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The introduction of Large Language Models (LLM) to the chatbot landscape has opened intriguing possibilities for academic libraries to offer more responsive and institutionally contextualized support to users, especially outside of regular service hours. While a few academic libraries currently employ AI-based chatbots on their websites, this service has not yet become the norm and there are no best practices in place for how academic libraries should launch, train, and assess the usefulness of a chatbot. In summer 2023, staff from the University of Delaware's Morris Library information technology (IT) and reference departments came together in a unique partnership to pilot a low-cost AI-powered chatbot called UDStax. The goals of the pilot were to learn more about the campus community's interest in engaging with this tool and to better understand the labor required on the staff side to maintain the bot. After researching six different options, the team selected Chatbase, a subscription-model product based on ChatGPT 3.5 that provides user-friendly training methods for an AI model using website URLs and uploaded source material. Chatbase removed the need to utilize the OpenAI API directly to code processes for submitting information to the AI engine to train the model, cutting down the amount of work for library information technology and making it possible to leverage the expertise of reference librarians and other public-facing staff, including student workers, to distribute the work of developing, refining, and reviewing training materials. This article will discuss the development of prompts, leveraging of existing data sources for training materials, and workflows involved in the pilot. It will argue that, when implementing AI-based tools in the academic library, involving staff from across the organization is essential to ensure buy-in and success. Although chatbots are designed to hide the effort of the people behind them, that labor is substantial and needs to be recognized. [ABSTRACT FROM AUTHOR]

For the past 70 years, researchers and experimental musicians have been working with computersynthesized music, forming a collaborative relationship with generative artificial intelligences known as human--AI co-creation. The last several years have shown that musical artists are quickly adopting AI tools to produce music for AI music competitions and for commercial production of songs and albums. The United States Copyright Office, in response to this trend, has released its latest policy revisions to clearly define what is eligible for copyright registration. Soon after, the Program for Cooperative Cataloging (PCC) also released new guidelines, providing recommendations for how library catalogers should address AI-generated materials. In both cases, they reject the notion of considering AI as a contributor. The language in each of these policies, however, is self-contradicting, showing that they are ill equipped to address generative AI. This study leverages critical textual analysis and qualitative content analysis and uses case examples to probe the manner in which these policies regard generative AI. Recommendations are made for addressing shortcomings in the PCC's policies, and moral philosophical frameworks such as virtue ethics and consequentialism support arguments for supplementing catalog item records with information from authoritative external sources, deviating from this policy for the sake of truth-seeking. [ABSTRACT FROM AUTHOR]

Concepts such as "global work" and "cross-cultural interaction" have been used to refer to a variety of types of encounters, resulting in imprecise theorizing and difficulty drawing implications for practice. Integrating across disparate literatures, we developed a meta-theory for "global work encounters," defined as instances in which individuals associated with different cultural, national, or geopolitical institutional contexts interact for the purpose of completing organizationally sanctioned tasks. Our meta-theory incorporates theoretical perspectives from the domains of diversity, cross-cultural psychology, and international management, each of which focuses on different global work encounters and the processes and spaces they create: "cosmopolitan spaces," characterized by status entrenchment resulting from maintenance processes; "hybrid spaces," characterized by amalgamation resulting from adaptation processes; and "optimally distinctive spaces," characterized by both uniqueness and commonality resulting from adjustment processes. Our theoretical framework identifies the initial conditions—consequences at the individual level on identity, interpersonal level on mutuality, and task level on synthesized knowledge—that give rise to these three types of spaces and the processes that prompt evolution from one space to another. We thus offer a nuanced view of global work encounters to capture the range of experiences individuals may have in global work. [ABSTRACT FROM AUTHOR]

We propose a theoretical framework and develop a game-theoretical analysis to advance understanding of the cooperation dilemma in team production. We conceptualize team production as a process where productive and appropriative activities coexist, shifting the focus from whether team members cooperate to what type of cooperative behavior they are willing to adopt. Depending on the extent to which members cooperate to create value and compete to appropriate value, we can observe scenarios of full, partial, and no cooperation. After characterizing member behavior in the different scenarios, we study which form of cooperation can be sustained through repeated interaction, mutual monitoring, and reciprocity. To do so, we allow for different deviations from cooperation, which are then accompanied by different reactions according to an equivalent retaliation strategy. Our focus is on how member behavior and incentives to cooperate relate to team size. We also introduce conceptual elements that describe team production in organizational teams as well as interorganizational relationships. [ABSTRACT FROM AUTHOR]

In the article, the author discusses how public libraries can promote a vibrant local music community by citing their efforts at the New Orleans Public Library to support artists through their Crescent City Sounds streaming service. Also cited are how libraries can provide more credibility and recognition of artists to the listening public and the comment of Justin Powers of Marina Orchestra on the role of libraries in promoting the music industry.

Star performers do not always sustain their performance edge after moving to new organizations. We offer an important explanation for whether star performers may flourish or flounder when they join a new team. Integrating insights from attribution theory and social comparison research, we present a process model explaining how incumbents make sense of star newcomer status. We propose that incumbents determine whether the star newcomer attained their star status through internal factors (e.g., ability, grit) or external factors (e.g., luck, affiliation), which gives rise to one of four distinct emotions: optimism, inspiration, shame, or envy. Incumbents who feel optimism or inspiration attempt to enhance their status through learning or helping behaviors that subsequently facilitate star newcomer performance, whereas incumbents who feel shame or envy seek to protect their status through withdrawal or destructive behaviors that hinder star newcomer performance. We further propose that the effect of incumbent behaviors on star newcomer performance is particularly likely when there is a high need for task-related interactions and complementary skills among team members. Our theoretical framework helps to advance the star newcomer literature by examining the largely overlooked influence of incumbents and highlighting the cognitive process that precedes their behavior toward star newcomers. [ABSTRACT FROM AUTHOR]

Introduction: Nurses, as frontline healthcare professionals, play a crucial role in ensuring patient safety, making their ability to speak up imperative. However, there are limited studies categorizing nurses based on their speaking‐up behaviors and comparing their organizational characteristics. This study aimed to identify patterns of nurses' speaking‐up behaviors and examine differences in organizational cultures, teamwork climates, and working conditions according to these patterns. Methods: A cross‐sectional survey was conducted, involving 597 nurses directly participating in nursing care in Korean hospitals. The Speaking Up about Patient Safety Questionnaire (SUPS‐Q), Nursing Organizational Culture Questionnaire, and Safety Attitude Questionnaire‐Korean version (SAQ‐K) were employed to measure nurses' speaking‐up‐related behaviors, organizational culture, teamwork climate, and working conditions. Cluster analysis was used to identify clusters of nurses based on their speaking‐up‐related behavior. Differences in nursing organizational culture, teamwork climate, and working conditions among clusters were analyzed using one‐way analyses of variance. Results: Three clusters of nurses were identified based on their speaking‐up‐related behaviors. Cluster 1 (35%) showed high perceived concerns, moderate withholding, and speaking up, while Cluster 2 (37%) had moderate concerns, low withholding, and high speaking up. Cluster 3 (28%) had moderate concerns but low withholding and speaking up. Clinical experience significantly differed among clusters, with less experienced nurses predominantly in Cluster 1. Cluster 2 had the most collaborative culture, best teamwork climate, and working conditions. Conclusion: Ensuring patient safety requires nurses to speak up about patient safety concerns. Creating safe working environments and fostering an organizational culture that prioritizes patient safety are essential steps in promoting nurses' willingness to speak up about patient safety. [ABSTRACT FROM AUTHOR]

Background: Happiness is crucial for human wellbeing. Nursing students encounter distinct challenges such as stress, burnout, and emotional exhaustion, which can negatively impact their mental health. Cultural and societal factors also influence happiness. Objective: This study conducted a comparative analysis of Big Five personality traits and emotional regulation (ER) as predictors of happiness among nursing students in Saudi Arabia and Jordan. Methods: This cross‐sectional study included 739 nursing students from Jordan and Saudi Arabia who were selected using a multistage sampling technique. The instruments utilized in this study were the short version of the Big Five Inventory for assessing personality, Oxford Happiness Inventory for measuring happiness levels, and Emotional Regulation Questionnaire for evaluating ER. To identify the predictors of student happiness, stepwise regression analysis was conducted, and cross‐country comparisons were made using a "pool analysis" method. Results: The findings indicated that 62.1% of the participants reported moderate levels of happiness, whereas 36.0% reported high levels. There were significant differences in happiness levels between Jordan and Saudi Arabia (p = 0.003), with Jordanian students reporting lower happiness levels. In Saudi Arabia, there were significant variations based on age (p = 0.049) and academic year (p = 0.013). Multiple regression analysis revealed that higher agreeableness, extraversion, and conscientiousness were positively associated with happiness while openness had a weak association. Conversely, higher Neuroticism, being in Jordan, and being male were negatively associated with happiness. Nominal regression analysis indicated that extraversion and agreeableness are significant predictors of higher levels of happiness, whereas neuroticism is associated with lower levels of happiness. Furthermore, males and non‐Saudis were more likely to report lower levels of happiness. Conclusion: This study revealed notable determinants of happiness among nursing students in Saudi Arabia and Jordan. ER, Big Five personality traits, and demographic factors play influential roles. Overall, the robust regression model emphasized the dependability of these findings, providing valuable insights for nursing education and interventions aimed at improving student wellbeing. From a practical standpoint, these findings can guide the development of personalized mental health support programs and interventions designed to enhance the happiness and wellbeing of nursing students. [ABSTRACT FROM AUTHOR]

Background: Female Sex Workers (FSW) in Sub Saharan Africa face multiple challenges increasing their vulnerability to poor health, particularly poor sexual and reproductive (SRH) health outcomes and violence. The aim of this study was to assess the use of gynecology health care services and factors associated with its use as well as experiences of violence among FSW in Togo. Method: A cross-sectional study was carried out in 2021 among FSW in two cities of Togo. A snowball sampling method was used and initial seeds were identified in each site in collaboration with FSW non-governmental organizations. A logistic regression was performed to identify factors associated with the use of a SRH service and violence. Results: A total of 447 FSW with a median age of 30 [IQR: (24–38)] participated in this study and 43.4% of them had reached at least secondary school. Among them, 29.1% reported having been to a gynecological consultation over the previous year. Factors associated with a gynecological consultation included: living in the Lomé capital city (aOR = 0.35, 95%CI 0.22–0.54), and an experience of condom breakage or slippage (aOR = 2.00; 95%CI 1.19–2.64). The majority reported at least one lifetime pregnancy (87.9%), 39.8% reported ever having an unintended pregnancy and 67.6% of them ever had an abortion. Finally, 61.1% indicated being victims of physical, sexual, or emotional violence in the previous six months. Sex workers living in Lomé (aOR = 1.78; 95%CI 1.16–2.73); a history of abortion (aOR = 1.53; 95%CI 1.03–2.31) and having more than 15 clients per week (aOR = 4.87; 95% CI 1.99–11.94), were more likely to experience violence. Conclusion: There is an under-utilization of health care services among FSW in Togo in addition to overall poor sexual and reproductive health outcomes with a high prevalence of gender-based violence. Those results highlight the importance of continued advocacy for the integration of SRH care with HIV prevention services geared toward FSW as well as a holistic approach to SRH care with innovative ways to prevent violence. Plain Language Summary: Female Sex Workers (FSW) in sub-Saharan Africa face multiple challenges including challenges linked to access to health care services, particularly sexual and reproductive health services and issues related to violence. However, few studies in Togo have explored sexual and reproductive health and violence among FSW. We used a cross-sectional study design to describe the use of sexual and reproductive health services by FSW in Togo and to document their experience of violence. A total of 130 FSW reported a gynecological consultation in the previous year, 42.7% had STI symptoms and 60.7% of them consulted a health care professional for those symptoms. We also found that 179 FSW ever had an unintended pregnancy and among them 67% ever had an abortion. Almost all FSW reported the use of condoms as their main contraception method, however 87.7% of FSW used condoms consistently with their clients. The majority of FSW reported ever being victim of physical, sexual or emotional violence. FSW with a history of abortion, with a high number of clients per week (> 15), and living in the capital city were more likely to have experience of violence. Those results would be helpful as a basis to advocate for a greater access of FSW to SRH services as part of their package of HIV prevention, care and treatment. [ABSTRACT FROM AUTHOR]

Purpose: County-level hospitals in China constitute a vital component of the healthcare system, delivering essential medical services, emergency care, and specialized treatments, particularly in oncology. This study aimed to comprehensively evaluate the current status of cancer diagnosis and treatment in county hospitals and assess their overall capacity. Methods: A nationwide cross-sectional survey by the China Anti-cancer Association (CACA) from February to May 2023 assessed cancer diagnosis and treatment in mainland China's county hospitals. Using a multi-center approach, a fifty-five-question questionnaire was administered to oncology professionals and management staffs, focusing on hospital facilities, oncology specialists, cancer cases, treatment capabilities, and healthcare collaboration. Questionnaire reliability and validity were established in a 2022 national survey. Participants, aged 18 or older, were recruited through purposive sampling, receiving self-administered questionnaires for confidentiality. SAS 9.4 software facilitated statistical analysis. Results: The study encompassed 76 county-level medical institutions, with 82.9% of them featuring established oncology departments providing comprehensive cancer care, including early screening, diagnosis, treatment, and long-term follow-up. Notably, a total of 56.6% of the institutions surveyed implemented programs for cancer screening and early diagnosis. A significant proportion of advanced cancer patients received treatment and follow-up at the county level. Persistent disparities in medical insurance policies at the county level were identified as a continuing challenge. Furthermore, 82.9% of hospitals had cultivated collaborative relationships with higher-level institutions to enhance patient care quality and treatment capacity. The study revealed a 56.6% shortage of remote collaboration platforms in these hospitals. The need for a patient-centered approach in county hospitals was underscored. Conclusion: While county-level hospitals face challenges, such as a shortage of specialized oncologists and advanced resources, they exhibit progress in standardizing cancer care to enhance diagnosis and treatment in rural areas. [ABSTRACT FROM AUTHOR]

Evidence suggests that people experiencing inequities and who are highly marginalized (e.g., people impacted by racism, sexism, discrimination, stigma, mental illness, substance use issues, disability, and the effects of homelessness; also referred to as structurally vulnerable individuals) often die alone, in pain, and not receiving the care they need. Some research even points to highly marginalized people not feeling worthy of care. The need to consider equity in the context of palliative care has recently emerged but little attention has been paid to how ethical decision-making generally, and relational ethics, specifically, could provide guidance in the care of highly marginalized people who are on a palliative trajectory. Relational ethics offers a model of care and decision-making framework that emphasizes how clients, healthcare providers, and larger social structures are interwoven and acknowledge that structural conditions can position people to have less choice than others. Relational approaches in the context of palliative care for highly marginalized people have the potential to provide a lens to better support the delivery of equitable palliative care. This critical essay explores relational ethics as a way to approach equity in palliative care to support clients facing structural vulnerabilities. We discuss relational ethical considerations to approach collaborative partnerships between clients, healthcare providers, and the larger community with the goal of aligning care with clients' values. An ethical case for how a relational ethics approach might be used to promote equitable access to palliative care will be explored, highlighting how such approaches have the potential to better align client wishes with their needs and to ensure decision-making and care delivery is trauma-informed, harm reduction focused, and culturally respectful. Relational ethics can support social change in equity and palliative care by contributing ethically informed ways of caring for/with/about highly marginalized people. [ABSTRACT FROM AUTHOR]

Background: People living in precarious socio-economic conditions are at greater risk of developing mental and physical health disorders, and of having complex needs. This places them at risk of health inequity. Addressing social determinants of health (SDH) can contribute to reducing this inequity. Case management in primary care is an integrated care approach which could be an opportunity to better address SDH. The aim of this study is to better understand how case management in primary care may address the SDH of people with complex needs. Methods: A case management program (CMP) for people with complex needs was implemented in four urban primary care clinics. A qualitative study was conducted with semi-structured interviews and a focus group with key informants (n = 24). An inductive thematic analysis was carried out to identify emerging themes. Results: Primary care case managers were well-positioned to provide a holistic evaluation of the person's situation, to develop trust with them, and to act as their advocates. These actions helped case managers to better address individuals' unmet social needs (e.g., poor housing, social isolation, difficulty affording transportation, food, medication, etc.). Creating partnerships with the community (e.g., streetworkers) improved the capacity in assisting people with housing relocation, access to transportation, and access to care. Assuming people provide their consent, involving a significant relative or member of their community in an individualized services plan could support people in addressing their social needs. Conclusions: Case management in primary care may better address SDH and improve health equity by developing a trusting relationship with people with complex needs, improving interdisciplinary and intersectoral collaboration and social support. Future research should explore ways to enhance partnerships between primary care and community organizations. [ABSTRACT FROM AUTHOR]

Background: Hypertension (HTN) is a major global health concern, affecting approximately 1.28 billion adults worldwide. In Rwanda, hypertension contribute to 2.81 of the disability adjusted life years (DALYs) and 1.87% of hypertensive heart disease mortality. Traditional medicine remains popular in Africa with some herbal remedies which have shown antihypertensive properties. However, no study was done to explore traditional Practitioners' approach to hypertension in Rwanda. Objective: To explore the experience of traditional Practitioners while managing hypertension in Rwanda. Methodology: This qualitative study utilized an ethnographic approach to explore the experience of traditional Practitioners (TPs) while managing HTN in Rwanda. Semi- structure interviews were conducted with 20 traditional Practitioners from three districts known for their popular use of traditional medicine in Rwanda. Participants were purposively selected, and interviews were guided by a pretested semi-structured interview guide in local language. Thematic analysis was used to generate the key themes. Results: Three main themes emerged from analysis: first, traditional medicine is often undervalued by modern medical providers, resulting in limited collaboration and communication between traditional Practitioners and modern medical providers. Despite this, TPs are trusted by the community, often receiving referrals from patients dissatisfied with modern treatment. Second, TPs face challenges in diagnosing HTN due to lack of diagnostic tools, often relying on their observation, patients' description of symptoms and patient's response to treatment. TPs expressed desire for collaboration with modern medicine and access to diagnostic tools. Third, lack of legal framework and standardized practices for traditional medicine remains a challenge. Conclusion: The study highlights the need to promote collaboration between traditional and modern medicine in Rwanda. To enhance HTN management, we recommend training of traditional Practitioners, setting standardized practice and legal framework to guide traditional Practitioners in Rwanda as well as improving their access to HTN diagnostic tools. [ABSTRACT FROM AUTHOR]

Background: The challenges associated with ensuring widespread system changes to enable early diagnosis and prevention of oral cancer could benefit from interprofessional practice. A needs assessment study was conducted to inform the Interprofessional Education and Collaborative Practice (IPECP) course related to oral cancer. The primary objectives of this study were 1) to establish a tool assess the knowledge attitude and practice (KAP) related to prevention and early detection of oral cancer of health professional students, and 2) to assess the same KAP of pre-licensure dental students. Additional objectives were to consider the possibility that dental students would demonstrate good scores related to early detection and prevention of oral cancer thus indicating their readiness for interprofessional learning and collaborative practice. Methods: Two questionnaires were utilized for this study which included 1) Readiness for interprofessional learning was assessed using the pre- validated tool of Readiness for Interprofessional Learning Scale (RIPLS) 2) A questionnaire to assess the KAP related to early diagnosis and prevention of oral cancer which was developed, validated, and evaluated. Statistical analysis includes, descriptive statistics, Mann–Whitney U test, Ordered logistic regression and Probit analysis. p value was set at < 0.05. Results: A total of 130 dental students (74.6% female) were included in the study. Mean scores related to KAP were 15.96 ± 1.394, 4.70 + 1.146, 7.02 ± 1.019 respectively. The mean score of RIPLS was 73.15 ± 15.961. The probability of overall samples to have good RIPLS scores was around 0.68 to 0.76 (Male 0.68—0.82 & Female 0.68 -0.74). The percentage of students having good knowledge score was 93.8%, good attitude score was around 54.6% and good practice score was around 90%. Conclusion: Knowledge and practice related to prevention and early detection of oral cancer were scored highly. Attitude scores were lower in a relatively higher proportion of participants and needed to be addressed in the curriculum. RIPLS score indicates a positive attitude towards interprofessional learning. [ABSTRACT FROM AUTHOR]

Background: A number of patients have complex care needs that arise from interactions among multiple factors, such as multimorbidity, mental health issues, and social vulnerability. These factors influence decisions about healthcare and health services. Shared decision-making (SDM), a collaborative process between patients and professionals, is known to improve the quality of the decision-making process. However, follow-up challenges of patients with complex care needs (PCCNs) can lead to SDM specificities. Objective: To identify specificities of SDM with PCCNs. Methods: We conducted a scoping review using the Joanna Briggs Institute (JBI) methodology. We conducted a systematic search across MEDLINE, CINAHL, PsycINFO, and Academic Search Complete databases. Empirical studies about SDM with PCCNs published between 1997 and 2023 were eligible for inclusion. We conducted a mixed thematic analysis using deductive (Ottawa Decision Support Framework and Interprofessional Shared Decision-Making Model) and inductive approaches. Following Arksey & O'Malley's and Levac et al.'s methodological recommendations, we consulted experts (researchers, healthcare professionals, and patient partners) to enhance the findings. Results: Twelve studies were included in the review. Overall, our results demonstrated the importance of recognizing some specificities of SDM with PCCNs, such as the simultaneous presence of multiple decisions and the multidisciplinary and intersectoral nature of the healthcare and health services they receive. Conclusion: This scoping review highlights some specificities that must be considered in SDM with PCCNs to maintain its already-known benefits and ensure positive health and decision-making outcomes. [ABSTRACT FROM AUTHOR]

Background: Smoking is a significant global public health concern, presenting substantial risks to individuals' health. Smoking cessation is essential for improving patients' well-being, and nurses play a critical role in assisting patients to quit smoking. However, there is a lack of research on nurses' specialized roles in smoking cessation interventions for patients. Objective: To define the specific responsibilities of nurses in facilitating smoking cessation among patients, and provide guidance for future nursing interventions in smoking cessation. Methods: The scoping review process was conducted for Arksey and O'Malley's framework. Based on the three-step search strategy of Joanna Briggs Institute (JBI), a comprehensive search was performed across ten databases including PubMed, CINAHL, Web of Science, Embase, Cochrane Library, OVID, PsycINFO, CNKI, Wan Fang Data Knowledge Service Platform, and VIP Database for Chinese Technical Periodicals, covering studies from the inception of the databases to February 2024. The inclusion and exclusion criteria were developed using the JBI (participants, content, and context) principle. Randomized controlled trials or quasi-experimental studies with nurse-led or involved smoking cessation interventions for patients were included. Data extraction was conducted independently by two reviewers. The findings were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Results: In total, 53 studies were eligible for the final charting and synthesis. The analysis identified six key roles that nurses played in smoking cessation interventions: assessors, educators, practice facilitators, coordinating collaborators, organizers, and supervisors. Among these, the roles of assessors, educators, and practice facilitators were the most commonly reported. The motivation interview and 5A method were the predominant techniques employed for smoking cessation. Nurses primarily promoted smoking cessation through the distribution of pamphlets, face-to-face education, and the provision of smoking cessation guidance. The primary participants in these studies were patients with chronic obstructive pulmonary disease (COPD). Conclusions: Nurses play an indispensable role in smoking cessation interventions, occupying multiple critical roles. However, this review identified a gap in the pre-intervention training of nurses, indicating a need for enhanced training programs to better prepare nurses for effective smoking cessation interventions. [ABSTRACT FROM AUTHOR]

Background: One of the fundamental pillars of integrating a palliative approach in nursing home care is increasing professional competencies and institutional capacity. However, conventional training designs have been proven to fall short of supporting this integration. This paper details the results of a practice development intervention that used critical companionship as a learning design to facilitate the integration of a palliative approach in the care of nursing home residents in France. Objectives: This study aimed to explore the perceived outcomes of Padi-Palli critical companionship in supporting the integration of a palliative approach in the care of residents in nursing homes in France. Design: Qualitative multiple case study situated within a constructivist theoretic lens. Methods: This qualitative multiple case study is part of a larger interventional mixed-method study. Nurses with palliative care clinical expertise facilitated experiential learning with nursing home professionals for 10 months spread across three phases. At the end of the intervention, a purposive sampling method was used to select professionals from six nursing homes that participated, including leaders and critical companions. Focus groups and individual interviews were used to collect data between February 2023 and March 2024. Data analysis followed Braun and Clarke's reflexive thematic analysis. Results: Four interrelated themes explained how Padi-Palli critical companionship enhanced the palliative care competencies of professionals, improved nursing home palliative care practices, supported organisational practices for palliative care and facilitated collaborative learning at the bedside. The collaborative and co-creative principles that informed the delivery of the Padi-Palli critical companionship program facilitated a culture shift towards integrating a palliative approach in resident care at individual, team and organisational levels. Conclusion: Critical companionship offers an innovative practice development approach that can support the delivery of timely palliative care for residents in nursing homes. Trial registration: ID-RCB 2020-A01832-37. [ABSTRACT FROM AUTHOR]

Background: Nurses play an essential role as frontline caregivers, particularly in recognizing and responding to patient deterioration. This study addresses nurses' self-leadership in the face of challenging situations such as patient deterioration, emphasizing the importance of self-leadership skills in navigating complex patient care scenarios. Delayed recognition of subtle changes in patient's conditions has been linked to adverse outcomes, necessitating a closer examination of the role of self-leadership in nursing practice. Objective: The objective of this research was to explore and understand the implications of self-leadership among nurses when confronted with challenging situations, specifically focusing on patient deterioration. Methods: A qualitative, exploratory, and descriptive research design was employed, utilizing focus group discussions (FGDs) with nurses from a private hospital in Pretoria, South Africa. Semistructured interview guide facilitated the FGDs, and data saturation was achieved after the eight sessions. The sample included nurses with various qualifications and shifts, offering diverse perspectives on self-leadership in patient care. Rigorous data collection and trustworthiness measures, including member checking and verbatim transcriptions, were employed to enhance the conformability of the study. Results: The findings revealed six overarching themes and 15 subthemes, demonstrating the interconnectedness of self-leadership and nursing practice. Themes included responsibility and autonomy, compassion and care, support and collaboration, learning from experience, teamwork, and appreciation and recognition. These themes explained how nurses actively engaged in self-observation, constructive thought patterns, and natural reward strategies to proactively address patient deterioration. Conclusion: The study underlines the significance of integrating self-leadership principles into nursing practice. Embracing self-leadership in nursing holds promise for improving patient outcomes and nurturing a resilient and competent nursing workforce. [ABSTRACT FROM AUTHOR]

The article suggests partnership and cooperation between mental health clinicians and law enforcement to prevent mental illness. Topics include role of Crisis Intervention Team (CIT programs) in preparing officers to assist individuals experiencing a mental health crisis, way psychiatrists and mental health clinicians can improve crisis response within their communities, and the use of the Sequential Intercept Model to address the overrepresentation of individuals with serious mental illness.

Public-private partnerships (PPPs) are integral to the National Health Mission (NHM). Kasturba Medical College (KMC), Mangalore, was the first private institution in India to embrace the PPP model way back in 1953. The then Government of Madras permitted KMC Mangalore to partner with the 2 district hospitals - the Government Wenlock and the Lady Goschen Hospitals. For almost seven decades, KMC Mangalore has been using the clinical facilities at District Wenlock and Lady Goschen hospitals to provide quality health care and also train the Undergraduate and Postgraduate students of KMC. The Manipal experiment is a shining example of public-private collaboration to provide quality accessible health care to everyone, which is in line with the Sustainable Development Goal (SDG) 3 and its targets. [ABSTRACT FROM AUTHOR]

AIM This scoping study aimed to identify the applications for VoiceThread in nursing education. BACKGROUND VoiceThread can facilitate collaboration through asynchronous sharing of presentations, images, and videos. To date, no knowledge synthesis exists to inform nurse educators' use of this technology. METHOD Using the Updated Methodological Guidance for the Conduct of Scoping Reviews, relevant published articles and gray literature were identified through a standardized search and selection process, followed by data synthesis. RESULTS Thirty-two sources described applications including student presentations, asynchronous discussions, case studies, and instructor lectures. VoiceThread iswell accepted by students and faculty with few barriers to its use. There is limited scientific rigor in studies that measured efficacy; most sources did not evaluate the efficacy of VoiceThread. CONCLUSION Considering its many applications, more evidence is needed about the effectiveness of VoiceThread in nursing education. [ABSTRACT FROM AUTHOR]

AIM The aim of the study was to identify specific actionable behaviors academic nurse leaders can implement to improve nurse faculty job satisfaction. BACKGROUNDThe nurse faculty shortage is a persistent and worsening problem, with job dissatisfaction a significant contributor in the United States. However, little is known about actionable behaviors academic nurse leaders can do to improve nurse faculty job satisfaction. METHODQualitative semistructured interviews were conducted with 15 nurse faculty. Inductive thematic analysis was used to analyze and interpret the interviews. RESULTSFour themesemerged about academic nurse leader behavior: 1) build relationships with leaders and faculty, 2) create an environment where autonomy is valued, 3) facilitate faculty growth and development, and 4) serve as a role model. CONCLUSION Effective leadership contributes to nurse faculty job satisfaction. Academic nurse leaders need to be aware of their influential behaviors and intentionally contribute to creating a workplace environment that promotes nurse faculty job satisfaction. [ABSTRACT FROM AUTHOR]

In this topical review, we integrate 3 concepts—public health practice, community engagement, and cross-sector governance—to consider the following question: What is the underlying relationship between public health and cross-sector governance according to which the field can understand the role of community engagement in achieving health equity? We begin with an overview of public health practice and the practice of community engagement. Next, we position these practices in the broader turn toward cross-sector governance. The integration of these themes reveals that common tools for community engagement fail to address questions about how services should be funded, how resources should be distributed, and which members of the community have a claim to services. We therefore suggest that distinguishing between community engagement for equity and equitable community engagement is a first step toward deepening dialogue about the role of public health in achieving health equity. [ABSTRACT FROM AUTHOR]

Rapid Acceleration of Diagnostics–Underserved Populations (RADx-UP) Kansas worked with 10 Kansas counties from November 2020 through June 2022 to form local health equity action teams (LHEATs), develop COVID-19 testing strategies, foster communication about COVID-19, and share best practices through a learning collaborative. Participating counties documented 693 distinct COVID-19 testing and 178 communication activities. Although the intervention was not associated with changes in the proportion of positive COVID-19 tests, LHEATs in the learning collaborative implemented new testing strategies and responded to emerging COVID-19 challenges. (Am J Public Health. 2024;114(11):1202–1206. https://doi.org/10.2105/AJPH.2024.307771) [ABSTRACT FROM AUTHOR]

The author proposes a socio-ecological framework to make cancer clinical trials (CCT) more accessible, equitable and acceptable to adolescents and young adults (AYA). Topics covered include how to optimize AYA CCT participation with a socio-ecological approach, the socio-ecological barriers, facilitators and strategies for AYA participation in CCTs and the treatment setting and CCT characteristics in the community-level.

Background: In the COVID-19 pandemic, novel regional services and communication channels emerged across all sectors of the German healthcare system. To contribute to pandemic preparedness, this study aims to describe newly established services in response to the COVID-19 pandemic from a stakeholder perspective and to examine the interprofessional communication channels, applying a nationwide cross-sectional approach. Methods: A nationwide sample of German healthcare stakeholders comprising general practitioners, associations of statutory health insurance physicians, hospital medical directors, local health departments, rescue coordination centres, medical directors of emergency services, outpatient nursing services, nursing homes, community care access centres, and hospital nursing managers was surveyed. A web-based questionnaire asked for their level of participation in newly implemented regional COVID-19 services and communication channels. Stakeholders' level of recommendation was measured using the Net Promotor Score (NPS), a metric that assesses their satisfaction towards the services surveyed. Results: In total, 1312 healthcare stakeholders participated in the survey. Diagnostic centres (23.0–90.9%), COVID-19 wards in hospitals (40.5–92.1%), emergency medical vehicles designated solely for COVID-19 patients (16.5–68.4%), and crisis intervention teams (11.6–30.6%) exhibited the highest rates of engagement. The services receiving the highest recommendation for future use were COVID-19 focus practices (NPS: 33.4–43.7), COVID-19 wards in hospitals (NPS: 47.6–84.4), transportation of COVID-19 patients exclusively by predefined professional groups (NPS: 12.5–36.4), and newly implemented digitally supported nursing services (NPS: 58.3–100.0). Telephones emerged as the most frequently used communication channel (58.0–96.7%), while email was the primary digital channel (23.7–81.5%). Conclusions: During the COVID-19 pandemic, Germany experienced significant variation in the implementation of pandemic-related services across healthcare sectors, with stakeholders prioritising services built on existing healthcare structures. Developing a proactive digital infrastructure to connect healthcare professionals from different sectors is crucial for better future pandemic management. [ABSTRACT FROM AUTHOR]

Introduction: Clinical trials are crucial for advancing medical knowledge and improving healthcare outcomes. Despite an increase in research publications in Saudi Arabia, clinical trial productivity has lagged behind. Understanding the barriers to conducting clinical trials in Saudi Arabia is essential. This study aims to explore the challenges and propose solutions for improving clinical trial capacity in the Kingdom. Specifically, we aim to develop national strategies to enhance clinical trial infrastructure, identify educational needs, and suggest ways to strengthen research education and training in Saudi Arabia. Methods: The study utilized a qualitative research design with a grounded theory approach. Participants were recruited through purposive sampling, including clinical trial professionals from Riyadh, Jeddah, and Al Khobar, who participated in three half-day workshops. Discussions focused on required skillsets, barriers to conducting trials, improvement recommendations, gaps in research education, and strategies for the Saudi National Institute of Health (SNIH) to support clinical trials. Data were collected through pre-workshop surveys and focus group discussions, and thematic analysis was employed to identify common themes. Results: A total of 35 participants, mainly from the government sector (67%), attended the workshops. Physicians represented the largest professional group (31%), with the majority being Saudi nationals (83%) and engaged in clinical practice (65%). The study identified key challenges, including limited resources (82%), inadequate infrastructure (82%), time constraints (80%), and insufficient funding (80%). While satisfaction with educational programs was mixed, a need for improved infrastructure and support for clinical trials in Saudi Arabia was evident. The focus group discussions further highlighted the importance of research competency, identifying 11 essential domains such as research methodology, data management, and project leadership. Nine major challenges were noted, including funding, infrastructure, and collaboration deficits. A total of 38 recommendations were proposed to address these challenges and enhance the national clinical trial ecosystem. Conclusions: This study underscores the importance of addressing the challenges in conducting clinical trials in Saudi Arabia through targeted educational programs, training initiatives, and enhanced support from the SNIH. By implementing strategies that focus on funding, resources, training, and collaboration, Saudi Arabia can significantly advance its clinical trial landscape, improve research quality and efficiency, and position itself as a leader in global health research. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship (AMS) involves a coordinated set of actions aimed at promoting the appropriate use of antibiotics within healthcare settings. This systematic review of qualitative studies assessed nurses' knowledge and perceptions of the barriers and facilitators that impact their involvement in AMS programs. Methods: This meta-synthesis followed the Joanna Briggs Institute methodology for systematic reviews of qualitative evidence. Relevant studies published between 2018 and 2023 were identified through searches on PubMed, CINAHL, EMBASE, PsycINFO, and Google Scholar. The studies were critically appraised using the CASP checklist, with 19 articles meeting the inclusion criteria from five continents. Results: Six recurring themes emerged from the analysis of nurses' experiences and opinions regarding their roles in AMS programs. These themes included the organization of AMS programs, availability of resources, training and education, communication, and the evolving role of nurses in AMS. Conclusions: Nurses at every level of the profession might play a crucial role in antimicrobial stewardship. Although active involvement of nurses in antibiotic stewardship requires further exploration and research, this topic is being examined internationally. The literature on this subject primarily analyzes the phenomenon from a quantitative perspective rather than a qualitative one, and it is contextualized more within hospital settings rather than community settings. [ABSTRACT FROM AUTHOR]

Background: This article reviews the current state of pharmaceutical care in community pharmacies in Poland and proposes a collaborative framework for its advancement. While pharmaceutical care has evolved significantly worldwide, with Europe leading the way, Poland has lagged in its development. Although Polish pharmacists are well-qualified and community pharmacies are numerous, pharmaceutical care remains underdeveloped. Methods: We conducted a literature review and analyzed case studies from European countries with advanced pharmaceutical services. Based on these findings, we collaborated with policy makers, commissioners, and academics to develop a framework for enhancing pharmaceutical care in Poland. The plan emphasizes integrating seven key services into Polish community pharmacies. Results: Our proposed framework outlines seven essential pharmaceutical services: medicine use reviews, new medicine services, minor ailment services, repeat prescription services, integrated prevention programs, cardiovascular disease prevention programs, and vaccination programs. Evidence from other European countries suggests that implementing these services could significantly improve health outcomes and patient quality of life. This is particularly important in light of Poland's ageing population, the rising prevalence of chronic diseases, and the healthcare system's increasing burden due to polypharmacy. Conclusions: The proposed framework presents a practical and collaborative approach to advancing pharmaceutical care in Poland. By adopting these key services, community pharmacies could play a more integral role in improving patient care quality and alleviating pressure on the broader healthcare system. [ABSTRACT FROM AUTHOR]

Background: There are high documented rates of exposure to traumatic events and mental health disorders among youths yet existing disparities in access to care for racial and ethnic minority youths and youths in rural communities. Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based behavioral health therapy for children. The delivery of TF-CBT via telehealth can decrease access to care barriers. An interdisciplinary clinical team developed a training program to guide clinicians to effectively provide TF-CBT via telehealth. The goal of this study was to describe variation in implementation processes of the telehealth TF-CBT program and identify barriers and facilitators to program implementation post-training, which were utilized to develop implementation strategies for intervention sustainability. Methods: Using a mixed-methods approach, data were collected on telehealth implementation processes and facilitators and barriers to the delivery of telehealth TF-CBT. This study was guided by an adapted implementation science framework, namely the Exploration, Preparation, Implementation, Sustainment model. Interviews and surveys were completed with clinical site leaders who had participated in the telehealth TF-CBT training. Results: Throughout clinical sites, there was varied adoption and penetration of the telehealth TF-CBT program. Facilitators to implementation included leadership and site staff buy in, community needs, and training resources, while barriers included funding, available logistical resources, and child and family involvement. Conclusions: The feedback gained from this project assisted in the development of implementation strategies for increased adoption and sustainment of TF-CBT delivered via telehealth. Strategies include ongoing interactive assistance and resource support, enhanced training for stakeholders, and program adaptations, with the goal to increase access to quality mental health care for underserved populations. [ABSTRACT FROM AUTHOR]

Background: According to the Chinese Society of Anesthesiology, it is recommended that patients with difficult airways be documented and notified, which will provide healthcare professionals with a direct reference when managing airways. However, compliance with this initiative remains unclear. This study was conducted to investigate the current status and need for difficult airway notification at Plastic Surgery Hospital and to explore the factors contributing to noncompliance. Methods: Anesthesiologists, surgeons, and patients in Plastic Surgery Hospital were administered separate questionnaires regarding notification of difficult airway management. Participants were surveyed regarding their attitudes and current practices regarding difficult airway notification. In addition, questions were asked regarding the barriers that contribute to noncompliance. Results: A total of 632 valid responses were obtained and analyzed, giving a response rate of 99.21%. 399 patients (89.46%) felt it was very important for anesthesiologists to inform them about their difficult airway, and 91.03% felt it was very important for them to receive a letter of their airway assessment. However, twenty-two anesthesiologists (64.7%) reported verbally informing less than 50% of patients about their difficult airway after surgery, and only four anesthesiologists informed all patients they encountered. Most surgeons (91.22%) and anesthesiologists (91.18%) believe that it is vital to inform patients verbally, while 114 surgeons (77.03%) and 31 anesthesiologists (91.18%) believe that it is essential to complete a difficult airway notification alert. Among the factors causing noncompliance, 17 (34.69%) believed that absence of mandatory rules, 9 (18.37%) believed that increased workload, and 8 (16.33%) believed that notification methods were lacking. Conclusions: The compliance to difficult airway notification remains low in Plastic Surgery Hospital despite the high incidence of difficult airways. Although anesthesiologists, surgeons, and patients are strongly in favor of it. Among the barriers to compliance were the absence of a well-developed notification system and a means of notification such as an alert form for difficult airways. This may spur the anesthesiology society to publish the notification system. [ABSTRACT FROM AUTHOR]

Background: Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents and young adults worldwide. It is linked to a broad variety of mental disorders and an increased suicide risk. Despite its high prevalence, research on the underlying mechanisms and on potential risk and resilience factors for maintaining or quitting NSSI remains scarce. This manuscript presents an overview of the "Self-injury: Treatment-Assessment-Recovery" (STAR) collaboration, which aimed to address these gaps. Methods: We investigated the natural course of NSSI as well as its social, psychological, and neurobiological predictors (observational study; OS). OS data collection occurred at four timepoints (baseline [T0], 4 [post, T1], 12 [follow-up (FU), T2], and 18 [FU, T3] months after baseline) for the NSSI group, which was compared to a healthy control (HC) group at T0 only. Online self-report was used at all timepoints, while semi-structured interviews (face-to-face (f2f)) were conducted at T0 and T3. At T0 only, we conducted ecological momentary assessment and neurobiological investigations. Here, we present the general methodology and sample characteristics of the completed OS including the f2f subprojects, while other subprojects are not within the scope of this paper. Sample description: The OS sample consists of 343 participants at T0 (180 NSSI, 163 HC). Mean age in the NSSI group (T0) was 18.1 years (SD = 2.09, range: 15–25), gender-related data is available for 166: 156 = female, 7 = male, 3 = transgender, 10 = not disclosed). In the HC group, mean age (T0) was 19.1 years (SD = 2.35, range: 15–25) (142 = female, 21 = male). At T1, 128 (71.11%) of the NSSI participants completed the questionnaires, at T2 125 (69.44%) and at T3 104 (57.78%). In the fMRI subproject, 126 adolescents participated (NSSI = 66, HC = 60, 100% female; mean age (T0): NSSI = 18.10 years, SD = 2.21; HC = 19.08, SD = 2.36). Conclusion: Understanding predictors is of utmost importance for adequate diagnosis and intervention for NSSI. Our OS applied a multimodal investigation of social, psychological, and neurobiological parameters and is the largest sample of adolescents with NSSI to date including follow-up assessments. As health care providers require specific knowledge to develop new treatments, we believe that our in-depth assessments can potentially enhance care for youths engaging in NSSI. [ABSTRACT FROM AUTHOR]

Background: Due to the weaknesses of the public health system and its low reach, especially in border areas, provision of health services by non-state actors (NSAs) has historically played an important role in Myanmar. NSAs include local and international NGOs and civil society organisations (CSOs), but also Ethnic Health Organisations (EHOs) in the border areas, as well as the private (for profit) sector. This study aims to understand the changing role of NSAs in the shifting political environment of Myanmar between 2010 and 2022, and to explore their contribution to health system resilience. Methods: Our study includes three main components: a documentary review (n = 22), key informant interviews (KIIs) at central level (n = 14) and two township-level case studies (13 KIIs, 4 FGDs). Mostly qualitative data were collected in 2022 and synthesized, using a health system resilience framework to structure the analysis. Results: During the transition period (2010–2014) and the new political era (2015–2020), while the country gradually transitioned to a democratic system, the government increasingly recognized NSAs. Initially, engagement with NSAs remained focused on disease-specific activities and government oversight was limited, but later it expanded to health system strengthening, including the start of a "convergence" with ethnic health systems. Progress was relatively slow, but defined by a clear vision and plans. The military coup of February 2021 brought a halt to this progress. Collaboration between government and NSAs was interrupted, and NSAs restored previous practices and parallel systems. Initially, most health service provision stopped, but with time coping strategies emerged, which showed the capacity of NSAs to absorb the shocks (focusing on basic services; using informal communication channels; maintaining buffer stocks of supplies) and adapt (changing modes of delivery and supply chains, and adjusting HRH training). Conclusions: The study highlights the role of NSAs during crises, and provides insights on how the resilience capacities built over time by NSAs to provide services in adverse circumstances have informed the response to the latest crisis. While strategies of absorption and adaptation are noted in the study, we did not identify any transformation strategy – which might indicate the difficulty of NSAs to introduce radical changes when subjected to multiple shocks and a hostile political environment. [ABSTRACT FROM AUTHOR]

Background: Communication between nurses and physicians is essential to providing patient care in the emergency department. The American College of Graduate Medical Education includes interpersonal and communication skills as one of six core competencies for residents. There is a known correlation between poor communication and negative patient outcomes. Yet, formalized training programs in doctor-nurse communication are lacking and literature reports that physicians may view collaboration as less important than nurses. To address this gap, we developed and implemented a novel, pilot "Nurse-InteRN Mentorship Program". The program aimed to improve trainees' communication with nurses and enhance emergency department collaboration. We then evaluated the impact of this program on participant perception of nurse-physician communication, efficacy and overall benefit. Methods: We used Kern's Six-step approach to develop and implement this program. We then evaluated the program's impact with a pre-program and post-program 12-question survey to evaluate participation, perceived benefit, and efficacy of the program using a 1–5 Likert scale. Nurse vs. intern responses were compared using Fisher's exact and Wilcoxon rank sum tests. Pre- and post- intervention responses were paired by respondent and compared using marginal homogeneity tests. Results: 13 interns and 22 nurses participated in the program. All 13 interns and 19 of 22 nurses completed the pre-program survey. 10 of 13 interns and 11 of 22 nurse mentors completed the post-program survey. Nurses showed greater interest in providing feedback on communication skills than interns showed in receiving feedback (p < 0.001). Interns rated themselves higher in communication skills with patients than nurses rated them (p = 0.004). Perceived benefit among nurses and interns decreased after completion of the program. Conclusion: We were able to successfully implement a one-year nurse-intern mentorship program aiming to promote communication, collaboration and professional development. Our results show differing attitudes between nurses and interns around interns' communication skills. There was some perceived benefit, but unfortunately this decreased over the course of the program. Further studies are needed to determine how this program impacts communication, teamwork, and patient care. We hope that given the novelty of such a nurse-intern mentorship program, this study may serve as a pilot for future programs. [ABSTRACT FROM AUTHOR]

Background: Pakistan faces profound mental health challenges, which necessitate the urgent need for a comprehensive assessment of its mental healthcare system. A holistic understanding of the mental health landscape is essential to identify strengths, weaknesses, and existing gaps within the system, which can inform targeted interventions and policy enhancements to improve mental healthcare accessibility. Objective: The primary objective of this desk research is to conduct an in-depth analysis of Pakistan's mental healthcare system across various dimensions, guided by the World Health Organization's Assessment Tool for Mental Health Systems (WHO-AIMS). Methods: Data for this desk research and scoping was obtained through desk research, including an examination of existing policies and legislation and consultations with various health facilities across Pakistan. This comprehensive analysis focused on six critical domains within the WHO-AIMS framework: policy and legislation, mental health services, integration of mental health into primary care, public awareness and collaboration with other sectors, human resources, and monitoring and research initiatives. Results: The findings provides a snapshot of strength and opportunities for improvement in Pakistan's mental healthcare system that can serve as the foundation for revising and updating national priorities. Key areas of focus include enhancing policy and legislation, expanding access to mental health services, improving existing initiatives for better integration of mental health into primary care, improving public awareness and sector collaboration, addressing human resource challenges, and strengthening monitoring and research initiatives. Conclusion: This desk research provides a roadmap for refining and enhancing Pakistan's mental health ecosystem and informs the prioritization of mental health campaigning efforts. [ABSTRACT FROM AUTHOR]

Background: The cost of cancer drugs presents a significant challenge to accessibility of treatment worldwide. Projections indicate that by 2040, two-thirds of cancer cases will occur in low- and middle- income countries. Paradoxically, despite this impending burden, LMICs command less than 5% share of global resources for treating cancer. Morocco, like many LMICs, faces significant obstacles in providing innovative cancer treatments to its population. Aim: Firstly, we aimed to conduct an original research investigating the availability and affordability of innovative cancer drugs in Morocco. Secondly, we sought to review the broader market dynamics, pricing, and reimbursement policies in the country. Methods: For the first objective, we identified a preliminary list of medicines approved for oncological indications in the Moroccan market based on resources from ANAM (National Agency for Health Insurance), pharmacy regulators, and online resources that compile information on approved medicines. For the second objective, we exhaustively reviewed the regulatory documents, legal texts and grey literature reports. All the informations were examined by pharma delegates and local experts. Results: As of January 2024, Morocco has 39 innovative anticancer medicines with market authorization. 30% of these drugs were approved after 2020. The majority of approved drugs were for breast, lung, colorectal, and prostate cancer. The period between FDA approval and entry into the Moroccan market ranges from 2 to 7 years, with a median of 3 years for breast cancer drugs and 7 years for more expensive drugs like Olaparib and Osimertinib. 22 out of the 39 drugs are not reimbursed, with an average reimbursement time of 4 years. Compared to prices in France, the most notable pricing disparities concern immunotherapy agents, priced 600 to 900 euros lower in France, while drugs like Pazopanib and Erlotinib cost 50% less in Morocco. Conclusion: Our study reveals significant disparities in the availability and affordability of innovative cancer drugs in Morocco. Regulatory hurdles, importation challenges, and pricing strategies contribute to this inequitable landscape. Addressing systemic barriers, fostering collaborations between stakeholders, and adopting a value-based pricing approach are imperative steps toward ensuring equitable access to high-quality interventions for patients, regardless of their geographical location. [ABSTRACT FROM AUTHOR]

Background: Caring plays a vital role in nursing and serves as an indicator of quality. Nurse caring behaviors are directed towards patients' safety and wellbeing. Nurses' perceptions of caring behaviors are affected by different factors. Understanding the factors linked to how nurses perceive caring behaviors is crucial for enhancing the quality of care. The aim of this study was to examine the factors associated with nurses' perceptions of caring behaviors and gain a more comprehensive understanding. Methods: A multicenter sequential explanatory mixed-methods study was conducted among medical-surgical nurses at three referral hospitals in the Amhara region, Ethiopia. Quantitative data were collected using a pretested self-administered survey package including the Amharic version of the Caring Behaviors Inventory-16. Qualitative interviews using semi-structured, open-ended questions were conducted after the survey to complement and clarify the quantitative results, facilitating integrate through a connecting approach. A multiple linear regression model was used to examine the relationship between nurses' perceptions of caring behaviors and associated factors. The qualitative data was examined to find meaningful patterns using codebook thematic analysis. This method was deductive and followed the guidelines by Braun and Clarke, building on the findings from the quantitative results. Results: The overall mean of nurses' perceptions of caring behaviors was 4.75. The multiple linear regression analysis showed that female sex (b = 0.300, P = 0.004), age (b = 0.028, P = 0.001), nurse staffing (b=–0.115, P = 0.001), work-related stress (b = 0.298, P = 0.003), and job satisfaction (b=–0.254, P = 0.016) were associated with nurses' perceptions of caring behaviors. The codebook thematic analysis generated three themes, caring is universal and fundamental in nursing, impediments to provision of comprehensive care, and perception of the work conditions. The findings of the qualitative data complemented the results of the quantitative data. Conclusion: Discrepancies between nurses' expectations and the actual working environment may create uncertainty in care provision and impact quality-of-care. Strategies to harmonize the nurses' working environment should consider work-related factors. [ABSTRACT FROM AUTHOR]

Background: As the healthcare sector grapples with its environmental footprint, the concept of Eco-conscious Nursing emerges as a pivotal framework for integrating sustainability into nursing practice. This study aims to clarify and operationalize Eco-conscious Nursing, examining its attributes, antecedents, consequences, and providing operational definitions to guide future research and practice. Methods: Utilizing a systematic literature review across PubMed, Google Scholar, and CINAHL Ultimate, this study identifies and analyzes existing theories, frameworks, and practices related to eco-conscious nursing. Through conceptual analysis, key attributes, antecedents, and consequences of Eco-conscious Nursing are delineated, leading to the formulation of comprehensive operational definitions. Results: The study reveals Eco-conscious Nursing as a multifaceted concept characterized by environmental stewardship, sustainable healthcare practices, and a commitment to reducing the ecological impact of nursing care. Operational definitions highlight the role of education, awareness, and institutional support as antecedents, with improved environmental health and sustainable healthcare outcomes as key consequences. Conclusion: Eco-conscious Nursing represents a crucial ethos for the nursing profession, emphasizing the necessity of sustainable practices within healthcare. The operational definitions provided serve as a foundation for embedding eco-conscious principles into nursing, addressing the urgent need for sustainability in healthcare settings. Future research should focus on the empirical application of these definitions and explore the economic and cross-cultural dimensions of eco-conscious nursing. [ABSTRACT FROM AUTHOR]

Background: At least 10% of Covid-19 recovered individuals experience persistent symptoms (Long Covid). Primary healthcare and general practitioners (GPs) are at the forefront in their care. In this study, GPs' knowledge, perceptions and experiences with Long Covid, and the definition used in two countries, are investigated to provide insight into GPs' care for Long Covid patients at a cross-country level. Methods: A cross-sectional study targeted towards GPs was conducted in Belgium and Malta during spring and early summer 2022. An online survey consisting of 15 questions on Long Covid was disseminated. Additionally, country-specific practice and demographic characteristics were collected. Descriptive and logistic regression analyses were performed. Results: A total of 150 GPs (Belgium = 105; Malta = 45) responded. Female GPs represented 58.0%, median age was 49 years (IQR: 37–61). Concerning GPs' knowledge and perception on Long Covid, in both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Access to educational material was limited and an awareness-rising campaign on Long Covid was deemed necessary. Moreover, two out of three GPs stated that Long Covid patients were not well followed up by primary healthcare in mid-2022. For diagnosing Long Covid, 54.7% required a positive Covid-19 test, more often among Belgian GPs than Maltese (64.3% vs. 45.2%, p = 0.036). To assess Long Covid, GPs mainly applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms (4 weeks to 5 months). Most GPs had experience with Long Covid patients in their practice, regardless of practice type and GPs' country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%) stated that Long Covid patients should follow multidisciplinary approach, 48.3% reported providing care for these patients themselves or with GP colleagues and only 29.8% by multidisciplinary cooperation. Conclusions: GPs frequently provide (multidisciplinary) care to Long Covid patients and GPs' care showed similarities at cross-country level. Although GPs perceive lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria among GPs were noted. Uniform evidence-based guidelines, scientific support and training for GP across Europe must be a priority to enhance their treatment approach to Long Covid. [ABSTRACT FROM AUTHOR]

Menstrual health represents an interdisciplinary concern that necessitates a broad, integrated understanding beyond its biological foundations, encompassing social, psychological, and cultural dimensions. This study examines whether the corpus of scientific literature from 1970 to 2023 aligns with this holistic perspective by exploring the evolving paradigms within menstrual health. Grounded in Kuhn's theoretical framework, the research delves into thematic shifts, author collaborations, and international partnerships that have emerged over the decades. Utilizing advanced text-mining methodologies, we analyzed a dataset of 34,854 documents obtained from Institute for Scientific Information Web of Science and PubMed in September 2023. These documents were processed through deduplication and data cleaning to ensure accuracy. The study employs a combination of univariate analyses, correspondence factor analyses, hierarchical cluster analyses, and network analyses to uncover insights into thematic evolution and collaborative dynamics within menstrual health research. Thematic analysis reveals three distinct periods in menstrual health research, depicting evolving paradigms. In the first period (1970–1996), the focus was on reproductive health, infertility treatments, hormonal regulation, and epidemiology. The second period (1997–2017) witnesses a transition, emphasizing menstrual health and social inequalities, gynecological studies, and contraception. The third period (2018–2023) maintains a focus on contraception and reproductive health but introduces a pronounced psychological dimension, emphasizing menstrual disorders, gynecological surgery, and socioeconomic concerns. Collaboration analysis indicates increased connectivity, consolidation of researcher communities, and a shift toward interdisciplinary approaches. While international collaborations demonstrate global commitment, geographical concentration prompts questions about paradigm universality. The study shows the existence and evolution of the menstrual health paradigm. Findings suggest a trajectory toward paradigmatic inscription, marked by heightened collaboration and global commitment. Acknowledging the pivotal role of biological aspects, the study underscores the need for a balanced, holistic understanding of menstrual health. Continued efforts are essential to tailor interventions, foster inclusivity, and honor diverse cultural and psychological realities related to menstruation. Plain language summary: Menstrual health isn't just about biology—it also touches on social, emotional, and cultural aspects. But how have researchers addressed this complex topic over the years? What did the researchers do ? In this study, the researchers examined research on menstrual health from 1970 to 2023. They used special tools to analyze how this research has changed over time, what themes were explored, and how scientists around the world have worked together. Why does this matter ? The researchers wanted to see if there's a clear and consistent way that menstrual health is approached in research. If there is, it can help improve health policies and medical practices. But if not, it could mean that different approaches are scattered, leading to less effective solutions. What did the researchers find ? After analyzing over 34,000 documents, the researchers identified three main phases in menstrual health research: • From 1970 to 1996, the focus was mostly on reproductive health. • Between 1997 and 2017, researchers started to look more at social inequalities and contraception. • Since 2018, there has been a new focus on the psychological aspects of menstruation. They also noticed that researchers are collaborating more than before, which is a good sign for a more integrated approach to menstrual health. However, even though interest in this topic is global, certain regions are more active in this research than others. This raises the question: is there a shared vision worldwide? Why is this important ? This work highlights how menstrual health research has evolved and suggests that a more comprehensive approach is needed to guide future studies and health policies. By better understanding the different dimensions of menstrual health, policymakers, healthcare providers, and researchers can create more inclusive and effective solutions for women everywhere. [ABSTRACT FROM AUTHOR]

Communities of practice in health settings often serve to address contemporary public health issues by sharing knowledge and experiences about accelerating implementations and innovative solutions. Because there are gaps between the practical application of communities of practice and the scientific knowledge about their effectiveness, this realist synthesis aimed to identify how and why members of communities of practice translate the shared knowledge and apply it in their daily practice. In a six‐step process, this realist synthesis included a scoping review that led to an initial theory map (Step 1), followed by searches (Step 2), appraisal (Step 3), extracts and organisation (Step 4), and analysis and synthesis (Step 5). These steps organised the literature into context–mechanism–outcome configurations that guided the development of a realist framework that can support research and practice (Step 6). We identified three key ways in which knowledge translation may occur: (1) Members bring (new) knowledge to their parent organisation; (2) members change the (daily) practice in their parent organisation; and (3) members improve health outcomes through systemic changes. We found that an initial outcome of knowledge sharing within the community of practice is conditional to achieving outcomes of knowledge translation outside the community of practice. This knowledge sharing within the community of practice is more likely to occur in a structured and trusted environment where members feel safe, as well as where members recognise individual and organisational benefits from participation. To achieve knowledge translation outside the community of practice, support from the parent organisation becomes important, alongside learning and developing confidence to implement the knowledge. The synthesis of the different contexts that potentially trigger mechanisms that lead to desired outcomes provides insight into how best to inform community of practice initiators and facilitators about supporting effective public health responses. [ABSTRACT FROM AUTHOR]

Introduction: Nursing education continues to evolve with the integration of innovative technologies aimed at enhancing student engagement and understanding of complex medical concepts. Gamification, the application of game elements in nongame contexts, emerges as a promising tool in nursing education. Method: Faculty members collaborated with instructional designers to develop, The Treasures of the Renal Isles, a gamified module for nursing education. Drawing upon their expertise, faculty provided content knowledge and identified key gaming elements, while designers crafted a virtual world and storyline to contextualize the learning experience. The module was implemented within the curriculum, and student feedback was solicited through the Gameful Experience Scale (GAMEX), a validated tool for assessing gamified learning experiences. Additionally, exam scores were analyzed to determine the gamified module's impact on learning outcomes. Results: Analysis of student responses to the GAMEX tool revealed favorable perceptions of the gamified renal module. Specifically, 77.3% of students believed that the module facilitated their understanding of renal content, indicating its efficacy in knowledge acquisition. Moreover, 71% of students expressed a desire for additional gamified modules, highlighting their engagement and interest in this instructional approach. However, despite positive feedback, no significant differences in test scores were observed postimplementation. Conclusion: The findings of this project highlight the potential of gamification as an interactive learning method in nursing education. While the gamified renal module received positive feedback from students regarding its effectiveness in facilitating understanding, the lack of significant improvement in test scores warrants further refinement. By incorporating student feedback and revising the module accordingly, nursing educators can utilize gamification to bridge the gap between theoretical knowledge and clinical judgment. The development of additional gamified modules holds promise for enriching the learning experience and preparing nursing students for the complexities of clinical practice. [ABSTRACT FROM AUTHOR]

Background: High quality diabetes care is an essential service in primary care settings since the prevalence and associated complications of diabetes is increasing. Physical activity is effective for the prevention and management of diabetes yet is underutilized in diabetes care. Exercise professionals have specialized skills to deliver physical activity interventions, but effective interprofessional collaboration for diabetes care requires role clarity. This study established the competencies of entry-level physiotherapists and kinesiologists for physical activity interventions for diabetes care in primary care settings and used these competencies to develop clinical tools to promote role clarity in interprofessional care teams. Methods: We used a modified Delphi process. Eleven physiotherapy and three kinesiology subject matter experts participated in two rounds of Delphi surveys to develop discipline and context specific competencies. These competencies were used to draft competency profiles and a referral pathway tool. Eleven of the participants then participated in a focus group for member-checking of the tools. Descriptive statistics and content analysis were used to analyze quantitative and qualitative data respectively. Results: The modified Delphi process resulted in 38 physiotherapy and 27 kinesiology competencies that identify the distinct roles of physiotherapists and kinesiologists in delivering physical activity interventions for diabetes care. The physiotherapy competencies describes their unique role in supporting people with all types of diabetes to engage in physical activity despite complex medical or physical barriers. The kinesiology competencies indicate where these professionals may require additional training, especially when working with people living with type 1 diabetes or who are pregnant. All developed tools had good face validity and were seen to be potentially useful tools by the subject matter experts. Conclusions: The findings highlight that both physiotherapists and kinesiologists have fundamental skills and abilities to deliver physical activity interventions to people living with diabetes, but that different exercise professionals may be needed depending on the complexity of the clinical profile. The developed clinical tools support improved interprofessional collaboration by clarifying physiotherapy and kinesiology roles in delivering physical activity interventions for diabetes care and highlighting how the two distinct professions can contribute to addressing the growing diabetes epidemic in primary care. [ABSTRACT FROM AUTHOR]

Background: This paper evaluates the introduction of ten Community Health and Well-being Workers (CHWW) in four pilot sites across Cornwall. The period evaluated was from the initial start in June 2022 until June 2023, covering the project setup and implementation across a range of Primary Care Networks (PCNs) and Voluntary sector partners (VSCO). Methods: All ten CHWWs and their managers at each site were interviewed (n = 16) to understand the barriers and enablers to implementation and wider learning that could be captured around the project setup. Qualitative methods were used for data collection, including semi-structured interviews and focus groups. Transcripts were thematically analysed for cross-cutting themes, as well as site-specific effects. Results: In terms of learning, we cover the following key areas, which were of most importance to the successful implementation of the pilot: The CHWWs were introduced into an already established, successful social prescribing (SP) system by the time the CHWW project began. CHWWs can access some of the same training and office space as SPs, with overlapping meeting schedules allowing them joint input on some topics. It seemed that all the pre-work in terms of relationships and learning about a similar role helped a rapid implementation. Each site's CHWW management structure uses the same line management as the SPs. Roles were clustered together to remove duplication, maximise coverage and triaging of residents. The largest barrier to overcome was integrating VSCO staff into NHS systems. Conversely, hosting CHWWs within an NHS organisation has pros and cons, namely better access to NHS data and staff, but longer lead-in time for registration on systems, and more bureaucracy for procurement/spend. Conclusions: Looking to the future, the pilot's success has spread the programme to other integrated care areas in the country, with ongoing plans for further rollout and evaluation in the coming years. [ABSTRACT FROM AUTHOR]

Objective: Burnout is becoming a major problem in medicine, and some articles have pointed to the link between burnout and anxiety. Several factors can contribute to burnout and anxiety, and recognizing each can improve medical education environments. The purpose of this study is to determine the relationship between personal characteristics, anxiety and burnout of orthopedic residents. Method: In this cross-sectional study, the anxiety rate, depression, and burnout were evaluated in 94 orthopedic residents above the second year and orthopedic fellowships in three hospitals. Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), and Maslach Burnout Inventory—Human Services Survey (MBI-HSS) were used to measure the levels of depression, anxiety, and burnout, respectively. Multivariate logistic regression analysis was used to evaluate predictor variables for burnout. Results: Severe anxiety and depression were reported in 17% and 12.77% of residents, respectively. The rate of burnout for Emotional Exhaustion (EE), Depersonalization (DP), and low sense of Personal Accomplishment (PA) subscales was 18.09%, 28.72%, and 43.62% of people with high levels of burnout, respectively. Multivariate analysis of logistic regression showed that Works > 60 h per week, Anxiety score > 28, Time spent in the hospital > 9 h per Day, Academic year and Experience being abused by the upstream, Balance between work and life, Feeling the need for support from nurses in the hospital were significantly associated with burnout. Conclusion: stress and anxiety can be considered a severe factor in burnout; this issue can provide a clear perspective of the psychological cycle that ultimately leads to a decrease in the efficiency of the medical system and related services. [ABSTRACT FROM AUTHOR]

Healthcare requires practitioners to successfully negotiate boundaries between communities of practice (CoP) in a clinical landscape of practice (LoP), with development of interprofessional identity important in promoting successful interprofessional collaboration. Interprofessional education (IPE) centered around acute hospital inpatients offers a potential pathway to encourage boundary negotiation and interprofessional identity development. This study aimed to explore interprofessional student teams and their interactions with patients in an acute hospital setting, while investigating if such interactions encouraged interprofessional collaboration and the development of an interprofessional identity. Pivoting around acute hospital inpatients, four interprofessional workshops occurred involving senior medicine, nursing and physiotherapy students. We utilized a concurrent mixed methods design, with qualitative predominating. Qualitative reflexive thematic analysis of post-workshop semi-structured focus groups was supported by quantitative investigation using a validated pre-test post-test international socialisation and valuing scale. Using the landscapes of practice theory lens, we noted that the central role of acute hospital inpatients in the IPE workshops enabled healthcare students to develop knowledgeability of the clinical LoP, in line with the three modes of identification of LoP, namely Engagement, Imagination and Alignment. Following the IPE workshops, where acute inpatients played the pivotal role, students demonstrated a statistically significant increase in interprofessional collaborative practice in terms of the overall interprofessional socialisation and valuing scale and its subscales of value, ability, and comfort in working with each other. Our findings indicate that IPE centered around acute hospital inpatients is a beneficial and effective way to successfully implement IPE in the undergraduate curriculum. [ABSTRACT FROM AUTHOR]

Digital medical devices (DMDs) present unique opportunities in their regulation and reimbursement. A dynamic landscape of DMD assessment frameworks is emerging within the European Union, with five clusters of prevailing approaches identified. Despite notable gaps in maturity levels, cross-country learning effects are becoming prevalent. We expect more countries, both within the EU and beyond, to follow the steps of current frontrunners, hence expediting the harmonization process. [ABSTRACT FROM AUTHOR]

Background/Objectives: The importance of family carer dementia education is highlighted in research, practice guidance, and policy. Less attention is paid to how facilitators learn and prepare for their role. This research aimed to explore and describe facilitator learning experiences within a bespoke Scottish Carers' Academy designed around a theory-guided approach called Care Empathia. A healthcare and university partnership ensured integration with services and the fusion of dementia higher education know-how with clinical practice expertise. Methods: Nineteen facilitator questionnaires were completed from two Carer Academy hubs; thirteen participated in online focus groups. Results: The questionnaire findings highlighted the learning gained from being a facilitator, observing expert facilitators in action, and listening to the testimonies of family carers. The framework analysis of the focus group data identified six themes, including safe learning approaches, the art of facilitation, emotional work, team learning, and leadership. These findings highlight the importance of facilitator preparation and the advantages of co-delivery models that combine clinical and practice education expertise. Conclusion: Facilitators need to understand how to walk the talk of theory-guided educational models, be open to reciprocity in learning, and be prepared for the emotional work of delivering trauma-informed practical dementia care education to family carers. [ABSTRACT FROM AUTHOR]

One potential complication in bariatric surgery is rhabdomyolysis, which is a condition involving muscle tissue damage that can significantly impact a patient's health. The causes of rhabdomyolysis can be broadly classified into two major categories: traumatic and non-traumatic. Early investigations into the development of intraoperative rhabdomyolysis in bariatric surgery identified the main risk factors as tissue compression—primarily affecting the lower extremities, gluteal muscles, and lumbar region—as well as prolonged periods of immobilization. Clinically, rhabdomyolysis is typically suspected when a patient presents with muscle pain, weakness, and potentially dark urine or even anuria. However, the most reliable biomarker for rhabdomyolysis is elevated serum creatine kinase levels. The primary goal in managing hydration is to correct intravascular volume depletion, with solutions such as Lactated Ringer's or 0.9% saline being appropriate options for resuscitation. Perioperative diagnosis of rhabdomyolysis poses a significant challenge for anesthesiologists, requiring a high degree of clinical suspicion, particularly in bariatric patients. In this vulnerable population, prevention is crucial. The success of treatment depends on its early initiation; however, there are still significant limitations in the therapies available to prevent renal injury secondary to rhabdomyolysis. [ABSTRACT FROM AUTHOR]