainstream development agenda highlights how important access to health care is for poorer regions of the world. In the area of maternal health, this is expressed in a concern to drive down rates of maternal morbidity and improve access to maternal health care services. While important, the focus on metrics misses the way that relations of care are fundamental to good health. This paper takes an example of a project which is offering a different approach to health and development in the resource scarce environment of Luang Prabang Province, in northern Laos. Here, a group of antipodean midwives has partnered with provincial health authorities to offer a midwifery training programme to health workers posted in remote rural health centres. Supported by the analytical tools of diverse economies, this paper explores how this programme centres relationality, collectivity and an ethic of kindness, and discusses the advantages of being relationship based, small and informal. The paper concludes that this training programme can be understood as an example of a community economy of care: based on global networks of care instead of formal development programmes built on global networks of bureaucracy. [ABSTRACT FROM AUTHOR]

Background: The high‐density microarray patch (HD‐MAP) promises to be a robust vaccination platform with clear advantages for future global societal demands for health care management. The method of action has its base not only in efficient delivery of vaccine but also in the reliable induction of a local innate physical inflammatory response to adjuvant the vaccination process. The application process needs to induce levels of reactivity, which are acceptable to the vaccine, and from which the skin promptly recovers. Materials and methods: 1 × 1 cm HD‐MAP patches containing 5000, 250‐μm long microprojections were applied to the skin in 12 healthy volunteers. The return of skin barrier function was assessed by transepidermal water loss (TEWL) and reaction to topical histamine challenge. Results: Skin barrier recovery by 48 h was confirmed for all HD‐MAP sites by recovered resistance to the effects of topical histamine application. Conclusions: Our previous observation, that the barrier disruption indicator TEWL returns to normal by 48 h, is supported by this paper's demonstration of return of skin resistance to topical histamine challenge in twelve healthy subjects. [ABSTRACT FROM AUTHOR]

Process mining (PM) is a well‐known research area that includes techniques, methodologies, and tools for analyzing processes in a variety of application domains. In the case of healthcare, processes are characterized by high variability in terms of activities, duration, and involved resources (e.g., physicians, nurses, administrators, machineries, etc.). Besides, the multitude of diseases that the patients housed in healthcare facilities suffer from makes medical contexts highly heterogeneous. As a result, understanding and analyzing healthcare processes are certainly not trivial tasks, and administrators and doctors look for tools and methods that can concretely support them in improving the healthcare services they are involved in. In this context, PM has been increasingly used for a wide range of applications as reported in some recent reviews. However, these reviews mainly focus on discussion on applications related to the clinical pathways, while a systematic review of all possible applications is absent. In this article, we selected 172 papers published in the last 10 years, that present applications of PM in the healthcare domain. The objective of this study is to help and guide researchers interested in the medical field to understand the main PM applications in the healthcare, but also to suggest new ways to develop promising and not yet fully investigated applications. Moreover, our study could be of interest for practitioners who are considering applications of PM, who can identify and choose PM algorithms, techniques, tools, methodologies, and approaches, toward what have been the experiences of success. This article is categorized under:Application Areas > Health CareFundamental Concepts of Data and Knowledge > Key Design Issues in Data Mining [ABSTRACT FROM AUTHOR]

More than two decades ago, a well‐known study on heart attack treatments provided evidence suggesting that, when appropriately adjusted for quality, medical care prices were actually declining (Cutler, McClellan, Newhouse, and Remler (1998)). Our paper revisits this subject by leveraging estimates from more than 8000 cost‐effectiveness studies across a broad range of conditions and treatments. We find large quality‐adjusted price declines associated with treatment innovations. To incorporate these quality‐adjusted indexes into an aggregate measure of inflation, we combine an unadjusted medical‐care price index, quality‐adjusted price indexes from treatment innovations, and proxies for the diffusion rate of new technologies. In contrast to official statistics that suggest medical care prices increased by 0.53 percent per year relative to economy‐wide inflation from 2000 to 2017, we find that quality‐adjusted medical care prices declined by 1.33 percent per year over the same period. [ABSTRACT FROM AUTHOR]

The origins of marginalization in nursing and the health sector in Ghana can be traced to colonialism and how a colonial era laid a solid foundation for inequities and entrenched disparities, as well as the subsequent normalization of marginalizing acts, in the health sector, particularly for women. Drawing upon varied literature over a 60‐year period and perspectives from feminist theory, this paper considers the lasting impact of Ghanaian women's historical position during the colonial era and within the patriarchal system that ensued. Through this process, it becomes possible to shed light on the crucial role that colonialism has played in women's experiences, perspectives, and health‐seeking behaviors, and the manner in which it has created a healthcare sector that marginalizes women's health. Although women possess valuable knowledge which should be an asset to consider when providing healthcare services, marginalization of that knowledge has become normalized across society and the healthcare system. There is an urgent need to disrupt and challenge this normalization, and to advocate empowerment and recognition of women's valuable knowledge and experiences, providing women a voice in health decision‐making discourses and in the research processes by which we understand and develop healthcare. Through this, healthcare in Ghana could become more empowering, inclusive, and responsive to the unique experiences and needs of Ghanaian women. By understanding something of the historical origins of women's health marginalization within colonialism, nurses can begin to appreciate women's knowledge and integrate it into healthcare strategies that are more gender‐sensitive and equitable. [ABSTRACT FROM AUTHOR]

Many organisations struggle to achieve their true potential. In part it is a problem of organisational design, which is an outcome of a particularly common—command and control—leadership philosophy. The traditional linear hierarchical structure of organisations suggests that all knowledge and power concentrates at the top organisational layer, and that people in the lower layers need to be told what to do and when. These arrangements disempower people at the lower level, preventing them from providing the necessary feedback to pre‐emptively address emerging concerns. Systems and complexity thinking provide different ways of understanding organisations and their complex adaptive behaviours. In this paper, we first describe the key characteristics of complex adaptive organisations—their structure and dynamic behaviours—and then propose a three‐dimensional visualisation of a complex adaptive organisation that allows its members to clearly see and appreciate its interdependencies. [ABSTRACT FROM AUTHOR]

Stroke is one of the leading causes of adult disability affecting millions of people worldwide. Post‐stroke cognitive and motor impairments diminish quality of life and functional independence. There is an increased risk of having a second stroke and developing secondary conditions with long‐term social and economic impacts. With increasing number of stroke incidents, shortage of medical professionals and limited budgets, health services are struggling to provide a care that can break the vicious cycle of stroke. Effective post‐stroke recovery hinges on holistic, integrative and personalized care starting from improved diagnosis and treatment in clinics to continuous rehabilitation and support in the community. To improve stroke care pathways, there have been growing efforts in discovering biomarkers that can provide valuable insights into the neural, physiological and biomechanical consequences of stroke and how patients respond to new interventions. In this review paper, we aim to summarize recent biomarker discovery research focusing on three modalities (brain imaging, blood sampling and gait assessments), look at some established and forthcoming biomarkers, and discuss their usefulness and complementarity within the context of comprehensive stroke care. We also emphasize the importance of biomarker guided personalized interventions to enhance stroke treatment and post‐stroke recovery. [ABSTRACT FROM AUTHOR]

Policy PointsThe health care sector is increasingly investing in social conditions, including availability of safe, reliable, and adequate transportation, that contribute to improving health.In this paper, we suggest ways to advance the impact of transportation interventions and highlight the limitations of how health services researchers and practitioners currently conceptualize and use transportation.Incorporating a transportation justice framework offers an opportunity to address transportation and mobility needs more comprehensively and equitably within health care research, delivery, and policy. [ABSTRACT FROM AUTHOR]

Romantic relationships are more satisfying and fulfilling when power is balanced relatively equally between partners (Leonhardt et al., Journal of Family Psychology, 34, 2020, and 1). Yet, few couples therapy models explicitly outline how to confront relational power issues (Knudson‐Martin & Huenergardt, 2015, Socio‐emotional relationship therapy: Bridging emotion, societal context, and couple interaction, Springer). Emotionally Focused Therapy (EFT; Johnson, 2020, The practice of emotionally focused couple therapy, Routledge) is a well‐established, evidence‐based therapy modality that many therapists use with couple clients, yet despite its effectiveness, it does not provide direction for explicitly addressing and treating power differentials in couple relationships. In this paper, we explore the integration of EFT with Socio‐emotional Relationship Therapy (SERT), a model overlay that acknowledges the impact of social discourse on enactments of power in intimate couple relationships. We first address the importance of understanding power in couple relationships, addressing power in couples therapy, and provide a brief overview of SERT and EFT. We then introduce an integration of the models intended to help therapists balance power, increase connection, and secure attachment bonds between romantic partners. [ABSTRACT FROM AUTHOR]

Background: Supporting psychosocial well‐being in aphasia is necessarily person‐centred, interdisciplinary and coordinated. Shortcomings in such support are described in Ireland and elsewhere. Speech and language therapists (SLTs) are integral; and describing current practice and barriers they experience is important for enhancing service delivery. Aims: To understand how SLTs enact, and are supported to enact, aphasia psychosocial care in Ireland. Methods & Procedures: This is a cross‐sectional, online, self‐administered clinician survey targeting SLTs working minimally 1 year post‐qualification with persons with aphasia of any aetiology in Ireland. The survey questions were charted against key constructs of the implementation science framework, normalization process theory (NPT), and descriptive statistics were applied. Outcomes & Results: A total of 54 eligible datasets were included. SLTs believed psychosocial support to be part of their role, but perceived multiple barriers in enacting it. These included a lack of training, clinical supervision, management support, role recognition, and access to and joint working with mental health professionals and services. Conclusions & Implications: SLTs in Ireland face a range of individual and structural barriers, including care coordination and resourcing. There is a clear need not only for training, upskilling and mentorship, but also for wider changes around access to mental health professionals and clarity around the processes of referral, coordination and integration of aphasia care across settings. These findings comprise preliminary insights into current practices. Further research is needed as well as clarity on best‐practice pathways for different aetiologies of aphasia. Articulating current practices using NPT may have utility for developing empirically informed and principled interventions to improve service delivery. WHAT THIS PAPER ADDS: What is already known on this subject: People with aphasia of all aetiologies are at risk of psychosocial problems. Shortcomings in access and the availability of appropriate support have been documented both internationally and in Ireland. To address this issue, an important first step is to understand how SLTs in Ireland currently enact and are supported to enact aphasia psychosocial care. What this study adds to the existing knowledge: The findings describe the potential levers and barriers to progressing aphasia psychosocial care in Ireland. A range of individual, team and structural factors were identified. These were locally contextualized but similar issues are reported in other countries. Linking attitudes with NPT constructs provides a first step for further principled implementation projects. What are the practical and clinical implications of this study?: Addressing psychosocial problems is perceived as a legitimate part of the speech and language therapy role. SLTs in Ireland enact a range of therapeutic approaches but may need opportunities for formal training and supervision, and for better coordination and integration with other mental health services and disciplines. Understanding differences in care pathways across the range of aphasia aetiologies is additionally important given the emphasis on post‐stroke aphasia in the literature. [ABSTRACT FROM AUTHOR]

This paper presents current information on policy developments, service design, best practices, and approaches to empower the users of health and medical care services for people with intellectual disabilities in Poland. Polish regulations allow systemic support to be provided for all people with disabilities. However, Polish patients with intellectual disabilitiy (PwID) and their caregivers face many barriers. Although a key obstacle is the lack of a standard definition that approaches disability in an interdisciplinary way, PwID are also more likely to experience difficulties in personal communication in medical settings and less likely to encounter specialists prepared to work with this group. There is also a need to pay greater attention to the expectations of PwID. To facilitate a holistic approach to diagnosis and therapy, there needs to be coordination between different specialists, including medical staff, paramedics, psychologists, and teachers. Providing personal communication training for medical personnel, as well as developing dedicated procedures for PwID in primary health care, clinics and hospitals, will improve equal access to health and health literacy for all in Poland. Even so, it is important to respect the autonomy of PwID and the commitment of caregivers. [ABSTRACT FROM AUTHOR]

The Italian healthcare system is public and freely available to the population. With a few exceptions, there are no distinctions between the healthcare services and practices (e.g., primary care) designed for the general population and those for individuals with intellectual and developmental disabilities (IDD). Prevalence data on adults with IDD are lacking and most disability policies and resources are designed for people with disabilities broadly defined, without specification based on disability type or severity level. Recent legislation provides specific supports for individuals with severe disabilities or autism spectrum disorder. This paper describes the legislation and health policies developed for people with disabilities, the organization of the Italian healthcare system, and the organization of disability support services and healthcare services. Strengths (e.g., availability of many financial resources, adoption of biopsychosocial approach to disability, presence of innovative projects to address the healthcare needs of people with IDD) and weaknesses (e.g., lack of distinction among disability types, territorial differences, lack of disability training of healthcare providers) of the current healthcare practices are reported and discussed. [ABSTRACT FROM AUTHOR]

Irish health and social care policy has undergone a significant evolution in recent years to address inequalities, improve standards and update models of care to incorporate a rights‐based approach. The following account describes the Irish health and social care system, as delivered in the Republic of Ireland, and details how it operates for those with intellectual and developmental disabilities. The paper is informed by government policy, legislation, reviews, national plans, parliamentary reports, and population data. Clear progress has been made in shifting from a service‐led to a rights‐based, service‐user led model of care; however, resourcing this fundamental transition in approach to service provision poses challenges for the Irish State. [ABSTRACT FROM AUTHOR]

This paper aims to give a short description of Swedish healthcare provision for persons with intellectual and developmental disabilities (IDD). Swedish persons with IDD should have access to the general healthcare system on the same terms as the general population, and thereby enjoy equal opportunities for healthcare of good quality. Reports from government agencies and interest groups, however, describe a decentralised and fragmented healthcare system that requires significant coordination; a lack of adjustments; a lack of specialised healthcare professionals; and gaps in healthcare provision. Research in recent years has reported unequal access to planned healthcare; excess mortality and premature deaths; and insufficient or inadequate support in end‐of‐life care. We conclude that health inequalities and healthcare challenges faced by Swedish persons with IDD might be caused by obstacles at several structural levels. Allowing persons with IDD to access timely and adequate healthcare requires the development of better opportunities for coordination of healthcare and social services, as well as training for healthcare professionals and direct support staff. [ABSTRACT FROM AUTHOR]

Legislations for persons with disabilities emerged in the 1990s in India, providing them with rights and entitlements. Aligned with the UNCRPD, the Rights of Persons with Disabilities Act (2016) supports improved programmes and services. There are no exclusive policies for those with intellectual and developmental disabilities. Different government departments and non‐government organisations provide services including centrally sponsored programmes to persons with disabilities and enable them to exercise their rights. For example, rehabilitation and provision of aids and appliances lie with the Ministry of Social Justice and Empowerment, right to education is with the Ministry of Education, and, early intervention and health services and related supports are with the Ministry of Health. In India, non‐government organisations also play a vital role in health care services. In this paper, we discuss the existing health care systems including medical services in India for persons with disabilities with a specific focus on persons with intellectual and developmental disabilities. The discussion include how the system was evolved and what is in place today, the coverage, strengths, and limitations in the system. We have tried to provide a comprehensive description of existing policies, and practices of health care as well as the cultural influences with regard to health care for people with intellectual and developmental disabilities in India. [ABSTRACT FROM AUTHOR]